Search Results (64)

Accurate localization of the visible track region is essential for perception using front-mounted cameras on underground rail-guided mine vehicles. The task is difficult because the track foreground occupies only a small image area, and its boundary appearance changes with illumination, water, dust, and scene clutter. This study formulates local perception of the track corridor as binary semantic segmentation of the surface bounded by the two visible rails. RailDLA is a lightweight encoder–decoder network. It combines track context preconditioning, RDLA directional strip propagation, context-guided feature fusion, and track axis proxy decoding. On a self-constructed dataset of underground mine vehicle imagery, RailDLA achieves 96.50% mIoU, 92.10% track IoU, 97.50% track accuracy, and 99.70% pixel accuracy. On the working split, its track IoU exceeds those of FastSCNN, PIDNet-S, DDRNet-23-slim, and SegNeXt-S by absolute margins of 6.06, 1.70, 1.56, and 0.37 percentage points, respectively. Under the unified runtime protocol, RailDLA reaches 120.00 FPS on an NVIDIA GeForce RTX 3070 Laptop GPU. These results demonstrate accurate, real-time inference for underground mine vehicle perception. Full article

This study focuses on the situation where multiple vehicles simultaneously intercept a maneuvering target with desired line-of-sight (LOS) angles and impact time in a three-dimensional environment. A predefined-time cooperative guidance law is proposed, which adapts to the switching communication topologies among the vehicles. To accomplish the task of adjusting the impact time by leveraging the multi-agent consensus principle, a novel adaptive predefined-time consensus protocol is designed in the LOS direction, which allows multiple vehicles to intercept the target at the desired impact time, while ensuring that the impact times of all vehicles converge within a predefined time. In the LOS normal direction, based on the error transformation function, a novel predefined-time non-singular fast terminal sliding mode guidance law is proposed to guarantee the convergence of the LOS angular rate within the predefined time, achieving the simultaneous interception of the target by multiple vehicles at different terminal angles and eliminating singularities. At the same time, the tracking error satisfies the prescribed performance constraint. In particular, for scenarios where the target acceleration is unknown, a predefined-time external state observer is employed to estimate disturbances and compensate within the guidance law. The simulation results validate the effectiveness and robustness of the proposed method. Full article

Background: Venous thromboembolism (VTE) remains a clinically relevant complication following major orthopaedic procedures, particularly total hip arthroplasty (THA), total knee arthroplasty (TKA), and fracture surgery. Although low-molecular-weight heparin (LMWH) and direct oral anticoagulants (DOACs) are widely regarded as standard pharmacological options, aspirin (acetylsalicylic acid, ASA) has gained renewed attention because of its low cost, oral administration, and favourable bleeding profile. However, the available evidence is heterogeneous, and its interpretation is complicated by differences in patient selection, timing and duration of prophylaxis, diagnostic methodology, aspirin dosing regimens, and the increasing adoption of modern fast-track arthroplasty pathways. Methods: A structured evidence-based review was conducted in accordance with PRISMA 2020 principles. PubMed, Embase, Web of Science, and the Cochrane Library were searched through September 2025 for randomised controlled trials (RCTs), major international clinical practice guidelines, and selected high-level studies relevant to the interpretation of aspirin-based orthopaedic thromboprophylaxis. Nine RCTs, four major guideline documents, and sixteen additional Level I–II studies were included. Outcomes of interest were symptomatic deep vein thrombosis (DVT), pulmonary embolism (PE), major bleeding, and mortality. Risk of bias was assessed using the Cochrane ROB 2 framework. Owing to marked methodological heterogeneity, no formal pooled meta-analysis was undertaken. Results: The available RCT evidence suggests that aspirin may perform adequately within structured sequential or risk-stratified prophylaxis strategies, but not in all clinical settings. In arthroplasty, EPCAT II demonstrated non-inferiority of aspirin when introduced after an initial five-day course of rivaroxaban, whereas CRISTAL showed higher early symptomatic VTE rates when aspirin was used as sole primary prophylaxis from postoperative day 0. Importantly, thromboembolic events in CRISTAL occurred earlier in the aspirin cohort, supporting the concept that anticoagulant therapy remains important during the immediate postoperative hypercoagulable phase. In trauma surgery, PREVENT CLOT established non-inferiority of aspirin compared with LMWH for 90-day mortality; however, the predominantly young study population and the inclusion of upper-extremity fractures limit extrapolation to elderly hip fracture patients. Several smaller RCTs reported no major differences between aspirin and anticoagulants, but these studies were frequently underpowered and relied on less sensitive diagnostic strategies. Historical and contemporary guidelines remain heterogeneous, and evidence from modern fast-track arthroplasty pathways suggests that current trial-based conclusions may not be directly generalisable to short-duration prophylaxis settings. Conclusions: Aspirin may have a role in orthopaedic thromboprophylaxis when used within structured, risk-adapted or sequential protocols, particularly in standard-risk arthroplasty patients and selected trauma populations. However, current evidence does not support its universal use as sole primary prophylaxis in major orthopaedic surgery, especially during the early postoperative hypercoagulable phase or in high-risk patients. Furthermore, the available literature does not permit definitive recommendations regarding the optimal aspirin dose or duration of prophylaxis. The generalisability of the existing literature is further limited by methodological heterogeneity and by the absence of RCTs directly evaluating ultra-short anticoagulant regimens versus prolonged aspirin prophylaxis in modern fast-track arthroplasty. Further high-quality, standardised trials are required. Full article

Background: Anesthetizing frail patients for hip surgery is challenging; spinal (SA) and general anesthesia (GA) often cause hemodynamic instability. Traditional nerve blocks provide analgesia but rarely complete surgical anesthesia without motor block. We evaluate the clinical feasibility of the SAFE (Subarachnoid-alternative Anaesthesia For Endoprosthesis) protocol—combining Anterior Pericapsular Nerve Group (A-PENG), POsterior pericapsular Nerve Group (PONG), and Local Infiltration Analgesia (LIA) under intravenous sedation—as a primary anesthetic preserving motor function and avoiding SA/GA. Methods: This single-center retrospective series analyzed patients undergoing elective or trauma-related hip surgery using the SAFE protocol between September 2022 and April 2026. The primary outcome was success rate (completion without SA/GA conversion). Secondary outcomes included procedural timings, recovery room (RR) transit, and motor preservation. Variables are reported as medians [IQR]. Results: We included 48 patients (median age 83.5 years [IQR: 68.7–87.2]; 66.7% female) undergoing hip hemiarthroplasty (n = 28) or total hip arthroplasty (n = 20). The success rate was 100%, without SA/GA conversion or advanced airway management. Median anesthetic preparation and surgical durations were 55 [IQR: 50–76.2] and 85 min [IQR: 74–110], respectively. RR transit times (recorded for 35 patients) were brief (40 min [IQR: 34.0–67.5]). Crucially, lower-limb motor capacity was preserved in 100% of cases. The technique also proved opioid-sparing, substantially reducing postoperative opioid consumption. Conclusions: The SAFE protocol is a clinically feasible primary anesthetic strategy for hip surgery. By preserving motor function and enabling rapid fast-tracking, it aligns with ERAS pathways, offering a promising alternative to conventional anesthesia for elective and frail trauma patients. Randomized controlled trials are warranted to validate these outcomes. Full article

Background/Objectives: Total knee arthroplasty (TKA) is often associated with extensive bleeding and the need for intraoperative and postoperative blood transfusions. Due to concern about the risks associated with them, a push has been made in surgery toward the development of new intraoperative blood management devices and innovative postoperative care strategies. Tranexamic acid (TXA), fibrin sealant and standard electrocautery are widely used in orthopedic surgery, since several studies provided evidence about their efficacy and safety. A new device, the bipolar sealer system (BSS), provides hemostasis at lower temperature (<100°) than conventional electrocautery. It does not produce smoke, necrosis or burn tissue. Methods: In this study, we retrospectively analyzed data from 480 patients who underwent TKA between January 2017 and December 2024. The cohort was divided into two groups based on the hemostatic protocol adopted. The control group enrolled 240 patients who received the standard protocol with TXA and fibrin sealant, while the study group enrolled 240 patients who followed protocol with Aquamantys BSS and TXA. Hematological parameters, including hemoglobin (Hb), hematocrit (HCT) and red blood cells (RBCs) were analyzed preoperatively (T0) and postoperatively: immediately after surgery (T1), at day one (T2) and day three (T3). Results: Changes in hemoglobin from baseline to postoperative follow-up were significantly lower among patients who received TXA plus BSS and those receiving TXA plus fibrin sealant, with p-values of 0.0003 at T1 (immediately after surgery), 0.027 at T2 (one day post-op), and 0.0001 at T3 (three days post-op). Comparable results were observed for HCT and RBC values. Conclusions: These data demonstrate that Aquamantys is more effective than fibrin glue in controlling blood loss after knee replacement surgery, not only immediately after the procedure but also in the following days. Full article

Lithium iron phosphate (LiFePO₄, LFP) batteries dominate grid-scale energy storage, yet their cycle life is capped by its capacity fade issues. Conventional failure workflows suffer from redundant tests, high cost, and long turnaround time because the underlying mechanisms remain unclear. Herein, multi-scale characterization coupled with electrochemical tests have been quantitatively established to reveal four synergistic fade modes of LFP: active-Li loss, FePO₄ secondary-phase formation, SEI rupture, and particle fracture. A two-tier “screen–validate” protocol is proposed to accurately and efficiently disclose its mechanism. In the screening tier, capacity, cyclic voltammetry, electrochemical impedance spectroscopy, low-magnification scanning electron microscopy, and snapshot X-ray diffraction (XRD) rapidly flag the most probable failure cause. The validation tier then deploys mechanism-matched in situ/ex situ tools (operando XRD, TEM, XPS, ToF-SIMS, etc.) to build a comprehensive evidence chain of dynamic structural evolution, materials loss tracking, and quantitative proof. The streamlined workflow preserves scientific rigor and reproducibility while cutting analysis time and cost, offering a closed-loop route for fast failure diagnosis and targeted optimization of next-generation LFP batteries. Full article

Background/Objectives: Prolonged fasting—defined as voluntary abstinence from caloric intake for periods exceeding 24 h—is increasingly recognized not only as a metabolic intervention but also as a psycho-behavioral modulator. According to the 2024 international consensus, intermittent fasting encompasses diverse temporal patterns including time-restricted feeding, alternate-day fasting, and periodic fasting of multi-day duration. While metabolic benefits are well documented, the psychoneurobiological and psychiatric consequences remain incompletely characterized. This review critically appraises current evidence on the psychological and psychiatric effects of prolonged and intermittent fasting, including both secular and religious practices. Methods: A narrative synthesis was conducted on clinical trials, observational studies, and translational research published between January 2010 and June 2025 in PubMed, Scopus, and PsycINFO. Search terms included combinations of “prolonged fasting,” “intermittent fasting,” “psychological,” “psychiatric,” “religious fasting,” “Ramadan,” and “Orthodox Church.” Eligible studies required explicit evaluation of mood, cognition, stress physiology, or psychiatric symptoms. Data were analyzed qualitatively, with particular attention to study quality, fasting regimen characteristics, and participant vulnerability. This is a non-registered narrative synthesis drawing on clinical trials, observational studies, and preclinical evidence published between January 2010 and June 2025. Results: Eighty-seven studies met inclusion criteria (39 human; 48 preclinical). In metabolically healthy adults, short-term time-restricted eating and supervised prolonged fasting were associated with modest reductions in depressive symptoms and perceived stress, with small improvements in executive functioning—typically observed in small samples and with limited follow-up. Religious fasting during Ramadan and the Orthodox Christian fasting periods demonstrated similar neuropsychological effects, including greater perceived spiritual meaning and affective modulation, though cultural context played a moderating role. Potential adverse mental-health impacts included mood destabilization, anxiety exacerbation, and rare psychotic or manic decompensations in vulnerable individuals. Randomized trials reported few adverse events and no signal for severe psychiatric harm, whereas observational studies more often noted symptom exacerbations in at-risk groups. Patients with eating disorder phenotypes exhibited increased cognitive preoccupation with food and a heightened risk of behavioral relapse. Methodological heterogeneity across studies—including variation in fasting protocols, psychological assessments, and follow-up duration—limited cross-study comparability. Conclusions: Evidence indicates a bidirectional relationship wherein fasting may foster psychological resilience in select populations while posing significant psychiatric risks in others. Inclusion of religious fasting traditions enriches understanding of culturally mediated outcomes. To enhance rigor and safety, future studies should incorporate clinician-rated outcomes (e.g., HDRS-17, CGI-S/CGI-I), standardized adverse-event tracking using validated psychiatric terminology, and prospective safety monitoring protocols, with ≥6–12-month follow-up. Full article

Fast-track extubation has emerged as a vital component of Enhanced Recovery After Surgery pathways, designed to optimize recovery and resource utilization after cardiac surgery, contrasting with traditional prolonged ventilation. This review explores the evidence supporting fast-track extubation, detailing patient selection criteria based on preoperative risk factors and functional status and outlining perioperative management strategies. It synthesizes findings from various studies, including randomized controlled trials, retrospective studies, and meta-analyses, focusing on intraoperative techniques such as low-dose opioids, neuromuscular blockade reversal, controlled cardiopulmonary bypass duration, judicious inotrope use, and minimal transfusion, alongside structured postoperative protocols emphasizing early sedative weaning and spontaneous breathing trials. Results demonstrate that fast-track extubation decreases intensive care unit stay, reduces costs and ventilator-associated complications, with a safety comparable to conventional care. Prolonged cardiopulmonary bypass time, dependency on inotropes, and intraoperative blood transfusions are identified as critical predictors of fast-track extubation failure. In conclusion, the successful implementation of fast-track extubation protocols requires a collaborative, multidisciplinary approach, proving essential for improving patient outcomes, minimizing complications such as postoperative delirium, and enhancing hospital efficiency in cardiac surgery. Further research should aim to refine patient selection and standardize protocols across healthcare systems. Full article

Background: Adolescence is marked by heightened reward sensitivity and incomplete maturation of cognitive control, creating conditions that favor engagement in risky behaviors. Traditional self-report methods often overlook the fast, automatic processes—such as attentional biases, approach–avoidance tendencies, and associative schemas—that shape adolescent decision-making in real time. Aims: This Perspective aims to synthesize recent (2018–2025) advances in the study of implicit measures relevant to adolescent risk behaviors, evaluate their predictive value beyond explicit measures, and identify translational pathways for prevention and early intervention. Methods: A narrative synthesis was conducted, integrating evidence from eye-tracking, drift-diffusion modeling, approach–avoidance tasks, single-category implicit association tests, ecological momentary assessment (EMA), and passive digital phenotyping. Emphasis was placed on multi-method phenotyping pipelines and on studies validating these tools in adolescent populations. Results: Implicit indices demonstrated incremental predictive validity for risky behaviors such as substance use, hazardous driving, and problematic digital engagement, outperforming self-reports in detecting context-dependent and state-specific risk patterns. Integrative protocols combining laboratory-based measures with EMA and passive sensing captured the influence of peer presence, affective state, and opportunity structures on decision-making. Mobile-based interventions, including approach bias modification and attention bias training, proved feasible, scalable, and sensitive to change in implicit outcomes. Acoustic biomarkers further enhanced low-burden state monitoring. Conclusions: Implicit measures provide a mechanistic, intervention-sensitive complement to explicit screening, enabling targeted, context-aware prevention strategies in adolescents. Future priorities include multi-site validations, school-based implementation trials, and the use of implicit parameter change as a primary endpoint in prevention research. Full article

Modern pollen deposition studies are essential to forestry and palaeoecological research, as they provide the key to understanding the relationship between the abundance of palynomorphs in natural (moss, litter, top core sediment) or artificial traps and the surrounding vegetation cover. In 1996, the EPMP (European Pollen Monitoring Programme) laid the foundations for pollen monitoring research in Europe, involving several countries and dozens of researchers in placing “Tauber-style” artificial traps across a wide range of ecosystems, and legitimising the collection of mosses for comparative studies. Here, we propose a straightforward, fast, and effective procedure—developed within the ALIVE “TrAcking Long-term declIne of forest biodiVErsity in Italy to support conservation actions” Project—for the collection of moss polsters and vegetation data, aimed at monitoring modern pollen deposition at the national scale. This protocol addresses a gap in existing literature, as no shared fieldwork guidelines are currently available. We demonstrate how the spatial pattern of modern pollen deposition can be investigated using two of the ALIVE Project’s target taxa (Fagus and evergreen Quercus) to explore the potential of microbotanical data in reflecting the current distribution of forest tree taxa at a national scale. The data collected within the ALIVE Project provide a synoptic picture of pollen deposition across Italy’s highly diversified landscapes and allow for preliminary considerations on the relationships between pollen deposition and modern vegetation cover of forest taxa. Full article

This study presents the development and the mechanical and clinical characterization of a flexible biodegradable chitosan–glycerol–graphite composite strain sensor for real-time respiratory monitoring, where the main material, chitosan, is derived and extracted from Tenebrio Molitor larvae shells. Chitosan was extracted using a sustainable, low-impact protocol and processed into a stretchable and flexible film through glycerol plasticization and graphite integration, forming a conductive biocomposite. The sensor, fabricated in a straight-line geometry to ensure uniform strain distribution and signal stability, was evaluated for its mechanical and electrical performance under cyclic loading. Results demonstrate linearity, repeatability, and responsiveness to strain variations in the stain sensor during mechanical characterization and performance, ranging from 1 to 15%, with minimal hysteresis and fast recovery times. The device reliably captured respiratory cycles during normal breathing across three different areas of measurement: the sternum, lower ribs, and diaphragm. The strain sensor also identified distinct breathing patterns, including eupnea, tachypnea, bradypnea, apnea, and Kussmaul respiration, showing the capability to sense respiratory cycles during pathological situations. Compared to conventional monitoring systems, the sensor offers superior skin conformity, better adhesion, comfort, and improved signal quality without the need for invasive procedures or complex instrumentation. Its low-cost, biocompatible design holds strong potential for wearable healthcare applications, particularly in continuous respiratory tracking, sleep disorder diagnostics, and home-based patient monitoring. Future work will focus on wireless integration, environmental durability, and clinical validation. Full article

Autonomous earthwork machinery is gaining traction as a means to boost productivity and safety on space-constrained urban sites, yet the fast-growing literature has not been fully integrated. To clarify current knowledge, we systematically searched Scopus and screened 597 records, retaining 157 peer-reviewed papers (2015–March 2025) that address autonomy, integrated control, or risk mitigation for excavators, bulldozers, and loaders. Descriptive statistics, VOSviewer mapping, and qualitative synthesis show the output rising rapidly and peaking at 30 papers in 2024, led by China, Korea, and the USA. Four tightly linked themes dominate: perception-driven machine autonomy, IoT-enabled integrated control systems, multi-sensor safety strategies, and the first demonstrations of fleet-level collaboration (e.g., coordinated excavator clusters and unmanned aerial vehicle and unmanned ground vehicle (UAV–UGV) site preparation). Advances include centimeter-scale path tracking, real-time vision-light detection and ranging (LiDAR) fusion and geofenced safety envelopes, but formal validation protocols and robust inter-machine communication remain open challenges. The review distils five research priorities, including adaptive perception and artificial intelligence (AI), digital-twin integration with building information modeling (BIM), cooperative multi-robot planning, rigorous safety assurance, and human–automation partnership that must be addressed to transform isolated prototypes into connected, self-optimizing fleets capable of delivering safer, faster, and more sustainable urban construction. Full article

Background/Objectives: Fast-track (FT) protocols have been developed to reduce the surgical burden and enhance recovery, but they still need to be established for carotid endarterectomy (CEA). In this scenario, carotid stenting has gained momentum by answering the need for a less invasive treatment, despite a still debated clinical advantage. We aim to propose a FT protocol for CEA and to analyze its clinical outcomes. Methods: This retrospective, monocentric study enrolled consecutive patients who underwent CEA for asymptomatic carotid stenosis using an FT protocol between January 2016 and December 2024. Patients undergoing CEA for symptomatic carotid stenosis, carotid bypass procedures, and combined interventions were excluded. Our FT protocol comprises same-day hospital admission, exclusive use of local anesthesia, non-invasive assessment of cardiac and neurological status, and selective utilization of cervical drainage. Discharge criteria were goal-directed and included the absence of pain, electrocardiographic abnormalities, hemodynamic instability, neck hematoma, or cranial nerve injury, with a structured plan for rapid readmission if required. Postoperative pain was assessed using the numerical rating scale (NRS), administered to all patients. The perioperative clinical impact of the protocol was evaluated based on complication rates, pain control, length of hospital stay, and early readmission rates. Results: Among 1051 patients who underwent CEA, 853 met the inclusion criteria. General anesthesia was required in 17 cases (2%), while a cervical drain was placed in 83 patients (10%). The eversion technique was employed in 765 cases (90%). Postoperative intensive care unit (ICU) monitoring was necessary for 7 patients (1%). The mean length of hospital stay was 1.17 days. Postoperatively, 17 patients (2%) required surgical revision. Minor stroke occurred in three patients (0.4%), and acute myocardial infarction requiring angioplasty in two patients (0.2%). Inadequate postoperative pain control (NRS > 4) was reported by five patients (0.6%). Hospital readmission was required for one patient due to a neck hematoma. Conclusions: The reported fast-track protocol for elective carotid surgery was associated with a low rate of postoperative complications. These findings support its clinical value and highlight the need for further validation through controlled comparative studies. Furthermore, the implementation of fast-track protocols in carotid surgery should prompt comparative medico-economic research. Full article

Background/Objectives: Recent advances in artificial intelligence (AI) and machine learning (ML) enable targeted optimization of emergency department (ED) operations. We examine how reworking an ED’s vertical processing pathway (VPP) using AI- and ML-driven recommendations affected patient throughput. Methods: We trained a non-linear ML model using triage data from 49,350 ED encounters to generate a personalized risk score that predicted whether an incoming patient is suitable for vertical processing. This model was integrated into a stochastic patient flow framework using queueing theory to derive an optimized VPP design. The resulting protocol prioritized a vertical assessment for patients with Emergency Severity Index (ESI) scores of 4 and 5, as well as 3 when the chief complaints involved skin, urinary, or eye issues. In periods of ED saturation, our data-driven protocol suggested that any waiting room patient should become VPP eligible. We implemented this protocol during a 13-week prospective trial and evaluated its effect on ED performance using before-and-after data. Results: Implementation of the optimized VPP protocol reduced the average ED length of stay (LOS) by 10.75 min (4.15%). Adjusted analyses controlling for potential confounders during the study period estimated a LOS reduction between 7.5 and 11.9 min (2.89% and 4.60%, respectively). No adverse effects were observed in the quality metrics, including 72 h ED revisit or hospitalization rates. Conclusions: A personalized, data-driven VPP protocol, enabled by ML predictions, significantly improved the ED throughput while preserving care quality. Unlike standard fast-track systems, this approach adapts to ED saturation and patient acuity. The methodology is customizable to patient populations and ED operational characteristics, supporting personalized patient flow optimization across diverse emergency care settings. Full article

Sarcomas, a rare and complex group of cancers, require multidisciplinary care across multiple healthcare settings, often leading to delays, redundant testing, and fragmented data. This fragmented care landscape obstructs the implementation of Value-Based Healthcare (VBHC), where care efficiency is tied to measurable patient outcomes.ShapeHub, an interoperable digital platform, aims to streamline sarcoma care by centralizing patient data across providers, akin to a logistics system tracking an item through each stage of delivery. ShapeHub integrates diagnostics, treatment records, and specialist consultations into a unified dataset accessible to all care providers, enabling timely decision-making and reducing diagnostic delays. In a case study within the Swiss Sarcoma Network, ShapeHub has shown substantial impact, improving diagnostic pathways, reducing unplanned surgeries, and optimizing radiotherapy protocols. Through AI-driven natural language processing, Fast Healthcare Interoperability Resources, and Health Information Exchanges, HIEs, the platform transforms unstructured records into real-time, actionable insights, enhancing multidisciplinary collaboration and clinical outcomes. By identifying redundancies, ShapeHub also contributes to cost efficiency, benchmarking treatment costs across institutions and optimizing care pathways. This data-driven approach creates a foundation for precision medicine applications, including digital twin technology, to predict treatment responses and personalize care plans. ShapeHub offers a scalable model for managing rare cancers and complex diseases, harmonizing care pathways, improving precision oncology, and transforming VBHC into a reality. This article outlines the potential of ShapeHub to overcome fragmented data barriers and improve patient-centered care. Full article