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IOT-Driven accident detection and notification system with smart speed cameras for traffic signal optimization in vehicular environments
No full textIn our rapidly urbanizing world, the movement of goods, people, and services is greatly facilitated by transportation infrastructure. Each year, lost resources, higher fuel consumption, and increased pollution result in billion-dollar costs associated with traffic congestion, accidents on the roads, and inefficiencies in the transportation systems.
The road network is under pressure due to the increase in the urban population, and innovative solutions are needed to increase road safety. To improve road safety but also to increase the smooth flow of traffic, automatic accident detection systems as well as the traffic light optimization system must be implemented.
Both systems use the latest technology, artificial intelligence (AI), machine learning, as well as the Internet of Things (IoT). The automatic accident detection system focuses on real-time accident detection to inform emergency services as quickly as possible to minimize injuries and deaths, while the traffic light optimization system focuses on improving traffic flow, so that there is unimpeded passage of emergency vehicles, which are directed to the incident location. This technology not only saves lives but also helps the overall performance of urban and intercity transportation systems.
This thesis studies how these two systems can be implemented in the future to increase road safety and reduce emergency response times, as so far, the times are quite high.
In this way, this thesis offers several contributions to the field of traffic management as well as the management of a traffic accident. The research presented in this thesis tries to highlight the problem using real evidence from the Aegean Motorway and focuses on creating a system that will try to close various gaps from previous attempts to create a similar system.
The research highlights the importance of integrating emerging technologies such as IoT, AI, and ML into traffic control systems in a bid to mitigate growing issues such as traffic congestion, accidents, and ineffective transit. Automatic Accident Detection System (AADS) utilizes sensors, cameras, and intelligent algorithms to detect accidents in real time and alert rescue teams in a timely fashion. By making accurate accident data available to first responders, this rapid response can also minimize the severity of injuries and fatalities. The Traffic Light Optimization System (TLOS), on the other hand, optimizes the timing of traffic lights according to traffic flow to minimize congestion and maximize the overall efficiency of the city's transportation networks.
Although AADS and TLOS can and do provide many advantages, there are some challenges associated with their adoption, as highlighted by the study. High cost, privacy and data concerns, and the need for robust communication infrastructure are significant drawbacks that must be overcome. Public acceptance is also a key factor in the implementation of these technologies. While people know the possible benefits of AADS and TLOS in reducing traffic congestion and improving road safety, they also have concerns regarding the efficiency, cost, and privacy of the systems. Public education and resolution of these concerns are very important steps towards gaining more acceptance of the technologies.
The study also highlights the environmental benefits of TLOS as it can be utilized for the reduction of car emissions and fuel usage as well as traffic flow optimization. The study includes an analysis at the Agia interchange, which illustrates how the application of TLOS can reduce travel time and waiting time in traffic. For AADS and TLOS to be effective, several stakeholders, including city or state citizens, policymakers, and industry professionals, must be involved in the implementation of the systems to address the challenges and build trust. By continuously improving such systems, it is possible to move towards more sustainable, efficient, and safe transportation solutions.
First, in this specific research, a literature review was conducted so that we could understand exactly how these systems work, as well as find implementations of systems around the world. It was also very important to highlight the pros and cons of these systems.
Then, a microscopic analysis was carried out through the VISSIM, in a specific area of the highway, to determine the problems that may be created by the existence of traffic lights, such as e.g. the increased travel times as well as the increased queues that can also lead to traffic accidents.
This specific analysis could not be missing from a survey that aimed to understand how familiar drivers are with these systems, as well as their perception of them. Finaly, to complete this specific research, we tried to create an application as well as a system that would have the ability to inform all parties involved in the event of an accident and would have the ability to provide information that was previously unknown and was a deterrent in dealing with traffic accidents.
Regarding the results, this specific research came to fill the gaps that had been found during the literature review. The existence of an application that contains all the necessary information for the most appropriate response to a traffic accident is now a fact. This system can in the future become a "car black box" which, with the appropriate connection to the car, can even provide information about the weather
Cardiac resynchronization therapy for enabling guideline-directed medical therapy optimization in heart failure
No full textAimsWe aimed to assess whether cardiac resynchronization therapy (CRT) might serve as an enabler for guideline-directed medical therapy (GDMT) optimization. Methods and results Patients with heart failure with reduced ejection fraction (HFrEF) enrolled in the Swedish Heart Failure Registry between January 2009 and August 2022 were considered. Patients receiving a CRT close to the index registration were the cases, whereas controls had not received a CRT despite having an indication. Overall, 1543 (25%) HFrEF cases and 4537 (75%) controls were analysed in the intention-to-treat analysis. At baseline, beta-blockers, angiotensin-converting enzyme inhibitor (ACEi), angiotensin receptor blocker (ARB) or angiotensin receptor-neprilysin inhibitor (ARNi), mineralocorticoid receptor antagonist (MRA) and loop diuretic use was 84% versus 86%, 89% versus 88%, 57% versus 46% and 62% versus 59% in patients receiving versus not receiving CRT, respectively. At 1.5-year follow-up, patients receiving a CRT more likely experienced an improved use/dose of beta-blocker therapy (46% vs. 35%) and decreased loop diuretic use/dose (30% vs. 24%) versus controls. These associations were consistent after adjustments (odds ratio [OR] 1.83, 95% confidence interval [CI] 1.58-2.13, and OR 1.26, 95% CI 1.07-1.48, respectively), and confirmed in the per-protocol analysis (i.e. after excluding controls who received a CRT during follow-up). A significant association between CRT and the likelihood of ACEi/ARB/ARNi and MRA optimization (OR 1.22, 95% CI 1.04-1.44, and OR 1.25, 95% CI 1.05-1.50, respectively) was observed in the per-protocol analysis. Conclusions In this large nationwide real-world population with HFrEF, CRT implantation was associated with enabled use/dose of heart failure GDMT and decreased loop diuretic need (use/dose).This study received support through a grant from Medtronic to Dr. Gianluigi Savarese’s institution. The grant sources had no role in the design or analysis, nor in the interpretation of findings, manuscript preparation, or
decision to submit the results.
We thank all staff members at all care units in Sweden for their contribution to the SwedeHF and the Swedish Implantable Cardiac Defibrillator and Pacemaker Registr
Performance benchmarking and analysis of lithium-sulfur batteries for next-generation cell design
No full textLithium-sulfur batteries are emerging as strong contenders in energy storage; however, a cohesive design framework, systematic performance analysis and benchmarks remain absent. This study bridges this gap by examining recent advancements, with a focus on functional sulfur host materials, using a data-driven approach. Through a meticulous literature review, we digitize 866 galvanostatic cycling and rate capability plots, along with the collection of key host material properties-such as specific surface area and polysulfide binding/adsorption energy-as well as essential cell design parameters including sulfur loading, electrode formulation, and electrolyte-to-sulfur ratios, to standardize performance using specific energy and power metrics. This approach enables us mapping field advancements and identify impactful research contributions. Additionally, irrespective of materials chemistry, a comprehensive analysis of this database helps us to disclose general patterns that apply universally across all cells, highlight the most constructive and detrimental regions of the design-parameter space, and perceive potential synergies. These insights outline key areas for optimization, guiding future development of practical lithium-sulfur battery technology.This work was supported by SIM (Strategic Initiative Materials in Flanders) and VLAIO (Flemish Government Agency Flanders Innovation and Entrepreneurship) within the SBO project “FuGels” (Grant HBC.2021.0016) under the SIM research program “SIMBA—Sustainable and Innovative Materials for Batteries”
Economic impact of RSV infections in young children attending primary care: a prospective cohort study in five European countries, 2021 to 2023
No full textBackground: Data on economic costs of respiratory syncytial virus (RSV) infections among children in primary care are scarce, although most RSV-infections are managed in this setting. Aim: To estimate outpatient costs for RSV-positive childrenaged < 5 years. Methods: In the RSV ComNet prospective cohort, chil-dren<5 years with acute respiratory infection were recruited for RSV testing through primary care physicians in Belgium, Italy, the Netherlands, Spain and the United Kingdom (UK) during RSV seasons 2020/21 (UK only), 2021/22 and 2022/23. Outpatient healthcare utilisation and parental work absence were assessed over 30 days through parental questionnaires. Average costs per RSV episode were calculated from outpatient healthcare sector and societal perspectives, stratified by country and age. Results: We included 3,414 children and 1,124 (33%) tested RSV-positive. Physicians completed reports for 878 episodes, with follow-up questionnaire data for 819 (93%). Outpatient costs ranged from EUR 97 (95% CI: 91-104) in the Netherlands to EUR 300 (95% CI: 287-312) in Spain and were higher for infants than children aged 1-5 years. Societal costs ranged from EUR 454 (95% CI: 418-494) in the UK to EUR 994 (95% CI: 938-1,053) in Belgium. For children aged 1-5 years, societal costs were primarily driven by parental work absence. In infants, the main societalcost driver varied by country, but overall outpatient healthcare costs represented a higher proportion of societal costs vs older children. Conclusion: RSV infections in children attending primary care result in substantial economic costs per episode, although differences exist across countries. This study provides essential data to inform cost-effectiveness analyses on novel RSV immunisations.The authors would like to acknowledge the important role of their late colleague, John Paget, for his invaluable contributions to the conceptualisation and design of this study, as well as his significance in interpreting the results and providing supervision. John was also instrumental in the establishment and development of the RSV ComNet Network,
for which his efforts will be remembered. The authors thank Sanofi and AstraZeneca for funding this collaborative study
Fertility care in low-and middle-income countries: Public sector access to medically assisted reproduction in South Africa: a case study
No full textIn South Africa, approximately 10% of the calculated need for medically assisted reproduction is being met due to limited access and unequal availability of these services. To facilitate understanding of challenges associated with access to assisted reproduction, a retrospective case study spanning 6 years was performed at one public sector hospital in South Africa offering these services. Demographic profiles, including income, region of residency and access to medical insurance, of patients seeking assistance to become pregnant were investigated. Patients were categorised as those who underwent diagnostic investigations only vs those who returned for therapeutic procedures, and the difference in demographic profiles between the two groups was determined. This investigation showed that patients from the lower-income classification group, without medical insurance, tend to return for therapeutic procedures less often than those with a higher income and medical insurance, even though these low-income patients qualify for a therapeutic procedure subsidy. An inverse relationship existed where patient numbers decreased as their travel distance increased, but patients who were required to travel further for assisted reproductive therapy tended to return for these procedures more often than patients who resided closer to the medical facility. In conclusion, access to medically assisted reproduction facilities is critically undersupplied and limited in the region. In order to ease the travel distance of patients, alternative primary diagnostic routes with accessible clinics are needed. In addition, costs of therapeutic procedures in the public sector should be re-evaluated to be offered at affordable rates for marginalised patients.Lay summaryIn South Africa, about 10% of patients who need assistance to become pregnant are being helped. To better understand this phenomenon, researchers considered information about patients from a public sector hospital in South Africa. This includes how much money the patients earned, how far they travelled to the hospital and whether they had medical insurance. The patients were grouped into those who requested initial investigations but never returned for treatments, and those who returned for medical treatment. The differences between these groups were then evaluated. The research showed that people with less money tend to abandon further treatment more often, or take longer to return, than those with more money. The conclusion drawn is that assisted reproductive therapy is too expensive and that more IVF clinics are needed, using cheaper and simpler procedures of the same quality.Funding
The lead author’s research is supported through Hasselt University’s BOF-Bilateral Scientific Cooperation grant (reference number BOF21BL16).
The contributions of Ms Robyn Leeke (Reproductive Biology Laboratory, University of Pretoria) with data collection and Prof Piet Becker (University of Pretoria), who assisted in statistical analysis of the data, are acknowledged
Early complications after penile implant surgery
No full textcitation ID: qdaf077.229 EARLY COMPLICATIONS AFTER PENILE IMPLANT SURGERY Objectives: Erectile dysfunction is a prevalent condition that may significantly impact psychosocial health and quality of life of patients suffering from this condition. While various treatment modalities exist, penile prosthesis implantation offers a permanent solution for patients that do not respond to or are not suitable for other treatment options. Surgery however, carries inherent risks and potential complications. The aim of this study was to determine the incidence and risk factors of early postoperative complications after penile implant surgery in a large, multicenter, prospective, observational cohort study. Methods: Data were analyzed from patients participating in the PHOENIX registry, an international multicenter study on penile implant surgery conducted by the EAU Research Foundation. Patients were operated on from November 2021 until august 2024 in 30 centers from 8 countries. Data were collected prospectively. Our study was not limited to one device or brand, all available devices were eligible for inclusion. Postoperative complications were registered at different time points during follow-up, up to 2 years post-surgery. For this analysis we studied complications that occurred within 2 weeks after surgery. Results: Data on early complications after penile implant surgery of 1072 patients were analyzed. Patients were on average 61 years old when receiving their penile implant. A total of 639 (60%) patients received a drain peroperatively. A total of 39 patients reported complications within 2 weeks after surgery. Infection occurred in 19 (1.8%) patients, 4 of which within 2 weeks post-surgery. Penoscrotal hematoma occurred in 9 (0.8%) patients, 6 of which within 2 weeks post-surgery. Of those patients who developed an infection, 8 (42%) patients had received a drain and 11 (58%) had not. A total of 278 (26%) patients were known with diabetes mellitus, whereas five (26%) patients with a postoperative infection suffered from diabetes mellitus. Conclusions: This large and only-of-its-kind prospective, international, multicenter study confirms that penile implant surgery is a safe procedure with a low rate of early postoper-ative complications. Moreover, peroperative drain placement and diabetes mellitus do not appear to impact the occurrence of postoperative infections. Conflicts of Interest: Funded by Boston Scientific Corp, Coloplast Corporation
Association of environmental pollutants with asthma and allergy, and the mediating role of oxidative stress and immune markers in adolescents
No full textBackground: Asthma and allergic diseases are among the common causes of morbidity and mortality globally. Various environmental pollutants are linked to the development of asthma and allergic diseases. Evidence on the role of oxidative stress and immune markers in the association of environmental pollutants with asthma and allergy is scant. We examined cross-sectional associations between environmental pollutants and asthma and allergy, investigated mixture effects and possible mediation by oxidative stress or immune markers. Methods: We used data from the Flemish Environment and Health Study 2016-2020 (FLEHS IV), including 409 adolescents aged 13-16 years. Fifty-four pollutants, including metals, phthalates, Di(isononyl) cyclohexane-1,2dicarboxylate (DINCH), bisphenols, currently used and legacy pesticides, flame retardants, per- and polyfluoroalkyl substances (PFAS), polyaromatic hydrocarbons (PAHs), and polychlorinated biphenyls (PCBs) were analyzed. Outcomes were self-reported asthma, rhinitis, eczema, allergies, respiratory infection, and airway inflammation, measured through fractional exhaled nitric oxide (FeNO). Single pollutant models using multiple regression analysis and multipollutant models using Bayesian Kernel Machine Regression (BKMR) were fitted. As sensitivity analysis, Bayesian model averaging (BMA) and elastic net (ENET) models were also performed. For Bayesian models, posterior inclusion probabilities (PIP) were used to identify the most important chemicals. Mediation analysis was performed to investigate the role of oxidative stress, measured by urinary 8-hydroxy-2' -deoxyguanosine (8-OHdG), and immune markers (eosinophils, basophils, InterLeukin 8, InterLeukin 6, and Interferon-vin blood). Results: In single pollutant models, FeNO was significantly higher by 20% (95% CI: 6, 36%) and 13% (95% CI: 2, 25%) per interquartile range (IQR) fold in mono-n-butyl phthalate (MnBP) and mono-benzyl phthalate (MBzP), respectively. In BKMR analysis, the group PIPs indicated phthalates and DINCH as the most important group (group PIP = 0.509), with MnBP being the most important pollutant within that group (conditional PIP = 0.564; %change = 28%; 95%CI: 6, 54%). Similar patterns were observed in all multipollutant models. Eosinophil count mediated 37.8% (p = 0.018) and 27.9% (p = 0.045) of the association between MBzP and FeNO, and the association between MnBP and FeNO, respectively. 8-OHdG plays a significant mediating role in the association of 2,4-Dichlorophenoxyacetic acid (2,4-D) (55.4%), 3,5,6-Trichloro-2-pyridinol (TCPY) (48.1%), and 1-Naphthylamine (1-NAP) (32.7%) with rhinitis, while the total effects of these chemicals on rhinitis were not statistically significant. Conclusions: This study found associations between phthalates, MnBP and MBzP, and elevated FeNO, which appeared to be mediated by eosinophil count. 8-OHdG plays a significant mediating role in the association between 2,4-D, TCPY, and 1-NAP with rhinitis, while their direct effects remain non-significant. Use of in- flammatory and oxidative stress markers can enhance the understanding of inflammatory processes in asthma and allergic diseases due to environmental pollutants.Funding
This work was carried out in the framework of the European Partnership for the Assessment of Risks from Chemicals (PARC) and has received funding from the European Union’s Horizon Europe research and innovation program under Grant Agreement No 101057014. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Health and Digital Executive Agency. Neither the European Union nor the granting authority can be held responsible for them. The FLEHS IV study was conducted within the framework of the Flemish Center of Expertise on Environment and Health (FLEHS, 2016–2020), funded by the Environment, Nature, and Energy Department of the Flemish government. The views expressed herein are those of the author(s) and are not necessarily endorsed by the Flemish government Analysis of phthalates and per-and polyfluoroalkyl substances were co-funded from the EU Horizon 2020 Framework Project HBM4EU, Grant Agreement No 733032.
Acknowledgement
We thank the adolescents and their families who participated in FLEHS IV. Without their effort, this study would not have been possible. We thank the field workers from the Provincial Institute of Hygiene and VITO for the sample and data collection. We thank all collaborators of the scientific teams of the Flemish Center of Expertise on Environment and Health (https://www.milieu-en-gezondheid.be/en/about-the-cente r-0) and Karen Van Campenhout and Caroline Teughels from the Flemish Department of Environment & Spatial Development for their valuable input in the field work committee
Home-based urinary sodium monitoring via point-of-care testing for personalized diuretic titration in heart failure management: The EASY-STOP study
No full textAims: Loop diuretics alleviate symptoms in heart failure (HF), but despite recommendations for dynamic dosing, implementation in practice remains challenging. The EASY-STOP trial investigated whether ambulatory urinary sodium monitoring using a point-of-care sensor could guide diuretic down-titration. Methods and results: This prospective, single-centre study enrolled 50 euvolaemic HF patients on stable guideline-directed medical therapy for >= 3 months and receiving maintenance loop diuretic (>= 20 mg furosemide equivalent daily). After a 1-week baseline phase of daily self-measured first-void and post-diuretic urinary sodium assessment, loop diuretics were gradually reduced by 50% and discontinued when = I, oedema, pleural effusion, ascites, rise in right ventricular systolic pressure >= 10 mmHg, or worsening diastolic dysfunction >= 1 grade). Investigators and patients were blinded for urinary sodium analysis during the study. Patients were 75 (68-79) years old, had left ventricular ejection fraction 46 (+/- 11)%, estimated glomerular filtration rate 47 (35-65) ml/min and N-terminal pro-B-type natriuretic peptide 899 (326-2558) ng/L. Among the 50 patients, 62 diuretic down-titrations were performed, of which 34 (55%) were successful. Baseline urinary sodium before loop diuretic down-titration was similar between groups. However, patients who successfully achieved down-titration exhibited a significant increase in first-void urinary sodium following down-titration (53-74 mmol/L, p < 0.001), whereas those requiring reinitiation showed no significant change (56-58 mmol/L, p = 0.331). A 10 mmol/L increase predicted successful down-titration with 79.4% sensitivity and 78.6% specificity (area under the curve = 0.851). Conclusions: Point-of-care urinary sodium monitoring may represent a non-invasive and personalized approach to diuretic titration in HF management. Further trials are warranted to validate its clinical utility and long-term benefits
Real-life effectiveness of sacubitril/valsartan in older Belgians with heart failure, reduced ejection fraction and most severe symptoms
No full textWe assessed the real-world effectiveness of sacubitril/valsartan in patients with chronic heart failure (HF) and reduced ejection fraction (HFrEF) with an emphasis on those with older age (≥ 75 years) or with New York Heart Association (NYHA) class IV, for whom greater uncertainty existed regarding clinical outcomes. We conducted a retrospective cohort study based on patient-level linkage of electronic healthcare datasets. Data from all adults with HFrEF in Belgium receiving a prescription for sacubitril/valsartan between 01-November-2016 and 31-December-2018 were collected, with a follow-up of > 6 years. The total study population comprised 5446 patients, older than the PARADIGM-HF trial participants, and with higher NYHA class (all P 26% in the overall cohort, and in subgroups of patients ≥ 75 years, with NYHA class III/IV (all P < 0.0001) or with NYHA class IV (P < 0.05), vs. baseline. All-cause mortality did not increase in real-world patients with NYHA class III/IV. The results support the long-term beneficial effects of sacubitril/valsartan in older patients and in those experiencing the most severe symptoms.Acknowledgements
Healthdata.be, Sciensano, Brussels, Belgium facilitated data exchange for this study, enabling the analysis of this Belgian registry. Specifcally, we thank Hélène Ameels and Johan Van Bussel for helpful discussion and comments on a draf version of this manuscript. We thank Tahnee Sente, former project manager at Novartis Pharma Belgium, who initiated the project with healthdata.be in 2017. We thank the Data42 team at Novartis Pharma, and specifcally Silvia Zaoli and Nelly Hajizadeh, data science experts who provided great support and guidance for the use of the internal platform and the analyses related to the PARADIGM-HF trial. We thank the members of the cardio-renal-metabolic medical department and market access team at Novartis Pharma Belgium for helpful discussion
The impact of neoadjuvant therapy in patients with left-sided resectable pancreatic cancer: an international multicenter study
No full textBackground: Left-sided pancreatic cancer is associated with worse overall survival (OS) compared with right-sided pancreatic cancer. Although neoadjuvant therapy is currently seen as not effective in patients with resectable pancreatic cancer (RPC), current randomized trials included mostly patients with right-sided RPC. The purpose of this study was to assess the association between neoadjuvant therapy and OS in patients with left-sided RPC compared with upfront surgery. Patients and methods: This was an international multicenter retrospective study including consecutive patients after left-sided pancreatic resection for pathology-proven RPC, either after neoadjuvant therapy or upfront surgery in 76 centers from 18 countries on 4 continents (2013-2019). The primary endpoint was OS from diagnosis. Time-dependent Cox regression analysis was carried out to investigate the association of neoadjuvant therapy with OS, adjusting for confounders at the time of diagnosis. Adjusted OS probabilities were calculated. Results: Overall, 2282 patients after left-sided pancreatic resection for RPC were included of whom 290 patients (13%) received neoadjuvant therapy. The most common neoadjuvant regimens were (m)FOLFIRINOX (38%) and gemcitabine-nab-paclitaxel (22%). After upfront surgery, 72% of patients received adjuvant chemotherapy, mostly a single-agent regimen (74%). Neoadjuvant therapy was associated with prolonged OS compared with upfront surgery (adjusted hazard ratio 0.69, 95% confidence interval 0.58-0.83) with an adjusted median OS of 53 versus 37 months (P = 0.0003) and adjusted 5-year OS rates of 47% versus 35% (P = 0.0001) compared with upfront surgery. Interaction analysis demonstrated a stronger effect of neoadjuvant therapy in patients with a larger tumor (P-interaction = 0.003) and higher serum carbohydrate antigen 19-9 (CA19-9; P-interaction = 0.005). In contrast, the effect of neoadjuvant therapy was not enhanced for splenic artery (P-interaction = 0.43), splenic vein (P-interaction = 0.30), retroperitoneal (P-interaction = 0.84), and multivisceral (P-interaction = 0.96) involvement. Conclusions: Neoadjuvant therapy in patients with left-sided RPC was associated with improved OS compared with upfront surgery. The impact of neoadjuvant therapy increased with larger tumor size and higher serum CA19-9 at diagnosis. Randomized controlled trials on neoadjuvant therapy specifically in patients with left-sided RPC are needed