bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of the equipment used in the mining rescue activity in Romania and the nature of their specific requests
Authors: Ilioni Cristian
Published: July 2021

Occupational safety and health is increasingly considered to be a distinct scientific discipline, with a well-defined place in the labor sciences system. The evolution of research in recent years at European and international level has highlighted an increasing interpenetration of occupational safety and health with other scientific disciplines circumscribed or related to the field of industrial engineering, such as medicine and occupational hygiene, ergonomics, sociology, mathematics, computer science etc. In national legislation, the intervention and rescue activity in toxic / explosive / flammable environments has so far proved to be generally appropriate both in terms of prevention and in terms of limiting the effects of technological damage of lesser or greater magnitude. The theoretical and instrumental aspects presented in the paper have a wide applicability, being intended for all rescue stations, regardless of the branch of activity, as well as for specialists in the field of occupational safety and health. Understanding the relationship between the environment, equipment and rescue station personnel and ho-w these three components interact is fundamental to achieving increased efficiency in rescue work.
Long-term stability of the final slopes of the mining waste dumps from Oltenia
Authors: Lazar Maria , Faur Florin , Apostu Izabela-Maria , Rada Constantin
Published: July 2021

The waste dumps resulted from the lignite exploitation activities from Oltenia are constructions that reach, in most cases, impressive dimensions and store large volumes of sterile rocks. Usually, the dumps are arranged and ecologically restored, but between the moment of their release from technological tasks and the beginning of the arrangement works, periods of time, measured even in years, can pass. The calculations regarding the geometry of the waste dumps are performed in the design stage, taking into account the mechanical strength characteristics of the mixture of sterile material that forms them, so as to ensure a sufficient stability reserve during the construction period and when the projected storage capacity is achieved. If the arrangement and ecological restoration works do not start immediately after the depositing activity is stopped, the exposure of loose and disaggregated material to the influence of external factors (especially erosion and rainfall infiltration) can lead to landslides with disastrous consequences on natural and anthropogenic objectives located in the influence area. This paper analyzes the stability elements of waste dumps under normal operating conditions, the modification of the strength characteristics over time and the geometry required in the final phase so as to ensure their long-term stability.
Geological and hydrogeological characterization of the landfill areas located around Bucharest city in the context of environmental management
Authors: Balint Alexandru
Published: July 2021

The process of risk assessment and investigation of potentially contaminated soil and groundwater is highly dependent on a proper understanding of the geological and hydrogeological conditions of the investigated site. The current paper aims at identifying the general geological and hydrogeological conditions of the landfill areas around Bucharest city based on interpretations of the data available in research articles, books, public reports, and geological and hydrogeological maps. Several soil samples were collected, and laboratory analyses were conducted to validate the initial expectations in terms of physical properties of the underlying strata. Results were presented as cross-sections and piezometric maps suitable for developing tridimensional models, conceptual site models and contaminant fate and transport modeling with sufficient accuracy for environmental urban planning. The research provides a quick method which may be used when assessing the general geological and hydrogeological conditions of various sites in environmental studies. The vulnerability of the Romanian legislation in data management and decision-making was also highlighted, therefore a series of recommendations to improve the data availability and quality were provided.
Considerations regarding the adaptation of cities to thermal stress, effect of climate change
Authors: Varga Lucia-Ana , Zaman Gheorghe , Dunca Emilia-Cornelia
Published: July 2021

The paper aims to contribute to increasing the level of knowledge about climate change and its impact on cities in western Romania. The existing legislative framework at European and national level on resilience and adaptation to climate change is presented. The necessary climatic information is identified in order to create a scenario regarding the thermal stress and the health risk of the inhabitants of Timişoara. The results are extrapolated to other cities in the west of the country. The data obtained from the use of climate models are processed in order to use them to establish the necessary adaptation measures in order to reduce the risk to the health of the population due to future thermal stress. The paper presents uncertainties and limitations, as well as conclusions and personal contributions.
Automatic identification of NBOMe illicit psychoactive substances based on combined molecular descriptors
Authors: Ion Adelina , Praisler Mirela , Burlacu Catalina Mercedes , Stanica Nicolae Catalin
Published: July 2021

During the last decade, a growing prevalence of new psychoactive substances (NPS) has been noticed by the law enforcement agencies. Although NPS have no medical use due to their very high toxicity, they are often sold on the black market. NBOMe defines a group of toxic amphetamines that has as parent compound 25I-NBOMe, a synthetic derivative of 2C-I (2,5-dimethoxy-4-iodophenetylamine). In this paper, we are presenting a series of Artificial Neural Networks (ANNs) designed to identify the NBOMe class membership based on a mixture of topological and 3D-MoRSE descriptors. For this purpose, the molecular structures of 160 compounds representing NBOMe compounds, narcotics, sympathomimetic amines, potent analgesics, as well as their main precursors have been first optimized. Then a molecular database was formed by computing a large number of topological and 3D-MoRSE descriptors that characterize these structures. This database was used as input for building an ANN system designed to recognize NBOMes. The relevance of the input variables on its classification performance has been assessed and new systems have been built by using different combinations of selected topological and 3D-MoRSE descriptors. The best performing system has been found by comparing various classification efficiency criteria.
Contributions to development of an inertial separation system for suspended solid particles in air
Authors: Matei Daniel Ion , Nan Marin Silviu , Aron Cristian , Lapadusi-Macesaru Cristina
Published: July 2021

The separation of particles with big inertial mass transported in the air, is most often done with the help of cyclones, due to their resistance to wear at contact with abrasive particles. However, pneumatic conveying of heavy and abrasive granular material mixed with fines, are problematic even for cyclone hardened inlets. The paper studies a new method of dividing the main airflow in two airstreams, one further divided in more smaller streams to achieve the laminar regime, by using a corrugated shaped inlet. Thus generating an improvement in impact resistance, overall cyclone grade efficiency and decreasing pressure drop.
Competition in the Georgian banking sector and its impact on the credit policy of commercial banks
Authors: Abuselidze George , Sharabidze Mariam
Published: July 2021

Based on the role of banking sector in the development of the country’s economy, we consider it important to study the current situation in this sector. The existence of a competitive environment ensures the efficient functioning of the banking sector. The aim of the study is to estimate the competitive environment in the banking sector, to determine the relationship between competition and interest rates. The research is based on the use of different economic models and indexes. Competition in the banking sector is studied on the example of Georgian banking sector, for that we used HHI Net Loans and H-statistic indicators. The study analyses the impact of competition in the banking sector on the net interest income and interest rate in the same sector.
Psychological predictors of formation and development of personal identity of older preschool children
Authors: Pomytkina Liubov , Moroz Ruslana , Kovalchuk Oleksandr , Pomytkin Eduard
Published: July 2021

The article presents the results of the study to determine the predictors of the formation and development of personal identity of older preschool children. The conceptual basis of the study is the assumption that the formation of triangulatory relations internalized in the personality structure of maternal and paternal objects is an important prerequisite for the development of a holistic, stable, differentiated personality. The purpose: to highlight the results of empirical analysis of features and to determine the factors of formation and development of personal identity of older preschool children.

Methods: biographical, semi-structured interview, analysis of family narratives; test of M. Kuhn and T. McPartland “Who I am?”, “Three trees”, “Compose a fairy tale”; H. Olson, J. Portner, I. Lavi “FASES-3”, “Interaction of parents and the child” of I. Markovska; E. Eidemiller’s “Analysis of Family Interaction”; “Scale of rejection of the child in the family” of A. Barkan; content analysis; methods of mathematical statistics SPSS-17. As a result of a factor analysis parameters of the family system, identification with the maternal or paternal object, four factors were identified: ability to triangulatory relations, stability/instability of personal identity of older preschool children, neutral selfattitude, factor of prerequisites for the formation of personal identity.

Thus, in the course of the study it was determined that the formation of personal identity of a child of older preschool age is determined by the correlation between the place that the child occupies in the system of human relationships, and above all in the system of family relationships, and psychological features which have already been formed.
Economic and social development based on education, research and industry
Authors: Anghelache Constantin , Anghel Mădălina-Gabriela , Iacob Ştefan Virgil
Published: July 2021

The economic and social evolution in the current context, of the sanitary and economic-financial crisis raises problems regarding the future economic evolution. The authors highlight the current situation of the Romanian economy. Measures must be taken to ensure that standards in education and research are raised. The industry needs to modernize on digitalization, robotics and other achievements of science. Today, the industry needs to develop based on the latest achievements of science. Innovation must be the basis of high-quality education, be an element of research, and research without innovation cannot exist. The method used is that of comparative study, static and dynamic, and the use of statisticaleconomic models to highlight the role of education, research and industry, based on innovation. From the data we have at our disposal, it results the need for these aspects to constitute the equilateral triangle of a program of economic and social development in the future. The final conclusion of this research is the need to intensify efforts, including financing an economy based on deep and quality education, connecting high-level education with research and bringing through innovations new attributes that the industry must fulfil.
Science, research and innovation, essential elements in the economic evolution of the European Union
Authors: Anghelache Constantin , Anghel Mădălina-Gabriela , Iacob Ştefan Virgil
Published: July 2021

The European Union has development programs to ensure the economic growth of the European Union. Member States are going through a deep health and economic and financial crisis with greater effects than in 1929-1933. The elements underpinning Community programs must be based on research and innovation. Increased funding for education, research and innovation is needed. The aim of the research is to highlight the need for sustained efforts to overcome the current situation affecting the world economy and the economy of each country individually. In the study we used statistical-econometric methods, which by analysing and interpreting the data we have to highlight the need for immediate action of concrete measures. In this direction, the data available to us show that the European economy cannot adjust without focusing on innovation, which must accompany high-quality education, coupled with in-depth research. From this perspective it follows that attention must be paid to putting innovation at the heart of high quality education and research. Only on the basis of this fulfilled goal can we think that the European Union will be able to find its bed and move immediately to economic recovery, which will ensure a sustainable economic and social development.
The method of observing the student’s behavior in the educational environment
Authors: Cristea Pleşan Niculeta
Published: July 2021

This paper aims to highlight the efficiency of using the method of observing student behavior in the educational environment. Observation is one of the most widely used research methods in the social sciences. The characteristics aimed at constructing the instrument were: accuracy, focus, duration of observation, awareness of the presence of the observer, the level of information of the subject. In order to observe the student’s behavior in the school environment, the observation grid with standardized answers was designed on the Likert scale (scale from 1 to 10), following the degree of expression of the described behavioral manifestations.

The observation grid of the student’s behavior in the school environment aims at supervising 4 dimensions (each with 5 items: observable behaviors): interest in school activities, organization of activity / punctuality in the school environment, resistance to intellectual effort, socio-affective relationships.

Following the application of the research tool, depending on the scores obtained, it is recommended the targeted psycho-pedagogical intervention at the level of the deficient dimension / behaviors, as well as the monitoring of the results through the periodic application.
Rasche Hilfe bei psychischen Belastungen am Arbeitsplatz: Die
Psychosomatische Sprechstunde im Betrieb
Authors: Balint Elisabeth Maria , Gantner Melanie , Gündel Harald , Herrmann Kristin , Pößnecker Tim , Rothermund Eva , von Wietersheim Jörn
Published: July 2021

Hintergrund Die psychosomatische Sprechstunde im Betrieb (PSIB) ist ein
Angebot für psychisch und psychosomatisch belastete
Beschäftigte. Kernelemente sind frühzeitige Diagnostik und
Kurzpsychotherapie mit dem Ziel der Verbesserung der Versorgung von psychisch
belasteten Beschäftigten. Ziel dieses Artikels ist die Charakterisierung
der Hilfesuchenden und die Darstellung erster Daten zu den Effekten der
Kurzpsychotherapie.

Material und Methoden Von 05/2016 bis 12/2019 wurden bei
allen sich in der PSIB vorstellenden Beschäftigten Basisdaten erfasst.
Mittels Fragebogen wurden zu Beginn sowie im Falle einer Kurzzeit-intervention
zum Abschluss soziodemografische Daten, vorausgehende Behandlungen,
Selbsteinschätzungen zu Arbeitsfähigkeit, Depressivität
(PHQ-9), Angst (GAD-7), somatische Belastung (PHQ-15), Einschätzung der
eigenen psychischen Verfassung sowie Einstellungen zu
Behandlungsmöglichkeiten erhoben.

Ergebnisse 672 Beschäftigte aus 20 Betrieben (49%
Männer) wurden vorwiegend über den Betriebsarzt zugewiesen.
Anpassungsstörungen und depressive Störungen machten jeweils
knapp ein Drittel der Diagnosen aus. Ein Viertel der sich in der Sprechstunde
vorstellenden Beschäftigten war aktuell krankgeschrieben. Am
häufigsten wurde die Empfehlung einer Kurzintervention im Rahmen der
Sprechstunde gegeben, am zweithäufigsten ambulante Psychotherapie. 343
(51%) Beschäftigte füllten den Fragebogen aus, von
diesen erhielten 187 (55%) eine Kurztherapie. Die Symptomatik
verbesserte sich signifikant über alle Fragebogenskalen hinweg. Die
Zufriedenheit mit der PSIB war sehr hoch.

Diskussion Die PSIB ist ein innovatives Versorgungskonzept im
Arbeitskontext, das in verschiedenen Branchen gut angenommen wird. Wichtig
für ein gutes Gelingen ist die enge Kooperation mit betrieblichen
Akteuren wie Betriebsärzten.
Ankle Angle but Not Knee Angle Influences Force Fluctuations During Plantar Flexion
Authors: Trypidakis Georgios , Amiridis Ioannis G. , Enoka Roger , Tsatsaki Irini , Kellis Eleftherios , Negro Francesco
Published: July 2021

The purpose of the study was to evaluate the influence of changes in ankle- and knee-joint angles on force steadiness and the discharge characteristics of motor units (MU) in soleus when the plantar flexors performed steady isometric contractions. Submaximal contractions (5, 10, 20, and 40% of maximum) were performed at two ankle angles (75° and 105°) and two knee angles (120° and 180°) by 14 young adults. The coefficient of variation of force decreased as the target force increased from 5 to 20% of maximal force, then remained unaltered at 40%. Independently of knee angle, the coefficient of variation for force at the ankle angle of 75° (long length) was always less (p<0.05) than that at 105° (shorter length). Mean discharge rate, discharge variability, and variability in neural activation of soleus motor units were less (p<0.05) at the 75° angle than at 105°. It was not possible to record MUs from medial gastrocnemius at the knee angle of 120° due to its minimal activation. The changes in knee-joint angle did not influence any of the outcome measures. The findings underscore the dominant role of the soleus muscle in the control of submaximal forces produced by the plantar flexor muscles.
Effizienzsteigerung und Kostenreduktion durch Straffung der Wundversorgung von chronischen Wunden in einem Klinikverbund mit 16 Kliniken
Authors: Bruning Guido , Marquet Enno , Woitalla-Bruning Jasmin
Published: July 2021

Seit Jahren gilt die feuchte Wundbehandlung als Standard in der Wundversorgung. Obwohl dieser Grundsatz allgemein akzeptiert ist, ist die Evidenz schon für dieses Dogma überschaubar. Die Industrie bietet auf diesem Grundsatz eine Vielzahl von Produkten zur Wundversorgung an, deren Überlegenheit gegenüber anderen Produkten auf evidenzbasierter Grundlage oft nicht gegeben ist.

Ziel war es, in einer Klinikgruppe das Sortiment unter hauptsächlich einkaufspolitischen Kriterien zu straffen und zu häufige, unbegründete Therapiewechsel zu vermeiden. Daraus ergab sich die Aufgabe, sich nach Möglichkeit auf wenige Hersteller zu begrenzen.

Um die Akzeptanz und die Gründe für alle Anwender im Prozess transparent zu gestalten, wurden diese über eine strukturierte Abfrage für das Thema sensibilisiert und mitgenommen. Als Ergebnis ist ein kleines, sehr straffes Kontingent in der Wundversorgung mit hoher Anwenderakzeptanz entstanden. Hierdurch lassen sich im Einkauf deutliche Kosteneinsparungen realisieren.
Auditory and Vestibular Functioning in Individuals with Type-2 Diabetes Mellitus: A Systematic Review
Authors: Kumar Prawin , Singh Niraj Kumar , Apeksha Kumari , Ghosh Vipin , Kumar Raveendran Rajesh , Kumar Muthaiah Bhanu
Published: July 2021

Introduction Diabetes mellitus is a metabolic disease associated with a rise in the level of blood glucose. Individuals with diabetes mellitus are more likely to develop hearing loss, tinnitus, and dizziness due to macro- and microvascular complications. The extent to which auditory and vestibular functions are impaired in individuals with type-2 diabetes mellitus is still under debate.

Objective To systematically review studies focusing on auditory and vestibular functions in individuals with type-2 diabetes mellitus.

Data Synthesis A search was conducted in the PubMed, MedlinePlus, Ingenta Connect and Google Scholar databases for articles published until June 2019. A total of 15,980 articles were primarily retrieved, 33 of which were shortlisted based on the inclusion criteria set by the investigators for the systematic review. Out of 33 full-length articles, 26 evaluated the functioning of the auditory system, while 7 evaluated the functioning of the vestibular system. Most studies related to auditory functioning reported a significant effect of type-2 diabetes mellitus on the peripheral auditory system, whereas studies on vestibular functioning reported no significant effect of diabetes mellitus on the functioning of the peripheral vestibular end-organ.

Conclusion Overall, the results of various audiological and peripheral vestibular tests reveal distinctive peripheral and/or central auditory and vestibular end-organ impairments in individuals with type-2 diabetes mellitus.
Acute Colonic Pseudo-obstruction and Volvulus: Pathophysiology, Evaluation, and Treatment
Authors: Underhill Joshua , Munding Emily , Hayden Dana
Published: July 2021

Acute colonic pseudo-obstruction (ACPO) and volvulus are two disease processes that affect the colon causing abdominal distension and may necessitate operation intervention. ACPO may be associated with multiple comorbidities, infectious diseases, and cardiac dysfunction. It may be treated with conservative management including endoscopic decompression or neostigmine. If the distension is not addressed, high mortality may result if peritonitis develops. Volvulus most commonly occurs in the sigmoid colon or cecum. If left-sided, endoscopic decompression may resolve the obstruction if detorsion is successful, although sigmoid colectomy should be performed during the admission. If cecal volvulus is identified, right hemicolectomy should be performed.
Sudden Cardiac Death in the General Population: Can We Improve Risk Stratification and Prevention?
Authors: Murray Gary L. , Colombo Joseph
Published: July 2021

A total of 15 to 20% of deaths worldwide are sudden (within 1 hour of symptom onset). Our ability to predict and prevent sudden cardiac death (SCD) in the general population, in which 85% have no known organic heart disease (OHD) or stable OHD with left ventricular ejection fraction >40%, is limited to poor. The purpose of this commentary is to suggest a new approach to SCD in this population. Oxidative stress is a common thread in development and progression of the major cardiac diseases associated with SCD. It has a profound adverse effect upon heart rate variability (HRV), sympathetic tone (S), and parasympathetic tone (P). Recently, developed technology finally has allowed accurate measures of S and P. Using this technique, the general population can be screened, those at risk for SCD can be identified with a higher degree of success, and preventative measures instituted. For example, in 133 geriatric type 2 diabetics with S and/or P abnormalities upon screening, the potent and natural antioxidant (r)α lipoic acid reduced SCD (relative risk reduction) 43% (p = 0.0076), mean follow-up 6.31 years. Diabetes mellitus patients have high glycemic oxidative stress. Addressing oxidative stress S and P abnormalities can reduce SCD. S and P screening of the general population will be discussed.
Profile of Crohn’s Disease Patients Who Underwent Anorectal Examination under Anesthesia
Authors: Carvalho Alexandre Lopes de , Sena Natalie Fernanda Baqueiro , Sampaio Jamile Caramello Ortins , Trajano Aline de Oliveira , Codes Lina Maria Goes de , Fidelis Flávia de Castro Ribeiro , Alcantara Rogerio Souza Medrado de , Barreto Marcelo da Silva
Published: July 2021

Introduction Crohn’s disease (CD) is an inflammatory bowel disease, and in ∼ 30% of cases it is associated with perianal manifestations. To identify the extent of the damage and to implement an appropriate treatment, anorectal examination under anesthesia (EUA) is fundamental.

Objective To describe the profile of patients who underwent anorectal EUA in university and private hospitals in the state of Bahia, Brazil.

Methodology A retrospective, descriptive study with 46 patients who underwent anorectal EUA between March, 2016 and November, 2019.

Results A total of 62 anorectal EUAs were performed in 46 patients. With an average age of 36.8 years, the female gender was predominant (52.2%) among these patients. Anal fistulas were the most frequent findings (83.8%), and in most cases they were treated with a seton placement (69.4%). The main recommended surgical indication was a proper evaluation and identification of perianal disease, followed by drainage of the abscess and therefore immunobiological therapy (59.6%).

Conclusion In the present study, the profile of CD patients was similar to those found in the literature, with a high rate of complex anal fistulas. Additional studies are still necessary to further comprehend and treat this particular and debilitating manifestation of the disease.
Magnetic Resonance Imaging of Perianal Fistulas in Clinically Symptomatic Patients and the Correlation Among Plain, Contrast, and Post Jelly MRI Fistulography
Authors: Gupta Ruchi , Kumar Subhash , Kumar Anil , Tiwari Richa , Sinha Neetu
Published: July 2021

Objectives To evaluate different types of perianal fistulas and their complications on magnetic resonance imaging (MRI) and to compare plain, contrast, and jelly magnetic resonance fistulography findings.

Materials and Methods This prospective study was performed in 30 patients who presented with perianal pus discharge or external fistulous opening. Magnetic resonance imaging of the perianal region before and after giving intravenous contrast and after injecting jelly through a percutaneous opening was performed on a 3T scanner and the results were correlated.

Results The mean age of the patients was 40.13 ± 13.88 years (range 19–75 years). The male to female ratio was 14:1. The most common type of fistula was St. James classification type I, which was seen in 13 patients (43%), followed by type IV in 30%, type III in 16%, type II in 6.66%, and type V in 3.33% of the patients. Using agreement analysis, we compared the number of primary and secondary tracts, internal openings, and horseshoe tracts and found a significant agreement between plain and post Jelly MRI fistulography (kappa statistic close to 1). When comparing plain and contrast MRI, there was significant agreement in the primary and secondary tracts, while statistically insignificant results were obtained (p > 0.05) for the horseshoe tract and internal openings. Contrast injection was helpful in 7 subjects (23.3%) as peripheral enhancement of abscesses were better delineated.

Conclusion Magnetic resonance imaging is the one stop diagnostic modality for perianal fistulas. Acquisition of axial (Ax) T2, axial T2 FS, coronal T2 and coronal T2 FS sequences without administering intravenous contrast or jelly is usually sufficient for the diagnosis of fistulas and their complications.
Revising Our Concepts about Stoma Covering a Low Rectal Anastomosis
Authors: Lotfy Wael E. , Abdel Fattah Ahmed Raafat , Eltih Osama A. , Wasef Peter H. , Ashour Hassan R.
Published: July 2021

Introduction There has been conclusive evidence that defunctioning stoma with either transverse colostomy or ileostomy mitigates the serious consequences of anastomotic leakage. However, whether transverse colostomy or ileostomy is preferred for defunctioning a rectal anastomosis remains controversial. The present study was designed to identify the best defunctioning stoma for colorectal anastomosis.

Objective To improve the quality of life in patients with rectal resection and anastomosis and reduce the morbidity before and after closure of the stoma.

Patients and Methods The present study included 48 patients with elective colorectal resection who were randomly arranged into 2 equal groups, with 24 patients each. Group I consisted of patients who underwent ileostomy, and group II consisted of patients who underwent colostomy as a defunctioning stoma for a low rectal anastomosis. All surviving patients were readmitted to have their stoma closed and were followed-up for 6 months after closure of their stomas. All data regarding local and general complications of construction and closure of the stoma of the two groups were recorded and blotted against each other to clarify the most safe and tolerable procedure.

Results We found that all nutritional deficiencies, dehydration, electrolytes imbalance, peristomal dermatitis, and frequent change of appliances are statistically more common in the ileostomy group, while stomal retraction and wound infection after closure of the stoma were statistically more common in the colostomy group. There were no statistically significant differences regarding the total hospital stay and mortality between the two groups.

Conclusion and Recommendation Ileostomy has much higher morbidities than colostomy and it also has a potential risk of mortality; therefore, we recommend colostomy as the ideal method for defunctioning a distal colorectal anastomosis.
The “Flip-Flap” Technique for Laparoscopic Port-Site Closure—Description of a Novel, Cost-Effective Technique with Review of Literature
Authors: Wani Ajaz Ahmed , Khuroo Suhail , Jain Saurabh Kumar , Heer Vikas Kumar , Rajput Deepak , Maqsood Shadab
Published: July 2021

Overview Laparoscopic approach has changed the face of surgical care offered to patients. Almost all surgical procedures across specialties are now undertaken by the laparoscopic approach. Closure of port sites to prevent trocar-site hernias (TSHs) forms an integral part of the laparoscopic procedure. TSH is an area of preventable surgical morbidity. We hereby report our technique that is easily applicable, simple, safe, and highly cost-effective. It requires no additional instruments or retractors, is easy to learn, and has a very favorable safety profile.

Materials and Methods This prospective case series enrolled a total of 454 port-site closures in 255 patients undergoing different laparoscopic procedures over a period of 2 years. The intraperitoneal tissue forceps were used in the reverse direction to lift the fascia up and a right-angled retractor was used to retract back the skin and subcutaneous tissue. The port-site closure is done under vision and no adverse events were reported.

Results This technique was used in 454 port sites in 255 patients. No intraoperative incidents were noted. There is no requirement of any specialized instruments or retractors. No additional tissue trauma or dissection is required. There is no extension of operative time. The technique is simple to learn and easy to teach. No bowel injuries or TSHs were reported during a follow-up of 26 months.

Conclusion The described technique is easy, simple, cost-effective, and has a good safety profile.
A Novel Technique for the Treatment of a Case of Verneuil's Disease of Perineum and Axillary Regions
Authors: El-Helou Etienne , Kansoun Alaa , Abi Fadel Elissa , Nassif Ali , Mazraani Houssam Bashir , Neaime Georges Robert , Kassem Moussa Houssein Amin , Bassil Georges , Ibrahim Serge , Assaf Georges R. , Alam Houssam
Published: July 2021

Hidradenitis suppurativa (HS) is a chronic inflammatory disease involving apocrine glands of the skin. It carries out an important burden on the daily life of the patient. Unfortunately, it presents a major concern for medical care management in the absence of clear guidelines for proper medical and surgical treatment. Hence, we report a case of concomitant axillary and perianal HS. We opted for surgical management using a novel technique, which proved efficacy for a year of follow-up recurrence free.
Diagnostic Performance of Ankle-Brachial Pressure Index in Lower Extremity Arterial Disease
Authors: Alagha Mohammed , Aherne Thomas M. , Hassanin Ahmed , Zafar Adeel S. , Joyce Doireann P. , Mahmood Waqas , Tubassam Muhammad , Walsh Stewart R.
Published: July 2021

Introduction Ankle-brachial pressure indices (ABIs) continue to form the basis of diagnostics for lower extremity arterial disease (LEAD). However, there remains a paucity of data to support its accuracy. This study aims to evaluate its diagnostic sensitivity and specificity using established arterial-imaging modalities as a benchmark.

Methods In this retrospective study, a regional, prospectively maintained, vascular laboratory database was interrogated to identify referred patients with arterial disease who underwent concomitant assessment with ABI and lower limb arterial duplex ultrasound (DUS). Duplex acted as the reference standard. Those who had peripheral computed tomography angiogram (CTA) within 3 months of initial assessment were included in a subgroup analysis to correlate ABI with CTA. The primary end point was the sensitivity and specificity of ABI compared with DUS as the reference standard.

Results Concomitant assessment was performed in 438 limbs (250 patients) over a 27-month period. The ABI was normal (0.9 to 1.4) in 196 limbs (44.9%) and abnormal in the remaining 241 limbs (55.1%). False-positive results occurred in 83 out of 241 limbs (34.4%), and false-negative results occurred in 54 limbs out of 196 (27.5%). True-positive results were 158 out of 241 limbs (65.6%), whereas true-negative results were 142 out of 196 limbs (72.4%). ABI using DUS as a benchmark identified a sensitivity for peripheral artery disease of 72.3% and a specificity of 69.3%. Concomitant CTA imaging was available in 200 limbs. The sensitivity and specificity of ABI correlated with CTA were 65.5 and 68.8%, respectively.

Conclusion ABIs have a moderate predictive value in the diagnosis of LEAD. Normal range outcomes cannot be taken to infer the absence of LEAD and, as such, further arterial imaging in the form of DUS or angiography should be strongly considered in those with suspected underlying disease requiring intervention. Further noninvasive tests such as exercise studies or pulse volume waveforms should be considered, if diagnostic uncertainty exists, in those requiring nonoperative intervention and risk factor control.
Appendicitis Inflammatory Response Score in Comparison to Alvarado Score in Acute Appendicitis
Authors: Jose Toney , Rajesh PS
Published: July 2021

Appendicitis is a common differential diagnosis of right lower quadrant pain. Clinical evaluation alone results in high negative appendicectomy rates. Alvarado scoring is the most commonly used clinical prediction rule. The study aimed to compare the recently developed appendicitis inflammatory response (AIR) score with the Alvarado score. This cross-sectional observational study included patients who underwent appendicectomy for clinical suspicion of appendicitis. The clinical and laboratory parameters required for obtaining Alvarado score and AIRS were gathered. Area under ROC curve was calculated for both Alvarado score and AIRS. The study included 130 patients (77 males and 53 females). The negative appendicectomy rate was 10.7%. The perforation rate was 10.3%. The area under ROC for Alvarado score was 0.821 and for AIR score was 0.901. The Alvarado score had a sensitivity of 72% and a specificity of 79% at score ≥6. The appendicitis inflammatory response score had a sensitivity of 98% for scores ≥5 and a specificity of 97% for score ≥6. The C-reactive protein (CRP) value was the best performing individual parameter with an area under ROC of 0.789, followed by WBC count with an area under ROC of 0.762. Appendicitis inflammatory response score is a recently developed score that outperforms the Alvarado score. AIR score has a higher specificity. The sound construction, gradation of parameters, the inclusion of CRP, and avoidance of subjective parameters make the AIR score an attractive clinical prediction rule which can decrease the rate of negative appendicectomy.
Arthroscopic Treatment of Capitate Nonunion: A New Technique
Authors: de Villeneuve Bargemon Jean-Baptiste , Jaloux Charlotte , Levet Paul , Levadoux Michel
Published: July 2021

Isolated fractures of the capitate are very rare which means that their nonunion is even rarer. Repair techniques have always been performed by open surgery which may result in loss of mobility due to the capsulotomy. The typically used surgical techniques such as arthrodesis of the carpal or wrist bones can have irreversible consequences on range of motion. No arthroscopic technique has ever been described for this condition. Here, we describe a case of isolated capitate nonunion without ligament tears or other carpal fractures in a 21-year-old male, following a capitate fracture 10 years prior. We describe our arthroscopic treatment technique for this capitate nonunion.
Partial Flap Loss in Gender Affirming Phalloplasty
Authors: Cylinder Isabel , Heston Aaron , Carboy Jourdan , Jedrzejewski Breanna , Peters Blair , Berli Jens Urs
Published: July 2021

Background Flaps used in phalloplasty are larger than described for other indications, with a design that is tubularized up to two times. While the incidence of partial flap loss (PFL) is well described, current literature lacks granularity comparing donor sites and techniques with minimal discussion of etiology and management. The purpose of this study was to review our experience with PFL in phalloplasty.

Methods This was a retrospective cohort study of patients who underwent phalloplasty by a single surgeon at a single institution between 2016 and 2020. PFL was defined as any patient requiring sharp excision of necrotic tissue and reconstruction. Patient variables (demographics, body mass index, American Society of Anesthesiologists physical status classification, comorbidities), flap variables (donor site, design, dimensions, perforator number) and intraoperative variables (use of vasopressors, intraoperative fluid volume) were collected.

Results Of 76 phalloplasties, 6 patients suffered PFL (7.9%). 5/6 patients were radial forearm free flap tube-within-tube (TWT) and 1/5 patients were pedicled anterolateral thigh TWT. 4/6 cases involved the shaft only and were treated with excision ± Integra and full-thickness skin grafting. 2 cases of PFL involved the urethral extension requiring excision of the necrotic segment.

Conclusion PFL occurred in 7.9% of cases and was solely found in the TWT cohort. The majority of cases involved the shaft, sparing the urethral segment. Cases in the acute postoperative period appeared to be related to macrovascular venous congestion, while cases in the subacute period appeared to be due to microvascular arterial ischemia.
Investigating Decreased Rates of Nulliparous Cesarean Deliveries during the COVID-19 Pandemic
Authors: Sinnott Colleen M. , Freret Taylor S. , Clapp Mark A. , Reiff Emily , Little Sarah E.
Published: July 2021

Objective Preventing the first cesarean delivery (CD) is important as CD rates continue to rise. During the novel coronavirus disease 2019 (COVID-19) pandemic, quality improvement metrics at our hospital identified lower rates of CD. We sought to investigate this change and identify factors that may have contributed to the decrease.

Study Design We compared nulliparous singleton deliveries at a large academic hospital during the COVID-19 pandemic (April through July 2020 during a statewide “stay-at-home” order) to those in the same months 1 year prior to the pandemic (April through July 2019). The primary outcome, mode of delivery, was obtained from the electronic medical record system, along with indication for CD.

Results The cohort included 1,913 deliveries: 892 in 2019 and 1,021 in 2020. Patient characteristics (age, body mass index, race, ethnicity, and insurance type) did not differ between the groups. Median gestational age at delivery was the same in both groups. The CD rate decreased significantly during the COVID-19 pandemic compared with prior (28.9 vs. 33.6%; p = 0.03). There was a significant increase in the rate of labor induction (45.7 vs. 40.6%; p = 0.02), but no difference in the proportion of inductions that were elective (19.5 vs. 20.7%; p = 0.66). The rate of CD in labor was unchanged (15.9 vs. 16.3%; p = 0.82); however, more women attempted a trial of labor (87.0 vs. 82.6%; p = 0.01). Thus, the proportion of CD without a trial of labor decreased (25.1 vs. 33.0%; p = 0.04).

Conclusion There was a statistically significant decrease in CD during the COVID-19 pandemic at our hospital, driven by a decrease in CD without a trial of labor. The increased rate of attempted trial of labor suggests the presence of patient-level factors that warrant further investigation as potential targets for decreasing CD rates. Additionally, in a diverse and medically complex population, increased rates of labor induction were not associated with increased rates of CD.

Key Points
Digitalisierung: Die Pandemie ist nicht der Haupttreiber
Authors: Gocke Peter
Published: July 2021

Auch wenn dies derzeit oft kolportiert wird: Die Pandemie ist nicht der Haupttreiber der Digitalisierung. Das würde definitiv zu kurz greifen. Der demographische Wandel in Kombination mit dem sich abzeichnenden Fachkräfte-Mangel im Gesundheitswesen erfordert viel dringlicher die konsequente Digitalisierung als Werkzeug für effizientere Medizin. Die Echtzeit-Vernetzung der Leistungserbringer untereinander wird eine immer wichtigere Rolle einnehmen, insbesondere dadurch, dass hier endlich auch die Patientinnen und Patienten digital teilhaben können.
Projekt „AI Rescue“: Simulierte Rettungskette
Authors: Kohrs Jens
Published: July 2021

Kann Künstliche Intelligenz helfen, den Rettungsdienst zu optimieren? Diese Frage beschäftigt mehrere Forschungsteams in dem Projekt „AI Rescue“. In einem am Rechner originalgetreu nachgebildeten Musterlandkreis in Brandenburg spielen sie neue Ideen durch – ohne Denksperren.
The effectiveness of using edublogs as an instructional and motivating tool in the context of higher education
Authors: Campillo-Ferrer José María , Miralles-Martínez Pedro , Sánchez-Ibáñez Raquel
Published: July 2021

The aim of this research is to study the impact of blogs on improving self-reported motivation and learning in a higher education context. A quasi-experimental study was carried out in a social science core unit of the Primary Education degree at the University of Murcia, Spain. The study involved two groups of student teachers, with a total of 101 participants, who created their own blogs as a framework for exchanging their views and sharing their ideas on a variety of contemporary issues related to social science teaching. Data were collected through pre- and post-tests to measure whether the expected changes had occurred as a result of using this digital information platform. The results indicate that the use of blogs helped students to develop their digital literacy, to enhance their social and civic skills, and increase their self-perceived motivation. It is therefore worth updating the current communication processes with regard to online learning with a view to promoting digital access to information and fostering a meaningful learning network through these web resources.
Everyone does it—differently: A window into emerging adults’ smartphone use
Authors: Griffioen Nastasia , Scholten Hanneke , Lichtwarck-Aschoff Anna , van Rooij Marieke , Granic Isabela
Published: July 2021

Concerns regarding smartphones’ and social media’s impact on youth remain high amidst a growing realization that current research is not designed to confirm (or refute) such concerns. This study aims to answer fundamental questions regarding youths’ use of smartphones, by implementing a novel user-centric research method. The smartphone use of 114 emerging adults was recorded, followed by in-depth interviews that incorporated the recording and in-app information to help participants recall their behaviours, motivations, and feelings. Results indicate that smartphone use is indeed ubiquitous; 88 out of 114 participants started using their smartphone as soon as they were left alone. However, the findings of this study also demonstrate great diversity in smartphone use, in e.g. social media platforms used and motivations for using different apps. These results illustrate that it no longer seems sensible to refer to “screen time” as if it represents a homogeneous phenomenon across youth. Additionally, preliminary indications have been found of relationships between individual differences in mental health indices and variations in smartphone use. The current study provides new insights into youths’ smartphone use and its relationship with wellbeing.
Pressure amplification effect of using resorcinol/formaldehyde foam ablators in laser-shock experiments
Authors: Katagiri Kento , Ozaki Norimasa , Yamanoi Kohei , Sano Takayoshi , Kodama Ryosuke
Published: July 2021

Resorcinol/formaldehyde (RF) foam-aluminum-quartz-layered targets were shock compressed up to 0.9 TPa in quartz to quantitatively evaluate the pressure-amplification effect of using a low-density RF foam as an ablator. The velocimetry and pyrometry were used to obtain the shock pressure and temperature in the quartz. The results show the use of an RF foam ablator with a density of 100 mg/cm3 increases the peak pressure of quartz by 76 (±11)% compared to the case with a polypropylene ablator. Our results also confirm that preheating of the quartz ahead of the shock wave due to the x rays produced in the ablated foam is negligible, indicating that a low-density RF foam is an ideal ablator material for laser-shock experiments.
Multiobjective optimization and parameters study of hybrid offshore wind and pumped hydrostorage power system: Modeling and case study
Authors: Liu Xiaoyu , Li Nan , Mu Hailin , Li Miao , Liu Xinxin
Published: July 2021

Offshore wind energy has been widely exploited as a promising renewable energy source in China in recent years. This renewable source's high curtailment rate due to strict wind energy penetration limits, however, remains a challenge of concern. Also, the difference between peak and valley loads of electric power systems continues to increase with economic and societal development. To address these issues, this study proposes a hybrid system composed of a high-capacity offshore wind farm coupled with a pumped hydrostorage (PHS) power system to absorb rejected wind power. The hydraulic energy stored by PHS system is expected to provide guaranteed energy during peak load demands on the main power grid. This study presents a multiobjective technoeconomic assessment model based on the principle of dynamic economy for optimizing the size of the PHS system. The conclusions can be summarized as follows: (1) the seasonal characteristics affect the utilization of wind energy; (2) PHS operating strategies have an influence on the PHS configuration, energy utilization, and economic benefit; (3) reducing the wind curtailment is the key to improve the system performance and economic feasibility; (4) the drop in water level has a negative effect on economic benefit and (5) provides clear guidance to set external financial parameters for a hybrid power station. The results show that a size-optimizing study is important in determining the system's economic feasibility and predicted performance.