Current Standards Research Articles

A UNDERSTANDING OF HADITH BASED ON SOCIOLOGICAL APPROACH

Grasping hadith in any methodology, including the humanistic angle, will empower new translations that adjust to the circumstances and circumstances of the times. This becomes critical when strict issues can't be settled absolutely literarily.
 Taking care of issues in a specific period expects that there be an adjustment of understanding of hadith texts in light of existing real factors. So the unbending nature of importance won't happen, and on second thought the normal adaptability, without setting to the side the current standards.
 With the goal that the significance of mahram in examining this hadith requires an adjustment of the importance contained in that. The job of ladies at the hour of the Prophet was not equivalent to that of ladies in the current period. The contribution of ladies in friendly, social and financial perspectives expects ladies to have a major offer in propelling world progress. Not just around the kitchen region, beddings and wells. So the significance of mahram isn't simply private yet coordinated to the security framework that is felt by ladies in their wellbeing

Osteoporosis and Vertebral Column.

Osteoporosis is an age-related metabolic disease which has a significant impact on bone health and overall quality of life. It is gaining importance as a major medical consideration with the rapid increase in geriatric population globally. It increases the risk of vertebral fractures, progressive spinal deformities and neurological complications, contributing significantly to morbidity and mortality. Increase in life expectancy and advancement of medical technology has led to an increase in the proportion of geriatric patients undergoing orthopaedic procedures. It is becoming vital to adequately evaluate, investigate and treat osteoporosis before planning spinal surgery, especially spinal fusions and instrumentation. Historically, osteoporosis was considered a contraindication to spine surgery adding to the burden of Disability Adjusted Life Years (DALYs) and mortality. Conversely, osteoporotic patients who underwent spine surgery were not adequately optimized, leading to an increase in failure and complication rates. Better understanding of the pathophysiology of osteoporosis and the biomechanics of an osteoporotic spine with knowledge of current standards of treatment of osteoporosis facilitate the timely and adequate management of this disease. Advances in surgical and anaesthetic techniques facilitate successful surgeries on high-risk elderly and osteoporotic patients with multiple comorbidities allowing for a significantly high predictability for long-term positive outcomes.This article discusses the biomechanics of the osteoporotic spine, the diagnosis and management of osteoporotic patients with spinal disease, and the new treatments, recommendations, surgical indications, strategies and advances in instrumentation in patients with osteoporosis who require spinal surgery. In this article, the authors aim to provide a generalized overview for better understanding of the pathophysiological processes underlying osteoporosis in the vertebral column. This review provides a comprehensive set of guidelines for overall health and management of spine patients with pathologies, either caused by or compounded with osteoporosis. An overview of current techniques, strategies and technologies designed to address the challenges associated with spine surgery in osteoporotic patients is also outlined. Content for this article has been sourced from routinely cited articles available via PubMed, from National Institute of Health consensus development conference, from the recommendations by World Health Organization technical report series, from previous articles by the authors and from the protocols established by the authors in their clinical practice based on experience and detailed case reviews.

Options to Determine the Time for Conversion Osteosynthesis in Patients With Multiple Trauma

Objective: To reduce the complication rate in patients with multiple trauma (including bone fractures) by objectifying criteria that allow conversion from the external fixator to the definitive osteosynthesis.Materials and methods: The study was based on a retrospective analysis of the treatment outcomes in 308 patients (18­60 years, males and females) with multiple trauma and no apparent comorbidity.All patients were divided into 3 groups depending on the treatment outcomes. The therapeutic and diagnostic approaches in both groups were equal and compliant with the current standards and guidelines. Surgical treatment was performed according to the damage control principles in orthopedics.As the groups were statistically comparable, their data could be used for an accurate comparative statistical analysis.Results: The statistical analysis of the treatment outcomes in patients from all the groups demonstrated the possibility of using the SOFA scale to determine the conversion time. In patients who underwent conversion osteosynthesis, with comparable severity of injuries according to the NISS scale, a SOFA score >10 points right prior to the surgery was associated with the maximum number of complications including mortality. A SOFA score <6 points right prior to the surgery was associated with significantly lower number of complications and no mortality.Conclusions: Objective tools for assessing the severity of the condition, such as the SOFA scale, will allow to customize the approach to the time of conversion osteosynthesis in patients with multiple trauma and improve the treatment outcomes in general.

Supervisory Monitoring and Control Solution on Android Mobile Devices for the Water Industry 4.0

The capacity for using mobile devices for monitoring and controlling local processes has seen rapid growth in industry for maintenance operations before and after deployment. This is especially important in the case of geographically widely-dispersed locations, such as in the case of the water sector, where processes, technologies, and local automation solutions are widely spread. Usually, the available mobile solutions are dependent on Supervisory Control and Data Acquisition (SCADA) software installed in the control rooms of water and wastewater facilities, usually without configuration possibilities. Considering the various SCADA control rooms, each focusing on a specific system, and hundreds of smaller locations accessible only with PLC and eventually a small touch screen, the dependence on local SCADA software is proving increasingly impractical. This paper presents the implementation of an easy-to-use SCADA system for the Android operating system, conceived following Industry 4.0 concepts. An OPC UA client-based architecture is proposed to cope with current interoperability standards, mobility and security across industrial processes in various domains. The design relies on a foreground service for uninterrupted communication between the application and the OPC UA client. The system is envisaged to provide notifications to alert the user when alarms are triggered, including both an independent application level alarming module and a new Alarms and Conditions based protocol level module, increasing visibility and response time for technical issues or faults, and being adaptable to both legacy and modern OPC UA specifications. The solution was tested first in the laboratory to validate the communication system with as many OPC UA structures as possible, and then in real scenarios with drinking water and wastewater systems interfacing PLC, HMI and SCADA level OPC UA servers. The tests in the real scenarios included a second-level test for water operators and engineers which accessed and monitored various processes with the developed solution, and all results proved to be satisfactory.

Collection and Analysis of Adherence Information for Software as a Medical Device Clinical Trials: Systematic Review.

The rapid growth of digital health apps has necessitated new regulatory approaches to ensure compliance with safety and effectiveness standards. Nonadherence and heterogeneous user engagement with digital health apps can lead to trial estimates that overestimate or underestimate an app's effectiveness. However, there are no current standards for how researchers should measure adherence or address the risk of bias imposed by nonadherence through efficacy analyses. This systematic review aims to address 2 critical questions regarding clinical trials of software as a medical device (SaMD) apps: How well do researchers report adherence and engagement metrics for studies of effectiveness and efficacy? and What efficacy analyses do researchers use to account for nonadherence and how appropriate are their methods? We searched the Food and Drug Administration's registration database for registrations of repeated-use, patient-facing SaMD therapeutics. For each such registration, we searched ClinicalTrials.gov, company websites, and MEDLINE for the corresponding clinical trial and study articles through March 2022. Adherence and engagement data were summarized for each of the 24 identified articles, corresponding to 10 SaMD therapeutics. Each article was analyzed with a framework developed using the Cochrane risk-of-bias questions to estimate the potential effects of imperfect adherence on SaMD effectiveness. This review, funded by the Richard King Mellon Foundation, is registered on the Open Science Framework. We found that although most articles (23/24, 96%) reported collecting information about SaMD therapeutic engagement, of the 20 articles for apps with prescribed use, only 9 (45%) reported adherence information across all aspects of prescribed use: 15 (75%) reported metrics for the initiation of therapeutic use, 16 (80%) reported metrics reporting adherence between the initiation and discontinuation of the therapeutic (implementation), and 4 (20%) reported the discontinuation of the therapeutic (persistence). The articles varied in the reported metrics. For trials that reported adherence or engagement, there were 4 definitions of initiation, 8 definitions of implementation, and 4 definitions of persistence. All articles studying a therapeutic with a prescribed use reported effectiveness estimates that might have been affected by nonadherence; only a few (2/20, 10%) used methods appropriate to evaluate efficacy. This review identifies 5 areas for improving future SaMD trials and studies: use consistent metrics for reporting adherence, use reliable adherence metrics, preregister analyses for observational studies, use less biased efficacy analysis methods, and fully report statistical methods and assumptions.

Feasibility and safety of intraoperative bile duct clearance by antegrade transcystic balloon sphincteroplasty: A prospective observational pilot study.

Concomitant cholecystolithiasis and choledocholithiasis are common. Standard treatments are endoscopic retrograde cholangiography (ERC) followed by cholecystectomy or laparoendoscopic rendezvous. Endoscopic retrograde cholangiography has drawbacks, such as post-ERC pancreatitis or bleeding, and potentially more than one intervention is required to address common bile duct (CBD) stones. Safety and feasibility of an intraoperative antegrade transcystic single-stage approach during cholecystectomy with balloon sphincteroplasty and pushing of stones to the duodenum has not been evaluated prospectively. The aim of this pilot study was to evaluate this procedure regarding safety, feasibility, and stone clearance rate. Prospective single-center intervention study (SUPER Reporting-Guideline). Main inclusion criterion was confirmed choledocholithiasis (stones ≤6 mm) at intraoperative cholangiography. Success of the procedure was defined as CBD stone clearance at intraoperative control cholangiography, absence of symptoms and no elevated cholestasis parameters at 6 weeks follow-up. Simon's two-stage design was used to determine sample size. From January 2021 to April 2022, a total of 57 patients fulfilled the final inclusion criteria and were included. Mild pancreatitis or cholangitis were present upon admission in 15 (26%) and 15 (26%) patients, respectively. Median number of CBD-stones was 1 (1-6). Median stone diameter was 4 mm (0.1-6 mm). Common bile duct stone clearance was achieved in 54 patients (94%). The main reason for failed CBD clearance was the inability to push the guidewire along the biliary stone into the duodenum. Median intervention time was 28 minutes (14-129 minutes). While there was no postoperative pancreatitis, two patients (3.5%) had asymptomatic hyperlipasemia 4 hours postoperatively. Intraoperative CBD stone clearance by antegrade balloon sphincteroplasty appears to be safe and highly feasible. Its overall superiority to the current standards warrants evaluation by a randomized controlled trial. Therapeutic/Care Management, Level V.

Extrapolating wind pressures on roof soffits of low-rise buildings using few-shot learning

Current wind standards assume identical external wind pressure coefficients on roof soffits and adjacent wall surfaces. However, recent experiments suggest that this correlation significantly decreases with an increase in overhang width. This research introduces a few-shot learning model addressing the need for a machine learning approach that can efficiently obtain the wind pressure coefficients on roof soffits when the overhang width is large (i.e., larger than 2 ft). This research proposed a few-shot learning model to extrapolate the wind-induced pressures on roof soffits for low-rise buildings based on the wind tunnel dataset investigating the three large overhang widths (i.e., 2.4, 4.8, and 7.2 inches in 1:10 scale models). Prior knowledge relating to zonal information and wind directions shown in the standard of minimum design loads and associated criteria for buildings and other structures (i.e., ASCE 7) is incorporated into the model. The proposed few-shot learning model was trained on scale model buildings with overhang widths of 2.4 and 4.8 inches and tested on a 7.2-inch overhang width case. When predicting the minimum wind pressure coefficient for both the southside and eastside soffit surfaces, low mean-squared errors and high coefficient of determination values were observed. This study marks the first application of few-shot learning techniques to extrapolate wind pressures across different roof overhang widths and provide reliable predictions that outperform the weak correlation between the soffit and the adjacent wall surface assumed currently. This model reduces reliance on physical wind tunnel experiments and requires only a low-resolution measurement tap configuration.

Efficiency of limiting nitrogen oxides emissions by exhaust gas recirculation systems of marine internal combustion engines

The subject of this study is systems for ensuring environmental safety of marine internal combustion engines, in particular, technologies for limiting emissions of nitrogen oxides (NOx). The regulatory requirements for reducing emissions are presented in the paper. The main theoretical aspects of the problem of nitrogen oxides formation during combustion in a diesel engine are considered. On the basis of these theoretical aspects the effectiveness of using various methods to achieve the requirements for the permissible level of NOx concentration in the exhaust gases is assessed. Exhaust gas recirculation (EGR) systems and selective catalytic reduction (SCR) systems are considered as the main technologies; they allow achieving the highest indicators of nitrogen oxide emissions control in accordance with the requirements of the Tier 3 standard. Taking into account the peculiarities of the requirements for the design and layout of systems as part of a ship power plant, as well as operational and investment costs, the main attention in the work is paid to systems of indirect influence on the engine in-cylinder processes, which include exhaust gas recirculation systems. Based on the comparison of high and low pressure EGR, the advantages and disadvantages of the designs are determined. It is noted that high-pressure exhaust gas recirculation systems have a number of advantages, which primarily include the compactness and high speed of the system response to changes in operational conditions. On the example of the leading manufacturers developments, the potential capabilities of the high-pressure EGR system and the engine characteristics confirming the effectiveness of its use are demonstrated. Based on the results of the work, a conclusion about the high efficiency and expediency of using exhaust gas recirculation systems to meet the requirements of the current environmental safety standards of ship power plants is made.

Life cycle assessment of higher education institutions – method and case study

Against the backdrop of climate change and resource depletion, sustainability and sustainable development has been brought in the focus of industries and organisations. To quantify the environmental impacts of products and organisations the methodology of life cycle assessment (LCA) is applied area-wide in many different sectors. The higher education sector in particular has an important role to play in sustainable development due to the multiplier role by educating the academic employees of the future. Additionally, higher education institutions (HEIs) are a relevant sector by themselves due to their size and number of employees as well as their impact on innovation and future technologies. Therefore, HEIs should be at the forefront of assessing and reducing their environmental impact. In contrast to this an analysis of the available LCAs of HEIs shows significant limitations with regards to availability of assessments as well as guidelines on assessment methodologies. To contribute to closing this gap and increase the availability of LCA information for HEIs, a guideline is developed based on current LCA standards, which contains assistance regarding the goal and scope definition, life cycle inventory and life cycle impact assessment. The guideline is applied in a case study for Leibniz Universität Hannover (LUH), one of the nine leading technical universities in Germany. Results of the case study show that the major contributors for the impact of the LUH are the transport activities, infrastructure and energy supply. In 13 of the 16 assessed impact categories, transport activities account for the largest share of potential environmental impacts, ranging from about 43% to 82%. However, the results of the case study must be considered with care as primary data availability from the LUH has been limited and therefore must be extended in the future.

Prognostic value and determinants of high sensitive cardiac Troponin levels in patients with a systemic right ventricle: insights from the SERVE-Trial

Abstract Background The prognostic value of high-sensitivity cardiac Troponin T (hs-cTnT) in patients with a systemic left ventricle is well-established. However, the determinants and prognostic value of hs-cTnT among patients with a systemic right ventricle (sRV) are largely unknown. Purpose We aimed to assessed the determinants and prognostic value of hs-cTnT among patients with sRV. Methods Ninety-eight patients from the randomized-controlled SERVE-trial were included. The correlation between baseline hs-cTnT concentrations and bi-ventricular volumes and function quantified by cardiac magnetic resonance was assessed by adjusted linear regression models. The prognostic value of hs-cTnT and other established prognostic markers were assessed by adjusted cox proportional hazards models, survival analysis and c-statistics. The primary outcome was the composite of clinically relevant arrhythmia, hospitalization for heart failure or all-cause death. Results Median age [interquartile range, IQR] was 39 [32, 48] years and 32% were female. Median hs-cTnT concentration was 7 [IQR, 4-11] ng/L. Coefficients of determination for the relationship between hs-cTnT concentrations and right ventricular end-systolic volume index, (RVESVi) and ejection fraction (RVEF) were +0.368, p=0.046; and -0.381, p=0.018, respectively. The sex and aged adjusted hazard ratio [95%, confidence interval, CI] of hs-cTnT at 2- and 4-times the reference level (5 ng/l) for the primary outcome were 2.89 [1.14-7.29] and 4.42 [1.21-16.15], respectively (Figure 1). Patients with hs-cTnT concentrations ≤7 ng/L (median) had better event-free survival (89% vs. 67%, p=0.004). The prognostic performance quantified by the C-statistics [95%, CI] for age and sex adjusted models based on hs-cTnT, RVEF, and peak VO2 predicted (%) were comparable: 0.71 [0.61-0.82], 0.72 [0.59-0.84], and 0.71 [0.59-0.83], respectively (Figure 2). Conclusion Hs-cTnT concentration was significantly correlated with RVEF and RVESVi in patients with a sRV. The prognostic accuracy of this biomarker was comparable to that of the current gold standards (RVEF and peak VO2 predicted).Figure 1Figure 2

A semi-analytical model to predict residual stress distribution in thick wall girth weld with narrow gap welding

Benefited by its high efficiency and low cost, the narrow gap welding has been widely used in thick wall pressure equipment. Considering the fact that defects in welded joints inevitable, the safety assessments for welding equipment with residual stress are crucial. However, for the thick-wall equipment using narrow-gap welding, the current safety assessment standards specifying the residual stress distribution are not detailed or missing. In this paper, the through-wall residual stress of thick wall girth welds with narrow gap welding is studied. The stress components (bending stress, membrane stress and self-equilibrating stress) at the evaluation point are obtained by stress decomposition. The effects of the heat input, the wall thickness, the radius thickness ratio and the number of welding passes on residual stress are considered, respectively. The results show that the heat input only affects the distribution of bending stress and membrane stress. The axial and hoop bending stresses decrease with the increase of the wall thickness, and the hoop membrane stress is about 0.75 times material yield strength. With the increase of radius thickness ratio, the bending stress decreases while the hoop membrane stress increases. The stress distribution is fluctuating when the number of welding layers is small, which be expressed by trigonometric function. The distribution model of welding residual stress through the wall thickness is proposed. The stress distribution obtained by the proposed prediction model is in good agreement with the finite element calculation results.

Approximation algorithms for scheduling parallel machines with an energy constraint in green manufacturing

Motivated by current green manufacturing standards, in this paper we study a parallel-machine scheduling model in which the energy cost incurred on each machine is machine-dependent and proportional to the load of the machine. The objective is to determine a production schedule with the minimum makespan subject to the energy constraint that the total energy cost does not exceed a given bound. We provide a technical lemma that enables us to design a very efficient approximation algorithm with a worst-case bound that can arbitrarily approach 43, improving on the existing performance ratio of 33+14≈1.686 in the literature. By introducing the concept of a monotonic schedule, we are able to develop the first polynomial time approximation scheme for this scheduling problem. The scheduling problem studied in this paper is an important special case of the generalized assignment problem (GAP). Our techniques and results bring new insights into research on the GAP.

Challenge of achieving truly individualised informed consent in therapeutic endoscopy

ObjectiveGuidance covering informed consent in endoscopy has been refined in the UK following the obstetric case of Nadine Montgomery, and in light of updated General Medical Council guidance. All risks...

Increasing Hearing Readiness Using Boothless Audiometry

ABSTRACT Introduction U.S. Army regulations require all soldiers to undergo annual audiometric testing to maintain hearing readiness. The standard method of monitoring hearing in the DoD is via multi-person testing in sound-treated booths using the Defense Occupational and Environmental Health Readiness System—Hearing Conservation. COVID-19 significantly hindered the standard method, resulting in alarming declines in hearing readiness. In response, the Army Hearing Program initiated a pilot program to use boothless audiometers to supplement standard methods to increase hearing readiness. Materials and Methods Funding from the Coronavirus Aid, Relief, and Economic Security Act was used to purchase 169 boothless audiometers and increase staffing at dozens of Army Hearing Program clinics. Standard operating procedures were established for audiometric testing outside the booth using a process matching standard test parameters (i.e., test frequencies, tone characteristics, and interstimulus intervals). Additional capabilities developed to leverage this new technology during the annual hearing exam include the administration of automated contralateral masking, enhanced tinnitus screening, and hearing health education and training. Results Monitoring audiometry using boothless audiometers has been conducted for nearly 12,000 service members worldwide. Thresholds obtained via boothless audiometers are comparable to follow-up thresholds obtained from the standard test methods in the booth (mean difference 95% CI, −1.2, 0.9), and hearing readiness has returned to pre-pandemic levels at installations where this novel technology is being used regularly. Conclusions Significant reductions in patient encounters as a direct result of the COVID-19 pandemic have led to innovative solutions leveraging boothless audiometers. While this has aided the primary mission to maintain a medically ready force, innovations from this endeavor highlight several additional improvements relative to current standards of care that should be considered for permanent inclusion in DoD Hearing Conservation Programs.

Front-of-Pack Nutrition Labelling: are Health Policy Decisions Reconcilable with the WTO Disciplines?

Over the past decade, States have increasingly used various forms of front-of-pack nutrition labelling to prevent the proliferation of obesity and related non-communicable chronic diseases. Some forms of front-of-pack nutrition labelling highlight increased amounts of certain nutrients in foods and are mandatory for compliance. The growing popularity of such measures raises serious concerns amongst the Members of the World Trade Organization, since, to date, no position has been formed on the conformity of such labelling with the core disciplines of the WTO. This article attempts to reach that understanding and to suggest how national legislators may adjust their labelling initiatives so as to bring them in line with the WTO Agreement on Technical Barriers to Trade (TBT Agreement). Section 1 the paper analyses Art. 2.1 of the TBT Agreement (principle of non-discrimination) and concludes that the legislator should take into account all dietary options in order to avoid discriminati on against certain types of foods. Unpackaged goods should also be covered by regulatory interventions, since by nutritional composition they are similar to pre-packaged foods. Section 2 looks at Art. 2.2 of the TBT Agreement (principle of necessity) and summarises that the adopting Member has to be cautious when setting the goals of the labelling measure, since demonstration of its necessity would further require to separately establish what contribution to any of the stated objectives the measure makes. Moreover, the WTO Member must determine how labelling schemes discourage consumption of various nutrients. Otherwise, there may be a problem in demonstrating the expected regulatory results. The anticipated contribution of front-of-pack labelling could be enhanced by creating a supporting environment of regulatory interventions. Section 3 focuses on Arts. 2.4 and 2.5 of the TBT Agreement (harmonisation principle) and concludes that current international standards recognize the relevance and authority of regional studies, including those examining dietary patterns of locals. Nonetheless, this does not exempt the WTO Members from the need to provide a scientific justification for how the measure relates to the consumption of particular foods and nutrients.

From cocoons to butterflies: Cross-cultural resilience of the first graduates of an international undergraduate pedagogy program at the University of Pécs

The University of Pécs, UP has a long tradition of training international students, and educational sciences related programs have a crucial role within this repertoire. Amongst these programs an undergraduate one, i.e. Pedagogy BA – Intercultural Educational Assistant Specialization was developed, authorized and issued in the middle of the Covid 2019 Pandemic.
 Due to the international nature of the program both its content and command must meet criteria of current standards, therefore it aims at fulfilling the ethos of the 2030 OECD Learning Compass. The first graduates received their degrees in July 2023, and are heading towards their future careers as educators – but are they armed with competences suggested by the OECD 2030 Learning Compass?
 Besides outlining the peculiarities of the program, and the ways its designers coped with the struggles of the circumstances of the pandemic years via the author’s (i.e. program manager’s) participative-observational narrative description, a brief interpretation of students’ cross cultural resilience is being introduced based on a survey carried out amongst the first graduates. Their feedback is overall positive regarding the development of their own self-perceived cross cultural resilience. Also, it may be concluded that the newly introduced major could cope with the challenges that occurred during the years of the Pandemic.
 The practical significance of this report is obvious, as it reflects on relevant lessons that may be learnt by the management of the program and initiators of future programs alike. It also calls attention to the significance of the learner’s role shift that may be attached to the OECD 2030 Learning Compass framework.

A randomized controlled trial: Comparison of 14 and 24 French thoracic drainage after minimally invasive lobectomy – MZ 14-24 study

BackgroundThe optimal placement of a chest drain after video-assisted minimally invasive lobectomy should facilitate the aspiration of air and drainage of fluid. Typically, a conventional 24Ch polyvinyl chloride chest drain is used for this purpose. However, there is currently no scientific literature available on the impact of drain diameter on postoperative outcomes following anatomical lung resection. MethodsThis is a prospective, randomized, phase-1 trial that will include 40 patients, which will be randomly assigned into two groups. Group 1 will receive a 24 French chest drain according to current standards, while group 2 will receive a 14 French drain. Primary endpoint of the trial is the incidence of postoperative drainage-related complications, such as obstruction, dislocation, pleural effusion, and reintervention. Secondary endpoints are postoperative pain, chest drainage duration, incidence of complications, and hospital length of stay. The study aims to determine the number of subjects needed to achieve a sufficient test power of 0.8 for a non-inferiority study. DiscussionThoracic surgery is becoming more and more minimally invasive. One of the remaining unresolved problems is postoperative pain, with the intercostal drain being one of the main contributing factors. Previous data from other studies suggest that the use of small-bore drains can reduce pain and speed up recovery without an increase in drain-related complications. However, no studies have been conducted on patients undergoing anatomic lung resections to date. The initial step in transitioning from larger to smaller drains is to establish the safety of this approach, which is the primary objective of this trial.Trial registration: The study has been registered in the German Clinical Trials Register.Registration number: DRKS00029982.URL: https://drks.de/search/de/trial/DRKS00029982.

Gender peculiarities of hepatopathy manifestation in adolescents with type 1 diabetes

The incidence of diabetes mellitus is steadily increasing worldwide, including in the pediatric population. Type 1 diabetes is a disease that is often accompanied by liver damage in the form of glycogenosis, steatosis, and fibrosis. However, there is paucity of research devoted to this problem.
 Objective — to determine the gender characteristics of the clinical course of hepatopathy in adolescents with type 1 diabetes.
 Materials and methods. The study included 86 boys and 87 girls aged 8 to 18 years (school-age children in the period of hormonal puberty adjustment), suffering from type 1 diabetes. Clinical and anamnestic, laboratory and instrumental examinations were carried out in accordance with the current standards. Blood biochemistry examinations included determining the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, total bilirubin and its fractions, total cholesterol, triglycerides, high density lipoprotein, β­lipoproteins. According to the results of ultrasound examinations, adolescents with type 1 diabetes were divided into groups based on the liver size.
 Results and discussion. The groups did not differ significantly by the nature of dyspeptic complaints. During ultrasound examinations, an increase in the liver size was determined more often in boys; the frequency of steatosis signs did not depend on gender. Absence of positive dynamics of these signs was established in 50 % of patients, regardless of the state of glycemic control. Regardless of gender, functional disorders of the biliary tract were found in almost all of them. The indicators of the lipid panel in girls were slightly higher than in boys, and the difference in β­lipoproteins level was significant. In most adolescents, levels of high density lipoprotein were within the normal ranges, but the frequency of its decrease in boys with enlarged liver was higher compared to girls. ALT activity significantly increased only in girls with enlarged liver, and in boys it only tended to increase; the frequency of increased ALT activity in girls with enlarged liver was 1.5 times higher compared to boys. The AST/ALT ratio in every fifth patient, regardless of gender and liver size, was ≥ 1.3 (a marker of fibrosis formation).
 Conclusions. The performed investigation revealed the gender peculiarities of clinical, ultrasound and biochemical manifestations of hepatopathy in adolescents with type 1 diabetes, which can be the basis for the administration of patient oriented therapeutic, preventive and rehabilitation measures.

Encoding the Enforcement of Safety Standards into Smart Robots to Harness Their Computing Sophistication and Collaborative Potential: A Legal Risk Assessment for European Union Policymakers

Abstract Until robots and humans mostly worked in fast-paced and yet separate environments, occupational health and safety (OHS) rules could address workers’ safety largely independently from robotic conduct. This is no longer the case: collaborative robots (cobots) working alongside humans warrant the design of policies ensuring the safety of both humans and robots at once, within shared spaces and upon delivery of cooperative workflows. Within the European Union (EU), the applicable regulatory framework stands at the intersection between international industry standards and legislation at the EU as well as Member State level. Not only do current standards and laws fail to satisfactorily attend to the physical and mental health challenges prompted by human–robot interaction (HRI), but they exhibit important gaps in relation to smart cobots (“SmaCobs”) more specifically. In fact, SmaCobs combine the black-box unforeseeability afforded by machine learning with more general HRI-associated risks, towards increasingly complex, mobile and interconnected operational interfaces and production chains. Against this backdrop, based on productivity and health motivations, we urge the encoding of the enforcement of OHS policies directly into SmaCobs. First, SmaCobs could harness the sophistication of quantum computing to adapt a tangled normative architecture in a responsive manner to the contingent needs of each situation. Second, entrusting them with OHS enforcement vis-à-vis both themselves and humans may paradoxically prove safer as well as more cost-effective than for humans to do so. This scenario raises profound legal, ethical and somewhat philosophical concerns around SmaCobs’ legal personality, the apportionment of liability and algorithmic explainability. The first systematic proposal to tackle such questions is henceforth formulated. For the EU, we propose that this is achieved through a new binding OHS Regulation aimed at the SmaCobs age.

Seismic behaviour of post-earthquake composite frame structures with different damage levels

Since earthquakes pose a huge threat to buildings, the post-earthquake safety assessment is quite important, especially in earthquake-prone areas. This paper investigates the seismic performance of post-earthquake composite frame structures with different damage levels. Two-stage nonlinear time history analysis is carried out for a ten-story steel–concrete composite frame and the peak ground acceleration (PGA) of the seismic waves is used as the main parameter characterizing the seismic intensity and damage level. In the first stage, the seismic waves with the PGAs of 0.20 g, 0.30 g and 0.40 g are applied to the frame to result in three different damage levels. The peak inter-story drift ratios, residual inter-story drift ratios and plastic hinge ratios of the structure in the first-stage earthquakes are analysed, which presents a uniform distribution pattern for the three damage levels. The composite frame is evaluated as structurally safe at all three damage levels based on the limits of residual inter-story drift ratios given in current standards. In the second stage, the seismic waves with the PGA of 0.40 g are used to explore the residual capacity of the structure subjected to strong earthquakes. The dynamic responses of the intact structure and the structure with different damage levels are compared. The results indicate that despite the recognised structural safety, pre-existing seismic damage can enlarge the lateral deformation, reduce the internal forces and resistance capacity and increase the plastic hinges when the composite frame is exposed to the second-stage earthquakes. Generally, the damage caused by earthquakes with the PGA of 0.40 g will have an obvious influence on the seismic behaviour of the post-earthquake structure, in which situation further safety assessment and structural repairs are necessary.