Fourth Level Research Articles

Coal Mine Fire Emergency Rescue Capability Assessment and Emergency Disposal Research

Nowadays, underground coal mine accidents occur frequently, causing huge casualties and economic losses, most of which are gas explosion accidents caused by fires. In order to improve the emergency rescue capability of coal mine fires and reduce the losses caused by coal mine fires, this article is dedicated to the assessment of coal mine fire rescue capability. Taking the fire emergency rescue system of Lugou mine as an example, based on the introduction of gray system theory and gray evaluation method, an evaluation model was established to assess the risk of the fire emergency rescue index system of Lugou mine. Four primary and 19 secondary indicators were delineated, and a hierarchical structure model of the fire emergency rescue capability of the Lugou mine was established by combining expert opinions, and the weights of indicators at all levels were calculated by using hierarchical analysis. We then used the gray system evaluation method and expert scoring to judge the safety level of various indicator factors in the index system. The evaluation results show that the risk level of the emergency rescue system of the Lugou mine fire is higher than the fourth level. The main risk indicator factors are firefighting equipment, decision-making command, emergency education and training, and fire accident alarm. In response to this evaluation result, corresponding control measures were formulated in four aspects: rescue organization guarantee, personnel guarantee, material guarantee, and information guarantee, which optimally improved the emergency rescue capability of the Lugou mine fire and reduced the loss caused by fire.

Estimation of geomechanical rock characteristics from specific energy data using combination of wavelet transform with ANFIS-PSO algorithm

The geomechanical characteristics of a drill formation are uncontrollable factors that are crucial to determining the optimal controllable parameters for a drilling operation. In the present study, data collected in wells drilled in the Marun oilfield of southwestern Iran were used to develop adaptive network-based fuzzy inference system (ANFIS) models of geomechanical parameters. The drilling specific energy (DSE) of the formation was calculated using drilling parameters such as weight-on-bit (WOB), rate of penetration (ROP), rotational speed of drilling string (RPM), torque, bit section area, bit hydraulic factor, and bit hydraulic power. A stationary wavelet transform was subsequently used to decompose the DSE signal to the fourth level. The approximation values and details of each level served as inputs for ANFIS models using particle swarm optimization (PSO) algorithm and genetic algorithm (GA). As model outputs, the Young’s Modulus, uniaxial compressive strength (UCS), cohesion coefficient, Poisson’s ratio, and internal friction angle were compared to the geomechanical parameters obtained from petrophysical logs using laboratory-developed empirical relationships. Both models predicted the Young’s modulus, UCS, and cohesion coefficient with high accuracy, but lacked accuracy in predicting the internal friction angle and Poisson’s ratio. The root mean square error (RMSE) and determination coefficient (R2) were lower for the ANFIS-PSO model than for the ANFIS-GA model, indicating that the ANFIS-PSO model presents higher accuracy and better generalization capability than the ANFIS-GA model. As drilling parameters are readily available, the proposed method can provide valuable information for strategizing a drilling operation in the absence of petrophysical logs.

A principal component model to identify Turkish soundscapes’ affective attributes based on a Corpus-Driven Approach

This study focused on achieving linguistic and culturally appropriate equivalents of Turkish soundscape attributes present in ISO 12913–3 by incorporating a Corpus-Driven Approach (CDA). A two-phase experiment was set up to find Turkish equivalents of affective quality attributes. The first phase consisted of the formation of a Corpus. An online questionnaire was prepared and sent to 196 native Turkish speakers from all around Türkiye to define adjectives. The second phase of the experiment was performed in a listening room. For this purpose, twenty-four binaural sound recordings were collected from seven public spaces. Afterward, forty individuals evaluated the recordings by using the attributes from Phase 1. The perceptual dimensions were obtained from the generated corpus in Turkish based on a rating scale by applying the Principal Component Analysis (PCA). Results indicated a two-dimensional model with two main components, Pleasantness and Eventfulness. Each component is associated with a main orthogonal axis denoted by ‘annoying-comfortable’ and ‘dynamic-uneventful,’ respectively. This circular organization of soundscape attributes is supported by two derived axes, namely ‘chaotic-calm’ and ‘monotonous-enjoyable’, rotated 45°on the same plane. Additionally, by using Spearman’s rank correlation coefficient, sixty-four different bipolar adjective pairs were found. The adjective pairs showed that the highest correlations are mainly on the pleasant-unpleasant continuum, namely Component 1 of PCA. The collected data were also analyzed using Agglomerative Hierarchical Cluster analysis with the Ward method in R programming language to cluster the adjectives. The results inferred that there are four top-level categories. From the first to the fourth level, categories consisted of pleasant, uneventful, eventful, and annoying adjectives, respectively. Moreover, the terms grouped on the first cluster found their dichotomous on the fourth cluster, while maintaining the same relationship in the pleasant-unpleasant continuum.

<p>Factors Affecting University Graduates’ Employability in Egypt Using Egyptian University Students as a Case Study</p>

Employability refers to the process of gaining initial employment, maintaining employment, and successfully obtaining new employment if required. In simple terms, employability is about being capable of obtaining and keeping fulfilling work. Employability is having a set of skills, including knowledge, understanding, and personal attributes that make a person more likely to choose and secure occupations in which they can be satisfied and successful. Employability depends on knowledge (what you know), skills (what you do with what you know), and attitudes (how you approach things). In higher education, the employment of university graduates is influenced by many factors including institutional ranking, image, branding, and program structure. Therefore, university reputation in specific programs is important and affects the employability of graduates directly.
 In a recent paper by the corresponding author, we argued that university branding is critical for developing a favorable image and impacts one’s identity formation and promotion substantially, thus differentiating and placing one in a highly competitive context. In this paper, we will investigate the factors that influence employability among university graduates and determine which ones can affect the overall graduate employability of university graduates in Egypt. These factors include academic branding, academic performance, technical skills, communication skills, personality, leadership and motivational skills, and teamwork and problem-solving skills, taken as independent variables, while overall graduate employability was considered the dependent variable. In addition, we consider the impact of the university’s reputation on graduate employability.
 Survey methods were used on 500 graduates and undergraduates (fourth level) from different Egyptian universities who have not yet performed employability behavior, chosen at random, by using exploratory factor analysis to validate the items under those independent variables and structural equation modeling with AMOS to test the hypothesized relationship between the independent variables and the dependent variable. The questionnaire had 20 questions, including demographic inquiries and questions about the abovementioned topics. The findings of this study can help scholars further investigate the employability aspects and guide fresh graduates in acquiring the required employability skills while assisting companies in recruiting suitable people with the required skills and performance.

Preoperative standing to prone spinal-pelvic sagittal parameter changes in old traumatic spinal fractures with kyphosis

To investigate the changes in spinal-pelvic sagittal parameters from preoperative standing to prone position in old traumatic spinal fractures with kyphosis. The clinical data of 36 patients admitted between December 2016 and June 2021 for surgical treatment of old traumatic spinal fractures with kyphosis, including 7 males and 29 females, aged from 50 to 79 years (mean, 63.9 years), were retrospectively analyzed. Lesion segments included 2 cases of T 11, 12 cases of T 12, 2 cases of T 11, 12, 4 cases of T 12 and L 1, 12 cases of L 1, 2 cases of L 2, 1 case of L 2, 3, and 1 case of L 3. The disease duration ranged from 4 to 120 months, with an average of 19.6 months. Surgical procedures included Smith-Petersen osteotomy in 4 cases, Ponte osteotomy in 6 cases, pedicle subtraction osteotomy in 2 cases, and improved fourth level osteotomy in 18 cases; the remaining 6 cases were not osteotomized. The bone mineral density ranged from -3.0 to 0.5 T, with a mean of -1.62 T. The spinal-pelvic sagittal parameters from preoperative standing to prone positions were measured, including local kyphosis Cobb angle (LKCA), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and PI and LL mismatch (PI-LL). The kyphotic flexibility=(preoperative standing LKCA-preoperative prone LKCA)/preoperative standing LKCA×100%. Spinal-pelvic sagittal parameters were compared between standing position and prone position before operation, and Pearson correlation was used to judge the correlation between the parameters of standing position and prone position before operation. When the position changed from standing to prone, LKCA and TK decreased significantly ( P<0.05), while SS, LL, PT, and PI-LL had no significant difference ( P>0.05). Pearson correlation analysis showed that LL was significantly correlated with SS and PI-LL in both standing and prone positions ( P<0.05), and the correlation strength between LL and SS in prone position was higher than that in standing position. In the standing position, LKCA was significantly correlated with SS and PT ( P<0.05). However, when the position changed from standing to prone, the correlation between LKCA and SS and PT disappeared, while PT and PI-LL was positive correlation ( P<0.05). The kyphotic flexibility was 25.13%-78.79%, with an average of 33.85%. For the patients of old traumatic spinal fractures with kyphosis, the preoperative LKCA and TK decrease significantly from standing position to prone position, and the correlation between spinal and pelvic parameters also changed, which should be taken into account in the formulation of preoperative surgical plan.

Robot-assisted giant paraesophageal hernias repair in a fourth level hospital in Bogotá, Colombia, Shaio Clinic: Case series and literature review

Robot-assisted giant paraesophageal hernias repair in a fourth level hospital in Bogotá, Colombia, Shaio Clinic: Case series and literature review

FISCAL DECENTRALIZATION AS A FOURTH-LEVEL BUDGET MANAGEMENT MECHANISM IN KAZAKHSTAN

The purpose of the study is to identify the role and significance, the main problems of fiscal decentralization as a mechanism for managing the budget of the fourth level. Identification of possible mechanisms for increasing the tax base of an independent budget with the help of fiscal decentralization.Research methodology. For general research, theoretical methods of research, analysis and synthesis, a systematic approach were used. Economic analysis (horizontal and vertical analysis) using qualitative and quantitative research methods was used to analyze independent budget revenues in Kazakhstan.Originality / value of the study. The analysis of fiscal decentralization as a mechanism for managing the fourth-level budget, the analysis of fourth-level budget revenues in Kazakhstan for 2019-2021, the priorities, competencies and responsibilities assigned to state and local government bodies are considered. The main directions of decentralization reform and recommendations for improving the efficiency of fourth-level budget management are identified.Findings: concrete conclusions are proposed based on the results of the implementation of this multifaceted trend. The main conditions for the effective functioning of any level of government are: accountability, transparency and control; possession of clearly defined powers and functions; availability of a personal budget with permanent sources of income; ownership of property.

Four-level regulation of lifespan through the biopsychological clock

A model of life expectancy regulation through biopsychological clocks of four levels is considered. The first level is represented by the intracellular molecular genetic clock, which is responsible for maximum life expectancy. At the second level, the regulation of activity time occurs (time management), this level is associated with the psychological clock, there is also a connection with the activity of annual and monthly biorhythms. This level is associated with the organization of life path, regulation of lifestyle, and professional longevity of a person. At the third level, wakefulness and sleep are regulated through circadian biorhythms with a period of 20-28 hours. Here the regulation of health and restoration of immunity occurs. The fourth level is associated with the regulation of the rhythms of the respiratory and cardiac systems, the phenomenon of premature death is associated with it, and it is responsible for the cessation of life. We consider regulation from top to bottom, with each level responsible for its own aspect of life expectancy. There is interaction between the levels, but its mechanisms have been little studied. In addition, there are also mechanisms that ensure the autonomous functioning of metabolism at each level. Conclusion: to restore health, prevent sudden death, and potentially increase life expectancy, it is necessary to develop comprehensive strategies that combine all levels of the biopsychological clock.

Management by processes from the coordination of the Career of Information systems

The investigative work has as its main objective to automate and systematize, through a computer application, the process of enrollment and record of grades of Basic Education schools, for this purpose the research is based theoretically on the educational and computer precepts related to the subject such as the generally accepted Evaluation, Qualification and Promotion of Students. A fourth level programming language as a global trend in developing systems for the public and private sectors. The methodology used in the design of the system was based on the client-server network structure and the MySQL application for data storage management, through the use of forms and OOP object-oriented programming, the realization of the system constitutes a fact of great importance and importance both for the users of the software developed based on the facilities generated by its use as well as for the author of the same based on the great experience that deeply enriched his professional training. The system resulted in the development of a computer product for real use in the educational sector and with a great impact on customer satisfaction and the performance of the employer, for this reason the application of the system at the local, regional and national level is recommended, in addition to the establishment for which it was originally designed.

Medical Students’ Perception and Satisfaction Towards Team-Based Learning

Background: Team-based learning (TBL) is an active learning strategy that provides learners with opportunities to apply conceptual information through a series of activities that include individual work, group work and instant feedback. It is defined as an evidence-based cooperative learning educational strategy designed around modules that are taught in three stages; learners preparation; individual and group readiness assessment test; and finally, team application. Aim: The study aimed to assess the perception and satisfaction of medical students towards TBL at Alfajr Collage for Science and Technology. Methodology: The study was a cross-sectional study, conducted at Alfajr College for Science and Technology in the year 2022. The targeted group was students from the fourth and fifth levels; the data was collected through a self-administered online interview using a pretested structured questionnaire. The data were entered, cleaned, and analyzed using SPSS version 25. The chi-square test was used for categorical variables. Results: Of 131 interviewed medical students, females were the majority constituting 61%. More than half (53%) of the students found that their performance on the examination is affected positively by their participation in TBL; and the fifth- year students stated that they benefited much from TBL specifically in the surgery course. Nearly 90% of students were satisfied with the TBL approach and they felt that they would recommend the TBL program to other universities in Sudan. There was a significant correlation between the female gender and the perception of the usefulness of TBL (p value = 0.009). Conclusion: Medical students at Alfajr College had positive perception towards TBL and the majority of students were satisfied with the TBL approach. The number of TBL activities during the course was crucial to reinforce the students' benefit from this type of activity. This was reflected in the students' opinion of the benefits of TBL in the surgery course, which happened to have the largest number of activities compared to other courses.

The characteristics of the urogenital fascia in the retrorectal space based on male cadaveric dissection and its clinical application

BackgroundThe architecture of retrorectal fasciae is complex, as determined by different anatomical concepts. The aim of this study was to examine the anatomical characteristics of the inferomedial extension of the urogenital fascia (UGF) involving the pelvis to explore its relationship with the adjacent fasciae. Furthermore, we have expounded on the clinical application of UGF.MethodFor our study, we examined 20 adult male pelvic specimens fixed in formalin, including 2 entire pelvic specimens and 18 semipelvic specimens. Our department has performed 466 laparoscopic rectal cancer procedures since January 2020. We reviewed the surgical videos involving UGF preservation and analyzed the anatomy of the UGF.ResultsThe bilateral hypogastric nerves ran between the visceral and parietal layers of the UGF. The visceral fascia migrated ventrally at the fourth sacral vertebra, which formed the rectosacral fascia together with the fascia propria of the rectum; the parietal layer continually extended to the pelvic diaphragm, terminating at the levator ani muscle. At the third to fourth sacral vertebra level, the two layers constituted the lateral ligaments.ConclusionThe double layers of the UGF are vital structures for comprehending the posterior fascia relationship of the rectum. The upper segment between the fascia propria of the rectum and the visceral layer has no evident nerves or blood vessels and is regarded as the " holy plane” for the operation.

Comparison of cardiogenic NEC and classical NEC in the fourth level neonatal intensive care center

BackgroundThe most common inflammatory gastrointestinal disorder in newborn infants is necrotizing enterocolitis (NEC). Despite the multifactorial etiology of NEC, its pathogenesis is the same regardless of the etiology—a decrease in enteric perfusion that results in enteritis, dysmotility, necrosis, and sepsis. This study aims to evaluate whether the characteristics of NEC in infants with congenital heart disease (CHD) are different from those of classical NEC.The records of 39 NEC patients were reviewed retrospectively. Based on the presence or absence of CHD, the patients were divided into two groups. The group with NEC and CHD was named cardiogenic NEC and the other group was named classical NEC. The two groups were compared in terms of mode of delivery, gestational age, birth weight, age at onset of NEC, surgical treatment rate, NEC localization, and mortality rate.ResultsThe cardiogenic NEC group consisted of 25 patients, and the classical NEC group consisted of 14 patients. The results indicate that there were no differences between the two groups in terms of sex, mode of delivery, and location of the NEC. There were higher levels of gestational age, birth weight, and age at which NEC was diagnosed in the cardiogenic group. The mortality rate of the cardiogenic NEC group (72%) was higher than that of the classical NEC group (28.6%). In addition, the surgical treatment rate of the cardiogenic NEC group (84%) was higher than that of the classical NEC group (57.2%).ConclusionsThe clinical course of NECs with CHD is different from that of classical NEC. In NEC, CHD can be identified as an important risk factor.

Enhancing Reading Comprehension by Using the Strategies of Scanning and Skimming for Institute of Technology Indonesia CIE's Fourth Level Students

&lt;p&gt;The purpose of this research is to determine the students' of CIE fourth level achievement in reading skill by scanning and skimming strategies, as well as the effectiveness of scanning and skimming strategies at Institute of Technology Indonesia. The pre-experimental research technique was employed by using a one-group pretest-posttest design. The population of this research was a fourth level CIE class of 60 students, and the sample was a class of IV-A pupils of 20 students. The instrument was a 25-question of multiple-choice survey. The findings prior to utilizing the scanning and skimming method, pretest; the maximum score was 80, the lowest score was 56, the mean score was 70.6, the median score was 72; and the mode score was 72, the standard deviation was 8.13, and the variance was 66.15. The posttest findings of the scanning and skimming approach were as follows: the highest score was 100, the lowest score was 72, the mean score was 92, the median score was 96, the mode score was 96, the variance was 80.84, and the standard deviation was 8,99. Based on the findings of the research, the tcount was 4.352 with a significant threshold of 0.05 and the ttable was 2,086, and the scores were compared. As a result, tcount exceeds ttable (4.352 &amp;gt; 2,086). It signifies that the research hypothesis (H1) has been accepted. In conclusion, utilizing scanning and skimming strategies has a considerable influence on reading comprehension at the fourth level students of Institute of Technology Indonesia.&lt;/p&gt;

Effect of Pruning Treatments and the Addition of Humic Acid on Growth and Yield of Zaytoni Cultivar Grape Trees

This study was conducted in one of the private orchards located in the Altun Kobri sub-district of Dibs district, about (20) km away from Kirkuk governorate, during the growing season (2020-2021). This is to study the effect of six levels of summer pruning, the first level (T1) without pruning, the second level (T2) removing the tops of the main branches after the decade, and the third level (T3) removing the tops of the main branches after the decade and the fourth level (T4) removing leaves and leaving (8) Leaves for each fruit cluster, the fifth level (T5) remove the leaves and leave (10) leaves for each fruit cluster, the sixth level (T6) remove the leaves and leave (12) leaves for each fruit cluster. And the addition of three levels of humic acid (zero, 20, 40) g. vine-1 and its symbol (H1, H2, H3) sequentially, in the growth and yield characteristics of grape vines of the olive variety, and it was added a week after the contract (25/5/2021). The experiment was carried out according to a randomized complete block design with three sectors.

Trophic structure using ecological relationships between five dominant commercial fish in Kolahi to Dargahan

AbstractThe purpose of this study was to determine the effects of frequent species population fluctuations and the impact of different rates of exploitation on other ecological links in the food web. The mass‐balanced Ecopath model represents the trophic interactions among the 31 defined functional groups in the Kolahi to Dargahan area, with five main species, including Trichiurus lepturus, Saurida tumbil, Nemipterus japonicus, Sillago sihama, and Cynoglossus arel (from April 2018 to April 2019). To investigate the effects of fishing and environmental disturbances, the Ecopath modeling approach combines software for analyzing ecosystem trophic‐level balances with population dynamic models. In the past 5 years, Hormozgan province has caught more than 45% of the benthic fish caught off the northern coasts of the Persian Gulf. From Kolahi to Dargahan, one of the most important fishing grounds in this province's southeast is located. Food web models are used to represent a marine system's current state, assess stock levels, and predict change over time. Over a year, the first five dominant fish in the study area, S. tumbil, S. sihama, C. arel, N. japonicus, and T. lepturus, were biometrically measured, and their population dynamics parameters as well as feeding ecology indices were analyzed. According to the trophic‐level index results, the five most common species studied in this study belonged to the third (N. Japonicas, S. sihama, and C. arel) and fourth (T. lepturus, and S. tumbil) trophic levels. The key species with the greatest impact on other groups of studied species were identified as S. tumbil and T. lepturus, respectively. The estimated ecosystem indicators were the system operational power (75846.797), the primary production/respiration ratio (0.034), the connectance index (0.159), and the system omnivory index (0.253). A pedigree index (PI) of 0.38 was estimated for the present model. Overexploitation of T. lepturus could disrupt the aquatic food web and adversely affect the long‐term sustainable use of aquatic resources, according to data. As a result, ecosystem‐based fisheries management should be implemented to find a more appropriate solution to sustainable exploitation in the studied habitat, an important fishing area in the Persian Gulf's north.

Intensity‐dependent effects of cattle and sheep grazing in sand grasslands — Does livestock type really matter?

AbstractAimsBy analysing cattle‐ and sheep‐grazed sand grasslands, we tested the following hypotheses: (i) livestock type has a stronger effect on the vegetation characteristics than grazing intensity; (ii) sheep grazing results in lower biomass and species and functional diversity than cattle grazing, regardless of intensity; and (iii) increased grazing intensity causes a shift of the trait composition in grasslands.LocationSand grasslands in the Nyírség region, East Hungary.MethodsWe selected 26 sand grassland sites grazed by cattle or sheep and classified them into four intensity levels. Vegetation composition was surveyed in 2 m × 2 m plots. We harvested the above‐ground biomass from 20 cm × 20 cm plots; then dried and sorted it to live biomass, litter, moss, and lichen. We compared Rao dissimilarity index, species richness, Shannon diversity, evenness, and the community‐weighted means of nine vegetative and generative traits along a grazing intensity gradient. We calculated functional richness, evenness, and divergence for comparison.ResultsWe found that some diversity metrics and community‐weighted means of most studied traits were significantly affected by grazing intensity. Several characteristics were also affected by the interaction of grazing intensity and livestock type, but none of the studied characteristics was affected by livestock type in itself. Increasing Rao dissimilarity index peaking at the fourth grazing intensity level was detected, but for other multitrait indices, no such changes were proven, except for functional divergence, which was the lowest at the first intensity level. Graminoid, forb, and litter biomass were significantly affected by intensity, but none of the biomass fractions was affected by livestock type.ConclusionsWe suggest that for the management of sand grasslands, grazing intensity should be carefully adjusted, considering not only livestock units per hectare. For practical recommendations, well‐defined, long‐term experiments studying different livestock and habitat types along an intensity gradient would be essential.

The Evaluation of Field Teaching Practice Using Kirkpatrick’s Model

This study aims to evaluate a Field Teaching Practice program carried out by students of the social studies education study program at the Tazkia Islamic University College using the Kirkpatrick model, which includes reaction, learning, behavior, and result. The research method used is a descriptive approach with an evaluation of Kirkpatrick's model. The subject of this research used purposive sampling. Data collection techniques using observation, in-depth interview, and documentation. The data analysis technique in this study used an interactive model. The results: 1) Evaluation at level one (reaction) show that students already responded positively, enthusiastically, and happy in implementing Field Teaching Practice because it was equipped with micro-teaching to facilitate the implementation process. (2) Second level evaluation (learning) shows that only a few students can achieve the target in the learning process in class. Unable to meet the target due to the limited time and infrastructure constraints hinder the learning process. (3) Third level evaluation (behavior) shows that students' change in behavior is seen from how students are increasingly proficient and their confidence increases when dealing with students. (4) The fourth level results from student satisfaction with Field Teaching Practice sustainability; most students are mature and ready to become teachers after graduation because with this Field Teaching Practice, in addition to getting experience as a teacher, they can also know the world of education comprehensivelyKeywords: Evaluation, Field Teaching Practice, Kirkpatrick’s Model

A prospective randomized controlled study to assess the effectiveness of super FIXSORB WAVE® for sternal stabilization after sternotomy.

We developed a new sternal fixation device, Super FIXSORB WAVE®, a corrugated plate made of u-HA/PLLA, to improve sternal stability after sternotomy. This present study aimed to evaluate the new device clinically. This prospective, single-blinded, multicenter trial randomized 69 patients to either wire cerclage only (group C, n = 30) or wire cerclage plus Super FIXSORB WAVE® (group W, n = 39). The primary endpoint was a degree of sternal displacement at six months. Displacement of the sternal halves in the anteroposterior and lateral directions was measured using computed tomography horizontal section images at the third costal and fourth intercostal levels. The secondary endpoints were sternal pain and quality-of-life over 6 months. Group W showed significantly reduced sternal anteroposterior displacement at both the third costal (0 [0-1.9] mm vs. 1.1 [0-2.1] mm; P = 0.014) and fourth intercostal (0 [0-1.0] mm) vs. 1.0 [0-1.8] mm; P = 0.015) levels than group C. In group W, lateral displacement was suppressed without a significant increase from 2weeks to 6months, while it increased in group C. There was no significant difference in postoperative sternal pain and quality-of-life between the two groups. No adverse events, such as infection, inflammation, or foreign body reaction, were observed with this device. Using Super FIXSORB WAVE®, sternal displacement was significantly suppressed in both the anteroposterior and lateral directions. The use of this device results in safe and easy sternal reinforcement without any adverse events, and sternal healing can be accelerated. This study was registered in the Japan Registry of Clinical Trials (February 21, 2019; jRCTs032180146).

Obesity and the obesity paradox in patients with severe COVID-19

ObjectiveTo test the presence of the obesity paradox in two cohorts of patients hospitalized for COVID-19. DesignTwo multicenter prospective cohorts. SettingThree fourth level institutions. PatientsAdults hospitalized in the general ward for confirmed COVID-19 in the three institutions and those admitted to one of the 9 critical care units of one of the institutions. InterventionsNone. Main variables of interestCategorized weight and its relationship with admission to the ICU in hospitalized patients and death in the ICU. ResultOf 402 hospitalized patients, 30.1% were obese. Of these, 36.1% were admitted to the ICU vs. 27.1% of non-obese patients. Of the 302 ICU patients, 46.4% were obese. Of these, mortality was 45.0% vs. 52.5% for non-obese. The requirement to transfer hospitalized patients to the ICU admission get a HR of 1.47 (95%CI 0.87–2.51, p = 0.154) in the multivariate analysis. In intensive care patients, an HR of 0.99 (95%CI: 0.92–1.07, p = 0.806) was obtained to the association of obesity with mortality. ConclusionsThe present study does not demonstrate an association between obesity and risk of inpatient transfer to intensive care or death of intensive care patients due to COVID-19 therefore, the presence of an obesity paradox is not confirmed.

Mental models of management

One of the approaches to creating mental models that allow managers to quickly make decisions in complex multi-valued situations is considered. A stratified description of an economic object is used as a means of consistently deepening the detailing of management considerations, as well as a morphological system analysis to clarify the composition of the components, elements and subsystems of an economic object, identify and analyze the interrelations of components, analyze the integrity of the management system, as well as separate its managed and unmanaged features. An original tabular form of representation of such models is proposed, in which elements of five types are defined: a subsystem of the corresponding level; the purpose of the subsystem; the purpose of the study of the subsystem; interrelationships between subsystems; relationships that ensure the movement of the material flow in the economic object. Each element has its own identification number and a textual description of the subsystem, which facilitates the use of models in computer information systems. The model of the first level serves to isolate the object of study from the external environment. In the model of the second level, an external addition of the management control object was made. The third level model displays activity functions for an economic entity and management functions for management. It is noted that already at the fourth level of the study, which represents the tasks solved by functional components, the number of model elements increases significantly. Accordingly, the perception of the model as a mental model is difficult. However, the study of models of the fourth and fifth levels allows managers to better understand the principles of process management of economic objects. The proposed mental models can be used as a basis that provides a systematic approach to the study of problems of managing economic objects at different levels, from a structural unit of an enterprise to a large association or industry.