Mobilization Procedures Research Articles

Cross-border personnel mobility and bilateral value chain linkages: Evidence from visa liberalization in China

The cross-border personnel mobility has emerged as a crucial feature and trend in the process of globalization. This paper examines the impact of unilateral visa-free-entry policies in China on bilateral value chain linkages using a DID model. The research reveals that the implementation of visa-free-entry policies significantly promotes bilateral value chain linkages, with this effect lasting for approximately four years. Mechanism tests suggest that visa-free-entry policies facilitate the acquisition of soft information and strengthen the linkage between domestic and foreign value chains through three pathways: promoting information dissemination, enhancing the trust environment, and extending production steps. Heterogeneous analysis demonstrates that the positive impact of cross-border personnel mobility is more pronounced in low asset-specific industries, manufacturing, and the service sector. It has a greater effect on forward value chain linkages and high-value chain linkage industries. This paper provides valuable insights for the rational simplification of cross-border personnel mobility restrictions and procedures.

Transcatheter aortic valve implantation versus surgery: 4-year survival according to life expectancy.

In the last years, transcatheter aortic valve implantation (TAVI) indication has expanded to younger and lower risk patients. Consequently, interest in mid and long-term follow up and in the role of life expectancy, as a key factor for selecting the most tailored treatment, has grown. The aim of this retrospective study is to compare the 4-year survival of patients who underwent aortic valve replacement (AVR) vs. TAVI at our department. From September 2017 to December 2020, 673 consecutive patients with severe aortic valve stenosis were enrolled for AVR (n = 283) or TAVI (n = 390). Inclusion criteria was isolated severe aortic stenosis, while exclusion criteria were redo surgery, valve-in-valve procedure and the need for concomitant surgical procedures. Based on the Lee index, patients were divided into four groups according to their 4-year life expectancy. Four-year survival was assessed and reported using the Kaplan-Meier method. A multivariate regression analysis of risk factors for 4-year mortality was performed. Four years survival is always superior in the AVR patients (89.8% vs. 75.6%, P < 0.001). Surgery is associated with a higher incidence of acute kidney injury (23% vs. 5.1%, P < 0.001), while TAVI is related to a higher incidence of new onset left bundle branch block (0 vs. 23.8%, P < 0.001), pace-maker implantation (2.5% vs. 11.8%, P = 0,02) and mild-to-moderate paravalvular leak (0.3% vs. 5.4%, P < 0.001). The independent risk factors for 4-years mortality are post-procedural AKI, poor mobility and transcatheter procedure. In our analysis, 4 years survival is always superior in the AVR patients. Life expectancy is a key factor for selecting the most appropriate approach for each patient. A longer follow up is mandatory before extending TAVI indication to patients with a long-life expectancy.

Apheresis product total CD34+ cell count prediction at peripheral stem cell collection via a formula: A multicenter study

IntroductionEffective mobilization of Stem Cells(SCs) to peripheral blood (PB) is crucial for obtaining sufficient CD34+ cell numbers via apheresis. The ratio of pre-apheresis PB CD34+ cells is the best parameter for predicting the product CD34+ cell count. However, quantitating CD34+ PB cells requires flow cytometry, which usually takes two or more hours to obtain the results. We hypothesized that the product CD34+ cell count could be predicted using the counts of white blood cells (WBCs), mononuclear cells (MNCs), and pre-apheresis CD34+ cells. A formula that achieves this would substantially affect the efficiency and effectiveness of apheresis. We, therefore, aimed to estimate the number of CD34+ cells in the product using a formula that incorporates pre-apheresis PB WBC, MNC, and CD34+ cell counts and product WBC and MNC counts. MethodsWe examined the results of 373 leukapheresis procedures for SC mobilization. Effective separation of CD34+ PBSCs (count/μL) via apheresis was estimated using the following formula: [Product WBC (count/μL) × MNC (count/μL) × pre-apheresis CD34+ cell (percentage/μL)] ÷ [PB WBC count/μL × PB MNC (count/μL)]. ResultsA strong correlation was observed between the CD34+ cell count calculated using our formula and the post-apheresis CD34+ cell count measured via flow cytometry (R = 0.939, based on linear regression analysis). In the subgroup analysis, this correlation was observed for all the disease subgroups and healthy donors. ConclusionWe developed a formula that predicts the product CD34+ cell count and is useful for determining whether a second apheresis procedure will be required.

Trust and Satisfaction in Digital Banking in the Philippines - Integrating Delone and Mclean Information System Success Model

Trust and satisfaction are difficult to develop with mobile payments. Several papers have revealed and explained the benefits of using online payments. Despite this, mobile payment procedures in the Philippines remain low. This is the problem that this study wishes to address. The study validated and evaluated the Delone and Mclean model and the relationship between the dimensions that make up the success of IS implementation. Processes were completed by conducting a survey, collecting and analysing data, testing the validity of hypotheses, and providing interpretation thereof. The study proves that customers’ demographic variables, such as education, have a significant impact on trust. Also, education and No. of Years with the Bank is the only variable that has a significant impact on satisfaction. When the effect of the Delone and Mclean Model on trust and satisfaction is examined, it is observed that all three quality dimensions significantly impact trust and user satisfaction. This finding highlights the importance of continuous monitoring and enhancing the quality associated with these factors. This shows that the characteristics of a system from a technical perspective are especially of significant importance for enhancing the trust and satisfaction users feel towards mobile banking. When considering the effects of the three quality dimensions on trust and satisfaction, it is important to foster system, information, and service quality. In this vein, banks need to continuously monitor and initiate improvements in the associated aspect of quality. The Philippines is an Archipelago, which makes it difficult to build structures in other parts of the country. The government and the private sectors should kindly consider how to progress the digital infrastructure soon. Any substantial efforts to improve the prices or deliver improved rates of online contributions would have a great effect on affordability and, hence, access.

The Significance of Intra-Organizational Mobility Procedures in Modern Organizations

The Significance of Intra-Organizational Mobility Procedures in Modern Organizations

Mobile Forensic Investigation on iOS &amp; Android Smartphones: Case Study Investigation on WhatsApp

Following the exponential growth of information and communication technologies, the smartphone market, as well as advances in wireless data networks (3G and 4G), has accelerated. Mobile apps for social networking and instant messaging have been created by these firms. Other instant messaging (IM) smartphone programs like WhatsApp (WA), Viber, and IMO have also been created. WA is the most widely used instant messaging program. With WA, you can send and receive messages in a variety of formats, including text, voice, video, and documents. Various cybercrime incidents were committed through WA's. WA use leaves several artifacts that may be examined to detect the digital evidence. In addition, iOS and Android are two of the most popular smartphone operating systems. Because of this, the inquiry will involve the use of forensic investigative techniques and methodologies. Forensics on both iOS and Android cellphones were utilized to investigate a digital crime that was believed to have been perpetrated in WA. To conclude the investigation, we analyzed chat logs, phone records, and other media to gather proof. Legal framework and established processes were used to guarantee that evidence was preserved from change or destruction and that the witness's account was acceptable in court throughout the investigative process. It was finally stated that the inquiry and evidence had been presented. As a result, WA forensic artifacts might be evaluated and found effectively utilizing the mobile forensic procedure.

Steady-State Versus Chemotherapy-Based Stem Cell Mobilization in Multiple Myeloma: A Single-Center Study to Analyze Efficacy and Safety.

High-dose chemotherapy followed by autologous hematopoietic stem cell support is recommended in the treatment of eligible multiple myeloma (MM) patients. The aim of this study was to compare the efficacy and safety of steady-state versus chemotherapy-based stem cell mobilization in our Hungarian patient population. The subjects were 210 MM patients who underwent stem cell mobilization procedure between 2018 and 2022. Solo granulocyte colony-stimulating factor (G-CSF) was administered in 104 cases, while 106 patients received chemotherapy which was followed by G-CSF administration. We evaluated the ratio of successful mobilizations, the amount of collected stem cells, the incidence of infections and cost-effectivity in the two groups. In the steady-state group, there was a significantly higher need for plerixafor (45% vs. 13%, P < 0.001), unsuccessful stem cell mobilization was more frequent (11% vs. 3%, P = 0.024) and the mean amount of collected stem cells was lower (6.9 vs. 9.8 × 106, P < 0.001) than in the chemotherapy group. However, infections were less frequent (4% vs. 27%, P < 0.001) and the number of days spent in hospital was significantly lower (6 vs. 14 days, P < 0.001). Plerixafor was more frequently administered in those who had received lenalidomide or daratumumab than in those who had been treated with other regimens (41% vs. 23%, P = 0.007 and 78% vs. 23%, P < 0.001, respectively). Steady-state mobilization is a safe method; however, the higher rate of plerixafor administration and unsuccessful attempts may question its superiority to chemomobilization.

Autologous peripheral blood stem cell mobilization and apheresis in pediatric patients with cancer: A single-center report of 64 procedures.

The published experience concerning autologous peripheral blood stem cell collection in children is very limited. The data of pediatric patients who underwent autologous stem cell mobilization and apheresis between January 2011 and April 2020 were analyzed retrospectively. We studied retrospectively 64 mobilization and apheresis procedures in 48 pediatric patients (34 males, 14 females), mean age of 7.31 ± 5.38 (range, 1.5-19.7) years, the underlying disease was mostly neuroblastoma (NBL). The body weight of 21 patients (43.75%) was 15 kg or less. The targeted autologous peripheral stem cell apheresis (APSCA) was successfully achieved in 98% of patients. Neuroblastoma patients were younger than the rest of the patients and underwent apheresis after receiving fewer chemotherapy cycles than others and all of them mobilized within the first session successfully. Plerixafor was added to mobilization in nine heavily pretreated patients (18.7%), median two doses (range, 1-4 doses). 11 patients (22.9%) underwent radiotherapy (RT) before mobilization with doses of median 24 Gy (range, 10.8-54.0 Gy). Patients with RT were older at the time of apheresis and had received more chemotherapy courses than patients without RT. As a result, patients with a history of RT had significantly lower peripheral CD34+ cells and CD34+ yields than those without RT. In 17 patients (35.4%), 22 different complications were noted. The most common complications were catheter-related infections (n:10, 20.8%), followed by catheter-related thrombosis in eight patients (16.7%). Patients who had far less therapy before apheresis were more likely to mobilize successfully. Our study provides a detailed practice approach including complications during APSCA aiming to increase the success rates of apheresis in transplantation centers.

Comparison of two autologous hematopoietic stem cell mobilization strategies in patients with multiple myeloma: CE plus G-CSF versus G-CSF only: A single-center retrospective analysis.

Despite recent advances in the treatment of multiple myeloma, high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (ASCT) remains an essential therapeutic keystone. As for the stem cell mobilization procedure, different regimens have been established, usually consisting of a cycle of chemotherapy followed by application of granulocyte-colony stimulating factor (G-CSF), although febrile neutropenia is a common complication. Following national guidelines, our institution decided to primarily use G-CSF only mobilization during the COVID-19 pandemic to minimize the patients' risk of infection and to reduce the burden on the health system. In this retrospective single-center analysis, the efficacy and safety of G-CSF only mobilization was evaluated and compared to a historic control cohort undergoing chemotherapy-based mobilization by cyclophosphamide and etoposide (CE) plus G-CSF. Although G-CSF only was associated with a higher need for plerixafor administration (p < .0001) and a higher number of apheresis sessions per patient (p = .0002), we were able to collect the target dose of hematopoietic stem cells in the majority of our patients. CE mobilization achieved higher hematopoietic stem cell yields (p = .0015) and shorter apheresis sessions (p < .0001) yet was accompanied by an increased risk of febrile neutropenia (p < .0001). There was no difference in engraftment after ASCT. G-CSF only mobilization is a useful option in selected patients with comorbidities and an increased risk of serious infections, especially in the wintertime or in future pandemics.

Postoperative orthostatic intolerance following fast-track unicompartmental knee arthroplasty: incidence and hemodynamics—a prospective observational cohort study

BackgroundEarly postoperative mobilization is essential for early functional recovery but can be inhibited by postoperative orthostatic intolerance (OI). Postoperative OI is common after major surgery, such as total knee arthroplasty (TKA). However, limited data are available after less extensive surgery, such as unicompartmental knee arthroplasty (UKA). We, therefore, investigated the incidence of OI as well as cardiovascular and tissue oxygenation responses during early mobilization after UKA.MethodsThis prospective single-centre observational study included 32 patients undergoing primary UKA. Incidence of OI and cardiovascular and tissue oxygenation responses during mobilization were evaluated preoperatively, at 6 and 24 h after surgery. Perioperative fluid balance, bleeding, surgery duration, postoperative hemoglobin, pain during mobilization and opioid usage were recorded.ResultsDuring mobilization at 6 h after surgery, 4 (14%, 95%CI 4–33%) patients experienced OI; however, no patients terminated the mobilization procedure prematurely. Dizziness and feeling of heat were the most common symptoms. OI was associated with attenuated systolic and mean arterial blood pressure responses in the sitting position (all p < 0.05). At 24 h after surgery, 24 (75%) patients had already been discharged, including three of the four patients with early OI. Only five patients were available for measurements, two of whom experienced OI; one terminated the mobilization procedure due to intolerable symptoms. We observed no statistically significant differences in perioperative fluid balance, bleeding, surgery duration, postoperative hemoglobin, pain, or opioid usage between orthostatic intolerant and tolerant patients.ConclusionsThe incidence of orthostatic intolerance after fast-track unicompartmental knee arthroplasty is low (~ 15%) and is associated with decreased orthostatic pressure responses. Compared to the previously described orthostatic intolerance incidence of ~ 40% following total knee arthroplasty, early orthostatic intolerance is uncommon after unicompartmental knee arthroplasty, suggesting a procedure-specific component.Trial registration: Prospectively registered at ClinicalTrials.gov; registration number: NCT04195360, registration date: 13.12.2019.

БОЕВОЙ ПУТЬ 6-Й ГВАРДЕЙСКОЙ СТРЕЛКОВОЙ ДИВИЗИИ (1941–1943 гг.)

The purpose of the article is to characterize the main tactical unit of the Red Army ground forces – the rifle troops. The main role in them was assigned to the rifle division. The 120th Rifle Division, formed in the Orel Military District on the eve of the Great Patriotic War, took part in hostilities from the very beginning of the war. A similar fate was experienced by other rifle divisions formed in the same district – the 19th, 89th, 145th, 149th, 217th and 222nd. The common point for all these divisions was that just before the war they were all in summer camps, where they were overtaken by the news of the treacherous attack of Nazi Germany on the USSR. The next day, all divisions received orders to move out of the camps to permanent deployment points to undergo the necessary mobilization procedure. All divisions of the district were transferred to the Bryansk region, where at the first stage they participated in the construction of defensive structures at the border of the Desna River and its tributaries, together with the local population, as well as students of Moscow and Voronezh universities. The 120th Division operated especially successfully during the Elninsky operation of 1941, for which it was one of the first to receive the honorary name «Guards» and was reorganized into the 6th Guards Rifle Division. The division acted no less successfully in the autumn battles, holding back the advance of fascist troops on Moscow, in the Mtsensk region. The 6th Guards Rifle Division fought stubborn battles in the area of Efremov, which ended with the final capture of the city. During the winter campaign of 1942–1943, the division's fighters were able to liberate a number of settlements from German enslavement in two neighboring regions - Orel and Tula, including the city of Novosil. The soldiers of the division covered themselves with unfading glory in the battles near the village of Krivtsovo. During the autumn-winter campaign of 1942–1943, conducting active offensive operations, the division was able to liberate more than 170 settlements. In general, considering the course of combat operations of the 6th Guards Division in 1941–1943, we can say that the division went from Orel to Orel with stubborn, fierce battles. On the base of one military unit, the author shows the full severity of military operations, the courage and heroism of soldiers during the bloody battles for the freedom and independence of their homeland. As a result, the author emphasizes that futher to understand the battles of the division in detail, evaluate the correctness or incorrectness of the decisions made when planning and carrying out combat operations, and identify the degree of coordination in the battle formations of the division’s units and formations are the point.

The effectiveness and safety of rectal modular dissection for male middle and low rectal cancer after neoadjuvant chemoradiation therapy: the short-term outcome.

Background: The purpose of this study was to assess the efficacy and safety of rectal modular dissection (RMD) in male patients with middle and low rectal cancer. RMD is a technique used to guide the surgical procedure for rectal mobilization, with the ultimate goal of achieving total mesorectal excision. In order to evaluate the effectiveness of RMD, a single-center, non-inferiority randomized clinical trial was carried out. Methods: Eligible patients were randomly assigned into two groups: the RMD group and the traditional rectal mobilization (TRM) group. Demographic characteristics, perioperative data and pathological results of the surgical specimens were collected for analysis. additionally, assessments of urogenital function and defecation function were conducted for all participants. Results: A total of 103 patients (RMD group 53 patients and TRM group 50 patients) were included to analyzed. There were no significant differences in age, body mass index, ASA classification, and tumor characteristics between two groups. The RMD group had significantly lower blood loss (P = 0.00), shorter operative duration (P = 0.00), and shorter hospital stay (P = 0.04) compared to the TRM group. The complete rate of mesorectal excision was higher in the RMD group (98.1%) compared to the TRM group (86.0%, P = 0.02). In terms of functional outcomes, the RMD group had better evaluation scores for urethral function (IPSS score, P = 0.01), erectile function (IIEF-5 score, P = 0.00) and defecation function (LARS score, P = 0.00) at the one-year postoperative follow-up. The 1-year disease-free survival rate was similar between the two groups (P = 0.28). Conclusions: These results suggest that RMD is an effective and safe approach for achieving total mesorectal excision while promoting better functional outcomes for patients. The trial was registered in Chinese Clinical Trial Registry (ChiCTR2100052094).

Elevated Functional Hematopoietic Stem and Progenitor Cells in the Peripheral Blood of G-CSF-Mobilized Dnmt3a-Mutant Mice

Clonal hematopoiesis (CH) arising from somatic mutations in hematopoietic stem cells (HSCs) is associated with increased risk of developing several non-hematologic and hematologic diseases. In the context of stem cell transplantation, donor HSCs carrying CH-associated somatic mutations can be passed from donor to recipient during stem cell transplantation. Most literature supports that there is no negative impact on recipient survival or outcomes after allogeneic stem cell transplantation (allo-HSCT) from donors with CH. However, it is less clear how allo-HSCT donors with CH respond to common mobilization methods such as Neupogen (G-CSF). As hematopoietic stem and progenitor cells (HSPCs) with CH mutations have been found to respond to external stimuli such as inflammation in a manner distinct from wild-type HSPCs, it is plausible that CH-mutant HSPCs also distinctly respond to G-CSF mobilization. It is important to understand whether the process of mobilization differentially enriches for CH-mutant HSPCs in the mobilized peripheral blood product. To address this gap in knowledge, we used a murine model of Dnmt3a-mutant CH. After five consecutive days of Neupogen (G-CSF) administration, modeling the procedure for human HSC mobilization, we observed that Dnmt3a-mutant mice had significantly increased white blood cell, neutrophil and monocyte counts compared to control mice. We observed a significant increase in cell surface marker-defined HSPCs in the peripheral blood and spleen of G-CSF-treated Dnmt3a-mutant mice compared to G-CSF-treated control mice. Using in vitro colony-forming unit assays, the peripheral blood of G-CSF-treated Dnmt3a-mutant mice was found to contain a greater number of functional hematopoietic progenitors compared to G-CSF-treated control mice. To determine if the peripheral blood of G-CSF-treated Dnmt3a-mutant mice had a greater abundance of functional HSCs, we transplanted equal volumes of mobilized blood from Dnmt3a-mutant and control mice into primary and secondary lethally irradiated wild-type recipient mice. We observed increased long-term engraftment of mobilized blood from Dnmt3a-mutant mice compared to control mice in both primary and secondary recipient animals. At a mechanistic level, HSC mobilization is facilitated by myeloid cells that respond directly to G-CSF via the G-CSF receptor ( Csf1r). In Dnmt3a-mutant mice, we observed increased Csf1r expression in myeloid progenitor and mature myeloid cells compared to control mice, providing a putative mechanism by which increased mobilization is enabled. Together, our data support differential mobilization potential of Dnmt3a-mutant compared to control HSCs in response to G-CSF, which may have implications in the context of allo-HSCT.

Logistics outsourcing for armed forces: The mobilisation of civilian transportation vehicles

One aspect of the total defence concept involves the temporary requisition of civilian transportation vehicles to meet the increased logistical demands of a wartime army. These vehicles are selected and managed in peacetime, mobilised at the onset of the war, used by military units throughout the war, and returned to their original owners afterwards. This paper presents a model for the reception process of such civilian vehicles during mobilisation. In practice, however, reception processes are not without challenges. Under the time constraints of mobilisation, issues may arise, including inappropriate reception, missed deadlines, and compromised operational readiness. To investigate these issues, the study employs conceptual modelling, supplemented by insights from professional experience. The main contributions of this paper include a conceptual model of the mobilisation process, a framework for maintaining records of mobilised assets, and a focus on previously underexplored mobilisation issues. Proper reception of mobilised vehicles significantly affects the transportation capability and operational readiness of military units as well as the accuracy of the post-conflict return process. Implementation of the proposed solutions requires careful consideration due to interdependencies with other aspects of the mobilisation process, such as doctrinal arrangements, administrative systems, mobilisation procedures as well as the quality and regularity of both professional and reservist military training.

Orthostatic intolerance after acute mild hypovolemia: incidence, pathophysiologic hemodynamics, and heart-rate variability analysis—a prospective observational cohort study

PurposeEarly postoperative mobilization can be hindered by orthostatic intolerance (OI). Postoperative OI has multifactorial pathogenesis, possibly involving both postoperative hypovolemia and autonomic dysfunction. We aimed to investigate the effect of mild acute blood loss from blood donation simulating postoperative hypovolemia, on both autonomic function and OI, thus eliminating confounding perioperative factors such as inflammation, residual anesthesia, pain, and opioids.MethodsThis prospective observational cohort study included 26 blood donors. Continuous electrocardiogram data were collected during mobilization and night sleep, both before and after blood donation. A Valsalva maneuver and a standardized mobilization procedure were performed immediately before and after blood donation, during which cardiovascular and tissue oxygenation variables were continuously measured by LiDCOrapid™ and Massimo Root™, respectively. The incidence of OI, hemodynamic responses during mobilization and Valsalva maneuver, as well as heart rate variability (HRV) responses during mobilization and sleep were compared before and 15 min after blood donation.ResultsPrior to blood donation, no donors experienced OI during mobilization. After blood donation, 6/26 (23%; 95% CI, 9 to 44) donors experienced at least one OI symptom. Three out of 26 donors (12%; 95% CI, 2 to 30) terminated the mobilization procedure prematurely because of severe OI symptoms. Cardiovascular and cerebral tissue oxygenation responses were reduced in patients with severe OI. After blood loss, HRV indices of total autonomic power remained unchanged but increased sympathetic and decreased parasympathetic outflow was observed during mobilization, but also during sleep, indicating a prolonged autonomic effect of hypovolemia.ConclusionWe describe a specific hypovolemic component of postoperative OI, independent of postoperative autonomic dysfunction, inflammation, opioids, and pain.Study registrationClinicalTrials.gov (NCT04499664); registered 5 August 2020.

The Role of Mobile Games and Environmental Factors in Improving Learning and Metacognitive Potential of Young Students

Environmental sensitivity, which refers to the capacity to recognize and react to environmental stimuli, has been linked to increased levels of metacognition, which is the capacity to learn about one’s own learning processes. Sensory processing sensitivity (SPS) is a characteristic that can make people more sensitive to the stimuli and settings in their surroundings. Regarding the development of mobile game-based educational procedures, the study of the neurocognitive bases of the mechanisms underlying them, such as metacognition and environmental factors, could play a crucial role in the implementation of these educational practices. The purpose of the current narrative review is to identify the key mechanisms by which mobile games affect young learners’ metacognitive and environmental sensitivity profiles and to suggest future research directions on the specific selection of gamification-based educational interventions.

Investigation of the Radiographic Imaging Volume and Occupational Dose of Radiologic Technologists before and during the COVID-19 Pandemic.

This study aimed to assess occupational radiation doses for radiologic technologists (RTs) in Saudi Arabia shortly before and during the COVID-19 pandemic, considering changes in imaging volume during that time. This retrospective study included the imaging volume data and the RTs' occupational dose records from a central hospital for 2019 and 2020. The occupational dose-in terms of annual and quarterly mean effective doses (AMEDs and QMEDs)-was estimated for 115 RTs using thermoluminescent dosimeter records. There was a 22% increase in the AMED in 2020 compared with 2019, though the overall imaging volume decreased by 9% in 2020. The percentage changes in AMEDs between 2019 and 2020 for general radiography (GR), computed tomography (CT), interventional radiology (IR), nuclear medicine (NM), and mammography (MG) were 45%, 56%, 9%, 18% and -2%, respectively. The highest contribution to AMEDs in 2020 for modalities was due to GR and CT procedures, accounting for 0.50 mSv and 0.58 mSv, respectively. The percentage change in imaging volumes between 2019 and 2020 depicted a slight decrease in Q2 (-1%) and a substantial decrease in Q1 (-10%), Q3 (-12%), and Q4 (-11%) for 2020. The overall percentage changes in imaging volumes in 2020 for GR (conventional and mobile), CT, IR, NM, and MG were -7% (-19% and 48%), -11%, 13%, -26%, and -46%, respectively. Investigating the changes in 2020 by comparing Q1 of 2020 (before the pandemic restrictions) with Q2 (during the pandemic restrictions and changes in workflow) revealed that the QMED during Q2 increased by 5% with a 17.4% decrease in the imaging volume. However, CT procedures were increased by 11.1% during the pandemic restrictions in Q2 of 2020, with an increase in the corresponding QMED of 66%. Moreover, mobile GR procedures increased by 21% in Q2 of 2020 compared to Q1. This study indicated the impact of the COVID-19 pandemic on imaging volume and occupational dose. Overall, the study observed a decrease in the imaging volume and an increase in RTs' effective doses by 2020. However, there was an increase in mobile GR and CT examinations during the COVID-19 pandemic restrictions in 2020. This study suggested that the increased mobile GR and CT examinations contributed to greater effective doses for RTs in 2020.

P99: Progressive Mobilization Protocol for Patients Supported on ECMO Via Multidisciplinary Culture Change

Our project was aimed at changing the culture surrounding mobilization of the patient supported on ECMO. Due to the critical nature of patients supported on ECMO a multidisciplinary approach of ECMO trained staff members is essential. It is known that critically ill patients benefit from early mobilization. Culture around mobilizing patients supported on ECMO at our facility has been historically conservative and progressive mobility was met with resistance. Our goal was to initiate culture change to one in which progressive mobility is an expectation for the critically ill while designing and implementing a standardized formal protocol for mobilization of patients supported on VA/VV ECMO. This initiative required a multidisciplinary team of stakeholders and influencers to promote acceptance and willingness from nursing, perfusion, pulmonary critical care team and ICU lead physicians. Our team created a protocol with the following goals: 1) increase early and progressive mobilization of patients supported on ECMO 2) decrease time of eligibility to transplant listing of patients supported on ECMO 3) improve outcomes of patients supported on ECMO to include; earlier decannulation, decreased hospital length of stay and discharge to home or rehab vs skilled nursing facility or LTACH 4) change nursing culture to one where early and progressive mobilization is the expectation for patients supported on ECMO 5) increase confidence among healthcare staff regarding early and progressive mobility of the critically ill patient. For every ECMO patient on our unit, bedside nursing staff completes a daily checklist. The purpose of this list was to create ownership from nursing to allow them stake in the process. Checklist was created and vetted by all teams to allow input and to cultivate a multidisciplinary approach. The bedside nurse and physical therapist reviewed the patients’ case daily. Once the patient passes the suggested guidelines for mobility the multidisciplinary team, led by the physical therapist and consisting of the bedside nurse, perfusionist and respiratory therapist, initiates mobility per physical therapy protocol. If patients do not pass the safety checklist by nursing, a multidisciplinary conversation occurs to determine the appropriateness (risk/benefit) of mobilizing the patient, and session is either initiated or deferred. A specialized team and protocol are imperative to successful mobility for this patient population. This initiative created influencers who consisted of team leads targeted to implement change. Culture change has occurred and patients receiving ECMO support are mobilized daily without hesitation. Our future plans include modification of nursing checklists and physical therapy protocol, creation of post mobilization procedures to collect and analyze data, and the development and implementation of an ECMO competency for our PT/OT rehabilitation staff to ensure a high level of training and clinical competence.

Smart mobility procedure for road traffic noise dynamic estimation by video analysis

Road Traffic Noise is a major concern in Europe, with more than 20% of people exposed to harmful noise levels. Efficient monitoring and assessment of the sound levels in critical areas are crucial to support decision strategies to control/reduce noise exposure. However, continuous and long-time ranged spatio-temporal measurements require high-cost equipment and maintenance duties. Therefore, this paper aims to develop a cost-efficient smart mobility procedure for the estimation of traffic noise levels based on roadside video images. The developed procedure involves an algorithm that extracts traffic volumes, identifies vehicle classes, estimates each vehicle’s speed from video recordings, and a noise assessment component using dynamic microscopic models. These latter are based on existing Noise Emission Models – NEMs, for the assessment of the source sound power levels, coupled with a sound propagation model able to consider each on-road vehicle speed as input and evaluate the equivalent continuous A-weighted sound pressure levels. The developed approach is characterized by a modular structure that easily allows to replace NEMs and/or incorporate extra variables in the sound propagation model. The procedure is tested on a rural road of a medium-sized city, under different levels of service, and results show that the errors concerning the noise estimations are below 1 dBA, revealing high accuracy.

THE INFLUENCE OF MOBILIZATION AND ISCHEMIC COMPRESSION ON PAIN AND DISABILITY IN ADHESIVE CAPSULITIS AND MYOFASCIAL PAIN SYNDROME

The purpose of the study: to investigate the effect of end-range mobilization and ischemic compression on pain and disability scores among patients with adhesive capsulitis of the shoulder joint and myofascial pain syndrome in the thoracic region.&#x0D; Materials and methods. Goniometry of the shoulder joint, assessment of pain at the end points of the range of motion and trigger points (when applying a pressure of 2.5 kg×cm-2), as well as the Shoulder Pain and Disability Index questionnaire were used before the intervention and after physical therapy.&#x0D; Physical therapy began after an examination and consultation with an orthopedic traumatologist. The majority of patients received 15 planned procedures of end-range mobilization performed by a physical therapist within 3 weeks, only two patients received 14 and 16 procedures. Mobilization from I to V degrees of intensity according to the Maitland classification was used. The patient performed ischemic compression independently after instruction (determination of the localization of trigger points, formation of their map, training in exposure techniques). Compression was performed with an average level of pain or more than average; duration of 30 seconds for each point.&#x0D; Results. The proportion of male patients was 20.8%. In the examined group of patients, the values of Me (25%; 75%) for age were 53.5 (48.25; 58.5) years, and for the duration of symptoms 4 (2; 5.5) months. Localization of adhesive capsulitis on the right side was observed in 9 patients (37.5%), and on the dominant upper limb in 8 (33.3%) patients. In five patients, the lesion was on the dominant right limb. The evaluation of the transfer of end-range mobilization procedures at the end of the first, sixth, eleventh and last procedure established that the maximum pain on a 10-point scale during mobilization was, respectively: 10 (9; 10) points, 8 (7.25; 9) points, 7 (5 ; 8) points and 4 (3; 5) points. In the course of physical therapy, the indicators of amplitudes of movements and pain at maximum amplitude, as well as at trigger points, improved statistically. The median value for active abduction increased by 74.5° and for active flexion increased by 116.5°. The median value for active internal rotation increased by 77.5°, and for active external rotation, flexion increased by 75°. The median value of pain when reaching the maximum amplitude of active abduction decreased by 6 points, and for active flexion, internal and external rotation, the median dynamics indicator was similar. It should be noted that the pain index at the trigeminal point at the first assessment was 9 (9; 9) points, and at the final assessment it statistically improved and was 4 (3; 4) points (Z = -4.340; p&lt;0.001). All items of the Shoulder Pain and Disability Index questionnaire improved statistically, leading to improvements in domain values and the index itself. Іndicators Me (25%; 75%) of the pain domain decreased from 93 (63; 100) points to 16 (6.5; 20) points (Z = -4.287; p&lt;0.001), and the disability domain from 83.8 (56.9; 91.6) points to 5.6 (3.8; 10.9) points (Z = -4.286; p&lt;0.001). Тhe median indicator of the pain domain decreased by 77 points, and the disability domain by 78.2 points. The index decreased from 88.7 (54.1; 94.4) points to 10.5 (4.2; 15.4) points. (Z = -4.286; p&lt;0.001).&#x0D; Conclusions. The use of a combination of end-range mobilization and ischemic compression was effective in reducing the index of shoulder pain and disability among the examined patients.