Aspects Of Procedure Research Articles

Procedural Aspects of Overcoming Sovereign Immunity: Relevance for Ukraine and the International Legal Order (SDG'S)

Objective: The object of this research article is the procedural domestic and international aspects of overcoming the sovereign immunity of a State that has committed military aggression, violating international humanitarian law and human rights law, with a focus on compensation for the damage caused by such actions. Method: The method of study involves a critical analysis of the approaches taken by the Supreme Court of Ukraine to overcome jurisdictional immunity, in light of international law norms. The authors employs a combination of legal analysis, case law examination, and comparative analysis of international practices to evaluate the compliance of the court's decisions with conventional provisions on compensation for damages. Results: This research article analyses the procedural domestic and international aspects of overcoming the sovereign immunity of a State whose military aggression has violated international humanitarian law and human rights law, and on this basis raises the issue of compensation for the damage caused by such actions. Special attention is paid to the approaches to overcoming jurisdictional immunity by the Supreme Court of Ukraine. Taking into account the norms of international law, the author critically analyses the court's compliance with the conventional provisions establishing the procedure for consideration of cases on compensation for damages. The aggressor State's disregard for the norms and principles of international law, sovereignty of other States, and international good faith does not give rise to a disregard for the norms of international law based on the principle of reciprocity. The author emphasises that compliance with the rules on court proceedings must comply with the conventional requirements, and this should be the basis for national case law on school compensation. The authors analyses legal immunities and jurisdictional immunity of the State in particular in the context of ensuring justice, which, according to international standards, is the basis for fair treatment of victims of armed aggression and ensuring access to justice. Contribution: It is noted that the application of the rules of jurisdictional immunity is the basis for limiting the right to a trial, which should be proportionate. The authors identifies the prospects for the development of international practice of interpreting the areas of ensuring the right to a fair trial, in particular, based on the practice of international courts. The author summarises the directions of changing approaches to the validity of the application of absolute immunity, and the dynamic interpretation of the legitimate purpose of limiting the right to a court, which is necessary and permissible provided that the essence of this right is preserved. The author emphasises the importance of the effectiveness of reparations as a principle and its significance for the development and provision of transitional justice in Ukraine.

A Comprehensive Review of Percutaneous and Surgical Left Atrial Appendage Occlusion.

Atrial fibrillation (AF) is the most common arrhythmia worldwide, and is associated with a significant risk of thromboembolic events. Left atrial appendage occlusion (LAAO) has emerged as a promising alternative for patients with contraindications or intolerance to anticoagulant therapy. This review summarises the current evidence, indications, and technical advancements in surgical and percutaneous LAAO. Preprocedural planning relies on various imaging techniques, each with unique advantages and limitations. The existing randomised clinical trials and meta-analyses demonstrate favourable results for both percutaneous and surgical LAAO. Postprocedural management emphasises personalised anticoagulation strategies and comprehensive imaging surveillance to ensure device stability and detect complications. Future focus should be put on antithrombotic regimens, investigating predictors of device-related complications, and simplifying procedural aspects to enhance patient outcomes. In summary, LAAO is presented as a valuable therapeutic option for preventing AF-related thromboembolic events, with ongoing research aimed at refining techniques and improving patient care.

Tablet-based Rey–Osterrieth Complex Figure copy task: a novel application to assess spatial, procedural, and kinematic aspects of drawing in children

The paper-and-pencil Rey–Osterrieth Complex Figure (ROCF) copy task has been extensively used to assess visuo-constructional skills in children and adults. The scoring systems utilized in clinical practice provide an integrated evaluation of the drawing process, without differentiating between its visuo-constructional, organizational, and motor components. Here, a tablet-based ROCF copy task capable of providing a quantitative assessment of the drawing process, differentiating between visuo-constructional, organizational, and motor skills, is trialed in 94 healthy children, between 7 and 11 years of age. Through previously validated algorithms, 12 indices of performance in the ROCF copy task were obtained for each child. Principal component analysis of the 12 indices identified spatial, procedural, and kinematic components as distinct dimensions of the drawing process. A composite score for each dimension was determined, and correlation analysis between composite scores and conventional paper-and-pencil measures of visuo-constructional, procedural, and motor skills performed. The results obtained confirmed that the constructional, organizational, and motor dimensions underlie complex figure drawing in children; and that each dimension can be measured by a unique composite score. In addition, the composite scores here obtained from children were compared with previsions results from adults, offering a novel insight into how the interplay between the three dimensions of drawing evolves with age.

Crime Scene Investigation and Reconstruction – Criminal Procedure and Criminalistics Aspects in North Macedonia

Crime Scene Investigation and Reconstruction – Criminal Procedure and Criminalistics Aspects in North Macedonia

Exploring Digital Transformation Intensity and Its Relationship with Sustainability: Greek Managers’ Perspectives

The digital transformation process gained significant research interest in recent years especially related to achievements in sustainability goals. Even though there exists growing research regarding various aspects of digital transformation and sustainability procedures, a more detailed analysis is needed in different national environments. The proposed study empirically analyzes the Greek managers’ perspective on the relationship between digital transformation intensity and sustainability practices implemented. Almost 156 Greek senior managers from various organizational sectors were interviewed, while a synthetic index already developed from previous studies was used. Results indicate that Greek companies do not fully exploit digital technologies to further develop their environmental practices. A digital transformation strategy contributes effectively to environmental strategies in the case of reducing emissions of waste and avoiding environmental accidents, while in the rest of the cases, emerging technologies play a less important role and not as a part of a holistic digital strategy.

Therapeutic Aspects of Lipofilling, Abdominoplasty in Combination with Body Liposuction and Bariatric Surgery

This review article is dedicated to the therapeutic aspects of various plastic surgery procedures. Nowadays, improving appearance and quality of life through plastic surgery is becoming increasingly popular. Managing patients after lipofilling and abdominoplasty combined with liposuction is an interdisciplinary challenge. Intraoperative risks in plastic surgery are associated with anesthesia and comorbidities. The immediate response of the cardiovascular and respiratory systems to the administration of anesthetic agents and the anesthesiologist's qualifications determines the immediate success of the operations. The duration of the surgery, volumetric disturbances, reduction of body surface area, and changes in metabolic and immunological status after mechanical impact on adipose tissue significantly alter the rate of compensatory-adaptive reactions of the body. In the long-term period after lipofilling, abdominoplasty, liposuction, and augmentation mammoplasty, systemic complications are often observed. These include insomnia, chronic kidney disease, protein-energy malnutrition, arthropathies, nonspecific interstitial lung lesions, unverified hepatitis, lupus-like syndrome, antibodies to transplanted fats and silicone materials, idiopathic limb edema, as well as autoinflammatory syndromes. The presented work also provides data on propofol infusion syndrome and the clinical-prognostic significance of vascular endothelial growth factor in plastic surgery. The authors’ team also presents their own clinical data on obesity and associated diseases. To maintain the aesthetic effect and prevent long-term complications after lipofilling, liposuction, augmentation mammoplasty, blepharoplasty, and rhinoplasty, it is recommended to follow a hypoallergenic and low-calorie diet for the next 3-6 months, avoid night work, excessive physical exertion, simultaneous intake of antibiotics and anti-inflammatory drugs, sun exposure, trips to mountainous areas, and long flights.

Cultural and Linguistic Adaptation of Parent-Implemented Language Interventions for At-Risk Children: A Systematic Review

ABSTRACT Children from low socioeconomic backgrounds are at an increased risk for delayed language and literacy development. In recognizing the role parents play in children’s language and literacy development, organizations throughout the world are identifying and implementing parent-focused interventions early in children’s lives. Impacting the success of parent-implemented language interventions, however, is the fit with recipient families’ culture. Although cultural and linguistic adaptation is gaining more emphasis in the education field, there is little focus on cultural and linguistic adaptation of parent-implemented language interventions. Twenty-four studies were evaluated for quality and effectiveness and were examined to identify how researchers adapted interventions culturally and linguistically. We further evaluated how researchers addressed social validity in these interventions. Interventions were of medium to high quality and were reported to effectively enhance children’s language and literacy outcomes. Overall, the studies supported the sociolinguistic pride of participants’ culture by using community metaphors and concepts and supported the use of participants’ home language. Twelve studies included an assessment of social validity, primarily in the aspects of intervention procedures and content, and almost exclusively at the end of the intervention. This review emphasizes the importance of adapting parent-implemented language interventions with cultural and linguistic practices of local populations to enhance children’s language outcomes.

Clinical Applicability and Safety of Conventional Frame-Based Stereotactic Techniques for Stereoelectroencephalography.

Stereoelectroencephalography (SEEG) is increasingly being recognized as an important invasive modality for presurgical evaluation of epilepsy. This study focuses on the clinical and technical considerations of SEEG investigations when using conventional frame-based stereotaxy, drawing on institutional experience and a comprehensive review of relevant literature. This retrospective observational study encompassed the surgical implantation of 201 SEEG electrodes in 16 epilepsy patients using a frame-based stereotactic instrument at a single tertiary-level center. We provide detailed descriptions of the operative procedures and technical nuances for bilateral and multiple SEEG insertions, along with several illustrative cases. Additionally, we present a literature review on the technical aspects of the SEEG procedure, discussing its clinical implications and potential risks. Frame-based SEEG electrode placements were successfully performed through sagittal arc application, with the majority (81.2%) of cases being bilateral and involving up to 18 electrodes in a single operation. The median skin-to-skin operation time was 162 minutes (interquartile range [IQR], 145-200), with a median of 13 minutes (IQR, 12-15) per electrode placement for time efficiency. There were two occurrences (1.0%) of electrode misplacement and one instance (0.5%) of a postoperative complication, which manifested as a delayed intraparenchymal hemorrhage. Following SEEG investigation, 11 patients proceeded with surgical intervention, resulting in favorable seizure outcomes for nine (81.8%) and complete remission for eight cases (72.7%). Conventional frame-based stereotactic techniques remain a reliable and effective option for bilateral and multiple SEEG electrode placements. While SEEG is a suitable approach for selected patients who are strong candidates for epilepsy surgery, it is important to remain vigilant concerning the potential risks of electrode misplacement and hemorrhagic complications.

Assessing the effectiveness of tumour board education among medical students: a pre-post-test analysis.

Multidisciplinary tumour boards (MDTs) play a vital role in providing high-quality cancer care. In Pakistan's compromised healthcare system, there is a lack of tumour board establishment. To bridge this gap, we aimed to enhance medical education by exposing medical students to the processes and advantages of MDTs early in their careers through conducting a mock tumour board. This approach seeks to provide students with a practical understanding of cancer care and the collaborative decision-making involved in managing cancer patients. A session took place at Jinnah Postgraduate Medical Centre in May, 2023, with participants voluntarily agreeing to attend. This session comprised six components: a Pretest questionnaire, a didactic lecture on the concept of tumour boards, an interactive group discussion following the lecture, a simulated tumour case presentation, a workshop simulating a tumour board scenario and a Posttest questionnaire. A total of 80 participants were included in the study. The mean age of study participants was 22. Among these, 36 (45%) were in their final year, 34 (42.5%) in their fourth year and 10 (12.5%) in their third year. While the majority of students possessed a fundamental understanding of tumour boards, they lacked awareness regarding their importance, implementation and procedural aspects involved. Before the mock tumour board, 53 (66.3%) students were unfamiliar with tumour board procedures; post-workshop, all 80 (100%) gained awareness of the process. Additionally, the study showed a positive shift in perceptions regarding the cost-effectiveness of tumour boards. Initially, 44(55%) students responded with 'maybe' regarding tumour board's cost-effectiveness, but after training, 64 (80%) perceived it as cost-effective from patient's perspective. Moreover, students' overall pretest score was 66.5%, and posttest was 94.62%., showing an overall difference in knowledge of 28%. The mock tumour board workshop successfully heightened students' understanding of tumour board procedures, positively shaped their views on cost-effectiveness, and resulted in a noteworthy enhancement of their knowledge scores. Organising similar workshops for undergraduates offers a practical approach to bridging the current gap in the establishment of tumour boards in the future in Pakistan.

DIRECTIONS AND PROCEDURE FOR COORDINATION OF MATERIAL AND PROCEDURAL NORMS OF FINANCIAL LAW IN REGULATING THE BEHAVIOR OF SUBJECTS OF TAX RELATIONS

The article is devoted to the analysis and coordination of material and procedural norms of financial law in the context of regulating the behaviour of subjects of tax relations. The author examines the main directions and order of interaction of legislative acts, doctrinal positions aimed at regulating the financial aspects of taxation, with the aim of harmonizing these norms for effective control and ensuring compliance with their requirements. The article highlights the important aspects of the influence of material norms on the tax practice of subjects, defines the key aspects of legal personality in the taxation system and argues for the need to harmonize the material and procedural aspects of financial law. The article examines in detail the tools and mechanisms of coordination of material and procedural aspects of financial law to ensure the effective functioning of the taxation system and reduce the risks of violations. The author analyses the relationship between legal standards and real practice in the field of tax relations, taking into account economic and social factors affecting the behaviour of tax subjects.

Early marginal ulceration prevalence following primary RYGB: a rare events model of the MBSAQIP 2015-2021

PurposeMarginal ulceration (MU) following Roux-en-Y gastric bypass (RYGB) is an established complication, with early MU (within 30-days of operation) being less understood compared to its late counterpart. This study aims to identify risk factors for early MU in patients undergoing primary RYGB. MethodsUtilizing data from the Metabolic and Bariatric Surgery Accreditation Quality Improvement Project (MBSAQIP 2015-2021), 1,346,468 records were evaluated. After exclusions for revisions, conversions, pediatric cases, nonbinary gender, missing body mass index (BMI) data, and missing operative time; 291,625 cases of primary RYGB were included for full analysis and rare events modeling of early MU. ResultsThe prevalence of early MU was .29% (n = 850). Higher rates of early MU were associated with BMI, race, history of diabetes mellitus (DM), prior thrombotic complications (deep vein thrombosis (DVT) and pulmonary embolism (PE)), prior percutaneous cardiac intervention (PTC), immunosuppressive therapy, and anticoagulation status. Additionally, procedural aspects like the nonspecialization of the surgeon and longer operative times also correlated with higher early MU rates. Rare-events regression modeling noted significant associations of early MU with younger age, diabetes requiring insulin, history of PTC, DVT, immunosuppressive therapy, and anticoagulation status. ConclusionEarly MU remains a relatively rare complication. The lower than previously reported occurrence suggests possible improvements in both patient preparation and surgical technique. The identification of relevant risk factors enables better perioperative and intraoperative management of patients at risk of developing early MU.

Clinical outcomes of the Burnett "snake" maneuver shunt modification for ischemic priapism.

Major ischemic priapism (IP) is defined as a persistent penile erection for >4hours. IP may cause serious complications, especially if prompt resolution is not achieved. Therefore, selecting the most effective and usable shunt technique is crucial in IP cases that are refractory to medical therapy. To compare the effectiveness and complication risks of distal corporoglanular shunt procedures with and without the Burnett "snake" maneuver. We conducted a retrospective study of patients who presented with IP and underwent surgical treatment at our institution between 2005 and 2021. The patients were categorized into 2 groups: group 1 (n = 26) underwent distal shunt + Burnett snake maneuver, and group 2 (n = 56) underwent distal shunt-only. Clinical history, parameters of IP, details of medical and surgical treatments, and follow-up information were evaluated. Outcomes included differences in IP resolution and recurrence, functional erections, and complications between corporoglanular shunt procedures with and without the Burnett snake maneuver. In group 1, 24 of 26 patients (92.3%) experienced priapism resolution with a single surgical intervention, while this outcome was observed in 30 of 56 patients (53.6%) in group 2 (P < .001). Notably, priapism recurrence was significantly lower in group 1, occurring in 1 of 24 patients (4.2%), as opposed to 8 of 30 patients (26.6%) in group 2 (P < .001). Of the patients with documented sexual function status at follow-up, functional erections (capable of penetration with or without phosphodiesterase 5 inhibitors) were noted in 6 of 14 patients (42.8%) in group 1 and 13 of 26 patients (50%) in group 2 (P = .66). This study provides valuable insights regarding technical aspects of distal shunt procedures with and without the Burnett snake maneuver for treating major IP episodes. These results can help surgeons with clinical decision making for patients who present with IP. Limitations include the single-site retrospective design with potential selection bias, inaccuracies in medical record data, challenges in controlling confounding variables, and the lack of validated questionnaire scores for erectile function evaluation. Our study demonstrates that modifying distal shunt procedures using the Burnett snake maneuver significantly improves priapism resolution and effectively prevents further priapism episodes without introducing additional complications or erectile function loss, thereby distinguishing it from distal shunt-only procedures.

Incorporating Computational Thinking into Education: From Teacher Training to Student Mastery

The concept of computational thinking originated in the 1950s and 1960s as “algorithmic thinking” (Denning, 2009), which involves using a systematic and precise sequence of steps to solve problems, potentially using computers to automate the process. Today, 'computational thinking' is defined as is a solving problem process that involves formulating problems and solutions in a way that can be represented and solved through a series of computational steps, designing systems and understanding human behaviour, based on fundamental computer concepts. It includes processes such as abstraction and decomposition when dealing with complex tasks or designing extended systems (Wing, 2006). From an educational point of view, the challenge is to identify the cognitive skills that are expected of a person with this type of thinking and their ability to apply them in practice. Computational thinking encompasses a set of thought processes that originate from computer science, but are applicable in various fields. However, it is often wrongly perceived as “technological thinking”, which implies a mindset aimed exclusively at the effective use of technologies. The contribution points out that the lack of a clear definition hinders the integration of this concept into teacher training and broader educational contexts. If understood correctly, computational thinking could significantly improve understanding of the procedural aspects of knowledge, which are very useful for teaching. In this sense, the contribution also describes an exploratory research on the opinions of primary school teachers in central Italy aimed at understanding the perceived benefits that the incorporation of computational thinking could bring in a teaching context.

Model Independent and Dependent Methods for Dissolution Profiles Comparison: Can we take the Road Less Travelled?

Dissolution testing plays an important role in pharmaceutical development due to its ability to provide critical insight into in vivo performance. Dissolution testing during routine pharmaceutical development can ensure batch-to-batch consistency and helps to ensure that the commercial batches are of representative quality to that of studied in the pivotal clinical studies. For comparing the dissolution profiles, there are multitude of approaches suggested by various regulatory agencies that consist of model independent and dependent approaches. The present review aims to summarize the current understanding of dissolution profile similarity approaches. Dissolution profile comparison approaches suggested by various regulatory agencies were compared and contrasted. Further, detailed procedural aspects were provided for the determination of similarity using model independent and dependent approaches. Model independent approaches such as f2 bootstrap, and Multivariate Statistical Distance (MSD) were portrayed from a practical perspective. Advanced tools such as Bias-Corrected and accelerated (BCa) for f2 bootstrap were discussed in depth. Further, model dependent approaches such as zero order, and Weibull models were discussed from realistic scenarios. Finally, the utility of modeling and simulation approaches such as physiologically based pharmacokinetics model (PBPK) and physiologically based biopharmaceutics model (PBBM) were discussed in the context of their ability and potential to supersede traditional dissolution dissimilarity. Overall, this article acts as a ready-to-use guide for pharmaceutics and biopharmaceutics scientists for effective methodologies for dissolution profile comparison for internal decision-making and regulatory justifications.

Mathematical Work of a Future Teacher in Teaching the Box Plot Diagram

Objective: The study aims to characterize the teaching proposals of the future Mathematics teacher in the context of their practical training in the final year of their university studies. Theoretical Framework: To achieve this, we consider the theory of Mathematical Workspaces, which allows for the analysis of both the mathematical activity that an individual engages in while solving a mathematical task, and the activity that is promoted during teaching. Method: A qualitative methodology is adopted through the design of an instrumental case study. The case pertains to a future teacher conducting a class on constructing a box plot. This class was observed and transcribed for analysis in light of the proposed mathematical work. Results and Discussion: The mathematical work exhibited by the future teacher includes a strong semiotic component and the use of non-material artifacts for quartile calculations. Students' prior knowledge is utilized in this context, with procedural aspects taking precedence over statistical thinking. Implications of the Research: The study raises concerns about the statistical education of mathematics teachers and its impact on future teaching proposals. Originality/Value: This research contributes to the study of statistics and initial teacher training in their influence on the future practices of Mathematics teachers. It provides a characterization of the mathematical work promoted by a future teacher and offers insights into concerns regarding the development of statistical thinking.

Assessing the Influence of Patient Anxiety on the Efficacy of Endodontic Procedures.

Patient anxiety is known to influence various aspects of dental procedures, including endodontic treatments. However, the extent of its impact on the efficacy of such procedures remains uncertain. Understanding this influence is crucial for improving patient outcomes and optimizing treatment protocols. A prospective cohort study was conducted involving 100 patients undergoing endodontic procedures. Patient anxiety levels were assessed using standardized anxiety scales before and after treatment. The efficacy of endodontic procedures was evaluated based on posttreatment pain scores, success rates of root canal treatments, and patient-reported satisfaction levels. The mean pre-treatment anxiety score was 45.7 (SD = 9.2), while the mean posttreatment anxiety score reduced significantly to 32.4 (SD = 7.6), indicating a significant reduction in anxiety levels following endodontic procedures (P < 0.001). Posttreatment pain scores were lower in patients with reduced anxiety levels, with an average pain score of 2.1 (SD = 1.3) compared to 3.8 (SD = 1.6) in patients with persistently high-anxiety levels (P = 0.002). Additionally, the success rate of root canal treatments was higher in patients with lower anxiety levels (85%) than those with higher anxiety levels (65%) (P = 0.015). Overall patient satisfaction was also significantly higher in the low-anxiety group (P < 0.001). Patient anxiety significantly influences the efficacy of endodontic procedures, affecting posttreatment pain, success rates of root canal treatments, and patient satisfaction levels. Efforts to reduce patient anxiety before and during endodontic procedures may lead to improved treatment outcomes and higher patient satisfaction.

Analysis and Reconstruction of Student Practicum Worksheets on Food Carbohydrate Testing

Practicum worksheets are a tool used by students to increase their understanding of various biological concepts through experiments and direct observation. However, there are many biology practicum worksheets used today often do not meet the appropriate standards. Therefore, this research aims to analyze conceptual, procedural, and knowledge construction aspects based on vee diagrams on students' practicum worksheets. The method used in this research is qualitative-descriptive. The samples were selected using purposive sampling so that six samples of practicum worksheets for phase F students in the Merdeka Curriculum were obtained with material testing carbohydrates in food. The research results show that conceptually, the practicum content is not in accordance with the learning outcomes in the Merdeka Curriculum. Procedurally, the practicum worksheets still need to be improved in terms of tools, materials, procedures, phenomenon objects, and data recording. This has an impact on students' difficulties in constructing their knowledge. It is hoped that the results of the reconstruction of practicum worksheets based on conceptual, procedural, and knowledge construction analysis can be used as a reference and basis for teachers in designing practicum activities specifically on digestive system material.

Evaluating International Criminal Procedures: Inquisitorial, Adversarial, or Hybrid - Lessons for the Pakistani Legal System

This Article examines two key aspects of international criminal procedure (ICP): the normative frameworks that govern ICP and procedures being utilized by International Criminal Tribunals (ICT) and Courts. It examines the established norms and practices of international tribunals. The discussion encompasses the formulation of standards, guidelines, and guarantees aimed at preventing judicial errors. It evaluates that whether ICP can be characterized as "adversarial," "inquisitorial," or “a blend of both”. It examines the case law and legal framework of international courts and tribunals. Employing a comparative and analytical research methodology, this article demonstrates that a genuinely hybrid procedure has emerged through successive amendments to the ICT for the former Yugoslavia and its rules of Procedure and Evidence (RPE) and the formulation of the Rome Statute. This procedure effectively synthesizes elements from both traditions; common law (adversarial) and civil law (inquisitorial) into a cohesive international legal framework. The article emphasizes the convergence of legal positions across jurisdictions. The observed similarities in legal frameworks arise from the universal recognition of the importance of justice in shaping human coexistence. However, the article acknowledges that the diversity in human minds leads to variations in devising solutions and creating means, explaining the inherent disparities in legal approaches across different contexts. It will be beneficial for Pakistan to adopt Islamic Criminal Procedure having hybrid criminal procedure that will improve the efficiency of our judicial system, ensuring swift resolution of criminal cases with effective outcomes.

The Power of Color Flow Doppler Ultrasonography Versus Blind Technique in Localization of Epidural Catheter: A Randomized Prospective Study.

The success of epidural analgesia hinges on the precise insertion of the needle within the epidural space; failure rates have been reported to reach 32%. We report a new method using color Doppler to help verify the accurate location of the epidural needle tip. This is a randomized prospective study. Sixty patients undergoing hysterectomy were enrolled, with 30 patients in each group. Color flow Doppler (CFD) ultrasonography was employed to guide epidural catheter placement. The ultrasound-guided epidural technique was used for patients where challenges in identifying traditional landmarks for epidural space localization were anticipated. The procedure commenced with a spinal epidural technique. After sterile preparation and draping of the area, a curvilinear ultrasound transducer, encased in a sterile sheath, was used to locate the interspinous space. The primary outcome measure focused on flow visualization at different insertion levels. Secondary outcome measures included the duration of catheter implantation, intervertebral level of insertion, and dermatome sensory levels. The study also assessed the quality of epidural analgesia and patients' assessment of analgesic quality using a Verbal Numerical Rating Scale. The study reported a successful and predominantly safe outcome, with high success rates in flow visualization and effective anesthesia coverage. Flow visualization at the insertion and surrounding levels demonstrated a 100% success rate at all observed points. The Visual Numeric Rating Scale (VNRS) results indicated a median pain score of 2 with an interquartile range (IQR) of 2 - 3, showcasing a generally low level of post-procedural pain among the subjects, reflecting good quality post-operative analgesia. Regarding dermatome sensory levels after 2 hours, the distribution across various levels, including T4, T6, T7, T8, T10, and T12, exhibited a favorable outcome. The highest proportion was observed at T10 (68.3%), suggesting effective anesthesia coverage in the targeted areas. The study demonstrated comparable efficiency between the CFD-guided and blind techniques in terms of procedural aspects. However, notable distinctions were observed in patients' reported pain levels, with the CFD group experiencing lower pain compared to the blind technique group. Additionally, the study highlighted the association between CFD and improved procedural accuracy and safety. This study advocates for the integration of CFD into routine clinical practice to enhance procedural outcomes and patient safety during hysterectomy surgeries.

KELEMBAGAAN DAN KEWENANGAN PENGADILAN NIAGA TENTANG UPAYA HUKUM KEBERATAN TERHADAP PUTUSAN KOMISI PENGAWAS PERSAINGAN USAHA

Article 24A (5) of the 1945 Constitution regulates the composition, position, membership, and procedural law of the Supreme Court and subordinate judicial bodies. Initially limited to bankruptcy, postponement of debt payment obligations (PKPU), and commercial matters by Law Number 37 of 2004, the jurisdiction of the Commercial Court has expanded through other laws. This expansion raises two key issues: (1) The need for legal remedies for objections to decisions of the Competition Supervisory Commission (KPPU), and (2) The competence of the Commercial Court to address these objections. This research uses a normative juridical method, suggesting that legal remedies for objections to KPPU decisions should be regulated in a separate law, addressing decisions from institutions beyond the judiciary’s jurisdiction. The procedural aspects for contesting KPPU decisions, outlined in Article 45 of the Omnibus Law Number 6 of 2023, should first be determined within the competence of the Commercial Court as regulated by law. The current institutional arrangements and authority of the Commercial Court, as outlined in the Bankruptcy and PKPU Laws and laws on Intellectual Property Rights, should be revised through a dedicated Law on Commercial Courts. This law should define the court's structure, powers, procedural rules, and set time limits and sanctions for case resolution at both the Commercial Court and the Supreme Court.