Stand-alone Cases Research Articles

7-Year Efficacy and Safety of iStent inject Trabecular Micro-Bypass in Combined and Standalone Usage.

This study evaluated 7-year effectiveness and safety of second-generation trabecular micro-bypass implantation (iStent inject) either in combination with cataract surgery or as a standalone procedure (Combined or Standalone subgroups, respectively) in eyes with open-angle glaucoma. This prospective, non-randomized, unmasked, longitudinal study included 125 consecutive iStent inject cases of a single surgeon at a large German academic hospital. Patients had considerable preoperative disease burden, with mean intraocular pressure (IOP) of 23.5mmHg, 84.8% of eyes on ≥ 2 medications, and 38.4% of eyes with prior glaucoma surgery. IOP, medications, adverse events, and secondary surgeries were assessed through 7years in the Overall cohort and in Combined (n = 81) and Standalone (n = 44) subgroups. Over 7-year follow-up, mean IOP decreased by 36.2-40.0% in Overall eyes, 34.1-38.9% in Combined eyes, and 39.5-43.5% in Standalone eyes (p < 0.001 at all timepoints for all groups). Meanwhile, mean medications decreased by 59.3-71.3% in Overall eyes, 57.9-69.0% in Combined eyes, and 62.1-76.2% in Standalone eyes (p < 0.001 at all timepoints in all groups). At last follow-up (mean 77.4months; 92.8% of patients with last visit at 6 or 7years), 83.7% of Overall eyes, 82.3% of Combined eyes, and 86.4% of Standalone eyes had achieved ≥ 20% IOP reduction vs preoperative. At last follow-up vs preoperative, 100% of eyes in all groups had the same or lower IOP and 100% had the same or lower medication regimen. Safety outcomes were favorable, with no filtration surgeries and only 4.84% of eyes experiencing clinically significant visual field loss over 7years of follow-up. iStent inject implantation with or without phacoemulsification produced significant and durable 7-year reductions in IOP (~ 34-44% reduction) and medications (~ 58-76% reduction) while preventing filtering surgery in this cohort of patients with relatively high preoperative disease burden. Combined and Standalone cases had similarly favorable effectiveness and safety.

An Extremely Wideband Tightly Coupled Dipole Array With Shared-Aperture Configuration

The intent of this letter is to expand the tightly coupled dipole array (TCDA) concept in a shared-aperture configuration for high radiation efficiency and extremely wide bandwidth. Specifically, a high-band TCDA is deployed beneath the aperture of a low-band TCDA. With this configuration, the profile height keeps the same as that of a stand-alone low-band TCDA. It offers a thin λ <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">L</sub> /13.7 (or 1.7λ <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">H</sub> ) array with 23.2:1 bandwidth for active VSWR < 3, where λ <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">L</sub> and λ <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">H</sub> are the wavelengths at the lowest and highest frequencies of the operating frequency band. Although the shared-aperture configuration is profit for low profile and bandwidth extension, it causes cross-band coupling and deteriorates radiation performance. To solve this issue, the low-band TCDA is designed to be electromagnetic transparent to the high-band electromagnetic waves. The two TCDAs become immune to the cross-band interference and operate properly as in their stand-alone cases. An array prototype consisting of a 16 × 16 high-band array and an 8 × 8 low-band array is fabricated and measured. The measured radiation efficiency is demonstrated to be 77% on average across a 23.2:1 bandwidth.

Quantum Binary Field Multiplication with Optimized Toffoli Depth and Extension to Quantum Inversion

The Shor's algorithm can find solutions to the discrete logarithm problem on binary elliptic curves in polynomial time. A major challenge in implementing Shor's algorithm is the overhead of representing and performing arithmetic on binary elliptic curves using quantum circuits. Multiplication of binary fields is one of the critical operations in the context of elliptic curve arithmetic, and it is especially costly in the quantum setting. Our goal in this paper is to optimize quantum multiplication in the binary field. In the past, efforts to optimize quantum multiplication have centred on reducing the Toffoli gate count or qubits required. However, despite the fact that circuit depth is an important metric for indicating the performance of a quantum circuit, previous studies have lacked sufficient consideration for reducing circuit depth. Our approach to optimizing quantum multiplication differs from previous work in that we aim at reducing the Toffoli depth and full depth. To optimize quantum multiplication, we adopt the Karatsuba multiplication method which is based on the divide-and-conquer approach. In summary, we present an optimized quantum multiplication that has a Toffoli depth of one. Additionally, the full depth of the quantum circuit is also reduced thanks to our Toffoli depth optimization strategy. To demonstrate the effectiveness of our proposed method, we evaluate its performance using various metrics such as the qubit count, quantum gates, and circuit depth, as well as the qubits-depth product. These metrics provide insight into the resource requirements and complexity of the method. Our work achieves the lowest Toffoli depth, full depth, and the best trade-off performance for quantum multiplication. Further, our multiplication is more effective when not used in stand-alone cases. We show this effectiveness by using our multiplication to the Itoh-Tsujii algorithm-based inversion of F(x8+x4+x3+x+1).

Sustainable mobility strategies deconstructed: a taxonomy of urban vehicle access regulations

BackgroundIn recent decades, cities worldwide are increasingly adopting vehicle access policies and technologies to alleviate the negative externalities related to high car use in the urban built environments. As such, car-oriented infrastructures and mobility policies implemented post-World War II are giving way to sustainable mobility strategies that aim to make cities healthier, more livable and more inclusive for all.PurposeMost of these strategies are considered as stand-alone cases related to a specific environmental, political and social urban context. However, similarities and patterns between different strategies can provide information on the replicability of mobility strategies in other urban contexts.MethodsThrough a literature review, this paper illustrates the wide range of urban vehicle access regulations (UVAR) applied within sustainable mobility strategies. In addition, we critically examine the process from ideation over design and implementation to operation phase for 12 West-European cities and define what measures are combined to end up with a sustainable mobility strategy.ResultsThis results in a taxonomy of UVAR interventions, subdivided in three categories: spatial interventions, pricing aspects and regulatory measures. We also highlight a number of complementary supportive measures implemented to counter the often restrictive nature of UVAR.ResultsThe paper shows that the strategies highlighted in the case studies are an amalgam of different UVAR and supportive measures. As such, deconstructing various sustainable mobility strategies enables us to shed light on the available UVAR options cities can combine to define consistent and robust sustainable mobility strategies.

AxPPA: Approximate Parallel Prefix Adders

Addition units are widely used in many computational kernels of several error-tolerant applications such as machine learning and signal, image, and video processing. Besides their use as stand-alone, additions are essential building blocks for other math operations such as subtraction, comparison, multiplication, squaring, and division. The parallel prefix adders (PPAs) is among the fastest adders. It represents a parallel prefix graph consisting of the carry operator nodes, called prefix operators (POs). The PPAs, in particular, are among the fastest adders because they optimize the parallelization of the carry generation ( <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$G$ </tex-math></inline-formula> ) and propagation ( <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$P$ </tex-math></inline-formula> ). In this work, we introduce approximate PPAs (AxPPAs) by exploiting approximations in the POs. To evaluate our proposal for approximate POs (AxPOs), we generate the following AxPPAs, consisting of a set of four PPAs: approximate Brent–Kung (AxPPA-BK), approximate Kogge–Stone (AxPPA-KS), Ladner-Fischer (AxPPA-LF), and Sklansky (AxPPA-SK). We compare four AxPPA architectures with energy-efficient approximate adders (AxAs) [i.e., Copy, error-tolerant adder I (ETAI), lower-part OR adder (LOA), and Truncation (trunc)]. We tested them generically in stand-alone cases and embedded them in two important signal processing application kernels: a sum of squared differences (SSDs) video accelerator and a finite impulse response (FIR) filter kernel. The AxPPA-LF provides a new Pareto front in both energy-quality and area-quality results compared to state-of-the-art energy-efficient AxAs.

Stand-Alone Xen Gel Microstent Implantation Compared With Kahook Dual Blade Goniotomy.

Both Xen gel Microstent implantation and Kahook Dual Blade (KDB) goniotomy are safe and effective as stand-alone procedures, but the Xen Gel Microstent was associated with more postoperative interventions and achieved higher success at a lower intraocular pressure threshold. To evaluate outcomes of stand-alone Xen Gel Microstent implantation compared with stand-alone KDB goniotomy for moderate to severe glaucoma. A retrospective, single-center, case-series analysis comparing outcomes of Xen Gel Microstent implantation and KDB goniotomy stand-alone cases in 75 eyes. Primary outcomes included intraocular pressure (IOP) reduction, glaucoma medication reduction, surgical success, and complications. Surgical success was defined using IOP<21 mm Hg and IOP<18 mm Hg thresholds, with or without glaucoma medications, and without further glaucoma surgery. Subjects were followed for at least 24 months after surgery. Mean baseline IOP was comparable between the Xen Gel Microstent and KDB goniotomy groups (23.7±8.4 and 25.9±7.9 mm Hg, respectively, P =0.32). At 24 months after surgery, the mean IOP after Xen Gel Microstent was 14.7±3.2 mm Hg (32.7% reduction from baseline, P =0.018) and KDB goniotomy was 16.7±3.2 mm Hg (40.4% reduction from baseline, P =0.049). Although the mean IOP was significantly lower during the first month after Xen Gel Microstent implantation, no difference in mean IOP was observed between the 2 treatment groups at 24 months after surgery ( P =0.416). At 24 months after surgery, the percent reduction of IOP from baseline was not significantly different between the 2 groups. The mean reduction of glaucoma medications from baseline at 24 months was 1.69 drops after Xen Gel Microstent implantation ( P =.008) and 1.67 drops after KDB goniotomy ( P =0.038). Postoperative complications were nonvision-threatening and were not significantly different between the 2 groups ( P =0.550). Interventions not included with complications were needling performed in 21 (37%) of eyes in the Xen Gel Microstent group and Nd:YAG goniopuncture in 1 (5.6%) eye after KDB goniotomy. With an IOP threshold <21 mm Hg, surgical success was not significantly different between the 2 groups ( P =0.06). At a lower IOP threshold (<18 mm Hg), surgical success was higher after Xen Gel Microstent implantation compared with KDB goniotomy ( P =0.001). Both stand-alone Xen Gel Microstent implantation and KDB goniotomy can effectively and safely reduce IOP for moderate to severe glaucoma. The Xen Gel Microstent was associated with a higher need for postoperative interventions and achieved greater success at a lower IOP threshold.

Two-component doublet-triplet scalar dark matter stabilizing the electroweak vacuum

A two-component scalar dark matter scenario comprising an additional scalar doublet and a $Y=0$ scalar triplet is proposed. Key features of the ensuing dark matter phenomenology are highlighted with emphasis on interconversion between the two dark matter components. For suitable choices of the model parameters, we show that such interconversion can explain the observed relic abundance when the doublet dark matter component has mass in the desert region while the triplet component has sub-TeV mass. This finding is important in the context of such mass regions known to predict underabundant relic density for the stand-alone cases of the scalar doublet and triplet. In addition, we also show that the present scenario can stabilize the electroweak vacuum up to the Planck scale in the parameter space responsible for the requisite dark matter observables.

Biomechanical analysis of stand-alone lumbar interbody cages versus 360° constructs: an in vitro and finite element investigation.

Low fusion rates and cage subsidence are limitations of lumbar fixation with stand-alone interbody cages. Various approaches to interbody cage placement exist, yet the need for supplemental posterior fixation is not clear from clinical studies. Therefore, as prospective clinical studies are lacking, a comparison of segmental kinematics, cage properties, and load sharing on vertebral endplates is needed. This laboratory investigation evaluates the mechanical stability and biomechanical properties of various interbody fixation techniques by performing cadaveric and finite element (FE) modeling studies. An in vitro experiment using 7 fresh-frozen human cadavers was designed to test intact spines with 1) stand-alone lateral interbody cage constructs (lateral interbody fusion, LIF) and 2) LIF supplemented with posterior pedicle screw-rod fixation (360° constructs). FE and kinematic data were used to validate a ligamentous FE model of the lumbopelvic spine. The validated model was then used to evaluate the stability of stand-alone LIF, transforaminal lumbar interbody fusion (TLIF), and anterior lumbar interbody fusion (ALIF) cages with and without supplemental posterior fixation at the L4-5 level. The FE models of intact and instrumented cases were subjected to a 400-N compressive preload followed by an 8-Nm bending moment to simulate physiological flexion, extension, bending, and axial rotation. Segmental kinematics and load sharing at the inferior endplate were compared. The FE kinematic predictions were consistent with cadaveric data. The range of motion (ROM) in LIF was significantly lower than intact spines for both stand-alone and 360° constructs. The calculated reduction in motion with respect to intact spines for stand-alone constructs ranged from 43% to 66% for TLIF, 67%-82% for LIF, and 69%-86% for ALIF in flexion, extension, lateral bending, and axial rotation. In flexion and extension, the maximum reduction in motion was 70% for ALIF versus 81% in LIF for stand-alone cases. When supplemented with posterior fixation, the corresponding reduction in ROM was 76%-87% for TLIF, 86%-91% for LIF, and 90%-92% for ALIF. The addition of posterior instrumentation resulted in a significant reduction in peak stress at the superior endplate of the inferior segment in all scenarios. Stand-alone ALIF and LIF cages are most effective in providing stability in lateral bending and axial rotation and less so in flexion and extension. Supplemental posterior instrumentation improves stability for all interbody techniques. Comparative clinical data are needed to further define the indications for stand-alone cages in lumbar fusion surgery.

Computed Tomography Hounsfield Units as a Predictor of Reoperation and Graft Subsidence After Standalone and Multilevel Lateral Lumbar Interbody Fusion

Standalone single and multilevel lateral lumbar interbody fusion (LLIF) have been increasingly applied to treat degenerative spinal conditions in a less invasive fashion. Graft subsidence following LLIF is a known complication and has been associated with poor bone mineral density (BMD). Previous research has demonstrated the utility of computed tomography (CT) Hounsfield units (HUs) as a surrogate for BMD. In the present study, we investigated the relationship between the CT HUs and subsidence and reoperation after standalone and multilevel LLIF. A prospectively maintained single-institution database was retrospectively reviewed for LLIF patients from 2017 to 2020, including single and multilevel standalone cases with and without supplemental posterior fixation. Data on demographics, graft parameters, BMD determined by dual-energy x-ray absorptiometry, preoperative mean segmental CT HUs, and postoperative subsidence and reoperation were collected. We used 36-in. standing radiographs to measure the preoperative global sagittal alignment and disc height and subsidence at last follow-up. Subsidence was classified using the Marchi grading system corresponding to disc height loss: grade 0, 0%-24%; grade I, 25%-49%; grade II, 50%-74%; and grade III, 75%-100%. A total of 89 LLIF patients had met the study criteria, with a mean follow-up of 19.9 ± 13.9 months. Of the 54 patients who had undergone single-level LLIF, the mean segmental HUs were 152.0 ± 8.7 for 39 patients with grade 0 subsidence, 136.7 ± 10.4 for 9 with grade I subsidence, 133.9 ± 23.1 for 3 with grade II subsidence, and 119.9 ± 30.9 for 3 with grade III subsidence (P= 0.032). Of the 96 instrumented levels in the 35 patients who had undergone multilevel LLIF, 85, 9, 1, and 1 level had had grade 0, grade I, grade II, and grade III subsidence, with no differences in the HU levels. On multivariate logistic regression, increased CT HU levels were independently associated with a decreased risk of reoperation after both single-level and multilevel LLIF (odds ratio, 0.98; 95% confidence interval, 0.97-0.99; P= 0.044; and odds ratio, 0.97; 95% confidence interval, 0.94-0.99; P= 0.017, respectively). Overall, the BMD determined using dual-energy x-ray absorptiometry was not associated with graft subsidence or reoperation. Using a receiver operating characteristic curve to separate the patients who had and had not required reoperation, the threshold HU level determined for single-level and multilevel LLIF was 131.4 (sensitivity, 0.62; specificity 0.65) and 131.0 (sensitivity, 0.67; specificity, 0.63), respectively. Lower CT HUs were independently associated with an increased risk of graft subsidence after single-level LLIF. In addition, lower CT HUs significantly increased the risk of reoperation after both single and multilevel LLIF with a critical threshold of 131 HUs. The determination of the preoperative CT HUs might provide a more robust gauge of local bone quality and the likelihood of graft subsidence requiring reoperation following LLIF than overall BMD.

The Role of Hounsfield Unit in Intraoperative Endplate Violation and Delayed Cage Subsidence with Oblique Lateral Interbody Fusion.

Retrospective clinical case series. To investigate the risk factors for intraoperative endplate violations and delayed cage subsidence after oblique lateral interbody fusion (OLIF) surgery. Secondly, to examine whether low Hounsfield unit (HU) values at different regions of the endplate are associated with intraoperative endplate violation or delayed cage subsidence. 61 patients (aged 65.1 ± 9.5years; 107 segments) who underwent OLIF with or without posterior instrumentation from May 2015 to April 2019 were retrospectively studied. Intraoperative endplate violation was measured on sagittal reconstructed computerized tomography (CT) images immediate postoperatively, while delayed cage subsidence was evaluated using lateral radiographs and defined at 1-month follow-up or later. Demographic information and clinical parameters such as age, body mass index, bone mineral density, number of surgical levels, cage dimension, disc height restoration, visual analogue scale (VAS), and HU at different regions of the endplate were obtained. Total postoperative cage subsidence was identified in 45 surgical levels (42.0%) in 26 patients (42.6%) up till postoperative 1-year follow-up. Low HU value at the ipsilateral epiphyseal ring was an independent risk factor for intraoperative endplate violation (P = .008) with a cut-off value of 326.21 HUs. Low HU values at the central endplate had a significant correlation with delayed cage subsidence in stand-alone cases (P = .013) with a cut-off value of 296.42 HUs. VAS scores were not different at 1 week postoperatively in cases with or without intraoperative endplate violation (3.12 ± .73 vs 2.89 ± .72, P = .166) and showed no difference at 1year with or without delayed cage subsidence (1.95 ± .60 vs 2.26 ± .85, P = .173). Intraoperative endplate violation and delayed cage subsidence are not uncommon with OLIF surgery. HUs of the endplate are good predictors for intraoperative endplate violation and cage subsidence since they can represent the regional bone quality of the endplate in contact with the implant. VAS improvements were not affected by intraoperative endplate violation or delayed cage subsidence at 1-year follow-up. Level III.

Production of Sustainable Aviation Fuels in Petroleum Refineries: Evaluation of New Bio-Refinery Concepts

The potential for petroleum refineries (PRs) to integrate sustainable aviation fuel (SAF) technologies is manifold, unlike with other existing industrial infrastructures that lack such technical similarities. A midsize PR with a crude oil capacity of 120,000 barrels per day was analyzed in this study to determine the feasibility of integrating five well-known lignocellulosic SAF technologies, namely, Virent’s BioForming (VB), alcohol to jet (ATJ), direct sugar to hydrocarbon (DSHC), fast pyrolysis (FP), and gasification and Fischer–Tropsch (GFT) methods, as well as one novel concept referred to as integrated carbonization-gasification-Fischer–Tropsch (ICGFT). The following three integrated scenarios were studied to derive the costs and environmental impact reductions: sharing of infrastructures from outside battery limits (OSBL), co-processing of SAF technology-derived intermediates with PR-derived gas oil inside battery limits (ISBL) and repurposing of an idle or shutdown PR. Sharing OSBL infrastructures resulted in reductions of the minimum fuel selling price (MFSP) by 3–14% relative to the corresponding standalone cases. Co-processing of intermediate products such as VB-derived long chain hydrocarbons, ATJ-derived ethanol, DSHC-derived farnesene, pyrolysis-derived bio-oil, and GFT-derived FT products reduced the MFSP by 10–19% from corresponding standalone cases. Moreover, repurposing scenarios reduced the costs by 16–34%. Greenhouse gas (GHG) estimations showed that 17 of 21 integrated scenarios resulted in GHG savings (7–92%). Lignocellulosic SAF technologies are limited by low fuel yields, which are governed by the high oxygen content of the feedstock. However, ICGFT was found to be advantageous in terms of fuel production at a maximized fuel yield.

75. Evaluation of cage subsidence in standalone lateral lumbar interbody fusion: Novel 3D printed titanium versus polyetheretherketone (PEEK) cage

<h3>BACKGROUND CONTEXT</h3> Lateral lumbar interbody fusion (LLIF) is a common treatment for degenerative spine diseases. However, implant subsidence is a prevalent complication especially in stand-alone cases, which can negatively affect patient outcomes. The novel 3D-printed titanium (Ti) cages with porous architecture are reportedly more osteoconductive, maximize bone-to-implant contact, and have more compressive shear strength under physical force. Nevertheless, the subsidence rate of these new Ti cages compared to polyetheretherketone (PEEK) cages has not been investigated in standalone cases. <h3>PURPOSE</h3> This study aims to compare the early subsidence rate (6-12 months) of standalone Ti vs PEEK interbody cages after LLIF. <h3>STUDY DESIGN/SETTING</h3> Retrospective study. <h3>PATIENT SAMPLE</h3> A total of 113 patients and 186 levels. <h3>OUTCOME MEASURES</h3> Early cage subsidence. <h3>METHODS</h3> A retrospective study of 113 patients (186 levels) who underwent LLIF surgery with Ti or PEEK cages was conducted. Early subsidence was measured in each treated level using the Marchi et al. classification in radiographs or CT scans acquired at 6-12 months follow-up. Multivariate logistic regression analyses with generalized mixed models, setting subsidence as the outcome variable and including cage type (Ti vs PEEK) as well as significant and trending variables (p<0.10) in univariate analyses, was conducted. <h3>RESULTS</h3> In total, 51 female and 62 male patients were analyzed. The median (IQR) age at surgery was 60.0 (51.0-70.0) years. Of the 186 levels, 119 levels were treated using PEEK and 67 levels with Ti cages. The overall subsidence rate for Grades I-III was significantly less in the Ti vs the PEEK group (p=0.003). For high-grade subsidence (Grade II or III), Ti cages also demonstrated a subsidence rate (3.0%) that was significantly less compared to PEEK cages (18.5%)(p= 0.002). Multivariate analysis showed that patients treated with Ti cages were less likely to develop severe subsidence compared to those treated with PEEK (OR= 0.05, 95%CI= 0.01, 0.30)(p= 0.001). <h3>CONCLUSIONS</h3> Our study demonstrated that 3D-printed novel Ti cages had a significantly lower early subsidence rate compared to PEEK cages in standalone LLIF patients. <h3>FDA DEVICE/DRUG STATUS</h3> Titanium and PEEK Cage (Approved for this indication).

Saksi Mahkota dalam pembuktian pidana kasus Narkotika

A crown witness is a witness who comes or is taken from one of the suspects or other defendants who jointly committed a criminal act, and in which case the witness is given a crown. The crown given to a witness with the status of a defendant is in the form of negating the prosecution of his case or the imposition of a very light charge if the case is submitted to court or is forgiven for wrongdoing. The formulation of the problem in this research is the strength of the testimony of the crown witness in proving narcotics trafficking and the existence of human rights if he is placed as the crown witness in proving the narcotics trafficking. This type of research is an empirical juridical research, namely an integrative and conceptual method of analysis to identify, process and analyze documents to understand the meaning, significance, and relevance that produces descriptive data in the form of written or spoken words from the people or observed behavior. . The results showed that the testimony of the crown witness was considered strong and as strong as the testimony of other witnesses because he was also under oath. The strength of the testimony of the crown witness in proving the narcotics trade in his position as the crown witness has not been regulated separately in the existing law. Crown witness itself is a term that can be interpreted as a defendant who has the status of being a witness in the case of another defendant who has both committed a criminal act, namely in the event that the case files are separated (splitsing) on the separation of the case files during examination based on Article 141 of the Criminal Procedure Code. Human rights are very much considered in the judicial process when the crown witnesses give information such as the absence of intervention that makes the crown witnesses depressed. The existence of human rights when placed as a crown witness in proving narcotics trafficking, where the crown witness is presented before the court because of the splitsing mechanism regulated in Article 142 of the Criminal Procedure Code (KUHAP). By splitting the case files into several stand-alone cases, between one defendant and another defendant, each of them can be used as a mutual witness. Meanwhile, if they are combined in one file and in a trial examination, they cannot be used as mutual witnesses between one another. It is recommended to the Government, especially the legislators, that if indeed this crown witness is an important tool to reveal a legal act, then it should make legislation that specifically regulates the existence of Crown Witness.

Outcomes of Concurrent Functional Endoscopic Sinus Surgery and Rhinoplasty: A Meta-analysis

Chronic rhinosinusitis (CRS) and functional nasal airway obstruction are common but distinct medical problems which affect quality of life. In certain instances, patients often benefit from concomitant functional septorhinoplasty, or elect for cosmetic rhinoplasty, in addition to functional endoscopic sinus surgery (FESS) and prefer combining procedures. Determining outcomes of combined surgery is important when discussing risks and benefits with patients. A thorough literature search of articles published in PubMed, Ovid MEDLINE, and Cochrane databases. Patients were categorized as either having FESS or rhinoplasty alone or combined. Binary random-effects models were applied to calculate odds ratios (ORs) for outcomes including complications, recurrence, and satisfaction. Of the 55 screened articles, 6 were included in the analysis, and of these, 6 (405 patients), 2 (90 patients), 4 (290 patients), and 3 (190 patients) provided data for postoperative complications, recurrence of CRS symptoms, revision rates, and patient satisfaction, respectively. Major complications were observed in 11 (5.8%) total combined cases, 0 (0%) FESS cases, and 6 (3.5%) rhinoplasty cases with no statistical difference between combined cases and rhinoplasties (OR 1.37, 95% CI 0.45-4.16, p = 0.58). Recurrence of CRS symptoms was noted in 35.6% combined cases and 28.9% FESS cases (OR 1.42, 95% CI 0.55-3.64, p = 0.47). There was no observed difference in revision rates between combined and isolated rhinoplasties (OR 1.00, 95% CI 0.43-2.32, p = 1). Lastly, 91.6% of patients were satisfied with results of combined cases compared to 87.4% of patients in standalone cases (OR 1.57, 95% CI 0.61-4.03, p = 0.35). Aggregate evidence demonstrates similar risk in complication rates in combined surgical cases compared to stand-alone rhinoplasty. There appears to be no significant difference in recurrence of symptoms, revision rates or patient satisfaction.

Reputations and corruption: Bell Pottinger in South Africa

Learning outcomes The case can be used in strategic management, international business or ethics courses. In strategic management courses, students will be able to identify political relationships as sources of a firm’s competitive advantage. Students will also understand the role of ethics in the firm’s competitive advantage. In international business courses, the students will be able to analyze the role that corruption and bribery play in the analysis of a country’s institutions. Students will also understand how corruption in a host country influences a firms’ decision to internationalize. Finally, students will understand the challenges that firms face when serving customers in other countries. In ethics courses, students will understand the nature of state/business corruption, i.e. the abuse of public office for private gain and the concept of state capture, i.e. managers controlling the political system for their advantage. Students will be able to analyze the decision of whether to collaborate with unethical partners or customers. Case overview/synopsis Bell Pottinger Private (BPP) was a British public relations (PR) firm with a successful but questionable reputation of helping famous critical figures and despots improve their public image. In 2016, Lord Tim Bell and the other leaders of BPP were asked to create a PR campaign for the Gupta family. The Guptas were a group of businessmen headed by three brothers who migrated from India to South Africa in the early 1990s. By the 2010s, they had built a business empire allegedly thanks to a corrupt relationship with the President of South Africa, Jacob Zuma and his family. The press and prosecutors were increasing their investigations on these relations. The case has two parts, which address two separate challenges and can be taught as standalone cases or in a sequence in two sessions. Complexity academic level MBA and Executive Education. Supplementary materials Teaching notes are available for educators only. Subject code CSS 5: International business.

Rate of failure of indirect decompression in lateral single-position surgery: clinical results.

Lateral single-position surgery (LSPS) of the lumbar spine generally involves anterior lumbar interbody fusion (ALIF) performed in the lateral position (LALIF) at L5-S1 with or without lateral lumbar interbody fusion (LLIF) at L4-5 and above, followed by bilateral pedicle screw fixation (PSF) without repositioning the patient. One obstacle to more widespread adoption of LSPS is the perceived need for direct decompression of the neural elements, which typically requires flipping the patient to the prone position. The purpose of this study was to examine the rate of failure of indirect decompression in a cohort of patients undergoing LSPS from L4 to S1. A multicenter, post hoc analysis was undertaken from prospectively collected data of patients at 3 institutions who underwent LALIF at L5-S1 with or without LLIF at L4-5 with bilateral PSF in the lateral decubitus position between March 2018 and March 2020. Inclusion criteria were symptoms of radiculopathy or neurogenic claudication, central or foraminal stenosis (regardless of degree or etiology), and indication for interbody fusion at L5-S1 or L4-S1. Patients with back pain only; those who were younger than 18 years; those with tumor, trauma, or suspicion of infection; those needing revision surgery; and patients who required greater than 2 levels of fusion were excluded. Baseline patient demographic information and surgical data were collected and analyzed. The number of patients in whom indirect decompression failed was recorded and each individual case of failure was analyzed. A total of 178 consecutive patients underwent LSPS during the time period (105 patients underwent LALIF at L5-S1 and 73 patients underwent LALIF at L5-S1 with LLIF at L4-5). The mean follow-up duration was 10.9 ± 6.5 months. Bilateral PSF was placed with the patient in the lateral decubitus position in 149 patients, and there were 29 stand-alone cases. The mean case time was 101.9 ± 41.5 minutes: 79.3 minutes for single-level cases and 134.5 minutes for 2-level cases. Three patients (1.7%) required reoperation for failure of indirect decompression. The rate of failure of indirect decompression in LSPS from L4 to S1 is exceedingly low. This low risk of failure should be weighed against the risks associated with direct decompression as well as the risks of the extra operative time needed to perform this decompression.

Design, economic evaluation, and market uncertainty analysis of LOHC-based, CO2 free, hydrogen delivery systems

As the number of new candidates for liquid organic hydrogen carriers (LOHC) that are being identified and experimentally tested is increasing, so does the requirement to analytically evaluate large scale hydrogen delivery processes which will utilize these chemicals. Here, we detail a technological evaluation, cost estimation, and market performance analysis of a large-scale (1000 m3/h H2), CO2 emission-free, LOHC dehydrogenation system and the accompanying costs of supply logistics. Four reversible LOHC systems, Eutectic biphenyl/diphenylmethane mixture (EUT), 2-(N-Methylbenzyl)pyridine (MBP), N-phenylcarbazole (NPC), and N-ethylcarbazole (NEC) were evaluated in stand-alone cases, with the fifth case utilizing all four in a temperature-cascade (TC) process intensification. Total capital investments for this H2 output scale were found to range from 24 to 44 mil USD, with shipping cost and LOHC price determined to be main parameters affecting the process economics. Market performance results show that for the 3.5 USD/kg H2 selling price, the purchase prices of LOHC chemicals must be 5.44, 4.74, 4.01, 4.12 USD/kg for EUT, MBP, NPC and NEC respectively. Finally, the TC market operating and market performance was quantified and market conditions for justifiable investment in such a system were defined.

Assessing the feasibility of blockchain technology in industries: evidence from Turkey

PurposeThe objective of this study is to assess quantitatively how feasible blockchain is for various industries, such as logistics and supply chain, health, energy, finance, automotive, pharmaceutical and agriculture and food using a comprehensive list of indicators.Design/methodology/approachA decision aid was applied to the problem of identifying the feasibility of blockchain in Turkish industries. To this end, first, a set of indicators was identified. Then, the fuzzy AHP and fuzzy TOPSIS were utilized to assess the feasibility comparatively using the data gathered from a group of experts. Finally, a scenario analysis was conducted to ensure the consistency of our evaluation.FindingsThe findings of this study suggest that comparatively, logistics and supply chain, finance and health industries are the most feasible industries for blockchain. This study further suggests that blockchain is the least feasible for the automotive industry compared to the rest of the identified industries.Research limitations/implicationsIt is cumbersome to find out the respondents who have sufficient knowledge of both blockchain and the identified industries. Even if we took the utmost care in identifying the right respondents, we limited our search to the biggest industrial hubs of Turkey.Practical implicationsThe findings of this research may help various decision-makers employed in governments, conglomerates, software and consulting firms and national research institutions make more informed decisions and allocate their resources more effectively.Originality/valueTo this date, the current studies have solely investigated possible research opportunities in blockchain and demonstrated several blockchain applications in stand-alone cases. To the best of our knowledge, however, no single study exists that evaluates the feasibility of blockchain comparatively and holistically among a group of industries using various indicators.

Single-Epoch, Single-Frequency Multi-GNSS L5 RTK under High-Elevation Masking.

The Japanese Quasi-Zenith Satellite System (QZSS) satellite system has placed in orbit four satellites by October 2017. The Indian Regional Navigation Satellite System (IRNSS) system has launched the new satellite IRNNSS-11 in April 2018, completing seven operational satellites. Together with the GPS block IIF satellites and the Galileo satellites, four different global navigation satellite systems (GNSSs) are providing precise L5 signals on the frequency of 1176.45 MHz. In this contribution, we challenge the strength of the multi-GNSS model by analysing its single-frequency (L5), single-epoch (instantaneous) precise positioning capabilities under high-elevation masking (up to 40 degrees). With more satellites available, multi-GNSS real time kinematic (RTK) positioning is possible using L5-only signals with a high customary elevation mask. This helps to enable positioning in areas with constrained measurement geometry, and could significantly reduce the multipath effects in difficult measurement environments like urban canyons and mountainous areas. In this study, benefiting from the location of the Asia–Australia area, instantaneous multi-GNSS L5 RTK analysis is performed with respect to the ambiguity resolution and positioning performance. Formal results are shown and discussed for baselines located in different grids covering Australia, part of the Pacific Ocean, Indian Ocean and Asia, and empirical analysis is given for two baselines in Perth, Australia. Compared to the stand-alone cases, for baselines in Perth, it is shown that combining L5 signals from GPS/Galileo/QZSS/IRNSS significantly improves both the ambiguity success rates (ASR) and the positioning performance under high elevation mask. While the average single-system ASR is under 50% even with a low elevation mask of 10 degrees, combining all the four systems increases the ASR to above 95% under an elevation cut-off angles of 40 degrees. With an elevation mask of 40 degrees, using satellites from one system does not allow for meaningful positioning solutions of more than 8 h within the test day, while mm-to-cm level ambiguity-fixed standard deviations could be obtained based on the positioning results of almost the entire day when combining all the four systems. In addition to that, simulation was also performed for receivers with larger signal standard deviations, i.e., for low-cost receivers or receivers located in environments with larger multipath.

Progressive disclosure cases: The design and evaluation of use in multiple therapeutics courses

Background and purposeCase-based learning is used frequently throughout pharmacy education. Although beneficial, stand-alone cases may result in segmented learning that does not simulate realistic longitudinal patient care. We report the development, implementation, and evaluation of a longitudinal progressive disclosure case surrounding a single patient spanning two different therapeutics courses. Educational activity and settingA patient case was developed surrounding topics in two third professional year therapeutics courses occurring sequentially in the same semester. Changes to the patient's status were provided to students longitudinally via “disclosures.” Students were assessed via quizzes and written assessment and plans. Students completed four perceptions of confidence surveys via a four-point Likert Scale. Surveys included questions surrounding confidence in areas of the pharmacists’ patient care process (PPCP) before and after courses utilizing the progressive disclosure case. Case assessment grades were used to evaluate the impact on student performance on course examinations. Students also completed a survey on final perceptions of the activity. FindingsSeventy students were enrolled in the two courses participating in the progressive disclosure case and there were 50 (71.4%) matched, completed surveys completed for analysis. Significant improvements were seen in several questions surrounding confidence in the areas of the PPCP between the beginning and conclusion of courses that contained the progressive disclosure case. No correlation between case activity grades and examination performance was found. Discussion and conclusionOverall, student confidence in patient care skills associated with information collection, assessment, plan design, and monitoring improved with the use of progressive disclosure cases within two sequential therapeutics courses.