Search Results (60)

Background/Objectives: The placement of central venous access devices, including peripherally inserted central catheters (PICCs) and PICC-PORTs, is a routine procedure in oncology care. Usually associated with limited physical pain, these procedures may nevertheless generate significant anxiety and negatively influence the overall procedural experience. Virtual reality (VR) has emerged as a non-pharmacological intervention capable of modulating attentional and emotional responses during medical procedures; however, evidence in adult oncology patients undergoing vascular access placement remains scarce. The aim of this study is to evaluate the effect of VR on an oncological patient’s overall procedural experience. Methods: This manuscript outlines the design and methodology of a prospective, single-centre randomised controlled trial. Adult oncology patients scheduled for PICC/PICC-PORT placement are randomised to receive standard care alone or standard care combined with an immersive VR intervention delivered via a head-mounted display during the procedure under pragmatic, real-world clinical conditions. The primary outcome is a composite patient-reported procedural experience endpoint, assessed through a non-aggregated framework encompassing procedural anxiety, comfort, satisfaction and procedural tolerability. Procedural anxiety constitutes the main quantitative driver; the remaining domains are analysed as individual component dimensions and interpreted jointly to contextualise the overall experience. Secondary outcomes include procedural pain, physiological parameters and procedural characteristics. A mixed-methods approach integrates quantitative assessment with qualitative phenomenological analysis. Results: The study is expected to provide methodological and clinical insight into the role of immersive VR in improving procedural experience and support future multicentre trials. Conclusions: This trial will contribute to the expanding field of digital and immersive health technologies by evaluating VR as a patient-centred adjunct intervention in oncological procedural care using a predefined patient-reported experience-based primary endpoint. The protocol has been submitted to ClinicalTrials.gov with the registration number NCT07384741. Full article

Protected areas are increasingly expected to reconcile biodiversity conservation with socio-economic sustainability, yet operational tools for assessing local sustainability are limited. This study develops a replicable viability index as an operationalization of socio-economic sustainability at the settlement scale, focusing on the capacity of rural communities to maintain demographic balance and housing dynamics over time. The framework was applied to the West Estonian Archipelago Biosphere Reserve (WEABR), an inhabited UNESCO “Man and the Biosphere” site. Using harmonized census data from 1979 to 2021, the index combines three village-level binary indicators: population dynamics, residential construction activity, and demographic balance. Binary scoring reduces statistical volatility in small settlements and enables comparison across time. Approximately 60% of rural settlements remained viable over four decades, while highly viable settlements declined from 14% to 7%. Population stabilization increased, but ageing intensified and new construction decreased. Viability concentrates near urban centres, ports, transportation corridors, and coastal areas, while inland peripheral villages stagnate. Compared with mainland rural Estonia, WEABR shows a relatively resilient middle tier of viable settlements. The framework provides a transferable tool for monitoring settlement level socio-economic sustainability in inhabited protected areas. Full article

Background/Objectives: This study aimed to determine the inguinal hernia recurrence rate after transabdominal preperitoneal (TAPP) repair, particularly considering the effect of simultaneous umbilical hernia repair. The secondary aim was to assess whether closing the 10 mm midline supraumbilical port-site fascia affects the incidence of trocar-site hernia (TSH) following inguinal TAPP. Methods: We reviewed medical records of consecutive patients undergoing inguinal TAPP at the Department of Surgery, University Hospital Centre Zagreb, between 1 January 2014 and 30 June 2022, and supplemented the data with telephone follow-up. Demographic, clinical, and operative variables were compared between patients who did and did not report inguinal hernia recurrence. Patients were also grouped by operating surgeon to compare TSH rates. Surgeon A routinely closed the 10 mm supraumbilical fascial defect with a single suture, while Surgeon B mostly did not, deciding on a case-by-case basis. Results: The analysis included 281 patients with a median follow-up of 60 months. The overall recurrence rate was 10.6%. Baseline demographic and clinical characteristics did not differ significantly between patients who reported recurrence and those who did not. A prior hernia repair was more common in the recurrence group (34.1% vs. 17.2%; p = 0.007). Concomitant umbilical hernia repair was performed in 12.5% of cases. Patient-reported recurrence was higher after combined TAPP and umbilical hernioplasty than after TAPP alone (14.3% vs. 12.2%), but this difference was not statistically significant (p = 0.784). Surgeon A had a lower observed TSH rate than Surgeon B (1.0% vs. 3.6%), although this difference did not reach statistical significance (p = 0.242). Conclusions: Concurrent TAPP and umbilical hernioplasty is not associated with a higher recurrence rate, but further research on a larger cohort is necessary. Routine closure of the 10 mm midline supraumbilical fascial defect could reduce the TSH rate, although the difference was not statistically significant. The side of the hernia does not influence recurrence after TAPP. Full article

In this study, using global liner shipping schedules, UNCTAD’s Port Liner Shipping Connectivity Index and Liner Shipping Bilateral Connectivity Index, together with bilateral trade-value data for 2022–2024, we construct a multilayer weighted port-to-port network that explicitly embeds port-level cargo-handling and service organisation capabilities, as well as demand-side routing pressure, into node and edge weights. Building on this network, we apply CONCOR-based structural-equivalence analysis to delineate functionally homogeneous port clusters, and adopt a structural role identification framework that combines multi-indicator connectivity metrics with Rank-Sum Ratio–entropy weighting and Probit-based binning to classify ports into high-efficiency core, bridge-control, and free-form bridge roles, thereby tracing the reconfiguration of cluster-level functional structures before and after the Red Sea crisis. Empirically, the clustering identifies four persistent communities—the Intertropical Maritime Hub Corridor (IMHC), Pacific Rim Mega-Port Agglomeration (PRMPA), Southern Commodity Export Gateway (SCEG), and Euro-Asian Intermodal Chokepoints (EAIC)—and reveals a marked spatial and functional reorganisation between 2022 and 2024. IMHC expands from 96 to 113 ports and SCEG from 33 to 56, whereas EAIC contracts from 27 to 10 nodes as gateway functions are reallocated across clusters, and the combined share of bridge-control and free-form bridge ports increases from 9.6% to 15.5% of all nodes, demonstrating a thicker functional backbone under rerouting pressures. Spatially, IMHC extends from a Mediterranean-centred configuration into tropical, trans-equatorial routes; PRMPA consolidates its role as the densest trans-Pacific belt; SCEG evolves from a commodity-based export gateway into a cross-regional Southern Hemisphere hub; and EAIC reorients from an Atlantic-dominated structure towards Eurasian corridors and emerging bypass routes. Functionally, Singapore, Rotterdam, and Shanghai remain dominant high-efficiency cores, while several Mediterranean and Red Sea ports (e.g., Jeddah, Alexandria) lose centrality as East and Southeast Asian nodes gain prominence; bridge-control functions are increasingly taken up by European and East Asian hubs (e.g., Antwerp, Hamburg, Busan, Kobe), acting as secondary transshipment buffers; and free-form bridge ports such as Manila, Haiphong, and Genoa strengthen their roles as elastic connectors that enhance intra-cluster cohesion and provide redundancy for inter-cluster rerouting. Overall, these patterns show that resilience under the Red Sea crisis is expressed through the cluster-level rebalancing of core–control–bridge roles, suggesting that port managers should prioritise parallel gateways, short-sea and coastal buffers, and sea–land intermodality within clusters when designing capacity expansion, hinterland access, and rerouting strategies. Full article

Ports often act as bottlenecks in import cycles. Yet feasibility assessments of port–dry port systems still privilege distance/location over the process dynamics that generate time and cost. This paper proposes a process-centred feasibility method that links process analysis and reengineering, operational cycle design, and economics. We map AS-IS/TO-BE activities, design shuttle-train operations between port and dry port, and estimate costs via a time-driven approach aligned with TDABC. The method is applied to the Port of Genoa—Rivalta Scrivia dry port. Consolidating containers to a single inland destination and relocating customs clearance to the dry port via Fast Corridor stabilises yard operations, removes re-handling in the port-to-dry-port cycle, reduces dwell, and improves train formation and reliability. Under these conditions, the process-based configuration becomes time- and cost-competitive vis-à-vis all-road and conventional block-train baselines for relevant inland destinations. This paper reframes feasibility from a distance-based view to a process, cycle, and economics logic, offering managerial guidance and policy implications on regulatory enablers that unlock dry-port benefits. Full article

The port of Gaženica, managed by the Port Authority of Zadar, is open to public traffic of special economic interest to the Republic of Croatia. Situated outside Zadar’s city centre, with convenient access to the airport and A1 highway, this port presents significant opportunities for Zadar County’s economic growth. While also serving as a cargo and fishing port, as the second-largest passenger port in Croatia, the port of Gaženica prioritises the development of cruise ship traffic. The expansion of intermodal traffic is being facilitated through the development of a multipurpose terminal to accommodate general, roll-on/roll-off, and containerised cargo (full and empty containers). The rising number of passenger ships—particularly cruise ships—along with the increasing passenger, vehicle, and cargo traffic, poses a significant risk of pollution due to dust, noise, greenhouse gases, and other pollutants. Considering these risks, the use of alternative energy sources, decarbonisation of maritime transport, the separation of waste by type, and the proper handling and disposal of ship waste are of utmost importance. The aim of this study is to present and analyse the green transition process of the port of Gaženica through the results that have been achieved or are yet to be achieved through the implementation of green projects by the Port Authority of Zadar. For this purpose, a mixed-methods approach combining project analysis and the qualitative analysis of emissions data is used. It is important to highlight that the method of interviews with relevant representatives of institutions involved in the project was also used to gain insight into financial and infrastructural challenges, the accessibility of certain data, and potential improvements in implementation. The research results indicate that the port of Gaženica has completed four green projects, while another four are currently being implemented, with their completion expected by 2026. The research concludes that it is necessary to strengthen environmental awareness regarding proper waste disposal among all stakeholders in maritime transport, including the local community, businesses, and local authorities. The results demonstrate a need to focus on certification with the aim of strengthening the green transition process through involvement in the EcoPorts and Green Award certification schemes. It is also necessary to actively improve the public availability of data from the base station in the port of Gaženica to inform the public about environmental impacts in real time (24/7) while facilitating data collection for statistical reporting purposes. Full article

Launched in 2013, China’s Belt and Road Initiative (BRI) was originally devised to link East Asia and Europe through a network of physical and digital infrastructure. This article analyses the BRI’s development in the European context by offering a comparative analysis of 727 BRI and BRI-like projects within 46 European countries from 2005 to 2021. The analysis considers projects’ location, typology, status, and the main enterprises involved in each project. According to our results, there is a “two-speed Europe”. Indeed, while the vast majority of projects are included in the Digital Silk Road (e.g., telecommunication, transfer technology, data centre, 5G, fintech) and are located in North-Western Europe, traditional investments in infrastructure (e.g., ports, roads, railways, SEZ) are concentrated in South-Eastern Europe and the Balkan countries. While North-Western Europe is particularly concerned about cyber security and data protection issues, various South-Eastern European countries look favorably upon the development opportunities offered by the BRI. The BRI is clearly different from the Western approach to development (based on competition and economic liberalism) and integration (based on treaties). The BRI approach—including its platform, leveraging political flexibility, economic pragmatism, ability to mobilize resources, and ability to create synergies between state and business—could take advantage of the flaws of the European integration process. The BRI, with its strengths as well as weaknesses, represents an opportunity for the EU to understand the need for greater economic and political foresight, social cohesion, and economic flexibility to meet the development needs of its member countries. China, too, can draw inspiration from cooperating with EU countries on how to improve the reception of its investment initiatives by focusing on reciprocity, security guarantees, and protection of rights and the environment. Full article

Mean flow velocities and the corresponding turbulence fluctuation velocities were measured within the suction port of a standard twin-screw compressor using LDV and PIV optical techniques. Time-resolved velocity measurements were carried out over a time window of 1° at a rotor speed of 1000 rpm, a pressure ratio of 1, and an air temperature of 55 °C. Detailed LDV measurements revealed a very stable and slow inflow, with almost no influence from rotor movements except near the rotors, where a more complex flow formed in the suction port. The axial velocity near the rotors exhibited wavy profiles, while the horizontal velocity showed a rotational flow motion around the centre of the port. The turbulence results showed uniform distributions and were independent of the rotors’ motion, even near the rotors. PIV measurements confirmed that there is no rotor movement influence on the inflow structure and revealed complex flow structures, with a crossflow dominated by a main flow stream and two counter-rotating vortices in the X-Y plane; in the Y-Z plane, the presence of a strong horizonal stream was observed away from the suction port, which turned downward vertically near the entrance of the port. The corresponding turbulence results in both planes showed uniform distributions independent of rotor motions that were similar in all directions. Full article

Background and Objectives: Robotic-assisted partial nephrectomy (RAPN) is a preferred minimally invasive option for renal tumours, but its use in highly complex cases (RENAL score ≥ 9) remains underexplored. Only four Asian countries, India, China, South Korea, and Japan, have published studies on RAPN for complex kidney tumours, highlighting limited evidence. The aim of this study is to assess the perioperative, functional, and oncological effects of RAPN for complex renal tumours at a single tertiary centre in Malaysia. Materials and Methods: Patient demographics, tumour characteristics, perioperative parameters, and postoperative results were collected through a retrospective review that was conducted on 35 patients who had undergone RAPN between January 2023 and June 2024. The outcomes were analyzed using descriptive statistics, correlation analysis, and comparative tests between surgical approaches (transperitoneal vs. retroperitoneal). Results: Of the 35 patients, all had high-complexity tumours. RAPN achieved a “trifecta” outcome in 88.6% of patients. Significantly lower intraoperative blood loss is associated with the retroperitoneal approach in comparison with the transperitoneal approach, whereas other perioperative parameters, which include warm ischaemia time, did not show any significant differences. No positive surgical margins were observed, and no local recurrences or port-site metastases were detected during a mean follow-up of 11.31 ± 5.78 months. Postoperative changes in renal function were negligible, with a mean creatinine change of 5.69 ± 20.39 µmol/L. Conclusions: RAPN is a safe and effective option for complex renal tumours, offering excellent functional and oncological outcomes. The choice between transperitoneal and retroperitoneal approaches should be tailored to tumour characteristics for optimal surgical outcomes. This single-centre Malaysian study contributes to the limited Southeast Asian literature on RAPN for complex renal tumours. Full article

Ports in the Baltic Sea region play an integral role in advancing sustainable maritime practices in the area, due to their geographic interconnectedness, economic importance, and sensitivity to environmental challenges. While numerous port sustainability assessment methods exist, most of which are grounded in the Triple Bottom Line (TBL) metric, many tend to emphasise whether specific targets have been met, rather than evaluating port sustainability on a scalar basis. This study explores the sustainability strategies of seven selected ports in five Baltic Sea countries using an innovative qualitative evaluation framework developed by the Swedish Maritime Competence Centre (SMCC). The SMCC model integrates the three core pillars of sustainability-environmental, social, and economic dimensions, while incorporating energy efficiency and digitalisation as critical enablers of modern port operations. The findings reveal significant variation in sustainability performance among the selected ports, shaped by regional contexts, operational profiles, and prior engagement with sustainability initiatives. Also, the results bring into light the most common sustainable practices used in the ports, e.g., LED lightning, onshore power supply, and port information systems. Full article

Various activities, whether economic, social, or environmental, exert pressure on a coastal area. The extent of economic activities taking place in coastal regions is continuously increasing, particularly in tourism, maritime transport, port operations, and fisheries and aquaculture. Therefore, the decision to establish activities in a coastal area is complex and requires careful consideration by all stakeholders who use this space, which is potentially one of the most important natural resources for the development of any coastal country. This research is focused on assessing the justification for establishing economic activities in a coastal area, taking into account the interconnection of spatial, safety, environmental, and social factors. Therefore, three possible scenarios have been proposed: the location of the communal port, the location of the nautical port-marina, and the location of the marine entertainment and recreation centre. The goal was to develop a model that would enable the objective assessment and selection of the most suitable activity that would simultaneously benefit society and have the least harmful impact on the environment. Therefore, a multi-criteria analysis was conducted using the AHP (Analytic Hierarchy Process) method. The decision-making process was based on the expert validation of criteria, sub-criteria, and alternatives. An analytical tool called Expert Choice was used to synthesise the results and select the optimal activity. The sensitivity analysis confirmed the stability and reliability of the obtained results, with the AHP method proving to be an effective tool in structuring the decision-making process regarding the establishment of activities in the coastal area. Based on the results of the multi-criteria assessment, planning the establishment of activities is an important precondition for the long-term and sustainable development of coastal activities in an area. Full article

Ports represent the point of intersection between sea and land, as well as a crucial node for the integration of maritime and land transport in the global logistics chain. Consequently, it is crucial to consider an articulated system that includes dry ports, freight interchange and intermodal logistics platforms, since the relationships between the port and the city, as well as those between the different decision-makers involved, are multiple and complex. Maritime transport and port operations have a direct and indirect impact on the surrounding contexts, with significant effects, particularly from an environmental point of view. Therefore, the green transition in logistics, port, and maritime systems is essential for reducing these impacts. In this context, the aspects related to operational practices and terminal design are of great importance. This paper aims to explore sustainable strategies for ports and maritime logistics in order to provide a methodological approach to green transition. The proposed methodology was divided into phases. First, an analysis of international and European legislation was conducted in order to identify the main critical issues. Subsequently, a review of the existing literature and best practices was carried out to identify tested solutions. The third phase included a Stakeholder Engagement Process, centred on the use of a thematic focus group to foster a collaborative approach to the definition of priorities and operational strategies. Part of the proposed methodology was implemented as part of the DEMASTER—Design of Maritime Sustainable Terminals—project, and it can allow for the evaluation of the different options and the identification of more effective and innovative solutions for the green transition. Full article

Background: Single-port laparoscopic hepatectomy is a minimally invasive modality for the treatment of benign and malignant liver lesions. Due to the method’s technical challenges, it is suitable for experienced hepatobiliary surgeons and selected groups of patients. The aim of this study was to evaluate the results of a single Slovenian center performing single-port laparoscopic hepatectomy with a literature overview. Methods: A single-center retrospective consecutive case series of the twenty-six patients with liver disease operated with the single-port technique from January 2018 to July 2024 at the Department of Abdominal Surgery at the University Medical Centre, Ljubljana, was performed. Lesions were located in easy-to-treat segments. Operative time, conversion rate, length of hospital stay, and surgical complications were recorded and evaluated. Results: We performed twenty-six single-port laparoscopic liver resections (median age 63.5, range 31 to 79 years). The mean operative time was 92 ± 31 min. None of the cases were converted to multi-port laparoscopic or open surgery. Safe resection margins were obtained in cases of malignant disease. The mean hospital stay was 4 days. The post-operative complication rate involving intervention was 7% (2/26). The incisional hernia rate was 11.5% (3/26). No life-threatening surgical complications or morbidity were noted. Conclusions: Single-port laparoscopic hepatectomy is a safe and feasible technique for the resection of benign and malignant liver lesions in the hands of skilled and well-trained hepatobiliary surgeons. Full article

Background: Awareness, diagnosis, and treatment of familial hypercholesterolemia (FH) starting from childhood are a cornerstone of cardiovascular disease prevention. The LIPIGEN Paediatric Group, a network of specialised centres for the diagnosis and management of familial genetic dyslipidemia, is an active part of this mission. Materials and Methods: This is the second exploratory survey organised within the LIPIGEN (LIpid transPort disorders Italian GEnetic Network) paediatric centres. A digital questionnaire consisting of 16 questions was proposed to the principal investigators of 35 LIPIGEN centres in September 2023. We analysed the main FH screening strategies implemented in Italy, which are the referral characteristics to the lipid clinics and clinical and biochemical criteria considered to diagnose FH in paediatric patients. Results: Centres frequently reported conducting cascade screening (88.6%) and reverse screening (57.1%), whereas 28.6% of respondents indicated using selective screening and only 5.7% reported employing child–parent screening. We documented a detailed biochemical characterisation of paediatric patients (62.9% of respondents usually perform full lipoprotein profile and 80% determine lipoprotein(a) for each patient) and a high percentage of genetic analysis (82.9%). We have also highlighted a quite low awareness of FH as a genetic condition involving paediatric patients among primary care paediatricians and general practitioners. Conclusions: The results of our survey show that specialised lipid centres usually have good diagnostic competence when dealing with paediatric patients with hypercholesterolemia. However, FH awareness and the importance of early diagnosis and treatment initiation in childhood still need to be further improved. Full article

Maritime accidents frequently occur in the Philippine archipelagic waters, often resulting in significant loss of life. These incidents highlight the urgent need for improvements in the country’s maritime safety systems. By utilising accident data from the Philippine Coast Guard and the GISIS IMO databases, spatial analytical approaches were employed to determine incident distribution patterns and resulted in an overall depiction of the likelihood component of risk across the country’s territorial waters. Kernel density and hotspot analysis revealed areas where incidents were concentrated and where statistically significant hotspots occurred. The Maxent tool was used to develop risk likelihood models for the incident locations using environmental rasters representing wind speed, significant wave height, depth, surface current, land distance and port distance. Model performance metrics including the AUC, TSS and Kappa were used to compare the two datasets and provide confidence on model robustness. Variable contribution figures showed that land distance is the most influential variable, with the majority of high-risk areas predominantly located near population centres. The resulting maps provide an intuitive and informative depiction of the characteristic patterns of maritime accidents in the country, identify areas of high risk requiring immediate attention and offer valuable insights to support strategies for improving and enhancing the country’s maritime safety. Full article