Search Results (19)

Background/Objectives: The aim of this case series is to evaluate the outcomes and safety of video-assisted mastectomy, illustrating the harmonious collaboration of oncologic and plastic surgery. This novel minimally invasive technique allows immediate prosthetic reconstruction and represents a cost-effective alternative to robotic breast surgery. Methods: Video-assisted, single-port nipple-sparing mastectomies were performed in patients with small to medium-sized breasts, followed by immediate direct-to-implant reconstruction with either prepectoral or dual plane implant placement. The patients’ electronic medical records were analyzed, including demographic characteristics, operative times and histopathology reports. Results: A total of 18 patients underwent successful video-assisted mastectomy, without conversion to traditional open procedure. Fifteen of the operations were risk-reducing mastectomies. Twelve patients had complementary procedures performed concurrently on the previously operated contralateral breast (delayed reconstruction/expander-to-implant exchange). Moreover, three patients benefited from additional minimally invasive techniques during the same surgery (prophylactic laparoscopic hysterectomy). Immediate breast reconstruction with polyurethane or microtextured breast implants up to 450 cc was performed, with satisfactory aesthetic outcomes and no cancer recurrences at 6 to 12 months postoperative follow-up. Early complications included transient hypercapnia, areolar congestion and cellulitis. No skin necrosis or implant-related complications were reported. The most frequently encountered late issues were contour irregularities. Conclusions: Video-assisted mastectomy facilitates the safe removal of proven pathologic or healthy breast tissue with minimal damage to the breast’s skin envelope, facilitating single-stage breast reconstruction. Full article

As pivotal nodes in maritime logistics networks, ports face mounting pressure to reconcile economic growth with environmental sustainability. Although the SBM-Undesirable model has been extensively applied to assess port environmental efficiency (PEE), most applications assume strong disposability and disregard heterogeneity in technological capacities across different port scales, potentially biasing the assessments. To overcome these limitations, coastal ports are initially categorized into three subgroups based on operational scale criteria. A meta-frontier SBM-Undesirable model incorporating weak disposability is then developed to evaluate PEE. Dynamic characteristics are further explored via the Global Malmquist Index. Results indicate substantial disparities between subgroup frontiers and the meta-frontier. The average group PEE (0.732) exceeded the meta PEE (0.570), implying potential overestimation under homogeneity assumptions. Large-sized ports, with a mean technology gap ratio (TGR) of 0.956, operated near the meta-frontier, whereas medium-sized and small-sized ports, with TGRs of 0.770 and 0.600 respectively, exhibited substantial technological gaps. Total factor productivity (TFP) demonstrated a volatile upward trend, averaging 6.8% annual growth. In large-sized and medium-sized ports, TFP growth was primarily driven by technological innovation, whereas in small-sized ports, it stemmed from combined improvements in technical efficiency and technological level. These insights underscore the necessity of differentiated decarbonization strategies for port management. Full article

Small- and medium-sized ports (SMSPs) face multifaceted challenges, including environmental pressures (pollution, resource depletion) as well as socio-economic strains (community impacts, trade dynamics). Governance complexities, regulatory fragmentation, limited funding, and stakeholder conflicts further exacerbate these challenges. This study identifies context-driven sustainability indicators for SMSPs and proposes best practices to enhance their resilience. Four small/medium-sized ports (SMSPs) in Crete, Greece—Souda (CHA), Heraklion (HER), Rethymnon (RET), and Sitia (SIT)—were evaluated to benchmark their sustainability performance using tailored indicators. The primary objectives were the following: (a) to identify sustainability indicators relevant to SMSPs, focusing on economic, environmental, and social aspects, and (b) to propose best practices for enhancing sustainability in these ports, considering their unique characteristics and constraints. A combination of the Best Worst Method (BWM) and VlseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR) analysis was employed. The findings revealed that “environmental monitoring and management” and “security of employment and social protection” are top priorities for medium-sized ports, while “competitiveness” was a crucial indicator for small ports, emphasizing the need for financial sustainability in the context of global trade. These results offer a strategic roadmap for policymakers, guiding interventions aimed at improving the sustainability and resilience of SMSPs, thereby supporting regional economies and international trade networks. Full article

The present research points to an alternative concern against the mainstream research of future ports’ development by taking a transdisciplinary approach of a Living Lab (LL) concept for a better sustainability and innovation record in Small and Medium-Sized Ports (SMSPs). Deploying qualitative research for the examination of this new phenomenon of aggregating LLs into SMSPs, this research builds upon stakeholder workshops, in-depth interviews, and designed port pilots as case studies dedicated to innovation and sustainability transition in the Baltic Sea Region (BSR) at the turn of 2030. Given its rich and significant empirical foundation, the present research substantially contributes to sustainability orientation and transitions in ports. The key original elements of this study are fourfold: (1) the research provides a theoretical and practical LL framework enabling innovation and sustainability to be grasped in ports in times of technological, social, and political disruption; (2) this research increases the minimal number of existing previous efforts studying SMSPs in the transitional discourse; (3) the paper addresses not only hard technological innovation concerns but also aspects of social acceptance and the role of social interactions; (4) the research goes beyond geographical boundaries of a single port, thus providing a joint and collaborative approach towards sustainability rather than an individual perception on sustainability transition, existing networks, and clusters. Full article

The Italian coast has about 700 ports, which are different in typology, dimension, role, and ownership. Historically, this has led to the significant fragmentation of governance and space and a lack of cooperation that ports and cities still experience today. Among all ports, small and medium-sized ports (SMPs), such as marinas, small touristic harbors, and moorings, are the most affected. Unlike the main ports, where spatial and strategic regulation planning fall under the port authority’s responsibilities, SMPs are a combination of public and private management and are, therefore, excluded from national and regional planning and larger strategies. Improving SMPs’ cooperation at the regional level can drive more effective sustainable management among related activities (tourism and the fishing sector) and reduce pressures on the land–sea interaction (LSI). In filling the gaps, this article challenges the existing legal framework, planning tools, approaches, and initiatives and may pave the way to establishing a better-integrated national governance for SMPs. In conclusion, this paper identifies two main opportunities that can support the steady establishment of governance and the systematic harmonized development of these SMPs. The first one is offered by maritime spatial planning (MSP) as a strategic and legal tool whereby SMPs are recognized and, if financially supported, could find incentives and measures for their development. The second one is through European projects, programs, and initiatives such as Framesport as drivers in establishing a common ground among public and private interests and as a cooperation engine at a local scale. Full article

Over the last few years, the European Union (EU) has placed significant emphasis on the interoperability of critical infrastructures (CIs). One of the main CI transportation infrastructures are ports. The control systems managing such infrastructures are constantly evolving and handle diverse sets of people, data, and processes. Additionally, interdependencies among different infrastructures can lead to discrepancies in data models that propagate and intensify across interconnected systems. This article introduces “BigDaM”, a Big Data Management framework for critical infrastructures. It is a cutting-edge data model that adheres to the latest technological standards and aims to consolidate APIs and services within highly complex CI infrastructures. Our approach takes a bottom-up perspective, treating each service interconnection as an autonomous entity that must align with the proposed common vocabulary and data model. By injecting strict guidelines into the service/component development’s lifecycle, we explicitly promote interoperability among the services within critical infrastructure ecosystems. This approach facilitates the exchange and reuse of data from a shared repository among developers, small and medium-sized enterprises (SMEs), and large vendors. Business challenges have also been taken into account, in order to link the generated data assets of CIs with the business world. The complete framework has been tested in the main EU ports, part of the transportation sector of CIs. Performance evaluation and the aforementioned testing is also being analyzed, highlighting the capabilities of the proposed approach. Full article

Ports are under increased pressure to reduce their negative climate and environmental impacts. Their roles and functions in transportation systems and the economy make them a key industry in promoting sustainability. In particular, small- and medium-sized ports (SMSPs) should serve as lighthouses or flagships of environmental and digital transformation, allowing access to remote locations and integrating peripheral regions. Their sustainability planning faces significant challenges in this context, such as limited resources, access to technical expertise, and stakeholder involvement. Sustainable planning strives for long-term viability, while balancing economic, social, and environmental goals. Ports can ensure that they are cost-effective, environmentally sustainable, and capable of satisfying local people’s and companies’ long-term demands by applying sustainable planning methods. This research aims to assist stakeholders in designing and implementing activities that will optimize the sustainability of SMSPs, promote the sustainable development of the neighboring communities, and encourage the sustainable use of coastal and marine resources. Full article

Internationalization has become increasingly important to the competitiveness of firms of all sizes, including small and medium-sized enterprises (SMEs). SMEs play a crucial role in the development of lower-income countries. In Bangladesh, SMEs account for between 80 and 85 percent of industrial employment and 23 percent of total employment and are critical to economic growth. Though the literature on firm internationalization is well established, the internationalization process of SMEs from developing countries, such as Bangladesh, remains relatively under-explored. The main aim of this study is to explore factors that hinder the internationalization of SMEs in a developing country, with Bangladesh serving as the context of the investigation. Qualitative research methods were adopted, comprising semi-structured interviews with leaders of 16 SMEs in Bangladesh. Six major themes were identified as hindrances to the firms’ internationalization: (1) lack of market knowledge, (2) lack of family support, (3) the proliferation of ‘scammer buyers’, (4) the (negative) involvement of third parties, (5) mismanagement of domestic ports, and (6) unregulated local market. Regarding positive factors, only one theme emerged from the data, the strong support from the local government, which provides considerable backing for local SMEs with international ambitions. This study’s primary contribution and originality lie in the context of the investigation, with Bangladesh primarily overlooked in the international business literature. Therefore, the study presents several novel insights into the internationalization process of SMEs. Full article

The increasing growth in the global population has led to a substantial demand for low-carbon energy infrastructure, metals, and minerals. This has put more pressure on land-based deposits, which have been unsustainably exploited over the years. As a result, attention has shifted towards exploring minerals in sea-based environments. Currently, industry and researchers have identified potentially commercially viable locations for the exploration of these nodules. However, significant knowledge gaps remain in the sustainable, efficient, and effective recovery and transportation of the nodules to onshore locations. To address these gaps, the study develops a logistics and cost model embedded in a multiobjective optimization (MOO) approach. This model considers several parameters, such as the production targets, port distance and location, storage capacity, vessel characteristics, transportation options, and cost inputs. By incorporating these parameters, the study analyzes different combinations of vessel classes and onshore locations and provides insights into optimizing offshore–onshore logistics and transportation options. The findings reveal that small and medium-sized vessels require lower storage capacity because they can complete more trips. Furthermore, the analysis reveals the cost of deploying additional vessels outweighs the benefits of reduced storage space for long-distance transport; therefore, smaller and medium-sized vessels are more suitable for locations closer to the offshore production site. Additionally, proximity to the onshore location is important, as it reduces transport costs and simplifies logistics operations. Subsequently, there is a need to have a reasonable buffer rate as this reduces the impact of potential disruptions during transport. From a managerial viewpoint, the study highlights the need to carefully consider vessel types based on transport requirements and journey characteristics. The analysis further identifies the benefits of having an onshore location close to the offshore production site. This will lead to optimized transport and logistics operations. Based on this, the study contributes to the body of knowledge in offshore logistics by developing a multiobjective optimization model for offshore–onshore transport logistics and cost analysis. This model provides a practical tool for informed decision-making and provides insight into vessel size and location considerations. Finally, the study establishes how simultaneous consideration of multiple factors in transport operations can lead to optimized and informed decision-making. Full article

Automated surveillance systems based on machine learning and computer vision constantly evolve to improve shipping and assist port authorities. The data obtained can be used for port and port property surveillance, traffic density analysis, maritime safety, pollution assessment, etc. However, due to the lack of datasets for video surveillance and ship classification in real maritime zones, there is a need for a reference dataset to compare the obtained results. This paper presents a new dataset for estimating detection and classification performance which provides versatile ship annotations and classifications for passenger ports with a large number of small- to medium-sized ships that were not monitored by the automatic identification system (AIS) and/or the vessel traffic system (VTS). The dataset is considered general for the Mediterranean region since many ports have a similar maritime traffic configuration as the Port of Split, Croatia. The dataset consists of 19,337 high-resolution images with 27,849 manually labeled ship instances classified into 12 categories. The vast majority of the images contain the port and starboard sides of the ships. In addition, the images were acquired in a real maritime zone at different times of the year, day, weather conditions, and sea state conditions. Full article

The gold-standard treatment for functional tumors is adrenalectomy, and the procedure can be either open or laparoscopic. Laparoscopic adrenalectomy (LA) is a minimally invasive technique designated for small–medium-sized adrenal tumors without vascular invasion. LA is routinely performed using three or four ports with the patient in sternal or lateral recumbency. The aim of the study was to evaluate the feasibility of LA with two ports in order to reduce invasiveness and improve patient recovery. In total, 16 dogs with adrenal tumors were included in the study and the two-port technique was performed. Adrenalectomy was performed based on the presence of hypercortisolism in thirteen cases, whereas, in three cases, adrenalectomy was performed in the absence of evidence of cortisol production. Thirteen cases were carcinomas and three were adenomas of the adrenal gland; furthermore, twelve were on the left side and four were on the right side. Capsule rupture occurred in five cases. After performing the technique in all cases, no additional ports or laparotomy conversion occurred. Based on the authors’ experience, laparoscopic adrenalectomy can be performed with two ports. Full article

The implementation of measures to limit electricity consumption in many provinces of China has caused coal prices to rise irrationally, further aggravating the financing problems of small and medium-sized enterprises in the supply chain. Small and medium-sized enterprises lacking funds cannot effectively participate in the green transformation and development of the coal industry, which slows down the sustainable development process of the coal industry. Under the current background of low-carbon advocacy, blockchain technology can reasonably allocate resources and efficiently process information, thereby providing a solution for this financing problem. This paper first proposes a coal accounts receivable financing model based on blockchain technology, then builds a coal accounts receivable financing system dominated by ports through blockchain technology. Finally, the Stackelberg yield–benefit model is used to analyze the income function of each participant in the process of accounts receivable financing. The results show that the use of blockchain technology can reduce the financing condition of financial institutions and improve the maximum income of cooperative enterprises in the chain while solving the financing problems of small and medium-sized enterprises in the coal supply chain. This study provides practical significance and theoretical value for promoting the transformation and upgrading of coal enterprises and accelerating the opening of the sustainable development model of the coal industry. Full article

The concentration of the world’s population in coastal areas means an increase in pressure on the environment and coastal ecosystems. The impacts of climate change affect natural biophysical and ecological systems and human health. Research has been developed to create coastal monitoring with Unmanned Aerial Vehicles (UAVs) that allow data to be obtained and methodologies that integrate computer vision algorithms for 3D and image processing techniques for analysis, combined with maritime information. The Valencian oval is located on the Spanish Mediterranean coast and registers significant coastal erosion. It is a densely populated area, with high economic relevance and tourist activity. The main goals of the developed research in this coastal area include creating a methodology of data collection that identifies environmental indicators significant to community health and uses in the coastal areas, to test progression of interventions and to assess coastal erosion detection and monitoring. The final objective is to aid in decision-making and coastal management. Sediment characterization was obtained, and continuous maritime information was collected. The dynamic evolution of coastal areas was researched by using UAVs on the Spanish Mediterranean coast. This technique is suitable for measuring medium to small coastal changes. Flight planning was carried out using the grid mode and adapted to areas in order to obtain a homogeneous pixel size and precision. This monitoring program takes advantage of technological development with very low economic costs and is a good tool for making decisions that must be based on scientific information. With the monitoring work, an annual erosion between 12 and 6 m was detected. The monitoring program has evidenced the shoreline trend as a result of the impact of rigid structures, mainly ports and groins, in promoting down-drift erosion processes in the area. Full article

Currently, seaports are actively searching for methods and ways to improve their operational efficiency. Digitalization is considered as one of the main directions of current ports’ development. Ports’ digitalization levels are varied and may depend on different factors, including port size, traditions, turnover and handled cargo type, etc. Ports often face decision-making challenges related to assessment of their digitization level and choice of development directions. The article aims to develop a methodology to evaluate ports’ digitalization level. A marketing research tool was used to collect the data needed for the analysis. A mathematical model allowing simulations is proposed and a case study of 30 ports located in the Baltic, North and Mediterranean Seas regions is explored. Based on conducted calculations, a ranking of analysed ports considering their digitalization level was created. The ports were compared within groups of small, medium-sized and large ports. It was estimated that the digitalization level in small and medium-sized ports is about 30% lower than the level of large seaports. The research results may be of interest to seaports striving to assess their level of digitalization and choose the best digital improvement solutions. Full article

Recent research shows increasing efforts to unfold the potential of Cultural and Creative Industries (CCIs) for regions in order to pursue new sources of innovation, competitive edge and to manifest sustainable and inclusive growth paths driven by creativity. Due to its strong commitments to the Sustainable Development Goals (SDGs) of the United Nations, on the global level, the Baltic Sea Region (BSR) has become a role model in sustainable development. Yet, individual BSR countries face challenges in the implementation of those goals. In this light, by building on the intermediate results (2017–2020) of two EU Interreg projects—Creative Ports and CTCC—this research reveals CCIs’ potential for sustainable development avenues. The investigation is based on case study methodology underpinned by empirical data gathered from participating Small and Medium-Sized Enterprises (SMEs) and topical experts met during the projects’ implementation and study visits. The present multi-project applied research reduces the research-to-practice gap pertaining to the so far underestimated role of CCIs for supporting traditional SMEs in the implementation of their sustainable ideas. Once engaged into cross-sectoral collaboration with traditional SMEs, CCIs become important brokers—sustainable innovation drivers and enablers within regional ecosystems through contribution to environmentally responsible, socially equitable and economically feasible solutions for the business they work with. Thus, on the one hand, CCIs support SMEs in their transition towards more sustainable managerial performance. On the other hand, CCIs overcome disconnection and increase their recognition through new collaboration opportunities, thus providing them with new capitalization avenues on the regional and international level. Full article