DEZVOLTAREA EDUCAȚIEI NATO PENTRU ASIGURAREA CALITĂȚII PRIN IMPLEMENTAREA MODELULUI DE INSTRUIRE „ÎNVĂȚĂ-VIZIONEAZĂ-INTREABĂ”

Lucrarea prezintă o analiză detaliată și o metodă de implementare a modelului de instruire „Învață-Vizionează-Întreabă” (IVI), ca o potențială soluție, pentru a îmbunătăți instruirea în domeniul asigurării calității în cadrul NATO. Prin abordarea cerințelor rapid evolutive din cadrul domeniilor specializate, modelul IVI integrează instrumente digitale și metode tradiționale de predare pentru a crea o experiență de învățare care să răspundă nevoilor cursantului. Modelul este alcătuit din trei componente interdependente: modulul Învață, reprezentat de un curs online structurat; modulul Vizionează, susținut de un canal YouTube specializat pentru o înțelegere vizuală îmbunătățită; și modulul Întreabă, creat cu ajutorul unui chatbot bazat pe Inteligență Artificială (IA) pentru o învățare interactivă. Această abordare inovatoare oferă diverse stiluri de învățare, conferind sistemului eficacitate și accesibilitate continuă. Lucrarea analizează în continuare deficiențele identificate în modelele tradiționale de instruire, subliniind nevoia de elemente practice, vizuale și interactive în educația modernă. Este explorată opțiunea integrării asistentului IBM WatsonX ca și chatbot conversațional IA, în cadrul modelul IVI, evidențiind avantajele sale în furnizarea de interacțiuni consistente, precise și ușor de utilizat, comparat cu modelele IA de tip Generative Pre-trained Transformer (GPT). Adițional, este descris un proces alcătuit din șapte pași destinat adaptării modelului IVI la diverse domenii, precum și descrierea unei proces de îmbunătățire continuă pentru asistentul IBM WatsonX, asigurând relevanța și eficiența acestuia în peisajul educațional aflat în evoluție rapidă. Modelul IVI, prin întrebuințarea unică a tehnologiilor educaționale moderne, nu numai că îmbunătățește experiența de învățare din carul cursul NATO de asigurare a calității (S7-137), dar are și potențialul de a fi adaptat în diverse domenii de specialitate, promițând o forță de muncă mai eficientă

ADVANCING NATO'S QUALITY ASSURANCE EDUCATION BY IMPLEMENTING THE 'LEARN-WATCH-ASK' TRAINING MODEL

The paper introduces a detailed analysis and a method of implementing the "Learn-Watch-Ask" (LWA) training model, as a potential solution, to enhance quality assurance training within NATO. By addressing the fast-evolving demands of specialized domains, the LWA model integrates digital tools with traditional teaching methods to create a learning experience that is responsive to the student`s needs. The model is comprised of three interdependent components: the Learn module, represented by a structured online course; the Watch module, supported by a specialized YouTube channel for enhanced visual understanding; and the Ask module, created with an AI-driven chatbot for interactive learning. This innovative approach supports diverse learning styles, offering 24/7 accessibility and effectiveness. The paper further digs deeper into the identified shortcomings of traditional training models, emphasizing the need for practical, visual, and interactive elements in modern education. It explores the integration of the IBM WatsonX Assistant as a conversational AI chatbot in the LWA model, highlighting its advantages in providing consistent, accurate, and user-friendly interactions over Generative Pre-Trained (GPT) AI models. Additionally, a 7-step process for adapting the LWA model to various domains is outlined, as well as the description of a comprehensive continuous improvement loop for the IBM WatsonX Assistant, ensuring its relevance and efficiency in the rapidly evolving educational landscape. The LWA model, with its unique approach to modern educational techniques, not only enhances the learning experience for NATO’s Quality Assurance Course (M7-137) but also has the potential to be adapted across various specialized domains, promising a more effective and efficient workforce

Association of Image-Defined Risk Factors with Clinical, Biological Features and Outcome in Neuroblastoma

Background: Neuroblastoma (NB) is the most common pediatric extracranial solid tumor and the most common cancer encountered in children younger than 12 months of age. Localized tumors have a good prognosis, but some cases undergo treatment failure and recurrence. The aim of the study was to analyze the link between the neuroblastoma risk factors and the prognosis for patients diagnosed with NB. Method: All patients admitted to the department of Pediatric Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, between 1 January 2010 and 1 July 2022 were included in this analysis when diagnosed with neuroblastoma. Results: Thirty-one patients with NB were admitted to the surgical department, 20 boys and 11 girls. We observed an association between large tumors and positive imaging-defined risk factor (IDRF) status; The Fisher test showed an association between the tumor’s diameter when bigger than 8 cm and a positive IDRF status, with p < 0.001. We supposed that positive IDRF status at diagnosis may be linked to other prognostic factors. We discovered that an NSE value over 300 was associated with IDRF status (p < 0.001, phi = 0.692) and death. Conclusions: This study confirms the impact of IDRF status at diagnosis as it can be clearly correlated with other risk factors, such as a high level of NSE, MYCN amplification status, large tumor size, incomplete tumor resection, and an unfavorable outcome

Our Experience with Cyst Excision and Hepaticoenterostomy for Choledocal Cyst: A Single Center Case Review of 16 Patients

Background and Objectives: Choledocal cyst is a rare congenital disease of the biliary tree defined by dilatation of the extrahepatic and/or intrahepatic biliary ducts. Untreated, it leads to complications such as cholangitis, stone formation and malignant degeneration. The standard treatment for choledocal cyst is complete excision and subsequent biliary reconstruction via hepaticojejunostomy or hepatiocoduodenostomy. Materials and Methods: We report our experience with 16 pediatric cases of choledocal cyst over a 10-year period. Results: The predominant symptoms were nausea and jaundice, both at 62.5% (n = 10), followed by abdominal pain at 56.3% (n = 9). Ultrasonography was the diagnostic method used in all patients. Computed tomography was used in 75% (n = 12) and magnetic resonance imaging in 25% (n = 4) of cases. Age at the time of intervention ranged from 2 months to 17 years with a mean of 4 years and 5 months. The open approach was used in nine patients and the laparoscopic approach was used in seven patients, with one conversion to open surgery. Complete excision of the choledocal cyst was performed in 15 cases (93.7%), and partial excision with mucosectomy was performed in one case (6.2%). Eight patients (50%) underwent hepaticoduodenostomy and eight (50%) underwent hepaticojejunostomy, out of which one was attempted laparoscopically but was converted. We had a postoperative complication rate of 12.5% (n = 2) represented by anastomotic leak and pancreatitis. Conclusions: From our experience with these cases, we concluded that a wide hepaticoduodenostomy constitutes a favorable choice over the traditional hepaticojejunostomy, being more physiological and less time consuming

Hypertriglyceridemia Induced Acute Pancreatitis Caused by a Novel LIPC Gene Variant in a Pediatric Patient

Hypertriglyceridemia induced acute pancreatitis is a rare cause of pancreatitis in children. Hepatic lipase deficiency is an extremely rare cause of hypertriglyceridemia, reported in only a few families to date. Hepatic lipase is the enzyme involved in the hydrolysis of triglycerides and phospholipids in remnants of triglyceride-rich lipoproteins that have a role in the conversion of very low density lipoprotein remnants to low density lipoproteins. Hepatic lipase deficiency is inherited in an autosomal recessive pattern. Detection of heterozygous carriers of hepatic lipase mutations remains accidental at the population level, as affected persons with a heterozygous state of hepatic lipase mutation do not display specific lipoprotein abnormalities and also patients with complete hepatic lipase deficiency have inconstant phenotype. The proximal promoter of the LIPC gene consists of four polymorphic sites in complete linkage disequilibrium. Five missense mutations in encoding exons have been described and proved to be responsible for hepatic lipase deficiency to date: S267F, T383M, L334F, A174T, and R186H, affecting the activity and secretion of hepatic lipase. We identified a primary disorder of the lipid metabolism as the cause of the acute episode of pancreatitis in a four years old patient, consisting of hepatic lipase deficiency caused by a novel genetic variant of the LIPC gene, a gross deletion of the genomic region encompassing exon 1. This variant was not previously described in the literature in persons with LIPC-related disorders and its significance is currently uncertain, but in the presented clinical and paraclinical context, it has the characteristics of a pathological variant inducing a hepatic lipase deficiency phenotype

Dysplasia Epiphysealis Hemimelica (Trevor’s Disease) in Children, Two New Cases: Diagnosis, Treatment, and Literature Review

Dysplasia epiphysealis hemimelica (DEH), also known as Trevor’s disease, is a rare nonhereditary skeletal disorder affecting one side of the epiphyses or the epiphyses-equivalents. It is often misdiagnosed for traumatic injuries, infections, or other tumors because of the nonspecific clinical features. The diagnosis is mostly based on radiographic involvement of one half of the epiphysis displaying an overgrowth; it is hard to distinguish between DEH and osteochondroma on the gross hystopathological exam. There are few immunohistochemical markers, as well as genetic tests, for EXT1 and EXT2 gene expression that can reveal a more accurate diagnosis. No evidence of malignant changes has been reported and no hereditary transmission or environmental factor has been incriminated as an etiological factor. The natural history of the disease is continuous growth of the lesions until skeletal maturity. Without treatment, the joint might suffer degenerative modification, and the patient can develop early onset osteoarthritis. In the present paper, we report two new cases of DEH of the ankle. The aim of this paper is to consider Trevor’s disease when encountering tumoral masses in the epiphyses of pediatric patients and to present our treatment approach and results

Fetal Pancreatic Hamartoma Associated with Hepatoblastoma—An Unusual Tumor Association

Abdominal tumor masses are a very rare disease in the fetus. The authors present the first reported case of neonatal multicystic adenomatoid hamartoma of the pancreas associated with well-differentiated fetal epithelial subtype hepatoblastoma and reveal clinical, histologic, and imagistic aspects. Case presentation: A 36-week-old female newborn in whom a 25-week ultrasound showed a relatively homogeneous pancreatic echogenic mass (34 × 30 × 55 mm) with compression of the inferior vena cava and retrograde dilation. Postnatal CT showed a giant pancreatic tumor mass (113 × 70 × 60 mm), with areas enhancing contrast and cystic/necrotic areas and a hypodense, hypocaptive nodule of 8 × 6 mm located at segment IV of the liver; thrombosis of the subhepatic segment of the inferior vena cava and both renal veins. Histopathological and immunohistochemical studies confirmed the diagnosis of multicystic pancreatic adenomatoid hamartoma and well-differentiated fetal epithelial subtype hepatoblastoma. Conclusions: Pancreatic hamartoma can be difficult to diagnose (especially prenatal), with or without nonspecific symptoms. The synchronous presence of hepatoblastoma complicated the therapeutic conduct and prognosis of this case, with the diagnosis being confirmed histopathologically and immunohistochemically after liver biopsy

The Use of Tranexamic Acid in Anterior Cruciate Ligament Reconstruction: A Systematic Review

Background: There are several papers that investigate the use of tranexamic acid (TXA) in anterior cruciate ligament reconstructions (ACLR) or other arthroscopic procedures that show favorable results and little to no complications. We aimed to perform a systematic review of all published randomized controlled trials (RCTs) that wanted to determine the effectiveness of intravenous use of TXA in ACLR. Methods: Data collection was performed independently by two authors via a previously created spreadsheet. They extracted information such as: first author name, publication year, lot size, TXA protocol, surgical protocol, outcome measures and follow-up duration. Results: After applying the screening process and the inclusion criteria, we were left with a total six RCTs. The selected studies included a total of 699 randomized patients. Statistical significance regarding a lower pain score (VAS) in the intervention groups was mostly reported for the early postoperative period (2 weeks). A statistically significant decrease in hemarthrosis grade was reported for the first 2–3 weeks. Conclusions: in our study, we show that TXA use in arthroscopic ACLR decreases postoperative blood loss and pain. Some evidence of improvement in functional scores was observed, but we believe that this needs to be addressed in specific long-term result studies

Deliverable D7.2 - Final report on benchmarking of management protocols

This deliverable summarizes key research results obtained during the second phase of the WP7 activities. The research activities addressed the performance evaluation of management frameworks (SNMP and JMX). For these management frameworks, the current work presents qualitative and quantitative requirements associated to the management task. The SNMP framework is analysed with respect to a set of traces gathered from an operational network. The JMX framework is analysed based on synthetic data obtained from a process injection driven activity

Deep vein thrombosis following the treatment of lower limb pathologic bone fractures – a comparative study

Abstract Background Deep vein thrombosis is a well-known complication of fracture occurrence, lower limb surgery and periods of prolonged immobilisation. Its incidence can be increased even more in specific cases with metastatic bone disease and adjuvant treatment. There is a small amount of literature that addresses the incidence of DVT by comparing osteosynthesis and arthroplasty as surgical treatments. Current recommended anticoagulation protocols might be inadequate for specific groups of cancer patients undergoing osteosynthesis or arthroplasty. Methods The study was designed and performed in a retrospective manner and carried out on patients that presented at our Emergency Clinical County Hospital between 01.01.2008–31.12.2016. The patients’ evolution was followed for a standard of 2 months. All our deep vein thrombosis events were diagnosed via venous duplex imaging. The studied lot (n = 85) was paired with a control group (n = 170) with similar baseline characteristics. Results Our lot was comprised of 85 patients that underwent 85 surgeries, on both of our hospital’s Orthopaedic and Traumatology wards. When performing the student t-test and calculating OR (odds ratio) and RR (risk ratio) we encountered 11 cases of DVT in our studied group and 12 cases of DVT in our control group (p < 0.04). We found statistical significance when correlating DVT with type of implant (prosthesis), the presence of metastases over primary tumour and the choice of implant (prosthesis over intramedullary nail). There was no statistical significance found when correlating DVT events with the type of anticoagulation and the amount of blood transfusion units required. Conclusion Patients who undergo surgical treatment for lower limb pathological fracture due to malignancy are at increased risk of DVT or death due to PE under current general thromboprophylaxis regimens. The risk is higher for the immediate postoperative period (10 days). The risk is increased by metastasis, arthroplasty and adjuvant therapy (radiotherapy, chemotherapy), and we think that a more aggressive prophylactic protocol should be used