Implementation of Aggregated Response Plan to Effectively Protect Crew Health and Safety and Prevent Spread of Covid-19 Pandemic Aboard Ships

The global outbreak of Covid-19 has had a severe impact affecting all maritime sectors. It caused a significant worldwide health and economic crisis with a wide-ranging impact on maritime transport and trade. During this period, access to essential goods and medical items was ensured mainly by the ability of the marine supply chain to adapt by developing systems and processes quickly. Thus, regulations and instructions were imposed in response to the pandemic to monitor and counter the spread and the ancillary effects. This paper aims to assess and codify all those maritime regulations and instructions hastily created to protect the crew\u27s health and safety and prevent the spread of Covid-19 aboard ships. Initially, all relevant rules and countermeasures to crew health and safety are explored and evaluated under the exploratory research coupled with the analysis of the relevant regulatory framework. Then, methods and processes are being created and proposed to offer a composed reaction plan to each case where the effects and consequences of the pandemic may occur. The relevant regulations are the primary source of data and similar studies conducted presently, whose outcomes are used to create and justify the recommended processes and the steps that should be followed based on the special conditions of individual cases. The paper concludes that implementing standard processes and procedures, such as those provided by the analysis, will enhance the speed and the effectiveness of handling the pandemic. It is also concluded that proactive measures coupled with fast and efficient responses are critical for developing effective procedures

Legal Analysis of Impact of Revised BIMCO Clauses on Crew Health and Safety During COVID-19 Era

This paper evaluates how the revised BIMCO Crew Change Clause 2020 affected crew health during this period. To satisfy the need for specific clauses, regulating the contractual relationships during the COVID-19 period, BIMCO created sets of clauses, such as the BIMCO Crew Change Clauses for Time Charter Parties (2020). The rationale of those clauses was based upon the pre-existing BIMCO Infectious or Contagious Diseases Clause for Voyage and Time Charter Parties 2015, but it was evidenced that the COVID-19 virus had many intricacies. Thus, new sets of rules are presently emerging to eliminate the gaps created. The basic downside of this legislation and the focus of this paper is to prove that these clauses are focused only on regulating the contractual relationship, without actually taking into consideration the crews’ health and safety. The analysis is focused on the impact of a COVID-19 incident on four specific legal aspects, i.e. i) vessels’ seaworthiness, ii) charter parties, iii) port safety, and iv) refusal of orders. There is also an analysis of the imminent Decease Clause 2021 and its actual impact upon the shipping industry. The analysis of the relevant legislation is based on legal doctrine, dominant form in legal research, aiming to provide a systematic exposition of the legal and regulatory principles. It analyzes the relationship between those principles to provide clarifications, utilizing legislation and relevant case law as the primary source of data. This research method is qualitative and is very similar to critical analysis, whose application is performed through (a) research and description of the existing legislation, (b) prescription, whose essence is to explore the statutory framework, locate the critical points, and assess the effectiveness of legislation on protecting the crew health and safety, and (c) evaluation of possible amendments or additions. The majority of studies conclude that shipping companies will be able to protect crew health and safety only through proactive measures and due diligence. The revised BIMCO terms on crew changes during Covid-19 and the new Disease Clause 2021 sadly did not have crew protection as their top priority. In most parts they tried to allocate and even mitigate the risk of the contracting parties, providing “windows” of opportunity for both sides to be excepted from any liability. Based on the analysis of resources, the new clause is not engaging the concept of proactive measures, unquestionably the most important method for the preservation of crew health usually referred to as “exercising due diligence”. It is a fact that BIMCO protects the clients’ interests, with the clients being the charter parties. It is also valid that the shipping industry supported the nations during the COVID-19 outbreak, but the BIMCO clauses were concentrated on the preservation of contractual relationships, leaving the concept of crew health and safety uncharted

Potential Development Strategy for the Shipbuilding and Ship Repair in Baltics: A Case Study of Latvia

This research is focused on the shipbuilding and ship repair industries in Latvia. The main purpose of this manuscript is to investigate all possible options to further develop the shipbuilding and ship repair industries in Latvia Initially, a brief overview of Baltics and of Latvia, with its biggest shipbuilding companies and its possibilities, are depicted in detail. The analysis is developed with the help of SWOT analysis and a Risk assessment matrix to find Latvia’s strengths, weaknesses, opportunities, and threats, then to identify all possible risks in order to identify potential issues that could negatively impact key business initiatives or critical projects, and to develop a marketing strategy. It is concluded that Latvian shipbuilding can be benefited by i) its strategic location in Baltics, ii) the highly qualified workforce employed in Latvian shipyards, iii) the certified naval expertise of the shipbuilding facilities. At the same time, the external environment and the regional competition is harsh and some points are suggested for Latvian shipbuilding to survive and possibly flourish over the next years, such as: i) repair the technologically obsolete equipment and facilities to be able to satisfy the present market trends, ii) incorporate and utilize new materials and technologies, iii) give incentives to qualified natives that went abroad for employment to similar facilities to return to Latvia and utilize their accumulated experience, thus solving the issue of the declining workforce on the sector and iv) specialize in some aspects of shipbuilding, such as luxury ships and ice class, to secure a more specialised and dedicated market

Pitfalls in the diagnosis of a tumefactive demyelinating lesion: A case report

<p>Abstract</p> <p>Introduction</p> <p>In rare instances, demyelinating disorders manifest as tumefactive lesions that simulate brain tumors. We report a patient with a space-occupying lesion in the parietal lobe, which presented a serious diagnostic dilemma, between a rare tumefactive demyelinating disease, such as Balo concentric sclerosis and a glioma. This case report highlights important diagnostic clues in the differential diagnosis of Balo concentric sclerosis.</p> <p>Case presentation</p> <p>A 20-year-old Caucasian woman with acute onset of left-sided weakness and numbness was admitted to hospital with neurologic signs of left-sided hemiparesis and hypoesthesia. Brain magnetic resonance imaging showed a mass lesion of abnormal signal intensity with concentric enhancing rings in the right parietal lobe, without perifocal edema. The characteristic concentric pattern detected on the magnetic resonance images was highly suggestive of Balo disease, and corticosteroids were administered. Evoked potentials, cerebrospinal fluid analysis, and magnetic spectroscopy findings were not specific, and glioma was also included in the differential diagnosis. A stereotactic biopsy was not diagnostic.</p> <p>After one month the patient showed moderate clinical improvement, and during 12 months follow-up, no further relapses occurred. In the follow-up magnetic resonance imaging, the concentric pattern had completely disappeared, and only a low-signal, gliotic lesion remained.</p> <p>Conclusion</p> <p>We hope this case presentation will advance our understanding of clinical and radiologic appearance of Balo concentric sclerosis, which is a rare demyelinating disease. Although this is a specific entity, it has a broader clinical impact across medicine, because it must be differentiated from other space-occupying lesions in the central nervous system.</p

«Οι ευπαθείς κοινωνικές ομάδες και τα δικαιώματα τους μέσα από τη συνταγματική και γενικότερη δικαιϊκή ιστορία της σύγχρονης Ελλάδας»: Ζητήματα φύλου, φυλετικής και εθνοτικής καταγωγής, σεξουαλικού προσανατολισμού, ταυτότητας φύλου και αναπηρίας από το 1821 μέχρι το 2017

Η έννοια του δικαιώματος έχει συνδεθεί ιστορικά με αγώνες και διεκδικήσεις απέναντι στην εκάστοτε καθεστηκυία τάξη και τις αυθαιρεσίες της, ενώ πάντα εξέφραζε την ανάγκη προστασίας της μειοψηφίας από την εξουσία της πλειοψηφίας. Η σημασία των δικαιωμάτων επιβεβαιώνεται από τις κατοχυρώσεις τους στα συνταγματικά κείμενα και την εξέλιξη και εμβάθυνση τους από τους νόμους. Παρόλα αυτά, αρκετά συχνά, δικαίωματα που αφορούσαν ευπαθείς ομάδες παραλείπονταν ή η έννομη μορφή που έπαιρναν παρουσίαζε ελλείψεις ή προβλήματα στο περιεχόμενο τους. Σκοπός, λοιπόν, της παρούσας μελέτης είναι η ανάδειξη της σχέσης μεταξύ δικαιώματων και Σύνταγματος - νόμων και της θέσης που δίνει το δεύτερο μέρος στο πρώτο, εστιάζοντας στα δικαιώματα κάποιων ευπαθών ομάδων που δέχονται διακρίσεις με βαση το φύλο, την φυλετική/εθνοτική καταγώγη, τον σεξουαλικό προσανατολισμό, την ταυτότητα φύλου και την αναπηρία. Για τον σκοπό αυτό, εξετάζεται η πορεία των συγκεκριμένων δικαιωμάτων μέσα σε όλη τη σύγχρονη ιστορία της χώρας, τα Συντάγματα που προέκυψαν αλλά και τους βασικότερους νόμους που θεσπίστηκαν, σε συνδυασμό με προεκτάσεις στον ευρωπαϊκό και, γενικότερα, διεθνή χώρο, καταλήγοντας στο σήμερα και στις νέες θεσμικές ανάγκες που δημιουργούνται

Malignant neuroleptic syndrome following deep brain stimulation surgery: a case report

<p>Abstract</p> <p>Background</p> <p>The neuroleptic malignant syndrome is an uncommon but dangerous complication characterized by hyperthermia, autonomic dysfunction, altered mental state, hemodynamic dysregulation, elevated serum creatine kinase, and rigor. It is most often caused by an adverse reaction to anti-psychotic drugs or abrupt discontinuation of neuroleptic or anti-parkinsonian agents. To the best of our knowledge, it has never been reported following the common practice of discontinuation of anti-parkinsonian drugs during the pre-operative preparation for deep brain stimulation surgery for Parkinson's disease.</p> <p>Case presentation</p> <p>We present the first case of neuroleptic malignant syndrome associated with discontinuation of anti-parkinsonian medication prior to deep brain stimulation surgery in a 54-year-old Caucasian man.</p> <p>Conclusion</p> <p>The characteristic neuroleptic malignant syndrome symptoms can be attributed to other, more common causes associated with deep brain stimulation treatment for Parkinson's disease, thus requiring a high index of clinical suspicion to timely establish the correct diagnosis. As more centers become eligible to perform deep brain stimulation, neurologists and neurosurgeons alike should be aware of this potentially fatal complication. Timely activation of the deep brain stimulation system may be important in accelerating the patient's recovery.</p

Intermittent Myokymia as a Pointer to Hemangioblastoma of the Cervical Spine: A Case Report

Hemangioblastomas represent 3% of all central nervous system (CNS) tumors. The majority of CNS hemangioblastomas are infratentorial, with the cerebellum being the most frequent location, while 13% are found in the brainstem. Symptoms of brainstem hemangioblastomas can be very subtle and might therefore be overlooked or misinterpreted. We report the case of a patient with a hemangioblastoma at the junction of the medulla oblongata and the cervical spine and provide a brief review of the literature

Prevalence of Clinical and Neuroimaging Markers in Cerebral Amyloid Angiopathy: A Systematic Review and Meta-Analysis

BACKGROUND: Limited data exist regarding the prevalence of clinical and neuroimaging manifestations among patients diagnosed with cerebral amyloid angiopathy (CAA). We sought to determine the prevalence of clinical phenotypes and radiological markers in patients with CAA. METHODS: Systematic review and meta-analysis of studies including patients with CAA was conducted to primarily assess the prevalence of clinical phenotypes and neuroimaging markers as available in the included studies. Sensitivity analyses were performed based on the (1) retrospective or prospective study design and (2) probable or unspecified CAA status. We pooled the prevalence rates using random-effects models and assessed the heterogeneity using the Cochran Q and I2 statistics. RESULTS: We identified 12 prospective and 34 retrospective studies including 7159 patients with CAA. The pooled prevalence rates were cerebral microbleeds (52% [95% CI, 43%-60%]; I2=93%), cortical superficial siderosis (49% [95% CI, 38%-59%]; I2=95%), dementia or mild cognitive impairment (50% [95% CI, 35%-65%]; I2=97%), intracerebral hemorrhage (ICH; 44% [95% CI, 27%-61%]; I2=98%), transient focal neurological episodes (48%; 10 studies [95% CI, 29%-67%]; I2=97%), lacunar infarcts (30% [95% CI, 25%-36%]; I2=78%), high grades of perivascular spaces located in centrum semiovale (56% [95% CI, 44%-67%]; I2=88%) and basal ganglia (21% [95% CI, 2%-51%]; I2=98%), and white matter hyperintensities with moderate or severe Fazekas score (53% [95% CI, 40%-65%]; I2=91%). The only neuroimaging marker that was associated with higher odds of recurrent ICH was cortical superficial siderosis (odds ratio, 1.57 [95% CI, 1.01-2.46]; I2=47%). Sensitivity analyses demonstrated a higher prevalence of ICH (53% versus 16%; P=0.03) and transient focal neurological episodes (57% versus 17%; P=0.03) among retrospective studies compared with prospective studies. No difference was documented between the prevalence rates based on the CAA status. CONCLUSIONS: Approximately one-half of hospital-based cohort of CAA patients was observed to have cerebral microbleeds, cortical superficial siderosis, mild cognitive impairment, dementia, ICH, or transient focal neurological episodes. Cortical superficial siderosis was the only neuroimaging marker that was associated with higher odds of ICH recurrence. Future population-based studies among well-defined CAA cohorts are warranted to corroborate our findings

Clinical, Neuroimaging, and Genetic Markers in Cerebral Amyloid Angiopathy-Related Inflammation: A Systematic Review and Meta-Analysis

Background: There are limited data regarding the prevalence of distinct clinical, neuroimaging and genetic markers among patients diagnosed with cerebral amyloid angiopathy-related inflammation (CAA-ri). We sought to determine the prevalence of clinical, radiological, genetic and cerebrospinal fluid biomarker findings in patients with CAA-ri. Methods: A systematic review and meta-analysis of published studies including patients with CAA-ri was conducted to determine the prevalence of clinical, neuroimaging, genetic and cerebrospinal fluid biomarker findings. Subgroup analyses were performed based on (1) prospective or retrospective study design and (2) CAA-ri diagnosis with or without available biopsy. We pooled the prevalence rates using random-effects models and assessed the heterogeneity using Cochran-Q and I2-statistics. Results: We identified 4 prospective and 17 retrospective cohort studies comprising 378 patients with CAA-ri (mean age, 71.5 years; women, 52%). The pooled prevalence rates were as follows: cognitive decline at presentation 70% ([95% CI, 54%-84%]; I2=82%), focal neurological deficits 55% ([95% CI, 40%-70%]; I2=82%), encephalopathy 54% ([95% CI, 39%-68%]; I2=43%), seizures 37% ([95% CI, 27%-49%]; I2=65%), headache 31% ([95% CI, 22%-42%]; I2=58%), T2/fluid-attenuated inversion recovery-hyperintense white matter lesions 98% ([95% CI, 93%-100%]; I2=44%), lobar cerebral microbleeds 96% ([95% CI, 92%-99%]; I2=25%), gadolinium enhancing lesions 54% ([95% CI, 42%-66%]; I2=62%), cortical superficial siderosis 51% ([95% CI, 34%-68%]; I2=77%) and lobar macrohemorrhage 40% ([95% CI, 11%-73%]; I2=88%). The prevalence rate of the ApoE (Apolipoprotein E) ϵ4/ϵ4 genotype was 34% ([95% CI, 17%-53%]; I2=76%). Subgroup analyses demonstrated no differences in these prevalence rates based on study design and diagnostic strategy. Conclusions: Cognitive decline was the most common clinical feature. Hyperintense T2/fluid-attenuated inversion recovery white matter lesions and lobar cerebral microbleeds were by far the most prevalent neuroimaging findings. Thirty-four percent of patients with CAA-ri have homozygous ApoE ϵ4/ϵ4 genotype and scarce data exist regarding the cerebrospinal fluid biomarkers and its significance in these patients