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Assessing the impact of hotels and restaurants on the environment proves that, despite expectations, compared to economic benefits, the hospitality sector is one of the least sustainable. This reality can be changed by decoupling the development of the hospitality sector from the increase in resource consumption. This paper aims at defining the concept of Sustainable Resource Management and highlighting its peculiarities in the hospitality sector, as well as the development of a set of indicators for hotel and restaurant sustainable management of resources, which is coherent, perfectible and adaptable to the realities of each unit in the hospitality sector. To this end, a combination of techniques was applied, including the study of relevant scientific papers in the field of sustainable tourism and resource management, qualitative interviews with managers and owners of hospitality entities, and direct observation of the activity of three restaurants in the touristic destination of Braşov. The results show that for restaurant and hotel managers, cost constraints are a hindrance to the application of sustainability principles, as well as the notion that environment-friendly policies do not provide guarantees on the incidence of food risks. Difficulties also arise from the lack of experience in applying performance assessment methods to ensure the sustainability of business in hospitality. A system of Sustainable Resource Management indicators can play the role of a guide in this direction, the one proposed in this paper having four main dimensions: food and energy management, restaurant hardware management (capital goods, kitchen tools and inventory of serving salons), restaurant software management (human resources, consumer behavior, social responsibility) and financial performance of sustainable resource management. [ABSTRACT FROM AUTHOR]

In palaeoecology, plant and faunal macrofossils can reconstruct the local (<500 m) landscape and environmental conditions. Subfossil beetle remains are a valuable proxy in this regard because they preserve extremely well under anoxic conditions, can be identified to the genus or species level most of the time, and inhabit specific environments and climatic niches. In Western Europe and North America, fossil beetle assemblages have been used to reconstruct changes in landscape composition, forest cover, relative humidity, and air temperatures for the Holocene, Late Glacial, and much further back in time. For example, the Late Glacial temperature reconstructions from beetle assemblages proved extremely valuable, showing vegetation lags after climatic changes. Palaeoecological research involving beetle remains has been largely absent in Central Europe, but recent publications demonstrate its potential as a proxy for reconstructing past ecosystems/landscape change and environmental conditions. The results from several natural sites in the Czech Republic and Slovakia will be presented here. In these studies, beetle remains contributed greatly to e.g., demonstrate the local presence of certain tree species, disturbances in the landscape, and (the effect of) human activity on insect populations. Based on these first studies on beetle remains in this region, we discuss the potential of such future studies in Central and Eastern Europe. [ABSTRACT FROM AUTHOR]

The interaction of solids with multiple electromagnetic fields is of great importance in quantum electronics. This paper presents the investigations conducted on the behaviour of the heat transfer in a solid irradiated by multiple laser beams. The directions of the propagation of the laser beams are supposed to be along the Cartesian coordinate axes. The spatial distribution of the laser beams is supposed to be a sum of decoupled transversal modes ((m,n) for the irst laser beam, (p,q) for the second laser beam and (r,t) for the third laser beam). The model is valid for any laser-solid system whose interaction can be described by the generalized Beer law. It is also possible to include the multi-photons absorption in the model. Calculations were performed using the integral transform method [1, 2]. [ABSTRACT FROM AUTHOR]

Objectives: To describe the Agarwal loop-ligation technique for the management of the distal ureter during laparoscopic radical nephroureterectomy (LRNU) for upper tract urothelial carcinoma (UTUC) and report on long-term oncological outcomes., Patients and Methods: In the Agarwal loop-ligation technique, the distal ureteric stump is controlled using endoscopic Endoloop ® or PolyLoop ® ligation to ensure en bloc excision of the bladder cuff and prevent spillage of upper tract urine into the perivesical space. A retrospective review of the medical records of 76 patients who underwent the Agarwal loop-ligation technique for UTUC at participating centres from July 2004 to December 2017 was performed. Data collected included demographics, perioperative, and long-term oncological outcomes. Survival was calculated using Kaplan-Meier survival analyses., Results and Limitations: A total of 76 patients were included. The median age was 71.5 years and median operative time was 4.3 h. The intramural ureter and bladder cuff were completely excised in all patients. Distal surgical margins were clear in all, with only two patients found to have tumour extending to the circumferential surgical margin. There were no cases of perivesical recurrence or port-site metastasis. The 5-year bladder, local, and contralateral recurrence-free survival was 59.6%, 89.0% and 93.5%, respectively. Metastasis-free survival at 5-years was 73.5%. The 5-year overall survival and cancer-specific survival rates were 70.3% and 84.7%, respectively., Conclusions: We have described the Agarwal loop-ligation technique for the management of the distal ureter in LRNU. This technique complies with oncological principles outlined in the European Association of Urology guidelines, which minimises tumour spillage. Long-term oncological outcomes are satisfactory, with no cases of perivesical recurrence detected in this series., (© 2020 The Authors BJU International © 2020 BJU International.)

Purpose: Arteriovenous malformations (AVMs) are abnormal communications between arteries and veins without an intervening capillary system. The best endovascular treatment option for these is unclear and may involve multiple staged procedures using a variety of embolic materials. We report our initial experience using a modified version of a previously published neurointerventional technique to treat soft tissue AVMs with single-stage curative intent., Materials and Methods: Soft tissue AVMs treated endovascularly using either sole arterial or combined arterial and venous balloon-assisted techniques with liquid embolic agents were retrospectively identified over a 3.5 year period (January 2017 to June 2020)) at two centres. Clinical, pre-operative radiological, procedural technical and post treatment details were recorded., Results: Seven patients were treated for symptomatic soft tissue arteriovenous malformations. These AVMs were located in the peripheral limbs (five), tongue (one) and uterus (one). Curative treatment was achieved in 6/7 patients with one patient requiring a second treatment approximately 1 year later. A variety of liquid embolisation agents (LEAs) including sclerosants and polymers were used. Clinical success rate was 100% following treatment. One patient experienced expected temporary post-operative tongue swelling requiring tracheostomy occurred following embolisation of the lingual AVM. A minor complication in a second patient was due to an access site haematoma developed following treatment of the hand AVM requiring surgical intervention. No long-term sequelae or additional complications were observed., Conclusion: Endovascular arterial and venous balloon assisted LEA embolization of soft tissue AVMs with curative intent is feasible. This technique may provide an alternative treatment option for achieving durable occlusion for complex soft tissue AVMs.

Tremor in people with multiple sclerosis (MS) is a frequent and debilitating symptom with a relatively poorly understood pathophysiology. To determine the relationship between clinical tremor severity and structural magnetic resonance imaging parameters. Eleven patients with clinically definite MS and right-sided upper limb tremor were studied. Tremor severity was assessed using the Bain score (overall severity, writing, and Archimedes spiral drawing). Cerebellar dysfunction was assessed using the Scale for the Assessment and Rating of Ataxia. Dystonia was assessed using the Global Dystonia Scale adapted for upper limb. For all subjects, volume was calculated for the thalamus from T1-weighted volumetric scans using Freesurfer. Superior cerebellar peduncle (SCP) cross-sectional areas were measured manually. The presence of lesions was visually determined and the lesion volumes were calculated by the lesion growth algorithm as implemented in the Lesion Segmentation Toolbox. Right thalamic volume negatively correlated with Bain tremor severity score (ρ = - 0.65, p = 0.03). Left thalamic volume negatively correlated with general Bain tremor severity score (ρ = - 0.65, p = 0.03) and the Bain writing score (ρ = - 0.65, p = 0.03). Right SCP area negatively correlated with Bain writing score (ρ = - 0.69, p = 0.02). Finally, Bain Archimedes score was significantly higher in patients with lesions in the contralateral thalamus. Whole brain lesion load showed no relationship with tremor severity. These results implicate degeneration of key structures within the cerebello-thalamic pathway as pathological substrates for tremor in MS patients.

Periorificial lentiginosis, also knew as Peutz-Jeghers Syndrome (PJS), is an autosomally dominant inherited condition determined by a mutation localized at 19p13.3 responsible for mucocutaneous pigmentation and gastrointestinal polyps. Skin- and mucosal pigmentation may be present at birth but usually occur in early childhood, and occasionally may develop later. Round, oval or irregular patches of brown or almost black pigmentation 1 to 5 mm diameter, irregularly distributed over the oral mucosa, gums, hard palate and lips (especially the lower) are observed. The pigmented maculae on the face, encountered especially around the nose and mouth are smaller. Polyps may appear in the stomach, small bowel or colon, with hamartomatous aspects on histology. Acute upper gastrointestinal bleeding and chronic fecal blood loss may appear during the course of disease. There is a higher risk of intestinal and extraintestinal cancers in those patients. We present the case of an 18-year-old young girl accusing since the age of 3 slight intermittent episodes of bloating and abdominal pain without a particular localization, as well as mild iron-deficiency anemia. Physical examination revealed pigmented lesions suggesting PSJ on the palatine and jugal mucosa while endoscopy found a lot of polyps in stomach and a few, isolated in the colon, all having the same hamartomatous pattern. The presence in early infancy of small, well-demarcated and dark-brown to blue-black lentigines on the lips, buccal mucosa and perioral skin, should alert the clinician to PJS.