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Quadruple and Quintuple Helix innovation systems are based on democracy and ecology. Two propositions are here key: (1) without a democracy or knowledge democracy, the further advancement of knowledge and innovation are seriously constrained, so in that sense, knowledge and innovation evolution depend on democracy and knowledge democracy; (2) ecology and environmental protection represent a necessity and challenge for humanity, but they also act as drivers for further knowledge and innovation (this should lead to a win–win situation for ecology and innovation). Therefore, for an innovation system to be a Quadruple/Quintuple Helix innovation system, the political regime hosting these helixes needs to be democratic in essence, not just in form. The next stage in evolution of innovation systems may be that this also will require a “democracy of climate” (promoting a social, cultural, economic, and political “climate for democracy”), where democracies as innovation enablers are creating innovation that regard the ecology as a crucial driver for further innovation and for responsible innovation.

This article explores the representations of Ukrainians in the work of Włodzimierz Odojewski. Focusing on his trilogy of books set in Ukraine, Zasypie wszystko, zawieje . . ., Wyspa ocalenia and the earlier collection of stories, Zmierzch świata, the article considers Odojewski's representations of the Ukrainians, mainly peasants, among whom his Polish landowning protagonists live. The article identifies a purported preoccupation in Odojewski's work with trying to understand the motivations for the Ukrainians who participated in the horrific violence that erupted in what is today western Ukraine in 1943–44; yet at the same time, Odojewski's literary strategies consistently defer any understanding by rendering the Ukrainian characters in his work voiceless or imperceptible, reducing them to symbolic elements of a pre-existing Romantic martyrological discourse around the “kresy,” which ultimately precludes any deeper reflection on the experiences of the “other side” of the conflict.

PurposeSeveral energy sources are available to clear stones during PCNL. Required improvements are faster stone clearance, optimized suction and ease of use while maintaining high patient safety standard. EMS LithoClast® Trilogy, is the first device combining electromagnetic impactor with ultrasonic energy and suction, all-in-one probe. Animal studies and in vitro phantom stone studies have proven safety and efficacy of this device. We aim to study safety and clinical efficacy of Trilogy in our patients.Methods31 patients with renal stones were included. Amplatz sheath sizes/Trilogy probe size was 22–28 Fr/10.2 Fr for standard PNL (n = 20) and 15 Fr./5.7 Fr for mini PNL access (n = 11). Analysis was done with respect to demography, stone characteristics, operation duration (total time and lithotripter activation time), post op Hb drop, clearance rate and adverse events. Stone area/volume was calculated based on CT using 3D doctor. Efficacy was determined by stone volume clearance rate (mm3/min).ResultsMale:female ratio was 6:5 and 16:4 for mini (MPNL)/standard PNL (SPNL). Stone densities were 1229 ± 206 vs. 1168 ± 344 HU (MPNL vs. SPNL). Mean stone volumes were 3776.1 ± 2132 mm3 for MPNL and 7096 ± 6441 for SPNL. Mean stone volume clearance ratios were 370.5 ± 171 mm3/min and 590.7 ± 250mm3/min for MPNL and SPNL, respectively. Hb drop was 1.24 ± 0.64 g/dL (MPNL) and 1.23 ± 0.89gm/dL (SPNL). Total procedure time/lithotripter activation time was 53.4 ± 23.8/14.7 ± 12.4 min for MPNL and 65.2 ± 23.5/12.0 ± 8.9 for SPNL. Immediate post-operative/1 month stone clearance rates were 93%/96% with one clinically insignificant residual fragment (< 3 mm) and no necessity for auxiliary procedures. No device failure occured and three Clavien grade I and one grade II complications were observed.ConclusionSwiss LithoClast® Trilogy provides fast stone clearance in standard/mini-PCNL procedures. Ease of use, high tissue safety and optimized suction that avoids fragment blockings are other key features.

IntroductionThere has been recent introduction of novel lithotripters and high-power lasers for stone disintegration. With miniaturization of PCNL, there is need of effective disintegration and faster stone-clearance. This study aimed to evaluate efficiency of Trilogy™ and Thulium fibre laser (TFL) in mini-percutaneous nephrolithotomy (mini-PCNL).MethodsThis is prospective study comparing efficiency and outcomes of Trilogy™ and TFL in mini-PCNL between January 2019 and February 2020. Primary objective was to compare stone fragmentation rates, with secondary objectives beings stone-free rates and complications.ResultsThere were 60 mini-PCNL with suction using either Trilogy™ or TFL energy source. Mean stone size and density were 27.60 ± 10.17 mm, 22.04 ± 9.69 mm (p = 0.05) and 1172.9 ± 313.5HU, 1308.9 ± 333.9HU (p = 0.10) for Trilogy™ and TFL, respectively. Using 3D doctor imaging software from CT images, mean stone volumes were 3718.9 ± 3038.7mm3 for Trilogy™ and 3425.9 ± 3096.1mm3 for TFL(p = 0.77). Using probe-activation time or lasing time, stone-fragmentation rate was 5.98 ± 4.25mm3/sec for Trilogy™ and 3.95 ± 1.00mm3/sec for TFL(p = 0.015). Treatment time (puncture to complete clearance) was 32.48 ± 15.39 min for Trilogy™ and 28.63 ± 18.56 min for TFL(p = 0.38). Haemoglobin drop was 1.19 ± 0.76gm/dl for Trilogy™ and 0.99 ± 0.74gm/dl for TFL (p = 0.30). Trilogy™ arm had 96.6% complete clearance and TFL had 76.6% in TFL at 48 h. One patient in Trilogy™ arm required auxiliary RIRS for residual stone. Both arms had complete stone clearance at 1 month follow-up. Trilogy™ arm had 3 Clavien–Dindo grade-II complications while TFL had 2 Clavien–Dindo grade-II complications (UTI requiring antibiotics). There was no blood transfusion in either of arm.ConclusionTrilogy™ had significantly better stone fragmentation rate than TFL in managing renal stones. However, stone-free rates and complications were comparable for Trilogy™ and TFL.

This study aimed to determine the extent to which values are assessed to create and propose a framework intended for stakeholders to develop and apply outcomes for the acquisition, teaching, and assessment of values. The research on assessing values frequently emphasizes general issues and pays little attention to the unique discipline circumstances that influence the creation and implementation in practice. Though that the assessments and analyses that concentrated on values necessary to fulfill the demands of the modern workplace are sparse. This is the gap in the literature that this study intends to contribute. Bloom’s taxonomy was used as a theoretical framework to determine how values assessment might provide solutions to this problem. The question posed was “How can Bloom’s taxonomy’s values domain be used to build a framework for assessing the values at the study university?” A quantitative approach was used to examine the relationships among variables by collecting and analyzing numeric data expressed in numbers or scores using the self-developed Trilogy Assessment Affective Domain Inventory on the extent to which values were assessed in higher education. This instrument was completed by 268 lecturers from various disciplines at the South African University of Technology in the Gauteng province. Data were analyzed using SPSS version 28.0 descriptive statistics. The reliability was tested using Cronbach’s alpha as a high value for internal consistency. The results revealed that seventy-four percent of the lecturers were not assessing the values domain. These results highlight the need for a framework to help solve the problem. The utilization of the proposed framework may assist stakeholders in improving learning outcomes design, acquisition, teaching, and assessment of values.

This paper focuses on Irish writer, playwright and television screenwriter Eugene McCabe’s fictional representation of the Northern Irish ‘Troubles’ in his trilogy Victims, published in the collection Heaven Lies about Us (2005). Living most of his life on his family farm on the Monaghan/Fermanagh border between Northern Ireland and the Republic, McCabe had a deep understanding of the historically entrenched hatreds, bigotry and fundamentalisms of its inhabitants, and his fiction reflects the human tragedy underlying the violence. This paper draws on an eco-philosophical framework to suggest that by capturing the entanglement between the natural and cultural place-world McCabe’s poetics offers, from a liberal humanist perspective, an indictment of anthropocentric patriarchy at the root of violent dispute. McCabe’s literary world, evoking natural and cultural landscapes, encapsulates the absurdity of isolating territories via false political borders, marginalizing the value of bioregion and diversity and ignoring the vital oneness of humanity. Thus, though McCabe’s short stories are indeed culturally and politically specific, in shedding light on the self-destructiveness of human behaviour they are ultimately timeless and universal.

PurposePCNL requires a lithotrite to efficiently break stones, and some devices include active suction to remove the fragments. We set out to determine the efficacy and safety of the Swiss LithoClast® Trilogy, in a prospective European multicentre evaluation and compared it to published stone clearance rates for Trilogy based on surface area (68.9 mm2/min) and using the 3D calculated stone volume (526.7 mm3/min).MethodsTen European centres participated in this prospective non-randomized study of Trilogy for PCNL. Objective measures of stone clearance rate, device malfunction, complications and stone-free rates were assessed. Each surgeon subjectively evaluated ergonomic and device effectiveness, on a 1–10 scale (10 = extremely ergonomic/effective) and compared to their usual lithotrite on a 1–10 scale (10 = extremely effective).ResultsOne hundred and fifty seven PCNLs using Trilogy were included (53% male, 47% female; mean age 55 years, range 13–84 years). Mean stone clearance rate was 65.55 mm2/min or 945 mm3/min based on calculated 3D volume. Stone-free rate on fluoroscopy screening at the end of the procedure was 83%. Feedback for suction effectiveness was 9.0 with 9.1 for combination and 9.0 for overall effectiveness compared to lithotrite used previously. Ergonomic score was 8.1, the least satisfactory element. Complications included 13 (8.2%) Clavien–Dindo Grade II and 2 (1.3%) Grade III. Probe breakage was seen in 9 (5.7%), none required using a different lithotrite.ConclusionsWe have demonstrated that Trilogy is highly effective at stone removal. From a user perspective, the device was perceived by surgeons to be highly effective overall and compared to the most commonly used previous lithotrite, with an excellent safety profile.

Background and purpose The study evaluated the differences in leaf positioning deviations by the log files of three advanced accelerators with two delivery techniques, and established specific assessment parameters of leaf positioning deviations for different types of accelerators. Methods A total of 420 treatment plans with 5 consecutive treatment log files were collected from the Trilogy, TrueBeam and Halcyon accelerators. Millennium MLC was equipped on the Trilogy and TrueBeam accelerators. A jawless design and dual-layer MLC were adopted on the Halcyon accelerator. 70 IMRT and 70 VMAT plans were selected randomly on each accelerator. The treatment sites of all plans included head and neck, chest, breast, pelvis and other sites. The parsing tasks for 2100 log files were proceeded by SunCheck software from Sun Nuclear Corporation. The maximum leaf root mean square (RMS) errors, 95th percentile errors and percentages of different leaf positioning errors were statistically analyzed. The correlations between these evaluation parameters and accelerator performance parameters (maximum leaf speed, mean leaf speed, gantry and arc angle) were analyzed. Results The average maximum leaf RMS errors of the Trilogy in the IMRT and VMAT plans were 0.44 ± 0.09 mm and 0.79 ± 0.07 mm, respectively, which were higher than the TrueBeam's 0.03 ± 0.01 mm, 0.03 ± 0.01 mm and the Halcyon's 0.05 ± 0.01 mm, 0.07 ± 0.01 mm. Similar data results were shown in the 95th percentile error. The maximum leaf RMS errors were strongly correlated with the 95th percentile errors (Pearson index > 0.5). The leaf positioning deviations in VMAT were higher than those in IMRT for all accelerators. In TrueBeam and Halcyon, leaf position errors above 1 mm were not found in IMRT and VMAT plans. The main influencing factor of leaf positioning deviation was the leaf speed, which has no strong correlation with gantry and arc angles. Conclusions Compared with the quality assurance guidelines, the MLC positioning deviations tolerances of the three accelerators should be tightened. For both IMRT and VMAT techniques, the 95th percentile error and the maximum RMS error are suggested to be tightened to 1.5 and 1 mm respectively for the Trilogy accelerator. In TrueBeam and Halcyon accelerators, the 95th percentile error and maximum RMS error of 1 and 0.5 mm, respectively, are considered appropriate.

In the Prometheus trilogy, fate dictates critical actions taken by Prometheus, such as forming alliances, stealing fire, facing punishment, and eventual liberation. This trajectory gradually aligns with the divine will of Zeus, reflecting the theological framework of early Greek religion. Within the play, Prometheus’s rebellion against the established order of distribution determines his “unlawful act”, which brings about retributive justice—a theological necessity for restoring the balance between human advancement and divine sovereignty. In essence, Prometheus’s punishment results from the interplay between fate and Zeus’s rule, yet this suffering is essential for the harmonization of the cosmic order. Consequently, throughout this process, Zeus’s divine justice undergoes continuous evolution, ultimately establishing the foundation for the legitimacy of civic ethics and providing a theological justification for the justice of human suffering. Ultimately, Aeschylus traces civic ethical norms to Zeus’s justice, demonstrating how democracy gains legitimacy through theological discourse, which highlights the intricate connections among Greek religion, democracy, and tragedy.

The article focuses on the successful series of Red Westerns/Easterns produced in Romania in the late 1970s and early 1980s, known as the “Transylvanians” trilogy. The article will look at the films in the specific context of the period, one characterized by the increasingly idiosyncratic evolution of the Romanian communist regime and by growing economic difficulties, and will examine the way in which the films construct models of masculinity at the intersection between three different types of masculine models: those of the American Western (whether adopted or parodied), those of traditional Romania (such as the idealized, wise peasant), and masculine typologies derived from communist propaganda. I will argue that the films skillfully balance the tension between a critique of American models, in the face of which Romanian models emerge as superior, and legitimizing themselves as well as relying heavily in their entertainment value on the very models of the American Western they are supposed to subvert.