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OBJECTIVE: Global studies report a significant decline in ST-elevation myocardial infarction (STEMI) related hospitalization rates during the coronavirus disease 2019 (COVID-19) pandemic outbreak. However, there have been several divergent reports on hospital outcomes. In this study, we aim to investigate the impact of the COVID 19 outbreak on hospitalizations because of STEMI and in-hospital outcomes in Albania. METHODS: This was a retrograde study, collecting data for hospitalizations because of STEMI from March 9, (first COVID 19 case in our country) to April 30, 2020, (period of total lockdown) compared with the same period in 2019 at our center. The incidence rate ratio (IRR) was used to compare admissions because of STEMI and procedures and the risk ratio (RR) to compare mortality and other complication rates. RESULTS: Admissions for STEMI declined during the COVID-19 period from a total of 217 in 2019 to 156 in 2020 (−28.1%) representing IRR 0.719 (p=0.033). PCIs also reduced from 168 procedures in 2019 to 113 in 2020 (−33%), representing an IRR of 0.67, p=0.021. The time from symptom onset to arrival at our intensive care unit was significantly higher in 2020 compared to 2019 (925.6±1097 vs. 438.7±385 minutes, p

Një ese biografike për Qamil Guranjakun.

Bota intelektuale përgatitet që të përkujtojë në fund të këtij viti dy çaste në shenjë të Mis Edith Durhamit, atë të lindjes dhe të shuarjes së saj. Ajo lindi më 8 dhjetor 1863 dhe vdiq një treçerek shekulli më parë, më 15 nëntor 1944. Atë Shqipëria e nderoi për gjithë sa rrojti dhe u mbajt gjallë, por dhe u kujtua gjithë motit, se i pat bërë vend vetes me librat që ia kushtoi Atdheut tonë. Sa për ne, ne nuk lahemi me Edith Durhamin. Ajo është e para që Elbasanin ia paraqiti Evropës së kulturuar në veprën “Brenga e Ballkanit”. Në pjesën “Vendi i Shqiponjës”, i gjithë kreu i shtatë, na jep një pasqyrë të gjallë për Elbasanin në fillim të këtij shekulli, por ai kapitull mbetet i vetmi dokument autentik nga mund të nisë historia e qytetit tonë, në vitet e Rilindjes Kombëtare. Me atë dashuri që flet për gjithë shqiptarët, po ashtu do të shkruajë edhe për gjyshërit tanë.

Why do some international organizations (IO) accrete delegated authority over time while in others delegation is static or declines? We hypothesize that the dynamics of delegation are shaped by an IO’s founding contract. IOs rooted in an open-ended contract have the capacity to discover cooperation over time: as new problems arise these IOs can adopt new policies or strengthen collaboration in existing areas. This, in turn, triggers a demand for delegation. However, this logic is mediated by the political regime of the IO. In predominantly democratic IOs, delegation is constrained by politicization which intensifies as an IO’s policy portfolio broadens. These claims are tested using an updated version of the Measure of International Authority dataset covering 41 regional IOs between 1950 and 2019. Controlling for alternative explanations and addressing potential endogeneity across a range of model specifications, we find robust support for our argument.

BACKGROUND: Cardiologists and surveys from all over the world have reported an important drop in admissions of patients with acute coronary syndromes (ACS) and related coronary procedures during the outbreak of coronavirus disease 19 (COVID 19) pandemic. AIM: We investigated the impact of the COVID 19 pandemic on hospitalizations for ACS and related invasive procedures in a country with low COVID 19 incidence. METHODS: We conducted a single-center, observational retrospective study including all consecutive patients admitted for ACS in the Cardiology Department of University Hospital Center Mother Theresa from March 9, 2020 (1st day of application of social distance measures) to April 30th (period of total lockdown). Patients admitted in the same time period in 2019 served as controls. All data were collected from the medical files. Admissions were classified as ST-elevation myocardial infarction (STEMI) or non-ST-elevation ACS (NSTEACS). Total and weekly admissions and invasive procedures were assessed. Mean incidence difference (MID) in weekly ACS admissions and procedures was also calculated. RESULTS: Overall, 781 patients were included in this analysis: 321 patients (37%) were admitted during study period and 550 patients (63%) were admitted during the control period (overall reduction of 41.6%;weekly MID of 28.6 (95% confidence interval [CI] 13.3 to 44.0;p = 0.001). The occurrence of all ACS types was reduced: STEMI, by 28.1%;weekly MID 7.3 [0.6-15.2];p = 0.048];NSTEACS by 50.5%, weekly MID 19.1 [13.9-24.4];p

Primitive vein popliteal aneurysms are rare and potentially fatal vascular disorders. The most dangerous complications of popliteal vein aneurysms are thromboembolic events, mainly pulmonary embolisms, a life-threatening event that requires a timely diagnosis and prompt management. As a treatable cause of recurrent pulmonary embolisms, their actual incidence is believed to be underestimated. Herein, we present a case report of a popliteal vein aneurysm in a previously healthy16-year old male, presenting with a swelling behind his left knee that causes minimal discomfort while walking. When feasible, early surgical repair of both symptomatic and asymptomatic popliteal venous aneurysms is advised, since they are associated with an ill-defined possibility of pulmonary embolism and mortality, if left untreated.

This comparative study uses the legacy effect of the Soviet past to explain the changes in public capital budgeting and management in the three former Soviet republics: Russian Federation, Moldova,...

Background Patients with type 2 diabetes (T2DM) present an increased risk of cardiovascular (CV) disease and excess CV-related mortality. Beyond the established role of brain natriuretic peptide (BNP) and cardiac troponins (cTn), other non-cardiac-specific biomarkers are emerging as predictors of CV outcomes in T2DM. Methods Serum levels of soluble suppression of tumorigenesis 2 (sST2), high-sensitivity (hs)-cTnI, and N-terminal (NT)-proBNP were assessed in 568 patients with T2DM and 115 healthy controls (CTR). Their association with all-cause mortality and the development of diabetic complications was tested in T2DM patients over a median follow-up of 16.8 years using Cox models and logistic regressions. Results sST2 followed an increasing trend from CTR to uncomplicated T2DM patients (T2DM-NC) to patients with at least one complication (T2DM-C), while hs-cTnI was significantly higher in T2DM-C compared to CTR but not to T2DM-NC. A graded association was found between sST2 (HR 2.76 [95% CI 1.20–6.33] for ≥ 32.0 ng/mL and 2.00 [1.02–3.94] for 16.5–32.0 ng/mL compared to Conclusions sST2, hs-cTnI, and NT-proBNP are associated with 15-year mortality and onset of CV events in T2DM. The long-term prognostic value of sST2 and its ability to track variables related to insulin resistance and associated metabolic disorders support its implementation into routine clinical practice.

Carbonic anhydrase inhibitors (CAIs) are prescription drugs also used in doping to dilute urine samples and tamper with urinalyses. Dorzolamide, brinzolamide, and acetazolamide are prohibited by the World Anti-Doping Agency. Detecting CAIs and their metabolites in biological samples is crucial to documenting misuse in doping. We quantified dorzolamide, brinzolamide, acetazolamide, and their metabolites in the urine and hair of 88 patients under treatment for ocular hypertension or glaucoma. Samples of the patients’ relatives were analyzed to assess potential for accidental exposure. After washing, 25 mg hair was incubated with an acidic buffer at 100 °C for 1 h. After cooling and centrifugation, the supernatant was analyzed by ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). Urine (100 μL) was diluted and centrifuged before UHPLC-MS/MS analysis. Run time was 8 min through a reverse-phase column with a mobile phase gradient. MS/MS analysis was performed in a multiple-reaction monitoring mode after positive electrospray ionization. Median urinary concentration was 245 ng/mL (IQR: 116.2–501 ng/mL) for dorzolamide, 81.1 ng/mL (IQR: 35.9–125.3 ng/mL) for N-deethyl-dorzolamide, 0.77 ng/mL (IQR: 0.64 ng/mL–0.84 ng/mL) for N-acetyl-dorzolamide, 38.9 ng/mL (IQR: 20.4–79.2 ng/mL) for brinzolamide, and 72.8 ng/mL (IQR: 20.7–437.3 ng/mL) for acetazolamide. Median hair concentration was 0.48 ng/mg (IQR: 0.1–0.98 ng/mg) for dorzolamide, 0.07 ng/mg (IQR: 0.06–0.08 ng/mg) for N-deethyl-dorzolamide, 0.40 ng/mL (IQR: 0.13–1.95 ng/mL) for brinzolamide. Acetazolamide was detected in only one hair sample. Dorzolamide and brinzolamide were detected in the urine of three and one relatives, respectively. Cutoff concentrations of urinary dorzolamide and brinzolamide are necessary to preclude false positives due to contamination or passive exposure. We reported the first concentrations of brinzolamide in hair.

Background Multiple studies conducted worldwide and in Albania documented an important reduction of acute ST-elevation myocardial infarction (STEMI) admissions during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding STEMI admissions and outcomes during the ongoing pandemic after the initial lockdown. We aimed to study STEMI admissions and in-hospital outcomes after the COVID-19 lockdown period. Methods A retrospective single-center study was conducted, collecting data for all consecutive STEMI admissions from March 9th, (the first COVID-19 case) until April 30

PurposeThis study investigates the relationship between police officer's willingness to use Employee Assistance Program (EAP) and their perceptions about stress and help-seeking in policing, considering the effect of gender and ethnicity in this association.Design/methodology/approachA survey of 431 Illinois police officers is used to measure officer's perceptions about help-seeking and organizational stressors. The conditional PROCESS modeling (Hayes, 2012) was employed to analyze the hypothesized mediation model. The ANOVA test was used to determent the effect of gender and ethnicity on organizational stressors in policing.FindingsFindings suggest police officer's willingness to use EAP is shaped by the perceived negative effect of stress on promotion through the mediator, confidence in their departments to receive adequate assistance, with noticeable gender and ethnic differences. The analysis demonstrated that female police officers feel stressed because of unfair promotional opportunities and poor relationships with supervisors. Female police officers are less willing to apply for the EAP services to mitigate stress than male police officers. The findings reveal that ethnicity is a significant predictor of the police officers' willingness to apply for EAP services to mitigate stress.Research limitations/implicationsThe current study is limited by its focus on only one police department located in the Illinois, USA. This may limit the generalizability of the results. The cross-sectional nature of data used to draw conclusions and variation in departments' characteristics and compositions could influence results.Practical implicationsThe research has practical implications for those who are interested to understand organizational stressors and perceptions on help-seeking in policing. This study provides suggestions for police administrators to make effort in creating more sensitive working environment to reduce stressors for female police officers and representatives of ethnic groups.Originality/valueThe research unveils the significance of officer's confidence in their departments in modifying their willingness to use EAP, revealing the effect of organizational stressors on confidence. The study adds empirical evidence to existing research on impact of gender and ethnicity on their willingness to use EAP.

Malformations of the portal venous system consist of congenital and acquired anomalies. Congenital portosystemic shunts represent rare vascular developmental anomalies that allow partial or complete diversion of blood flow from the portal venous system to the systemic venous system, bypassing the liver. Congenital portosystemic shunts may be associated with malformations or congenital absence of the portal vein, and it was first described by John Abernethy in 1793. Most cases are diagnosed in early childhood, but some congenital shunts may remain asymptomatic and are encountered incidentally because of the widespread use of computed tomography and magnetic resonance imaging. In this report, we discuss the case of a 40-year-old female who presented to the Emergency Department with right upper quadrant pain, nausea, and vomiting. Clinical presentation and abdominal computed tomography angiography were consistent with the diagnosis of calculous cholecystitis and congenital absence of portal vein with intrahepatic portosystemic shunts. We discuss the importance of radiology in diagnosing such incidental malformations, coupled with a review of the current literature on this topic.

The tendency for higher economic development with the aim of increasing the citizens’ standard of living has led many natural resources in Kosovo to be overused and degraded. This environmental degradation is nowadays presented in the form of air, water and soil pollution. To cope with environmental problems in a society, its citizens, especially the young generations, need environmental education which plays a very important role for development of environmental attitudes and beliefs, which should be friendly and protective for environment and natural resources. In our survey, we used 15-item NEP scale to evaluate the environmental worldview of three groups of employees in city of Kacanik, in order to see if they have pro-anthropocentric approach, Dominance Social Paradigm which declares that natural sources are eternal, so they can be broadly utilized to fulfill human demands, or pro-ecological view, New Environmental Paradigm (NEP) that expects the integral part of the ecosystem is human being and natural resources cannot be utilized without control because they are insufficient. Our results show that all groups of respondents have a high pro-NEP score, higher than 45%, which means that the citizens are conscious about environmental problems in their city and country in general; thus, they have environmental concerns and are ready to support environmental policies for a sustainable economic development.

Përpara inteligjencës shqiptare, qëndron detyrimi moral për ndritjen e figurës së shkencëtares angleze, Margaret Hasluck. Kjo barrë, më shumë, u takon intelektualëve elbasanas, jo për tjetër gjë, po ngaqë anglezja e famshme, duke banuar për 13 vjet në Elbasan, i dha emër të mirë qytetit tonë, kudo në botë. Ka qenë një kohë, kur historia e qytetit u lidh ngushtë me jetën e kësaj zonje të nderuar. Si padashur, emri i saj u përjetësua nëpër rrugë e ndërtesa, por edhe nëpër lule e pemë. Në fëmijëri ne dilnim për shëtitje me shkollën nga “Rruga e Englezkës”, shihnim “Vilën e Englezkës”, laheshim te “Rema e Englezkës”... Ndërsa nëpër oborre, mbanim trëndafila të “englezkës” e rritnim mollë nga të sajat. Po erdhi një kohë, më vonë, kur s’na linin ta zinim me gojë Gretën tonë... dhe, pastaj zunë të na e denigrojnë e t’i ngjisnin lloj-lloj bishtash... E kush e bënte këtë?.

Ka në historinë tonë, çaste të një rëndësie të veçantë... por, momentin më kulminant, në të gjitha përpjekjet e popullit shqiptar për liri kombëtare, e shënon Shpallja e Pavarësisë dhe ajo Ditë e Flamurit e 28 Nëntorit 1912. Mbahet mend dhe është shkruar, nëpër faqet e historisë... se, më së pari, flamuri me shqiponjë dykrenore, u ngrit në Elbasan, më 25 Nëntor të vitit 1912. Mbi këtë datë simbolike, studiues dhe qytetarë atdhetarë, duhet t’i çojnë sytë herë e mbas here... Akti i shpalosjes së Flamurit Kombëtar, ndër treva të Elbasanit, u shoqërua, në çast me ndërtimin e një administrate shqiptare, në rang prefekture, nëpër të gjitha hapësirat e qarkut... Duhet shënuar se, nën këtë juridiksion, atëherë ndodheshin edhe krahina të tilla, si: Mokra, Golloborda, Shëngjergji, Martaneshi, Zhullima, Malësia e Rrogozhinës dhe e Pezës, po ashtu dhe krejt Darsia e Hysgjokajt... gati dyfishi i kësaj prefekture që kemi sot. Kjo qeverisje lokale kishte për detyrë të zëvendësonte ish-administratën turke, në të gjitha instancat: prefekturë-nënprefekturë-krahinari... Tërë kjo veprimtari përbënte një akt të ligjëruar për t’u rrëfyer forcave ndërluftuese të Koalicionit Ballkanik, krejt i pavarur nga Perandoria Osmane dhe... neutral e i papërzier në mosmarrëveshjet e palëve në konflikt.

Ka në historinë tonë, çaste të një rëndësie të veçantë... por, momentin më kulminant, në të gjitha përpjekjet e popullit shqiptar për liri kombëtare, e shënon Shpallja e Pavarësisë dhe ajo Ditë e Flamurit e 28 Nëntorit 1912. Mbahet mend dhe është shkruar, nëpër faqet e historisë... se, më së pari, flamuri me shqiponjë dykrenore, u ngrit në Elbasan, më 25 Nëntor të vitit 1912. Mbi këtë datë simbolike, studiues dhe qytetarë atdhetarë, duhet t’i çojnë sytë herë e mbas here... Akti i shpalosjes së Flamurit Kombëtar, ndër treva të Elbasanit, u shoqërua, në çast me ndërtimin e një administrate shqiptare, në rang prefekture, nëpër të gjitha hapësirat e qarkut... Duhet shënuar se, nën këtë juridiksion, atëherë ndodheshin edhe krahina të tilla, si: Mokra, Golloborda, Shëngjergji, Martaneshi, Zhullima, Malësia e Rrogozhinës dhe e Pezës, po ashtu dhe krejt Darsia e Hysgjokajt... gati dyfishi i kësaj prefekture që kemi sot. Kjo qeverisje lokale kishte për detyrë të zëvendësonte ish-administratën turke, në të gjitha instancat: prefekturë-nënprefekturë-krahinari... Tërë kjo veprimtari përbënte një akt të ligjëruar për t’u rrëfyer forcave ndërluftuese të Koalicionit Ballkanik, krejt i pavarur nga Perandoria Osmane dhe... neutral e i papërzier në mosmarrëveshjet e palëve në konflikt.

In this study, we investigate how socioeconomic status is related to people's commitment to liberal democracy. Based on sociological and psychological theories of social conflict and dominance, we argue that those who enjoy a more privileged position in the social hierarchy tend to develop stronger preferences for the existing social and political order. Conversely, people in underprivileged positions tend to be less supportive of that order. Hence, we expect the relationship between socioeconomic status and commitment to liberal democracy to be context-specific: positive in liberal democracies but negative in autocracies. Furthermore, we argue that income inequality amplifies these dynamics, widening the gap between low and high status individuals. We test our hypotheses using the fifth wave of the World Value Surveys.

Funding Acknowledgements Type of funding sources: None. Background The incidence of acute coronary syndromes (ACS) decreased during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding gender differences in ACS admissions and outcomes during the pandemic that presented divergent results. Purpose The impact of COVID-19 pandemic on male and female ACS admissions and in-hospital outcomes. Methods A retrograde single-center study was conducted, collecting data for ACS admissions from March 9th (first COVID-19 case) until April 30th2020, compared with the same period of 2019. ACS admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA). Incidence rate ratio (IRR) was used to compare all-ACS and subgroups admissions, and risk ratio (RR) to compare overall/male/female mortality. Results There were 321 ACS patients (238 males, 83 females) during the pandemic period and 550 patients (400 males, 150 females) during 2019. The IRR of all-ACS/males/females were significantly lower during COVID-19 period,respectively 0.58 (0.44-0.76), 0.59 (0.43-0.75) and 0.55 (0.37-0.74). The IRR for STEMI was significantly lower among females (0.59[0.39-0.89]), but not in males (0.76 [0.55-1.08]). The IRR for NSTEMI was lower but unsignificantly, meanwhile for UA it was significantly lower for both, males (0.40 [0.24-0.51]) and females (0.50 [0.33-0.84]). The overall ACS mortality was importantly increased during the COVID-19 period (7.4% vs. 3.4%) RR=2.16 (1.20-3.89). Significant increase was found in males (7.45% vs. 2.5%) RR=3.02 (1.42-6.44), but not in females (7.2% vs. 6%) RR=1.20 (0.44-3.27). Conclusions Admissions for ACS were reduced similarly in males and females during the COVID-19 pandemic. Main reductions were observed in UA group similarly in both genders and in STEMI predominantly in females. While we identified a substantial increase in the overall ACS mortality, significant increase was observed only in males reducing the differences between genders. Further studies are necessary for a better understanding of the increase in male mortality during this period.

Funding Acknowledgements Type of funding sources: None. Background Multiple studies documented an important reduction of acute coronary syndromes (ACS) admissions during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding the ACS admissions and outcomes during the ongoing pandemic after the initial lockdown. Purpose We aimed to study the ACS admissions and in-hospital outcomes during and after the COVID-19 lockdown period. Methods A retrograde single-center study was conducted. The data for all admissions were collected from March 9th, (first COVID-19 case) until April 30th, the corresponding period of 2020 total lockdown, for three consecutive years from 2019 to 2021. The control period was considered the year 2019 and the study periods were in 2020 (lockdown) and 2021 (ongoing pandemic). ACS admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA). Incidence rate ratio (IRR [95%CI]) was used to compare all-ACS and subgroups admissions, and risk ratio (RR [95%CI]) to compare the mortality between each study period with the control one. Results Were included 550 ACS patients (pts) during 2019, 321 pts during 2020, and 473 pts during 2021 period. The overall-ACS admissions IRR was significantly lower during 2020 lockdown (0.58 [0.44-0.76]), and not significant during 2021 ongoing pandemic (0.86 [0.62-1.18]). During 2020 lockdown, significant reduction for STEMI and UA, the IRR respectively (0.72 [0.56-0.94]) and (0.42 [0.22-0.76]), and not significant during 2021 respectively (0.87 [0.63-1.21]) and (0.86 [0.51-1.46]) were observed. The reduction in NSTEMI admissions was not significant in both periods. The overall mortality was, importantly increased during the lockdown period (7.45 vs. 3.4 %), RR=2.16 (1.2-3.89). Meanwhile the 2021 mortality was similar (4.2 vs. 3.4%), RR=1.22 (0.66-2.26). Conclusions After the initial reduction of admissions in all-ACS, STEMI and UA during the 2020 lockdown period and the increase of all-ACS mortality, the number of admissions and the mortality returned to a similar range during 2021 despite the ongoing COVID-19 pandemic.

Background The incidence of acute coronary syndromes (ACS) decreased during the coronavirus disease 2019 (COVID-19) pandemic. Few studies have investigated gender differences in ACS admissions and outcomes during pandemics and have presented divergent results. This study aimed to investigate the effect of the COVID-19 pandemic on male and female hospitalizations and in-hospital outcomes in patients presenting with ACS. Methodology We designed a retrograde, single-center trial gathering data for ACS hospitalizations during the lockdown (March 9, 2020, to April 30, 2020) compared with the same timeframe of 2019. ACS hospitalizations were subgrouped as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA). We calculated the incidence rate ratio (IRR) to compare all-ACS and subgroups for male and female hospitalizations and the risk ratio (RR) to compare overall male/female mortality. Results This study included 321 ACS patients (238 males, 83 females) during the COVID-19 lockdown and 550 patients (400 males, 150 females) during 2019. The IRRs of all-ACS/males/females were significantly lower during the COVID-19 period at 0.58 (95% confidence interval (CI) = 0.44-0.76), 0.59 (95% CI = 0.43-0.75), and 0.55 (95% CI = 0.37-0.74), respectively. The IRR for STEMI was significantly lower among females (0.59 (95% CI = 0.39-0.89)), but not among males (0.76 (95% CI = 0.55-1.08)) The IRR for NSTEMI was not significantly lower, meanwhile it was significantly lower for UA among both males and females. The overall ACS mortality increased during the COVID-19 period (7.4% vs. 3.4%; RR = 2.16 (95% CI = 1.20-3.89)). Important increase was found in males (7.45% vs. 2.5%; RR = 3.02 (95% CI = 1.42-6.44)), but not in females (7.2% vs. 6%; RR = 1.20 (95% CI = 0.44-3.27). Conclusions The admissions of ACS reduced similarly in males and females during the COVID-19 pandemic. The admissions of STEMI reduced predominantly in females. We identified a substantial increase in the overall ACS mortality, but predominantly in males, reducing the differences between males and females. Further studies are necessary to better understand the increase in male mortality during the pandemic.

Additional file 1: Table S1. Comparison of raw and log-transformed sST2, hs-cTnI, and NT-proBNP serum levels between healthy control subjects (CTR) and patients with type 2 diabetes mellitus (T2DM). Data are median (IQR). P-values for Mann-Whitney U test. Table S2. Correlation matrix between selected clinical/biochemical variables and serum sST2, hs-cTnI, and NT-proBNP in CTR (n=115) and T2DM (n=568) subjects. Table S3. Results of the MANCOVA model in which log-transformed concentrations of sST2, NT-proBNP, and hs-cTnI were used as dependent variables and each T2DM complication as factor. Age, sex, and HbA1c were used as covariates. Univariate tests for post-hoc comparisons are reported. Arrows indicate significant increase of the dependent variable with complications/treatments. Table S4. C-statistics, with 95% confidence intervals, of the Cox regression models for predicting all-cause mortality in T2DM patients. Table S5. Logistic regression model predicting likelihood of developing the composite endpoint death or MACE in T2DM patients without previous history of MACE. Model summary, χ²=107, df=12, p

The use of course-management software such as Blackboard, Moodle, and Canvas has become ubiquitous at all levels of education in the United States. A potentially useful feature of these products is the ability for instructors to administer assessments including quizzes and tests that are flexible, easy to customize, and quick and efficient to grade. Although computer-based assessments offer clear advantages, instructors might be concerned about their effect on student performance. This article evaluates whether student performance differs between handwritten and computer-based exams through a randomized field experiment conducted in a research methods course. Overall, our findings suggest a significant improvement in student performance on computer-based exams that is driven primarily by the relative ease of producing thorough responses on the computer versus by hand.

Background Limited data exist about the impact of gender-specific outcomes in patients with heart failure (HF) who develop concomitant sepsis. Methods This is a retrospective cohort study of patients with HF who developed sepsis. Clinical outcomes, including in-hospital mortality, development of cardiogenic shock (CS), pulmonary edema requiring urgent intravenous diuretics (IVD), acute kidney injury (AKI), length of stay (LOS), and 30-day HF-related readmission, were evaluated in men vs. women. Results This cohort of 618 patients includes 272 (44%) women with a mean age of 75±14 years. Coronary artery disease (p

In this paper we present the results of a study on the distribution of butterfly species in the protected area Mirusha Waterfalls in Kosovo, conducted in the period from April to the end of September 2016. No studies on butterfly fauna in this area had been conducted previously. The survey was organized in 13 sites with different types of habitats, mostly dominated by grassland, natural forest and shrubs. During our study 83 species of butterflies were recorded. The highest diversity (Shannon-Wiener diversity index H) was registered at the site Dush i Sverkes which hosted 68 out of 83 recorded species. The highest number of species was Euro-Siberian (ES) followed by Euro-Oriental (EO), Euro-Meridional (EM) and Holarctic species (Hol). Our results confirm a rich diversity of butterfly fauna influenced by the climate characteristics, geology and plant composition of the studied area. Out of 83 recorded species in our survey, 7 have Near Threatened status in Europe: Carcharodus floccifera (Zeller, 1847); Parnassius mnemosyne (Linnaeus, 1758); Cupido decolorata (Staudinger, 1886); Hipparchia fagi (Scopoli, 1763); Hipparchia statilinus (Hufnagel, 1758); Melitea aurelia (Nickeri, 1850) and Chazara briseis (Linnaeus, 1764)., U radu prikazujemo rezultate istraživanja rasprostranjenosti vrsta leptira u zaštićenom području slapova Mirusha na Kosovu, provedenog u razdoblju od travnja do kraja rujna 2016. Fauna leptira tog područja nije prethodno istraživana. Istraživano je 13 lokaliteta s različitim tipovima staništa, dominirali su travnjaci, šuma i grmlje. Tijekom istraživanja zabilježene su 83 vrste leptira. Najveća raznolikost (Shannon-Wienerov indeks raznolikosti H) bila je na lokalitetu Dush i Sverkes, 68 od 83 zabilježene vrste. Najviše je bilo eurosibirskih vrsta (ES), slijedile su euroorijentalne (EO), euromeridionalne (EM) I holarktičke vrste (Hol). Naši rezultati potvrđuju bogatu bioraznolikost, na koju utječu klimatske značajke, geologija i biljni svijet istraživanog područja. Od 83 zabilježene vrste, 7 ih ima status gotovo ugroženih u Europi: Carcharodus floccifera (Zeller, 1847); Parnassius mnemosyne (Linnaeus, 1758); Cupido decolorata (Staudinger, 1886); Hipparchia fagi (Scopoli, 1763); Hipparchia statilinus (Hufnagel, 1758); Melitea aurelia (Nickeri, 1850) i Chazara briseis (Linnaeus, 1764).

Beginning in 2015, Macedonia has suffered great instability and political intrigue due to a wiretapping scandal that exposed staggering state capture and authoritarian practices by the then-ruling VMRO-DPMNE party. This article puts current events in the broader historical context of Macedonia’s postcommunist experience. It argues that Macedonia’s political life has revolved around two basic questions: Who are the Macedonians, and to whom does Macedonia belong? Both within and beyond the country’s borders, these questions are deeply contested, and this has led to a dominance of identity politics at the expense of good governance and democratic consolidation.

Emanuel syndrome (ES) is a very rare chromosomal disorder, also known as Supernumerary derivative (22)t(11;22) Syndrome. Although the chromosomal disorder exhibits classic clinical features to the post-natal child, parents usually may be phenotypically normal. In most of the cases, a carrier parent has inherited the t(11;22) from one of his parents. Usually it presents a wide range of clinical presentation, such as growth delay, failure to thrive, congenital heart defects, renal abnormalities, craniofacial dysmorphism and microcephaly. ES as a complex disorder that requires a multidisciplinary team of different specialists aims for improving the quality of life and obtaining a stationary condition. Early detection and follow-up of the development of milestones in these patients leads to rapid improvement of their clinical and laboratory findings. We here present an interesting case of a 10 year old male with ES managed step by step complications in years.

Background Cardiovascular diseases remain the number one cause of mortality in the world despite modern scientific and therapeutic advancement. Gender difference pathophysiology, treatment and outcome have been hypothesized and studied. Whether there are sex differences in the outcome after PCI remains controversial. Aim of the study We undertook this study to assess whether there are sex-related differences in intrahospital outcome of patients undergoing percutaneous coronary intervention. Materials and methods This is a prospective observational study. We enrolled consecutively all patients undergoing PCI in UHC “Mother Theresa” from April to October 2018 and were followed in the 1st Clinic of Cardiology. Data for 352 patients were collected, 261 males and 91 females. We excluded from the study patients that could not be followed. Results Women were older (5.27; 95% CI: 2.98–7.6; p Conclusion Female sex seems to have a tendency for higher mortality even after losing its significance after multivariate adjustments. Females get more myocardial infarction and procedural related complications and have longer hospital stays than men.

While considering all the changes that are happening in society and science, the role and personality of the teacher is not left untouched. The teacher role isn’t only to teach or to lecture but they also have a motivational and encouraging role for pupil`s, to be a good manager, strategist and a ideator of different new innovation. They should be the submitters of the question, the questions that will encourage pupils to think and being logic. The modern teacher builds the concept of teaching in the function of achieving educational results and guides the teaching according to the pupil`s needs and interests.

Albania has one of the youngest populations among the European countries. Albania continues to be involved in a progressive improvement of standards for the protection and respect of children's rights to health. We describe the Albanian pediatric health system, with a particular focus on pediatric primary health care and, first access care, and the structure and staffing of health centers and women and children's consulting centers. Secondary and tertiary pediatric care and neonatal care are also described. The Albanian national laws approved during recent years have had a positive impact on the status of women and children; however, the outcomes seem to be insufficient because of the persistence of several negative socioeconomic factors. The Albanian Pediatric Society believes that the important and beneficial changes observed during the last 20 years should be further supported and implemented. In this regard, Albanian Pediatric Society is fully committed to developing initiatives described in this report and to join the efforts of international collaborative programs and studies aimed at improving the social and health conditions of Albanian children.

The inclusion of 11 new member states from the former Eastern bloc constitutes a significant challenge to the European Union in various respects. Many worry that whatever tenuous ‘European identity’ existed prior to the eastern enlargement, it has now become so diluted that no meaningful European political community can form. We provide an empirical account of the state of European identity after the eastern enlargement through a comparative analysis of affective and cognitive European identity in the old and the new Central and Eastern European member states. Our empirical analyses indicate that while the overall levels of cognitive European identification in the East are indeed lower than in the West, citizens from new member states are just as attached to Europe as citizens from old member states. Most importantly, not only is there no discernable difference in cognitive identification among young Europeans in East and West, but the youngest in the East seem to be even more strongly attached to Europe than their peers in the West.

As Moldova works toward building democracy and sustainable development, it is focusing its attention on increasing the effectiveness of public capital investment management. The chapter summarizes the current legal framework and practices in the field of capital management and budgeting in Moldova and compares the processes with a normative framework for effective capital investment management, focusing on capital planning, capital financial management, capital project execution and management, and public infrastructure maintenance. The analysis demonstrates that the public capital management and budgeting process in Moldova at the level of planning, allocation, and implementation of capital budgets falls short of its potential. The case reveals that despite a promising budgetary reform and comprehensive legal framework, the process of capital budgeting and management in Moldova remains ineffective due to institutional, economic, and political constraints.

Blunt abdominal trauma following gunshot wound. Case report and literature review Introduction: Similarly to blast weapons, every firearm produces explosion at the moment of shooting, which can cause injuries in every region of the body. The aim of this paper is to present the mechanism of blunt abdominal injury following gunshot wounds, bringing this uncommon disease to the clinicians' attention and to review the literature available.A patient developed a delayed bowel perforation following a gunshot injury of the abdomen without breaking of the peritoneum. It was clinically suspected eight hours later and confirmed with contrast-enhanced computed tomography scan. The patient underwent immediate laparotomy. Resection, end-to-end anastomosis, and large lavage of the peritoneal cavity was performed. The patient was discharged ten days after operation in good condition.Failure to recognize blunt trauma mechanism following firearm wounds increases the risk of missed injuries. Distant injuries should be suspected in all cases after blast wave and firearms exposure and a follow up should be done for many days to make sure such injuries are excluded. CT scan total body is recommended in all such cases. Key words: Blunt trauma, Distant Injuries, Firearm injuries, Pressure Waves.Presentiamo il caso di un paziente che ha sviluppato una perforazione dell’ileo terminale a distanza di 8 ore dopo aver subito una ferita d’arma da fuoco superficiale dell’addome, in assenza di soluzioni di continuo del peritoneo. In questo paziente, l’arma da fuoco ha prodotto l’esplosione del viscere da improvviso ed intenso aumento della pressione endoluminale che ha causato la tipica lesione da “scoppio”. Il mancato riconoscimento di questo meccanismo di trauma da onda d’urto, come conseguenza di una ferita d’arma da fuoco interessante la parete addominale espone al rischio di una tardiva identificazione della lesione viscerale. Lesioni remote dovrebbero dunque essere sempre sospettate, in presenza di esplosioni di qualunque tipo. È consigliabile, l’attento monitoraggio del paziente, per poter escludere lesioni secondarie di questo tipo. Il controllo TC total body è raccomandabile in tutti i casi.

Aging is accompanied by a progressive decline of endothelial function and a progressive drift toward a systemic pro-inflammatory status that has been designated "inflammaging". Both phenomena are accelerated and exacerbated in patients with the most common age-related diseases (ARDs), including cancer. The finding that chronic cell stress activates a pro-inflammatory program leading to acquisition of the senescence-associated secretory phenotype (SASP) and to the propagation of senescence to surrounding cells through the secretome, suggests that cell senescence may have a role in both processes. Here we: i) describe the role of cell senescence in endothelial dysfunction, ii) emphasize the contribution of the endothelial cell SASP to inflammaging, and iii) suggest that selective removal of senescent endothelial cells may not only hinder such harmful processes, but also reduce the risk of developing ARDs and their complications. Although in vivo detection and targeting of senescent endothelial cells are still being investigated, it is likely that therapeutic strategies based on antioxidant and anti-inflammatory compounds would involve generalized anti-aging effects also benefiting endothelial cells. MicroRNA (miRNAs) - single-stranded, non-coding RNAs expressed by all living cells and involved in the epigenetic modulation of all transcriptional programs - may constitute an innovative, valuable tool to detect and target senescent endothelial cells and to devise treatments that can slow down the pro-inflammatory program activated in senescent endothelial cells.

Objectives/Hypothesis Altered microRNA expression has been found in many cancer types, including laryngeal squamous cell carcinoma (LSCC). We investigated the association of LSCC-related miR-34c-5p with disease-free survival and overall survival. Study Design Retrospective cohort study. Methods Expression levels of miR-34c-5p were detected in 90 LSCC formalin-fixed paraffin-embedded tissues by reverse-transcription quantitative polymerase chain reaction. Overall survival and disease-free survival were evaluated using the Kaplan-Meier method, and multivariate analysis was performed using Cox proportional hazard analysis. Results A downregulation of miR-34c-5p expression significantly correlated with worse disease-free and overall survival. In the multivariate analysis, low miR-34c-5p expression was associated with an increased risk of recurrence. Conclusions A downregulation of miR-34c-5p in LSCC is independently associated with unfavorable disease-free survival, suggesting that miR-34c-5p might be a promising marker for evaluating the risk of recurrences. Level of Evidence NA Laryngoscope, 125:E306–E312, 2015

The aim of the current paper is to emphasize the correlation between FDI inflows and GDP growth rate in selected countries from Central and Eastern Europe (CEE). The dynamic of FDI inflows and GDP growth rate have been significantly affected by the current economic crisis, which has led to a decrease in foreign capital inflows and a restrained of investment projects. However, macroeconomic imbalances and increased volatilities have determined a strong contraction of GDP growth rates in these economies, except Poland which was the most resilient to worldwide shocks. The results show a unidirectional causality between FDI and GDP growth in all cases, except Hungary. Further analysis will be developed testing the impact of foreign flows volatility on GDP growth.

This chapter presents profiles on the delegation and pooling of authority of ten international organizations (IOs) in Africa. Each profile explains how the coding scheme is applied to the IO by charting a path from the primary and secondary evidence to scoring judgments. They tell the reader how the assembly, executive, secretariat, consultative body, and dispute settlement of each IO are composed, what decisions each body makes, and how they make decisions. The profiles chart these developments annually since 1950. The authors indicate four kinds of uncertainty in superscript: α‎ for thin information; β‎ for a case that falls between the intervals on a dimension; γ‎ for disagreement among sources; δ‎ for inconsistency between written rules in the IO. Each profile is followed by tables summarizing the authors’ observations. Data and codebooks for the Measure of International Authority (MIA) are available on the authors’ websites.

This chapter presents profiles on the delegation and pooling of authority in eleven multi-regional or global international organizations (IOs). Each profile explains how the coding scheme is applied to the IO by charting a path from the primary and secondary evidence to scoring judgments. They tell the reader how the assembly, executive, secretariat, consultative body, and dispute settlement of each IO are composed, what decisions each body makes, and how they make decisions. The profiles chart these developments annually since 1950. The authors indicate four kinds of uncertainty in superscript: α‎ for thin information; β‎ for a case that falls between the intervals on a dimension; γ‎ for disagreement among sources; δ‎ for inconsistency between written rules in the IO. Each profile is followed by tables summarizing the authors’ observations. Data and codebooks for the Measure of International Authority (MIA) are available on the authors’ websites.

This part of the book walks through the evidence that we have gathered to estimate international governance. The route takes us through forty-six international organizations (IOs), and tells the reader how IO bodies are composed, what decisions each body makes, and how they make decisions. This sounds simpler than it actually is, and few readers will accompany us on the entire journey. However, it may be reassuring for the expert and the non-expert alike to know that should they have a specific query about any of the organizations covered in this book, they can discover how we code it by looking in the profiles in this book or online....

This chapter presents profiles on the authority of seven international organizations (IOs) in Europe. Each profile explains the coding scheme is applied to the IO by charting a path from the primary and secondary evidence to scoring judgments. They tell the reader how the assembly, executive, secretariat, consultative body, and dispute settlement of each IO are composed, what decisions each body makes, and how they make decisions. The profiles chart these developments annually since 1950. The authors indicate four kinds of uncertainty in superscript: α‎ for thin information; β‎ for a case that falls between the intervals on a dimension; γ‎ for disagreement among sources; δ‎ for inconsistency between written rules in the IO. Each profile is followed by tables summarizing the authors’ observations. Data and codebooks for the Measure of International Authority (MIA) are available on the authors’ websites.

This chapter presents profiles on the delegation and pooling of authority in four international organizations (IOs) in the Middle East. Each profile explains how the coding scheme is applied to the IO by charting a path from the primary and secondary evidence to scoring judgments. They tell the reader how the assembly, executive, secretariat, consultative body, and dispute settlement of each IO are composed, what decisions each body makes, and how they make decisions. The profiles chart these developments annually since 1950. The authors indicate four kinds of uncertainty in superscript: α‎ for thin information; β‎ for a case that falls between the intervals on a dimension; γ‎ for disagreement among sources; δ‎ for inconsistency between written rules in the IO. Each profile is followed by tables summarizing the authors’ observations. Data and codebooks for the Measure of International Authority (MIA) are available on the authors’ websites.

Chapter One discusses the theoretical-conceptual underpinnings of the Measure of International Authority (MIA). In what respects, and to what extent, do international organizations exert legal rational authority? What powers do non-state actors have in international decision making and dispute settlement? To what extent, when, and how do states sacrifice the national veto in collective decision making? The chapter is structured in a sequence of five steps from the abstract to the particular: conceptualize authority; specify the concept as formal authority of international organizations; unfold in the dimensions of delegation and pooling; operationalize international organization (IO) composition and decision making in indicators that describe institutional alternatives that can be reliably assessed; explicate principles for scoring and adjudicating cases.

This book sets out a measure of authority for seventy-six major international organizations (IOs) from 1950 to 2010 in an effort to provide systematic comparative information on international governance. On the premise that transparency is key in the production of data, the authors chart a path in laying out the assumptions that underpin the measure. Successive chapters detail the authors’ theoretical, conceptual, and coding decisions. In order to assess their authority, the authors model the composition of IO bodies, their roles in decision making, the bindingness of IO decisions, and the mechanisms through which they seek to settle disputes. Profiles of regional, cross-regional, and global IOs explain how they are composed and how they make decisions. A distinctive feature of the measure is that it breaks down the concept of international authority into discrete dimensions. The Measure of International Authority (MIA) is built up from coherent ingredients—the composition and role of individual IO bodies at each stage in policy making, constitutional reform, the budget, financial compliance, membership accession, and the suspension of members. These observations can be assembled—like Lego blocks—in diverse ways for diverse purposes. This produces a flexible tool for investigating international governance and testing theory.