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Introduction: Prehospital emergency medical services (EMS) are essential to emergency medical care. They provide emergency assessment and treatment for seriously ill or injured patients and transport them by ambulance to an emergency department. Adopting triage methods for systematically prioritizing patients according to how urgent patients need care, including Triage of requests for acute medical treatment, is a promising development in our healthcare system. In Kosovo, there is a gap between the effects of prehospital triage systems and the impact of using the same triage system in two or more EMS settings. In this quality improvement study, implementing the TT app intervention was associated with higher rates of inefficient Triage in prehospital settings. However, supporting EMS professionals in their decision-making by calculating the probability of an individual patient needing specialized care at the scene of injury is a new and promising approach to optimize Triage in the field. If we can fully realize the potential of this approach, it could significantly improve the efficiency and effectiveness of our emergency medical care, leading to better patient outcomes. Standards and most health professionals need to be educated and trained in this critical component of EMS. Education, education, and training for the three levels of health care should be an obligatory component to enhance the quality of emergency medical care for children and adults at risk. It is high time to develop and test a conceptual triage scheme or model that will rely on a triage system that responds to the conditions of our health system. Develop clinical guidelines, algorithms, and triage protocols at the three levels of health care. All healthcare professionals must be educated and trained in ongoing coaching, communication courses, BLS AED, Pediatric, PHTLS, Adult Advanced Life Support, ATLS, and International Trauma Life Support. Conclusion: Triage is vital in optimizing patient outcomes in the high-pressure EMS world. It is the process of rapidly assessing a patient's condition to determine the urgency of care and the most appropriate destination for definitive treatment. Done effectively, prehospital Triage ensures that patients receive the right level of care at the right time, maximizing their chances of survival and minimizing long-term complications.

Introduction: Coronavirus diseases-2019 (COVID-19) have been ongoing for more than two years. Despite the scientific research conducted in this process, there is still no widely accepted definitive treatment for the disease. For treating COVID-19, using antiviral agents previously used for the treatment of other RNA-virus infections has been seen as a fast way to a solution, and favipiravir is one of the leading agents. This prospective, multicenter, observational study was designed to investigate the safety of favipiravir in 500 patients treated with favipravir for favipravir. Methods: This study was conducted as a multicenter prospective study. Eight different sites from four cities participated, and 500 patients were included in the study. Follow-up of laboratory parameters, adverse events (AEs), and amelioration of fever, dyspnea, and cough symptoms of the patients was recorded in a case report form. Results: A total of 475 patients from eight centers completed the study. A total of 401 AEs were reported in 206 (51.4%) patients, which were mild-to-moderate in the majority of cases. Serious AEs occurred in 5 patients and death occurred in 4 patients. From the first to the last measurement, serum alanine aminotransferase levels (31.9±27.7 vs. 47.2±49.7 U/L, p37.8 for 6.6% on day 3, 3.2% on day 5, and 0.6% on day 10), dyspnea (for 56.4% on day 5, 62.4% on day 7, and 81.2% on day 10), and cough (46.0% on day 5, 73.0% on day 7, and 87.3% on day 10) were noted in an increasingly higher percentage of patients with continued therapy. Conclusion: The current study provides real-life data of favipiravir, which is a unique option in Turkey for treating COVID-19 patients. The results revealed that favipiravir is a well-tolerated agent with a low side-effect profile. However, it needs to be evaluated with well-designed, dose-compared, randomized controlled studies for the evaluation of efficacy.

Abstract Transdermal drug delivery is of vital importance for medical treatments. However, user adherence to long-term repetitive drug delivery poses a grand challenge. Furthermore, the dynamic and unpredictable disease progression demands a pharmaceutical treatment that can be actively controlled in real-time to ensure medical precision and personalization. Here, we report a spatiotemporal on-demand patch (SOP) that integrates drug-loaded microneedles with biocompatible metallic membranes to enable electrically triggered active control of drug release. Precise control of drug release to targeted locations (

@ propósito estético dominante da fotografia moderna foi, como nos sugere El Lissitzky, fincar uma cunha no agora, alargando cada vez mais a distância entre o antes e o depois. Quem se dá ao trabalho de inventariar seus resultados constata a variedade de sentidos, de possibilidades de sentido, para ser exato, que logrou-se assim realizar. Da fenda aberta por esta cunha emergem as formas do instantâneo que vieram a constituir o repertório típico do fotojornalismo (“o que é isso?”, “como isso está?”, “para onde isso vai?” etc.): perguntas às quais uma legenda deve necessariamente responder. Para que o fotógrafo torne visível cada uma destas oportunidades de legenda, uma vez que tenha mergulhado na duração em busca do instantâneo, deve agora retroceder com sua presa e oferecê-la cristalinamente ao público. Um dos limites evidentes da experiência fotográfica moderna foi, então, persistir na duração, sem retroceder, permanecendo indefinidamente no transe do instante. Comparem-se estas fotos carnavalescas de Zeka Araújo (tiradas entre 1987 e 1989, creio) com as imagens de êxtase propostas por Arthur Omar na Antropologia da face gloriosa. A obra de Omar nos fornece o testemunho deste transe, único modo de habitar o interior do instante. O carnaval de Zeka Araújo buscou forçar os limites da fotografia moderna de um outro modo.

Background: Temperature variability (TV) is associated with increased mortality risk. However, it is still unknown whether intra-day or inter-day TV has different effects. Objectives: We aimed to assess the association of intra-day TV and inter-day TV with all-cause, cardiovascular, and respiratory mortality. Methods: We collected data on total, cardiovascular, and respiratory mortality and meteorology from 758 locations in 47 countries or regions from 1972 to 2020. We defined inter-day TV as the standard deviation (SD) of daily mean temperatures across the lag interval, and intra-day TV as the average SD of minimum and maximum temperatures on each day. In the first stage, inter-day and intra-day TVs were modelled simultaneously in the quasi-Poisson time-series model for each location. In the second stage, a multi-level analysis was used to pool the location-specific estimates. Results: Overall, the mortality risk due to each interquartile range [IQR] increase was higher for intra-day TV than for inter-day TV. The risk increased by 0.59% (95% confidence interval [CI]: 0.53, 0.65) for all-cause mortality, 0.64% (95% CI: 0.56, 0.73) for cardiovascular mortality, and 0.65% (95% CI: 0.49, 0.80) for respiratory mortality per IQR increase in intra-day TV0–7 (0.9 °C). An IQR increase in inter-day TV0–7 (1.6 °C) was associated with 0.22% (95% CI: 0.18, 0.26) increase in all-cause mortality, 0.44% (95% CI: 0.37, 0.50) increase in cardiovascular mortality, and 0.31% (95% CI: 0.21, 0.41) increase in respiratory mortality. The proportion of all-cause deaths attributable to intra-day TV0–7 and inter-day TV0–7 was 1.45% and 0.35%, respectively. The mortality risks varied by lag interval, climate area, season, and climate type. Conclusions: Our results indicated that intra-day TV may explain the main part of the mortality risk related to TV and suggested that comprehensive evaluations should be proposed in more countries to help protect human health.

Assessing the association between temperature frequency and mortality can provide insights into human adaptation to local ambient temperatures. We collected daily time-series data on mortality and temperature from 757 locations in 47 countries/regions during 1979–2020. We used a two-stage time series design to assess the association between temperature frequency and all-cause mortality. The results were pooled at the national, regional, and global levels. We observed a consistent decrease in the risk of mortality as the normalized frequency of temperature increases across the globe. The average increase in mortality risk comparing the 10th to 100th percentile of normalized frequency was 13.03% (95% CI: 12.17–13.91), with substantial regional differences (from 4.56% in Australia and New Zealand to 33.06% in South Europe). The highest increase in mortality was observed for high-income countries (13.58%, 95% CI: 12.56–14.61), followed by lower-middle-income countries (12.34%, 95% CI: 9.27–15.51). This study observed a declining risk of mortality associated with higher temperature frequency. Our findings suggest that populations can adapt to their local climate with frequent exposure, with the adapting ability varying geographically due to differences in climatic and socioeconomic characteristics.

Abstract Background Air pollution and social characteristics have been shown to affect indicators of health. While use of spatial methods to estimate exposure to air pollution has increased the power to detect effects, questions have been raised about potential for confounding by social factors. Methods A study of singleton births in Eastern Massachusetts was conducted between 1996 and 2002 to examine the association between indicators of traffic, land use, individual and area-based socioeconomic measures (SEM), and birth outcomes (birth weight, small for gestational age and preterm births), in a two-level hierarchical model. Results We found effects of both individual (education, race, prenatal care index) and area-based (median household income) SEM with all birth outcomes. The associations for traffic and land use variables were mainly seen with birth weight, with an exception for an effect of cumulative traffic density on small for gestational age. Race/ethnicity of mother was an important predictor of birth outcomes and a strong confounder for both area-based SEM and indices of physical environment. The effects of traffic and land use differed by level of education and median household income. Conclusion Overall, the findings of the study suggested greater likelihood of reduced birth weight and preterm births among the more socially disadvantaged, and a greater risk of reduced birth weight associated with traffic exposures. Results revealed the importance of controlling simultaneously for SEM and environmental exposures as the way to better understand determinants of health.

Exploring the integration of 5D Building Information Modeling (BIM) within the Norwegian construction sector, this study examines its transformative impact on cost estimation and project management, highlighting technological and skill-based adoption challenges. Through methodical case studies and interviews with industry experts, it is revealed that 5D BIM significantly enhances the precision of cost estimations and effectively reduces financial overruns in complex construction projects, indicating an industry shift towards its broader acceptance. The research sets out to explore current challenges and opportunities in 5D BIM, assess the usability and integration of software tools, and understand systemic barriers and skill gaps hindering further progress. These objectives lead to a detailed understanding of 5D BIM’s role in improving economic and procedural efficiencies in construction. Suggesting its pivotal role in the evolving construction management realm, the study contributes important insights into 5D BIM’s transformative potential and underscores its importance in advancing the construction industry’s digital transformation.

This study aims at determining the occupational anxiety level of pre-service physical education teachers according to variables, and revealing the correlation between occupational anxiety and academic self-efficacy. Study group consists of 586 pre-service teachers from 10 different universities in Turkey. Data is collected by "Occupational Anxiety Scale for Pre-Service Teachers (OAS)" and "Academic Self-Efficacy Scale (ASES)." T-test and One-Way ANOVA are used for data analysis, and Levene test is conducted for variance equality. Confidence interval is 0.95. For gender variables, the results reveal that women's occupational anxiety is significantly higher than men's in the dimensions of OAS "total occupational anxiety", "socio-economic anxiety" and "school management anxiety" (p<0.05). According to grade levels, there is significant differentiation in the dimension of OAS "total occupational anxiety", "job-oriented anxiety," "socio-economic anxiety," "interaction with students' anxiety," "colleagues and students' parents anxiety" (p<0.05). For variables of participation in socio-cultural and sportive activities and in "socio-economic" dimension, the participants, who never participate in any activities, have significantly higher level of occupational anxiety than those who regularly participate in activities (p<0.05). There is also a negative correlation between OAS and ASES (p<0.01).

Introduction Social anxiety disorder (SAD) has an early onset, a high lifetime prevalence, and may be a risk factor for developing other mental disorders. Gaze behaviour is considered an aberrant feature of SAD. Eye-tracking, a novel technology device, enables recording eye movements in real time, making it a direct and objective measure of gaze behaviour. Virtual reality (VR) is a promising tool for assessment and diagnostic purposes. Developing an objective screening tool based on examination of gaze behaviour in SAD may potentially aid early detection. The objective of this current study is, therefore to examine gaze behaviour in SAD utilising VR.Methods and analysis A case–control study design is employed in which a clinical sample of 29 individuals with SAD will be compared with a matched healthy control group of 29 individuals. In the VR-based eye-tracking paradigm, participants will be presented to stimuli consisting of high-res 360° 3D stereoscopic videos of three social-evaluative tasks designed to elicit social anxiety. The study will investigate between-group gaze behaviour differences during stimuli presentation.Ethics and dissemination The study has been approved by the National Committee on Health Research Ethics for the Capital Region of Denmark (H-22041443). The study has been preregistered on OSF registries: https://doi.org/10.17605/OSF.IO/XCTAKAll participants will be provided with written and oral information. Informed consent is required for all the participants. Participation is voluntarily, and the participants can at any time terminate their participation without any consequences. Study results; positive, negative or inconclusive will be published in relevant scientific journals.

This study investigates the knowledge and expectations regarding Advanced Nurse Practitioners (ANPs) in Kosovo’s hospital environment, aiming to enhance healthcare standards to meet European benchmarks. Drawing insights from leading European nations, we assess Kosovo’s healthcare landscape to drive advancements in this role. A qualitative approach was employed, utilising semi-structured interviews with thirty-two healthcare workers, including nurses, physicians, health managers, and hospital directors. Participants answered twelve questions focusing on their understanding and expectations regarding the role of ANPs in hospital settings. While many healthcare personnel were unaware of ANPs, those familiar acknowledged their value in setting priorities and addressing clinical demands. However, incomplete information about the role of ANPs was recognized as a challenge. Expectations for integrating ANPs in Kosovo’s healthcare system included enhancing nursing service quality, job processes, service delivery, and communication. While some healthcare personnel recognized ANPs’ capacity, the majority showed limited understanding. Awareness training on the role of ANPs is crucial, as emphasized by chief nurses and regional hospital administrators.

Naturally occurring stilbenoids, such as the (E)-stilbenoid resveratrol and the (Z)-stilbenoid combretastatin A4, have been considered as promising lead compounds for the development of anticancer drugs. The antitumour properties of stilbenoids are known to be modulated by cytochrome P450 enzymes CYP1A1 and CYP1B1, which contribute to extrahepatic phase I xenobiotic and drug metabolism. Thirty-four methyl ether analogues of resveratrol were synthesised, and their anticancer properties were assessed, using the MTT cell proliferation assay on a panel of human breast cell lines. Breast tumour cell lines that express CYP1 were significantly more strongly affected by the resveratrol analogues than the cell lines that did not have CYP1 activity. Metabolism studies using isolated CYP1 enzymes provided further evidence that (E)-stilbenoids can be substrates for these enzymes. Structures of metabolic products were confirmed by comparison with synthetic standards and LC-MS co-elution studies. The most promising stilbenoid was (E)-4,3′,4′,5′-tetramethoxystilbene (DMU212). The compound itself showed low to moderate cytotoxicity, but upon CYP1-catalysed dealkylation, some highly cytotoxic metabolites were formed. Thus, DMU212 selectively affects proliferation of cells that express CYP1 enzymes.

Abstract Somatic hybridization has been frequently used to overcome sexual incompatibility between potato and its secondary germplasm. The primary objective of this study was to produce and evaluate somatic hybrids of Solanum tuberosum (Stub) and S. bulbocastanum (Sblb) for breeding purposes. In 2007, 23 somatic hybrids were produced using an electrofusion of mesophyll protoplasts of diploid (2n = 2x = 24) potato line StubDH165 and S. bulbocastanum PI24351 (Sblb66). Phenotype of somatic hybrids in field conditions were evaluated, together with constitution and stability of 30 nuclear (ncSSR) and 27 cytoplasmic (cpSSR) microsatellite markers and content of main glycoalkaloids. All somatic hybrids had very high field resistance against late blight, but the plants were infertile: the viability of pollen grains insignificantly varied between 0.58 and 8.97%. A significant somaclonal variation was observed in terms of the morphology of plants, the date of emergence, the quantity of harvested tubers, the content of glycoalkaloids in foliage, and nuclear microsatellite markers (ncSSR). The analysis of ncSSR identified five distinct genotypes of hybrids partly associated with phenotype variations. The process of somatic hybridization with regeneration of shoots was identified as the most likely source of somaclonal variation because the ncSSR genotypes of hybrids, which were maintained in vitro, remained stable for more than 10 years. The infertile somatic hybrids have no practical breeding potential, but they are considered very suitable for advanced studies of the differential expression of genes in the pathways linked to dormancy of tubers and synthesis of glycoalkaloids.

Summary: Background: Increased mortality risk is associated with short-term temperature variability. However, to our knowledge, there has been no comprehensive assessment of the temperature variability-related mortality burden worldwide. In this study, using data from the MCC Collaborative Research Network, we first explored the association between temperature variability and mortality across 43 countries or regions. Then, to provide a more comprehensive picture of the global burden of mortality associated with temperature variability, global gridded temperature data with a resolution of 0·5° × 0·5° were used to assess the temperature variability-related mortality burden at the global, regional, and national levels. Furthermore, temporal trends in temperature variability-related mortality burden were also explored from 2000–19. Methods: In this modelling study, we applied a three-stage meta-analytical approach to assess the global temperature variability-related mortality burden at a spatial resolution of 0·5° × 0·5° from 2000–19. Temperature variability was calculated as the SD of the average of the same and previous days’ minimum and maximum temperatures. We first obtained location-specific temperature variability related-mortality associations based on a daily time series of 750 locations from the Multi-country Multi-city Collaborative Research Network. We subsequently constructed a multivariable meta-regression model with five predictors to estimate grid-specific temperature variability related-mortality associations across the globe. Finally, percentage excess in mortality and excess mortality rate were calculated to quantify the temperature variability-related mortality burden and to further explore its temporal trend over two decades. Findings: An increasing trend in temperature variability was identified at the global level from 2000 to 2019. Globally, 1 753 392 deaths (95% CI 1 159 901–2 357 718) were associated with temperature variability per year, accounting for 3·4% (2·2–4·6) of all deaths. Most of Asia, Australia, and New Zealand were observed to have a higher percentage excess in mortality than the global mean. Globally, the percentage excess in mortality increased by about 4·6% (3·7–5·3) per decade. The largest increase occurred in Australia and New Zealand (7·3%, 95% CI 4·3–10·4), followed by Europe (4·4%, 2·2–5·6) and Africa (3·3, 1·9–4·6). Interpretation: Globally, a substantial mortality burden was associated with temperature variability, showing geographical heterogeneity and a slightly increasing temporal trend. Our findings could assist in raising public awareness and improving the understanding of the health impacts of temperature variability. Funding: Australian Research Council, Australian National Health & Medical Research Council.

Abstract Most cases of neuromyelitis optica spectrum disorders (NMOSD) harbor pathogenic autoantibodies against the water channel aquaporin 4 (AQP4). Binding of these antibodies to AQP4 on astrocytes initiates damage to these cells, which culminates in the formation of large tissue destructive lesions in the central nervous system (CNS). Consequently, untreated patients may become permanently blind or paralyzed. Studies on the induction and breakage of tolerance to AQP4 could be of great benefit for NMOSD patients. So far, however, all attempts to create suitable animal models by active sensitization have failed. We addressed this challenge and identified peptides, which mimic the conformational AQP4 epitopes recognized by pathogenic antibodies of NMOSD patients. Here we show that these mimotopes can induce the production of AQP4-reactive antibodies in Lewis rats. Hence, our results provide a conceptual framework for the formation of such antibodies in NMOSD patients, and aid to improve immunization strategies for the creation of animal models suitable for tolerance studies in this devastating disease.

Exploring the integration of 5D Building Information Modeling (BIM) within the Norwegian construction sector, this study examines its transformative impact on cost estimation and project management, highlighting technological and skill-based adoption challenges. Through methodical case studies and interviews with industry experts, it is revealed that 5D BIM significantly enhances the precision of cost estimations and effectively reduces financial overruns in complex construction projects, indicating an industry shift towards its broader acceptance. The research sets out to explore current challenges and opportunities in 5D BIM, assess the usability and integration of software tools, and understand systemic barriers and skill gaps hindering further progress. These objectives lead to a detailed understanding of 5D BIM's role in improving economic and procedural efficiencies in construction. Suggesting its pivotal role in the evolving construction management realm, the study contributes important insights into 5D BIM's transformative potential and underscores its importance in advancing the construction industry's digital transformation. [ABSTRACT FROM AUTHOR]

This article introduces a methodology that aims to develop a detailed framework and guideline for analyzing and measuring the urban form of any settlement, and especially the urban fabric that represents an organic layout. The basis of the methodology lays on Conzenian approach that analyzes the urban morphology by categorizing it in three main elements: streets, plots, and buildings. Since then, many studies are conducted in the field of urban morphology but only few of them focuses on measuring the spatial features of the urban space. Especially, the measurement of irregular (organic) settlements has been a real challenge since it represents a high complexity that is difficult to be measured with mathematical tools. This study tries to develop a method that is useful for measuring the spatial qualities of an organic historic settlement. Firstly, it makes a more detailed categorization and structure of the urban components. Secondly, it makes detailed mathematical measurement to extract the distances, dimensions, areas, proportions and other relationships in the settlement in different scales. The methodology uses AutoCAD and GIS tools for producing maps and making different measurements. • The methodology is useful for measuring the complexity of urban form in organic settlements. • It makes a detailed framework of urban components and is helpful for synthesizing the information and understanding the relationships among different units of the complex urban system. • It can be useful to develop an automated software/tool that makes these measurements and makes correlations between different features of measured units. Method name: Organic urban form measurement, Keywords: Urban morphology, Measuring urban form, Organic settlement, ArcGIS

The objective of this work was to investigate the effect of selenium (Se) on the biomass production and the contents of photosynthetically active pigments. The pot experiment included two maize genotypes: hybrid 408BC originating from Croatia and a local maize population from Kosovo. The doses of Se applied were 0, 1.30, 6.57, 13, and 26 mg kg−1. The lowest Se dose (1.30 mg Se kg−1) had a positive effect on shoot and root biomass production as well as on the contents of chlorophyll b (Chl-b), total chlorophyll, and carotenoids (just for the hybrid). Chlorophyll a (Chl-a) was reduced with increasing Se doses, whereas chlorophyll b (Chl-b) and total chlorophyll further increased with medium Se doses. The highest Se dose strongly reduced biomass and the contents of photosynthetically active pigments. Chl-a and carotenoids positively correlated with shoot (for both genotypes) and root (for the hybrid) biomass, whereas no correlation was observed between Chl-b and biomass. Low amounts of Se application are favorable for biomass production and chlorophyll and carotenoids contents, whereas high amounts of Se application negatively affect both.

In the course of the COVID-19 pandemic, it has become clear that primary healthcare systems play a critical role in clinical care, such as patient screening, triage, physical and psychological support and also in promoting good community advice and awareness in coordination with secondary healthcare and preventive care. Because of the role of social and environmental factors in COVID-19 transmission and burden of disease, it is essential to ensure that there is adequate coordination of population-based health services and public health interventions. The COVID-19 pandemic has shown the primary and community healthcare (P&CHC) system’s weaknesses worldwide. In many instances, P&CHC played only a minor role, the emphasis being on hospital and intensive care beds. This was compounded by political failures, in supporting local community resilience. Placing community building, social cohesion and resilience at the forefront of dealing with the COVID-19 crisis can help align solutions that provide a vision of ‘planetary health’. This can be achieved by involving local well-being and participation in the face of any pervasive health and environmental crisis, including other epidemics and large-scale ecological crises. This paper proposes that P&CHC should take on two critical roles: first, to support local problem-solving efforts and to serve as a partner in innovative approaches to safeguarding community well-being; and second, to understand the local environment and health risks in the context of the global health perspective. We see this as an opportunity of immediate value and broad consequence beyond the control of the COVID-19 pandemic.