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In neurosurgery, an exact delineation of functional areas is of great interest to spare important regions to ensure the best possible outcome for the patient, i.e. maximum removal while maintaining the highest possible quality of life. Preoperative imaging is routinely performed, including the visualization of not only structural but also functional information. During surgery however, brain shift can occur, leading to an offset between the previously defined and the real position. Real-time imaging during the procedure is therefore desired to obtain this information while performing surgery. In this study 15 patients suffering from glioblastoma multiforme were included. These patients underwent structural and perfusion imaging using Arterial Spin Labeling during the procedure. The latter has been used for gathering information about tumor residual perfusion. However, special post-processing of this data allows for additional mapping of resting state networks and is intended to be used to gather deeper insights to aid the surgeon in planning the further procedure. The data of each patient could be successfully post-processed and used to map different resting state networks alongside the default mode network. Based on this study, it is feasible to use the information obtained from perfusion imaging to not only visualize vascular signal but also functional activation of resting state networks without acquiring any additional data besides the already available information. This may help guide the neurosurgeon in real time to adjust the surgical plan.

Background. A female patient presented four years following spontaneous bladder rupture with a recurrent spontaneous bladder rupture. Summary. Urinary bladder rupture is a condition usually caused by trauma or surgical instrumentation. Spontaneous bladder rupture is a much more uncommon condition and is associated with intoxication, radiation, stricture, or neurogenic bladder. We describe a case of a 40-year-old woman with a history of three caesarian sections with an idiopathic recurrent spontaneous bladder rupture. Originally, she presented with one day of worsening severe abdominal pain. CT showed possible ischemic bowel. She was taken to the operating room (OR) and found to have a bladder rupture. This was repaired, and she did well postoperatively. Four years later, she presented to the emergency department (ED) with one week of worsening abdominal pain that became severe acutely. Given that she had a similar issue four years prior the patient was suspicious, her bladder was again ruptured. CT cystogram showed contrast extravasation into the peritoneum. The patient was taken urgently to the operating room for an open repair of the bladder rupture. She did well following the procedure. Conclusion. Spontaneous bladder rupture is a surgical emergency and should be in the differential diagnosis of any patient with peritonitis with elevated creatinine and free intraperitoneal fluid. This diagnosis should especially be considered if the patient has a history pelvic radiation, neurogenic bladder, or intoxication. We submit that a history of multiple pelvic surgeries should be included in this list. CT cystogram is the diagnostic test of choice. Operative repair is generally the treatment for this condition.

The main objective of this paper is to highlight the importance of social media in the development of enterprises, and in particular the development of new products, and highlight the role of social media in customer relations, where the development of a new product is one of the most important elements for an enterprise. For the realization of this paper, a special questionnaire was used, where its structure was divided into three parts, where in the first part are presented the demographic questions, in the second part are the questions related to the use of social media, as and the third part includes questions related to the productivity of products and the enterprise in general. Participants in this paper were 350 companies. The paper results are presented through descriptive analysis, correlation analysis, and regression. Based on the results of this paper, we can say that Kosovar companies through social media establish relationships with their customers and keep them informed, which also greatly influences the development of new products, as well as organizational performance. Also what is noticed in this paper is the enterprises have managed to improve the quality of products through the study of customer feedback. The results also show that the use of social media to create relationships with customers and inform them, statistically affect the organizational performance and product success of Kosovo enterprises. The results also show that social media have an impact on organizational performance, the success of the company, close customer relationships, and timely information. Doi: 10.28991/esj-2021-01263 Full Text: PDF

Purpose: This research will aim to provide a more complete view of the IAS implementation process by large enterprises in Kosovo and its impact on their financial position., Methodology: For this research, we used primary and secondary sources. We conducted quantitative research through a customized questionnaire, which was completed by the accountants of 102 chosen companies, regarding the implementation of IAS and its impact on the company’s financial position., Findings: Based on data analysis, we have identified that the level of implementation of IAS is average, and the main factors of this are the complexity of IAS, cost of implementation, lack of knowledge, and adequate certifications about IAS., Originality/Value: This paper aims to provide empirical evidence in the implementation of IAS in Kosovo and give a contribution to researchers in this field., peer-reviewed

The main goal of the present research is to address the role and importance of audited financial statements in increasing the efficiency of credit risk management in the banking system of Kosovo. In addition, the research will help users understand the financial statement assurance process and the audit process work for a proper assessment of credit risk by banks. The research is treated in sections as below: the first section includes a review of literature (theoretical and empirical review) related to theoretical concepts regarding the importance and development of financial statement audit at financial institutions, in region and beyond. The second section includes a general overview of the relationship between audit of financial statements of clients that establish financial relations with banks and credit risk management. The third section presents the results of the survey and the confirmation of the formulated hypotheses. The last part of the paper presents conclusions and recommendations that have arisen from our study. The main method during our research has been the use of qualitative/quantitative analysis, which has been carried out during various techniques, among which the main ones are the survey interviews & internal observation of processes based on our own professional experience in the banking channels. The paper aspires to provide a better understanding of challenges in assuring qualitative accounting information for decision-making, as well as presents the basis for further study of this issue in the future. The results of the study aim at adding the value to regulatory bodies’ documents such as politics/strategies/instructions and also setting new rules in regard to credit risk management.

Among children who sustain mild traumatic brain injury (mTBI), 10-30% develop a cluster of cognitive, physical, and emotional symptoms commonly referred to as post-concussion syndrome (PCS). Symptoms typically resolve within 7-10 days, but a minority of patients report symptoms that persist for months or even years. The aim of our study was to identify a neurobiochemical marker after mTBI that can predict the presence of post-concussion syndrome three months after head injury in paediatric patients.Children between 7 and 16 years of age who had head trauma and no other complaints were included. Three months after the initial visit, participants or parents/guardians were interviewed in person about the children's PCS symptoms using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ).The mean value of S100B protein in serum in 38 patients without signs of PCS was 0.266 μg LOur prospective study showed that S100B protein is a useful neurobiomarker for detecting paediatric patients at risk for post-concussion syndrome. We found that the biomarker S100B correlated with the severity of traumatic brain injury (number of lesions on CT) and the presence of post-concussion syndrome.

Background: In the absence of mitral valve disease, increased left atrial volume (LAV) is a marker of diastolic dysfunction and long-standing elevated left ventricle (LV) pressure. The aim of this study was to assess the role of increased baseline LAV in predicting clinical outcome of patients presenting with acute coronary syndrome (ACS). Methods: We systematically searched all electronic databases up to September 2020 in order to select clinical trials and observational studies, which assessed the predictive role of LAV indexed (LAVI) on clinical outcome in patients with ACS. Primary clinical endpoints were as follows: major adverse cardiac events (MACE), all-cause mortality and hospitalization. Secondary endpoints were in-hospital complications. Results: A total of 2,705 patients from 11 cohort studies with a mean follow-up 18.7 +/- 9.8 months were included in the meta-analysis. Patients with low LAVI had low risk for MACE (15.9% vs. 33.7%; p < .01), long-term all-cause mortality (9.14% vs. 18.1%; p < .01), short-term mortality (3.31% vs. 9.38%; p = .02) and lower hospitalization rate (11.6% vs. 25.5%; p < .01) compared to patients with increased LAVI. Atrial fibrillation and cardiogenic shock as in-hospital events were lower (p < .05 for all) in patients with low LAVI but ventricular fibrillation/tachycardia was not different between groups (p = .14). Conclusion: Increased LAVI is an independent predictor of outcome in patients with ACS. Thus, assessment of LA index in these patients is important for better risk stratification and guidance towards optimum clinical management.

Purpose: This research aims to present the main obstacles of the application and implementation of the IFRS during the transition period from Kosovo Accounting Standards (KAS) to International Financial Reporting Standards (IFRS). Considering that the development of accounting in Kosovo, it has not been an easy transition as can be expected. -- Design/methodology/approach: We conducted a quantitative research through a customized questionnaire which was addressed to 130 certified accountants and auditors in Kosovo, regarding the challenges presented during this period, of which 77 have resulted in positive answers, but with 2 incomplete answers. -- Findings: Through this research we have managed to identify some of the main challenges faced by accountants and auditors during the transition period from KAS to IFRS and how many respondents agreed that the transition process is complicated. From the analysis of data and results we can conclude that the need for ongoing training and lack of knowledge and experience needed for accountants and auditors has increased the complexity of the IFRS application process. -- Originality/value: Findings from this study can be a contribution to the application of IFRS for developing countries as well as a contribution to the literature regarding the practical, legal challenges, continuing education regarding the transition phase and regarding the implementation and application of IFRS., peer-reviewed

This paper presents the level or degree of debt in the financing of projects or the budget of Kosovo municipalities. In general, the public debt in Kosovo is increasing from year to year, but Kosovo municipalities from the post-war period until now have a very small level of public debt, mainly in the form of guarantees from the north of Kosovo. In macroeconomic terms for public policy, governments should strive to ensure that the level and pace of growth of their public debt is substantially stable and can be served in a wide range of circumstances, meeting cost and risk objectives. Debt managers need to ensure that fiscal authorities are aware of the impact of municipal government funding requirements and debt levels on borrowing costs. The entire State Debt will have parity and equality of status, will be "equal basis", regardless of when it was caused, and regardless of whether it is in the form of Government Securities, Financing Contracts, or other contractual borrowings. Municipal Debt, or Debt, is a monetary obligation or liability created by a financing agreement, treasury receipt, unsecured debt instrument, obligation, overdraft or issue of securities and, unless otherwise provided by law, includes a guarantee. In this paper it will be treated the concept and types of public debt, municipal debt in particular, then the restrictions of public debt under the legislation in Kosovo, state guarantees, the criteria for mar r yen of public debt by municipalities in Kosovo and will eventually the findings and recommendations given as a result of the research are presented.

Mass production, which started with the industrial revolution, caused both the unconscious consumption of the resources and the damages to the ecological system after the production. In this respect, the concept of sustainability, which is one of the most important conception of responsibility, is gradually gaining value in terms of protecting resources and transferring them to future generations. (Mori and Christodoulou, 2012: 94-106). Sustainability In the first place, it has started to be used mostly in the management of natural resources; later, it was used in different fields such as sectoral practices and energy tourism (Diaz - Baltciro, Voces, Romero, 2011: 761-773). Today, the expectations of the society from the enterprises have changed compared to the past. These changing expectations lead businesses to new searches. The most important concept that guides these quests is to be sustainable. The concept of sustainability for enterprises gains a new dimension in the form of corporate sustainability”. For corporate sustainability, it is possible for organizations to achieve individual results only to a certain extent. Because companies are affected to a great extent by all kinds of economic, social and even cultural formations occurring in their environment (Kuşat, 2012: 238). The most important benefit of sustainability indices is that it leads to improvements in transparency without the need for regulations, better understanding of the social and environmental impacts of companies and guiding them to reduce the negative effects of company activities. The BIST Index serves as a guide for companies on what to measure, what needs to be developed and what can be explained. Thus, it creates opportunities for companies to see social and environmental risks and opportunities and to manage their sustainability performances correctly. The index, on the other hand, provides information to investors and the community about the sustainability performance of companies. The aim of this study is whether the BIST Sustainable Index makes a difference for companies compared to BIST 100. "Does the BIST Sustainability Index really make a difference?" will be examined. In this context, data between 2014-2018 of BIST Sustainability and BIST 100 index will be examined. Based on the results obtained in the study, it shows that there is no strong evidence of the impact of inclusion in the BIST Sustainability Index on the stock returns of companies. At the same time, the BIST Sustainability Index has been shown to have similar returns to the BIST 100 Index. Key Words: Sustainability Index, BIST, Corporate.

The man by nature tries and develops his activity for a better, richer and happier life, which in its essence means fulfilling diversified material, spiritual and cultural needs. Government, social-political communities or public legal entities, contemporary entities and institutions with forms of organization, with mechanism, and their instruments based on laws, must offer an organized life and opportunities for fulfilling general and common needs. Up to date, theoretical and practical knowledge shows that basic needs (security, education, healthcare, protection, jurisprudence, etc.) can be fulfilled more easily, faster, and more successfully, more rationally and continually, with higher quantity and quality with better and fairer organizing of the state and of the public legal entities of the institutions that respond to requests on realization of the new social and economic order of the world. The healthcare sector in Kosovo is financed mainly on income taxes, taxes, and co-payments, whereas out-of-pocket private payments are very high and include about 40% of costs for healthcare services. The budget for healthcare allocated by the government in the year 2015 was in total 163,760,703 million €, whereas the participation of budget for healthcare out of Kosovo’s total budget is 9.73., and 2,79% of GLP, that provided 90.72 € per citizen within one year! PHC is financed through transfers from the central budget to municipalities on specific grant form, on the amount 42,085,036 € that includes 28 % of the budget provided for healthcare. SHC and THC are financed by the Ministry, and it includes over 72% of the budget provided for healthcare. (PHC-primary healthcare, SHC-secondary healthcare, THC- tertiary healthcare).

Liquidity management and its impact on the profitability of commercial banks are two issues of particular importance in the further development of the business and at the same time two sources of concern for financial managers. For this reason, this study aims to determine the impact of changes in liquidity levels on the profitability of commercial banks in Kosovo. The study is based on secondary data for nine commercial banks in Kosovo over 9 years, respectively for the period from 2011 to 2019, taken from the audited annual statements of these financial institutions. The study measures the relationship between liquidity management and profitability and its impact on profitability. In order to process the data, regression analysis and correlation were used, while the findings determine whether there is a significant relationship between liquidity management and profitability in commercial banks in Kosovo. The current ratio, the quick ratio, the cash ratio and the capital adequacy ratio have been taken as liquidity indicators, while return on assets and return on equity are considered as profitability indicators.

During 2013–2016, a total of 32 patients were treated for Crimean-Congo hemorrhagic fever in Prishtina, Kosovo; 11 died. In the 11 patients who died, findings included viral loads >1 × 108.5/mL, lactate dehydrogenase >2,700 U/mL, bleeding, and impaired consciousness. Ribavirin therapy had no noticeable effect in this small patient sample.

A IoT of studies address the use of IoT devices coupled with machine learning to predict and better detect health problems. Diabetes is an issue that society is struggling with for a very long time. The ease with which ECG signals can be recorded and interpreted provides an opportunity to use Deep Learning techniques to predict the estimated Sugar Levels of a patient. This research aims at describing a Deep Learning approach to provide models for different short-term heart rate variability measurements. Our approach is based on a special method to calculate Heart Rate Variability (HRV) with identification of segments, then averaging and concatenating them to exploit better feature engineering results. The short-term HRV is used for the determination of instantaneous plasma glucose levels. The Deep Learning method is based on Autokeras, the neural architectural search provided the best results for the 15-minute measurements. Our research question is to develop a solution to estimate the Instantaneous glucose value from heart rate variability with sufficient quality. The evaluated test set gave the following results: RMSE(0.368), MSE(0.193), R square(0.513), and R squared loss(0.541).

Objective: The goal of this study was to investigate the gender difference in manifestation of clinical symptoms related to allergic rhinitis and eczema in a population of school children aged 13-14 years from the city of Gjilan in Kosovo. Material and method: About 1200 school children aged between 13-14 years, from randomly selected schools, were included in the study, once the passive consent of their parents/guardians had been received. This study covers the data analysis from the questions related to the nose and skin problems (14 out of 53 questions). Results: Prevalence related to allergic rhinitis; a) sneezing, or a runny or blocked nose ever was 34.20% and in the last 12 months it was 25%; and b) hay fever ever was 14.5%. Prevalence related to eczema,; a) itchy rash at any time in the past 12 months was 7.5%; and b) eczema ever in life was 4.2%. Conclusion: This study found a higher prevalence of allergic rhinitis symptoms in female children comparing to male, while no significant connection was found between gender and eczema symptoms

Background/Aim. Peripheral artery disease (PAD) is a common macrovascular complication in patients with diabetes mellitus (DM) as a result of impairment of homeostatic mechanisms of the endothelium, thus initiating the process of atherosclerosis. The imbalance between endothelium- derived vasodilators and vasoconstrictors plays an important role in the pathogenesis of diabetic microangiopathy, as well as in other vascular complications in diabetes. Perfusion scintigraphy using technetium-99m-methoxyisobutyl isonitrile (99mTc-MIBI) can be very useful method for evaluation of the lower limbs muscle perfusion. The aim of this study was: to compare the results of dynamic and static studies of lower limbs tissue muscle perfusion scintigraphy with 99mTc-MIBI (one-day rest-stress protocol) in patients with and without DM and to determine the perfusion reserve for diagnostic evaluation of PAD in patients with DM type 2, as well as to assess the endothelin-1 (ET-1) levels as a vasoconstrictor agent in patients with and without diabetes. Methods. Prospective study was performed in 90 patients, divided into two groups according to the presence of DM ? patients with DM type 2 (DP), 60/90 (67%), and patients without DM (NDP), 30/90 (33%). Lower limbs tissue muscle perfusion scintigraphy was done with 99mTc-MIBI including two studies (?rest? and ?stress?). Results. In the DP group significantly lower pick of radioactivity was detected in comparison with the NDP group, in both phases (rest and stress), for both calves. Lower counts from the static phase were registered in the region of both calves. Lower inter-extremity indexes as well as perfusion reserve were found in the DP group. There was a significant difference in concentrations of ET-1 between groups (higher concentrations were found in tzhe DP group). Conclusion. This one-day protocol (rest-stress with 99mTc-MIBI) of perfusion scintigraphy of lower limbs is considered a useful procedure in PAD assessment in patients with DM type 2, especially the asymptomatic form.

Since 2012, WHO has recommended influenza vaccination for health care workers (HCWs), which has different costs than routine infant immunization; however, few cost estimates exist from low- and middle-income countries. Albania, a middle-income country, has self-procured influenza vaccine for some HCWs since 2014, supplemented by vaccine donations since 2016 through the Partnership for Influenza Vaccine Introduction (PIVI). We conducted a cost analysis of HCW influenza vaccination in Albania to inform scale-up and sustainability decisions.We used the WHO's Seasonal Influenza Immunization Costing Tool (SIICT) micro-costing approach to estimate incremental costs from the government perspective of facility-based vaccination of HCWs in Albania with trivalent inactivated influenza vaccine for the 2018-19 season based on 2016-17 season data from administrative records, key informant consultations, and a convenience sample of site visits. Scenario analyses varied coverage, vaccine presentation, and vaccine prices.In the baseline scenario, 13,377 HCWs (70% of eligible HCWs) would be vaccinated at an incremental financial cost of US$61,296 and economic cost of US$161,639. Vaccine and vaccination supplies represented the largest share of financial (89%) and economic costs (44%). Per vaccinated HCW financial cost was US$4.58 and economic cost was US$12.08 including vaccine and vaccination supplies (US$0.49 and US$6.76 respectively without vaccine and vaccination supplies). Scenarios with higher coverage, pre-filled syringes, and higher vaccine prices increased total economic and financial costs, although the economic cost per HCW vaccinated decreased with higher coverage as some costs were spread over more HCWs. Across all scenarios, economic costs were0.07% of Albania's estimated government health expenditure, and5.07% of Albania's estimated immunization program economic costs.Cost estimates can help inform decisions about scaling up influenza vaccination for HCWs and other risk groups.

BACKGROUND In diffuse WHO grade II gliomas (LGG), the extent of resection (EOR) required to achieve significant survival benefits remains elusive. OBJECTIVE To evaluate the association of residual volume (RV) and EOR with progression-free survival (PFS) or overall survival (OS) in LGG in a retrospective, multicenter series by the German study group of intraoperative MRI (GeSGIM). METHODS Consecutive cases were retrospectively assessed from 5 centers. Tumors were volumetrically quantified before and after surgery, and clinical data were analyzed, including IDH mutations and neurologic deficits. Kaplan-Meier estimates, accelerated failure time models (AFT), and multivariate Cox regression models were calculated to identify determinants of survival. RESULTS A total of 140 cases were analyzed. Gross total resection (GTR) was associated with significantly longer PFS compared to any incomplete resection (P = .009). A significant survival disadvantage was evident even for small (>0-5 ml) residuals and increased for moderate (>5-20 ml) and large remnants (>20 ml) P = .001). Accordingly, PFS increased continuously for 20% incremental steps of EOR (P

This article briefly describes the development of the tourism sector in Albania, summarizing consumer behavior theory at a micro prospective, and providing a few general ideas on how the Albanian market can stimulate a change in European consumers' behavior and attract a larger and constant stream of tourists. This article is elaborated from three perspectives of the environment: the economic, the socio–cultural, and the technological. Starting with the economic environment perspective, the authors explore ways to ensure the efficient development of the economy through resource management, with the purpose of creating space for future generations. Following the social-cultural environment perspective, they analyze the way social and cultural sustainability ensures and enhances people's life skills, strengthens community identity and improves food safety practices through educational campaigns in the hospitality sector. Closing with the technological environment perspective, the authors explore ways to strengthen Albania's online position and improve telecommunication channels between urban and rural areas.

Residential sector represents the largest energy consumer in the city of Pristina, as a capital of Republic of Kosovo. This is also the most diverse sector in terms of the energy sources used for s...

A multi-port DC-DC converter has been studied in paper. It can be used both in energy storage systems and in power supplying systems with several sources. A high-frequency transformer integrates the converters of the multiport converter. For converters, circuits with specific characteristics are used - resonant inverters with voltage limitation on the part of resonant capacitor. They can work as bidirectional converter. The paper describes the modes of operation of the converter in different directions of energy transmission. Results of research through simulation models are presented.

From January 1, 2018, most of the commercial banks in Kosovo adopted IFRS 9. The new standard introduces the expected credit loss model to allow for timely recognition of credit losses, estimated not only on the actual credit loss but also on forward-looking information regarding the current loan portfolio. Although, transition phases may lead to increasing impairments and a decrease in banks’ equity, which directly influences the financial stability of banks. This paper examines the day-one transition effect of IFRS 9 on the level of assets balance, allowance for loan losses, and capital regulatory class II of banks in Kosovo. To test our hypothesis, we have performed a comparative analysis for the six biggest commercial banks in Kosovo to identify correlation and causality between studied variables. As a statistical technique, we have employed a “paired sample t-test” where we compare financial indicators before and after adopting IFRS 9 to examine the impact on financial stability for commercial banks in Kosovo. Our results are in line with the results of recent studies in the IFRS 9 field and conclude that the transition phase has a significant influence on the recognition of additional loan impairment but assets and capital regulations are not affected significantly. Results demonstrate the transition to IFRS 9 causes instability and re-consolidation of capital, but in the long-run reduce the possibility for large and sudden losses. Commercial banks in Kosovo should follow a balanced growth approach without compromising the quality of the loan portfolio.

This study is an original study and adds to the research debate on the impact of small and medium enterprises in generating new jobs, with a special focus on the industry and services sector, as in Kosovo for these sectors still do not there has been special research. The objective of this research paper is presents the impacts of small and medium enterprises have in generating new jobs. To achieve the stated objective and to prove the hypotheses in this research, the OLS regression model has been used whereas the data processing has been done through Statistical Package for Social Sciences (SPSS). This research paper has been conducted by using secondary data collected by the World Bank and Kosovo Agency of Statistics. The data are presented for the time period 2012-2018. Results in this research paper from this model show that the industry and services sector affects generating new jobs in Kosovo, therefore there is a positive correlation between the presented variables. Also we can notice a positive correlation between the GDP and employment rate. The results presented in this research paper can be used as a guide for new businesses in the services and industry sector and their impact on the generation of new jobs in Kosovo, as well as efforts to further improve performance in these sectors.

Endurance training (ET) has multiple beneficial effects on cardiovascular health (CVH), but there is an evident lack of knowledge on differential effects of various types of ET on indices of CVH in women. The aim of this study was to analyse the effectiveness of two different types of ET on changes in indicators of CVH in apparently healthy adult women. The sample included 58 women (24 ± 3 years; height: 165 ± 6 cm, mass: 66.7 ± 7.2 kg, BMI: 24.3 ± 2.5 kg/m2, at baseline) divided into one control non-exercising group (n = 19), and two exercising experimental groups (EE). The first EE participated in choreographed aerobic-endurance training (CAT; n = 19), while the second participated in treadmill-based endurance exercise (TEE; n = 20) during the experimental protocol (8 weeks, 24 training sessions). The testing included pre- and post-exercise protocols and measures of anthropometric/body composition indices, lipid panel, and endurance capacity. Two-way analysis of variance for repeated measurements with consecutive post hoc analysis was applied to the “group” and “measurement” variables. The main significant ANOVA effects found for measurement, and “Group x Measurement” interaction (p < 0.05) were found for all variables but body height. The EE induced positive changes in lipid panel variables, anthropometric/body-build status, and endurance capacity. However, TEE improved endurance capacity to a greater extent than CAT. The results suggest that that the optimal exercise intensity and self-chosen type of physical-activity may result in positive effects on indices of CVH, even in women of young age and good health status.

Crimean-Congo Hemorrhagic Fever Virus (CCHFV) is a geographically widespread tick-borne arbovirus that has been recognized by the WHO as an emerging pathogen needing urgent attention to ensure preparedness for potential outbreaks. Therefore, availability of accurate diagnostic tools for identification of acute cases is necessary. A panel comprising 121 sequential serum samples collected during acute, convalescent and subsided phase of PCR-proven CCHFV infection from 16 Kosovar patients was used to assess sensitivity. Serum samples from 60 healthy Kosovar blood donors were used to assess specificity. All samples were tested with two IgM/IgG immunofluorescence assays (IFA) from BNITM, the CCHFV Mosaic 2 IgG and IgM indirect immunofluorescence tests (IIFT) from EUROIMMUN, two BlackBox ELISAs for the detection of CCHFV-specific IgM and IgG antibodies (BNITM), two Anti-CCHFV ELISAs IgM and IgG from EUROIMMUN using recombinant structural proteins of CCHFV antigens, and two ELISAs from Vector-Best (IgM: μ-capture ELISA, IgG: indirect ELISA using immobilized CCHFV antigen). Diagnostic performances were compared between methods using sensitivity, specificity, concordance and degree of agreement with particular focus on the phase of the infection. In early and convalescent phases of infection, the sensitivities for detecting specific IgG antibodies differed for the ELISA test. The BlackBox IgG ELISA yielded the highest, followed by the EUROIMMUN IgG ELISA and finally the VectorBest IgG ELISA with the lowest sensitivities. In the subsided phase, the VectorBest IgM ELISA detected a high rate of samples that were positive for anti-CCHFV IgM antibodies. Both test systems based on immunofluorescence showed an identical sensitivity for detection of anti-CCHFV IgM antibodies in acute and convalescent phases of infection. Available serological test systems detect anti-CCHFV IgM and IgG antibodies accurately, but their diagnostic performances vary with respect to the phase of the infection., Author summary The Crimean-Congo Hemorrhagic Fever Virus (CCHFV) is the geographically most widespread tick-borne arbovirus and it is endemic in several countries. Because of its high case fatality rates, its potential for nosocomial outbreaks and the difficulties in treatment and prevention, CCHFV has been included in the WHO’s R&D Blueprint for Action to Prevent Epidemics. For fast implementation of infection control measures in CCHFV-affected countries, reliable diagnosis utilizing qualified molecular and serological tests is essential. Here we compared diagnostic performances of ten serological tests based on detection of IgM and IgG antibodies against CCHFV using samples from CCHFV patients and samples from healthy blood donors collected in Kosovo. The analyses focused on the phase of infection, because IgM and IgG tests have differing intended purposes. We concluded that the tests are suitable for accurate detection of anti-CCHFV IgM and IgG antibodies, but varied in their respective diagnostic performances with respect to the phase of the infection. IgM tests are mainly intended to support the diagnosis of acute infections and performed well in the early and convalescent phases of infection. IgG tests become relevant at later stages of disease progression and for disease surveillance and reached highest sensitivities in the subsided phase of infection.

Background: Homocystinuria is a rare autosomal recessive disease complicated by early and aggressive occlusive arterial disease. This may be related to the grossly increased homocysteine concentrations seen in this disease. More recently, milder hyperhomocysteinemia has been proposed as an independent risk factor for coronary artery disease. Cardiovascular disease (CVD) is among the diseases with multiple contributing factors, hence making it difficult to pinpoint a particular factor alone. The main factor that is of relevance to this study is homocysteine. Coronary artery disease is the narrowing or blockage of the arteries and vessels that supply oxygen and nutrients to the heart (1, 2). CVD is the major cause of morbidity and mortality worldwide. Obesity, HTA, Diabetes mellitus, hypercholesterolemia, and smoking have been recognized as major risk factors for CVD. Aim: Aim of this paper is to examine concentrations of Hcyt and lipid profiles in patients with CVD and positive personal history for CVD, comparing them with the control group composed of healthy individuals. Our study aimed to verify the role of Homocysteine as a new independent risk factor on the onset of early atherosclerosis and atheromatous processes in coronary arteries in patients with CVD. Materials and methods: The results obtained represent the average value earned once every three months in the 3 year period. 5ccm serum with a few heparin spots was sent to the Clinical Laboratory of the University Clinic of Skopje. Results: The results obtained from patients with CVD and control groups are presented in the following text, where a statistically significant difference was observed for p

Purpose: Lyme borreliosis (LB) occurs throughout Europe. No clinical and seroprevalence studies for LB in Kosovo have been publicly available thus far. Therefore, this study aimed to investigate LB from a tick bite perspective in the Pristina region, Kosovo. Methods: This single-center prospective observational study enrolled consecutive adult participants (≥18 years of age) with tick bite (embedded tick in the skin), who were examined at the Clinic of Infectious Diseases, Pristina, between January 2015 and August 2018. At the first visit related to the index tick bite, ticks (the complete ticks or parts of the ticks) were removed from the skin, blood samples were taken for serological tests, and antibiotic treatment was started when deemed necessary. The complete, undamaged ticks removed were proceeded for entomological identification. Participants were followed up at 2 months (serological tests were repeated) and 6 months after the index event for the development of clinical manifestations of LB and/or seroconversion against Borrelia burgdorferi. Results: A total of 380 subjects were included in the study. Most cases were seen in May and June in all study years. All 117 preserved ticks were identified as Ixodes ricinus. Immunoglobulin G seroprevalence among subjects during the first visit in the study was 28/380 (7.4%). Erythema migrans (EM) was clinically diagnosed in 74/380 patients (19.5%, 95% confidence interval 15.6- 23.8). Only 15 clinically diagnosed EM (in seronegative patients) were serologically confirmed with seroconversion (2 months later), 3.9% of all subjects included in the study. There were three cases with clinical manifestation between the second and third visit: EM recidivans, multiple erythema, or several nonspecific systemic symptoms. Doxycycline and amoxicillin were mainly used for the treatment of borrelial skin lesions. Conclusion: This assessment can help indicate the need for disease awareness and reinforce the importance of primary prevention measures, early diagnosis, and appropriate treatment.

Objective: The aim of the study was to investigate the maternal-child S. mutans infection, mutual interaction and potential risk factors altering this interaction. Material and methods: A total of 160 mothers who were paired with their children were recruited. Saliva from mothers and children was collected and S. mutans categorized levels were analyzed. A questionnaire was used to collect maternal and child conventional caries risk factors. A proportional odds regression model was used to investigate whether the level of infection of mothers would similarly affect the level of infection of their children, thus adjusting for other risk factors. Results: The average age of mothers was 28.1 years and children had a median age of 5.1 months. Paired mother-child S. mutans crossclassification into non-infected and infected subjects showed no agreement in mutual contamination. Maternal in-fection of the child was highest when the mother was infected with 10 >3 S. mutans/ml of saliva. The results obtained by the regression model showed that none of the potential risk factors influenced the level of infection in the child. Conclusion: Mothers with a high S. mutans level increase the risk of S. mutans acquisition for her five- month- old child but no evidence was found that other maternal/ child factors may influence this., Svrha: Cilj je bio istražiti infekciju kod majke i djeteta bakterijom S. mutans, međusobnu interakciju i moguće čimbenike rizika koji mijenjaju tu interakciju.Materijali i metode: U istraživanju je ukupno sudjelovalo 160 majki sa svojom djecom. Prikupljena je njihova slina te su analizirane kategorizirane razine S. mutans. Upotrijebljen je upitnik za prikupljanje čimbenika rizika za nastanak karijesa kod majke i djeteta. Model proporcionalne regresije vjerojatnosti korišten je za istraživanje hoće li razina infekcije kod majki na sličan način utjecati na razinu zaraze njihove djece, čime se prilagođavaju dru-gi čimbenici rizika. Rezultati: Prosječna dob majki bila je 28,1 godina, a djece 5,1 mjesec. Uparena klasifikacija majke i djeteta u nezaražene i zaražene ispitanike bakterijom S. mutans nije pokazala slaganje u međusobnoj kontaminaciji. Majčinska infekcija djeteta bila je najveća kada je majka bila zaražena s 10 >3 S. mutans/mL sline. Rezultati dobiveni regresijskim modelom pokazali su da ni jedan od potencijalnih čimbenika rizika nije utjecao na razinu infekcije kod djeteta. Zaključak: Majke s visokom razinom S. mutans povećavaju rizik od prijenosa te bakterije na svoju petomjesečnu djecu, ali nisu pronađeni dokazi da na to mogu utjecati drugi čimbenici povezani s majkom/djetetom.

During 2020, students and higher education institutions faced massive change regarding the online teaching/learning process, which evoked numerous debates within the institutions, teachers and students. The aim of this study is to verify the relationship between the attitudes towards online teaching and environmental factors, equipment, noise and distraction from other people, in the students of the State University of Tetova in North Macedonia.

There is an evident lack of research simultaneously investigating endurance training (ET) and resistance training (RT) with regard to their potential influence on fitness and health status in young women. This study aimed to determine the effects of RT and ET three times a week over an eight-week period on anthropometric/body composition indices, blood pressure (BP), and muscular fitness in apparently healthy young women who participated in a self-preferred program. The sample of participants comprised 57 young healthy women (23.9 ± 3.08 years, 165.5 ± 5.8 cm, 66.8 ± 7.2 kg) divided into ET (n = 18), RT (n = 19), and non-exercising (C) (n = 20) groups. The variables consisted of anthropometric/body composition indices (body mass, BMI, body fat, and lean body mass), muscular fitness variables (lower body strength, upper body strength, abdominal strength, dynamometric force, and flexibility), and cardiovascular parameters (resting heart rate and systolic and diastolic BP). A pre- and post-testing design, with factorial analysis of variance for repeated measurements (ANOVA: Group × Measurement), including a consecutive post hoc test, was applied. The ANOVA indicated a similar improvement in body composition (increase in lean body mass and decrease in body fat percentage), resting heart rate, and flexibility in both of the exercise groups, with no significant changes in the C group. RT improved the participants’ strength and force capacities to a greater extent than ET. BP showed a trend of improvement in both of the training groups, but without statistically significant pre- to post-changes. Correlation analysis calculated with variables of pre- to post-differences (VDs) indicated poor associations between VDs, indicating relative independence of the obtained effects for the different variables in each training group. Although this investigation comprised apparently healthy young women, numerous positive changes indicated the efficacy of both programs in a relatively short period of time. While the participants in this study self-selected training programs, the evidenced positive effects can be at least partially related to this fact.

Purpose: This research aims to present the essential differences during preparation of financial statements according to commercial accounting rules and tax accounting rules; the ability of authorized people to differentiate two categories of reporting, and other findings regarding their orientation of preparation FS under IAS and then use them for the preparation FS under tax rules or inversely., Design/methodology/approach: we have realized questionnaire research which was addressed to certified accountants and others under this qualification to gather the information that will serve our research questions. This paper applied descriptive statistics and analytical-inferential statistics in terms of the application research method., Findings: The findings of this research show that there is a satisfactory level of accountant’s knowledge about the differences between commercial accounting and tax accounting rules. According to the obtained empirical results, we concluded that more than 50% of the respondents prefer to prepare the FS initially according to KCFR requirements followed by adjustments under tax requirements., Originality/value: Few known studies of this type, increase the contribution of this research in terms of drafting regulations related to the preparation of FS according to IAS and preparation of FS according to TAK rules to create a more approximate system of both forms of reporting., peer-reviewed

This study provides empirical evidence on income smoothing from the banking sector in nine South-Eastern Europe (SEE) countries for the period 2005-2014 by applying a number of methodological approaches. First, by using a sample of 321 banks this paper confirms our first hypothesis that banks in the SEE region use loan loss provisions (LLPs) to smooth their incomes. Second, by dividing the loan loss provision into its two components (discretionary and non-discretionary,) the study provides new evidence on the effects of loan loss provisions components on growth in bank lending. The results clearly prove our second hypothesis that the components of LLPs do matter on growth in bank lending. Third, this paper estimates the use of loan loss provisions for capital management by banks. The empirical results do not support the hypothesis of capital management for SEE banks. The novelty of this paper, unlike other works, is the inclusion of SEE countries., Ovo istraživanje primjenom brojnih metodoloških pristupa pruža empirijske dokaze o izravnavanju prihoda u bankarskom sektoru u devet zemalja jugoistočne Europe (JIE) za razdoblje 2005.-2014. Prvo, korištenjem uzorka od 321 banke, ovaj rad potvrđuje našu prvu hipotezu da banke u regiji Jugoistočne Europe koriste rezervacije za gubitke po kreditima (LLP) kako bi izravnale svoje prihode. Drugo, dijeljenjem rezerviranja za kreditne gubitke na njegove dvije komponente (diskrecijsku i ne-diskrecijsku), ovo istraživanje pruža nove dokaze o učincima komponenata rezervacija za kreditne gubitke na rast bankarskog kreditiranja. Rezultati jasno potvrđuju našu drugu hipotezu da su komponente LLP-a bitne za rast bankarskog kreditiranja. Treće, ovaj rad procjenjuje upotrebu banaka za rezerviranje gubitaka po kreditima za upravljanje kapitalom. Empirijski rezultati ne podupiru hipotezu o upravljanju kapitalom za banke u jugoistočnoj Europi. Za razliku od ostalih istraživanja, novost u ovome radu je uključivanje zemalja jugoistočne Europe.

Background A previous single-center survey of trauma and general surgery faculty demonstrated perceived positive impact of trauma and surgical subspecialty service-based advanced practice providers (SB APPs). The aim of this multicenter survey was to further validate these findings. Methods Faculty surgeons on teams that employ SB APPs at 8 academic centers completed an electronic survey querying perception about advanced practice provider (APP) competency and impact. Results Respondents agreed that SB APPs decrease workload (88%), length of stay (72%), contribute to continuity (92%), facilitate care coordination (87%), enhance patient satisfaction (88%), and contribute to best practice/safe patient care (83%). Fewer agreed that APPs contribute to resident education (50%) and quality improvement (QI)/research (36%). Although 93% acknowledged variability in the APP level of function, 91% reported trusting their clinical judgment. Conclusion This study supports the perception that SB APPs have a positive impact on patient care and quality indicators. Areas for potential improvement include APP contribution to resident education and research/QI initiatives.

In 1991, North Macedonia became an independent state and began its political and economic transformation. The country has set forth the goal of European Union (EU) accession as a symbolic achievement marking the completion of its transition. Among the Copenhagen criteria that remain to be met is macroeconomic stability. Given its small market of just over two million and limited domestic savings opportunities, foreign direct investment (FDI) is viewed as a means to achieving economic growth. The first decade after the independence was marked by symbolic levels of FDI inflows, mainly due to the privatization process of state-owned enterprises. These came mostly in the form of mergers and acquisitions (M&As) in the services sector, by companies in a position to exploit their monopoly positions in the domestic market. During the second decade, the government drafted a new model for attracting greenfield FDI through Technological Industrial Development Zones (TIDZs). In TIDZs, foreign investors enjoy a range of tax holidays and other forms of financial concessions. This program is also intended to increase exports and stimulate reindustrialization. Despite these efforts, the level of FDI remains modest. After nearly two decades, a solution to the name dispute with Greece brings new optimism to North Macedonia regarding membership in Euro-Atlantic organizations and growth through accelerated attraction of FDI.

Hypoxia is a well-known complication in cemented arthroplasty; however, it is not known whether the level of hypoxia is related to the intramedullary pressure or to the age of the patient; therefore, we studied the intramedullary pressure and level of hypoxia in patients undergoing cemented arthroplasty. A prospective study was performed during cemented arthroplasties in 25 patients with an average age of 66.2 ± 12.1 years old. The intramedullary pressure (IMP) was measured by placing a pressure transducer within the bone while simultaneously measuring the pulse oximetry arterial oxygen saturation (SpO2), pulse, and blood pressure. These variables were obtained immediately after spinal anaesthesia, five minutes after cementation, and 15 minutes after prosthesis insertion. One hundred percent of patients had hypoxia at some level, but 83% of elderly patients (older than 66.5 years) had hypoxia (SpO2

Introduction. Diabetes is a chronic metabolic disease characterized with a rapid progression of prevalence in last 3 decades, especially in countries with low and middle income. Next three decades this number of diabetes in the world is expected to be doubled. Early diagnosis and appropriate management of diabetes is the primary way to prevent and delay cardiovascular complications. Patients and methods. In this retrospective study, we used the data from National electronic system e-health which was performed in late 2014, wich gives us nearly precise data, and we made statistical analysis for diabetes in last 5 years (2015-2019). Results. In 2015 we have registered 103480 patients with DM, in 2016 108130 patients, in 2017 114408, in 2018 119999 and in 2019 124450 patients with DM. 95% of patients are with T2DM and 4, 1% with T1DM. According the data from State statistical office for population of Republic of Macedonia, the prevalence of T2DM for the years 2015-2019 is as follows: 5,66% in 2015, 6.13% In 2016, 6.55% I 2017, 7,06% in 2018 and 7,2% in 2019. Conclusions. The number of registered patients with diabetes in last 5 years has grown up for 20970 or 20%, in the last 5 years the number of patients with type 2 diabetes has grown up for 18272 patients or 11%. The prevalence of T2DM has increased for 1.54%. Involvement of primary health care professionals has improved the early diagnosis of type 2 diabetes.

Background. A 76-year-old male patient who suffered small bowel anastomotic dehiscence believed to be a complication provoked by Clostridioides difficile enteritis. Case Presentation. The patient was a 76-year-old male who underwent small bowel resection with primary anastomosis for a small bowel obstruction. On postoperative day #7, he rapidly decompensated and upon return to the operating room was found to have complete anastomotic dehiscence with copious enteric spillage. The presentation appeared as if the staple line had burst open. Enteric contents confirmed the diagnosis of Clostridioides difficile enteritis. Subsequent hospital course was complicated by ventilatory-dependent respiratory failure, hemodynamic instability, and persistent anemia secondary to gastric ulcer requiring endoscopic cauterization. After a prolonged hospital course, he eventually progressed and was transferred to a skilled nursing facility on hospital day #42. Discussion. Clostridioides difficile causes inflammation and copious large volume secretions that would theoretically increase intraluminal pressures creating an internal tension. This tension along with other factors from the infection itself would likely be inhibitory of anastomotic healing. Although it is rare, Clostridioides difficile enteritis is being reported with increasing frequency, and in the setting of recent small bowel anastomosis, it should be considered a possible risk factor for anastomotic leak.

The use of technology in banking operations has facilitated many daily banking activities. However, the use of technology in electronic banking services has its problems/deficiencies as well. The aim of this study is to examine the impact on electronic banking services of security and ease of use. After a thorough review of the literature, this study provides a statistical analysis through a distributed questionnaire to examine the effect of security and ease of use in decreasing issues with electronic banking. Regression analysis demonstrates that security and ease of use of electronic banking services have a negative effect on issues with electronic banking services, which implies that with enhanced security and/or ease of use their issues are decreased.

Optical resonator biosensors have emerged as one of the most sensitive and practical microsystem biodetection technology. Here, we have developed a model for an optical microring resonator to be used as an ultrasensitive biosensor. A linear correlation between increasing the radius of the microring and the red shift in the resonance wavelengths has been observed. In fact, resonance shifts for very small changes in microring radius, as low as 10 nm, have been detected. Furthermore, sensing capability of the resonator has been simulated by introducing TiDO2 nanoparticles and protein molecules to the resonator surface by varying both thickness and effective refractive index of the attached layer such that the layer size has been changed from 10 nm to 100 nm with an increment of 10 nm. We have observed readily detectable unique resonance shifts for both TiDO2 nanoparticles and protein molecules. Moreover, effective medium approach has been implemented in order to account for refractive index fluctuations in sensing medium. As a consequence, combination of optical resonators with microfluidics could produce a simple-to-operate, portable and robust diagnostic tool enabling new insights into biomolecular function and recognition.

// Thomas Lindner 1, * , Hajrullah Ahmeti 2, * , Julia Juhasz 1 , Michael Helle 3 , Olav Jansen 1 , Michael Synowitz 2 and Stephan Ulmer 1 1 Clinic for Radiology and Neuroradiology, UKSH Kiel, Kiel, Germany 2 Clinic for Neurosurgery, UKSH Kiel, Kiel, Germany 3 Philips Research Laboratories, Hamburg, Germany * These authors contributed equally to this work Correspondence to: Thomas Lindner, email: Thomas.Lindner@uksh.de Keywords: magnetic resonance; imaging; perfusion; glioblastoma; in-vivo Received: November 19, 2017 Accepted: March 18, 2018 Published: April 06, 2018 ABSTRACT Resection control using magnetic resonance imaging during neurosurgical interventions increases confidence regarding the extent of tumor removal already during the procedure. In addition to morphological imaging, functional information such as perfusion might become an important marker of the presence and extent of residual tumor mass. The aim of this study was to implement arterial spin labeling (ASL) perfusion imaging as a noninvasive alternative to dynamic susceptibility contrast (DSC) perfusion imaging in patients suffering from intra-axial tumors for resection control already during surgery. The study included 15 patients suffering from glioblastoma multiforme in whom perfusion imaging using DSC and ASL was performed before, during, and after surgery. The data obtained from intraoperative scanning were analyzed by two readers blinded to any clinical information, and the presence of residual tumor mass was evaluated using a ranking scale. Similarity of results was analyzed using the intraclass correlation coefficient and Pearson’s correlation coefficient. The results show that intraoperative ASL is as reliable as DSC when performing intraoperative perfusion imaging. According to the results of this study, intraoperative imaging using ASL represents an attractive alternative to contrast agent-based perfusion imaging.

Unlike the other forms of investment strategies, foreign direct investment (FDI) involves the long-term commitment in the host country. FDI determinants are complex and multi-dimensional phenomena that result from both macro-economic and firm strategy considerations. The main objective of the present research is to review the empirical studies on FDI determinants in order to find out what motives international corporations are pursuing since the FDI policies and nation-specific business environment are directly affecting international corporations’ activity involvement. The literature and document review research method is adopted for this research, and the research is refined by including only papers that contained empirical studies on FDI determinants. Research has been carried out using secondary data drawn from a diverse pool of materials, including books, journals and other credible reports from international institutions. This research concludes the evidence of the mixed results on such a linkage.

This paper has the main focus in energy consumption by the residential sector in city of Prishtina. Considering the fact that the energy production in Kosovo is not sufficient in relation with the everyday demand and at the same time the growth of the energy demand based on different resources is evident, a detailed analysis and identification of the energy performance of this sector is inevitable. One of the main components that cause the energy demand in residential sector is the heating energy demand. The energy resource and heating systems used by the residential sector in city of Prishtina are diverse. This paper elaborates and identifies the number of residential buildings, number of dwellings, building typologies, heating energy resources, heating systems used by the dwellings and the energy demand for heating energy, by using quantitative methodology. Based on the results achieved by the research, future detailed analysis is possible to identify other components, which affect the heating energy demand by the residential sector. These first results can be used as a basis of the first district scaled energy modeling of the city of Pristhina. By applying the energy management method, developed by Prof. Gerhard Hausladen and his research group at the TU München, a first modeling step will be absolved. After analysis of the current state of the investigated districts, future concepts will be made increasing efficiency and sustainability.

Background and Aims: We aimed to compare the diabetes knowledge and metabolic control between insulin-treated diabetes patients who completed structured and those who completed unstructured diabetes education at diagnosis and to evaluate the effects of structured diabetes education program (SDEP) on diabetes knowledge and metabolic control. Subjects and Methods: Prospective, observational study of 59 insulin-treated diabetes patients invited for SDEP at University Clinic of Endocrinology, Diabetes and Metabolic Disorders, Skopje, in the period from March 2013 to December 2014 and divided into two groups if they completed SDEP at diagnosis. Patients were tested for their diabetes knowledge (scale of 0 to 100 points) before SDEP and immediately after SDEP and evaluated for their metabolic control. Patients were invited 1 year after completion of SDEP for evaluation of their diabetes knowledge and metabolic parameters. Results: Groups were not significantly different in diabetes knowledge before SDEP (67.3 ± 11.1 vs. 68.0 ± 13.1 points, P = 0.835), and results improved in both groups after completion of SDEP (Group 1: 19.6 ± 8.9 points, P < 0.001; Group 2: 16.9 ± 7.8 points, P < 0.001) with no significant difference between groups. Diabetes knowledge 1 year after SDEP was significantly higher in Group 2 (82.9 ± 7.8 vs. 76.6 ± 11.1 points, P = 0.014). Significant reduction in glycated hemoglobin was obtained 1 year after SDEP within both groups with no significant difference between groups. Conclusion: Continuous SDEP results in sustainable increase in diabetes knowledge and improved glycemic control, thus avoiding or delaying diabetes complications, and reducing the burden on the society.

Aims The 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets. Methods and results In this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries. Across ESC member countries, the prevalence of obesity (body mass index ≥30 kg/m2) and diabetes has increased two- to three-fold during the last 30 years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20 years appears sufficient for the WHO target to be achieved. The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension {23.8% [interquartile range (IQR) 22.5–23.1%] vs. 15.7% (IQR 14.5–21.1%)}, diabetes [7.7% (IQR 7.1–10.1%) vs. 5.6% (IQR 4.8–7.0%)], and among males smoking [43.8% (IQR 37.4–48.0%) vs. 26.0% (IQR 20.9–31.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.0–10.8) vs. 16.7% (IQR 13.9–19.7%)]. There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income [7160 (IQR 5655–8115)] compared with high-income [2235 (IQR 1896–3602)] countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%). Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures. Conclusion A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest.