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Across many countries of Central and Eastern Europe the emigration of skilled professionals since 1990 has become a serious problem of the loss of specialised human capital. This paper on Albanian doctors is one of the first to study in depth an example of this broader phenomenon of brain drain from the CEE region. There is a global demand for medical doctors which exceeds supply, leading to international competition in which the richer countries, with higher salaries and better working conditions, attract medical graduates and trained doctors from poorer countries. The migration of doctors from Albania is set within this globalised and hierarchised market for medical expertise. On the one hand, the movement of doctors to richer countries helps to plug the deficit in their supply in such countries and enables the individuals concerned to improve their incomes and life conditions. On the other hand, the loss of medical professionals severely harms the structure and quality of the health service in the sending country. This paper addresses three main questions. First, what are the characteristics of the Albanian medical brain drain in terms of its size, socio-demographics and destination countries? Second, what are the causes and consequences of Albania’s loss of medical doctors? Third, what are the prospects of the migrant doctors returning to Albania or contributing their expertise from abroad? Answers are provided via a dual methodology of an online survey of Albanian doctors currently working abroad (N=301) and follow-up interviews with 25 of them. More than half of the survey respondents do not intend to return to Albania and a further third are undecided. Interview data indicate that the doctors are well-integrated abroad and see ‘no future’ for themselves and their families in Albania. There is, however, a greater willingness to share expertise with the home country via cooperation and short visits. Obstacles to return are partly income-related but, to a greater extent, reflect the poor working conditions and career prospects in Albania, including endemic corruption – the same factors that caused emigration in the first place. The policy implications of our findings are challenging; one solution is to mandate a period of work in Albania for newly qualified doctors before they are allowed to go abroad.

Introduction: Multiple sclerosis (MS) is a chronic autoimmune disorder of the central nervous system (CNS), marked by inflammation, demyelination, and significant oligodendrocyte injury. This disease arises from a complex interplay of genetic predispositions and environmental triggers that drive immune-mediated damage to oligodendrocytes and myelin proteins. This research paper explores the multifaceted aspects of oligodendrocyte injury in MS, ranging from underlying pathophysiological mechanisms to potential therapeutic interventions and translational implications for clinical practice. Oligodendrocyte damage in MS occurs via multiple mechanisms, including metabolic stress, oxidative damage, and cytokine-induced apoptosis, mainly mediated by interferon-gamma (IFN-γ) signaling. This process exacerbates neuroinflammation and contributes to disease progression. Emerging therapeutic strategies, such as targeting metabolic pathways, reducing oxidative stress, and enhancing autophagy, have demonstrated potential in preclinical studies. Furthermore, stem cell therapies are being explored for their ability to regenerate oligodendrocytes and restore myelin integrity. Conclusions: The intricate interplay among oligodendrocyte injury, demyelination, and neuroinflammation is central to multiple sclerosis (MS) pathogenesis. Oligodendrocytes safeguard myelin in the CNS, facing challenges from immune attacks to metabolic stress. Understanding oligodendrocyte dysfunction is vital for targeted therapies that suppress immune damage and promote remyelination and CNS repair. MS's etiology,

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

Working with gifted pupils is a specific problem which differs from the work with other pupils. It wouldn't be correct if we say that working with talented pupils is the same with the general pedagogical work. Even though we accept the gifted students as a particular problem, it is not right to see them as a world in its own, divided from other students. They require additional work with creative and practical character. We can find out in practice whether students understand what they read and explain in theory and we think that the problem of talented students should be investigated furthermore. These researches should include the psychological, pedagogical, didactical and social aspects with the aim to strengthen the teaching process of such pupils and give them support.

This case presents the typical scenario in a medium-sized municipality when it appears the economy is headed into a recession. The organization must make spending choices while also considering city council priorities. In this case, Karl Meier, the chief financial officer of River City, has just received some updated economic forecasts at a recent professional development conference. He calls upon his principles of cutback budgeting and citizen engagement to position the organization for the next fiscal year. The expected budget deficit is about $7.5 million. River City will need to consider both revenues and expenditures to achieve a projected budget balance, mindful of the council's strategic goals and priorities. Students assume a budgeting actor role and use the Balancing Act simulation to propose a balanced budget to the city council reflective of the budgeting actor's community perspective. [ABSTRACT FROM AUTHOR]

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

Teaching presents a dynamic process which since the beginning of organized education until now experiences continuous changes, from which, mostly can be seen as innovations, to be more exact as something different from the work in previous teaching. Rather, the educational process in school should as a whole turn to those changes, among which the creative work of students and teachers is very current and necessary in the realization of the creative teaching. The creative teaching is studied as a challenge and an aim of the contemporary education in which the teachers, as the key holders of this process have a significant role, whereas the creative teaching is realized as a segment of the contemporary innovations in the contemporary educational process. Subject of this research is the study of the views of the teachers and their assessment in terms of encouraging and manifestation of the creativity in creative teaching with the purpose of developing the creative abilities of the students. The objective of this research is gaining knowledge of the placement of the creative teaching, teachers' creativity and their impact in the development of the creativity in students. In the research a scaling technique is applied, whereas as an instrument--a survey--scale with closed question for the opinions and views of the teachers for the creativity in school. Starting from the contemporary relevance and scientific placement of the problem that is researched, afore all the development of the capacities of the students for the educational work and for the society overall, I believe that this paper possesses adequate justification and application in advancement of the educational process.

The "home education" as a term, represents educational impact of the family on children. It has been proved that in various family environments, children do acquire a variety of experiences, through performing various activities and is constantly exposed to a range of influence and expectations from the people he/she cohabits. In this paper we will analyze the influence of the parents over their children's education within family environment. It will focus issues why each family has different educational potentials. In nowadays social circumstances, the family has a huge and very tough responsibility; as it has to take proper care on their health, their physical development, their overall education, the development of their intellectual affinities, as well as creation for a better moral values and convictions and attitudes, habits to a firm and well behaved cultural relations in the family itself as well as in the society where the child lives. On the other hand, the family as an institution has to create conditions for development of positive relationship towards work, which as such is a predisposition towards a better establishment of a realistic approach for a better development of the children's personality.

The rapid development undertaken in science, technique and technology, has strongly influenced the radical change of the pace of human existence, and therefore as a very important part in the everyday life of society along with mandatory time is regarded leisure time, also. Given the fact that free time as a pedagogical and sociological issue is of interest to pupils or children, it requires planning, organization and meaningful use. Therefore, special attention should be taken regarding the content, purpose and duties of leisure time activities. For the organization and quality use of leisure time, of great importance are the conditions or opportunities offered to children by society and the environment where they live, grow and develop. The organization and use of leisure time has different, diverse forms, but we should be careful that children rationally and in a positive manner use leisure time, in order to acquire and develop their talent and cultural trends. The management of pupils' leisure time is a serious pedagogical, sociological and social problem, because the same pupils that are now found in school desks are those pupils that in the near future will be the protagonists of society, so accordingly to how pupils are today, is their reflection of the future. Therefore, I regard as reasonable to observe, analyze and infer how elementary school children today spend their leisure time. In order to achieve the expected results and to further compare the organization and leisure time spent between children/pupils (urban and rural ones) in the research we have included both urban and rural primary schools. The subject of our research was to study the organization and use of leisure time by children and also the opportunities made available to children from the social circle for the organization of leisure time. The aim of our research was to verify how children, particularly primary school pupils organize and use leisure time. Do they have special and adequate places, offered to them by the environment where they live, grow and develop in order to perfect their talents and abilities or not? Therefore, we posed the hypothesis: "Children, pupils do not organize and properly use their free time". Our research has a theoretical and empirical character and the following instruments were used: survey and evaluation scale. The research included parents, children and teachers of the both city and village. The results obtained from the research clearly indicate that parents, schools and municipalities as state institutions should pay even more attention to this issue. This will enable children/pupils to organize and more rationally use their leisure time.

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

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, a disease affecting mainly the respiratory system, has become the major cause of a worldwide crisis, imposing a real challenge for the healthcare systems. The underlying pathological mechanisms of coronavirus disease 19 (COVID-19), such as increased inflammatory and immune responses, endothelial damage, prothrombotic status, were expected to increase the incidence of acute coronary syndromes (ACS), but observational studies so far indicate an important reduction in ACS admissions and treatment, possibly because of the fear of contagion, reorganization of medical structures and reduction of physical activity. Further work is needed to identify the factors responsible for this situation.

Today, Information and communication technology has become a way of life in which children are drawn. Today's children are beginning to use digital tools at a very young age, so that the school should respond to the needs of students. Also today it is impossible for any profession performs without the help of information technology. The computer and the Internet gives us endless possibilities and resources in improving the quality of work. Even in education, computer skills and additional equipment are needed, because they create great opportunities for teachers and inspire curiosity, imagination and interest of students.Teachers should not oppose change, but they should use new technology for better quality teaching and make it more interesting. The use of technology will positively improve results faculty and students. Teachers must carefully plan the use and integration of technology in teaching. How to integrate technology into teaching mainly depends on how many computers has at its disposal.

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

One of the main global problems related to the environment is air pollution which not only affects the environment and the ecosystem but also affects human health. Many countries of the world did research on how to reduce air pollution so that the concentrations do not exceed the permissible thresholds which are set at that level so that neither human health nor the environment are exposed to further damage. One of the issues regarding air pollution is the concentrations of PM particles 2.5 and 10, PM particles are a big problem in developing countries such as the Republic of North Macedonia. The research paper was focused in processing the data that has been collected for daily averages of PM 2,5 and PM10 particles that contribute in air pollution. All analyzes and processing of the results are done in compliance with the current laws of the Republic of North Macedonia and with Directive 2008/50/EC, all for µg/m3. In the city of Skopje, numerous exceedances of the permissible thresholds of PM particles 2.5 and 10 were recorded at the two measurement stations where the results were obtained for the months of January, February, March, April, May and June of 2023. [ABSTRACT FROM AUTHOR]

This study explores the effect of government fiscal stimulus on nonprofit performance during the COVID‐19 pandemic. More specifically, it investigates whether access to the Paycheck Protection Program (PPP) increased the ability of nonprofit organizations operating in the crisis context conditions to continue supplying funds for payroll and maintain effective delivery of services and programs after the initial revenue shock. The study findings are derived from the analysis of survey data collected from 160 Wisconsin nonprofit organizations in July and August 2020 linked to publicly available Internal Revenue Service tax filings. Regression analysis reveals a strong positive connection between the PPP loans and the nonprofit capacity to continue funding payroll and providing services within the next months of the pandemic. The empirical results suggest that the government stimulus policies offering direct economic assistance can indeed contribute to the continuity of nonprofit services and payroll in times of fiscal uncertainty, albeit the policy may not yield equally significant results across all types of organizations. This study increases the understanding of nonprofit performance during an extended revenue crisis, offering answers to policymakers, researchers, and practitioners interested in learning more about the efficacy of federal stimulus funding in enabling private organizations to mitigate the financial consequences of the COVID‐19 crisis. [ABSTRACT FROM AUTHOR]

Across many countries of Central and Eastern Europe the emigration of skilled professionals since 1990 has become a serious problem of the loss of specialised human capital. This paper on Albanian doctors is one of the first to study in depth an example of this broader phenomenon of brain drain from the CEE region. There is a global demand for medical doctors which exceeds supply, leading to international competition in which the richer countries, with higher salaries and better working conditions, attract medical graduates and trained doctors from poorer countries. The migration of doctors from Albania is set within this globalised and hierarchised market for medical expertise. On the one hand, the movement of doctors to richer countries helps to plug the deficit in their supply in such countries and enables the individuals concerned to improve their incomes and life conditions. On the other hand, the loss of medical professionals severely harms the structure and quality of the health service in the sending country. This paper addresses three main questions. First, what are the characteristics of the Albanian medical brain drain in terms of its size, socio-demographics and destination countries? Second, what are the causes and consequences of Albania's loss of medical doctors? Third, what are the prospects of the migrant doctors returning to Albania or contributing their expertise from abroad? Answers are provided via a dual methodology of an online survey of Albanian doctors currently working abroad (N=301) and follow-up interviews with 25 of them. More than half of the survey respondents do not intend to return to Albania and a further third are undecided. Interview data indicate that the doctors are well-integrated abroad and see 'no future' for themselves and their families in Albania. There is, however, a greater willingness to share expertise with the home country via cooperation and short visits. Obstacles to return are partly income-related but, to a greater extent, reflect the poor working conditions and career prospects in Albania, including endemic corruption - the same factors that caused emigration in the first place. The policy implications of our findings are challenging; one solution is to mandate a period of work in Albania for newly qualified doctors before they are allowed to go abroad. [ABSTRACT FROM AUTHOR]

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

Background: Cervical cytology is the best single method for large screening of the population in identifying precancerous lesions of the uterine cervix. Aim: To estimate the frequency of human papillomavirus (HPV) positivity in a group of Albanian women, the prevalence of vaginal coinfections, and the relationship of coinfections with HPV, as well as their role in metaplasia or cervical intraepithelial lesions (CIN). Materials and Methods: In this retrospective study, 2075 vaginal smears were examined. The Papanicolaou stain was used for all slides. The New Bethesda System 2001 was used for the interpretations of the smears. Data analysis was completed using the Statistical Package for the Social Sciences version 19.0. Results: Prevalence of HPV positivity was 43.9% with an average age of 35.48 ± 9.27 years. Candida coinfection resulted in 57.8% of HPV positive women with a significant relationship between them. Gardnerella coinfection resulted in 36 (23%), mixed flora in 34 (8%), and Trichomonas vaginalis in 50% of HPV positive woman. Among the women with positive HPV, 19% had CIN, 8% had metaplasia, and 1% had metaplasia and CIN; 9% of the women with HPV had CIN1 and one of the coinfections. Conclusions: There is a strong relationship between CIN1 and HPV positivity as well as between CIN1 and coinfections. HPV infection is a major factor contributing to metaplasia, and bacterial coinfections in HPV positive women have a statistically significant impact in the development of metaplasia.

Teachers, including the subjects involved in the education process, are the key factors in the continuous implementation of socio-emotional learning, as well as responsible for promoting the learning and well-being of their students. Since teachers are on the front line of the battle as the main leaders in managing emotions and building a balance of these feelings, their competencies should also include promoting these skills in an organized way within the classroom. In the school year 2022/2023, a significant number of schools in RNM were involved in training where, in addition to being introduced to the concepts of socio-emotional learning, they were introduced to methods to recognize, understand, treat, express, and learn appropriately emotions. The study conducted among primary school teachers in North Macedonia aimed to examine and present the real situation regarding teachers' competencies. 110 teachers from the country participated in the study as a random sample, a sample which will be organized in the study to answer the research questions. Through the relevant statistical tests Levene's Test and Anova, the findings show statistically significant patterns for their attitude regarding socio-emotional learning, organized and voluntary involvement for the development of the necessary competence, self-initiative for improving the opportunities and conditions for improving their practice, as well as promoting the benefits of integrating this practice into classroom management. Negative attitudes turn out to be closely related to environmental and other associated factors. Our findings indicate the need for greater attention to social-emotional learning in both initial teacher preparation programs and continuing professional development initiatives. [ABSTRACT FROM AUTHOR]

Transparency, one of the many tools of the strategic planning concept, is commonly assumed to result in a number of diffuse benefi ts for government. Yet, empirical research demonstrates that the relationship between transparency and good governance is not as straightforward as often assumed. As a result, many are now debating the role of transparency in fostering effective governance. This study argues that current debates over the benefi ts of transparency stem from too general conceptualization of what transparency actually is. As such, drawing upon existing literature, we contribute to this debate over the utility of transparency in the following ways. First, we offer a framework that suggests a more nuanced understanding of the different types of information needed to enhance government transparency. Second, we discuss how the different types of information outlined in our framework promise to improve specifi c aspects of government. Finally, we demonstrate how transparency is dependent on a strong political leadership and how it needs to be integrated into the organizational strategic planning in order to be effective.

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