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Building Information Modeling (BIM) technologies have attracted much research attention, especially in the last fifteen years. The prospects and benefits that BIM promises for all participants in the design, construction and operation of buildings are hopeful and enthusiastic. Nevertheless, the global adoption of BIM has been slow and uneven. A bibliometric analysis shows that BIM research is concentrated in a few centers and performed by a narrow group of specialists. As a result, there are research areas with few or no publications (“blind spots”). One such area is the economics of BIM implementation. Considering the transition to the use of BIM as an investment project, the authors of the article formulate the necessary conditions for BIM implementation to become investment attractive. It is shown that the participation of governmental structures is necessary for a wide transition to digital technologies in the architectural and construction sphere.

Succession planning and changeover between outgoing and incoming leaders within medical education is an important but largely neglected topic (Rayburn, Grigsby & Brubaker, 2016). The paucity of literature is even more apparent regarding leadership transitioning at regional medical campuses (RMC). With this paper, perhaps one of the first to inform this topic, we hope to bridge this gap by assembling the shared perspectives of an administrator, senior faculty member and a learner from the same RMC. Specifically, this work will focus on the following two questions: • Based on our collective experiences what are the critical issues facing an incoming RMC dean? • Are there practical strategies which might assist an incoming RMC dean with the leadership transition process? This commentary is the result of our collective experience at Western University’s Windsor Campus, a 10-year old regional medical campus of the Schulich School of Medicine & Dentistry located in southwestern Ontario, Canada. We make the assumption that RMC’s encountering leadership transitions are adequately funded, in this way incoming deans can properly attend to effective leadership succession processes. This paper might be of particular interest to those who are personally transitioning as new RMC deans or who will soon take on such a leadership role. We have no conflicts of interest to declare.

The ability of the land surface temperature (LST) and normalized difference vegetation index (NDVI) to examine land surface change is regarded as an important climate variable. However, no significant systematic examination of urbanization concerning environmental variables has been undertaken in the narrow valley of Thimphu, Bhutan. Therefore, this study investigated the impact of land use/land cover (LULC) dynamics on LST, NDVI, and elevation, using Moderate Resolution Imaging Spectroradiometer (MODIS) data collected in Thimphu, Bhutan, from 2000 to 2020. The results showed that LSTs varied substantially among different land use types, with the highest occurring in built-up areas and the lowest occurring in forests. There was a strong negative linear correlation between the LST and NDVI in built-up areas, indicating the impact of anthropogenic activities. Moreover, elevation had a noticeable effect on the LST and NDVI, which exhibited very strong opposite patterns at lower elevations. In summary, LULC dynamics significantly influence LST and NDVI, highlighting the importance of understanding spatiotemporal patterns and their effects on ecological processes for effective land management and environmental conservation. Moreover, this study also demonstrated the applicability of relatively low-cost, moderate spatial resolution satellite imagery for examining the impact of urban development on the urban environment in Thimphu city., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Pneumonia is the leading cause of post-neonatal death amongst children under five years of age; however, there is no simple triage tool to identify children at risk of progressing to severe and fatal disease. Such a tool could assist for early referral and prioritization of care to improve outcomes and enhance allocation of scarce resources. We compared the performance of inflammatory and endothelial activation markers in addition to clinical signs or scoring scales to risk-stratify children hospitalized with pneumonia at the national referral hospital of Bhutan with the goal of predicting clinical outcome. Of 118 children, 31 evolved to a poor prognosis, defined as either mortality, admission in the paediatric intensive care unit, requirement of chest drainage or requirement of more than five days of oxygen therapy. Soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) was the best performing biomarker and performed better than clinical parameters. sTREM-1 levels upon admission had good predictive accuracy to identify children with pneumonia at risk of poor prognosis. Our findings confirm that immune and endothelial activation markers could be proactively used at first encounter as risk-stratification and clinical decision-making tools in children with pneumonia; however, further external validation is needed., Competing Interests: Declaration of Competing Interest The authors declare no competing interests., (Copyright © 2022. Published by Elsevier Ltd.)

Diagnosing pneumonia and identifying those requiring antibiotherapy remain challenging. Chest radiographs (CXR) are often used as the reference standard. We aimed to describe clinical characteristics, host-response biomarkers and etiology, and assess their relationship to CXR findings in children with pneumonia in Thimphu, Bhutan. Children between 2 and 59 months hospitalized with WHO-defined pneumonia were prospectively enrolled and classified into radiological endpoint and non-endpoint pneumonia. Blood and nasopharyngeal washing were collected for microbiological analyses and plasma levels of 11 host-response biomarkers were measured. Among 149 children with readable CXR, 39 (26.2%) presented with endpoint pneumonia. Identification of respiratory viruses was common, with no significant differences by radiological outcomes. No clinical sign was suggestive of radiological pneumonia, but children with radiological pneumonia presented higher erythrocyte sedimentation rate, C-reactive protein and procalcitonin. Markers of endothelial and immune activation had little accuracy for the reliable identification of radiological pneumonia., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

The unprecedented experience of national lockdowns and uncertainty of academic career due to the COVID-19 pandemic has multifaceted impacts on mental health among university students worldwide. This study determined its impact on depression and anxiety level, and associated risk factors among engineering students studying at College of Science and Technology (CST), Phuentsholing, Bhutan during the first lockdown in the country. Self-reported depression and anxiety levels were assessed using Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) respectively. Data was collected using an e-questionnaire link generated in Google form and the link was shared with students via the student's official email group. A total of 278 students (response rate, 26.9%) completed the questionnaire. The majority of respondents were male (69.8%) and were aged from 18 to 30 (Mean: 21.7 ±SD 2.07) years. The prevalence of self-reported moderate to severe depression and anxiety were 44.2% (95% CI, 38.5-49.6) and 27.3% (95% CI, 22.3-32.4) respectively. Participants having their family members as frontline workers reported a significantly higher level of anxiety (χ2 = 4.85, p = 0.028). In multivariable logistic regression analysis, students who were academically lagging showed a higher risk of depression (AOR = 5.36, 95% CI = 2.86-10.04) and anxiety (AOR = 3.83, 95%CI = 1.86-7.88) as compared to students who were not academically behind. A high percentage of depression and anxiety was reported by students of CST during the COVID-19 pandemic. Findings from the study highlight the importance of adopting appropriate online-based teaching and learning methods to ensure timely academic and professional achievements. Moreover, the relevant stakeholders should put health system strategies in place to provide psychological support to university students during the COVID-19 pandemic., Competing Interests: The authors have declared that no competing interests exist.