Capturing complexity is both a conceptual and a practical challenge in palliative care. The HexCom model has proved to be an instrument with strong reliability and valid for describing the needs and strengths of patients in home care. In order to explore whether it is also perceived to be helpful in enhancing coordinated and patient-centered care at a practical level, a methodological study was carried out to assess the face validity of the model. Particularly, a Delphi method involving a group of 15 experts representing the full spectrum of healthcare professionals involved in palliative care was carried out. The results show that there is a high level of agreement, with a Content Validity Index-Item greater than 0.92 both with regard to the complexity model and the HexCom-Red, HexCom-Basic and HexCom-Clin instruments, and higher than 0.85 regarding the HexCom-Figure and the HexCom-Patient instruments. This consensus confirms that the HexCom model and the different instruments that are derived from it are valued as useful tools for a broad range of healthcare professional in coordinately capturing of complexity in healthcare practice.

The airport ground handling services (AGHS) equipment supplier selection problem involves a safety guarantee on the part of the AGHS company that carries out the daily work. AGHS company can prevent aircraft damage and delays in airlines schedules, and ensure reliable and high-quality ground handling service. In our research, we developed an AGHS equipment supplier selection model based on the analytic hierarchy process and an AHP weighted fuzzy linear programming approach, and we solved the AGHS equipment supplier’s selection problem. The main objective of this article is to create an AHP and AHP-FLP decision model in order to help the AGHS company authorities select the best AGHS equipment supplier. The practical application in AGHS equipment supplier selection decisions can be interpreted as demonstrating that the proposed model provides knowledge and practical value for the AGHS industry.

Equine-assisted services (EAS) are being increasingly used as complementary interventions for military veterans who have experienced trauma. However, there is limited evidence of benefit for this population and almost no literature describing desired potential outcomes and possible mechanisms of action. The aim of this article is to address these gaps by reviewing the extant literature of animal-assisted interventions in general, and equine-assisted services in particular, with the goal of providing guidance for future investigations in the field. Currently, the field is in the early stage of scientific development, but published results are promising. Interventions that enhance treatment compliance and/or outcomes could benefit this population. Preliminary results, reviewed herein, indicate that EAS interventions might benefit the military veteran population by enhancing treatment engagement and therapeutic alliance, as well as contributing to symptom reduction and resulting in various transdiagnostic benefits. It is recommended that future studies include exploration of potential beneficial outcomes discussed herein as well as investigate suggested mechanisms of action.

Digital transformation can become a complex process when workers have insufficient skills, which makes training in the digital field essential. Herein, we intended to relate digital literacy perceived by workers with their training needs for the Portuguese public sector context. Additionally, based in the Human capital theory, we also investigate which professional/demographic characteristics increase training propensity in digital fields. Through an online questionnaire, a dataset with information on 573 workers was obtained. Data analysis was made by using a probabilistic regression model and additional statistical techniques. The results revealed that workers with higher levels of education and higher professional skills have higher probability of participating in training in the digital field. On average, workers reveal low levels of digital knowledge and low participation in training in the digital fields, but the majority present a willingness to participate in future training sessions, especially in the fields of Dataset management, Cybersecurity and Communication systems. This study provides information on training in the digital field of workers in the public sector, which is essential for public organizations to better prepare for digital transformation. Additionally, it contributes to a very recent literature on digital learning, and it can be extended to other contexts.

This paper explores the relationships between marketing strategies, social media platforms, the adoption and diffusion of products and services, and organizational resilience to gain an understanding of the ability of organizations to cope with disruptive events (e.g., COVID-19). This can be achieved through effective marketing strategies and the efficient use of social media platforms. In fact, resilience thinking can help organizations maintain their operations by increasing the adoption and diffusion of their products and services through the use of effective marketing strategies. To achieve this article’s objectives, a literature review is conducted to help develop a conceptual framework that highlights a clear relationship between the previously discussed concepts. In addition, the novel nature of the relationship between marketing strategies and organizational resilience is dissected and its significance for organizations is demonstrated. In fact, the findings of this study suggest that effective marketing strategies that consider the "what," "who," and "how" dichotomies and the efficient use of social media to promote the adoption and diffusion of products and services can significantly enhance the resilience of organizations. These relationships can serve as a starting point for further studies examining and empirically analyzing marketing strategies and their positive effect on strengthening organizational resilience.

Novel strategies in coastal protection are needed to cope with climate change-induced sea level rise. They aim at the sustainable development of coastal areas in light of an intensification and land use changes. A promising approach is the design of nature-based solutions (NbS), complementing the safety levels of technical infrastructures. However, NbS lack a widespread and large-scale implementation. To address this deficit, co-design concepts are needed that combine experiences from science and practice. This work presents and discusses the approach of a coast-specific real-world laboratory (RwL) addressing the inclusive design of ecosystem-based coastal protection. Strategies of RwLs are applied for the first time in a coastal context along the North Sea coastline in Germany. We found the concept of RwLs suitable for coastal transdisciplinary research, although adaptions in the spatial reference level or flexibility in location and time of experimentation are necessary. A profound actor analysis is indispensable to specify participatory processes and interaction levels. A criteria-based cooperative selection of RwL sites helps to reveal and solve conflicting interests to achieve trust between science and practice. Addressing site-specific characteristics and practitioners’ needs, our coastal RwL provides a mutual learning space to develop and test NbS to complement technical coastal protection.

Water hyacinth (Eichhornia crassipes) is a potential accumulator of water pollutants in aquatic ecosystems, and its presence in water systems can affect water quality. This study used different field measurements and laboratory tests of Lake Water to determine the impact of water hyacinth phytoremediation capacity. A total of eight sampling stations used for the two lakes; Lake Koka and Lake Ziway. Sampling stations were selected from sites infested with water hyacinth (low, medium and high) and non-water hyacinth aquatic plants during wet and dry seasons to compare the effects of plants on water quality in the two lakes. All the sampled stations had various human interventions. The water samples were tested for the selected physico-chemical properties namely phosphate, nitrate, pH, electrical conductivity (EC), Biological oxygen demand (BOD5), temperature, and heavy metals (Chromium (Cr), Lead (Pb), Cadmium (Cd), Zinc (Zn), and Copper (Cu). These water quality variables were compared by means of ANOVA. Despite the COD of Lake Ziway, this study found no significant (p > 0.05) variation in the concentrations of Cu, EC, pH and temperature between wet and dry seasons in either lake. Variations in Zn concentration and other physico-chemical parameters (EC, BOD, COD, nitrate, phosphate) between low, medium and high levels of water hyacinth were significant in both lakes (p<0.05). Water hyacinth has shown significant phytoremediation nature during wet and dry seasons. The lowest average heavy metal, phosphate, and nitrate concentrations; and significant pH and temperature variations were observed in Lakes Koka and Lake Ziway, among water hyacinth and other grass-infested sites.

(1) Background: Applied health services research (AHSR) relies upon coordination across multiple organizational boundaries. Our aim was to understand how competing organizational and professional goals enhance or impede the conduct of high quality AHSR. (2) Methods: A qualitative study was conducted in two local health care systems in the UK, linked to a feasibility trial of a clinic-based intervention in secondary care. Data collection involved 24 semi-structured interviews with research managers, clinical research staff, health professionals, and patients. (3) Results: This study required a dynamic network of interactions between heterogeneous health and social care stakeholders, each characterized by differing ways of organizing activities which constitute their core functions; cultures of collaboration and interaction and understanding of what research involves and how it contributes to patient care. These interrelated factors compounded the occupational and organizational boundaries that hindered communication and coordination. (4) Conclusions: Despite the strategic development of multiple organizations to foster inter-professional collaboration, the competing goals of research and clinical practice can impede the conduct of high quality AHSR. To remedy this requires the alignment and streamlining of organizational goals, so that all agencies involved in AHSR develop a shared understanding and mutual respect for the progress of evidence-based medicine and the complex and often nuanced environments in which it is created and practiced.

We present a normative methodology, for value-pricing B2B services, using a Nash Equilibrium mechanism. Value is fundamental to any service, yet it has defied a definition. The literature is conspicuously silent on how to define value, but abounds in richly descriptive characterizations. To overcome this deficit, we focus on the financial economics of service-value. We formulate an axiomatic definition and a differential equation that embodies the idea of service-value. We specify a set of value axioms and multidisciplinary postulates that coherently form our service-value constructs. Value-pricing is challenging. It is natural that providers desire a high price and customers want a low price. Realistically, both will agree on a win-win price. To uncover this price, we specify an algorithm to reveal the Nash Equilibrium. Once agreed, it validates providers’ and customers’ commitments, and payment obligations. Service value is cocreated by both provider and customer. For a reciprocal process, its treatment is remarkably asymmetric favoring the customer. We argue that one-sided descriptions of value-in-use and value-proposition are limiting mental models. We propose the additional ideas of value-from-use and value-supposition to strengthen the conceptual symmetry of cocreation. Our work reveals a critical gap in service science, metrology. Metrology, the science of measurements, is absent from service-science. Service-value is silent on the questions of quantities, units, scales, measurement principles and instruments. We argue for a call to action for Service Metrology. We sketch a roadmap of actionable suggestions to get started.

The unresolved territories are privileged places for the proliferation of degradation phenomena that affect the environment and human well-being. The impacts of their critical conditions go beyond the limits of the damaged urban fragments, involving the built environment, society, economy, culture and conditioning quality of life. This paper proposes a methodological approach to landscape design supported by an evaluation framework to orient strategic design planning with specific attention to unresolved territories consistent with circular economy perspective. The circular city principles are applied to spatial planning of landscape, by operationalising Ecosystem Services, Landscape Services, and Ecosystem Disservices, as interpretative categories for multi-dimensional regenerative strategies. Starting from the theoretical framework, the objective of the analysis is to implement an approach to the regenerative design of landscapes of waste, defined wastescapes. The industrial area of East Naples is the case study where an incremental evaluative approach has been defined to design scenarios to provide services and values, aimed to drive the conversion in a regenerativescape. A multi-criteria analysis through PROMETHEE-GAIA method has been implemented to compare the base case scenario with two incremental new scenarios and identify situated sustainable priorities.

1) Background: Intellectual disability is more common in low- and middle-income countries than in high-income countries. Stigma and discrimination have contributed to barriers to people with intellectual disability accessing healthcare. As part of a larger study on caregiving of children with intellectual disability in urban Cape Town, South Africa, we interviewed a sub-group of families who had never used the intellectual disability services available to them, or who had stopped using them; 2) Methods: We employed a qualitative research design and conducted semi-structured interviews to explore the views and perspectives of parents and caregivers of children with intellectual disability who are not using specialised hospital services. We developed an interview guide to help explore caregivers’ and parents’ views; 3) Results: Results revealed that caregivers and parents of children with intellectual disability did not use the service due to financial difficulties, fragile care networks and opportunity costs, community stigma and lack of safety, lack of faith in services and powerlessness at effecting changes, and self-stigmatisation; 4) Conclusion: Current findings highlight a need for increased intervention at community level and collaboration with community-based projects to facilitate access to services, and engagement with broader issues of social exclusion.

A large number of smart devices (things) are being deployed with the swift development of Inter- net of Things (IOT). These devices, owned by different organizations, have a wide variety of services to offer over the web. During a natural disaster or emergency (i.e., a situation), for example, relevant IOT services can be found and put to use. However, appropriate service matching methods are required to find the relevant services. Organizations that manage situation responses and organizations that provide IOT services are likely to be independent of each other, and therefore it is difficult for them to adopt a common ontological model to facilitate the service matching. Moreover, there exists a large conceptual gap between the domain of discourse for situations and the domain of discourse for services, which cannot be adequately bridged by existing techniques. In this paper, we address these issues and propose a new method, WikiServe, to identify IOT services that are functionally relevant to a given situation. Using concepts (terms) from situation and service descriptions, WikiServe employs Wikipedia as a knowledge source to bridge the conceptual gap between situation and service descriptions and match functionally relevant IOT services for a situation. It uses situation terms to retrieve situation related articles from Wikipedia. Then it creates a ranked list of services for the situation using the weighted occurrences of service terms in weighted situation articles. WikiServe performs better than a commonly used baseline method in terms of Precision, Recall and F measure for service matching.

Access to health services compromises therapeutic adherence in patients with HTN, which is a risk factor for cardiovascular disease and premature death. The aim of the research is to determine the influence of access to health services on adherence to antihypertensive treatment during the COVID-19 pandemic. We included a cross-sectional analytical study. A survey was applied to 241 hypertensive patients at the Daniel Alcides Carrión Hospital, Callao-Peru. Data were analyzed using SPSS software. Absolute and relative frequencies were reported and the chi-square test was applied with a statistical significance level of p<0.05. In addition, multiple logistic regression analysis was performed using the Stepwise method. An association was found between non-adherence to treatment and health expenses (ORa: 1.9 CI 95% 1.7-2.2), not receiving care due to lack of a doctor (ORa: 2.8 CI 95% 1.5-3.2), having difficulty with schedules (ORa: 3.7 CI 95% 2. 3-5.5), fear of receiving care at the hospital (ORa: 4.5 CI 95 % 2.7-6.8), trust in health personnel (ORa: 7.5 CI 95% 2.3-10.5) and considering that the physician does not have enough knowledge (ORa: 3.1 CI 95% 2.4-7.8). Therapeutic adherence was associated with physician availability for care, difficulty with schedules, fear of being seen in the hospital, trust in health personnel, and waiting time.

In the past decades, one of the most widely reported phenomena on Caribbean reefs is the general fall in coral cover and rise in macroalgae. Reefs with low coral cover and high macroalgal abun-dances are often presumed to provide poorer ecosystem functions and services. In this study, we assessed the condition of coral reefs on the Caribbean Coast of Costa Rica and determined how eight key ecosystem metrics varied in response to differential coral and fleshy macroalgae covers. Most reefs surveyed had high fleshy macroalgae and low live coral covers, with an average (± SD) of 31 ± 28% and 14 ± 13% per site. We found that the rugosity, urchin density, fish richness, total fish biomass, large fish density, and the potential fishery value of the reef were higher in sites with low fleshy macroalgae covers (>10%). The value of many of the ecosystem metrics estimated for coral reefs of the region appears to be lower than what’s been reported for other areas in the Caribbean, which may be related to the high macroalgae covers found on the reefs. Our results concur with the prevailing paradigm that an increase in macroalgae abundance could reduce the ecosystem services provided by coral reefs.

Abstract The aim of our study is to analyse the perception of the families and concerned social workers. The research was conducted in an underprivileged and disadvantaged microregion in North Hungary. The main focus was the perception on the available health, educational, child welfare and social services and supports. The starting point was to enquire the target group’s knowledge of these services. The study examines the extent to which social work is able to provide support to disadvantaged, marginalized families with children, and the way how the dysfunctional operation of the system contributes to the perpetuation of the clients’ life conditions. Analysing the quality of these services and supports is crucial to understand the social mobility chance of the children living in this microregion. The results show that without capability and talent development for the children and given the lack of welfare services, the mobility chance and opportunities of these families are extremely low in Hungary.

The European Union green deal has proposed the “organic farming action plan” to render this farming system more sustainable for climate mitigation and adaptation and to meet the United Nations Sustainable Development Goals (UN-SDGs). While this policy instrument is fundamental to reach sustainable agriculture, there is still no agreement on what sustainable agriculture is and how to measure it. This opinion paper proposes an ecosystem-based framework on the crop life-cycle to determine the balance between economic, social and environmental pillars of sustainability to support decision-making.

Proactivity is a particularly important attribute of knowledge-intensive organizations, where the work required to increase the potential of knowledge-intensive employees is crucial. A priority challenge for these firms is also to understand the increasing importance of the functioning of cognitive mechanisms leading to increased knowledge workers' well-being following the implementation of the psychological contract. The aim of this article is to identify the relationship between inclusive leadership, the fulfillment of the psychological contract, two dimensions of well-being: workplace and life well-being and knowledge workers' proactivity. Based on survey data collected through the CAWI method from 1.000 knowledge workers employed in Polish companies in the business services sector, the research hypotheses were tested using a stepwise equation modelling (SEM) technique, leading to a model containing all the main constructs. The results obtained indicate that inclusive leadership positively impacts the fulfillment of the psychological contract. Furthermore, the fulfillment of the psychological contract positively affects proactive working behavior with and the wellbeing of knowledge workers. Along with proactive work behavior, two dimensions of well-being, were examined as outcome variables. The analysis also shows that knowledge-intensive organizations, intending to build the proactivity of their employees and nurture a high level of well-being in their lives and in the workplace, should take care to fulfil the expectations and obligations of the psychological contract. However, one way to achieve this is for managers to use an inclusive management style, which supports an atmosphere of a safe working environment in a diverse setting and leads to employees feeling comfortable sharing their opinions and ideas. The study of inclusive leadership in the context of knowledge-intensive organizations provides human resource professionals and employee man-agers with important insights into how inclusive leadership can effectively contribute to the psychological contract, which will consequently lead to proactive work behavior and also improve employees' workplace and life well-being.

(1) Aims: To analyse the relationship between demographic and clinical characteristics and particular kinds of suicidal behaviour and its relationship with a nurse-led suicide prevention program. (2) Methods: A 5-year cross-sectional study design. Study performed in the region of Osona (Catalonia) during 2013-2017. Suicidal behaviour was classified as suicidal ideation, interrupted self-directed violence, suicide attempt and completed suicide. (3) Results: The sample included 753 patients ─ of whom 53 died by suicide─ and encompassed 931 suicidal behaviour episodes. Men represented 38.4% of the sample but 81.1% of deaths by suicide. Mental disorders were associated with suicidal behaviour in 75.4% of the sample. 66.4% of the individuals were engaged in the nurse-led Suicidal Behaviour Case Management Program, of which 0.8% (n=4) died by suicide. (4) Conclusion: The main risk factors were female sex for suicidal behaviour, and male sex and older age for suicide. Mental disorders, widowhood and retirement were also associated with suicide. A high proportion of patients was engaged to the nurse-led suicide prevention program with a low proportion of suicides.

Wetland ecosystems provide valuable services to human beings, but they are also among the most threatened ecosystems in the world (1). Sixteen ecosystem services are identified through the South African Water Research Commission's Wet-Health Tool (2). This study sought to establish which of these ecosystem services are highly ranked/rated by the community members living in the Soutpansberg area in South Africa. This area is a strategic water source/watershed. The area is rich in biodiversity and is also experiencing competing administrative jurisdictions: the local traditional leadership and the municipal council. This study also sought to determine the influence of age, education status, employment status, and family income, among other demographic factors, on how people view the importance of services derived from wetlands. It also sought to establish whether people in urban settings view the ecosys-tem services obtained from wetlands similarly to people in rural settings. A literature review was conducted to understand the wetland ecosystem services and how communities benefit from these services. A close-ended questionnaire was used to collect data for the current study, which was circulated among the villagers around the wetlands, particularly those living close to the wetlands. One hundred and sixteen responses from the study were recorded. Food for livestock was ranked the greatest benefit or service derived from the wetlands rated by 82% of the participants, followed by the provision of cultivated foods at 60%, provision of water for human use at 58%, provision of harvestable resources at 42% and erosion control at 38% completes the top 5 ranked ecosystem services in the area. The study concluded that the participants living in rural areas had greater awareness of wetlands' ecosystem services than their urban counterparts.

Blockchain is considered a technological trend with a unique and unprecedented foundation of ways of working, and has the potential to fundamentally change society in conducting activities related to the public or private sector. Although the academic literature on blockchain is generally focused on cryptocurrencies, in recent years, literature with different perspectives has begun to emerge regarding the use of blockchain in the context of the public sector. The unique characteristics of how blockchain technology works make it an innovation that is expected to change many activities, structures, and processes related to the implementation of public sector activities, especially in public services such as administrative processes, welfare provision, and regulatory practices. This article discusses through a systematic literature review about the potential use of blockchain in public services. This literature review identifies the types of public services most likely affected by the introduction of blockchain. In addition, this article highlights the benefits, potentials, and challenges and risks of blockchain for governments and citizens/society in general. Governments, in general, can optimize efficiency and tracking through the use of blockchain, but regulatory uncertainty and scalability capabilities being major challenges, which are still poorly researched in the literature, can benefit from reduced bureaucracy and improved coordination through blockchain adoption, despite the lack of blockchain knowledge and skills being significant barriers to its implementation. For citizens or the public, security and transparency are key benefits, while the main risk lies in data security concerns. The article closes by noting a number of limitations in the existing literature and providing suggestions and recommendations for future research.

The issues concerning the development of the smart systems for the management of freight transport are related to many factors which are influencing by properties of such a complex processes and ICT development. We are concerned with the recognition of a wide spectrum of services and provision specifics under conditions of wireless communication networks. Also, we are investigated for the adequate provision of context data with problematic of a definition of such context data and with possibilities to apply formalized artificial intelligence methods for recognition of this context information needs for transportation. In this stage of application of the smart system, we are solving the problem of priority of provision of possible providing services, ensuring of quite optimal quality of data supply channels and restriction of flooding of wireless communication channels. The proposed methodology is based on methods of indication of con-text-aware situations and integration of such data into the situation recognition algorithms. The constructions of smart service provision system are developed for more safety management of transportation. The experimental results are demonstrated on analysis of heterogeneity of smart services, construction of schemas for service provision priorities, and extension of potential of intelligent transport with intellectual recognition possibilities of context-aware information in the transportation process.

This study focuses on land cover and land management changes in relation to food security and environmental services in a semi-arid area of East Nusa Tenggara (ENT) – Indonesia. The study was conducted in Central Sumba District of ENT Province. Classification and regression tree (CART) for land cover classification has been analyzed using machine learning techniques using Google Earth Engine. A survey with Focus Group Discussion (FGD) and followed with in-depth interviews were conducted for primary data collection involving a total of 871 respondents. The Socio-economic data analyzed statistics descriptively and non-parametric tests. The study showed that: 1). There has been a substantial land use change during the devo-lution era that has both positive and negative implications for food security and envi-ronmental services. 2). There has been population pressure in the fertile or agricultur-al land as the direct impact of the development of city infrastructures; and 3). Nation-al intervention through the Food Estate program has fostered and shaped land use change and land management in Central Sumba District. The study highlights the importance that the devolution spirit should help to well manage the limited ara-ble/agricultural land in dominated semi-arid to ensure food security and environment services.

Forest ecosystems provide diverse services and values that contribute to human well-being. Although high proportion of species is still undiscovered, tropical forests alone are thought to host more than 50% of the world’s biodiversity. Beyond supporting via direct use of products like timber, fiber and biomass energy, they play an important role in providing a wide range of ecosystem services such as regulating water flow and quality, water purification, improving infiltration, fresh water, erosion control, carbon sequestration and sedimentation control. They are one of the important parts of terrestrial and the largest carbon pool, occupying an integral position in the global carbon cycle. However, these days, deterioration of nature and forest biodiversity is a severe danger to the global environment. This will be accompanied by increased strains on food supply, causing increased pressure on already delicate ecological systems. Thus, better forest management strategies are necessary for managing forests sustainably. Nevertheless, little is known regarding the existing forest management approaches and their associated benefits and challenges. Multidisciplinary approaches are needed to achieve sustainable management of forests. These can be accomplished if suitable forest management innovations are put in place. Various technologies can also be adopted through applying different forest assessment tools like remote sensing using light detection and ranging technology (LiDAR) in forest management. Harnessing such technologies will definitely result in providing increased socio-economy as well as improved environmental sustainability. However, the speed of transformation depends much on level of commitment of stakeholders including policy makers. As a result, this review is intended to explore existing forest management innovations which are suitable both ecologically as well as socio-economically. This shows that while there is a lot to be improved, there are already developed forest management innovations that are already in use including PFM and MFM, which helps to achieve SFM.

Virtual assistants (VAs) have gained widespread popularity across a wide range of applications, and the integration of Large Language Models (LLMs) such as ChatGPT has opened up new possibilities for developing even more sophisticated VAs. However, this integration poses new ethical issues and challenges that must be carefully considered, particularly as these systems are increasingly used in public services: transfer of personal data, decision-making transparency, potential biases, and privacy risks. This paper, an extension of the work presented at IberSPEECH 2022, analyzes the current regulatory framework for AI-based VAs in Europe and delves into ethical issues in depth, examining potential benefits and drawbacks of integrating LLMs with VAs. Based on the analysis, this paper argues that the development and use of VAs powered by LLMs should be guided by a set of ethical principles that prioritize transparency, fairness, and harm prevention. The paper presents specific guidelines for the ethical use and development of this technology, including recommendations for data privacy, bias mitigation, and user control. By implementing these guidelines, the potential benefits of VAs powered by LLMs can be fully realized while minimizing the risks of harm and ensuring that ethical considerations are at the forefront of the development process.

The complexity of urban spatial configuration, which affects human-well being and landscape functioning, needs acquisition and 3d visualisation data to inform decision-making process better. One of the main challenges in sustainability research is to conceive spatial models which are capable of adapting to changes in scale and recalibrating the related indicators depending on the degree of detail and data availability. In this perspective, the inclusion of the third dimension into Urban Ecosystem Services (UES) assessment studies highlights the details of urban structure-function relationships, improves modelling and visualisation of data and impacts, aiding decision-makers to localise, assess and manage urban development strategies. The main goal of the proposed framework concerns mapping, evaluating and planning of the UES within a 3d-virtual environment to improve the visualisation of the spatial relationships among the services allocation and the urban fabric density.

Background: Emergency medical services (EMS) are the first health care contact for the majority of stroke patients. However, there is a lack of data on the current paramedics’ hospital-directed feedback and training needs across different health care settings. We aimed to evaluate paramedics’ prehospital stroke care knowledge, training needs, and current status of feedback on suspected stroke patients. Methods: We surveyed paramedics from the Vilnius region from September to November 2019, and compared the answers between the city and the district agencies. The questionnaire content included questions on paramedics’ demographic characteristics, prehospital stroke care self-assessment, knowledge on stroke mimics, stroke training needs, and the importance of hospital-directed feedback on suspected stroke patients. Results: A total number of 161 paramedics were surveyed, with more district paramedics rating their prehospital stroke care knowledge as inadequate (44.8% (95% confidence interval (CI) 32.8–57.6) vs 28.1% (95% CI 20.1–27.8), p = 0.028). In addition, more district paramedics indicated a need for additional stroke training (83.1% (95% CI 71.5–90.5) vs 69.8% (60.0–78.1), p = 0.043). However, respondents reported being the most confident while dealing with stroke (71.3%, 95% CI 63.8–77.7) compared to other time-critical conditions (p < 0.001). Vertigo (60.8%, 95% CI 53.0–68.0), brain tumours (56.3%, 95% CI 48.5–63.8), and seizures (54.4%, 95% CI 46.7–62.0) were indicated as the most common stroke mimics. Only 6.2% (95% CI 3.4–11.1) of respondents received formal feedback on the outcome of suspected stroke patients brought to the emergency department. Conclusion: A high proportion of paramedics self-perceive having inadequate stroke knowledge and an urgent need for further stroke training. The EMS staff indicate receiving an insufficient amount of feedback on suspected stroke patients, even though the usefulness is perceived to be paramount.

We have estimated the level of Risk Weighted Assets among 30 countries in Europe, in 30 trimesters, using data of the European Banking Authority-EBA of 139 variables. We perform an econometric model using Pooled OLS, Panel Data with Fixed Effects, Panel Data with Random Effects, Weighted Least Squares. We found that Risk Weighted Assets is negatively associated, among others, to the level of NFC loans in mining and quarrying, in public administration and defence, and in financial and insurance activities and positively associated, among others to distribution of NFC loans in human health services and social work activities, in education and the level of net fee and commission income. Furthermore, we apply a cluster analysis with the k-Means algorithm, and we find the presence of two clusters. A comparison was then made between eight different machine learning algorithms for predicting the value of the RWAs and we found that the best predictor is the linear regression. The RWA value is predicted to increase by 1.5%.

[Background] Previous research achievements of the service-oriented tourist city network have often focused on the analysis of its geographical distribution and service role of the important cities instead of the connections and hierarchical tendencies between the whole city in a large region.[Method]Using big data approaches on the regional connections of 38 tourism organizations including famous hotels, air passenger transport, tourism service agencies across 63 most important tourist cities in China. Fuzzy c-means clustering analysis is used to define 8 city arena clusters. [Results]According to the distributions of connectivity between 63 cities, these eight clusters play different service functional roles in the urban tourism network at four hierarchies. With their “center-edge” memberships, these arena clusters are formed by the interweaving process of regional and hierarchical tourism service connections. The results include the analysis of the various service-oriented tourist city in China and point out the geography “gap” faced by network. [Conclusion] Service-oriented tourist cities need to find their hierarchies and positioning in the network scientifically to avoid blind development, to make regional urban tourism sustainable development.

The objective of this study was to assess the impact of different inoculation technologies on the aerobic biological semi-decomposition process of bokashi-type biofertilizer formulations. We examined their effects on the chemical and biological quality of the product, as well as their influence on the agronomic and nutritional characteristics of red-beet and cabbage crops in the field. The highest yields of field-grown beet crops were obtained from seedlings produced using the following treatments: bokashi biofertilizer + biodynamic preparations 502-507 BPB (62.6 Mg ha-1), bokashi + Chamomilla 12CH (60.2 Mg ha-1), and bokashi + Carbo vegetabilis 12 CH (56.3 Mg ha-1). These results corresponded to an increase of 60.9%, 54.7%, and 44.7%, respectively, compared to the yield of the control treatment (38.9 Mg ha-1). The increase in productivity of cabbage plants was higher in the treatment bokashi + Calcarea carbônica 12 CH (35.8 Mg ha-1), being 148.6% higher than the control (14.4 Mg ha-1).The content of moisture, carbon, nitrogen, C/N ratio, and pH H2O in the majority of the evaluated formulations, comply with the standards outlined in IN Nº 61, 2020, by Ministry of Agriculture, Fisheries and Supply, qualifying them as class "A" solid organic compound fertilizers.

This paper explores decision analysis on product integration of family security services and residential fire insurance in the London and Taiwan markets by using the proposed mathematical models for counting sustainable value. This paper shows the five main different results between London and Taiwan markets with ten different parameters of the family security market, to find out the optimal number of family security integrated services for each security company in London. The improvement of the risk aversion effect based on risk and financial management will enhance the market share of the private security industries in the London and Taiwan markets. The results of this research can serve as a reference for the decision-making of private security industries on product integration under sustainable value consideration. The research findings highlight the potential benefits for both the private security industry and the insurance industry in their design and negotiation for product integration to improve both of business operation and achieve corporate social responsibility goals to match the sustainability in the future.

Objective: to assess level of trust in health services during COVID-19 pandemic in Brazil. Methods: Cross-sectional study, carried out between 2020 and 2021, among Brazilians over 18. A non-probabilistic sampling was used. Descriptive and inferential statistics were applied, using the Local Bivariate Moran’s technique was used to verify the existence of spatial dependence between the incidence and mortality of COVID-19 and trust in health services. Furthermore, multinomial regression was also used to analyze the factors associated with the confidence level, with the calculation of the Odds Ratio and with a confidence interval of 95%. Results: 50.6% reported trust in hospital services while 41.4% did not trust Primary Health Care services. With the application of the Local Bivariate Moran, both for the incidence and mortality of COVID-19, the trust in tertiary care and primary care services showed a statistically significant spatial association predominant in the Midwest (High-Low) and North (Low-High) regions of Brazil. The level of trust was associated with education, religion, region of the country and income. Conclusions: The level of trust in hospital services, more than Primary Health Care services, may be related to the population's culture of prioritizing the search for hospital care at the detriment of health promotion and disease prevention

A healthy park-people relation depends essentially on the fair and sustainable maintenance of rural livelihood. When protected area is designated, rural people may face restrictions of access to land and resource use for multiple ecosystem services. In Wuyishan of China, we analysed the role of traditional tea cultivation during consistent protected area management to find ways to maintain stability of this social-ecological system in the new national park era. We used an intensive social survey to investigate tea’s role, perception of ecosystem services and impacts on tea cultivation from consistent conservation policies. Results showed that tea cultivation brought major household income and associated with multiple culture services. Protected area management affected land use and conservation outcomes were more obvious to farmers than economic and social ones. From the perspective of a social-ecological system, tea cultivation in national should be conservation-compatible activities from which the potentially lost economic value is remedied by ecological and cultural valorisation. To sustain the resilience of the social-ecological system, we proposed a three-scale management framework to regulate biophysical elements at land plot scale, to link production and market at the mountain level, and to secure tenure and encourage community participation at the landscape level.

Family support is offered to Australian parents of young children using a mix of targeted and universal child and family health services. A feature of the universal services is the ability for nurses to work in partnership with families and to offer flexibility depending on need. This model of progressive universalism relies on the voluntary engagement of families, including families with complex needs. In this study, the capacity to engage and retain families, including those at risk for child maltreatment and family violence, was examined. Child and Family Health Nurses (n=129) participated in a pragmatic, multilevel mixed-methods study using the McCurdy and Daro (2001) Integrated Theory of Parent Involvement. A questionnaire was used in the first phase of the study to collect the quantitative data. Focus groups were then held with 27 participants recruited from phase one. Both homogeneous and heterogenous practices identified from the questionnaire were the focus of the discussions. Three phases of practice were identified and described: enrolment, retention and conclusion of the nurse-parent relationship and are presented and discussed in this paper. The retention of families with complex needs relies on flexible, advanced, and multidimensional nursing practices.

The escalating environmental challenges that stem from urban residential waste in densely populated areas have become increasingly prominent in recent times. As a result, the waste management sector has experienced significant growth nationwide. However, due to the predominantly manual nature of these processes, their effectiveness falls short of meeting the current demand. Addressing these issues requires process enhancement. In this context, Industry 4.0, particularly the concept of Digital Twins, emerges as a potential avenue for refining processes. To tackle both current and future industry challenges, it is imperative to create a comprehensive methodology capable of generating effective solutions within the waste management sector. This paper provides an explanation of digital twins, outlines the methodological framework comprising an architectural structure and layered model, and details a series of sequential methodical stages for implementing digital twins based on the specific scope determined by the end-user. A noteworthy aspect is the transformative potential of digital twins in enhancing efficiency and precision within waste management practices. By providing a virtual real-time representation of the waste management system, digital twins empower simulations and experimentation to fine-tune processes. Furthermore, they facilitate informed decision-making by offering a detailed visualization of the complete system, simplifying the identification of challenges and opportunities for improvement. that this article derives from the presentation titled "Digital Twin application methodology for the improvement of production and service systems. Application to waste management processes" at the "Sustainable Smart Cities and Territories International Conference" held in the city of Manizales, Colombia, from 21st to 23rd June 2023.

Stream chemistry effectively integrates watershed ecosystem processes on both spatial and temporal scales. Streams of coastal areas integrate a more homogeneous, flat topography wherein there can be interactions between the stream and the body of water into which it drains, especially where tidal fluxes occur. The present study assessed water quality of Thompson Bayou, which comes to the campus of the University of West Florida in a wetland after flowing through 4 km of commercial and private property with associated impacts on water quality. Sampling was carried out for one year at eight discrete sites along Thompson Bayou from the UWF campus to the Escambia River. We used a portable field meter to measure temperature, pH, dissolved O2 (DO), and specific conductivity (SC). Except for temperature, all variables exhibited a spatial pattern of significant variation with distance, with consistent increases in DO and SC as the stream approached the river. These variables also exhibited a temporal pattern of significant seasonal variation, including—and especially—temperature. Data suggest that spatial and temporal patterns of water quality of Thompson Bayou are determined by (1) processing of water by the wetland, (2) interactions of the stream channel with upland forest stands, and (3) the tidal hydrology of the Escambia River.

There is a growing consensus that to effectively adapt to climate change, cities need user-friendly tools and reliable high-resolution biophysical and socio-economic data for analysis, mapping, modeling, and visualization. This study examines availability of various types of information used in climate adaptation plans of 40 municipalities with population less than 300,000 people in the United and in France, probing into the choice and usage of relevant information by small municipalities. We argue that non-climatic spatial data, such as population demographic and socio-economic patterns, urban infrastructure, and environmental data must be integrated with climate tools and datasets to inform effective vulnerability assessment and equitable climate adaptation planning goals. Climate adaptation plans frequently fail to address the existing structural inequalities and environmental injustices in urban infrastructure and land use. Adaptation methodological approaches should be reassessed in the context of much needed societal transformation. Lessons learned from our studies offer valuable insights for potential development of the national and state-level climate adaptation information services for cities.

Rapid urbanization and climate change effects may cause dramatic change of ecosystem functions in cities, thereby inevitably affecting the growth performance of ancient trees. Few studies have explored species diversity and spatial differentiation in Benin urban area. Here, we took Cotonou city to do that. The objective of the study conducted in the city of Cotonou, was to determine the predominant level of plant diversity in the city's land-use units. The urban green frame was subdivided into six land use units, namely establishments, residences, green spaces, commercial areas, administrative areas, and roads. The forest inventories were carried out in 149 plots with surfaces evaluated at 2500 m2 each. A total of 62 tree species in 55 genera and 27 families were recorded. The results show that the flora of the city of Cotonou is characterized by a strong preponderance of exotic species. The most abundant species with high ecological importance (IVI) in the different type of land use of the city are Terminalia catappa (IVI=121.47%), Terminalia mentally (IVI=90.50%), Mangifera indica (IVI=64.06%) and Khaya senegalensis (IVI=151.16%). This study shows that a directed development of this urban vegetation could improve the resilience of urban life to climate hazards through the provision of urban ecosystem services, potential ecological infrastructure foundations and urban nature-based solutions.

Economic valuations of ecosystem services often transfer previously estimated global unit values to the geographical setting of interest. While this approach produces quick results, its reliability depends on how representative the large-scale average unit values are for the given local context. Here, we estimate the values of three ecosystem services (ES) – water filtration, nutrient cycling and carbon sequestration – in the Grand River watershed (GRW) of southern Ontario, Canada. The watershed covers nearly 7000 km2, has a humid continental climate and a population of close to one million people. Land cover is dominated by agriculture. We compare ES valuations using locally derived (i.e., GRW-specific) unit values to valuations based on unit values from a regional database and those compiled in the global Ecosystem Services Valuation Database (ESVD). The regional database includes mean unit values from three case studies within southern Ontario and one boreal watershed in British Columbia. As expected, the regional database yields average monetary values for the three ES that are close to those obtained with the local unit values but with larger associated uncertainties. Using the ESVD, however, results in significantly higher monetary values for the ES. For water filtration, the ESVD value is more than five times higher than the regional and local estimates. We further illustrate the effect of the extent of aggregation of forested and agricultural land categories on the ES values. For example, by subdividing the forest category into three sub-categories (deciduous, coniferous, and mixed forest), the estimated value of the carbon sequestration ES of forested areas within the GRW increases by 15%. Overall, our results emphasize the importance of critically assessing the origin of unit values and the land cover resolution in ES valuation, especially when the latter is used as a policy-guiding tool.

Understanding aspects of maritime/underwater cultural heritage (MUCH) and the associated cultural values and integrating them into maritime spatial planning (MSP) endeavors, is a new global challenge, alongside the rapid increase of human activities at sea and climate change impacts on the seas and the oceans. The article highlights the significance of cultural values in shaping human interactions with the marine environments, and how MSP can address the cultural dimensions of marine resources management. To this end, a systematic literature review was carried out to address the research question on how maritime/underwater cultural heritage is incorporated into MSP and map relevant academic literature. Following, a methodology that entailed an academic database search and the application of exclusion criteria, 346 articles resulted from Scopus. These articles were classified using science mapping techniques (i.e the VOSviewer Software ) and several categories (clusters) were created. The research showed a diversity of literature addressing the relationship between MUCH and MSP with a strong focus on sustainability, the significance of cultural ecosystem services (CES) and cultural values, the role of indigenous and local communities, but also of local stakeholders, the transfer of traditional knowledge to MSP and the participatory approaches and tools. The article concludes that for MSPlans to be innovative and acceptable by local communities, the “missing layer”of socio-cultural values and data is indispensable. In the MSP process, MUCH should be understood within this broader framework of socio-cultural considerations and values.

The National Occupational Competency Profile (NOCP) – the competency framework for paramedics in Canada – is presently undergoing revision. Since the NOCP was published in 2011, paramedic practice, healthcare and society have changed dramatically. To inform the revision, we sought to identify emerging concepts in the literature that would inform the development of competencies for paramedics. We conducted a restricted literature review and content analysis of all published and grey literature pertaining to or informing Canadian paramedicine from 2011 to 2022. Three authors performed a title and abstract, and full-text review to identify and label concepts informed by existing findings. A total of 302 articles were categorized into eleven emerging concepts related to competencies: Inclusion, Diversity, Equity, and Accessibility (IDEA) in paramedicine; Social responsiveness, justice, equity and access; Anti-racism; Healthy Professionals; Evidence Informed Practice and Systems; Complex Adaptive Systems; Learning Environment; Virtual Care; Clinical Reasoning; Adaptive Expertise; and Planetary Health. This review identified emerging concepts to inform the development of the 2023 National Occupational Standard for Paramedics (NOSP). These concepts will inform data analysis, development group discussions, and competency identification.

A small proportion of health care users are recognised to use a significantly higher proportion of health system resources, largely due to systemic, inequitable access and disproportionate health burdens. These high-resource health system users are routinely characterised as older, with multiple comorbidities, and reduced access to adequate health care. Geographic trends also emerge, with more rural and isolated regions demonstrating higher rates of high-resource use than others. Despite known geographical discrepancies in health care access and outcomes, health policy and research initiatives remain focused on urban population centers. To alleviate mounting health system pressure from high-resource users, their characteristics must be better understood within the context in which it arises. To examine this, a scoping review was conducted to provide an overview of characteristics of high-resource users in rural and remote communities in Canada and Australia. In total, 21 papers were included in the review. Using qualitative thematic coding, primary findings characterised rural high-resource users as those of an older age; with increased comorbid conditions and condition severity; lower socioeconomic status; and elevated risk behaviours.

The COVID19 pandemic had a major impact on emergency medical communication centres (EMCC). A live video facility was made available to second-line physicians in an EMCC with a first-line paramedic to receive emergency calls. The objective of this study was to measure the contribution of live video to remote medical triage. The single-centre retrospective study included all telephone assessments of patients with suspected COVID19 symptoms from 01.04.2020 to 30.04.2021 in Geneva, Switzerland. The organisation of the EMCC and the characteristics of patients who called the two emergency lines (official emergency number and COVID19 number) with suspected COVID19 symptoms were described. A prospective web-based survey of physicians was conducted during the same period to measure the indications, limitations and impact of live video on their decisions. 8,957 patients were included. 2,157 (48.0%) of the 4,493 patients assessed on the official emergency number had dyspnoea. 4,045 (90.6%) of 4,464 patients assessed on the COVID19 number had flu-like symptoms. 1,798 (20.1%) patients were reassessed remotely by a physician, including 405 (22.5%) with live video, successfully in 315 (77.8%) attempts. The web-based survey (107 forms) showed that physicians used live video to assess mainly the breathing (81.3%) and general condition (78.5%) of patients. They felt that their decision was modified in 75.7% (n=81) of cases, and caught 7 (7.7%) patients in life-threatening emergency. Medical triage decisions for suspected COVID19 patients are strongly influenced by the use of live video.

Background: The Covid-19 pandemic abruptly disrupted global healthcare systems, necessitating rapid adaptations. This study evaluates the impact on health systems and services in the aftermath of the first wave in the Indian context. It analyses the disruptions, adaptive measures, and changes made, as well as the challenges faced by healthcare providers and seekers. Valuable insights from this study will enhance the resilience and preparedness of healthcare systems for future challenges. Methods: The eligible studies included primary studies conducted in the Indian context that explore the impact of COVID-19 on health services provision, utilisation, and the well-being of healthcare providers and seekers. Electronic searches were conducted in six databases: PubMed, MEDLINE, Embase, Global Health, CINAHL, and the WHO database on COVID-19. The results were analysed using detailed narrative synthesis. Results: The review includes 38 articles, incorporating a total of 22,502 subjects. There has been a substantial impact on health service provision, particularly in outpatient departments (OPD) (n=19) and elective services (n=16), while emergency services continued at sub-optimal levels (n=20). Various adaptations and changes were implemented in precautionary measures, protocols, staff allocation and training, usage of personal protective equipment (PPE), preoperative, operative, and postoperative measures, as well as physical infrastructure and resources. Depression and stress (n=14), fear of contracting the infection (n=6), stigmatisation (n=5), and financial repercussions (n=5) significantly affected the mental health of healthcare providers, and healthcare seekers also faced significant challenges (n=11). Conclusion: The study reveals COVID-19's substantial impact on health services. The healthcare system responded by quickly adjusting staff management, resource allocation, and infection prevention measures. The study also highlights the mental health challenges faced by healthcare providers and the concerns of healthcare seekers regarding delays and suboptimal care. Looking ahead, the findings underscore the importance of preparedness for future pandemics, including improved healthcare infrastructure, resource optimisation, and comprehensive protocols. Lessons learned from COVID-19 should inform strategies to mitigate disruptions and ensure the well-being of healthcare providers and seekers in future outbreaks.

Keywords: Ecosystem services; Cultural Ecosystem Services; marine/maritime spatial planning; mapping, assessment, tools, methods, PPGIS

1) Background: Genomic medicine harbors the real potential to improve the health and healthcare jour-ney of patients, care provider experiences, and improve health system efficiency – even reducing health care costs. There is expected to be an exponential growth in medically necessary new genome- based tests and test approaches in coming years. Testing can also create scientific research and commercial opportu-nities beyond healthcare decision-making. The purpose of this research is to generate a better under-standing of Canada’s state of readiness for genomic medicine, and to provide some insights for other healthcare systems; (2) Methods: a mixed-methodsapproach of literature review and key informant in-terviews with a purposive sample of experts was used. Health system readiness was assessed using a pre-viously published set of conditions. (3) Results: Canada has created some of the established conditions but more needs to be done to improve the state of readiness for genome-based medicine. Important gaps are the need for linked information systems and data integration; evaluative processes that are timely, and transparent; navigational tools for care providers; dedicated funding to facilitate rapid onboarding and supports test development and proficiency testing; and broader engagement with a broader set of inno-vation stakeholders. These findings highlight the known role of organizational context, social influence, and other factors that are known to affect the diffusion of innovation within health systems

Climate and land-use changes have been contributing to increase the occurrence of extreme wild-fires, shifting fire regimes and driving desertification, particularly in Mediterranean-climate regions. However, few studies have researched the effects of land-use change on fire regimes and carbon storage at the broad national scale. To address this gap, we used spatially explicit data from annual burned areas in mainland Portugal to build a typology of fire regimes based on the accumulated burned area and its temporal concentration (Gini index) between 1984 and 2019, which was combined with 2018 carbon stock data (above- and below-ground), and a landscape typology re-sulting from cluster analysis over land-use composition, diversity and configuration, to explore relationships between landscape types and the two major ecosystem services at stake: wildfire reduction and carbon stock. Cross tabulations, logistic and linear regressions were performed on these data and results revealed a strong relationship between landscapes dominated by maritime pine and eucalypt forest plantations and high-hazardous fire regime but hold the highest carbon stock. Shrubland-mixed landscapes were associated with lower carbon stocks but less hazardous fire regimes. Specialized agricultural landscapes, as well as mixed native forests and mixed agro-forestry landscapes, were the least associated with wildfires. In the case of agricultural landscapes however, this good wildfire performance is achieved at the cost of the poorest carbon stock, de-noting land degradation, whereas native forests and agroforestry landscapes strike the best trade-off between carbon stock and fire regime. Our findings support how nature-based solutions promoting wildfire mitigation and carbon stock ecosystem services may prevent and revert land degradation harming Mediterranean regions.

Through a variety of unique ecosystem services, peatlands provide critical support to society and play a significant part in the global environmental system. Unfortunately, anthropogenic activities pose a hazard to these peatlands. This study estimated a total economic value (TEV) of peatland ecosystem services and examined relationships between the TEV and landscape characteristics in Riau province, Indonesia. A comprehensive economic valuation questionnaire, covering household socioeconomic conditions, ecological information and landscape characteristics, perception of peatland importance, peatland product collection data, and villagers' willingness to pay (WTP) for habitat and biodiversity protection, was administered to 200 household representatives (92% confidence) from five villages distributing across distinct landscapes. The survey took place from May to June 2023. The respondents derived numerous advantages from the peatlands, culminating in an average TEV of USD 3,174.31 per household per year. This value predominantly reflects a use value, accounting for 80.85% of the TEV. Notably, the use value emanates primarily from the provisioning of food through fishing, soil fertility, wild plants, and animals. However, to a lesser extent, there exists a marginal presence of a non-use value, encompassing the habitats provided to endemic or endangered species, the preservation of biodiversity for future generations, and the sanctity associated with forests deemed sacred. The observed variance in landscape characteristics appears to wield an influence on amounts of benefits derived from the peatlands. This phenomenon can be attributed to prevailing land use conditions and geographical distances.

Objective: To describe the methodology used and the results found in the implementation of Lean in Emergencies in the Emergency sector of the Hospital de Clínicas of the Federal University of Uberlândia (HC-UFU), verifying the difficulties and particularities that involved the process, as well as the result obtained. Material and methods: For the comparison between the periods before (T1), contemporary (T2) and after (T3) the implementation of Lean, hospital data were used , and the indicators corresponding to 10 variables were analyzed: Male Hospitalization and Female Hospitalization; High Male and High Female; Male Transfer and Female Transfer, Male Death <24h and Female Death <24h; Male Death >24h and Female Death >24h and general occupancy rate. All raw data related to the 36 months of evaluation were provided by the HC-UFU Statistics sector in spreadsheets without identifying patients. The indicators were compared to each other in the three analyzed periods, with the study directed as follows: Previous stage - Pre -intervention (T1): considered between the months of April 2017 to March 2018, completing 12 months before the implementation of Lean; Intra-intervention stage - contemporary (T2): considered between the months of April 2018 to March 2019, in a total of 12 months which was the implementation period; Post-Intervention Stage (T3): later: considered between the months of April 2019 to March 2020, completing 12 months after the implementation of Lean. The Lean in Emergencies scores (NEDOCS and LOS) were only recorded during the period that the implementation team was able to record and were used only to demonstrate trend over time. Comparison of the indicators with those found in other hospital units that also implemented Lean was carried out based on bibliographical research. Results and Discussion: The analysis of the behavior of the indicators did not demonstrate effectiveness related to the implementation of the system in the emergency sector. The failure to obtain better indicators can be attributed to discontinuity in monitoring the project, the lack of involvement of the clinical staff and alignment with the needs of the staff training academy, the difficulty of understanding the project by local and regional public entities. geographical location where the hospital is located, and by users of the health system who were not properly informed about the development of the project. These aspects should be considered in future management projects that may be implemented in the hospital. Despite the result of the implementation of Lean in the emergency sector not having reached the expected goals, the attempt showed windows of opportunity for future action on points that can improve the hospital management process and that should be tested in the next experiences. Conclusion: The methodology followed for the implementation of Lean in Emergencies in the emergency sector of the hospital did not produce improvement in hospital indicators.

One of the fastest growing customer service delivery platforms is online banking. However, the increasing number of attacks on online banking platforms is driving the banks to constantly review their security. This study developed an enhanced Multi-factor authentication scheme with a track and trace capability to reduce these threats. Five modalities of authentication were incorporated in the proposed scheme: The traditional username, password, personal identification number (PIN) and one-time PIN (OTP), augmented with fingerprints or facial scans, registered smart devices, and a time locked user's location. One of the scheme's most impressive accomplishments is its capacity to seamlessly detect undesired activities and send alerts in the form of secretly obtained photographs and location triangulation.

Violence against paramedics is increasingly recognized as an important occupational health problem, but pervasive and institutionalized underreporting hinders efforts at risk mitigation. Earlier research has shown that the organizational culture within paramedicine may contribute to underreporting and researchers have recommended involving paramedics in the development of violence prevention policies, including reporting systems. Eighteen months after the launch of a new comprehensive violence reporting system in Peel Region, Ontario, Canada, we surveyed paramedics about their willingness to report violent encounters. A total of 204 (33% of eligible) paramedics chose to participate, of whom 67% (N=137) had experienced violence since the launch of the new reporting process, with 83% (N=114) reporting the incidents at least some of the time. In choosing to report, participants cited the accessibility of the new reporting process and the desire to promote accountability among perpetrators while contributing to a safer workplace as motivating factors. Their decisions to file a report, however, could be influenced by the perceived ‘volitionality’ and severity of the violent encounters, particularly in the context of (un)supportive co-workers and supervisors. Ultimately, the participants’ belief that the report would lead to meaningful change within the service was a key driver of reporting behavior.

More than 13.5 billion COVID-19 vaccine doses have so far been delivered between 2021 and 2023 through a mix of delivery platforms, with mass vaccination campaigns being the main approach. In 2022, with the most likely scenario of continued circulation of SARS-CoV-2 and the need for periodic booster doses, there was a need for countries to plan for more sustainable approaches to provide COVID-19 vaccination. In this context of uncertainty, a global tool for integrating COVID-19 vaccines into immunization programmes and primary health care was published jointly by WHO and UNICEF to respond to country needs. The guidance leveraged existing health system frameworks, proposed four steps for the COVID-19 integration journey, and identified investment areas. The development process maximized robust global stakeholder and country engagement, and the timeframe was aligned with donor funding windows to support the integration of COVID-19 vaccination. The rapid dissemination of guidance allowed its use by countries to ascertain their readiness for integrating COVID-19 vaccination and inform the development of national plans and funding applications. While progress has been made in specific areas (e.g., optimizing cold chain and logistics leveraging COVID-19 vaccination), in the context of decreasing demand for COVID-19 vaccines, reaching adult COVID-19 vaccine high-priority-use groups and engaging and coordinating with other health programmes (beyond immunization) remains a challenge. We share the learning that despite the uncertainties of a pandemic, guidance documents can be developed and used within a short timeframe. Working in partnership with stakeholders beyond immunization towards a common objective is powerful and can allow progress to be made on integrating health services and preparing better for future pandemics.

In the last two centuries, land use change (LUC) has been the most important direct changes driver for terrestrial ecosystems. To contrast the consequent ecosystems degradation, forward-looking spatial policies and target landscape and land-use planning processes, promoting a sustainable land use change, are needed. The present paper proposes a framework of action including different landscape planning and ecological approaches: from the spatial modelling to recognize the LUC and build different scenarios, to the ecosystem services (ESs) assessment to evaluate the possible environmental impacts. Three different scenarios were built: Trend, No-Tillage and Energy crops. The Sediment Delivery Ratio and Carbon Storage and Sequestration ESs were assessed and compared for each scenario. The aim of the paper is to support decision-makers and local communities into the landscape planning process. Results show that a regional development in line with past trend could lead to further land degradation. Instead, the two scenarios proposed in compliance with EU policies, could bring benefits only if related to moderate LUCs and respecting the naturally grass-vegetated land. From the local to global scale, a guided and shared LUC management allows implementing sustainable development, basing on a deep knowledge of physical-environmental but also social and economic issues.

Payments for Ecosystem Services are a voluntary market-based instrument to remunerate provider(s) of ecosystem services by those who benefit from them. Our research aimed to create an ex-post evaluation framework to identify bottlenecks and elements hindering the success of a solution-driven PES scheme. The framework was applied to a case study to test its feasibility and concerns the provision of health and recreational services in the Medvednica Nature Park (Zagreb, Croatia). The framework was set up through three main sources: the study of PES implementation project documentation, semi-structured interviews with visitors and key stakeholders and web-scraping of TripAdvisor reviews of the park. The main findings confirmed society's interest in the park, but the lack of mapping, quantification, economic valuation and accounting of the services analysed, society's little or no demand to pay for their provision and confused knowledge of the property rights of some ecosystem service providers in the area limit the success of the PES scheme. The framework was useful to describe the chosen PES scheme and to identify bottlenecks and fragilities of the system in place, allowing to correct its application flaws and, on the other hand, to demonstrate its replicability in other contexts.

Agroforestry with a sustainable model of production is considered to be an effective solution to the unsustainability of the existing model in agricultural production, and it is also an important topic for ecosystem services and sustainable development goals to improve human well-being. In addition, existing literatures confirm that the importance of forest functions in increasing agricultural production and maintaining agro-ecological sustainability. The "rice-fish-duck-forest" is an important representative of the agroforestry complex ecosystem because of its unique management mechanism and characteristic social culture. As a result, "rice-fish-duck-forest" ecosystem services are beginning to be studied. In the absence of a systematic scientific understanding of the ecosystem services of "rice-fish-duck-forest", there are potential challenges to its sustainable development. This study thoroughly analyzed the current literature on rice-fish-duck-forest ecosystem services in order to have a more thorough grasp of it and to be more sustainable. This research found that research on the ecosystem services of "rice-fish-duck-forest" involves four themes: "regulational", "ecology", "economy", and "socio-culture". Deforestation, socio-cultural marginalization, and Low community management participation are the three main issues facing the "rice-fish-duck-forest" ecosystem service. To address these issues, this paper builds a framework for the sustainable development of rice-fish-duck-forest ecosystem services within the context of current management frameworks for agriculture and forestry, and further discusses its relevance to the Sustainable Development Goals. This study will provide a theoretical decision-making guide for the transformation of agriculture to agroforestry and the sustainable development of agroforestry.

Modern research applies the Open Science approach that fosters the production and sharing of Open Data according to the FAIR (Findable, Accessible, Interoperable, Reusable) principles. In the geospatial context this is generally achieved through the setup of OGC Web services that implements open standards that satisfies the FAIR requirements. Nevertheless, the requirement of Findability is not fully satisfied by those services since there’s no use of persistent identifiers and no guarantee that the same dataset used for a study can be immutably accessed in a later period: a fact that hinders the replicability of research. This is particularly true in recent years where data-driven research and technological advances have boosted frequent updates of datasets. Here, we review needs and practices, supported by some real case examples, on frequent data or metadata updates in geo-datasets of different data types. Additionally we assess the currently available tools that support data versioning for databases, files and log-structured tables. Finally we discuss challenges and opportunities to enable geospatial web services that are fully FAIR: a fact that would provide, due to the massive use and increasing availability of geospatial data, a great push toward open science compliance with ultimately impacts on the science transparency and credibility.

The fusion of machine learning, biomedical, and bioengineering research offers novel ways to understand, diagnose, and treat various health conditions. However, the complexities of biomedical and bioengineering data, coupled with the intricate process of developing and deploying machine learning solutions, often pose significant challenges to researchers in these fields. We introduce a new Automatic Semantic Machine Learning Microservice Framework (AIMS) that addresses these challenges by automating key aspects of the machine learning pipeline, from data preprocessing to model evaluation. Our proposed framework emphasizes model interpretability, the integration of domain knowledge, and the efficient handling of biomedical data. Furthermore, it incorporates self-supervised knowledge learning strategies, enabling the automatic generation, optimization, and continuous adaptation of machine learning models in response to new tasks and data. We illustrate the potential of our framework through three case studies in biomedical research, showcasing its capacity to streamline research processes, improve scientific exploration quality, and provide a foundation for significant breakthroughs.

Certain services can help avoid environmental impact in larger contexts. However, there is no commonly agreed bottom-up methodology for calculation of the total net reduction effect of specific digital services. Life Cycle Assessment (LCA) is a common denominator for most methodologies. The most common method is the Attributional LCA (ALCA), and recently the emerging handprint ALCA estimating so-called positive environmental impacts. Moreover, Consequential LCA (CLCA) can be used to capture market effects. The third conceptual approach is Input-Output LCA. The purpose is to propose and test a new method based on some of the existing ones. The existing concepts are compared and a synthesis is made to create a practical but still useful method. The new method is applied to two illustrative cases in the Information and Communication Technology (ICT) domain; the introduction of a 5G enabled drone for pipe inspection and the 5G enabled health consultation. Compared to simplified ALCA, the difference between the absolute score for the baseline system and the target system changes up to 15% when the proposed simplified CLCA (SCLCA) method is used. The results show that SCLCA, when combined with analytical methods for expressing digital ICT services’ own impact, is a fruitful approach which is both practical and feasible.

Achieving universal access to water and sanitation services in developing countries requires a coherent legal, political, and institutional environment, along with a clear financial strategy. Regionalizing utilities may be crucial for addressing disparities, economic inequalities, and governance challenges. Regionalization offers economies of scale, resource efficiency, knowledge sharing, and collaboration. The cornerstone will be ensuring the financial-economic viability of regional utilities, considering their social impacts in terms of affordability. The State of Santa Catarina case study is assessed. In the case of Santa Catarina, only four regional utilities currently generate sufficient revenue, without factoring in necessary investments, indicating the need to review design parameters to improve operational efficiency and increase revenues. Additional financial support may be required to ensure universal access. Tariff adjustments must strike a balance between cost-effectiveness and affordability for families.

Violence against paramedics has been described as a ‘serious public health problem’ but one that remains ‘vastly underreported’, owing to an organizational culture that stigmatizes reporting – hindering efforts at risk mitigation in addition to creating a gap in research. Leveraging a novel reporting process developed after extensive stakeholder consultation and embedded within the electronic patient care record, our objective was to provide a descriptive profile of violence against paramedics in a single paramedic service in Ontario, Canada. Between February 1, 2021, through January 31, 2023, a total of 374 paramedics in Peel Region (48% of the workforce) generated 941 violence reports, of which 40% documented physical (n=364) or sexual (n=19) assault. The violence was typically perpetrated by patients (78%) and primarily took place at the scene of the 9-1-1 call (47%); however, violent behavior frequently persisted or recurred while in transit to hospital and after arrival. Collectively, mental health, alcohol, or drug use were listed as contributing circumstances in 83% of violence reports. In all, 81 paramedics were physically harmed because of an assault. On average, our data correspond to a paramedic filing a violence report every 18 hours, being physically assaulted every 46 hours, and injured every 9 days.

The goods and services produced by forest vegetation ecosystem are the driving force for the rapid, high-quality and sustainable development of human society. In history, with the increase of population and economic development, there is an increasing demand for the quantity and variety of forest vegetation ecosystem products and services in a country or a region. To meet the demands, most of the original forest has become farmland, plantation and grass and crops land. As a result, the plant water relationship changed from equilibrium to non-equilibrium, which easily led to soil drought, soil degradation and vegetation decline in dry years or waste of soil water in rainy years in most of water-limited regions. In order to solve the question and realize the sustainable utilization of soil water resources and the high-quality sustainable development of forest, it is necessary to apply the limit theory of plant utilization of soil water resources and the vegetation carrying capacity theory in the critical period of plant-water relationship regulation to adjust the relationship between plant growth and soil moisture to obtain the maximum yield and benefit and realize high-quality and sustainable development.

Recent Socio-economic changes resulted to mass abandonment of agricultural lands in Central-Eastern Europe. This leads to landscapes homogenisation, especially the disappearance of semi-open habitats of the farmland-woodland interface. The information on potentials of transforming feral, abandoned landscapes to wood-pastures is limited. We studied the ecological features and silvopastoral benefits of a landscape subjected to intensive cattle grazing after ~20 years of abandonment, i.e. the mosaic of habitats, cattle’s preference for habitats and for arboreal forages. The nutritional characteristics of arboreal forage and herbaceous forage were compared. After the initial increase in the landscape’s woodland share, cattle grazing halted further woody succession and stabilised the landscape structure, with treeless grassland occupying 49% of the landscape (most preferred by cattle with regard to the time spent), followed by treed grassland (19%), pioneering birch/alder groves (13%), riparian vegetation (12%, least preferred by cattle), and close-canopy woods (6%). The consumption intensity of arboreal forages was on about 4.5 folds higher than that of herbaceous forage. Our study proved that the grazing herd of arobust cattle breed can turn a feral, post-agricultural land into a working wood pasture, consisting of interconnected open grasslands and various facets of woodland, which seldom occur in contemporary high forests. We advocate for the transition management of abandoned farmlands towards integrated silvopastoral landscapes for sustainable provision of multiple ecosystem services that cannot be provided by segregated agriculture and forestry.

Anarchic urbanization and land artificialization expose urban ecosystems and Ecosystem Services (ES) to the threat. Urban ecosystems and trees play a crucial role in improving urban environments, and their management depends on the perceptions and preferences of urban residents. An assessment of the socio-ecological factors determining the perception of the actors allows for the proper design and planning of ecological urban policies and urban adaptation to climate change. In this study, we assessed the perception and discriminating variables of the different stakeholders of urban ES provided in the city of Cotonou. Thus, 381 city dwellers were individually interviewed after statistical sampling. Focus group discussions with the stakeholders also made it possible to highlight the ES provided in the different Land Use Units (LU). The results show that 73.23% of the city dwellers agreed that they were aware of ecosystem services. The hierarchical classification shows two homogeneous groups of perceivers with ethnicity, age and education as statistically discriminating sociological variables (pv˂0.001). Urban dwellers in the city of Cotonou perceived more SEs in the cultural and regulatory services category significantly (pv<0.001; v-test>3). The principal component analysis (PCA) reveals the varying availability of ES according to the different LU in the city. This study adds scientific value in the application of urban ecology to decision-making in climate and environment policy planning for sustainable cities in Africa and all over the world.

The reliance on cloud computing services and related technologies has increased due to their many benefits, including resource sharing and the need for organizations to maintain their competitive advantage in the digital market. Also, the pace of cloud growth has significantly increased because of COVID-19. Many companies and businesses have shifted their core processes to the cloud for seamless operations during the pandemic. This migration of legacy systems to the cloud creates many opportunities for businesses. However, on the other hand, it may also bring substantial challenges. Hence, a careful decision is needed to align with company goals. In this paper, we demonstrate the need and advantages of cloud computing, followed by highlighting AWS's characteristics as one of the leading cloud service providers. We also discuss the merger of AWS with SDN to improve cloud data security and performance. The outcomes of this study can provide a data migration strategy and guide decision-makers toward a secure and sustainable migration to a cloud computing environment.

The Covid-19 pandemic has forced the transfer of local government public ser-vices to the virtual world. Remote handling of matters in government offices has be-come the norm rather than the exception. The 2016 EU directive on public sector web-sites and mobile applications and the 2019 European Digital Accessibility Act made it mandatory that these services be provided electronically and accessible to people with disabilities. The purpose of the study conducted by the authors was to determine whether the Covid-19 pandemic resulted in the implementation of European solutions in the Polish legal order and whether this implementation resulted in the actual adap-tation of digital activities of local government units (LGUs) to the needs of people with disabilities. The research was conducted in Q4 2022 in two trial formats: 1. In the form of a survey (about 250 LGUs), which covered compliance with for-mal requirements, the level of readiness of the officials to create digitally accessible documents and content, and organizational readiness of the offices. 2. In the form of an analysis of the source code of the websites of 66 Polish cities with county rights - due to the availability of results of the same sample from 2015. The completed research showed that the LGUs in Poland: 1. met the formal and organizational requirements for digital accessibility, 2. did not make the necessary efforts to prepare employees to create digitally ac-cessible documents and content, 3. the surveyed websites had inferior source code in terms of meeting the WCAG standard in 2022 than in 2015. It seems reasonable to conclude that the Covid-19 pandemic had a formal, rather than real, impact on the digital accessibility of services provided by Polish LGUs.

Cloud computing has become a widespread technology due to ICT advancements. It allows businesses to move and take advantage of the pay-as-you-go price model. Enterprises pay for what they use and don't have to buy, setup, or maintain resources. However, outsourcing core resources such as storage, servers, operating systems, and software applications from a third party needs careful decisions to take advantage of cloud facilities. Choice of appropriate service provider, deployment and service model must be aligned with business needs and goals. In this paper, we will present cloud computing benefits, cloud deployment methods, services, state-of-the-art migration methods, tools and techniques and will conclude with the role of SDN in cloud computing.

Introduction Headache is a common public health problem, but its burden could be avoided by raising headache awareness and the appropriate use of acute medication and prophylactic medication. Few reports on raising headache awareness in the general public have been reported, and there are no reports on headache awareness campaigns through social networking services (SNS), or social media, in Japan. We prospectively performed a headache awareness campaign from March 2022 through 2 SNS, targeting nurse and wind instrumental musicians, because they are with high headache prevalence. Methods Through the 2 SNS, the article and video were distributed, respectively. The article and video described the 6 important topics for the general public about headaches, which were described in the Clinical Practice Guideline for Headache Disorders 2021. Just after reading or watching them as e-learning, we performed online questionnaire sheets to investigate the awareness of the 6 topics through the 2 SNS. The awareness of the 6 topics before and after the campaign was evaluated. Results In the SNS nurse-senka, we obtained 1191 responses. Women comprised 94.4%, and the median (range) age was 45 (20 to 71) years old. Headache sufferers were 63.8%, but only 35.1% had consulted doctors. In the SNS Creatone, we got the response from 134 professional musicians, with 77.3% of women. The largest number of respondents were in their 20s (range 18-60 years old). Headache sufferers were 87.9%. Of them, 36.4% had consulted doctors, 24.2% were medication-overuse headache. The ratios of individuals who were aware of the 6 topics significantly increased from 15.2%-47.0% to 80.4-98.7% after the online questionnaire in both SNS (p < 0.001, all). Conclusions We conducted this headache awareness campaign through e-learning and an online survey via 2 SNS. The ratios of individuals who were aware of the 6 topics about headaches significantly increased 1 month after e-learning. Our results suggest that e-learning and online survey can improve headache awareness. The materials in this campaign can be installed into smartphone applications and further spread on SNS, leading to strong influence. With rapid digital transformations such as online telemedicine and artificial intelligence diagnosis, raising awareness will be more efficient and effective and should be important.

Health services research is a multidisciplinary discipline that aims to improve population health by studying healthcare services' organization, delivery, and financing. Over time, the field has worked to define its boundaries and establish a set of core research topics and methods addressing population wellbeing, access, quality, and cost. Although the influence of health technology is significant, our literature survey on health services research showed that SCs in general—containing their management, cost, and policy—had received little attention. Importantly, our assessment also showed that the system’s readiness to handle supply policy and supply device deficiencies like those encountered during pandemic was hardly ever mentioned. Reduced open areas and water bodies, deteriorating infrastructure, and changes in the biological morphology all affect cities’ uncontrollable and unplanned growth. Urban amenities, facilities, and healthcare services were unevenly distributed due to this unchecked urban population development. In light of this, this research suggests two reliable models for site selection issues for one of Hong Kong’s main hospitals. Levels of uncertainty, infeasibility tolerance, and reliability are taken into consideration. Then, two categories of uncertainty—symmetric and bound-ed—were examined. As a result, the challenge of scheduling in uncertainty has been considered, and potential solutions have been presented using a specified probability distribution function. The paper concludes by introducing the specific justice and health problems and outlining four typical strategies. In order to ensure that medications and other healthcare supplies are produced, distributed, and given to patients, a vast network of systems, components, and procedures must be effectively managed. This research contributes in this regard. Also, its grantee fairness in health systems and the populations health locally, nationally, and globally. It highlights health inequity, advances the measurement of health inequity, and promotes public dialogues on health inequity.

The development of a decision framework for landscape governance and management has become one of the prioritised policy instruments for actualising policy objectives relating to agri-food system, biodiversity conservation, nature restoration, environmental management, climate change mitigation and adaptation, net zero greenhouse gas emissions, and the transition to renewable energy supplies in the United Kingdom (UK). However, the landscape lens in policy-making is challenging because of the diverse landscape archetypes, environmental problems, and diverging policy targets that it must address. This highlights the importance of having a robust, evidence-based landscape decisions framework. To address this issue, this study undertakes a systematic review and transdisciplinary synthesis of research outputs from the Landscape Decisions Programme (LDP). This study compiles and synthesizes outputs from the LDP projects in the context of the relevant literature to develop an understanding of the relationships among the emerging evidence with respect to decision-making for more sustainable and multifunctional landscapes. The synthesis analyzed the drivers of landscape decisions, and methodological approaches used to generate evidence for decision-making. The emerging themes from the synthesis were distilled into five principles that can be used as a basis for a roadmap towards the development of a holistic landscape decisions framework.

At the Rio Conference in 1992, the sustainable development agenda promised a new era for natural resource management, where the well-being of human society would be enhanced through the sustainable use of natural capital. Several decades on, economic growth continues unabated at the expense of natural capital, as evidenced by biodiversity loss, climate change and further environmental issues. Why is this happening and what can be done about it? In this research, we present three Agent-Based Models that explore the social, economic and governance factors driving (un)sustainability in complex social-ecological systems. Our modelling results reinforce the idea that the current economic system does not protect the natural capital on which it depends. This is due to a disjunction between the economic and environmental elements upon which the sustainable development paradigm is founded. Additionally, various factors appear to enhance social-ecological system unsustainability: the role of financial entities and monetary debt; economic speculation; technological development and efficiency; lack of long-term views and late government interventions; inefficient tipping point management; and the absence of strong top-down and bottom-up conservation forces. Interestingly, alternative scenarios showed that these same factors could be redirected to enhance sustainable development. The current economic system may, therefore, not be inherently unsustainable, but rather specific economic mechanisms, agents’ decision-making, and the kinds of links between economic and natural systems could be at the root of the problem. We argue that short- and medium-term sustainability can be enhanced by implementing mechanisms that shift capitalist forces to support environmental conservation. Long-term sustainability, however, requires further paradigm change: where the economy integrates, and fully accounts for, externalities and recognises the actual value of natural capital.

The construction industry, characterized by its intricate network of stakeholders and diverse workforce, grapples with the challenge of managing information effectively. This study delves into this issue, recognizing the universal importance of safeguarding data, particularly amid rising concerns of unauthorized access and breaches. Aiming to harness the potential of blockchain technology to address these challenges, this study used a hypothetical biographical and safety data of construction workers and securely stored on a Hyperledger Fabric blockchain. Developed within the Amazon Web Services (AWS) cloud platform, this blockchain infrastructure emerged as a robust solution for enhancing data security and privacy. Anchored in the core principles of data security, the model emerges as a potent defender against the vulnerabilities of traditional data management systems. Beyond its immediate implications, this study exemplifies the marriage of blockchain technology and the construction sector, potentially reshaping workforce management, especially in high-risk projects, optimizing risk assessment, resource allocation, and safety measures to mitigate work-related injuries. Practical validation through transaction testing using Hyperledger Explorer validates the model's feasibility and operational effectiveness, serving as a blueprint for the industry's data management. Ultimately, this research not only showcases the promise of blockchain technology in addressing construction data security challenges but also underscores its practical applicability through comprehensive testing, heralding a new era of data management that harmonizes security and efficiency for stakeholders' benefit.

The study of man-land relationship in urbanization process is the current frontier and focus of international research. How to balance urban development and ecosystem conservation in the Upper Yellow River is a key issue for sustainable development in China. In this study, we evaluated the Lanzhou-Xining urban agglomeration （LXUA）by constructing a multi-dimensional assessment system for urbanization quality and ecosystem services. The efficacy function model, entropy weight method, and Integrated Valuation of Ecosystem Services and Tradeoffs (InVEST) model were used to quantitatively assess the subsystems' state of development. Then, the coupling model (CD) and the coordination degree（CCD）model were used to explore the coupling coordination relationship and spatial-temporal change characteristics of the composite system. The findings indicate that: 1）In 2020, the quality of urbanization in LXUA showed the pattern of "double core". The development of urban centers in each city is insufficient, and the proportion of counties with low-level is too high. 2）Integrated ecosystem services showed an increasing distribution pattern from the northeast to the southwest. Water provision services, soil conservation services and carbon fixation services all showed growth trends. 3）Each county’s composite system was in the run-in stage or highly coupled stage. The subsystems were closely related to each other. 4）The CCD was decreased by 6% between two decades. The number of counties on the verge of disorder was the highest. About 80% of the counties are relatively lagging behind in ecosystem services.

The patient's satisfaction level concerning hospitalization has certain particularities, related to the geographical area, medical/non-medical assistance, the age, incomes, morbidity and mortality of the population. The objective of this study is to emphasize the degree of patients' satisfaction, depending on the specialty of the hospitalization department: surgical, medical, oncological, psychiatry, and to evidence the factors influencing the reliability and accuracy of patients' answers, such as: the patient's health condition upon admission, the duration of the admission, the level of physical pain and the emotional state. Patients and methods: The research was conducted between April and December 2021 on patients hospitalized in two public hospitals from the north-west of Romania, both of them being independent Legal Entities: the Municipal Clinical Hospital of Oradea (MCHO) and the County Clinical Emergency Hospital of Oradea (CCEHO). Results: The lowest score of PSS recorded in these two analyzed public hospitals from the north-western of Romania was appointed for the Pharmaceutical availability of patients medical treatment (2.24), attitude of the staff (2.56) and the quality of nursing care offered (2.58). Conclusions: The hospital management’s focus has been set to improve the communication skills among medical staff, to evidence their compassion, politeness, and to ensure the availability of essential drugs.

The proliferation of the Internet of Things (IoT) has revolutionized traditional services, giving rise to emerging smart infrastructures by connecting the physical and digital worlds. Sensory data is essential in IoT-based systems for providing context-aware and location-based services. Hence, the accurate localization of IoT devices is paramount. Anchor misplacement can significantly affect location information and coverage services in IoT. We study the effect of anchor misplacement in typical IoT settings where sensors are randomly deployed, can be mobile and may belong to multiple providers. We identify sensing coverage holes formed by anchor misplacement and analyze their presence and impact. To mitigate the impact of anchor misplacement on network reliability, we propose a framework to identify the affected sensor nodes and then identify and remove misplaced anchor nodes. The validity of our approach is verified, and its effectiveness is demonstrated by several experiments with different network topologies and parameters. Our results are promising and can be utilized in multiple coverage applications, such as smart agriculture systems and habitat monitoring, regardless of the sensors or deployment types. It also sheds light on best practices and methods for a reliable design of IoT-based systems.

In this study, tree selection/plantation DSS (Decision Support Systems) were reviewed and assessed based on essential objectives in the available literature. We reviewed existing DSS using multiple data sources and available online resources such as web interfaces. We compared the existing DSS, focusing primarily on five primary objectives in this study, which DSS may address when it comes to the tree selection, including a) Climate resilience, b) Infrastructure/Space Optimization, c) Agroforestry, d) Ecosystem services, e) Urban sustainability. Climate resilience of tree species and urban sustainability is addressed relatively less in existing systems, which can be holistically internalized in future DSS tools Based on this review, DNN (Deep Neural Networks) is recommended to address achieving trade-offs between complex objectives such as maximizing ecosystem services, climate resilience of tree species, maintaining Agroforestry, and other benefits.

Paramedics are increasingly being subjected to violence, creating the potential for significant physical and psychological harm. Where a patient has a history of violent behavior, hazard flags - applied either to the individual, their residential address, or phone number - can alert paramedics to the possibility of violence, potentially reducing the risk of injury. Leveraging a novel violence reporting process embedded in the electronic patient care record, we reviewed violence reports filed over a thirteen-month period since its inception in February 2021to assess the effectiveness of hazard flagging as a potential risk mitigation strategy. Upon reviewing a report, paramedic-supervisors can generate a hazard flag if recurrent violent behavior from the patient is anticipated. In all, 502 violence reports were filed, for which paramedic-supervisors generated hazard flags in 20% of cases (n=99). In general, cases were not flagged either because the incident occurred at a location not amenable to flagging, or because the supervisors felt that a hazard flag was not warranted based on the details in the report. Hazard flagging was associated with an increased risk of violence during subsequent paramedic attendance (Odds Ratio [OR] 6.21, p

The inherited ‘EIA’ process at Brexit is based on a ‘Project’ period from Inception tothe start of construction works. The ‘Incompleteness’ of the process covers andidentifies stages that will impact on the environmental cycle: construction period,operational life, de-commissioning and a return to acceptable environmental footprint.A master environment structure-plan framework is required to commence with theupgrading of the complete ‘EIA’ process, embracing separate limbs for the UK’spriority environmental targets for climate change, and other major adverse effectswhich result in serious ‘harm’ to the UK environment. The identification of the processfor ‘incompleteness’ requires effective sustainability, and inclusion of effectivemanagement tools, for the essential ‘monitoring/control/recording’ proceduresthroughout the project life and the natural environmental cycle. This will allow theopportunity for a new approach to a structured ‘Suite of EIAR Directives’, to enable a‘EIAR’ regime that ‘will remain fit and proper for UK purpose’.

The wetlands in northeastern Bangladesh are home to some of the most prolific and valuable ecosystems on the planet, offering a wide range of benefits to both the local and wider communities. A limited number of research on this topic have been carried out in various wetlands in coastal hilsa, but none have been located in the northeastern region of Bangladesh. Thus, the goal of this study was to better understand the most commercially relevant species (anadromous hilsa) in northeastern Bangladesh as well as to assess the wetland ecosystem services more thoroughly with the contribution of their fish genetic resources. In addition to laboratory studies, fieldwork was done in the fishing settlements along the Surma River, Hakaluki Haor, and Tanguar Haor. The study classified 77 fish species into 21 subcategories of ecosystem services, of which 56% were not threatened, 17% were vulnerable, and 10% were highly endangered. The species Hilsa was found to be the most economically significant, accounting for 1% of the GDP overall. The study determined if the hilsa stock of the examined wetlands maintains a single or several subpopulations in comparison to other parts of the country when they migrate from saline water to northeastern Bangladesh (freshwater). But when compared to other groups, the FST score was between 0.000 to 0.017, indicating that the populations are identical and that there is genetic material sharing between them. Additionally, these statistics imply that the Sylhet haor and adjacent river systems contain a single stock of Hilsa fish. Nevertheless, a number of stresses and risks, including overexploitation, illicit and destructive fishing, siltation, and natural disasters like flash floods, have been linked to changes in the supply of hilsa and other ecosystem services. This study also emphasizes the necessity of policy attention and research to address the concerns.

Based on multi-source remote sensing data, scenario analysis, and model simulation, the Pareto optimal solutions for water supply, water purification (N retention), and carbon storage and sequestration services under different scenarios were sought by adjusting its land use structure. The results showed that. In Scenario 1(S1), the water supply service needs to increase by 86.820 to 11.211 billion cubic metres, the water purification (N retention) service needs to decrease by 11,400 to 11,700 tons, and the carbon storage and sequestration service need to decrease by 2.070 to 2.487 billion tons. In Scenario 2(S2), the water supply service needs to increase by 8.243–10.666 billion cubic metres, the water purification (N retention) service needs to decrease by 11,300–1.10 million tons, and the carbon storage and sequestration service needs to decrease by 2.033 to 2.466 billion tons. In Scenario 3 (S3), the water supply service needs to increase by 7.832–11.437 billion cubic metres, the water purification (N retention) service needs to decrease by 1.16–10,800 tons, and the carbon storage and sequestration service needs to decrease by 19.220 to 2.380 billion tons. After land use optimisation and adjustment, the S3 ecological land structure is complete and consistent with the vision of ecological protection and urban development in the study area, which is the optimal scenario. After optimising the S3 ecosystem service supply pattern, the water supply, water purification (N retention), and carbon storage and sequestration services could connect the western and eastern ecosystem service supply areas, balance the overall ecosystem service supply pattern of the study area and meet the demand for ecosystem services. The results can guide regional land planning and ecosystem service management optimisation.

Background The workload of nurses in the intensive care unit (ICU) can affect the quality of nursing services. Aim This study aimed to determine the relationship between the nursing activity score and missed care in patients hospitalized in the ICU in Zanjan, Iran. Methods This observational and prospective study was conducted from April 3 to September 18 in 2021. In this study, the tools used included a patient and nurses' profile questionnaire, Nursing Activity Score (NAS). Missed care was observed in the 301 patients for whom the NAS was calculated. Analysis of variance (ANOVA) was used to investigate the differences in mean levels of missed care. Logistic regression models were used to assess the association between factors and missed nursing care. Results Results show that the Medical ICU's mean NAS was 76.31 (95% CI: -13.06 -14.89). In 9 dimensions of care, the extent of missed care was 40.7%. In the care dimensions of assessment, hand hygiene, and infection control, the mean NAS had a statistically significant increase at higher levels of missed care (P<.5). Furthermore, work experience was identified as a protective factor for missed care (OR =.59, 95% CI: .37–.94, χ2= =4.97, p =.026). Conclusion The study revealed a high incidence of missed care. The study revealed that the mean workload was high in certain dimensions of care such as assessment, hand hygiene, and infection control. The increase in workload for nurses results in lost care. Nonetheless, the utilization of experienced nurses can help mitigate this problem. However, utilizing experienced nurses can help reduce this problem.

Background and objectives: Effective management for chronic diseases, hereditary and rare diseases and Thalassaemia in particular constitutes an important indicator for the quality of healthcare systems. We aimed at assessing healthcare services in different countries by using publicly available health indicators and by surveying Thalassaemia patients and their caregivers. Materials and Methods: We reviewed official worldwide databases from the WHO, World Bank, and scientific resources and also used a structured patient tailored self-completed questionnaire to survey Thalassaemia patients and their caregivers in 2023. Results: A total of 2,082 participants were surveyed (mean age 27 years, males 42%). About 1 in 4 respondents had less than high school education, while 24% had a bachelor degree. About a third of respondents were married and had either full- or part-time employment. The vast majority (~80%) had initiated transfusion therapy between 1 – 4 years of age. Only 42% reported no delays in receiving blood transfusion, while 47% reported occasional delays and 8% serious delays. About half of patients reported being very satisfied (11%) or satisfied (38%) with the quality of provided services, while 1 in 3 patients reported being unsatisfied or very unsatisfied, and their access to treatment was difficult or very difficult due to traveling expenses and high cost of treatment. Conclusion: Important improvements in the care of Thalassaemia patients have been documented during the past decades. Nevertheless, our recent survey reveals many unmet needs where additional focus is required through national healthcare systems in order to address them effectively and achieve satisfactory patient outcomes.

Access to maternal healthcare services is a challenge in most low and middle-income countries. South Africa is one of the countries striving to improve the accessibility of maternal healthcare services. Although South Africa has put some interventions to improve the accessibility of maternal healthcare services, vulnerable women including women with disabilities are still facing numerous challenges when trying to access maternal healthcare services. The aim of the study was to explore the experiences of women with disabilities in the province of KwaZulu-Natal in South Africa in accessing public maternal healthcare services. Twelve women with disabilities (four with physical impairments, four with hearing impairments and four with visual impairments) were interviewed for this study. Data were transcribed verbatim and analysed utilising the Framework of Assessing Access to Maternal Healthcare Services by Peters et al. 2008. The study found that narrow passages and information in inaccessible formats were a challenge for women with visual impairments. The women with hearing impairments had challenges in communication as most facilities did not have sign language interpreters, negative attitudes of health care workers and being ignored when they asked for help. The women with physical impairments encountered inaccessible buildings, narrow passages, small consultation rooms and equipment which is not adjustable such as beds and scales.

The concept of ecosystem services (ESs) provides a valuable approach to communicate societies' dependence on natural ecosystems, assisting in the evaluation of measures to protect vegetation in watersheds that promote water-related ESs. Vegetation cover and land use are important factors related to the capacity of ecosystems to provide soil loss regulation and sediment retention services, which are highly relevant for sediment management in watersheds draining into reservoirs with multiple water uses. This study aims to assess the relationship between potential changes in land use and land cover and the sediment retention service provided by riparian vegetation in a watershed draining into a hydroelectric reservoir in the Brazilian Cerrado. Sediment load was selected as a physical variable that affects different water uses in reservoirs, with these uses being dependent on the quality or quantity of stored water. Scenarios were analyzed to represent landscape reconfigurations from a baseline condition in order to account for the recovery of riparian vegetation by the agricultural sector, as foreseen in the Brazilian Forest Code. To map and quantify variations in annual sediment retention, the InVEST model was used, which allows estimating an integrated response of the drainage basin to large-scale land use changes over time and space. The results show that for the drainage basin of the Corumbá IV Hydroelectric Power Plant (HPP), the recovery of riparian areas occupied by annual crops has the potential to generate greater benefits to water use in the reservoir. In the studied catchment area, 14% of the total vegetation deficit in riparian areas is occupied by crops, while 86% is occupied by pastures. This highlights the buffering role of riparian vegetation as an effective practice for managing sediment flows originating from sheet erosion in agricultural landscapes. The methodology employed in this study allows for the quantification and mapping of the effects of soil and water conservation measures in river basins. This enables the prioritization of sectoral efforts for the restoration of native vegetation, considering the highest returns in benefits perceived by water users affected by sediment input in reservoirs. The study's results reinforce the importance of conserving vegetation in riparian areas and their surroundings for sediment retention, highlighting the role of these areas as assets in providing water-related ecosystem services.

Motivation: The visualization of biological data is a fundamental technique that enables researchers to understand and explain biology. Some of these visualizations have become iconic, for instance: tree views for taxonomy, cartoon rendering of 3D protein structures, or tracks to represent features in a gene or protein, for instance in a genome browser. Nightingale provides visualizations in the context of proteins and protein features. Results: Nightingale is a library of re-usable data visualization web components that are currently used by UniProt and InterPro, among other projects. The components can be used to display protein sequence features, variants, interaction data, 3D structure, etc. These components are flexible, allowing users to easily view multiple data sources within the same context, as well as compose these components to create a customized view. Availability: Nightingale examples and documentation are freely available at https://ebi-webcomponents.github.io/nightingale/. It is distributed under the MIT license, and its source code can be found at https://github.com/ebi-webcomponents/nightingale.

Nature-Based Solutions (NBSs) can help to achieve multiple Water-Ecosystem-Food Nexus Do-main Objectives & Nexus Resilience Qualities, facilitating the transition to more resilient agrifood systems and providing an evidence base for a broader Nexus policy dialogue. This paper de-scribes the stepwise methodology developed in the EU-funded LENSES project to carry out a comprehensive analysis of NBSs in 6 pilot areas in 5 Mediterranean countries, and presents the results of NBSs implementation in 4 pilot areas, highlighting obstacles and opportunities. The methodology includes the development of an analytical evaluation framework and of a com-prehensive catalogue of Nexus-related NBSs, whose suitability needs to be assessed at the local level to achieve better use of protected/natural ecosystems, increase the sustainability and mul-tifunctionality of managed ecosystems and design and manage novel ecosystems. Subsequently, in a collective learning process which supported the operationalisation of the WEF Nexus, NBSs were identified that address specific contextual vulnerabilities, improve water distribution and enhance food security, while preserving ecosystems and supporting adaptation to climate change. The added value of the proposed methodology lies in the multi-stakeholder participatory approach to gain in-depth knowledge of local agri-food systems, including their main WEF-related challenges, and to facilitate overcoming barriers to NBS implementation.

The impact of COVID-19 pandemic on the cardiovascular healthcare services in Croatia has not been systematically examined. In this study, we compared utilization and provision of cardiovascular services in Croatia during the pre-pandemic period (2017 to end of 2019) and pandemic period (2020 to end of 2021) by using large nationwide data from the Croatian Health Insurance Fund, an institution covering 95% of all insurance claims in Croatia. We report that the use of advanced heart failure treatment modalities increased while the number of coronary angiographies decreased while the number of performed percutaneous coronary interventions remained similar, even increasing in the setting of acute myocardial infarction, comparing pandemic to pre-pandemic period. Similarly, the number of transcatheter aortic valve implantations increased significantly during the pandemic era. There was a significant increase in laboratory diagnostic testing with troponin and natriuretic peptide assays during the pandemic period while the use of most cardiovascular services remained stable or only slightly decreased, compared to pre-pandemic period. These data suggest that Croatian cardiovascular healthcare services during COVID-19 pandemic showed resilience and managed to maintain or even increase the number of various diagnostic and interventional procedures despite the widespread societal and logistical challenges encountered during pandemic.

Modern electrical power systems integrate ancillary services to provide security and quality of service in real-time operation because of the intense variations in frequency caused by the massive development and uncertainty of solar-wind generation. Therefore, this ancillary services market focuses on power reserves for secondary and tertiary frequency control. Adjusting reserves and dispatching plants is a manual instruction executed by the system operator to maintain the frequency in the normal operating state (49.80≤f≤50.20 Hz). However, in the absence of an economic model for real-time power reserve reallocation in the ancillary services market, the reserve adjustments made by the system operator are not always optimal since they generate a displacement between the scheduled and actual marginal costs. Then, this work proposes a methodology for operating the ancillary services market in real-time through a dynamic and hourly mathematical model that integrates the variability of solar-wind generation, the demand monitoring curve, and the trajectory of the marginal cost. This model minimizes power reserve costs, which are governed by hourly price auctions, for candidate plants classified as supra/infra-marginal and can optimally reallocate power reserves for secondary and tertiary frequency control.

The paper aims to develop and test an algorithm for classifying Russian-language text reviews of patients’ experiences with medical facilities and physicians, extracted from social media. This is motivated by the limitations of conventional methods of surveying consumers to assess their satisfaction with the quality of services, which are being replaced by automatic processing of text data from social media. This approach enables to get more objective results due to the increased representativeness and independence of the sample of service consumers. The authors have tested machine learning methods using various neural network architectures. A hybrid method was developed to classify text reviews of medical facilities posted by patients on the two most popular physician review websites in Russia. Overall, more than 60,000 reviews were analysed. The main results are as follows: 1) the classification algorithm developed by the authors has a high efficiency, the best result being achieved by the GRU-based architecture (val_accuracy = 0.9271); 2) applying the named entity search method to text messages following their partitioning improved the classification efficiency for each of the classifiers based on artificial neural networks. To further enhance the classification quality, reviews need to be semantically partitioned by target and sentiment and the resulting fragments need to be analysed separately.

This paper explores the application of fisheries management theories to broader environmental issues, including climate change and biodiversity conservation. It underscores the inherent trade-off in fisheries between yield and resource conservation, identifying harvesting as a significant environmental burden. Early recognition of the sustainability concept aimed to address challenges like economic discounts and the tragedy of the commons, contributing to the issue of overfishing. These insights extend beyond fisries to other environmental concerns, particularly climate change. The development of adaptive management, initially tailored to address uncertainties and non-stationarity in fisheries, has found application in diverse environmental issues. Recognizing humans as integral parts of ecosystems highlights the impossibility of achieving zero environmental impact when utilizing natural resources. The paper advocates for passive restoration to prevent overfishing, leveraging nature's resilience. While goals like complete biodiversity restoration are inherent in fisheries, their relevance may not be immediately apparent to other environmentalists. Despite ongoing discussions on the sustainability of ecosystem services, legislation often tends to favor the long-term maximization of fisheries yield. The paper calls for mutual understanding of theories and experiences across various environmental fields, including fisheries, to enhance collaborative efforts in each field.

The integration of the increasing share of Renewable Energy Sources (RES) requires the availability of suitable energy storage systems to improve the grid flexibility, and Compressed Air Energy Storage (CAES) systems could be a promising option. In this study, a CO2-free Diabatic CAES system is proposed and analysed. The plant configuration is derived from a down-scaled version of the McIntosh diabatic CAES plant, where the natural gas is replaced with green hydrogen, produced on site by a Proton Exchange Membrane electrolyser powered by a Photovoltaic power plant. In this study, the components of the hydrogen production system are sized to maximize the Self-Consumption share of PV energy generation and the effect of the design parameters on the H2-CAES plant performance are analysed on a yearly basis. Moreover, a comparison between the use of natural gas and hydrogen in terms of energy consumption and CO2 emissions is discussed. The results show that the proposed hydrogen fuelled CAES can effectively match the generation profile and the yearly production of the natural gas fuelled plant by using all the PV energy production, while producing zero CO2 emissions.

Wildfires are a rising environmental threat which health impact remains poorly documented, in particular beyond the fire period. This ecological study investigates changes in health conditions before, during, and after two consecutive wildfires that occurred in France´s Gironde district in the summer 2022. Electronic records from the district´s emergency medical communication centre were used to identify calls with respiratory and cardiovascular diseases, and two specific subgroups of those, asthma (all ages and 0-5 years) and cardiac arrest, respectively. Compared to before the fires, respiratory disease cases were fewer during each fire (OR = 0.85, 95% CI: 0.79, 0.90 and OR = 0.62, 95% CI: 0.58, 0.67, respectively), cardiovascular disease cases, more common during the second fire, and asthma cases, higher following the fires (ORall ages= 1.85, 95% CI: 1.56, 2.21 and ORchildren= 3.52, 95% CI: 2.62, 4.80). Asthma cases also rose during the same calendar time in 2021, but to a lesser extent. In sum, except for asthma, emergency calls data in Gironde reveal few significant potentially smoke-related symptoms around fire periods, apart from post-fire asthma. Whether the effects are smoke- or season-related remains to be determined, preferably using additional data sources.

Urban Green Space (UGS) has important impacts on human health, but an integrated participatory approach to UGS design for improved residents’ health was lacking to date. The aim of our study was to develop and evaluate such a novel approach to address this gap. The approach was developed following guiding principles from the literature, and tested with groups of children and elderly as participants in two neighborhoods of Maastricht (The Netherlands) with a low score on economic and health indicators. Novel aspects of the approach are the inclusion of both positive and negative health effects, the combination of participant self-assessment and model-based assessment of the health effects of UGS designs, and the use of maps to visualize UGS designs and health effects. The participant-generated UGS designs resulted in a considerable self-assessed increase in use of the UGS for meeting, stress reduction or leisure-based physical activity, as compared to the current situation. The model-assessed positive and negative health effects of the participant-generated UGS designs were limited. The major strength of the developed approach is that it combines active participation of residents in UGS (re)design with assessment of the health effects of these UGS designs. Whereas in other participatory approaches to UGS design it often remains unclear whether the resulting designs represent an improvement in terms of health, our combination of computer model-based assessment and a participatory process produced clear outcomes regarding the health benefits and use of UGS designs.

The maternal death rate remains high in South Africa despite the availability of many existing strategies to improve the quality of service. A 30% increase in maternal mortality rate was reported between 2020-2021, with Limpopo ranking fourth highest out of nine provinces. Vhembe district remained number three with a high maternal death rate. This study explored strategies to reduce the maternal death rate and improve the provision of quality maternal healthcare services in selected hospitals of Vhembe district, Limpopo province. One hospital was purposively sampled from every four municipalities. A qualitative approach using phenomenological design was employed. Twenty-eight participants were sampled using a convenience sampling method. The semi-structured interview guide was used to collect data. An audio recorder was also used until data saturation. Data saturation was reached at the 20th participant, but the researcher continued until 28 sampled participants were interviewed. Interpretative phenomenological analysis was used following the analytical stages of interpretative data analysis. The study proposal was ethically cleared by the University of Venda Ethics Committee (FHS/22/PH/08/3108). Results indicate that despite implementing strategies to improve maternal healthcare services and reduce the maternal death rate, several factors, such as lack of material resources, shortage of staff, incompetent staff, and poor infection control, affect the quality of maternal health service in Vhembe district. Limpopo Department of Health and hospital management should ensure that hospitals have all necessary resources and support healthcare professionals through in-service training to ensure the functionality of existing strategies.

Violence against paramedics is widely recognized as a serious, but underreported, problem. While injurious physical attacks on paramedics are generally reported, non-physical violence is less likely to be documented. Verbal abuse can be very distressing, particularly if the harassment targets personal or cultural identities, such as race, ethnicity, gender, or sexual orientation. Leveraging a novel, point-of-event reporting process, our objective was to estimate the prevalence of harassment on identity grounds against paramedics in a single paramedic service in Ontario, Canada, and assess its potentially differential impact on emotional distress. In an analysis of 502 reports filed between February 1, 2021, through February 28, 2022, two paramedic-supervisors independently coded the free-text narrative descriptions of violent encounters for themes suggestive of sexism, racism, and homophobia. We achieved high interrater agreement across the dimensions (k=0.73-0.83), and after resolving discrepant cases, we found that 1 in 4 violent reports documented abuse on at least one of the identity grounds. In these cases, paramedics were 60% more likely to indicate being emotionally distressed than for other forms of violence. Our findings offer unique insight into the type of vitriol paramedics experience in the course of their work and its potential for psychological harm.

Background: In a Beveridgean decentralized healthcare system, like the Italian one, where regions are responsible for their own health planning and financing, the analysis of patients’ migration appears very interesting as it has economic and social implications. The study aims to analyze both patients’ migration for hospital rehabilitation and if the beds endowment is a driver for these flows; Methods: from 2011 to 2019, admissions data were collected from the Hospital Dis-charge Cards database of the Italian Ministry of Health, population data from Italian National Institute of Statistics and data of beds endowment from the Italian Ministry of Health website. To evaluate patients’ migration, we used Gandy’s Nomogram, while to assess if beds endowments are mobility drivers, we have created two matrices, one with attraction indexes (AI) and one with escape indexes (EI). The beds endowment, for each Italian region, were correlated with AI and EI. Spearman’s test was carried out through STATA software; Results: Gandy’s Nomogram showed that only some northern regions had good hospital planning for rehabilitation. A statistically significant correlation between beds endowment and AI was found for four regions, while with EI for eight regions. Conclusions: Only some northern regions appear able to satisfy the care needs of their residents, with an attraction minus escapes positive epidemiological balance. The beds endowment seems to be a driver of Patients’ migration, mainly for escapes. Certainly, the search for mobility drivers needs further investigation given the events in Molise and Basilicata.

The owners of forests with water protection functions in Bulgaria do not receive compensation for their limited right to use wood and non-wood forest products from the forest areas they own. At the same time, the contribution derived from forests with water protection functions is received by water users and water consumers, whereas the costs of managing the forests are borne by their owners. The problem thus defined is not a forestry one, but an economic one, and the purpose of this paper ensues therefrom, namely to propose and test a methodology for valuating the produc-tion function of forest areas with water protection function in Bulgaria, allowing a fair distribu-tion of income between the forest owner and the user of forest ecosystem services. The methodol-ogy is based on the form of forest management and the analytical expression of the economic rela-tionship between a forest owner and a user of forest ecosystem services, constructed using Schen-rock’s formula. It has been tested with actual data on forest areas with water protection functions falling within the administrative and territorial scope of Velingrad municipality and based on the obtained results proposals have been made for the distribution of the contributions generated by forest ecosystems between the forest owner and the user of the forest ecosystem services.

Ensuring access to water, sanitation, and hygiene (WASH) facilities, coupled with behavior change education in schools, is fundamental for fostering a conducive learning environment and promoting principles of inclusion, dignity, and equality. This study focuses on 12 primary schools in Anápolis, Brazil, encompassing 4,394 students and 248 teachers. WASH assessments were conducted through a questionnaire, observation of water and sanitation facilities and structures, and microbiological analysis. Over the period 2018 to 2020, the proportion of schools with safely managed drinking water surged from 42% to 92%. However, sanitation conditions in the schools were categorized as a basic level, with hygiene services rated as limited in 92% of the schools due to the absence of soap. While this study reveals that Anápolis schools generally align with WASH guidelines for basic/advanced drinking water services, there is a crucial need for enhancements in both hardware and software facilities to address sanitation and hygiene challenges.

The rapid development of the regional economy in China has led to the rise of local ecological risks. It is very important to provide enjoyable ecosystem services to residents while reducing ecological risks. In order to understand spatial relationships between ecosystem services and ecological risks, we took Chongqing as an example in this study to assess the spatial relationship between ecosystem services and ecological risks at the county scale based on the ES-DPSIR system. The main findings include: (1) significant variation in the spatial distribution of the comprehensive ecosystem service index, where the lowest ecosystem service index (0.013) was found in the main urban area of Chongqing and the scores gradually increased outward from this center, reaching 0.689 in the outermost areas, (2) the increase of the comprehensive ecological risk index from east to west, ranging from -0.134 to 0.333, (3) the spatial relationship between ecosystem services and ecological risks was prominent, with 52.63% of the districts and counties being imbalanced or mild imbalanced, and (4) the significant differences between development trends of ecosystem services-ecological risks, including 60.53% being imbalanced districts and 30.47% mildly balanced. Overall, it was necessary to improve the relationship between ecosystem services and ecological risks in Chongqing by reducing ecological risks., and these research results could provide effective approaches and technical support for improving regional ecological security and enhancing ecosystem service capabilities.

During the pandemic, educational digitization experienced a significant increase. In Mexico, social service is a crucial component of technical and professional training, a phase during which individuals apply the knowledge gained throughout their university education. The aim of this study is to standardize a digital model for the management of social service in the health care sector within health care units. This study employed an analytical, observational, retrospective, and longitudinal approach, involving two groups of trainees: Group A (n=133), utilizing a Non-Digital Model, and Group B (n=50), employing a Digital Model. In Stage I. the model design underwent validation through the Delphi method with a panel of three experts. The model was implemented on a Classroom® digital platform with the integration of the elements 1) a monthly rotation rubric 2) care services rubric 3) clinical cases or nursing process rubric, and 4) innovation project rubric. The validation of the model achieved 100% agreement (K=1). The variables measured for each group included the school of origin, career, unit of assignment, timely enrolment, and timely delivery of rubrics on the platform. The difference between the two groups was measured using Chi-Square. To measure the impact, the difference in the timeliness of the products was considered. From the University of Quintana Roo, the difference was 20.3 vs 34%. According to the Unit of Attachment the most frequent was HGR No. 17 with Group A at 22.5 vs 52%. According to the product the least delivered was Product 4, with 69% vs 81%. Timely enrollment was observed in Group A at 89% vs Group B at 80% p=0.001. Overall timely delivery in Group A was 81% vs Group B at 91% p=0.001 in the first 6 months post-implementation. Demonstrating that the implementation of the digital platform was effective, representing a significant advance in the adaptation of medical education to the circumstances imposed by the pandemic, highlighting the feasibility and effectiveness of digital teaching methods in the training of health professionals.

The purpose of this study is to bring out a scientometric analysis of the advances of digital transformation in the global banking sector. For this, a background search of the term "Digital Transformation Banking " has been brought out from the Web of Science (Wos) Database, covering records published between 2002 and 2023. A set of 312 publications was identified, which mainly includes a set of 264 academic articles, 29 articles published without cataloging a specific volume of a journal, 9 articles under review, 5 editorial material documents, 4 conference articles, and 1 document is a book chapter. Nowadays the scientific production is low but showing growing development presenting 123 publications and 7,754 citations for the year 2022. Among the scientific production, 43 publications from the Republic of China (8.8%) and 35 publications from Ukraine (7.8%) stand out. ,2%). It is also worth mentioning that the most relevant authors on this topic are Ricardo Palomo, professor and dean of San Pablo University, and Robert J Kauffman, professor at Singapore Management University in terms of influence. Main institutions in terms of scientific production, mainly: the Massachusetts Institute of Technology (MIT) of the United States and the Russian Academy of Sciences of Russia.

Background: Misconceptions and knowledge gaps about antibiotic use contribute to inappropriate antibiotic use and antimicrobial resistance. Aim: Identifying and prioritizing misconceptions and knowledge gaps about antibiotic use from a healthcare professionals’ perspective. Methods: A modified Delphi study of two rounds with an expert meeting. A literature search was conducted to create statements about misconceptions and knowledge gaps about antibiotic use. These were rated by healthcare professionals from five EU countries representing general practice, out-of-hour services, nursing homes, and pharmacies. Consensus was achieved if ≥80% of the participants rated 4+ on a five-point Likert scale during the second Delphi round. Results. In total, 44 misconceptions were identified through the literature search within four themes: 1) antimicrobial resistance in general, 2) use of antibiotics in general, 3) use of antibiotics for respiratory tract infections, and 4) use of antibiotics for urinary tract infections. Consensus was reached for more than half of the statements within each setting. Conclusions. Experts from different settings and nationalities acknowledge that multiple misconceptions and knowledge gaps can contribute to inappropriate use of antibiotics in the community. These results provide valuable information to use in educational campaigns for patients and healthcare professionals to improve the use of antibiotics.