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.

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: 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

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.

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 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.

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.

Grasslands are at risk of degradation due to unsustainable management practices and climate change. Sustainable grassland soil management can promote ecosystem service delivery and improve the resilience of the entire grassland ecosystem to anthropogenic change. Here, we re-view the principal soil quality indicators (SQIs) and how they have been used to evaluate the sustainability of different grassland management practices globally. We then discuss sustainable grazing management practices, before reviewing some novel grassland species which may im-prove grassland resilience with relevance for grassland management in Europe and the UK. We also give an overview of current sustainable grassland management methods and their assessment at field scale. From this, we suggest that sustainable Grazing Management Plans (GMPs), together with the testing of drought-resistant grass species and appropriate SQIs monitoring, is key to increasing resilience of grassland ecosystems to anthropogenic change.

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.

Whether it’s cellphones, personal computers, or gaming consoles, technology is a part of everyone’s everyday lives, and storage is frequently a problem. One of the solutions we have for this difficulty is the on-demand accessibility of computer framework assets, which enables cloud storage and makes it accessible in any format and from any device. It is a major benefit of cloud computing. Amazon Web Administrations (or basically AWS) may be a secure cloud services stage advertising about everything businesses ought to construct advanced applications with adaptability, versatility, and unwavering quality. Another advantage is that it is significantly less expensive than purchasing items with comparable functionality, such as an SSD storage device. For many enterprises, it is also preferable to host their servers in the cloud using services like Google Cloud and Oracle Cloud. Our main topic of the paper is to compare three different major cloud computing services—AWS, Google, and Azure. Since there are different types of cloud computing services available, we would compare them to determine which is best for usage by individuals or organizations. We can also look at the services’ shared features and unique aspects that they provide to consumers.

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.

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.

Introduction: Like other public safety professions, paramedicine has historically been a male-dominated occupation, both in the demography of its workforce and in its organizational culture. Although women are increasingly choosing paramedicine as a career, participation in leadership roles remains limited. Drawing on data from a recent comprehensive mental health survey, we describe the proportion of women in leadership in a single, large, urban paramedic service in Ontario, Canada. Methods: We distributed an in-person, paper-based survey during the fall 2019 - winter 2020 Continuing Medical Education (CME) sessions. Participating paramedics completed a demographic questionnaire alongside a battery of mental health screening tools. We assessed the demography of the workforce and explored differences in employment classification, provider level (e.g., primary vs. advanced care), and participation in formal leadership roles along self-reported gender lines. Results: Out of 607 paramedics attending CME, we received 600 completed surveys, with 11 excluded for missing data, leaving 589 for analysis and a 97% response rate. Women comprised 40% of the active-duty paramedic workforce, with an average of 8 years of experience. Compared to men, women were more than twice as likely to have a university degree (Odds Ratio [OR] 2.02), but almost half as likely to practice at the Advanced Care Paramedic level (OR 0.61), and somewhat less likely to be employed full-time (OR 0.77). Women were nearly 70% less likely to hold a leadership role in the service compared to men (OR 0.36), occupying just 20% of leadership positions. Conclusion: Although paramedicine is witnessing an encouraging shift in the demography of its workforce with greater participation from women, there is still work to be done, particularly in leadership. Future research should focus on identifying and ameliorating barriers to career advancement among women and other historically underrepresented people.

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.

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.

Introduction: As the paramedic profession continues to grow and evolve, a shift from reactive to holistic patient care models is required. As the first and often the only point of medical contact for many patients from marginalized and under-served populations, the paramedic role, and its potential future implications in caring for these patients needs to be explored. Aim: The objective of this scoping review was to explore the paramedic's role in caring for people who use illicit drugs. Methods: A scoping review of English language literature published since 2002 was conducted using CINAHL, MEDLINE, EMBASE, and Google Scholar. We used a previously published paramedic search term filter for sensitivity combined with search terms related to drug-related substance use and addiction. Studies were selected based on relevance to the research question. Results: A total of 104 peer-reviewed and 14 grey literature articles were selected for inclusion. The main finding of this scoping review is the notable lack of evidence base surrounding the contemporary paramedic role in the care provision of people who use drugs (PWUD). The results highlight high rates of mortality following a paramedic-attended drug poisoning event, presenting a unique opportunity for paramedics to intervene in meaningful ways that extend past traditional drug poisoning response. Conclusions: The interface between the community of PWUD and the paramedic may be a highly influential encounter during a patient's journey through the healthcare system. The evolving role of the paramedic in this encounter requires focused study and should be viewed as a research priority in response to the ongoing drug poisoning crisis.

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.

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.

Residents’ perceptions on ecosystem services (ESs) provided by urban green spaces (UGSs) are vital for developing sustainable cities. However, there has been limited research on this issue in Malaysia. The aim of this paper is to assess Malaysians’ perceptions on ESs provided UGSs and how their perceptions are influenced by different socio-demographic factors. We used a structured online questionnaire and obtained 645 responses on 16 ESs from regulatory, cultural, and supporting ES categories. Descriptive statistics and binary logistic regressions were used for data analysis. In general, city dwellers have high positive perceptions on ESs provided by UGSs. Their perceptions for global climate regulation, noise buffering, pest regulation, spiritual, and research and education services would likely to significantly increase as they grow older. Households with moderate income have significantly greater perceptions of microclimate regulation, air filtration and aesthetic services. Having non-tertiary level education would significantly lower their perceptions of global climate and microclimate regulation, spiritual, aesthetics, and recreational services. Tertiary educated residents with non-environmental degrees also showed similar associations. Infrequent visits to UGSs would likely to significantly reduce the perception of global climate regulation, noise buffering, runoff reduction, erosion control, spiritual, and aesthetics services. People living far (>5km) from the UGSs also have significantly lower perceptions of microclimate regulation, air filtration services. Suggestions are made to incorporate ESs related content in pre-university curriculum and establishing small parks in neighborhoods to improve knowledge and uses of UGSs. These findings would assist urban planners designing environmentally sound urban policies and thereby improving human wellbeing in the cities.

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.

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.

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

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.

Seniors safety is a compelling need, which necessitates 24/7 real-time monitoring and timely dangerous action recognition. Being able to mirror characteristics of physical objects (PO) to corresponding logical objects (LO) and seamlessly monitor their footprints thus detect anomaly parameters, Digital Twins (DT) has been considered a practical way to provide virtual health services for seniors safety. Meanwhile, widely adopted Internet of Medical Things (IoMT) consisting of wearable sensors and non-contact optical cameras for self and remote health data monitoring also raises concerns on information security and privacy violation. Therefore, security of POs, LOs and reliable data sharing among healthcare professionals are challenging as constructing trust and privacy-preserving virtual health services. Thanks to characteristics of decentralization, traceability and unalterability, Blockchain is promising to enhance security and privacy properties in many areas like data analysis, finance and healthcare. This paper envisions a lightweight authentication framework (LAF) to enable secure and privacy-preserving virtual healthcare services. Leveraging Non-Fungible Token (NFT) technology to tokenize LOs and data streams on blockchain, anyone can certify the authenticity of a digital LO along with its synchronized data between PO without relying on a third-party agency. In addition, the NFT-based tokenization not only allows owners fully control their IoMT devices and data, but it also enables verifiable ownership and traceable transferability during data sharing process. Moreover, NFT only contains references to encrypted raw data that are saved on off-chain storage like local files or distributed databases, such a hybrid storage strategy ensures privacy-preservation for sensitive information. A proof-of-concept prototype is implemented and tests are conducted on a case study of seniors safety. The experimental evaluation shows the feasibility and effectiveness of the proposed LAF solution.

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.

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&lt;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.

Maritime transport has become very important due to its ability to internationally unite all continents. In turn, during the last two years, we have observed that the increase of consumer goods has resulted in global shipping deadlocks. In addition, the future goes through the role of ports and efficiency in maritime transport, with the aim of decarbonizing its impact on the environment. In order to improve the economy and people's lives, in this work, we propose to enhance services offered in maritime logistics. To do this, a communications system is designed on the deck of ships to transmit data through a constellation of satellites using interconnected smart devices based on IoT. Among the services, we highlight the monitoring and tracking of refrigerated containers, the transmission of geolocation data from GPS, and security through AIS. This information will be used for a fleet of ships to make better decisions and help guarantee the status of the cargo, as well as maritime safety on the routes. The system design, network dimensioning, and a communications protocol for decision-making will be presented.

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.

Background: Tele-emergency physicians (TEPs) take an increasingly important role in the need-oriented provision of emergency patient care. To improve emergency medicine in rural areas, we set up the project Land|Rettung (English: Rural|Rescue), which uses TEPs to restructure professional rescue services using information and communication technologies (ICTs) in order to reduce the therapy-free interval. Successful implementation of ICTs relies on user acceptance and knowledge sharing behavior. Methods and findings: We conducted a factorial design with active knowledge transfer and technology acceptance as a function of work satisfaction (high vs. low), workload (high vs. low) and point in time (prior to vs. after digitalization). Data were collected via machine readable questionnaires issued to 755 persons (411 pre, 344 post), of which 304 or 40.3% of these persons responded (194 pre, 115 post).Technology acceptance was higher after the implementation of TEP for nurses but not for other professional groups, and it was higher when the workload was high. Regarding active communication and knowledge sharing, employees with low work satisfaction are more likely to share their digital knowledge as compared to employees with high work satisfaction. Additional and more detailed analyses reveal that this is an effect of previous knowledge concerning digitalization. After implementing the new technology, work satisfaction increased for the more experienced employees, but not for the less experienced ones. Results are discussed considering the Dunning-Kruger effect. The Dunning-Kruger effect describes a cognitive bias. People with high expertise often underestimate their actual skill level. They have a more critical attitude towards their performance and feel the urgent need to fill possible knowledge gaps they notice. Conclusions: Our research illustrates that employees’ workload has an impact on the intention of using digital applications. The higher the workload, the more people are willing to use TEPs. Regarding active knowledge sharing, we see that employees with low work satisfaction are more likely to share their digital knowledge compared to employees with high work satisfaction. This might be attributed to the Dunning-Kruger effect. Highly knowledgeable employees initially feel uncertain about the change, which translates into temporarily lower work satisfaction. They feel the urge to fill even small knowledge gaps, which in return leads to higher work satisfaction. Those responsible need to acknowledge that digital change affects their employees’ workflow and work satisfaction. During such times, employees need time and support to gather information and knowledge in order to cope with digitally changed tasks.

Bus services play a significant role as the main public transportation, especially in urban areas throughout the years. Since bus services compete greatly with other types of public transportation, such as e-hailing service and private vehicles, they have recently attracted scholars to conduct many relevant studies. However, most past research studies in the Asian region were not focused on engineering, social science, and Internet of Things (IOT). This present study concentrated on the service quality of bus services in Asia by using systematic literature review of articles. This study conducted a review based on previous studies, specifically on the service quality of performance. Several previous studies were selected by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIMSA) approach. SCOPUS and Science Direct were chosen as the main journal database. By using this method, 41 articles were selected for further analysis. This study was merely focused on three primary themes, such as study approach, stakeholder, and service quality attributes. Advanced analysis on these primary themes was used to formulate another 18 sub-themes. All themes and sub-themes which reflected the significant impacts of service quality towards bus services were discussed in detail. This study had addressed several qualities of bus services of bus performance towards improvement of urban transportation polices. Lastly, several recommendations that could provide necessary knowledge and information for future research were presented.

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%.

Cities are undergoing huge shifts in technology and operations in recent days, and `data science' is driving the change in the current age of the Fourth Industrial Revolution (Industry 4.0 or 4IR). Extracting insights or actionable knowledge from city data and building a corresponding data-driven model is the key to making a city system automated and intelligent. Data science is typically the study and analysis of actual happenings with historical data using a variety of scientific methodology, machine learning techniques, processes, and systems. In this paper, we concentrate on and explore ``Smart City Data Science", where city data collected from various sources like sensors and Internet-connected devices, is being mined for insights and hidden correlations to enhance decision-making processes and deliver better and more intelligent services to citizens. To achieve this goal, various machine learning analytical modeling can be employed to provide deeper knowledge about city data, which makes the computing process more actionable and intelligent in various real-world services of today's cities. Finally, we identify and highlight ten open research issues for future development and research in the context of data-driven smart cities. Overall, we aim to provide an insight into smart city data science conceptualization on a broad scale, which can be used as a reference guide for the researchers, professionals, as well as policy-makers of a country, particularly, from the technological point of view.

Malaysia implemented a movement control order (MCO) to curb the spread of the SARS-CoV-2 virus in March 2020. Despite healthcare services remaining operational, rising COVID-19 infections and MCO restrictions have forced healthcare professionals to seek a compromise between service capacity and standard operating procedure compliance. A cross-sectional survey was conducted among public and private sector doctors, dentists and pharmacists to determine how lockdown measures impacted healthcare services. Responses from 413 doctors, 193 dentists, and 163 pharmacists were analysed. Pharmacy services remained mostly unaffected throughout the MCO. In contrast, operational capacities for surgical and dental services were severely affected during the MCO. All service sectors reported restricting patients or accompanying individuals at the workplace, reductions in staffing capacity, and shortened patient contact time at various degrees. Many pharmacy and medical participants reported supplying extended medication supplies to patients. Adoption of virtual healthcare services was generally poor. All private service sectors suffered financial losses ranging between 59 to 75%. Periodic assessments of the healthcare system throughout the pandemic are required to identify which patients have their treatment compromised so that healthcare managers and policy makers can plan and implement appropriate interventions that help alleviate pressure within the health system.

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.

Purpose –The basic purpose of this paper is to find out the librarians perceptions, skills, most effective and constrains to use social media for the marketing purposes in the University libraries and to examine how these libraries perceive the importance of social media marketing. Design/methodology/approach –A nation-wide online survey on University libraries in the Pakistan was conducted to flourish this study, and a total number of 161 responses were used to analyze collected data. Findings –This study revealed the application of social media in university Libraries is very high .The results also disclosed that University libraries observe social media as a substantial tool to increase marketing of library sources and services anticipate to increase their use. Practical implications –The findings of this study can help as a parameter for University libraries when engaging social media for marketing purposes in their libraries. Originality/value –This study calculated the present situation of social media use for marketing in the University Libraries environment, a background that has been under-study in the literature, from these perspectives: perceptions, Skills, effectiveness, practices and constrains

There is growing recognition in research and policy of a mental health crisis among Canada’s paramedics but despite this, epidemiological surveillance of the problem is in its infancy. Just weeks before the emergence of the COVID-19 pandemic, we surveyed paramedics from a single, large, urban paramedic service in Ontario, Canada to assess for symptom clusters consistent with Post-Traumatic Stress Disorder (PTSD), major depressive disorder, and generalized anxiety disorder and to identify potential risk factors for each. In total, we received 589 completed surveys (a 97% completion rate) and found that 11% screened positive for PTSD, 15% for depression, and 15% for anxiety, with 1 in 4 active-duty paramedics screening positive for any of the three as recently as February 2020. In adjusted analyses, the risk of a positive screen varied as a function of employment classification, gender, self-reported resilience, and previous experience as a member of the service’s peer support team. Our findings support the position that paramedics screen positive for mental disorders at high rates – a problem likely to have worsened since the onset of the COVID-19 pandemic. We echo the calls of researchers and policymakers for urgent action to support paramedic mental health in Canada.

Cultural ecosystem services has been increasingly influential in both environmental research and policy decision-making, such as for urban green spaces However, its popular definition conflates the concepts of ‘services’ and ‘benefits’ which made it challenging for planners to employ it directly for urban green space management. One the most widely used definition of this non-tangible ecosystem services are “functions of environmental spaces and cultural activities which may then result in the enjoyment of cultural ecosystem benefits”; yet the latter itself have never found its way into official laws and regulations. In this study, via a case study in Singapore, we propose new evidence to re-evaluate and re-position the two of the most important emerging concepts in managing the green spaces in urban areas. Using the transdisciplinary mixed methods of public participation GIS and social media text mining analysis, a wealth of cultural ecosystem services and their associated benefits were reported. This was especially so with regards to recreational and aesthetic services and experiential benefits. Recommendations to improve the park were also suggested, alongside sharing of methodological considerations for future research. Overall, this paper recommends the employment of the redefined cultural ecosystem services conceptual framework to generate relational, data-driven and actionable insights to better support urban green space management, which is not only useful to Singapore governments but also world-wide relevant.

We investigate the effect of geopolitical risk on the returns of the Information Technology, Communication Services, and Consumer Staples sector firms within the S&P 500 index. We use the event study methodology and perform more than 17,000 regressions to provide empirical evidence at the sector level that geopolitical risk leads to different responses across these 3 sectors. The response of the Information Technology sector is negative for all event windows under study, except the one spanning 10 days prior to the geopolitical event and 10 days after. The Communication Services sector has positive returns as a result of geopolitical events for all event windows, except the one from the geopolitical event date and 5 days after. The Consumer Staples sector shows a negative impact on geopolitical risk for all event windows except the one from the geopolitical event date and 5 days after, demonstrating a negative correlation to the Communication Services sector.

Currently, most middleware application developers have two choices when designing or implementing API services: They can either stick with REST or explore the emerging GraphQL technology. Although REST is widely considered the standard method for API development, GraphQL is believed to overcome the main drawbacks of REST, especially data fetching issues. Yet, doubts remain as there are no experimental studies with convincing results to evaluate the performance of the two services. In this paper, we propose a research methodology to evaluate the performance of REST and GraphQL API services, which includes two main contributions. The first contribution is that the performance evaluation of the two services is conducted in the real operation of a massive and intensively accessible management information system. The second contribution is the fair and independent performance evaluation results obtained for both API services. The performance evaluation was studied using basic measures of QoS, including response time, throughput, CPU load, and memory usage. The results show that REST is still faster in response time and throughput, while GraphQL is very efficient in resource utilization, i.e., CPU load and memory utilization. Therefore, GraphQL is the right choice when data requirements change frequently and resource utilization is the most important consideration. REST is used when some data is frequently accessed called by multiple requests.

Financial Payment has evolved into mobile payment for easy access and convenience. Despite the benefits of mobile payment, the adoption rate is unsatisfactory worldwide. Therefore, understanding the customer's adoption intention factors is essential for both researchers and practitioners. This study examines mobile payment intention and actual use by adapting the integrated framework, which combines the Mobile Technology Acceptance Model and the Theory of Planned Behaviour with additional new constructs found to be related. The new model consists of 12 variables moderated by the individual's experience and is examined via a structured PLS equation mixed-mode methodology. Knowing mobile payment influence will shape the industry strategic decision and socially contribute to transforming society into a cashless society. This paper provides an opportunity to prove the relationship between technology variables and human behaviour concerning mobile payment adoption. In contrast, this study novelty adopted an integrated model that combines MTAM with the TPB.

Distance learning has assumed a relevant role in the Educational scenario. The use of Virtual Learning Environments contributes to obtain a substantial amount of educational data. In this sense, the analyzed data generate knowledge used by institutions to assist managers and professors in strategic planning and teaching. The discovery of students’ behaviors enables a wide variety of intelligent services for assisting in the learning process. This article presents a literature review in order to identify the intelligent services applied in distance learning. The research covers the period from January 2010 to May 2021. The initial search found 1,316 articles, among which 51 were selected for further studies. Considering the selected articles, 33% (17/51) focus on learning systems, 35% (18/51) propose recommendation systems, 26% (13/51) approach predictive systems or models, and 6% (3/51) use assessment tools. This review allowed to observe that the principal services offered are recommendation systems and learning systems. In these services, the analysis of student profiles stands out to identify patterns of behavior, detect low performance and identify probabilities of dropouts from courses.

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.

Anonymous communications networks were born to protect the privacy of our communications, preventing censorship and traffic analysis. The most famous anonymous communication network is Tor. This anonymous communication network provides some interesting features, among them, we can mention user’s IP location or Tor Hidden Services (THS) as a mechanism to conceal the location of servers, mainly, web servers. THS is an important research field in Tor. However, there is a lack of reviews that sump up main findings and research challenges. In this article we present a systematic literature review that aims to offer a comprehensive view on the research made on Tor Hidden services presenting the state of the art and the different research challenges to be addressed. This review has been developed from a selection of 57 articles and present main findings and advances regarding Tor Hidden Services, limitations found, and future issues to be investigated.

Motorcycles can be considered a new form of smart vehicle when taking into account their small and modern structure and due to the fact that nowadays they are used in the new role of ambu-lance to rapidly reach emergency patients in large cities with traffic congestion. However, there is no study regarding the measuring of access time for motorcycle ambulances in large cities of Thailand. Therefore, this study aims to compare access times to patients between motorcycle ambulances and conventional ambulances, including analysis of the use of AED installed on motorcycle ambulances to contribute to the sustainable development of public health policies. In two hundred and seventy-one operations, it was found that the times from dispatch to vehicle (ambulance and motorlance) being en route and times from the 1669 center (center for com-mand-and-control EMS in Thailand) call receipt to arrival on scene (response time) of motorcycle ambulances was shorter than that of a conventional ambulance and the use of AED on a motor-cycle ambulance can increase the chances of survival for patients with cardiac arrest outside the hospital in public places where AEDs are not available and in all cases where access to an AED was less than eight minutes.

Adolescent’s access to quality Sexual and Reproductive Health and Rights interventions has been a major issue in most of the low- to middle-income countries (LMICs) across the globe. This systematic review aims to identify the relevant community and school-based interventions that can be implemented in -LMICs to promote adolescent’s sexual and reproductive health and rights outcomes. We identified 54 studies and our review findings suggest that Adolescent’s Sexual and Reproductive Health and Rights (ASRHR) educational interventions, provision of financial incentives, and provision of comprehensive -post-abortion family planning services are effective in increasing adolescent’s knowledge on ASRHR, attitude towards ASRHR, uptake of ASRHR services, contraception and decreased unwanted pregnancy rates among young women. However, we found inconclusive and limited evidence on the effectiveness of the interventions to improve violence prevention and adolescent behaviors towards safe sexual practices. More rigorous studies with long-term follow-ups are needed to assess the effectiveness of such interventions.

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.

Meta-analysis has increasingly been used to synthesize the ecosystem services literature, with some testing of the use of such analyses to transfer benefits. These are typically based on local primary studies. However, meta-analyses associated with ecosystem services are a potentially powerful tool for transferring benefits, especially for environmental assets for which no primary studies are available. In this study we use the Ecosystem Service Valuation Database (ESVD), which brings together 1350 value estimates from more than 320 studies around the world, to estimate meta-regression functions for provisioning, regulating &amp; maintenance and cultural ecosystem services across 12 biomes. We tested the reliability of these meta-regression functions and found that even using variables with high explanatory power, transfer errors could still be large. We show that meta-analytic transfer performs better than simple value transfer and, in addition, that local meta-analytical transfer (i.e. based on local explanatory variable values) provides more reliable estimates than global meta-analytical transfer (i.e. based on mean global explanatory variable values). Thus, we conclude that when taking into account the characteristics of the study area under analysis, including explanatory variables such as income, population density and protection status, we can determine the value of ecosystem services with greater accuracy.

The purpose of this study is to explore conceptual approaches in co-production studies and to examine current research trends of the study. The conceptual paper includes research articles related to co-production in public administration field. By thoroughly scrutinizing 32 research works of co-production, this study highlights major loopholes in the field of the study. The contributions of the study are: (1) identifying two common characteristics of co-production, (2) categorising three types of co-producing by end-users, and (3) finding that goals and success of co-production are more beneficial for service providers though its initial approach is citizen-centric approach. We suggest that future studies should be (1) to focus on reasons for co-production failures or success, (2) to discover further hindrances for co-production in service production, (3) to examine influencing factors on service providers as well as institutional impacts on co-production process, and (4) to include practical assessment in co-production study.

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.

Client or patient satisfaction is a very important indicator in determining service quality, patient satisfaction with various factors, but the main determining factor for patient satisfaction is the nurse, because nurses are medical personnel who are always near the patient and almost approaching the treatment that the client receives always involves the nurse. In it, therefore, nursing services, namely in the form of nursing care, are important to penetrate patient satisfaction. The purpose of this paper is to determine the effect of the quality of nursing services in increasing patient satisfaction. The method used in this research was a literature study which is analyzed from 25 articles searched through Google Scholar and Pubmed and selected based on indexes, namely Scopus, Sinta 1, and 2 and the topics discussed. The results showed that if the quality of service of nursing or nursing care can significantly increase patient satisfaction.

Soils provide important regulating ecosystem services and have crucial implications for human well-being and environmental conservation. However, soil degradation and particularly soil erosion jeopardize the maintenance and existence of these services. This study explores the spatio-temporal relationships of soil erosion to understand the distribution patterns of sediment retention services in mainland Portugal. Based on Corine Land Cover maps from 1990 to 2018, the InVEST Sediment Delivery Ratio (SDR) model was used to evaluate the influence of sediment dynamics for soil and water conservation. Spatial differences in the sediment retention levels were observed within the NUTS III boundaries, showing which areas are more vulnerable to soil erosion processes. Results indicated that the Region of Leiria, Douro and the coastal regions have decreased importantly sediment retention capacity over the years. However, in most of the territory (77.52%) changes in sediment retention were little or not important (i.e., less than 5%). The statistical validation of the model proved the consistency of the results, highlighting the usefulness of this methodology to analyse the state of soil erosion in the country. These findings can be relevant to support strategies for more efficient land use planning regarding soil erosion mitigation practices.

Tropical island countries are often highly populated and deliver immense ecosystem service benefits. As human wellbeing depends on these ecosystems proper management is crucial in the resource-rich tropical lands where related research is less. Though the ecosystem service and biodiversity studies are a promising path to inform the ecosystem management for these mostly developing countries published evidence of using ecosystem service studies in decision-making is lacking. The purpose of this study is to provide an overview of ecosystem services and related research in Sri Lanka examining trends and gaps and how these studies are conceptualized. Out of considered 139 peer-reviewed articles majority of articles 42.4% were terrestrial and forest related while coastal ecosystems were considered in 34.5% of studies. In most studies, the ecosystem service category was provisioning (33.8%) followed by regulatory service (30.9%). Studies investigating and quantifying ecosystem services, pressures on ecosystems, and their management were fewer compared to studies related to biodiversity or species introduction. Moreover, studies investigating the value of ecosystem services and biodiversity to the communities or involvement of stakeholders in the development of management actions regarding the ecosystem services were rare in Sri Lanka and intense focus of future studies in these aspects are timely and necessary.

Background: Australia’s healthcare system is complex and fragmented which can create challenges in healthcare, particularly in rural and remote areas. Aboriginal people experience inequalities in healthcare treatment and outcomes. This study aimed to investigate barriers and enablers to accessing healthcare services for Aboriginal people living in rural and remote Australia. Methods: Semi-structured interviews were conducted with healthcare delivery staff and stakeholders recruited through snowball sampling. The communities were selected for their high proportion of Aboriginal people and geographical representation (coastal, rural, and border). Thematic analysis identified barriers and enablers. Results: Thirty-one interviews were conducted (n =5 coastal, n=13 remote, and n=13 border) and six themes identified: 1) Improved coordination of healthcare services; 2) Better communication between services and patients; 3) Trust in services and cultural safety; 4) Importance of prioritizing health services by Aboriginal people; 5) Importance of reliable, affordable and sustainable services; 6) Distance and transport availability. These themes were often present as both barriers and enablers to healthcare access for Aboriginal people. They were also present across the healthcare system and within all three communities. Conclusions: This study describes a pathway to better healthcare outcomes for Aboriginal Australians by providing insights into ways to improve access.

The goods and services produced by forest and vegetation ecology system is the power by which human society can be promoted fast in high-quality and sustainable way. With the increase of population and economic development in water-limited regions, there is an increasing demand for the quantity and variety of forest vegetation ecosystem products and services. To meet the demands of this situation, most of the original forest has changed into farmland, non-native forest and grass land. As a result, water-plant relationship changed from equilibrium to non-equilibrium, which 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 questions and realize the sustainable utilization of soil water resources and the high quality and sustainable development of social economy, it is necessary to apply the utilization limit theory of soil water resources by plants and the theory of soil water carrying capacity for vegetation to adjust the relationship between plant growth and soil moisture to obtain the maximum yield and benefit of vegetation and serve high-quality and sustainable development.

(1) Introduction: The unprecedented coronavirus disease 2019 (COVID-19) epidemic has caused millions of infections worldwide and represents a significant challenge facing modern health care systems. This study was conducted to investigate the impact of lockdown measures on regional neonate services, which might be used to predict the long-term effects of medical behavior. (2) Methods: Using hospital information system (HIS) Statistics data from 4 January 2019 to 27 August 2020, an interrupted time-series analysis was employed to compare changes and trends in hospital admissions and disease spectrum before and after the lockdown interventions. Furthermore, this study was designed to evaluate whether the pandemic influenced newborns' healthcare behavior. (3) Results: Overall, 13,540 infants were admitted to the NICU during the pre-COVID period (n = 12082) and COVID-impacted period (n =4558). The patients' age at admission were younger than that of the pre-COVID-19 period (median age 5d vs. 6d after birth, p＜0.001). The overall number of neonate visits consistently decreased from the first days of the lockdown measures (24 January 2020). The disease spectrum for respiratory system, infectious diseases, and gastrointestinal disease indicated no declined immediately after intervention(p =0.079, p =0.113, p =0.060, respectively). There was an immediate decline in the volume of Jaundice-related conditions (p<0.001) after lockdown measures. The percentage of patients who suffer from respiratory system and infectious diseases has decreased (p =0.005 and p =0.002). However, a relatively high percentage of patients admitted to the neonatal intensive care unit (NICU) presented with Jaundice-related conditions (p <0.001). (4) Conclusions: In summary, the COVID-19 pandemic profoundly impacted the regional neonate services. However, it is still unclear what might be the effect of long-term effects from pandemic.

With the rapid development of urbanization and industrialization in China, environmental issues have become a knotty problem, especially issues related to air, water, and solid-waste pollution. These pollutants pose threats to the health of the population and to that of communities and have a vicious influence on the healthcare system. Additionally, pollution also exhibits spill-over effects, which means that pollution in the local region could affect the healthcare services in a neighbouring region. Therefore, it is necessary to explore the relationship between pollution and healthcare. A spatial autocorrelation analysis was conducted and spatial panel econometric models were constructed to explore the characteristics of pollution and healthcare services in China and the relationship between them using data on all 31 provinces over twelve consecutive years (2006-2017). The results showed that the utilization of healthcare services and environmental pollution were not randomly distributed; unsurprisingly, air pollution and solid-waste pollution were mainly found in parts of northern China, while water pollution was highest in southern and coastal China. In addition, environmental pollution exhibited spill-over effects on healthcare services. For example, a 1% increase in solid waste in one specific geographical unit was estimated to increase the inpatient visits per capita in adjacent counties by 0.559%. Specifically, pollution showed different degrees of influence on healthcare services, which means that the impact of environmental pollution on the number of outpatient visits is greater than on the number of inpatient visits. Our results provide the government with evidence for effectively formulating and promulgating policies, especially policies aimed at tackling spill-over effects among different regions.

Natural capital is the wealth of nations that give them the economic status they represent. Worldwide, vulnerable people depend on natural capital for employment, salaries, wealth, and livelihoods and, in turn, determine the developmental index of the nation to which they belong. The availability of ecological services is crucial for clean water and air, food and fodder, and agricultural development. In this short commentary, we have tried to sum up the ideas and discussions over natural capital's role in ascribing economic status to countries. We have discussed how the prosperity of humans is intertwined with the services ecosystems provide and how poor natural resource management (NRM) has adversely cost human well-being. The paper concludes that to ensure the current and future human well-being, an in-depth understanding of the services ecosystems provide, is essential.

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.

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.

Background: Low-level physical activity (PA) among Chronic Low Back Pain (cLBP) is associated with various biopsychosocial factors. This research aimed to study the predictors of PA behavior among cLBP patients. Methods: In the present study 300 eligible patients with cLBP who referred to comprehensive health service centers in the Shahid Beheshti University of Medical Sciences (SBUMS) in Tehran, Iran were random selected.To diagnose the predictors of PA behavior, all the Theory of Reasoned Action (TRA) constructs were examined as risk factors to see if they influence on the probability of PA behavior occurrence and were interpreted through odds ratio (OR). SPSS version 19 was used to analyze the data. Results: Totally 280 cLBP patients with mean age of 57.07 ±13.09 years old participated in the study. This study showed that motivation to comply significant predictor the cLBP patients for subjective norm OR (%95CI): 2.095(0.116-2.792), p-value<0.001), intention was significant predictor for perform the PA behavior OR (%95CI): 1.431(0.138-1.538), p-value <0.001), behavior beliefs could predictor for attitude OR (%95CI): 1.276(0.106-1.355), p-value= 0.002). attitude, normative beliefs, subjective norm ,and evaluation outcome behavior could predictors the cLBP patients for intention to perform the PA behavior OR (%95CI): 1.188(0.032-1.312), p-value<0.001)., OR (%95CI): 1.158(0.076-2.208), p-value=0.003) ., OR (%95CI): 1.104(0.076-1.128), p-value<0.001) ., OR (%95CI): 0.814(0.301-1.440), p-value=0.007). Conclusions: This study showed that the cLBP patients who were normative beliefs and evaluation regarding PA behavior could effect on the intention to engage in greater PA than those via other constructs (attitude and subjective norm). This study showed that the cLBP patients who were normative beliefs and evaluation regarding PA behavior could effect on the intention to engage in greater PA than those via other constructs (attitude and subjective norm). This study showed that the cLBP patients who were normative beliefs and evaluation regarding PA behavior could effect on the intention to engage in greater PA than those via other constructs (attitude and subjective norm).

Research focused on understanding wider systemic factors driving behavioral change is limited with a dominant focus on the role of individual farmer and psychosocial factors for farming practice change, including reducing fertilizer application in agriculture. Adopting a wider systems perspective, the current study examines change and the role that supporting services have on fertilizer application rate change. A total of 238 sugarcane growers completed surveys reporting on changes in fertilizer application along with factors that may explain behavior change. Logistic regressions and negative binomial count-data regressions were used to examine whether farmers had changed fertilizer application rates and if they had, how long ago they made the change, and to explore the impact of individual and system factors in influencing change. Approximately one in three sugarcane growers surveyed (37%) had changed the method they used to calculate fertilizer application rates for the cane land they owned/managed at some point. Logistic regression results indicated growers were less likely to change the basis for their fertilizer calculation if they regarded maintaining good relationships with other local growers as being extremely important, they had another source of off-farm income, and if they had not attended a government-funded fertilizer management workshop in the five years preceding the survey. Similar drivers promoted early adoption of fertilizer practice change; namely, regarding family traditions and heritage as being unimportant, having sole decision-making authority on farming activities and having attended up to 5 workshops in the five years prior to completing the survey. Results demonstrated the influence of government-funded services to support practice change.

This study presents an in–depth analysis and strategic planning techniques for approaching a situation or achieving progress related to information technology services of Nueva Ecija University of Science and Technology, particularly the San Isidro Campus. As an educational organization and one in the region excellence providers in education, the University has so much vital information to manage and services to offer to provide the student's needs through the Management Information System department, application of IT services as a competing instrument to combat tedious tasks such as online admission, grade release, enrollment information, and online learning, university announcement, and possible students’ internship. The objective of this study is to determine the influence of information technology in day–to–day activities of the organization and strategy applied to streamline processes more conveniently. The researchers develop a conceptual model that would analyze the IT services' impact by identifying its strengths, weaknesses, opportunities, and threats and cleverly act on it using the TOWS Matrix in generating strategic decisions. The overall results were beneficial to the University and MIS as a basis for formulating competitive strategies and integrating it in an extended development plan.

Agricultural expansion is altering the provision of ecosystem services and seriously affecting the well-being of the indigenous communities still living in forests. In this paper, we evaluate the impact of forest loss and degradation on the indigenous forest dependent communities of Eastern Salta, Argentina, between 2001 and 2015. First, we identified the demand area of ten final ecosystem services for 202 indigenous communities using participatory mapping data. Second, we calculated the remaining usage area using a deforestation geodatabase based on Landsat images. Third, we analyzed the significance of trends in forest productivity processing vegetation spectral indices from MODIS products. By last, we detected changes in the growing season length by evaluating monthly trends in spectral indices. Our results show a reduction of 21% in the area used by indigenous communities for capturing final ecosystem services, and significant negative trends in forest productivity for the demand area of 64% of the communities, indicating that the area of use is not only being reduced, but also remnant forest area is being degraded and the growing season is being shortened. These aspects indicate an important loss in the provision of ecosystem services that deeply affects the wellbeing of indigenous communities.

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.

This paper investigates empirically the effect of export diversification (i.e., both export product diversification and services export diversification) on financial openness, using a sample of 119 countries (including both developed and developing countries) over the period 1985-2014. Based on the Blundell and Bond's two-step system Generalized Methods of Moments, the analysis has revealed that both export product diversification and services export diversification influence positively financial openness. However, this outcome hides differentiated effects across countries in the full sample. Specially, countries with a very high real per capita income experience a positive effect of export concentration on financial openness, while for countries with a relatively lower per capita income, it is rather export diversification that drives positively financial openness. Interestingly, the effect of export diversification on financial openness depends on the size of external shocks that affect domestic economies, as well as countries' economic growth performance. Overall, these findings add to the empirical literature on the effect of international trade on financial openness by showing that both export product diversification and services export diversification matter for financial openness.

Efficient use of the operating room (OR) is crucial for any hospital. One of the major inefficiencies in the OR is surgical cases not starting or finishing on time as scheduled. When a case is delayed, it affects all subsequent cases in that OR. This study uses discrete choice analysis to determine the significant factors, including team familiarity, that influence OR case on-time start and finish. A case is considered on-time if the documented procedure start and finish times are no more than 10 minutes after the scheduled start and finish times. The analysis uses surgical case data from a large tertiary referral hospital and academic center in Greenville, South Carolina. The case data includes all surgical cases (15,091) performed during regular workdays in 2013. Two binary logit models are developed: one for case on-time start and one for case on-time finish. Results indicate that higher team familiarity between surgeon and anesthesiologist, surgeon and circulating nurse, surgeon and scrub nurse, and surgeon and CRNA improve the likelihood of an OR case on-time start and on-time finish. This finding indicates that the OR scheduling staff in the study hospital make a concerted effort to schedule the surgical teams with members who have worked well together in the past.

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.

Designed by a group of ME/CFS researchers and health professionals, the European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (EUROMENE) has received funding from the European Cooperation is Science and Technology (COST) (https://www.cost.eu/cost-actions/what-are-cost-actions/ ) - COST action 15111 - from 2016 to 2020. The main goal of the Cost Action was to assess the existing fragmented knowledge and experience on health care delivery for people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in European countries, and to enhance coordinated research and health care provision in this field. We report on the recommendations for clinical diagnosis, heath services and care for people with ME/CFS in Europe, as prepared by the group of clinicians and researchers from 22 countries and 55 European health professionals and researchers, who have been informed by people with ME/CFS (https://www.cost.eu/actions/CA15111/#tabs|Name:overview).

(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.

This review examines from a services perspective strategies for preparedness and response to mental health impacts of three types of climate-related events: 1) acute climate-related events such as hurricanes, floods and wildfires, 2) sub-acute or long-term changes in the environment such as drought and heat stress; and 3) the existential threat of long-lasting changes, including higher temperatures, rising sea levels and a permanently altered and potentially uninhabitable physical environment. Strategies for acute events include development and implementation of guidelines and interventions for monitoring and treating adverse mental health outcomes and strengthening individual and community resilience, training of non-mental health professionals for services delivery, and the mapping of available resources and locations of at-risk populations. Additional strategies for sub-acute changes include advocacy for mitigation policies and programs and adaptation of guidelines and interventions to address the secondary impacts of sub-acute events such as economic loss, threats to livelihood, health and well-being, population and family displacement, environmental degradation and collective violence. Strategies for long-lasting changes include implementation of evidence-based risk communication interventions that address the existential threat of climate change, promoting the mental health benefits of environmental conservation, and promoting positive mental health impacts of climate change.

Ethiopia has decades of experience in implementing land and water management interventions. Nonetheless, there remains persisting challenges to follow an adaptive management (AM) approach in efforts of restoring and transforming agricultural landscapes. This review was carried out to synthesize evidences on the impact on agricultural landscapes following the implementation of land and water management practices and to evaluate the use of AM approaches. We explored how elements of the structures and functions of landscapes have been transformed, and how the components of AM, such as structured decision-making and learning processes, have been applied. Despite numerous environmental and economic benefits of land and water management interventions in Ethiopia, this review revealed gaps in AM approaches. These include: (i) insufficient efforts in relation to evidence based contextualization of interventions, (ii) insufficient efforts in monitoring of bio-physical and socio-economic processes and changes post implementation, (iii) lack of trade-off analyses, and (iv) inadequacy of local community engagement and provision of feedback. Given the many uncertainties we must deal with, efforts to restore and transform agricultural landscapes cannot follow a business-as-usual approach. Future investment, in AM approach, tailored to the needs and context would help to achieve the goals of sustainable agricultural landscape transformation. The success depends on three interdependent pillars of action: the ability to make a robust, co-developed plan of interventions, the ability to continuously monitor changes based on key variables, and to learn from the knowledge generated and apply the learning as implementation evolves.

Plans are currently being drafted for the next decade of action on biodiversity – both the post-2020 Global Biodiversity Framework of the Convention on Biological Diversity (CBD) and Biodiversity Strategy of the European Union (EU). Freshwater biodiversity is disproportionately threatened and under-prioritized relative to the marine and terrestrial biota, despite supporting a richness of species and ecosystems with their own intrinsic value and providing multiple essential ecosystem services. Future policies and strategies must have a greater focus on the unique ecology of freshwater life and its multiple threats, and now is a critical time to reflect on how this may be achieved. We identify priority topics including environmental flows, water quality, invasive species, integrated water resources management, strategic conservation planning, and emerging technologies for freshwater ecosystem monitoring. We synthesize these topics with decades of first-hand experience and recent literature into 14 special recommendations for global freshwater biodiversity conservation based on the successes and setbacks of European policy, management and research. Applying and following these recommendations will inform and enhance the ability of global and European post-2020 biodiversity agreements to halt and reverse the rapid global decline of freshwater biodiversity.

Recent years have seen a proliferation of platform-based “shared mobility services” (SMS) such as car-, bike-, and e-scootersharing in many cities in Germany and around the world. At the same time, these services have become the subject of intense debates: Are they replacing private car travel, thus contributing to sustainable mobility in cities? Or are they drawing users away from public transit and cycling while obstructing public space? From the perspective of sustainable mobility politics it seems far from clear which role these new services could play in transitioning to a less car-centric mobility system. While a number of potential effects and ensuing governance issues of shared mobility services (e.g. regarding questions of equitable access, data governance, the role of public versus private actors) have already been studied this article explores the role of shared mobility services (SMS) in triggering system dynamics and feedback loops in the context of sustainability transitions. The article connects questions regarding the sustainability effects of “shared mobility services” with the role of “push” measures to reduce private car traffic in cities. Using a theoretical framework from socio-technical transitions research and from the sociology of technology it describes the recent growth of shared mobility services in Berlin as an example of the upscaling dynamics of socio-technical niche innovations. Drawing on a series of workshops with mobility service providers and representatives of public authorities it analyses the potential for conflict as well as for coalition building between service providers and public authorities. Based on the theoretical concept of the role of feedback loops and windows of opportunity for transitions it shows how the market growth of shared mobility services added momentum to an already ongoing political debate over the legitimate use of public space in Berlin. Against this backdrop the article shows how growing numbers of car-, bike-, and e-scootersharing vehicles could open up windows of opportunity for re-distributing space away from private cars. The article concludes that supporting and regulating SMS will be key to steering their growth into the direction of sustainability.

Increased proliferation of IT services in all sectors has reinforced the adoption and diffusion across all levels of education and training institutions. However, lack of awareness of and knowledge about the key challenges and opportunities of elearning, seem to allude policymakers, resulting in low adoption or increased failure rate of many e-learning projects. Our study tries to address this problem through a review of relevant literature in e-learning. Our goal was to draw from the existing literature, insights into the opportunities and challenges of e-learning diffusion, and the current state-of-research in the field. To do this, we employed a systematic review of literature on some of the salient opportunities and challenges of e-learning innovation for educational institutions. These results aimed to inform policymakers and suggest some interesting issues to advance the research and adoption and diffusion of e-learning. Moreover, the bibliometric analysis shows that the field is experiencing high research attraction among scholars. However, several research areas in the field witnessed relatively low research paucity. Based on these findings, we discussed topics for possible future research.

Reductions in water availability and increasing rainfall variability are generating a narrative of growing competition for water in the Mediterranean basin. In this article, we explore the distribution and importance of water resources in the Muga River Basin (Catalonia, Spain) based on key stakeholders’ perceptions. We performed a sociocultural evaluation of the main water ecosystem services in the region through stakeholder interviews and participatory mapping. The basin was generally perceived as a hotspot of ecosystem services, but we detected varying opinions and considerable differences in the perceptions of importance and spatial distribution of water ecosystem services. These discrepancies were linked to the varying levels of stakeholders’ dependence on water. Our findings are important for contributing to correct water planning and management in the river basin, which is a complex water social system marked by conflicts between different stakeholder groups vying for the same resource. This complex situation requires bottom-up strategies to create transparent, participatory decision-making models.

There is little understanding of patients' experiences and perceptions with satisfaction by health professionals such as medical and dental clinicians. Furthermore, patient satisfaction is not well understood. The objective of this article is to better understand patients' satisfaction with their medical and dental care. The methods of the current article are based on a narrative review of the literature strategy. Patient satisfaction's multidimensional nature has been established since the perceived reasons for satisfaction varied widely among patients. Many aspects of the treatment influence participant satisfaction at different stages of the intervention's process. An improved understanding of the basis for managing patients' expectations with information reiteratively and efficiently may ultimately reduce patients' potential for negative feelings toward the medical and dental treatment experience. The consumerist method may misrepresent the concept of satisfaction in health service.

Stormwater management is a key urban issue in the world, in line with the global issues of urban sprawl and climate change. It is urgent to investigate the effectiveness in managing stormwater with different strategies for maintain urban resilience. A method based on a storm water management model (SWMM) was developed for assessing the control of stormwater runoff volume and the percentage removal of suspended solids by implementing a Sponge City strategy. An interdisciplinary approach was adopted incorporating Low Impact Development (LID) with urban Green Infrastructure and Gray Infrastructure paradigms in a typical old residential community in Suzhou, China. Four types of sponge facilities for reducing stormwater runoff were bio-retention cells, permeable pavements, grassed pitches, and stormwater gardens. The simulation results indicate that the stormwater pipe system can meet the management standard for storms with a five-year recurrence interval. The volume capture ratio of annual runoff is 91% and the reduction rate of suspended solids is 56%. This study demonstrates that Sponge City strategy is an effective approach for managing stormwater, particularly in old and densely populated urban areas. Implementing spongy facilities with a LID strategy for stormwater management can significantly enhance urban water resilience and increase ecosystem services.

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.

The aim of this research is forwarded for assessment of provision possibilities of the multi-componential and heterogeneous services in the fast-changing topology of cargo transportation processes. The mobile intelligent services in nowadays transport means require the development of complex infrastructure for multi-compositional service support. Our objectives are related to the investigation in data-transfer capabilities for heterogeneous service support, by offering some improvements for developing the infrastructure of transportation of vehicles by helping in the administration of transport processes. This research aims to develop an approach for assessment of infrastructure for sustainable management of cargo transportation processes by roads. Such assessment is multi-layered by including the management possibilities of cargo transportation logistic processes and electronic (smart, mobile) services by implementing of nowadays innovative software and hardware of information communication technologies (ICT). Special attention is paid for road safety, more environment cleanable, and paperless management by assessing the integration of potentials and prospects of wireless, vehicle Ad-hoc communication networks (VANET), and other communication possibilities. Some requirements are revealed for such type of infrastructure for the provision of heterogeneous services. The results of the development of infrastructure demonstrate the capacities of the potential of wireless networks for the provision of high-level of multi-component, heterogeneous services.

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.

Agricultural extension and advisory services in Africa have significant impact on food security as well as economic and social development. Recent moves towards a pluralistic delivery system, including the emergence of private-sector led initiatives in many countries are subject of policy and academic discourse. Our study used an adapted, fit-for-purpose market systems development framework to review available research in extension and advisory services in selected sub-Sahara Africa countries. Using a literature survey methodology, we report evidence of multiple actors in extension delivery, findings that point towards evolution towards mixed delivery as well as objectives. While there are significant uptake of cost-recovery approaches among commercially-oriented farmers, many smallholder farmers still depended on donor-funded services. Our review adds to existing knowledge through incorporating a market systems development framework, which extends the often-used willingness to pay approach, and highlights the need for merger of the public and private-sector objectives to achieve developmental outcomes.

The South African Weather Service (SAWS) manages an in-situ solar irradiance radiometric network of 13 stations and a very dense sunshine recording network; located in all six macro-climate zones of South Africa. A sparsely distributed radiometric network and over a landscape with dynamic climate and weather shifts is inadequate for solar energy studies and applications. Therefore, there is a need to develop mathematical models to estimate solar irradiation for a multitude of diverse climates. In this study, the annual regression coefficients, a and b, of the Ångström-Prescott (AP) model that can be used to estimate global horizontal irradiance from observed sunshine hours were calibrated and validated with observed station data. The AP regression coefficients were calibrated and validated for each of the six macro-climate zones of South Africa using the observation data that spans 2013 to 2019. The predictive effectiveness of the calibrated AP model coefficients was evaluated by comparing estimated and observed daily global horizontal irradiance. The maximum annual relative Mean Bias Error (rMBE) was 0.371 %, relative Mean Absolute Error (rMAE) was 0.745 %, relative Root Mean Square Error (rRMSE) was 0.910 % and the worst-case correlation coefficient (R2) was 0.910. The statistical validation metrics results show that there is a strong correlation and linear relation between observed and estimated solar radiation values. The AP model coefficients calculated in this study can be used with quantitative confidence in estimating daily GHI data at locations in South Africa where the daily observation sunshine duration data is available.

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.

Background and motivation: Combining Deep Reinforcement Learning (Deep RL) and Health Systems Simulations has significant potential, for both research into improving Deep RL performance and safety, and in operational practice. While individual toolkits exist for Deep RL and Health Systems Simulations, no framework to integrate the two has been established. Aim: Provide a framework for integrating Deep RL Networks with Health System Simulations, and to ensure this framework is compatible with Deep RL agents that have been developed and tested using OpenAI Gym. Methods: We developed our framework based on the OpenAI Gym framework, and demonstrate its use on a simple hospital bed capacity model. We built the Deep RL agents using PyTorch, and the Hospital Simulation using SimPy. Results: We demonstrate example models using a Double Deep Q Network or a Duelling Double Deep Q Network as the Deep RL agent. Conclusion: SimPy may be used to create Health System Simulations that are compatible with agents developed and tested on OpenAI Gym environments. GitHub repository of code: https://github.com/MichaelAllen1966/learninghospital

Only 15% of the global population has access to occupational safety and health services. In Africa only 5% of employees working from major establishments, have access to occupational health services (OHS). Access to primary health care (PHC) services is addressed in many settings and inclusion of OHS in these facilities might increase efficiency in preventing occupational diseases. A cross-sectional study was conducted in four SADC countries aiming at assessing the availability of OHS at PHC facilities and the organization of OHS. We conducted a literature review to assess the provision and organization of OHS services. In addition to the review, a total of 23 doctors from PHC facilities were interviewed using questionnaires in order to determine the availability of OHS and training. Consultations with heads of ministries were done in four SADC countries. Results showed that in the SADC region, OHS are fragmented and lack a comprehensive approach. In addition, out of 23 PHC facilities only two (13%) provided occupational health and PHC. However, OHS provided at PHC facilities were limited to TB screening and audiometric testing. Our study showed a huge inadequacy of trained occupational health practitioners. This study supports the World Health Organization’s advocacy of integrating OHS at PHC level.

Smartphone has become one of the most revolutionary devices in the history of computing. With various kinds of applications, the scope of smartphone has been significantly broadened in the past few years including almost every aspect in our daily life. However, due to the limited on-board resources such as CPU, storage, network bandwidth and battery power, smartphones and the mobile network serving them bring new challenges that have not been encountered in the traditional computing and networking environments. This dissertation focuses on the research areas of improving the network architecture and enhancing the current applications on smartphones. It mainly investigates the areas in the following two directions for three representative categories of mobile services. - In the first direction, the dissertation aims to develop new communication models for smartphone Ad-Hoc networks to achieve efficient communication in the proximity. It is motivated by the fact that smartphone Ad-Hoc networks can help improve the current location-based services and propel new applications. Moreover, the new communication models provide complementary alternatives to the traditional infrastructure-based wireless networks. - In the second direction, the dissertation focuses on improving the other two categories of services, cloud storage services and real-time video streaming services for mobile devices. In the field of cloud storage, we introduce a cloud-assisted approach to provide a set of advanced file operations, such as encryption, decryption and compression, on smartphones. Furthermore, by utilizing the on-board Near Field Communication(NFC) module, we develop an algorithm to securely share the files between mobile devices. For the services of real-time video streaming, we propose approaches that identify a user’s status by analyzing the accelerometer data and then, dynamically adjust the buffer mechanism to save network bandwidth on smartphones.

[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.

This short note proposes a national Geographic Information System (GIS) - based health infrastructure to deal with epidemics and pandemics. Currently, there is no pan-India health infrastructure available that can compile, update, and report the spread of epidemic diseases. It not only curtails the opportunity of finding the real-time data on the spatial distribution of a disease but prevents one to inquire into the causes of the disease through epidemiological analysis. The proposed infrastructure in this study is a pan-India one and can broadly be divided into two parts, hotspot mapping and accessibility to services. In the first part, hospitals are proposed to act as nodes of data collection, sending data to a national GIS portal. This portal shall have the capabilities of plotting the data using map rendering services such as Google and Bing Maps. This way, hotspots can be visualized in no time, benefitting the government and common citizenry alike. The second part deals with the accessibility of citizenry to a wide range of services, i.e., healthcare services, grocery outlets, emergency services, baby food, and many other essential services of the day to day life. In order to implement this, we propose that the government need to enforce a mandatory submission of locational coordinates of all Goods and Services Tax (GST) enrolled service providers. Once the coordinates are submitted, the government can effectively control the opening and closing of services and inform the citizenry at the same time. The proposed infrastructure is going to help deal with the extraordinary situations during epidemic and pandemics similar to what the world is currently facing in the form of Corona Virus Disease 2019 (COVID-19). Furthermore, the infrastructure can be scaled up or down as per the spread of a disease. The health-GIS platform proposed in this concept paper, shall help India in controlling and managing the epidemic more efficiently.

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.

The COVID-19 pandemic has presented the world with increased challenges. The response to this pandemic has led to a sudden disruption of routine medical and elective surgical care. Most hospitals across the globe have had to change the way outpatient clinics are carried out and postpone non-urgent elective surgical procedures. NHS England ceased all elective general surgeries to train and re-deploy their staff to support the increased pressures from COVID-19 in an intensive care setting. However, with a decline of reported cases and deaths, the return to undertaking non-urgent elective services is imminent. In May 2020, Radha and Afzal published the first evidence-based guidelines for the resumption of elective orthopaedic services titled “Evidence based suggestions for the return to elective orthopaedic surgery following the COVID-19 Pandemic”. The pathway presented is adapted from the “Evidence based suggestions for the return to elective orthopaedic surgery following the COVID-19 Pandemic” and could potentially be used as a model for other surgical specialities. We present a three-phased return back to urological services. Safe resumption of elective care is possible but needs to be carefully planned.

(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.

Since the 1950s sugarcane production has grown rapidly from less than 0.5 billion tonnes in the late 50s to reach over 1.9 billion tonnes in 2012 on about 27 million hectares of agricultural land. This expansion has been boosted by the high demand for bioethanol promoted as a sustainable bioenergy source which accounted in 2010 for the biggest share of the global biofuel market. Despite its benefits, the scientific debate on sugar is growing especially that counterarguments are so many, including negative impacts on different interacting ecosystems and human well-being, e.g. bigger stress on land and water resources, environmental externalities on air, a harmful impact on the biodiversity and endemic species, negative environmental externalities, health, and socio-economic aspects. This paper provides a narrative systematic review (SR) of the impacts of sugarcane production on these different ecosystems employing the ecosystem services framework for its acceptance by policy-makers. The references included for the SR were 163 and results showed that the majority of the studies are from Brazil, Australia, South Africa and the USA (≈ 75% of the literature), most of them were from peer-reviewed journals (85%), and most of the case studies adopted a quantitative research approach (93%). The literature assessed showed that sugarcane, like all agro-systems, depends on the practices and techniques to transform negative impacts into positive externalities on ecosystems and human well-being. However, the literature studied failed to include the inter-linkage in sugarcane production impacts’ and therefore to evaluate the related ecosystem services with respect to the Millennium Ecosystem Assessment (MA) framework to account for existing trade-offs. Therefore, the findings are addressed to the scientific community and decision-maker for an intensification of interdisciplinary and integrated research based on the MA framework to cover all ecosystem services, for sustainable development of the sugarcane sector.

The Forest Stewardship Council initiated a pilot Forest Certification for Ecosystem Services (ForCES) project from 2011 to 2017 to improve and promote sustainable forest management addressing a range of ecosystem services. Three sites in Indonesia were studied in the pilot. Whilst the development of the certification standard was largely by a partnership between the certification standard organization, civil society and research organisations, implementation and monitoring of the impact of this voluntary sustainability standard will entail interaction with state regulations. This study sought to understand how certification and state regulations concerning ecosystem services in Indonesia interplay, particularly in the agenda setting and negotiation stage. Using the conceptual lenses of transition theory and state and non-state market-based governance, the interrelationships between ecosystem services certification and regulations were found to be both complementary, supporting and antagonistic. The majority were complementary. Antagonism occurred where regulations do not accommodate land use issues and due to different contradictory state regulations. The voluntary instruments were developed largely in the absence of state involvement and without any substitution with regulatory standards. Given the increasing proliferation of voluntary market-driven initiatives at farm, forest concession and landscape level, stakeholders developing and managing voluntary standards need to collaborate with national and local governments to create synergy to enable their acceptance, adoption and effectiveness to positively enhance the conservation of ecosystem services through incentivizing market-based instruments.

Green public space immensely provides ecological soundness (ES), social resilience, social inclusiveness, mental health, self-esteem, and cultural prosperity from privileged class to lower ones. This research aims at estimating the effect of social services, safety, and infrastructural amenity in green space (parks) on mental health building self-esteem for elderly population. Data were collected from four parks out of 21 in Dhaka selected by systematic random sampling. Two-hundred and three elderly participants were picked up for survey using snowball sampling. The survey was conducted in a pre-structured questionnaire consisted of 40 close-ended questions. Data was analyzed applying ordinal logistic model, multivariate regression analysis, and Partial Least Square (PLS) -Path Modeling. The study explored several key findings-1) Infrastructural amenities impacted social services of parks; 2) Social services contributed positively to mental health boosting up self-esteem for elderly population. 3) Likewise, mental health for elderly population was affected by safety measure of green space. Dhaka requires constructing age-friendly parks to promote elderly mental health.

Patient engagement is receiving a growing attention in the healthcare context. However, although worldwide healthcare stakeholders agree that patient engagement is a priority for quality and effective care, no shared recommendations on how to promote patient engagement are currently available. Based on these premises, a Consensus Conference (CC) was promoted to address four main issues: What is the definition of Patient Engagement? How measuring Patient Engagement? What are the most recommended methodologies and the tools to promote Patient Engagement? What is the role of new technologies in promoting of Patient Engagement? The consensus was obtained through an iterative process that began with a systematic synthesis of the available literature in each domain followed by plenary expert discussions. This CC - including the systematic analysis of internationals scientific evidences (2749 sources across the major international scientific databases) together with experiences of a multi-disciplinary consortium of investigators and key stakeholders - attempted to provide the first evidence-based Expert Consensus Statement for the promotion of Patient Engagement in chronic care. These recommendations should be envisaged as inspirational principles to promote a real eco-system of engagement and might orient health services research and interventions.

Humanity will soon define a new era for nature – one that seeks to correct decades of underwhelming responses to the global biodiversity crisis. Area-based conservation efforts, which include both protected areas and other effective area-based conservation measures, are likely to extend and diversify. But persistent shortfalls in ecological representation, management effectiveness and measurable biodiversity outcomes diminish the potential role of area-based conservation in stemming biodiversity loss. Here we show how protected area expansion by governments since 2010 has had limited success in increasing biodiversity coverage, and identify four emergent issues that –if addressed – will enhance the performance of area-based conservation post-2020. We close with recommendations for a broad biodiversity agenda that maximises the potential of area-based conservation. Parties to the Convention on Biological Diversity must recognise that area-based conservation primarily focuses on local threats to species and ecosystems, and needs enhanced emphasis on biodiversity outcomes to better track and fund its contribution to global conservation efforts.

Introduction: Patients’ satisfaction was extensively researched over the last decades, given its role in building loyalty, compliance to treatment, prevention, and eventually higher levels of wellbeing and improved health status. Patients’ feedback on the perceived quality of health services can be incorporated into practice; therefore, understanding factors and mechanisms responsible for patients’ satisfaction allows providers to tailor targeted interventions. Method: A questionnaire assessing patients’ perception of the quality of health services was administered to a country-representative sample of 1500 Romanian patients. Using a partial least squares—path modeling approach (PLS-PM), with cross-sectional data, we developed a variance-based structural model, emphasizing the mediating role of trust and satisfaction with various categories of health services. Results: We confirmed the mediating role of trust in shaping the relationship between the procedural accuracy of health professionals, along with the perceived intensity of their interaction with patients, and patients’ experienced quality of the health services. We confirmed the mediating role of satisfaction by the categories of services in the relationship between waiting time on the premises, attention received, and the perceived reliability of the information received, as predictors, and the experienced quality of the health services. In addition, indirect assessment of patients’ satisfaction is a good predictor for direct assessment, thereby affirming the idea that the results of the two types of evaluations converge. Discussions: One of the most efficient solutions to increase both patients’ satisfaction and their compliance is to empower the communication dimension between patients and health practitioners. Given the non-linear relationships among variables, we advocate that, unless the nature of the relationships between satisfaction and its predictors is understood, practical interventions could fail. The most relevant variable for intervention is the degree of attention patients perceive they received. We suggest three methods to turn waiting time into attention given to patients.

The continuous increase in tuition fees in university education in many countries requires justification by the university authorities through improved learning resources that can guarantee employment opportunities for the students through hands-on industry training. This paper describes the design of curriculum of cloud computing module in collaboration with Amazon Web Services (AWS) Academy to include industry-based practical hands-on labs in the curriculum to improve the employability of Internet of Things (IoT) engineering students. This study introduces industry best practices and hands-on labs in cloud computing and discovered that students’ understanding and learning experience in the subject increase when exposed to real-life applications. The study blends academic theories in cloud computing with their applications as obtained in industry to enable students to have both the theoretical and practical skills that will prepare them for careers in cloud computing. To achieve this, cloud computing lecturers were trained by AWS Academy as a prerequisite to ensure that the tutors themselves acquire hands-on proficiency in cloud computing technologies. The study finds that students tend to be more engaged and learn better when academic theories and concepts are combined with real-world applications as obtained in the industry.

Ever since pharmacy has become a profession, pharmacist's role has been continuously subjected to changes due to specific influences from historical, socio-economic, political, and scientific context. Nowadays the classic perception of pharmaceutical profession in Community Pharmacy is facing worldwide extinction due to many factors. Modern services, such as online, mail-order, and telephone-order pharmacies are increasingly gaining ground thanks to their ability to facilitate customer demand. However, at the same time, they are endangering “face-to-face” contact, affecting the building of customer loyalty based on direct “human” interaction, and consequently reducing pharmacists to mere commercial figures. Communication is in fact emphasized as the essential element to build a solid and appropriate interpersonal relationship with the client, to make the consultancy process effective, and to strengthen pharmacist's professionalism in community pharmacy. The aim of this work is to analyze pharmacist’s role in modern society by pinpointing the factors affecting pharmacy profession practice. Specific purpose will be improving both the academic training of future professionals and their capacity to approach public relations through a deepened study and practice of behavioral, communication, educational, and sociological methodologies and techniques that would allow the development of more effective communication skills useful for providing an efficient consultancy service.

The School Fruit and Vegetables Scheme (SFVS) implemented by the European Union during 2009/10 aims to improve the diet of school children and to support agricultural markets and environmental sustainability. The objective of this study was to characterize the SFVS implementation in Spain (2009-2017). A descriptive, longitudinal, observational and retrospective study was carried out based on document analysis of annual strategies of the SFVS. We studied the average budget for the EU, the number of students enrolled, the cost of the SFVS by student and by day, the duration of the SFVS, the quantity of fruits and vegetables (FV) per student, the variety of FV, the inclusion of local, seasonal and organic foods, and the education activities (EA). The results were studied by autonomous community (AC). The budget increased from 7.4 million euros in 2009/10 to 14.4 in 2016/17. Since 2014/15, the increase came from EU funds, the number of students increased from 18% in 2009 to 20% in 2016. The quantity of FV went from 2,579 to 4,000 tons, duration increased from 9.8 to 19.6 days and the variety of fruits and vegetables increased from 20 to 21 and from 5 to 6 respectively. In AC there were important variations in EA, in the number of enrolled students (7.4% to 45.6%), in the cost per student (2.3€ to 28€) and in the duration in days (5.6 to 70 days). The inclusion of local, seasonal and organic foods was identified in 5 of the 8 years studied. The development and reach of the SFVS in Spain is still insufficient to influence dietary patterns and health in the school population. However, the SFVS has generated an economic market for agricultural production.