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.

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.

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.

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.

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

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

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.

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.

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

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

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.

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.

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.

In terms of sustainability, cities become smart when they provide intelligent services to the inhabitants using information and communication technologies without threatening the future of the environment, economy or the society. However, the process of developing such sustainable smart services has certain challenges, especially in understanding the real needs of the people living in the city. Inhabitants of the city or the citizens are the key stakeholders in case of smart services in a city. Active involvement of the people throughout the process is a way to design such services. On the other hand, integrating sustainability, for example including environmental data to the smart city services has been found challenging. Therefore, this research discusses an approach on combining environmental data with regular smart city services and to engage city inhabitants in the process, the approach that is adapted from the concept of living lab methodology. Finally, an application has been developed to represent a smart city service following this method.

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.

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.

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

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

BACKGROUND: Body mass index (BMI) is calculated by dividing a person's height in meters by their weight in kilograms and is always expressed in kg/m². BMI is a reliable risk indicator for various diseases that can develop due to a higher percentage of body fat. There is a possibility of developing certain medical conditions including heart disease, high blood pressure, type 2 diabetes, gallstones, breathing problems and some malignancies that increase with BMI. OBJECTIVE: This study seeks to identify the trends in the Body Mass Index (BMI) of women visiting Better Life Primary Health Care Centre in Ondo City, Ondo State, Nigeria for various healthcare services. METHODOLOGY: Seventy (70) women who participated in this study were randomly selected using systematic random sampling. Their necessary information was obtained using a prepared record sheet to collect their data. Results were analysed using SPSS version 21. RESULTS: The results show mean age of the respondents is 30.50 + 6.52921 21 (30%) were between 31 – 35 years, 21 (30%) were traders, 36 (51%) had tertiary education, 39 (55.7%) were between 151 – 160 cm in height. 32 (45.7%) were between 60 – 80 kg in weight and 30 (42.9%) had normal weight, respectively. CONCLUSION: Body Mass Index (BMI) calculation is an essential tool that can help in identifying one of the significant public health issues that leads to obesity; a predisposing factor to various medical conditions like hypertension, musculoskeletal issues, heart diseases, cancers, and lots more. It is therefore important to incorporate BMI calculation into routine checks to prevent or reduce health burdens that may arise from obesity.

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

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

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.

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.

Ecosystem services (ES) are increasingly recognized as a means to adapt to the ongoing impact of climate change and associated impacts. However, these ES itself are facing adverse impact of climate change especially in developing countries where most of the people are dependent on these services for their livelihood. Very little is known about the relationship between the climate change and ES. Here we assess the impact of climate change on ecosystem services in ES rich landscape of Panchase Mountain Ecological Region of western Nepal. The study area was divided into three ecoregions from lowland through midland to the upland region. Focus group discussion, and key informant interview were used to elicit the required data for the study, which was further supported by transect walk, field observation and secondary source of information. Major impacts of climate change were observed are, reduced availability of water, reduced food production, forest ecosystem, shifting species composition in forest ecosystem, farmland abandonment, and their associated ecosystem services. We recommend to initiate the management actions to help ES adapt to climate change, and which in return could support the ecosystem itself and people dependent on the ES in adaptation to climate change by providing various goods and services.

Urban lakes, especially those of natural origin, provide ecosystem services, recreation being one of the most important and highly valued by the city dwellers. Fulfilling the needs of city residents to relax and have contact with nature has become a priority in urbanized areas and has been proved to positively affect people’s health and well-being. The recreational potential of water bodies was identified to be most important aspect of ecosystem services to the residents of the neighboring areas. An assessment of recreational ecosystem services (RES) provisioning to society based on the real time spent by the citizens and housing values in the rural-urban gradient revealed that the economic benefits of lakes differ in urbanized, suburban and rural landscapes. The growth of cities has led to an increased population density in the surroundings of ecologically valuable areas, resulting in higher pressure from visitors seeking recreational areas. Along with urbanization, the impoverishment of ecosystem functions takes place, limiting their capability to provide ecosystem services. In this work provisioning of recreational ecosystem services of 28 floodplain lakes located along the urban-rural gradient of the Warsaw agglomeration was assessed. The relationship between the ecological value of the water bodies, measured using naturalness indices, and the recreational ecosystem services they can provide was assessed. The results showed that the floodplain lakes located along the urban-rural gradient are of a great importance to the citizens due to their recreational potential. The provisioning of recreational ecosystem services is poorly connected with the ecological characteristics of the floodplain lakes. Only hemeroby, was significantly correlated with provisioning, and there was no relationship with factors such as naturalness of vegetation or water quality, demonstrating that public preference was not generally influenced by high ecological quality. These data should be available to potential buyers and be integrated in spatial planning management plans in order to shape future housing policy.

This paper presents a method for a decentralised peer-to-peer software license validation system using cryptocurrency blockchain technology to ameliorate software piracy, and to provide a mechanism for software developers to protect copyrighted works. Protecting software copyright has been an issue since the late 1970's and software license validation has been a primary method employed in an attempt to minimise software piracy and protect software copyright. The method described creates an ecosystem in which the rights and privileges of participants are observed.

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

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

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

Background and Aims: Paramedics attend an unprecedented number of drug poisoning events daily in British Columbia (BC), Canada due to the ongoing public health crisis related to an increasingly toxic and unregulated supply of illicit drugs. Paramedics have the potential to support alternative models of care to reduce harm, but their perspectives towards harm reduction initiatives are polarized. Understanding the drug-related substance use content in paramedic curriculum documents is important for deploying effective harm mitigating programs. The objective of this study was to understand what drug-related substance use content currently exists within paramedic curriculum documents in British Columbia. Methods: We performed a document analysis of curriculum documents in BC’s paramedic training institutions, the primary program textbook, and the 2011 National Occupational Competency Profile (NOCP). We used the Checklist for Assessment and Reporting of Document Analysis (CARDA) tool to perform our analysis. We analysed and coded documents both inductively and deductively and subsequently combined, refined, and used the codes to inform the development of themes via reflexive thematic analysis. Results: Of the 44 documents analysed, 22 included codes relevant to the research questions. Paramedics are primarily taught to care for people who use drugs in an acute drug-poisoning response only, with little consideration of holistic care, and no meaningful mention of harm reduction. Some stigmatizing language was found within the content. Conclusions: Many opportunities to introduce holistic models of care for people who use drugs along the entire continuum of care are unaddressed by paramedic curriculum documents in BC. Curriculum developers should include people who have lived and living experience of drug use in the co-design of educational programs involving their care. Further qualitative analyses are required to evaluate the relationship between paramedic education and provider-based stigma.

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 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.

We aimed at developing and validating a scale on the beliefs and attitudes of mental health professionals towards services users’ rights in order to provide a valid evaluation instrument for training activities with heterogeneous mental health professional groups. Items were extracted from a review of previous instruments, as well as from several focus groups which have been conducted with different mental health stakeholders, including mental health service users. The preliminary scale consisted of 44 items and was administered to 480 mental health professionals. After eliminating non-discriminant and low weighting items, a final scale of 25 items was obtained. Exploratory and confirmatory factor analyses produced a four-factor solution consisting of the following four dimensions; system criticism/justifying beliefs, freedom/coercion, empowerment/paternalism, and tolerance/discrimination. The scale shows high concordance with our theoretical model as well as adequate parameters of explained variance, model fit, and internal reliability. Additional work is required to assess the cultural equivalence and psychometrics of this tool in other settings and populations, including health students.

This is a theoretical and empirical article. Basic issues related to consumer behaviour on the market of cultural services are presented in the first part of the article. The second part presents the brief characteristics of consumers of cultural services in Poland, as well as an analysis of their market behaviour. For this purpose, surveys were conducted on a group of 2599 consumers of the cultural offer. Research was conducted in Katowice - the largest city in the Silesia region in Poland. The article also highlights the main trends in consumer behaviour on the market of cultural services in Poland in particular: increasing mobility of the consumers of the cultural offer, growing diversity in the methods of acquiring information about cultural events and increase in the importance (purchasing power) of consumers in the retirement age in the market of cultural services. In the last part of article authors indicate on the resulting implications for sustainable cultural management in Poland - particularly marketing.

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

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

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

We seek to examine effective collaboration when engaging in value cocreation with the customer for mobile financial services in EMs. Our study is a motivation for multi-stakeholder engagement in value cocreation with financial inclusion of all consumers including marginalized populations. Furthermore, our work discovers that social sustainability is a product of social creativity and results in financial inclusion. We apply a qualitative descriptive methodology utilizing exemplars from extant research and phenomenology to analyze the data from the contexts of Ghana and Kenya. The results show that value is co-created for mobile financial services in networks in emerging markets when actors integrate resources for social and environmental sustainability as essential elements for mobile financial inclusion.

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

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

Early treatment is the mainstay of sepsis therapy. We suspected that early recognition of sepsis by prehospital healthcare providers may shorten time to antibiotic administration in the Emergency Department. We retrospectively evaluated all patients above 18 years of age that were diagnosed with sepsis or severe infection in our Emergency Department between 2018 and 2020. We recorded the suspected diagnosis at time of presentation, type of referring healthcare provider and time until initiation of antibiotic treatment. Differences between groups were calculated using Kruskal-Wallis rank sum test. Of the 277 patients that were diagnosed with severe infection or sepsis in the emergency department, an infection was suspected in 124 (44.8%) patients and sepsis was suspected in 31 (11.2%) patients by referring healthcare providers. Time to initiation of antibiotic treatment was shorter in patients where sepsis or infection had been suspected prior to arrival for both patients with severe infections (p = 0.022) and sepsis (p = 0.004). Given the well described outcome benefits to early sepsis therapy, recognition of sepsis needs to be improved. Appropriate scores should be used as part of routine patient assessment to reduce time to antibiotic administration and improve patient outcomes.

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

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

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

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.

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.

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.

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.

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.

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.

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.

Objectives: The aim of this study was to describe potential factors contributing to neonatal mortality in Takeo, Cambodia through assessment of verbal autopsies collected following newborn deaths in the community. The mortality review was nested within a trial of a behavioral intervention to improve newborn survival, and was conducted after the close of the trial, within the study setting. The World Health Organization standardized definition of neonatal mortality was employed, and two pediatricians independently reviewed data collected from each event to assign a cause of death. Results: Thirteen newborn deaths of infants born in health facilities participating in a community based, behavioral intervention were reported during February 2015–November 2016. Ten deaths (76.92%) were early neonatal deaths, two (15.38%) were late neonatal deaths, and one was a stillbirth. Five out of 13 deaths (38.46%) occurred within the first day of life. The largest single contributor to mortality was neonatal sepsis; six of 13 deaths (46.15%) were attributed to some form of sepsis. Twenty-three percent of deaths were attributed to asphyxia. The study highlights the continuing need to improve quality of care and infection prevention and control, and to fully address causes of sepsis, in order to effectively reduce mortality in the newborn period.: The study highlights the continuing need to improve both intrapartum and postnatal quality of care and infection prevention and control, and to fully address causes of sepsis, in order to effectively reduce mortality in the newborn period.

Fighting corruption and enhancing tax compliance through digital public services represent key factors for increasing sustainable development in Romania. We argue that fighting corruption may increase the level of sustainable development, through digital pubic services. Using digital public services leads to the increase of the level of tax compliance, because entrepreneurs will feel more confident and responsible and they will decide to better comply. Tax regulations can affect the level of tax compliance through the additional costs they generate. The discussion is based on the consideration of the costs generated by compliant behavior and we explain how such costs influence the entrepreneurs’ decision in the fiscal environment. If the costs are higher, entrepreneurs will take evasive initiatives and will refuse to comply. Among the numerous tools developed to fight corruption, the use of communication technologies has recently been researched and there is still need for further research in the Romanian economic environment. The use of digital public services reduces costs for entrepreneurs and increases their confidence in state institutions due to higher levels of transparency. We argue for increasing sustainable development in Romania through digital public services, thus fighting corruption and enhancing tax compliance.

The purpose of the present research was to analyze the available data on river restoration projects. As the framework of our study, we conducted a structured international survey. We asked selected entities and experts from among those responsible for river restoration in European countries about the details and costs of European Union river restoration projects. We examined 119 river restoration projects that were implemented in Europe between 1989 and 2016; some of the projects were still ongoing. We observed that the number of river restoration projects has been increasing since 1989, which expresses society’s growing interest in improving the quality of aquatic environments. We revealed that 56% of these European river restoration projects have been implemented by dedicated entities and stakeholders, not as part of any structured, larger-scale river restoration policy; this indicates that most European countries do not have integrated plans for river restoration. Our analysis showed that 52% of the projects analyzed have been designed and implemented without the participation of local stakeholders. It also showed that the budgets for river restoration projects did not differ significantly across various time horizons from 1981 to 2016. In our study, the average cost of restoring 1 ha of an average European river was 310 000 EUR (or 195 000 EUR if 4 outlying values are excluded). Considering these projects’ permanent assets and including their amortization, for European river systems, we calculated the average unit price of a river restoration’s value in terms of ecosystem meta-service to be 7 757 EUR · ha^-1 · year^-1 (4 875 EUR · ha^-1 · year^-1 if 4 outlying values were excluded).

(1) Background: There is insufficient empirical evidence on the correlates of health care utilization of irregular migrants currently living in Turkey. The aim of this study was to identify individual level determinants associated with health service and medication use. (2) Methods: 155 Afghans completed surveys assessing service utilization including encounters with primary care physicians and outpatient specialists in addition to the use of prescription and nonprescription medicines. Multivariate logistic regression analyses were employed to examine associations between service use and a range of predisposing, enabling, and perceived need factors. (3) Results: Health services utilization was lowest for outpatient specialists (20%) and highest for nonprescription medications (37%). Female gender and higher income predicted encounters with primary care physicians. Income, and other enabling factors such as family presence in Turkey predicted encounters with outpatient specialists. Perceived illness-related need factors had little to no influence on use of services; however, asylum difficulties increased the likelihood for encounters with primary care physicians, outpatient services, and the use of prescription medications. 4) Conclusion: This study suggests that health services use among Afghan migrants in Turkey is low considering the extent of their perceived illness-related needs, which may be further exacerbated by the precarious conditions in which they live.

Reducing GHG emissions is a crucial challenge in urban areas, characterized by high energy consumption and reduced exposure to nature. In this context, the urban green system could play a pivotal role. In the literature, scholars analyzed both the ability of species-specific and layout-specific green infrastructures to increase carbon sequestration and the best location sites of new green infrastructures, to increase the provision of overall ecosystem services. There is a lack of studies helping green urban planners and designers choose where and which green infrastructure to implement, based on vegetation species-specific performance and local carbon emissions of city components. This paper uses tree inventory data from a medium-sized city in central Italy (Perugia) to develop a spatial analysis of the urban parks' performance in carbon sequestration. Then, the method evaluates the carbon emission of a public city building to generate a spatialized balance between buildings’ demand and trees’ supply, to support local decisions about the best locations for new green infrastructures and the choice between species. The paper contributes to GIS-based tools that vary the recommended location sites and species for new green infrastructures based on the demanded ecosystem service.

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.

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

This research study examined the compensation requirements for households facing involuntary displacement caused by a railway development project in Ethiopia's Amhara Region. Using the contingent valuation approach, researchers estimated compensation needs, taking into account ecosystem services and household characteristics. Surveys and questionnaires were conducted with 170 affected households to gather data on compensation preferences and experiences using double-bounded dichotomous method. The collected data were analyzed using a probit model to assess the influence of compensation amount, satisfaction, marital status, religion, and education on the satisfaction levels of affected households. The findings emphasized the significant impact of these factors and the necessity of fair compensation policies in development projects. The study revealed that the Minimum Willingness to Accept (MWTA) for households was - 2.274 billion Ethiopian Birr, significantly surpassing the compensation amount provided. The study highlighted the importance of considering household possessions and the ecosystem in designing tailored compensation strategies. The research revealed strong opposition to displacement, underscoring the need for customized compensation schemes that address preferences and non-monetary aspects. The discontent expressed by the respondents emphasized the importance of designing compensation schemes that ensure the sustenance of livelihoods without further disruptions. The study provided valuable guidance to stakeholders involved in addressing involuntary displacement, empowering them to make informed decisions and implement context-specific compensation policies. These findings contribute to the formulation of more effective and equitable compensation schemes, emphasizing comprehensive strategies for the welfare of affected households.

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

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

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

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

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

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

Background: Public engagement is needed to make sure urban forestry management efforts align with the values of the public being served. Noting this, we determined current and desired urban forest access of Florida (United States) residents using the criteria from the 3-30-300 rule (i.e., 3 trees visible from home, 30% canopy in neighborhood, and a green space within 300 meters of home). Methods: A survey of 1,716 Florida residents was conducted to assess canopy coverage and green space access. Respondents were then asked if this level of urban forest access was sufficient for their needs. We also asked their perceptions of the benefits and drawbacks of urban trees and whether they had any negative interactions with trees in the past. Results: We found that 37.3% of Florida residents met all three criteria of the 3-30-300 rule. Despite this, half the respondents would prefer more trees in their neighborhoods. When asked to name the top benefits provided by trees, the most common responses were shade, beauty, and attracting wildlife. The most common drawbacks to urban trees included risk to property, leaves/debris, and fears regarding storms and hurricanes. Conclusions: Florida residents largely value their urban forest and would like to see it maintained or enhanced. Improving access to greenspaces for recreation is the most pressing concern for urban forest managers in Florida looking to meet the requirements of the 3-30-300 rule. Results from this study can inform and test urban forest management at national and global scales.

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.

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.

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.

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.

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) 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.

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.

(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.

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.

Along with the advantages associated with access to information and fast communication, screen time from increased digital media consumption has recently been associated with adverse effects on youth well-being. To get a clearer picture of its value for global youth based sustainability initiatives, this study investigates the effects of increased digital media consumption on youth's interests in ecosystem services, sustainability and science as a means for disease prevention. We achieve this, using data on 187821 adolescent students from 50 countries worldwide. Methodologically, we rely on a mixed bivariate ordered probit representation of youth's joint interest in the biosphere (ecosystem services and sustainability) and science as a means for disease prevention, which we then estimate using Markov Chain Monte Carlo (MCMC) Methods. We found that each level increase in adolescent students' reported frequency of news blogs visits and web browsing on broad science adversely affect their interests in ecosystem services, sustainability and science as a means for disease prevention. Although each level increase in youth's frequency of ecological website visits also reduces by 20% (with 95% CI [-0.36; -0.32]) their interests in the biosphere, it is found to increase however by 3% (with 95% CI [0.02; 0.05]) their interest science as a means for disease prevention. Overall, our results highlight heterogeneous effects of digital media consumption on adolescents' well-being in terms of their interests in ecosystem services, sustainability, and science as a means for disease prevention.

Putting value to ecosystem services is something that society still refuses or simply ignores because it is not aware of the benefits that ecosystems provide us. In fact, people should be aware that a good understanding of ecosystem services can lead to win-win situations. Being aware of the importance of preserving the ecosystem and attaching value to its services will enable the development of self-sustaining strategies and appropriate policies for better ecological governance. Decades of over exploitation of natural resources, introduction and spread of alien species and, also, climate change, forest fires among other threats, have fostered biodiversity loss. The European Union Biodiversity Strategy has as one of its main goals to stop biodiversity loss and the degradation of ecosystem services; if possible, to recover the most threatened and degraded ecosystems, based on 20 Actions divided into 6 Targets. The present work falls within the scope of Action 5 of Target 2 – Improve knowledge of ecosystems and their services in the EU. The specific focus of this study is the Site of Community importance “Dunas de Mira, Gândara and Gafanhas” (Portugal) and the assessment of its ecosystem services, in accordance with the methodology proposed by the MAES (Mapping and Assessment of Ecosystems and their Services) Working Group. The work currently under way, a small segment of which is presented here, aims to identify, map and, when possible, assign value to the ecosystem services. For this purpose, modern GIS technologies will be used. This approach was implemented using a combination of data and tasks, including the photo-interpretation of Sentinel 2 (COPERNICUS Program) satellite imagery. The data geoprocessing tasks and image segmentation were developed using QGIS software and IMPACT Toolbox software (developed by the Joint Research Center – JRC, of the European Union), respectively. The analysis of Land Use and Burned Areas maps for the SCI "Dunas de Mira, Gândara and Gafanhas" led us to conclude that Forests ecosystems, the most affected by the fire of October 2017, continue to have the greatest expression in the area under study even though they have lost more than 50% of the area, and their services were also the ones most affected by the fire.

In the last decade, probably in response to global changes and environmental crisis, the use of the term “social-ecological system” (SES) in the scientific literature has been growing. This is certainly a sign of the recognition of the need and importance of transdisciplinary research. Here, we explore whether the use of the term is a buzzword, or it actually represents a key concept toward the integration of social and ecological research. We compiled a data base of publications (N = 1289) that mentioned SES in title, keywords and abstract. Subsequently, we analyzed: authors affiliations, type of work (conceptual, empirical, review), study site, prevailing human use, temporal and spatial scales of analysis, kind of variables analyzed (socioeconomic, biophysical), and the method/s used to integrate them. We detected four time spans in the use of the term (1975–1997, 1998–2006, 2007–2012, 2013–2016). Our results suggest that SES is a widely invoked concept to study the interface between social and ecological systems. Most works show some common elements such as the analysis of resilience, ecosystem services, sustainability, governance and adaptive management. However, the majority of studies does not study SES as a whole, integrating both social and ecological variables and their feedback loops. We consider that SES is still a concept in construction in order to build a necessary framework to integrate social and ecological sciences. For a robust evolution we recommend to focus on 1. a conscious, discussed and agreed effort of scientists to conduct transdisciplinary research needed to study SES; 2. developing methodological tools for the true integration of social and ecological data.

Given the cross-scale interactions of agricultural ecosystems, it is important to collect ecosystem service data at the multiple spatial scales they operate at. Mapping of ecosystem services helps to assess their spatial and temporal distribution and is a popular communication tool of their availability and value. For example, maps can be used to quantify distance between areas of available ecosystem services and their beneficiaries and how services fluctuate with changes in land use patterns over time, allowing identification of synergies and trade-offs. However, a lack of local context and too large a resolution can reduce the utility of these maps, whilst masking heterogeneities in access due to equity dynamics. This review identifies and summarizes eight main methods of ESS mapping found in the literature—remote sensing, biophysical modelling, agent based modelling, economic valuation, expert opinion, user preference, participatory mapping, and photo-elicitation. We consider what spatial scales these methods are utilized at and the transferability of data created by each method. The analysis concludes with a methodological framework for mapping ecosystem services, intended to help researchers identify appropriate methods for a multi-scale research design. The framework is exemplified with an overview of a research project in Ethiopia.

Scientific studies had shown that mixed forests of silver fir (Abies alba Mill.) and European beech (Fagus sylvatica L.) provide higher ecosystem services than monospecific forests. Mixed forests are known for their high resilience to climate change impacts and superior biodiversity compared to monospecific forests. In many countries, promotion of mixed forests in forest management is becoming a government policy since they can contribute to fulfill the Sustainable Development Goals set by the United Nation, respectively Goal 13 and 15. However, not much is known about public perceptions on mixed forests compared to monoculture forests. Our study on ecosystem services provided by mixed and monospecific forests in southwest Germany fill this gap. Based on a survey with 520 valid responses we analyzed people’s perception on 18 different supporting, cultural, regulating and provisioning ecosystem services measured by Likert scale. Stepwise regression analyses show relations between social profiles (gender, age, education, profession) and preferences on respondents’ perceptions. Our findings show that people perceive that mixed forests provide better cultural, regulating and supporting ecosystem services than monospecific forests of fir and beech whereas provisioning services were perceived as being equally or better provided by monospecific forests. Significant effects towards a positive perception on ecosystem services provided by mixed forests were mainly influenced by the perceived abundance of old trees, feeling of pleasantness in mixed forests, age, profession, and education. Our findings indicate that there is a high public support for the promotion of silver fir and beech mixed forests in Southwest Germany.

The article discusses early diagnosis and intervention for developmental delays in children, emphasizing the role of specialized services and personnel in supporting recovery and development. It presents findings from a pilot project initiated in Bucharest, aiming to assess the incidence of developmental delays in children aged 1-3 years in selected kindergartens, including ASD. The study involved children, parents, and specialists, utilizing systematic behavior observation (SBO) and semi-structured interviews. Results indicate that out of 613 evaluated children, 81 received specialized control recommendations, with 4 cases showing potential risk of ASD. Additionally, 8 children were diagnosed with autism. The incidence of autism in children aged 1-3 years was 1 in 51. Although exploratory, these findings suggest a model of good practice for future early diagnosis campaigns nationally. Conclusively, the study underscores the importance of early diagnosis and intervention for developmental delays, advocating for a responsive community and emphasizing the significance of national-level efforts to address these issues effectively.

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

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

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

Several studies have already demonstrated the relationship between the loss of natural habitats and the incidence of diseases caused by vectors, such as dengue, which is an acute fever disease, considered a serious public health problem. The aim of the present study was to analyze the relationship between land use changes between 2009 and 2019 and the occurrence of dengue fever in 2015 and 2019 by municipality, using the state of Minas Gerais as a case study. For this, secondary data obtained from openly available sources were used. Natural vegetation cover data were obtained from the MAPBiomas platform and dengue occurrence data from the Ministry of Health, in addition to socioeconomic indicators from the Brazilian Institute for Geography and Statistics. Between 2015 and 2019, 1,255,731 cases of dengue were recorded throughout the state of Minas Gerais, ranging from 0 to 227 per thousand inhabitants between municipalities. The occurrence of dengue was distributed throughout all regions of Minas Gerais, affected by climatic and socioeconomic aspects. In general, municipalities with net loss of natural vegetation, predominantly located in the Cerrado biome, had the highest number of dengue cases in the studied period. Despite the significant positive relationship between these two variables, three of the eight socioeconomic parameters analyzed also affected the occurrence of dengue: population density, human development index (both positively) and Gini inequality index (negatively). These results indicate that, contrary to expectations, municipalities with better social conditions had more dengue cases. Our study indicates that natural vegetation is, directly or indirectly, involved in the ecosystem service of dengue control, despite the occurrence of this disease being affected by multiple factors that interact in a complex way. Thus, policies towards reducing deforestation must be complemented by a continuous investment in public health policies and reduction of social inequalities to efficiently control dengue fever.

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

The present study examines the long-term care service awareness, needs, and usage intention of elderly male homosexuals in Taiwan and their ideal long-term care service model. This study of five elderly male homosexual subjects aged 66 to 73 years was intended as a preliminary exploration. Interviews were used to collect data. The study determined that the five subjects had high awareness of long-term care services, as they had actual experience of long-term care services or even participated in care service staff training to obtain certificates. Some even had experience in applying for home care services and experienced problems during use. The subjects perceived that they were very likely to require long-term care services in the future and tended to use home care services if they required long-term care services. Due to their personal experiences, the subjects had negative awareness of long-term care services and worried that long-term care service staff had poor attitudes toward homosexuals. The subjects considered the most important aspects of long-term care to be basic medical care and lifestyle care. However, they worried that long-term care staff would delay or refuse to provide such services due to the subjects’ sexual orientation or stereotypes, and they were concerned above all about the “friendly attitude” of long-term care staff. They hoped that long-term care staff were friendly toward homosexuals and did not discriminate against them, and they felt that it would be more appropriate for homosexual long-term care staff to provide assistance. In terms of vision, while preferring organizations with homosexual employees, the subjects worried that they would be stigmatized and discriminated against . With regard to ideal long-term care services, while considering institutions with homosexual staff to be ideal, the subjects also worried that these would be labeled as institutions that were dedicated to homosexuals, potentially resulting in discrimination. Therefore, they hoped that the sexuality sensitivity of long-term care staff could be improved and that they would undergo professional continuing education to learn about homosexuals, the situation and care needs of homosexuals, and care techniques for homosexuals.

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

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

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

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

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

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

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

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.

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.

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