Preventing unplanned hospitalisations, including readmissions and re-presentations to the emergency department, is an important strategy for addressing the growing demand for hospital care. Significant successes have been reported from interventions put in place by hospitals to reduce their incidence. However, there is limited use of data-driven algorithms in hospital services to identify patients for enrolment into these intervention programs. Here we present the results of a study aiming to develop algorithms deployable at scale as part of a state government’s initiative to address rehospitalizations and which fills several gaps identified in the state-of-the-art literature. To the best of our knowledge, our study involves the largest-ever sample size for developing risk models. Logistic regression, random forests and gradient boosted techniques were explored as model candidates and validated retrospectively on five years of data from 27 hospitals in Queensland, Australia. The models used a range of predictor variables sourced from state-wide Emergency Department(ED), inpatient, hospital-dispensed medications and hospital-requested pathology databases. The investigation leads to several findings: (i) the advantage of looking at a longer patient data history, (ii) ED and inpatient datasets alone can provide useful information for predicting hospitalisation risk and the addition of medications and pathology test results leads to trivial performance improvements, (iii) predicting readmissions to the hospital was slightly easier than predicting re-presentations to ED after an inpatient stay, which was slightly easier again than predicting re-presentations to ED after an EDstay, (iv) a gradient boosted approach (XGBoost) was systematically the most powerful modelling approach across various tests.

In a recent study published in Nature Serger connected intermittent fasting (IF) to gut microbiome alterations and enhanced peripheral nerve regeneration following injury. 1 Fasting has been purported to have neuroregenerative effects, but the underlying mechanisms remained unclear. The authors found that IF-induced elevation of IPA (a microbiome-derived metabolite) promotes neutrophil in fi ltration into the dorsal root ganglia (DRG), which enhances the regeneration of sciatic nerve fi bers 1). 2 for

This letter to editor contains an overview of commentary article in which the authors explain how they designed the novel biomarker. The Electrophysiologic Coefficient of Depressiveness - δEPCD detects the presence of a depressive disorder while being able to quantify its severity. This biomarker follows vital function - high frequency heart rate variability in relation with neuroactive metabolic components - concentration ratio between quinolinic acid, and kynurenine acid and it is both sensitive and specific in regard to depressive disorders. Diagnostics of depressive disorders could be improved by checking this novel biomarker and/or re-assessment of individuals who might have depression as well as in rising the awareness about the depressive disorders' prevalence and treatment. So far biomarkers have been classified as dynamic (descriptive) or static (prognostic). With this new complex biomarker, that comprises potentials of both categories, we might be able to introduce a new category - a physiological biomarker. Physiological biomarkers should not have exclusive application within the depressive disorder, but the future research should identify more physiological biomarkers related to other diseases.However, the findings need further evidence procuring new information regarding diagnostics of depressive disorders. Though it presents a novel methodology which would add to a biomarkers research, more specifically type-classification, lack of clear and concise protocol regarding clinical interpretation and a consistent administrative structure and/or logistics to perform the measurements are present. For this reason, further research in different settings and on a larger sample size are necessary.

Archaeological sites from prehistory are very important for understanding humanity. However, they are very difficult to understand for common visitors. We see traces of excavations and fragments of archaeological findings, but we do not grasp their meaning. Interactive digital storytelling has potential to present the significance of these sites and make them attractive and educational at the same time. We will show this through the case study of Crvena stijena in Montenegro, presented in a Virtual Reality application. Through interactive stories, gameplay and digital replicas of archaeological findings the users obtain better perception of the physical site and are attracted to visit the museum.

In the last decade, substantial differences in the epidemiology of, antiretroviral therapy (ART) for, cascade of care in and support to people with HIV in vulnerable populations have been observed between countries in Western Europe, Central Europe (CE) and Eastern Europe (EE). The aim of this study was to use a survey to explore whether ART availability and therapies have evolved in CE and EE according to European guidelines.

Small bowel and ileocecal diseases remain a diagnostic and therapeutic challenge, despite the introduction of various modalities for deep enteroscopy. Novel Motorized Spiral Enteroscopy is an innovative technology that uses an overtube with a raised spiral at the distal end to pleat the small intestine. It consumes less time and meets both the diagnostic and therapeutic needs of small bowel diseases. The objective of this article is to highlight the possibility of using NMSE as an alternative technique when a target lesion is inaccessible during conventional colonoscopy or cecal intubation cannot be achieved. We report the case of a 61-year-old man who presented with pain in the right lower abdominal segment, diarrhea, and rapid weight loss for more than 3 months. An initial ultrasound showed a suspicious liver metastasis. Computerized tomography scans showed an extensive ileocecal tumor mass with liver metastasis. The colonoscopy was unsuccessful and incomplete due to dolichocolon and intestinal tortuosity. Later, endoscopy was performed using a Novel Motorized Spiral Enteroscope in a retrograde approach, passing the scope through the anus and colon up to the ileocecal segment, where a tumor biopsy was performed and adenocarcinoma was pathohistologically confirmed.

The process of improving tourism requires prior determination of the existing offer, as well as assessment of the advantages and weaknesses of the given offer. Upon the analysis, it is possible to improve the tourist offer. This study examined ways in which agro-tourism can be improved, related to the foundation of sustainability. Methodologically, this article involves the use of expert assessment, additionally supported with fuzzy logic based on the fuzzy PIPRECIA and fuzzy MARCOS methods. Using the fuzzy PIPRECIA method, the criteria and sub-criteria were weighted, while the observed agro-tourism facilities in Bosnia and Herzegovina (BiH) were ranked according to the applied fuzzy MARCOS method. The results of the application of the fuzzy PIPRECIA method showed that for experts the most important are economic criteria, then environmental, and the latter important are social criteria. The most important sub-criterion is the quality of services. Out of the six facilities in question, the most appropriate results are achieved at the “Šadrvan” rural household, while the worst outcome is exhibited at the agro-tourism facility, (rural household) “Kovačević.” Sensitivity analysis confirmed these results. The aim of this article was to evaluate the agritourism offer in BiH, taking into consideration these six agritourism facilities. Based on that, it is necessary to determine on what advantages to build agritourism in BiH, and what should be corrected in order to be more competitive. Based on the obtained results, the facilities management should determine which sustainability criteria would need to be improved, as well as on which criteria it is desirable to build a competitive advantage, aiming to advance the tourist offer.

Ectopic liver is defined as the presence of normally organized liver tissue outside its normal location. It is frequently found in the gallbladder. Ectopic liver is normally asymptomatic and only discovered incidentally. We report a case of 51- year- old woman with ectopic liver and we also review the characterization of this rare entity .This report adds another case to the very rarely reported ectopic liver located in the gallbladder.

Globalization and transition are two processes that have the same goal and that goal is to change the current or existing state. Globalization is change on a global scale while the transition is taking place within one or more countries. Globalization has made the world different. From the first economists Adam Smith and David Ricardo to today's economic theorists, the basis of social change, especially at the global level, is a change in the sphere of economy and in the economic structure of both the developed and the developing countries. Economic changes condition both the social as well as the political changes. These changes do not come one without the other. The common basis and desire of the agents of change is to achieve them in accordance with the set goals and achievements that are desirable for its protagonists. However, changes often take place against the will and expectations of its protagonists and actors. The consequences are often unpredictable although controlled and programmed. The programmed changes are part of the globalization strategy whose actors are developed countries.

People face various evaluative situations in which their abilities, skills, traits, knowledge and the like are tested throughout their lives. Since school success, employment opportunities, and career advancement are almost always dependent on success in various test types, many of those evaluations have serious consequences for people’s lives and future. Most people have a specific type of anxiety present in evaluative situations, also known as test anxiety. The aim of this review article is to provide an overview of knowledge about test anxiety, its structure, many causes and risk factors, various symptoms and consequences, and preventive measures and interventions that are commonly applied in practice. Since test anxiety is most prevalent in pupils and students, the last part of the article provides guidelines for pupils, students, and teachers on how to lower the test anxiety level

PurposeThe research aims to examine the varying influence of printed inkjet ink on the warm/cool feeling and air permeability of printed textile materials and thus on the thermal properties of printed garments.Design/methodology/approachThe influence of different number of printing pass and different tone value (TV) coverage was examined. The tested samples were printed with water-based pigment inkjet inks with 10, 50 and 100% TVs with one, three and five printing passes. The tested samples were subjected to thermal characteristics testing by measuring the warm/cool feeling and air permeability before and after printing.FindingsThe research results showed that there is an increase in the value of the warm/cool feeling by increasing the amount of applied ink on the textile material, which occurs by increasing the TVs and the number of printing pass. At the same time values of air permeability decrease by increasing the number of printing pass, as well as by increasing TVs.Originality/valueBased on the results, mathematical models of the dependence of the warm/cool feeling value of printed textile materials on the air permeability and parameters of digital inkjet printing were created. These models are important in clothing design because they show in advance the values of the warm/cool feeling of the clothes being designed and thus enable the design of clothes for different purposes with optimal esthetic and thermal properties.

Background Given the fact that the studies that examined oxidative stress in relation to obesity that included late adolescents are scarce and show inconclusive results we aimed to investigate a wide spectrum of nitro-oxidative stress biomarkers i.e., malondialdehyde (MDA), xanthine oxidase (XO), xanthine oxidoreductase (XOD), xanthine dehydrogenase (XDH), advanced oxidation protein products (AOPP) and nitric oxide products (NOx), as well as an antioxidative enzyme, i.e., catalase (CAT) in relation with obesity in the cohort of adolescent girls ages between 16 and 19 years old. Methods A total of 59 teenage girls were included in this cross-sectional study. Binary logistic regression analysis was performed to examine possible associations between biochemical and nitro-oxidative stress markers and body mass index (BMI). Results There were not significant differences between oxidative stress markers between normal weight and overweight/obese girls (i.e., AOPP, XOD, XO, XDH) and CAT, except for MDA (p<0.001) and NOx (p=0.010) concentrations which were significantly higher in overweight/obese adolescent girls. Positive associations were evident between BMI and high sensitivity C-reactive protein (hsCRP) (OR=2.495), BMI and uric acid (OR=1.024) and BMI and MDA (OR=1.062). Multivariable binary regression analysis demonstrated significant independent associations of BMI and hsCRP (OR=2.150) and BMI and MDA (OR=1.105). Even 76.3% of the variation in BMI could be explained with this Model. Conclusions Inflammation (as measured with hsCRP) and oxidative stress (as determined with MDA) independently correlated with BMI in teenage girls.

Abstract Background Accumulated evidence on risk factors for adverse COVID-19 outcomes revealed that old age and male sex are main associates, next to pre-existing comorbidities, as analysed from scattered single cohorts of hospitalised COVID-19 patients of accessible electronic medical records. Hence, evidence from federated analyses is called for to provide a more comprehensive and robust analyses of risk factors. Methods Using the unCoVer network, i.e., a research platform of 29 partners for the expert use of patient data as routinely gathered in real-world healthcare settings, present analyses restricted to available data of four hospitals from Spain, Slovakia, Romania and Bosnia and Herzegovina covering 8,287 hospitalised COVID-19 patients. In-hospital death after COVID-19 diagnosis was examined in relation to common pre-existing comorbidities using virtual pooling of logistic regression models adjusted for age and sex. Results Patients were on average 60.1 (± 20.9) years, 50.7% were male, almost half (43.3%) had at least one pre-existing comorbidity (17.4% having obesity, 21.9% hypertension, 18.0% diabetes and 13.7% cardiovascular diseases (CVD)), and 12.6% died during hospitalisation. Patients with comorbidities had a higher risk of mortality that was increasing with the number of comorbidities: from a virtual pooled odds ratio of 1.16 (95%CI: 0.96, 1.40) for one vs none to 1.30 (1.04, 1.64) and 2.14 (1.64, 2.79) for two and three or more comorbidities, respectively. Of the comorbidities, highest risk was seen for CVD (1.68; 1.40, 2.01), followed by hypertension (1.40; 1.19, 1.64) and diabetes (1.27; 1.07, 1.50), and the lowest for obesity (1.13; 0.94, 1.37). Conclusions By federated analyses, this study confirmed that the number of comorbidities was a strong risk factor for in-hospital death after COVID-19, in particular CVD. The unCoVer platform pursues using scattered data sources by innovative computational resources and integrated information for enhanced impact. Key messages Federated analyses, capable of streamlining ethical and legal aspects, provide unique opportunities for robust results to inform public health. Higher COVID-19 in-hospital mortality risk with increasing number of comorbidities.