Conservation of historical centres is a pressing need for Mediterranean countries, that are characterized by masonry aggregates representing the most typical construction type within cities. Masonry clustered buildings were usually designed without seismic design criteria. Moreover, the current seismic standard codes do not foresee a clear calculation method to predict their non-linear behaviour. For this reason, in this paper, a wide overview on the seismic response of masonry aggregates has been done considering analysis at different levels, from simplified large-scale evaluations to sophisticated non-linear analyses. In the former investigation kind, a vulnerability form appropriately conceived for clustered buildings has been applied to different historical centres with the aim to perform risk analysis considering both empirical approaches and real data deriving from occurred past earthquakes. In the second evaluation type, the macro-elements analysis method has been examined with reference to typical clustered buildings of the Italian territory. In particular, global assessments, performed using the 3Muri non-linear analysis program, have been performed with the final goal to derive fragility curves of structural units of masonry aggregates considering their plan position in the clustered building (end of row, internal, and corner).

Regulatory frameworks surrounding medical devices (MDs) and medical locations are of utter importance for safeguarding patients and users, and for granting a universal access to healthcare. Currently, as the main existing regulatory frameworks are drafted by high-income countries, they pretend to be general and applicable globally, but fail to understand particular contexts, specifically those in low-resource settings (LRSs), resulting, therefore, inapplicable. In particular, LRSs present a varied situation, with legal transplants of guidelines from their previous colonial regimes. This apparently theoretical issue, is, effectively, a tangible and rising matter of concern, given the ever-increasing number of MD patent applications per year, as well as the appearance of low- and middle-income countries (LMICs) on the MD market itself. This article will focus on the European Regulation on MDs 745/2017 and its applicability in LRSs, specifically presenting the case of Benin, a Sub-Saharan African country. This work is based on a field study conducted in 2019 in Benin, which is particularly exemplar to show the complexity of the “legal transplantation” concept. A multidisciplinary approach, comprising the standard tools and methods of ethics, law, and biomedical engineering, was used to draft a heuristic hermeneutic framework, and to analyse related bioethical issues concerning Medical Device Regulations (MDRs) in LRSs, the role of Maintenance, and other sociological questions; as well as the rural population’s perception on MDs and health technologies, and the role of ethics in the hospitals of LRSs. The definition of these themes helped approach the local perspective and define the research questions. Downstream of the analysis of the Medical Devices Regulations, the Maintenance and other bioethical issues in Benin, the heuristic hermeneutic framework was created to guide a shift in the paradigm of law and regulation making, so as to make them more contextualised and inclusive, globally. This article proposes a framework that will help policymakers take into account the particularism of each context, especially those of the most vulnerable countries, when drafting and issuing regulatory frameworks, promoting an ever-evolving model of universalism.

Vernacular architecture and its responses to natural factors through architectural patterns are recognized as expressions of bioclimatic principles and national architectural responses to location. The vernacular architectural heritage of architecture is one of the most important factors in preserving and developing the cultural identity of a nation. Through research on the vernacular architecture of the coastal area of Skadar Lake, our goal is to recognize and potentially valorize the local traditional characteristics of authentic houses as ecological building patterns, which also express the fundamentals of sustainability principles. Although examples of vernacular architecture are disappearing due to contemporary globalization, and a mere imitation of motifs from past periods occurs, the historical specifics of architectural expression remain the inspiration and catalyst for future achievements based on the idea of preserving the local and regional recognizability of architecture. This research resulted in a redefinition of vernacular, bioclimatic concepts in a way that preserves construction techniques, which basically have an ecological approach, and, at the same time, provides modern solutions with bioclimatic concepts. The case study conducted on the village of Karuč in the area of Skadar Lake presented in the paper contributes to revealing the potential of bioclimatic principles and the energy rehabilitation of vernacular architecture in order to revitalize it through a new contemporary architectural expression. This study’s contents propose revitalization solutions at two levels of the following: settlement and typical houses. The study also aims to create a model, that is, a modern expression of a characteristic Karuč house, with improved functionality and energy characteristics for national architecture. Identifying all the basic building patterns, including the positioning of buildings, construction, the application of available materials, and the design of buildings, this paper presents conditions for the adequate valorization and preservation of authentic vernacular architecture and creates guidelines for further upgrades and the bioclimatic revitalization of vernacular architecture in a certain location.

Rehabilitation must be based on the individual needs and specific goals of the person and must be adapted to his abilities. According to the recommendation of the World Stroke Organization, the team involved in conducting rehabilitation should be multidisciplinary. One of the treatments that are applied within the multidisciplinary approach to a neurological patient is educational-rehabilitation treatment, which is multi-component in nature. Before starting educational-rehabilitation treatment, an educational-rehabilitation clinical assessment is necessary, which aims to detect difficulties caused by impairment; identify potentials and constraints in these areas; determine the specifics, course, and forecasts of difficulties; formulate clear treatment recommendations; form a watch list that will be available to all team members in the process of diagnosis, treatment, education, and to evaluate the effectiveness of treatment; and continuously monitor the ability and adaptive behavior of the person. Educational-rehabilitation clinical treatment includes treatment of cognitive abilities, treatment of motor skills, relaxation, treatment of adaptive skills, as well as informing the person about the disease and counseling. This review focuses on some aspects of rehabilitation such as treatment of cognitive and motor disorders, treatment of adaptive skills, relaxation issues, and informing and counseling patients from the perspective of an educational rehabilitator with practical experiences in this area of rehabilitation.

Fundal or Kristeller’s pressure (FP) is known to be associated with numerous reports of severe maternal and fetoneonatal injuries, although it is used in a variety of modifications in many maternity hospitals and there is no evidence based on medical evidence of its effect on good clinical practice (Habek et al. 2008; Gimovsky and Berghella 2022). Peripartum pneumothorax (PPT) is a life-threatening clinical curiosity most commonly associated with pre-existing lung disease (lung cysts, tumours and bronchiectasis) and increased intrathoracic pressure associated with peripartum induced Valsalva’s manoeuvre and distal alveolar rupture. It is more common in pregnancy than in childbirth alone or in combination with Hamman’s syndrome (pneumomediastinum, pneumothorax and subcutaneous emphysema) with also extremely rare incidence in 1:2000 to 1:100,000 births (Najafi and Guzman 1978; Oshovskyy and Poliakova 2020). From the non-litigating Croatian obstetric practice, the case of a PPT in healthy primipara, without comorbidity and normal course of pregnancy and spontaneous term delivery is known. The parturient somatogram was unfavourable in terms of short stature (156 cm) and body weight of 68 kg, orderly eutrophic newborn and the course of the first labour phase. During the end of the II labour stage, the obstetrician decided on FP and with episiotomy, a live eutrophic newborn was born with Apgar score 10/10. Immediately after the birth, the mother became tachydyspnoic, cyanotic, tachycardic, hypotonic, with signs of acute respiratory insufficiency, so obstetric embolism was suspected, which was excluded by radiographic, electrocardiographic and laboratory methods. However, right-sided complete PPT without pulmonary or other intrathoracic pathological condition was verified, and with thoracentesis and drainage, there was complete reexpansion of the lungs and recovery of the mother with several days of subcutaneous emphysema. In 1978, seven cases of spontaneous PPT were presented in a pulmonary comorbidity (pulmonary cyst) using forceps with episiotomy in childbirth (Najafi and Guzman 1978), and Oshovskyy and Poliakova (2020) recently demonstrated intrapartum development of the syndrome Hamman which fully recovered by thorakocenthesis. FP could certainly have been avoided due to the orderly course of labour and the absence of maternal pulmonary comorbidity, and its application has contributed to the emergence of a life-threatening condition of the mother, which is beyond the scope of good clinical obstetric practice. Based on many years of clinical and forensic practice, we agree with the opinion of the authors of numerous papers and reviews of cases of obstetric injuries (Habek et al. 2008; Hasegawa et al. 2015; Zaami et al. 2018; Malvasi et al. 2019; Habek 2021; Gimovsky and Berghella 2022), FP is not recommended in modern obstetrics as a method of assistention during delivery. In this case shown, it can certainly be interpreted as iatrogenic rather than spontaneous PPT due to unnecessary and inappropriate force in normal, spontaneous childbirth.

Checkpoint inhibitor immunotherapy has revolutionised cancer treatment. However, immunotoxicity due to dysregulated immune control can affect a range of non-cancer tissues causing dermatitis, colitis and endocrinopathies in up to 80% of exposed patients. Peripheral nerve neurotoxicity is rare (<5%) and described as GBS-like or CIDP-like in published case series. Here we present two cases of checkpoint inhibitor associated peripheral neuropathy suggesting this neuritis is a novel pathological entity. Case 1 55-year-old man treated with nivolumab and ipilimumab for renal cell carcinoma developed painful sensory predominant neuropathy after cycle 1. Gait impairment led to discontinuation by cycle 3. NCS revealed axonal loss and conduction slowing but no demyelinating features. He was treated with IVIg without response. Case 2 55-year-old woman with metastatic melanoma was treated with pembrolizumab for 16 months without complication. Within weeks of change to nivolumab she developed painful neuropathic symptoms causing difficulty walking. Neurophysiology was similar to case 1 but she improved to normal with high dose corticosteroids over 4 months. Both sural nerve biopsies showed active large fibre degeneration with diffuse, predominantly T cell inflam- matory infiltrate. No malignant cells. No evidence of a primary demyelinating pathology. This novel inflammatory neuropathy warrants recognition due to alternative treatment response.

In this article, the corrosion inhibition of steel DIN 2391 St 37-4 in acidic medium 5% H2SO4 with and without the presence of eco inhibitors of leaf (Petroselinum Sativum) was examined. Inhibitory properties of parsley leaves (Petroselinum Sativum) on steel DIN 2391 St 37-4 were examined by potentiodynamic polarization - Tafel extrapolation, and FTIR method in order to categorize the oxide layer. The test was performed in static medium and with stirring at 600 rpm. By Tafel extrapolation based on changes in corrosion potential, the inhibitor behaves as mixed. Increasing the concentration of inhibitors increases the efficiency of inhibition. Corrosion processes are inhibited by adsorption of organic matter on the surface of steel DIN 2391 St 37-4, forming a film. The obtained results indicate that parsley leaf (Petroselinum Sativum) is an effective eco inhibitor for the tested steel in 5% sulfuric acid.

Abstract Background In Southeast Europe (SEE) standard treatment of patients with psychosis is largely based on pharmacotherapy with psychosocial interventions rarely available. DIALOG+ is a digital psychosocial intervention designed to make routine care therapeutically effective. This trial simultaneously examined effectiveness of DIALOG+ versus standard care on clinical and social outcomes (Aim 1) and explored intervention fidelity (Aim 2). Methods A hybrid type II effectiveness–implementation, cluster-randomized trial was conducted in five SEE countries: Bosnia and Herzegovina, Kosovo*, Montenegro, North Macedonia, and Serbia. The intervention was offered to patients six times across 12 months instead of routine care. The outcomes were subjective quality of life (primary), clinical symptoms, satisfaction with services, and economic costs. Intervention fidelity was operationalized as adherence to the protocol in terms of frequency, duration, content, and coverage. Data were analyzed using multilevel regression. Results A total of 81 clinicians and 468 patients with psychosis were randomized to DIALOG+ or standard care. The intervention was delivered with high fidelity. The average number of delivered sessions was 5.5 (SD = 2.3) across 12 months. Patients in the intervention arm had better quality of life (MANSA) at 6 months (p = 0.03). No difference was found for other outcomes at 6 months. Due to disruptions caused by the COVID-19 pandemic, 12-month data were not interpretable. Conclusions DIALOG+ improved subjective quality of life of individuals with psychosis at 6 months (after four sessions), albeit with small effect size. The intervention has the potential to contribute to holistic care of patients with psychosis.

Objectives Comprehension of speech in adverse listening conditions is challenging for hearing-impaired (HI) individuals. Noise reduction (NR) schemes in hearing aids (HAs) have demonstrated the capability to help HI to overcome these challenges. The objective of this study was to investigate the effect of NR processing (inactive, where the NR feature was switched off, vs. active, where the NR feature was switched on) on correlates of listening effort across two different background noise levels [+3 dB signal-to-noise ratio (SNR) and +8 dB SNR] by using a phase synchrony analysis of electroencephalogram (EEG) signals. Design The EEG was recorded while 22 HI participants fitted with HAs performed a continuous speech in noise (SiN) task in the presence of background noise and a competing talker. The phase synchrony within eight regions of interest (ROIs) and four conventional EEG bands was computed by using a multivariate phase synchrony measure. Results The results demonstrated that the activation of NR in HAs affects the EEG phase synchrony in the parietal ROI at low SNR differently than that at high SNR. The relationship between conditions of the listening task and phase synchrony in the parietal ROI was nonlinear. Conclusion We showed that the activation of NR schemes in HAs can non-linearly reduce correlates of listening effort as estimated by EEG-based phase synchrony. We contend that investigation of the phase synchrony within ROIs can reflect the effects of HAs in HI individuals in ecological listening conditions.

ABSTRACT The COVID-19 pandemic has significantly impacted the forest-products industry locally and globally, including the availability of raw materials, supply chain, production, and product sales. Therefore, it was essential to study the effect of COVID-19 in Central and Southeast European countries, including Slovenia, Croatia, Serbia, and Bosnia and Herzegovina, where the forest-products industry plays a vital global role. An international group of wood scientists developed and implemented the web-based questionnaire that consisted of four parts: demographic questions, production changes, COVID data gathering, governmental response to COVID-19, and lessons learned. Participants were mainly from furniture production, joinery, and wood processing. Results indicate that more than 80% of respondents reported negative changes. The COVID-19 pandemic has seriously affected the supply chain, and the most significant changes were in the availability of solid wood (23%) and engineered wood products (21%). Among the most critical issues were increased prices of all materials, increased transportation costs, extended delivery times, limited quantities for all materials, and total disruption of supply chains.

The fifth edition of the WHO Blue Book on urological tumours, specifically in the bladder chapter, represents a refinement and update in the classification of bladder tumours building on the aggregate major changes made in previous editions. Progress in the molecular underpinnings of urothelial tumours, particularly with promising stratifiers for more precision‐based treatment approaches, have been made. Special attention has been paid to burning questions in bladder pathology, such as grading, heterogeneous lesions, inverted tumours and substaging. The concept of neuroendocrine tumours will be explained precisely.

Background Despite anterior cruciate ligament (ACL) re-ruptures being common, research on patient experiences after knee trauma has primarily focused on the time after primary ACL reconstruction. Integrating qualitative research and patient experiences can facilitate researchers and clinicians in understanding the burden of an ACL re-rupture. The aim of the study was to explore the experiences of an ACL re-rupture journey in young active females aiming to return to knee-strenuous sports after primary ACL reconstruction. Method Fifteen young (19[range 16–23] years old) active females who suffered an ACL re-rupture were interviewed with semi-structured interviews. Qualitative content analysis using deductive approach based on Wiese-Bjornstal’s ‘integrated model of response to sport injury’ was used. Results The results are presented in two timelines 1) from first ACL injury to ACL re-rupture, and 2) from ACL re-rupture to present day, and further stratified according to the domains of the ‘integrated model of psychological response to injury’. Results in the first timeline are summarised into seven categories: Finding hope for the journey; Accepting my ACL injury; I succeeded; What matters now? Who am I?; Where will this end? What is going to happen? In the second timeline, eight categories were identified: Fighting spirit; A helping hand; Working hard; I am a new me; I am destroyed; Loneliness; Painful changes; and, I could have made it to the pro´s. Conclusion Young active females who suffered an ACL re-rupture did not express any positive experience following their first ACL injury, however, in contrast, expressed positive experiences and personal growth after going through the ACL re-rupture journey, characterized by a lot of struggling, and ultimately led to the experience of becoming a new, stronger person.

The aim of this research was to determine the differences related to morphological characteristics and body composition among female players of Montenegro national junior volleyball team and Kosovo national junior volleyball team. A sample of the subject consists of a total of 25 top-level female junior players who were members of two national teams, participants of the European Championship qualifying 2020. The first sub-sample of the subjects consisted of 13 players of National team of Montenegro, of the average age 17.13 ± 0.54, while the other sub-sample consisted of 12 players of National team of Kosovo, of the average age of 16.35 ± 0.41. Anthropometric characteristics in the body composition were evaluated by a battery of 11 variables: body height (cm), body weight (kg), triceps skinfold (mm), back skinfold, biceps skinfold, abdominal skinfold, thigh skinfold, calf skinfold, body mass index (BMI), percentage of fat (%) and muscle mass (kg). Statistically significant differences (p< 0.05) between body composition and morphological characteristic of the female volleyball players of two national teams, Montenegro and Kosovo, were determined by using a discriminatory parametric procedure with t-test for small independent samples. The results showed that the female volleyball players of Montenegro are somewhat higher, also they have greater body mass index, greater muscle mass and a significantly lower percentage of fat, compared to the female volleyball players of Kosovo. When it comes to variables of skinfolds, it was demonstrated only one statistical significance in favor of the Montenegrin National team, variable skinfold thigh.