This study aimed to examine the impact of personality on glycemic regulation in adult patients with type 1 diabetes mellitus (T1DM). The study group consisted of subjects with T1DM, who were ≥ 18 years of age. The study was conducted in two phases: At baseline, subjects completed the Croatian version of the International Personality Item Pool scale (IPIP50s) and a questionnaire designed to gather socioeconomic data, duration of diabetes, presence of chronic complications, presence of cardiovascular risk factors, frequency, and type of pre-existing hypoglycemic episodes per week. Blood and urine samples were collected and body mass index (BMI) was calculated. Each participant was provided with the intermittently scanned glucose monitoring system (isCGM) Freestyle Libre. During the second visit (3 months from the start of the trial), glycemic parameters were collected from the reports generated from the Freestyle Libre system. Estimated glycated hemoglobin (HbA1c) values were significantly lower after three months compared to baseline HbA1c (Wilcoxon test, p < 0.001). An inverse correlation between the number of daily scans and degree of extraversion among subjects was observed, e.g., higher degrees of extraversion resulted in lower numbers of daily scans, while lower degrees of extraversion, i.e., introvertedness, resulted in higher numbers of daily scans (Rho = −0.238 p = 0.009). There was a positive correlation between emotional stability and time spent in hypoglycemia (Rho = 0.214; p = 0.02). In addition, a shorter duration of diabetes was associated with higher percentages of TIR and vice versa (p = 0.02). Investigating personality traits can be a useful tool for identifying patients predisposed to hypoglycemia and lower scanning frequency. Patients with a longer history of T1DM require closer follow-up and should be re-educated when necessary.

Due to higher requirements for achieving sustainable development goals, current challenging sociopolitical climate and internationalization, business models remain problematic, resulting in a more complex global competition among firms and the need for sustainability incorporation. Throughout this study, a conceptual model based on the systematic literature review was applied as the methodology, with the study's purpose to propose the new Model of Continuous Enterprise Sustainability, which is designed to facilitate and enhance enterprise management in today's demanding and complex business environment by providing concise steps for effectively incorporating sustainability into day‐to‐day business activities. Five essential components, through their interconnectedness, form the Model of Continuous Enterprise Sustainability, which smooth the path of sustainable management in a dynamic environment, which are as follows: (1) situational factors, (2) creating factors/processes, (3) triple‐sustainable results, (4) organizational results, and (5) continuous stakeholder communication, optimization, innovation and learning. This conceptual model contributes in the first line to advancement and detail explanation of how to achieve sustainable human, financial and natural resources management within enterprises. In addition to directions for sustainable internal resources management, this model also involves clarification how to strategically manage with external resources and prime stakeholders in order to integrate meaningful sustainability matters in firm's business core and create continuously greater value for firm and its prime interested parties.

Introduction Various side effects and complications in the perioperative period can occur with the use of hyperbaric lidocaine and bupivacaine. Goal Comparative presentation of the occurrence of side effects and complications of hyperbaric lidocaine and bupivacaine during spinal anesthesia in our patients. Methods The study was retrospective and included 178 patients of both sexes. Patients were divided into two groups. In Group I (n-98) hyperbaric lidocaine 5% was used for spinal block. Group II (n-80) was divided into 2 subgroups, A- where hyperbaric Markain 0.5% was used (n-51), and B (n-29) where hyperbaric Sensorkain 0.75% was used. In the study, we analyzed gender, age, block onset, and complications. Results There were 98 patients in Group I, 79 males and 19 females. There were 80 patients in Group II, 69 males and 11 females. The mean age of patients in Group I was 44.96 and in Group II 48.16 years. There was no statistically significant difference in the age of patients in both groups p> 0.05 (p = 0.2321). The occurrence of spinal block occurred significantly faster in Group I compared to group II (p <0.0001), and in subgroup B faster than in subgroup A (p <0.005). The clinical occurrence of complications and side effects during spinal anesthesia is somewhat more common in spinal block with 5% lidocaine. Conclusion The compared incidence of adverse perioperative clinical effects and complications after administration of hyperbaric lidocaine and bupivacaine in spinal anesthesia was not statistically significant.

Introduction Healthcare utilisation requires knowing one’s entitlements and how to access them (navigation) and having access to grievance redressal when entitlements are denied. To ensure citizen access to and use of health insurance entitlements, the Health Insurance Fund established an initiative called the Protector of Patients’ Health Insurance Entitlements (PPHIE). PPHIEs are supposed to provide patient navigation and grievance redressal services. This paper explores to what extent this initiative meets its objectives and is used by the elderly in rural areas. Methods This study employed a mixed methods approach. We conducted in-depth interviews with elderly patients in rural areas, PPHIEs, health providers and health insurance managers (N=39), as well as focus groups (N=5) and a household survey (N=715) with elderly rural patients. Qualitative data were analysed using content analysis, and the household survey results were analysed using descriptive statistics. Results The majority of elderly patients were not aware of the PPHIE initiative and instead received patient navigation support from their healthcare providers. The PPHIE programme was poorly publicised among the population. Although PPHIEs had a mandate to pursue grievance redressal they rarely did so, and their role in the system was more symbolic than functional. Conclusion While healthcare providers have (by default) filled the navigation role left by inactive PPHIEs, the grievance redressal role remains unfilled. Information about health insurance entitlements and access to grievance redressal must be provided through visible, accessible and efficient mechanisms that should be continuously monitored and improved.

High-voltage direct current (HVDC) circuit breaker development and deployment strongly depend on the testing process, which ensures that the HVDC circuit breakers will satisfy design requirements. This article presents an HVDC circuit breaker test bench circuit configuration that can provide controllable large output currents to simulate different fault conditions for the current breaking test and high output voltage for the dielectric withstand test. The current breaking test circuit is based on multiple cascaded power converters connected in parallel to provide the necessary output current capability. Each cascaded power converter is composed of multiple cells that are operated by a phase-shifted pulsewidth-modulated signal for greater controllability and higher quality of the output waveform. The dielectric withstand test circuit is a simple high-voltage source with a low power rating that can also be used to charge the test bench and the internal circuitry of the circuit breaker that is to be tested. The proposed test bench ensures that fault conditions can be replicated accurately and offers greater flexibility by being able to test mechanical, semiconductor-based, or hybrid HVDC circuit breakers with different current and voltage ratings on the same hardware without any changes. The idea and the operating principle of the proposed test bench are verified experimentally on a downscaled system that consists of three cascaded power converters connected in parallel with three cells per cascaded power converter and with a total equivalent switching frequency of 92.5 kHz.

Objective. To identify the type of the non-invasive ventilatory treatment for patients diagnosed with chronic obstructive pulmonary disease (COPD), with respiratory status deteriorated by COVID-19 pneumonia, and in need of treatment in the Intensive Care Unit (ICU). Materials and Methods. This cross-sectional study was conducted over a one-year period in the medical intensive care units of two hospitals. As the patients’ clinical condition deteriorated and the parameters of the arterial blood gas (ABG) analysis worsened, oxygen support was applied via a high flow nasal cannula (HFNC) or by non-invasive positive pressure ventilation (NPPV). According to the control values of the arterial oxygen saturation (SaO2) and the parameters of ABG, the patients were enabled to be transferred between the two types of non-invasive ventilatory support. The primary outcome was the length of hospital stay, while secondary outcomes were the rate of intubation, the mortality rate, and respiratory support-free days. Results. Out of 21 critical patients with COPD and COVID-19, 11 (52.4%) were initially treated with NPPV and 10 (47.6%) with HFNC. The ages (67±9.79 in NPPV group vs. 70.10±10.25 in HFNC group) and severity of illness (SOFA score 5 (3.5) in NPPV group vs. 5 (2.8) in HFNC group) were similar between the two groups. Switching the mode of respiratory support was more common in NPPV (58.3% in survivor group vs. 41.7% in non-survivor group). Patients treated with NPPV compared to HFNC had a nominally longer length of stay (15 (11) vs. 11.5 (4.25)), and higher risk of intubation (66.7% vs. 33.3%) and mortality (66.7% vs. 33.3%), but the comparisons did not reach statistical significance. Survivors had significantly longer Medical Intensive Care Unit and hospital stays, but significantly lower FiO2 (0.60 vs.1) and higher values of PaO2/FiO2 (78(32.4) vs. 56.3(17.8)) than non-survivors. All patients were treated with corticosteroids, and the duration of treatment was similar between groups. Conclusion. In critically ill patients with COPD and COVID-19, both HFNC and NPPV were commonly used as the initial mode of ventilation. Switching to a different mode and adverse patient outcomes were more frequent in patients initially treated with NPPV. Survivors had higher values of PaO2/FiO2 than non-survivors.

Abstract This scientific paper examines the relationship between macroeconomic variables whose performance is measured under the implementation of Quantitative Easing in the US, by estimating vector autoregression (VAR) and Impulse Response Function with monthly data from US Federal Reserve, observed during the period January 1994-January 2022. Variables include: Consumer Price Index (CPIAUCSL); Industrial Production (INDPRO); Unemployment Rate (UNRATE); Interest Rates, Government Securities, Government Bonds (INTGSBUSM193N); Volatility Index (VIXCLS), Real Broad Effective Exchange Rate (RBUSBIS), Federal Surplus or Deficit (MTSDS133FMS), Money Supply M1 (WM1NS), M2 (WMNS), M3 (MABMM301USM189S). An evidence on macroeconomic variables of Consumer Price Index and Industrial Production when evaluating the effectiveness of QE is provided.

The integration of renewable generation in electrical power systems is exponentially increasing for multiple reasons. First, a fast decarbonization of the electrical energy system is a critical milestone to slow climate change and facilitate the decarbonization of other energy sectors, such as transportation and heat. Second, renewable generation from wind and solar have become much cheaper compared to conventional sources like gas, coal, and nuclear. Third, renewable generation is in many cases decentralized, which increases the resilience of the energy system, for example, in the face of natural disasters.

Reliable power system operation with 100% inverter-based resources (IBRs) is an unsolved and challenging problem. One of the most challenging factors is ensuring power system stability after N-1 contingencies. This paper presents a promising solution using an operator support system (OSS) to enable stable operation of power system with up to 100% IBR generation. The OSS consists of two components. First is dynamic security assessment to evaluate the system resiliency, and identify critical N-1 contingencies that could endanger the system. The second component, as the key technology behind the OSS, is dynamic security optimization (DSO). The DSO optimizes the control parameters of generators and inverters to improve the stability of the system towards the identified N-1 contingencies. The key to system with 100% IBRs, as emphasized in many recent studies, is to establish the grid frequency reference using grid-forming (GFM) inverters. We show through high-fidelity Electro-Magnetic-Transient (EMT) simulations of the future generation models of Hawai‘i Island system with 100% IBR capacity that a system with 100% IBRs can be operated stably with the help of GFM inverters, and appropriate controller parameters can be found by DSO for the inverters. The DSO is verified via 28 critical N-1 contingencies of Hawai‘i Island system identified by Hawaiian Electric. The simulation results verify the effectiveness of DSO, and show significant stability improvement from DSO.

Introduction Systemic corticosteroids are the mainstay of treatment for immune checkpoint inhibitor induced (CPI) colitis but are associated with complications including life-threatening infection. The topically acting oral corticosteroid beclomethasone dipropionate (BD) is an effective treatment for mild to moderate flares of ulcerative colitis, and has fewer side effects than systemic corticosteroids. We hypothesized that BD would be an effective treatment for CPI-induced colitis. Methods We performed a retrospective analysis of all patients who started BD for CPI-induced colitis at three UK cancer centers between November 2017 and October 2020. All patients underwent endoscopic assessment and biopsy. The initial regimen of BD was 5 mg once daily for 28 days. Data were collected from electronic patient records. Clinical outcomes were assessed at 28 days after initiation of treatment. Results Twenty-two patients (14 male) with a median age of 64 (range 45–84) with CPI-induced colitis were treated with BD. At baseline, the median number of loose stools in a 24-hour period was six (common terminology criteria for adverse events, CTCAE grade diarrhea=2). Thirteen patients (59%) were dependent on systemic corticosteroids prior to starting BD. Baseline sigmoidoscopy showed moderate inflammation (Mayo Endoscopic Score (MES) = 2) in two patients (9%), mild inflammation (MES=1) in nine patients (41%) and normal findings (MES=0) in eleven patients (50%). Twenty patients (91%) had histopathological features of inflammation. All 22 patients (100%) had a clinical response to BD and 21 (95%) achieved clinical remission with a return to baseline stool frequency (CTCAE diarrhea=0). Ten patients (45%) had symptomatic relapse on cessation of BD, half within 7 days of stopping. All patients recaptured response on restarting BD. No adverse events were reported in patients treated with BD. Conclusions Topical BD represents an appealing alternative option to systemic immunosuppressive treatments to treat colonic inflammation. In this study, BD was effective and safe at inducing remission in CPI-induced colitis, which was refractory to systemic corticosteroids. Further randomized studies are needed to confirm these findings and determine the optimum dosing regimen.

Since the appearance of the novel coronavirus disease of 2019—COVID-19, various therapeutic approaches were attempted, with complementary and alternative medicine (CAM) taking an important place. The aim of this study was to investigate the use of CAM with the purpose of prevention or treatment of COVID-19 during the pandemics. A prospective, cross-sectional study, in the form of an on-line survey was conducted. A total of 1704 responses were collected. Among the respondents, 2.76% declared currently and 22.12% previously having COVID-19. Approximately one quarter of interviewees (23.24%) declared themselves as phytotherapy users. The most frequently used medicinal plants were garlic, ginger and chamomile. The majority of respondents stated that they expected positive effects on immune and respiratory system. Medicinal plants were frequently used, on a daily basis. The main sources of information for applied self-medication were populistic thematic literature, followed by the Internet. Approximately one-third of phytotherapy users (35.25%) consulted with a medical professional before the application of phytotherapy. Regarding dietotherapy, 41.14% of respondents reported using non-herbal dietary supplements, while only 7.16% reported specific diet. The presented results suggest that CAM is recognized and readily used as a potential alternative and complementary regimen in the fight against COVID-19.