Background: Two-dimensional volumetric exercise stress echocardiography (ESE) provides an integrated view of left ventricular (LV) preload reserve through end-diastolic volume (EDV) and LV contractile reserve (LVCR) through end-systolic volume (ESV) changes. Purpose: To assess the dependence of cardiac reserve upon LVCR, EDV, and heart rate (HR) during ESE. Methods: We prospectively performed semi-supine bicycle or treadmill ESE in 1344 patients (age 59.8 ± 11.4 years; ejection fraction = 63 ± 8%) referred for known or suspected coronary artery disease. All patients had negative ESE by wall motion criteria. EDV and ESV were measured by biplane Simpson rule with 2-dimensional echocardiography. Cardiac index reserve was identified by peak-rest value. LVCR was the stress-rest ratio of force (systolic blood pressure by cuff sphygmomanometer/ESV, abnormal values ≤2.0). Preload reserve was defined by an increase in EDV. Cardiac index was calculated as stroke volume index * HR (by EKG). HR reserve (stress/rest ratio) <1.85 identified chronotropic incompetence. Results: Of the 1344 patients, 448 were in the lowest tertile of cardiac index reserve with stress. Of them, 303 (67.6%) achieved HR reserve <1.85; 252 (56.3%) had an abnormal LVCR and 341 (76.1%) a reduction of preload reserve, with 446 patients (99.6%) showing ≥1 abnormality. At binary logistic regression analysis, reduced preload reserve (odds ratio [OR]: 5.610; 95% confidence intervals [CI]: 4.025 to 7.821), chronotropic incompetence (OR: 3.923, 95% CI: 2.915 to 5.279), and abnormal LVCR (OR: 1.579; 95% CI: 1.105 to 2.259) were independently associated with lowest tertile of cardiac index reserve at peak stress. Conclusions: Heart rate assessment and volumetric echocardiography during ESE identify the heterogeneity of hemodynamic phenotypes of impaired chronotropic, preload or LVCR underlying a reduced cardiac reserve.

In the paper presented above, the authors are dealing with current criminal regulation issues of the criminal offence of malpractice, and the criminal liability of the doctor as the main provider of health care. The criminal offense of malpractice is one of the so-called delicta propria, because this criminal offense can only be done by a medical doctor, dental doctor, or another health care professional. The paper presents the comparative analysis and a critical review of the criminal offense of malpractice treatment in Bosnia and Herzegovina, Croatia, and Slovenia. The paper will present the detailed analysis of this crime in Bosnia and Herzegovina, with a comparative analysis of this crime in Croatia and Slovenia, with reference on jurisprudence in the above countries.

Background Due to COVID-19, domestic violence victims face a range of mental health challenges, possibly resulting in substantial human and economic consequences. However, there is a lack of mental health interventions tailored to domestic violence victims and in the context of COVID-19. In this study, we aim to identify interventions that can improve domestic violence victims’ mental health amid the COVID-19 pandemic to address the research gap. Main text Drawing insights from established COVID-19 review frameworks and a comprehensive review of PubMed literature, we obtained information on interventions that can address domestic violence victims’ mental health challenges amid COVID-19. We identified practical and timely solutions that can be utilized to address mental health challenges domestic violence victims face amid COVID-19, mainly focusing on (1) decreasing victims’ exposure to the abuser and (2) increasing victims’ access to mental health services. Conclusion Domestic violence is a public health crisis that affects all demographics and could result in significant morbidity and mortality. In addition to emphasizing mental health challenges faced by domestic violence victims, multidisciplinary interventions are identified that could provide timely and practical solutions to domestic violence victims amid the pandemic, which range from tailored shelter home strategies, education programs, escape plans, laws and regulations, as well as more technology-based mental health solutions. There is a significant need for more multipronged and multidisciplinary strategies to address domestic violence amid and beyond the pandemic, particularly interventions that could capitalize on the ubiquity and cost-effectiveness of technology-based solutions.

Networks often need to concurrently process millions of flows with varying Quality-of-Service (QoS) requirements. Doing so by deploying flow-specific rules at network nodes would require significant memory and overhead.In this paper, we take a fundamentally different approach, called P4QoS, by embedding QoS requirements in the packets themselves and leveraging P4-programmable network switches to process the traffic based on them. We illustrate and evaluate our approach with latency as our QoS metric, but our concept can be applied to other metrics as well. Our evaluation, both in software (Mininet) and in hardware (Intel Tofino), shows that P4QoS can satisfy application-specific QoS requirements with negligible memory overhead.

The concept of network slicing enables operators to provision multiple virtual networks on top of a single (shared) physical infrastructure. Adding elasticity to slicing, i.e., the ability to on-demand provision/release dedicated network resources, improves resource utilization. However, efficiently allocating and scaling slice resources, while maintaining state consistency, is challenging. Especially with P4-programmab1e network devices that process packets at Tbps speeds, controller-driven scaling of network functions would be too time-consuming, and data-plane scaling is needed. In this paper, we address this need, by developing a custom scaling protocol and framework that can consistently, with negligible delay, scale network slices and functions transparently to the slice end-users. We compare, via emulation and experiments on programmable hardware, our approach to state-of-the-art scaling techniques and demonstrate significant slice resource utilization improvements and scaling duration reductions.

Introduction: Various functional neuroimaging studies help to better understand the changes in brain activity during meditation. The purpose of this study was to investigate how brain energy metabolism changes during focused attention meditation (FAM) state, measured by phosphorous magnetic resonance spectroscopy (31P-MRS). Methods: 31P-MRS imaging was carried out in 27 participants after 7 weeks of FAM training. Metabolite ratios and the absolute values of metabolites were assessed after meditation training in two MRI measurements, by comparing effects in a FAM state with those in a distinct focused attention awake state during a backwards counting task. Results: The results showed decreased phosphocreatine/ATP (PCr/ATP), PCr/ inorganic phosphate (Pi), and intracellular pH values in the entire brain, but especially in basal ganglia, frontal lobes, and occipital lobes, and increased Pi/ATP ratio, cerebral Mg, and Pi absolute values were found in the same areas during FAM compared to the control focused attention awake state. Conclusions: Changes in the temporal areas and basal ganglia may be interpreted as a higher energetic state induced by meditation, whereas the frontal and occipital areas showed changes that may be related to a down-regulation in ATP turnover, energy state, and oxidative capacity.

Spatial planning is a vital process for a rapid and successful development of projects related to wetland management, and thereby projects related to tourism. Tourist activities could provide a boost to the development of general understanding of wetlands and raise public awareness of the functions and the ecosystem services wetlands provide. The tourism economy could be a source of income and could provide employment opportunities in rural areas. However, tourists also have an impact on wetlands. Protected areas accessible to tourists require a comprehensive management. In order to ensure a harmonious relationship between tourism activities and environmental protection, when developing an urban design within a protected area, it is crucial to have a sensitive approach. The paper suggests an approach to the development of the Urban Design "Karaotok", within the Hutovo Blato Nature Park.

Distribution system state estimation is becoming an increasingly important feature in the modern power grid, but the lack of real measurements makes its implementation particularly difficult. A solution for this problem could be the generation of accurate pseudo measurements. For this purpose, an Artificial Neural Network based reactive power pseudo measurement generating algorithm (PMG-ANN) was created, which was implemented in a distribution system state estimation. After testing, it was concluded that the artificial neural network based pseudo measurement generator has successfully made the distribution network observable and achieved a high accuracy in the examined predictions. However, some points were identified where further improvements could be made.

The paper covers numerical analysis of an experiment with five T-beams that are loaded to failure. The beams are designed to have the same ultimate bearing capacity with different ratios of prestressed to classic reinforcement. A detailed overview of the experiment is shown with exact section dimensions, as well as exact position and ratio of prestressed to classic steel. As a result of the experiment, force-displacement diagrams for each beam are presented and analyzed. Numerical model of the beams, reinforced in accordance with the experiment, is also shown. Two models for materials are used to analyze the beams: design model to check the design failure force and a new material model with concrete tension to simulate the actual behavior of the beams. All beams are gradually loaded to numerical failure by incrementally increasing the load that simulates press load. At the end, an analysis and comparison between experimental and numerical results is conducted to determine if the numerical model is a good representation of actual beam behavior.

We describe a purely image-based method for finding geometric constructions with a ruler and compass in the Euclidea geometric game. The method is based on adapting the Mask R-CNN state-of-the-art image processing neural architecture and adding a tree-based search procedure to it. In a supervised setting, the method learns to solve all 68 kinds of geometric construction problems from the first six level packs of Euclidea with an average 92% accuracy. When evaluated on new kinds of problems, the method can solve 31 of the 68 kinds of Euclidea problems. We believe that this is the first time that a purely image-based learning has been trained to solve geometric construction problems of this difficulty.

This article makes the case for why higher education institutions should take the teaching of peacebuilding seriously. It is co-authored by a team from four countries (Bosnia and Herzegovina, Rwanda, Colombia and the United Kingdom) who were involved in a small international research project looking at “Pedagogies for Peacebuilding”. Together they are trying to answer questions about the legitimacy of bringing these discussions into higher education and lecturer/student relationships. The authors discuss the spaces in which peacebuilding can be usefully considered within higher education curricula; the significance of higher education in helping young people develop habits of peace; and how the citizens and leaders of the future might be helped to understand the meaning and importance of peacebuilding. In the course of their argument, the authors consider the intention and impact of different pedagogical approaches.

The increasing penetration of renewable energy resources such as solar and wind via power electronic inverters is challenging grid dynamics, as well as grid planning, operation, and protection. Recently, the North American Electric Reliability Corporation (NERC) has reported a series of similar events of the unintended loss of solar generation in Southern California over a large geographic area following the transmission-level disturbances. These events highlight the importance of understanding the characteristics of the transmission-side disturbances propagating into the distribution systems and their impacts on the operation of inverter-based resources. In this paper, a real-time electromagnetic simulation testbed is constructed for real-time electromagnetic simulations to generate realistic transmission-level disturbances and investigate their impacts on the solar PV operation under different fault types and locations, solar penetration levels, and loading levels. Through the simulation analysis and grid strength assessment, it is found that the grid strength at points of integration (POIs) of solar PVs significantly affects the transient stability of solar generators. Particularly, undesirable transient stability events are more likely to occur at the weak POIs following the transmission-level disturbances. Moreover, undesirable transient stability events become severer when the transmission-level disturbance is closer to the weak POIs or the disturbances become more serious. Additionally, the impact of the transmission-level disturbances on the solar PVs at the weak POIs exacerbate with the increasing solar penetration levels and loading levels. Thus, it is important to study and develop new technologies for grid planning, operation, and protection in weak grid conditions to address the emerging issues of integrating the high penetration of solar PVs and other IBRs.

Este artigo tem como proposta relacionar o papel da farmácia hospitalar diante de um cenário de pandemia, como a do novo coronavírus, e ressaltar a importância de um plano de contingência para o enfrentamento do impacto causado por esta pandemia em um hospital. A partir de uma revisão teórica, onde buscou-se trabalhos científicos e literaturas sobre o tema, em plataformas de pesquisa Scielo e Google Acadêmico, foi possível selecionar e analisar planos de contingência da farmácia hospitalar propostos em âmbito nacional e internacional, assim como artigos, livros, dados estatísticos, declarações, manuais, normas técnicas, dentre outros materias, que permeiam essa temática, correlacionando-os com as atribuições de um serviço de farmácia em unidades de saúde. Os resultados da revisão bibliográfica corroboram para as evidências da necessidade de se elaborar um plano de contingência específico para este cenário. Com isso concluiu-se que compete ao farmacêutico entender do processo assistencial e de gestão para se implementar e executar um plano de contingência na farmácia hospitalar específico para a pandemia por COVID-19. De forma a combater o vírus SARS-CoV-2 e mitigar seu impacto no âmbito hospitalar e na sociedade como um todo, garantindo a qualidade e a segurança dos pacientes e colaboradores.