The inadequacy of intensive care medicine in low-resource settings (LRS) has become significantly more visible after the COVID-19 pandemic. Recommendations for establishing medical critical care are scarce and rarely include expert clinicians from LRS. In December 2023, the National Association of Intensivists from Bosnia and Herzegovina organized a hybrid international conference on the topic of organizational structure of medical critical care in LRS. The conference proceedings and literature review informed expert statements across several domains. Following the conference, the statements were distributed via an online survey to conference participants and their wider professional network using a modified Delphi methodology. An agreement of ≥ 80% was required to reach a consensus on a statement. Out of the 48 invited clinicians, 43 agreed to participate. The study participants came from 20 countries and included clinician representatives from different base specialties and health authorities. After the two rounds, consensus was reached for 13 out of 16 statements across 3 domains: organizational structure, staffing, and education. The participants favored multispecialty medical intensive care units run by a medical team with formal intensive care training. Recognition and support by health care authorities was deemed critical and the panel underscored the important roles of professional organizations, clinician educators trained in high-income countries, and novel technologies such as tele-medicine and tele-education. Delphi process identified a set of consensus-based statements on how to create a sustainable patient-centered medical intensive care in LRS.

The study presents an in-depth analysis of the impact of noise from mining operations, focusing on the spatial distribution of noise levels and their compliance with regulatory limits. Utilizing advanced modeling and visualization techniques, it demonstrates effective noise management strategies that ensure compliance with national regulations. Findings highlight the importance of integrating environmental assessments and technological innovations in mitigating noise pollution, underscoring the mining industry’s commitment to sustainable practices and community well-being. This research contributes valuable insights into environmental management, offering a model for balancing industrial activities with ecological and health considerations. Key findings emphasize the significance of integrating environmental assessments and technological innovations to mitigate noise pollution, showcasing the mining industry’s commitment to sustainable practices and community well-being. The study underlines the importance of noise management strategies that align with national regulations to protect both the environment and public health. Using advanced modeling and visualization techniques, the research offers valuable insights into environmental management, presenting a model for balancing industrial activities with ecological and health considerations. It contributes significantly to the understanding of noise pollution in the mining sector, proposing effective solutions for its control. This work is grounded in a broad review of literature on environmental pollution and specific studies on noise pollution’s effects on health, highlighting the broader context of industrial and urban noise sources. It presents a detailed analysis of noise levels around a specific mining operation, including modeling and visualization of noise propagation and its impact on surrounding residential areas. The conclusion drawn from this study is that through strategic planning, technological interventions, and adherence to regulations, mining operations can effectively mitigate noise pollution. This ensures that noise levels remain within acceptable limits, thereby minimizing their impact on nearby communities and contributing to a safer and more sustainable mining environment.

Objective This study aimed to assess the practicality and trustworthiness of explainable artificial intelligence (XAI) methods used for explaining clinical predictive models. Methods Two popular XAIs used for explaining clinical predictive models were evaluated based on their ability to generate domain-appropriate representations, impact clinical workflow, and consistency. Explanations were benchmarked against true clinical deterioration triggers recorded in the data system and agreement was quantified. The evaluation was conducted using two Electronic Medical Records datasets from major hospitals in Australia. Results were examined and commented on by a senior clinician. Results Findings demonstrate a violation of consistency criteria and moderate concordance (0.47-0.8) with true triggers, undermining reliability and actionability, criteria for clinicians’ trust in XAI. Conclusion Explanations are not trustworthy to guide clinical interventions, though they may offer useful insights and help model troubleshooting. Clinician-informed XAI development and presentation, clear disclaimers on limitations, and critical clinical judgment can promote informed decisions and prevent over-reliance.

BACKGROUND The causative agent of the coronavirus disease (COVID-19) is a virus from the SARS-CoV-2 group of viruses that cause severe acute respiratory syndrome. The aim of the study was to examine the differences in hematological analyses of patients suffering from COVID-19 with and without comorbidities, to determine the degree of the clinical picture based on the MEWS scale and to examine the persistence of inflammatory parameters with the severity of the clinical picture. METHODS The research is a cross-sectional retrospective study, conducted in the laboratory diagnostics service of Tesanj General Hospital. It included 211 respondents positive for the coronavirus in the Tesanj General Hospital. The degree of severity of the clinical picture was determined on the basis of the MEWS scale. RESULTS A total of 211 patients positive for coronavirus participated in the study, of which 61.1% (129) were male and 38.9% (82) were female. Based on the results, a statistically significant difference was found in the ratio of hematological parameters in subjects with and without comorbidities (p < 0.05). A strong positive correlation was found between the ratio of SE and D-dimer in subjects and the degree of severity of the clinical picture. CONCLUSIONS A statistically significant difference was recorded in the ratio of hematological parameters (lymphocytes, granulocytes, erythrocytes, hematocrit, and APTT) in subjects with and without comorbidities in all three of the observed groups (p < 0.05), while there were no statistically significant differences in other hematological parameters (p > 0.05).

The main aim of the study was to determine the difference in the effects between the two applied protocols (Unilateral and Bilateral), on the ability of planned agility and acceleration. For this research, the sample were active soccer players (N=30; 14 years in average). Two equal groups were formed randomly, unilateral group (EG=15) and bilateral group (CG=15). The study included an 8-week intervention of unilateral and bilateral plyometric training, applied as an integral part of soccer training, with three training sessions in one week. Both applied protocols were equalized according to the total load volume, the number of foot contacts with the ground and the character of the jump performance. Variables included tests of planned agility (side step test, and 505 test, arrowhead test), and acceleration tests (5- and 20 meters sprint). T-test for independent samples, and combined analysis of variance (2x2 / time x group) were calculated. The results showed no differences between the treatment groups, but absolute effects were achieved in both groups. The sidestep test, 505 planned agility test, arrowhead test, and 5 and 20-meter sprint test improved equally in both groups (p<0.05). In conclusion, unilateral and bilateral plyometric training lasting eight weeks led to significant improvements (pre/post= p<0.05) in sprint-type explosive power (acceleration ability) and preplanned agility, but without statistically significant differences in the magnitude of the effects between training groups.

Active malignant disease is associated with pulmonary embolism and the treatment of this condition is very challenging. The efficacy and safety of thrombolytic therapy for acute severe PE in patients with active malignant disease is unknown. This study aimed to investigate hospital mortality rate and the incidence of major bleeding at 7 days according to the International Society of Thrombosis and Hemostasis (ISTH) criteria in patients with active malignant disease who were treated with thrombolytic therapy due to severe acute PE. Patients with acute PE proven by computed tomography pulmonary angiography who were admitted to intensive care units have enrolled in the Regional PE Registry (REPER) since 2015, consisting of 10 hospitals from the 4 east Balkan countries. The decision to use thrombolytic therapy was at the discretion of the attending physicians, and it was used in high-risk, and intermediate-high-risk PE patients. Hospital mortality and the incidence of major bleeding at 7 days were compared between patients with active cancer and those without it who received thrombolytic therapy. Alteplase-based therapy was used. Among 2070 patients with acute PE enrolled in REPER, intermediate-high and high-risk PE had 795 patients without malignant disease and 135 had active malignant disease in the last 6 months. Patients with malignant disease had less chance to be treated with thrombolysis than patients without it (29.1% vs 44.7%, OR 0.508, 95%CI 0.341-0.756, p=0.001). For patients treated with thrombolysis, hospital mortality was non significantly higher in patients with the malignant disease compared to patients without it (25.6% vs 16,1%, OR 1.803, 95%CI 0.833-3.904, p=0.132), and the incidence of major bleeding at seven days was similar (15.4% vs 18.5%, OR 0.800, 95%CI 0.322-1.989, p=0.6131). There was no significant difference in age, sex, and PE risk distribution between patients with active malignant disease and those without it who were treated with thrombolysis. Thrombolytic therapy seems to be underutilized in patients with the active malignant disease compared to patients without it in severe acute PE. In the selected patients who were treated with thrombolysis for severe acute PE, the efficacy and safety are similar between patients with and without active malignant disease.

Acute pulmonary embolism (PE) management guidelines categorize normotensive patients with right ventricle dysfunction (RVD) and normal cardiac troponin (cTn) as intermediate low risk. This study explores the prevalence of cardiovascular comorbidities and their impact on risk stratification in this specific cohort. To investigate the characteristics of normotensive acute PE patients with RVD and normal cTn, emphasizing the role of pre-existing cardiovascular diseases in determining the intermediate-low risk status. A total of 1675 PE patients from a regional registry were screened, excluding high-risk and intermediate-high-risk cases. Among the remaining 400 normotensive patients with RVD, 353 with echocardiography and normal cTn were included. Patients were categorized into low or intermediate-low risk based on RVD presence. Cardiovascular comorbidities were assessed, and logistic regression analyzed their association with intermediate-low risk. Intermediate-low-risk patients (n=137) exhibited significantly higher rates of chronic heart failure, arterial hypertension, coronary artery disease, diabetes, and atrial fibrillation compared to low-risk patients (n=216). A substantial 77.4% of intermediate-low-risk patients had at least one cardiovascular comorbidity, significantly elevating the risk of RV dysfunction (adjusted OR 2.954, p<0.001). The all-cause hospital mortality was 5.1% in intermediate-low-risk and 1.4% in low-risk PE. Normotensive acute PE patients with RVD and normal cTn are predominantly burdened with chronic cardiovascular conditions. The majority of intermediate-low-risk patients have at least one cardiovascular comorbidity, indicating an increased risk of death during hospitalization compared to low-risk patients. This study underscores the necessity for nuanced risk stratification considering pre-existing cardiovascular diseases for tailored and effective management. These findings have important implications for optimizing treatment strategies and improving outcomes in this high-risk population.

This literature survey explores the domain of remote driving of road vehicles within autonomous vehicles, focusing on challenges and state-of-the-art solutions related to driving feedback, latency, support control, as well as remote driving platform and real applications. The advancement towards Level-5 autonomy faces challenges, including sensor reliability and diverse scenario feasibility. Currently, remote driving is identified as vital for commercialization, however, it comes with challenges like low situational awareness, latency, and a lack of comprehensive feedback mechanisms. Solutions proposed include enhancing visual feedback, developing haptic feedback, employing prediction techniques, and use control methods to support driver. This paper reviews the existing literature on remote driving in these fields, revealing research gaps and areas for future studies. Additionally, this paper reviews the industry applications of remote driving and shows the state-of-art use cases.

As surface wear is one of the major failure mechanisms in many applications that include polymer gears, lifetime prediction of polymer gears often requires time-consuming and expensive experimental testing. This study introduces a contact mechanics model for the surface wear prediction of polymer gears. The developed model, which is based on an iterative numerical procedure, employs a boundary element method (BEM) in conjunction with Archard’s wear equation to predict wear depth on contacting tooth surfaces. The wear coefficients, necessary for the model development, have been determined experimentally for Polyoxymethylene (POM) and Polyvinylidene fluoride (PVDF) polymer gear samples by employing an abrasive wear model by the VDI 2736 guidelines for polymer gear design. To fully describe the complex changes in contact topography as the gears wear, the prediction model employs Winkler’s surface formulation used for the computation of the contact pressure distribution and Weber’s model for the computation of wear-induced changes in stiffness components as well as the alterations in the load-sharing factors with corresponding effects on the normal load distribution. The developed contact mechanics model has been validated through experimental testing of steel/polymer engagements after an arbitrary number of load cycles. Based on the comparison of the simulated and experimental results, it can be concluded that the developed model can be used to predict the surface wear of polymer gears, therefore reducing the need to perform experimental testing. One of the major benefits of the developed model is the possibility of assessing and visualizing the numerous contact parameters that simultaneously affect the wear behavior, which can be used to determine the wear patterns of contacting tooth surfaces after a certain number of load cycles, i.e., different lifetime stages of polymer gears.

PurposeThe primary goal of this research is to evaluate the seismic performance of Asla Hocine Primary School, a heritage school building in Annaba, Algeria, to prevent additional damage during future earthquakes in the region. The study aims to guide decision-makers in strengthening weak parts or elements in the building, implementing preventive measures and ultimately reducing earthquake disaster risk by mitigating vulnerability.Design/methodology/approachThe research employs the 3Muri software to model the seismic behavior and structural failures of the school’s elements. An integrated multimodal pushover analysis is used to generate the non-linear capacity curve of the school to assess its seismic performance. The seismic demand is determined based on Algerian seismic regulations, with peak ground acceleration derived from a probabilistic seismic hazard analysis of Annaba city for return periods of 100, 200 and 500 years. The study develops three seismic scenarios to evaluate performance levels and expected damage probabilities.FindingsThe study reveals that the Asla Hocine Primary School faces a high risk of damage and potential collapse under the expected seismic hazard of the region. The analysis indicates variable resilience across different seismic return periods (100, 200 and 500 years), with the performance level degrading from life safety to collapse prevention and total collapse under increasing seismic intensity. This underscores the need for targeted structural analysis and potential retrofitting to enhance the building’s seismic robustness.Research limitations/implicationsThe paper encouraged to account for soil-structure interaction in similar studies, as it can significantly affect the overall seismic performance of buildings. Furthermore, conducting out-of-plane analysis when necessary can offer valuable insights into the structural behavior of specific components.Practical implicationsThe insights provided by this study contribute vital data toward conservation efforts and risk mitigation strategies for heritage structures in seismic zones. The findings are intended to guide decision-makers in implementing preventive measures and strengthening weak parts or elements in the studied school building, ultimately reducing earthquake disaster risk by mitigating vulnerability.Originality/valueThis research offers a comprehensive framework for assessing the seismic vulnerability of heritage schools using detailed modeling and analysis. It highlights the importance of considering return periods of seismic events in assessing a building’s seismic performance and provides a deeper understanding of the structural response to seismic stresses at both macrostructural and individual element levels. The study emphasizes the critical need for seismic risk assessment and targeted retrofitting to preserve cultural heritage assets and ensure their continued use.