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Monkeys serve as first animal model of smallpox
admin rrsthswp November 18, 2020 No Comments
The authors say that the ideal animal model of smallpox would more closely resemble ordinary smallpox in humans, with a longer clinical course and without hemorrhagic manifestations, but would still cause high mortality. They tried to achieve this by giving monkeys lower doses of virus, which resulted in both reduced hemorrhage and lower mortality. "The demonstration that variola virus strains can produce lethal disease in monkeys is a significant advance toward the development of antiviral drugs and improved vaccines, as well as an improved understanding of variola pathogenesis," says the report by Peter B. Jahrling of the US Army Medical Research Institute of Infectious Diseases (USAMRIID) and colleagues from USAMRIID, the Centers for Disease Control and Prevention, and Stanford University. Under the Food and Drug Administration's (FDA's) "animal efficacy rule," treatments and vaccines can be approved on the basis of animal data alone if human trials are impractical or unethical, as in the case of smallpox. The FDA rule requires that the actual pathogen be used and that "the disease process be faithful to the human disease," the report notes. Nineteen of 21 monkeys that received the highest doses of virus died, most of them within 6 days after exposure. Of 12 monkeys that received a lower dose, only one died. Both strains of virus were lethal to most of the monkeys at the highest doses, and the infections were mostly fatal regardless of whether exposure was by injection and aerosol or by injection alone. Oct 14, 2004 (CIDRAP News) – Federal researchers report they have succeeded in infecting monkeys with fatal smallpox, creating the first animal model of the disease for use in testing vaccines and treatments for humans. The team previously reported exposing two groups of monkeys to a variola virus aerosol, which caused infection but not serious illness. In the present experiment, the researchers used two other variola strains (Harper and India 7124). Groups of monkeys received either an intravenous injection of virus accompanied by aerosol exposure or an IV injection alone. Analysis of tissue from the infected monkeys has already yielded some information about how smallpox changes gene activity in cells attacked by the virus, yielding clues about how it overcomes host defenses, according to a separate report in PNAS. "The i.v. inoculation of high doses of variola virus produced an overwhelming, hemorrhagic disease course, ending in acute deaths, usually within 6 days of inoculation," the report states. Postmortem examination showed high levels of virus and widespread hemorrhages in the monkeys' organs. Researchers exposed cynomolgus macaques to high doses of variola (smallpox) virus, causing most of them to die of the hemorrhagic form of smallpox within a few days, according to an online report in the Proceedings of the National Academy of Sciences (PNAS). Scientists previously thought that humans were the only species susceptible to smallpox. Jahrling PB, Hensley LE, Martinez MJ, et al. Exploring the potential of variola virus infection of cynomolgus macaques as a model for human smallpox. Proc Nat Acad Sci 2004 Oct 11 (published online before print) (Full text) The use of IV inoculation of the virus eliminated the incubation and prodromal stages of natural smallpox, causing "instantaneous viremia" and resulting in a much shorter clinical course than was typical when smallpox still existed in humans, the authors note. "Yet, the sequence of events in the monkeys is similar to human hemorrhagic smallpox, a form that was almost always fatal." In humans, only about 2% to 3% of smallpox cases were hemorrhagic. Rubins KH, Hensley LE, Jahrling PB, et al. The host response to smallpox: analysis of the gene expression program in peripheral blood cells in a nonhman primate model. Proc Nat Acad Sci 2004 Oct 11 (published online before print) (Full text) David Relman, MD, of Stanford University, and colleagues analyzed how the smallpox infection altered gene expression in the monkeys' blood cells, according to a news release from the National Institute of Allergy and Infectious Diseases (NIAID), which supported the research. The researchers used DNA microarrays, a fairly new tool, to examine changes in levels of gene expression and expression of some proteins in the blood of infected monkeys. The success of Jahrling and his team in inducing lethal smallpox in monkeys has been no secret, having been described in Richard Preston's 2002 book The Demon in the Freezer. But the current PNAS report is apparently the first full description of the research in a journal. "This new research fills in some of the gaps in our understanding of smallpox," NIAID Director Dr. Anthony Fauci, MD, said in the news release. "Now we are better positioned to speed the development of protective measures." The article says that variola and monkeypox viruses cause very similar diseases in monkeys. Accordingly, the authors hope to test most smallpox countermeasures in the monkeypox model. "The variola primate model would be reserved for testing only those countermeasures that have passed all other FDA requirements for drug or vaccine licensure," they state. read more
Asian nations vow cooperation on avian flu
admin jfggttdz November 18, 2020 No Comments
Dec 2, 2004 (CIDRAP News) – As public health ministers and officials from 13 Asian countries conferred in Bangkok last week on how to prevent the spread of H5N1 avian influenza, experts offered troubling predictions.The highly lethal H5N1 strain, which has claimed tens of millions of poultry across eastern Asia this year, is the world's likeliest candidate to cause global devastation in the form of a human flu pandemic, according to experts from the World Health Organization (WHO).While acknowledging that all estimates are essentially guesses, WHO experts have predicted in recent weeks that a pandemic could kill anywhere from 2 million to 100 million people.Confirmed H5N1 avian flu has already killed 32 people and sickened 12 more in Vietnam and Thailand this year. What is keeping the disease in check, for now, is the virus's inability to spread easily from person to person.Under the shadow of that threat, the Association of Southeast Asian Nations (ASEAN) and other Asian countries sought to reach agreements on how to collaborate to prevent the spread of the disease at a conference that ended Nov 26.In a joint closing statement, delegates pledged to collaborate through prompt and open communication, research, and allocation of resources, according to a press release from the WHO's Western Pacific Region Office. The nations also agreed to prepare contingency plans for a human flu pandemic."We believe a pandemic is highly likely, unless intensified international efforts are made to take control of the situation," said Dr. Shigeru Omi, WHO western Pacific regional director, in the press release. "When I contemplate the 'where, how, and when' of a possible influenza pandemic, I find myself faced with an inescapable conclusion—that we who are assembled in this room have an historic role to play in addressing a global health threat that continues in our region."In a Nov 29 speech in Hong Kong, Omi predicted that a pandemic could cause 20 million to 50 million deaths, or possibly up to 100 million, according to a Nov 29 New York Times report.Omi's opinion that a pandemic is highly likely was echoed in a report released recently by the Institute of Medicine (IOM) of the National Academies. "The danger mounts as the world's capacity to produce vaccines shrinks and H5N1 reaches endemic levels in poultry in many parts of Asia," says the report, titled "The Threat of Pandemic Influenza: Are We Ready?" The 300-page report is a summary of a conference held in June.Meanwhile, members of ASEAN are addressing local avian flu problems.Thai government officials made several recent announcements about progress against H5N1, although they encountered setbacks as well. They announced that a vaccine to protect humans against avian flu is expected to be ready by 2007, following clinical trials in Thailand, according to an Associated Press story Nov 24. A Dec 1 story from the Thai News Agency said the government was claiming success in efforts to prevent the H5N1 virus from mutating. The same story noted the plans have not worked everywhere because villagers sometimes hid news of dying birds for fear of having their flocks culled.In addition, the story said authorities in northern Thailand's Chiang Mai province will meet with owners of cock-fighting rings later this month to discuss reopening rings and how to prevent fighting cocks from spreading H5N1. An 18-year-old Thai man who often sucked fluids from the mouths of his fighting birds died from H5N1, according to a New York Times story on Nov 7.Thailand reported to the World Organization for Animal Health (OIE) that between Nov 18 and 25 it logged 17 new H5N1 outbreaks, leading to the deaths of more than 16,000 fowl.Hong Kong authorities said on Nov 29 they may bar shopkeepers from slaughtering poultry, a popular practice for assuring shoppers that their purchases are fresh, according to a story compiled from news agencies and published on the China Daily web site yesterday.Scientists have struggled against the practice of killing chickens at markets since Hong Kong's first bout with human H5N1, which killed six people in 1997. The poultry industry has strongly opposed the ban in the past, the China Daily report said. However, the government is pursuing the plan, which could include creating one large central slaughterhouse or limiting the slaughter to a few areas, the story said.See also:IOM report "The Threat of Pandemic Influenza: Are We Ready? Workshop Summary"http://www.nap.edu/books/0309095042/html/ read more
Conference "Sustainable Beach Management"
The Administrative Department for Tourism of the County of Istria and the Institute for Agriculture and Tourism are organizing a conference called "SUSTAINABLE BEACH MANAGEMENT".The conference will be held in Thursday, March 15, 2018 in Poreč, Hotel Diamant, Magnolia Hall. Study visits to cities and beaches in Porec and Novigrad will be organized in Friday, March 16, 2018The conference is organized to encourage public dialogue on responsible and sustainable beach management in Istria, and will present concrete examples from cities and municipalities in the Region of Tuscany, Cyprus and the County of Istria in which the model is tested and implemented. The Green Beach model is an example of a sustainable beach management model in the Mediterranean. "We believe that the conference is an excellent platform for the further development of this valuable resource in the function of considering further tourism development. The conference is primarily intended for local self-government units and hotel companies, that is, for all those who manage beaches and tourist boards that deal with the promotion and improvement of tourist destinations. " stand out from the Institute of Agriculture and Tourism.Due to the limited number of participants, their arrival should be confirmed no later than Friday, 9. March 2018. with the exact date of arrival (March 15 and / or March 16, 2018). Applications for participation are submitted to the e-mail address: anovoselic@iptpo.hr or phone number 052 / 408-309.Conference program SUSTAINABLE BEACH MANAGEMENTOrganisers:Administrative Department for Tourism of the County of Istria and the Institute of Agriculture and Tourismin cooperation with the City of Poreč and the City of NovigradDate:15.-16. March 2018Location:Lectures (March 15, 3) Hotel Diamant, conference hall Magnolia, PorečStudy visits (March 16, 3) Tours of cities and beaches in Poreč and Novigrad15. March 2018.ProgramModerator: dr. Sc. Danijela Poljuha, Institute of Agriculture and Tourism8: 45-9: 15 Registration9: 15-9: 45 Official opening of the conferencemr. sc. Valter Flego, County Prefect of Istriadr. sc. Dean Ban, director of the Institute of Agriculture and Tourism9: 45-10: 00 Review of Istrian tourism 2017Denis Ivošević, Director of the Office of the Istria County Tourist Board10: 00-10: 15 Encouraging sustainable tourism development in the Mediterranean (EU project MITOMED +)dr. sc. Kristina Brščić, Institute of Agriculture and Tourism10: 15-10: 30 Models of integrated tourism in the Mediterranean Plus – MITOMED +Maria Luisa Mattivi, Project Manager, Economic and Tourism Promotion Sector, Region of Tuscany10: 30-11: 00 Presentation of the model "Green Beach" – Cyprusdr. sc. Eudokia Balamou, ANETEL, Larnaca, Cyprus11: 00-11: 30 Coffee break11: 30-11: 45 Presentation of the "Green Beach" from Tuscany – Commune di San VincenzoSimina Chelaru, San Vincenzo Municipality Urban Planning Office11: 45-12: 00 Presentation of the "Green Beach" from Tuscany – Comune di MontignosoRaffaello Gianfranceschi, Councilor of the Municipality of Montignoso12: 15-12: 30 Presentation of the "Green Beach" from Tuscany – Castiglione della PescaiaElena Nappi, Deputy Mayor of the Municipality of Castiglione della Pescaia12: 30-14: 00 Lunch break14: 00-14: 15 Presentation of the research of attitudes and satisfaction of tourists with the destination according toETIS questionnaire (destinations Poreč, Novigrad, Labin / Rabac)dr. sc. Kristina Brščić, Institute of Agriculture and Tourism14: 15-14: 30 Survey results – Green beaches (Novigrad, Rabac, Poreč)Tina Šugar, M.Sc. ing. agr., Institute of Agriculture and Tourism14: 30-14: 45 Green beach – town of NovigradVanja Gorički, B.Sc. oec., advisor for EU projects and international cooperation of the City of Novigrad14: 45-15: 00 Green beach – RabacRobert Mohorović, mag.oec., Senior expert associate for international projects of the City of Labin15: 00-15: 15 Green beach – the city of Porecdr. sc. Damir Hrvatin, Head of the Administrative Department for Spatial Planning and Environmental Protection of the City of Poreč15: 15-15: 30 Discussion and closing of the conference16. March 2018.Study visits8:30 – 10:30 Tour of the city of Poreč, tour of the beach "Gradsko kupalište"11: 00-12: 30 Tour of the city of Novigrad, tour of the beach "Karpinjan"English and Italian translation provided read more
The impact of creative industries on tourism as one of the main topics of the Croatian Tourism Day
Another edition of the Croatian Tourism Day, organized by the Ministry of Tourism, the Croatian Chamber of Commerce and the Croatian Tourist Board, will once again bring together tourism industry professionals from the country, the region and the world. On the sunniest Croatian island, which this year marks 150 years of organized tourism, in the town of Hvar on September 24 and 25, lectures, panels and professional gatherings will analyze the current state and trends in tourism, and will be presented by government representatives, experts from tourism, but also accompanying horizontal activities.In addition to classic tourism indicators and analyzes, this year's gathering is dedicated to the favorite leisure activities of most people: food and drink, the film industry and the Internet. The connection between them as creative industries and tourism will be confirmed by world-renowned experts through the rich program of this year's Days of Croatian Tourism. PANEL "FILM INDUSTRY AND TOURISM"In recent years, Croatia has been the natural scenery of numerous film blockbusters, series and reality shows. Authentic locations of Croatian tourist destinations are the backdrop of numerous scenes of famous films, and creative tourist services that include touring locations of shooting, making authentic souvenirs or storytelling, develop a new tourist product that contributes to the overall tourist competitiveness of the country. Why is it being filmed in Croatia, what does it bring to the local environment and what is the situation in other countries of the European Union and abroad, those gathered as part of the panel "Film industry and tourism", under the moderation of the director of the Croatian Audiovisual Center Daniel Rafaelić, answered representatives of the Croatian and world film industries. On behalf of the Ministry of Culture of the Republic of Croatia, State Secretary Krešimir Partl will present the support and contribution of the line ministry for the system of encouraging the export of audiovisual services and attracting international film and television productions in Croatia. World blockbusters such as Mamma Mia, Star Wars, Robin Hood or Winettou have been filmed in several locations around the world, including Morocco, Hungary and Croatia. What this, in terms of tourism and cinema, has brought to these countries, will be presented by the director of the Moroccan Film Institute Mohamed Sarim El Haq Fassi Fihri and director of the Hungarian National Film Office Miklós Taba. Additionally, within the mentioned panel, there will be a presentation on the state of the Croatian film scene Nebojsa Taraba, a successful Croatian television producer and journalist, known for hit series in the formats of reality shows Dvornikovi, Police Patrol, Instruktor, Loza, urban crime story Mamutica and the latest hit series Novine for which the Israeli media company Keshet International bought the rights to global broadcasting. Another panelist of this gathering gained the world attention of the media and the profession, Vanja Černjul, A Croat with a New York address, is also the proud winner of the American Cameramen's Award for the best director of photography in the television series category. Chernyul has been nominated for an Emmy on several occasions, and is best known as the director of photography for the world's best series in the United States such as 30 Rock and Sister Jackie (Nurse Jackie), Orange is the New Black, Bored to Death. Marco Polo, The Deuce (Times Square Chronicles), and the latest project, the film "Crazy Rich Asians" presented this summer at the box office earned $ 48 million. The film festival is an important part of the cultural heritage and one of the most frequent motives for coming to Croatia, so the contribution to the discussion at the panel "Film and Industry" will be given by Gordana Restović, director of the Pula Film Festival, which has been gathering lovers of the seventh art for sixty-five years.PANEL "CROATIA – NEW GASTRO ICON OF EUROPE"In the existing strategy for tourism development until 2020, gastronomy and oenology have been singled out as one of the key tourism products on which the development of tourism in Croatia will be built in the future, and the panel "Croatia – a new gastronomic icon of Europe" aims to answer questions. determinants of successful gastro tourism, what is obtained by the development of gastro tourism, what is its horizontal and vertical connection, what are the success factors and what place does Croatia occupy on the European gastronomic map. This panel will bring together representatives of the Croatian / Hvar and Italian gastronomic scene under the moderator's baton Snježana Boranić Živoder from the Institute of Tourism. By focusing on indigenous products such as white truffles and wine, the province of Alba has positioned itself as a world-famous gastronomic brand, a kind of gastronomy center under UNESCO protection and as one of the largest concentrations of Michelin-starred restaurants in one area. present on this panel Director General of the Alba Bra Tourist Board Langhe Roero Mauro Carbone. What we can learn from our Italian neighbors and how far we have come will be confirmed Ingrid Badurina Danielsson, director of Gault & Millau Croatia, representatives of the hotel Sunny Hvar which in the gastronomic offer include indigenous local products and representatives of the Hvar gastro scene.PANEL "TOURIST BLOGGERS – DREAM OCCUPATION. MYTH OR REALITY? "Social media allows modern tourists to inform, participate and interact on different platforms. Modern social media has changed the way people think and share their travel experiences and is also a good promotional tool for tourism marketing. What do tourist bloggers have, and what destinations and accommodation facilities they visit, under the moderator's baton Frane Ridjana, will be revealed by the most famous Croatian blogger and influencer Ella Dvornik (iamella.com), Polish blogger Wojtek Tylus (Crolove.pl), Japanese blogger Yuya Matsuo (EseJapan) and the owner of the Vestibul Hotel in Split Neno Nizic who hosted American actress and luxury travel blogger Eva LaRue this summer. How to direct communication on social networks will conclude Nick Evans from Hills Balfour, a leading marketing and communications agency in the United Kingdom specializing in tourism.Attachment:DHT PROGRAM 2018 HVAR read more
Krešimir Dobrilović, CARWIZ: Today it is not enough to sell a product, but you must provide the user with an experience
admin hqzxturt November 18, 2020 No Comments
Also, through the prism of the importance of promoting a tourist destination, the much-needed synergy between all tourist entities in the destination is important. Again, we are stronger together and working on better promotion. As the number of overnight stays increases, everyone benefits, so synergy is key. When we talk about rent a car service, the staff of rent a car company is one of the first contacts with local people, and therefore they are ambassadors of our tourism, a tool for recommendation and sales, suggestions, etc.… Technology and tourism have always gone together, and with the development of the same symbiosis is getting bigger and bigger. What is definitely Carwiz's differentiation from the competition are the added services they offer to their customers. So they introduced new services and benefits for customers in their cars at Carwiz, and it is a GoPro camera and WiFi service in the car, which is added value. "In a very short time, we expect the transformation of rent a car service, enhanced by switching to electric vehicles. In the slightly distant future, we will have to transform the sector thanks to autonomous vehicles. We are also waiting for the development of leases through various share platforms, which will influence the creation of new types of offers in the car rental industry. This will give users the opportunity to rent a car through this type of business. In today's age of modern technology, end users are becoming more demanding. They are aware and know what they want. In order to meet their expectations, it is necessary to create a high level of service quality by packaging products, work systematically on technological development of business and business processes, but also continuously monitor technological development and know how to implement it in their business."Concludes Dobrilović. At the end of the year, as a "proof of concept", it came from the world's largest vehicle reservation website rentalcars.com, where, according to user reviews, Carwiz rent a car is the best rated rent a car company in Croatia. "Looking at the level of total business performance in the past 2018, business growth was achieved, ie the number of leases in the rent a car segment. Such a business result primarily refers to the increase in airline guests who were the main users of our services in the past years as well. It should be emphasized that the overall growth in the number of tourists is not at the same time an indicator of growth in the car rental business itself. It is known that Croatia is largely a car destination, and such guests do not use the services of our sector. However, as the number of airline guests grows from year to year, this trend is reflected in our business. We expect that the trend will continue in the coming years, while it is up to us to ensure the trust of customers who will choose our services with the breadth and innovation of the offer."Points out Dobrilović. Krešimir Dobrilović, CARWIZ Carwiz is a relatively young company, founded in early 2017, but in a short time it managed to position itself and expand in Croatia as a leader in providing car rental services. With the opening of the initial six branches, today Carwiz is present through 13 branches in all major cities and major tourist centers in Croatia. From Zagreb in the north, Dubrovnik in the south and Pula and Osijek in the west and east. In addition to the above-mentioned cities, the branches are also located in Poreč, Rijeka and Split, and will soon expand to the global market. Precisely on the topic of connection with tourism as well as whether the record tourist season was felt on the growth of car rental services in Croatia, I spoke with Krešimir Dobrilović, owner of a rent a car of Carwiz, who points out that their air guests are the main users of car rental services and generators of growth through the tourism sector. And Dobrilović also sees room for cooperation in this field, which the cooperation of all entities at the level of the tourism sector is the only right way to achieve a positive result. "Thus, we also cooperate well and are in constant development communication with hotel companies and groups, as well as domestic and foreign tour operators who bring guests to Croatia. With a common strategic approach, we ensure that every guest after leaving Lijepa naša leaves full of impressions that will create a desire to come again, but also ensure that they pass on positive experiences to their acquaintances and thus create new users eager to visit our country."Points out Dobrilović. They are aware of the importance of destination promotion in Carwiz, and researching the company for interviews, I was thrilled to be under the category of Inspirations in Carwiz promoting our destinations and events, and thus actively involved in the segment of tourism promotion. Also, through the same prism, they see their contribution to the development of a tourist destination in Carwiz through cooperation with various tourist events that are the motive for coming. Thus, one of the first steps was the sponsorship of the recently completed Snow Queen in Zagreb. As info related to Croatia's direct air connection with emitting markets, the Croatian National Tourist Board's Market Research and Strategic Planning Department regularly reviews the direct flights and direct air connections of Croatian airports from 12 major emitting markets twice a year, which is regularly updated with new information. I keep emphasizing that the motive for coming is not accommodation, but a tourist destination. That is why it is extremely important that everyone in the tourist chain understands the importance of promoting a tourist destination, and not primarily themselves and their services and products. It is imperative to "sell" the destination, ie to give a good enough motive for the guest to come to it, and only then comes the consumption and consumption of all other services and products offered by the destination. So in the case of ren a car services. "Our goal is not just to expand to the region. This way I will give you a little exclusive regarding our business plans. This is a business achievement by which we will establish contractual relations for the placement of our brand on the global market at the end of the month. Our ambitions are not small and we think big accordingly. We want to be one of the leading drivers of integrating the number of tourist arrivals in Croatia. At the local level, we will continue to work systematically on business stability, technological innovation, market strengthening and awareness of the availability of car rental services. In addition to the systematic improvement of all sales channels with an emphasis on strengthening the web platform, our priorities will be quality staffing and education of our employees."Points out Dobrilović, and emphasizes that only through satisfied and professional staff can we achieve the desired achievements. The main factor associated with tourism when we talk about car rental service is certainly the best possible air transport, ie direct air connections with emitting markets. It was this segment that achieved great growth last year, and Croatia has never been better and better connected. Last year, a record tourist season was achieved, and since tourism is not one industry, but connects various industries vertically and horizontally, so various industries directly benefit from tourism. One of them is certainly the car rental market, which has been growing from year to year for a couple of years. Find out more in the attachment. Last year, Rent-a-car companies lobbied for the rent a car service to be included in the new amendments to the Law on the Provision of Services in Tourism, and the campaign bore fruit. When asked what this means for the current development of car rental services, Dobrilović points out that any law that burdens business is not good for the sector, including this case. "Thus, until recently, certain legal aspects were insufficiently in line with the conditions that allow for improved business. Through quality communication and cooperation with the competent authorities, the rent a car industry has managed to find a common language that has resulted in the adjustment and change of the legal framework. That this decision is correct will be clear in a very short time when analyzing the achieved numerical and financial indicators. I personally welcome the readiness of the institutions for dialogue and respect for the sector's need for corrections. Only such two-way communication is possible to achieve improved business conditions that will result in a positive impact on our sector, and consequently on the domestic economy."Said Dobrilovic. "Surely. Modern tourism is based on a quality DMC where rent a car must give its all in the true sense of the word. Thus, we daily analyze and get involved in events that ensure an increase in the number of tourist arrivals, and consequently the promotion of our tourist offer. In addition to the Snow Queen, this season we have a dozen other events planned throughout Lijepa naša, which we will use our support, knowledge and offer to try to help achieve the set results. Our tendency is for the tourist result and offer to develop well in less developed areas such as Slavonia. It is for this reason that we have opened a branch office in Osijek, which will contribute to the desire to make continental tourism one of the main driving forces of this region." Announcements for this tourist season are positive and are expanding day by day and opening new airlines. And companies in the car rental segment where airline guests are certainly looking forward to this news are one of the main generators of demand for car rental services in tourism. Today, Croatia is in a favorable position due to the positive perception and trend, which indicates that Croatia is a desirable destination, Dobrilović believes, and adds that such a trend should be built and supplemented from season to season. "If we lurk in complacency, it will not be good. Therefore, we at Carwiz, and taught by knowledge from leading tourism fairs such as WTM, will continue to complement our offer and keep the trend I mention with constant development. If such an approach is maintained by other entities in the tourism sector, then there is no fear for tourism. It is important to emphasize that such an approach must be followed by the competent institutions, which with their measures, incentives and legal corrections must not be a burden but a quality partner of the business and tourism sector.. " Direct air connection Ryanair has confirmed that it will open eight new routes to Zadar Airport in the new season, from the Czech Republic, Poland, Italy and Germany, and two new connections to Rijeka Airport, London and Manchester. Also, flights to Dubrovnik and Split from Dublin have been announced, four times a week since June. The outcome in which others follow us, and not others, is an indicator of Carwiz's strength and market position, Dobrilović points out and adds: "From the very beginning of our business, our foundation was the tendency to create a better and more meaningful offer. Today, it is not enough to sell a product, but you must provide the user with an experience. That is how we work every day to improve our offer. We are based on new technologies and global trends that are becoming an integral part of life, both younger and all other generations. Our offer is, I would dare say, a driver of market trends. This is evidenced by the fact that the competition often follows the sales and content trends that we set and in large numbers implement our ideas and innovations in their business. We are primarily proud of this because we believe that the outcome in which others follow us, and not others, is an indicator of the strength and market position of Carwiz.. " Carwiz at the WTM Tourism Fair in London In the end, the future of car rental services is bright, believes Dobrilović, mostly in the segment of switching to electric vehicles and share platforms. read more
Zagorje mills became the 23rd Croatian product protected in the EU
"Zagorski mlinci" has been awarded the European protected geographical indication, the European Commission published in the Official Journal of the European Union L 168 on June 25, 2019.Thus, "Zagorski mlinci" are entered in the register of protected designations of origin and protected geographical indications and protected throughout the European Union.The geographical area of production of "Zagorje mills" includes the area of Hrvatsko Zagorje, ie the entire area of Krapina-Zagorje County, the entire area of Varaždin County and the peripheral parts of Zagreb County bordering Krapina-Zagorje and Varaždin County, ie municipalities: Brdovec, Marija Gorica, Pušća, Dubravica, Luka , Jakovlje, Bistra and Bedenica.Croatia now has 23 agricultural and food products whose name is registered in the European Union as a protected designation of origin or a protected geographical indication. In addition to the name Zagorski mlinci, the following are registered: Krk prosciutto, Extra virgin olive oil Cres, Neretva mandarin, Ogulin sauerkraut / Ogulin sauerkraut, Baranja kulen, Lika potatoes, Istrian prosciutto / Istrian prosciutto, Drniš prosciutto, Dalmatian prosciutto, Poljički soparnik / Poljički zeljannik Krk olive oil, Korčula olive oil, Pag lamb, Šolta olive oil, Varaždin cabbage, Slavonian kulen / Slavonian kulin, Međimurje meat 'from Tiblica, Slavonian honey, Lika lamb, Istria and Pag salt. For these products, the EU mark of protected designation of origin or protected geographical indication on the packaging guarantees the consumer the purchase of an authentic product. More information The process of protection of the name "Zagorski mlinci" began in September 2016, when the Association for the Protection, Preservation and Promotion of Traditional Zagorje Products "Tradition of Zagorje" submitted a request to the Ministry of Agriculture to protect the geographical indication. In April 2017, the Ministry of Agriculture issued a Decision on the transitional national protection of the name "Zagorski mlinci", and in June of the same year a request was sent to the European Commission for the registration of the name at the level of the European Union.The simple recipe of "Zagorje mills", which contained only flour, salt and water, was passed down through the generations in the families of Hrvatsko Zagorje and has remained until today. The recognizable appearance and fragile texture of "Zagorje mills" is due to the specific way of baking the dough on flat or rounded hot plates, which lasts only a few minutes. Baking mills on such plates is a traditional way of baking "Zagorje mills", just as it used to be baked on ovens in Zagorje houses."Zagorski mlinci" is a product that, after being prepared, is traditionally served with roasted poultry meat, so in almost all records related to the way of consuming "Zagorski turkey", it is stated that it is served with "Zagorski mlinci". Both products belong to the most important autochthonous products of Hrvatsko Zagorje and are found in almost all tourist, gastronomic and other publications related to Hrvatsko Zagorje, and together they form a recognizable combination – the "main dish" of Hrvatsko Zagorje, most often called "Zagorje turkey with grinders"."Zagorski mlinci" is a bakery product prepared from wheat smooth flour type 550, water and salt from which a thin, rolled and hand-stretched dough up to 2,5 mm thick is made. The stretched dough is then cut into rectangular pieces, which are baked in two stages on hot plates and dried until done. The finished product "Zagorski mlinci" is a thin, baked dough of rectangular shape with possible uneven edges, white-yellow color, flat and in some places slightly raised surfaces with characteristic, sometimes burnt protrusions (bubbles) light brown, brown to black color due to swelling of the dough baking. Before consumption, "Zagorski mlinci" are manually broken into smaller pieces and poured over with boiled water, after which they should be left to stand for a short time. They are then drained, traditionally seasoned with hot baking fat and can be consumed."Rarely does anyone have such a complete story – turkey and grinders, both protected. We expect that the picky European market will recognize our products, but also that manufacturers will be able to form an adequate price for that market.. Through the Entrepreneurship Center, we will make a proposal to the Ministry of Agriculture that they also subsidize the increase in production. ", concluded the prefect of Krapina-Zagorje County, Željko Kolar."The Ministry of Agriculture wants to increase the number of producers participating in the system of control of protected products. Given that entering the control system for producers means a certain financial cost in the Rural Development Program of the Republic of Croatia for the period 2015-2020, we have envisaged Measure 3, which is intended for new producers of protected agricultural and food products, and in which they are fully recognize and finance product control costs. Also through this measure, co-financing of various promotional activities carried out by producer groups is envisaged. Thus, we are trying to increase the number of manufacturers, and thus products and their promotion, which will certainly facilitate the placement of products outside the borders of the Republic of Croatia. I call on our manufacturers to protect as many products as possible, because that way their products also get added value" pointed out the Deputy Prime Minister and Minister of Agriculture, Tomislav Tolusic. Photo: Ministry of Agriculture read more
First GET STARS marks assigned
admin iewfhvzf November 18, 2020 No Comments
The awarding of GET Stars for the first few winemakers of the Moslavina vineyards was held in cooperation with the Sisak-Moslavina County Tourist Board, the Sisak-Moslavina County and the winemakers of the Moslavina vineyards. Photo: Silvija Munda The "Stars of Wine Tourism" project consists of the White Cluster Award, GET Stars labeling of wineries and online guides. In addition to the Recommendation, one, two or three Stars, in the GET Stars label system there is also Excellence GET Star (Star of Excellence), for wineries that raise their presentation to a much higher level and create an unforgettable experience. The evaluation is performed according to a single rulebook, the criteria of which serve as guidelines according to which the jury, with the conclusions of several expert controllers in the field of tourism, ethnography and urbanism, according to its own assessment makes the final evaluation. "After the winery receives the label, the control does not stop, so the obtained labels can be confirmed or improved, but also lost. This way we will ensure that GET STARS labels are a guarantee for the quality of service in wineries ", explains Tomislav Stiplošek and adds:" What Michelin is for restaurants, GET STARS will become for wineries in wine tourism " First GET STARS tags the GET Recommendation plate was received by Sven Đozo in front of the basement Ilovčakpločica s oznakom "one G.E.T Star" (jedna Zvjezdica) dodijeljena je vinarijama Mix i Miklaužić Sve vinarije bit će uvrštene u višejezičan online vodič – katalog koji pruža mogućnost pretrage prema ključnim riječima i G.E.T. Stars oznakama. Uz takav vodič i druge komunikacijske kanale, G.E.T. Stars oznake dobivaju svoju praktičnu primjenu – one moraju biti poznate i vidljive široj publici koja će putem njih vrlo lako zaključiti o kakvoj vinariji se radi i što mogu tamo očekivati. pločica s oznakom "three G.E.T. Stars" (tri Zvjezdice) dodijeljena je gospodarstvu Kezele. With the aim of raising the quality and recognizability of the tourist offer in wine, ie eno-gastro tourism, the Zagreb Association for Table Culture GET (gastronomy, oenology, tourism) launched the project GET Stars – Stars of wine tourism. Pločica s oznakom "three G.E.T. Stars" (tri Zvjezdice) dodijeljena je gospodarstvu Kezele / Foto: Silvija Munda pločica s oznakom "two G.E.T. Stars" (dvije Zvjezdice) dodijeljena je vinarijama Trdenic i Vostinic-Klasnic "Turistima nije bitan samo proizvod, već cijeli doživljaj. Zato smo odlučili provesti kategorizaciju vinarija temeljenu prvenstveno na aspektima turističke ponude. Cilj je tako turistima olakšati izbor gdje, kada i kamo otići, što mogu očekivati i ono najbitnije, unaprijed im dati do znanja što svakako trebaju probati, jer mnogi od njih ne poznaju naše vinarije i vinare, a domaćini se ne sjete ponuditi neke proizvode, ili čak smatraju da su neki proizvodi "preobični", a upravo su takvi proizvodi turistima interesantni" ističu iz G.E.T. Udruge te dodaju kako su segmenti projekta "Zvijezde vinskog turizma" nastali su iz zaključaka proizašlih iz dugogodišnjeg rada na terenu i razgovora sa svim akterima vinskog turizma – od vinara, preko turističkih djelatnika do turista i potrošača. read more


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16 defining NCEL League games of the decade involving Yorkshire sides
What a decade it has been for Toolstation NCEL football. Some big clubs have passed through, Farsley Celtic, Scarborough Athletic, Tadcaster Albion, Brighouse Town, Pontefract Collieries spring to mind. Four of those clubs are enjoying great success in the Northern Premier Division, while Farsley are riding high in the National North. We have delved into read more→
Non League Yorkshire Team of the Decade
It has taken some deliberation, but we have finally have a Non League Yorkshire Team of the Decade, as well as manager. The Team is made up of players who we believe have consistently excelled in the Northern Premier League and Northern Counties East League whilst playing for Yorkshire clubs between 2010 and 2019. Team read more→
Avenue need to look local and into the past
The 2018/19 season goes from bad to worse for Bradford (Park Avenue). Two 5-0 defeats started the campaign and led to the sacking of rookie manager Garry Thompson. In came interim boss Marcus Law. Results improved initially, but have now deteriorated to the extent that they were embarrassingly annihilated 8-0 by Brackley Town – one read more→
NPL should publicly praise Pontefract
Pontefract Collieries got to Workington after an horrendous five-hour journey to Cumbria. The Collieries eventually lost 2-1 in the BetVictor North West clash which kicked off at 3.45pm. Jake Picton gave Pontefract late hope in the fixture. Pontefract had set off to Workington at 10am, but the three-hour journey took five because of a major read more→
Who will win the NCEL Premier and Division One titles?
Choosing who will finish in the top ten of each Division has been hard enough so picking the actual winners is difficult. With more promotion places available in both Divisions, a vast number of teams have shelled out on top signings – making it harder for us so-called pundits to call. We've sure they will read more→
NCEL Premier Division top ten predictions
A lot of top signings and three promotion spots make the 2019/20 Toolstation NCEL Premier Division season one to look forward to. Non League Yorkshire has only predicted the top ten for the Division – in alphabetical order as it is too hard to decide where teams will actually finish! Bridlington Town Brett Agnew enjoyed read more→
NCEL Division One top ten predictions
The new Toolstation NCEL Division One season promises to be one of the best ever. Not since 2007 have there been more than two promotion places. Teams can now have a sustained assault on winning promotion as there are four slots available. Non League Yorkshire expects ten clubs to be in the mix for the read more→
Chesterfield, Halifax or Harrogate: Who will have the more success this season?
Chesterfield and Harrogate both have reasonable chances of a successful season, in the hopes of breaking into the Football League come May. Unfortunately for Halifax Town, their odds of 40/1 reflect a tough campaign, who may well be spending the coming months fighting against relegation, rather than battling it out at the top. John Sheridan and read more→
Can a Non-League Team Make a Run in the 2020 FA Cup?
The FA Cup is the ultimate opportunity for teams in lower divisions of English football, as they get chances to take on some of the top teams in the higher levels of the ladder with a chance at going down in history. And while a non-league football club making a deep run in the tournament read more→
Guiseley Gaffer warns players they still aren't safe from the drop
Guiseley's joint boss Marcus Bignot has been at pains to stress to his side that despite opening up a small gap over 20th place with a handful of fixtures to go, they still aren't safe from the drop. The Lions have done well to pull away from danger in recent weeks but Bignot is making read more→
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§ 1624. Regulations; issuance; p...
§ 1626. Relation to other progra...
Securities laws exemption
Laws; termination date of exempt status
A Native Corporation shall be exempt from the provisions, as amended, of the Investment Company Act of 1940 (54 Stat. 789) [15 U.S.C. 80a–1 et seq.], the Securities Act of 1933 (48 Stat. 74) [15 U.S.C. 77a et seq.], and the Securities Exchange Act of 1934 (48 Stat. 881) [15 U.S.C. 78a et seq.] until the earlier of the day after—
the date on which the corporation issues shares of stock other than Settlement Common Stock in a transaction where—
the transaction or the shares are not otherwise exempt from Federal securities laws; and
the shares are issued to persons or entities other than—
individuals who held shares in the corporation on February 3, 1988;
Natives;
descendants of Natives;
individuals who have received shares of Settlement Common Stock by inheritance pursuant to section 1606(h)(2) of this title;
Settlement Trusts; or
entities established for the sole benefit of Natives or descendants of Natives; or
the date on which alienability restrictions are terminated; or
the date on which the corporation files a registration statement with the Securities and Exchange Commission pursuant to either the Securities Act of 1933 [15 U.S.C. 77a et seq.] or the Securities Exchange Act of 1934 [15 U.S.C. 78a et seq.].
Status of Native Corporations after termination date
No provision of this section shall be construed to require or imply that a Native Corporation shall, or shall not, be subject to provisions of the Acts listed in subsection (a) after any of the dates described in subsection (a).
Annual report to shareholders; shareholders of record
A Native Corporation that, but for this section, would be subject to the provisions of the Securities Exchange Act of 1934 [15 U.S.C. 78a et seq.] shall annually prepare and transmit to its shareholders a report that contains substantially all the information required to be included in an annual report to shareholders by a corporation subject to that Act.
For purposes of determining the applicability of the registration requirements of the Securities Exchange Act of 1934 on or after the date described in subsection (a), holders of Settlement Common Stock shall be excluded from the calculation of the number of shareholders of record pursuant to section 12(g) of that Act [15 U.S.C. 78l(g)].
Wholly owned subsidiaries; Settlement Trusts; voluntary registration as Investment Company
Notwithstanding any other provision of law, prior to January 1, 2001, the provisions of the Investment Company Act of 1940 [15 U.S.C. 80a–1 et seq.] shall not apply to any Native Corporation or any subsidiary of such corporation if such subsidiary is wholly owned (as that term is defined in the Investment Company Act of 1940) by the corporation and the corporation owns at least 95 per centum of the equity of the subsidiary.
The Investment Company Act of 1940 shall not apply to any Settlement Trust.
If, but for this section, a Native Corporation would qualify as an Investment Company under the Investment Company Act of 1940, it shall be entitled to voluntarily register pursuant to such Act and any such corporation which so registered shall thereafter comply with the provisions of such Act.
(Pub. L. 92–203, § 28, as added Pub. L. 94–204, § 3, Jan. 2, 1976, 89 Stat. 1147; amended Pub. L. 100–241, § 14, Feb. 3, 1988, 101 Stat. 1811.)


We offer full-service design, from client consultancy, through concept development and detailed design to built projects. Our architecture is progressive, always focusing on bringing the client's ambitions to life, while at the same time providing lifelong added value to the users and local context.
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Live ITP in this 3 bedroom, 2 bath home w/easy access to I-75, 85, & 285, and the airport. Upgrades include stainless steel appliances, solid surface counters, shiplap accent walls, built-in bookcases, farmhouse sink, hardwood floors, & a trey ceiling. The renovated bungalow is certified energy star efficient with a tankless water heater, storm windows, & ceiling insulation. Outside you'll find low maintenance 30 year architectural shingles, & a professionally landscaped yard w/fenced private backyard.


Torchflame Books is an imprint of Light Messages Publising serving authors by bringing to light meaningful books.
We were founded in 1998 by a group of authors who believed that there had to be a better model than vanity or self-publishing for emerging authors. As a hybrid publishing company, we work closely with our authors to polish, publish, and sell their books whether written for a broad or select market. We look beyond the immediate profits of the latest "hot topic" to offer a platform for as many subjects as possible.
We are located in Durham, North Carolina. Our primary market is the United States but we also sell books in a number of other nations. We prefer to print locally whenever possible, working wiith printers around the world to decrease delivery time and cost. We offer short-run or high volume printed editions in numerous sizes as well as electronic books in all the standard formats.
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Clara Lemlich Shavelson is primarily known for her impassioned speeches during the 1909 Uprising of 20,000. The majority of histories written about her address her involvement in organizing women garment workers in New York's Lower East Side from her arrival in New York in 1903 up through the eleven-week general strike in 1909. After this, the literature would have you believe she fades into obscurity, for there is only one book that addresses her life post 1909. Shavelson did not give up organizing after 1909. She got married, moved to Brooklyn, and started a family. In Brooklyn, she organized women in her neighborhood--wives and mothers--to engage in consumer activism like food boycotts and rent strikes. She joined the Communist Party and was instrumental in leading more consumer actions up through the Great Depression. She ran for office in New York State, was called to testify in front of the Senate Judiciary Committee, and had her passport revoked after a trip to the Soviet Union. An organizer and supporter of labor until the end of her life, Shavelson convinced the administration of her retirement home to support the United Farm Workers produce boycott, and helped the nurses and orderlies organize for union representation.
Cohn, Sarah B., "Clara Lemlich Shavelson: An Activist Life" (2017). CUNY Academic Works.


text:
Man vs. machine: Predicting hospital bed demand from an emergency department
Filipe Rissieri Lucini,
Roles Conceptualization, Formal analysis, Methodology, Software, Writing – original draft
Affiliations Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada, Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Mateus Augusto dos Reis ,
Roles Investigation, Writing – review & editing
* E-mail: mreis@hcpa.edu.br
Affiliations Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil, Department of Internal Medicine, Faculty of Medicine, Postgraduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
Giovani José Caetano da Silveira,
Roles Writing – review & editing
Affiliation Haskayne School of Business, University of Calgary, Calgary, AB, Canada
http://orcid.org/0000-0001-6960-955X
Flavio Sanson Fogliatto,
Roles Conceptualization, Formal analysis, Methodology, Supervision, Writing – original draft
Affiliation Industrial Engineering Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
Michel José Anzanello,
Roles Software, Writing – review & editing
Giordanna Guerra Andrioli,
Roles Investigation
Affiliation Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
Rafael Nicolaidis,
Rafael Coimbra Ferreira Beltrame,
Jeruza Lavanholi Neyeloff,
Beatriz D'Agord Schaan
Mateus Augusto dos Reis,
https://doi.org/10.1371/journal.pone.0237937
Filipe Rissieri Lucini Mateus Augusto dos Reis ... Beatriz D'Agord Schaan
The recent literature reports promising results from using intelligent systems to support decision making in healthcare operations. Using these systems may lead to improved diagnostic and treatment protocols and to predict hospital bed demand. Predicting hospital bed demand in emergency department (ED) attendances could help resource allocation and reduce pressure on busy hospitals. However, there is still limited knowledge on whether intelligent systems can operate as fully autonomous, user-independent systems.
Compare the performance of a computer-based algorithm and humans in predicting hospital bed demand (admissions and discharges) based on the initial SOAP (Subjective, Objective, Assessment, Plan) records of the ED.
This was a retrospective cohort study that compared the performance of humans and machines in predicting hospital bed demand from an ED. It considered electronic medical records (EMR) of 9030 patients (230 used as a testing set, and hence evaluated both by humans and by an algorithm, and 8800 used as a training set exclusively by the algorithm) who visited the ED of a tertiary care and teaching public hospital located in Porto Alegre, Brazil between January and December 2014. The machine role was played by Support Vector Machine Classifier and the human prediction was performed by four ED physicians. Predictions were compared in terms of sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUROC).
All graders achieved similar accuracies. The accuracy by AUROC for the testing set was 0.82 [95% confidence interval (CI) of 0.77–0.87], 0.80 (95% CI: 0.75–0.85), 0.76 (95% CI: 0.71–0.81) for novice physicians, machine, experienced physicians, respectively. Processing time per test EMR was 0.00812±0.0009 seconds. In contrast, novice physicians took on average 156.80 seconds per test EMR, while experienced physicians took on average 56.40 seconds per test EMR.
Our data indicated that the system could predict patient admission or discharge states with 80% accuracy, which was similar the performance of novice and experienced physicians. These results suggested that the algorithm could operate as an autonomous and independent system to complete this task.
Citation: Lucini FR, Reis MAd, Silveira GJCd, Fogliatto FS, Anzanello MJ, Andrioli GG, et al. (2020) Man vs. machine: Predicting hospital bed demand from an emergency department. PLoS ONE 15(8): e0237937. https://doi.org/10.1371/journal.pone.0237937
Editor: Itamar Ashkenazi, Technion - Israel Institute of Technology, ISRAEL
Received: April 7, 2020; Accepted: August 5, 2020; Published: August 27, 2020
Copyright: © 2020 Lucini et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The data underlying this study contains potentially identifying and sensitive patient information. This restriction has been imposed by the the ethics committee of Hospital de Clínicas de Porto Alegre. Data access requests can be sent to HCPA's ethics committee (cep@hcpa.edu.br)
Funding: This work was supported by the Fundo de Incentivo à Pesquisa – Hospital de Clínicas de Porto Alegre (FIPE-HCPA) and by the Postgraduate Program in Medical Sciences: Endocrinology - Universidade Federal do Rio Grande do Sul. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: No authors have competing interests.
Overcrowding in emergency departments (EDs) is internationally recognized as one of the greatest challenges to healthcare provision [1]. Emergency department crowding is associated both with objective negative clinical endpoints, such as mortality [2], as well as flawed clinically important processes of care, such as lengthened time to treatment for patients with time-sensitive conditions [3]. Over the years, multiple small process improvement projects have attempted to improve ED overcrowding, but these processes do not improve the fundamental problem of improving hospital capacity [4]. Predicting ED attendances could help with resource allocation and reduce pressure on busy hospitals.
In healthcare operations, the growing use of intelligent systems (e.g. to support clinical decisions) may represent an important transition to a "new healthcare" [5]. Intelligent systems can help dealing with demands for more accurate diagnostics [6], safer and more effective medicines [7], and more effective treatments [8]. Using these systems may lead to improved diagnostic and treatment protocols, procedures [8] and help to predict hospital bed demand.
Emergency departments are time sensitive, highly stressful, non-deterministic, interruption-laden, and life-critical environments [9]. In these conditions, effective decision making is difficult or even impossible to achieve by humans. Despite some effort to develop intelligent systems to support ED decision-making [10], there is not much evidence from studies assessing their capability to operate as fully-automated, user-independent systems. We still lack knowledge on whether computer-based systems may be considered suitable to substitute humans in ED decision making, be it clinical or managerial decisions. This study targets such knowledge gap by investigating the performance of an intelligent system developed to predict hospitalizations and discharges, based on early ED patient text records using the SOAP (Subjective, Objective, Assessment, and Plan) framework comparing the performance of a computer-based algorithm and humans in predicting hospital bed demand in an ED.
Study database
This was a retrospective cohort study, which compared the performance of humans and machines in predicting hospital bed demand from an ED. Predictions were made by a set of physicians and by a trained algorithm, based solely on the records of the initial ED evaluation (i.e. SOAP notes), and compared to actual patient status after (admitted as an inpatient or discharged from the ED) 24 hours since first evaluation. This study was approved by the ethics committee of Hospital de Clínicas de Porto Alegre. Consent was not obtained because the data were analyzed anonymously and retrospectively. Authors have complied with the recommendations of the Declaration of Helsinki. The database was made available by the ED of an 842-bed, tertiary care and teaching public hospital located in the city of Porto Alegre, Brazil. Each electronic medical records (EMR) contained relevant information on early clinical care provided to patients, such as SOAP framework notes, prescriptions and exams. All textual records were written in Brazilian Portuguese.
EMR from all 16,703 patients who visited the ED between January and December 2014 were assessed in this study. Exclusion criteria were duplicated and empty textual records and those where patient final status were explicitly described in the SOAP notes; e.g. texts such as "HAA" (hospital admission authorized), "patient left", "PD" (patient discharged), "patient not located", and "patient did not answer when called". Also excluded incomplete textual records, corresponding to those with missing information on one or more subjects of the SOAP framework. Consequently, the number of EMRs was reduced to 9,030, of which 4,673 were records from discharged patients and 4,357 were records of admitted patients; Table 1 details the reasons for records removal. Note that this hospital's ED classifies patient acuity according to the Manchester Triage System [11], and is tasked within the local health system with providing care only to patients in the immediate (I), very urgent (VU), and urgent (U) categories. The balanced ratio between inpatient and discharged classes in the dataset reflects the type of care provided by the ED. No sample adjustments were made.
Table 1. Selection of reports from the database.
https://doi.org/10.1371/journal.pone.0237937.t001
The database was adjusted to be used as input to both machine and human graders. Records were structured with two fields of information. The first was a dummy variable indicating patient final status (inpatient or discharged). The second contained the free-form textual SOAP notes entered by the hospital's healthcare providers during the first patient-physician encounter.
Next, the dataset was randomly split into stratified (i.e. same ratio between classes, inpatient and discharged, as in the original sample distribution) training and testing sets. The training set was used to develop the machine's algorithm and the testing set was used to compare machine and human graders. We sampled 2.5% of the records to comprise the testing set (230 records). This sample translates to a margin of error of 6.4%, with a confidence interval of 95%. The remaining 8,800 records were considered the training set. The ratio between records belonging to classes inpatient and discharged was kept constant in both sets, according to the original sample distribution. As a result, training and testing sets presented 4,553 and 120, and 4,247 and 110 records in classes discharged and inpatient, respectively.
Intelligent system protocol
The machine role was played by Support Vector Machine Classifier (SVMC), which was the best predicting algorithm according to a previous analysis [12]. Textual information from all records were pre-processed and the algorithm trained. Next, the algorithm was used to predict the final status of 230 patients from the testing set.
The SVMC was first introduced by [13], being widely used to solve supervised classification problems from different application domains [14]. The two-class SVMC finds a hyperplane that ensures maximum separation between classes. Separating margins are identified by few data elements named support vectors [13]. The best predicting algorithm in [12] uses a variation of the two-classes SVMC called nu-Support Vector Classifier (nu-SVC). Proposed by [15], nu-SVC uses a parameter to control the number of support vectors and training errors. More details about the classifier are available in [15]. In this study, the nu-SVC was implemented using a linear kernel and default parameters of the package scikit-learn [16] from Python 3.6 [17].
As proposed previously [12], four pre-processing steps were carried out to prepare the textual information to be used as input to the algorithm: normalization, tokenization, feature selection, and conversion to set-of-words. In the normalization step, punctuation marks, numerical characters, and stop words were removed; capital letters were substituted by lowercases; and words were reduced to radical forms. In the tokenization step, the continuous string of characters of each record was broken down into linguistic units called tokens, which were delimited by blank spaces in the string. The algorithm uses the combination of unigrams, bigrams and trigrams as features, which are sequences of one, two or three adjacent words from the list of tokens. In the feature selection step, the F-Value of each feature from the training set was calculated. Following [12], features with an F-Value above the 65-th percentile of largest values were selected. The F-Value of a particular feature is calculated by: (1) where Xi, and is the average of the i-th feature in the complete, inpatient, and discharged datasets, respectively; is the i-th feature of the k-th inpatient instance, and is the i-th feature of k-th discharge instance. The last pre-processing step was the conversion to set-of-words representation, which results in a matrix indicating the occurrence of selected features in records. Matrix columns represent each of all selected features, while matrix rows represent each of the records. Matrix cells were filled out using term frequency–inverse document frequency (TF-IDF) indicator results. It may be expressed as: (2) where t denotes the feature, d denotes the record, D is the total number of records in the collection, and f(t,d) is the number of occurrences of feature t in record d.
Once all pre-processing steps were performed, the algorithm was trained and the final status of patients from the testing set was predicted. Records of the testing set could be classified as belonging to one of two classes, inpatient or discharged. It was assumed that if a record was classified as inpatient, the patient stayed in the hospital and a ward bed was required. On the other hand, if a record was classified as discharged, there was no need for hospitalization. As a result, a list indicating the class of the 230 records in the testing set was made available. This list was used to measure the intelligent system performance in the present study.
Human predictions
The manual prediction of the testing set was performed by four hospital's ED physicians. Following [18], recruited physicians had different levels of experience. Two were novice ED physicians, with less than two years of experience working in the hospital's ED, while the other two had been working in the hospital's ED for more than 10 years.
Manual prediction was carried out in two steps. The first step aimed to verify substantial inter-observer agreement between physicians with similar experience. A trial testing subset of 30 randomized records was created, 14 belonging to the inpatient class and 16 belonging to the discharged class. All four physicians analysed the records and the Cohen's Kappa coefficient [19] was used to measure their level of agreement. Kappa values between 0.61 and 0.80, and between 0.81 and 1.00 represent "substantial" and "almost perfect" strengths of agreement respectively [19]. Thus, 0.61 was used as minimum threshold for grouping evaluations from each pair of physicians with same experience.
The pair of novice physicians and the pair of experienced physicians disagreed in 4 and 5 predictions respectively. As a result, Cohen's Kappa coefficient was 0.74 for novice physicians and 0.66 for experienced physicians; both scores indicated "substantial" level of agreement, surpassing the minimum established threshold for grouping evaluations.
In the second step, the remaining 200 records were split into subsets, observing class frequencies, and assigned to physicians for assessment. Eventually, each of the 200 records were analyzed by both experienced and novice physicians.
Physicians received personalized weblinks to access the records they were expected to evaluate. For each record, physicians were instructed to read and answer the following question: "Based exclusively on this SOAP note, what do you think happened to the patient?" Two options were given: (i) "INPATIENT–Patient required a hospital ward bed" or (ii) "DISCHARGED–Patient was discharged after consultation, not requiring a hospital ward bed". Records consisted of four paragraphs, one to each subject of the SOAP framework. Physicians did not receive any feedback about their answers. In addition, physicians we not allowed to consult any other records, systems, colleagues, or other resources. Fig 1 shows an example of record presented to physicians.
Fig 1. Record sample in SurveyMonkey (translated from Portuguese).
https://doi.org/10.1371/journal.pone.0237937.g001
In case of divergence between answers of physicians in the same experience group the conservative answer ("Inpatient") was considered. The conservative answer maximized patient safety and was consistent with clinical practice when there is doubt regarding patient immediate prognosis.
This study used validation methods similar to those in [18]. The statistical analysis was carried out in R x64 3.3.3 [20]. Receiver Operating Characteristic (ROC) analysis was performed for both machine and humans. Accuracies of the intelligent system protocol and human predictions were expressed as the area under the receiver operating characteristic curve (AUROC), and compared using the nonparametric test by [21]. Youden's J statistic [22] was used to calculate the optimal cutoff for sensitivity and specificity. According to [23], sensitivity and specificity are the same as true positive rate (i.e., the number of true inpatients divided by the total number of cases classified as inpatients) and true negative rate (i.e., the number of true discharged divided by the total number of cases classified as discharged), respectively. We considered a p-value equal to or smaller than 0.05 as indicative of significant differences.
All computations were performed on an Intel Core i7-7500U@2.9GHz and 16GB RAM. Machine training was completed successfully in 2 minutes and 46 seconds. Processing time per test EMR was 0.00812±0.0009 seconds. In contrast, novice physicians took on average 156.80 seconds per EMR, while experienced physicians took on average 56.40 seconds per EMR.
Receiver Operating Characteristic curves for machine and novice and experienced physicians are presented in Fig 2.
Fig 2. ROC curves by group.
Table 2 shows accuracy by AUROC for the testing set. All graders achieved similar accuracies. The accuracy by AUROC for the testing set was 0.82 [95% confidence interval (CI) of 0.77–0.87], 0.80 (95% CI: 0.75–0.85), 0.76 (95% CI: 0.71–0.81) for novice physicians, machine, experienced physicians, respectively. Table 2 also shows sensitivity and specificity for the testing set at optimal cutoff point.
Table 2. Accuracy, sensitivity and specificity with 95% CI considering the testing set.
Prediction accuracy by AUROC was not significantly different among graders (Table 3).
Table 3. DeLong's test p-values for two correlated ROC curves.
Table 4 summarizes prediction success in the 230 cases. The machine was correct, but the physicians were not in 14 cases; the opposite occurred in 19 cases. All graders were correct in 137 cases, but incorrect in 10 cases. There were divergences between physicians in 50 cases.
Table 4. Comparison of mistakes and successes among graders.
The intelligent system protocol used 1,538,956 features to make predictions. The most informative features for admission were associated with the presence of symptoms (e.g. "edema", "non-measured fev", "paroxysmal nocturnal dyspnea"). On the other hand, the most informative features for discharge were related to normal physical examination or absence of symptoms (such as "well perfused extrem", "normal breath sound", and "no history dysuria").
To our knowledge, this is the first study comparing an algorithm generated through machine learning with ED physicians in predicting patient admissions after their first evaluation. A computer running such algorithm could provide real-time data on bed necessity and aid bed management teams to improve patient flow processes. Our main results show that performances (accuracy) of physicians (novice or experienced) and machine were similar. Highest sensitivity was achieved by both novice and experienced physicians, and higher specificity was achieved by the machine, although confidence intervals had some overlap. In addition, the algorithm was significantly faster when compared to doctors. On average, novice and experienced physicians took 156.80 seconds and 56.40 seconds to analyze each record, respectively. In contrast, the algorithm analyzed the whole testing set in less than two seconds.
From a practical perspective, predictions made by the algorithm are almost instantaneous and allow immediate action from bed capacity planners, independent of the number of patients. There are some months in the year or times of the day that ED is most overcrowded as demonstrated by [24] using two scales: National Emergency Overcrowding Scale (NEDOCS), and Emergency Department Work Index (EDWIN). When humans are responsible for planning hospital bed demand, waiting times may increase when the ED is overcrowded, because of diminished physicians' availability.
In our study, the computer algorithm was as accurate as the doctors. Note that physicians reviewed records outside working hours in the ED, in a calm setting, without multitasking or time constraints. It is difficult to predict how their performances could be affected if evaluations were carried out in parallel with their ED working activities, but it is reasonable to speculate that they would be worse. On the other hand, machine performance is not affected by the working environment.
Improving patient flow and discharge processes through bed management supporting teams [25] have resulted in reduction in length of stay, cancelled interventions and increase in planned discharges [26]. The use of a computer algorithm as decision support system could enable hospital staff and health decision makers to better manage hospital inpatient beds, thus potentially reducing costs and inpatient length of stay [27]. Previous studies evaluated mathematical programs to model bed assignment [28] and prediction models to improve efficiency [29] with positive results, but none could made the predictions in real time, as it is possible with the herein tested algorithm.
The algorithm presented similar sensitivity and specificity values, while doctors tended to present higher sensitivity and lower specificity. That could be due to a clinical conservative bias–when in doubt, it would be safer to admit a patient then to discharge her. However, from a management standpoint a more balanced cut-off point on the ROC curve would be potentially more beneficial, since bed demand prediction would then be more stable with similar false negative and false positive rates. As [30] have discussed, a key requirement for effective bed management is information; anticipatory planning requires prediction of admissions and discharges. The authors have stated that there is a huge potential to improve information made available to bed management teams, and that few bed management functions have access to reliable data on patients expected to come in and be admitted.
The proportion of cases in which physicians were correct while the machine was wrong, and in which the machine was correct while physicians were wrong was similar (8.26% and 6.09%, respectively). The former group (physicians correct) is composed of nine admissions and ten discharges. On the discharges, it would seem that the algorithm has difficulty in recognizing information on patients being sent to other health services (two cases). On six other cases, there seemed to be extensive information on patient health history on the SOAP note, which was not directly related to the current condition of the patient. On the admissions, it is harder to presume causes for incorrect classification; for human readers, some SOAP notes clearly indicated either emergencies or the need for interventions: e.g. unstable angina, intestinal obstruction, nephrolithiasis necessitating a double J stent, and new onset atrial fibrillation. Since these descriptions were shortly stated on the Assessment item of the note, it is possible that the algorithm did not find enough information in the remaining of the note to justify admission and could not interpret the medical condition alone.
Regarding the cases where the algorithm was correct and physicians were wrong, most cases were discharges (12 of the 14 cases). This again may show a conservative bias from physicians, tending to classify cases as "admissions" when in doubt. It is hard for human readers to explain why the algorithm was correct; some SOAP notes describe serious diagnostic hypotheses, such as suspicion of acute coronary syndrome or of deep vein thrombosis, while others describe cases which appear to be non-complicated urinary tract infections, gastroenteritis or headaches. Human understanding of artificial intelligence (AI) decisions is known to be limited, and it has been proposed that it would be possible to train AI itself to provide natural language justifications of its decisions [31].
A possible refinement to the tested algorithm would be to include lab results into the available data; however, since the authors' goal was to have the earliest possible prediction on patient admission or discharge, they chose to use only the first SOAP note registered by a physician. Indeed, the combination of four data mining operations including from lab results to clinical information let to a correct diagnosis in 98% of the cases in a pediatric emergency room, although retrospectively [32].
The study has some limitations. It was not confirmed whether the evaluators had the same clinical experience, the graduation time was used to choose the evaluators. The ED of HCPA provided care to high complexity cases, which includes only patients in the immediate, very urgent and urgent categories of the Manchester Triage System. The raw database presented a 50:50 proportion of cases in the inpatient and discharged categories. If the algorithm was applied to low complexity cases the results could be different. This is a single-hospital study, and thus its results may not be generalizable to other institutions. In one hand, few annotation studies assessed the SOAP framework for ED approaches and thus may be difficult to compare our results with other studies. No other machine learning options were explored, limited to the methods presented in the original document [12].
The sophisticated computer algorithm here tested could predict patient admission or discharge with 80% accuracy, based solely on the first SOAP note from the ED. The algorithm had comparable performance to both novice and experienced ED physicians. We believe there are potential uses of intelligent computer systems in aiding hospital management, and it is possible that these systems could effectively support physicians in clinical decision making. The proposed algorithm is one such example; its implementation could provide useful data for bed management teams, improving patient flow processes throughout the hospital.
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text:
Album Reviews 2021, 2020, 2019, 2018, 2017, 2016
Kill The Lights - The Sinner (Album Review)
Written by Alex Stojanovic
Shed My Skin
Watch You Fall
Tear Me Apart
Label: Fearless Records
Website: www.killthelightsofficial.com
www.facebook.com/OfficialKillTheLights
KILL THE LIGHTS IS:
James Clark - Vocals / Travis Montgomery - Guitars / Jordan Wheelan - Guitars / Michael "Moose" Thomas - Drums
It's coming on three years since Michael "Moose" Thomas was ultimately dismissed from Bullet For My Valentine, but that did not stop him from continuing on his musical path. At the start of 2019, he announced his new band Kill The Lights, which also features Jordan Wheelan (Still Remains) and Travis Montgomery (Threat Signal) sharing guitar duties, and James Clark (Throw The Fight) on vocals. The band also featured Davey Richmond (Glamour Of The Kill) on bass, but he ended up leaving the band, so they are currently without a bassist. The band gave their first taste of music with two songs in early 2019. After they released the two songs, updates from the band came to a halt, and things went silent for a while, which got people speculating that the band was already over.
However, they came back with a couple more new tracks at the start of this year, and they are finally ready to release their much-anticipated debut album The Sinner. The album saw Moose reuniting with production legend Colin Richardson, who produced the first two BFMV albums (The Poison and Scream Aim Fire), as well Venom. As the haunting spoken word intro accompanied by an organ on opener "Shed My Skin" begins, you can tell that you're in for something intense, and then a fierce sonic attack with an intense scream, rampaging riff and blast beats drops out of nowhere and explodes like a nuclear bomb. It's one of the heaviest tracks here, but the chorus is absurdly catchy. When it comes to the choruses, it's hard to pick a favourite because just about everyone of them manages to stick in your head.
Musically, there's many moments on here that feel reminiscent of old-school BFMV. Fans from the Poison era will find a lot to love on this record. The opening riff to "Watch You Fall" immediately conjures those early Poison vibes, but this band is not meant to be a clone of BFMV, or Still Remains, or Threat Signal, or Throw The Fight, but you can certainly hear elements of all these bands in the music. "Open Your Eyes" is another standout track, because it's probably the most intense song on the record, with a rampaging thrash-oriented riff, blast beats and a searing solo from Montgomery, but once again, the chorus just sticks in your head like crazy. Tracks like this one, "The Faceless", "Shed My Skin" and "Unmoved" are guaranteed to give musicians a good workout.
Given that Moose is the biggest name of all the members in the band, it's obvious that Bullet For My Valentine is the band that Kill The Lights will be compared to the most. For proof, go to any of the videos that the band released so far, head to the comment sections, and you'll see exactly what I mean. However, you can hear elements of other bands as well. "Sober" gives off a heavy Killswitch Engage vibe, and is another one of the record's standout points. As I always say, dynamics are important to any record. While we take a break from the heaviness, we're treated to some more radio-friendly tracks like "Through The Night", which talks about James Clark's struggles with anxiety and depression. There's also "Tear Me Apart" and "Rest". The former has one of the most hypnotic choruses on the record. I found myself repeating that chorus quite a few times.
There's not really any major flaws with this record. I think the only thing I would point out when it comes to any type of flaw is that the main riff in "Plagues" doesn't seem to stand out like the other riffs. The chorus makes up for whatever the music lacks. I hardly listen to metalcore anymore because I grew out of it, with the exception of a small handful of bands that are stil putting out great music, but I have to say that this was a really solid metalcore record, and probably the best one I'll hear this year. This is certainly the most intense drumming we've gotten from Moose since Scream Aim Fire. At the same time, the guitar work from Montgomery and Wheelan is majestic, and Clark's vocals are on point. Since there's no bassist, the bass had to have recorded by either Wheelan or Montgomery. For those who are BFMV fans that miss Moose behind the kit, and hated the last album Gravity, fear not because the man is back with a vengeance with Kill The Lights, and The Sinner is a stunning first salvo of music from the band. We're looking forward to seeing where the band goes from here.
Highs: Probably the most solid metalcore record that 2020 will see.
Lows: "Plagues" is the only non-perfect song
FINAL RATING


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text:
Q: String Concatenation in bash with space and putting quote around I got a very good response in my last question. The idea was to process N number of inputs from command line, save first 9 to variables and make a string with 10 to onward.
I found this to be the easiest solution.
var1="$1"
var2="$2"
var3="$3"
var4="public"
var5="$5"
var6="''"
var7="$7"
var8="$8"
var9="$9"
var10="$(shift 9; IFS=""; echo "$*")"

echo snmptrap $var1 $var2 $var3  $var4 $var5 $var6 $var7 $var8 $var9 "$var10"

snmptrap $var1 $var2 $var3  $var4 $var5 $var6 $var7 $var8 $var9 "$var10"

The output looks like this...
./snmptas  -v 2c -c "" 9.48.85.57 "" 1.3.6.1.4.1.2.6.201.3 s s  ABC DDEF EFFF

snmptrap -v 2c -c public 9.48.85.57 '' 1.3.6.1.4.1.2.6.201.3 s s ABCDDEFEFFF

But I wanted $var10 in this form
"ABC DDEF EFFF".
This needs to changed. It's taking the spaces off.
var10="$(shift 9; IFS=""; echo "$*")"

How can I make var10 = "ABC DDEF EFFF"?
Thanks

A: A subshell with echo is not really appropriate there. Better this way:
shift 9
var10="$*"

If you want quotes around that as part of the value, then change the last line to:
var10=\""$*"\"

Unrelated to that, I'm wondering if your treatment for var6 does what you intended. I suspect that this will be closer to what you really intended:
snmptrap $var1 $var2 $var3  $var4 $var5 '' $var7 $var8 $var9 "$var10"

Or this:
var6=
snmptrap $var1 $var2 $var3  $var4 $var5 "$var6" $var7 $var8 $var9 "$var10"

But if my guess is wrong and your original treatment is working as intended then never mind, ignore these remarks.

A: To get the variable var10 to contain quotes, you need something like this:
shift 9
printf -v "var10" '"%s"' "$*"

And, if you want to quote all your variables, such that missing ones have a place, use this:
#!/bin/bash
set -- -v 2c -c "" 9.48.85.57 "" 1.3.6.1.4.1.2.6.201.3 s s  ABC DDEF EFFF

for ((i=1;i<=9;i++)); do
    printf -v "var$i" '"%s"' "${!i}"
done

shift 9
printf -v "var10" '"%s"' "$*"

echo snmptrap $var{1..10}

To get the script to read the arguments passed instead of the ones written in the code, just comment out the set -- line.

The output will be:
$ ./snmptrap
snmptrap "-v" "2c" "-c" "" "9.48.85.57" "" "1.3.6.1.4.1.2.6.201.3" "s" "s" "ABC DDEF EFFF"

That each parameter has quotes means no problem to use them as input to the script.

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