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PurposeThis study aims to develop a decision support tool to improve planning for the rehabilitation of water distribution networks (WDN) using the analytical hierarchy process (AHP) method and the urgency level score.Design/methodology/approachIn this paper the AHP method was used to outclass the indicators having a strong influence on the deterioration of the pipes and the score of the level of urgency is calculated to establish the rehabilitation program (short, medium and long term). The proposed model was tested for the case of the city of Souk-Ahras in Algeria.FindingsBased on the judgments of twenty-four experts, the relative weights of the three physical, operational and environmental criteria of the pipeline were calculated and found to be equal to 35.40%, 55.60% and 9.00%, respectively. The two indicators, number of failures and pressure, were found to have the highest overall weights. The results of this article can be used to improve decision-making in WDN rehabilitation planning in Algeria.Research limitations/implicationsThe main objective of water companies is to provide citizens with good quality drinking water in sufficient quantity. However, over time, WDN age, degrade and deteriorate. This degradation leads to a drop in the performance through the degradation of water quality and an increase in loss rates. WDN rehabilitation is one of the most widely adopted solutions to address these drawbacks.Originality/valueApplication of a hybrid method (AHP- Level of Emergency) for the planning of the rehabilitation of WDN in Algeria.

Background Effective triage systems are crucial for prioritizing patients based on urgency and optimizing resource utilization. An ideal triage system is expected to have low resource utilization, hospitalization and mortality among patients classified at low urgency levels. Furthermore, it should exhibit an increase in the risk of hospitalization and mortality as urgency levels increase, ensuring the most critically ill patients receive priority care first. However, it is unclear which triage system performs best. Objective To compare the performance of the Manchester Triage System (MTS), the Emergency Severity Index (ESI), and the Netherlands Triage Standard (NTS) by investigating the association between urgency levels and resource utilization, hospitalization and in-hospital mortality in Emergency Department (ED) patients. Methods Observational multicenter cohort study using data from the Netherlands Emergency department Evaluation Database, comprising seven representative EDs in six Dutch hospitals. All consecutive ED patients with a registered urgency level were included. Resource utilization, hospitalization and mortality were measured across all urgency levels. In each triage system, multivariable logistic regression was used to assess the association between urgency level and in-hospital mortality and hospitalization, adjusting for age, sex, presenting complaints and hospital type. Results A total of 696,518 ED visits (MTS 320,406 (46.1%), ESI 214,267 (30.8%), NTS 161,845 (23.3%) patients) were included. Resource utilization was substantially lower in the lowest urgency level of the ESI compared to the MTS and NTS. Hospitalization to a regular ward, cardiac, medium or intensive care unit in the least urgent level was 3.9% in the ESI, considerably lower than in the MTS (23.1%) and NTS (34.3%) ( P  < 0.05). Mortality in the lowest urgency level of the ESI was 0.8%, while in the MTS and NTS this was 6.3% and 12.4%, respectively ( P  < 0.05). In the ESI, the risk (Adjusted Odds Ratios) for hospitalization and mortality increased much more with increasing urgency levels compared to the MTS and NTS. Conclusion This study suggests that the ESI may be more effective in distinguishing between patients with low and high urgency, with a reduced risk of undertriage when compared to the MTS and NTS.

We modify the beta distribution by adding a parameter ρ ≥ 0 to capture the urgency level with which nations address drinking water crises. In essence, the urgency parameter relates to region’s environmental or development levels. The modified version is named an urgency biased beta distribution (UBBD). Its statistical properties are considered and illustrated by analysis of the drinking water data in the World Health Organization (2011) report. The methodology of this article is applicable to similar data sets arising in ecological, engineering, medical, business, marketing, and communication, etc. studies.

Background Emergency room (ER) use is increasing in several countries. Variability in the proportion of non-urgent ER visits was found to range from 5 to 90 % (median 32 %). Non-urgent emergency visits are considered an inappropriate and inefficient use of the health-care system because they may lead to higher expenses, crowding, treatment delays, and loss of continuity of health care provided by a general practitioner. Urgency levels of doctor–walk-in patient encounters were assessed based on their region of origin in a diverse Norwegian population. Methods An anonymous, multilingual questionnaire was distributed to all walk-in patients at a general emergency outpatient clinic in Oslo during two weeks in September 2009. We analysed demographic data, patient–doctor assessments of the level of urgency, and the results of the consultation. We used descriptive statistics to obtain frequencies with 95 % confidence interval (CI) for assessed levels of urgency and outcomes. Concordance between the patients’ and doctors’ assessments was analysed using a Kendall tau-b test. We used binary logistic regression modelling to quantify associations of explanatory variables and outcomes according to urgency level assessments. Results The analysis included 1821 walk-in patients. Twenty-four per cent of the patients considered their emergency consultation to be non-urgent, while the doctors considered 64 % of encounters to be non-urgent. The concordance between the assessments by the patient and by their doctor was positive but low, with a Kendall tau-b coefficient of 0.202 ( p  < 0.001). Adjusted logistic regression analysis showed that patients from Eastern Europe (odds ratio (OR) = 3.04; 95 % CI 1.60–5.78), Asia and Turkey (OR = 4.08; 95 % CI 2.43–6.84), and Africa (OR = 8.47; 95 % CI 3.87–18.5) reported significantly higher urgency levels compared with Norwegians. The doctors reported no significant difference in assessment of urgency based on the patient’s region of origin, except for Africans (OR = 0.64; 95 % CI 0.43–0.96). Conclusion This study reveals discrepancies between assessments by walk-in patients and doctors of the urgency level of their encounters at a general emergency clinic. The patients’ self-assessed perception of the urgency level was related to their region of origin.

The variation in the acoustic structure of alarm calls appears to convey information about the level of response urgency in some species, while in others it seems to denote the type of predator. While theoretical models and studies on species with functionally referential calls have emphasized that any animal signal considered to have an external referent also includes motivational content, to our knowledge, no empirical study has been able to show this. In this paper, I present an example of a graded alarm call system that combines referential information and also information on the level of urgency. Acoustically different alarm calls in the social mongoose Suricata suricatta are given in response to different predator types, but their call structure also varies depending on the level of urgency. Low urgency calls tend to be harmonic across all predator types, while high urgency calls are noisier. There was less evidence for consistency in the acoustic parameters assigned to particular predator types across different levels of urgency. This suggests that, while suricates convey information about the level of urgency along a general rule, the referential information about each category of predator type is not encoded in an obvious way.

Field observations and acoustic analyses have shown that suricate (Suricata suricatta) alarm calls vary in their acoustic structure depending on predator type. In this study, we tested whether receivers respond appropriately when hearing a call in the absence of a predator. Although the only way for suricates to escape from predators is to retreat to boltholes, responses to playbacks could be divided into distinct categories. The subjects responded differently to alarm calls given in response to aerial or terrestrial predators and to recruitment calls emitted in response to snakes and deposits on the ground. Suricates also showed rather distinct responses to low, medium and high urgency aerial calls. Differences in the responses were less obvious for different levels of urgency in the terrestrial and recruitment calls. Suricate receivers thus gain information about both the predator type and level of urgency from the acoustic structures of their calls.

As our behavioral patterns change due to the COVID-19 crisis, our impact on nature and the environment changes too. Pollution levels are showing significant reductions. People are more aware of the importance of access to local green and blue spaces. By analyzing online search behavior in twenty European countries, we investigate how public awareness of nature and the environment has evolved during the COVID-19 crisis. We find that the crisis goes hand in hand with a positive shift in public awareness of nature-related topics, but that awareness of environmental topics remains unaffected. While the decreasing pollution levels and media attention may reduce the overall sense of urgency to tackle pollution problems, the increased experience with local natural resources may strengthen public support for a recovery program that puts the transition towards a more sustainable economic system centrally.

The predominant responses to rising sea levels are in situ adaptations. However, increasing rates of sea-level rise will render ex situ adaptations—in the form of relocations—inevitable in some low-lying coastal zones. Particularly small island states like the Maldives face this significant adaptation challenge. Here, government action is necessary to move vulnerable communities out of flood-prone areas. Yet, little empirical knowledge exists about the governance of relocations. While the literature often highlights risks and benefits of relocations, it remains unclear how governments organized relocations and what drove relocation policy. Therefore, we examined Maldivian relocation policies from 1968 to 2018 to explain government support of relocations. For this, we used a qualitative research design and extended the multiple streams approach with the theoretical lens of historical institutionalism. To gather data, we conducted semi-structured interviews (n = 23) with relocation policy experts and locals affected by relocations. Interview data was complemented with a desk review of relevant laws, historical records, and policy documents. We find 29 completed and 25 failed cases of relocations in the 50-year period. Key drivers of relocation policies are focusing events, socioeconomic development, and institutionalized island autonomy. We find that relocations were predominantly initiated as means to facilitate economic development, not as a response to rising seas or coastal risk. With current rapid economic development and strengthened democratic institutions, relocations are not considered as a policy option anymore. We conclude that implementing relocations proactively will face significant barriers in the future, which highlights the urgency of successful in situ adaptations in the Maldives.

Introduction and Hypothesis The objective was to explore the correlation between total testosterone levels and stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) in older patients, emphasizing frailty. Methods This prospective cross-sectional study included 1,328 women over 60 years of age at an incontinence specialty clinic. Participants were assessed for UI, frailty, using the Japanese Frailty Scale, and total testosterone levels. Analysis of a logistic regression model was employed for age, body mass index (BMI), and vaginal deliveries adjustment, with association and multivariate analyses to evaluate the associations with SUI and UUI. Results The frailty and nonfrailty groups each consisted of 664 individuals. After age, BMI, and the number of vaginal deliveries adjustment, the analysis showed a negative association between total testosterone levels and both SUI ( p  < 0.001) and UUI ( p  < 0.001) in the frailty group. Multivariate analysis revealed that, in the nonfrailty group, factors such as low total testosterone levels ( p  = 0.0145), diabetes ( p  = 0.0052), and cerebral infarction ( p  = 0.0254) were related to SUI, whereas no significant factors were associated with UUI. In the frailty group, factors associated with SUI included low total testosterone levels ( p  < 0.0001), the number of vaginal deliveries ( p  < 0.0001), smoking ( p  = 0.0240), chronic lung disease ( p  < 0.0248), and hypertension ( p  < 0.0265). Factors associated with UUI were age ( p  < 0.0001), low total testosterone levels ( p  = 0.0025), diabetes ( p  < 0.0001), and the number of vaginal deliveries ( p  = 0.0152). Conclusions The study highlights the significance of incorporating the assessment of frailty and testosterone levels in addressing UI among older women, particularly in the aged population, underscoring the need for tailored approaches in this demographic.

Recent advancements in digital technologies, including artificial intelligence (AI), Internet of Things (IoT), and information and communication technologies (ICT), are transforming homes into interconnected ecosystem of services. Yet, discourse on home technologies remains fragmented due to inconsistent terminologies. This paper addresses the lack of a framework, studying distinctions between smart and non-smart homes and forecasting connectivity and automation growth. Experts (21) participated in online surveys and interviews in 2021, exploring language, structure, and technical/social aspects of basic and smarter homes. Quantitative survey data and qualitative interview analyses yield insights on defining smarter homes, barriers to adoption, and framework improvements to establish universal definitions. This study underscores the urgency of harmonizing language and concepts in the domain of smart homes, revealing user understanding gaps and usability issues as barriers. This bridges gaps for consumer engagement and tech adoption.