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Background: In the Balkans, rising concerns about invasive fungal infections over the past decade stem from various factors. Primarily, there has been a notable uptick in immunocompromised individuals, including those with chronic illnesses like immunological and hematological diseases. Thus, it is essential to assess the region's laboratory capabilities and the availability of antifungals. This evaluation is vital for gauging the preparedness to diagnose and treat fungal infections effectively, thus minimizing their public health impact. Methods: Data were collected via an online questionnaire targeting healthcare professionals specializing in relevant fields across diverse healthcare settings in Balkan countries. The survey covered various aspects, including diagnostic methods, imaging techniques, and available antifungal armamentarium. Results: Responses were obtained from 50 institutions across the Balkans. While conventional diagnostic methods like microscopy (96 %) and culture (100 %) diagnostics were widely available, access to newer diagnostic tools such as molecular assays (61 %) were limited, often relying on outsourced services. Imaging modalities like ultrasound (100 %) and CT scans (93 %) were universally accessible. A variety of antifungal drugs were available, including amphotericin B formulations (80 %), echinocandins (79 %), and triazoles (100 %). However, access to newer agents like posaconazole (62 %) and isavuconazole (45 %) was inconsistent. Therapeutic drug monitoring (53 %) services were also limited. Conclusion: The study underscores the need for equitable access to diagnostic facilities and antifungal treatments across healthcare settings in the Balkan geographic region. Improving access to molecular diagnostic tools and essential antifungal drugs, as well as implementing therapeutic drug monitoring, would optimize the management of fungal infections in the region.

A woman with recent personalized external aortic root support implant presented in cardiogenic shock with bilateral coronary ostial occlusion and aortic inflammation requiring emergency coronary angioplasty. Subsequent computed tomography with positron emission tomography scanning demonstrated aortitis with extensive inflammation adjacent to the personalized external aortic root support mesh, the first report of this important complication.

Drinking water has long been a free resource, but its cost is rising due to increased pollution of both surface and aquifer water sources. Drinking water requires special treatment to be potable and usable by the general public, treatments that consume a certain amount of energy. In addition, the treatment process of wastewater before it is discharged into the environment consumes energy. According to the study, the energy required for wastewater treatment is significantly greater than the energy required for preparing drinking water. Water treatment is a significant source of GHG emissions due to the use of energy and chemicals, and reducing energy consumption would significantly reduce our overall carbon footprint. Furthermore, the UN’s Sustainable Development Goals encourage access to safe drinking water and sanitation while also calling for greater resource efficiency. This research aims to provide an overview of the energy used in water treatment. This study attempts to depict the energy used in water treatment. Electricity consumption for water supply and wastewater treatment is substantial and has a significant environmental impact, particularly in countries where electricity is generated using fossil fuels.

Introduction: Planning cranioplasty (CPL) in patients with suspected or proven post-traumatic hydrocephalus (PTH) poses a significant management challenge due to a lack of clear guidance. Research question: This project aims to create a European document to improve adherence and adapt to local protocols based on available resources and national health systems. Methods: After a thorough non-systematic review, a steering committee (SC) formed a European expert panel (EP) for a two-round questionnaire using the Delphi method. The questionnaire employed a 9-point Likert scale to assess the appropriateness of statements inherent to two sections: ''Diagnostic criteria for PTH'' and ''Surgical strategies for PTH and cranial reconstruction.'' Results: The panel reached a consensus on 29 statements. In the ''Diagnostic criteria for PTH'' section, five statements were deemed ''appropriate'' (consensus 74.2−90.3 %), two were labeled ''inappropriate,'' and seven were marked as ''uncertain.''In the ''Surgical strategies for PTH and cranial reconstruction'' section, four statements were considered ''appropriate'' (consensus 74.2−90.4 %), six were ''inappropriate,'' and five were ''uncertain.'' Discussion and conclusion: Planning a cranioplasty alongside hydrocephalus remains a significant challenge in neurosurgery. Our consensus conference suggests that, in patients with cranial decompression and suspected hydrocephalus, the most suitable diagnostic approach involves a combination of evolving clinical conditions and neuroradiological imaging. The recommended management sequence prioritizes cranial reconstruction, with the option of a ventriculoperitoneal shunt when needed, preferably with a programmable valve. We strongly recommend to adopt local protocols based on expert consensus, such as this, to guide patient care.

Objective: The study objective was to provide a detailed overview of health resource use from birth to 18 years old for patients with functionally single ventricles and identify associated risk factors. Methods: All patients with functionally single ventricles treated between 2000 and 2017 in England and Wales were linked to hospital and outpatient records using data from the Linking AUdit and National datasets in Congenital HEart Services project. Hospital stay was described in yearly age intervals, and associated risk factors were explored using quantile regression. Results: A total of 3037 patients with functionally single ventricles were included, 1409 (46.3%) undergoing a Fontan procedure. During the first year of life, the median days spent in hospital was 60 (interquartile range, 37-102), mostly inpatient days, mirroring a mortality of 22.8%. This decreases to between 2 and 9 in-hospital days/year afterward. Between 2 and 18 years, most hospital days were outpatient, with a median of 1 to 5 days/year. Lower age at the first procedure, hypoplastic left heart syndrome/mitral atresia, unbalanced atrioventricular septal defect, preterm birth, congenital/acquired comorbidities, additional cardiac risk factors, and severity of illness markers were associated with fewer days at home and more intensive care unit days in the first year of life. Only markers of early severe illness were associated with fewer days at home in the first 6 months after the Fontan procedure. Conclusions: Hospital resource use in functionally single ventricle cases is not uniform, decreasing 10-fold during adolescence compared with the first year of life. There are subsets of patients with worse outcomes during their first year of life or with persistently high hospital use throughout their childhood, which could be the target of future research.

Background: There is increasing awareness of sex-specific differences in epidemiology and pathophysiology of atrial fibrillation (AF). It is, however, unknown whether males and females differ in atrial electrophysiological properties during sinus rhythm (SR). The aim of this study was therefore to investigate sex-based (regional) differences in electrophysiological properties during SR of the right (RA) and left (LA) atrium including Bachmanns Bundle (BB) and pulmonary vein region (PVA). Methods: Intra-operative, high resolution mapping during SR was performed in 53 matched females with males (without a history of AF), to measure lines of conduction block (CB), continuous conduction delay and block (cCDCB), conduction velocities (CV), total atrial activation times (TAT), unipolar potential voltages and percentage of low voltage areas (LVA). Results: Compared to males, females have significantly 1) lower unipolar potential voltages and slower CV at both RA and BB, 2) more LVAs, CB and cCDCB lines and longer CB and cCDCB lines at the RA only (all P

This paper presents the area-selective wet etching (ASWE) method as a novel approach to have a selective patterning of a 6.8 nm-thick zirconium-doped hafnium oxide (HZO) thin film, to improve the performance of a metal ferroelectric metal (MFM)-like structure. According to the electromagnetic simulations of microwave phase shifters with patterned HZO thin films, it is underlined the importance to have selectively targeted areas covered with HZO instead of full-coverage wafers, to gain a further increase in the microwave performance of low-voltage tunable high-frequency components. The impact of the ASWE method on the morpho-structural properties was studied using various investigation tools in a non-destructive manner. X-ray reflectivity (XRR) has been employed at different immersion times, up to 120 s. Based on the extended Fast Fourier Transform (FFT) analysis, as well as from the simulation of the experimental curves in the framework of parallel-tempering algorithm, the determination of the etching rate became possible. X-ray diffraction (XRD), atomic force microscopy (AFM), and X-ray photoelectron spectroscopy (XPS) clearly indicated the complete removal of HZO after etching processes at 180 s. The method is fast, reliable, and low-cost, thus filling the actual gap in providing the necessary ferroelectric thin films exclusively in selected areas of interest.

Using the Weibull distribution function, the study presents a statistical evaluation of wind characteristics and onshore wind power potential under temperate continental climate conditions. Wind energy projects are more expensive to install than conventional energy sources, but they have lower operating and maintenance costs (zero costs for fuel). Because the initial investment is so large, conducting as precise and reliable feasibility studies as possible is critical because they play a significant role in lowering the cost of energy production. As a result, wind speed measurements are critical for conducting accurate feasibility studies. The availability and accuracy of weather data are critical for determining wind potential at a specific location. Wind speed is an important factor to consider when analyzing the wind speed distribution function. The monthly and yearly values of Weibull parameters, and wind power density at the analyzed location, were estimated using wind speed data. The yearly value of the k parameter for the Weibull analysis was 1.153, and for the c parameter was 5.602, respectively. Also, the yearly average wind speed was found to be greater than the maximum wind speed. Another important conclusion is that the maximum energy-producing wind speed, rather than the average or most frequent wind speed, has the greatest influence on wind potential. The final outcome of this study indicate that the location analyzed is adequate for the exploitation of wind energy.

The pressure on natural resources including water, energy and land is continuously growing through changes in climate and land use. Representatives of academia, industry, governments and society need to join forces in order to develop new pathways towards sustainable natural resource use and management. Such pathways start from the basic idea that natural resources are finite and interlinked and that human activities can affect these resources and links, with partly irreversible effects. We combine the water–energy–land nexus and the climate services concept and present a cross-sectoral approach of knowledge co-creation to inform natural resource use and management. The approach is tested in three case studies across Europe that face different challenges resulting from climate and socio-economic change. We present the process, applied methods and major results of knowledge co-creation for sustainable natural resource use and management, and we reflect on the challenges and opportunities from engaging multiple stakeholders. Even if a comprehensive, cross-sectoral approach encourages embedding the water–energy–land nexus into climate services and allows the development of pathways towards sustainable natural resource use and management, maintaining these achievements and partnerships beyond the lifetime of a research project remains challenging.

Non-Alcoholic Fatty Liver Disease (NAFLD) is a common condition affecting around 10–25% of the general adult population, 15% of children, and even > 50% of individuals who have type 2 diabetes mellitus. It is a major cause of liver-related morbidity, and cardiovascular (CV) mortality is a common cause of death. In addition to being the initial step of irreversible alterations of the liver parenchyma causing cirrhosis, about 1/6 of those who develop NASH are at risk also developing CV disease (CVD). More recently the acronym MAFLD (Metabolic Associated Fatty Liver Disease) has been preferred by many European and US specialists, providing a clearer message on the metabolic etiology of the disease.The suggestions for the management of NAFLD are like those recommended by guidelines for CVD prevention. In this context, the general approach is to prescribe physical activity and dietary changes the effect weight loss. Lifestyle change in the NAFLD patient has been supplemented in some by the use of nutraceuticals, but the evidence based for these remains uncertain. The aim of this Position Paper was to summarize the clinical evidence relating to the effect of nutraceuticals on NAFLD-related parameters. Our reading of the data is that whilst many nutraceuticals have been studied in relation to NAFLD, none have sufficient evidence to recommend their routine use; robust trials are required to appropriately address efficacy and safety.

Summary: Background: Data on risk factors for carbapenem-resistant Enterobacterales (CRE) with wider applicability are needed to inform preventive measures and efficient design of randomised trials. Methods: An international matched case-control-control study was performed in 50 hospitals with high CRE incidence from March 2016 to November 2018 to investigate different aspects of infections caused by CRE (NCT02709408). Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors. Findings: Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-β-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74–15.53;

The study presents a new analytical model capable to reveal the thermal behaviour of all the components of the solar ammonia-water absorption system, powered by parabolic trough collectors, serving different types of food storages: refrigeration chamber, refrigerated food storage, freezing chamber and frozen food storage. The heat inputs, that determine the total cooling load, for each food storage spaces consist of: heat gains through walls, heat gains through ventilation (fresh air), heat that must be dissipated from the stored products (technological cooling load required to cool down the products) and heat gains through operation. The influence of the number of solar parabolic trough collectors and of the storage tank size on different parameters of the refrigeration plant are investigated under low and high storage temperatures. • Food cooling with solar absorption refrigeration system. • Hourly based variation of NH3-H2O solar absorption system performances. • Long term simulation of solar absorption cooling for refrigeration and cooling.

The paper analyzes the energy consumption of an energy-independent house in two different situations, namely when the exterior insulation is installed and, respectively, in its absence. The result of the analysis was used to assess the reduction of fuel consumption and greenhouse gas emissions of the auxiliary heating system, namely a biomass boiler. The home’s heating system consists of a Stirling cogeneration system with biogas, which produces 3 kW of electricity and 9 kW of heat, and a 50 kW biomass boiler. The biomass boiler must provide the additional heat necessary to cover the consumption of the house when the Stirling engine is running and respectively ensure the coverage of the complete heat consumption of the building when the Stirling engine is in standby mode. The analysis showed that the installation of external insulation on the building walls will reduce energy consumption by 13%–16%, depending on the variation of the outside air temperature.

Summary: Background: Alpha-1 Antitrypsin (AAT) deficiency (AATD), the most common genetic cause of emphysema presents with unexplained phenotypic heterogeneity in affected subjects. Our objectives to identify unique and shared AATD plasma biomarkers with chronic obstructive pulmonary disease (COPD) may explain AATD phenotypic heterogeneity. Methods: The plasma or serum of 5,924 subjects from four AATD and COPD cohorts were analyzed on SomaScan V4.0 platform. Using multivariable linear regression, inverse variance random-effects meta-analysis, and Least Absolute Shrinkage and Selection Operator (LASSO) regression we tested the association between 4,720 individual proteins or combined in a protein score with emphysema measured by 15th percentile lung density (PD15) or diffusion capacity (DLCO) in distinct AATD genotypes (Pi*ZZ, Pi*SZ, Pi*MZ) and non-AATD, PiMM COPD subjects. AAT SOMAmer accuracy for identifying AATD was tested using receiver operating characteristic curve analysis. Findings: In PiZZ AATD subjects, 2 unique proteins were associated with PD15 and 98 proteins with DLCO. Of those, 68 were also associated with DLCO in COPD also and enriched for three cellular component pathways: insulin-like growth factor, lipid droplet, and myosin complex. PiMZ AATD subjects shared similar proteins associated with DLCO as COPD subjects. Our emphysema protein score included 262 SOMAmers and predicted emphysema in AATD and COPD subjects. SOMAmer AAT level

The COVID-19 pandemic represented a significant challenge to higher education and forced academic institutions worldwide to abruptly shift to remote teaching. Higher education institutions are continuously confronted with the difficulties of creating satisfactory online learning experiences that adhere to the new norms. This paper presents a study concerning the perceptions of the quality and efficiency of the educational process in higher education concerning distance learning at the Instituto Politécnico Nacional of Mexico during the COVID-19 pandemic. The data analysis identified the level of satisfaction with distance learning education separately for students and professors and the lived experience for future education models. Data analysis consisted of a stepwise regression model to identify the most important variables related to the satisfaction aspect of e-learning for students and professors. The main findings are associated with the perception of one's own skills as the most crucial variable to define the aspects of e-learning satisfaction. Therefore, these skills involve the knowledge of e-learning platforms and the adoption rate of new technologies. The study found that the students emphasized that the variable ''low sense of community'' negatively impacts e-learning due to the loss of personal contact with the academic workspace. The key contribution of our research is a knowledge translation into a sustainable innovation capability model.