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This paper describes the main findings from an experimental investigation into overall and local strength of four dual-phase (DP) steels classified based on their tensile strength (TS) levels from DP590, to 780, to 980, to 1180, a martensitic steel (MS) 1700, and a high-strength low-alloy (HSLA) steel in rolled and additively manufactured (AM) conditions. The DP steels and the MS steel consist of ferrite and martensite, while the HSLA steel is solely martensitic. High throughput nanoindentation mapping is employed to measure the mechanical hardness of individual phases contributing to strength of the steels. A clustering methodology for correlating measured hardness and phase maps is conceived to infer hardness per phase. With increasing fractions of martensite, the hardness values of both ferrite and martensite are found to increase with more rapid increase in the hardness of ferrite than martensite. The phases increasingly dislocate with the fraction of martensite as rationalized by crystal plasticity modeling of strength of the steels. Initial slip resistances and a set of hardening parameters associated with the slip in ferrite and martensite are established to model the flow stress behavior of the steels. In modeling the co-dependent nature of crystallographic slip in ferrite and martensite, the initial dislocation densities are inferred and correlated with the measured hardness values. The hardness of martensite in the rolled HSLA steel is comparable to the hardness of martensite in the MS steel, while martensite in the AM HSLA steel is softer owing to the tempering occurring during the AM process.

Microstructurally flexible high entropy alloys (HEAs) can be tailored for strength via dual-phase strengthening mechanisms, which originate from the strain-induced phase transformation microstructural phenomena. One such alloy is a recently synthesized Fe42Mn28Co10Cr15Si5 (at%) HEA consisting of metastable gamma austenite (γ), stable epsilon martensite (ε), and stable sigma (σ) phases. In this work, a crystal plasticity homogenization incorporating a physically based phase transformation and hardening models is used to interpret and better understand the effects of strain induced phase transformation phenomena on the overall hardening response of the alloy. The transformation model is conceived based on the grain-scale stress sensitive motion of partial dislocations forming shear bands, while the hardening model is an extended Kocks-Mecking-type dislocation density-based formulation sensitive to grain size and shape. The deformation of constituent grains per phase in the alloy is modeled as a combination of anisotropic elasticity, crystallographic glide, and γ→ε phase transformation. Parameters of the hardening and transformation models within the homogenization are calibrated and validated on a suite of data including flow stress curves and phase fractions measured under compression, while the corresponding texture evolution data is used solely for verification. Good predictions of the model elucidate that the transformation induced dynamic Hall-Petch-type barrier effect is the primary origin of strain hardening along with the increase in the ε-phase fraction and dislocation density, while the individual strength of the phases gives rise to the overall strength. The modeling framework described in the present work is expected to be applicable to other HEA systems.

The 2021 Tajogaite eruption was marked by intense pyroclastic fallout that covered a substantial portion of La Palma island, with maximum thicknesses in the central-western part. This, combined with lava flows, resulted in widespread damage to public and private properties. In this study, we investigated if volcanic ash from this eruption could serve as a raw material in the synthesis of alkali activated materials (AAMs) and contribute to the construction of eco-friendly buildings and the restoration of those damaged by the eruption. Volcanic ash-based AAMs were synthesized using NaOH and Na2SiO3 as alkaline solutions and by adding metakaolin to enhance ash reactivity and enable processing at ambient temperatures. Lightweight porous AAMs were also produced using H2O2 and metallic aluminum as foaming agents. Chemical, textural, physical, and mechanical analyses on the final products assessed their suitability as environmentally friendly materials to be used in the reconstruction of the island infrastructure, opening new perspectives on recovery actions that can be undertaken after disastrous eruptions. Of all the islands in the Canary Archipelago, La Palma has experienced the highest number of eruptions (8) in historical times, all of which showing considerable similarity in terms of eruptive mechanisms and composition to the most recent Tajogaite event. Although this study investigated fresh Tajogaite ash, similar perspectives can be envisaged for both other recent eruptions at La Palma and other similar volcanic scenarios worldwide.

Abstract Nerve tumors in the retroperitoneal space are a rarity. Radical surgery according to soft tissue tumors can lead to persistent pain and neurological deficits. This study aims to evaluate clinical outcomes of patients treated by a visceral- / neurosurgical approach. 33 patients with a retroperitoneal nerve tumor underwent surgery between 01/2002 and 12/2022 at our department. A visceral surgeon provided access to the retroperitoneal space, followed by micro-neurosurgical tumor preparation under neuromonitoring. Clinical examination and MRI were performed 12 weeks after surgery and further 3 months (WHO grade > 1) or 12 months (WHO grade 1). Further examinations were based on MRI findings and residual symptoms with median follow-up time of 24 months. One patient was treated for two distinct masses resulting in a total of 34 histological findings. Schwannomas (n = 15; 44.1%) and neurofibromas (n = 10; 29.4%) were the most common tumors. Long-term improvements were noted in radicular pain (15/18 patients; 83.3%), motor deficits (7/16 patients; 43.8%), abdominal discomfort and pain (5/7 patients; 71.4%). Recurrences were observed in 3/33 (9,1%) patients. This study represents the largest series of retroperitoneal BPNSTs treated with microsurgical techniques. Prospective multicenter studies are warranted to establish standardized treatment guidelines.

Abstract Controlling many-body interactions in two-dimensional systems remains a formidable task from the perspective of both fundamental physics and application. Here, we explore remarkable electronic structure alterations of MoS2 monolayer islands on graphene on Ir(111) induced by non-invasive self-intercalation. This introduces significant differences in morphology and strain of MoS2 as a result of the modified interaction with the substrate. Consequently, considerable changes of the band gap and non-rigid electronic shifts of valleys are detected, which are a combined effect of the screening of the many-body interactions and strain in MoS2. Furthermore, theory shows that each substrate leaves a unique stamp on the electronic structure of two-dimensional material in terms of those two parameters, restricted by their correlation.

Leaf removal in the grape zone is one of the most common viticultural practices to manipulate the microclimate of grapevines and reduce canopy density. The timing of defoliation plays an important role in the synthesis of volatile compounds in the grapes, as they are synthesized at different times during grape ripening. A two-year study (2018 and 2019) was conducted in a vineyard in the region of Croatian Uplands, sub-region Prigorje-Bilogora, to investigate the effects of different timing of leaf removal on the volatile profile of the grape variety Merlot (Vitis vinifera L.). The experiment was conducted with four treatments: no leaf and lateral shoot removal, basal leaf and lateral shoot removal before flowering, at bunch closure and at the beginning of veraison, with 4 basal leaves and all lateral shoots per shoot removed. Yield and leaf area to yield ratio were not affected by leaf removal, while early leaf removal (before flowering) reduced cluster and berry weight. Regardless of the time of defoliation, total acidity in the must decreased, while only defoliation at the beginning of the veraison led to an increase in sugar content in the must. Leaf removal reduced the content of C6 volatile compounds, which produce green and vegetal aromas. Changing the microclimate in the canopy by removing leaves can significantly improve the volatile composition of grapes and thus contribute to the improvement of grape quality.

This paper describes a study into the evolution of damage in commercial-purity titanium (CP–Ti) sheets subjected to cyclic bending under tension (CBT) and uniaxial tension (simple tension, ST). Sections were taken from sheets that were strained to various levels under both methods and were imaged using X-ray computed tomography (XCT) to reveal insights into the size, density, and distribution of microvoids in the sheets. Digital image correlation (DIC) was also used to observe the surface strain of CBT and ST sheets during testing. These results showed that elongation to failure (ETF) for CBT deformation is about 2.5× higher than for ST, local longitudinal strains in the bulk of the CBT sample are around 1.3× higher than the peak strain in the ST necked region, and 1.7× higher in the localized region of CBT failure. It was found that the volume-density of voids in both sheets followed a similar exponential increase with strain, reaching nearly 45× higher in the CBT than the ST sheets before the onset of failure, mainly due to the higher strain levels achieved. A higher volume density of voids developed in the center of sheets at high levels of strain, for both processes, with the density in the sheet center becoming approximately double that found near the edges. Scanning electron microscopy (SEM) was used to examine the fracture surface of CBT and ST sheets after failure. The observations are presented and discussed highlighting the CBT process as effective to delay ductile fracture of the CP-Ti sheets.

Cyclic bending under tension (CBT) has been shown to increase room temperature elongation-to-failure in various sheet metals beyond that of simple tension. A greater understanding of deformation mechanisms in CBT would allow for its elongation-enhancing effects to be more fully exploited, creating potential for new forming strategies. CBT-induced cyclic bending/unbending stresses combined with applied macroscopic tensile stresses create complex through-thickness stress profiles, where differing hardening behavior is expected near the surfaces compared with the middle of the sheet. This work uses high resolution electron backscatter diffraction characterization of geometrically necessary dislocation density together with X-ray diffraction-based evaluations of total dislocation density and in-plane digital image correlation to provide an in-depth analysis of through-thickness dislocation development and associated hardening rates throughout the CBT process in CP-Ti Grade 4 sheet metal. It was found that dislocation density is relatively uniform across the sheet at lower cycles, increases in the sheet center at higher cycles, and eventually approaches saturation near failure. Namely, dislocation accumulation occurs more slowly in the ratcheting, bending/unbending portions of the sheet (i.e., near the surfaces) from cyclic load reversals, and develops faster in the central tensile portion, where dislocation density up to 1.43x higher than near the surfaces was observed. High dislocation densities in the sheet center were found to precede significant central void accumulation, concentrating damage away from peak surface stresses, presumably contributing to delayed failure.

Abstract An integrated care pathway to manage small and nutritionally at‐risk infants under 6 months (u6m) and their mothers (MAMI Care Pathway) is consistent with 2023 WHO malnutrition guidelines and is being tested in a randomised controlled trial (RCT) in Ethiopia. To optimise trial implementation, we investigated contextual fit with key local stakeholders. We used scenario‐based interviews with 17 health workers and four district managers to explore perceived feasibility. Eighteen policymakers were also surveyed to explore policy coherence, demand, acceptability, evidence needs, opportunities and risks. The Bowen feasibility framework and an access to health care framework were adapted and applied. Health workers perceived the MAMI Care Pathway as feasible to implement with support to access services and provide care. The approach is acceptable, given consistency with national policies, local protocols and potential to improve routine care quality. Demand for more comprehensive, preventive and person‐centred outpatient care was driven by concerns about unmet, hidden and costly care burden for health services and families. Inpatient care only for severe wasting treatment is inaccessible and unacceptable. Support for routine and expanded components, especially maternal mental health, is needed for successful implementation. Wider contextual factors may affect implementation fidelity and strength. Policymakers cautiously welcomed the approach, which resonates with national commitments, policies and plans but need evidence on how it can work within varied, complex contexts without further system overstretch. A responsive, pragmatic randomised controlled trial will generate the most useful evidence for policymakers. Findings have informed trial preparation and implementation, including a realist evaluation to contextualise outcomes.

U radu su prezentovani rezultati dendroekoloških istraživanja u dvema sastojinama hrasta kitnjaka na toplijim staništima na području Nacionalnog parka „Đerdap”. Za sagledavanje uticaja temperature i padavina na prirast (radijalni prirast – RW, prirast kasnog drveta – LW i prirast ranog drveta – EW) ove vrste drveća korišćena su četiri metodološka pristupa: korelacije između tromesečnih (sezonskih) veličina temperature i padavina i rezidualne hronologije, korelacije između mesečnih temperatura i padavina i rezidualne hronologije, tzv. odzivne funkcije i korelacije između SPEI indeksa suše i rezidualne hronologije. Rezultati su pokazali veliku senzitivnost hrasta kitnjaka prema padavinama u letnjim mesecima, na taj način da veće količine padavina u leto, naročito u julu, prouzrokuju statistički značajno veće iznose prirasta. Variranje prirasta mnogo je manje uslovljeno varijacijama temperature, pri čemu je registrovan slabiji negativan uticaj viših julskih i avgustovskih temperatura na veličinu prirasta. Konstatovano je da je u ukupnoj veličini radijalnog prirasta i u prirastu kasnog drveta detektovan jači klimatski signal nego u prirastu ranog drveta. Utvrđena reakcija hrasta kitnjaka u ovde analiziranim toplijim stanišnim uslovima u pogledu prirasta i njegove zavisnosti od klime slična je reakciji kitnjaka iz sastojina u neposrednom okruženju NP „Đerdap” i iz drugih okolnih zemalja koje se karakterišu srodnim klimatskim uslovima.

U ovom istraživačkom radu sprovedena je analiza dva tipa veštačkih neuronskih mreža (Artificial Neural Network – ANN) za predikciju snage na izlazu hidroelektrane (HE). Prvi tip je veštačka neuronska mreža sa jednosmernim prostiranjem signala (Feedforward Artificial Neural Networks – FF-ANN), dok je drugi tip rekurentna neuronska mreža (Recurrent Neural Network – RNN). Detaljno su analizirani koraci koji su preduzeti u procesu implementacije neuronskih mreža za ovu svrhu, od prikupljanja i pripreme podataka do treniranja, evaluacije i analize rezultata. Kao ulazni podaci korišćeni su neto pad, protok vode kroz turbinu, kota gornje vode, kota donje vode i temperatura ulazne rashladne vode. Na osnovu koeficijenta korelacije pojedinih veličina iz ulaznog sloja sa izlaznom snagom izvršena implementacija novih ANN. Rezultati dobijeni ovim varijacijama su sistematski analizirani kako bi se postiglo što preciznije modelovanje, sa akcentom na dinamičke promene u protoku vode kroz turbinu.

Abstract The diagnosis of acute appendicitis and concurrent surgery referral is primarily based on clinical presentation, laboratory and radiological imaging. However, utilizing such an approach results in as much as 10–15% of negative appendectomies. Hence, in the present study, we aimed to develop a machine learning (ML) model designed to reduce the number of negative appendectomies in pediatric patients with a high clinical probability of acute appendicitis. The model was developed and validated on a registry of 551 pediatric patients with suspected acute appendicitis that underwent surgical treatment. Clinical, anthropometric, and laboratory features were included for model training and analysis. Three machine learning algorithms were tested (random forest, eXtreme Gradient Boosting, logistic regression) and model explainability was obtained. Random forest model provided the best predictions achieving mean specificity and sensitivity of 0.17 ± 0.01 and 0.997 ± 0.001 for detection of acute appendicitis, respectively. Furthermore, the model outperformed the appendicitis inflammatory response (AIR) score across most sensitivity–specificity combinations. Finally, the random forest model again provided the best predictions for discrimination between complicated appendicitis, and either uncomplicated acute appendicitis or no appendicitis at all, with a joint mean sensitivity of 0.994 ± 0.002 and specificity of 0.129 ± 0.009. In conclusion, the developed ML model might save as much as 17% of patients with a high clinical probability of acute appendicitis from unnecessary surgery, while missing the needed surgery in only 0.3% of cases. Additionally, it showed better diagnostic accuracy than the AIR score, as well as good accuracy in predicting complicated acute appendicitis over uncomplicated and negative cases bundled together. This may be useful in centers that advocate for the conservative treatment of uncomplicated appendicitis. Nevertheless, external validation is needed to support these findings.

Abstract Childhood radioactive iodine exposure from the Chornobyl accident increased papillary thyroid carcinoma (PTC) risk. While cervical lymph node metastases (cLNM) are well-recognized in pediatric PTC, the PTC metastatic process and potential radiation association are poorly understood. Here, we analyze cLNM occurrence among 428 PTC with genomic landscape analyses and known drivers (131I-exposed = 349, unexposed = 79; mean age = 27.9 years). We show that cLNM are more frequent in PTC with fusion (55%) versus mutation (30%) drivers, although the proportion varies by specific driver gene (RET-fusion = 71%, BRAF-mutation = 38%, RAS-mutation = 5%). cLNM frequency is not associated with other characteristics, including radiation dose. cLNM molecular profiling (N = 47) demonstrates 100% driver concordance with matched primary PTCs and highly concordant mutational spectra. Transcriptome analysis reveals 17 differentially expressed genes, particularly in the HOXC cluster and BRINP3; the strongest differentially expressed microRNA also is near HOXC10. Our findings underscore the critical role of driver alterations and provide promising candidates for elucidating the biological underpinnings of PTC cLNM.

Understanding the impacts of climate change on the future growth of tree species is particularly important for conserving endemic species with limited geographic distributions, such as Serbian spruce (Picea omorika (Pančić) Purk.). This study describes an approach to assessing the effects of future climate conditions on the growth and the implications for future management to conserve this endangered species on the IUCN Red List. To investigate the climate-growth relationship, age structure and diameter growth trends, we have sampled 231 trees across 11 locations at National Park ''Tara'' in western Serbia. The existence of heterogeneous age structures suggests that Serbian spruce poses considerable potential for continual regeneration in stands with open canopy. Conducted dendroclimatological analysis exhibits exceptional coherence in growth patterns within populations (Rxy 0.67–0.78), allowing the established climate-sensitive mixed-effect model to achieve conditional Rc2 ​= ​0.683. It is revealed that the radial increment of Serbian spruce is dominantly regulated by water deficit in the summer season. The rainfall amount during the spring is another meaningful climatic factor for growth trends, while minimal winter temperatures and previous autumn water balance show varying influences. Finally, the growth projections under climate change scenarios RCP4.5 and RCP8.5 foreseen reductions of up to one-third and almost half from the historical mean growth rate. The given estimations should be seen as a critical warning signal calling for immediate conversion from passive to active protection to preserve this unique species.

Purpose To provide details of a pooled data set that will be used to estimate absolute and relative mortality risks and other outcomes among children less than 59 months of age and the predictive performance of common risk exposures, both individually and in combination.Participants Children from birth to 5 years of age recruited at health facilities or community settings into 33 longitudinal observational or intervention studies in 17 low- and middle-income countries.Findings to date The data set includes 75 287 children with a median age of 3 months (IQR 1–12) at first measurement. In the pooled sample, 2805 (3.7%) of the study children died. Data on birth weight was recorded in 19 studies, and gestational age in 13 studies. Among these, 14% of the included children were reported as having low birth weight, and 14% had preterm birth. At first measurement, 33% of the children were stunted, 24% were wasted and 35% underweight. 13% and 7% of caregivers reported that their child had acute diarrhoea or acute lower respiratory tract infection before the study visit, respectively. The proportion of children reported as breastfed at any study visit decreased from 99% at age

Open mires constitute a characteristic part of boreal natural landscapes, which is under various cumulative anthropogenic pressures. As a response, remaining mires are increasingly protected, and their degradation is addressed by ecological restoration (mostly drainage closure). To evaluate alternative environmental policies, there is a necessity for high-resolution landscape simulation models to assess future dynamics of mires under different management scenarios. We present such a model, SooSim, its R-script, and derivation and validation of its key parameters. SooSim iterates mire types and woody encroachment dynamics within 25 × 25 m grid at 1-year intervals. Management interventions (restoration; ditch renovation) are sequentially introduced based on priority rules in locations delineated prior to simulation. We applied SooSim to three management scenarios, compared with natural succession, until 2050 in Estonia. The ‘current’ (2022) database comprised >3.8 M mire pixels and > 7 M peatland-forest pixels (sparse-cover ones considered for mire restoration). The model parameterization, based on Lidar data, revealed rapid ongoing woody encroachment across all mire types, with significant positive feedback. The simulations revealed that, even in scenarios with intensive restoration (2500 ha annually), open mire conditions are reduced by >10 % until 2050, while few mire types lose >1 % in area. Ditch renovations mostly reduced restoration perspectives in currently forested peatlands. Thus, SooSim explicitly depicts a decision-making dilemma where mire restoration is time-sensitive but also uncertain. To address this and related land-use dilemmas in the environmental policy, landscape models such as SooSim have further importance as visualization tools to explain complex processes to a wide range of stakeholders.

This narrative review describes the state of the art in the management of anastomotic leakage in ovarian cancer. Multiple surgical procedures, including bowel resection, are often required to achieve “optimal” cytoreduction in locally advanced ovarian cancer. Intestinal anastomosis is currently the most common way to restore bowel continuity. However, in some patients, a temporary protective stoma is indicated to prevent anastomotic leakage. This is an important issue to improve surgical outcomes and until recently there has been a lack of objective data to clarify the risk factors for anastomotic leakage. This review describes the risk factors for AL associated with surgery and compares the results of recent studies. We also review the current indications for placement of a protective ileostomy and treatment options for conservative management of AL. We present two examples of practical clinical AL risk calculators, in addition to the most assessed AL risk factor. To date, the decision-making processes that lead surgeons to perform a protective ileostomy are quite heterogeneous and based on the personal experience of the surgeon, mainly depending on individual training. Three different management options after colorectal anastomosis in OC are described: conservative management, diversion ileostomy and ghost ileostomy.

Acutely decompensated heart failure is one of the leading causes of hospitalisation worldwide, with a significant majority of these cases attributed to congestion. Although congestion is commonly mistaken for volume overload, evidence suggests that decompensation can occur without significant water accumulation, being attributed to volume redistribution. Yet, the distinction between intravascular and extravascular congestion in heart failure often blurs, as patients frequently exhibit overlapping features of both, and as patients may transition between phenotypes over time. Considering that differentiation between intravascular and extravascular congestion can lead to different management strategies, the aim of this review was to delineate the pathophysiological nuances between the two, as well as their correlation with clinical, biochemical and imaging indices.

Background/Aims: Argon plasma coagulation (APC) is an alternate ablative method to radiofrequency ablation for the treatment of Barrett’s esophagus (BE), and it is preferred due to its lower cost and widespread availability. The present meta-analysis aimed to analyze the safety and efficacy of APC for the management of BE.Methods: A literature search from January 2000 to November 2022 was done for studies analyzing the outcome of APC in BE. The primary outcomes were clearance rate of intestinal metaplasia and adverse events (AE). Pooled event rates were expressed with summative statistics.Results: A total of 38 studies were included in the final analysis. The pooled event rate for clearance rate of intestinal metaplasia with APC in BE was 86.8% (95% confidence interval [CI], 83.5% to 90.2%), with high-power and hybrid APC having a higher rate compared to standard APC. The pooled incidence of AE with APC in BE was 22.5% (95% CI, 15.3% to 29.7%), without any significant difference between the subgroups, with self-limited chest pain being the commonest AE. The incidence of serious AE was only 0.4% (95% CI, 0.0% to 1.0%), while stricture development was seen only in 1.7% (95% CI, 0.9% to 2.6%) of cases. The pooled recurrence rate of BE was 16.1% (95% CI, 10.7% to 21.6%), with a significantly lower recurrence with high-power APC than standard APC.Conclusions: High-power and hybrid APC seem to have an advantage over standard APC in terms of clearance rate and recurrence rate. Further studies are required to compare the efficacy and safety of hybrid APC with standard APC and radiofrequency ablation.

Abstract Background Biosimilars are biologic drugs that have the potential to increase the efficiency of healthcare spending and curb drug-related cost increases. However, their introduction into hospital formularies through initiatives such as non-medical switching must be carefully orchestrated so as not to cause treatment discontinuation or result in increased health resource utilization, such as additional visits or laboratory tests, among others. This retrospective cohort study aims to assess the impact of the introduction of CT-P13 on the healthcare expenditures of patients who were treated with originator infliximab or CT-P13. Methods Gastroenterology, immunoallergology and rheumatology patients treated between September 2017 and December 2020 at a university hospital in Western Switzerland were included and divided into seven cohorts, based on their treatment pathway (i.e., use and discontinuation of CT-P13 and/or originator infliximab). Costs in Swiss francs were obtained from the hospital's cost accounting department and length of stay was extracted from inpatient records. Comparisons of costs and length of stay between cohorts were calculated by bootstrapping. Results Sixty immunoallergology, 84 rheumatology and 114 gastroenterology patients were included. Inpatient and outpatient costs averaged (sd) CHF 1,611 (1,020) per hospital day and CHF 4,991 (6,931) per infusion, respectively. The mean (sd) length of stay was 20 (28) days. Although immunoallergology and rheumatology patients had higher average costs than gastroenterology patients, differences in costs and length of stay were not formally explained by treatment pathway. Differences in health resource utilization were marginal. Conclusions The introduction of CT-P13 and the disruption of patient treatment management were not associated with differences in average outpatient and inpatient costs and length of stay, in contrast to the results reported in the rest of the literature. Future research should focus on the cost-effectiveness of non-medical switching policies and the potential benefits for patients.

Abstract Key message We applied the generalized algebraic difference approach (GADA) to develop dynamic models of height growth for pedunculate oak (Quercus robur L.) in Serbia. According to the dominant heights, the studied region comprises some of Europe’s most productive sites for pedunculate oak. Therein, we have generated a map showing the current site index class of stands. Such a map could be used to enhance forest management and evaluate climate change impacts. Context Although sustainable forest management requires reliable prediction of forest site productivity, such indicators are currently unavailable for pedunculate oak sites in Serbia. The site index (SI) curves represent the most commonly used indirect scale for site productivity classification. The dynamic equations derived by the Generalized Algebraic Difference Approach (GADA) are the state-of-the-art approach in growth modeling, but they have not been widely applied for studying the height dynamics of pedunculate oak. Aims The main objectives of this study were to develop the first dynamic site index curves for pedunculate oak in Serbia and subsequently to provide stand-level maps with predicted site indices. Methods We have tested five flexible polymorphic equations with variable asymptotes derived by the GADA approach. Models were calibrated using artificially established growth trajectories obtained from 3636 detailed temporary sample plots. The selection of the most suitable model was accomplished according to (1) quantitative measures of goodness of fit, (2) the analysis of residual scattering, and (3) the biological plausibility of obtained height growth curves. Results After correcting the error terms with a continuous first-order autoregressive structure and conducting a three-stage performance analysis, the GADA dynamic site index model derived from the Hossfeld base equation shows the best overall properties. Insight into the oscillations of relative error suggested that 100 years is the most suitable age for site index referencing. Comparison with existing height growth models revealed greater flexibility and a considerably better representation of the height growth dynamic of pedunculate oak in the studied region. Additionally, we have produced a spatially explicit map showing the expected SI100 for 1907 stands with pedunculate oak within 22 management units. Conclusion Dynamic SI-curves based on GADA will serve forest practitioners to update management plans and serve as a reference point for benchmarking the impact of climate change and for developing adaptation strategies. The utilized approach allowed unbiased estimation of SI100 across all age classes so that the results could be mapped at a broader scale. This study provides the second known application of the dynamic model for pedunculate oak in Europe but the first that includes some of the most productive sites in the species distribution range.

Background/Objectives: While the concept of viral community-acquired pneumonia (CAP) changed with COVID-19, the role of non-influenza viruses as a cause of CAP is less clear. The aim of this study was to describe the clinical course, risk factors, inflammatory profiles, antibiotic use, outcomes and complications of adenoviral (AdV) CAP. Methods: A prospective, non-interventional, observational cohort study included consecutively hospitalized immunocompetent adult patients with AdV CAP during an 18-month period. Clinical and laboratory data, including lymphocyte subpopulations and serum cytokine profiles were collected and correlated to clinical outcomes. Results: Fifty-eight patients with AdV CAP were included; 81% were males, with a median age of 33 (IQR 28–41) years and 62% without any comorbidities. All patients initially had high-grade fever for a median duration of 6 (5–7) days and respiratory symptoms. Increased CRP and procalcitonin, lymphopenia, mild thrombocytopenia and liver injury were frequent. Radiographic findings mimicked bacterial pneumonia (83% had unilateral involvement). Twenty-two patients (38%) had criteria for severe CAP, and these patients had higher procalcitonin, NLR, AST, ALT, LDH and CK, and lower T-lymphocyte CD4+ count. In comparison to influenza and bacterial CAP, patients with AdV had higher serum IL-2, IL-1β, IL-8, IL-10, CXCL10 and MCP-1, and lower TGF-β1 concentration. Thirteen patients required low-flow oxygen therapy, and 13 advanced respiratory support. Complications occurred in 29%, with one fatal outcome. While all patients received empirical antibiotic therapy, after AdV detection it was stopped in 21%, although only one patient had detected a possible bacterial coinfection. Conclusions: Since AdV CAP in immunocompetent patients is clinically and radiologically indistinguishable from bacterial CAP, it is associated with prolonged clinical course and lack of clinical response to antibiotics. This emphasizes the importance of AdV testing which could lead to more rational antimicrobial treatment.

The study of long-term behavior in stochastic systems is critical for understanding the dynamics of complex processes influenced by randomness. This paper addresses the existence and uniqueness of Stepanov-like pseudo S-asymptotically (ω,c)-periodic solutions for a class of stochastic integro-differential equations. These equations model systems where the interplay between deterministic and stochastic components dictates the overall dynamics, making periodic analysis essential. The problem addressed in this study is the lack of a comprehensive framework to describe the periodic behavior of such systems in noisy environments. To tackle this, we employ advanced techniques in stochastic analysis, fixed-point theorems and the properties of L1- and L2-convolution kernels to establish conditions for the existence and uniqueness of mild solutions under these extended periodicity settings. The methodology involves leveraging the decay properties of the operator kernels and the boundedness of stochastic integrals to ensure well-posedness. The major outputs of this study include novel results on the existence, uniqueness and stability of Stepanov-like pseudo S-asymptotically (ω,c)-periodic solutions, along with illustrative example demonstrating their applicability in real-world stochastic systems.

Obesity is one of the leading causes of chronic diseases, and its prevalence is still rising in children and adolescent populations. Chronic cardiovascular complications result in metabolic syndrome (MS) and type 2 diabetes mellitus. Key factors in the development of MS are insulin resistance and low-grade inflammation. The disorder of glucose and insulin metabolism has not been fully elucidated so far, and an oral glucose tolerance test (OGTT) has been the only tool used to look into the complex metabolism disorder in children and adolescents with obesity. Continuous glucose monitoring (CGM) has become commercially available for over two decades and is primarily used to manage type 1 diabetes mellitus in pediatric populations. This review aims to present the current knowledge about the use of CGM in children and adolescent populations with obesity. CGM systems have the potential to serve as valuable tools in everyday clinical practices, not only in the better diagnosis of chronic complications associated with obesity, but CGM can also assist in interventions to make better adjustments to nutritional and therapeutic approaches based on real-time glucose monitoring data. Despite these promising benefits, further research is needed to fully understand the role of CGM in metabolic disorders in pediatric populations with obesity, which will additionally strengthen the importance of CGM systems in everyday clinical practices.

Abstract Small and nutritionally at‐risk infants aged under 6 months (

Abstract Age and sex influence the risk of childhood wasting. We aimed to determine if wasting treatment outcomes differ by age and sex in children under 5 years, enroled in therapeutic and supplementary feeding programmes. Utilising data from stage 1 of the ComPAS trial, we used logistic regression to assess the association between age, sex and wasting treatment outcomes (recovery, death, default, non‐response, and transfer), modelling the likelihood of recovery versus all other outcomes. We used linear regression to calculate differences in mean length of stay (LOS) and mean daily weight gain by age and sex. Data from 6929 children from Kenya, Chad, Yemen and South Sudan was analysed. Girls in therapeutic feeding programmes were less likely to recover than boys (pooled odds ratio [OR]: 0.84, 95% confidence interval [CI]: 0.72–0.97, p = 0.018). This association was statistically significant in Chad (OR: 0.61, 95% CI: 0.39–0.95, p = 0.030) and Yemen (OR: 0.47, 95% CI: 0.27–0.81, p = 0.006), but not in Kenya and South Sudan. Multinomial analysis, however, showed no difference in recovery between sexes. There was no difference between sexes for LOS, but older children (24–59 months) had a shorter mean LOS than younger children (6–23 months). Mean daily weight gain was consistently lower in boys compared with girls. We found few differences in wasting treatment outcomes by sex and age. The results do not indicate a need to change current programme inclusion requirements or treatment protocols on the basis of sex or age, but future research in other settings should continue to investigate the aetiology of differences in recovery and implications for treatment protocols.

Abstract Malnutrition and disability are major global public health problems. Poor diets, inadequate access to nutrition/health services (NaHS), and poor water, sanitation and hygiene (WASH) all increase the risk of malnutrition and infection. This leads to poor health outcomes, including disability. To better understand the relationship between these factors, we explored access to NaHS and household WASH and dietary adequacy among households with and without children with disabilities in Uganda. We used cross‐sectional secondary data from 2021. Adjusted logistic regression was used to explore associations between disabilities, access to NaHS, WASH and dietary adequacy. Of the 6924 households, 4019 (57.9%) reported having access to necessary NaHS, with deworming and vaccination reported as both the most important and most difficult to access services. Access to services was lower for households with children with disabilities compared to those without, after adjusting for likely confounding factors (Odds ratio = 0.70; 95% CI 0.55–0.89, p = 0.003). There is evidence of an interaction between disability and WASH adequacy, with improved WASH adequacy associated with improved access to services, including for children with disabilities (interaction odds ratio = 1.12, 95% CI: 1.02–1.22, p = 0.012). The proportion of malnourished children was higher among households with children with disabilities than households without it (6.3% vs. 2.4% p

Recuperating bioactive compounds and nutrients from agricultural by-products for livestock feed is a potential solution for their reuse. Three of the agricultural by-products whose potential needs to be further explored are hempseed (Cannabis sativa L.) hull and sea buckthorn (Hippophae rhamnoides) pomace and leaves. Free amino compounds content has not yet been explored for these samples and they were compared to oat (Avena sativa) bran and apple (Malus domestica Borkh.) pomace, since they have already been employed as livestock feed. For the analysis of amino compounds, the samples were derivatized with diethyl ethoxymethylenemalonate (DEEMM) followed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis, in an approach called derivatization-targeted analysis. Overall, 46 free amino compounds were quantified, and a correlation matrix revealed that amino compounds’ profile of sea buckthorn leaves resembles that of oat bran, indicating that it is the most suitable agricultural by-product to be employed as feed supplement.

Incidenca melanoma v svetu in Sloveniji še vedno narašča, se je pa preživetje v zadnjih 20 letih izboljšalo, predvsem zaradi zgodnejšega odkrivanja melanoma in enotnih pristopov v primarnem zdravljenju. Posodobljena Priporočila v letu 2024 prinašajo precej novosti, predvsem v diagnostičnih postopkih odkrivanja in zamejitve zgodnjih stadijev melanoma, kot tudi natančnih priporočil sledenja po primarnem zdravljenju, na področju kirurškega zdravljenja in pa predvsem sistemskega zdravljenja, tako metastatske bolezni, predvsem pa v adjuvan- tnem sistemskem zdravljenju v visoko rizičnem stadiju II, in neo- adjuvantnem sistemskem zdravljenju operabilnega melanoma. V tokratna Priporočila smo vključili tudi poglavji prehranskega in paliativnega tima.

In this paper we investigate whether the banks which fall under direct supervision by the European Central Bank (ECB) are more likely to be considered more stable and trustworthy by the depositors due to the stricter supervisory activities performed since the implementation of the Single Supervisory Mechanism (SSM). Under the SSM, significant banks switched from national supervisors to ECB, whereas the remaining banks remained under national supervisory authorities (NSAs). Using the difference-in-difference (DID) method, we have found evidence of increased depositors’ trust in significant banks after the SSM implementation. Additionally, in anticipation of the SSM launch and the comprehensive assessment, we have found evidence of increased depositors’ trust in the banks which were expected to be supervised by the ECB.

Abstract Background Vision is an important and defining element of laparoscopy and significantly affects the outcome of surgery in terms of time, error, and precision. Several new imaging systems have become available for laparoscopic surgery, including three-dimensional (3D) high-definition (HD) and two-dimensional (2D) ultra-high-resolution (4K) monitors. 3D HD systems offer a number of potential benefits to surgeons and patients over traditional 2D systems, including reduced operating time, blood loss, and hospital stay. However, the performance of 3D systems against the new, ultra-high definition 4K systems is barely known and highly controversial. There is a paucity of studies comparing them in clinical settings. The aim of this study is to compare 2D 4K and 3D HD perspectives in gastric bypass surgery. Methods Forty-eight patients with an indication for gastric bypass will be randomized to receive laparoscopic gastric bypass surgery using either 2D 4K or 3D HD systems. The operations will be performed by a well-coordinated team of three senior surgeons. The primary outcome is operative time. Secondary outcomes include intraoperative complications, blood loss, operator workload as assessed by the validated Surg-TLX questionnaire, and postoperative complications according to the Clavien-Dindo classification. An interim analysis is planned after enrollment of 12 participants for each group. Discussion This prospective, randomized trial is designed to test the hypothesis that the use of a 3D HD system will result in a significant improvement in operative time compared to a 2D 4K system in bariatric surgery. The objective is to provide clinical evidence for new laparoscopic imaging systems and to evaluate potential benefits. Trial registration This trial is registered at clinicaltrials.gov under the identifier NCT05895058. Registered 30 May 2023. BASEC2023-D0014 [Registry ID Swissethics, approved 3 May 2023]. SNCTP000005489 [SNCTP study register, last updated 13 July 2023].