BACKGROUND Tuberculosis (TB) is the leading global cause of death from a single infectious agent. Recent reductions in global health funding have threatened TB control, making comprehensive assessment of TB, HIV-related TB, and drug-resistant TB burdens before these disruptions essential for shaping effective responses. The WHO End TB Strategy sets targets of a 95% reduction in TB deaths and a 90% reduction in TB incidence between 2015 and 2035. Using results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, this study aims to assess the burden of TB and multidrug-resistant TB (MDR-TB) across 204 countries and territories, and to evaluate progress towards the WHO End TB incidence and mortality targets. METHODS We quantified TB mortality using the Cause of Death Ensemble modelling platform with global vital registration, surveillance, verbal autopsy, and minimally invasive tissue sampling data. For TB morbidity estimation, we simultaneously modelled incidence, prevalence, and mortality by age and sex using DisMod-MR 2.1. A population attributable fraction (PAF) approach was applied to stratify morbidity and mortality estimates by HIV and drug-resistance status. We also calculated disability-adjusted life-years (DALYs) as the sum of years of life lost and years lived with disability. For the risk factor analysis, a comparative risk assessment framework was used and PAFs were derived for alcohol use, smoking, and high fasting plasma glucose to determine the proportion of TB burden associated with these risk factors. FINDINGS In 2023, there were an estimated 9·11 million (95% uncertainty interval 8·04-10·3) incident cases of all-form TB, 1·22 million (0·98-1·49) deaths, and 54·6 million (43·8-65·5) DALYs globally. HIV-related TB comprised 781 000 (690 000-879 000) incident cases and 210 000 (142 000-279 000) deaths, contributing 11·0 million (7·56-14·3) DALYs. MDR-TB accounted for 466 000 (198 000-1 080 000) incident cases, 102 000 (31 700-238 000) deaths, and 3·96 million (1·31-9·01) DALYs. From 2015 to 2023, global all-form TB incidence rates declined by 19·2% (17·8-20·5) and deaths declined by 22·6% (4·7-35·7); declines were larger for drug-susceptible TB than for MDR-TB. Sub-Saharan Africa and south Asia had the highest mortality burdens in 2023; reductions in all-form TB incidence and mortality were uneven between 2000 and 2023, with limited progress in both measures in Latin America and the Caribbean. Removing smoking, alcohol use, and high fasting plasma glucose would reduce global TB deaths to 768 000 (592 000-970 000) and DALYs to 34·9 million (27·8-43·8) in 2023; MDR-TB deaths would decrease to 77 200 (23 400-183 000) and DALYs to 3·12 million (1·03-7·29). INTERPRETATION Global progress towards WHO End TB targets is disparate and fragile. Although many regions achieved meaningful gains, others have stagnated in recent years. The complexity of TB prevention is amplified by divergent MDR-TB trends, the persistent burden of HIV, and growing exposure to modifiable risk factors. Recent volatility in global health financing threatens to further destabilise this vulnerable epidemiological landscape; concerted action is urgently needed to temper disruptions and preserve progress. FUNDING Gates Foundation.

Successful speech communication in multi-talker scenarios requires a skillful combination of sustained attention and rapid attention switching. While the neurophysiology literature offers detailed insights into the neural underpinnings of sustained attention, there remains considerable uncertainty on how attention switching takes place. In this study, using EEG recordings from normal-hearing adults in an immersive multi-talker environment, we measured the neural encoding of two competing speech streams amid background babble. Participants were cued to switch attention between streams every 15–30 s. Neural tracking was assessed via Temporal Response Functions (TRF), confirming reliable decoding of attentional focus. Our results indicate asymmetric disengagement and engagement processes during attention switches, where the neural tracking of the new target stream emerges before disengaging from the previous target, revealing a transient simultaneous encoding of two speech streams. That transition was closely mirrored by a reduction in EEG alpha power, informing on the cognitive effort during different phases of the attention switch. We then isolated cortical activity reflecting lexical prediction mechanisms to determine how lexical context is updated after an attention switch, comparing four context-accumulation strategies that were constructed using Large Language Models. Our findings elucidate both the temporal and contextual mechanisms underlying auditory attention shifts, pointing to the possibility that listeners carry out a reset in lexical context after switching attention. By focusing on dynamic attentional reallocation, this study offers insights into the brain’s capacity for flexible speech processing in complex listening environments.

The introductory section defines the concepts of graphomotor skills and hearing impairment.The aim of this study was to examine the characteristics of graphomotor skills in children with hearing impairments compared to hearing children. Additionally, one of the objectives was to investigate whether there are differences in graphomotor skills depending on the quality of hearing, as well as to identify the factors that influence these skills.For assessment purposes, the Diagnostic Set for Testing Speech, Language, Reading, and Writing Abilities in Children –Diagnostic Material for Identifying Specific Difficulties in Reading and Writing wasused, focusing on variables related to graphomotor skills. Descriptive statistics, optimal scaling regression analysis, and linear regression analysis were employed for statistical data processing.The study revealed that hearing participants achieved statistically significantly better results in graphomotor skills compared to participants with hearing impairments.The degree of hearing impairment affects the graphomotor skills of children with hearing impairment, while educational conditions and gender did not show any influence on these skills. Age also impacts the graphomotor skills of children with hearing impairment.These findings provide insight into the specific needs of children with hearing impairments and emphasize the importance of individualized education, taking into account the unique characteristics of each child with hearing impairment.Keywords: graphomotor skills, graphomotor development, children with hearing impairment

Digital narratives, particularly animated films, are increasingly recognized as powerful educational tools capable of fostering empathy and promoting inclusive values among school-age children. This study examined how viewing the animated film Jonathan from Seagull Mountaincontributes to the development of empathy and understanding of diversity among primary school students in Bosnia and Herzegovina. A mixed-methods design was employed, integrating quantitative and qualitative data collection and analysis.The sample comprised 214 students aged 9 to 15 years from four cities (Tuzla, Sarajevo, Zenica, and Mostar), while a purposive subsample of 32 students participated in four focus groups. Data were collected through a structured post-viewing questionnaire and semi-structured focus group discussions. Quantitative data were analyzed using descriptive statistics, while qualitative data from focus group transcripts were analyzed through thematic analysis. Results indicate that the film elicited positive emotional responses in the majority of participants, with 78.6% expressing a desire to help the protagonist and 78.0% reporting increased motivation to support peers who are different from them. Girls demonstrated markedly higher levels of affective empathy than boys, with the most pronounced difference recorded on the item relating to sadness over the protagonist's exclusion (86.5% vs. 53.6%). Thematic analysis identified five main themes: emotional experience of the narrative, development of empathy and acceptance of diversity, peer support and moral responsibility, symbolic elements, and student recommendations for more inclusive school practices. The findings confirm the potential of digital narratives as a pedagogical tool for developing empathy and inclusive attitudes among primary school students. Keywords:digital narratives, empathy, inclusion, animated film, primary school students

Abstract Heterobranch sea slugs represent one of the most diverse groups of marine gastropods in the Mediterranean Sea; however, their diversity and distribution along the short coastline of Bosnia and Herzegovina remain insufficiently documented. In this study, we report the first confirmed record of the sacoglossan nudibranch Elysia gordanae T. E. Thompson & Jaklin, 1988 from the marine waters of Bosnia and Herzegovina. A single specimen was observed and collected in the intertidal zone of Neum Bay during field surveys conducted in August 2023. Morphological characteristics correspond well with published descriptions of the species. This finding represents the easternmost confirmed record of E. gordanae in the Adriatic Sea to date and contributes to the growing knowledge of heterobranch diversity in Bosnia and Herzegovina, highlighting the need for continued systematic surveys of its poorly explored marine habitats.

BACKGROUND Fractures in older adults arise from complex interactions between bone fragility, falls, and comorbid conditions. This study aimed to map the comorbidity environment of osteoporosis (M80/M81) by sex and age, and assess whether osteoporosis is systematically coded at the time of fracture-related hospitalization across fracture types. METHODS We conducted a nationwide retrospective analysis of Austrian inpatient data collected for insurance claims between 2003 and 2014, including 1,705,684 hospitalized patients aged 50-79 years. Comorbidity network analysis was used to characterize sex- and age-specific diagnoses co-occurring with osteoporosis (ICD-10: osteoporosis with pathological fracture M80 and osteoporosis without pathological fracture M81). In paralell, fracture-centered networks were constructed for major fracture types (S22, S32, S42, S52, S62, S72) to assess whether osteoporosis was systematically coded during fracture related hospitalizations. Sex-specific odds ratios (ORs) were calculated to compare comorbidity associations between males and females across three age groups (50-59, 60-69, 70-79 years). RESULTS Across all age groups, females exhibited substantially broader M81-associated comorbidity networks than males, with the number of linked diagnoses increasing from 142 to 245 to 330 in females and from 76 to 137 to 164 in males between ages 50-59, 60-69, and 70-79 years, respectively. Fracture-centered analyses showed that across age groups, fractures were embedded within multimorbidity networks rather than forming isolated diagnostic links with osteoporosis. Hip fractures (S72) showed the strongest co-occurrence with osteoporosis diagnoses, particularly in females aged ≥60 years, whereas upper limb fractures - forearm (S52), wrist and hand (S62), and humerus (S42) - showed no osteoporosis diagnoses among significant co-diagnoses in any age group despite these fractures being considered early fragility fractures. In patients aged 50-69 years, male fracture networks showed stronger co-occurrence with trauma-related and alcohol-related diagnoses, while in older age groups networks in both sexes increasingly included neurodegenerative, cardiovascular, respiratory, and renal diseases. In sex-stratified analyses, the co-occurrence between osteoporosis without pathological fracture (M81) and osteoporosis with pathological fracture (M80) was consistently stronger in males than in females across all ages (e.g. OR 63.74 vs 18.53 at 50-59 years). CONCLUSIONS Osteoporosis is not systematically coded across all fracture types in routine hospital data. Upper limb and thoracic fractures were rarely recorded alongside osteoporosis diagnoses despite being recognized as potential fragility fractures. These patterns suggest under-recognition of osteoporosis at the time of fracture, particularly in younger patients and in males.

Indoor air quality may be compromised by elevated radon levels, a naturally occurring radioactive gas. Prolonged exposure to increased radon levels can adversely affect human health. This paper presents the results of indoor radon activity concentration measurements conducted at 20 locations using a passive method. CR-39-based radon detectors were deployed over three different exposure periods, from January to April. The aim of the study was to compare and analyse average indoor radon activity concentrations obtained over different detector exposure periods, and to determine whether reliable information on indoor air quality can be obtained using shorter exposure durations. The measured indoor radon activity concentrations ranged from 6.0 to 727 Bq/m 3 , 10.1 to 561 Bq/m 3 , and 15.1 to 480 Bq/m 3 for the three-month, two-month, and one-month exposure periods, respectively. Comparative analysis of the results showed that the mean ratio of radon activity concentrations for one-month to two-month, two-month to three-month, and one-month to two-month exposure periods were 1.24, 1.57, and 1.85, respectively. To establish the relationship between radon activity concentrations obtained for different exposure periods, linear regression analysis was performed. The analysis of the estimated relative percentage differences showed that the results for different exposure periods agreed within ±20% at approximately 53% of the locations.

Vocal fold nodules (VFNs) are the main cause of paediatricdysphonia. Voice therapy is regarded as the preferred treatment approach for VFNs in children. The aim of this study was to evaluate voice characteristics before and after voice therapy using acoustic analysis. Thirty female patients with VFNs were enrolled in this study. Each patient underwent voice therapy conducted by an experienced voice therapist twice a week. Acoustic voice assessments were performed before and after the therapeutic intervention. Acoustic analyses were performed using computerized acoustic voice analysis. Post-therapy findings demonstrated a consistent and statistically significant improvement across multiple acoustic parameters. Significant reductions were observed in jitter and shimmer measures, as well as in noise-related acoustic parameters such as the noise-to-harmonics ratio, suggesting improved stability and efficiency of vocal fold vibration. Fundamental frequency showed a slight decrease following therapy. Overall, these findings indicate a more stable, less perturbed, and acoustically improved voice signal after intervention. The findings of this study suggest the effectiveness of voice therapy in improving acoustic voice parameters in children with VFNs. The observed improvements highlight the importance of early and structured behavioral intervention in pediatric dysphonia and reinforce the role of acoustic analysis as a valuable tool for objective assessment of therapeutic outcomes. Keywords: vocal fold nodules, dysphonia, voice therapy, acoustic analysis.

The aim of the study was to examine the level of knowledge and awareness of healthcare professionals regarding feeding, sucking, and swallowing disorders, as well as their understanding of the role of speech and language therapists in the diagnosis and treatment of these disorders. The study was conducted on a sample of 51 healthcare professionals from public and private healthcare institutions in the Una-Sana Canton, using a questionnaire specifically designed for the purposes of this research.According to the results, 56.9% of respondents had received formal education on dysphagia, while only 27.5% had undergone training in the field of pediatric feeding disorders. Clinical experience with dysphagia was reported by 64.7% of respondents, whereas experiencewith pediatric feeding disorders was reported by 25.5%. Although 68.6% of respondents reported being familiar with the distinction between the terms “dysphagia” and “feeding disorders,” only 29.4% demonstrated a professionally grounded understanding of these concepts.Participation in diagnostic procedures related to pediatric feeding disorders was reported by 9.8% of respondents, while 7.8% reported participation in therapeutic interventions. In cases of dysphagia, 35.3% of respondents reported involvement in diagnostic procedures, whereas 17.6% participated in therapeutic treatment. Only 7.8% of respondents identified the speech and language therapist as a key member of the multidisciplinary team.Respondents also assessed the strengthening of knowledge on pediatric feeding disorders and dysphagia as being of high professional importance. The results indicate significant gaps in knowledge, education, and clinical involvement among healthcare professionals, particularly regarding the recognition of the roleof speech and language therapists, while respondents simultaneously express a high level of readiness for further professional development. These findings highlight the need for continuous and systematic education, as well as for strengthening interprofessional collaboration.Keywords: dysphagia; pediatric feeding disorders; healthcare professionals’ knowledge and competencies; speech-language pathology; multidisciplinary team