A 61-year-old male presented to emergency department with symptoms of shortness of breath, palpitations, and night sweats. We performed bedside transthoracic echocardiography which showed shunt from the left ventricle to the right atrium in systole with color Doppler examination. Gerbode-type ventricular septal defect and an image of a fibrillar, mobile mass compatible with vegetation was observed just above the tricuspid valve. We performed transesophageal echocardiography which showed vegetations on the aortic valve noncoronary cusp. Two sets of blood cultures were positive for Streptococcus sanguinis. The patient was evaluated by the heart team and an operation decision was made for the patient. The patient underwent surgery after 2 weeks of antibiotic theraphy. In the surgery, the Gerbode-type ventricular septal defect was closed with a polytetrafluoroethylene patch. Tricuspid annuloplasty was performed with De Vega technique. Mechanical aortic valve was implanted. Postoperative transthoracic echocardiography showed no residual shunt.

Circuit breakers (CBs) play an important role in modern society because they make the power transmission and distribution systems reliable and resilient. Therefore, it is important to maintain their reliability and to monitor their operation. A key to ensure a reliable operation of CBs is to monitor their condition. In this work, we performed an accelerated life testing for mechanical failures of a vacuum circuit breaker (VCB) by performing close-open operations continuously until failure. We recorded data for each operation and made the collected run-to-failure dataset publicly available. In our experiments, the VCB operated more than 26000 close-open operations without current load with the time span of five months. The run-to-failure long-term monitoring enables us to monitor the evolution of the VCB condition and the degradation over time. To monitor CB condition, closing time is one of the indicators, which is usually measured when the CB is taken out of operation and is completely disconnected from the network. We propose an algorithm that enables to infer the same information on the closing time from a non-intrusive sensor. By utilizing the short-time energy (STE) of the vibration signal, it is possible to identify the key moments when specific events happen including the time when the latch starts to move, and the closing time. The effectiveness of the proposed algorithm is evaluated on the VCB dataset and is also compared to the binary segmentation (BS) change point detection algorithm. This research highlights the potential for continuous online condition monitoring, which is the basis for applying future predictive maintenance strategies.

Slušno procesiranje je sposobnost da slušamo, razumijemo i odgovaramo na informacije koje čujemo kroz svoje slušne kanale. Poremećaj slušnog procesiranja (PSP) je senzorni poremećaj koji najčešće pogađa razumijevanje govora i učenje, te stvara poteškoće u procesiranju auditivnih informacija. Istraživanje je provedeno sa ciljem utvrđivanja razlika u poremećajima slušnog procesiranja (PSP) kod djece različitih uzrasnih grupa. Ukupno je testirano 560 djece. Sa ciljem utvrđivanja postojanja razlika slušnog procesiranja između pet uzrasnih grupa korišten je statistički test analiza varijanse (ANOVA) za poređenje prosječnih vrijednosti postignutih na subtestovima. Na testu filtriranih riječi (TFR) registrovana je statistički značajna razlika ANOVA testom (F=13,09, p<0,001). Na testu govora u buci (TGB) takođe je registrovana statistički značajna razlika ANOVA testom (F=11,04, p<0,001). Na dihotičkom testu riječi (DTR), također je registrovana statistički značajna razlika ANOVA testom (F=12,30, p<0,001), kao i na dihotičkom testu rečenica (DTRE) (F=8,60, p<0,001). Analizom rezultata našeg istraživanja, mogu se konstatovati statistički značajne razlike među uzrasnim grupama, gdje je prisutan trend ostvarivanja boljih rezultata sa porastom hronološke dobi ispitanika. S obzirom da je prilikom ispitivanja normalne raspodjele Kolmogorov-Smirnov testom pokazano da neki od postignutih rezultata ne prate normalnu distribuciju, rezultati su analizirani i neparametrijskim Kruskal-Wallis testom, te je uočljiva saglasnost sa rezultatima ANOVA testa. Mjerni instrument koji je korišten u ovom istraživanju je Baterija testova za ispitivanje poremećaja slušnog procesiranja PSP 1 (Heđever, 2015) i isti je jako koristan standardizirani mjerni instrument.

Background DIALOG+ is an evidence-based, generic, cost-saving and easily deliverable psychosocial intervention, adaptable to clinicians’ personal manner of interaction with patients. It was implemented in mental health services in five low- and middle-income countries in South-Eastern Europe during a 12-month randomised-controlled trial (IMPULSE) to improve the effectiveness of out-patient treatment for people with psychotic disorders. Aims To investigate barriers and facilitators to the perceived sustainability of DIALOG+ that has been successfully implemented as a part of the IMPULSE project. Method Three months after the IMPULSE trial's end, perceived sustainability of the DIALOG+ intervention was assessed via a short survey of clinicians and patients who took part in the trial. Quantitative data collected from the survey were analysed using descriptive statistics; content analysis assessed qualitative survey data. The views and experiences of key informants (patients, clinicians and healthcare policy influencers) regarding the sustainability and scale-up of DIALOG+ were further explored through semi-structured interviews. These data were explored using framework analysis. Results Clinicians mostly appreciated the comprehensiveness of DIALOG+, and patients described DIALOG+ meetings as empowering and motivating. The barrier most commonly identified by key informants was availability of financial resources; the most important facilitators were the clinically relevant structure and comprehensiveness of the DIALOG+ intervention. Conclusions Participants showed a willingness to sustain the implementation of DIALOG+. It is important to maintain collaboration with healthcare policy influencers to improve implementation of DIALOG+ across different levels of healthcare systems and ensure availability of resources for implementing psychosocial interventions such as DIALOG+.

High-throughput sequencing provides sufficient means for determining genotypes of clinically important pharmacogenes that can be used to tailor medical decisions to individual patients. However, pharmacogene genotyping, also known as star-allele calling, is a challenging problem that requires accurate copy number calling, structural variation discovery, variant calling and phasing within each pharmacogene copy present in the sample. Here we introduce Aldy 4, a fast and efficient tool for genotyping pharmacogenes that utilizes combinatorial optimization for accurate star-allele calling across different sequencing technologies. Aldy 4 adds support for long reads and ships with a novel phasing model and improved copy number and variant calling models. We compare Aldy 4 against the current state-of-the-art star-allele callers on a large and diverse set of samples and genes sequenced by various sequencing technologies, such as whole-genome and targeted Illumina sequencing, barcoded 10X Genomics and PacBio HiFi. We show that Aldy 4 is the most accurate star-allele caller with near-perfect accuracy in all evaluated contexts. We hope that Aldy remains an invaluable tool in the clinical toolbox even with the advent of long-read sequencing technologies. Availability Aldy 4 is available at https://github.com/0xTCG/aldy.

Opći val useljenika, najviše sa prostora Bliskog istoka, ali i iz Afrike, posebice njenog sjevernog dijela, dolazi na granice evropskih i drugih zemalja. Uz opće loše fizičko stanje u kojem se imigranti nalaze, u velikom postotku idu i psihički problemi praćeni očajem i nasilnim ponašanjem, napadima na domaće stanovništvo i njihovu imovinu, itd., što još više produbljuje krizu njihovog statusa u društvu zemlje primateljice, stvarajući neku vrstu začaranog kruga. Cilj istraživanja jeste utvrditi prisustvo nasilničkog ponašanja kod imigranata sa Bliskog Istoka i Sjeveroistočne Afrike po ulasku u novu zemlju. U istraživanju se pošlo od pretpostavki da su imigranti izloženi nasilju i u većem broju su žrtve u odnosu na domaće stanovništvo, te da su imigranti koji dolaze u potrazi za boljim socioekonomskim prilikama više nasilni od onih koji bježe od rata. Uzorak studije obuhvaća 100 ispitanika, useljenika i domaćeg stanovništva, različitog spola, starosti, zemlje podrijetla i drugih demografskih faktora. Ispitivanje je provedeno u „St Andrew Church Refugee Service“ te online radi anonimnosti na području Egipta, Kairo. Podaci su prikupljeni ASEBA Youth Self-Report – YSR upitnikom. Rezultati istraživanja pokazuju da imigrantsko stanovništvo ima značajnije izražen osjećaj da drugi ljudi u društvi imaju želju da im naškode u usporedbi sa domicilnim stanovništvom. U rezultatima istraživanja su predstavljene i razlike između sjeverno-afričkih i blisko-istočnih useljenika u pogledu malicioznog ponašanja prema drugim osobama iz okoline (pošto blisko-istočni imigranti potječu iz regija sa aktualnim i većim ratnim razaranjima). Može se zaključiti da imigranti porijekla sa Bliskog istoka pokazuju veći stepen lošeg postupanja prema drugim ljudima, u poređenju sa sjeverno-afričkim imigrantima.

The potential advantages of intelligent wireless communications with millimeter wave (mmWave) and massive multiple-input multiple-output (MIMO) are based on the availability of instantaneous channel state information (CSI) at the base station (BS). However, no existence of channel reciprocity leads to the difficult acquisition of accurate CSI at the BS in frequency division duplex (FDD) systems. Many researchers explored effective architectures based on deep learning (DL) to solve this problem and proved the success of DL-based solutions. However, existing schemes focused on the acquisition of complete CSI while ignoring the beamforming and precoding operations. In this paper, we propose an intelligent channel feedback architecture using eigenmatrix and eigenvector feedback neural network (EMEVNet). With the help of the attention mechanism, the proposed EMEVNet can be considered as a dual channel auto-encoder, which is able to jointly encode the eigenmatrix and eigenvector into codewords. Simulation results show great performance improvement and robustness with extremely low overhead of the proposed EMEVNet method compared with the traditional DL-based CSI feedback methods.

Regulatory frameworks surrounding medical devices (MDs) and medical locations are of utter importance for safeguarding patients and users, and for granting a universal access to healthcare. Currently, as the main existing regulatory frameworks are drafted by high-income countries, they pretend to be general and applicable globally, but fail to understand particular contexts, specifically those in low-resource settings (LRSs), resulting, therefore, inapplicable. In particular, LRSs present a varied situation, with legal transplants of guidelines from their previous colonial regimes. This apparently theoretical issue, is, effectively, a tangible and rising matter of concern, given the ever-increasing number of MD patent applications per year, as well as the appearance of low- and middle-income countries (LMICs) on the MD market itself. This article will focus on the European Regulation on MDs 745/2017 and its applicability in LRSs, specifically presenting the case of Benin, a Sub-Saharan African country. This work is based on a field study conducted in 2019 in Benin, which is particularly exemplar to show the complexity of the “legal transplantation” concept. A multidisciplinary approach, comprising the standard tools and methods of ethics, law, and biomedical engineering, was used to draft a heuristic hermeneutic framework, and to analyse related bioethical issues concerning Medical Device Regulations (MDRs) in LRSs, the role of Maintenance, and other sociological questions; as well as the rural population’s perception on MDs and health technologies, and the role of ethics in the hospitals of LRSs. The definition of these themes helped approach the local perspective and define the research questions. Downstream of the analysis of the Medical Devices Regulations, the Maintenance and other bioethical issues in Benin, the heuristic hermeneutic framework was created to guide a shift in the paradigm of law and regulation making, so as to make them more contextualised and inclusive, globally. This article proposes a framework that will help policymakers take into account the particularism of each context, especially those of the most vulnerable countries, when drafting and issuing regulatory frameworks, promoting an ever-evolving model of universalism.

Conservation of historical centres is a pressing need for Mediterranean countries, that are characterized by masonry aggregates representing the most typical construction type within cities. Masonry clustered buildings were usually designed without seismic design criteria. Moreover, the current seismic standard codes do not foresee a clear calculation method to predict their non-linear behaviour. For this reason, in this paper, a wide overview on the seismic response of masonry aggregates has been done considering analysis at different levels, from simplified large-scale evaluations to sophisticated non-linear analyses. In the former investigation kind, a vulnerability form appropriately conceived for clustered buildings has been applied to different historical centres with the aim to perform risk analysis considering both empirical approaches and real data deriving from occurred past earthquakes. In the second evaluation type, the macro-elements analysis method has been examined with reference to typical clustered buildings of the Italian territory. In particular, global assessments, performed using the 3Muri non-linear analysis program, have been performed with the final goal to derive fragility curves of structural units of masonry aggregates considering their plan position in the clustered building (end of row, internal, and corner).

Vernacular architecture and its responses to natural factors through architectural patterns are recognized as expressions of bioclimatic principles and national architectural responses to location. The vernacular architectural heritage of architecture is one of the most important factors in preserving and developing the cultural identity of a nation. Through research on the vernacular architecture of the coastal area of Skadar Lake, our goal is to recognize and potentially valorize the local traditional characteristics of authentic houses as ecological building patterns, which also express the fundamentals of sustainability principles. Although examples of vernacular architecture are disappearing due to contemporary globalization, and a mere imitation of motifs from past periods occurs, the historical specifics of architectural expression remain the inspiration and catalyst for future achievements based on the idea of preserving the local and regional recognizability of architecture. This research resulted in a redefinition of vernacular, bioclimatic concepts in a way that preserves construction techniques, which basically have an ecological approach, and, at the same time, provides modern solutions with bioclimatic concepts. The case study conducted on the village of Karuč in the area of Skadar Lake presented in the paper contributes to revealing the potential of bioclimatic principles and the energy rehabilitation of vernacular architecture in order to revitalize it through a new contemporary architectural expression. This study’s contents propose revitalization solutions at two levels of the following: settlement and typical houses. The study also aims to create a model, that is, a modern expression of a characteristic Karuč house, with improved functionality and energy characteristics for national architecture. Identifying all the basic building patterns, including the positioning of buildings, construction, the application of available materials, and the design of buildings, this paper presents conditions for the adequate valorization and preservation of authentic vernacular architecture and creates guidelines for further upgrades and the bioclimatic revitalization of vernacular architecture in a certain location.

Checkpoint inhibitor immunotherapy has revolutionised cancer treatment. However, immunotoxicity due to dysregulated immune control can affect a range of non-cancer tissues causing dermatitis, colitis and endocrinopathies in up to 80% of exposed patients. Peripheral nerve neurotoxicity is rare (<5%) and described as GBS-like or CIDP-like in published case series. Here we present two cases of checkpoint inhibitor associated peripheral neuropathy suggesting this neuritis is a novel pathological entity. Case 1 55-year-old man treated with nivolumab and ipilimumab for renal cell carcinoma developed painful sensory predominant neuropathy after cycle 1. Gait impairment led to discontinuation by cycle 3. NCS revealed axonal loss and conduction slowing but no demyelinating features. He was treated with IVIg without response. Case 2 55-year-old woman with metastatic melanoma was treated with pembrolizumab for 16 months without complication. Within weeks of change to nivolumab she developed painful neuropathic symptoms causing difficulty walking. Neurophysiology was similar to case 1 but she improved to normal with high dose corticosteroids over 4 months. Both sural nerve biopsies showed active large fibre degeneration with diffuse, predominantly T cell inflam- matory infiltrate. No malignant cells. No evidence of a primary demyelinating pathology. This novel inflammatory neuropathy warrants recognition due to alternative treatment response.

In this article, the corrosion inhibition of steel DIN 2391 St 37-4 in acidic medium 5% H2SO4 with and without the presence of eco inhibitors of leaf (Petroselinum Sativum) was examined. Inhibitory properties of parsley leaves (Petroselinum Sativum) on steel DIN 2391 St 37-4 were examined by potentiodynamic polarization - Tafel extrapolation, and FTIR method in order to categorize the oxide layer. The test was performed in static medium and with stirring at 600 rpm. By Tafel extrapolation based on changes in corrosion potential, the inhibitor behaves as mixed. Increasing the concentration of inhibitors increases the efficiency of inhibition. Corrosion processes are inhibited by adsorption of organic matter on the surface of steel DIN 2391 St 37-4, forming a film. The obtained results indicate that parsley leaf (Petroselinum Sativum) is an effective eco inhibitor for the tested steel in 5% sulfuric acid.

Fundal or Kristeller’s pressure (FP) is known to be associated with numerous reports of severe maternal and fetoneonatal injuries, although it is used in a variety of modifications in many maternity hospitals and there is no evidence based on medical evidence of its effect on good clinical practice (Habek et al. 2008; Gimovsky and Berghella 2022). Peripartum pneumothorax (PPT) is a life-threatening clinical curiosity most commonly associated with pre-existing lung disease (lung cysts, tumours and bronchiectasis) and increased intrathoracic pressure associated with peripartum induced Valsalva’s manoeuvre and distal alveolar rupture. It is more common in pregnancy than in childbirth alone or in combination with Hamman’s syndrome (pneumomediastinum, pneumothorax and subcutaneous emphysema) with also extremely rare incidence in 1:2000 to 1:100,000 births (Najafi and Guzman 1978; Oshovskyy and Poliakova 2020). From the non-litigating Croatian obstetric practice, the case of a PPT in healthy primipara, without comorbidity and normal course of pregnancy and spontaneous term delivery is known. The parturient somatogram was unfavourable in terms of short stature (156 cm) and body weight of 68 kg, orderly eutrophic newborn and the course of the first labour phase. During the end of the II labour stage, the obstetrician decided on FP and with episiotomy, a live eutrophic newborn was born with Apgar score 10/10. Immediately after the birth, the mother became tachydyspnoic, cyanotic, tachycardic, hypotonic, with signs of acute respiratory insufficiency, so obstetric embolism was suspected, which was excluded by radiographic, electrocardiographic and laboratory methods. However, right-sided complete PPT without pulmonary or other intrathoracic pathological condition was verified, and with thoracentesis and drainage, there was complete reexpansion of the lungs and recovery of the mother with several days of subcutaneous emphysema. In 1978, seven cases of spontaneous PPT were presented in a pulmonary comorbidity (pulmonary cyst) using forceps with episiotomy in childbirth (Najafi and Guzman 1978), and Oshovskyy and Poliakova (2020) recently demonstrated intrapartum development of the syndrome Hamman which fully recovered by thorakocenthesis. FP could certainly have been avoided due to the orderly course of labour and the absence of maternal pulmonary comorbidity, and its application has contributed to the emergence of a life-threatening condition of the mother, which is beyond the scope of good clinical obstetric practice. Based on many years of clinical and forensic practice, we agree with the opinion of the authors of numerous papers and reviews of cases of obstetric injuries (Habek et al. 2008; Hasegawa et al. 2015; Zaami et al. 2018; Malvasi et al. 2019; Habek 2021; Gimovsky and Berghella 2022), FP is not recommended in modern obstetrics as a method of assistention during delivery. In this case shown, it can certainly be interpreted as iatrogenic rather than spontaneous PPT due to unnecessary and inappropriate force in normal, spontaneous childbirth.

Rehabilitation must be based on the individual needs and specific goals of the person and must be adapted to his abilities. According to the recommendation of the World Stroke Organization, the team involved in conducting rehabilitation should be multidisciplinary. One of the treatments that are applied within the multidisciplinary approach to a neurological patient is educational-rehabilitation treatment, which is multi-component in nature. Before starting educational-rehabilitation treatment, an educational-rehabilitation clinical assessment is necessary, which aims to detect difficulties caused by impairment; identify potentials and constraints in these areas; determine the specifics, course, and forecasts of difficulties; formulate clear treatment recommendations; form a watch list that will be available to all team members in the process of diagnosis, treatment, education, and to evaluate the effectiveness of treatment; and continuously monitor the ability and adaptive behavior of the person. Educational-rehabilitation clinical treatment includes treatment of cognitive abilities, treatment of motor skills, relaxation, treatment of adaptive skills, as well as informing the person about the disease and counseling. This review focuses on some aspects of rehabilitation such as treatment of cognitive and motor disorders, treatment of adaptive skills, relaxation issues, and informing and counseling patients from the perspective of an educational rehabilitator with practical experiences in this area of rehabilitation.

Abstract Background In Southeast Europe (SEE) standard treatment of patients with psychosis is largely based on pharmacotherapy with psychosocial interventions rarely available. DIALOG+ is a digital psychosocial intervention designed to make routine care therapeutically effective. This trial simultaneously examined effectiveness of DIALOG+ versus standard care on clinical and social outcomes (Aim 1) and explored intervention fidelity (Aim 2). Methods A hybrid type II effectiveness–implementation, cluster-randomized trial was conducted in five SEE countries: Bosnia and Herzegovina, Kosovo*, Montenegro, North Macedonia, and Serbia. The intervention was offered to patients six times across 12 months instead of routine care. The outcomes were subjective quality of life (primary), clinical symptoms, satisfaction with services, and economic costs. Intervention fidelity was operationalized as adherence to the protocol in terms of frequency, duration, content, and coverage. Data were analyzed using multilevel regression. Results A total of 81 clinicians and 468 patients with psychosis were randomized to DIALOG+ or standard care. The intervention was delivered with high fidelity. The average number of delivered sessions was 5.5 (SD = 2.3) across 12 months. Patients in the intervention arm had better quality of life (MANSA) at 6 months (p = 0.03). No difference was found for other outcomes at 6 months. Due to disruptions caused by the COVID-19 pandemic, 12-month data were not interpretable. Conclusions DIALOG+ improved subjective quality of life of individuals with psychosis at 6 months (after four sessions), albeit with small effect size. The intervention has the potential to contribute to holistic care of patients with psychosis.