We sought to investigate the inter- and intra-country variation in paediatric heart transplantation (HTx) and mechanical circulatory support (MCS) availability and practice in Europe. Data was obtained through a survey circulated to paediatric transplant cardiologists identified through the Association of European Paediatric and Congenital Cardiology between November 2022 and March 2023. Twenty-eight respondents from twenty-eight European countries completed the survey. Twenty-four (86%) had paediatric and 25 (89%) had adult congenital HTx services. National paediatric HTx centre density ranged from 0.00 to 5.35 per 10 million inhabitants. Eighteen (64%) countries followed either Eurotransplant or Scandiatransplant protocols for organ allocation and 59% of the surveyed countries had low HTx volumes (< 4 paediatric HTx annually), based on the self-reported numbers. A ventricular assist device (VAD) programme was operational in 22 (79%) countries. In only 9 countries (38%), there were dedicated resources for HTx as part of the hospital budget; however, a vast majority (77%) reported that families suffered no cost when a VAD was utilised. Twenty-one countries (78%) reported limited intensive care unit beds and 14 (54%) reported that HTx impacted on congenital heart surgery cases. Only 12 of 27 countries (44%) had a standardised national protocol for post-HTx care. There was no correlation between paediatric HTx centre density, population or GDP per capita. Conclusion: There is a high degree of variation both within and between the surveyed European countries with regard to paediatric HTx centre density, VAD availability, listing protocols, and post-HTx management. Multiple factors contribute to this heterogeneity, which makes standardisation of HTx listing and VAD criteria challenging. Increased cross-national collaborative efforts between European countries may strengthen both HTx and MCS availability and outcomes, especially in regions with several smaller neighbouring countries. What is Known: • The care of paediatric heart transplant (HTx) and mechanical support (MCS) patients varies across Europe. What is New: • This paper elucidates the differences in transplant service organisation and the care of transplant and MCS patients in twenty-eight European countries. • These findings could potentially encourage broader open dialogue and facilitate collaboration across European paediatric HTx centres with development of standardised listing criteria, improved collective European registry data and creation of standards for screening post-HTx patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00431-026-06927-1.

Background: The clinical course of COVID-19 is highly variable, ranging from asymptomatic infection to critical illness with hyperinflammation and multiorgan failure. Oxidative stress plays a central role in COVID-19 pathogenesis, and genetic polymorphisms in glutathione S-transferase (GST) enzymes, particularly GSTM1 and GSTT1 null genotypes, may impair antioxidant defense and exacerbate inflammatory responses. This study aimed to investigate the association of GSTM1 and GSTT1 null genotypes with both disease severity and serum cytokine levels in hospitalized COVID-19 patients. Methods: This cross-sectional study enrolled 137 COVID-19 patients hospitalized during the second pandemic wave (July–September 2020). Patients were stratified into mild (n = 67) and severe (n = 70) groups based on clinical criteria. GSTM1 and GSTT1 polymorphisms were determined by multiplex polymerase chain reaction. Serum levels of 13 cytokines were measured using flow cytometry. Logistic regression analyzed genotype associations with disease severity, and multivariate linear regression assessed relationships between null genotypes and pro-inflammatory cytokine levels (IL-6, TNF-α, IL-17A, IFN-γ), adjusted for age, sex, hypertension, and diabetes. Results: The GSTT1 null genotype was significantly associated with severe COVID-19 (adjusted OR = 2.56, 95% CI: 1.08–6.07, p = 0.032). Severe patients exhibited significantly elevated levels of IL-6 (75.6% increase, p = 0.008), TNF-α (69.4% increase, p = 0.005), IL-17A (54.4% increase, p = 0.016), and IFN-γ (10.1% increase, p = 0.021). Both GSTM1 and GSTT1 null genotypes were associated with higher levels of these cytokines, with stronger effects observed for GSTT1 null. In multivariate analysis, GSTT1 null independently predicted elevated IL-6 (β = 52.6, p = 0.003), TNF-α (β = 13.8, p = 0.002), IL-17A (β = 2.4, p = 0.001), and IFN-γ (β = 56.4, p = 0.012). The combined both null genotype showed the strongest associations but was limited by small sample size (n = 10) and should be interpreted with caution. Conclusions: The GSTT1 null genotype is associated with severe COVID-19 and appears to be associated with heightened pro-inflammatory cytokine responses, particularly IL-6, TNF-α, IL-17A, and IFN-γ. These findings suggest a potential role for genetic impairment of antioxidant defense may contribute to hyperinflammation in COVID-19 hyperinflammation, although validation in larger cohorts is needed.

Advances in generative AI have given rise to a growing industry centred on interactive representations of deceased individuals. Within this emerging “digital afterlife industry”, interactive deadbots (IDBs) are presented as hyper-realistic avatars that use a person’s likeness, voice, and personal data to simulate conversational interactions with them. Rapidly moving from a niche experiment to a mainstream phenomenon, IDBs are poised to reshape the ethical, social, legal, and governance landscapes surrounding death, mourning, and digital legacy. This paper examines the disruptive nature of IDB technology through a multidisciplinary lens, using the concept of indeterminacy as its guiding analytical framework and a novel way to conceptualise the unstable field. Rather than advancing a unified understanding of indeterminacy, we introduce a structured analytical map and provisional taxonomy that distinguishes technological, social, philosophical, legal, and regulatory manifestations of indeterminacy in IDBs. By offering a tentative and necessarily selective map of this fluid and nascent field, we explore how indeterminacy and IDBs intersect. The paper examines how IDBs amplify existing forms of indeterminacy and how indeterminacy itself shapes the development and use of these systems across five domains: technological, social, philosophical, legal, and regulatory.

This response to the letter expands the discussion on the evolving demands of peer review for systematic reviews and meta-analyses. We emphasize that the main concern surrounding artificial intelligence is not its limited and disclosed use for language support, but undisclosed application and insufficient human verification, which may compromise citation accuracy, interpretation, and overall trustworthiness. We also argue that similarity reports should be interpreted contextually, particularly in evidence syntheses where standardized methodological language is unavoidable, and that low similarity does not necessarily exclude manuscript manipulation. Finally, we highlight reference verification as a central research-integrity challenge that should not rest on peer reviewers alone. Preserving the credibility of evidence synthesis requires shared responsibility across authors, reviewers, editors, and publishers.

Wood finger joints are widely used in both structural timber and high-quality furniture due to their ability to create long, continuous members from shorter pieces. The mechanical performance of these joints depends not only on the wood species but also on the geometry of the interlocking teeth and the quality of the adhesive bond. This study explores how the geometry of finger joints affects the tensile behavior and fracture characteristics of beech (Fagus sylvatica L.) and oak (Quercus robur L.). Specimens with varying tooth dimensions were tested using a 50 kN universal testing machine from Shimadzu. Key metrics such as ultimate tensile load, effective cross-sectional area, cohesive stress, energy required to cause failure, and fracture energy (Gc) at 0.5, 1.0, and 2.0 mm displacements were systematically measured. The results revealed that beech specimens achieved ultimate tensile loads up to 21,320 N and cohesive stress of 204 MPa, while oak reached 21,631 N with a cohesive stress of 239 MPa. Fracture energy (Gc) values ranged from 0.036 N/mm for beech to 0.051 N/mm for oak, depending on joint geometry. Results show that both the type of wood and the tooth design, including width and length, play a decisive role in joint performance. In general, longer teeth and larger bonded areas improved tensile capacity and increased resistance to fracture. These findings offer deeper insights into the fracture mechanics of hardwood finger joints and provide practical guidance for optimizing glued connections in furniture and structural timber. The collected data can also support accurate modeling, quality assurance, and numerical simulations in future studies.

Toxicity and harassment are widespread in the video-gaming context. Especially in competitive online multiplayer scenarios, gamers oftentimes send harmful messages to other players (teammates or opponents) whose consequences span from mild annoyance to withdrawal and depression. Abundant prior work tackled these problems, e.g., pointing out the negative effects of toxic interactions. However, few works proposed countermeasures specifically developed and tested on textual messages sent during a match -- i.e., when the"harassment"actually occurs. We posit that such a scarcity stems from the lack of high-quality datasets that can be used to devise"automated"detectors based on natural-language processing (NLP) and machine learning (ML), and which can -- ideally -- mitigate the harm of toxic comments during a gaming session. This work provides a foundation for addressing the problem of toxicity and harassment in video games. First, through a systematic literature review (n=1,039), we provide evidence that only few works proposed ML/NLP-based detectors of toxicity/harassment during live matches. Then, we partner-up with 8 expert League of Legend (LoL) players and create a fine-grained labelled dataset, L2DTnH, containing 1.4k toxic and 13.8k non-toxic messages exchanged during LoL matches. We use L2DTnH to develop a detector that we then empirically show outperforms general-purpose and state-of-the-art toxicity detectors reliant on NLP. To further demonstrate the practicality of our resources, we test our detector on game-related data beyond that included in L2DTnH; and we develop a Web-browser extension that flags toxic content in Webpages -- without querying third-party servers owned by AI companies. We publicly release all of our resources. Our contributions pave the way for more applied research devoted to fighting the spread of toxicity and harassment in video games.

Introduction: Fear of childbirth (FOC) is a common concern during pregnancy that can negatively affect women’s well-being and childbirth experiences. Understanding how different dimensions of FOC relate to one another before and after prenatal interventions may help optimize supportive care. The aim of this study was to examine correlations among specific domains of childbirth fear before and after participation in a prenatal childbirth preparation program. Methods: This prospective longitudinal study included 97 pregnant women with uncomplicated pregnancies who participated in a one-month prenatal childbirth preparation program between November 2024 and February 2025. The intervention consisted of theoretical education and physical exercise sessions, held twice a week. FOC was assessed before and 7 days after the intervention using the Childbirth Fear Questionnaire (CFQ). Spearman correlation coefficients were used to examine relationships among CFQ subscales. Results: Participants had a mean age of 30.5 ± 3.8 years and a mean gestational age of 32.5 ± 3.0 weeks at the time of study entry. Before the intervention, the total CFQ score was most strongly correlated with fear of medical interventions (p = 0.823). After the intervention, the strongest association shifted to fear of pain during vaginal birth (p = 0.859). Conclusion: Following participation in the prenatal childbirth preparation program, the pattern of associations among childbirth fears changed, with fear of medical interventions becoming less dominant and fear of pain during vaginal delivery emerging as a central concern. These findings suggest that prenatal interventions may influence not only the intensity but also the structure of childbirth-related fears, highlighting the importance of addressing multiple fear dimensions simultaneously.

Background Antimicrobial resistance (AMR) is an appreciable public health threat, exacerbated by considerable inappropriate use of antibiotics including for upper respiratory tract infections (URTIs). Whilst there have been high levels of inappropriate prescribing of antibiotics in primary care in South Africa, study findings vary regarding the extent of dispensing of antibiotics without a prescription. Where this occurs, this is typically for patients with urinary tract infections (UTIs) and sexually transmitted infections (STIs). Consequently, there is a need to update knowledge regarding antibiotic dispensing patterns in primary care in South Africa alongside key factors influencing this. The findings can provide future direction to key stakeholders in South Africa grappling with high AMR rates. Methods A previously piloted questionnaire was administered to patients leaving community pharmacies in a rural province using their preferred language. The questionnaire collected data on current antibiotic utilisation patterns alongside their knowledge and attitudes towards AMR. Results 465 patients were interviewed exiting community pharmacies with a medicine. 78.7% of patients who were dispensed antibiotics were dispensed these without a prescription. Perceived STIs were the most common infectious disease where this occurred, with 99.1% of antibiotics issued for this condition dispensed without a prescription. Only 1 out of 116 patients with a perceived STI, received an antibiotic from a prescription issued by an authorized prescriber. The reverse was seen with patients with URTIs where there was very little dispensing of antibiotics without a prescription for these patients. This may be because surveyed patients were prepared to take advice from community pharmacists, who typically offered symptomatic relief to patients with suspected URTIs. This situation contrasts with antibiotics from prescriptions where URTIs were the most common infection where antibiotics were prescribed (59.3%). Questioning patients in their own language enhanced their understanding of key issues. Conclusion There is an urgent need to re-consider community pharmacist activities in South Africa with some countries allowing them to prescribe antibiotics for UTIs. Trained community pharmacists can also potentially engage with patients to help prevent and manage STIs with patients appearing to preferentially seek assistance from community pharmacists for their perceived STIs. Community pharmacists can also potentially work with prescribers to improve their antibiotic use especially for URTIs.

Background/Objectives: Totally endoscopic mitral valve repair reduces surgical trauma and accelerates recovery but can be technically challenging, particularly for precise annuloplasty suturing. The VirtuoSEW® (LSI Solutions, Victor, NY 14564m, USA) automated annular suturing system was developed to standardize and simplify suture placement. This study was an early evaluation of this technology’s safety, efficacy, and feasibility in totally endoscopic microInvasive mitral valve repair (µMVr). Methods: We conducted a retrospective observational study of 20 patients with severe mitral valve disease of various etiologies. All patients underwent mitral valve repair using the VirtuoSEW® system for automated placement of annuloplasty sutures, combined with leaflet resection or chordal management as appropriate. Postoperative outcomes were assessed at one month using echocardiography and clinical evaluation. Perioperative and postoperative complications and early mortality were systematically recorded. Results: VirtuoSEW®-assisted mitral valve repair was safe and effective, achieving complete elimination of severe mitral regurgitation in all patients (N = 20, 100%). Annuloplasty rings included Physio-ring (N = 12, 60%), Memo 3D (N = 4, 20%), and Memo 4D (N = 4, 20%), combined with leaflet repair techniques: leaflet plication (N = 5, 25%), neochordae implantation (N = 7, 35%), sliding plasty (N = 2, 10%), commissural repair (N = 1, 5%), and hemibutterfly repair (N = 1, 5%). Concomitant procedures included: tricuspid valve repair (N = 1, 5%) and atrial septal defect closure (N = 1, 5%). Mitral annulus diameter decreased from 42.0 ± 5.3 mm to 34.2 ± 2.2 mm (p = 0.001). Mean total surgery, cardiopulmonary bypass, and aortic cross-clamp times were 170.3 ± 21.3, 143.4 ± 21.5, and 80.4 ± 7.9 min, respectively. ICU stay was 1.0 ± 0.2 days, with a hospital stay of 8.0 ± 1.9 days. No perioperative complications—including bleeding (N = 0, 0%), stroke (N = 0, 0%), infections (N = 0, 0%), or 30-day mortality (N = 0, 0%)—occurred. Conclusions: µMVR invasive mitral valve repair using the VirtuoSEW® system is safe, effective, and reproducible, as well as compatible with almost all repair techniques, providing complete restoration of valve competence with no early device-related complications. To our knowledge, this is the first clinical study reporting outcomes with this device, supporting its potential to streamline mitral repair and improve procedural efficiency.

We investigate the asymptotic behavior of a proposed ordinary differential equation (ODE) model for Genetic Toggle switches from Gardner et. al. and I. Rajapakse and S. Smale: dxdt=a1+ym−x and dydt=b1+xn−y where a,b,m,n>0 and x(t),y(t)≥0. We also investigate the asymptotic behavior of the Euler discretization of this system: xn+1=a1xn+b11+ynm=f(xn,yn) and yn+1=a2yn+b21+xnn=g(xn,yn), where 1−h=a1, 1−k=a2, ah=b1 and bk=b2, a1,a2∈(0,1) and h,k>0 are steps of discretizations. Here, x and y represent protein concentrations at a particular time in both genes and a,b,m,n>0, respectively, above. We will apply the theory of competitive maps to find the basins of attractions of different equilibrium points and period-two solutions of systems of difference equations.

Cell-Free Massive Multiple-Input Multiple-Output (CF-MaMIMO) in Open Radio Access Network (O-RAN) promises high spectral efficiency but is limited by frequent Channel State Information (CSI) exchanges, which strain fronthaul/midhaul/backhaul (X-haul) bandwidth and exceed the capabilities of existing approaches relying on uncompressed CSI or heavy predictors. To overcome these constraints, we propose LITE, a lightweight pipeline combining a 1-D convolutional Autoencoder (AE) at the O-RAN Distributed Unit (O-DU) with a Squeeze-and-Excitation (SE)-enhanced Bidirectional Long Short-Term Memory (BiLSTM) predictor at the Near-Real-Time RAN Intelligent Controller (Near-RT-RIC), enabling short-horizon trajectory-unaware forecasting under strict transport and processing budgets. LITE applies 50% CSI compression and an asymmetric SE-BiLSTM, reducing model complexity by 83.39% while improving accuracy by 5% relative to a baseline BiLSTM. With compression-aware training, the Lightweight Intelligent Trajectory Estimator (LITE) incurs only 6% accuracy loss versus the BiLSTM baseline, outperforming independent and end-to-end strategies. A TensorRT-optimized implementation achieves 147k Queries per Second (QPS), a 4.6x throughput gain. These results demonstrate that LITE delivers X-haul-efficient, low-latency, and deployment-ready channel-gain prediction compatible with O-RAN splits.

The Tortonese’s stingray (Dasyatis tortonesei Capapé, 1975) is a poorly understood species, likely endemic to the Mediterranean Sea, where its distribution remains inadequately delineated due to historical taxonomic uncertainty and misidentification with its closely related congeners. The present study reports the first well-documented records of D. tortonesei in the Adriatic Sea, based on six specimens collected during systematic field surveys off Vlorë, Albania. All specimens were identified through a comprehensive assessment of diagnostic morphological features, and detailed biometric data are provided. Notably, one individual exhibited a fully healed traumatic loss of both the tail and stinging apparatus, suggesting a degree of resilience to sub-lethal injury. The present findings extend the range of D. tortonesei and establish a valuable baseline for future biodiversity assessments. In addition, this paper underscores the urgent need for integrative taxonomic approaches and regional capacity-building to improve species-level identification and inform effective conservation of Mediterranean elasmobranchs (sharks and rays).

Noise-induced hearing loss (NIHL) occurs as a result of long term exposure to workplace noise. The aim of the study was to identify job positions with an increased risk of hearing impairment due to occupational noise exposure, by analyzing changes in audiometric findings over a six-month period of work under conditions with elevated noise levels. The study included participants exposed to workplace noise and participants working in a quiet environment, employed in the same companies but in different job positions. Audiometric examinations were conducted at baseline and after six months of follow-up. Paired and independent-samples t-tests were applied. A statistically significant difference in hearing loss was found among participants exposed to occupational noise during the six-month period (t = 4.84, df = 35, p < 0.001), while no significant difference was observed among participants working in a quiet environment (t = 1.64, df = 35, p = 0.109). A significant difference was also identified between the noise-exposed group and the control group in mean hearing threshold values at baseline and at the final assessment after six months (t = 4.13, df = 71, p < 0.001). Occupations with an increased risk of the development and progression of hearing impairment were identified. The results confirmed the need for continuous monitoring and implementation of preventive hearing protection measures in high-risk workplaces, including oil refineries, textile and metal industries, the wood-processing sector, and selected service industries.

The fruit of Rosa canina (rosehip) has long been used in traditional medicine, and recent studies confirm its health benefits due to its content of flavonoids, carotenoids, fatty acids, and high vitamin C levels. This study examined three preparations: infusion, ultrasound-assisted extract, and traditional jam. Total phenols were measured using the Folin-Ciocalteu method, and antioxidant activity by the DPPH method. The highest total phenolic content was observed in the infusion of dried fruit (163.477 mg GAE/l), followed by the fruit extract (44.932 mg GAE/l), with the jam extract showing the lowest content (23.477 mg GAE/l). Antioxidant activity was assessed via DPPH inhibition percentage and IC50 values to identify the most effective form of compounds. The findings suggest that infusion of dried rosehip fruit provides the highest antioxidative capacity, highlighting its potential as a functional food ingredient.