In the Croatian apple germplasm, there are, presumably, unique genotypes that have not yet been documented in reference molecular databases. Due to similarities between accessions, incorrect names are often used, which creates a problem in the identification of accessions. Overall, 169 apple accessions and 11 reference cultivars from the largest ex situ apple collection in the Republic of Croatia were investigated within this study. The examined accessions have been genotyped using SSR markers. In order to assess the advantage of a high-resolution marker system, such as SNPs, compared to low-resolution markers, such as SSRs, a subset of 23 unique apple accessions and eight reference cultivars were genotyped using the 480K Affymetrix Axiom SNP array. Results obtained through the use of two marker systems revealed 26 synonyms, 40 duplicates, 13 mislabeling accessions, 45 accessions with confirmed identity (known cultivars), and 45 unique accessions, as well as the true identity of a large number of accessions, currently maintained at the Croatian National Apple Germplasm Bank. In order to investigate the pomological variability of unique apples, a three-year study was carried out on eleven pomological traits. The researched germplasm shows an exceptional diversity of pomological properties. Many of the accessions can be considered unique, and the results of the pomological characterization indicated that this germplasm contains valuable traits of interest for future breeding programs.

A novel method for solving the multiple-attribute decision-making problem is proposed using the complex Diophantine interval-valued Pythagorean normal set (CDIVPNS). This study aims to discuss aggregating operations and how they are interpreted. We discuss the concept of CDIVPN weighted averaging (CDIVPNWA), CDIVPN weighted geometric (CDIVPNWG), generalized CDIVPN weighted averaging (CGDIVPNWA) and generalized CGDIVPN weighted geometric (CGDIVPNWG). This study aimed to examine several aggregation operators using complex Diophantine interval-valued Pythagorean normal sets. We calculated the weighted average and geometric distance based on an aggregating model. We demonstrate that complex Diophantine interval-valued Pythagorean normal sets satisfy algebraic structures such as associative, distributive, idempotent, bounded, commutative and monotonic properties. In this study, we discuss the mathematical properties of the score and accuracy values. We provide an example of how enhanced score and accuracy values are used in the real world. Machine tool technology and computer science play essential roles in robots. To evaluate robotic systems, four factors must be considered such as tasks, precision, speed and completion of the work. Consequently, it is evident that the models are significantly influenced by the natural number \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\nabla$$\end{document}. To further demonstrate the effectiveness of the suggested approach, flowchart based multi-criteria decision-making is provided and applied to a numerical example. Additionally, a comparative study has been carried out to demonstrate the better results that the proposed approach provides when compared to current approaches.

Background: There are limited therapeutic options in cases of failed reperfusion (modified thrombolysis in cerebral infarction [mTICI] score < 2b) after stent-retriever and/or aspiration based endovascular treatment (EVT) for acute ischemic stroke. Despite the absence of data supporting its use, rescue therapy (balloon angioplasty and/or stent implantation) is often utilized in such cases. Studies are limited to large vessel occlusions, while the outcomes and complications after rescue therapy in medium/distal vessel occlusions (MDVOs) have not been reported. This study aims to report the outcomes of rescue therapy in MDVO stroke patients. Methods: We performed an analysis of the “Blood pressure and Antiplatelet medication management after reScue angioplasty after failed Endovascular treatment in Large and distal vessel occlusions with probable IntraCranial Atherosclerotic Disease” (BASEL ICAD) retrospective registry. All MDVO stroke patients were included in the analysis. Results: Out of the 718 registry patients, 87 (12.1%) presented with an MDVO. Fifty-six patients (64.4%) showed an occlusion of the M2 segment of the middle cerebral artery. Rescue stenting was performed in 78 patients (89.7%) while balloon angioplasty alone was performed in 9 patients (10.3%). Successful reperfusion (mTICI score ⩾ 2b) was achieved in 73 (83.9%) patients after rescue therapy. Symptomatic intracranial hemorrhage (sICH) occurred in 8 patients (9.2%) and post-treatment stent occlusion in 12 patients (13.8%). Ninety days mortality was 20.7%. Twenty-eight patients (32.2%) achieved functional independence at 90 days (modified Rankin Scale 0–2). Conclusion: Rescue therapy with stenting and/or balloon angioplasty in patients undergoing EVT for isolated MDVO with suspected underlying intracranial atherosclerotic disease is an effective reperfusion strategy but is associated with complications and poor functional outcomes.

The natural progression of bioprosthetic valve degeneration over time requires further interventions for those experiencing symptomatic prosthesis dysfunction. Transcatheter aortic valve replacement (TAVR) emerges as a promising therapeutic option to alleviate symptoms in such patients. The valve-in-valve (ViV) technique eliminates the necessity for repetitive open-heart surgical procedures, offering particular advantages for individuals with higher surgical risks. In this report, we describe the case of a 78-year-old female patient presenting with severe symptomatic aortic restenosis of a biological aortic valve implanted 5 years prior. Given the patient’s high surgical risk, a transcatheter ViV implantation was chosen as the treatment approach. Utilizing a balloon-expandable valve, the intervention resulted in the successful implantation of a functional TAVR, resulting in symptom relief and enabling a fast discharge from the hospital.

To ensure food security amid dwindling natural resources, alternative proteins (APs) have been suggested as a sustainable solution. Yet, the adoption and consumption of APs remain limited. This review aims to delve into the latest progress (following PRISMA guidelines) concerning the utilization of proteins from alternative sources, particularly focusing on their effective incorporation into food products. Our findings reveal that insect proteins can improve amino acid profiles in bakery products. However, consumer acceptance remains low due to cultural biases, with optimal sensory results being achieved at lower substitution levels (5–10%). Mushroom proteins, when incorporated into meat analogs and bakery items, enhance nutritional value and offer favorable sensory properties, making them viable replacements in meat products. Plant-based proteins, such as pea and soy proteins, increase fiber and antioxidants and improve texture in meat alternatives, although formulation adjustments are necessary to meet consumer expectations for taste and overall experience. Microalgae offer unique benefits for bakery, confectionery, and dairy products by boosting protein, fatty acids, and probiotic growth while maintaining sensory acceptability. In conclusion, this study highlights that the effective incorporation of APs into food products can help in the development of healthier, more sustainable diets. That said, the success of AP acceptance will depend on continued innovations in formulation and consumer education.

This study evaluated Maltodextrin (MD), Gum Arabic (GA), and Carboxymethylcellulose (CMC) in different ratios as coating materials to encapsulate citrus pomace phenolic compounds. Citrus encapsulates were obtained by ultrasound-assisted extraction followed by the freeze-drying process and were characterized regarding the microencapsulation efficiency, physical, and chemical properties. Carrier material choice reflected a significant effect on encapsulation efficiency, phenolic compounds retention, and reconstitution properties of encapsulated extract. The encapsulation efficiency of prepared encapsulates ranked from 50.909% to 84.000%, and it was strongly dependent upon CMC addition. A wide range of reconstitution parameters (water absorption index-WAI and water solubility index-WSI) suggested possible release mechanism modifications. HPLC analysis revealed the presence of three main phenolic compounds, namely Hesperidin, Naringin, and Rutin. A wall material mixture of MD, GA, and CMC in the same proportions was optimal for freeze-drying. This combination resulted in encapsulates with a low moisture content (1.936 ± 0.012%) and a low water activity (0.110 ± 0.001), indicating prolonged stability. Based on the obtained results, freeze-drying as an encapsulation technique should be considered as a promising solution to recover compounds from industry byproducts and protect them from environmental and gastrointestinal circumstances.

In this study, the effect of ammunition on soil quality (physical and chemical indicators) at shooting ranges was investigated at four sites in Croatia. The sites differ in soil type (fluvisols, leptosols and terra rossa) and climatic conditions (Mediterranean and continental). The intensity of shooting range use (calculated from the age of the lane and the average number of targets used per year) and the distance from the shooting range (−40 m to +240 m) were examined in relation to soil chemical composition and soil quality. High contents of Pb and Sb at 100 m from the shooting position were observed in fluvisol and terra rossa soils, and the contamination factors (CFs) ranged from 6 up to 97. The study found high natural soil Cr and Ni content in leptosols and terra rossa due to paedogenic reasons (CFs < 1.3) and soil acidification (a decrease in soil pHKCl) due to ammunition/target use. Long-term measures for sustainable soil management and environment protection must be taken at shooting ranges to minimise the potential risks to ecosystems, wildlife and human health (an EU strategy).

Importance Rapid digitalization of health care and a dearth of digital health education for medical students and junior physicians worldwide means there is an imperative for more training in this dynamic and evolving field. Objective To develop an evidence-informed, consensus-guided, adaptable digital health competencies framework for the design and development of digital health curricula in medical institutions globally. Evidence Review A core group was assembled to oversee the development of the Digital Health Competencies in Medical Education (DECODE) framework. First, an initial list was created based on findings from a scoping review and expert consultations. A multidisciplinary and geographically diverse panel of 211 experts from 79 countries and territories was convened for a 2-round, modified Delphi survey conducted between December 2022 and July 2023, with an a priori consensus level of 70%. The framework structure, wordings, and learning outcomes with marginal percentage of agreement were discussed and determined in a consensus meeting organized on September 8, 2023, and subsequent postmeeting qualitative feedback. In total, 211 experts participated in round 1, 149 participated in round 2, 12 participated in the consensus meeting, and 58 participated in postmeeting feedback. Findings The DECODE framework uses 3 main terminologies: domain, competency, and learning outcome. Competencies were grouped into 4 domains: professionalism in digital health, patient and population digital health, health information systems, and health data science. Each competency is accompanied by a set of learning outcomes that are either mandatory or discretionary. The final framework comprises 4 domains, 19 competencies, and 33 mandatory and 145 discretionary learning outcomes, with descriptions for each domain and competency. Six highlighted areas of considerations for medical educators are the variations in nomenclature, the distinctiveness of digital health, the concept of digital health literacy, curriculum space and implementation, the inclusion of discretionary learning outcomes, and socioeconomic inequities in digital health education. Conclusions and Relevance This evidence-informed and consensus-guided framework will play an important role in enabling medical institutions to better prepare future physicians for the ongoing digital transformation in health care. Medical schools are encouraged to adopt and adapt this framework to align with their needs, resources, and circumstances.

Environmental negotiations are complex, and conveying the interaction between science and policy in traditional teaching methods is challenging. To address this issue, innovative educational approaches like serious gaming and role-playing games have emerged. These methods allow students to actively explore the roles of different stakeholders in environmental decision-making and weigh for instance between sometimes conflicting UN Sustainable Development Goals or other dilemmas. In this work the phosphorus negotiation game (P-Game) is for the first time introduced. We present the initial quantitative and qualitative findings derived from engaging 788 students at various academic levels (Bachelor, Master, PhD, and Postdoc) across three continents and spanning 22 different countries. Quantitative results indicate that female participants and MSc students benefitted the most significantly from the P-Game, with their self-reported knowledge about phosphorus science and negotiation science/practice increasing by 71–93% (overall), 86–100% (females), and 73–106% (MSc students in general). Qualitative findings reveal that the P-Game can be smoothly conducted with students from diverse educational and cultural backgrounds. Moreover, students highly value their participation in the P-Game, which can be completed in just 2–3 h. This game not only encourages active engagement among participants but also provides valuable insights into the complex environmental issues associated with global phosphorus production. We strongly believe that the underlying methodology described here could also be used for other topics.

Hypermobility spectrum disorders (HSD) and hypermobility Ehlers–Danlos syndrome (hEDS) are frequently associated with gastrointestinal symptoms, although the underlying mechanisms remain unclear. This study aimed to compare antroduodenal motility in patients with and without HSD/hEDS. We included 239 patients (50 HSD/hEDS and 189 non‐HSD/hEDS) with gastrointestinal symptoms undergoing antroduodenal manometry (ADM). The prevalence of antroduodenal dysmotility was not different between both groups, but enteric dysmotility was less common in the HSD/hEDS group (13% vs. 34%, p = 0.006). Delayed gastric emptying rates were similar, suggesting that delayed gastric emptying is more relevant for patients with HSD/hEDS and gastrointestinal symptoms.

AIM To investigate immigrant women's experiences of childbirth in Swedish maternity care. METHODS A systematic search was conducted in PubMed, Embase, CINAHL, and Web of Science for qualitative and quantitative literature on immigrant women's experiences with Swedish maternity care. An inductive thematic analysis generated themes and subthemes. RESULTS Sixteen studies were included in this research. The three main themes were access to healthcare, professional treatment, and feeling significant in care. Key findings revealed that immigrant women struggled with trauma, difficult interactions with midwives, communication issues, interpreter problems, lack of detailed information, the role of doulas, and future concerns. CONCLUSION Immigrant women's experiences of Swedish maternity care were marked by information gaps, ignorance, and disrespect, leading to mistrust and delayed help-seeking. Language barriers with midwives caused misunderstandings. A sense of belonging to Swedish society was crucial for a positive experience. More qualitative research, education in transcultural care, and training in interpreter use are needed to improve maternity care for foreign women.

The best maintenance therapy after a steroid-responsive acute severe ulcerative colitis (ASUC) episode remains poorly studied and is not addressed in current guidelines. We aimed to compare the impact of different treatment strategies following hospitalization for steroid-responsive ASUC. Multicentric, multinational, retrospective cohort study including patients hospitalized with ASUC, between 2010-2021, who responded to intravenous steroids (Oxford Criteria). Patients were categorized according to treatment instituted after discharge - 5ASA, immunomodulators (IMM) and advanced therapy (AT). AT was considered as the reference for comparison. Our primary outcome was a composite of time until disease progression (need for steroids, need for therapy change, new hospitalization or colectomy); secondary outcomes were each event analyzed separately. Survival analysis and multivariate cox regression were performed. 271 steroid-responsive patients from 19 countries were included; median-age at diagnosis was 33 (IQR 25-48) years, 49% were male, 49% had extensive colitis at diagnosis; median disease duration was 26 (IQR 3.0-92.3) months. Following hospitalization for steroid responsive ASUC, 34% of patients received 5-ASA as a maintenance therapy, 23% IMM and 43% AT. During a median follow up of 59 months (IQR 38-92), 68% had disease progression: new course of steroids was needed in 40%, therapy change in 54%, new hospitalization in 33% and colectomy in 10%. In univariate analysis, patients treated with 5-ASA had a trend towards earlier disease progression, compared to AT (HR 1.37, CI 95% 0.99-1.91, p=0.06), earlier need for steroids (HR 1.70, CI 95% 1.11-2.59, p=0.014) and therapy change (HR 1.68, CI 95% 1.15-2.43, p=0.007). In multivariate analysis, adjusting for age and disease extension at diagnosis, disease duration, use of AT prior to ASUC hospitalization, and period of hospitalization (2010-2015 vs 2016-2021), patients treated with 5-ASA had a higher risk of disease progression compared to both IMM (HR 1.50, CI 95% 1.02-2.21, p=0.041) and AT (HR 1.86, CI 95% 1.26-2.74, p=0.002) – Figure 1. No differences were seen between IMM and AT in uni- and multivariate analysis. Shorter disease duration (HR 0.99, CI 95% 0.99-0.99, p=0.007), and prior use of AT (HR 1.67, CI 95% 1.13-2.47, p=0.010) were also associated with higher risk of disease progression – Table 1. After an episode of steroid-responsive ASUC, shorter disease duration and prior use of advanced therapy were risk factors for disease progression. Approximately 1/3 of patients was treated with 5ASA alone. This strategy was also associated with a higher risk of poor outcomes and should be avoided.

AIM The position of science and scientific research in Bosnia and Herzegovina (B&H) is unfavourable. University education lacks research programs, hindering students from developing critical evaluation skills. METHODS This cross-sectional study examined knowledge, attitudes, experience and perceived barriers towards scientific research among biomedical students and recent graduates at the University of Sarajevo in B&H. A self-reporting questionnaire was distributed via social networks and among students from all years of the Medical, Dentistry, Pharmaceutical faculties, the Faculty of Health Sciences, and the Faculty of Science, as well as recent graduates. RESULTS The survey was completed by 243 participants. The mean knowledge score of 4.3/11 was noticed; 216 (96%) believed research was necessary for healthcare improvement. Although 147 participants (65.3%) attended courses on research methodology, only 63 (28%) engaged in scientific research at their faculties. Only 5 (8.5%) employed graduates participated in research at their jobs. Almost half, 99 (44%) participants consulted scientific papers only upon recommendation. The majority of participants, 199 (82.2%), reported they experienced barriers to conducting research in B&H. CONCLUSION Biomedical students and graduates demonstrated limited research knowledge, but had positive attitudes and acknowledged significant barriers. Improved faculty curricula in research areas and more opportunities are needed.

AIM Lung ultrasound (LUS) can be used for an assessment of volume overload in patients with end-stage kidney disease (ESKD) and those undergoing dialysis. The aim of this study was to analyse whether the initial use of LUS in evaluating volume status could benefit patients by optimizing haemodialysis treatment and improving their clinical status. METHODS The study included 50 haemodialysis patients in stage V of ESKD with the diagnosis of ischaemic heart failure with reduced (HFrEF) or midrange ejection fraction (HFmrEF). The assessment of volume status was verified solely by LUS (along with the analysis of B lines as measures of volume status). The specified laboratory parameters were performed initially, after three, and after six months. RESULTS The number of B-lines on LUS were decreased during the six-month follow-up compared to baseline, indicating a reduction in volume overload due to the LUS-guided protocol. Statistically significant differences were observed in the average creatinine (p=0.001) and parathormone (PTH) (p=0.003) levels over the six-month monitoring period. Significant differences were also noted in triglyceride (p=0.000) and potassium (p=0.02) levels. No significant differences were found in the values of other monitored parameters. CONCLUSION In haemodialysis patients diagnosed with heart failure, LUS can aid the achievement of a more efficient volume reduction by decreasing B-lines, which are indicative of congestion. Our study also demonstrated beneficial effects of LUS on potassium and parathormone levels.