Abstract Background Artificial intelligence (AI)–driven clinical decision support (CDS) tools offer promising solutions for health care delivery by optimizing resource allocation, detecting deterioration, and enabling early interventions. However, adoption remains limited due to insufficient validation and a lack of transparency and trust. Explainable AI (XAI) seeks to improve user understanding of AI outputs; however, how clinicians interpret and integrate these explanations into their decision-making remains underexplored. Furthermore, discrepancies in explanations, known as the “disagreement problem,” can undermine trust and, at worst, lead to poor clinical decisions. Objective This study examines clinicians’ perspectives on the role and value of explainability in AI-driven CDS tools within Australian critical care settings and the impact of discrepancies in AI-generated explanations on clinical decision-making. Methods Qualitative data were collected using semistructured interviews with 14 clinical experts, incorporating scenario-based exercises, and were analyzed using inductive thematic analysis. Results Clinicians valued explainability, particularly in complex or unfamiliar situations, when explanations were clear, plausible, and actionable. Trust and perceived usefulness extended beyond explanation quality, encompassing factors such as system accuracy, alignment with clinicians’ reasoning, workflow integration, and perceived reliability. Discrepancies in explanations generated by different XAI methods were not a major concern, provided that the AI-generated predictive alerts were accurate. Conclusions This study provides design recommendations for developing trustworthy, user-centric CDS tools that incorporate XAI. Findings highlight that explainability is critical for establishing initial trust in AI-driven tools by supporting perceived usefulness, but its importance diminishes over time and with user expertise and familiarity, as learned usefulness takes precedence. Recommendations highlight the importance of aligning the design and implementation of AI tools with clinicians’ needs to enhance trust, mitigate risks, and promote successful adoption for improved patient outcomes.

Industry 4.0 marks a new phase of industrial transformation, driven by the integration of advanced technologies such as industrial robotics, the Internet of Things (IoT), artificial intelligence (AI), cloud computing, and cyber‑physical systems (CPS). The Republic of Korea and Singapore are global frontrunners in this domain, ranking first and second worldwide in robot density per 10,000 manufacturing workers. This paper explores how the strategic integration of robotics with key Industry 4.0 technologies contributes to smart manufacturing and enhanced industrial performance. Using a comparative case study approach, the research analyzes national policies, investments in R&D and education, 5G infrastructure, and support for innovation ecosystems that have enabled these countries to develop flexible, automated, and intelligent production systems. Findings indicate that both Korea and Singapore have successfully combined robotics with IoT, big data analytics, and cloud platforms to create efficient and adaptive manufacturing environments. The study emphasizes that robotization alone is not sufficient; its effectiveness depends on alignment with broader digital transformation strategies. Based on longitudinal data from 2013 to 2023, sourced from the International Federation of Robotics (IFR), the OECD, and national innovation agencies, the research highlights how coordinated implementation of Industry 4.0 technologies fosters sustainable and globally competitive manufacturing.

The historical evolution of auditing reflects an increasing complexity in organizational demands, culminating in the emergence of Audit 5.0—an approach that integrates emerging technologies with professional judgment. This study aims to analyze how technological adoption influences risk assessment and materiality determination in financial auditing within a practical, real-world context. The research, qualitative in nature, combines narrative and thematic analysis of the literature, ethnography in a professional setting, and task analysis, developed over four years of experience in a firm of Chartered Accountants. The findings reveal that although digital tools enhance efficiency and accuracy, professional judgment remains essential to ensure the ethics, reliability, and contextualization of audited information. This study contributes to the advancement of understanding regarding the complementarity between technology and the human factor, proposing paths toward more robust and digitally adapted auditing practices.

Water supply and sewage drainage pipes have a critical role to play in the provision of clean water and sanitation, and pipe material selection influences infrastructure life, water quality, and microbial communities. Zinc-containing compounds are highly valued due to their mechanical properties, anticorrosion behavior, and antimicrobial properties. However, the effect of zinc salts, such as zinc sulfate heptahydrate and zinc chloride, on biofilm-forming bacteria, including Escherichia coli and Enterococcus faecalis, is not well established. This study investigates the antibacterial properties of these zinc salts under simulated pipeline conditions using minimum inhibitory concentration assays, biofilm production assays, and antibiotic sensitivity tests. Findings indicate that zinc chloride is more antimicrobial due to its higher solubility and bioavailability of Zn2+ ions. At higher concentrations, zinc salts inhibit the development of a biofilm, whereas sub-inhibitory concentrations enhance the growth of biofilm, suggesting a stress response in bacteria. zinc chloride also enhances antibiotic efficacy against E. coli but induces resistance in E. faecalis. These findings highlight the dual role of zinc salts in preventing biofilm formation and modulating antimicrobial resistance, necessitating further research to optimize material selection for water distribution networks and mitigate biofilm-associated risks in pipeline systems.

Gender diversity and the inclusion of women in leadership roles are increasingly recognized as critical drivers of organizational equity and sustainability, particularly through their influence on workforce diversity, employee development, and fair compensation practices. While these effects are well-documented in developed economies, evidence from transitional contexts remains limited. This study explores the impact of female leadership on the social dimension of Environmental, Social, and Governance (ESG) performance in private sector companies in Bosnia and Herzegovina. Focusing on three key outcome areas—inclusive hiring, investment in employee training, and average employee compensation—it examines whether a higher share of women in decision-making positions correlates with stronger ESG-related practices. Using original data from 131 firms that applied for the 2024 United Nations Development Programme’s SDG Business Pioneers Award, the analysis reveals a positive association between female leadership and all three outcome variables. These findings suggest that gender-inclusive leadership contributes meaningfully to socially responsible business practices, even in transitional economies. By providing empirical insights from Bosnia and Herzegovina, this study adds to the growing body of research on gender and sustainability. It highlights the potential of female leadership as a lever for advancing ESG goals and offers practical implications for policymakers and corporate actors aiming to align business strategy with inclusive and sustainable development.

Abstract Objectives To compare pregnancy prolongation and neonatal outcomes in women with signs of threatened preterm birth (PTB) and intact membranes by administration of low-doses of prednisone for 3 weeks compared to women who received standard protocols of tocolysis and respiratory distress syndrome (RDS) prophylaxis in a pilot randomized controlled trial. Methods We randomized 26 women with signs of threatened PTB and intact membranes between 24 and 34 weeks of gestation to either continued prednisone administration for 3 weeks following the initiation of the standard protocol (intervention group) or standard therapy for threatened PTB (control group). The primary outcome was the gestational length in women with and without using low-doses of prednisone. The secondary outcome included incidence of RDS, intraventricular hemorrhage, necrotizing enterocolitis, the need for mechanical ventilation, and perinatal mortality in newborns from both study groups. Results Participants in the intervention group had significantly longer pregnancy prolongation than the control group (65.38 vs. 40.54 days, p=0.001). Although the difference was not statistically significant (p=0.153), the gestational age at delivery in the intervention group (38.35 weeks) was 10 days longer than in the control group (36.89 weeks). There were no significant differences between the groups in neonatal outcomes. Conclusions The first pilot randomized controlled study on low-dose prednisone in threatened PTB and intact membranes suggests it may prolong pregnancy without adverse neonatal outcomes. Due to the small sample size and single-centre design, these preliminary findings should be interpreted with caution and confirmed in larger, adequately powered trials.

Disorders of gut–brain interaction (DGBI) affect up to 40% of people worldwide and in several studies an association with hypermobility spectrum disorders (HSD) was described. HSD patients frequently report gastrointestinal (GI) symptoms and GI dysmotility has been suggested as underlying mechanism. This study evaluates whether individuals with (undiagnosed) joint hypermobility and/or HSD show different GI symptom and motility patterns compared to those without hypermobility/HSD. In this prospective open-label study, patients who were referred for GI motility assessment between 2016 and 2018 were included. Motility assessments included esophageal manometry, gastric emptying test, antro-duodenal manometry, colonic manometry, and/or a colonic transit study. Joint hypermobility was assessed using the Beighton score, and HSD was diagnosed using the Brighton criteria. Symptom severity, anxiety and depression, and quality of life were evaluated through validated questionnaires. Eighty-seven participants were included (73 women, median age 42.0 years), and categorized into HSD (n = 23) and non-HSD (n = 64), with further subdivision by Beighton cut-off values (≥ 4, and ≥ 6). GI symptom scores were high, with 37% of the total population exhibiting depressive symptoms (HADS ≥ 8), and 32% experiencing anxiety. Quality of life scores were generally low, with a physical composite score of 26.9 (13.2) and a mental composite score of 47.3 (17.1). Across all comparisons, no significant differences in GI symptoms or motility patterns were found between all groups. This exploratory tertiary care study found no distinct GI symptom or dysmotility patterns between patients with and without hypermobility/HSD. Further research is warranted to investigate whether GI dysmotility is related to hypermobility.

Inguinal hernia is a prevalent condition requiring surgical intervention, and accumulating evidence suggests that the type of anesthesia administered may influence systemic inflammatory responses. This study investigates the concentrations of inflammatory parameters in patients with inguinal hernia who underwent surgery utilizing either general or spinal anesthesia. The cohort comprised 87 male patients with inguinal hernia, classified as American Society of Anesthesiologists (ASA) physical status 1-2, who underwent elective surgical procedures. Participants were divided into two groups based on the anesthesia type: 44 received general anesthesia while 43 received spinal anesthesia. Plasma concentrations of leukocytes, C-reactive protein (CRP), interleukin-6 (IL-6), and lipopolysaccharide-binding protein (LBP) were quantified using automated immunoassays and a hematological analyzer. Standard parametric and non-parametric statistical tests were employed for data analysis, and the predictive capacity of select parameters, along with body mass index (BMI) and age, was assessed through Receiver Operating Characteristic (ROC) analysis with Area Under the Curve (AUC). Statistical analysis via the t-test identified significant differences in LBP concentrations (LBP 1, LBP 2, and LBP 3) between patients receiving general and spinal anesthesia. Correlation analysis of BMI and the measured parameters revealed statistically significant positive correlations for LBP 1 and LBP 2 in patients who underwent spinal anesthesia. Notably, the preoperative concentration of LBP, with a cutoff value exceeding 9.7 µg/mL, suggests a potentially superior approach with spinal anesthesia compared to general anesthesia, demonstrating 50% sensitivity and 81.4% specificity. Other parameters did not exhibit statistical significance in differentiating the type of anesthesia used for inguinal hernia surgery.

Surface modification of biomaterials, particularly by adding bioactive coatings, enhances cell-material interactions at the nanoscale, improving implant performance at the macroscale. One approach involves gene delivery via surface-bound coatings, allowing for controlled local release of viral particles. However, viral gene delivery systems, such as lentiviral vectors, face challenges in precision targeting and transduction efficiency. To address these, a bio-orthogonal coating was developed and used on titanium using chemical vapor deposition (CVD) polymerization. Co-presenting a cell binding peptide and immobilized lentiviral particles on the surface of Ti increased gene delivery efficiency by directing cells to the surface, making them easier to transduce. Specifically, a poly[(4-(3,4dibromomaleimide)-p-xylylene)-co-(4-pentafluorophenol ester-p-xylylene)] coating was prepared using CVD polymerization on Ti discs as a bio-orthogonal layer to tether lentiviral particles delivering GJA1, the gene for the gap junction protein Connexin 43 (Cx43) and the mesenchymal stem cell (MSC) binding peptide, DPIYALSWSGMA. The polymer coating exhibited high binding efficiency for both lentivirus and peptide, allowing for precise microcontact printing. Immobilized lentiviral transduction efficiency matched that in supernatant, with co-delivery increasing transduction efficiency by 35%. The biorthogonal coating boosted MSC binding 2.7-fold, leading to a density-dependent rise in cell–cell communication. High-density seeding enabled gap junction formation, while Cx43 transduction increased intercellular communication by 36%. In low-density culture, transduction led to an 84% increase in cell–cell communication within 4 h of in vitro culture. This work presents a simple, repeatable surface modification method for biomolecular immobilization, combining engineered viral vectors and peptides to enhance gene delivery approaches.

Background and Objectives While MRI is known to be crucial for TIA workup, the benefit of perfusion-weighted imaging (PWI) is underexplored. We aimed to assess the association between focal hypoperfusion on baseline PWI MRI and the long-term incidence of subsequent acute ischemic stroke (AIS) after TIA. Methods Consecutive patients with TIA who underwent baseline PWI MRI as part of their emergency consultation between January 2015 and December 2019 were retrospectively identified. For study inclusion, both a time-based (symptom duration <24 hours) and an imaging-based (no signs of ischemia on diffusion-weighted imaging) TIA definition were applied. Long-term incidences of AIS after TIA were identified based on follow-up reports. Associations between focal hypoperfusion and subsequent AIS were assessed using Cox regression models adjusted for predefined predictors of stroke occurrence including symptomatic extracranial or intracranial stenosis. In subgroup analyses, we aimed to determine effects of focal hypoperfusion within vs outside the expected TIA territory, defined as a brain region potentially correlating with TIA symptoms. Results Of 1,359 eligible patients with TIA, 1,075 with PWI MRI (79%) were included (median age 70 years, 46% female). Focal hypoperfusion was identified in 211 patients (20%); in 116 of 211 (55%), hypoperfusion occurred within the expected TIA territory. The median time from symptom onset to imaging was 233 minutes (interquartile range [IQR] 131–632) for patients with focal hypoperfusion vs 229 minutes [IQR 140–441] for patients without (p = 0.42). Focal hypoperfusion was associated with a higher incidence of AIS (adjusted hazard ratio [aHR] 2.13; 95% CI 1.19–3.80). While this was observed for focal hypoperfusion within the expected TIA territory (aHR 3.95; 95% CI 2.05–7.60), there was no such association in case of focal hypoperfusion outside the expected TIA territory (aHR 0.72; 95% CI 0.25–2.03). Discussion Focal hypoperfusion on acute PWI MRI was found in 1 in 5 patients with TIA. It was associated with a higher incidence of AIS during long-term follow-up, especially when within the expected TIA territory. Further research is needed to clarify the predictive value of focal hypoperfusion in relation to the incidence of AIS after TIA and to explore potential therapeutic implications.

The future circular e+e− collider (FCC-ee or CEPC) will provide unprecedented sensitivity to indirect new physics signals emerging as small deviations from the Standard Model predictions in electroweak precision tests. Assuming new physics scenarios containing a dark matter candidate and a t-channel mediator, we analyse the synergy and interplay of future Tera-Z factories and non-collider tests conducted through direct and indirect searches of dark matter. Our results highlight the excellent prospect for a Tera-Z run to indirectly probe the presence and nature of dark matter.

This article examines the integration challenges faced by foreign workers in Bosnia and Herzegovina, based on qualitative data from 16 workers across various professions. It addresses how these workers perceive integration policies and the legal, bureaucratic, social, and cultural barriers they encounter. With a significant outflow of skilled labor from Bosnia, foreign workers play a crucial role in filling the workforce gaps. The European Migration Network predicts a need for 45 million qualified workers in Western Europe, including Bosnia, by 2030, prompting a high emigration rate from the Western Balkans, which, in turn, will increase the demand for foreign labor. This will, in turn, make it more complex for BiH to fulfill its commitment to the Agenda 2030, as set forth by the United Nations in 2015, through the 17 Sustainable Development Goals (SDGs). A low birth rate contributes to the increasing need to increase the labor force, which may ultimately result in social engineering. Although the number of foreign workers in Bosnia has increased, they experience limited access to integration programs and face social isolation and administrative hurdles, which this article analyzes and aims to emphasize better integration policies. Future studies can explore the social acceptance of foreign workers by the locals in Bosnia.

Introduction With their remarkable flight capabilities, wild and captive birds play a pivotal role in the global dissemination of zoonotic pathogens including Chlamydia psittaci, Avian Influenza viruses (AIV), Chikungunya virus (CHIKV), Usutu virus (USUV), and West Nile virus (WNV). They function both as hosts and reservoirs responsible for transporting the mentioned infectious agents across vast geographic regions. Additionally, captive birds and birds inhabiting urban environments, particularly in tourist destinations, present significant public health concerns due to facilitated close interactions with humans. Methods A total of 358 samples originating from fifteen bird species were collected across 21 locations in Sarajevo Canton, over three consecutive years (2022–2024). Upon collection, the samples were subjected to molecular analysis to detect the presence of zoonotic pathogens. For detection of Chlamydia spp., and C. psittaci, real-time PCRs (qPCR) were used following established protocols. Additionally, reverse transcriptase real-time PCR (RT-qPCR) were utilized for the detection of emergent viral pathogens including avian influenza viruses, Chikungunya, Usutu, and West Nile virus. Results Chlamydia spp. was detected in 29.9% (95% CI: 25.2–34.9) of samples. Further, C. psittaci was identified in 10.3% (95% CI: 5.2–17.7) of positive samples originating from captive birds and birds inhabiting urban environments. One sample (0.3%) originating from a wild bird was positive to West Nile Virus. None of the samples tested positive for Avian Influenza viruses, Chikungunya and Usutu virus. Discussion The identification of C. psittaci and West Nile virus highlights the increased likelihood of zoonotic transmission. This underscores the imperative for bolstered biosecurity measures and public health strategies aimed at mitigating the risk associated with both environmental exposure and direct contact, especially in areas characterized by substantial tourist activity.

BACKGROUND AND OBJECTIVES Diffusion-weighted imaging (DWI) lesions in patients with intracerebral hemorrhage (ICH) are associated with poor outcomes. Knowledge about the underlying pathophysiology is scarce, and it is hypothesized that they are related to either the ICH itself, adverse effects of treatment, or the activity of the underlying small vessel disease (SVD) causing the ICH. We investigated their association with time point of MRI acquisition and underlying SVD type and burden. METHODS In this Swiss multicenter ICH cohort, we enrolled patients who underwent MRI within 15 days after SVD-associated ICH. The primary outcome was presence of DWI lesions. Time point of MRI was investigated as a continuous (days) and dichotomized (hyperacute = MRI on admission vs subacute = MRI during follow-up) variable. We measured cerebral amyloid angiopathy (CAA) and SVD severity using MRI burden scores and defined the type of SVD using CADMUS classification and Boston 2.0 criteria. At 3 months, we assessed functional outcome using the modified Rankin Scale score, recurrent ICH, and ischemic stroke. RESULTS We included 644 patients (median age 73 years, interquartile range [IQR] 64-79, median SVD burden 1 IQR 1-2; median CAA burden 2 IQR 1-3; 208 patients/32.3% with Boston 2.0 CAA, 431 patients/66.9% with mixed CAA-DPA phenotype according to CADMUS). Among enrolled patients, 16.0% underwent hyperacute MRI and 84.0% underwent subacute MRI (median on day 2 IQR 1-5), and 166 patients (25.8%) had DWI lesions (18.4% with hyperacute MRI vs 27.2% with subacute MRI). We observed no association of presence of DWI lesions with hyperacute MRI (adjusted odds ratio [aOR] 0.61, 95% CI 0.36-1.00, p = 0.073) but with time to MRI in days (aOR 1.07, 95% CI 1.00-1.13, p = 0.007). Higher SVD (aOR 1.33, 95% CI 1.12-1.59, p = 0.001) and CAA (aOR 1.29, 95% CI 1.15-1.44, p < 0.001) burdens were associated with presence of DWI lesions. There was no association between type of SVD (CADMUS) or CAA (Boston criteria) and DWI lesions. There was no association between DWI lesions and functional outcome, recurrent ICH or ischemic stroke at 3 months. DISCUSSION DWI lesions in patients with ICH are already common at baseline. Their prevalence is higher with a longer time since symptom onset and with higher SVD burden. Overall, these findings suggest a relation with the underlying condition resulting in ICH. The significant number of DWI lesions visible on admission MRI might diminish their use as surrogate outcome in future trials in ICH.