This study explores an innovative method to enhance Directed Energy Deposition (DED) of aluminum 5356 products by integrating an electromagnetic vibration system into the DED setup. The application of vibrations significantly improved surface quality, reducing surface waviness and increasing building efficiency by 14%, from 78.5% to 92.25%.Gas porosity was reduced from 1.5 ± 0.04% in as-built (AB) components to 0.34 ± 0.07% in vibration-assisted (VA) parts. Tensile tests showed a marked reduction in anisotropy, with the tensile strength deviation between the x and z directions decreasing to less than 0.4% for vibration-assisted samples, compared to 7.9% for asbuilt ones. Additionally, secondary phase analysis revealed a homogenization effect, with magnesium- and iron-rich precipitates displaying a finer dispersion (3.57 ± 3.42 µm²) compared to 11.28 ± 12.49 µm² in as-built parts. Overall, the findings highlight the potential of vibration-assisted DED to improve part properties, reduce defects, and advance the DED manufacturing process.

Executive functions (EF) have been significantly correlated with many important participant characteristics, including education, behavior, and overall health. Assessing EF in children is particularly important, as doing so can help clinicians develop programs for EF remediation. However, there is a limited understanding of comprehensive performance-based EF assessment tools for children. Our goal in the present paper was to conduct a Confirmatory Factor Analysis (CFA) of the Yellow-Red test, a performance-based EF measure, in a Bosnian sample of early elementary school students. Specifically, our participants were 180 children aged 8–11 years (M age = 9.6 years, SD = 1), including 83 girls and 97 boys. The CFA showed that the data fit well with both a unidimensional model (global EF) and a two-dimensional EF model, comprised of (i) working memory and (ii) inhibition plus cognitive flexibility. A comparison of these two models showed that the two-factor model was a statistically better fit to this sample’s performance than the unidimensional model. These results suggest that EF in this age group can be viewed as both a single construct and a multi-factor construct (with at least two-factors). The Yellow-Red Test, with its engaging and cross-cultural research base, is a useful instrument for detecting EF dysfunction, and it can provide valuable insights for informing tailored interventions.

Abstract Mental health is deteriorating quickly and significantly globally post-COVID. Though there were already over 1 billion people living with mental disorders pre-pandemic, in the first year of COVID-19 alone, the prevalence of anxiety and depression soared by 25% worldwide. In light of the chronic shortages of mental health provider and resources, along with disruptions of available health services caused by the pandemic and COVID-related restrictions, technology is widely believed to hold the key to addressing rising mental health crises. However, hurdles such as fragmented and often suboptimal patient protection measures substantially undermine technology’s potential to address the global mental health crises effectively, reliably, and at scale. To shed light on these issues, this paper aims to discuss the post-pandemic challenges and opportunities the global community could leverage to improve society’s mental health en masse.

Hydropower is the world's most exploited renewable energy source. It provides a substantial, flexible, and reliable source of renewable energy, complementing other renewables like solar and wind power. Besides conventional hydropower potentials and technologies, the development of technologies for the exploitation of hidden hydropower potentials is an ongoing process. This paper presents the current state of hidden hydropower technologies and links them with possible applications in different hydropower potentials. Technologies and potential applications are structured within three main groups (pressurized systems, hydro storage, unpressurized systems), with their mutual interconnections analysed and displayed throughout the paper. The opportunity for the application of hidden hydropower technologies in different roles within the energy system is recognized through the concepts of off- and on-grid roles, the prosumer concept, and on-site measurement powering. This paper shows that hidden hydropower technologies could emerge as significant contributors to a smoother energy transition, especially with the prosumer and off-grid concepts.

BACKGROUND The childhood immunization coverage in Serbian communities in Kosovo after the 1999 armed conflict has not been investigated. The study purpose was to evaluate the trend of immunization coverage with vaccines from the national childhood immunization program in Serbian communities in Kosovo and Metohija from 2003 to 2022. METHODS Data were retrieved from the annual reports of the Public Health Institute of Kosovska Mitrovica received through notifications from the primary health centers where vaccines are being administered. Data were analyzed using the linear regression and join-point regression models. RESULTS In the examined period, a significant decrease in vaccination coverage was observed for the following diseases: diphtheria, tetanus and pertussis (DTP), polio, as well as measles, mumps and rubella vaccines (MMR), then, the first revaccination for DTP and polio, the second revaccination against diphtheria and tetanus for children (DT) and polio, and the third revaccination against diphtheria and tetanus for adults (dT), as well as the second dose of the MMR vaccine. During the COVID-19 pandemic, a significant decrease in coverage was observed for primary vaccination against: DTP, polio and hepatitis B, first and second doses of the MMR vaccine, as well as the first and second revaccination for DTP and polio, and the third revaccination for dT. CONCLUSION A decline in coverage with DTP, MMR, polio and hepatitis B vaccines was observed between 2003 and 2022. This was even more pronounced during the COVID-19 pandemic. Further research on individual-level factors contributing to lower vaccination coverage is warranted.

Background and Objectives: This study primarily aims to evaluate the preoperative staging effectiveness of PET-CT in early-stage cervical cancer, particularly, its ability to detect primary tumors and micrometastases. Materials and Methods: In this retrospective study, cervical cancer patients who had undergone preoperative 18F FDG PET-CT scans and were treated at the Department of Gynecology, Institute of Oncology, Vojvodina, in Sremska Kamenica, during the period from 2016 to 2020 were analyzed. Results: The study included 62 patients (mean age, 49.3 ± 9.6 years). Squamous cell carcinoma was the predominant histological type (95.2%), with G2 differentiation (82.3%) and FIGO stage Ib1 (80.6%) being the most common. Assessed by 18F FDG PET-CT, the mean tumor size was 26.4 ± 10.8 mm, which is slightly lower than the 26.9 mm measured during clinical examination (p = 0.784), with a significant (r = 0.678, p < 0.001) correlation between these methods. 18F FDG PET-CT demonstrated an overall accuracy of 88.7% for identifying primary tumors, with a sensitivity of 86.8%, specificity of 100.0%, PPV of 100.0%, and NPV of 56.2%. An intraoperative examination showed identical overall accuracy but higher sensitivity (98.1%) and lower specificity (33.3%). For 18F FDG PET-CT, the level of agreement with the histopathological examination was good (Kappa 0.656), while for the intraoperative examination, it was moderate (Kappa 0.409). Regarding the lymph node assessment, 18F FDG PET-CT’s accuracy was 82.2%, with a sensitivity of 53.8% and a specificity of 89.8%. The intraoperative examination showed lower accuracy (66.1%) but higher sensitivity (76.9%). The 18F FDG PET-CT Kappa value indicated moderate agreement (0.449), while the intraoperative examination showed poor agreement (0.282). Conclusions: In conclusion, significant effectiveness is shown by 18F FDG PET-CT for preoperative staging of early-stage cervical cancer, offering superior accuracy in detecting primary tumors and micrometastases, particularly in predicting lymph node metastases, thereby enhancing diagnostic accuracy and informing treatment decisions.

BACKGROUND CONTEXT Spondylodiscitis management presents significant clinical challenges, particularly in critically ill patients, where the risks and benefits of surgical intervention must be carefully balanced. The optimal timing of surgery in this context remains a subject of debate. PURPOSE This study aims to evaluate the effectiveness of early surgery versus delayed surgery or conservative management in critically ill patients with de novo pyogenic spondylodiscitis. STUDY DESIGN/SETTING This is an international, multicenter retrospective cohort study involving 24 centers, primarily in Europe. PATIENT SAMPLE The study included 192 critically ill patients (65.63% male) with a median age of 69 years, all severely affected by pyogenic spondylodiscitis characterized by an initial CRP level >200 mg/l or the presence of two out of four Systemic Inflammatory Response Syndrome criteria upon admission. OUTCOME MEASURES The primary outcome was 30-day mortality. Secondary outcomes included length of ICU stay, length of hospital stay, and relapse rates of spondylodiscitis. METHODS Patients were divided into three groups: early surgery (within three days of admission), delayed surgery (after three days of admission), and conservative therapy. Propensity score matching and multivariate regression analyses were performed to adjust for baseline differences and assess the impact of treatment modalities on mortality and other clinical outcomes. RESULTS Delayed surgery was associated with significantly lower 30-day mortality (4.05%) compared to early surgery (27.85%) and conservative therapy (27.78%) (p<0.001). Delayed surgery also resulted in shorter hospital stays (42.76 days) compared to conservative therapy (55.53 days) and early surgery (26.33 days) (p<0.001), and shorter ICU stays (4.52 days) compared to conservative therapy (16.48 days) and early surgery (7.92 days) (p<0.001). The optimal window for surgery, minimizing mortality, was identified as ten to fourteen days post-admission (p=0.02). Risk factors for increased mortality included age (p<0.05), multiple organ failure (p<0.05), and vertebral body destruction (p<0.05), whereas delayed surgery (p<0.05) and the presence of an epidural abscess were associated with reduced mortality (p<0.05). CONCLUSIONS Delayed surgery, optimally between 10 to 14 days post-admission, was associated with lower mortality in critically ill spondylodiscitis patients. These findings highlight the potential benefits of considering surgical timing to improve patient outcomes.

Cancer progression is an evolutionary process driven by the selection of cells adapted to gain growth advantage. We present a formal study on the adaptation of gene expression in subclonal evolution. We model evolutionary changes in gene expression as stochastic Ornstein-Uhlenbeck processes, jointly leveraging the evolutionary history of subclones and single-cell expression data. Applying our model to sublines derived from single cells of a mouse melanoma revealed that sublines with distinct phenotypes are underlined by different patterns of gene expression adaptation, indicating non-genetic mechanisms of cancer evolution. Sublines previously observed to be resistant to anti-CTLA4 treatment showed adaptive expression of genes related to invasion and non-canonical Wnt signaling, whereas sublines that responded to treatment showed adaptive expression of genes related to proliferation and canonical Wnt signaling. Our results suggest that clonal phenotypes emerge as the result of specific adaptivity patterns of gene expression. A record of this paper's transparent peer review process is included in the supplemental information.

Abstract Duplication of the vermiform appendix is a rare anomaly observed in patients undergoing appendectomy. A 27-month-old male toddler presented with a 9-day history of abdominal pain, vomiting, and diarrhea, progressing to an acute abdomen with signs of severe peritonitis. Intraoperative findings revealed a periappendicular infiltrate from a perforated vermiform appendix of the tenia coli type. A second, inflamed appendix was incidentally discovered in its typical location during the procedure. Vermiform appendix duplication presents a clinical challenge due to its rarity and potential for complications. According to the Cave–Wallbridge classification, this case represents Type B2, or the tenia coli variant, characterized by a perforated appendix originating at the tenia coli convergence and a smaller, secondary appendix in a retrocecal position. This case emphasizes the importance of thorough distal and proximal exploration during initial appendectomy when this anomaly is suspected, particularly in cases of Type B2.

In this paper, the author aims to address and problematize the adequacy of the criminal enforcement system in terms of the social adaptation and reintegration of convicted persons after serving a prison sentence, as well as to critically examine the potential problems and risks faced by this population. The humanization of the criminal enforcement system requires respect for the personal integrity and dignity of each individual, along with the implementation of appropriate programs and treatments aimed at behavior change and raising awareness about the harmful effects of criminal activity to achieve specific objectives. In this context, the legislator has prescribed a catalog of rights and established certain rules of conduct, particularly for specific categories, such as minors, individuals with mental disorders, persons with disabilities, and drug users. Special attention is given to juveniles due to their age, criminal-legal status, and the potential risk of recidivism (criminal reoffending), with a particular focus on sentencing and the execution of juvenile imprisonment. Accordingly, the paper centers on the social adaptation and reintegration of former offenders, with a particular focus on the real problems and challenges they face after serving their sentences and being released from correctional institutions.

Abstract The paper focuses on analyzing key factors influencing the effectiveness of internal audit in the public sector of Bosnia and Herzegovina (BiH). Through multiple regression analysis (Ordinary Least Squares-OLS), the impact of five independent variables (competence of internal auditors, size of internal audit department, relationship between internal and external auditors, management support for internal audit, and independence of internal auditors), two control variables (organization’s sector and total number of employees in the organization), on the dependent variable (effectiveness of internal audit) was measured. Research results indicate that a significant portion (.2 = 45.00%, Adj .2 = 40.90%) of the variability in the effectiveness of internal audit can be explained by the variability of the five independent variables in the model. The largest positive impact on the effectiveness of internal audit is attributed to the size of the internal audit department and the independence of internal auditors. Conversely, management support for internal audit had the least impact, which contradicts our predictions and the results of previous research. The limited impact of management support on the effectiveness of internal audit in the public sector of BiH may stem from a lack of understanding regarding the role and importance of internal audit, as well as from perceiving it as merely a formal legal requirement without substantial value.