Cerebral visual impairment (CVI) is a complex neurological disorder that significantly affects the visual functioning of school-age children, often unrecognized within educational settings. The aim of this study was to determine the presence and frequency of specific visual behaviors associated with the risk of CVI in lower primary school students, and to examine differences in their recognition between parents and teachers. The study included 112 students from grades three through five, with data collectedusing an abbreviated version of the Screening for Cerebral Visual Impairmentquestionnaire. The results indicated that parents recognize specific visual behaviors considerably more often than teachers. Although this difference did not reach statistical significance, a borderline trend was observed. The findings suggest a need for enhanced teacher training, strengthened collaboration with parents, and the introduction of systematic screening procedures to enable timely identification of children at risk forCVI.Keywords:cerebral visual impairment, specific visual behaviors, visual difficulties

BACKGROUND Tuberculosis (TB) is the leading global cause of death from a single infectious agent. Recent reductions in global health funding have threatened TB control, making comprehensive assessment of TB, HIV-related TB, and drug-resistant TB burdens before these disruptions essential for shaping effective responses. The WHO End TB Strategy sets targets of a 95% reduction in TB deaths and a 90% reduction in TB incidence between 2015 and 2035. Using results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, this study aims to assess the burden of TB and multidrug-resistant TB (MDR-TB) across 204 countries and territories, and to evaluate progress towards the WHO End TB incidence and mortality targets. METHODS We quantified TB mortality using the Cause of Death Ensemble modelling platform with global vital registration, surveillance, verbal autopsy, and minimally invasive tissue sampling data. For TB morbidity estimation, we simultaneously modelled incidence, prevalence, and mortality by age and sex using DisMod-MR 2.1. A population attributable fraction (PAF) approach was applied to stratify morbidity and mortality estimates by HIV and drug-resistance status. We also calculated disability-adjusted life-years (DALYs) as the sum of years of life lost and years lived with disability. For the risk factor analysis, a comparative risk assessment framework was used and PAFs were derived for alcohol use, smoking, and high fasting plasma glucose to determine the proportion of TB burden associated with these risk factors. FINDINGS In 2023, there were an estimated 9·11 million (95% uncertainty interval 8·04-10·3) incident cases of all-form TB, 1·22 million (0·98-1·49) deaths, and 54·6 million (43·8-65·5) DALYs globally. HIV-related TB comprised 781 000 (690 000-879 000) incident cases and 210 000 (142 000-279 000) deaths, contributing 11·0 million (7·56-14·3) DALYs. MDR-TB accounted for 466 000 (198 000-1 080 000) incident cases, 102 000 (31 700-238 000) deaths, and 3·96 million (1·31-9·01) DALYs. From 2015 to 2023, global all-form TB incidence rates declined by 19·2% (17·8-20·5) and deaths declined by 22·6% (4·7-35·7); declines were larger for drug-susceptible TB than for MDR-TB. Sub-Saharan Africa and south Asia had the highest mortality burdens in 2023; reductions in all-form TB incidence and mortality were uneven between 2000 and 2023, with limited progress in both measures in Latin America and the Caribbean. Removing smoking, alcohol use, and high fasting plasma glucose would reduce global TB deaths to 768 000 (592 000-970 000) and DALYs to 34·9 million (27·8-43·8) in 2023; MDR-TB deaths would decrease to 77 200 (23 400-183 000) and DALYs to 3·12 million (1·03-7·29). INTERPRETATION Global progress towards WHO End TB targets is disparate and fragile. Although many regions achieved meaningful gains, others have stagnated in recent years. The complexity of TB prevention is amplified by divergent MDR-TB trends, the persistent burden of HIV, and growing exposure to modifiable risk factors. Recent volatility in global health financing threatens to further destabilise this vulnerable epidemiological landscape; concerted action is urgently needed to temper disruptions and preserve progress. FUNDING Gates Foundation.

ABSTRACT Background: Interaction between healthcare professionals and patients is a complex process influenced by communication, environmental, individual, and organizational factors. Objective: To synthesize qualitative and quantitative evidence and identify key characteristics of effective interaction between patients and nurse anesthetists during the perioperative period. Methods: A systematic literature search was conducted in PubMed, MEDLINE, CINAHL, Embase, and the Cochrane Library to identify qualitative and quantitative studies examining factors influencing interaction between patients and nurse anesthetists in the perioperative setting. Results: Both facilitators and barriers to effective interaction were identified. Facilitators included respectful, patient-centered care, a supportive work environment, and clear, timely communication. Barriers included negative staff attitudes, procedural stress, interpersonal conflicts, exposure to violence, and communication challenges such as low speech volume, unclear articulation, and limited language proficiency. Effective communication was associated with improved patient safety, enhanced team cohesion, and more efficient information exchange. However, increased reliance on advanced technology may reduce patient engagement and interpersonal communication within the healthcare team. Conclusion: Nurse anesthetists play a critical role in supporting patients during potentially stressful perioperative experiences. Organizational factors, time constraints, and communication strategies may influence the quality of patient–provider interaction. Further research is needed to determine how these factors can be optimized to improve perioperative care and patient outcomes.

Abstract Hemorrhagic cystitis (HC) in children is most associated with infection or treatment-related toxicity, whereas other cases remain uncommon. We report a 5-year-old boy presenting with recurrent painless gross hematuria in whom a structured, stepwise evaluation excluded glomerular, infectious, structural, and systemic causes. Cystoscopy revealed diffuse mucosal inflammation with focal hemorrhagic changes involving the bladder neck and posterior wall, consistent with noninfectious HC. In the absence of an identifiable etiology and with persistent symptoms, management was directed toward restoring urothelial barrier integrity using intravesical hyaluronic acid (HA). The clinical response was rapid, with resolution of gross hematuria after the first instillation, followed by sustained remission and progressive endoscopic improvement. The treatment was well tolerated, and the patient remained disease-free at 12 months of follow-up. This case highlights the diagnostic complexity of unexplained hematuria in children and supports a potential role of urothelial barrier dysfunction in the pathogenesis of noninfectious HC.

OBJECTIVE To investigate reported paper mill involvement among retracted systematic reviews and meta-analyses (SR/MAs), and to compare retracted SR/MAs with and without reported paper mill involvement with respect to temporal patterns, disciplinary profile, country recorded in the database, and retraction characteristics. STUDY DESIGN AND SETTING Cross-sectional study based on the Retraction Watch database. Records were screened to identify retracted SR/MAs. Reported paper mill involvement was assigned only when explicitly stated in the Retraction Watch record or associated retraction information; fake peer review was coded separately. Group comparisons used the Pearson chi-square and Mann-Whitney U tests. Associations with reported paper mill involvement were estimated using univariable Poisson regression with robust variance and reported as prevalence ratios (PRs) with 95% confidence intervals (CIs). These analyses were treated as exploratory, non-inferential internal contrasts within the dataset of already retracted SR/MAs. RESULTS Among 69,163 retracted publications in the Retraction Watch dataset, 1,071 (1.5%) were identified as retracted SR/MAs. Of those, 191 (17.8%) were paper mill-associated and 880 (82.2%) were not. In the database country field, China was recorded for 732/1,071 retracted SR/MAs (68.3%) and 177/191 SR/MAs with reported paper mill involvement (92.7%). The annual number of paper mill-associated SR/MAs peaked in 2023 (n=152). Within this restricted dataset, paper mill-associated SR/MAs had a longer median time to retraction (511 vs 459 days; p=0.024), more frequent results-related concerns (89.0% vs 30.0%), data issues (53.4% vs 17.5%), referencing concerns (53.9% vs 13.6%), and ethical concerns (8.9% vs 2.6%) (all p<0.001), and less frequent multi-country authorship (8.9% vs 17.6%; p=0.004). In univariable Poisson regression analyses restricted to retracted SR/MAs, larger observed proportions of reported paper mill involvement were seen among records linked to China in the database country field (PR 5.86, 95% CI 3.45-9.93), more recent publication years (PR 1.20 per 1-year increase, 95% CI 1.16-1.23), the medical broad domain (PR 3.66, 95% CI 1.66-8.08), and records with results-related concerns (PR 11.88, 95% CI 7.68-18.39). These PRs should not be interpreted as likelihoods, risks, or rates beyond the analyzed Retraction Watch subset. CONCLUSION In this Retraction Watch-based analysis, reported paper mill involvement was identified in 191/1,071 retracted SR/MAs (17.8%). These records were most often linked to China in the database country field (177/191; 92.7%) and clustered in recent years, particularly 2023. These findings should be interpreted as descriptive patterns within detected and retracted records, not as country-level rates, comparative performance indicators, or estimates of the true prevalence of paper mill activity.

Chronic kidney disease is increasingly recognised as a systemic disorder with important neurological consequences, including cognitive impairment. However, the field remains challenging because CKD-related cognitive decline involves diverse uremic toxins, overlapping vascular, inflammatory, metabolic, endothelial, and neurodegenerative pathways, inconsistent cognitive screening practices, and no unified treatment strategy. Within this context, the kidney–brain axis provides a useful framework for integrating renal dysfunction, toxin retention, systemic inflammation, blood–brain barrier disruption, and cognitive vulnerability. Of these mechanisms, uremic neurotoxicity offers a biologically credible connection between compromised renal clearance and cerebral dysfunction. Retained solutes such as indoxyl sulfate, p-cresyl sulfate, indole-3-acetic acid, trimethylamine-N-oxide, urea, guanidino compounds, lanthionine, quinolinic acid, and homocysteine may induce endothelial injury, oxidative stress, neuroinflammation, mitochondrial dysfunction, excitotoxicity, and glial activation. Although these pathways are supported by experimental and translational studies, direct causal evidence in humans remains limited, and most clinical data should currently be interpreted as associative rather than definitive proof of causality. These processes converge on neuronal and synaptic vulnerability and may elucidate the distinctive cognitive profile associated with chronic kidney disease, particularly deficits in attention, processing speed, and executive function. This review summarizes the most recent evidence on the epidemiology and clinical phenotype of cognitive impairment in chronic kidney disease. It also discusses the molecular and cellular mechanisms of uremic neurotoxicity and examines new biomarkers of the kidney–brain axis, including neurofilament light chain, glial fibrillary acidic protein, brain-derived neurotrophic factor, tight junction proteins, and uremic toxins. However, these biomarkers remain insufficiently validated for routine clinical use, as their interpretation is complicated by reduced renal clearance, systemic inflammation, comorbid vascular disease, methodological heterogeneity, and the lack of longitudinal studies linking biomarker changes to cognitive outcomes. Therapeutic strategies targeting uremic toxins remain compelling from a mechanistic standpoint, but they are not yet fully developed in clinical practice. Subsequent research ought to amalgamate toxin profiling, cognitive phenotyping, neuroimaging, endothelial and inflammatory biomarkers, alongside patient-centered outcomes. Integrating cognitive assessment into nephrology care may enhance risk stratification, collaborative decision-making, and personalised management for patients with chronic kidney disease.

The introductory section defines the concepts of graphomotor skills and hearing impairment.The aim of this study was to examine the characteristics of graphomotor skills in children with hearing impairments compared to hearing children. Additionally, one of the objectives was to investigate whether there are differences in graphomotor skills depending on the quality of hearing, as well as to identify the factors that influence these skills.For assessment purposes, the Diagnostic Set for Testing Speech, Language, Reading, and Writing Abilities in Children –Diagnostic Material for Identifying Specific Difficulties in Reading and Writing wasused, focusing on variables related to graphomotor skills. Descriptive statistics, optimal scaling regression analysis, and linear regression analysis were employed for statistical data processing.The study revealed that hearing participants achieved statistically significantly better results in graphomotor skills compared to participants with hearing impairments.The degree of hearing impairment affects the graphomotor skills of children with hearing impairment, while educational conditions and gender did not show any influence on these skills. Age also impacts the graphomotor skills of children with hearing impairment.These findings provide insight into the specific needs of children with hearing impairments and emphasize the importance of individualized education, taking into account the unique characteristics of each child with hearing impairment.Keywords: graphomotor skills, graphomotor development, children with hearing impairment

Digital narratives, particularly animated films, are increasingly recognized as powerful educational tools capable of fostering empathy and promoting inclusive values among school-age children. This study examined how viewing the animated film Jonathan from Seagull Mountaincontributes to the development of empathy and understanding of diversity among primary school students in Bosnia and Herzegovina. A mixed-methods design was employed, integrating quantitative and qualitative data collection and analysis.The sample comprised 214 students aged 9 to 15 years from four cities (Tuzla, Sarajevo, Zenica, and Mostar), while a purposive subsample of 32 students participated in four focus groups. Data were collected through a structured post-viewing questionnaire and semi-structured focus group discussions. Quantitative data were analyzed using descriptive statistics, while qualitative data from focus group transcripts were analyzed through thematic analysis. Results indicate that the film elicited positive emotional responses in the majority of participants, with 78.6% expressing a desire to help the protagonist and 78.0% reporting increased motivation to support peers who are different from them. Girls demonstrated markedly higher levels of affective empathy than boys, with the most pronounced difference recorded on the item relating to sadness over the protagonist's exclusion (86.5% vs. 53.6%). Thematic analysis identified five main themes: emotional experience of the narrative, development of empathy and acceptance of diversity, peer support and moral responsibility, symbolic elements, and student recommendations for more inclusive school practices. The findings confirm the potential of digital narratives as a pedagogical tool for developing empathy and inclusive attitudes among primary school students. Keywords:digital narratives, empathy, inclusion, animated film, primary school students

The aim of this study was to examine the impact of perceived stress levels on anxiety and depression among parents of children with disabilities. The study included a sample of 104 parents of children with different types of disabilities, of whom 85.6% were mothers and 14.4% were fathers. The Perceived Stress Scale (PSS-10) was used to assess the level of perceived stress, the Generalized Anxiety Disorder Scale (GAD-7) was used to assess anxiety, and the Patient Health Questionnaire (PHQ-9) was used to assess depression. Data were analyzed using descriptive statistics and linear regression analysis. The results indicated the presence of a moderate level of anxiety (M = 11.17; SD = 4.53), a moderately severe level of depression (M = 15.92; SD = 6.60), and a high level of perceived stress (M = 28.73; SD = 5.11) among parents of children with disabilities. Linear regression analysis showed that the level of perceived stress was a statistically significant predictor of anxiety (R² =0.25; p < 0.001) and depression (R² = 0.27; p < 0.001). The obtained findings indicate that higher levels of perceived stress contribute to higher levels of anxiety and depression among parents of children with disabilities. The study results highlight the need for the development of systematic psychological and social support for parents of children with disabilities in order to preserve their mental health. Keywords:perceived stress, anxiety, depression, parents of children with disabilities, mental health, psychological burden

BACKGROUND Human brucellosis remains endemic in Bosnia and Herzegovina (B&H), yet integrative studies explaining transmission patterns, population structure, and susceptibility profiles in an endemic setting are lacking. This study aimed to characterise human Brucella melitensis (B. melitensis) isolates from B&H using a combined epidemiological, phenotypic, and genomic approach. METHODS A total of 60 B. melitensis blood isolates obtained from patients with confirmed brucellosis between 2015 and 2021 were selected from a multicentre collection for phenotypic antimicrobial susceptibility testing (AST) and whole-genome sequencing (WGS). Broth microdilution (BMD) in three different broth media was used and interpreted according to the Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. Genomic analyses included phylogenomic contextualisation using publicly available genomes, and screening for acquired antimicrobial resistance determinants and virulence-associated genes. RESULTS Human brucellosis predominantly affected working-age males and was strongly associated with occupational and household exposure. While phenotypic AST showed that first-line antimicrobials remain effective in vitro, the results were significantly impacted by both the choice of culture media and the interpretive framework, with major discrepancies observed between CLSI and EUCAST classification, particularly for streptomycin and trimethoprim-sulfamethoxazole. WGS revealed a high degree of clustered genomic homogeneity within the East Mediterranean lineage. No acquired antimicrobial resistance (AMR) genes were detected, while a conserved virulence gene repertoire was observed across isolates, including genes associated with membrane adaptation such as mprF. CONCLUSIONS Human brucellosis in B&H is characterised by sustained endemic transmission within a genetically conserved B. melitensis population. Integration of epidemiological, phenotypic AST, and genomic data highlights the importance of interpreting susceptibility patterns in the light of Brucella's slow evolutionary dynamics and local epidemiological context. The genomic baseline established in this study supports future One Health surveillance integrating human and animal reservoirs.

The paper presents a comprehensive quasi-static digital twin of a utility-scale wind turbine developed in Python. The proposed digital twin framework combines dynamically acquired turbine measurements with static system parameters to reconstruct the steady-state operational behaviour of the wind turbine under real-world conditions. The digital twin integrates historical and real-time operational data to provide dynamic visualization of key performance indicators, enabling continuous insight into turbine behaviour and operational conditions. The model is trained using comprehensive SCADA datasets, including turbine operational data, grid measurements, meteorological observations, and alarm logs, with target variables encompassing the turbine’s active power output and efficiency-related performance metrics. Through systematic data processing, filtering, and aggregation, the digital twin provides a representation of expected turbine behaviour across a wide range of operating conditions. The developed digital twin supports performance benchmarking, operational condition assessment, and early detection of deviations that may indicate aerodynamic inefficiencies, control limitations, or emerging component degradation. Its quasi-static formulation ensures computational efficiency and numerical robustness, making it suitable for real time deployment within wind farm monitoring environments. The presented approach is fully transparent, reproducible, and modular, allowing straightforward extension toward advanced digital twin functionalities, including condition-based maintenance, performance degradation analysis, and integration with forecasting or control-oriented applications. Key words. Digital twin, Wind turbine, Power production, Prediction

Background: Bartonella henselae infection has been associated with a broad spectrum of neurological and autonomic manifestations, although its impact on autonomic nervous system function remains insufficiently characterized, and the aim of this study was to evaluate autonomic function in patients with polymorphic symptoms and Bartonella henselae IgM seroreactivity. Methods: In this cross-sectional study, 75 patients were compared with 75 age- and sex-matched healthy controls, and all participants underwent cardiovascular autonomic reflex testing, short-term (5 min) and long-term (24 h) heart rate variability analysis, and 24 h ambulatory blood pressure monitoring, while head-up tilt testing was performed in the Bartonella group. Results: Abnormal autonomic reflex tests were significantly more frequent in the Bartonella IgM-seroreactive group, particularly those reflecting parasympathetic function, while heart rate variability analysis demonstrated reduced high-frequency components and lower long-term variability indices, and head-up tilt testing revealed heterogeneous hemodynamic responses including orthostatic hypotension and pronounced blood pressure variability, with ambulatory monitoring additionally showing higher nighttime blood pressure values and reduced nocturnal dipping. Conclusions: These findings indicate a consistent pattern of autonomic imbalance characterized predominantly by parasympathetic impairment and altered blood pressure regulation in patients with Bartonella henselae IgM seroreactivity, although further studies are required to clarify underlying mechanisms and clinical implications.

BACKGROUND Fractures in older adults arise from complex interactions between bone fragility, falls, and comorbid conditions. This study aimed to map the comorbidity environment of osteoporosis (M80/M81) by sex and age, and assess whether osteoporosis is systematically coded at the time of fracture-related hospitalization across fracture types. METHODS We conducted a nationwide retrospective analysis of Austrian inpatient data collected for insurance claims between 2003 and 2014, including 1,705,684 hospitalized patients aged 50-79 years. Comorbidity network analysis was used to characterize sex- and age-specific diagnoses co-occurring with osteoporosis (ICD-10: osteoporosis with pathological fracture M80 and osteoporosis without pathological fracture M81). In paralell, fracture-centered networks were constructed for major fracture types (S22, S32, S42, S52, S62, S72) to assess whether osteoporosis was systematically coded during fracture related hospitalizations. Sex-specific odds ratios (ORs) were calculated to compare comorbidity associations between males and females across three age groups (50-59, 60-69, 70-79 years). RESULTS Across all age groups, females exhibited substantially broader M81-associated comorbidity networks than males, with the number of linked diagnoses increasing from 142 to 245 to 330 in females and from 76 to 137 to 164 in males between ages 50-59, 60-69, and 70-79 years, respectively. Fracture-centered analyses showed that across age groups, fractures were embedded within multimorbidity networks rather than forming isolated diagnostic links with osteoporosis. Hip fractures (S72) showed the strongest co-occurrence with osteoporosis diagnoses, particularly in females aged ≥60 years, whereas upper limb fractures - forearm (S52), wrist and hand (S62), and humerus (S42) - showed no osteoporosis diagnoses among significant co-diagnoses in any age group despite these fractures being considered early fragility fractures. In patients aged 50-69 years, male fracture networks showed stronger co-occurrence with trauma-related and alcohol-related diagnoses, while in older age groups networks in both sexes increasingly included neurodegenerative, cardiovascular, respiratory, and renal diseases. In sex-stratified analyses, the co-occurrence between osteoporosis without pathological fracture (M81) and osteoporosis with pathological fracture (M80) was consistently stronger in males than in females across all ages (e.g. OR 63.74 vs 18.53 at 50-59 years). CONCLUSIONS Osteoporosis is not systematically coded across all fracture types in routine hospital data. Upper limb and thoracic fractures were rarely recorded alongside osteoporosis diagnoses despite being recognized as potential fragility fractures. These patterns suggest under-recognition of osteoporosis at the time of fracture, particularly in younger patients and in males.