Background Large language models (LLMs) are increasingly being studied as potentially valuable support tools in oncology practice including clinical decision support. Yet, their real-world utility in melanoma treatment decision-making is still not sufficiently considered, especially in resource-limited settings. Accordingly, this study evaluated the performance of four LLMs against real-world treatment decisions of a melanoma multidisciplinary tumor board (MDT). Methods This retrospective single-center study included 151 consecutive patients with newly diagnosed cutaneous melanoma discussed at the MDT at the University Clinical Center Tuzla, Bosnia and Herzegovina, between 2020 and 2024. Melanoma treatment recommendations generated by four LLMs, ChatGPT-4o, ChatGPT-5 Thinking, Gemini 2.5 Pro and DeepSeek-V3.2, were evaluated by four board-certified oncologists against the actual MDT treatment decisions. Additionally, the LLM-generated recommendations were also rated across five pre-specified domains: clarity, clinical applicability, coverage, explanation and support with evidence, and guideline concordance. Results In this study, inter-rater reliability was acceptable to good, supporting the consistency of expert evaluation. ChatGPT-5 Thinking showed the strongest and most consistent overall performance, followed by ChatGPT-4o, while Gemini 2.5 Pro and DeepSeek-V3.2 were rated less favorably. Differences between LLMs were statistically significant across all evaluated domains. Performance differences appeared most clinically relevant in more complex scenarios, particularly when consideration of adjuvant or systemic treatment strategies was required. Conclusion The findings of this study suggest that selected LLMs may have a supportive role in everyday melanoma MDT practice particularly in oncology centers with limited resources. However, the current results do not support the use of LLM-generated recommendations as independent treatment decisions, and further prospective studies are required before LLM-assisted treatment recommendations can be safely integrated into the MDT workflow.

A comprehensive book review of the recently published two-volume study, "Russia and the Eastern Question: Challenges of De-Ottomanization and Balkan Responses", authored by the distinguished historian Dr. Safet Bandžović and published by the Institute for History, University of Sarajevo.

Breast cancer remains a major challenge to public health. Biomarkers may be useful to improve prediction of breast cancer survival. Several epigenetic markers of cell division and ageing based on DNA methylation have been proposed. In this study, we measured these epigenetic markers in breast tumours and assessed their prognostic value. We used genome-wide DNA methylation data measured in 1992 breast cancer tumours from the Melbourne Collaborative Cohort Study and publicly available datasets. We calculated four markers of cell division (epiTOC2, stemTOC, MiAge and CellDRIFT), two markers of chronological age (Horvath age and BTEC), and four markers of biological age (PhenoAge, GrimAge, MRscore and DunedinPACE). Cox regression models were used to assess the associations of age-adjusted epigenetic markers with 5-year overall survival, with adjustment for clinical variables. Effect modification by estrogen receptor (ER) status and molecular subtype was also investigated. After adjustment for age and stratification by study, higher levels of cell division markers were associated with poorer survival (e.g., epiTOC2: per one-standard-deviation increase, hazard ratio [HR] = 1.14, 95% CI: 1.03-1.27), whereas higher chronological age markers were linked to better prognosis (e.g., Horvath age: HR = 0.70, 95% CI: 0.61-0.82). Epigenetic markers of biological age showed variable associations. These associations were partly explained by the main clinicopathological variables at diagnosis and varied across subtypes. Our study revealed associations of several epigenetic markers with breast cancer survival. The associations were quite weak, suggesting these markers may have limited prognostic value. The varying associations observed among subtypes may reflect underlying biological differences that should be further investigated.

Social justice in Islamic theological education represents a concept that is normatively central yet pedagogically underarticulated. Rooted in the Qur’an, the Sunnah, and the broader Islamic intellectual tradition, it carries legal obligation, ethical responsibility, spiritual maturity, and social sensitivity. These sources consistently affirm social justice as a foundational principle of a balanced and equitable social order, but its translation into educational practice remains unabiding. This research examines how social justice is positioned within the higher education syllabus for future Islamic religious education practitioners (teachers and imams) in Bosnia and Herzegovina. Using Mayring’s qualitative content analysis, in this study, written responses collected through an open-ended qualitative expert survey were analysed. Thematic indicators were developed as an outcome and were used as criteria for the subsequent documentary analysis of the official syllabus. Then followed an analytical examination of the syllabus of a study programme leading to the qualification of Islamic religious education practitioners. The findings indicate that social justice is not explicitly articulated within intended learning outcomes as knowledge, attitude, or pedagogical competence. The analysis structured through Bloom’s taxonomy demonstrates the presence of pedagogical and methodological sensitivity across all cognitive levels, from knowledge to evaluation. This reveals a discrepancy between the normative centrality of social justice and its partial pedagogical realisation. This study identifies a persistent tension between theological ideals and educational practice. The potential for rearticulating a theological–pedagogical framework in which social justice becomes an explicit, lived, and transformative category within practitioners’ education was highlighted as something in place of a conclusion.

A systematic investigation of how different circuit and arc parameters affect the threshold value for the R500 interruption limit (R500th) has been provided. These parameters include the breaker cooling power, arc time constant, time delay of the transient recovery voltage (TRV), parallel capacitance, and network impedance. The results are obtained through black-box model calculations based on Mayr’s arc model. Our findings suggest that the interruption limit for the R500 method has negligible dependency on the cooling power used in Mayr’s arc model. On the other hand, it is shown that larger values of parallel capacitance and TRV time delay led to a decrease of the R500th. On the contrary, R500th rises by increasing the network impedance. These results imply that the influence of arc–circuit interaction must be considered when applying this approach for assessing the interruption limit. As a validation step, the numerical findings have been cross validated by selected measurement results provided in the literature.

The flow chart shows the identification of spatially explicit detention basins, their incorporation in the distributed modelling and the received results at the local and catchment scale. Weather extremes in recent years, particularly floods, together with their projected intensification, underscores the need for sustainable approaches to vulnerability reduction through climate adaptation and flood mitigation. Nature-based solutions offer an alternative to conventional grey infrastructure, and upstream water retention is a well-established strategy for reducing downstream flood peaks. This study presents a theoretical assessment of the water-holding capacity and peak-flow-reduction potential of spatially explicit upstream detention basins (DBs) in Svartån, a medium-sized catchment (761 km2) in central Sweden. Potential DB locations were delineated using high-resolution spatial data and their hydrological functioning was evaluated through distributed modelling over a three-year period. Model performance in the baseline scenario was high (Kling–Gupta efficiency: 0.88). Without recalibration, a water-retention scenario introducing 37 DBs across the catchment resulted in a 2–3% reduction in 95th-percentile flows at the catchment scale. At local scales, the corresponding peak flows were reduced by up to nearly 70%, although attenuation efficiency varied depending on the interplay between upstream contributing area, DB-specific storage capacity, and the maximum allowable discharge. Distributed modelling thus provides a useful framework for exploring alternative DB configurations under site-specific constraints and for identifying designs that maximise flow attenuation or support shifts toward broader ecosystem-service provisioning.

Summary Background Extremely preterm infants often develop anemia of prematurity, partly caused by blood losses for laboratory diagnostic tests during their stay in the neonatal intensive care unit (NICU). However, international quantitative data on diagnostic blood loss in extremely preterm infants are limited. Methods We performed an international, prospective, observational study across 64 NICUs across 22 European countries (ISRCTN17267090) to describe diagnostic blood losses during the first 28 days after birth in extremely preterm infants born below 28 weeks. Data collected between September 1st, 2022 and August 31st, 2023 (6-weeks per center). Findings We included 320 extremely preterm infants (46% female; median gestational age at birth 26 + 1 weeks; median birthweight 800 g). Median estimated cumulative diagnostic blood loss at day 28 in infants born at 24, 25, 26, 27 weeks’ gestation was 49.6%, 25.9%, 19.7%, 11.5% of calculated initial blood volume (assuming 70 mL/kg birthweight), respectively. Median number of laboratory tests ranged from 6.5 to 25 per center after birth (postnatal day 1–2), and median associated diagnostic blood loss on day 1 and 2 combined ranged from 1.6 to 26.7 mL/kg. There was considerable variation between centers in minimum blood volumes required for laboratory testing. Infants admitted to centers with small-volume analyzers experienced half the cumulative diagnostic blood loss by day 28 (8.2 mL/kg), compared to those admitted to centers with medium- and large-volume analyzers (17.3 and 19.9 mL/kg, respectively). Interpretation In this cohort study of extremely preterm infants, we found significant diagnostic blood losses, particularly in the first week, resulting in an estimated cumulative loss of half of the initial blood volume in infants born at 24 weeks. Our findings highlight considerable variations between European centers, underlining the need to understand these differences and minimize diagnostic blood losses whenever possible in this vulnerable patient population. Funding Sanquin, ESPR, EBA.

Highlights What are the main findings? In-hospital adverse events were associated with higher 30-day mortality after hip fracture surgery. Baseline-only models, based on the ASA PS Classification, the Charlson Comorbidity Index, and the Elixhauser Comorbidity Index, showed broadly comparable discrimination for 30-day mortality in this cohort. What are the implications of the main findings? Routinely available comorbidity indices provided broadly similar short-term risk stratification, although their discrimination was acceptable rather than perfect. In-hospital adverse events should be interpreted as time-dependent clinical events associated with mortality rather than baseline predictors or evidence of causality. Abstract Background/Objectives: Hip fractures are associated with high short-term mortality in older adults. This study aimed to determine 30-day mortality after hip fracture surgery and evaluate factors associated with short-term mortality, with particular attention to baseline comorbidity indices and in-hospital adverse events. Methods: This retrospective cohort study included 785 patients who underwent surgery for hip fracture at University Hospital of Split, Croatia, between January 2021 and December 2022. Clinical data were extracted from medical records. The primary outcome was 30-day mortality, including in-hospital and post-discharge deaths. Associations with mortality were examined using univariable and multivariable logistic regression. Baseline-only comorbidity models were constructed using the American Society of Anesthesiologists Physical Status Classification System (ASA PS Classification), the Charlson Comorbidity Index (CCI), and the Elixhauser Comorbidity Index (ECI). Exploratory hospital-course models additionally included in-hospital adverse events, which were interpreted as time-dependent hospital-course events rather than baseline predictors. Results: 30-day mortality was 11.0% (86/785). Older age, male sex, higher comorbidity burden, and in-hospital adverse events were associated with mortality. Mortality was 5.7% without documented adverse events, 24.2% with one adverse event, and 42.4% with two or more adverse events. Baseline-only comorbidity models showed acceptable and broadly comparable discrimination, with AUCs of 0.73–0.77. Exploratory hospital-course models showed higher discrimination, with AUCs of 0.80–0.82. Conclusions: 30-day mortality after hip fracture surgery was associated with baseline patient vulnerability and in-hospital adverse events. Baseline-only models based on the ASA PS Classification, the CCI, and the ECI provided broadly comparable short-term risk stratification. In-hospital adverse events should be viewed as markers of an adverse clinical trajectory, not evidence of causality.

BACKGROUND Tumour DNA methylation is a potentially valuable marker of breast cancer survival, but previous studies have been limited by relatively small sample sizes. This study aimed to use a large sample size to identify survival-associated DNA methylation markers and develop a methylation-based signature predictive of breast cancer survival. METHODS We used DNA methylation data from 2,157 breast tumours collected in the Melbourne Collaborative Cohort Study (MCCS) and nine publicly available datasets. An epigenome-wide association study (EWAS) was conducted for five-year overall survival (N = 1,992 cases). Subgroup analyses were carried out by estrogen receptor status. Pathway enrichment analyses were conducted to identify related biological pathways. Elastic net Cox regression was used to develop a signature of survival from DNA methylation data and clinical characteristics, trained on publicly available datasets and tested in the MCCS (N = 425) in addition to the main clinical characteristics. A set of triple-negative tumours (N = 165) with disease-free survival as the outcome was used for additional replication. RESULTS We identified 2,535 CpGs showing an association (P < 1 × 10- 7) with survival in age-adjusted models, including 281 after adjustment for estrogen receptor (ER) status. In ER-positive tumours, there were 389 associations, of which 315 were absent from the primary EWAS. A 228-CpG signature showed a strong association with survival in the MCCS after adjustment for clinical characteristics: per SD, HR = 1.7, 95%CI: 1.2-2.3, P = 0.001, with a C-index of 0.79, compared with a C-index of 0.75 without methylation information (C-index increase: 0.04, 95%CI: 0.01-0.10). The signature was also predictive of disease-free survival beyond clinical characteristics in triple-negative tumours (HR per SD = 1.4, 95% CI: 1.1-1.8). CONCLUSION Our findings revealed numerous CpG sites where tumour DNA methylation was associated with breast cancer survival. A substantial improvement in the accuracy of five-year overall survival prediction was achieved by adding a 228-CpG epigenetic score to the main clinicopathological variables. These results suggest that DNA methylation markers may provide additional prognostic information beyond established clinicopathological factors.

Molecular hydrogen (H2) and hydrogen sulfide (H2S) are central gut metabolites that shape microbial metabolism and affect host health. In Crohn’s disease (CD), the shift in microbiota composition (‘dysbiosis’) is associated with intestinal accumulation of these gases, but the responsible microbes remain poorly resolved. Here, we analysed 4,644 bacterial and archaeal species-level genomes from the Unified Human Gastrointestinal Genome Collection to identify H2-cycling microbes, assessed their prevalence in ca. 1,700 stool metagenomes from healthy and diseased individuals, and validated their activity using culture-based incubations of stool isolates and biopsy samples. Approximately half of all species encoded H2-producing abilities, with acetate- and propionate-forming fermenters such as Phocaeicola and Bacteroides dominating healthy cohorts, whereas comparatively few taxa, including Escherichia and Megamonas, encoded H2 consuming abilities. In CD, H2 producers became more abundant but less diverse, favouring species with multiple H2-evolving hydrogenases and more fermentation routes, especially Clostridium and Enterocloster species. Consistently, isolates enriched in CD produced H2 faster and at higher concentrations than health-associated isolates. Increased H2S-producing capacity in CD was driven mainly by these H2-producing fermenters carrying anaerobic sulfite reductases (Asr), rather than sulfate-reducing bacteria, and was supported by elevated H2S production in Asr-positive isolates, likely providing an additional electron sink. These findings provide a species-resolved view of gut gas metabolism and implicate metabolically flexible fermenters in excessive gas and sulfide production in gut disorders.

Teaching assistants are essential for inclusion because they provide individualized support that enables children with developmental disabilities to participate, learn and thrive alongside their peers in mainstream educational settings. The aim of study is to examine differences in the attitudes of parents of children with developmental disabilities and parents of children with autism spectrum disorder (ASD) regarding their children’s inclusive education. The study sample consisted of parents of children with ASD and other developmental disabilities. A random sample include 62 parents of children with different types of disabilities (ASD=30; other developmental disabilities=32). To examine parents’ attitudes, the questionnaire “Attitudes of Parents of Children with disabilities toward Teaching Assistants in the Tuzla Canton” was developed specifically for the purposes of this study. The findings indicate there are no statistically significant differences in attitudes toward teaching assistants between parents of children with ASD and those of children with other developmental disabilities and no significant relationship was found between the child’s age and parental attitudes. By providing insight into parental attitudes, the study contributes to a better understanding of the perceived value and challenges of assistant support in inclusive education and offers a foundation for future research and policy development in this field.

This study investigated the role of teaching experience in delivering gymnastics content in Slovak primary schools, offering evidence for future interventions and curriculum development. A total of 1 246 primary school teachers participated in a cross-sectional, quantitative study using an online questionnaire. Participants were divided into two cohorts: teachers with ˂ 10 years (N = 508) of teaching experience and teachers with ≥ 10 years (N = 738) of teaching experience. Descriptive statistics and chi-square tests (χ²) were used to identify significant differences between the groups across various indicators. Both cohorts identified Gymnastics and Dance as among the most demanding areas of Physical Education curriculum. Teachers with ≥ 10 years of teaching experience more frequently used traditional gymnastics apparatus, whereas teachers with ˂ 10 years of teaching experience tended to adopt non-traditional or mixed approaches. Significant differences were found in apparatus use (p < .01) and perceived challenges in specific thematic units (p < .01). Smaller but still significant differences were also observed in the evaluation of material (technical) conditions (p = .02), with most teachers in both groups rating them as “Sufficient” or “Good” and equipment preferences (p = .05). Teaching experience influences teaching gymnastics in Slovak primary schools. While teachers with ≥ 10 years of teaching experience adhere more to traditional methodology, teachers with ˂ 10 years of teaching experience are more inclined toward innovative and blended practices. Despite pedagogical differences, both groups face systemic limitations in infrastructure and equipment. The findings underscore the need for differentiated professional development and improved material support to enhance gymnastics education at the primary level.

This study explores the drivers of social network site (SNS) users’ purchase intentions for products recommended by influencers. Drawing on social cognitive theory (SCT) and the cognition-affection-behavior (CAB) model, it investigates the factors influencing users’ decisions to follow social media influencers (SMIs) and their affective commitment toward these influencers, which in turn impacts purchase intentions. Specifically, this study examines the roles of social interaction ties, social norms, personal outcome expectations and trust in shaping users’ emotional attachment to influencers. By empirically testing the conceptual framework, this research identifies affective commitment as a key mediator between cognition and purchase intentions. Specifically, the findings show that cognitive evaluations (concretely, trust and personal outcome expectations) significantly drive affective commitment, which in turn strengthens purchase intentions. This evidence underscores the sequential role of cognitive and affective mechanisms in explaining influencer marketing effectiveness. This research contributes to the influencer marketing literature and provides practical insights for selecting influencers who can effectively drive purchase intentions, offering valuable input for brands, influencers, and policymakers in the rapidly growing digital marketing landscape.

Introduction/Objectives: Patient-centered communication is essential in oncology care, where healthcare professionals often manage emotionally demanding conversations, uncertainty, complex decisions, and patient involvement in care. However, the relationship between communication knowledge, empathic listening, and practical communication skills remains insufficiently examined. This study aimed to examine the associations between communication knowledge, empathic listening, and interpersonal communication skills among healthcare professionals involved in oncology care. Methods: A cross-sectional study was conducted in Croatia from May to November 2025 on a convenience sample of 138 healthcare professionals involved in oncology care. Communication knowledge was assessed using a study-specific questionnaire, empathic listening using an adapted Active Empathic Listening Scale, and interpersonal communication skills using an adapted Interpersonal Communication Skills Inventory. Because the instruments were adapted to the oncology care context, their dimensions were examined using exploratory factor analysis and interpreted as sample-specific exploratory constructs. Descriptive statistics, correlation analyses, and multiple linear regression analyses were performed. Results: Clear message delivery and assertiveness had the highest self-reported score, whereas emotional interaction management had the lowest. Communication knowledge was not an independent predictor of communication skills dimensions. Processing and responding positively predicted clear message delivery and assertiveness (β = 0.361; p = 0.001; R2 = 13.4%), while noticing emotional and nonverbal cues negatively predicted emotional interaction management (β = −0.234; p = 0.032; R2 = 7.6%). The explained variance of the models was low. Conclusions: The findings suggest limited but potentially relevant associations between selected dimensions of empathic listening and self-reported communication skills in oncology care. Communication knowledge, measured using a study-specific exploratory instrument, was not independently associated with communication skills. Because of the exploratory design, self-report measures, adapted instruments, and convenience sampling, the results should be interpreted with caution.