Background: Bruton Tyrosine Kinase inhibitors (BTKi) are targeted therapies that have demonstrated promising results in the treatment of hematological malignancies; however, they are associated with adverse cardiac events. Direct comparisons of the cardiotoxic profile between old-generation and new-generation BTKi are limited. Research Question: Are novel BTKi associated with a lower incidence of cardiac adverse events compared with ibrutinib? Aims: We aimed to perform a systematic review and meta-analysis of cardiac events from studies comparing new-generation BTKi versus ibrutinib in patients with hematological malignancies. Methods: We searched PubMed, Embase, and Cochrane Library for studies comparing any new-generation BTKi with ibrutinib in patients with hematological malignancies. Outcomes included 1) risk of cardiac events; 2) atrial fibrillation (AF); 3) rate of treatment discontinuations due to AF; and 4) hypertension. We pooled risk ratios (RR) with 95% confidence intervals (CI). Statistical analysis was performed using R software 4.3.1, under a random-effects model. Heterogeneity was assessed using I 2 statistics. Results: We included four randomized controlled trials with 1905 patients, of whom 957 (50%) received new-generation BTKi. Age ranged from 28 to 90 years, with 1337 (70%) male patients. Prior lines of systemic therapy ranged from none to 12. Overall cardiac events were significantly lower in patients who received novel BTKi compared with those who received ibrutinib (RR 0.75; 95% CI 0.63 to 0.90; p=0.002; I 2 =0%; Fig.1A). New-generation BTKis were associated with a statistically significant reduction in the risk of AF (RR 0.48; 95% 0.35 to 0.64; p<0.001; I2=0% Fig.1B) and treatment discontinuation due to AF (RR 0.07; 95% CI 0.01 to 0.34; p=0.001; I 2 =0%), compared with ibrutinib. However, there was no statistically significant reduction in the risk of hypertension with novel BTKi relative to ibrutinib (RR 0.58; 95% CI 0.34 to 1.01; p=0.053; I 2 =81%). Conclusion: Our findings suggest that treatment with new-generation BTKi is associated with a significant reduction in the risk of cardiac events, AF, and AF-related treatment discontinuation compared with the old-generation BTKi.

Background: Cyclophosphamide is an alkylating agent of the nitrogen mustard class that has become standard of care for graft-versus-host disease prophylaxis after hematopoietic stem cell transplantation. Although its cardiac toxicity in conditioning regimens is well-documented, data on cardiac events after administration of post-transplant cyclophosphamide (PT-Cy) administration remains limited. Research Question: Is PT-Cy associated with a higher incidence of cardiac adverse events compared with no PT-Cy? Aims: We aimed to perform a systematic review and meta-analysis of cardiac events from studies comparing PT-Cy versus no PT-Cy in patients with hematological disorders who received hematopoietic stem cell transplantation. Methods: We searched PubMed, Embase, and Cochrane Library for studies comparing PT-Cy versus no PT-Cy in patients with hematological conditions who received hematopoietic stem cell transplantation. We pooled risk ratios (RR) with 95% confidence intervals (CI). Statistical analyses were performed using Review Manager 5.4.1, under a random-effects model. Heterogeneity was assessed using I2 statistics. Results: We included four studies, all of which were retrospective, with 1,546 patients, of whom 826 (53%) received PT-Cy. Age ranged from 18 to 77 years, and 840 (54%) were male. A total of 1549 allogeneic transplants were performed, primarily for malignant hematological conditions. The conditioning regimens used were myeloablative (52%), reduced intensity (33%), non-myeloablative (8%), and sequential (7%). The most common cardiac events in patients receiving PT-Cy were heart failure (28%) and cardiomyopathy (27%), followed by arrhythmias (25%), pericarditis/pericardial effusion (14%) and acute coronary syndrome (5%). The incidence of adverse cardiac events was significantly higher in patients who received PT-Cy compared with those who did not receive PT-Cy (RR 2.05; 95% CI 1.36, 3.10; p<0.001; I 2 =44%). Conclusion: These findings suggest that PT-Cy is associated with a higher incidence of adverse cardiac events, the most common of which is heart failure/cardiomyopathy.

Introduction: The efficacy and safety of use and impact of pulmonary artery catheter (PAC) in patients with cardiogenic shock (CS) treated with Impella remains unclear. The use of PAC in conjunction with Impella for patients with CS might be associated with improved clinical outcomes and increased safety compared to the use of Impella alone. We aimed to perform a systematic review and meta-analysis comparing Impella with versus without PAC for patients with CS. Methods: We systematically searched PubMed, Embase, and Cochrane databases for studies comparing PAC use in patients with CS treated with Impella. We pooled odds ratios (OR) with 95% confidence intervals (CI) applying random-effects model. We used R version 4.3.2 for statistical analyses. Results: We included two observational studies comprising 11,463 patients, of whom 6,058 (53%) had PAC. Compared with no PAC, the use of PAC was associated with a significantly lower in short-term mortality rates (37% vs. 42%; OR 0.83; 95% CI 0.77-0.90; p<0.01; Figure 1A). There was no significant difference in the incidence of arrhythmias 59% vs. 63%; OR 1.14; 95% CI 0.92-1.41 p=0.44; Figure 1B) or renal complications between groups (47% vs. 50%; OR 1.08; 95% CI 1.00-1.17; p=0.06; Figure 1C). Conclusions: In patients with CS, adjunctive PAC to Impella is associated with lower mortality rates, but no significant difference in arrhythmias and renal complications. Randomized controlled trials are warranted to further validate this results.

Microscopic signs indicative of drowning are not specific to drowning but also to any other form of suffocation where mechanical obstruction is involved. Our study aimed to evaluate both macroscopic and microscopic findings across different groups sharing a common mechanism of death but differing causes and to compare the diatom test with pathohistological examination.Twenty-nine adult Wistar rats, weighing within recommended ranges, were divided into four groups (L1-L4). The diatom test followed established guidelines for diatoms in water from the Bosna River. Microscopic examination revealed diatoms in the lungs of rats in L3 and L4 groups. Pathohistological findings showed varying degrees of changes including consolidation and inflammatory cell infiltration, dominated by lymphocytes and macrophages, with some samples also showing eosinophilic leukocytes.Significant differences were observed between animals whose cause of death was mechanical asphyxia (suffocatio) and those that were submersed for1 hour versus those that were submersed for 72 hours after death. Diatoms identified in group L4 samples 3, 4, and 5 included Navicula sp. (U3 and U6) and Ulnaria ulna (U4).Our findings suggest combining the diatom test with pathohistological analysis to support a drowning diagnosis. Further examination of other organs could enhance result reliability.

The global surge in displacement, with nearly 110 million people uprooted due to violence, underscores the pressing need to comprehend the challenges faced by refugees. Population growth, environmental crises, and political instability contribute to this crisis, projecting an escalating trend in the decades ahead. While hosting countries strive to address concerns related to labour markets, state provisions, and cultural integration, understanding the well-being of refugees upon entry needs to be more adequately explored. This study focuses on refugee stability and integration, employing Austria as a case study. Stability is assessed through residential movement, where more frequent moves indicate instability. Utilising comprehensive administrative data spanning November 2022 to November 2023, we examine residence movements as a proxy for stability. Our findings reveal a stark contrast in the stability of refugees compared to other migrant groups. Analysing movement profiles, we establish that refugees exhibit significantly higher rates of residential mobility than their counterparts, especially among male refugees. This imbalance persists even when comparing refugees to migrants from top refugee-sending countries without official refugee status. This study contributes valuable insights into the intricate dynamics of refugee stability, shedding light on the enduring challenges faced by this population. By examining movement patterns as a key indicator, we provide a nuanced understanding of the residential experiences of refugees, that can inform targeted policies and interventions for enhanced refugee well-being and integration.

This paper introduces a conceptual evaluation learning analytics (LA) model developed by Keypath Education and Melbourne Business School to analyse student engagement in an online learning environment. The paper describes how a targeted LA intervention was grounded within the ICAP theory for active learning to identify, visualise and analyse student engagement metrics in a 100% online setting. The architecture of the model, including its design principles and underlying assumptions, are broadly examined against the latest research in educational, LA, and data analytics research. This includes a discussion of our initial phase testing results of captured student data alongside a discussion of key questions and desired study outcomes for the upcoming phase 2 of the data intervention. As a result, this paper provides both specific insights into how we created an evidence based and pedagogically sound evaluation model of online student engagement within a specific suite of asynchronous educational tools, as well as more general and practical insights into how other universities could develop similar approaches to enhance understanding and support of a growing online student population.

In deaf students, there is no contextual understanding and recognition of word types through linguistic competence testing compared to the hearing population, because 67.10% do not understand, and 10.00% of deaf children partially understand the contextual application of word types in a written text task. The aim of the study is to determine the distance of language discourse between deaf and hearing respondents and to establish a discrimination factor that can be used for practical purposes in a classification sense, with the aim of determining the priority of linguistic education and language elements of deaf children in relation to their lagging behind hearing children. The study was conducted on a sample of 140 respondents. The first subsample of respondents, the experimental group consisted of 70 deaf students, and the second subsample, the control group of 70 hearing students, of the same chronological age and gender. The measuring instrument “Test of comprehension of the written form of expression” was applied. The collected data were processed using the discriminant analysis method. The results of the study showed that the discrimination factor is in the sequence of the use of words, adjectives, exclamations and adverbs. Nouns and prepositions have a negative correlation, which points to the fact that these four types of words are in direct implication with nouns and prepositions, and represents information that these four types of words must be more represented in the educational materials of written expression of deaf children. The results of the study also open up a series of questions focused on the quality of the educational processes of deaf children, as well as the level of lag in written communication compared to hearing children. The results of the study can influence the raising of general rehabilitation procedures to a higher level of responsibility in education centers where deaf children are educated.

The primary objective of this study is to examine the statistically homogeneous clustering in the hierarchical arrangement of the use of adverbial clauses for location, recognition, and comprehension of words presented in three-dimensional, rebus, and distorted forms. The study was conducted on a sample of 140 participants. The first subset of participants constituted the experimental group, consisting of 70 deaf students, while the second subset formed the control group, comprising 70 hearing students of the same chronological age. A battery of tests was utilized as a measurement instrument, including the “Test of Writing and Comprehending Adverbial Clauses for Location,” “Test of Reading, Writing, and Comprehending Words Presented in Three-Dimensional Form,” “Test of Reading, Writing, and Comprehending Words Presented in Rebus Form,” and “Test of Reading, Writing, and Comprehending Words Presented in Distorted Form.” In the descriptive analysis, frequencies of the total words achieved by both deaf and hearing participants were computed for the different types of measurement instruments employed. To identify the most robust homogeneity of participants concerning the applied variables, non-hierarchical and hierarchical Cluster Analyses were employed. The research results indicate a significant lag in the use of adverbial clauses for location, writing, reading, and understanding words presented in three-dimensional, rebus, and distorted forms among deaf children in comparison to their hearing peers. The Cluster Analysis revealed the most significant linkage between the variable “Number of used adverbial clauses for location” and the variable “Number of recognized words presented in three-dimensional form.” This link was clustered with the variable “Number of written words presented in rebus form” and the variable “Number of written words presented in three-dimensional form.” An analysis of variance for isolated clusters identified a statistically significant difference in the entire measurement space of adverbial clauses for location, three-dimensional, rebus, and distorted forms of words, with a level of statistical significance at p=0.00.

Syringocystadenoma papilliferum is a benign cutaneous adnexal tumor of eccrine and apocrine glands, with a warty appearance that is usually found on the scalp, neck and face, much less frequently appears in the chest or abdomen and extremely rarely on the female genital organs, i.e. the vulva. We present a case of Syringocystadenoma papilliferum on the vulva of a 64-year-old woman. This case illustrates the atypical location of this rare disease and adds to the differential diagnosis of lesions on the vulva.

COVID-19 offers many valuable lessons, many of which could be found in unique societies like Hong Kong. The metropolis is special for its drastically varying—good and bad—COVID-19 performances. Hong Kong was widely considered a pandemic control and containment success for maintaining a remarkably low number of COVID-19 infections and deaths, until it was not. In March 2022, for instance, Hong Kong had the world’s highest COVID-19 infection rates. As Hong Kong shares many similarities with other metropolises around the world, it is important to learn the hard-earned lessons from its failure to control infections. Drawing insights from the literature and our own research, this analysis aims to identify key lessons societies could gain from Hong Kong’s COVID-19 responses to ensure better preparation for future pandemics.

The study investigated the extraction yield of defatted Silybum marianum seed samples using maceration as the sole extraction technique. Different solvent types (methanol, ethanol, and water) and extraction durations were tested. Prior to extraction, the samples were ground and defatted with n-hexane. For each combinationofsolvent type, and extraction duration, the extracted mass (g of extract/g of defatted sample) was determined. The impact of each parameter on the yield was analyzed, revealing significant effects.Results showed that water-based maceration for 4 hours yielded the highest average mass of dry extract, followed by shorter durations at 2 hours. Ethanol occasionally outperformed methanol, particularly at the 2-hour mark, but methanol consistently produced lower yields across longer extraction durations. These findings emphasize the need for careful optimization of solvent type and extraction duration to maximize extraction yield.Subsequent analysis using Tukey's HSD test revealed significant differences in dry extract mass among solvents. Water yielded the highest at 2 and 4 hours, ethanol at 4 hours, and methanol at 4 hours as well. KEYWORDS:Silybum marianum;maceration;solvent types;plant extraction,yield analysis

Background Poorly regulated and insufficiently maintained medical devices (MDs) carry high risk on safety and performance parameters impacting the clinical effectiveness and efficiency of patient diagnosis and treatment. After the MD directive (MDD) had been in force for 25 years, in 2017 the new MD Regulation (MDR) was introduced. One of the more stringent requirement is a need for better control of MD safety and performance post-market surveillance mechanisms. Objective To address this, we have developed an automated system for management of MDs, based on their safety and performance measurement parameters, that use machine learning algorithm as a core of its functioning. Methods In total, 1997 samples were collected during the inspection process of defibrillator inspections performed by an ISO 17020 accredited laboratory at various healthcare institutions in Bosnia and Herzegovina. This paper presents solution developed for defibrillators, but proposed system is scalable to any other type of MDs, both diagnostic and therapeutic. Results Various machine learning algorithms were considered, including Decision Tree (DT), Random Forest (RF), Naïve Bayes (NB) and Logistic Regression (LR). In addition, random forest regressor and XG Boost algorithms were tested for their predictive capabilities in the field of defibrillator output error prediction. These algorithms were selected because of their ability to handle large datasets and their potential for achieving high prediction accuracy. The highest accuracy achieved on this dataset was 94.8% using the Naive Bayes algorithm. The XGBoost Regressor with its r2 of 0.99 emerged as a powerful tool, showcasing exceptional predictive accuracy and the ability to capture a substantial portion of the dataset's variability. Conclusion The results of this study demonstrate that clinical engineering (CE) and health technology management (HTM) departments in healthcare institutions can benefit from proposed automatization of defibrillator maintenance scheduling in terms of increased safety and treatment of patients, on one side, and cost optimization in MD management departments, on the other side.

Honey and honeydew are natural foods with a very complex composition that contain both, organic and inorganic ingredients. Regardless of the progress of the industry, it can't be replaced by some production process.The quality of honey varies from year to year, and bees can never produce the same honey and honeydew. Weather conditions, grazing, treatment of bees, proximity to industry, roads, etc., greatly affect the quality of the obtained honey. Although minerals and heavy metals are minor constituents of honey, they play a vital role in determining its quality.The goal of the research is to assess the qualitative status of honey based on the content of contaminants, heavy metals from the area of the Tuzla Canton.The research was conducted on 30 (thirty) honey samples. The samples were collected in the period September/October 2022 and constitute the grazing of the specified year.In the samples that were the subject of research, As and Cd did not exceed the limit of quantification (LOQ = 0.009 mg/kg). Current regulations does not define MRL’s for these two metals. As for the quantified amount of lead (Pb), it was the same in 12 samples and in 11 samples there was an evident deviation from the MRL. The measured lead (Pb), values range from 0.06 to 5.34 mg/kg.The quality of bee products from the aspect of contamination with heavy metals can serve as bioindicator of environmental pollution, that is, as an indicator of the level of good beekeeping practices. KEYWORDS:honey; honeydew; heavy metals; Tuzla canton

Currently, humanity is facing two existential problems: the constant reduction of fossil fuel supplies, primarily crude oil, and global climate change, which is a direct consequence of the increasing use of fossil fuels both in industry and in the transport sector[1,2].One of the possible solutions for these problems arebiofuels, fuels obtained from renewable raw materials, as it isbiodiesel [2], which attracted attention due to characteristics such as high degradability, non-toxicity and low emission of carbon monoxide, particulate matter and unburned hydrocarbons, as well as the possibility of being used either in a mixture with fossil with diesel or independently as 100% biodiesel fuel[3,4,5,6].Heterogeneous catalysts in transesterification processes, i.e. biodiesel production, have been an area of significant and extensive research for many years.It is noticeable that there are significantly fewer works in which the application of Ca(OH)2, was investigated, and the published works show conflicting results, both in terms of its catalytic activity and in terms of the achieved yield of fatty acid methyl esters (FAME).The main goal of this work was to analyze the physico-chemical, chemical, mineralogical, morphological and surface characteristics of hydrated lime produced by Stamal Ltd.Kreševo, with the aim of examining the possibility of its application as a catalyst in the process of transesterification of vegetable oils.The obtained results unequivocally show that by using this hydrated lime as a catalyst in the transesterification process of rapeseed oil, it is possible to achieve a yield of methyl esters that meets the minimum limit of 96.5% prescribed by the European standard for biodiesel, EN 14214. KEYWORDS:biodiesel, heterogeneous catalysts, hydrated lime

Purpose: This paper aims to analyze the core emotional and motivational factors influencing serial killers, particularly examining the role of traumatic childhood experiences and psychological disorders in the development of violent tendencies. The study seeks to enhance the understanding of the psychological profiles of serial killers, ultimately providing insights that can inform ethical judicial strategies for identifying and preventing serial homicides. Methodology: A qualitative approach is employed, utilizing psychological, behavioral, and developmental models to comprehensively map the psychological profiles of serial killers. Case studies are examined, emphasizing how early trauma and psychological disorders shape behavior. A comparative analysis investigates key emotional motives and patterns, focusing on the correlation between traumatic experiences and recurrent violent behaviors. Additionally, clinical assessments and available case data are utilized to identify common patterns and individual variations in psychological disorders. Findings: The analysis indicates that a combination of early traumas, psychological disorders, and emotional patterns, such as impulsivity, lack of empathy, and aggression, significantly prevails among serial killers. Traumatic childhood experiences not only shape individual behavior but also play a crucial role in the development of violent tendencies and complex psychological disorders. The interconnection between emotional factors and psychological disorders enables a deeper understanding of the psychological profiles of serial killers, aiding researchers and practitioners in grasping the mechanisms that drive such behavior. The analysis of specific cases reveals a correlation between traumatic experiences and criminal behavior, suggesting that emotional patterns, such as the desire for power and revenge, often reflect internal conflicts or deep-seated trauma. These findings illuminate the complex relationship between emotional dynamics and criminal behavior, providing important insights that can enhance judicial strategies. Understanding these psychological aspects can assist in the development of more effective identification and intervention methods, contributing to an ethical approach in working with individuals who have committed serious crimes. Unique Contributions To Theory, Practice and Policy: This study makes several unique contributions to the fields of psychology and criminology by integrating the understanding of early trauma, psychological disorders, and emotional patterns into the analysis of serial killers' motivations. Theoretically, it expands existing frameworks by emphasizing the interplay of these factors, thereby enriching our comprehension of criminal behavior. In practice, the findings provide valuable insights for law enforcement and mental health professionals, highlighting the importance of a nuanced understanding of the psychological profiles of serial killers. This knowledge can inform more effective investigative techniques and interventions aimed at preventing serial homicides. Policy-wise, the recommendations advocate for the incorporation of these insights into judicial strategies, fostering ethical identification and prevention measures that consider the psychological and sociocultural contexts of serial offenders. By bridging the gap between theory and practice, this study aims to contribute to more informed decision-making processes within the criminal justice system, ultimately enhancing the safety and well-being of communities.