Background: The optimal management of patients with isolated posterior cerebral artery occlusion is uncertain. We compared clinical outcomes for endovascular therapy (EVT) versus medical management (MM) in patients with isolated posterior cerebral artery occlusion. Methods: This multinational case-control study conducted at 27 sites in Europe and North America included consecutive patients with isolated posterior cerebral artery occlusion presenting within 24 hours of time last well from January 2015 to August 2022. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The coprimary outcomes were the 90-day modified Rankin Scale ordinal shift and ≥2-point decrease in the National Institutes of Health Stroke Scale. Results: Of 1023 patients, 589 (57.6%) were male with median (interquartile range) age of 74 (64–82) years. The median (interquartile range) National Institutes of Health Stroke Scale was 6 (3–10). The occlusion segments were P1 (41.2%), P2 (49.2%), and P3 (7.1%). Overall, intravenous thrombolysis was administered in 43% and EVT in 37%. There was no difference between the EVT and MM groups in the 90-day modified Rankin Scale shift (aOR, 1.13 [95% CI, 0.85–1.50]; P=0.41). There were higher odds of a decrease in the National Institutes of Health Stroke Scale by ≥2 points with EVT (aOR, 1.84 [95% CI, 1.35–2.52]; P=0.0001). Compared with MM, EVT was associated with a higher likelihood of excellent outcome (aOR, 1.50 [95% CI, 1.07–2.09]; P=0.018), complete vision recovery, and similar rates of functional independence (modified Rankin Scale score, 0–2), despite a higher rate of SICH and mortality (symptomatic intracranial hemorrhage, 6.2% versus 1.7%; P=0.0001; mortality, 10.1% versus 5.0%; P=0.002). Conclusions: In patients with isolated posterior cerebral artery occlusion, EVT was associated with similar odds of disability by ordinal modified Rankin Scale, higher odds of early National Institutes of Health stroke scale improvement, and complete vision recovery compared with MM. There was a higher likelihood of excellent outcome in the EVT group despite a higher rate of symptomatic intracranial hemorrhage and mortality. Continued enrollment into ongoing distal vessel occlusion randomized trials is warranted.

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The fibrosis of the LA, which is characteristic of AF, causes mechanical dysfunction of the LA and may also be present in patients without LA enlargement. LA strain represents a surrogate marker of this mechanical dysfunction. Early detection of LA dysfunction may be crucial in identifying patients who are more likely to experience AF recurrence following cardioversion and ablation. Before cardioversion and ablation, the probability of AF recurrence might be predicted, which could lead to better patient selection, an individualized therapeutic strategy with reduced risk and focused follow-up. Purpose The aim of this study was to evaluate the additional predictive value of LA function assessed by using strain echocardiography for early AF recurrence after cardioversion and ablation. Methods 94 patients diagnosed with symptomatic persistent atrial fibrillation (EHRA symptom score ≥3 (mean age 59.4 ± 12.2 years, 58% male, 42%female), preserved LV ejection fraction were prospectively analyzed. In 39 (41,5%) patients pharmacological cardioversion was done after saturation with antiarhythmic drugs,in 27 (28,7%) patients planed electrical cardioversion was done after medical saturation with antiarrhythmic drugs and failure of pharmacological cardioversion, and in 28 (29,8%) patients planed RF ablation was performed. Complete echocardiography evaluation including strain and volume index LA was performed before cardioversion and ablation. The rhythm evaluation was done in the first month after cardioversion and RF ablation (35±5 days). The primary endpoint was persistent AF recurrence. Results 29 (30,8%) patients had AF recurrence in the overall study population, independently of duration of AF or method of rhythm control. Peak atrial longitudinal strain (PALS) ≤15% had the highest incremental predictive value for AF recurrence (HR =8.42, 95% CI: 3.17–25.12, p < 0.001). In patients with non-dilated LA, PALS≤15% remained an independent predictor of AF recurrence (HR = 5.32, 95% CI: 1.77–17.42, p = 0.005). Conclusion This study shown that, in addition to LA dilatation, LA function as determined by PALS can provide a prognostic value for early AF recurrence after cardioversion or ablation. PALS also predicted AF recurrence in patients with nondilated LA. These findings highlight the additional prognostic usefulness of LA strain and recommend its implementation in the systematic assessment of AF patients prior to the choice of rhythm/rate control.

In the strong-field ionization of atomic and molecular systems, the photoelectron is exposed to the long-range Coulomb force which is neglected in the standard theories based on the strong-field approximation (SFA). We introduce an ansatz which takes into account the Coulomb effects and at the same time is as simple as the standard SFA. Our Coulomb distorted plane wave-Volkov approximation provides analytical expressions for the relevant matrix elements. We also present a generalization of this approximation taking into account first-order term of an expansion in the atomic potential. Similarly as in the standard improved SFA, this generalized approximation describes well the rescattering plateau and the cutoff observed in the photoelectron spectra. Our new approximation is illustrated with numerical examples of strong-field ionization of the hydrogen atom exposed to linearly and circularly polarized laser pulses. The spectra obtained are slightly flatten in comparison with the SFA spectra and this effect is stronger for shorter laser wavelengths.

Occupational exposure in Bosnia and Herzegovina is regulated by the national regulation on radiation protection for occupational and public exposure. All radiation workers are required to be monitored using whole body passive thermoluminescent dosemeters and, in case of non-uniform external exposures, by dosemeters that would indicate dose to the most affected body parts. Exposed workers are almost exclusively employed in the medical field, and some of them work in nuclear medicine departments where they handle unsealed radioactive sources. Introduction of the positron emission tomography-computed tomography (PET-CT) in two largest clinical centers in the country was expected to cause the increase of equivalent doses to hands received by staff handling the positron emitting radionuclides. Hence, routine monitoring of finger doses became a necessity. The purpose of this study was to evaluate the available data on monitoring with ring dosemeters during PET-CT procedure in two hospitals in Bosnia and Herzegovina and compare them with other practices in the nuclear medicine department, as well as with the results of monitoring in other countries. In general, results confirm that effective doses, as well as equivalent doses to hands, are well below annual dose limits. Finger dosemeters have been proven to be an invaluable asset in the incidental situations that sometimes occur in nuclear medicine departments. Different number of patients and differences in injection methodologies are identified as a possible source of differences between doses in two hospitals. Overall, routine evaluation of doses to hands provides a sound basis for possible optimization processes, as well as confirmation of good practices.

Sleep is essential to physical and mental health. However, the traditional approach to sleep analysis—polysomnography (PSG)—is intrusive and expensive. Therefore, there is great interest in the development of non-contact, non-invasive, and non-intrusive sleep monitoring systems and technologies that can reliably and accurately measure cardiorespiratory parameters with minimal impact on the patient. This has led to the development of other relevant approaches, which are characterised, for example, by the fact that they allow greater freedom of movement and do not require direct contact with the body, i.e., they are non-contact. This systematic review discusses the relevant methods and technologies for non-contact monitoring of cardiorespiratory activity during sleep. Taking into account the current state of the art in non-intrusive technologies, we can identify the methods of non-intrusive monitoring of cardiac and respiratory activity, the technologies and types of sensors used, and the possible physiological parameters available for analysis. To do this, we conducted a literature review and summarised current research on the use of non-contact technologies for non-intrusive monitoring of cardiac and respiratory activity. The inclusion and exclusion criteria for the selection of publications were established prior to the start of the search. Publications were assessed using one main question and several specific questions. We obtained 3774 unique articles from four literature databases (Web of Science, IEEE Xplore, PubMed, and Scopus) and checked them for relevance, resulting in 54 articles that were analysed in a structured way using terminology. The result was 15 different types of sensors and devices (e.g., radar, temperature sensors, motion sensors, cameras) that can be installed in hospital wards and departments or in the environment. The ability to detect heart rate, respiratory rate, and sleep disorders such as apnoea was among the characteristics examined to investigate the overall effectiveness of the systems and technologies considered for cardiorespiratory monitoring. In addition, the advantages and disadvantages of the considered systems and technologies were identified by answering the identified research questions. The results obtained allow us to determine the current trends and the vector of development of medical technologies in sleep medicine for future researchers and research.

Background: Patients with acute pulmonary embolism (PE) may have various types of atrial fibrillation (AF). The role of AF in hemodynamic states and outcomes may differ between men and women. Methods: In total, 1600 patients (743 males and 857 females) with acute PE were enrolled in this study. The severity of PE was assessed using the European Society of Cardiology (ESC) mortality risk model. Patients were allocated into three groups according to their electrocardiography recordings taken during hospitalization: sinus rhythm, new-onset paroxysmal AF, and persistent/permanent AF. The association between the types of AF and all-cause hospital mortality was tested using regression models and net reclassification index (NRI) and integrated discrimination index (IDI) statistics with respect to sex. Results: There were no differences between the frequencies of the types of AF between men and women: 8.1% vs. 9.1% and 7.5% vs. 7.5% (p = 0.766) for paroxysmal and persistent/permanent AF, respectively. We found that the rates of paroxysmal AF significantly increased across the mortality risk strata in both sexes. Among the types of AF, the presence of paroxysmal AF had a predictive value for all-cause hospital mortality independent of mortality risk and age in women only (adjusted HR, 2.072; 95% CI, 1.274–3.371; p = 0.003). Adding paroxysmal AF to the ESC risk model did not improve the reclassification of patient risk for the prediction of all-cause mortality, but instead enhanced the discriminative power of the existing model in women only (NRI, not significant; IDI, 0.022 (95% CI, 0.004–0.063); p = 0.013). Conclusion: The occurrence of paroxysmal AF in female patients with acute PE has predictive value for all-cause hospital mortality independent of age and mortality risk.

We present constraints on the left-handed dimension-6 interactions that contribute to semileptonic and leptonic decays of K, D, pions and to nuclear beta decay. We employ the flavour covariant description of the effective couplings, identify universal CP phases of New Physics and derive constraints from decay rates and CP-odd quantities. As a result, we can predict the maximal effects of such flavoured NP in D decays from stringent K decay constraints and vice-versa.

RATIONALE Tobacco smoking and air pollution are primary causes of chronic obstructive pulmonary disease (COPD). However, only a minority of smokers develop COPD. The mechanisms underlying the defense against nitrosative/oxidative stress in non-susceptible smokers to COPD remain largely unresolved. OBJECTIVES To investigate the defense mechanisms against nitrosative/oxidative stress that possibly prevent COPD development or progression. METHODS Four cohorts were investigated: (1) sputum samples (healthy, n=4; COPD, n=37), (2) lung tissue samples (healthy, n=13; smokers without COPD, n=10; smoker+COPD, n=17), (3) pulmonary lobectomy tissue samples (no/mild emphysema, n=6) and (4) blood samples (healthy, n=6; COPD, n=18). We screened 3-nitrotyrosine (3-NT) levels, as indication of nitrosative/oxidative stress, in human samples. We established a novel in vitro model of a cigarette smoke extract (CSE)-resistant cell line and studied 3-NT formation, antioxidant capacity, and transcriptomic profiles. Results were validated in lung tissue, isolated primary cells and an ex vivo model using adeno-associated virus-mediated gene transduction and human precision-cut lung slices (hPCLS). MEASUREMENTS AND MAIN RESULTS 3-NT levels correlate with COPD severity of patients. In CSE-resistant cells, nitrosative/oxidative stress upon CSE was attenuated, paralleled by profound upregulation of heme-oxygenase-1 (HO-1). We identified carcinoembryonic-antigen-related-cell-adhesion-molecule-6 (CEACAM6) as a negative regulator of HO-1-mediated nitrosative/oxidative stress defense in human alveolar type 2 epithelial cells (hAEC2). Consistently, inhibition of HO-1 activity in hAEC2 increased the susceptibility towards CSE-induced damage. Epithelium-specific CEACAM6 overexpression increased nitrosative/oxidative stress and cell death in hPCLS upon CSE treatment. CONCLUSIONS CEACAM6 expression determines the hAEC2 sensitivity to nitrosative/oxidative stress triggering emphysema development/progression in susceptible smokers.

The Message Queuing Telemetry Transport (MQTT) protocol is one of the most widely used IoT protocol solutions. In this work, we are especially interested in open-source MQTT Broker implementations (such as Mosquitto, EMQX, RabbitMQ, VerneMQ, and HiveMQ). To this end, we engineer a network testbed to experimentally benchmark the performance of these implementations in an edge computing context with constrained devices. In more detail, we engineer an automated deployment and orchestration of the containerized MQTT broker implementations, with support for deployment across either moderately powerful AMD64 devices, or more resource constrained ARM64 devices. The proposed MQTT implementations are evaluated in terms of overhead response time and different payload sizes. Results showed that the hardware platform used as well as the message size, and the network parameters (latency, packet loss and jitter) have a significant impact on the performance differences between the brokers. All results, software tools and code are fully reproducible and free and open source.

Courses in principles of digital computers usually begin with elementary logic circuits, proceed through increasingly complex ones, and often end with the design of a central processing unit. Such processors are typically simpler to explain than commercial microprocessors, but also often have very limited capabilities. The educational processor presented in this paper has a good balance between simplicity and capabilities. All its instructions, including multiplication and bit rotation, are executed in one clock cycle. The method of encoding and decoding instructions is quite simplified so that the encoding of instructions can be done even manually without tables, and the decoder unit is a simple forwarding of parts of the instruction word to the control bits of multiplexers. The processor is symmetric around the number 16: it has 16 three-operand instructions, 16 registers, each register is 16 bits wide, as well as the address and data bus. It is simulated at the logic gates level, a Verilog implementation on FPGA, and an emulated computer run by an implementation of a Forth interpreter written partly in its machine language.

Introduction: Stress among students is a growing problem. As emotional stress increases, the limbic structures and hypothalamus are stimulated, activating the gamma efferent system, which ultimately leads to an increase in muscle tone or additional muscle activity that can become repetitive behaviors such as bruxism. The aim of the study was to investigate the stress level that students are exposed to, to determine the difference between students in terms of gender, faculty, and year of study, and to evaluate the possible relationship between stress level and self-reported bruxism in college students during the pandemic COVID-19. Methods: In April 2022, a cross-sectional study was conducted on a sample of students from the Faculty of Dentistry and the Faculty of Pharmacy at the University of Sarajevo (BiH). The students answered a questionnaire consisting of two parts: The first part contained questions on basic personal data and data on self-reported bruxism and the second part contained questions on the perceived stress scale (PSS). Results: The study included 756 students from both faculties. Analysis of stress levels among students revealed higher stress levels. Female students were more likely to be under stress than male respondents. Students in the Faculty of Pharmacy were more likely to be stressed than students in the Faculty of Dentistry. At the Faculty of Pharmacy, there was no difference in stress levels between the different years of study, while at the Faculty of Dentistry, the individual score for PSS was highest among 1st-year students. A high prevalence (46.8%) of self-reported bruxism was found among students in both faculties. Conclusion: A slight positive correlation between self-reported bruxism and stress suggests that it is important to implement stress management strategies during academic education and to prevent bruxism and its consequences.

Support channels represent a unique opportunity to improve customer satisfaction by offering a consistent experience in resolving customer issues. Several surveys show that customers have raised their standards of customer support services. While only a few years ago customers willingly waited a long time to speak with one of the service agents and were patient for their problem to be resolved, today’s customers have very limited patience and want a solution to the problem immediately. Customers don’t want to settle for a mediocre support channel experience. Support channels must provide superior service capacities so that customers see that the company values their choice and time. Efficient management of support centers implies accurate modeling of customer behavior on hold. The subject of our research is the application of data research techniques for predicting customer behavior in support channels. In this paper, we apply machine learning methods to predict customer behavior. Based on historical data in the service system, we use classification algorithms to predict customer patience in service channels.

Software processes consist of a complex set of activities required to deliver software products within predicted quality, costs, and deadlines. To accomplish such goals, a software organization needs a quality and mature software process as a prerequisite for success. Adopting Software Capability Maturity Model Integration (CMMI) represents a well-known path in the pursuit of mature software processes. However, its implementation is a subject of a permanent effort that implies different approaches and methods, and often leads to unsuccessful or limited success, though. This is especially emphasized in small software companies given the dynamic environment influenced by different factors, including insufficient resources, changes in technology, and staff turnover. In this paper, a case study of a small software company implementing software process improvement is presented. In a tailored approach to process improvement, a specific method using the balanced scorecard as input into the IDEAL model has been designed, enabling a narrow link between business goals and specific improvement goals. The results show that the software process and selected performance indicators were improved, and suggest the potential of the proposed approach in small organizations.