Introduction: Rescue stenting (RS) is a recognized bailout strategy following failed endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). First-line stenting (FLS) has emerged as a potential alternative to avoid vascular injury and improve outcomes. However, direct comparisons between these strategies remain limited. Methods: We conducted a comparative analysis of FLS and RS using data from the RESISTANT registry, an international, multicenter, retrospective cohort of AIS patients who received intracranial stenting during EVT from 2016 to 2023. Patients were categorized by stenting strategy: FLS (stent placed without prior thrombectomy) or RS (stent placed after failed thrombectomy). The primary effectiveness outcome was functional independence (modified Rankin Scale [mRS] 0–2) at 90 days. The primary safety outcome was symptomatic intracranial hemorrhage (sICH). Propensity score inverse probability of treatment weighting (IPTW) was used to adjust for baseline differences. Results: Among 827 patients, 723 were in the RS cohort and 104 in the FLS cohort. Compared to RS, FLS patients more often had diabetes (46.2% vs. 35.2%, p =0.03), prior stroke (46.2% vs. 25.3%, p <0.001), prior antiplatelet use (50.0% vs. 27.7%, p <0.001), and known ICAS (28.8% vs. 6.0%, p <0.001). They also had lower baseline NIHSS scores at presentation (median 8 vs. 14, p <0.001) and shorter onset-to-recanalization times (median 363 vs. 392 min, p =0.006). After IPTW adjustment, functional independence was similar between groups (OR=0.64; 95% CI 0.38–1.07), as was the risk of sICH (OR=0.93; 95% CI 0.34–2.59). No significant differences were observed in secondary outcomes including successful reperfusion, mortality, or procedural complications. Outcomes were similar in both the anterior circulation subgrou (n=589; functional independence: OR=0.62; 95% CI 0.60–1.25; sICH: OR=0.81; 95% CI 0.30–2.18) and the posterior circulation subgroup (n=234; functional independence: OR=0.82; 95% CI 0.32–2.10; sICH: OR=0.81; 95% CI 0.30–2.18). Conclusion: FLS and RS strategies during EVT for AIS demonstrated comparable safety and efficacy. Prospective, randomized trials are needed to better define optimal treatment approaches.

Health literacy (HL) and physical literacy (PL) are hypothesized to be important determinants of physical activity (PA) in older individuals. The aim of the study was to evidence possible associations between PL, HL, and PA, evidencing structural comparison of exercising and nonexercising postmenopausal women. The sample included 62 females (+60 years of age) divided into exercising (E; n=37) and nonexercising groups (NE; n=25). Participants were tested on HL (via the European Health Literacy Survey Questionnaire), PL (via the Perceived Physical Literacy Questionnaire), and PA (via the Nordic Physical Activity Questionnaire – short) in controlled settings. Group-specific Pearson’s correlation matrices were calculated to examine associations among PL, HL, and PA. Between-group differences in correlations were tested using Fisher’s z-transformation with false discovery rate correction, and structural patterns were further explored using correlation network analysis. Fisher’s z tests identified significant between-group differences in selected associations, with E women showing a stronger bridging role of PL and weaker cognitive constraints on PA. Network analyses further demonstrated greater connectivity and cognitive dominance in NE women, whereas E women exhibited more differen- tiated and functionally organized relational structures. The results suggest that PA-related interventions targeting older women should move beyond information provision and explicitly promote PL development.

BACKGROUND Minimally invasive surgery is rapidly expanding globally, yet there is insufficient knowledge of how to scale this technology safely and equitably across diverse health systems. We aimed to identify health-system factors associated with safe implementation of minimally invasive surgery globally, using minimally invasive cholecystectomy as a tracer procedure. METHODS We conducted a multicentre, prospective cohort study of consecutive adults undergoing cholecystectomy between July 31 and Nov 19, 2023, in 1218 hospitals across 109 countries. Data were collected by more than 10 000 health-care workers using a core measurement set mapped to the WHO Health System Building Blocks and the Global Patient Safety Action Plan. The primary outcome was 30-day procedure-specific complications, with multilevel logistic regression used to examine associations between health-system features and patient outcomes. This study is registered on ClinicalTrials.gov (NCT06223061). FINDINGS Among 52 187 included patients, the adjusted procedure-specific complication rate varied 40-fold between hospitals, from 0·3% in the lowest risk quintile to 12·1% in the highest risk quintile. Despite large structural differences across income groups in access to minimally invasive surgery, diagnostics, and emergency services, country income level was not independently associated with complication rates (adjusted odds ratio [OR] 0·81 [95% CI 0·59-1·10] for upper-middle income vs high income and 0·99 [0·70-1·39] for lower-middle income or low income vs high income). Three modifiable hospital-level factors were strongly associated with safer outcomes: establishment of local simulation-based training facilities (adjusted OR 0·78 [0·71-0·86]; p<0·0001), adoption of intraoperative safety and communication strategies (0·87 [0·79-0·96]; p=0·0046), and on-site CT diagnostics (0·79 [0·65-0·97]; p=0·0220). Training facilities showed the greatest benefit in hospitals with limited infrastructure and an inexperienced workforce: the number needed to treat to prevent a procedure-specific complication was 21 (95% CI 14-35; p<0·0001). INTERPRETATION Safe implementation of minimally invasive surgery varies widely worldwide but is not defined by national income level; differences in outcomes reflect the ability of health systems to adopt and safely deploy new surgical techniques. We identified for the first time that the presence of local simulation-based training facilities is independently associated with improved patient outcomes. Simulation appears to be fundamental to the safe delivery of minimally invasive surgery, particularly in resource-constrained settings. Together with safety systems and diagnostic capacity, these findings offer actionable targets for health systems seeking to equitably scale up essential surgical technologies. FUNDING NIHR Global Health Research Unit and Wellcome Leap SAVE Programme.

Modification of the contents of alloying elements with a narrower interval of Cr, Ni and Al can be obtained austenitic-martensitic steel 17-7PH which by, a subsequent heat treatment, can have values of mechanical and chemical properties required for components of automotive engine. Studies have confirmed that the rod dimensions 16mm made of steel 17-7PH with modified content of chromium, nickel and aluminum in combination with heat treatment solution annealing and precipitation hardening, gave values of mechanical properties, satisfying the requirements for steel with standard chemical composition.After aging was obtained martensitic austenitic microstru-cture, with a high percentage of martensite with a slight presence of delta ferrite.

This study aims to examine how the design of the work environment and its key dimensions—job design, employee involvement in goal setting and decision-making, as well as teamwork practices and open communication—affect productivity, organizational identification, and workforce stability in organizations in Bosnia and Herzegovina. Using a quantitative research approach and linear regression analysis on a sample of employees from the industrial sector, the results indicate that the work environment exerts a statistically significant and consistent effect on all observed outcomes. Among the analyzed components, employee involvement in decision-making proved to be the most significant factor, indicating that a sense of appreciation and the ability to influence one's own work have a strong effect on employees' motivation, loyalty, and willingness to stay in the organization. The results show that the impact of work environment design on employee performance is largely realized through strengthening employees’ connection to the organization. When the work environment is designed to ensure pleasant working conditions in which employees are actively involved in work processes, it becomes a powerful source of employee motivation and engagement. Therefore, a policy of adequately designing the work environment does not represent merely a short-term solution, but rather a realistic and sustainable approach to strengthening organizational stability and long-term success.

This study explores first-year Electrical Engineering and Computer Science students’ use and perception of artificial intelligence (AI) tools in a programming course, and their preferences for future development. We conducted an anonymous exploratory survey, consisting of items with predefined response options and open-ended items. Responses to the former and open-ended items were analyzed using descriptive statistics and inductive thematic analysis, respectively. Additionally, we clustered students using the Affinity Propagation algorithm based on their expressed preferences for possible improvements of AI tools The findings show that AI tools are not universally effective, with seven student clusters identified based on differing needs and expectations. Students expressed a need for AI tools that offer more detailed error explanations and guidance rather than just delivering correct solutions. The most common concern among students is the provision of correct solutions without adequate explanations of the underlying mistakes, leading to a lack of deeper understanding This study takes an exploratory approach by examining students’ perceptions and preferences for the design and capabilities of AI tools in helping them learn programming. Clustering students by preferences reveals distinct approaches that may be needed for different groups of learners. Given the limited research on such desires or on applying clustering to them, our analysis offers valuable insights into distinct viewpoints that can guide the design of future personalized educational AI tools

OBJECTIVES Aortic stenosis (AS) is the most common valvular heart disease, with transcatheter aortic valve implantation (TAVI) now preferred for select severe cases. This study evaluated the early safety and performance of the new Myval Octacor Transcatheter Heart Valve (THV) (Meril Life Sciences), for which limited clinical data exist. METHODS The authors retrospectively analyzed 43 consecutive patients with severe AS who underwent TAVI using the Myval Octacor THV at a tertiary cardiac center. Primary outcomes included all-cause mortality, stroke, major vascular complications, conduction abnormalities, new pacemaker implantation, paravalvular leak, and valve failure at 30 days follow-up. RESULTS The median age was 81 years (IQR: 7), and 22 patients (51.2%) were female. Coronary artery disease was present in 24 (55.8%). Technical success rate was 100%. Mean pressure gradient decreased significantly post-procedure (55 mm Hg [IQR: 24] vs 5 mm Hg [IQR: 2]; P ≤ .001). No in-hospital deaths occurred. Two patients (4.7%) received permanent pacemakers during hospitalization, and 3 (7.0%) required pacemakers within a week because of conduction issues. Two patients (4.7%) experienced Bleeding Academic Research Consortium Type 3a bleeding. At 30 days, 42 patients remained in follow-up (98%), with 55% improved to New York Heart Association Class I. No vascular complications, stroke, acute kidney injury, valve thrombosis, or endocarditis occurred. One patient had valve failure from a significant paravalvular leak and 1 noncardiac death occurred 2 weeks post-discharge. CONCLUSIONS Early outcomes suggest that the Myval Octacor THV is a safe and effective option for TAVI in severe AS; however, larger studies with longer follow-up are required.

Na temelju sačuvanih bilježaka Balda Bogišića i drugih dostupnih izvora rad analizira Bogišićevu ulogu u procesu pregovora o sadržaju bračnog ugovora između crnogorske princeze Jelene Petrović Njegoš i talijanskog prijestolonasljednika Viktora Emanuela III. Pregovori su održani u Rimu u listopadu 1896. godine, a rezultirali su potpisivanjem ugovora čije su odredbe uključivale niz pravnih, dinastičkih i međunarodnih pitanja. U radu se ukazuje na to kako je cijeli proces predstavljao diplomatsku misiju najviše razine u okviru koje su Bogišićev pravni autoritet i diplomatska vještina bili izrazito važni za zaštitu interesa Crne Gore.

Abstract This research investigates the technological underpinnings of Local Flexibility Markets (LFMs). It delves into the synergistic relationship between Information Technology (IT) and Operational Technology (OT) to ensure seamless LFM operations. A key focus is on the Information and Communications Technology (ICT) architecture, which plays a pivotal role in LFM functionality. The research addresses the critical aspect of interoperability within LFMs. It explores standardized data formats for electricity markets, the Common Information Model (CIM) for efficient data exchange, and relevant standards such as the Common Distribution Power System Model Profile (CDPSM) and the Common Grid Model Exchange Standard (CGMES). To ensure secure data exchange, the research investigates various ICT protocols and the significance of Internet of Things (IoT) protocols in enabling LFMs. It underscores the importance of a layered cybersecurity approach to protect LFM infrastructure and sensitive data. The findings of this research highlight the importance of a robust ICT architecture, coupled with secure data exchange mechanisms, to ensure the interoperability, reliability, and overall success of LFMs.

Sustainable innovation is important in Albania, a small transition economy facing pressures from digitalization, the green transition, and increased competition. Yet the country’s innovation system is still developing, and academia–business linkages remain weak. This article investigates how academia–business (A2B) collaboration contributes to firms’ sustainable innovation, addressing the lack of quantitative evidence from a country in the Western Balkans context. Building on innovation systems and resource-based perspectives, A2B cooperation is conceptualized as a multidimensional latent construct, capturing types of collaboration, key actors, and organizational drivers. Using survey data from 298 firms operating in Albania, collected in 2025, the study applies Covariance-Based Structural Equation Modeling (CB-SEM) to test whether the intensity and quality of A2B cooperation are linked to sustainable innovation outcomes. The findings indicate that collaboration is still limited and inconsistent, dominated by student internships and sporadic joint projects. However, the CB-SEM results confirm that more intensive and better-structured cooperation is strongly associated with higher levels of sustainable innovation. The study offers one of the first CB-SEM-based quantitative assessments of A2B collaboration and sustainable innovation in Albania and provides policy implications for strengthening innovation-oriented partnerships in transition economies.

Education in modern business conditions plays a strategic role in the development of knowledge-based and innovation-driven societies. Investment in education represents one of the key determinants of democratization and the economic empowerment of individuals. The goal of contemporary education is to strengthen professional knowledge and to develop key competencies, including digital skills, which enable individuals to be prepared for new professional challenges and actively participate in current socio-economic trends. This paper aims to analyse, through conducted empirical research, the impact of formal education and acquired digital competencies on employability in the Republic of Serbia. Special emphasis is placed on the relationship between the level of education, digital literacy, and employment opportunities, to provide recommendations for improving educational policies and professional training programs.

Background/Objectives. Ebstein’s anomaly (EA), which accounts for fewer than 1% of congenital heart diseases, and atrioventricular canal defect (AVCD), present in approximately 4–5% of cases, exceptionally coexist, with this combination observed in fewer than 0.5% of patients with AVCD. We aim to report the oldest documented case of a 45-year-old female with the exceptionally rare combination of complete AVCD, EA, and right ventricular hypoplasia and to provide a concise review of these anomalies. Case presentation. Diagnosed in early childhood with a complete AVCD, pulmonary stenosis, and right ventricular (RV) hypoplasia, the patient underwent palliative surgical intervention with a modified Blalock–Taussig shunt at the age of 10 but did not receive subsequent regular follow-up. Over the ensuing 35 years, she remained largely untreated until presentation at 45 years of age with progressive exertional dyspnea, central cyanosis, and palpitations, corresponding to NYHA class III. Comprehensive multimodal imaging, including transthoracic echocardiography and cardiac magnetic resonance, revealed a complete AVCD with moderate-to-severe mitral regurgitation secondary to an anterior mitral leaflet cleft, severe tricuspid regurgitation, RV hypoplasia, and hallmark features of EA. Given the complex cardiac anatomy and the elevated surgical risk, the patient was considered inoperable, and a strategy of conservative management with multidisciplinary follow-up was implemented. Conclusions. This case highlights the exceptional longevity of a patient with the rare coexistence of complete AVCD, EA, and RV hypoplasia, surviving 45 years from diagnosis despite limited early intervention. It underscores the importance of lifelong follow-up in complex congenital heart disease and illustrates the role of multimodal imaging in assessing anatomy and guiding management when surgical options are high-risk or not feasible.

Background: While rescue stenting (RS) is a recognized bailout strategy following failed endovascular thrombectomy (EVT) for acute ischemic stroke with large vessel occlusion (AIS-LVO), first-line stenting (FLS) has emerged as a potential alternative to avoid vascular injury and improve outcomes. However, direct comparisons between these strategies remain limited. We conducted a comparative analysis of FLS versus RS using data from a large, multicenter international registry to evaluate their relative safety and effectiveness. Methods: We conducted a comparative analysis of FLS versus RS using data from the RESISTANT registry, a multicenter, international, retrospective cohort of AIS patients treated with intracranial stenting during EVT (2016-2023). Patients were categorized by stenting strategy: FLS (stent placed without prior thrombectomy) or RS (stent placed after failed thrombectomy). The primary effectiveness outcome was functional independence (modified Rankin Scale [mRS] 0-2) at 90 days; the primary safety outcome was symptomatic intracranial hemorrhage (sICH). Propensity score inverse probability of treatment weighting (IPTW) was used to adjust for baseline differences. Results: Among 827 patients, 723 were in the RS cohort (median age 67 years [IQR 59-77], 64.2% male) and 104 in the FLS cohort (median age 65.5 years [IQR 58.8-77], 72.1% male). Using FLS as the reference strategy, IPTW=adjusted analyses did not detect significant differences in functional independence (OR=0.64; 95% CI 0.38-1.07) or sICH (OR=0.93; 95% CI 0.34-2.59). No significant differences were observed in secondary outcomes including successful reperfusion, mortality, or procedural complications. In the anterior circulation cohort (n=589), outcomes were likewise comparable (functional independence: OR=0.62; 95% CI 0.60-1.25; sICH: OR=0.81; 95% CI 0.30-2.18). Similarly, in the posterior circulation cohort (n=234), no significant differences were found (functional independence: OR=0.82; 95% CI 0.32-2.10; sICH: OR=0.81; 95% CI 0.30-2.18). Conclusions: In this study, no significant differences in safety or effectiveness were detected between FLS and RS strategies during EVT for AIS. Prospective, randomized trials are needed to better define optimal treatment approaches.

Mantle plumes beneath major oceanic hot spots appear to be rooted in unusually large structures near the core-mantle boundary, which have markedly reduced seismic wave speeds. The origin of these large ultralow-velocity zones (ULVZs), referred to as mega-ULVZs, remains uncertain partly because of lack of constraints on the relative reduction in shear versus compressional wave speeds (RS/P). This ratio can give clues into the compositional makeup of the mega-ULVZs. Through joint seismic analysis of core-diffracted P and S waves beneath Hawai’i, we constrain the RS/P of its mega-ULVZ to 1 to 1.3. Mineralogical modeling reveals that iron enrichment via solid iron-rich magnesiowüstite [(Mg,Fe)O] matches this seismic constraint, independent of modeled ULVZ thickness. Enrichment of metallic iron-rich magnesiowüstite likely enhances the thermal conductivity of mega-ULVZs and provides a mechanism to drive localized plume upwelling. Higher reported RS/P values for smaller ULVZs near subduction zones may therefore indicate different processes at play controlling ULVZ formation across the diverse core-mantle boundary landscape.