Background: Hashimoto's thyroiditis (HT) is the most common autoimmune thyroid disease and is characterized by the presence of thyroid peroxidase (anti-TPO) and thyroglobulin (anti-Tg) antibodies. However, the clinical and biochemical factors associated with these antibodies remain incompletely understood. Objective: To evaluate the associations between anti-TPO and anti-Tg antibody levels and demographic, clinical, biochemical, and lifestyle-related factors in patients with HT. Methods: This retrospective cross-sectional study included 100 patients with HT. Clinical, biochemical, and laboratory data were retrospectively collected from medical records. Group comparisons were performed using non-parametric tests, correlations were assessed using Spearman's rank analysis, and multivariable linear regression was used to identify independent predictors of log-transformed anti-TPO and anti-Tg levels. Results: Anti-TPO levels differed significantly according to TSH status and were independently associated with higher TSH concentrations, longer disease duration, and lower BMI. Smoking was the only independent predictor of anti-Tg levels. No significant associations were observed between thyroid autoantibody levels and age, sex, vitamin D status, or family history of thyroid disease. Conclusion: Anti-TPO and anti-Tg antibodies demonstrated distinct clinical associations in patients with HT. These findings support the complementary clinical value of both thyroid autoantibodies and should be confirmed in larger prospective multicenter studies.

Background/Objectives: Postoperative bleeding remains a major complication following coronary artery bypass grafting (CABG), contributing to transfusion requirements, reintervention, and morbidity. The objective of this study was to assess the clinical significance of preoperative platelet function testing and postoperative viscoelastic testing in patients undergoing elective isolated on-pump CABG. Methods: This prospective observational study included 708 patients undergoing surgery between January 2023 and January 2025. Preoperative platelet function was assessed with Multiplate® impedance aggregometry (ADPHS and ASPI), and postoperative coagulation was assessed with ClotPro® after cardiopulmonary bypass. The prespecified Multiplate thresholds were population- and assay-specific and were not intended as universal cutoffs. Postoperative bleeding was defined by cumulative chest-tube drainage during the first 24 h. Results: In unadjusted analyses, low ADPHS values (≤602.5 AU·min) were associated with higher platelet transfusion, cryoprecipitate use, and overall transfusion, and ADPHS showed modest discrimination for blood loss > 500 mL/24 h (AUC = 0.61, p = 0.041). Low ASPI values (≤453 AU·min) were associated with increased cryoprecipitate use and showed modest discrimination for blood loss > 1000 mL/24 h (AUC = 0.62, p = 0.005). After multivariable adjustment for baseline differences, neither ADPHS ≤ 602.5 (adjusted OR 1.01, 95% CI 0.74–1.39, p = 0.936) nor ASPI ≤ 453 (adjusted OR 0.89, 95% CI 0.64–1.23, p = 0.475) was independently associated with postoperative bleeding > 500 mL/24 h. Postoperative ClotPro® parameters showed statistically significant associations with transfusion and bleeding, but their discriminatory performance was limited. Conclusions: Perioperative platelet function and viscoelastic test results were associated with bleeding and transfusion outcomes in unadjusted analyses, but discrimination was modest, and the platelet function cutoffs were not independently associated with bleeding > 500 mL after adjustment. These findings support a complementary hemostatic assessment role for combined POC testing but do not establish a standalone predictive model or an implementable transfusion algorithm.

Physical ability testing is an essential part of police education, as fitness assessments indicate students’ preparedness for police work. Clear documentation and reporting of test protocols and measurement properties are essential for interpreting, evaluating, and comparing the usefulness of different test batteries. Therefore, this scoping review aimed to map the fitness tests used in police education programs internationally, including reporting standards of test protocols, reliability, validity, and sex-based test specificity, thereby providing insight into the physical abilities considered important for police work. The main searches were conducted in the databases CINAHL, PubMed, SPORTDiscus, and Web of Science. The database search yielded 1323 articles, of which 92 met the inclusion criteria. An additional nine articles were included through citation and hand searching. Of the 101 studies, 95 used an average of 4–5 general fitness tests, and 29 included work-related police tests. Test protocols were generally well documented across studies. However, only a few studies included in this review assessed test–retest reliability, and only a limited number of studies, whose primary aim was to validate the tests, evaluated test validity. The most commonly used assessments were upper-body and core muscular endurance (60 s push-up, maximum pull-up, and 60 s sit-up tests), upper-body muscular strength (hand-grip test), lower-body power (standing long jump, and vertical jump tests), and aerobic capacity (20 m multistage fitness, 2400 m Cooper, and 12 min Cooper tests. Only 19 studies reported sex-specific performance standards, including differences in test execution, scoring systems, VO2max estimation, or time limits. The findings indicate that tests of upper-body muscular endurance and strength, lower-body power, and aerobic capacity are among the most frequently measured physical abilities in police education programs internationally, while also highlighting the need for more standardized reporting of test protocols, reliability, and validity.

BACKGROUND Despite a general improvement in the HIV burden over the past two decades, gendered social determinants including intimate partner violence (IPV) continue to affect women's vulnerability to HIV, which could be further exacerbated as resources dwindle over the coming years. Our study aimed to quantify recent trends in the HIV burden, the magnitude of the HIV burden associated with IPV, and the potential impact of declining financial support globally. METHODS Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework, we estimated annual HIV incidence, prevalence, and mortality for 204 countries and territories from 1990 to 2023, disaggregated by age and sex. Input data included national HIV programme reports, population-based serosurveys, clinical and vital registration data, and systematically reviewed literature. Countries and territories were grouped according to the availability and completeness of HIV prevalence and mortality data, with tailored modelling approaches applied for each group. To characterise the potential contributions of IPV to the HIV burden, time series estimates of IPV prevalence by location and effect size estimates were combined to generate population attributable fractions of the HIV burden. To forecast future trends and assess the potential impact of reductions in development assistance for health, we used a non-parametric stochastic frontier approach to estimate how funding levels could affect antiretroviral therapy (ART) coverage. Adjustments in future ART coverage were integrated into our forecasts, altering projected rates of HIV-related incidence and mortality. We compared scenarios with and without funding cuts, quantifying the potential epidemiological effects of reduced ART availability by sex. FINDINGS Between 2003 and 2023, the annual number of new HIV infections declined globally, from 2·85 million (95% uncertainty interval [UI] 2·76-2·96) to 2·06 million (1·88-2·29). Meanwhile, HIV-related deaths decreased from a peak of 1·71 million (1·61-1·83) in 2004 to 0·83 million (0·73-0·96) in 2023. The number of people living with HIV rose from 26·3 million (25·5-27·3) in 2003 to 42·4 million (40·3-44·4) in 2023, reflecting improved survival associated with ART expansion. Although females continued to have higher prevalence of HIV than males in 2023 (23·4 million [22·2-24·6] vs 19·1 million [17·6-20·5]), the gap in incidence between females and males has substantially declined. Regionally, sub-Saharan Africa had the greatest declines in both incidence (64·3%; 58·0-68·6) and mortality (74·6%; 70·4-78·5) between 2003 and 2023, while central Europe, eastern Europe, and central Asia recorded the highest increases in incidence rates (232·1%; 146·5-299·1) and mortality rates (37·8%; 31·2-45·5) during this period. IPV was associated with an estimated 10·7% (1·6-20·4) of HIV-related deaths among females aged 15 years and older globally in 2023, corresponding to 40 700 (6400-80 600) deaths, with the highest population attributable fractions observed in Oceania (17·4%; 2·8-33·1), central sub-Saharan Africa (14·2%; 2·1-29·4), and eastern sub-Saharan Africa (13·2%; 2·0-25·3). Forecasts indicate that funding reductions could decrease ART coverage by 8·1% globally between 2025 and 2030, resulting in approximately 1·6 million new HIV infections among females and 1·3 million new HIV infections among males, alongside 790 600 and 670 600 HIV-related deaths, respectively. These impacts are primarily concentrated in sub-Saharan Africa. INTERPRETATION Despite two decades of substantial progress, the global HIV response remains highly sensitive to gendered social determinants and funding stability. The potential contribution of IPV to HIV-related mortality among women underscores the need for integrated interventions that address violence prevention and post-violence care alongside HIV treatment. The projected effects of funding cuts-millions of additional infections and deaths-highlight the fragility of the gains achieved and the urgent need to protect HIV financing. Achieving and sustaining the UNAIDS 2030 targets will require renewed investment, gender-responsive programming, and resilient health systems capable of providing equitable access to care. FUNDING Gates Foundation and the US National Institute of Allergy and Infectious Diseases.

Background Pharmacogenomics-guided prescribing uses patient genetic information to individualize drug selection and dosing and has attracted interest as a strategy to improve outcomes and reduce adverse drug events in cardiovascular diseases. Several systematic reviews have examined its cost-effectiveness, but their findings have not been synthesized across drug classes and healthcare settings. Objective To identify, critically appraise, and synthesize findings from systematic reviews evaluating cost-effectiveness or cost-utility of pharmacogenomics-guided treatment of cardiovascular diseases. Methods This systematic review of systematic reviews was pre-registered in PROSPERO (CRD420261281565). Five databases were searched from inception, without language restrictions. Eligible studies were systematic reviews that summarized cost-effectiveness evidence on pharmacogenomics-guided cardiovascular drug prescribing. Risk of bias was assessed using ROBIS and methodological quality using AMSTAR 2. Findings were synthesized narratively. Results Ten systematic reviews (2010–2024) were included, encompassing 149 unique primary cost-effectiveness studies. The corrected covered area across reviews was 9.47% (moderate overlap). Most evidence was derived from economic modelling studies and substantial heterogeneity was observed across drug–gene pairs, comparators, and healthcare settings. CYP2C19-guided clopidogrel therapy was frequently reported as cost-effective or cost-saving, although results were less favourable when universal ticagrelor served as comparator. Evidence for CYP2C9/VKORC1-guided coumarin anticoagulation was more heterogeneous with cost-effectiveness varying across contexts. Limited evidence suggested that SLCO1B1-guided statin therapy may be cost-effective, although data were sparse. No review reported pooled incremental cost-effectiveness ratios or net monetary benefit. Risk of bias was low in 7 reviews; AMSTAR 2 confidence was high in 4 and low in 5. Conclusion Cost-effectiveness of pharmacogenomics-guided cardiovascular treatment seems to vary by drug–gene pair, comparator, healthcare context, and modelling assumptions. Further real-world studies and standardized economic evaluations are needed to clarify broader clinical adoption.

Simple Summary The biodiversity of bats in Bosnia and Herzegovina has only been assessed by methods that require capture and/or the analysis of echolocation signals, thus giving and incomplete picture of the true biodiversity. To address this, we aimed to measure bat diversity by analyzing DNA from bat droppings (guano) and comparing the results of this advanced genetic method to traditional morphological measurements of captured bats. The results revealed that while the morphological method identified only 10 bat species, the DNA analysis successfully identified 13 species—including Mehely’s horseshoe bat, a species never recorded in the country before. Furthermore, DNA testing clarified uncertain morphological identifications and discovered more species at every location. The study concludes that Bosnia and Herzegovina hosts a much richer diversity of bats than previously thought, and proves that non-invasive DNA sampling from guano is a highly effective tool for routine bat monitoring and provides an easy, harmless way for conservationists to pinpoint and protect critical natural habitats, ensuring the survival of these ecologically vital animals and maintaining healthy local ecosystems.

The rapid growth of e-commerce has intensified last-mile delivery activities in urban areas, creating challenges for city logistics systems related to operational efficiency, congestion, and environmental impacts. In this context, understanding the factors that influence customer satisfaction with logistics operators is increasingly important, as mismatches between customer expectations and delivery service characteristics may lead to operational inefficiencies such as failed delivery attempts and repeated delivery rounds. This study proposes a machine learning framework for predicting customer satisfaction with postal and logistics operators in urban delivery systems using survey data on customer characteristics, preferences, and service perceptions. Several machine learning algorithms were developed and evaluated to identify the key determinants of customer satisfaction and assess their predictive performance. Beyond predictive accuracy, the study interprets customer satisfaction as an indicator of the alignment between customer expectations and delivery service configurations. Improved alignment may support service configurations that reduce delivery mismatches and repeated delivery attempts, which are recognized as a significant source of additional transport activity in urban freight systems. By identifying customer segments whose expectations are not adequately addressed by existing delivery services, the proposed framework can support more informed service design and operational decision-making. From a city logistics perspective, the potential reduction in failed deliveries and repeated delivery rounds may contribute to lower vehicle kilometers travelled, congestion, energy consumption, and emissions associated with urban freight transport, although these operational and environmental indicators were not directly measured in this study. The proposed approach therefore provides a data-driven decision-support tool that can help operators improve service quality and serve as a basis for future integration with operational and environmental indicators in sustainable last-mile delivery planning.

This retrospective study of 98 patients assessed whether hypertensive heart disease (HHD) is associated with angiographic coronary artery disease (CAD) burden, quantified by the Duke CAD Index, and whether HHD or CAD burden influenced revascularization strategy. HHD was independently associated with higher Duke CAD Index values in linear regression (B = 10.33, p = 0.038) and with greater odds of more severe CAD categories in ordinal regression (OR = 3.19, p = 0.015). However, revascularization choice did not differ by HHD status or CAD severity (p = 0.95). A model incorporating age, sex, diabetes mellitus, and HHD demonstrated moderate discriminative ability for predicting severe CAD (AUC = 0.753). These findings suggest that HHD identifies a high-risk coronary atherosclerotic phenotype, but they are hypothesis-generating and require confirmation in larger prospective studies before clinical application.

Background/Objectives: Early risk stratification remains challenging in patients with non-ST-segment elevation myocardial infarction (NSTEMI). The present study evaluated the prognostic value of 24 h high-sensitivity cardiac troponin I (hs-Troponin I) and assessed whether combining biomarkers and echocardiographic parameters improves short-term risk prediction. Methods: This prospective observational cohort study included 170 consecutive adult patients with confirmed NSTEMI who were admitted to a Medical Intensive Care Unit and prospectively enrolled between February 2022 and January 2023. Clinical, routine biochemical, inflammatory, hematological, lipid, and echocardiographic data were collected during index hospitalization. High-sensitivity cardiac troponin I was measured at admission and again 24 h after hospitalization, with the 24 h value used as the principal marker of myocardial injury in the prediction analyses. The primary endpoint was major adverse cardiovascular events (MACEs), defined as cardiovascular death, recurrent myocardial infarction, ischemic stroke, urgent coronary revascularization, or hospitalization for worsening heart failure, within 3 months. Multivariable logistic regression, Cox regression, sequential prediction modeling, and internal bootstrap validation were performed. Results: MACEs occurred in 88 patients (51.8%). Twenty-four-hour hs-Troponin I, but not admission hs-Troponin I, was independently associated with MACEs (OR 1.57, 95% CI 1.09–2.26; p = 0.015) and a shorter time to the first MACE event (HR 1.38, 95% CI 1.07–1.78; p = 0.012). Lower left ventricular ejection fraction (LVEF) was also independently associated with adverse outcomes. The addition of 24 h hs-Troponin I, LVEF, and C-reactive protein improved discrimination from an AUC of 0.665 to 0.759 (optimism-corrected AUC, 0.717), with corresponding improvements in reclassification. A simplified multimarker score was independently associated with event-free survival (HR 2.36, 95% CI 1.53–3.64; p < 0.001). Conclusions: In patients admitted to a medical intensive care unit with NSTEMI, the integration of 24 h hs-Troponin I, LVEF, and C-reactive protein improved short-term risk prediction beyond that of clinical variables alone. A practical multimarker model based on routinely available parameters identified patients at increased risk of adverse cardiovascular outcomes during early follow-up.