Hungary is a member of the European Union (E.U.), so more than three-quarters of its trade relations are with the E.U. Hungary’s strategic objective is to be among the top-ten E.U. member states in digitalization by 2030. This study aims to examine the country’s digitization development and planned digitization programs and, based on these, to predict Hungary’s expected digitization status. This study also attempts to answer whether Hungary is among the ten most digitally developed E.U. member states. We use the K-means clustering method to assess the current state of digitization and different generic methods to determine future development. The results show that Hungary’s digital development is close to the middle level of the E.U. However, future digital development in Hungary will be more dynamic than in the European Union. This more dynamic Hungarian growth is predicted to catch up with the average of the E.U.’s digital development. However, the results of the extrapolation calculations show that the Hungarian goal of Hungary being among the ten most developed digital countries in the E.U. by 2030 is unrealistic. Full article

Sarcopenia screening tools have a low capacity to predict adverse outcomes that are consequences of sarcopenia in the elderly population. This study aimed to evaluate the ability of a new sarcopenia screening tool SARC-GLOBAL to predict negative clinical outcomes in the elderly. A total of 395 individuals were evaluated in a 42-month period. The screening tools SARC-GLOBAL, SARC-F, and SARC-CalF and the diagnosis of sarcopenia according to European Working Group on Sarcopenia in Older Persons (EWGSOP2) were performed at the beginning of the study. Logistic and Poisson regression models were applied to assess the predictive value of the tools for the odds and risks of negative clinical outcomes, respectively. The most common negative clinical outcome in the followed population was falls (12.9%), followed by infections (12.4%), hospitalizations (11.8%), fractures (4.3%), and deaths (2.7%). Both SARC-GLOBAL and SARC-F were similar in predicting the odds of falls and hospitalizations during the follow up period, however SARC-CalF only predicted the odds of hospitalizations at 42 months. Full article

Structure-based virtual screening utilizes molecular docking to explore and analyze ligand–macromolecule interactions, crucial for identifying and developing potential drug candidates. Although there is availability of several widely used docking programs, the accurate prediction of binding affinity and binding mode still presents challenges. In this study, we introduced a novel protocol that combines our in-house geometry optimization algorithm, the conjugate gradient with backtracking line search (CG-BS), which is capable of restraining and constraining rotatable torsional angles and other geometric parameters with a highly accurate machine learning potential, ANI-2x, renowned for its precise molecular energy predictions reassembling the wB97X/6-31G(d) model. By integrating this protocol with binding pose prediction using the Glide, we conducted additional structural optimization and potential energy prediction on 11 small molecule–macromolecule and 12 peptide–macromolecule systems. We observed that ANI-2x/CG-BS greatly improved the docking power, not only optimizing binding poses more effectively, particularly when the RMSD of the predicted binding pose by Glide exceeded around 5 Å, but also achieving a 26% higher success rate in identifying those native-like binding poses at the top rank compared to Glide docking. As for the scoring and ranking powers, ANI-2x/CG-BS demonstrated an enhanced performance in predicting and ranking hundreds or thousands of ligands over Glide docking. For example, Pearson’s and Spearman’s correlation coefficients remarkedly increased from 0.24 and 0.14 with Glide docking to 0.85 and 0.69, respectively, with the addition of ANI-2x/CG-BS for optimizing and ranking small molecules binding to the bacterial ribosomal aminoacyl-tRNA receptor. These results suggest that ANI-2x/CG-BS holds considerable potential for being integrated into virtual screening pipelines due to its enhanced docking performance. Full article

Early-onset neonatal sepsis (EONS), a serious infection in newborns within 3 days, is challenging to diagnose. The current methods often lack accuracy, leading to unnecessary antibiotics or delayed treatment. This study investigates the role of the frozen section examination of placental membranes and umbilical cord (FSMU) to improve EONS diagnosis in the daily lab practice. This retrospective study reviewed data from 59 neonates with EONS risk factors who underwent FSMU according to our institutional protocol. Concordance between the FSMU and the Final Pathological Report (FPR) was assessed. The FSMU demonstrated a high concordance (Kappa = 0.88) for funisitis diagnosis, with excellent accuracy (98.3%). A moderate concordance was observed for chorioamnionitis stage and grade. The FSMU shows promise as a rapid and accurate tool for diagnosing EONS, particularly for funisitis. This study suggests that the FSMU could be a valuable tool for EONS diagnosis, enabling a more judicious antibiotic use and potentially improving outcomes for newborns. Full article

Objectives: We investigated spatial patterns between primary and recurrent tumor sites and assessed long-term toxicity after dose escalation stereotactic body radiation therapy (SBRT) to the dominant intra-prostatic nodule (DIN). Materials and methods: In 33 patients with intermediate–high-risk prostate cancer (PCa), doses up to 50 Gy were administered to the DIN. Recurrence sites were determined and compared to the original tumor development sites through multiparametric MRI and ⁶⁸Ga-labeled prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (⁶⁸Ga-PSMA-PET/CT) images. Overlap rates, categorized as 75% or higher for full overlap, and 25–74% for partial overlap, were assessed. Long-term toxicity is reported. Results: All patients completed treatment, with only one receiving concomitant androgen deprivation therapy (ADT). Recurrences were diagnosed after a median of 33 months (range: 17–76 months), affecting 13 out of 33 patients (39.4%). Intra-prostatic recurrences occurred in 7 patients (21%), with ≥75% overlap in two, a partial overlap in another two, and no overlap in the remaining three patients. Notably, five patients with intra-prostatic recurrences had synchronous bone and/or lymph node metastases, while six patients had isolated bone or lymph node metastasis without intra-prostatic recurrences. Extended follow-up revealed late grade ≥ 2 GU and GI toxicity in 18% (n = 6) and 6% (n = 2) of the patients. Conclusions: Among patients with intermediate–high-risk PCa undergoing focal dose-escalated SBRT without ADT, DIN recurrences were infrequent. When present, these recurrences were typically located at the original site or adjacent to the initial tumor. Conversely, relapses beyond the DIN and in extra-prostatic (metastatic) sites were prevalent, underscoring the significance of systemic ADT in managing this patient population. Advances in knowledge: Focal dose-escalated prostate SBRT prevented recurrences in the dominant nodule; however, extra-prostatic recurrence sites were frequent. Full article

The control strategy of a power shift system has a significant impact on the driving stability and comfort of cotton pickers. To prevent the cotton picker from stopping to shift and reduce the jerks while shifting, in this study, the power shift system of a four-speed cotton picker was taken as the research object, and the working principles of the power shift transmission of the cotton picker and the hydrostatic transmission were analyzed. Firstly, the intelligent fuzzy control strategy of the variable pump and dual variable motor displacement of the cotton picker power shift system was designed using a fuzzy algorithm, and two-input and three-output fuzzy controllers were constructed with the engine rotational speed and vehicle speed as the input parameters, and the variable pump displacement, front motor displacement, and rear motor displacement as the outputs. Secondly, the model of the whole vehicle travel drive system of the cotton picker was constructed using co-simulation of Amesim and Simulink. Finally, the influence of the fuzzy shift control strategy and conventional manual shift method on the speed and driving distance of the cotton picker was compared and analyzed. The analysis results show that the fuzzy algorithm-based control strategy of the power shift system of the cotton picker can ensure that the cotton picker travels stably according to the target speed, and effectively reduces the speed fluctuation and jerks while shifting. The results of the study are of great significance to realize the non-stop shifting of the cotton picker as well as improve the stability and smoothness of the shift while driving. Full article

To compare the differences in the soil microbial community structure in yellow soil paddy fields after the long-term application of chemical fertilizer, the role and mechanism of chemical fertilizer in maintaining soil microbial diversity were analyzed, and a theoretical basis for fertilization management in farmlands was provided. In this study, long-term experiments were conducted at the Scientific Observation and Experimental Station of the Arable Land Conservation and Agricultural Environment (Guizhou), Ministry of Agriculture and Rural Affairs. Soil samples were collected from five treatments: fertilizer N, P, and K (NPK); fertilizer P and K (PK); fertilizer N and K (NK); fertilizer N and P (NP); and no fertilizer (CK). High-throughput sequencing technology was used to analyze the microbial composition and diversity of the colonies, and the influencing factors are discussed. An analysis of the soil bacterial α diversity indices under the different fertilization treatments revealed that the long-term application of NPK fertilizers had less of an effect on the soil bacterial α diversity indices than did the CK. The long-term application of chemical fertilizers significantly reduced the soil bacterial Chao1, Shannon, and Simpson indices, while there was no significant difference in the bacterial Pielou e index among the treatments. The long-term application of chemical fertilizers significantly increased the soil fungal Chao1 index, but the effects on the other indices were not significant (p < 0.05). An analysis of the bacterial and fungal species under different fertilization treatments showed found that compared with CK, the long-term application of chemical fertilizer increased the relative abundance of Proteobacteria to varying degrees while reducing the relative abundance of Chloroflexi. The impact of other phyla was relatively small, and the difference in the relative abundance of fungi was not significant (p < 0.05). Principal component analysis revealed that, at the genus level, the bacterial and fungal community structures in the CK and NK treatments were relatively independent, while those in the NPK, PK, and NP treatments were similar. Random forest analysis revealed that OM, TP, and TK are the dominant factors that affect soil bacteria α diversity. The dominant factors affecting fungi α diversity are pH, OM, and AK. Redundancy analysis indicated that AK and TP were the main factors affecting bacterial community structure, while AP, AK, and pH were the main factors affecting fungal community structure. The conclusion drawn from this study is that the long-term application of nitrogen, phosphorus, and potassium fertilizer; phosphorus and potassium fertilizer; and nitrogen and phosphorus fertilizer can improve soil fertility, alter the soil environment, enhance microbial diversity, and improve the microbial community structure in yellow soil paddy fields, promoting soil ecosystem stability and health. Full article

With the increasing awareness of plastic pollution in the environment and the accumulation of microplastics in water, a significant amount of research and development is ongoing to replace the synthetic plastics in packaging and coatings. In this work, we explored the blends of carboxymethyl cellulose (CMC) and washed cottonseed meal (CSM, consisting mostly of cottonseed protein) as agro-based, biodegradable, and sustainable alternatives to plastics. Glycerol was found to be a suitable plasticizer for these blends. The blends of CMC/CSM were produced as single-layer films from 50 to 90 μm in thickness, consisting of different proportions of the components and plasticizer. The evaluated properties included opacity, water vapor permeability, mechanical properties, thermogravimetric analysis, moisture sorption analysis, and water swelling test. Higher percentages of CSM in the blend resulted in higher opacity and lower water vapor permeation rates. The mechanical strength waned with lower levels of CMC. Possible applications for these blends include their use as water-soluble food packaging and coatings and as dissolvable bags and pouches for detergents and agrochemicals. Full article

Extractive reserves (RESEXs) are relevant areas that aim to allow the conservation of environmental resources and sustainable production practices of extractivism, agriculture, and livestock. In this study, we evaluated whether this aim is viable in the context of sustainability and conservation. Data were collected in the Alto Juruá, Rio Ouro Preto, and Rio Cajari RESEXs, via 384 questionnaires to investigate environmental, economic, social, and institutional issues in different communities. Here, we conclude that the failure of RESEXs in relation to conservation and development is correlated with a lack of institutional investment in innovations and technologies; low production from extractivism, agriculture, and livestock; lack of technical support; low production; and difficulties in markets for the commercialization of products. Full article

This study explored parents’ attitudes towards vaccinating their children against COVID-19 and the rate of vaccine hesitancy in Oman. A cross-sectional, online, self-administered questionnaire, previously validated and administered between June 2021 and May 2022, was used. The questionnaire consisted of nine items. Parents of children younger than 12 years were eligible for participation. A total of 384 participants, including 207 males (54%), completed the questionnaire, resulting in an 86% response rate (384/447). The results showed that 69% of participants were hesitant to vaccinate their children aged 1–11 years. In parents of children aged 1–4 years, vaccination status was significantly associated with vaccine hesitancy (odds ratio [OR], 0.116; 95% confidence interval [CI], 0.044–0.306; p = 0.001). Furthermore, after multivariable analysis, compared to the fathers, mothers were significantly less likely to be associated with vaccine hesitancy (OR, 0.451; 95% CI, 0.240–0.848; p = 0.013). Full article

The origin of difficult birth is still a matter of debate in obstetrics. Recent studies hypothesized that early hominins already experienced obstructed labor even with reduced neonatal head sizes. The aim of this work is to test this hypothesis using an extant obstetrical sample with known delivery outcomes. Three delivery outcomes (i.e., instrument-assisted, Caesarean section, and vaginal birth) were evaluated using a discriminant analysis based on 131 mother–baby dyads and 36 feto-pelvic variables. This obstetrical sample was compared with 20 australopithecine “dyads” generated from the combination of six pelvic reconstructions (three for Australopithecus afarensis, two for A. africanus, and one for A. sediba) and three fetal head size estimations. The obstetrical analysis revealed that dystocic births can be predicted by pelvic features such as an anteroposteriorly flattened pelvic inlet. Australopithecines shared these pelvic morphologies with humans and had eutocic birth only for infants of 110 g brain size or smaller, equaling a human-like neonatal/adult brain size ratio of 25–28%. Although birth mechanism cannot be deduced, the newborn/adult brain size ratio was likely more human-like than previously thought, suggesting that australopithecines were secondarily altricial to circumvent instances of obstructed labor and subsequently require a prolonged postnatal brain growth period, implying some aspects of life history pattern similar to modern humans. Full article

The present study aims to evaluate the effect of up to 3 wt.% Nd on pure Zn in terms of physical properties and in vitro analysis. The use of Nd as an alloying element is due to its relatively adequate biocompatibility and its potential capability to reinforce metals with a hexagonal close-packed (HCP) crystal structure, such as Mg and Zn. The microstructural assessment was executed using X-ray diffraction analysis, along with optical and scanning electron microscopy. The mechanical properties were evaluated by hardness and tensile strength testing. The corrosion performance in simulated physiological environments was examined by means of immersion tests, potentiodynamic polarization, and impedance spectroscopy using phosphate-buffered saline (PBS) solution. Cytotoxicity assessment was carried out by indirect cell viability analysis according to the ISO 10993-5/12 standard using Mus musculus 4T1 cells, which are known to be very sensitive to toxic environments. The obtained results clearly highlighted the reinforcing effect of Nd in Zn-base alloys, mainly due to the formation of a secondary phase: NdZn_5. This strengthening effect was acquired without impairing the inherent ductility and corrosion performance of the tested alloys. The cytotoxicity assessment indicated that the addition of Nd has a strong favorable effect on cell viability, which stimulates the inherent anti-inflammatory characteristics of Zn. Full article

Employing catalytic decomposition to break down reducing agents in intermediate-level radioactive waste during nuclear fuel reprocessing offers significant advantages. This study focuses on investigating the deactivation behavior of 5% Ru/C catalysts by two different synthesis processes used for reducing agent destruction. Deactivation experiments were conducted by subjecting the 5% Ru/C catalysts to 100 and 150 reaction cycles. Changes in the concentration of free radicals on the carbon-based carrier were measured to analyze the loading position and loss of Ru ions. Additionally, sorption–desorption curves and pore size distributions of the four catalysts were obtained. Analysis results reveal that Ru ions on the catalyst adsorb onto active free radical sites on the carbon-based carrier. Under ultrasonic conditions, some Ru ions partially desorb from the free radical sites on the carbon-based carrier, and desorbed Ru ions may adsorb onto weak free radical sites, while undesorbed Ru ions may adsorb onto strong free radical sites. After hundreds of hours of reaction, SM1 and SM2 exhibited approximately a 30% decrease in specific surface area and pore volume compared to SM0. However, the catalyst activity remained unchanged, and the catalyst pore size remained essentially unchanged, which primarily means that the micropores on the catalyst’s surface have undergone corrosion and damage. Full article

Xie Fuya (1892–1991), a major Chinese Christian thinker, has contributed much to the development of Sino-theology. However, his work has yet to receive the recognition it deserves. As a thinker who is well-versed in both Chinese and Western philosophies while dedicating himself to the exploration of the philosophy of religion, Xie presents a dual feature in his writings. On the one hand, his work engages in a dialogical discourse between Eastern and Western philosophies. On the other hand, his writings represent an ambitious attempt to interpret traditional Chinese philosophical tenets within the context of Christian theology, transverse from the level of human nature to the level of ontological existence, representing an innovative model of contemplation in the field of Sino-theology. This contribution is of immense value to the development of Chinese philosophical thought. For this reason, this article attempts to illustrate, through Xie’s writings in various stages of his life, his relentless effort to promote the integration of Eastern and Western philosophies within the framework of Chinese thought. His most notable accomplishment in this East–West confluence effort is his unique assumption of God’s attributions as both zhonghe (literally “middle harmony”, connoted as interdependency by Xie) and bianyi (change). Full article

The level of NCP implementation varies across countries due to differences identified in major components of health systems such as infrastructures, legislation, training, and cultural diversities. Dietitians in Greece receive sufficient training in the implementation of the NCP as part of their main studies; however, the level of awareness and adoption of the NCP model is still quite low, with limited information on the potential barriers. The primary aim of this study was to gain a deeper understanding of the perspectives of Greek dietitians on the NCP and the use of digital tools. An online survey was created and distributed through the platform “SurveyMonkey version 4.1.1”. The overall structure of the questionnaire was modeled according to the validated NCP/NCPT INIS Tool. A total of 279 subjects were included in this study, and 192 were aware of the NCP tool. The most important challenges for the implementation of the NCP included communication with other healthcare professionals (68.2%), provision of appropriate care (33.9%), and insufficient access to continuous education (29.2%). Of the 192 participants who knew the NCP, 81.3% reported using digital applications for the collection and assessment of health data, while 18.8% indicated that they did not utilize such tools. No relationship was found between the use of digital applications by dietitians, NCP knowledge, and demographic characteristics. Our findings highlight the need for targeted educational interventions and appropriate application of standardized protocols by Greek dietitians in daily practice. National Dietetic Associations should provide sufficient guidance on digital tool utilization in facilitating patient data management and enhancing NCP implementation. Full article

Current research does not fully elucidate the key compounds and their mechanisms that define the aroma profile of fresh jujube fruits. Therefore, this study conducted a comprehensive analysis of both free and glycosidically bound aroma compounds in fresh jujube fruits of ten cultivars. Utilizing gas chromatography–mass spectrometry (GC-MS), we identified 76 volatile free aroma compounds and 19 glycosidically bound volatile compounds, with esters, aldehydes, and ketones emerging as the predominant volatile compounds in the jujube fruits. Odor activity value (OAV) analysis revealed that the primary aroma profile of the jujubes is characterized by fruity and fatty odors, with β-damascenone being a key contributor to the fruity aroma, and (E)-2-oct-en-1-al and nonanal significantly influencing the fatty aroma. Moreover, the integration of sensory evaluation and partial least squares regression (PLSR) analysis pinpointed octanal, (E)-2-oct-en-1-al, nonanal, β-damascenone, and pentanal as significant contributors to the jujube’s characteristic aroma, while isoamyl acetate was identified as significantly influencing the fatty acid taste. This study not only underscores the complexity of the jujube aroma composition but also highlights the impact of environmental factors on aroma profiles, offering valuable insights into the sensory characteristics of jujube fruits. Full article

In recent years, all-inorganic perovskite solar cells have become a research hotspot in the field of photovoltaics due to their excellent stability and optoelectronic performance, and the power conversion efficiency has increased from the initial 2.9% to over 20%. This article briefly introduces the development of cesium lead-based all-inorganic perovskite solar cells (CsPbX₃-IPSC), including the characteristics of CsPbX₃ perovskite materials, the preparation methods, and the structure and working principle of IPSCs. Different optimization strategies for preparing high optoelectronic performance and high-stability IPSCs, such as element doping and interface modification, are discussed. The development and application prospects of IPSCs are also summarized. Full article

(1) Background: Achieving inactive disease decreases long-term joint damage in patients with polyarticular juvenile idiopathic arthritis (polyJIA). The aim of our study was to describe average time to treatment and medication changes over time. (2) Methods: Incident polyJIA patients were retrospectively identified in the InGef and WIG2 longitudinal health claims databases. Drug escalation level changes were evaluated longitudinally and cross-sectionally across three years, as follows: no treatment, glucocorticoids (GCs) and/or non-steroidal anti-inflammatory drugs (NSAIDs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and biological disease-modifying antirheumatic drugs (bDMARDs). (3) Results: On average, newly diagnosed polyJIA patients received their first csDMARD prescription after 128 days and their first bDMARD prescription after 327 days. More patients were treated with csDMARDs than with bDMARDs at diagnosis; however, 24% and 12% (InGef and WIG2 databases, respectively) had no JIA treatment. After three years, 45% and 31% were not taking any treatments, while 18% and 36% were prescribed bDMARDs. Among patients initiating bDMARDs, most continued treatment for three years, with some switching to csDMARDs or discontinuing treatment. Patients treated only with csDMARDs took them longer, compared to those additionally taking other DMARDs. Patients treated with bDMARDs took them about twice as long as the csDMARDs they took prior. (4) Conclusion: A substantial number of patients with polyJIA are not treated as intensively as guidelines recommend. Full article

Due to some limitations in the data collection process caused either by human-related errors or by collection electronics, sensors, and network connectivity-related errors, the important values at some points could be lost. However, a complete dataset is required for the desired performance of the subsequent applications in various fields like engineering, data science, statistics, etc. An efficient data imputation technique is desired to fill in the missing data values to achieve completeness within the dataset. The fuzzy integral is considered one of the most powerful techniques for multi-source information fusion. It has a wide range of applications in many real-world decision-making problems that often require decisions to be made with partially observable/available information. To address this problem, algorithms impute missing data with a representative sample or by predicting the most likely value given the observed data. In this article, we take a completely different approach to the information fusion task in the ordered weighted averaging (OWA) context. In particular, we empirically explore for different distributions how the weights/importance of the missing sources are distributed across the observed inputs/sources. The experimental results on the synthetic and real-world datasets demonstrate the applicability of the proposed methods. Full article

Introduction: The ongoing concern of the medical profession regarding chronic medication is related to increasing patient adherence and compliance to treatment and reducing medication side effects. In this respect, drugs represented by fixed-dose combinations of active substances within the same tablet have emerged. Such a principle can be extrapolated by following the potential beneficial effects that a chronic medication can have on chronic pathologies affecting different systems. Materials and Methods: The study included 48 female Albino Wistar rats, aged 16–18 months, which were divided into two groups: ovariectomized and non-ovariectomized rats. One batch of 12 non-ovariectomized rats received no treatment, becoming a control batch (NOVX-M). The ovariectomized (OVX) group was divided into 3 batches of 12 rats each: no treatment, control (OVX-M), fenofibrate-treated (OVX-F) and statin-treated (OVX-S) rats. At 12 weeks after ovariectomy, a femoral fracture occurred in the right hind limb of all animals included in the experiment To reveal the changes, at intervals of 2, 4, 6 and 8 weeks post-fracture, the proximal part of the femur was evaluated by NMR diffusiometry, which allows random motion of proton molecules expressed by self-diffusion coefficients, D, thus allowing analysis of the size and complexity of microscopic order cavities within biological structures, such as pores inside bones. Results: The effects of hypolipidemic medication in the absence of estrogen were evidenced, proving the beneficial effect that fenofibrate can have in preserving healthy tissue exposed to osteoporotic risk during the menopausal period. The effects of lipid-lowering medication are also influenced by the duration of administration. Conclusions: Osteoporosis and heart disease are two chronic pathologies that affect mainly female population in the second half of life, and proving the dual therapeutic potential of lipid-lowering medication may also have positive effects by increasing adherence and compliance to treatment. Full article

Improvements in nitrogen use efficiency can be achieved through fertilizer management strategies that capitalize on nutrient synergies. However, limited research on synergies between nitrogen, sulfur, and calcium complicates understanding causal links and developing sustainable management. In this regard, the effects of different nitrogen sources on productivity and nitrogen use efficiency in Italian ryegrass (Lolium multiflorum Lam.) and pearl millet (Pennisetum glaucum (L.)), along with their impacts on forage quality and secondary production, were investigated. Treatments included: Urea (46% N), ammonium nitrate (NH₄NO₃; 32% N), ammonium nitrate supplemented with calcium and sulfur (NH₄NO₃ (+), 27% N + 5% Ca + 3.7% S), and control treatment with no N application. The application of fertilizers that combine nitrogen with calcium and sulfur enhances primary production in both winter and summer pastures. Fertilization with NH₄NO₃ (+) increased nitrogen use efficiency by 125% in Italian ryegrass compared to NH₄NO₃. However, within the framework of rotatinuous grazing management principles, optimizing plant nitrogen use efficiency does not necessarily lead to a better forage quality or animal performance. These findings highlight that using fertilizers that promote synergies among nutrients, such as the combination of nitrogen with calcium and sulfur, can bring benefits to the sustainability of pasture-based livestock production systems. Full article

Background and Objectives: Ketogenic diet therapy (KDT) has been used as a non-pharmacological treatment for childhood refractory epilepsy. Its efficacy and safety have been described in numerous studies and reviews. However, there have been fewer studies evaluating the challenges experienced by patients and their family members when starting KDT. When implementing a new treatment method, challenges arise for both the healthcare professionals and patients, making it important to summarize the initial results and compare them with the experiences of other centers. To analyze and evaluate the efficacy and safety of KDT in children with epilepsy, as well as to consider the challenges faced by their parents/caregivers. Materials and Methods: A retrospective analysis of patients’ data (N = 30) and an analysis of the completed questionnaires of the parents/caregivers (N = 22) occurred. Results: In the study group, 66.7% of the patients had a >50% decrease in seizure frequency, and 2/3 of them had a >90% decrease in seizure frequency or were seizure-free, which enabled reducing the anti-seizure medications in 36.4% of the patients, as well as reducing the hospital visits. Cognitive improvement and better alertness were subjectively reported by 59.1% of the parents/caregivers. No dangerous long-term adverse effects of KDT have been observed in the study group. The patients with generalized epilepsy experienced significantly more adverse events. Most of the adverse effects of KDT were related to the digestive system, but usually they were temporary and controllable. The challenges of the parents/caregivers were mostly related to social life issues and financial difficulties; the medical-related challenges were minimal. Conclusions: KDT is an effective and safe treatment option for children with drug-resistant epilepsy, and the challenges faced by families are resolvable. In order to ensure effective KDT, a multidisciplinary team is required. This would ensure smooth and comprehensive care and the timely resolution of emerging problems. The cooperation of the families undergoing KDT is also important, enabling them to share their experiences. Full article