Mercer (Czechia)

CKD is common, and its prevalence is increasing rapidly worldwide. The aim of this study was to investigate the relationship between CKD and dynamic changes in cerebral oxygenation, which may help explain the link between CKD, cerebrovascular disease, and cognitive impairment. This observational study used data from waves three (2014-2015) and six (2020-2023) of The Irish Longitudinal Study on Ageing (TILDA), a nationally representative, population-based cohort of community-dwelling adults aged ≥50 years in Ireland. A total of 2,322 participants (mean age 64.7 ± 7.6 years; 53% female) were included.7.1% had CKD, defined by estimated glomerular filtration rate (eGFR). Cerebral oxygenation, indicated by the Tissue Saturation Index, was continuously measured using near-infrared spectroscopy during and after an orthostatic manoeuvre. Participants with CKD were older, had lower levels of educational attainment and higher prevalence of cardiovascular and cerebrovascular disease and cognitive impairment. At wave three, cerebral oxygenation was significantly and independently lower at all time points post-standing in those with CKD (30 s:-0.23 [95% CI -0.43 to -0.04], 60 s:-0.31 [-0.51 to -0.11], 90 s -0.34 [-0.54 to -0.14], 120 s: -0.34 [-0.54 to -0.14], 150 s: -0.32 [-0.52 to -0.12] and 180 s: -0.36 [-0.55 to -0.16], p <0.05). The co-existence of orthostatic hypotension amplified this association at later timepoints while systolic hypotension may mitigate it. Lower eGFR was associated with lower cerebral oxygenation, eGFR 45-59 mL/min/1.732 showed the most pronounced decline. CKD is significantly and independently associated with reduced cerebral oxygenation during orthostatic challenge. This may represent a key mechanism linking CKD to cognitive impairment. Further longitudinal studies are warranted to explore the clinical utility of cerebral oxygenation as a predictive biomarker for cognitive decline in CKD.

Abstract Background Romosozumab is a dual acting antiresorptive and anabolic agent used for severe postmenopausal osteoporosis. Eligibility criteria includes T score ≤ -2.5 at hip, spine or distal forearm (if hip and spine not available) and fracture of humerus, distal radius, hip or vertebrae in the last 24 months. Romosozuamb is recommended as a first line therapy in patients at very high fracture risk. However, contraindications include previous MI or stroke and there is caution with use when significant cardiovascular risk factors. We aimed to identify hip fracture patients at our hospital who might be suitable for romosozumab. Methods Retrospective review of female patients admitted with a hip fracture at our hospital over a one year period. Information on demographics and medical history was collated: myocardial infarction (MI), stroke, ischaemic heart disease (IHD), peripheral arterial disease (PAD), heart failure, atrial fibrillation (AF), diabetes and current smokers. Data on DXA derived T scores in a subset was also recorded. Results 133 patients, mean age 82.8 ± 7.7 years. 8.2% had a history of MI or stroke, 16.5% IHD, 13.5% AF, 10.5% HF and 6.0% PAD. Diabetes was found in 9.0% and 6.7% were current smokers. Overall, 45% had an MI or stroke history and/or any of above the risk factors. In a subset with BMD assessment (n=68), 55.8% had T scores &amp;lt; 2.5 and of them 63.1% had none of the above risk factors. Overall, 35.2% of this sample had none of the above risk factors and T scores &amp;lt; -2.5. Conclusion Nearly 10% had absolute contraindications to therapy, though nearly half had significant cardiovascular risk factors. While the sample with DXA results was small, results suggest that up to one third might potentially be suitable for therapy. However, other factors such as physical frailty, and cognitive impairment are also likely to preclude its use.

Abstract Background Dementia is preventable and deferrable yet remains a major cause of disability and dependency and the seventh leading cause of death worldwide. The Lancet Commission on dementia published a report in July 2024, identifying 14 modifiable dementia risk factors and estimating a 45% reduction in dementia cases with risk factor elimination. The aim of this study is to assess the prevalence of modifiable dementia risk factors, providing crucial context for the delivery of dementia prevention in Ireland. Methods This is a longitudinal study using data from three waves of the Irish Longitudinal Study on Ageing (TILDA) to quantify the prevalence of modifiable dementia risk factors in Ireland over a 10·93 (±0·37) year follow-up. TILDA is a population-based prospective cohort study, representative of community-dwelling adults aged 50 years and older, living in Ireland. Data were analysed using Stata 15·1 applying inverse probability weighting. Results 8,171, 6,615 and 4,318 participants were included in wave one, three and six analyses. 70·6%, 61·1% and 54·2% of the population had 4 or more modifiable risk factors for dementia at consecutive waves amounting to over 500,000 people with 4 or more modifiable risk factors for dementia on weighted population analysis at wave six.77% of those with severe decline in cognitive performance during follow-up had 4 or more risk factors at baseline. An estimated 32,480 cases of severe decline in cognitive performance during follow-up were potentially preventable if risk factors were eliminated. Conclusion This study identifies a high prevalence of modifiable dementia risk factors in Ireland and highlights the need for public education on the concept of brain health and the development of a clinical framework focused on delivering on the opportunity of dementia prevention. Preventing and delaying dementia onset has the potential to compress morbidity and increase healthy lifespan in older age.

El estudio de la productividad de la riqueza y su interacción con la presión fiscal es un eje fundamental de la economía pública moderna, abordando cómo los sistemas impositivos impactan en la acumulación y uso eficiente de los recursos patrimoniales. A través de la historia económica, se ha sostenido que los impuestos representan tanto un mecanismo de redistribución como una potencial barrera al crecimiento del capital privado y la inversión (Kuznets y Friedman, 1945). Este debate se centra en si la inter- vención fiscal excesiva puede desincentivar el ahorro y la inver- sión productiva, ralentizando el ascenso social y económico al limitar la capacidad de los individuos para transformar la riqueza acumulada en flujos de ingresos estables (Piketty, 2021). La pre- sión fiscal elevada, entendida como el nivel de carga impositiva sobre los ingresos, la propiedad y otros activos, se asocia a menudo con efectos negativos en la eficiencia económica y, en consecuencia, en la productividad de la riqueza (Martínez-Váz- quez y McNab, 2000).

Within the dynamic and constantly evolving digital landscape of Web 3.0, the significance of ethical leadership cannot be overstated, as it plays a crucial role in guiding enterprises and individuals towards responsible behaviour and decision-making. This chapter aims to analyse the core concepts of ethical leadership in the digital age, emphasizing the challenges and opportunities presented by Web 3.0 technology. The qualitative research methodology outlined in this chapter provides a robust framework for exploring ethical leadership in the digital age. This study highlights the importance of transparency, responsibility, and societal obligations in ethical leadership in the digital age. Leaders may cultivate trust with stakeholders, mitigate risks, and create a culture of ethical innovation and governance by prioritizing these ideals. The findings of this research have significant implications for those in positions of leadership, politics, and academia who want to promote ethical behaviour and decision-making within the context of the digital age. Using ethical leadership principles in organizational practices and policies may contribute to promoting a digital environment that is both ethical and sustainable. The present study contributes to the existing literature by examining the principles of ethical leadership within the distinct context of Web 3.0 technology. This study comprehensively examines leaders’ challenges and opportunities in the digital age.

Ensuring the safety and reliability of modern railway systems is increasingly challenging due to mechanical failures, undetected component degradation, and track-level obstacles. Traditional methods such as periodic manual inspection and rule-based monitoring are inadequate for realtime risk prevention in large-scale networks. To address these limitations, this study presents an integrated AI-driven framework combining predictive maintenance and collision avoidance modules. The predictive maintenance component employs vibration signal analysis using a hybrid model that fuses Long Short-Term Memory (LSTM) networks and XGBoost classifiers. This system predicts a Health Index (HI) and classifies component states as Normal, Warning, or Failure, enabling condition-based maintenance. For real-time obstacle detection, a collision avoidance module utilizes YOLOv8, finetuned on over 5,000 annotated railway images, to detect and classify hazards such as humans, animals, and vehicles. Stereo vision and LiDAR inputs enable accurate depth estimation, while a danger zone logic initiates automated braking within 50 meters of an identified threat. Experimental results demonstrate that the fused predictive maintenance model achieved an accuracy of $95.1 \%$, precision of $94.4 \%$, recall of $93.9 \%$, and a low MSE of $\mathbf{0. 0 0 8 7}$. The YOLOv8-based detection system achieved $97.1 \%$ detection accuracy, mAP@ 0.5 of $96.3 \%$, and real-time latency of $23 \mathrm{~ms} /$ frame. The integrated edge-cloud architecture ensures low-latency inference, real-time alerting, and secure cloud logging. This research validates the effectiveness of AI in enhancing railway safety through proactive diagnostics and automated hazard response.

Abstract Sea lamprey ( Petromyzon marinus ) are anadromous fish that spend one to two years as haematophagous ectoparasites in marine environments. This study provides the first quantitative insight into their feeding phase, which remains poorly understood. We investigate the occurrence of P. marinus feeding on basking sharks ( Cetorhinus maximus ) in the Northeast Atlantic. Between 2011 and 2020, 775 records of basking sharks were collected via video, photographs and written observations. After quality control, 434 records were analysed. Of these, 41.8% showed lampreys attached. The number of lampreys per shark ranged from one to eight, with an average of 1.9 (± 1.4 SD). Lampreys were significantly more likely to attach to the ventral surface, although attachment site was not linked to shark sex. We discuss mechanisms of attachment, as well as the role of shark migratory behaviour and olfactory cues from coastal aggregations that may increase opportunities for P. marinus to attach. This study provides the first evidence of a significant ecological association between the two species, suggesting C. maximus may be a preferred or more accessible host. These findings offer new insight into lamprey ecology and may inform understanding of how this species could respond to future environmental change.