Articles

Background: </b>Hospital-acquired infections (HAIs) caused by multidrug resistant (MDR) bacteria are a major public health problem especially in resource-limited settings. Local data on antimicrobial resistance (AMR) are crucial to inform empirical therapy and infection prevention. <b>Objectives:</b> To identify bacterial pathogens causing HAIs, determine their AMR profiles and independent risk factors for MDR infections in a tertiary hospital in Erbil City, Iraq. <b>Materials and Methods:</b> A cross-sectional study was done at Hawler Teaching Hospital between January and June 2026. Standard microbiological methods were used to analyse 200 clinical specimens from patients with HAIs (≥48 hr after admission). Antimicrobial susceptibility testing was performed according to CLSI 2024 guidelines. MDR was defined as nonsusceptibility to at least one agent in three or more antimicrobial classes. Multivariate logistic regression was used to assess independent risk factors. <b>Results:</b> Bacterial growth was obtained in 149 of 200 specimens (74.5%). The major pathogens were <i>Escherichia coli</i> (31.5%), <i>Klebsiella pneumoniae</i> (23.5%), <i>Staphylococcus aureus</i> (21.5%), <i>Pseudomonas</i> <i>aeruginosa</i> (14.1%) and <i>Acinetobacter </i><i>baumannii</i> (6.1%). In total, 69.1% of the isolates were MDR, with the highest rates in <i>K. pneumoniae</i> (80.0%) and <i>A. </i><i>baumannii</i> (77.8%). Independent predictors of MDR infection were previous antibiotic use (AOR=4.45), ICU admission (AOR=3.92), and hospitalization >7 days (AOR=3.10). <b>Conclusion:</b> This study documented a significant burden of MDR-HAIs in Erbil City and determined modifiable clinical risk factors. The findings provide evidence to support antimicrobial stewardship, infection prevention and AMR surveillance in Iraqi healthcare settings.

This study investigates the spatial and temporal dynamics of shoreline deformation along the San Bartholomeo River over 30 years (1995–2025) using an integrated geospatial approach. The research combines Interferometric Synthetic Aperture Radar (InSAR) and Digital Shoreline Analysis System (DSAS) techniques to quantify both vertical land motion and horizontal shoreline change. Results reveal a decline in land area from 32.622 km² (56.65%) in 1995 to 30.284 km² (52.59%) in 2025, alongside an increase in water body extent, indicating progressive shoreline retreat. Shoreline change rates varied significantly, with erosion reaching −8.04 m/yr and accretion up to 16.73 m/yr. Net Shoreline Movement (NSM) and Shoreline Change Envelope (SCE) analyses further highlighted zones of persistent erosion and high variability. InSAR-derived deformation patterns confirmed the presence of subsidence contributing to shoreline instability. The findings demonstrate that a combination of hydrodynamic forces, sediment imbalance, and anthropogenic activities drives shoreline deformation in the study area. This study contributes to improved shoreline monitoring by integrating vertical and horizontal deformation metrics, providing a robust framework for sustainable shoreline management in deltaic environments.

Heterotaxy syndrome comprises a group of congenital anomalies resulting from disrupted left-right axis patterning during embryonic development, leading to an abnormal arrangement of the thoracic and abdominal organs [1]. It is a rare condition, with an estimated prevalence of approximately 1 per 10,000 live births, and is frequently associated with complex congenital heart defects, making it a life-threatening disorder with significant morbidity and mortality [1]. Clinically, heterotaxy syndrome is classified into right atrial isomerism (Ivemark syndrome) and left atrial isomerism. Ivemark syndrome represents the most severe form and is primarily characterized by asplenia, complex cardiovascular anomalies, and abnormal positioning of the thoracoabdominal organs [2]. In this condition, paired organs exhibit right-sided morphology bilaterally, commonly accompanied by functionally univentricular physiology, extensive septal defects, dextrocardia, and extracardiac malformations such as intestinal malrotation and congenital absence of the spleen [2,3]. Asplenia is a hallmark feature that markedly increases susceptibility to overwhelming bacterial infections, while the associated congenital heart defects account for the high morbidity and mortality observed during the neonatal period [2]. Herein, we report the case of a male neonate with clinical and imaging findings consistent with Ivemark syndrome who experienced a rapidly progressive and fatal clinical course during the first week of life. A comprehensive review of the available literature identified only a limited number of published cases and scarce documented evidence. Therefore, this case report is supported primarily by the currently available international literature.

This study utilized a qualitative approach to completely ascertain Junior High School Social Studies teachers’ knowledge, strategies and tools used in formative assessment. This study employed a qualitative approach. The study, which was based on a qualitative paradigm, used a phenomenological research methodology to investigate the lived experience and acuity of formative assessment procedures. A selected sample of nine (9) Junior High School Social Studies teachers was chosen based on their academic credentials and professional teaching experience. A focus group discussion was employed to gather data, which was then thematically examined in light of the research questions. The results showed that the participants had a robust knowledge and were adept at using formative assessment strategies and tools in Social Studies lesson. It was recommended that pre-service and in-service teachers should be allowed to use formative assessment techniques sparingly. The National Teaching Council seminars ought to focus on how Junior High School Social Studies teachers can effectively use formative assessment techniques to enhance instruction.

This study presents a physics-based parametric optimization framework for thermoelastic energy harvesting from cyclic temperature variations using a cylindrical AISI 4340 steel rod. The model couples thermoelastic force and displacement, Euler buckling and yielding constraints, lumped-capacitance heat transfer, and mass-power multi-objective optimization. The feasible design space was evaluated as a function of rod diameter, length, temperature change, and load-transfer parameter. The results show that Euler buckling governs the practically relevant portion of the design space at moderate temperature changes, whereas yielding becomes increasingly restrictive at higher thermal loads. The Pareto-optimal solutions exhibit a clear mass-power scaling law, with the analytical prediction P<SUB>avg</SUB> ∝ m<SUP>2/3</SUP> closely reproduced by the numerical fit (n = 0.66717, R² = 0.999999). Under the baseline condition λ = 0.50, the maximum-power design produces approximately 0.16624 W, while a distance-to-ideal criterion identifies a substantially lighter compromise design with m = 223.0 kg and P<SUB>avg</SUB> = 0.09231 W. Refined optimization gives λ<SUB>opt</SUB> = 0.473 and P<SUB>max</SUB> = 0.170454 W, indicating a power penalty of only 2.47% when the simpler λ = 0.50 condition is used. Grid-refinement tests show changes below 0.006% in maximum power and below 0.5% in the compromise-design mass between the 250 × 250 and 500 × 500 grids. The results establish compact scaling and optimization rules for balancing structural stability, thermal response, mass, and average mechanical power in thermoelastic energy-harvesting elements.

<b>Background: </b>The rising prevalence of diabetes mellitus and its adverse effects on pregnancy outcomes have made pre-pregnancy care (PPC) a critical component of diabetes management among women of reproductive age. Diabetes poses significant risks during pregnancy, but PPC provides an opportunity to prevent complications. Despite these benefits, Nigerian women of childbearing-age living with diabetes still miss out on these advantages due to poorly defined and imperfect integration of PPC into the country’s healthcare system by Health Birth professionals (HBPs). Therefore, their understanding of PPC and the integration of PPC into routine diabetes management practices for childbearing women is essential. The study, therefore, aims to explore HBPs’ provision of PPC for women with pre-existing diabetes in Lagos, Nigeria. <b>Methodology: </b>A qualitative exploratory research design was conducted at two tertiary health institutions in Lagos. A total of 20 participants were purposively selected among doctors and nurse/midwives. The data collected through in-depth semi-structured interviews were transcribed verbatim and analyzed thematically. The trustworthiness of this study was established following the criteria of trustworthiness (credibility, dependability, transferability, and conformability), authenticity was added based on the research worldview. <b>Result:</b> Five themes and eleven subthemes emerged from the analysis. The main themes were clinical importance of PPC for women with diabetes, pregnancy-intention screening for diabetic women, PPC as standard care practice for women with diabetes, raising awareness of PPC, and the enablers of PPC provision. <b>Conclusion:</b> The study emphasized the clinical significance of PPC for women with diabetes; the need for pregnancy-intention screening among diabetic women; the need to make PPC a standard of care for women with diabetes; the importance of raising awareness; and the enablers of PPC. The study highlighted the significance of PPC and the factors that would facilitate its integration PPC into Nigeria's healthcare system. The provision of PPC for women of childbearing potential living with diabetes, as it is key to improving obstetric outcomes and reducing the risks associated with diabetes in pregnancy. It would also be beneficial for leaders at various levels of healthcare institutions to seek the necessary regulatory approvals from the Nigerian government to establish PPC.

The number 12 is a superior highly composite number divisible by 2, 3, 4, and 6. Analyzing natural numbers through their prime factorization reveals striking patterns and symmetries. The duodecimal system, based on 12, provides a natural framework for structuring natural numbers into periods and groups with similar properties. These structures offer an intuitive perspective on the behavior of the divisor and sigma functions and on residue-class constraints relevant to Goldbach-type decompositions. Furthermore, they help to interpret observed patterns in prime gaps, accounting for the prominence of certain gaps and suggesting empirical trends. This article does not claim new theorems in analytic number theory. Its contribution is a unified mod‑12 framework that brings together several classical facts and makes certain structural regularities visually and arithmetically explicit.

<b>Objectives: </b>To evaluate the potential role of hysteroscopic subendometrial autologous platelet-rich plasma application in a patient with refractory thin endometrium after multiple high-quality embryo transfers. <b>Methods:</b> We report the case of a 45-year-old female with a 9-year history of infertility, 15 previous IVF cycles, 8 frozen embryo transfers with a persistently thin endometrium of <7mm. After the exclusion of intrauterine pathology via diagnostic hysteroscopy, leukocyte-poor PRP was activated with calcium gluconate and injected into the subendometrial region. A comparison of endometrial thickness, as well as uterine and subendometrial arterial blood flow before and after PRP application was made. <b>Results:</b> In the subsequent cycle, endometrial thickness increased to 8.2 mm, Doppler vascular parameters improved, and a euploid frozen embryo transfer resulted in a clinical pregnancy and live birth. This case supports further investigation of hysteroscopic subendometrial PRP in selected patients. <b>Conclusion:</b> The regenerative characteristics of PRP in optimizing blood flow should be considered crucial to improving the microcirculation of the endometrial basal layer and subsequent tissue remodeling.

We investigated how targeted reactivation of cortical memory engrams during sleep influences systems consolidation of contextual fear memory. Using a mouse model of contextual fear conditioning (CFC), we tagged retrosplenial cortex (RSC) neurons activated during learning with channelrhodopsin-2 (ChR2) via a c-Fos-based TRAP system. Twenty-four hours post-training, animals received optogenetic stimulation of these RSC engram cells selectively during non-rapid eye movement (NREM) sleep or REM sleep. Immediately after, hippocampal activity was transiently blocked (muscimol infusion) to test hippocampal dependence. We found that NREM-specific reactivation of RSC engrams preserved contextual fear recall despite hippocampal inactivation, whereas REM stimulation or no stimulation failed to rescue memory. These results indicate that engram reactivation during NREM accelerates the transfer of memory to cortical storage. We present high-level diagrams of experimental workflow and results, and report a timeline of revisions. Abbreviations and keywords are provided. This comprehensive revision addresses all reviewer comments and renders the manuscript submission-ready.

Oral and maxillofacial surgery has moved over the past two decades toward auditable systems of verification, as implant-based rehabilitation, digitally guided planning, and multi-operator procedures have multiplied the interfaces at which small deviations can escalate into irreversible harm. This narrative review examines that transformation through two recent monographs that occupy sequential positions in the field's move toward standardization. The first documents the contemporary technique base for regenerative and reconstructive procedures and its associated complication profile; the second converts that technique base into an explicit protocol architecture covering identity verification, planning-data validation, guidance-system tolerance, and documentation. The central claim of the second monograph, that checklist-based verification is the most consistently supported safety intervention available to the specialty, is corroborated here against an independent literature search; its treatment of digital and robotic precision, which frames accuracy as a governable tolerance rather than an inherent property of any device, likewise holds up against the accuracy literature. At the same time, several clinically consequential questions that this framework does not fully resolve, most notably the value of routine antibiotic prophylaxis in implant surgery, remain genuinely unsettled despite decades of trial evidence.

Conventional SCADA-based water utility control relies on hydraulic models recalibrated through discrete campaigns spaced months to years apart, leaving controllers to act on models that degrade silently between updates. This paper specifies and evaluates a framework that couples a gradient-calibrated hydraulic digital twin to a hierarchically decomposed reinforcement learning controller, coordinating production, transmission, and distribution decisions through Lagrangian relaxation of inter-tier coupling constraints. A differentiable hydraulic solver updates pipe roughness, demand allocation, and valve loss parameters through exact gradients of the prediction residual within a rolling 24-hour window, while a temporal fusion transformer propagates quantile demand forecasts into a risk-sensitive reward term. Evaluated on a 2,400-node benchmark network against a rule-based SCADA baseline across thirty replicated simulation runs, the framework reduced specific energy consumption from 0.58 to 0.40–0.42 kWh/m³, demand forecast error from 14.7% to 4.0–5.0% MAPE, anomaly detection latency from 4.3 hours to 0.3–0.5 hours, treatment dosing error from ±15% to ±4%, and non-revenue water from 32.1% to 21–22%. Lagrangian decomposition reduced joint action-space cardinality from a multiplicative to an additive function of per-tier size, yielding an approximately two-orders-of-magnitude reduction in effective search space for the tested topology. Parameter identifiability under sensor coverage sparser than the benchmark configuration remains untested and bounds the framework's applicability to deployments matching the assumed instrumentation density.

<b>Background:</b> Antimicrobial resistance (AMR) is a major global public health threat that compromises the effectiveness of antimicrobial therapy. Nurses play a critical role in antimicrobial stewardship (AMS); however, evidence regarding their knowledge, attitudes, and practices (KAP) in the Philippine setting remains limited. <b>Objective:</b> To determine the knowledge, attitudes, and practices regarding antimicrobial stewardship among bedside nurses employed in selected tertiary hospitals in Baguio City, Philippines, and to examine the relationships between selected socio-demographic characteristics and AMS competencies. <b>Methods: </b>A quantitative descriptive cross-sectional correlational study was conducted among 119 bedside nurses from two tertiary hospitals in Baguio City. Data were collected using a modified, validated self-administered questionnaire. Descriptive statistics summarized respondents' characteristics and KAP scores. The Shapiro–Wilk test assessed normality. Univariate linear regression examined associations between socio-demographic characteristics and KAP outcomes. Statistical significance was set at p < 0.05. Results: Most respondents demonstrated moderate knowledge, highly positive attitudes, and favorable antimicrobial stewardship practices. Greater knowledge was significantly associated with better stewardship practices. Likewise, positive attitudes were positively associated with stewardship practices. Previous antimicrobial stewardship education and selected socio-demographic characteristics were associated with improved KAP outcomes. <b>Conclusion:</b> Bedside nurses demonstrated positive attitudes and favorable antimicrobial stewardship practices despite moderate knowledge levels. Strengthening competency-based antimicrobial stewardship education may enhance nurses' participation in stewardship initiatives and improve patient safety while contributing to national and global efforts to combat antimicrobial resistance.

For an attentive reading of the city and to help understand the public policy of memory, we need to pay closer attention to the processes of sense-making inscribed in uncommon forms. Public art has long been recognised for its potential to transform urban spaces. While the most traditional way of conserving memory centres on formal street art, graffiti may be seen as subversive. Graffiti is considered vandalism; its role in urban memory is overlooked. The author argues that such a notion is not directly related to protecting public and private property in Cairo, but rather conflicts with the elites’ and authorities’ need to control the urban narrative, the diversity of cultural values, and political positions. The article explores the role of graffiti in Cairo by selecting numerous graffiti pieces across the city. The graffiti pieces were selected to address cultural diversity, aesthetics, and political aspects. They were selected to represent what came to be known as guerrilla memory. Graffiti pieces were classified by their objectives and analysed semiotically. Besides the political graffiti, Cairo exhibits commercial, aesthetic and religious graffiti. The different types of graffiti in Cairo tell a story about the community’s hopes, frustrations, and cultural values. This turns the city walls into memory carriers. Graffiti in Cairo plays a significant role in expressing the silenced community’s thoughts by providing a visible and tangible representation. Graffiti’s visibility and its imposition of diverse, unauthorised urban narratives explain why it is highly contested in Cairo, as it draws marginalised citizens’ voices into urban places.

Knowledge work teams operating under variable demand face a class of delivery failure that single-layer governance models cannot prevent: structural overload injected at the commitment-formation boundary, invisible to execution-layer metrics, and amplified by cognitive fragmentation that standard workflow instruments do not register. This article examines the architectural conditions under which knowledge work control systems reduce cognitive load and improve delivery predictability. Through a grouped analytical review of empirical and theoretical literature on WIP-limit governance, team cognitive load, and observability-driven telemetry, the article identifies a shared structural limitation across all three bodies of research: none models the coupling between commitment formation, execution mode, and cognitive context as a single governed system. Drawing on control systems theory, queueing dynamics, and cognitive psychology, the article argues that delivery predictability degrades not from execution inefficiency but from the absence of cross-loop coupling rules that prevent obligation surplus, flow degradation, and cognitive fragmentation from reinforcing one another. The three-loop flow architecture comprising a Commit Loop with capacity-bounded intake, a Delivery Loop with explicit Normal, Overload, and Recovery operating modes, and a Cognition Loop enforcing context-capacity constraints through a Context Token Protocol is identified as a structural response to the documented failure modes of existing frameworks. The analytical contribution is a precise specification of the boundary conditions under which WIP-limit Kanban, team-topology design, and DORA-type telemetry each remain adequate, and the condition under which none of them does.

<b>Background:</b> <i>Gallibacterium</i><i> </i><i>anatis</i> is an opportunistic pathogen, mainly associated with infections in poultry. Infections in humans have only been described four times (in France and China). <b>Case presentation:</b> We report the case of a 62-year-old non-immunocompromised male patient with a gastric bypass in his medical history, presenting with cholecystitis in whom <i>Gallibacterium</i><i> </i><i>anatis</i> was isolated from the blood, besides an <i>Escherichia coli</i>. Identification of the <i>G. </i><i>anatis</i> was achieved using MALDI-TOF MS and confirmatory 16s RNA sequencing. The patient was successfully treated with piperacillin-tazobactam, resulting in clinical improvement. In the context of impaired host defenses due to acute cholecystitis with an <i>E. coli</i> bacteremia, it is conceivable that <i>G. </i><i>anatis</i> entered the bloodstream through bacterial translocation from the gastrointestinal tract. <b>Conclusion:</b><b> </b>This case highlights the importance of advanced identification techniques and awareness of rare pathogens in clinical practice. <i>Gallibacterium</i><i> </i><i>anatis</i>, particularly drug-resistant strains, may represent a potential infectious agent and should therefore be considered in diagnostic work-up.

This study investigates whether the Feedback Literacy Scale (FLS) can be developed and validated to measure student teachers’ feedback literacy in teacher education in Myanmar. Based on the Feedback Literacy Scale (FLS) by Yildiz et al. (2020) [1], the Student Feedback Literacy Scale (SFLS) developed by Liao (2021) [2], and the Student Feedback Literacy (SFL) scale by Woitt et al. (2023) [3], the Feedback Literacy Scale was validated. Firstly, the item pool for the feedback literacy scale contained 76 items. The participants of this study were 1550 from 360 first-year, 367 second-year, 378 third-year and 445 fourth-year student teachers. The exploratory factor analysis resulted in a four-factor structure, and the final confirmatory factor analysis indicated acceptable model fit. The final scale demonstrated strong internal consistency and acceptable validity and reliability for use with Myanmar student teachers in teacher education. Therefore, the Feedback Literacy Scale (FLS) was found to be valid and reliable for measuring feedback literacy of student teachers of the teacher education program in Myanmar. This study indeed helps student teachers, school administrators and education policymakers improve their understanding of feedback and application of feedback in their learning for future professional teaching in the Myanmar teacher education program.

We have reported novel solid-cancer treatment modality of nano-thermal ablation therapy using two medical devices of 100kHz electromagnetic field radiator and heat-generating nanoparticles of MCL particle [1]. External 100kHz electromagnetic field radiation induced heat generation of MCL particle in tumor tissue and caused tumor specific cytotoxicity and blood vessel disruption [1]. MCL particle was designed to be about 100nm diameter and to move within tumor tissue by composing heat-generating magnetite (Fe<SUB>3</SUB>O<SUB>4</SUB>) with neutral and cationic lipids [1]. However, concerning 100kHz radiator, rational concept of its performance and specification was not fully discussed. Purpose of this seminar is to describe significance of 100kHz magnetic flux density for rational designing, specification and usage of the radiator, referring to our unpublished data during 2004~2025. At first, our calibration method of 100kHz magnetic flux density was shown, and then its application to density distribution analysis of our radiators HTS-5010H and Hi-Heater 5010 was described. And, based on density distribution profile of Hi-Heater 5010 radiator, effective density at tumor locus in the standard treatment condition of the therapy was confirmed 15mT. Based on the recorded data of clinical research using HTS-5010H radiator, safety radiation condition toward groin, breast, thigh, neck, chest and arm were shown with density distribution in patient bodies. With all respect, quoting MFH<SUP>®</SUP>300F (100kHz) radiator [2], availability of three types radiators for various target cancers was discussed on the basis of effective tumor density and mitigation of normal tissue heating. According to Design Control Guidance of medical device [3], design process of the radiator was exemplified by drafted documents of design input and output.

<i>Roseomonas</i><i> mucosa</i> is a slow-growing, pink-pigmented, Gram-negative coccobacillus historically considered an opportunistic pathogen in severely immunocompromised oncology patients. However, recent genomic and clinical data demonstrate its primary reservoir is the human skin microbiome, facilitating an evolving epidemiology. We report a case of <i>R. mucosa</i> bacteremia in a 69-year-old woman with short bowel syndrome (SBS) and total parenteral nutrition (TPN) dependence. This case supports an emerging pattern: <i>R. mucosa</i> is increasingly identified in "device-compromised" hosts. Furthermore, this pathogen may present without elevated host-response biomarkers and exhibits intrinsic resistance to empiric broad-spectrum beta-lactams, complicating early management.

Between 27% and 46% of small and medium enterprises that successfully scale revert to their prior operational size within three years, a rate that is structurally amplified in vehicle-based businesses where capital is concentrated in depreciating physical assets and competitive differentiation occurs primarily on price and service reliability rather than product innovation. This article examines the conditions under which entrepreneurial management functions as a genuine strategic asset in small and medium vehicle-based businesses, rather than as a dispositional attribute of owner-managers that is orthogonal to firm performance. The analysis identifies a systematic misfit between the dominant theoretical frameworks, specifically dynamic capabilities theory and the five-dimension entrepreneurial orientation model, and the operational context of vehicle-based SMEs. Drawing on a critical synthesis of 13 empirical and theoretical sources, the article argues that dynamic capabilities yield measurable performance returns only under conditions of high environmental dynamism, a threshold that asset-intensive transport markets do not reach, and that the entrepreneurial orientation-performance relationship in this sector is mediated by competitive positioning through contractual and regulatory foresight rather than by innovativeness or risk-taking. Three sector-specific mechanisms are identified through which entrepreneurial management converts into competitive advantage: the institutionalization of operationally scripted routines that free management bandwidth for strategic positioning decisions; proactive regulatory compliance that generates first-mover advantages in fleet certification and route licensing; and the development of decision-support infrastructure that enables analytically grounded fleet renewal and platform coopetition choices. The article concludes that the standard EO measurement instrument requires sector-specific reweighting before it can reliably predict performance outcomes in vehicle-based SMEs, and that longitudinal firm-level data from commercial transport markets represent the most tractable foundation for that instrument's development.

<b>Background: </b>Cystatin C (CysC) predicts adverse outcomes in heart failure (HF), yet its prognostic value relative to underlying renal function remains undefined. We aimed to determine the association between serum CysC and 1-year readmission risk in HF patients stratified by chronic kidney disease (CKD) status. <b>Methods:</b> This retrospective cohort study analyzed 2,008 hospitalized HF patients. Based on CKD status, patients were categorized into non-CKD and CKD groups. Serum CysC levels were analyzed as both continuous variable and in tertiles. The association with 1-year readmission was assessed using multivariable Cox proportional hazards models. <b>Results:</b> Overall, each 1 mg/L increase in CysC was independently associated with an 11% higher risk of re-admission (adjusted HR: 1.11, 95% CI: 1.01-1.23, p=0.003). A significant interaction with CKD status was found (p=0.003). In the non-CKD group, elevated CysC (>1.98 mg/L) was associated with a 51% increased risk (adjusted HR: 1.51, 95% CI: 1.18-1.92, p=0.001), with a non-linear threshold effect identified at 0.998 mg/L. Conversely, no significant association was observed in CKD patients (adjusted HR: 0.96, 95% CI: 0.82-1.12, p=0.576). <b>Conclusions:</b> Elevated serum CysC is a potent predictor of 1-year readmission in HF patients without CKD, but not in those with established CKD. Its prognostic utility is therefore highly dependent on renal context, highlighting its greatest value in patients without advanced renal dysfunction.