Аssessment of adequacy of prescribing therapy in the elderly with cardiovascular diseases

Cilj: Istraživanje koje je vršeno imalo je za cilj da odredi prevalencu PIM-a u populaciji starih ispitanika koji su imali dijagnostikovano kardiovaskularno oboljenje i da kvantifikuje značaj određenih varijabli na prisustvo PIM-a. Metoda: Sprovedena je hibridna studija koja je u prvom delu, od početka 2016. godine do kraja 2017.godine izvedena kao studija preseka (periodična prevalencija), a u drugom delu, tokom 2018. godine, kao klinička studija sa intervencijom putem edukacije, sa poređenjem pre i posle intervencije. Studijski uzorak obuhvatao je 1500 pacijenata starijih od 65 godina sa kardiovaskularnim oboljenjima a da su bili korisnici zdravstvenih usluga i imali dostupnu medicinsku dokumentaciju u Zavodu za gerijatriju i palijativno zbrinjavanje u Beogradu. Intervencijski deo istraživanja vršen je sa lekarima koji sprovode zdravstvenu zaštitu starih osoba a samim tim i propisivanje medikamentozne terapije čija adekvatnost propisivanja je analizirana upotrebom standardnih međunarodnih kriterijumima, American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. Potrošnja lekova u navedenoj ustanovi za posmatrane periode je vršena prema utvrđenoj ATC/DDD metodologiji koja je definisana od strane ekperata SZO. Rezultati: Učestalost PIM-a u ispitivanoj populaciji iznosila je 70,3% za period 2016.-2017. godine i 71,3% u toku 2018. godine. Posmatrano u odnosu na pol, ispitanice ženskog pola su bile dominatnije u grupi sa PIM-om. Najviše ispitanika imalo je 4 komorbiditeta uz osnovnu dijagnozu. Komorbiditeti sa visokom frekvencom su bili u grupi bolesti I00-I99 (bolesti srca i krvnih sudova) (36.9%). Dijagnoze koje su najviše zabeležene su bile iz podgrupe I10- I15 (hipertenzivne bolesti) (48,83%), I20-I25 (ishemijske bolesti srca) (20,38%). Po pacijentu je u periodu 2016-2017 godine propisivano 7,2 leka dok je tokom 2018. godine iznosio 7,3. Lekovi koji su potencijalno neadekvatno propisivani sa najvećom frekvencom su: benzodiazepini srednjeg delovanja (79,03%), centralni α blokatori (23,57%), antipsihotici (tipični i atipični) (30,75%). Potencijalno klinički značajne neinfektivne interakcije lek-lek koje bi trebalo izbegavati kod starih osoba beleži pad sa (35,5% na 30,9%) u prospektivnom periodu. Potencijalno neadekvatno propisivanje lekova koji se moraju koristiti sa oprezom kod starih osoba beleži smanjenje za: antipsihotike (29,5% na 27,8%), diuretike (69,9% na 63,8%) i SSRI (22,7% na 19,7%). Potencijalno neadekvatno propisivanje lekova usled lek-bolest ili lek-sindrom interakcije koje mogu pogoršati bolest ili sindrom zabeleženo je u periodu 2016.-2017. u 105 slučajeva ili (8,6%) a nakon intervencije 2018.godine u 74 slučajeva odnosno (6,4%) Prediktori za PIM su brojni i to: polifarmacija, pol, upotreba nikotina, kognitivni status, uhranjenost i komorbiditet za period pre intervencije a nakon toga je pokazan i uticaj bračnog stanja i emocionalnog statusa. Zaključak: Kardiovaskularne bolesti u starijoj populaciji povezane su sa visokom prevalencijom potencijalno neadekvatnog propisivanja lekova. Iako je zabeleženo smanjenje potrošnje pojedinih kardiovaskualrnih lekova nakon održane edukacije, prevalenca PIM-a nije se smanjila. Kreiranje zdravstvenih preporuka za propisivanje lekova kod starijih osoba koje bi naglasile navedene faktore moglo bi uticati na smanjenje prevalencije PIM-a u navedenoj popilaciji.Aim: Study has purpose to show prevalence of PIM in the population of elderly person with the cardiovascular disease and to quantify influence of the specific variable on PIM presence. Methods: A hybrid study was performed, which in the first part, from the beginning of 2016 to the end of 2017, was performed as a cross-sectional study (periodic prevalence), and in the second part, during 2018, as a clinical study with interventions during education and after interventions. Sample of the study inluded 1500 partcipants older then 65 years with cardiovascular disease and who was used specific health services and had medical data at the Institute for Gerontology and Palliative Care, Belgrade. Interventional part of the study was done with medical doctor who presribed drugs at this institution. The adequacy of the prescribed therapy was assessed by American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. Drug consumption for the observed periods was determinated by established ATC/DDD methodology defined by WHO experts. Results: PIM frequency in the examined population was 70,3% during the period 2016-2017 and 71,3% during the 2018. Observed in relation to gender, female respondents were more dominant in the group with PIM. Most subjects had 4 comorbidities with a basic diagnosis. Comorbidities with high frequency were in the group of diseases I00-I99 (cardiovascular diseases) (36.9%). The most frequently diagnosed diagnoses were from subgroup I10-I15 (hypertensive diseases) (48.83%), I20-I25 (ischemic heart diseases) (20.38%). In the period 2016-2017, 7.2 drugs were prescribed per patient, while in 2018 it was 7.3. Drugs that are potentially inadequately prescribed with the highest frequency are: medium-acting benzodiazepines (79.03%), central α blockers (23.57%), antipsychotics (typical and atypical) (30.75%). Potentially clinically significant non-infectious drug-drug interactions that should be avoided in the elderly decreased from 35.5% to 30.9% in the prospective period. Potentially inadequate prescribing of drugs that must be used with caution in the elderly decreased for: antipsychotics (29.5% to 27.8%), diuretics (69.9% to 63.8%) and SSRIs (22.7% to 19.7%). Potentially inadequate drug prescribing due to drug-disease or drugsyndrome interactions that may exacerbate the disease or syndrome was noted in the period 2016-2017. in 105 cases or (8.6%) and after the intervention in 2018 in 74 cases or (6.4%) Predictors for PIM are numerous, as follows: polypharmacy, sex, nicotine use, cognitive status, nutrition and comorbidity for the period before interventions and after that the influence of marital status and emotional status is shown. Conclusion: Cardiovascular diseases in the elderly population are associated with a high prevalence of potentially inadequate drug prescribing. Although a decrease in the consumption of certain cardiovascular drugs was observed after the training, the prevalence of PIM did not decrease. Creating health recommendations for prescribing drugs in the elderly that would emphasize these factors could reduce the prevalence of PIM in this population

Inflationary RSII Model with a Matter in the Bulk and Exponential Potential of Tachyon Field

In this paper we study a tachyon cosmological model based on dynamics of a 3-brane in the second Randall-Sundrum (RSII) model extended to include matter in the bulk. The presence of matter in the bulk changes warp factor which leads to modification of inflationary dynamics. The additional brane behaves effectively as a tachyon. We calculate numerically observation parameters of inflation: the scalar spectral index ($n_s$) and the tensor-to-scalar ratio ($r$) for the exponential potential of tachyon field.Comment: 9 pages, 1 figure, will be published in the Special Issue of Facta Universitatis, Series: Physics, Chemistry and Technology devoted to the SEENET-MTP Balkan Workshop BSW2018 (3-14 June 2018

A New Fractal-Based Design of Stacked Integrated Transformers

Silicon-based radio-frequency integrated circuits are becoming more and more competitive in wide-band frequency range. An essential component of these ICs is on-chip (integrated) transformer. It is widely used in mobile communications, microwave integrated circuits, low-noise amplifiers, active mixers, and baluns. This paper deals with the design, simulation, and analysis of novel fractal configurations of the primary and secondary coils of the integrated transformers. Integrated stacked transformers, which use fractal curves (Hilbert, Peano, and von Koch) to form the primary and secondary windings, are presented. In this way, the occupied area on the chip is lower and a number of lithographic processes are decreased. The performances of the proposed integrated transformers are investigated with electromagnetic simulations up to 20 GHz. The influence of the order of fractal curves and the width of conductive lines on the inductance and quality factor is also described

Numerical Calculation of Hubble Hierarchy Parameters and Observational Parameters of Inflation

We present results obtained by a software we developed for computing observational cosmological inflation parameters: the scalar spectral index ($n_s$) and the tensor-to-scalar ratio ($r$) for a standard single field and tachyon inflation, as well as for a tachyon inflation in the second Randall-Sundrum model with an additional radion field. The calculated numerical values of observational parameters are compared with the latest results of observations obtained by the Planck Collaboration. The program is written in C/C++. The \textit{GNU Scientific Library} is used for some of the numerical computations and R language is used for data analysis and plots.Comment: 8 pages, 5 figures, based on talk presented at The 10th Jubilee Conference of the Balkan Physical Union (BPU10), 26-30 August 2018 (Sofia, Bulgaria

Use of linear radiofrequency device in liver resection

Background/Aim. Linear radiofrequency device (LRFD) is disposable tool designed for liver parenchyma transection using controlled radiofrequency to 'seal' blood vessels and bile ducts, making liver resection easier and safer compared to classical resectional techniques. The aim of this study was to determine real value of the LRFD compared to the standard 'keliclasia' technique. Methods. This prospective study analyzed the significant intraoperative parameters and postoperative results of the 200 patients who underwent surgery at the Surgery Clinic of Clinical Centre in Niš, between January 1, 2001, and January 1, 2009. The patients were divided into two groups: the control Keli group (144 patients) with the 'keliclasia' resection technique and the control RF group (with resection performed using LRFD - Tissue Link / Dissection Sealer (DS - 3.0) (56 patients). The following parameters were analyzed: duration of liver ischemia, liver parenchyma transection time, intraoperative blood loss, significant intraoperative and postoperative complication rate, duration of hospitalization and mortality. Results. LRFD was used in 56 liver resections. The average duration of liver ischemia in the RF group was shorter than in the Keli group (7 versus 22 minutes). Parenchymal liver transection was significantly slower in the RF group than in the Keli group (2.05 versus 4.34 cm2/minutes, respectively). There was less intraoperative bleeding using LRFD 'Keliclasia' tehniquethan in the control group (390 mL compared to 420 mL, respectively). After the use of LRFD two cases of biliary leak and 4 pleural effusions were registered. Conclusion. LRFD is simple device for safe liver transection with decreased need for liver ischemia and singificant reducing of the intraoperative blood loss. High price for disposable device and slow parenchyma transection are disadvantages of this device

Participation of environmental taxes in government expenditures for environmental protection: the case of selected EU countries

The aim of this paper is to show whether the current system of environmental taxation and environmental policies of the states is efficient for solving environmental problems. We analyze the link between environmental tax revenues and total government expenditure as independent variables and government expenditures for environmental protection as dependent variable in selected EU countries. By the implementation of panel data regression analysis on a defined sample, we came to the conclusion that among the observed variables there is a positive relationship. However, this relationship shows that the growth of expenditures for environmental protection is slower than the growth of total expenditure. The results also suggest that the relationship between revenues from environmental taxes and expenditures of the state in the area of environmental protection is a little weaker. With respect to the result of analysis, it can be concluded that the existing state policy in is not sufficiently effective

Development of hybrid models in phase multiple- criteria for prioritization reliability environment suppliers mining systems

Pravilan izbor dobavljaĉa danas ima izuzetan znaĉaj za poslovanje i za sveukupni uspeh kompanije. Sa sve većim i intenzivnijim razvojem informacionih tehnologija, tj. uvoĊenjem popularnih programa, dolazi do konstantnog poboljšanja u domenu inţenjeringa, logistike i upravljanja proizvodnjom, što zahteva bolje i ĉvršće veze sa dobavljaĉima. Kao rezultat svega toga dolazi do smanjenja potrebnog vremena za nabavku (dobara, usluga ili radova), tj. izvesnijih isporuka taĉno na vreme i povećanja kvaliteta (dobara, usluga ili radova) u lancima snabdevanja proizvodnih sistema. U sluĉaju da je kompanija smanjila broj dobavljaĉa u svojoj bazi dobavljaĉa, a sa manjim brojem dobavljaĉa ispunjava dugoroĉnije ugovore, dolazi do smanjenje ţelje za promenom postojećih dobavljaĉa. Ovo je dodatni imperativ zašto je izbor pouzdanih dobavljaĉa izuzetno vaţna aktivnost u proizvodnim sistemima. Danas, eminentni dobavljaĉi ukljuĉuju mnogobrojne resurse kako bi ocenili performanse dobavljaĉa i njihove sposobnosti u razliĉitim sferama. Sam proces izbora dobavljaĉa je postao toliko znaĉajan da ekspertski timovi bivaju angaţovani za izvršenje ovih zadataka (ocenjivanje i rangiranje dobavljaĉa). Dakle, racionalna odluka o izboru dobavljaĉa moţe umanjiti ili ukloniti mnoge probleme u poslovanju kompanija. Cilj ove doktorske disertacije jeste da ukaţe i objasni mogućnosti unapreĊenja donošenja odluke o izboru poverljivog (pouzdanog) dobavljaĉa u proizvodnim sistemima. Izbor se vrši na osnovu unapred odreĊenih kriterijuma koje obiĉno definiše naruĉilac. Kada kod izbora pouzdanog dobavljaĉa postoji manji broj dobavljaĉa, izbor je jednostavan, jer su utvrĊeni kvantitativni kriterijumi koji se mogu meĊusobno uporeĊivati, ali u situacijama u kojima se nalazi veliki broj dobavljaĉa, kako danas, realan ţivot i praksa nameću, izbor najpoverljivijeg dobavljaĉa vrši se na osnovu kvalitativnih i kvantitativnih kriterijuma i metoda. U disertaciji je predstavljen sistem za podršku odluĉivanju zasnovan na konceptu višekriterijumskog odluĉivanja i teorije fazi skupova. Na osnovu definisanog originalnog integralnog AHP – PROMETHEE/GAIA – AHP –TOPSIS model u fazi okruţenju, kao i fazi set model sa MAX-MIN kompozicijom za prioritizaciju pouzdanosti dobavljaĉa – na bazi njihovih performansi i uĉinka, nakon sprovedenih metoda, došlo se do zakljuĉka da je dobavljaĉ D4,najbolje rangiran.Right choice of supplier have a huge impact on companys business results. Along with present trend in constant increase and growth in IT sector it lead to increase in quality in area of engeneering, logistics and handling production, along with that it demands better and more tight connections with the suppliers. Result is seen as a less time needed to get the supplies of any kind, right on time delivering and higher quality in chains of suppliers. In case that company reduced number of suppliers in its own base of suppliers, but they sign long term contracts with them, it leads to lower chance of changing suppliers. This is additional must have because having a high quality suppliers is very important. Important companies today include a lot of different resources to rate performances of supliers and their skills in different areas. Process of picking right suppliers became so important that companies hire experets to do this task. So, a right decision in picking the supplier can solve a lot of problems in buissnis. Goal of this PhD is to show and explain possibilities of improving decisions in picking a adequate supplier in companies. Choice is made by criteriums that are chosen in advance by company. When choice of supplier is narrowed down to a small number of suppliers then choice is very simple to make but in situations when there is a lot of different suppliers picking the right one cane be very difficult and choice is made based on quality and quantity criteria and methods. In PhD is shown a support system for decision based on multi criteria concept and theory of faze numbers. Based on already defined integral AHP – PROMETHEE/GAIA – AHP –TOPSIS models the fuzzy setting, as they set the fuzzy model with MAX-MIN composition for priorities of reliable suppliers – but based on their performance and work, after using all this methods it came to conclusion that supplier D4 is best ranked supplier

Promene u strukturi ćelijskog zida lucerke tokom vegetacije

The investigation was done on 141 samples of one alfalfa cultivar, collected from the same location during the first three growth cycles: spring growth, the first and the second regrowth. Within each growth cycle, sampling was done during the whole growing period, commencing when plant height was below 150 mm and continuing until plants were bearing ripe seeds. On all collected samples the following cell wall characteristics were determined: neutral detergent fibre (NDF), acid detergent fibre (ADF), acid detergent lignin (ADL), neutral detergent insoluble crude protein (NDICP), acid detergent insoluble crude protein (ADICP). Cellulose and hemicellulose were detected on the base of the mentioned chemical parameters. Significantly lower (p lt 0.01) content of aNDF, ADF, ADL, ADICP and cellulose is found in the second regrowth, while there were no significant differences between the other two growth cycles. Except in NDICP and ADICP, the increase in all accompanying components of the cell wall was observed, and expressed in average daily changes. There was no consistent trend in NDICP and ADICP. During the spring growth from late bud to full-bloom stage the 'plateau' was observed. The plateau was represented as almost constant content of aNDF, ADF, ADL and cellulose. The correlations between all components of the cell wall were shown. The equation aNDF = 36.713 + 1.181 × ADF is recommended for conversion of ADF into aNDF in alfalfa.Istraživanje je sprovedeno na 141 uzorku iste sorte lucerke, sakupljene na istoj lokaciji tokom prva tri ciklusa vegetacije: prolećni ciklus, drugi ciklus i treći ciklus. Tokom svakog ciklusa, uzorkovanjem je obuhvaćen ceo ciklus vegetacije, od momenta kada su biljke imale visinu manju od 150 mm sve do momenta kada su biljke imale zrelo seme. U svim sakupljenim uzorcima određeni su sledeći parametri ćelijskog zida: vlakna nerastvorljiva u neutralnom deterdžentu (aNDF), vlakna nerastvorljiva u kiselom deterdžentu (ADF), lignin (ADL), protein nerastvorljiv u neutralnom deterdžentu (NDICP), protein nerastvorljiv u kiselom deterdžentu (ADICP). Celuloza i hemiceluloza su određene na osnovu navedenih hemijskih parametara. Utvrđena je značajno manja (p lt 0.01) količina aNDF, ADF, ADL, ADICP i celuloze u trećem ciklusu vegetacije, dok između ostala dva ciklusa nisu utvrđene veće razlike. Izuzev kod NDICP i ADICP, utvrđen je porast svih praćenih komponenata ćelijskog zida i izražen u prosečnim dnevnim promenama. Kod NDICP i ADICP je zabeleženo odsustvo trenda. Tokom prolećnog ciklusa od faze punog pupoljenja do faze punog cvetanja je zabeležen 'plato', odnosno skoro konstantna količina aNDF, ADF, ADL i celuloze. Prikazane su korelacije između svih parametara ćelijskog zida. Jednačina aNDF = 36.713 + 1.181 × ADF je preporučena za konverziju ADF u aNDF u lucerki

Uticaj stepena sabijanja i inokulacije na biohemijske promene u silažama lucerke

The effect of different levels of compression (A1 = 420 gdm-1, A2 = 560 gdm-1) and inoculation (B1 = no inoculant, B2 = with inoculant) on changes in chemical composition, proteolysis and quality of lucerne silage was investigated in this paper. Based on the results of chemical analysis we found that in silages with more compressed material there was a reduction in the amount of ammonia nitrogen, soluble nitrogen and acetic acid, and increased content of protein nitrogen ('true'protein) and production of lactic acid (p lt 0.05). With the inoculation of the ensiling material the production of ammonia nitrogen and acetic acid was reduced but the content of lactic acid and acidity was increased (p lt 0.05). The interaction of both investigated factors (A×B) induced a decrease in the proteolysis degree, increase of lactic acid production and decrease in acetic acid production, and decrease in pH values (p lt 0.001) in investigated silages. The investigated factors had less influence on the chemical composition of lucerne material, and the significant variations were observed in fat and NFE contents. On the basis of this investigation the degree of compression is the most important parameter in ensiling technology. With the adequate compression and reduction of air in the starting material, the aerobic phase is reduced and the activity of proeolytic enzymes is decreased. In practice the special attention should be given to factors on which directly or indirectly the level of compression of ensiled material depends: wilting, cutting, object selection and/or selection of machines used for compression.U radu je ispitivan uticaj različitog stepena sabijanja (A1 = 420 gdm-1, A2 = 560 gdm-1) i inokulacije (B1 = bez inokulanta, B2 = sa inokulantom) na promene parametara hemijskog sastava, proteolize i kvaliteta silaže lucerke. Na osnovu rezultata hemijskih analiza utvrđeno je u silažama od bolje sabijenog materijala smanjenje količine amonijačnog i rastvorljivog azota, kao i sirćetne kiseline, i povećanje količine proteinskog azota ('pravog' proteina) i mlečne kiseline (p lt 0,05). Inokulacijom siliranog materijala smanjena je produkcija amonijačnog azota i sirćetne kiseline i istovremeno povećana produkcija mlečne kiseline i kiselost silaža (p lt 0,05). Interakcijom ispitivanih faktora (A×B) došlo je do smanjenja stepena proteolize u silažama, povećanja produkcije mlečne kiseline i smanjenja količine sirćetne kiseline, a time i smanjenja pH vrednosti (p lt 0,001). Ispitivani faktori su bili od manjeg značaja za promene parametara hemijskog sastava hraniva pa su signifikantno varirali samo količina masti i BEM-a. Na osnovu izvedenih ispitivanja može se zaključiti da je stepen sabijanja najvažnija mera u tehnologiji siliranja hraniva. Adekvatnim sabijanjem skraćuje se trajanje aerobne faze i ograničava delatnost proteilitičkih enzima. U praksi treba posvetiti maksimalnu pažnju faktorima od kojih direktno ili indirektno zavisi stepen sabijenosti siliranog materijala: stepenu provenulosti, dužini seckanja, izboru tipa objekta za siliranje i/ili izboru mehanizacije za sabijanje (gaženje ili baliranje)