Socio-economic Indicators Influence in Terms of Natural Gas Supply Policy and Decision Making - Macedonian Case

Sustainable energy planning is very important in creating energy policies that underpin reliable energy systems. Macedonia has mainly coal based energy production, implying significant air pollution. Thus, natural gas is pointed out as a solid substitute. In order to analyze the combined implications of economic and social aspects when assessing six natural gas supply options vs. a set of selected relevant indicators, the Multi Criteria Decision Making (MCDM) and Analytic Hierarchy Process (AHP) technique were applied. The purpose of this paper is to address the combined effects of economic and social indicators affecting natural gas supply policy and decision making

Quality of Life-Repeated Measurements Are Needed In Dialysis Patients

BACKGROUND: There is a general agreement that, besides survival, the quality of life is a highly relevant outcome in the evaluation of treatment in patients with the end-stage renal disease. Moreover, it is very important to determine whether the quality of life impacts survival.AIM: This study aims to assess whether changes or absolute scores of the quality of life (QOL) measurements better predict mortality in dialysis patients.MATERIAL AND METHODS: In a longitudinal study comprising 162 prevalent hemodialysis patients QOL was assessed with the 36-item - Short Form Health Survey Questionnaire (SF-36) at baseline and after 12 months. Patients were followed for 60 months. Mortality risk was assessed using Cox proportional hazards analysis for patients with below and above median levels of both physical and mental QOL component scores (PCS and MCS, respectively).RESULTS: At the beginning of the study the mean Physical Component score was 47.43 ± 26.94 and mean Mental Component Score was slightly higher 50.57 ± 24.39. Comparative analysis of the changes during the first year showed a marked deterioration of all quality of life scores in surviving patients. The 5-point decline for PCS was noted in 39 (24%) patients and 42 (26%) for MCS. In the follow-up period of 60 months, 69 (43%) patients died. In the Cox analysis, mortality was significantly associated with lower PCS: HR = 2.554 [95% confidence interval (CI): 1.533-4.258], (P < 0.000) and lower MCS: 2.452 (95%CI: 1.478-4.065), P < 0.001. The patients who had lower levels of PCS and MCS in the second QOL survey 1 year later, had similarly high mortality risk: 3.570 (95%CI: 1.896-6.727, P < 0.000); 2.972 (95%CI: 1.622-5.490, P < 0.000), respectively. The hazard ratios for mortality across categories for the change of PCS and MCS were not significant. In the multivariate model categorising the first and second scores as predictors and adjusted for age, only the second PCS and MCS score were associated with mortality.CONCLUSION: Low QOL scores are associated with mortality in repeated measurements, but only the more recent overwhelmed the power of the decline

Excess Mortality in a Nephrology Clinic during First Months of Coronavirus Disease-19 Pandemic: A Pragmatic Approach

BACKGROUND: Excess mortality is defined as mortality above what would be expected based on the non-crisis mortality rate in the population of interest. AIM: In this study, we aimed to access weather the coronavirus disease (COVID)-19 pandemic had impact on the in-hospital mortality during the first 6 months of the year and compare it with the data from the previous years. METHODS: A retroprospective study was conducted at the University Clinic of Nephrology Skopje, Republic of Macedonia. In-hospital mortality rates were calculated for the first half of the year (01.01–30.06) from 2015 until 2020, as monthly number of dead patients divided by the number of non-elective hospitalized patents in the same period. The excess mortality rate (p-score) was calculated as ratio or percentage of excess deaths relative to expected average deaths: (Observed mortality rate–expected average death rate)/expected average death rate *100%. RESULTS: The expected (average) overall death mortality rate for the period 2015–2019 was 8.9% and for 2020 was 15.3%. The calculated overall excess mortality in 2020 was 72% (pscore 0.72). CONCLUSION: In this pragmatic study, we have provided clear evidence of high excess mortality at our nephrology clinic during the 1st months of the COVID-19 pandemic. The delayed referral of patients due to the patient and health care system-related factors might partially explain the excess mortality during pandemic crises. Further analysis is needed to estimate unrecognized probable COVID-19 deaths

Investment Incentives for Rehabilitation and Performance Improvement of TPP Bitola

The main purpose of this activity as well the purpose of this paper is to identify the most appropriate rehabilitation Investment Program for TPP Bitola, that will extend lifetime of main equipment, improve energy efficiency and overall performance as well as reduce environmental impacts, taking into account the locally available lignite reserves and/or potential fuel supply schemes. In regard with future strategic plan of Bitola TPP, two main long-term scenarios has carried out, plus a minor third: • The first – related to the exploitation of the existing coal (lignite) reserves in Macedonia; • The second is related to the potential use of natural gas; • The third is related to the potential import of coal, via Thessaloniki – Greece With regard to the exploitation of the domestic lignite reserves, the following sub-scenarios have been taken into consideration: 1. Rehabilitation of the three existing units; 2. Rehabilitation of the two existing units, and building of one 300 MW unit; 3. Rehabilitation of one existing unit, and building of one 500MW unit; 4. Building of one 500 MW unit, and one 300 MW unit

The Role and Interdependence of Economic Indicators in Optimal Natural Gas Supply in Macedonia as a transitional Economy

This paper elaborates the importance of the economic set of indicators relevant for assessing natural gas supply options, as a part of the multi criteria decision making (MCDM) method. Such an approach is a useful tool for decision makers. Thus, the paper is not only dealing with economic indicators arising from investment and other types of costs, but it mostly focuses on macroeconomic environment and macroeconomic preconditions strongly related to energy infrastructure. MCDM is firstly utilized to calculate the indicator’s weighting factors, and further, regression analyses are performed in terms of identifying interdependencies among the indicators

Active Smoking is Associated with Lower Dialysis Adequacy in Prevalent Dialysis Patients: Active smoking and dialysis adequacy

BACKGROUND: Dialysis adequacy measured by single pool Kt/V (spKt/V) lower than 1.2 or urea reduction rate (URR) lower than 65% is associated with a significant increase in patient mortality rate. Patients’ adherence to the medical treatment is crucial to achieve recommended targets for spKt/V. Smoking is a recognized factor of non-adherence. AIM: In this study we sought to assess the association of active smoking and dialysis adequacy. METHODS: A total of 134 prevalent dialysis patients from one dialysis center were included in an observational cross-sectional study. Clinical, laboratory and dialysis data were obtained from medical charts in previous 6 months. The number of missed, on purpose interrupted or prematurely terminated dialysis sessions was obtained. Dialysis adequacy was calculated as spKt/V and URR. Patients were questioned about current active smoking status. T-test and Chi-Square test were used for comparative analysis of dialysis adequacy with regard to smoking status. RESULTS: The majority of patients declared a non-smoking status (100 (75%)) and 34 (25%) were active smokers. Male gender, younger age and shorter dialysis vintage were significantly more often present in the active smokers ((9 (26%) vs 25 (73%), p = 0.028; 57.26 ± 12.59 vs 50.15 ± 14.10, p = 0.012; 118.59 ± 76.25 vs 88.82 ± 57.63, p = 0.030)), respectively. spKt/V and URR were significantly lower and Kt/V target was less frequently achieved in smokers ((1.46 ± 0.19 vs. 1.30 ± 0.021, p = 0.019; 67.14 ± 5.86 vs. 63.64 ± 8.30, p = 0.002; 14 (14%) vs. 11 (32%), p = 0.023), respectively. Shorter dialysis sessions, larger ultra filtrations and higher percentage of missed/interrupted dialysis session on patients’ demand were observed in smokers (4.15 ± 0.30 vs. 4.05 ± 0.17, p = 0.019; 3.10 ± 0.78 vs. 3.54 ± 0.92, p = 0.017; 25 (0.3%) vs. 48 (1.8%), p = 0.031), respectively. CONCLUSION: Active smokers, especially younger men, achieve lower than the recommended levels for dialysis adequacy. Non-adherence to treatment prescription in smokers is a problem to be solved. Novel studies are recommended in patients on dialysis, to further elucidate the association of dialysis adequacy with the active smoking status