Health system performance assessment landscape at the EU level: a structured synthesis of actors and actions

Background: Many policy makers and other stakeholders in the EU have expressed interest in better understanding the performance of their own health systems to identify opportunities for improvement in effectiveness, efficiency and equity. Health system performance assessment (HSPA) has received considerable attention at EU level as an instrument to improve transparency and accountability. This is equally important for population health and sustainable health spending. The goal of this paper is to synthesise and map the current state and developments in the field of HSPA relevant in the EU context and by this aid the navigation in the growing HSPA system, understand the available tools and identify opportunities for improvement. Methods: Structured synthesis of the literature on initiatives in the field of HSPA at EU level was carried out. Key literature was identified by a focused review performed between October 2015 and June 2016 on websites of key institutions including the EU, OECD and WHO and Google engine. We used six predefined criteria for identifying key literature. Identified initiatives were classified according to analytical and conceptual output or whether a guiding or advisory role was resumed. A visual map of the relationships between the different actions and actors involved in HSPA was developed. In addition, expert opinion was sought to refine the map. Results: We identified a total of 64 relevant initiatives and their relationships in the field of HSPA. These include institutions such as the European Commission (73%), European Council (8%), OECD (9%) and WHO-EUR (9%). 24 initiatives produced analytical outputs, four developed conceptual outputs and six had a guiding role. The role of the EU in HSPA and collaboration with other key actors have intensified considerably since the adoption of the EU Health Strategy in 2013. The EU HSPA landscape is complex with seemingly few streamlining activities. Conclusions: Knowledge transfer and exchange of expertise are key to HSPA. While cooperation between the key actors have intensified recently and clearly reflect the "Health in all Policies" (HIAP) approach, there is considerable room for improved streamlining activities to share knowledge and avoid overlapping efforts, especially within the European Commission

DIGITAL VIOLENCE: PERCEPTION OF ELEMENTARY SCHOOL STUDENTS WITH AND WITHOUT DISABILITIES FROM THE TERRITORY OF AP VOJVODINA

The goal of this research is to deepen the knowledge about the phenomenon of digital violence against children with and without developmental disabilities and to raise environmental awareness of the presence of digital violence in the population of children and youth with and without developmental disabilities in order to guide society in the direction of the possibility of protection from it. In the research participated 5227 elementary school age students with and without disabilities.The data was collected in elementary schools and schools for students with developmental disabilities in the territory of AP Vojvodina within the project of the Provincial Secretariat for Education, Regulations, Administration and National Minorities - National Communities "Violence on the Internet: How to prevent and fight against violence on the Internet?". The results of the research showed that digital violence among children and young people with and without disabilities in the territory of AP Vojvodina is represented in a significant percentage.  Research data shows that the largest number of children and young people access the Internet through their mobile phones, which supports the fact that the risk of children and young people experiencing this type of violence is significant.  Likewise, the data analysis showed that the largest percentage of children and young people believe that they, their parents and teachers are responsible for protecting children and young people from digital violence.  From this arises a clear need for the education of children and young people, better communication between schools and teachers, students and parents and clearer procedures related to the prevention and protection of children and young people from violence on the Internet or procedures when violence occurs, all for the purpose of preventing  numerous negative outcomes that digital violence can lead to

A NEW RECORD FOR THEOPHYLEA SUBCYLINDRICOLLIS HLADIL, 1988 (COLEOPTERA: CERAMBYCIDAE) IN SERBIA

During field research in 2011 in Banat and Bačka only one male of Theophilea subcylindricollis Hladil, 1988 was found in a field northeast of Lake Palić. This is the third record of it in our country, with one of the two previous recorded sites destroyed by a building construction. This paper gives an overview of the factors threatening this strictly protected species in Serbia

Next generation sequencing as a tool for pharmacogenomic profiling: Nine novel potential genetic markers for targeted therapy in childhood acute lymphoblastic leukemia

Uvod/Cilj Sekvenciranje nove generacije (SNG) omogućilo je genomsko profilisanje svakog bolesnika. Nova saznanja u oblasti farmakogenomike omogućavaju primenu podataka dobijenih ovom metodom u cilju otkrivanja novih mogućih genetičkih markera za ciljanu terapiju mnogih, posebno malignih bolesti. Cilj ovog istraživanja je bio da se primenom SNG odre- di genetski profil akutne limfoblastne leukemije (ALL) kod dece u cilju procene mogućih molekularnih meta za ciljanu terapiju. Metode Analizirali smo DNK uzorke 17 bolesnika obolelih od ALL dečjeg doba koristeći ciljano SNG. Napredne bioinformatičke metode su korišćene da identifikuju nove mutacije u analiziranim genima i da predvide njihov uticaj i farmakogenomski potencijal. Rezultati Identifikovali smo devet genskih varijanti koje do sada nisu opisane u relevantnim bazama podataka. U navedenim varijantama identifikovane su dve 'besmislene' varijante, ABL1 p.Q252* i AKT1 p.W22*, jedna varijanta koja pomera okvir čitanja, STK11 p.G257fs*28, i šest nesinonimnih varijanti. Kreirali smo trodimenzionalni model za četiri proteina koji bi bili produkt novih nesinonimnih varijanti. Analizirali smo farmakogenomski potencijal svake varijante i otkrili da su dve, STK11 c.1023G gt T/ p.L341F i ERBB2 c.2341C gt T/ p.R781W, mogući kandidati za ciljanu terapiju. Zaključak Nove varijante otkrivene u ovoj studiji pripa- daju uglavnom genima povezanim sa Ras signalnim putem, koji je često zahvaćen mutacijama u ALL kod dece. Farmakogenomsko profilisanje svake dečje ALL biće nezamenljivo za nove terapijske pristupe. Detekcija i inicijalna analiza novih genskih varijanti, koja je predstavljena u ovoj studiji, postaće standardna procedura za dizajniranje i razvoj individualizovane terapije za decu obolelu od ALL.Introduction/Objective Next generation sequencing (NGS) technology has enabled genomic profiling of each patient. Growing knowledge in pharmacogenomics makes it possible to use NGS data for discovery of novel potential genetic markers for targeted therapy of many diseases, especially cancers. The aim of this study was to use targeted NGS to make a genetic profile of childhood acute lymphoblastic leukemia (cALL) in order to evaluate potential molecular targets for targeted therapy. Methods We analyzed DNA samples from 17 cALL patients using NGS targeted sequencing. Advanced bioinformatic analysis was used to identify novel mutations in analyzed genes and to predict their effect and pharmacogenomic potential. Results We identified nine variants that have not been previously reported in relevant databases, including two stop-gain variants, ABL1 p.Q252* and AKT1 p.W22*, one frameshift, STK11 p.G257fs*28, and six missense variants. We created three-dimensional models of four proteins harboring novel missense variants. We analyzed pharmacogenomic potential of each variant and found that two of them, STK11 c.1023G gt T/ p.L341F and ERBB2 c.2341C gt T/ p.R781W, are suitable candidates for targeted therapy. Conclusion Most new variants detected in this study were found in the genes associated with Ras signaling pathway, which is frequently mutated in cALL patients. Pharmacogenomic profiling of each cALL will be indispensable for novel therapy approaches. Detection and initial analysis of novel variants, presented in this study, will become a standard procedure for the design and development of individualized therapies for children with ALL, leading to improved patient outcomes

Efekti multifazne ishrane u starter periodu na proizvodne performanse brojlera

The objective of the present study was to investigate the effect of multiphase nutrition, i.e. different mixtures used in broiler nutrition, whose protein content was reduced in several phases, on production performances of broilers. The study was performed on 1216 individually tagged chickens of the Ross 308 strain, separated by sex, and divided into four groups. The standard fattening technology, with four nutrition treatments, was applied during the trial period (1-21 days). Chickens of the first group (control) were fed diet containing 23% of proteins from the 1st to 21st day, while the protein content in the remaining three trial groups was reduced during the trial period in several phases. Based on processed data it can be concluded that different programmes of multiphase nutrition had resulted in different effects on production performances of male and female chickens. Multiphase nutrition at the end of the starter period (21st day) had no statistically significant effect on a body weight of male and female chickens, i.e. the reduction of the protein level in mixtures for broilers had no effect on the decrease of the body weight compared to control male (723.48 g) and female (680.66 g) chickens. At the same time, programmes of multiphase nutrition (T4) resulted in the most favourable feed conversion in male (1.468) and female (1.502) chickens, which is in favour of the application of multiphase nutrition, considering that the difference in feed conversion can be essential for accomplishing positive economical results in the production. .Cilj istraživanja je bio da se ispita uticaj multifazne ishrane, odnosno uticaj različitih smeša za ishranu brojlera u kojima je sadržaj proteina smanjen višefazno, na proizvodne osobine tovnih pilića. Ispitivanje je izvedeno na 1216 individualno obeleženih pilića, provenijence Ross 308, razdvojenih po polu, podeljenih u četiri grupe. U oglednom periodu (1-21 dan) primenjena je standardna tehnologija tova, sa četiri tretmana ishrane. Pilići prve grupe (kontrolne) hranjeni su smešom sa 23% proteina u trajanju od 1. do 21. dana, a ostalim trima grupama sadržaj proteina je tokom oglednog perioda smanjen višefazno. Na osnovu obrađenih podataka može se konstatovati da su različiti programi multifazne ishrane rezultirali različitim efektima na proizvodne performanse pilića muškog i ženskog pola. Multifazna ishrana na kraju starter perioda (21 dan) nije statistički značajno uticala na telesnu masu pilića muškog i ženskog pola, odnosno smanjenje nivoa proteina u smešama za ishranu brojlera nije uticalo na smanjenje telesne mase u poređenju sa kontrolnom grupom pilića muškog (723,48 g) i ženskog (680,66 g) pola. Istovremeno, program multifazne ishrane (T4) rezultirao je najpovoljnijom konverzijom hrane kod pilića muškog (1,468) i ženskog (1,502) pola, što ide u prilog primeni multifazne ishrane, s obzirom da razlika u konverziji hrane može biti ključna za ostvarenje pozitivnog ekonomskog efekta proizvodnje.

DJELOVANJE MULTIFAZNE HRANIDBE NA PROIZVODNE PERFORMANSE BROJLERA

Cilj istraživanja bio je istražiti utjecaj multifazne hranidbe, odnosno različitih smjesa za hranidbu brojlera u kojima je sadržaj bjelančevina smanjen višefazno, na proizvodne osobine tovnih pilića. Istraživanje je izvedeno na 1216 individualno obilježenih pilića, provenijence Ross 308, razdvojenih po spolu. U pokusnom razdoblju (1. do 42. dana) primijenjena je standardna tehnologija tova, s četiri tretmana hranidbe (T1-T4). Pilići prve skupine (kontrolne) hranjeni su smjesom s 23% bjelančevina u trajanju od 1. do 21. dana, a u ostale tri skupine sadržaj bjelančevina je tijekom pokusnog razdoblja smanjen višefazno, prema određenom programu multifazne hranidbe. Programi multifazne hranidbe, u uzrastu 42 dana, nisu utjecali na tjelesnu masu pilića muškog i ženskog spola, odnosno usporedbom pokusnih (T2, T3 i T4) skupina kod oba spola, s kontrolnom skupinom (T1) pilića muškog (2055,16 g) i ženskog (1963,11 g) spola nisu utvrđene statistički značajne razlike. Program multifazne hranidbe za pokusnu T4 skupinu rezultirao je najpovoljnijom konverzijom hrane kod pilića muškog (1,870) i ženskog spola (1,867) u usporedbi s kontrolnom skupinom pilića muškog (1,918) i ženskog spola (1,951). U provedenom istraživanju multifazna hranidba imala je pozitivan utjecaj na proizvodne performanse, odnosno na stupanj iskorištenosti hrane, što ide u prilog njene primjene, s obzirom da razlika u konverziji hrane može biti ključna za ostvarenje pozitivnog ekonomskog djelovanja proizvodnje.The objective of the research was to investigate the effect of multiphase nutrition, i.e. different mixtures used in broiler nutrition, whose protein content was reduced in several phases during the first fattening stage, on production performances of broilers. The investigation was carried out on 1216 individually tagged chickens of Ross 308 strain divided by sex. In the trial period (1st to 42nd day), standard fattening technology was applied, with four nutrition treatments (T1-T4). Chickens of the first group (control) were fed mixture containing 23% of protein in duration from 1st to 21st day, and in remaining three groups protein content during the trial period was reduced in several phases, according to specific program of multiphase nutrition. Programs of multi-phased nutrition, at the age of 42 days, did not influence the body mass of male and female broilers, meaning that the comparison of the surveyed groups (T2, T3 and T4) with the male and female broilers from the control group (T1) did not reveal any significant differences. The multi-phase nutrition program for the surveyed T4 group showed the most favourable feed conversion with the male broilers (1.870) and female broilers (1.867) in comparison to the representatives of the control group of male broilers (1.918) and female broilers (1.951). Based on results obtained, it can be concluded that multiphase nutrition affected the production performance, i.e. the level of feed utilization, which was in favour of its application, considering that difference in feed conversion could be decisive for realization of the positive economic production performance

Preeclamptic Women Have Disrupted Placental microRNA Expression at the Time of Preeclampsia Diagnosis: Meta-Analysis

Introduction: Preeclampsia (PE) is a pregnancy-associated, multi-organ, life-threatening disease that appears after the 20th week of gestation. The aim of this study was to perform a systematic review and meta-analysis to determine whether women with PE have disrupted miRNA expression compared to women who do not have PE.Methods: We conducted a systematic review and meta-analysis of studies that reported miRNAs expression levels in placenta or peripheral blood of pregnant women with vs. without PE. Studies published before October 29, 2021 were identified through PubMed, EMBASE and Web of Science. Two reviewers used predefined forms and protocols to evaluate independently the eligibility of studies based on titles and abstracts and to perform full-text screening, data abstraction and quality assessment. Standardized mean difference (SMD) was used as a measure of effect size.Results: 229 publications were included in the systematic review and 53 in the meta-analysis. The expression levels in placenta were significantly higher in women with PE compared to women without PE for miRNA-16 (SMD = 1.51,95%CI = 0.55-2.46), miRNA-20b (SMD = 0.89, 95%CI = 0.33-1.45), miRNA-23a (SMD = 2.02, 95%CI = 1.25-2.78), miRNA-29b (SMD = 1.37, 95%CI = 0.36-2.37), miRNA-155 (SMD = 2.99, 95%CI = 0.83-5.14) and miRNA-210 (SMD = 1.63, 95%CI = 0.69-2.58), and significantly lower for miRNA-376c (SMD = -4.86, 95%CI = -9.51 to -0.20). An increased level of miRNK-155 expression was found in peripheral blood of women with PE (SMD = 2.06, 95%CI = 0.35-3.76), while the expression level of miRNA-16 was significantly lower in peripheral blood of PE women (SMD = -0.47, 95%CI = -0.91 to -0.03). The functional roles of the presented miRNAs include control of trophoblast proliferation, migration, invasion, apoptosis, differentiation, cellular metabolism and angiogenesis.Conclusion: miRNAs play an important role in the pathophysiology of PE. The identification of differentially expressed miRNAs in maternal blood creates an opportunity to define an easily accessible biomarker of PE

Detection of preleukemic clones in neonatal blood spots of children with B-cell precursor acute lymphoblastic leukemia

Introduction: Childhood B-cell precursor acute lymphoblastic leukemic (BCP-ALL) can be traced back to birth using leukemic clone-specific immunoglobulin heavy chain (IGH) rearrangements, implying prenatal origin of this disease. The aim of this study was to analyze neonatal blood spots (Guthrie cards) of childhood BCP-ALL patients for the presence of clonotypic IGH rearrangements. Methods: The study enrolled 24 patients aged 1 to 9.6 years. Based on the sequences of IGH rearrangements identified in diagnostic lymphoblasts, 2 patient-specific primers were designed for each patient and used in semi-nested PCR for the detection of preleukemic clones at birth. Results: Clonotypic IGH rearrangements were detected in neonatal blood spots of 54.2% of patients. In two cases that had double IGH rearrangements at diagnosis, only one rearrangement was present at birth, while in the third case both leukemic rearrangements were detected in neonatal blood. Guthrie card-positive findings were significantly more frequent in children ≤5 years of age than in older children (p=0.011). Regarding patients’characteristics at birth and at diagnosis, Guthrie card-positivity was not associated with sex, birth weight and mother’s age, as well as with white blood cell count, percentage of bone marrow blasts, immunophenotype and the presence of ETV6/RUNX1 and TCF3/PBX1 fusion genes at diagnosis. Conclusion: Our study confirms that a large proportion of childhood BCP-ALL originates in utero, regardless of the molecularsubtype defined by chromosomal aberrations. The latency period to the overt leukemia depends on the presence of preleukemic clone at birth, as well as on the postnatal transforming genetic events

Effect of alkali modification on adsorption efficiency of fly ash

As coal combustion in thermal power plants generates huge amounts of waste such as bottom ash and fly ash, there is a need to find new applications for these materials. One of the ways of its reuse is chemical or thermal modification of the ash in order to obtain new materials, which can be further used as adsorbents of various pollutants from water. The subject of this research was the alkali modification and alkali activation of fly ash in purpose to increase the adsorption capacity towards heavy metal ions. The success of modification process and characterization of the obtained materials was monitored by Fourier transform infrared spectroscopy, X-ray fluorescence spectroscopy and scanning electron microscopy. The concentration of zinc and cadmium ions after adsorption was determinated by atomic absorption spectroscopy. The kinetics of the adsorption process on the most efficient adsorbent were examined and the experimental data were compared with pseudo-first and pseudo-second order models. The achieved results show a positive effect of alkaline modification of fly ash on adsorption efficiency of both metals, while alkaline activation gives an exceptionally effective adsorbent in the case of zinc