PROCJENA POTREBNIH RESURSA ZA AB TEHNOLOGIJE GRAĐENJA

Cilj ovoga rada bio je utvrditi potrebne resurse za uspješno odvijanje procesa građenja armiranim betonom. Opisana je priprema građenja i organizacije te je grubo planiran proces građenja. Ciljevi pripreme rada su građevinski zahvati koordinirani od početka do završetka, odnosno provođenje radnih procesa na gradilištu bez prekida i smetnji. Pripremom građenja se definira mogućnost provođenja ukupnog procesa na najpovoljniji način, planiranjem se uz pomoć pokazatelja efikasnosti vrši procjena građenja, a tijekom izvođenja radova dobiva potvrda da je to uistinu izvedivo. Pripremom građenja se definira mogućnost provođenja ukupnog procesa na najpovoljniji način, planiranjem se na temelju različitih pokazatelja efikasnosti vrši procjena građenja, a tijekom izvođenja radova dobiva jasna slika o stvarnim vrijednostima pokazatelja pojedinih radova. Dobra organizacija i pažljivo planiranje procesa građenja osnova su za postizanje optimalne pripreme građenja, odnosno kvalitetno i uspješno odvijanje cjelokupnog procesa građenja

Echocardiographic Findings for Non Cardiologists – How to Read the Report?

Transtorakalna ehokardiografija (TTE) slikovna je metoda koja daje detaljan uvid u morfologiju i funkciju srčanih struktura i velikih krvnih žila. Mogućnost prikupljanja velikog broja važnih kliničkih informacija, niska cijena i visoka reproducibilnost čine ju metodom izbora u dijagnostici i praćenju većine kardiovaskularnih bolesti. Široka zastupljenost metode sve jasnije nalaže osnovno poznavanje ehokardiografskih načela i u zdravstvenih djelatnika koji nisu kardiolozi. Da bi pružio jasnu kliničku informaciju, nalaz mora imati jasnu logičku strukturu, biti pisan na razumljiv način i sadržavati sva definirana obavezna standardna mjerenja. Radna skupina za slikovne metode u kardiologiji Europskoga kardiološkog društva izdala je preporuke i smjernice za standardizaciju TTE-postupaka i pisanje nalaza, čiji je cilj unaprijediti kvalitetu informacije koju pruža TTE-izvješće. Uz obavezne opće podatke o bolesniku, kliničko pitanje, obavezna standardna mjerenja i datum pretrage, izvješće mora sadržavati i opisnu interpretaciju mjerenja s kliničkom interpretacijom i naglaskom na mogućim ograničenjima pretrage.Transthoracic echocardiography (TTE) is an imaging technique that provides comprehensive evaluation of cardiac and vascular structures and function. Amount and quality of the provided information, low cost and high reproducibility, make it the technique of choice in the diagnosis and follow-up of most of cardiovascular disease. The broad representation of the method requires a basic knowledge of the echocardiographic principles even among health professionals who are not cardiologists. Report should have a clear, logical structure, it should be written in an understandable way, and contain all standard measurements. Working Group on Echocardiography of the European Society of Cardiology has established recommendations and guidelines for standardization of echocardiography performance, dana acquisition and reporting of echocardiographic studies. The aim of these recommendations is to improve the quality of clinical information provided by the TTE report. Mandatory items that should be included in the report include patient identification and demographics, clinical question, standard measurements and the date. The report should also contain a descriptive interpretation of measurements with clinical interpretation and emphasis on the possible limitations of the technique

PODUZETNIČKI MARKETING I ETIKA - UTJECAJ KULTURE OTKAZIVANJA NA BREND

U uvjetima globalizacije, što podrazumijeva dostupnost informacija iz svih dijelova svijeta, poduzeće je samo jedan klik daleko od otkazivanja. Bojkot brenda ali i osoba je neizbježan kada dirnu u tradicionalne vrijednosti. Kultura otkazivanja sve je popularnija praksa povlačenja podrške javnim osobama i poduzećima nakon nekog njihovog negativnog poteza ili izjave kojem se prigovara ili se smatra uvredljivim ili neprihvatljivim. Iz tog razloga danas je sve veći fokus na marketingu i vrijednostima za koje se poduzeće zalaže, a koje promovira prema javnosti. U ovome su radu dani primjeri poznatih brendova iz Hrvatske i svijeta koji su se našli na udaru kritika poput brenda Pipi bezalkoholno piće i Oreo keksi. U radu su analizirani pojmovi poduzetničkog marketinga i etika te odnos vrijednosti brenda i kulture otkazivanja kako bi se pokazali negativni utjecaji i posljedice koje kultura otkazivanja ima na brend. Rezultati istraživanja, navedeni u ovome radu, pokazuju razinu informiranosti hrvatske javnosti o kulturi otkazivanja i koliko sustavi vrijednosti imaju utjecaj na lojalnost brendu

PODUZETNIČKI MARKETING I ETIKA - UTJECAJ KULTURE OTKAZIVANJA NA BREND

U uvjetima globalizacije, što podrazumijeva dostupnost informacija iz svih dijelova svijeta, poduzeće je samo jedan klik daleko od otkazivanja. Bojkot brenda ali i osoba je neizbježan kada dirnu u tradicionalne vrijednosti. Kultura otkazivanja sve je popularnija praksa povlačenja podrške javnim osobama i poduzećima nakon nekog njihovog negativnog poteza ili izjave kojem se prigovara ili se smatra uvredljivim ili neprihvatljivim. Iz tog razloga danas je sve veći fokus na marketingu i vrijednostima za koje se poduzeće zalaže, a koje promovira prema javnosti. U ovome su radu dani primjeri poznatih brendova iz Hrvatske i svijeta koji su se našli na udaru kritika poput brenda Pipi bezalkoholno piće i Oreo keksi. U radu su analizirani pojmovi poduzetničkog marketinga i etika te odnos vrijednosti brenda i kulture otkazivanja kako bi se pokazali negativni utjecaji i posljedice koje kultura otkazivanja ima na brend. Rezultati istraživanja, navedeni u ovome radu, pokazuju razinu informiranosti hrvatske javnosti o kulturi otkazivanja i koliko sustavi vrijednosti imaju utjecaj na lojalnost brendu

Patogeneza bronhijalne hiperreaktivnosti u bolesnika s alergijskim rinitisom

Bronchial hyperreactivity denotes an enhanced bronchial response to usual physiological stimuli, and can manifest with cough or paroxysmal cough through tussive syncope and bronchospasm. Bronchial hyperreactivity can be transient or permanent. Transient bronchial hyperreactivity occurs in acute inflammation of the upper and lower airways, and manifests with dry irritation cough that may persist for up to two months. Permanent bronchial hyperreactivity is found in 10% - 50% of patients with allergic rhinitis, 50% of patients with chronic bronchitis, and 100% of patients with asthma. The pathophysiological mechanism of bronchial hyperreactivity in patients with allergic rhinitis has not yet been fully clarified, however, the following theories have been implicated: loss of nasal function, direct aspiration of inflammatory secretion and antigens, aerogenic transfer of antigens depending on particle size, gastroesophageal reflux, neurogenic mechanisms including the action of neuropeptides in the onset of neurogenic inflammation, and the concept of allergic reaction as a systemic response to local antigen presentation. It should be noted that bronchial hyperreactivity is not asthma; however, the clinical manifestation of asthma is just a matter of time. Therefore, allergic rhinitis should be considered a predisposing factor for the occurrence of asthma.Pod bronhijalnom hiperreaktivnošću podrazumijeva se pojačan odgovor bronha na uobičajene fiziološke podražaje, koji se može očitovati kašljem, paroksizmom kašlja, sve do tusigene sinkope i bronhospazma. Bronhijalna hiperreaktivnost može biti prolazna i trajna. Prolazna bronhijalna hiperreaktivnost pojavljuje se kod akutnih upala gornjih i donjih dišnih putova, očituje se suhim podražajnim kašljem koji može potrajati i do dva mjeseca. Trajna bronhijalna hiperreaktivnost nalazi se u 10% - 50% bolesnika s alergijskim rinitisom, 50% bolesnika s kroničnim bronhitisom, te u 100% bolesnika s astmom. Patofiziološki mehanizam nastanka bronhijalne hiperreaktivnosti u bolesnika s alergijskim rinitisom nije u potpunosti jasan, a spominju se slijedeće teorije: gubitak funkcije nosa, izravna aspiracija upalnog sekreta i antigena, aerogeno prenošenje antigena ovisno o veličini cestica, gastroezofagusni refluks, neurogeni mehanizmi uključujući i djelovanje neuropeptida u nastanku neurogene upale, te shvaćanje alergijske reakcije kao sistemske reakcije na lokalno prikazivanje antigena. Valja istaknuti da bronhijalna hiperreaktivnost nije astma, ali je pitanje dana kada će se astma klinički očitovati. Stoga se alergijski rinitis može smatrati predisponirajućim čimbenikom u pojavi astme

Patogeneza bronhijalne hiperreaktivnosti u bolesnika s alergijskim rinitisom

Bronchial hyperreactivity denotes an enhanced bronchial response to usual physiological stimuli, and can manifest with cough or paroxysmal cough through tussive syncope and bronchospasm. Bronchial hyperreactivity can be transient or permanent. Transient bronchial hyperreactivity occurs in acute inflammation of the upper and lower airways, and manifests with dry irritation cough that may persist for up to two months. Permanent bronchial hyperreactivity is found in 10% - 50% of patients with allergic rhinitis, 50% of patients with chronic bronchitis, and 100% of patients with asthma. The pathophysiological mechanism of bronchial hyperreactivity in patients with allergic rhinitis has not yet been fully clarified, however, the following theories have been implicated: loss of nasal function, direct aspiration of inflammatory secretion and antigens, aerogenic transfer of antigens depending on particle size, gastroesophageal reflux, neurogenic mechanisms including the action of neuropeptides in the onset of neurogenic inflammation, and the concept of allergic reaction as a systemic response to local antigen presentation. It should be noted that bronchial hyperreactivity is not asthma; however, the clinical manifestation of asthma is just a matter of time. Therefore, allergic rhinitis should be considered a predisposing factor for the occurrence of asthma.Pod bronhijalnom hiperreaktivnošću podrazumijeva se pojačan odgovor bronha na uobičajene fiziološke podražaje, koji se može očitovati kašljem, paroksizmom kašlja, sve do tusigene sinkope i bronhospazma. Bronhijalna hiperreaktivnost može biti prolazna i trajna. Prolazna bronhijalna hiperreaktivnost pojavljuje se kod akutnih upala gornjih i donjih dišnih putova, očituje se suhim podražajnim kašljem koji može potrajati i do dva mjeseca. Trajna bronhijalna hiperreaktivnost nalazi se u 10% - 50% bolesnika s alergijskim rinitisom, 50% bolesnika s kroničnim bronhitisom, te u 100% bolesnika s astmom. Patofiziološki mehanizam nastanka bronhijalne hiperreaktivnosti u bolesnika s alergijskim rinitisom nije u potpunosti jasan, a spominju se slijedeće teorije: gubitak funkcije nosa, izravna aspiracija upalnog sekreta i antigena, aerogeno prenošenje antigena ovisno o veličini cestica, gastroezofagusni refluks, neurogeni mehanizmi uključujući i djelovanje neuropeptida u nastanku neurogene upale, te shvaćanje alergijske reakcije kao sistemske reakcije na lokalno prikazivanje antigena. Valja istaknuti da bronhijalna hiperreaktivnost nije astma, ali je pitanje dana kada će se astma klinički očitovati. Stoga se alergijski rinitis može smatrati predisponirajućim čimbenikom u pojavi astme

POSTTRAUMATIC STRESS DISORDER AND COMORBID SEXUAL DYSFUNCTIONS

The rates of sexual dysfunctions among patients with PTSD are much higher than in the general population. An increasing body of scientific research has confirmed clinically relevant sexual problems (Letourneau et al. 1997, Kotler et al. 2000, Hossain et al. 2013, Yehuda et al. 2015, Tran et al. 2015), among which erectile dysfunction (ED) and premature ejaculation (PE) were the most frequent (Letourneau et al. 1997). It is important to underline that patients, particularly military veterans with PTSD, have an increased risk of sexual dysfunction independent of the use of psychiatric medications (Benjamin et al. 2014). Considering the utilization of pharmacotherapy, data indicate that over 80% of the veterans treated for PTSD in the USA have been receiving at least one of the psychotropic medications (Bernardy et al. 2012). A drug utilization study conducted in Croatia revealed that the annual frequency of drug use among pharmacologically treated PTSD patients was the highest for anxiolytics (75.83% patients), antidepressants (61.36%), hypnotics (35.68%) and antipsychotics (30.21%) in 2012 (LeticaCrepulja et al. 2015). In this context, it is very important to highlight that a variety of psychotropic medications recommended for the treatment of PTSD can induce sexual function disorders (Clayton & Shen 1998, Labbate 2008). Most practice guidelines for the treatment of PTSD highlight antidepressants as the first-line pharmacotherapeutic agents, particularly selective serotonin reuptake inhibitors (SSRIs) (Ballenger et al. 2000, American Psychiatric Association 2004, National Institute for Clinical Excellence (NICE) 2005, Baldwin et al. 2005, Forbes et al. 2007) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (Bandelow et al. 2008, Benedek et al. 2009, Stein et al. 2009, Department of Veterans Affairs 2010, World Health Organization 2013, Baldwin et al. 2014). Since the introduction of these medications, increasing attention has been given to the side effects, such as sexual dysfunction (Labbate 2008, Corona et al. 2009, Serretti & Chiesa 2011). SSRIs can negatively affect all domains of sexuality (desire-arousal-orgasm-resolution) (Corona et al. 2009). A study of sexual functioning in war veterans with posttraumatic stress disorder conducted in Croatia showed that these patients had less sexual activity, hypoactive sexual desire and more frequent ED compared with healthy volunteers. These problems might be associated with the antidepressant therapy (Antičević & Britvić 2008). Another Croatian study revealed that the population exposed to traumatic event(s) had the same level of sexual functioning (or the same incidence of sexual dysfunction) regardless of the absence or presence of PTSD symptoms and their severity (Arbanas 2010). The aim of this report was to present a patient with PTSD and comorbid sexual dysfunctions

Ultrazvučna analiza štitnjače u trudnoći

The aim of the study was to determine whether pregnancy induced ultrasonographically detectable changes of the thyroid gland. It is a very interesting clinical feature, because some parts of inland Croatia were an endemic goiter area before the implementation of the 1996 act on salt iodination. Sixty-six pregnant women with no history of thyroid disease were repeatedly examined by ultrasound during the course of pregnancy. The size and echostructure of the thyroid were estimated. The thyroid volume increased slightly during pregnancy, but mostly remained within the normal range for particular age. A significant thyroid volume enlargement was observed in third trimester as compared with either first trimester (p=0.02) or control group (p=0.01). Mild goiter of 16% was found in pregnant women in comparison to control group. Morning urine sample, thyroid hormone, TSH and thyroid antibodies were also analyzed in 89 women. Median urine iodine was 8.8 µg/dL. Sixty percent of pregnant women had an iodine concentration below 10 µg/dL. In four out of nine subjects with goiter, urinary iodine excretion was below 5 µg/dL. Elevated serum TSH concentration was recorded in three (3%) women; however, they were euthyroid at the time of the study. Results of the study supported the hypothesis that thyroid volume and thyroid function adapt to the physiologically increased iodine and energy demands. The possible goitrogenic effect of pregnancy could be prevented by an increased iodine intake by diet rich in iodine.U kontinentalnim dijelovima Hrvatske prije uvođenja novoga pravilnika o jodiranju soli 1996. godine zabilježena je endemska gušavost. Stoga je svrha ovoga istraživanja bila utvrditi postoji li i u kojoj mjeri gušavost, odnosno povećanje volumena štitnjaču trudnica sa zagrebačkog područja. Šezdeset šest zdravih trudnica u kojih prethodno nije postojala bolest štitnjače u više je navrata pregledano ultrazvukom, pri čem je određen volumen i ehostruktura štitnjače. Utvrđen je porast volumena štitnjače u sva tri trimestra trudnoće koji je, međutim, prelazio gornju granicu normalne veličine štitnjače (18 mL) i to uglavnom u trećem trimestru. Značajan porast veličine štitnjače ustanovljen je u trećem trimestru u odnosu na prvi trimestar (p=0,02) te na kontrolnu skupinu (p=0,01). Umjerena guša nađena je u 16% trudnica u odnosu na kontrolnu skupinu. U skupini od 89 trudnica određena je koncentracija joda u mokraći, koncentracija hormona štitnjače, TSH te tiroidna protutijela. Utvrđen je medijan koncentracije joda u mokraći od 8,8 µg/dL, a 60% trudnica imalo je koncentraciju nižu od 10 µg/dL. U četiri od devet trudnica s ustanovljenom gušom razina joda bila je ispod 5 µg/dL. Povišena razina TSH u serumu nađena je u 3% trudnica, ali uz normalne razine hormona štitnjače. Ovim smo ispitivanjem potvrdili očekivani porast volumena štitnjače u trudnoći kao posljedicu povećane potrebe za energijom i jodom. Stoga zaključujemo da se očekivani goitrogeni učinak trudnoće može spriječiti prehranom obogaćenom jodom

SIDE-EFFECTS OF GENERIC

New trends in medicine which are much more oriented towards pharmacoeconomy, are ever so common these days. There\u27s an aim within the focus of the health system which is cutting down treatment expenses, and that relates to psychiatry practice too. Prescription drugs issued by specialist doctors are allowed to be switched with cheaper ones of the same group of drugs by GP doctors, with an aim of cost reduction. „Instead of the medicament prescribed, a GP doctor is allowed to prescribe an alternative medicament of the same efficacy in the dosage of an adequate strength“ (taken from the specialist medical report form). A 74 years old man is treated for psychotic depression. Exogenic environmental factors caused the symptoms manifestation due to which hospitalization in a psychiatric ward occurred in two incidences. At the risperidone introduction soon after the second hospitalization event, a long term remission was obtained which lasted for several years. Despite a stable dose of psychopharmacs, new episode of the illness occurred. Researching the potential factors which lead towards the aggravation of the course of the illness disclosed that instead of the original risperidone, the pharmacist issued a generic in an equivalent dose