Upotreba alternativnih izvora energije u poljoprivredi u cilju zaštite životne sredine

Due to modern economic, technological and social development, the science encounters numerous problems, the solutions of which should provide clear guidelines for further existence. This intention represents a starting point in finding solutions and providing answers to numerous questions. One of the above-mentioned questions is the one related to exploitation of well-known and widely exploited energy sources. The objective of this paper is the attempt to provide answers and solutions that should point the way to use of alternative energy sources, especially in the segment of agriculture, which, along with other fields, appears in the capacity of a large energy consumer. In this sense, the insufficiently exploited energy sources, such as solar energy, water, wind, biomass energy and other, joined with institutional support of the state represent the only path to sustainable development.Zahvaljujući savremenom ekonomskom, tehnološkom i društvenom razvoju, pred naukom se nalaze brojni problemi čija rešenja treba da daju jasne smernice za dalju egzistenciju. Sa takvom namerom se kreće u iznalaženje rešenja i pružanje odgovora na brojna pitanja. Jedno od njih je i ono u vezi sa iscrpljivanjem poznatih i široko eksploatisanih izvora energije. Cilj ovog rada je pokušaj pružanja odgovora i rešenja koja bi trebalo da upute na korišćenje izvora energije alternativne prirode, a naročito u segmentu poljoprivrede koja se kao i druge oblasti pojavljuje u ulozi velikog potrošača energije. U tom smislu, nedovoljno eksploatisani izvori energije, kao što su: energija sunca, energija vode, energija vetra, energija biomase i dr., a uz institucionalnu podršku države, predstavljaju jedini put ka održivom razvoju

Attitudes of Primary School Teachers Toward Inclusive Education

Background: The aims of our study are related to examining the relevance of teachers' attitudes toward the implementation of inclusive education. In addition, its subject is related to the implications on inclusive education policies, limitations of the existing study along with the recommendations for our future research endeavors. Methods: The research is a cross-sectional study type. The sample included 64 primary school teachers in the lower grades of primary school (grades 1–4), selected by using simple random sampling, in three primary schools on the territory of Belgrade, Serbia in 2021 (26, 17, and 21 primary school teachers). The Questionnaire for Teachers, which was used as a research instrument, was taken from the Master's Thesis Studen Rajke, which was part of the project “Education for the Knowledge Society” at the Institute for Educational Research in Belgrade. Dependent variables measured in the study referred to the attitudes of primary school teachers toward inclusive education. Categorical variables are represented as frequencies and the Chi-square test was used to determine if a distribution of observed frequencies differed from the expected frequencies. Results: One in three teachers (32.8%) thought that inclusion was useful for children with disabilities (29.7%), of them thought that schools did not have the conditions for inclusive education, whereas one in four teachers (25.0%) believed that inclusion was not good. No statistically significant differences were found in the attitudes of professors, when observed in terms of their gender, age and length of service. Conclusion: Investing more resources and time in developing and implementing special education policies can promote successful inclusive education

Impact of fluid balance and opioid-sparing anesthesia within enchanced recovery pathway on postoperative morbidity after transthoracic esophagectomy for cancer

BackgroundEnhanced Recovery After Surgery (ERAS) protocol for esophagectomy may reduce the high incidence of postoperative morbidity and mortality. The aim of this study was to assess the impact of properly conducted ERAS protocol with specific emphasis on fluid balance and opioid-sparing anesthesia (OSA) on postoperative major morbidity and mortality after esophagectomy.MethodsPatients undergoing elective esophagectomy for esophageal cancer at the Hospital for Digestive Surgery, University Clinical Center of Serbia, from December 2017 to March 2021, were included in this retrospective observational study. Patients were divided into two groups: the ERAS group (OSA, intraoperative goal-directed therapy, and postoperative “near-zero” fluid balance) and the control group (opioid-based anesthesia, maintenance mean blood pressure ≥ 65 mmHg, and liberal postoperative fluid management). The primary outcome was major morbidity within 30 days from surgery and 30-day and 90-day mortality. Multivariable analysis was used to examine the effect of the ERAS protocol.ResultsA total of 121 patients were divided into the ERAS group (69 patients) and the control group (52 patients). Patients in the ERAS group was received less fentanyl, median 300 (interquartile range (IQR), 200–1,550) mcg than in control group, median 1,100 (IQR, 650–1750) mcg, p < 0.001. Median intraoperative total infusion was lower in the ERAS group, 2000 (IQR, 1000–3,750) mL compared to control group, 3,500 (IQR, 2000–5,500) mL, p < 0.001. However, intraoperative norepinephrine infusion was more administered in the ERAS group (52.2% vs. 7.7%, p < 0.001). On postoperative day 1, median cumulative fluid balance was 2,215 (IQR, −150-5880) mL in the ERAS group vs. 4692.5 (IQR, 1770–10,060) mL in the control group, p = 0.002. After the implementation of the ERAS protocol, major morbidity was less frequent in the ERAS group than in the control group (18.8% vs. 75%, p < 0.001). There was no statistical significant difference in 30-day and 90-day mortality (p = 0.07 and p = 0.119, respectively). The probability of postoperative major morbidity and interstitial pulmonary edema were higher in control group (OR 5.637; CI95%:1.178–10.98; p = 0.030 and OR 5.955; CI95% 1.702–9.084; p < 0.001, respectively).ConclusionA major morbidity and interstitial pulmonary edema after esophagectomy were decreased after the implementation of the ERAS protocol, without impact on overall mortality

Predicting the survival probability of functional neuroendocrine tumors treated with peptide receptor radionuclide therapy: Serbian experience

IntroductionPeptide receptor radionuclide therapy (PRRT) is a treatment option for well-differentiated, somatostatin receptor positive, unresectable or/and metastatic neuroendocrine tumors (NETs). Although high disease control rates seen with PRRT a significant number NET patients have a short progression-free interval, and currently, there is a deficiency of effective biomarkers to pre-identify these patients. This study is aimed at determining the prognostic significance of biomarkers on survival of patients with NETs in initial PRRT treatment.MethodologyWe retrospectively analyzed 51 patients with NETs treated with PRRT at the Department for nuclear medicine, University Clinical Center Kragujevac, Serbia, with a five-year follow-up. Eligible patients with confirmed inoperable NETs, were retrospectively evaluated hematological, blood-based inflammatory markers, biochemical markers and clinical characteristics on disease progression. In accordance with the progression og the disease, the patients were divided into two groups: progression group (n=18) and a non-progression group (n=33). Clinical data were compared between the two groups.ResultsA total of 51 patients (Md=60, age 25-75 years) were treated with PRRT, of whom 29 (56.86%) demonstrated stable disease, 4 (7.84%) demonstrated a partial response, and 14 (27.46%) demonstrated progressive disease and death was recorded in 4 (7.84%) patients. The mean PFS was a 36.22 months (95% CI 30.14-42.29) and the mean OS was 44.68 months (95% CI 37.40-51.97). Univariate logistic regression analysis displayed that age (p<0.05), functional tumors (p<0.05), absolute neutrophil count (p<0.05), neutrophil-lymphocyte ratio-NLR (p<0.05), C-reactive protein-CRP (p<0.05), CRP/Albumin (p<0.05), alanine aminotransferase-ALT (p<0.05), were risk factors for disease progression. Multivariate logistic regression analysis exhibited that functional tumors (p<0.001), age (p<0.05), CRP (p<0.05), and ALT (p<0.05), were independent risk factors for the disease progression in patients with NETs. Tumor functionality was the most powerful prognostic factor. The median PFS (11.86 ± 1.41 vs. 43.38 ± 3.16 months; p=0.001) and OS (21.81 ± 2.70 vs 53.86 ± 3.70, p=0.001) were significantly shorter in patients with functional than non-functional NETs respectively.ConclusionThe study’s results suggest that tumor functionality, and certain biomarkers may serve as prognostic survival indicators for patients with NETs undergoing PRRT. The findings can potentially help to identify patients who are at higher risk of disease progression and tailor treatment strategies accordingly

Methodological approach towards a Gap Assessment of the Serbian microbiology system in the function of surveillance in line with EU standards and acquis

Introduction. Italian and Serbian Health authorities performed an in-depth Gap Assessment of the Serbian microbiology system in the function of communicable disease surveillance using a methodology adapted to context and information needs. Methods. There were two study phases: a capacity based survey and an equipment mapping survey. Invited participants included national health authorities, heads of national reference laboratories and of public/private diagnostic laboratories in Serbia. Findings were analysed preliminarily and identified gaps were discussed, prioritized and validated through two ad hoc workshops involving all concerned institutions. Results. The Gap Assessment was performed between September and December 2017.The overall response rate was 69% for phase one and 74% for phase two. Identified gaps were assessed as highly relevant during the project workshops. Discussion. Gaps and priorities were highlighted, validated, and studied with a suitable level of detail to develop a concrete action-plan. The same methodological approach

Contamination, risk, and source apportionment of potentially toxic microelements in river sediments and soil after extreme flooding in the Kolubara River catchment in Western Serbia

Climate change is contributing to an increase in extreme weather events. This results in a higher river flooding risk, causing a series of environmental disturbances, including potential contamination of agricultural soil. In Serbia, the catastrophic floods of 2014 affected six river basins, including the Kolubara River Basin, as one of the larger sub-catchments of the large regional Sava River Basin, which is characterized by large areas under agricultural cultures, various geological substrates, and different types of industrial pollution. The main aim of this study was to establish the sources of potentially toxic elements in soil and flood sediments and the effect of the flood on their concentrations. Field sampling was performed immediately after water had receded from the flooded area in May 2014. In total, 36 soil samples and 28 flood sediment samples were collected. After acid digestion (HNO3), concentrations of the most frequent potentially toxic elements (PTE) in agricultural production (As, Cd, Cr, Cu, Ni, Pb, Zn) and Co which are closely related to the geological characteristics of river catchments, were analyzed. The origin, source, and interrelations of microelements, as well as BACKGROUND: values of the PTE of the river catchment, the pollution index (Pi), enrichment factor (Ef), and geological index (Igeo), were determined, using statistical methods such as Pearson correlations, principal component analysis (PCA), and multiple linear regression (MLRA). The content of the hot acid-extractable forms of the elements, PCA, and MLRA revealed a heavy geological influence on microelement content, especially on Ni, Cr, and Co, while an anthropogenic influence was observed for Cu, Zn, and Cd content. This mixed impact was primarily related to mines and their impact on As and Pb content. The pseudo-total concentrations of all the analyzed elements did not prove to be a danger in the catchment area, except for Cu in some samples, indicating point-source pollution, and Ni, whose pseudo-total content could be a limiting factor in agricultural production. For the Ef, the Ni content in 59% soil and 68% flood sediment samples is classified into influence classes. The similar pseudo-total contents of the elements studied in soil samples and flood sediment and their origin indicate that the long-term soil formation process is subject to periodic flooding in the Kolubara River Basin without any significant changes taking place. This implies that floods are not an endangering factor in terms of the contamination of soil by potentially toxic elements in the explored area

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Creating a State Brand: A Brand and Branding Serbia

The states make different attempts to attract more tourists, foreign investors, develop the international partnerships, stimulate export, make better position for their products and services, but also to position and impose itself more efficiently, meaningful and innovative, by the personally recognizable brands, to the international environment. Aiming at this, it is not only necessary to devote oneself to branding of a country, but to do it in a way that significantly differs from others, which initially favours the positive branding of the country. The subject of this paper is to analyse the significance of state branding and measuring the state position as a brand, as in the case of Serbia. For Serbia as a brand, there are characteristic numerous efforts on its positioning, but also numerous obstacles that are on that way

PUBLIC HEALTH SIGNIFICANCE OF UNFULFILLED HEALTH NEEDS OF THE POPULATION OF SERBIA

Health care is a comprehensive and organized activity of society in preserving and improving the health of citizens and families. It represents society's response to unplanned and unpredictable events that endanger the health and ensure levels of health and the causes of illness. The availability of public health is determined by various factors that relate to both the patient and the health system. Health insurance coverage, coverage in staff, space, equipment and financial resources, scheduling and referral systems, quality of services provided, and continuity of health care are factors of the health system that can affect the availability of health care. However, factors such as age, socioeconomic status, previous experiences with health services, perceptions of the quality of public health, and health literacy constitute the characteristics of the individual, which may also influence their decisions to provide health care (1). One of the socio-economic aspects of health is unequal aging health care (2). A key indicator for monitoring a degree of inequality in health care, and through the approach, use, and realization of health care, is the satisfaction or dissatisfaction of clients (3). Unmet needs represent diversity in the provision of health services: needs that are considered necessary and essential for the care of specific health issues (4). Unmet public health needs affect people's health and quality of life. They can also directly alter mortality risks and/or be indirectly linked to the statuses of several psychosomatic and psychiatric illnesses today (5, 6). Numerous factors related to real unmet health needs are reflected in gender, age, lack of insurance, education, unemployment, low wages, and more. All of the above points to unequal access to health care from a socio-economic point of view. The characteristics of the health care system, such as the number of doctors or dentists, the method of payment of primary health care doctors, and the amount of money for out-of-pocket services, also have a severe impact on unmet health care needs. The results of many studies show that the frequency of unmet medical or dental needs varies significantly from country to country, which can be partly explained by differences in health care financing (6). Since inequalities in access and usage of health services are some of the determinants of health (socioeconomic, etc), public policymakers must identify these determinants to understand the specific barriers that health care users are faced with, in terms of physical, geographical, cultural, and financial accessibility of the health care (7). Identifying such barriers is a crucial indicator for measuring health inequalities at both local and national levels (8). The results of research conducted in neighboring countries show that: reasons for non-fulfillment of health achievements are lack of necessary financial resources, the inadequate expectation of a scheduled medical examination, a greater distance of residence from health care providers with a frequency of (about) 13% in Montenegro, 108% in Macedonia, 8% in Croatia, and 0.5% in Slovenia (9). In many EU countries, unmet health care needs have nearly doubled from 5.26% to 9.99%, while in other there has been a significant increase of 15% (10). There has also been a growth expressed as a percentage of people reporting unmet health needs in the United States and Canada. Rates of unmet public health needs in the United States are higher (5-20%) compared to the same in Canada (4-12%), (11). In New Zealand, 16.5% of respondents in primary public health missed a visit to a general practitioner due to costs, while 9.3% reported unmet health needs in secondary healthcare (12). Research related to the prevalence of unmet health needs in a survey of (around) 13760 citizens of Serbia, conducted by the Ministry of Health of the Republic of Serbia in 2013, showed that the biggest obstacles to meeting the needs of health care in this population group are due to financial reasons (20%), long wait for an appointment with a doctor (8%), and problems with transportation to a remote place where health care is provided (5%). The biggest obstacles in achieving health care relate to dental (13.5%), general health care (13%), prescribing necessary medications (11%), and care for patients with altered and impaired mental health (2.5%) (13). The estimated number of people with unmet health needs in our country indicates that significant changes in health policy are necessary. The fact is that various barriers prevent people from accessing existing health services. In Serbia and the other countries in transition, demographic and socioeconomic inequalities in health care have not been realistically and sufficiently studied. Public health policies do not receive the necessary and sufficient social attention. Reducing disparities in health and health care is a crucial precondition for the future evolution of health systems and their institutions (13). The health needs of the entire population, which are unmet in the health system, represent a significant challenge for any health system. Therefore, more detailed analyzes in the future and revealing the factors that are related to them are important for creating health policies that would contribute to reducing inequalities in access, use, and realization of health care needs