Assessing international competitiveness and its role towards the economic prosperity within EU integration framework

Enhancing competitiveness in the era of globalization has become an essential topic of academic and policy debates for all contemporary economies. The role of a country’s competitiveness has been addressed by many scholars aiming to assess the extent to which this concept is associated with economic prosperity matters, such as social welfare and attracting foreign direct investments. Along with this debate, there has been a growing interest in understanding the linkages between the competitive forces and the gap in economic progress across the EU members, this being one of the main concerns within the EU. Filling this gap and achieving greater convergence among the EU countries has been one of the critical goals in shaping the European structural policy reforms. However, following the empirical findings, there has been little consensus on what are the main sources of a country’s economic progress as addressed through the prism of national competitiveness, particularly if being studied in the context of EU integration. In this context, the study aims to assess the economic performance of the countries that joined the EU first and those that joined last, concerning its linkages with a country’s international competitiveness. The focus is placed on innovation and business sophistication factors’ relative significance and contribution to the economic growth for the observed period (2008-2017). The analysis is based on the World Economic Forum methodology for measuring the Global Competitiveness Index and World Bank database. The research is conducted through comparative analysis, as well as regression analysis aiming to evaluate the relationship between competitiveness and economic development indicators. The findings of the study emphasize a better understanding of the importance of the EU accession date for the country’s overall competitiveness and economic performance, as well as the contribution of R&D innovation and business sophistication, as more advanced competitiveness factors, to economic prosperity and development

Značaj POSSUM skora i ranih pokazatelja periferne perfuzije za predviđanje postoperativnih komplikacija u hirurgiji digestivnog sistema

Postoperative complications are the major cause of postoperative morbidity and mortality and remain to be a serious burden for a healthcare system. The early identification of patients at risk may play a pivotal role in rational decisions regarding perioperative management. The aim of this study was to explore the characteristics of complications in high-risk patients after major abdominal surgery. We also assessed and compared the accuracy of the Clavien-Dindo classification (CDC) and the Comprehensive Complication Index (CCI) for evaluation of postoperative morbidity and the predictive performance of the POSSUM scoring system for complications and mortality. Finally, we wanted to explore the significance of early indicators of altered peripheral perfusion after major abdominal surgery for the occurrence of severe complications. A prospective, observational, cohort study included 206 high-risk surgical patients undergoing major abdominal surgery at the Clinic for Digestive Surgery, Clinical Center of Serbia, from November 2016 to October 2017. We found that the complication rate in our cohort was 60.7% and that the occurrence of complications was associated with the longer ICU stay (p<0.001), postoperative length of stay (p<0.001) and lower functional activity at hospital discharge (p<0.001). The CCI was shown to be of superior accuracy in high-risk patients with multiple complications compared to the CDC as it demonstrated a higher correlation to the resource utilization indicators (p<0.001). The POSSUM scoring system showed the sub-optimal performance for prediction of morbidity and mortality in this cohort of patients (AUCmorbidity= 0.708, O:E ratio=1.07; AUCmortality= 0.744, O:E ratio=0.38). We found that the alterations of peripheral perfusion early after the operation were more pronounced in patients who developed more severe complications. Capillary refill time, central-to-peripheral temperature gradient, and venoarterial pCO2 difference to arteriovenous O2 content ratio on admission to the ICU after the operation, as well as serum lactate concentration and base excess 12 hours after the admission to the ICU were the independent predictors of severe complications. Finally, based on the preoperative, intraoperative, and postoperative variables, with the application of the machine learning algorithms, we developed a new model for the prediction of postoperative complications. The model was validated on the new set of patients and it demonstrated an excellent predictive performance (AUC=0.91; sensitivity 92%; specificity 78%; PPV 87%).Postoperativne komplikacije su vodeći uzrok postoperativnog morbiditeta i mortaliteta i predstavljaju značajno opterećenje za zdravstveni sistem u celini. Rana identifikacija bolesnika sa povećanim rizikom može imati ključnu ulogu u donošenju racionalnih odluka u vezi sa perioperativnim lečenjem. Cilj ove studije bio je da ispita karakteristike komplikacija kod visokorizičnih bolesnika nakon velike abdominalne hirurgije. Takođe smo procenili i uporedili preciznost Clavien-Dindo klasifikacije (CDC) i Comprehensive Complication Index-a (CCI) za evaluaciju postoperativnog morbiditeta i ispitali prediktivne karakteristike POSSUM skora za komplikacije i mortalitet. Konačno, analizirali smo značaj ranih pokazatelja periferne perfuzije za pojavu teških komplikacija nakon velike abdominalne hirurgije. Prospektivna, opservaciona, kohortna studija pratila je 206 visokorizičnih bolesnika podvrgnutih velikoj abdominalnoj operaciji na Klinici za digestivnu hirurgiju Kliničkog centra Srbije, od novembra 2016 do oktobra 2017.godine. Pokazali smo da je učestalost komplikacija u našoj kohorti bila 60.7% i da je pojava komplikacija bila udružena sa dužim boravkom u jedinici intenzivnog lečenja (JIL) (p< 0.001), dužom postoperativnom hospitalizacijom (p<0.001) i nižim funkcionalnim kapacitetom na otpustu iz bolnice (p<0.001). Takođe je prikazano da je CCI prikladnija skala za visokorizične bolesnike sa udruženim komplikacijama u poređenju sa CDC jer je ispoljila jaču korelaciju sa parametrima hospitalizacije (p<0.001). POSSUM skor je pokazao suboptimalne karakteristike u predviđanju rizika za morbiditet i mortalitet u ovoj kohorti bolesnika (AUCmorbiditet = 0.708, O:E odnos = 1.07; AUCmortalitet = 0.744, O:E odnos =0.38). Poremećaj periferne perfizije rano nakon operacije bio je izraženiji kod onih bolesnika kod kojih su se razvile teže komplikacije. Kao nezavisni prediktori teških komplikacija su se izdvojili vreme kapilarnog punjenja, centralno-periferni gradijent temperature i odnos venoarterijske razlike pCO2 i arteriovenske razlike u sadržaju kiseonika na prijemu u JIL nakon operacije, kao i serumska koncentracija laktata i bazni eksces 12 sati nakon operacije. Konačno, na osnovu preoperativnih, intraoperativnih i postoperativnih varijabli, primenom algoritama mašinskog učenja, kreirali smo novi model za predviđanje postoperativnih komplikacija. Model je eksterno validiran i pokazao je odlične prediktivne karakteristike (AUC = 0.91; senzitivnost 92%; specifičnost 78%; pozitivna prediktivna vrednost 87%)

Biljna proizvodnja po konceptu organske poljoprivrede u svetu i Republici Srbiji - istorijat i trenutno stanje

Unlike conventional agriculture, organic farming, as a form of sustainable agriculture, and its production methods preserve and upgrade biodiversity of the soil and biodiversity of the entire ecosystem by protecting the environment, plants, and human health. It appeared at the beginning of XX century in Poland and has been spreading in many countries worldwide ever since. In 2015, this type of agricultural production was implemented at a global level on an area of 50.9 million ha. The largest areas are located in Oceania (22.8 mil. ha) and Europe (12.7 mil. ha), whereas grass areas make up the most, and arable land makes up only 15% there of. In the period 2014-2015, the area increased by 6.5 mil. ha at the global level. In 2015, the largest increase was recorded in Oceania (23.2%) and in 98 countries around the world, while a decrease was recorded in 32 countries. Europe performs ¼ of the world's organic production. In Serbia, organic production makes up 15298 ha (13398 ha belongs to arable land, 1899 ha to meadows and pastures). The largest number of producers is located in Vojvodina, and in Western and Southern Serbia. Cereals have a leading role with a production area of 2182.89 ha. Having in mind the great potentials for organic production in Serbia, experts' plan for the next decade is to increase the area for this type of agricultural production by 20%.Organska poljoprivredna proizvodnja, kao vid održive poljoprivrede, za razliku od konvencionalne poljoprivrede, svojim metodama proizvodnje povećava plodnost zemljišta, čuva i unapređuje njegov biodiverzitet, kao i biodiverzitet čitavog ekosistema, štiteći životnu sredinu, zdravlje biljaka, životinja i čoveka, uz primenu najviših standarda kvaliteta proizvodnje. Pojavljuje se početkom dvadesetog veka u Poljskoj, nastavljajući širenje u mnogobrojnim zemljama širom sveta do današnjih dana, te tako, u 2015. godini zauzima površinu od 50.9 miliona ha na globalnom nivou. Najveće površine pod ovim vidom poljoprivredne proizvodnje nalaze se u Okeaniji (22.8 miliona ha) i Evropi (12.7 miliona ha), pri čemu u strukturi površina dominiraju travne površine, a obradive čine svega 15%. Na globalnom nivou, u toku perioda od 2014-2015. godine, površine su uvećane za 6.5 miliona ha. U 2015. godini, najveće uvećanje zabeleženo je u Okeaniji (za 23.2%), kao i u 98 zemalja širom sveta, dok je pad zabeležen u 32 zemlje. U Evropi je skoncentrisana ¼ svetske organske proizvodnje. U Srbiji, organska proizvodnja se odvija na površini od 15298 ha (13398 ha pripada obradivom zemljištu, a 1899 ha livadama i pašnjacima), pri čemu se najveći broj proizvođača nalazi u Vojvodini, a zatim u Zapadnoj i Južnoj Srbiji. Žita, sa proizvodnim površinama od 2182.89 ha, zauzimaju vodeću ulogu. S obzirom na izuzetne potencijale za organsku proizvodnju u Srbiji, plan stručnjaka je da se u narednoj deceniji površine pod ovim vidom poljoprivredne proizvodnje uvećaju za 20%

Anesthesia in patients with neurological diseases: Coma (neurological disorders and anesthesia)

Neurological disorders have increasing prevalence. Patients who come for surgery and anesthesia are more common with neurological comorbidities. This comorbidity, which has significant consequences for the behavior, psychological and physical characteristics of patients, has a need for numerous medications. When meeting these patients, anesthesiologists want answers to the following questions: the duration of the disease and the degree of illness, used therapy, the quality of life, the influence of anesthetics on the disease and the effect of therapy on the performance of anesthesia, the continuation of therapy after intervention and postoperative recovery. Still there are two dilemmas, whether and when before anesthesia and surgical interventions to stop the use of drugs that allow the function of patients and what are the possible interactions of drugs with anesthesia? The most common neurological diseases with which the anesthesiologist face as comorbidities are: Alzheimer's disease, Parkinson's disease, multiple sclerosis, epilepsy, circulatory disorders, and lately increases the likelihood of coma patients. Answering on the questions above will help a doctor to decide on the type of anesthesia and which dosage of drugs he will use. If a patient is without restrictions in work and habits, then anesthesia in this case is the same as in a person without this comorbidity. The therapy for the existing disease should be carried out until surgery or anesthesia, and should be continued immediately after surgery. Due to the significant influence of used drugs and the nature of the disease, it is necessary to use lesser doses of relaxants, opioids and sedatives. The use of regional anesthesia has its place, and it is used when the degree of illness is such that it allows the patient to cooperate

Organic Fruit Production in Serbia

Organic fruit production and demands for such a production have been growing in Europe and worldwide. Agroecological conditions in Serbia exceptionally favour the development of organic fruit production, particularly of berries with raspberry varieties ranking first (raspberry from Arilje make up to 30% of the total world production of this species). Areas with organic orchards in our country amount to 2208.05 ha, ranking second, just behind the areas with cereals. The greatest areas with organic orchards are located in the regions of southern and eastern Serbia (1244.22 ha), then in Šumadija and western Serbia (830.61 ha). The Toplica District is a leading district in this most important region with the area of 1152.62 ha. Considering the fact that Serbia provides excellent natural capacities for the production of organic fruit, producers are still underutilizing these available natural resources, which represents a significant challenge for the future improvement of organic fruit production

Koncept integralne zaštite jabuke i kruške

This paper implies current and economically significant diseases and pests of an apple and pear, i.e. problems of integral protection of these species of fruits in our country. Measures for their prevention are recommended regarding an adequate period. Special consideration is given to the diseases such as Venturia pyrina, Venturia inaequalis, Monilinia fructigena, Podosphaera leucotricha and Chondrostereum purpureum, as well as to pests such as Cydia pomonella, Cacopsylla pyri, Cacopsilla pyrisuga, Eryiophidae, Panonychus ulmi and Aphididae. The demand and importance of mass implementation of the concept of integral production in terms of obtaining biologically more valuable and ecologically safer fruits, i.e. preservation of the environment and health have been implied.U radu je ukazano na aktuelne i ekonomski značajne bolesti i štetočine jabuke i kruške, odnosno na probleme integralne zaštite ovih vrsti voćaka u našoj zemlji. Preporučene su i mere njihovog suzbijanja u adekvatnom periodu. Poseban osvrt dat je na bolesti Venturia pyrina, Venturia inaequalis, Monilinia fructigena, Podosphaera leucotricha i Chondrostereum purpureum, kao i na štetočine Cydia pomonella, Cacopsylla pyri, Cacopsilla pyrisuga, Eryiophidae, Panonychus ulmi i Aphididae. Ukazano je na potrebu i značaj masovnijeg uvođenja koncepta integralne proizvodnje u cilju dobijanja biološki vrednijih i ekološki bezbednijih plodova, odnosno očuvanja životne sredine i zdravlja ljudi

Nutritivni sastav organski i konvencionalno proizvedenih namirnica

Given the fact that the nutritional value, safety and health status of food produced by conventional agriculture vary around the world, the system of organic farming is emerging as a system that achieves a sustainable production of healthy and safe food, free of pesticide residues. This paper presents evidence that organic foods compared to conventional contain significantly less nitrates, a higher level of dry substance and minerals (especially Fe, Mg and P), vitamin C, essential amino acids and total sugars, then the phenolic compounds, while foods of animal origin contain more unsaturated fatty acids. As for the level of protein, it is generally lower in organic foods. The current scientific data indicate that there is an insufficient number of studies on vitamin levels, in particular b-carotene and vitamin B group. Organically produced fruits and vegetables (in particular apple, cherry, currants, sugar beet, beetroot, carrot, spinach, kale and potatoes) contain higher levels of sucrose and total all sugars. When it comes to animal products, the current available data are insufficiently documented due to different farming systems on farms. However, studies show that chicken eggs and cow's milk do not show significant differences in protein content compared to conventionally produced, organic cow's milk products contain less lipids, while organic chicken meat has a much higher level of iron. However, strict rules laid down by the system of organic production provides food production that meets high quality standards.S obzirom na to da je činjenica da nutritivna vrednost, bezbednost i zdravstveno stanje namirnica proizvedenih konvencionalnom poljoprivredom variraju širom sveta, sistem organske proizvodnje se nameće kao sistem kojim se postiže održiva proizvodnja zdrave i bezbedne hrane bez ostataka pesticida. Ovim radom su prikazani podaci da organska hrana u poređenju sa konvencionalnom sadrži znatno manje nitrata, a više suve materije i minerala (naročito Fe, Mg i P), vitamina C, esencijalnih aminokiselina i ukupnih šećera, a zatim i fenolnih jedinjenja, dok namirnice životinjskog porekla sadrže i više nezasićenih masnih kiselina. Što se tiče nivoa proteina, on je uglavnom niži u organskim namirnicama. Dosadašnji naučni podaci ukazuju da postoji nedovoljan broj studija vezanih za ispitivanje nivoa vitamina, naročito b-karotena i vitamina B grupe. Organski proizvedeno voće i povrće (naročito jabuka, višnja, ribizla, šećerna repa, cvekla, šargarepa, spanać, kelj i krompir) sadrže viši nivo saharoze, kao i svih ukupnih šećera. Kada su u pitanju animalni proizvodi, dosadašnji dostupni podaci su nedovoljno dokumentovani usled različitog sistema uzgoja na farmama. Ipak, istraživanja dokazuju da kokošja jaja i kravlje mleko ne pokazuju značajne razlike u sadržaju proteina u odnosu na konvencionalno proizvedene, organski kravlji proizvodi sadrže manje lipida, dok meso organskih pilića ima znatno viši nivo gvožđa. Ipak, strogo propisanim pravilima sistem organske proizvodnje obezbeđuje proizvodnju hrane koja zadovoljava visoke standarde kvaliteta

Sedation in intensive care units

Critically ill patients during the treatment in the intensive care units (ICU) are exposed to various interventions and stressors from the environment that represent a significant source of discomfort. Sedative and analgesic medications are commonly administered to provide comfort and improve tolerance of ICU management. It has been recognized that pain and delirium, coupled with oversedation, are associated with increased morbidity and mortality if not properly addressed. Routine monitoring with reliable tools enables early detection of agitation and pain, thus avoiding excessive sedation and harsh consequences of delirium. Individual approach implies selection of medications that meet patient's needs while taking into account the presence of organ dysfunctions that may influence drug metabolism and predispose a patient to severe side effects of sedation. The current evidence reveals that a deep sedation should always be avoided as long as there is no mandatory clinical indication. The newest guidelines also suggest the use of non-benzodiazepine (either propofol or dexmedetomidine) sedation whenever feasible to improve clinical outcomes in mechanically ventilated patients. Aside from specific situations (increased intracranial pressure, the administration of muscle relaxants, seizures) the required goal should be an alert, cooperative patient who can tolerate necessary interventions in the ICU. It has been demonstrated that daily interruption of sedation and sleep promotion are beneficial in decreasing the duration of mechanical ventilation and decreasing the incidence of cognitive impairments. Further studies are needed to elucidate the association of non-pharmacological interventions with long-term psychological outcomes

Samoprijavljene alergije na lijekove kod kirurških bolesnika u Srbiji

History of drug allergy is of major concern during perioperative period. Medical records usually lack documents confirming the stated allergy. This study aimed to investigate the prevalence of self-reported drug allergies and their characteristics in adult Serbian surgical population, and to analyze their influence on drug prescription during perioperative period. The study enrolled patients scheduled for general surgery during a one-year period at a tertiary care hospital. They were questioned using a structured questionnaire about the existence of drug allergy and its nature. Medical records were examined after discharge to assess medical prescription during hospitalization. Of 1126 patients evaluated during the study period, 434 (38.5%) reported a total of 635 drug reactions. The most common allergy claim was to antibiotics (68%), nonsteroidal antiinflammatory drugs (16.4%) and iodine (3.9%). Women, urban residents and herbal drug consumers were more likely to state an allergy. The majority of reported reactions were cutaneous (72%) and respiratory (34%), while anaphylaxis was reported by 3.2% of patients. Only 38 (8.7%) patients had previously undergone any allergology testing. Retrospective chart review revealed that 26 (6%) patients were administered the drug to which they had reported allergic reaction in the past, with no adverse effects. Drug allergies are frequently self-reported in surgical population in Serbia, which is in contrast to a very low rate of explored and documented allergies. In order not to deny an effective treatment or postpone a surgery, health care practitioners should pay more attention to an accurate classification of adverse drug reactions.Podatak o alergiji na lijekove je od velikog značenja u perioperacijskom razdoblju, a medicinska dokumentacija obično ne sadrži dokumente koji potvrđuju prijavljenu alergiju. Cilj ovoga istraživanja bio je ispitati učestalost i značajke samoprijavljenih alergija na lijekove od strane odraslih kirurških bolesnika u Srbiji i analizirati utjecaj takvog anamnestičkog podatka na propisivanje lijekova u perioperacijskom razdoblju. Studija je obuhvatila bolesnike podvrgnute elektivnim kirurškim intervencijama iz područja opće kirurgije tijekom jednogodišnjeg razdoblja u tercijarnoj zdravstvenoj ustanovi. Oni su ispitivani primjenom strukturiranog upitnika o postojanju alergija i njihovoj naravi. Medicinska dokumentacija je pregledana nakon otpusta iz bolnice kako bi se ispitalo propisivanje lijekova tijekom hospitalizacije. Od 1126 bolesnika evaluiranih tijekom studije, 434 (38,5%) ih je prijavilo ukupno 635 reakcija na lijekove. Najčešće samoprijavljene alergijske reakcije su bile na antibiotike (68%), nesteroidne protuupalne lijekove (16,4%) i jodni kontrast (3,9%). Samoprijavljivanje alergija je bilo češće kod žena, stanovnika urbanih područja i korisnika biljnih lijekova. Većinu prijavljenih reakcija su činile kožne (72%) i respiracijske (34%), dok je anafilaksu prijavilo 3,2% bolesnika. Samo 38 (8,7%) bolesnika je nakon reakcije podvrgnuto nekom alergološkom testiranju. Pregled povijesti bolesti je pokazao da je 26 (6%) bolesnika tijekom hospitalizacije primilo lijek na koji su prijavili alergijsku reakciju u prošlosti, što nije bilo praćeno neželjenim učincima. Samoprijavljivanje alergija na lijekove je veoma često kod kirurških bolesnika u Srbiji, što je u suprotnosti s niskom stopom ispitanih i dokumentiranih alergija. Kako se bolesnicima ne bi uskratila učinkovita terapija ili odlagala operacija, zdravstveni radnici bi trebali više pozornosti posvetiti preciznoj klasifikaciji neželjenih reakcija na lijekove

Comparative digestomics of Tropomyosin of vertebrates and invertebrates in real food matrix

Shellfish, is a highly nutritive food resource in the world, but also among the eight allergic food groups accounting for approximately 90% of all immunoglobulin E food allergies worldwide [1]. This work focuses on the only well-recognized major allergen muscle protein tropomyosin(TM) that is responsible for cross reactivity between shellfish and other invertebrates [2]. By contrary, TM of vertebrates (chicken, pig, cow) is not a prominent allergen. The stability of food allergens to digestion is an important factor contributing to their allergenicity. Most in vitro digestibility studies are based on the protein extract rather than whole food matrix thus overlooking its effect on TM stability [3]. Our objective was to primarily test the pepsin digestibility of invertebrates and vertebrates (raw and thermally treated based on their real life consumption modes) mimicking the gastric digestion under standardized conditions. To closely observe and compare the vertebrates’ and invertebrates’ TM stability, we aimed to perform the specific antibody based western blot analysis with two primary antibodies; ❶Rabbit anti shrimp TM antibody (invertebrates), and ❷ Rabbit anti human TM antibody (species reactivity to vertebrates). Methods: Thermal treatment of selected samples to compare TM heat stability, Standardized static in vitro methods of simulated gastric digestion[4] for the evaluation and comparison of TM resistance to pepsin, Sodium Dodecyl Sulfate-Polyacryl amide Gel Electrophoresis (SDS-PAGE) of digesta supernatant under reducing and non-reducing conditions to quantify proteins and compare thermally treated invertebrates and vertebrates protein profiles focusing on TM, specific antibody based semi dry Western blot analysis. Results and discussions: SDS-PAGE analysis of vertebrates and invertebrates’ samples showed a range of proteins in varied amounts between 10-250 kDa. Depending upon samples, varied numbers of prominent protein bands were observed including the distinct bands corresponding with the molecular weights of TM(37-39kDa). In agreement with publications, TM was, indeed, resistant against pepsin digestion as well as thermal treatment prominently in case of invertebrates. This was confirmed upon Ab based Western blot analysis. Our results show that, upon thermal treatment, TM is partially degraded as is observed in case of raw and cooked beef electrophoretic profile as well as WB analysis. Significantly, upon pepsin digestion, TM (allergen) is completely degraded in vertebrates in contrast to the invertebrates’ TM (which is pepsin resistant and heat stable). This result provides an insight on the differences in digestibility of allergenic versus non-allergenic TM in real food matrix and upon thermal treatments of solid food samples. Methods: Thermal treatment of selected samples to compare TM heat stability, Standardized static in vitro methods of simulated gastric digestion[4] for the evaluation and comparison of TM resistance to pepsin, Sodium Dodecyl Sulfate-Polyacryl amide Gel Electrophoresis (SDS-PAGE) of digesta supernatant under reducing and non-reducing conditions to quantify proteins and compare thermally treated invertebrates and vertebrates protein profiles focusing on TM, specific antibody based semi dry Western blot analysis. Results and discussions: SDS-PAGE analysis of vertebrates and invertebrates’ samples showed a range of proteins in varied amounts between 10-250 kDa. Depending upon samples, varied numbers of prominent protein bands were observed including the distinct bands corresponding with the molecular weights of TM(37-39kDa). In agreement with publications, TM was, indeed, resistant against pepsin digestion as well as thermal treatment prominently in case of invertebrates. This was confirmed upon Ab based Western blot analysis. Our results show that, upon thermal treatment, TM is partially degraded as is observed in case of raw and cooked beef electrophoretic profile as well as WB analysis. Significantly, upon pepsin digestion, TM (allergen) is completely degraded in vertebrates in contrast to the invertebrates’ TM (which is pepsin resistant and heat stable). This result provides an insight on the differences in digestibility of allergenic versus non-allergenic TM in real food matrix and upon thermal treatments of solid food samples