bluuebunny/crossref_metadata_2025 huggingface dataset:
The distant moral agent
Authors: Andreassen Tom
Published: November 2017

Among the defining characteristics of moral cosmopolitanism are the convictions that personal relations, membership in social or political organizations like local communities or nation-states are insignificant for agents when determining their scope of moral concern. The moral scope is unlimited and the moral duties reach globally. Following up observations made by Onora O’Neill and others, it is argued that Singer’s model needs a complementary tool to allocate duties.That tool can be found by supplementing the agent centered perspective of the model with a regard for the social and institutional circles encompassing right holders. Instead of focusing on the duty holder, I suggest that the cosmopolitan’s “ultimate unit of moral concern” – here, the claimholder is regarded central.Thus, Singer’s cosmological model is kept, but in a rights-based methodological approach for allocating duties. Methodologically, what needs to be investigated is whether the scope of legitimate moral claims expands from the agent for the same reasons that the circle of moral concern expands from Singer’s agent.
Hostile urban architecture: A critical discussion of the seemingly offensive art of keeping people away
Authors: De Fine Licht Karl Persson
Published: November 2017

For many years, some urban architecture has aimed to exclude unwanted groups of people from some locations. This type of architecture is called “defensive” or “hostile” architecture and includes benches that cannot be slept on, spikes in the ground that cannot be stood on, and pieces of metal that hinder one’s ability to skateboard. These defensive measures have sparked public outrage, with many thinking such measures lead to suffering, are disrespectful, and violate people’s rights. In this paper, it is argued that these views are difficult to defend and that much more empirical research on the topic is needed.
Etiske utfordringer med nyere reproduksjonsteknologi
Authors: Hofmann Bjørn
Published: November 2017

Moderne teknologi gir fantastiske muligheter for menneskelig formering. Mange som tidligere ikke kunne få barn, eller som fikk syke barn, kan nå hjelpes. Samtidig reiser mulighetene en rekke vanskelige moralske spørsmål, som ikke har enkle svar – ofte fordi de bunner i grunnleggende etiske motsetninger. Denne artikkelen gir en kort oversikt over de mulighetene som tre typer teknologier gir: assisterende, seleksjonsfremmende og egenskapsendrende teknologier. Deretter peker den på noen av de viktige moralske spørsmålene som disse teknologiene reiser i betydningen «Hvordan bør teknologiene brukes»? Så stilles spørsmålet: Hvordan skal vi begrunne bruken? Dette spørsmålet peker på en rekke grunnleggende etiske utfordringer. Det er disse utfordringene som gjør at de moralske spørsmålene sjelden finner solide og stabile svar, men til stadighet blusser opp i til dels heftige offentlige debatter. I tillegg løfter artikkelen frem flere moralske spørsmål som er glemt eller gjemt. Spørsmålene som vi ikke stiller kan ofte fortelle oss like mye om oss selv og våre verdier, som de spørsmålene som drøftes eksplisitt. De moralske spørsmålene – samt de underliggende etiske utfordringene og de glemte spørsmålene – kan forklare hvorfor debattene ofte står på stedet hvil, og hva vi må jobbe med for å komme videre i drøftingene av moderne reproduksjonsteknologi. Vi synes å være teknologiske helter som er fremragende på teknikk, men elendige på etikk. Målet er å forhindre at vi blir tragiske helter som går til grunne på våre beste egenskaper.  Nøkkelord: reproduksjonsteknologi, assistert reproduksjon, invitro-fertilisering, fosterdiagnostikk, genredigering, sortering, abortEnglish summary: Ethical challenges with newer reproductive technology  Modern technologies provide fascinating opportunities for human reproduction. Many persons previously infertile, or who risked having diseased children, can now have healthy children. At the same time, these technological opportunities also raise a wide range of moral questions, which rarely have easy answers. One reason for this is that they are based on profound ethical challenges. This article sets out to give a short overview of three types of technologies: assisting, selective, and characteristic-changing technologies. It goes on to highlight some of the important moral questions raised by these technologies. The third part addresses the basic ethical challenges lurking behind the moral questions and debates. The fourth part addresses some forgotten or hidden questions, arguing that these are telling and important. The article ends with arguing that many of the basic ethical challenges and the unaddressed questions can explain why debates on reproductive technologies are so heated and static. We appear to have become technological giants, but ethical infants. Accordingly, we should try to avoid becoming tragic heroes succumbing to our very best abilities.
Providing High Quality Standard of Training in the Tertiary Education Sector in Botswana: Evaluation of Resources in Enhancing Effectiveness
Authors: Olukemi Sangodoyin Oluranti
Published: November 2017

The research goal of study is to accentuate on high quality standard of training and provision of adequate resources and its effects on the overall development of tertiary education sector in Botswana. Special attention is paid to Botswana Qualification Authority (BQA) and it’s emphasizes on the issue of compliance in the standards set by its regulatory authorities. This paper discusses opportunities for enhancing the efficiency of education by providing quality training and using resources more strategically to increase its impact on national and global education outcomes. Since Education Training Providers have advocacy for more students which has been targeted towards Directorate of Tertiary Education Council (DTEF), hence, attention to deliver effectiveness must be largely emphasized. In programme development and procedures, delivery styles used on the programme must be appropriate to the needs of the learners. Adequate resources are necessary for successful achievement by learners of the programme objectives and maintain on the programme, and there should be plentiful evidence to indicate that the programme aspect meets expectations. Various resources for successful participation by learners are allocated to maintain programmes.It has been deliberated that assessment must be available to all learners who have the potential to achieve the standards required for a particular qualification. Care must be taken that any proposed assessment methods are of quality for learners and demonstrate that they have achieved the international standard. Measures must be taken to ensure that all learners have adequate access to facilities and resources. The resources available to programmes must be in accordance with programme objectives and budget allocation. Finally, to ensure the introduction of relevant programmes in a socio-economic context; analysis of enquiries and administration of needs analyses must be conducted.
Effects of Exploratory and Heuristic Multi-methods on System-oriented Curricula Based on Clinical Scenarios
Authors: Lu Chunting , Huang Simin , Li Zejian , Feng Lie , Yang Jing
Published: November 2017

A system-oriented curriculum in which basic medical courses and clinical subjects are integrated and reformed is a new trend for medical education in China. In order to train and enhance the comprehensive clinical competency, thirty-two excellent medical students who formed a observation group from grade 2010 in Jinan University were selected to participated in this study. Three different exploratory and heuristic pedagogies, which employed the flexible application of case-based learning (CBL), problem-based learning (PBL), and team-based learning (TBL), were explored and implemented in cardiovascular, respiratory, and digestive teaching sections. The effects of these exploratory and heuristic pedagogical approaches based on the flexible application of the CBL, PBL, and TBL methods with clinical scenarios in system-oriented curricula are satisfactory. Accordingly, these teaching methods and experiences had been summarized and promoted to mainland and non-mainland medical students from grade 2014 in Jinan University. Teaching and learning effects are also satisfactory. In addition, different characteristics in conducting these courses between two types of university students are further compared and analyzed for the improvement of all system-oriented curricula in the future.
Optimize the Role of Commitment of Employees in Improving Accountability Office Report on Local Government Budget
Authors: Istikhoroh Siti , Sukamdani Yuni
Published: November 2017

This study aims to analyze the factors that affect employee commitment so that its role in improving the accountability of budget reporting can be optimized. The study was conducted on 20 units of East Java Provincial Government Office in 2016. Data were collected by giving questionnaires to 268 respondents and analyzed using multiple linear regression method. Researchers establish organizational learning and locus of control as a variable that affects the commitment of employees. The results of the analysis prove that employee commitment can be optimized through organizational learning process with indicators in the form of thinking systems, mentality, personal skills, teamwork, and understanding of the vision of the organization. Meanwhile, locus of control measured by internal control and external control proved unable to increase employee commitment.
Factors Affecting Derivatives Use for Life Insurance Companies
Authors: Hee Park Kwang , Song Woon Kyung
Published: November 2017

The aim of this article is to investigate what factors affect derivatives use for life insurance companies in Korea. For life insurance companies in Korea, there are some problems to solve. First one is to meet IFRS standard which emphasizes solvency. Second one is to overcome problems from macroeconomic including low economic growth and low interest rate, fluctuating foreign currency exchange rate, and problems from population composition change and longer longevity. One of the possible ways to control the risks that life insurance companies face is using derivatives. Traditionally life insurance companies use reinsurance to hedge their inherent risks. However, hedging by using derivatives provides some different merits from those by reinsurance, such as, effects of controlling risks from macroeconomic change, in some cases less costs to control risks, etc. So using derivatives to control risks for life insurance companies is not only for sustainable management but for growth and becoming more competitive. The study results show that asset size, foreign assets and liabilities, proportion of deposit insurance, liquidity, RBC are significant factors affecting derivatives use.
Machine Learning in Macro-Economic Series Forecasting
Authors: Liao Yun
Published: November 2017

In this paper I conducted a simple experiment to using Artificial Neural Network in time-series forecasting, by combining First order Markov Switching Model and K-means algorithms, the forecasting performance of machine learning has outperformed the benchmark of time-series inflation rate forecasting. The paper reveal the potential of ANN forecasting, also provide future direction of research.
The SEC Disclosure Requirement and Directors’ Turnover Around Stock Repurchase
Authors: Hamouda Foued , Henchiri Jamel Eddine
Published: November 2017

The aim of this research is to outline board turnover when firms repurchase their own shares. Indeed, to control insiders’ short-swing trading during repurchase events and protect outsiders against speculation, it is useful to know how boards are changed. We examine the introduction of the SEC 2004 disclosure requirement effectiveness on repurchase announcement returns and director’s turnover in a sample of 764 companies over 1998 to 2013. In a broad cross-section of US firms, we argue that the SEC 2004 Rule appears to receive greater weight in turnover decision. However, the more insiders are entrenched into the board, the more they cannot be replaced easily even though 2004 disclosure Rule is adopted. We also find that a large number of board independencecontinue to explain the variation of board turnover.
Dealing with Anxiety: Relationships among Interpersonal Attachment Style, Psychological Wellbeing and Trait Anxiety
Authors: Andrews Emma E. E. , Hicks Richard E.
Published: November 2017

Anxiety is a major contributor to poor quality mental health for many people in our community, and is a leading cause of presentations at medical and health clinics. Patterns of trait anxiety, or dysfunctional responding, have become ingrained in individuals’ approaches to problems they face. Research has shown that psychological wellbeing and interpersonal attachment style are both predictors of trait anxiety. However, the relationships among these variables have not been clarified. The current study sought to determine whether psychological wellbeing mediates the relationship between interpersonal attachment style and trait anxiety, and which of the six psychological wellbeing subscales would contribute most to any mediation effects. A convenience sample of 149 adult participants from South East Queensland, Australia completed a series of online questionnaires including a demographic questionnaire, the Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI-Form Y2), the Inventory of Parent and Peer Attachment (IPPA), Ryff’s Psychological Wellbeing Scale (PWB), and a Social Desirability Scale (SDS-17). Psychological Wellbeing was found to partially mediate the relationship between interpersonal attachment style and trait anxiety. The Positive Relations with Others subscale of the PWB was the only significant sub-scale of the PWB that significantly predicted trait anxiety. Overcoming anxiety appears to be most related in our sample to those who deal better with interpersonal relations. Targeting this aspect in treatment approaches appears most likely to lead to improved outcomes for clients.
O genezie „cielesnych” motywów w twórczości Mariny Cwietajewej
Authors: Janczuk Elena
Published: November 2017

It is difficult to form a coherent conception of Marina Tsvetaeva’s considerations
about the body, as sometimes they contradict each other and sometimes
they complement each other. However, they were changing as new experiences
were accumulated. From the idea that the body is like a wall or an obstacle in the
way, Tsvetaeva moves to the idea of the body as a separate zone of her personality,
where freedom and democracy go along with subjection, and where the rigorous
part of the personality – soul is to be subdued. When the poet starts to lose
contact with the body, when she becomes convinced that she no longer can
identify with it, she experiences a stormy passion in which she hopes to complete
her own incarnation. However, she comes to the conclusion that the nature of her body is flawed and the signs of gender are not proper. She consciously resigns
from love, claiming that love and creativity cannot be reconciled. Her body
bothers her, it seems to cast a veil on the true reality, which is invisible and
“by which one thinks”. After another period of her soul and body disassociation,
she comes to the conclusion that she did not know her body at all.
Życie dzielone Karla Dedeciusa (1921–2016)
Authors: Stanaszek Maciej
Published: November 2017

The article presents the figure of Karl Dedecius (1921–2016) by exploring his
activity as a translator and ambassador of Polish – but also Russian – literature
and culture in German-speaking countries (mainly Germany). Having spent his
youth in pre-war multicultural Łódź and – after the outbreak of WW II – having
been a prisoner of war in Soviet camps, in December 1949 Dedecius moved to the
GDR, from where he fled three years later with his family to West Germany.
For 25 years he had divided – his life between literary translation, notably poetry,
work as an insurance agent and family matters, and after retiring he managed
to set up the Deutsches Polen-Institut, a non-governmental institution devoted to
the popularisation of Polish literature in Germany, which he led in the years
1980–1998. As one of his close collaborators states, Dedecius’s editorial legacy
comprises about 200 books which he either translated, wrote or edited, with
poetry translations and literary essays being the core of his literary activity.
He rendered some 3,000 poems of roughly 300 Polish poets into German and
composed ca. 10 books that present and analyse – chiefly the 20th-century – Polish
literature; some of them also contain essays on translation, fragments of which
are cited and commented in the present article. Another important source
and basis of considerations is Dedecius’s autobiography Ein Europäer aus Lodz
[A European from Łódź], which explains the background of the author’s life at
its different stages.
Irma Kudrowa, Marina Cwietajewa: bezzakonnaja kometa. Biografia, Wydawnictwo
AST, Moskwa 2016, 864 s.
Authors: Janczuk Elena
Published: November 2017

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Empresas madeireiras e resíduos sólidos na Região Metropolitana de Belém
Authors: Ramos Wilson Fernandes , D’Aquino Gilma Izabel Rego , Ruivo Maria de Lourdes Pinheiro
Published: November 2017

O presente artigo apresenta informações preliminares sobre o levantamento da quantidade de indústrias de base florestal que atuam na Região Metropolitana de Belém (RMB) e o potencial em relação aos resíduos gerados por essas indústrias. Para a coleta de dados, foram utilizados os bancos de dados da Secretaria Estadual do Meio Ambiente e da Associação das Indústrias Exportadoras de Madeira do Estado do Pará. Os resultados preliminares indicam que 120 indústrias do setor madeireiro são, potencialmente, geradoras de resíduos madeireiros na RMB. Os resíduos gerados por essas indústrias acarretam inúmeros problemas de ordem social e ambiental em virtude de não haver uma política de reaproveitamento desse material. Muito desses resíduos gerados na RMB são doados para fábricas de cerâmicas, olarias ou reciclados como biomassa para a geração de energia térmica, a qual é usada na própria empresa.
A violência no campo e a cobertura nos jornais impressos Diário do Pará e O Liberal: uma análise dos casos Dorothy Stang e José Cláudio Ribeiro
Authors: Campos Ana Lídia , Ravena Nírvia
Published: November 2017

Este trabalho apresenta uma análise da cobertura da violência no campo feita pelos jornais impressos Diário do Pará e O Liberal, tendo como objeto de estudo o assassinato de Dorothy Stang, em 2005, e do casal José Cláudio Ribeiro e Maria do Espírito Santo, em 2011. Depois de um apanhado histórico da violência no campo no Pará, incluindo a atuação da Comissão Pastoral da Terra (CPT) e a descrição dos assassinatos, apresentasse um conjunto teórico de suporte para a análise além de uma descrição sucinta dos jornais pesquisados. O trabalho traz a análise quantitativa e qualitativa de matérias referentes ao tema violência no campo, bem como ao assassinato da missionária e à morte do casal de ambientalistas, seguindo uma mesma linha de pesquisa em ambos os casos. Por fim, são apresentadas as considerações do tema abordado levando em conta o encontro de teoria e prática.
Eficiência do turismo nas unidades federativas do Brasil
Authors: Queiroz Luan De Oliveira , Duarte Leandro Batista , Gomes Adriano Provezano
Published: November 2017

A atividade turística tem demonstrado ser importante para o desenvolvimento socioeconômico mundial, gerando emprego e fonte de riqueza. Deste modo, o presente artigo tem o intuito de identificar as Unidades Federativas Eficientes e Ineficientes quanto à atração de receitas turísticas e fluxo de turistas. A pesquisa foi realizada por meio de dados secundários de órgãos oficiais do turismo e de estudos macroeconômicos, como a Secretaria de Turismo da Bahia, o Ministério do Turismo, o Instituto Brasileiro de Geografia e Estatística e o Banco Central, utilizando como metodologia a abordagem Análise Envoltória de Dados (DEA - Data Envelopment Analysis) que calcula a eficiência relativa e compara as unidades entre si, identificando aquelas de melhor desempenho, uma vez que estas serão parceiras de excelência (benchmarks) para as unidades ineficientes. Nos resultados, observou-se que as unidades federativas que foram tecnicamente eficientes na atração de turistas (Modelo 2) não foram as mesmas quando foram analisadas pela ótica das receitas (Modelo 1), exceto para São Paulo e Espírito Santo, existindo a possibilidade dos estados eficientes no fluxo de turistas aproveitarem este potencial para gerar receitas turísticas a fim de mobilizar dinamicamente sua economia e buscar a eficiência também no cômputo de receitas.
Saúde, ação pública e território: análise comparativa França e Brasil
Authors: Plas Philippe , Ponte Vanderlúcia Da Silva
Published: November 2017

O nível de melhoria de saúde é uma questão importante para os Estados, tanto para os europeus como os que vivem nos países do Sul. O problema de saúde é um grande desafio em todos os lugares. A saúde de uma nação é o resultado da interação de uma variedade de fatores que se relacionam e não somente resultante dos aspectos biomédicos. A partir de uma abordagem comparativa entre a França e o Brasil, este artigo procura colocar em evidência os elementos que formam o sistema de saúde. É necessária uma abordagem local e regionalizada do tema. A desigualdade do território em termos de estado de saúde ou por acesso à saúde é uma realidade, que se apresenta na França e no Brasil. Enfim, um sistema local de saúde pública foi implantado nos dois países, sendo este um ponto comum, no entanto, a lógica de sua implantação parece ser diferente. Com efeito, o sistema francês parece ser mais uma questão de um processo de “bottom-up”, do que “top-down”, enquanto o inverso é verdadeiro no contexto brasileiro. Esta é provavelmente a razão pela qual o Brasil tem muita distorção entre os modelos de ação legalmente definidos e a realidade da sua implementação, em particular no que diz respeito aos povos indígenas da Amazônia.
Mobilidade social no garimpo: herança ou esforço pessoal?
Authors: Barrozo João Carlos
Published: November 2017

Os garimpeiros de diamante do Alto Paraguai eram filhos de agricultores, vindos predominantemente do Nordeste. De lá foram expulsos pela seca, pelo latifúndio, pela pobreza e atraídos pelo sonho de enriquecer no garimpo. A herança social não é determinante, mas tem um grande peso para os filhos. Muitos herdaram a posição social dos pais, continuando no garimpo, dependendo da “sorte”, ou da vontade divina. Mas outros romperam este círculo vicioso, pelo esforço próprio e com o apoio da rede familiar. A segunda e a terceira gerações, filhos e netos, que estudaram e se qualificaram, construíram uma trajetória social ascendente, escapando da herança social dos pais e avós.
A Escola de Samba Bole-Bole em Belém/PA: história, comunidade e identidade
Authors: Cunha Gordo Margarida Do Espírito Santo , Silva Herivelto Martins e
Published: November 2017

Este artigo tem o objetivo fazer uma análise sobre a história do carnaval e de escolas de samba de Belém, a partir da Escola de Samba Bole-Bole, ressaltando a sua importância para a economia e o fortalecimento identitário de sua comunidade com o bairro a que pertence. Foi realizada uma revisão bibliográfica sobre o carnaval, tendo como referência a tese de doutorado de Gordo (2015). A relevância deste estudo se caracteriza em desvelar pontos significativos que acontecem nas escolas de samba, na maioria das vezes desconhecidos ou ignorados pela sociedade.
Desenvolvimento e acumulação por espoliação: o caso do território Cantuquiriguaçu - Paraná
Authors: Theis Ivo Marcos , Krajevski Luis Claudio
Published: November 2017

O Território Cantuquiriguaçu é a segunda microrregião menos desenvolvida do Estado do Paraná. Dentre as justificativas para esta situação, este ensaio discorre sobre a ideia de que a acumulação por espoliação contribui para o atraso desta região se comparada as demais microrregiões paranaenses. Desta forma, o objetivo deste artigo é verificar até que ponto a acumulação por espoliação promove o desenvolvimento desigual das regiões, especialmente quanto ao desenvolvimento do Território Cantuquiriguaçu. Para isso, se utiliza de revisão bibliográfica e documental a respeito das ações adotadas, bem como de dados socioeconômicos do Paraná. A análise consiste na comparação destes dados entre o Território Cantuquiriguaçu com os dados estaduais. Os resultados não só confirmam o atraso da região, como também indicam que o intenso processo de concessões e privatizações, ocorrido a partir do final dos anos 1990, promoveu práticas de acumulação por espoliação via ação estatal, impulsionando as disparidades regionais anteriormente existentes.
New scale insects (Homoptera: Coccinea) from the Cape Floristic Region
Authors: Gavrilov-Zimin Ilya A. , Chetverikov Philipp E.
Published: November 2017

Three new scale insect species, Coccidohystrix daedalea Gavrilov-Zimin sp. nov., Mirococcopsis ptilura Gavrilov-Zimin sp. nov. (both from the family Pseudococcidae) and Cryptinglisia millari Gavrilov-Zimin sp. nov. (family Coccidae), are described and illustrated from the Western Cape Province of South Africa.
Zdravljenje idiopatskega in kompleksnega prirojenega talipes ekvinovarusa z metodo po Ponsetiju
Authors: Suhodolčan Lovro , Schara Karin , Brecelj Janez , Antolič Vane
Published: November 2017

Abstract:Congenital idiopathic clubfoot is a deformity typically occurring in an otherwise healthy child which occurs in 11,4 in 10.000 live births. Approximately one-half of cases present with bilateral deformity and affects boys and girls equally. Clubfoot is characterized by adduction, supination and cavus deformity of the forefoot and midfoot, varus of the heel, and a fixed plantar flexion (equinus) of the ankle. Treatment od idiopathic type of clubfoot consists of corrective manipulation and casting by the Ponseti method, where usually four to six casts are needed. Equinus is corrected with tendo Achillis tenotomy followed by foot abduction brace application.Complex type of clubfoot, which has more severe rigid deformation, is present in 6,5% of all clubfeet and is refractory to the usual corrective manipulation and casting by the Ponsetti method. Clinically, complex clubfoot is characterized  as short, stubby foot,  having rigid equinus, severe adduction and plantar flexion of all metatarsals, a deep crease above the heel and a transverse crease in the sole of the foot. Modified Ponsetti method for treatment of complex clubfoot consists of simultaneus correction of adduction and heel varus and subsequent cavus and rigid equinus correction. After the Achillis tendon tenotomy, modified foot abduction brace is applied, where foot is in 40° outer rotation in contrast to 70° abduction used in less rigid congenital idiopathic clubfoot. Relapse occurs in 14% and is ussually related to problems with shoe fit and patient coplience.
Evbakterijski PCR – uporabnost molekularne metode v klinični praksi
Authors: Lužnik Zala , Cerar Kišek Tjaša , Ružić-Sabljić Eva , Müller Premru Manica , Jurca Tomaž , Tomažič In Janez
Published: November 2017

AbstractBackground: Isolation and identification of bacterial pathogens enables accurate diagnosis of bacterial infection, allowing rational use of appropriate narrow-spectrum antibiotics. In some cases, the routine bacterial culture can give negative results. In those cases additional use of molecular techniques such as eubacterial (broad-range 16S rRNA) PCR may detect and identify bacterial genetic material.Methods: Between February 2012 and April 2013 42 specimens from 35 patients, already treated with antimicrobials, were taken and tested by eubacterial PCR in addition to routine microbiological culture. Results: Eubacterial PCR yielded positive result in 21/42 specimens in 18 patients (in three mixed sequences). Therefore, in 15 patients the diagnosis of bacterial infection was obtained with DNA identification and the results were interpreted in accordance to patients’ history, laboratory and image diagnostics. Only 4 specimens were culture-positive.Conclusions: Although eubacterial PCR enables the identification of any bacterial DNA in clinical specimens, there are some limitations: no information concerning antimicrobial susceptibility of the causative agents, problem of differentiating living from dead bacteria and problem to differentiate contaminants from pathogenic bacteria. The method is also expensive. In the following article recommendations for appropriate and rational use of eubacterial PCR are presented.
Healthcare process analysis and improvement at Department of abdominal surgery-University Medical Centre Ljubljana
Authors: Damij Nadja , Damij Talib , Jelenc Franc
Published: November 2017

Background: Healthcare processes in hospitals, like processes in companies or governmental organizations, may accumulate problems and obstacles over time, which consequently cause the processes to become ineffective. BPM is an approach for process modeling, improvement and automating, which has been used with great success for process improvement.Methods: This work was to examine the possibility of carrying out healthcare process improvement using BPM. To implement BPM ideas, a revised TAD methodology was developed, representing an important contribution to the BPM. The first three phases of the TAD methodology were introduced in a step-by-step approach. The first phase deals with process identification, the second develops the "as-is" model, and the third phase discusses process improvement by developing the "to-be" model.Results: We found that (a) the Surgery process is efficient and well organized; (b) patient stay in the clinic could be shortened; however for humane and social reasons the leadership prefers to leave the residence time as it is; (c) the process is connected to some time-consuming activities which are perfrmed in other departments and represent the bottleneck of the process.Conclusions: The following were concluded (a) BPM proved to be a suitable approach for carrying out healthcare process improvement; (b) the revised TAD methodology showed to be consistent and efficient in performing BPM approach; (c) The Surgery process discussed was found to be an effective one and no changes or improvements are needed; (d) Concerning time-consuming activities, the leadership decided to discuss this problem with the management of the departments where the activities are executed.
Urogenitalna tuberkuloza – klinični primer
Authors: Smrkolj Tomaž , Likar Boštjan , Galič Dejan
Published: November 2017

Urogenital tuberculosis is uncommon in developed countries. Numerous and nonspecific urologic complaints are characteristic, e.g. lower urinary tract symptoms, haematuria, renal pain, palpable lesions in testis and epididymis and constitutional symptoms. Microbiological diagnostic tests together with imaging and endoscopy are indicated in urogenital tuberculosis. The role of surgery has changed in the era of modern antimycobacterial agents. Surgery is used in advanced stages and is reconstructive rather than ablative for removal of infected tissue. Article describes procedures for treatment of urinary obstruction, surgical procedures on kidney, ureter, bladder, prostate and urethra and testis with epididymis.Case report presents 69 year old man who presented with left side epididymitis, however after initial diagnostic tests tumour of left testis and epididymis and right kidney with liver metastasis was suspected. Computer tomography of thorax diagnosed miliary tuberculosis. Patient was transferred to pulmonary department, where tuberculosis was confirmed and medical antituberculous therapy was initiated. Adequate treatment response with regression of tuberculous lesions in urogenital tract was observed.
Stres na delovnem mestu in variabilnost srčne frekvence
Authors: Rauber Martin , Bilban Marjan , Starc Radovan
Published: November 2017

Brief description of the article: This article considers heart rate variability as a measurable parameter of stress reaction and present recent studies that examined the impact of occupational stress on heart rate variability and thus autonomic nervous system.ABSTRACT Stress is a complex psychoneuroendocrinological and immune response of an individual to stressogenic factor. The most important contemporary stressogenic factors are mental, psycho-social and socio-economic stressors. This especially holds true for occupational stress. Many symptoms and signs of disease are associated with chronic occupational stress. Among those are cardiovascular diseases, metabolic and psychiatric disorders.This article describes different stressogenic factors that lead to occupational stress and two conceptual models of occupational stress (Karasek’s Demand/Control Model and Siegrist’s Effort-Reward Imbalance Model). Reaction to stress can be measured in various ways. This article summarizes the physiology of heart beat regulation and presents heart rate variability as a measurable parameter of stress reaction. Heart rate variability gives us an insight into autonomic modulation of the heart and functioning of the entire autonomic nervous system. This article presents the latest results of larger studies that examined the impact of occupational stress on heart rate variability and various mechanisms that lead to end-organ damage due to changes in autonomic nervous system as a result of work stress. Subjects exposed to chronic stress have significantly lower heart rate variability compared with subjects unaffected by stress. Researches have shown that reduced heart rate variability reliably predicts mortality among health adults, as well as morbidity and mortality in patients after acute myocardial infarction, in patients with chronic heart failure and mortality in patients with chronic kidney disease.
Myocardial Infarction in Pregnancy – a Review Article with a Case Report
Authors: Cerar Andraž , Latifić Jasnič Dunja , Gričar Marko , Fabjan Vodušek Vesna , Kožellj Mirta
Published: November 2017

Acute myocardial infarction in pregnancy is a rare but potentially devastating event which has to be diagnosed and treated as soon as possible.
PROTITELESA PROTI PROTROMBINU
Authors: Žigon Polona , Ambrožič Aleš , Božič Borut , Čučnik Saša
Published: November 2017

In patients with the antiphospholipid syndrome (APS), the presence of a group of pathogenic autoantibodies called antiphospholipid antibodies causes thrombosis and pregnancy complications. The most frequent antigenic target of antiphospholipid antibodies are phospholipid bound β2-glycoprotein 1 (β2GPI) and prothrombin. The international classification criteria for APS connect the occurrence of thrombosis and/or obstetric complications together with the persistence of lupus anticoagulant, anti-cardiolipin antibodies (aCL) and antibodies against β2GPI (anti-β2GPI) into APS. Current trends for the diagnostic evaluation of APS patients propose determination of multiple antiphospholipid antibodies, among them also anti-prothrombin antibodies, to gain a common score which estimates the risk for thrombosis in APS patients. Antiprothrombin antibodies are common in APS patients and are sometimes the only antiphospholipid antibodies being elevated. Methods for their determination differ and have not yet been standardized. Many novel studies confirmed method using phosphatidylserine/prothrombin (aPS/PT ELISA) as an antigen on solid phase encompass higher diagnostic accuracy compared to method using prothrombin alone (aPT ELISA). Our research group developed an in-house aPS/PT ELISA with increased analytical sensitivity which enables the determination of all clinically relevant antiprothrombin antibodies. aPS/PT exhibited the highest percentage of lupus anticoagulant activity compared to aCL and anti-β2GPI. aPS/PT antibodies measured with the in-house method associated with venous thrombosis and presented the strongest independent risk factor for the presence of obstetric complications among all tested antiphospholipid antibodies.
Diplopija: Praktičen pristop k diagnostiki
Authors: Šivec Igor , Kosec Dragica
Published: November 2017

Diplopia means seeing two images of the same, one object. It is a symptom with numerous causes that can involve many different structures. The cause can lay in the eyeball itself: the cornea, the lens and the retina or behind the eyeball: in the orbit or intracranial. Diplopia is only a symptom that can indicate a life threatening ilness like an aneurysm, a dissection or a brain tumor. That is why when presented with it we have to do a thorough examination and look for a red flag that could indicate danger. This way we can make a timely intervention, saving the patients sight or life. This article describes the most crucial signs of a dangerous underlying condition that we cannot afford to miss, a practical guide to the historical assesment, as well as to the physical examination of a patient with double vision to help localize the cause.
REKONSTRUKCIJA OBRAZA Z EPITEZO, SIDRANO NA VSADKIH
Authors: Prodnik Luka , Didanovič Vojko , Ihan Hren Nataša , Eberlinc Andreja , Maver Tomaž , Kuhar Milan , Kansky Andrej
Published: November 2017

In this article, our clinical experience with an external ear and periorbital region reconstruction with implant-supported craniofacial epitheses are described. According to our experience, this kind of facial reconstruction is simple and reliable
Evaluation of theophylline therapeutic drug monitoring service
Authors: Rugelj Neža , Trobec Katja Čvan , Pišlar Mitja , Brguljan Pika Meško , Košnik Mitja , Mrhar Aleš
Published: November 2017

BackgroundTherapeutic monitoring of theophylline serum levels is required due to its narrow therapeutic range and marked interindividual pharmacokinetic variability. We evaluated therapeutic drug monitoring service for theophylline in Slovenian clinical setting, which currently includes no pharmacokinetic evaluation of measured theophylline serum concentrations. MethodsWe  retrospectively evaluated 127 randomly selected theophylline serum level determinations performed in 2010 in a tertiary clinical setting in Slovenia. Demographic data, information on theophylline dosing and blood sampling was collected from patients’ data files. Authors evaluated the appropriateness of the following procedures: indications for theophylline serum concentration measurement, timing of blood sampling and dosage adjustments made after theophylline levels had been reported. On the basis of collected data, population pharmacokinetic model for theophylline was built and further used for the evaluation of dosage adjustments. ResultsOut of 127 cases, 107 (84.3%) had clinically justified indication for theophylline serum level measurement. Near half of measurements (44.9%) were performed before the steady state of theophylline concentrations was established. 65% of measured concentrations were subtherapeutic and the average measured concentration was below therapeutic range (53.1 μmol/L). Despite subtherapeutic concentrations the dose of theophylline was mainly not increased. Pharmacokinetic model enabled the calculation of average optimal daily dose which was significantly higher than the average actual daily dose used (876 mg vs. 572 mg, p < 0.001). ConclusionsTheophylline TDM service should be optimized and pharmacokinetic interpretation of theophylline serum levels should be integrated into clinical practice.
AMBULANTNO ZDRAVLJENJE BOLNIKOV Z RAKOM IN VENSKO TROMBEMBOLIJO
Authors: Cvajnar Urška , Mavri Alenka , Štalc Monika
Published: November 2017

Background: Patients with cancer are at increased risk for venous thromboembolism (VTE). Cancer-associated VTE increases the burden of malignant disease and has an unfavorable effect on survival.Aim: To establish the safety and efficiency of ambulatory treatment of patients with cancer and VTE.Methods: In retrospective longitudinal cohort study we investigated documentation of all patients with cancer and VTE who were ambulatory treated at our department from November 2005 to February 2011. Their clinical features and complications while on anticoagulant treatment were analyzed. Patients were followed for at least two years from the date of VTE event.Results: 290 patients with cancer and VTE were enrolled (134 women; mean age 68±12 years; 78,2% proximal venous thrombosis (VT); 10% pulmonary embolism (PE); 74,5% metastatic disease). They were treated with low-molecular-weight heparin (LMWH) in the first six months, later on with coumarins. 94 bleeding (33% major and 67% minor) and 41 recurrent VTE events (34,2% PE and 65,8% VT) were recorded. Two-year survival rate was 45,5%. The cause of death was progression of cancer in 87,4%, major bleeding in 2,5% and PE in 1,9% of patients. Advanced stage of cancer, low body mass index and low hemoglobin concentration at initiation of anticoagulant treatment turned out to be the independent prognostic factors of survival.Conclusions: Ambulatory treatment of patients with cancer and VTE is safe and efficient. Survival of patients with cancer and VTE predominantly depends on advanced stage of cancer and general performance status of a patient.
Assessing Independence of Residents Suffering from Dementia in Meeting Basic Living Needs in Ljubljana Nursing Homes
Authors: Kobentar Radojka Trkulja , Kogoj Ales , Maver Darja Zorc , Savič Brigita Skela
Published: November 2017

Background:Obviously a very high proportion of nursing home residents exhibit the clinical signs of dementia, which affect the independence of the impaired individual. The purpose of the study is to determine the level of independence of the residents in performing basic life activities.Methods:The research examines 233 residents of both sexes, with a clinical diagnosis of dementia that are aged 65 years and over that have resided in one of the four Ljubljana municipality nursing homes for at least one year prior to the begin of the study. The autonomy in carrying out 11 basic live activities was measured on a three-level scale and their cognitive skills with a quick test of cognitive abilities (KPSS). The data was processed with SPSS, ver. 13.0 through methods of descriptive statistics, t-test for two independent samples and the variance analysis (ANOVA).Results:The examined population sample shows a high cognitive decline measured on the KPSS scale, as 50.2% of subjects in mid-stage reached ≤ 24-11 points and 43.4% of those in the late-stage reached ≤ 10-0 points in the scale (out of 30 in total). Those in the early stage reached ≤ 29-25 points in only 6.4 % of the examined population. The significant findings may thus indicate a high overall average depending on the implementation of all 11 life activities (x = 2.57) on the three-level scale (1 being self-sufficient, 2 and 3 standing for partially dependent and entirely dependent, respectively).Conclusions:The examined nursing home residents in the sample, suffering from dementia, show a high degree of dependency in performing basic life activities. The survey results so far present a starting point for the planning of programmes for increasing involvement of residents in psychosocial activities, through practical exercises in self-sufficiency through implementation of fundamental life activities.
Endoskopsko zdravljenje skafocefalije: prikaz primera in nove operacijske tehnike
Authors: Jugović Domagoj , Spazzapan Peter
Published: November 2017

The most common craniosynostosis, scaphocephaly, is the consequence of premature closure of the sagittal suture. Craniosynostosis does not just pose a cosmetic problem, but it can also lead to the permanent neurological deficits. Therefore early diagnosis and treatment are crucial for good outcome. Open surgery with large skin incision is currently the standard procedure. We present our first endoscope-assisted surgical procedure for scaphocephaly. The infant did not need transfusion or intensive therapy after the surgery and skin incision was minimal. This minimal invasive, new surgical technique and its development were described.
NOVOSTI V OBRAVNAVI PLJUČNE BOLEZNI PRI OTROCIH IN MLADOSTNIKIH S CISTIČNO FIBROZO
Authors: Praprotnik Marina , Kotnik Pirš Ana , Salobir Barbara , Oštir Majda , Turel Matjaž , Krivec Uroš
Published: November 2017

Cystic fibrosis (CF) is a multi-organ disease,  affecting mostly lungs and gastrointestinal tract. Data from patient registries show that the survival of patients with CF has progressively improved over the past several decades, as a result of advances in antibiotic treatment, supplementation of pancreatic enzymes, better nutrition and a holistic approach to treatment in CF centres.The purpose of this review is to survey recent developments in the treatment of lung disease  in children and adolescents with CF.We describe newborn screening for CF.When chronic respiratory insufficiency occurs, lung transplantation becomes a very important issue.Lung disease is the most common cause of morbidity and mortality in CF patients. Emerging new therapies are targeted at all points in the pathogenesis of lung disease, from drugs that treat infection and inflammation in the airways to gene transfer studies  and to drugs that augment airway surface liquid height. A number of antibacterial agents formulated for inhalation are at various stages of study and there are several anti-inflammatory candidate drugs in  clinical trials.  The most important development  in the recent years is  modulation of the abnormal protein that causes CF, the cystic fibrosis transmembrane regulator (CFTR), where drugs are targeted at specific defects in the transcription, processing or functioning.When chronic respiratory insufficiency occurs, lung transplantation becomes a very important issue. The role of the CF nurse, who has responsibilities in educating and teaching clinical skills to patients and families, is described.
Poklicne dermatoze pri izpostavljenosti kolofoniji
Authors: Mihelač Aleš Christian , Bilban Marjan
Published: November 2017

Colophony is a resin, obtained from pine trees. It has many applications in industry as well as in products for everyday life and exposure is virtually impossible to avoid. In article, we concentrate on occupational exposure, which is frequent in workers in electronics, furniture and paper industry, production of adhesives, plastics, printing ink and synthetic rubber as well as in everyone, daily in contact with products, which contain colophony, or pine wood, like carpenters and woodworkers. Main allergens are oxidation products of abietic-type acids, but cross-reactivity with fragrances, wood resins, Balsam of Peru, wood tar and oil of turpentine is also possible. Exposure to colophony manifests itself on skin in allergic patients mainly as allergic contact dermatitis. The diagnosis is based on history of exposure, clinical presentation and epicutaneous testing. Although the only effective treatment is complete avoidance of exposure, it is difficult to avoid colophony. Consequently, prophylaxis is essential and concentrates on safe working practices, personal hygiene and protection.