OBJECTIVES Depth of invasion (DOI) is the most important predictor for lymph node metastasis (LNM) in early stage (T1-T2) oral cancer. The aim of this study is to validate the cut-off value of 4 mm on which the decision to perform an Elective Neck Dissection (END) is made. MATERIALS AND METHODS We performed a retrospective study in patients with pathologically proven early stage oral cavity squamous cell carcinoma (OCSCC) without clinical or radiological signs of LNM, who were treated between 2013 and 2018. An END was performed when DOI was ≥ 4 mm and a watchful waiting protocol was applied in patients with DOI < 4 mm. RESULTS Three hundred patients were included. END was performed in 77% of patients with DOI ≥ 4 mm, of which 36% had occult LNM (pN+). Patients in the watchful waiting group (48%) developed a regional recurrence in 5.2% for DOI < 4 mm and 24.1% for DOI ≥ 4 mm. For DOI ≥ 4 mm, regional recurrence free survival was higher for patients who were treated with END compared to watchful waiting (p = 0.002). A Receiver-Operator-Curve -analysis showed that a DOI cut-off value of 4.0 mm was the optimal threshold for the prediction of occult LNM (95.1% sensitivity, 52.9% specificity). CONCLUSION A DOI of ≥ 4 mm is an accurate cut-off value for performing an END in early stage OCSCC. END results in higher survival rates and lower regional recurrence rates in patients with DOI ≥ 4 mm.

Objectives To evaluate the clinical outcome and complications in the pediatric population who had splenectomy at our institution, emphasizing the incidence of postplenectomy reactive thrombocytosis (RT) and its clinical significance in children without underlying hematological malignancies. Materials and methods The medical records of pediatric patients undergoing splenectomy were retrospectively reviewed for the period 1999–2018. The following variables were analyzed: Demographic parameters (age, sex), indications for surgery, operative procedures, preoperative and postoperative platelet count (postplenectomy RT), the use of anticoagulant therapy, and postoperative complications. The patients were divided into two groups according to indications for splenectomy: The non-neoplastic hematology group and the non-hematology group (splenectomy for trauma or other spleen non-hematological pathology). Results Fifty-two pediatric (37 male and 15 female) patients who underwent splenectomy at our institution were reviewed. Thirty-four patients (65%) were in the non-hematological group (splenic rupture, cysts, and abscess) and 18 patients (35%) in the non-neoplastic hematological group (hereditary spherocytosis and immune thrombocytopenia). The two groups did not differ significantly in regards to the patients’ age, sex, and preoperative platelet count (P>0.05 for all variables). Forty-nine patients (94.2%) developed postplenectomy RT. The percentages of mild, moderate and extreme thrombocytosis were 48.9%, 30.7%, and 20.4%, respectively. The comparisons of RT patients between the non-neoplastic hematology and the non-hematology group revealed no significant differences in regards to the patients’ age, sex, preoperative and postoperative platelet counts, preoperative and postoperative leukocyte counts, and the average length of hospital stay (P>0.05 for all variables). None of the patients from the cohort was affected by any thrombotic or hemorrhagic complications. Conclusions We confirm that RT is a very common event following splenectomy, but in this study it was not associated with clinically evident thrombotic or hemorrhagic complications in children undergoing splenectomy for trauma, structural lesions or non-neoplastic hematological disorders.

We investigate the local and global character of the unique equilibrium point and boundedness of the solutions of certain homogeneous fractional difference equation with quadratic terms. Also, we consider Neimark–Sacker bifurcations and give the asymptotic approximation of the invariant curve.

Macroporous silica ceramic was obtained using clay and diatomite. Boric acid as a low-cost additive in the amount of 1 wt% was used. These porous materials were obtained at low forming pressure (40-80 MPa) and lower sintering temperature (850-1300 ?C) for 4h in air. The influence of boric acid, forming pressure, and sintering temperature on the microstructure, porosity parameters, and mechanical properties of obtained porous monoliths were investigated. As-received and the modified samples were characterized by X-ray diffraction, FTIR, SEM, and mercury porosimetry measurements. As for modified clay and diatomite, they were pressed at 60 MPa and then sintered at 1150 ?C, obtaining porosities of about 10 % and 60 %, respectively. Both of the analyzed samples had the pore diameter in the range of macroporous materials. The pore diameters of clay samples are ranging from 0.1-10 ?m, whereas the pore diameter of diatomite samples was slightly lower with values ranging from 0.05-5 ?m. Modified diatomite samples have a lower Young modulus in comparison to modified clay samples.

This study analyzes the feasibility of valorizing industrial by-product, fly ash from a thermal power plant as a partial replacement of mineral filler-limestone for the production of self-compacting concrete (SCC). Three types of SCC mixtures with different portions of fly ash and the reference mixture with limestone were designed. The synthesized SCCs in the fresh state were examined for density, entrained air content, flowability (Slump flow, Slump flow time (t500), V-funnel time (tv)), passing ability (L-box), and segregation resistance, while hardened state testing included: density, compressive and flexural strength, static modulus of elasticity, water permeability, resistance against freezing in the presence of de-icing salt, and SEM analysis. Taking into account the obtained results it can be concluded that the addition of fly ash has a positive impact on the concrete properties and that the optimal content of fly ash is 20 % with respect to the total filler mass.

Healthcare systems and general surgeons are being challenged by the current pandemic. The European Association for Endoscopic Surgery (EAES) aimed to evaluate surgeons’ experiences and perspectives, to identify gaps in knowledge, to record shortcomings in resources and to register research priorities. An ad hoc web-based survey of EAES members and affiliates was developed by the EAES Research Committee. The questionnaire consisted of 69 items divided into the following sections: (Ι) demographics, (II) institutional burdens and management strategies, and (III) analysis of resource, knowledge, and evidence gaps. Descriptive statistics were summarized as frequencies, medians, ranges,, and interquartile ranges, as appropriate. The survey took place between March 25th and April 16th with a total of 550 surgeons from 79 countries. Eighty-one percent had to postpone elective cases or suspend their practice and 35% assumed roles not related to their primary expertise. One-fourth of respondents reported having encountered abdominal pathologies in COVID-19-positive patients, most frequently acute appendicitis (47% of respondents). The effect of protective measures in surgical or endoscopic procedures on infected patients, the effect of endoscopic surgery on infected patients, and the infectivity of positive patients undergoing laparoscopic surgery were prioritized as knowledge gaps and research priorities. Perspectives and priorities of EAES members in the era of the pandemic are hereto summarized. Research evidence is urgently needed to effectively respond to challenges arisen from the pandemic.

PurposeThe purpose of this paper is to investigate the determinants of innovative work behavior (IWB) by examining the moderating role of transformational leadership in the context of small and medium enterprises (SMEs).Design/methodology/approachThe study surveyed 371 employees from SMEs in Bosnia and Herzegovina by adopting convenience sampling. Hierarchical regression was used to test the hypotheses.FindingsThe findings supported the authors’ assumptions that IWB determinants such as psychological empowerment, participation in the decision-making process and organizational justice are positively related to IWB. Besides, transformational leadership moderates the relationship between organizational justice and IWB.Research limitations/implicationsThe data for this study was collected by using convenience sampling as well as a cross-sectional survey method, which limits the generalization of results.Practical implicationsTo spur the IWB among the employees in SMEs, an organization has to create an environment where psychological empowerment is high, employees have a chance to participate in the decision-making process and organizational rules and procedures are fair. In the case of organizational justice, the relationship shall be stronger if transformational leadership is present.Originality/valueIn SMEs, transformational leadership plays an important role. To the best of the authors' knowledge, this is the first study that demonstrates the moderating effect of transformational leadership on the relationship between one specific IWB determinant and IWB.

Glycogen synthase kinase 3 (GSK3) is a monomeric serine-threonine kinase discovered in 1980 in a rat skeletal muscle. It has been involved in various cellular processes including embryogenesis, immune response, inflammation, apoptosis, autophagy, wound healing, neurodegeneration, and carcinogenesis. GSK3 exists in two different isoforms, GSK3α and GSK3β, both containing seven antiparallel beta-plates, a short linking part and an alpha helix, but coded by different genes and variously expressed in human tissues. In the current review, we comprehensively appraise the current literature on the role of GSK3 in various cancers with emphasis on ovarian carcinoma. Our findings indicate that the role of GSK3 in ovarian cancer development cannot be decisively determined as the currently available data support both prooncogenic and tumor-suppressive effects. Likewise, the clinical impact of GSK3 expression on ovarian cancer patients and its potential therapeutic implications are also limited. Further studies are needed to fully elucidate the pathophysiological and clinical implications of GSK3 activity in ovarian cancer.

Interval recognition is an important part of ear training—the key aspect of music education. Once trained, the musician can identify pitches, melodies, chords, and rhythms by listening to music segments. In a conventional setting, the tutor would teach a trainee the intervals using a musical instrument, typically a piano. However, this is expensive, time consuming, and nonengaging for either party. With the emergence of new technologies, including virtual reality (VR) and areas such as edutainment, this and similar trainings can be transformed into more engaging, more accessible, customizable (virtual) environments, with the addition of new cues and bespoke progression settings. In this work, we designed and implemented a VR ear training system for interval recognition. The usability, user experience, and the effect of multimodal integration through the addition of a perceptual cue, spatial audio, was investigated in two experiments with 46 participants. The results show that the system is highly acceptable and provides a very good experience for users. Furthermore, we show that the added spatial auditory cues provided in the VR application give users significantly more information for judging the musical intervals, something that is not possible in a non-VR environment.

Introduction: Self-medication has been very popular and globally prevalent for a long time. Aim: This research aims to present pharmacists’ engagement in the process of self-medication in the Sarajevo Canton. Methods: A total of 312 respondents completed an anonymous questionnaire-based survey. The first group (165 respondents) was surveyed in the pharmacy after buying a non-prescription drug, and the second group (147 respondents) outside the pharmacy. Results: The most commonly purchased drug was paracetamol, whereas headache was dominant amongst health conditions for which treatment respondents intended to use the purchased drug. A belief that respondents could cure themselves was the most common answer when asked why they had not visited a doctor, whereas previous experience with the purchased drug prevailed as an answer when asked from whom they had gotten information about the adequacy of the purchased drug for their health problem. Respondents mostly bought drugs for themselves. Pharmacists instructed 65% of respondents on how to take the purchased drug and checked whether 55% of respondents bought an appropriate drug for their health problem. Only 25% and 29% of respondents were informed about the adverse effects and potential contraindications or interactions of the purchased drug, respectively. According to 45% of respondents, pharmacists spent up to one minute in a conversation with them about the purchased drug. Conclusion: In the Sarajevo Canton, pharmacists should be more actively involved in the process of self-medication and provide the necessary advice to patients consuming non-prescription drugs. Further research is needed to create a clearer picture.

Abstract. Current global mitigation ambition up to 2030 under the Paris Agreement, reflected in the National Determined Contributions (NDCs), is insufficient to achieve the agreement's 1.5  ∘ C long-term temperature limit. As governments are preparing new and updated NDCs for 2020, the question as to how much collective improvement is achieved is a pivotal one for the credibility of the international climate regime. The recent Special Report on Global Warming of 1.5  ∘ C by the Intergovernmental Panel on Climate Change has assessed a wide range of scenarios that achieve the 1.5  ∘ C limit. Those pathways are characterised by a substantial increase in near-term action and total greenhouse gas (GHG) emission levels about 50 % lower than what is implied by current NDCs. Here we assess the outcomes of different scenarios of NDC updating that fall short of achieving this 1.5  ∘ C benchmark. We find that incremental improvements in reduction targets, even if achieved globally, are insufficient to align collective ambition with the goals of the Paris Agreement. We provide estimates for global mean temperature increase by 2100 for different incremental NDC update scenarios and illustrate climate impacts under those median scenarios for extreme temperature, long-term sea-level rise and economic damages for the most vulnerable countries. Under the assumption of maintaining ambition as reflected in current NDCs up to 2100 and beyond, we project a reduction in the gross domestic product (GDP) in tropical countries of around 60 % compared to a no-climate-change scenario and median long-term sea-level rise of close to 2 m in 2300. About half of these impacts can be avoided by limiting warming to 1.5  ∘ C or below. Scenarios of more incremental NDC improvements do not lead to comparable reductions in climate impacts. An increase in aggregated NDC ambition of big emitters by 33 % in 2030 does not reduce presented climate impacts by more than about half compared to limiting warming to 1.5  ∘ C. Our results underscore that a transformational increase in 2030 ambition is required to achieve the goals of the Paris Agreement and avoid the worst impacts of climate change.