OBJECTIVES To provide an overview of the paediatric rheumatology (PR) services in Europe, describe current delivery of care and training, set standards for care, identify unmet needs and inform future specialist service provision. METHODS An online survey was developed and presented to national coordinating centres of the Paediatric Rheumatology International Trials Organisation (PRINTO) (country survey) and to individual PR centres (centre and disease surveys) as a part of the European Union (EU) Single Hub and Access point for paediatric Rheumatology in Europe project. The survey contained components covering the organization of PR care, composition of teams, education, health care and research facilities and assessment of needs. RESULTS Response rates were 29/35 (83%) for country surveys and 164/288 (57%) for centre surveys. Across the EU, approximately one paediatric rheumatologist is available per million population. In all EU member states there is good access to specialist care and medications, although biologic drug availability is worse in Eastern European countries. PR education is widely available for physicians but is insufficient for allied health professionals. The ability to participate in clinical trials is generally high. Important gaps were identified, including lack of standardized clinical guidelines/recommendations and insufficient adolescent transition management planning. CONCLUSION This study provides a comprehensive description of current specialist PR service provision across Europe and did not reveal any major differences between EU member states. Rarity, chronicity and complexity of diseases are major challenges to PR care. Future work should facilitate the development, dissemination and implementation of standards of care, treatment and service recommendations to further improve patient-centred health care across Europe.

BACKGROUND Clinical Chemistry is the backbone of medical treatment, diagnostics, and prevention. The laborato-ries are trying to improve the quality and to reduce diagnostic errors and processing time and safeguard trace-ability of all laboratory procedures to ensure patient safety. Six sigma belongs to statistical quality control and provides a new methodology for measuring and improving process performance in laboratory. METHODS Activities of AST, ALT, CK, LDH, Amy, and γ-GT were determined by standard kinetic methods on a Vitros 5600 biochemistry analyzer. Two daily quality controls (Verifier I and Verifier II) were run over 60 days. Total percent CV was calculated from routine daily QC. Between-instrument bias was also calculated from daily QC. RESULTS The calculated sigma metrics for AST were 6.9 and 3.8; for ALT 9.3 and 5.6; for CK 6.6 and 5.3; LDH 5.2 and 5.2; for γ-GT 4.9 and 2.7; and for amylase 8.7 and 7.1. Analytical performance for AST, ALT, CK, LDH, and Amylase is world class. On the other hand, γ-GT analytical performance is poor. CONCLUSIONS Six Sigma benefits from earlier quality management approaches that creates new challenges for medical laboratories.

The paper presents an approach to web-based visualization of automatically generated data models, which combines visualization principles used in desktop applications, and usage of web-based technologies. The proposed approach is implemented and integrated with an existing online system for automatic synthesis of conceptual database models based on business process models. The approach and implemented online system named AMADEOS are illustrated by an example of visualization of the UML class diagram representing the conceptual database model automatically generated based on the source BPMN model.

impairment. These differences could be partially attributed to the localised marketing strategy. Conclusions: This interim analysis has demonstrated that older adults (65-85 years old) are willing and able to engage in web-based assessments. Furthermore, CANTAB Recruit provides an effective strategy to identify those with impair-ments in episodic and working memory domains. The feasibility and sensitivity of online screening for older adults at risk of Alzheimer’s disease is encouraging. Background:

Metastatic involvement of the gallbladder is uncommon. We report a case of an 84-year-old male who presented with acute cholecystitis secondary to metastatic urothelial carcinoma (UC). An 84-year-old man presented with right upper quadrant pain and a positive Murphy's sign on the background of known metastatic UC. He was diagnosed with acute cholecystitis and underwent laparoscopic cholecystectomy. His postoperative period was complicated by a cardiac event, and he died 2 days later. Histology of the gallbladder revealed extensive infiltration by nested malignant epithelioid proliferation, consistent with UC. This case demonstrates that although uncommon, UC may metastasize to unusual sites, including the gallbladder. This serves as a reminder for surgeons to consider metastatic disease as a cause for acute cholecystitis.

Aim: To simulate the stability and degradation of superparamagnetic iron oxide nanoparticles (MNP) in vitro as part of their life cycle using complex simulated biological fluids. Materials & methods: A set of 13 MNP with different polymeric or inorganic shell materials was synthesized and characterized regarding stability and degradation of core and shell in simulated biological fluids. Results: All MNP formulations showed excellent stability during storage and in simulated body fluid. In endosomal/lysosomal media the degradation behavior depended on shell characteristics (e.g., charge, acid-base character) and temperature enabling the development of an accelerated stress test protocol. Conclusion: Kinetics of transformations depending on the MNP type could be established to define structure-activity relationships as prediction model for rational particle design.

Background Better understanding, documentation and evaluation of different refugee health interventions and their means of health system integration and intersectoral collaboration are needed. Objectives Explore the barriers and facilitators to the integration of health services for refugees; the processes involved and the different stakeholders engaged in levaraging intersectoral approaches to protect refugees’ right to health on resettlement. Design Scoping review. Methods A search of articles from 2000 onward was done in MEDLINE, Web of Science, Global Health and PsycINFO, Embase. Two frameworks were applied in our analysis, the ‘framework for analysing integration of targeted health interventions in systems’ and ‘Health in All Policies’ framework for country action. A comprehensive description of the methods is included in our published protocol. Results 6117 papers were identified, only 18 studies met the inclusion criteria. Facilitators in implementation included: training for providers, colocation of services, transportation services to enhance access, clear role definitions and appropriate budget allocation and financing. Barriers included: lack of a participatory approach, insufficient resources for providers, absence of financing, unclear roles and insufficient coordination of interprofessional teams; low availability and use of data, and turf wars across governance stakeholders. Successful strategies to address refugee health included: networks of service delivery combining existing public and private services; system navigators; host community engagement to reduce stigma; translation services; legislative support and alternative models of care for women and children. Conclusion Limited evidence was found overall. Further research on intersectoral approaches is needed. Key policy insights gained from barriers and facilitators reported in available studies include: improving coordination between existing programmes; supporting colocation of services; establishing formal system navigator roles that connect relevant programmes; establishing formal translation services to improve access and establishing training and resources for providers.

Neurological adverse events from immune checkpoint inhibition are increasingly recognised, especially with combination anti-cytotoxic T-lymphocyte antigen 4 (CTLA4) and anti-programmed death receptor 1 (anti-PD-1) therapies. Their presenting symptoms and signs are often subacute and highly variable, reflecting the numerous components of the nervous system. Given the risk of substantial morbidity and mortality, it is important to inform patients of symptoms that may be of concern, and to assess any suspected toxicity promptly. As with other immune-related adverse events, the cornerstone of management is administration of corticosteroids. Specialist neurology input is vital in this group of patients to guide appropriate investigations and tailor treatment strategies.

This paper presents an educational game fostering a new experience-based approach to teaching knowledge transfer using a codification strategy alone. The goal is to address and highlight some common issues and challenges that occur during knowledge transfer in product development and that are often difficult for especially students to grasp through exclusively a theoretical teaching approach. The game is introduced to 60 students in the final year of their Master's curriculum. In parallel, the game has been applied in a similar setting in a comparable higher educational institution, as well as in a product development organization.“Sometimes you win—other times you lose and learn.”

This document presents an algorithm for a non-obtrusive recognition of Sleep/Wake states using signals derived from ECG, respiration, and body movement captured while lying in a bed. As a core mathematical base of system data analytics, multinomial logistic regression techniques were chosen. Derived parameters of the three signals are used as the input for the proposed method. The overall achieved accuracy rate is 84% for Wake/Sleep stages, with Cohen’s kappa value 0.46. The presented algorithm should support experts in analyzing sleep quality in more detail. The results confirm the potential of this method and disclose several ways for its improvement.

Due to a growing awareness of environmental protection, an interest in replacing toxic corrosion inhibitors with more environmentally acceptable alternatives is also growing. Chromates, as one of the best inhibitors, have been eliminated as technically viable inhibitors because of their high toxicity, and the use of polyphosphates has diminished as they disrupt the balance in the Plantae kingdom. The emphasis is on exploration and testing of organic compounds that can be obtained from plant material. Rosemary extracts (leaf and flower) have been shown to have inhibitory activity on iron corrosion in 3% NaCl and seawater. Corrosion rate values ​​show that rosemary flower extracts are better inhibitors of corrosion than the leaf extracts and that the maximum inhibitory protection has not been achieved in the range of tested concentrations.

U radu su prikazani rezultati utvrđivanja sadržaja arsena u plodovima dvije sorte nektarina na tri lokacije Hercegovine (Mostar, Čapljina i Stolac) tijekom 2015. i 2016. godine. Nakon utvrđivanja sadržaja arsena u plodovima nektarina, uradio se proračun procjene rizika proračunom nekancerogenog indeksa opasnosti (Hazard Quotient Index, HQI; Indeks koeficijenta opasnosti). Na istraživanim lokacijama uzgajane su dvije sorte nektarina (Big Top i Caldesi 2000). Sadržaj arsena u 2015. godini je utvrđen samo na lokaciji Stolac. U 2016. godini na svim lokacijama je bio ispod LQO (Limit of Quantification, Granica kvantifikacije). Procjenom dnevnog unosa (Estimated daily intake, EDI) i tjednog unosa (Estimated weekly intake, EWI) arsena navedenim sortama nektarina utvrđeno je da nema akutnog ni kroničnog rizika na zdravlje ljudi.

The Bihać tourism geographical region is rich in diverse, pollution-free, natural tourism potentials that can be the basis for the development of more specific forms of tourism (mountain, hunting, rural, excursion-recreational, adventure, recreational-sports, fishing and ecotourism) of local and regional as well as national and international significance. This paper will present the most important natural tourism potentials of the Bihać tourism geographical region, their valorization, as well as their possibility of exploitation for tourist purposes. Moreover, the tourist traffic and accommodation capacities of this tourism geographic region will be shown. Finally, it will be concluded how these unique still unpolluted natural phenomena should be treated in order for them to remain the same for future generations.