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P. Tutman, M. Ćaleta, Z. Marčić, I. Buj, A. Hamzić, B. Kalamujić Stroil, D. Golub, R. Šanda et al.

In terms of ichthyology, Bosnia and Herzegovina (BiH) is one of the most interesting parts of Southeast Europe, due to its rich biodiversity and high level of endemism. Despite its relevance, the entire territory has been poorly explored. Here, we provide an updated inventory of the current state of knowledge on fishes, including lampreys, from the freshwaters of BiH by hydrographic basin, with recent distributional data and updated taxonomic status reviewed and compared with previous lists. The checklist was compiled based on the existing scientific and grey literature, technical reports, scientific congresses, academic dissertations, and unpublished/personal observations. In total, 123 species including diadromous and euryhaline fishes have been documented in BiH freshwaters to date. Of these, 110 are primarily freshwater. In comparison to the last published monography (Sofradžija 2009), we present a 9% increase in species number (11 species), resulting mainly from taxonomic re-evaluations of existing taxa on the basis of new information and the adoption of a new changes in the taxonomic status of several species. Among the valid primarily freshwater species, 87 are native and 23 are non-native. A total of 38 endemic species have restricted distribution, and are threatened by numerous anthropogenic pressures. Four species are considered endemic only to BiH: Cobitis herzegoviniensis Buj & Šanda, 2014; Phoxinellus pseudalepidotus Bogutskaya & Zupančič, 2003; Telestes dabar Bogutskaya, Zupančič, Bogut & Naseka, 2012; and T. metohiensis (Steindachner, 1901). In total, 75 genera and 34 families are represented: Leuciscidae is represented by 37 species, the Salmonidae by 13, followed by the Cyprinidae, Cobitidae and Percidae, each with eight species. The native species richness follows a pattern similar to that observed in other southern European countries. A national list of endangered species has not yet been proposed to BiH and management strategies for their protection or conservation are also not implemented. Hopefully, this updated checklist will serve as a basis for future research aimed at understanding the origin and status of conservation of the BiH fishes diversity, and supporting effective management and conservation programmes.

J. Strmisková, A. Valverde, L. Moranova, J. Arnouts, F. Zavadil-Kokas, S. Koljenović, K. Zwaenepoel, T. Vandamme et al.

KRAS mutations are among the most prevalent oncogenic alterations in colorectal, lung, and pancreatic cancer, yet their detection remains analytically challenging in the presence of an overwhelming wild-type (WT) background. Here, we report a photoelectrochemical (PEC) genotyping platform that integrates clamp-inhibited loop-mediated isothermal amplification (C-LAMP) with enzyme-free singlet oxygen (1O2)-driven PEC transduction for mutation-selective KRAS detection. Locked nucleic acid (LNA) clamp probes selectively suppress WT amplification during isothermal amplification, enriching mutant alleles and enabling single-nucleotide variant (SNV) discrimination with high selectivity. Amplified products are magnetically captured and transduced into photocurrent via visible-light-induced 1O2 redox cycling, eliminating enzymatic reporters and reducing background interference. The C-LAMP/PEC platform achieves a limit of detection of 35 copies µL-1 (58 aM) and a minimum detectable variant allele frequency (VAF) of 4.8% in heterogeneous mutant/WT genomic DNA mixtures. Analytical performance was validated in cancer cell lines and in patient-derived fresh frozen tissues, showing complete concordance with Nanopore sequencing and droplet digital PCR (ddPCR) within the evaluated cohort (n = 16). This work introduces a robust and modular PEC biosensing strategy that combines molecular WT suppession with enzyme-free photoelectrochemistry, offering an economically competitive and instrumentation-simplified approach for clinically relevant KRAS mutation analysis toward decentralized testing.

S. Bonaretti, Mojtaba Barzegari, M. Bevers, S. Boyd, Andrew J Burghardt, D. Cameron, Francesco Chiumento, Gianluigi Crimi et al.

Abstract The Open and Reproducible Musculoskeletal Imaging Research community is a scientific community dedicated to promoting openness and reproducibility in musculoskeletal imaging, image processing, and computational modeling. In this perspective paper, we outline the motivations for conducting transparent research and provide practical guidelines for implementing it. We start by defining open and reproducible research and describing the benefits and challenges of working transparently. Next, we redefine the outputs of a computational research study as—ideally—a combination of data, code, and a publication, recommend a folder and file structure that reflects these three study outcomes, and describe how to maintain and update such a structure during the study and at study publication. Finally, we emphasize that working in an open and reproducible manner is a learning process, and the best way to acquire the necessary competencies is simply to start.

S. Bonaretti, Mojtaba Barzegari, M. Bevers, S. Boyd, Andrew J Burghardt, D. Cameron, Francesco Chiumento, G. Crimi et al.

The Open and Reproducible Musculoskeletal Imaging Research (ORMIR) community is a scientific community dedicated to promoting openness and reproducibility in musculoskeletal imaging, image processing, and computational modelling. In this perspective paper, we outline the motivations for conducting transparent research and provide practical guidelines to implement it. We start with defining open and reproducible research and describing the benefits and challenges of working transparently. Next, we redefine the outputs of a computational research study as—ideally—a combination of data, code, and a publication, recommend a folder and file structure that reflects these three study outcomes, and describe how to maintain and update such a structure during the study and at study publication. Finally, we emphasize that working in an open and reproducible manner is a learning process and the best way to acquire the necessary competencies is simply to start. Lay summary: The ORMIR community promotes openness and reproducibility in musculoskeletal imaging research. In this perspective paper, we explain why transparency matters and recommend how to conduct a computational study in an open and reproducible manner focusing on its three outputs: data, code, and publication. Finally, we highlight that the best way to learn these practices is simply to start.

BACKGROUND Inflammation-driven mechanisms play a central role in adverse outcomes after non-ST-elevation myocardial infarction (NSTEMI), yet simple, widely available biomarkers for early risk stratification remain insufficiently defined. Hemogram-derived indices and iron-related inflammatory markers may provide complementary prognostic information. OBJECTIVE To evaluate the prognostic significance of the mean platelet volume-to-monocyte ratio (MMR) and serum ferritin in predicting major adverse cardiovascular events (MACE) in patients with NSTEMI, and to assess the association of angiotensin-converting enzyme (ACE) inhibitor therapy with clinical outcomes. METHODS This prospective cohort study included 170 consecutive NSTEMI patients admitted to the University Clinical Center Tuzla between February 2022 and January 2023. All patients received dual antiplatelet therapy and high-intensity statins. The baseline evaluation included a complete blood count, serum ferritin, and C-reactive protein. MMR was calculated as the ratio of mean platelet volume to absolute monocyte count. Patients were followed for 12 months for the occurrence of MACE, defined as cardiovascular death, non-fatal myocardial infarction, urgent revascularization, stroke, or hospitalization for heart failure. RESULTS During follow-up, 103 patients (60.6%) experienced MACE. Admission MMR (18.1 ± 11.7 vs 13.2 ± 5.5; P = 0.003) and ferritin levels (284 ± 396 vs 152 ± 109 µg/L; P = 0.001) were significantly higher in patients with events. In multivariable analysis, both MMR (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.02-1.11; P = 0.008) and ferritin (OR 1.28 per 100 µg/L, 95% CI 1.10-1.55; P = 0.003) independently predicted MACE, while ACE inhibitor therapy was associated with a lower risk (OR 0.24, 95% CI 0.08-0.70; P = 0.01). The combined model demonstrated good discriminative performance (AUC 0.72; 95% CI 0.64-0.80). CONCLUSION AND RELEVANCE Elevated admission MMR and ferritin were independently associated with a higher 1-year risk of MACE in patients with NSTEMI. ACE inhibitor therapy was associated with improved outcomes, although causality cannot be inferred. These findings suggest that readily available inflammatory biomarkers may complement established clinical parameters for early risk stratification and support continued guideline-directed pharmacotherapy in NSTEMI.

Ghil Schwarz, Angelo Cascio Rizzo, Gareth Ambler, Paweł Wrona, Agnieszka Słowik, Szymonn Kotas, M. Doheim, A. Al-Bayati et al.

Background and Objectives Contrast-associated acute kidney injury (CA-AKI) is a potentially preventable complication after exposure to iodinated contrast media. In patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke (AIS), the incidence and clinical impact are poorly characterized, and no validated prediction tool is currently available. The aim of this study was to assess the incidence and prognostic significance of CA-AKI in EVT-treated patients with AIS and to develop and validate a predictive score. Methods A retrospective, multicenter cohort study was conducted involving EVT-treated patients across 73 centers in 16 countries (January–December 2023). Inclusion criteria were age ≥18 years, absence of dialysis, availability of preprocedural and 48-hour postprocedural creatinine levels, and available 90-day follow-up (modified Rankin Scale [mRS] score). The primary outcome was CA-AKI, defined by KDIGO (Kidney Disease: Improving Global Outcomes criteria;creatinine increase ≥0.3 mg/dL or ≥1.5 times baseline, within 48 hours). Secondary outcomes were (1) in-hospital mortality, (2) 90-day mRS score, and (3) 90-day severe disability or death (mRS score >3). Logistic models assessing associations with outcomes accounted for within-center clustering by applying robust standard errors. CA-AKI prediction models were developed across imputed data sets using univariable selection (p < 0.20), backward elimination (p < 0.05), and coefficient-based scoring after categorization of continuous predictors, with internal validation by bootstrap to obtain optimism-adjusted estimates. Results Among 6,638 patients (median age 74 years; 48.7% male), CA-AKI occurred in 326 (4.9%) and was independently associated with in-hospital mortality (adjusted odds ratio [aOR] 2.269; 95% CI 1.615–3.190), higher 90-day mRS scores (adjusted common odds ratio 1.584; 95% CI 1.110–2.258), and 90-day severe disability or death (aOR 1.530; 95% CI 1.057–2.216). A preprocedural risk model including 12 routine clinical variables—sex, ethnicity, arterial hypertension, dyslipidemia, chronic kidney disease, antiplatelet therapy, NIH Stroke Scale score at admission, serum glucose, estimated glomerular filtration rate, hemoglobin, mean arterial pressure, and IV thrombolysis—demonstrated acceptable discrimination (area under the receiver operating characteristic curve 0.710 [95% CI 0.682–0.738]; precision-recall area under the curve 0.13 [95% CI 0.10–0.16]), good calibration (slope 0.870 [95% CI 0.759–0.928]), good overall performance (Brier score 0.045 [95% CI 0.042–0.049]). A second model that included EVT-related variables (e.g., contrast volume) showed similar performances. Discussion In this large, international cohort, CA-AKI occurred in approximately 1 in 20 EVT-treated patients with AIS and was independently associated with poor outcomes. A simple preprocedural risk score enables early identification of high-risk individuals and may support preventive strategies.

B. Rozpłochowski, J. Kowalska, A. Harxhi, L. Fleischhans, S. Antoniak, D. Gokengin, A. Vassilenko, Kersti Aimla et al.

Early in 2020, the WHO recommended that existing drugs be evaluated as a repurposed resource to fight the SARS-CoV-2 pandemic. Here, we investigate the trends of using repurposed and off-label drugs among people living with HIV in Central and Eastern Europe (CEE). From November 2020 to May 2021, data on the clinical outcomes of HIV-positive patients diagnosed with COVID-19 were collected on eCRFs (SurveyMonkey® platform, Inc. San Mateo, CA, USA). Factors associated with the off-label drugs available at this time (chloroquine, hydroxychloroquine, favipiravir, oseltamivir, and lopinavir/ritonavir) were identified using logistic regression models. Of the 557 HIV-positive patients assessed with COVID-19 disease, 67 (12.0%) received off-label drugs, as well as 11.6% (16/138) of hospitalized and 12.2% (51/419) of ambulatory patients (p = 0.8564). In the adjusted logistic regression model, higher odds of off-label drug use were found in patients who had their diagnoses confirmed by an RT PCR test (aOR 5.08 [95%CI 1.17–22.0], p = 0.0396), and who came from a non-EU region (aOR 6.79 [95%CI 3.51–13.1], p < 0.0001). The only factor decreasing the odds of off-label drug use was co-infection (aOR 0.31 [95%CI 0.10–0.94], p < 0.0395). In a cohort of HIV patients from the CEE, 12% were prescribed off-label drugs for COVID-19. Symptomatic patients with confirmed SARS-CoV-2 infection or who were from non-EU countries were more likely to receive a repurposed drug. Drug repurposing is an immediate solution to emerging pandemics. All data regarding the safety and effectiveness of such use should be monitored, reported, and publicly available. Access patterns within and outside the EU should be analyzed to prevent potential inequalities in access to care during epidemics in European settings.

Z. Maksimović, S. Babić, Glorija Milanović, M. Rifatbegović

Leptospirosis, a reemerging zoonotic disease caused by pathogenic bacteria of the genus Leptospira, affects a wide range of domestic and wild animals. The only investigation into sheep leptospirosis in Bosnia and Herzegovina was conducted nearly 50 years ago. This study aimed to assess the seroprevalence of leptospirosis and to identify the most common serovars in sheep in Bosnia and Herzegovina, using the microscopic agglutination test (MAT). Leptospirosis seroprevalence was determined to be 2.16% at a cut-off titer of ≥1:100 (55/2542) and 8.10% at a cut-off of ≥1:25 (206/2542), with all positive cases related to a single serovar. The MAT titers were 1:25 and 1:100, with the majority of positive animals having low titer (1:25) (151/206; 73.3%). At a cut-off of ≥1:100, the sera most frequently reacted to Pomona (54.55%) and Hardjo (27.27%), and less commonly to Saxkoebing and Icterohaemorrhagiae (0.2%) (P<0.05). Odds of seropositivity were higher for Pomona and Hardjo than for Saxkoebing and Icterohaemorrhagiae. The results of this study showed for the first time in Bosnia and Herzegovina, the presence of serovar Icterohaemorrhagiae in sheep, with Pomona and Hardjo as the dominant serovars. Although the seroprevalence is low, the potential zoonotic risk requires continuous monitoring and control strategies to prevent the spread of leptospirosis.

Ariel J. Lee, Hao Sheng, Arnau Marin-Llobet, Zheliang Wang, Jaeyong Lee, Ren Liu, Xinhe Zhang, Emma Hsiao et al.

Neural activity reorganizes profoundly after birth, transitioning from highly synchronous population events to sparse, decorrelated firing in the mature brain. Although inhibitory maturation and shifts in excitation-inhibition balance have been implicated in this process, how individual neurons implement the transition remains unclear because rapid brain growth has prevented long-term, same-neuron mapping. Here, we introduce growth-adaptive spring electronics that provide depth-wise compliance during tissue expansion, maintaining a stable electrode-tissue interface over weeks of neonatal development. We developed a vision-language model-assisted spike processing pipeline for the developing brain that probabilistically matches units across days using high-density waveform spatial footprints, despite developmental changes in the neonatal brain. Together, these innovations enable spike-resolved mapping of the same neurons in rat visual cortex and medial prefrontal cortex from postnatal day 10 to 45. Using population coupling to quantify each neuron’s coordination with local population activity, we show that developmental decorrelation is driven primarily by a distinct subset of neurons that progressively shifts from strong to weak coupling during postnatal weeks 3 to 5, whereas other neurons remain stably weakly or strongly coupled throughout development. These results resolve population-level desynchronization into identifiable neuron-specific trajectories. This framework enables direct tests in neurodevelopmental disorder models, including schizophrenia and autism, of whether altered maturation reflects global circuit imbalance or selective disruption and mistiming of specific developmental programs.

E. Sher, Amina Džidić-Krivić, Emma Pinjić, Nejra Selak, Kanita Omerbasic, A. Chupin, Andrej Belančić, Almir Fajkić

Chimeric Antigen Receptors (CAR) T-cell therapy is a ground-breaking discovery in immunotherapy, mainly known for its exceptional results in treating haematological malignancies. The latest research has revealed that the potential of CAR T-cell therapy extends far beyond its current capabilities and could represent a novel therapeutic approach for treating various cancers. This review aims to summarize the latest innovations in CAR T-cell therapy applied in cancer treatment, including multiple myeloma, osteosarcoma, glioblastoma, melanoma and various childhood malignancies. However, several challenges limit success of CAR T-cell therapy, including the antigen escape phenomenon, 'on-target off-tumour' toxicity, penetration into solid tumour tissue, alongside the cost-effectiveness concerns. The improvement of cancer immunotherapies currently available requires an increase in the effectiveness of CAR T-cells in managing refractory and solid cancers. This could be achieved by using CAR T-cells to target various antigens, enhancing their local delivery and tumour infiltration capabilities and utilizing CAR T-cells in combination with checkpoint blockade and immunotherapy, such as PD-1 blockade and CD19 CAR T-cell combined therapy. Although CAR T-cell treatment offers a lot of promise, its cost needs to be taken into account, especially in healthcare systems with limited funding. More importantly, frameworks for Health Technology Assessment (HTA) must adapt to incorporate ethical, sociological and psychological aspects. Reducing CAR T-cell toxicity is also essential, as it remains among biggest obstacles to their widespread application in clinical practice. Future research should therefore focus on enhancing our understanding of CAR T-cell therapy and expanding the application of immunotherapy in treatment.

Catherine Dunn Shiffman, Dina Sijamhodžić-Nadarević

This article examines the use of collaborative online international learning to support educator and educational leadership preparation. As part of a university partnership, the authors piloted virtual exchanges in 2021 and 2022 between university students in the United States (U.S.) and Bosnia and Herzegovina (B.H.). The pilot included 18 U.S. doctoral leadership students and 22 B.H. bachelor's, master's and doctoral students in religious pedagogy and theology. Qualitative case study methods were used to examine two COILs. The authors analyzed curricular and instructional materials, student reflections, faculty notes and correspondence and publicly available B.H. media accounts. Reported learning emphasized reflection focused on cultural attitudes, knowledge and skills; intercultural and interlinguistic awareness; intercultural team functioning and educational leadership, system and policy comparisons. Supports for and challenges to reported learning were structural, curricular and instructional in nature. Little research exists on the use of virtual exchange for educational leadership preparation. This study offers early lessons for using virtual technologies to incorporate an international and intercultural dimension into educational leadership preparation.

C. Kurmann, A. Mujanović, M. Beyeler, Leander Clénin, Philip L. Becker, R. Rohner, Richard McKinley, Shaokai Zheng et al.

Background: Allergic scalp contact dermatitis (ASCD) is a delayed type of hypersensitivity from contact with a specific allergen to which the patients has developed a specific sensitivity. The aim of the study was to evaluate the results of patch testing with standard series of contact allergen in patients suspected to have ASCD. Methods: 112 cases of scalp contact dermatitis were included in the study. Test substances were applied on the upper part of the patient's back, on clinically uninvolved and untreated skin. The patch test was removed and reaction were evaluated after 48 h and 72 h. The grading of negative (-) to positive (+ to ++++) patch test was done in accordance with the International Contact Dermatitis Research Group. Results: Among the 112 cases, 83 patients were female (74.1 %) and 29 were male (25.9 %). The age of participants spanned 17 to 72 years. The commonest age group affected was 41-50 years. The most common positive reactions were recorded to nickel sulphate 22 (26.2%), cobalt chloride 18 (21.4%), fragrance mix 16 (19%), balsam of Peru 14 (16.7%), carba mix 8 (9.5%) and paraphenylenediamine 5 (5.9%).  Females were more likely to show a positive response to two or more allergens. Scalp itching or burning were reported as the most common symptom. Conclusions: Scalp ACD predominantly affects middle-aged women. Our results suggest that nickel sulphate and cobalt are the predominant allergens responsible for the induction of ASCD. These findings are crucial in the treatment, long term management, and education of patients with ASCD.

C. Van Berckelaer, K. Zwaenepoel, L. Cox, D. Charlotte, D. Julie, E. Louise, H. Fleur, L. Evy et al.

Ki67 is a well-established proliferation marker in breast cancer. Current clinical use focuses on the proportion of Ki67-positive cells, ignoring spatial heterogeneity in expression. However intra-tumoral heterogeneity has demonstrated to be associated with worse outcome. We hypothesized that spatial Ki67 heterogeneity carries clinical information beyond conventional scoring and aimed to evaluate its added value for predicting pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) and for stratifying recurrence risk using genomic expression profiling (GEP). Using digital image analysis (DIA), precise and spatial quantification of biomarker distribution is possible. We analyzed two retrospective breast cancer cohorts using an AI-assisted DIA pipeline. Tumor sections stained for ER, PR, Ki67, and HER2 were digitized and analyzed in QuPath. Using AI, individual tumor cells were recognized and four tumor regions (0.5mm x 0.5mm) with the highest tumor/stroma ratio were selected for analysis. Spatial Ki67 heterogeneity was quantified using the Morisita-Horn Index (MHI) after the Ki67-positive and Ki67-negative tumor cells were mapped using XY-coordinates and square tessellation (100×100 µm tiles) was applied. The MHI was used to compare the similarity in cell composition between all pairs of tiles within a region. MHI values range from 0 to 1, with higher values indicating a more uneven distribution of Ki67+ cells. We used logistic regression and model comparison with Akaike Information Criterion (AIC), likelihood ratio test (LRT) or Vuong test, to evaluate the predictive value of Ki67 heterogeneity. In the first cohort (n=45), spatial heterogeneity was assessed on pretreatment biopsies from patients treated with NACT. In the second cohort (n=79), heterogeneity was evaluated in HR+/HER2- breast cancer patients stratified as high or low risk of recurrence based on GEP. In the GEP cohort, both a higher proportion of Ki67- positive cells and greater Ki67 heterogeneity were significantly associated with high genomic risk. The median MHI was 0.24 (0.03–0.35) in the high-risk group compared to 0.14 (0.01–0.43) in the low-risk group (P = 0.008). This higher MHI indicates more heterogeneous regionally clustered Ki67 expression, suggesting biologically distinct proliferative zones. In multivariate models, Ki67 heterogeneity remained a significant predictor of high-risk classification (OR 0.22, P = 0.036). Furthermore, in nested model comparison using LRT, addition of Ki67 heterogeneity significantly improved the model for predicting genomic risk (P = 0.034). These findings were consistent across biopsy and resection specimens, highlighting the robustness of heterogeneity measures. In the NACT cohort, Ki67 heterogeneity was higher in patients who achieved pCR (median MHI 0.26 [0.17–0.35]) compared to those who did not (median MHI 0.22 [0.12–0.40], P = 0.023). In multivariate modeling, Ki67 heterogeneity emerged as an independent predictor of pCR (OR 23.5, P = 0.038), outperforming Ki67 density and improving model fit (AIC 31.6 vs. 36.1; P = 0.038). Finally, in both cohorts, DIA-derived Ki67 models slightly outperformed traditional pathologist scoring, although Vuong tests did not show a statistically significant difference. Spatial Ki67 heterogeneity provides additional prognostic and predictive value beyond conventional Ki67 scoring. This heterogeneity indicates distinct areas of higher proliferation, clinically relevant biological variation, not captured by simple percentage positivity. Although validation in larger, prospective cohorts is necessary before clinical implementation, DIA provides a more objective and reproducible alternative to manual scoring, particularly when incorporating spatial heterogeneity. C. Van Berckelaer, K. Zwaenepoel, L. Cox, D. Charlotte, D. Julie, E. Louise, H. Fleur, L. Evy, G. R. Devi, A. Ramadhan, S. Koljenovic, P. Van Dam. Ki67 Spatial Heterogeneity as a Predictive and Prognostic Marker in Breast Cancer: A Spatial Image Analysis Approach [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS2-08-19.

Dragan Spaić, Srđan Mašić, D. Bokonjić, N. Rajović, Z. Bukumiric, Nada Avram, Vladimir Milutinović, Jelena Vladicic Masic et al.

<p><strong>Introduction. </strong>The development of information technologies in education has enabled the introduction of new teaching approaches, among which the Flipped classroom (FC) model has gained increasing attention. The FC model has emerged as a student-centered approach that promotes active learning in medical education. The&nbsp;<br />aim of this study was to examine students&rsquo; perceptions of the FC implementation in medical education.<br /><strong>Method.</strong> A cross-sectional study was conducted on a sample of 63 third-year medical students at the Faculty of Medicine in Foča. Data were collected through an anonymous online questionnaire distributed via the Moodle platform, consisting of six domains and a total of 31 statements.<br /><strong>Results. </strong>Students expressed generally positive attitudes toward the FC model: over 50% provided positive responses, about one-third were neutral. The highest average scores were related to learning independence&nbsp;<br />(x̄ = 3.84) and preparedness and motivation for classes (x̄ = 3.79). No statistically significant differences were&nbsp;<br />found between male and female students&rsquo; attitudes, while students with a higher-grade point average (&ge; 8.50) showed significantly more favorable attitudes in the domains of overall attitudes (p = 0.036) and communication (p = 0.013). Logistic regression analysis indicated that the communication domain was a significant predictor of belonging to the group with higher academic achievement (p = 0.020).<br /><strong>Conclusion.</strong> The results indicate that medical students perceive the FC positively and recognize its contribution&nbsp;<br />to better motivation, independence, and interactivity in the learning process. These findings may serve as a basis for further research on the impact of this model on academic outcomes and for a deeper understanding of students&rsquo; perceptions of modern learning approaches in medical education.</p>

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