Juvenile systemic sclerosis (jSSc) is a rare disease with a prevalence of around 3 in 1,000,000 children. To better capture the clinical manifestations of jSSc the juvenile systemic sclerosis inception cohort (jSScC) has been prospectively enrolling patients with predetermined clinical variables over the past 12 years. One of the goals is to study the demographic, clinical features, and physician and patient reported outcome differences between those with juvenile limited cutaneous (lc) compared to diffuse cutaneous (dc) disease subtypes, to determine if characteristics are similar or different between dc and lc jSSc.Evaluation of the baseline clinical characteristics of jSSc patients in the jSScC. Compare clinical phenotype between diffuse (dcjSSc) and limited cutaneous (lcjSSc) subtypes.Demographic, physical examination, organ system evaluation, autoantibody profile, treatment, and patient and physician reported outcome variables were evaluated from the jSSc Inception cohort and summary statistics applied using chi-square test and Mann Whitney U-test comparing lcjSSc and dcjSSc subtypes.At the time of data extraction, 175 jSSc patients were enrolled in the cohort, 81% were Caucasian and 81% female. Diffuse cutaneous jSSc subtype predominated (73%). Mean disease duration was 3.1 year (±2.7). Mean age at Raynaud´s was 10 years (+3.8) and mean age of first non-Raynaud´s was 10.2 years (±3.8). Significant differences were found between dcjSSc versus lcjSSc, regarding several clinical characteristics. Patients with diffuse cutaneous subtype had significantly higher modified Rodnan skin score (p=0.001), presence of sclerodactyly (p=0.02), presence of Gottron’s papules (p=0.003), presence of telangiectasia (p=0.001), history of digital tip ulceration (p=0.01), and frequency of elevated CK value (p=0.04). Cardiac involvement was significantly higher in limited cutaneous jSSc subtype (p=0.02). Diffuse cutaneous jSSc patients had significantly worse scores for Physician Global Assessment of disease activity (38 vs 25; p=0.002) and disease damage (34 vs 19; p=0.008).Table 1.Comparison of demographic data and significant differences between dcjSSc and lcjSSc at time of inclusionWhole CohortN=175Diffuse SubtypeN=128Limited SubtypeN=47P valueFemale to Male Ratio4.3:1 (142/33)4.1:1 (103/25)4.8:1 (39/8)0.829Cutaneous subtypeDiffuse subtype73% (128)1280Limited subtype27% (47)047Mean Disease duration (years)3.1 (± 2.7)3.3 (± 2.9)2.6 (± 2.2)0.135Mean age of onset of Raynaud´s (years)10.0 (± 3.8)17 non-Raynaud9.8 (± 3.6)10 non-Raynaud10.6 (± 4.3)7 non-Raynaud0.219Mean age of onset of non-Raynaud´s (years)10.2 (± 3.9)10.0 (± 3.7)10.9 (± 4.3)0.173Disease modifying drugs88% (154)89% (114)85% (40)0.446CutaneousMean modified Rodnan skin score14.3 (0-51)17.4 (0-51)6.1 (0-24)0.001Gottron Papules27% (46/171)33% (41/124)11% (5)0.003Sclerodactyly78% (126/162)82% (98/119)65% (28/43)0.020Laboratory valuesElevated CK25% (30/122)30% (26/88)12% (4/34)0.041VascularTelangiectasia36% (56/154)44% (49/111)16% (7/43)0.001History of ulceration53% (91/173)61% (77/127)30% (14/46)0.001CardiacCardiac Involvement6% (10)2% (3)15% (7)0.002Patient Related OutcomesPhysician global disease activity(0-100) min -max35(0-90) n=14138(0-90) n=10825(0-80) n=330.002Physician global disease damage(0-100) min -max31(0-85) n=14034(0-85) n=10819(0-60) n=320.008Results from this large international cohort of jSSc patients demonstrate significant differences between dcjSSc and lcjSSc patients. According to the general organ involvement and physician global scores, the dcjSSc patients had significantly more severe disease. These observations strengthen our previous findings of the unique organ pattern of pediatric patients.Supported by the “Joachim Herz Stiftung”None declared.

Background According to available scientific references and textbooks, there are contradictory views concerning the etiology of signs and symptoms of TMD. Objectives The aim of this study was to determine a correlation between the incidence of signs and symptoms of TMD in children aged 12-18 who do not wear a fixed orthodontic appliance and the incidence of signs and symptoms of TMD in children who wear a fixed orthodontic appliance. Material and Methods The total number of 120 subjects were included in this survey and divided into two groups. There were 60 respondents in the experimental group that consisted of 30 boys and 30 girls with different types of malocclusion, who were treated with a fixed orthodontic straight wire technique. The remaining 60 respondents, which was a group that also consisted of 30 boys and 30 girls, were patients with neutroclusion. Results The results of the study have shown that the TMJ clicking sound symptom, the most common symptom of TMD, occurs with almost equal prevalence in both groups of respondents; specifically, 56.4% in orthodontic patients, and 46.6% in the control group respondents. A statistically significantly higher percentage of female respondents in both groups have experienced headache problems (p <0.03). Conclusion On the basis of the statistics obtained as a result of this research, we can come to the conclusion that there is no correlation between the fixed orthodontic treatment and the development of signs and symptoms of TMD.

Background: The use of computer assisted surgery, navigation (NAV) in shoulder arthroplasty is still under discussion, regarding the clinical outcome and prosthesis longevity, especially when combining these factors with cost, time and surgeon’s experience. Beside the NAV, there has been in use patient-specific instrumentation (PSI) as an additional tool for more precise glenoid implant position. Surgical NAV and PSI for glenoid implant positioning in anatomic and reverse total shoulder arthroplasty are in last years under observation and discussion. Objective: To critically review and evaluate the current literature regarding the use of computer navigation and PSI in shoulder arthroplasty. Methods: Critical review of the existing literature. Results: Cost-effectiveness, prosthesis longevity and revision arthroplasty rate have not yet been proven clinically. Moreover, heterogeneity is high in studies that include different positioning systems (NAV, PSI and standard instrumentation). Heterogeneity is due to differences in surgical technique, implants, surgeon’s expertise, radiographic image analysis technique. Conclusion: The use of navigation systems and PSI should be clinically proven in the shoulder arthroplasty. Independent experts’ opinion and independent high level studies lack at the moment. There will be still a lot of talk regarding this topic in future.

Background: Multisystem inflammatory syndrome in children (MIS-C) was recognized during the 2020 pandemic of SARS-CoV-2. Because of the relative rarity current knowledge is limited, especially in the European Caucasian population. Objectives: To report the epidemiology, clinical and laboratory characteristics of patients with MIS-C in a nationwide cohort study in Slovenia. Methods: This is a nationwide prospective cohort study of all consecutive patients with MIS-C, admitted from the beginning of epidemics to 31st December 2020 to University Medical Centre Ljubljana, Slovenia, the only tertiary care pediatric rheumatology center in the country. The inclusion criteria were meeting the CDC criteria for MIS-C. Infection with SARS-CoV-2 was confirmed in all patients by positive antibodies for SARS-CoV-2. Data were collected from the patients' medical records. Data on the COVID-19 epidemics in Slovenia were collected from National Institute of Public Health. Population data were provided by the Statistical Office of the Republic of Slovenia. Results: Twenty-three patients with MIS-C were diagnosed nationwide in Slovenia, all of them in the second wave of epidemics from 14th September to 31st December 2020. All patients were Caucasian and the estimated prevalence of MIS-C was 5.8/100 000 persons younger than 19 years of age. Detailed analyses were available in 20 patients of which 14 were boys (70 %), median age was 12.4 years (4 months to 17.7 years). Two patients (10 %) were treated in the intensive care unit and none of the patients died. Troponin was elevated in 15/20 (75 %) patients during the disease course, and 7/15 (47 %) of these had normal troponin level at admission. The serum level of troponin closely followed the serum level of CRP. Six out of 20 (30 %) patients had elevated pancreatic enzymes in the second week of the disease after treatment was already given,and one patient developed asymptomatic acute pancreatitis with serum lipase level reaching the maximum of 25μkat/L. All patients had elevated levels of D-dimer with no signs of thrombosis. Five patients (5/20;25 %) had pleural effusions and five patients (5/20, 25 %) had ascites. Half of the patients (10/20;50 %) had hepatosplenomegaly and eight (8/20;40 %) had mesenterial lymphadenopathy. Three patients (3/20;15 %) had radiologic signs of cholecystitis. Two patients had thickened lung parenchyma. All patients received IVIG and systemic glucocorticosteroids. Because of resistant or organ threatening disease 4 patients (4/20, 20%) received high dose methylprednisolone pulse therapy. Biologic therapy with anakinra was started in 2 patients. Nineteen patients (19/20, 95%) received acetylsalicylic acid and prophylactic anticoagulation was prescribed in 15/20 (75%) of patients. The mean follow up was 50 days (14 -122). At the last follow-up visit all patients had normal laboratory parameters of inflammation, troponin, pro-BNP, d-dimer values and normal heart function. Conclusion: A very high incidence of MIS-C, estimated 5.8/100 000 persons under the age of 19 with a predominantly cardiac involvement but very good outcome was noted in European Caucasian population in a nationwide cohort study in Slovenia. Attention to newly described pancreatic involvement should be raised.

Abstract The objective of the article is to investigate the effects of the stage of integration on convergence in the European Union. The relationships between the selected macro-economic variables and per capita GDP growth rate are econometrically tested for the period 2004–2018 and three sub-periods: the pre-crisis period 2004–2008, the crisis period 2009–2013, and the post-crisis period 2014–2018. Convergence is estimated using ordinary least squares (OLS) semi-log regression based on cross-sectional data. The findings show that convergence rates range between 1.9 percent and 4.8 percent. The positive effects of deeper integration are identified, as well as the negative effects of the 2008/2009 crisis. The empirical results suggest that the selected variables have an impact on the per capita GDP growth rate in at least one analyzed period.

Background: Epilepsy is a brain disorder characterised by unpredictable and excessive nerve cell activity that causes epileptic seizures. Epileptic seizures are more common in children and adolescents than in elderly population. Electroencephalography (EEG) is a diagram of electrical activity of the brain and it is used as a method of choice for diagnosing epilepsy. Despite the accurate EEG tracing of electrical activity in the brain, the disadvantage of this type of analysing is the doctor’s skill to read the EEG correctly. Objective: The aim of this study was ro represents further research presented in our pevious works with wavelet based EEG analysis after masuring a multiresolution as relation between time and frequency resolution. Methods: Signal database set consist of 51 patients: a) healthy patient; b) 50 patients with a diagnosis of epilepsy. Additional characteristics of the analysed data: a) 19 signals-channels of EEG, b) Duration – 20 s or 2688 samples and. Nowadays, we can find dozens of EEG signal analysis papers using mathematical approach and with a focus on identification of epilepsy. Results: This paper represents some results relating to the analysis of EEG in children using Wavelet Transform (WT). The signals was collected and analysed at the Department of neuropediatrics, Pediatric Clinic at the University Clinical Center, University of Sarajevo. Conclusion: Using this approach it is possible to clearly differentiate patients with a diagnosis of epilepsy from healthy ones.

© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. We come from Bosnia and Herzegovina, a small country in western Balkans. Our Faculty of Pharmacy at the University of Sarajevo was opened in 1973, but from then on there was no kind of online teaching. So when the COVID-19 pandemic broke out, and when the university decided to stop all kinds of ‘inclass’ teaching (12 March 2020), we were faced with something new. We work at the Department of Pharmaceutical Technology, where we teach regular courses on ‘Drug Formulation’ and ‘Industrial Pharmacy’. Students take classes in these subjects in the seventh, eighth and ninth semesters. The exercises are practical and last several hours. On 25 March 2020, classes in the lecture hall were suspended until further notice by the decision of the Senate of the University of Sarajevo, and then we realised that we must embark on the adventure of organising online classes. We carried out short research on available online teaching platforms to find basic information on the platform’s capabilities, identify their advantages and disadvantages, and check their commercial prices. We studied the following platforms for online courses: Google Meet, Adobe Connect, Zoom and BigBlueButton, and the following platforms for online examinations: Exam. net, Virtualx, Google Forms, Skillsbook, Papershala, Edbase, Kaldin and TCExam. After examining the possibilities of the available online teaching platforms, we agreed that Zoom and Google Meet provide the best results for running online courses. Adobe Connect, Blackboard Collaborate and BigBlueButton work on the same principle, but professional versions of these platforms were quite unaffordable to us. The results for the online examination platforms are summarised in table 1. Given the security and price of the platforms, we concluded that Exam. net currently meets our criteria, but that it would be necessary to use two platforms simultaneously during the examination, one of which would allow an established video connection with students during the examination (eg, a combination of Exam. net and Zoom). Students accessed the examination platform from their laptop while simultaneously established a video connection with the teacher on their mobile device. At the end of the semester, we conducted an online survey in which 60 (70.93%) of 86 students participated, and for 98.4% of the students this was their first online learning experience. Although it is assumed that current students (digital natives) have adequate information and communications technology competence, they differ in their computer and information literacy as they come from different socioeconomic backgrounds. Of the students, 21.3% had technical difficulties (ie, unstable connection). One of them said she/he has problems with misunderstanding from parents who required help with housework at the time of the lecture because she/he comes from the countryside. Of the students, 75% were satisfied with the conducted online classes at our department. Onethird found it easier to follow theoretical lectures online. Here are some comments from the students:

Background: EMVI is a direct invasion of a vein by a tumor. As a predictor of hematogenous metastasis, it is a poor prognostic factor in rectal cancer and can be accurately identified on MRI prior to surgical procedure. Objective: To evaluate the role of contrast-enhanced T1-weighted magnetic resonance imaging (CET1WI) in addition to high-resolution T2-weighted imaging (HRT2WI) in assessing extramural venous invasion (EMVI) of rectal cancer. Methods: In all 195 patients with rectal cancer, HRT2WI and CET1WI sequences were produced within pre-operative MRI for the purpose of assessing for the presence of EMVI (mrEMVI). CET1WI sequences were produced following administration of Gadolinium contrast medium. mrEMVI assessment results were classified into two groups. Group A consisted of mrEMVI assessment results obtained using HRT2WI sequences only. Group B consisted of mrEMVI assessment results obtained using a combination of HRT2WI + CET1WI sequences. Results obtained for each group (A and B) were correlated with a histopathological finding (pEMVI) as a reference standard. Results: Out of a total of 195 rectal cancer patients, mrEMVI was positive in 41 (21%) patients in group A, and in 45 (23%) patients in group B. Histopathological finding demonstrated pEMVI in 54 (27.7%) patients. A statistical analysis of group A (HRT2WI sequences) resulted in 75.9% sensitivity to mrEMVI and 96.4% specificity, Positive Predictive Value of 89.1% and Negative Predictive Value of 91.2% (95% confidence interval (CI), p< 0.05). Statistical analysis of group B (HRT2WI + CET1WI sequences) resulted in 83.3% sensitivity to mrEMVI and 98.5% specificity, Positive Predictive Value of 89.1% and Negative Predictive Value of 91.2% (CI 95%, p< 0.05). Conclusion: T1-weighted magnetic resonance imaging (CET1WI) in addition to high-resolution T2-weighted imaging (HRT2WI) increased evaluation of extramural venous invasion (EMVI) of rectal cancer.

The thematic conception of the work consists of legal issues of special forms of control of state administrative in Bosnia and Herzegovina (at the state level, the level of federal units and districts). The paper analyzes the structure of bodies that perform this type of control, starting with the ombudsman institutions (Ombudsman for Human Rights of Bosnia and Herzegovina, Ombudsman for Children of Republic of Srpska), and with special reference to the institutions of auditors (of which there are four in Bosnia and Herzegovina). The author will present the organization of these institutions, the election of their members (ombudsmen and auditors), the way they act, and the possibilities they have, as well as the legal mechanisms they can use to protect both citizens and the public interest.

Abstract The purpose of this paper is to advance the theory and contribute to the practice of luxury perfumes’ shelf management by decoding the relationship between attention on the shelf, purchase decision-making, and brand recall. It employs an eye-tracking experiment to analyze attention spans and fixations, which is combined with a questionnaire to uncover recall and purchase intent. The research identifies attention patterns and the influence of attention on recall and purchase intention. It further reveals the main factors that influence attention on the shelf in the luxury perfume industry. This is a milestone for further elaboration on the benefits of the fashion mainstream for luxury perfumes and the debate regarding whether luxury perfumes should be treated similar to mainstream fashion or similar to any other product in basic shelf management rules. This study enables shelf managers and marketers to place the perfumes both on the shelf and in consumer minds to maintain a top-of-the-mind brand position. Managerial implications are significant and address perfume industry packaging as well as shelf positioning.

Abstract This study explores revenue recognition and reporting expenses relevant to the stage of completion of the contract agreements. Literature suggests that the taxation effects financial reporting, realization of capital gains as well as revenue recognition. We argue that construction firms make use of these estimates to postpone revenue and value added tax recognition. The analysis grounds on the assumption that the value added tax effects timely recognition of revenues from construction agreements, where managers are incentivized to underestimating stage of completion and suppress recognition of gross earnings to better align emerging of the value tax related liability with contracted and expected inflows of cash. Results show that the revenue recognition is positively associated with reported income before tax and cost of material as a direct expense that can be allocated to the execution of construction agreements. These findings build baseline for future research that assesses effects of newly adopted standard IFRS 15 on real earnings management practice in construction industry of Bosnia and Herzegovina.

Linear regression analysis is one the most common methods for weather-normalizing energy data, where energy versus degree-days is plotted, quantifying the impacts of outside temperature on buildings’ energy use. However, this approach solely considers dry-bulb temperature, while other climate variables are ignored. In addition, depending on buildings’ internal loads, weather impact can be less influential, making the linear regression method not applicable for energy data normalization in internally driven buildings (such as research laboratory buildings, healthcare facilities, etc.). In this study, several existing buildings from different categories, all located on the University of Massachusetts Amherst campus and exposed to the same weather conditions in a heating-dominated climate, were analyzed. For all cases, regression of monthly steam use on heating degree-days and floor-area normalized steam data were used, investigating applicability of the former when the latter changes. It was found that internal loads can skew steam consumption, depending on the building functionality, making the effect of degree-days negligible. For laboratory-type buildings, besides heating and domestic hot water production, steam is also used for scientific experiments. Here, daily occupancy percentage, even during weekends and holidays, was higher than that of other buildings, indicating the intensity of scientific experiments performed. This significantly impacted steam consumption, resulting in higher floor-area-normalized steam usage. In these cases, steam use did not provide an outstanding correlation to heating degree-days. Whereas, for cases with other functionality-types and lower floor-area normalized steam, coefficients of determination in regressions were high. This study concludes that even for buildings located in the same climate, depending on how building functionality and occupancy schedule influence floor-area normalized steam use, multivariate linear regression can provide more accurate analysis, rather than simple linear regression of steam on heating degree-days.

Antimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up.