Introduction: In this study we wanted to examine the hormonal responses due to stress exposure during laparoscopic cholecystectomy with standard (12-15 mm / Hg) (LCSP) and low (6-8 mm / Hg) (LCLP) intraabdominal pressure and open cholecystectomy (OC), with particular emphasis on stress hormone responses. Aim: Determination of adrenocorticotropic hormone (ACTH) and cortisol stress hormones before and after laparoscopic cholecystectomy with standard and low insufflation pressure, determination of ACTH and cortisol values before and after open cholecystectomy and comparison of ACTH and cortisol values between the patient sub-groups. Methods: In a prospective study conducted between July 2016 and February 2018, we involved 110 patients which were divided into two groups: 70 patients with laparoscopic cholecystectomy (LC) and 40 patients with open cholecystectomy (OC). The first group of patients was further divided into two subgroups of 35 patients, (subgroup LC with standard and subgroup LC with low intraabdominal pressure). All patients met the preset inclusion and exclusion criteria of the study. There were no statistically significant differences in the demographic characteristics of patients between the investigated groups. The stress hormones determined were adrenocorticotropic hormone (ACTH) and cortisol. Results: During the first, second and seventh day postoperative day (POD),ACTH values were significantly lower (p <0.0001) in LCLP than in LCSP and OC groups. This was also the case for comparison in LCSP and OC groups. By comparing LC and OC groups during first, the second and seventh POD, there was a significant difference (p <0.0001) in the ACTH levels. The concentration of this hormone was higher in the OC group in all three cases. The first, second and seventh POD were also statistically significant (p <0.0001) in cortisol values and between LC and OC groups there was an increase in cortisol levels in patients operated by open method. There was also a significant difference (p <0.0001) in cortisol values measured between LCLP and LCSP groups in the investigated days. Cortisol levels were higher in patients in the LCSP group. Conclusion: During open and laparoscopic cholecystectomy the response of the body to stress increased. The stress response of the organism during laparoscopic cholecystectomy was less than during open cholecystectomy. The stress response of the organism during laparoscopic cholecystectomy with low insufflation pressure ( 6-8mmHg) was less than during laparoscopic cholecystectomy with standard insufflation pressure (12-15mmHg).

Aim To develop and validate a screening questionnaire for migraine without aura with sufficient diagnostic accuracy to be used in primary care settings. Methods The study was designed as cross-sectional, multicentric, diagnostic accuracy trial of new questionnaire for screening patients who visit general practitioners, with an aim to reveal migraine without aura. The instrument was constructed for the purpose of this study, and validated on the sample of 429 primary care outpatients. The gold standard of diagnosing migraine without aura was clinical estimate by a neurologist based on the International Classification of Headache Disorders 3rd edition (ICHD-III) criteria. Diagnostic accuracy of the instrument was tested through construction of the Receiver Operator Curve. Results The Balkan Migraine Screening Questionnaire (BMSQ) instrument showed good diagnostic accuracy (sensitivity 83.4% and specificity 79.9%) for migraine without aura, with significant screening yield among previously undiagnosed patients of 75.9%. The study also confirmed a high percentage of patients with hidden migraine without aura (MWA) (52.9%) revealed by the BMSQ and the ICHD-III criteria that would otherwise remain undiagnosed. Conclusion The BMSQ is a valid and reliable clinical instrument for revealing migraine without aura, which could be easily selfadministered by patients. It has high screening yield, discovering majority of patients with previously undiagnosed migraine without aura, whose definite diagnosis should later on be confirmed by the attending physicians using the ICHD-III criteria.

OBJECTIVE To investigate the level and causes of stress and the risk of onset of burnout syndrome among physicians employed at the Primary Health Care Centre, Banja Luka. SUBJECTS AND METHODS Between March 1, 2018, and May 31, 2018 all physicians from the Primary Health Care Centre, Banja Luka were offered the following questionnaires to fill in: a socio-demographic questionnaire, a questionnaire for self-assessment of the level of stress and the Maslach Burnout Inventory for assessment of the risk of burnout syndrome. RESULTS Out of 211 physicians, 85.8% were female. A high level of stress was found in 77.7% of the subjects. Older doctors had higher levels of emotional exhaustion compared to younger doctors with a shorter length of service (r=0.236, P=0.01). Emotional exhaustion was significantly correlated with a high level of depersonalization, a low level of personal accomplishment and a high level of stress (r=0.380, r=-0.174 and r=0.574, P=0.01, P=0.04 and P<0.01, respectively). Depersonalization correlated with a low level of personal accomplishment and stress (r=-0.347 and r=0.283, P<0.01 and P=0.01, respectively), while the level of personal accomplishment was in a negative correlation with stress (r=-0.281, P=0.01). A high stress level was associated with a high degree of emotional exhaustion (OR 56.543; 95% CI 11.35-213.09; P<0.001) as well as lack of personal accomplishment (OR 0.155; 95% CI 0.04-0.50; P=0.003). CONCLUSION A high level of stress was associated with older age, female gender, as well as with a high degree of emotional exhaustion and a lack of personal accomplishment. Preventive measures are warranted.

Aim To determine the prevalence of depressive episodes and recurrent depressive disorders despite of the length of therapy and type of antidepressants. Methods The study was conducted among 508 patients aged 19-65 years who were treated for depression for at least 3 months (mild and moderate episodes were controlled and the effects of treatment monitored by family physicians, while severe episodes were controlled by a psychiatrist) during 2013- 2015 in Zenica-Doboj Canton using the Hamilton Depression Rating Scale (HDRS). Results The average age of the patients was 48.98±11.585 years. Depressive disorder was most commonly represented in patients with high-level education, 22%, more frequently in non-productive workers (non-productive vs. manufacturing 58%:35%). A significant number of patients who were treated for depression were unemployed (57%). All respondents were suffering from the most serious episode of depression with an average depression rate at the Hamilton scale 18.49±8.603, with a very serious depression level of 32%, severe 17%, moderate 21%, and mild 20%. Most patients were treated with paroxetine, 27%, fluoxetine 22% and sertraline 17%. Efficacy of depression treatment with different types of selective serotonin reuptake inhibitors antidepressants (SSRIs) was not significantly different (p=0.502). Conclusion Success of the treatment with the absence of symptoms of depression was achieved in 10% and the maintenance of depressive episodes occurred in 90% of cases. Adverse reactions with the most commonly prescribed SSRI in our country should be important in creating procedures and strategies for the future treatment of depression in family medicine.

This study argues that the shift to open business models relies on aligning value-creation and value-capture activities through interactive processes that involve both provider and customer. Yet, l...

Temperature distribution at depth is of key importance for characterizing the crust, defining its mechanical behavior and deformation. Temperature can be retrieved by heat flow measurements in boreholes that are sparse, shallow, and have limited reliability, especially in active and recently active areas. Laboratory data and thermodynamic modeling demonstrate that temperature exerts a strong control on the seismic properties of rocks, supporting the hypothesis that seismic data can be used to constrain the crustal thermal structure. We use Rayleigh wave dispersion curves and receiver functions, jointly inverted with a transdimensional Monte Carlo Markov Chain algorithm, to retrieve the VS and VP/VS within the crust in the Italian peninsula. The high values (>1.9) of VP/VS suggest the presence of filled‐fluid cracks in the middle and lower crust. Intracrustal discontinuities associated with large values of VP/VS are interpreted as the α−β quartz transition and used to estimate geothermal gradients. These are in agreement with the temperatures inferred from shear wave velocities and exhibit a behavior consistent with the known tectonic and geodynamic setting of the Italian peninsula. We argue that such methods, based on seismological observables, provide a viable alternative to heat flow measurements for inferring crustal thermal structure.

The fact that since March 2018 Agile is included in the Project Management Body of Knowledge (PMBOK), indicates the importance of this methodology in project management. Scrum as the one of the most accepted Agile forms emphasizes the importance of Scrum Master who has many responsibilities: teaching, coaching, mentoring the team, removing impediments, acting as a protector of the team, etc. However, many companies assign this role as additional work to a team member, a project manager or even to an executive. Guided by the impression that the role of Scrum Master is not fully recognized and appreciated, this paper will attempt to determine the potential risk of not having a dedicated Scrum Master within an agile team. As a research tool, we used interviews and online surveys with employees of companies that use Scrum.

In this paper, we propose a self-deployment strategy for non-stationary wireless extenders, where both back-haul and front-haul links are optimized. We present an artificial intelligence (AI) case based reasoning (CBR) framework that enables self-deployment with learning the environment by means of sensing and perception. New actions, i.e., extender positions, are created by problem-specific optimization and semi-supervised learning that balance exploration and exploitation of the search space. An IEEE 802.11 standard compliant simulations are performed to evaluate the framework on a large scale and compare its performance against existing conventional coverage maximization approaches. Experimental evaluation is also performed in an enterprise environment to demonstrate the competence of the proposed AI-framework.

Milivoje Kostic (1883-1974), Academician and Professor in the field of Surgery at the Faculty of medicine of University of Sarajevo and Faculty of medicine of University of Belgrade (1, 2).

Aim To compare hospital costs of acute limb ischemia treatment in two periods of time and to show evidence of long-term repercussions on reducing costs during successful treatment. Methods Retrospective analysis of data obtained from 100 patients' medical history in the period 2000-2016 at the Clinic of Vascular Surgery Sarajevo: group A - 60 patients with acute limb ischemia in the period 2005-2016 and group B - 40 patients with acute limb ischemia (ALI) in the period 2000-2005. From 2000 to 2005 conservative treatment method was used, invasive diagnostic and surgical procedures were often delayed for a shorter or longer period of time. During the period from 2005 to 2016, the management model and safe practice included emergency diagnostic procedures, colour-Doppler, arteriography, emergency surgery (embolectomy by Fogharty and if necessary, vascular by-pass). Results Better health service for the patients with acute limb ischemia was offered in the period 2005-2016, which relied on proven medical treatment trends. The largest share of the total costs of each patient included costs of hospital bed with significant difference between the period 2005-2016 and 2000-2005, mean of 1398.71 KM and 2480.45KM, respectively (p<0.0001), indicating rationalization of time that patients spend at the Vascular Clinic. Conclusion This trend of money/fund savings is an example of good practice, effectiveness and efficiency in the treatment of ALI and as such was used in patients with other vascular diseases.