Over the last few decades, researchers put efforts to improve intelligent tutoring systems' abilities with the aim to get them as close as possible to the ultimate goal of one-to-one tutoring. CoLaB Tutor and AC-ware Tutor are intelligent tutoring systems based on conceptual knowledge learning and are notable due to the fact they are relatively easy to generalize to multiple knowledge domains. CoLaB Tutor's forte lies in teacher-learner communication in controlled natural language, while AC-ware Tutor focuses on the automatic and dynamic generation of adaptive courseware. In order to compare various intelligent tutoring system supported education environments, in this chapter, the authors summarize several empirical evaluations of CoLaB Tutor and AC-ware Tutor. The results of intelligent tutoring systems' effectiveness in these environments offer the possibility to observe the specific intelligent tutoring system across various education levels, as well as to compare the intelligent tutoring systems' supported education environments.

Mastitis is one of the most important diseases in dairy cow farms and one of the most common cause for antibiotic treatment. Aims of this study were: to investigate frequency and trends of clinical mastitis in cows on a large dairy farm, describe clinical characteristics of mastitis and investigate causative infectious agents in selected cases alongside antimicrobial resistance. In our study we used farm records for clinical mastitis recorded for period 2016 and 2017. We also used results of the regular on farm testing of the somatic cell count for 2017. Samples of milk from all clinical mastitis cases were taken during November and December 2017 in order to investigate causative agents and their antimicrobial resistance. Occurrence of clinical mastitis was 205 cases (47.7%) in 2017 compared to 93 cases (29.7%) recorded in 2016. In 2017 reoccurrence of clinical mastitis in same animal was recorded for 93 cows (45.4%). In 2016 reoccurrence of clinical mastitis in same animal was recoded for 49 cows (29.7%). Average course of clinical mastitis in 2016 was 3 days, while in 2017 4.5 days (continuous days of recording a case in farm records). Somatic cell count in more than half of tested animals was higher than 200.000 SC/ml according to the measurements from February and July 2017 (number of cows tested 236 and 169, respectively). Out of 23 milk samples, 20 had bacteriological growth. In 9 samples we identified S.aureus, in 6 streptococcus spp., in 4 coagulase negative staphylococci (CNS) and one sample contained E.coli. Most common resistance was found for lincomycin-spectinomycin (100%) gentamicin (92%), followed by cefquinome (65%), linkomycin (53%) and erythromycin (47%). Isolates of S.aureus were resistant on the largest number of investigated antibiotics.

Background: Following the recent legalization of medical cannabis in Canada, and many other countries around the world, people are turning to this drug for both medical and recreational reasons. Naturally, as human’s age, many rely on medication to maintain a better quality of life. Surveys show that, once legal, there will be an increase in cannabis consumption. Many adverse health reactions may occur by concurrently taking cannabis and other medications. Methods: A survey was distributed in-person throughout Vancouver targeting people who do not consume cannabis. The same survey was distributed in Vancouver, but to people coming out of dispensaries, targeting people who do consume cannabis. The survey consisted of seven knowledge questions asking about possible adverse drug interactions occurring between cannabis and commonly used licit and illicit drugs. A chi-square analysis was used to compare knowledge of users and non-users of cannabis. Results: Both users and non-users seemed to be most knowledgeable on the interaction between cannabis and alcohol; 39 out of 57 users (68%) and 23 out of 30 non-users (77%) gave the correct response. As for all the other interactions, neither group was very knowledgeable. The distribution of questions that were answered incorrectly seemed evenly spread between the two groups. The knowledge between users and non-users were significantly different when participants were asked on the possible adverse reactions between cannabis and opioid drugs (p=0.005), and cannabis and sedative drugs (p=0.002). In these cases, cannabis users were more knowledgeable about cannabis interactions than non-users. Conclusion: This study indicates that the general public is not very knowledgeable on the possible adverse reactions that may come about as a result of mixing cannabis and other commonly used licit and illicit drugs. Actions should be taken to provide the public with tools that will aid them in making the right decision when thinking about concurrently using cannabis and other licit and/or illicit drugs.  

Introduction. Fibrous dysplasia is a noninherited benign skeletal disorder associated with abnormal bone development. Single bone involvement, the monostotic form, accounts for 70 ? 80% of cases, while the polyostotic form, with multiple bone involvement, accounts for 20 ? 30% of cases. Cystic degeneration and occasional aneurysmal bone cyst formation may be found in fibrous dysplasia lesions, particularly in the costal lesions. Case Report. A 51-year-old man presented with acute shortness of breath after sustaining simple chest wall injury. Chest computed tomography showed multiple massive osteolytic rib lesions, as well as a massive left-sided pleural effusion with compression atelectasis of the lung parenchyma. Osteolytic lesions of the anterior 2nd and 7th thoracic vertebral body were found, along with a well defined osteolytic lesion in the body of the sternum. Video-assisted thoracoscopy of the left pleural space was performed and frozen sections, collected using endoscopic biopsy forceps of the cystic wall and solid parts of the tumors, were sent for ex tempore histopathological analysis. Results showed fibrous dysplasia with suspected malignancy. Talc pleurodesis was performed based on the obtained results. At present, the patient is asymptomatic with his daily routine uninterrupted by his medical condition. Conclusion. Treatment of pleural effusion caused by a cyst rupture of unresectable degenerated polyostotic fibrous dysplasia of the ribs represents a surgical challenge. Surgical drainage of the cysts followed by chemical pleurodesis seems to be a reasonable solution in cases where pulmonary functions are impacted by combined effects of pleural effusion and cystic compression.

Introduction/Objective Isolated hypertransaminasemia (IHTS) is a common, benign, and transient appearance in patients with celiac disease (CD). The aim of this study is to determine the frequency of IHTS in children up to two years old with clinically classical CD, as well as its connection with the onset of the first symptoms of the disease, the age of diagnosis, the clinical and laboratory nutritional parameters, and the degree of damage of small intestinal mucosa. Methods The study was based on a sample of 82 children, 55 female and 27 male, ages 7?24 (14.28 ? 4.41) months. The diagnosis of CD was based on the revised ESPGHAN criteria and the activity of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) by standard laboratory methods. Results IHTS was found in 39 (47.56%) patients, 27 of whom (69.23%) had elevated levels of both transaminases and 12 of only one ? eight of AST and four of ALT. The increase in relation to the aforementioned reference value for ALT was 1.1?10.08 (1.67 ? 1.73), and for AST it was 1.08?7.91 (1.56 ? 1.29) times. In patients with IHTS compared to those with normal transaminasemia, the age of onset of CD was significantly lower (9.83 ? 3.69 vs. 12.95 ? 4.43 months, p = 0.001), as well as the age of diagnosis (12.97 ? 3.88 vs. 15.47 ? 4.56 months; p = 0.01), while the differences in the other observed parameters were not significant. Conclusions IHTS occurs in almost half of children up to two years old with classical CD. Hypertransaminasemia is in most cases mild and significantly more frequent in patients with earlier clinical expression of the CD.

Introduction/Objective. Anemia is the most common extraintestinal manifestation of celiac disease (CD) in children. The aim of this study was to determine the frequency, severity and type of anemia in children with a classical CD, as well as the differences between anemic and non-anemic patients in their age, duration of illness, percentile body length or height, percentage of body weight (BW) deviation compared to ideal, and the degree of damage to the small intestine mucosa. Methods. The study was based on a sample of 90 children, 56 females and 34 males, ages 7?90 (18.23 ?} 12.7) months with classical CD. The diagnosis of CD is based on the ESPGHAN criteria from 1990 and 2012, and of anemia on the 2011 WHO reference values. Results. Anemia was found in 47 (52.22%) patients, of which it was mild in 23 cases [hemoglobin (Hb) 100?109 g/L] and moderately severe in 24 (Hb 70?99 g/L), in 34 (72.34%) it was microcytic [mean cell volume (MCV) < 70 fl] and normocytic (MCV 70?87 fl) in 13 patients. Low serum iron levels (< 10.7 ?mol/L) were found in 68 (75.56%), and hypoferritinemia (< 16 ng/ml) in 77 (85.56%) patients. Except for a greater deficit of BW in patients with anemia compared to those without anemia (-14.64 ? 9.60 vs. -8.56 ? 11.87%, p < 0.01), differences in other defined features were not significant. Conclusion. Mild or moderate iron deficiency anemia occurs in slightly more than half of children with a classical type CD. In anemic compared to non-anemic patients, there is a significantly higher BW deficit, while differences in other characteristics typical for this type of disease are not significant. This article has been corrected. Link to the correction 10.2298/SARH1910649E

Background/Aim. Drug utilisation monitoring could identify drug-related problems and hence improve the awareness of irrational drug use. The objective of this study was to analyse the drug utilisation patterns in a rehabilitation hospital over the period 2011?2016. Methods. The Anatomic Therapeutic Chemical classification/Defined Daily Dose (ATC/DDD) methodology was used to monitor the drug utilisation expressed as a number of DDD per 100 patient-days (HPD). The values of DDDs were obtained from the World Health Organisation (WHO) Collaborating Centre for Drug Statistics Methodology. Utilisation trends were analysed by means of the Compound Aggregate Growth Rate (CAGR), which is defined as an average annual change rate of some value during the period of interest. Results. The number of patient-days increased during the six years period; the CAGR being1.8% annually. At the same time, the total number of dispensed DDDs as well as the number of DDD/HPD decreased with the CAGR of -2.0% and -3.7% respectively. The average drug cost per patient-day varied from BAM 1.38 in 2013 to 0.95 in 2016; the CAGR being -1.8%. The most utilised drugs belonged to the ATC groups C, A, B, M and N and they contributed to an average of 77% of all drugs used each year. On the top of the list of most utilised drugs were: hydroxocobalamin, thioctic acid, enalapril, diclofenac, amlodipine, acetylsalicylic acid, pantoprazole, paracetamol and bromazepam. Conclusions. The overall drug utilisation in the hospital was modest and almost equal in 2016 compared to 2011. Besides the leading consumption of vitamin B12 and thioctic acid, this study points out some interesting prescribing patterns, such as predominant use of diclofenac over ibuprofen, and overuse of proton pump inhibitors. There is a need for educative interventions among physicians in order to improve their prescribing practice.