Glucose is a main source of energy in human body and its regulation is controlled by a biological mechanism with organ/cell interactions that are related to glucose-insulin dynamics. This paper presents the model of physiological behaviors of glucose-insulin regulatory mechanism. This model allows investigation of blood glucose dynamics dependency on food intake. The model presented in this paper discusses several parameters within this complex system.

Introduction: Although during undergraduate study students have a high opinion of family medicine and often praise it, during postgraduate studies they show little interest in this medical specialty. Aim: The study aimed to examine the interest of public medical school students in family medicine as a career choice, to establish whether it changed during the study and if there was a difference in that regard among students studying at medical schools in Bosnia and Herzegovina. Hypotheses: students’ attitudes change with learning about the way a family doctor works. Methods: Descriptive cross-sectional survey. This manuscript presents a nationwide survey (63% response rate) of public medical school students in Bosnia and Herzegovina regarding their likelihood of selecting Family Medicine as a specialty. An anonymous questionnaire was distributed to all medical students on all six state universities in Bosnia and Herzegovina. Data basis of all doctors who have completed specialization programs were taken from ministries of health. Results: In the period from 01/01/08 to 12/31/18, only 8.4% of all completed specializations were family medicine doctors in Bosnia and Herzegovina. Interest in family medicine, as a future career, was shown by 31% of medical students, of which over 75% were female students. The largest interest in family medicine was shown by the sixth-year medical students, stating their extensive knowledge of medicine as a reason. Conclusion: Students’ interest in FM specialization is changing through the years of study. Unfortunately, it is not only the lack of interest, that is the cause of the small number of family medical specialities among students but also poor health policy, which should be subjected to actual reform.

Introduction: Early correction of congenital ptosis may be indicated due to a risk of amblyopia or because of an abnormal head tilt. One of the main problems, of planning ptosis surgery in very young children, is the inability to measure the levator function. Aim: The aim of the article was to analyze the early correction of congenital myogenic ptosis. Methods: This was a retrospective, interventional, case series study, conducted on 12 eyes of 12 patients with unilateral, mild to moderate, congenital myogenic ptosis. Surgical correction of ptosis was performed by transconjunctival levator muscle plication. Pre- and postoperative measurements of the upper lid margin to central corneal reflex (MRD1) and upper lid skin crease height (UEC) were obtained, as well as the presence or absence of a reaction to topically applied phenylephrine 2.5% solution. Results: The mean age of the patients was 29.83 months (range 14-45 months). A negative phenylephrine test was noted in only 3 (25%) of cases. Equalization of upper lid height was achieved in 6 (50%), and a hypocorrection of up to 1 mm was noted in 4 (33%) of patients. There was only 1 hypercorrection of 1 mm, noted in the first postoperative month. In one case of hypocorrection of 2 mm, the height of the lid dropped between the 1 and 3 months follow up. Subsequent revision surgery was performed, with a good outcome. With regard to the upper lid skin crease height (UEC), the mean preoperative difference in relation to the contralateral (non-operated) lid, was 2.16 mm, whereas the average postoperative or final difference was 0.41 mm. Conclusion: Correction of myogenic ptosis in small children, using transconjunctival levator plication, in whom levator function cannot be measured, may have a satisfactory postoperative outcome.

Nowadays, high voltage circuit breaker (CB) simulations are mostly based on Computational Fluid Dynamics (CFD) models. Such simulations require significant computer resources. An alternative approach is to use enthalpy flow models, which do not use space discretization of the interrupter unit chambers and valves. Gas flow is calculated based on state of gas in adjacent chambers and valve settings. However, the valve shape has significant influence on the effective flow cross section between chambers. Therefore, in order to ensure correct simulation results, it is necessary to determine the correct values of discharge coefficients for all valves in the interrupter unit of a circuit breaker. In this paper, the discharge coefficients were determined by combining a series of CFD and enthalpy flow simulations for each valve in the interrupter unit. After that, discharge coefficients are used as input for further simulations based on the enthalpy flow model. This way, benefits from both models are combined: more precise gas flow calculation and faster simulations. The proposed novel approach is validated in a high-power laboratory by pressure measurements on a 420 kV 63 kA self-blast circuit breaker.

Colorectal cancer (CRC) is a common malignancy with a high mortality rate worldwide. It is a complex, multifactorial disease that is strongly impacted by both hereditary and environmental factors. The role of microbes (e.g., viruses) in the pathogenesis of CRC is poorly understood. In the current study, we explored the status of high-risk human papillomaviruses (HPV) and Epstein–Barr virus (EBV) in a well-defined CRC cohort using immunohistochemistry and polymerase chain reaction assays. Our data showed that high-risk HPVs were common (~80%) and EBV had a low presence (14–25%) in the CRC samples. The most common high-risk HPVs are HPV16, 31, 18, 51, 52 and 45 genotypes. The co-presence of high-risk HPV and EBV was observed in ~16% of the sample population without any significant association with the clinicopathological variables. We conclude that high-risk HPVs are very prevalent in CRC samples while EBV positivity is relatively low. The co-expression of the two viruses was observed in a minority of cases and without any correlation with the studied parameters. Further studies are necessary to confirm the clinical relevance and potential therapeutic (preventive) effects of the observations reported herein.

Background: Smoking is one of the most significant modifiable exosomes risk factors for rheumatoid arthritis (RA) (1). Studies suggest that 25-30% of people with RA in Denmark smoke (2). This is almost twice as many as in the background population in Denmark. People with RA have a significant increased risk of severe comorbidity including cardiovascular disease. In addition, there are indications that smokers with RA have a poorer effect of the medical inflammatory treatment compared to non-smokers, and consequently more difficult to achieve remission of the disease activity (3). Tobacco addiction is complex and can be a challenge in smoking cessation. In addition to physiological dependence, habits and social and environmental factors may influence addiction. Tobacco smoking is associated with an addiction to nicotine and it is unexplored how this addiction appears in people with RA. Objectives: The aim of this study was to examine from the patient’s perspective how tobacco addiction appears in people with rheumatoid arthritis. Methods: We conducted a qualitative study based on a hermeneutics approach. People with RA who previously had participated in a randomized controlled study (4) about smoking cessation conducted at the Center for Rheumatology and Spine Diseases at Rigshospitalet, Denmark were recruited for semi-structured interviews. Results: In total, 12 people with RA (50% female) were included in the study. The median age was 62 years and median RA disease duration was 12 years. The degree of physical dependence measured by Fagerstroms Test for Nicotine dependence (FTND) was on average: 4.9 (score: 0-10, 0=nonphysical dependence). Three categories of how tobacco addiction appeared emerged during the analysis: 1) It develops into ingrown habits referring to the fact that smoking already in adolescence contributes to the development of specific physical, mental and social smoking behavior. Not all individuals considered themselves addicted to nicotine as they did not necessarily connect the nicotine to the ingrown habits. 2) The body craves for nicotine referring to nicotine proved calming, while a lacking or insufficient dose caused withdrawal symptoms. Furthermore, smoking became a habit where a craving for smoking occurred in certain situations. 3) Ambivalence – for and against referring to the physical dependence and smoking habits making a smoking cessation difficult. Dependency to nicotine and challenges to quit smoking led to a feeling of ambivalence and a lack of control. Conclusion: Tobacco addiction appeared as a physical dependence and a habit, which, during a smoking cessation, led to ambivalent feelings. Therefore, based on this study, there is still a need for health professionals to talk to patients about smoking. But also, a need to articulate the complexity of addiction in order to support for smoking cessations. Information should be strengthened in the clinical practice in relation to nicotine’s implication in tobacco addiction as well as the consequences of tobacco smoking for individuals with RA. References: [1]Scott DL, Wolfe F, Huizinga TW. Lancet. 2010 ### [2]Loppenthin K, Esbensen BA, Jennum P, Ostergaard M, Tolver A, Thomsen T, et al. Clin Rheumatol. 2015. ### [3]Roelsgaard IK, Ikdahl E, Rollefstad S, Wibetoe G, Esbensen BA, Kitas GD, et al. Rheumatology (Oxford). 2019. ### [4]Roelsgaard IK, Thomsen T, Ostergaard M, Christensen R, Hetland ML, Jacobsen S, et al. Trials. 2017;18(1):570.### Disclosure of Interests: None declared

Abstract Buško Blato Reservoir, the third largest hydro accumulation in Europe, is situated in the south-eastern part of the karstic Livanjsko Polje Valley. This aquatic ecosystem is distinguished by a very rich ichthyofauna and the presence of four endemic fish species. Numerous studies focus on ichthyological researches of Buško Blato Reservoir. Its ichthyofauna has been exposed to changes in ecological factors, which in turn reflected on the structure and composition of fish populations. The main objective of this paper was to assess the current state and predict future trends in the ichthyofauna structure and dynamics based on the field data and comprehensive analyses of literature data. The results of the research indicated the presence of 11 fish species from four families, which is the largest number of fish species ever recorded in this ecosystem. Sander lucioperca, Lepomis gibbosus, Pseudorasbora parva and Tinca tinca were recorded for the first time in this ecosystem, while some previously recorded species were not found. The results of the analyses clearly indicate the presence of natural interspecific competition and significant level of threats to the endemic fish species caused by human activities.

Lightning is the main cause of line outages on overhead distribution lines, especially for lines located in mountain areas and without line surge arresters installed along the line. This paper is dedicated to lightning outage performance of distribution line “Kotor – Lovćen” that operates in mountain Lovćen area. Shielding failure rate, shielding failure flashover rate and back flashover rate are calculated using Sigma Slp software. Lightning data collected by two advanced lightning activity monitoring systems are analyzed and used in number of simulations conducted for purposes of this paper.

Different types of transient phenomena are found in power systems. Switching transients in power systems have always been a matter of concern in insulation coordination studies. The reactors in power system are widely used elements which purpose is to provide stable power flow in normal conditions and to reduce dynamical and thermal stresses during short circuits and some other faults. Many shunt reactors are switched frequently, even daily. Shunt reactor switching imposes a unique and severe stress on the connected system and the circuit breaker. This paper presents study of overvoltages due to shunt reactor switching in 400 kV substation.

Systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) are associated with an increased risk of developing cardiovascular diseases as a result of complex interaction between traditional risk factors, chronic inflammation and specific impact of antibodies on endothelium. There are very limited data regarding level of physical activity (PA) in APS patients.To analyze different domains of PA in Serbian APS patients and their possible relationship to clinical and laboratory criteria of the main disease.From a large Serbian APS database comprehending 527 APS patients (371 Primary – PAPS, and 156 APS associated with other autoimmune diseases, predominantly systemic lupus erythematosus (SLE)) we interviewed 51 APS patients, age range of 15-69 years: 29 patients with primary APS (PAPS), 25 women, 4 men, age 44±11.50, and 22 APS/SLE, 18 women, 4 men, age 48.41±11.75, using a long form of The International Physical Activity Questionnaire (IPAQ), translated onto Serbian language. Data on last seven days of PA divided onto leisure time PA, domestic and gardening (yard) activities, work-related PA and transport-related PA were acquired, and proposed scoring method was used. Based on the level of PA, patients were categorized to low, moderate or high level of PA. For the purpose of insight into atherosclerotic progression, we performed color Doppler scan of carotid arteries in all patients and presence of atherosclerotic plaques has been notified.Average total PA score was 7706.18±11771.97 MET-minutes/week. The greatest average values for different PA domains were for work (2733.21±6158.66 MET-minutes/week) and domestic/garden/yard (2522.31±3847.24 MET-minutes/week) and the lowest scores achieved in leisure time (500.87±695.45 MET-minutes/week). Majority of Serbian APS patients had low or moderate level of PA (37.3%, 43.1%, respectively) whereas lowest percentage was in high category of PA (19.6%). All domains of PA were significantly negatively correlated to age and BMI. There were no significant difference regarding PA scores between PAPS and APS/SLE patients. Although higher percentage of PAPS patients had high level of PA (27.65 compared to 9.1% of SLE/APS), the overall difference was not significant. There was no significant difference regarding antiphospholipid antibody (aPL) type or thrombotic/obstetric events presence. Significant difference occurred regarding presence of carotid arteries plaques. APS patients with lower PA scores had significantly higher prevalence of carotid arteries plaque especially for PA in transportation (p=0.004), and total PA (p=0.025)Serbian APS patients at younger age, tend to have low or moderate level of PA, with the lowest level of activity in leisure time. Low level of PA was undoubtedly related to progression of atherosclerosis in these patients, emphasizing a need for PA promotion in APS.Aleksandra Djokovic Speakers bureau: KRKA, Astra Zeneca, Actavis, Ljudmila Stojanovich: None declared, Natasa Stanisavljevic: None declared, Gordana Bogdanovic: None declared, Sandra Djokic: None declared

Abstract The author analyses volunteering in Bosnia and Herzegovina, focusing on women’s activism in connection with values associated with the concept of civil society, such as solidarity, equity, and reciprocity. Civil society in Bosnia and Herzegovina generally suffers from fragmentation, donor-driven approaches, insufficient transparency and low trust among the general population, all of which present obstacles to voluntary work, as does a legal framework which is certainly not conducive to volunteering. Unlike organizations that do no more than promote the interests of their members, or groups connected to or controlled by political parties, women’s organizations are often seen as undertaking genuine activism. The author reveals differences in attitudes to volunteer work among individual women in organizations of varying sizes, explaining that those differences depend to some extent on women’s locations, ages or experience. Both inter-group and intra-group dynamics, including women’s networks, provide additional insights into voluntarism, especially with regard to the value of solidarity.

Structural size optimization of a device for external bone fixation within a formed iterative hybrid optimization algorithm was presented in this paper. The optimization algorithm was in interaction with the algorithms for generative design and FEM analysis and completely integrated within CATIA CAD/CAM/CAE system. The initial model, representing the current design of the bone external fixation device Sarafix, was previously verified by experimental testing. The formed hybrid optimization algorithm was created as an integration of the global (SA method) and local (CG method) algorithm. The constraints of the optimization model are the clinical limitations of the interfragmentary displacements and the material strength. The optimized design has less weight, greater rigidity and less transverse interfragmentary displacements at the point of fracture compared to the current design.