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Background Tuberculosis (TB) remains a significant worldwide social and life-threatening epidemiological problem. Because this disease requires multiple drug treatment and prolonged therapy for several months, followed by a high probability of adverse effects (AEs), we assessed AE monitoring for anti-TB drugs in the Health Care System of Kosova. Methods This survey was a cross-sectional analysis performed at the primary, secondary and tertiary health care levels in Kosova. We included 930 registered tuberculosis patients within three levels of this health system in our study. Furthermore, we interviewed 62 physicians and 71 nurses at TB health facilities. Data were collected from official TB registers and personal contact with patients for 12 months. Results The representative age group was 19 to 29 years (30.49%), followed by a group of patients aged >60 years (23.23%). Among 930 patients treated with TB drugs, the total incidence of adverse AEs was 29.03%. Female TB patients had a higher rate of AEs than did male patients (33.56% vs 28.84%, respectively). The highest incidence of registered AEs was recorded in the gastrointestinal system (270, 80.83%), followed by the central nervous system (CNS, 7.50%) and was lower in other organ systems. The reporting of anti-TB drug effects by medical staff (TB medical doctor and TB medical nurse) at different levels of TB medical settings occurred among 62.90% of medical doctors and 81.69% of nurses. Only 53.23% of medical doctors and 46.48% of nurses completed pharmacovigilance training. Conclusion The pharmacovigilance approach in Health System of Kosova is not comprehensible and not systematic. The relatively low incidence of AEs among TB patients is due under reporting of these by medical staff. The knowledge, attitudes, and adherence of medical staff reveal low awareness for pharmacovigilance activities, and this concern should be addressed to reinforce this important issue for the safe treatment of TB patients.

Introduction: Surveillance of antimicrobial medicines consumption is central to improving their use and reducing resistance rates. There are few published data on antibiotic consumption in Eastern Europe and Central Asia. To address this, 18 non-European Union (EU) countries and territories contribute to the WHO Regional Office for Europe (WHO Europe) Antimicrobial Medicines Consumption (AMC) Network. Objectives: (i) Analyse 2015 consumption of J01 class antibacterials for systemic use from 16 AMC Network members; (ii) compare results with 2011 data and 2015 ESAC-Net estimates; (iii) assess consumption against suggested indicators; (iv) evaluate the impact of planned changes to DDDs in 2019 for some commonly used antibiotics; (v) consider the utility of quantitative metrics of consumption for policy action. Methods: Analysis methods are similar to ESAC-Net for EU countries. The Anatomical Therapeutic Chemical (ATC) classification and defined daily doses (DDD) methodology were used to calculate total consumption (DDD/1000 inhabitants/day [DID]), relative use measures (percentages), extent of use of WHO Watch and Reserve group antibiotics and impact of DDD changes. Findings: Total J01 consumption in 2015 ranged 8·0-41·5 DID (mean 21·2 DID), generally lower than in 2011 (6·4–42·3 DID, mean 23·6 DID). Beta-lactam penicillins, cephalosporins and quinolones represented 16·2 to 56·6%, 9·4 to 28·8%, and 7·5 to 24·6% of total J01 consumption respectively. Third-generation cephalosporins comprised up to 90% of total cephalosporin consumption in some countries. Consumption of WHO Reserve antibiotics was very low; Watch antibiotics comprised 17·3 to 49·5% of total consumption (mean 30·9%). Variability was similar to 2015 ESAC-Net data (11·7 to 38·3 DID; mean 22.6 DID). DDD changes in 2019 impact both total and relative consumption estimates: total DIDs reduced on average by 12·0% (7·3-35·5 DID), mostly due to reduced total DDDs for commonly used penicillins; impact on rankings and relative use estimates were modest. Discussion: Quantitative metrics of antibiotic consumption have value. Improvements over time reflect national activities, however, changes in total volumes may conceal shifts to less desirable choices. Relative use measures targeting antibiotics of concern may be more informative. Some, including WHO Watch and Reserve classifications, lend themselves to prescribing targets supported by guidelines and treatment protocols.

Cancer affects one in three people worldwide. Surgery remains the primary curative option for localized cancers, but good prognoses require complete removal of primary tumors and timely recognition of metastases. To expand surgical capabilities and enhance patient outcomes, we developed a six-channel color/near-infrared image sensor inspired by the mantis shrimp visual system that enabled near-infrared fluorescence image guidance during surgery. The mantis shrimp's unique eye, which maximizes the number of photons contributing to and the amount of information contained in each glimpse of its surroundings, is recapitulated in our single-chip imaging system that integrates arrays of vertically stacked silicon photodetectors and pixelated spectral filters. To provide information about tumor location unavailable from a single instrument, we tuned three color channels to permit an intuitive perspective of the surgical procedure and three near-infrared channels to permit multifunctional imaging of optical probes highlighting cancerous tissue. In nude athymic mice bearing human prostate tumors, our image sensor enabled simultaneous detection of two tumor-targeted fluorophores, distinguishing diseased from healthy tissue in an estimated 92% of cases. It also permitted extraction of near-infrared structured illumination enabling the mapping of the three-dimensional topography of tumors and surgical sites to within 1.2-mm error. In the operating room, during surgical resection in 18 patients with breast cancer, our image sensor further enabled sentinel lymph node mapping using clinically approved near-infrared fluorophores. The flexibility and performance afforded by this simple and compact architecture highlights the benefits of biologically inspired sensors in image-guided surgery.

Introduction: There are appreciable concerns among European health authorities with growing expenditure on cancer medicines and issues of sustainability. The enhanced use of low-cost generics could help. Aims: Consequently, there is a need to comprehensively document current and future arrangements regarding the pricing of generic cancer medicines across Europe, and whether these are indication specific, as well as how this translates into actual prices to provide future direction. Methodology: Mixed-method approach with qualitative research among senior health authority personnel and their advisers. Quantitative research via health authority databases to ascertain current prices for oral cancer medicines that had lost their patent and the influence of population size and economics on prices. Results: Twenty-five European countries participated. The research found the following issues: (a) variable approaches to the pricing of generic cancer medicines, which will continue; (b) no concerns with substitution for oral generic cancer medicines; (c) substantial price reductions versus originators for generic capecitabine (up to -93.1%), generic imatinib (up to -97.8%) and generic temozolomide (up to -80.7%). Prices for oncology medicines are not generally indication specific, and are not affected by population size although influenced by pricing approaches. There have also been price increases for some non-patented cancer medicines following manufacturer changes although now stabilizing. Conclusion: The considerable price reductions seen for some generics means health authorities should further encourage the use of generic oncology medicines when they become available to fund increased volumes and new valued cancer medicines. Countries are also starting to address price increases for generics following changes in the manufacturer.

Introduction: There are appreciable concerns among European health authorities with growing expenditure on cancer medicines and issues of sustainability. The enhanced use of low cost generics could help. Aims: Consequently, there is a need to comprehensively document current and future arrangements regarding the pricing of generic cancer medicines across Europe, and whether these are indication specific, as well as how this translates into actual prices to provide future direction. Methodology: Mixed method approach with qualitative research among senior health authority personnel and their advisers. Quantitative research via health authority databases to ascertain current prices for oral cancer medicines that had lost their patent and the influence of population size and economics on prices. Results: 25 European countries participated. Currently we see (a) variable approaches to the pricing of generic cancer medicines, which will continue; (b) no concerns with substitution for oral generic cancer medicines; (c) substantial price reductions versus originators for generic capecitabine (up to -93.1%), generic imatinib (up to -97.8%) and generic temozolomide (up to -80.7%). Prices for oncology medicines are not indication specific, and are not affected by population size although influenced by pricing approaches. There have also been price increases for some non-patented cancer medicines following manufacturer changes although now stabilising. Conclusion: The considerable price reductions seen for some generics means health authorities should further encourage the use of generic oncology medicines when they become available to fund increased volumes and new valued cancer medicines. Countries are also starting to address price increases for generics following changes in the manufacturer

Syftet med denna kvalitativa uppsats är att undersöka och kritiskt reflektera hur de berörda aktörerna i Halmstad utifrån befintliga resurser arbetar förebyggande med spelproblematiken. Detta vill vi undersöka i relation till den snabba utvecklingen av spelmarknaden och samhällets risker samt hur dessa påverkar utvecklingen av spelberoende. Genom att analysera samverkan mellan olika aktörer har vi skapat en bild om hur arbetet inom spelproblematiken utförs i Halmstad. Studien tolkades ur ett hermeneutiskt perspektiv och analyserades med stöd i utvalda teorier. Risksamhällets teori kompletteras med utgångspunkt i begreppet ackumulation genom fråntagande och relateras till spelmarknadens utveckling och spelreklam som bidragande faktorer till att börja eller fortsätta spela om pengar. Riskerna belyses ur ett mikro- och makroperspektiv där individers livsvillkor och samhället i stort påverkas. Teorin om Jämlikhetsanden, bidrog till en förklaring om strävan efter en högre social status genom snabba pengar. Den lärande organisationsmodellen användes som komplement till den byråkratiska modellen för att nå en utveckling inom samverkan i arbetet. Med utgångspunkt i begreppen personliga bekymmer och allmänna problem beskrevs en viktig del av resultatet som visade ett stort mörkertal i frågan. Från och med den 1 januari 2018 är kommuner, landsting och regioner förpliktade att förebygga spelproblem. Det innebär att personer med spelproblem har samma rätt till hjälp och stöd som personer med alkohol- eller drogproblem. Resultatet visade att lagändringen inte implementerats på samtliga verksamheter och att det finns ett behov av utveckling inom det förebyggande arbetet. The purpose of this qualitative study is to map how the invlovled actors, based on existing resources, work preventively with the gamblingproblem. We want to examine how the work is carried out in relation to society's risks and development, and how these factors influence the development of gambling addiction. By analyzing the interaction between different actors, we have created a picture of how the work with the gambling problem is carried out in Halmstad. The study was interpreted from a hermeneutic perspective and was analyzed with support from selected theories. The risk society's theory is supplemented on the basis of the concept of accumulation by dispossession and is related to the game market's development and gambling advertising as contributing factors to starting or continuing to play for money. The risks are highlighted from a micro- and macro-perspective where individuals' living conditions and society as a whole are affected. The spirit level theory contributed to the explanation about the pursuit of a higher social status through quick money. The learning organizational model was used as a complement to the bureaucratic model in order to achieve a development within collaboration at work. The structural issues and personal troubles concept, an important part of the result was described, which showed a great deal of darkness on the issue. As of January 1st, 2018, municipalities, county councils and regions are obliged to prevent gambling problems. This means that people with gambling problems have the same right to help and support as people with alcohol or drug problems. The result showed that the change to the law was not implemented on all activities and that there is a need for development in the preventive work.

Contains fulltext : 203380.pdf (Publisher’s version ) (Closed access) INTRODUCTION: In January 2018 the European Commission published a Proposal for a Regulation on Health Technology Assessment (HTA): 'Proposal for a Regulation on health technology assessment and amending Directive 2011/24/EU'. A number of stakeholders, including some Member States, welcomed this initiative as it was considered to improve collaboration, reduce duplication and improve efficiency. There were however a number of concerns including its legal basis, the establishment of a single managing authority, the preservation of national jurisdiction over HTA decision-making and the voluntary/mandatory uptake of joint assessments by Member States. Areas covered: This paper presents the consolidated views and considerations on the original Proposal as set by the European Commission of a number of policy makers, payers, experts from pricing and reimbursement authorities and academics from across Europe. Expert commentary: The Proposal has since been extensively discussed at Council and while good progress has been achieved, there are still divergent positions. The European Parliament gave a number of recommendations for amendments. If the Proposal is approved, it is important that a balanced, improved outcome is achieved for all stakeholders. If not approved, the extensive contribution and progress attained should be sustained and preserved, and the best alternative solutions found.

Objectives There are no reliable data on antibiotic use in Kosovo hospitals. The aim of this survey was to monitor volumes and patterns of antibiotic use in hospitalised patients in order to identify targets for quality improvement. Methods Data on antimicrobial use were collected from seven hospitals in Kosovo during 2013 using the standardised point prevalence survey (PPS) methodology as developed by the ESAC (European Surveillance of Antimicrobial Consumption) and ARPEC (Antibiotic Resistance and Prescribing in European Children). The survey included all inpatients receiving an antimicrobial agent on the day of the PPS. Results Overall, 1667 patients were included in the study: adults 1345 (81%) and children 322 (19%). Of the hospital inpatients, 579/ 1345 (43%) adults and 188/ 322 (58%) children received at least one antibiotic during a hospital stay. The top three antibacterial subgroups (ATC level 3) were beta-lactam antibiotics, cephalosporins and aminoglycosides. In all hospital centres, the most commonly prescribed antibiotic was ceftriaxone (39% for adult and 36% for children). Antibiotics were administered mainly parenterally in 74% of adults and 94% of children. Empirical prescribing was higher in adults 498/ 579 (86%) and children 181/ 188 (96%), compared with targeted treatment based on susceptibility testing-81 (14%) and 8 (4%), respectively. Conclusions Antibiotic use in Kosovo's hospitals is very high. Gathered data will be an important tool to identify targets for quality improvement and will support preparation of guidelines and protocols for the prudent use of antibiotics.

Albanian folk music, this great treasure preserved over generations is an expression of high consciousness of everything precious inherited from the past. In determining the typology of this folklore, Albanian Ethnomusicology rightly refers to two major ethnographic divisions, which, according to the natural boundary defined by Shkumbini River, are Gheg in the northern part and Tosk, south of it. In a general approach (even within these two large ethno music areas, folklore is presented with its striking diversity), it can be said, that: northern folklore, respectively Gheg one, is distinguished for its monodic singing, based on oj- and chromatic modes with 11 sounds, influenced by oriental music, while southern folk music generally appears unified in iso polyphony, which by modal perspective is built on pentatonic (Tole, 2007, 5). The types of degree’s steps that are encountered in Albanian folklore music can be divided in two categories, defined by their own origins. In the first group, the so-called diatonic modes, include older modes, in which did not penetrate the later influences that came from the Orient (when Albanian became part of the Ottoman Empire) (Koçi, 2002, 143), a part of which with ancient origins, like three, tetra, penta and hexachord, while the rest derived from church modes, like eolik and jonic, but also anhemitonic pentatonic. To the other group belong chromatic modes, with oriental origin. Consequently, even the Albanian folk music melody is based on diatonic modes on one hand, where eolic, doric and jonic dominate (and the combination of two modes, eolic and jonic are a rather frequent phenomenon), as well as in defective modes mentioned above and on the other hand in chromatic modes (Çefa. 1997, 97).

This research paper is based on the contemporary techniques presented in the discipline of CVP Analysis. Techniques applied to carry out a complete and accurate financial analysis based on the CVP Analysis. In this paper, an application of theoretical concepts of the CVP Analysis has been realized. The quality of information and the recognition of specific features of business activity influence the achievement of a qualitative analysis. The cost-volume-profit analysis (CVP Analysis) is a powerful tool for planning and making decisions. Since the CVP analysis highlights the reciprocal cost ratio, the quantity sold and the price, it brings together all the financial information of the enterprise.

Aim: To determine genetic diversity of HCV among different population groups in Prishtina, Kosovo. Methods: Anti-HCV positive samples of dialysis patients, IDUs, blood donors, and chronic HCV patients were HCV genotyped and sequenced. To better understand the underlying conditions of HCV infection, interviews were used with all groups. Results: Anti-HCV positive findings were observed in 22% of dialysis patients in Prishtina, and as average among 53% of patients at dialysis centers of Kosovo, as well as in 48% of IDUs. HCV subtype 1a was most prevalent among dialysis patients in Prishtina (47%) and overall in Kosovo (62%), and among IDUs (64%), whereas genotype 1b was most prevalent among chronic HCV patients (42%) and blood donors (67%). The second most prevalent genotypes were 3a among IDUs (34%) and 4d among dialysis patients in Prishtina (44%) and overall at dialysis centers of Kosovo (33%). Phylogenetic trees of HCV subtypes 1a, 1b, 3a, and 4d showed phylogenetic clusters of samples related to dialysis centers or drug use. Duration of dialysis and receiving dialysis in different centers were factors associated with anti-HCV positivity among Kosovo dialysis patients, whereas specifically for Prishtina, in addition to the above, those factors included blood transfusion, age and knowledge about HCV among dialysis patients, while among IDUs those were age, duration of drug injection, lower educational level, drug injection in shooting galleries, and being in prison. Conclusion: High levels of HCV infection at dialysis center in Prishtina and overall at Kosovo dialysis centers and among IDUs are present in Kosovo, with HCV subtype 1a being most prevalent. This situation reiterates the need for strict adherence to infection control practices at dialysis centers and implementation of harm reduction activities among IDUs.

Introduction: The Ministry of Health (MoH) leads and organizes health policy in Kosovo, which includes procurement and provision of medicines. Cancer medicines are part of this. There are concerns with their affordability in view of growing costs and high profile. This is similar in Kosovo where anti-cancer medicines compose a special group of medicines, with most available medicines part of the Ministry of Health’s Essential List of Medicines. National drug utilization is available to guide future activities. However, there has been limited analysis of anti-cancer medicines to date. Such analyses are important to guide future care within limited resources. Consequently, the objective of this study is to undertake such research in Kosovo to provide future guidance. Method: Document utilisation and expenditure on anti-cancer medicines (ATC L) initially from 2011 to 2013, especially for anti-cancer medicines on the essential medicines list. In addition, document current systems for procuring and managing anti-cancer medicines in Kosovo. Results: There was appreciable variability in the utilization of anti-cancer medicines over the years, with low or limited use of some anti-cancer medicines on the essential medicine list. This is a concern in view of their documented effectiveness. From 2011 to 2013, € 16.49 million, or 13.5% of total expenditure, was spent on anti-cancer medicines (ATC L). The process of selection of new medicines begins with suggestions from doctors at the University Clinical Centre in Kosovo. Conclusion: The analysis has shown concerns with current utilization patterns for anti-cancer medicines in Kosovo. This needs to be addressed as part of improving the drug management process to optimize patient care within available resources. Future years and reforms will be assessed to improve current utilization and expenditure patterns.

Background: Globally, 10 million injecting drug users (IDUs) are estimated to be HCV-positive, resulting in a prevalence of 67%. We evaluated the previously unassessed HCV infection amongst IDUs in Kosovo. We determined the distribution of HCV genotypes among IDUs in Prishtina, ascertained their phylogenetic relatedness, and investigated the main risk factors associated with the HCV infection. Methods: Samples were obtained from 205 IDUs in Prishtina, Kosovo, during the Biological and Behavioral Surveillance Study (BioBSS). HCV-positive samples were further genotyped and sequenced. The results were linked with epidemiological data obtained in interviews determining the underlying causes of HCV transmission. Results: The majority of the 205 IDUs participating in the BioBSS were men (89.3%) with a mean age of 36 years and a history of imprisonment, unemployment, and over a decade of injection drug use. Forty-eight percent of the IDUs were positive for anti-HCV antibodies, and HCV RNA was detected in 70 IDUs (70.7% of the anti-HCV positive IDUs). The following HCV subtypes were detected: subtype 1a (64.3%), subtype 3a (34.3%), and subtype 2k (1.4%). Phylogenetic clustering was evident among 66.7% of the HCV subtype 1a samples and 71.4% of the subtype 3a samples. Significant independent predictors for anti-HCV positivity among IDUs were older age, longer duration of drug use, low education level, drug injection in “shooting galleries”, and imprisonment. Conclusions: In Prishtina, Kosovo, nearly half of the IDUs were determined to be anti-HCV positive and the majority had an active infection. HCV subtype 1a was found to be most prevalent, followed by subtype 3a. Our results emphasize the urgent need for the implementation of harm-reduction programs among IDUs in Kosovo, specifically treatment and prevention through needle/syringe exchange programs directed at gathering places, such as shooting galleries.

The cellular surface moleculeHis-taggedAssay validation was performed using paired serum samples from 15 Kosovar patients with a PCR-confirmed CCHFV infection and 28 Brazilian patients with a PCR-confirmed ZIKV infection, along with a panel of a priori CCHFV/ZIKV-IgM-negative serum samples. Both ELISAs were highly reproducible. Sensitivity and specificity were comparable with or even exceeded in-house gold standard testing and commercial kits. Furthermore, latex beads coated withRecombinant

Кратака содржина Кариограмот претставува графичка слика којашто на интерактивен начин го прикажува ризикот од развој на нов ка- риес во иднина кај пациентот, а притоа придонесува за утврдување до кој степен различни етиолошки фактори на кариес го предизвикуваат ризикот од кариес кај одреден пациент. Цел на трудот да се направи проценка на кариес ризик фактори и прираст на ка- риес во временскиот период од 2 години кај испитаници со трајни заби со корис- тење на редуцираниот кариограм. Дистрибуцијата на кариес ризик (%) утвр ден со кариограм во првата година (I) од испитувањето, редуцираниот кариог- рамбез саливарни тестови и streptococcus mutans од вкупно 88 деца на возраст од 10- 12 години, кај 44,32% деца утврден беше многу висок ризик за кариес, кај 21,59%бе- ше висок ризик за кариес, умерен ризик за кариес имаа 25,00% деца, кај 4,55% деца утврден беше низок ризик за кариес, а многу низок ризик за кариес регистриран е кај 4,55% од децата и, шансата да се од- бегне кариес кај овие деца изнесуваше 81 – 100 %. Кариес ризикот утврден со кари- ограм во втората година од испитување- то (редуцираниот кариограм) без сали- варни тестови и Streptococcus mutans, кај 4,32% деца беше утврден многу висок ри- зик за кариес, кај 20,45% утврден беше ви- сок ризик за кариес, а умерен ризик за ка- риес имаа 25,00% деца, а кај 10,23% деца утврден беше низок ризик за кариес и шансата да се одбегне кариес кај овие де- ца изнесуваше 81 – 100 %. Клучни зборови: Кариесот ризик фак- тори, reducirancariogram, DMFS

Background: End Stage Renal disease (ESRD) as it was historically termed is a term that encompasses all degrees of decreased renal function, from damaged–at risk through mild, moderate, and severe chronic kidney failure. ESRD is a worldwide public health problem. In the United States, there is a rising incidence and prevalence of kidney failure, with poor outcomes and high cost (see Epidemiology).Material and Methods: The blood sample for routine analysis (lipidogram) and specific analysis was taken at 08o'clock in the morning with the room temperature that variated from 19 to 24°C, before the hemodialysis session, minimum 12 hours of fasting - with tendency to avoid the absorption effect of food by the intestine as well as avoid absorption of lipids and formation of chilomicrones. In all samples regardless of their group, the concentration of ApoC-II and lipids were analyzed in a period of 12 months in a period of 12 months (the measurements were made every three months, it means we totally made 3 measurements in 9 months).Results: The results from patients and controlling group for Apo-C3 and lipid profile (ChT, TG, HDL-ch, LDL-ch) are given in table number 3. A significant statistical difference with p

The interest in holism is leading to new ways for development of multi-layered skills working towards a holistic integrated approach and developing new ways of multidimensional and multi-layered conceptualization of space. When the making of the place is requested, urban designers must be able to sense and interpret the visible and invisible dimension of place, in order to come to an understanding which leads to the holistic approach. Especially knowing how to recognize the invisible dimension of the site and knowing how to visualize it is one of the main challenges. This doesn’t depend only on methods or tools, but also on creativity and imagination that has a relation with experience, culture or knowledge of the architect. The following is important in most of the cases: intuition, sensitivity for the unseen, balance between the imagination, truth and the world around us. The aim of this research is to show that architects must perceive the site as a living being, as a unity of aspect of consciousness and essence, aspect of energy and vitality and aspect of physical form. Through this approach, by understanding and using of invisible patterns, we can generate sustainable concepts that lead towards environmental harmony. Keywords: Invisible patterns, perceiving, sensing, concept, environmental harmony.

Crimean-Congo hemorrhagic fever orthonairovirus (CCHFV) is a tick-borne virus which causes severe disease in humans with fatality cases up to 30%. We investigated the genetic and evolutionary characteristics of CCHFV in Kosovo, in particular in humans and found that different virus variants of genotype V circulate, with Turkey as a possible origin for the progenitor of southern European CCHF outbreaks. Phylogenetic analyses also revealed a single introduction event and in situ evolution of CCHFV in this country. The viral metagenomics revealed a more abundant virome in the fatal CCHF cases and the presence of a novel tick-borne segmented RNA virus belonging to the recently discovered Jingmenvirus group which raises questions about the potential pathogenic effect of this novel virus on human and animal health.

Drug shortages have been identified as a public health problem in an increasing number of countries. This can negatively impact on the quality and efficiency of patient care, as well as contribute to increases in the cost of treatment and the workload of health care providers. Shortages also raise ethical and political issues. The scientific evidence on drug shortages is still scarce, but many lessons can be drawn from cross-country analyses. The objective of this study was to characterize, compare, and evaluate the current systemic measures and legislative and organizational frameworks aimed at preventing or mitigating drug shortages within health care systems across a range of European and Western Asian countries. The study design was retrospective, cross-sectional, descriptive, and observational. Information was gathered through a survey distributed among senior personnel from ministries of health, state medicines agencies, local health authorities, other health or pharmaceutical pricing and reimbursement authorities, health insurance companies and academic institutions, with knowledge of the pharmaceutical markets in the 28 countries studied. Our study found that formal definitions of drug shortages currently exist in only a few countries. The characteristics of drug shortages, including their assortment, duration, frequency, and dynamics, were found to be variable and sometimes difficult to assess. Numerous information hubs were identified. Providing public access to information on drug shortages to the maximum possible extent is a prerequisite for performing more advanced studies on the problem and identifying solutions. Imposing public service obligations, providing the formal possibility to prescribe unlicensed medicines, and temporary bans on parallel exports are widespread measures. A positive finding of our study was the identification of numerous bottom-up initiatives and organizational frameworks aimed at preventing or mitigating drug shortages. The experiences and lessons drawn from these initiatives should be carefully evaluated, monitored, and presented to a wider international audience for careful appraisal. To be able to find solutions to the problem of drug shortages, there is an urgent need to develop a set of agreed definitions for drug shortages, as well as methodologies for their evaluation and monitoring. This is being progressed., peer-reviewed

Table S1. Questionnaire used in the face-to-face interviews with patients on hemodialysis in 2015. (DOCX 23 kb)

The aim of this article is characterization of natural zeolite (clinoptilolite) and its application for removal of heavy metals from aqueous solution. Characterization of the natural zeolite from Beli Plast deposit, Kardjali, was conducted using: classical chemical analysis, XRD, SEM/EDS, DTA/TG/DTG, XRF, FTIR and BET. Based on the results of the chemical composition, XRD, SEM/EDS and FTIR analyses, it is evident that the major component of the working material (~ 95%) is clinoptilolite. In fact, the working material is alumino-silicate with high silicate module and it is of clinoptilolite type. The applied material has the specific surface area of 31.3 m2/g determined by BET method with nitrogen adsorption. The maximum capacity of clinoptilolite towards zinc, nickel and cobalt removal under the studied conditions is approximately 3.5 mg/g, for copper and manganese is approximately 4.5 mg/g and for lead ions is approximately 30 mg/g. Natural zeolite (clinoptilolite) was used as a potential raw material for the purpose of removal of Cu(II), Zn(II), Mn(II), Pb(II), Co(II) and Ni(II) ions from model solutions. The experimental results were obtained in a laboratory scale batch glass reactor with continuous stirring at 400 rpm. The adsorption of studied heavy metal ions from solution were efficiently onto used adsorbent and approximately 90% from ions were removed from single ion solutions. Generally, it can be concluded that studied clinoptilolite is a potential raw material for effective removal of heavy metals ions from various types of waste waters.

Die vorliegende Studie hat das Ziel, Einstellungen und Motive erwachsener kosovarischer Deutschlernenden zu beleuchten. Der theoretische Teil dieser Arbeit beinhaltet einen Überblick zur Motivationsforschung, für diese Arbeit relevante Begriffe zu Einstellungen, Motiven und zur Motivation. Außerdem werden im theoretischen Teil Informationen zum Land, zur kosovarischen Emigration und zum kosovarischen Bildungssystem geliefert. Im empirischen Teil dieser Masterarbeit werden diese überprüft bzw. erweitert. Dazu wurden zwölf ProbandInnen aus drei verschiedenen Institutionen im Kosovo ausgewählt und befragt. Diese ProbandInnen wurden aufgrund erkennbarer Unterschiede bezüglich Einstellungen zur deutschen Sprache, zu den amtlich deutschsprachigen Ländern und zu Motiven und deren Einflussfaktoren in zwei Gruppen geteilt, jene, die in einem amtlich deutschsprachigen Land aufgewachsen sind, und andere, die sich nie in einem amtlich deutschsprachigen Land aufgehalten haben bzw. noch keine Möglichkeit dazu hatten. Es konnte ermittelt werden, dass ProbandInnen der ersten Gruppe grundsätzlich positive Einstellungen zur deutschen Sprache und zum amtlich deutschsprachigen Raum haben, teilweise instrumentell orientiert sind, aber nicht das Ziel haben, in einem amtlich deutschsprachigen Land zu leben, sondern versuchen wollen, im Kosovo zu verbleiben und hier einen Beitrag zu leisten. Bei der zweiten Gruppe handelt es sich um solche, die ebenso positive Einstellungen zur deutschen Sprache und zu den amtlich deutschsprachigen Ländern haben, jedoch rein instrumentell orientiert sind und das Ziel verfolgen, in einem deutschsprachigen Raum zu arbeiten/studieren bzw. zu leben (z.B. Familienzusammenführung).

The 7th International Scientific and Professional Conference Water for all is organized to honour the World Water Day by the Josip Juraj Strossmayer University of Osijek, European Hygienic Engineering & Design Group (EHEDG), Danube Parks, Croatian Food Agency, Croatian Water, Faculty of Food Technology Osijek, Faculty of Agriculture in Osijek, Faculty of Civil Engineering Osijek, Josip Juraj Strossmayer University of Osijek Department of Biology, Josip Juraj Strossmayer University of Osijek Department of Chemistry, Nature Park “Kopački rit”, Osijek- Baranja County, Public Health Institute of the Osijek- Baranja County and „Vodovod-Osijek“ -water supply company in Osijek. The topic of World Water Day 2017 was "Wastewater" emphasizing the importance and influence of wastewater treatments on global environment. The international scientific and professional conference Water for all is a gathering of scientists and experts in the field of water management, including chemists, biologists, civil and agriculture engineers, with a goal to remind people about the significance of fresh water and to promote an interdisciplinary approach and sustainability for fresh water resource management. The Conference has been held since 2011. About 300 scientists and engineers submitted 95 abstracts to the 7th International Scientific and Professional Conference Water for all, out of which 33 was presented orally and 62 as posters. 47 full papers were accepted by the Scientific Committee. 38 full papers became the part of the this Proceedings while 9 papers were accepted for publication in Croatian Journal of Food Science and Technology and Electronic Journal of the Faculty of Civil Engineering Osijek - e-GFOS.

1980’li yıllarda Yugoslavya Sosyalist Federal Cumhuriyeti (YSFC) içindeki Kosova Özerk Bölgesi’nin statüsü sorunu, Yugoslavya Komünist Partisi’nde (YKP) yapılan tartışmaların ana konusu olmuştur. 1981’deki öğrenci gösterilerinin meydana gelmesi YSFC içinde ve dışında konuşulan bir olay haline gelirken aynı zamanda Kosova sorununun uluslararası bir kimlik kazanmasına neden olmuştur. Sırbistan, YSFC içindeki avantajlı konumunu kullanarak 1974 yılı Anayasası ile verilen Kosova’nın özerklik statüsünü 27 Eylül 1990’da kaldırmayı başarmıştır. 1980’ler YSFC’nin zayıf yönlerini diğer bir deyişle federal makamların YSFC’nin içinde başlayan ayaklanmaları durdurmak için fazla güçsüz olduğunu ortaya çıkarmıştır. Kosova özerkliğinin kaldırdıktan sonraki 1990-1995 yıllarını kapsayan dönemde Kosova’daki sivil direniş incelenmektedir. Bu tezin amacı Yugoslavya’nın dağılma sürecindeki en önemli konu başlıklarından biri olarak bilinen Kosova sorununu incelemektedir. The issue of the status of the Autonomous Province of Kosovo within the Federal Socialist Republic of Yugoslavia (FSRY) during the 1980s became the main topic in the debates within the Communist Party of Yugoslavia. The outbreak of student demonstrations in 1981 became a much-discussed incident both inside and outside of FSRY, and in the meanwhile, the Kosovo problems internationalization has been the reason for developing its identity. Serbia by using its favourable position inside the FSRY, on September 27th 1990 achieved to abolish the autonomy that was given to Kosovo with the Constitution of 1974. The 1980s showed up the weaknesseses that FSRY had, in other words federal authorities had been unable to stop the outbreak of riots inside the FSRY. The period of 1990-1995, after the withdrawal of the Kosovo autonomy, examines the civil resistance in Kosovo. The purpose of this thesis is to examine the problem of Kosovo, which is known as one of the most important topics during the Yugoslavia’s collapsing process.

Introduction: There is continued unmet medical need for new medicines across countries especially for cancer, immunological diseases, and orphan diseases. However, there are growing challenges with funding new medicines at ever increasing prices along with funding increased medicine volumes with the growth in both infectious diseases and non-communicable diseases across countries. This has resulted in the development of new models to better manage the entry of new medicines, new financial models being postulated to finance new medicines as well as strategies to improve prescribing efficiency. However, more needs to be done. Consequently, the primary aim of this paper is to consider potential ways to optimize the use of new medicines balancing rising costs with increasing budgetary pressures to stimulate debate especially from a payer perspective. Methods: A narrative review of pharmaceutical policies and implications, as well as possible developments, based on key publications and initiatives known to the co-authors principally from a health authority perspective. Results: A number of initiatives and approaches have been identified including new models to better manage the entry of new medicines based on three pillars (pre-, peri-, and post-launch activities). Within this, we see the growing role of horizon scanning activities starting up to 36 months before launch, managed entry agreements and post launch follow-up. It is also likely there will be greater scrutiny over the effectiveness and value of new cancer medicines given ever increasing prices. This could include establishing minimum effectiveness targets for premium pricing along with re-evaluating prices as more medicines for cancer lose their patent. There will also be a greater involvement of patients especially with orphan diseases. New initiatives could include a greater role of multicriteria decision analysis, as well as looking at the potential for de-linking research and development from commercial activities to enhance affordability. Conclusion: There are a number of ongoing activities across countries to try and fund new valued medicines whilst attaining or maintaining universal healthcare. Such activities will grow with increasing resource pressures and continued unmet need. © 2018 Godman, Bucsics, Vella Bonanno, Oortwijn, Rothe, Ferrario, Bosselli, Hill, Martin, Simoens, Kurdi, Gad, Gulbinovič, Timoney, Bochenek, Salem, Hoxha, Sauermann, Massele, Guerra, Petrova, Mitkova, Achniotou, Laius, Sermet, Selke, Kourafalos, Yfantopoulos, Magnusson, Joppi, Oluka, Kwon, Jakupi, Kalemeera, Fadare, Melien, Pomorski, Wladysiuk, Markovic-Pekovic, Mardare, Meshkov, Novakovic, Fürst, Tomek, Zara, Diogene, Meyer, Malmström, Wettermark, Matsebula, Campbell and Haycox.

Table S2. Questionnaire used in the face-to-face interviews with the management of hemodialysis centers. (DOCX 14 kb)