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Health Economic Analysis of the Most Common Surgical Procedures in Ophthalmology: Cataract and Rhegmatogenous Retinal Detachment Procedure in Split-Dalmatia County
No full textCilj istraživanja: Cilj istraživanja bio je provesti zdravstveno-ekonomsku analizu dviju kirurških oftalmoloških intervencija: operacije mrene i operacije regmatogenog odignuća mrežnice (engl. rhegmatogenous retinal detachment, RRD). Temeljem intraoperacijskih fakoemulzifikacijskih (PHACO) parametara, htjeli smo procijeniti i usporediti troškove operacije mrene u bolesnika s i bez pseudoeksfolijacijskog sindroma (PEX-a). Također, analizom troškovne korisnosti cilj nam je bio procijeniti i usporediti isplativost triju suvremenih tehnika operacije RRD-a. Metode i ispitanici: Ovo retrospektivno istraživanje kvalitete temeljeno na registru sastoji se od dva dijela, povezana zdravstveno-ekonomskom analizom u jedinstvenu cjelinu. U prvom dijelu istraživanja u analizu je uključeno 5889 bolesnika (6236 očiju) podvrgnutih PHACO operaciji mrene u Klinici za očne bolesti KBC-a Split u razdoblju od 7 godina, podijeljenih u dvije skupine, ovisno o prisutnosti PEX-a. Analizirani su i uspoređivani intraoperacijski PHACO parametri, intraoperacijske komplikacije i troškovi zahvata (temeljeni prije svega na razlikama u duljini trajanja operacijskog zahvata) između promatranih skupina. Analizirana je i prikladnost šifri dijagnostičko-terapijskih skupina (DTS) povezanih s PHACO operacijom mrene. Drugi dio istraživanja uključio je 151 bolesnika s RRD-om, liječenog u Klinici za očne bolesti KBC-a Split tijekom trogodišnjeg razdoblja, jednom od tri kirurške tehnike (pneumoretinopeksija – PR, konvencionalna operacija – SB ili pars plana vitrektomija – PPV) kako bi se procijenili anatomski i funkcionalni ishodi pojedine tehnike. Nadalje, provedena je opsežna zdravstveno-ekonomska analiza troškova i korisnosti (mjerenih očekivanim vrijednostima QALY-a, temeljenih na anatomskim i funkcionalnim ishodima navedenih metoda) te je uspoređena isplativost kirurških tehnika izračunavanjem omjera troškovne učinkovitosti (ICER-a). Rezultati: Pseudoeksfoliacijski sindrom dijagnosticiran je u 6,13 % slučajeva uključenih u istraživanje. Svi intraoperacijski PHACO parametri bili su viši u PEX skupini bolesnika, osobito u onih sa tvrđim nuklearnim mrenama. Trajanje operacijskog zahvata bilo je 1,5 puta dulje, a intraoperacijske komplikacije značajno češće u PEX skupini. Očekivani troškovi PHACO postupka bili su značajno veći u bolesnika s PEX-om, neovisno o tvrdoći nuklearne mrene (osobito u skupini bolesnika s većom tvrdoćom nukleusa) te isti nisu pokriveni trenutačnom naknadom DTS-a, tako da se gubitak očekivanih, neobračunatih troškova po zahvatu kretao u rasponu od 36 % do čak 69 %. U drugom dijelu istraživanja, primarni anatomski uspjeh postignut je u 86%bolesnika liječenih zbog RRD-a. Nije dokazana statistički značajna razlika u anatomskom uspjehu između triju kirurških tehnika. Međutim, funkcionalni ishod (temeljen na konačnoj vidnoj oštrini) značajno se razlikovao između promatranih tehnika. Posljedično, vrijednosti očekivanog QALY-a značajno su se razlikovale među pojedinim tehnikama te su bile niže za PPV, nego za PR i SB. Nadalje, PR je pokazao dominantnu isplativost u odnosu na PPV, s vrijednošću ICER-a od -6253 €/QALY. Zaključak: Istraživanje je pokazalo da su troškovi povezani s PHACO operacijom mrene u bolesnika s PEX-om značajno veći u odnosu na one bez PEX-a, i nisu pokriveni trenutačnim sustavom naknade DTS. Stoga se nameće potreba prilagodbe sustava naknade DTS za PHACO postupke u bolesnika s PEX-om, osobito onih s većom tvrdoćom nukleusa. Prilagodba i dopuna šifri naknade DTS-a potrebna je i u slučaju RRD-a. Istraživanje je također pokazalo da je PR uodgovarajućim slučajevima, uz to što daje najbolje funkcionalne rezultate, troškovnonajisplativija tehnika za liječenje RRD-a. To bi trebalo posebno uzeti u obzir u zemljama s ograničenim zdravstvenim resursima (poput Hrvatske), gdje bi se odluke o liječenju RRD-a trebale temeljiti na analizi troškovne korisnosti.Objective: The aim of the study was to conduct a health-economic analysis of two ophthalmic surgical interventions: cataract surgery and rhegmatogenous retinal detachment (RRD) surgery. Based on intraoperative phacoemulsification (PHACO) parameters, we sought to evaluate and compare the costs of cataract surgery in patients with and without pseudoexfoliation syndrome (PEX). Additionally, through a cost-utility analysis, we aimed to assess and compare the cost-effectiveness of three modern surgical techniques for RRD treatment. Methods and Participants: This retrospective quality registry-based study consists of two parts, linked by health-economic analysis into a single whole. In the first part, 5,889 patients (6,236 eyes) who underwent PHACO cataract surgery at the Eye department, Split University Hospital, over a 7-year period were included in the analysis. Patients were divided into two groups based on the presence or absence of PEX. Intraoperative PHACO parameters, intraoperative complications, and procedural costs were analyzed and compared between the groups, with a focus on differences in costs arising from the duration of surgical procedures. The appropriateness of diagnosis-related group (DRG) codes associated with PHACO cataract surgery was also evaluated. The second part included 151 patients with RRD treated at the Eye department, Split University Hospital, over a 3-year period using one of three surgical techniques: pneumatic retinopexy (PR), scleral buckling (SB), or pars plana vitrectomy (PPV). The anatomical and functional outcomes of each method were assessed. Additionally, an extensive health-economic analysis of costs and utility (measured by expected QALY values based on anatomical and functional outcomes) was performed. The cost-effectiveness of surgical techniques was compared using incremental cost-effectiveness ratio (ICER). Results: Pseudoexfoliation syndrome was diagnosed in 6.13% of cases included in the study. All intraoperative PHACO parameters were higher in the PEX group, particularly in patients with harder nuclear cataracts. The duration of the procedure was 1.5 times longer in the PEX group, and intraoperative complications were significantly more frequent. The expected costs of PHACO procedures were significantly higher in patients with PEX, regardless of nuclear cataract hardness (especially in patients with harder nuclei). These costs were not covered by the current DRG reimbursement system, leading to an expected unreimbursed cost loss per procedure ranging from 36% to as high as 69%. In the second part of the study, primary anatomical success was achieved in 86% of patients treated for RRD. There was no statistically significant difference in anatomical success among the three surgical techniques. However, functional outcomes (based on final visual acuity) significantly differed between the techniques. Consequently, expected QALY values also significantly varied, being lower for PPV compared to PR and SB. Furthermore, PR demonstrated dominant cost-effectiveness compared to PPV, with a cost-effectiveness ratio of -6,253 €/QALY. Conclusion: The study revealed that costs associated with PHACO cataract surgery in patients with PEX are significantly higher than in those without PEX and are not adequately covered by the current DRG system. This underscores the need to adjust the DRG reimbursement system for PHACO procedures in PEX patients, particularly those with harder nuclei. Adjustments and supplements to DRG reimbursement codes are also needed for RRD cases. The study also demonstrated that PR, in appropriate cases, is not only the most cost-effective technique for RRD repair but also yields the best functional outcomes. This should be particularly considered in countries with limited healthcare resources (such as Croatia), where decisions regarding RRD treatment should be based on cost-utility analyses
INCOME FROM SELF-EMPLOYMENT
No full textDohodak od nesamostalnog rada je razlika između primitaka priteklih u poreznom razdoblju i izdataka nastalih u istom poreznom razdoblju. Plaća predstavlja primitak koji poslodavac isplaćuje ili daje u naravi radniku na temelju radnog odnosa. Prema poreznim propisima plaća se tretira kao dohodak od nesamostalnog rada, a njen bruto iznos uključuje doprinose, poreze, prirez i neto iznos. Dohodak od nesamostalnog rada važan je segment poreznog sustava jer obuhvaća većinu zaposlenih osoba koje ostvaruju prihode kroz radni odnos. Dohodak od nesamostalnog rada podliježe jasno definiranim pravilima obračuna pri čemu ključnu ulogu imaju doprinosi, osobni odbitak i primjena progresivnih poreznih stopa. Analizirani primjeri pokazuju kako dodatne isplate poput bonusa i neoporezivih naknada, plaće u naravi utječu na ukupni porezni teret i neto primanja radnika.Income from employment is the difference between receipts received in a tax period and expenses incurred in the same tax period. A salary is a receipt that an employer pays or gives in kind to an employee based on an employment relationship. According to tax regulations, a salary is treated as income from employment, and its gross amount includes contributions, taxes, surtax and the net amount. Income from employment is an important segment of the tax system because it covers the majority of employed persons who earn income through employment. Income from employment is subject to clearly defined calculation rules, with contributions, personal allowances and the application of progressive tax rates playing a key role. The analysed examples show how additional payments such as bonuses and non-taxable benefits, salary in kind affect the total tax burden and net income of employees
Prevalence of the Mediterranean diet in the general adult population of the Split-Dalmatia County: a cross-sectional study
No full textCilj: Glavni je cilj ovoga istraživanja bio ispitati učestalost mediteranske prehrane u odrasloj populaciji ispitanika Splitsko-dalmatinske županije.
Metode i ispitanici: Presječno istraživanje provodilo se od travnja do srpnja 2024. godine. Korištene su metode online upitnika, papirnatih anketa (metoda snježne grude) te dijeljenja poveznice putem aplikacije Whatsapp.U istraživanju je sudjelovalo 753 ispitanika iz Splitsko-dalmatinske županije. Upitnik je obuhvaćao opće demografske podatke te MDSS (Indeks konzumiranja mediteranske prehrane). Također su analizirani i čimbenici poput dobi, spola, konzumacije doručka te broja glavnih obroka.
Rezultati: Rezultati su pokazali da se manje od 10 % ispitanika Splitsko-dalmatinske županije pridržava obrasca mediteranske prehrane. Statistički značajna povezanost vidljiva je u povezanosti starije dobi (p = 0,002), ženskog spola (p = 0,006) i redovitog doručkovanja (p = 0,029) s pridržavanjem preporuka mediteranske prehrane. Žene su se, u odnosu na muškarce, češće pridržavale preporučene količine konzumacije voća, povrća, mliječnih proizvoda te smanjene konzumacije crvenog mesa. S druge strane, muškarci su se češće pridržavali konzumacije preporučene količine vina. Multivarijantna analiza potvrđuje da su dob, spol i konzumacija doručka najvažniji prediktori u pridržavanju obrasca mediteranske prehrane.
Zaključak: Istraživanje je pokazalo nisku razinu pridržavanja mediteranske prehrane među odraslom populacijom Splitsko-dalmatinske županije. Potrebno je podignuti svijest o važnosti mediteranske prehrane u sprečavanju nastajanja kroničnih bolesti te podizanja kvalitete života ponajviše među muškarcima te mlađim dobnim skupinama.Objective: The main objective of this study was to examine the prevalence of the Mediterranean diet among the adult population of Split-Dalmatia County.
Methods and Participants: This cross-sectional study was conducted from April to July 2024. Data collection methods included online questionnaires, paper-based surveys (snowball sampling method), and link sharing via the WhatsApp application. A total of 753 participants from Split-Dalmatia County took part in the study. The questionnaire included general demographic data and the MDSS (Mediterranean Diet Serving Score). Factors such as age, gender, breakfast consumption, and the number of main meals were also analyzed.
Results: The results showed that less than 10% of participants from Split-Dalmatia County adhered to the Mediterranean dietary pattern. Statistically significant associations were found between older age (p = 0.002), female gender (p = 0.006), and regular breakfast consumption (p = 0.029) with adherence to Mediterranean diet recommendations. Compared to men, women were more likely to follow recommended intakes of fruits, vegetables, dairy products, and reduced consumption of red meat. Conversely, men were more likely to consume the recommended amount of wine. Multivariate analysis confirmed that age, gender, and breakfast consumption are the most important predictors of adherence to the Mediterranean dietary pattern.
Conclusion: The study revealed a low level of adherence to the Mediterranean diet among the adult population of Split-Dalmatia County. It is necessary to raise awareness of the importance of the Mediterranean diet in preventing chronic diseases and improving quality of life, especially among men and younger age groups
Prilagodljivo formativno vrednovanje temeljeno na poboljšanom modelu Bayesovog praćenja znanja
No full textThis doctoral thesis utilised enhanced Bayesian Knowledge Tracing (BKT) models to assess student knowledge adaptively and to extend the standard functionalities of widely used Learning Management Systems (LMS). It was hypothesised that incorporating time spent on task and the number of code evaluations in the introductory programming domain would enhance student performance’s predictive accuracy and knowledge mastery estimation within the vanilla BKT model. Empirical research employing in situ quasi-experimental design was conducted during an Introduction to Programming in Python course, involving a substantial sample of 174 undergraduate students. The weekly course topics were structured into granular Domain Knowledge Components (DKC) and Controlled Environment formative assessments (CE). The study examined 18 BKT models incorporating various combinations of Prior knowledge, Guess, Slip, Learn and Forgets parameter probabilities, implemented using the Python library for cognitive modelling, pyBKT. In general, the enhanced BKT models outperformed the baseline vanilla model in predicting student performance across multiple DKCs. Also, the enhanced BKT models outperformed the vanilla model in estimating students’knowledge mastery. Regarding the model convergence, the enhanced BKT models provided more effective and reliable paths to knowledge mastery than the vanilla model. The previous results supported the proposal of a framework for ranking BKT models based on their capacity to predict student performance, estimate knowledge mastery, and model efficient learning paths. This framework identified the most effective BKT models, offering a systematic approach to selecting models that outperformed the vanilla BKT model.Ne temelju prethodnih poboljšanja osnovnog Bayesovog modela za praćenje znanja učenika (eng. Bayesian Knowledge Tracing, BKT), u radu se istražuju BKT modeli za prilagodljivu procjenu znanja, proširujući pritom standardne funkcionalnosti sustava za e-učenje. Postavljena je hipoteza da uvođenje značajki vremena provedenog na pitanju i broja evaluacija koda u području početnog programiranja poboljšava prediktivnu točnost učenikovih odgovora te procjenu razine usvojenog znanja. Empirijsko istraživanje provedeno je korištenjem in situ kvazi-eksperimentalnog dizajna tijekom kolegija Uvod u programiranje u kojem je sudjelovalo 174 studenta prijediplomskog studija. Tjedni nastavni sadržaji strukturirani su u granularne komponente znanja (eng. Domain Knowledge Components, DKC) uz pripadajuća formativna vrednovanja (eng. Controlled Environment assessments, CE). Korištenjem pyBKT Python biblioteke za kognitivno modeliranje, istraženo je 18 BKT modela koji uključuju različite kombinacije parametara predznanja (eng. Prior), pogađanja (eng. Guess), slučajne pogreške (eng. Slip), učenja (eng. Learn) i zaboravljanja (eng. Forgets). Predloženi BKT modeli nadmašili su osnovni model u predviđanju uspjeha učenika u više DKC-ova. Također, nadmašili su osnovni model u procjeni razine usvojenog znanja. U kontekstu konvergencije modela, predloženi BKT modeli pružili su učinkovitije i pouzdanije modeliranje individualnih pristupa učenju. Rezultati istraživanja rezultirali su prijedlogom okvira za rangiranje BKT modela s obzirom na njihovu sposobnost predviđanja učenikovih odgovora, procjene razine usvojenog znanja i modeliranje individualnih pristupa učenju. Predloženi okvir identificirao je najučinkovitije BKT modele, nudeći sustavan pristup odabiru modela koji nadmašuju rezultate osnovnog BKT modela
DETERMINATION OF INTERNAL FORCES OF LANGERS GIRDERS
No full textU ovom radu izvršen je proračun i dimenzioniranje ojačane grede i štapova koji tvore ojačanje grede za dvije varijante ojačanja i za dva materijala. U uvodnom dijelu opisani su osnovni pojmovi koji se spominju u radu i predstavljena je metodologija rješavanja. U prvom dijelu proračuna greda se oslobaĎa od veza kako bi se odredile reakcije oslonaca. Nakon toga se upotrebom metode presjeka i metode čvorova odreĎuju sile unutar štapova ojačanja grede, a zatim se raspodjelom grede na karakteristične presjeke odreĎuju unutarnje sile tih presjeka. Povezivanjem rezultata unutarnjih sila karakterističnih presjeka dobiva se slika unutarnjih sila ojačane grede. U drugom dijelu proračuna predstavljena su dva materijala, te je za njih izvršeno dimenzioniranje grede i štapova koji tvore ojačanje.This paper contains the calculation and design of a reinforced beam and rods which make up the reinforcement structure, for two variants and two materials. The introduction describes basic terms and the problem solving methodology used in this paper. In the first part of the calculation the beam is relieved of all links and reactions of the supports are calculated. After that the method of sections and the method of joints are used to determine the forces inside the reinforcement rods. Finally, by dividing the beam into distinct sections, internal forces of those sections are calculated as well. By combining the results of the internal forces of distinct sections an image of internal forces of the beam is formed. In the second part of the calculation two materials are presented and then used as the basis for the design of the beam and reinforcement rods
LABOR RIGHTS PROTECTION THROUGH CRIMINAL LAW WITH A SPECIAL REFFERENCE TO THE NON-PAYMENT OF SALARY
No full textProblematika kaznenopravne zaštite radničkih prava tema je ovog rada. Prava radnika prvenstveno su predmet regulacije radnog prava, no ponekad gruba kršenja tih prava zahtijevaju inkriminaciju kaznenim pravom. Takve inkriminacije postoje u Hrvatskoj odavno, a trenutno važeći Kazneni zakon objedinio je pet kaznenih djela u Glavu XII. naziva „Kaznena djela protiv radnih odnosa i socijalnog osiguranja“. U radu će se analizirati svako od njih, počevši s povredom prava na rad, koja uključuje zaštitu tzv. zviždača, zaštitu od otkaza zbog sudjelovanja u zakonitom štrajku te neizvršavanje odluke suda o vraćanju radnika na posao. Kazneno djelo neisplate plaće, na koji će se staviti posebni naglasak u ovom radu, obuhvaća pet stavaka kojima se propisuju modaliteti počinjena ovog kaznenog djela, kao i razlozi isključenja protupravnosti te mogućnosti oslobođenja od kazne. U radu će se prikazati statistički podaci o prijavama za ovo kazneno djelo, broju odbačenih prijava i broju osuda, te će se analizirati §266a njemačkog Kaznenog zakona koji je poslužio hrvatskom zakonodavcu kao uzor pri inkriminaciji neisplate plaće. Na kraju će se analizirati zaštita dostojanstva radnika, odnosno zaštita od mobinga, povreda prava iz socijalnog osiguranja te protuzakonito zapošljavanje.The issue of labor rights protection through criminal law is the topic of this paper. Workers' rights are primarily subject to labor law regulation, but sometimes gross violations of these rights require incrimination by criminal law. Such incriminations have existed in Croatia for a long time, and the currently valid Criminal Code has united five criminal offenses in Chapter XII. titled "Criminal offenses against labor relations and social security". The paper will analyze each of them, starting with the violation of the right to work, which includes the protection of the so-called ‘whistleblower’, protection from dismissal for participating in a lawful strike, and failure to enforce a court decision to reinstate workers. The criminal offense of non-payment of salary, which will be given special emphasis in this paper, includes five paragraphs with the modalities of committing this criminal offense, as well as the reasons for excluding illegality and the possibility of exemption from punishment. The paper will present statistical data on reports of this criminal offense, the number of dismissed reports and the number of convictions, and will analyze §266a of the German Criminal Code, which served our legislator as a model for incriminating non-payment of salary. Finally, the protection of workers' dignity, i.e. protection against mobbing, violation of social security rights and illegal employment will be analyzed at the end of this paper
THE IDEA OF THE SOCIAL CONTRACT IN THE POLITICAL PHILOSOPHY OF JOHN RAWLSA
No full textRad ne sadrži sažetak
Budgetary Law
No full textProračunsko pravo grana je financijskog prava koja regulira donošenje proračuna i njegovo izvršenje. Proračun je osnovni financijsko pravni instrument kojim se predviđaju prihodi i rashodi države za jednu proračunsku godinu. U Republici Hrvatskoj, Hrvatski sabor je zadužen za donošenje proračuna, a za realizaciju proračuna zadužena je Vlada Republike Hrvatske. Zakon o proračunu uređuje planiranje, izradu, donošenje, izvršenje te sva druga pitanja vezana za javne financije.Budget law is a branch of financial law that regulates the adoption of the budget and its execution. The budget is the basic financial legal instrument that forecasts the state's revenues and expenditures for a single budget year. In the Republic of Croatia, the Croatian Parliament is responsible for adopting the budget, and the Government of the Republic of Croatia is responsible for implementing the budget. The Budget Act regulates planning, preparation, adoption, execution and all other issues related to public finances
IMPACT OF MEDIUM VOLTAGE NETWORK AUTOMATION ON REDUCING NETWORK LOSSES
No full textTema ovog završnog rada je analiza utjecaja automatizacije srednjenaponske mreže na smanjenje gubitaka u elektroenergetskom sustavu. Automatizacijom se omogućuje brže otkrivanje i otklanjanje kvarova, optimizacija tokova snage te učinkovitije upravljanje mrežom. U radu se istražuju ključne tehnologije automatizacije, kao što su senzori, komunikacijski sustavi i SCADA platforme, te njihov doprinos smanjenju tehničkih i netehničkih gubitaka. Kroz studiju slučaja prikazuje se konkretna primjena automatizacije i njezin utjecaj na poboljšanje pouzdanosti, sigurnosti i energetske učinkovitosti srednjenaponske mreže.The topic of this thesis is the analysis of the impact of medium-voltage network automation on the reduction of losses in the power system. Automation enables faster fault detection and elimination, optimization of power flows, and more efficient network management. The paper explores key automation technologies, such as sensors, communication systems, and SCADA platforms, and their contribution to reducing technical and non-technical losses. A case study is presented to demonstrate the practical application of automation and its impact on improving the reliability, safety, and energy efficiency of the medium-voltage network