Search Results (186)

Purpose: This retrospective study aimed to compare the efficacy of cycloplegic (CR) versus non-cycloplegic refraction (NCR) methods in detecting refractive errors among children and adolescents. Methods: Electronic data from pediatric ophthalmology clinics at the University Hospital “Sveti Duh”; Zagreb, Croatia, from January 2008 to July 2023, were analyzed. Comprehensive eye examinations, including Logarithmic Visual Acuity tests, subjective refraction, cycloplegic retinoscopy, slit lamp, and fundus examinations, were conducted. Results: The dataset included 1075 individuals, with 180 undergoing NCR and 895 undergoing CR. In premyopes, the NCR group had a longer follow-up (5.04 vs. 3.45 years; p < 0.001) with similar SE progression. In low myopia, NCR showed more negative first visit SE (−1.86 D vs. −1.35 D; p < 0.001) and faster progression (p = 0.01). In high myopia, follow-up was longer in NCR (5.08 vs. 2.08 years; p = 0.03) with no other significant differences. SE progression was highest in 4–6-year-olds and significantly faster in NCR (−0.61 vs. −0.40 D/year; p = 0.05). Conclusions: Cycloplegic refraction is essential for accurately assessing refractive status, especially in cases of low myopia, as it prevents misclassification and ensures precise evaluation in children and adolescents, thereby facilitating the appropriate diagnosis and treatment of refractive errors. Full article

Background/Objectives: A direct link between sensory processing disorder (SPD) and strabismus has not been systematically investigated, though prior studies suggest sensory modulation may influence visual behaviors. Traditional approaches view strabismus through a binary lens—either normal or pathological motor deviation. This report presents a proof-of-concept case suggesting strabismus may represent a neurobehavioral manifestation of sensory processing imbalance, rooted within the broader framework of SPD. Methods: We report a pediatric case marked by episodic monocular eye closure triggered by environmental stimuli, without identifiable ophthalmologic or neurologic pathology. The child’s symptoms were most consistent with sensory over-responsivity (SOR), a subtype of SPD, manifesting as stimulus-bound monocular eye closure and secondary self-regulatory behaviors. Results: We propose the Fusion Dysregulation Hypothesis, suggesting that exotropia and esotropia represent opposing outcomes along a continuum of sensory connectivity: exotropia arising from neural underwiring (hyporesponsivity and fusion instability), and esotropia from overwiring (hyperresponsivity and excessive fusion drive). Our case, marked by sensory hyperresponsivity, showed frequent monocular eye closure that briefly disrupted but did not impair fusion. This suggests an “overwired” binocular system maintaining single vision despite sensory triggers. In early-onset esotropia, such overconnectivity may become maladaptive, leading to sustained convergence. Conversely, autism spectrum disorder, typically associated with hypoconnectivity, may predispose to exotropia through reduced fusion maintenance. Conclusions: These findings highlight the need for interdisciplinary evaluation. We advocate for structured sensory profiling in children presenting with strabismus and, conversely, for ophthalmologic assessment in those diagnosed with SPD. While our findings remain preliminary, they support a bidirectional screening approach and suggest that sensory modulation may play a previously under-recognized role in the spectrum of pediatric strabismus presentations. Full article

Field data, as the basis for planning and designing forest roads, must have high spatial accuracy. Classical (using a theodolite and a level) and modern (based on total stations and GNSSs) surveying methods are used in current field data survey for forest road design. This study analyzed the spatial accuracy of classical and modern surveying methods, the accuracy of spatial data recorded using a UAV equipped with an RGB camera at different flight altitudes, and the accuracy of lidar data of the Republic of Croatia. This study was conducted on a forest area where salvage logging was carried out, which enabled the use of a GNSS receiver in RTK mode as a reference method. The highest RMSE values of the spatial coordinates were recorded for measurements obtained with the classical surveying method (0.89 m) and a total station (0.33 m). The flight altitude of the UAV did not significantly affect the spatial error of the collected data, which ranged between 0.07 and 0.09 m. The cross-terrain slope, as one of the factors that significantly affect the amount of earthworks, did not differ statistically significantly between the methods. The ALS error was strongly influenced by the cross-terrain slope. The authors conclude that the new survey methods (SfM and lidar data) provide high-accuracy data but also draw attention to challenges in their use, such as vegetation and biomass on the ground. Full article

Potyviruses (family Potyviridae, genus Potyvirus), including emerging ones, pose a growing threat to cucurbit production. This study presents the first virome analysis of severely symptomatic cucurbits in continental Croatia, combining high-throughput sequencing (HTS) and RT-PCR diagnostics. Zucchini, cucumber, and butternut squash plants with severe virus-like symptoms sampled in 2021–2022 were found to consistently host a complex of potyviruses, including watermelon mosaic virus (WMV), zucchini yellow mosaic virus (ZYMV), and Moroccan watermelon mosaic virus (MWMV)—the latter being newly reported in Croatia and representing likely its northernmost detection in Europe. Phylogenetic analysis classified WMV isolates as emerging strains of subgroup EM3 and ZYMV as subgroup A1, consistent with European lineages. Croatian MWMV isolates formed a distinct subclade within the Mediterranean group, raising questions about its diversification trajectory. The findings highlight the expanding range of MWMV and underscore the value of HTS for early detection of emerging threats. These results have critical implications for cucurbit disease management, indicating the need to re-evaluate resistance claims in commercial cultivars and implement stricter phytosanitary surveillance in Croatia. The potential role of climate change in facilitating virus spread via aphid vectors is discussed, warranting further risk assessment and international monitoring efforts. Full article

Maize is one of the most important agricultural crops that has been cultivated in the Republic of Croatia for centuries. Fusarium mycotoxins as secondary metabolites of molds that naturally contaminate maize crops can have negative effects on human and animal health, but also on economic aspects. The aim of this study was to monitor the trend of natural occurrence of Fusarium mycotoxins in maize crops from Croatia during a period of 10 years, from 2014 to 2024. A total of 1285 maize samples were analyzed for the contents of zearalenone (ZEN), deoxynivalenol (DON), fumonisins B (FUM) and T-2/HT-2 toxin (T-2/HT-2) using validated ELISA methods. A high occurrence of the analyzed mycotoxins was found in all years examined, e.g., for ZEN 15–64%, DON 47–95%, FUM 60–96% and T-2/HT-2 24–89%. In addition, their concentrations ranged from 3.2–10,990 μg/kg, 18–25,000 μg/kg, 29–18,180 μg/kg and 9–595 μg/kg, respectively. The mycotoxin concentrations were found to differ from year to year, with an increasing trend observed for FUM and T-2/HT-2 in terms of concentrations and an increasing trend in the occurrence of all mycotoxins, with the exception of T-2/HT-2. Full article

Background/Objectives: The purpose of this study was to determine the incidence of salivary gland tumors based on age, gender, histological type, and localization over an eleven-year period at the University Hospital of Split. Methods: The medical records of the Department of Otorhinolaryngology with Head and Neck Surgery and the Department of Maxillofacial Surgery at the University Hospital of Split regarding salivary gland tumors were searched from January 2012 to December 2022. The current fifth World Health Organization (WHO) Classification of Head and Neck Tumors and its criteria were considered during that process. Results: Out of 404 patients, 211 (52.20%) were female and 193 (47.77%) male. The mean age was 60. There were four pediatric patients. Six patients had a combination of two different histological types of salivary gland tumors present simultaneously at the exact localization. Therefore, there were 410 histological types in total, 214 related to females and 196 to males. A total of 361 (88.05%) benign and 49 (11.95%) malignant primary salivary gland tumors were detected. The parotid gland was the predominant location (N = 361, 87.8%). There were no cases affecting the sublingual gland. Pleomorphic adenoma was the most common benign histological type (N = 169, 41.2%). The most common malignant histological types were adenoid cystic carcinoma (N = 9, 2.2%) and mucoepidermoid carcinoma (N = 9, 2.2%). The average incidences of salivary gland tumors in the 11 years for the four Dalmatian counties and the Republic of Croatia were 4.45/100,000 and 0.9/100,000, respectively. Conclusions: The results of this study, primarily the ones concerning histological types and localization, do not deviate from general knowledge about salivary gland tumors. Simultaneous and ipsilateral occurrence of different histological types is a rare and extremely valuable finding. The average incidence for Dalmatian counties and the Republic of Croatia is within the range of the International Agency for Research on Cancer estimates. Full article

Energy efficiency (EE) is an important driver of quality of life (QoL), which is an overarching goal of sustainable development (SD). The levels of these phenomena in the European Union (EU) vary. Previous analyses presented in the literature have focused mainly on a one-dimensional view of EE and QoL. The authors of this article, given the multidimensional nature of the phenomena under study, present both categories from a holistic perspective. The purpose of this study was to identify the level of QoL in the context of EE and to compare the results of the classification of EU countries in terms of the analyzed phenomena. The study was conducted using the ELECTRE Tri method, one of the advanced techniques of multi-criteria decision analysis (MCDA). The classification procedure used made it possible to assign countries to predefined decision-making categories on the basis of preference threshold values and dominance relations to reference profiles. The 27 EU member states were analyzed on the basis of empirical data from 2023, using a set of 20 indicators characterizing EE and QoL. Countries were assigned to one of five classes, differentiating the level of development in both analyzed areas. Optimistic and pessimistic approaches were used to assess the stability of the classifications. The analysis showed the presence of countries with consistent results (e.g., Poland and Germany), extreme countries (Ireland and the Netherlands—high QoL with low EE; Romania and Croatia—inversely), as well as non-unique cases (e.g., Malta, the Czech Republic/Czechia, and Finland). The spatial approach indicated regions requiring special support. The results of the study can be a useful tool to support the process of designing public policies aimed at integrating social, economic, energy, and environmental goals within SD. Full article

This study systematically examines the impact of immigration, emigration, and the influx of foreign workers on employment, unemployment, and economic growth in the Republic of Croatia. The primary objective of the research is to understand how these demographic and economic changes shape the labor market and evaluate their long-term effects on gross domestic product (GDP) and wage levels. The methodology used in this study involves a comprehensive analysis of macroeconomic data from Croatia over the past 11 years, focusing on critical indicators such as employment, unemployment, immigration, emigration, foreign workers, wages, and GDP trends. This approach provides valuable insights into how migration patterns influence critical labor market indicators. The findings reveal that immigration and foreign workers significantly impact employment, particularly in stabilizing sectors like tourism and construction. Additionally, a positive correlation was found between the number of foreign workers and GDP growth. In conclusion, the research underscores the importance of immigration and foreign workers in addressing labor shortages and driving economic growth in Croatia. However, targeted policies are needed to ensure the successful integration of foreign workers and the long-term sustainability of the domestic labor market. Full article

For effective transportation planning, land use, travel behavior, and infrastructure capacity should be optimized to support sustainable urban growth and reduce congestion. Every new site development generates traffic volume, which can affect the quality of traffic flow in the surrounding road network. Therefore, trip generation, which predicts future travel demand, is a crucial step in the traditional four-step transportation model. In this context, the main objective of this study is to develop a model for estimating vehicle trip generation due to the construction of a shopping center, which is a significant traffic generator. The survey was conducted in Split (Croatia) at five existing locations, and linear regression analysis was used to develop models for different time periods. The results indicated that vehicle trips are strongly correlated with the gross floor area of shopping centers, with a high coefficient of determination. Additionally, this study presents a comparison of measured traffic volumes with estimates using ITE Trip Generation Manual equations. The findings suggest that these vehicle trip estimates should be reduced by approximately 40%. Since no previous studies have been conducted on the impact of land use on trip generation in the Republic of Croatia, the developed models represent a first step in creating a database that should be expanded with new data. Estimating the traffic generated by a new site development is a crucial component of traffic management, as it helps planners and engineers assess its impact on the surrounding road network and implement necessary measures to ensure efficient and safe traffic flow. Full article

Disease-causing variants in the IDH3A gene are associated with autosomal recessive retinitis pigmentosa 90 (RP90) and Leber congenital amaurosis, with or without macular pseudocoloboma. Here, we report two patients: one compound heterozygous for IDH3A c.364G>A, p.(Ala122Thr), which has conflicting classifications, and for IDH3A c.293C>T, p.(Pro98Leu), which is likely pathogenic, and the other homozygous for IDH3A c.364G>A, p.(Ala122Thr). This study is aimed at providing evidence to link the latter variants to a clinical phenotype. The first patient was a 6-year-old girl, and the second patient was a 29-year-old female. In both patients, the diagnostic assessments were consistent with the phenotype of RP, characterized by macular pseudocoloboma but of varying severity. Patients’ phenotypes suggest that the c.293C>T, p.(Pro98Leu) variant is linked to a more severe and extensive clinical phenotype, while the c.364G>A, p.(Ala122Thr) variant results in a milder condition, primarily limited to retinal involvement. In Patient 2, the presence of both global and local stereopsis, indicating advanced visual development, suggests that the p.(Ala122Thr) missense variant may act as a hypomorphic allele which likely allows for some residual enzymatic activity of the IDH3A protein. This report highlights that macular pseudocoloboma can manifest even in the absence of a null variant. In contrast, more severe symptoms, such as mitochondrial encephalopathy, seem to be associated with the presence of a null allele. Furthermore, to the best of our knowledge, this is the first report of the IDH3A c.293C>T, p.(Pro98Leu) variant. Full article

Background/Objectives: This case report presents a unique case of multiple postoperative complications, including sterile silicone implant extrusion, symblepharon formation, and the development of a giant cyst, following extensive multimodal chemotherapy for unilateral retinoblastoma in a pediatric patient. The case was further complicated by recurrent methicillin-resistant Staphylococcus aureus (MRSA) colonization, which persisted despite multiple eradication attempts. Methods: A 5-year-old boy presented with right-sided proptosis one year after receiving a secondary dermis-fat orbital graft. He had undergone 12 cycles of intravitreal, intra-arterial, and systemic chemotherapy as well as thermotherapy and cryotherapy due to recurrent retinoblastoma in the right eye. Following a third relapse, secondary enucleation was performed with a primary silicone orbital implant. However, extrusion of the implant occurred, and an orbital swab confirmed MRSA colonization. A secondary dermis-fat graft was harvested and implanted after ensuring MRSA clearance. A year later, the child developed rapid right-sided proptosis. Ultrasound revealed a cyst within the dermis-fat graft measured 23.6 mm in anteroposterior diameter. Surgery was postponed due to chickenpox, and the cyst enlarged reaching an anteroposterior diameter of 26.7 mm over two months. A complete excision was performed. Results: The surgery was uneventful. Intraoperative orbital swab was sterile, but MRSA was detected in a conjunctival swab, leading to treatment with local moxifloxacin drops and oral rifampicin. Conclusions: Giant cyst formation in a dermis-fat graft is an extremely rare complication. Complete excision remains the treatment of choice. However, in this case, it resulted in persistent anophthalmic socket syndrome, posing further reconstructive challenges. Full article

The aim of this study is to examine the impact of key competitiveness factors on sustainable business performance in the hospitality sector through the application of an integrated approach, from the perspective of hotel service users. The research was conducted on a sample of 1640 hotel guests who stayed in hotels operating in the Republic of Serbia, Croatia, and Slovenia. Utilizing a structural equation modeling (SEM) framework, the study meticulously analyzed various competitiveness factors: service quality, service, service recovery, hotel user satisfaction, loyalty and discretionary behavior and dysfunctional consumer behavior. The results of the research reveal that all identified key factors significantly impact the sustainable performance of hotel operations. The findings suggest that hotels must prioritize these elements to enhance their competitiveness and ensure ongoing success in a challenging market environment. Notably, one intriguing finding is that loyalty does not serve as a buffer in the relationship between customer dissatisfaction and dysfunctional behavior, indicating that even loyal customers can exhibit negative behaviors when their expectations are not met. This underscores the importance of addressing guest satisfaction proactively to mitigate potential adverse outcomes and retain a loyal customer base. Moreover, this study provides valuable insights for hotel management, highlighting the necessity for holistic strategies that not only aim to improve guest experiences but also consider the intricate dynamics between various competitiveness factors that ultimately contribute to the sustainability and profitability of the hospitality industry. Rejecting the sub-hypothesis that loyalty among hotel service users moderates the impact of dissatisfaction on the expression of dysfunctional consumer behavior indicates the need to review certain theories that comprise the dominant theoretical framework in the field of hospitality. This implies the need for further analysis of the validity of the dominant theories in the hospitality industry, especially in defining the conditions under which their postulates hold indisputably. Second, further examination of the role of loyalty is needed, since there are different types of loyalty. Full article

Background: Nutritional support through oral nutritional supplements (ONSs) is important for patients. It leads to improved nutritional intake and better clinical and economic outcomes. Objectives: The problem that often accompanies the use of ONSs is their consumption below the optimal prescribed doses. One of the reasons for this is patient education on the importance of ONS intake. This study investigated hospitalized patients and focused on the impact that educational sources have on ONS intake. It also investigated patient compliance with the intake of the prescribed dose, and the time of initiation and discontinuation of ONS consumption. Methods: A qualitative survey using an anonymous questionnaire was conducted on 120 hospital patients across three locations in the Republic of Croatia: Varaždin General Hospital, the Special Hospital for Chronic Diseases in Novi Marof, and the hospital for lung diseases and tuberculosis in Klenovnik. Data were collected by independent nurses and analyzed using appropriate statistical tests, including Shapiro–Wilk, Levene, Mann–Whitney, and χ² tests. Results: There is a statistically significant difference between compliance with the intake at home and the source of information on how to consume ONSs (p = 0.003). There is also a statistically significant difference between compliance with intake at home and the initiation of ONS consumption (p = 0.000) with a key time of six months (half a year) when most of them give up. Conclusions: Only 47.95% complied with the recommended dose of ONS intake at home who received the information from a nurse, if we look at the information source. There is a clear need to change patient education by developing a standardized form and tools accessible to patients. After six months, most patients discontinue ONS consumption. Further research is necessary to determine whether a medical specialist is the reason for discontinuation, or whether discontinuation happened due to insufficient education on the importance of ONS intake. Full article

A three-year pilot study investigated the effectiveness of artificial intelligence (AI) as a motivational tool for teaching programming concepts within the Croatian Informatics curriculum. The study was conducted in schools through the extracurricular activity EDIT CodeSchool with the Development of Intelligent Web Applications (RIWA) module. Twelve schools in Split-Dalmatia County in the Republic of Croatia participated, resulting in 112 successfully completed student projects. The program consisted of two phases: (1) theoretical instruction with examples and exercises, and (2) project-based learning, where students developed final projects using JavaScript and the ml5.js library. The study employed project analysis and semi-structured student interviews to assess learning outcomes. Findings suggest that AI-enhanced learning can effectively support programming education without increasing instructional hours, providing insights for integrating AI concepts into existing curricula. Full article

The management of public institutions is focused not only on providing and improving public services but also on managing the physical infrastructure that these institutions use—buildings for provision of such services. The focus of this paper is on decision support to the management of individual buildings and the set of such buildings (portfolio) during the planning phase. More precisely, it is directed towards support towards both the decision-maker (DM) and decision-making process (DMP) when planning construction activities/projects such as maintenance, renovation, reconstruction, extension, construction, design/preparation of project-technical documentation, etc. The aforementioned DMP includes the processing of a large amount of diverse data (technical, economic, social, etc.) expressed differently—numerically or descriptively, as well as in different units of measurement, simultaneously taking into account the different wishes and attitudes of stakeholders (consequently meeting their often conflicting goals and criteria). The above indicates that it is a complex and ill-defined multi-criteria problem faced by the DM/planner. On top of that, and knowing that the DM usually does not have all the necessary knowledge and skills, this paper proposes how to overcome these issues by supporting the DM within the DMP during such a planning process. The proposed concept promotes an integral (considering relevant aspects of this management problem) and inclusive (taking into account the views of relevant stakeholders) approach to managing complex construction projects and their portfolios. It is methodologically based on the logic of decision support systems and multi-criteria analysis. The multi-criteria methods used include the Preference Ranking Organization METhod for Enrichment Evaluation (PROMETHEE) for the evaluation and comparison of alternatives in an integral manner, as well as the Analytic Hierarchy Process (AHP) for determining the weights of criteria and achieving an inclusive and consistent approach to relevant stakeholders (based on the goal tree approach). The concept was tested on the planning of infrastructure management at a university in the Republic of Croatia, and it was proven to be useful because it provided the DM with a basis for decision making. The usefulness of the concept was confirmed by the concordance of the plan obtained using the concept and the activities/projects actually realized. Full article