Selection of an Insurance Company in Agriculture through Hybrid Multi-Criteria Decision-Making.

Crop insurance is used to reduce risk in agriculture. This research is focused on selecting an insurance company that provides the best policy conditions for crop insurance. A total of five insurance companies that provide crop insurance services in the Republic of Serbia were selected. To choose the insurance company that provides the best policy conditions for farmers, expert opinions were solicited. In addition, fuzzy methods were used to assess the weights of the various criteria and to evaluate insurance companies. The weight of each criterion was determined using a combined approach based on fuzzy LMAW (the logarithm methodology of additive weights) and entropy methods. Fuzzy LMAW was used to determine the weights subjectively through expert ratings, while fuzzy entropy was used to determine the weights objectively. The results of these methods showed that the price criterion received the highest weight. The selection of the insurance company was made using the fuzzy CRADIS (compromise ranking of alternatives, from distance to ideal solution) method. The results of this method showed that the insurance company DDOR offers the best conditions for crop insurance for farmers. These results were confirmed by a validation of the results and sensitivity analysis. Based on all of this, it was shown that fuzzy methods can be used in the selection of insurance companies.

Changes in the incidence of transfusion reactions in hematological patients over the past 30 years.

BACKGROUND: Patients with hematological diseases are polytransfused and often immunocompromised, therefore susceptible to transfusion reactions (TR). This study aims to document the incidence of TRs in adult hematological patients and assess the effect of changes in the production of blood components and transfusion practice on their occurrence. STUDY DESIGN AND METHODS: Retrospective observational analysis of TRs reported from 1993 to 2019 was performed. For the analysis of the effect of changes on the incidence of TRs, the evaluated time was divided into two periods: the 1st period before the introduction of changes in production, when leukoreduced blood components were used only selectively, and the 2nd period, when semi-automated method of production and universal leukoreduction was introduced. RESULTS: The decrease in the incidence of TRs was observed for both red blood cell (RBC) and platelet concentrate (PC) transfusions in the 2nd period. Since platelet additive solution has been used, a further decrease in the incidence was reported. The decrease in incidence was also observed for delayed hemolytic/serological transfusion reactions and for transfusion-transmitted bacterial infections. Four cases of incorrect blood transfusions were uniquely related to the hematological patients, caused by antigen loss and transfusion ordering after ABO-incompatible hematopoietic stem cell transplantation. DISCUSSION: Our results provided evidence that the introduction of tools offered by modern transfusion medicine: universal leukodepletion, plasma replacement with additive solutions, sensitive laboratory techniques, prophylactic antigen matching policy, informatization, and automatization, decreased the incidence of TRs and improved transfusion safety.

The role of serological and molecular testing in the diagnostics and transfusion treatment of autoimmune haemolytic anaemia.

Autoimmune haemolytic anaemia (AIHA) is a rare autoimmune disease characterised by haemolysis associated with the presence of immunoglobulins and/or components of the complement system on red blood cells (RBCs). It is classified into warm or cold antibody-mediated AIHA according to the temperature at which autoantibodies bind optimally to RBCs. Clinicians should be familiar with the procedural tests used for a complete laboratory investigation of AIHA. Good collaboration between clinicians and laboratory specialists with correct sample handling and an exact diagnostic work-up is extremely important for the correct classification and proper therapeutic management of AIHA. Specialised serological test procedures are very complex. Problems with serological testing may be excluded with the molecular testing, which has now become a gold standard to predict a patient's phenotype in order to secure the right antigen-matched blood for AIHA patients. More recently, genotyping has been used instead of serological typing and complex adsorption tests. This paper offers a description of various tests for differentiating between types of AIHA. A diagnostic algorithm and the problems of laboratory investigation are also presented, and an application of molecular methods for the blood group typing in AIHA is elaborated.

K antigens on neonatal red blood cells blocked by anti-K with titer of 32.

CONCLUSIONS: The blocking of red blood cell (RBC) antigens occurs when potent maternal antibodies bind to antigens on fetal or neonatal RBCs, causing them to be negative when typed with human IgM antisera. This phenomenon is rare; when it does occur, the antibody is usually of a high titer. This reported finding is typically due to anti-D, with rare reports describing false-negative K phenotyping due to blocking by maternal anti-K. We report a case of a potent anti-K with a titer of 32 that blocked K antigens on neonatal RBCs, causing them to phenotype as K-. The neonate also had clinically significant anemia (i.e., hemolytic disease of the newborn) due to the anti-K.

Exploring training dental implant placement using computer-guided implant navigation system for predoctoral students: A pilot study.

INTRODUCTION: Recent computer-guided dynamic navigation systems promise a novel training approach for implant surgery. This study aimed to examine learning progress in placement of dental implants among dental students using dynamic navigation on a simulation model. MATERIALS AND METHODS: Senior students with no implant placement experience were randomly assigned five implant placement attempts involving either three maxillary or four mandibular implants distributed in the anterior/posterior, and left/right segments. Implant placement was planned using a Navident Dynamic Guidance system. Surgical time was recorded. Horizontal, vertical and angulation discrepancies between the planned and placed implant positions were measured using superimposed CBCT scans. Data were analysed with repeated measures regression with Tukey's adjusted pairwise comparisons (α = 0.05). RESULTS: Fourteen students participated, with a mean age of 26.1 years and equal males and females. Mean time for implant placement was associated with attempt number (P < 0.001), implant site (P = 0.010) and marginally related to gender (P = 0.061). Students had a significant reduction in time from their first attempt to their second (10.6 vs 7.6 minutes; adjusted P < 0.001) then plateaued. Overall 3D angulation (P < 0.001) and 2D vertical apex deviation (P = 0.014) improved with each attempt, but changes in lateral 2D (P = 0.513) and overall 3D apex deviations (P = 0.784) were not statistically significant. Implant sites were associated with lateral 2D, 2D vertical and overall 3D apex deviation (P < 0.001). DISCUSSION: Males were marginally faster than females, had slightly lower overall 3D angulation, and reported higher proficiency with video games. Novice operators improved significantly in speed and angulation deviation within the first three attempts of placing implants using dynamic navigation. CONCLUSION: Computer-aided dynamic implant navigation systems can improve implant surgical training in novice population.

Susceptible and protective HLA-DR and HLA-DQ alleles for Fya alloimmunization in the Croatian population.

BACKGROUND: Alloimmunization is a known risk of transfusion therapy caused by exposure to foreign RBC antigens. However, alloimmunization is not observed in all transfused patients. Human leukocyte antigen (HLA) molecules may contribute to the recognition and presentation of foreign antigens and to the potency of immune responses that result in the production of antibodies. The aim of this study was to determine the association of HLA-DR and HLA-DQ polymorphisms with alloimunization to Fya antigen in Croatian patients. STUDY DESIGN AND METHODS: The study was conducted on 70 alloimmunized patients to Fya antigen and two control groups: 165 healthy Croatian individuals (Control 1) and 45 Fya antigen-negative nonimmunized patients exposed to Fya antigen (Control 2). Phenotype frequencies for HLA-DRB1 and HLA-DQB1 alleles were compared between the cases and control groups. RESULTS: Statistically significant differences in phenotype frequencies between cases and controls were found for DRB1*04 (odds ratios [ORs], 10.5 and 18.7 for Control 1 and Control 2, respectively), DRB1*15 (ORs, 8.0 and 6.9), and DQB1*02 alleles (ORs, 0.2 and 0.03); and DRB1*04-DQB1*03:01 (ORs, 7.9 and 17.6), DRB1*04-DQB1*03:02 (ORs, 5.5 and 7.6), DRB1*15-DQB1*06:02 (ORs, 7.3 and 5.5), DRB1*03-DQB1*02:01 (OR, 0.1), and DRB1*07-DQB1*02:02 (OR, 0.3) haplotypes. CONCLUSION: Several HLA-DRB1 and HLA-DQB1 alleles and haplotypes were proved to contribute to and protect from alloimmunization to Fya antigens. Alleles DRB1*04 and DRB1*15, as well as haplotypes DRB1*04-DQB1*03:02 and DRB1*15-DQB1*06:02 can be considered as risk factors, while allele DQB1*02 and haplotype DRB1*03-DQB1*02:01 have a protective role in Fya alloimmunization.

[Analysis of preoperative autologous blood donation in patients having revision hip arthroplasty]. / Analiza prijeoperacijske donacije autologne krvi za ugradnju revizijskih endoproteza kuka.

Preoperative donation of blood for autologous transfusion has become a routine practice for patients who are scheduled to have an ortopaedic procedure. The purpose of this retrospective study was to evaluate the effect of preoperative autologous donation on reduction of allogeneic blood transfusion in patients undergoing revision hip arthroplasty. Data of 289 patients who had had a revision total hip arthroplasty during sixty-six-month period were evaluated retrospectively. One hundred and thirty-eight patients donated 1 or two units of autologous blood (47.8%), and 151 patients (52.2%) did not. Preoperative autologous blood reduced allogeneic blood transfusion in patients who had a revision of femoral component only or revision of acetabular component only. Two predonated autologous units and basic hemoglobin level >150 g/L reduced allogeneic blood transfusion in patients who had revision of acetabular and femoral component. All patients who had revision of acetabular and femoral component and had basic hemoglobin level <120 g/L, required additional allogeneic blood transfusion despite predonation blood.