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In contemporary narratives, rural landscapes and identities, as judged by the inhabitants' sense of belonging, continue to be important points that need to be (re)considered when discussing places as instruments for local development. This paper pushes forward these debates and explores the construction of rural and regional identity in Romania with the help of a case study that focuses on perceptions of rural landscapes as cultural heritage in two rural communities situated on opposite sides of the river Mureș. Based on participant and ethnographic observation and making use of a survey and a qualitative analysis, this paper highlights the most significant features of the local cultural identities and their rural landscape heritage expressed by the two sets of people, which often coincide with the most important characteristics attributed to the regions separated by the river Mureș. The results of this study underline the dividing role of the river in the preservation of rural identity and cultural heritage. They also demonstrate that rural landscapes and the construction of identities along the river have generated both development opportunities and various risks. [ABSTRACT FROM AUTHOR]

Simple Summary: Achieving improved rates of overall survival remains a significant challenge in advanced-stage ovarian cancer; even if complete debulking is achieved, certain patients report poor results in terms of survival. Therefore, the aim of this paper is to investigate new prognostic markers that could point out which cases could benefit most from debulking surgery and which ones should be rather submitted to neoadjuvant therapies followed by debulking surgery. Background: Despite improving surgical techniques and achieving more often complete debulking procedures, certain patients with advanced-stage ovarian cancer still have a very poor prognosis. The aim of the current paper is to investigate whether inflammatory and nutritional status can predict the long-term outcomes of ovarian cancer patients. Methods: A retrospective analysis of 57 cases diagnosed with advanced-stage ovarian cancer submitted to surgery as first intent therapy was carried out. In all cases, the preoperative status was determined by calculating the CRP/albumin ratio, as well as the Glasgow score, the modified Glasgow score and the prognostic nutritional index. Results: Patients presenting higher values of the CRP/albumin ratio, with a higher Glasgow score, modified Glasgow score and prognostic nutritional index (PNI), were more frequently associated with incomplete debulking surgery, a higher peritoneal carcinomatosis index and poorer overall survival (20 months versus 9 months for the CRP/albumin ratio p = 0.011, 42 versus 27 versus 12 months for the Glasgow score p = 0.042, 50 versus 19 versus 12 months for the modified Glasgow score, p = 0.001, and 54 months versus 21 months, p = 0.011 for the prognostic nutritional index). Conclusions: A strong relationship between the nutritional and inflammatory status in advanced-stage ovarian cancer seems to exist. [ABSTRACT FROM AUTHOR]

Industrial Organization, the Resource-Based View, and the Relational View are some classical, well-established, and widely accepted theories in the strategic management domain regarding the understanding, explanation, and prediction of competitive advantage of firms and above-average firm performance. Recent evidence of economic geography and regional economics added to this stream of research new perspectives like cluster theory and microeconomic competitiveness. Despite the high enthusiasm with which companies and policymakers embraced the new advancements, there is some contradictory evidence regarding the positive effect of local conditions on firm performance. Thus, in this paper, we aim to empirically test some aspects of a modern regional development theory, proposed mainly by Michael Porter and collaborators, and the impact of these aspects on firm performance. External determinants considered at three levels of analysis (local economy, local clusters, and industry) will be investigated in relation to firm performance. We will analyze empirical data through detailed correlational analyses and by building multilinear regression models. After the statistical analysis of the answers provided directly by 67 medium and large manufacturing companies operating in Romania, we will provide empirical support for some external determinants, while for other determinants, we will show that the data rejected the proposed associations. The main conclusion derived from this study is that different combinations of external determinants, considered at all three levels of analysis, have a positive and significant effect on different measures of firm performance. The findings in our paper are important for both regional economics and the strategic management literature, suggesting the importance of creating local or urban conditions depending on the type of performance that the firms in the local economy are underperforming. [ABSTRACT FROM AUTHOR]

Due to its simplicity, the one-diode model is commonly used for modeling the operation of photovoltaic (PV) modules at standard test conditions (STC). However, its inherent implicit nature often presents challenges in modeling PV energy production. In this paper, the innovative explicit one-diode model developed by us over time is adapted for estimating PV power production under real weather conditions. Simple yet accurate equations for calculating the energy output of a PV generator equipped with a maximum power point tracking (MPPT) system are proposed. The model's performance is assessed under various normal and harsh operating conditions against measured data collected from the experimental setup located at the Solar Platform at West University of Timisoara, Romania. As an application of the new equation for maximum power, this paper presents a case study where the energy loss in the absence of an MPPT system is evaluated based on atmospheric and sky conditions. [ABSTRACT FROM AUTHOR]

This study focuses on an overview of two programs applied to the residential building stock of Bucharest (Romania), namely, the seismic strengthening program and the thermal rehabilitation program. The methodology for seismic risk assessment given in the current generation of Romanian codes, as well as in previous regulations, is examined. A brief review of other seismic risk assessment methodologies currently applied in various seismically prone countries is also presented. Examples of high-rise buildings in Bucharest that suffered significant damage during the Vrancea 1977 earthquake and that were thermally rehabilitated without any strengthening works are shown in this paper. The consistent differences between the current outcomes of the two programs are presented and discussed. Finally, this review paper highlights the lack of coherence in terms of seismic risk assessments for the same class of buildings, inducing, in some situations, a false feeling of safety in the building inhabitants. In addition, a combined procedure for both seismic strengthening and thermal rehabilitation is mandatory, considering the seismicity of Romania, as well as ongoing climate change. [ABSTRACT FROM AUTHOR]

In Europe, it is estimated that 14% of existing buildings were built before 1919, whereas 26% were built before 1945. In Romania, about 31% of the buildings date from before 1961, contributing to the current stock of old buildings with historic and architectural value in the country. This paper illustrates the current state of buildings with historic and architectural value in Romania, alongside a case study of a representative administrative building in Câmpulung, Romania. The analysis of the Town Hall building in Câmpulung, Romania, demonstrates that potential energy savings of up to 47.53% can be achieved by implementing interventions such as upgrading windows, insulating the attic, and installing photovoltaic panels. The highest energy reduction is obtained by replacing the window glass with a value of 18.16% with attic insulation with a value of 16.1%. This paper also presents indoor measurements of temperature and humidity in different offices positioned in the north and the south. The study conducted on the south façade office revealed consistent temperatures ranging from 21.7 °C to 24.4 °C, with an average of 23.31 °C. However, the humidity levels fluctuated considerably, ranging from 17.1% to 39.1%, with an average of 26.89%. The sun-exposed section of the building saw relatively stable temperature conditions, but the varying humidity levels could have a detrimental impact on the quality of the indoor atmosphere and potentially decrease the effectiveness of the workforce. By contrast, the north façade office exhibited lower and more fluctuating temperatures, ranging from 19.8 °C to 23.6 °C, with an average of 21.74 °C. Additionally, it had higher and more stable humidity levels, ranging between 19.5% and 41.7%, with an average of 29.83%. A thermographic analysis was performed on the north façade of the Câmpulung Town Hall, utilizing thermal imaging technology to detect areas of heat loss, and thus identifying the energy inefficiency problems of the building's exterior. The investigation found notable variations in temperature, especially around the windows, where temperatures could be as high as 14.1 °C, highlighting the insufficiency of the building's antiquated timber-framed windows in preventing energy loss. [ABSTRACT FROM AUTHOR]

Spatial planning decisions form the basis of territorial progress by enhancing the resilience and opportunities for local and regional development. Therefore, decisions made as a result of multidisciplinary studies based on GIS assessment of all involved factors can provide a real and up-to-date image of the analyzed territory. In this context, geomorphic processes are among the factors restricting development, affecting built-up areas, transport infrastructure, and economic activities. This paper assesses geomorphic processes at the level of Cluj County, Romania, which mainly consist of active landslides that directly impact the accessibility of communities and their degree of safety, while accelerated soil erosion severely affects the output of land used for agriculture. GIS technology and a semi-quantitative model for determining the landslide hazard were used to classify landslides across occurrence probability classes. This methodology was implemented in Romania through Government Decision no. 447/2003. The USLE model was used to determine the soil erosion. As a result, the territory of Cluj County, which is the study area of this paper, was entirely included in one of the classes of risk concerning active geomorphic processes. Another important aspect consisted of categorizing transport infrastructure according to risk classes. A population risk assessment was also performed, taking into account the degree of accessibility of the territorial emergency department in the event that such hazards and processes occur. These results form the basis of proposals to efficiently plan the county territory, adapting decisions to the present trends in the evolution. [ABSTRACT FROM AUTHOR]

Background: In recent years, the integration of large language models (LLMs) into healthcare has emerged as a revolutionary approach to enhancing doctor–patient communication, particularly in the management of diseases such as prostate cancer. Methods: Our paper evaluated the effectiveness of three prominent LLMs—ChatGPT (3.5), Gemini (Pro), and Co-Pilot (the free version)—against the official Romanian Patient's Guide on prostate cancer. Employing a randomized and blinded method, our study engaged eight medical professionals to assess the responses of these models based on accuracy, timeliness, comprehensiveness, and user-friendliness. Results: The primary objective was to explore whether LLMs, when operating in Romanian, offer comparable or superior performance to the Patient's Guide, considering their potential to personalize communication and enhance the informational accessibility for patients. Results indicated that LLMs, particularly ChatGPT, generally provided more accurate and user-friendly information compared to the Guide. Conclusions: The findings suggest a significant potential for LLMs to enhance healthcare communication by providing accurate and accessible information. However, variability in performance across different models underscores the need for tailored implementation strategies. We highlight the importance of integrating LLMs with a nuanced understanding of their capabilities and limitations to optimize their use in clinical settings. [ABSTRACT FROM AUTHOR]

This paper aims to identify the factors that are positively or negatively impacting students' well-being and their academic engagement. We used partial least-squares structural equation modeling (PLS-SEM) using the data collected through a questionnaire from four countries: Romania, Turkey, Slovakia, and Bulgaria. The model includes seven factors that influence the well-being of students and indirectly their academic engagement: stressors in the students' lives; professors' support; social support from family and friends; the students' perceived satisfaction in their lives; engaging in activities during their leisure time; self-exploration regarding their careers; and environmental exploration regarding their careers. The results show that all factors, except for stressors and environmental exploration regarding their careers, positively influence the students' well-being and thus their academic engagement. These findings are useful for university professors and managers in better organizing activities to increase academic performance. [ABSTRACT FROM AUTHOR]

The rehabilitation of abandoned mining sites is an increasingly pressing issue in the context of sustainable development. Recent research has emphasized the need for a holistic approach to the abandoned mining sites and their environmental rehabilitation. Based on field analysis, environmental assessments, satellite imagery processing and geographic information operations, this paper pushes forward the existing knowledge by conducting a comprehensive assessment of abandoned mining sites in the Romanian Carpathians and by proposing innovative and sustainable rehabilitation solutions. Our findings highlight that abandoned mining sites and their surrounding territories in the Romanian mountains have significant ecological imbalances and complex socio-economic issues. The findings also suggest that by adopting innovative, integrated, and sustainability-oriented approaches, territories affected by mining can be transformed into valuable and sustainable spaces to meet human needs. We conclude by presenting the importance of innovation in ecological reconstruction and spatial–functional reintegration of mining sites in mountain areas as a useful tool in making fair decisions, both in the context of implementing appropriate development policies as well as for the resilience and environmental sustainability of mining-affected mountain areas. [ABSTRACT FROM AUTHOR]

In Romania, excessive fragmentation of croplands remains persistent in areas of significant agricultural potential as a consequence of combined factors involving both land governance and farms' characteristics. This paper examines the fragmentation of agricultural land use in the Romanian Plain, focusing on the impact of land policies implemented in Romania during the past three decades. The analysis relies on a survey of local policies that helps to distinguish three phases that marked the evolution of the fragmentation of agricultural land during 1990–2020. Additionally, metrics derived from remote sensing time series further assist in capturing the fragmentation levels during the identified phases and the spatial differences for the analyzed period. The fragmentation levels appear strikingly contrasting between the western part of the Romanian Plain and the Danube alluvial areas; this has been attributed as being the joint result of various land governance components which both enabled and constrained proper utilization of agricultural land, and concurrent factors related to economic and sociodemographic changes. We find excessive fragmentation emerged in plain field areas, triggered by the high overall rates of institutional change. The findings underscore the importance of jointly considering the fragmentation phenomenon in its evolution, intensity and spatial differences for effective land use policy formulation, emphasizing the need for proactive governance to support the efficient use of agricultural resources. [ABSTRACT FROM AUTHOR]

This study explores religious diversity in Romania and how the trends of indices of religious fractionalization and polarization manifest at the county level in a post-communist period. The county level was selected as the relevant level for analysis due to its more clearly visible spatial dynamics with regard to religions. Recent studies have revealed that the erosion of diversity is an important aspect for any country and needs to be considered as an important aspect of democracy. This paper highlights how digital mapping of religious polarization and fractionalization in Romania has been generally maintained, although the regions of Transylvania, Banat, Dobrogea and Western Moldova remain areas in which there are different religions. Other than the general aspect of religious diversity depending on ethnic trends, there has been a rise of Pentecostals and Baptists at the county level. This aspect has further implications for our study, which calls for creating new institutions for dialogue between majority Orthodox communities and Protestants, not only so that potential conflicts do not appear between Orthodox and emerging religious communities but also to ensure objective, cultural, religious coherence. Our maps revealed the distribution patterns and the temporal evolution of religious denominations for the 1992–2011 period. The major line of originality in our research rests in the findings that after conducting a bivariate spatial autocorrelation analysis of religious fractionalization and polarization, we were able to identify two distinct clusters with spatial overlap over historical provinces. [ABSTRACT FROM AUTHOR]

In this paper, based on our previous expertise on ceramic artifacts, several archaeometric methods applied to some samples collected from the Dudești archaeological site (Oltenia region, Romania) are reported for the first time in the literature. The chemical composition, and microstructural and morphological characterization of these samples offer important conclusions about the processing conditions. Some specific techniques such as X-ray diffraction (XRD), wavelength-dispersive X-ray fluorescence (WDXRF), optical microscopy (OM), stereomicroscopy, environmental scanning electron microscopy (ESEM), Fourier-transform infrared spectroscopy (FTIR), and Raman spectroscopy provide compositional information about composition and the decay processes. Additionally, the Brunauer–Emmett–Teller (BET) method helps to estimate pore sizes and specific surface areas. A thermogravimetric analysis (TGA/TDG) was used to establish details regarding the production technology and also the raw materials source used to make the ceramics. The obtained results indicated that the ceramics are based on a paste of muscovite and feldspar, with high plasticity, together with quartz and hematite/goethite and calcite, the latter in very low concentrations. According to the obtained results, we could assume that clays from the investigated samples had a low concentration of calcium. Gypsum is present as paste in a very low concentration, identified by the presence of a sulphate group in WDXRF. In the same context, iron oxides have a significant impact on the firing atmosphere of iron-rich clay, resulting in blackening under reducing conditions and a reddish coloration under oxidative conditions. The use of hematite and gypsum as pigments further contributes to the color variations in the pottery. The consistent firing temperature range of 200–600 °C in Dudești pottery implies a standardized production process, the variation in color being dependent on the specific reducing/oxidative regime conditions (reducing atmosphere followed by rapid oxidation). This relationship between clay composition and local sources suggests a connection to Neolithic pottery production in the region and their color depending on the reducing/oxidative regime conditions. [ABSTRACT FROM AUTHOR]

This paper aimed to evaluate the effects of the COVID-19 pandemic on prescription rates and antibiotic resistance in a university hospital. A retrospective study was conducted on the medical records of patients admitted to the Bihor Emergency Clinical County Hospital in Romania in 2019 (pre-pandemic) and 2021 (during the pandemic period). We evaluated the antibiotic consumption index (ACI) and susceptibility rates. The overall percentage of antibiotic prescribing increased in 2021, while the total number of patients decreased. Genito-urinary, digestive, respiratory infections, heart diseases and wounds were the most common conditions for antibiotic prescriptions, but the number of them decreased in 2021. There was a decrease in the proportion of antibiotics from the Watch and Reserve class and an increase in the proportion of antibiotics from the Access class. Antibiotic use has been reduced despite an increase in the number of patients, with a high consumption in the Watch group in the ICU wards. By contrast, surgical wards had the highest rate of antibiotic prescriptions, but a decrease in the number of patients. The patients who were administered antibiotics were hospitalized for diagnoses other than COVID-19. Almost all prescribed antibiotics displayed decreasing sensitivity rates. The number of isolated ESKAPE pathogens, except for Staphylococcus aureus methicillin-resistant strains, were increased. Strategies to control antibiotic prescriptions and the spread of resistant pathogens should be improved. [ABSTRACT FROM AUTHOR]

Social isolation and loneliness greatly contribute to negative health consequences in older adults. Technological solutions can be an asset in promoting social connections and healthy behaviours. This paper presents an innovative structure for an Internet of Things (IoT) platform specifically tailored for older persons. The framework utilises a supervised learning algorithm to classify users into four identified profiles to facilitate the adoption and engagement of technology. The platform incorporates wearables, such as socks and smart bands, to track physical activity, and a messaging module to encourage social interaction. The platform processes the acquired data to quantify steps and deliver tailored interventions remotely to the older adults through the AGAPE Assistant, the mHealth solution of the platform. Furthermore, the AGAPE Assistant has a user interface design for older adults, with a focus on their specific needs. Additionally, improving digital literacy among older adults is crucial for maximizing the long-term compliance and benefits of such technological solutions. On the other hand, AGAPE Monitor is a web application used by formal caregivers to configure the tailored interventions. The platform's usability was assessed using different usability scale questionnaires, which revealed a mild level of user satisfaction and acceptance. The proposed framework is currently being deployed on more than 112 older adults across three countries: Italy, Romania, and Portugal. The proposed framework provides a holistic solution to encourage active ageing by adopting technology, implementing hybrid interventions, and promoting social interactions. [ABSTRACT FROM AUTHOR]

In Romania, influenza vaccination uptake among healthcare workers decreased over time despite access to the vaccine being constantly improved. The aim of this paper is to provide a comparative analysis of the knowledge and attitudes of Dental Medicine and Medicine students towards recommended vaccinations for healthcare workers, focusing on influenza vaccination. A cross-sectional study was conducted during the entire 2021–2022 academic year. Data were collected using 2 electronic questionnaires which were applied to the students from the Faculty of Medicine (n = 883) and, respectively, the Faculty of Dental Medicine of the Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. The questionnaires were offered to 1187 students and completed by 911 students (response rate = 77%). Out of these, 85% (n = 778) identified the influenza vaccine as recommended; 35% (n = 321) reported getting an annual influenza vaccination; and 37% (333) reported getting an influenza vaccination in the previous season. Overall, 45% (n = 222) of the respondents who completed the questionnaires from October 2021 to February 2022 reported that they intend to get vaccinated against influenza in the 2021–2022 season and approximately 8% (n = 39) reported that they had already been vaccinated. The multivariable analysis showed that the habit of getting annually vaccinated against influenza as well as the knowledge that influenza vaccine is recommended for all healthcare workers were associated with a higher probability of intending to get vaccinated. The current study emphasizes the need to raise awareness among medical students regarding influenza vaccination and to involve medical education institutions, public health authorities, and healthcare facilities in promoting this vaccination among students since the influenza vaccine uptake rate among medical students included in this study was suboptimal. [ABSTRACT FROM AUTHOR]

This study offers, by an empirical analysis, another perspective on post-socialist development, highlighting the role of the urban–rural interface in regional dynamics. The current literature on the relationships between both issues is not too rich and our paper analyzes the relationships between core cities, their peri-urban areas, and their regions, through a comparative overview of their growth over the last three decades. Romania, as a special case study for a contradictory transition, due to the great step from a drastic dictatorial regime to a democracy and a market economy, is a good example to test these complex relationships. Considering the new development trend at the urban–rural interfaces, our key idea was to depict their contribution to regional development (NUTS 3) compared to city cores. The second question was how this differentiated contribution can be measured, using the simplest tool. The starting point was the fact that population dynamics reflect all changes in the city core and at the urban–rural interface, and less so at a regional level. Consequently, we selected the dynamics of the number of inhabitants for the first two, as well as the dynamics of GDP per capita at the regional level. We found higher and significant correlations between GDP per capita and urban–rural interfaces, but no significant correlations in the case of city cores. Our conclusion is that, in the transition period, the dynamics of urban–rural interfaces influenced more regional development dynamics, than those of city cores. This means that urban–rural interfaces amplify the development coming from cities, adding their own contribution and then dissipating it regionally. Future research should identify what the urban–rural interface offers to regions, in addition to the city core. [ABSTRACT FROM AUTHOR]

Mining communities often rely on tourism as a vehicle for post-mining territorial development. Sometimes, these expectations of the locals are justified by the natural setting and/or the well-preserved industrial heritage; however, these potential tourist destinations are disadvantaged primarily by their image, often associated with decay in the perception of travellers. In this paper, we treat travellers as stakeholders, able to decisively influence the image of a destination by uploading content (photos, reviews and ratings) on Google Maps and TripAdvisor, and we emphasise that user-generated content should be considered when shaping the tourism development strategies. Taking as case studies three former mining regions trying to capitalise on their tourist potential—Jiu Valley and Ștei, in Romania and La Louvière, in Belgium—this article proposes a method for assessing the image of the destination, also aiming to identify those aspects that require improvement. [ABSTRACT FROM AUTHOR]

Water bodies can offer local microclimates that have the potential to attenuate the effects of urban heat islands by reducing local temperature. This capability is shaded when the river is channelized. In such cases, the river temperature rises during hot periods, leading to negative impacts on the water quality. The main aim of this paper is to develop a local simple model to predict the temperature of the Dâmbovița River at its exit from Bucharest City, the capital of Romania. The location is chosen based on the historical critical impacts, in terms of extreme heatwaves that took place during hot summers, as well as future possible risks due to climate change. The water temperature prediction model is based on an artificial neural network that uses the Levenberg–Marquardt algorithm, due to its stability and rapid convergence capabilities. The model forecasts, with an accuracy of ±1 °C, the water temperature in an ungauged, downstream location, as a function of measured air and upstream water temperatures. The proposed model represents a first attempt to provide water managers in Bucharest City with a useful tool that will allow them to take timely measures to counteract the unwanted effects that can be generated by high water temperatures. [ABSTRACT FROM AUTHOR]

In Romania, natural gas production is concentrated in two large producers, OMV Petrom and Romgaz. However, there are also smaller companies in the natural gas production area. In these companies, the deposits are mostly mature, or new deposits have low production capacity. Thus, the production forecast is very important for the continued existence of these companies. The model is based on the pressure variation in the gas reservoir, and the exponential model with production decline is currently used by gas and oil producers. Following the variation in the production of the gas wells, we found that in many cases, the Gaussian and Hubbert forecast models are more suitable for simulating the production pattern of gas wells. The models used to belong to the category of poorly conditioned models, with little data, usually called gray models. Papers published in this category are based on data collected over a period of time and provide a forecast of the model for the next period. The mathematical method can lead to a very good approximation of the known data, as well as short-term forecasting in the continuation of the time interval, for which we have these data. The neural network method requires more data for the network learning stage. Increasing the number of known variables is conducive to a successful model. Often, we do not have this data, or obtaining it is expensive and uneconomical for short periods of possible exploitation. The network model sometimes captures a fairly local pattern and changing conditions require the model to be remade. The model is not valid for a large category of gas wells. The Hubbert and Gauss models used in the article have a more comprehensive character, including a wide category of gas wells whose behavior as evolutionary stages is similar. The model is adapted according to practical observations by reducing the production growth period; the layout is asymmetric around the production peak; and the production range is reduced. Thus, an attempt is made to replace the exponential model with the Hubbert and Gauss models, which were found to be in good agreement with the production values. These models were completed using the Monte Carlo method and matrix of risk evaluation. A better appreciation of monthly production, which is an important aspect of supply contracts, and cumulative production, which is important for evaluating the utility of the investment, is ensured. In addition, we can determine the risk associated with the realization of production at a certain moment of exploitation, generating a complete picture of the forecast over the entire operating interval. A comparison with production results on a case study confirms the benefits of the forecasting procedure used. [ABSTRACT FROM AUTHOR]

Botulism is a priority disease worldwide because it has a very severe course of evolution that can lead to death. This paper aims to describe the main epidemiological characteristics of botulism cases confirmed in Romania over 14 years (2007–2020). We performed a retrospective study using the publicly available national surveillance data and reported to the National Institute of Public Health. A total of 325 cases of foodborne botulism were reported in Romania, with no infant or wound botulism. Most of the cases (125, 38.5%) were reported among young adults (25–44 years old), over half (205, 63%) of them living in rural areas. The incriminated food item was identified in 161 cases; in most cases (145, 90%) the food item was prepared in the household. The main food category was represented by meat and meat-based products (94, 68.6%). In almost all cases the identified type was BoNT/B (230/231, 99.5%). Fifteen deaths were recorded, and the case fatality rate was 4.6%. Botulism cases were reported annually in Romania. Surveillance data are essential for implementing control measures and adapting educational campaigns according to existing needs. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aims to assess the health status and factors influencing healthy choices among children and young people in Romania, as well as the efficacy of related health education programs. Through understanding these dynamics, the study seeks to provide insights that can shape targeted interventions, policies, and educational strategies to improve this demographic's overall health and well-being. Materials and Methods: For this study, we performed a literature review of original published papers on the health status, healthy habits, health education, predisposition to making healthy choices in the future, and accessibility to the paediatric health system of Romanian children and young people, as well as the effects of different types of educational interventions on this demographic in Romania. Results: The prevalence of dental caries is high in Romania. In terms of eating habits and nutritional status, a worrying proportion of children are overweight or obese, which can lead to a variety of future physical and psychological problems. In terms of physical activity, few adolescents demonstrate regular fitness practices. Romania presents an increase in alcohol and tobacco consumption among adolescents. The mental health of students has become a pressing public health concern, exacerbated by the COVID-19 pandemic. The use of social networks is linked to mental health issues among young people. Romania still has one of the highest rates of sexually transmitted diseases and faces a high incidence of cervical cancer, with a mortality rate three times higher than the EU average. High rates of teenage pregnancies are linked to limited information about sexuality and a lack of access to family planning at a young age. There are large discrepancies in the accessibility of medical services between urban and rural areas. Conclusions: Romania faces significant obstacles to providing high-quality healthcare to children and young people. Improving nutrition, immunisation rates, and access to medical services represent essential areas for enhancing the health of children and young people in Romania. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic was a challenge for the whole world, and it had major secondary effects on humans and environmental health. The viral infection induced, in many situations, secondary bacterial infections, especially enteric infections, by destabilizing the balance of the gastrointestinal microbiota. The large-scale use of antibiotics and biocides for both curative and preventive purposes has resulted in an increase in bacterial resistance, and at the same time, the possibility of pathogenic microorganism multiplication and their dissemination to natural environments. Wastewater is the main vector of fecal microorganisms that favors their dissemination into natural aquatic ecosystems. The present paper aims to analyze the effect of the COVID-19 pandemic on the microbiological quality of wastewater from sewage treatment plants in Romania and its impact on receiving rivers. In order to highlight different and important areas in Romania, three cities from the east, center and west were selected for a microbiological evaluation of their WWTP influents and effluents from the pre-COVID-19 period and during the COVID-19 pandemic peak period, when the COVID-19 pandemic had a direct impact on WWTP microbial compositions. Our study shows that a higher level of contamination with fecal bacteria is linked to a higher COVID-19 incidence. The increased usage of pharmaceutical compounds, in turn, increases the number of resistant bacteria reaching the environment via WWTP effluents. [ABSTRACT FROM AUTHOR]

In this paper, we discuss the evolutionary implications of the correlation between different species of Peucedanum plants and the distribution of Gortyna borelii moth populations in Romania. We highlight geographic separation and isolation among these populations due to anthropogenic landscape fragmentation, which hinders genetic exchange. A geometric morphometric analysis was utilized to visualize and compare the morphometric variations in relation to the environmental variables, particularly the host plant. Additionally, the distribution of G. borelii populations across Europe and in Romania that are correlated with the host plant was analyzed. The significant morphological and morphometric differences between the analyzed populations support our working hypothesis, according to which the use of different Peucedanum species by the larvae of G. borelii leads to an intraspecific diversification correlated with the host plant species. The newly discovered population of G. borelii in Romania holds substantial conservation importance, necessitating protection measures, including demarcating habitat areas and raising awareness among stakeholders. G. borelii is a protected species at the European level (Habitats Directive 92/43/EEC, Appendices II and IV), considered endangered due to the isolation of its populations and anthropogenic pressures exerted through agricultural practices. Understanding the impact of agricultural practices on their habitat is crucial for effective management strategies. Overall, this study sheds light on the complex interplay between ecological adaptation, host plant specialization, and speciation dynamics in phytophagous insects, emphasizing the importance of conservation efforts to preserve G. borelii populations and their habitats. [ABSTRACT FROM AUTHOR]

Hypertensive disorders of pregnancy (HDPs) represent a significant source of severe maternal and fetal morbidity. Screening strategies relying on traditional medical history and clinical risk factors have traditionally shown relatively modest performance, mainly in the prediction of preeclampsia, displaying a sensitivity of 37% for the early-onset form and 29% for the late-onset form. The development of more accurate predictive and diagnostic models of preeclampsia in the early stages of pregnancy represents a matter of high priority. The aim of the present paper is to create an effective second trimester prediction algorithm of early-onset HDP occurrence and severity, by combining the following two biochemical markers: a soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio and uterine artery Doppler ultrasound parameters, namely the pulsatility index (PI) and the resistivity index (RI), in a population of high-risk pregnant women, initially assessed through traditional risk factors. A prospective single-center observational longitudinal study was conducted, in which 100 women with singleton pregnancy and traditional clinical and medical history risk factors for preeclampsia were enrolled at 24 weeks of gestation. Shortly after study enrollment, all women had their sFlt-1 and PlGF levels and mean uterine artery PI and RI determined. All pregnancies were followed up until delivery. Receiver operating characteristic (ROC) analysis established algorithms based on cutoffs for the prediction of the later development of preeclampsia: PI 1.25 (96.15% sensitivity, 86.49% specificity), RI 0.62 (84.6% sensitivity, 89.2% specificity) and sFlt-1/PlGF ratio 59.55 (100% sensitivity, 89.2% specificity). The sFlt-1/PlGF ratio was the best predictor for preeclampsia, as it displayed the highest area under the curve (AUC) of 0.973. The prediction algorithm for the severe form of preeclampsia, complicated by fetal growth restriction leading to preterm birth, antepartum fetal demise or acute fetal distress with a cerebro-placental ratio of

This review aims to explore the role of professional diagnostic rapid testing of acute respiratory infections (ARIs), especially COVID-19 and influenza, ensuring proper disease management and treatment in Europe, and particularly in Czech Republic, Poland, and Romania. The paper was constructed based on a review of scientific evidence and national and international policies and recommendations, as well as a process of validation by four experts. The development of new testing technologies, treatment options, and increased awareness of the negative multidimensional impact of ARI profiles transformed differential diagnosis into a tangible and desirable reality. This review covers the following topics: (1) the multidimensional impact of ARIs, (2) ARI rapid diagnostic testing platforms and their value, (3) the policy landscape, (4) challenges and barriers to implementation, and (5) a set of recommendations illustrating a path forward. The findings indicate that rapid diagnostic testing, including at the point of care (POC), can have a positive impact on case management, antimicrobial and antibiotic stewardship, epidemiological surveillance, and decision making. Integrating this strategy will require the commitment of governments and the international and academic communities, especially as we identified room for improvement in the access and expansion of POC rapid testing in the focus countries and the inclusion of rapid testing in relevant policies. [ABSTRACT FROM AUTHOR]

Bee bread has received attention due to its high nutritional value, especially its phenolic composition, which enhances life quality. The present study aimed to evaluate the chemical and antimicrobial properties of bee bread (BB) samples from Romania. Initially, the bee bread alcoholic extracts (BBEs) were obtained from BB collected and prepared by Apis mellifera carpatica bees. The chemical composition of the BBE was characterized by Fourier Transform Infrared Spectroscopy (FTIR) and the total phenols and flavonoid contents were determined. Also, a UHPLC-DAD-ESI/MS analysis of phenolic compounds (PCs) and antioxidant activity were evaluated. Furthermore, the antimicrobial activity of BBEs was evaluated by qualitative and quantitative assessments. The BBs studied in this paper are provided from 31 families of plant species, with the total phenols content and total flavonoid content varying between 7.10 and 18.30 mg gallic acid equivalents/g BB and between 0.45 and 1.86 mg quercetin equivalents/g BB, respectively. Chromatographic analysis revealed these samples had a significant content of phenolic compounds, with flavonoids in much higher quantities than phenolic acids. All the BBEs presented antimicrobial activity against all clinical and standard pathogenic strains tested. Salmonella typhi, Candida glabrata, Candida albicans, and Candida kefyr strains were the most sensitive, while BBEs' antifungal activity on C. krusei and C. kefyr was not investigated in any prior research. In addition, this study reports the BBEs' inhibitory activity on microbial (bacterial and fungi) adhesion capacity to the inert substratum for the first time. [ABSTRACT FROM AUTHOR]

This paper presents a set of Ground Penetrating Radar (GPR) data obtained from in situ measurements conducted in four ornamental stone quarries located in Italy (Botticino quarry) and Romania (Ruschita, Carpinis, and Pietroasa quarries). The GPR is a Non-Destructive Testing (NDT) technique that enables the detection and localization of fractures without damage to the surface, among other capabilities. In this study, two instruments of ground-coupled GPR were used to detect and locate the fractures, discontinuities, or weakened zones. The GPR data contains radargrams for discontinuities and fracture detection, besides the geographic location of the measures. For each measurement site, a set of radargrams has been acquired in two orthogonal directions, allowing for a 3D reconstruction of the investigated site. Dataset: DOI:10.17632/w26n6nftxs.3 (https://data.mendeley.com/datasets/w26n6nftxs/3) Dataset License: CC BY-NC-ND [ABSTRACT FROM AUTHOR]

The mining method that is still often used in salt deposits is the room-and-pillar mining method, in which the dimensioning of the most requested element in the system is followed. The pillars are the elements subjected to the greatest loads. Knowing the size and distribution mode of the secondary state of stress—deformation—is a necessity that can lead to the design and realization of stable, reliable underground excavations. This paper proposes an analytical assessment model of the secondary stress state in the pillars between the operating rooms, as well as in the whole system room–pillar–floor, based on the results obtained from laboratory research through modeling and in situ research. For this purpose, the evaluation of the secondary stress state was carried out considering the following methods: (1) the dimensioning method based on the theory of limit equilibrium, taking into account the effective stress in the pillars; and (2) the mechanics of the continuous environment based on the design of some analytical models for evaluating the secondary stress-deformation state in the pillar and floor. The exploitation of one of the largest salt deposits in Romania is used as a case study, and the stability of the exploitation system with rooms and pillars is evaluated by analytical methods. The secondary state of tension was calculated at different points on the height of the pillar. Through the proposed algorithm, the value of the axial component of the secondary stress state at different points along the axis of a pillar located at a depth of 100 m varies between 1.498 and 1.657 MPa, compared to the value obtained by the finite element method and in situ measurements, which was 1.64 MPa. The comparison revealed a high degree of agreement between the results obtained for the depth of 100 m using both the FEM and laboratory and in situ measurements. This suggests that the proposed algorithm is a reliable method for predicting the secondary stress state. The presented algorithm can be extended in the field of mining deposits, where mining methods with rooms and pillars are used. [ABSTRACT FROM AUTHOR]

In this paper, attention is drawn to the deterioration of Romanian surface water ecosystems due to eutrophication, an important environmental issue both at national and international levels. An inventory of existing studies dealing with the issue of the eutrophication of lakes and reservoirs in Romania is made, aiming to identify the main problems Romania is facing in monitoring, classifying, and managing eutrophic ecosystems. On Web of Science, the keyword "Eutrophication", with "Romania" as country/region, leads to 50 publications, which are analyzed in this review. The number of articles found does not reflect the real environmental issue represented by eutrophic lakes and reservoirs in Romania. At a national level, only 126 lakes and reservoirs have been monitored and assessed between 2018 and 2020, in terms of ecological status/ecological potential. Thus, at a global evaluation, 77% of natural lakes and 33% of artificial ones do not reach the quality objectives. The results of this study showed that the frequency of measurements taken by water quality indicators is not the strongest point of measurement campaigns, as it is not sufficient for the diagnosis of eutrophic lakes, and supplementary measures must be undertaken to better understand and mitigate this phenomenon. [ABSTRACT FROM AUTHOR]

Organophosphate ester flame retardants (OPFRs) are ubiquitous organic pollutants in the environment and present an important preoccupation due to their potential toxicity to humans and biota. They can be found in various sources, including consumer products, building materials, transportation industry, electronic devices, textiles and clothing, and recycling and waste management. This paper presents the first survey of its kind in Romania, investigating the composition, distribution, possible sources, and environmental risks of OPFRs in five wastewater treatment plants (WWTPs) and the rivers receiving their effluents. Samples from WWTPs and surface waters were collected and subjected to extraction processes to determine the OPFRs using liquid chromatography with mass spectrometric detection. All the target OPFRs were found in all the matrices, with the average concentrations ranging from 0.6 to 1422 ng/L in wastewater, 0.88 to 1851 ng/g dry weight (d.w.) in sewage sludge, and 0.73 to 1036 ng/L in surface waters. The dominant compound in all the cases was tri(2-chloroisopropyl) phosphate (TCPP). This study observed that the wastewater treatment process was inefficient, with removal efficiencies below 50% for all five WWTPs. The environmental risk assessment indicated that almost all the targeted OPFRs pose a low risk, while TDCPP, TCPP, and TMPP could pose a moderate risk to certain aquatic species. These findings provide valuable information for international pollution research and enable the development of pollution control strategies. [ABSTRACT FROM AUTHOR]

Background and Objectives: The mainstay treatment of non-small-cell lung carcinoma is still surgery, but its impact on survival beyond nine years has never been reported/analysed in Romania. Therefore, we studied the clinical characteristics and the short- and long-term survival of a population of 1369 patients diagnosed and treated in a single institution, with the variables included in the database being collected retrospectively. Materials and Methods: In this paper, we aimed to study a number of factors that might influence prognosis and survival in non-small bronchopulmonary carcinoma. Consequently, we analysed a series of parameters such as the age of patients, their sex, the histopathological type, the tumour stage, the presence of bronchial invasion, and the completeness of surgical resection. Results: All patients underwent major lung resection for curative purposes (pneumonectomy, lobectomy, or bilobectomy) between January 2015 and January 2023. The vital status of patients included in the study was obtained by checking the DGEP (General Directorate for Persons Record) database and verifying the reporting of "non-deceased" by the hospital administrative database, as well as by telephone interviews (with patients or their relatives). On univariate analysis, predictors of worse survival were the following: male sex (the hazard of death was 1.54 times higher in men); pT (compared to pT1 tumours, pT2 tumours have a 1.60 times higher hazard of death, pT3 tumours have a 2.16 times higher hazard, and pT4 tumours have a 2.97 times higher hazard); maximum tumour size (a 10 mm increase in tumour size is associated with a 10% increase in the hazard of death); the degree of differentiation (compared to patients with G1 tumours, those with G3 tumours have a 2.16 times higher hazard of death); resectability (compared to R0, R1 B+ has a 1.84 times higher hazard of death, R1 V+ has a 1.82 times higher hazard of death, and R1 B+&V+ has a 2.40 times higher hazard of death). Conclusions: As a result, long-term survival can be achieved after complete surgery for NSCLC, and factors that classically predict overall survival suggest that both the initial tumour aggressiveness and host characteristics act beyond the period usually considered in oncology. [ABSTRACT FROM AUTHOR]

The present study introduces a monitoring initiative focused on the quality of groundwater in the Piatra locality, situated in the North-West region of Romania. This paper employs an evaluation of 21 physico-chemical parameters, encompassing factors such as electrical conductivity, pH, chemical oxygen demand, turbidity, total hardness, NH4+, NO3−, Cl−, PO43−, Li, Na, K, Ca, Mg, Ba, Sr, Al, Fe, Mn, Sn, and Ti. Additionally, it examines five heavy metals (Cr, Cu, Ni, Pb, and Zn) and arsenic in water sourced from six distinct private wells. Each well, with its characteristics, serves as a unique drinking water source. The assessment encompassed the evaluation of pollution levels, quality status, and risk factors for all drinking water sources, utilizing pollution, quality, and risk indices. The aim of this study was to establish the level of toxicity in water, assess its impact on human health, and disseminate information to the public about the appropriate utilization of individual water sources. The results indicated a general contamination with chloride, ammonium, manganese, chromium, and iron. Human health risk assessment indices revealed that the consumption of studied waters presented non-carcinogenic risks associated with Cr for adults and with Cr, As, Pb, and Cu for children for some of the groundwater sources. The water quality index (WQI) categorizes the samples as possessing excellent and good quality. This research represents one of the initial endeavors to assess the groundwater source quality in connection with the potential human health risks posed by the metals studied within the protected area of the Tisa River Basin. [ABSTRACT FROM AUTHOR]

The landscapes and, implicitly, the surfaces of secondary grasslands in the mountain areas have been intensively modified and transformed by humans. In this context, this paper analyses the spatial and temporal changes of grassland surfaces following the impact of human population reduction. Thus, the study proposes the implementation of the Grassland Anthropic Impact Index (GAII) as a "measurement tool" to functionally link the two components, grassland surface and human population. The spatiotemporal analyses are based on Corine Land Cover data and demographic data, processed via Geographic Information Systems (GIS) methods and the Land Change Modeler (LCM) tool. The research shows that over a period of 28 years, the population, which was continuously decreasing, caused a series of transformations to the grasslands over an area of 33343 ha. The influence of the reduction in the number of inhabitants was also demonstrated by the direction of the changes produced in the grassland surfaces: in the better populated areas, the grasslands expanded over lands with other uses, and in the sparsely populated areas, they were abandoned. GAII values generally increase with the decrease of the population in the target area, meaning that for an inhabitant (potential user) a greater grassland surface is reported, resulting in a greater responsibility for the management of this resource on a space and time scale. Following the evaluation of the trend of the last 28 years, it was observed that the depopulation of mountain areas can be seen as a threat to grassland ecosystems, either through the transition to other categories of use, or through abandonment. The implications of these phenomena are much broader: they produce chain reactions and affect other components of the regional geosystem. [ABSTRACT FROM AUTHOR]

The contribution of sustainable public administration to the promotion of sustainable development is increasingly emphasized in the literature, including through an emerging and facilitating concept: collaborative administration. The sustainability of public organizations and of the public interventions carried out by these organizations is a central pillar of a modern administrative model, the desideratum of any government agenda. For this reason, the aim of this paper is to contribute to a more nuanced view on the relationship of sustainable development–institutional sustainability–collaborative dimension, covering some gaps that prevail in the literature by contextualizing the theoretical hypotheses in a case study. The novelty and added value of the research lies in establishing links between these three concepts by referring to a fourth concept: organizational intelligence. The study uses theoretical instruments, such as a questionnaire based on the design model proposed by Lefter et al., for the indirect assessment of the collaborative dimension. The outcomes demonstrate that the collaborative dimension of a public organization can be quantified using the proposed model. Moreover, organizational plans that promote the sustainability of public administration and sustainable development are identified. However, additional complementary studies are required to further investigate the cause-and-effect relationship between sustainable development, institutional sustainability, and collaborative dimensions. [ABSTRACT FROM AUTHOR]

To adapt to the business environment, organisations adhere to management strategies capable of removing the effects of negative events, transforming themselves into resilient organisations. Physical and mental difficulties are the consequences of recent corporate developments, and protecting these organisations is a significant concern for managers. Using regression analysis of panel data, we evaluate the effectiveness and performance of 34 tourism and transport companies listed on the BSE in the 2005–2022 period by testing the effect of leverage on financial performance. Then, we focus on identifying the effects of recent crises (the global financial crisis of 2007–2008 and the COVID-19 pandemic) on financial performance and, implicitly, on organisational resilience. The findings suggest that the research hypotheses were partially validated, noting that the indicators included in the study registered significant decreases for the COVID-19 crisis period compared to the global financial crisis period. The paper provides information on measuring the resilience of companies through their ability to withstand the global financial crisis and the crisis triggered by the COVID-19 pandemic. This study is also among the first to examine the role of financial crises in the leverage and financial performance relationship in Romania. [ABSTRACT FROM AUTHOR]

Cystic echinococcosis (CE) is a cosmopolitan parasitic disease caused by Echinococcus granulosus. We aimed to assess the epidemiological aspects of the disease in hospitalized children from Western Romania, a well-known endemic area for CE. We retrospectively investigated the medical records of children hospitalized between 1998 and 2022. A total of 144 patients were included, and 58.3% were from rural areas. The number of cases increased with age, from 9% in the age group 3–5 years to 59.7% in the age group 11–17 years. The liver was more frequently affected (65.3%), and a significant association between gender and the affected organ was noted; liver cysts were more frequently diagnosed in girls, while lung cysts were recorded mostly in boys. Complications were more frequently reported in patients with pulmonary CE compared to hepatic CE (p = 0.04). Boys had more complications (16/23, 69.6%) compared to girls (7/23, 30.4%) (p = 0.03). A third of the children were hospitalized for more than 14 days, and multiple hospitalizations were recorded in 31.3% of the patients. This paper provides new insights into the epidemiologic features of cystic echinococcosis in children from Western Romania. Our findings indicate that exposure to the parasite starts in childhood, and the rate of hospitalization increases with age. Public health strategies should be implemented and permanently improved in order to lower the prevalence of CE in children. [ABSTRACT FROM AUTHOR]

Windthrow is a phenomenon that causes major changes to tree stand evolution by blowing down or breaking either isolated trees or entire tree stands, with a strong ecological, social and economic impact. Both scattered and large-scale windthrow occurred in spruce (Picea abies (L.) Karst.) tree stands of Romania. They affected surfaces of various dimensions from harvestable forests. Such a phenomenon took place in the Curvature Carpathians in February 2020. Large-scale windthrow occurred in this area in 1995 as well, in the upper watershed of Bâsca river. Using the climate data from February 2020, this paper aims to identify the manner in which factors such as climate and site conditions together with tree stand characteristic and the anthropogenic factor impacted and influenced the occurrence of windthrow. The results showed that the intensity of this phenomenon had maximum effects when the wind coming from north/northeast reached the maximum speed of 32 m·s−1. Pure spruce tree stands situated on slopes with an inclination between 16 and 30° were mainly affected. Their position was counter to the wind direction, at an altitude between 1300 and 1500 m, on cambisols and spodosols. The analysis and statistical interpretation of data in the case of scattered and large-scale windthrow from the two management units showed that the same factors studied influence the variation of windthrow intensity in a different manner, or sometimes they do not influence it at all or they can only account for a small part of this variation. [ABSTRACT FROM AUTHOR]

The paper presents the study of the soil quality and health expressed by the chemical and biological properties in a research field placed at Varciorog, Bihor County, Romania. The soil samples were collected from 3 soil variants in March 2023. In each soil variant, some soil chemical parameters and the abundance of bacteria were determined. The frequency and intensity of colonization, along with arbuscules and vesicles, were scored to determine the mycorrhizal potential of each soil. The community-level physiological profile was used to determine the functional microbiome and its ability to decompose a specific set of substrates. In the control variant (CTRL), which is a functional forest cultivated with beech in a proportion of 90%, the soil properties were compared with those determined from Site 1 (a declined mixed forest) and from Site 2 (chestnut forest in a stage of complete drying). The data were statistically processed with a one-way ANOVA test, followed by the Duncan post-hoc test, which revealed significant variation in the potential of microbial functional communities across the analyzed sites. Also, the soil parameters that significantly varied in the 3 soil variants were bacterial number, pH, humus, exchangeable aluminum, coarse sand, dust, and fine sand. The Pearson correlation was computed to study the links between bacterial numbers and chemical parameters. The results showed strong correlations between most of the studied soil properties. The Ecoplates approach to soil functional microbiome highlighted various differences between the microbial communities of the three tested sites. Mycorrhizal colonization shows different potentials for symbiosis formation. The peak of mycorrhizal colonization was in declined forest, with 43.36% colonization frequency and 24.56% intensity. Arbuscules reached 11.36% in declined forest, while in control and decayed sites, the indicator was under 4%. Vesicles are more associated with control and decayed forests, with values of presence over 1.30%. As an indicator of microbial general activity, the sum of recorded activities was higher in declined and decayed forests. At these sites, the activity of the functional microbiome was amplified. The decline process activates a higher diversity of functional groups and is associated with a larger area of substrate decomposition capacity, which indicates a more extensive range of microbial functions related to breaking down organic matter. [ABSTRACT FROM AUTHOR]

Sepsis is an uncontrolled reaction of the body to an infection, and if not effectively treated, it can progress to septic shock, multiple organ failure, and ultimately, death. Objective: To determine the resistance profile of Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) strains isolated in sepsis cases diagnosed at the Infectious Diseases Clinic in Craiova, Romania. Methods: The bacteria responsible for sepsis cases were identified using the Vitek 2 Systems version 06.01, which was then employed to assess their antimicrobial susceptibility (Global CLSI and Phenotypic 2017). Results: We have identified 989 patients diagnosed with bacterial sepsis. Among these, 953 cases were caused by Gram-negative rods, with 415 attributed to E. coli and 278 to K. pneumoniae. High levels of resistance to ampicillin were recorded for E. coli strains isolated in sepsis cases (64.6%); adding sulbactam lowers the level of resistance to 41.8%. Resistance to 3rd generation cephalosporins varied between 7.47 and 14.6% and another 3.41 to 11.1% are dose-dependent susceptibility strains. Resistance to carbapenems (i.e., ertapenem, meropenem) is low—2.18–2.42%. More than 95% of the tested K. pneumoniae strains were resistant to ampicillin and adding sulbactam as a β-lactamase inhibitor only halves that level. Resistance to 3rd generation cephalosporins varied between 20.7% and 22.5%; resistance levels for K. pneumoniae were notably higher than those for E. coli. Over 95% of K. pneumoniae strains showed resistance to ampicillin, and resistance to 3rd generation cephalosporins varied between 20.7% and 22.5%. Additionally, K. pneumoniae exhibited higher resistance to carbapenems (13.7–19.5%) compared to E. coli (2.18–2.42%). Conclusions: Antimicrobial resistance levels are generally lower than continental and national data, except for ampicillin and carbapenems (meropenem and ertapenem). K. pneumoniae strains are significantly more resistant than E. coli strains. [ABSTRACT FROM AUTHOR]

Background: End-of-life care raises ethical, moral, legal and economic dilemmas, especially when physicians have to decide whether to initiate or to stop treatments that may be considered disproportionate and futile. Aim: To explore the opinion of health care professionals involved in end-of-life patient care on interventions considered disproportionate and futile at this stage of care, the causes and factors of pressure leading to such situations, and possible solutions to reduce the phenomenon. Material and method: The study used an adapted, designed questionnaire intended for health professionals caring for patients at the end of life. The 128 respondents were physicians, nurses, psychologists and social workers who expressed their opinions about therapeutic obstinacy in end-of-life care. Results: The results of the research highlight the role of the family as a pressure factor, the causes related to the non-acceptance of the prognosis and diagnosis of a terminal condition, fear of death and ignorance of the patient's wishes. Interventions considered disproportionate at the end of life were cardiopulmonary resuscitation, mechanical ventilation, transfusion of blood derivatives, complex diagnostic investigations and the establishment of gastrostomy/jejunostomy in the last days of life. Conclusions: End-of-life therapeutic obstinacy is a reality in end-of-life care, and healthcare professionals face many ethical challenges in this process. Care decisions must be made together with the patient and their family, respecting the rights, dignity and respect of all parties involved in the process. [ABSTRACT FROM AUTHOR]

This study investigates Romanian physicians' acceptance of telemedicine using the Technology Acceptance Model. We analyzed 1093 responses to an online survey distributed nationwide to physicians via email by the National Authority of Quality Management in Health, employing the partial least squares algorithm to estimate the relationship between the behavioral intention to adopt telemedicine and its potential determinants. Our findings reveal that the model accounts for 84.6% of the variance in behavioral intention to use telemedicine. Among the two constructs of the TAM model, perceived usefulness is a stronger predictor of behavioral intention than perceived ease of use. Additionally, subjective norms positively and significantly influence physicians' intention to use telemedicine and their perception of its usefulness. Furthermore, perceived incentives and accessibility to medical records also positively impact the behavioral intention to use telemedicine. [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI) has emerged as an essential tool in healthcare for optimizing healthcare delivery and improving patient outcomes. This study is motivated by using AI in healthcare as a step for social responsibility implementation. The research aimed to investigate the attitudes of healthcare professionals on this issue, and it assessed physicians' opinions regarding their perceptions of AI and their intention to use and implement AI tools in their activity. An electronic survey was proposed during February–June 2024 to a sample of healthcare professionals (309 were admitted into the study, 62 males and 247 females, with a mean age of 42). The results of the survey highlighted both groups' excellent perceptions of AI and the low perceived knowledge of AI, which arises from more technical questions. The use of AI in healthcare represents a step for social responsibility implementation; it is an unstoppable process, and stakeholders should take into consideration investing more in monitoring and training activities. [ABSTRACT FROM AUTHOR]

Fallopia japonica (FJ), commonly known as Japanese knotweed, is now recognized as one of the most invasive plants in Europe and globally. Despite its widespread presence in Europe and its significant nectar production, there is currently limited scientific data on the unique unifloral honey derived from it. This study examines the physicochemical composition of Fallopia japonica honey (FJH) samples collected from various regions in Romania. Additionally, the nutritional and antioxidant profiles of FJH were assessed. The sensory analysis revealed a honey with a brown-caramel color and an intense flavor, characterized by fine, consistent crystals during crystallization. The results indicated that FJH has a high carbohydrate content (fructose: 35.12–40.65 g/100 g; glucose: 28.06–37.79 g/100 g); elevated electrical conductivity (387–692 µS/cm), diastase activity (9.11–17.01 DN), and acidity (21.61–42.89 meq/kg); and substantial total phenolic (89.87–120.08 mg/100 g) and flavonoid (18.13–39.38 mg/g) contents. These findings highlight FJH's favorable nutritional properties, aligning with the standard codex for honey. The antioxidant profile of FJH demonstrated strong DPPH and ferric reduction antioxidant power (FRAP) activities, comparable to those of buckwheat honey, underscoring its potential health benefits and commercial value. These results provide new insights into how this invasive plant can be harnessed as a valuable resource for sustainable beekeeping practices. [ABSTRACT FROM AUTHOR]

Background: Oral hygiene is essential for low caries or gingivitis prevalence in children. This study aimed to determine the oral hygiene profile of children from secondary schools (10–17 years) in Bucharest, Romania, and to explore options for preventing their future oral diseases. Methods: The study was cross-sectional, with a sample of n = 1595 pupils. The sample was stratified by clusters in city areas, grades, and the criterion of the presence/absence of in-school dental service. Dental check-ups were performed by using a commune dental examination kit. The oral hygiene simplified index (OHI; Silness and Löe) was used to assess the children's oral hygiene status. Five questions were used to determine oral hygiene habits. Results: The mean value of the OHI was 1.04. Some differences in oral hygiene scores were found for different socioeconomic variables, such as parents' education (p < 0.05): parents with vs. without a university degree—0.95/0.94 (male/female) vs. 1.06. Most of the children used manual toothbrushes (88%). Conclusions: The analysis of objective data (OHI) revealed a good level of oral hygiene, with many socioeconomic disparities. [ABSTRACT FROM AUTHOR]

Earth's climate cannot be ignored any longer. Policies are vital in order to mitigate the negative effects of climate change. The energy crisis created by the Russo-Ukrainian war in Europe and COVID-19 pandemic affected the EU and its member states. The focus is more than ever on its energy policies and independence. The EU revised the energy strategy in response to the regional conflict, and it sped up all the processes for energetic independence from other countries outside of the EU. This benefited the climate change policies the most, as all the measures involved reducing energy consumption and increasing renewables, thus contributing to reducing greenhouse gas emissions. As a member state of the EU, Romania is committed to complying with EU regulations. With a high degree of energy independence compared with the other EU members, Romania plans to become a regional energy provider and modernize the energy infrastructure internally as a response to the regional conflict. The measures that the EU and Romania implemented after the conflict started in 2022 have come to fruition, and the effects are becoming visible a year later. This study aims to study the energy strategy of Romania in correlation with the EU strategy in the turbulent period of pandemics and conflict between 2019 and 2023, with the latest available data. [ABSTRACT FROM AUTHOR]

The study aimed to evaluate for the first time the degree of contamination of soil and crops with major and trace elements (Cd, Co, Cr, Cu, Ni, Pb, Zn, F, Na, Mg, Si, P, Cl, Fe, Al) in agricultural lands situated in the Lower Danube Basin, Galati and Braila counties (SE Romania), impacted by the steel industry. Soil samples, as well as leaves and seeds of wheat, corn, and sunflower, were collected from two depths in 11 different sites. Along with elemental and mineralogical analyses, performed by HR-CS AAS, PIGE, SEM-EDX, and ATR-FTIR, the soil pH, texture, organic matter, electric conductivity, and CaCO3 content were investigated. The results showed that the levels of Cr (83.27–383.10 mg kg−1), Cu (17.11–68.15 mg kg−1), Ni (30.16–55.66 mg kg−1), and F (319–544 mg kg−1) in soil exceeded the Romanian regulations for sensitive use of the land. Igeo, EF, PI, and PERI pollution indices indicate that the soil is moderate to highly contaminated with Cr, Ni, and Cu, while the CSI and mERMQ indices suggested a relatively low risk for metal contamination. The elemental concentrations in plant tissues and bioaccumulation factors (BFs) provide valuable insights into the soil–plant relationship, health risks, and the selectivity of plant compartments for different elements. Thus, the results revealed that the wheat plants tended to exclude the bioaccumulation of particular elements in their tissues, while exhibiting a different bioaccumulation pattern for Zn and Cu. In the case of corn, most BFs were below one, indicating a limited phytoaccumulation capacity. However, exceptions were observed for Cd, Zn, and Cu with the sunflower BFs indicating higher bioconcentration of these elements in leaves and seeds compared to other elements. Chromium (Cr) contributes to non-carcinogenic dermal contact and ingestion hazards, children being more susceptible to the adverse effects of this contaminant. [ABSTRACT FROM AUTHOR]

Background: Nasal high-frequency oscillatory ventilation (nHFOV) has emerged as an effective initial and rescue noninvasive respiratory support mode for preterm infants with respiratory distress syndrome (RDS); however, little is known about nHFOV use in Romanian neonatal intensive care units (NICUs). Objectives: We aimed to identify the usage extent and clinical application of nHFOV in Romania. Methods: A structured web-based questionnaire was designed to find the rate of nHFOV use and knowledge of this new method of noninvasive respiratory support in Romanian level III NICUs. Using multiple-choice, open-ended, and yes/no questions, we collected information on the NICU's size, noninvasive respiratory support modes used, nHFOV use, indications, settings, nasal interfaces, secondary effects, and equipment used. Descriptive statistics and comparisons were performed using IBM SPSS Statistics 26.0. Results: A total of 21/23 (91.3%) leaders from level III NICUs (median [IQR] number of beds of 10 [10–17.5]) responded to the survey. The most frequently used noninvasive ventilation modes were CPAP mode on mechanical ventilators (76.2%), followed by NIPPV (76.2%); heated, humidified high-flow nasal cannula (HHHFNC) (61.9%); and nHFOV (11/21 units; 52.4%). A total of 5/11 units reported frequent nHFOV use (in two or more newborns/month) in both term and preterm infants. The main indications reported for nHFOV use were CPAP failure (90.9%), hypercapnia (81.8%), and bronchopulmonary dysplasia (72.7%). Face/nasal masks and short binasal prongs are the most commonly used nasal interfaces (90.9% and 72.7%, respectively). Air leaks at the interface level (90.9%), thick secretions (81.8%), and airway obstruction (63.6%) were the most frequently mentioned adverse effects of nHFOV. Only three of the NICUs had a written protocol for nHFOV use. Most units not yet using nHFOV cited lack of equipment, experience, training, or insufficient information and evidence for the clinical use and outcome of nHFOV use in neonates as the main reasons for not implementing this noninvasive respiratory mode. Conclusions: Our survey showed that nHFOV is already used in more than half of the Romanian level III NICUs to support term and preterm infants with respiratory distress despite a lack of consensus regarding indications and settings during nHFOV. [ABSTRACT FROM AUTHOR]

Background: Otic involvement is common in children during acute infectious diseases, and is an important cause of morbidity and health service utilization. Methods: We performed a retrospective analysis of pediatric cases hospitalized in the largest infectious disease hospital in Romania between 2018 and 2023, with the aim of quantifying the incidence and impact of acute otitis (AO) according to pediatric age subgroups. Results: A total of 1118 cases diagnosed with AO were eligible and included in the analysis. Acute congestive otitis media was the most common subtype, identified in 53.3% of cases, followed by acute purulent otitis media (APOM) in 26.7% of children. The majority of AO cases (69.9%) were diagnosed in the pre-pandemic period (2018–2019), and infants (10.6%), toddlers (49.4%), and preschoolers (29.2%) were the most affected age groups. A viral infection associated with the AO episode was documented in 49.6% of cases. Influenza viruses were most commonly reported (20.5%), followed by SARS-CoV-2 (5.8%), and adenovirus (4.9%). A total of 38 cases of AO were identified in children with measles. In 15.9% of APOM cases, Streptococcus pneumoniae was isolated by culture from otic secretions. The duration of hospitalization was longer in children with APOM and acute otitis externa compared to the other subtypes of AO (p < 0.001). Conclusions: Our study highlights the importance of ENT (ear, nose, and throat) monitoring in children hospitalized for acute infectious diseases, as the majority of AO cases occur in the context of a viral infection. These findings emphasize the necessity for tailored assessment and intervention in suspected cases of AO, especially in young children under 5 years of age. [ABSTRACT FROM AUTHOR]

(1) Objectives: Assessment of novel impedance parameters such as the post-reflux swallow-induced peristaltic wave (PSPW) index and mean nocturnal baseline impedance (MNBI) have been proposed to enhance the accuracy of gastroesophageal reflux disease (GERD) diagnosis. We aimed to evaluate the clinical value of MNBI and the PSPW index in discerning different phenotypes of GERD in children. (2) Methods: We conducted a prospective, observational study that included 49 children aged 5–18 years, referred for MII-pH monitoring due to negative endoscopy and persisting gastroesophageal reflux symptoms despite acid-suppressant treatment. The PSPW index and MNBI were assessed along with conventional metrics. (3) Results: Using a receiver operating characteristic (ROC) curve analysis, MNBI (AUC 0.864) and the PSPW index (AUC 0.83) had very good performance in differentiating between non-erosive reflux disease (NERD) and functional phenotypes. The PSPW index (AUC 0.87) discriminated better between functional heartburn (FH) and reflux hypersensitivity (RH) compared to the MNBI (AUC 0.712). A PSPW cut-off value of 65% provided a sensitivity of 76.9% and a specificity of 90% in distinguishing FH and RH. The PSPW index (AUC 0.87) proved to have better performance than the MNBI (AUC 0.802) in differentiating between FH and non-FH patients. MNBI diagnosed FH with a sensitivity of 84% and a specificity of 80.6% at a cut-off value of 2563 Ω. (4) Conclusions: The PSPW index and MNBI are useful to distinguish between GERD phenotypes in pediatric patients. [ABSTRACT FROM AUTHOR]