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Medical libraries have had to swiftly change the way they connected their clients to instruction services starting Spring of 2020. The focus of this article is on the instructional services of [hospital library] pre and post 2020 and it will also provide insights into what hospital libraries in Canada have been doing, what they are succeeded at and working on. This paper will describe the design, implementation, and outcomes of a Quality Improvement (QI) project and concludes by exploring the changes recommended to enhance online instructional services in an urban research and teaching hospital library environment. The QI project led the team to prioritize three areas for improvement: a peer feedback system that has been designed to support instructors in building their confidence and skills; monthly the Instruction Team will debrief any workshops using the peer feedback data, attendance information, instructor feedback, and attendee evaluations. The workshops offered will expand beyond the typical hour-long, one-off workshop sessions to other formats. The results of the QI process have produced many ideas that could be used to improve the design and delivery of online instruction and confirmed that libraries in hospitals across Canada are encountering similar barriers around time, staffing capacity, technology, and training.

Following a historical review of the tribe Typhlotricholigioidini, we define the tribe and the genera which, according to our view, are included in it. The genus Brackenphiloscia Ortiz, Garcia Debraz and Lalana, 1999 we interpret as part of this tribe. The examination of the holotype of the species Caucasonethes borutzkyi Verhoeff, 1932, the type species of the genus Caucasonethes, as well as individuals from the type series of several species attributed to the genus Amerigoniscus Vandel, 1950, allowed us to endorse the viability of the synonymy established by Vandel (1953a): Caucasonethes Verhoeff, 1932 syn. Amerigoniscus Vandel, 1950.

Following a historical review of the tribe Typhlotricholigioidini, we define the tribe and the genera which, according to our view, are included in it. The genus Brackenphiloscia Ortiz, Garcia Debraz and Lalana, 1999 we interpret as part of this tribe. The examination of the holotype of the species Caucasonethes borutzkyi Verhoeff, 1932, the type species of the genus Caucasonethes, as well as individuals from the type series of several species attributed to the genus Amerigoniscus Vandel, 1950, allowed us to endorse the viability of the synonymy established by Vandel (1953a): Caucasonethes Verhoeff, 1932 syn. Amerigoniscus Vandel, 1950.

The present paper attempts to deal with two classical themes in a new and fresh context. The amount of works on leadership and entrepreneurship is vast, but the authors identified a gap in the research of these concepts in relation with tech start-ups, a domain that developed significantly in the recent period. The authors performed a detailed literature review, followed by an interview with a selected panel of entrepreneurs in Romania. The results of the study highlights few important trends related to the leadership traits of Romanian entrepreneurs. The results also confirmed a positive mindset and attitude which triggers an optimistic outlook for the Romanian entrepreneurial ecosystem.

Introduction. Cancer surgery often involves excisions that lead to important anatomical defects. The reconstruction methods following an ablative surgery for head skin cancer are unique and require special attention for both shape and function. Utilisation of split-thickness or full-thickness skin grafts is indicated for face regions with minimal motion. Case presentations. We present four cases of skin cancer, who required a flap for the reconstruction of post-excision defects. The first case is of a 90-year-old male with a right preauricular squamous cell carcinoma. The remaining defect after tumour ablation was reconstructed with a full-thickness skin graft harvested from the arm. The second case is of a 45year-old male with a malignant melanoma of the scalp. The defect on the scalp was also covered with a skin graft. The third case is of a 51-year-old diabetic woman with left nasal skin cell carcinoma.

Introduction. Paragangliomas are benign tumours that arise from the paraganglionic system. The most frequently encountered symptoms of tympanojugular paragangliomas are pulsatile tinnitus and conductive hearing loss. High resolution computed tomography, with reconstruction in axial and coronal planes, is mandatory in every suspected case of tympanojugular paraganglioma. The treatment is guided by the classification of Fish. Cases presentation. We present two cases in whom the clinical manifestations and paraclinical investigations established the diagnosis of tympanojugular paraganglioma. Both surgery and postoperative evolution are described for each case. In most of these tumours, surgery remains the mainstay treatment. According to the preoperative plan of the first case, it was decided that the tumour can be resected safely, without compromising the cranial nerves. In the second case, the entire tumour was removed, but with the sacrifice of the inferior cranial nerve, caught in the tumour mass. Conclusions. These tumours have the tendency to involve multiple vital structures of the skull base. A detailed preoperative plan of treatment is required to maximize tumour resection, while minimizing morbidity of the great vessels and lower cranial nerves.

Introduction. Meningiomas are benign tumours of the arachnoid layer and although relatively frequent they have an intracranial development, implications of the visceral cranium or the neck are rare. Case presentation. We present the case of a 67-year-old male with an intracranial meningioma, with recurrences in the extra cranial area. We focused on clinical presentation, imaging studies and treatment options in this kind of tumour. Extra cranial meningiomas, primary or secondary, are rare and a sinonasal type should always be considered that it may be an extension of an intracranial tumour. The recurrence rate is moderate and outcome is good, but a missed follow-up may lead to unfavourable consequences. Treatment options may vary from „watch and wait“ to surgery – transcranial and endoscopic approaches, combined techniques – and even radiotherapy, depending on the site and extension. Conclusions. Endoscopic endonasal surgery may be a safe and effective way of treatment for skull base tumours, although it requires advanced techniques and a good knowledge of reconstruction of dura and skull base defects. There are also limitations, that can be surpassed with a combined approach.

Introduction. The quality of life of patients after total laryngectomy is influenced by both the disease and the radical therapeutic interventions. After surgical treatment, vocal rehabilitation, along with pulmonary and deglutition rehabilitation, are necessary. The objective of the study was to assess the quality of life in patients with total laryngectomy. Materials and methods. A questionnaire with 14 questions was randomly addressed to 100 patients with total laryngectomy who presented to Coltea Clinical Hospital, Bucharest, Romania, over a period of three months. Results. Fifty patients answered that they had no pain. Regarding everyday activities, 34 patients answered that they were as active as before surgery. Regarding their appearance, 50 patients answered that there is no change, or the change is minor, while 39 answered that their appearance bothers them, but they remain active, and 5 answered that they feel disfigured and limit their activity, while 6 patients answered that they cannot be with other people because of their aspect. 34 patients answered that they could swallow as well as prior to surgery, other 34 patients answered that they cannot swallow certain foods, while 21 answered that they only swallow liquid food or are dependent on a feeding tube. Regarding everyday activity, 67 patients answered there are times when they cannot keep up with their old pace, but they get out of the house and enjoy life. About their mood, 38 patients answered that they were not in a good mood, nor depressed, while 36 said their mood is generally good and only occasionally affected by cancer. Six patients answered that their mood is excellent, while 15 patients were somewhat depressed and 5 were extremely depressed. Conclusions. The quality of life is influenced by the patients’ appearance after total laryngectomy, and their ability to maintain everyday activities. Swallowing, taste and saliva quality have a great impact on the quality of life of patients with total laryngectomy and also influence their nutritional status.

Introduction. Squamous cell carcinoma of the tongue is a very rare disease among children, with only a few cases reported in the literature. The tongue is the most common site for oral malignancy. The main contributing factors to pelvilingual cancer are constant irritants of the oral mucosa, such as tobacco, alcohol, and dentures. In children, however, the risk factors are immunosuppression induced by a hemopathy such as Fanconi anemia or by chemotherapy, Xeroderma Pigmentosum Syndrome or KID (keratitis, ichthyosis, deafness), Plummer-Vinson syndrome. Cases presentations. The authors present two cases of children, 12 and 15 years old, diagnosed with pelvilingual malignant neoplasia, for which review of the clinical manifestations, the methods of diagnosis and treatment used, but also the evolution will be described. Conclusions. Clinical symptoms of tongue cancer are similar to other types of neoplastic diseases developed in the oral cavity (for example oral floor neoplasm). Confirmation of the diagnosis is made by histopathological examination of the tissue specimen obtained from the tumor site. Therapy has a complex multimodal approach and includes, depending on staging, general condition, and the patient’s option, primary and adjuvant methods. Surgery followed by radio-, chemo-, immunotherapy are the preferred methods. Another possibility is tumor stage conversion by radio-, chemo- and immunotherapeutic treatment, followed by surgery. In some cases, surgery is an ultimate method of therapy, a salvage therapy.

Introduction. The infections of the deep neck spaces, are often a clinical challenge, being a medico-surgical emergency with a bad prognosis and lethal potential in the absence of early diagnosis and well applied treatment. Case report 1. The first case presented is a woman, 72-year-old, known with anaemia due to myelodysplastic syndrome, admitted in the haematology department. The symptoms were dysphagia with odynophagia and right submandibular tumefaction, on an afebrile background. In this case the infection started with the peritonsillar abscess which then developed into a parapharyngeal abscess. The main medical difficulties appeared after the surgery, the general condition of the patient worsening despite the favourable evolution of the surgical wound. A total recovery, including deglutition, was possible two months after discharge. Case report 2. The second patient is a young female, aged 26, with a good social and material status, without associated comorbidities. The triggering factor is the extraction of the 3.7 molar prior to the appearance of the symptoms. The condition of the patient was critical during the first seven days after surgery due to the severity of the cervical and mediastinal lesions. Conclusions The management of deep neck infections is a diagnostic and therapeutic challenge, and must be based on the multidisciplinary aid. The prevalence of deep neck infections is decreasing, due to antibiotics, but still remains an ENT emergency.

Inflammation of the salivary glands manifest differently, depending on the etiologic agent and patient population. Inflammatory and infectious pathology of the salivary glands is multifactorial and has a multimodal therapy. Bacterial infections are the result of ductal blockage or decreased salivary production. On this background, retrograde contamination of glandular parenchyma occurs. Some systemic viral infections produce salivary pathology such as mumps or AIDS. Many granulomatous infections can affect salivary glands such as tuberculosis (TB), syphilis, tularemia, toxoplasmosis, actinomycosis, and bartonellosis. Salivary inflammation occurs either in the secretory canal or in the whole gland. Suppuration of the salivary glands in immunosuppressed individuals can extend to cervicofacial regions and the mediastinum and require immediate treatment. Interdisciplinary collaboration with the infectionist, parasitologist and radiologist is the golden standard towards the benefit of the patient. Authors describe the clinical features and treatment of inflammatory diseases of the salivary glands.

Although a common condition, acne is a complex condition that involves chronic inflammation and hyperkeratosis of the hair follicles, increased sebum secretion, and colonization of Propionibacterium acnes. Metformin has been found to play a role in acne, particularly hormonal acne. Our goal is to review the relevant studies and their results following metformin administration in patients with acne.

Human Papilloma Virus (HPV) is the virus responsible for the most common and widespread sexually-transmitted infection. Most sexually active people will acquire at least one type of HPV in their lifetime and some may be repeatedly infected. In most cases, HPV infection is transient and asymptomatic, but when the infection persists it can cause benign diseases, precancerous lesions and malignancies of various locations. Low risk HPV types can produce proliferative lesions either in the skin or mucosa, whereas high risk types possess carcinogenic potential. This paper is a review of the latest data in the literature regarding the clinical manifestations of HPV infections, current prevention and therapeutic possibilities.

The ENT practitioner has a principal role for diagnosis, treatment and clinical recovery of vestibular schwannoma patients. These tumors require a special attention, concerning the treatment and the follow-up, because of their location in a deep anatomical region, very rich in vascular and neurological elements. If surgery is chosen as the best treatment modality, the vascular related complications, during surgery or immediately after surgery, can be disastrous for the patient. The surgeon must have the anatomical knowledge and appropriate skills. The anatomy of the venous system has an individual variability, with an impact to the procedure’s surgical risks. The objective of this publication is to synthetize the local venous anatomy and surgical practices in case of venous bleeding at the level of the pontocerebellar angle.

A patient with pontocerebellar pathology has complaints in the ENT field, like hearing loss, tinnitus, vertigo or facial pain The vestibular and non-vestibular schwannoma are the most frequent pathologies of this anatomical region, and because of their “mild” clinical manifestations, the diagnosis can be delayed during a regular follow-up. Improvement of differential diagnosis between vestibular schwannoma and non-vestibular schwannoma requires a detailed anamnesis as well as radiological and electrophysiological exams. Nevertheless, the non-vestibular tumors are often misdiagnosed as vestibular tumors. The surgeon must have all the knowledge and skills in order to provide, case by case, the right diagnosis and the best care for his patient. The aim of this publication is to overview the most recent data related to pontocerebellar non-vestibular schwannoma.

Psoriasis is a chronic inflammatory disease that affects the patients’ quality of life. In psoriatic patients, the quality of life is generally low due to multiple co-morbidities, treatments, stigma and misperceptions about this condition. Sexual dysfunction, in both women and men, is a comorbidity that may impact the quality of life of these patients, in addition to those listed above. Because the recognition of sexual dysfunction by the patient can be difficult and considered shameful, it is necessary for the family doctor to intervene to improve the sexual health of these patients.

Vitiligo is a chronic, asymptomatic, disease that affects the patient from a cosmetic point of view. It is characterized by the appearance of depigmented areas on the skin or mucous membranes. Depending on the morphology of the lesions, vitiligo can be classified into: segmental, non-segmented or mixed. Vitiligo is associated with a range of autoimmune disorders, most commonly autoimmune thyroid diseases, alopecia areata, halo nevi, psoriasis, diabetes, etc. Etiology is not entirely elucidated, autoimmune theory related to specific genetic mutations being the most studied.

Introduction. Considered by many authors a vestigial structure, the appendix is a small dimensions organ with mostly unknown functions. Acute appendicitis is the most common condition of the ileocecal appendix, having multifaceted clinical manifestations, often masquerading as various unrelated syndromes, but causing increased morbidity, especially when diagnosed late. Although the disease could manifest at any age, there is a progressive increase of its incidence from birth, with a maximum between 10 to 40 years. Case presentation. We report the case of an 84 years-old female patient, who presented with significant abdominal pain in the lower quadrants, mainly in the right iliac fossa and in whom the CT examination was suggestive of a utero-appendicular fistula, a very rare complication in daily practice and even more seldomly encountered in the elderly. Conclusions. Acute appendicitis remains a condition for which surgery is still the optimum treatment, especially in the case of an elderly patient having a radiologically suspected fistula with the uterus that could easily lead to septic gynecological complications and possibly progression to multiple organ failure.

Located in central Greece, Melissotrypa Cave is a hypogenic cave that contains a sulfidic lake. Biological investigations in this cave led to the discovery of several endemic troglobitic invertebrates, some of which occur in high densities of up to 200 specimens per square meter

Background. Rhinoplasty is considered as one of the most challenging objectives in plastic surgery and tip rhinoplasty is arguably the greatest challenge for the surgeon performing rhinoplasty. No routine tip procedure is ever used and there are many ways to reconstruct and make nasal tips more attractive. Objective. The aim of this study was to evaluate the different correction techniques, in order to improve the outcomes in tip rhinoplasty. Methods. A prospective study was performed, including all patients with nasal tip deformities who underwent closed or open rhinoplasty between December 2015-August 2016 in Bombay Hospital, India. The patients were divided into two groups: group A – treated with various types of tip sutures (12 cases), and group B – treated with combined tip sutures and grafts (18 cases). Results. The study included 30 patients, 24 (80%) females and 6 (20%) males. 12 (40%) were patients with bulbous tips, 7 (23%) were patients with droopy tips, 5 (17%) were patients with boxy (broad) tips, 3 (10%) were patients with wide tips, and 3 (10%) were patients with bifid tips. A total of 27 (90%) cases involved primary rhinoplasties, and 3 (10%) cases involved revision. Patient’s and doctor’s satisfactions were recorded by a score from 0 to 3, with 0 being the less satisfied by the result of surgery and 3 being the highest satisfied. Conclusion. Aesthetic outcome following the management of nasal tips deformities with combined suture techniques and grafts is more satisfactory than the outcome that can be achieved following suture alone, especially in certain cases.

Upon conclusion of an international tourism contract, the contracting parties - one of which (the beneficiary) acts as the consumer – are facing legal difficulties, which are addressed by this study from the perspective of the interference between the national law and the European Union law. Thus, one of the primary issues considered herein is that concerning the determination of the applicable law based on which the rights and obligations of the contracting parties are to be established. Secondly, this study examines the applicable procedural rules in the case where a Romanian court is requested to settle a dispute arising from an international tourism contract. Finally, the study deals with the hypothesis where a dispute arising from such a contract is settled by a foreign court, and in particular with the effects of the judgment given by the foreign court on the territory of Romania. The above mentioned issues are the grounds behind this research on the legal status of international tourism contracts, in addition to the fact that, despite the rich contractual practice in the field under consideration, the amount of specialized literature on this subject is rather limited.

The paper presents the development of the nuclear power sector in Romania from the perspective of sustainable development. The current state is analysed and the expected future development is investigated. The implementation of ALFRED LFR demonstrator in Romania (reference site: nuclear platform Mioveni) is approached from the point of view of the current stage of RDI and implementation and the contribution to sustainable development in Romania and Europe.

The Dada Movement: Origins, Literary History; The Pioneer of Surrealism. The Mysterious Figure of Romanian poetry, Tristan Tzara. Globally, the Dada movement can be considered a precursor of the crisis of European consciousness insofar as, coming as a reaction against the First World War, it rejects systems, ideologies, frontiers and rational categories. REZUMAT. Mișcarea dadaistă: începuturi, istorie literară; precursoarea suprarealismului. Personajul misterios al poeziei românești, Tristan Tzara. Luatӑ în integralitate, mișcarea Dada poate fi consideratӑ drept sindrom precursor al crizei conștiinţei europene în mӑsura în care, apărând ca reacție împotriva primului război mondial, ea refuzӑ sistemele, ideologiile, frontierele și categoriile raţionale. Cuvinte cheie: dadaism, suprarealism, artӑ, sculpturӑ, crizӑ, primul rӑzboi mondial, tabula rasa, umor negru.

Research background. An intelligent rural community in our vision wants to be a balance between people and the environment, through a transformation of long-term economic, social and environmental characteristics. This paper aims to investigate the need to change this environment in the South-East Region, Romania, a rural plain. Purpose of the article. Villages with a certain risk of poverty are most at risk of depopulation due to the presence of low-income people, disadvantaged groups, with a population of "third age" and "fourth age". In other mountain areas, for example, there are rich villages where aging does not characterize low-income people and retired migrants. Methods. The objectives of the research are to describe the Chiscani, Brăila area, the need to transform the villages in its composition, but also to identify activities with potential for sustainable development at its level. Awareness of the community by promoting those economic activities that support the smart plain area is the basis of the whole concept. Findings & Value added. The aim of this study is to evaluate the perceptions about smart village (SV) to attract entrepreneurs, tourists and business development in the South East Region, Chiscani.

Research background. Specialists show a decrease in awareness of the issues of sustainability of tourism activities among various stakeholders [1], followed by arguments [2], and irresponsible practices of visitors. Local key actors could be the main interdependent factors in solving [3] these issues that characterize sustainable tourism through the emergence of the phenomenon of digitalization and high popularization of social networks. Digital communication networks have left their mark on the impact that brand tourism - considered as local tourist destinations, has on the behavior of residents and tourists [5], [6]. In this research we aim to evaluate the various advantages that sustainable tourism can have due to digital media in the Pietroasele area, Buzau County, Romania. Purpose of the article. In this research we aim to evaluate the various advantages that sustainable tourism can have due to digital media in the Pietroasele area, Buzau County, Romania. Methods. Digital communication networks have left their mark on the impact that brand tourism - considered as local tourist destinations, has on the behavior of residents and tourists [7],[8], Findings & Value added. The aim of this study is to evaluate the perceptions about the local brand as a way to attract entrepreneurs, tourists and business development in the wine area Pietroasele, Buzau, Romania based on the following specific research objectives: 1. Knowledge of the role of the local brand in the management of local businesses and authorities. 2. Monitoring the application of mechanisms used by specialists to develop local branding, including collaboration with local partners. 3. Evaluation of the perspectives arising from the development of the analyse brand.

It reveals that imports have increased in the last decade compared to exports, which had an importance quite special, and taken the fact that for two decades, every year, the trade balance of Romania was deficient in terms of exports and politics foreign trade. Moreover, the balance has increased exponentially in recent times.

Manipulation. A word with such a special echo that exceeds the boundaries of semantics, creating rumor and scenarios which are more or less whimsical, with a pregnant whiff of conspiration. Passing through the scientific-psychological essential aspects, we reach the coup de grace: from the manipulation of the masses, through the culture of mediocrity, to the much debated manipulation through the use of mass media. We do not strictly treat the psychology of large groups, neglecting the individual. Thus, we will tangentially walk the path of Intelligence. How are these strings pulled? Who are the puppeteers and how can we become them?

Testing of F/M Heads (loaded/unloaded car) before installing them in the CANDU reactor is a task of utmost importance in the process of commissioning the nuclear power plant. Maximum capacity reactor operation in safe conditions depends on successfully testing of the F/M Heads. Completion of F/M Heads Testing for Cernavoda Unit 2, certifies both the proper functioning of the machinery as well as the ability of the staff and existing technology from INR Piteşti to achieve complex activities for nuclear power plant, F/M Heads testing being a national and European premiere.

Hydrogen and fuel cell technologies were identified amongst new renewable energy technologies which contribute strongly to mitigating climate change. Important research activities were directed to the injection molded bipolar plates made by conductive polymeric composites. The mold surface quality can help obtaining better conductivity. In this paper are presented the experiments regarding complex micro-machining of the surfaces of an injection mold for a conductive polymeric composite product by micro-milling and for finishing and cleaning by laser beam micro-machining. The laser ablation consists in removing material from a solid surface by irradiating it with a laser beam, in successive layers in order to achieve complex geometries with accuracy of about micrometres. Injection moulding experiments evidenced the very good replication of the micro-machined surface pattern.

In most of the organizations, people are now recognized as the vital asset. Their knowledge, skills and abilities must be deployed to the maximum effect if the organization is to become successful. The intangible value of an organization relating to the people it employs and its human resource strategies is gaining recognition and it is generally accepted that this has implications for long-term sustained performance. The recent chances in the economy and the development of new technologies are creating the proper set for a series of other changes regarding the human resource management. The first one refers to the need to respond to the challenges raised by the knowledge workers and the second one refers to the increasing role of human resource management in the strategical moves of the organizations. Lately, because of the recent mentioned developments, strategic human resource management became a subject of ongoing discussion for academics. Its definition and relationships with other aspects of business planning and strategy wary, but the common agreement is that strategic human resource management is a complex process that is constantly evolving and that there is a need of understanding its usefulness. Having quality professional practices is a must, but this shouldn’t be the only focus of the best human resource practitioners. They need to be able to combine their attention to basic administration with also making important strategic inputs that have a positive impact on the organization. The purpose of this article is to present the current research state in the field of strategic human resource management. In order to achieve this, the factors that underline the importance of human resource management are assessed. The study has been accomplished using the methodology of bibliographic study and qualitative research.

Utopias are perfect places but the term itself says that they are nowhere to be found, making them practically impossible. Dystopias, even if they are written as a warning of how things can get worse, seem much more probable. All utopian societies are systems of plenty where everyone has enough and no one lacks the basic necessities. Yet resources do not come out of nowhere. A political system may be needed in a utopia but it is not the sole condition. A barren environment would make perfection impossible. A devastated land, then, can lead to a dystopia. Our way of life is connected to the environment around us. A drastic change there would alter human behavior significantly. If utopia is the dream situation, the dystopia is obviously the nightmare. The late 20th century had a feeling of “the end”, a lot of finalities were imagined, including “the end of history”. However, once those notions were left behind, even dystopias started to imagine events happening in a post-apocalyptic situation. One such dystopia is The Road, a novel about the struggles of a father and a son trying to survive after an unnamed cataclysm. The father’s desire to take his child toward the sea, where he thinks it might be safe, also implies a journey through the devastated land. In their travel they will witness the devastation of nature and the changes that brings to human behavior, a change that was unwanted and, for the son, an inheritance the father was unwilling to pass on.

A team of international nuclear safety experts completed, a preliminary assessment of the safety issues linked with TEPCO's Fukushima Dai-ichi Nuclear Power Station accident following the Great East Japan Earthquake and Tsunami. Considering the gravity of the accident and the conclusions of the IAEA Fact-Finding Team, the European Council declared that ”the safety of all EU nuclear plants should be reviewed, on the basis of a comprehensive and transparent risk assessment (“stress tests”). This paper presents a summary of the catastrophic events on Japan and their impact on world nuclear power.