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Abstract Background Healthcare systems aim to enhance the health status and well-being of the individuals and populations they serve. To achieve this, measuring and evaluating the quality and safety of services provided and the outcomes achieved is essential. Like other countries, Romania faces challenges regarding the quality of care provided in its public hospitals. To address this, the Romanian Ministry of Health initiated reforms in 2022, including implementing a pay-for-performance model based on quality indicators. This paper presents a descriptive analysis of processes, methods, results and lessons learned from developing and piloting a set of Quality of Care indicators for Romanian public hospitals. Methods World Health Organization’s Athens Office on Quality of Care and Patient Safety assisted Romania in developing and piloting a set of quality-of-care indicators for public hospitals. The development phase included defining indicator domains, identifying potential indicators across these domains, and defining the final indicator set. The piloting phase involved selecting and recruiting piloting hospitals, developing data collection and validation methods and tools, training hospital staff, and collecting and analysing indicator data. Piloting ended with an evaluation workshop. Mixed, quantitative and qualitative methods were used, including literature reviews, stakeholder consultation workshops, survey instruments developed for this study, modified Delphi panels and consensus-building meetings. National stakeholders were actively involved throughout the process. Results Four priority domains were defined for quality-of-care indicators for Romanian public hospitals: patient safety, patient experience, healthcare workforce training and safety, and clinical effectiveness. 25 core indicators were selected across these domains. During the pilot, hospitals achieved an average completion rate of 90% for data submission, with all domains rated equally relevant during post-pilot evaluations. Lessons included the need for supportive legislation, improved internal auditing practices and enhanced staff training, refinement of indicator data collection methods and alignment of indicators with hospital-specific contexts. Conclusions This work presents a significant stride in improving Romanian public hospitals’ quality of care and patient safety. It underscores the importance of high-level commitment, stakeholder engagement, and robust data practices in driving successful quality improvement efforts. Emphasising the role of data-driven and patient-centric approaches in achieving optimal healthcare outcomes, lessons learned offer insights for the continuation of quality improvement work in Romania but also for healthcare systems elsewhere.

The electrocardiogram (ECG) is a powerful tool to measure the electrical activity of the heart, and the analysis of its data can be useful to assess the patient’s health. In particular, the computational analysis of electrocardiogram data, also called ECG signal processing, can reveal specific patterns or heart cycle trends which otherwise would be unnoticeable by medical experts. When performing ECG signal processing, however, it is easy to make mistakes and generate inflated, overoptimistic, or misleading results, which can lead to wrong diagnoses or prognoses and, in turn, could even contribute to bad medical decisions, damaging the health of the patient. Therefore, to avoid common mistakes and bad practices, we present here ten easy guidelines to follow when analyzing electrocardiogram data computationally. Our ten recommendations, written in a simple way, can be useful to anyone performing a computational study based on ECG data and eventually lead to better, more robust medical results.

Bee-collected pollen (BCP) and bee bread (BB) are honey bee products known for their beneficial biological properties. The main goal of this study was to investigate BB microbiota and its contribution to bioactivity exerted by BB. The microbiota of BB samples collected at different maturation stages was investigated via culture-independent (Next Generation Sequencing, NGS) and culture-dependent methods. Microbial communities dynamically fluctuate during BB maturation, ending in a stable microbial community structure in mature BB. Bee bread bacterial isolates were tested for phenotypes and genes implicated in the production and secretion of enzymes as well as antibacterial activity. Out of 309 bacterial isolates, 41 secreted hemicellulases, 13 cellulases, 39 amylases, 132 proteinases, 85 Coomassie brilliant blue G or R dye-degrading enzymes and 72 Malachite Green dye-degrading enzymes. Furthermore, out of 309 bacterial isolates, 42 exhibited antibacterial activity against Staphylococcus aureus, 34 against Pseudomonas aeruginosa, 47 against Salmonella enterica ser. Typhimurium and 43 against Klebsiella pneumoniae. Artificially fermented samples exerted higher antibacterial activity compared to fresh BCP, strongly indicating that BB microbiota contribute to BB antibacterial activity. Our findings suggest that BB microbiota is an underexplored source of novel antimicrobial agents and enzymes that could lead to new applications in medicine and the food industry.

Abstract Gene function conservation is crucial in molecular ecology, especially for key traits like growth and maturation in teleost fish. The vgll3 and six6 genes are known to influence age‐at‐maturity in Atlantic salmon, but their impact on other fish species is poorly understood. Here, we investigated the association of vgll3 and six6 in the domestication of gilthead seabream and European seabass, both undergoing selective breeding for growth‐related traits in the Mediterranean. We analysed two different sets of samples using two different genotyping approaches. The first dataset comprised farmed and wild populations from Greece, genotyped for SNPs within the two genes (‘gene‐level genotyping’). The second dataset examined 300–600 k SNPs located in the chromosomes of the two genes, derived from a meta‐analysis of a Pool‐Seq experiment involving farmed and wild populations distributed widely across the Mediterranean (‘chromosome‐level genotyping’). The gene‐level analysis revealed a statistically significant allele frequency differences between farmed and wild populations on both genes in each species. This finding was partially supported by the chromosome‐level analysis, identifying highly differentiated regions may be involved in the domestication process at varying distances from the candidate genes. Noteworthy genomic features were found, such as a CpG island in gilthead seabream and novel candidate genes in European seabass, warranting further investigation. These findings support a putative role of vgll3 and six6 in the maturation and growth of gilthead seabream and European seabass, emphasizing the need for further research on their conserved function.

Objective: Acute myocardial infarction (AMI) is one of the leading causes of death; however, updated data regarding clinical presentation and current management are missing in Greece. This study aimed to prospectively record the demographic and clinical characteristics of a representative sample of patients suffering from AMI, their management, and short-term outcomes. Methods: ILIAKTIS is a national, prospective, multicenter, noninterventional study conducted under the auspices of Hellenic Society of Cardiology (HCS) and the European Initiative Stent - Save a Life. From 1st April 2020 to 30th June 2020, consecutive adult patients with STEMI or NSTEMI were enrolled in the 50 participating hospitals, appropriately selected to match the geographical and population distribution in the Greek territory. Results: In total, 1862 patients (mean age: 64.2 ± 13.2 yrs.; 77.2% males) with AMI were enrolled. More patients presented with NSTEMI (56.8%) than with STEMI (43.2%). Primary PCI (pPCI) was the preferable treatment option for STEMI patients in PCI-hospitals (76.9% vs. 39.9% for non-PCI, p

Bats form a diverse order of mammals with a crucial ecological role. Bat populations appear to be declining because of human-induced environmental stress. Genetic methods contribute to study the species’ diversity and assess their population status. We aimed to study the genetic diversity of bats across the Rhodope Mountain Range, where both species with a large distribution as well as rare species with a limited distribution are found. Βat samples were collected and morphologically identified within the catchment area of Nestos (Mesta) River and from caves in the region of Momchilgrad – Komotini. Based on the analysis of a mitochondrial COI gene region of 650 bp length, the samples were classified in 9 distinct genera and 21 species, an important part of Balkan bat species diversity. Miniopterus schreibersii displayed the highest number of haplotypes and Rhinolophus hipposideros the highest mtDNA diversity levels. The majority of the samples were grouped with other European sequences and no specific geographic distribution of haplotypes was observed, except for Barbastella barbastellus and Hypsugo savii, where a western/eastern divide is apparent. Three species with the most numerous samples were further analyzed using 4-5 microsatellite markers per species. No sign of population differentiation was found between studied samples for these three species and moderate to high diversity levels were detected for Rhinolophus blasii and Rhinolophus euryale in contrast to mitochondrial analysis. The results confirm the presence of specific bat species in the cross-border area of Greece and Bulgaria through genetic identification and provide information for levels of genetic variation for some of them that may contribute to future bat management efforts in the region.

The electrocardiogram (ECG) is a powerful tool to measure the electrical activity of the heart, and the analysis of its data can be useful to assess the patient's health. In particular, the computational analysis of electrocardiogram data, also called ECG signal processing, can reveal specific patterns or heart cycle trends which otherwise would be unnoticeable by medical experts. When performing ECG signal processing, however, it is easy to make mistakes and generate inflated, overoptimistic, or misleading results, which can lead to wrong diagnoses or prognoses and, in turn, could even contribute to bad medical decisions, damaging the health of the patient. Therefore, to avoid common mistakes and bad practices, we present here ten easy guidelines to follow when analyzing electrocardiogram data computationally. Our ten recommendations, written in a simple way, can be useful to anyone performing a computational study based on ECG data and eventually lead to better, more robust medical results. [ABSTRACT FROM AUTHOR]

Abstract Background Apoptosis is a caspase regulated cell death present in all metazoans defined by a conserved set of morphological features. A well-described function of apoptosis is the removal of excessive cells during development and homeostasis. Recent studies have shown an unexpected signalling property of apoptotic cells, affecting cell fate and/or behaviour of neighbouring cells. In contrast to the apoptotic function of cell elimination, this new role of apoptosis is not well understood but seems caspase-dependent. To deepen our understanding of apoptotic functions, it is necessary to work on a biological model with a predictable apoptosis pattern affecting cell fate and/or behaviour. The tunicate Ciona intestinalis has a bi-phasic life cycle with swimming larvae which undergo metamorphosis after settlement. Previously, we have shown that the tail regression step during metamorphosis, characterized by a predictable polarized apoptotic wave, ensures elimination of most tail cells and controls primordial germ cells survival and migration. Results We performed differential transcriptomic analysis between control metamorphosing larvae and larvae treated with the pan-caspase inhibitor Z-VAD-fmk in order to explore the transcriptional control of apoptotic cells on neighbouring cells that survive and migrate. When caspase activity was impaired, genes known to be involved in metamorphosis were downregulated along with other implicated in cell migration and survival molecular pathways. Conclusion We propose these results as a confirmation that apoptotic cells can control surrounding cells fate and as a reference database to explore novel apoptotic functions in animals, including those related to migration and differentiation.

Mediterranean finfish aquaculture is mainly represented by the production of the gilthead sea bream (Sparus aurata) and sea bass (Dicentrarchus labrax) growing in marine cage farms. Despite the numerous benefits of fish farming, the ecological risk potentially caused by fish escapes to the wild populations is occasionally high. In the current study, an integrated review of fish escapes is presented regarding S. aurata and D. labrax escapes and their potential effect on the genetic composition of wild populations. The collected data from the literature are combined and discussed along with recorded escapes in a fish farm located in the Aegean Sea, Greece. According to these records, fish escapes present a generally stable rate, ranging between 0 and 2% in each escape event, which occur 5–8 times per year. Although for other farmed fish species worldwide, the ecological risk may be higher, this risk is probably lower in Mediterranean finfish populations, which are characterized by generally low levels of genetic differentiation. Nevertheless, the risk of genetic introgression still exists. Particularly in sea bream and sea bass farming, genetic structure and differentiation in wild populations seem to be unaffected for now. Nevertheless, suitable management measurements would be a useful strategy to avoid future negative effects of fish escapes. These strategies should be focused on further efforts towards recapture program development, reduced escapees’ survival, and proper legislation. Furthermore, more data on escapees’ survival percentage, their migration pathways, and the way these pathways relate to mortality, the type of escape event, and the season of release would be also valuable.

Insects have been proposed as a rich alternative source of protein for the partial or total replacement of fishmeal in aquaculture. For maximum safety and effectiveness of insect meals, control of the quality composition of these products is considered mandatory. The aim of this study was the genetic analysis of the composition of commercially available insect meals at the species level. Commercially available Hermetia illucens, Tenebrio molitor and Musca domestica individuals, as well as nine insect meals produced from these species, were analyzed. The genetic identification of insects at the species level was based on a COI fragment, and analysis of the insect meals’ composition was performed with the processes of cloning and colony PCR. Genetic analysis indicated that the commercially available larvae morphologically identified as Musca domestica belonged to the species Muscina stabulans. In the commercially available insect meals, no other animal species was identified beyond the expected one. However, in the insect meal produced for research purposes, fungal growth was detected. The used methodology, herein, allows for the qualitative genetic identification of insect meals and could be included in the methods of traceability of products containing insects and other animal species.

Abstract In human‐dominated landscapes, connectivity is crucial for maintaining demographically stable mammalian populations. Here, we provide a comprehensive noninvasive genetic study for the brown bear population in the Hellenic Peninsula. We analyze its population structuring and connectivity, estimate its population size throughout its distribution, and describe its phylogeography in detail for the first time. Our results, based on 150 multilocus genotypes and on 244‐bp sequences of the mtDNA control region, show the population is comprised by three highly differentiated genetic clusters, consistent with geographical populations of Pindos, Peristeri, and Rhodope. By detecting two male bears with Rhodopean ancestry in the western demes, we provide strong evidence for the ongoing genetic connectivity of the geographically fragmented eastern and western distributions, which suggests connectivity of the larger East Balkan and Pindos‐Dinara populations. Total effective population size (Ne) was estimated to be 199 individuals, and total combined population size (NC) was 499, with each cluster showing a relatively high level of genetic variability, suggesting that migration has been sufficient to counteract genetic erosion. The mtNDA results were congruent with the microsatellite data, and the three genetic clusters were matched predominantly with an equal number of mtDNA haplotypes that belong to the brown bear Western mitochondrial lineage (Clade 1), with two haplotypes being globally new and endemic. The detection of a fourth haplotype that belongs to the Eastern lineage (Clade 3a1) in three bears from the western distribution places the southernmost secondary contact zone between the Eastern and Western lineages in Greece and generates new hypotheses about postglacial maxima migration routes. This work indicates that the genetic composition and diversity of Europe's low‐latitude fringe population are the outcome of ancient and historical events and highlight its importance for the connectivity and long‐term persistence of the species in the Balkans.

Climate change is emerging as a major threat to farming, food security and the livelihoods of millions of people across the world. Agriculture is strongly affected by climate change due to increasing temperatures, water shortage, heavy rainfall and variations in the frequency and intensity of excessive climatic events such as floods and droughts. Farmers need to adapt to climate change by developing advanced and sophisticated farming systems instead of simply farming at lower intensity and occupying more land. Integrated agricultural systems constitute a promising solution, as they can lower reliance on external inputs, enhance nutrient cycling and increase natural resource use efficiency. In this context, the concept of Climate-Smart Agriculture (CSA) emerged as a promising solution to secure the resources for the growing world population under climate change conditions. This work proposes a CSA architecture for fostering and supporting integrated agricultural systems, such as Mixed Farming Systems (MFS), by facilitating the design, the deployment and the management of crop–livestock-=forestry combinations towards sustainable, efficient and climate resilient agricultural systems. Propelled by cutting-edge technology solutions in data collection and processing, along with fully autonomous monitoring systems, e.g., smart sensors and unmanned aerial vehicles (UAVs), the proposed architecture called MiFarm-CSA, aims to foster core interactions among animals, forests and crops, while mitigating the high complexity of these interactions, through a novel conceptual framework.

Biodiversity is a key factor for the functioning and efficiency of an ecosystem. Greece, though covering a relatively small surface area, hosts a great deal of species diversity. This is especially true for freshwater fishes. In recent years, the traditional methods of species identification have been supplemented by the use of molecular markers. The present study therefore aims to extensively produce DNA barcodes for Greek freshwater fish species and investigate thoroughly if the presently accepted species classification is in agreement with molecular data. A 624-bases long fragment of the COI gene was sequenced, from 406 freshwater fish specimens belonging to 24 genera and originating from 18 lake and river sites. These sequences were used along with 596 sequences from the same genera, recovered from BOLD, for the construction of phylogenetic trees and the estimation of genetic distances between individuals. In total, 1002 sequences belonging to 72 species were analyzed. The method was found to be effective for 55 of 72 studied species. 17 closely related species with low interspecific genetic distances were observed, for which further study is proposed. It should also be noted that, in four cases, cryptic diversity was observed, where groups originally identified as one species exhibited genetic distance great enough to be separated into discrete species. Region specific haplotypes were also detected within populations of 14 species, giving the possibility to identify even the geographic origin of a species. Our findings are discussed in the light of the rich history of the Balkan peninsula and provide a significant steppingstone for the further study of Greek and European freshwater fish biodiversity.

Gilthead sea bream is an important target for both recreational and commercial fishing in Europe, where it is also one of the most important cultured fish. Its distribution ranges from the Mediterranean to the African and European coasts of the North-East Atlantic. Until now, the population genetic structure of this species in the wild has largely been studied using microsatellite DNA markers, with minimal genetic differentiation being detected. In this geographically widespread study, 958 wild gilthead sea bream from 23 locations within the Mediterranean Sea and Atlantic Ocean were genotyped at 1159 genome-wide SNP markers by RAD sequencing. Outlier analyses identified 18 loci potentially under selection. Neutral marker analyses identified weak subdivision into three genetic clusters: Atlantic, West, and East Mediterranean. The latter group could be further subdivided into an Ionian/Adriatic and an Aegean group using the outlier markers alone. Seascape analysis suggested that this differentiation was mainly due to difference in salinity, this being also supported by preliminary genomic functional analysis. These results are of fundamental importance for the development of proper management of this species in the wild and are a first step toward the study of the potential genetic impact of the sea bream aquaculture industry.

In this study, leaf hydraulic functionality of co-occurring evergreen and deciduous shrubs, grown on Olympus Mountain, has been compared. Four evergreen species (Arbutus andrachne, Arbutus unedo, Quercus ilex and Quercus coccifera) and four deciduous species (Carpinus betulus, Cercis siliquastrum, Coronilla emeroides and Pistacia terebinthus) were selected for this study. Predawn and midday leaf water potential, transpiration, stomatal conductance, leaf temperature and leaf hydraulic conductance were estimated during the summer period. The results demonstrate different hydraulic tactics between the deciduous and evergreen shrubs. Higher hydraulic conductance and lower stomatal conductance were obtained in deciduous plants compared to the evergreens. Additionally, positive correlations were detected between water potential and transpiration in the deciduous shrubs. The seasonal leaf hydraulic conductance declined in both deciduous and evergreens under conditions of elevated vapor pressure deficit during the summer; however, at midday, leaf water potential reached comparable low values, but the deciduous shrubs exhibited higher hydraulic conductance compared to the evergreens. It seems likely that hydraulic traits of the coexisting evergreen and deciduous plants indicate water spending and saving tactics, respectively; this may also represent a limit to drought tolerance of these species grown in a natural environment, which is expected to be affected by global warming.

Current technology to prevent biofouling usually relies on the use of toxic, biocide-containing materials, which can become a serious threat to marine ecosystems, affecting both targeted and nontargeted organisms. Therefore, the development of broad-spectrum, less toxic antifouling materials is a challenge for researchers; such materials would be quite important in applications like aquaculture. In this respect, surface chemistry, physical properties, durability and attachment scheme can play a vital role in the performance of the materials. In this work, acrylonitrile butadiene styrene (ABS)/micro ZnO or nano ZnO composite lattices with different metal oxide contents were developed using 3D printing. Their antifouling behavior was examined with respect to aquaculture applications by monitoring growth on them of the diatoms Navicula sp. and the monocellular algae Chlorella sp. with image analysis techniques. As shown, the presence of metal oxides in the composite materials can bring about antifouling ability at particular concentrations. The present study showed promising results, but further improvements are needed.

Recent technological developments in the primary sector and machine learning algorithms allow the combined application of many promising solutions in precision agriculture. For example, the YOLOv5 (You Only Look Once) and ResNet Deep Learning architecture provide high-precision real-time identifications of objects. The advent of datasets from different perspectives provides multiple benefits, such as spheric view of objects, increased information, and inference results from multiple objects detection per image. However, it also raises crucial obstacles such as total identifications (ground truths) and processing concerns that can lead to devastating consequences, including false-positive detections with other erroneous conclusions or even the inability to extract results. This paper introduces experimental results from the machine learning algorithm (Yolov5) on a novel dataset based on perennial fruit crops, such as sweet cherries, aiming to enhance precision agriculture resiliency. Detection is oriented on two points of interest: (a) Infected leaves and (b) Infected branches. It is noteworthy that infected leaves or branches indicate stress, which may be due to either a stress/disease (e.g., Armillaria for sweet cherries trees, etc.) or other factors (e.g., water shortage, etc). Correspondingly, the foliage of a tree shows symptoms, while this indicates the stages of the disease.

The identification of the genetic basis of domestication in fish species is of timely importance for the aquaculture industry in order to increase productivity, quality, and the welfare of farmed fish. The goal of this study is to investigate the largely unknown aquaculture-induced evolution in gilthead seabream, which is one of the most important farmed fish in the Mediterranean region. We used a panel of 1159 genome-wide SNPs, and genotyped 956 fish from 23 wild populations of Mediterranean-wide distribution and 362 farmed fish from five Greek hatcheries. We assessed the genetic diversity of the sampled populations and contrasted the results of four different approaches of outlier detection methods. We recognized one very strong candidate and two good candidate SNPs with evidence for aquaculture-induced evolution in gilthead seabream. The annotation of these SNPs revealed neighboring genes with biological roles from stress tolerance and disease resistance to sexual maturation that may explain our observations. In conclusion, we demonstrate that the genome of gilthead seabream, despite the fact that the species is often suggested to be in the early stages of the domestication process, shows evidence of aquaculture-induced evolution. We report on a list of genes that may explain our observations and that may be investigated further. We anticipate that our findings will stimulate additional research with the use of SNP panels of higher density that can elucidate the genomic architecture of domestication in this species of high aquacultural interest.

Dairy sheep farming is a vital sector of the agricultural economy in Greece. Information on the effect of the farming system on sheep milk characteristics is critical for producing dairy products with improved nutritional value according to the current guidelines for healthy food consumption. This study aimed to investigate the basic composition, physicochemical characteristics, fatty acid composition, and nutritional indices of milk produced in intensive and semi-intensive sheep farms. Bulk tank milk samples from 20 intensive and 20 semi-intensive sheep farms were examined. Sheep in the intensive farms were kept indoors and were fed with roughage, silage, and concentrates. Sheep in the semi-intensive farms were kept indoors during the night and were moved to the pastures during the day. Sheep were fed with roughage, silage, and concentrates in combination with grazing. Milk composition and somatic cell count were determined with automatic analyzers. The physicochemical characteristics were determined with standard laboratory methods. The fatty acid composition was analyzed by gas chromatography. The farming system did not affect milk chemical composition and physicochemical characteristics. However, milk fatty acid composition and nutritional value were significantly improved in milk from farms using the semi-intensive production system, and this favorable effect was attributed to the inclusion of pasture in sheep diet.