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The ferrous metallurgy represents a traditional occupation, being extremely important for the national economy. Romania has gone through all the stages foreseen for the restructuring of this industry in compliance with the provisions of the European Council’s Decision (1999/582/EC) concerning the partnership for the EU adherence, which included a special chapter on ferrous metallurgy, the provisions of the Protocol no. 2 (ECSC), as well as with other significant normative acts subsequently enacted. Following the performed restructuring – privatizations, state allowances, liquidations, re-technologization – the activity of this sector has developed, still being under the potential of the Romanian metallurgic industry. Nowadays, the disadvantages relating to energy intensity and the increased need for imported raw materials are doubled by the difficulties generated by the global crisis.

Objective Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). We compared 5‐year adverse event (AE) incidence rates (IRs) between patients initiating tofacitinib and those initiating new biological disease‐modifying antirheumatic drugs (bDMARDs) within the United States (US) Corrona RA registry. Methods IRs (number of first events/100 patient‐years) of major adverse cardiovascular events (MACE), serious infection events (SIEs), herpes zoster (HZ), malignancies, and death were estimated among tofacitinib and bDMARD initiators, regardless of dose/schedule, between November 6, 2012 (US Food and Drug Administration tofacitinib approval), and July 31, 2018 (follow‐up through January 31, 2019). Propensity score (PS) methods were used to control for nonrandom prescribing practices. Hazard ratios (HRs) were calculated to compare rates using multivariable‐adjusted Cox regression. Different risk windows were used for acute (MACE, SIEs, HZ, and venous thromboembolic events [VTEs]) and long‐term (malignancy and death) events. VTEs were assessed descriptively. Results For MACE, SIEs, and HZ, 1999 (3152.1 patient‐years) and 8358 (12 869.4 years) tofacitinib and bDMARD initiators were included, respectively; for malignancy/death, 1999 (4505.6 patient‐years) and 6354 (16 670.8 patient‐years) initiators were included, respectively. AE rates were similar across cohorts, except for HZ, which was significantly higher with tofacitinib versus bDMARDs (PS‐trimmed adjusted HR 2.32; 95% confidence interval [CI] 1.43‐3.75). There were 45 (zero serious) and 88 (five serious) HZ events with tofacitinib and bDMARDs, respectively. Sensitivity analyses demonstrated similar results. VTE IRs (95% CI) were 0.29 (0.13‐0.54) and 0.33 (0.24‐0.45) for tofacitinib and bDMARDs, respectively. Conclusion In this registry analysis, both cohorts had similar MACE, SIE, malignancy, death, and VTE rates; HZ rates were higher for tofacitinib initaitors than for bDMARD initiators.

The aim of this paper was to empirically analyze the relationship between public health expenditure and health outcomes among EU developing countries. Using regression analysis and factor analysis, we documented that public health expenditure and health outcomes are in a long-run equilibrium relationship and the status of health expenditure can improve life expectancy and reduce infant mortality. Secondarily, we studied how the status of good governance, health care system performance, and socioeconomic vulnerabilities affect the public health's outcomes in the selected countries. We found that the effectiveness of health and the way to reduce infant mortality or to improve life quality is directed conditioned by good governance status. Moreover, the consolidation of health care system performance directly improves the quality of life among EU developing countries, which indicates that public policymakers should intervene and provide political and financial support through policy mixes.

The COVID-19 pandemic stressed the importance of understanding the sources of vulnerabilities that can lead to a financial crisis and highlighted the predominant impact on health systems. Firstly, the paper aims to conduct a retrospective analysis of the Romanian health care system, over the period of time 1985-2019, based on our own computed sustainability index for public health. Secondly, using the Gregory-Hansen cointegration method, we provide new evidence on the causal relationship between health expenditure and GDP for Romania over the period of time 1985-2017. Based on the retrospective analysis of the long-run co-movement between health spending and GDP, the study allows one to prospectively examine not only the effects of the COVID-19 pandemic on health care spending, but also to reveal the government's fiscal position and vulnerabilities. Our results highlight the intergenerational costs related to the policy incoherence roadmap and regulatory fragmentation, stressing the importance of economic system resilience through fiscal diligence and the consolidation of the institutional context.

The last years have brought into attention more than ever concerns regarding the accelerating degradation of the environmental conditions which threaten both the present but mainly the future of human society. Under such circumstances, the society and especially the governments need to acknowledge the seriousness of environment issues and be able to develop and put into practice specific policies to counteract them. In this regard, this paper performs an analysis on a group of 11 European developing countries, over the period between 2000 and 2017, aiming first to evaluate the impact of the changing environment conditions and of the governmental actions regarding environment protection, on citizens life, namely on their life expectancy. In order to evaluate, as accurately as possible, the quality of the environment we propose and elaborate upon an environmental sustainability index based on 17 proxies for environment issues, whose values reveal several similarities between some of the analyzed countries. Secondly, using this index and also several categories of public expenses as proxies for the government actions towards environment protection, we analyze their impact on the life expectancy of the citizens during the sample period and draw some specific conclusions on the actions to be taken forward by governments.

Background: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD., Methods: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels., Results: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P < .01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P = .15). Secondary end points did not differ between groups after follow-up., Conclusions: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

The objective of this paper is to summarize an extensive bibliographical search by presenting the retrospective of EU organic food from the point of regulation, policy framework, trends and challenges. We also make a critical review of existing scientific evidence regarding European trends in organic food consumption and production and we identify research gaps for future comprehensive assessments of the policy and legal framework. This review has indicated the importance of the two pillars, namely regulation and policy, highlighting not only the need for solid restrictions regarding organic food production, however also the need to support food safety and consumer confidence in the growing organic food market.

Background: There is little evidence to inform practice regarding the optimum aseptic technique of drawing up saline for epidural insertion. Our regional practice is to draw up saline from a non-sterile packaged plastic ampoule, therefore introducing the risk of bacterial contamination. Usually, the anaesthetist draws up saline directly from the vial held by an assistant using a needle (needle technique). Alternatively, the saline vial is emptied onto a sterile tray by an assistant and then drawn up by the anaesthetist (tray technique). We hypothesised that the latter will lead to an increase in the number of contaminated saline samples as they are exposed to the environment., Methods: In labour rooms and before epidural catheter insertion, 110 samples of saline 20mL were randomly drawn up using our hospital's recommended epidural aseptic precautions, using either the needle or the tray technique. Equal amounts of saline were inoculated into aerobic and anaerobic blood culture bottles., Results: Eleven percent of samples in the needle arm and 24% of samples in the tray arm grew commensal micro-organisms including coagulase-negative Staphylococcus, Micrococcus luteus and Streptococcus viridans. A two-sided Fisher's exact test for categorical unpaired data showed no statistical difference between the two arms of the trial (P=0.13)., Conclusion: The difference in the saline contamination rate between the two techniques did not reach statistical significance. As bacterial contamination occurred with both techniques, we recommend using sterile saline pre-packaged in the epidural tray or individually wrapped sterile glass saline ampoules., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: To determine the validity of an electronic health record (EHR) in the identification of patients with left ventricular dysfunction in a primary care setting., Design: A cross-sectional study., Setting: Nine clinics participating from the Providence Research Network (PRN) comprising 75 physicians serving approximately 200,000 patients. All clinics utilise the Logician EHR for all patient care activities., Patients: The study included all PRN patients with an active chart., Interventions: All patients with a heart failure diagnosis in the problem list were identified by database query. Left ventricular ejection fraction (LVEF) data were identified through query of local cardiology and hospital echocardiography databases. Additional LVEF data were sought in a manual search of paper charts., Measurements and Main Results: To determine the problem list coding accuracy for a heart failure (HF) diagnosis we evaluated sensitivity, positive predictive value and related derived statistical measures using documented LVEF as the 'gold standard'. Of 205 755 active PRN patients, 1731 were identified with a problem list entry of HF. Based on comparison with documented LVEF, the sensitivity for problem list entry was 43.9% and 54.4% when HF was defined as an LVEF < or = 55% and < or = 40%, respectively., Conclusion: The validity of an EHR problem list entry of HF was poor. The problem list validity could be enhanced through reconciliation with other data sources. Inaccurate EHR problem lists may have clinical consequences, including underprescribing of beneficial therapies.

The researches of the authors on the quinine chlorohydrate QH+Cl- and sodium metavanadate (Vv) reaction have led to the elaboration of two methods--a conductometric one and a gravimetric one--of dozing the QH+Cl- and, in general, of any quinine soluble salt with NaVO3. The methods, that have applications in the domain of drugs and is based on the formation of a white precipitate, in which the molar ratio QH+:Vv = 1:1. Since some authors have used quinine as a reagent in order to determine polarimetrically some ions (Ag+ and Cu2+), by taking into consideration the optic activity of quinine, we have aimed at using the formation reaction of QHVO3 for quantitatively determine the Vv with quinine chlorohydrate, by measuring the rotation angle of polarized light alpha both for the excess of QHCl reagent and for the solution obtained by dissolving the QHVO3 precipitate formed within the reaction. For this purpose there has been necessary the construction of two standard scales alpha = f(c) and there has been suggested a working methodology for the dozing of Vv with quinine chlorohydrate or any other of its soluble salts, by using any laboratory polarimeter. The results are satisfactory and depend on the sensitivity of the apparatus.

In order to adapt the UV spectrophotometry method to oleanolic acid dosing, absorption spectra within the range from 230 to 350 nm have been determined for both OA systems in glacial acetic acid (lambda max = 256 nm) and OA systems in ethyl alcohol (lambda max = 277 nm). The time stability of oleanolic acid in the presence of the two solvents has also been investigated in this study. Besides, the composition of etalon series and graphical representation of experimental results (n = 6) have been performed. Also, the calculation algorithm was given, the regression lines have been drawn and statistical parameters were calculated to establish the mathematical expression of OA concentration (mg%).

The spectrophotometric method used in dozing the iodides in the water, has been studied in order to use it in determining the iodides in a series of food products. This method is based on the catalyzed reduction of the iodide of Ce4+ by the arsenious acid. In order to determine the iodide in several food products of animal origin (eggs, milk and meat), the sample is first treated with a concentrated KOH solution and is maintained on a water bath until is obtained a residue; this is then subjected to calcination at temperatures of 500-600 degrees C until a perfectly white ash is obtained. After cooling, the ash is dissolved in water, concentrated H2SO4 is added and is completed with water up to a certain volume. The thus obtained solution is used for determination of the iodide in food, according to the method described above. The content of iodide (microgram%) have been calculated with the relation deduced from the equation of the regression line delineated in VIS at 459 nm. The method is selective and the procedure is widely applicable to the determination of iodide in different food products of animal origin.