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Background: Chronic diseases are major causes of morbidity and mortality in developed countries. Their effects can be mitigated by high quality evidence-based care, but this is not the norm in most systems. The Chronic Care Model (CCM) is an evidence-based policy response to this practice gap, which uses multiple strategies to promote the quality of chronic care. Objective: To review CCM with an ethical lens. Methods: We reviewed the published empirical and non-empirical articles of CCM to analyse the ethical underpinnings of this model. Results and conclusions: We argue that its principal ethical value lies in the institutional cooperation it builds between the stakeholders involved in health care services. First, we briefly describe CCM and argue that the pathways through which it aims to improve patients' health outcomes are not made explicit. Second, we argue that the potential of CCM to be more beneficent, compared with traditional health care systems, depends on its capacity to promote mutual trust between health care providers and patients. There is no evidence to date that the implementation of CCM enhances mutual trust between health care professionals and patients. Third, we argue that CCM seeks to enhance human agency, allowing increased expression of individual autonomy and increased respect for individuals thereby expanding human freedom and avoiding social discrimination. However, we review the communication patterns that characterize the model of doctor-patient relationship promoted by this model and argue that these communication patterns raise ethical concerns that may prevent the model from reaching its expected outcomes. [ABSTRACT FROM AUTHOR]

Danube shad is a fish with high economic and socio-cultural value for the human communities established in the Danubian-Pontic space. In Romania, shad fishery has a market value of about 1.5 million euro, with average annual catches of 200-500 tonnes. Biological material was collected during research surveys organized along the Black Sea coast, in 2012-2013, in spring season (March, April), summer (June, July) and autumn (September). Experimental fishing was done with fishing gillnets. Demographic structure of Alosa immaculata consists of generations of 2-5 years, dominated by generations of 3 to 4 years. The aim of this paper is to provide recent data regarding Alosa immaculata population along the Black Sea Coast considering that its biology is less known.

The synthesis and the study of some coordination polymers derived from the interaction of the acetylacetonate of Fe(III) with dinaphthylphosphinic acid, dinaphthylthiophosphinic acid and dinaphthyldithiophosphinic acid are presented. The methods applied for the study were chemical analysis, gel chromatography, Mössbauer and IR absorption spectroscopy, X-ray diffraction and thermogravimetric analysis from which the kinedic parameters of the thermal decomposition reactions were determined. The semiconductive properties of the synthesized compounds were also examined. Based on the obtained experimental data and on literature indications, the structural formulae of these compounds were assigned.

Endogenous Cushing's syndrome is rare, with an incidence of 0.7-2.4 per a million people a year. Clinical presentation of Cushing syndrome can be pleomorphic, and establishing diagnosis can be difficult. Early recognition and rapid control of hypercortisolaemia are necessary to decrease morbidity and mortality in these patients. We report a series of 6 endogenous Cushing's syndromes of different etiologies (4 Cushing's disease and 2 adrenal Cushing's syndrome) assessed in our endocrine department over a decade (2009-2019). In order to highlight the diversity of clinical forms, diagnostic tools and specific management of this condition we labelled each case suggestively: the typical Cushing's disease, the Pseudo Cushing's, the elusive Cushing's disease, the mild autonomous cortisol hypersecretion, Cushing's syndrome in pregnancy and Cushing's disease with thromboembolism. We discussed their particularities which were revelatory for the diagnosis, such as dermatologic, cardiovascular, musculoskeletal, neuropsychiatric, or reproductive signs, reviewing literature for each manifestation. We also discuss the commonalities and differences in laboratory and imagistic findings. Therapeutic approach can also differ with respect to the particular condition of each patient and the multiple choices of therapy will be reviewed. [ABSTRACT FROM AUTHOR]

Background: The risk to physicians who worked with patients without confirmed COVID-19 testing during the pandemic has been little studied. However, they were at high risk., Methods: In the summer of 2020, 1285 Romanian physicians participated in a single-center study. Participants (mean age = 48.21 years; 302 males and 982 females, all specialties) completed a series of single-item measures adapted from previous studies on work ethics and responsibility. This study used Mann-Whitney comparisons between physicians who reported that they knowingly had direct contact with COVID patients and those who did not regarding their willingness to work., Results: Compared with their colleagues, physicians who reported not knowingly having direct contact with COVID patients reported less access to protective equipment, less overall willingness to respond when asked to work with infected patients, more likely to work out of fear of losing their jobs, and fear of legal repercussions. They received less training in the use of protective equipment., Conclusions: Physicians who worked with patients not yet diagnosed with COVID-19 were significantly less willing to work. The perception of invisible risk may explain the observed differences.

Little research has been done on professionals' perceptions of institutions and governments during epidemics. We aim to create a profile of physicians who feel they can raise public health issues with relevant institutions during a pandemic. A total of 1285 Romanian physicians completed an online survey as part of a larger study. We used binary logistic regression to profile physicians who felt they were able to raise public health issues with relevant institutions. Five predictors could differentiate between respondents who tended to agree with the trust statement and those who tended to disagree: feeling safe at work during the pandemic, considering the financial incentive worth the risk, receiving training on the use of protective equipment, having the same values as colleagues, and enjoying work as much as before the pandemic. Physicians who trusted the system to raise public health issues with the appropriate institutions were more likely to feel that they shared the same values as their colleagues, to say they were trained to use protective equipment during the pandemic, to feel that they were safe at work during the pandemic, to enjoy their work as much as before the pandemic, and to feel that the financial bonus justified the risk.

Spontaneous Ca 2+ local transients (SCaLTs) in isolated oligodendrocyte precursor cells are largely regulated by the following fluxes: store-operated Ca 2+ entry (SOCE), Na + /Ca 2+ exchange, Ca 2+ pumping through Ca 2+ -ATPases, and Ca 2+ -induced Ca 2+ -release through ryanodine receptors and inositol-trisphosphate receptors. However, the relative contributions of these fluxes in mediating fast spiking and the slow baseline oscillations seen in SCaLTs remain incompletely understood. Here, we developed a stochastic spatiotemporal computational model to simulate SCaLTs in a homogeneous medium with ionic flow between the extracellular, cytoplasmic, and endoplasmic-reticulum compartments. By simulating the model and plotting both the histograms of SCaLTs obtained experimentally and from the model as well as the standard deviation of inter-SCaLT intervals against inter-SCaLT interval averages of multiple model and experimental realizations, we revealed the following: (1) SCaLTs exhibit very similar characteristics between the two data sets, (2) they are mostly random, (3) they encode information in their frequency, and (4) their slow baseline oscillations could be due to the stochastic slow clustering of inositol-trisphosphate receptors (modeled as an Ornstein-Uhlenbeck noise process). Bifurcation analysis of a deterministic temporal version of the model showed that the contribution of fluxes to SCaLTs depends on the parameter regime and that the combination of excitability, stochasticity, and mixed-mode oscillations are responsible for irregular spiking and doublets in SCaLTs. Additionally, our results demonstrated that blocking each flux reduces SCaLTs' frequency and that the reverse (forward) mode of Na + /Ca 2+ exchange decreases (increases) SCaLTs. Taken together, these results provide a quantitative framework for SCaLT formation in oligodendrocyte precursor cells., Competing Interests: Declaration of interests Nothing to declare., (Copyright © 2022 Biophysical Society. Published by Elsevier Inc. All rights reserved.)

Metabolic syndrome (MetSyn) is a major health problem affecting approximately 25% of the worldwide population. Since the gut microbiota is highly connected to the host metabolism, several recent studies have emerged to characterize the role of the microbiome in MetSyn development and progression. To this end, our study aimed to identify the microbiome patterns which distinguish MetSyn from type 2 diabetes mellitus (T2DM). We performed 16S rRNA amplicon sequencing on a cohort of 70 individuals among which 40 were MetSyn patients. The microbiome of MetSyn patients was characterised by reduced diversity, loss of butyrate producers ( Subdoligranulum , Butyricicoccus , Faecalibacterium prausnitzii ) and enrichment in the relative abundance of fungal populations. We also show a link between the gut microbiome and lipid metabolism in MetSyn. Specifically, low-density lipoproteins (LDL) and high-density lipoproteins (HDL) display a positive effect on gut microbial diversity. When interrogating the signature of gut microbiota in a subgroup of patients harbouring both MetSyn and T2DM conditions, we observed a significant increase in taxa such as Bacteroides , Clostridiales , and Erysipelotrichaceae . This preliminary study shows for the first time that T2DM brings unique signatures of gut microbiota in MetSyn patients. We also highlight the impact of metformin treatment on the gut microbiota. Metformin administration was linked to changes in Prevotellaceae , Rickenellaceae , and Clostridiales . Further research focusing on the microbiome-metabolome patterns is needed to clarify the exact association of various gut microbial communities with the progression of T2DM and the occurrence of various complications in MetSyn patients.

Metabolic syndrome (MetSyn) has a rapidly growing worldwide prevalence, affecting over 1 billion people. MetSyn is clustering many pathological conditions, which, untreated, could increase the risk and often lead to more severe metabolic defects such as type 2 diabetes and non-alcoholic fatty liver disease. Many data demonstrate the complex role of gut microbiota in the host metabolism, and hence, deciphering the microbiome patterns linked to MetSyn could enable us for novel diagnosis and monitoring markers and for better disease management. Moreover, interventions designed to alter patient microbiome composition may help prevent or decrease morbidity linked with MetSyn. However, the microbiome composition is largely different across geographically distinct populations. Our study investigated the microbiota and mycobiome patterns in Romanian metabolic syndrome patients. We also correlated the identified microbiome-mycobiome patterns with levels of metabolites important for host health such as short chain fatty acids, organic acids, and taurine. We found that MetSyn patients are harboring a microbiome enriched in Enterobacteriaceae , Turicibacter sp., Clostridium coccoides, and Clostridium leptum, while beneficial taxa such as Butyricicoccus sp., Akkermansia muciniphila , and Faecalibacterium prausnitzii were decreased. These microbiome changes were correlated with lower butyrate levels and increased succinate. In terms of mycobiome signatures, MetSyn was associated with a high abundance of Saccharomyces and Aspergillus species. Our data are the first reported on a Romanian population and confirming that the pathogenesis of MetSyn is closely related to gut microbiome and homeostasis.

Healthcare accessibility and equity remain important issues, as corruption in the form of informal payments is still prevalent in many countries across the world. This study employs a panel data analysis over the 2006-2013 period to explore the role of different institutional factors in explaining the prevalence of informal payments. Covering 117 countries, our findings confirm the significant role of both formal and informal institutions. Good governance, a higher trust among individuals, and a higher commitment to tackling corruption are associated with diminishing informal payments. In addition, higher shares of private finance, such as out-of-pocket and domestic private health expenditure, are also correlated with a lower prevalence of informal payments. In policy terms, this displays how correcting institutional imperfections may be among the most efficient ways to tackle informal payments in healthcare.

The study aimed to compare the growth performance and physiological responses of bester (B) and backcrossed bester ♀ × beluga ♂ (BB) in response to crowding stress under different stocking densities, as well as to establish a threshold stocking density for rearing BB in a recirculating aquaculture system (RAS) without welfare impairment. For this purpose, in the first trial (T1), B (181.15 ± 21.21 g) and BB fingerlings (181.98 ± 28.65 g) were reared in two stocking densities of 2 kg/m 2 and 4 kg/m 2 in fiberglass tanks (1 m 3 ) for 6 weeks. In a parallel trial (T2), the BB hybrids (335.24 ± 39.30 g) were kept in four initial stocking densities, ranging from 5 kg/m 2 to 12 kg/m 2 . The results of T1 revealed better growth indices (i.e., final mean weight, weight gain, specific growth rate) at lower stocking densities for both hybrids; however, in terms of growth performance, the BB hybrid showed better results when compared with the B hybrid. BB hybrids registered significantly ( p < 0.05) lower serum cortisol and MDA and higher lysozyme than B hybrids, showing higher tolerance to crowding stress. Nevertheless, at higher densities, selected serum parameters (i.e., hematological indices, cortisol, glucose, protein, malondialdehyde, lysozyme) and growth performance indices used to evaluate the hybrids indicate that high stocking density could affect the growth and welfare of BB hybrids, and that the selected serum parameters could be used as good indicators for chronic stress caused by overcrowding conditions.

Various patterns of electrical activities, including travelling waves, have been observed in cortical experimental data from animal models as well as humans. By applying machine learning techniques, we investigate the spatiotemporal patterns, found in a spiking neuronal network with inhibition-induced firing (rebounding). Our cortical sheet model produces a wide variety of network activities including synchrony, target waves, and travelling wavelets. Pattern formation is controlled by modifying a Gaussian derivative coupling kernel through varying the level of inhibition, coupling strength, and kernel geometry. We have designed a computationally efficient machine classifier, based on statistical, textural, and temporal features, to identify the parameter regimes associated with different spatiotemporal patterns. Our results reveal that switching between synchrony and travelling waves can occur transiently and spontaneously without a stimulus, in a noise-dependent fashion, or in the presence of stimulus when the coupling strength and level of inhibition are at moderate values. They also demonstrate that when a target wave is formed, its wave speed is most sensitive to perturbations in the coupling strength between model neurons. This study provides an automated method to characterize activities produced by a novel spiking network that phenomenologically models large scale dynamics in the cortex., (© Springer Nature B.V. 2020.)

Background: We aimed to verify the issue of the ethics audit and its use in the system of accreditation of hospitals. It presents the results of a survey conducted among hospital managers from Romania., Methods: Our article highlights the results of the second part of a research carried out in 2012 on the pertinence and the structure of the ethics audit integrated within the accreditation process of hospitals, according the opinion of the 47 executives and managers involved in the quality management of Romania hospitals. The data have been gathered with the aid of the online questionnaire., Results: An ethics audit integrated within the accreditation process of hospitals should include primarily the respect of the patients' rights, the good relations of the institutions with its patients and the respect of the moral rights of the employees., Conclusion: The usefulness of this study is due to the fact that it consults precisely those who should really contribute to the creation, application and monitoring of ethical policies and instruments necessary in every hospital which are permanently under the scrutiny of public opinion and confront themselves with the obligation to give a thorough account of their results and spending of the public resources. This study gain consistency as the relevant aspects that could form the structure of a hospital ethics audit are identified with the direct help of the managers responsible for implementing it.

Background: Steady and persisting falls in gastric cancer (GC) mortality rates have been observed worldwide in the last 50 years, and in Romania too. Colorectal cancer (CRC) is presently the most frequent digestive neoplasia in the Western countries. An increase of CRC incidence and mortality rates has been reported recently in Eastern European countries, including Romania., Methods: Mortality data from GC and CRC, derived from population based mortality statistics, have been available on a national scale for 1955-2003. The data were identified from the statistics of the Ministry of Health (Bucharest, Romania) and of IARC/OMS (Lyon, France). GC and CRC mortality rates global and/or per gender were registered by time intervals. After 1995, only data on general mortality rates were available., Results: Between 1955-59 and 1990-92, GC mortality rates/100,000 decreased from 33.14 to 17.70 in males and from 18.77 to 7.00 in females. Between 1995 and 2003, general mortality rates/100,000 from GC remained stable (17.54 and 17.74, respectively). Between 1955-59 and 1990-92, CRC mortality rates/100,000/gender increased from 4.65 to 10.10 in males and from 4.57 to 7.40 in females. Between 1995 and 2003, CRC general mortality rates/100 000 increased from 14.90 to 19.20., Conclusions: Our study reports opposite trends in GC and CRC mortality rates in the period under study, with GC declining and CRC increasing. A male predominance was registered in both neoplasms under study, more obvious in GC (male/female ratio: 2-3/1) than in CRC (male/female ratio: 1.5/1).

Purpose: To present the technique of total body irradiation (TBI), applied for the first time in Romania, at the Institute of Oncology Bucharest, as part of stem cell transplantation for hematological malignancies., Patients and Methods: The total dose administered was 12 Gy at the reference point, 2 Gy/fraction, one fraction per day, 6 consecutive days, with a total dose of 8 - 11.4 Gy delivered to the lung, using Mevatron Primus linear accelerator (6 MV & 15 MV, 200-300 cGy/min in isocenter), in vivo dosimetry detectors and equipment for the reference dosimetry, personalized blocks for lung shielding sustained by polymethylmethaacrylate (PPMA) plate, Simulix HP simulator, and computer tomographic (CT) scans. Techniques used were: a) two parallel opposed anteroposterior / posteroanterior (AP/PA) fields with the patient in prone and supine position; b) two parallel opposed lateral fields with the patient placed on a lateral table, at 320 cm from the source. The percentage depth dose, tissue maximum ratio (TMR), off axis ratio (OAR) and the reference dose rate were measured for every patient's geometrical characteristics, with an uncertainty of +/- 2.2% and were used to calculate monitor units and to evaluate the dose in organs at risk (lungs, gonads, eyes etc)., Results: 5 patients (3 with the AP/PA technique and 2 with the lateral technique) were irradiated. All patients completed their irradiation in good clinical condition. The acute side effects were minimal (WHO grade 1: nausea/ vomiting--all patients; diarrhea--1 patient; headache--2 patients; photophobia and diplopia--1 patient; head and neck skin erythema--all patients). Because of the short follow-up period no safe evaluation of late side effects can be done. However, during this period one patient developed a non-aggressive form of chronic liver graft vs. host disease (GVHD) and one patient died due to acute GVHD., Conclusion: TBI as part of stem cell transplantation for hematological malignancies was successfully realized at our Institute, with favorable clinical results. This technique is easy to carry out and reproducible.