The European Commission enables increased use of the OPAL pipeline by Gazprom. OSW COMMENTARY NUMBER 226 | 09.11.2016

In response to a request by the German energy regulator, on 28 October the European Commission announced its decision setting out the rules for increased utilisation by the Russian gas company Gazprom (and possibly other companies) of the onshore leg of the Nord Stream gas pipeline, i.e. the OPAL pipeline. This decision raises a series of questions as to its content, its publication procedure, the context of its adoption and its potential consequences. These doubts are aggravated by the lack of clarity of information regarding both the OPAL pipeline itself and the initial rules governing its utilisation (including its exemption from the third party access rule – TPA), and the present decision by the European Commission. As a consequence, the Commission’s decision is provoking conflicting reactions. On the one hand, it is being received (for example by the Polish and the Ukrainian side) as one that enables Gazprom to increase its access to the European market, which could compromise the security of gas supplies to Central Europe and the transit of gas via Ukraine. On the other hand, it is being interpreted as a decision which does not meet the expectations of Gazprom and the OPAL pipeline operator, which sought increased opportunities to book the pipeline’s capacity in the long term. Therefore, it is not known if and when the rules concerning the of OPAL as proposed by the EC will be implemented and, as a consequence, whether the EC’s decision will put an end to the process of negotiating the rules for the German pipeline’s use that has been ongoing for many years

Ocena wiedzy studentów pielęgniarstwa, położnictwa i opiekunów medycznych na temat postępowania w omdleniach

Wstęp. Omdlenie określane jest jako stan krótkotrwałej utraty świadomości wraz z obniżeniem tonusu mięśniowego w wyniku niedostatecznego niedotlenienia mózgu. Charakteryzuje się gwałtownym początkiem i samoistnym, całkowitym ustąpieniem. Około 30–40% wszystkich omdleń niejasnego pochodzenia stanowią omdlenia wazowagalne i są najczęstszym typem omdleń wśród dzieci i młodzieży (75–85%) oraz u osób w wieku starszym. Omdlenie należy do częstych objawów, a każda utrata przytomności zawsze budzi niepokój pacjenta i jego bliskich. Silne poczucie choroby, a nawet zagrożenia życia, które towarzyszy omdleniom powoduje obniżenie komfortu i jakości życia. Wiodącą metodą leczenia omdleń wazowagalnych jest edukacja pacjenta i jego rodziny. Dobre wyedukowanie pacjenta pomaga uniknąć sytuacji, które doprowadzają do rozwinięcia się reakcji wazowagalnej, a także pomagają nauczyć się prawidłowego postępowania w momencie pojawienia się objawów prodromalnych. Ogromne znaczenie w edukacji odgrywa pielęgniarka, dlatego tak ważne jest aby znała podstawowe zasady profilaktyki omdleń.Cel. Celem pracy była ocena wiedzy osób uczących się zawodów medycznych na temat postępowania w omdleniach.Materiał i metody. Badaniami ankietowymi objęto 133 osoby, w tym 66 (49,6%) studentów pierwszego roku II stopnia na kierunku pielęgniarstwo: (12 studentów niestacjonarnych i 54 — stacjonarnych), 39 (29,3%) studentów pierwszego roku studiów II stopnia na kierunku położnictwo (21 studentów dziennych i 18 — zaocznych) oraz 28 (21,1%) osób uczących się zawodu opiekuna medycznego. Zastosowaną metodą badawczą był sondaż diagnostyczny przeprowadzony z użyciem anonimowego kwestionariusza ankiety.Wyniki. 75% badanej grupy było świadkiem omdlenia i zdecydowana większość (97,7%) deklaruje, że wie jak pomóc osobie, która zemdlała oraz u której występują objawy prodromalne (98,5%). Aby udzielić pomocy osobie, która zemdlała najwięcej respondentów wskazało odpowiedź: „otwarcie okna” (95,4%) oraz „uniesienie nóg do góry” (92,4%), natomiast wśród 29 osób uzyskano odpowiedź, że osobę, która zemdlała należy napoić szklanką z wodą (21,8%). W przypadku wystąpienia objawów zwiastujących omdlenie najwięcej respondentów poleciłoby opuszczenie dusznego powietrza (93,9%), zmianę pozycji ciała na leżącą lub siedzącą oraz uniesienie kończyn dolnych (75,93%). Najmniej uzyskano odpowiedzi dotyczących prowokowania kaszlu (18,0%), dreptania nogami (9,02%), zgięcie brzucha (9,77%) i zaciskanie pięści (5,26%).Wnioski. Badana grupa charakteryzowała się dobrą ogólną wiedzą na temat postępowania w omdleniach, przy czym lepszą wiedzą wykazały się osoby z wykształceniem wyższym. W badanej grupie rzadziej wykazywano się wiedzą zachowań w przypadku wystąpienia objawów prodromalnych takich jak stosowanie kaszlu, dreptanie w miejscu oraz napinanie ramion i nadgarstków. (PNN 2016;5(2):40–45)Introduction. Syncope is defined as a state of short-term loss of consciousness with reduction of muscle tone due to insufficient hypoxic brain. It is characterized by a sudden onset and spontaneous, complete subsiding. Approximately 30–40% of all syncopes of unclear origin represent vasovagal syncope which are the most common type among children, young people (75–85%) and in people in old age. Syncope is a common condition, and any loss of consciousness always causes concern the patient and his/her relatives. A strong sense of the disease and the risk of even life-threatening situations accompanying syncope reduces comfort and quality of life. The leading method of treatment of vasovagal syncope is to educate the patients and their families. Good education of the patient helps to avoid situations that lead to the development of a vasovagal reaction and also helps to learn the proper procedure when dealing with prodromal symptoms. A nurse has a great role in the education, therefore it is so important for her to know the basic rules of syncope prevention.Aim. The aim of the study was to assess the knowledge of learners of medical sciences on dealing with syncope.Material and Methods. The survey involved 133 patients, including 66 (49.6%) first-year students of the second degree in nursing (12 — part-time students and 54 — full-time students), 39 (29.3%) first-year students studying the second degree in midwifery (21 full-time students and 18 — part-time) and 28 (21.1%) trainees studing to be a medical caretaker. The applied research method was a diagnostic study conducted with the use of an anonymous survey questionnaire, which contained only closed questions.Results. 75% of the study group has witnessed syncope and a vast majority (97.7%) declare they know how to help the person who fainted, and who presents prodrome symptoms (98.5%). In order to assist the person who fainted most respondents indicated the answer: “opening a window” (95.4%) and “lifting the legs up” (92.4%), whereas 29 respondents said that the person who fainted should be given a glass of water (21.8%). In the event of syncope symptoms most respondents would recommend leaving the stuffy air (93.9%), change in body position to lying or sitting and lifting the lower limbs (75.93%). The smallest number of the answers obtained referred to cough provoking (18.0%), trotting (9.02%), abdominal flexion (9.77%) and clenching the fists (5.26%).Conclusions. The study group was characterized by a good general knowledge of the proceedings in syncope, with a better knowledge shown by people with higher education. More rarely the respondents demonstrated the knowledge on behavior in the case of prodromal symptoms, such as the use of cough, tripping and arms and wrists straining. (JNNN 2016;5(2):40–45

Gazprom's expansion in the EU - co-operation or domination? OSW Report, April 2008

The energy sector, especially with regard to natural gas trade, is one of the key areas of co-operation between the EU and Russia. However, the character of this co-operation has given rise to increasing doubts both in Brussels and among the EU member states. The questions have emerged whether this co-operation does not make the EU excessively dependent on Russian energy supplies, and whether Gazprom's presence in the EU will not allow Moscow to interfere in the proces of devising the EU energy policy. This report is intended to present the factual base and data necessary to provide accurate answers to the foregoing questions. The first part of the report presents the scope and character of Gazprom's economic presence in the EU member states. The second part shows the presence of the EU investors in Russia. The data presented has been provided by the International Energy Agency, European Commission, the Central Bank of Russia and the Russian Federal State Statistics Service. Some of the data is the result of calculations made by the Centre for Eastern Studies' experts who were basing on the data provided by energy companies, the specialist press and news agencies

A ‘last-minute’ transit contract? Russia-Ukraine-EU gas talks. OSW Commentary NUMBER 291 | 25.01.2019

On 21 January another round of trilateral gas talks between Russia, Ukraine and the European Union was held in Brussels. This meeting mainly concerned the new Russian-Ukrainian transit contract; the transit contract currently in force between Gazprom and Naftogaz will expire as of 1 January 2020. During the meeting, European Commission Vice-President Maroš Šefčovič submitted proposals to the parties concerning the parameters of a new contract transit, but did not make them public. The meeting was the latest in this series of trilateral gas talks; the previous round was held in Berlin in July 2018. In Brussels Russia declared its willingness to conclude a new transit agreement, although it highlighted the need for the legal dispute between Naftogaz and Gazprom to be resolved before that could happen. The lack of success during the talks so far, the divergent interests of the various parties and the current political context suggests that a new contract transit will probably only be concluded by the late autumn or winter of this year, and possibly in the period immediately before the expiry date of the current contract between Naftogaz and Gazprom. It is also conceivable that the negotiations will be extended into 2020, and that meanwhile transit will take place on the basis of principles agreed in the short term, along the lines of the so-called winter packages in 2014 and 2015, something which would be very disadvantageous for Ukraine and the EU, but extremely convenient for Moscow. There is no reason to expect rapid progress in the Russian-Ukrainian negotiations; they are proceeding in complicated conditions, including the ongoing political conflict between Kiev and Moscow, the numerous legal disputes between Naftogaz and Gazprom, the construction of new Russian export pipelines, the continuing fundamental reform of the Ukrainian gas sector, and finally a packed political calendar (for both Ukraine and the EU) in 2019. The negotiation process is also difficult because of the contradiction between the long-term interests of Ukraine, which wants to maintain its status as a key transit route for Russian gas in the long term, and Russia, whose strategic goal is to become independent of the Ukrainian transmission network

Gazprom’s expansion in the EU: co-operation or domination? OSW Report, October 2009. Second edition, revised

Introduction. The energy sector, especially with regard to the gas trade, is one of the key areas of co-operation between the EU and Russia. However, the form this co-operation has taken has been giving rise to some concern, both in Brussels and in the EU member states. Questions arise as to whether the EU has not become excessively dependent on Russia for energy, and whether the presence of the Russian gas monopoly in the EU does not enable Russian interference with the development of EU energy policy. The objective of this series of OSW reports (for the previous edition,see Gazprom’s expansion in the EU: co-operation or domination? April 2008 – pdf 1.2 MB) is to provide facts which will permit an accurat answer to these questions to be formulated. Over the course of last year, two new factors strongly affected Gazprom’s capability to operate on the EU market. One was the ongoing global economic crisis, which has depressed demand for gas both in Russia and in Europe. Gazprom has cut both its own production and the quantities of gas it purchases from the Central Asian states, and the decrease in export revenues has forced the company to modify some of its current investment plans. Less demand for gas and the need to reduce production are also having a positive impact – the Russian company is likely to avoid the difficulties in meeting all of its export commitments which, only a year or so ago, it was expected to experience. The other factor affecting Gazprom’s expansion in Europe is the observed radicalisation of the rhetoric and actions of both the company itself and of the Russian authorities with regard to the gas sector as broadly understood. The gas crisis between Russia and Ukraine in January 2009, which resulted in a two-week interruption of gas supplies from Russia to Europe via Ukraine, was the most prominent example of this radicalisation. The hardening of rhetoric in the ongoing energy talks with the EU and other actors, and increased political and business activities designed to promote Russian gas interests in Europe, in particular the lobbying for the Nord Stream and South Stream projects, are further signs of this shift in tone. These issues raise the question of whether, and to what extent, the current condition of Gazprom’s finance will permit the company to implement the infrastructural projects it has been endorsing and its other investment plans in Europe. Another important question is whether the currently observed changes in how Gazprom operates will take on a more permanent character, and what consequences this will have for the European Union. The first part of this report discusses Gazprom’s production and export potential. The second comprehensively presents the scope and nature of Gazprom’s economic presence in the EU member states. Finally, the third part presents the Russian company’s methods of operation on foreign markets. The data presented in the report come mainly from the statistics of the International Energy Agency, the European Commission and Gazprom, as well as the Central Bank of Russia and the Russian Statistical Office. The figures presented here also include proprietary calculations by the OSW based on figures disclosed by energy companies and reports by professional press and news agencies

Miłość w perspektywie dzieci ze szkół pracujących w oparciu o pedagogikę M. Montessori i system tradycyjny

The article presents the results of the research of understanding of the concept of “love” by children attending to schools based on traditional and M. Montessori’s alternative system. The research was conducted in 2018 on a group of 80 children (aged 6–9). The results were collected on the basis of the analysis of their artistic products, presenting an image of love (drawings with the use of various techniques) and associations expressed by the child with the word love. According to the analyses, a greater variety of interpretations of love among children learning on the basis of an alternative system, i.e. the pedagogy of Montessori, has been noticed.W artykule opisano wyniki badań dotyczących rozumienia pojęcia „miłość” przez dzieci uczęszczające do szkół pracujących w oparciu o system tradycyjny oraz alternatywny – M. Montessori. Badania zostały przeprowadzone w 2018 r. w grupie 80 dzieci w wieku 6–9 lat. Wyniki zostały zebrane na podstawie analizy wytworu plastycznego, przedstawiającego wyobrażenie miłości (rysunek wykonany dowolną techniką), oraz wypowiadanych przez dziecko skojarzeń ze słowem miłość. Na podstawie przeprowadzonych analiz zauważono większą różnorodność interpretowania miłości wśród dzieci uczących się w oparciu o system alternatywny, jakim jest pedagogika Montessori

Reverse Δ-wave as a possible sign in electrocardiography to diagnose mitral valve prolapse

<p>Abstract</p> <p>Background</p> <p>Mitral valve prolapse (MVP) is defined as superior displacement of the mitral valve leaflets more than 2 mm into the left atrium during systole. Easier and cheaper assessment of this common disease is a priority in cardiac health care facilities.</p> <p>Presentation of the hypothesis</p> <p>In this study I addressed electrocardiographic presentation in 300 patients with MVP compared with 100 healthy individuals. I faced a novel finding in electrocardiogram (ECG) examination of these patients. It was a notch (reverse Δ-wave) in descending arm of QRS observed in 79% (237/300) of patients, consisting of 58% (174/300) in inferior leads and 21% (63/300) in I and aVL leads. The notch was identified only in 6 men in control group.</p> <p>Testing the hypothesis</p> <p>Considering the relatively higher prevalence of disease, a population-based diagnostic clinical trial study is appropriate to test the hypothesis.</p> <p>Implications of the hypothesis</p> <p>The hypothesis on diagnostic value of reverse Δ-wave in MVP may help in decreasing the rate of unnessessary echocardiography in some patients.</p

Between energy security and energy market integration. Guidelines for the future development of the EU’s external energy policy in Europe’s neighbourhood. OSW Report, June 2011

For many years the European Union has been improving the efficient use of energy resources and yet the demand for energy in the EU continues to increase. When Europe belonged to one of the world’s key energy markets with relatively easy access to energy resources, growing energy needs were not seen as a source of concern. Today, however, as the competition for energy resources is intensifying and the global position of the EU energy market is being challenged by growing economies in the developing countries, above all China and India, the EU needs to adopt bold policies to guarantee the sustainable supply of energy. This report argues the EU needs to develop a fully-fledged external energy policy; i.e. a common, coherent, strategic approach that build bridges between the interests and needs of the EU integrated energy market on the one hand and supplier countries on the other. The EU’s external energy policy has two main objectives. The first one is to ensure a sustainable, stable and cost-effective energy supply. The second is to promote energy market integration and regulatory convergence with neighbouring countries (often but not always this supports the achievement of the first objective). However, in order to improve its effectiveness, the EU’s external energy policy needs to be seen in a broader economic and political context. Any progress in energy cooperation with third countries is contingent upon the EU’s general stance and offer to those countries

Wrodzony zespół wydłuzonego QT - aspekty diagnostyczne

Zespół wydłużonego QT charakteryzuje się zaburzeniami repolaryzacji z wydłużeniem czasu trwania odstępu QT w zapisie EKG i predyspozycją do groźnych komorowych arytmii (torsade de pointes) prowadzących do omdleń i nagłych zgonów. Na podstawie badań molekularnych za przyczynę zaburzeń elektrofizjologicznych występujących w tym zespole uznano defekty w białkach kanałów jonowych (potasowych i sodowych) błony komórkowej komórek mięśnia sercowego. Dziedziczony autosomalnie dominująco, bez wrodzonej głuchoty zespół Romano- -Warda jest zbiorem co najmniej 6 genotypów, z których najczęściej występują 3 pierwsze postacie LQTS1, LQTS2 i LQTS3. W zależności od położenia zmutowanego genu na chromosomie 11 (IKs), 7 (IKr) lub 3 (INa) te 3 genotypy różnią się między sobą zaburzeniami okresu repolaryzacji ze zmienną morfologią załamka T w zapisach elektrokardiograficznych oraz czynnikami wyzwalającymi objawową arytmię komorową. W obrazie klinicznym dominują nawracające utraty przytomności, które w LQTS1 i LQTS2 są najczęściej wywołane stymulacją układu adrenergicznego (wysiłek, emocje, przestrach, nagły bodziec dźwiękowy). W genotypie LQTS3 objawowa arytmia komorowa najczęściej występuje w spoczynku lub we śnie. U 40% pacjentów z wrodzonym zespołem wydłużonego QT przebieg kliniczny jest bezobjawowy. W postaciach LQTS klinicznie utajonych &#8212; wydłużenie odstępu QT, zmiany załamka T oraz komorowe zaburzenia rytmu serca &#8212; mogą występować napadowo, co można zaobserwować w zapisie Holtera lub w teście wysiłkowym. Często u pozornie zdrowych dzieci i młodzieży pierwszym objawem może być zatrzymanie krążenia lub nagły zgon. Młodzi pacjenci bez objawów powinni być objęci leczeniem profilaktycznym ze względu na możliwość występowania u nich epizodów nagłego zatrzymania krążenia, bez objawów poprzedzających. (Folia Cardiol. 2005; 12: 403&#8211;411

Wartości w pracy nauczyciela montessoriańskiego i tradycyjnego. Badania porównawcze

The article presents the results of questionnaire concerned values preferred by teachers working in schools on the basis of traditional and alternative systems - Maria Montessori. The research was conducted in 2017 in the Lublin, Mazovian and Kuyavian-Pomeranian provinces. The S. Schwartz PVQ-RR questionnaire was used in the Polish adaptation of Jan Cieciuch. Overall, the research group of 102 respondents were qualified for the final analysis (Montessori teachers = 51, traditional = 51).In the research undertaken, the aim was to identify values that are valid both by Montessori teachers (research group) and teachers working in the traditional system (comparative group). The collected data presents whether there are differences in the preferred values between the both groups.Artykuł prezentuje wyniki badań kwestionariuszowych dotyczących wartości preferowanych przez nauczycieli w szkołach pracujących w systemie tradycyjnym oraz al-ternatywnym – Marii Montessori. Badania zostały przeprowadzone w 2017 roku na terenie województw lubelskiego, mazowieckiego oraz kujawsko-pomorskiego. Zastosowano kwestio-nariusz PVQ-RR Shaloma Schwartza w polskiej adaptacji Jana Cieciucha. Ogółem przebadano 102 osoby (51 nauczycieli montessoriańskich, 51 tradycyjnych) i zakwalifikowano ich wyniki do ostatecznej analizy. Celem badań było określenie wartości, które są cenione zarówno przez nauczycieli montessoriańskich (grupa badawcza), jak i nauczycieli pracujących w systemie tradycyjnym (grupa porównawcza), a także zbadanie, czy istnieją różnice w zakresie prefe-rowanych wartości między tymi dwiema grupami