Artificial neural network applied in forecasting the composition of municipal solid waste in Iasi, Romania

Neural network time series (NNTS) tool was used to predict municipal solid waste composition in Iasi, Romania. The nonlinear input output (NIO) time series model and nonlinear autoregressive model with external (exogenous) input (NARX) included in this tool were selected. The coefficient of determination (R2) and root mean square error (RMSE) were chosen for evaluation. By applying NIO, the optimum model is 4-11-6 artificial neural network (ANN, R2 = 0.929) in the case of testing as for the validation, with all 0.849 and 0.885, respectively. Applying NARX, the suitable model became 4-13-6 ANN model, with R2 = 0.999 for training, 0.879 for testing, and 0.931, respectively 0.944 for validation and all. The resulted RMSE is zero for training and 0.0109 for validation in the case of this model which had 4 inputs, 13 neurons and 6 outputs. The four input variables were: number of residents, population aged 15–59 years, urban life expectancy, total municipal solid waste (ton/year). The suitable ANN model revealed the lowest root mean square error and the highest coefficient of determination. Results indicate that NNTS tool is a complex instrument, NARX is more accurate than NIO model, and can be used and applied easily

The psychological influence of the diagnosis of breast cancer on therapeutic options selection

The therapeutic management decision-making process for breast cancer is complex, and is influenced by multiple factors including patient age, comorbidities, ethnicity, education, and availability of immediate or delayed reconstruction options. Our study analysed 276 patients diagnosed with breast cancer in the “Colțea” Clinical Hospital between 2014 and 2015. Mean patients age was 61.24, median 62, with a range of 31 to 89 years. Younger age was associated with a less advanced local disease and younger patients were more likely to choose and benefit from conservative surgery. Most patients (61.76%) came from rural areas. Place of origin had a significant influence on the tumor size at the time of diagnosis (3.9 cm vs. 1.8cm) as well as on the choice of surgical procedure. Personalized treatment management plans that include aesthetic satisfaction coupled with oncological safety should be the objectives of contemporary breast surgery. Patient age is so important to the decision making process that it has been proposed as a determinant of educational and counselling strategies. From our experience, young patients from urban areas were more proactive patients. They were diagnosed earlier and more involved in treatment decisions compared with patients from rural areas, who generally did not question the surgeon’s opinion. Factors that influence the decision-making process likely include age, socioeconomic status, availability of radiotherapy, the necessity of periodic follow-up and the concern about recurrence

Cardiac autonomic neuropathy in diabetes

Introduction: Cardiovascular form of diabetic autonomic neuropathy (CDAN) is represented by sympathetic (accelerative) and/or parasympathetic (inhibitive) influence upon cardiovascular system induced by prolonged action of elevated glicemia. CDAN perturbs cotidian usual activity, decreases life quality, increases mortality level and also it occupies an imposing part of healthcare service costs[2]. According to different studies, CDAN prevalence variates between 16,8 - 25,3% in diabetes type 1 and 22,1 - 34,3% in type 2. [3] CDAN manifestations such as decrease in effort toleration level and silent ischemia, determine an unfavourable prognosis, as a result myocardial infarction develops 50% more frequently in CDAN diabetics versus non-CDAN (Valensi J. 2001). Prolonged QTc interval, being an independent predictive factor of cardiovascular mortality, is associated with a high risk of developing malignant ventricular arrhythmias and sudden death. Prompt diagnosis and chronic complications screening of diabetes have a positive impact upon therapeutic efficiency, life quality improvement and decrease in mortality level. Objectives: Frequency determination of cardiovascular form of diabetic autonomic neuropathy depending on type of diabetes, its duration in concordation with clinical and paraclinical data. Materials and methods: There have been examined 72 patients (18 with type 1 diabetes and 54 with type 2) through clinical (examination, inquiry) and paraclinical (Ewing tests, QTc interval, sinus rhythm variability, circadian index) methods. This patients were divided, according to diabetes duration, into 3 groups - A(0-5years), B(5-10years) and C(>10years). Results: In group of patients with type 1 diabetes, CDAN incidence - 22,2% (4 pts). Group A: 6 pts., with average duration of diabetes 2,4±3,2years - there wasn’t any data of CDAN. Group B: 8 pts., average duration 9,4±l,6years, signs of CDAN were determined in 2 pts (25%). In group C: 4 pts., average duration 17,5±6,2years - 2 pts (50%). In group of patients with type 2 diabetes, CDAN incidence - 29,6% (16 pts). Group A: 17 pts., average duration 2,89±l,62years - CDAN datas in 17%. Group B: 21 pts., average duration 10,32±l,5years, CDAN in 43% cases. In group C: 16 pts., average duration 17,56±4,8years, CDAN signs in 25% cases. Conclusions: In type 1 diabetes first signs appear after a diabetic evolution of over 5 years with subsequent incidence elevation directly proportional to diabetes duration. In type 2 diabetes CDAN mani­festations may be present during primary diagnosis, determining an insignificant increase in incidence during evolution. All patients with type 1 diabetes with diabetic duration over 5 years and patients with type 2 diabetes during diagnosis - require evaluation against CDAN. Clinical manifestations of DAN may significantly affect patients life, however it continues to be frequently misdiagnosed [1]. Application of functional tests, ECG, inquiry and Holter-ECG monitoring distinguish precocious signs of CDAN much before suggestive clinical manifestations

Stress-induced Perioperative Depressive Symptoms

Sustained stress has been correlated with increases in cortisol levels and decreased levels of brain transmitters including serotonin or dopamine. As a result of better understanding of human pathophysiology and pain physiology, the fields of surgery and anesthesia have seen major advances in the last years.However, a high percentage of patients develop depressive symptoms following major surgery and pathogenic perspective is very complex and require an holistic approach

Depression and breast cancer; postoperative short-term implications

Introduction. Pre and postoperative psychological status is an important aspect in patients diagnosed with breast cancer, having a great impact on their quality of life. Considering the high incidence, mortality rate, and the added effect on self-image, breast cancer is considered a major stressor for women worldwide, almost 50% of these experiencing psychological distress. Methods. Our study retrospectively analysed the relationship between preoperative diagnosed depression and the number of medical care days, on patients diagnosed with breast cancer and admitted for surgical treatment in Colțea Clinical Hospital between 2017 and 2018. Results. We had 62 patients scheduled for breast cancer surgery, who had been preoperatively evaluated using psychological tests. Of those patients, 18 had scores indicating significant symptoms of depression (moderate or severe symptoms, HDSR \u3e17). Patients with high HDSR scores needed an 18.4% longer hospitalization than patients without symptoms of depression. They also had 35.4% more ambulatory visits in the month following discharge, and a higher incidence of postoperative complications. Conclusions. There seem to be both physiological and somatic determinants responsible for the need of prolonged medical care, but the mechanisms responsible for these effects remain unclear. Identifying high-risk patients could not only lower the postoperative morbidity, but also increase the therapeutic outcomes

Tourism Development in Rodna Mountains National Park: the Public Administration, a Key Stakeholder

The research paper approaches the sustainable tourism topic, which is discussed at national level and has a significant impact upon the economic development and the international image of Romania. Its objectives are to minimize the negative effects on the environment, to protect the cultural heritage and also to offer learning opportunities, including benefits for the local economy and contributing to the structural development of local communities. The case study is focused on Rodna commune. The research methods used are secondary data analysis, comparisons, analogies and syntheses, primary qualitative research (induction and deduction methods). It aims at identifying: the current situation of Rodna commune, the community's point of view regarding tourism development and, also, identifying opportunities for sustainable tourism development. The research results show that both the local administration and the owners are aware of the poor condition of local tourism, but they have also shown optimism about the future possibilities of restoring the initial economic well-being of the mining period. In this regard, predictions are that tourist arrivals will increase due to the rehabilitation of tourist spots, the future improvement of infrastructure and the increasing quality of accommodation services.</p

THE LOCALS’ OPINIONS AND THE DEVELOPMENT OF SUSTAINABLE TOURISM IN RODNA COMMUNE

This study refers to sustainability, a much debated concept at global level. Because of the high levels of pollution and limited resources, sustainability has become an international goal. Furthermore, one of the engines for development in emerging economies is, of course, the tourism industry, which is also Romania’s case. Combining these two elements, the authors find that sustainable tourism development is both a long-term goal and a dynamic concept. This concept is represented by three pillars: growing the local economy, protecting and promoting the cultural heritage, and increasing the social well-being. The present paper consists of a case study that focuses on Rodna commune, a beautiful Transylvanian rural settlement, located in Bistrița-Năsăud County. The research methods used are secondary data analysis (based on the study of different statistics, guides, and specialized sites), comparisons, analogies and syntheses, primary qualitative research (based on face-to-face interviews with the locals), and induction and deduction methods, which all aim at identifying: the current position of Rodna commune from the socio-economic point of view, the locals’ opinion related to the sustainable development of the destination’s tourism industry, and also the ways in which this objective can be achieved. The subjects interviewed were selected in order to relevantly cover most of the local population: honor citizens, teachers, priests, doctors and students, each of them representing stakeholders in the development of the tourism industry. The research results show that the locals are aware of the strong connection between the development of tourism and the economic well-being of the commune, they helped identifying the major problems that need to be addressed and solved in order for this process to be efficient but also the fact that they are not yet aware of their role and do not acknowledge the ways in which they can make a difference for themselves and for the commune. The conclusions reveal the current situation of Rodna commune from the subjects’ points of view and their proposals for achieving better living standards. Also, the interviews show the lack of implication caused by the fact that the subjects are neither aware of their stakes, nor of their possibilities to help developing the local tourism. JEL Classification: L83, Q01, Z32

REGIONAL PLANNING FOR RODNA AS A TOURIST DESTINATION

This paper continues previous researches dedicated to highlighting the importance of planning from a managerial point of view and to discussing the regional dimension of planning, to which it adds up the current topic, that of rural tourism planning – features, particularities, approaches, multi-functionality of land use, collaboration and partnerships, negative planning, green economy, and case-studies. Bearing the theory in mind, a radiography of Rodna commune was briefly made, taking into consideration the following aspects: economy, locals, tourist flows, accommodation, tourists’ profile, food services, accessibility and transportation, travel agents, attractions and heritage, types of tourism, IT & C, sustainability, and traditions. The reason for the description of the commune is to properly understand the context and the particularities of the analyzed destination. Further, the steps of regional planning are revealed, and each of them is separately discussed and analyzed, from both a theoretical and a practical point of view. The outcome is a strategy the community can adopt, with a vision, three directions, and several SMART objectives. This strategy is reflected in a document that aims to engage each stakeholder in the process, as well as to establish in a clear, comprehensive way the common framework. Also, there are several proposals for every community and destination that understands the importance of planning and its implications: collaboration, win-win approach, partnerships, the involvement of the community, sustainability in every dimension, and so on. JEL Classification: L83, Q01, Z32

Clustering categorical functional data Application to medical discharge letters

International audienceCategorical functional data represented by paths of a stochastic jump process are considered for clustering. For paths of the same length, the extension of the multiple correspondence analysis allows the use of well-known methods for clustering finite dimensional data. When the paths are of different lengths, the analysis is more complex. In this case, for Markov models we propose an EM algorithm to estimate a mixture of Markov processes. A simulation study as well as a real application on hospital stays will be presented