EVALUATION OF LANDSCAPE ECOLOGICAL POLARIZATION AND ITS APPLICATION FOR STRATEGICAL TERRITORIAL PLANNING

To avoid antagonism in system nature-economy-society the concept of state territory management has to be based on the principles of sustainable and balanced development. The strategy of economy development should follow not only the criteria of economical effectiveness, but also the indexes of ecological stability of the territory.The extent of ecological polarization (measure of landscape stability) is conditioned by the combination of (1) landscape geochemical sensitivity and (2) technogeochemical pressure defined in respective territorial units. With respect to self-cleaning features of landscapes 7 levels of geosystem sensitivity were distinguished and mapped in Lithuania territory. The largest part of the territory is occupied by averagely and more than averagely sensitive geosystems, the least area is taken by relatively insensitive and extremely sensitive geosystems. The technogeochemical pressure was evaluated through the detailed analysis of landscape technomorphological structure. Using the GIS data bases, in the technotopes distinguished the technogeochemical pressure was evaluated according to the area of industrial and built-up territories, agricultural lands, road net density (adjusted by traffic intensity), and dosmestic pollution (assessed according to the population density). Each of the agents was given different weitcoefficients in regard to its pollution emissions. The layer superposition of the geosystem sensitivity and technogeochemical pressure gave the emergence of cartoscheme revealing the distribution of areas with different ecological polarization, divided into 5 tension levels. In order to distinguish the priority territories of land management and optimization the polarization area net and the natural frame of Lithuania were superposed.Knowledge of the ecological polarization areas allows the rendering of recommendations to economy units for their economical activity organization that should be developed considering the means of landscape ecological stability maintenance like increase of forest percentage, formation of geochemical barriers, proper distribution of land use

IMPORTANCE OF SUSTAINABILITY IN BUSINESS

In the modern day, businesses face many challenges: from economic recessions to political and social trends, no wonder, that the modern enterprise should not just be aiming at earning profits but also at complying with the social norms and trends of the modern world. Sustainability is a vast term that describes many different things, therefore it is important for businesses to clearly define it, know what the examples of it are and which practices to use to stay sustainable. This article aims to provide theoretical basis for sustainability in businesses and evaluate the level of sustainability of some enterprises in Europe and to provide the theoretical basis for sustainability in business and conduct the analysis of levels of sustainability of four enterprises based in Lithuania and Ukraine

Platelet role in the prediction of MIS-C severity

IntroductionMultisystem inflammatory syndrome in children (MIS-C) has been reported as one of the cytokine storm syndromes associated with COVID-19. Despite the several proposed diagnostic criteria, MIS-C remains a diagnostic and clinical challenge. Recent studies have demonstrated that platelets (PLTs) play a crucial role in COVID-19 infection and its prognosis. This study aimed to investigate the clinical importance of PLT count and PLT indices in predicting MIS-C severity in children.Patients and methodsWe conducted a retrospective single-center study at our university hospital. A total of 43 patients diagnosed with MIS-C during a 2-year period (from October 2020 to October 2022) were included in the study. MIS-C severity was evaluated according to the composite severity score.ResultsHalf of the patients were treated in the pediatric intensive care unit. No single clinical sign was associated with a severe condition, except for shock (p = 0.041). All the routine biomarkers, such as complete blood count (CBC) and C-reactive protein (CRP), used for MIS-C diagnosis were significant in predicting MIS-C severity. Single PLT parameters, such as mean PLT volume, plateletcrit, or PLT distribution width, did not differ between the severity groups. However, we found that a combination of PLT count and the previously mentioned PLT indices had the potential to predict MIS-C severity.ConclusionsOur study emphasizes the importance of PLT in MIS-C pathogenesis and severity. It revealed that together with routine biomarkers (e.g., CBC and CRP), it could highly improve the prediction of MIS-C severity

Tendinţele de schimbare din peisajul rural lituanian şi consecinţele lor după obţinerea independenţei

Within a few centuries, Lithuania has gone through many land reforms. All these periods formed different anthropogenic elements in the natural environment of Lithuanian rural landscape, which gradually made changes in the people's way of thinking, living and working conditions. This article analyses the last periodes of land reforms, which had the largest influence on Lithuanian rural landscape changes. During the Soviet period in Lithuania territory dominated kolkhozes - Soviet agricultural companies, which were based on the idea of collective farming. Creation of large industrial farms in a rural, mostly natural environment, has made major changes. After the restoration of Lithuania's independence, farming conditions changed. Large complexes of the collective farms were replaced by private complexes, which took on the architectural expression with individual elements, having a different impact on the rural landscape

SKEMPI 2.0: an updated benchmark of changes in protein–protein binding energy, kinetics and thermodynamics upon mutation

Motivation: Understanding the relationship between the sequence, structure, binding energy, binding kinetics and binding thermodynamics of protein–protein interactions is crucial to understanding cellular signaling, the assembly and regulation of molecular complexes, the mechanisms through which mutations lead to disease, and protein engineering. Results: We present SKEMPI 2.0, a major update to our database of binding free energy changes upon mutation for structurally resolved protein–protein interactions. This version now contains manually curated binding data for 7085 mutations, an increase of 133%, including changes in kinetics for 1844 mutations, enthalpy and entropy changes for 443 mutations, and 440 mutations, which abolish detectable binding.This work has been supported by the European Molecular Biology Laboratory [I.H.M.]; Biotechnology and Biological Sciences Research Council [Future Leader Fellowship BB/N011600/1 to I.H.M.]; Spanish Ministry of Economy and Competitiveness (MINECO) [BIO2016-79930-R to J.F.R.]; Interreg POCTEFA [EFA086/15 to J.F.R.]; European Commission [H2020 grant 676556 (MuG)].Peer ReviewedPostprint (published version

Overuse of medical care in paediatrics: A survey from five countries in the European Academy of Pediatrics.

Studies and initiatives such as the "Choosing wisely" (CW) campaign emphasise evidence-based investigations and treatment to avoid overdiagnosis and overtreatment. The perception of the extent of medical overactivity among professionals and drivers behind are not well studied in the paediatric field. Aim We aimed to investigate the physicians' opinion and clarify the main drivers regarding medical overactivity in member countries of the European Academy of Paediatrics (EAP). Methods In this study, paediatricians, paediatric residents, primary care paediatricians, and family doctors treating children were surveyed in Norway, Lithuania, Ukraine, Italy, and Switzerland. Over-investigation was defined as "diagnostic work-up or referral that is unlikely to provide information which is relevant for a patient" and overtreatment was defined as "treatment that does not benefit or can harm more than benefit the patient." The original questionnaire was developed in 2018 by a working group from the Norwegian Paediatric Association. Results Overall, 1,416 medical doctors participated in the survey, ranging from 144 in Lithuania to 337 in Switzerland. 83% stated that they experienced over-investigation/overtreatment, and 81% perceived this as a problem. The majority (83%) perceived expectations from family and patients as the most important driver for overtreatment in their country. Other drivers for overuse were use of national guidelines/recommendations, worry for reactions, and reduction of uncertainty. Conclusion This is the first study investigating knowledge and attitude toward medical overactivity in European countries. Despite different cultural and economic environments, the patterns and drivers of increased investigations and medicalisation are similar

Over-investigation and overtreatment in pediatrics: a survey from the European Academy of Paediatrics and Japan Pediatric Society

IntroductionAvoiding over-investigation and overtreatment in health care is a challenge for clinicians across the world, prompting the international Choosing Wisely campaign. Lists of recommendations regarding medical overactivity are helpful tools to guide clinicians and quality improvement initiatives. We aimed to identify the most frequent and important clinical challenges related to pediatric medical overactivity in Europe and Japan. Based on the results, we aim to establish a (European) list of Choosing Wisely recommendations.MethodsIn an online survey, clinicians responsible for child health care in Europe and Japan were invited to rate 18 predefined examples of medical overactivity. This list was compiled by a specific strategic advisory group belonging to the European Academy of Paediatrics (EAP). Participants were asked to rate on a Likert scale (5 as the most frequent/important) according to how frequent these examples were in their working environment, and how important they were considered for change in practice.ResultsOf 2,716 physicians who completed the survey, 93% (n = 2,524) came from 17 countries, Japan (n = 549) being the largest contributor. Pediatricians or pediatric residents comprised 89%, and 51% had 10–30 years of clinical experience. Cough and cold medicines, and inhaled drugs in bronchiolitis were ranked as the most frequent (3.18 and 3.07 on the Likert scale, respectively), followed by intravenous antibiotics for a predefined duration (3.01), antibiotics in uncomplicated acute otitis media (2.96) and in well-appearing newborns. Regarding importance, the above-mentioned five topics in addition to two other examples of antibiotic overtreatment were among the top 10. Also, IgE tests for food allergies without relevant medical history and acid blockers for infant GER were ranked high.ConclusionOvertreatment with antibiotics together with cough/cold medicines and inhaled drugs in bronchiolitis were rated as the most frequent and important examples of overtreatment across countries in Europe and Japan

Preparedness and Response to Pediatric COVID-19 in European Emergency Departments : A Survey of the REPEM and PERUKI Networks

Publisher Copyright: © 2020 American College of Emergency Physicians Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Study objective: We aim to describe the variability and identify gaps in preparedness and response to the coronavirus disease 2019 pandemic in European emergency departments (EDs) caring for children. Methods: A cross-sectional point-prevalence survey was developed and disseminated through the pediatric emergency medicine research networks for Europe (Research in European Pediatric Emergency Medicine) and the United Kingdom and Ireland (Paediatric Emergency Research in the United Kingdom and Ireland). We aimed to include 10 EDs for countries with greater than 20 million inhabitants and 5 EDs for less populated countries, unless the number of eligible EDs was less than 5. ED directors or their delegates completed the survey between March 20 and 21 to report practice at that time. We used descriptive statistics to analyze data. Results: Overall, 102 centers from 18 countries (86% response rate) completed the survey: 34% did not have an ED contingency plan for pandemics and 36% had never had simulations for such events. Wide variation on personal protective equipment (PPE) items was shown for recommended PPE use at pretriage and for patient assessment, with 62% of centers experiencing shortage in one or more PPE items, most frequently FFP2 and N95 masks. Only 17% of EDs had negative-pressure isolation rooms. Coronavirus disease 2019–positive ED staff was reported in 25% of centers. Conclusion: We found variation and identified gaps in preparedness and response to the coronavirus disease 2019 epidemic across European referral EDs for children. A lack in early availability of a documented contingency plan, provision of simulation training, appropriate use of PPE, and appropriate isolation facilities emerged as gaps that should be optimized to improve preparedness and inform responses to future pandemics.publishersversionPeer reviewe

Presentations of children to emergency departments across Europe and the COVID-19 pandemic: A multinational observational study

BACKGROUND: During the initial phase of the Coronavirus Disease 2019 (COVID-19) pandemic, reduced numbers of acutely ill or injured children presented to emergency departments (EDs). Concerns were raised about the potential for delayed and more severe presentations and an increase in diagnoses such as diabetic ketoacidosis and mental health issues. This multinational observational study aimed to study the number of children presenting to EDs across Europe during the early COVID-19 pandemic and factors influencing this and to investigate changes in severity of illness and diagnoses. METHODS AND FINDINGS: Routine health data were extracted retrospectively from electronic patient records of children aged 18 years and under, presenting to 38 EDs in 16 European countries for the period January 2018 to May 2020, using predefined and standardized data domains. Observed and predicted numbers of ED attendances were calculated for the period February 2020 to May 2020. Poisson models and incidence rate ratios (IRRs), using predicted counts for each site as offset to adjust for case-mix differences, were used to compare age groups, diagnoses, and outcomes. Reductions in pediatric ED attendances, hospital admissions, and high triage urgencies were seen in all participating sites. ED attendances were relatively higher in countries with lower SARS-CoV-2 prevalence (IRR 2.26, 95% CI 1.90 to 2.70, p < 0.001) and in children aged <12 months (12 to <24 months IRR 0.86, 95% CI 0.84 to 0.89; 2 to <5 years IRR 0.80, 95% CI 0.78 to 0.82; 5 to <12 years IRR 0.68, 95% CI 0.67 to 0.70; 12 to 18 years IRR 0.72, 95% CI 0.70 to 0.74; versus age <12 months as reference group, p < 0.001). The lowering of pediatric intensive care admissions was not as great as that of general admissions (IRR 1.30, 95% CI 1.16 to 1.45, p < 0.001). Lower triage urgencies were reduced more than higher triage urgencies (urgent triage IRR 1.10, 95% CI 1.08 to 1.12; emergent and very urgent triage IRR 1.53, 95% CI 1.49 to 1.57; versus nonurgent triage category, p < 0.001). Reductions were highest and sustained throughout the study period for children with communicable infectious diseases. The main limitation was the retrospective nature of the study, using routine clinical data from a wide range of European hospitals and health systems. CONCLUSIONS: Reductions in ED attendances were seen across Europe during the first COVID-19 lockdown period. More severely ill children continued to attend hospital more frequently compared to those with minor injuries and illnesses, although absolute numbers fell. TRIAL REGISTRATION: ISRCTN91495258 https://www.isrctn.com/ISRCTN91495258