INSOLVENCY IN BULGARIA INTERNALIZATION OF GENERATIONS AT WORK

Based on results from empirical research into generations at work in Bulgaria - pre- and post-war generation (born 1925 – 1944), the generation of the transition period from patriarchal order to modernity (born 1945 – 1964), the growth generation (born 1965 – 1980) and the digital generation (born 1981 – 2000) - carried out during 2008 – 2010, in 2011 and 2015, we uphold the thesis that the low degree of institutionalization of insolvency predetermines the externalization of its rules, principles and values – passively justified and substantiated as necessary and useful. It has been proven that there is need for internalization of insolvency – accepting it as compulsory institution in society to regulate the conflict of interests between debtors and creditors, establishing sustainable social order. Recommendations have been made with regard to social practice – the change process should be conducted through enlarging the research area, increasing the number of publications, making education more comprehensive, creating an acceptable media image of insolvency as a social necessity and as a regulator of the economic life in the Bulgarian society.Based on results from empirical research into generations at work in Bulgaria - pre- and post-war generation (born 1925 – 1944), the generation of the transition period from patriarchal order to modernity (born 1945 – 1964), the growth generation (born 1965 – 1980) and the digital generation (born 1981 – 2000) - carried out during 2008 – 2010, in 2011 and 2015, we uphold the thesis that the low degree of institutionalization of insolvency predetermines the externalization of its rules, principles and values – passively justified and substantiated as necessary and useful. It has been proven that there is need for internalization of insolvency – accepting it as compulsory institution in society to regulate the conflict of interests between debtors and creditors, establishing sustainable social order. Recommendations have been made with regard to social practice – the change process should be conducted through enlarging the research area, increasing the number of publications, making education more comprehensive, creating an acceptable media image of insolvency as a social necessity and as a regulator of the economic life in the Bulgarian society

The Impact of Nursing Care in the Intensive Care Unit

As the population ages, the number of patients with more than one chronic disease increases, leading to a greater need for medical care. As a result, the demand for emergency and intensive care in recent years has become increasingly critical. It is advanced practice nurses who play a key role in patient care, and the drive to strengthen the workforce necessitates an increase in their involvement. The independence of advanced practice nurses and their impact on patient outcomes after critical care are of interest. The important role of nurses in the provision of health care has recently been recognized. Critical care needs inter-professional teams that provide collaborative health care, which includes the need for trained nurses. Expert and specialized care for the most seriously ill or injured patients in intensive care units (ICUs) and hospitals is provided by intensive care nurses. Working as part of a multidisciplinary team, they are experienced professionals who are highly skilled and safety-critical. The greatest responsibility for the care and treatment of patients in a critical or unstable clinical situation in the intensive care unit rests with the nurse. Her primary activities are the management and coordination of nursing care through assessments, therapies, and critical interventions. Based on the best available scientific evidence, clinical experience, and patient preferences, the nurse makes important clinical decisions in the intensive care unit

Anemia, heart failure and treatment with erythropoiesis-stimulating agents

Aнемията е често съпътстващо заболяване при пациентите със сърдечна недостатъчност и причина за влошаване на прогнозата и лошия изход от болестта. Aнемия сред популацията на пациентите със сърдечна недостатъчност е много по-често срещана от колкото в останалото население. Счита се, че тя варира между 17и 70% в зависмост от това дали става въпрос за хоспитализирани или амбулаторни болни. Честотата на анемията сред български пациенти, хоспитализирани за остра сърдечна недостатъчност, според едно проучване е 32,7%. Лечението на тази съпътстваща коморбидност се определя от етиологията , като чести причини са желязо-дефицитната анемия, анемията при хронично заболяване, наличие на хронично бъбречно заболяване. Лечението на анемия с еритропоетинови препарати, първоначално е било обещаващо, но последващите резултати се оказват разочароващи. Еритропоеза-стимулиращите агенти увеличават тромемболичния риск, честотата на инсултите, макар да се наблюдава покачване в стойността на хемоглобина.Anemia is a common concomitant disease in patients with heart failure and is a cause for deteriorating prognosis and poor outcome of the disease. Anemia in the population of patients with heart failure is much more common than in the general population. It is estimated that it varies between 17 and 70% depending on whether the patients are hospitalized or not. The incidence of anemia among the hospitalized for acute heart failure patients in one Bulgarian study is 32.7%. The treatment of this concomitant state is defined by its etiology. The most common causes of anemia in heart failure are iron defficiency, chronic inflamation and chronic kidney disease. The treatment of anemia with erythropoiesis-stimulating agents was initially promising, but the results that came out later showed disappointing data. Erythropoiesis-stimulating agents increase the thrombotic risk, the incidence of stroke, although an increase in the level of hemoglobin is found

The challenge to manage a patient with advanced heart failure and necrotizing vasculitis - a clinical case

Пациентите с напреднала сърдечна недостатъчност много често имат и придружаващи заболявания, които повлияват и ограничават избора на лечение както за сърдечната недостатъчност, така и за придружаващото заболяване. Предствяме мъж, на 64години, с механична клапна протеза на аортно място, с високостепенна трикуспидална регургитация и високостепенна пулмонална хипертония, с тотална сърдечна недостатъчност, захарен диабет, периферна артериална болест и некротизиращ васкулит. Лечението, което бе предприето е напълно съобразено с препоръките за лечение на сърдечна недостатъчност на Европейското дружество по Кардиология от 2016 год., както и съвременните препоръки за лечение на захарен диабет и васкулити.Patients with advanced heart failure are patients with a lot of comorbidities that have important influence on the options of treatment - both for heart failure and the concomitant diseases. Here we present a 64-year-old man with mechanical aortic valve prosthesis, severe tricuspid regurgitation, severe pulmonary hypertension and total heart failure, diabetes mellitus type 2, peripheral artery disease and necrotizing vasculitis. The management of heart failure is according to the guidelines for the treatment of patients with heart failure of the European Society of Cardiology 2016; the treatment of the diabetes mellitus and the necrotizing vasculitis is also in accordance with the latest recommendations

Lithium Manganese Sulfates as a New Class of Supercapattery Materials at Elevated Temperatures

To make supercapattery devices feasible, there is an urgent need to find electrode materials that exhibit a hybrid mechanism of energy storage. Herein, we provide a first report on the capability of lithium manganese sulfates to be used as supercapattery materials at elevated temperatures. Two compositions are studied: monoclinic Li$_2$Mn(SO$_4$)$_2$ and orthorhombic Li$_2$Mn$_2$(SO$_4$)$_3$, which are prepared by a freeze-drying method followed by heat treatment at 500 °C. The electrochemical performance of sulfate electrodes is evaluated in lithium-ion cells using two types of electrolytes: conventional carbonate-based electrolytes and ionic liquid IL ones. The electrochemical measurements are carried out in the temperature range of 20–60 °C. The stability of sulfate electrodes after cycling is monitored by in-situ Raman spectroscopy and ex-situ XRD and TEM analysis. It is found that sulfate salts store Li+ by a hybrid mechanism that depends on the kind of electrolyte used and the recording temperature. Li$_2$Mn(SO$_4$)$_2$ outperforms Li$_2$Mn$_2$(SO$_4$)$_3$ and displays excellent electrochemical properties at elevated temperatures: at 60 °C, the energy density reaches 280 Wh/kg at a power density of 11,000 W/kg. During cell cycling, there is a transformation of the Li-rich salt, Li$_2$Mn(SO$_4$)$_2$, into a defective Li-poor one, Li$_2$Mn$_2$(SO$_4$)$_3$, which appears to be responsible for the improved storage properties. The data reveals that Li$_2$Mn(SO$_4$)$_2$ is a prospective candidate for supercapacitor electrode materials at elevated temperatures

Samproduksjon i mulighetsrommet for brukermedvirkning i norske helse- og omsorgstjenester

Ideen om at brukere er deltakende og aktive samarbeidspartnere når det gjelder sine egne velferdstjenester, er sentral i de politiske strategiene for norske helse- og omsorgstjenester. Brukermedvirkning og samproduksjon fremstilles som et ideal for tjenestene. Men hva skjer med dette idealet i en arbeidshverdag hvor deltakerne i samproduksjonen kan ha svært ulike interesser og motivasjoner for å delta? Basert på feltarbeid i to norske kommuner utforsker vi i denne artikkelen mulighetsrommet for brukermedvirkning som samproduksjon. Gjennom fortetting av etnografiske data presenterer vi tre caser som illustrerer essensielle betingelser og utfordringer i hjemmesykepleien, sykehjem og bofellesskap. De ulike hverdagskontekstene innen disse tre områdene begrepsfestes som «omsorgssettinger». Analysen viser at sentrale begrensninger av brukermedvirkningens mulighetsrom innen hjemmetjenestene handler om tidspress og individualisering av de ansattes ansvar: I sykehjemmet dreier det seg om profesjonshierarkier og kommunikasjon via pårørende; og i bofellesskap om profesjonskultur. Studien gir innsikt i variasjon av samproduksjonens betingelser og utfordringer i hverdagskontekster, som her er knyttet til hjemmetjenester for eldre, institusjonstjenester for eldre og tjenester i bofellesskap for personer med psykisk utviklingshemning.publishedVersio

Heart failure treatment in patients with thalassemia major

Съвременното лечение на сърдечната недостатъчност при пациентите с талсемия започва с профилактиката на сърдечните увреждания при тези пациенти. Кардиомиопатията в резултата от натрупване на желязо е най-тежкото и животозасташяващо усложнение на трансфузионно завиимата таласемия, но поради връзката му с отлагането на желязо е обратима. Лечението се провежда с хелатори, както и с конвенционални лекарства за сърдечна недостатъчност. Тежко декомпенсирани форми се лекуват в специализирани центрове.The modern treatment of heart failure (HF) in patients with thalassemia is based on the prevention of cardiac impair- ment. Iron overload cardiomyopathy is the most serious and life-threatening complication of transfusion-dependent thalassemia, but due to its association with iron deposition it is reversible. Treatment includes chelation therapy and conventional medication for HF. Severely decompensated cases are treated in specialized centers

A clinical case of a patient with subclinical hypothyroidism and newly diagnosed diabetes mellitus and arterial hypertension

Захарният диабет и хипотиреоидизмът са двете най-често срещани ендокринни нарушения, който при съчетанието си при един и същи пациент биха могли да протекат с различен ход от колкото изолирано. Инсулинът и тиреоидните хормони са тясно свързани в клетъчния метаболизъм и техния ексцес или дефицит взаимно се повлияват. Познаването на връзките между тях е полезно в клиничната практика за скрининга и управлението на тези заболявания. Добре известно е, че хормоналните отклонения при една ендокринна жлеза могат да повлияят функцията и на другите жлези. Така например, хипотиреоидизма и хипертиреоидизма променят стойностите на кръвната захар и трябва да се имат предвид при интерпретацията на лабораторните резултати. От друга стана наличието на захарен диабет, особенно автоимунната форма, става често причина да се търси асоциирано автоимунно заболяване като тиреоид на Хашимото. Представяме клиничен случай на пациентка с хипертонична криза, без известнa до този момент артериална хипертония, която става повод да се диагностицират редици други заболявания, като тиреоидна дисфункция и захарен диабет. Представяме подхода при диагнозата, оценката на таргетните увреди и избора на терапия в светлината последните съвременните ръководства.Diabetes mellitus and hypothyroidism are the most common endocrine disorders and when concomitant in the same patient can change the course of each conditions in a rather different way than when running their course on their own. Both hormones - insulin and the thyroid hormone, act on cell metabolism and the excess or insufficient secretion of any of them affects the function of the other. In clinical practice, it is very useful to be familiar with the interaction between these two hormones for better screening and management of the diseases. It is well known that a single hormone dysfunction can change other hormone activity. It is the situation in hyper- or hypothyroidism, both influence blood glucose level and that should be taken into account when biochemistry is analyzed. On the other hand, diagnosing diabetes mellitus, especially the autoimmune form of the disease, directs our attention toward searching for another autoimmune disorder like Hashimoto thyroiditis. Here, we present a clinical case of a female patient with hypertensive crises with unestablished arterial hypertension, in whom additional concomitant disorders - thyroid dysfunction and diabetes mellitus, were diagnosed simultaneously. We discuss the approach to the diagnosis and target organ evaluation, as well as the management of the diseases in the light of the newest guidelines

Differentiation of Xanthomonas

During the last 20 years, the causative agents of bacterial spot of tomato and pepper have been subjected to many studies and reclassifications. According to the current data, the species are four (X. euvesicatoria, X. vesicatoria, X. gardneri, and X. perforans) and cause similar symptoms in plants but possess different phenotypic properties. This work provides the full metabolic characteristics obtained by Biolog system of bacterial spot’s xanthomonads based on a large selection of strains from different vegetable-producing regions of Bulgaria with accent on their major differentiating properties which could be used for species differentiation by metabolic profiles. The results are compared to the data available in the literature in order to clarify the strong features of each species and distinguish the variable ones. Simple characteristics like amylase activity and utilization of cis-aconitate cannot serve alone for differentiation

Aktivitet og fellesskap blant eldre - Erfaringer med sosial omsorg i Steigen og Tana/Deatnu

Source at https://nordlandsforskning.no/nb/publikasjoner/report/aktivitet-og-fellesskap-blant-eldre-erfaringer-med-sosial-omsorg-i-steigen-ogI denne rapporten presenterer vi funn fra det offentlige innovasjonsprosjektet «Aktiv og meningsfylt hverdag: Mot en modell for ivaretakelse av sosiale omsorgsbehov i norske kommuner». I prosjektet har Steigen kommune, Tana/ Deatnu kommune, Nordlandsforskning og Høgskolen på Vestlandet samarbeidet om å finne ut hvordan kommunene kan legge bedre til rette for aktivitet og fellesskap. Det ble gjennomført et utviklingsprosjekt i hver av kommunene og i løpet av prosjektperioden har vi samlet inn data med sikte på å dokumentere og formidle erfaringer. Analysene er basert på et stort datamateriale som består av individuelle intervjuer, gruppeintervjuer, dokumenter, møtereferater og referater fra en metode vi har valgt å kalle «kvalitativ samtaleserie». Med utgangspunkt i dette empiriske datamaterialet presenterer vi detaljerte og innsiktsgivende eksempler på hvordan man kan legge til rette for aktivitet og fellesskap blant eldre, både hjemmeboende og eldre som bor på institusjon (kapittel 5). Datamaterialet viser at enkle og hverdagslige aktiviteter som det å ta en kopp kaffe sammen, lage mat og spise sammen spiller en viktig rolle. Arbeidsoppgaver som gjør at man kan benytte kunnskap som sitter i kroppen etter et langt liv, eksempelvis håndverk, matlaging, røyke kjøtt, fiske eller bøte garn. Disse aktivitetene vekker minner og skaper grunnlag for gode samtaler. Å legge til rette for turer – alt fra å gå en runde rundt huset til isfiske – skaper gode øyeblikk og gir nye minner. I kapittelet «Struktur for sosial omsorg» (kapittel 6) viser vi hvordan mangel på strukturer og systematikk i arbeidshverdagen til ansatte i helse- og omsorgssektoren gjør det vanskelig å gjennomføre prosjektarbeid. Analysene fokuserer på hvordan slike strukturer kan bygges opp og hva som skal til for å skape et større fokus på sosial omsorg i helse- og omsorgssektoren. Samtidig er ikke strukturer, i form av arbeidslister, journalføring, personalmøter og kompetanseheving, en tilstrekkelig forutsetning for å yte sosial omsorg. Det å se folk, anerkjenne dem og legge til rette for aktiviteter som oppleves som meningsfylte for den enkelte krever en fintfølende oppmerksomhet og evne til å se andre (kapittel 7). Denne kompetansen er helt avgjørende i helse- og omsorgssektoren og må anerkjennes og tas vare på. I det siste analysekapittelet beskriver vi frivillighetens rolle i å tilrettelegge for aktivitet og fellesskap blant eldre (kapittel 8). Analysene viser at gleden ved å glede andre er en viktig motivasjon, men at aktivitetene man organiserer og relasjonene man inngår i som frivillig også oppleves som meningsfylte og givende for en selv. I rapportens siste kapittel presenterer vi konklusjoner og anbefalinger for å styrke den sosiale omsorgen og legge bedre til rette for aktivitet og fellesskap i den kommunale eldreomsorgen i prosjektkommunene, så vel som i andre kommuner. Vi konkluderer med at tydeligere strukturer og føringer på alle nivå i sektoren, fra nasjonale myndigheter til avdelinger, er nødvendig for å styrke den sosiale omsorgen