FRACTAL DIMENSION OF URBAN EXPANSION BASED ON REMOTE SENSING IMAGES

Fractal Dimension of Urban Expansion Based on Remote Sensing Images: In Cluj-Napoca city the process of urbanization has been accelerated during the years and implication of local authorities reflects a relevant planning policy. A good urban planning framework should take into account the society demands and also it should satisfy the natural conditions of local environment. The expansion of antropic areas it can be approached by implication of 5D variables (time as a sequence of stages, space: with x, y, z and magnitude of phenomena) into the process, which will allow us to analyse and extract the roughness of city shape. Thus, to improve the decision factor we take a different approach in this paper, looking at geometry and scale composition. Using the remote sensing (RS) and GIS techniques we manage to extract a sequence of built-up areas (from 1980 to 2012) and used the result as an input for modelling the spatialtemporal changes of urban expansion and fractal theory to analysed the geometric features. Taking the time as a parameter we can observe behaviour and changes in urban landscape, this condition have been known as self-organized – a condition which in first stage the system was without any turbulence (before the antropic factor) and during the time tend to approach chaotic behaviour (entropy state) without causing an disequilibrium in the main system

Institutional discrimination in mental health services: a comparative analysis of schizophrenia and diabetes in Romania

Background: This thesis aims to ascertain the extent and nature of institutional discrimination against people with mental illness in specialist health care settings in Romania. The hypothesis is that such discrimination exists. Building on the definition in EU directives, discrimination is defined, for the purposes of this thesis, as harm that is caused to individuals or groups on the basis of identifiable characteristics bearing negative connotations. Harm is defined as the receipt of care that is less good than, inequitable in comparison to that received by others with similar needs, (long-term physical and mental illness), on grounds of stigma against people with mental illness. To assess the presence of discrimination, two groups were identified suffering from disorders that, although at first sight quite different, actually have much in common. They are schizophrenia and type 1 diabetes. Methods: The research method was Rapid Assessment, involving initial assessment, study area profile, contextual assessment, and health intervention assessment. The presence of horizontal inequity was determined by means of a de jure and a de facto assessment of specialist health care for people with schizophrenia and type 1 diabetes, using a set of criteria for aspects of care that are equally applicable to the management of both conditions, namely: 1) accessibility of specialist services; 2) availability of evidence-based treatment and care; 3) delivery of care; 4) quality of facilities; 5) protection of human and civil rights. The presence of stigma was determined the by ascertaining whether those in a position of authority and influence, namely the health professionals interviewed during the fieldwork, displayed stigmatising of attitudes and beliefs, language or approaches to treatment. The research triangulated data collected using a range of methods that include systematic review and comparative analysis of laws, policy documents and other literature, interview strategies (focus groups, group interviews and semi-structured interviews) and observations of practice. Analysis of the data involved three methods: content analysis, narrative structure analysis, and critical appraisal. For the fieldwork, a total of 228 participants (service users and health professionals) were selected using multi-stage sampling, covering each condition in each specialist setting (mental health acute and chronic inpatient services and outpatient services as well as inpatient and a comparative analysis o f schizophrenia and diabetes in Romania outpatient services for type 1 diabetes) in two selected locations in Romania (Bucharest and Slatina). Data collection took place between the 19th of September 2007 and the 8th of January Findings: In assessing equity, weaknesses were found in management of both conditions, particularly poor access to medication for associated health problems and lack of follow-up after discharge, poor continuity of care. In many areas, treatment and care for people with schizophrenia was worse generally, though some aspects were equitable: access to care in community-based settings, geographical accessibility of services, access to services when needed (temporal access), access to different parts of the system, as needed (referral system), financial access to appropriate care, access to social care, availability of enough staff in all settings, involvement of service users in shaping the services, involvement of families and carers, protection of service users’ privacy and safety, decent living environment and hygiene of health facilities. Patients with schizophrenia were significantly disadvantaged in: access to a comprehensive range of evidence-based specialized services and to qualified and competent multidisciplinary staff, the quality of health facilities, access to care for other health conditions and, availability of individual treatment plans developed for each patient, empowerment of service users to care for themselves and live as independent a life as possible, and respect of all human and civil rights on health facilities and a number of patient rights. In assessing stigma, I found that all types of mental health professionals, in all settings, stigmatised people with schizophrenia, manifest through their attitudes and beliefs, language and approaches to treatment. Conclusions: This research found that people with schizophrenia suffer direct institutional discrimination in Romania, manifest inequities in both the legislation that applies to them and the specialist care delivered when compared with people with type 1 diabetes, and that these inequities arise in a context of stigmatising attitudes to people with severe mental health problems by those in a position of authority and influence (health professionals)

Assessing Regulatory Impact Analyses: The Failure of Agencies to Comply With Executive Order 12,866

None.Environment, Health and Safety, Regulatory Reform

Assessing the Quality of Regulatory Impact Analyses

This study provides the most comprehensive evaluation of the quality of recent economic analyses that agencies conduct before finalizing major regulations. We construct a new dataset that includes analyses of forty-eight major health, safety, and environmental regulations from mid-1996 to mid-1999. This dataset provides detailed information on a variety of issues, including an agency's treatment of benefits, costs, net benefits, discounting, and uncertainty. We use this dataset to assess the quality of recent economic analyses and to determine the extent to which they are consistent with President Clinton's Executive Order 12866 and the benefit-cost guidelines issued by the Office of Management and Budget (OMB). We find that economic analyses prepared by regulatory agencies typically do not provide enough information to make decisions that will maximize the efficiency or effectiveness of a rule. Agencies quantified net benefits for only 29 percent of the rules. Agencies failed to discuss alternatives in 27 percent of the rules and quantified costs and benefits of alternatives in only 31 percent of the rules. Our findings strongly suggest that agencies generally failed to comply with the executive order and adhere to the OMB guidelines. We offer specific suggestions for improving the quality of analysis and the transparency of the regulatory process, including writing clear executive summaries, making analyses available on the Internet, providing more careful consideration of alternatives to a regulation, and estimating net benefits of a regulation when data on costs and benefits are provided.

Major hepatic resections – the progress of a new HBP surgical-centre

Spitalul Clinic “Dr. Ion Cantacuzino”, București, România, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: In mod istoric, rezecțiile hepatice au fost insoțite de morbitate si morbitate majore, reprezentând un tip prohibitiv de chirurgie până în ultimii ani. Odata cu evoluția tehnologiei și imbunătățirea tehnicilor imagistice, cât și a dezvoltării unui management perioperator specific ficatului, rezectiile hepatice au ajuns sa fie efectuate în centre de volum mare cu o rată a mortalitații de < 5%. Material si metode: În ultimii 5 ani, Spitalul Clinic “Dr. Ion Cantacuzino” s-a dezvoltat ca un nou centru de chirurgie hepato-biliopancreatică, o varietate largă de rezecții hepatice fiind practicate de rutină. Rezultate: Experiența acestei clinici în ceea ce privește rezecțiile hepatice majore a progresat până la 15 cazuri, la ora actuală, cu un singur deces postoperator. Concluzii: Din perspectiva unui centru în creștere a devenit aparent faptul ca se pot realiza rezecții hepatice majore în siguranță și cu rezultate postoperatorii bune, atât timp cât se aplica o selecție riguroasă a pacienților și sunt urmarite protocoale standardizate.Background: Historically major hepatic resections have been associated with high morbidity and mortality, being a prohibitive type surgery until recent years. With the advancement of technology and better imaging techniques, as well as liver-specific perioperative care, hepatic resections are performed in high-volume centres with a mortality of less than 5 %. Method and materials: The “Dr. Ion Cantacuzino” Hospital in Bucharest has developed as a new hepato-biliary-pancreatic surgical centre in the past 5 years, with a wide variety of hepatic resections performed on a regular basis. Results: The experience of this clinic, as far as major hepatic resections is concerned, has progressed, to date, to 15 such cases, with just one postoperative death. Conclusion: From the perspective of a growing centre it has become apparent that major hepatic resections can be safely performed and with good postoperative outcomes, with a thorough selection of patients and if standardised protocols are followed

hernia repair – is there a place for one-day surgery?

Spitalul Clinic “Dr. Ion Cantacuzino”, București, România, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Tratamentul chirurgical al herniilor inghinale este una dintre cele mai frecvente intervenții chirurgicale care se practică pe plan mondial, în ciuda faptului că persistă o lipsă de conses în ceea ce privește “cel mai bun” procedeu; unii autori susținând avantajele procedeelor deschise, în principiu operația Lichtenstein, în timp ce alții beneficiile abordarilor laparoscopice, TAPP sau TEP. Material și metode: Am realizat un studiu retrospectiv în cadrul Spitalului Clinic “Dr. Ion Cantacuzino”, pe o perioadă de 5 ani, pe 517 pacienți la care s-au practicat diferite intervenții chirurgicale pentru tratamentul herniilor inghinale. Pacienții au fost imparțiți în 2 grupuri, unii beneficiind de un procedeu deschis, în timp ce alții de laparoscopie. Variabile introduse în studiu au fost vârsta, sexul, perioada medie de spitalizare, media zilelor de spitalizare postoperatorie, timpul operatorie si costurile aferente spitalizării. Rezultate: Procedee laparoscopice s-au efectuat la 304/517 (59,37%), cu o mică prevalență TEP vs TAPP. Perioada de spitalizare, cheltuielile și timpii operatori au fost semnificativ mai mici pentru grupul TEP, majoritatea pacientilor fiind externați în prima zi postoperator. Concluzii: Rezultatele studiului nostru sprijină ideea ca procedeul TEP se poate practica într-un regim de “one-day surgery” într-un spital public astfel crescând confortul pacientului și scazând cheltuielile de spitalizare.Background: Hernia surgery is one of the most frequent operation performed world-wide, although there still seems to be a lack of consensus as to “the best” technique, with some authors still advocating for open, mainly Lichtenstein repair, while others supporting laparoscopic techniques, TAPP or TEP. Methods and materials: A retrospective study was performed in a public county hospital, over a period of 5 years, on 517 patients who benefitted from a surgical procedure for inguinal hernia treatment. Patients were divided into 2 groups, one with open surgical repair and, the other, laparoscopic. Variables taken into account were age, sex, mean hospital stay, mean postoperative hospital stay, hospital expenses, and operative time. Results: Laparoscopic repair was performed for 304/517 (59,37%), with a slight prevalence of TEP over TAPP; Hospital stay, expenses and operative time were significantly lower for the TEP group, most of the patients being discharged the following day. Conclusion: The results of our study seems to support the idea that TEP hernia repair could be performed on a “one-day surgery” basis in a public hospital, thus increasing patient comfort and decreasing hospital expenses

THE EVALUATION OF ACCESSIBILITY TO HOSPITAL INFRASTRUCTURE AT REGIONAL SCALE BY USING GIS SPACE ANALYSIS MODELS: THE NORTH-WEST REGION, ROMANIA

The Evaluation of Accessibility to Hospital Infrastructure at Regional Scale by Using GIS Space Analysis Models: the North-West Region, Romania. Easy access of the population to hospital infrastructure represents one of the main preoccupations of local and national authorities in the attempt to increase the degree of deliverance of quality medical services. The analysis of territorial distribution of various hospital categoriescity, clinical, teaching, emergency hospitals- has revealed some areas of deficit in what regards the availability of various types of medical assistance. Identifying the areas of deficit from the point of view of accessibility to hospital infrastructure is carried out by means of a GIS model of space analysis (Cost Surface Modeling type) based on the calculation of access time from any location in the territory to the nearest hospital taking into consideration the vector databases (access ways, hospitals etc.), assignment (speed of motion on access ways, hospital type) and raster (access time)

Multivisceral resections in invasive colorectal tumors – indication and postoperative outcome

Spitalul ,,Dr.I.Cantacuzino”, Clinica chirurgie II, București, România, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Rezecțiile colorectale pentru neoplaziile de colon și rect reprezintă intervenții chirurgicale bine codificate. Cu toate acestea, neoplaziile avansate, cu invazie locoregională, care necesită îndepărtarea tuturor țesuturilor și organelor interesate, pot ridica probleme de tactică și tehnică operatorie, precum și îngrijiri postoperatorii deosebite. Scopul: Prezentarea experienței unei echipe chirurgicale în abordarea leziunilor pluriviscerale în cancerele colorectale invazive. Material și metode: Au fost urmărite retrospectiv, în intervalul ianuarie 2013 - iunie 2015, cancerele colorectale invazive, primitive sau recurente, operabile, care au necesitat rezecții complexe multiorgan. Nu au fost luate în calcul tumorile colorectale cu metastaze hepatice la care s-a făcut, pe lîngă rezecția segmentului digestiv, îndepărtarea metastazelor hepatice. Rezultate: Au fost 24 de cazuri de rezecții multiorgan care au asociat rezecții colorectale. Cele mai multe situații au fost reprezentate de invaziile tumorilor de rect sau sigmoid în ansele ileale, dar au fost și situații de invazii de colon drept sau unghi splenic în pancreas, stomac, rinichi, suprarenale, necesitînd îndepărtarea organelor respective. În 9 cazuri au fost interesate organele pelvine, uter și/sau vezica urinară, ceea ce a impus rezecții rectosigmoidiene tip Dixon sau Hartman asociate histerectomiilor și pelvectomiilor. Concluzii: Considerate pînă nu demult ca inoperabile, cazurile de neoplazii colonice și rectale care au depășit limita organului invadînd organele vecine, cavitare sau parenchimatoase, beneficiază actualmente de rezecțiile multiorganice. Diversitatea organelor interesate nu permite standardizarea intervențiilor chirurgicale, dar se pot stabili unele principii de tactică operatorie care să permită o rezecție chirurgicală cu tentă de radicalitate.Introduction: Colorectal resections in colonic and rectal neoplasms are now well coded. However, advanced neoplasms with regional/local invasion can challenge the operative strategy and require special postoperative care. Aim: To present experience of a single surgical team in multi-visceral resections for invasive tumors (T4) with colorectal origin.Material and methods: We analyzed retrospectively between January 2013 and June 2015 all patients admitted with invasive but resectable colorectal tumors that required multivisceral resections. From analysis were excluded colorectal tumors with metastasis in the liver. Results: There were 24 colorectal tumors that required multivisceral resections; most of them were with rectal origin involving urinary bladder or internal genital organs and required beside rectal procedure hysterectomies or pelvectomies; other cases were invasive: colon tumors affecting stomach, pancreas, kidney or spleen and necessitating “en-bloc” multivisceral resections. Conclusions: Considered until recently as unresectable, cases of colorectal cancers that have invaded multiple neighboring organs currently benefit from multivisceral resections with promising results in terms of survival and morbidity. Diversity of involved organs allows only for general surgical strategy aiming for oncological cure

Recurrence risk factors after laparoscopic treatment for inguinal hernia

Clinica chirurgie II, Spitalul ,,Dr.I.Cantacuzino”, Bucureşti, România, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Scop: Considerată în prezent marker al eșecului tratamentului chirurgical, recidiva herniei inghinale are în literatură o rată ce variază între 1-4% indiferent de calea de abord. Această lucrare își propune să găsească factorii semnificativi cu rol în apariția recidivei. Material și metode: Un total de 257 pacienți au fost incluși într-un studiu prospectiv din ianuarie 2013 pînă în octombrie 2014 cu urmărire clinică postoperatorie la 1 lună, 6 luni și 1 an. Rezultate: Chiar dacă recidiva după abordul laparoscopic nu a depășit 4%, cei mai importanți factori de risc au fost identificați în curba de instruire și în dimensiunea protezei folosite. Concluzii: Deoarece cele mai multe recidive au fost diagnosticate în prima lună postoperator acest studiu subliniază că erorile tehnice au fost principalii factori cu rol în recidivă, subliniind astfel rolul urmăririi postoperatorii.Purpose: Recurrence after inguinal hernia surgery is currently considered a marker of treatment failure being quoted in literature with a rate ranging in between 1-4% regardless laparoscopic or conventional approach. This paper aims to find significant risk factors for recurrence.Material and methods: A total of 257 patients with diagnosed inguinal hernia were included in a study and evaluated prospectively (from January 2013 until October 2014). Follow-up was performed at 1 month, 6 and 12 months respectively from surgery aiming recurrence and postoperative pain syndrome. Results: Though recurrence rate in laparoscopic approach did not exceed 4% learning curve and the size of the prosthesis were identified as the most important risk factors. Conclusions: As most of recurrences were diagnosed in the first postoperative month after inguinal hernia surgery this study highlights that technical errors account as a main cause for recurrence, highlighting also the role of postoperative follow-up

Total pelvectomy – indications and postoperative outcomes

Clinica chirurgie II, Spitalul ,,Dr.I.Cantacuzino”, Bucureşti, România, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Exenteraţia pelvină este cea mai complexă operaţie radicală, utilizată în general pentru neoplaziile tractului genital intern cu invazie în organe vecine, şi care îndepărtează total sau parţial, tractul genital intern, vezica urinară, rectul și canalul anal. Intervenţiile se diferenţiaza prin extensia rezecţiei şi prin modalitatea de diversie a tractului digestiv şi a aparatului urinar. Lucrarea urmăreşte indicaţia chirurgicală, punctul de origine şi extensia locoregională a neoplaziilor, modalităţile de rezolvare a polului urinar și digestiv, precum şi rezultatele postoperatorii ale cazurilor operate de o singură echipă chirurgicală într-un interval de 2,5 ani. Material şi metode: Au fost urmărite retrospectiv, în intervalul ianuarie 2013 – iunie 2015, exenteraţiile pelvine totale sau pelvectomiile parţiale, anterioară sau posterioară, efectuate în Clinica de chirurgie a spitalului “Dr.I.Cantacuzino”, Bucureşti. Rezultate: Din totalul de 20 de operaţii, au fost 12 exenteraţii totale (2 bărbaţi asociind prostatectomie totală), 3 pelvectomii anterioare şi 5 pelvectomii posterioare. În doar 5 din intervenţii s-a prezervat un bont anal care a permis anastomoza mecanică ultrajoasă protejată de ileostomie. Cele mai dificile probleme de management postoperator le-a ridicat modalitatea de rezolvare a polului urinar. În cîte o situaţie s-a putut reimplanta ureterul în vezica urinară sau s-a creat o neovezică cu perete ileal. În 7 cazuri s-a practicat ureterostomie percutană în “ţeavă de puşcă”, iar în 6 cazuri ureteroileostomie “Bricker”. Mortalitatea la 30 de zile a fost de 3 (15%) cazuri. Concluzii: Deși sunt considerate intervenţii dificile pentru echipa chirurgicala şi mutilante pentru pacienţi, exenteraţiile pelvine reprezintă o modalitate de îmbunătăţire a duratei de supravieţuire şi a calităţii vieţii pacienţilor aflaţi în stadii avansate de neoplazii pelvine, rectale sau genitourinare.Introduction: Pelvic exenteration is one of the most complex oncological procedures with indication mainly in invasive genital neoplasia. Procedures differ by the extent of resection or by the type of urinary and digestive diversion. This paper aims to evaluate surgical indications, histological type and degree of local tumor invasion, technical options for urinary and digestive diversions and the postoperative outcome of all cases approached by one surgical team during 2.5 years. Material and methods: We retrospectively analyzed all cases operated on with total or partial (anterior/posterior) pelvectomies. Results: Twelve out of 20 cases were total pelvectomies and the rest of 8 cases were partial approaches (3 anterior and 5 posterior exenterations). Only in 5 cases we performed an ultra-low colo-anal anastomosis with temporary ileal diversion. Most difficult postoperative issues were related to urinary diversion. In one situation was possible to re-implant the ureter into urinary bladder and in another – to create the neo-bladder from the ileal wall. In 7 cases the percutaneous ureterostomiy and in 6 cases – ureteroileostomy “Bricker” were performed. The 30-day mortality rate was 15% (3 patients). Conclusions: Although considered a difficult intervention for surgeon and impairing for patient, pelvectomy represents an acceptable solution to extend survival and quality of life in patients with advanced stages of rectal or genital neoplasms