The State of Human Resource in Terms of Digitalization of Cultural Heritage in Some of the Major Public Libraries in Bulgaria

The purpose of this article is to discuss the state of human resource in terms of digitalization of Cultural heritage in some of the major Public libraries in Bulgaria. Are we ready to meet modern requirements and to manage these resources? The report will show one of the first initiatives taken in this regard in our country (the Operational Programme „Human Resources Development“ 2007–2013; Project „Glob@ l Libraries – Bulgaria“ Project „Europeana“, Project ABLE). Also it will illustrate the first united online catalogs, associated with the digitalization of Cultural heritage along with the difficulties in making them for less qualified staff. For a country in transition, such as Bulgaria, it is obvious that the Bulgarian public library should seek competitive advantages in relying heavily on the development of human factors, including the ability to strategically orient and guide their activities. Because modern libraries require not only product quality but also quality of service, as much as the service sector forms the greater part of the national income of the developed countries

Palliative care in Bulgarian general practice

Background. GPs in Bulgaria provide basic care to people with advanced disease; there is no legislative framework for palliative care. The aim of the study was to investigate the activities of the GPs involving patients who need palliative care. Material and methods. The 42 GPs followed up a total of 211 patients, meeting the diagnostic criteria for inclusion. A form was developed for the purposes of the study, reflecting the activities during the 625 consultation. The subjective opinion of the patient was also registered. The statistical processing of data was made by a SPSS 17. Results. The patients above 60 years of age predominated. The ratio by gender was balanced. The distribution by diagnostic criteria was: oncological disease (87/41.28 ± 3.38%); chronic heart failure (CHF) (65/30.80 ± 3.17%); chronic obstructive pulmonary disease (COPD) (20/9.47 ± 2.01%) and combinations (39/18,48 ± 2,67%). No significance was found between the referrals and the social and diagnostic characteristics. Weak correlations were found between the lower level of education, the lower social status, COPD patients and the greater frequency of home visits. Principal symptoms in our study were pain and fatigue. Discrepancy between the evaluations of patients and GPs was found regarding the ones that are subjective. In cases of oncological diseases the diagnosis and prognosis, were discussed more frequently with the relatives. Conclusion. Within the framework of their general obligations, GPs perform activities characteristic of palliative care. The investigation of these activities and the analysis of the results can serve as a first step in the formation of structured palliative care in our country. Adv. Pall. Med. 2011; 10, 1: 17–22Background. GPs in Bulgaria provide basic care to people with advanced disease; there is no legislative framework for palliative care. The aim of the study was to investigate the activities of the GPs involving patients who need palliative care. Material and methods. The 42 GPs followed up a total of 211 patients, meeting the diagnostic criteria for inclusion. A form was developed for the purposes of the study, reflecting the activities during the 625 consultation. The subjective opinion of the patient was also registered. The statistical processing of data was made by a SPSS 17. Results. The patients above 60 years of age predominated. The ratio by gender was balanced. The distribution by diagnostic criteria was: oncological disease (87/41.28 ± 3.38%); chronic heart failure (CHF) (65/30.80 ± 3.17%); chronic obstructive pulmonary disease (COPD) (20/9.47 ± 2.01%) and combinations (39/18,48 ± 2,67%). No significance was found between the referrals and the social and diagnostic characteristics. Weak correlations were found between the lower level of education, the lower social status, COPD patients and the greater frequency of home visits. Principal symptoms in our study were pain and fatigue. Discrepancy between the evaluations of patients and GPs was found regarding the ones that are subjective. In cases of oncological diseases the diagnosis and prognosis, were discussed more frequently with the relatives. Conclusion. Within the framework of their general obligations, GPs perform activities characteristic of palliative care. The investigation of these activities and the analysis of the results can serve as a first step in the formation of structured palliative care in our country. Adv. Pall. Med. 2011; 10, 1: 17–2

Opieka paliatywna w podstawowej opiece zdrowotnej w Bułgarii

Wstęp. W Bułgarii podstawową opiekę zdrowotną osobom poważnie chorym zapewniają lekarze pierwszego kontaktu (POZ). W chwili obecnej brakuje regulacji prawnych dotyczących opieki paliatywnej. Celem niniejszej pracy była analiza tych działań lekarzy POZ, które dotyczą pacjentów wymagających opieki paliatywnej. Materiał i metody. Grupę 211 pacjentów spełniających kryteria diagnostyczne wymagane do włączenia do badania obserwowało 42 lekarzy POZ. Na potrzeby badania opracowano specjalny formularz, odzwierciedlający czynności wykonane podczas 625 konsultacji lekarskich. W formularzu ujęto również subiektywną ocenę pacjentów. Statystyczną analizę danych wykonano za pomocą oprogramowania SPSS 17. Wyniki. W grupie badanych przeważali pacjenci w wieku powyżej 60 lat. Rozkład według płci był zrównoważony. Podział według kryteriów diagnostycznych przedstawiał się następująco: choroba nowotworowa (87 — 41,28 ± 3,38%); przewlekła niewydolność serca (CHF) (65 — 30,80 ± 3,17%); przewlekła obturacyjna choroba płuc (POChP) (20 — 9,47 ± 2,01%) oraz choroby stanowiące połączenia wyżej wymienionych (39 — 18,48 ± 2,67%). Nie stwierdzono istotnych zależności pomiędzy liczbą wystawionych skierowań a diagnozą i statusem socjalnym pacjenta. Wykazano nieznaczną współzależność między niższym poziomem wykształcenia, niższym statusem socjalnym, obecnością POChP a większą częstością wizyt domowych. Ból i zmęczenie były podstawowymi objawami zaobserwowanymi w niniejszym badaniu. Rozbieżność w ocenach pacjentów i lekarzy POZ dotyczyła objawów subiektywnych. W przypadku chorób nowotworowych diagnoza i rokowania były omawiane częściej z członkami rodziny pacjenta. Wnioski. W ramach swoich podstawowych obowiązków lekarze POZ wykonywali czynności związane z opieką paliatywną. Zbadanie tych czynności oraz analiza wyników mogą posłużyć jako pierwszy krok w uzyskaniu informacji na temat strukturalnej opieki paliatywnej w Bułgarii. Medycyna Paliatywna w Praktyce 2011; 5, 2: 54–5

Invasive Evaluation for Coronary Vasospasm

Vasospastic angina (VSA) occurs at rest and on exertion, with transient electrocardiographic ischemic changes. VSA presents with spontaneous coronary artery spasm (CAS); it has been associated with stable angina, acute coronary syndromes, and sudden cardiac death. CAS can be identified in normal arteries or non-obstructive coronary atherosclerosis, but is also prevalent in patients with coronary artery disease. The diagnosis is made with invasive coronary reactivity testing with provocation using acetylcholine (Ach). Epicardial spasms can be visualized through coronary angiography as a reversible epicardial vessel narrowing, while the diagnosis of microvascular spasm can be made when angina symptoms and ECG changes happen following intracoronary Ach without epicardial spasm. Identification of CAS allows for risk stratification and specific therapies targeting endothelial dysfunction and paradoxical vascular smooth muscle cell constriction. Therapies include calcium channel blockers as monotherapy or in a combination of a dihydropyridine and non-dihydropyridine. Short-acting nitrates offer acute symptomatic relief but long-acting nitrates should be used sparingly. This current update on invasive evaluation of VSA discusses unified Ach protocols

Parameters VS Algorithms: The New Urban Paradigm Parameters VS Algorithms: The New Urban Paradigm

Abstract This paper focuses on two contemporary architectural and urban movements -Schumacher's Parametric Design and Watanabe's Induction Design. Both the Parametric and the Induction design are in tight relation with the currently active Complexity paradigm and self-organization concepts, and are distinctive for their intense use of specific morphogenic software. Thus, they themselves serve as powerful instruments in the process of creation of the new millennium urban Utopias. Induction Design acts as an extension of the brain and gives precise solutions (entirely based on specific assessments and calculations) to numerous complex architectural, urban and environmental problems. Parametric Design, on the other hand, could be described as an extension of the hand and its primary task is to organize and to articulate the increased complexity of the modern society by setting strict rules for morphogenesis. As both trends operate on all levels, from interior design to urban planning, we cannot help but wonder if any of them has the required qualities to become the next great style and to establish the new design paradigm. The author has conducted a study of the two trends, which includes exploration of their emergence, history, socio-cultural and scientific context, principles and methods, and thorough examination of multiple examples of their application. As a conclusion from the study and the comparative analysis, the author proves that despite their apparent similarities, the Parametric and the Induction Design have not just different characteristics, programmes, methods but also face different problems and thus provide different solutions

ANOVA bootstrapped principal components analysis for logistic regression

Principal components analysis (PCA) is often used as a dimensionality reduction technique. A small number of principal components is selected to be used in a classification or a regression model to boost accuracy. A central issue in the PCA is how to select the number of principal components. Existing algorithms often result in contradictions and the researcher needs to manually select the final number of principal components to be used. In this research the author proposes a novel algorithm that automatically selects the number of principal components. This is achieved based on a combination of ANOVA ranking of principal components, the bootstrap and classification models. Unlike the classical approach, the algorithm we propose improves the accuracy of the logistic regression and selects the best combination of principal components that may not necessarily be ordered. The ANOVA bootstrapped PCA classification we propose is novel as it automatically selects the number of principal components that would maximise the accuracy of the classification model

Coronary microvascular disease in contemporary clinical practice

Coronary microvascular disease (CMD) causes myocardial ischemia in a variety of clinical scenarios. Clinical practice guidelines support routine testing for CMD in patients with ischemia with nonobstructive coronary artery disease. Invasive testing to identify CMD requires Doppler or thermodilution measures of flow to determine the coronary flow reserve and measures of microvascular resistance. Acetylcholine coronary reactivity testing identifies concomitant endothelial dysfunction, microvascular spasm, or epicardial coronary spasm. Comprehensive testing may improve symptoms, quality of life, and patient satisfaction by establishing a diagnosis and guiding-targeted medical therapy and lifestyle measures. Beyond ischemia with nonobstructive coronary artery disease, testing for CMD may play a role in patients with acute myocardial infarction, angina following coronary revascularization, heart failure with preserved ejection fraction, Takotsubo syndrome, and after heart transplantation. Additional education and provider awareness of CMD and its role in cardiovascular disease is needed to improve patient-centered outcomes of ischemic heart disease