The Danube Delta, the second-largest wetland in Europe, provides people with multiple ecosystem services, consisting of drinking water, food, flood protection, nutrient recycling, and recreation, as it is a complex social–ecological system. Nowadays, the area faces heavy depopulation due to its failure in achieving an equilibrium between social, economic, and environmental issues. Therefore, its resurgence is the core element of its sustainable development strategy, and particular sectors such as fishing and aquaculture, agriculture, and tourism national strategies deal individually with essential issues without considering the potential conflicts that may arise from a particular sector’s development. This study develops a complex method for decision making concerning the sustainable development of the Danube Delta Biosphere Reserve based on the consultation of both local and higher-level stakeholders in decision making, and the identification of social, economic, and environmental key problems. After their validation by experts, we developed a system dynamics model and ran the identified scenarios together with the stakeholders and recommended policies for the sustainable development of the area. The scenario that combines the transition towards the moderate Intensification of aquaculture with ecological agriculture and slow tourism brings a reduced impact on water quality, but measures to reduce nutrients are still recommended.

No abstract

BACKGROUND: Adults with neurodevelopmental disability (NDD) have poor employment outcomes when compared to their peers without disabilities. Examining employment outcomes beyond common dichotomous descriptive metrics (i.e., employed versus unemployed) depends on the use of standard measures and structured procedures. OBJECTIVE: This review of vocational research literature focused on identifying measures of employment outcomes for adults with NDD. METHODS: Searches were conducted across five databases -ERIC, MEDLINE, CINAHL, HaPI, and PsycINFO. Screening was conducted in duplicate, with all disagreements adjudicated by the senior researcher. RESULTS: A total of 45 articles met inclusion criteria, and data extraction revealed that 64 different employment measures were used in these vocational research studies. CONCLUSIONS: This work summarizes the employment measures for people with NDD utilized in the literature. Descriptions of these measures were provided and coding by person and environment themes, which is a useful resource for planning future vocational research for people with NDD.

No abstract

Background and aimsAcute bronchiolitis (AB) is a relatively frequent respiratory disease in paediatric practice. Severity is variable, from mild – that can be treated as outpatient, to severe – that requires admission in the intensive care unit. Management continues to be controversial, no consensus exists on the use of bronchodilators, corticosteroids and hypertonic saline. The aim of this paper was to analyse changes in the management of AB within the space of a decade.MethodsWe conducted a retrospective study of patients admitted to our institution in the months of Jan – March and October – Dec of 2006 and 2016 with the diagnosis of AB. Data collection and analysis – ANOVA and Fisher’s exact tests were performed with IBM SPSS Statistics version 22. A p value<0.05 was considered statistically significant.ResultsA total of 459 admissions of 446 children were studied, 59.9% were males. 245 of children were admitted in 2006, 201 in 2016. Age at admission was less than 1 month in 4%, 1–12 months old in 76.9%. 205/446 (45.9%) had moderate to severe AB. Within the 10 year period median length of hospital stay has declined by one day, from 6 to 5 days (p=0.048).Respiratory Syncitial Virus was identified in 48 samples, adenovirus in 7 cases. In 2016, as bacterial coinfections could be tested by PCR, the most frequent associated bacterium was streptococcus pneumoniae, encountered mostly in severe AB.Therapeutical options used included oxygen (O2 – in 38.3% of the cases), hypertonic saline (HS −16.4%) – used predominantly in mild AB, nebulized adrenaline (79.1%) and salbutamol (22.9%). Corticosteroids – intravenous (40.1%) and inhaled (17.3%), nebulized ipratropium (4%) and antibiotics (62.3%) were used mostly in moderate – severe AB. None of the patients required mechanical ventilation.Within the ten years, significant changes were noted in the use of O2 – increased (p=0.049), HS – increased from 1.2% to 34.8%, mostly in mild AB (p<0.001). Ipratropium use increased from 1.2% to 7.5% (p=0.001), corticosteroids – decreased from 70.2% to 41.8% (p<0.001), antibiotics – decreased from 78% to 44.3% (p<0.001), mostly used in moderate – severe AB.ConclusionsAs controversies persist in the management of AB, in our sample significant changes have occurred within a decade – HS has become an option for mild cases and the use of corticosteroids and antiobiotics has declined in general, whilst they continue to be used in severe AB.