European System Research Articles

The European Thyroid Imaging and Reporting Data System as a Remedy for the Overdiagnosis and Overtreatment of Thyroid Cancer: Results from the EUROCRINE Surgical Registry.

The European Thyroid Imaging and Reporting Data System (EU-TIRADS) aims to reduce the overdiagnosis of thyroid cancer (TC) by guiding the selection of nodules for fine-needle aspiration biopsy (FNAB). This study sought to validate EU-TIRADS nodule selection criteria using data from EUROCRINE, an extensive international endocrine surgery registry. We reviewed indications for FNAB among patients with TC compared to those with benign disease who underwent surgery between March 2020 and March 2022, considering preoperative EU-TIRADS scores and dominant nodule size (FNAB is recommended in Category 5 (˃10 mm or ˂10 mm with suspicious lymph nodes), 4 (˃15 mm), and 3 (˃20 mm)). Patients were categorized into three risk groups: minimal risk (patients with papillary microcarcinoma), high risk (patients with pT3b stage or higher, pN1b, or pM1), and low-moderate risk (all other patients). We conducted a Receiver Operating Characteristic (ROC) analysis to assess the diagnostic accuracy of the EU-TIRADS. We analyzed 32,008 operations. Approximately 68% of the surgical records included EU-TIRADS classifications. The EU-TIRADS exhibited diagnostic accuracy across high-volume sites, with a median ROC Area Under the ROC Curve (AUC) of 0.752, indicating its effectiveness in identifying malignancy. Among the cases, 7907 patients had TC. Notably, 55% of patients with TC underwent FNAB despite not initially meeting the EU-TIRADS criteria. These patients were distributed across the minimal- (58%), low-moderate- (36%), and high-risk (5.8%) categories. Of the patients with TC recommended for FNAB, 78% were deemed low-moderate risk, 21% high risk, and only 0.7% minimal risk. The EU-TIRADS offers effective preoperative malignancy risk stratification. Promoting the proper use of the EU-TIRADS in clinical practice is essential to mitigate the overdiagnosis and overtreatment of low-risk TC.

ІНСТИТУЦІЙНА ПОБУДОВА ЄВРОПЕЙСЬКОЇ ТА МІЖАМЕРИКАНСЬКОЇ СИСТЕМИ ЗАХИСТУ ПРАВ ЛЮДИНИ: ПОРІВНЯЛЬНО-ПРАВОВИЙ АНАЛІЗ

Institutional accoding to normative framework adopted by international organizations established on the European and American continents. In addition, in Europe it is supplemented by the European Union Acts. Both systems have judicial and extrajudicial human rights protection mechanisms. The key judicial bodies are the European and Inter-American Courts for the Protection of Human Rights. Courts perform jurisdictional, advisory and preventive functions. They are authorized to decide both interstate complaints and individual petitions. An indicative criterion for the effectiveness of the work of the European and Inter-American Courts is the implementation of their decisions by the member states of the Council of Europe and the Organization of American States. The extrajudicial mechanism for the protection of human rights is implemented by convention bodies that are present in both systems and ensure the protection of certain categories of persons (convicts, women, children), namely: the Commissioner for Human Rights (Europe) and the Inter-American Commission for the Protection of Human Rights (North and South America ). The Agency for Fundamental Rights, which promotes the realization of human rights and freedoms (European Union), operates on the territory of Europe. The article states that the complaint review procedure has its own peculiarities. In Europe, the European Court of Human Rights is the main body for reviewing complaints. On the American continent, the complaints are first examined by the Inter-American Commission on Human Rights, and then the latter can refer them to the Inter-American Court of Human Rights, i.e. a two-level system of human rights protection is provided. On the basis of the given analysis of the theoretical material, conclusions were formulated, which set out the common and distinctive features inherent in the institutional system of human rights protection in the member states of the Council of Europe and the Organization of American States. Key words: European system, American system, institutional system, international conventions, human rights, protection of human rights, protection procedure.

The value of ACR, European, Korean, and ATA ultrasound risk stratification systems combined with RAS mutations for detecting thyroid carcinoma in cytologically indeterminate and suspicious for malignancy thyroid nodules.

The aim of this study was to evaluate the diagnostic value of four commonly utilized ultrasound (US) RSSs, namely, the American College of Radiology [ACR], European [EU], Korean [K] TI-RADSs and American Thyroid Association [ATA] US-based RSS criteria, in combination with activating point mutations of the RAS genes (NRAS, HRAS, and KRAS) for detection of thyroid carcinoma in cytologically indeterminate and suspicious for malignancy thyroid nodules. We retrospectively analyzed cytologically indeterminate and suspicious for malignancy thyroid nodules which underwent US, molecular testing and surgery between September 1, 2018, and December 31, 2023. Receiver operating characteristic (ROC) curves were generated, and the area under the curve (AUC, 95% confidence interval [CI]) was calculated. A total of 100 cytologically indeterminate and 24 suspicious for malignancy thyroid nodules were analyzed. Compared to the four US-based RSSs alone, the diagnostic value of the four US-based RSSs combined with RAS mutations did not significantly improved (cytologically indeterminate, AUC [95% CI] 0.6 [0.5-0.7] and 0.6 [0.5-0.7], respectively, p = 0.70; cytologically suspicious for malignancy, AUC [95% CI] 0.7 [0.5-0.9] and 0.8 [0.6-0.9], respectively, p = 0.23). The diagnostic value of the four main US-based RSSs (ACR, EU, K, and ATA) was not improved in conjunction with the evaluation of RAS mutations for preoperative risk stratification of cytologically indeterminate thyroid nodules. In cytologically indeterminate nodules categorized according to US-based RSSs, isolated RAS positivity does not reliably distinguish between benignity and malignancy.

The effect of a selenium-based anti-inflammatory strategy on postoperative functional recovery in high-risk cardiac surgery patients - A nested sub-study of the sustain CSX trial

AimThe cardiac surgery-related ischemia-reperfusion-related oxidative stress triggers the release of cytotoxic reactive oxygen and nitrogen species, contributing to organ failure and ultimately influencing patients' short- and long-term outcomes. Selenium is an essential co-factor for various antioxidant enzymes, thereby contributing to the patients' endogenous antioxidant and anti-inflammatory defense mechanisms. Given these selenium's pleiotropic functions, we investigated the effect of a high-dose selenium-based anti-inflammatory perioperative strategy on functional recovery after cardiac surgery. Materials and methodsThis prospective study constituted a nested sub-study of the SUSTAIN CSX trial, a double-blinded, randomized, placebo-controlled multicenter trial to investigate the impact of high-dose selenium supplementation on high-risk cardiac surgery patients' postoperative recovery. Functional recovery was assessed by 6-min walk distance, Short Form-36 (SF-36) and Barthel Index questionnaires. Key findings174 patients were included in this sub-study. The mean age (SD) was 67.3 (8.9) years, and 78.7 % of the patients were male. The mean (SD) predicted 30-day mortality by the European System for Cardiac Operative Risk Evaluation II score was 12.6 % (9.4 %). There was no difference at hospital discharge and after three months in the 6-min walk distance between the selenium and placebo groups (131 m [IQR: not performed – 269] vs. 160 m [IQR: not performed – 252], p = 0.80 and 400 m [IQR: 299–461] vs. 375 m [IQR: 65–441], p = 0.48). The SF-36 and Barthel Index assessments also revealed no clinically meaningful differences between the selenium and placebo groups. SignificanceA perioperative anti-inflammatory strategy with high-dose selenium supplementation did not improve functional recovery in high-risk cardiac surgery patients.

2024 Update on Postmarketing Nutrivigilance Safety Profile: A Line of Dietary Food Supplements Containing Red Yeast Rice for Dyslipidemia.

IntroductionConsidering lack of a European standardized postmarketing food supplement surveillance system, some member states and companies have developed their own approaches to monitoring potential AEs to secure a high level of product safety. This paper updates 2021 results of the use of a nutrivigilance system in monitoring the incidence of spontaneously reported suspected AEs associated with RYR-containing food supplements.Material and methodsWe report the data from a product marketed under the trademark Armolipid/Armolipid Plus. Postmarketing information was collected in a voluntary nutrivigilance system established by the manufacturing company (Meda Pharma SpA, a Viatris Company, Monza, Italy). From 1st October 2004-31st December 2023, this system captured cases of suspected AEs spontaneously reported by consumers, healthcare professionals, health authorities, regardless of causality.ResultsThe total number of case reports received mentioning the RYR-food supplement product line increased to 1186, in which 1904 AEs were reported. The total reporting rate of AEs was estimated to be 0.049% of 3,880,865 exposed consumers. Of the 1186 cases, 28 (0.0007%) included suspected SAEs. After careful investigation, 9 cases (0.0002%) and 12 AEs were assessed by the manufacturer as serious and potentially related to exposure to the above-mentioned RYR-based nutraceutical. Off-label reports linked to the newly introduced limitation at 70 years of age were observed, in contrast to the previous analysis.ConclusionsThese updated results confirm a very low incidence of RYR suspected AEs. Consumer safety of food supplements could be generally improved by raising awareness of the importance of following the indications and warnings detailed in a food supplement’s labelling.

Out-of-plane bending properties of cross laminated timber (CLT)

In Europe the structural timber building product cross laminated timber (CLT) is regulated via European Technical Assessments (ETAs), which require large and voluminous test campaigns to obtain. So far, there is no standardised CLT strength class system nor a set of harmonised properties. Such a strength class system and tabulated values could be accompanied by a set of so-called load-bearing models, analogous to the current regulations for glued laminated timber (GLT). The aims of this contribution are to comprehensively analyse the first known load-bearing model for out-of-plane bending of CLT from 2006 and to validate and benchmark this approach with possible further candidates. The aim is to initiate the establishment of a European strength class system for CLT based on its out-of-plane bending properties, for a more reliable, regulatory compliant structural building product and for enhancing its market acceptance. Therefore, a comprehensive analysis of various potential influencing parameters on out-of-plane CLT bending properties is effected by means of stochastic-numerical investigations as well as a large amount of test campaigns, the latter in the form of a retrospective study. The first approach from 2006, in particular in its adapted version, is successfully validated and confirmed as a valuable candidate for the future regulation of CLT due to its overall more accurate and more reliable strength predictions compared with the other candidates. In addition, models for the density and the modulus of elasticity parallel to the grain, as currently defined for glulam, are confirmed to be applicable also for CLT. An analysis of the variation in the properties of the base material and CLT motivates additional efforts towards grading and quality assurance in order to meet the expectations of the nominal strength class of boards and to fulfil minimum requirements for finger joint quality to better utilise the high performance of CLT and to increase its reliability.

Паттерны трансформации партийных систем стран ЕС: направление перемен и причины различий

The article presents an original classification of patterns of transformation of party systems in EU countries under the influence of the institutionalization of a new post-industrial cleavage. Drawing on theories of cleavage and spatial competition and using party positioning databases, electoral indices and statistics, the author attempts to identify the main trajectories of the transformation of the European party systems between 1990 and 2023 and identify factors that explain the differences between them. The study identified five patterns associated with the effects of two key parameters. The first one is the structural specificity of the conditions of party competition in post-communist and other EU countries, associated with the difference between the old structured and new volatile party systems. The second parameter is the type of a country’s party-political system in accordance with Arend Lijphart’s classification — either majoritarian-polarized or coalition-consensus. While under majoritarian system the institutionalization of a new cleavage often gave rise to a radical breakdown of the old configuration of parties with the emergence of powerful populist forces, under consensus system — a smooth increase in fragmentation with the outflow of votes in favor of various new parties and the complication of the process of forming coalitions. For a number of countries other factors, such as the level of socio-economic development, ethnocentricity of politics, the type of electoral system and the stability of the welfare state appeared relatively important. In contrast, hypotheses about the significance of the initial configuration of party systems, the timing of formation of new parties and the geographical proximity of countries were not confirmed.

Performance Drift in Machine Learning Models for Cardiac Surgery Risk Prediction: Retrospective Analysis.

The Society of Thoracic Surgeons and European System for Cardiac Operative Risk Evaluation (EuroSCORE) II risk scores are the most commonly used risk prediction models for in-hospital mortality after adult cardiac surgery. However, they are prone to miscalibration over time and poor generalization across data sets; thus, their use remains controversial. Despite increased interest, a gap in understanding the effect of data set drift on the performance of machine learning (ML) over time remains a barrier to its wider use in clinical practice. Data set drift occurs when an ML system underperforms because of a mismatch between the data it was developed from and the data on which it is deployed. In this study, we analyzed the extent of performance drift using models built on a large UK cardiac surgery database. The objectives were to (1) rank and assess the extent of performance drift in cardiac surgery risk ML models over time and (2) investigate any potential influence of data set drift and variable importance drift on performance drift. We conducted a retrospective analysis of prospectively, routinely gathered data on adult patients undergoing cardiac surgery in the United Kingdom between 2012 and 2019. We temporally split the data 70:30 into a training and validation set and a holdout set. Five novel ML mortality prediction models were developed and assessed, along with EuroSCORE II, for relationships between and within variable importance drift, performance drift, and actual data set drift. Performance was assessed using a consensus metric. A total of 227,087 adults underwent cardiac surgery during the study period, with a mortality rate of 2.76% (n=6258). There was strong evidence of a decrease in overall performance across all models (P<.0001). Extreme gradient boosting (clinical effectiveness metric [CEM] 0.728, 95% CI 0.728-0.729) and random forest (CEM 0.727, 95% CI 0.727-0.728) were the overall best-performing models, both temporally and nontemporally. EuroSCORE II performed the worst across all comparisons. Sharp changes in variable importance and data set drift from October to December 2017, from June to July 2018, and from December 2018 to February 2019 mirrored the effects of performance decrease across models. All models show a decrease in at least 3 of the 5 individual metrics. CEM and variable importance drift detection demonstrate the limitation of logistic regression methods used for cardiac surgery risk prediction and the effects of data set drift. Future work will be required to determine the interplay between ML models and whether ensemble models could improve on their respective performance advantages.

An Updated Review of the Marine Ornamental Fish Trade in the European Union

Wild-caught fish from coral reefs, one of the most threatened ecosystems on the planet, continue to supply the marine aquarium trade. Despite customs and veterinary checks during imports, comprehensive data on this global industry remain scarce. This study provides consolidated data on the largest import market by value, the European Union (EU): a 24-million-euro annual trade value, detailing the main exporting and importing countries, as well as the species and families of the 26 million specimens imported between 2014 and 2021. A watchlist alert system based on the number of specimens traded, import trends, and vulnerability index according to FishBase and the IUCN Red List conservation status is presented, providing key information on which species should require closer scrutiny by authorities. While the European TRAde Control and Expert System (TRACES) electronically monitors the movement of live animals to respond quickly to biosecurity risks, one-third of marine ornamental fish imported lack species-level information. With minor adjustments, TRACES holds the potential to significantly enhance data granularity and the monitoring of wildlife trade, with marine ornamental fish being an interesting case study to validate this approach.

Supervisory bodies in the systems of power in Russia and certain foreign countries: Comparative analysis

The significance of law enforcement cannot be understated in any state, and diverse models and traditions of law enforcement have evolved within different legal sustems. The status of the Procuracy in the Russian Empire, the Soviet Union and modern Russia, has been consistently characterized by its own independent power for supervising legality, including the actions of government officials. This contrasts with the European and Anglo-American legal systems where the concept of “general supervision” is not present and prosecutors do not possess equivalent powers. In the socialist model of China, an independent system of supervisory bodies has been established separately from the procurator’s office to oversee the activities of government officials. Each model exhibits distinct ontological, structural and organizational features, and a comparative analysis of their accumulated experiences facilitates the identification of their respective advantages and disadvantages, underscoring the relevance of this study. The research aimes to identify and analyze the commonalities and differences among four organizational models for ensuring the rule of law. Notably, the empirical basis for comparing supervisory authorities emphasises the state superiority function, irrespective of the body responsible for its execution (functional approach), rather than external similarities such as the name "prosecutor's office" or "prosecutor". The study draws from authentic legal texts, regulations, authoritative doctrinal commentaries, relevant judicial practices, and official interpretations of foreign legislation. The outcomes of the research lead to informed conclusions regarding the distinctiveness of the Russian model of the Procuracy, which incorporates several advantages from each foreign model, complements them with its own features and is thus capable of embracing positive experiences, regardless of their origins, to effectively filfill its mission.

ინტეგრაციისა და რეინტეგრაციის ბენეფიციარების საჭიროების კვლევა

Georgia faces significant challenges, the main of which is the rapid and sustainable development of the country's economy in adherence to the principles of the free market, the establishment of institutions relevant to the modern European and universal democratic values system, the provision of social welfare, and integration into the European and Euro-Atlantic space. Overcoming these challenges and building a modern democratic state requires systemic changes in the management and implementation of state policy. Despite the legislative reforms implemented in the field of migration in recent years, the improvement of legal mechanisms for regulating this area remains a challenge, while certain issues still require legal regulation due to the needs of the beneficiaries. Based on the results of the survey, it is advisable to implement the following measures in order to better integrate internationally protected persons: promoting the teaching of the Georgian language, improving access to public services, employment assistance, budget increase of integration programs.

The Poor Integration Results of the Common European Asylum System Compared to the Temporary Protection Directive: The Case of the Netherlands

AbstractTaking the case of the Netherlands, we compare integration outcomes of the traditional asylum reception system (implementing the Refugee Convention), applied to, for example, Syrians and Afghans, and the EU’s Temporary Protection Directive (TPD) which is applied to Ukrainians. We show that the TPD is not just less costly for receiving countries but also results in much faster labor market integration. While rapid integration is an important policy goal, the traditional asylum system is not effective, and talents are underutilized. We show how spatial and temporal aspects of the asylum procedures for Common European Asylum System (CEAS) refugees lead to slow integration, while Ukrainians under TPD work immediately and can build connections in Dutch society.

Cost-Effective Target Capacity Assessment in the Energy Transition: The Italian Methodology

Long-term transmission expansion planning has to face the energy transition in a restructured electricity market environment. Increased transmission capacity within and between Member States is likely to play an essential role in maintaining the secure and economic operation of the whole European power system and ensuring the integration of growing renewable generation. This paper proposes a novel iterative methodology aimed at assessing an optimal level of interconnection between relevant bidding zones, simultaneously investigating different potential alternatives. Starting from a reference grid, a multi-criteria analysis is adopted to select the additional transmission capacities to be tested in each iteration via network and market simulations in order to confirm that transmission expansion benefits outweigh the estimated realization costs. The proposed approach is applied to the Italian case in two contrasting energy scenarios for the mid-term 2030 and very-long-term 2040 horizons: different development strategies are derived, and the least regret criterion is applied to define the most cost-effective as the target development strategy for the Transmission System Operator (TSO). Furthermore, sensitivity analyses on relevant input data variation are performed to test the robustness of the results obtained.

The usage of genetic algorithms when planning railway transportation in international connection

The railway transport system in Ukraine stands as a pivotal sector within the nation's transportation infrastructure, accounting for a substantial portion of freight and passenger movement compared to domestic alternative modes of transportation. With direct border connections and collaboration with railways in Moldova, Poland, Romania, Slovakia, and Hungary, Ukrzaliznytsia JSC facilitate operations through forty international railway crossings. The political climate in Ukraine, particularly the focus on export to EU countries, has sparked increased interest in transportation towards western border regions [1, 2]. This article delves into the challenges and opportunities surrounding the enhanced cooperation of Ukrainian border terminals with EU countries during wartime and post-war periods. It analyzes the current state of freight transportation to Europe, addressing existing challenges and outlining short- and long-term development prospects for railways. Emphasis is made on the vital role of railway transport in Ukraine's integration into the European transport network, presenting avenues for implementing plans connected with railway reconstruction and development. Container transportation commands a significant market share, with a growing trend towards its adoption. Container transport facilitates a substantial reduction in loading operations, a notable increase in labor productivity, and enables comprehensive mechanization and automation of cross-docking operations. As a transit country—four out of ten existing pan-European transport corridors traverse Ukraine— the nation possesses considerable potential for developing its railway transport system. With the third-largest railway network in Europe (19,787 km, including 9,319 km of electrified tracks), railway transport assumes a leading role in Ukraine's transportation landscape. However, despite its advantages, Ukraine's transportation and logistics system lags behind those of other countries worldwide. Modernization of tracks and rolling stock necessitates significant capital investment and time, underscoring the immediate need to enhance the quality of logistics services [3]. Therefore, this article explores optimization methods for container traffic from Ukraine to EU countries with the use of mathematical methods and algorithms. The genetic algorithm among the discussed methods is recognized as one of the premier mathematical algorithms for the specified task. This approach could play a pivotal role in establishing a robust technical system for railways along Ukraine's western border, optimizing border crossing operations, and enhancing Ukrainian railway transportation capabilities. It not only aids in identifying the fastest or most economical routes but reveals weaknesses in Ukrainian border terminals. Additional strategies can be devised for modernizing and expanding border terminals and stations by leveraging this insight, facilitating the integration of Ukrainian railways into the European transport system.

Dissemination of extensively drug-resistant NDM-producing Providencia stuartii in Europe linked to patients transferred from Ukraine, March 2022 to March 2023

Background The war in Ukraine led to migration of Ukrainian people. Early 2022, several European national surveillance systems detected multidrug-resistant (MDR) bacteria related to Ukrainian patients. Aim To investigate the genomic epidemiology of New Delhi metallo-β-lactamase (NDM)-producing Providencia stuartii from Ukrainian patients among European countries. Methods Whole-genome sequencing of 66 isolates sampled in 2022–2023 in 10 European countries enabled whole-genome multilocus sequence typing (wgMLST), identification of resistance genes, replicons, and plasmid reconstructions. Five bla NDM-1-carrying-P. stuartii isolates underwent antimicrobial susceptibility testing (AST). Transferability to Escherichia coli of a bla NDM-1-carrying plasmid from a patient strain was assessed. Epidemiological characteristics of patients with NDM-producing P. stuartii were gathered by questionnaire. Results wgMLST of the 66 isolates revealed two genetic clusters unrelated to Ukraine and three linked to Ukrainian patients. Of these three, two comprised bla NDM-1-carrying-P. stuartii and the third bla NDM-5-carrying-P. stuartii. The bla NDM-1 clusters (PstCluster-001, n = 22 isolates; PstCluster-002, n = 8 isolates) comprised strains from seven and four countries, respectively. The bla NDM-5 cluster (PstCluster-003) included 13 isolates from six countries. PstCluster-001 and PstCluster-002 isolates carried an MDR plasmid harbouring bla NDM-1, bla OXA-10, bla CMY-16, rmtC and armA, which was transferrable in vitro and, for some Ukrainian patients, shared by other Enterobacterales. AST revealed PstCluster-001 isolates to be extensively drug-resistant (XDR), but susceptible to cefiderocol and aztreonam–avibactam. Patients with data on age (n = 41) were 19–74 years old; of 49 with information on sex, 38 were male. Conclusion XDR P. stuartii were introduced into European countries, requiring increased awareness and precautions when treating patients from conflict-affected areas.

Prediction of 30‐day mortality after surgery for infective endocarditis using risk scores: Insights from a European multicenter comparative validation study

BackgroundIt remains unclear today whether risk scores created specifically to predict early mortality after cardiac operations for infective endocarditis (IE) outperform or not the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II). MethodsPerioperative data and outcomes from a European multicenter series of patients undergoing surgery for definite IE were retrospectively reviewed. Only the cases with known pathogen and without missing values for all considered variables were retained for analyses. A comparative validation of EuroSCORE II and five specific risk scores for early mortality after surgery for IE – (1) STS-IE (Society of Thoracic Surgeons for IE); (2) PALSUSE (Prosthetic valve, Age ≥70, Large intra-cardiac destruction, Staphylococcus spp, Urgent surgery, Sex (female), EuroSCORE ≥10); (3) ANCLA (Anemia, New York Heart Association class IV, Critical state, Large intra-cardiac destruction, surgery on thoracic Aorta); (4) AEPEI II (Association pour l’Étude et la Prévention de l'Endocardite Infectieuse II); (5) APORTEI (Análisis de los factores PROnósticos en el Tratamiento quirúrgico de la Endocarditis Infecciosa) – was carried out using calibration plot and receiver-operating characteristic curve analysis. Areas under the curve (AUCs) were compared 1:1 according to the Hanley-McNeil's method. The agreement between APORTEI score and EuroSCORE II of the 30-day mortality prediction after surgery was also appraised. ResultsA total of 1,012 patients from five European university-affiliated centers underwent 1,036 cardiac operations, with a 30-day mortality after surgery of 9.7%. All IE-specific risk scores considered achieved better results than EuroSCORE II in terms of calibration; AEPEI II and APORTEI score showed the best performances. Despite poor calibration, EuroSCORE II overcame in discrimination every specific risk score (AUC, 0.751 vs. 0.693 or less, p=0.01 or less). For a higher/lesser than 20% expected mortality, the agreement of prediction between APORTEI score and EuroSCORE II was 86%. ConclusionEuroSCORE II discrimination for 30-day mortality after surgery for IE was higher than five established IE-specific risk scores. AEPEI II and APORTEI score showed the best results in terms of calibration.

Revolving doors in Europe: does hiring from the public sector facilitate access?

Abstract In recent years, the movement of personnel from the public sector to interest groups has garnered considerable attention throughout Europe. Consequently, there has been an increased focus on the phenomenon of revolving door lobbyists within academic literature. This research contributes to this scholarly discussion by examining how the employment of such lobbyists facilitates access. We argue that interest groups gain advantages by recruiting individuals from the public sector in policy domains with limited mobilization, but this benefit decreases as more interest groups mobilize. Our analysis of survey data from seven European political systems supports these expectations, indicating that recruiting professionals with experience in the public sector enhances access, especially in policy areas with minimal lobbying activity. This highlights the potential for interest mobilization to counterbalance the advantages of hiring revolving door lobbyists.

Econometric Analysis of the Influence of Factors on the Share of Energy From Renewable Sources in the EU

The use of renewable energy is at the core of EU energy policy, reducing dependence on fossil fuels imported from non-EU countries, reducing greenhouse gas emissions and decoupling energy costs from oil prices. Currently, 22.5% of energy consumed in the EU comes from renewable sources. This increase over 2021 is due to strong growth in solar energy. This share is also increasing due to the consumption of non-renewable energy sources in 2022. According to expert forecasts, the share of renewable energy sources in Europe will continue to grow. Achieving the 42.5% target by 2030 will require a deep transformation of the European energy system. The very strong climate and energy policies pursued in the EU for about a dozen years and aimed at limiting emissions of harmful substances into the environment have led to a gradual abandonment of traditional energy sources. Increasing demand for energy while reducing its supply from traditional sources means that in order not to make the economy too dependent on energy imports, the dynamic development of renewable energy is necessary. The EU is therefore taking very extensive operational and strategic actions to use other sources for production, such as wind, solar energy, mechanical water energy, biomass and geothermal energy, as well as tidal waves, ocean heat, wave energy and sea currents. In this study, we assess the impact of energy, economic and environmental factors on the share of renewable energy in the EU. The aim of these studies was to identify the energy, economic and environmental indicators that have the greatest impact on the share of energy from renewable sources in the European Union. The study was conducted using the Statgraphics Centurion software package. The source data for the study was data from the official Eurostat website for the period from 2012 to 2022. The results of this study show that changes in gross domestic product in market prices per capita have a positive impact, as do changes in greenhouse gas emissions per capita negatively affect the share of energy from renewable sources in the EU in the period 2012-2022. This may most likely be due to the fact that EU countries are more likely to invest in renewable energy as they can afford to invest in the development of expensive renewable energy technologies and support subsidies for the promotion and regulation of renewable energy. The negative impact of per capita greenhouse gas emissions on renewable energy development is due to the high share of coal in the EU energy mix, meaning that coal not only has negative environmental impacts, but also negative environmental impacts. development of renewable energy.

EU Energy Securitisation: Ukraine's Place in the European Energy System

This article focuses on the investigation of the European Union's securitisation policy in the energy sector, in particular, the provision of energy carriers to the Union, which was developed in response to Russia's energy wars of 2006–2007 and 2008–2009 against Ukraine and indirectly against the European Union. The theory of securitisation, formulated by S. Ozkan, B. Buzan and other researchers, focuses not so much on eliminating the consequences of crises as on creating a system of securitisation for the relevant industries with increased stress resistance, diversification of economic and technological ties with partners and strengthening the social orientation of their functioning. The algorithmization of this policy and the changes that led to the institutional response to Russian aggression in the energy sector are investigated. The research is based on the approach of sociological (neo)institutionalism, which allows explaining political processes in terms of not only economic benefits, but also their importance for the development of other spheres of public life and international cooperation. This approach is based on the notion that, first, the institutional environment in which a particular institution operates provides it with the necessary resources, as well as legitimates and regulates its activities. As a result, sociological institutionalism emphasises the role of norms, rules, and culture, influencing the self-identification of actors associated with this institution, as well as defining „friends” and „foes” in the overall institutional structure. It is shown that changes in the EU energy policy are dictated not only by economic or technological considerations, but also by the requirement to meet the needs of the population and economy of the EU member states. At the same time, Ukraine's inclusion in the EU's common securitisation system is in the economic, political, and social interests of Ukraine, which, both under the Association Agreement and in the event of its accession to the EU, will have the status of an acceptor country. The article considers possible options for the EU and Ukraine to establish Ukraine as the EU's eastern securitizer and their respective consequences for both parties.

Sternum-sparing multivessel coronary surgery as a routine procedure: Midterm results of total coronary revascularization via left anterior thoracotomy

ObjectiveA sternum-sparing approach of minimally invasive total coronary revascularization via left anterior thoracotomy demonstrated promising early outcomes in unselected patients with coronary artery multivessel disease. Follow-up data are still missing. MethodsFrom November 2019 to September 2023, coronary artery bypass grafting via left anterior minithoracotomy on cardiopulmonary bypass and cardioplegic cardiac arrest was performed as a routine procedure in 392 consecutive, nonemergency patients (345 men; 67.0 ± 9.9 years; range, 32-88 years). All patients had multivessel coronary artery disease (77.6% 3-vessel-disease, 22.4% 2-vessel-disease, and 32.9% left main stenosis). Patients at old age (older than a 80 years, 12.5%), with severe left ventricular dysfunction (ejection fraction <30%, 7.9%), diabetes mellitus (34.9%), massive obesity (body mass index > 35, 8.9%), and chronic lung disease (17.1%) were included. Mean European System for Cardiac Operative Risk Evaluation II score was 2.9 ± 2.8. Mean midterm follow-up (100%) was 15.2 ± 10.7 months (range, 0.1-39.5 months). ResultsLeft internal thoracic artery (99.0%), radial artery (70.4%), and saphenous vein grafts (57.4%) were used, and 70.4% of patients received at least 2 arterial grafts. A total of 3.0 ± 0.8 anastomoses (range, 2-5 anastomoses) per patient were performed to revascularize the territories of left anterior descending (98.7%), circumflex (91.6%), and right coronary (70.9%) artery. Complete anatomical revascularization was achieved in 95.1%. At follow-up, all-cause-mortality, myocardial infarction, repeat revascularization, and stroke was 3.1%, 1.5%, 5.4%, and 0.7%, respectively. Overall major adverse cardiac and cerebrovascular events rate was 8.7%. ConclusionsThis is the first report of midterm follow-up after routine sternum-sparing total coronary revascularization via left anterior thoracotomy for multivessel coronary artery disease with a high rate of multiple arterial grafting and complete anatomical revascularization. Outcome was favorable and similar to that of contemporary conventional coronary artery bypass grafting.