Статті в журналах: "Patient monitoring Victoria Equipment and supplies"

1

Gaievskyi, Stanislav, and Colin Meghoo. "Availability of Essential Medical Equipment for Prehospital Trauma Care on Public Ambulances in Ukraine." Prehospital and Disaster Medicine 34, s1 (May 2019): s104. http://dx.doi.org/10.1017/s1049023x19002164.

Повний текст джерела

Анотація:

Introduction:The public ambulance system in Ukraine is the primary deliverer of prehospital care for trauma patients in this Eastern European country, but no national assessment has previously been made to ensure the presence of essential medical equipment on these ambulances.Aim:Working with the Ukraine Ministry of Health, our aim was to assess the availability of public ambulances of medical equipment essential for managing traumatic injury using an internationally recognized standard for prehospital care.Methods:We identified 53 Advanced Life Support (ALS) ambulances from randomly selected cities for evaluation. We performed an inventory of available medical equipment and supplies on these ambulances against a matrix of essential equipment for prehospital providers developed by the World Health Organization (WHO).Results:Essential medical equipment in the categories of personal protection, patient monitoring, hemorrhage control, and immobilization were generally available in the ALS public ambulances surveyed. Deficiencies were noted in equipment and supplies for basic and advanced airway monitoring and management.Discussion:Public ALS ambulances across Ukraine are adequately equipped with many essential medical supplies to manage traumatic injury, but have deficiencies in both basic and advanced airway management. Correcting these deficiencies may improve prehospital survival of the traumatically injured patient. The results of this study will enable the Ukraine Ministry of Health to develop requirements of essential medical equipment for all public ALS ambulances in the country, to inform resource allocation decisions, and to guide public health policy regarding prehospital trauma care.

Стилі APA, Harvard, Vancouver, ISO та ін.

2

Peevy, Keith J., and Michael W. Hall. "Transcutaneous Oxygen Monitoring: Economic impact on Neonatal Care." Pediatrics 75, no. 6 (June 1, 1985): 1065–67. http://dx.doi.org/10.1542/peds.75.6.1065.

Повний текст джерела

Анотація:

Five years (1978 to 1982) of respiratory care data were reviewed to determine the changes in patient charges, hospital costs, and frequency of neonatal blood gas analysis created by the introduction of transcutaneous oxygen monitoring. During the 4 years of transcutaneous oxygen monitoring (1979 to 1982), an estimated $196,000 reduction in patient charges was accomplished. When reduced patient charges were balanced with the increased cost to the hospital for equipment, supplies, and personnel time, a net reduction of more than $100,000 for health care delivery was achieved. Transcutaneous oxygen monitoring is an example of technologic achievement in which society receives both economic and medical benefits.

Стилі APA, Harvard, Vancouver, ISO та ін.

3

Jones, Jessica, Katherine Bubric, Susan Biesbroek, and Jason Laberge. "Human Factors Guidelines for the Design of Mobile Medical Environments." Ergonomics in Design: The Quarterly of Human Factors Applications 26, no. 3 (January 16, 2018): 9–16. http://dx.doi.org/10.1177/1064804617744975.

Повний текст джерела

Анотація:

Mobile medical environments, such as ground and air ambulances, have unique design challenges that can affect safe and effective patient care. Members of a provincial human factors department completed five evaluation projects on the interior design of these environments, resulting in the generation of more than 250 design recommendations. An inductive content analysis informed the development of a list of human factors guidelines for designing various mobile medical environments. Guidelines address equipment and supplies, patient visibility and monitoring, practitioner and patient comfort and ergonomics, communication, and working in motion.

Стилі APA, Harvard, Vancouver, ISO та ін.

4

Van Vooren, Steven, James Grayson, Marc Van Ranst, Elisabeth Dequeker, Lies Laenen, Reile Janssen, Laurent Gillet, et al. "Reliable and Scalable SARS-CoV-2 qPCR Testing at a High Sample Throughput: Lessons Learned from the Belgian Initiative." Life 12, no. 2 (January 21, 2022): 159. http://dx.doi.org/10.3390/life12020159.

Повний текст джерела

Анотація:

We present our approach to rapidly establishing a standardized, multi-site, nation-wide COVID-19 screening program in Belgium. Under auspices of a federal government Task Force responsible for upscaling the country’s testing capacity, we were able to set up a national testing initiative with readily available resources, putting in place a robust, validated, high-throughput, and decentralized qPCR molecular testing platform with embedded proficiency testing. We demonstrate how during an acute scarcity of equipment, kits, reagents, personnel, protective equipment, and sterile plastic supplies, we introduced an approach to rapidly build a reliable, validated, high-volume, high-confidence workflow based on heterogeneous instrumentation and diverse assays, assay components, and protocols. The workflow was set up with continuous quality control monitoring, tied together through a clinical-grade information management platform for automated data analysis, real-time result reporting across different participating sites, qc monitoring, and making result data available to the requesting physician and the patient. In this overview, we address challenges in optimizing high-throughput cross-laboratory workflows with minimal manual intervention through software, instrument and assay validation and standardization, and a process for harmonized result reporting and nation-level infection statistics monitoring across the disparate testing methodologies and workflows, necessitated by a rapid scale-up as a response to the pandemic.

Стилі APA, Harvard, Vancouver, ISO та ін.

5

Furlanetto, Denise de Lima Costa, Wallace Dos Santos, Magda Duarte dos Anjos Scherer, Fabrício Vieira Cavalcante, Aimê Oliveira, Klébya Hellen Dantas de Oliveira, Ricardo Ramos dos Santos, Thaís Alessa Leite, Katia Crestine Poças, and Leonor Maria Pacheco Santos. "Structure and responsiveness: are Primary Health Care Units prepared to face COVID-19?" Saúde em Debate 46, no. 134 (2022): 630–47. http://dx.doi.org/10.1590/0103-1104202213403.

Повний текст джерела

Анотація:

ABSTRACT The COVID-19 pandemic reinforced the need for global efforts to grant universal health coverage and access, which imposes management challenges for Primary Health Care (PHC). This study aimed to develop and apply an instrument to assess the PHC Units’ responsiveness to COVID-19, based on co-production efforts between university researchers and PHC technical teams. The instrument composed of two modules, included identification, operating hours, workforce, work process, structure, equipment, furniture, supplies, Personal Protection Equipment (PPE), Symptomatic Respiratory Patient (SRP) examinations and follow-up, information, surveillance, integration, communication, and management. All the 165 PHC Units in Brasília were invited to complete the instrument. Main results: there was physical structure adaptation (adequate configuration of waiting rooms, internal and external spaces allowing safe distance); provision of PPE and COVID-19 tests; active search for SRP/COVID-19 suspects by phone, mobile or home visits; monitoring flows of patient transfer and telehealth implementation. In conclusion, the PHC Units reorganized their services to meet the demands of the pandemic context. Providing information about structure and responsiveness of PHC Units may subside health systems for planning and decision-making at different levels of management, which is crucial to determine strategies to empower and reinforce PHC responsivity in situations of pandemics and other calamities.

Стилі APA, Harvard, Vancouver, ISO та ін.

6

Eom, Joong Sik. "What is the Fee for Infection Prevention and Control? Current Status and Prospect." Korean Journal of Medicine 97, no. 4 (August 1, 2022): 199–203. http://dx.doi.org/10.3904/kjm.2022.97.4.199.

Повний текст джерела

Анотація:

Infection control is an essential factor for improving the quality of acute and long-term care facilities, including patient safety. Infection control should be implemented in all medical facility sectors, and participation of all healthcare workers is required. For efficient infection control, securing and maintaining professionals with sufficient experience and training to establish and implement infection control plans focusing the infection control unit is imperative. Moreover, there should be no shortage of infection control supplies, including consumables and disposables necessary for hand hygiene, personal protective equipment, and isolation. The fee for infection prevention and control should be resourced as necessary funding to establish such infection control infrastructure. Moreover, re-evaluating whether the standard for the fee for infection prevention and control is appropriate, improving the current payment mode, and monitoring whether the fee used is executed as infection control costs are necessary.

Стилі APA, Harvard, Vancouver, ISO та ін.

7

Nedelea, Paul Lucian, Tudor Ovidiu Popa, Emilian Manolescu, Catalin Bouros, Gabriela Grigorasi, Doru Andritoi, Catalin Pascale, Avramescu Andrei, and Diana Carmen Cimpoesu. "Telemedicine System Applicability Using Drones in Pandemic Emergency Medical Situations." Electronics 11, no. 14 (July 10, 2022): 2160. http://dx.doi.org/10.3390/electronics11142160.

Повний текст джерела

Анотація:

Drones have evolved significantly in recent years, acquiring greater autonomy and carrier capacity. Therefore, drones can play a substantial role in civil medicine, especially in emergency situations or for the detection and monitoring of disease spread, such as during the COVID-19 pandemic. The aim of this paper is to present the real possibilities of using drones in field rescue operations, as well as in nonsegregated airspace, in order to obtain solutions for monitoring activities and aerial work in support of the public health system in crisis situations. The particularity of our conceptual system is the use of a “swarm” of fast drones for aerial reconnaissance that operate in conjunction, thus optimizing both the search and identification time while also increasing the information area and the operability of the system. We also included a drone with an RF relay, which was connected to a hub drone. If needed, a carrier drone with medical supplies or portable devices can be integrated, which can also offer two-way audio and video communication capabilities. All of these are controlled from a mobile command center, in real time, connected also to the national dispatch center to shorten the travel time to the patient, provide support with basic but life-saving equipment, and offer the opportunity to access remote or difficult-to-reach places. In conclusion, the use of drones for medical purposes brings many advantages, such as quick help, shortened travel time to the patient, support with basic but life-saving equipment, and the opportunity to access remote or difficult-to-reach places.

Стилі APA, Harvard, Vancouver, ISO та ін.

8

Azizi Farsani, Hamidreza, Faranak Behnaz, Zahra Azizi Farsani, and Shayesteh Khorasanizadeh. "Regional anesthesia during COVID-19 pandemic: A minireview and practical recommendations." Journal of Shahrekord University of Medical Sciences 24, no. 1 (January 26, 2022): 42–46. http://dx.doi.org/10.34172/jsums.2022.08.

Повний текст джерела

Анотація:

Background and aims: Coronavirus disease 2019 (COVID-19) has posed many challenges for healthcare workers around the world. This study aims to present the most appropriate and evidence-based scientific advice for safe regional anesthesia practice during the COVID-19 pandemic. Methods: To perform regional anesthesia during respiratory disease outbreaks, several databases were investigated, including PubMed, Google Scholar, Up-to-date, and ScienceDirect. Searches were in English during a timeframe spanning from February 15, 2019, until February 15, 2021, and the applied keywords were "COVID-19 anesthesia", "surgery", and "operating room" Results: We have focused on definite areas such as workforce and resource planning, modification of clinical setting, preparation of equipment, supplies, and medications, selection of proper personal protective equipment (PPE), cardiorespiratory monitoring of the patient, and sedation and oxygen therapy. Other fields were assessing safe regional anesthesia techniques and monitoring during anesthesia, post-anesthesia care, and follow-ups. In these recommendations, keeping the patients safe while protecting healthcare providers from potential exposure to infection is of particular interest. Conclusion: The safety of healthcare workers and patients during the anesthesia management of suspected and positive COVID-19 cases is of utmost importance. Although there is limited evidence regarding performing regional anesthesia, these presented suggestions summarize the best accessible data and explain some doubts in this respect.

Стилі APA, Harvard, Vancouver, ISO та ін.

9

Korytkowski, Mary, Kellie Antinori-Lent, Andjela Drincic, Irl B. Hirsch, Marie E. McDonnell, Robert Rushakoff, and Ranganath Muniyappa. "A Pragmatic Approach to Inpatient Diabetes Management during the COVID-19 Pandemic." Journal of Clinical Endocrinology & Metabolism 105, no. 9 (June 4, 2020): 3076–87. http://dx.doi.org/10.1210/clinem/dgaa342.

Повний текст джерела

Анотація:

Abstract The pandemic of COVID-19 has presented new challenges to hospital personnel providing care for infected patients with diabetes who represent more than 20% of critically ill patients in intensive care units. Appropriate glycemic management contributes to a reduction in adverse clinical outcomes in acute illness but also requires intensive patient interactions for bedside glucose monitoring, intravenous and subcutaneous insulin administration, as well as rapid intervention for hypoglycemia events. These tasks are required at a time when minimizing patient interactions is recommended as a way of avoiding prolonged exposure to COVID-19 by health care personnel who often practice in settings with limited supplies of personal protective equipment. The purpose of this manuscript is to provide guidance for clinicians for reconciling recommended standards of care for infected hospitalized patients with diabetes while also addressing the daily realities of an overwhelmed health care system in many areas of the country. The use of modified protocols for insulin administration, bedside glucose monitoring, and medications such as glucocorticoids and hydroxychloroquine that may affect glycemic control are discussed. Continuous glucose monitoring systems have been proposed as an option for reducing time spent with patients, but there are important issues that need to be addressed if these are used in hospitalized patients. On-site and remote glucose management teams have potential to provide guidance in areas where there are shortages of personnel who have expertise in inpatient glycemic management.

Стилі APA, Harvard, Vancouver, ISO та ін.

10

Sickbert-Bennett, Emily, Kate Schultz, Lisa Teal, Lauren DiBiase, and David J. Weber. "529. Halting Multi-Modal Transmission of a Novel Carbapenemase-Producing Enterobacteriaceae Outbreak." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S254—S255. http://dx.doi.org/10.1093/ofid/ofz360.598.

Повний текст джерела

Анотація:

Abstract Background In January 2018, the first case of anOXA-48 carbapenem-resistant Klebsiella pneumoniae (OXA-48 CRKP) was identified in a North Carolina hospital in a patient arriving from Eastern Europe. Over the next year across multiple inpatient adult units, 14 patients had clinical isolates and 2 patients had positive rectal surveillance screens for OXA-48 CRKP. Methods Investigation activities to characterize the OXA-48 CRKP epidemiology included: >1000 rectal colonization screens of epidemiologically linked patients, chart reviews of infected and colonized patients, hand hygiene and environmental cleaning observations on affected units, environmental sampling to include endoscopes, sinks and toilets, and molecular analyses (pulsed-field gel electrophoresis and whole-genome sequencing). Results Molecular analyses confirmed a clonal outbreak. All environmental cultures including endoscope cultures performed were negative for OXA-48 CRKP. All cases were explained by at least one of three mechanisms: (1) time/space overlap on same unit (presumed lack of hand hygiene or contamination of shared patient equipment), (2) patient housed in room where previously infected patient was housed (presumed inadequate terminal disinfection/contaminated environment), or (3) a single upper gastrointestinal endoscope. Interventions included surveillance to identify and isolate colonized patients, discharge room cleaning of OXA-48 CRKP patients enhanced by ultraviolet light disinfection, curtain laundering, and discarding unused patient supplies, and monitoring and feedback for compliance with hand hygiene, cleaning, and use of personal protective equipment. A single endoscope used between multiple OXA-48 CRKP patients with no other known transmission link was quarantined upon identification, sterilized with ethylene oxide, and ultimately placed out of service. Conclusion A clonal outbreak of a novel carbapenemase-producing Enterobacteriaceae likely spread via multiple modes of transmission. The investigation was complicated by infrequent identification of colonization among patients epidemiologically linked to known cases. Multiple interventions based on epidemiological links were necessary to halt hospital-wide transmission. Disclosures All authors: No reported disclosures.

Стилі APA, Harvard, Vancouver, ISO та ін.

11

Ratansi, Nabeela, Aimee Langan, Irene Blais, Erin Svara, Karla Houser, Bronwen McCurdy, Jessica Moffatt, and Lori Elliott. "Moving toward patient-based funding through quality-based procedures (QBPs) for GI endoscopy and colposcopy." Journal of Clinical Oncology 32, no. 30_suppl (October 20, 2014): 43. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.43.

Повний текст джерела

Анотація:

43 Background: As part of the Ministry’s Health System Funding Reform initiative, Cancer Care Ontario is tasked to develop and implement Quality-Based Procedures (QBPs) for programs such as GI Endoscopy and Colposcopy. QBPs are clusters of patients with clinically related diagnoses or treatments that have been identified by an evidence-based framework as providing opportunity for improving quality outcomes and reducing costs. As stated by the Ministry, the goal is to reimburse providers for the types and numbers of patients treated, using evidence-informed rates associated with the quality of care delivered. Methods: QBPs are multiyear and have four key deliverables: Clinical: developing clinical best practices. Funding: tying best practices to pricing. Capacity Planning: understanding procedure types/volumes for capacity management. Monitoring/Evaluation: measuring the QBP’s impact. Developing the QBPs has involved: Creating Clinical Expert Advisory Groups (CEAG) of clinicians who are recognized for their knowledge and expertise. Tasking the CEAG to define quality and develop best practices informed by literature reviews, jurisdictional scans, and guidelines. Documenting these standards and clinical pathways in a clinical handbook, providing information on the practices that should be implemented to ensure consistent care delivery. The development of best practices is imperative to the foundation of the QBP and spans multiple years. Once best practice development is complete, it will be tied to pricing, where the procedure will be micro-costed based on workload, equipment, supplies, and other administrative costs. Results: The QBPs continue to evolve and aim to: Reduce practice variation. Improve patient outcomes. Improve system accountability. Improve cost-effectiveness of services. Effectiveness will be measured through a performance management framework, including an integrated QBP scorecard measuring appropriateness, access, and efficiency. Conclusions: The underpinning for moving towards an evidence-based, patient-based funding model involves defining quality standards and clincal best practices, and applying these guidelines to determine the cost of quality care.

Стилі APA, Harvard, Vancouver, ISO та ін.

12

Patel, Leena N., Samantha Kozikott, Rodrigue Ilboudo, Moreen Kamateeka, Mohammed Lamorde, Marion Subah, Fatima Tsiouris, Anna Vorndran, and Christopher T. Lee. "Safer primary healthcare facilities are needed to protect healthcare workers and maintain essential services: lessons learned from a multicountry COVID-19 emergency response initiative." BMJ Global Health 6, no. 6 (June 2021): e005833. http://dx.doi.org/10.1136/bmjgh-2021-005833.

Повний текст джерела

Анотація:

Healthcare workers (HCWs) are at increased risk of infection from SARS-CoV-2 and other disease pathogens, which take a disproportionate toll on HCWs, with substantial cost to health systems. Improved infection prevention and control (IPC) programmes can protect HCWs, especially in resource-limited settings where the health workforce is scarcest, and ensure patient safety and continuity of essential health services. In response to the COVID-19 pandemic, we collaborated with ministries of health and development partners to implement an emergency initiative for HCWs at the primary health facility level in 22 African countries. Between April 2020 and January 2021, the initiative trained 42 058 front-line HCWs from 8444 health facilities, supported longitudinal supervision and monitoring visits guided by a standardised monitoring tool, and provided resources including personal protective equipment (PPE). We documented significant short-term improvements in IPC performance, but gaps remain. Suspected HCW infections peaked at 41.5% among HCWs screened at monitored facilities in July 2020 during the first wave of the pandemic in Africa. Disease-specific emergency responses are not the optimal approach. Comprehensive, sustainable IPC programmes are needed. IPC needs to be incorporated into all HCW training programmes and combined with supportive supervision and mentorship. Strengthened data systems on IPC are needed to guide improvements at the health facility level and to inform policy development at the national level, along with investments in infrastructure and sustainable supplies of PPE. Multimodal strategies to improve IPC are critical to make health facilities safer and to protect HCWs and the communities they serve.

Стилі APA, Harvard, Vancouver, ISO та ін.

13

Kusoski, Carolyn, Jennifer Booth, Stephanie Salch, Harrison Jozefczyk, and Julie Kennerly-Shah. "Costs associated with United States pharmacopeia compliant infusion clinics." Journal of Oncology Pharmacy Practice 28, no. 1 (October 14, 2021): 141–48. http://dx.doi.org/10.1177/10781552211048871.

Повний текст джерела

Анотація:

Purpose As costs continue to rise in oncology, a strategy that has been implemented to limit these costs is use of alternative sites of care. However, there are differences in regulatory standards between common sites of care such as freestanding infusion clinics and hospital outpatient departments. The costs associated with United States Pharmacopeia compliance were evaluated in order to better understand the cost of universally compliant hospital outpatient departments. Methods Annual operational costs associated with United States Pharmacopeia compliance were estimated for a 30-chair infusion clinic with United States Pharmacopeia <797> and <800> pharmacy cleanrooms for non-hazardous and hazardous drugs, respectively. Annual United States Pharmacopeia compliance costs included: competency assessments, personal protective equipment, closed system transfer devices, labels, cleaning supplies, and environmental monitoring. One-time costs included initial cleanroom construction and renovations. Published information and benchmarks provided baseline assumptions for patient volume, staffing, and unit costs. If no published data was available, prices were estimated based on a similarly sized clinic. Results Recurring annual costs for a 30-chair fully compliant infusion clinic were calculated to be $785,207. One-time costs associated with initial construction and renovations were estimated to be $1,365,207–$1,535,207 and $965,207–$1,005,207, respectively. Conclusions Costs associated with increased operational oversight and regulatory standards are a major contributing factor to the facility fee of hospital outpatient departments. Ultimately, all sites of care share in the goal to provide optimal patient care while considering all aspects of patient care, including cost. Therefore, a move towards consistent regulatory standards across all settings would aid in preventing discrepancies in care.

Стилі APA, Harvard, Vancouver, ISO та ін.

14

Crist, Matthew B., John R. McQuiston, Maroya Spalding Walters, Elizabeth Soda, Heather Moulton-Meissner, Ainsley Nicholson, and Kiran Perkins. "868. Investigations of Healthcare-Associated Elizabethkingia Infections – United States, 2013-2019." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S472. http://dx.doi.org/10.1093/ofid/ofaa439.1057.

Повний текст джерела

Анотація:

Abstract Background Elizabethkingia (EK) are non-motile gram-negative rods found in soil and water and are an emerging cause of healthcare-associated infections (HAIs). We describe Centers for Disease Control and Prevention (CDC) consultations for healthcare-associated EK infections and outbreaks. Methods CDC maintains records of consultations with state or local health departments related to HAI outbreaks and infection control breaches. We reviewed consultations involving EK species as the primary pathogen of concern January 1, 2013 to December 31, 2019 and summarized data on healthcare settings, infection types, laboratory analysis, and control measures. Results We identified 9 consultations among 8 states involving 73 patient infections. Long-term acute-care hospitals (LTACHs) accounted for 4 consultations and 32 (43%) infections, and skilled nursing facilities with ventilated patients (VSNFs) accounted for 2 consultations and 31 (42%) infections. Other settings included an acute care hospital, an assisted living facility, and an outpatient ear, nose, and throat clinic. Culture sites included the respiratory tract (n=7 consultations), blood (n=4), and sinus tract (n=1), and E. anophelis was the most commonly identified species. Six consultations utilized whole genome sequencing (WGS); 4 identified closely related isolates from different patients and 2 also identified closely related environmental and patient isolates. Mitigation measures included efforts to reduce EK in facility water systems, such as the development of water management plans, consulting water management specialists, flushing water outlets, and monitoring water quality, as well as efforts to minimize patient exposure such as cleaning of shower facilities and equipment, storage of respiratory therapy supplies away from water sources, and use of splash guards on sinks. Conclusion EK is an important emerging pathogen that causes HAI outbreaks, particularly among chronically ventilated patients. LTACHs and VSNFs accounted for the majority of EK consultations and patient infections. Robust water management plans and infection control practices to minimize patient exposure to contaminated water in these settings are important measures to reduce infection risk among vulnerable patients. Disclosures All Authors: No reported disclosures

Стилі APA, Harvard, Vancouver, ISO та ін.

15

Payne, K. A., M. P. Desrosiers, I. Proskorovsky, K. Ishak, N. Lordan, and J. F. Baladi. "Total Annual Costs of Infused Iron Chelation Therapy in the United States." Blood 108, no. 11 (November 16, 2006): 3359. http://dx.doi.org/10.1182/blood.v108.11.3359.3359.

Повний текст джерела

Анотація:

Abstract Background: Patients suffering from thalassemia or sickle cell disease (SCD) who are undergoing chronic blood transfusions are at risk for iron overload which, if not treated by iron chelation therapy (ICT), can create serious organ damage and reduce life expectancy. Deferoxamine (DFO), an ICT agent, has to be infused for 8–10 hours, 5–7 times a week. Although the clinical need for ICT is clearly established, less is known about the economic burden of DFO treatment. Aim: To estimate the total annual costs of DFO ICT by identifying resource utilization and compliance data from medical chart reviews and patient interviews, supplemented by the medical literature. Methods: A naturalistic cohort study of the resource utilization and quality of life burden of infused ICT in the usual care setting (acute hospital and out-patient) was conducted in four US treatment centers between September and December 2005. A total of 49 patients (40 thalassemia; 9 SCD; 50% male; mean age 28 ± 10 years) undergoing infused ICT participated. Data from patients’ initial and most recent years of ICT, related to prescribed ICT regimens, infusions performed in a health care setting, and monitoring, were abstracted from the charts. In patient interviews, compliance to ICT as well as resource utilization related to ICT equipment, supplies and home delivery were queried. To supplement data not otherwise obtained from the study, a review of the literature was also performed. Unit costs (2004/2005 USD) were applied. Results: The estimated mean weighted annual cost was $70 for ICT home delivery, $3,293 for equipment, $562 for monitoring and $7,232 for home health care. The mean weighted annual cost for in-patient infusions were estimated at $6,222 for the initial year and at $1,766 for subsequent years of ICT administration. The annual per patient mean cost of the drug alone, adjusted for compliance, ranged from $9,060 to $18,857 (when drug used as prescribed: $9,060 to $25,691) depending on the age and weight of the patient (mean weighted annual cost: $17,081 when adjusted by compliance and $23,466 when drug was used as prescribed). Thus, total mean weighted per patient treatment costs were estimated at $34,460 for the initial year and at $30,004 for subsequent years of ICT. When only ancillary costs were considered, the mean weighted cost per infusion for the initial year of ICT was estimated at $86 and at $64 for subsequent years. When home health care costs were excluded, the mean weighted ancillary costs per infusion were estimated at $50 for the initial year and at $28 for subsequent years of ICT. The total annual costs of infused ICT have likely been underestimated because treatment costs for the clinical consequences of poor adherence to DFO and lost productivity were not included. Conclusions: Cost estimates of ICT are higher in the initial year than in subsequent years of ICT. Total costs of ICT appear substantial and well exceed the cost of DFO alone. The drug cost only accounts for 34% to 77% of annual costs of DFO treatment (50% and 57% of total mean-weighted annual cost of initial and subsequent years of ICT respectively).

Стилі APA, Harvard, Vancouver, ISO та ін.

16

Hatzfeld, Jennifer J., George Hildebrandt, Joseph K. Maddry, Dario Rodriquez, Elizabeth Bridges, Anne C. Ritter, Cubby L. Gardner, Vikhyat S. Bebarta, and Andrew P. Cap. "Top 10 Research Priorities for U.S. Military En Route Combat Casualty Care." Military Medicine 186, no. 3-4 (February 26, 2021): e359-e365. http://dx.doi.org/10.1093/milmed/usaa480.

Повний текст джерела

Анотація:

ABSTRACT Introduction Within the Military Health System, the process of transporting patients from an initial point of injury and throughout the entire continuum of care is called “en route care.” A Committee on En Route Combat Casualty Care was established in 2016 as part of the DoD Joint Trauma System to create practice guidelines, recommend training standards, and identify research priorities within the military en route care system. Materials and Methods Following an analysis of currently funded research, future capabilities, and findings from a comprehensive scoping study, members of a sub-working group for research identified the top research priorities that were needed to better guide evidence-based decisions for practice and policy, as well as the future state of en route care. Results Based on the input from the entire committee, 10 en route care research topics were rank-ordered in the following manner: (1) medical documentation, (2) clinical decision support, (3) patient monitoring, (4) transport physiology, (5) transfer of care, (6) maintaining normothermia, (7) transport timing following damage control resuscitation or surgery, (8) intelligent tasking, (9) commander’s risk assessment, and (10) unmanned transport. Specific research questions and technological development needs were further developed by committee members in an effort to guide future research and development initiatives that can directly support operational en route care needs. The research priorities reflect three common themes, which include efforts to enhance or increase care provider capability and capacity; understand the impact of transportation on patient physiology; and increase the ability to coordinate, communicate, and facilitate patient movement. Technology needs for en route care must support interoperability of medical information, equipment, and supplies across the global military health system in addition to adjusting to a dynamic transport environment with the smallest possible weight, space, and power requirements. Conclusions To ensure an evidence-based approach to future military conflicts and other medical challenges, focused research and technological development to address these 10 en route care research gaps are urgently needed.

Стилі APA, Harvard, Vancouver, ISO та ін.

17

Laws, Edward R., Judith M. Wong, Timothy R. Smith, Kenneth de los Reyes, Linda S. Aglio, Alison J. Thorne, David J. Cote, Felice Esposito, Paolo Cappabianca, and Atul Gawande. "A checklist for endonasal transsphenoidal anterior skull base surgery." Journal of Neurosurgery 124, no. 6 (June 2016): 1634–39. http://dx.doi.org/10.3171/2015.4.jns142184.

Повний текст джерела

Анотація:

OBJECT Approximately 250 million surgical procedures are performed annually worldwide, and data suggest that major complications occur in 3%–17% of them. Many of these complications can be classified as avoidable, and previous studies have demonstrated that preoperative checklists improve operating room teamwork and decrease complication rates. Although the authors’ institution has instituted a general preoperative “time-out” designed to streamline communication, flatten vertical authority gradients, and decrease procedural errors, there is no specific checklist for transnasal transsphenoidal anterior skull base surgery, with or without endoscopy. Such minimally invasive cranial surgery uses a completely different conceptual approach, set-up, instrumentation, and operative procedure. Therefore, it can be associated with different types of complications as compared with open cranial surgery. The authors hypothesized that a detailed, procedure-specific, preoperative checklist would be useful to reduce errors, improve outcomes, decrease delays, and maximize both teambuilding and operational efficiency. Thus, the object of this study was to develop such a checklist for endonasal transsphenoidal anterior skull base surgery. METHODS An expert panel was convened that consisted of all members of the typical surgical team for transsphenoidal endoscopic cases: neurosurgeons, anesthesiologists, circulating nurses, scrub technicians, surgical operations managers, and technical assistants. Beginning with a general checklist, procedure-specific items were added and categorized into 4 pauses: Anesthesia Pause, Surgical Pause, Equipment Pause, and Closure Pause. RESULTS The final endonasal transsphenoidal anterior skull base surgery checklist is composed of the following 4 pauses. The Anesthesia Pause consists of patient identification, diagnosis, pertinent laboratory studies, medications, surgical preparation, patient positioning, intravenous/arterial access, fluid management, monitoring, and other special considerations (e.g., Valsalva, jugular compression, lumbar drain, and so on). The Surgical Pause is composed of personnel introductions, planned procedural elements, estimation of duration of surgery, anticipated blood loss and fluid management, imaging, specimen collection, and questions of a surgical nature. The Equipment Pause assures proper function and availability of the microscope, endoscope, cameras and recorders, guidance systems, special instruments, ultrasonic microdoppler, microdebrider, drills, and other adjunctive supplies (e.g., Avitene, cotton balls, nasal packs, and so on). The Closure Pause is dedicated to issues of immediate postoperative patient disposition, orders, and management. CONCLUSIONS Surgical complications are a considerable cause of death and disability worldwide. Checklists have been shown to be an effective tool for reducing preventable errors surrounding surgery and decreasing associated complications. Although general checklists are already in place in most institutions, a specific checklist for endonasal transsphenoidal anterior skull base surgery was developed to help safeguard patients, improve outcomes, and enhance teambuilding.

Стилі APA, Harvard, Vancouver, ISO та ін.

18

Estrela, Vania V. "SDR-Based High-Definition Video Transmission for Biomedical Engineering." Medical Technologies Journal 4, no. 3 (December 7, 2020): 584–85. http://dx.doi.org/10.26415/2572-004x-vol4iss3p584-585.

Повний текст джерела

Анотація:

Background: Software-Defined Radio (SDR) frameworks from cellular telephone base stations, e.g., Multiservice Distributed Access System (MDAS) and small cells, employ extensively integrated RF agile transceivers. The Internet of Medical Things (IoMT) is the collection of medical devices and applications that connect to healthcare IT systems through online computer networks. Medical devices equipped with Wi-Fi allow M2M communication, which is the backbone of IoMT and associated devices linked to cloud platforms containing stored data to be analyzed. Examples of IoMT include remote patient monitoring of people with chronic or long-term conditions, tracking patient medication orders and the location of patients admitted to hospitals, and patients' wearables to send info to caregivers. Infusion pumps connected to dashboards and hospital beds rigged with sensors measuring patients' vital signs are medical devices that can be converted to or deployed as IoMT technology. Methods: This work proposes an SDR architecture to allow wireless High-Definition (HD) video broadcast for biomedical applications. This text examines a Wideband Wireless Video (WWV) signal chain implementation using the transceivers, the data transmitted volume, the matching occupied RF bandwidth, the communication distance, the transmitter’s power, and the implementation of the PHY layer as Orthogonal Frequency Division Multiplexing (OFDM) with test results to evade RF interference. Results: As the IoMT grows, the amount of possible IoMT uses increases. Many mobile devices employ Near Field Communication (NFC) Radio Frequency Identification (RFID) tags allowing them to share data with IT systems. RFID tags in medical equipment and supplies allow hospital staff can remain aware of the quantities they have in stock. The practice of using IoMT devices to observe patients in their homes remotely is also known as telemedicine. This kind of treatment spares patients from traveling to healthcare facilities whenever they have a medical question or change in their condition. Conclusion: An SDR-based HD biomedical video transmission is proposed, with its benefits and disadvantages for biomedical WWV are discussed. The security of IoMT sensitive data is a developing concern for healthcare providers.

Стилі APA, Harvard, Vancouver, ISO та ін.

19

Howanitz, Peter J., and Bruce A. Jones. "Comparative Analytical Costs of Central Laboratory Glucose and Bedside Glucose Testing: A College of American Pathologists Q-Probes Study." Archives of Pathology & Laboratory Medicine 128, no. 7 (July 1, 2004): 739–45. http://dx.doi.org/10.5858/2004-128-739-cacocl.

Повний текст джерела

Анотація:

Abstract Context.—One of the major attributes of laboratory testing is cost. Although fully automated central laboratory glucose testing and semiautomated bedside glucose testing (BGT) are performed at most institutions, rigorous determinations of interinstitutional comparative costs have not been performed. Objectives.—To compare interinstitutional analytical costs of central laboratory glucose testing and BGT and to provide suggestions for improvement. Design.—Participants completed a demographic form about their institutional glucose monitoring practices. They also collected information about the costs of central laboratory glucose testing, BGT at a high-volume testing site, and BGT at a low-volume testing site, including specified cost variables for labor, reagents, and instruments. Participants.—A total of 445 institutions enrolled in the College of American Pathologists Q-Probes program. Main Outcome Measure.—Median cost per glucose test at 3 testing sites. Results.—The median (10th–90th percentile range) costs per glucose test were $1.18 ($5.59–$0.36), $1.96 ($9.51– $0.77), and $4.66 ($27.54–$1.02) for central laboratory, high-volume BGT sites, and low-volume BGT sites, respectively. The largest percentages of the cost per test were for labor (59.3%, 72.7%, and 85.8%), followed by supplies (27.2%, 27.3%, and 13.4%) and equipment (2.1%, 0.0%, and 0.0%) for the 3 sites, respectively. The median number of patient specimens per month at the high-volume BGT sites was 625 compared to 30 at the low-volume BGT sites. Most participants did not include labor, instrument maintenance, competency assessment, or oversight in their BGT estimated costs until required to do so for the study. Conclusions.—Analytical costs per glucose test were lower for central laboratory glucose testing than for BGT, which, in turn, was highly variable and dependent on volume. Data that would be used for financial justification for BGT were widely aberrant and in need of improvement.

Стилі APA, Harvard, Vancouver, ISO та ін.

20

Heydari, Abbas, Ali Vafaee-Najar, and Mahmoud Bakhshi. "Intensive Care Nurses' Belief Systems Regarding the Health Economics: A Focused Ethnography." Global Journal of Health Science 8, no. 9 (January 21, 2016): 172. http://dx.doi.org/10.5539/gjhs.v8n9p172.

Повний текст джерела

Анотація:

BACKGROUND: Health care beliefs can have an effect on the efficiency and effectiveness of nursing practices. Nevertheless, how belief systems impact on the economic performance of intensive care unit (ICU) nurses is not known. This study aimed to explore the ICU nurses' beliefs and their effect on nurse's practices and behavior patterns regarding the health economics.METHODS: In this study, a focused ethnography method was used. Twenty-four informants from ICU nurses and other professional individuals were purposively selected and interviewed. As well, 400 hours of ethnographic observations were used for data collection. Data analysis was performed using the methods described by Miles and Huberman (1994).FINDINGS: Eight beliefs were found that gave meaning to ICU nurse's practices regarding the health economics. 1. The registration of medications and supplies disrupt the nursing care; 2.Monitoring and auditing improve consumption; 3.There is a fear of possible shortage in the future; 4.Supply and replacement of equipment is difficult; 5.Higher prices lead to more accurate consumption; 6.The quality of care precedes the costs; 7. Clinical Guidelines are abundant but useful; and 8.Patient economy has priority over hospital economy. Maintaining the quality of patient care with least attention to hospital costs was the main focus of the beliefs formed up in the ICU regarding the health economics.CONCLUSIONS: ICU nurses’ belief systems have significantly shaped in relation to providing a high-quality care. Although high quality of care can lead to a rise in the effectiveness of nursing care, cost control perspective should also be considered in planning for improve the quality of care. Therefore, it is necessary to involve the ICU nurses in decision-making about unit cost management. They must become familiar with the principles of heath care economics and productivity by applying an effective cost management program. It may be optimal to implement the reforms in various aspects, such as the hospital's strategic plan and supply chain management system.

Стилі APA, Harvard, Vancouver, ISO та ін.

21

Desrosiers, Marie-Pierre, Krista A. Payne, and Jean-Francois Baladi. "Estimating the Total Cost of Infused Iron Chelation Therapy." Blood 106, no. 11 (November 16, 2005): 5576. http://dx.doi.org/10.1182/blood.v106.11.5576.5576.

Повний текст джерела

Анотація:

Abstract Background: Patients suffering from β-thalassemia or sickle cell disease require on-going blood transfusions. Chronic transfusion, however, results in iron overload, which if not removed by iron chelation therapy (ICT), causes organ damage. Deferoxamine (DFO) is currently the standard of care for ICT, but many patients do not adhere to therapy possibly because of the need for almost daily infusions lasting 8 to 10 hours each. Rationale: While the impact of current care on clinical and patient outcomes is generally understood, less is known about the total cost of DFO therapy. Objectives: To identify a complete set of cost items to inform the development of an ICT related Resource Use Questionnaire (RUQ) for administration in an international cohort study of the actual cost of ICT in practice; and to obtain a preliminary, literature-based estimate of total annual per patient costs of ICT. Methods: A search of the literature (EMB Reviews; Scirus and Ovid Medline (1996+); PubMed (1995+) was performed using the following key words: thalassemia, sickle cell disease, myelodysplastic syndrome, cost, iron chelation, Desferal, deferoxamine, resource use, reimbursement and compliance. Cost items were extracted from eligible studies to create an aggregated, composite set of ICT-related variables to which unit costs (2004/2005 USD) were applied. Results: Of 396 abstracts obtained, all but 96 were excluded because ICT cost data were lacking. Of those retained, only 4 studies (1 Israël;1 US;2 UK) reported ICT-related costs (1 lifetime;3 annual). Cost variables differed markedly among studies each focusing on some specific aspect. The application of unit costs to the composite list of ICT-related variables and associated resource use profiles reveal that total annual per patient ICT costs may be as high as $7,487 to $15,836 (£4,191 to £8,865) depending on age. The cost of DFO accounts for only 16%–31% of these estimated total costs, with the balance accounted for by other annual ancillary expenditures such as equipment and supplies, monitoring, and home health care services. Total costs could well be underestimated given that component lifetime costs such as DFO treatment complications, the clinical sequelae of poor adherence to DFO, and the indirect costs of lost productivity were not included. Cost estimates will be supplemented and validated at the time of abstract presentation by the resource use and unit cost data generated by the RUQ employed in the aforementioned international cohort study. Conclusions: Estimated total costs of ICT are substantial and well exceed the cost of DFO alone. A paucity of published data related to the total costs of ICT underscores the need for additional ICT cost data from actual practice to better understand the economic impact of novel ICT agents.

Стилі APA, Harvard, Vancouver, ISO та ін.

22

Turner, Sarah. "Empowering Patient Self-Management: A Community Paramedicine Model of Care in Ontario." Health Reform Observer - Observatoire des Réformes de Santé 10, no. 2 (October 17, 2022). http://dx.doi.org/10.13162/hro-ors.v10i2.4833.

Повний текст джерела

Анотація:

Community Paramedicine Remote Patient Monitoring (CPRPM) was launched in Ontario in April 2015 to address high health system usage in vulnerable patients living with chronic disease. CPRPM expands on the home visit model of community paramedicine (CP) to bridge gaps in patient care and address inefficiencies in resource utilization. At patient and systems levels, CPRPM aims to promote patient self-management of chronic diseases. Several reports driving the development of the Ontario Seniors Strategy, which include key recommendations for expanding CP programs, provided the impetus for government to deliver on their electoral platform promise to increase health care spending. The Local Health System Integration Act, 2006 gave Local Health Integration Networks the authority to make home and community care services accessible to Ontario residents, including the supplies and equipment required by patients and their caregivers to support their care at home. Outcome measures of CPRPM point to positive benefits for encouraging patient self-management of chronic diseases and reducing health system strain, with a return on investment of 542%. The variety of options for patient interaction and ability to lessen health system burden makes CPRPM a desirable model of care.

Стилі APA, Harvard, Vancouver, ISO та ін.

23

Boord, Jeffrey B., Rochelle Symlar, Brittany L. Cunningham, John McPherson, Kathleen Burns, and Jeannie Byrd. "Abstract P294: Transport Time Out for Cardiovascular Intensive Care Unit Patients Traveling off of the Unit." Circulation: Cardiovascular Quality and Outcomes 4, suppl_1 (November 2011). http://dx.doi.org/10.1161/circoutcomes.4.suppl_1.ap294.

Повний текст джерела

Анотація:

Background: Transportation of critically ill patients to other areas for diagnostic testing or procedures can present risks to patient safety. It is necessary to ensure that the same level of care and support be provided for critically ill patients when they are removed from the ICU environment. There were no established processes available in the literature to address this safety issue. Aim: To establish a “transport time out” checklist process for transport of critically ill patients outside of the ICU environment. This process ensures that patient care and monitoring continues at the level deemed necessary by patient condition without interruption. Methods: A multidisciplinary team of nurses, physicians, and respiratory therapists created an algorithm to ensure that crucial care elements were considered prior to leaving the ICU environment with a critically ill patient. Elements were categorized in the “Airway, Breathing, Circulation, Drugs (ABCD)” format. Tools developed included a flowchart and transport time out check list (Figure). Results: The checklist outlines essential equipment and supplies for respiratory care, intravenous infusions, and clinical monitoring. The process has been in use for over 9 months encompassing approximately 330 patient transports. The process was rapidly and widely accepted by nursing staff. No adverse events during transport have occurred since implementation of the transport time out process. Conclusion: Use of a “transport time out” checklist process potentially can decrease the likelihood of adverse events during transport of a critically ill patient from the ICU. The process was simple and easy to implement.

Стилі APA, Harvard, Vancouver, ISO та ін.

24

Naqvi, Waqar M. "OCCUPATIONAL HEALTH AND SAFETY OF HEALTH CARE WORKERS IN COVID 19: A RISING CONCERN IN INDIA." Journal of Medical pharmaceutical and allied sciences, July 15, 2021, 2866–70. http://dx.doi.org/10.22270/jmpas.v10i3.1123.

Повний текст джерела

Анотація:

The COVID-19 pandemic has put a strain on healthcare services all over the world. With the rising range of healthcare providers diagnosed with COVID globally and with the second wave in India, the crisis has gained global attention and assistance. The healthcare system in India is under strain, putting frontline healthcare staff on edge. Long and exhausting work hours, quickly depleting supplies of personal protective equipment, day-to-night news reports of COVID-19 statistics, inadequate availability of particular drugs, and insufficient societal assistance may all lead to the additional emotional strain of these HCWs. Depression, anxiety, insomnia, and stress are very prevalent among HCWs. Employed in the high-risk division like infectious disorder and pulmonology, and to see a family member that has been diagnosed, deficient or inadequate hand hygiene before and after interaction with patients, insufficient PPE, direct patient interaction (12 times a day), long daily contact hours (15 hrs), and uncontrolled exposure were all linked to COVID-19 risk among Health Care Workers. Working with COVID-19 has demonstrated the interdependence of various components of the work system, such as personal protective equipment (PPE), ventilators, monitoring equipment, staffing, work setting, and so on. Healthcare workers should also implement a detailed ‘infectious disease preparedness and recovery strategy' to train and protect staff before and after a pandemic. Workers must be closely watched, supported, and, when possible, supplied with evidence-based practice after the crisis has passed.

Стилі APA, Harvard, Vancouver, ISO та ін.

25

Hatzfeld, Jennifer J., George Hildebrandt, Joseph K. Maddry, Dario Rodriquez, Elizabeth Bridges, Anne C. Ritter, Cubby L. Gardner, Vikhyat S. Bebarta, and Andrew P. Cap. "Top 10 Research Priorities for U.S. Military En Route Combat Casualty Care." Military Medicine, January 5, 2021. http://dx.doi.org/10.1093/milmed/usaa480.

Повний текст джерела

Анотація:

ABSTRACT Introduction Within the Military Health System, the process of transporting patients from an initial point of injury and throughout the entire continuum of care is called “en route care.” A Committee on En Route Combat Casualty Care was established in 2016 as part of the DoD Joint Trauma System to create practice guidelines, recommend training standards, and identify research priorities within the military en route care system. Materials and Methods Following an analysis of currently funded research, future capabilities, and findings from a comprehensive scoping study, members of a sub-working group for research identified the top research priorities that were needed to better guide evidence-based decisions for practice and policy, as well as the future state of en route care. Results Based on the input from the entire committee, 10 en route care research topics were rank-ordered in the following manner: (1) medical documentation, (2) clinical decision support, (3) patient monitoring, (4) transport physiology, (5) transfer of care, (6) maintaining normothermia, (7) transport timing following damage control resuscitation or surgery, (8) intelligent tasking, (9) commander’s risk assessment, and (10) unmanned transport. Specific research questions and technological development needs were further developed by committee members in an effort to guide future research and development initiatives that can directly support operational en route care needs. The research priorities reflect three common themes, which include efforts to enhance or increase care provider capability and capacity; understand the impact of transportation on patient physiology; and increase the ability to coordinate, communicate, and facilitate patient movement. Technology needs for en route care must support interoperability of medical information, equipment, and supplies across the global military health system in addition to adjusting to a dynamic transport environment with the smallest possible weight, space, and power requirements. Conclusions To ensure an evidence-based approach to future military conflicts and other medical challenges, focused research and technological development to address these 10 en route care research gaps are urgently needed.

Стилі APA, Harvard, Vancouver, ISO та ін.

26

Pradhan, Nousheen Akber, Ammarah Ali, Sana Roujani, Sumera Aziz Ali, Samia Rizwan, Sarah Saleem, and Sameen Siddiqi. "Quality of inpatient care of small and sick newborns in Pakistan: perceptions of key stakeholders." BMC Pediatrics 21, no. 1 (September 10, 2021). http://dx.doi.org/10.1186/s12887-021-02850-6.

Повний текст джерела

Анотація:

Abstract Background In LMICs including Pakistan, neonatal health and survival is a critical challenge, and therefore improving the quality of facility-based newborn care services is instrumental in averting newborn mortality. This paper presents the perceptions of the key stakeholders in the public sector to explore factors influencing the care of small and sick newborns and young infants in inpatient care settings across Pakistan. Methods This exploratory study was part of a larger study assessing the situation of newborn and young infant in-patient care provided across all four provinces and administrative regions of Pakistan. We conducted 43 interviews. Thirty interviews were conducted with the public sector health care providers involved in newborn and young infant care and 13 interviews were carried out with health planners and managers working at the provincial level. A semi-structured interview guide was used to explore participants’ perspectives on enablers and barriers to the quality of care provided to small and sick newborns at the facility level. The interviews were manually analyzed using thematic content analysis. Findings The study respondents identified multiple barriers contributing to the poor quality of small and sick newborn care at inpatient care settings. This includes an absence of neonatal care standards, inadequate infrastructure and equipment for the care of small and sick newborns, deficient workforce for neonatal case management, inadequate thermal care management for newborns, inadequate referral system, absence of multidisciplinary approach in neonatal case management and need to institute strong monitoring system to prevent neonatal deaths and stillbirths. The only potential enabling factor was the improved federal and provincial oversight for reproductive, maternal, and newborn care. Conclusion This qualitative study was insightful in identifying the challenges that influence the quality of inpatient care for small and sick newborns and the resources needed to fix these. There is a need to equip Sick Newborn Care Units with needed supplies, equipment and medicines, deployment of specialist staff, strengthening of in-service training and staff supervision, liaison with the neonatal experts in customizing neonatal care guidelines for inpatient care settings and to inculcate the culture for inter-disciplinary team meetings at inpatient care settings across the country.

Стилі APA, Harvard, Vancouver, ISO та ін.

27

Tonkin-Crine, Sarah, Monsey McLeod, Aleksandra Borek, Anne Campbell, Phillip Anyanwu, Ceire Costelloe, Mike Moore, et al. "O01 Nuances of implementing antibiotic stewardship in high-prescribing English general practices: an implementation study." JAC-Antimicrobial Resistance 4, Supplement_2 (May 31, 2022). http://dx.doi.org/10.1093/jacamr/dlac052.001.

Повний текст джерела

Анотація:

Abstract Background Trials have identified several antimicrobial stewardship (AMS) strategies that effectively reduce antibiotic use in primary care. However, many are not commonly used in England and evidence is lacking around how to support high-prescribing general practices to implement AMS. We co-developed a customizable implementation intervention to improve adoption and use of three AMS strategies; enhanced communication strategies with/without patient leaflets, delayed prescriptions, and point-of-care C-reactive protein testing (POC-CRPT). This study aimed to investigate the use of the implementation intervention in high-prescribing practices and its effect on antibiotic prescribing. Methods Nine high-prescribing practices had access to the intervention for 12 months from November 2019. This was primarily delivered remotely via the ‘Antibiotic Optimisation’ website with practices required to identify an in-practice ‘Antibiotic Champion’. In a mixed-methods evaluation, we compared routinely collected prescribing data between 9 intervention and 45 matched control practices using a difference in differences analysis. Intervention material use was assessed through website monitoring and practice requests for supplies. Surveys and interviews were conducted with professionals at baseline and follow-up timepoints to capture experiences of using the intervention. Results There was no evidence that the intervention affected antibiotic prescribing. Engagement with intervention materials differed substantially between practices and depended on the individual Antibiotic Champion's preconceptions regarding the AMS strategies and opportunity to do the implementation tasks. Champions in five practices initiated changes to encourage use of at least one of the three AMS strategies, mostly POC-CRPT and patient leaflets. One Champion used the website resources to drive discussions about implementation of all three strategies in their practice. Elsewhere, lack of website engagement meant clinicians did not recognize novelty in the communication and delayed prescription content. POC-CRPT was used most often when equipment was allocated to one person in a practice. Conclusions AMS strategies are complex interventions and require clinicians to have detailed knowledge on how to adopt them in practice if they are to reduce antibiotic prescribing. Successful adoption may be achieved by allocating one or two persons to use an AMS strategy rather than all clinicians. Although effective in trials, remote, one-sided provision of AMS strategies is unlikely to change prescribing; initial clinician engagement and understanding needs to be monitored to avoid misunderstanding and suboptimal use.

Стилі APA, Harvard, Vancouver, ISO та ін.

28

Quan, Alexander. "Addressing Shortcomings in Contingency Standards of Care." Voices in Bioethics 8 (September 17, 2022). http://dx.doi.org/10.52214/vib.v8i.9991.

Повний текст джерела

Анотація:

Photo by Adhy Savala on Unsplash ABSTRACT During a crisis, when healthcare capacity becomes overwhelmed and cannot meet regular standards of patient care, crisis standards of care are invoked to distribute scarce hospital space, staff, and supplies. When transitioning between conventional standards of care and crisis standards, hospitals may have to manage resources under scarcity constraints in an intermediate phase defined as the contingency phase. While much attention has been paid to the ethics of crisis standard of care protocols, contingency measures were more widely implemented, though little exists within the literature on the ethics of contingency measures or a clearly explicated contingency standard of care. This paper addresses three ethical issues with the current contingency response to COVID-19: the lack of formalization, the risks of using short-term solutions for prolonged contingency shortages, and the danger of exacerbating health disparities through hospital-level resource allocation. To mitigate these ethical issues, I offer recommendations for reimagining resource allocation during contingency standards of care. INTRODUCTION When transitioning between conventional standards of care and crisis standards, or in situations where shortages do not immediately threaten care delivery, hospitals may have to manage scarce resources in an intermediate phase, known as the “contingency” phase.[1] While much attention has been paid to the ethics of crisis standards, less literature covers the ethics of contingency measures or a clearly explicated contingency standard of care. Many states and hospital systems do not have contingency standards of care to dictate allocation absent an event triggering crisis standards. Crisis standards of care, used when healthcare capacity becomes overwhelmed and cannot meet regular standards of patient care, reflect ethical priorities relevant in times of shortage or other emergencies. These priorities include saving the most lives, the stewardship of scarce resources, and justice relating to equitable resource distribution.[2] Crisis standards of care delineate specialized allocation protocols and triage decision-making bodies at the institutional or state levels. Crisis standards of care require formal activation at the state level, and in the absence of clear triggers or governmental willingness to use them, hospitals may adopt informal strategies to manage allocation in the form of contingency measures. The contingency phase is defined by two simultaneous goals: prevent or stall crisis-level scarcity by managing limited resources and providing patient care that is functionally equivalent to usual care.[3] In other words, allocate scarce resources with no significant health consequences to patients. However, this is an unrealistic expectation: meeting a patient’s medical needs and allocating resources on the basis of scarcity instead of medical indications can be at odds, creating ethical tension. This paper addresses three ethical issues with the current contingency response stemming from this tension: the lack of formalization, the risk of using short-term solutions for prolonged contingency shortages, and the danger of exacerbating health disparities through hospital-level resource allocation. To mitigate these ethical issues, I offer recommendations for reimagining resource allocation during contingency standards of care. l. Lack of Formalization One shortcoming of current contingency measures is that they fail to meet the same level of procedural detail and clarity as crisis standards. The early COVID-19 surges in Italy and France demonstrated the pitfalls of bedside allocation in the absence of procedural guidance. The acute scarcity of critical care resources forced doctors in these countries to make allocation decisions at the bedside, which often resulted in de facto age-based allocation as well as experiences of moral distress and shame among providers.[4] In France, medical allocation guidelines and statistics were never released to the public, raising concerns over the role of transparency in implementing crisis standards and triage guidelines and causing the public to question the trustworthiness of provider triage.[5] Though many states in the US have crisis standards of care that can be implemented in the case of a large-scale triage event, these measures vary widely. A 2020 review of 31 crisis standards of care in the US found that only 18 contained strong “ethical grounding,” 28 used “evidence-based clinical processes and operations,” 21 included “ongoing community and provider engagement, education, and communication,” and 16 had “clear indicators, triggers, and lines of responsibility.”[6] The need for standardization, public transparency, and guidelines for crisis standards of care to prevent bedside allocation has been widely recognized. However, these issues remain unresolved by public policy or legislative efforts during the contingency period before (or after) crisis standards apply. A recent public health study that observed triage team members in a high-fidelity triage simulation highlighted the challenges of making equitable frontline allocation decisions.[7] In the simulation, participants nudged patient priority status up or down depending on what they subjectively identified as morally relevant factors. Through the simulation, participants reported difficulty separating implicit biases about patient characteristics from their clinical judgment. In the absence of formal institutional or regional guidelines for allocation during contingency-level shortages, there are few to no procedural safeguards against biased, ad hoc, and non-transparent rationing. Without formalized or standardized contingency allocation guidance, providers are left to make bedside allocation decisions that are susceptible to individual biases and patterns of unintended discrimination. An example of this susceptibility is seen when hospitals allow patients who no longer benefit from ICU resources to continue occupying ICU beds. This is based on a first-come-first-served (FCFS) approach to bed allocation. FCFS is often a default for patient intake, which led to disparities in care access during the early COVID-19 pandemic. Media reports of hospitals with “plenty of space” being unwilling to accept patients from overwhelmed, lower-income hospitals illustrate that the FCFS default advantages those who could show up first to a particular hospital: often privileged, well-funded healthcare systems that were inaccessible to low-income communities.[8] FCFS is blind to several morally relevant factors, including the likelihood of survival to discharge, reciprocity (i.e. prioritizing healthcare workers), and varying degrees of access to healthcare. Therefore, it inappropriately privileges those in proximity to healthcare systems or with social connections enabling greater initial access to care.[9] During crisis standards of care, excessive mortality that would result from FCFS is mitigated through formalized system-wide triage protocols based on current patient health status and potential benefit from resources. Crisis and contingency standards may provide liability coverage for providers who reallocate critical care beds away from those who no longer benefit during periods of scarcity. This liability coverage shifts bed allocation away from an FCFS model, but only if the policy is well-defined, clearly established, and known to providers. Without a formal system to guide the process or transition from the usual method of allocation to the contingency period, contingency decisions about who gets a scarce resource may continue to operate on an implicit FCFS basis, even when approaching crisis levels of scarcity. Additionally, these decisions will fall unsustainably on individual providers or transfer center workers, leading to moral distress on the frontlines when hospitals are already strained. Lessons from the crisis and contingency responses during COVID-19 can improve future contingency responses. There are multiple ways of achieving equity during contingency allocation, ranging from hospital-level to state-level policy changes. State-wide policies and interventions to facilitate resource-sharing can relieve some of the scarcity burdens that hospitals may face during the contingency period. For example, moving ICU patients to lower levels of care once they have sufficiently recovered is a challenge for doctors, who often call other hospitals to find open beds. In these situations, providers who do not move patients who no longer benefit from ICU beds unknowingly reinforce the FCFS system in which those who arrive first keep the scarce beds, while those who arrive later or wait for one are disadvantaged by having limited access to them. State-wide patient transfer centers, often facilitated by state public health departments, present an alternative by balancing patient needs and bed distribution more equitably and efficiently than individual physicians do, as demonstrated following COVID-19 surges in hospitalization.[10] These centers aid not only in allocating open tertiary care beds, but also in identifying open beds at lower levels of care and assisting physicians with transferring out patients who can be safely downgraded and no longer benefit from tertiary care resources. However, the simplest solution is to encourage the creation of ethics guidance or protocols for contingency allocation at the hospital level. In hospitals, institutional ethics guidance can help providers navigate difficult decisions and conversations with patients. When providers face time-sensitive allocation decisions, like the allocation of open ICU beds, the guidance would be a useful tool for making transparent, principled, and ethically justified allocation decisions in real-time to mitigate the risk of ad hoc or implicit rationing. ll. Unsuited for Prolonged Resource Shortages Secondly, neither contingency nor crisis standards are currently designed to respond to prolonged strains on the healthcare system. Since the start of the pandemic, a prolonged period of staffing shortages began and is projected to persist.[11] However, both crisis and contingency standards assume that the system will eventually return to conventional standards of care. For example, as a contingency or crisis standard, many hospitals deferred elective surgeries to preserve limited resources for emergency and life-saving procedures. Massachusetts, for instance, issued a public health emergency order that required hospitals to defer 50 percent of all non-essential and non-urgent (elective) surgeries. This order demonstrates the use of this contingency measure in response to prolonged staffing and bed shortages.[12] However, the deferral of elective procedures can result in adverse long-term community health consequences. Medical conditions typically addressed through elective surgery, such as joint replacement surgeries for osteoarthritis patients, may worsen if delayed. This can result in greater numbers of acute emergencies, the need for more complex surgical procedures later, increased reliance on pain medications, and longer recovery times.[13] Without a greater understanding of long-term complications in community health, existing contingency strategies, such as the deferral of elective surgeries, may be unsuitable for prolonged shortages. This becomes a greater threat to patient safety when contingency measures inappropriately take the place of crisis standards, risking the long-term implementation of emergency measures designed for temporary use. Although some state emergency planning documents identify indicators and triggers for activating contingency and crisis operations,[14] this transition is not always clear in action. For example, New York did not implement crisis standards of care during the early COVID-19 pandemic despite being one of the hardest-hit cities in the US.[15] Other states, including California, Texas, and Florida, did not activate crisis standards of care, leaving hospitals to implement informal contingency measures that ultimately required allocation strategies very similar or identical to many crisis standards of care protocols.[16] Due to the hesitance to activate crisis standards, ad hoc contingency measures and bedside decision-making prevailed over formal triage protocols. If contingency measures are not set forth in objective documents and are inappropriately used in the place of crisis standards, these short-term measures may result in an unfair or non-transparent distribution of scarce resources. When shortages in space, staff, or supplies jeopardize the ability to provide necessary care for critically ill patients under a conventional standard of care, failures to activate crisis standards risk the inappropriate use of ad hoc contingency measures in their place. With clear contingency standards of care, the duration of an ad hoc approach could be limited. Crisis standards are defined and activated at the regional or state-wide level, but outside of hospital-specific resource limitations, there are generally no standardized indications or triggers for transitioning into and out of contingency measures. Leaving contingency needs to individual hospitals may seem beneficial but defining the contingency period at the hospital level and the crisis period at the state or regional level blurs the line about when it is appropriate for decision makers to activate crisis standards, risking delayed activation or failure to activate them at all. Therefore, it is important that state policies implement automatic triggers for activation that clearly delineate between contingency and crisis responses.[17] Automatic triggers based on validated metrics like remaining available resources can inform the appropriate decision makers about when they must activate crisis standards. These triggers should be transparent to the public, validated, and updated over time with evolving data. These automatic triggers would prevent confusion, inconsistent guidelines, and inequitable contingency allocation at the hands of distressed providers when crisis standards are needed. Defining when to begin crisis standards could help limit the length of the contingency period. This would protect against the inappropriate application of contingency measures to crisis-level scarcity and prolonged shortages that they could not sustainably ameliorate. lll. Potential to Exacerbate Health Disparities Inconsistencies in contingency allocation open the door to disparities in care and unequal distribution of scarcity burdens among different communities based on their location or health needs. This is a concern because it is unclear whether contingency measures can meet their goal of achieving functionally equivalent patient outcomes when resource allocation must be balanced with patient-centered care.[18] The care under contingency standards is meant to be functionally equivalent to regular care. The definition assumes (or may wrongly suggest) that any contingency strategy in place to avoid critical scarcity has no significant impact on patient outcomes. While functional equivalence is attainable, there is currently little research into which contingency measures achieve functionally equivalent outcomes and which patient groups may be disproportionately affected by harmful resource allocation strategies. Although the transition from contingency standards to crisis standards is defined by the inability to provide functionally equivalent care, the difference in practice may merely be a distinction between visible, immediate sacrifices to patient well-being during crises and less-obvious, long-term decrements in community health due to protracted contingency care alterations. Two common contingency measures are cause for concern over disparate patient outcomes and the attainability of functional equivalence. First, restricting emergency room visits by the patient’s degree of need has worrying consequences. In late 2021 and early 2022, hospitals in Massachusetts faced widespread staffing shortages, leading to an emergency order that restricted emergency visits to emergency needs.[19] While this order is a reasonable method of allocating limited staff in the emergency department during severe shortages, it is doubtful that the outcomes of this restriction were equivalent to usual care. Health issues that are soon-to-be emergencies are filtered out until they worsen, resulting in patients overflowing to urgent care clinics or presenting to ERs with more severe forms of sicknesses later on. Given the empirical evidence demonstrating ER treatment and admission disparities that disadvantage Black and Hispanic patients, such a measure would only exacerbate these disparities by further limiting access to needed care.[20] Second, altered staffing ratios, which stretch a limited number of providers to meet patient needs during a staffing shortage, are another concerning yet common contingency measure. Staffing allocation is often viewed similarly to the allocation of space and medical equipment, such that contingency alterations to staffing operations may not seem like they significantly jeopardize patient care quality and outwardly appear functionally equivalent.[21] However, lower ratios of qualified nurses are associated with poor outcomes such as higher inpatient mortality[22] and lower survival rates of in-hospital cardiac arrest for Black patients.[23] These examples highlight the strong potential for contingency measures to amplify social health disparities, particularly when adopted over a prolonged time frame. Lowered standards of care in crisis allocation disproportionately impact racial and ethnic minorities.[24] For example, crisis standards of care used clinical scoring systems that were not developed or validated for crisis triage to prioritize access to life-saving treatments during the COVID-19 pandemic. This practice actively gives rise to racial health disparities and discrimination against disabled patients.[25] Not only were the standards inequitable in practice, but they varied widely from state to state and sometimes even from hospital to hospital, creating disparities across and within geographic regions.[26] If contingency measures are similarly implemented across hospitals or hospital departments without standardization or advance planning to ensure equitable outcomes, it is likely that the burden of a lower standard of care will fall primarily on disadvantaged patient groups and racial minorities. However, standardization alone may be insufficient. Other factors like varying levels of details on patients’ charts between hospitals could produce unfair outcomes if used to determine patient admission or transfer priority, even if the criteria for admissions and transfers are consistent. Thus, ongoing monitoring for unintended patterns of disparity must accompany standardization to ensure that blind spots in the allocation process are identified and corrected. Bioethics has long been preoccupied with the micro-allocation of limited resources within hospitals instead of confronting the structural inequities that underlie broader scarcity and patient needs. The traditional dilemma of allocating limited hospital resources among a certain number of patients overlooks questions about how other resources have already been allocated, which patients were present at the hospital in the first place, where hospitals have (and have not) been built, and whether previous allocation strategies created bias in the broader distribution of resources. Therefore, to achieve fairness, bioethicists must pay attention to aspects of the broader distribution of resources, such as social determinants of health and the allocation of preventative resources at the public health level. One strategy for measuring and addressing these disparities is the Area Deprivation Index (ADI). The ADI quantifies the effects of race, class, and socioeconomic background by geographic region for use in public health research and the prioritization of resources.[27] It has shown promise in identifying geographic regions in need of targeted community health efforts for diabetes management based on electronic patient health records.[28] The ADI and similar tools would be useful in proactively deciding how to allocate public health resources when hospitals are strained. Moreover, through using population health and resource data, public health organizations may forecast contingency shortages allowing for the adoption of early measures to mitigate health disparities that might otherwise be amplified from hospital-level contingency allocation decisions. CONCLUSION Meeting community health needs during periods of contingency scarcity, both before and after crisis standards of care apply, will require contingency standards of care rather than a bedside ad hoc distribution of scarce resources. While it is not inherently ethically unjustifiable for hospitals to adopt measures that may lower the standard of care during contingency standards, the necessity of these measures requires that bioethicists consider how equity, transparency, and the overall aim of functional equivalence can best be achieved under conditions of scarcity. The long-term health consequences of existing contingency measures, the potential for ad hoc and inconsistent allocation of scarce resources, and the need for consensus about when it becomes appropriate to make the formal transition to crisis standards of care demand further consideration. Because contingency measures will likely amplify existing disparities as crisis standards have, hospital-level management of scarcity is inadequate. Public health measures should be adopted in parallel to anticipate and manage health needs at the community or state level when resources are strained. - [1] Altevogt, B. M., Stroud, C., Hanson, S. L., Hanfling, D., & Gostin, L. O. (2009). Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report. The National Academies Press. https://doi.org/10.17226/12749 [2] Emanuel, E. J., Persad, G., Upshur, R., Thome, B., Parker, M., Glickman, A., Zhang, C., Boyle, C., Smith, M., & Phillips, J. P. (2020). Fair Allocation of Scarce Medical Resources in the Time of Covid-19. New England Journal of Medicine, 382(21), 2049–2055. https://doi.org/10.1056/NEJMsb2005114 [3] Alfandre, D., Sharpe, V. A., Geppert, C., Foglia, M. B., Berkowitz, K., Chanko, B., & Schonfeld, T. (2021). Between Usual and Crisis Phases of a Public Health Emergency: The Mediating Role of Contingency Measures. The American Journal of Bioethics, 21(8), 4–16. https://doi.org/10.1080/15265161.2021.1925778 [4] Rosenbaum, L. (2020). Facing Covid-19 in Italy—Ethics, Logistics, and Therapeutics on the Epidemic’s Front Line. New England Journal of Medicine, 382(20), 1873–1875. https://doi.org/10.1056/NEJMp2005492 [5] Orfali, K. (2020). What Triage Issues Reveal: Ethics in the COVID-19 Pandemic in Italy and France. Journal of Bioethical Inquiry, 17(4), 675–679. https://doi.org/10.1007/s11673-020-10059-y [6] Romney, D., Fox, H., Carlson, S., Bachmann, D., O’Mathuna, D., & Kman, N. (2020). Allocation of Scarce Resources in a Pandemic: A Systematic Review of US State Crisis Standards of Care Documents. Disaster Medicine and Public Health Preparedness, 14(5), 677–683. https://doi.org/10.1017/dmp.2020.101 [7] Butler, C. R., Webster, L. B., Diekema, D. S., Gray, M. M., Sakata, V. L., Tonelli, M. R., & Vranas, K. C. (2022). Perspectives of Triage Team Members Participating in Statewide Triage Simulations for Scarce Resource Allocation During the COVID-19 Pandemic in Washington State. JAMA Network Open, 5(4), e227639. https://doi.org/10.1001/jamanetworkopen.2022.7639 [8] Dwyer, J. (2020, May 14). One Hospital Was Besieged by the Virus. Nearby Was ‘Plenty of Space.’—The New York Times. The New York Times. https://www.nytimes.com/2020/05/14/nyregion/coronavirus-ny-hospitals.html [9] Persad, G., Wertheimer, A., & Emanuel, E. J. (2009). Principles for allocation of scarce medical interventions. Lancet (London, England), 373(9661), 423–431. https://doi.org/10.1016/S0140-6736(09)60137-9 [10] Mitchell, S. H., Rigler, J., & Baum, K. (2022). Regional Transfer Coordination and Hospital Load Balancing During COVID-19 Surges. JAMA Health Forum, 3(2), e215048. https://doi.org/10.1001/jamahealthforum.2021.5048 [11] ASPE. (2022, May 3). Impact of the COVID-19 Pandemic on the Hospital and Outpatient Clinician Workforce: Challenges and Policy Responses. ASPE. https://aspe.hhs.gov/reports/covid-19-health-care-workforce [12] Executive Office of Health and Human Services. (2021). Baker-Polito Administration Provides COVID-19 Update on Mask Advisory, Hospital Support | Mass.gov. https://www.mass.gov/news/baker-polito-administration-provides-covid-19-update-on-mask-advisory-hospital-support [13] The Lancet Rheumatology. (2021). Too long to wait: The impact of COVID-19 on elective surgery. The Lancet Rheumatology, 3(2), e83. https://doi.org/10.1016/S2665-9913(21)00001-1 [14] For an example of transition planning between crisis and contingency standards, see Minnesota Department of Health. (2021). Ethical Framework for Transitions Between Conventional, Contingency, and Crisis Conditions in Pervasive or Catastrophic Public Health Events with Medical Surge Implications (Minnesota Crisis Standards of Care). https://www.health.state.mn.us/communities/ep/surge/crisis/framework_transitions.pdf [15] Powell, T., & Chuang, E. (2020). COVID in NYC: What We Could Do Better. The American Journal of Bioethics, 20(7), 62–66. https://doi.org/10.1080/15265161.2020.1764146 [16] Persoff, J., & Wynia, M. K. (2021). Ethically Navigating the Murky Waters of “Contingency Standards of Care.” The American Journal of Bioethics, 21(8), 20–21. https://doi.org/10.1080/15265161.2021.1939810 [17] Board on Health Sciences Policy & Institute of Medicine. (2013). Indicators and Triggers. In Crisis Standards of Care: A Toolkit for Indicators and Triggers. National Academies Press (US). http://www.ncbi.nlm.nih.gov/books/NBK202381/ [18] Frith, L., Draper, H., Fovargue, S., Baines, P., Redhead, C., & Chiumento, A. (2021). Neither ‘Crisis Light’ nor ‘Business as Usual’: Considering the Distinctive Ethical Issues Raised by the Contingency and Reset Phases of a Pandemic. The American Journal of Bioethics, 21(8), 34–37. https://doi.org/10.1080/15265161.2021.1940363 [19] Rosseau, M. (2022, January 14). New emergency orders issued to help understaffed Mass. Hospitals. Boston.Com. https://www.boston.com/news/coronavirus/2022/01/14/new-emergency-orders-issued-to-help-understaffed-mass-hospitals/ [20] Zhang, X., Carabello, M., Hill, T., Bell, S. A., Stephenson, R., & Mahajan, P. (2020). Trends of Racial/Ethnic Differences in Emergency Department Care Outcomes Among Adults in the United States From 2005 to 2016. Frontiers in Medicine, 7. https://www.frontiersin.org/articles/10.3389/fmed.2020.00300 [21] Hick, J. L., Hanfling, D., & Wynia, M. (2022). Hospital Planning for Contingency and Crisis Conditions: Crisis Standards of Care Lessons from COVID-19. The Joint Commission Journal on Quality and Patient Safety. https://doi.org/10.1016/j.jcjq.2022.02.003 [22] Musy, S. N., Endrich, O., Leichtle, A. B., Griffiths, P., Nakas, C. T., & Simon, M. (2021). The association between nurse staffing and inpatient mortality: A shift-level retrospective longitudinal study. International Journal of Nursing Studies, 120, 103950. https://doi.org/10.1016/j.ijnurstu.2021.103950 [23] Brooks Carthon, M., Brom, H., McHugh, M., Sloane, D. M., Berg, R., Merchant, R., Girotra, S., & Aiken, L. H. (2021). Better Nurse Staffing Is Associated With Survival for Black Patients and Diminishes Racial Disparities in Survival After In-Hospital Cardiac Arrests. Medical Care, 59(2), 169–176. https://doi.org/10.1097/MLR.0000000000001464 [24] Annas, G. J., & Crosby, S. S. (2021). Standard Racism: Trying to Use “Crisis Standards of Care” in the COVID-19 Pandemic. The American Journal of Bioethics, 21(8), 1–3. https://doi.org/10.1080/15265161.2021.1941424 [25] Wynia, M. K., & Sottile, P. D. (2020). Ethical Triage Demands a Better Triage Survivability Score. The American Journal of Bioethics, 20(7), 75–77. https://doi.org/10.1080/15265161.2020.1779412 [26] Fink, S. (2020). Ethical Dilemmas in Covid-19 Medical Care: Is a Problematic Triage Protocol Better or Worse than No Protocol at All? The American Journal of Bioethics, 20(7), 1–5. https://doi.org/10.1080/15265161.2020.1788663 [27] Knighton, A. J., Savitz, L., Belnap, T., Stephenson, B., & VanDerslice, J. (2016). Introduction of an Area Deprivation Index Measuring Patient Socioeconomic Status in an Integrated Health System: Implications for Population Health. EGEMS (Washington, DC), 4(3), 1238. https://doi.org/10.13063/2327-9214.1238 [28] Kurani, S. S., Lampman, M. A., Funni, S. A., Giblon, R. E., Inselman, J. W., Shah, N. D., Allen, S., Rushlow, D., & McCoy, R. G. (2021). Association Between Area-Level Socioeconomic Deprivation and Diabetes Care Quality in US Primary Care Practices. JAMA Network Open, 4(12), e2138438. https://doi.org/10.1001/jamanetworkopen.2021.38438

Стилі APA, Harvard, Vancouver, ISO та ін.

29

Chavdarov, Anatoliy V. "Special Issue No. – 10, June, 2020 Journal > Special Issue > Special Issue No. – 10, June, 2020 > Page 5 “Quantative Methods in Modern Science” organized by Academic Paper Ltd, Russia MORPHOLOGICAL AND ANATOMICAL FEATURES OF THE GENUS GAGEA SALISB., GROWING IN THE EAST KAZAKHSTAN REGION Authors: Zhamal T. Igissinova,Almash A. Kitapbayeva,Anargul S. Sharipkhanova,Alexander L. Vorobyev,Svetlana F. Kolosova,Zhanat K. Idrisheva, DOI: https://doi.org/10.26782/jmcms.spl.10/2020.06.00041 Abstract: Due to ecological preferences among species of the genus GageaSalisb, many plants are qualified as rare and/or endangered. Therefore, the problem of rational use of natural resources, in particular protection of early spring plant species is very important. However, literary sources analysis only reveals data on the biology of species of this genus. The present research,conducted in the spring of 2017-2019, focuses on anatomical and morphological features of two Altai species: Gagealutea and Gagea minima; these features were studied, clarified and confirmed by drawings and photographs. The anatomical structure of the stem and leaf blade was studied in detail. The obtained research results will prove useful for studies of medicinal raw materials and honey plants. The aforementioned species are similar in morphological features, yet G. minima issmaller in size, and its shoots appear earlier than those of other species Keywords: Flora,gageas,Altai species,vegetative organs., Refference: I. Atlas of areas and resources of medicinal plants of Kazakhstan.Almaty, 2008. II. Baitenov M.S. Flora of Kazakhstan.Almaty: Ġylym, 2001. III. DanilevichV. G. ThegenusGageaSalisb. of WesternTienShan. PhD Thesis, St. Petersburg,1996. IV. EgeubaevaR.A., GemedzhievaN.G. The current state of stocks of medicinal plants in some mountain ecosystems of Kazakhstan.Proceedings of the international scientific conference ‘”Results and prospects for the development of botanical science in Kazakhstan’, 2002. V. Kotukhov Yu.A. New species of the genus Gagea (Liliaceae) from Southern Altai. Bot. Journal.1989;74(11). VI. KotukhovYu.A. ListofvascularplantsofKazakhstanAltai. Botan. Researches ofSiberiaandKazakhstan.2005;11. VII. KotukhovYu. The current state of populations of rare and endangered plants in Eastern Kazakhstan. Almaty: AST, 2009. VIII. Kotukhov Yu.A., DanilovaA.N., AnufrievaO.A. Synopsisoftheonions (AlliumL.) oftheKazakhstanAltai, Sauro-ManrakandtheZaisandepression. BotanicalstudiesofSiberiaandKazakhstan. 2011;17: 3-33. IX. Kotukhov, Yu.A., Baytulin, I.O. Rareandendangered, endemicandrelictelementsofthefloraofKazakhstanAltai. MaterialsoftheIntern. scientific-practical. conf. ‘Sustainablemanagementofprotectedareas’.Almaty: Ridder, 2010. X. Krasnoborov I.M. et al. The determinant of plants of the Republic of Altai. Novosibirsk: SB RAS, 2012. XI. Levichev I.G. On the species status of Gagea Rubicunda. Botanical Journal.1997;6:71-76. XII. Levichev I.G. A new species of the genus Gagea (Liliaceae). Botanical Journal. 2000;7: 186-189. XIII. Levichev I.G., Jangb Chang-gee, Seung Hwan Ohc, Lazkovd G.A.A new species of genus GageaSalisb.(Liliaceae) from Kyrgyz Republic (Western Tian Shan, Chatkal Range, Sary-Chelek Nature Reserve). Journal of Asia-Pacific Biodiversity.2019; 12: 341-343. XIV. Peterson A., Levichev I.G., Peterson J. Systematics of Gagea and Lloydia (Liliaceae) and infrageneric classification of Gagea based on molecular and morphological data. Molecular Phylogenetics and Evolution.2008; 46. XV. Peruzzi L., Peterson A., Tison J.-M., Peterson J. Phylogenetic relationships of GageaSalisb.(Liliaceae) in Italy, inferred from molecular and morphological data matrices. Plant Systematics and Evolution; 2008: 276. XVI. Rib R.D. Honey plants of Kazakhstan. Advertising Digest, 2013. XVII. Scherbakova L.I., Shirshikova N.A. Flora of medicinal plants in the vicinity of Ust-Kamenogorsk. Collection of materials of the scientific-practical conference ‘Unity of Education, Science and Innovation’. Ust-Kamenogorsk: EKSU, 2011. XVIII. syganovA.P. PrimrosesofEastKazakhstan. Ust-Kamenogorsk: EKSU, 2001. XIX. Tsyganov A.P. Flora and vegetation of the South Altai Tarbagatay. Berlin: LAP LAMBERT,2014. XX. Utyasheva, T.R., Berezovikov, N.N., Zinchenko, Yu.K. ProceedingsoftheMarkakolskStateNatureReserve. Ust-Kamenogorsk, 2009. XXI. Xinqi C, Turland NJ. Gagea. Flora of China.2000;24: 117-121. XXII. Zarrei M., Zarre S., Wilkin P., Rix E.M. Systematic revision of the genus GageaSalisb. (Liliaceae) in Iran.BotJourn Linn Soc.2007;154. XXIII. Zarrei M., Wilkin P., Ingroille M.J., Chase M.W. A revised infrageneric classification for GageaSalisb. (Tulipeae; Liliaceae): insights from DNA sequence and morphological data.Phytotaxa.2011:5. View | Download INFLUENCE OF SUCCESSION CROPPING ON ECONOMIC EFFICIENCY OF NO-TILL CROP ROTATIONS Authors: Victor K. Dridiger,Roman S. Stukalov,Rasul G. Gadzhiumarov,Anastasiya A. Voropaeva,Viktoriay A. Kolomytseva, DOI: https://doi.org/10.26782/jmcms.spl.10/2020.06.00042 Abstract: This study was aimed at examining the influence of succession cropping on the economic efficiency of no-till field crop rotations on the black earth in the zone of unstable moistening of the Stavropol krai. A long-term stationary experiment was conducted to examine for the purpose nine field crop rotation patterns different in the number of fields (four to six), set of crops, and their succession in crop rotation. The respective shares of legumes, oilseeds, and cereals in the cropping pattern were 17 to 33, 17 to 40, and 50 to 67 %. It has been established that in case of no-till field crop cultivation the economic efficiency of plant production depends on the set of crops and their succession in rotation. The most economically efficient type of crop rotation is the soya-winter wheat-peas-winter wheat-sunflower-corn six-field rotation with two fields of legumes: in this rotation 1 ha of crop rotation area yields 3 850 grain units per ha at a grain unit prime cost of 5.46 roubles; the plant production output return and profitability were 20,888 roubles per ha and 113 %, respectively. The high production profitabilities provided by the soya-winter wheat-sunflower four-field and the soya-winter-wheat-sunflower-corn-winter wheat five-field crop rotation are 108.7 and 106.2 %, respectively. The inclusion of winter wheat in crop rotation for two years in a row reduces the second winter wheat crop yield by 80 to 100 %, which means a certain reduction in the grain unit harvesting rate to 3.48-3.57 thousands per ha of rotation area and cuts the production profitability down to 84.4-92.3 %. This is why, no-till cropping should not include winter wheat for a second time Keywords: No-till technology,crop rotation,predecessor,yield,return,profitability, Refference: I Badakhova G. Kh. and Knutas A. V., Stavropol Krai: Modern Climate Conditions [Stavropol’skiykray: sovremennyyeklimaticheskiyeusloviya]. Stavropol: SUE Krai Communication Networks, 2007. II Cherkasov G. N. and Akimenko A. S. Scientific Basis of Modernization of Crop Rotations and Formation of Their Systems according to the Specializations of Farms in the Central Chernozem Region [Osnovy moderniz atsiisevooborotoviformirovaniyaikh sistem v sootvetstvii so spetsi-alizatsiyeykhozyaystvTsentral’nogoChernozem’ya]. Zemledelie. 2017; 4: 3-5. III Decree 330 of July 6, 2017 the Ministry of Agriculture of Russia “On Approving Coefficients of Converting to Agricultural Crops to Grain Units [Ob utverzhdeniikoeffitsiyentovperevoda v zernovyyee dinitsysel’s kokhozyaystvennykhkul’tur]. IV Dridiger V. K., About Methods of Research of No-Till Technology [O metodikeissledovaniytekhnologii No-till]//Achievements of Science and Technology of AIC (Dostizheniyanaukiitekhniki APK). 2016; 30 (4): 30-32. V Dridiger V. K. and Gadzhiumarov R. G. Growth, Development, and Productivity of Soya Beans Cultivated On No-Till Technology in the Zone of Unstable Moistening of Stavropol Region [Rost, razvitiyeiproduktivnost’ soiprivozdelyvaniipotekhnologii No-till v zone ne-ustoychivog ouvlazhneniyaStavropol’skogokraya]//Oil Crops RTBVNIIMK (Maslichnyyekul’turyNTBVNIIMK). 2018; 3 (175): 52–57. VI Dridiger V. K., Godunova E. I., Eroshenko F. V., Stukalov R. S., Gadzhiumarov, R. G., Effekt of No-till Technology on erosion resistance, the population of earthworms and humus content in soil (Vliyaniyetekhnologii No-till naprotivoerozionnuyuustoychivost’, populyatsiyudozhdevykhcherveyisoderzhaniyegumusa v pochve)//Research Journal of Pharmaceutical, Biological and Chemical Sciences. 2018; 9 (2): 766-770. VII Karabutov A. P., Solovichenko V. D., Nikitin V. V. et al., Reproduction of Soil Fertility, Productivity and Energy Efficiency of Crop Rotations [Vosproizvodstvoplodorodiyapochv, produktivnost’ ienergeticheskayaeffektivnost’ sevooborotov]. Zemledelie. 2019; 2: 3-7. VIII Kulintsev V. V., Dridiger V. K., Godunova E. I., Kovtun V. I., Zhukova M. P., Effekt of No-till Technology on The Available Moisture Content and Soil Density in The Crop Rotation [Vliyaniyetekhnologii No-till nasoderzhaniyedostupnoyvlagiiplotnost’ pochvy v sevoob-orote]// Research Journal of Pharmaceutical, Biological and Chemical Sciences. 2017; 8 (6): 795-99. IX Kulintsev V. V., Godunova E. I., Zhelnakova L. I. et al., Next-Gen Agriculture System for Stavropol Krai: Monograph [SistemazemledeliyanovogopokoleniyaStavropol’skogokraya: Monogtafiya]. Stavropol: AGRUS Publishers, Stavropol State Agrarian University, 2013. X Lessiter Frank, 29 reasons why many growers are harvesting higher no-till yields in their fields than some university scientists find in research plots//No-till Farmer. 2015; 44 (2): 8. XI Rodionova O. A. Reproduction and Exchange-Distributive Relations in Farming Entities [Vosproizvodstvoiobmenno-raspredelitel’nyyeotnosheniya v sel’skokhozyaystvennykhorganizatsiyakh]//Economy, Labour, and Control in Agriculture (Ekonomika, trud, upravleniye v sel’skomkhozyaystve). 2010; 1 (2): 24-27. XII Sandu I. S., Svobodin V. A., Nechaev V. I., Kosolapova M. V., and Fedorenko V. F., Agricultural Production Efficiency: Recommended Practices [Effektivnost’ sel’skokhozyaystvennogoproizvodstva (metodicheskiyerekomendatsii)]. Moscow: Rosinforagrotech, 2013. XIII Sotchenko V. S. Modern Corn Cultivation Technologies [Sovremennayatekhnologiyavozdelyvaniya]. Moscow: Rosagrokhim, 2009. View | Download DEVELOPMENT AND TESTING OF AUTONOMOUS PORTABLE SEISMOMETER DESIGNED FOR USE AT ULTRALOW TEMPERATURES IN ARCTIC ENVIRONMENT Authors: Mikhail A. Abaturov,Yuriy V. Sirotinskiy, DOI: https://doi.org/10.26782/jmcms.spl.10/2020.06.00043 Abstract: This paper is concerned with solving one of the issues of the general problem of designing geophysical equipment for the natural climatic environment of the Arctic. The relevance of the topic has to do with an increased global interest in this region. The paper is aimed at considering the basic principles of developing and the procedure of testing seismic instruments for use at ultralow climatic temperatures. In this paper the indicated issue is considered through the example of a seismic module designed for petroleum and gas exploration by passive seismoacoustic methods. The seismic module is a direct-burial portable unit of around 5 kg in weight, designed to continuously measure and record microseismic triaxial orthogonal (ZNE) noise in a range from 0.1 to 45 Hz during several days in autonomous mode. The functional chart of designing the seismic module was considered, and concrete conclusions were made for choosing the necessary components to meet the ultralow-temperature operational requirements. The conclusions made served for developing appropriate seismic module. In this case, the components and tools used included a SAFT MP 176065 xc low-temperature lithium cell, industrial-spec electronic component parts, a Zhaofeng Geophysical ZF-4.5 Chinese primary electrodynamic seismic sensor, housing seal parts made of frost-resistant silicone materials, and finely dispersed silica gel used as water-retaining sorbent to avoid condensation in the housing. The paper also describes a procedure of low-temperature collation tests at the lab using a New Brunswick Scientific freezing plant. The test results proved the operability of the developed equipment at ultralow temperatures down to -55°C. In addition, tests were conducted at low microseismic noises in the actual Arctic environment. The possibility to detect signals in a range from 1 to 10 Hz at the level close to the NLNM limit (the Peterson model) has been confirmed, which allows monitoring and exploring petroleum and gas deposits by passive methods. As revealed by this study, the suggested approaches are efficient in developing high-precision mobile seismic instruments for use at ultralow climatic temperatures. The solution of the considered instrumentation and methodical issues is of great practical significance as a constituent of the generic problem of Arctic exploration. Keywords: Seismic instrumentation,microseismic monitoring,Peterson model,geological exploration,temperature ratings,cooling test, Refference: I. AD797: Ultralow Distortion, Ultralow Noise Op Amp, Analog Devices, Inc., Data Sheet (Rev. K). Analog Devices, Inc. URL: https://www.analog.com/media/en/technical-documentation/data-sheets/AD797.pdf(Date of access September 2, 2019). II. Agafonov, V. M., Egorov, I. V., and Shabalina, A. S. Operating Principles and Technical Characteristics of a Small-Sized Molecular–Electronic Seismic Sensor with Negative Feedback [Printsipyraboty I tekhnicheskiyekharakteristikimalogabaritnogomolekulyarno-elektronnogoseysmodatchika s otritsatel’noyobratnoysvyaz’yu]. SeysmicheskiyePribory (Seismic Instruments). 2014; 50 (1): 1–8. DOI: 10.3103/S0747923914010022. III. Antonovskaya, G., Konechnaya, Ya.,Kremenetskaya, E., Asming, V., Kvaema, T., Schweitzer, J., Ringdal, F. Enhanced Earthquake Monitoring in the European Arctic. Polar Science. 2015; 1 (9): 158-167. IV. Anthony, R. E., Aster, R. C., Wiens, D., Nyblade, Andr., Anandakrishnan, Sr., Huerta, Audr., Winberry, J. P., Wilson, T., and Rowe, Ch. The Seismic Noise Environment of Antarctica. Seismological Research Letters. 2015; 86(1): 89-100. DOI: 10.1785/0220150005 V. Brincker, R., Lago, T. L., Andersen, P., and Ventura, C. Improving the Classical Geophone Sensor Element by Digital Correction. In Conference Proceedings: IMAC-XXIII: A Conference & Exposition on Structural Dynamics Society for Experimental Mechanics, 2005. URL: https://www.researchgate.net/publication/242452637_Improving_the_Classical_Geophone_Sensor_Element_by_Digital_Correction(Date of access September 2, 2019). VI. Bylaw 164 of the State Committee for Construction of the Russian Federation “On adopting amendments to SNiP 31-01-99 “Construction climatology”. URL: https://base.garant.ru/2322381/(Date of access September 2, 2019). VII. Chao Xu, Junbo Wang, Deyong Chen, Jian Chen, Bowen Liu, Wenjie Qi, XichenZheng, Hua Wei, Guoqing Zhang. The Electrochemical Seismometer Based on a Novel Designed.Sensing Electrode for Undersea Exploration. 20th International Conference on Solid-State Sensors, Actuators and Microsystems &Eurosensors XXXIII (TRANSDUCERS &EUROSENSORS XXXIII). IEEE, 2019. DOI: 10.1109/TRANSDUCERS.2019.8808450. VIII. Chebotareva, I. Ya. New algorithms of emission tomography for passive seismic monitoring of a producing hydrocarbon deposit: Part I. Algorithms of processing and numerical simulation [Novyye algoritmyemissionnoyto mografiidlyapassivnogoseysmicheskogomonitoringarazrabatyvayemykhmestorozhdeniyuglevodorodov. Chast’ I: Algoritmyobrabotki I chislennoyemodelirovaniye]. FizikaZemli. 2010; 46(3):187-98. DOI: 10.1134/S106935131003002X IX. Danilov, A. V. and Konechnaya, Ya. V. Analytical comparison of seismic instruments for stationary surveys in the Arctic [Sravnitel’nyyanalizseysmicheskoyapparaturydlyastatsionarnykhnablyudeniy v Arktike]. DSYS. URL: https://dsys.ru/upload/id254_docPDF_FranzJosefLand.pdf(Date of access September 2, 2019). X. Dew point temperature calculator. Maple Tech. International LLC. URL: https://www.calculator.net/dew-point-calculator.html?airtemperature=20&airtemperatureunit=celsius&humidity=0.34&dewpoint=&dewpointunit=celsius&x=51&y=14(Date of access September 2, 2019). XI. Frolov, A. S. Matching of wave fields recorded by different geophysical receivers [Soglasovaniyevolnovykhpoley, poluchennykh s primeneniyemrazlichnoyregistriruyushcheyapparatury]. Abstracts IX International scientific and technical conference competition of young specialists “Geophysics-2013”. Saint-Petersburg: Gubkin University, 2013. URL: https://www.gubkin.ru/faculty/geology_and_geophysics/chairs_and_departments/exploration_geophysics_and_computers_systems/files/2013_SPb_Frolov.pdf. (Date of access September 2, 2019). XII. Gibbons, S. J., Asming, V., Fedorov, A., Fyen, J., Kero, J., Kozlovskaya, E., Kværna, T., Liszka, L., Näsholm, S.P., Raita, T., Roth, M., Tiira, T., Vinogradov, Yu. The European Arctic: A laboratory for seismoacoustic studies. Seism. Res. Letters. 2015; 86 (3): 917–928. XIII. GOST 8.395-80. State system for ensuring the uniformity of measurements. Reference conditions of measurements while calibrating. General requirements [Gosudarstvennayasistemaobespecheniyaedinstvaizmereniy. Normal’nyyeusloviyaizmereniypripoverke. Obshchiyetrebovaniya]. Moscow: Standartinform, 2008. URL: http://gostrf.com/normadata/1/4294821/4294821960.pdf (Date of access September 2, 2019). XIV. Guralp 6TD. Operators’ Guide. Document Number: MAN-T60-0002, Issue J: April, 2017. Guralp Systems Limited. URL: https://www.guralp.com/documents/MAN-T60-0002.pdf (Date of access September 2, 2019). XV. Inshakova, A. S., Barykina, E. S., and Kozlov, V. V. Role of silica gel in adsorption air drying [Rol’ silikagelya v adsorbtsionnoyosushkevozdukha]. AlleyaNauki (Alley of Science). 2017; 15. URL: https://www.alley- science.ru/domains_data/files/November2017/ROL%20SILIKAGELYa%20V%20ADSORBCIONNOY%20OSUShKE%20VOZDUHA.pdf(Date of access September 2, 2019). XVI. Ioffe, D. and Pozdnyakov, P. Searching for Hidden Reserves of Modern Microchip Circuits. Part I [Poiskskrytykhrezervovsovremennykhmikroskhem. Chast’ I].Komponenty I tekhnologii (Components and Technologies). 2015; 4: 144-46. XVII. Jiang Xu, Xi Wang, Ningyi Yuan, Jianning Ding, Si Qin, Joselito M. Razal, Xuehang Wang, ShanhaiGe, Gogotsi, Yu. Extending the low temperature operational limit of Li-ion battery to −80 °C. Energy Storage Materials (IF0). Published 2019-04-27. DOI: 10.1016/j.ensm.2019.04.033. XVIII. Kouznetsov, O. L., Lyasch, Y. F., Chirkin, I. A., Rizanov, E. G., LeRoy, S. D., Koligaev, S. O. Long-term monitoring of microseismic emissions: Earth tides, fracture distribution, and fluid content. SEG, APPG Interpretation. 2016: 4 (2): T191–T204. XIX. Laverov, N. P., Bogoyavlenskiy, V. I., Bogoyavlenskiy, I. V. Fundamental Aspects of Rational Management of the Petroleum and Gas Resources of the Arctic and the Russian Continental Shelf: Strategy, Prospects, and Problems [Fundamental’nyyeaspektyratsional’nogoosvoyeniyaresursovneftiigazaArktiki I shel’faRossii: strategiya, perspektivyi problem].Arktika: ekologiya I ekonomika [Arctic: Ecology and Economy]. 2016; 2 (22): 4-13. XX. Lee, P. Low Noise Amplifier Selection Guide for Optimal Noise Performance, Analog Devices, Inc., AN-940 Application Note. Analog Devices, Inc. URL: https://www.analog.com/media/en/technical-documentation/application-notes/AN-940.pdf(Date of access September 2, 2019). XXI. Markatis, N., Polychronopoulou, K., Tselentis, Ak. Passive seismic tomography: A passive concept actively evolving. First Break. 2012; 30 (7): 83-90. XXII. Matveev, I. V. and Matveeva, N. V. Portable seismic recorder “SEISAR-5” with very low energy consumption for autonomous work in harsh climatic conditions [Portativnyyseysmicheskiyregistrator «Seysar-5» s ochen’ nizkimenergopotrebleniyemdlyaavtonomnoyraboty v slozhnykhklimatic heskikhusloviyakh]. Nauka I tekhnologicheskierazrabotki (Science and Technological Developments). 2017; 96 (3): 33-40. [Special Issue “Applied Geophysics: New Developments and Results. Part 1. Seismology and Seismic Exploration]. DOI: 10.21455/std2017.3-3. XXIII. Mishra, R. The Temperature Ratings of Electronic Parts.Electronics Cooling magazine. URL: http://www.electronics-cooling.com/2004/02/the-temperature-ratings-of-electronic-parts(Date of access September 2, 2019). XXIV. Moore, Sue E.; Stabeno, Phyllis J.; Van Pelt, Thomas I. The Synthesis of Arctic Research (SOAR) project. Deep-Sea Research Part II. 152: 1-7. DOI: 10.1016/j.dsr2.2018.05.013. XXV. MS-SPORT Viscous Silicone Lubricant with Fluoroplastic. ToR2257-010-45540231-2003. OOO VMPAUTO, URL: https://smazka.ru/attachments/get/469/ms-sport-tds.pdf(Date of access September 2, 2019). XXVI. New Brunswick™ Premium -86 °C Freezers. Operating manual. URL: https://www.eppendorf.com/product-media/doc/en/142770_Operating-Manual/New-Brunswick_Freezers_Operating-manual-86-C-Premium-Freezers.pdf(Date of access September 2, 2019). XXVII. New seismic digitizer/recorder for passive seismic monitoring applications. LandTech Enterprises. URL: http://www.landtechsa.com/Images/Instrument/SRi32L/SRi32L.pdf(Date of access September 2, 2019). XXVIII. Parker, T., Winberry, P., Huerta, A., Bainbridge, G., Devanney, P. Direct Burial Broadband Seismic Instrumentation for Polar Environments. Nanometrics Inc. URL: https://www.nanometrics.ca/sites/default/files/2017-11/direct_burial_bb_seismic_instrumentation_for_polar_environments.pdf. (Date of access September 2, 2019). XXIX. Peterson, J. Observation and Modeling of Seismic Background Noise. Albuquerque, New Mexico: US Department of Interior Geological Survey, 1993. XXX. Razinkov, O.G., Sidorov-Biryukov, D. D., Townsend, B., Parker, T., Bainbridge, G., Greiss, R. Strengths and Applications of Direct Burial Seismic Instruments [Preimushchestva I oblastiprimeneniyaseysmicheskikhpriborovdlyapryamoyustanovki v grunt] in Proc. VI Sci. Tech. Conf. “Problems of Complex Geophysical Monitoring of the Russian Far East”, Petropavlovsk-Kamchatskiy: Geophysical Survey, Russian Academy of Sciences, 2017. URL: http://www.emsd.ru/conf2017lib/pdf/techn/razinkov.pdf (Date of access September 2, 2019). XXXI. Roux, Ph., Wathelet, M., Roueff, Ant. The San Andreas Fault revisited through seismic-noise and surface-wave tomography. Geophysical Research Letters. 2011; 38 (13). DOI: 10.1029/2011GL047811. XXXII. Rubber O-ring seals for hydraulic and pneumatic equipment. Specifications [Kol’tsarezinovyyeuplotnitel’nyyekruglogosecheniyadlyagidravlicheskikh I pnevmaticheskikhustroystv. Tekhnicheskiyeusloviya]. GOST 18829-2017 Interstate standard. Moscow: Standartinform, 2017. URL: https://files.stroyinf.ru/Data/645/64562.pdf (Date of access September 2, 2019). XXXIII. Sanina, I., Gabsatarova, I., Chernykh, О.,Riznichenko, О., Volosov, S., Nesterkina, M., Konstantinovskaya, N. The Mikhnevo small aperture array enhances the resolution property of seismological observations on the East European Platform. Journal of Seismology (JOSE). 2011; 15 (3): 545-56. (DOI: 10.1007/sl0950-010-9211-х). XXXIV. SM-3VK Magnetoelectric Seismic Pickup. Specifications. ToR-4314-001-02698826-01. N. Laverov Federal Centre for Integrated Arctic Research, Russian Academy of Sciences. URL: http://fciarctic.ru/index.php?page=ckpg (Date of access September 2, 2019). XXXV. Sobisevich, A. L.,Presnov, D. A.,Agafonov, V. M.,Sobisevich, L. E. Autonomous geohydroacoustic ice buoy of new generation [Vmorazhivayemyyavtonomnyygeogidroakusticheskiy buy novogopokoleniya]. Nauka I tekhnologicheskierazrabotki (Science and Technological Developments). 2018; 97 (1): 25–34. [Special issue “Precise Geophysical Monitoring of Natural Hazards. Part 1. Instruments andTechnologies”]. DOI: 10.21455/ std2018.1-3. XXXVI. Zhukov, Y. V. Issues of resistance and reliability of electronic equipment products to the exposure factors [Voprosystoykosti i nadezhnostiizdeliyradioelektronnoytekhniki k vneshnimvozdeystvuyushchimfaktoram]. Provintsial’nyyenauchnyyezapiski (The journal Provincial scientific proceedings). 2019; 1 (9): 118-124. View | Download COMPARATIVE ANALYSIS OF RESULTS OF TREATMENT OF PATIENTS WITH FOOT PATHOLOGY WHO UNDERWENT WEIL OPEN OSTEOTOMY BY CLASSICAL METHOD AND WITHOUT STEOSYNTHESIS Authors: Yuriy V. Lartsev,Dmitrii A. Rasputin,Sergey D. Zuev-Ratnikov,Pavel V.Ryzhov,Dmitry S. Kudashev,Anton A. Bogdanov, DOI: https://doi.org/10.26782/jmcms.spl.10/2020.06.00044 Abstract: The article considers the problem of surgical correction of the second metatarsal bone length. The article analyzes the results of treatment of patients with excess length of the second metatarsal bones that underwent osteotomy with and without osteosynthesis. The results of treatment of patients who underwent metatarsal shortening due to classical Weil-osteotomy with and without osteosynthesis were analyzed. The first group consisted of 34 patients. They underwent classical Weil osteotomy. The second group included 44 patients in whomosteotomy of the second metatarsal bone were not by the screw. When studying the results of the treatment in the immediate postoperative period, weeks 6, 12, slightly better results were observed in patients of the first group, while one year after surgical treatment the results in both groups were comparable. One year after surgical treatment, there were 2.9% (1 patient) of unsatisfactory results in the first group and 4.5% (2 patients) in the second group. Considering the comparability of the results of treatment in remote postoperative period, the choice of concrete method remains with the operating surgeon. Keywords: Flat feet,hallux valgus,corrective osteotomy,metatarsal bones, Refference: I. A novel modification of the Stainsby procedure: surgical technique and clinical outcome [Text] / E. Concannon, R. MacNiocaill, R. Flavin [et al.] // Foot Ankle Surg. – 2014. – Dec., Vol. 20(4). – P. 262–267. II. Accurate determination of relative metatarsal protrusion with a small intermetatarsal angle: a novel simplified method [Text] / L. Osher, M.M. Blazer, S. Buck [et al.] // J. Foot Ankle Surg. – 2014. – Sep.-Oct., Vol. 53(5). – P. 548–556. III. Argerakis, N.G. The radiographic effects of the scarf bunionectomy on rearfoot alignment [Text] / N.G. Argerakis, L.Jr. Weil, L.S. Sr. Weil // Foot Ankle Spec. – 2015. – Apr., Vol. 8(2). – P. 89–94. IV. Bauer, T. Percutaneous forefoot surgery [Text] / T. Bauer // Orthop. Traumatol. Surg. Res. – 2014. – Feb., Vol. 100(1 Suppl.). – P. S191–S204. V. Biomechanical Evaluation of Custom Foot Orthoses for Hallux Valgus Deformity [Text] // J. Foot Ankle Surg. – 2015. – Sep.-Oct., Vol.54(5). – P. 852–855. VI. Chopra, S. Characterization of gait in female patients with moderate to severe hallux valgus deformity [Text] / S. Chopra, K. Moerenhout, X. Crevoisier // Clin. Biomech. (Bristol, Avon). – 2015. – Jul., Vol. 30(6). – P. 629–635. VII. Computer assisted planning and custom-made surgical guide for malunited pronation deformity after first metatarsophalangeal joint arthrodesis in rheumatoid arthritis: a case report [Text] / M. Hirao, S. Ikemoto, H. Tsuboi [et al.] // Comput. Aided Surg. – 2014. – Vol. 19(1-3). – P. 13–19. VIII. Correlation between static radiographic measurements and intersegmental angular measurements during gait using a multisegment foot model [Text] / D.Y. Lee, S.G. Seo, E.J. Kim [et al.] // Foot Ankle Int. – 2015. – Jan., Vol.36(1). – P. 1–10. IX. Correlative study between length of first metatarsal and transfer metatarsalgia after osteotomy of first metatarsal [Text]: [Article in Chinese] / F.Q. Zhang, B.Y. Pei, S.T. Wei [et al.] // Zhonghua Yi XueZaZhi. – 2013. – Nov. 19, Vol. 93(43). – P. 3441–3444. X. Dave, M.H. Forefoot Deformity in Rheumatoid Arthritis: A Comparison of Shod and Unshod Populations [Text] / M.H. Dave, L.W. Mason, K. Hariharan // Foot Ankle Spec. – 2015. – Oct., Vol. 8(5). – P. 378–383. XI. Does arthrodesis of the first metatarsophalangeal joint correct the intermetatarsal M1M2 angle? Analysis of a continuous series of 208 arthrodeses fixed with plates [Text] / F. Dalat, F. Cottalorda, M.H. Fessy [et al.] // Orthop. Traumatol. Surg. Res. – 2015. – Oct., Vol. 101(6). – P. 709–714. XII. Dynamic plantar pressure distribution after percutaneous hallux valgus correction using the Reverdin-Isham osteotomy [Text]: [Article in Spanish] / G. Rodríguez-Reyes, E. López-Gavito, A.I. Pérez-Sanpablo [et al.] // Rev. Invest. Clin. – 2014. – Jul., Vol. 66, Suppl. 1. – P. S79-S84. XIII. Efficacy of Bilateral Simultaneous Hallux Valgus Correction Compared to Unilateral [Text] / A.V. Boychenko, L.N. Solomin, S.G. Parfeyev [et al.] // Foot Ankle Int. – 2015. – Nov., Vol. 36(11). – P. 1339–1343. XIV. Endolog technique for correction of hallux valgus: a prospective study of 30 patients with 4-year follow-up [Text] / C. Biz, M. Corradin, I. Petretta [et al.] // J. OrthopSurg Res. – 2015. – Jul. 2, № 10. – P. 102. XV. First metatarsal proximal opening wedge osteotomy for correction of hallux valgus deformity: comparison of straight versus oblique osteotomy [Text] / S.H. Han, E.H. Park, J. Jo [et al.] // Yonsei Med. J. – 2015. – May, Vol. 56(3). – P. 744–752. XVI. Long-term outcome of joint-preserving surgery by combination metatarsal osteotomies for shortening for forefoot deformity in patients with rheumatoid arthritis [Text] / H. Niki, T. Hirano, Y. Akiyama [et al.] // Mod. Rheumatol. – 2015. – Sep., Vol. 25(5). – P. 683–638. XVII. Maceira, E. Transfer metatarsalgia post hallux valgus surgery [Text] / E. Maceira, M. Monteagudo // Foot Ankle Clin. – 2014. – Jun., Vol. 19(2). – P.285–307. XVIII. Nielson, D.L. Absorbable fixation in forefoot surgery: a viable alternative to metallic hardware [Text] / D.L. Nielson, N.J. Young, C.M. Zelen // Clin. Podiatr. Med. Surg. – 2013. – Jul., Vol. 30(3). – P. 283–293 XIX. Patient’s satisfaction after outpatient forefoot surgery: Study of 619 cases [Text] / A. Mouton, V. Le Strat, D. Medevielle [et al.] // Orthop. Traumatol. Surg. Res. – 2015. – Oct., Vol. 101(6 Suppl.). – P. S217–S220. XX. Preference of surgical procedure for the forefoot deformity in the rheumatoid arthritis patients–A prospective, randomized, internal controlled study [Text] / M. Tada, T. Koike, T. Okano [et al.] // Mod. Rheumatol. – 2015. – May., Vol. 25(3). – P.362–366. XXI. Redfern, D. Percutaneous Surgery of the Forefoot [Text] / D. Redfern, J. Vernois, B.P. Legré // Clin. Podiatr. Med. Surg. – 2015. – Jul., Vol. 32(3). – P. 291–332. XXII. Singh, D. Bullous pemphigoid after bilateral forefoot surgery [Text] / D. Singh, A. Swann // Foot Ankle Spec. – 2015. – Feb., Vol. 8(1). – P. 68–72. XXIII. Treatment of moderate hallux valgus by percutaneous, extra-articular reverse-L Chevron (PERC) osteotomy [Text] / J. Lucas y Hernandez, P. Golanó, S. Roshan-Zamir [et al.] // Bone Joint J. – 2016. – Mar., Vol. 98-B(3). – P. 365–373. XXIV. Weil, L.Jr. Scarf osteotomy for correction of hallux abducto valgus deformity [Text] / L.Jr. Weil, M. Bowen // Clin. Podiatr. Med. Surg. – 2014. – Apr., Vol.31(2). – P. 233–246. View | Download QUANTITATIVE ULTRASONOGRAPHY OF THE STOMACH AND SMALL INTESTINE IN HEALTHYDOGS Authors: Roman A. Tcygansky,Irina I. Nekrasova,Angelina N. Shulunova,Alexander I.Sidelnikov, DOI: https://doi.org/10.26782/jmcms.spl.10/2020.06.00045 Abstract: Purpose.To determine the quantitative echogenicity indicators (and their ratio) of the layers of stomach and small intestine wall in healthy dogs. Methods. A prospective 3-year study of 86 healthy dogs (aged 1-7 yrs) of different breeds and of both sexes. Echo homogeneity and echogenicity of the stomach and intestines wall were determined by the method of Silina, T.L., et al. (2010) in absolute values of average brightness levels of ultrasound image pixels using the 8-bit scale with 256 shades of gray. Results. Quantitative echogenicity indicators of the stomach and the small intestine wall in dogs were determined. Based on the numerical values characterizing echogenicity distribution in each layer of a separate structure of the digestive system, the coefficient of gastric echogenicity is determined as 1:2.4:1.1 (mucosa/submucosa/muscle layers, respectively), the coefficient of duodenum and jejunum echogenicity is determined as 1:3.5:2 and that of ileum is 1:1.8:1. Clinical significance. The echogenicity coefficient of the wall of the digestive system allows an objective assessment of the stomach and intestines wall and can serve as the basis for a quantitative assessment of echogenicity changes for various pathologies of the digestive system Keywords: Ultrasound (US),echogenicity,echogenicity coefficient,digestive system,dogs,stomach,intestines, Refference: I. Agut, A. Ultrasound examination of the small intestine in small animals // Veterinary focus. 2009.Vol. 19. No. 1. P. 20-29. II. Bull. 4.RF patent 2398513, IPC51A61B8 / 00 A61B8 / 14 (2006.01) A method for determining the homoechogeneity and the degree of echogenicity of an ultrasound image / T. Silina, S. S. Golubkov. – No. 2008149311/14; declared 12/16/2008; publ. 09/10/2010 III. Choi, M., Seo, M., Jung, J., Lee, K., Yoon, J., Chang, D., Park, RD. Evaluation of canine gastric motility with ultrasonography // J. of Veterinary Medical Science. – 2002. Vol. 64. – № 1. – P. 17-21. IV. Delaney, F., O’Brien, R.T., Waller, K.Ultrasound evaluation of small bowel thickness compared to weight in normal dogs // Veterinary Radiology and Ultrasound. 2003 Vol. 44, № 5. Р 577-580. V. Diana, A., Specchi, S., Toaldo, M.B., Chiocchetti, R., Laghi, A., Cipone, M. Contrast-enhanced ultrasonography of the small bowel in healthy cats // Veterinary Radiology and Ultrasound. – 2011. – Vol. 52, № 5. – Р. 555-559. VI. Garcia, D.A.A., Froes, T.R. Errors in abdominal ultrasonography in dogs and cats // J. of Small Animal Practice. – 2012. Vol. 53. – № 9. – P. 514-519. VII. Garcia, D.A.A., Froes, T.R. Importance of fasting in preparing dogs for abdominal ultrasound examination of specific organs // J. of Small Animal Practice. – 2014. Vol. 55. – № 12. – P. 630-634. VIII. Gaschen, L., Granger, L.A., Oubre, O., Shannon, D., Kearney, M., Gaschen, F. The effects of food intake and its fat composition on intestinal echogenicity in healthy dogs // Veterinary Radiology and Ultrasound. 2016. Vol. 57. № 5. P. 546-550 IX. Gaschen, L., Kircher, P., Stussi, A., Allenspach, K., Gaschen, F., Doherr, M., Grone, A. Comparison of ultrasonographic findings with clinical activity index (CIBDAI) and diagnosis in dogs with chronic enteropathies // Veterinary radiology and ultrasound. – 2008. – Vol. 49. – № 1. – Р. 56-64. X. Gil, E.M.U. Garcia, D.A.A. Froes, T.R. In utero development of the fetal intestine: Sonographic evaluation and correlation with gestational age and fetal maturity in dogs // Theriogenology. 2015. Vol. 84, №5. Р. 681-686. XI. Gladwin, N.E. Penninck, D.G., Webster, C.R.L. Ultrasonographic evaluation of the thickness of the wall layers in the intestinal tract of dogs // American Journal of Veterinary Research. 2014. Vol. 75, №4. Р. 349-353. XII. Gory, G., Rault, D.N., Gatel, L, Dally, C., Belli, P., Couturier, L., Cauvin, E. Ultrasonographic characteristics of the abdominal esophagus and cardia in dogs // Veterinary Radiology and Ultrasound. 2014. Vol. 55, № 5. P. 552-560. XIII. Günther, C.S. Lautenschläger, I.E., Scholz, V.B. Assessment of the inter- and intraobserver variability for sonographical measurement of intestinal wall thickness in dogs without gastrointestinal diseases | [Inter-und Intraobserver-Variabilitätbei der sonographischenBestimmung der Darmwanddicke von HundenohnegastrointestinaleErkrankungen] // Tierarztliche Praxis Ausgabe K: Kleintiere – Heimtiere. 2014. Vol. 42 №2. Р. 71-78. XIV. Hanazono, K., Fukumoto, S., Hirayama, K., Takashima, K., Yamane, Y., Natsuhori, M., Kadosawa, T., Uchide, T. Predicting Metastatic Potential of gastrointestinal stromal tumors in dog by ultrasonography // J. of Veterinary Medical Science. – 2012. Vol. 74. – № 11. – P. 1477-1482. XV. Heng, H.G., Lim, Ch.K., Miller, M.A., Broman, M.M.Prevalence and significance of an ultrasonographic colonic muscularishyperechoic band paralleling the serosal layer in dogs // Veterinary Radiology and Ultrasound. 2015. Vol. 56 № 6. P. 666-669. XVI. Ivančić, M., Mai, W. Qualitative and quantitative comparison of renal vs. hepatic ultrasonographic intensity in healthy dogs // Veterinary Radiology and Ultrasound. 2008. Vol. 49. № 4. Р. 368-373. XVII. Lamb, C.R., Mantis, P. Ultrasonographic features of intestinal intussusception in 10 dogs // J. of Small Animal Practice. – 2008. Vol. 39. – № 9. – P. 437-441. XVIII. Le Roux, A. B., Granger, L.A., Wakamatsu, N, Kearney, M.T., Gaschen, L.Ex vivo correlation of ultrasonographic small intestinal wall layering with histology in dogs // Veterinary Radiology and Ultrasound.2016. Vol. 57. № 5. P. 534-545. XIX. Nielsen, T. High-frequency ultrasound of Peyer’s patches in the small intestine of young cats / T. Nielsen [et al.] // Journal of Feline Medicine and Surgery. – 2015. – Vol. 18, № 4. – Р. 303-309. XX. PenninckD.G. Gastrointestinal tract. In Nyland T.G., Mattoon J.S. (eds): Small Animal Diagnostic Ultrasound. Philadelphia: WB Saunders. 2002, 2nd ed. Р. 207-230. XXI. PenninckD.G. Gastrointestinal tract. In: PenninckD.G.,d´Anjou M.A. Atlas of Small Animal Ultrasonography. Blackwell Publishing, Iowa. 2008. Р. 281-318. XXII. Penninck, D.G., Nyland, T.G., Kerr, L.Y., Fisher, P.E. Ultrasonographic evaluation of gastrointestinal diseases in small animals // Veterinary Radiology. 1990. Vol. 31. №3. P. 134-141. XXIII. Penninck, D.G.,Webster, C.R.L.,Keating, J.H. The sonographic appearance of intestinal mucosal fibrosis in cats // Veterinary Radiology and Ultrasound. – 2010. – Vol. 51, № 4. – Р. 458-461. XXIV. Pollard, R.E.,Johnson, E.G., Pesavento, P.A., Baker, T.W., Cannon, A.B., Kass, P.H., Marks, S.L. Effects of corn oil administered orally on conspicuity of ultrasonographic small intestinal lesions in dogs with lymphangiectasia // Veterinary Radiology and Ultrasound. 2013. Vol. 54. № 4. P. 390-397. XXV. Rault, D.N., Besso, J.G., Boulouha, L., Begon, D., Ruel, Y. Significance of a common extended mucosal interface observed in transverse small intestine sonograms // Veterinary Radiology and Ultrasound. 2004. Vol. 45. №2. Р. 177-179. XXVI. Sutherland-Smith, J., Penninck, D.G., Keating, J.H., Webster, C.R.L. Ultrasonographic intestinal hyperechoic mucosal striations in dogs are associated with lacteal dilation // Veterinary Radiology and Ultrasound. – 2007. Vol. 48. – № 1. – P. 51-57. View | Download EVALUATION OF ADAPTIVE POTENTIAL IN MEDICAL STUDENTS IN THE CONTEXT OF SEASONAL DYNAMICS Authors: Larisa A. Merdenova,Elena A. Takoeva,Marina I. Nartikoeva,Victoria A. Belyayeva,Fatima S. Datieva,Larisa R. Datieva, DOI: https://doi.org/10.26782/jmcms.spl.10/2020.06.00046 Abstract: The aim of this work was to assess the functional reserves of the body to quantify individual health; adaptation, psychophysiological characteristics of the health quality of medical students in different seasons of the year. When studying the temporal organization of physiological functions, the rhythm parameters of physiological functions were determined, followed by processing the results using the Cosinor Analysis program, which reveals rhythms with an unknown period for unequal observations, evaluates 5 parameters of sinusoidal rhythms (mesor, amplitude, acrophase, period, reliability). The essence of desynchronization is the mismatch of circadian rhythms among themselves or destruction of the rhythms architectonics (instability of acrophases or their disappearance). Desynchronization with respect to the rhythmic structure of the body is of a disregulatory nature, most pronounced in pathological desynchronization. High neurotism, increased anxiety reinforces the tendency to internal desynchronization, which increases with stress. During examination stress, students experience a decrease in the stability of the temporary organization of the biosystem and the tension of adaptive mechanisms develops, which affects attention, mental performance and the quality of adaptation to the educational process. Time is shortened and the amplitude of the “initial minute” decreases, personal and situational anxiety develops, and the level of psychophysiological adaptation decreases. The results of the work are priority because they can be used in assessing quality and level of health. Keywords: Desynchronosis,biorhythms,psycho-emotional stress,mesor,acrophase,amplitude,individual minute, Refference: I. Arendt, J., Middleton, B. Human seasonal and circadian studies in Antarctica (Halley, 75_S) – General and Comparative Endocrinology. 2017: 250-259. (http://dx.doi.org/10.1016/j.ygcen.2017.05.010). II. BalandinYu.P. A brief methodological guide on the use of the agro-industrial complex “Health Sources” / Yu.P. Balandin, V.S. Generalov, V.F. Shishlov. Ryazan, 2007. III. Buslovskaya L.K. Adaptation reactions in students at exam stress/ L.K. Buslovskaya, Yu.P. Ryzhkova. Scientific bulletin of Belgorod State University. Series: Natural Sciences. 2011;17(21):46-52. IV. Chutko L. S. Sindromjemocionalnogovygoranija – Klinicheskie I psihologicheskieaspekty./ L.S Chutko. Moscow: MEDpress-inform, 2013. V. Eroshina K., Paul Wilkinson, Martin Mackey. The role of environmental and social factors in the occurrence of diseases of the respiratory tract in children of primary school age in Moscow. Medicine. 2013:57-71. VI. Fagrell B. “Microcirculation of the Skin”. The physiology and pharmacology of the microcirculation. 2013:423. VII. Gurova O.A. Change in blood microcirculation in students throughout the day. New research. 2013; 2 (35):66-71. VIII. Khetagurova L.G. – Stress/Ed. L.G. Khetagurov. Vladikavkaz: Project-Press Publishing House, 2010. IX. Khetagurova L.G., Urumova L.T. et al. Stress (chronomedical aspects). International Journal of Experimental Education 2010; 12: 30-31. X. Khetagurova L.G., Salbiev K.D., Belyaev S.D., Datieva F.S., Kataeva M.R., Tagaeva I.R. Chronopathology (experimental and clinical aspects/ Ed. L.G. Khetagurov, K.D. Salbiev, S.D.Belyaev, F.S. Datiev, M.R. Kataev, I.R. Tagaev. Moscow: Science, 2004. XI. KlassinaS.Ya. Self-regulatory reactions in the microvasculature of the nail bed of fingers in person with psycho-emotional stress. Bulletin of new medical technologies, 2013; 2 (XX):408-412. XII. Kovtun O.P., Anufrieva E.V., Polushina L.G. Gender-age characteristics of the component composition of the body in overweight and obese schoolchildren. Medical Science and Education of the Urals. 2019; 3:139-145. XIII. Kuchieva M.B., Chaplygina E.V., Vartanova O.T., Aksenova O.A., Evtushenko A.V., Nor-Arevyan K.A., Elizarova E.S., Efremova E.N. A comparative analysis of the constitutional features of various generations of healthy young men and women in the Rostov Region. Modern problems of science and education. 2017; 5:50-59. XIV. Mathias Adamsson1, ThorbjörnLaike, Takeshi Morita – Annual variation in daily light expo-sure and circadian change of melatonin and cortisol consent rations at a northern latitude with large seasonal differences in photoperiod length – Journal of Physiological Anthropology. 2017; 36: 6 – 15. XV. Merdenova L.A., Tagaeva I.R., Takoeva E.A. Features of the study of biological rhythms in children. The results of fundamental and applied research in the field of natural and technical sciences. Materials of the International Scientific and Practical Conference. Belgorod, 2017, pp. 119-123. XVI. Ogarysheva N.V. The dynamics of mental performance as a criterion for adapting to the teaching load. Bulletin of the Samara Scientific Center of the Russian Academy of Sciences. 2014;16:5 (1): S.636-638. XVII. Pekmezovi T. Gene-environment interaction: A genetic-epidemiological approach. Journal of Medical Biochemistry. 2010;29:131-134. XVIII. Rapoport S.I., Chibisov S.M. Chronobiology and chronomedicine: history and prospects/Ed. S.M. Chibisov, S.I. Rapoport ,, M.L. Blagonravova. Chronobiology and Chronomedicine: Peoples’ Friendship University of Russia (RUDN) Press. Moscow, 2018. XIX. Roustit M., Cracowski J.L. “Non-invasive assessment of skin microvascular function in humans: an insight into methods” – Microcirculation 2012; 19 (1): 47-64. XX. Rud V.O., FisunYu.O. – References of the circadian desinchronosis in students. Ukrainian Bulletin of Psychoneurology. 2010; 18(2) (63): 74-77. XXI. Takoeva Z. A., Medoeva N. O., Berezova D. T., Merdenova L. A. et al. Long-term analysis of the results of chronomonitoring of the health of the population of North Ossetia; Vladikavkaz Medical and Biological Bulletin. 2011; 12(12,19): 32-38. XXII. Urumova L.T., Tagaeva I.R., Takoeva E.A., Datieva L.R. – The study of some health indicators of medical students in different periods of the year. Health and education in the XXI century. 2016; 18(4): 94-97. XXIII. Westman J. – Complex diseases. In: Medical genetics for the modern clinician. USA: Lippincott Williams & Wilkins, 2006. XXIV. Yadrischenskaya T.V. Circadian biorhythms of students and their importance in educational activities. Problems of higher education. Pacific State University Press. 2016; 2:176-178. View | Download TRIADIC COMPARATIVE ANALYSIS Authors: Stanislav A.Kudzh,Victor Ya. Tsvetkov, DOI: https://doi.org/10.26782/jmcms.spl.10/2020.06.00047 Abstract: The present study of comparison methods based on the triadic model introduces the following concepts: the relation of comparability and the relation of comparison, and object comparison and attributive comparison. The difference between active and passive qualitative comparison is shown, two triadic models of passive and active comparison and models for comparing two and three objects are described. Triadic comparison models are proposed as an alternative to dyadic comparison models. Comparison allows finding the common and the different; this approach is proposed for the analysis of the nomothetic and ideographic method of obtaining knowledge. The nomothetic method identifies and evaluates the general, while the ideographic method searches for unique in parameters and in combinations of parameters. Triadic comparison is used in systems and methods of argumentation, as well as in the analysis of consistency/inconsistency. Keywords: Comparative analysis,dyad,triad,triadic model,comparability relation,object comparison,attributive comparison,nomothetic method,ideographic method, Refference: I. AltafS., Aslam.M.Paired comparison analysis of the van Baarenmodel using Bayesian approach with noninformativeprior.Pakistan Journal of Statistics and Operation Research 8(2) (2012) 259{270. II. AmooreJ. E., VenstromD Correlations between stereochemical assessments and organoleptic analysis of odorous compounds. Olfaction and Taste (2016) 3{17. III. BarnesJ., KlingerR. Embedding projection for targeted cross-lingual sentiment: model comparisons and a real-world study. Journal of Artificial Intelligence Research 66 (2019) 691{742. doi.org/10.1613/jair.1.11561 IV. Castro-SchiloL., FerrerE.Comparison of nomothetic versus idiographic-oriented methods for making predictions about distal outcomes from time series data. Multivariate Behavioral Research 48(2) (2013) 175{207. V. De BonaG.et al. Classifying inconsistency measures using graphs. Journal of Artificial Intelligence Research 66 (2019) 937{987. VI. FideliR. La comparazione. Milano: Angeli, 1998. VII. GordonT. F., PrakkenH., WaltonD. The Carneades model of argument and burden of proof. Artificial Intelligence 10(15) (2007) 875{896. VIII. GrenzS.J. The social god and the relational self: A Triad theology of the imago Dei. Westminster: John Knox Press, 2001. IX. HermansH.J. M.On the integration of nomothetic and idiographic research methods in the study of personal meaning.Journal of Personality 56(4) (1988) 785{812. X. JamiesonK. G., NowakR. Active ranking using pairwise comparisons.Advances in Neural Information Processing Systems (2011) 2240{2248. XI. JongsmaC.Poythress’s triad logic: a review essay. Pro Rege 42(4) (2014) 6{15. XII. KärkkäinenV.M. Trinity and Religious Pluralism: The Doctrine of the Trinity in Christian Theology of Religions. London: Routledge, 2017. XIII. KudzhS. A., TsvetkovV.Ya. Triadic systems. Russian Technology Magazine 7(6) (2019) 74{882. XIV. NelsonK.E.Some observations from the perspective of the rare event cognitive comparison theory of language acquisition.Children’s Language 6 (1987) 289{331. XV. NiskanenA., WallnerJ., JärvisaloM.Synthesizing argumentation frameworks from examples. Journal of Artificial Intelligence Research 66 (2019) 503{554. XVI. PührerJ.Realizability of three-valued semantics for abstract dialectical frameworks.Artificial Intelligence 278 (2020) 103{198. XVII. SwansonG.Frameworks for comparative research: structural anthropology and the theory of action. In: Vallier, Ivan (Ed.). Comparative methods in sociology: essays on trends and applications.Berkeley: University of California Press, 1971 141{202. XVIII. TsvetkovV.Ya.Worldview model as the result of education.World Applied Sciences Journal 31(2) (2014) 211{215. XIX. TsvetkovV. Ya. Logical analysis and variable scales. Slavic Forum 4(22) (2018) 103{109. XX. Wang S. et al. Transit traffic analysis zone delineating method based on Thiessen polygon. Sustainability 6(4) (2014) 1821{1832. View | Download DEVELOPING TECHNOLOGY OF CREATING WEAR-RESISTANT CERAMIC COATING FOR ICE CYLINDER". JOURNAL OF MECHANICS OF CONTINUA AND MATHEMATICAL SCIENCES spl10, № 1 (28 червня 2020). http://dx.doi.org/10.26782/jmcms.spl.10/2020.06.00048.

Повний текст джерела

Стилі APA, Harvard, Vancouver, ISO та ін.

Статті в журналах з теми "Patient monitoring Victoria Equipment and supplies"

Оформте джерело за APA, MLA, Chicago, Harvard та іншими стилями