ANALYSIS OF THE BEST PRACTICES OF IMPLEMENTING LEAN PROJECT AND PROGRAM MANAGEMENT TECHNOLOGIES IN RUSSIA

This article considers the principles and tools of lean management. The paper gives practical examples of the implementation of the concept of lean production in large Russian organizations, in state and municipal institutions. The analysis showed that there are many opportunities for improving operational and project activities that justify the introduction of a lean approach in organizations. The problems in understanding the need for lean production arise since people are generally reluctant to change established processes, but positive follow-up examples contribute to the success of implementing lean management and help in developing adequate development strategies for companies and government agencies

Pre- and postoperative left atrial appendage visualization: selecting the optimal method

Background: Atrial fibrillation (AF) is reported to be one of the main etiological factors of ischemic stroke. Transcatheter occlusion of the left atrial appendage (LAAO) is an alternative to anticoagulant therapy in the thromboembolism prevention in atrial fibrillation patients with a high bleeding risk. The role of contrast-enhanced cardiac computed tomography (CT) for preoperative assessment and postoperative control has not been sufficiently studied to the present moment.Objective: Comparison of the possibilities of transesophageal echocardiography (TEE) and computed tomography in pre- and postoperative imaging in the context of LAAO interventions.Material and methods: This retrospective cohort study included 38 patients divided into 2 groups: in the first group TEE was used for intervention planning and postoperative control, patients of the second group were examined with CT. The indicators obtained during LAA measurements were assessed, as well as the result of the intervention – according to the risk of peripheral leakage into the left atrial appendage.Results: The average left atrial appendage depth and orifice diameter according to transesophageal echocardiography were significantly smaller compared to computed tomography data (25.58 ± 4.65 versus 31.05 ± 6.41, p = 0.011; 17.21 ± 2.70 versus 18.55 ± 3.05 p = 0,006, respectively). In the computed tomography group, there was a not statistically significant trend towards a lower risk of leakage for 4–5 mm leaks (RR = 0.500; 95% CI 0.060–3.710) and for 2–3 mm leaks (RR = 0.500; 95% CI 0.150–1.540). In addition, 45 days after the intervention computed tomography revealed 5 cases of incomplete endothelialization of the device with the contrast agent leak into the LAA in the absence of peripheral leakage.Conclusion: Contrast-enhanced cardiac computed tomography, unlike transesophageal echocardiography, allows to detect incomplete occlusive device endothelialization, which may influence the choice of postoperative antithrombotic therapy. The use of computed tomography in an intervention planning for the LAAO may reduce the risk of peripheral leakage, however, this hypothesis needs to be confirmed in studies with a larger number of patients

Принципиальное значение запрета на поворот к худшему для уголовно-процессуальной системы

The article deals with the problem of the expediency of a criminal case’s returning to the prosecutor at the stage of appointment and preparation of a court session in Russian criminal proceedings. This problem is relevant to the science of criminal procedure.The purpose of the study is to analyze critically the practice of returning of a criminal case back to the prosecutor in order to correct mistakes made at the pre-trial stages of the proceedings according to the new concept of justice independence and the absence of an accusatory bias in the court functioning.The methodological basis of the study is a set of scientific techniques, focused mostly on the dialectical approach, which made it possible to determine the essential characteristics of the prohibition to turn the criminal proceedings in Russia for the worse. Both general scientific (analysis, synthesis, systematic method) and specific scientific methods (formal-legal, historical-legal, comparative-legal) of knowledge were also used. The analysis helped to formulate the position of understanding the turn for the worse as an independent principle of criminal procedural law, to study the procedural form of the turn for the worse. The synthesis method made it possible to determine the return of the criminal case to the prosecutor at the stage of appointment and preparation of the court session as a holistic institution of the criminal procedure. The systematic approach allowed to determine not only the mixed nature of the mechanism for changing the prosecution to a more serious one, but the investigative organization of pre-trial proceedings and its place in the structure of criminal proceedings, the separation of the investigative and “accusatory powers” of the prosecutors as well as their balance. The historical method let us trace the evolution of the prohibition to turn the Soviet and Russian criminal procedural systems for the worse. The comparative-legal method made it possible to assess the potential of domestic legislators' reception of foreign experience of regulating the prohibition to turn for the worse and formulate proposals to improve the Russian criminal procedural legislation.The main scientific results of this research consist of justification of the conclusion of the conversion expediency of the domestic judicial proceedings to the adversarial model of accusation which is carried out within the trial on the previously filed charge. The presentation of a new charge (criminal action) in court and the procedure of supplementing the charge change it for the worse. This model of re-indictment for the worse for the defendant appears to be fairer and more convenient both for the prosecuting authority and for the legal organization of combating crime. The changeover to the suggested form of implementation of the ban to turn for the worse in the institution of bringing and changing charges in court is possible only in a systematic link with the reform of the preliminary investigation. Conclusion. The institution of the criminal case returning by the court to the prosecutor in order to change the charge to a more serious one when implementing the adversarial model of bringing charges in the criminal procedure system of Russia will fully satisfy the concept of independence of justice administration and the absence of an accusatory bias in the activities of the court, while at the same time with fairly organized the prosecutorial power aimed at countering crime.The section 1 was prepared by N.N. Lysov, section 2 by K.D. Vanyan (together with M.T. Tashilin), section 3 by A.S. Shuisky (together with I.R. Gilmanov), section 4 by V.V. Kosterin.Исследование посвящено актуальной для уголовно-процессуальной науки проблеме целесообразности существования в российском уголовном судопроизводстве института возвращения прокурору уголовного дела на стадии назначения и подготовки судебного заседания. По мнению авторов, запрет на поворот к худшему имеет более фундаментальное значение для уголовно-процессуальной системы, чем ему обычно приписывает теория. Справедливость и эффективность процедуры возвращения судом дела на доследование, позволяющей следователю изменить положение подсудимого посредством предъявления нового обвинения, сомнительны. Предпочтительнее выглядит модель изменения государственным обвинителем обвинения в суде с соблюдением состязательной процедуры, существующая в ряде государств, имеющих состязательный тип уголовного судопроизводства.Раздел 1 подготовлен Н.Н. Лысовым, раздел 2 – К.Д. Ванян (совместно с М.Т. Тащилиным ), раздел 3 – А.С. Шуйским (совместно с И.Р. Гильмановым), раздел 4 – В.В. Костериным

Efficacy of Esophageal Protector in Treating Gastroesophageal Reflux Disease with Extraesophageal Symptoms: a Multicenter, Open-Label, Observational Study

Aim: to assess effects of esophageal protector Alfasoxx on extraesophageal symptoms in patients with GERD.Materials and methods. A prospective open multicenter post-registration observational study was conducted. The study included 546 patients aged 6 to 85 years (the average age of patients is 42.4 ± 16.9 years) with a verified diagnosis of GERD (endoscopically and/or pH-metrically), the presence of extraesophageal symptoms of the disease (according to the results of an objective examination and consultations of specialists), to whom the attending physician prescribed a course of treatment with a medical device Alfasoxx in accordance with the instructions for medical use. The patients were recruited by 51 researchers in 26 cities of Russia. The study in chronological order consisted of a screening visit and two recorded visits (the observation period within the framework of the use of the Alfasoxx esophagoprotector). The screening visit was conducted on the day of the patient's admission. Visit 1 could be conducted on the same day as the screening visit, whereas visit 2 was conducted 4–5 weeks after visit 1 at the end of the course of treatment.Results. According to the results obtained, at the end of the study, 42.7 % (95 % CI: 38.5–46.9) had complete disappearance of extraesophageal GERD symptoms (questionnaire RSI = 0 points). When comparing the average values of the total RSI score before and after treatment, there was also a statistically significant regression from 13.8 points (95 % CI: 13.2–14.4) at visit 1 to 2.0 points (95 % CI: 1.8–2.2) at visit 2. Thus, the decrease in the total score was significant and exceeded 80 % of the initial value. When analyzing the dynamics of individual indicators of the RSI scale before and after treatment, a significant regression in the severity of all symptoms of the disease was noted. In addition, the results showed that the proportion of patients taking antacid-containing drugs at visit 1 significantly decreased from 58.2 % (95 % CI: 54.0–62.4) to 15.2 % (95 % CI: 12.1–18.3) by visit 2. The average score on the Likert scale of satisfaction with treatment was 4.8 (95 % CI: 4.8–4.9), whereas the convenience of using Alfasoxx is 4.7.Conclusion. This prospective observational multicenter study demonstrated that the addition of Alfasoxx to standard GERD therapy contributes to a significant regression of both esophageal and extraesophageal symptoms, as well as a decrease in the need for antacid medications

АНАЛИЗ ИЗМЕНЕНИЙ ПОКАЗАТЕЛЕЙ СЫВОРОТОЧНОГО ЦИСТАТИНА С, КРЕАТИНИНА И РЕНАЛЬНОГО ЛИПОКАЛИНА, АССОЦИИРОВАННОГО С ЖЕЛАТИНАЗОЙ НЕЙТРОФИЛОВ, У БОЛЬНЫХ ГЕМОРРАГИЧЕСКОЙ ЛИХОРАДКОЙ С ПОЧЕЧНЫМ СИНДРОМОМ

Introduction. Acute kidney injury is a frequent complication of hemorrhagic fever with renal syndrome. The objective evaluation of аcute kidney injury severity degree is significant in determining the amount of medical actions at hemorrhagic fever with renal syndrome.Objective. Тhe shifts of acute kidney injury biomarkers’ levels (urine neutrophil gelatinase-associated lipocalin, serum cystatin C and serum creatinine) at different periods of hemorrhagic fever with renal syndrome were evaluated.Methods. Depending to hemorrhagic fever with renal syndrome severity the patients were divided into groups with severe (n=16) and moderate form of hemorrhagic fever with renal syndrome (n=10); the control group included 10 healthy individuals. The levels of biomarkers were measured by ELISA.Results. Тhe serum concentration of creatinine and cystatin C – markers of glomerular pathology – increased significantly in hemorrhagic fever with renal syndrome, peaking at oligouric period; while changes of cystatin C were more rapid. Urine neutrophil gelatinase-associated lipocalin level – marker of renal tubular damage – increased 30 to 96 times compared to the control group in fever period of hemorrhagic fever with renal syndrome and gradually decreased thereafter.Conclusion. Тhe use of modern biochemical markers of renal pathology (sCystatin C, urine neutrophil gelatinaseassociated lipocalin) in hemorrhagic fever with renal syndrome, along with traditional indicators, allows a more differentiated approach to the assessment of renal pathology and gives additional evidence to highlight stage and severity of the disease.Введение. Острое повреждение почек является частым осложнением геморрагической лихорадки с почечным синдромом. Объективная оценка степени острого повреждение почек очень важна в определении объема лечебных мероприятий у больных.Цель. Провести анализ изменений концентрации биохимических маркеров острого почечного повреждения (липокалин, ассоциированный с желатиназой нейтрофилов, в моче, цистатин C и креатинин в сыворотке крови) в различные периоды геморрагической лихорадки с почечным синдромом.Методы. Больные были разделены на группы с тяжелой (n=16) и среднетяжелой (n=10) формой геморрагической лихорадки с почечным синдромом; группа контроля состояла из здоровых людей (n=10). Уровень указанных биомаркеров определяли ИФА-методом.Результаты. Концентрация сывороточного креатинина и цистатина С – маркеров гломерулярной патологии – при геморрагической лихорадке с почечным синдромом существенно повышалась, достигая максимума в олигоанурический период; при этом цистатин С проявлял большую динамичность. Концентрация липокалина, ассоциированного с желатиназой нейтрофилов, в моче, отражающая степень повреждения почечных канальцев, уже в лихорадочный период геморрагической лихорадки с почечным синдромом возрастала в 30–96 раз по сравнению с группой контроля, постепенно снижаясь в дальнейшем.Выводы. Использование современных биохимических маркеров почечной патологии при геморрагической лихорадке с почечным синдромом, наряду с традиционными показателями, позволяет более дифференцированно подходить к оценке развития патологии почечных структур, доказательно выделять стадии и судить о степени тяжести заболевания

Seasonal variation in carbon dioxide exchange over a Mediterranean annual grassland in California

Understanding how environmental variables affect the processes that regulate the carbon flux over grassland is critical for large-scale modeling research, since grasslands comprise almost one-third of the earth's natural vegetation. To address this issue, fluxes of CO{sub 2} (F{sub c}, flux toward the surface is negative) were measured over a Mediterranean, annual grassland in California, USA for 2 years with the eddy covariance method. To interpret the biotic and abiotic factors that modulate F{sub c} over the course of a year we decomposed net ecosystem CO{sub 2} exchange into its constituent components, ecosystem respiration (R{sub eco}) and gross primary production (GPP). Daytime R{sub eco} was extrapolated from the relationship between temperature and nighttime F{sub c} under high turbulent conditions. Then, GPP was estimated by subtracting daytime values of F{sub c} from daytime estimates of R{sub eco}. Results show that most of carbon exchange, both photosynthesis and respiration, was limited to the wet season (typically from October to mid-May). Seasonal variations in GPP followed closely to changes in leaf area index, which in turn was governed by soil moisture, available sunlight and the timing of the last frost. In general, R{sub eco} was an exponential function of soil temperature, but with season-dependent values of Q{sub 10}. The temperature-dependent respiration model failed immediately after rain events, when large pulses of R{sub eco} were observed. Respiration pulses were especially notable during the dry season when the grass was dead and were the consequence of quickly stimulated microbial activity. Integrated values of GPP, R{sub eco}, and net ecosystem exchange (NEE) were 867, 735, and -132g C m{sup -2}, respectively, for the 2000-2001 season, and 729, 758, and 29g C m{sup -2} for the 2001-2002 season. Thus, the grassland was a moderate carbon sink during the first season and a weak carbon source during the second season. In contrast to a well-accepted view that annual production of grass is linearly correlated to precipitation, the large difference in GPP between the two seasons were not caused by the annual precipitation. Instead, a shorter growing season, due to late start of the rainy season, was mainly responsible for the lower GPP in the second season. Furthermore, relatively higher R{sub eco} during the non-growing season occurred after a late spring rain. Thus, for this Mediterranean grassland, the timing of rain events had more impact than the total amount of precipitation on ecosystem GPP and NEE. This is because its growing season is in the cool and wet season when carbon uptake and respiration are usually limited by low temperature and sometimes frost, not by soil moisture

Seasonal variation of carbon fluxes in a sparse savanna in semi arid Sudan

<p>Abstract</p> <p>Background</p> <p>Large spatial, seasonal and annual variability of major drivers of the carbon cycle (precipitation, temperature, fire regime and nutrient availability) are common in the Sahel region. This causes large variability in net ecosystem exchange and in vegetation productivity, the subsistence basis for a major part of the rural population in Sahel. This study compares the 2005 dry and wet season fluxes of CO₂for a grass land/sparse savanna site in semi arid Sudan and relates these fluxes to water availability and incoming photosynthetic photon flux density (PPFD). Data from this site could complement the current sparse observation network in Africa, a continent where climatic change could significantly impact the future and which constitute a weak link in our understanding of the global carbon cycle.</p> <p>Results</p> <p>The dry season (represented by Julian day 35–46, February 2005) was characterized by low soil moisture availability, low evapotranspiration and a high vapor pressure deficit. The mean daily NEE (net ecosystem exchange, Eq. 1) was -14.7 mmol d^-1for the 12 day period (negative numbers denote sinks, i.e. flux from the atmosphere to the biosphere). The water use efficiency (WUE) was 1.6 mmol CO₂mol H₂O^-1and the light use efficiency (LUE) was 0.95 mmol CO₂mol PPFD^-1. Photosynthesis is a weak, but linear function of PPFD. The wet season (represented by Julian day 266–273, September 2005) was, compared to the dry season, characterized by slightly higher soil moisture availability, higher evapotranspiration and a slightly lower vapor pressure deficit. The mean daily NEE was -152 mmol d^-1for the 8 day period. The WUE was lower, 0.97 mmol CO₂mol H₂O^-1and the LUE was higher, 7.2 <it>μ</it>mol CO₂mmol PPFD^-1during the wet season compared to the dry season. During the wet season photosynthesis increases with PPFD to about 1600 <it>μ</it>mol m^-2s^-1and then levels off.</p> <p>Conclusion</p> <p>Based on data collected during two short periods, the studied ecosystem was a sink of carbon both during the dry and wet season 2005. The small sink during the dry season is surprising and similar dry season sinks have not to our knowledge been reported from other similar savanna ecosystems and could have potential management implications for agroforestry. A strong response of NEE versus small changes in plant available soil water content was found. Collection and analysis of flux data for several consecutive years including variations in precipitation, available soil moisture and labile soil carbon are needed for understanding the year to year variation of the carbon budget of this grass land/sparse savanna site in semi arid Sudan.</p

Climate controls over ecosystem metabolism: insights from a fifteen-year inductive artificial neural network synthesis for a subalpine forest

Eddy covariance (EC) datasets have provided insight into climate determinants of net ecosystem productivity (NEP) and evapotranspiration (ET) in natural ecosystems for decades, but most EC studies were published in serial fashion such that one study's result became the following study's hypothesis. This approach reflects the hypothetico-deductive process by focusing on previously derived hypotheses. A synthesis of this type of sequential inference reiterates subjective biases and may amplify past assumptions about the role, and relative importance, of controls over ecosystem metabolism. Long-term EC datasets facilitate an alternative approach to synthesis: the use of inductive data-based analyses to re-examine past deductive studies of the same ecosystem. Here we examined the seasonal climate determinants of NEP and ET by analyzing a 15-year EC time-series from a subalpine forest using an ensemble of Artificial Neural Networks (ANNs) at the half-day (daytime/nighttime) time-step. We extracted relative rankings of climate drivers and driver-response relationships directly from the dataset with minimal a priori assumptions. The ANN analysis revealed temperature variables as primary climate drivers of NEP and daytime ET, when all seasons are considered, consistent with the assembly of past studies. New relations uncovered by the ANN approach include the role of soil moisture in driving daytime NEP during the snowmelt period, the nonlinear response of NEP to temperature across seasons, and the low relevance of summer rainfall for NEP or ET at the same daytime/nighttime time step. These new results offer a more complete perspective of climate-ecosystem interactions at this site than traditional deductive analyses alone