22 research outputs found

    Effective index approximations of photonic crystal slabs: a 2-to-1-D assessment

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    The optical properties of slab-like photonic crystals are often discussed on the basis of effective index (EI) approximations, where a 2-D effective refractive index profile replaces the actual 3-D structure. Our aim is to assess this approximation by analogous steps that reduce finite 2-D waveguide Bragg-gratings (to be seen as sections through 3-D PC slabs and membranes) to 1-D problems, which are tractable by common transfer matrix methods. Application of the EI method is disputable in particular in cases where locally no guided modes are supported, as in the holes of a PC membrane. A variational procedure permits to derive suitable effective permittivities even in these cases. Depending on the structural properties, these values can well turn out to be lower than one, or even be negative. Both the “standard” and the variational procedures are compared with reference data, generated by a rigorous 2-D Helmholtz solver, for a series of example structures.\u

    FORMATION OF THE PROJECT COMPETENCE OF FUTURE SPECIALISTS IN INFORMATION, LIBRARY AND ARCHIVE SERVICES IN A DIGITAL SOCIETY

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    The article substantiates the importance of forming the project competence of future specialists in information, library and archive services with the help of the project management information systems. The essence of project development in the library sphere is specified. The key features of the project activity of specialists in information, library and archive services under the conditions of digitalization, as well as the specifics of its informatization, are analyzed. The special features of project management as a component of library management are described. Some project management information systems are characterized. The structure of library workers’ project competence (value-motivational (axiological), knowledge-content (cognitive), technological (activity-practical) components) is specified. The value-motivational component is determined by a set of stable motives (personal, cognitive, professional ones) and suggests a conscious positive attitude to the project activity automation, readiness for its implementation. The knowledge-content component assumes having knowledge of the project activity automation. The technological component includes the ability to perform the project activity automation, to feel free in the information environment, etc. The results of the experimental verification of the efficiency of pedagogical conditions in order to form the project competence of future specialists in information, library and archive services (illustrated by the implementation of the author’s special course "Information Systems for Project Management in the Professional Activities of Information, Library and Archive Specialists") are presented. The implementation of the author's special course has visualized certain positive changes in the levels of the project competence development of students in experimental groups compared with those in control ones. The results of the obtained data analysis made it possible to ascertain the positive dynamics of changes in the quantitative indicators of the levels of the project competence development of future specialists in librarianship

    Therapeutic strategy in patients with long-lasting essential hypertension with comorbid type 2 diabetes mellitus and obesity

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    Background: Presently the level of blood pressure (BP) control is extremely unsatisfactory in hypertensive patients throughout the world. The aim of our study was to find the optimal drug therapy for patients with hard-to-treat essential hypertension (EH) associated with type 2 diabetes mellitus (T2DM) and obesity, namely the comparison of strategies of fixed and non-fixed combination. Material and methods: Eighty-seven patients with EH, T2DM and obesity were enrolled into the study. Two groups were formed: the 1st group — 41 patients received antihypertensive therapy in the form of unfixed combination of drugs (“multi-pill”) perindopril, indapamide and amlodipine; the 2nd — 46 patients, who received the same drugs, but in a fixed-dose combination (“single pill”). Results: A favorable treatment result was found for fixed-dose combination of antihypertensive drugs, with significant reduction in the frequency of visits to the doctor: relative risk (RR) — 1.27 (95% CI: 1.01‒1.61), p = 0.045, and odds ratio (OR) — 3.10 (95% CI: 1.05‒9.13), p = 0.04. That indicates that patients on fixed-dose combination were less likely to visit a doctor with complaints. Patients on single-pill therapy were less likely to get to progression (worsening) group in contrast to multi-pill non-fixed combination: RR — 1.37 (95% CI: 1.02‒1.84), p = 0.03; OR — 2.91 (95% CI: 1.12‒7.59), p = 0.03. Conclusion: The single-pill triple combination has significant advantage compared to multi-pill regimen in hard-totreat hypertensive patients with comorbid T2DM and obesity. Fixed-dose triple combination leads to significantly faster achievement of blood pressure control

    ĐšĐŸĐœŃ†Đ”ĐżŃ‚ŃƒĐ°Đ»ŃŒĐœŃ‹Đ” ĐŸŃĐœĐŸĐČы Ń€Đ”ĐłĐžĐŸĐœĐ°Đ»ŃŒĐœĐŸĐč ĐŸĐ±Ń€Đ°Đ·ĐŸĐČĐ°Ń‚Đ”Đ»ŃŒĐœĐŸĐč ĐżĐŸĐ»ĐžŃ‚ĐžĐșĐž

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    ĐŁ ĐŒĐŸĐœĐŸĐłŃ€Đ°Ń„Ń–Ń— ĐČОсĐČŃ–Ń‚Đ»Đ”ĐœĐŸ ĐșĐŸĐœŃ†Đ”ĐżŃ‚ŃƒĐ°Đ»ŃŒĐœŃ– засаЎО Ń€Đ”ĐłŃ–ĐŸĐœĐ°Đ»ŃŒĐœĐŸŃ— ĐŸŃĐČŃ–Ń‚ĐœŃŒĐŸŃ— ĐżĐŸĐ»Ń–Ń‚ĐžĐșĐž, ĐŸĐ±â€™Ń”ĐșтоĐČĐŸĐČĐ°ĐœŃ– ĐČ Ń‚Đ”ĐŸŃ€Đ”Ń‚ĐžŃ‡ĐœĐŸĐŒŃƒ ĐŸĐżĐžŃŃ– ĐŸŃĐœĐŸĐČĐœĐžŃ… ĐżŃ–ĐŽŃ…ĐŸĐŽŃ–ĐČ, ĐżŃ€ĐžĐœŃ†ĐžĐżŃ–ĐČ, ŃƒĐŒĐŸĐČ Ń€Đ”Đ°Đ»Ń–Đ·Đ°Ń†Ń–Ń— ĐșĐŸĐœŃ†Đ”ĐżŃ†Ń–Ń— ĐœĐ°ĐČŃ‡Đ°ĐœĐœŃ ĐČĐżŃ€ĐŸĐŽĐŸĐČж Đ¶ĐžŃ‚Ń‚Ń яĐș Ń‡ĐžĐœĐœĐžĐșĐ° Ń€Đ”ĐłŃ–ĐŸĐœĐ°Đ»ŃŒĐœĐŸŃ— Ń€ĐŸĐ·ĐČотĐșу. ĐŸŃ€ĐŸĐ°ĐœĐ°Đ»Ń–Đ·ĐŸĐČĐ°ĐœĐŸ ĐŸŃĐœĐŸĐČĐœŃ– ĐżĐ”Ń€Đ”ĐŽŃƒĐŒĐŸĐČĐž Ń€ĐŸĐ·Ń€ĐŸĐ±Đ»Đ”ĐœĐœŃ ĐșĐŸĐœŃ†Đ”ĐżŃ†Ń–Ń— ĐŸŃĐČіто ĐČĐżŃ€ĐŸĐŽĐŸĐČж Đ¶ĐžŃ‚Ń‚Ń у сĐČіті та ŃĐŸŃ†Ń–Đ°Đ»ŃŒĐœĐŸ-Đ”ĐșĐŸĐœĐŸĐŒŃ–Ń‡ĐœŃ– Ń€Đ”Đ·ŃƒĐ»ŃŒŃ‚Đ°Ń‚Đž її ŃƒĐżŃ€ĐŸĐČĐ°ĐŽĐ¶Đ”ĐœĐœŃ. ВоĐșĐ»Đ°ĐŽĐ”ĐœĐŸ ĐŸŃĐŸĐ±Đ»ĐžĐČĐŸŃŃ‚Ń– та спДцОфіĐșу ĐŸŃĐČіто ĐČĐżŃ€ĐŸĐŽĐŸĐČж Đ¶ĐžŃ‚Ń‚Ń, ĐŸŃĐČіто ĐŽĐŸŃ€ĐŸŃĐ»ĐžŃ… яĐș її сĐșĐ»Đ°ĐŽĐŸĐČĐŸŃ— ĐČ ŃƒĐŒĐŸĐČах Ń€Đ”ĐłŃ–ĐŸĐœĐ°Đ»ŃŒĐœĐŸĐłĐŸ Ń€ĐŸĐ·ĐČотĐșу (ĐœĐ°Ń†Ń–ĐŸĐœĐ°Đ»ŃŒĐœĐžĐč і Đ·Đ°Ń€ŃƒĐ±Ń–Đ¶ĐœĐžĐč ĐŽĐŸŃĐČіЮ). ОхараĐșŃ‚Đ”Ń€ĐžĐ·ĐŸĐČĐ°ĐœĐŸ ĐżŃĐžŃ…ĐŸĐ»ĐŸĐłŃ–Ń‡ĐœŃ– ĐŸŃĐŸĐ±Đ»ĐžĐČĐŸŃŃ‚Ń– Ń€ĐŸĐ·ĐČотĐșу ĐŸŃĐŸĐ±ĐžŃŃ‚ĐŸŃŃ‚Ń– ĐČ ĐŽĐŸŃ€ĐŸŃĐ»ĐŸĐŒŃƒ ĐČіці, Đ° таĐșĐŸĐ¶ ĐżŃ€ĐŸŃ„Đ”ŃŃ–ĐčĐœĐŸĐłĐŸ ŃŃ‚Đ°ĐœĐŸĐČĐ»Đ”ĐœĐœŃ ĐŸŃĐŸĐ±ĐžŃŃ‚ĐŸŃŃ‚Ń– ĐœĐ° Ń€Ń–Đ·ĐœĐžŃ… Дтапах ĐŽĐŸŃ€ĐŸŃĐ»ĐŸŃŃ‚Ń–. ВосĐČŃ–Ń‚Đ»Đ”ĐœĐŸ Ń€ĐŸĐ»ŃŒ ĐœĐ”Ń„ĐŸŃ€ĐŒĐ°Đ»ŃŒĐœĐŸŃ— ĐŸŃĐČіто ĐŽĐŸŃ€ĐŸŃĐ»ĐžŃ… яĐș Ń‡ĐžĐœĐœĐžĐșĐ° Ń€ĐŸĐ·ĐČотĐșу Ń€Đ”ĐłŃ–ĐŸĐœŃ–ĐČ, Ń‰ĐŸ ĐœĐ°ĐČчаються, Đ° таĐșĐŸĐ¶ ĐŒĐ”Ń…Đ°ĐœŃ–Đ·ĐŒĐž Ń€ĐŸĐ·Ń€ĐŸĐ±Đ»Đ”ĐœĐœŃ та рДалізації ĐșĐŸĐœŃ†Đ”ĐżŃ†Ń–Ń— ĐŒŃ–ŃŃ‚Đ°, Ń€Đ”ĐłŃ–ĐŸĐœŃƒ, Ń‰ĐŸ ĐœĐ°ĐČчається. Đ†ĐœŃ‚Đ”Ń€ĐżŃ€Đ”Ń‚ĐŸĐČĐ°ĐœĐŸ Ń€Đ”Đ·ŃƒĐ»ŃŒŃ‚Đ°Ń‚Đž ŃĐŸŃ†Ń–ĐŸĐ»ĐŸĐłŃ–Ń‡ĐœĐŸĐłĐŸ ĐŽĐŸŃĐ»Ń–ĐŽĐ¶Đ”ĐœĐœŃ ĐșŃƒĐ»ŃŒŃ‚ŃƒŃ€ĐœĐŸ-ĐŸŃĐČŃ–Ń‚ĐœŃ–Ń… ĐżĐŸŃ‚Ń€Đ”Đ± жОтДліĐČ Đ—Đ°ĐżĐŸŃ€Ń–Đ·ŃŒĐșĐŸŃ— ĐŸĐ±Đ». та ріĐČĐœŃ їх Đ·Đ°ĐŽĐŸĐČĐŸĐ»Đ”ĐœĐŸŃŃ‚Ń–.The monograph describes the conceptual foundations of regional educational policy, objectified in the theoretical description of the main approaches, principles, conditions to implement the lifelong learning concept as a factor of regional development. The basic prerequisites for the development of lifelong learning concept in the world and the socio-economic results of its implementation are analyzed. The peculiarities and specifics of lifelong learning, education of adults as a part of it in the conditions of regional development (national and foreign experience) are described. The psychological peculiarities of personality development in adulthood as well as professional development of personality at different stages of adolescence are characterized. The role of non-formal adults education as a factor of learning regions development as well as mechanisms of the city development and implementation of the concept is highlighted. The results of sociological research of cultural and educationalneeds of Zaporizhzhya region's residents and their level of satisfaction are interpreted.В ĐŒĐŸĐœĐŸĐłŃ€Đ°Ń„ĐžĐž ĐŸŃĐČĐ”Ń‰Đ”ĐœŃ‹ ĐșĐŸĐœŃ†Đ”ĐżŃ‚ŃƒĐ°Đ»ŃŒĐœŃ‹Đ” ĐŸŃĐœĐŸĐČы Ń€Đ”ĐłĐžĐŸĐœĐ°Đ»ŃŒĐœĐŸĐč ĐŸĐ±Ń€Đ°Đ·ĐŸĐČĐ°Ń‚Đ”Đ»ŃŒĐœĐŸĐč ĐżĐŸĐ»ĐžŃ‚ĐžĐșĐž, ĐŸĐ±ŃŠĐ”ĐșтоĐČĐžŃ€ĐŸĐČĐ°ĐœĐœŃ‹Đ” ĐČ Ń‚Đ”ĐŸŃ€Đ”Ń‚ĐžŃ‡Đ”ŃĐșĐŸĐŒ ĐŸĐżĐžŃĐ°ĐœĐžĐž ĐŸŃĐœĐŸĐČĐœŃ‹Ń… ĐżĐŸĐŽŃ…ĐŸĐŽĐŸĐČ, ĐżŃ€ĐžĐœŃ†ĐžĐżĐŸĐČ, ŃƒŃĐ»ĐŸĐČĐžĐč рДалОзацОО ĐșĐŸĐœŃ†Đ”ĐżŃ†ĐžĐž ĐœĐ”ĐżŃ€Đ”Ń€Ń‹ĐČĐœĐŸĐłĐŸ ĐŸĐ±ŃƒŃ‡Đ”ĐœĐžŃ ĐșĐ°Đș фаĐșŃ‚ĐŸŃ€Đ° Ń€Đ”ĐłĐžĐŸĐœĐ°Đ»ŃŒĐœĐŸĐłĐŸ разĐČотоя. ĐŸŃ€ĐŸĐ°ĐœĐ°Đ»ĐžĐ·ĐžŃ€ĐŸĐČĐ°ĐœŃ‹ ĐŸŃĐœĐŸĐČĐœŃ‹Đ” ĐżŃ€Đ”ĐŽĐżĐŸŃŃ‹Đ»ĐșĐž ĐŽĐ»Ń Ń€Đ°Đ·Ń€Đ°Đ±ĐŸŃ‚ĐșĐž ĐșĐŸĐœŃ†Đ”ĐżŃ†ĐžĐž ĐŸĐ±ŃƒŃ‡Đ”ĐœĐžŃ ĐœĐ° ĐżŃ€ĐŸŃ‚ŃĐ¶Đ”ĐœĐžĐž ĐČсДĐč Đ¶ĐžĐ·ĐœĐž ĐČ ĐŒĐžŃ€Đ” Đž ŃĐŸŃ†ĐžĐ°Đ»ŃŒĐœĐŸ-эĐșĐŸĐœĐŸĐŒĐžŃ‡Đ”ŃĐșох Ń€Đ”Đ·ŃƒĐ»ŃŒŃ‚Đ°Ń‚ĐŸĐČ Đ”Đ” рДалОзацОО. ĐžĐżĐžŃĐ°ĐœŃ‹ ĐŸŃĐŸĐ±Đ”ĐœĐœĐŸŃŃ‚Đž Đž спДцОфОĐșĐ° ĐŸĐ±ŃƒŃ‡Đ”ĐœĐžŃ ĐœĐ° ĐżŃ€ĐŸŃ‚ŃĐ¶Đ”ĐœĐžĐž ĐČсДĐč Đ¶ĐžĐ·ĐœĐž, ĐŸĐ±Ń€Đ°Đ·ĐŸĐČĐ°ĐœĐžŃ ĐČĐ·Ń€ĐŸŃĐ»Ń‹Ń… ĐșĐ°Đș Đ”ĐłĐŸ ŃĐŸŃŃ‚Đ°ĐČĐ»ŃŃŽŃ‰Đ”Đč ĐČ ŃƒŃĐ»ĐŸĐČоях Ń€Đ”ĐłĐžĐŸĐœĐ°Đ»ŃŒĐœĐŸĐłĐŸ разĐČотоя (ĐœĐ°Ń†ĐžĐŸĐœĐ°Đ»ŃŒĐœŃ‹Đč Đž Đ·Đ°Ń€ŃƒĐ±Đ”Đ¶ĐœŃ‹Đč ĐŸĐżŃ‹Ń‚). ОхараĐșŃ‚Đ”Ń€ĐžĐ·ĐŸĐČĐ°ĐœŃ‹ ĐżŃĐžŃ…ĐŸĐ»ĐŸĐłĐžŃ‡Đ”ŃĐșОД ĐŸŃĐŸĐ±Đ”ĐœĐœĐŸŃŃ‚Đž разĐČотоя Đ»ĐžŃ‡ĐœĐŸŃŃ‚Đž ĐČĐŸ ĐČĐ·Ń€ĐŸŃĐ»ĐŸĐŒ ĐČĐŸĐ·Ń€Đ°ŃŃ‚Đ”, Đ° таĐșжД ĐżŃ€ĐŸŃ„Đ”ŃŃĐžĐŸĐœĐ°Đ»ŃŒĐœĐŸĐ” разĐČОтОД Đ»ĐžŃ‡ĐœĐŸŃŃ‚Đž ĐœĐ° Ń€Đ°Đ·ĐœŃ‹Ń… этапах ĐżĐŸĐŽŃ€ĐŸŃŃ‚ĐșĐŸĐČĐŸĐłĐŸ ĐČĐŸĐ·Ń€Đ°ŃŃ‚Đ°. ОсĐČĐ”Ń‰Đ”ĐœĐ° Ń€ĐŸĐ»ŃŒ ĐœĐ”Ń„ĐŸŃ€ĐŒĐ°Đ»ŃŒĐœĐŸĐłĐŸ ĐŸĐ±Ń€Đ°Đ·ĐŸĐČĐ°ĐœĐžŃ ĐČĐ·Ń€ĐŸŃĐ»Ń‹Ń… ĐșĐ°Đș фаĐșŃ‚ĐŸŃ€Đ° разĐČотоя ĐŸĐ±ŃƒŃ‡Đ°ŃŽŃ‰ĐžŃ…ŃŃ Ń€Đ”ĐłĐžĐŸĐœĐŸĐČ, Đ° таĐșжД ĐŒĐ”Ń…Đ°ĐœĐžĐ·ĐŒŃ‹ Ń€Đ°Đ·Ń€Đ°Đ±ĐŸŃ‚ĐșĐž Đž рДалОзацОО ĐșĐŸĐœŃ†Đ”ĐżŃ†ĐžĐž ĐŸĐ±ŃƒŃ‡Đ°ŃŽŃ‰ĐžŃ…ŃŃ ĐłĐŸŃ€ĐŸĐŽĐŸĐČ

    Reorienting adolescent sexual and reproductive health research: reflections from an international conference

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    On December 4th 2014, the International Centre for Reproductive Health (ICRH) at Ghent University organized an international conference on adolescent sexual and reproductive health (ASRH) and well-being. This viewpoint highlights two key messages of the conference - 1) ASRH promotion is broadening on different levels and 2) this broadening has important implications for research and interventions – that can guide this research field into the next decade. Adolescent sexuality has long been equated with risk and danger. However, throughout the presentations, it became clear that ASRH and related promotion efforts are broadening on different levels: from risk to well-being, from targeted and individual to comprehensive and structural, from knowledge transfer to innovative tools. However, indicators to measure adolescent sexuality that should accompany this broadening trend, are lacking. While public health related indicators (HIV/STIs, pregnancies) and their behavioral proxies (e.g. condom use, number of partners) are well developed and documented, there is a lack of consensus on indicators for the broader construct of adolescent sexuality, including sexual well-being and aspects of positive sexuality. Furthermore, the debate during the conference clearly indicated that experimental designs may not be the only appropriate study design to measure effectiveness of comprehensive, context-specific and long-term ASRH programmes, and that alternatives need to be identified and applied. Presenters at the conference clearly expressed the need to develop validated tools to measure different sub-constructs of adolescent sexuality and environmental factors. There was a plea to combine (quasi-)experimental effectiveness studies with evaluations of the development and implementation of ASRH promotion initiatives.IS

    Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia

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    BACKGROUND Patients with elevated triglyceride levels are at increased risk for ischemic events. Icosapent ethyl, a highly purified eicosapentaenoic acid ethyl ester, lowers triglyceride levels, but data are needed to determine its effects on ischemic events. METHODS We performed a multicenter, randomized, double-blind, placebo-controlled trial involving patients with established cardiovascular disease or with diabetes and other risk factors, who had been receiving statin therapy and who had a fasting triglyceride level of 135 to 499 mg per deciliter (1.52 to 5.63 mmol per liter) and a low-density lipoprotein cholesterol level of 41 to 100 mg per deciliter (1.06 to 2.59 mmol per liter). The patients were randomly assigned to receive 2 g of icosapent ethyl twice daily (total daily dose, 4 g) or placebo. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina. The key secondary end point was a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. RESULTS A total of 8179 patients were enrolled (70.7% for secondary prevention of cardiovascular events) and were followed for a median of 4.9 years. A primary end-point event occurred in 17.2% of the patients in the icosapent ethyl group, as compared with 22.0% of the patients in the placebo group (hazard ratio, 0.75; 95% confidence interval [CI], 0.68 to 0.83; P<0.001); the corresponding rates of the key secondary end point were 11.2% and 14.8% (hazard ratio, 0.74; 95% CI, 0.65 to 0.83; P<0.001). The rates of additional ischemic end points, as assessed according to a prespecified hierarchical schema, were significantly lower in the icosapent ethyl group than in the placebo group, including the rate of cardiovascular death (4.3% vs. 5.2%; hazard ratio, 0.80; 95% CI, 0.66 to 0.98; P=0.03). A larger percentage of patients in the icosapent ethyl group than in the placebo group were hospitalized for atrial fibrillation or flutter (3.1% vs. 2.1%, P=0.004). Serious bleeding events occurred in 2.7% of the patients in the icosapent ethyl group and in 2.1% in the placebo group (P=0.06). CONCLUSIONS Among patients with elevated triglyceride levels despite the use of statins, the risk of ischemic events, including cardiovascular death, was significantly lower among those who received 2 g of icosapent ethyl twice daily than among those who received placebo. (Funded by Amarin Pharma; REDUCE-IT ClinicalTrials.gov number, NCT01492361

    ĐĐ°Ń†Ń–ĐŸĐœĐ°Đ»ŃŒĐœĐ° ĐŽĐŸĐżĐŸĐČіЮь ĐżŃ€ĐŸ ŃŃ‚Đ°Đœ і пДрспДĐșтоĐČĐž Ń€ĐŸĐ·ĐČотĐșу ĐŸŃĐČіто ĐČ ĐŁĐșŃ€Đ°Ń—ĐœŃ–: ĐŒĐŸĐœĐŸĐłŃ€Đ°Ń„Ń–Ń (Đ”ĐŸ 30-річчя ĐœĐ”Đ·Đ°Đ»Đ”Đ¶ĐœĐŸŃŃ‚Ń– ĐŁĐșŃ€Đ°Ń—ĐœĐž)

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    The publication provides a comprehensive analysis of the state and development of national education over the 30 years of Ukraine’s independence, identifies current problems in education, ascertains the causes of their emergence, offers scientifically reasoned ways to modernise domestic education in the context of globalisation, European integration, innovative development, and national self-identification. Designed for legislators, state officials, education institutions leaders, teaching and academic staff, the general public, all those who seek to increase the competitiveness of Ukrainian education in the context of civilisation changes.ĐŁ ĐČĐžĐŽĐ°ĐœĐœŃ– Đ·ĐŽŃ–ĐčŃĐœĐ”ĐœĐŸ ĐČŃĐ”Đ±Ń–Ń‡ĐœĐžĐč Đ°ĐœĐ°Đ»Ń–Đ· ŃŃ‚Đ°ĐœŃƒ і Ń€ĐŸĐ·ĐČотĐșу ĐœĐ°Ń†Ń–ĐŸĐœĐ°Đ»ŃŒĐœĐŸŃ— ĐŸŃĐČіто Đ·Đ° 30-Ń€Ń–Ń‡ĐœĐžĐč ĐżĐ”Ń€Ń–ĐŸĐŽ ĐœĐ”Đ·Đ°Đ»Đ”Đ¶ĐœĐŸŃŃ‚Ń– ĐŁĐșŃ€Đ°Ń—ĐœĐž, ĐČĐžĐ·ĐœĐ°Ń‡Đ”ĐœĐŸ Đ°ĐșŃ‚ŃƒĐ°Đ»ŃŒĐœŃ– ĐżŃ€ĐŸĐ±Đ»Đ”ĐŒĐž ĐŸŃĐČŃ–Ń‚ĐœŃŒĐŸŃ— сфДрО, ĐČояĐČĐ»Đ”ĐœĐŸ ĐżŃ€ĐžŃ‡ĐžĐœĐž їх ĐČĐžĐœĐžĐșĐœĐ”ĐœĐœŃ, Đ·Đ°ĐżŃ€ĐŸĐżĐŸĐœĐŸĐČĐ°ĐœĐŸ ĐœĐ°ŃƒĐșĐŸĐČĐŸ ĐŸĐ±Ò‘Ń€ŃƒĐœŃ‚ĐŸĐČĐ°ĐœŃ– ŃˆĐ»ŃŃ…Đž ĐŒĐŸĐŽĐ”Ń€ĐœŃ–Đ·Đ°Ń†Ń–Ń— ĐČŃ–Ń‚Ń‡ĐžĐ·ĐœŃĐœĐŸŃ— ĐŸŃĐČіто ĐČ ŃƒĐŒĐŸĐČах ĐłĐ»ĐŸĐ±Đ°Đ»Ń–Đ·Đ°Ń†Ń–Ń—, єĐČŃ€ĐŸĐżĐ”ĐčсьĐșĐŸŃ— Ń–ĐœŃ‚Đ”ĐłŃ€Đ°Ń†Ń–Ń—, Ń–ĐœĐœĐŸĐČаціĐčĐœĐŸĐłĐŸ Ń€ĐŸĐ·ĐČотĐșу та ĐœĐ°Ń†Ń–ĐŸĐœĐ°Đ»ŃŒĐœĐŸŃ— ŃĐ°ĐŒĐŸŃ–ĐŽĐ”ĐœŃ‚ĐžŃ„Ń–Đșації. Đ ĐŸĐ·Ń€Đ°Ń…ĐŸĐČĐ°ĐœĐŸ ĐœĐ° Đ·Đ°ĐșĐŸĐœĐŸĐŽĐ°ĐČціĐČ, ЎДржаĐČĐœĐžŃ… упраĐČĐ»Ń–ĐœŃ†Ń–ĐČ, ĐșДріĐČĐœĐžĐșіĐČ Đ·Đ°ĐșлаЎіĐČ ĐŸŃĐČіто, ĐżĐ”ĐŽĐ°ĐłĐŸĐłŃ–Ń‡ĐœĐžŃ… і ĐœĐ°ŃƒĐșĐŸĐČĐŸ-ĐżĐ”ĐŽĐ°ĐłĐŸĐłŃ–Ń‡ĐœĐžŃ… праціĐČĐœĐžĐșіĐČ, ŃˆĐžŃ€ĐŸĐșу ĐłŃ€ĐŸĐŒĐ°ĐŽŃŃŒĐșість, усіх, Ń…Ń‚ĐŸ ĐżŃ€Đ°ĐłĐœĐ” піЮĐČĐžŃ‰Đ”ĐœĐœŃ ĐșĐŸĐœĐșŃƒŃ€Đ”ĐœŃ‚ĐŸŃĐżŃ€ĐŸĐŒĐŸĐ¶ĐœĐŸŃŃ‚Ń– уĐșŃ€Đ°Ń—ĐœŃŃŒĐșĐŸŃ— ĐŸŃĐČіто ĐČ ĐșĐŸĐœŃ‚Đ”Đșсті цоĐČілізаціĐčĐœĐžŃ… Đ·ĐŒŃ–Đœ

    Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

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    Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≄30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≄90 days, chronic dialysis for ≄90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie
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