Ambulatory tuberculosis treatment in post-Semashko health care systems needs supportive financing mechanisms

The tuberculosis (TB) control strategy in the Republic of Karakalpakstan, Uzbekistan, is being changed to decentralised out-patient care for most TB patients by the Government of Uzbekistan, in collaboration with the international medical humanitarian organisation Médecins Sans Frontières. Ambulatory treatment of both drug-susceptible and drug-resistant TB from the first day of treatment has been recommended since 2011. Out-patient treatment of TB from the beginning of treatment was previously prohibited. However, the current Uzbek health financing system, which evolved from the Soviet Semashko model, offers incentives that work against the adoption of ambulatory TB treatment. Based on the 'Comprehensive TB Care for All' programme implemented in Karakalpakstan, we describe how existing policies for the allocation of health funds complicate the scale-up of ambulatory-based management of TB

CFD model of acceleration of thermal-hydrodynamic processes in solar air collectors

Recent studies on increasing the thermal-hydrodynamic efficiency of solar air collectors have been carried out on the installation of barriers of various shapes on the surface of the absorber, and this method ensures a significant increase in the energy efficiency of the collector. The transfer of the air flow washing the surface of the absorber from a laminar flow state to an accelerated lumped air flow is carried out by installing obstacles. Installation of barriers is the main factor in increasing the heat transfer in solar air collectors and prolongs the time of air flow in the collector. The barrier solar air collector has a high local heat transfer coefficient, and the Nusselt number value is up to 3.5 times higher than that of the flat plate solar air collector. Also, this article presents the results of CFD modeling of the air flow in the solar air collector, the results of which can be used in the theoretical research of the solar air collector

International Consensus on Guiding Recommendations for Management of Patients with Nonsteroidal Antiinflammatory Drugs Induced Gastropathy-ICON-G

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs), one of the most commonly used medications worldwide, are frequently associated with gastrointestinal adverse events. Primary care physicians often face the challenge of achieving adequate pain relief with NSAIDs, while keeping their adverse events to a minimum. This is especially true when long-term use of NSAIDs is required such as in patients with osteoarthritis and rheumatoid arthritis. To help primary care physicians deal with such challenges more effectively, a panel of expert gastroenterologists came together with the aim of developing practice recommendations. Methods: A modified ‘Delphi’ process was used to reach consensus and develop practice recommendations. Twelve gastroenterologists from nine countries provided their expert inputs to formulate the recommendations. These recommendations were carefully developed taking into account existing literature, current practices, and expert opinion of the panelists. Results: The expert panel developed a total of fifteen practice recommendations. Following are the key recommendations: NSAIDs should be prescribed only when necessary; before prescribing NSAIDs, associated modifiable and non-modifiable risk factors should be considered; H. pylori infection should be considered and treated before initiating NSAIDs; patients should be properly educated regarding NSAIDs use; patients who need to be on long-term NSAIDs should be prescribed a gastroprotective agent, preferably a proton pump inhibitor and these patients should be closely monitored for any untoward adverse events. Conclusion/clinical significance: These practice recommendations will serve as an important tool for primary care physicians and will guide them in making appropriate therapeutic choices for their patients. Keywords: Gastropathy, Gastroprotective agents, Non-prescription drugs, Nonsteroidal Anti-inflammatory Agents, Proton pump inhibitor. How to cite this article: Hunt R, Lazebnik LB, Marakhouski YC, Manuc M, Ramesh GN, Aye KS, Bordin DS, Bakulina NV, Iskakov BS, Khamraev AA, Stepanov YM, Ally R, Garg A. International Consensus on Guiding Recommendations for Management of Patients with Nonsteroidal Anti-inflammatory Drugs Induced Gastropathy-ICON-G. Euroasian J Hepatogastroenterol, 2018;8(2):148-160. Source of support: Nil Conflict of interest: Richard Hunt has served as a consultant for INSYS, Dr Reddy's, Takeda, and Novartis. He has received an honorarium from Novartis, Danone, Dr Reddy's, and Takeda. He has been on the speaker's bureau for Takeda and Dr Reddy's and on scientific advisory board for INSYS. Dmitry S Bordin has served as a lecturer for Astellas, AstraZeneca, KRKA and Abbott. For the remaining authors, there are no conflicts of interest

Modern termites inherited the potential of collective construction from their common ancestor

Animal collective behaviors give rise to various spatial patterns, such as the nests of social insects. These structures are built by individuals following a simple set of rules, slightly varying within and among species, to produce a large diversity of shapes. However, little is known about the origin and evolution of the behavioral mechanisms regulating nest structures. In this study, we discuss the perspective of inferring the evolution of collective behaviors behind pattern formations using a phylogenetic framework. We review the collective behaviors that can be described by a single set of behavioral rules, and for which variations of the environmental and behavioral parameter values produce diverse patterns. We propose that this mechanism could be at the origin of the pattern diversity observed among related species, and that, when they are placed in the proper conditions, species have the behavioral potential to form patterns observed in related species. The comparative analysis of shelter tube construction by lower termites is consistent with this hypothesis. Although the use of shelter tubes in natural conditions is variable among species, most modern species have the potential to build them, suggesting that the behavioral rules for shelter tube construction evolved once in the common ancestor of modern termites. Our study emphasizes that comparative studies of behavioral rules have the potential to shed light on the evolution of collective behaviors.journal articl

EVALUATING CADET LEADERSHIP POSITIONS AT THE HIGHER MILITARY AVIATION SCHOOL OF THE REPUBLIC OF UZBEKISTAN

This article deals with the evaluating cadet leadership positions at the Higher Military Aviation School of the Republic of Uzbekistan (HMAS RU). It also provides the evidence of a positive relationship between participation in a cadet line position and promotion to Lieutenant Colonel. Furthermore, this article aims to assist in assessing the value of admission criteria, awarding leadership positions, and designing leadership position experiences. Informing decisions in these areas is likely to improve the Higher School’s ability to develop effective leaders for the Air Force

Evaluating Cadet Leadership Positions at the Higher Military Aviation School of the Republic of Uzbekistan

This article deals with the evaluating cadet leadership positions at the Higher Military Aviation School of the Republic of Uzbekistan (HMAS RU). It also provides the evidence of a positive relationship between participation in a cadet line position and promotion to Lieutenant Colonel. Furthermore, this article aims to assist in assessing the value of admission criteria, awarding leadership positions, and designing leadership position experiences. Informing decisions in these areas is likely to improve the Higher School's ability to develop effective leaders for the Air Force

Тактичні підходи до хірургічної корекції післяопераційних ускладнень в аноректальній зоні у дітей

Purpose. To improve the results of surgical correction of postoperative complications in children’s anorectal zone.Materials and methods. 58 patients with IB in the anorectal zone during primary and repeated correction of anorectal malformations (ARM), who underwent 137 reconstructive operations, were examined. The diagnostic algorithm consisted of traditional complex methods of clinical, radiological, laboratory examination, including ultrasound, MRI and endoscopic methods of examination.Results and concludians. The analysis of long-term results showed that unreliable primary diagnostics, lack of preoperative preparation, inadequate indications for the choice of surgery method led to the development of software for primary and repeated correction of ARM, which required a large number of repeated operations to treat. At the same time, the causes of the complication were studied, errors were analyzed, indications, terms, accesses, volume and efficiency of the primary operation were optimized, as well as failures leading to the necessity of repeated operations in children. Optimization of tactics, methods of surgical and rehabilitation treatment led to improvement of software results up to 85.6%.The study was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. Informed consent of the parents of the children was obtained for the study.Цель: улучшение результатов хирургической коррекции послеоперационных осложнений (ПО) в аноректальной зоне у детей.Материалы и методы. Обследованы 58 больных с ПО в аноректальной зоне после первичной и повторной коррекции аноректальных мальформаций (АРМ). Проведены 137 реконструктивных операций. Диагностический алгоритм включал клиническое, рентгенологическое, лабораторное, эндоскопическое обследование, МРТ.Результаты и выводы. Анализ отдаленных результатов после первичной и повторной коррекции АРМ показал, что недостоверная первичная диагностика, неадекватная предоперационная подготовка, выбор метода операции привели к развитию недостаточности анального сфинктера (НАС), что потребовало проведения большого количества повторных операций. Изучены причины осложнений, проанализированы ошибки, оптимизированы показания, сроки, доступы, объем и методы повторной операции. Оптимизация тактических подходов, методов хирургического и реабилитационного лечения привела к улучшению результатов лечения послеоперационной НАС до 85,4%.Исследование выполнено в соответствии с принципами Хельсинкской Декларации. Протокол исследования одобрен Локальным этическим комитетом всех участвующих учреждений. На проведение исследований было получено информированное согласие родителей детей.Мета: покращення результатів хірургічної корекції післяопераційних ускладнень (ПУ) в аноректальній зоні у дітей.Матеріали і методи. Обстежено 58 хворих з ПУ в аноректальній зоні після первинної і повторної корекції аноректальних мальформацій (АРМ). Проведено 137 реконструктивних операцій. Діагностичний алгоритм включав клінічне, рентгенологічне, лабораторне, ендоскопічне обсеження, МРТ.Результати і висновки. Аналіз віддалених результатів після первинної і повторної корекції АРМ показав, що недостовірна первинна діагностика, неадекватна доопераційна підготовка, вибір методу операції призвели до розвитку недостатності анального сфінктера (НАС), що вимагало проведення великої кількості повторних операцій. Вивчалися причини ускладнень, проаналізовані помилки, оптимізовані показання, терміни, доступи, обсяг і методи повторної операції. Оптимізація тактичних підходів, методів хірургічного і реабілітаційного лікування призвела до покращення результатів лікування післяопераційної НАС до 85,4%.Дослідження виконані відповідно до принципів Гельсінської Декларації. Протокол дослідження ухвалений Локальним етичним комітетом всіх зазначених у роботі установ. На проведення досліджень було отримано поінформовану згоду батьків дітей (або їхніх опікунів)