Improve business process efficiency by value engineering

This article is devoted to the problems of business processes optimization by value engineering (FCA) method. The business processes analysis is particularly relevant in modern conditions. The purpose the investigation is to adapt the value engineering to the business process. The FCA is a universal and highly efficient method of parameters optimization and other structural, technological, organizational, economic characteristics of a product, work or services. The hypothesis of the applying a value engineering to a business process possibility is considered. The article discusses FCA tools as an example of a metal rolling business delivery process. A business process model is being constructed as an object structural element model. The functions decomposition is carried out. Functions are classified into basic and auxiliary on the basis of the level. In the article the significance and functional costs are determined. A functional-cost diagram is constructed to identify the functions with the most deviations needing improvement. The FCA stages are accompanied by graphical illustrations, tables that illustrate the logic of applying the method to the business process. As a result, an optimal business-process concept with the lowest cost is being developed. © Published under licence by IOP Publishing Ltd

Carbon Paper Modified with Functionalized Poly(diallyldimethylammonium chloride) Graphene and Gold Phytonanoparticles as a Promising Sensing Material: Characterization and Electroanalysis of Ponceau 4R in Food Samples

This paper presents a novel eco-friendly sensing material based on carbon paper (CP) volumetrically modified with a composite nanomodifier that includes functionalized poly(diallyldimethylammonium chloride) graphene (PDDA-G) and phytosynthesized gold nanoparticles (phyto-AuNPs). The functionalization of graphene was justified by Fourier-transform infrared spectroscopy. The phyto-AuNPs (d = 6 nm) were prepared by “green” synthesis with the use of strawberry leaf extract. The sensing material was characterized using scanning electron microscopy, electrochemical impedance spectroscopy, and voltammetry. The research results indicated a more than double increase in the electroactive surface area; a decrease in the resistance of electron transfer on nanocomposite-modified CP, compared to bare CP. The phyto-AuNPs/PDDA-G/CP was used for the electrosensing of the synthetic dye Ponceau 4R. The oxidation signal of colorant enhanced 4-fold on phyto-AuNPs/PDDA-G/CP in comparison to CP. The effect of the quantity of nanomodifier, solution pH, potential scan rate, accumulation parameters, and differential pulse parameters on the peak current of Ponceau 4R was studied. Under optimal conditions, excellent sensory characteristics were established: LOD 0.6 nM and LR 0.001–2 μM for Ponceau 4R. High selectivity and sensitivity enable the use of the sensor for analyzing the content of Ponceau 4R in food products (soft drinks, candies, and popsicles) without additional sample preparation. © 2022 by the authors

ЛУЧЕВОЕ ПОРАЖЕНИЕ КЛАПАННОГО АППАРАТА СЕРДЦА

The increasing life expectancy of patients after complex therapy for breast cancer is accompanied by the growth of remote postradiation pathology of the heart. Late diagnosis and correction of these complications leads to deterioration in the quality of life of patients and increases the risk of cardiac mortality. Presents a clinical case of development of aortic valve disease in the late period after radiotherapy in the patient with left-sided localization of breast cancer.Увеличение продолжительности жизни пациентов после комплексной терапии рака молочной железы сопровождается ростом отдаленной постлучевой патологии сердца. Несвоевременная диагностика и коррекция этих осложнений приводит к ухудшению качества жизни пациентов и увеличивает риск сердечной смертности. Представлен клинический случай развития порока аортального клапана в отдаленном периоде после применения лучевой терапии у пациентки с левосторонней локализацией рака молочной железы

СЛУЧАЙ МЕНИНГОЭНЦЕФАЛИТА У РЕБЕНКА ИЗ ОЧАГА ТУБЕРКУЛЕЗНОЙ ИНФЕКЦИИ

In sectional clause the clinical case of a tubercular meningocephalitis at the child 6 years from the center drug resistant bacterial excretion is described. The analysis of the parents and risk factors of occurrence sectional astroprocessor of the shape of tuberculosis is given.Описан клинический случай туберкулезного менингоэнцефалита у ребенка 6 лет из очага лекарственно-устойчивого бактериовыделения туберкулеза. Приведен анализ причин и факторов риска возникновения данной остро прогрессирующей формы туберкулеза.

Эхогенность каротидных атеросклеротических бляшек как предиктор неблагоприятных сердечно-сосудистых событий у пациентов 40–64 лет: проспективное исследование

INTRODUCTION: Noninvasive assessment of carotid atherosclerotic plaque (CAP) morphology represents a promising direction, allowing to optimize not only cardiovascular event risk assessment, but also the selection of patients for carotid revascularization. Determination of CAP echogenicity by means of GSM-analysis can be used as part of multiparametric assessment of CAP instability and prediction of adverse cardiovascular events.OBJECTIVE: To assess the predictive value of echogenicity of carotid atherosclerotic plaques in relation to the development of adverse cardiovascular events in patients 40–64 years old.MATERIALS AND METHODS: The study included 191 patients with carotid atherosclerosis aged 40–64 years. All patients underwent duplex scanning of the arteries of the carotid basin with determination of the echogenicity of carotid ASBs. The combined end point (CEP) consisted of the following possible events: nonfatal myocardial infarction or unstable angina, nonfatal stroke, coronary revascularization or peripheral artery revascularization, and death from cardiovascular causes. Data on the onset of CVD were collected during follow-up visits and using medical information systems. Statistics: Data were analyzed using MedCalc software (version 20.216). Frequencies and percentages were used to describe nominal data, and medians and quartiles were used for quantitative data. The Kaplan-Meier survival analysis method was used to estimate the probability of events constituting the combined endpoint. Cox regression analysis was used to estimate the risk of the event and the influence of independent variables on the risk.RESULTS: By correlation analysis, carotid AP echogenicity (GSM) was inversely correlated with BMI (r=-0,355; p<0,0001), waist circumference (r=-0.37; p<0.0001), triglyceride levels (r=-0.163; p=0.027), uric acid (r=-0.188; p=0.028). The duration of the follow-up period was 15.1 (12.2; 22.9) months. Events constituting CEP occurred in 15 (7.85%) patients: nonfatal myocardial infarction in 2 (1.05%) patients, nonfatal stroke in 2 (1.05%) patients, myocardial revascularization in 6 (3.14%) patients, unstable angina in 5 (2.61%) patients. The presence of carotid AP with echogenicity ≤39 conventional units allowed predicting the development of events constituting CEP with sensitivity of 53.3% and specificity of 80.7%. Kaplan-Meier survivalanalysis revealed that cumulative survival of patients with carotid AP with echogenicity ≤39 conventional units was statistically significantly lower compared to patients with carotid ASB with echogenicity >39 conventional units.DISCUSSION: It should be noted that in the presented study, decreased echogenicity of carotid AP was associated with the risk of adverse cardiovascular events only in the simple and sex- and age-adjusted models, but not in the full-adjusted model. It is likely that this may be due to the fact that the echogenicity of CAP is closely related to the cumulative burden of cardiovascular risk factors, which has been shown in earlier studies including. Probably, combined assessment of carotid atherosclerosis burden and morphological features of CAP may be the most promising approach to obtain additional prognostic information in patients with carotid atherosclerosis.CONCLUSION: Among patients with carotid atherosclerosis 40–64 years old, the presence of ACS with echogenicity ≤39 conventional units was associated with a 3.44 (95% CI 1.19–9.91) fold increase in the relative risk of events constituting the combined endpoint after adjusting for sex and age.ВВЕДЕНИЕ: Неинвазивная оценка морфологии каротидных атеросклеротических бляшек (АСБ) представляет собой перспективное направление, позволяющее оптимизировать не только оценку риска сердечно-сосудистых событий, но и отбор пациентов для реваскуляризации сонных артерий. Определение эхогенности АСБ посредством GSM-анализа может быть использовано в рамках мультипараметрической оценки нестабильности АСБ и прогнозирования неблагоприятных сердечно-сосудистых событий.ЦЕЛЬ: Оценить предиктивную ценность эхогенности каротидных атеросклеротических бляшек в  отношении развития неблагоприятных сердечно-сосудистых событий у пациентов 40–64 лет.МАТЕРИАЛЫ И  МЕТОДЫ: В  исследование был включен 191 пациент с  каротидным атеросклерозом в  возрасте 40–64 лет. Всем пациентам проводили дуплексное сканирование артерий каротидного бассейна с определением эхогенности каротидных АСБ. Комбинированная конечная точка (ККТ) состояла из  следующих возможных событий: нефатальный инфаркт миокарда или нестабильная стенокардия, нефатальный инсульт, коронарную реваскуляризацию или реваскуляризацию периферических артерий, смерть от сердечно-сосудистых причин. Сбор данных о наступлении ККТ, проводили во время повторных визитов и с помощью медицинских информационных систем.Статистика: Анализ данных проводили с помощью программного обеспечения MedCalc (версия 20.216). Для описания номинальных данных использовали частоты и проценты, для количественных данных медиану и квартили. Для оценки вероятности развития событий, составляющих комбинированную конечную точку, применяли метод анализа выживаемости Каплана–Майера. С целью оценки риска наступления события и влияния независимых переменных на указанный риск применяли регрессионный анализ Кокса.РЕЗУЛЬТАТЫ: По результатам корреляционного анализа эхогенность каротидных АСБ (GSM) обратно коррелировала с ИМТ (r=–0,355; p<0,0001), окружностью талии (r=–0,337; p<0,0001), уровнем триглицеридов (r=–0,163; p=0,027), мочевой кислотой (r=–0,188; p=0,028). Длительность периода наблюдения составляла 15,1 (12,2; 22,9) мес. События, составляющие ККТ, произошли у 15 (7,85%) пациентов: нефатальный инфаркт миокарда — у 2 (1,05%) пациентов, нефатальный инсульт — у 2 (1,05%), реваскуляризация миокарда — у 6 (3,14%), нестабильная стенокардия — у 5 (2,61%) пациентов. Наличие каротидных АСБ с эхогенностью ≤39 усл.ед. позволяло прогнозировать развитие событий, составляющих ККТ, с чувствительностью 53,3% и специфичностью 80,7%. По результатам анализа выживаемости Каплана–Мейера было установлено, что кумулятивная выживаемость пациентов, имеющих каротидные АСБ с  эхогенностью ≤39 усл.ед., была статистически значимо ниже, в сравнении с пациентами, имеющими каротидные АСБ с эхогенностью >39 усл.ед.ОБСУЖДЕНИЕ: Необходимо отметить, что в представленном исследовании снижение эхогенности каротидных АСБ было связано с  риском неблагоприятных сердечно-сосудистых событий только в  простой модели и  модели с  поправкой на  пол и возраст, но не в модели с полной поправкой. Вероятно, это может быть связано с тем, что эхогенность АСБ тесно связана с кумулятивным бременем кардиоваскулярных факторов риска, что было показано в том числе в более ранних исследованиях. Вероятно, комбинированная оценка бремени каротидного атеросклероза и морфологических особенностей АСБ может быть наиболее перспективным подходом к получению дополнительной прогностической информации у пациентов с каротидным атеросклерозом.ЗАКЛЮЧЕНИЕ: Среди пациентов с каротидным атеросклерозом 40–64 лет наличие АСБ с эхогенностью ≤39 усл. ед. ассоциировалось с  увеличением относительного риска развития событий, составляющих комбинированную конечную точку в 3,44 (95% ДИ 1,19–9,91) раза после поправки на пол и возраст

Dispersion mapping in donozologic diagnostics

Work is dedicated to description of the possibilities of the new method - dispersion mapping

Increase in high-sensitive C-reactive protein as a marker of polyvascular disease in patients with cardiovascular diseases

Aim. To estimate the prevalence of inflammatory residual risk in patients with stable atherosclerotic cardiovascular disease (ASCVD) and establish the relationship between concentration of C-reactive protein (CRP) and the presence of the polyvascular disease.Materials and Methods. The study included 120 patients with stable ASCVD. The plan of the instrumental study included ultrasound scanning of the carotid arteries and lower limb arteries with measurement of the ankle-brachial index. The concentration of hsCRP in the serum was determined by the enzyme-linked immunosorbent assay.Results. An increase in the content of hsCRP ≥ 2,0 mg/l was detected in 45,8% of patients. Clinically significant lesion of one vascular bed was observed in 41,6% of patients, two – in 36,6%, three – in 21,6%. In the group of patients with atherosclerosis of the three vascular beds, the median value of hsCRP was 3,28 (1,77–5,67) mg/l, which was statistically significantly higher compared to patients with the involvement of one vascular bed – 1,56 (0,68–3,92) mg/L. An increase in hsCRP over 2,0 mg/l was associated with an increase in the relative risk of a patient with polyvascular disease with a atherosclerosis of three vascular beds 3,63 times (95% CI 1,06–12,4; p = 0,04) with adjusting for gender, age, obesity, diabetes, smoking, cholesterol levels and glomerular filtration rate.Conclusion. Inflammatory residual risk was observed in 45,8% of patients with stable ASCVD. An increase in CRP was established with an increase in the number of affected vascular beds. An increase in hsCRP over 2,0 mg/l was independently associated with an increase in the relative risk of a patient having an polyvascular disease

THE CASE OF MENINGOENCEPHALITIS IN A CHILD FROM THE SOURCE TUBERCULOSIS INFECTION

In sectional clause the clinical case of a tubercular meningocephalitis at the child 6 years from the center drug resistant bacterial excretion is described. The analysis of the parents and risk factors of occurrence sectional astroprocessor of the shape of tuberculosis is given

СЛУЧАЙ МЕНИНГОЭНЦЕФАЛИТА У РЕБЕНКА ИЗ ОЧАГА ТУБЕРКУЛЕЗНОЙ ИНФЕКЦИИ

In sectional clause the clinical case of a tubercular meningocephalitis at the child 6 years from the center drug resistant bacterial excretion is described. The analysis of the parents and risk factors of occurrence sectional astroprocessor of the shape of tuberculosis is given.Описан клинический случай туберкулезного менингоэнцефалита у ребенка 6 лет из очага лекарственно-устойчивого бактериовыделения туберкулеза. Приведен анализ причин и факторов риска возникновения данной остро прогрессирующей формы туберкулеза. </p