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

Ultrasound Atherosclerosis Burden Score as a tool for predicting adverse cardiovascular events in patients with various cardiovascular risks aged 40-64 years

Aim. To investigate the prognostic significance of the Atherosclerosis Burden Score (ABS) in relation to the development of major adverse cardiovascular events in patients of different cardiovascular risks (CVR) aged 40 to 64 years.Material and methods. Men and women aged 40 to 64 years were included in the study. All the patients underwent duplex scanning of the carotid arteries and lower limb arteries. The total ABS was calculated by assessing the presence of plaque in the carotid and femoral bifurcations on both sides. The combined endpoint was cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or peripheral artery revascularization.Results. The study included 232 patients who met the inclusion criteria, with a median age of 55,0 years. Very high CVR was established in 94 (40,5%) patients, while high CVR — in 48 (20,7%) patients, and low and intermediate CVR — in 90 (38,8%) patients. The follow-up period lasted 23,6 (15,5; 51,2) months, providing 632,6 patient-years of follow-up. Events within composite endpoint occurred in 28 (12,1%) patients. Increased cumulative risk of adverse cardiovascular events was observed for ABS ≥2, with a significant increase in relative risk (RR) for ABS ≥3. According to Cox regression analysis, ABS 3 was associated with a 3,71-fold (95% CI 1,18-11,6; p=0,025) increase in the RR of adverse cardiovascular events after adjustment for sex, age, baseline CVR, obesity, smoking, diabetes, CAD, a history of myocardial revascularization, type 2 diabetes, drug therapy, and levels of non-high density lipoprotein cholesterol, highly sensitive C-reactive protein, and glomerular filtration rate.Conclusion. In patients of various CVR aged 40-64 years, an ABS ≥3 was associated with a 3,71-fold (95% CI, 1,18-11,6; p=0,025) increase in relative risk of adverse cardiovascular events after adjusting for potential confounders, including sex, age, baseline CVR, CAD, and type 2 diabetes

Non-invasive topical drug delivery to spinal cord with carboxyl-modified trifunctional copolymer of ethylene oxide and propylene oxide

© 2015 Elsevier B.V. In this study the effect of oxidative modification on micellar and drug delivery properties of copolymers of ethylene oxide (EO) and propylene oxide (PO) was investigated. Carboxylated trifunctional copolymers were synthesized in the reaction with chromium(VI) oxide. We found that carboxylation significantly improved the uniformity and stability of polymeric micelles by inhibiting the microphase transition. The cytotoxicity of copolymers was studied in relation to their aggregative state on two cell types (cancer line vs. primary fibroblasts). The accumulation of rhodamine 123 in neuroblastoma SH-SY5Y cells was dramatically increased in the presence of the oxidized block copolymer with the number of PO and EO units of 83.5 and 24.2, respectively. The copolymer was also tested as an enhancer for topical drug delivery to the spinal cord when applied subdurally. The oxidized copolymer facilitated the penetration of rhodamine 123 across spinal cord tissues and increased its intraspinal accumulation. These results show the potential of using oxidized EO/PO based polymers for non-invasive delivery of protective drugs after spinal cord injury

Interactions between immunosuppressor neutrophiles, innate and adaptive immunity indexes in the patients with subclinical atherosclerosis

The last fifteen years have been marked by rapid progress in the study of neutrophils. The discovery of transcriptional plasticity of neutrophils, their phenotypic and functional heterogeneity contributed to launching active interdisciplinary studies on the role of neutrophils in various chronic inflammatory diseases. Increased systemic circulation of immunosuppressive neutrophils can be observed not only in sepsis, but also in chronic systemic inflammation, which, along with disorders of lipid metabolism, is the major mechanism of atherosclerosis development and progression. Monocytes, dendritic cells, Tlymphocytes and neutrophils are key participants and modulators of inflammation in atherosclerosis. Potential significance of immunosuppressive neutrophils in atherogenesis and regulation of inflammatory response in atherosclerosis has not been currently established. However, taking into account their possible effects upon T lymphocytes and innate immunity cells, the study of immunosuppressive neutrophils seems promising in the context of atherosclerosis and atherosclerotic cardiovascular diseases. The purpose of this study was to evaluate relationship between the numbers of circulating immunosuppressive neutrophils and subpopulations of T cells and monocytes in the patients with subclinical atherosclerosis. The study enrolled patients aged 40-64 years with subclinical atherosclerosis of peripheral arteries. Subpopulations of neutrophils, lymphocytes and monocytes were phenotyped by flow cytometry using “Navios 6/2” (Beckman Coulter). 133 patients, 65 (48.8%) males and 68 (51.2%) females were included into the study. Correlation analysis showed that increased number of circulating CD16hiCD11bloCD62Lbr neutrophils was associated with increased number of regulatory T lymphocytes. The patients with subclinical atherosclerosis and absolute numbers of circulating immunosuppressive neutrophils within the first quartile (<136 cells/μL) had a statistically significantly lower number of regulatory T lymphocytes compared with patients in the 2-4 quartiles. An increase in immunosuppressive neutrophils was associated with decreased number of classical monocytes expressing TLR4 (r = -0.335; p = 0.004), and a decrease in TLR2 surface expression intensity (r = -0.268; p = 0.023) on the non-classical monocytes. In patients with subclinical atherosclerosis of 40-64 years old, an increase in immunosuppressive CD16hiCD11bloCD62Lbr neutrophils was associated with increase in regulatory T lymphocytes and nonclassical monocytes, as well as decrease in classic monocytes expressing TLR4, and lower intensity of TLR2 expression on the non-classical monocytes

Relationships between serum HMGB1 concentration and subpopulation composition of circulating monocytes in patients with subclinical atherosclerosis

Chronic non-infectious inflammation of low intensity is the most important mechanism of development and progression in atherosclerosis. Under the conditions of persistent non-resolving inflammation observed in the vascular wall and atherosclerotic plaque (ASB), permanent tissue damage occurs, thus leading to increased formation of endogenous danger-associated molecular patterns (DAMPs). The non-histone chromosomal protein HMGB1 may be regarded as a prototypical DAMPs. HMGB1 acts as a DAMP if entering the extracellular space, causing inflammation by its binding to pattern-recognizing receptors (TLR2, TLR4, RAGE, CD36, etc.). A number of clinical studies have revealed higher HMGB1 levels in the blood of patients with coronary heart disease and atherosclerotic disease of the lower limb arteries, as well as its interrelations with the burden of coronary artery atherosclerosis. Currently, the mechanisms of HMGB1-mediated atherosclerosis progression are studied only fragmentary. The aim of our study was to investigate relationships between the serum HMGB1 level and subsets of circulating monocyte subpopulations in patients with subclinical atherosclerosis.The study enrolled patients aged 40-64 years with subclinical atherosclerosis of peripheral arteries. Serum HMGB1 concentration was determined using enzyme immunoassay kits (Human HMGB1/HMG-1 ELISA Kit, NBP2-62766, Novus Biologicals, USA). The serum HMGB1 threshold was 18.75 pg/ml, whereas the measurement range was 31.25 to 2000 pg/ml. Phenotyping of the blood monocyte subpopulations was performed by flow cytometry using Navios 6/2 device (Beckman Coulter, USA).An increase in serum HMGB1 concentration was associated with decreased number of classical M2 monocytes, and an increase in intermediate and M1 monocytes. Moreover, an increase in HMGB1 concentration was associated with higher numbers of classical, intermediate, and non-classical monocytes expressing CD36 and TLR2. Increased HMGB1 concentration (from Q1 to Q4) correlated with higher numbers of classical (p = 0.001) and intermediate monocytes (p = 0.006) but not with non-classical phenotypes (p = 0.147). Upon increase of HMGB1 concentration (Q1 to Q4), we have found an increase in the number of classical (p < 0.0001), intermediate (p < 0.0001), and non-classical (p < 0.0001), CD36-expressing monocytes. An increased number of intermediate (p = 0.022; p1, 4 = 0.034) and non-classical, TLR2-expressing monocytes was also revealed (p = 0.002; p1, 4 = 0.035). By mean of correlation analysis, IL-1β concentrations showed direct correlation with the number of M1 monocytes (r = 0.268; p = 0.035) and inverse relation with the number of M2 monocytes (r = -0.376; p = 0.003).Increased serum HMGB1 concentration in patients with subclinical atherosclerosis was associated with decreased numbers of classical and M2 monocytes, as well as higher numbers of intermediate and M1 monocytes, like as with increased contents of intermediate and non-classical monocytes expressing CD36 and TLR2. IL-1β levels directly correlated with HMGB1 concentration and the number of Mi-monocytes

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

Extracting the differential inverse inelastic mean free path and differential surface excitation probability of Tungsten from X-ray photoelectron spectra and electron energy loss spectra

Precise knowledge of the differential inverse inelastic mean free path (DIIMFP) and differential surface excitation probability (DSEP) of Tungsten is essential for many fields of material science. In this paper, a fitting algorithm is applied for extracting DIIMFP and DSEP from X-ray photoelectron spectra and electron energy loss spectra. The algorithm uses the partial intensity approach as a forward model, in which a spectrum is given as a weighted sum of cross-convolved DIIMFPs and DSEPs. The weights are obtained as solutions of the Riccati and Lyapunov equations derived from the invariant imbedding principle. The inversion algorithm utilizes the parametrization of DIIMFPs and DSEPs on the base of a classical Lorentz oscillator. Unknown parameters of the model are found by using the fitting procedure, which minimizes the residual between measured spectra and forward simulations. It is found that the surface layer of Tungsten contains several sublayers with corresponding Langmuir resonances. The thicknesses of these sublayers are proportional to the periods of corresponding Langmuir oscillations, as predicted by the theory of R.H. Ritchie