Заключение прямых договоров с ресурсоснабжающими организациями

The subject of the paper is conclusion and execution of direct contracts between consumers and utilities providers.The main aim of the paper is to confirm or disprove the hypothesis that direct contracts between consumers and utilities providers are more convenient for utilities providers than for consumers.The methodology of the study includes general scientific methods (analysis, synthesis, comparison, generalization, description) as well as particular academic legal methods (formal-legal analysis of theoretical and regulatory sources, interpretation of legal acts, judicial and arbitration practice).The main results and scope of their application. The current procedure for the provision and payment of utilities is based on the concept of "performer of utilities", which are the management organizations, homeowners' associations, housing cooperatives. The performer of utilities enters into a contract with utilities provider. These utilities are acquired by the contractor at the border of its operational responsibility (on the border of an apartment building), then this resource is already provided as a utility service to final users – tenants and owners of premises in an apartment building. Consumers pay for utility services to the contractor of utilities, and he, in turn, transfers the received payments to the utilities provider (resource supplying organization). Such a scheme of contractual relations leads to problems, including the following: the performers do not enter into contracts with the utilities providers (resource-supplying organizations), thereby trying to exclude their responsibility for the quality of services; do not pay fully or partially for the supplied utility resource. In this regard, the legislation has been amended to allow direct contracts between consumers of public services and resource organizations and, accordingly, directly pay for utilities.Conclusions. Direct contracts between consumers and utilities providers are more convenient for utilities providers than for consumers in the scope of responsibility for the poor quality of utilities.Рассматривается закрепленная в жилищном законодательстве и подтвержденная правоприменительной практикой концепция «исполнителя коммунальных услуг», допускающая возможность осуществления прямых расчетов и заключения прямых договоров потребителей коммунальных услуг с ресурсоснабжающими организациями, анализируются проблемы, связанные с введением нового порядка заключения прямых договоров с ресурсоснабжающими организациями и региональным оператором по обращению с твердыми коммунальными отходами

Drawing as a research tool: what does it add?

Background and topic: Representing an epistemological shift within qualitative methodology (Boydell, 2012) healthcare research has increasingly employed visual methods as a means to further understand the patient’s experience of health and healthcare (Broadbent, 2009; Phillips et al, 2015). An advantage of using drawing, rather than any other form visual method, is its potential to offer a way of communicating other than speech. We discuss the use of drawing, in an exploratory, qualitative study, to enrich the narrative account during data collection using semi-structured interviews with a purposive sample of palliative healthcare professionals (n=16) from one hospice in West Yorkshire, England (February-May 2016). This study aimed to utilise drawing as a tool to explore the process of drawing to help facilitate the exploration, communication and our understanding of how healthcare staff emotionally resource their roles within a Hospice setting. As such, we were not concerned with an end product, such as a representational image, that would lend itself to measurement and quantification, but the process of facilitation. Aims: To outline and debate the use of drawing, as a visual imagery method, within the research process and (ii) provide a critical reflection of the use of drawing in the research process. Methodological discussion: Discussion will focus on the (i) the practicalities of undertaking drawing during data collection using semi-structured interviews i.e. participant preparation, informed consent and dynamics (ii) participants perspectives in undertaking drawing during data collection using semi-structured interviews i.e. concern with the production of a ‘good’ picture (iii) the practicalities of undertaking data analysis. The presentation will then debate what this visual imagery method adds to: (i) data collection (ii) the the narrative account and (iii) data analysis. Conclusion: This paper will outline the use of drawing as a data collection tool alongside semi-structured interviews to enrich the narrative account

Observation and modeling of energetic particles at synchronous orbit on July 29, 1977

In the twelve hours following a worldwide storm, there was a series of at least four magnetospheric substorms, the last and largest of which exhibited an expansion phase onset at approximately 1200 UT. Data from six spacecraft in three general local time groupings (0300, 0700, and 1300 LT) were examined and vector magnetic field data and energetic electron and ion data from approximately 15 keV to 2 MeV were employed

Patterns of adiposity, vascular phenotypes and cognitive function in the 1946 British Birth Cohort.

BACKGROUND: The relationship between long-term exposure to whole body or central obesity and cognitive function, as well as its potential determinants, remain controversial. In this study, we assessed (1) the potential impact of 30 years exposure to different patterns of whole body and central adiposity on cognitive function at 60-64 years, (2) whether trajectories of central adiposity can provide additional information on later cognitive function compared to trajectories of whole body adiposity, and (3) the influence of vascular phenotypes on these associations. METHODS: The study included 1249 participants from the prospective cohort MRC National Survey of Health and Development. Body mass index (BMI), waist circumference (WC), and vascular (carotid intima-media thickness, carotid-femoral pulse wave velocity) and cognitive function (memory, processing speed, reaction time) data, at 60-64 years, were used to assess the associations between different patterns of adult WC or BMI (from 36 years of age) and late midlife cognitive performance, as well as the proportion of this association explained by cardiovascular phenotypes. RESULTS: Longer exposure to elevated WC was related to lower memory performance (p < 0.001 for both) and longer choice reaction time (p = 0.003). A faster gain of WC between 36 and 43 years of age was associated with the largest change in reaction time and memory test (P < 0.05 for all). Similar associations were observed when patterns of WC were substituted with patterns of BMI, but when WC and BMI were included in the same model, only patterns of WC remained significantly associated with cognitive function. Participants who dropped one BMI category and maintained a lower BMI had similar memory performance to those of normal weight during the whole follow-up. Conversely, those who dropped and subsequently regained one BMI category had a memory function similar to those with 30 years exposure to elevated BMI. Adjustment for vascular phenotypes, levels of cardiovascular risk factors, physical activity, education, childhood cognition and socioeconomic position did not affect these associations. CONCLUSIONS: Longer exposure to elevated WC or BMI and faster WC or BMI gains between 36 and 43 years are related to lower cognitive function at 60-64 years. Patterns of WC in adulthood could provide additional information in predicting late midlife cognitive function than patterns of BMI. The acquisition of an adverse cardiovascular phenotype associated with adiposity is unlikely to account for these relationships

Hearing aid effectiveness after aural rehabilitation - individual versus group (HEARING) trial: RCT design and baseline characteristics

<p>Abstract</p> <p>Background</p> <p>Hearing impairment is the most common body system disability in veterans. In 2008, nearly 520,000 veterans had a disability for hearing loss through the Department of Veterans Affairs (VA). Changes in eligibility for hearing aid services, along with the aging population, contributed to a greater than 300% increase in the number of hearing aids dispensed from 1996 to 2006. In 2006, the VA committed to having no wait times for patient visits while providing quality clinically-appropriate care. One approach to achieving this goal is the use of group visits as an alternative to individual visits. We sought to determine: 1) if group hearing aid fitting and follow-up visits were at least as effective as individual visits, and 2) whether group visits lead to cost savings through the six month period after the hearing aid fitting. We describe the rationale, design, and characteristics of the baseline cohort of the first randomized clinical trial to study the impact of group versus individual hearing aid fitting and follow-up visits.</p> <p>Methods</p> <p>Participants were recruited from the VA Puget Sound Health Care System Audiology Clinic. Eligible patients had no previous hearing aid use and monaural or binaural air-conduction hearing aids were ordered at the evaluation visit. Participants were randomized to receive the hearing aid fitting and the hearing aid follow-up in an individual or group visit. The primary outcomes were hearing-related function, measured with the first module of the Effectiveness of Aural Rehabilitation (Inner EAR), and hearing aid adherence. We tracked the total cost of planned and unplanned audiology visits over the 6-month interval after the hearing aid fitting.</p> <p>Discussion</p> <p>A cohort of 659 participants was randomized to receive group or individual hearing aid fitting and follow-up visits. Baseline demographic and self-reported health status and hearing-related measures were evenly distributed across the treatment arms.</p> <p>Outcomes after the 6-month follow-up period are needed to determine if group visits were as least as good as those for individual visits and will be reported in subsequent publication.</p> <p>Trial Registration</p> <p>NCT00260663</p

Gene expression signatures for colorectal cancer microsatellite status and HNPCC

The majority of microsatellite instable (MSI) colorectal cancers are sporadic, but a subset belongs to the syndrome hereditary nonpolyposis colorectal cancer (HNPCC). Microsatellite instability is caused by dysfunction of the mismatch repair (MMR) system that leads to a mutator phenotype, and MSI is correlated to prognosis and response to chemotherapy. Gene expression signatures as predictive markers are being developed for many cancers, and the identification of a signature for MMR deficiency would be of interest both clinically and biologically. To address this issue, we profiled the gene expression of 101 stage II and III colorectal cancers (34 MSI, 67 microsatellite stable (MSS)) using high-density oligonucleotide microarrays. From these data, we constructed a nine-gene signature capable of separating the mismatch repair proficient and deficient tumours. Subsequently, we demonstrated the robustness of the signature by transferring it to a real-time RT-PCR platform. Using this platform, the signature was validated on an independent test set consisting of 47 tumours (10 MSI, 37 MSS), of which 45 were correctly classified. In a second step, we constructed a signature capable of separating MMR-deficient tumours into sporadic MSI and HNPCC cases, and validated this by a mathematical cross-validation approach. The demonstration that this two-step classification approach can identify MSI as well as HNPCC cases merits further gene expression studies to identify prognostic signatures

Access to and impact of psychological support for healthcare professionals working in palliative care settings.

Background: Palliative healthcare professionals’ wellbeing and the degree to which they experience themselves as stressed is an important part of quality care delivery and ensuring patients receive good compassionate care (Hospice UK, 2015). Caring for dying patients involves high levels of emotional engagement (Meier and Beresford, 2006) and repeated exposure to suffering and death (Peters et al, 2013). Healthcare professionals can find it difficult to balance compassionate care and self-care and need support to cope with the associated stress of caring in this environment, but little is known about psychological support availed by palliative healthcare professionals. Aims: To: (i) explore the impact of psychological support for healthcare professionals working in palliative care; (ii) identify helpful forms of psychological support alongside any potential barriers to accessing such support. Methods: Exploratory, qualitative research design. Semi-structured interviews and drawing (to enrich the narrative account), with a purposive sample of palliative healthcare professionals (n=16) from one hospice in West Yorkshire, England (February-May 2016). Ethical approval was granted. Data were analysed using framework approach of verbatim transcripts. Results: Four main themes emerged through data analysis (i) types of support (ii) coping strategies (iii) barriers/facilitators to accessing psychological support (iv) developing/maintaining resilience. Staff participated in various formal and informal psychosocial support and coping strategies to reduce their vulnerability. Several barriers and facilitators to accessing psychological support and ways of developing and strengthening their own personal resilience were identified. Discussion & Conclusion: Palliative healthcare professionals use a diverse portfolio of psychosocial support and coping strategies to promote their personal well-being. Having the opportunity to access psychological support during working hours is an important part of staff support strategies in the workplace. Managers have a key role in providing access to psychological support to help reduce vulnerability to and impact of stress in the workplace

Hormone Receptor–Positive, HER2-Negative Metastatic Breast Cancer: Redrawing the Lines

Estrogen receptor modulators and estrogen deprivation have become standards of care for hormone receptor– positive metastatic breast cancer. However, after traditional first-line endocrine monotherapy treatment, the disease typically progresses despite the initial high rate of clinical benefit. Multiple studies have aimed at optimizing treatment strategies to improve upon clinical benefit beyond the traditional single-agent endocrine treatment. With the availability of new data and novel therapies, the clinical practice challenge becomes how best to define the optimal treatment sequence to maximize clinical benefit. In this review, we present treatment options clinically relevant to the management of hormone-positive, her2-negative metastatic breast cancer, and we propose a treatment algorithm based on the current literature