Long-term glycemic control and factors, associated with response to pump insulin therapy in children

Background: In recent years, pump-based insulin therapy, also known as continuous subcutaneous insulin infusion (CSII), has become a common treatment for children with type 1 diabetes mellitus (T1DM). Despite the fact that, in general, children with type 1 diabetes achieve the best glycemic control indices during pump therapy, while there is a significant heterogeneity of metabolic outcomes among individual patients, many children with CSII do not reach the target level of HbA1c.Objective: To assess the level of glycemic control and factors associated by withdrawal of use, the response to treatment with prolonged use of CSII in children with type 1 diabetes.Materials and methods: The study included 458 children aged 1 to 18 years, treated to pump therapy at least 3 years before the study, the presence of the analyzed data in the register.Results: The level of HbA1c decreased by -0.7% compared with the primary endpoint, which was accompanied by an increase in the number of patients who reached the target level of HbA1c (<7.5%) from 17% to 36%. The best response was observed for patients under 6 years of age with HbA1c over 9% for pump insulin therapy, as well as in patients who regularly use additional bolus and basal functions and CGM. The main reason for stopping the use of the insulin pump is the inconvenience of using and wearing — 47.7%. Risk factors for pump abandonment: later age of start treatment on CSII and frequent episodes of severe hypoglycemia.Conclusion: According to the results of the study, it was shown that pump therapy is an effective method of insulin therapy, which allows to achieve a lower level of HbA1c compared to the initial values

CONCOMITANT CARDIOVASCULAR DISEASES AND ANTIHYPERTENSIVE TREATMENT IN OUTPATIENT PRACTICE (BY THE RECVASA REGISTRY DATA)

Aim. To study a pattern of concomitant cardiovascular diseases (CVDs) and to estimate particularities and quality of medical antihypertensive therapy in hypertensive patients in real outpatient practice with a help of the Registry in Ryazan region.Material and methods. A total of 3690 patients with hypertension, ischemic heart disease, chronic heart failure and atrial fibrillation, who had attended general practitioners and cardiologists of 3 outpatient clinics in Ryazan city, were enrolled in the outpatient Registry of cardiovascular diseases (RECVASA). The diagnosis of hypertension was recorded in 3648 of 3690 (98.9%) outpatient charts, 28.1% of the subjects were men and 71.9% - women.Results. A total of 2907 (79.7%) of 3648 patients had combination of hypertension with other CVDs. Combination of 3-4 cardiovascular diagnoses was registered in 63.8% of the cases. 11.5% and 9.5% of the patients had a history of myocardial infarction and cerebral stroke, respectively. Diagnosis of hypertension was verified in 448 of 450 randomized hypertensive patients (99.6%). The incidence of prescription of one and two antihypertensive drugs (AHDs) was 25% and 39%, respectively, of 3 AHDs – 21%, 4 and more – 2%. AHDs were not prescribed in 13% of hypertensive patients. The mean number of prescribed AHDs was 1.73. The mean incidence rate of target blood pressure achievement was 26.1%. We have noted insufficient ACE inhibitors/angiotensin receptor blockers (ARB) and beta-blockers prescription in different concomitant CVDs. Patients with 3-4 cardiovascular diagnoses were more often prescribed combined antihypertensive treatment. Prescription of ACE inhibitors/ARB, beta-blockers and thiazide diuretics combination was preferable in 74.1% of the cases, when taking into account absolute and relative contraindications for betablockers use – in 64.0%. 15.2% of the hypertensive patients used reimbursed drugs for CVDs at the moment of the Registry enrollment as compared with 39.2% in previous years (p<0.05).Conclusion. The RECVASA study data allowed revealing high incidence of concomitant CVDs in hypertensive patients, insufficient use of combined antihypertensive treatment, including AHDs with proved favorable influence on prognosis. Achievement of concordance of medical treatment to national and international guidelines, taking into account concomitant CVDs, and optimization of patients’ coverage with reimbursed drugs are the main reserves for antihypertensive treatment quality improvement

Состояние радиационной обстановки на территории Орловской области, подвергшейся радиоактивному загрязнению вследствие аварии на Чернобыльской АЭС

Research objective is retrospective analysis of radiation conditions in the Oryol region during 1986- 2015 and assessment of efficacy of the carried out sanitary and preventive activities for population protection against radiation contamination caused by the Chernobyl NPP accident.Article materials were own memoirs of events participants, analysis of federal state statistic surveillance forms 3-DOZ across the Oryol region, f-35 “Data on patients with malignant neoplasms, f-12 “Report on MPI activities”. Risk assessment of oncological diseases occurrence is carried out on the basis of AAED for 1986- 2014 using the method of population exposure risk assessment due to long uniform man-made irradiation in small doses. Results of medical and sociological research of genetic, environmental, professional and lifestyle factors were obtained using the method of cancer patients’ anonymous survey. Data on "risk" factors were obtained from 467 patients hospitalized at the Budgetary Health Care Institution of the Oryol region “Oryol oncology clinic”; a specially developed questionnaire with 60 questions was filled out.The article employs the method of retrospective analysis of laboratory and tool research and calculation of dose loads on the Oryol region population, executed throughout the whole period after the accident.This article provides results of the carried out laboratory research of foodstuff, environment objects describing the radiation conditions in the Oryol region since the first days after the Chernobyl NPP accident in 1986 till 2015.We presented a number of activities aimed at liquidation of man-caused radiation accident consequences which were developed and executed by the experts of the Oryol region sanitary and epidemiology service in 1986-2015. On the basis of the above-stated one may draw the conclusions listed below. Due to interdepartmental interaction and active work of executive authorities in the Oryol region, the population of the territories impacted by radioactive contamination is provided with conditions in compliance with radiation safety requirements and hygienic specifications.Since January 1987 according to radiation and hygienic monitoring in the Oryol region, the local foodstuff did not exceed the hygienic specifications on radiation. In the territories included in the zone of radioactive contamination, the economic activities may be carried out without special protective measures for decrease of caesium-137 and strontium-90 content in produce, there are no restrictions on picking of wild-growing berries, herbs and mushrooms.Being direct participants of development and carrying out of activities for the region protection in case of emergency situation at the radiation hazardous site, we believe that the data presented in this article may be useful both for experts and general population.Целью исследования являлся ретроспективный анализ радиационной обстановки на территории Орловской области за период 1986-2015 гг. и оценка эффективности проведенных санитарно-профилактических мероприятий по защите населения от радиационного загрязнения в результате аварии на Чернобыльской АЭС. Материалом для статьи являлись собственные воспоминания участников тех событий, формы федерального государственного статистического наблюдения 3-ДОЗ по Орловской области, ф-35«Сведения о больных злокачественными новообразованиями», ф-12 «Отчет о работе ЛПУ». Оценка риска возникновения онкологических заболеваний проведена на основании СГЭД за 1986-2014 гг. в соответствии с методикой оценки радиационного риска у населения за счет длительного равномерного техногенного облучения в малых дозах. Результаты медико-социологического исследования генетических, средовых, профессиональных факторов и образа жизни получены методом анонимного анкетирования больных онкологическими заболеваниями. Сведения о факторах риска получены у 467 пациентов, находящихся на стационарном лечении в БУЗ Орловской области «Орловский онкологический диспансер», с заполнением специально разработанной анкеты из 60 вопросов.В статье использован метод ретроспективного анализа лабораторных, инструментальных исследований и расчетов дозовых нагрузок на население Орловской области, выполненных на протяжении всего периода после аварии.В настоящей статье приведены результаты проведенных лабораторных исследований пищевых продуктов, объектов внешней среды, характеризующие радиационную обстановку на территории Орловской области с первых дней после аварии на Чернобыльской АЭС в 1986 г. и до 2015 г. Нами представлен объем мероприятий, направленных на ликвидацию последствий техногенной радиационной аварии, которые были разработаны и выполнены специалистами санитарно-эпидемиологической службы Орловской области в 1986-2015 гг. На основании вышеизложенного можно сделать следующие выводы. На территории Орловской области в результате широкого межведомственного взаимодействия и активной работы исполнительной власти обеспечено проживание населения на территориях, подвергшихся радиоактивному загрязнению, с соблюдением требований и гигиенических нормативов радиационной безопасности.По данным радиационно-гигиенического мониторинга, с января 1987 г. в Орловской области в продовольственном сырье и пищевых продуктах, выращенных на территории области, не выявлялись превышения гигиенических нормативов по радиологическим показателям. Хозяйственная деятельность на территориях, отнесенных к зоне радиоактивного загрязнения, может проводиться без применения специальных защитных мероприятий по снижению содержания цезия-137 и стронция-90 в производимой продукции, отсутствуют ограничения на сбор дикорастущих ягод, трав, грибов.Являясь прямыми участниками разработки и реализации мероприятий по защите региона при возникновении чрезвычайной ситуации на объекте, представляющем радиоактивную опасность, полагаем, что данные, представленные в данной статье, могут быть полезны как специалистам, так и населению

Patients with a Combination of Atrial Fibrillation and Chronic Heart Failure in Clinical Practice: Comorbidities, Drug Treatment and Outcomes

Aim. To assess in clinical practice the structure of multimorbidity, cardiovascular pharmacotherapy and outcomes in patients with a combination of atrial fibrillation (AF) and chronic heart failure (CHF) based on prospective registries of patients with cardiovascular diseases (CVD).Materials and Methods. The data of 3795 patients with atrial fibrillation (AF) were analyzed within the registries RECVASA (Ryazan), RECVASA FP (Moscow, Kursk, Tula, Yaroslavl), REGION-PO and REGION-LD (Ryazan), REGION-Moscow, REGATA (Ryazan). The comparison groups consisted of 3016 (79.5%) patients with AF in combination with CHF and 779 (29.5%) patients with AF without CHF. The duration of prospective observation is from 2 to 6 years.Results. Patients with a combination of AF and CHF (n=3016, age was 72.0±10.3 years; 41.8% of men) compared with patients with AF without CHF (n=779, age was 70.3±12.0 years; 43.5% of men) had a higher risk of thromboembolic complications (CHA2DS2-VASc – 4.68±1.59 and 3.10±1.50; p<0.001) and hemorrhagic complications (HAS-BLED – 1.59±0.77 and 1.33±0.76; p<0.05). Patients with a combination of AF and CHF significantly more often (p<0.001) than in the absence of CHF were diagnosed with arterial hypertension (93.9% and 83.8%), coronary heart disease (87.9% and 53,5%), myocardial infarction (28.4% and 14.0%), diabetes mellitus (22.4% and 7.7%), chronic kidney disease (24.8% and 16.2%), as well as respiratory diseases (20.1% and 15.3%; p=0.002). Patients with AF in the presence of CHF, compared with patients without CHF, were more often diagnosed with a permanent form of arrhythmia (49.3% and 32.9%; p<0.001) and less often paroxysmal (22.5% and 46.2%; p<0.001) form  of  arrhythmia.  Ejection  fraction  ≤40%  (9.3%  and  1.2%;  p<0.001),  heart  rate  ≥90/min  (23.7% and 19.3%; p=0.008) and blood pressure ≥140/90 mm Hg (59.9% and 52.2%; p<0.001) were recorded with AF in the presence of CHF more often than in the absence of CHF. The frequency of proper cardiovascular pharmacotherapy was higher, albeit insufficient, in the presence of CHF (64.9%) than in the absence of it (56.1%), but anticoagulants were prescribed less frequently when AF and CHF were combined (38.8% and  49, 0%; p<0.001). The frequency of unreasonable prescription of antiplatelet agents instead of anticoagulants was 52.5% and 33.3% (p<0.001) in the combination of AF, CHF and coronary heart disease, as well as in the combination of AF with coronary heart disease but without CHF. Patients with AF and CHF during the observation period compared with those without CHF had higher mortality from all causes (37.6% and 30.3%; p=0.001), the frequency of non-fatal cerebral stroke (8.2% and 5.4%; p=0.032) and myocardial infarction (4.7% and 2.5%; p=0.036), hospitalizations for CVD (22.8% and 15.5%; p<0.001).Conclusion. Patients with a combination of AF and CHF, compared with the group of patients with AF without CHF, were older, had a higher risk of thromboembolic and hemorrhagic complications, they were more often diagnosed with other concomitant cardiovascular and chronic noncardiac diseases, decreased left ventricular ejection fraction, tachysystole, failure to achieve the target blood pressure level in the presence of arterial hypertension. The frequency of prescribing proper cardiovascular pharmacotherapy was higher, albeit insufficient, in the presence of CHF, while the frequency of prescribing anticoagulants was less. The  incidence of mortality from all causes, the development of non-fatal myocardial infarction   and cerebral stroke, as well as the incidence of hospitalizations for CVDs were higher in AF associated with CHF

Combination of Atrial Fibrillation and Coronary Heart Disease in Patients in Clinical Practice: Comorbidities, Pharmacotherapy and Outcomes (Data from the REСVASA Registries)

Aim. Assess the structure of comorbid conditions, cardiovascular pharmacotherapy and outcomes in patients with atrial fibrillation (AF) and concomitant coronary artery disease (CAD) included in the outpatient and hospital RECVASA registries.Materials and methods. 3169 patients with AF were enrolled in outpatient RECVASA (Ryazan), RECVASA AF-Yaroslavl registries and hospital RECVASA AF (Moscow, Kursk, Tula). 2497 (78.8%) registries of patients with AF had CAD and 703 (28.2%) of them had a previous myocardial infarction (MI).Results. There were 2,497 patients with a combination of AF and CAD (age was 72.2±9.9 years; 43.1% of men; CHA2DS2-VASc – 4.57±1.61 points; HAS-BLED – 1.60±0,75 points), and the group with AF without CAD included 672 patients (age was 66.0±12.3 years; 43.2% of men; CHA2DS2-VASc – 3.26±1.67 points; HAS-BLED – 1,11±0.74 points). Patients with CAD were on average 6.2 years older and had a higher risk of thromboembolic and hemorrhagic complications (p<0.05). 703 patients with a combination of AF and CAD had the previous myocardial infarction (MI; age was 72.3±9.5 years; 55.2% of men; CHA2DS2-VASc – 4.57±1.61; HAS-BLED – 1.65±0.76), and 1794 patients didn't have previous MI (age was 72.2±10.0 years; 38.4% of men; CHA2DS2-VASc – 4.30±1.50; HAS-BLED – 1.58±0.78). The proportion of men was 1.4 times higher among those with the previous MI. Patients with a combination of AF and CAD significantly more often (p <0.0001) than in the absence of CAD received a diagnosis of hypertension (93.8% and 78.6%), chronic heart failure (90.1% and 51.2%), diabetes mellitus (21.4% and 13.8%), chronic kidney disease (24.8% and 17.7%), as well as anemia (7.0% and 3.0%; p=0.001). Patients with and without the previous MI had the only significant difference in the form of a diabetes mellitus higher incidence having the previous MI (27% versus 19.2%, p=0.0008). The frequency of proper cardiovascular pharmacotherapy was insufficient, mainly in the presence of CAD (67.8%) than in its absence (74.5%), especially the prescription of anticoagulants (39.1% and 66.2%; p <0.0001), as well as in the presence of the previous MI (63.3%) than in its absence (74.3%). The presence of CAD and, in particular, the previous MI, was significantly associated with a higher risk of death (risk ratio [RR]=1.58; 95% confidence interval [CI] was 1.33-1.88; p <0.001 and RR=1.59; 95% CI was 1.33-1.90; p <0.001), as well as with a higher risk of developing a combined cardiovascular endpoint (RR=1.88; 95% CI was 1.17-3 , 00; p <0.001 and RR=1.75; 95% CI was 1.44-2.12; p<0.001, respectively).Conclusion. 78.8% of patients from AF registries in 5 regions of Russia were diagnosed with CAD, of which 28.2% had previously suffered myocardial infarction. Patients with a combination of AF and CAD more often than in the absence of CAD had hypertension, chronic heart failure, diabetes, chronic kidney disease and anemia. Patients with the previous MI had higher incidence of diabetes than those without the previous MI. The frequency of proper cardiovascular pharmacotherapy was insufficient, and to a greater extent in the presence of CAD and the previous MI than in their absence. All-cause mortality was recorded in patients with a combination of AF and CAD more often than in the absence of CAD. All-cause mortality and the incidence of nonfatal myocardial infarction were higher in patients with AF and the previous MI than in those without the previous MI. The presence of CAD and, in particular, the previous MI, was significantly associated with a higher risk of death, as well as a higher risk of developing a combined cardiovascular endpoint

СРАВНИТЕЛЬНАЯ ХАРАКТЕРИСТИКА МУЛЬТИМОРБИДНОСТИ, МЕДИКАМЕНТОЗНОГО ЛЕЧЕНИЯ И ИСХОДОВ У БОЛЬНЫХ С СОЧЕТАНИЕМ ПЕРЕНЕСЕННОГО ОСТРОГО НАРУШЕНИЯ МОЗГОВОГО КРОВООБРАЩЕНИЯ И ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ ПРИ НАЛИЧИИ ИЛИ ОТСУТСТВИИ АНАМНЕЗА ИНФАРКТА МИОКАРДА (ДАННЫЕ РЕГИСТРОВ РЕГИОН)

AIM. Within the framework of outpatient and hospital registers of REGION (REGIster of patients who have undergone acute cerebrovascular accident) to carry out a comparative assessment of demographic and clinical-anamnestical characteristics, medical treatment and outcomes in clinical practice in patients with a combination of undergone acute cerebrovascular accident (ACVA) and atrial fibrillation (AF) in the presence or absence of myocardial infarction (MI) in the medical history.MATERIAL AND METHODS. Outpatient registers REGION (Ryazan) and hospital register REGION (Moscow) included 1886 patients who have undergone ACVA (age 70.6 ± 12.5 years, 41.9% of men), of them 516 (27.4%) people with AF. Comparison groups included 152 (8.1%) patients with a combination of ACVA, AF and MI in medical history (ACVA + AF + MI group) and 364 (19.3%) patients with ACVA, AF without MI (ACVA + AF without MI group). The presence of cardiovascular diseases (CVD), concomitant diseases, drug therapy and outcomes were analyzed.RESULTS. In the group of ACVA + AF + MI patients, compared to the ACVA + AF without MI group, the share of patients with AH (100% and 97.2%), IHD (100% and 87.1%), CHD (68.4% and 57.1%), repeated ACVA (36.9% and 23.9%), diabetes mellitus in women (39.5% and 20.4%) was statistically significantly higher. In the comparison groups, the share of smokers (13.3% and 15.5%), patients with burdened heredity of early development of CVDs (2.1% and 1.1%) and hypercholesterolemia (41.1% and 50.0%) did not differ significantly, however, in the group of ACVA + AF + MI, in comparison with the group of ACVA + AF without MI, there was a higher risk on the CHA2DS2-VASc scale (5.26 ± 1.32 and 4.09 ± 1.44; p < 0.001) and HAS-BLED scale (1.91 ± 0.76 and 1.62 ± 0.79; p < 0.01). Patients with AF of REGION register, both with and without MI, had insufficient frequency of proper medical prescriptions for CVDs (46.6% and 38.9% on average), especially prescription of anticoagulants (19.1% and 21.4%), statins in case of IHD (33.6% and 27.4%) and beta-adrenoblockers in case of CHD (39.4% and 35.6%).  During the four-year period of observation, in comparison with post-stroke patients without a history of MI, the mortality rate for all causes was 1.5 times higher (56.6% and 37.6%, p = 0.0001), the incidence of non-fatal MI was higher (2.0% and 0.3%,p = 0.04). CONCLUSION. Patients with a combination of ACVA, AF and MI history are a very high risk group for adverse outcomes observed on an outpatient stage. For these patients it is very important to improve the quality of drug therapy and the effectiveness of secondary prophylaxis.ЦЕЛЬ. В рамках амбулаторных и госпитального регистров РЕГИОН (РЕГИстр больных, перенесших Острое Нарушение мозгового кровообращения) провести сравнительную оценку демографических и клинико-анамнестических характеристик, медикаментозного лечения и исходов в клинической практике у больных с сочетанием перенесенного острого нарушения мозгового кровообращения (ОНМК) и фибрилляции предсердий (ФП) при наличии или отсутствии инфаркта миокарда (ИМ) в анамнезе.МАТЕРИАЛ И МЕТОДЫ. В амбулаторные регистры РЕГИОН (Рязань) и в госпитальный регистр РЕГИОН (Москва) включено 1886 пациентов, перенесших ОНМК (возраст 70,6 ± 12,5 лет, 41,9% мужчин), из них с ФП 516 (27,4%) человек. Группы сравнения составили 152 (8,1%) пациента с сочетанием перенесенного ОНМК, ФП и ИМ в анамнезе (группа ОНМК + ФП + ИМ) и 364 (19,3%) больных с ОНМК, ФП без анамнеза ИМ (группа ОНМК + ФП без ИМ). Проанализированы наличие сердечно-сосудистых заболеваний (ССЗ), сопутствующих заболеваний, медикаментозная терапия и исходы.РЕЗУЛЬТАТЫ. В группе пациентов ОНМК + ФП + ИМ, по сравнению с пациентами группы ОНМК + ФП без ИМ, была статистически значимо выше доля лиц с АГ (100% и 97,2%), ИБС (100% и 87,1%), ХСН (68,4% и 57,1%), повторного ОНМК (36,9% и 23,9%), сахарного диабета у женщин (39,5% и 20,4%). В группах сравнения доля курящих (13,3% и 15,5%), пациентов с отягощенной наследственностью раннего развития ССЗ (2,1% и 1,1%) и гиперхолестеринемией (41,1% и 50,0%) существенно не различалась, однако в группе ОНМК + ФП + ИМ, по сравнению с группой ОНМК + ФП без ИМ, был выше риск по шкале СHA 2DS2–VASc (5,26 ± 1,32 и 4,09 ± 1,44; p < 0,001) и шкале HAS-BLED (1,91 ± 0,76 и 1,62 ± 0,79; p < 0,01). У больных с ФП регистра РЕГИОН, как с перенесенным ИМ, так и без ИМ, частота должных медикаментозных назначений по поводу ССЗ была недостаточной (в среднем 46,6% и 38,9%), особенно назначения антикоагулянтов (19,1% и 21,4%), статинов при ИБС (33,6% и 27,4%) и бета-адреноблокаторов при ХСН (39,4% и 35,6%). За четырехлетний период наблюдения у больных группы ОНМК + ФП + ИМ, по сравнению с постинсультными пациентами без анамнеза ИМ, смертность от всех причин была в 1,5 раза выше (56,6% и 37,6%, p = 0,0001), чаще развивался нефатальный ИМ (2,0% и 0,3%, р = 0,04).ЗАКЛЮЧЕНИЕ. Больные с сочетанием перенесенных ОНМК, ФП и анамнеза ИМ являются группой очень высокого риска неблагоприятного исхода при наблюдении на амбулаторном этапе. Для данных пациентов крайне важным является повышение качества медикаментозной терапии и эффективности вторичной профилактики

Психологічні та творчі аспекти роботи концертмейстера в процесі диригентсько-хорової підготовки майбутнього вчителя музичного мистецтва

The article examines the process of concertmaster professional work in higher education institutions in choral conducting classes, explores the peculiarity of the concertmaster professional activity within the discipline, which is the leading in the conducting-choral education system, systematized and specified the concertmaster professional requirements in the musical-pedagogical process, generalized and formulated psychological and creative aspects of the concertmaster’s work; the concept of professional concertmaster’work is proposed in the conditions of work in higher education institutions at the classes of choral conducting. In the choir conductor training system, the artistic and pedagogical efficiency of the classes is created by the efforts of two people – a teacher and a concertmaster. Despite the apparent unity, interpenetration and the organic continuity of each individuals work, their official status is significantly different: the teacher is always considered the main, leading person in the educational process, and concertmasters, according to the staffing schedule, belong to the so-called "teaching and support staff". Such the official definition puts them in a minor position. We will try to prove the principle error of this point of view in this article. Consequently, the problem of this work is the contradiction between the concertmaster official status and the real functions of his professional activities. Bythe content of his work, he is a full complement of the creative and pedagogical process, while the statute of "support" staff creates an incorrect orientation and causes some underestimation of the concertmaster’s work. The actual content of the teacher-concertmaster work and the truth of the significance of his activity in the system of conducting-choral education are still notsufficiently recognized at the official level. Therefore, the purpose of this work is to substantiate the true value of the concertmaster activity in the musical-pedagogical process and to form the concept of the concertmaster professional work in the modern musical-pedagogical process. The subject of the work is related directly to everyday pedagogical practice and it is stipulated. That’s why, the practical significance of the work is obvious and does not require additional explanations.У статті розглянуто процес професійної роботи концертмейстера в закладах вищої освіти на заняттях з хорового диригування, досліджено своєрідність професійної діяльності концертмейстера в межах навчальної дисципліни, яка є провідною в системі диригентсько-хорової освіти, систематизовано і конкретизовано професійні вимоги до концертмейстера у музично-педагогічномупроцесі, узагальнено і сформульовано психологічні та творчі аспекти роботи концертмейстера, запропоновано концепцію професійної діяльності концертмейстера в умовах роботи у закладах вищої освіти на заняттях з хорового диригування. В системі підготовки хорового диригента художня і педагогічна ефективність занять створюється зусиллями двох людей – викладача і концертмейстера.Незважаючи на уявну єдність, взаємопроникнення і органічну нерозривність роботи кожної з цих осіб, їх офіційний статус істотно відрізняється: педагог завжди вважається головною, провідною персоною в навчальному процесі, а концертмейстери, згідно штатного розкладу, відносяться до так званого "навчально-допоміжного персоналу". Таке офіційне визначення ставить їх у другорядне становище. В даній статті ми спробуємо довести принципову помилковість такої точки зору.Отже, проблемою даної роботи є суперечність між офіційним статусом концертмейстера і реальними функціями його професійної діяльності. За змістом своєї роботи він є повноправним співучасником творчого і педагогічного процесу, тоді як статут "допоміжного" персоналу створює невірну орієнтацію і викликає певну недооцінку роботи концертмейстерів. Реальний зміст роботи педагога-концертмейстера та істинна значущість його діяльності в системі диригентсько-хорової освіти досі залишаються недостатньо визнаними на офіційному рівні. Тому мета цієї роботи полягає в тому, щоб обґрунтувати дійсне значення концертмейстерської діяльності у музично-педагогічному процесі і сформувати концепцію професійної роботи концертмейстера у сучасному музично-педагогічному процесі. Тематика роботи безпосередньо пов’язана з повсякденною педагогічною практикою і нею же обумовлюється. Тому практична значущість роботи є очевидною і додаткових пояснень не потребує

English. vol.VI

163 tr. ; 22 cm

PHYLOGENETIC RELATIONSHIPS AMONG POPULATIONS OF THE RED VOLE MYODES (= CLETHRIONOMYS) RUTILUS PALLAS, 1779 IN THE NORTHERN PRIOKHOTYE AND KOLYMA REGIONS

The goal of the work was the determination of phylogenetic relationships in red vole associations of the Northern Priokhotye and Kolyma regions on the base of analysis of partial mtDNA cytb gene sequence polymorphism in some Myodes (Сlethrionomys) rutilus populations of Northeastern Asia and Alaska. Genetic analysis allowed the different levels of differentiation among red vole populations from the basins of Kolyma and Yama rivers and the suburbs of Magadan city to be determined. The haplotypes of red vole in the populations from islands of Tauysk Bay, the continental part of the Northern Priokhotye region, and the Kolyma region belong to the eastern lineage with the basal B1 gene variant. The haplotypes of representatives of populations from Kamchatka, Alaska, and Matykil and Sakhalin islands belong to the Beringean lineage. The Siberian samples differ significantly from the above lineages, being an interlink between them. The differentiation of red vole populations in the region and phylogenetic relationships among groups appear to be a consequence of certain features of the species expansion to the northeast in the Late Pleistocene. The first wave of red vole migrated to North America across the Bering land bridge. Presently the descendants of this wave inhabit Alaska, Sakhalin, Kamchatka, and Matykil island. For the second time, the red vole entered the region at the end of the Late Pleistocene. During the second wave of dispersal, red voles from the eastern branch occupied the drainage area of the Kolyma river and the coast of the Sea of Okhotsk together with some neighboring islands