RISK MANAGEMENT ALGORITHM FOR ENSURING THE SANITARY SAFETY OF THE POPULATION IN THE AREA OF THE OIL REFINERY

The article reveals the main features and characteristics of the algorithm of actions to ensure environmental safety of the population in the areas of oil refineries based on the mechanism of health risk assessment at all stages of the life cycle of environmentally hazardous production facilities. Methodologically, the algorithm implements the provisions of existing standards, regulatory documents and recommendations on health risk assessment of the population and is a sequence of procedures for making informed decisions on ensuring that health risk to the population exposed to potential negative environmental impacts meets the regulatory level. Application of the algorithm ensures compliance with the regulatory level of environmental impacts on the border of the sanitary protection zone of oil refineries and adjacent residential areas.A special emphasis is made on the stages of design and operation of environmentally hazardous objects, when the level of created health risks is especially sensitive to the results of decisions made. Timely identification of hazards and assessment of health risks at the design stage helps to choose the location of environmentally hazardous facilities, considering created risks in specific industrial and urban conditions. At the operation stage, the areas with highest risk levels of the sanitary protection zone boundary and the industrial site are identified, as well as priority production facilities and chemical toxicants (in terms of created risks). This gives a reason for adjusting the programs of industrial and environmental control, for specifying the priority of investment programs and plans of environmental protection measures. In practical terms the specific features of actions in conditions of high risks are defined to ensure the health risk meets the regulatory level in functioning of environmentally hazardous oil refining object, avoiding significant financial environmental costs as a result of making ecologically insufficiently justified planning and technological decisions at the design stage. The algorithm is universal, because it can be used for the existing production facilities and new construction projects, regardless of industry specifics

确保炼油厂附近居人群的环境安全的风险管理算法

The article reveals the main features and characteristics of the algorithm of actions to ensure environmental safety of the population in the areas of oil refineries based on the mechanism of health risk assessment at all stages of the life cycle of environmentally hazardous production facilities. Methodologically, the algorithm implements the provisions of existing standards, regulatory documents and recommendations on health risk assessment of the population and is a sequence of procedures for making informed decisions on ensuring that health risk to the population exposed to potential negative environmental impacts meets the regulatory level. Application of the algorithm ensures compliance with the regulatory level of environmental impacts on the border of the sanitary protection zone of oil refineries and adjacent residential areas.A special emphasis is made on the stages of design and operation of environmentally hazardous objects, when the level of created health risks is especially sensitive to the results of decisions made. Timely identification of hazards and assessment of health risks at the design stage helps to choose the location of environmentally hazardous facilities, considering created risks in specific industrial and urban conditions. At the operation stage, the areas with highest risk levels of the sanitary protection zone boundary and the industrial site are identified, as well as priority production facilities and chemical toxicants (in terms of created risks). This gives a reason for adjusting the programs of industrial and environmental control, for specifying the priority of investment programs and plans of environmental protection measures. In practical terms the specific features of actions in conditions of high risks are defined to ensure the health risk meets the regulatory level in functioning of environmentally hazardous oil refining object, avoiding significant financial environmental costs as a result of making ecologically insufficiently justified planning and technological decisions at the design stage. The algorithm is universal, because it can be used for the existing production facilities and new construction projects, regardless of industry specifics. В статье раскрываются основные черты и особенности алгоритма действий по обеспечению экологической безопасности населения, проживающего в районах размещения предприятий нефтепереработки, на основе механизма оценки рисков здоровью на всех этапах жизненного цикла экологически опасных производственных объектов. Методологически алгоритм реализует положения действующих стандартов, нормативных и рекомендательных документов по оценке риска здоровью населения и представляет собой набор последовательных процедур принятия обоснованных решений по обеспечению нормативного показателя остаточного риска здоровью населения, подверженного потенциальному негативному экологическому воздействию. Применение алгоритма обеспечивает соблюдение нормативного уровня экологических воздействий на границе санитарно-защитной зоны предприятий нефтепереработки и на прилегающих жилых территориях.Особый акцент делается на этапы проектирования и эксплуатации экологически опасного объекта, когда уровень создаваемых рисков здоровью особенно чувствителен к результатам принимаемых решений. Благодаря своевременным идентификации опасностей и оценке рисков здоровью на этапе проектирования уточняется расположение проектируемых экологически опасных установок с учетом их рискогенности в конкретных производственных и градостроительных условиях. На этапе эксплуатации выявляются наиболее рискогенно-опасные участки границы санитарно-защитной зоны и промплощадки, приоритетные (по величине формируемых рисков) производственные установки и химические токсиканты. Это дает основание для корректировки программ производственного контроля и производственного экологического контроля, для уточнения приоритетности инвестиционных программ и планов природоохранных мероприятий. В практическом плане сформулированы особенности действий в условиях высоких рисков для обеспечения нормативного уровня остаточного риска здоровью населения при функционировании экологически опасного производственного объекта нефтепереработки, при этом избегаются значительные финансовые природоохранные затраты как результат принятия экологически недостаточно обоснованных планировочных и технологических решений на этапе проектирования. Алгоритм универсален, поскольку может использоваться для действующих производственных объектов и объектов нового строительства независимо от отраслевой специфики. 文章揭示了为确保炼油厂所在地区居人群的环境安全而采取的行动算法的主要特点和特殊性﹐其依据是对环境有害的生产设施的生命周期的各个阶段的健康风险评估机制｡在方法上﹐该算法执行了现有的公共卫生风险评估标准﹑法规和指南的规定｡该算法是一套连续的程序﹐用于作出明智的决定﹐以确保暴露于潜在不利环境影响的人群的健康有一个规范的残余风险指标｡该算法的应用确保了炼油厂和邻近居群民区的卫生防护区边界符合环境影响的监管水平｡特别强调的是环境危险设施的设计和运营阶段﹐此时﹐所带来的健康风险水平对决策的结果特别敏感｡在设计阶段及时评估健康风险﹐可以根据具体工业和城市环境中的危险性来确定环境危险设施的位置｡在经营阶段﹐可确定卫生防护区边界和工业场地的最危险区域﹐以及优先（就产生的风险大小而言）的生产装置和化学毒物｡这为调整工业控制和工业环境控制方案﹐以及明确环境保护措施的投资方案和计划的优先次序提供了依据｡制定了在高风险环境中实际行事的具体内容﹐为确保环境危险的炼油生产设施运营期间对公众健康的残余风险达到监管水平｡在设计阶段提供无害环境规划和技术解决方案的结果是将避免巨大的环境财政成本｡该算法是通用的｡它既可用于现有的生产基地﹐也可用于新建筑工地﹐不受行业限制

The possibility of a favourable outcome and reversibility of severe ankle joint damage on the example of a clinical observation

The problem of aseptic talus necrosis consists of the following features: a) manifestation of the disease in the form of acute articular syndrome without typical symptoms; b) inevitable serious consequences in the form of disfiguring deforming arthrosis of the ankle joint, development of gross deformities of the rearfoot, etc., resulting in disability. The lack of methods for monitoring the dynamics of the disease also plays an important role. This is particularly so with such an important issue as the substantiation of stopping immobilization and allowing the load on the foot in order to avoid collapsed talus and subsequent complications. It is believed that treatment started before radiographic changes helps to avoid severe complications, but for a number of reasons patients arrive already at the stage of late severe destructive changes. All of the above explains the high relevance of the problem of treatment of patients with aseptic talus necrosis. The importance of the presented clinical case and the value of this information can be considered several points: its  example demonstrates the possibility of early diagnosis of severe talus damage cause by aseptic necrosis; based on objective data, a substantiation was made for allowing the load on the leg with body weight in the complex of rehabilitation measures; the possibility of regression of pathological changes associated with aseptic talus necrosis and the dynamics of the course of aseptic talus necrosis with a favorable outcome were demonstrated, which is confirmed by modern research methods. Thus, the need for magnetic resonance imaging has been confirmed for all referred patients with a clinical picture of local articular syndrome in the ankle joint, the possibility of complete regression of avascular necrosis symptoms in case of conservative treatment at the early stages and the possibility of resolving the load on the leg in the complex of rehabilitation treatment have been demonstrated

Peculiarities of the relationship to disease and level of anxiety in children under treatment in the stationary conditions

The article describes the types of attitudes of children under treatment in the cardiological, gastroenterological and nephrology departments to the disease, assessed their levels of anxiety, revealed and justified the relationship between the attitude to the disease and anxietyВ статье рассмотрены типы отношения детей, находящихся на лечении в кардиологическом, гастроэнтерологическом и нефрологическом отделениях, к болезни, оценены уровни их тревожности, выявлена и обоснована взаимосвязь между отношением к болезни и тревожностью

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

The Heat Transfer Characteristics in the Furnace for One-Stage Oxygen Fuel-Fired Autogenous Smelting of Copper Sulphide Concentrates

The theoretical basics of copper-bearing sulphide concentrate one-stage recycling technology in oxygen fuel-fired furnaces for blister copper (white matte) melting are stated. The pre-design furnace heat transfer characteristics investigation based on polyzonal mathematical model has been led. It has been found that the designed scheme of the unit with vertical charge-oxygen fires provides adequate durability and efficiency.Изложены теоретические основы технологии одностадийной переработки медьсодержащего сульфидного концентрата в печах автогенной кислородно-факельной плавки на черновую медь (белый матт). На основе многозональной математической модели проведены предпроектные исследования особенностей теплообмена в печи. Установлено, что конструкция разработанного печного агрегата с вертикальным расположением шихтово-кислородных факелов обеспечивает достаточную надежность и экономичность его работы

The Heat Transfer Characteristics in the Furnace for One-Stage Oxygen Fuel-Fired Autogenous Smelting of Copper Sulphide Concentrates

The theoretical basics of copper-bearing sulphide concentrate one-stage recycling technology in oxygen fuel-fired furnaces for blister copper (white matte) melting are stated. The pre-design furnace heat transfer characteristics investigation based on polyzonal mathematical model has been led. It has been found that the designed scheme of the unit with vertical charge-oxygen fires provides adequate durability and efficiency.Изложены теоретические основы технологии одностадийной переработки медьсодержащего сульфидного концентрата в печах автогенной кислородно-факельной плавки на черновую медь (белый матт). На основе многозональной математической модели проведены предпроектные исследования особенностей теплообмена в печи. Установлено, что конструкция разработанного печного агрегата с вертикальным расположением шихтово-кислородных факелов обеспечивает достаточную надежность и экономичность его работы

Intensifying separating processes of high-concentration uranyl solutions and fine-dispersed suspended solids

The investigations on intensifying separation processes of highly concentrated uranylnitrate solutions and solid fine-dispersed suspended particles (ferric, silicon, molybdenum oxides and others) applying organic coagulants and flocculants have been carried out. It is shown that in the investigated regions of uranium concentrates of 300...450 g/l, nitric acid of 0,5...3,0 mole/l at optimal temperature 30...50 °С for effective phases separation the introduction of 100...200 mg/l of coagulant FLOQULATTM FL 45 С (or an analogue VPK-402) and 5...10 mg/l of flocculant FLOPAMTM FO 4140 PWG type is enoug

Barriers to sustainable tuberculosis control in the Russian Federation health system.

The Russian Federation has the eleventh highest tuberculosis burden in the world in terms of the total estimated number of new cases that occur each year. In 2003, 26% of the population was covered by the internationally recommended control strategy known as directly observed treatment (DOT) compared to an overall average of 61% among the 22 countries with the highest burden of tuberculosis. The Director-General of WHO has identified two necessary starting points for the scaling-up of interventions to control emerging infectious diseases. These are a comprehensive engagement with the health system and a strengthening of the health system. The success of programmes aimed at controlling infectious diseases is often determined by constraints posed by the health system. We analyse and evaluate the impact of the arrangements for delivering tuberculosis services in the Russian Federation, drawing on detailed analyses of barriers and incentives created by the organizational structures, and financing and provider-payment systems. We demonstrate that the systems offer few incentives to improve the efficiency of services or the effectiveness of tuberculosis control. Instead, the system encourages prolonged supervision through specialized outpatient departments in hospitals (known as dispensaries), multiple admissions to hospital and lengthy hospitalization. The implementation, and expansion and sustainability of WHO-approved methods of tuberculosis control in the Russian Federation are unlikely to be realized under the prevailing system of service delivery. This is because implementation does not take into account the wider context of the health system. In order for the control programme to be sustainable, the health system will need to be changed to enable services to be reconfigured so that incentives are created to reward improvements in efficiency and outcomes