The psychological self-training program of an elite athlete in the pre-Olympic period (on the example of biathlon)/

Рукопись поступила в редакцию: 18.02.2023. Принята к публикации: 18.03.2023.Received: 18.02.2023. Accepted: 18.03.2023.В статье излагаются результаты кейс-исследования психологической самоподготовки спортсменки – члена национальной женской сборной России по биатлону в предолимпийский период. Дается теоретическое обоснование психологической самоподготовки, базирующееся на подходах к самоуправлению и самоэффективности как личностному ресурсу спортсмена. Представлена программа психологической самоподготовки, обозначены критерии эффективности программы и представлены качественные результаты исследования, включающие использование ведущих стратегий преодоления стрессовых ситуаций и результаты по стрельбе на протяжении предолимпийского сезона, а также на Олимпийских играх в Пекине в 2022 году. Представленная программа может быть рекомендована спортсменам и тренерам как примера включения спортсменов в процесс психологической самоподготовки.The article presents the case-study results of psychological self-training of an athlete – a member of the national women’s biathlon team of Russia during the pre-Olympic period. The theoretical justification of psychological self-training has been given; it is based on approaches to self-management and self-efficacy as a personal resource of the athlete. The program of psychological self-training has been presented. The criteria for the effectiveness of the program are outlined and qualitative research results are also presented, including the use of leading coping-strategies and shooting results during the pre-Olympic season, as well as at the Olympic Games in Beijing in 2022. The presented program can be recommended to athletes and coaches as an example of athletes’ inclusion in the process of psychological self-training

МЕХАНИЗМ СТРАХОВАНИЯ В СЕЛЬСКОМ ХОЗЯЙСТВЕ РЕСПУБЛИКИ БЕЛАРУСЬ КАК ФИНАНСОВЫЙ ИНСТРУМЕНТ ОБЕСПЕЧЕНИЯ ЕГО УСТОЙЧИВОГО РАЗВИТИЯ

The insurance of agricultural risks is the object of close attention and support of the state in many developed countries of the world. Insurance in agriculture has its own peculiarities, often large losses can not be compensated by agricultural producers and insurance companies themselves, therefore, state support for agricultural insurance is required. In addition, state support for agricultural insurance programs, according to the rules of the World Trade Organization, is exempted from obligations on reduction, which is of particular interest to the Republic of Belarus due to plans to join this organization. The article determines some features of efficient mechanism of agricultural insurance and criteria for compliance of agricultural insurance programs with the requirements of the World Trade Organization. Analysis of the existing insurance mechanism in agricultural sector of the Republic of Belarus made it possible to identify the main problems that hinder the development of this tool. In this connection, possible directions for development of insurance mechanism in agricultural sector of the Republic of Belarus with participation of budgetary funds and attraction of additional subjects to it have been worked out. The proposed approaches will allow expanding the list of insured agricultural crops, increasing the amount of state support for agriculture, which, in accordance with the WTO rules, do not fall under reduction obligations, which can positively affect the financial sustainability of agricultural organizations and their activity efficiency. The novelty of these approaches is the use of index insurance principles, consisting in use of regional yield index, previously not used in our republic, but applied in developed countries. Index insurance will allow reducing administrative costs affecting the insurance rate, raise attractiveness of agricultural insurance for insurance companies and its availability for agricultural producers, as well as reduce crop loss risks.Во многих развитых странах мира страхование сельскохозяйственных рисков является объектом пристального внимания и поддержки со стороны государства. Страхование в сельском хозяйстве имеет свои особенности, зачастую крупные потери не могут быть возмещены самими сельхозпроизводителями и страховыми организациями, поэтому необходима государственная поддержка сельскохозяйственного страхования. Кроме этого, государственная поддержка программ сельскохозяйственного страхования, согласно правилам Всемирной торговой организации, освобождена от обязательств по сокращению, что представляет особый интерес для Республики Беларусь в связи с планами по присоединению к данной организации. В статье определены некоторые особенности эффективного механизма сельскохозяйственного страхования и критерии соответствия программ сельскохозяйственного страхования требованиям Всемирной торговой организации. Анализ существующего механизма страхования в сельском хозяйстве Республики Беларусь позволил определить основные проблемы, препятствующие развитию данного инструмента. В связи с этим выработаны возможные направления развития механизма страхования в сельском хозяйстве Республики Беларусь с участием бюджетных средств и привлечением в него дополнительных субъектов. Предлагаемые подходы позволят расширить перечень страхуемых сельскохозяйственных культур, увеличить объем государственной поддержки сельского хозяйства, которые в соответствии с правилами ВТО не попадают под обязательства по сокращению, что может положительно сказаться на финансовой устойчивости сельскохозяйственных организаций и эффективности их деятельности. Новизной данных подходов является использование принципов индексного страхования, заключающихся в использовании индекса региональной урожайности, ранее не используемого в нашей республике, но получившего применение в развитых странах. Индексное страхование позволит снизить административные расходы, влияющие на величину страхового тарифа, повысить привлекательность сельскохозяйственного страхования для страховых компаний и его доступность для производителей сельскохозяйственной продукции, а также снизить риски потерь урожая

EFFICACY AND SAFETY OF SINUS RHYTHM RESTORATION WITH AMIODARONE AND PROPAFENONE IN OUTPATIENTS, ECONOMIC ASPECTS (BASED ON DATA OF N.A. SEMASHKO NORTHERN MEDICAL CLINICAL CENTER)

Aim. To study efficacy and safey of sinus rhythm restoration with amiodarone and propafenone in outpatients with recurrent atrial fibrillation (AF), and to estimate pharmacoeconomic efficiency of such cardioversion in comparison with hospital treatment.Material and methods. Patients (n=199; aged 59.2±1.36) with paroxysmal (73.9%) or persistent (26.1%) AF were included into the multicenter prospective study. Follow-up period was 13.14 months (min 1 month, max 36 months). Patients with arrhythmia relapse <48 h received outpatient cardioversion with amiodarone or propafenone orally. Daily outpatient examination, including ECG and blood pressure monitoring every 30-60 min, was carried out to evaluate efficacy of cardioversion and hemodynamics. Phone contact with patients was available. Patients with unstable hemodynamics received cardioversion in hospital. Patients received propafenone in cumulative dose of 600 mg (150-300 mg every hour), and amiodarone 600-800 mg daily. The cost/effectiveness ratio (CER) was estimated. This ratio shows the cost of one unit of effect.Results. Outpatient cardioversion with amiodarone was started 24 h earlier (p=0.029) and with propafenone — 4.5 h earlier (p=0.002) than that in hospital. The average dose of amiodarone in ambulatory cardioversion was 1.3 times less (713.7±84,62 mg, p=0.345) than that in hospital cardioversion. Outpatient treatment with amiodarone restored sinus rhythm 8.7 h earlier, and with propafenone - 3.5 h earlier than the same treatments in hospital. Efficiency of hospital cardioversion with amiodarone was 70%, with propafenone - 80%, and efficiency of outpatient cardioversion — 96,1% and 98,4%, respectively. Outpatient treatment did not cause any severe side effects. Expenses for outpatient cardioversion made up 143 724.25 rubles, and for hospital cardioversion — 92 870.47 rubles. Average treatment costs for one patient in hospital was 6 times greater than for an outpatient. Outpatient cardioversion had the lowest CER (~1300 rubles%).Conclusion. Outpatient cardioversion with amiodarone or propafenone is not only effective and safe, but also economically feasible

Выбор метода периоперационного обезболивания при тотальном эндопротезировании тазобедренного сустава

Objective: to evaluate the efficiency and safety of various perioperative analgesia modes during total hip joint replacement (THR). Subjects and methods. A randomized controlled trial enrolled 90 patients who were divided into 3 groups according to the choice of a perioperative analgesia mode on day 1: general sevofluorane anesthesia, by switching to intravenous patient-controlled analgesia with fentanyl (PCA, GA group), a combination of general and spinal bupiva-caine anesthesia, by switching to PCA with fentanyl (SA group), a combination of general and epidural ropivacaine anesthesia with continuous postoperative epidural ropivacaine infusion (EA group). All the patients received non-opi-oid analgesics after surgery. Results. Prolonged epidural block ensures better postoperative analgesia at rest and during mobilization and a less need for opioids than other analgesia modes (p<0.05). With neuroaxial block, the preoperative need for sympatomimetics is much higher than that in the GA group (p<0.05). There is also a trend toward a higher incidence of cardiac arrhythmias and postoperative nausea and vomiting in the SA and EA groups. There are no differences in the frequency of hemotransfusion and postoperative complications and the length of hospital stay. Conclusion. Prolonged epidural block provides excellent perioperative analgesia during THR, but the risk-benefit ratio needs to be carefully assessed when an analgesia mode is chosen.Цель исследования . Оценить эффективность и безопасность различных методов периоперационного обезболивания при тотальном эндопротезировании тазобедренного сустава (ТЭТС). Материал и методы. В рандомизированное контролируемое исследование вошло 90 пациентов, которые были разделены на 3 группы в зависимости от выбора метода периоперационного обезболивания в 1-е сутки: общая анестезия севофлураном с переходом на внутривенную контролируемую пациентом анальгезию фентанилом (КПА, группа ОА), комбинация общей и спинномозговой анестезии бупивакаином с переходом на КПА фентанилом (группа СА), комбинация общей и эпиду-ральной анестезии ропивакаином с постоянной послеоперационной эпидуральной инфузией ропивакаина (группа ЭА). Все пациенты после операции получали неопиоидные анальгетики. Результаты. Продленная эпидуральная блокада обеспечивает лучшее послеоперационное обезболивание в покое и при движении, а также меньшую потребность в опиоидах в сравнении с другими группами (р<0,05). При нейроаксиальной блокаде периоперационная потребность в симпатомиметиках значительно выше, чем в группе ОА (р<0,05). Также отмечена тенденция к большей частоте возникновения нарушений ритма сердца и послеоперационной тошноты и рвоты в группах СА и ЭА. Различий в частоте проведения гемотрансфузии, послеоперационных осложнений и длительности госпитализации выявлено не было. Заключение. Продленная эпидуральная блокада обеспечивает отличную периоперационную анальгезию при ТЭТС, но при выборе метода обезболивания необходимо тщательно оценивать соотношение риск-польза

Оценка производственных процессов на наиболее типичных фермах и комплексах по производству молока

The article presents the results of research, according to an energy assessment, of the most common options for combining spatial planning and technological solutions of buildings and structures, the set of technological equipment used on the most typical operating farms and milk production complexes. The most significant elements of technology and technological equipment, its operating modes, energy consumption by cost elements for the processes of preparation and distribution of feed, manure removal and provision of the required microclimate parameters, determining the intensity level of the production process in various variants of building layout and livestock, have been studied. The results obtained allow us to determine the most effective options for mechanization and automation of the production process and improve the technological methods of their implementation.Изложены результаты исследований по энергетической оценке наиболее распространенных вариантов сочетания объемно-планировочных и технологических решений зданий и сооружений, применяемого комплекта технологического оборудования на наиболее типичных фермах и комплексах по производству молока. Изучены наиболее значимые элементы технологии и технологическое оборудование, режимы его работы, энергопотребление по элементам затрат для процессов приготовления и раздачи кормов, удаления навоза и обеспечения требуемых параметров микроклимата, определяющие уровень интенсивности производственного процесса при различных вариантах планировки зданий и поголовья животных. Полученные результаты позволяют определить наиболее эффективные варианты механизации и автоматизации производственного процесса и усовершенствовать технологические приемы их выполнения

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Hydrophilic interaction liquid chromatography (HILIC)—a powerful separation technique

Hydrophilic interaction liquid chromatography (HILIC) provides an alternative approach to effectively separate small polar compounds on polar stationary phases. The purpose of this work was to review the options for the characterization of HILIC stationary phases and their applications for separations of polar compounds in complex matrices. The characteristics of the hydrophilic stationary phase may affect and in some cases limit the choices of mobile phase composition, ion strength or buffer pH value available, since mechanisms other than hydrophilic partitioning could potentially occur. Enhancing our understanding of retention behavior in HILIC increases the scope of possible applications of liquid chromatography. One interesting option may also be to use HILIC in orthogonal and/or two-dimensional separations. Bioapplications of HILIC systems are also presented

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes