12 research outputs found
ΠΠ±ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠ΅ Π΄ΠΈΡΠ»ΠΎΠΊΠ°ΡΠΈΠΈ ΠΌΠ΅ΠΆΡΠ΅Π³ΠΈΠΎΠ½Π°Π»ΡΠ½ΡΡ ΡΠ΅Π½ΡΡΠΎΠ² ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ Ρ ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ Π΄Π΅ΡΡΠΌ Π² Π ΠΎΡΡΠΈΠΉΡΠΊΠΎΠΉ Π€Π΅Π΄Π΅ΡΠ°ΡΠΈΠΈ
Introduction. In Russia, there is a need to reorganize the system of providing specialized surgical care to children, primarily in emergency and urgent care and in remote, sparsely populated, and hard-to-reach areas. This need is evidenced by the significant persisting disparities in the mortality rate in the countrys various regions.
Purpose of the study. This study aims to provide multifactorial substantiation of the expediency, profile, and location of specialized (surgical) interregional centers (MRC), including high-tech, medical care for children, by the priority profiles of activity, about medical organizations of the federal districts (FD) of Russia.
Materials and methods. The study design included a two-level (regional and federal) system of professional expertise and justification in terms of the profile, location, and area of responsibility of the MRC in the federal district of the country. At the regional level, Delphi technology was implemented with a mathematical and statistical analysis of 103 expert opinions from 85 constituent entities of Russia, the result of which activities priority profiles were substantiated (newborn surgery, neurosurgery, thoracic surgery, oncology, combustiology) and patient routing preferences. At the second stage of the work, with the involvement of federal experts, the SWOT analysis technology was implemented as a universal method of strategic planning, with the justification of the location and number of MRCs in individual FD of the country, about specific medical organizations where they are based. For an objective (quantitative) assessment of the provision of the Federal District of Russia with the MRC of specialized medical care for children according to the established profiles of activity, we have proposed a calculated indicator the regional contingency coefficient (CRC), representing the ratio of two uniformly calculated values the number of MRCs and regions in a particular Federal District, or the country as a whole.
Results. The consolidated position of federal experts regarding the location of the MRC was formulated according to the established profiles of activity about FD and specific medical organizations in the Russian Federation constituent entities. The cattle in the profile of the activity of neonatal surgery was 0.14, and about neurosurgery, thoracic surgery, and oncology, respectively, 0.12, 0.11, and 0.11 for Russia as a whole. The lowest (0.09) cattle in the country characterized the situation with the combustiology profile. In the overwhelming majority (76.0%), the location of the MRC is tied to the administrative centers of the Federal District or cities of federal significance. Among the 50 MRCs of all priority profiles, 43 (86%) were potentially designated by experts based on multidisciplinary pediatric medical organizations.
Discussion. The effectiveness of the MRC functioning is due to the organization of medical and evacuation support for children with diseases and injuries. The development of consultative and resuscitation centers in the primary hospital structure is promising. Its functionality, along with remote counseling, treatment, and evacuation activities, includes monitoring the condition of sick and affected children at the place of primary hospitalization. An alternative is a presence on the clinical base of the MRC of a structural unit or a branch of the regional center for emergency medical care and disaster medicine.
Conclusion. Overcoming the inequality in the availability and quality of medical care for children in certain FD and regions of Russia is necessary to reorganize the current system of staged medical care. Optimal logistics of medical and evacuation support for specialized patients and injured people include the MRC as a collector for children in need of specialized care, including high-tech medical care, with the implementation of the predominant principle of evacuation of oneself.ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. ΠΠ±ΠΎΡΠ½ΠΎΠ²Π°Π½Π° Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΡ ΡΠ΅ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΠΈ ΡΠΈΡΡΠ΅ΠΌΡ ΠΎΠΊΠ°Π·Π°Π½ΠΈΡ ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ Π΄Π΅ΡΡΠΌ Π ΠΎΡΡΠΈΠΈ, ΠΏΡΠ΅ΠΆΠ΄Π΅ Π²ΡΠ΅Π³ΠΎ Π² ΡΠΊΡΡΡΠ΅Π½Π½ΠΎΠΉ ΠΈ Π½Π΅ΠΎΡΠ»ΠΎΠΆΠ½ΠΎΠΉ ΡΠΎΡΠΌΠ°Ρ
, Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ Π² ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΡΡ
, ΠΌΠ°Π»ΠΎΠ½Π°ΡΠ΅Π»Π΅Π½Π½ΡΡ
ΠΈ ΡΡΡΠ΄Π½ΠΎΠ΄ΠΎΡΡΡΠΏΠ½ΡΡ
ΡΠ°ΠΉΠΎΠ½Π°Ρ
, Ρ ΠΏΠΎΠ·ΠΈΡΠΈΠΉ ΡΠΎΡ
ΡΠ°Π½ΡΡΡΠΈΡ
ΡΡ ΡΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΡ
Π΄ΠΈΡΠΏΡΠΎΠΏΠΎΡΡΠΈΠΉ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ ΡΠΌΠ΅ΡΡΠ½ΠΎΡΡΠΈ Π² ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ
ΡΠ΅Π³ΠΈΠΎΠ½Π°Ρ
ΡΡΡΠ°Π½Ρ.
Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ. ΠΠ½ΠΎΠ³ΠΎΡΠ°ΠΊΡΠΎΡΠ½ΠΎΠ΅ ΠΎΠ±ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠ΅ ΡΠ΅Π»Π΅ΡΠΎΠΎΠ±ΡΠ°Π·Π½ΠΎΡΡΠΈ, ΠΏΡΠΎΡΠΈΠ»Ρ ΠΈ Π΄ΠΈΡΠ»ΠΎΠΊΠ°ΡΠΈΠΈ ΠΌΠ΅ΠΆΡΠ΅Π³ΠΈΠΎΠ½Π°Π»ΡΠ½ΡΡ
ΡΠ΅Π½ΡΡΠΎΠ² (ΠΠ Π¦) ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ (Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ), Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ Π²ΡΡΠΎΠΊΠΎΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΎΠΉ, ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ Π΄Π΅ΡΡΠΌ, ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ ΠΏΡΠΈΠΎΡΠΈΡΠ΅ΡΠ½ΡΠΌ ΠΏΡΠΎΡΠΈΠ»ΡΠΌ Π΄Π΅ΡΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ, ΠΏΡΠΈΠΌΠ΅Π½ΠΈΡΠ΅Π»ΡΠ½ΠΎ ΠΊ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΠΌ ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΡΠΌ ΡΠ΅Π΄Π΅ΡΠ°Π»ΡΠ½ΡΡ
ΠΎΠΊΡΡΠ³ΠΎΠ² (Π€Π) Π ΠΎΡΡΠΈΠΈ.
ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΠΈΠ·Π°ΠΉΠ½ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π²ΠΊΠ»ΡΡΠ°Π» Π΄Π²ΡΡ
ΡΡΠΎΠ²Π½Π΅Π²ΡΡ (ΡΠ΅Π³ΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠΉ ΠΈ ΡΠ΅Π΄Π΅ΡΠ°Π»ΡΠ½ΡΠΉ) ΡΠΈΡΡΠ΅ΠΌΡ ΠΏΡΠΎΡΠ΅ΡΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ ΡΠΊΡΠΏΠ΅ΡΡΠΈΠ·Ρ ΠΈ ΠΎΠ±ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΡ Π² ΡΠ°ΡΡΠΈ ΠΏΡΠΎΡΠΈΠ»Ρ, Π΄ΠΈΡΠ»ΠΎΠΊΠ°ΡΠΈΠΈ, Π·ΠΎΠ½Ρ ΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎΡΡΠΈ ΠΠ Π¦ Π² Π€Π ΡΡΡΠ°Π½Ρ. ΠΠ° ΡΠ΅Π³ΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠΌ ΡΡΠΎΠ²Π½Π΅ ΡΠ΅Π°Π»ΠΈΠ·ΠΎΠ²Π°Π»ΠΈ ΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΠΈΡ ΠΠ΅Π»ΡΡΠΈ Ρ ΠΌΠ°ΡΠ΅ΠΌΠ°ΡΠΈΠΊΠΎ-ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈΠΌ Π°Π½Π°Π»ΠΈΠ·ΠΎΠΌ 103 ΡΠΊΡΠΏΠ΅ΡΡΠ½ΡΡ
Π·Π°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠΉ ΠΈΠ· 85 ΡΡΠ±ΡΠ΅ΠΊΡΠΎΠ² Π ΠΎΡΡΠΈΠΈ, Π² ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ΅ ΠΊΠΎΡΠΎΡΠΎΠ³ΠΎ Π±ΡΠ»ΠΈ ΠΎΠ±ΠΎΡΠ½ΠΎΠ²Π°Π½Ρ ΠΏΡΠΈΠΎΡΠΈΡΠ΅ΡΠ½ΡΠ΅ ΠΏΡΠΎΡΠΈΠ»ΠΈ Π΄Π΅ΡΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ (Ρ
ΠΈΡΡΡΠ³ΠΈΡ Π½ΠΎΠ²ΠΎΡΠΎΠΆΠ΄Π΅Π½Π½ΡΡ
, Π½Π΅ΠΉΡΠΎΡ
ΠΈΡΡΡΠ³ΠΈΡ, ΡΠΎΡΠ°ΠΊΠ°Π»ΡΠ½Π°Ρ Ρ
ΠΈΡΡΡΠ³ΠΈΡ, ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡ, ΠΊΠΎΠΌΠ±ΡΡΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡ) ΠΈ ΠΏΡΠ΅Π΄ΠΏΠΎΡΡΠ΅Π½ΠΈΡ Π² ΡΠ°ΡΡΠΈ ΠΌΠ°ΡΡΡΡΡΠΈΠ·Π°ΡΠΈΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². ΠΠ° Π²ΡΠΎΡΠΎΠΌ ΡΡΠ°ΠΏΠ΅ ΡΠ°Π±ΠΎΡΡ, Ρ ΠΏΡΠΈΠ²Π»Π΅ΡΠ΅Π½ΠΈΠ΅ΠΌ ΡΠΊΡΠΏΠ΅ΡΡΠΎΠ² ΡΠ΅Π΄Π΅ΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΡΠΎΠ²Π½Ρ, ΡΠ΅Π°Π»ΠΈΠ·ΠΎΠ²Π°Π»ΠΈ ΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΠΈΡ SWOT-Π°Π½Π°Π»ΠΈΠ·Π° ΠΊΠ°ΠΊ ΡΠ½ΠΈΠ²Π΅ΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΌΠ΅ΡΠΎΠ΄Π° ΡΡΡΠ°ΡΠ΅Π³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΏΠ»Π°Π½ΠΈΡΠΎΠ²Π°Π½ΠΈΡ, Ρ ΠΎΠ±ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ Π΄ΠΈΡΠ»ΠΎΠΊΠ°ΡΠΈΠΈ ΠΈ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π° ΠΠ Π¦ Π² ΠΎΡΠ΄Π΅Π»ΡΠ½ΡΡ
Π€Π ΡΡΡΠ°Π½Ρ, ΠΏΡΠΈΠΌΠ΅Π½ΠΈΡΠ΅Π»ΡΠ½ΠΎ ΠΊ ΠΊΠΎΠ½ΠΊΡΠ΅ΡΠ½ΡΠΌ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΠΌ ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΡΠΌ ΠΈΡ
Π±Π°Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΡ. Π‘ ΡΠ΅Π»ΡΡ ΠΎΠ±ΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠΉ (ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠΉ) ΠΎΡΠ΅Π½ΠΊΠΈ ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠ΅Π½Π½ΠΎΡΡΠΈ Π€Π Π ΠΎΡΡΠΈΠΈ ΠΠ Π¦ ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ Π΄Π΅ΡΡΠΌ ΠΏΠΎ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½Π½ΡΠΌ ΠΏΡΠΎΡΠΈΠ»ΡΠΌ Π΄Π΅ΡΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ Π½Π°ΠΌΠΈ ΠΏΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½ ΡΠ°ΡΡΠ΅ΡΠ½ΡΠΉ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ ΠΊΠΎΡΡΡΠΈΡΠΈΠ΅Π½Ρ ΡΠ΅Π³ΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ ΡΠΎΠΏΡΡΠΆΠ΅Π½Π½ΠΎΡΡΠΈ (ΠΠ Π‘), ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΡΡΠΈΠΉ ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ Π΄Π²ΡΡ
ΠΎΠ΄Π½ΠΎΡΠΎΠ΄Π½ΠΎ ΠΈΡΡΠΈΡΠ»Π΅Π½Π½ΡΡ
Π²Π΅Π»ΠΈΡΠΈΠ½ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΠΠ Π¦ ΠΈ ΡΠ΅Π³ΠΈΠΎΠ½ΠΎΠ² Π² ΠΊΠΎΠ½ΠΊΡΠ΅ΡΠ½ΠΎΠΌ Π€Π, Π»ΠΈΠ±ΠΎ ΡΡΡΠ°Π½Π΅ Π² ΡΠ΅Π»ΠΎΠΌ.
Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠΎΠ½ΡΠΎΠ»ΠΈΠ΄ΠΈΡΠΎΠ²Π°Π½Π½Π°Ρ ΠΏΠΎΠ·ΠΈΡΠΈΡ ΡΠ΅Π΄Π΅ΡΠ°Π»ΡΠ½ΡΡ
ΡΠΊΡΠΏΠ΅ΡΡΠΎΠ² Π² ΡΠ°ΡΡΠΈ Π΄ΠΈΡΠ»ΠΎΠΊΠ°ΡΠΈΠΈ ΠΠ Π¦ Π±ΡΠ»Π° ΡΡΠΎΡΠΌΡΠ»ΠΈΡΠΎΠ²Π°Π½Π° ΠΏΠΎ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½Π½ΡΠΌ ΠΏΡΠΎΡΠΈΠ»ΡΠΌ Π΄Π΅ΡΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ ΠΏΡΠΈΠΌΠ΅Π½ΠΈΡΠ΅Π»ΡΠ½ΠΎ ΠΊ Π€Π ΠΈ ΠΊΠΎΠ½ΠΊΡΠ΅ΡΠ½ΡΠΌ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΠΌ ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΡΠΌ Π² ΡΡΠ±ΡΠ΅ΠΊΡΠ°Ρ
Π Π€. ΠΠ Π‘ ΠΏΠΎ ΠΏΡΠΎΡΠΈΠ»Ρ Π΄Π΅ΡΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ Ρ
ΠΈΡΡΡΠ³ΠΈΡ Π½ΠΎΠ²ΠΎΡΠΎΠΆΠ΄Π΅Π½Π½ΡΡ
ΡΠΎΡΡΠ°Π²ΠΈΠ» 0,14, Π° ΠΏΡΠΈΠΌΠ΅Π½ΠΈΡΠ΅Π»ΡΠ½ΠΎ ΠΊ Π½Π΅ΠΉΡΠΎΡ
ΠΈΡΡΡΠ³ΠΈΠΈ, ΡΠΎΡΠ°ΠΊΠ°Π»ΡΠ½ΠΎΠΉ Ρ
ΠΈΡΡΡΠ³ΠΈΠΈ, ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΠΈ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ 0,12, 0,11, 0,11 Π΄Π»Ρ Π ΠΎΡΡΠΈΠΈ Π² ΡΠ΅Π»ΠΎΠΌ. ΠΠ°ΠΈΠ±ΠΎΠ»Π΅Π΅ Π½ΠΈΠ·ΠΊΠΈΠΉ (0,09) ΠΠ Π‘ Π² ΡΡΡΠ°Π½Π΅ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΠΎΠ²Π°Π» ΡΠΈΡΡΠ°ΡΠΈΡ Ρ ΠΏΡΠΎΡΠΈΠ»Π΅ΠΌ ΠΊΠΎΠΌΠ±ΡΡΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡ. Π ΠΏΠΎΠ΄Π°Π²Π»ΡΡΡΠ΅ΠΌ Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²Π΅ (76,0 %) Π΄ΠΈΡΠ»ΠΎΠΊΠ°ΡΠΈΡ ΠΠ Π¦ ΠΏΡΠΈΠ²ΡΠ·Π°Π½Π° ΠΊ Π°Π΄ΠΌΠΈΠ½ΠΈΡΡΡΠ°ΡΠΈΠ²Π½ΡΠΌ ΡΠ΅Π½ΡΡΠ°ΠΌ Π€Π, Π»ΠΈΠ±ΠΎ Π³ΠΎΡΠΎΠ΄Π°ΠΌ ΡΠ΅Π΄Π΅ΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π·Π½Π°ΡΠ΅Π½ΠΈΡ. Π‘ΡΠ΅Π΄ΠΈ 50 ΠΠ Π¦ Π²ΡΠ΅Ρ
ΠΏΡΠΈΠΎΡΠΈΡΠ΅ΡΠ½ΡΡ
ΠΏΡΠΎΡΠΈΠ»Π΅ΠΉ 43 (86 %) ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎ Π±ΡΠ»ΠΈ ΠΎΠ±ΠΎΠ·Π½Π°ΡΠ΅Π½Ρ ΡΠΊΡΠΏΠ΅ΡΡΠ°ΠΌΠΈ Π½Π° Π±Π°Π·Π΅ ΠΌΠ½ΠΎΠ³ΠΎΠΏΡΠΎΡΠΈΠ»ΡΠ½ΡΡ
ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΡ
ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΠΉ ΠΏΠ΅Π΄ΠΈΠ°ΡΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΏΡΠΎΡΠΈΠ»Ρ.
ΠΠ±ΡΡΠΆΠ΄Π΅Π½ΠΈΠ΅. ΠΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΡΡΠ½ΠΊΡΠΈΠΎΠ½ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΠ Π¦ ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»Π΅Π½Π° ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΠ΅ΠΉ Π»Π΅ΡΠ΅Π±Π½ΠΎ-ΡΠ²Π°ΠΊΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠ΅Π½ΠΈΡ Π΄Π΅ΡΠ΅ΠΉ Ρ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡΠΌΠΈ ΠΈ ΡΡΠ°Π²ΠΌΠ°ΠΌΠΈ. ΠΠ΅ΡΡΠΏΠ΅ΠΊΡΠΈΠ²Ρ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ΅Ρ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ Π² ΡΡΡΡΠΊΡΡΡΠ΅ Π±Π°Π·ΠΎΠ²ΡΡ
Π±ΠΎΠ»ΡΠ½ΠΈΡ ΠΊΠΎΠ½ΡΡΠ»ΡΡΠ°ΡΠΈΠ²Π½ΠΎ-ΡΠ΅Π°Π½ΠΈΠΌΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΡΠ΅Π½ΡΡΠΎΠ², ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π» ΠΊΠΎΡΠΎΡΡΡ
, Π½Π°ΡΡΠ΄Ρ Ρ Π΄ΠΈΡΡΠ°Π½ΡΠΈΠΎΠ½Π½ΡΠΌ ΠΊΠΎΠ½ΡΡΠ»ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΈ Π»Π΅ΡΠ΅Π±Π½ΠΎ-ΡΠ²Π°ΠΊΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΉ Π΄Π΅ΡΡΠ΅Π»ΡΠ½ΠΎΡΡΡΡ, Π²ΠΊΠ»ΡΡΠ°Π΅Ρ ΠΌΠΎΠ½ΠΈΡΠΎΡΠΈΠ½Π³ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΈ ΠΏΠΎΡΠ°ΠΆΠ΅Π½Π½ΡΡ
Π΄Π΅ΡΠ΅ΠΉ ΠΏΠΎ ΠΌΠ΅ΡΡΡ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠΉ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ. ΠΠ»ΡΡΠ΅ΡΠ½Π°ΡΠΈΠ²ΠΎΠΉ ΡΠ²Π»ΡΠ΅ΡΡΡ Π½Π°Π»ΠΈΡΠΈΠ΅ Π½Π° ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±Π°Π·Π΅ ΠΠ Π¦ ΡΡΡΡΠΊΡΡΡΠ½ΠΎΠ³ΠΎ ΠΏΠΎΠ΄ΡΠ°Π·Π΄Π΅Π»Π΅Π½ΠΈΡ, Π»ΠΈΠ±ΠΎ ΡΠΈΠ»ΠΈΠ°Π»Π° ΡΠ΅Π³ΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠ΅Π½ΡΡΠ° ΡΠΊΠΎΡΠΎΠΉ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ ΠΈ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½Ρ ΠΊΠ°ΡΠ°ΡΡΡΠΎΡ.
ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΡΠ΅ΠΎΠ΄ΠΎΠ»Π΅Π½ΠΈΠ΅ Π½Π΅ΡΠ°Π²Π΅Π½ΡΡΠ²Π° Π΄ΠΎΡΡΡΠΏΠ½ΠΎΡΡΠΈ ΠΈ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ Π΄Π΅ΡΡΠΌ Π² ΠΎΡΠ΄Π΅Π»ΡΠ½ΡΡ
ΡΠ΅Π΄Π΅ΡΠ°Π»ΡΠ½ΡΡ
ΠΎΠΊΡΡΠ³Π°Ρ
ΠΈ ΡΠ΅Π³ΠΈΠΎΠ½Π°Ρ
Π ΠΎΡΡΠΈΠΈ ΡΠΎΠΏΡΡΠΆΠ΅Π½ΠΎ Ρ ΡΠ΅ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΠ΅ΠΉ Π΄Π΅ΠΉΡΡΠ²ΡΡΡΠ΅ΠΉ ΡΠΈΡΡΠ΅ΠΌΡ ΡΡΠ°ΠΏΠ½ΠΎΠΉ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ. ΠΠΏΡΠΈΠΌΠ°Π»ΡΠ½Π°Ρ Π»ΠΎΠ³ΠΈΡΡΠΈΠΊΠ° Π»Π΅ΡΠ΅Π±Π½ΠΎ-ΡΠ²Π°ΠΊΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠ΅Π½ΠΈΡ ΠΏΡΠΎΡΠΈΠ»ΡΠ½ΡΡ
Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΈ ΠΏΠΎΡΠ°ΠΆΠ΅Π½Π½ΡΡ
Π²ΠΊΠ»ΡΡΠ°Π΅Ρ ΠΠ Π¦ Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΠΊΠΎΠ»Π»Π΅ΠΊΡΠΎΡΠ° Π΄Π»Ρ Π΄Π΅ΡΠ΅ΠΉ, Π½ΡΠΆΠ΄Π°ΡΡΠΈΡ
ΡΡ Π² ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ, Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ Π²ΡΡΠΎΠΊΠΎΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΎΠΉ, ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ, Ρ ΡΠ΅Π°Π»ΠΈΠ·Π°ΡΠΈΠ΅ΠΉ ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΠΏΡΠΈΠ½ΡΠΈΠΏΠ° ΡΠ²Π°ΠΊΡΠ°ΡΠΈΡ Π½Π° ΡΠ΅Π±Ρ