Networking in the food sector of regional economy

Purpose: The article aims to study the features and the directions of development of network interaction of subjects of the food sector in different regions of the economy. Design/Methodology/Approach: The use of different methodological approaches allowed us to formulate a holistic management concept for the development of a network of competences in the food sector of the regional economy. Findings: The study identified the subjects of such interaction, as well as features that allow them to unite into groups that form networks of competencies. Considering the food sector of the region's economy as a socio-economic system, noted its extreme structural complexity, which necessitates the development of special approaches to its management, or rather the need for structural management is presented. The format of such interaction is a network of competencies, representing a spatially localized socio-economic structure formed on the initiative of active subjects of the regional economy. Practical Implications: The results obtained can be used as a basis for designing a network form of development of the food sector of the region's economy, taking into account the nature of placement and interaction of participants, as well as allowing for effective use of their resource capabilities, experience and knowledge. Originality/Value: In order to overcome the problems associated with the formation of network identity, network management competence is proposed to use a structured approach allowing them to make targeted decisions based on objective conditions and institutional nature.peer-reviewe

Корреляция лабораторных маркеров активации системы гемостаза с концентрацией и размером внеклеточных микрочастиц плазмы крови у пациентов с COVID-19

Introduction. In recent years, much attention has been paid to the study of extracellular microparticles (microvesicles and exosomes) and their role in the pathogenesis of human diseases.The objective of this study was to determine the number and size of plasma extracellular microparticles (PEMP) in patients with severe and extremely severe COVID-19 and correlate these data with the markers of hemostasis activation, inflammation, and tissue damage.Methods and Materials. The study included 29 patients with severe and extremely severe COVID-19. Concentration and size of PEMP were determined by nanoparticle trajectory analysis (NTA). All patients underwent the complete blood count and the thromboelastometry (TEM). Hemostatic, biochemical, and immunological parameters were assessed including fibrinogen, prothrombin time, activated partial thromboplastin time, D-dimer, C-reactive protein, lactate dehydrogenase, procalcitonin, von Willebrand factor antigen, interleukin 6, and interleukin 18.Results. There were 14 patients (48.3 %) discharged from the ICU with improvement (group 1— survived patients), and 15 patients (51.7 %) with lethal outcomes (group 2 — lethal outcome); the PEMP concentration did not differ between these groups. In group 2, there were heterogeneity of PEMP population, and a tendency to the larger PEMP size (p=0.074). In all patients, the PEMP concentration correlated negatively with both prothrombin time and the number of large platelets; the size of PEMP correlated negatively with the level of von Willebrand factor antigen, and positively with the fibrinogen. In group 1, the PEMP concentration had a direct correlation with both the level of interleukin 18 and maximum clot lysis in TEM; the PEMP size had a direct correlation with the maximum clot lysis in TEM and an inverse correlation with both the level of procalcitonin and maximum clot density in TEM.Conclusion. Our study confirms the importance of the process of extracellular microparticles formation in the COVID-19 pathogenesis. Our findings are consistent with the hypothesis that the parameters of PEMP population can be predictive biomarkers of the COVID-19 severity.Введение. В последние годы большое внимание уделяется изучению внеклеточных микрочастиц — микровезикул и экзосом — и их роли в патогенезе заболеваний человека.Цель — проанализировать количество и размеры внеклеточных микрочастиц плазмы крови (ВМЧПК) у пациентов с COVID-19 тяжелого и крайне тяжелого течения и сопоставить эти параметры с лабораторными маркерами активации гемостаза, воспаления и повреждения тканей.Методы и материалы. В исследование были включены 29 пациентов с COVID-19 тяжелого и крайне тяжелого течения. Концентрацию и размеры ВМЧПК определяли методом анализа траекторий наночастиц (nanoparticle trajectory analysis, NTA). Пациентам выполняли общий клинический анализ крови и тромбоэластометрию (ТЭМ), а также оценивали в крови коагулологические, биохимические и иммунологические показатели, включая фибриноген, протромбиновое время, активированное частичное тромбопластиновое время, D-димер, С-реактивный белок, лактатдегидрогеназу, прокальцитонин, антиген фактора Виллебранда, интерлейкины-6 и -18.Результаты. Были выписаны из отделения реанимации и интенсивной терапии с улучшением 14 (48,3 %) пациентов (группа 1 — выжившие), а 15 (51,7 %) пациентов умерли (группа 2 — летальный исход); концентрация ВМЧПК между этими группами не различалась. В группе 2 была выявлена гетерогенность размера ВМЧПК, а также тенденция к увеличению размера ВМЧПК (р=0,074). Среди всех обследованных пациентов концентрация ВМЧПК обратно коррелировала с протромбиновым временем и числом крупных тромбоцитов, а размер ВМЧПК обратно коррелировал с уровнем антигена фактора Виллебранда и имел прямую корреляцию с фибриногеном. В группе 1 концентрация ВМЧПК имела прямую корреляцию с интерлейкином-18 и максимальным лизисом тромба при ТЭМ, а размер ВМЧПК прямо коррелировал с максимальным лизисом тромба при ТЭМ и обратно коррелировал с прокальцитонином и максимальной плотностью сгустка при ТЭМ.Заключение. Проведенное исследование подтверждает важность процесса образования внеклеточных микрочастиц в патогенезе новой коронавирусной инфекции (COVID-19) и согласуется с гипотезой о том, что параметры пула ВМЧПК могут являться прогностическими биомаркерами степени тяжести COVID-19

INSTRUMENTAL PROVISION OF INDICATIVE MANAGEMENT FOOD INDUSTRY AND ITS IMPROVEMENT

The article is devoted to instruments of indicative management of industrial enterprises, which represent a means of making objective and operational administration solutions, theoretical research, as well as the implementation of management actions on the basis of the analytical and forecasting estimates management indicator

ISSUES OF MEDICAL SPECIALISTS EDUCATION. FOUNDATION OF INSTITUTE OF INDEPENDENT PROFESSIONAL EXPERTS

Medical care improvement in Russan federation directly depends upon implementation to broad practice of professionally-public accreditation of professional   educational   programs   of  medical  profile.  Important  role  in  the evaluation of professional education and specialists preparing, including physicians, for the  labour  market  and  professional  standards, play a  personality  of expert participating in accreditation procedure. Under the realization of Russian society of Cardiology project “Professional-public accreditation of educational programs as an element  of medical education  improvement” and with involvement of the Central expert board  of Russian Unity of medical association  “National medical board” in fsBI “North-Western federal Medical Research Centre  n.a.  V. A. Almazov”  of the Ministry of Health, experts training is go for professional-public accreditation of the programs  of medical profile

INDIVIDUAL ANTIPLATELET THERAPY IN PATIENTS WITH ATHEROSCLEROSIS OF LOWER EXTREMITIES: MYTH OR REALITY?

The incidence of atherosclerosis in the arteries of the lower extremities is increasing all over the world, and studies conducted in several countries have shown that increased incidence of chronic obliterating diseases of lower extremity arteries is associated with other cardiovascular events, and with poor prognosis. The development of an algorithm for an integrated approach to treatment that will make it possible to personalize the drug therapy in this group of patients was one of the ways to improve the long-term results of reconstructive interventions on the arteries of the lower extremities. The study included 105 patients of both sexes (mean age 68 ± 1) who underwent reconstructive surgery on the arteries due to obliterating atherosclerosis of the lower extremities followed-up in the City Diagnostic Center No. 1 in St. Petersburg from 2008 until now. Before seeking treatment, all patients received acetylsalicylic acid (ASA) 100 mg per day as antiplatelet therapy.  The antiplatelet therapy was adjusted on the basis of clinical data, taking into account the laboratory and molecular genetic test results. The functional activity of platelets was monitored according to the ADP- and collagen-induced impedance aggregation indices.  Identification of genetic peculiarities of the drug metabolism and the factors that influence platelet aggregation and the simultaneous laboratory evaluation of the functional activity of platelets made it possible to achieve the stably low residual reactivity of platelets in all patients included in the study by assigning an individual regimen (ASA monotherapy, clopidogrel monotherapy, DAT) and doses (ASA 100 mg or 150 mg per day) of antiplatelet agents

Prospects for the implementation of a bachelor’s degree in medicine

According to modern healthcare requirements, it is necessary to increase workforce capacity of primary care practice, therefore, improving the specialist training is one of the high-priority problems of medical education. Not enough attention is paid to paramedic education and their role in Russian healthcare. The presented analysis of the paramedic profession history and the current state of high-quality healthcare in Russia shows the need to create a regulatory basis for the training of paramedics in the higher education system — a bachelor’s degree

Clopidogrel effectiveness in patients with ST elevation myocardial infarction

Aim. То analyse the effectiveness of clopidogrel therapy (Zilt®) in patients with myocardial infarction (MI), according to genetic variants of Р-450 ЗА cytochromes, platelet adenosine diphosphate (ADPH) receptors, fibrinogen and collagen.Material and methods. The study included 34 patients with ST elevation MI (MI-ST). Antiaggregant therapy effectiveness was assessed based on ADPH-induced platelet aggregation (photometric method by Bom). Polymorphisms A-293G CYP3A4, G6986A CYP3A5, C18T and G36T P2Y12, Leu33Pro GPIIIa, C-154T and T13254C GPVI, C807T GPIa were detected by polymerase chain reaction method, with subsequent restriction endonuclease-based analysis.Results. Clopidogrel therapy was associated with reduced aggregation — 23,5±2,5 %., 32,9±2,8 %, 40,0±3,1% and 16,3±2,6 Щ, 27,0±3,0 %, 35,0±3,4 % at points 1 and 2 for 2,5, 5 and 10 mkM of ADPH, respectively (p<0,04, p<0,l). Individuals with polymorphisms G36T P2Y12, C-154T and T13254C GPVI, C807T GPIa, as well as people with no protective allele T18 P2Y12, demonstrated higher aggregation at baseline and more effective reduction associated with therapy. One exception, Leu33Pro GPIIIa mutation, was observed, linked to no reduction in platelet aggregation. Clopidogrel was more effective in participants with A-293G CYP3A4 mutation, while no clear associations were observed for G6986A CYP3A5.Conclusion. Clopidogrel effectively reduced platelet aggregation in patients with MI-ST, with one exception — Leu33Pro GPIIIa mutation

Pelvic inflammatory disease: basic principles of therapy

Inflammatory diseases of the female genitals are an actual problem of obstetrics and gynaecology, as there is no tendency towards decline in the prevalence of these diseases despite improvements in treatment methods. An inadequate assessment of the severity of the infection process and an incorrectly chosen therapy scheme leads to the recurring chronic course

Rating the efficiency of regional health systems and compulsory health insurance

In the face of increasing of the regional differentiation of the health systems and compulsory health insurance, the comparative analysis and efficiency assessment of their performance in the context of the subjects of the Russian Federation becomes particularly relevant. Therefore, the research is focused on the regional health systems and compulsory health insurance (CHI), and the subject matter of the study is the analysis of the system performance. In the article, the comparative analysis of the authors' approaches to the formation of efficiency criteria of the performance of regional health systems and CHI, as well as to the development of a typology of the constituent entities of the Russian Federation based on these criteria is conducted. The authors propose a system of indicators to measure the economic, medical and social efficiency of the systems under consideration. Moreover, a set of indicators of economic efficiency forms two groups of indicators. The first group of indicators reflects the financial performance, and the second-the structural efficiency. A methodological approach to the formation of the rating for subjects of the Russian Federation according to the levels of efficiency, based on the procedures of cluster analysis and fuzzy mathematics are developed. A feature of the proposed approach to the construction of a typology of the subjects in terms of efficiency is the introduction of a reference subject with the national average performance indicators system that allows to qualitatively assess the effectiveness of regional health systems and CHI by comparing them with the «reference subject». The results of the empirical research have indicated a high differentiation of the subjects of the Russian Federation in terms of economic efficiency, have allowed to identify the subjects-outsiders. The theoretical and practical results can be used for the rational choice of priorities of the state policy in the field of the public health and CHI at the federal and regional levels.Проведен компаративный анализ подходов к формированию критериев оценки эффективности деятельности региональных систем здравоохранения и обязательного медицинского страхования. Предложена система показателей оценки экономической и медико-социальной эффективности деятельности рассматриваемых систем. Разработан методологический подход к формированию рейтинга субъектов Российской Федерации по уровням эффективности, основанный на процедурах кластерного анализа и аппарате нечеткой математики