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Purpose of the study. To assess the sensitivity, specificity and diagnostic accuracy of the method for non-invasive differential diagnosis of liver diseases by polyhepatography.Materials and methods. A random sampling method examined 45 primary patients. Polygepatography was performed on all patients to detect disorders of intrahepatic microcirculation during primary contacting. Based on the detected changes in intrahepatic hemodynamics and based on the morphofunctional hemodynamic model, a conclusion was made about the violation of intrahepatic blood flow and an assumption was made about the etiology and stage of liver disease. Subsequently, the diagnosis of liver diseases was verified after a detailed study of clinical-laboratory, instrumental and morphological data generally accepted in hepatology. Puncture liver biopsy by the Mancini method was performed in 11.1 % of the subjects.Results. All subjects were divided into three groups based on the data obtained on impaired intrahepatic hemodynamics during polyhepatography (PHG). The group I consisted of patients with impaired venous inflow, the group II included patients with impaired arteriovenous inflow, and group III — with impaired venous outflow. The obtained polyhepatographic data were compared with the results of clinical-laboratory, instrumental and morphological data. The high sensitivity, sufficient specificity and accuracy of the polyhepatography method in the diagnosis of chronic liver diseases have been determined.Conclusion. The studies carried out indicate that PHG is a simple, accessible and not burdensome examination method for the patient, which makes it possible to assess the localization of intrahepatic blood flow disorders, and, with a certain degree of probability, to assume the etiological factor of the disease and the stage of the disease. Given the specificity of changes in liver hemodynamics, de pending on the etiological factor and stage of the disease, assessment of intrahepatic hemodynamics by polyhepatography can be recommended as a screening method for examining patients with liver diseases, which will shorten the diagnostic search time.

Objective. The purpose of the work was to assess the application of modified ways of polyhepatography (PHG) and peripheral arterial tonometry (PAT) in the evaluation of regulation of peripheral circulation (capillary blood flow).Design and methods. We included 150 people, divided into four groups. The first group (n = 40) includes patients with stage II hypertension, moderate and high risk of cardiovascular complications. The second group (n = 40) includes patients with stable forms of coronary heart disease in combination with hypertension. The third group (n = 40) includes patients with chronic liver diseases. The fourth group (n = 30) consisted of subjects without anamnestic and objective data of pathology. All subjects underwent a comprehensive clinical and laboratory examination, an assessment of intrahepatic hemodynamics by the PGG method, an assessment of the endothelial function by the PAT method. A modified method of PAT was used to evaluate the central reaction of the peripheral blood flow regulation system (endothelium-independent vasodilation).Results. Endothelial dysfunction was found in patients with cardiovascular pathology and in patients with chronic liver diseases. A modified method of PAT showed a multidirectional reaction of peripheral blood flow to the test with local ischemia. A number of features were identified in the study groups when assessing disorders of intrahepatic microcirculation. Patients of group I had multidirectional disorders of arteriovenous inflow (45% cases, confidence interval (CI) from 27 % to 63 %) and outflow (37,5 %, CI from 22 % to 56 %) in the liver, while in patients of group II and group III, disorders of arteriovenous inflow were more common, 85 % (CI from 70 % to 95%) and 90% (82 % to 94%), respectively. Rheographic signs of bile passage disorders were more common in groups II and III. A significant negative relationship was established between endothelial dysfunction and the severity of intrahepatic microcirculation disorders (r = –0,35, p < 0,001).Conclusions. Modified methods of peripheral arterial tone and PHG enable assessment of local and central mechanisms of blood flow regulation at the microvascular level in patients with hypertension, coronary heart disease and chronic liver diseases. The relationship between impaired endothelial function and intrahepatic microcirculation allows us to consider the liver as a target organ in cardiovascular pathology.

The paper clarifies not only the great diversity of natural and economic conditions created in small areas in conditions of severe relief and severe surface fragmentation, but also the spatial development of multi-sectoral economy, many macroeconomic factors: In this context, the further development of rural areas is possible only after a radical change in the budget policy of the state in terms of their financial support, after the development of public-private partnership through more active state regulation of these issues. So far, destructive demographic processes are prevalent in the village. It is impossible to disagree with them, as evidenced by statistics on the decline of the rural population and the increase of abandoned rural areas. The situation is aggravated by the fact that the most important documents of strategic importance for the balanced territorial development of the republic, which have been adopted recently, have not received the required level of clarification. If the possible development of the third sector of the agri-food system is not taken into account in time for the development of the concept, strategy and scheme of the territorial organization of the agrarian sector, considering the coordination of joint actions for the justified placement and specialization of agri-food production of the EEU member states, it will negatively influence the balanced development of rural areas.

Background Syphilis in pregnancy is common in Africa with prevalence as high as 10%. In high prevalence areas ( > 5%), WHO recommends universal syphilis screening and benzathine penicillin G treatment at the first antenatal clinic (ANC) visit. Implementation barriers include global stock outs and supply chain issues. Our goal was to document treatment rates and factors associated with lack of treatment among pregnant women with syphilis in Zambia. Methods The retrospective cohort study analyzed medical record data from pregnant women who sought care in 10 public ANC clinics in Lusaka, Zambia during 2018-2019 and tested positive for syphilis. Syphilis was diagnosed based on positive RPR testing and treatment was defined as documented penicillin therapy at the same facility. Patient characteristics were compared across treatment status using Wilcoxon Rank Sum Test for continuous variables, and Pearson Chi-Square Test for categorical variables. Simple logistic models with treatment status as the binary outcome were conducted to evaluate potential factors associated with lack of syphilis treatment in pregnancy. A multivariable logistic model was performed and a 2-sided P < 0.05 was accepted as statistically significant. Results Among 28,480 pregnant women screened for syphilis, 5.6% (n=1363) tested positive. Among those with syphilis, median age was 27 years, 21% of women were nulliparous and 43% were living with HIV. Most women (72%) had their initial ANC visit during the 2nd trimester and 96% were screened for syphilis at the first visit. The documented treatment rate was 42% and the only factor associated with lack of treatment was ANC entry in 2019 compared to 2018 (aOR 2.2; 95% CI 1.7-2.8; p < 0.001). (refer to Tables 1-2). Conclusion Syphilis prevalence among pregnant women tested in ANC clinic in Zambia during 2018-2019 was 5.6%. Recommended penicillin treatment was only documented in 42% of cases. No maternal or clinic characteristic was associated with lack of therapy. Calendar year may have been associated with treatment for unclear reasons. Novel approaches to ensure access to universal diagnosis and early treatment of syphilis among pregnant women in Zambia are needed to improve maternal and neonatal outcomes. Disclosures All Authors: No reported disclosures.

The article considers the issues with regard to the direct effect of the Constitution. The topic is presented by analyzing the techniques for proper implementation of the Constitution and ensuring the constitutionality of the law enforcement/judicial practice. Author differentiates the content of the concepts „direct effect” and “direct implementation” of the Constitution, presenting the essence of each of the notions. Techniques for proper implementation of constitutional norms are suggested by the author, analyzing also the implementation priority rules. According to the author implementing legislative provisions in conformity with their constitutionallegal content is another precondition for ensuring the proper application of the Constitution. The law enforcement/judicial practice can become a subject of consideration by the Constitutional Court of the Republic of Armenia if itis not an issue of legitimacy of the mentioned practice, but an issue of constitutionality of the latter, an issue of evaluation of the circumstance whether the legal acts are implemented in conformity with their constitutional-legal content in the frames of the mentioned practice is raised.

The article tries to bring to the light the role of symbolism in the organized human life, in general, and the contemporary societies with the accelerating changes almost in all social structures, in particular. The rational of symbolism in changing socio-political and legal environment creates complexity of the issue, which has been studied in the article, taking into account the methodology of complex system theory. The interconnectivity and interdependency of law, morality and politics create the picture of synergy of different social norms with each other in changing environment. Their positive synergy is able to create a perception of the ‘ethical state’ – the focal point of equilibrium expressed in the attractor of future admired development. In the legal perspective, the symbol of that attractor appears to be the constitution as the society’s and the nation’s symbol of coexistence based on the values of mutual past, necessary present and admired future. It is substantiated that the Constitution is the phenomenon, representing a concrete constitutional idea and constitutional identity, and should be the one to be considered as such in a lot of people’s minds if we intend to have a proper constitutional system and values. Hence, the Constitution is not just a document with a highest legal force, but also a symbol of a concrete constitutional system, and from this viewpoint the Basic Law has a symbolic significance. The authors substantiate that the mentioned significance of the Constitution makes it clear that constitutional policy in any state should be established and implemented in a manner, obviously demonstrating an attitude towards the Constitution, in the frames of which it is considered as a symbol of a concrete constitutional system. The most important circumstance in this context is to never transform the Constitution (directly or indirectly) from a symbol to an instrument in the hands of both the people and the state power and the whole constitutional policy of the state should be based on the discussed essential idea. Moreover, according to the authors the Constitution should not be subject to amendment parallel to every change of political situation of the state or formation of a new political majority merely conditioned by the mentioned changes. The Constitution has a fundamental role from the aspect of regulating social relations, has symbolic significance and can’t be used just as a tool for solving ongoing political problems.

The discovery of the system of trace amines and their receptors twenty years ago opened new avenues for studying monoamine systems in the brain. However, of the six trace amine-associated receptors found in humans, mice and rats, only the TAAR1 receptor and its ligands are well studied. The biological functions of the remaining five receptors are currently unknown. We assessed behavioral, biochemical and morphological parameters of TAARR9 knockout (TAAR9-KO) female rats that received a 20% fructose solution instead of water for 2 months. Physiological changes were investigated in open field, elevated plus maze, and Morris water maze behavioral tests; also analyzed were changes in grooming microstructure. As a result, significant differences in exploratory activity, burrowing behavior and thermoregulation, as well as changes in some biochemical parameters and lipid accumulation in the liver, were revealed in TAAR9 gene knockout female rats.

BackgroundAccording to the Global Strategy to Accelerate the Elimination of Cervical Cancer launched by the World Health Organizations (WHO), 70% of all women should undergo cervical cancer (CC) screening by 2030. While integrated HIV care and CC screening services exist, lack of unified data and patient management systems hinder reaching the set WHO goals. We used record linkage methods to assess the number of women receiving HIV care and visual inspection with acetic acid (VIA) based CC screening at Kanyama First Level Hospital (FLH) in Lusaka, Zambia. MethodsWe retrieved HIV patient records from SmartCare, Zambia’s National Electronic Health Records system, and the CC screening database for the years 2004 to 2018, and 2010 to 2018, respectively. We restricted this pilot study to women attending Kanyama FLH for HIV services, and its surrounding clinics for CC screening. We used the following linkage variables: first name, last name, facility, and year of birth. We used a machine learning based approach with Random Forest classifiers to identify records from the HIV and CC screening services belonging to the same person. We created synthetic patient record datasets to train and test the linkages. After the linkage, we anonymized the data and retrieved screening status from the CC screening database. We assessed the percentage of women in HIV care undergoing CC screening and the respective screening results. We calculated the time to CC screening with reference to the start of the HIV Antiretroviral Therapy treatment (ART). ResultsWe retrieved a total of 32,970 records from SmartCare and 176,736 records from CC screening databases. With the linkage we determined that of all women that ever accessed HIV treatment services at Kanyama FLH between 2004 and 2018, 2,999 (9%) received CC screening. Of those that were screened, 30% received the CC service at Kanyama FLH, while the rest from 13 surrounding facilities. 61% of women accessed CC services before starting ART. Of the women screened for CC, 371 had a positive VIA result (12%), 2,395 (80%) a negative and 233 (8%) had a missing or indeterminate result. When we restricted the analysis to women, who were eligible for screening (aged 25 to 59 years), the screening coverage was 9.6%. ConclusionOur study demonstrates the significance of record linkage efforts in determining CC screening coverage among women living with HIV. According to these findings, CC screening coverage among patients receiving ART services between 2004 and 2018 was at 9%, showing the depth of effort required to meet WHO targets at the time. The linkage output was primarily influenced by the scarcity of available linkage variables and data missingness, resulting in potentially overestimating or underestimating the CC coverage. This is typical of data systems in low- and middle-income countries; however, this study demonstrates that record linkage is useful in bridging these widespread data gaps.

ObjectiveThe Bayley Scales of Infant Development (BSID) is the most used diagnostic tool to identify neurodevelopmental disorders in children under age 3 but is challenging to use in low-resource countries. The Ages and Stages Questionnaire (ASQ) is an easy-to-use, low-cost clinical tool completed by parents/caregivers that screens children for developmental delay. The objective was to determine the performance of ASQ as a screening tool for neurodevelopmental impairment when compared with BSID second edition (BSID-II) for the diagnosis of moderate-to-severe neurodevelopmental impairment among infants at 12 and 18 months of age in low-resource countries.MethodsStudy participants were recruited as part of the First Bites Complementary Feeding trial from the Democratic Republic of Congo, Zambia, Guatemala and Pakistan between October 2008 and January 2011. Study participants underwent neurodevelopmental assessment by trained personnel using the ASQ and BSID-II at 12 and 18 months of age.ResultsData on both ASQ and BSID-II assessments of 1034 infants were analysed. Four of five ASQ domains had specificities greater than 90% for severe neurodevelopmental delay at 18 months of age. Sensitivities ranged from 23% to 62%. The correlations between ASQ communications subscale and BSID-II Mental Development Index (MDI) (r=0.38) and between ASQ gross motor subscale and BSID-II Psychomotor Development Index (PDI) (r=0.33) were the strongest correlations found.ConclusionAt 18 months, ASQ had high specificity but moderate-to-low sensitivity for BSID-II MDI and/or PDI Trial registration numberNCT01084109.

Thrombosis is an extremely dangerous complication in elderly patients with COVID-19. Since the first months of the pandemic, anticoagulants have been mandatory in treatment protocols for patients with COVID-19, unless there are serious contraindications. We set out to discover if genetic thrombophilia factors continue to play a triggering role in the occurrence of thrombosis in patients with COVID-19 with prophylactic or therapeutic anticoagulants. We considered the following genetic markers as risk factors for thrombophilia: G1691A in the FV gene, C677T and A1298C in the MTHFR gene, G20210A and C494T in the FII gene, and (−675) 4G/5G in the PAI-I gene. In a cohort of 176 patients, we did not obtain a reliable result indicating a higher risk of thrombotic complications when taking therapeutic doses of anticoagulants in carriers of genetic markers for thrombophilia except the C494T mutation in the FII gene. However, there was still a pronounced tendency to a higher incidence of thrombosis in patients with markers of hereditary thrombophilia, such as FV G1691A and FII G20210A mutations. The presence of the C494T (Thr165Met) allele in the FII gene in this group of patients showed a statistically significant effect of the mutation on the risk of thrombotic complications despite anticoagulant therapy.

The aim of the study was to determine the effect of triamcinolone monotherapy on the quality of life of patients with persistent allergic rhinitis. The study was placebo-controlled, randomized and double-blinded. The study included 46 patients in the study group and 24 patients in the control group, all were diagnosed with persistent allergic rhinitis for at least two years. Patients were examined twice after diagnosis was made. The study group was administered intramuscularly with 40 mg of triamcinolone once, while the control group was given placebo. To estimate the quality of life in both groups, a specially designed questionnaire was used, according to which the final scores were calculated. The triamcinolone group had a lower overall score on the questionnaire compared with the placebo group (p < 0.001). The difference between the scores at the beginning of the study and at the end of the first month for all indicators was statistically significant (p < 0,001). The difference in changes from the start of the study to the end of the first month (difference in treatment) between placebo and the study groups was statistically significant, in favour of the study group. Triamcinolone is a drug that improves the quality of life of patients treated for persistent allergic rhinitis, better than placebo.

A study of intrahepatic blood flow by polyhepatography and evaluation of endothelial function by peripheral arterial tonometry in patients with essential hypertension and coronary heart disease was conducted. The study included 105 people. The subjects were divided into three groups: patients with hypertension, coronary heart disease in combination with hypertension, and a group of healthy people. In all observed cases, except for the healthy group, hemodynamic changes were detected. The features of impaired intrahepatic blood flow in patients with cardiovascular pathology were revealed. The nature of blood flow disorders largely depended on the etiologic factor. The endothelial dysfunction revealed in patients with cardiovascular disease. In patients with arterial hypertension in combination with or without coronary heart disease, a relationship was found between endothelial dysfunction and intrahepatic hemodynamic disorders. The relationship of endothelial dysfunction and intrahepatic hemodynamic disorders was established, in patients with hypertension in combination with coronary heart disease or without it. Therefore, the liver is involved in the pathological process, regardless of the form of myocardial damage in cardiovascular pathology. It is accompanied by varying degrees of severity of intrahepatic microcirculation disorders and endothelial dysfunction of the peripheral vascular bed. This may be a consequence of the universal reaction of the endothelium due to realized effect of risk factors for the development of cardiovascular diseases. In this regard, the liver can be considered as one of the target organs in patients with cardiovascular pathology.

THE CONCEPT OF AGRICULTURAL DIVISION INTO DISTRICTS WITH DEFINITION OF ZONE SPECIALIZATION OF AGRICULTURAL PRODUCTION RА In Agrarian sector of Armenia the issue of the territorial organization of an economy should be discussed on the basis of the concept about division into districts. Hence in the current contribution special attention is given to discussion and estimation of the approaches, referring such concepts, as "specialization", "territorial administration", "adaptive-landscape approach", "vertically - landscape zones". Moreover on the basis of territorially - branch division of labor there is a necessity more proved placing and natural deepening of specialization of manufacture of an agricultural zone. In this context during the Soviet period of development of Agrarian sector under different schemes nature - agricultural division into districts the agro-industrial estimation of all territory of the republic has been given. During this period as system-design units have been accepted uniformity of vertical landscape zones and law of transitions. However in Agrarian activity, in connection with high level of state intervention, the principle of the proved distribution of branches and sub-sectors which corresponded to agricultural zones of the republic was broken. In a market economy, the absolutization of land ownership began to interfere with this. For changing the situation it is necessary to develop corresponding territorial Agrarian policy.

This article is part of the author’s dissertation research. Our research, which began with the study of fashion discourse in general and the fashion discourse of the 1960s in particular, led us to the discovery of the fact that in this field there are currently no linguistic works covering the period of the second half of the 20th century. The author presents a review of several Russian-language sources — monographs and articles written in the 21st century by Russian researchers in the fields of cultural studies, art history, sociological and economic research, analysing the features of the 1960s era in the spheres of production and consumption in the Soviet Union. Our article presents a linguistic argumentative approach to the analysis of the vestimentary discourse that unfolded on the pages of Soviet printed periodicals in the 1960s; articles and notes from the newspaper “Sovetskaya Kultura” [Soviet Culture] were especially interesting for us. In the article, we pay attention to the following aspects identified by us, inherent in the newspaper vestimentary discourse of the analysed era: the tactics of exposing anti-creativity (detective script); actualisation of the effect of deceived expectations; objectivity and subjectivity of professional discourse; reflection as a factor of the adequate implementation of vestimentary discourse elements (explicativeness of discourse); the tone of discourse (an optimistic ending as the author’s attitude). Each of the listed blocks of our work is illustrated by vivid examples — excerpts from two articles from the newspaper “Sovetskaya Kultura” [Soviet Culture] for 1960 and 1965. Using the methods of contextual and linguistic argumentative analysis, we find that the Soviet vestimentary discourse of the 1960s was characterised by dialogueness, explicativeness, and concern for the addressee. The results of our research can be practically applied in teaching the following disciplines: discourse and communicative practices, linguistic argumentation, text analysis and interpretation, the history of Russian journalism, the language of press.

This article considers the formation of archival funds about Austro-Russian relations in the late seventeenth century in one of the four departments of the Austrian State Archives (the Haus-, Hof- und Staatsarchiv of the Habsburgs). The analysis demonstrates that the archival funds formed alongside the development of the archive’s structure. The sources referred to include documents dedicated to the foreign policy contacts of the Habsburg dynasty with Russia in the late seventeenth century. The authors focus on the period when, because of the Ottoman threat, interactions between Vienna and Moscow intensified, which manifested itself in the active exchange of embassies and correspondence. The authors reveal the main type of structure of the archival funds mentioned. The collection contains several types of historical sources, among which the authors single out official letters (der Brief), instructions (die Instruktion) for Viennese representatives sent to Moscow, authentications (die Beglaubigung), decrees, minutes of audiences, envoy accounts (der Gesandtenbericht), and reports (der Bericht) of the Viennese envoys in Moscow. The characterisation of archival documents by fund and type demonstrates the deep research potential of the sources. The authors reveal that despite the long development and numerous military conflicts that influenced the preservation of the funds, the Haus-, Hof-, und Staatsarchiv are an institution of supranational importance, accumulating the historical heritage of Austria and Russia. The archive department contains a large array of documents shedding light on various aspects of diplomatic relations between Vienna and Moscow in the second half of the seventeenth century, making possible a comprehensive study of Habsburg contacts with Russia. This makes it necessary to consider introducing the source base into scholarly circulation.

Background Globally, complications due to preterm birth are the leading contributor to neonatal mortality, resulting in an estimated one million deaths annually. Kangaroo Mother Care (KMC) has been endorsed by the World Health Organisation as a low cost, safe, and effective intervention in reducing morbidity and mortality among preterm infants. The objective of this study was to describe the implementation of a KMC model among preterm infants and its impact on neonatal outcomes at a tertiary level hospital in Lusaka, Zambia. Methods We conducted a prospective descriptive study using data collected from the KMC room at the University Teaching Hospital between January 2016 and September 2017. Mothers and government nurses were trained in KMC. We monitored skin-to-skin and breastfeeding practices, weight at admission, discharge, and length of admission. Results We enrolled 573 neonates into the study. Thirteen extremely low weight infants admitted to the KMC room had graduated to Group A (1,000g-1,499g) at discharge, with a median weight gain of 500g. Of the 419 very low weight neonates at admission, 290 remained in Group A while 129 improved to Group B (1,500g-2,499g), with a median weight gain of 280g. Among the 89 low weight neonates, 1 regressed to Group A, 77 remained in Group B, and 11 improved to Group C (≥2,500g), individually gaining a median of 100g. Of the seven normal weight neonates, 6 remained in Group C individually gaining a median of 100g, and 1 regressed to Group B. Among all infants enrolled, two (0.35%) died in the KMC room. Conclusions Based on the RE-AIM metrics, our results show that KMC is a feasible intervention that can improve neonatal outcomes among preterm infants in Zambia. The study findings show a promising, practical approach to scaling up KMC in Zambia. Trial registration The trial is registered under ClinicalTrials.gov under the following ID number: NCT03923023.

Delayed HIV diagnosis in HIV-exposed infants (HEIs) results in missed opportunities for early antiretroviral therapy (ART), causing significant morbidity and mortality. Early infant diagnosis (EID) depends on the availability of accessible and reliable testing services. We explored the acceptability, appropriateness, and feasibility of deploying a targeted community-based point-of-care (POC) EID testing model (i.e., "community POC model") to reach high-risk mother-infant pairs (MIPs) in Lusaka, Zambia.We conducted in-depth interviews with a purposive sample of health care workers, study staff, and caregivers in high-risk MIPs at 6 health facilities included in a larger implementation research study evaluating the community POC model. We defined "high-risk MIPs" as mothers who did not receive antenatal testing or an attended delivery or infants who missed EID testing milestones. Interviews were audio-recorded, translated, and transcribed verbatim in English. Content and thematic analysis were done using NVivo 10 software.Health care workers (n=20) and study staff (n=12) who implemented the community POC model noted that the portability and on-screen prompts of the POC platform made it mobile and easy to use, but maintenance and supply chain management were key to field operations. Respondents also felt that the community POC model reached more infants who had never had EID testing, allowing them to find infants with HIV infection and immediately initiate them on ART. Caregivers (n=22) found the community POC model acceptable, provided that privacy could be ensured because the service was convenient and delivered close to home.We demonstrate the acceptability, appropriateness, and feasibility of implementing the community POC model in Zambia, while identifying potential challenges related to client privacy and platform field operations. The community POC model may represent a promising strategy to further facilitate active HIV case finding and linkage to ART for children with undiagnosed HIV infection in the community.

Summary Background Globally, cervical cancer is the fourth leading cause of cancer-related death among women. Poor uptake of screening services contributes to the high mortality. We aimed to examine screening frequency, predictors of screening results, and patterns of sensitisation strategies by age group in a large, programmatic cohort. Methods We did a cohort study including 11 government health facilities in Lusaka, Zambia, in which we reviewed routine programmatic data collected through the Cervical Cancer Prevention Program in Zambia (CCPPZ). Participants who underwent cervical cancer screening in one of the participating study sites were considered for study inclusion if they had a screening result. Follow-up was accomplished per national guidelines. We did descriptive analyses and mixed-effects logistic regression for cervical cancer screening results allowing random effects at the individual and clinic level. Findings Between Jan 1, 2010, and July 31, 2019, we included 183 165 women with 204 225 results for visual inspection with acetic acid and digital cervicography (VIAC) in the analysis. Of all those screened, 21 326 (10·4%) were VIAC-positive, of whom 16 244 (76·2%) received treatment. Of 204 225 screenings, 92 838 (45·5%) were in women who were HIV-negative, 76 607 (37·5%) were in women who were HIV-positive, and 34 780 (17·0%) had an unknown HIV status. Screening frequency increased 65·7% between 2010 and 2019 with most appointments being first-time screenings (n=158 940 [77·8%]). Women with HIV were more likely to test VIAC-positive than women who were HIV-negative (adjusted odds ratio 3·60, 95% CI 2·14–6·08). Younger women (≤29 years) with HIV had the highest predictive probability (18·6%, 95% CI 14·2–22·9) of screening positive. Interpretation CCPPZ has effectively increased women's engagement in screening since its inception in 2006. Customised sensitisation strategies relevant to different age groups could increase uptake and adherence to screening. The high proportion of screen positivity in women younger than 20 years with HIV requires further consideration. Our data are not able to discern if women with HIV have earlier disease onset or whether this difference reflects misclassification of disease in an age group with a higher sexually transmitted infection prevalence. These data inform scale-up efforts required to achieve WHO elimination targets. Funding US President's Emergency Plan for AIDS Relief.

The constitutional identity is the originality, individuality and uniqueness of the given constitutional system, which includes not just the originally existing features, providing the given system with a quality of uniqueness, but also the features of larger systems, which are borrowed by the constitutional system and with which the latter starts to identify itself. Because of it, the constitutional identity should be perceived not as a feature, initially belonging to a given social system, but a feature, which is formed and transformed as the result of social interactions. At the same time, all the newly formed peculiarities, including the ones are borrowed from other systems, also become features, defining originality and individuality of the given system. Hence, while borrowing constitutional-legal peculiarities of international and supranational institutions or of any other state, it should be taken into account that mechanical import or not accepting and artificially preserving the mechanically imported features will not in any way contribute to finding a balance between peculiarities of a concrete constitutional system and features borrowed from the mentioned systems. This, in its turn, will lead to the complete distortion of the idea of constitutional identity. At the contemporary stage of development of constitutional law doctrine it is preferable to discuss the notions of “state identity” and “constitutional identity” not as a correlation of correspondingly the whole and the part, but from the viewpoint of different levels, though in some cases they can have points of coincidence. The reason is that within the framework of the mentioned doctrine notions “Constitution”, “Constitutional stability” should per se be perceived not just from the aspect of the written text of the Constitution, but from the viewpoint of constitutional values and their implementation in real social development.

Maternal death is the greatest health disparity globally, with postpartum hemorrhage the most common cause. As senior leaders in obstetrics and maternal health from Bolivia, Canada, Colombia, Côte d'Ivoire, Honduras, India, Kenya, Nepal, Niger, Norway, Peru, Tanzania, the UK, the USA, and Zambia, we are deeply disturbed by recent calls for randomized controlled trials (RCTs) of uterine balloon tamponade (UBT) in women with uncontrolled postpartum hemorrhage (PPH). Our collective experience, in combination with mounting evidence, unequivocally supports the effectiveness of commercial and condom UBTs in averting death and disability from PPH associated with atonic uterus. We believe it would be highly unethical to embark on an RCT of UBT, now or in the future, unless compared with a proven equivalent intervention. This article is protected by copyright. All rights reserved.

A new approach to evaluating of the state of cardiovascular system for patients with verified diagnosis of coronary heart disease (CHd), cardiac syndrome X (COAG) and hypertension (GB) by modification of known techniques of the PAT (peripheral arterial tonometry) is represented in the article. The results of studies by the method of us PAT patients with various cardiovascular disease indicate a particular clinical significance is not only the assessment of local «endothelial dysfunction» (the known value of reactive hyperemia index RHI), but also assess the nature of the Central system response regulation of blood circulation. In the article it is shown that more convenient for this relatively simpleCtrlmeasure R(relative change in the amplitude of pulsations in case of occlusion of the blood supplyto the sample identified on the hand are not subjected to occlusion). For patients without evidenceCtrlof cardiovascular disease the index value Rwas close to unity. The hypertensive patients, as a rule,observed values of R1. The differences associated, pre-CtrlCtrlsumably, with the changing balance between the degree of disturbance of peripheral blood circulationand degree of preservation of the reserves of the pumping function of the heart. This allows to consider the index RCtrl as an additional feature, an essential for individual selection of therapy in patients with cardiovascular pathology.

To determine whether early polyethylene bag use with skin-to-skin care compared with skin-to skin care alone reduce hypothermia among infants born at term in resource-limited settings.Infants born at term in the tertiary referral center in Lusaka, Zambia, were randomized using sequentially numbered sealed opaque envelopes in 2 phases: after birth (phase 1) and at 1 hour after birth (phase 2) to either skin-to-skin care with polyethylene bags or skin-to-skin care alone. Infant and maternal temperatures were recorded at birth, 1 hour, and every 4 hours until discharge or 24 hours.We enrolled 423 infants from May 2017 to August 2017. The rate of moderate-severe hypothermia (temperature36.0°C) at 1 hour was 72 of 208 (34.6%) in the skin-to-skin care with a polyethylene bag group compared with 101 of 213 (47.4%) in the skin-to-skin care alone group (relative risk, 0.71; 95% CI 0.56-0.90; P .01; number needed to treat = 8). phase 1 treatment assignment significantly modified the effect of phase 2 treatment (P = .02 for interaction effect). Among infants randomized to skin-to-skin care with a polyethylene bag in phase 1, the risk of moderate-severe hypothermia was decreased in infants randomized to continue this intervention until discharge compared with infants randomized to skin-to-skin care alone. The rates of severe hypothermia, hyperthermia, and other adverse events did not differ significantly between groups.Low-cost polyethylene bags started after birth in combination with skin-to-skin care reduced moderate or severe hypothermia at 1 hour and at discharge among infants born at term in a resource-limited setting compared with skin-to-skin care alone.ClinicalTrials.gov: NCT03141723.

Objective. To investigate the efficacy of Cortexin in the treatment of cognitive and affective disorders in cerebral ischemia (AI) developing on the background of arterial hypertension or atherosclerosis. Materials and methods. We present an analysis of the all-Russian screening program for the efficacy of Cortexin, “Cognitive and Affective Disorders in the Treatment of Cerebral Ischemia with Cortexin” (KarKaDE), in 50,000 patients with AI developing on the background of arterial hypertension and/or atherosclerosis in 2013 in 70 Russian cities. Results. All patients received Cortexin at a dose of 10 mg/day for 10 days and were investigated before treatment and on days 11 and 30 after the first dose. More extensive analysis was applied to results from the treatment of 500 patients with stage II AI, mean age 63.7 ± 10.23 years. Treatment efficacy was evaluated using a five-point rating scale for subjective and objective neurological symptoms, the five-word memory test, the Schulte test, the MMSE, the Hamilton scales for evaluation of anxiety, and the short form of the Geriatric Depression Scale. Conclusions. Treatment decreased or completely eliminated focal neurological symptomatology and produced positive changes in measures of cognitive impairments, these changes being accompanied by normalization of patients’ emotional status and decreases in the level of depression.

A review contains a description of the most common methods of evaluation and monitoring of "endothelial dysfunction" that are assessed in terms of their information content and applicability in the practice of medicine. The term "endothelial function" is interpreted primarily as a function of the regulation of capillary blood flow, carried out by the expense of the dynamic change of the phase of vasoconstriction and vasodilatation in vessels of resistive type (in accordance with the changing needs of cellular metabolism). Assessment of endothelial dysfunction is understood as a generalized indicator of the extent and nature of violations of the regulation of peripheral circulation. It includes an assessment of imbalances between endotheliumdependent vasoconstrictor and vasodilating factors or mismatch of the local and central regulation of capillary blood flow in response to various functional tests or other effects (eg, cold test, or test with local ischemia). All methods of endothelial dysfunction assessment in the survey are divided into invasive and non-invasive. The main feature of invasive methods lies in the direct effect on the endothelium of the coronary or other vessels by introducing into these vessels vasoactive substances such as acetylcholine. Response to the test (vasoconstriction or vasodilation) is evaluated by coronary angiography or by ultrasound. Non-invasive methods of the assessment of endothelial dysfunction or functions of regulation of the peripheral circulation are regarded as the most promising for widespread use. There are two basic methods that underlie functional tests: methods PAT (peripheral arterial tone) and PHG (polyhepatography). Assessment of endothelial dysfunction in many modern scientific researches is important. They are regarded as the causative factors of many different diseases. Such assessments can be useful in everyday medical practice. Assessment of endothelial function provides the clinician with critical information essential for a personalized selection of therapy. In particular, for taking into account the individual characteristics of the local and central regulatory system response of peripheral blood circulation in the various functional tests, or other effects.

To build a model of technological processes, linear and nonlinear regression equations are used to solve the problems of developing new food products. At the initial stage, the analysis was conducted of the study of the most real technical and technological economic system. As an object of study, depending on the purpose of the study, a particular enterprise, or group of enterprises, as well as an entire branch of the economy of a region or country, or perhaps the gross regional product of a certain subject of the Russian Federation or the country’s GDP, can be chosen. Gooseberry processing complex is considered as an example. The correctness of the choice of model type can be proved very conditionally, as well as from the point of view of the researcher conducting the analysis, his system of preferences regarding models and modeling methods. As an example, consider some conditional company VRM, for which we simulate the initial data on sales for the last 4 years.

The main purpose of economic development of economic entities at all levels and, first of all, of small or medium-sized businesses is the getting a profit, which is the basis for the formation of both explicit and implicit designated funds, namely the reserve fund, the production development fund, the collective development fund and fund of material incentive. Today, the formation of firms’ funds for solving social problems is becoming increasingly important, the main one at the government level is improving the quality of life of the population of the country, which is primarily formed by the wages. Salary (payroll) and profit (the fund of material incentives) are the economic basis for the formation of the quality of life of workers. The amount of wages spent on the creation of products and profits of the enterprise from the sale of manufactured products is the added value or net production created by the firm for the analyzed period. The article considers the factors of the formation of added value as a result of the company’s production and economic activities. Various variants of calculation of the added cost are considered depending on a level of rates of the tax to profit and deductions for social needs.

QIA Motherâ s Questionnaire Quality improvement assessment motherâ s questionnaire v1.0 (DOC 112Â kb)

Dynamics of changes in characteristics of the flow of grain pile entering in dryer have been analyzed on basis of experimental data. Stochastic mathematical model determining the initial operating conditions of dryers is constructed. The model allows to simulate the operating conditions of dryers regardless of their throughput capacity.

Background Antenatal corticosteroids for pregnant women at risk of preterm birth are among the most effective hospital-based interventions to reduce neonatal mortality. We aimed to assess the feasibility, effectiveness, and safety of a multifaceted intervention designed to increase the use of antenatal corticosteroids at all levels of health care in low-income and middle-income countries. Methods In this 18-month, cluster-randomised trial, we randomly assigned (1:1) rural and semi-urban clusters within six countries (Argentina, Guatemala, India, Kenya, Pakistan, and Zambia) to standard care or a multifaceted intervention including components to improve identification of women at risk of preterm birth and to facilitate appropriate use of antenatal corticosteroids. The primary outcome was 28-day neonatal mortality among infants less than the 5th percentile for birthweight (a proxy for preterm birth) across the clusters. Use of antenatal corticosteroids and suspected maternal infection were additional main outcomes. This trial is registered with ClinicalTrials.gov, number NCT01084096. Findings The ACT trial took place between October, 2011, and March, 2014 (start dates varied by site). 51 intervention clusters with 47 394 livebirths (2520 [5%] less than 5th percentile for birthweight) and 50 control clusters with 50 743 livebirths (2258 [4%] less than 5th percentile) completed follow-up. 1052 (45%) of 2327 women in intervention clusters who delivered less-than-5th-percentile infants received antenatal corticosteroids, compared with 215 (10%) of 2062 in control clusters (p

Conditions conducive to the penetration of the fluid into the annular space, despite the great number of studies in this area have been insufficiently studied. Guided wave and chemical mudding - a way to combat the root causes and thereby preventing casing flow of oil and especially gas wells. Scope jet-wave clogging can be quite broad, but in our case we recommend its use in the treatment unconsolidated sandstones and sandstones alternating with clay interlayers to prevent erosion of rock skeleton high-pressure jets of washing liquid. This is explained by the fact that at relatively low linear flow velocities raznoplotnostnyh mud particles passing through the jet-wave kolmatator configured a certain way on the use of resonance phenomena, mudding efficiency is high. This technology is based on the scientific basis of wave mechanics using nonlinear effects in different resonance modes. The basic idea lies in the wave technologies to transform the vibration exposure in one-sided directional repetitive motion, provides the required process. For a description of such processes are commonly used mechanical and mathematical models. The simplest of these is the movement of particles suspended in a liquid in wave fields. For the mathematical description occurring in this dynamic process model is used multiphase medium "liquid - solid particles." Discussed the theoretical aspects of the basis for the creation of an inkjet-wave mudding. Experimental verification process conducted at the stands UGNTU (Ufa), the results of which are given in the article. The study of the effect of jet-wave influence on the process of filtering the washing liquid in the reservoir is of considerable interest, as the scientific and technical literature almost no materials on the subject.

We conducted a theory-driven process evaluation of a cluster randomized controlled trial comparing two types of complementary feeding (meat versus fortified cereal) on infant growth in Guatemala, Pakistan, Zambia and the Democratic Republic of Congo. We examined process evaluation indicators for the entire study cohort (N = 1236) using chi-square tests to examine differences between treatment groups. We administered exit interviews to 219 caregivers and 45 intervention staff to explore why caregivers may or may not have performed suggested infant feeding behaviors. Multivariate regression analysis was used to determine the relationship between caregiver scores and infant linear growth velocity. As message recall increased, irrespective of treatment group, linear growth velocity increased when controlling for other factors (P < 0.05), emphasizing the importance of study messages. Our detailed process evaluation revealed few differences between treatment groups, giving us confidence that the main trial’s lack of effect to reverse the progression of stunting cannot be explained by differences between groups or inconsistencies in protocol implementation. These findings add to an emerging body of literature suggesting limited impact on stunting of interventions initiated during the period of complementary feeding in impoverished environments. The early onset and steady progression support the provision of earlier and comprehensive interventions.

OBJECTIVES:Term infants in resource-poor settings frequently develop hypothermia during the first hours after birth. Plastic bags or wraps are a low-cost intervention for the prevention of hypothermia in preterm and low birth weight infants that may also be effective in term infants. Our objective was to test the hypothesis that placement of term neonates in plastic bags at birth reduces hypothermia at 1 hour after birth in a resource-poor hospital.METHODS:This parallel-group randomized controlled trial was conducted at University Teaching Hospital, the tertiary referral center in Zambia. Inborn neonates with both a gestational age ≥37 weeks and a birth weight ≥2500 g were randomized 1:1 to either a standard thermoregulation protocol or to a standard thermoregulation protocol with placement of the torso and lower extremities inside a plastic bag within 10 minutes after birth. The primary outcome was hypothermia (RESULTS:Neonates randomized to plastic bag (n = 135) or to standard thermoregulation care (n = 136) had similar baseline characteristics (birth weight, gestational age, gender, and baseline temperature). Neonates in the plastic bag group had a lower rate of hypothermia (60% vs 73%, risk ratio 0.76, confidence interval 0.60–0.96, P = .026) and a higher axillary temperature (36.4 ± 0.5°C vs 36.2 ± 0.7°C, P < .001) at 1 hour after birth compared with infants receiving standard care.CONCLUSIONS:Placement in a plastic bag at birth reduced the incidence of hypothermia at 1 hour after birth in term neonates born in a resource-poor setting, but most neonates remained hypothermic.

The asymmetric synthesis of novel non-proteinogenic β-heterocyclic α-amino acids via the diastereoselective conjugate addition of heterocyclic nucleophiles to the dehydroalanine moiety of chiral Ni(II) complexes has been studied. The complexes were formed from the Schiff base of dehydroalanine using (S)-2-N-(N-benzylprolyl)aminobenzophenone as a chiral auxiliary. After decomposition of the complexes, the α-amino acids were isolated with 30–99% ee.