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Therapeutic inertia in type 2 diabetes (T2DM) is the failure to receive timely treatment intensification as indicated per T2DM treatment guidelines. Multifactorial causes of therapeutic inertia in T2DM have been documented at the level of persons with diabetes (PwD), healthcare providers, and healthcare systems. We developed a 3-part mixed-methods research program called the “Moving to Overcome Therapeutic Inertia Obstacles Now in T2DM” (MOTION) Study to inform the development of strategies to address therapeutic inertia in T2DM. We present the results from focus groups which had the objectives of 1) understanding PwD and general practitioner/family practitioner (GPFP) determinants of behaviour related to treatment intensification using the Theoretical Domains Framework (TDF) and 2) identifying the sources of behaviours contributing to therapeutic inertia in T2DM as proposed by the Behaviour Change Wheel (BCW). Two focus groups with PwD and 4 with GPFPs were conducted. Transcripts from the focus groups were coded independently by two investigators to identify themes, mapped to TDF domains, and linked using the BCW. For PwD, the most commonly coded TDF domains were intentions, goals, knowledge, beliefs about consequences, and social influences. For GPFPs the most common domains were intentions, environmental context and resources, and social/professional role and identity. The BCW identified that PwD interventions should include reflective motivation, psychological capability, and social opportunity; GPFP interventions should include physical opportunity, social opportunity, and reflective motivation. Comprehensive strategies that target both PwD and GPFP barriers would encourage a more collaborative approach towards treatment intensification decisions and to reduce therapeutic inertia.

Background Although convenient single-tablet antiretroviral regimens have been developed to treat HIV in recent years, some patients have continued to take a multi-tablet treatment, nevirapine extended-release (NVP XR) plus two nucleoside reverse transcriptase inhibitors (NRTIs) due to its excellent safety profile. This observational study examined the demographic and clinical characteristics of HIV-positive patients who switched to dolutegravir plus lamivudine (DTG/3TC) from NVP XR plus 2 NRTIs, following discontinuation of NVP XR from the Canadian market. Methods Virally suppressed (< 50 cps/mL) HIV-positive adults ≥18 years who switched from NVP XR plus 2 NRTIs to DTG/3TC between 20 August 2019 and 30 April 2020 were retrospectively identified from Electronic Medical Records housed at Spectrum Health in British Columbia, Canada. Baseline demographic and clinical characteristics were summarized using descriptive statistics at the date of first DTC/3TC prescription. Virologic control, CD4 cell count, weight-related changes and exploratory characteristics related to metabolic syndrome were summarized at baseline and at 12 ± 6-months post-switch using descriptive statistics. Reasons for treatment discontinuation were also captured. Results Sixty-nine patients were identified (mean age ± SD = 54.2 ± 8.5 years; 100% male). Mean length of use (±SD) of NVP XR was 4.6 ± 2.6 years. Sixty-three (91.3%) persisted on DTG/3TC at the 12-month timepoint post-switch with 61 (96.8%) virally suppressed < 50 cps/mL and all 63 (100%) virally suppressed < 200 cps/mL. Among persistent patients with CD4 cell counts available, mean CD4 cell count (±SD) remained stable, increasing slightly from 724.4 ± 238.4 to 740.3 ± 240.6 cells/uL. All six (8.7%) patients who discontinued DTG/3TC, discontinued due to tolerability and not effectiveness reasons. Conclusion Our findings are the first to examine real-world use of single-tablet, 2-drug DTC/3TC among patients who switched from multi-tablet, 3-drug NVP XR plus 2 NRTIs in Canada. The majority persisted on DTG/3TC and remained virally suppressed at the < 50 cps/mL level 12-months post-switch. This, coupled with excellent tolerability, demonstrates the effectiveness of DTG/3TC in maintaining viral suppression among a unique and stable group of older men. Disclosures Joss de Wet, MBChB CCFP FCFP, Gilead: Advisor/Consultant|Gilead: Board Member|Gilead: Grant/Research Support|ViiV: Advisor/Consultant|ViiV: Board Member|ViiV: Grant/Research Support Joann K. Ban, PharmD, MSc, GlaxoSmithKline Canada Inc.: Employee Gustavo Verdier, BSc, BPharm, MBA, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare ULC: Salary Juejing Ling, MSc, GSK: Employee of IQVIA , a company that receives consulting fees from GSK. Andrean Bunko, MPH, GlaxoSmithKline Inc.: GSK contracted with IQVIA for this and other projects. I am acting as an author in capacity of my employment with IQVIA. Michael McKimm, BSc, ViiV Healthcare: employee.

The objectives of this scoping review were to: (1) identify the target audience and contexts in which strategies to improve type 2 diabetes mellitus (T2DM) medication adherence have been used, (2) provide an overview of behaviour change techniques (BCTs) used, (3) describe the determinants of behaviour targeted by strategies and (4) to identify current gaps in strategies.A systemic search for articles related to T2DM, medication adherence and strategies was conducted in EMBASE, Ovid MEDLINE and Epub Ahead of Print, In-ProcessOther Non-Indexed Citations and Daily using the OvidSP platform on 11 March 2021. All publications involving strategies to overcome medication non-adherence among adults with T2DM were included. Strategies were categorized according to the BCT taxonomy and the determinants of behaviour targeted by each strategy were classified by using the Theoretical Domains Framework (TDF).The search identified 58 articles and 61 strategies. The BCT categories Antecedents and Natural consequences and BCTs Feedback on outcome(s) of behaviour, Adding objects to the environment and Information about health consequences were identified most frequently as components of strategies resulting in statistically significant improvement in medication adherence. Strategies targeting the TDF domains Reinforcement and Beliefs about Consequences most often resulted in statistically significant improvements in adherence measures.The findings from this review identify BCTs and targeted behaviours with demonstrated success. Further exploration of the myriad of BCTs and the corresponding determinants of behaviour which were not accessed may be warranted for the development of future strategies to improve medication adherence in type 2 diabetes.

Pre-sowing treatment of flax seeds in a magnetic field increases its yield, reduces plant morbidity, improves their biochemical parameters and product quality. Under the action of the magnetic field, the rate of chemical and biochemical reactions in flax seeds, solubility of salts and acids, biopotential, ion transport, membrane permeability, seed water absorption and oxygen concentration in cells increases, which has a positive effect on plant growth and development. It is established that the change in the biometric parameters of flax during pre-sowing treatment of seeds in a magnetic field depends on the square of the magnetic induction, the gradient of the magnetic field and the velocity of the seeds. Based on the experimentally obtained growth curves of flax plants, it can be concluded that during pre-sowing treatment of seeds in a magnetic field, plants have the best biometric indicators throughout the growing season. The best biometric indicators were in plants whose seeds were treatment in a magnetic field with a magnetic induction of 0.065 T, with four-fold re-magnetization, a magnetic field gradient of 0.57 T / m (pole division of 0.23 m) and a seed velocity of 0.4 m/s. Under this mode of pre-sowing treatment of seeds in a magnetic field, the length of flax stalks increased by 10.5 %, straw yield - by 0.7 t/ ha, seeds - 0.79 t/ ha. Key words: flax, seeds, magnetic induction, seed velocity, magnetic field gradient, plant biometrics

Despite the availability of many effective medications and management options, many people with type 2 diabetes have low adherence to treatments which can lead to adverse health outcomes. We aimed to better understand the challenges related to type 2 diabetes medication adherence through interviews with people with type 2 diabetes with varying degrees of medication adherence. Phone interviews were conducted in English or French, lasted 45 minutes, and followed a semi-structured discussion guide informed by the Theoretical Domains Framework (TDF) . Eligibility criteria included being diagnosed with type 2 diabetes for at least 2 years and current use of diabetes medication (s) . A total of 30 people with type 2 diabetes were interviewed, with representation across Canada, by gender (14F/16M) , years since diagnosis (12.9±7.9) , types of medication and regimen (n=15 on polypharmacy) , and medication adherence levels (n=for each of the low/medium/high adherence groups) . Themes related to medication adherence identified from interviews mapped to 12 of the 14 TDF domains, with the Knowledge and Skills domain being the exceptions. Compared to people with type 2 diabetes categorized to the high adherence group, those categorized to the low adherence group doubted the appropriateness of their medications; reported less access to healthcare providers; tended not to use organizational tools to help with taking medication; and discussed financial barriers to accessing their medications. In contrast to those in the low adherence category, we found that highly adherent people with type 2 diabetes often viewed taking their medication as an emotionally neutral task. To validate these findings, additional quantitative research is underway to help support people with type 2 diabetes to overcome the psychological and tangible barriers to adherence and impact the perception of taking medication as a task without emotional connotations and stigma. Disclosure M. Vallis: Advisory Panel; Bausch Health, Canada, Novo Nordisk Canada Inc. Consultant; Abbott Diabetes, LifeScan. Speaker's Bureau; AbbVie Inc., Bausch Health, Canada, LifeScan, Novo Nordisk, Novo Nordisk A/S. S. Jin: Advisory Panel; Novo Nordisk Canada Inc. Consultant; Abbott Diabetes, Boehringer Ingelheim International GmbH, Dexcom, Inc., HLS Therapeutics Inc., Janssen Pharmaceuticals, Inc., MDBriefcase. Research Support; Novo Nordisk Canada Inc. Speaker's Bureau; Abbott Diabetes, Boehringer Ingelheim International GmbH, Eisai Inc., EOCI Pharmacomm Ltd., Janssen Pharmaceuticals, Inc., Novo Nordisk Canada Inc., Pfizer Inc., Roche Diabetes Care. Other Relationship; Diabetes Canada. A. Klimek-Abercrombie: Employee; Novo Nordisk Canada Inc. G. Ng: Other Relationship; Novo Nordisk Canada Inc. A. Bunko: Other Relationship; Novo Nordisk Canada Inc. A.A. Kukaswadia: Other Relationship; Novo Nordisk. C.S. Neish: Other Relationship; Novo Nordisk Canada Inc.

The article is devoted to the analysis of the inclusion of the Republic of Belarus in the processes of achieving the goals of sustainable development adopted by the world community. Environmental marketing is seen as a tool to achieve sustainable development goals in the area of responsible consumption. The essence of environmental marketing at the level of organizations and at the state level is determined. Directions for the development of environmental marketing in the Republic of Belarus have been identified in order to reduce the volume of non-decomposable waste and waste that cannot be recycled, including due to improper collection.

Background In Ontario, Canada, little is currently known about the extent to which un-immunized children may cluster geographically. Our objectives were to: describe the geographic distribution of fully un-immunized children; identify geographic clusters (hotspots) of un-immunized children; and to characterize the contribution of spatial effects and covariates on hotspots, where found. Methods Our analytic cohort consisted of Ontario students aged 7–17 years in the 2016–2017 school year. We defined students as un-immunized if they had zero doses of any vaccine and a non-medical exemption recorded in Ontario’s registry. We calculated unadjusted proportions of un-immunized students by Census Subdivision (CSD) and then used a sequential approach to identify hotspots starting first with hotspot identification at the CSD level and then probed identified hotspots further by Dissemination Area (DA) and including covariates. Hotspots were identified using the Besag-York-Mollie Bayesian spatial model and were defined as areas with >95% probability of having two times the proportion of un-immunized students, relative to the province overall. Results We identified 15,208 (0.94%) un-immunized children within our cohort consisting of more than 1.61 million students. Unadjusted proportions of un-immunized students varied greatly by geography, ranging from 0% to 21.5% by CSD. We identified 16 hotspot CSDs which clustered in five distinct areas, all of which were located in southern Ontario. The contribution of covariates and spatial effects on the risk of having un-immunized students varied greatly across hotspot areas. Conclusions Although the provincial proportion (0.94%) of un-immunized students is small, geographical clustering of such students is evident in Ontario and in some areas presents an important risk for future outbreaks. Further qualitative work within these hotspot areas would be a helpful next step to better characterize the factors associated with vaccine refusal in these communities.

Purpose. Ensuring the optimal mode of gas transportation from local sections of the main gas trunkline (GT), subject to repair (maintenance) and/or shutdown, to existing main gas trunkline based on the calculation, determination, and establishment of rational values of the operating modes of mobile compressor stations during the entire time of gas pumping. Methodology. The studies are based on existing physical principles and laws that describe the effect of the properties of natural gas and the geometric parameters of pipelines through which gas is pumped on the dynamics of changes in the mass and pressure of the transported gas. The calculation of the change in the mass and pressure of the gas in the gas pipeline from which the gas is pumped is based on a number of existing theoretical and empirical dependencies included in the generally accepted methods for their calculation. Known physical relationships and mathematical models are used to carry out the calculations. Findings. The mass approach to the issue of calculating the gas transportation time is more mathematically accurate than the volumetric one. The ratio of the relative mass to the relative gas pressure in a localized section of the main gas pipeline, during the entire pumping time, is a constant value. The use of the values of the quantities obtained at the point of intersection of the graphs of changes in the relative mass and relative pressure of the gas, in the preliminary calculation of the time for pumping gas, or pressure, or mass, or the volume of gas in each time interval, makes it possible to select the optimal rate of building up/reducing gas pressure by compressor units and optimal modes of gas transportation by operating gas pipelines during the operation of mobile compressor stations. Originality. The proposed approach to calculating and determining the time of gas pumping by mobile compressor stations from local sections of the main gas pipelines subject to repair (maintenance) and/or shutdown to sections of existing main gas pipelines proves that it is advisable to establish stable patterns in the transportation of natural gas using reciprocating compressor units only after modeling in time the change in the mass and pressure of gas in the local section of the main gas pipeline from which the gas is pumped. Practical value. The proposed approach to optimizing the time of gas pumping by mobile compressor stations makes it possible to increase the level of energy and resource efficiency of gas transmission enterprises, as well as to improve the technical and economic indicators of technologies for repairing the main gas pipelines, compressor stations of main gas pipelines associated with the need to bleed gas from sections of the main (technological) pipelines subject to repair (maintenance) and/or shutdown. Optimization of gas pumping time significantly reduces the time spent by employees of gas transmission enterprises under the influence of hazardous and harmful production factors, thereby reducing the level of relevant risks. Gas emissions and associated risks are reduced by 90%.

It is possible to increase crop yields and product quality through the use of electrophysical methods of pre-sowing seed treatment, among which pre-sowing seed treatment in a magnetic field is promising. For successful introduction of magnetic seed treatment in production it is necessary to establish mode parameters of treatment and their optimum values. To do this, it is necessary to establish the effect of the magnetic field on the change in activation energy during pre-sowing seed treatment. The aim of the study was to determine the change in activation energy during pre-sowing treatment of crop seeds in a magnetic field. To determine the change in the activation energy, the change in the biopotential of the seed during its treatment in a magnetic field was experimentally investigated by the experimental planning method. It was found that the change in seed biopotential depends on the square of the magnetic induction and the velocity of the seed in a magnetic field. An analytical expression was obtained that relates the change in activation energy to the change in seed biopotential, which made it possible to establish the dependence of the change in activation energy on the treatment parameters. It was found that the greatest seed biopotential and activation energy change at a magnetic induction of 0.065 T, a magnetic field gradient of 0.57 T/m and a velocity of 0.4 m/s. Under this mode of pre-sowing seed treatment of agricultural crops, the activation energy changes by 3.1 - 5.7 kJ/g-eq.

Introduction In Ontario, Canada, parents have the responsibility to report their child’s routine infant and childhood vaccines to the provincial immunization registry (the Digital Health Immunization Repository; DHIR) without healthcare provider validation. Despite its use in routine immunization coverage monitoring, no study has previously examined the completeness of immunization data within the DHIR. Methods We assessed the completeness of DHIR immunizations, as compared to immunizations within the Electronic Medical Records—Primary Care (EMRPC) database, also known as EMRALD, a network of family physician electronic medical records (EMRs). We linked client records from the DHIR and EMRPC to a centralized population file. To create the study cohort, we examined children born during 2005–2008 and further defined the cohort based on those rostered to an EMRPC physician, visit criteria to ensure ongoing care by an EMRPC provider, and school attendance in Ontario at age 7. We calculated up-to-date (UTD) immunization coverage at age 7 for individual vaccines and overall using data from the DHIR and EMRPC separately, and compared the estimates. Results The analytic cohort to assess DHIR data completeness included 2,657 children. Overall UTD coverage (all vaccines assessed) was 82.0% in the DHIR and 67.6% in EMRPC. UTD coverage was higher in the DHIR for all vaccines assessed individually, with the exception of meningococcal C conjugate vaccine (difference = 0.3%). After excluding two EMRPC sites with irregularities in immunization data, the difference in overall UTD coverage between systems decreased from 14.4% to 6.6% Interpretation These results validate the use of DHIR for coverage assessment but also suggest that bidirectional exchange of immunization information has the potential to increase immunization data completeness in both systems.

Ensuring an increase in crop yields and a reduction in plant morbidity without the use of chemicals is an important task. Currently, many researchers have found a positive effect of a constant magnetic field on crop seeds during pre-sowing treatment, which is manifested in increasing crop yields, reducing plant morbidity, improving biochemical parameters and product quality. The aim of the study was to establish the influence of the magnetic field on the sowing qualities of oat seeds during pre-sowing treatment. Experimental studies of the effect of the magnetic field on the germination energy and seed germination were performed with oat seeds of the Desnyansky variety by the experimental planning method. It has been established that the rate of chemical reactions, ion transport, membrane permeability, seed water absorption and oxygen concentration in cells increase during seed treatment in a magnetic field, which contributes to the improvement of seed sowing qualities. It is established that the change of sowing qualities of seeds during their treatment in a magnetic field depends on the square of magnetic induction, the magnetic field gradient and the seed velocity. The most effective mode of pre-sowing treatment of oat seeds in a magnetic field is a magnetic induction of 0,065 T with fourfold re-magnetization, a magnetic field gradient of 0,57 T/m and a velocity of 0,4 m/s.

The use of pre-sowing treatment of seeds in a magnetic field makes it possible to increase crop yields, reduce plant morbidity, improve plant biochemical parameters and product quality. During seed treatment in a magnetic field, the rate of chemical reactions, ion transport, membrane permeability, seed water absorption and oxygen concentration in the cells increase, which contributes to the improvement of seed sowing qualities. It is established that the change of sowing qualities of seeds during their treatment in a magnetic field depends on the square of magnetic induction, the gradient of the magnetic field and the velocity of movement of seeds. With a change in magnetic induction from 0 to 0.065 T germination energy and seed germination increase, and with a further increase in magnetic induction begin to decrease. The change in sowing qualities of seeds is influenced by the velocity of their movement in the magnetic field and the gradient of the magnetic field, although they are less significant factors than magnetic induction. The best results were at lower velocity values and a larger magnetic field gradient. The most effective mode of pre-sowing seed treatment in a magnetic field is a magnetic induction of 0.065 T with four re-magnetization, a magnetic field gradient of 0.57 T m and a velocity of 0.4 m/s. With this mode of pre-sowing treatment of seeds in a magnetic field, the germination energy of cereals compared to the control increased by 16 – 50 %, and germination - by 10 – 38 %. Key words: seeds, magnetic induction, seed velocity, magnetic field gradient, germination energy, germination

In the article, the issues of terminology of technique philosophy related to the notions of a concept, a risk and an uncertainty are considered. It is noted that a concept in terms of philosophy is considered as a category of human thinking, of how a man being a subject perceives the environment: objects, processes, actions of other people. From philosophical point of view, a concept is characterized by four levels; "consciousness - authorial concept - concept of interpreter - collective consciousness". Definition of the levels can differ, but their sense remains unchanging. A concept is considerably wider than a notion and is syncretic by its content. Basic criterion, by which it is possible to distinguish between "a concept" and "a notion", is simple enough: if we can give a clear (of course, subjective) definition, then it is a notion, if we cannot – it is a concept. A concept becomes a notion when a subject has set it forth (authorial concept), listeners (readers) have interpreted it (interpreter concept), discussed and created a collective concept – after this the concept is formalized as notions. Good example of such chain of a concept transforming into totality of publicly-meaningful, clear and suitable for the practical use results is defending of a scientific dissertation. A risk is considered in philosophical understanding: it is impossible to formulate any universal definition for it as a risk is always subjective and inherent to a concrete participant of some technological or public process in concrete field. A risk should not be mixed up with an uncertainty, as a risk is a method for overcoming an uncertainty. A risk is a function of an uncertainty which does not have clear definition and can be estimated only partially. A risk relates to a subjective uncertainty only: an objective uncertainty should be only taken into account and cannot be an object of control as it cannot be diminished by way of experiments or analysis of statistics. A risk in philosophical understanding can be only a basis for further concretization by engineering sciences: there and only there it is possible to try (and it has been already partially realized) to work out methods for assessing a risk and use the obtained results for improving reliability of production and minimizing the accident rate.

An increase in the pace of cleaning and preparatory work, a transition to deeper horizons, a high concentration of machines and mechanisms in places where minerals are excavated and transported increase the likelihood of one of the most difficult and dangerous types of underground accidents - sudden outbursts of coal, rock and gas. In the event of a sudden outburst, the air distribution existing in the ventilation network experiences a sharp dynamic effect, leading to a violation of the stability of the ventilation of the workings close to the center of the outburst and the overturning of the air flow in them. The methane released in this case forms an atmosphere dangerous for humans in the adjacent workings. The size of the gas contamination zone depends on many factors: the intensity of the outburst, the ventilation scheme of the mine, the presence of ventilation facilities, their number, and others, and can become the object of special studies, including the study of the outburst process itself and its interaction with the ventilation network. The specificity of the occurrence of an oytburst as a type of accidents does not allow obtaining statistical and experimental results directly during its course, which greatly complicates the study of this process. In this regard, the most acceptable research method that allows assessing the results of the interaction of the outburst with the ventilation network and, guided by them, to develop effective measures to eliminate its consequences and restore the normal functioning of the mine, is the simulation method using a PC. The article analyzes the stages of changes in the mining-geological and mining-technical conditions preceding the occurrence of the outburst, the stage of the outburst, the calculation formulas are given, by which it is possible to evaluate the configuration and dynamics of the development of the zone polluted with methane as a result of the outburst. The results of modeling the gas-dynamic manifestations of the outburst and its effect on the state of mine ventilation are of great importance in ventilation calculations in emergency modes in order to use the possibilities of ventilation effects on an emergency, limit emergency zones and increase the effectiveness of eliminating the consequences of an accident.

As the conducted studies show, deviations and asymmetry of the outside have the greatest impact on the electric drives of production machines and mechanisms.Voltage asymmetry leads to losses that have an electromagnetic and technological component.Studies on the effect of voltage asymmetry on the technological characteristics of working machines and mechanisms have shown that their productivity decreases with voltage asymmetry. However, there are no studies on the influence of spring asymmetry on the energy characteristics of working machines.The purpose of the study is to establish the effect of voltage asymmetry on the energy characteristics of belt conveyors.With voltage asymmetry, constant and variable losses in an asynchronous electric motor change.It is proposed to carry out an energy evaluation of the electric drive of the belt conveyor according to the specific consumption of electricity.The influence of voltage asymmetry on the energy characteristics of belt conveyors was studied. The dependence of the specific power consumption on the change in stiffness of the mechanical characteristics of the electric motor, which is caused by voltage asymmetry, is obtained. It was established that slippage and power losses increase with voltage asymmetry. As a result, specific losses of electricity in the electric drive of belt conveyors increase.

The development of the tourism industry is one of the strategic directions of development of many countries, the contribution of this industry to the world GDP is growing every year. Over the past two decades, the Republic of Belarus has set itself such a task, which is characterized by global trends in the development of this industry. However, despite the significant tourism potential of Belarus, there is a significant lag in the share of the contribution of this sector of the economy to the country's GDP, which continues to remain a negative balance of foreign trade in tourist services of Belarus. In order to improve the use of the existing potential of Belarus in this area, the article discusses the possibility of using the theory of generations in forecasting trends in demand for tourist services.