Mandatory Assessment Research Articles

Adolescent Body Mass Index and Early Chronic Kidney Disease in Young Adulthood

Despite increasing obesity rates in adolescents, data regarding early kidney sequelae are lacking. To assess the association between adolescent body mass index (BMI) and early chronic kidney disease (CKD) in young adulthood (<45 years of age). This cohort study linked screening data of mandatory medical assessments of Israeli adolescents to data from a CKD registry of a national health care system. Adolescents who were aged 16 to 20 years; born since January 1, 1975; medically evaluated for mandatory military service through December 31, 2019; and insured by Maccabi Healthcare Services were assessed. Individuals with kidney pathology, albuminuria, hypertension, dysglycemia, or missing blood pressure or BMI data were excluded. Body mass index was calculated as weight in kilograms divided by height in meters squared and categorized by age- and sex-matched percentiles according to the US Centers for Disease Control and Prevention. Follow-up started at the time of medical evaluation or January 1, 2000 (whichever came last), and ended at early CKD onset, death, the last day insured, or August 23, 2020 (whichever came first). Data analysis was performed from December 19, 2021, to September 11, 2023. Early CKD, defined as stage 1 to 2 CKD by moderately or severely increased albuminuria, with an estimated glomerular filtration rate of 60 mL/min/1.73 m2 or higher. Of 629 168 adolescents evaluated, 593 660 (mean [SD] age at study entry, 17.2 [0.5] years; 323 293 [54.5%] male, 270 367 [45.5%] female) were included in the analysis. During a mean (SD) follow-up of 13.4 (5.5) years for males and 13.4 (5.6) years for females, 1963 adolescents (0.3%) developed early CKD. Among males, the adjusted hazard ratios were 1.8 (95% CI, 1.5-2.2) for adolescents with high-normal BMI, 4.0 (95% CI, 3.3-5.0) for those with overweight, 6.7 (95% CI, 5.4-8.4) for those with mild obesity, and 9.4 (95% CI, 6.6-13.5) for those with severe obesity. Among females, the hazard ratios were 1.4 (95% CI, 1.2-1.6) for those with high-normal BMI, 2.3 (95% CI, 1.9-2.8) for those with overweight, 2.7 (95% CI, 2.1-3.6) for those with mild obesity, and 4.3 (95% CI, 2.8-6.5) for those with severe obesity. The results were similar when the cohort was limited to individuals who were seemingly healthy as adolescents, individuals surveyed up to 30 years of age, or those free of diabetes and hypertension at the end of the follow-up. In this cohort study, high BMI in late adolescence was associated with early CKD in young adulthood. The risk was also present in seemingly healthy individuals with high-normal BMI and before 30 years of age, and a greater risk was seen among those with severe obesity. These findings underscore the importance of mitigating adolescent obesity rates and managing risk factors for kidney disease in adolescents with high BMI.

Automated threat modelling and risk analysis in e-Government using BPMN

Recent progress integrates security requirements into BPMN, enhancing its framework. Extensions aim to seamlessly embed security concepts, yet the inherent ambiguity of security terms may lead to misinterpretations and vulnerabilities. Unfortunately, many business process experts lack the expertise to accurately interpret and integrate vital security concepts. In this study, we present an innovative automated methodology tailored to assist business process experts in identifying security threats and conducting risk assessments, particularly in the context of e-Government processes. Our approach streamlines the process, requiring only a business specialist to annotate BPMN entities with high-level, non-security-related information. Based on these annotations, potential threats to the system can be automatically identified. To develop our methodology, we leverage the standard BPMN annotation mechanism. From the annotated BPMN, the methodology utilises the ENISA Threat Landscape knowledge base for threat identification and employs the OWASP Risk Rating Methodology for risk assessment. To demonstrate the effectiveness of our approach, we applied it to a straightforward case study within the e-Government domain. Through this example, we illustrate how our methodology can be employed to ensure compliance with the General Data Protection Regulation and meet the mandatory Data Protection Impact Assessment requirements.

Formative assessments during COVID-19 pandemic: an observational study on performance and experiences of medical students

Background Because of COVID-19, the 2020 written medical examinations were replaced by mandatory formative online assessments. This study aimed to determine students’ performance, self-assessment of performance, and perception about the switch from a summative to a formative approach. Methods Medical students from year 2 to 5 (n=648) were included. They could repeat each test once or twice. They rated their performance after each attempt and were then given their score. Detailed feedback was given at the end of the session. An online survey determined medical students’ perception about the reorganization of education. Two items concerned the switch from summative to formative assessments Results Formative assessments involved 2385 examinees totaling 3197 attempts. Among examinees, 30.8% made at least 2 attempts. Scores increased significantly at the second attempt (median 9.4, IQR 10.8), and duration decreased (median -31.0, IQR 48.0). More than half of examinees (54.6%) underestimated their score, female students more often than male. Low performers overestimated, while high performers underestimated their scores. Students approved of the switch to formative assessments. Stress was lessened but motivation for learning decreased. Conclusions Medical students’ better scores at a second attempt support a benefit of detailed feedback, learning time and re-test opportunity on performance. Decreased learning motivation and a minority of students repeating the formative assessments point to the positive influence of summative assessment on learning.

Underestimation of Venous Thromboembolism Risk: A Common Health Care Quality Deficit

Venous thromboembolism (VTE) is a complication of hospitalization but not all patients are at high risk. VTE risk assessment models have been developed to identify patients whose risk is sufficient to warrant pharmacologic thromboprophylaxis. To ensure all patients are risk assessed upon admission, we implemented a mandatory risk assessment tool embedded in admission order sets in our electronic health record (EHR) system. We hypothesized that the accuracy of these risk assessments was variable. We performed a retrospective cohort study of patients discharged from the Johns Hopkins Hospital medicine service between January 1 st-December 31 st 2019. The cohort consisted of consecutive patients classified into normal, intermediate or low mobility groups using the Johns Hopkins Highest Level of Mobility score. Using a standardized chart review algorithm, elements of the Padua and Improve risk scores were determined using the admission note and the JH-HLM scores for mobility assessment. We report the results of the Padua score comparison. Provider risk assessments, VTE prophylaxis orders, symptomatic VTE, major bleeding (ISTH criteria) and deaths were determined by chart review. We measured concordance between provider risk factors identified and those identified on retrospective chart review. Statistical analyses were done using Chi-squared or Fisher's exact test and were performed using Stata v.18. The cohort consist of 2992 patients with a median age of 58 (Interquartile range (IQR) 45-70). Characteristics of the cohort are in Table 1. The median provider Padua score was 1 (IQR 0,3) compared with 2 (IQR 1,5) for chart review. Providers identified 2480 patients (82.9%) as being low risk compared with 1882 (62.9%) upon chart review (P&amp;lt;0.001). Differences in risk factor assessments are presented in Figure 1. Concordance rates between providers and chart review were high (93.6%-99.6%) for all risk factors except obesity (87.5%), heart failure (76.4%), reduced mobility (72.5%) and acute infection (66.1%).(Figure 1) Thirty-six VTE (27 DVT, 9 PE; 1.2%) occurred during the hospital stay and sixty-one (44 DVT;17 PE; 2.2%) within 3 months. Among patients who suffered an in-hospital VTE, providers assessed 29 (80.6%) as low risk compared with 13 (36.1%) by chart review. Fourteen patients (48.3%) were not prescribed prophylaxis. Forty-seven of 61 patients (77.0%) who developed VTE within 3 months were classified as low risk by providers compared with 26 (42.6%) among chart reviewers. Twenty-five (41.0%) were not prescribed prophylaxis. 727 of 2480 (29.3%) patients risk assessed as low risk by providers were assessed as being at high risk upon chart review. 707 of 2480 (28.5%) low risk patients were not prescribed prophylaxis. 157 of these 707 (22.2%) would have been prescribed prophylaxis based upon chart review. Among these 157 patients, 7 VTE occurred during the hospital stay and 11 events occurred within 3 months. Major bleeding occurred during prophylaxis in 4 patients (0.17%). Underestimation of VTE risk is common in hospitalized medically-ill patients. Development of improved EHR VTE risk assessment tools that assist the provider in identifying patient risk factors could improve VTE prevention and reduce hospital-associated VTE.

“They Are Lost Souls”: Medicare Home Care Nurses’ Perceptions of Medicare’s Inadequate Coverage of Homebound Persons With Alzheimer’s Disease

Alzheimer’s disease is a major and increasing cause of illness and death in the United States, imposing significant social, economic, and psychological burdens on patients and their caregivers. This article explores the perceptions of Medicare home health nurses as to the impact of Medicare home health requirements on their decisions to admit, treat, cope with, and meet patient care needs of Alzheimer’s disease patients. It presents an exploratory study, which resulted from a gap in the literature review that found only 3 studies and 1 article since 1965. The study is based on interviews of a convenience sample of 37 home care nurses from 5 home health agencies in the New York City metropolitan area. Analysis followed the grounded theory 3-stage coding of interview data: open, axial, and selective coding. This research methodology was used because it was developed for interpreting qualitative data in the absence of a pre-existing theory. Five themes emerged from interviews: (1) Most Medicare home health patients have some level of Alzheimer’s disease (AD). Medicare home care regulations: (2) restrict nurses’ admissions of persons with AD and lack a mandatory evidence-based assessment for AD; (3) restrict the care that nurses can order for persons with AD; (4) do not cover evidence-based non-pharmacological interventions for AD patients ; and (5) nurses use 3 coping strategies to deal with the restrictions: most as conformists, others as innovators, some as rebels. Policymakers are urged to consider legislation expanding coverage of home-based, evidence-based non-pharmacological interventions for persons with Alzheimer’s disease; expanding Medicare home care social work services to allow delivery of appropriate services; requiring an evidence-based Alzheimer’s disease assessment at intake and as part of the OASIS; additional reimbursement for home health agencies treating Medicare homebound persons with Alzheimer’s disease.

Functional state of the cardiovascular system in children after COVID-19

Introduction. The new coronavirus infection (COVID-19) in children often occurs in a mild, moderate, or asymptomatic. After experiencing COVID-19, some children, as well as adults, had persistent symptoms over more than 12 weeks and could not be explained by alternative diagnoses. These changes are called Post-acute COVID-19 Syndrome (PACS, post-COVID-19 syndrome or post-covid syndrome). Clinical manifestations of post-covid syndrome in children are very diverse, there are combinations of autonomic, psycho-emotional, cognitive and somatic disorders, including disorders of the cardiovascular system. &#x0D; Aim: analysis of changes in the functional state of the cardiovascular system in children in the post-covid period.&#x0D; Materials and methods. The study included one hundred thirty one child aged of 5 to 17 years 11 months 29 days (mean age 12 years [9.5; 15]). The observed children were divided into 2 groups: group 1 (main) — children who had a mild new coronavirus infection (n = 76). The comparison group consisted of children who did not have COVID-19, suffered from acute respiratory viral infections of unspecified etiology of a mild course (n = 55). All children were analyzed for medical history, underwent clinical examination, electrocardiographic examination (ECG), echocardiographic examination (ECHO-KG), 24-hour Holter ECG monitoring and 24-hour blood pressure (BP) monitoring.&#x0D; Results. Children who have had COVID-19 are significantly more often showed sinus tachycardia (p = 0.025), extrasystole (supraventricular, ventricular) (p = 0.046), atrioventricular blockade of the 2nd degree (p = 0.027) compared with children with ARVI. After undergoing COVID-19, in 19.7% of children an increase in blood pressure was detected, in 15.8% of children there was a significant decrease in blood pressure at night (p = 0.008). In 38.2% of children after COVID-19, there was a decrease in the activity of the parasympathetic division of the nervous system.&#x0D; Conclusion. Children who have had a new mild coronavirus infection were shown to undergo a clinical examination with a mandatory assessment of blood pressure, heart rate and an ECG 3 and 6 months after the illness.

A perspective from the EU: unintended genetic changes in plants caused by NGT-their relevance for a comprehensive molecular characterisation and risk assessment.

Several regions in the world are currently holding discussions in regard to the regulation of new genomic techniques (NGTs) and their application in agriculture. The European Commission, for instance, is proposing the introduction of specific regulation for NGT plants. Various questions need to be answered including e.g., the extent to which NGT-induced intended and unintended genetic modifications must be subjected to a mandatory risk assessment as part of an approval procedure. This review mostly focuses on findings in regard to unintended genetic changes that can be caused by the application of NGTs. More specifically, the review deals with the application of the nuclease CRISPR/Cas, which is currently the most important tool for developing NGT plants, and its potential to introduce double strand breaks (DSBs) at a targeted DNA sequence. For this purpose, we identified the differences in comparison to non-targeted mutagenesis methods used in conventional breeding. The review concludes that unintended genetic changes caused by NGT processes are relevant to risk assessment. Due to the technical characteristics of NGTs, the sites of the unintended changes, their genomic context and their frequency (in regard to specific sites) mean that the resulting gene combinations (intended or unintended) may be unlikely to occur with conventional methods. This, in turn, implies that the biological effects (phenotypes) can also be different and may cause risks to health and the environment. Therefore, we conclude that the assessment of intended as well as unintended genetic changes should be part of a mandatory comprehensive molecular characterisation and risk assessment of NGT plants that are meant for environmental releases or for market authorisation.

Police Realistic Tactical Training Is Not Risk-Free: Stress-Induced Wide-QRS Paroxysmal Tachyarrhythmia in a Healthy Police Officer and Professional Athlete

The reported case, a spin-off of a wider ongoing national study investigating the individual stress reactions of police officers during realistic police tactical training, highlights the eventuality that stress-induced paroxysmal arrhythmias might occur and remain undetected without ECG monitoring as a standard practice. The ECG of a 41-year-old frontline police officer (and professional athlete of the State Police’s rugby team) was monitored with a wireless, textile-based, wearable device during stressful scenarios implying the use of force. ECG data were processed with the Kubios software to assess training-induced time-varying changes of heart rate variability parameters and of the parasympathetic, sympathetic, and stress indices. Multiparametric analysis of the heart rate variability quantified remarkable stress-induced increment of vagal withdrawal and of sympathetic dominance, with exceptionally high-stress index and sudden occurrence of a wide-QRS paroxysmal tachyarrhythmia (240 bpm) with concomitant operational failure. Subsequent exhaustive mandatory clinical assessment excluded any structural and arrhythmogenic cardiac abnormality. Although exceptional and to the best of our knowledge so far unique, the recording of a stress-induced paroxysmal wide-QRS arrhythmia occurring during realistic tactical training in a healthy police officer and highly fit athlete is worth to be shared as a caveat about the potential risk if eventually occurring in officers with unknown cardiovascular risk factors (e.g., for ischemic heart disease). Moreover, the demonstration that such a high level of stress may occur even in an experienced, healthy, and highly fit officer altering the physiologic dynamicity of brain–heart interaction with a negative consequence on the operational outcome strongly suggests that individual emotional reactions induced by stressful duty events must be safely experienced and assessed with realistic training, to adopt preventive coping strategies, to improve police officers’ efficiency in front of threats, and to lower the risk of inappropriate use of force with dramatic consequences on the street.

Exploring the policy space for public health in large-scale mining in Burkina Faso: A Q-methodology study

Large-scale resource extraction may lead to significant negative externalities on the environment, social well-being and public health. Negative environmental impacts of extractive projects are regularly considered through mandatory environmental impact assessments; however, public health impacts frequently remain unaddressed due to a lack of legal requirements, particularly in Africa where many resource extraction projects are being implemented. While policy instruments are available to mitigate negative externalities on public health - the most eminent being the Health Impact Assessment (HIA) - such instruments have not been widely established. We use Q-methodology to explore the policy space available to advance public health in large-scale mining projects in Burkina Faso. A Q-methodology study is purposeful as it allows to reveal common ground between government, private sector and civil society stakeholders on whose support successful policy initiatives depend. We identify two broader stakeholder perspectives that reveal an overarching consensus on the need to regulate health impacts of mining projects. Both perspectives reject industry self-regulation and broadly agree on introducing HIA as a regulatory instrument, but also point to different priorities and focal points among stakeholders. We develop a conceptual framework to map stakeholders’ shared and divergent policy preferences. The findings can help to initiate a policy dialogue on safeguarding public health in large-scale mining projects and may guide policymakers to implement public health policy reform.

A "Parenting Licence" Granted by One’s Existing Children? Critical Analysis of the Judgment in Ex Parte JCR 2022 5 SA 202 (GP)

In Ex parte JCR 2022 5 SA 202 (GP) the Pretoria High Court per Neukircher J seeks to introduce new requirements for all surrogacy agreements in South African law. The court considered the psychological impact of surrogacy on the children of both the surrogate parents and the commissioning parents and the need to put in place procedures ‘for preparing them for this process [of not bringing the surrogate baby home]’ or ‘for a new addition to their family’, respectively. The court ordered the mandatory psychological assessment of the existing children of the surrogate parents and commissioning parents. A report emanating from such an assessment would ostensibly assist the court in determining the best interests of the existing children of the parties to the agreement. We argue that the psychological evaluation of the existing children of the parties to a surrogate motherhood agreement fundamentally upsets the balance between the interests of the parties involved in the surrogacy process. In fact, it shifts the balance of power almost entirely into the hands of the existing children, such that they may be said to decide whether their parents allowed to have any more children. We argue that the court’s interpretation that such assessments would be in the best interests of existing children, is based on a fundamental misunderstanding of the court’s duty in this regard. The new assessment requirement is more likely to undermine these children’s interests, to violate the commissioning parents’ constitutional rights to dignity and equality, and their rights to reproductive autonomy, privacy, and access to reproductive healthcare.

Structural attribution of emissions along the global supply chain and implications for climate policy

AbstractTo develop and implement effective policies to mitigate climate change, it is important to understand the emission profile of sectors that comprise the network of global supply chains. Focusing on the relationship between sectors’ positions in the global supply chain, this study develops a structural position analysis framework based on input–output analysis. Our framework reveals the highest‐priority sectors and transactions, and the best strategies for CO2 emission reduction in the global supply chain. The strategies identified focus on cross‐border transactions and highlight the need for inter‐sectoral and international collaboration. The results indicate that the United States and China have different priorities and characteristics (even vis‐à‐vis the same industry), and that joint emission reduction policies should be coordinated to take advantage of each country's emission reduction potential. Our findings suggest that, in the United States and Europe, policies to promote the reduction of direct emissions from production of goods for exports through carbon taxes are important. Contrarily, in Asian countries, carbon emissions originate mainly from intermediate goods trades, suggesting the need for mandatory life cycle assessment reporting and emissions disclosure. Our analytical framework thus proposes specific policies that could effectively reduce specific sectors' and transactions’ carbon footprints.

Formative assessments during COVID-19 pandemic: an observational study on performance and experiences of medical students.

Background: Because of COVID-19, the 2020 written medical examinations were replaced by mandatory formative online assessments. This study aimed to determine students' performance, self-assessment of performance, and perception about the switch from a summative to a formative approach. Methods: Medical students from year 2 to 5 (n=648) were included. They could repeat each test once or twice. They rated their performance after each attempt and were then given their score. Detailed feedback was given at the end of the session. An online survey determined medical students' perception about the reorganization of education. Two items concerned the switch from summative to formative assessments Results: Formative assessments involved 2385 examinees totaling 3197 attempts. Among examinees, 30.8% made at least 2 attempts. Scores increased significantly at the second attempt (median 9.4, IQR 10.8), and duration decreased (median -31.0, IQR 48.0). More than half of examinees (54.6%) underestimated their score, female students more often than male. Low performers overestimated, while high performers underestimated their scores. Students approved of the switch to formative assessments. Stress was lessened but motivation for learning decreased. Conclusions: Medical students' better scores at a second attempt support a benefit of detailed feedback, learning time and re-test opportunity on performance. Decreased learning motivation and a minority of students repeating the formative assessments point to the positive influence of summative assessment on learning.

ANALYSIS OF REGULATORY AND METHODOLOGICAL DOCUMENTATION IN THE MANDATORY CERTIFICATION OF INDIVIDUAL FALL PROTECTION

Personal protective equipment (PPE) is used at many industrial sites where work takes place at height with the use of safety and restraint systems. In Russia, means of individual fall protection are regulated by the Customs Union, TR TS 019/2011 “On the safety of personal protective equipment”, and are subject to mandatory compliance assessment. The manufacturer of personal fall protection equipment must comply with safety requirements TR TS 019/2011 and to mark the products sold on the market (EAC). To apply and fulfill the requirements of TR CU 019/2011, there is a list of standards and documents containing the rules and methods of research. The analysis of safety requirements of TR TS 019/2011 related to PPE against falls has helped to determine regulatory documents. Further analysis of these documents in terms of determining the requirements for PPE against falls requires a significant amount of work for the manufacturer and appropriate staff qualification. PPE against falls has a complex design, so their compliance is confirmed within the compulsory certification. To undergo the mandatory certification, the manufacturer must choose a certification body from the register of the federal executive body that performs the functions of the national accreditation body of the Russian Federation. In accordance with TR TS 019/2011 for PPE against falls, a certification plan is established (1c, 3c, 4c, 5c, 6c), approved by the Commission of the Customs Union. The mandatory certification includes several steps, depending on the certification plan. When a certification plan 3c (certification of a product batch) and 4c (single products (samples)) are used, the applicant must specify the identifying characteristics of the product batch. There is no inspection for plans 3c and 4c. Using the certification scheme 6c, the application must contain information about the manufacturer's compliance certificate of the management system. The paper establishes the algorithm of the compulsory certification of PPE against falls depending on the plan. Each step of the algorithm is described by a regulatory document, which will allow the manufacturer not to waste time looking for it and reviewing it. The conducted review of regulations describing the rules and test methods allows the manufacturer to meet the safety requirements of TR TS 019/2011 related to PPE against falls.

Beyond the artisan trade test: Using the COMET Model to build occupational competence

The South African trade test is a mandatory end-point assessment that certifies an apprentice to practise as a qualified artisan after a specified period of training. Whereas the manufacturing sector has relied on the traditional trade test to provide assurance of an artisan candidate’s required level of competence, recent competence-development studies based on the COMET Model of competence development and measurement have challenged the ability of traditional task-based trade tests to prepare candidates adequately for integrated work processes. Studies in other contexts have shown the potential for COMET-based assessments not only to serve as a means of measuring competence, but also to develop it. This article reports on research that investigated how, through the application of COMET assessments, occupational competencies were developed beyond those measured by the traditional apprentice trade test. A mixed-methods, quasiexperimental approach produced strong evidence that COMET-inspired authentic assessments enhanced learners’ levels of competence and developed vocational identity among candidates who undertook such preparation for a trade test.

Ecological and toxicological assessment of hazard of contamination of water bodies by the γ-polyoxymethylene

Introduction. In the process of production, storage and application of the representative of new components of solid rocket fuels – γ-polyoxymethylene, its ingress into the water of reservoirs is not excluded, which determines the mandatory assessment of the danger of its single contamination of this ecosystem.&#x0D; Material and methods. As an object of research, γ-polyoxymethylene (γ-POM, polyformaldehyde, acetal copolymer) was used – a mixture of dimethyl esters of polyoxymethylene glycols – a fine amorphous white powder, CAS registration number 66455-31-0. The empirical formula is CH3O(CH2O)nCH3 at n = 100–300. It is practically insoluble in water.&#x0D; Results. It was found that the ecotoxicant content in water at a concentration of 50.0 mg/l led to a change in its transparency. The indicated concentration of γ-POM was determined as a threshold for organoleptic harmfulness.&#x0D; In the course of studying the effect of the toxicant on the general sanitary regime of reservoirs, in the absence of changes in the indicators of biochemical oxygen consumption, its negative impact on nitrification processes and saprophytic microflora was revealed. The threshold concentration of the substance according to the general sanitary indicator of harmfulness is 3.5 mg/l.&#x0D; In experiments on laboratory animals, it was noted that a single intragastric administration of the tested xenobiotic in the form of a suspension in a 2.5% solution of aqueous starch caused a significant decrease in heart rate and a change in a number of hematological parameters. The threshold of a single general toxic effect of γ-POM is 90.0 mg/kg.&#x0D; Limitations of the study. The revealed features of the behavior of γ-polyoxymethylene must be taken into account when it once pollutes the water of reservoirs (in case of an emergency). However, the data obtained are insufficient to substantiate the hygienic standard of the connection in the water of water bodies.&#x0D; Conclusion. The results of the performed experiments indicate that a single ingress of γ-polyoxymethylene into the water represents an ecological and toxicological hazard registered for all three basic signs of harmfulness, which is taken into account when justifying its maximum permissible concentration in the water of reservoirs.

#2537 EPIDEMIOLOGY OF CHRONIC KIDNEY DISEASE IN THE REPUBLIC OF UZBEKISTAN

Abstract Background and Aims Chronic kidney disease (CKD) is an emerging global health problem, currently affecting up to 15% of the global adult population, and is independently associated with an increased risk of cardiovascular disease (CVD) similar to that of diabetes mellitus or coronary artery disease. heart [Reddy K.S., Shah B., Varghese S., Ramados A. 2005; 366: 1744-1749]. To assess the epidemiological characteristics of the development of CKD in the Republic of Uzbekistan (RUz) for 2020. Method The object of the study is the database of the Republican Specialized Scientific and Practical Medical Center for Nephrology and Kidney Transplantation of the Republic of Uzbekistan. Results According to the Institute of Health and Medical Statistics of the Ministry of Health of the Republic of Uzbekistan, the number of patients with end-stage renal disease (ESRD) decreased between 2011 and 2015. However, according to the data for 2020, the number of patients with stage 5 CKD reached 23,773 thousand and its increase is expected. The proportion of patients with chronic renal failure older than 18 years was registered 21,003 thousand in 2011 and 19,149 thousand in 2015, in those years there was a decrease. However, according to the national registry for 2020, CKD cases in the Republic of Uzbekistan, identified in all regions, amounted to 118026, there were 23773 patients with chronic renal failure receiving hemodialysis - 5149. The number of registered patients with CKD in the Autonomous Republic of Karakalpakstan was 9013, with CRF - 912, in need of hemodialysis - 115, receiving hemodialysis - 98, in need of transplantation - 21. In Andijan region, 416 persons were registered, with CRF - 201, in need of replacement therapy 137, receiving dialysis - 137, needing in transplantation - 11. In the Bukhara region, 4500 such patients were registered, CKD - 501, in need of substitution therapy - 172, receiving dialysis - 164 and in need of transplantation - 36. Conclusion With a general increase in the prevalence of CKD in the Republic of Uzbekistan in the dynamics of 2020, there is an improvement in the quality of diagnosing complications at earlier stages, at a later age and with a longer duration of CKD. Advances in the management of patients with CKD in recent years do not reduce the risk of end-stage chronic renal failure, but delay its development. Pronounced interregional differences in the frequency of registration of CKD in the database indicate problems in diagnosing CKD in a number of regions where the standard for examining patients with CKD with a mandatory assessment of glomerular filtration rate (GFR) and albuminuria at least once a year is not met.

Towards automated risk assessments for modular manufacturing systems

Abstract Manufacturing systems based on Industry 4.0 concepts provide a greater availability of data and have modular characteristics enabling frequent changes. This raises the need for new security engineering concepts that cover the increasing complexity and frequency of mandatory security risk assessments. In contrast, the current standardization landscape used for the assessment of these systems only offers abstract, static, manual, and resource-intensive procedures. Therefore, this work proposes a method that further specifies the IEC 62443 aiming to automate the security risk assessments in such a way that manual efforts can be reduced and a consistent quality can be achieved. The methodology is presented using network segmentation as a guiding example and consists of four main steps: Information collection based on a process analysis, information formalisation with a semi-formal model, information usage applying first order logic to extract expert knowledge, and information access using the concept of the digital twin. In addition, the applicability of the IEC 62443 standard to the risk assessment of modular manufacturing systems is evaluated.

MOSUNETUZUMAB DEMONSTRATES DURABLE RESPONSES IN PATIENTS WITH RELAPSED/REFRACTORY FOLLICULAR LYMPHOMA AND ≥2 PRIOR THERAPIES: UPDATED ANALYSIS OF A PIVOTAL PHASE II STUDY

MOSUNETUZUMAB DEMONSTRATES DURABLE RESPONSES IN PATIENTS WITH RELAPSED/REFRACTORY FOLLICULAR LYMPHOMA AND ≥2 PRIOR THERAPIES: UPDATED ANALYSIS OF A PIVOTAL PHASE II STUDY

List of IMF Member Countries with Delays in Completion of Article IV Consultations or Mandatory Financial Stability Assessments Over 18 Months

List of IMF Member Countries with Delays in Completion of Article IV Consultations or Mandatory Financial Stability Assessments Over 18 Months

The place of fast-track technologies in patients with strangulated abdominal hernias without hollow organ resection

The aim of the study is to substantiate the possibilities and analyze the results of fast-track technologies in patients with strangulated abdominal hernias without hollow organ resection. Materials and methods. The work was based on the result analysis of surgical treatment for 691 patients with strangulated abdominal hernias without resection of a hollow organ, who were divided into 2 groups depending on the specifics of diagnostic and therapeutic tactics, and into 2 subgroups depending on the localization of strangulated hernias. For patients of group 2, in contrast to group 1, the following diagnostic tactics: mandatory and justified laparoscopic intra-abdominal assessment of the strangulated organ condition; mandatory physicochemical intraoperative assessment of the hernial fluid condition; mandatory intraoperative instrumental assessment of the strangulated organ condition; as well as the therapeutic tactics: mandatory use of a comprehensive fast-track program; expansion of indications for laparoscopic surgery were used. The clinical and diagnostic algorithms included laboratory, instrumental and biochemical methods of examination. Results. It has been found that the proposed diagnostic and therapeutic tactics in group 2 patients with strangulated abdominal hernias without hollow organ resection, in contrast to group 1 patients, allowed to increase the number of laparoscopic operations by 51.15 % as well as the number of surgical interventions using fast-track technology by 51.21 %. This was accompanied by a decrease in complications according to the Clavien-Dindo scale from 83 (24.56 %) in group 1 patients to 39 (11.05 %) in group 2 patients. In addition, in group 2 patients, in contrast to group 1, a decrease in the acute pain severity in the early postoperative period and chronic pain according to the sf-IPQ in the late postoperative period has been revealed. Conclusions. The indication expansion for fast-track technologies in group 2 patients with strangulated abdominal hernias without hollow organ resection has allowed using these procedures in 238 (67.23 %) cases, while there were only 54 (16.02 %) such cases in group 1 patients. The proposed diagnostic and therapeutic tactics in group 2 patients with strangulated abdominal hernias without hollow organ resection, in contrast to group 1 patients, have enabled an increase in the number of laparoscopic operations from 16.27 % in group 1 patients to 67.42 % in group 2, which was accompanied by a decrease in postoperative complications according to the Clavien-Dindo scale from 24.56 % to 11.05 %.