Normative Value Research Articles

Distribution, prevalence, and impact on the metatarsosesamoid complex of first metatarsal pronation in hallux valgus

BackgroundPrevious simulated weight-bearing CT (WBCT) studies classifying first metatarsal (M1) pronation suggested a high prevalence of M1 hyper-pronation in hallux valgus (HV). These findings have prompted a marked increase in M1 supination in HV surgical correction. No subsequent study confirms these M1 pronation values, and two recent WBCT investigations suggest lower normative M1 pronation values. The objectives of our WBCT study were to (1) determine M1 pronation distribution in HV, (2) define the hyperpronation prevalence compared to preexisting normative values, and (3) assess the relationship of M1 pronation to the metatarso-sesamoid complex. We hypothesized that the M1 head pronation distribution would be high in HV. MethodsWe retrospectively identified 88 consecutive feet with HV in our WBCT dataset and measured M1 pronation with the Metatarsal Pronation (MPA) and α angles. Similarly, using two previously published methods defining the pathologic pronation threshold, we assessed our cohort’s M1 hyper-pronation prevalence, specifically (1) the upper value of the 95% confidence interval (CI95) and (2) adding two standard deviations at the mean normative value (2 SD). Sesamoid station (grading) was assessed on the coronal plane. ResultsThe mean MPA was 11.4+/−7.4 degrees and the α angle was 16.2+/−7.4 degrees. According to the CI95 method, 69/88 HV (78.4%) were hyperpronated using the MPA, and 81/88 HV (92%) using the α angle. According to the 2 SD method, 17/88 HV (19.3%) were hyperpronated using the MPA, and 20/88 HV (22.7%) using the α angle. There was a significant difference in MPA among sesamoid gradings (p = 0.025), with a paradoxical decrease in MPA when metatarsosesamoid subluxation was increased. ConclusionM1 head pronation distribution in HV was higher than in normative values, but threshold change demonstrated contradictory hyper-pronation prevalences (85% to 20%), calling into question the previously reported high prevalence of M1 hyper-pronation in HV. An increase in sesamoid subluxation was associated with a paradoxical decrease in M1 head pronation in our study. We suggest that a greater understanding of the impact of HV M1 pronation is warranted before routine M1 surgical supination is recommended for patients with HV. Level of evidenceLevel III, retrospective cohort study.

Impact of the correctional rehabilitation program on the walking locomotion of amateur athletes after brain contusion

The ascertaining experiment involved 38 men involved in amateur sports at the age of 25-42 years with the consequences of brain contusion in the late remote period. The issue of renewal of combatants by means of physical culture and sports rehabilitation for amateur sports becomes topical. A correctional and rehabilitation program was developed: stage 1 (28 days) was held on the basis of the Ukrainian Research Institute of Prosthetics, stage 2 (42 days) independently, but Gr1 was trained under the supervision of a specialist in physical culture and sports rehabilitation using modern telecommunication technologies. The difference of the program in Gr1 was the appointment in the variable component of the Neurac technique on the Redcord suspension system, instead of training on a multifunctional block simulator; Nordic walking instead of training walking; vestibular gymnastics. It was found that after the 2nd stage in amateur athletes Gr1, the assessment of muscle strength according to the Lovett test, indicators of the dynamic characteristics of walking, such as the coefficient of rhythm and load asymmetry, acquired a normative value. Gr2 men showed a slow improvement in all studied parameters. The formative experiment confirmed that a multidisciplinary approach, conducting independent classes under the supervision of a rehabilitation specialist positively affects the walking locomotion of amateur athletes with the consequences of a brain contusion and brings the return to sports closer.

Expansion of the Possibilities of Providing the Control and Protection System of Asynchronous Motors With an Electric Signal

This article presents a study of the measuring windings that provide a high-quality electrical signal for the control system and protection during the shaving of phases occurring in asynchronous motors. The magnitude of the asynchronous motor stator currents in the form of secondary voltage imposes such requirements as high sensitivity and high rate of change of the sensor elements of the converter, isolation from the primary circuit, efficiency, small size and weight, low cost. To meet these requirements, a three-phase sensitive control and reactive power control element of an asynchronous motor is placed in the space between the main windings and windings on the stator wedges and provides the normative value of the received output signals. At the same time, receiving a signal from a sensitive element that determines the symmetry of the three-phase primary currents of an asynchronous motor and disconnecting the current from a stator can expand the capabilities of this current converter and ensure a normal electrical value at the output, as well as the possibility of using these signals directly in the protection and control systems of an asynchronous motor. The rational choice of the number of windings of the measuring instrument and their placement on the stator wedges when obtaining a normalized output voltage on three-phase current converters of the asynchronous motor protection system was carried out by the recommended methods. The sensing element of the three-phase current converter of the asynchronous motor stator complements the function of the basis for transmitting information to the control, monitoring and protection system. This current-to-voltage converter is a structurally simple and easy-to-manufacture technology that allows you to continuously change and measure the operating state of an asynchronous motor, control system and sew up when a signal is given.

A coherence framework for fact-finding before the International Court of Justice

AbstractIt is the task of the International Court of Justice to establish the operative facts from which to draw normative conclusions in all contentious cases that come before it. This task, however, is complicated where those facts necessitate engagement with specialized epistemic fields other than law such as science. Drawing on legal theory and epistemology I propose a coherence framework for the establishment of the facts in such cases. In essence, this means that the Court need not show that its factual determinations have been established beyond all doubt, nor even that they satisfy a certain standard of probability. Rather, what the Court must show is that a factual determination it has made has been arrived at through a rational process and that it is coherent. The coherence framework also has both descriptive and normative value as it both maps neatly on to the current (best) practice of the Court and provides a justification for why it should operate this way in the future.

It’s very difficult to set the boundaries, it’s human nature to want to respond: exploring health professions educators’ responses to student mental health difficulties through a positioning theory lens

By virtue of their teaching role and contact with students, health professions (HP) educators are often the first point of connection for students who are experiencing mental health difficulties. Educators are increasingly expected to include some form of pastoral care in their role. Mental health-related interactions with students may have a negative emotional impact on educators, particularly when roles and expectations are not clearly defined and where boundaries are not managed effectively. Using positioning theory as a lens, this study explored how educators experienced such interactions and how this manifested in positions, storylines, and speech acts. Interviews were conducted with 27 HP educators at a faculty of medicine and health sciences. Reflexive thematic analysis using inductive coding identified themes corresponding to the nearing, weighted, ambivalent, and distancing positions participants adopted in relation to students with mental health difficulties. There was fluidity in and between positions, and more than one position could be occupied simultaneously; participants each moved through different positions in response to different relational situations. Multiple storylines informed these positions, representing how moral- and care-informed responsibility intersected with responsiveness to make certain actions possible or impossible. Normative and personal value narratives were evident in storylines, in many cases underscored by care or justice ethics. The value of positioning theory in facilitating reflective faculty development initiatives for educators engaged in these interactions is discussed.

Developing a strategic planning model for developing, monitoring and evaluating digital transformation initiatives: a soft system approach

PurposeThis research aims to develop a strategic planning model for developing, monitoring and evaluating digital and sustainable transformation initiatives in organizations. The purpose of this model is to provide a useful tool for managers and practitioners in the field of digital transformation.Design/methodology/approachThis research draws on the soft systems literature and combines the reference models of the balanced scorecard and the logical framework approach to develop the model. The model identifies the key dimensions to be considered in the planning, monitoring and evaluation phases of a digital transformation initiativeFindingsThis research makes important theoretical and practical contributions to the literature on digital transformation. This study enriches the literature and proposes a model that is useful both in the strategic planning phase and in the ex-post evaluation. The model identifies the key dimensions to be considered in the planning phase of a digital transformation initiative and describes the dimensions to be taken into account when monitoring the development of the initiative and the final evaluation of the impact achieved.Originality/valueThis model is original in its approach, as it draws on the soft systems literature and combines the reference models of the balanced scorecard and the logical framework approach. The model provides a useful tool for managers and practitioners that has normative and prescriptive value. The research makes important contributions to the literature on digital transformation by proposing a model that considers both the theoretical and practical aspects of digital transformation initiatives.

Validation of the Czech Version of the Voice Handicap Index

Objective(s)The present study aims to evaluate the reliability and construct validity of the Czech version of the Voice Handicap Index (VHI-CZ) and determine the cut-off value to distinguish dysphonic patients from nondysphonic individuals. Study designProspective study, Parallel group design. MethodsThe study investigated 100 adult patients with dysphonia, divided into three groups based on the etiology of the voice problem (neurogenic, functional, and structural). Out of these, 25 patients were used for test-retest analysis, and 45 patients to determine the responsiveness to change. The control group consisted of 51 healthy subjects. All 151 individuals completed the VHI-CZ and were examined with the videolaryngostroboscopy. The internal consistency (Cronbach’s alpha), the test-retest reliability (Intra-class Correlation Coefficient, ICC), and the construct validity were analyzed and the normative cut-off value was determined. ResultsThe internal consistency of the VHI-CZ was excellent (Cronbach α = 0.984), and test-retest reliability was also excellent (ICC = 0.95, P < 0.001). The correlation between the self-assessed severity of the voice disorder and the VHI-CZ score was strong (Spearman's ρ = 0.877, P < 0.001). The VHI scores differences between dysphonic and nondysphonic patients were statistically significant (Mann-Whitney U test, P < 0.001). The differences among the three etiological subgroups (neurogenic, functional, and structural) were also statistically significant (Kruskal-Wallis test, P < 0.001). Moreover, the differences in the VHI-CZ total scores between pretreatment and posttreatment were statistically significant (Wilcoxon test, P < 0.001). The cut-off score of 13 points was found, by the analysis of the Receiver Operating Characteristic (ROC, Youden Index), to be most suitable for preselecting dysphonic individuals. ConclusionThe existing VHI-CZ showed excellent reliability and construct validity. The Czech VHI is a useful and valid monitoring tool for clinicians.

The agreement on the emphytesis concerning land for agricultural needs and peculiarities of judicial protection of the parties to such agreement

The article is devoted to the specifics of the normative and legal regulation of the contract of emphytheusis and its judicial practice, in which the right has a place, regarding the use of a plot of land for agricultural purposes.&#x0D; In the scientific literature, there are several approaches to defining the concept of emphytheusis. In particular, it is considered that this is a contract of use, which establishes a land easement, and as the right to own and use someone else's land plot for personal needs.&#x0D; It is an absolute fact that the current land legislation does not determine either the terms or the procedure for payment under the contract of emphyteussis. This means that the parties must determine these essential terms of the contract independently, which is essentially not only the duty, but also the right of the parties to such a contract. Failure to take into account and settlement or improper settlement of this issue may have negative consequences in the field of performance of such a contract.&#x0D; It is these problematic issues that most often become the subject of their judicial review. Of course, the long-term duration of such contracts does not take into account the inflationary components of the increase in the normative monetary value of land, other force majeure circumstances or changes in legislation, etc.&#x0D; These and other facts and circumstances definitely affect both proof and enforcement in the field of judicial protection of the rights of the parties to the emphytheusis contract. It is for these reasons that the author notes that judicial practice is not as unambiguous as it would be desirable. In this regard, the work examines the practice of the Supreme Court, which is essentially final in nature. At the same time, the work conducts a legal analysis of changes in the current legislation of Ukraine in the field of land use during the current state of war.&#x0D; The author also analyzes the issue of the automatic extension of emphyteusis treaties, based on their termination after the introduction of martial law in Ukraine. In addition, the work draws attention to the presence of legislative gaps, which courts overcome at the expense of judicial law-making in the field of emphytheusis legal relations, in connection with which the author provides suggestions on ways to eliminate them.

Autonomous Control of Music to Retrain Walking After Stroke

Background Post-stroke care guidelines highlight continued rehabilitation as essential; however, many stroke survivors cannot participate in outpatient rehabilitation. Technological advances in wearable sensing, treatment algorithms, and care delivery interfaces have created new opportunities for high-efficacy rehabilitation interventions to be delivered autonomously in any setting (ie, clinic, community, or home). Methods We developed an autonomous rehabilitation system that combines the closed-loop control of music with real-time gait analysis to fully automate patient-tailored walking rehabilitation. Specifically, the mechanism-of-action of auditory-motor entrainment is applied to induce targeted changes in the post-stroke gait pattern by way of targeted changes in music. Using speed-controlled biomechanical and physiological assessments, we evaluate in 10 individuals with chronic post-stroke hemiparesis the effects of a fully-automated gait training session on gait asymmetry and the energetic cost of walking. Results Post-treatment reductions in step time (Δ: −12 ± 26%, P = .027), stance time (Δ: −22 ± 10%, P = .004), and swing time (Δ: −15 ± 10%, P = .006) asymmetries were observed together with a 9 ± 5% reduction (P = .027) in the energetic cost of walking. Changes in the energetic cost of walking were highly dependent on the degree of baseline energetic impairment (r =− .90, P < .001). Among the 7 individuals with a baseline energetic cost of walking larger than the normative value of healthy older adults, a 13 ± 4% reduction was observed after training. Conclusions The closed-loop control of music can fully automate walking rehabilitation that markedly improves walking after stroke. Autonomous rehabilitation delivery systems that can safely provide high-efficacy rehabilitation in any setting have the potential to alleviate access-related care gaps and improve long-term outcomes after stroke.

The ESM Reform and Its Missing Legitimacy in Non-Euro Area Member States

The goal of this article is to analyse whether the European Stability Mechanism (ESM) and its current reform have been subjected to sufficient legal and democratic approval in non-euro area Member States. It is argued that the establishment of the ESM and the consequential obligation to accede to it after entering the euro area is at least to a certain extent legally and democratically underpinned by Article 136(3) Treaty on the Functioning of the European Union (TFEU). The establishment of the prospective euro area entrants’ obligation to join the ESM after adopting the euro is a manifestation of the normative value of Article 136(3) TFEU. However, the 2021 ESM reform has not been accompanied by a similar Treaty amendment and thus lacks legal and democratic legitimacy in non-euro area countries. This may have legal and political consequences for the obligation to adopt the euro in the affected countries. ESM, European Stability Mechanism Reform, ESM Treaty, Economic and Monetary Union, euro adoption, euro area entry criteria, Article 136 TFEU, democratic legitimacy

Youth values in the context of traditions and innovations

The article analyzes the values of the younger generation in the context of the relationship between continuity and progress in the development of traditions and considers traditional values and how they are related to the development of "new" values and young people’s worldview. The relation of tradition to innovation is comprehended, and the existing definitions of tradition and the role of its functions are analyzed. The paper defines the role of mass communications and their influence on the formation of the value world of the younger generation; factors for the formation of viable generations and the spread of the principles of viability to all spheres of social life are identified. The article deals with a complex of ideological, conceptual, theoretical, and socio-cultural issues related to the socio-philosophical and cultural aspects, as well as to the understanding of political socialization and culture as an integral characteristic of the social sphere of life of modern Kazakhstani society. The genesis, structure, dynamics, institutional forms, and normative value content of the political socialization and culture of the Kazakhstan youth, conditioned by national traditions and political culture, are analyzed.

Normative Values for the Inner EAR Scale.

To determine normative values for the Inner Effectiveness of Auditory Rehabilitation (Inner EAR) scale, a validated instrument utilized to study the impact of hearing loss and potential treatments. Observational outcomes study. Academic medical center and community care sites. We included patients who were at least 18 years of age and completed the Inner EAR scale, pure-tone audiometry, and word recognition score assessment. Based on audiometry results, patients were categorized as having: (1) normal bilateral hearing, (2) unilateral hearing loss, and (3) bilateral hearing loss. The distributions of Inner EAR scale scores were assessed within each category. Fisher's exact test was utilized to determine whether data-driven threshold values could discriminate among the 3 clinical groups. Two hundred and twenty-two consecutive patients with hearing-related complaints met inclusion criteria. Mean Inner EAR scores for patients with bilateral hearing loss (29.2, interquartile range [IQR] 10-41.5), unilateral hearing loss (38.9, IQR 23-49), and normal hearing (46.6, IQR 31-62) were significantly different (analysis of variance F < 0.0001). An Inner EAR score threshold of 50 supported the ability to statistically significantly discriminate between bilateral hearing loss and normal hearing (p = .003), as well as between unilateral hearing loss and normal hearing (p = .015). An Inner EAR score normative threshold value of 50 provides significant discriminatory ability between normal hearing and unilateral or bilateral hearing loss on audiometry. Normative values provide useful, frequently referenced data when assessing responses to treatment. Based on these data, this threshold may help distinguish patients with and without perceived functional impact from hearing loss.

DETERMINATION OF THE DYNAMIC PARAMETERS OF THE MOBILE FIRE STATION OPERATOR IN THE FREQUENCY DOMAIN

Determination of the dynamic parameters of the operator of the mobile fire apparatus is based on the use of its amplitude-frequency and phase-frequency characteristics, the value of which is used at a priori set frequency. The value of these frequency characteristics of the operator of the mobile fire apparatus is used as initial data. Using the exponent and trigonometric form of the expression for the complex transfer function of the operator of the mobile fire apparatus, the functional dependence between its phase-frequency characteristic and dynamic parameters - the delay time and the operator's time constant - was obtained. This functional dependence is given in the form of two additive components, one of which is represented by a trigonometric function, the argument of which is the value of the phase-frequency characteristic of the operator and its delay time. The second additive component is a function of the time constant of the operator. The constructed functional dependence is used to determine the delay time of the operator of the mobile fire apparatus, provided that another dynamic parameter - the time constant - is determined using the amplitude-frequency characteristic of the operator and the normative value of its transmission coefficient. A graphical interpretation is given for the constructed functional dependence, which can be used as a component of the algorithm when determining the dynamic parameters of the operator of a mobile fire extinguisher. The algorithm for determining the dynamic parameters of the operator of a mobile fire installation is presented, which is presented in verbal form. The developed algorithm for determining the dynamic parameters of the operator of the mobile fire apparatus during its implementation involves the use of a graphical interpretation of the functional dependence between the delay time and the time constant of the operator of the mobile fire apparatus. The presented algorithm differs from the known ones by the simplicity of its implementation, which is ensured by reducing the number of a priori frequencies used to determine the values of the frequency characteristics by four times. An example of the implementation of the algorithm for determining the dynamic parameters of the operator of a mobile fire installation is given. Key words: operator, fire installation, dynamic parameters.

Operation control and optimization of high efficiency hot primary air temperature adjustment device

Aiming at the problems existing in the control logic of the current hot primary air temperature adjustment device, such as adjustment lag, poor adjustment quality, deviation of the pulverizing system operation from the normative value and insufficient energy-saving effect in the adjustment process, a standard-based calculation method was proposed. It is a logical optimization scheme that dynamically adapts to the moisture content of raw coal and the coal volume of the pulverized. It has the advantages of faster adjustment speed, high system energy saving effect, and ensures the standard operation of the coal mill.

Dynamics of indicators of vestibular dysfunction and walking locomotion in men aged 25-42 years with the consequences of a combat wound as a result of the influence of physical culture and sports rehabilitation

The purpose of the study was to investigate and evaluate the dynamics of basometry and stabilometry in men aged 25-42 with the consequences of a combat injury.&#x0D; Material &amp; Methods: examined 38 men aged 25-42 years with long-term consequences of closed craniocerebral injury in the late long-term period, which were divided into Gr1 (n=20) and Gr2 (n=18). Vestibular dysfunction, mobility was determined by the Bohannon and "TUG" tests. To determine the biomechanical characteristics of walking, a hardware-software basometric complex and methods of the Ukrainian Research Institute for Prosthetics, Prosthetic Engineering and Recovery were used.&#x0D; Results: when developing a correctional and rehabilitation program, thanks to the concept of the ICF, Smart goals were set. At stage 1 of inpatient rehabilitation (28 days), the program is composed of components. For men in both groups, the normative component was the same. Kinesitherapy, classes on the C-mill system, on the «Cosmos» treadmill, and massage were prescribed. Persons Gr1 in the variable part were trained on the Redcord suspension system, Nordic walking and vestibular gymnastics. The men of Gr2 were prescribed a general training on a multifunctional block simulator, training walking. At the 2nd stage (42 days) the persons of both groups were exercising independently, however, the persons of Gr1, with the help of modern telecommunication technologies, were exercising under the supervision of a specialist in physical rehabilitation. The dynamics of the balance indicator according to the Bohann test indicated that the persons Gr1 balance indicator almost approached the normative value. In Gr2 positive changes were observed, however, after stage 2 the difference was only 0.44 points compared with the dynamics of stage 1 (p&gt;0,05). The dynamics of functional mobility and balance according to the "TUG" test indicated that the average time to complete the test after stage 2 approached the standard value. In patients, Gr2 tended to decrease (p&gt;0,05). Biomechanical studies of statics, namely the coefficient of resistance, rotation of pressure centers, the common center of pressure in the frontal and sagittal plane in men Gr1 acquired significant differences (p&lt;0,05); in men Gr2 tended to improve (p&gt;0,05). The main indicators of walking locomotion, namely the pace and speed in men Gr1 and Gr2, acquired a standard value (p&lt;0,05). The walking rhythm coefficient and load asymmetry index in men Gr2 did not acquire the normative value (p&gt;0,05), in comparison with the indices of men Gr1 (p&lt;0,05), who were engaged under the supervision of a specialist in physical culture and sports rehabilitation.&#x0D; Conclusions: the results of the study revealed a violation of walking in men aged 25-42 years with the consequences of a combat injury in the form of temporal, kinematic and dynamic asymmetry. The analysis of the dynamics of the parameters of vestibular dysfunction and walking locomotion confirmed the advantages of the author's program.

Philosophy of worldview as a basis for world perception and socio-cultural traditions

In the era of globalisation's transformation of socio-cultural standards, the worldview philosophy serves as the basis for their revision and implementation of appropriate changes. Particularly, the requirement to ensure the norms of cultural diversity restores the need to refer to a worldview category in the scientific and public discourse. The research goal of this article is to provide an appropriate justification of the philosophy of worldview as the basis of world perception and socio-cultural traditions. Namely, the paper addresses the following questions: (1) What is the broader context for the Eastern European levelled description model of worldview? (2) Is the explanation of the world perception as a subset of worldview relevant? (3) What are the conjunctures of socio-cultural tradition and world perception at the level of worldview? (4) Is the tradition change possible as a result of changing the sum of the worldviews of actors? The methodology is based on an iterative progression of analytical and synthetic methods. The review of publications served as basis for testing the theoretical model to encapsulate the interaction between the actor and the cultural context. The results organise the connectors between the worldview and world perception in the socio-cultural dimension. The level model of worldview needs to be revised and empirically tested, but it provides auxiliary constructs for the operationalisation. The changes in worldview that are implemented at different levels have a different normative value. Implications of the presented research are contained in the dimension of cultural hybridization, which leads to the formation of new worldview schemes, and socially desirable outcomes, through changes in the world perception of actors. The spread of the Eastern European level model will contribute to a shift away from the Western-centred methodology and will also provide the necessary tools for a revision of traditional practices.

Расчетные параметры функционального зонирования озелененной территории центральной части города Реутова

Introduction. The article devoted to the relevant problem of optimizing the natural framework of the city on the basis of rational use of the territory of the settlement as a public green area. The approach, based on the modern tendencies of urbanization, ecological utility, social benefits and rational use of territories. One of the important elements of the optimization of the ecological environment is the greening of the city space. At present, maintaining the balance of urbanized areas is a priority because with the growth and development of cities, the environment is becoming more and more aggressive. Also, with the increase in the number of residents, the recreational load increases, and due to the high concentration of emissions from motor vehicles and industrial enterprises, the state of urban natural systems is changing, which leads to a deterioration in the quality of life of the population. The system of green spaces of a modern city is being formed to improve the environment, enrich the appearance of the city, create conditions for mass recreation of the population in the natural environment. For the formation of the ecological situation in the city, along with cardinal measures, it is necessary to preserve and develop natural massifs and landscaping of the city territory. The article analyzes the relevant planning opportunities and constraints for urban transformation of the city, and also selects the optimal strategy for spatial development of the reorganization of the natural framework. Materials and methods. The collected attributive information, legal documents and cartographic materials are used in the work. The calculation of potential visitors was carried out on the basis of the normative value for recreational load, and the calculation of visitors to the natural-anthropogenic territorial complex (hereafter — NATC) was carried out by means of field observation. The observation results were processed using the Microsoft Office Excel software, followed by modelling of the project proposal for the use of the Reutov green space in the Qgis software package. Results. On the basis of the conducted research, the excess of the normative value of recreational load of the NATC “Apple Orchard” in Reutov was identified and a functional zoning project, including the design of three functional zones, was proposed. Conclusions. The increased rate of population influx and environmental pollution is forcing a reorganization of the green cores of cities.

Оцінка ефективності перинатальної допомоги в Україні

In the context of political changes, increasing social heterogeneity of society, high income differentiation, Russia’s aggressive war against Ukraine, and the COVID-19 pandemic, women during pregnancy and childbirth and newborns are becoming the most vulnerable groups in the population. Effective maternal and newborn health can only be promoted and maintained through effective healthcare systems. Purpose - to analyze and evaluate the integrated effectiveness of perinatal care in Ukraine at the national and regional levels. Materials and methods. A comprehensive analysis of regional peculiarities and an assessment of the main indicators of perinatal care in Ukraine in 2017, 2021 according to the data of the State Institution «Centre for Medical Statistics of the Ministry of Health of Ukraine», perinatal audit according to the World Health Organization «MATRIX - BABIES» methodology were carried out. A modified outcome model was used to assess the integrated effectiveness of perinatal care. Methods of systematic approach, comparative analysis, bibliographic, statistical data processing were used. Results. The population-based comprehensive study of the integrated performance of perinatal care at the national and regional levels showed a sufficient, above-average level of achievement of results (comprehensive assessment ratio (CAR) - 0.77 in 2017 and 0.73 in 2021) with a high level of coefficient of achievement of normative values of resource components (0.82 and 0.86) and activities (0.76 and 0.77, respectively), which is likely due to the reorientation of perinatal care facilities and institutions to evidence-based medical and organizational technologies. The negative trend in the perinatal care CAR for 2017-2021 (5.19% decline rate) is due to a decrease in the ratio of achievement of the normative value of the performance component from 0.79 to 0.64 due to the rapid increase in maternal mortality from 12.5 to 42.5 per 100 thousand live births and an increase in bleeding in the sequential and postpartum periods from 7.1 to 8.9 per 1000 births, respectively, which may be due to the COVID-19 pandemic. Changes in the CAR of the integrated effectiveness of regional perinatal care systems in Ukraine in 2021 compared to 2017 were downward in the vast majority (15) of territories (the highest rate of decrease in the CAR (19.05-15.0%) was in Zhytomyr, Dnipro, Zaporizhzhia, and Poltava regions), and upward in 9 territories (the highest rate of increase in the CAR (9.37-7.58%) was in Zakarpattia, Chernivtsi, and Volyn regions), with stabilization of this indicator in Rivne region. The leaders of the integrated perinatal care efficiency (the Group 1) with a high level of results achievement ratio (CAR≥0.80), which indicates that the perinatal service in the regions is quite effective, are Kyiv, Ternopil, Ivano-Frankivsk, Lviv, and Chernivtsi regions. An another group of regions (the Group 2) with above average CAR (0.7-0.79), which requires strengthening of certain components of perinatal service facilities and institutions, includes 13 regions. The outsiders of the integral effectiveness of perinatal care (the Group 3 of regions with an average CAR of 0.6-0.69), requiring management decisions on more efficient operation of perinatal service facilities and institutions, are 7 regions (Dnipro, Donetsk, Zhytomyr, Zaporizhzhia, Kyiv, Poltava and Kherson regions). Conclusions. The integrated assessment of the effectiveness of perinatal care makes it possible to evaluate the effectiveness of management actions in ensuring the availability and quality of perinatal care, and to respond in a timely manner to changes in the macro- and microenvironment. Given that the model of integrated assessment of perinatal care effectiveness has dynamic properties, it is planned to revise them in the future as the healthcare sector transforms and the normative values of individual indicators of the integrated assessment are achieved. No conflict of interests was declared by the authors.

Partial factor for the shear resistance model in the 2nd generation of Eurocode 2 for GFRP reinforced concrete members

Fibre-reinforced polymer (FRP) bars provide a useable alternative to conventional steel reinforcement in concrete structures exposed to chlorides from de-icing salts and marine environments. Glass fibre-reinforced polymer (GFRP) bars have the widest practical applications in concrete structures all over the world. The lower modulus of elasticity and bond with concrete compared to steel rebars led to the development of new or modification of existing design models for predicting the shear capacity. The 2nd generation of Eurocode 2 (prEC2) introduces a new design provision for predicting the shear capacity of concrete members reinforced with FRP bars together with a new partial factor for shear γV. The paper deals with the statistical analysis of the accuracy and reliability of this design model. The analysis was carried out using a database of 288 experimental tests on beams and one-way slabs reinforced with GFRP bars. The correction factor bcor of a model and the coefficient of variation of the model error Vδ were evaluated according to Annex D of the EN 1990. Probabilistic properties of the random variables in the resistance function were assumed according to the recommendations of the JCSS Probabilistic Model Code and values introduced in Annex A of the prEC2. The analysis showed acceptable accuracy with Cov of model uncertainty Vθ = 0.190. However, the partial factor γV ranged within the interval of 1.62 to 1.65 which is a higher value than the proposed normative value of 1.50. The lower safety of the model also confirmed the comparison of the results with the performance of the design provisions in Canadian standard CSA S806-12 and in the ACI code of practice ACI 440.1R-15. An adjustment of the prEC2 design provision was proposed with the aim to increase the reliability of the model and maintain the normative value of the partial factor for shear on a proposed value of 1.50.

Definition of New Three-Dimensional Cephalometric Analysis of Maxillomandibular Sagittal Relationship for Orthodontics and Orthognathic Surgery: Normative Data Based on 700 CBCT Scans.

The objective of the study was to define the norm of new 3-dimensional cephalometric analysis of maxillomandibular sagittal relationship with the patient in Natural Head Position. A cross-sectional study was performed using 700 consecutives cone beam computed tomography datasets of pre-orthodontic patients received for three-dimensional craniofacial analysis. To stablish the clinical norm of the new sagittal reference (linear distance A-B), the correlation with the gold standard (ANB angle) was estimated with the Pearson's correlation coefficient. Subsequently, the prognostic values of the linear distance A-B was calculated to define the clinical norm. The sample was composed by 463 women (66.1%) and 237 men (33.9%). The mean age was 30 ± 14,5 years old (range 6-71y old). According to the skeletal class classification (ANB), 46.1% (323) were class I, 42% (294) class II, and 11.9% (83) class III. The regression model found that each additional grade of the ANB angle imply a mean increase of 1.24mm of the distance A-B ( P <0.001). The normative value of the linear distance A-B was obtained through the prognostic values of the distance for the limits of the ANB norm 0 to 4. These values were on the range of 0.52 to 5.48mm. Therefore, the clinical norm for cephalometric maxillomandibular sagittal relationship using linear distance from point A-B is: 3±2.48mm. With this new approach, we can define the skeletal sagittal relationship of the patient in natural head position overcoming the limitations of using intracranial or occlusal plane references improving the diagnosis and orthognathic surgical planning process.