Operation Period Research Articles

Guidelines and consensus: Jejunoileostomy for diabetes mellitus-surgical norms and expert consensus (2023 version)

Diabetes mellitus (DM) is a group of diseases characterized by high blood glucose caused by insufficient absolute or relative secretion of insulin. Once diagnosed, patients need long-term treatment with hypoglycemic drugs. Currently, the existing first-line hypoglycemic drugs do not provide effective treatment for DM and its complications. In the past, the first generation and the second generation of weight loss surgery, such as gastric bypass and sleeve gastric surgery, had strict body mass index requirements. Moreover, post-surgery, patients are prone to fluctuating hypoglycemia, gastroesophageal reflux, and dumping syndrome. Hence, the curative effect of this type of surgery was compromised to a certain extent. Jejunoileostomy is a third-generation surgery for patients with DM, which has been shown to improve glucose and lipid metabolism, without changing the original gas-trointestinal tract structure. Different from previous weight loss surgeries, jejunoileostomy has been clinically observed to delay the development of DM-related complications. Additionally, the postoperative complications are mild and do not affect the patient’s quality of life. Based on our clinical observations from multi-center large samples, our team developed a consensus on the operative period and perioperative management of jejunoi-leostomy as a reference for clinical researchers.

VS 06 - HPB Laparoscopic Caudate lobectomy and resection of exophytic cyst

Abstract Background A 64 year old lady with no comorbidities presented with early satiety and upper abdominal discomfort. Imaging (CT abdomen and MR Liver) revealed multiple cystic lesions in liver including 9cm X 8cm X 6 cm cyst in segment 2 and 10cm X 8 cm X 8cm cyst in caudate lobe suspicious of Simple cyst/biliary cystadenoma. Method A laparoscopic caudate lobectomy and resection of exophytic cyst was done. Results Post operative period was uneventful and patient was discharged on post operative day 5. Patient is on follow up. Conclusion A video of a successful laparoscopic caudate lobectomy and resection of exophytic cyst is presented.

BN SO46 - PANDORA's BOX- When anatomy trumps the pathology

Abstract Background Obturator hernias are usually attributed to elderly females presenting with small bowel obstruction. We present a case of an elderly gentleman with severe Kyphoscoliosis presenting with small bowel obstruction. His past medical history included Ischaemic Heart Disease with stents in the coronary arteries and on dual antiplatelets. His Kyphoscoliosis precluded him from being able to lie flat on his back. The spinal deformity as revealed in the CT scans proved challenging to position him dsafely for surgery. The lack of access between costal margins and the pelvis meant that surgical access with Laparoscopy was going to be impossible. Method After initial resuscitation, he underwent CT scan of his Chest, abdomen and pelvis which revealed an obstructed Obturator Hernia on the left side with small bowel obstruction. The CT was also concerning for the Anaesthetists due to the challenge posed by the severe Kyphoscoliosis. After fibreoptic intubation, abdomen was accessed through a transverse muscle cutting incision, at the level of the umbilicus. The Obturator membrane was approached from above and the hernia was reduced. The obstructed small bowel was viable and the defect in the obturator membrane was closed with No1 Ethibond sutures. The abdomen was closed with mass closure. Results Patient had a smooth post operative period and was discharged home after 2 weeks. Obturator hernias are notorious for their occult presentation. Unless the patient is scanned with CT imaging, it is impossible to make the diagnosis although clinical signs like Howship- Romberg sign may be present with pain on internal rotation of the hip, as a result of irritation of the Obturator nerve. Obturator Neuralgia may be elicited with positive Hannington- Kiff sign, which is an absence of absent adductor reflux in the thigh. Conclusion Obturator hernias are typically seen in skinny old females. When presenting with small bowel obstruction, Obturator herniae are challenging both in terms of diagnosis as well as in management. In our case, the challenging anatomy posed greater risk to safe airway control. From surgical view, laparoscopy as a less invasive option was ruled out because of the restricted access. When anatomy is challenging, the Surgeon will be forced to think outside the box and consider access to the abdomen through incisions which are not routinely used. The preoperative imaging shows the challenge posed by the extreme spinal deformity.

AHP SO01 - Establishing Physiotherapy led Prehabilitation for patients undergoing major hepatobiliary surgery in a Regional Centre - A Service Improvement

Abstract Background Prehabilitation is increasingly on the agenda for major surgical patients and will be an essential service in an ageing population with increasing cancer prevalence. By 2040 5.3 million people in the UK will be living with cancer physical fitness can have an impact on both treatment options and survival rates. Prehabilitation has been mentioned in both the Major Conditions Strategy and the Long-Term Plan. Currently within the trust, there are no established multiprofessional prehabilitation services. New funding allowed a service improvement project to develop a ‘model’ for a specialist physiotherapy prehabilitation pathway pilot in patients undergoing major hepatobiliary surgery. Method Patients undergoing major surgery complete Cardiopulmonary Exercise Testing, providing data indicating fitness levels and guides risk stratification. Patients deemed to be at high risk due to poor fitness, (anaerobic threshold 10.9 or below), were referred to the prehabilitation physiotherapist. Patients attended a 1:1 assessment with a Physiotherapist, were provided with an individualised home exercise programme, including cardio-vascular and muscle strengthening. Weekly follow up virtual follow was provided. Outcome measures taken at initial appointment included five sit to stand (5STS) time, Grip strength and EQ-5D. These were repeated before surgery, and after hospital discharge. Patients had the opportunity to provide feedback. Results Average improvement in all outcome measures was demonstrated. Outcome MeasuresPre-intervention averagePost intervention averageAverage changeEQ-5D Score8.17.30.8EQ-5D Health score687465 STS (seconds)14.711.5-3.1Grip (kg)29.831.31.5Sarcopenic 5 STS (seconds)20.913.1-7.9 Patient and staff feedback was positive, finding patients reported they felt prepared for the post operative period, and staff noted and increased in their patients preparedness. It is too early to say if Prehabilitation has had an impact on hospital length of stay or post operative complications, though early results are promising. Conclusion Physiotherapy led prehabilitation is beneficial for patients undergoing major HPB surgery, demonstrating improvements in physical strength and fitness following an individualised home exercise programme with regular virtual support, especially those who have sarcopenia.

Exploring the Impact of Regional Environment and Institutional Factors on Operation Period of Nursing Facilities in Taiwan.

This study examines factors influencing the operational durations of nursing facilities in Taiwan. It departs from previous closure-focused research by analyzing the duration of facility operation. A Cox regression model was employed to assess the impact of regional, governmental, and individual institutional factors on 199 facilities across diverse areas in Taiwan from 2011 to 2019. Results demonstrate closure hazards associated with rising property prices, particularly for rented facilities, with metropolitan locations exhibiting superior survival rates and lower institutional appraisal grades significantly increasing closure. Additionally, operator background, facility type, and bed occupancy emerged as influential factors. These findings underscore the financial vulnerability of rented facilities to market fluctuations and the challenges associated with adjusting resident fees. Furthermore, the study highlights the unique challenges faced by facilities in low-density areas regarding resident access to resources. Policymakers should closely monitor regional factors and consider proactively implementing early warning systems to address these challenges.

Zeolite‐Based “Particle Board” Membranes for Rapid and Selective Hydrogen Permeation

AbstractZeolites, with their well‐defined pore sizes and outstanding stability, are regarded as the quintessential material for precise molecular separation tasks. However, the leap from easily produced zeolite powders to synthesizing free‐standing zeolite membranes, which can fully leverage their ordered porosity, presents substantial technical hurdles. Addressing this challenge, this study introduces polymers of intrinsic microporosity (PIM‐1) as adhesives through a wrapping‐compression method for the facile fabrication of high‐performance and free‐standing zeolite (FAU) “particle board” membranes. The 3D tomogram reconstruction from the focused ion beam‐scanning electron microscope images reveals the “particle board” membranes exhibit hierarchical porous structures. The non‐interconnecting macropores between zeolite particles facilitate the rapid H2 permeation, and the zeolites’ ordered micropores sieve the gas molecules. The optimized FAU@PIM‐1 free‐standing membrane with hierarchically pore structures demonstrated hydrogen permeance (2240 GPU) alongside H2/CH4 selectivity (31.68) for mixed gas and maintained this performance level under pressure ranges from 1.2 to 4.0 bar and over protracted operational periods (up to 3200 h). Meanwhile, EMT and MFI‐type zeolites have also been successfully applied to validate the versatility of this method, demonstrating its widespread potential for the fabrication of various free‐standing zeolite membranes.

Hand Assisted Transperitoneal versus Retroperitoneal Laparoscopic Nephrectomy (A Comparative Study): Our Experience in Prince Hussein Urology Center

Aim: Hand assisted laparoscopic nephrectomy could be an excellent alternative option to the open approach for benign renal conditions. Besides that, renal malignant processes can be managed by the previous mentioned hand-assisted laparoscopic technique of nephrectomy. In this research the outcomes and the complications of transperitoneal and retroperitoneal approaches of hand assisted laparoscopic nephrectomy were estimated for the differences. Methods: Retrospectively (223) hand assisted laparoscopic nephrectomies (transperitoneal grid iron incision (group1, N= 112) vs. retroperitoneal Pfannenstiel incision (group2, N=111) which were done between September 2022 and June 2024 in Prince Hussein Urology Center were enrolled in this study. Demographic and categorical data of both groups were compared herein. Follow-up period is between 3 and 18 months. Results: Patients’ ages were between (35 and 62 years). There were no differences in patient demographic, and most of categorical data between the both groups. The mean duration of the transperitoneal procedure was significantly shorter than that of the retroperitoneal approach (197.3 and 238.5 minutes, respectively, P < 0.05). While the lower incidence of incisional hernia, blood loss, solid organs impact, and bowel injury were in group2 (P < 0.05). Conclusion: Hand-assisted laparoscopic retroperitoneal nephrectomy is superior to transperitoneal approach in regards to incisional hernia incidence, operative blood loss, and organs injury. Due to the steeper learning in the retroperitoneal approach, the operative period can be equal to or shorter than that of the transperitoneal technique after the surgeons used to and getting more experience in this approach.

ROOT ANALYSIS OF LOSS STRUCTURAL INTEGRITY FOR OIL COOLING RADIATORS IN COMPRESSOR STATIONS PUMPING ASSOCIATED PETROLEUM GAS CONTAINING WET H2S

One of the main problems in the associated petroleum gas treatment is its further beneficial usage. Gases of the end stages of separation require special technical solutions when involving them in the production process due to low pressure. At the same time, gases of the first stages of separation by 70–90 % of the total amount are mainly used in gas processing plants. Gas of the end stages of separation contains components C3+ and higher from 400 to 2000 g/m3 and is a valuable petrochemical raw material. To transporting gas of the end stages of separation, compression is necessary to achieve sufficient pressure. When compressing gases of the end stages of separation, a significant amount of unstable condensate containing hydrocarbons C4–C12 and water is released. In addition, the end-stage gas is saturated with sulfur compounds (H2S and R-SH), which evaporate intensively from the crude oil after its heating from the end-stage separators of oil treatment. The equipment of compressor stations for gas treatment and transportation, as a rule, does not have protection against internal corrosion. Recently, failures of cooling system radiators, pipes of air gas cooling devices made of non-ferrous metal alloys have been recorded. Radiator failures are associated with the loss of their structural integrity. Oil stains without visible flows, cracks or pits appear on the outer surface of the radiator cooling channels, while in the channels of copper alloy channels radiators, clogging of individual channels is often observed over a short period of operation of the compressor station. Understanding the causes of leaks in liquid cooling radiators as part of compressor stations for pumping associated petroleum gas of the end stages of separation is an important aspect for ensuring reliable operation of process equipment and preventing possible emergency situations. The article reflects the results of studies aimed at identifying the causes of radiators structural integrity loss of oil cooling systems in the composition of block compressor stations for compression of associated petroleum gas containing hydrogen sulfide and moisture. Solutions and recommendation to minimize the risks of equipment failures of for compression stations are made.

A Deep Learning Dependent Controller for Advanced Ultracapacitor SoC Concept to Increase Battery Life Span of Electric Vehicles

ABSTRACTOn a global scale, significant progress is being made in the field of battery technology for Electric Vehicle (EV) applications, driven by the need to combat carbon emissions and mitigate the effects of global warming. Accurately determining critical parameters, making sure battery storage system diagnosis, and functioning are correct are critical to the feasibility of EVs. However, insufficient supervision and safety measures for these storage systems may lead to serious problems like a thermal runaway, overcharging, overheating, cell imbalances, and fire hazards. To tackle these challenges, the presence of an efficient battery management system becomes paramount. By facilitating accurate monitoring, managing heat dissipation, regulating charging‐discharging procedures, guaranteeing battery safety, and offering protection measures, this system is essential to maximizing battery performance. The key intention of this innovative approach is to improve the longevity of EV batteries during extended periods of operation. By assessing vehicle velocity, remaining battery energy, and State of Charge (SoC), the proposed method effectively manages SoC in both the battery and ultracapacitor. This control is accomplished through a two‐stage convolutional neural network‐based system known as the Charge Sustain‐CNN Controller and the Charge Deplete‐CNN Controller. These controllers are fine‐tuned using the Fractional Latrans‐Hunt optimization (FLHO) algorithm to optimize the performance. The evaluation criteria encompass the battery and ultracapacitor's energy efficiency, as well as vehicle velocity. This novel approach significantly improves the energy storage system in EVs, leading to enhanced energy efficiency and prolonged battery life. Ultimately, experimental results validate the practicality and effectiveness of this developed method. Specifically, the proposed approach attained the Battery's SoC of 72.47%, 91.99%, and 82.88% for the different drive cycles including the FTP75, J1015, and UDDS, respectively.

NHPP Software Reliability Model with Rayleigh Fault Detection Rate and Optimal Release Time for Operating Environment Uncertainty

Software is used in diverse settings and depends on development and testing environments. Software development should improve the reliability, quality, cost, and stability of software, making the software testing period crucial. We proposed a software reliability model (SRM) that considers the uncertainty of software environments and the fault detection rate function as a Rayleigh distribution, with an explicit mean value function solution in the model. The goodness-of-fit of the proposed model relative to several existing nonhomogeneous Poisson process (NHPP) SRMs is presented based on three software application failure datasets. Further, a cost model is also presented that addresses the error-removal risk level and required time. The optimal testing release policy for minimizing the expected total cost (ETC) is also determined for NHPP SRMs. The impact of the software environment is studied by varying it, and the optimal release times and minimum ETCs are compared. The goodness-of-fit comparison confirmed that the proposed model has more accurate prediction values than other models. Further, whereas the existing models applied to the cost model do not change after a certain operation period, the proposed model yields changes in release time even for long operating periods.

Comparison of the outcome of dynamic hip screw versus proximal femoral nail for treatment of intertrochanteric femoral fractures among elderly patients.

Objective: To compare the outcome of DHS versus PFNA for treatment of intertrochanteric femoral fractures (IFFs) among elderly patients. Study Design: Randomized Clinical Trial. Setting: Sheikh Zayed Hospital, Lahore. Period: 2-03-2022 to 2-09-2022. Methods: In total 90 patients fulfilling inclusion criteria were registered after approval from the ethical review committee of the hospital. Every patient provided written informed consent. Patients were allotted to each group (Group A = PFNA, Group B = DHS) using lottery method. Patients were operated upon by a single surgical team. Data was obtained VIA questionnaires designed for pre- operative period, immediate post-operative period, 1 and 3 months follow up. Patients were interviewed and evaluated by blind researchers at each stage. Harris hip score was used to assess the functional outcomes. Results: In 90 patients (45 in each), 36.2% (n=17) were male in PFNA group and 63.8% (n=30) in DHS group and 65.1% (n=28) were female in PFNA and 34.9% (n=15) in DHS group, p=0.011. Mean age of PFNA group was calculated as 66.00± 3.41 years and mean age of DHS group was 66.80±3.71 years (p=0.714). Distribution of BMI was 28.14+6.20kg/m2 in PFNA group and 27.47+6.24kg/m2 in DHS group, p=0.612. Distribution of Harris hip score at 1 month was 31.11+4.08 in PFNA group and 30.11+4.18 in DHS group, p=0.254 and Harris hip score at 3 months was 88.68+1.23 in PFNA group and 81.68+0.95 in DHS group, p=0.000. Conclusion: We concluded that PFN is superior to DHS in treating Boyd and Griffin type II intertrochanteric fractures of femur. It’s only a matter of time that PFN becomes the new gold standard for these fractures.

An advanced real-time crash prediction framework for combined hard shoulder running and variable speed limits system using transformer

One of the important applications of real-time crash prediction analysis lies in the field of proactive traffic management, where instantaneous crash risk evaluation and dynamic decision-making are prerequisites. This research proposes an integrated and advanced real-time crash risk prediction framework for Variable Speed Limits (VSL) and Hard Shoulder Running (HSR) implemented freeways considering their operational periods. Statistical methods are utilized to identify the significant crash contributing factors (related to traffic, roadway geometry, and weather conditions) and explain their relationships with crashes. Time-Embedded Transformer models are proposed to predict the likelihood of real-time crash events. The sensitivity and false alarm rate of the proposed AM peak model are found to be 0.76 and 0.27, respectively, whereas the values are 0.78 and 0.24, respectively for the PM peak model. Additionally, the results indicate substantial improvements in model prediction performance (i.e., an increment of sensitivity values by 7.04% and 8.33% in the AM and PM models, respectively) after incorporating the general safety condition of a freeway segment as an input feature while estimating real-time crash prediction models. Practitioners and policymakers could apply this method to obtain a more accurate real-time crash likelihood estimation, identify important crash precursors, dynamically update algorithms, and enhance safety aspects while operating traffic management strategies on freeways.

Enrichment of Methanothrix species via riboflavin-loaded granular activated carbon in anaerobic digestion of high-concentration brewery wastewater amidst continuous inoculation of Methanosarcina barkeri

Effective treatment of high-concentration brewery wastewater through anaerobic digestion (AD) has always been a challenging issue. Enhancing direct interspecies electron transfer (DIET) was demonstrated to increase methane production during AD under high organic loading rate (OLR). Herein, the feasibility of enhancing DIET with the addition of riboflavin-loaded granular activated carbon (RF-GAC) as well as co-addition with Methanosarcina barkeri (Rf-GAC+M.barkeri) was investigated (M.barkeri is well-known to be capable of DIET with electroactive bacteria). During the whole process, the Rf-GAC and the Rf-GAC+M.barkeri group both achieved average COD removal rates above 97 %, which was 14 % higher than that of the control. The average methane production in the Rf-GAC group and the Rf-GAC+M.barkeri group respectively reached 0.334 ± 0.02 L(stp)/g COD and 0.345 ± 0.02 L(stp)/g COD, 1.35 and 1.39 times higher than the 0.247 ± 0.03 L(stp)/g COD reached by the control. The control reactor deteriorated at an OLR of 12 kg COD/(m3·d), whereas the Rf-GAC and the Rf-GAC+M.barkeri group maintained stable as the OLR reached as high as 17.5 kg COD/(m3·d) and the volatile fatty acids concentration was consistently below 10 mM. The RF-GAC performed better than Rf-GAC+M.barkeri in enriching Methanothrix, whose relative abundance was 60.6 % in the former group. Metabolic pathway analysis revealed the addition of RF-GAC upregulated genes related to DIET in Methanothrix species, including hdrA and fpoD. Furthermore, Methanothrix remained the dominant archaea even continuously inoculating pure strains of M.barkeri during the entire operational period. Pure culture experiments proved that GAC inhibited M.barkeri growth. The results of this study can be optimized for practical application of AD treating high-concentration brewery wastewater.

Enhancing simultaneous nitrogen and phosphorus removal using partial nitritation/anammox with an airlift inner-circulation partition bioreactor

The partial nitritation/anammox (PNA)-hydroxyapatite (HAP) process for synchronized nitrogen (N) and phosphorus (P) removal has attracted much attention; however, its use has been restricted by the limited availability of optimal bioreactor configuration and its operational conditions. In the present study, a new single-stage PNA reactor, the airlift inner-circulation partition bioreactor (AIPBR), was continuously operated for 261 days at a fixed hydraulic retention time of 6 h. The results showed that the optimal removal performance (ammonia, 92.77 ± 0.72 %; total N, 76.92 ± 1.78 %; %, total P, 86.57 ± 2.84 %) was achieved at a Ca/P ratio of 4.0 during the operation period; the influent ammonia and P concentrations were maintained at 250 mg/L and 20 mg/L, respectively. The P removal efficiency was 10 % higher than that reported in similar studies, indicating that a highly efficient PNA-HAP process can be successfully achieved using the AIPBR. By enhancing the circulation of the mixture between the inner and outer layers, accelerating the accumulation of ammonia-oxidizing and anaerobic ammonia-oxidizing bacteria, and promoting simultaneous biological autotrophic denitrification and phosphorization, the sludge granulation and HAP crystallization were gradually strengthened by the pH increase inside the sludge particles. Our findings provide a scientific basis for developing next-generation technologies for synchronized N and P removal from wastewater.

Rainstorm Flood Risk Assessment of Urban Metro System in Different Operating Periods: A Case Study of the Central Urban Area of Tianjin, China

Rainstorm Flood Risk Assessment of Urban Metro System in Different Operating Periods: A Case Study of the Central Urban Area of Tianjin, China

Exercise benefits following breast cancer surgery – a narrative review

One of the most common cancer diseases among women is breast cancer. Treatment following breast cancer surgery leads to many complications. Exercises play an important role from the immediate post operative period which could help in preventing post-surgical complications. Prevention of complications improves the quality of life of women. Though women feel that performing exercises following treatment are difficult there are many positive effects of exercises. This current study was done with an objective to analyse the various effects of exercises especially on the resisted exercises in preventing Secondary lymphedema (SL) and to focus light on the benefits of the exercises during and after chemotherapy. Literature search of PubMed, Clinical Key and Google scholar was performed. For women recovering from breast cancer surgery, resisted exercises, either by themselves or in combination with aerobic exercises, were safe and effective. These exercises improved upper body strength, increased endurance, decreased adipose tissue, decreased waist and hip circumferences, increased lean body mass, improved cardiovascular fitness, improved self-esteem, and decreased depression. Women with breast cancer related lymphedema had a considerable improvement in pain after performing deep breathing exercises combined with upper limb movements. Exercise can help mitigate the negative effects of chemotherapy and helps to overcome cancer related fatigue. Along with conventional exercises including range of motion exercises and aerobic exercises, moderate-intensity upper body resistance exercises are recommended to be a part of exercise protocol prescribed and educated to the women following breast cancer surgery for them to lead a better quality of life.

First access to ELM-free negative triangularity at low aspect ratio

Abstract A plasma scenario with negative triangularity (NT) shaping is achieved on MAST-U for the first time. While edge localized modes (ELMs) are eventually suppressed as the triangularity is decreased below δ ≲ − 0.06 , an extended period of H-mode operation with Type-III ELMs is sustained at less negative δ even through access to the second stability region for ideal ballooning modes is closed. This documents a qualitative difference from the ELM-free access conditions documented in NT scenarios on conventional aspect ratio machines. The electron temperature at the pedestal top drops across the transition to ELM-free operation, but a steady rise in core temperature as δ is decreased allows for similar normalized β in the ELM-free NT and H-mode positive triangularity shapes.

Advanced model for a non-adiabatic capillary tube considering both subcooled liquid and non-equilibrium two-phase states of R-600a

Previous empirical correlations have largely failed to predict the mass flow rate variations of R-600a during the transient pull-down operation of household refrigerators. This shortcoming is attributed to the fact that these correlations were developed for specific thermodynamic states of the refrigerant at the capillary inlet, whereas the thermodynamic state varies during transient operations, particularly involving non-equilibrium two-phase states. To address these limitations, a novel model has been developed. This model comprises two distinct sub-models corresponding to the refrigerant state at the capillary tube inlet: one for the subcooled liquid state and the other for the non-equilibrium two-phase state. These sub-models are integrated to account for the transitions in the thermodynamic state of R-600a at the capillary inlet. The integrated model demonstrates excellent agreement with observed variations in the R-600a mass flow rate during the pull-down operation of actual refrigerators. The mean absolute percentage error between the measured and estimated mass flow rates is approximately 10 % over the entire period of pull-down operations tested under various environmental conditions.

About expediency of changing the connection diagram of hot water supply units

PURPOSE. The article is devoted to an urgent problem for domestic district heating. A widespread situation is considered when consumers from heat supply systems with a closed connection scheme for hot water supply plants are switched to an open heat supply system from a thermal power plant. METHODS. Study of operating modes of operating heat supply systems was performed. Data collection was carried out using an online system for monitoring and commercial accounting of energy resources. Methodology for calculation of compared mode parameters is proposed. RESULTS. Using the example of the existing heat supply system, it is shown that the effect of the measure to switch subscribers of uneconomical boiler houses to heat sources with combined heat and power generation is leveled by legislative restrictions on the development of open heat supply systems, as well as by the regulatory method for determining heat consumption in hot water supply systems. The main technical and economic indicators were selected for comparative analysis of the operation of the centralized heat supply system in conditions of complete switching of hot water supply plants according to an open circuit and in the presence of a certain number of hot water supply plants with a closed connection scheme. CONCLUSION. The period of inefficient operation of the centralized heat supply system was determined and the amount of annual economic damage was calculated, which made it possible to prove the need to bring all schemes for connecting hot water supply plants in one heat supply system to a single type.

Injury of the musculoskeletal system in civilian casualties as a result of hostilities. Report 1. Age structure

The integration of the military medical supply system into the unified medical space of Ukraine involves the functional combination of forces and means of medical services and the civilian health care system in order to maximize their capabilities for effective medical supply of the troops while preserving organizational independence. The purpose of our study was to determine the clinical and epidemiological characteristics of civilian patients with trauma due to modern hostilities. Materials and methods. To carry out our work, we analyzed skeletal traumas in 137 civilian patients who were injured during modern hostilities in Ukraine and were treated in health care facilities of the frontline zone in 2014–2023. Results. Comparing epidemiological data in two different periods of the war in Ukraine, we concluded that there is some difference in the age structure of victims with traumatic injuries sustained during modern hostilities. Thus, during the high-intensity conflict, the number of children’s injuries increased dramatically. The share of victims under the age of 15 during the full-scale invasion increased 4.5 times. In this period, the percentage of young and middle-aged wounded civilians decreased. If in the period of Anti-Terrorist Operation/Joint Forces Operation the number of people aged 16–60 was 67.6 %, then with the beginning of hostilities their share decreased to 42.0 %. This trend indicates the strengthening of internal and external migration starting from February 2022. Unlike the young and middle-aged, the share of elderly and senile people increased dramatically during the full-scale war. During the period of low-intensity military operations, the number of patients aged 61–91 was 29.4 %, while during high-intensity conflict, it was already 44.8 %. A sharp increase in traumatic injuries among elderly and senile patients is another feature of this conflict. Conclusions. Publicizing the experience of providing medical care to patients with injuries sustained due to military actions in Ukraine is only at the beginning of its existence. That is why, based on the above, we planned to continue scientific research on this problem.