Priority Treatment Research Articles

Strategie rozwoju pielęgniarstwa na świecie i w Polsce. Perspektywy rozwoju pielęgniarstwa w Polsce

Constantly changing environment and constantly growing needs and requirements of patients, make nursing define its competences, look for place in the health care system, plan tasks and create nursing development strategies. It tries to meet the requirements, becoming at the same time a key link in the health care system and a fully autonomous profession but with an unchangeable mission which is to save human life and care for the patient. Permanent changes in health care, in society as well as in the structures in medical professions cause that nursing constantly strives for its development and tries to engage substantive dialogue with those responsible for health policy, in order to outline the framework of the profession in the actual reality and its future. A review of selected national strategies for nursing development, the circumstances in which they developed and key assumptions allow to conclude about their positive impact on public health in a given country and on the quality of patient care. What connects individual strategies is the priority treatment of multi-sectoral cooperation in health care, aspects related to the promotion of the profession, education of nurses and the definition of new roles and new competences in the context of the requirements and needs of a given country. An example may be prescribing, providing nursing advice or introducing the role of an advanced practice nurse. A great achievement for nursing in Poland is the initiative of creation “Strategy of Development for nursing”. It is a planning document that defines the directions of activities ensuring high quality, safety and access to nursing care of patients.

The effect of orthopaedic surgeons\u2019 and interventional radiologists\u2019 availability on the priority treatment sequence for hemodynamically unstable pelvic fractures: a survey of US Level I trauma centers

BackgroundMost guidelines recommend both pelvic packing (PP) and angioembolization for hemodynamically unstable pelvic fractures, however their sequence varies. Some argue to use PP first because orthopaedic surgeons are more available than interventional radiologists; however, there is no data confirming this.MethodsThis cross-sectional survey of 158 trauma medical directors at US Level I trauma centers collected the availability of orthopaedic surgeons and interventional radiologists, the number of orthopaedic trauma surgeons trained to manage pelvic fractures, and priority treatment sequence for hemodynamically unstable pelvic fractures. The study objective was to compare the availability of orthopaedic surgeons to interventional radiologists and describe how the availability of orthopaedic surgeons and interventional radiologists affects the treatment sequence for hemodynamically unstable pelvic fractures. Fisher’s exact, chi-squared, and Kruskal-Wallis tests were used, alpha = 0.05.ResultsThe response rate was 25% (40/158). Orthopaedic surgeons (86%) were on-site more often than interventional radiologists (54%), p = 0.003. Orthopaedic surgeons were faster to arrive 39% of the time, and interventional radiologists were faster to arrive 6% of the time. There was a higher proportion of participants who prioritized PP before angioembolization at centers with above the average number (> 3) of orthopaedic trauma surgeons trained to manage pelvic fractures, as among centers with equal to or below average, p = 0.02. Arrival times for orthopaedic surgeons did not significantly predict prioritization of angioembolization or PP.ConclusionsOur results provide evidence that orthopaedic surgeons typically are more available than interventional radiologists but contrary to anecdotal evidence most participants used angioembolization first. Familiarity with the availability of orthopaedic surgeons and interventional radiologists may contribute to individual trauma center’s treatment sequence.

The Parkinson's Disease Activities of Daily Living, Interference, and Dependence Instrument.

Individuals with Parkinson's disease often experience periods of off time when their motor symptoms are poorly controlled, significantly impacting their lives. To identify the consequences of motor fluctuations on day-to-day activities and areas of unmet treatment priority among individuals with moderate to advanced Parkinson's disease, to assess whether existing patient-reported outcome instruments adequately capture these consequences and priorities, and based on these evaluations, to adapt an existing or develop a new instrument. The research was conducted in 2 stages: concept exploration and content confirmation. Concept exploration included direct input from individuals with Parkinson's disease representing the intended context of use via concept elicitation interviews. Content confirmation and item refinement was achieved through 5 rounds of cognitive debriefing. Final rounds of cognitive debriefing also included usability testing of the draft instrument for electronic data capture. Concept elicitation interviews were conducted among 29 individuals with Parkinson's disease (55% male; mean age 60.8 years). Concept saturation was achieved quickly with more than 90% of concepts identified by the end of the 16th interview. None of the existing outcome instruments were found to be fit for purpose in the intended context of use; therefore, a new instrument was developed. After 5 rounds, cognitive debriefing participants indicated clear and consistent interpretation of the items. Evidence from this study supports the content validity of the Parkinson's Disease Activities of Daily Living, Interference and Dependence Instrument as the basis of a clinical trial endpoint for capturing priority treatment benefit outcomes to individuals with moderate to advanced Parkinson's disease experiencing motor fluctuations.

Low Appetite Child and Nutrition Therapy Approaches

Lack of appetite and nutritional difficulties such as food selection and food phobia are common health problems in childhood, especially in infants and young children. Under each nutritional behavior, there can be important physiological causes as well as psychological reasons.The primary aim of treatment is to determine the underlying causes of loss of appetite and other nutritional problems. In the presence of an underlying organic cause, priority treatment should be elimination of this cause. One of the other important approaches is the identification of nutritional problems. This situation is important for the effectiveness of treatment approaches. Nutritional principles appropriate for the age of the child or baby may support the effective treatment of nutritional problems in practice. Determination of the nutritional strength of the patient and the planning of treatment methods for it are important for the effectiveness of the treatment.

Solidarity and Responsibility in Health Care.

Some healthcare systems are said to be grounded in solidarity because healthcare is funded as a form of mutual support. This article argues that health care systems that are grounded in solidarity have the right to penalise some users who are responsible for their poor health. This derives from the fact that solidary systems involve both rights and obligations and, in some cases, those who avoidably incur health burdens violate obligations of solidarity. Penalties warranted include direct patient contribution to costs, and lower priority treatment, but not typically full exclusion from the healthcare system. We also note two important restrictions on this argument. First, failures of solidary obligations can only be assumed under conditions that are conducive to sufficiently autonomous choice, which occur when patients are given ‘Golden Opportunities’ to improve their health. Second, because poor health does not occur in a social vacuum, an insistence on solidarity as part of healthcare is legitimate only if all members of society are held to similar standards of solidarity. We cannot insist upon, and penalise failures of, solidarity only for those who are unwell, and who cannot afford to evade the terms of public health.

Variability in the timeliness of interventional radiology availability for angioembolization of hemodynamically unstable pelvic fractures: a prospective survey among U.S. level I trauma centers

BackgroundPatients with hemodynamically unstable pelvic fractures have high mortality due to delayed hemorrhage control. We hypothesized that the availability of interventional radiology (IR) for angioembolization may vary in spite of the mandated coverage at US Level I trauma centers, and that the priority treatment sequence would depend on IR availability.MethodsThis survey was designed to investigate IR availability and pelvic fracture management practices. Six email invitations were sent to 158 trauma medical directors at Level I trauma centers. Participants were allowed to skip questions and irrelevant questions were skipped; therefore, not all questions were answered by all participants. The primary outcome was the priority treatment sequence for hemodynamically unstable pelvic fractures. Predictor variables were arrival times for IR when working off-site and intervention preparation times. Kruskal-Wallis and ordinal logistic regression were used; alpha = 0.05.ResultsForty of the 158 trauma medical directors responded to the survey (response rate: 25.3%). Roughly half of participants had 24-h on-site IR coverage, 24% (4/17) of participants reported an arrival time ≥ 31 min when IR was on-call. 46% (17/37) of participants reported an IR procedure setup time of 31–120 min. Arrival time when IR was working off-site, and intervention preparation time did not significantly affect the sequence priority of angioembolization for hemodynamically unstable pelvic fractures.ConclusionsTrauma medical directors should review literature and guidelines on time to angioembolization, their arrival times for IR, and their procedural setup times for angioembolization to ensure utilization of angioembolization in an optimal sequence for patient survival.

코퍼스를 활용한 호텔영어의 키워드 연구

This study extracted and examined the key words of Hotel English Corpus. The Hotel English Corpus used in this study consists of 719,578 words and five genres such as hotel homepages, academic journals, newspapers, books and spoken English textbooks. WordSmith tools 6.0 was used to extract the positive and negative key words in 5 genres and compare the lexical characteristics. The keywords were classified into two main categories; the positive keywords and the negative keywords. The positive keywords generated from the Hotel English Corpus show the characteristics of Hotel English and should be given priority treatment. The study confirms that the keyword lists which are different according to the each genre are essential and helpful and also play a significant role in hotel English education and research. This study suggests that there are different keywords which are frequently used in each genre and the hotel English learners including hotel employees, hotel guests and researchers should study these words to understand and use better hotel English.

Assessing future water–sediment interaction and critical area prioritization at sub-watershed level for sustainable management

Changes in the response of water and sediment have brought imbalances in present land resources as well as future management practices. Such critical areas need to be identified and prioritized for conservation and protection interventions. The Betwa River basin, located in the central part of India, has natural resources problems due to hydrologic changes. Thus, the present study has been focused on water–sediment interaction and prioritization of critical areas identified from a simulation using the Soil and Water Assessment Tool (SWAT). A downscaled and bias-corrected CMIP5 global climate model dataset has been used to simulate the water and sediment yields of the river basin. The analysis period was grouped into a 20-year period starting with a baseline of 1986 (from 1986 to 2005) and four future horizons, i.e. horizon 2020 (2020–2039), horizon 2040 (2040–2059), horizon 2060 (2060–2079) and horizon 2080 (2080–2099). Based on the sediment yield obtained from the SWAT simulation, identification of an empirical relationship and prioritization of critical areas were carried out. Results show that the relationship between annual water and sediment yields has a good correlation (R2 = 0.75) for horizon 2020; however, a low correlation (R2 = 0.63) was observed for horizon 2060. The analysis reveals that the water–sediment interaction will be affected due to changes of monsoon precipitation in future. Based on priority treatment, the critical sub-watersheds were identified and prioritized for the baseline as well as future climate horizons. Analysis shows that the sediment yield of sub-watersheds SW-5, SW-6, SW-11, SW-17, SW-18, SW-34 and SW-45 has increased with changing climate conditions. Further, these sub-watersheds would undergo changes in erosion class from moderate to very severe. Thus, the identified critical sub-watersheds for the baseline as well as for future climate conditions need to be considered for prioritization and management. The present approach can be used for sub-watershed-level sustainable planning and management.

Improving the awareness and care of veterans in healthcare services.

This article aims to raise awareness of veterans (people who have served in the UK military) who are receiving nursing care. Nurses will often provide care and treatment for veterans, so they should be aware of the potential health needs of this patient group to provide optimum care. Veterans should receive priority treatment where it relates to a condition that results from their service in the armed forces. Therefore, it is important for healthcare professionals to recognise if patients may be veterans and if their conditions are attributable to military service. Increased awareness of veterans is required in primary care services, as well as in healthcare professionals' education and training, to ensure that they gain access to appropriate care and support.

State Policies Targeting Alcohol Use during Pregnancy and Alcohol Use among Pregnant Women 1985-2016: Evidence from the Behavioral Risk Factor Surveillance System.

Most states have at least one policy targeting alcohol use during pregnancy. The public health impact of these policies has not been examined. We sought to examine the relationship between state-level policies targeting alcohol use during pregnancy and alcohol use among pregnant women. Data include state-level alcohol and pregnancy policy data and individual-level U.S. Behavioral Risk Factor Surveillance System data about pregnant women's alcohol use from 1985 to 2016 (N=57,194). Supportive policies include mandatory warning signs, priority substance abuse treatment, reporting requirements for data and treatment purposes, and prohibitions on criminal prosecution. Punitive policies include civil commitment, Child Protective Services reporting requirements, and child abuse/neglect. Analyses include logistic regression models that adjust for individual- and state-level controls, include fixed effects for state and year, account for clustering by state, and weight by probability of selection. Relative to having no policies, supportive policy environments were associated with more any drinking, but not binge or heavy drinking. Of individual supportive policies, only the following relationships were statistically significant: mandatory warning signs was associated with lower odds of binge drinking, and priority treatment for pregnant women and women with children was associated with higher odds of any drinking. Relative to no policies, punitive policy environments were also associated with more drinking, but not with binge or heavy drinking. Of individual punitive policies, only child abuse/neglect was associated with lower odds of binge and heavy drinking. Mixed policy environments were not associated with any alcohol outcome. Most policies targeting alcohol use during pregnancy do not seem to be associated with less alcohol consumption during pregnancy.

Retention Ponds Pollution Level Monitoring in Palembang City for Achieving a Sustainable Urban Environmental Health and Ecosystem Service

Retention pond (RP) is part of green open space in the city. One of its functions is to provide ecosystem service to urban lives, thus its health should be protected. Measuring its pollution level is an important step for designing action plans for its protection and restoration. This study showed, based on Palmer Pollution Index scoring, both retention ponds located in PSCC and beside Siti Khodijah hospital showed possible high organic pollution levels (scores are 17 and 18) respectively, these are signals for priority treatment actions. The other seven RPs are at a medium level (the scores are 11 to 13), and the last four showed low organic level (the scores are 0-3). A further observation found that the PSSC retention pond was constantly dominated by Planktotrhix agardhii., a cyanobacter under concerned due to its potential to release cyanotoxin. A preliminary study was done in this study showed it had an effect to Cyprinus carpio L., gill and pathologic effects in the gill’s lamella.

Sensitivity and specificity of trauma team activation protocol criteria in an Italian trauma center: A retrospective observational study

BackgroundThe trauma team (TT) model could reduce mortality, morbidity, and duration of hospital stay, costs, and complications. To avoid over- or undertriage for trauma team activation, robust criteria have to be chosen. ObjectiveThis study aimed to evaluate the sensitivity and specificity of a TT activation protocol for major trauma patients to predict the need for emergency treatment. MethodsA retrospective observational study was carried out in the Emergency Department (ED) of a major Italian trauma center. Patients with trauma or burns who accessed the ED in 2015 with a triage red or yellow priority treatment code were included, while pediatric patients were excluded. Sensitivity, specificity and positive predictive values were calculated for each TT activation criteria and the aggregated criteria. ResultsData from 240 patients were collected: 40.42% of patients had a congruent triage while 50% were overtriaged and 9.58% undertriaged. A correct triage led to a lower hospital stay (p < 0.01), while undertriage was not associated with patients’ death (p = 0.16). All criteria had a specificity higher than 95%, a total sensitivity of 80.83% and a total positive predictive value of 43.49%. ConclusionThis study highlighted that the TT activation criteria had high specificity and sensitivity, while the positive predictive value of the criteria was lower. Mechanisms of injury criteria were less specific and sensitive in detecting the TT activation correctly. As nurses play a pivotal role in the triage of traumatized patients and the TT, reduction of under- and overtriage is essential to improve the patients’ health outcome.

Variability in pelvic packing practices for hemodynamically unstable pelvic fractures at US level 1 trauma centers

BackgroundMortality from hemodynamically unstable pelvic fractures remains high. Guidelines offer varying care approaches including the use of pelvic packing (PP), which was recently adopted for potential control of bleeding for this condition. However, the implementation of PP is uncertain as the debate on the optimal resuscitation strategy, angioembolization or PP continues. The study was designed to assess current practices among level 1 trauma centers in the US in regard to PP treatment for hemodynamically unstable pelvic fractures.MethodsA cross-sectional survey was created to assess when to apply PP, application approach, and the respondent’s anecdotal perception on safety and effectiveness. Trauma Medical Directors at 158 US level 1 trauma centers were sent biweekly email invitations for 3 months. Participants were allowed to skip questions for any reason. The study hypothesis was that PP practices vary by US census bureau region, annual trauma admissions, and length of time in years since each trauma center received their respective level 1 trauma center designation.ResultsTwenty-five percent (40/158) of trauma medical directors participated and 75% (118/158) of the trauma medical directors did not participate. Of those who took the survey, 36/40 (90%) completed the survey and 4/40 (10%) partially completed the survey. Only 36 trauma medical directors responded on their perception of safety and effectiveness; 72% (26/36) of participants perceived PP as safe, whereas only a third (12/36) of participants perceived PP as effective. There were 25 trauma medical directors who provided the sequence of treatment modalities utilized at their level 1 trauma center, 76% (19/25) of participants reported that PP is utilized as the third or fourth priority. None of the participating level 1 trauma centers reported a preference towards utilization of PP as the first priority treatment. Half of the participants reported a preference towards applying PP only as a last resort to control hemorrhage. Northeastern and Western level 1 trauma centers were significantly more likely than Midwestern and Southern level 1 trauma centers to have reported application of PP to all hemodynamically unstable patients (p = 0.05). Midwestern, Southern, and Western level 1 trauma centers were significantly more likely to have perceived PP as safe than Northeastern level 1 trauma centers (p = 0.04). All low-volume and 38% high-volume level 1 trauma centers perceived PP to increase infection risks, (p = 0.03). We observed no association between the length of time each trauma center was designated a level 1 trauma center, and all participant responses.ConclusionControversy and varying anecdotal perception regarding safety and effectiveness of PP prevails among trauma medical directors at level 1 trauma centers in the US.

How much priority bonus should be given to registered organ donors? An experimental analysis

Giving registered organ donors priority on organ waiting list can substantially increase the number of donors and save lifes. Evidence for these effects comes from recent experiments that implemented such priority rules in abstract laboratory environments. In these experiments, participants who registered as organ donors were fully prioritized over those who did not. In the field, however, registering as a donor is only one factor affecting the recipient’s score. In this paper, we provide a comparative statics analysis of the priority treatment by varying the number of bonus periods that a registered person can skip on the waiting list. We find that behavior is monotonic: giving more priority to registered donors leads to higher registration rates. Our results also indicate that a medium sized bonus improves registration rates as much as absolute priority (used in the previous literature).

Treatment of uterine artery pseudoaneurysm by embolization or hysteroscopy combined with laparoscopy: two case reports

Uterine artery pseudoaneurysm (UAP) is a rare but potentially life-threatening condition when it ruptures. The primary therapeutic method is embolization, which is approved by most specialists. The authors researched two case reports of UAP. By conducting Doppler ultrasonography and arteriography, two women were diagnosed with UAP after caesarean section, and then arterial embolization was performed for treatment. After embolization, the treatment was successful in one patient but failed in the other one with repeated vaginal bleeding. Therefore, laparoscopy combined with hysteroscopy was performed to the other patient, in which uterine myometrial lesions were located under hysteroscopy and resected by laparoscopy. Finally, the uterine wall defect was reconstructed by suture, and the abnormal vaginal bleeding was successfully stopped after operation. Patients with unexplained abnormal vaginal bleeding, especially after trauma in uterus, should be cared for in case of developing UAP. Embolization is the priority treatment for UAP, while laparoscopy combined with hysteroscopy could be an alternative treatment of unsuccessful embolization.

Differential Effects of Pregnancy-Specific Alcohol Policies on Drinking Among Pregnant Women by Race/Ethnicity.

Purpose: Alcohol use during pregnancy is a significant public health concern. Nearly all U.S. states have enacted policies targeting alcohol use during pregnancy, but there has been little research examining their impact, particularly across racial/ethnic groups.Methods: Using data from the Behavioral Risk Factor Surveillance System and about eight state-level, pregnancy-specific alcohol policies from 1985 to 2016, the aim of this study was to examine the differential effects of these policies on drinking among pregnant women by race/ethnicity.Results: We found evidence of differential effects for priority treatment, prohibitions on criminal prosecution, and civil commitment policies. In relation to priority treatment policies, effects benefited versus harmed different racial/ethnic groups depending on whether the priority treatment policies were for pregnant women only or if they gave priority to both pregnant women and pregnant women with children.Conclusions: Findings from this study suggest that benefits and harms from these policies do not appear to be equitably distributed across different racial/ethnic groups. Research considering the impact of alcohol/pregnancy policies should consider differential effects by race/ethnicity.

Which Body Position Is the Best for Chest Wall Motion in Healthy Adults? A Meta-Analysis.

Chest wall motion is a vital component of the respiratory system. Body position changes disturb joint orientation around the chest wall and results in performance modifications of respiratory muscles and movement surrounding the rib cage and the abdomen. Body position is a priority treatment for preserving and promoting chest wall motion. The objective of the study was to conduct a meta-analysis to provide insight into which body position most effectively improves chest wall motion. Medical literature databases were systemically searched up to January 31, 2018. Methodological quality was evaluated by using a checklist for measuring quality. A meta-analysis was performed to evaluate the effects of body positions on chest wall motion. The quality of evidence was judged by using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. Six studies (5 high- and 1 low-quality) were identified. Our results showed that the sitting position provided greater improvement in chest-wall diameter changes and volume related to rib-cage function versus other body positions (very low to moderate evidence). The supine position demonstrated greater enhancement of chest-wall-diameter changes and volume in the part of the abdomen than the other body positions with very low to moderate evidence. The results of this review indicated that the sitting position improved the rib-cage compartment of the chest wall, whereas the supine position resulted in the superior enhancement in the part of the abdomen relative to other body positions. These changes in the body position could have some effect on the movements of the rib cage and abdomen and the variations in lung volumes, which need to be interpreted with caution when considering implementation in the clinical setting.

Effect of age on waiting time of emergency patients: a retrospective analysis of 219 299 patients in consecutive 2 years

To evaluate whether patients aged over 70 years old is an independent predictor for prolonging the waiting time, and to know whether the population can be prioritized in the emergency grading system. A retrospective analysis was conducted. All the clinical data of adult visitors to the emergency department of the Third Affiliated Hospital of Sun Yat-sen University from January 1st in 2016 to December 31st in 2017 were collected. All the patients received four emergency first aid triages and treated according to the emergency classification results. The relevant data of selected patients were retrieved from the hospital information system (HIS) including gender, age, triage level, triage department, outpatient service and initial diagnosis time. According to the conclusion of pre-phase analysis that the patients over 65 years old was not associated with waiting time, all subjects were divided into ≥ 70 years old group and < 70 years old group for further analysis. The waiting time was defined as the difference in registration time and the initial diagnosis time, and the patients were divided into two groups according to whether it exceeded the target waiting time (TWT). TWT was considered as follows according to each emergency triage level: level I instantly, level II 10 minutes, level III 30 minutes, level IV 60 minutes (subacute patients) or 2-4 hours (non-urgent patients). The multivariable Logistic regression analysis was conducted to determine whether the factor that aged over 70 years old was an independent predictor for prolonging waiting time over TWT. There were 272 989 adult visits recorded totally, of which obstetrics and gynecology department visits, incomplete personnel information, invalid diagnosis (or no diagnosis), triage level I, abnormal waiting time (the waiting time exceeded 99% of the average waiting time of all samples) records were excluded. Finally, 219 299 emergency patients were enrolled, with 102 218 male and 117 081 female, which showed an average age of (35.86±15.81) years, 208 082 patients (94.9%) in < 70 years old group, and 11 217 (5.1%) in ≥ 70 years old group. Totally 191 588 patients (87.4%) were diagnosed within the TWT, and the number was 86.5% (9 701/11 217) in the ≥ 70 years old group. Multivariate Logistic regression analysis indicated that age under 70 years old was independently associated with an exceeded TWT [adjusted odds ratio (OR) = 1.106, 95% confidence interval (95%CI) = 1.041-1.176, P = 0.001]. Meanwhile, visits during the peak period or low triage level was also a risk factor of exceeded TWT. According to the Logistic regression analysis of different departments and removing other factors, in the emergency internal medicine with the most elderly patients, the probability of exceeded TWT in ≥ 70 years old group was lessened (adjusted OR = 1.203, 95%CI = 1.121-1.291, P < 0.001). In the emergency pre-grading system, the elderly aged (≥ 70 years old) was more likely to see a doctor in TWT than those under 70 years old, so they were easy to get priority treatment.

Обгрунтування робочої міри ефективності електротехнологічної водоочистки

The purpose of research – substantiation of the operational efficiency of sewage treatment systems and methods of its use in production. Materials and methods of research. This is primarily due to the significant interdependence of quality indicators of runoff and constant stochastic changes in the parameters of production technology; with the measurement taking from several tens of minutes to several hours, even days (oxygen bio-consumption, Coli-index). In the case of volumes of hazardous industrial discharges from 500 m 3 /day to 10 000 m 3 /day, inefficiencies and long-term measurements, in terms of environmental safety, are unacceptable - especially in the context of the potential impact of unusual situations (US) on production and, accordingly, volley increases in the values of pollutants and / or wastewater costs. The situation is complicated by the lack of or low accuracy and speed of modern means of automatic measurement of water composition (there are temperature, pressure, turbidity, flow rates, pH, oxidation, chlorine content, ionic composition). That is, in reality, it is not possible to operate a water treatment system in real time based on modern measuring instruments, as there will be one of the negative scenarios: 1. Insufficient water purification and pollution of the environment; 2. Inappropriate use (over-utilization) of resources (electricity, reagents, etc.). In such the layout, the working measure efficiency electrotechnological water cleaning makes it possible to set up industrial water treatment systems that use the following basic methods: - biological: through the calculation of supply by the compressor of oxygen and known parameters of its oxidizing action on organic pollutants; - physical: evaluating the filtration through the sorption filter; - chemical: by establishing the degree of oxidation in oxidants and the efficiency of coagulation in the reactor vessel; - physico-chemical: assessing the work of the electrolyzer-pH correction and oxidizing agents. Accordingly, the working measure efficiency electrotechnological water cleaning can be used to correct the dependencies of the normative documents, implementing the object-oriented concept of designing water treatment systems on the basis of, for example, methods of dominant dynamic pollutant (DDP) and cross-pollutant impacts (CPI). Recalculation from energy consumption indicators is performed in accordance with the dependencies SNiP 2.04.03-85 "Design of sewage treatment facilities" and other basic studies. In the proposed scheme, the working measure efficiency electrotechnological water cleaning performs the tasks: - priority treatment of wastewater (part of the treated water no more than 1% of the total volume) with the choice of effective regimes for the operation of the main treatment facilities; - constant correction (adaptation) of the modes of the main treatment plants by comparing the quality of the effluents upon their exit with the quality of the waste after passing (processing) the working measure efficiency electrotechnological water cleaning. Conclusions 1. Based on modern instrumental means it is practically impossible in real time to operate a water treatment system based on modern means of measuring techniques, as there will be either poor water purification and pollution of the environment or inappropriate use of resources (electricity, reagents, etc.). 2. The grounded and created the working measure efficiency electrotechnological water cleaning allows to provide designing and real-time use of combined wastewater treatment systems of multipurpose objects. Key words : electrotechnological complex, ecological safety, measurement, working conditions, unpredictability, water purification

Pharmacodynamics of atabecestat (JNJ-54861911), an oral BACE1 inhibitor in patients with early Alzheimer\u2019s disease: randomized, double-blind, placebo-controlled study

Backgroundβ-Secretase enzyme (BACE) inhibition has been proposed as a priority treatment mechanism for Alzheimer’s disease (AD), but treatment initiation may need to be very early. We present proof of mechanism of atabecestat (also known as JNJ-54861911), an oral BACE inhibitor for the treatment of AD, in Caucasian and Japanese populations with early AD who do not show signs of dementia.MethodsIn two similarly designed phase I studies, a sample of amyloid-positive elderly patients comprising 45 Caucasian patients with early AD diagnosed as preclinical AD (n = 15, Clinical Dementia Rating [CDR] = 0) or with mild cognitive impairment due to AD (n = 30, CDR = 0.5) and 18 Japanese patients diagnosed as preclinical AD (CDR-J = 0) were randomized 1:1:1 to atabecestat 10 or 50 mg or placebo (n = 6–8/treatment) daily for 4 weeks. Safety, pharmacokinetics (PK), and pharmacodynamics (PD) (i.e., reduction of cerebrospinal fluid [CSF] amyloid beta 1–40 [Aβ1–40] levels [primary endpoint] and effect on other AD biomarkers) of atabecestat were evaluated.ResultsIn both populations, atabecestat was well tolerated and characterized by linear PK and high central nervous system penetrance of unbound drug. Atabecestat significantly reduced CSF Aβ1–40 levels from baseline at day 28 in both the 10-mg (67–68%) and 50-mg (87–90%) dose groups compared with placebo. For Caucasians with early AD, the least squares mean differences (95% CI) were − 69.37 (− 72.25; − 61.50) and − 92.74 (− 100.08; − 85.39), and for Japanese with preclinical AD, they were − 62.48 (− 78.32; − 46.64) and − 80.81 (− 96.13; − 65.49), respectively. PK/PD model simulations confirmed that once-daily 10 mg and 50 mg atabecestat can attain 60–70% and 90% Aβ1–40 reductions, respectively. The trend of the reduction was similar across the Aβ1–37, Aβ1–38, and Aβ1–42 fragments in both atabecestat dose groups, consistent with Aβ1–40. CSF amyloid precursor protein fragment (sAPPβ) levels declined from baseline, regardless of patient population, whereas CSF sAPPα levels increased compared with placebo. There were no relevant changes in either CSF total tau or phosphorylated tau 181P over a 4-week treatment period.ConclusionsJNJ-54861911 at 10 and 50 mg daily doses after 4 weeks resulted in mean CSF Aβ1–40 reductions of 67% and up to 90% in both Caucasian and Japanese patients with early stage AD, confirming results in healthy elderly adults.Trial registrationALZ1005: ClinicalTrials.gov, NCT01978548. Registered on 7 November 2013.ALZ1008: ClinicalTrials.gov, NCT02360657. Registered on 10 February 2015.