ECONOMIC AND LEGAL FORECAST ANALYSIS OF THE HEALTHCARE FINANCING SOURCES MATURITY IN UKRAINE.

The purpose of this article is to analyze the current situation of the development of the financial support sources in healthcare. In theoretical part we used generalized scientific methods of research such as analysis and synthesis to determine all the financial support sources in healthcare. In practical part we used the bulk of raw and processed statistical data and forecasting engine from Excel 2019 to understand the development trends of the healthcare financing sources and to define the level of their maturity based on their development lines. Public expenses on healthcare cant cover all expenses of healthcare institutions, low level of insurance medicine in Ukraine, high corruption risks in healthcare sector and others. So, healthcare institutions have to search for additional funding. In our article, we analyzed both parts of the financial source maturity problem - theoretical and practical. In theoretical part we defined the term financial source maturity, underlined its levels and described the lines of indicators for each level. In practical part we proposed the mechanism of financing source maturity testing and tested the level of maturity of all available healthcare financing sources. As potential result, we tested that it is possible to use a forecasting engine based on AAA version of exponential smoothing that is provided by Excel 2016, 365 and 2019 versions for this research. Other versions contains the AAA version of exponential smoothing that doesn't have needed instructions and indicators.

Energy conversion efficiency in betavoltaic cells based on the diamond Schottky diode with a thin drift layer.

The HPHT diamond Schottky diode was assembled as a Metal/Intrinsic/p-doped structure betavoltaic cell (BC) with a very thin (1 µm) drift layer and tested under 5-30 keV electron beam irradiation using a scanning electron microscope (SEM). The effect of the ß-radiation energy and the backscattering of electrons on the energy conversion was studied. From the results obtained, it is shown that, the efficiency of the investigated BC increases from 1.01 to 3.75% with the decrease of ß-particle energy from 30 to 5 keV due to an increase of the electron beam absorption in a thin drift layer. Maximum efficiency is achieved when the electron beam energy is close to the average ß-decay energy of 3H. The BC maximum output power of the 1.6 µW was obtained at an electron beam energy of 15 keV, that matches the ß-decay energy of 63Ni. The total BC conversion efficiency at 15 keV electron-beam energy is about 3%. The calculations indicated that a preferable ß-source for the diamond based BCs with a thin (1 µm) drift layer is 63Ni.

BIOACTIVE GLASS-CERAMIC COMPOSITION IN SURGICAL MANAGEMENT OF PERIODONTAL INTRABONY DEFECTS.

It has been earlier proposed a novel graft on basis of bioactive glass-ceramics for infected bony defects, where silver and copper ions are represented as antibacterial agents. The objective was to investigate clinical and radiological efficacy of the bioactive glass-ceramic composition (BGCC) as bone substitute material for periodontal intrabony defects surgery. In a group of 47 patients with periodontitis was conducted controlled clinical study of the proposed composition. As a control in 24 patients it has been used deproteinized bovine bone mineral (DBBM) with collagen membrane. Such parameters as pocket probing depth (PPD), clinical attachment level (CAL), gingival recession, the early wound-healing index (EHI), hygienic and gingival indices, radiological bone density were used for evaluation surgical outcomes. Guided tissue regeneration was carried out in 56 intrabony defects. A year after surgery it has been determined almost the same significant (p<0.05) decrease PPD to 53.5% in the BGCC group and to 45.7% in the DBBM group, CAL gain to 30.4% in the BGCC group and to 28.0% in the DBBM group. Intrabony defects were bone filled to 27.5% and to 30.1% respectively with no significant differences for comparison groups. However, it was noted the advantage of significant increasing bone density in treated sites with BGCC (p<0.05). It also has shown a tendency to decrease discomfort for patients and to improve wound healing in postsurgical period according to the EHI in the same group. The using of BGCC with collagen membrane leads to significant reduction in probing depth, clinical attachment level gain, raises bone density profile. However, further long-term clinical studies with histological evaluation are necessary.

[PRACTICAL COURSE AS REQUIRED EMERGENCY CARE AS AN OBLIGATORY BASIS OF PROFESSIONAL COMPETENCE OF SURGICAL SPECIALTIES DOCTORS].

The results of the study to determine the general level of knowledge and practical skills to provide emergency medical care by interns surgical specialties were presented. Provides information on the practical rate of emergency care, developed for medical interns in the Bogomolets National Medical University. The expediency of the introduction of a practical course for emergency care for interns surgical specialties. Covering the structural features of general professional competence of a doctor surgical specialty were illustrated. These results of resurvey respondents after the successful development of a practical course of emergency were presented.

Atomically resolved STM imaging with a diamond tip: simulation and experiment.

The spatial resolution of a scanning tunneling microscope (STM) can be enhanced using light element-terminated probes with spatially localized electron orbitals at the apex atom. Conductive diamond probes can provide carbon atomic orbitals suitable for STM imaging with sub-Ångström lateral resolution and high apex stability crucial for the small tunneling gaps necessary for high-resolution experiments. Here we demonstrate that high spatial resolution can be achieved in STM experiments with single-crystal diamond tips, which are generally only considered for use as probes for atomic force microscopy. The results of STM experiments with a heavily boron-doped, diamond probe on a graphite surface; density functional theory calculations of the tip and surface electronic structure; and first-principles tunneling current calculations demonstrate that the highest spatial resolution can be achieved with diamond tips at tip-sample distances of 3-5 Å when frontier p-orbitals of the tip provide their maximum contribution to the tunneling current. At the same time, atomic resolution is feasible even at extremely small gaps with very high noise in the tunneling current.

[Ocular signs in anterior and posterior cervical sympathetic syndrome].

Features of anatomy and morphological changes of cervical spine resulting in sympathetic innervation defects, blood supply deficiency and ocular symptoms are reviewed. Results of experimental and clinical studies showing correlation of sympathetic cervical ganglions irritation and ocular pathologic conditions are presented. Ocular involvement in neurologic changes in anterior and posterior cervical sympathetic syndrome are reviewed.

[T(-786) --> C-polymorphism of the endothelial nitric oxide synthase promoter gene (eNOS) and exercise performance in sport].

Given the significant impact of the T(-786) --> C-polymorphism of the eNOS gene in the process of adaptation to physical stress, we aimed to investigate the effect of this polymorphism on physical performance in sportsmen and establish the possibility of its use as a marker of predisposition to the sport. DNA of 516 people, of which 195 qualified athletes and 321 people who had no experience of regular exercise was investigated. The frequency of genotypes and alleles of the T(-786) --> C-polymorphism of the eNOS gene in groups of athletes of different sports, the distribution of genotypes and alleles among athletes and those who are not involved in sports were studied. T allele frequency in a group of athletes on 6.4% (r(chi)2 = 0.03) than in control group. The association of the T allele of the T(-786) --> C-polymorphism of the eNOS gene with a predisposition for speed and power was established. In the group of athletes in speed and power sports, the T-allele frequency was higher than that in the control group by 12% (r(chi)2 = 0.002) and than in group endurance sports by 10% (r(chi)2 = 0.004). We found that the T(-786) --> C-polymorphism of the eNOS gene influence the power and efficiency ofthe functioning of the cardiorespiratory system of athletes during exercise.

[The changes of physiological reactivity of cardiorespiratory system to respiratory homeostasis with the use of complex stimulation of special work capacity].

We present the influence of the program of special additional stimulation of work capacity of high-performance athletes on the sensitivity of cardiorespiratory system to hypercapnic and hypoxic shifts in respiratory homeostasis. We found that under the influence of the pre-start complex a decrease in the sensitivity of ventilator responses to CO2-H+ stimuli in combination with a reduction in the thresholds of the reaction take place. This creates conditions for increased mobilization properties of the cardiorespiratory system and economization of its reaction under conditions of changes of respiratory homeostasis characteristic of intense training and competitive loads in the sport.

Results from a Ukrainian-US collaborative study: prevalence and predictors of respiratory symptoms among Ukrainian coal miners.

BACKGROUND: Underground coal mining is an expanding industry in Ukraine, yet little is known about the burden of respiratory disease among Ukrainian miners. METHODS: A Fogarty International Center-supported collaboration between researchers at the University of Illinois and the Institute of Occupational Health in Kyiv, Ukraine formed to improve capacity for conducting and monitoring medical surveillance among Ukrainian coal miners. A cross-sectional survey among a random sample of working and former miners was conducted; demographic, work, and health information were collected using a standardized questionnaire. Weighted prevalence rates were calculated and predictors of respiratory symptoms explored. RESULTS: Improvements in infrastructure, including spirometry and chest radiography testing, transformed medical surveillance among these miners. Results from the health study included that the prevalence of respiratory symptoms was higher among former compared to current miners (shortness of breath 35.6% vs. 5.1%; chronic bronchitis 18.1% vs. 13.9%, respectively). A statistically significant exposure-response relationship was observed between years mining and respiratory symptoms in former miners and between years mining at the coal face and respiratory symptoms among current miners. Evidence of downward bias from the healthy worker survivor effect was observed. CONCLUSIONS: This successful international collaboration built a sustainable infrastructure for conducting workplace medical surveillance and research. The resulting study was the first in the western literature to report on respiratory symptoms in this population; likely underestimation of disease rates due to selection and measurement biases was demonstrated. Efforts should continue to build this collaboration and to characterize and reduce respiratory illness among Ukrainian coal miners.

[State of vasoregulative function of vascular endothelium and cardiohemodynamics in patients with chronic obstructive diseases of the lung (CODL) treated with losartan].

The authors studied the influence of lozartan -angiotensin II antagonist on the state of cardiohemodynamics and function of vessel endothelial cell in patients with CODL in the process of the treatment. 90 patients with stage II or III CODL in remission (average age is 50.46+/-5.1) have been observed. The average duration of the disease was 16.2+/-7.6 years. 30 patients received additionally lozartan -angiotensin II antagonist. Cardiohemodynamics has been assessed using Doppler ultrasonography. To assess the state of function of vessel endothelial cell the authors carried out reactive hyperemia test and calculated the level of nitrite nitrogen in blood plasma and erythrocytes. The duration of observation was 12 weeks. Losartan appeared to be effective in patients with CODL to correct compromised cardiohemodynamics. Losartan dicreases the disfunction of endothelial cell and has cardioprotective properties.

[Types of physiological reactivity of the respiratory system and the features of physical work capacity in athletes].

On the basis researches of character responses of respiratory system (RS) on hypercapnic and physical load at 54 skilled athletes (the runners on 100, 800 and 5000 m) are analyzed of the features in physiological reactivity of system on shifts respiratory homeostasis, reflecting a various orientation of long-term adaptation (sports of the training). The interrelation of sensitivity and stability of responses to hypercapnic (CO2-H+), and also limits and kinetic characteristics of responses RS of physical loads with manifestation of work capacity and mobilization features aerobic and anaerobic processes of during physical loads energy-supply was demonstrated. By means of tacsonomic analyses are allocated types of individual responses of organism of the skilled athletes on the basis of character RS responses to hypercapnic shifts in respiratory homeostasis. They in a high degree have been caused by sports specialization of athletes.

[Results of the microbiological, clinical and immunological examination of children with Reiter's disease].

Infectious agents were detected in 100% of examined children with Reiter's disease (RD). Chlamydia trachomatis were detected in 98% of cases. In children with RD lesions of joints and eyes often took acute forms with cases of sacroiliitis, early muscular atrophy and conjunctivitis. In 95% of the patients the prostatitis manifestations were detected. In children with RD a rised number of CD lymphocytes in combination with the fivefold rised IL-4 content, an essential increase in the activity of C2-C5 components of the complement and a multiple rised level of PSA were registered.

[Immunohistochemical study of the expression of receptors to steroid hormones in endometrial hyperplastic processes]. / Immunogistokhimicheskie issledovaniia ékspressii retseptorov k steroidnym gormonam pri giperplasticheskikh protsessakh v éndometrii.

We examined 39 women with normal endometrium and 139 women with glandular-cystic hyperplasia of the endometrium (without atypia). According to clinical manifestations of hyperplasia, the patients were divided into 3 groups: 74 (53%) had reestablishing menstrual function after total curettage (group 1); 42 patients (30%) with glandular-cystic hyperplasia after curettage and hormonal therapy with progesterone and synthetic progestins (duration 3 to 6 months) had no repeated pathology of the endometrium (group 2); endometrial hyperplasia recurred 2 and 3 times as showed biopsies during 2-5 years of observation in 23 (17%) women (group 3). Immunohistochemical tests of normal endometrium revealed correlations between stages of menstrual cycle and steroid hormone receptors in nuclei of glandular epithelium and stromal cells. Maximum sensitivity of glandular epithelium to estrogen and pronounced expression of estrogenic receptors were observed at middle and late stages of proliferation. High sensitivity of glandular epithelium to progesterone was registered at middle and late stages of proliferation and early stage of secretion. Two types of hormone receptor expression were observed. Type 1 typical for the endometrium of middle and late stage of proliferation was characterised by a high content of receptors to E2 and P in glandular epithelium and stromal cells. Type 2 was observed in patients with recurring glandular hyperplasia and was characterised by a mosaic picture up to complete absence of receptor expression in nuclei of some glands and stromal cells. The detected zones free of receptors to estrogens and progesterone evidence for local disturbance of a regulating role of signal pathways of sexual steroids and can serve a substrate for formation of tissue autonomy.

Parameters of cellular immunity in perimenopausal patients with glandular and adenomatous endometrial hyperplasia.

No appreciable disorders of cellular immunity were detected in patients with glandular cystic endometrial hyperplasia. Atypical endometrial hyperplasia was associated with quantitative changes in T lymphocytes and their subpopulations, decreased level of lymphocytes carrying activation antigens, and increased count of natural killers. These changes can be characterized as immunocompensation.

Mesoscopic relaxation in homoepitaxial metal growth.

We demonstrate that a size-dependent mesoscopic mismatch exists in homoepitaxy, which has a strong impact on the morphology of the islands and the substrate. Atomic scale calculations for double layer Cu islands on Cu(111) reveal that mesoscopic strain relaxations in both islands and the substrate strongly influence the shape of islands and can effect the details of atomic motion near the island.

[Morphometric characteristics (assessment of ploidy) of the degree of differentiation of uterine body adenocarcinoma]. / Morfometricheskaia (otsenka ploidnosti) kharakteristika stepeni differentsirovki adenokartsinom tela matki.

53 histological slides obtained from 4 patients aged 35-68 years with diagnosis of uterine carcinoma without invasion (16 patients) and tumor invasion into uterine muscular membrane (24 patients) were retrospectively analyzed. On the basis of morphometry and ploidometry of 2989 nuclei on the image analyzer Imager-CG (Russia) with a computer program Avtan-San, a complex of diagnostic criteria characterizing the grade of malignancy of uterine tumors was obtained. Differential diagnostic ploidometric characteristics of 4 degrees of tumor progression are described. With the process intensification the amount of genetic material in tumor cell nuclei increase 1.7-fold, proliferative activity 2.2-fold, number of polyploid cells--1.5-fold. These data specify the degree of differentiation of uterine body adenocarcinoma and help to plan treatment policy for patients with uterine carcinoma.

[Differences in maximal aerobic capacity for athletes conditioned by direction in the long-term adaptation process]. / Vidminnosti maksymal'nykh aerobnykh mozhlyvostei sportsmeniv, zumovleni spriamovanistiu protsesu dovhostrokovoï adaptatsiï.

On the basis of investigation of 54 elite male athletes aged 19-24, specializing in different running distances (100, 800 and 5000 m), the influence of specific character of long-term adaptation in the body of athletes on general level of aerobic power and conditions of maximum manifestation of cardiorespiratory system aerobic capacity was demonstrated. The determine maximum level of aerobic capacity in the athletes, motor tests that take into account the features of maximum aerobic capacity mobilization conditions due to specifics of sports specialization were selected.

[Reiter's disease in children]. / Bolezn' Reitera u detei.

Two cases of diagnostic mistakes of Reuter's disease in for children have been described. 7-year-old girl has been operated on for the suspicion on hematogenic osteomyelitis. The diagnosis was not confirmed. The symptoms of Reuter disease-right knee and hip joints synovitis-have appeared in postoperative period. A nonsignificant trauma in 9-year-old boy was the reason for the diagnosis of nontraumatic arthritis. Despite of Reuter's disease symptoms (arthritis, urethritis and conjunctivitis) the immobilization of extremities has been done. In 7 of 30 patients the Reuter's disease has not been diagnosed from the beginning.

[Nucleotide metabolism in the lymph nodes of rats with hypoxic hypoxia]. / Stan nukleotydnoho obminu v limfatychnykh vuzlakh shchuriv pry hipoksychnii hipoksiï.

Nucleotide metabolism (pools A, G, C, U, xanthine, uric acid) in lymph nodes of two groups of white rats (the 1st model, the 2nd model) has been studied under the influence of hypoxic hypoxia (HH) with further comparative estimation of the findings. The 1st model of HH corresponded to 12 thou. m (up to the death of animals at that "height"). The nucleotide metabolism status in lymph nodes is characterized by irreversible disturbances of the nucleotide component levels and correlations. Significant tension of the nucleotide metabolism causes decompensation of the substrate-enzymatic regulation of metabolism in the lymphoid tissue. The 2nd model of HH corresponded also to 12 thou. m (up to the survival of animals at that "height"). Reversible indices of nucleotide metabolism in lymph nodes of rats are marked (deviations of the majority of indices are not so deep as in the 1st model). The reversible character of changes in the nucleotide metabolism testifies to conservation of the substrate-enzymatic self-regulation in the lymphoid tissue.