РАССМОТРЕНИЕ СВОЙСТВ ЛИЧНОСТИ В СТАРШИХ КЛАССАХ БОЛГАРСКОЙ ШКОЛЫ С ИНТЕНСИВНЫМ ОБУЧЕНИЕМ РКИ

The article discusses aspects of teaching Russian as a foreign language when working with texts of different genres and degrees of adaptation in the Bulgarian high school in the first year of Russian language teaching and demonstrates a variety of techniques and methods of working with a text. The author suggests a well-motivated staged introduction to literature in Russian for the purposes of language, literary and moral education. The proposed sequence involves not only the creation of specific semantic sets on the topic of "Character", the ability to use stable phrases, grammatical and syntactic constructions, but also the formation of certain psychological properties and traits, moral criteria. The suggested staged approach for working on the topic contributes to the development of speech and cognitive skills.

360-surgery for a giant cervical chordoma with involvement of the right vertebral artery

Background: Chordomas are malignant tumors that arise from the remnants of the notochord. Complete en bloc radical resection with postoperative radiation therapy is currently considered the gold standard. Here, we performed a 360-staged approach to manage a C3-C4 chordoma that involved the right vertebral artery. Case Description: A 40-year-old woman presented with a C3-C4 chordoma that invaded the right vertebral artery. She responded well to a circumferential approach including resection and stabilization. Conclusion: A 40-year-old woman with a C3-C4 spinal chordoma was optimally managed with a combined anterior/posterior surgical approach including decompression/fusion.

Evaluating the Clinical Utility of Staged Bronchoalveolar Lavage (BAL) Fluid Analysis in Adolescent and Adult Acute Leukemia and Lymphoma Patients with Febrile Neutropenia and Lung Infiltrates

Introduction: Lung infiltrates(LI) are seen in 30-45% of the patients with Febrile neutropenia(FN) in haematological malignancies.In FN patients with LI, accurate/probable microbiological diagnosis is possible in only 30 % with conventional blood culture and serological tests. BAL increases the microbiological diagnostic yield. The battery of microbiological tests done in BAL fluid analysis is not uniform.We evaluated a staged approach while analysing the BAL fluid sample, in the first stage we performed the routine cultures and antigen-based tests and in patients with negative results, we performed Polymerase Chain Reaction(PCR) tests guided by the radiological findings. Methods: This was a prospective observational study initiated after Institutional ethics committee approval and conducted at Tata memorial centre,Mumbai between November 2018 and June 2020.BAL testing was done as per a standard protocol(Sampsonas et al.) in hemodynamically stable patients with Spo2 more than 90% and platelet count above 300x10 9/L.Samples were sent for gram stain & bacterial cultures, ziehl neelsen stain and cultures, fungal stain and cultures and Galactomannan (ELISA) and an extra sample was preserved in an EDTA vacutainer at 10-20 degree C. If none of the initial reports were positive, then stored BAL sample was sent for PCR testing guided by the radiology and clinical picture i.e., with nodular infiltrates(Bacteria,Nocardia,Aspergillus,Mucor,P.Jiroveci,Mycobacterium TB,Atypical Mycobacterium TB) and with diffuse micronodular infiltrates Viruses,Legionella,mycoplasma PCR tests were sent. The causal association of the isolated organism was defined as per AGIHO guidelines(G. Maschmeyer et al.) The Primary objective is proportion of patients with a confirmed microbiological diagnosis using staged BAL analysis. The Secondary Objectives are proportion of patients who had a change in antimicrobial therapy,Feasibility of doing a Bronchoscopy and Proportion of Patients who develop Major or Minor complications during procedure and the 4 and 12weeks Clinical and Radiological Outcomes. A sample size of 130 patients was required for incidence of 50%(40-60%) positivity with 10% variation at 95% confidence interval. Results: A total of 172 patients were eligible of which 50 patients are not enrolled due to physician discretion in 37 patients,9 lost for followup and 2 refused consent and one patient expired and one palliated and 122 patients are enrolled and of these BAL couldn't be done in 20 patients due to hypoxia,low platelets,poor GCS at the time of performing BAL and finally BAL is feasible in 83.6%(n=102/122) patients. Baseline characteristics of patients are mentioned in Table 1.Median age of the patients was 30 (15-65) years with 69.6% males (n=85/122). A confirmed microbiological diagnosis (G. Maschmeyer et al.) was established in 71.3%( 81 /122 ) of cases.Microbiological results are depicted in Table2. A change of antimicrobial based on BAL (addition and removal of antimicrobial) was done for 78 patients(63.8%) of which 42 had removal of antibacterial and 11 patients had removal of antifungals. Among 42 patients who had removal of antibiotics, by the end of 4weeks, 36(85.7%) had clinical response and 34 had radiological response,(4 died and 2 lost for followup). By the end of 12weeks, 31 patients had sustained clinical and radiological response (2 died, 2 lost to follow-up and 1 progressive disease). Among 11 patients with removal of antifungals 9 had clinical and radiological response by the end of 4weeks (1 died and 1 non responder) which was sustained at week 12. Complications of BAL One patient had a major complication (persistent hypoxia), while minor complications were recorded in 27/122 (22%) (Hypoxia-16, hypertension-8,tachycardia-3) during procedure and in 21/122 (17%) (Fever-8, bleeds-6, tachycardia-5,hypertension-2)upto 24 hours post procedure. Clinical and Radiological responses as per criteria( Figure 1) Conclusion: BAL fluid analysis improves the diagnostic yield in febrile neutropenia with lung infiltrates. This leads to a change in antimicrobials in a significant number of patients. It contributes to improved outcomes in this patient population. The test is feasible in a large majority, is safe and the staged approach helps in optimisation of resources. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Use of the Washington Group Questions in Non-Government Programming

The Washington Group questions (WGQ) on functioning have been widely promoted as the go-to tool for disability data collection. Designed for use by government, the WGQ have been adopted by non-government organizations (NGOs) for use in programming. However, little is known about how the WGQs are being used by NGOs or how use may be contributing to disability inclusion. Method: This paper describes exploratory research on the use of the WGQ in NGO programming. An online survey provided an overview of adoption followed by semi-structured interviews from a purposive sample to explore data collection, analysis, and use. Results: Thematic analysis showed limited inclusion outcomes directly attributable to use of the WGQ, adoption driven by individual champions rather than systematically across organizations, and challenges in data collection resulting in a wide range of prevalence rates. What information the WGQ can realistically contribute to programs was also overestimated. However, the process of using the WGQ was raising awareness on disability inclusion within program teams and communities. Conclusion: Acknowledging differences in emerging use by NGOs beyond the WGQ’s intended purpose, alongside promoting a flexible and staged approach to adoption and use in programming, may improve utility and disability inclusion outcomes over time.

Integrated Analysis of Behavioral and Health Data: A Comparative Study of COVID19 Data in Israel and Italy

The response to the COVID19 pandemic has been highly variable, both in terms of between-nations variation and within the same nation, at different waves. In this context, governments applied different mitigation policy responses with varying impact on social and economic measures over time. This article examines the effect of mobility restriction measures in Italy and Israel and compares the association between health and population mobility data. Facing the pandemic, Israel and Italy implemented different policy measures and experienced different public activity patterns. The analysis we conducted is a staged approach using Bayesian Networks and Structural Equations Models to investigate these patterns. The goal is to assess the impact of pandemic management and mitigation policies on pandemic spread and population activity. We propose a methodology that first models data from health registries and Google mobility data and then shows how decision makers can conduct scenario analysis to help support pandemic management policies.

Digital Transformation of Transportation in the Age of COVID-19

Purpose: To highlight the key trends in the transportation industry and the role of emerging technologies and digital transformation in acceleration of value creation. The conceptual framework suggests how such transformation could be implemented. Design/methodology/approach: Research in a focus group was carried out where selected digital transformation frameworks were reviewed, and one was selected as the most applicable to the transportation industry. The selected framework was adopted for the transportation industry. Findings: 1. Value creation should be positioned as the key objective of transformation. 2. Digital transformation is not so much about technology as it is about people. 3. The staged approach towards transformation allows it to be paced with account being taken of the maturity of technology as well as the maturity of competencies across the organization. For a successful digital transformation, the organization invests in development of digital capabilities. Moving towards digital means a mindset shift, cultural change and adoption of new methods of working. Research limitations/implications: Transportation companies are at the early stage of transformation at such a scale. The case studies on successful transformations are limited. Therefore, experience is gathered mainly by the test and learn process. It is recommended that findings are validated with a wider group of experts when transformation matures. Comparing the same framework usage in other industries can also offer additional learnings to be considered by change leaders. Originality/value: Transportation industry is in a process of transformation towards connected, electric and autonomous solutions, accelerated during the COVID-19 pandemic. The presented framework, adopted for the transportation industry, offers a practical tool for executives and change leaders to lead the transformation.

Using an Endovascular Strategy in the Open Setting: The Challenges of Hybrid Repair Using Frozen Elephant Trunk in an Extensively Dilated Aorta Associated with Coarctation

With both stenosis and aneurysm, repairing a severely tortuous and coarcted aorta can present certain difficulties. The advent of hybrid arch frozen elephant trunk techniques, as well as other endovascular solutions, has produced safer surgical repair methods for such cases. We present the reconstruction and repair of a Type-1 thoracoabdominal aortic aneurysm using a staged approach in less-than-optimal anatomy. Interventions included hybrid frozen elephant trunk, balloon dilation, and thoracic endovascular repair.