No abstract

Сегодня процессу цифровой модернизации подвержены многие отрасли, в том числе и строительная, для которой особенно остро стоит задача внедрения инновационных цифровых технологий. Цифровое моделирование зданий и сооружений (далее BIM или BIM-технологии) является сейчас неотъемлемой частью и инструментом проектирования, управления и эксплуатации проектов строительства. Риск внедрения данной технологии можно охарактеризовать как инновационный, представляющий собой вероятность убытка в процессе внедрения инновационных технологии. Такие риски означают неопределенность эффективности результата внедрения системы управления проектами на основе BIM-технологий и влияют на стоимость, продолжительность и качество выполняемых работ. Для получения эффективного результата от внедрения BIM-технологий необходимо применять системный подход к их внедрению. Авторами предлагается рассмотреть и идентифицировать основные факторы риска, сопровождающие процесс внедрения данных технологий для формирования эффективной методики внедрения. Целью данной работы является выявление предпосылок для разработки системы управления рисками, возникающими при внедрении BIM-технологий в строительное проектирование и деятельность строительных и проектных организаций Удмуртской Республики. Методологической базой исследования является научная литература и данные экспертного опроса, проводимого в рамках исследования проблем, препятствующих внедрению BIM-технологий в деятельность проектных и строительных организаций Удмуртской Республики, статистические и опросные данные ведущих исследовательских организаций.

Clinical and neurological, neurophysiological, and neuropsychological examination of 50 patients aged 50–65 y. o. with an experience of COVID‑19 infection within the last 3 to 6 months, revealed pathological changes in the central nervous system in the form of cerebrastenic and autonomic disorders, motor disorders, vestibulopathy symptoms, which occurred in various combinations, with astheno-vegetative syndrome as obligate. Cognitive impairments were detected in 26% of patients; the mental fatigability index was 1.055 ± 0.124; a high level of situational anxiety was noted in 35% of patients, and a high level of personal anxiety in 50 % of patients with the experience of COVID‑19. The study of brain biopotentials revealed moderate diffuse changes (18%) and irritative disorders on the part of hypothalamic (69 %) and diencephalic structures (20%). All of the above may indicate that, regardless of the form of coronavirus infection occurred in humans, i. e., latent, mild, moderate or severe, one of the targets of the pathological impact of COVID‑19 virus is the median structures of the brain responsible for autonomic and cognitive functions. Nevertheless, in our opinion, these disorders are associated not with a direct pathological effect, but are mediated mainly by circulatory disorders in the microcirculatory bed due to endothelial damage and are rather functional disorders on the part of the central nervous system. This provides the grounds for the selection of pathogenetic therapy aimed at stabilizing the functional state of neurons, and one of the drugs of choice may be citicoline (Noocyl), the action of which is associated with reinforcing the cell membrane of the neuron and normalizing bioelectric processes.

The article covers the issues of organization of rehabilitation at the post-hospital stage for patients who have suffered an acute cerebrovascular accident. According to statistics, almost half of patients who have suffered an acute cerebrovascular accident have a risk of a repeated stroke in the next five years of life against the background of manifestations of post-stroke depression. It is established that in these cases, one of the causes of repeated cerebrovascular accidents is the failure of patients to take prescribed antidepressant medications. The article analyzes two groups of patients who were observed in dynamics up to 6–12 months after the rehabilitation treatment in the Department of Neurology of the hospital. The main group included the patients with diagnosed post-stroke depression. The control group included patients without signs of clinically apparent depression. As a result of a retrospective study, it was found that 85,7 % of patients in the main group who had a repeated stroke did not adhere to the regime for taking antidepressant medications. Among the patients who continue to take antidepressants, there have not been repeated cases of cerebral circulatory disorders. Therefore, timely detection and correction of post-stroke depression in the early stroke recovery period and maintaining the principle of continuity at the post-hospital stage of rehabilitation contributes not only to the recovery of neurological deficit, but also reduces the risk of developing repeated disorders of cerebral circulation.

The problem of preserving the quality of life in the postoperative period, one of the criteria of which is the cognitive function, retains its relevance. In patients with advanced and senile age, after undergoing surgery, cognitive disorders are swept aside, which, according to various authors, reaches 64 %. Postoperative cognitive dysfunction was studied in 168 elderly and elderly patients operated on for complications of colon cancer. Patients were divided into two groups. Patients of the control group were operated on operations conventionally, the main one — laparoscopically, using endovideosurgical technologies. Cognitive status was assessed before the operation, as well as on the first, third and seventh days of the postoperative period using the MMSE test (abbr. English Mini Mental State Examination). The incidence of postoperative cognitive dysfunction in both groups was traced. In the development of postoperative cognitive disorders, along with such factors as general anesthesia, age, aggravated neurological history, depressive disorders, operative trauma plays an important role. The use of endoscopic technologies allows reliably reducing the risk of postoperative cognitive impairment, which in turn has a beneficial effect on the postoperative period.