Репозиторий Университета

© 2019 The Authors This article is essentially a dataset necessary for analysing the taxation. The data analysis has allowed to determine the optimal taxation model, when the criteria of economic efficiency and equity are incompatible. The dataset has allowed the use of the method of successive concessions in tax optimization. The practical significance of the dataset lies in the ability to simultaneously improve the efficiency and equity in taxation. The dataset was obtained by using the method of expert estimates. A group of experts was asked to rank the taxes established by the Tax Code of the Russian Federation, in descending order of importance. Only strict rankings were allowed. The consistency of expert opinion was evaluated using the Kendall coefficient of concordance. The data set was supplemented with the expert ranking data of the basic principles of taxation, such as the principle of equity; the principle of certainty and accuracy of taxes; the principle of ease of tax collection for taxpayers; the principle of efficiency; the principle of commitment. The dataset can be used in the future to determine a rational amount of taxation depending on the established criteria.

The prevalence of habitual miscarriage varies depending on territories of the Russian Federation and other countries. The rate of premature delivery in the Moscow Zelenograd administrative okrug in 2013-2015 in average made up to 4.5%-4.7%. The percentage of habitual miscarriage made up to 3.6% that is a rather low indicator as compared with other Moscow okrugs and national average indices. The article considers three-level model of evaluation of medical, economic and social efficiency of obstetric gynecologic care support of population at the out-patient stage.

© 2018 The Authors. Objective: This study was conducted to evaluate the use of genetic tests, before prescribing drugs to reduce not only the level of side effects but also the costs associated with changing therapy. In this paper, the authors analyze the economic efficiency of HLA*5701 prospective screening of hypersensitivity to abacavir (ABC) in the treatment of HIV-infected patients. Methods: A retrospective study was conducted among HIV-infected patients taking first-line antiretroviral therapy and further, based on the results obtained with the ABC-hypersensitivity reactions, analyzed the costs that affect on healthcare system. Results: In the study group of HIV-infected patients, most of the cases belonged to a young, socially active part of the population. Among the study population of patients (n=637), 171 patients were assigned ABC-containing antiretroviral therapy. An increase in costs was found in 67% of cases when ABC-containing first-line therapy was replaced due to the occurrence of undesirable reactions. Conclusion: The results show that, using this screening, we could reduce the costs associated with replacement therapy.

© 2018 Authors. This article presents the results of studies devoted to assessing the survival of students' knowledge, regardless of their basic training. The study was conducted based on two groups of specialists, recertified under the program "Pharmacy management and economics" at the Pharmacy Department of Sechenov First Moscow State Medical University. Some of the specialists of the experimental groups had been previously trained at the Pharmacy Department of Sechenov First Moscow State Medical University in 2012-2013 using a new devel-oped didactic tool named "Activity Book". According to the results obtained, the skills acquired by the specialists trained using on "Activity Book" in 2012-2013, were characterized by higher "survivability".

© 2018 Pirogov Russian National Research Medical University. All rights reserved. Perioperative antimicrobial prophylaxis (PAP) involves administration of antimicrobial agents (AMA) to patients undergoing a surgical intervention and aims to reduce the risk of postoperative infectious complications, especially at surgical sites. In the present work we assess efficiency and safety of AMA used for prevention of postoperative infectious complications. In the course of our study we pre-analyzed 576 medical histories of post-op patients aged 18 to 87 years (mean age M ± SD was 57.4 ± 14.5 years), of which 347 (60.2%) were male and 229 (39.8%) female. Only 481 histories were selected for final analysis. We assessed the choice of antibacterial therapy, the frequency of adverse reactions (AR) and infectious complications and the type of the latter. PAP regimens were consistent with the official guidelines in 207 (43.04%) cases. PAP recommendations were ignored in 274 cases (56.96%), and the timing was wrong in 364 cases (75.7%). Incorrect dosages were administered in 225 cases (46.8%). We also discovered an association between irrational PAP regimens and 1) the length of patient's stay in the intensive care unit (p = 0.003 and p < 0.005), 2) the frequency of reoperations associated with infection (p = 0.001), 3) mortality rates (p = 0.002), and 4) isolation of strains with multidrug resistance (p = 0.016). We conclude that PAP regimens for the inpatients of surgical wards are often compromised by failure to comply with the official guidelines, wrong timing and incorrect dosage, which negatively affects hospital statistics.

© 2018 Media Sphera Publishing Group. All rights reserved. Objective - to evaluate the possible epidemiological and economic efficiency of pneumococcal vaccination in men with different chronic diseases. Material and methods. A prognostic (Markov) model was constructed based on the data available in the literature. The estimated efficiency of pneumococcal vaccination in reducing mortality, preventable diseases, and economic damage over a 5-year period was evaluated in able-bodied men. According to official statistics, the group at high risk for pneumonia in the Russian Federation includes 21,575,887 able-bodied men. The sources of data on the cost of the disease were governmental tariffs in the compulsory health insurance system in 2016 and those of vaccination cost were the results of competitive bidding for the procurement of 13-valent pneumococcal conjugate vaccine (PCV13). Results. The results of extrapolation of data from Russian and foreign studies in patients with chronic respiratory diseases, circulatory diseases, or diabetes mellitus showed a significant reduction in the risk of complications due to the underlying disease (RR=0.58; p<0.05), the number of hospitalizations (RR=0.02; p<0.05), and expected postvaccination mortality. The cost of vaccination in the assessed patient group was 25,869.5 million rubles. The use of PCV13 significantly reduces the number of exacerbations and, accordingly, hospitalizations, which saves about 14,359.9 million rubles in each subsequent year after vaccination. Thus, the total budget savings can reach 2,850.3 million rubles just during 2 years. A single dose of PCV13 will save at least 61,702 lives over 5 years. Conclusion. The results of this investigation suggest that pneumococcal vaccination has high epidemiological and clinical efficiency in able-bodied men with chronic diseases. This intervention reduces morbidity rates, the number of exacerbations and hospitalizations, as well as deaths in the vaccinated group, and it is a cost-effective investment in public health service.

© 2018 Ima-Press Publishing House. Mental disorders (MDS) of the anxiety-depressive spectrum (ADS) and cognitive impairment (CI) substantially deteriorate the course and efficiency of therapy for rheumatoid arthritis (RA). There have been practically no studies on the impact of psychopharmacotherapy (PPT) for MDS on the efficacy of standard disease-modifying antirheumatic drugs (DMARDs) and biological agents (BAs). Objective: to investigate the impact of adequate PPT for MDS of ADS on the efficacy of DMARDs and BAs in patients with RA. Subjects and methods. The investigation included 128 patients (13% men and 87% women) with documented RA in accordance with the 1987 American College of Rheumatology (ACR) criteria. The patients' mean age was 47.4}0.9 years; the median duration of RA was 96 [48; 228] months. DAS28 averaged 5.34}0.17. 75.1% of the patients received DMARDs. The diagnosis of MDS was based on the ICD-10 codes, by applying a semi-structured interview and the Hospital Anxiety and Depression Scale. Changes in the pattern and severity of ADS were evaluated using the Hamilton Anxiety Scale and the Montgomery-Asberg Depression Rating Scale. Clinical and psychological procedures were used to diagnose CI. At baseline, ADS was detected in 123 (96.1%) patients: major depression in 41 (32.1%), minor depression in 53 (41.4%), and anxiety disorders in 29 (22.6%). CI was diagnosed in 88 (68.7%). PPT was offered to all the patients with MDS; 52 agreed to treatment and 71 refused. The following therapeutic groups were identified according to the performed therapy: 1) DMARDs (n = 39); 2) DMARDs + PPT (n = 43); 3) DMARDs + BAs (n = 32); 4) DMARDs + BAs + PPT (n = 9). The dynamics of MDS and the outcomes of RA were estimated in 112 (91.0%) and in 83 (67.5%) of the 123 patients at one-and five-year follow-ups, respectively. The efficiency of RA therapy was evaluated from the changes in DAS28 and SDAI. Results and discussion. One year later, the patients who had received the complete cycle of PPT and took DMARDs achieved a satisfactory effect twice more frequently (58.1 and 32.3%, respectively; relative risk (RR) = 0.53; 95% confidence interval (CI), 0.2-1.39; p = 0.024) and did not respond to therapy 3 times less often (21.0 and 58.1%, respectively; RR = 2.41; 95% CI, 0.87-6.71; p = 0.001) according to the EULAR criteria than those who had refused PPT. The patients with MDS who received DMARDs + PPT during one year were unresponsive to therapy significantly less frequently than those who received DMARDs and BAs without PPT (21 and 44.8%, respectively; RR = 0.6; 95% CI, 0.21-1.7; p = 0.029). After 5 years of follow-up, the probability of no response to RA therapy in MD patients who received only DMARDs was 3.6 times higher than in those who had PPT (66.7% and 10.4%, respectively; RR = 3.58; 95% CI 0.82-15.5; p < 0.001). The patients adequately treated with DMARDs and BAs for MDS according to the DAS28 showed 1.3-fold more frequently good and satisfactory results (100 and 76.2%, respectively; p = 0.14) than those who refused PPT, but these differences were not statistically significant because the DMARD+BA+PPT group was small. Five-year follow-up indicated that DAS28 remission was more common in the patients receiving DMARDs and PPT than in those who had DMARDs and no PPT (34.5 and 8.3%, respectively; RR = 1.79; 95% CI, 0.34-9.24; p = 0.024). DAS28 remission was somewhat more frequently observed among the patients receiving DMARDs, BAs, and PPT than among those taking DMARDs and BAs (33.3 19.0%, respectively; RR = 1.64; 95% CI, 0.28-9.57; p = 0.34), but these differences were insignificant. Remissions according to the 2011 ACR/EULAR criteria were achieved by only the patients having DMARDs and PPT (6.9% and 13.8% after 1 and 5 years, respectively). Conclusion. Adequate treatment of MDS in RA patients results in a significant increase in the efficiency of antirheumatic therapy.

© 2018 Ima-Press Publishing House. All right reserved. The response rate to therapy for rheumatoid arthritis (RA) rarely exceeds 60%. Mental disorders (MDs) of the anxiety-depressive spectrum (ADS) and cognitive impairment (CI) substantially affect the evaluation of the efficiency of RA therapy. Adequate psychopharmacotherapy is one of the possible approaches to optimizing the treatment of RA. The factors influencing the efficiency of RA therapy with standard disease-modifying antirheumatic drugs (DMARDs) and biological agents (BAs) in combination with adequate psychopharmacotherapy have not been previously identified. Objective: to determine the predictors of response to therapy in patients with RA receiving DMARDs and BAs with or without adequate psychopharmacotherapy for ADS disorders. Subjects and methods. The investigation included 128 patients (13% men and 87% women) with a reliable diagnosis of RA. At baseline, 75.1% of patients received DMARDs; 7.8% - BAs. ADS disorders were detected in 123 (96.1%) patients. Psychopharmacotherapy was offered to all the patients with MDs; 52 patients agreed to treatment and 71 refused. The following therapeutic groups were identified according to the performed therapy: 1) DMARDs (n = 39); 2) DMARDs + psychopharmacotherapy (n = 43); 3) DMARDs + BAs (n = 32); 4) DMARDs + BAs + psychopharmacotherapy (n = 9). The changes of MDs symptoms and the outcomes of RA were assessed in 83 (67.5%) patients at five-year follow-up. The efficiency of RA therapy was evaluated with DAS28 (EULAR criteria). Predictors of response to therapy were determined using linear regression modeling. Results and discussion. At 5 years, 22 (26.5%) and 37 (44.6%) patients were recorded to show good and moderate responses to therapy, respectively; 24 (28.9%) patients were non-respondents. The linear regression model included 14 factors (p<0.001). The high values of DAS28 (β=0.258) at the inclusion; belonging to therapeutic groups 2 (β=0.267), 3 (β=0.235), and 4 (β=0.210), the absence of diabetes mellitus (β=-0.230), and experience in using glucocorticoids (β=-0.230) were associated with a high likelihood of response to therapy; high body mass index (β=-0.200) and long RA duration (β=-0,181), a high level of rheumatoid factor (β=-0.176), a history of myocardial infarction (β=-0.153), schizotypic disorder (β=-0.132), and extra-articular manifestations of RA (β=-0.106), and older age (β=-0.102) were related to a low probability of response. The area under the ROC curve for the model was 0.99 (p<0.001). Conclusion. BA therapy and psychopharmacotherapy, along with younger age, shorter duration and high activity of RA, a low level of rheumatoid factor, lower body mass index, the absence of diabetes mellitus, myocardial infarction, and extra-articular manifestations of RA in the history, schizotypic disorder, and experience in using glucocorticoids are associated with a greater likelihood of a good and moderate treatment response.

© 2018 SPIE.  We have investigated the influence of indium content (x) increase on spectral characteristics of In x Ga 1-x As photoconductor. To avoid the mismatch between crystalline parameters of In x Ga 1-x As and GaAs wafer we proposed to incorporate a step-graded metamorphic buffer layer. We showed that x increase strongly enhances THz emission and broadens THz spectrum of In x Ga 1-x As. Since no polarity rehearsal of the THz waveform occurs and electron diffusion mobility increases up to 90% with x increase we attribute the increase of THz intensity to photo-Dember effect contribution. The maximum efficiency of optical-to-THz conversion was obtained for In 0.72 Ga 0.28 As at optical fluence ∼0.01 μJ=cm 2 . The fabricated photoconductors can be used as promising photo-Dember or lateral photo-Dember THz emitters in pulsed THz spectroscopy and imaging, in particular, operating with long wave optical pump.