Effects of intensive language action therapy (ILAT) on automatic language processing were assessed using Magnetoencephalography (MEG). Auditory magnetic mismatch negativity (MMNm) responses to words and pseudowords were recorded in twelve patients with chronic aphasia before and immediately after two weeks of ILAT. Following therapy, Patients showed significant clinical improvements of auditory comprehension as measured by the Token Test and in word retrieval and naming as measured by the Boston Naming Test. Neuromagnetic responses dissociated between meaningful words and meaningless word-like stimuli ultra-rapidly, approximately 50 ms after acoustic information first allowed for stimulus identification. Over treatment, there was a significant increase in the left-lateralisation of this early word-elicited activation, observed in perilesional fronto-temporal regions. No comparable change was seen for pseudowords. The results may reflect successful, therapy-induced, language restitution in the left hemisphere.
This paper presents an improved incremental self-organizing map (I2SOM) network that uses automatic threshold (AT) value for the segmentation of ultrasound (US) images. In order to show the validity of proposed scheme, it has been compared with Kohonen’s SOM. Two-dimensional (2D) fast Fourier transform (FFT) and 2D continuous wavelet transform (CWT) were computed in order to form the feature vectors of US bladder and phantom images. In this study, it is observed that the proposed automatic threshold scheme for ISOM network has significantly eliminated the former ISOM network’s threshold problem for US images. This improvement enhances the robustness of ISOM algorithm. Obtained results show that ISOM with AT value has similar segmentation performance with Kohonen’s network.
The HIV epidemic among people who inject drugs (PWID) in Russia continues to spread. This exploratory study examines how HIV-prevention measures are perceived and experienced by PWID in the northwestern region of Russia.
Purposive sampling was used to obtain a variety of cases that could reflect possible differences in perception and experience of HIV-prevention efforts. We conducted 22 semi-structured interviews with PWID residing in the Arkhangelsk and St. Petersburg regions.
The main sources of prevention information on HIV for PWID were media campaigns directed to the general population. These campaigns were effective with regard to communicating general knowledge on HIV but were ineffective in terms of risk behavior change. The subjects generally had trust in medical professionals and their advice but did not follow prevention recommendations. Most informants had no or very little prior contact with harm reduction services. On the level of attitudes towards HIV prevention efforts, we discovered three types of fatalism among PWID: “personal fatalism” - uselessness of HIV prevention efforts, if one uses drugs; “prevention-related fatalism” - prevention programs are low effective, because people do not pay attention to them before they get infected; “state-related fatalism” – the lack of belief that the state is concerned with HIV prevention issues. Despite this fatalism the participants opined that NGOs would do a better job than the state as they are “really working” with risk groups.
As HIV prevention campaigns targeted at the general population and prevention advice received from medical professionals are not sufficiently effective for PWID in terms of risk behavior change, prevention programs, such as community-based and peer-based interventions specifically tailored to the needs of PWID are needed, which can be achieved by a large expansion of harm reduction services in the region. Personal communication should be a crucial element in such interventions in addition to harm reduction materials provision. Training programs, peer outreach, and culture-change interventions which try to alter widespread fatalistic norms or attitudes towards their health are especially needed, since this study indicates that fatalism is a major barrier for behavior change.
HIV treatment to reduce downstream HIV incidence and to decrease disease mortality and morbidity at a population level both require that hidden, out-of-care people living with HIV (PLH) in the community be reached and engaged to enter care. This research evaluated the feasibility of reaching out-of-care or non-adherent PLH through members of their social networks in St Petersburg, Russia.MATERIALS AND METHODS:
To recruit a social network sample of HIV-positive injection drug users, 16 HIV+ seeds were enrolled into the study through PLH-oriented websites and online forums using recruitment ads or approached in needle exchange sites. Interested persons called the study phone number and completed a brief eligibility interview. Seed inclusion criteria were HIV+ status, being 18 years or older, having ever injected drugs, and having not visited an HIV doctor in the past 6 months. Seeds provided blood specimens tested for HIV to confirm their self-reported status. Eligible seeds were enrolled, completed brief network elicitation interview, and were asked to invite their own HIV+ friends into the study. Incentives were provided as compensation for participants' time and additional smaller incentives were provided for inviting each HIV+ network member to also participate. The seed's PLH friends established the first ring of participants who, in turn were asked to invite their own PLH friends (second ring). All study participants completed assessment of psychosocial wellbeing and sexual and injection-related HIV risk behaviour. Blood samples were collected from all participants to confirm their HIV+ status.RESULTS:
Through this chain referral process, the initial 16 seeds led to the enrolment of a total of 66 PLH from the community (mean=4 per initial seed), most of whom - like the seed - were not presently in HIV care or were ART non-adherent.CONCLUSIONS:
Implementation of treatment cascade goals requires complementing conventional paths of identifying PLH with feasible and effective community-based approaches such as described in this study. This research establishes that PLH are connected in their day-to-day social networks with other HIV+ persons and shows that social network methods can be employed to reach infected persons through their connections with other PLH. This method has the potential to expand the reach of medical care efforts and ART uptake.
Working memory (WM) is essential to auditory comprehension; thus, understanding of the nature of WM is vital to research and clinical practice to support people with aphasia. A key challenge in assessing WM in people with aphasia is related to the myriad deficits prevalent in aphasia, including deficits in attention, hearing, vision, speech, and motor control of the limbs. Eye-tracking methods augur well for developing alternative WM tasks and measures in that they enable researchers to address many of the potential confounds inherent in tasks traditionally used to study WM. Additionally, eye-tracking tasks allow investigation of trade-off patterns between storage and processing in complex span tasks, and provide on-line response measures. The goal of the study was to establish concurrent and discriminative validity of a novel eye movement WM task in individuals with and without aphasia. Additionally, we aimed to explore the relationship between WM and general language measures, and determine whether trade-off between storage and processing is captured via eye-tracking measures. Participants with (n=28) and without (n=32) aphasia completed a novel eye movement WM task. This task, incorporating natural response requirements, was designed to circumvent potential confounds due to concomitant speech, motor, and attention deficits. The task consisted of a verbal processing component intermixed with presentation of colors and symbols for later recall. Performance on this task was indexed solely via eye movements. Additionally, participants completed a modified listening span task that served to establish concurrent validity of the eye-tracking WM task. Performance measures of the novel eye movement WM task demonstrated concurrent validity with another established measure of WM capacity – the modified listening span task. Performance on the eye-tracking task discriminated effectively between participants with and without aphasia. No consistent relationship was observed between WM scores and Western Aphasia Battery aphasia quotient and subtest scores for people with aphasia. Additionally, eye tracking measures yielded no trade-off between processing and storage for either group of participants. Results support the feasibility and validity of employing a novel eye-tracking method to index WM capacity in participants with and without aphasia. Further research is required to determine the nature of the relationship between WM, as indexed through this method, and specific aspects of language impairments in aphasia.
Functional impairment continues to represent a major challenge in schizophrenia. Surprisingly, patients with schizophrenia report a level of happiness comparable with control subjects, even in the face of the prominent functional deficits, a finding at odds with evidence indicating a positive relation between happiness and level of functioning. In attempting to reconcile these findings, we chose to examine the issue of values, defined as affectively infused criteria or motivational goals used to select and justify actions, people, and the self, as values are related to both happiness and functioning.
Russia underwent significant health reforms since the collapse of Soviet Union. We hypothesized that despite many changes, the Russian healthcare workforce structure remains largely unreformed and unique. This study conveys how human resources for healthcare are different in Russia compared to the most developed countries and examines the underlying reasons for these differences. Methods utilized include analysis of routine statistics and in-depth interviews with respondents who had experience as physicians and public health professionals in Russia and in the west, including physicians who emigrated from Russia and decision makers responsible for personnel policies. Results: Russian health system is traditionally viewed as vast, overstaffed, overspecialized while underfunded, however it is often overlooked that the total number of personnel employed in health care is relatively small. The relative understaffing of Russian health care results from a deficit of all categories of personnel except for physicians and nurses, as well as to misallocation of personnel. In Russia, the rates of health care workers that are neither physicians nor nurses is ca. 20 per 1000 population vs. 30-50 per 1000 in large OECD countries. In the past, an oversupply of physicians and nurses was created due to controlled enrolment in medical education. This allowed the salaries of medics to stay relatively low, while also reducing demand for allied health personnel. Since enrolment in medical colleges and schools is cut by about one third, this may lead to a need for rapid changes in personnel policies in the near future. The paper uses the outcome of the research project funded from the Basic Research Program at the National Research University Higher School of Economics.
The paper considers a problem of abortion in modern Russia. Using official statistics we analyze the dynamics of main abortion indicators since early 1990s. On the basis of representative national sample surveys we conclude that official statistics are complete and reliable. This in turn confirms the steady decline of abortions during the post-Soviet years.
Despite the positive trend, Russia remains one of the countries with the highest abortion rate in the world. The country’s turn to traditional values and growing role of the church are inadequate mechanisms to reduce abortions. The proven evidence based measures like promotion of family planning, sex education, etc. obtain no government support, but repression and restrictions. The authors indicate counterproductive effects of these restrictions on abortion reduction and pronatalist population policies.
The article recommends to pay more attention to improvements in quality of abortion provision, the introduction of modern medical standards and protocols.
In conclusion, the authors suggest the ways to improve the official statistics of abortions .
We studied the cytotoxicity of acadesine (5-aminoimidazole-4-carboxamide-1-β-D-ribofuranoside) for tumor and normal cells of various species and tissue origin. In tumor cells, acadesine triggered non-apoptotic death; the potency of the compound to normal cells was substantially lower. Acadesine was toxic for tumor cells with multidrug resistant phenotypes caused by the transmembrane transporter P-glycoprotein or lack of proapoptotic p53. Activity of adenosine receptors was required for acadesine-induced cell death, whereas functioning of AMP-dependent protein kinase was not required. A more pronounced cytotoxicity for tumor cells, as well as the non-canonical death mechanism(s), makes acadesine a promising candidate for antitumor therapy.
Topical issues on early childhood mental health are considered in the article. There is a high prevalence of psychiatric morbidity in early childhood and increase in mental disorders among children in general, which is ahead of a similar increase among adults. At the same time, unjustifiably on children’s mental health little attention is being paid, specialty “children’s psychiatrist” is not reestablished, the number of specialized beds is reduced etc. The data on the frowth of severe mental disorders (endogenous psychoses of the autism group) beginning in early and pre-school age.
We formulate the optimal control problem for a class of nonlinear objects that can be represented as objects with linear structure and state-dependent coefficients. The linear structure of the transformed nonlinear system and the quadratic quality functional let us, in the optimal control synthesis, to pass from Hamilton–Jacobi equations to a state-dependent Riccati equation. The main problem is the implementation of an optimal control problem is related to the search for solutions of this equation in the rate of the object functioning. This paper proposes a method of an algorithmic parameter optimization of the controller based on the use of the necessary conditions for the optimality of the considered control systems. The constructed algorithms can be used both for optimizing the non-stationary objects themselves, if the corresponding parameters are selected for this purpose, and for optimizing the entire managed system by means of the corresponding parametric adjustment of the regulators. The effectiveness of the developed algorithms is demonstrated by the example of medical treatment of patients with HIV.
The recovery of the masticatory function and good esthetic results of orthopedic treatment in patients with Kennedy IV mandibular defects is still a topical problem. The aim of the work was to study biochemical aspects of interactions between bony structures of the front part of the mandible and different endosteal implants, especially under functional load, to develop the most rational method of orthopedic treatment of patients with Kennedy IV mandibular defects. In total, 14 variants of elimination of defects in the front part of the mandible with different supports (natural teeth, standard implants, and miniimplants) for a non-removable orthopedic construction were studied. For each variant, maximal compression and stretch tensions, maximal shift tensions, and the probability of biochemical system destruction were calculated. These variables were compared, and conclusions on the most rational method of orthopedic treatment of patients with Kennedy IV mandibular defects were made; practical recommendations were given.
Now the electronic devices based on slow wave systems and electromagnetic waves excited in them were widely adopted in microwave electronics. They are also successfully applied at creation new elements of radio-frequency and microwave paths, instrumentations and devices, materials electromagnetic heating and etc. One of the perspective directions of slow wave systems usage is possibility of their implementation in biology and medicine as antennas and radiators for radio-frequency and microwave physical therapy, a radio-thermy and a tomography, sensitive elements for medical diagnostics, devices for sterilization and heat treatment. Advantages of usage slow wave systems in biology and medicine are based on electrodynamic and design features of structures which follow from distribution of an electromagnetic field near their surfaces. In this we are looking for features of usage slow wave systems in relation to area with high value of dielectric permeability, in particular to biofabrics, and also the problems connected with creation of electrodes for intracavitary microwave physical therapy on slow wave systems with primary concentration of electric field in biofabrics, adjacent to electrode surface. In this work the results of modeling microwave radiator on the basis of a ribbed coaxial line were received on Ansoft HFSS v.12 and CST Microwave Studio 2011 software. The theoretical ratios whice were received as a result of the electrodynamic analysis allow to calculate change of phase speed of slowed-down electromagnetic wave in the coaxial line with ridge conductors and are in good compliance with results of physical experiment. Application of such structure represents practical interest as allows to reduce its longitudinal geometrical sizes with preservation of electric wavelength. Except urological procedures of transurethral microwave thermotherapy, the offered electrode on the basis of a ribbed line can be used also as a radiation source for the microwave tomograph at research of large blood vessels or a gullet. Besides, its application as the tiny reception antenna at radiometry and a termografiya is possible.
In article the market of medical insurance is analysed, specifics of the market in St. Petersburg are studied, the problems disturbing to development of medical insurance are formulated and ways of their decision are presented, and also some forecasts concerning growth and development of this type of service in St. Petersburg are submitted.
These days russian pharmaceurtical industry faced a difficult problem – on the one hand there is a great number of foreign manufactures and it threatens the russian market, and on the other hand there are poor research and development, industrial and raw materials bases, financial and personnel components do not allow to make innovative projects that provide significant competitive advantage etc. At this article the results of market position zondage of russian pharmaceutical enterprises – medicine manufactures based on multicriterial matrix. Coverage of these enretprises (international, national and regional/inter-regional markets) and the number of innovative products (specific gravity of original medicines in the range of products of manufacture).
Control of heart rate (HR) is an important target during treatment of patients with stable angina. In a number of cases it can be achieved by the use of β adrenoblockers. But often a necessity arises to enhance pulse slowing therapy with the use of combinations of drugs exerting negative chronotropic effect. We present here results of the CONTROL study (n=1777), conducted with the aim of studying antianginal efficacy and tolerability of the If channels blocker ivabradine used in combination with β adrenoblockers in patients with stable functional class II-III angina and frequency of attacks ≥3/week and HR>70 bpm. The use of ivabradine for 12 weeks allowed to achieve greater reduction of frequency of anginal attacks (by 4 per week, 95% confidence interval 3-6) compared with the group of usual care (treatment at physicians discretion). At the end of the study in ivabradine group 43% of patients had no angina at all, HR lowering ≤60 bpm was noted in 46% of patients (in the comparison group14 and 6%, respectively, p<0.001). Reduction of frequency of attacks of angina correlated with HR lowering, more with pulse rate measured by patients themselves (r=0.411, p<0.001), than with values measured at visits to physicians (r=0.266, p<0.001). Rate of lethal outcomes as well as rate of nonfatal cardiovascular complications (myocardial infarction, stroke, urgent revascularization) were similar in compared groups. In ivabradine group compared with usual care group there were less hospitalizations (5.0 and 8.6%, respectively, p=0.021), calls for emergency service (13.3 and 25.4%), and sick leaves (6.6 and 13.1%, p=0.018). Adverse reactions were noted in 130 patients (8.7%) in ivabradine group and in 29 patients (10.0%) in usual care group p=0.580).