EFFICACY AND SAFETY OF SINUS RHYTHM RESTORATION WITH AMIODARONE AND PROPAFENONE IN OUTPATIENTS, ECONOMIC ASPECTS (BASED ON DATA OF N.A. SEMASHKO NORTHERN MEDICAL CLINICAL CENTER)

Aim. To study efficacy and safey of sinus rhythm restoration with amiodarone and propafenone in outpatients with recurrent atrial fibrillation (AF), and to estimate pharmacoeconomic efficiency of such cardioversion in comparison with hospital treatment.Material and methods. Patients (n=199; aged 59.2±1.36) with paroxysmal (73.9%) or persistent (26.1%) AF were included into the multicenter prospective study. Follow-up period was 13.14 months (min 1 month, max 36 months). Patients with arrhythmia relapse <48 h received outpatient cardioversion with amiodarone or propafenone orally. Daily outpatient examination, including ECG and blood pressure monitoring every 30-60 min, was carried out to evaluate efficacy of cardioversion and hemodynamics. Phone contact with patients was available. Patients with unstable hemodynamics received cardioversion in hospital. Patients received propafenone in cumulative dose of 600 mg (150-300 mg every hour), and amiodarone 600-800 mg daily. The cost/effectiveness ratio (CER) was estimated. This ratio shows the cost of one unit of effect.Results. Outpatient cardioversion with amiodarone was started 24 h earlier (p=0.029) and with propafenone — 4.5 h earlier (p=0.002) than that in hospital. The average dose of amiodarone in ambulatory cardioversion was 1.3 times less (713.7±84,62 mg, p=0.345) than that in hospital cardioversion. Outpatient treatment with amiodarone restored sinus rhythm 8.7 h earlier, and with propafenone - 3.5 h earlier than the same treatments in hospital. Efficiency of hospital cardioversion with amiodarone was 70%, with propafenone - 80%, and efficiency of outpatient cardioversion — 96,1% and 98,4%, respectively. Outpatient treatment did not cause any severe side effects. Expenses for outpatient cardioversion made up 143 724.25 rubles, and for hospital cardioversion — 92 870.47 rubles. Average treatment costs for one patient in hospital was 6 times greater than for an outpatient. Outpatient cardioversion had the lowest CER (~1300 rubles%).Conclusion. Outpatient cardioversion with amiodarone or propafenone is not only effective and safe, but also economically feasible

Influence of the scale of the enterprise on the efficiency of its activities

Определение разумного масштаба деятельности предприятия является необходимым условием его эффективного функционирования. Цель магистерской диссертации является совершенствование методического инструментария обоснования решений по изменению масштаба предприятия для повышения экономической эффективности его деятельности. В работе рассматривается генезис понятия предельных издержек и вопросы взаимосвязи масштаба предприятия и эффективности его деятельности. В качестве источников информации для апробации методического подхода использовались годовые отчёты предприятий. В магистерской диссертации был разработан методический подход к обоснованию решения о целесообразности наращивания масштаба предприятия и выбору конкретных направлений увеличения масштаба, основанный на анализе динамики вовлечения производственных факторов в производство и оценке устойчивых и существенных изменений их отдачи, вызванных ростом предельных издержек в долгосрочном периоде.Determination of a reasonable scale of the enterprise is a necessary condition for its effective functioning. The purpose of the master's thesis is to improve the methodological support for substantiating decisions on changing the scale of an enterprise, which will increase the economic efficiency of its activities. The work examines the genesis of the concept of marginal costs and the relationship between the scale of the enterprise and the efficiency of its activities. In the master's thesis, a methodological approach was developed to substantiate the decision on the feasibility of increasing the scale of the enterprise and the choice of specific directions for increasing the scale. It is based on the analysis of the dynamics of the involvement of production factors in production and the assessment of stable and significant changes in their returns, caused by an increase in marginal costs in the long run. Annual reports of enterprises were used as sources of information for testing the methodological approach

The spatial structure of lichen Hypogymnia phyzodes (L.) Nyl.

Structure analysis based on regular morphological variability at organism level is applied to study the shape and spatial construction of lichen Hypogymnia phyzodes (L.) Nyl. Some structural elements were determined at juvenile stage of development with the use of this approach. Five of them are dominant. Besides, five the most frequent encounter types of thallus branching were described. It is shown that thallus structure at adult stage is usually built from two main elements forming axial dichotomy. Analysis of thallus shape indicates that transformation of dichotomy elements into trichotomy ones may also take place during growth and development of thallus.В работе впервые для изучения формы и описания пространственной конструкции талломов лишайника Hypogymnia physodes (L.) Nyl использован структурный анализ, основанный на закономерностях морфологической изменчивости на организменном уровне. С помощью данного подхода на ювенильной стадии развития выделены девять структурных элементов конструкции, из которых пять являются основными. Кроме того, описаны пять наиболее часто встречающихся типов ветвления слоевищ. Показано, что во взрослом состоянии структура таллома, как правило, формируется двумя определяющими аксиальную дихотомию основными элементами. Анализ формы талломов свидетельствует о том, что в ходе роста и развития возможно преобразование элементов дихотомии в элементы трихотомии

Additional file 1: of Formation of Boron-Carbon Nanosheets and Bilayers in Boron-Doped Diamond: Origin of Metallicity and Superconductivity

Supplementary information. (PDF 603 kb

Double polarized dd-fusion experiment

We present an experiment to measure the spin-correlation coefficients for double-polarized deuteron-fusion in the energy range of 10-100 keV to determine the quintet suppression factor. The experiment setup and the future upgrade plans are describ ed. The possible gain for future thermonuclear fusion reactors is discussed as well