Gambling taxation in today’s Russia : principles, practices and actual figures

The article is devoted to today's situation and prospects for the development of gambling taxation in the country. The gambling industry is continually developed. Currently, this type of entrepreneurial activities can be found almost throughout the Russian Federation. But the problem of gambling industry is associated, to a large extent, with the fact that it is rather difficult to control the income and expense of bookmakers, owners of casinos and slot machines. Insufficient transparency of gambling industry leads to new restrictions or prohibitions by the state, instead of implementing an effective taxation system. As the objects for the study, the authors selected the main elements of the tax on gambling. In this article the dynamics of the number of taxpayers, subjects of taxation and amount of budget income by taxing the gambling industry over time is analysed. As a result of the study the problems of gambling taxation are defined and their possible solutions are proposed.peer-reviewe

Психологическая помощь ВИЧ-инфицированным пациентам в Санкт-Петербургском центре СПИД: история и современность

The psychological state of people living with HIV is suffering from the moment when the diagnosis of HIV infection is perceived to the onset of remission during treatment. To achieve real effectiveness of HIV treatment, it is important to use not only the potential of modern pharmacotherapy, it is equally important that all people living with HIV receive psychological support in overcoming the difficulties arising from daily regular intake of drugs throughout their lives. Psychologists who are working at the AIDS Center are ready and conduct crisis counseling, extended counseling on adherence to treatment, psychological diagnostics to identify disorders which prevent the initiation and continuation of drug therapy, psychological correction in case of treatment interruptions. The use of traditional psychological methods should be based on knowledge of the characteristics of the disease and the specific treatment of HIV-infected people, which is currently being acquired in real clinical conditions. The article summarizes the many years of experience of the team of psychologists at the St. Petersburg AIDS Center and presents a model of modern psychological care for HIV-infected people based on knowledge of the characteristics of the disease, its prevention and specific treatment. Психологическое состояние людей, живущих с вирусом иммунодефицита человека, подвергается испытаниям от момента восприятия диагноза ВИЧ-инфекция до наступления ремиссии на фоне лечения. Для достижения реальной эффективности лечения ВИЧинфекции важно использовать не только потенциал современной фармакотерапии, не менее важно, чтобы все люди, живущие с вирусом иммунодефицита человека, получали психологическую помощь в преодолении трудностей, возникающих при ежедневном регулярном приеме лекарственных средств на протяжении всей жизни. Психологи, работающие в Центре СПИД, готовы и проводят кризисное консультирование, расширенное консультирование по вопросам приверженности лечению, психологическую диагностику для выявления нарушений, препятствующих началу и продолжению лекарственной терапии, психологическую коррекцию при срывах лечения. Применение традиционных психологических методов должно быть основано на знании особенностей заболевания и специфического лечения ВИЧ-инфицированных, которое в настоящее время приобретается в реальных клинических условиях. В статье обобщен многолетний опыт работы коллектива психологов Санкт-Петербургского Центра СПИД и представлена модель современной психологической помощи ВИЧ-инфицированным, основанной на знании особенностей заболевания, его профилактики и специфического лечения.

Separatrix splitting at a Hamiltonian 02iω0^2 i\omega bifurcation

We discuss the splitting of a separatrix in a generic unfolding of a degenerate equilibrium in a Hamiltonian system with two degrees of freedom. We assume that the unperturbed fixed point has two purely imaginary eigenvalues and a double zero one. It is well known that an one-parametric unfolding of the corresponding Hamiltonian can be described by an integrable normal form. The normal form has a normally elliptic invariant manifold of dimension two. On this manifold, the truncated normal form has a separatrix loop. This loop shrinks to a point when the unfolding parameter vanishes. Unlike the normal form, in the original system the stable and unstable trajectories of the equilibrium do not coincide in general. The splitting of this loop is exponentially small compared to the small parameter. This phenomenon implies non-existence of single-round homoclinic orbits and divergence of series in the normal form theory. We derive an asymptotic expression for the separatrix splitting. We also discuss relations with behaviour of analytic continuation of the system in a complex neighbourhood of the equilibrium

Parabolic resonances and instabilities in near-integrable two degrees of freedom Hamiltonian flows

When an integrable two-degrees-of-freedom Hamiltonian system possessing a circle of parabolic fixed points is perturbed, a parabolic resonance occurs. It is proved that its occurrence is generic for one parameter families (co-dimension one phenomenon) of near-integrable, t.d.o. systems. Numerical experiments indicate that the motion near a parabolic resonance exhibits new type of chaotic behavior which includes instabilities in some directions and long trapping times in others. Moreover, in a degenerate case, near a {\it flat parabolic resonance}, large scale instabilities appear. A model arising from an atmospherical study is shown to exhibit flat parabolic resonance. This supplies a simple mechanism for the transport of particles with {\it small} (i.e. atmospherically relevant) initial velocities from the vicinity of the equator to high latitudes. A modification of the model which allows the development of atmospherical jets unfolds the degeneracy, yet traces of the flat instabilities are clearly observed

Психосоциальное консультирование при тестировании на вирус иммунодефицита человека: на что обратить внимание?

Introduction. Voluntary anonymous HIV counseling and testing can be an effective tool to reduce the behavior that has high risks of HIV, hepatitis C (HCV) and B (HBV) transmission. The dissemination of general information on HIV, HCV, HBV to reduce risky behavior is not as much of importance as counseling on specific individual infection-related sexual risk behavior. The objective was to identify HIV/HCV/HBV-related risk factors that have to be discussed during psychosocial counselingto help the individual to focus on his/her sexual risk behavior.Methods and materials. The study was conducted on the base of Saint-Petersburg Center for Control of AIDS with participation of 90 individuals who voluntary applied for HIV counseling and testing. Participants’ behavioral risks and HIV knowledge were assessed by the specifically developed structured questionnaire. The level of anxiety was measured by State-Train Anxiety Inventory (STAI adapted by Hanin), the level of need for extreme-risk behavior was measured by the Sensation Seeking Scale (Zuckerman).Results. Only 50 % of participants use condom with their steady sexual partner always or almost always. In 62 % cases, the steady sexual partner’s HIV-status is unknown. Many participants agree that HIV transmission occurs always after sexual contact with HIV-infected person. The level of situational anxiety is higher by those who do HIV testing repeatedly. Those who are more likely to seek new sensations use condom with their steady or other partner more often.Conclusion. Motivational intervention during pre- and post-counseling by HIV/HCV/HBV testing has to focus on the discussion of individual difficulties of condom use as the means for protection and on the individual’s resources for changing sexual behavior to protect him/her-self and his/her partner from infection with HIV and viral hepatitis.Введение. Консультирование при добровольном анонимном обследовании на вирус иммунодефицита человека (ВИЧ) может быть эффективным способом снижения частоты совершения поступков, имеющих высокие риски заражения ВИЧ и вирусными гепатитами В и С (ВГВ и ВГС). Для снижения частоты рискованных поступков имеют значение не столько предоставление общей профилактической информации о ВИЧ, ВГВ и ВГС, сколько обсуждение специфических особенностей сексуального рискованного поведения, опасного для инфицирования этими вирусами.Цель исследования – изучение факторов, связанных с рисками инфицирования ВИЧ и гепатитами В и С, обсуждение которых в процессе психосоциального консультирования поможет человеку обратить внимание на свое рискованное поведение в сексуальных отношениях с партнером.Методы и материалы. В исследовании, проведенном в Санкт-Петербургском Центре по профилактике и борьбе со СПИД и инфекционными заболеваниями, приняли участие 90 человек, добровольно обратившихся за анонимным консультированием и тестированием на ВИЧ. Поведенческие риски участников и уровень их осведомленности о ВИЧ оценивали с помощью специально разработанной структурированной анкеты. Уровень тревожности измеряли по методике Спилбергера – Ханина, склонность к экстремально-рискованному поведению – по методике Цукермана.Результаты. Лишь 50 % участников используют средства предохранения всегда или почти всегда при сексуальных контактах с постоянным партнером. В 62 % случаев ВИЧ-статус постоянного полового партнера неизвестен. Многие допускают мысль, что заражение ВИЧ-инфекцией происходит всегда при половом контакте с ВИЧ-инфицированным человеком. Уровень ситуационной тревоги выше у людей, кто обследуется на ВИЧ повторно. Люди, склонные к поиску новых или острых ощущений, чаще используют средства защиты при сексуальных контактах с постоянным или «другим» партнером.Заключение. Мотивационные вмешательства во время до- и послетестового консультирования приьобследовании на ВИЧ, ВГВ и ВГС должны быть направлены на обсуждение специфических трудностей, связанных с использованием презервативов в качестве средства предохранения, и на возможность пересмотра своего сексуального поведения с целью защиты себя и своего полового партнера от инфицирования ВИЧ и вирусными гепатитами

Detection of antibodies to erythropoietin-based drugs: is it possible to create the universal test system?

Our aim was to compare different immobilized erythropoietin (EPO) preparations for their ability to detect anti-EPO IgG antibodies in blood sera of EPO-treated patients with ELISA technique. 294 serum samples of the patients treated with erythropoietin were analyzed. 127 serum samples of patients who did not receive recombinant human EPO (rhEPO) were studied for comparative analysis. ELISA assay was performed, and different rhEPO drugs were immobilized on the anti-EPO monoclonal antibody-coated plates. Horseradish peroxidase-conjugated mouse monoclonal antibodies to human IgG, IgG1, and IgG4 was used for detection. The following drugs were studied: recombinant human erythropoietin rhEPO-beta (Shandong Kexing Bioproducts), European standard of erythropoietin BRP 3, commercial drugs Aranesp (Amgen Europe B.V.), Mircera (F. Hoffmann-La Roche Ltd.), Eprex (Johnson & Johnson LLC), Eralfon (Pharmaceutical Company Sotex). The sensitivity of the method was expressed as a positivity index (IP). IP calculated as the ratio of OD from tested sera to OD at the cut-off levels. The latter was assumed as a mean OD±SD for serum samples from EPO-naive patients. The results were evaluated as positive with IP > 1.1, and negative at IP < 0.9. Results in the range of 0.9 ≤ IP < 1.1 were considered as unidentified. Among the 294 samples, 32 specimens were evaluated as positive or unidentified for total IgG anti-EPO antibodies. The unidentified samples were detected in 1.0-1.7% of all cases. IgG1 subclass antibodies were found in 50-56.3% of patients and IgG4 subclass antibodies, in 43.850% of the patients. Mann—Whitney test showed a significant difference between the test samples compared to control group for all the ELISA modifications (p = 0.001). The Kruskal—Wallis test did not show significant differences between the IP results obtained with any of five immobilized EPO drugs (p = 0.05). The correlation quotient of IP was in the range of 0.99-0.96 for total IgG and > 0.98 for two subclasses of antibodies. Linear regression coefficients were close to one, thus indicating absence of significant differences in the sensitivity of the compared methods. This study indicate the opportunity of using the similar test systems to determine anti-EPO antibodies in the patients treated with various rhEPO drugs. Therefore, it is possible to develop a universal commercial test system to this purpose

Психологические трудности пациентов, инфицированных вирусом иммунодефицита человека, при подготовке к антиретровирусной терапии

Objectives: to find out and. analyze the problems of HIV-infected. patients which require additional attention of specialists during counseling before the start of antiretroviral therapy as well as to assess patients' needs in psychological help.Materials and methods: the data are collected, by the questionnaire and. psychometrical screening using The Somatic Symptom. Disorder — B Criteria Scale from 365 HIV-infected. patients, including 155 (42,5%) females who took part in the group psychological counseling for preparing to the start of antiretroviral therapy from July 2017 to July 2018. The average age was 37.2 years old.Results: the difficulties due to HIV-infection, which, are mentioned, by patients before the therapy start, are ranged, by the frequency of their answers as follows: 1) ««need, to conceal HIV diagnosis» — 27,1% answers, 2) ««lack of time for visiting the doctor» — 26,6%; 3) ««depression and/or anxiety» — 26,0%; 4) ««need, to use condom» — 19,5%; 5) ««restrictions in employment» — 10,1%; 6) ««disclosure of HIV diagnosis to the partner» — 8,5%. Less common are ««difficulties to interact with the doctor» (4,4%), ««impossibility to work in the specialty» (4,4%) and. ««the rejection from significant others» (4,1%). The monitoring of HIV treatment adherence showed, that 31,8% of patients were not ready to start taking medications right after the doctor's recommendations, and. 13,4% postpone the start of treatment for more than half a year.Conclusion: in preparation for the start of antiretroviral therapy a patient needs the assistance in time scheduling required. for treatment. The discussion, with patients about their attitudes towards condom use and their self-efficacy to use condom, helps patients to overcome their fear of HIV diagnosis disclosure and. therefore reduces their risky sexual behavior. Psychological screening helps revealing psychological tension and allows offering the consultation of psychiatrist or psychologist with the purpose to correct mental state as well as to facilitate patient's efforts to develop adherence to continual treatment.Цель: выявить и проанализировать трудности у пациентов с ВИЧ-инфекцией перед началом, антиретровирусной терапии, требующие особого внимания специалистов в процессе консультирования, а также оценить потребности пациентов в психологической помощи.Материалы, и методы: проанализированы, данные анкетирования и психометрического скрининга по шкале «The Somatic Symptom. Disorder — B Criteria Scale» 365 ВИЧ-инфицированных пациентов, в том числе 155 (42,5%) женщин, участвовавших в групповом, психологическом консультировании при подготовке к началу антиретровирусного лечения с июля 2017 г. по июль 2018 г. Средний возраст. — 37,2лет.Результаты: трудности в связи с ВИЧ-инфекцией, отмечаемые пациентами перед началом терапии, по частоте ответов распределились следующим образом: 1) ««необходимость скрывать диагноз» — 27,1% ответов, 2) «находить время на посещение врача» — 26,6%; 3) ««депрессия и/или тревога» — 26,0%; 4) «необходимость использовать презервативы.» — 19,5%; 5) «ограничения в трудоустройстве» — 10,1%; 6) ««сообщение диагноза партнеру» — 8,5%. Реже встречаются указания на ««трудности взаимодействия с врачом» (4,4%), «невозможность работать по специальности» (4,4%) и «отвержение со стороны, близких» (4,1%). Мониторинг приверженности лечению ВИЧ-инфекции показал, что 31,8% пациентов не склонны, начинать прием, препаратов сразу после рекомендации врача, а 13,4% откладывают. начало терапии более чем. на полгода.Заключение: при подготовке к началу антиретровирусной терапии пациент нуждается в помощи для планирования времени, связанного с лечением. Снижению рискованного сексуального поведения способствует разговор об отношении и готовности пациента к использованию презерватива, что, в свою очередь, помогает преодолевать страх раскрытия диагноза партнеру. Психологический скрининг позволяет, выявлять психологическую напряженность и предлагать консультации психиатра и психолога для коррекции состояния и облегчения усилий по формированию приверженности непрерывному лечению

Hyperexpression of TLR2 and TLR4 in patients with ischemic stroke in acute period of the disease

Pathogenesis of ischemic stroke  is actively  involved  in the  system  of innate immunity. Under conditions of cerebral  ischemia, a number of biologically  active  substances are  released  that  interact with innate immunity receptors, in particular TLR2  and  TLR4, which  exacerbate inflammation in brain  tissue. Identification of predictor markers  at the level of the innate immunity system may foresee the clinical course of ischemic stroke and ensure timely treatment. Our objective was to study expression of TLR2 and TLR4 receptors in peripheral blood leukocytes  in patients with ischemic stroke in the dynamics of the disease. 27 people  were included in the study. The main  group consisted of patients with ischemic stroke of varying severity (n = 19). Patients of the main  group were divided into two subgroups:  with an NIHSS index value of < 10 (n = 10) and > 10 (n = 9). The control group included healthy  donors  with no history  of acute  and chronic inflammatory diseases (n = 8). Peripheral blood  leukocytes  were used as the  test material. To determine expression  of the TLR2  and TLR4  genes, RT-PCR in real time was used. Surface  expression  of TLRs was determined by flow cytometry. A study of the TLR2 and TLR4 gene expression showed that on the 1st, 3rd  and 7th  day post-stroke, the TLR4 gene expression  in patients was significantly  increased, when compared to the control group (p < 0.01), whereas TLR2 gene expression on the 3rd  day of the disease was not statistically different from the control group. A study of surface expression  of receptors showed that the average TLR2 fluorescence intensity on the patients’ peripheral blood monocytes was significantly  increased on the 1st  and 3rd  day of disease when compared to the control group.  The  surface  expression  of TLR4  on monocytes has a statistically significant  increase  only on day 7. Assessment  of surface expression  of TLRs in subgroups  with different  severity values by NIHSS showed that  patients with a NIHSS index > 10 had a significantly  higher  level of surface of TLR2  expression  over the observation period, while the largest difference in TLR4  expression  in the subgroups  was observed  on the 1st day of the disease (p < 0.05). Patients with ischemic stroke showed an increase  in TLR2 and TLR4 expression at the gene and protein level, compared to healthy  donors. These indices can be considered possible predictors for clinical  prognosis  of ischemic stroke

Coagulation Disorders in Infective Endocarditis: Role of Pathogens, Biomarkers, Antithrombotic Therapy (Systematic Review)

The issue of antithrombotic therapy in patients with infective endocarditis has been studied for over 75 years. During that time studying of pathogenesis of the disease and its embolic complications, lead to the introduction of the concept of “immunothrombosis”. That mechanism allows infective agents (mostly bacteria) to be cloaked from the immune system and to multiply freely, leading to growth of vegetation, thus resulting in higher chance of fragmentation. Small-scale experimental and clinical studies on the correction of hemostatic disorders in infective endocarditis, that were performed in 20th century, didn’t show any significant results, that could affect clinical practice. However, reinterpretation of available data on coagulative system will allow to have elements of hemostasis as an application point in treating infective endocarditis. The article will discuss latest insights on the role of hemostasis system in pathophysisology of infective endocarditis, its effects on the development of the embolic complications, perspectives for diagnostics and treatment