Миф о "Братьях Карамазовых". Какой Достоевский нужен современной России?

В статье на основе текста романа «Братья Карамазовы» опровергается позиция И. Евлампиева, который видит в Ф.М. Достоевском по преимуществу гностического мыслителя, а также эксплицируются теоретические предпосылки тенденциозного подхода к творчеству русского писателя. Акцентируется внимание на связи романов Достоевского с православной традицией, а также значимости этой позиции для становления русского самосознания и истории России.У статті на основі тексту роману «Брати Карамазови» спростовується позиція І. Євлампієва, який вбачає у Ф.М. Достоєвському переважно гностичного мислителя, а також експлікуються теоретичні передумови тенденційного підходу до творчості російського письменника. Робиться акцент на зв’язку романів Достоєвського з православною традицією, а також на значимості цієї позиції для становлення російської самосвідомості та історії Росії.In the article the position of I. Evlampiev, who considers F.M. Dostoyevskiy, for the most part, as a gnostic thinker, is being disproved on the basis of the text of the novel “The Karamazov brothers”. Also, theoretical preconditions of tendentious understanding of the creative work of the Russian writer are being explicated. Besides, the relationship between Dostoyevskiy’s novels and orthodox tradition and the importance of this position for establishing Russian self-consciousness and the history of Russia are being indicated

Effect of smartphone-enabled health monitoring devices vs regular follow-up on blood pressure control among patients after myocardial infarction a randomized clinical trial

Importance Smart technology via smartphone-compatible devices might improve blood pressure (BP) regulation in patients after myocardial infarction. Objectives To investigate whether smart technology in clinical practice can improve BP regulation and to evaluate the feasibility of such an intervention. Design, Setting, and Participants This study was an investigator-initiated, single-center, nonblinded, feasibility, randomized clinical trial conducted at the Department of Cardiology of the Leiden University Medical Center between May 2016 and December 2018. Two hundred patients, who were admitted with either ST-segment elevation myocardial infarction or non-ST-segment acute coronary syndrome, were randomized in a 1:1 fashion between follow-up groups using smart technology and regular care. Statistical analysis was performed from January 2019 to March 2019. Interventions For patients randomized to regular care, 4 physical outpatient clinic visits were scheduled in the year following the initial event. In the intervention group, patients were given 4 smartphone-compatible devices (weight scale, BP monitor, rhythm monitor, and step counter). In addition, 2 in-person outpatient clinic visits were replaced by electronic visits. Main Outcomes and Measures The primary outcome was BP control. Secondary outcomes, as a parameter of feasibility, included patient satisfaction (general questionnaire and smart technology-specific questionnaire), measurement adherence, all-cause mortality, and hospitalizations for nonfatal adverse cardiac events. Results In total, 200 patients (median age, 59.7 years [interquartile range, 52.9-65.6 years]; 156 men [78%]) were included, of whom 100 were randomized to the intervention group and 100 to the control group. After 1 year, 79% of patients in the intervention group had controlled BP vs 76% of patients in the control group (P = .64). General satisfaction with care was the same between groups (mean [SD] scores, 82.6 [14.1] vs 82.0 [15.1]; P = .88). The all-cause mortality rate was 2% in both groups (P > .99). A total of 20 hospitalizations for nonfatal adverse cardiac events occurred (8 in the intervention group and 12 in the control group). Of all patients, 32% sent in measurements each week, with 63% sending data for more than 80% of the weeks they participated in the trial. In the intervention group only, 90.3% of patients were satisfied with the smart technology intervention. Conclusions and Relevance These findings suggest that smart technology yields similar percentages of patients with regulated BP compared with the standard of care. Such an intervention is feasible in clinical practice and is accepted by patients. More research is mandatory to improve patient selection of such an intervention.Cardiolog

Frailty score for elderly patients is associated with short-term clinical outcomes in patients with ST-segment elevated myocardial infarction treated with primary percutaneous coronary intervention

Objective Consistent with the aging population in the Western world, there is agrowing number of elderly patients with ST-segment elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) is the recommended reperfusion strategy in elderly patients; risk models to determine which of these patients are prone to have poor clinical outcomes are, however, essential. The purpose of this study was to assess the association between frailty and short-term mortality and PCI-related serious adverse events (SAE) in elderly patients.Methods All STEMI patients (aged >= 70 years) treated with primary PCI in 2013-2015 at the Leiden University Medical Centre were assessed. The Safety Management Programme (VMS) score was used to identify frail elderly patients. The primary endpoint was 30-day all-cause mortality; the secondary endpoint included 30-day clinical death, target vessel failure, major bleeding, contrast induced kidney insufficiency and stroke.Results A total of 206 patients were included (796.4 years, 119 [58%] male). The VMS score was 1 in 28% of all cases. Primary and secondary endpoint rates were 5 and 23% respectively. VMS score 1 was an independent predictor for both 30-day mortality (odds ratio [OR] 9.6 [95% confidence interval, CI 1.6-56.9] p-value = 0.013) and 30-day SAE (OR 2.9 [95% CI 1.1-7.9] p-value = 0.038).Conclusions VMS score for frailty is independently associated with short-term mortality and PCI-related SAE in elderly patients with STEMI treated with primary PCI. These results suggest that frailty in elderly patients is an important feature to measure and to be taken into account when developing risk models.Cardiolog

Predicting clinical outcomes in elderly patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

Pathophysiology, epidemiology and therapy of agein

Predicting clinical outcomes in elderly patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

Pathophysiology, epidemiology and therapy of agein

Q fever and pneumonia in an area with a high livestock density: a large population-based study.

Concerns about public health risks of intensive animal production in the Netherlands continue to rise, in particular related to outbreaks of infectious diseases. The aim was to investigate associations between the presence of farm animals around the home address and Q fever and pneumonia. Electronic medical record data for the year 2009 of all patients of 27 general practitioners (GPs) in a region with a high density of animal farms were used. Density of farm animals around the home address was calculated using a Geographic Information System. During the study period, a large Q fever outbreak occurred in this region. Associations between farm exposure variables and pneumonia or ‘other infectious disease’, the diagnosis code used by GPs for registration of Q fever, were analyzed in 22,406 children (0–17 y) and 70,142 adults (18–70 y), and adjusted for age and sex. In adults, clear exposure-response relationships between the number of goats within 5 km of the home address and pneumonia and ‘other infectious disease’ were observed. The association with ‘other infectious disease’ was particularly strong, with an OR [95%CI] of 12.03 [8.79–16.46] for the fourth quartile (>17,190 goats) compared with the first quartile (<2,251 goats). The presence of poultry within 1 km was associated with an increased incidence of pneumonia among adults (OR [95%CI] 1.25 [1.06–1.47]). A high density of goats in a densely populated region was associated with human Q fever. The use of GP records combined with individual exposure estimates using a Geographic Information System is a powerful approach to assess environmental health risks. (aut. ref.