Economic incentives in outpatient care and patient demand for pharmaceuticals. A study of antibiotics and addictive drugs prescriptions

The questions asked in this thesis relate to the economic incentives and characteristics of the health care market, which may result in suboptimal drug prescription. We consider two types of pharmaceuticals, such as antibiotics and addictive drugs. These pharmaceuticals are interesting because their use/misuse is associated with costs both at the individual and societal levels. The decision about the prescription of both antibiotics and addictive drugs is ideally made by a doctor, and over-the-counter sales are not available. A good share of the prescriptions is made in outpatient care or primary care (a part of outpatient care). This market is characterised by asymmetric information and may suffer from economic disincentives, which, together with patient-induced demand, may result in drug misuse. Thus there is a need for solutions aimed to facilitate optimal drug consumption, i.e. reducing consumption to a minimum consumption level, given that patients are effectively treated. This thesis considers several characteristics of the outpatient care market, such as free choice of provider, competition, and financial incentives within a health care centre to be important factors contributing to drug misuse. Knowledge about driving mechanisms is important for understanding how policies for more efficient antibiotic and addictive drugs consumption can be achieved. The first paper in the thesis relates to the ownership type of health care centres. It finds that private health care centres in the Västerbotten county of Sweden have a higher share of prescriptions for antibiotics than public ones. The second paper focuses on the competition between general practitioners and antibiotic prescription in Norwegian municipalities. The paper shows that the level of competition may be an important factor contributing to a more frequent antibiotic prescription. The third paper relates to the presence of free choice of the health care provider and uses the prescription data from Västerbotten county of Sweden to investigate patients' demand for addictive drugs and how a strategy to switch providers may affect individual drug consumption

Physics of Solid and Liquid Alkali Halide Surfaces Near the Melting Point

This paper presents a broad theoretical and simulation study of the high temperature behavior of crystalline alkali halide surfaces typified by NaCl(100), of the liquid NaCl surface near freezing, and of the very unusual partial wetting of the solid surface by the melt. Simulations are conducted using two-body rigid ion BMHFT potentials, with full treatment of long-range Coulomb forces. After a preliminary check of the description of bulk NaCl provided by these potentials, which seems generally good even at the melting point, we carry out a new investigation of solid and liquid surfaces. Solid NaCl(100) is found in this model to be very anharmonic and yet exceptionally stable when hot. It is predicted by a thermodynamic integration calculation of the surface free energy that NaCl(100) should be a well ordered, non-melting surface, metastable even well above the melting point. By contrast, the simulated liquid NaCl surface is found to exhibit large thermal fluctuations and no layering order. In spite of that, it is shown to possess a relatively large surface free energy. The latter is traced to a surface entropy deficit, reflecting some kind of surface short range order. Finally, the solid-liquid interface free energy is derived through Young's equation from direct simulation of partial wetting of NaCl(100) by a liquid droplet. It is concluded that three elements, namely the exceptional anharmonic stability of the solid (100) surface, the molecular short range order at the liquid surface, and the costly solid liquid interface, all conspire to cause the anomalously poor wetting of the (100) surface by its own melt in the BMHFT model of NaCl -- and most likely also in real alkali halide surfaces.Comment: modified version of JCP 123, 164701 15 pages, 25 figure

Melting and nonmelting of solid surfaces and nanosystems

We present an extensive but concise review of our present understanding, largely based on theory and simulation work from our group, on the equilibrium behavior of solid surfaces and nanosystems close to the bulk melting point. In the first part we define phenomena, in particular surface melting and nonmelting, and review some related theoretical approaches, from heuristic theories to computer simulation. In the second part we describe the surface melting/nonmelting behavior of several different classes of solids, ranging from van der Waals crystals, to valence semiconductors, to ionic crystals and metals. In the third part, we address special cases such as strained solids, the defreezing of glass surfaces, and rotational surface melting. Next, we digress briefly to surface layering of a liquid metal, possibly leading to solid-like or hexatic two dimensional phases floating on the liquid. In the final part, the relationship of surface melting to the premelting of nanoclusters and nanowires is reviewed.Comment: 54 pages, 26 figure

Elaborating principles of idiom-formation in the avant-garde literary discourse: a case study of Russian Cubo-Futurism

The paper sets out to explore the avant-garde literary discourse from the point of view of its idiomatic constituent. In particular, it studies avant-garde manifestoes written by the representatives of Cubo- Futurism, in which radical aesthetic renewal and the need for the reformation in the sphere of literature are proclaimed. As very expressive and complex rhetorical performances, manifestoes contain various kinds of idiomatic phrases that can be considered both vivid representations of a particular (avant-garde) approach to the language and prescriptions for certain ways of the language use. Special attention is paid to the elaboration of the methodology aimed to identify avant-garde idioms proper in the avant-garde literary discourse. The results obtained show that the manifestoes under consideration are, in essence, the first “trials” in the field of (poetic) language reformation and language experimentation and the sources of the idiomatics (idioms / idiomatic expressions) that can be termed “experimental”

Social networks as a tool for influence on the conscience of users

Статья посвящена изучению влияния социальных сетей на сознание пользователей. Эмпирическое исследование представлено контент-анализом социальной сети Instagram. Автор выделяет три основных фактора влияния социальных сетей на сознание пользователей: широкие мультимедиа возможности социальных сетей, стремление пользователей удовлетворить духовные и престижные потребности, а также масштабный охват аудитории.Article is devoted to studying of influence of social networks on consciousness of users. The empirical research is presented by the content analysis of social network Instagram. The author allocates three major factors of influence of social networks on consciousness of users: wide multimedia of a possibility of social networks, aspiration of users to satisfy spiritual and prestigious needs, and also large-scale coverage of audience

Methodological perspectives of studying linguistic creativity in the cinematic discourse

The research is devoted to the elaboration of the theory and methodology of the cinematic discourse poetics that is based on the analysis of linguistic creativity. The present paper highlights the main directions in which the theory of linguistic creativity is developing nowadays. Special attention is paid to the description of three approaches to the study of linguistic creativity that we elaborate within the framework of the poetics of cinematic discourse – a special interdisciplinary field of research. The given approaches have one and the same theoretical platform and share common key notions, but differ in the complex methods used to solve certain theoretical issues and practical tasks. These are the methods of discursive-parametric and corpus analysis of linguistic creativity, the method of multimodal measuring of linguistic creativity and the method of linguocultural analysis of linguistic creativity. The approaches under consideration aim to establish the specifics of how the creative potential of the language system is realized in the process of constructing films’ fictional reality and their peculiar poetics.Исследование посвящено разработке теории и методологии поэтики кинодискурса, основанной на анализе феномена лингвистической креативности. В статье отмечаются основные направления современного развития теории лингвокреативности. Освещается специфика трех подходов к изучению лингвокреативности, развиваемых в рамках поэтики кинодискурса – активно формирующейся сегодня междисциплинарной области гуманитарного знания. Данные подходы, базируясь на единой теоретической платформе и общих ключевых понятиях, отличаются применяемыми в них комплексными методами с целью решения конкретных теоретических проблем и практических задач. Это методы дискурсивно-параметрического и корпусного анализа лингвокреативности, метод полимодального измерения лингвокреативности и метод лингвокультурологического анализа лингвокреативности. В целом предлагаемые подходы позволяют выявить специфику проявления креативного потенциала языковой системы в построении художественной реальности кинопроизведения и его особой поэтики

Effects of ‘doctor shopping’ behaviour on prescription of addictive drugs in Sweden

Free choice of health care providers is aimed to improve the quality of health care by increasing both access to it and the competition between providers. However, it may also give patients possibilities for doctor shopping (DS) behaviour, i.e., visiting different providers to receive illicit drug prescriptions. Abuse of prescribed addictive drugs is a growing problem worldwide and is associated with increased mortality, lower quality of life and other problems on both the individual and societal level. We study DS behaviour for three categories of addictive drugs – opioid painkillers, benzodiazepine anxiolytics, and z-hypnotic sleeping drugs, in the outpatient care sector in V¨ asterbotten County, Sweden. Our dataset contains all drug prescriptions purchased by the residents of V¨ asterbotten in the period from January 2014 to April 2016 (approximately 160,000 observations). To identify signs of addictive prescription drugs abuse by DS, we analyse overlapping prescriptions. We use ‘Defined Daily Doses’ (DDDs), which is the average treatment dose of a specific drug per day for adults, as a proxy for the treatment duration. To control for medically legitimate overlaps, we compare overlapping prescriptions within a clinic with overlapping prescriptions between different clinics. Our empirical results suggest that there is a significant and positive relationship between the number of overlapping doses and the number of unique providers in the overlap. More specifically, we find that visiting different providers on average gives patients up to three additional DDDs per day. This is three times higher than the standard treatment dose. We discuss policy implications in the concluding discussion