[The systemic approach to analysis of opinions of patients about medical service].

The maintenance of health of residents of the Northern Regions of Russia, including those living in the Arctic zone of the cbountry, is a condition of its advance development in XXI century. The percentage of Russian citizen vaccinated against the new coronavirus infection (COVID-19) does not exceed 50% after beginning of implementation of vaccination program. It can be conditioned by lower level of both of credence of citizen to health care system and health literacy.Purpose of the study is to establish determinants of vaccination of population against COVID-19 in circumpolar region of Russia as exemplified by the Arkhangelsk Oblast.The sociological survey was carried out using the interview technique of patients of medical organizations (n=433) and conditionally healthy residents of the Arkhangelsk Oblast (n=139). To evaluate the level of general health literacy the Russian version of questionnaire HLS19 - Q22-RU was applied. The most of conditionally healthy respondents and consumers of medical services looked for information about methods of prevention and treatment (80.4% and 58.2% correspondingly), had an experience of vaccination against COVID-19 (79% and 56.3% correspondingly). The relative chances of conditionally healthy respondents, women, and respondents having no children and no credence to national health care system to independently look for information related to COVID-19 is higher at 2.94, 2.08, 1.55 and 1.48-1.57 times correspondingly. The relative chances of conditionally healthy respondents having no children in family and assessing one's economic status as "higher than average" to be vaccinated against COVID-19 is higher at 4.02, 1.52, 1.53 times correspondingly. Availability of experience of vaccination against COVID-19 is conditioned by higher level of general health literacy.In the Arkhangelsk Oblast and other circumpolar regions of Russia the programs of increasing loyalty of citizen to measures of population prevention, including vaccine prevention, is to be implemented with consideration of established determinants of of vaccinations against COVID-19.

[Results of decision support system implementation for prescribing anticoagulants to patients with atrial fibrillation in hospital].

BACKGROUND: In 819% of patients with atrial fibrillation (AF) with anticoagulant therapy (ACT), hemorrhagic complications occur, including due to excess doses of AC. At the same time, ACT is necessary for patients with AF, since anticoagulants effectively reduces the risk of ischemic stroke. To make a decision on the appointment of ACT, it is necessary to correlate the risks of ischemic stroke and bleeding, this requires knowledge of current clinical using ACT recommendations and instructions. Among patients admitted to hospital, 30% receive ACT, so increasing adherence to clinical recommendations for prescribing AC to patients with AF by doctors of various profiles is an urgent task. AIM: To analyze the adherence of physicians to recommendations for prescribing ACT before and after the introduction of decision support system (DSS) in patients with AF in a multi-specialty hospital. MATERIALS AND METHODS: A single-center non-randomized study with historical control to assess adherence to recommendations based on the analysis of medical prescriptions and the structure of drug errors in patients with AF in a multi-specialty hospital in Moscow before and after the introduction of DSS. Compliance with the recommendations of physicians was evaluated in the sections indications /contraindications to AC and dosage regimen of AC. The presence of deviations from the clinical recommendations /instructions for medical use of AC was regarded as management of the patient with non-compliance with recommendations. Physicians adherence level to recommendations was calculated as the ratio of cases of compliance with recommendations to the total number of cases. RESULTS: In the control and experimental groups, there was a significant increase in the proportion of POAC at discharge in comparison with admission to hospital: from 54.5 to 76.8% (p=0.0005) and from 63 to 85.7% (p=0.0002), respectively. However, only in the experimental group it was possible to significantly reduce the number of patients without a prescribed ACT (if there are indications) from 7.6 to 1% (p=0.04) in comparison with admission. During the study, it was possible to significantly increase physicians adherence level to the recommendations for the AC dosage regimen in patients with AF from 59% (44 discrepancies for 107 prescriptions) to 84.6% (16 discrepancies for 104 prescriptions); p0.005. Before the introduction of the DSS, the analysis of drug prescriptions revealed 56 drug errors (0.5 errors per patient), after the introduction of the DSS, the number of drug errors significantly decreased to 21 (0.2 errors per patient); p0.05. After the introduction of DSS, the number of sub-therapeutic doses of AC was reduced from 31 (27.7%) to 8 (7.6%); p0.05. CONCLUSION: The level of adherence to the recommendations for prescribing ACT to patients with AF in the hospital is high. The use of DSS increases the level of adherence to the recommendations on the AC dosage regimen in patients with AF, as well as eliminates errors in calculating the risk of ischemic stroke and systemic thromboembolic complications, and contributes to reducing the frequency of prescribing sub-therapeutic doses of AC.

Self-assembled nanoparticle patterns on carbon nanowall surfaces.

We observed that thermally treated carbon nanowalls serve efficiently as templates governing the formation of quasiperiodic patterns for nanoparticles deposited. Here we report self-assembled quasi-regular structures of diverse nanoparticles on a freestanding multilayer graphene-like material, i.e. carbon nanowalls. Metallic (Ag, Al, Co, Mo, Ni, and Ta) and semiconductor (Si) nanoparticles form coaxial polygonal closed loop structures or parallel equidistant rows, which evolve upon further deposition into bead-like structures and, finally, into nanowires. Weakly bonded nanoparticles decorate atomic steps, wrinkles and other extended defects on the carbon nanowalls as a result of anisotropic diffusion of atoms or clusters along the hexagonal sp(2)-carbon network followed by their aggregation and agglomeration. The decorated carbon nanowalls are found to be promising materials for surface enhanced Raman scattering (SERS) analysis.

[TULA HANTAVIRUS IN CRIMEA].

Genetic evidence of the Tula virus (TULV) in Crimea region of Russia is presented. Based on the reverse transcription PCR and subsequent sequence analysis, a total of 4 RNA isolates of the TULV were identified from the tissue samples of the Altai voles Microtus obscurus captured in the Bakhchisaray district of the Republic Crimea. Phylogenetic analysis of the S-, M-, and L-segment sequences of the Crimean TULV strains showed that they formed distinct genetic lineage, Russia IV, in the TULV variant. New sequences were most closely related to the lineage Russia I sequences obtained from common vole (M. arvalis) captured in the Tula region in Central Russia

Coronaviruses (Coronaviridae) of bats in the northern Caucasus and south of western Siberia.

INTRODUCTION: Bats are natural reservoirs of coronaviruses (Coronaviridae), which have caused three outbreaks of human disease SARS, MERS and COVID-19 or SARS-2 over the past decade. The purpose of the work is to study the diversity of coronaviruses among bats inhabiting the foothills and mountainous areas of the Republics of Dagestan, Altai and the Kemerovo region. MATERIALS AND METHODS: Samples of bat oral swabs and feces were tested for the presence of coronavirus RNA by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: It has been shown that the greater horseshoe bats (Rhinolophus ferrumequinum), inhabiting the Republic of Dagestan, are carriers of two different coronaviruses. One of the two coronaviruses is a member of the Sarbecovius subgenus of the Betacoronavirus genus, which includes the causative agents of SARS and COVID-19. The second coronavirus is assigned to the Decacovirus subgenus of the Alphacoronavirus genus and is most similar to viruses identified among Rhinolophus spp. from European and Middle Eastern countries. In the Altai Republic and Kemerovo region, coronaviruses belonging to the genus Alphacoronavirus, subgenus Pedacovirus, were found in the smooth-nosed bats: Ikonnikov`s bat (Myotis ikonnikovi) and the eastern bat (Myotis petax). The virus from the Altai Republic from M. ikonnikovi is close to viruses from Japan and Korea, as well as viruses from Myotis spp. from European countries. The virus from the Kemerovo region from M. petax groups with coronaviruses from Myotis spp. from Asian countries and is significantly different from coronaviruses previously discovered in the same natural host.

Reversal of the circular dichroism in angle-resolved photoemission from Bi2Te3.

The helical Dirac fermions at the surface of topological insulators show a strong circular dichroism which has been explained as being due to either the initial-state spin angular momentum, the initial-state orbital angular momentum, or the handedness of the experimental setup. All of these interpretations conflict with our data from Bi(2)Te(3) which depend on the photon energy and show several sign changes. Our one-step photoemission calculations coupled to ab initio theory confirm the sign change and assign the dichroism to a final-state effect. Instead, the spin polarization of the photoelectrons excited with linearly polarized light remains a reliable probe for the spin in the initial state.

[Shrew-borne hantaviruses (Hantaviridae: Orthohantavirus) in the Far East of Russia].

INTRODUCTION: Insectivores are newly recognized hantaviral reservoir worldwide. Four distinct shrew-borne hantaviruses (family Hantaviridae) have been identified in two regions located in southern and northern part of the Russian Far East, two genetic variants of Seewis virus (SWSV), Lena River virus (LENV), Kenkeme virus (KKMV) and Yakeshi virus (YKSV). Here, we describe geographic distribution of shrew-borne hantaviruses in southern part of the Russian Far East: Jewish Autonomous region, Khabarovsk Krai, Primorsky Krai and Sakhalin region. MATERIALS AND METHODS: Lung samples from shrews of genus Sorex, captured in the four regions of Far Eastern Russia, were examined for hantavirus RNA using reverse transcription polymerase chain reaction (RT-PCR). Phylogenetic analysis of the partial nucleotide sequences of viral genome was conducted using MEGA X software. RESULTS: New genetic variant of YKSV was identified in new reservoir host, long-clawed shrew (S. ungiuculatus) from Sakhalin Island. Genetic variant of SWSV, ARTV-Sc, has been found to circulate among S. caecutiens on the seacoast of Khabarovsk and Primorsky Krai. KKMV virus and second genetic variant of SWSV, ARTV-St, were found in S. roboratus and S. tundrensis, respectively from Jewish Autonomous region. CONCLUSION: Sorex-borne hantaviruses were found in all studied regions of Far Eastern Russia. Our results demonstrated co-evolution of SWSV, KKMV, and YKSV viruses throughout the geographic distribution of its hosts.

Tolerance of topological surface states towards magnetic moments: Fe on Bi2Se3.

We study the effect of Fe impurities deposited on the surface of the topological insulator Bi(2)Se(3) by means of core-level and angle-resolved photoelectron spectroscopy. The topological surface state reveals surface electron doping when the Fe is deposited at room temperature and hole doping with increased linearity when deposited at low temperature (~8 K). We show that in both cases the surface state remains intact and gapless, in contradiction to current belief. Our results suggest that the surface state can very well exist at functional interfaces with ferromagnets in future devices.

Nonmagnetic band gap at the Dirac point of the magnetic topological insulator (Bi(1-x)Mn(x))2Se3.

Magnetic doping is expected to open a band gap at the Dirac point of topological insulators by breaking time-reversal symmetry and to enable novel topological phases. Epitaxial (Bi(1-x)Mn(x))2Se3 is a prototypical magnetic topological insulator with a pronounced surface band gap of ∼100 meV. We show that this gap is neither due to ferromagnetic order in the bulk or at the surface nor to the local magnetic moment of the Mn, making the system unsuitable for realizing the novel phases. We further show that Mn doping does not affect the inverted bulk band gap and the system remains topologically nontrivial. We suggest that strong resonant scattering processes cause the gap at the Dirac point and support this by the observation of in-gap states using resonant photoemission. Our findings establish a mechanism for gap opening in topological surface states which challenges the currently known conditions for topological protection.

Decision support systems in clinical practice: The case of venous thromboembolism prevention.

BACKGROUND: Today medicine is facing a "knowledge crisis" in that explosively expanding medical knowledge encounters limited abilities to disseminate new practices [1]. Clinical practice guidelines (CPGs) are intended to promote high standards of care in specific areas of medicine by summarizing best clinical practice based on careful reviews of current research. However, doctors are often short of time to study these documents and check their updates, have little motivation for strict adherence to them. A systematic review of 11 studies reporting on 29 recommendations has found that median adherence to all recommendations was 34%, suggesting that potential benefits for patients from health research may be lost [2].Clinical decision support systems (CDSS) can serve as a knowledge translation tool, mediator between clinical guidelines and physicians by providing the right information to the right person at the right time. OBJECTIVE: To evaluate the effectiveness of implementation of international and national CPGs for venous thromboembolism (VTE) prevention with the help of CDSS in a general hospital. METHODS: A multifunctional CDSS based on national and international guidelines on the VTE prevention was developed and implemented in the Medical Center of the Bank of Russia (MC). The system has the following functionalities: 1) it supports the decision on the VTE prevention based on individual risk assessment of thrombosis (scales of Caprini, Rogers and Khorana, Padua Prediction Score, additional risk factors) and bleeding (IMPROVE scale for non-surgical patients, major bleeding scale for surgical patients and major orthopedic surgeries, hemorrhagic complications risk in cancer patients); 2) generates the summary containing the grade of recommendations and the level of evidence, personalized recommendations on regimen and duration of preventive antithrombotic therapy, dose correction according to creatinine clearance; 3) provides an audit form for and statistical analysis of VTE cases; 3) automatically generates a quality register for VTE prevention.CDSS was implemented in June 2014. We analyzed VTE cases identified by triggers (deep vein thrombosis diagnosed by Doppler ultrasound and pulmonary embolism at the chest CT) that occurred in 2014 before and after CDSS implementation, as well as in the first half of 2015. Patients with VTE diagnosed during the first 48 hours of hospitalization or receiving anticoagulants in therapeutic doses were excluded from the analysis. Chi-square test for linear trend and non-parametric methods of descriptive statistics were used for data analysis. RESULTS: CDSS utilization was regulated by a special hospital-wide policy; lectures were organized to educate doctors how to use the system. Although international recommendations require VTE risk assessment for all hospitalized patients (except those receiving anticoagulant in therapeutic doses), the doctors filled forms for only 306 patients during the first 6 months of CDSS functioning (14.1% of discharges with length of stay >48 hours during this period). In the first half of 2015 the coverage of VTE risk assessment with CDSS was 19% (n = 506). Correctness of filling out the forms was 78.4%, in the rest of cases doctors made mistakes in choosing patient's profile or when filling in risk scales.Doctors adhere to given recommendations in 85.4% of cases. Most often (47.5%) pharmacotherapy with low molecular weight heparin (LMWH), preventive doses, was recommended by the system, and in this category the adherence to recommended practice was the lowest (74.6%). Among patients who underwent pharmacoprophylaxis, in 21.1% cases the use of anticoagulants was inconsistent with clinical guidelines or drug package insert (typically inappropriate choice of LMWH prophylactic doses, delaying or reducing the duration of prophylaxis).The rate of hospital-acquired VTE significantly decreased after CDSS implementation and was 11.71, 8.28 and 4.84 per 1,000 hospitalizations in the first and second half of 2014 and in the first half of 2015, respectively (χ2 = 7.325, df = 1, p = 0.0068). The rate of postoperative VTE for the same period amounted to 8.76, 3.39 and 4.17 per 1,000 operations, respectively (χ2 = 7.266, df = 1, p = 0.007), reaching a level of the correspondent AHRQ safety indicator (4.99 per 1,000 operations) [3]. Deviations from clinical guidelines or anticoagulant package inserts were revealed in 74% of VTE cases; and more than 1/3 of deviations affected treatment outcomes. CONCLUSIONS: Coverage of hospitalized patients with documented VTE risk assessment gradually increased after the CDSS implementation, but remained at a low level (19% of eligible patients). Partly it may be attributed to the lack of CDSS integration in electronic health record or computerized physician order entry systems that would facilitate routine documentation of VTE and bleeding risks. However, the introduction of CDSS has allowed reducing significantly the rate of hospital-acquired VTE. This can be explained by drawing doctor's attention to the VTE problem and by training effect of CDSS. After receiving appropriate recommendations doctors adhere to them, on average, in 85.4% of cases, although for LMWH pharmacoprophylaxis this level was lower (74.6%). Development of hospital-acquired VTE in most cases (74%) was accompanied by non-compliance with CPGs recommendations, emphasizing the importance of additional measures for better adherence to evidence-based clinical practices.

Detection of highly conductive surface electron states in topological crystalline insulators Pb(1-x)SnxSe using laser terahertz radiation.

We suggest a method for detection of highly conductive surface electron states including topological ones. The method is based on measurements of the photoelectromagnetic effect using terahertz laser pulses. In contrast to conventional transport measurements, the method is not sensitive to the bulk conductivity. The method is demonstrated on an example of topological crystalline insulators Pb(1-x)SnxSe. It is shown that highly conductive surface electron states are present in Pb(1-x)SnxSe both in the inverse and direct electron energy spectrum.

Atomically precise semiconductor--graphene and hBN interfaces by Ge intercalation.

The full exploration of the potential, which graphene offers to nanoelectronics requires its integration into semiconductor technology. So far the real-world applications are limited by the ability to concomitantly achieve large single-crystalline domains on dielectrics and semiconductors and to tailor the interfaces between them. Here we show a new direct bottom-up method for the fabrication of high-quality atomically precise interfaces between 2D materials, like graphene and hexagonal boron nitride (hBN), and classical semiconductor via Ge intercalation. Using angle-resolved photoemission spectroscopy and complementary DFT modelling we observed for the first time that epitaxially grown graphene with the Ge monolayer underneath demonstrates Dirac Fermions unaffected by the substrate as well as an unperturbed electronic band structure of hBN. This approach provides the intrinsic relativistic 2D electron gas towards integration in semiconductor technology. Hence, these new interfaces are a promising path for the integration of graphene and hBN into state-of-the-art semiconductor technology.

Genetic diversity of hantaviruses associated with hemorrhagic fever with renal syndrome in the far east of Russia.

To identify the hantaviruses causing hemorrhagic fever with renal syndrome (HFRS) in the Far East of Russia, blood samples collected from HFRS patients in 1994-1998, were examined by reverse transcription-polymerase chain reaction. In addition, 36 sera were tested by an immunofluorescence assay for antibodies against Hantaan, Seoul, Puumala, and Khabarovsk viruses, and 54 samples were tested by plaque reduction neutralization test. With both serological assays, the highest antibody titers were to Hantaan and/or Seoul viruses. Of 110 blood samples 36 were found RT-PCR positive. Phylogenetic analysis the sequences of a 256-nucleotide (nt) fragment of the hantavirus M genome segment revealed at least 3 genetically distinct hantavirus lineages. Nucleotide sequence comparison showed that two of the lineages, designated as FE and Amur (AMR), differed from one another by 15.9-21.2% and from Hantaan virus by 9.8-17.5%. The third lineage, VDV, differed from Seoul virus by 2.6-5.1%. All S segment sequences were from FE lineage, and differed from Hantaan virus by 10.7-12.6%. Thirty of the 36 (83%) analyzed sequences were found to be the FE genotype, which is very similar to that of Hantaan virus, strain 76-118. Of the remaining hantaviruses, 11% were the AMR genotype, and 6% the VDV genotype, which are genetically novel genotypes of Hantaan or Seoul viruses, respectively.

Controlled assembly of graphene-capped nickel, cobalt and iron silicides.

The unique properties of graphene have raised high expectations regarding its application in carbon-based nanoscale devices that could complement or replace traditional silicon technology. This gave rise to the vast amount of researches on how to fabricate high-quality graphene and graphene nanocomposites that is currently going on. Here we show that graphene can be successfully integrated with the established metal-silicide technology. Starting from thin monocrystalline films of nickel, cobalt and iron, we were able to form metal silicides of high quality with a variety of stoichiometries under a Chemical Vapor Deposition grown graphene layer. These graphene-capped silicides are reliably protected against oxidation and can cover a wide range of electronic materials/device applications. Most importantly, the coupling between the graphene layer and the silicides is rather weak and the properties of quasi-freestanding graphene are widely preserved.

Carbon nanowalls: the next step for physical manifestation of the black body coating.

The optical properties of carbon nanowall (CNW) films in the visible range have been studied and reported for the first time. Depending on the film structure, ultra-low total reflectance up to 0.13% can be reached, which makes the CNW films a promising candidate for the black body-like coating, and thus for a wide range of applications as a light absorber. We have estimated important trends in the optical property variation from sample to sample, and identified the presence of edge states and domain boundaries in carbon nanowalls as well as the film mass density variation as the key factors. Also we demonstrated that at much lower film thickness and density than for a carbon nanotube forest the CNWs yield one order higher specific light absorption.

Prevalence of skin test reactions to natural rubber latex in hospital personnel in Russia and eastern Europe.

BACKGROUND: Allergic reactions to natural rubber latex have increased during the past 10 years, especially in many health care workers (HCWs) who have high exposure to latex allergens. The prevalence of skin test reactions to natural rubber latex in Russia, the Commonwealth of Independent States (CIS), and eastern Europe is unknown. OBJECTIVE: The purpose of this study was to determine the prevalence of skin test reactivity to natural rubber latex in a population of HCWs exposed to latex. METHODS: Nine hundred one HCWs regularly exposed to latex were evaluated using an allergy history questionnaire. Subjects were tested for latex allergy by titrated skin prick test with a biologically standardized latex extract. The diagnosis of latex allergy was defined by the presence of clinical symptoms when exposed to latex along with a positive skin prick test to latex. RESULTS: Forty-nine (5.4%) HCWs were skin test-positive to latex. Seventeen (1.9%) HCWs were classified as latex-allergic based upon positive skin tests to latex associated with allergy symptoms with exposure. Seven of 901 HCWs had experienced anaphylactic reactions to latex. The most frequently reported symptom related to latex exposure was contact urticaria. CONCLUSIONS: The prevalence of latex allergy among HCWs in Russia, the CIS, and adjacent eastern European countries is considerably less than reported in HCWs exposed to latex in western Europe and the United States. The low prevalence of latex allergy in Russia and the CIS suggests that lessened exposure to natural latex powdered gloves may diminish the prevalence of latex sensitization in HCWs in Russia and the CIS.