Parents' willingness to pay for diminishing children's pain during blood sampling.

BACKGROUND: Blood sampling is a frequent medical procedure, very often considered as a stressful experience by children. Local anesthetics have been developed, but are expensive and not reimbursed by insurance companies in our country. We wanted to assess parents' willingness to pay (WTP) for this kind of drug. PATIENTS AND METHODS: Over 6 months, all parents of children presenting for general (GV) or specialized visit (SV) with blood sampling. WTP was assessed through three scenarios [avoiding blood sampling (ABS), using the drug on prescription (PD), or over the counter (OTC)], with a payment card system randomized to ascending or descending order of prices (AO or DO). RESULTS: Fifty-six responses were collected (34 GV, 22 SV, 27 AO and 29 DO), response rate 40%. Response distribution was wide, with median WTP of 40 for ABS, 25 for PD, 10 for OTC, which is close to the drug's real price. Responses were similar for GV and SV. Median WTP amounted to 0.71, 0.67, 0.20% of respondents' monthly income for the three scenarios, respectively, with a maximum at 10%. CONCLUSIONS: Assessing parents' WTP in an outpatient setting is difficult, with wide result distribution, but median WTP is close to the real drug price. This finding could be used to promote insurance coverage for this drug.

Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Switzerland: sampling only invasive isolates does not allow a representative description of the local diversity of clones.

We conducted a molecular study of MRSA isolated in Swiss hospitals, including the first five consecutive isolates recovered from blood cultures and the first ten isolates recovered from other sites in newly identified carriers. Among 73 MRSA isolates, 44 different double locus sequence typing (DLST) types and 32 spa types were observed. Most isolates belonged to the NewYork/Japan, the UK-EMRSA-15, the South German and the Berlin clones. In a country with a low to moderate MRSA incidence, inclusion of non-invasive isolates allowed a more accurate description of the diversity.

Multidimensionnalité des violences envers les femmes. La Suisse en regard des États-Unis: pertinence et validité d'une comparaison

Summary : International comparisons in the area of victimization, particularly in the field of violence against women, are fraught with methodological problems that previous research has not systematically addressed, and whose answer does not seem to be agreed up~n. For obvious logistic and financial reasons, international studies on violence against women (i.e. studies that administer the same instrument in different countries). are seldom; therefore, researchers are bound to resort to secondary comparisons. Many studies simply juxtapose their results to the ones of previous wòrk or to findings obtained in different contexts, in order to offer an allegedly comparative perspective to their conclusions. If, most of the time, researchers indicate the methodological limitations of a direct comparison, it is not rare that these do not result in concrete methodological controls. Yet, many studies have shown the influence of surveys methodological parameters on findings, listing recommendations fora «best practice» of research. Although, over the past decades, violence against women surveys have become more and more similar -tending towards a sort of uniformization that could be interpreted as a passive consensus -these instruments retain more or less subtle differences that are still susceptible to influence the validity of a comparison. Yet, only a small number of studies have directly worked on the comparability of violence against women data, striving to control the methodological parameters of the surveys in order to guarantee the validity of their comparisons. The goal of this work is to compare data from two national surveys on violence against women: the Swiss component of the International Violence Against Women Survey [CH-IVAWS] and the National Violence Against Women Survey [NVAWS] administered in the United States. The choice of these studies certainly ensues from the author's affiliations; however, it is far from being trivial. Indeed, the criminological field currently endows American and Anglo-Saxon literature with a predominant space, compelling researchers from other countries to almost do the splits to interpret their results in the light of previous work or to develop effective interventions in their own context. Turning to hypotheses or concepts developed in a specific framework inevitably raises the issue of their applicability to another context, i.e. the Swiss context, if not at least European. This problematic then takes on an interest that goes beyond the particular topic of violence against women, adding to its relevance. This work articulates around three axes. First, it shows the way survey characteristics influence estimates. The comparability of the nature of the CH-IVAWS and NVAWS, their sampling design and the characteristics of their administration are discussed. The definitions used, the operationalization of variables based on comparable items, the control of reference periods, as well as the nature of the victim-offender relationship are included among controlled factors. This study establishes content validity within and across studies, presenting a systematic process destined to maximize the comparability of secondary data. Implications of the process are illustrated with the successive presentation of comparable and non-comparable operationalizations of computed variables. Measuring violence against. women in Switzerland and the United-States, this work compares the prevalence of different forms (threats, physical violence and sexual violence) and types of violence (partner and nonpartner violence). Second, it endeavors to analyze concepts of multivictimization (i.e. experiencing different forms of victimization), repeat victimization (i.e. experiencing the same form of violence more than once), and revictimization (i.e. the link between childhood and adulthood victimization) in a comparative -and comparable -approach. Third, aiming at understanding why partner violence appears higher in the United States, while victims of nonpartners are more frequent in Switzerland, as well as in other European countries, different victimization correlates are examined. This research contributes to a better understanding of the relevance of controlling methodological parameters in comparisons across studies, as it illustrates, systematically, the imposed controls and their implications on quantitative data. Moreover, it details how ignoring these parameters might lead to erroneous conclusions, statistically as well as theoretically. The conclusion of the study puts into a wider perspective the discussion of differences and similarities of violence against women in Switzerland and the United States, and integrates recommendations as to the relevance and validity of international comparisons, whatever the'field they are conducted in. Résumé: Les comparaisons internationales dans le domaine de la victimisation, et plus particulièrement en ce qui concerne les violences envers les femmes, se caractérisent par des problèmes méthodologiques que les recherches antérieures n'ont pas systématiquement adressés, et dont la réponse ne semble pas connaître de consensus. Pour des raisons logistiques et financières évidentes, les études internationales sur les violences envers les femmes (c.-à-d. les études utilisant un même instrument dans différents pays) sont rares, aussi les chercheurs sont-ils contraints de se tourner vers des comparaisons secondaires. Beaucoup de recherches juxtaposent alors simplement leurs résultats à ceux de travaux antérieurs ou à des résultats obtenus dans d'autres contextes, afin d'offrir à leurs conclusions une perspective prétendument comparative. Si, le plus souvent, les auteurs indiquent les limites méthodologiques d'une comparaison directe, il est fréquent que ces dernières ne se traduisent pas par des contrôles méthodologiques concrets. Et pourtant, quantité de travaux ont mis en évidence l'influence des paramètres méthodologiques des enquêtes sur les résultats obtenus, érigeant des listes de recommandations pour une «meilleure pratique» de la recherche. Bien que, ces dernières décennies, les sondages sur les violences envers les femmes soient devenus de plus en plus similaires -tendant, vers une certaine uniformisation que l'on peut interpréter comme un consensus passif-, il n'en demeure pas moins que ces instruments possèdent des différences plus ou moins subtiles, mais toujours susceptibles d'influencer la validité d'une comparaison. Pourtant, seules quelques recherches ont directement travaillé sur la comparabilité des données sur les violences envers les femmes, ayant à coeur de contrôler les paramètres méthodologiques des études utilisées afin de garantir la validité de leurs comparaisons. L'objectif de ce travail est la comparaison des données de deux sondages nationaux sur les violences envers les femmes: le composant suisse de l'International Violence Against Women Survey [CHIVAWSj et le National Violence Against Women Survey [NVAWS) administré aux États-Unis. Le choix de ces deux études découle certes des affiliations de l'auteure, cependant il est loin d'être anodin. Le champ criminologique actuel confère, en effet, une place prépondérante à la littérature américaine et anglo-saxonne, contraignant ainsi les chercheurs d'autres pays à un exercice proche du grand écart pour interpréter leurs résultats à la lumière des travaux antérieurs ou développer des interventions efficaces dans leur propre contexte. Le fait de recourir à des hypothèses et des concepts développés dans un cadre spécifique pose inévitablement la question de leur applicabilité à un autre contexte, soit ici le contexte suisse, sinon du moins européen. Cette problématique revêt alors un intérêt qui dépasse la thématique spécifique des violences envers les femmes, ce qui ajoute à sa pertinence. Ce travail s'articule autour de trois axes. Premièrement, il met en évidence la manière dont les caractéristiques d'un sondage influencent les estimations qui en découlent. La comparabilité de la nature du CH-IVAWS et du NVAWS, de leur processus d'échantillonnage et des caractéristiques de leur administration est discutée. Les définitions utilisées, l'opérationnalisation des variables sur la base d'items comparables, le contrôle des périodes de référence, ainsi que la nature de la relation victime-auteur figurent également parmi les facteurs contrôlés. Ce travail établit ainsi la validité de contenu intra- et inter-études, offrant un processus systématique destiné à maximiser la comparabilité des données secondaires. Les implications de cette démarche sont illustrées avec la présentation successive d'opérationnalisations comparables et non-comparables des variables construites. Mesurant les violences envers les femmes en Suisse et aux États-Unis, ce travail compare la prévalence de plusieurs formes (menaces, violences physiques et violences sexuelles) et types de violence (violences partenaires et non-partenaires). 11 s'attache également à analyser les concepts de multivictimisation (c.-à-d. le fait de subir plusieurs formes de victimisation), victimisation répétée (c.-à.-d. le fait de subir plusieurs incidents de même forme) et revictimisation (c.-à-d. le lien entre la victimisation dans l'enfance et à l'âge adulte) dans une approche comparative - et comparable. Dans un troisième temps, cherchant à comprendre pourquoi la violence des partenaires apparaît plus fréquente aux États-Unis, tandis que les victimes de non-partenaires sont plus nombreuses en Suisse, et dans d'autres pays européens, différents facteurs associés à la victimisation sont évalués. Cette recherche participe d'une meilleure compréhension de la pertinence du contrôle des paramètres méthodologiques dans les comparaisons entre études puisqu'elle illustre, pas à pas, les contrôles imposés et leurs effets sur les données quantitatives, et surtout comment l'ignorance de ces paramètres peut conduire à des conclusions erronées, tant statistiquement que théoriquement. La conclusion replace, dans un contexte plus large, la discussion des différences et des similitudes observées quant à la prévalence des violences envers les femmes en Suisse et aux États-Unis, et intègre des recommandations quant à la pertinence et à la validité des comparaisons internationales, cela quel que soit le domaine considéré.

Exposition des enfants à la fumée passive: le point sur des campagnes de sensibilisation

Enfants de moins de 10 ans fumant passivement 14 cigarettes ! D'avril 2010 à avril 2011, l'exposition de 148 enfants (81 garçons et 67 filles) a été testée: 10 enfants de moins d'un an, 25 de 1 à 5 ans, 19 de 5 à 10 ans, 30 de 10 à 15 ans et 64 de 15 à 18 ans. 10 d'entre eux sont des fumeurs et la plus jeune de 14 ans fume 10 cigarettes par jour. Leurs parents, ou parfois des jeunes eux-mêmes, ont commandé de manière volontaire, via les sites Internet des CIPRET Valais, Vaud et Genève, un badge MoNIC gratuit. Les résultats quant à l'exposition de ces enfants interpellent et méritent l'attention.Pour l'ensemble des enfants, la concentration moyenne de nicotine dans leur environnement intérieur mesurée via les dispositifs MoNIC est de 0,5 mg/m3, avec des maximums pouvant aller jusqu'à 21 mg/m3. Pour le collectif d'enfants âgés de moins de 10 ans (26 garçons et 28 filles; tous non-fumeurs), la concentration de nicotine n'est pas négligeable (moyenne 0,069 mg/m3, min 0, max 0,583 mg/m3). En convertissant ce résultat en équivalent de cigarettes inhalées passivement, nous obtenons des chiffres allant de 0 à 14 cigarettes par jour* avec une moyenne se situant à 1.6 cig/j. Encore plus surprenant, les enfants de moins d'un an (4 garçons et 6 filles) inhalent passivement, dans le cadre familial, en moyenne 1 cigarette (min 0, max 2.2). Pour les deux autres collectifs: 10-15 ans et 15-18 ans, les valeurs maximales avoisinent les 22 cigarettes. Notons cependant que ce résultat est influencé, ce qui n'est pas le cas des enfants plus jeunes, par le fait que ces jeunes sont également parfois des fumeurs actifs.* Quand la durée d'exposition dépassait 1 jour (8 heures), le nombre d'heures a toujours été divisé par 8 heures. Le résultat obtenu donne l'équivalent de cigarettes fumées passivement en huit heures. Il s'agit de ce fait d'une moyenne, ce qui veut dire que durant cette période les enfants ont pu être exposés irrégulièrement à des valeurs supérieures ou inférieures à cette moyenne. [Auteurs]

Free-breathing 3D steady-state free precession coronary MR angiography with radial k-space sampling: comparison with cartesian k-space sampling and cartesian gradient-echo coronary MR angiography--pilot study.

The authors compared radial steady-state free precession (SSFP) coronary magnetic resonance (MR) angiography, cartesian k-space sampling SSFP coronary MR angiography, and gradient-echo coronary MR angiography in 16 healthy adults and four pilot study patients. Standard gradient-echo MR imaging with a T2 preparatory pulse and cartesian k-space sampling was the reference technique. Image quality was compared by using subjective motion artifact level and objective contrast-to-noise ratio and vessel sharpness. Radial SSFP, compared with cartesian SSFP and gradient-echo MR angiography, resulted in reduced motion artifacts and superior vessel sharpness. Cartesian SSFP resulted in increased motion artifacts (P <.05). Contrast-to-noise ratio with radial SSFP was lower than that with cartesian SSFP and similar to that with the reference technique. Radial SSFP coronary MR angiography appears preferable because of improved definition of vessel borders.

A detailed urinary excretion time course study of captan and folpet biomarkers in workers for the estimation of dose, main route-of-entry and most appropriate sampling and analysis strategies

Captan and folpet are two fungicides largely used in agriculture, but biomonitoring data are mostly limited to measurements of captan metabolite concentrations in spot urine samples of workers, which complicate interpretation of results in terms of internal dose estimation, daily variations according to tasks performed, and most plausible routes of exposure. This study aimed at performing repeated biological measurements of exposure to captan and folpet in field workers (i) to better assess internal dose along with main routes-of-entry according to tasks and (ii) to establish most appropriate sampling and analysis strategies. The detailed urinary excretion time courses of specific and non-specific biomarkers of exposure to captan and folpet were established in tree farmers (n = 2) and grape growers (n = 3) over a typical workweek (seven consecutive days), including spraying and harvest activities. The impact of the expression of urinary measurements [excretion rate values adjusted or not for creatinine or cumulative amounts over given time periods (8, 12, and 24 h)] was evaluated. Absorbed doses and main routes-of-entry were then estimated from the 24-h cumulative urinary amounts through the use of a kinetic model. The time courses showed that exposure levels were higher during spraying than harvest activities. Model simulations also suggest a limited absorption in the studied workers and an exposure mostly through the dermal route. It further pointed out the advantage of expressing biomarker values in terms of body weight-adjusted amounts in repeated 24-h urine collections as compared to concentrations or excretion rates in spot samples, without the necessity for creatinine corrections.

New microfluidic-based sampling procedure for overcoming the hematocrit problem associated with dried blood spot analysis.

Hematocrit (Hct) is one of the most critical issues associated with the bioanalytical methods used for dried blood spot (DBS) sample analysis. Because Hct determines the viscosity of blood, it may affect the spreading of blood onto the filter paper. Hence, accurate quantitative data can only be obtained if the size of the paper filter extracted contains a fixed blood volume. We describe for the first time a microfluidic-based sampling procedure to enable accurate blood volume collection on commercially available DBS cards. The system allows the collection of a controlled volume of blood (e.g., 5 or 10 μL) within several seconds. Reproducibility of the sampling volume was examined in vivo on capillary blood by quantifying caffeine and paraxanthine on 5 different extracted DBS spots at two different time points and in vitro with a test compound, Mavoglurant, on 10 different spots at two Hct levels. Entire spots were extracted. In addition, the accuracy and precision (n = 3) data for the Mavoglurant quantitation in blood with Hct levels between 26% and 62% were evaluated. The interspot precision data were below 9.0%, which was equivalent to that of a manually spotted volume with a pipet. No Hct effect was observed in the quantitative results obtained for Hct levels from 26% to 62%. These data indicate that our microfluidic-based sampling procedure is accurate and precise and that the analysis of Mavoglurant is not affected by the Hct values. This provides a simple procedure for DBS sampling with a fixed volume of capillary blood, which could eliminate the recurrent Hct issue linked to DBS sample analysis.

Test result-based sampling: an efficient design for estimating the accuracy of patient safety indicators.

OBJECTIVE: Accuracy studies of Patient Safety Indicators (PSIs) are critical but limited by the large samples required due to low occurrence of most events. We tested a sampling design based on test results (verification-biased sampling [VBS]) that minimizes the number of subjects to be verified. METHODS: We considered 3 real PSIs, whose rates were calculated using 3 years of discharge data from a university hospital and a hypothetical screen of very rare events. Sample size estimates, based on the expected sensitivity and precision, were compared across 4 study designs: random and VBS, with and without constraints on the size of the population to be screened. RESULTS: Over sensitivities ranging from 0.3 to 0.7 and PSI prevalence levels ranging from 0.02 to 0.2, the optimal VBS strategy makes it possible to reduce sample size by up to 60% in comparison with simple random sampling. For PSI prevalence levels below 1%, the minimal sample size required was still over 5000. CONCLUSIONS: Verification-biased sampling permits substantial savings in the required sample size for PSI validation studies. However, sample sizes still need to be very large for many of the rarer PSIs.

MRI of coronary vessel walls using radial k-space sampling and steady-state free precession imaging.

OBJECTIVE: The objective of our study was to investigate the impact of radial k-space sampling and steady-state free precession (SSFP) imaging on image quality in MRI of coronary vessel walls. SUBJECTS AND METHODS: Eleven subjects were examined on a 1.5-T MR system using three high-resolution navigator-gated and cardiac-triggered 3D black blood sequences (cartesian gradient-echo [GRE], radial GRE, and radial SSFP) with identical spatial resolution (0.9 x 0.9 x 2.4 mm3). The signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), vessel wall sharpness, and motion artifacts were analyzed. RESULTS: The mean SNR and CNR of the coronary vessel wall were improved using radial imaging and were best using radial k-space sampling combined with SSFP imaging. Vessel border definition was similar for all three sequences. Radial k-space sampling was found to be less sensitive to motion. Consistently good image quality was seen with the radial GRE sequence. CONCLUSION: Radial k-space sampling in MRI of coronary vessel walls resulted in fewer motion artifacts and improved SNR and CNR. The use of SSFP imaging, however, did not result in improved coronary vessel wall visualization.

Lipophilicity and its relationship with passive drug permeation.

In this review, we first summarize the structure and properties of biological membranes and the routes of passive drug transfer through physiological barriers. Lipophilicity is then introduced in terms of the intermolecular interactions it encodes. Finally, lipophilicity indices from isotropic solvent systems and from anisotropic membrane-like systems are discussed for their capacity to predict passive drug permeation across biological membranes such as the intestinal epithelium, the blood-brain barrier (BBB) or the skin. The broad evidence presented here shows that beyond the predictive power of lipophilicity parameters, the various intermolecular forces they encode allow a mechanistic interpretation of passive drug permeation.

Prospective sampling based on model ensembles improves the detection of rare species

Identifying the geographic distribution of populations is a basic, yet crucial step in many fundamental and applied ecological projects, as it provides key information on which many subsequent analyses depend. However, this task is often costly and time consuming, especially where rare species are concerned and where most sampling designs generally prove inefficient. At the same time, rare species are those for which distribution data are most needed for their conservation to be effective. To enhance fieldwork sampling, model-based sampling (MBS) uses predictions from species distribution models: when looking for the species in areas of high habitat suitability, chances should be higher to find them. We thoroughly tested the efficiency of MBS by conducting an important survey in the Swiss Alps, assessing the detection rate of three rare and five common plant species. For each species, habitat suitability maps were produced following an ensemble modeling framework combining two spatial resolutions and two modeling techniques. We tested the efficiency of MBS and the accuracy of our models by sampling 240 sites in the field (30 sitesx8 species). Across all species, the MBS approach proved to be effective. In particular, the MBS design strictly led to the discovery of six sites of presence of one rare plant, increasing chances to find this species from 0 to 50%. For common species, MBS doubled the new population discovery rates as compared to random sampling. Habitat suitability maps coming from the combination of four individual modeling methods predicted well the species' distribution and more accurately than the individual models. As a conclusion, using MBS for fieldwork could efficiently help in increasing our knowledge of rare species distribution. More generally, we recommend using habitat suitability models to support conservation plans.