Cost Analysis of Long-Term Treatment of Patients with Symptomatic Gastroesophageal Reflux Disease (GERD) with Esomeprazole On-Demand Treatment or Esomeprazole Continuous Treatment: An Open, Randomized, Multicenter Study in Switzerland.

Objectives: To assess the difference in direct medical costs between on-demand (OD) treatment with esomeprazole (E) 20 mg and continuous (C) treatment with E 20 mg q.d. from a clinical practice view in patients with gastroesophageal reflux disease (GERD) symptoms. Methods: This open, randomized study (ONE: on-demand Nexium evaluation) compared two long-term management options with E 20 mg in endoscopically uninvestigated patients seeking primary care for GERD symptoms who demonstrated complete relief of symptoms after an initial treatment of 4 weeks with E 40 mg. Data on consumed quantities of all cost items were collected in the study, while data on prices during the time of study were collected separately. The analysis was done from a societal perspective. Results: Forty-nine percent (484 of 991) of patients randomized to the OD regimen and 46% (420 of 913) of the patients in the C group had at least one contact with the investigator that would have occurred nonprotocol-driven. The difference of the adjusted mean direct medical costs between the treatment groups was CHF 88.72 (95% confidence interval: CHF 41.34-153.95) in favor of the OD treatment strategy (Wilcoxon rank-sum test: P < 0.0001). Adjusted direct nonmedical costs and productivity loss were similar in both groups. Conclusions: The adjusted direct medical costs of a 6-month OD treatment with esomeprazole 20 mg in uninvestigated patients with symptoms of GERD were significantly lower compared with a continuous treatment with E 20 mg once a day. The OD therapy represents a cost-saving alternative to the continuous treatment strategy with E.

Etalonnage de trois ��preuves de recognition continue : Effets de l'��ge, du sexe et du niveau socio-professionnel sur les mesures de discrimination et de biais de r��ponse. [Standardization of three continuous recognition test forms - Effects of age, sex and socio-economic level on measurements of discrimination and response bias.]

Nous pr��sontons l'��talonnage d'un test mn��sique de recognition dans un ��chantillon de 180 adultes francophones de la Suisse Romande. Le test comprend trois formes utilisant un mat��riel verbal (mots) ou non verbal (visages ou paysages). Une attention particuli��re est accord��e �� l'��ge dans la pr��sentation des r��sultats. Celui-ci affecte plus pr��cocement et plus intens��ment la performance aux formes non verbales qu'�� la forme verbale du test. Il induit ��galement une importante augmentation du nombre de fausses reconnaissances pour les formes non verbales.

A qualitative continuous model of cellular auxin and brassinosteroid signaling and their crosstalk.

Motivation: Hormone pathway interactions are crucial in shaping plant development, such as synergism between the auxin and brassinosteroid pathways in cell elongation. Both hormone pathways have been characterized in detail, revealing several feedback loops. The complexity of this network, combined with a shortage of kinetic data, renders its quantitative analysis virtually impossible at present.Results: As a first step towards overcoming these obstacles, we analyzed the network using a Boolean logic approach to build models of auxin and brassinosteroid signaling, and their interaction. To compare these discrete dynamic models across conditions, we transformed them into qualitative continuous systems, which predict network component states more accurately and can accommodate kinetic data as they become available. To this end, we developed an extension for the SQUAD software, allowing semi-quantitative analysis of network states. Contrasting the developmental output depending on cell type-specific modulators enabled us to identify a most parsimonious model, which explains initially paradoxical mutant phenotypes and revealed a novel physiological feature.

Observation of a continuous interior crisis in the Hindmarsh-Rose neuron model.

Interior crises are understood as discontinuous changes of the size of a chaotic attractor that occur when an unstable periodic orbit collides with the chaotic attractor. We present here numerical evidence and theoretical reasoning which prove the existence of a chaos-chaos transition in which the change of the attractor size is sudden but continuous. This occurs in the Hindmarsh��Rose model of a neuron, at the transition point between the bursting and spiking dynamics, which are two different dynamic behaviors that this system is able to present. Moreover, besides the change in attractor size, other significant properties of the system undergoing the transitions do change in a relevant qualitative way. The mechanism for such transition is understood in terms of a simple one-dimensional map whose dynamics undergoes a crossover between two different universal behaviors

Continuous assessment of electrical epileptic activity in acute stroke.

OBJECTIVE: To determine the incidence and risk factors of electrical seizures and other electrical epileptic activity using continuous EEG (cEEG) in patients with acute stroke. METHODS: One hundred consecutive patients with acute stroke admitted to our stroke unit underwent cEEG using 10 electrodes. In addition to electrical seizures, repetitive focal sharp waves (RSHWs), repetitive focal spikes (RSPs), and periodic lateralized epileptic discharges (PLEDs) were recorded. RESULTS: In the 100 patients, cEEG was recorded for a mean duration of 17 hours 34 minutes (range 1 hour 12 minutes to 37 hours 10 minutes). Epileptic activity occurred in 17 patients and consisted of RSHWs in seven, RSPs in seven, and PLEDs in three. Electrical seizures occurred in two patients. On univariate Cox regression analysis, predictors for electrical epileptic activity were stroke severity (high score on the National Institutes of Health Stroke Scale) (hazard ratio [HR] 1.12; p = 0.002), cortical involvement (HR 5.71; p = 0.021), and thrombolysis (HR 3.27; p = 0.040). Age, sex, stroke type, use of EEG-modifying medication, and cardiovascular risk factors were not predictors of electrical epileptic activity. On multivariate analysis, stroke severity was the only independent predictor (HR 1.09; p = 0.016). CONCLUSION: In patients with acute stroke, electrical epileptic activity occurs more frequently than previously suspected.

Clinical relevance of L-carnitine-supplemented total parenteral nutrition in postoperative trauma. Metabolic effects of continuous or acute carnitine administration with special reference to fat oxidation and nitrogen utilization.

Carnitine-free total parenteral nutrition (TPN) is claimed to result in a carnitine deficiency with subsequent impairment of fat oxidation. The present study was designed to evaluate the possible benefit of carnitine supplementation on postoperative fat and nitrogen utilization. Sixteen patients undergoing total esophagectomy were evenly randomized and received TPN without or with L-carnitine supplementation (74 mumol.kg-1.d-1) during 11 postoperative days. On day 11, a 4-h infusion of L-carnitine (125 mumol/kg) was performed in both groups. The effect of supplementation was evaluated by indirect calorimetry, N balance, and repeated measurements of plasma lipids and ketone bodies. Irrespective of continuous or acute supplementation, respiratory quotient and fat oxidation were similarly maintained throughout the study in both groups whereas N balance appeared to be more favorable without carnitine. We conclude that carnitine-supplemented TPN does not improve fat oxidation or promote N utilization in the postoperative phase.

EFEITO DE INJ��RIAS MEC��NICAS NO PROCESSO RESPIRAT��RIO E NOS PAR��METROS QU��MICOS DE GOIABAS 'PALUMA' E 'PEDRO SATO'

O objetivo deste trabalho foi avaliar o efeito das inj��rias mec��nicas por impacto, compress��o ou corte na atividade respirat��ria e na composi����o qu��mica de goiabas 'Paluma' e 'Pedro Sato' colhidas no est��dio de matura����o "de vez" e armazenadas a 23,4��1 ��C e 62��6 % UR (condi����es de ambiente). Na inj��ria por impacto, os frutos foram deixados cair, por duas vezes e em queda livre, de uma altura de 1,20 m, sofrendo os impactos em lados opostos de sua por����o equatorial. Na inj��ria por compress��o, os frutos foram submetidos a um peso de 3 kg, por 15 minutos. Para a inj��ria por corte foram efetuados 2 cortes no sentido longitudinal dos frutos, de 30 mm de comprimento por 2 mm de profundidade. Os frutos injuriados foram colocados em bandejas de isopor e armazenados sob as condi����es de ambiente, com a atividade respirat��ria avaliada diariamente e seus conte��dos de s��lidos sol��veis totais, a����cares redutores, acidez total titul��vel e ��cido asc��rbico, determinados a cada 2 dias. Houve um incremento na evolu����o da atividade respirat��ria dos frutos em todos os tratamentos durante o armazenamento, com os injuriados produzindo maior quantidade de CO2 (184,12 mg de CO2.kg-1.h-1) que os do controle (164,23 mg de CO2.kg-1.h-1). Os frutos da 'Paluma' apresentaram essa atividade mais intensa (178,39 mg de CO2.kg-1.h-1) que os da 'Pedro Sato' (169,35 mg de CO2.kg-1.h-1), e n��o se detectou durante o per��odo de armazenamento a ocorr��ncia de pico respirat��rio. Os teores de s��lidos sol��veis totais (9,39 ��Brix), a����cares redutores (2,24 g de glicose.100 g-1), acidez total titul��vel (706,25 mg de ��cido c��trico.100 g-1) e ��cido asc��rbico (65,33 mg.100 g-1) dos frutos injuriados apresentaram-se com valores menores que os do controle, ao longo do per��odo de armazenamento.

Disposition of valganciclovir during continuous renal replacement therapy in two lung transplant recipients.

OBJECTIVES: To determine whether valganciclovir 450 mg every 48 h for cytomegalovirus (CMV) prophylaxis provides appropriate ganciclovir exposure in solid organ transplant recipients during continuous renal replacement therapy (CRRT). PATIENTS AND METHODS: Ganciclovir pharmacokinetics was intensively studied in two lung transplant recipients under valganciclovir 450 mg every 48 h over one dosing interval. In vitro experiments using blank whole blood spiked with ganciclovir further investigated exchanges between plasma and erythrocytes. RESULTS: Ganciclovir disposition was characterized by apparent total body clearance of 3.3 and 5.8 L/h, terminal half-life of 16.9 and 14.1 h, and apparent volume of distribution of 60.3 and 104.9 L in Patients 1 and 2, respectively. The observed sieving coefficient was 1.05 and 0.96, and the haemofiltration clearance was 3.3 and 3.1 L/h. In vitro experiments confirmed rapid efflux of ganciclovir from red blood cells into plasma, increasing the apparent efficacy of haemofiltration. CONCLUSIONS: A valganciclovir dosage of 450 mg every 48 h appears adequate for patients under CRRT requiring prophylaxis for CMV infection, providing concentration levels in the range reported for 900 mg once daily dosing outside renal failure.

Continuous positive airway pressure causes lung injury in a model of sepsis.

Continuous positive airway pressure, aimed at preventing pulmonary atelectasis, has been used for decades to reduce lung injury in critically ill patients. In neonatal practice, it is increasingly used worldwide as a primary form of respiratory support due to its low cost and because it reduces the need for endotracheal intubation and conventional mechanical ventilation. We studied the anesthetized in vivo rat and determined the optimal circuit design for delivery of continuous positive airway pressure. We investigated the effects of continuous positive airway pressure following lipopolysaccharide administration in the anesthetized rat. Whereas neither continuous positive airway pressure nor lipopolysaccharide alone caused lung injury, continuous positive airway pressure applied following intravenous lipopolysaccharide resulted in increased microvascular permeability, elevated cytokine protein and mRNA production, and impaired static compliance. A dose-response relationship was demonstrated whereby higher levels of continuous positive airway pressure (up to 6 cmH(2)O) caused greater lung injury. Lung injury was attenuated by pretreatment with dexamethasone. These data demonstrate that despite optimal circuit design, continuous positive airway pressure causes significant lung injury (proportional to the airway pressure) in the setting of circulating lipopolysaccharide. Although we would currently avoid direct extrapolation of these findings to clinical practice, we believe that in the context of increasing clinical use, these data are grounds for concern and warrant further investigation.

An experience beyond continuous assessment activities: virtual tour to the medieval medicinal plant garden of the Pedralbes monastery

[eng] The group of teaching innovation in the area of Botany (GIBAF), University of Barcelona (UB), is raised each year to design new accreditation activities under continuous evaluation framework. We present the experience carried out during the academic year 2008-09 in the course of Pharmaceutical Botany. The aim has been to involve students for a semester in the authorship of a tutored project immediately useful and of easy permanence, beyond its assessment proving usefulness. The Medicinal Plants Garden of the Monastery of Pedralbes has been used as a resource and a collaboration agreement has been signed between the UB faculty and the Institute of Culture of Barcelona. The students have developed the work using the Moodle platform CampusvirtualUB into five stages which included preparation of files by students that have been modified in some steps following the various feedbacks from teachers. At the beginning of the activity, students were provided with a complete schedule of activities, the schedule for its implementation, and a total of 18 forced-use library resources. Finally, through Google sites, a website has been implemented, allowing for a virtual tour of the garden, documenting by referenced literature 50 medicinal plants for their nomenclature, botanical description, distribution, uses historical, current and future) and toxicity. The result of the activity was presented at a public ceremony in the Monastery of Pedralbes and is available at: http://sites.google.com/site/jardimedievalpedralbes/ [spa] El grupo de innovaci��n docente integrado por profesores del ��rea de Bot��nica (GIBAF) de la Universidad de Barcelona (UB) se plantea cada curso el dise��o de nuevas actividades acreditativas en el marco de la evaluaci��n continuada. Se presenta la experiencia llevada a cabo durante el curso 2008-09 en la asignatura Bot��nica Farmac��utica. El objetivo ha sido implicar durante un semestre a los estudiantes en la autor��a de un proyecto tutorizado de inmediata utilidad y clara perdurabilidad, m��s all�� de su utilidad acreditativa. Como recurso se ha utilizado el Jard��n de Plantas Medicinales del Monasterio de Pedralbes y se ha firmado un convenio de colaboraci��n docente entre la UB y el Instituto de Cultura de Barcelona. Los estudiantes han realizado el trabajo utilizando la plataforma Moodle del Campus virtual de la UB en cinco etapas que han incluido la confecci��n de unas fichas que se han ido modificando en funci��n de las diversas retroacciones de los profesores. Al inicio de la actividad, se facilit�� a los estudiantes el cronograma completo de la actividad, la pauta para su realizaci��n, as�� como un total de 18 recursos bibliogr��ficos de uso obligado. Finalmente, a trav��s de GoogleSites, se ha realizado una web que permite realizar un paseo virtual por el jard��n, documentando de forma referenciada para las 50 plantas medicinales su nomenclatura, descripci��n bot��nica, distribuci��n, usos (hist��ricos, actuales y futuros) y toxicidad. El resultado de la actividad fue presentado en un acto p��blico en el Monasterio de Pedralbes y puede consultarse en: http://sites.google.com/site/jardimedievalpedralbes/

Long-term continuous-flow left ventricular assist devices (LVAD) as bridge to heart transplantation.

Heart transplantation (HTx) is the treatment of choice for end-stage heart failure but the limited availability of heart's donors still represents a major issue. So long-term mechanical circulatory support (MCS) has been proposed as an alternative treatment option to assist patients scheduled on HTx waiting list bridging them for a variable time period to cardiac transplantation-the so-called bridge-to-transplantation (BTT) strategy. Nowadays approximately 90% of patients being considered for MCS receive a left ventricular assist device (LVAD). In fact, LVAD experienced several improvements in the last decade and the predominance of continuous-flow over pulsatile-flow technology has been evident since 2008. The aim of the present report is to give an overview of continuous-flow LVAD utilization in the specific setting of the BTT strategy taking into consideration the most representative articles of the scientific literature and focusing the attention on the evolution, clinical outcomes, relevant implications on the HTx strategy and future perspectives of the continuous-flow LVAD technology.

The differentiable chain functor is not homotopy equivalent to the continuous chain functor

Let $S_*$ and $S_*^\{infty}$ be the functors of continuous and differentiable singular chains on the category of differentiable manifolds. We prove that the natural transformation $i: S_*^\infty \rightarrow S_*$, which induces homology equivalences over each manifold, is not a natural homotopy equivalence.

Mueller matrix microscope with a dual continuous rotating compensator setup and digital demodulation

In this paper we describe a new Mueller matrix (MM) microscope that generalizes and makes quantitative the polarized light microscopy technique. In this instrument all the elements of the MU are simultaneously determined from the analysis in the frequency domain of the time-dependent intensity of the light beam at every pixel of the camera. The variations in intensity are created by the two compensators continuously rotating at different angular frequencies. A typical measurement is completed in a little over one minute and it can be applied to any visible wavelength. Some examples are presented to demonstrate the capabilities of the instrument.

Bases cerebrales de la atenci��n sostenida y la memoria de trabajo: un estudio de resonancia magn��tica funcional basado en el Continuous Performance Test

Introducci��n. Uno de los paradigmas m��s utilizados en el estudio de la atenci��n es el Continuous Performance Test (CPT). La versi��n de pares id��nticos (CPT-IP) se ha utilizado ampliamente para evaluar los d��ficits de atenci��n en los trastornos del neurodesarrollo, neurol��gicos y psiqui��tricos. Sin embargo, la localizaci��n de la activaci��n cerebral de las redes atencionales var��a significativamente seg��n el dise��o de resonancia magn��tica funcional (RMf) usado. Objetivo. Dise��ar una tarea para evaluar la atenci��n sostenida y la memoria de trabajo mediante RMf para proporcionar datos de investigaci��n relacionados con la localizaci��n y el papel de estas funciones. Sujetos y m��todos. El estudio cont�� con la participaci��n de 40 estudiantes, todos ellos diestros (50%, mujeres; rango: 18-25 a��os). La tarea de CPT-IP se dise���� como una tarea de bloques, en la que se combinaban los per��odos CPT-IP con los de reposo. Resultados. La tarea de CPT-IP utilizada activa una red formada por regiones frontales, parietales y occipitales, y ��stas se relacionan con funciones ejecutivas y atencionales. Conclusiones. La tarea de CPT-IP utilizada en nuestro trabajo proporciona datos normativos en adultos sanos para el estudio del sustrato neural de la atenci��n sostenida y la memoria de trabajo. Estos datos podr��an ser ��tiles para evaluar trastornos que cursan con d��ficits en memoria de trabajo y en atenci��n sostenida.