Disease identification based on ambulatory drugs dispensation and in-hospital ICD-10 diagnoses: a comparison.

BACKGROUND: Pharmacy-based case mix measures are an alternative source of information to the relatively scarce outpatient diagnoses data. But most published tools use national drug nomenclatures and offer no head-to-head comparisons between drugs-related and diagnoses-based categories. The objective of the study was to test the accuracy of drugs-based morbidity groups derived from the World Health Organization Anatomical Therapeutic Chemical Classification of drugs by checking them against diagnoses-based groups. METHODS: We compared drugs-based categories with their diagnoses-based analogues using anonymous data on 108,915 individuals insured with one of four companies. They were followed throughout 2005 and 2006 and hospitalized at least once during this period. The agreement between the two approaches was measured by weighted kappa coefficients. The reproducibility of the drugs-based morbidity measure over the 2 years was assessed for all enrollees. RESULTS: Eighty percent used a drug associated with at least one of the 60 morbidity categories derived from drugs dispensation. After accounting for inpatient under-coding, fifteen conditions agreed sufficiently with their diagnoses-based counterparts to be considered alternative strategies to diagnoses. In addition, they exhibited good reproducibility and allowed prevalence estimates in accordance with national estimates. For 22 conditions, drugs-based information identified accurately a subset of the population defined by diagnoses. CONCLUSIONS: Most categories provide insurers with health status information that could be exploited for healthcare expenditure prediction or ambulatory cost control, especially when ambulatory diagnoses are not available. However, due to insufficient concordance with their diagnoses-based analogues, their use for morbidity indicators is limited.

1.° Bartholomaei Facii ad Alphonsum Regem dialogus de vitae felicitate. — 2.° Ejusdem epistola ad Robertum Strozam. — 3.° Mafei Vegii, Laudensis, dialogus de felicitate et miseria. — 4.° Ejusdem ad Eustachium, fratrem suum, dialogus de injuriis veritati illatis. — 5.° Anonymi dialogus inter Epicureum et Stoïcum de virtute et voluptate. — 6.° Platonis dialogus de morte contemnenda : interprete Cincio, Romano. — 7.° Plutarchi sermo de virtute et vitio : eodem interprete. — 8.° Apologia Socratis : authore Platone ; interprete verò Leonardo Aretino. — 9.° Platonis Crito : interprete anonymo. — 10.° Luciani Toxaris, sive, dialogus de amicitia : interprete anonymo.

Rogerii de Gaignieres

1.° Ars judiciaria secundùm novem Judices : authore anonymo. — 2.° Anonymi liber de inundatione Nili. — 3.° Anonymi liber de coloribus. — 4.° Anonymi liber de bona fortuna. — 5.° Anonymi libellus de lineis invisibilibus. — 6.° Liber de morte Aristotelis. — 7.° Liber de intelligentia Aristotelis. — 8.° Liber de causa motûs animalium. — 9.° Liber de juventute et senectute. — 10.° Liber de respiratione. — 11.° Aristotelis liber de morte et vita.

Colbertinus

10

D'une manière très synthétique, une agence est une entité publique qui bénéficie d'une certaine autonomie dans l'exécution des tâches qui lui sont assignées. La création d'agences ne constitue pas un phénomène nouveau au niveau de l'administration car de telles entités existent depuis très longtemps en Suisse comme dans d'autres pays. En revanche, leur nombre a augmenté très sensiblement dans les pays membres de l'Organisation de coopération et de développement économiques (OCDE) depuis les années 1980, consécutivement à une forte tendance à l'externalisation de l'exécution de tâches publiques (Pollitt et al. 2001; OCDE 2002; Pollitt et Bouckaert 2004; Verhoest et al. 2011).

A pilot study of delayed versus immediate serial casting after botulinum toxin injection for partially reducible spastic equinus.

BACKGROUND: Serial casting is often prescribed after botulinum toxin injections to improve joint ranges of motion and to potentiate the decrease in hypertonia. The aim of this study was to compare delayed versus immediate serial casting as an adjunct to botulinum toxin therapy for partially reducible spastic equinus. METHODS: Twelve children who presented spastic equinus associated with mild gastrosoleus contracture took part. Five of them had a diagnosis of spastic diplegia, whereas 7 had a diagnosis of congenital hemiplegia. Children were randomized to immediate serial casting (same day) or delayed serial casting (4 weeks later) after botulinum toxin injection to their gastrosolei. Casts were replaced weekly for 3 weeks. RESULTS: Three children complained of pain that required recasting in the immediate casting group versus none in the delayed casting group (P = 0.08). At 3 months, there was a 27-degree improvement in the fast dorsiflexion angle (Tardieu R1) in the delayed casting group versus 17 degrees in the immediate casting group (P = 0.029). At 6 months, a 19-degree improvement persisted in the delayed group compared with 11 degrees in the immediate group (P = 0.010). CONCLUSIONS: There is a clear benefit in delaying serial casting after the injection of botulinum toxin in the recurrence of spasticity at the gastrosoleus that may also offer an advantage regarding the incidence of painful episodes associated with casting. Most importantly, reducing the recurrence of spasticity by delayed serial casting may offer the possibility of decreasing the frequency of botulinum toxin reinjections.

IL-10 release by bovine epithelial cells cultured with Trichomonas vaginalis and Tritrichomonas foetus

Trichomonas vaginalis and Tritrichomonas foetus are parasitic protists of the human and bovine urogenital tracts, respectively. Several studies have described the cytotoxic effects of trichomonads on urogenital tract epithelial cells. However, little is known about the host cell response against trichomonads. The aim of this study was to determine whether T. foetus and T. vaginalis stimulated the release of the cytokine interleukin (IL)-10 from cultured bovine epithelial cells. To characterise the inflammatory response induced by these parasites, primary cultures of bovine oviduct epithelial cells were exposed to either T. vaginalis or T. foetus. Within 12 h after parasite challenge, supernatants were collected and cytokine production was analysed. Large amounts of IL-10 were detected in the supernatants of cultures that had been stimulated with T. foetus. Interestingly, T. vaginalis induced only a small increase in the release of IL-10 upon exposure to the same bovine cells. Thus, the inflammatory response of the host cell is species-specific. Only T. foetus and not T. vaginalis induced the release of IL-10 by bovine oviduct epithelial cells.

Official Positions for FRAX(®) clinical regarding glucocorticoids: the impact of the use of glucocorticoids on the estimate by FRAX(®) of the 10 year risk of fracture from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX(®).

Given the significant impact the use of glucocorticoids can have on fracture risk independent of bone density, their use has been incorporated as one of the clinical risk factors for calculating the 10-year fracture risk in the World Health Organization's Fracture Risk Assessment Tool (FRAX(®)). Like the other clinical risk factors, the use of glucocorticoids is included as a dichotomous variable with use of steroids defined as past or present exposure of 3 months or more of use of a daily dose of 5 mg or more of prednisolone or equivalent. The purpose of this report is to give clinicians guidance on adjustments which should be made to the 10-year risk based on the dose, duration of use and mode of delivery of glucocorticoids preparations. A subcommittee of the International Society for Clinical Densitometry and International Osteoporosis Foundation joint Position Development Conference presented its findings to an expert panel and the following recommendations were selected. 1) There is a dose relationship between glucocorticoid use of greater than 3 months and fracture risk. The average dose exposure captured within FRAX(®) is likely to be a prednisone dose of 2.5-7.5 mg/day or its equivalent. Fracture probability is under-estimated when prednisone dose is greater than 7.5 mg/day and is over-estimated when the prednisone dose is less than 2.5 mg/day. 2) Frequent intermittent use of higher doses of glucocorticoids increases fracture risk. Because of the variability in dose and dosing schedule, quantification of this risk is not possible. 3) High dose inhaled glucocorticoids may be a risk factor for fracture. FRAX(®) may underestimate fracture probability in users of high dose inhaled glucocorticoids. 4) Appropriate glucocorticoid replacement in individuals with adrenal insufficiency has not been found to increase fracture risk. In such patients, use of glucocorticoids should not be included in FRAX(®) calculations.

[10 phot. de France: Montbéliard, Montoire (phot. Yvon-Abel, phot. à Loches), la Mer de glace près Chamonix (phot. ancienne maison Martinet, 172, rue de Rivoli, Paris), le lac Chambon (Puy-de-Dôme), La Rochelle (phot. D. Tallon Larente, phot. dans cette ville), un dolmen près de Lodève (Hérault) (phot. E. Cartailhac), environs de Chambéry (phot. J.L. Perrot, phot. à Chambéry), le Pont du Gard, la Maladetta et le Port de Vénasque (Haute-Garonne Aragon), Cirque de Gavarnie (Hautes-Pyrénées). Don E. Reclus en 1886]

Donateur : Reclus, Élisée (1830-1905)

26/10/19, Croix Catelan [bois de Boulogne], départ du [prix] Roosevelt [course de 4827 m] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 56658

26/10/19, Longchamp, Shah de Perse aux courses : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 56630

Síntesi de la molècula ML-10 i del seu precursor immediat per poder obtenir 18F-ML-10, d'ús en tècniques PET

El 18F-ML-10 és un radiofàrmac utilitzat com a traçador de cèl·lules apoptòtiques mitjançant la tècnica del PET (Positron Emission Tomography). En el present treball de recerca s’ha dut a terme la síntesi de dos precursors del 18F-ML-10, i del producte final no marcat isotòpicament, el ML-10. S’ha plantejat una síntesi convergent per l’obtenció del compost final 3, partint del malonat de di-tert-butil i l’1,5-pentandiol. Tant el precursor tosilat 1 com el mesilat 2 s’han sintetitzat en 3 etapes amb un 29% i un 36% de rendiment, respectivament. El compost 3, utilitzat com a referència en la síntesi del 18F-ML-10, s’ha sintetitzat en 2 etapes a partir del precursor 2 amb un rendiment total de la síntesi del 31%. El procés de radiomarcació s’està portant a terme a l’Institut d’Alta Tecnologia – Parc de Recerca Biomèdica de Barcelona (IAT–PRBB), on posteriorment es faran estudis neurològics i oncològics on el seguiment de processos apoptòtics és clau.

2/6/19, remise du traité de paix aux Autrichiens [préliminaires au traité de Saint-Germain-en-Laye du 10 septembre, au château], maréchal Foch : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54218