Évaluation de l'impact clinique et économique du développement d'un traitement pour la schizophrénie

Contexte : Les stratégies pharmacologiques pour traiter la schizophrénie reçoivent une attention croissante due au développement de nouvelles pharmacothérapies plus efficaces, mieux tolérées mais plus coûteuses. La schizophrénie est une maladie chronique présentant différents états spécifiques et définis par leur sévérité. Objectifs : Ce programme de recherche vise à: 1) Évaluer les facteurs associés au risque d'être dans un état spécifique de la schizophrénie, afin de construire les fonctions de risque de la modélisation du cours naturel de la schizophrénie; 2) Développer et valider un modèle de Markov avec microsimulations de Monte-Carlo, afin de simuler l'évolution naturelle des patients qui sont nouvellement diagnostiqués pour la schizophrénie, en fonction du profil individuel des facteurs de risque; 3) Estimer le coût direct de la schizophrénie (pour les soins de santé et autres non reliés aux soins de santé) dans la perspective gouvernementale et simuler l’impact clinique et économique du développement d’un traitement dans une cohorte de patients nouvellement diagnostiqués avec la schizophrénie, suivis pendant les cinq premières années post-diagnostic. Méthode : Pour le premier objectif de ce programme de recherche, un total de 14 320 patients nouvellement diagnostiqués avec la schizophrénie ont été identifiés dans les bases de données de la RAMQ et de Med-Echo. Les six états spécifiques de la schizophrénie ont été définis : le premier épisode (FE), l'état de dépendance faible (LDS), l’état de dépendance élevée (HDS), l’état stable (Stable), l’état de bien-être (Well) et l'état de décès (Death). Pour évaluer les facteurs associés au risque de se trouver dans chacun des états spécifiques de la schizophrénie, nous avons construit 4 fonctions de risque en se basant sur l'analyse de risque proportionnel de Cox pour des risques compétitifs. Pour le deuxième objectif, nous avons élaboré et validé un modèle de Markov avec microsimulations de Monte-Carlo intégrant les six états spécifiques de la schizophrénie. Dans le modèle, chaque sujet avait ses propres probabilités de transition entre les états spécifiques de la schizophrénie. Ces probabilités ont été estimées en utilisant la méthode de la fonction d'incidence cumulée. Pour le troisième objectif, nous avons utilisé le modèle de Markov développé précédemment. Ce modèle inclut les coûts directs de soins de santé, estimés en utilisant les bases de données de la Régie de l'assurance maladie du Québec et Med-Echo, et les coûts directs autres que pour les soins de santé, estimés à partir des enquêtes et publications de Statistique Canada. Résultats : Un total de 14 320 personnes nouvellement diagnostiquées avec la schizophrénie ont été identifiées dans la cohorte à l'étude. Le suivi moyen des sujets était de 4,4 (± 2,6) ans. Parmi les facteurs associés à l’évolution de la schizophrénie, on peut énumérer l’âge, le sexe, le traitement pour la schizophrénie et les comorbidités. Après une période de cinq ans, nos résultats montrent que 41% des patients seront considérés guéris, 13% seront dans un état stable et 3,4% seront décédés. Au cours des 5 premières années après le diagnostic de schizophrénie, le coût direct moyen de soins de santé et autres que les soins de santé a été estimé à 36 701 $ canadiens (CAN) (95% CI: 36 264-37 138). Le coût des soins de santé a représenté 56,2% du coût direct, le coût de l'aide sociale 34,6% et le coût associé à l’institutionnalisation dans les établissements de soins de longue durée 9,2%. Si un nouveau traitement était disponible et offrait une augmentation de 20% de l'efficacité thérapeutique, le coût direct des soins de santé et autres que les soins de santé pourrait être réduit jusqu’à 14,2%. Conclusion : Nous avons identifié des facteurs associés à l’évolution de la schizophrénie. Le modèle de Markov que nous avons développé est le premier modèle canadien intégrant des probabilités de transition ajustées pour le profil individuel des facteurs de risque, en utilisant des données réelles. Le modèle montre une bonne validité interne et externe. Nos résultats indiquent qu’un nouveau traitement pourrait éventuellement réduire les hospitalisations et le coût associé aux établissements de soins de longue durée, augmenter les chances des patients de retourner sur le marché du travail et ainsi contribuer à la réduction du coût de l'aide sociale.

Comparación de las dinámicas de uso y apropiación del espacio público en parques de origen informal y formal: parque Villa de la Torre y parque Cayetano Cañizares

El interés de este estudio de caso es comparar las dinámicas de uso y apropiación del espacio público en parques de origen formal e informal, y discutir sus implicaciones en la vida social y urbana, teniendo como zonas el parque Villa de la Torre (informal) y el parque Cayetano Cañizares (formal). Este trabajo se enmarca en conceptos de uso y apropiación del espacio público, a partir de los cuales se examinan las dinámicas de formalidad e informalidad de los parques zonas de estudio, explorando qué efectos puede tener su origen, y revisando si el parque informal implica falta de apropiación y usos conflictivos, o si por el contrario, las dinámicas que en espacios públicos se dan pueden incluir dinámicas positivas y negativas indistintamente de su origen.

Catalysis and temperature dependence on the formation of ZnO nanoparticles and of zinc acetate derivatives prepared by the sol-gel route

The chemical and structural nature of powders prepared from the zinc acetate-derived precursor using the sol-gel route is discussed. The influence of the synthesis temperature and of the hydrolytic catalyst on the structural features of the powder is focused on the basis of X-ray powder diffraction (XRPD) and extended X-ray absorption fine structure (EXAFS) measurements and complemented with density and thermoanalysis (TG-DTA) results. EXAFS and XRPD results show that no-washed nanoparticulate powders are composed of a mixture of ZnO (wurtzite), zinc acetate, and zinc hydroxyacetate. The latter has a layered structure typical of hydroxy double salts (HDS). The main component of no-washed powders is always unreacted zinc acetate solid but the relative amount of the zinc-based compounds depends on the nature of the hydrolytic catalyst, hydrolysis ratio, and of synthesis temperature. According to the proportion of the three zinc-based compounds, three families of powders could be distinguished. The amount of ZnO nanoparticles (1.6 +/- 0.6 nm) decreases as the synthesis temperature increases, as the hydrolysis ratio decreases, or by changing from basic to acid catalysis. This finding suggests that the formation of zinc compounds is controlled by the equilibrium between hydrolysis-condensation and complexation-reprecipitation reactions.

Improvement of the Mo/TiO2-Al2O3 catalyst by the control of the sol-gel synthesis

Traditional hydrotreating catalysts are constituted by molybdenum deposited on Al2O3 promoted by nickel and phosphorous. Several studies have shown that TiO2-Al2O3 mixed oxides are excellent supports for the active phases. Results concerning the preparation, characterization and testing of molybdenum catalyst supported on titania-alumina are presented. The support was prepared by sol-gel route using titanium and aluminum isopropoxides, the titanium one chelated with acetylacetone (acac) to promote similar hydrolysis ratio for both the alcoxides. The effect of nominal molar ratio [Ti]/[Ti+Al] on the microstructural features of nanometric particles was analyzed by X-Ray Diffraction, N-2 Adsorption Isotherms and Transmission Electron Microscopy. The catalytic activity of Mo impregnated supports was evaluated using the thiophene hydrodesulfurization at different temperatures and atmospheric pressure. The pores size distribution curve moves from the micropores to the mesopores by increasing the Ti contents, allowing the fine tuning of average size from 2.5 to 6 nm. Maximal (367 m(2).g(-1)) and minimal (127 m(2).g(-1)) surface area were found for support containing [Ti]/[Ti+Al] ratio equal to 0.1 and 1, respectively. The good mesopore texture of alumina-titania support with [Ti]/[Ti+Al] molar ratio between 0.3 and 0.5 was found particularly valuable for the preparation of well dispersed MoS2 active phase, leading to HDS catalyst with somewhat higher activity than that prepared using a commercial alumina support.

Performance of constructed wetland system for public water supply

The project is being conducted in the town of Analândia, São Paulo, Brazil. The constructed wetlands system for water supply consists of a channel with floating aquatic macrophytes, HDS system (Water Decontamination with Soil - Patent PI 850.3030), chlorinating system, filtering system and distribution. The project objectives include investigating the process variables to further optimize design and operation factors, evaluating the relation of nutrients and plants development, biomass production, shoot development, nutrient cycling and total and fecal coliforms removal, comparing the treatment efficiency among the seasons of the year; and moreover to compare the average values obtained between February and June 1998 (Salati et al., 1998) with the average obtained for the same parameters between March and June 2000. Studies have been developed in order to verify during one year the drinking quality of the water for the following parameters: turbidity, color, pH, dissolved oxygen, total of dissolved solids, COD, chloride, among others, according to the Ministry of Health's Regulation 36. This system of water supply projected to treat 15 L s-1 has been in continuous operation for 2 years, it was implemented with support of the National Environment Fund (FNMA), administered by the Center of Environmental Studies (CEA-UNESP), while the technical supervision and design were performed by the Institute of Applied Ecology. The actual research project is being supported by FAPESP.

N-Acetylcysteine protects the peritoneum from the injury induced by hypertonic dialysis solution

Background: Oxidative stress has been implicated in the development of peritoneal damage. The aim of this study was to evaluate the effects of N-acetylcysteine (NAC) in a rat peritoneal infusion model. Methods: Eighteen male Wistar rats were divided in 3 groups: (i) control group; (ii) HDS group, receiving peritoneal dialysis solution (PDS); and (iii) HDS+NAC group, receiving PDS and oral NAC. Six weeks later they were evaluated for dialysate to plasma urea ratio (D/P), ratio of glucose concentration in peritoneal fluid (G1/G0), thiobarbituric acid reactive substances in plasma and urine and histology of peritoneal membrane. Results: The HDS+NAC group presented a lower increase in solute transport (D/P 0.51 +/- 0.1, and G1/GO 0.35 +/- 0.06) in comparison with the HDS group (D/P 0.67 +/- 0.1; p=0.03, and G1/G0 0.27 +/- 0.07; p=0.01). The HDS+NAC group showed lower thiobarbituric acid reactive substance concentrations compared with the HDS group. In the treated group, the peritoneal membrane presented lower thickness. Conclusions: Functional and histological peritoneal changes were significantly reduced by the treatment with NAC.

Catalizzatori per la reazione di Water Gas Shift a media ed alta temperatura

L’H2 è un vettore energetico di elevato interesse, utilizzato nell’industria chimica per la produzione di NH3 e CH3OH, oltre che per le reazioni di idrogenazione ed HDS. Un importante processo nella produzione di H2 è la reazione di Water Gas Shift (WGS), usata nel trattamento delle correnti uscenti dal reattore di Steam Reforming (SR) del metano: CO + H2O  CO2 + H2 ∆H0298K = -41,2 KJ/mol. Sulla base di precedenti lavori, sono stati sviluppati nuovi catalizzatori per la reazione WGS ad alta temperatura (HTS), alternativi ai tradizionali sistemi a base di Fe/Cr, in considerazione dei vincoli economici (elevati valori del rapporto vapore/gas secco o S/DG) ed ambientali (formazione di CrVI) di questi sistemi. Partendo da sistemi Cu/Zn/Al con un basso contenuto di rame, ottenuti da precursori tipo idrotalcite (HT), stato studiato l’effetto dell’aggiunta di piccole quantità di alcuni promotori sull’attività e stabilità dei catalizzatori ottenuti, osservando un effetto positivo sulle caratteristiche fisiche, come l’aumento dell’area superficiale e della dispersione della fase attiva. I campioni contenenti i promotori erano inoltre caratterizzati da una maggiore stabilità termica e, in alcuni casi, da un’attività catalitica superiore a quella del catalizzatore di riferimento privo di promotori. L’aggiunta di piccole quantità di alcali alla formulazione con la migliore attività portava ad un ulteriore aumento di attività e di stabilità, attribuibile ad una minore formazione di coke sulla superficie. I sistemi più interessanti potevano operare anche a bassi valori del rapporto S/DG, interessanti dal punto di vista industriale. Lo studio dell’adsorbimento di CO mediante FT-IR ha permesso di ipotizzare la possibile natura della fase attiva nei sistemi. Infine, lo studio è stato esteso a sistemi per la reazione di WGS a media temperatura (MTS), osservando anche in questo caso un positivo effetto legato all’aggiunta di promotori, con un aumento dell’attività catalitica e della stabilità con il tempo di reazione.

The first major incision of the Swiss Deckenschotter landscape

The Swiss Deckenschotter (“cover gravels”) is the oldest Quaternary units in the northern Swiss Alpine Foreland. They are a succession of glaciofluvial gravel layers intercalated with glacial and/or overbank deposits. This lithostratigraphic sequence is called Deckenschotter because it “covers” Molasse or Mesozoic bedrock and forms mesa-type hill-tops. Deckenschotter occurs both within and beyond the extent of the Last Glacial Maximum glaciers. The Swiss Deckenschotter consist of two sub-units: Höhere (Higher) and Tiefere (Lower) Deckenschotter. Although the Höhere Deckenschotter sub-unit (HDS) is topographically higher than the Tiefere Deckenschotter, it is older. The only available age for the Swiss Deckenschotter is 2.5–1.8 Ma based on mammal remains found in HDS at the Irchel site. In this study, we present an exposure age for the topographically lowest HDS, calculated from a cosmogenic 10Be depth-profile. Our results show that the first phase of the Deckenschotter glaciations in the Swiss Alps terminated at least 1,020+80−120 ka ago, which is indicated by a significant fluvial incision. This line of evidence seems to be close to synchronous with the beginning of the Mid-Pleistocene Revolution, when the frequency of the glacial-interglacial cyclicity changed from 41 to 100 ka and the amplitude from low to high, between marine isotope stages 23 and 22.

Blocking of LFA-1 enhances expansion of Th17 cells induced by human CD14(+) CD16(++) nonclassical monocytes.

Among human peripheral blood (PB) monocyte (Mo) subsets, the classical CD14(++) CD16(-) (cMo) and intermediate CD14(++) CD16(+) (iMo) Mos are known to activate pathogenic Th17 responses, whereas the impact of nonclassical CD14(+) CD16(++) Mo (nMo) on T-cell activation has been largely neglected. The aim of this study was to obtain new mechanistic insights on the capacity of Mo subsets from healthy donors (HDs) to activate IL-17(+) T-cell responses in vitro, and assess whether this function was maintained or lost in states of chronic inflammation. When cocultured with autologous CD4(+) T cells in the absence of TLR-2/NOD2 agonists, PB nMos from HDs were more efficient stimulators of IL-17-producing T cells, as compared to cMo. These results could not be explained by differences in Mo lifespan and cytokine profiles. Notably, however, the blocking of LFA-1/ICAM-1 interaction resulted in a significant increase in the percentage of IL-17(+) T cells expanded in nMo/T-cell cocultures. As compared to HD, PB Mo subsets of patients with rheumatoid arthritis were hampered in their T-cell stimulatory capacity. Our new insights highlight the role of Mo subsets in modulating inflammatory T-cell responses and suggest that nMo could become a critical therapeutic target against IL-17-mediated inflammatory diseases.

Sulfur Isotopic Ratios at 67P/Churyumov-Gerasimenko and Characterization of ROSINA-DFMS FM & FS

Comets are thought to be the most pristine bodies present in the Solar System. In consequence of spending the majority of their existence beyond 30 AU, their composition can give insights on the physical and chemical conditions during their formation. Since August 2014 the European Space Agency spacecraft Rosetta accompanies the Jupiter family comet 67P/Churyumov-Gerasimenko on its way to perihelion and beyond. In this study the isotope fractionation of 34S are reported in H2S, OCS, SO2, S2, and CS2 at 67P. In addition for the first time the isotope fractionation for 33S is presented for cometary volatiles. The ratio 32S/33S is given for H2S, SO2 and a tentative value is given for CS2. With a mean value of -50 ± 22‰ and -306 ± 31‰ for δ34S and δ33S respectively, H2S shows a significant depletion in both 34S and 33S. For SO2 the depletion is less distinct with δ34S and δ33S being -67 ± 40‰ and -130 ± 53‰, respectively. The strongest depletion is present for CS2 with -114 ± 21‰and -276 ± 55‰, respectively. For OCS and S2 only δ34S could be determined which is -252 ± 77‰ and -357 ± 145‰, respectively. A comparison with sulfur isotopic ratios measured in SiC grains revealed that both SiC grains and the five volatile species have similar sulfur isotopic ratios. However, it is beyond the scope of this work to investigate the possibility of a link between SiC grains and cometary ices. Nevertheless, mass-dependent or mass-independent fractionation due to photo dissociation can be ruled out as sole cause of the seen depletion of 33S and 34S. Furthermore, an upper limit of (9.64 ± 0.19)·10.4 for D/H in HDS has been determined. This value is about a factor two higher than D/H in H2O for the same comet reported by (Altwegg et al., 2015). Besides the investigation concerning isotopic ratios of sulfur bearing species in this work the calibration and characterization of ROSINA/DFMS has been continued. Here it is reported about the deviation of the mass scale for MCP/LEDA low resolution spectra and the calibration measurements performed in the laboratory. Furthermore the outcome of the attempt to describe the sensitivity of DFMS with an empirical function will be discussed. The last part of the characterization of DFMS is dedicated to determine the so-called individual pixel gain for the laboratory and the flight model. Moreover, correlation between the depletion’s manifestation of the MCP with respect to the applied voltages has been investigated for both models. It has been found that further measurements are needed to understand the manifestation of depletion at the laboratory model. For the model on board of Rosetta it could be shown that most of the present feature are due to the usage of the MCP and suggestions have been made in order to answer the remaining question considering the depletion of the MCP.

Fair Housing Enforcement and Changes in Discrimination between 1989 and 2000: An Exploratory Study

Using paired testing data from the 1989 and 2000 Housing Discrimination Studies (HDS) and data on fair housing enforcement activities during the 1990s in the corresponding metro areas, we investigate whether 1989-2000 changes in the metropolitan incidence of racial/ethnic discrimination correlate with fair housing enforcement activity during the 1990s. We found that higher amounts of state and local enforcement activity supported by HUD through its FHIP and FHAP programs (especially the amount of dollars awarded by the courts) were consistently associated with greater declines in discrimination against black apartment-seekers and home-seekers. The evidence does not support similar conclusions for housing market discrimination against Hispanics where the level of enforcement is much lower.

Hospital district viability and Medicaid /market changes

Hospital districts (HD) that serve the uninsured and the needy face new challenges with the implementation of Medicaid managed. The potential loss of Medicaid patients and revenues may affect the ability to cost-shift and subsequently decrease the ability of the HD to meet its legal obligation of providing care for the uninsured. ^ To investigate HD viability in the current market, the aims of this study were to: (1) describe HD's environment, (2) document the HDs strategic response, (3) document changes in the HD's performance (patient volume) and financial status, and (4) determine whether relationships or trends exist between HD strategy, performance and financial status. ^ To achieve these aims, three Texas HDs (Fort Worth, Lubbock, and San Antonio) were selected to be evaluated. For each HD four types of strategic responses were documented and evaluated for change. In addition, the ability of each HD to sustain operations was evaluated by documenting performance and financial status changes (patient volume and financial ratios). A pre-post case study design method was used in which the Medicaid managed care “rollout'” date, at each site, was the central date. First, a descriptive analysis was performed which documented the environment, strategy, financial status, and patient volume of each hospital district. Second, to compare hospital districts, each hospital district was: (i) classified by a risk index, (ii) classified by its strategic response profile, and (iii) given a performance score based upon pre-post changes in patient volume and financial indicators. ^ Results indicated that all three HDs operate in a high risk environment compared to the rest of the nation. Two HDs chose the “Status Quo” response whereas one HD chose the “Competitive Proactive” response. Medicaid patient volume decreased in two of three HDs whereas indigent patient volume increased in two of the three (an indication of increasing financial risk). Total patient revenues for all HDs increased over the study period; however, the rate of increase slowed for all three after the Medicaid rollout date. All HDs experienced a decline in financial status between pre-post periods with the greatest decline observed in the HD that saw the greatest increase in indigent patient volume. ^ The pre-post case study format used and the lack of control study sites do not allow for assignment of causality. However, the results suggest possible adverse effects of Medicaid managed care and the need for a larger study, based on a stronger evaluation research design. ^

The helical domain of a G protein α subunit is a regulator of its effector

The α subunit (Gα) of heterotrimeric G proteins is a major determinant of signaling selectivity. The Gα structure essentially comprises a GTPase “Ras-like” domain (RasD) and a unique α-helical domain (HD). We used the vertebrate phototransduction model to test for potential functions of HD and found that the HD of the retinal transducin Gα (Gαt) and the closely related gustducin (Gαg), but not Gαi1, Gαs, or Gαq synergistically enhance guanosine 5′-γ[-thio]triphosphate bound Gαt (GαtGTPγS) activation of bovine rod cGMP phosphodiesterase (PDE). In addition, both HDt and HDg, but not HDi1, HDs, or HDq attenuate the trypsin-activated PDE. GαtGDP and HDt attenuation of trypsin-activated PDE saturate with similar affinities and to an identical 38% of initial activity. These data suggest that interaction of intact Gαt with the PDE catalytic core may be caused by the HD moiety, and they indicate an independent site(s) for the HD moiety of Gαt within the PDE catalytic core in addition to the sites for the inhibitory Pγ subunits. The HD moiety of GαtGDP is an attenuator of the activated catalytic core, whereas in the presence of activated GαtGTPγS the independently expressed HDt is a potent synergist. Rhodopsin catalysis of Gαt activation enhances the PDE activation produced by subsaturating levels of Gαt, suggesting a HD-moiety synergism from a transient conformation of Gαt. These results establish HD-selective regulations of vertebrate retinal PDE, and they provide evidence demonstrating that the HD is a modulatory domain. We suggest that the HD works in concert with the RasD, enhancing the efficiency of G protein signaling.

Lune/eye gone, a Pax-like protein, uses a partial paired domain and a homeodomain for DNA recognition

Pax proteins, characterized by the presence of a paired domain, play key regulatory roles during development. The paired domain is a bipartite DNA-binding domain that contains two helix–turn–helix domains joined by a linker region. Each of the subdomains, the PAI and RED domains, has been shown to be a distinct DNA-binding domain. The PAI domain is the most critical, but in specific circumstances, the RED domain is involved in DNA recognition. We describe a Pax protein, originally called Lune, that is the product of the Drosophila eye gone gene (eyg). It is unique among Pax proteins, because it contains only the RED domain. eyg seems to play a role both in the organogenesis of the salivary gland during embryogenesis and in the development of the eye. A high-affinity binding site for the Eyg RED domain was identified by using systematic evolution of ligands by exponential enrichment techniques. This binding site is related to a binding site previously identified for the RED domain of the Pax-6 5a isoform. Eyg also contains another DNA-binding domain, a Prd-class homeodomain (HD), whose palindromic binding site is similar to other Prd-class HDs. The ability of Pax proteins to use the PAI, RED, and HD, or combinations thereof, may be one mechanism that allows them to be used at different stages of development to regulate various developmental processes through the activation of specific target genes.

Conservation and diversification in homeodomain-DNA interactions: a comparative genetic analysis.

Nearly all metazoan homeodomains (HDs) possess DNA binding targets that are related by the presence of a TAAT sequence. We use an in vitro genetic DNA binding site selection assay to refine our understanding of the amino acid determinants for the recognition of the TAAT site. Superimposed upon the conserved ability of metazoan HDs to recognize a TAAT core is a difference in their preference for the bases that lie immediately 3' to it. Amino acid position 50 of the HD has been shown to discriminate among these base pairs, and structural studies have suggested that water-mediated hydrogen bonds and van der Waals contacts underlie for this ability. Here, we show that each of six amino acids tested at position 50 can confer a distinct DNA binding specificity.