Implications of diagnosis related groups (DRGs) for the management of hospitals.

Although tremendous advances have been made in the diagnosis and treatment of patients, hospital administrative systems have progressed relatively slowly. The types of information available to managers in industrial sectors are not available in the health sector. For this reason, many phenomena, such as the variations of average costs and lengths of stay between different hospitals, have remained poorly explained.The DRG system defines groups of patients that consume relatively homogeneous quantities of hospital resources. On the basis, it is possible to standardize average lengths of stay and average hospital costs in terms of the differences in case mix treated. Thus DRGs can serve as an explanation of variations in these factors between different hospitals, and also (but not only) for prospective reimbursement schems. As in a number of other European countries, a project has been set up in Switzerland to examine the possibilities of using DRGs in hospital management, planning and financing.

Descriptive epidemiology of isolated anal anomalies: a survey of 4.6 million births in Europe.

The prevalence of anal anomalies among 4,618,840 births recorded in 33 EUROCAT registries between 1980 and 1994 was 4.05 per 10,000 births. Of the 1,846 recorded cases, 672 (36.4%) were isolated anal anomalies while 1,174 (63.6%) occurred together with other anomalies. Only isolated anal anomalies were analyzed in this study: 75.5% were atresias, 10.1% of which were above and 89.9% were below the level of the levator ani muscle. Fistula occurred in 53% of supralevator and 37% of infralevator atresia. Other anal anomalies were ectopic anus (3.4%), congenital anal fistula (14.7%), and persistent cloaca (0.9%). There was a predominance of males in anal atresia without fistula (male to female (M:F) ratio was 6.7 for supralevator and 2.3 for infralevator atresia), but no significant sex difference in atresias with fistula. There was a predominance of females in ectopic anus and congenital anal fistula (M:F = 0.11 and 0.36 respectively). High frequencies of fetal deaths were recorded in supralevator atresia without fistula (8.3%) and in persistent cloaca (11.1%). Mean gestational length and mean birth weights were reduced for persistent cloaca but were within normal limits for other isolated anal anomalies. Odds ratios (ORs) for mothers above 35 years were increased for supralevator atresia without fistula, supralevator atresia with fistula, and congenital anal fistula. ORs for mothers below 30 years were slightly increased for supralevator atresia without fistula and decreased for persistent cloaca. There were marked differences in prevalence and distribution of anal anomalies among the EUROCAT registries. The results indicated that there are epidemiological differences among the various types of anal anomalies which might reflect different embryological origins.

Traité de « ce qui concerne les honneurs et rengz des princes, pairs, prelatz, grandz vassaulx et officiers » du royaume, dédié par l'auteur, JEAN DU TILLET, Sr de La Bussière, greffier civil au parlement de Paris, au roi Charles IX. Exemplaire original.

Contient : Préface ; Traité

Cartonnages de momies

Contient : Egyptien 174a ; Egyptien 174b ; Egyptien 174c ; Egyptien 174d ; Egyptien 174e ; Egyptien 174f

Lessons From the Swiss Medical Board Recommendation Against Mammography Screening Programs

When the US Preventive Services Task Force (USPSTF) in 2009 recommended against universal breast cancer screening with mammography in women aged 40 to 49 years, some scientists, radiologists, politicians, and patients strongly objected. The controversy has been called the "mammography wars." The latest chapter in these wars comes from the Swiss Medical Board, which is mandated by the Conference of Health Ministers of the Swiss Cantons, the Swiss Medical Association, and the Swiss Academy of Medical Sciences to conduct health technology assessments. In a February 2014 report, the Swiss Medical Board stated that new systematic mammography screening programs should not be introduced, irrespective of the age of the women, and that existing programs should be discontinued. The board's main argument was that the absolute reduction in breast cancer mortality was low and that the adverse consequences of the screening were substantial. The absolute risk reduction in breast cancer mortality has been estimated by the board at 0.16% for women screened during 6.2 years and followed-up over 13 years, based on the results of a recent Cochrane Review. The adverse consequences include falsepositive test results, overdiagnosis and overtreatment of patients, and high costs, including the expense of follow-up testing and procedures.

Proto-South-East Asia as a trigger of early angiosperm diversification

Darwin described as an 'abominable mystery' the abrupt origin of angiosperms in the mid-Cretaceous and the high diversification rates in their early history. The father of evolutionary theory could not fathom this rapid diversification and rather invoked that 'there was during long ages a small isolated continent in the S. hemisphere, which served as the birthplace of the higher plants'. In this essay, we comment on the spatial origin of angiosperms, but focus primarily on understanding the abiotic factors that promoted the early diversification of angiosperms by reviewing palaeobotanical, palaeogeographical, phylogenetics and biogeographical evidence. We argue that islands located in the region today occupied by South-East Asia played a major role in angiosperm diversification during the Late Jurassic and Early Cretaceous.

Effect of antiviral therapy on circulating cytokeratin-18 fragments in patients with chronic hepatitis C.

Hepatocellular apoptosis plays a major role in the pathogenesis of chronic hepatitis C. It can be measured noninvasively by determining the circulating levels of cytokeratin-18 fragments. We hypothesized that the effect of antiviral therapy on this parameter will be different in patients with a sustained virological response, relapse (REL) and nonresponse (NR). We quantified cytokeratin-18 fragments in plasma of patients participating in the Swiss Hepatitis C cohort, who received antiviral therapy without stopping because of sides effects. A total of 315 patients were included, 183 with a sustained response, 64 with NR and 68 who relapsed. Mean levels ±SD of circulating cytokeratin-18 fragments before therapy were 174 ± 172 U/L for responsders, 188 ± 145 for nonresponders and 269 ± 158 U/L for patients who relapsed. The values were significantly higher in the REL group (ANOVA P < 0.006). A sustained response was associated with a significant improvement of the plasma levels (94 ± 92 U/L, paired test P < 0.000001), whereas there was no improvement in the nonresponder group (183 ± 158 U/L) and in the relapser group (158 ± 148 U/L). There was a weak correlation between alanine aminotransferase (ALT) and cytokeratin-18 fragment levels (r² = 0.35, P < 0.000001) before therapy but not after therapy and none with hepatitis C virus (HCV) viremia. Successful antiviral therapy results in a significant decrease in circulating levels of cytokeratin-18 fragments arguing for a reduction in hepatocellular apoptosis after clearance of the HCV. Baseline cytokeratin-18 fragment levels are higher in relapsers. Correlations with ALT are weak, suggesting that these two tests measure different but related processes.

Ontogeny and covariation in the Toarcian genus Osperleioceras (Ammonoidea)

Starting from embryonic (protoconch-ammonitella) and early juvenile shells, which are indistinguishable at the species level, growth curves of Osperleioceras from the Reynesi Subzone (Upper Toarcian) of the Causses Basin (Aveyron, France) show a continuous radiating range of correlated variation in dimensional and ornamental characters, such as involution, whorl compression, rib strength and rib density. This covariation pattern can be observed among single-horizon assemblages, as well as during individual ontogenetic development. The existence of a continuous intergradational series of shells, ranging from stout coarsely ribbed to smooth suboxycone morphologies, rules out functional or ecological selectivity to explain this non-random variability pattern. The complex interdependence of shape and sculpture can be simulated by a model in which sculpture intensity depends on mantle curvature [GUEX, 1999]. The expression of covariation in subadult specimens since the base of Upper Toarcian reveals a rise in variability, concomitant with a size decrease, both contemporaneous with environmental instability. It developed in successive bursts from a fairly long low variability period spanning the whole Middle Toarcian.

Reduced atrial emptying after orthotopic heart transplantation masquerading as restrictive transmitral Doppler flow pattern?

BACKGROUND: An elevated early (E) to late (A) diastolic filling velocities ratio, typically seen in advanced diastolic dysfunction, has also been observed after cardioversion of atrial fibrillation as a consequence of the depressed left atrial (LA) contractility. We hypothesized that the impaired LA contractile function demonstrated after orthotopic cardiac transplantation (OCT) could also lead to this "pseudorestrictive" pattern. METHOD: E/A ratio related to the tissue Doppler early mitral annular velocity (Ea) as preload-independent index of LV relaxation was evaluated in all consecutive OCT patients between 2005 and 2007. RESULTS: The study population comprised 48 patients 97 ± 77 months after OCT. Thirty-two patients (67%) had an E/A ratio > 2. LV systolic function and myocardial relaxation assessed by the Ea velocity were similar compared to patients with normal ratio (61 ± 6% vs. 60 ± 12%, P = 0.854 and 15 ± 4 cm/s vs. 14 ± 3 cm/s, r = 0.15, P = 0.323, respectively). On the other hand, the proportion of the recipient and donor LA cuffs as estimated by the recipient/global LA area ratio and the LA emptying fraction significantly correlated with the E/A ratio (r = 0.40, P = 0.005 and r =-0.33, P = 0.022, respectively). CONCLUSION: Our study shows that there is a high prevalence of elevated E/A ratio after standard OCT which seems mainly related to reduced LA contractility. Recognition of this "pseudorestrictive" pattern may avoid misdiagnosis of diastolic dysfunction.

Rhizosphere properties of maize genotypes with contrasting phosphorus efficiency

An experiment was conducted in a growth chamber to evaluate characteristics of the rhizosphere of maize genotypes contrasting in P-use efficiency, by determining length and density of root hairs, the rhizosphere pH and the functional diversity of rhizosphere bacteria. A sample of a Red Oxisol was limed and fertilized with N, K and micronutrients. In the treatment with the highest P level, 174 mg kg-1 P was added. Each experimental unit corresponded to a PVC rhizobox filled with 2.2 dm-3 soil. The experiment was completely randomized with three replications in a 5 x 2 factorial design, corresponding to five genotypes (H1, H2 and H3 = P-efficient hybrids, H4 and H5 = P-inefficient hybrids) and two P levels (low = 3 mg dm-3, high = 29 mg dm-3). It was found that 18 days after transplanting, the nodal roots of the hybrids H3 and H2 had the longest root hairs. In general, the pH in the rhizosphere of the different genotypes was higher than in non-rhizosphere soil, irrespective of the P level. The pH was higher in the rhizosphere of lateral than of nodal roots. At low P levels, the pH variation of the hybrids H2, H4 and H5 was greater in rhizospheric than in non-rhizospheric soil. The functional microbial activity in the rhizosphere of the hybrids H3 and H5 was highest. At low soil P levels, the indices of microbial functional diversity were also higher. The microbial metabolic profile in the rhizosphere of hybrids H1, H2, H3, and H5 remained unaltered when the plants were grown at low P. The variations in the rhizosphere properties could not be related to patterns of P-use efficiency in the tested genotypes.

Densidade e diversidade fenotípica de bactérias diazotróficas não simbióticas em solos da Reserva Biológica Serra dos Toledos, Itajubá (MG)

Bactérias diazotróficas não simbióticas (BDNS) atuam no desenvolvimento das plantas por meio da fixação biológica de nitrogênio e também pela produção e liberação de substâncias reguladoras do crescimento vegetal. Este estudo objetivou avaliar a densidade e diversidade fenotípica desse grupo de bactérias em fragmentos de solo da Reserva Biológica Serra dos Toledos e entorno, em Itajubá/MG. Essa reserva localiza-se na Área de Proteção Ambiental da Mantiqueira, constituindo-se em uma importante área de recarga e de abrigo à flora e fauna endêmicas. Amostras de solo superficial foram coletadas em áreas com diferentes declividades na reserva, em épocas representativas das estações de inverno (setembro/2006) e verão (abril/2007). A densidade, avaliada pelo número mais provável, utilizando os meios de cultura NFb, JNFb e Fam, para Azospirillum spp., Herbaspirillum spp. e A. amazonense, respectivamente, variou de 0,12 a 75,60 (NMP x 10(5)) bactérias g-1 solo seco. Foram obtidos 172 e 174 isolados, respectivamente para as amostras de inverno e verão, dos quais 30 e 55 % apresentaram similaridade igual ou superior a 70 % com as estirpes-tipo Azospirillum brasilense, A. amazonense, A. lipoferum, Herbaspirillum seropedicae e Burkholderia brasilensis. O resultado do comportamento dos isolados com base na tolerância à salinidade nem sempre foi semelhante ao obtido pelas características fenotípicas culturais a 70 % de similaridade, sendo indicado para estudos complementares de diversidade desses organismos. As BDNS apresentam potencial de utilização em estudos de avaliação da qualidade e sustentabilidade de ecossistemas. No entanto, apesar da alta densidade e diversidade fenotípica em solos da reserva, maiores valores foram obtidos no entorno, evidenciando o efeito positivo da cobertura vegetal do tipo gramíneas sobre elas, independentemente da variação climática.