Cuestiones controvertidas en evaluación económica (II): medidas de resultado en salud de las intervenciones sanitarias

In this second article of a series of three, we will discuss using the Metaplan technique on controversial issues of health outcomes in economic evaluation of health care interventions. The four-discussion areas focus on: choice of health outcomes measures, where any outcome measure is superior to another; extrapolation and transferability of health outcomes measures, which should not be assumed the results of an EEIS of one country to another without making certain adjustments; appropriate instruments to measure quality of life in Spain, where the EQ-5D was indicated as convenient due to its widespread international use; and, indirect comparisons, where the combination of both comparisons, direct and indirect, it would be advisable if the test for indirect estimates is consistent and has been validated. Finally, research lines to try to overcome the identified discrepancies were identified in each of these areas, some of those are: doing studies of correlation between scores of specific and generic instruments measuring quality of life; update or create a database of economic evaluations in Spain; estimating utilities for the Spanish population by existing generic and specific instruments; or, establish a common way to show the results of a meta-analysis network.

Cuestiones controvertidas en evaluación económica (III). Intervenciones sanitarias en tres situaciones especiales: enfermedades raras, tratamientos al final de la vida y externalidades en las evaluaciones.

The development of the economic evaluation of health care interventions has become a support tool in making decisions on pricing and reimbursement of new health interventions. The increasingly extensive application of these techniques has led to the identification of particular situations in which, for various reasons, it may be reasonable to take into account special considerations when applying the general principles of economic evaluation. In this article, which closes a series of three, we will discuss, using the Metaplan technique, about the economic evaluation of health interventions in special situations such as rare diseases and end of life treatments, as well as consideration of externalities in assessments, finally pointing out some research areas to solve the main problems identified in these fields.

City of Johnston, June 30, 2003

City Audit Report

Appanoose County, June 30, 2003

County Audit Report

Langage et cerveau : vingt ans d'imagerie fonctionnelle [Language and the brain: 20 years of functional imagery]

La masse considérable de travaux publiés dans le domaine de la neuroimagerie fonctionnelle concernant les fonctions ou modalités du langage (compréhension et expression de la parole, lecture) ou les différents processus linguistiques qui les sous-tendent (sémantique, phonologie, syntaxe) permet de dégager de grandes tendances en termes de substrats anatomiques. Si les « fondamentaux » issus des origines aphasiologiques du domaine n'ont pas été bouleversés, certaines spécificités non explorées par l'approche lésionnelle sont identifiables. Les méta-analyses, en regroupant les résultats de la littérature, nous procurent aujourd'hui une vision globale des substrats cérébraux du langage. Cependant la variabilité inter-individuelle reste importante en raison de multiples facteurs dont certains sont mal identifiés ; cartographier exhaustivement les fonctions du langage à l'échelle individuelle reste une gageure. La quête des images du langage est sans doute aussi inachevable que celle de l'étude du langage lui-même.

Recueil de commentaires exégétiques

F. 1r-40r : Abraham ben Isaac Tamakh, commentaire du Cantique des cantiques. F. 41r-55r : Benjamin ben Abraham Anaw, השערים. F. 55v-56v : miscellanées. F. 57r-67r : traité sur le calendier hébreu. F. 68r : Aharon de Lunel, liste chronologique d'événement survenus depuis la destruction du second temple de Jérusalem jsqu'en 1204. F. 70v-71r : miscellnées. F. 73r-102v : index des citations bibliques contenues dans le Moreh Nebuchim. F. 105r-111v : division des chapites de la bibles par les chrétiens. F. Colophon au f. 40r : ותשלם ... ע"י הצעיר ... בכמ"ר ... יצ"ו יו’ ג’ י’ אפרי’ רמ"א". שם המעתיק נמחק, ובסופו בכתיבה מאוחרת: "בסירמ’" Copié le 13 avril 5241 (1481) à Sermini (Italie)

Neck Pain in Adolescent Headache Sufferers. A Cohort Study of Schoolchildren

Although neck pain (NP) and headache (HA) are often concomitant in adolescents, few data exist on the association of NP with HA in this age group. The aim of the study was to examine the association of concomitant NP with adolescent HA and with the outcome of HA. The associations of self-reported NP, physical findings of the neck and disc degeneration of the cervical spine with adolescent HA were studied. This study is part of a population-based follow-up study of 12-year-old children (N 1135/1409) with and without HA. A sample of adolescents (N = 304) was followed to the age of 16 years. At the age of 17 years, 69 of them participated in a magnetic resonance imaging (MRI) study of the cervical spine. During the follow-up from 13 to 16 years of age, changes in both HA type and frequency were common. A poor outcome of HA was associated with NP interfering with daily activities at the age of 13 years. The changes in HA type were not predictable by NP. At the age of 16 years, local and referred palpation pain of the neck muscles, self-reported NP and NP intensity were associated with HA, and especially with disturbing HA unresponsive to analgesics. The association of NP with HA was not determined by HA type. Mild degenerative changes of the cervical spine were common but did not contribute to headache. HA in adolescence is often episodic, and prevention and treatment of NP could be important in the prevention of future chronic adult HA.

Restoration of connexin 40 (cx40) in Renin-producing cells reduces the hypertension of cx40 null mice.

Connexin 40 (Cx40) is expressed by the renin-producing cells (RSCs) of the kidneys and the endothelial cells of blood vessels. Cx40 null mice (Cx40(-/-)) feature a much increased renin synthesis and secretion, which results in chronic hypertension, and also display an altered endothelium-dependent relaxation of the aorta because of reduced eNOS levels and nitric oxide production. To discriminate the effect of Cx40 in renin secretion and vascular signaling, we targeted Cx40 to either the RSCs or the endothelial cells of Cx40 null mice. When compared with Cx40(-/-) controls, the animals expressing Cx40 in RSCs were less hypertensive and featured reduced renin levels, still numerous RSCs outside the wall of the afferent arterioles. In contrast, mice expressing Cx40 in the endothelial cells were as hypertensive as Cx40(-/-) mice, in spite of control levels of Cx37 and eNOS. Our data show that blood pressure is improved by restoration of Cx40 expression in RSCs but not in endothelial cells, stressing the prominent role of renin in the mouse hypertension linked to loss of Cx40.

Locating emergency services with priority rules: The priority queuing covering location problem

One of the assumptions of the Capacitated Facility Location Problem (CFLP) is thatdemand is known and fixed. Most often, this is not the case when managers take somestrategic decisions such as locating facilities and assigning demand points to thosefacilities. In this paper we consider demand as stochastic and we model each of thefacilities as an independent queue. Stochastic models of manufacturing systems anddeterministic location models are put together in order to obtain a formula for thebacklogging probability at a potential facility location.Several solution techniques have been proposed to solve the CFLP. One of the mostrecently proposed heuristics, a Reactive Greedy Adaptive Search Procedure, isimplemented in order to solve the model formulated. We present some computationalexperiments in order to evaluate the heuristics performance and to illustrate the use ofthis new formulation for the CFLP. The paper finishes with a simple simulationexercise.

Crucero de evaluación de la biomasa desovante de la anchoveta peruana, 1995. Actividades, resultados y perspectivas

Con el propósito de estimar la biomasa desovante de las especies anchoveta peruana (Engraulis ringens J.) y sardina (Sardinops sagax sagax J.), se ejecutó el Crucero 9508-09 a bordo del BIC Humboldt y del SNP-1, del 12 de agosto al 22 de setiembre de 1995, cubriendo el área entre Tambo de Mora (13°30 'S) y Paita (5°S). Se obtuvo los cinco parámetros que el Método de Producción de Huevos (MPH) requiere para estimar la biomasa de la población desovante de la anchoveta. Además se consideró cuatro perfiles para investigar las variables oceanográficas: Callao (12° S) y Chimbote (9°10 'S) hasta las 100 millas y Punta Falsa (6°S) y Paita hasta 150 millas de la costa. La biomasa desovante de la anchoveta estimada por el MPH entre Tambo de Mora y Punta Falsa en agosto y setiembre de 1995, fue calculada en 5,9 millones de toneladas, con una producción diaria de huevos de 19,1 E+13 y una frecuencia de desove de 0,12. La anchoveta estuvo localizada cerca de la costa entre Callao y Chimbote, mientras que de Salaverry (8°13 'S) a Punta Falsa, su distribución se amplió, alcanzando hasta las 60 millas fuera de la costa. No se pudo estimar la biomasa desovante de la sardina debido a la dispersión de este recurso. Durante el desarrollo del crucero, las condiciones oceanográficas se encontraron dentro de la normalizada para la época, con afloramientos intensos en la franja costera y con advección de aguas tropicales superficiales de Chancay (11°35 'S) a Casma (9°27 'S).

Agrarförbundets ordförande 1958 generaldirektör V. J. Sukselainen

Kirje

Delayed-Choice Experiments and the Metaphysics of Entanglement

Delayed-choice experiments in quantum mechanics are often taken to undermine a realistic interpretation of the quantum state. More specifically, Healey has recently argued that the phenomenon of delayed-choice entanglement swapping is incompatible with the view that entanglement is a physical relation between quantum systems. This paper argues against these claims. It first reviews two paradigmatic delayed-choice experiments and analyzes their metaphysical implications. It then applies the results of this analysis to the case of entanglement swapping, showing that such experiments pose no threat to realism about entanglement.