Traitement pharmacologique de la schizophrénie: évaluation comparative de la qualité des recommandations de pratique clinique [Comparative evaluation of clinical practice guidelines for the treatment of schizophrenia]

INTRODUCTION: Many clinical practice guidelines (CPG) have been published in reply to the development of the concept of "evidence-based medicine" (EBM) and as a solution to the difficulty of synthesizing and selecting relevant medical literature. Taking into account the expansion of new CPG, the question of choice arises: which CPG to consider in a given clinical situation? It is of primary importance to evaluate the quality of the CPG, but until recently, there has been no standardized tool of evaluation or comparison of the quality of the CPG. An instrument of evaluation of the quality of the CPG, called "AGREE" for appraisal of guidelines for research and evaluation was validated in 2002. AIM OF THE STUDY: The six principal CPG concerning the treatment of schizophrenia are compared with the help of the "AGREE" instrument: (1) "the Agence nationale pour le développement de l'évaluation médicale (ANDEM) recommendations"; (2) "The American Psychiatric Association (APA) practice guideline for the treatment of patients with schizophrenia"; (3) "The quick reference guide of APA practice guideline for the treatment of patients with schizophrenia"; (4) "The schizophrenia patient outcomes research team (PORT) treatment recommendations"; (5) "The Texas medication algorithm project (T-MAP)" and (6) "The expert consensus guideline for the treatment of schizophrenia". RESULTS: The results of our study were then compared with those of a similar investigation published in 2005, structured on 24 CPG tackling the treatment of schizophrenia. The "AGREE" tool was also used by two investigators in their study. In general, the scores of the two studies differed little and the two global evaluations of the CPG converged; however, each of the six CPG is perfectible. DISCUSSION: The rigour of elaboration of the six CPG was in general average. The consideration of the opinion of potential users was incomplete, and an effort made in the presentation of the recommendations would facilitate their clinical use. Moreover, there was little consideration by the authors regarding the applicability of the recommendations. CONCLUSION: Globally, two CPG are considered as strongly recommended: "the quick reference guide of the APA practice guideline for the treatment of patients with schizophrenia" and "the T-MAP".

The Impact of Higher Education Institution-Firm Knowledge Links on Firm-level Productivity in Britain

This paper estimates whether both sourcing knowledge from and/or cooperating on innovation with HEIs (Higher Education Institutions)1 impacts on establishment-level total factor productivity (TFP) using a dataset created by merging the UK government’s Community Innovation Survey (CIS) with the Annual Respondents Database (ARD). It also considers whether higher graduate employment (as a measure of human capital) also impacts positively on TFP at the establishment-level. Many studies have investigated the relationship between university-firm knowledge links and innovation (see, for example, Mansfield, 1991; Becker, 2003; Thorn et al, 2007). Most of these studies find a positive impact. Fewer studies have investigated the impact of university-firm knowledge links on productivity. Belderbos et al. (2004), using the Dutch CIS, find that cooperation with universities has no statistically significant impact on the growth of labour productivity. Medda et al. (2005) find no statistically significant effect of collaborative research undertaken by Italian manufacturing firms and universities on the growth of TFP. Arvanitis et al. (2008), using Swiss data, show that university-firm knowledge and technology transfer has both a direct impact on labour productivity and an indirect impact through its positive impact on innovation. In sum, there is as yet no clear consensus as to the impact of university-firm knowledge links on productivity.

Recommandations de pratique clinique dans la schizophrénie : de la théorie à la mise en application

Résumé: Dans le cadre d'une étude rétrospective au sein d'une unité de réhabilitation ,nous avons cherché à examiner le degré de respect de recommandations de pratique clinique (RPC) abordant le traitement pharmacologique au long cours de la schizophrénie, par des médecins qui n'en ont qu'une connaissance indirecte. « The Expert Consensus Guideline for the treatment of schizophrenia » (« ECGTS ») a été retenu comme référence sur la base d'une comparaison avec cinq autres RPC principales. Sur un collectif de 20 patients, les recommandations de «l'ECGTS» sont totalement respectées dans 65 % des cas, partiellement respectées dans 10% et non respectées dans 25 %, démontrant ainsi que la pratique clinique est clairement perfectible (principalement dans le traitement des symptômes psychotiques et dépressifs). Cependant, le respect des RPC ne garantit pas forcément la résolution de tous les problèmes cliniques rencontrés : 12 patients sur 20 présentent des effets secondaires à l'évaluation clinique, et pour 8 d'entre eux, les recommandations à ce niveau sont respectées. Notre étude montre cependant que le choix et l'application d'une RPC n'est pas simple. Les RPC actuelles donnent peu ou pas d'instrument de mesure, ni de critère précis pour évaluer les problèmes cliniques auxquels elles font référence. L'avenir appartient donc à des RPC qui proposent, outre les recommandations cliniques elles-mêmes, les moyens de leur vérification et de leur application sur le terrain.

Beyond Intermediates: The Role of Consumption and Commuting in the Construction of Local Input-Output Tables

It is a well-established fact in the literature on simulating Input-Output tables that mechanical methods for estimating intermediate trade lead to biased results where cross-hauling is underestimated and Type-I multipliers are overstated. Repeated findings to this effect have led to a primary emphasis on advocating the accurate estimation of intermediate trade flows. This paper reviews previous research and argues for a qualification of the consensus view: When simulating IO tables, construction approaches need to consider spill-over effects driven by wage and consumption flows. In particular, for the case of metropolitan economies, wage and consumption flows are important if accurate Type-II multipliers are to be obtained. This is demonstrated by constructing an interregional Input-Output table, which captures interdependencies between a city and its commuter belt, nested within the wider regional economy. In addition to identifying interdependencies caused by interregional intermediate purchases, data on subregional household incomes and commuter flows are used to identify interdependencies from wage payments and household consumption. The construction of the table is varied around a range of assumptions on intermediate trade and household consumption to capture the sensitivity of multipliers.

La Suisse, nation fêlée : essai sur le nationalisme helvétique

Dans l'histoire européenne ont commencé à se former, à partir de la fin du XVIIIe siècle, des objets politiques inédits que l'on appelle maintenant des nations. Le mouvement a commencé en France et en Grande-Bretagne, pour se propager rapi- dement dans toute l'Europe, soutenu par les profonds bouleversements entraînés par la révolution industrielle et une timide démocratisation des sociétés. Au milieu de ce continent en pleine mutation se trouve un autre objet politique, au moins aussi étrange, vieille confédération d'États souverains sortie tout droit du Moyen-Âge et qu'on appelait encore il y a peu le «Corps helvétique». La Suisse, puisque c'est d'elle qu'il s'agit, est-elle affectée par ce vaste mouvement des nationalismes, et si oui comment ? Les nations européennes se construisent fondamentalement autour de quatre éléments : un État centralisé, un territoire, une histoire et un peuple. Dans leur pléni- tude, ces quatre éléments manquent à la Suisse. En fait d'État centralisé, on trouve plutôt un pouvoir central faible, débordé à la fois par des cantons ayant conservé de nombreuses prérogatives et par des associations privées redoutablement efficaces. Son territoire n'est que le résultat hasardeux de traités d'entraide successifs; son histoire est marquée par la désunion et les guerres; quant au peuple suisse, il faut avoir une imagination fertile pour en concevoir concrètement l'existence. C'est pourquoi il faut parler, à propos de la Suisse, d'une fêlure nationale. A défaut de peuple facilement identifiable, on construit des mythes politiques rassembleurs, parmi lesquels la neutralité armée, le consensus, le fédéralisme ou la démocratie. Mais cette mythologie tourne toujours un peu à vide, ce sera le propos de cet essai de le montrer.

Spanish pension system: population aging and immigration policy

There is a widespread consensus in the literature that, as consequence of the demographic transition, the current Spanish pension system will become unsustainable in the next decades. In this article we evaluate the sustainability of the contributory pensions' sub-system, taking into account the demographic projections by the Spanish Statistical Office (INE). A baseline scenario is projected as well as several reforms are simulated, focusing on: (i) selective immigration policy, (ii) changes in the way of setting the pensions and (iii) increase of the legal age of retirement up to 68. The main results are the following. The current system would not incur deficits until 2018, from then deficits will begin to be accumulated. The expenditure in pensions practically would double (from 8.3 % in 2005 to 17.2 % in 2050). A selective immigration policy -towards foreign young people- would help, but does not solve the long-term sustainability of the current system. A policy that combines a pensions' growth at a pace lower than productivity growth and extends the legal age of retirement up to 68 would give solvency to the system beyond 2029

Disentangling the Housing Satisfaction Puzzle: Does Homeownership Really Matter?

There is a general consensus that homeownership has beneficial effects for both individuals and society in many outcomes. However, research regarding the effect of homeownership on individuals' subjective well-being remains inconclusive. In this paper, for the first time, we provide empirical evidence for the link between homeownership and housing satisfaction using panel data. We use the eight waves of the European Community Household Panel (ECHP) covering the period 1994-2001. We observe that renters who become homeowners not only experience a significant increase in housing satisfaction, but also after changing their tenure status, they obtain a different utility from the same housing context. This evidence might provide support to the hypothesis that a share of the differences in the perceived utility derived from housing can be attributed to (un)fulfilled expectations or aspirations regarding homeownership. Keywords: Housing satisfaction, subjective well-being, homeownership, fixed-effects, housing aspirations JEL classification: D1, R2.

Rendu-Osler disease: treatment with oestrogen/progestagen versus octreotide.

In Rendu-Osler disease, haemorrhages due to gastrointestinal vascular malformations are common. Surgical and endoscopic treatments for haemorrhage due to gastrointestinal vascular malformations are compromised when lesions are diffuse, escape identification or are inaccessible to treatment. Hormonal treatment with oestrogen and progestagens is still controversial based on contradictory results from two randomised clinical trials. Although somatostatin and its long-acting analogue, octreotide, have been reported to be beneficial in preventing rebleeding, there is no consensus on this type of treatment. This case report shows how the combination of ethinyloestradiol and norethisterone markedly reduced the need for blood transfusions with few side effects in one patient; in comparison, octreotide seems less effective but this could be related to a worsening of the disease.

Diffusion-weighted MR imaging of the spine at 3-T: feasibility, optimization of b-value and utility to differentiate benign from pathological vertebral compression fractures

Purpose: To evaluate the feasibility, determine the optimal b-value, and assess the utility of 3-T diffusion-weighted MR imaging (DWI) of the spine in differentiating benign from pathologic vertebral compression fractures.Methods and Materials: Twenty patients with 38 vertebral compression fractures (24 benign, 14 pathologic) and 20 controls (total: 23 men, 17 women, mean age 56.2years) were included from December 2010 to May 2011 in this IRB-approved prospective study. MR imaging of the spine was performed on a 3-T unit with T1-w, fat-suppressed T2-w, gadolinium-enhanced fat-suppressed T1-w and zoomed-EPI (2D RF excitation pulse combined with reduced field-of-view single-shot echo-planar readout) diffusion-w (b-values: 0, 300, 500 and 700s/mm2) sequences. Two radiologists independently assessed zoomed-EPI image quality in random order using a 4-point scale: 1=excellent to 4=poor. They subsequently measured apparent diffusion coefficients (ADCs) in normal vertebral bodies and compression fractures, in consensus.Results: Lower b-values correlated with better image quality scores, with significant differences between b=300 (mean±SD=2.6±0.8), b=500 (3.0±0.7) and b=700 (3.6±0.6) (all p<0.001). Mean ADCs of normal vertebral bodies (n=162) were 0.23, 0.17 and 0.11×10-3mm2/s with b=300, 500 and 700s/mm2, respectively. In contrast, mean ADCs were 0.89, 0.70 and 0.59×10-3mm2/s for benign vertebral compression fractures and 0.79, 0.66 and 0.51×10-3mm2/s for pathologic fractures with b=300, 500 and 700s/mm2, respectively. No significant difference was found between ADCs of benign and pathologic fractures.Conclusion: 3-T DWI of the spine is feasible and lower b-values (300s/mm2) are recommended. However, our preliminary results show no advantage of DWI in differentiating benign from pathologic vertebral compression fractures.

Référentiels des compétences et des métiers : une approche ontologique

Résumé La mondialisation des marchés, les mutations du contexte économique et enfin l'impact des nouvelles technologies de l'information ont obligé les entreprises à revoir la façon dont elles gèrent leurs capitaux intellectuel (gestion des connaissances) et humain (gestion des compétences). II est communément admis aujourd'hui que ceux-ci jouent un rôle particulièrement stratégique dans l'organisation. L'entreprise désireuse de se lancer dans une politique gestion de ces capitaux devra faire face à différents problèmes. En effet, afin de gérer ces connaissances et ces compétences, un long processus de capitalisation doit être réalisé. Celui-ci doit passer par différentes étapes comme l'identification, l'extraction et la représentation des connaissances et des compétences. Pour cela, il existe différentes méthodes de gestion des connaissances et des compétences comme MASK, CommonKADS, KOD... Malheureusement, ces différentes méthodes sont très lourdes à mettre en oeuvre, et se cantonnent à certains types de connaissances et sont, par conséquent, plus limitées dans les fonctionnalités qu'elles peuvent offrir. Enfin, la gestion des compétences et la gestion des connaissances sont deux domaines dissociés alors qu'il serait intéressant d'unifier ces deux approches en une seule. En effet, les compétences sont très proches des connaissances comme le souligne la définition de la compétence qui suit : « un ensemble de connaissances en action dans un contexte donné ». Par conséquent, nous avons choisi d'appuyer notre proposition sur le concept de compétence. En effet, la compétence est parmi les connaissances de l'entreprise l'une des plus cruciales, en particulier pour éviter la perte de savoir-faire ou pour pouvoir prévenir les besoins futurs de l'entreprise, car derrière les compétences des collaborateurs, se trouve l'efficacité de l'organisation. De plus, il est possible de décrire grâce à la compétence de nombreux autres concepts de l'organisation, comme les métiers, les missions, les projets, les formations... Malheureusement, il n'existe pas réellement de consensus sur la définition de la compétence. D'ailleurs, les différentes définitions existantes, même si elles sont pleinement satisfaisantes pour les experts, ne permettent pas de réaliser un système opérationnel. Dans notre approche; nous abordons la gestion des compétences à l'aide d'une méthode de gestion des connaissances. En effet, de par leur nature même, connaissance et compétence sont intimement liées et donc une telle méthode est parfaitement adaptée à la gestion des compétences. Afin de pouvoir exploiter ces connaissances et ces compétences nous avons dû, dans un premier temps, définir les concepts organisationnels de façon claire et computationnelle. Sur cette base, nous proposons une méthodologie de construction des différents référentiels d'entreprise (référentiel de compétences, des missions, des métiers...). Pour modéliser ces différents référentiels, nous avons choisi l'ontologie, car elle permet d'obtenir des définitions cohérentes et consensuelles aux concepts tout en supportant les diversités langagières. Ensuite, nous cartographions les connaissances de l'entreprise (formations, missions, métiers...) sur ces différentes ontologies afin de pouvoir les exploiter et les diffuser. Notre approche de la gestion des connaissances et de la gestion des compétences a permis la réalisation d'un outil offrant de nombreuses fonctionnalités comme la gestion des aires de mobilités, l'analyse stratégique, les annuaires ou encore la gestion des CV. Abstract The globalization of markets, the easing of economical regulation and finally the impact of new information and communication technologies have obliged firms to re-examine the way they manage their knowledge capital (knowledge management) and their human capital (competence management). It is commonly admitted that knowledge plays a slightly strategical role in the organization. The firms who want to establish one politic of management of these capitals will have to face with different problems. To manage that knowledge, a long process of capitalization must be done. That one has different steps like identification, extraction and representation of knowledge and competences. There are some different methods of knowledge management like MASK, CommonKADS or KOD. Unfortunately, those methods are very difficult to implement and are using only some types of knowledge and are consequently more limited in the functionalities they can offer. Knowledge management and competence management are two different domain where it could be interesting to unify those to one. Indeed, competence is very close than knowledge as underline this definition: "a set of knowledge in action in a specified context". We choose in our approach to rely on the concept of competence. Indeed, the competence is one of crucial knowledge in the company, particularly to avoid the loss of know-how or to prevent future needs. Because behind collaborator's competence, we can find company efficiency. Unfortunately, there is no real consensus on the definition of the concept of competence. Moreover, existing different definitions don't permit to develop an operational system. Among other key concept, we can find jobs, mission, project, and training... Moreover, we approach different problems of the competence management under the angle of the knowledge management. Indeed, knowledge and competence are closely linked. Then, we propose a method to build different company repositories (competence, jobs, projects repositories). To model those different repositories we choose ontology because it permits to obtain coherent and consensual definitions of the concepts with support of linguistics diversities too. This building repositories method coupled with this knowledge and competence management approach permitted the realization of a tool offering functionalities like mobility management, strategical analysis, yellow pages or CV management.

EAACI Position Paper: prevention of work-related respiratory allergies among pre-apprentices or apprentices and young workers.

ABSTRACT: Apprenticeship is a period of increased risk of developing work-related respiratory allergic diseases. There is a need for documents to provide appropriate professional advice to young adults aiming to reduce unsuitable job choices and prevent impairment from their careers. The present document is the result of a consensus reached by a panel of experts from European and non-European countries addressed to allergologists, pneumologists, occupational physicians, primary care physicians, and other specialists interested in this field, which aims to reduce work-related respiratory allergies (rhinoconjunctivitis and asthma) among allergic or nonallergic apprentices and other young adults entering the workforce. The main objective of the document is to issue consensus suggestions for good clinical practice based on existing scientific evidence and the expertise of a panel of physicians.

The Enigma of the Silent Closing of Acts (28,16-31)

(Résumé de l'ouvrage) In the first volume of this long-anticipated collection by Moessner and Tiede, seventeen leading scholars of antiquity present an amazing "sea change" of opinion that Luke is indeed the interpreter of Israel. The book represents an unprecedented international consensus that the Hellenistic author Luke composed a carefully crafted narrative in two parts to claim Jesus of Nazareth as Israel's true heritage and enduring legacy to the world. Part One explores the nature of Luke's prologues and his intention to write a narrative of "events brought to fruition," using the narrative conventions and audience expectations of the Greco-Roman milieu. Part Two illuminates the relation of Luke's second "volume" to the first by inquiring about the consistency and coherence of his narrative-thematic strategies in retelling the story of Israel's legacy of "the Christ." Whether Luke completed Acts, the larger role of Paul and, most significantly, the meaning of Israel by the end of Acts are approached from new perspectives and charged with provocative insights. In addition to the volume editors, the contributors include L. Alexander, D. Schmidt, V. Robbins, C. Thornton, R. Pervo, W. Kurz, C. Holladay, G. Sterling, D. Balch, E. Plmacher, Charles H. Talbert, J.H. Hayes, D. Marguerat, M. Wolter, R. Tannehill, and I. H. Marshall.

A drug administration decision support system

Drug delivery is one of the most common clinical routines in hospitals, and is critical to patients' health and recovery. It includes a decision making process in which a medical doctor decides the amount (dose) and frequency (dose interval) on the basis of a set of available patients' feature data and the doctor's clinical experience (a priori adaptation). This process can be computerized in order to make the prescription procedure in a fast, objective, inexpensive, non-invasive and accurate way. This paper proposes a Drug Administration Decision Support System (DADSS) to help clinicians/patients with the initial dose computing. The system is based on a Support Vector Machine (SVM) algorithm for estimation of the potential drug concentration in the blood of a patient, from which a best combination of dose and dose interval is selected at the level of a DSS. The addition of the RANdom SAmple Consensus (RANSAC) technique enhances the prediction accuracy by selecting inliers for SVM modeling. Experiments are performed for the drug imatinib case study which shows more than 40% improvement in the prediction accuracy compared with previous works. An important extension to the patient features' data is also proposed in this paper.

Choledocholithiasis: repetitive thick-slab single-shot projection magnetic resonance cholangiopancreaticography versus endoscopic ultrasonography.

This prospective study compares repetitive thick-slab single-shot projection magnetic resonance cholangiopancreatography (MRCP) with endoscopic ultrasonography (EUS) for the detection of choledocholithiasis. Fifty-seven consecutive patients (36 women, mean age 61) referred for suspected choledocholithiasis underwent MRCP, followed by EUS. Each procedure was performed by different operators blinded to the results of the other investigation. MR technique included a turbo spin-echo T2-weighted axial sequence with selective fat saturation (SPIR/TSE, TE=70 ms, TR=1,600 ms), followed by coronal dynamic MRCP. The same thick-slab slice was sequentially acquired 12 times as breath-hold single-shot projection imaging (SSh, TE=900 ms, TE=8,000 ms) centred on the common bile duct (CBD). Two experienced radiologists independently and blindly evaluated MR images for the detection of CBD stones. Their inter-observer agreement kappa was determined. Secondly, the two observers read MR images in consensus again. CBD stones were demonstrated in 18 out of 57 patients (31.6 %) and confirmed by endoscopic retrograde cholangiography (ERCP, n=17) or intraoperative cholangiography (n=1). Clinical follow-up served as the "gold standard" in patients with negative results without following invasive procedure (n=28). Sensitivity, specificity, accuracy, positive and negative predictive value for MRCP resulting from consensus reading were 94.9%, 94.4%, 94.7%, 97.4% and 89.5%, respectively. Corresponding values of EUS were 97.4%, 94.4%, 96.5%, 97.4% and 94.4%. Inter-observer agreement kappa was 0.81. Repetitive thick-slab single-shot projection MRCP is an accurate non-invasive imaging modality for suspected choledocholithiasis and should be increasingly used to select those patients who require a subsequent therapeutic procedure, namely ERCP.

Redistributive taxation, public expenditure, and size of governent

We introduce a model of redistributive income taxation and public expenditure. This joint treatment permits analyzing the interdependencies between the two policies: one cannot be chosen independently of the other. Empirical evidence reveals that partisan confrontation essentially falls on expenditure policies rather than on income taxation. We examine the case in which the expenditure policy (or the size of government) is chosen by majority voting and income taxation is consistently adjusted. This adjustment consists of designing the income tax schedule that, given the expenditure policy, achieves consensus among the population. The model determines the consensus in- come tax schedule, the composition of public expenditure and the size of government. The main results are that inequality is negatively related to the size of government and to the pro-rich bias in public expenditure, and positively or negatively related to the marginal income tax, depending on substitutability between government supplied and market goods. These implications are validated using OECD data.