Cost effectiveness of a new combined immunosuppressive and antiviral regimen on the one-year follow-up of kidney transplant patients.

Background: Medical prescription after organ transplant must prevent both rejection and infectious complications. We assessed the 1-year effectiveness and cost of introducing a new combined regimen in kidney transplantation. Methods: Patients transplanted from January 2000 to March 2003 (Period 1) were compared to patients transplanted from April 2003 to July 2005 (Period 2). In period 1, patients were treated with Basiliximab, Cyclosporin, steroids and Mycophenolate (MMF) or Azathioprine. Prophylaxis with Valacyclovir was prescribed only in CMV D+/R- patients. In period 2, immunosuppressive drugs were Basiliximab, Tacrolimus, steroids and MMF. A 3-month universal CMV prophylaxis with Valganciclovir was used. Medical charts of outpatient visits allowed identifying drug, laboratory and radiological tests use, and hospital information system causes of hospitalisation and length of stay (LOS) over the first year after transplant. Patients with incomplete costs data were excluded. Results: 53 patients were analysed in period 1, and 60 in period 2. CMV serostatus patterns were not significantly different between the 2 periods. Over 12 months, acute rejection decreased from 22 patients (42%) in period 1 to 4 patients (7%) in period 2 (p<0.001), and CMV infection from 25 patients (47%) to 9 patients (15%, p<0.001). Average total rehospitalisation LOS decreased from 28±19 to 20±11 days (p<0.007). Average outpatient visits decreased from 49±10 to 39±8 (p<0.001). Average immunosuppression and CMV prophylaxis costs increased from US$ 18,362±6,546 to 24,637±5,457 (p<0.001), while average graft rejection costs decreased form US$ 4,135±9,164 to 585±2,850 (p=0.005), and average CMV treatment costs from US$ 2,043±5,545 to 91±293 (p=0.008). Average outpatient visits costs decreased from US$ 7,619±1,549 to 6,074±1,043 (p<0.001), and other hospital costs from US$ 3,801±6,519 to 1,196±3,146 (p=0.007). Altogether, average 1-year treatment costs decreased from US$ 35,961±14,916 to 32,584±6,211 (p=0.115). Cost-effectiveness ratios to avoid graft rejection and CMV infection decreased from US$ 61,482±9,292 to 34,911± 1,639 (p=0.006) and US$ 68,070±11,122 to 39,899±2,650 (p=0.015), respectively. Conclusion: The new combined regimen administered in period 2 was significantly more effective. Its additional cost was more than offset by savings linked with complications avoidance.

Candida species distribution and antifungal susceptibility testing according to European Committee on Antimicrobial Susceptibility Testing and new vs. old Clinical and Laboratory Standards Institute clinical breakpoints: a 6-year prospective candidaemia survey from the fungal infection network of Switzerland.

We analyzed the species distribution of Candida blood isolates (CBIs), prospectively collected between 2004 and 2009 within FUNGINOS, and compared their antifungal susceptibility according to clinical breakpoints defined by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) in 2013, and the Clinical and Laboratory Standards Institute (CLSI) in 2008 (old CLSI breakpoints) and 2012 (new CLSI breakpoints). CBIs were tested for susceptiblity to fluconazole, voriconazole and caspofungin by microtitre broth dilution (Sensititre(®) YeastOne? test panel). Of 1090 CBIs, 675 (61.9%) were C. albicans, 191 (17.5%) C. glabrata, 64 (5.9%) C. tropicalis, 59 (5.4%) C. parapsilosis, 33 (3%) C. dubliniensis, 22 (2%) C. krusei and 46 (4.2%) rare Candida species. Independently of the breakpoints applied, C. albicans was almost uniformly (>98%) susceptible to all three antifungal agents. In contrast, the proportions of fluconazole- and voriconazole-susceptible C. tropicalis and F-susceptible C. parapsilosis were lower according to EUCAST/new CLSI breakpoints than to the old CLSI breakpoints. For caspofungin, non-susceptibility occurred mainly in C. krusei (63.3%) and C. glabrata (9.4%). Nine isolates (five C. tropicalis, three C. albicans and one C. parapsilosis) were cross-resistant to azoles according to EUCAST breakpoints, compared with three isolates (two C. albicans and one C. tropicalis) according to new and two (2 C. albicans) according to old CLSI breakpoints. Four species (C. albicans, C. glabrata, C. tropicalis and C. parapsilosis) represented >90% of all CBIs. In vitro resistance to fluconazole, voriconazole and caspofungin was rare among C. albicans, but an increase of non-susceptibile isolates was observed among C. tropicalis/C. parapsilosis for the azoles and C. glabrata/C. krusei for caspofungin according to EUCAST and new CLSI breakpoints compared with old CLSI breakpoints.

Development of a New Process for Determining Design Year Traffic Demands, TR-528, 2007

Researchers should continuously ask how to improve the models we rely on to make financial decisions in terms of the planning, design, construction, and maintenance of roadways. This project presents an alternative tool that will supplement local decision making but maintain a full appreciation of the complexity and sophistication of today’s regional model and local traffic impact study methodologies. This alternative method is tailored to the desires of local agencies, which requested a better, faster, and easier way to evaluate land uses and their impact on future traffic demands at the sub-area or project corridor levels. A particular emphasis was placed on scenario planning for currently undeveloped areas. The scenario planning tool was developed using actual land use and roadway information for the communities of Johnston and West Des Moines, Iowa. Both communities used the output from this process to make regular decisions regarding infrastructure investment, design, and land use planning. The City of Johnston case study included forecasting future traffic for the western portion of the city within a 2,600-acre area, which included 42 intersections. The City of West Des Moines case study included forecasting future traffic for the city’s western growth area covering over 30,000 acres and 331 intersections. Both studies included forecasting a.m. and p.m. peak-hour traffic volumes based upon a variety of different land use scenarios. The tool developed took goegraphic information system (GIS)-based parcel and roadway information, converted the data into a graphical spreadsheet tool, allowed the user to conduct trip generation, distribution, and assignment, and then to automatically convert the data into a Synchro roadway network which allows for capacity analysis and visualization. The operational delay outputs were converted back into a GIS thematic format for contrast and further scenario planning. This project has laid the groundwork for improving both planning and civil transportation decision making at the sub-regional, super-project level.

Objective results at 1 year of a new ultracongruent postero-stabilized total knee arthroplasty

Introduction: A new ultra congruent, postero-stabilized total knee arthroplasty (TKA) with a mobile bearing, the FIRST knee prosthesis (Free Insert in Rotation Stabilized in Translation, Symbios SA), was designed and expected to significantly reduce polyethylene wear, to improve the range of motion and the overall stability of the knee while ensuring a physiological ligament balance. Gait analysis has proven to give really objective outcome parameters after lower limb surgery. The goal of our study was to compare the subjective and really objective results of this new TKA with two other widespread models of TKA. Methods: A clinical prospective monocentric cohort study of 100 consecutive patients (47-88 yrs) undergoing a FIRST TKA for primary osteoarthritis is currently being done. Pre- and post-operative follow-ups (6 weeks, 4 months and 1 year) were done with well-recognized subjective evaluations (EQ-5D and WOMAC scores) and semi-objective questionnaires (KSS score and radiography evaluation) as well as with a really objective evaluation using gait parameters from 6 walking trials, performed at different speeds (slow, normal and fast) with an ambulatory gait analysis system (Physilog®, BioAGM CH). The outcomes of the first 32 new TKA after one year of follow-up were compared to the results after 1 year of a randomized controlled clinical trial comparing 29 NexGen® postero-stabilized TKA (Zimmer Inc) with a fixed bearing and 26 NexGen® TKA with a mobile bearing using the same methods. Results: Subjective and semi-objective results were similar for the three types of TKA. As for the really objective parameters, the gait cycle time of the FIRST TKA was statistically significantly shorter at normal speed of walk, as well as double-support periods, as compared to both standard models. The extension (in terms of range of motion when walking) of the operated knee was significantly improved for all three types of walk in favour of the FIRST TKAs compared to both NexGen TKAs. The normal walking speed was significantly higher with faster swing speed and stride lengths for the new TKA. Significantly better coordination scores were observed at normal walking speed for the FIRST TKA as compared to the fixed-bearing TKAs. Conclusion: The FIRST TKAs showed statistically significantly better objective outcomes in terms of gait after one year of follow-up with similar subjective and semi-objective results in comparison with widespread TKA designs. These encouraging short-terms results will have to be confirmed at a 5 years follow-up of the FIRST TKAs.

Transition into the teaching profession: induction and mentoring issues surrounding secondary music teachers /

The purpose of this study was to investigate the issues surrounding the transition into the teaching profession by specifically focusing on teacher induction and mentoring issues while explicitly addressing matters of concern by secondary music teachers in a large suburban school board in southern Ontario. Participants included beginning teachers with fewer than 5 years of teaching, mid career teachers with between 6 and 15 years of instruction, and experienced teachers with more than 16 years of practice. The ' processes of mentoring and inducting new teachers within the board were examined, along with their relationships between proteges, mentors, and administrators. Further, internal and external programs specifically designed and implemented for newer music teachers were scrutinized and discussed. An analysis of key documents and literature on the subject was performed, and data were collected through 16 personal interviews. The findings suggest that although the necessity of mentoring and induction processes has begun to be recognized, there exists a fundamental relationship between mentoring and induction and the effect of the professional attachments to mentoring; the institutional and administrative supports that are enabled; and essential processes and practices between mentors and proteges. Together these three arms combine to support successfiil induction and mentoring initiatives that will help ease the transition into teaching.

Special report of New York State Survey on the preservation of the scenery of Niagara Falls ; and fourth annual report on the triangulation of State. For the Year 1879 /

Notes by F. L. Olmsted.

New literacy kit. Year 9.

Recurso para la enseñanza del inglés para niños entre once y catorce años. Cada unidad se basa en un modelo de texto, periódicos, información técnica, autobiográfico, consejos para la salud, lenguaje figurado, poesía, teatro, etc., para ayudar al estudiante a desarrollar sus conocimientos de comprensión, análisis, interpretación y estructura del lenguaje en los diferentes textos. Las actividades incluyen gramática; trabajos transversales; escritura y oportunidades para hablar y escuchar.

New literacy kit. Year 8.

Recurso para la enseñanza del inglés para niños entre once y catorce años. Cada unidad se basa en un modelo de texto, periódicos, información técnica, autobiográfico, consejos para la salud, lenguaje figurado, poesía, teatro, etc., para ayudar al estudiante a desarrollar sus conocimientos de comprensión, análisis, interpretación y estructura del lenguaje en los diferentes textos. Las actividades incluyen gramática; trabajos transversales; escritura y oportunidades para hablar y escuchar.

New literacy kit. Year 7.

Recurso para la enseñanza del inglés para niños entre once y catorce años. Cada unidad se basa en un modelo de texto, periódicos, información técnica, autobiográfico, consejos para la salud, lenguaje figurado, poesía, teatro, etc., para ayudar al estudiante a desarrollar sus conocimientos de comprensión, análisis, interpretación y estructura del lenguaje en los diferentes textos. Las actividades incluyen gramática; trabajos transversales; escritura y oportunidades para hablar y escuchar.

New Ventures Brasil (Forum 2008) - Echo music

Echo music, empresa produtora de instrumentos musicais ecologicamente corretos

Heydrichia (?) poignantii, sp nov (Sporolithaceae, Sporolithales, Rhodophyta), a 100 million year old fossil coralline red alga from north-eastern Brazil, and a new Hauterivian record of Sporolithon from Switzerland

Fossil specimens of Heydrichia (?) poignantii, sp. nov. (Sporolithaceae, Sporolithales, Rhodophyta), representing the first confirmation of the genus in the fossil record, were discovered in thin sections of Albian limestones from the Riachuelo Formation, Sergipe Basin, and in thin sections of Albian -Cenomanian limestones from the Ponta do Mel Formation, Potiguar Basin in north-eastern Brazil. A detailed morphological-anatomical account of the species is provided, and its placement in Heydrichia is discussed in relation to current classification proposals. Comparisons with the four other known species of the genus, all non-fossil, show that H. poignantii is the only known species of Heydrichia in which thalli are encrusting to sparsely warty to horizontally layered with overlapping lamellate branches that commonly appear variously curved or arched, and in which thalli have sporangial complexes that become buried in the thallus. The evolutionary history of Heydrichia remains uncertain, but available data suggest that the genus may have diverged from the sporolithacean genus Sporolithon, known as early as Hauterivian times (c. 129.4-132.9 +/- 1 Ma) from Spain (and newly reported here from Switzerland), or it may have arisen from a graticulacean alga such as Graticula, dating from mid-Silurian times (c. 427-435 Ma). Current data also suggest that Heydrichia is more likely to have arrived in Brazil from Central Atlantic waters than from higher latitude South Atlantic waters. This implies that currently living species in southern Africa probably arose later from ancestors further equatorward in the South Atlantic, although confirming studies are needed. All non-fossil species of Heydrichia are known only from the southern hemisphere.

Evaluation of a New Strategy for Control of Bovine Tuberculosis in Michigan White-Tailed Deer: Year 1 Progress Report

The State of Michigan is striving to eliminate bovine tuberculosis (Tb) infection among free-ranging white-tailed deer in the northeastern Lower Peninsula of the state. Aggressive reduction in the overall deer population abundance may help to further reduce TB prevalence, but this course of action is unacceptable to many hunters and landowners. Targeted culling of sick deer would likely be far more acceptable to these stakeholders, so in the winter of 2003 the Michigan Department of Natural Resources pilot-trialed a new strategy based on live-trapping and Tb-testing of wild deer. The field study was conducted in a township with relatively high TB prevalence within Deer Management Unit 452 in the northeastern Lower Peninsula. Over a 2-month trapping period, 119 individual deer were live-trapped, blood sampled, fitted with a radio-collar, and released. A total of 31 of these deer were subsequently classified as Tb-suspect by at least one of five blood tests employed (however there was a low level of agreement among tests). A delay in testing meant that only six of these suspect deer were culled by sharpshooters before pre-programmed release of their radio-collars, after which they could no longer be located. Mycobacterium bovis was cultured from one of these six suspect deer; the other five were negative on culture. All target deer were located to within shooting range with 1 – 2 days of effort, and all the radio-collars on the apparently-healthy deer dropped off after the intended 90-day interval, and were thereafter recovered for re-use. There was considerable support for this pilot project among hunters, farmers, state and federal agriculture agencies, the media and the general public, and so we recommend that further field trials be undertaken using this technique. The initial focus of these trials should be on improving the efficacy and reliability of the blood testing procedure.