Does the pharmacy expenditure of patients always correspond with their morbidity burden? Exploring new approaches in the interpretation of pharmacy expenditure

<p>Abstract</p> <p>Background</p> <p>The computerisation of primary health care (PHC) records offers the opportunity to focus on pharmacy expenditure from the perspective of the morbidity of individuals. The objective of the present study was to analyse the behaviour of pharmacy expenditure within different morbidity groups. We paid special attention to the identification of individuals who had higher values of pharmacy expenditure than their morbidity would otherwise suggest (i.e. outliers).</p> <p>Methods</p> <p>Observational study consisting of 75,574 patients seen at PHC centres in Zaragoza, Spain, at least once in 2005. Demographic and disease variables were analysed (ACG^®8.1), together with a response variable that we termed 'total pharmacy expenditure per patient'. Outlier patients were identified based on boxplot methods, adjusted boxplot for asymmetric distributions, and by analysing standardised residuals of tobit regression models.</p> <p>Results</p> <p>The pharmacy expenditure of up to 7% of attendees in the studied PHC centres during one year exceeded expectations given their morbidity burden. This group of patients was responsible for up to 24% of the total annual pharmacy expenditure. There was a significantly higher number of outlier patients within the low-morbidity band which matched up with the higher variation coefficient observed in this group (3.2 vs. 2.0 and 1.3 in the moderate- and high-morbidity bands, respectively).</p> <p>Conclusions</p> <p>With appropriate validation, the methodologies of the present study could be incorporated in the routine monitoring of the prescribing profile of general practitioners. This could not only enable evaluation of their performance, but also target groups of outlier patients and foster analyses of the causes of unusually high pharmacy expenditures among them. This interpretation of pharmacy expenditure gives new clues for the efficiency in utilisation of healthcare resources, and could be complementary to management interventions focused on individuals with a high morbidity burden.</p

Frecuencia y variables asociadas a estigma-discriminación percibido en víctimas del conflicto armado colombiano

Resumen: Se desconoce la frecuencia de complejo estigma-discriminación percibido en víctimas del conflicto armado colombiano. El objetivo del estudio fue establecer la frecuencia y variables asociadas al estigma-discriminación percibido en víctimas del conflicto armado, en municipios del Departamento del Magdalena, Colombia. Se realizó un estudio transversal con víctimas registradas en el Programa de Atención Psicosocial y Salud Integral a Víctimas. Los síntomas depresivos se cuantificaron con cuatro ítems dicotómicos (tres o más se clasificaron como alto nivel de síntomas depresivos) y el estigma-discriminación percibido se cuantificó con seis incisos dicotómicos (dos o más afirmaciones se categorizó como alto estigma-discriminación percibido). Participaron 943 adultos (M = 47,9; DE = 14,2); 67,4%, mujeres; 109 (11,6%) informaron alto nivel de síntomas depresivos y 217 (23%) presentaron alto estigma-discriminación percibido. El alto estigma-discriminación percibido se asoció a alto nivel de síntomas depresivos (OR = 6,47; IC95%: 4,23-9,88). Se concluye que un cuarto de las víctimas del conflicto armado en Magdalena informa alto estigma-discriminación percibido; éste se asocia significativamente a alto nivel de síntomas depresivos

Frecuencia y variables asociadas a estigma-discriminación percibido en víctimas del conflicto armado colombiano

Cad. Saúde Pública 2017; 33(11)En este articulo el estudio fue establecer la frecuencia y variables asociadas al estigma-discriminación percibido en víctimas del conflicto armado, en municipios del Departamento del Magdalena, Colombia

Fission-fragment yields and prompt-neutron multiplicity for Coulomb-induced fission of 234,235U^{234,235}\mathrm{U} and 237,238Np^{237,238}\mathrm{Np}

Low-energy fission of U234,235 and Np237,238 radioactive beams, provided by the Fragment Separator (FRS) of the GSI Helmholtzzentrum für Schwerionenforschung facility (GSI), has been studied using the Reactions with Relativistic Radioactive Beams / Studies on Fission with Aladin (R3B/SOFIA) setup. The latter allows us, on an event-by-event basis, to simultaneously identify, in terms of their mass and atomic numbers, the fissioning nucleus in coincidence with both fission fragments after prompt-neutron emission. This article reports new results on elemental, isotonic, isobaric, and isotopic yields. Moreover, the high accuracy of our data allowed us to study in detail proton even-odd staggering, from elemental yields; neutron excess, from isotopic yields; and total prompt-neutron multiplicity, from the difference of masses of the fissioning nucleus and fission fragments. These results are then compared to previous experimental data in order to probe how these fission observables change as function of the excitation energy and atomic and neutron numbers of the compound nucleus

Study of High-Energy Fission in Inverse Kinematics

Fission at low excitation energy, is a process in which both macroscopic and microscopic aspects are involved. Some features in the total kinetic energy and in the N/Z distributions of the fragments, commonly associated with shell effects, came out in a series of recent experiments with high excitation energy fusionfission reactions in inverse kinematics. In the latest experiment of this campaign, a study of high-energy fission and quasi-fission between a 238U beam and a series of light targets was carried out by using the aforementioned technique, in order to probe the role of the shell structure in these processes

Review on the progress in nuclear fission—experimental methods and theoretical descriptions

Abstract : An overview is given on some of the main advances in experimental methods, experimental results and theoretical models and ideas of the last years in the field of nuclear fission. New approaches extended the availability of fissioning systems for experimental studies of nuclear fission considerably and provided a full identification of all fission products in A and Z for the first time. In particular, the transition from symmetric to asymmetric fission around 226Th and some unexpected structure in the mass distributions in the fission of systems around Z = 80 to 84 as well as an extended systematics of the odd-even effect in fission fragment Z distributions have been measured [A. N. Andreyev et al., Rep. Progr. Phys. 81 (2018) 016301]. Three classes of model descriptions of fission presently appear to be the most promising or the most successful ones: Self-consistent quantum-mechanical models fully consider the quantum-mechanical features of the fission process. Intense efforts are presently made to develop suitable theoretical tools [N. Schunck, L. M. Robledo, Rep. Prog. Phys. 79 (2016) 116301] for modeling the non-equilibrium, large-amplitude collective motion leading to fission. Stochastic models provide a fully developed technical framework. The main features of the fission-fragment mass distribution are well reproduced from mercury to fermium and beyond [P. M¨oller, J. Randrup, Phys. Rev. C 91 (2015) 044316]. However, the limited computer resources still impose restrictions, for example on the number of collective coordinates and on an elaborate description of the fission dynamics. In an alternative semi-empirical approach [K.-H. Schmidt et al., Nucl. Data Sheets 131 (2016) 107], considerable progress in describing the fission observables has been achieved by combining several theoretical ideas, which are essentially well known. This approach exploits (i) the topological properties of a continuous function in multidimensional space, (ii) the separability of the influences of fragment shells and macroscopic properties of the compound nucleus, (iii) the properties of a quantum oscillator coupled to the heat bath of other nuclear degrees of freedom, (iv) an early freeze-out of collective motion, and (v) the application of statistical mechanics for describing the thermalization of intrinsic excitations in the nascent fragments. This new approach reveals a high degree of regularity and allows calculating high-quality data that are relevant for nuclear technology without specific adjustment to empirical data of individual systems

A new Time-of-flight detector for the R 3 B setup

© 2022, The Author(s).We present the design, prototype developments and test results of the new time-of-flight detector (ToFD) which is part of the R3B experimental setup at GSI and FAIR, Darmstadt, Germany. The ToFD detector is able to detect heavy-ion residues of all charges at relativistic energies with a relative energy precision σΔE/ ΔE of up to 1% and a time precision of up to 14 ps (sigma). Together with an elaborate particle-tracking system, the full identification of relativistic ions from hydrogen up to uranium in mass and nuclear charge is possible.11Nsciescopu

Reconstruction of interactions in the ProtoDUNE-SP detector with Pandora

International audienceThe Pandora Software Development Kit and algorithm libraries provide pattern-recognition logic essential to the reconstruction of particle interactions in liquid argon time projection chamber detectors. Pandora is the primary event reconstruction software used at ProtoDUNE-SP, a prototype for the Deep Underground Neutrino Experiment far detector. ProtoDUNE-SP, located at CERN, is exposed to a charged-particle test beam. This paper gives an overview of the Pandora reconstruction algorithms and how they have been tailored for use at ProtoDUNE-SP. In complex events with numerous cosmic-ray and beam background particles, the simulated reconstruction and identification efficiency for triggered test-beam particles is above 80% for the majority of particle type and beam momentum combinations. Specifically, simulated 1 GeV/$c$ charged pions and protons are correctly reconstructed and identified with efficiencies of 86.1$\pm0.6$% and 84.1$\pm0.6$%, respectively. The efficiencies measured for test-beam data are shown to be within 5% of those predicted by the simulation