Cost-of-illness in systemic sclerosis: a retrospective study of an italian cohort of 106 patients

Aims: It is increasingly important to determine the economic consequences of diseases considering the policy of limited health–care budgets. In this study we evaluated the annual direct and indirect costs of Systemic Sclerosis (SSc) and we tried also to identify any cost predictors. Methods: We studied 106 patients (103 female, 3 male), 57 affected by Limited Systemic Sclerosis (LSSc) and 49 affected by Diffuse Systemic Sclerosis (DSSc). Mean age was 57 years (SD±13,8) and mean disease duration was 8,9 years (SD±7,2). Direct costs: data were calculated referring to DRG (Disease Related Group) expenses for the in-patients. We referred to national pharmacopoeia to calculate the pharmaceutical cost for the out-patients. Indirect costs: we estimated the expense comparing our cases to literature data. Intangible costs: these are attributable to pain and psychological suffering. It is very difficult to express the intangible costs in monetary terms and they are often conveyed as disability and poorer quality-of-life. We used the Health Assessment Questionnaire "HAQ" and the Short Form-36 "SF-36" to evaluate this issues. Results: Our study confirms, the extremely high costs caused by Systemic Sclerosis (total cost's 2001 year is € 1.173.842,93, and average yearly patient cost is € 11.073,99). Considering an estimated prevalence of 375 cases/106, the total yearly economic impact of SSc in Italy should be € 249.000.000,00. Intangible costs were calculated as modifications of the health status. Average value of the HAQ was significantly higher than the control population (0,94±0,72), average values in the SF-36 were significantly lower than the control population (49,99±19,16 for physical dimension and 58,42±27,71 for mental dimension). The diffuse form of SSc, positivity for anti-Scl 70 antibodies, high skin score and a poor health status (HAQ and SF-36) were found to be cost predictors. Conclusions: As reported in the literature, our study confirms, the extremely high costs for total and single patients caused by Systemic Sclerosis. The DSSc are more expensive than the LSSc approximately 11% (p=0,0067). The direct costs are 30% higher in the DSSc than the LSSc (p<0.001). The indirect and intangible costs are not significantly different. Moreover, our study shows also the possibility of identifying different cost predictors

Symmetrical anatomical variant of the anterior belly of the digastric muscle: clinical implicat

The digastric muscle is an important surgical landmark. Several anatomical variants of the digastric muscle are reported in literature and, in particular, the presence of accessory anterior bellies of the muscle is not uncommon. Here, an unreported symmetrical variant of the digastric muscle was found during a dissection of the suprahyoid region. The dissection showed digastric muscles with an accessory anterior belly, which originated from the anterior belly of muscles in proximity and anteriorly to the intermediate tendon. The accessory bellies were fused together on the midline and were attached with a unique tendon to the inner surface of the mental symphysis. These muscles completely filled the submental triangle. This unreported anatomical variant could be considered an additional contribution to description of the anatomical variants of the digastric muscle, with several implications in head and neck pathology, diagnosis and surgery.

The myloglossus in a human cadaver study: common or uncommon anatomical structure?

Background: Additional extrinsic muscles of the tongue are reported in literature and one of them is the myloglossus muscle (MGM). Since MGM is nowadays considered as anatomical variant, the aim of this study is to clarify some open questions by evaluating and describing the myloglossal anatomy (including both MGM and its ligamentous counterpart) during human cadaver dissections. Materials and methods: Twenty-one regions (including masticator space, sublingual space and adjacent areas) were dissected and the presence and appearance of myloglossus were considered, together with its proximal and distal insertions, vascularisation and innervation. Results: The myloglossus was present in 61.9% of cases with muscular, ligamentous or mixed appearance and either bony or muscular insertion. Facial artery provided myloglossal vascularisation in the 84.62% and lingual artery in the 15.38%; innervation was granted by the trigeminal system (buccal nerve and mylohyoid nerve), sometimes (46.15%) with hypoglossal component. Conclusions: These data suggest us to not consider myloglossus as a rare anatomical variant.

Technical note: First spectral measurement of the Earth&apos;s upwelling emission using an uncooled wideband Fourier transform spectrometer

The first spectral measurement of Earth&apos;s emitted radiation to space in the wideband range from 100 to 1400&nbsp;cm^&minus;1 with 0.5&nbsp;cm^&minus;1 spectral resolution is presented. The measurement was performed from a stratospheric balloon in tropical region using a Fourier transform spectrometer, during a field campaign held in Brazil in June 2005. The instrument, which has uncooled components including the detector module, is a prototype developed as part of the study for the REFIR (Radiation Explorer in the Far InfraRed) space mission. This paper shows the results of the field campaign with particular attention to the measurement capabilities of the prototype. The results are compared with measurements taken by IASI-balloon (Infrared Atmospheric Sounding Interferometer &ndash; Balloon version), aboard the same platform, and with forward model estimations. The infrared signature of clouds is observed in the measurements

First spectral measurement of the Earth's upwelling emission using an uncooled wideband Fourier transform spectrometer

International audienceThe first spectral measurement of Earth's emitted radiation to space in the wideband range from 100 to 1400 cm-1 with 0.5 cm-1 spectral resolution is presented. The measurement was performed from a stratospheric balloon in tropical region using a Fourier transform spectrometer, during a field campaign held in Brazil in June 2005. The instrument, which has uncooled components including the detector module, is a prototype developed as part of the study for the REFIR (Radiation Explorer in the Far InfraRed) space mission. This paper shows the results of the field campaign with particular attention to the measurement capabilities of the prototype. The results are compared with measurements taken by IASI-balloon (Infrared Atmospheric Sounding Interferometer – Balloon version), aboard the same platform, and with forward model estimations. The infrared signature of clouds is observed in the measurements

Technical note: First spectral measurement of the Earth's upwelling emission using an uncooled wideband Fourier transform spectrometer

International audienceThe first spectral measurement of Earth's emitted radiation to space in the wideband range from 100 to 1400 cm-1 with 0.5 cm-1 spectral resolution is presented. The measurement was performed from a stratospheric balloon in tropical region using a Fourier transform spectrometer, during a field campaign held in Brazil in June 2005. The instrument, which has uncooled components including the detector module, is a prototype developed as part of the study for the REFIR (Radiation Explorer in the Far InfraRed) space mission. This paper shows the results of the field campaign with particular attention to the measurement capabilities of the prototype. The results are compared with measurements taken by IASI-balloon (Infrared Atmospheric Sounding Interferometer – Balloon version), aboard the same platform, and with forward model estimations. The infrared signature of clouds is observed in the measurements

Antimicrobial Stewardship Interventions in Pediatric Oncology: A Systematic Review

Antimicrobial stewardship programs represent efficacious measures for reducing antibiotic overuse and improving outcomes in different settings. Specific data on pediatric oncology are lacking. We conducted a systematic review on the PubMed and Trip databases according to the PRISMA guidelines, searching for reports regarding antimicrobial stewardship in pediatric oncology and hematology patients. The aim of the study was to summarize the present literature regarding the implementation of antimicrobial stewardship programs or initiatives in this particular population, and provide insights for future investigations. Nine papers were included in the qualitative analysis: three regarding antifungal interventions, five regarding antibacterial interventions, and one regarding both antifungal and antibacterial stewardship interventions. Variable strategies were reported among the included studies. Different parameters were used to evaluate the impact of these interventions, including days of therapy per 1000-patient-days, infections with resistant strains, safety analysis, and costs. We generally observed a reduction in the prescription of broad-spectrum antibiotics and an improved appropriateness, with reduced antibiotic-related side effects and no difference in infection-related mortality. Antibiotic stewardship programs or interventions are effective in reducing antibiotic consumption and improving outcomes in pediatric oncology hematology settings, although stewardship strategies differ substantially in different institutions. A standardized approach needs to be implemented in future studies in order to better elucidate the impact of stewardship programs in this category of patients

Compact relaxations for polynomial programming problems

Reduced RLT constraints are a special class of Reformulation- Linearization Technique (RLT) constraints. They apply to nonconvex (both continuous and mixed-integer) quadratic programming problems subject to systems of linear equality constraints. We present an extension to the general case of polynomial programming problems and discuss the derived convex relaxation. We then show how to perform rRLT constraint generation so as to reduce the number of inequality constraints in the relaxation, thereby making it more compact and faster to solve. We present some computational results validating our approach