Hypoparathyroidism-related health care utilization and expenditure during the first postoperative year after total thyroidectomy for cancer: a comprehensive national cohort study

ObjectivesHypoparathyroidism is the most common complication of total thyroidectomy for cancer, and requires calcium and/or vitamin D supplementation for an unpredictable period of time. The additional cost associated with this complication has not hitherto been assessed. The aim of this study was to assess the economic burden of postoperative hypoparathyroidism after total thyroidectomy for cancer in France.MethodsBased on the French national cancer cohort, which extracts data from the French National Health Data System (SNDS), all adult patients who underwent a total thyroidectomy for cancer in France between 2011 and 2015 were identified, and their healthcare resource use during the first postoperative year was compared according to whether they were treated postoperatively with calcium and/or vitamin D or not. Univariate and multivariate cost analyses were performed with the non-parametric Wilcoxon test and generalized linear model (gamma distribution and log link), respectively.ResultsAmong the 31,175 patients analyzed (75% female, median age: 52y), 13,247 (42%) started calcium and/or vitamin D supplementation within the first postoperative month, and 2,855 patients (9.1%) were still treated at 1 year. Over the first postoperative year, mean overall and specific health expenditures were significantly higher for treated patients than for untreated patients: €7,233 vs €6,934 per patient (p<0.0001) and €478.6 vs €332.7 per patient (p<0.0001), respectively. After adjusting for age, gender, Charlson Comorbidity index, ecological deprivation index, types of thyroid resection, lymph node dissection and complications, year and region, the incremental cost of overall health care utilization was €142 (p<0.004).ConclusionOur study found a significant additional cost in respect of health expenditures for patients who had hypoparathyroidism after thyroidectomy for cancer, over the first postoperative year. Five-year follow-up is planned to assess the impact of more severe long-term complications on costs

Effect of Intraspecific Competition and Substrate Type on Terpene Emissions from Some Mediterranean Plant Species

International audienceCompetition is an important factor that has been extensively reported in the Mediterranean area. There is evidence that leaf terpene accumulation may vary between plants growing on calcareous and siliceous soils. In the present study, leaf terpene emissions from potted seedlings of Pinus halepensis, Cistus albidus, and Quercus coccifera, growing under natural environmental conditions on calcareous and siliceous substrates, were studied by using a bag enclosure method. In both substrates, seedlings were potted alone and in intraspecific competition, to examine the effect of substrate type and that of intraspecific competition on terpene emissions. The results showed that competition favored: (i) overall monoterpene and sesquiterpene emissions from Q. coccifera; (ii) overall monoterpene emissions from P. halepensis; (iii) overall sesquiterpene emissions from C. albidus. Substrate type affected terpene emissions to a limited extent and in a species-specific way. Whereas for Q. coccifera, the overall monoterpene emissions and that of Allo-aromadendrene were favored on siliceous substrate, no significant changes were found in emissions from P. halepensis. Only the release of AR-curcumene from C. albidus was higher on siliceous substrate. We also found high variability in terpene emission composition from the study species, particularly for P. halepensis and Q. coccifera. These two species released both monoterpenes and sesquiterpenes, instead of monoterpenes only, as shown in previous studies

Mountain building in Taiwan: A thermokinematic model

The Taiwan mountain belt is classically viewed as a case example of a critical wedge growing essentially by frontal accretion and therefore submitted to distributed shortening. However, a number of observations call for a significant contribution of underplating to the growth of the orogenic wedge. We propose here a new thermokinematic model of the Taiwan mountain belt reconciling existing kinematic, thermometric and thermochronological constraints. In this model, shortening across the orogen is absorbed by slip on the most frontal faults of the foothills. Crustal thickening and exhumation are sustained by underplating beneath the easternmost portion of the wedge (Tananao Complex, TC), where the uplift rate is estimated to ~6.3 mm a^(−1), and beneath the westernmost internal region of the orogen (Hsueshan Range units, HR), where the uplift rate is estimated to ~4.2 mm a^(−1). Our model suggests that the TC units experienced a synchronous evolution along strike despite the southward propagation of the collision. It also indicates that they have reached a steady state in terms of cooling ages but not in terms of peak metamorphic temperatures. Exhumation of the HR units increases northward but has not yet reached an exhumational steady state. Presently, frontal accretion accounts for less than ~10% of the incoming flux of material into the orogen, although there is indication that it was contributing substantially more (~80%) before 4 Ma. The incoming flux of material accreted beneath the TC significantly increased 1.5 Ma ago. Our results also suggest that the flux of material accreted to the orogen corresponds to the top ~7 km of the upper crust of the underthrust Chinese margin. This indicates that a significant amount (~76%) of the underthrust material has been subducted into the mantle, probably because of the increase in density associated with metamorphism. We also show that the density distribution resulting from metamorphism within the orogenic wedge explains well the topography and the gravity field. By combining available geological data on the thermal and kinematic evolution of the wedge, our study sheds new light onto mountain building processes in Taiwan and allows for reappraising the initial structural architecture of the passive margin

Investigating the kinematics of mountain building in Taiwan from the spatiotemporal evolution of the foreland basin and western foothills

The Taiwanese range has resulted from the collision between the Luzon volcanic arc and the Chinese continental margin, which started about 6.5 Myr ago in the north, and has since propagated southward. The building of the range has been recorded in the spatiotemporal evolution of the foreland basin. We analyze this sedimentary record to place some constraints on the kinematics of crustal deformation. The flexure of the foreland under the load of the growing wedge started with a 1.5 Myr long phase of rapid subsidence and sedimentation, which has migrated southward over the last 3.5 Myr at a rate of 31 +10/−5 mm/yr, reflecting the structural evolution of the range and the growth of the topography during the oblique collision. Isopachs from the Toukoshan (~0 to 1.1 Ma) and Cholan (~1.1 to 3.3 Ma) formations, as well as the sedimentation rates retrieved from a well on the Pakuashan anticline, indicate that the foreland basement has been moving toward the center of mass of the orogen by ~45–50 mm/yr during the development of the basin. From there, we estimate the long-term shortening rate across the range to 39.5–44.5 mm/yr. By considering available data on the thrust faults of the foothills of central Taiwan, we show that most (if not all) the shortening across the range is accommodated by the most frontal structures, with little if any internal shortening within the wedge. The range growth appears therefore to have been essentially sustained by underplating rather than by frontal accretion. In addition, only the upper ~7 to 9 km of the underthrusted crust participates to the growth of the orogen. This requires that a significant amount of the Chinese passive margin crust is subducted beneath the Philippine Sea plate

HyMeX: A 10-Year Multidisciplinary Program on the Mediterranean Water Cycle

Drobinski, P. ... et. al.-- 20 pages, 10 figures, 1 table, supplement material http://journals.ametsoc.org/doi/suppl/10.1175/BAMS-D-12-00244.1HyMeX strives to improve our understanding of the Mediterranean water cycle, its variability from the weather-scale events to the seasonal and interannual scales, and its characteristics over one decade (2010–20), with a special focus on hydrometeorological extremes and the associated social and economic vulnerability of the Mediterranean territoriesHyMeX was developed by an international group of scientists and is currently funded by a large number of agencies. It has been the beneficiary of financial contributions from CNRS; Météo-France; CNES; IRSTEA; INRA; ANR; Collectivité Territoriale de Corse; KIT; CNR; Université de Toulouse; Grenoble Universités; EUMETSAT; EUMETNET; AEMet; Université Blaise Pascal, Clermont Ferrand; Université de la Méditerranée (Aix-Marseille II); Université Montpellier 2; CETEMPS; Italian Civil Protection Department; Université Paris- Sud 11; IGN; EPFL; NASA; New Mexico Tech; IFSTTAR; Mercator Ocean; NOAA; ENEA; TU Delft; CEA; ONERA; IMEDEA; SOCIB; ETH; MeteoCat; Consorzio LAMMA; IRD; National Observatory of Athens; Ministerio de Ciencia e Innovación; CIMA; BRGM; Wageningen University and Research Center; Department of Geophysics, University of Zagreb; Institute of Oceanography and Fisheries, Split, Croatia; INGV; OGS; Maroc Météo; DHMZ; ARPA Piemonte; ARPA-SIMC Emilia-Romagna; ARPA Calabria; ARPA Friuli Venezia Giulia; ARPA Liguria; ISPRA; University of Connecticut; Università degli Studi dell'Aquila; Università di Bologna; Università degli Studi di Torino; Università degli Studi della Basilicata; Università La Sapienza di Roma; Università degli Studi di Padova; Università del Salento; Universitat de Barcelona; Universitat de les Illes Balears; Universidad de Castilla-La Mancha; Universidad Complutense de Madrid; MeteoSwiss; and DLR. It also received support from the European Community's Seventh Framework Programme (e.g., PERSEUS, CLIM-RUN)Peer reviewe

The Role of Mobile Health Technologies in Allergy Care:an EAACI Position Paper

Mobile health (mHealth) uses mobile communication devices such as smartphones and tablet computers to support and improve health-related services, data and information flow, patient self-management, surveillance, and disease management from the moment of first diagnosis to an optimized treatment. The European Academy of Allergy and Clinical Immunology created a task force to assess the state of the art and future potential of mHealth in allergology. The task force endorsed the "Be He@lthy, Be Mobile" WHO initiative and debated the quality, usability, efficiency, advantages, limitations, and risks of mobile solutions for allergic diseases. The results are summarized in this position paper, analyzing also the regulatory background with regard to the "General Data Protection Regulation" and Medical Directives of the European Community. The task force assessed the design, user engagement, content, potential of inducing behavioral change, credibility/accountability, and privacy policies of mHealth products. The perspectives of healthcare professionals and allergic patients are discussed, underlining the need of thorough investigation for an effective design of mHealth technologies as auxiliary tools to improve quality of care. Within the context of precision medicine, these could facilitate the change in perspective from clinician- to patient-centered care. The current and future potential of mHealth is then examined for specific areas of allergology, including allergic rhinitis, aerobiology, allergen immunotherapy, asthma, dermatological diseases, food allergies, anaphylaxis, insect venom, and drug allergy. The impact of mobile technologies and associated big data sets are outlined. Facts and recommendations for future mHealth initiatives within EAACI are listed