Patient characteristics differently affect early cup and stem loosening in THA: a case-control study on 7,535 patients

We postulated that certain patient characteristics have different effects on early THA component loosening. With two matched case-control studies we assessed 3,028 cups and 5,224 stems. Loosening was defined using signs of mechanical component failure on routine follow-up radiographs or revision for aseptic loosening. Women and men had similar cup-loosening odds, but women had lower odds for stem loosening (p < 0.0001). Odds for cup loosening decreased by 2.1% per additional year of age (p = 0.0004), those for stem loosening by 2.4% (p < 0.0001). Each additional kilogram of weight decreased cup loosening odds by 1.3% (p = 0.0051). Each additional unit of BMI increased stem loosening odds (p = 0.0109). Charnley classes B and C were protective factors against loosening of both components. There were no risk differences for the various main diagnoses. Certain patient characteristics differently affected early cup and stem loosening, although some characteristics had the same protective or harmful effect on component surviva

Supply sensitive services in Swiss ambulatory care: An analysis of basic health insurance records for 2003-2007

<p>Abstract</p> <p>Background</p> <p>Swiss ambulatory care is characterized by independent, and primarily practice-based, physicians, receiving fee for service reimbursement. This study analyses supply sensitive services using ambulatory care claims data from mandatory health insurance. A first research question was aimed at the hypothesis that physicians with large patient lists decrease their intensity of services and bill less per patient to health insurance, and vice versa: physicians with smaller patient lists compensate for the lack of patients with additional visits and services. A second research question relates to the fact that several cantons are allowing physicians to directly dispense drugs to patients ('self-dispensation') whereas other cantons restrict such direct sales to emergencies only. This second question was based on the assumption that patterns of rescheduling patients for consultations may differ across channels of dispensing prescription drugs and therefore the hypothesis of different consultation costs in this context was investigated.</p> <p>Methods</p> <p>Complete claims data paid for by mandatory health insurance of all Swiss physicians in own practices were analyzed for the years 2003-2007. Medical specialties were pooled into six main provider types in ambulatory care: primary care, pediatrics, gynecology & obstetrics, psychiatrists, invasive and non-invasive specialists. For each provider type, regression models at the physician level were used to analyze the relationship between the number of patients treated and the total sum of treatment cost reimbursed by mandatory health insurance.</p> <p>Results</p> <p>The results show non-proportional relationships between patient numbers and total sum of treatment cost for all provider types involved implying that treatment costs per patient increase with higher practice size. The related additional costs to the health system are substantial. Regions with self-dispensation had lowest treatment cost for primary care, gynecology, pediatrics and for psychiatrists whereas "prescription only" areas had lowest cost for specialists with non-invasive and invasive activities.</p> <p>Conclusions</p> <p>The results indicate that payment methods for services and for prescription drugs are associated with variations in treatment cost that are unlikely warranted by different medical needs of patients alone. Promoting physician accountability of care by linking reimbursements to quality, not quantity, of services are important policy measures to be considered for health care in Switzerland.</p

Anaerobic membrane reactor: Biomethane from chicken manure and high-quality effluent

Chicken manure was treated in a pilot scale reactor anaerobic membrane bioreactor constituted by a completely mixed reactor combined with an ultrafiltration tube-shaped membrane in a side-stream configuration. The process operated under mesophilic condition and the inhibition of high concentration of ammonia was avoided using an ammonia stripping system. The experimental plan included a preliminary evaluation, where organic loading rates between 1.0 and 7.6 kgVS/m3/day were tested. The organic load higher than 4 kgVS/m3/d caused the accumulation of volatile fatty acids and process instability. Application of the ammonia stripping was also evaluated. The best performances were achieved using a retention time of 21 days, an organic load between 1.4 and 2.0 kgVS/m3/d, and the recirculation of stripped permeate. Reduction of the ammonia permeate content by 90% through stripping and utilization of a mixture of chicken manure/water/permeate in a ratio of 0.22/0.72/0.72 w/w led to a specific biogas production of 0.59 m3biogas/kgVS and methane content of 66–69%. The ammonia thus removed can be recovered by sulphuric acid treatment as ammonium sulphate, which can be used as a fertilizer. The proposed configuration allowed satisfactory biogas production with appropriate methane percentages, recovery of ammonium sulphate, and a high-quality effluent

Eine empirische Untersuchung Risikoselektion in der Grundversicherung

Die als «Jagd nach guten Risiken» bezeichnete Risikoselektion wird in der Tagespresse derzeit wieder häufiger thematisiert. Zur aktuellen Popularität des Themas dürfte ein bekannter Internet-Vergleichsdienst beigetragen haben, der Presseangaben zufolge unlängst die Weiterleitung bestimmter Offertenanfragen an einige (hierfür zahlende) Versicherer verhinderte. Dieses Gebaren ist Ausdruck des Anreizes, in Versicherungssystemen mit Einheitsprämien jeweils Gesunde anzuwerben und Kranke abzuweisen. Während zur Theorie der Risikoselektion in der Krankenversicherung etliche Publikationen xistieren, standen bislang keine statistisch verwertbaren Daten zu Art und Ausmass allfälliger Risikoselektion in der Schweiz zur Verfügung. Ziel der hier vorgestellten Arbeit war es daher, entsprechende Daten zu erheben und auszuwerten. Im Mittelpunkt des Interesses standen dabei einerseits das Versichererverhalten gegenüber unterschiedlichen Versichertenpopulationen, (z. B. Antwortzeiten gegenüber guten versus schlechten Risiken) andererseits auch die Frage nach Verhaltensunterschieden zwischen Versicherergruppen (Antwortquoten von Multikassenkonzernen versus unabhängigen Krankenkassen).Die Auswertung realer Offertenanfragen und zugehöriger Antworten zeigt etliche statistisch signifikante Unterschiede sowohl zwischen guten und schlechten Risiken als auch zwischen Versicherergruppen. Es empfiehlt sich, die diesen Umstand bei einer allfälligen Umsetzung der umstrittenen Managed-Care-Vorlage zu berücksichtigen

Performance of Pheromone-Baited Traps to Monitor the Seasonal Abundance of Tortrix Moths in Chestnut Groves.

(1) Background: Pammene fasciana (L.), Cydia fagiglandana (Zeller), and C. splendana (H&uuml;bner) (Lepidoptera: Tortricidae) are considered key moth pests of chestnut in Europe. (2) Methods: Investigations were performed in 2018&ndash;2019 in northern Italy. Sticky traps and commercially available pheromones were used for monitoring; moreover, two experimental pheromone blends were tested. All specimens were identified according to male genitalia and molecular analyses. Newly formed chestnut husks and fruits were randomly collected to evaluate the presence of larvae and/or feeding damage, by comparing it to trap catches. (3) Results: P. fasciana was present in all the sites, whereas Cydia species were recorded in three sites of six, with differences in abundance related to pheromone blends studied. Several non-target species, such as Oegoconia novimundi (Busck) and Cydia ilipulana (Walsingham), were present. Data about the seasonal flight activity are provided. (4) Conclusions: This research contributes to ascertaining the presence and abundance of tortrix moths in Italian chestnut groves, and the presence of non-target species highlights the risk of overestimating catches. Fruit damage recorded did not always reflect catches made by pheromone traps, suggesting that monitoring may underestimate the real size of moths&rsquo; populations. All of the data acquired are important for planning specific control measures

Is high prevalence of Echinococcus multilocularis in wild and domestic animals associated with disease incidence in humans?

We investigated a focus of highly endemic Echinococcus multilocularis infection to assess persistence of high endemicity in rural rodents, explore potential for parasite transmission to domestic carnivores, and assess (serologically) putative exposure versus infection frequency in inhabitants of the region. From spring 1993 to spring 1998, the prevalence of E. multilocularis in rodents was 9% to 39% for Arvicola terrestris and 10% to 21% for Microtus arvalis. From June 1996 to October 1997, 6 (7%) of 86 feral dogs and 1 of 33 cats living close to the region tested positive for intestinal E. multilocularis infection. Testing included egg detection by coproscopy, antigen detection by enzyme-linked immunosorbent assay (ELISA), and specific parasite DNA amplification by polymerase chain reaction. Thus, the presence of infected domestic carnivores can increase E. multilocularis exposure risk in humans. A seroepidemiologic survey of 2,943 blood donors in the area used specific Em2-ELISA. Comparative statistical analyses of seroprevalence and clinical incidence showed an increase in Em2-seroprevalence from 1986 and 1996-97 but no increase in clinical incidence of alveolar hydatid disease