Performance Scores in General Practice: A Comparison between the Clinical versus Medication-Based Approach to Identify Target Populations

CONTEXT: From one country to another, the pay-for-performance mechanisms differ on one significant point: the identification of target populations, that is, populations which serve as a basis for calculating the indicators. The aim of this study was to compare clinical versus medication-based identification of populations of patients with diabetes and hypertension over the age of 50 (for men) or 60 (for women), and any consequences this may have on the calculation of P4P indicators. METHODS: A comparative, retrospective, observational study was carried out with clinical and prescription data from a panel of general practitioners (GPs), the Observatory of General Medicine (OMG) for the year 2007. Two indicators regarding the prescription for statins and aspirin in these populations were calculated. RESULTS: We analyzed data from 21.690 patients collected by 61 GPs via electronic medical files. Following the clinical-based approach, 2.278 patients were diabetic, 8,271 had hypertension and 1.539 had both against respectively 1.730, 8.511 and 1.304 following the medication-based approach (% agreement = 96%, kappa = 0.69). The main reasons for these differences were: forgetting to code the morbidities in the clinical approach, not taking into account the population of patients who were given life style and diet rules only or taking into account patients for whom morbidities other than hypertension could justify the use of antihypertensive drugs in the medication-based approach. The mean (confidence interval) per doctor was 33.7% (31.5-35.9) for statin indicator and 38.4% (35.4-41.4) for aspirin indicator when the target populations were identified on the basis of clinical criteria whereas they were 37.9% (36.3-39.4) and 43.8% (41.4-46.3) on the basis of treatment criteria. CONCLUSION: The two approaches yield very "similar" scores but these scores cover different realities and offer food for thought on the possible usage of these indicators in the framework of P4P programmes

Caractérisation phénotypique et fonctionnelle de cellules dendritiques différenciées, in vitro, en présence d'Interféron-B

Doctorat en Sciences médicalesinfo:eu-repo/semantics/nonPublishe

Caractérisation phénotypique et fonctionnelle de cellules dendritiques différenciées, in vitro, en présence d'Interféron-B

Doctorat en Sciences médicalesinfo:eu-repo/semantics/nonPublishe

Gas injection into a tilted rotating cylinder

The flux of CO 2 diffusing inside a new type of bioreactors has been measured experimentally. This geoinspired bioreactor consists in a partially filled cylinder rotating around its axis tilted with respect to the vertical, thus mimicking the precession motion of the Earth. The height of fluid is chosen equal to 2 radii in order for the first Kelvin mode to be resonant. The CO 2 diffuses through a membrane located at the bottom of the liquid. The partial pressure of CO 2 above the free surface is measured as a function of time. This temporal evolution is modeled by the presence of diffusive layers with no advection at the top and the bottom of the liquid. This basic model leads to an experimental value for the flux of CO 2 at the membrane, which is found to be proportional to the inverse square root of the Ekman number. This is in agreement with the presence of Ekman layers of thickness proportional to the square root of the Ekman number. At a given Ekman number the flux weakly depends on the tilt angle α with a scaling as α 1/4

From mixture theory to Biot's approach for porous media

International audienc

Systemic and placental productions of tumor necrosis factor contribute to induce fetal mortality in mice acutely infected with Trypanosoma cruzi.

Blood levels and placental productions of IFN-gamma and TNF, known to be harmful for pregnancy, were determined in pregnant mice acutely infected with Trypanosoma cruzi and suffering massive fetal losses without congenital infection. INF-gamma was detected mainly at day 9 and TNF at days 17 and 19 of pregnancy in plasma of infected mice. TNF levels were significantly correlated to the percentages of dead fetuses. Placental cells produced TNF but not IFN-gamma, and addition of T. cruzi lysate to such cells strongly stimulated TNF production. Treatment of infected mice with pentoxifylline, known to decrease IFN-gamma production and to inhibit the TNF-alpha gene transcription, reduced the placental production of TNF, and the fetal mortality in comparison to control animals. Altogether these result suggest that TNF produced at systemic and placental levels plays a role in the fetal mortality induced in mice acutely infected with T. cruzi.Journal ArticleResearch Support, Non-U.S. Gov'tSCOPUS: ar.jinfo:eu-repo/semantics/publishe

IL-6 produced by type I IFN DC controls IFN-gamma production by regulating the suppressive effect of CD4+ CD25+ regulatory T cells.

The dendritic cell family is composed of different subsets differentially governing the immune response. Type I interferon (IFN) dendritic cells (DC) are endowed with the ability to trigger both Th1 and Th2 type responses. In view of the pivotal role of regulatory T cells in limiting the effectiveness of effector cells, we analyzed the interactions between these cells and type I IFN DC. DC were generated from monocytes in the presence of IFN-beta and interleukin (IL)-3 (DCI3) or granulocyte macrophage-colony-stimulating factor and IL-4 (DCG4) and activated by poly(I:C). Despite the release of lower amounts of IL-12 after maturation, DCI3 were able to induce a higher IFN-gamma production by T lymphocytes during the mixed leucocyte reaction (MLR) as compared with DCG4. mRNA analysis disclosed that DCI3 overtranscribed the IL-6 gene and secreted high amounts of the protein. Neutralization of IL-6 revealed that this cytokine specifically contributed to the IFN-gamma release induced by DCI3. Finally, depletion of CD25+ T cells before the MLR identified these cells as a target for IL-6. We conclude that DCI3 are endowed with the property of regulating the suppressive effect of regulatory T cells through high IL-6 production. This novel mechanism of T cell control is relevant for the use of DCI3 in vaccination strategies.Journal ArticleResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe

Tilted rotating annular bioreactors

International audienc

DetournayOlivierZoologyRegulationCnidarianiDnoflagellate(Figure1).pdf

Animals must manage interactions with beneficial as well as detrimental microbes. Immunity therefore includes strategies for both resistance to and tolerance of microbial invaders. Transforming growth factor beta (TGFβ) cytokines have many functions in animals including a tolerance-promoting (tolerogenic) role in immunity in vertebrates. TGFβ pathways are present in basal metazoans such as cnidarians but their potential role in immunity has never been explored. This study takes a two-part approach to examining an immune function for TGFβ in cnidarians. First bioinformatic analyses of the model anemone Aiptasia pallida were used to identify TGFβ pathway components and explore the hypothesis that an immune function for TGFβs existed prior to the evolution of vertebrates. A TGFβ ligand from A. pallida was identified as one that groups closely with vertebrate TGFβs that have an immune function. Second, cellular analyses of A. pallida were used to examine a role for a TGFβ pathway in the regulation of cnidarian-dinoflagellate mutualisms. These interactions are stable under ambient conditions but collapse under elevated temperature, a phenomenon called cnidarian bleaching. Addition of exogenous human TGFβ suppressed an immune response measured as LPS-induced nitric oxide (NO) production by the host. Addition of anti-TGFβ to block a putative TGFβ pathway resulted in immune stimulation and a failure of the symbionts to successfully colonize the host. Finally, addition of exogenous TGFβ suppressed immune stimulation in heat-stressed animals and partially abolished a bleaching response. These findings suggest that the dinoflagellate symbionts somehow promote host tolerance through activation of tolerogenic host immune pathways, a strategy employed by some intracellular protozoan parasites during their invasion of vertebrates. Insight into the ancient, conserved nature of host-microbe interactions gained from this cnidarian-dinoflagellate model is valuable to understanding the evolution of immunity and its role in the regulation of both beneficial and detrimental associations