La régulation de la médecine ambulatoire en France : quel effet sur le comportement des médecins libéraux?

Les résultats présentés dans cet article s'inscrivent dans la continuité des travaux microéconomiques réalisés sur cette question. Il s'agit ici, d'examiner, dans quelle mesure la régulation de la médecine libérale en France, où les rémunérations sont définies selon le système de paiement à l'acte avec des tarifs conventionnels, contribue l'éventuel développement d'une demande induite. Sont ici effectivement mis en évidence des comportements de demande induite significatifs chez certains praticiens, dans une période de retournement de l'évolution de la démographie médicales dans certaines zones. [Auteurs]]]> Ambulatory Care ; Physicians fre oai:serval.unil.ch:BIB_2F9464514E2F 2022-05-07T01:14:09Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_2F9464514E2F Madhyamika and Epistemology. A Study of Kamalasila's Method for Proving the Voidness of All Dharmas. Introduction, Annotated Translations and Tibetan Texts of Selected Sections of the Second Chapter of the Madhyamakaloka Keira, R. Université de Lausanne, Faculté des lettres info:eu-repo/semantics/doctoralThesis phdthesis 2003 eng oai:serval.unil.ch:BIB_2F94AE0273F4 2022-05-07T01:14:09Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_2F94AE0273F4 Follow-up of 32 hypothalamo-hypopituitary patients treated with pulsatile gonadotropin-releasing hormone or human menopausal gonadotropin info:doi:10.3109/09513599909167583 info:eu-repo/semantics/altIdentifier/doi/10.3109/09513599909167583 info:eu-repo/semantics/altIdentifier/pmid/10685330 Marci, R. Dessole, S. Senn, A. De Grandi, P. Germond, M. info:eu-repo/semantics/article article 1999-12 Gynecological Endocrinology, vol. 13, no. 6, pp. 375-81 info:eu-repo/semantics/altIdentifier/pissn/0951-3590 <![CDATA[In a clinical retrospective study, a follow-up of hypothalamo-amenorrheic patients treated firstly with gonadotropin-releasing hormone (GnRH) pump stimulation and secondly with human menopausal gonadotropin (hMG) was performed. Thirty-two hypothalamo-amenorrheic patients, 24-38 years old, were submitted to 103 GnRH stimulation cycles. Seven, with polycystic ovaries (PCO) on ultrasound, were stimulated with hMG after one or several unsuccessful pump cycles. Ovulation was confirmed by a luteinizing hormone (LH) surge or triggered by human chorionic gonadotropin in 80 out of 103 cycles (77.7%/cycle) leading to 62 timed sexual intercourses and 17 intrauterine inseminations (IUI). Twenty-one pregnancies (26.3%/cycle) terminated in eight abortions (38.1%/pregnancy) and 13 deliveries (40.6%/patient). hMG stimulation, in the seven PCO patients (six IVF, one IUI), led to four additional deliveries in three patients. Five patients became pregnant spontaneously after pump failure (n = 2) or unsuccessful IVF (n = 3). Combining all cycles, 17 deliveries were obtained in 16 patients. No case of ovarian hyperstimulation syndrome (OHSS) was observed. GnRH is an efficient and safe treatment of hypothalamo-amenorrheic-induced anovulation. Following GnRH or hMG ovarian stimulation, spontaneous ovulation and conception may be restored in certain hypothalamo-amenorrheic patients

Induction de la demande de soins par les médecins libéraux français. Etude microéconométrique sur données de panel

Cette étude a pour objet d'analyser les comportements d'offre de soins des médecins libéraux français. On dispose pour cela d'un panel non cylindré de 7 925 médecins omnipraticiens ou spécialistes, des secteurs 1 ou 2, suivis sur la période 1979-1993 et représentatif de la population concernée. Les estimations mettent en évidence l'existence de comportements de demande induite indéniables dans le secteur 1. Ces comportements permettent aux médecins de limiter les rationnements qu'ils subissent sur le nombre de rencontres médecin-patient quand la densité médicale augmente, et de les compenser par une augmentation du volume de soins fournis au cours de chaque rencontre. Dans le secteur 2 (à honoraires libres), la réaction des médecins aux variations de la densité est compatible avec une absence de comportements d'induction. En effet, une élévation de la densité médicale conduit dans ce secteur à une baisse des tarifs et à une augmentation de l'activité, réactions conformes aux prédictions d'un modèle d'offre de soins basé sur l'hypothèse de concurrence monopolistique. Au total, on constate qu'une augmentation de la densité entraîne une hausse des quantités de soins fournies dans les deux secteurs. En outre, les baisses de tarifs observées dans le secteur 2 ne contribuent pas à un rééquilibrage des comptes sociaux, puisqu'elles ne concernent que les dépassements. Enfin, nos évaluations permettent d'établir que les élasticités estimées au niveau microéconomique correspondent, au niveau macroéconomique, à une forte dérive de la consommation de soins en liaison avec l'augmentation du nombre de médecins. [Auteurs]]]> Health Services Needs and Demand ; Physicians oai:serval.unil.ch:BIB_BCE6E4D86A8B 2022-05-07T01:26:04Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_BCE6E4D86A8B Le bébé collodion : attitude clinique et pathogénie moléculaire Hohl, D. info:eu-repo/semantics/article article 2002 Dermatologica Helevetica, vol. 1, pp. 27-28 info:eu-repo/semantics/altIdentifier/pissn/1420-2360 oai:serval.unil.ch:BIB_BCE74E386F8B 2022-05-07T01:26:04Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_BCE74E386F8B MHC class I expression dependent on bacterial infection and parental factors in whitefish embryos (Salmonidae). info:doi:10.1111/mec.12457 info:eu-repo/semantics/altIdentifier/doi/10.1111/mec.12457 info:eu-repo/semantics/altIdentifier/pmid/24028333 Clark, E.S. Wilkins, L.G. Wedekind, C. info:eu-repo/semantics/article article 2013 Molecular Ecology, vol. 22, no. 20, pp. 5256-5269 info:eu-repo/semantics/altIdentifier/eissn/1365-294X urn:issn:0962-1083 <![CDATA[Ecological conditions can influence not only the expression of a phenotype, but also the heritability of a trait. As such, heritable variation for a trait needs to be studied across environments. We have investigated how pathogen challenge affects the expression of MHC genes in embryos of the lake whitefish Coregonus palaea. In order to experimentally separate paternal (i.e. genetic) from maternal and environmental effects, and determine whether and how stress affects the heritable variation for MHC expression, embryos were produced in full-factorial in vitro fertilizations, reared singly, and exposed at 208 degree days (late-eyed stage) to either one of two strains of Pseudomonas fluorescens that differ in their virulence characteristics (one increased mortality, while both delayed hatching time). Gene expression was assessed 48 h postinoculation, and virulence effects of the bacterial infection were monitored until hatching. We found no evidence of MHC class II expression at this stage of development. MHC class I expression was markedly down-regulated in reaction to both pseudomonads. While MHC expression could not be linked to embryo survival, the less the gene was expressed, the earlier the embryos hatched within each treatment group, possibly due to trade-offs between immune function and developmental rate or further factors that affect both hatching timing and MHC expression. We found significant additive genetic variance for MHC class I expression in some treatments. That is, changes in pathogen pressures could induce rapid evolution in MHC class I expression. However, we found no additive genetic variance in reaction norms in our study population

Inégalités de santé et d'emploi : L'impact des facteurs sociaux

L'objectif de cet article est d'évaluer l'impact des facteurs sociaux, tels que le genre, l'âge ou la nationalité, sur les inégalités de santé et les inégalités de parcours professionnels. Un des apports de la recherche consiste à prendre en compte, dans l'analyse économétrique, l'interdépendance entre ces deux inégalités à l'aide de modèles tobits multivariés. A partir des données de l'enquête Santé et Itinéraire Professionnel (DARES - DREES), nous mettons en évidence que tous les facteurs sociaux ne produisent pas des effets directs sur la santé et la vie professionnelle mais que certains influencent seulement indirectement la santé des individus, via les inégalités d'emploi

Entreprises, modes de gestion de la main-d’oeuvre et allongement de la durée de chômage : une analyse économétrique

Cet article explore les liens empiriques entre la pluralité des formes institutionnelles et la durée de chômage pour apprécier le rôle des entreprises et de leurs modes de gestion de la main d’oeuvre dans l’allongement de la durée de chômage et dans la construction de l’employabilité des travailleurs. A partir du suivi longitudinal des chômeurs de l’enquête TDE - MLT, nous procédons à une analyse microéconométrique de la durée du premier épisode de chômage des individus en fonction des variables attachées aux entreprises et aux relations d’emploi passées. Les résultats établissent que certaines pratiques de gestion de la main-d’oeuvre développées par les entreprises déterminent les parcours de chômage des individus de notre échantillon et construisent en partie la vulnérabilité des travailleurs au chômage de longue durée.Durée de chômage, modes de gestion de la main d’oeuvre, catégories d’entreprises

GERMLINE GAIN-OF-FUNCTION MUTATIONS of ALK DISRUPT CENTRAL NERVOUS SYSTEM DEVELOPMENT

International audienceNeuroblastoma (NB) is a frequent embryonal tumour of sympathetic ganglia and adrenals with extremely variable outcome. Recently, somatic amplification and gain-of-function mutations of the anaplastic lymphoma receptor tyrosine kinase (ALK, MIM 105590) gene, either somatic or germline, were identified in a significant proportion of NB cases. Here we report a novel syndromic presentation associating congenital NB with severe encephalopathy and abnormal shape of the brainstem on brain MRI in two unrelated sporadic cases harbouring de novo, germline, heterozygous ALK gene mutations. Both mutations are gain-of-function mutations that have been reported in NB and NB cell lines. These observations further illustrate the role of oncogenes in both tumour predisposition and normal development, and shed light on the pleiotropic and activity-dependent role of ALK in humans. More generally, missing germline mutations relative to the spectrum of somatic mutations reported for a given oncogene may be a reflection of severe effects during embryonic development, and may prompt mutation screening in patients with extreme phenotypes

A Domain-Agnostic Approach for Characterization of Lifelong Learning Systems

Despite the advancement of machine learning techniques in recent years, state-of-the-art systems lack robustness to "real world" events, where the input distributions and tasks encountered by the deployed systems will not be limited to the original training context, and systems will instead need to adapt to novel distributions and tasks while deployed. This critical gap may be addressed through the development of "Lifelong Learning" systems that are capable of 1) Continuous Learning, 2) Transfer and Adaptation, and 3) Scalability. Unfortunately, efforts to improve these capabilities are typically treated as distinct areas of research that are assessed independently, without regard to the impact of each separate capability on other aspects of the system. We instead propose a holistic approach, using a suite of metrics and an evaluation framework to assess Lifelong Learning in a principled way that is agnostic to specific domains or system techniques. Through five case studies, we show that this suite of metrics can inform the development of varied and complex Lifelong Learning systems. We highlight how the proposed suite of metrics quantifies performance trade-offs present during Lifelong Learning system development - both the widely discussed Stability-Plasticity dilemma and the newly proposed relationship between Sample Efficient and Robust Learning. Further, we make recommendations for the formulation and use of metrics to guide the continuing development of Lifelong Learning systems and assess their progress in the future.Comment: To appear in Neural Network

Low-frequency variation near common germline susceptibility loci are associated with risk of Ewing sarcoma

Background: Ewing sarcoma (EwS) is a rare, aggressive solid tumor of childhood, adolescence and young adulthood associated with pathognomonic EWSR1-ETS fusion oncoproteins altering transcriptional regulation. Genome-wide association studies (GWAS) have identified 6 common germline susceptibility loci but have not investigated low-frequency inherited variants with minor allele frequencies below 5% due to limited genotyped cases of this rare tumor. Methods We investigated the contribution of rare and low-frequency variation to EwS susceptibility in the largest EwS genome-wide association study to date (733 EwS cases and 1,346 unaffected controls of European ancestry). Results We identified two low-frequency variants, rs112837127 and rs2296730, on chromosome 20 that were associated with EwS risk (OR = 0.186 and 2.038, respectively;P-value < 5x10(-8)) and located near previously reported common susceptibility loci. After adjusting for the most associated common variant at the locus, only rs112837127 remained a statistically significant independent signal (OR = 0.200, P-value = 5.84x10(-8)). Conclusions: These findings suggest rare variation residing on common haplotypes are important contributors to EwS risk. Impact Motivate future targeted sequencing studies for a comprehensive evaluation of low-frequency and rare variation around common EwS susceptibility loci

The transcriptional landscape of Shh medulloblastoma

© The Author(s) 2021. Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.Sonic hedgehog medulloblastoma encompasses a clinically and molecularly diverse group of cancers of the developing central nervous system. Here, we use unbiased sequencing of the transcriptome across a large cohort of 250 tumors to reveal differences among molecular subtypes of the disease, and demonstrate the previously unappreciated importance of non-coding RNA transcripts. We identify alterations within the cAMP dependent pathway (GNAS, PRKAR1A) which converge on GLI2 activity and show that 18% of tumors have a genetic event that directly targets the abundance and/or stability of MYCN. Furthermore, we discover an extensive network of fusions in focally amplified regions encompassing GLI2, and several loss-of-function fusions in tumor suppressor genes PTCH1, SUFU and NCOR1. Molecular convergence on a subset of genes by nucleotide variants, copy number aberrations, and gene fusions highlight the key roles of specific pathways in the pathogenesis of Sonic hedgehog medulloblastoma and open up opportunities for therapeutic intervention.info:eu-repo/semantics/publishedVersio