Impact of mineral and bone disorder on healthcare resource use and associated costs in the European Fresenius medical care dialysis population: a retrospective cohort study

BACKGROUND: Secondary hyperparathyroidism (SHPT) is associated with mortality in patients with chronic kidney disease (CKD), but the economic consequences of SHPT have not been adequately studied in the European population. We assessed the relationship between SHPT parameters (intact parathyroid hormone [iPTH], calcium, and phosphate) and hospitalisations, medication use, and associated costs among CKD patients in Europe. METHODS: The analysis of this retrospective cohort study used records of randomly selected patients who underwent haemodialysis between January 1, 2005 and December 31, 2006 at participating European Fresenius Medical Care facilities in 10 countries. Patients had ≥ 1 iPTH value recorded, and ≥ 1 month of follow-up after a 3-month baseline period during which SHPT parameters were assessed. Time at risk was post-baseline until death, successful renal transplantation, loss to follow-up, or the end of follow-up. Outcomes included cost per patient-month, rates of hospitalisations (cardiovascular disease [CVD], fractures, and parathyroidectomy [PTX]), and use of SHPT-, diabetes-, and CVD-related medications. National costs were applied to hospitalisations and medication use. Generalised linear models compared costs across strata of iPTH, total calcium, and phosphate, adjusting for baseline covariates. RESULTS: There were 6369 patients included in the analysis. Mean ± SD person-time at risk was 13.1 ± 6.4 months. Patients with iPTH > 600 pg/mL had a higher hospitalisation rate than those with lower iPTH. Hospitalisation rates varied little across calcium and phosphate levels. SHPT-related medication use varied with iPTH, calcium, and phosphate. After adjusting for demographic and clinical variables, patients with baseline iPTH > 600 pg/mL had 41% (95% CI: 25%, 59%) higher monthly total healthcare costs compared with those with iPTH in the K/DOQI target range (150–300 pg/mL). Patients with baseline phosphate and total calcium levels above target ranges (1.13–1.78 mmol/L and 2.10–2.37 mmol/L, respectively) had 38% (95% CI: 27%, 50%) and 8% (95% CI: 0%, 17%) higher adjusted monthly costs, respectively. Adjusted costs were 25% (95% CI: 18%, 32%) lower among patients with baseline phosphate levels below the target range. Results were consistent in sensitivity analyses. CONCLUSIONS: These data suggest that elevated SHPT parameters increase the economic burden of CKD in Europe

Is there an early gender gap in Ghanaian children development? Evidence from 3-4 years old boys and girls

Using data from the 2011 round of the Ghana Multiple Indicator Cluster Survey (MICS), we investigate the presence of an early gender gap in child development among children 3-4-year-old. Based on that survey, we built multidimensional indexes of child development that account for children’s ability to read, count, recognize numbers, interact with peers and others, follow rules and be independent for their health outcomes and for their physical skills. This allowed us to estimate the gender gap while controlling for factors affecting child development. Using this approach, we found overall no evidence of gender difference in children’s child development. One index suggests that being female is associated with higher children development. This result is robust to several specifications and sensitivity tests. We also found that a mother’s education, a father’s involvement and the fact of living in an urban area, all increase child development both for boys and for girls. In terms of policy, these findings indicate that the educational gender gap in Ghana most likely reflects unequal access to schooling opportunities between boys and girls

Is there an early gender gap in Ghanaian children development? Evidence from 3-4 years old boys and girls

Using data from the 2011 round of the Ghana Multiple Indicator Cluster Survey (MICS), we investigate the presence of an early gender gap in child development among children 3-4-year-old. Based on that survey, we built multidimensional indexes of child development that account for children’s ability to read, count, recognize numbers, interact with peers and others, follow rules and be independent for their health outcomes and for their physical skills. This allowed us to estimate the gender gap while controlling for factors affecting child development. Using this approach, we found overall no evidence of gender difference in children’s child development. One index suggests that being female is associated with higher children development. This result is robust to several specifications and sensitivity tests. We also found that a mother’s education, a father’s involvement and the fact of living in an urban area, all increase child development both for boys and for girls. In terms of policy, these findings indicate that the educational gender gap in Ghana most likely reflects unequal access to schooling opportunities between boys and girls

Complex multicomponent patterns rendered on a 3D DNA-barrel pegboard

DNA origami, in which a long scaffold strand is assembled with a many short staple strands into parallel arrays of double helices, has proven a powerful method for custom nanofabrication. However, currently the design and optimization of custom 3D DNA-origami shapes is a barrier to rapid application to new areas. Here we introduce a modular barrel architecture, and demonstrate hierarchical assembly of a 100 megadalton DNA-origami barrel of similar to 90nm diameter and similar to 250nm height, that provides a rhombic-lattice canvas of a thousand pixels each, with pitch of similar to 8nm, on its inner and outer surfaces. Complex patterns rendered on these surfaces were resolved using up to twelve rounds of Exchange-PAINT super-resolution microscopy. We envision these structures as versatile nanoscale pegboards for applications requiring complex 3D arrangements of matter, which will serve to promote rapid uptake of this technology in diverse fields beyond specialist groups working in DNA nanotechnology

F.A.R.O.G. FORUM, Vol. 5 No. 1

https://digitalcommons.library.umaine.edu/francoamericain_forum/1059/thumbnail.jp

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Cost-Effectiveness Analysis of Fosfomycin for Treatment of Uncomplicated Urinary Tract Infections in Ontario

Background and Objective. Bacterial resistance to antibiotics traditionally used to treat uncomplicated urinary tract infections (uUTIs) is rising in Canada. We compared the cost-per-patient in Ontario of including fosfomycin (an antibiotic with a low resistance profile) as an option for first-line empirical treatment of uUTIs with current cost of treatment with sulfonamides, fluoroquinolones, and nitrofurantoin. Methods. A decision-tree model was used to perform a cost-minimization analysis. All possible outcomes of a uUTI caused by bacterial species treated with either sulfonamides, fluoroquinolones, nitrofurantoin, or fosfomycin were included. Results. In the base case analysis, the cost-per-patient for treating uUTI with fosfomycin was $105.12. This is similar to the cost-per-patient for each of the other currently reimbursed antibiotics (e.g.,$96.19 for sulfonamides, $98.85 for fluoroquinolones, and$99.09 for nitrofurantoins). The weighted average cost-per-patient for treating uUTI was not substantially elevated with the inclusion of fosfomycin in the treatment landscape ($98.41 versus$98.29 with and without fosfomycin, resp.). The sensitivity analyses revealed that most (88.34%) of the potential variation in cost was associated with the probability of progressing to pyelonephritis and hospitalization for pyelonephritis. Conclusion. Fosfomycin in addition to being a safe and effective agent to treat uUTI has a low resistance profile, offers a single-dose treatment administration, and is similar in cost to other reimbursed antibiotics

Les Représentations de «Société Libre Et Démocratique» a la Cour Dickson : La Rhétorique Dans le Discours Judiciaire Canadien

The expression free and democratic society is the focus of our research, which sheds light on the contribution of the Supreme Court to the constitutionalization of this concept. Leaving aside the institutional and psycho-social factors, the study confirms the hypothesis that the interpretation of this expression will vary (1) according to the conceptions formerly held by the individual judges and (2) with respect to the factors favoured by a rhetorical Perelman-like analysis, which considers the factual and judicial context and the expectations of both the universal and specific audiences. At the Supreme Court level, the expectations of the latter should prevail over the former. Our results reveal that in addition to these factors others come into play: a third audience consisting of the Court itself the invariable core of the judges\u27 thinking; and real circumstances which undoubtedly represent the most serious factor, proving detrimental to the legal coherence necessary to meet the expectations of the specific audience

Les Représentations de «Société Libre Et Démocratique» a la Cour Dickson : La Rhétorique Dans le Discours Judiciaire Canadien

The expression free and democratic society is the focus of our research, which sheds light on the contribution of the Supreme Court to the constitutionalization of this concept. Leaving aside the institutional and psycho-social factors, the study confirms the hypothesis that the interpretation of this expression will vary (1) according to the conceptions formerly held by the individual judges and (2) with respect to the factors favoured by a rhetorical Perelman-like analysis, which considers the factual and judicial context and the expectations of both the universal and specific audiences. At the Supreme Court level, the expectations of the latter should prevail over the former. Our results reveal that in addition to these factors others come into play: a third audience consisting of the Court itself the invariable core of the judges\u27 thinking; and real circumstances which undoubtedly represent the most serious factor, proving detrimental to the legal coherence necessary to meet the expectations of the specific audience