404 research outputs found
Une poĂ©tique du malaise : les anciens combattants face aux mythes de lâarriĂšre (H. Barbusse, L.-F. CĂ©line, L. Guilloux, E. M. Remarque, L. Werth)
Un bon nombre de romans europĂ©ens des annĂ©es 1910 Ă 1930 ayant pour thĂšme lâexpĂ©rience des combattants de la Grande Guerre, mettent en scĂšne, Ă lâoccasion de la dĂ©mobilisation ou dâune permission de ces soldats, le malaise de ceux-ci face Ă la reprĂ©sentation dĂ©formĂ©e que le monde civil a de la guerre. Les combattants dĂ©couvrent des civils qui se veulent, du fait de leur engagement « moral », aussi « hĂ©roĂŻques » quâeux, qui contestent leur vision « partielle » de lâĂ©tat du front en prĂ©tendant Ă une « hauteur de vue » seule offerte par le recul de lâarriĂšre. Pour reprĂ©senter ce choc, le roman est dâautant plus efficace quâil ne se livre pas Ă une rhĂ©torique de la dĂ©nonciation : les personnages de combattants en question sont Ă la fois rĂ©voltĂ©s et passifs, opposĂ©s mais dâune certaine maniĂšre soumis Ă ces discours de la manipulation. Le « contre-rĂ©cit » romanesque travaille donc de lâintĂ©rieur les discours manipulĂ©s, et nâoffre pas pleinement les armes intellectuelles, idĂ©ologiques, pour sâen dĂ©faire : il invite le lecteur Ă sâinterroger sur ces discours sans lui offrir, au-delĂ du pacifisme commun aux auteurs citĂ©s, la solution dâun engagement politique prĂ©cis
Parathyroid scintigraphy findings in chronic kidney disease patients with recurrent hyperparathyroidism
Background Parathyroidectomy (PTX), either subtotal or total with forearm autografting, is a well-established treatment for refractory renal hyperparathyroidism (RHPT). However, 20â30% of patients develop persistent or recurrent disease. Obtaining accurate localization before reoperation is difficult. Patients and methods The study group comprised 21 consecutive adult patients (18 undergoing haemodialysis and 3 with a renal graft) imaged using 99mTc-sestamibi/123I subtraction scintigraphy. Of the 21 patients, 12 had undergone one previous PTX and the other 9 between two and four parathyroid operations. All patients had symptoms and signs of severe RHPT. The mean serum PTH level was 1,142 pg/ml. 99mTc-Sestamibi and 123I images were recorded simultaneously. Imaging views comprised a planar view of the neck and mediastinum, followed by a magnified pinhole view over the thyroid bed area. If parathyroid ectopy was detected, SPECT or SPECT-CT was performed. The forearm was imaged in case of autograft. Results Parathyroid scintigraphy was negative in one patient and positive in the other 20 (sensitivity 95.2%). One patient had uptake corresponding to two unresected parathyroid glands. Recurrence at the site of the partially resected gland or autograft was seen in 11 patients. However, six of them had a second 99mTc-sestamibi focus corresponding to a supernumerary parathyroid gland. Seven other patients had a supernumerary parathyroid gland as the sole cause of relapse. Three of the supernumerary glands showed major ectopy (intrathyroidal, low mediastinal, undescended within the vagus nerve). One patient had parathyromatosis with multiple parathyroid nodules scattered over the left side of the neck. Reoperation was possible in 13 patients, with no false-positive findings. Conclusion Many patients referred with the hypothesis of hyperplasia of a subtotally resected parathyroid gland or autograft were found to harbour a supernumerary parathyroid gland missed at the initial surgery
Evaluation of the benefits, harms and costâeffectiveness of potential alternatives to iFOBT testing for colorectal cancer screening in Australia
The Australian National Bowel Cancer Screening Program (NBCSP) will fully rollâout 2âyearly screening using the immunochemical Faecal Occult Blood Testing (iFOBT) in people aged 50 to 74 years by 2020. In this study, we aimed to estimate the comparative health benefits, harms, and costâeffectiveness of screening with iFOBT, versus other potential alternative or adjunctive technologies. A comprehensive validated microsimulation model, Policy1âBowel, was used to simulate a total of 13 screening approaches involving use of iFOBT, colonoscopy, sigmoidoscopy, computed tomographic colonography (CTC), faecal DNA (fDNA) and plasma DNA (pDNA), in people aged 50 to 74 years. All strategies were evaluated in three scenarios: (i) perfect adherence, (ii) high (but imperfect) adherence, and (iii) low adherence. When assuming perfect adherence, the most effective strategies involved using iFOBT (annually, or biennially with/without adjunct sigmoidoscopy either at 50, or at 54, 64 and 74 years for individuals with negative iFOBT), or colonoscopy (10âyearly, or onceâoff at 50 years combined with biennial iFOBT). Colorectal cancer incidence (mortality) reductions for these strategies were 51â67(74â80)% in comparison with no screening; 2âyearly iFOBT screening (i.e. the NBCSP) would be associated with reductions of 51(74)%. Only 2âyearly iFOBT screening was found to be costâeffective in all scenarios in context of an indicative willingnessâtoâpay threshold of A2,984/LYSâA$5,981/LYS (depending on adherence). The fully rolledâout NBCSP is highly costâeffective, and is also one of the most effective approaches for bowel cancer screening in Australia
Comorbidity and cervical cancer survival of Indigenous and non-Indigenous Australian women: a semi-national registry-based cohort study (2003-2012)
Background: Little is known about the impact of comorbidity on cervical cancer survival in Australian women, including whether Indigenous womenâs higher prevalence of comorbidity contributes to their lower survival compared to non-Indigenous women. Methods: Data for cervical cancers diagnosed in 2003â2012 were extracted from six Australian state-based cancer registries and linked to hospital inpatient records to identify comorbidity diagnoses. Five-year cause-specific and all-cause survival probabilities were estimated using the Kaplan-Meier method. Flexible parametric models were used to estimate excess cause-specific mortality by Charlson comorbidity index score (0,1,2+), for Indigenous women compared to non-Indigenous women. Results: Of 4,467 women, Indigenous women (4.4%) compared to non-Indigenous women had more comorbidity at diagnosis (score â„1: 24.2% vs. 10.0%) and lower five-year cause-specific survival (60.2% vs. 76.6%). Comorbidity was associated with increased cervical cancer mortality for non-Indigenous women, but there was no evidence of such a relationship for Indigenous women. There was an 18% reduction in the Indigenous: non-Indigenous hazard ratio (excess mortality) when comorbidity was included in the model, yet this reduction was not statistically significant. The excess mortality for Indigenous women was only evident among those without comorbidity (Indigenous: non-Indigenous HR 2.5, 95%CI 1.9â3.4), indicating that factors other than those measured in this study are contributing to the differential. In a subgroup of New South Wales women, comorbidity was associated with advanced-stage cancer, which in turn was associated with elevated cervical cancer mortality. Conclusions: Survival was lowest for women with comorbidity. However, there wasnât a clear comorbidity-survival gradient for Indigenous women. Further investigation of potential drivers of the cervical cancer survival differentials is warranted. Impact: The results highlight the need for cancer care guidelines and multidisciplinary care that can meet the needs of complex patients. Also, primary and acute care services may need to pay more attention to Indigenous Australian women who may not obviously need it (i.e. those without comorbidity).Abbey Diaz, Peter D. Baade, Patricia C. Valery, Lisa J. Whop, Suzanne P. Moore, Joan Cunningham, Gail Garvey, Julia M. L. Brotherton, Dianne L. O, Connell, Karen Canfell, Diana Sarfati, David Roder, Elizabeth Buckley, John R. Condo
Cancer Survival and Excess Mortality Estimates among Adolescents and Young Adults in Western Australia, 1982-2004: A Population-Based Study
Background: Data are limited on cancer outcomes in adolescents and young adults. Methods: Based on data from the Western Australian Data Linkage System, this study modelled survival and excess mortality in all adolescents and young adults aged 15-39 years in Western Australia who had a diagnosis of cancer in the period 1982-2004. Relative survival and excess all-cause mortality for all cancers combined and for principal tumour subgroups were estimated, using the Ederer II method and generalised linear Poisson modelling, respectively. Results: A cancer diagnosis in adolescents and young adults conferred substantial survival decrement. However, overall outcomes improved over calendar period (excess mortality hazard ratio [HR], latest versus earliest diagnostic period: 0.52, trend <0.0001). Case fatality varied according to age group (HR, oldest versus youngest: 1.38, trend <0.0001), sex (HR, female versus male: 0.66, 95% confidence interval [CI] 0.62-0.71), ethnicity (HR, Aboriginal versus others: 1.47, CI 1.23-1.76), geographical area (HR, rural/remote versus urban: 1.13, CI 1.04-1.23) and residential socioeconomic status (HR, lowest versus highest quartile: 1.14, trend <0.05). Tumour subgroups differed substantially in frequency according to age group and sex, and were critical outcome determinants. Conclusions: Marked progressive calendar-time improvement in overall outcomes was evident. Further research is required to disentangle the contributions of tumour biology and health service factors to outcome disparities between ethno-demographic, geographic and socioeconomic subgroups of adolescents and young adults with cancer. © 2013 Haggar et al
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