Mcguirehackett0404

in English, French Contexte On s’attend à ce que l’approbation de médicaments biosimilaires par les agences de santé nationales génèrent des économies importantes pour les systèmes de soins de santé. C’est particulièrement le cas pour le biosimilaire du rituximab approuvé pour le marché canadien en 2019. Cependant, plusieurs incertitudes demeurent quant à son utilisation. Objectifs Déterminer la proportion des dépenses pour chaque indication du rituximab par rapport à la dépense totale annuelle en médicaments dans un contexte hospitalier et déterminer les économies potentielles liées à l’introduction d’un biosimilaire. Méthode Une analyse d’impact budgétaire a été réalisée à partir de trois scénarios basés sur des données obtenues dans un grand centre hospitalier universitaire sur une période de 12 mois. Résultats Cette étude a examiné les données de 420 patients. Les dépenses annuelles relatives au rituximab, toutes indications confondues, représentaient 7,7 % des dépenses annuelles totales de l’hôpital. De cellesci, 5 % étaient liées en particulier aux indications approuvées par Santé Canada. Plus de 6 % des dépenses annuelles en médicaments étaient imputables à l’utilisation du rituximab à des fins oncologiques, y compris 1,8 % pour des utilisations que Santé Canada n’a pas approuvées. De manière générale, chaque réduction de 10 % du prix d’un produit biosimilaire du rituximab (parent du rituximab référence) entraînerait des économies annuelles d’environ 0,8 % du total des dépenses en médicaments dans cet hôpital si les produits biosimilaires étaient utilisés pour toutes les indications, qu’elles soient approuvées ou non par Santé Canada. Conclusions L’introduction d’un biosimilaire du rituximab sur le marché canadien engendrerait des économies importantes. L’évaluation adéquate des économies générées par un biosimilaire pour un hôpital ayant un budget limité nécessite la prise en compte de toutes les indications pour lesquelles il pourrait être utilisé.in English, French Contexte Malgré l’augmentation récente des surdoses d’opioïdes au Canada, peu d’initiatives menées sous la houlette de pharmacies ont été mises en place sur les enjeux potentiels liés à la prescription d’opiacés en milieu hospitalier. Objectifs L’objectif principal de cette étude visait à élaborer un outil destiné aux pharmaciens d’hôpitaux, s’inspirant des meilleures pratiques rapportées dans la documentation, qui fournirait une approche structurée pour améliorer la sécurité de la prescription d’opioïdes. L’objectif secondaire consistait à recueillir les opinions des pharmaciens sur la faisabilité et l’utilité d’un tel outil. Méthode Des recherches bibliographiques étendues ainsi qu’une analyse de groupes de discussion de pharmaciens ont fourni le contenu nécessaire à l’élaboration d’un outil clinique expérimental. Ensuite, cet outil a été testé par des pharmaciens cliniciens travaillant dans des unités médicales générales et chirurgicales au sein d’un seul hôpital. Les pharmaciens particiratique; cependant, ils ont aussi noté qu’une version simplifiée pourrait faciliter son utilisation. Conclusions Les pharmaciens cliniciens ont bien accueilli l’outil MORE. Sa mise en oeuvre dans la pratique courante exige cependant des changements supplémentaires pour faciliter son utilisation. Les versions à venir tiendront compte des propositions visant à le modifier et à le simplifier.[This corrects the article DOI 10.1039/C9SC04060A.]. This journal is © The Royal Society of Chemistry 2019.Salt marshes provide a bulwark against sea-level rise (SLR), an interface between aquatic and terrestrial habitats, important nursery grounds for many species, a buffer against extreme storm impacts, and vast blue carbon repositories. However, salt marshes are at risk of loss from a variety of stressors such as SLR, nutrient enrichment, sediment deficits, herbivory, and anthropogenic disturbances. Determining the dynamics of salt marsh change with remote sensing requires high temporal resolution due to the spectral variability caused by disturbance, tides, and seasonality. Time series analysis of salt marshes can broaden our understanding of these changing environments. This study analyzed aboveground green biomass (AGB) in seven mid-Atlantic Hydrological Unit Code 8 (HUC-8) watersheds. The study revealed that the Eastern Lower Delmarva watershed had the highest average loss and the largest net reduction in salt marsh AGB from 1999-2018. The study developed a method that used Google Earth Engine (GEE) enabled time series of the Landsat archive for regional analysis of salt marsh change and identified at-risk watersheds and salt marshes providing insight into the resilience and management of these ecosystems. The time series were filtered by cloud cover and the Tidal Marsh Inundation Index (TMII). The combination of GEE enabled Landsat time series, and TMII filtering demonstrated a promising method for historic assessment and continued monitoring of salt marsh dynamics.PURPOSE To study the outcome of botulinum toxin (BTX) treatment (group 1) in partially accommodative esotropia with high accommodative convergence/accommodation (AC/A) ratio, in comparison with bilateral medial rectus muscles recessions and posterior fixation (group 2). METHODS In a retrospective comparative study, children aged 3-8 years old treated between 2011 and 2016, with partially accommodative esotropia with high AC/A ratio, deviation at distance of 10 prism diopters or more, and at least 1 year of follow-up, were included. Visual acuity, alternate prism and cover test, stereoacuity, biomicroscopy, and cycloplegic retinoscopy were carried out at initial, baseline visit, 6 months and 1 year after BTX injection or surgery. click here Main outcome variables were deviation at distance and near, improvement in stereoacuity, and percentage of success. We used multiple regression or proportional odds analysis to control for potential confounding variables. RESULTS Of 95 patients, 84 were eligible, 48 children in group 1 and 36 in group 2. Deviation and stereoacuity were similar in the two groups at 6 months, but significantly better in the BTX group at 1 year (median distance deviation 0 prism diopters vs 5 prism diopters, p less then 0.01), although differences were not clinically relevant. Percentage of success was also significantly better only at 1 year (93% vs 72%, p = 0.01). Change in distance-near disparity was not significantly different in the two groups in the period of study. CONCLUSIONS Botulinum toxin could be superior to, or as effective as surgery, at middle term, in the treatment of partially accommodative esotropia with high AC/A ratio.Management of Human Immunodeficiency Virus Type 2 (HIV-2) infections present unique challenges due to low viral titers, slow disease progression, and poor response to standard antiviral therapies. The need for a nucleic acid assay to detect and quantify HIV-2 virus has led to the development of a number of molecular-based assays for detection and/or quantification of HIV-2 viral RNA in plasma in order to provide laboratory evidence of HIV-2 infection and viral loads for use in treatment decisions. link2 As HIV-2 is less pathogenic and transmissible than HIV-1 and has resistance to several of the antiretroviral drugs, delay of treatment is common. Cross sero-reactivity between HIV-1 and HIV-2 makes it difficult to distinguish between the two viruses based upon serological tests. As such we developed a quantitative reverse transcription PCR (qRT-PCR) assay targeting the 5' long terminal repeat of HIV-2 for detection and quantification of HIV-2 viral RNA in plasma to identify HIV-2 infection and for use in viral load ity, specificity, precision, and linearity of the WRAIR qRT-PCR assay makes it well suited for detection and monitoring of HIV-2 RNA levels in plasma of infected individuals.Several barriers protect the central nervous system (CNS) from pathogen invasion. Yet viral infections of the CNS are common and often debilitating. Understanding how neurotropic viruses co-opt host machinery to overcome challenges to neuronal entry and transmission is important to combat these infections. Neurotropic reovirus disseminates through neural routes and invades the CNS to cause lethal encephalitis in newborn animals. To define mechanisms of reovirus neuronal entry and directional transport, we used primary neuron cultures, which reproduce in vivo infection patterns displayed by different reovirus serotypes. Treatment of neurons with small-molecule inhibitors of different endocytic uptake pathways allowed us to discover that the cellular machinery mediating macropinocytosis is required for reovirus neuronal entry. link3 This mechanism of reovirus entry differs from clathrin-mediated endocytosis, which is used by reovirus to invade non-neuronal cells. Analysis of reovirus transport and release from isolated soma or axonal termini of neurons cultivated in microfluidic devices indicates that reovirus is capable of retrograde but only limited anterograde neuronal transmission. The dynamics of retrograde reovirus movement are consistent with fast axonal transport coordinated by dynein along microtubules. Further analysis of viral transport revealed that multiple virions are transported together in axons within non-acidified vesicles. Reovirus-containing vesicles acidify after reaching the soma, where disassembly of virions and release of the viral core into the cytoplasm initiates replication. These results define mechanisms of reovirus neuronal entry and transport and establish a foundation to identify common host factors used by neuroinvasive viruses. Furthermore, our findings emphasize consideration of cell type-specific entry mechanisms in the tailored design of neurotropic viruses as tracers, oncolytic agents, and delivery vectors.The main goal of this manuscript was to investigate the neurodevelopment of children exposed by Zika virus in the intrauterine period who are asymptomatic at birth. Newborns with documented Zika virus exposure during the intrauterine period who were asymptomatic at birth were followed in the first two years of life for neurodevelopment using Bayley III test. Children were classified as having normal or delayed neurodevelopment for age based on most recent Bayley III evaluation results. Eighty-four infants were included in the study. The first Bayley III evaluation was performed at a mean chronological age of 9.7±3.1 month; 13 children (15%) had a delay in one of the three domains, distributed as follow 10 (12%) in the language domain and 3 (3.5%) in the motor domain. The most recent Bayley III evaluation was performed at a mean age 15.3±3.1 months; 42 children (50%) had a delay in one of the three domains 4 (5%) in cognition, 31 (37%) in language, and 20 (24%) in motor performance. There were no statistical differences in Gender, Gestational Age, Birth Weight and Head Circurference at birth between children with normal and delayed neurodevelopment for age. A very high proportion of children exposed ZIKV during pregnancy who were asymptomatic at birth demonstrated a delay in neurodevelopment, mainly in the language domain, the first two years of life.