A transiting giant planet with a temperature between 250 K and 430 K.

Of the over 400 known exoplanets, there are about 70 planets that transit their central star, a situation that permits the derivation of their basic parameters and facilitates investigations of their atmospheres. Some short-period planets, including the first terrestrial exoplanet (CoRoT-7b), have been discovered using a space mission designed to find smaller and more distant planets than can be seen from the ground. Here we report transit observations of CoRoT-9b, which orbits with a period of 95.274 days on a low eccentricity of 0.11 +/- 0.04 around a solar-like star. Its periastron distance of 0.36 astronomical units is by far the largest of all transiting planets, yielding a 'temperate' photospheric temperature estimated to be between 250 and 430 K. Unlike previously known transiting planets, the present size of CoRoT-9b should not have been affected by tidal heat dissipation processes. Indeed, the planet is found to be well described by standard evolution models with an inferred interior composition consistent with that of Jupiter and Saturn.

Evaluation of the Physiological and Psychological Impact of Ballet Performances Across Age Cohorts: An Observational Uncontrolled Case Study.

Background: Ballet, epitomized by iconic seasonal performances such as "The Nutcracker," combines artistic expression with considerable physical demands. This study investigated the physiological and psychological responses of ballet dancers to the demands of intensive training and performance, with a specific focus on "The Nutcracker." Methods: Thirty- eight dancers volunteered for the study, including 6 youths (10.5 + 1.8 years, n = 6 female), 7 adolescents (15.4 + 1.1 years, n = 5 female), and 25 adults (21.1 + 2.1 years, n = 20 female). Employing an uncontrolled observational design, this pilot study tracked key biomarkers such as CK-MM for muscle damage and B-ALP for bone health, alongside psychological measures via PANAS-C/PANAS and DASS-21. Results: Significant findings included a post-performance reduction in cortisol and depression levels. Conclusion: These insights advocate for tailored strategies that address the multifaceted needs of dancers, acknowledging the intricate balance required to maintain peak performance and overall health within the demanding realm of professional ballet.

Video self-confrontation as a therapeutic tool in schizophrenia: A randomized parallel-arm single-blind trial.

BACKGROUND: Lack of insight is a barrier to treating psychosis. Preliminary studies have suggested that showing people videos of their psychotic behaviour may improve personal insight. This clinical trial aimed to assess the effect of video self-confrontation. METHODS: Inpatients between 18 and 65 years old with schizophrenia or schizoaffective disorder were filmed upon admission to two psychiatric hospitals while experiencing acute psychosis. After stabilization, individuals were randomized 1:1 to the "self-video" group where they watched their own video or to the "no video" control group. The primary outcome was the Scale to assess Unawareness of Mental Disorder (SUMD) at 48 h by a blinded assessor. Secondary objectives included psychotic and depressive symptoms, medication adherence and functioning using the Functional Remission of General Schizophrenia. Patients were followed up for four months. RESULTS: 60 participants were randomized and the level of insight did not differ between groups at 48 h (p = 0.98). There was no impact on SUMD subscores or the other insight questionnaires at any timepoint, nor on psychopathology or medication adherence. At one month, the level of functioning of those in the "self-video" group (n = 23) was higher (61.8 vs 53.5, p = 0.02), especially concerning "Treatment" and "Daily life". No adverse effects were reported. After video self-confrontation, people expressed more positive than negative emotions and were less lost to follow-up. CONCLUSION: Video self-confrontation did not change levels of insight, but may have a therapeutic impact nonetheless, by improving levels of self-care and adherence to care, indicating that this innovative therapeutic tool requires further study. TRIAL REGISTRATION NUMBER: NCT02664129.

[Economic importance of antibiotic sale for private food animal practices in Switzerland - example veal production]. / Ökonomische Bedeutung des Umsatzes mit Antibiotika für private Nutztierpraxen in der Schweiz ­ Beispiel Kälbermast.

INTRODUCTION: The use of antibiotics in Swiss veal production is considered an established method for controlling bacterial infectious diseases. Although the veterinary profession aims to ensure animal welfare, the veterinary business income needs to be ensured at the same time. Against the background of increasing problems with resistant pathogens in human and veterinary medicine, the use of antibiotics should be significantly reduced and used more selectively. The associated economic consequences for food animal practitioners are unknown. The aim of this study was to determine the economic importance of antibiotic sale volume for private food animal practitioners in veal production. An anonymized questionnaire was sent to 120 mixed veterinary practices in Switzerland, which offered services to veal and beef cattle farmers. Questions involved the pharmaceutical sale volume, details on veterinary invoices from three farms with average, below and above average animal health throughout 2017. Twenty-nine complete questionnaires (response rate: 24.2%) and veterinary invoices of 84 farms were returned. The study is not representative, but it allows a rough assessment of the economic framework in Swiss livestock practice. The majority of the total turnover with livestock farms was generated by the sale of antibiotics (54%). Antibiotic sales per animal were higher as expected in farms with a below-average animal health than in farms with an average or above-average animal health. Consulting services turnover contributed only 0.5% to the total sale volume in veal farming. The results document, that antibiotic reduction measurements in veal and beef production will have economic consequences for veterinary livestock practices. In the medium term, the profitable existence of livestock veterinary practice requires a change to cost based consulting services.

INTRODUCTION: En Suisse, dans le cadre de la pratique de l'engraissement des veaux, l'utilisation d'antibiotiques est principalement considérée comme une méthode éprouvée pour lutter contre les maladies infectieuses bactériennes. L'activité vétérinaire vise à prévenir ou minimiser les souffrances chez les animaux. Mais pour autant, les vétérinaires restent des entrepreneurs qui doivent assurer un revenu adéquat de leur pratique. Dans un contexte de problèmes croissants rencontrés avec les agents pathogènes résistants en médecine humaine et vétérinaire, l'utilisation d'antibiotiques devrait être considérablement réduite et ciblée. Les conséquences économiques associées pour la pratique vétérinaire rurale sont peu connues. Le but de la présente étude était de déterminer l'importance économique des ventes d'antibiotiques pour les pratiques vétérinaires rurales privées en utilisant l'exemple de l'engraissement des veaux. À cet effet, un questionnaire anonymisé a été envoyé à 120 cabinets vétérinaires mixtes en Suisse, qui s'occupent entre autres d'exploitations d'engraissement de veaux, de broutards et de taurillons. Les participants ont été interrogés sur le niveau des ventes de médicaments. En outre, nous les avons invités à envoyer des factures vétérinaires concernant trois entreprises d'engraissement avec un niveau de santé animale inférieur, égal et supérieur à la moyenne tout au long de l'année 2017. Vingt-neuf questionnaires complets (taux de réponse: 24,2%) ainsi que des factures vétérinaires concernant au total 84 exploitations d'engraissement de veaux, de broutards ou de taurillons nous ont été retournés. L'étude n'est certes pas représentative, mais elle permet une évaluation approximative du cadre économique des pratiques rurales en Suisse. La majorité du chiffre d'affaires total sur les exploitations d'engraissement de veaux, de broutards ou taurillons a été générée par la vente d'antibiotiques (54%). Il apparait que les ventes d'antibiotiques étaient plus élevées dans les exploitations où la santé animale était inférieure à la moyenne que dans les établissements où elle était supérieure ou égale à la moyenne. Le chiffre d'affaires des prestations de conseil ne représentait que 0,5% du chiffre d'affaires total dans le domaine des veaux. Ces résultats montrent que les mesures visant à réduire les antibiotiques dans les conditions actuelles de production de veau et de boeuf auront probablement des conséquences économiques non négligeables sur la part des exploitations d'engraissement dans les revenus des pratiques vétérinaire rurales. A moyen terme, afin d'assurer la rentabilité d'une pratique rurale, une nouvelle orientation de l'activité vétérinaire sera nécessaire: la mise en place d'un service de conseils payants pour les exploitations d'engraissement, ayant pour but l'établissement de concepts de prévention.

[Glass ceiling for women in academic medicine in France]. / Plafond de verre pour les femmes dans les carrières hospitalo-universitaires en France.

OBJECTIVE: To determine whether career development in academic medicine is more difficult for women than for men, and, if any, the nature and level of barriers to this progression. METHODS: Extraction of full-time medical staff in a Parisian hospital group, through the SIGAPS platform; an online questionnaire survey of career choices and barriers experienced by full-time male and female physicians. The study population comprises 181 hospital practitioners and 141 academic physicians (49 associate professors and 92 full professors). RESULTS: Women represent 49% of the medical staff but 15% of full professors. This underrepresentation of women is more important among intensivists/anesthesiologists than technique-based specialists (such as radiologists, biologists…). There is no difference in scientific output, marital status and parenthood between women and men. On the other hand, there is a difference in attitudes highlighted by the EVAR risk-taking scale as well as in the burden of familial involvement and the prejudices felt by women during the academic selection process. CONCLUSION: The glass ceiling exists in one of the largest French hospital group. Career development principles promote merit, but should decrease the benefit of "masculine" attitudes in the competition for academic positions. Academic selection criteria should evolve to limit the disadvantage of women related to deeper familial involvement and less competitive strategies and risk-taking attitudes.

Searching for Atmospheric Bioindicators in Planets around the Two Nearby Stars, Proxima Centauri and Epsilon Eridani-Test Cases for Retrieval of Atmospheric Gases with Infrared Spectroscopy.

We tested the ability of thermal infrared spectroscopy to retrieve assumed atmospheric compositions for different types of planets orbiting Proxima Centauri and Epsilon Eridani. Six cases are considered, covering a range of atmospheric compositions and some diversity in the bulk composition (rocky, water ocean, hydrogen rich) and the spectral type of the parent star (M and K stars). For some cases, we applied coupled climate chemistry, or climate-only calculations; for other cases, we assumed the atmospheric composition, ground temperature, and surface reflectivity. The IR emission was then calculated from line-by-line radiative transfer models and used to investigate retrieval of input atmospheric species. For the six cases considered, no false positive of the triple bioindicator (H2O, CO2, and O2, in specified conditions) was found. In some cases, results show that the simultaneous acquisition of a visible spectrum would be valuable, for example, when CO2 is very abundant and its 9.4 µm satellite band hides the 9.6 µm O3 band in the IR. In each case, determining the mass appears mandatory to identify the planet's nature and have an idea of surface conditions, which are necessary when testing for the presence of life.

The effect of anaesthetic agents on induction, recovery and patient preferences in adult day case surgery: a 7-day follow-up randomized controlled trial.

BACKGROUND AND OBJECTIVE: To compare induction, pre- and post-discharge recovery characteristics and patient preferences between four anaesthetic regimens in adult day-surgery. METHODS: Randomized controlled trial. In all, 1158 adults assigned to: propofol induction and maintenance, propofol induction with isoflurane/N2O, or sevoflurane/N2O maintenance, or sevoflurane/N2O alone. We prospectively recorded induction and pre-discharge recovery characteristics, collected 7-day post-discharge recovery characteristics using patient diaries and patient preferences by telephone follow-up. RESULTS: Recruitment rate was 73%--of the 425 refusals, 226 were not willing to risk a volatile induction. During induction, excitatory movements and breath holding were more common with sevoflurane only (P < 0.01). Injection pain and hiccup were more common with propofol induction (P < 0.01). In the recovery room and the postoperative ward, both nausea and vomiting were more common with sevoflurane only (P < 0.01). This difference disappeared within 48 h. There was no difference between groups in the mental state on awakening, recovery time, time to discharge or overnight admissions; then was also no difference in pain between the four groups for each of the seven postoperative days (P < 0.01), nor any differences in concentration or forgetfulness. Patients took 6.5 days (95% CI: 6.0-7.0, n = 693) to resume normal activities. Patients who received sevoflurane only were more likely to recall an unpleasant induction and least likely to want the same induction method again (P < 0.01). CONCLUSION: Differences in outcome between the four regimens are transient; sevoflurane is not an ideal sole agent for adult day case anaesthesia and, in this setting, patients base their preferences for future anaesthetics on the method of induction.

Using multi-criteria risk ranking methodology to select case studies for a generic risk assessment framework for exotic disease incursion and spread through Europe.

We present a novel approach of using the multi-criteria pathogen prioritisation methodology as a basis for selecting the most appropriate case studies for a generic risk assessment framework. The approach uses selective criteria to rank exotic animal health pathogens according to the likelihood of introduction and the impact of an outbreak if it occurred in the European Union (EU). Pathogens were evaluated based on their impact on production at the EU level and international trade. A subsequent analysis included criteria of relevance to quantitative risk assessment case study selection, such as the availability of data for parameterisation, the need for further research and the desire for the case studies to cover different routes of transmission. The framework demonstrated is flexible with the ability to adjust both the criteria and their weightings to the user's requirements. A web based tool has been developed using the RStudio shiny apps software, to facilitate this.

Herd-specific interventions to reduce antimicrobial usage in pig production without jeopardising technical and economic performance.

Pig farmers are strongly encouraged to reduce their antimicrobial usage in order to reduce the risk of antimicrobial resistance. Herd-level intervention is needed to achieve national and European reduction targets. Alternative, especially preventive measures, have to be implemented to reduce the need for antimicrobial treatments. However, little is known about the feasibility, effectiveness and return on investment of such measures. The objective of this study was to assess, across four countries, the technical and economic impact of herd-specific interventions aiming at reducing antimicrobial usage in pig production while implementing alternative measures. An intervention study was conducted between February 2014 and August 2015 in 70 farrow-to-finish pig farms located in Belgium, France, Germany and Sweden. Herd-specific interventions were defined together with the farmer and the herd veterinarian. Farms were followed over one year and their antimicrobial usage and technical performance were compared with values from the year before intervention. Compliance with the intervention plan was also monitored. Changes in margin over feed cost and net farm profit were estimated in a subset of 33 Belgian and French farms with sufficient data, using deterministic and stochastic modeling. Following interventions, a substantial reduction in antimicrobial use was achieved without negative impact the overall farm technical performance. A median reduction of 47.0% of antimicrobial usage was achieved across four countries when expressed in terms of treatment incidence from birth to slaughter, corresponding to a 30.5% median reduction of antimicrobial expenditures. Farm compliance with intervention plans was high (median: 93%; min-max: 20; 100) and farms with higher compliance tended to achieve bigger reduction (ρ=-0.18, p=0.162). No association was found between achieved reduction and type or number of alternative measures implemented. Mortality in suckling piglets, weaners and fatteners, daily weight gain and feed conversion ratio did not significantly change over the course of the study, while the number of weaned piglets per sow per year slightly increased. The median change in net farm profit among Belgian and French farms was estimated to be €4.46 (Q25-Q75:-32.54; 80.50) and €1.23 (Q25-Q75:-32.55; 74.45) per sow per year using the detererministic and stochastic models, respectively. It was more influenced by a change in feed conversion ratio and daily weight gain than by a change in antimicrobial expenditures or intervention direct net cost. Therefore, costs of alternative measures should not be perceived as a barrier, but rather as an opportunity to optimise production practices for sustained productivity and improved animal health.

Reproducibility of a task description questionnaire for working pregnant women.

The objective of this study was to evaluate the reproducibility of a Task Description Questionnaire that was designed to investigate exposures to, and influential factors for, problematic tasks experienced by working pregnant women. The questionnaire comprised questions concerning 22 task components (covering working posture, manual material handling, work pace, prolonged postures and others), eight influential factors contributing to problematic tasks, discomfort (measured using a body map) and level of effort to perform the tasks. Reproducibility of the questionnaire was assessed by interviewing participants on two occasions one week apart for interviews at both 20 and 34 weeks of pregnancy. Eleven and 13 problematic tasks were reported by 21 working pregnant women at 20 and 34 weeks of pregnancy, respectively. These tasks were surveyed using the Task Description Questionnaire. Kappa statistics and correlation coefficients (supplemented by paired t-tests) were used to examine the reproducibility of responses to the questionnaire. The results showed that most of the variables were measured with very good or satisfactory reproducibility. The reproducibility of exposure to work posture was higher than that of exposure to manual material handling. There was no significant difference between test and retest means for the discomfort scores measured on the body map, except for the maximum discomfort score for the whole body in the 34 weeks survey. The study suggests that the questionnaire can be reliably used in the study of problematic tasks experienced by pregnant women. But an initial preview of the questions by the subjects and explanation of the questions given to the subjects by the interviewer may help to produce more reliable results.

A case of stunning of lung and bone metastases of papillary thyroid cancer after a therapeutic dose (3.7 GBq) of 131I and review of the literature: implications for sequential treatments.

Thyroid stunning is usually defined as the inhibition or suppression of iodide trapping by remnant thyroid tissue or by functioning metastases following a diagnostic dose of 131I. The risk of stunning increases progressively with larger doses. Because the threshold above which this effect occurs in thyroid remnants seems to be between 37 MBq and 111 MBq of 131I, therapeutic 131I doses of 3.7 GBq may cause stunning. We describe stunning of papillary thyroid cancer lung and bone metastases after a therapeutic dose of 131I (3.7 GBq). A T1 bone metastasis and bilateral lung metastases were diagnosed by post-therapeutic dose whole-body scan. Nuclear MRI detected another lesion at T4, whose 131I fixation was not obvious. An additional 0.7 GBq were given after recombinant TSH, 37 days after the therapeutic dose; 24 h later, uptake by the lung and T1 metastases had disappeared, but trapping was again seen 6 months later on the post-therapeutic scan. This re-appearance is evidence in favour of the transitory and reversible character of stunning, and confirms its correspondence to the decreased ability of viable thyroid cells to trap iodine and not to their destruction. A better understanding of stunning would make it possible, in the event of rapidly progressing disease and in conjunction with recombinant thyroid stimulating hormone (TSH), to give several therapeutic doses of 131I in close succession without each dose hampering the effectiveness of the subsequent one.

Prediction of back strength using anthropometric and strength measurements in healthy females.

OBJECTIVES: The purpose of this study was to develop a regression equation to predict back extensor maximal voluntary contraction (back strength) for females based on several anthropometric and strength measurements using a multiple regression technique. BACKGROUND: Back strength is an important parameter in low back pain studies. However, the measurement of back strength is problematic in certain populations such as low back pain patients and pregnant women. METHODS: Back strength was measured as both moment at L4/L5 and force. Ten anthropometric or strength measurements were chosen to develop the prediction equation. The data used for developing the models were from eighty non-pregnant female subjects, age 18-42 and with no history of back pain in the past year. Backwards stepwise analysis was performed in order to choose the best fit predictors. The predictive ability of each of the models was checked using the cross-validation technique on 20 other subjects. FINDINGS: Two prediction models were developed for moment and force, respectively. The models explained 46.9% and 48.2% of the variance in back strength. No multicollinearity problem was found. The validation study showed that the observed back strength was highly correlated with the predicted back strength. INTERPRETATION: Mass, height, trunk length, grip strength and quadriceps strength are the best predictors of back strength in this study. The models developed in this study can be used for both general female low back pain patients and the pregnancy population.

A descriptive and follow-up study of 40 parricidal patients hospitalized in a French secure unit over a 15-year period.

Parricide is rare and represents 3% of all homicides in France, and 4% of resolved homicides in North America. Consequently, related international literature is sparse, especially concerning the evolution of offenders, and most studies concern small samples or anecdotal cases. We wished to identify the main characteristics of parricidal subjects and their victims, and to assess the socioclinical evolution of the offenders after the assault. To this end, we first studied the sociodemographic, clinical and forensic characteristics of all parricidal patients admitted to France's Henri Colin secure unit between 1996 and 2010 (40 patients). We also assessed the evolution of the 36 patients who had left the secure unit, using questionnaires sent to the psychiatric hospitals where the patients were transferred. We found most offenders to be men (97.5%), with a mean age of 28 years, who were mostly single, unemployed, living with the victim prior to the assault (77.5%), and with a history of psychiatric disorder (72.5%). The population of offenders also displayed an overrepresentation of schizophrenia (87.5%), significant toxic exposure and criminal or violent history. Some patients had attempted suicide before or right after the offense. The assault was mostly committed in the parent's house with an edged weapon, and was characterized by brutality and lack of premeditation. Precipitating factors included substance use and cessation of psychotropic medication. Matricide was more frequent than patricide. At the time of this study, half of the parricidal patients were working or attending therapeutic activities, and most were actively keeping in contact with their family, living as compliant outpatients with no signs of violent behavior. The results of our study on 40 parricidal patients are consistent with data in the literature. With regard to sample evolution, family and community reintegration was relatively effective considering the seriousness of the offense. Several biases in our study disallow the generalization of these findings, and further studies are needed.

Antithyroid hormone antibodies induced by interferon-alpha.

A 40-yr-old woman known for a multinodular goiter had hyperthyroidism. Treatment with antithyroid drugs and iodine therapy was effective. One year later, she received interferon-alpha for treatment of essential cryoglobulinemia. At that time, the patient was euthyroid. Testing for antithyroglobulin, antimicrosome, anti-TSH receptor, and antithyroid hormone antibodies was negative. After a 1-yr course of interferon-alpha, goiter enlargement was noticed. Apparently elevated free T3 and T4 serum values were measured by RIA, contrasting with clinical euthyroidism and normal TSH values. High serum levels of antithyroid hormone antibodies were found in the patient's serum, using a radiolabeled hormone immunoprecipitation assay. Antithyroglobulin and antimicrosome antibodies titers were also elevated and paralleled antithyroid hormone antibodies. After cessation of interferon-alpha therapy, clinical status and TSH levels remained normal, while thyroid hormone values and antithyroid hormone antibody levels progressively normalized. To our knowledge, this is the first report of antithyroid hormone antibodies induced by interferon-alpha. Since thyroid dysfunction is described in 10-15% of treated patients, the fact that interferon-alpha can induce antithyroid hormone antibodies has important implications: 1) the prevalence or intensity of thyroid dysfunction could be overestimated; and 2) artifactually elevated free T3 and T4 serum values could lead to inappropriate therapy of thyroid disease or cessation of interferon treatment.

Would I-123 di-iodotyrosine provide a harmless deiodination test? Concise communication.

Defective iodotyrosine deiodinase activity may benefit from a specific treatment, thus requiring an unequivocal diagnosis. In reported cases this diagnosis has been obtained from an in vivo deiodination test making use of di-iodotyrosine (DIT) labeled either with I-131 or I-125. Dosimetric calculation indicates that such tests may result in unacceptable irradiation of the thyroid of a child wrongly suspected of having defective iodotyrosine deiodinase activity; therefore other methods are needed. The use of I-123 DIT is shown to be feasible, but even a 1:30 reduction in the thyroid dose still remains too high. Suppression of thyroid I- uptake by ClO4-, together with I-125 DIT, eliminates almost all thyroid irradiation and provides a sensitive, harmless, and rapid test.

Thyroid iodine content measured by x-ray fluorescence in amiodarone-induced thyrotoxicosis: concise communication.

Iodine-induced thyrotoxicosis (liT) is characterized by (a) a low radioiodine uptake, increased by exogenous TSH, and (b) a spontaneous evolution towards cure within a few months. An hypothetical pathogenesis of liT is an initial inflation in the stores of thyroid hormones during iodine excess, followed by their sudden discharge into the circulation. Thyroid iodine content was measured by fluorescent scanning in 10 patients with amiodarone-induced thyrotoxicosis and in various control groups. Results were found to be high at the onset of the disease and to decrease during its course. The data agree with the hypothetical pathogenesis. Furthermore they may permit exclusion of a painless subacute thyroiditis, which is the main differential diagnosis of liT.

Radioiodine therapy of the autonomous thyroid nodule in patients with or without visible extranodular activity.

UNLABELLED: Patients with an autonomously functioning thyroid nodule (ATN) may be present with various clinical, biochemical and scintigraphic features. To optimize 131I dose planning and treatment timing in these patients, relationships between dosimetric data and clinical follow-up events must be established. METHODS: We retrospectively reviewed the records of 88 patients who received 131I (intended dose of 80 Gy) for an ATN, of whom 39 had evidence of extranodular activity (ENA) and 76 presented with overt thyrotoxicosis. In all of the patients, dosage calculation was monitored to estimate precisely both beta and gamma absorbed doses received by the ATN and the nodule-free lobe. The mean duration of follow-up was 75 mo (max 180) and always included biochemical thyroid tests. Finally, we compared the dosimetric profiles of four dosage schemes which had been normalized by simulation to ensure that the same absorbed dose threshold value was always delivered to the ATN. RESULTS: About 75% of the patients were cured at 6 mo for a mean 305 MBq administered. The absorbed doses delivered to the nodule-free lobe ranged from 12% (no ENA) to 86% (ENA) of the values delivered to the ATN, mainly in the form of beta irradiation. Life-table estimates for hypothyroidism and death were 9.6% and 22% at 75 mo, respectively. Hypothyroidism mainly developed in patients with nonsuppressed TSH levels but regardless of ENA, which often accounted for multifocal disease. CONCLUSION: We suggest that fixed doses bordering on 370 MBq are advizable in younger individuals and in patients with mild thyrotoxocosis, while 555 MBq-740 MBq can be administered in other patients and that ENA indicates multifocal autonomy in patients with toxic ATN and is a further indication for radioiodine treatment which should be begun as soon as possible to avoid the development of cardiac complications.

Influence of dose selection on absorbed dose profiles in radioiodine treatment of diffuse toxic goiters in patients receiving or not receiving carbimazole.

We retrospectively reviewed the records of 224 patients with diffuse goiters treated with radioiodine, half of which received carbimazole. In all the cases, we carefully monitored the calculation of dosage. A lower percentage of early hypothyroidism but a higher failure rate was observed in the carbimazole subgroup. Nevertheless, after one year, a constant (4.5%) incremental rate of hypothyroidism was found regardless of carbimazole administration. Since we were able to precisely estimate the absorbed doses in our series, we evaluated by simulation the dosimetric profiles of nine methods of dose selection (MDS). These MDS were calibrated in such a way that the same threshold value of absorbed dose would always be reached at the thyroid level. We showed that the more elaborate the MDS, the more accurate the irradiation at the thyroid level and the lower the radiation dose administered. In patients not receiving carbimazole, a rapid MDS using modified early uptake measurements to predict the 24-hr actual value was found to be advisable. With patients receiving carbimazole and if a goal is to delay the occurrence of hypothyroidism, we advise MDS based on either a 48-hr uptake or on the calculation of the individual half-life.

Would a healthier population consume fewer health service resources? A life-table analysis using hospital in-patient enquiry (HIPE) bed-usage statistics as a proxy for hospital treatment costs.

The long-term effects upon acute-care hospital costs of reductions of morbidity and mortality from various causes are explored. The daily number of beds used per million population for all diagnostic categories is suggested as a proxy measure of hospital costs. An index of lifetime bed usage for a hypothetical cohort of persons living out their lives under specified age-specific mortality and morbidity patterns is derived. Examples of the application of this index are given for differing assumptions about mortality and morbidity in males. It is shown that reducing ischaemic heart disease or cancer morbidity will lead to increased overall hospital costs whereas reductions in the rate of occurrence of accidents, injuries and poisonings would reduce overall costs. The assumptions underlying the use of the index are discussed and extensions to the population model are proposed.