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The loss of health status in rheumatoid arthritis and the effect of biologic therapy: a longitudinal observational study
Frederick Wolfe, Kaleb Michaud
Arthritis Research & Therapy , 2010, DOI: 10.1186/ar2944
Abstract: We studied change in function and health status in 18,485 RA patients (135,731 observations) at six-month intervals for up to 11 years, including a group of 4,911 patients (59,630 observations) who switched to biologic therapy from non-biologic therapy. We measured the SF-36 Physical Component (PCS) and Mental Component (MCS) Summary scales, the EQ-5D health utility scale, and the Health Assessment Questionnaire (HAQ) disability scale; and we calculated treatment and direct medical costs.RA onset caused an immediate and substantial reduction in physical but not mental health status. Thereafter, the progression of dysfunction in RA was very slow (HAQ 0.016 units and PCS -0.125 units annually), only slightly worse than the age and sex-adjusted US population. We estimated biologic treatment to improve HAQ by 0.29 units, PCS by 5.3 units, and EQ-5D by 0.05 units over a 10-year period. The estimated incremental 10-year total direct medical cost for this benefit was $159,140.Biologic therapy retards RA progression, but its effect is far less than is seen in clinical trials. In the community, cost-effectiveness is substantially less than that estimated from clinical trial data. The study results represent the incremental benefit of adding biologic therapy to optimum non-biologic therapy.Biologic therapy for rheumatoid arthritis (RA) has been shown to be efficacious in multiple clinical trials [1-10]. This efficacy extends from composite measures that include physician, patient, and laboratory tests such as the Disease Activity Index-28 (DAS28) [11] and the American College of Rheumatology (ACR) improvement criteria [12], to imaging studies [1], as well as to purely patient-based assessments such as the Health Assessment Questionnaire disability index (HAQ) and the Short Form-36 (SF-36) [13]. Efficacy data, from these trials, usually based on the HAQ or health utility scales [14], are used in cost-effectiveness studies and assessments of costs per Quality Adjusted Life-Year
Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases
Sherine E Gabriel, Kaleb Michaud
Arthritis Research & Therapy , 2009, DOI: 10.1186/ar2669
Abstract: Epidemiology has taken an important role in improving our understanding of the outcomes of rheumatoid arthritis (RA) and other rheumatic diseases. Epidemiology is the study of the distribution and determinants of disease in human populations. This definition is based on two fundamental assumptions. First, human disease does not occur at random; and second, human disease has causal and preventive factors that can be identified through systematic investigation of different populations or subgroups of individuals within a population in different places or at different times. Thus, epidemiologic studies include simple descriptions of the manner in which disease appears in a population (levels of disease frequency: incidence and prevalence, comorbidity, mortality, trends over time, geographic distributions, and clinical characteristics) and studies that attempt to quantify the roles played by putative risk factors for disease occurrence. Over the past decade considerable progress has been made in both types of epidemiologic studies. The latter studies are the topic of Professor Silman's review in this special issue of Arthritis Research & Therapy [1]. In this review we examine a decade of progress on the descriptive epidemiology (incidence, prevalence, and survival) associated with the major rheumatic diseases. We then discuss the influence of comorbidity on the epidemiology of rheumatic diseases, using RA as an example.The most reliable estimates of incidence, prevalence, and mortality in RA are those derived from population-based studies [2-6]. Several of these, primarily from the past decade, have been conducted in a variety of geographically and ethnically diverse populations [7]. Indeed, a recent systematic review of the incidence and prevalence of RA [8] revealed substantial variation in incidence and prevalence across the various studies and across time periods within the studies. These data emphasize the dynamic nature of the epidemiology of RA. A substantial dec
Minocycline and doxycycline therapy in community patients with rheumatoid arthritis: prescribing patterns, patient-level determinants of use, and patient-reported side effects
Christopher J Smith, Harlan Sayles, Ted R Mikuls, Kaleb Michaud
Arthritis Research & Therapy , 2011, DOI: 10.1186/ar3491
Abstract: We studied 15,716 patients with RA observed between 1998 and 2009 while participating in a long-term US observational study.Minocycline or doxycycline was prescribed by 18% of rheumatologists (interquartile range one to two patients per physician) to 9% of RA patients. Significant differences between minocycline-treated and doxycycline-treated patients and nontreated patients included age (58.4 years vs. 59.8 years), RA duration (14.8 years vs. 13.7 years), Caucasian race (93.7% vs. 89.7%), lifetime DMARDs and biologics (3.3 vs. 2.5), prednisone use (40.1% vs. 35.3%), and Medical Outcomes Study 36-Item Short Form Survey physical component summary score (35.0 vs. 36.4). In multivariable Cox regression, patients initiating minocycline or doxycycline had increased disease activity, more comorbidities, and a greater number of prior nonbiologic DMARDs. Side effects were reported by 17.8% of minocycline users and 11.8% of doxycycline users. Skin complaints accounted for 54% of minocycline patient-reported side effects. The most commonly effected organ systems for doxycycline were gastrointestinal (35.4%) and skin (33.7%). Approximately 75% of side effects were of mild or moderate severity.Rheumatologists have not embraced minocycline or doxycycline as primary treatment options for RA and reserve their use primarily in patients with long-standing, refractory disease. These drugs are generally well tolerated, with skin complaints, nausea, and dizziness being the most common patient-reported side effects.Minocycline and doxycycline are semi-synthetic tetracycline antibiotics with anti-inflammatory properties that are used to treat multiple inflammatory diseases, including rheumatoid arthritis (RA) [1,2]. Tetracyclines exhibit multiple anti-inflammatory properties, including the inhibition of T-cell activation and chemotaxis, the downregulation of proinflammatory cytokines, including TNFα and IL-1β [1-3], and the inhibition of matrix metalloproteinases [4-6].Minocycline has p
The Hydrogen Atom Fundamental Resonance States  [PDF]
André Michaud
Journal of Modern Physics (JMP) , 2018, DOI: 10.4236/jmp.2018.95067
Abstract: In the 1920’s, Louis de Broglie’s observation that the integer sequence that could be related to the interference patterns produced by the various electromagnetic energy quanta emitted by hydrogen atoms was identical to those of very well known classical resonance processes, made him conclude that electrons were captive in resonance states within atoms. This led Schr?dinger to propose a wave function to represent these resonance states that still have not been reconciled with the electromagnetic properties of electrons. This article is meant to identify and discuss the electromagnetic harmonic oscillation properties that the electron must possess as a resonator in order to explain the resonance volume described by the wave function, as well as the electromagnetic interactions between the elementary charged particles making up atomic structures that could explain electronic and nucleonic orbitals stability. An unexpected benefit of the expanded space geometry required to establish these properties and interactions is that the fundamental symmetry requirement is respected by structure for all aspects of the distribution of energy within electromagnetic quanta.
The Mechanics of Conceptual Thinking  [PDF]
André Michaud
Creative Education (CE) , 2019, DOI: 10.4236/ce.2019.102028
Abstract: Description of the mechanics of conceptual thinking?that?stems?from interaction sequences between the limbic system and the verbal areas of the neocortex. Description of the rise of the attention level to full active awareness when a feeling of uneasiness due to a verbal stimulus is triggered by the amygdala, followed by an active cogitation process involving the verbal areas of the neocortex, ending in the strengthening in the neocortex by the hippocampus of a synaptic network corresponding to a modified verbal sequence that removes or reduces the feeling of uneasiness that initiated the sequence. Description of the generalization abilitythat?emerges from the use of articulated languages, acquired by education, from which conceptual thinking andalso?the collectively intelligible mathematical language emerge that also develops to various degrees in some individuals by education. Description of the mathematical thinking mode, about?whose engrams have been located in the neocortex in areas that do not overlap the verbal areas.
The Effects of Assessment: a Reflection from within the Economic Worldview in Education
Olivier Michaud
Analytic Teaching and Philosophical Praxis , 2010,
Abstract: In a seminar held in my university last fall on education policy research, I was, like many of my colleagues, astonished at the dominance of the economic worldview in the shaping of American education. The question of what good education is was surprisingly absent from the book used in the seminar: Handbook of Education Policy Research (Sykes, Barbara, & Plank, 2009). The majority of the authors of this book were more interested in how we could make the educational system more efficient. More to the point, they were interested in how efficiency can be measured. This is why the main methodology used by the researchers was quantitative. Indeed, the assumption is that only quantitative methods allow for a more accurate judgment of reality at large, in this case the educational system, and show possible links between causes and effects.
‘Valeurs, normes et évaluations’.
Yves Michaud
EspacesTemps.net , 2005,
Abstract: Les normes se sont multipliées dans la réalité des pratiques et dans les modes de représentation des activités. Ce qui est relativement nouveau par rapport à une époque pas si lointaine où l’activité humaine était pensée en référence à des valeurs à la fois objectives et voulues par les sujets. Quelle est la signification du caractère conventionnel, utilitaire et collectif des normes ? Quelles sont les conséquences au plan de l’évaluation ? La pratique de l’évaluation systématique témoigne d’un mode de fonctionnement social qui fait intervenir flexibilité et réflexivité. On passe ainsi de l’ontologie des activités à leur être purement procédural. Norms invade our life in terms of normalized activities but also in terms of representation. This is something new compared to a not so distant time when human activities were described in reference to values which were both objective and the result of human will. What is the meaning of the conventional, utilitarian and collective nature of norms ? What are the consequences of this nature for evaluation ? The systematic benchmarking of activities and processes is connected to the presence of flexibility and reflexivity at the heart of the social system. We must realize that we moved from an ontology of action to a procedural view of it.
Science fiction as a culture of global innovation
Essachess : Journal for Communication Studies , 2010,
Abstract: Science fiction participates to the creation of a global culture of innovation. It is diffused in most of the developed countries to promote technical innovation and has motivated a lot of actors of capitalism to imitate the utopian technologies represented in these very popular movies and novels. The stake of this article is to define the strategic habitus in a cultural environment constituted of multiple centers of Research and Development (R&D) organized in network. The management of science fiction is necessary to optimize innovation at a global level. After the step of the ideological filtering of science fiction, the construction of discursive philters permits to manage productive systems with common and normalized cultural considerations. The approaches of sensemaking, storytelling and “strategy as discourse” are used at the theoretical level.
The National Longitudinal Survey of Children and Youth - Overview and Changes After Three Cycles
Michaud, Sylvie
Canadian Studies in Population , 2001,
Abstract: English The National Longitudinal Survey of Children and Youth (NLSCY) is a long-termstudy to monitor child development and well being of Canada's children as they grow from infancy toadulthood. To do so, a representative sample of Canadian children between 0-11 years old was selectedand interviewed in 1994-95. Interviews are conducted every two years and the current plans are tofollow that cohort of children until they reach the age of 25. The survey has now gone through threecollection cycles and already a number of changes hav been observed. The paper will give an overviewof the objectives of the survey, the survey design, the collection methodology, the survey content andthe products and research that have already been done. The last section will present the futuredirection of the survey. French L’Enquête nationale longitudinale sur les enfants et les jeunes concerne ledéveloppement et le bien-être des jeunes de l’enfance à la vie adulte. Unéchantillon représentatif d’enfants des ages 0-11 ans a d’abord fait parti del’enquête en 1994-1995. On veut continuer avec un interview chaque deux ansjusqu’à ce que les enfants ont 25 ans. Sur les trois premiers cycles, il y a déjàplusieurs changements. On décrit ici les objectifs de l’enquête, son dessin, laméthodologie de collecte, le contenu, la recherche qui à déjà été faite, et lefuture de l’enquête.
Vascular Tortuosities of the Upper Eyelid: A New Clinical Finding in Fabry Patient Screening
Langis Michaud
Journal of Ophthalmology , 2013, DOI: 10.1155/2013/207573
Abstract: Purpose. To report a new clinical finding related to Fabry disease. Methods. Fabry subjects were enrolled in the study, matched for age and sex with healthy individuals as a control group. This is a prospective review of all upper lid pictures taken for every subject at their last visit. A 4-step grading scale is proposed to classify this new entity. Results. Group A (Fabry) comprised 16 males and 22 females, aged 40 (±14) years on average. Group B (control) comprised 7 males and 8 females, aged 37 (±12) Vessels tortuosity was identified on the external superior lid in 36 of the Fabry patients (94.7%), while none of the subjects in group B showed similar vessels tortuosity. In addition, microaneurysms (MAs) were found in 10/38 group A subjects while none in group B presented a similar finding. The differences are highly significant. Conclusion. This paper proposes that blood vessels tortuosity on the upper eyelid be recognized as a new clinical entity for inclusion among the classic ocular manifestations of Fabry’s disease. Without evidence of any negative impact, it should be considered a benign sign contributing to evidence of suspected Fabry disease. 1. Introduction With an incidence varying from 1/3,000 newborn males to 1?:?40,000 or 1?:?117,000 live male births [1], Fabry is considered one of 7,000 known rare diseases that exist in the USA and elsewhere [2]. However, the number of patients is probably underestimated [3], because their symptoms are quite variable and unspecific, often leading to confusion with rheumatoid diseases or chronic inflammatory conditions [4]. A confirmatory diagnosis comes, on average, 14 years after the onset of the first symptoms for male adults and 16 years for females [5], three years for symptomatic children [6]. Considering the life-threatening aspect of the disease, this delay is unfortunate. Because ocular manifestations are among the first to appear in Fabry subjects [7], eye care practitioners are key players in detecting and screening for this disease. This paper aims to present a new clinical finding that may help them improve screening effort and alert them to potential Fabry subjects while performing slit lamp examinations. It also underscores the importance of examining the external surface of the upper lid, an area usually hidden and left unexplored during routine anterior segment examination of the eye. 2. Subjects and Methods The Université de Montréal, école d’Optométrie, is conducting a longitudinal study on ocular manifestations related to Fabry disease. Details of the study design and methods have
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