Objective of work: the aim of this study was to conduct a retrospective, quantitative, descriptive survey accompanied with a comparative statistical research, in which cases of patients with augmented renal clearance were examined and analyzed regarding the similarities and differences between them and their relevance for possible under-dosage of predominantly renally excreted drugs. Tasks: 1. to detect all cases of lower than 50 µmol/L Scr measurements and calculate possible ARC using Cockcroft-Gault equation in a defined period of time in a Lithuanian hospital in Kaunas. 2. To compare the performance of 3 different equations to distinguish the ARC as assessed by Cockcroft-Gault equation from non-ARC cases. 3. To analyze possible reasons associated with these ARC cases. 4. To search for the cases when predominantly renally excreted drugs were prescribed to these patients. / Tikslas darbo: Šio tyrimo tikslas buvo atlikti a posteriori, kiekybinį aprašomąjį tyrimą Kartu su lyginamosios statistinių tyrimų, kuriais atvejais pacientai, sergantys inkstų papildyta klirensas buvo išnagrinėti ir išanalizuoti apie panašumus ir skirtumus tarp jų ir jų svarbą galimo nepakankamo dozę daugiausia išsiskiria pro inkstus narkotikų. Uždaviniai: 1. Aptikti bet mažesnis negu 50 mmol / l SCR matavimų bylas ir apskaičiuoti galimą ARC naudojant Kokrofto-Gault lygtis nustatytą laiką, Lietuvos ligoninę Kaune. 2. Norėdami palyginti iš 3 skirtingų lygčių atskirti ARC, įvertintas Kokrofto-Gault lygtį kokybės iš ne ARC atvejais. 3. Išanalizuoti galimas priežastis, susijusias su šių ARC atvejais. 4. Norėdami ieškoti atvejai, kai daugiausia išsiskiria pro inkstus narkotikų buvo nustatyta, kad šiems pacientams.

Texas A&M University completed excavations at the Gault site (41BL323) in Bell County, Texas, in the spring season of 2000. Located at the head of Buttermilk Creek, past inhabitants have enjoyed perennial springs and a variety of natural resources available in the immediate area, including high quality chert from the Balcones Escarpment of the Edwards Plateau. Chipped stone material diagnostic of the Clovis period was recovered during the TAMU block excavation, informally referred to as the "Lindsey Pit," from clay deposits approximately 35 cm thick. Natural agents that may have impacted contextual integrity of the Clovis cultural deposits include stream action, pedoturbation, and bioturbation. Artifact spatial analyses examined long axis orientations and artifact degree of dip to identify non-random patterns that would result from stream action. Vertical and horizontal relationships of refitting artifacts were examined to evaluate post-depositional displacement. Orientations of chipped stone artifact long axes and inclination were found to be statistically random, with minor patterns that reflect the paleotopography. Thirty-three groups of refitting artifacts were identified, none of which contained elements recovered from deposits more recent than the Clovis clays. Five groups have elements that appear to come from both of the Clovis clay deposits, indicating a small degree of vertical displacement. The results of this research indicate the clays bearing Clovis materials retained a high degree of integrity such that the spatial patterns preserved in the archaeological record at this location are the result of cultural activities and not natural processes. Though time-consuming in the field and laboratory, additional fine-grained analyses such as artifact orientation and refit studies provide separate lines of evidence to account for natural processes that may have acted to obscure the original patterns of the archaeological record, and our understanding of past human cultures.

Prehistoric quarries in America are poorly understood and thus problematical to take into account when making inferences about past behavior. A microwear analysis of Clovis blades from the 2000 Texas A&M University excavations at the Gault site (41BL323), located in southern Bell County, Texas, provided a window into this problem. Texas A&M excavations on the site produced an extraordinarily large number of Clovis artifacts in two bounded geologic units, 3a and 3b. Included in the artifact types are blades, specialized elongate flakes associated with a core and blade technology. In conducting a microwear analysis of the Clovis blades from Gault, I proposed the following questions: (1) were the Clovis blades utilized at Gault?; (2) is there a difference in the use-wear patterns of Clovis blades from the geological units 3a and 3b?; and (3) is Gault, as a quarry/workshop site, a place to just obtain raw materials or did it also serve as a craft site? Observations from experiments, stereomicroscope analysis, compound microscope analysis, and SEM/EDS analysis led to answers for two research questions: (1) blades were used at Gault and (2) there is a difference between Clovis units 3a and 3b. Eight Clovis 3a blades, or 3.0% of the total Clovis 3a blade/blade fragment population (n=264), exhibit use-wear. Six Clovis 3b blades, 3.3% of the total Clovis 3b blade/blade fragment population (n=182), exhibit use-wear. In general, Clovis 3b blades were used on harder contact materials (wood to bone) than those in Clovis Unit 3a (softer contact materials similar to grass, sinew, and rawhide). The function(s) of quarries and quarry-related workshops were interpreted by William Henry Holmes as a place to obtain raw materials, while Kirk Bryan interpreted them as a place to bring other materials to work in craft activities. Following the microwear analysis of Clovis blades/blade fragments at Gault, I compared Gault to three other Paleoindian quarry-workshop sites (Wells Creek, Dutchess Quarry, and West Athens Hill). My intent is to provide supplemental data for the consideration when applying Holmes’ and Bryan’s respective hypotheses.

BACKGROUND: The Modification of Diet in Renal Disease (MDRD) formula and a modified version of the Cockcroft-Gault (CGm) formula adjusting for body surface area have been found to more accurately estimate glomerular filtration rate (GFR) compared with the original CG equation in specific patient populations. To date, the use of these formulas in determining drug dosage and estimating drug elimination has not been thoroughly investigated. OBJECTIVE: To evaluate the ability of the MDRD and CGm formulas to predict aminoglycoside elimination rate and clearance. METHODS: A 6-month prospective, noninterventional, pharmacokinetic study was conducted at a university teaching hospital. Patients receiving aminoglycoside antibiotics (amikacin, gentamicin, or tobramycin) were eligible for study inclusion. Predicted elimination rate and aminoglycoside clearance were calculated for each patient using the MDRD and CGm formulas. Actual (patient-specific) elimination rate and aminoglycoside clearance were calculated for each patient using measured aminoglycoside serum concentrations. Predictive ability of the formulas was compared through Spearman correlations and Student's t-tests. Accuracy of formula estimates was also evaluated. RESULTS: Seventy-one patients met study inclusion criteria; the majority (82%) were in an intensive care unit. The 6-variable MDRD formula was found to be a significantly better predictor of aminoglycoside clearance (p = 0.035) compared with CGm. There was no statistically significant difference between the 2 methods in predicting patient-specific elimination rates (p = 0.167). Among subgroups, the MDRD formula was a significantly better predictor of aminoglycoside clearance for patients with an estimated GFR less than 60 mL/min (p = 0.027). CONCLUSIONS: The 6-variable MDRD performs better than the CGm formula in predicting aminoglycoside clearance and may be considered as a tool in aminoglycoside dosing recommendations.

Introducción: El método convencional usado para estimar la tasa de filtrado glomerular (TFG) presenta limitaciones y dificultades para las mujeres en periodo de gestación, las cuales presentan alteraciones a nivel renal, pudiendo evolucionar hacia la pre eclampsia, ante esto se espera encontrar en la formula Cockcroft – Gault una alternativa adecuada para estimar y monitorear la TFG en gestantes. Objetivo: Establecer la correlación entre la fórmula Cockcroft – Gault y la depuración de creatinina endógena (DCE) por método colorimétrico en gestantes. Diseño: Correlacional, observacional, prospectivo y corte transversal. Lugar: Laboratorio central, Hospital Nacional Sergio Bernales de Lima, Perú. Participantes: Gestantes ambulatorias. Materiales y métodos: Muestras de sangre y orina de 24 horas de 92 gestantes entre noviembre 2015 y enero 2016. Se utilizó el coeficiente de correlación de Pearson para comparar ambos métodos usados para estimar la TFG. Resultados: El promedio de la DCE colorimétrica fue 73,65 ± 19,85 ml/min, la obtenida por fórmula fue 99,82 ± 18,75 ml/min y la correlación entre dichos métodos de laboratorio en el total de las gestantes fue moderada (r = 0,56). Gestantes del I trimestre tuvieron baja correlación (r = 0,40), las del II trimestre tuvieron moderada correlación (r = 0,67) y las del III trimestre mostraron baja correlación (r = 0,49), todos los casos presentaron diferencia significativa (p < 0,05). Conclusión: Se encontró baja correlación entre la DCE y la fórmula Cockcroft – Gault en gestantes. Palabras claves: tasa de filtrado glomerular, depuración de creatinina endógena colorimétrica, fórmula Cockcroft – Gault, grado de correlación. / --- Introduction: The conventional method used to estimate the glomerular filtration rate (GFR) has limitations and difficulties for women in gestation period, which present alterations to the kidney level and can progress to pre eclampsia, before it is expected to find in the Cockcroft - Gault an adequate alternative to estimate and monitor the GFR in pregnant women. Objective: To establish the correlation between the Cockcroft - Gault and endogenous creatinine clearance (ECC) by colorimetric method in pregnant women. Design: correlational, observational, prospective and cross-sectional. Location: Central Laboratory in Sergio Bernales National Hospital, Lima - Peru. Participants: Pregnant ambulatory women. Materials and Methods: Blood samples and 24-hour urine of 92 pregnant women between November 2015 and January 2016. The Pearson correlation coefficient was used to compare the two methods used to estimate GFR. Results: The average of the ECC Colorimetric was 73.65 ± 19.85 ml / min, obtained by formula was 99.82 ± 18.75 ml / min and the correlation between these laboratory methods in total pregnant women was moderate (r = 0.56). Gestating the first quarter had low correlation (r = 0.40), those of the second quarter had moderate correlation (r = 0.67) and the third quarter showed a low correlation (r = 0.49), all cases showed difference significant (p <0.05). Conclusion: It was found low correlation between the ECC and the Cockcroft – Gault formula in pregnant women. Keywords: glomerular filtration rate, colorimetric endogenous creatinine clearance, Cockcroft - Gault, degree of correlation.

RESUME Contexte La maladie rénale chronique (MRC) constitue un problème mondial majeur de Santé publique. Son ampleur réelle en Afrique demeure inconnue. Malgré, les progrès réalisés dans lidentification et la prévention de la MRC et le traitement de la phase terminale de la maladie, ces domaines restent un grand défi en Afrique Sub-saharienne à cause du manque cruel des ressources nécessaires. Objectif Ce travail a pour objectif de cerner lépidémiologie de la MRC à Kinshasa en vue délaborer des stratégies de dépistage précoce et de prévention adaptées. Le but ultime est de contribuer à la réduction de la morbidité et la mortalité rénales mais aussi cardiovasculaires. Méthodes : Le présent travail est une revue synthétique de 4 études menées à Kinshasa : Une étude documentaire des 412 cas réalisée aux Cliniques Universitaires de Kinshasa (CUK), durant la période allant de Janvier 2001 à Décembre 2004 pour identifier le profil épidémiologique et clinique des patients atteints de la MRC. Les résultats de cette étude ont motivé le besoin dévaluer lampleur de la maladie dans la population et dans les structures de santé existantes. Il en a résulté trois études. Une étude épidémiologique de type transversal effectuée à partir de 503 ménages sélectionnés de manière aléatoire selon un plan de sondage à plusieurs degrés dans 10 des 35 Zones de santé composant Kinshasa, capitale de la République Démocratique du Congo (RDC). Une seconde étude, aussi de type transversal, réalisée à partir de 527 patients à risque de MRC, fréquentant neuf Centres de santé (CS) de niveau primaire et quatre hôpitaux de référence de la ville de Kinshasa. Une campagne de dépistage de la protéinurie et des facteurs de risque de la MRC chez 3.018 sujets. Résultats : Lanalyse des données enregistrées en milieu hospitalier a montré : Une augmentation annuelle progressive et inquiétante des proportions (60,6%, 65,9%, 67,4% et 70,5%) de la MRC admises aux CUK quasi exclusivement au stade terminal de la maladie nécessitant une prise en charge rapide par la dialyse péritonéale. Malheureusement, 11% seulement pouvaient accéder à ce traitement onéreux. La majorité des malades à prédominance masculine (sexe ratio 2,2/1) décèdent prématurément à un âge moyen (45,8±14,5 ans), à un moment de leur vie où ils sont encore économiquement très productifs. Les causes probables de la MRC chez ces patients sont la glomérulonéphrite chronique (37%), lhypertension artérielle (27%) et le diabète sucré (26%). Les études transversales dans la population générale et les institutions de santé traditionnelles de la ville de Kinshasa ont mis en évidence les caractéristiques épidémiologiques suivantes: La prévalence globale (tous les stades confondus) de la MRC est de 12% dans la population générale, mais 3% seulement sont conscients de leur état de rein. Celle de linsuffisance rénale chronique (IRC) estimée par le débit de filtration glomérulaire (DFGe) < 60 ml/min/1,73 m² est de 8%. Cette MRC touche particulièrement les adultes (52±15 ans). Les facteurs de risque potentiels de la MRC, liés à des maladies non transmissibles (MNT) sont en progression comparativement aux études antérieures. Ces facteurs sont lhypertension (28%), le diabète sucré (12%) et lobésité (15%). Dans les Centres de santé de Kinshasa, la prévalence globale de la MRC méconnue parmi les sujets à risque est le triple de celle rapportée dans la population générale de la même ville. Parmi cette population malade, les proportions de la MRC atteignent 44% chez les hypertendus, 39% chez les diabétiques ; 16% chez les obèses et 12% chez les sujets infectés par le Virus de limmunodéficience humaine (VIH). 82% des diabétiques avaient une glycémie à jeun non contrôlée (> 126 mg/dl) et 78% dhypertendus navaient pas une pression artérielle sous la cible la moins stricte, cest à dire contrôlée à moins de 140/90 mmHg. Les déterminants identifiés de lIRC ont été lhypertension (OR ajusté 3,3), le diabète sucré (OR 2) et la protéinurie (OR 2,9). Les principaux déterminants de DFGe < 60 ml/min/1,73 m² chez les diabétiques étaient lâge et la durée du diabète sucré. Les résultats de la campagne de dépistage de la protéinurie et des facteurs de risque de la MRC ont révélé ce qui suit : La prévalence de la protéinurie a été de 17%. Les autres facteurs de risque de la MRC identifiés chez les sujets en bonne santé apparente ont été: lhypertension (37%), le diabète sucré (9%), lobésité (11%) et le syndrome métabolique (5%). Pour identifier un cas de protéinurie, il est nécessaire de dépister 4 diabétiques, 5 hypertendus, 4 sujets avec syndrome métabolique, 5 sujets âgés de plus de 50 ans et 9 personnes ne présentant aucune des conditions susmentionnées. Les déterminants majeurs de la protéinurie étaient lâge > 50 ans (OR ajusté 1,4), le diabète sucré (OR 1,3), le surpoids (OR 1,2) et le niveau socio-économique bas (OR 1,4). Conclusion : Ces études établissent pour la toute première fois dans une population africaine la forte prévalence de la MRC et ses facteurs de risque notamment lhypertension, le diabète sucré, lobésité, lâge > 50 ans et linfection à VIH. La maladie affecte ladulte encore jeune comparée aux Etats-Unis où elle prédomine à la vieillesse. Nos études ont montré aussi à la fois la forte prévalence de la protéinurie chez les sujets sans facteurs de risque traditionnels précités, le déficit du dépistage précoce de la MRC et de prise en charge des facteurs de risque dans le système de santé traditionnel favorisant la référence tardive et/ou les décès prématurés, ainsi que les limites malheureuses par manque de moyens de la prise en charge de la maladie au stade tardif. Ces études plaident pour la nécessité dun renforcement de la capacité du personnel soignant dans le domaine de détection précoce et de prise en charge des MNT dont la MRC. Elles montrent également quun dépistage annuel de masse de la population de la protéinurie et des facteurs de risque de la MRC est faisable et pourra, nous lespérons, constituer la base dune élaboration dune politique nationale de prévention. Mots-clé : diabète sucré, équation (Cockcroft & Gault, MDRD), hypertension artérielle, maladie rénale chronique, prévalence, protéinurie. SUMMARY Background Chronic kidney disease (CKD) is a worldwide public health problem. Little is known about its burden in Africa. Despite the advances in identification and prevention of CKD and management of end stage renal disease (ESRD), sub-Saharan Africa has been left far behind regarding these advances. This is because of the scarcity of necessary resources. Objective This work was designed to ascertain the epidemiologic knowledge of CKD in Kinshasa in order to define suitable baseline preventive strategies. It would aims ultimately, to reduce the morbidity and mortality from renal disease and related cardiovascular events. Methods: This current work summarises results of 4 studies undertaken in Kinshasa: A retrospective cross sectional study of 412 cases which was done in the Academic hospital of Kinshasa (AHK), from January 2001 to December 2004 to identify the epidemiologic and clinical profile of patients with CKD. The results of this study motivated us to investigate the extent of the burden of CKD in the population and the existing structures of healthcare. Thus, three further studies were carried out; In an epidemiologic cross sectional study, 503 adult residents in 10 of the 35 health zones of Kinshasa, the capital of the DRC were studied in a randomly selected sample; In a second study of higher risk subjects, 527 people in primary and secondary health care areas in the city of Kinshasa were studied from a random sample of at-risk out-patients with hypertension, diabetes, obesity, or who were infected by HIV; Finally, a mass screening for proteinuria and CKD risk factors was conducted in Kinshasa which involved 3,018 subjects. Results: The analysis of the data recorded in health care had showed: An overwhelmingly annual increasing proportion of CKD (60.6%, 65.9%, 67.4% and 70.5%) in AHK, unfortunately for the majority at stage 5, in other words at ESRD. Tragically enough, only 11% of them could be treated by peritoneal dialysis depending on their financial resources. The majority of the patients are young males (sex ratio 2.2/1) undergoing premature death (45.8±14.5). The probable causes of CKD in these subjects were chronic glomerulonephritis (37%), hypertension (27%) and diabetes mellitus (26%). The cross-sectional studies in the general population and the traditional structures of health care (HC) of the city of Kinshasa highlighted the following: The overall prevalence of CKD is 12% in the general population, but only 3% of those with CKD were aware of their condition. The prevalence of chronic renal failure (CRF) (eGFR < 60 ml/min/1.73 m ²) is 8%; CKD affects particularly young adults (52±15 years); Risk factors for CKD considered in this study, including hypertension (28%), diabetes (12%) and obesity (15%), are increasing compared to the former studies. In HC, the overall prevalence of undiagnosed CKD among at-the risk subjects is three times higher the prevalence of CKD in the general population of the same city. In those with the at-risk conditions, the % of CKD was: 44% in the hypertensive, 39% in the diabetics; 16% in the obese and 12% in those who were infected by the human immunodeficiency virus (HIV). 82% of those with history of diabetes had fasting serum glucose levels (> 126 mg/dl), and 78% of those with a history of hypertension did not have blood pressure controlled to less than 140/90 mmHg. The strongest determinants of CRF or CKD 3+ were: hypertension (adjusted OR 3.3), diabetes (OR 2) and proteinuria (OR 2.9). The principal determinants of eGFR < 60 ml/min/1.73 m² in the diabetic patients were age and the duration of diabetes. The results of the campaign of early detection for proteinuria and CKD risk factors revealed that: The prevalence of proteinuria was 17%. The other CKD risk factors identified were: hypertension (37%), diabetes (9%), obesity (11%) and metabolic syndrome (5%). To identify 1 case of proteinuria, one would need to screen 4 persons with diabetes, 5 persons with hypertension, 4 subjects having metabolic syndrome, 5 subjects aged ≥ 50 years and 9 people without any of the conditions mentioned above. The strongest determinants of proteinuria were age > 50 years (adjusted OR 1.4), diabetes (OR 1.3) and overweight (OR 1.2) and low socioeconomic status (OR 1.4). Conclusion: This work documents for the first time in Africa the high prevalence of CKD and its risk factors mainly hypertension, diabetes, obesity and HIV infection. CKD affects younger people in DRC, in contrast to the United States, where CKD is more prevalent in older. Our work also shows the high prevalence of proteinuria among subjects with neither diabetes nor hypertension, the deficit of the early detection and management of CKD risk factors in the traditional health care system leading to late referral or premature deaths, and the limits of renal replacement treatment. They also show that an annual mass screening of the population for proteinuria and CKD risk factors is feasible and will, it is hoped, provide the basis for building a nationwide prevention strategy. Key words: chronic kidney disease, diabetes mellitus, equation (Cockcroft &Gault, MDRD), arterial hypertension, prevalence, proteinuria.

<p><p></p><p>This dissertation posits that Nouvelle Cuisine brings together two of the most powerful cultural forces involved in constituting French national identity: food and revolution. As a result of this privileged position, Nouvelle Cuisine offers scholars a particularly rich object of study that can be related to larger issues at play in the formation and performance of national identity. In this work, I will argue that the revolutionary rhetoric used in the articulation of Nouvelle Cuisine serves several distinct and, at times, oppositional purposes. On the one hand, the revolutionary rhetoric is intended to create a break with a tumultuous and painful past, while asserting a new paradigm of national strength. On the other hand, however, the revolutionary rhetoric of equality and freedom also somewhat paradoxically participates in and supports the dark side of democracy, which includes but is not limited to behind-the-scenes jockeying for power and the elimination of groups that threaten or curtail either the power at the top or the legitimacy of the revolution itself. </p><p></p></p><p><p></p><p>This work will also argue that because of the very malleability of the revolutionary rhetoric and because French cuisine is considered such an important expression of the French nation, Nouvelle Cuisine and the contemporaneous culinary discourse transforms France's fine dining domain into a sort of theatre where national attitudes are not only represented to a socially diverse French public, but where the public itself is invited to participate in this performance of the nation: rehearsing, refining, and rejecting what it means to be French and, as a result, projecting both aspirations and anxieties of nationhood through this culinary landscape. </p><p></p></p><p><p></p><p>In writing this dissertation, I have drawn heavily on my training in literary studies, but have tried as much as possible to allow the subject matter to dictate an inclusive and interdisciplinary approach. I engage frequently with a wide variety of scholars such as Homi Bhabha, Roland Barthes, Michel Winock, Jean-Robert Pitte, Claude Fischler, and Stephen Mennell. Consequently, my argument places the classic literary tools of linguistic and semiotic methods alongside investigations that call on cultural studies, history, anthropology, sociology, political philosophy, and of course food studies. I use cookbooks, guidebooks, newspapers, magazines, menus, interviews, and multiple editions of the <italic>Larousse Gastronomique</italic> to provide first and foremost the context but also the evidence for this dissertation. I concentrate the bulk of my critical energies on the food and leisure magazine <italic>Le Nouveau Guide</italic> (founded by food critics Henri Gault and Christian Millau) and the cookbook series entitled "Les Recettes Originales de...", paying particular attention to Nouvelle Cuisine foundational chefs Paul Bocuse and Michel Gu&eacute;rard. </p><p></p></p><p><p></p><p>The narrative of Nouvelle Cuisine is equivocal, but it does not defy conclusions. My final analysis in this dissertation is that in the production and articulation of Nouvelle Cuisine, we see how food and revolution are used to reorganize the hierarchies and composition of a society. We see a reorganization that restores bourgeois, patriarchal values and clings to a hexagonal interpretation of France that prioritizes resistance over incorporation. We see a revolution that is perhaps less the French Revolution than the July Revolution. We see a revolution that is an alibi for restoration.</p><p></p></p> / Dissertation

A determination was made of the degree to which the four requirements of Gault were met in District I of the Utah Juvenile Court between July l, 1967 and June 30, 1969. The requirements handed down in 1967 by the U. S. Supreme Court were as follows: (a) guarantee to the right of notice given to the juvenile himself and to his parents; (b) right to counsel , representation by counsel in juvenile delinquency proceedings; (c) right to confrontation and cross-examination by prosecuting witness; and (d) privilege against self- incrimination in juvenile delinquency proceedings. Observable procedures indicate that sustained effort is being made by District I, Utah, toward affording protection of basic legal rights to juvenile court clients and their families. However, the juvenile court records, as the source of information for this study, show the four requirements of Gault as being met only in part during the period of time specified. It was also found that, with only two changes, the Utah Juvenile Court Act of 1965 would have already been fulfilling, in Utah, the requirements provided by the subsequent 1967 U.S. Supreme Court decision on Gault. These two recommended changes were, first, a provision requiring that it be recorded whether or not the child was notified of his rights; and second, that a provision be added to record the name of the complainant, his presence, and if his testimony was used during the proceeding.

Yes / Background: Kidney function reduces with age, increasing the risk of harm from increased blood levels of many medicines. Although estimated glomerular filtration rate (eGFR) is reported for prescribing decisions in those aged ≥65 years, creatinine clearance (Cockcroft–Gault) gives a more accurate estimate of kidney function. Aim: To explore the extent of prescribing outside recommendations for people aged ≥65 years with reduced kidney function in primary care and to assess the impact of using eGFR instead of creatinine clearance to calculate kidney function. Design and setting: A cross-sectional survey of anonymised prescribing data in people aged ≥65 years from all 80 general practices (70 900 patients) in a north of England former primary care trust. Method: The prevalence of prescribing outside recommendations was analysed for eight exemplar drugs. Data were collected for age, sex, actual weight, serum creatinine, and eGFR. Kidney function as creatinine clearance (Cockcroft–Gault) was calculated using actual body weight and estimated ideal body weight. Results: Kidney function was too low for recommended prescribing in 4–40% of people aged ≥65 years, and in 24–80% of people aged ≥85 years despite more than 90% of patients having recent recorded kidney function results. Using eGFR overestimated kidney function for 3–28% of those aged ≥65 years, and for 13–58% of those aged ≥85 years. Increased age predicted higher odds of having a kidney function estimate too low for recommended prescribing of the study drugs. Conclusion: Prescribing recommendations when kidney function is reduced are not applied for many people aged ≥65 years in primary care. Using eGFR considerably overestimates kidney function for prescribing and, therefore, creatinine clearance (Cockcroft–Gault) should be assessed when prescribing for these people. Interventions are needed to aid prescribers when kidney function is reduced.

La découpe de viandes et le filetage de poisson, destinés aux rois et aux nobles dans les siècles passés et, plus récemment, aux clients de la restauration traditionnelle, font partie de l’histoire de la gastronomie, au même titre que l’histoire de la cuisine. Ces pratiques, considérées comme une technique ou une science, voire, par certains, comme un art, bien que déjà présentes sous une forme ritualisée dans bien des textes mythologiques et des légendes fondatrices, ont connu plusieurs évolutions historiques. Dès le Moyen Âge, la pratique de la découpe des viandes et poissons auprès des élites s’est éloignée des techniques de la boucherie pour revêtir une dimension artistique. À partir de la Renaissance et jusqu’au XVIIIème siècle, les volailles et autres viandes sont filetées par les écuyers tranchants, véritables spécialistes qui effectuent des gestes empreints d’élégance, tel celui qui consiste à découper les viandes à la volée, maintenues en l’air en haut d’une fourchette. À partir du XVIIIème siècle, la découpe doit s’adapter aux changements sociaux : à la fin de l’Ancien Régime, en France, elle connaît une première grande évolution à la suite de changements radicaux dans la manière de concevoir la cuisine, puis avec l’apparition du service à la russe et la mise en valeur des rôts (pièces rôties) au centre du repas, évolution bientôt suivie par d’autres, en grande partie influencées par Marie-Antoine Carême puis Urbain Dubois et Emile Bernard. Plusieurs transformations sociales, culturelles et professionnelles auront aussi leur importance : la popularisation des sports d’hiver va marquer le déclin du poste de maître d’hôtel ; la loi Godart (juillet 1933) relative au contrôle et à la répartition des pourboires, va cristalliser le fameux conflit cuisine-salle ; par ailleurs, les « commandements de la nouvelle cuisine » prônés par Christian Millau et Henri Gault (1973) imposent la généralisation du service à l’assiette et rendent l’ancienne science du maître d’hôtel obsolète. Mais les pratiques de la découpe sont également présentes dans le foyer familial. De nombreux écrits sur les usages domestiques décrivent la manière de fileter viandes et poissons. Les pères de famille, dits amphitryons, possèdent et transmettent ce savoir-faire à l’occasion des réunions familiales. Traditionnellement, si la mère de famille officie en cuisine, le père de famille gère, en plus des boissons, les découpes de volailles et gigots. Mais, depuis la moitié du XXème siècle, ces usages sont en déclin. Malgré tout, l’art de la découpe a survécu sous forme de technique, dans certains restaurants et dans les écoles hôtelières, où il fait l’objet de débats houleux entre enseignants et professionnels, qui rejouent, à leur manière, la querelle des Anciens et des Modernes. La restauration française, actuellement en difficulté et en recherche de repères, a sans doute beaucoup à gagner de ces travaux sur les découpes et filetages devant les clients. En ce début du XXIème siècle, elle peut y retrouver une authenticité ancrée sur des racines profondes. / The carving tableside of meats, fishes and fruits, dedicated to kings and nobility in past centuries and demonstrated today in some traditional restaurants, is part of the history of gastronomy, as well as food history. Regarded as a technic or a science, or even as an art, this practice already present in a ritualized form in many mythological texts and founding legends, has undergone major changes in history. From the Middle Ages, it has moved away from the butchery techniques to get an artistic dimension. Since the Renaissance era to the eighteenth century, poultry and other meats are carved by real specialists called carving horsemen, who perform gestures imbued with elegance, like the « flying cut » (cutting the meat held in the air on top of a fork). From the eighteenth century, the cut must adapt to social changes at the end of the Old Regime in France, the first major carving art revolution follows radical changes in the way of designing food platers by chefs, then with the appearance of the russian service largely influenced by Marie-Antoine Carême and Urbain Dubois. The roast becomes the center of the meal. Subsequently, several social, cultural and professional changes will take place in the carving history : the popularization of winter sports that will mark the decline of carving station, the Godart law (July 1933), that legislates control of the distribution of tips and will crystallize the famous kitchen/waiting struggle, and finally the « commandments of Nouvelle Cuisine » led by Christian Millau and Henri Gault (1973) which impose the generalization of the plated service and render obsolete the ancient science of the maitre d’. But cutting practices is also found in the family home. Extensive litterature demonstrate how to thread meat and fish for domestic use. Fathers, called amphitryons in France, possess and transmit this knowledge during family gatherings. Traditionally, if the housewife officiates in the kitchen, the father manages, in addition to drinks, the cuts of poultry and legs of lamb. But since the mid-twentieth century, we must recognize that these uses are declining. Still, the art of cutting survived in the technical way, in some restaurants and hospitality schools, where it is subject of heated debate between teachers and professionals, replaying in their own way the quarrel of the Ancients and the Moderns. French restaurants, currently in great difficulty and in search of direction, have probably much to gain from a reflection on the return of threads and cut in front of customers. It would find, in our view, deep roots authenticity in this beginning of the 21st century.