LA BUDGETISATION AXEE SUR LA PERFORMANCE AU MAROC : BILAN ET PERSPECTIVES

Le système financier public marocain a connu de sérieuses réformes suite à la constitution de 2011 et à la promulgation de la loi organique des finances (LOF) de 2015 qui a transformé, au plan budgétaire, la culture managerielle de l’administration publique ; en effet, les principes constitutionnels se sont traduits par la mise en place d’un nouveau mode de gestion « la budgétisation axée sur les résultats » (BAR). L’enjeu est la performance. Cet enjeu a émergé avec le problème de déperdition des ressources publique qui pèsent lourdement sur le budget de l’Etat d’une part et l’endettement de l’Etat pour faire face aux attentes pressantes des citoyens vis à vis des finances publiques. On propose dans ce travail d’étudier l’impact de cette nouvelle approche sur la performance des administrations publiques marocaines à travers l’analyse des différentes phases d’implémentation de ce nouveau mode de gestion notamment : la phase d’expérimentation de la réforme budgétaire (2001-2011), l’adoption de la nouvelle constitution en 2011 et la refonte de la loi organique relative à la loi des finances (LOLF) de l’année 1998 par la LOLF n°130-13 promulguée en 2015. &nbsp

The epidermal growth factor receptor (EGFR) in head and neck cancer: its role and treatment implications

Epidermal growth factor receptor (EGFR) is a member of the ErbB family of receptors. Its stimulation by endogenous ligands, EGF or transforming growth factor-alpha (TGF-α) results in activation of intracellular tyrosine kinase, therefore, cell cycle progression. High levels of EGFR expression are correlated with poor prognosis and resistance to radiation therapy in a variety of cancers, mostly in squamous-cell carcinoma of the head and neck (SCCHN). Blocking the EGFR by a monoclonal antibody results in inhibition of the stimulation of the receptor, therefore, in inhibition of cell proliferation, enhanced apoptosis, and reduced angiogenesis, invasiveness and metastases. The EGFR is a prime target for new anticancer therapy in SCCHN, and other agents in development include small molecular tyrosine kinase inhibitors and antisense therapies

Recent technical innovations around HF radar technology and steps towards integrated national HF radar networks

HF Radar is a proven technology for ocean observing that has at present more than 600 references in the world and which is since April 2016 in application on all continents for the purpose of 2D surface currents and waves monitoring. This has only been possible 44 years after its first implementation in 1972 in San Clemente Island in California, thanks to the permanent evolution of the radar technology with key achievements such as the present unique system compactness and its capability to make a very efficient use of the radio spectrum. This paper firstly presents some of the latest technical innovations around HF radar technology that are making the technology even more reliable, accurate and useful such as the new Automatic Antenna Pattern Generation solution based on AIS vessel positions and the implementation of new added value trajectory models forced by HF Radar surface currents able to accurately predict oil spill transport and movement of particles on the sea or persons adrift. Secondly, we present current plans existing in the Iberian Peninsula HF Radar network to integrate HF Radar technology as an operational component of a national tsunami early warning system. Finally, the advanced HF Radar system implemented by the Direction de la Météorologie Nationale du Royaume du Maroc is presented; one of the latest deployed systems and the first permanent system operating in Africa.Peer Reviewe

New collocation path-following approach for the optimal shape parameter using Kernel method

The goal of this work is to develop a numerical method combining Radial Basic Functions (RBF) kernel and a high order algorithm based on Taylor series and homotopy continuation method. The local RBF approximation applied in strong form allows us to overcome the difficulties of numerical integration and to treat problems of large deformations. Furthermore, the high order algorithm enables to transform the nonlinear problem to a set of linear problems. Determining the optimal value of the shape parameter in RBF kernel is still an outstanding research topic. This optimal value depends on density and distribution of points and the considered problem for e.g. boundary value problems, integral equations, delay-differential equations etc. These have been extensively attempts in literature which end up choosing this optimal value by tests and error or some other ad-hoc means. Our contribution in this paper is to suggest a new strategy using radial basis functions kernel with an automatic reasonable choice of the shape parameter in the nonlinear case which depends on the accuracy and stability of the results. The computational experiments tested on some examples in structural analysis are performed and the comparison with respect to the state of art algorithms from the literature is given

The role of COX-2 in rectal cancer treated with preoperative radiotherapy

Radiotherapy is one of the principal modalities of rectal cancer treatment, and the ability to predict radio resistance could potentially improve survival through a targeted treatment approach. Cyclooxygenase-2 (COX-2) may protect against damage by irradiation that would justify the use of COX-2 inhibitors. The purpose of this study was to investigate the potential role of COX-2 in tumor response and outcome of patients with rectal cancer treated preoperatively with radiotherapy. Using immunohistochemistry, we examined COX-2 expression in 88 surgical specimens of rectal cancer treated preoperatively and in 26 pretherapeutic biopsies. We tested whether COX-2 expression was correlated with clinico-pathologic parameters and with survival and local recurrence. COX-2 was expressed in 50% of the pretherapeutic tumor biopsies and in 88.6% of post-irradiated surgical samples. COX-2 expression was correlated only with enhanced tumor inflammation (p = 0.03) and with tumor volume exceeding 30cc (p = 0.05). COX-2 was not significantly correlated with patient survival, but none of the patients with COX-2 negative tumors did recur locally, whereas 80% of patients with local recurrences have COX-2 positive tumors. We conclude that COX-2 expression is overexpressed in the majority of rectal cancers treated with radiotherapy and likely plays a role in local relaps

Comparison of neoadjuvant cisplatin-based chemotherapy versus radiochemotherapy followed by resection for stage III (N2) NSCLC

Objective: Comparison of prospectively treated patients with neoadjuvant cisplatin-based chemotherapy vs radiochemotherapy followed by resection for mediastinoscopically proven stage III N2 non-small cell lung cancer with respect to postoperative morbidity, pathological nodal downstaging, overall and disease-free survival, and site of recurrence. Methods: Eighty-two patients were enrolled between January 1994 to June 2003, 36 had cisplatin and doxetacel-based chemotherapy (group I) and 46 cisplatin-based radiochemotherapy up to 44Gy (group II), either as sequential (25 patients) or concomitant (21 patients) treatment. All patients had evaluation of absence of distant metastases by bone scintigraphy, thoracoabdominal CT scan or PET scan, and brain MRI, and all underwent pre-induction mediastinoscopy, resection and mediastinal lymph node dissection by the same surgeon. Results: Group I and II comprised T1/2 tumors in 47 and 28%, T3 tumors in 45 and 41%, and T4 tumors in 8 and 31% of the patients, respectively (P=0.03). There was a similar distribution of the extent of resection (lobectomy, sleeve lobectomy, left and right pneumonectomy) in both groups (P=0.9). Group I and II revealed a postoperative 90-d mortality of 3 and 4% (P=0.6), a R0-resection rate of 92 and 94% (P=0.9), and a pathological mediastinal downstaging in 61 and 78% of the patients (P≪0.01), respectively. 5y-overall survival and disease-free survival of all patients were 40 and 36%, respectively, without significant difference between T1-3 and T4 tumors. There was no significant difference in overall survival rate in either induction regimens, however, radiochemotherapy was associated with a longer disease-free survival than chemotherapy (P=0.04). There was no significant difference between concurrent vs sequential radiochemotherapy with respect to postoperative morbidity, resectability, pathological nodal downstaging, survival and disease-free survival. Conclusions: Neoadjuvant cisplatin-based radiochemotherapy was associated with a similar postoperative mortality, an increased pathological nodal downstaging and a better disease-free survival as compared to cisplatin doxetacel-based chemotherapy in patients with stage III (N2) NSCLC although a higher number of T4 tumors were admitted to radiochemotherap

The Reasons for Discrepancies in TargetVolume Delineation: A SASRO Study on Head-and-Neck and Prostate Cancers

Purpose: : To understand the reasons for differences in the delineation of target volumes between physicians. Material and Methods: : 18 Swiss radiooncology centers were invited to delineate volumes for one prostate and one head-and-neck case. In addition, a questionnaire was sent to evaluate the differences in the volume definition (GTV [gross tumor volume], CTV [clinical target volume], PTV [planning target volume]), the various estimated margins, and the nodes at risk. Coherence between drawn and stated margins by centers was calculated. The questionnaire also included a nonspecific series of questions regarding planning methods in each institution. Results: : Fairly large differences in the drawn volumes were seen between the centers in both cases and also in the definition of volumes. Correlation between drawn and stated margins was fair in the prostate case and poor in the head-and-neck case. The questionnaire revealed important differences in the planning methods between centers. Conclusion: : These large differences could be explained by (1) a variable knowledge/interpretation of ICRU definitions, (2) variable interpretations of the potential microscopic extent, (3) difficulties in GTV identification, (4) differences in the concept, and (5) incoherence between theory (i.e., stated margins) and practice (i.e., drawn margins

Decrease in Hemoglobin Levels Following Surgery Influences the Outcome in Head and Neck Cancer Patients Treated with Accelerated Postoperative Radiotherapy

Aim: To assess the influence of hemoglobin (Hb) levels in locally advanced head and neck cancer (LAHNC) patients treated with surgery and postoperative radiotherapy (PORT). Material and Methods: Pre- and postoperative Hb levels were collected in 79 patients treated with surgery followed by accelerated PORT for LAHNC. Median follow-up was 52months (range 12-95months). Results and Discussion: Four-year overall survival (OS) rate was 51%. Neither pre- nor postoperative Hb level (<120 or 130g/l in women or men, respectively) influenced the outcome. However, when Hb decrease between pre- and postoperative Hb values was taken into account, 4-year OS was significantly higher in patients with Hb difference less than 38g/l (quartile value) compared with those with Hb decrease 38g/l or more (61% versus 16%, P=0.008). Conclusion: Decrease in Hb level by more than 38g/l after surgery secondary to blood loss influences the outcome when postoperative RT is indicate

Feasibility and Efficacy of Accelerated Weekly Concomitant Boost Postoperative Radiation Therapy Combined with Concomitant Chemotherapy in Patients with Locally Advanced Head and Neck Cancer

Background: The aim of this study was to assess feasibility and efficacy of weekly concomitant boost accelerated postoperative radiation therapy (PORT) with concomitant chemotherapy (CT) in patients with locally advanced head and neck cancer (LAHNC). Methods and Materials: Conformal or intensity-modulated 66-Gy RT was performed in 5.5weeks in 40 patients. Cisplatin was given at days 1, 22, and 43. Median follow-up was 36months. Results and Discussion: Grade 3 mucositis, dysphagia, and erythema was observed in ten (25%), nine (23%), and six (13%) patients, respectively. Grade 3 or more anemia was observed in two (6%) patients, and leukopenia in five (13%) patients. No grade 3 or 4 thrombocytopenia was observed. Grade 3 nephrotoxicity was observed in one patient (3%). No treatment-related mortality was observed. Grade 2 or more xerostomia and edema were observed in ten (25%) and one (3%) patient, respectively. Locoregional relapse occurred in eight patients, and seven patients developed distant metastases. Median time to locoregional relapse was 6months. Three-year overall, disease-free survival, and locoregional control rates were 63%, 62%, and 81%, respectively. Multivariate analysis revealed that the only prognostic factor was nodal status. Conclusion: Reducing overall treatment time using accelerated PORT/CT by weekly concomitant boost (six fractions per week) combined with concomitant cisplatin CT is easily feasible with acceptable morbidit