Short-Term cost impact of compliance with clinical practice guidelines for initial sarcoma treatment

Background: The impact of compliance to clinical practice guidelines (CPG) on outcomes and/or costs of care has not been completely clarified.Objective: To estimate relationships between medical expenditures and compliance to CPG for initial sarcoma treatment.Research design: Selected cohorts of patients diagnosed with sarcoma in 2005 and 2006, and treated at the University hospital and/or the cancer centre of the Rhône-Alpes region, France (n=90). Main outcome measurements were: patient characteristics, compliance with CPG, health outcomes, and costs. Data were mainly extracted from patient records. The logarithm of treatment costs was modelled using linear and Tobit regressions.Results: Rates of compliance with CPG were 86%, 66%, 88%, 89%, and 95% for initial diagnosis, primary surgical excision, wide surgical excision, chemotherapy, and radiotherapy, respectively. Total average costs reached €24,439, with €1,784, €11,225, €10,360, and €1,016 for diagnosis, surgery (primary and wide surgical excisions), chemotherapy, and radiotherapy, respectively. Compliance of diagnosis with CPG decreased the cost of diagnosis, whereas compliance of primary surgical excision increased the cost of chemotherapy. Compliance of chemotherapy with CPG decreased the cost of radiotherapy.Conclusion: Since chemotherapy is one of the major cost drivers, these results support that compliance with guidelines increases medical care expenditures in short term.Oncology; Sarcoma; Cost; Clinical guidelines; Efficacy; Medical Practices; Government Policy; Regulation; Public Health

Syndrome métabolique des patients VIH+ sous traitement antirétroviral hautement actif au long cours

Depuis l'introduction des HAART, sont apparues des complications métaboliques chez les patients VIH+ traités au long cours (lipodystrophies, dyslipidémies et insulino-résistance). Le syndrome métabolique (SM) est un syndrome associant une hypertension artérielle, une obésité viscérale et des troubles glucido-lipidiques qui prédispose aux maladies cardio-vasculaires et au diabète de type 2. Son utilisation auprès des patients VIH+ se justifie au vu de l évolution chronique de cette maladie sous traitement spécifique (HAART), dont les effets secondaires sont à l origine d importants désordres métaboliques encore mal expliqués. Notre travail met en évidence l exposition importante de cette population aux risques cardio-vasculaires par l estimation de la prévalence du syndrome métabolique et par la caractérisation du profil lipidique, inflammatoire et oxydatif des patients atteints. L analyse biologique des paramètres apolipoprotéiques (Apo C, E et H) et inflammatoires (CRP, IL-6) identifie l insulino-résistance et l inflammation comme les causes principales de l installation du syndrome métabolique et confirme l intérêt d intégrer la CRP comme nouveau paramètre de définition. L étude du statut oxydatif nous aura permis d identifier le rapport PON et l Apo H comme deux facteurs prédictifs et indépendants du syndrome métabolique, et d envisager les modifications de répartition de l Apo H au sein des lipoprotéines impliquées dans les dyslipidémies.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

N-Substituted arylsulfonamide building blocks as alternative submonomers for peptoid synthesis

Peptoids (oligo N-substituted glycines) are peptidomimetic oligomers showing attractive structural and pharmacological properties. The efficiency of their synthesis has prompted the use of peptoids in combinatorial libraries. To increase the chemical diversity accessible in peptoid design and libraries, we demonstrate here that N-substituted o-nitrobenzenesulfonamide derivatives can be used as alternative building blocks in the synthesis of peptoids by the submonomer approach. The preparation of N,O-protected amino alcohol submonomers and the conditions for their incorporation into peptoid oligomers are reported. The described method is compatible with the submonomer approach and was applied to prepare peptoid oligomers bearing different hydroxylated side chains.Keywords : Peptoids; Peptidomimetics; Solid-phase synthesis; Nitrobenzenesulfonamide

Motion de M. Barnave pour l'ajournement de la discussion sur les postes, lors de la séance du 9 juillet 1790

Biron Armand-Louis de Gontaut, duc de, Barnave Antoine. Motion de M. Barnave pour l'ajournement de la discussion sur les postes, lors de la séance du 9 juillet 1790. In: Archives Parlementaires de 1787 à 1860 - Première série (1787-1799) Tome XVII - Du 9 juillet au 12 aout 1790. Paris : Librairie Administrative P. Dupont, 1884. p. 12

Preparation of N-substituted N-arylsulfonylglycines and their use in peptoid synthesis

To increase the chemical diversity accessible with peptoids and peptide-peptoid hybrids, N-alkylated arylsulfonamides were used to prepare side chain protected N-substituted glycines compatible with solid-phase synthesis. The described procedures give access to peptoid monomers bearing a wide variety of functional groups from commercially available amines in four straightforward steps. The prepared N-substituted N-arylsulfonylglycines were used as monomers in solid-phase synthesis to introduce relevant functionalized side chains into peptoid oligomers and peptide-peptoid hybrids

Actuator line method for ducted fan applications

An Actuator Line Method (ALM) based on integral velocity sampling is developed for application to ducted fans. In this work, the lifting surface is replaced by momentum source terms in the unsteady Reynolds-averaged Navier-Stokes equations. The source terms are computed at discrete locations along the blade’s span before being spread on the mesh using a nonisotropic Gaussian kernel allowing the source terms distribution to mimic the geometrical attributes of the blade at that location. The determination of the local effective freestream vector, a common difficulty of ALM approaches, is done with an integral velocity sampling that accounts for the blade’s local induced velocity. Including the projection function in the computation of the effective freestream velocity vector makes the formulation more general and removes the ambiguity surrounding the determination of the local velocity. The method is first validated against experimental data from Caradonna & Tung [1] for the open rotor case, and the influence of the nonisotropic Gaussian kernel parameters on the solution is then presented. The appropriateness of the method when applied to ducted geometries is validated against experimental data from wind tunnel testing of a ducted fan and against blade-resolved CFD. The results obtained for the ducted geometry show that the ALM is able to account for the presence of the duct, but that the effective expansion ratio of the duct in the ALM simulations is smaller than its blade-resolved equivalent

Glass Atmospheric Alteration: Cultural Heritage, Industrial and Nuclear Glasses,

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