The “Health Benefit Basket” in France

The French “Health Benefit Basket” is defined principally by positive lists of reimbursed goods and services; however, global budget-financed hospital-delivered services are more implicitly defined. The range of reimbursable curative care services is defined by two coexisting positive lists/fee schedules: the Classification Commune des Actes Médicaux (CCAM) and the Nomenclature Générale des Actes Professionnels (NGAP). The National Union of Health Insurance Funds has been updating these positive lists since August 2004, with the main criterion for inclusion being the proposed procedure’s effectiveness. This is assessed by the newly created High Health authority (replacing the former ANAES). In addition, complementary health insurers are consulted in the inclusion process due to their important role in French healthcare financing

Detection of Phase Jumps of Free Core Nutation of the Earth and their Concurrence with Geomagnetic Jerks

We detected phase jumps of the Free Core Nutation (FCN) of the Earth directly from the analysis of the Very Long Baseline Interferometer (VLBI) observation of the Earth rotation for the period 1984-2003 by applying the Weighted Wavelet Z-Transform (WWZ) method and the Short-time Periodogram with the Gabor function (SPG) method. During the period, the FCN had two significant phase jumps in 1992 and 1998. These epochs coincide with the reported occurrence of geomagnetic jerks.Comment: 8 pages, 4 figure

Algorithmes du module constant en filtrage adaptatif : impact des progrès récents

Les avancées importantes obtenues récemment sur les algorithmes du module constant permettent de mieux cerner leur fonctionnement et leurs performances. Ces résultats sont rappelés et leur impact est analysé sur deux problèmes critiques pour les applications que sont les minima locaux et l'initialisation. Une approche est proposée pour l'initialisation, en relation avec le choix du retard appliqué au signal de référence dans l'algorithme de minimisation de l'erreur quadratique moyenne

Transversal adaptive filtering

This paper presents a tutorial on the gradient (G) and recursive least squares (RLS) algorithme, both commonly used in adaptive transversal filters for estimating a linear model . It is shown how the algorithms utilize recursivity ta realize at the saine time the averaging involved in the optimisation criterion as well as the minimization. In steady state both algorithms can be viewed as minimizing the saure mean square error criterion. Then they have equivalent performances : the saure residual fluctuations up to an equivalence between the adaptation step-size t of (G) and the forgetting rate (1-w) of (RLS) . Due to the criterion itself emphasizing adaptation speed, it is the transient period which exhibits the (RLS) superiority . This is essentially at the price of a four times higher complexity and of difficulties with controling numerical effects, related (in part) to the presence of divisions that are not in (G) . A general methodology for decoupling the transient effects and permanent fluctuations is given ; the latter are due to the measurement noise disturbing the model . The more general problem of tracking the model variations is treated with that methodology and we emphasize the différence between the problems of tracking and of squeezing the transient period for a fixed model : the corresponding adaptation step-sizes differ significantly .Synthèse sur les algorithmes du gradient et des moindres carrés rapides. En régime permanent, ils ont des performances équivalentes. C'est en régime transitoire que les moindres carrés sont supérieurs; ceci au prix d'une complexité environ quatre fois supérieure et de difficultés de contrôle des variables numérique

Synchronisation de symbole et de chip dans le domaine fréquentiel pour les systèmes DS-CDMA et MC-CDMA

L'approche fréquentielle proposée conduit à des techniques simples et efficaces pour la synchronisation des symboles et des chips, applicable aux systèmes DS-CDMA et MC-CDMA. La technique de synchronisation des symboles présente une variance élevée et une non linéarité autour de la position du synchronisme de chip et doit être complétée. Les performances obtenues avec la méthode complémentaire proposée pour la synchronisation de chip sont équivalentes à celles de la technique Millier & Mueller Detector, et ainsi, la technique permet un traitement au débit de chip et non au double comme la méthode « early-late gate »

Restoration of NK Cell Cytotoxic Function With Elotuzumab and Daratumumab Promotes Elimination of Circulating Plasma Cells in Patients With SLE.

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease characterized by multiple cellular and molecular dysfunctions of the innate and adaptive immunity. Cytotoxic function of NK cells is compromised in patients with SLE. Herein, we characterized the phenotypic alterations of SLE NK cells in a comprehensive manner to further delineate the mechanisms underlying the cytotoxic dysfunction of SLE NK cells and identify novel potential therapeutic targets. Therefore, we examined PBMC from SLE patients and matched healthy controls by single-cell mass cytometry to assess the phenotype of NK cells. In addition, we evaluated the cell function of NK cells (degranulation and cytokine production) and the killing of B cell subpopulations in a B cell-NK cell in vitro co-culture model. We found that SLE NK cells expressed higher levels of CD38 and were not able to adequately upregulate SLAMF1 and SLAMF7 following activation. In addition, ligation of SLAMF7 with elotuzumab or of CD38 with daratumumab on SLE NK cells enhanced degranulation of both healthy and SLE NK cells and primed them to kill circulating plasma cells in an in vitro co-culture system. Overall, our data indicated that dysregulated expression of CD38, SLAMF1 and SLAMF7 on SLE NK cells is associated with an altered interplay between SLE NK cells and plasma cells, thus suggesting their contribution to the accumulation of (auto)antibody producing cells. Accordingly, targeting SLAMF7 and CD38 may represent novel therapeutic approaches in SLE by enhancing NK cell function and promoting elimination of circulating plasma cell

Tectonic Regime as a Control Factor for Crustal Fault Zone (CFZ) Geothermal Reservoir in an Amagmatic System: A 3D Dynamic Numerical Modeling Approach

Crustal fault zones provide interesting geological targets for high-temperature geothermal energy source in naturally deep-fractured basement areas. Field and laboratory studies have shown the ability of these systems to let fluid flow down to the brittle–ductile transition. However, several key questions about exploration still exist, in particular the fundamental effect of tectonic regimes on fluid flow in fractured basement domains. Based on poro-elasticity assumption, we considered an idealized 3D geometry and realistic physical properties. We examined a model with no tectonic regime (benchmark experiment) and a model with different tectonic regimes, namely a compressional, an extensional and a strike-slip tectonic regime. Compared to the benchmark experiment, the results demonstrate that different tectonic regimes cause pressure changes in the fault/basement system. The tectonic-induced pressure changes affect convective patterns, onset of convection as well as the spatial extent of thermal plumes and the intensity of temperature anomalies. Driven by poro-elastic forces, temperature anomalies around vertical faults in a strike-slip tectonic regime have a spatial extent that should be considered in preliminary exploratory phases

Optimization of cw sodium laser guide star efficiency

Context: Sodium laser guide stars (LGS) are about to enter a new range of laser powers. Previous theoretical and numerical methods are inadequate for accurate computations of the return flux and hence for the design of the next-generation LGS systems. Aims: We numerically optimize the cw (continuous wave) laser format, in particular the light polarization and spectrum. Methods: Using Bloch equations, we simulate the mesospheric sodium atoms, including Doppler broadening, saturation, collisional relaxation, Larmor precession, and recoil, taking into account all 24 sodium hyperfine states and on the order of 100 velocity groups. Results: LGS return flux is limited by "three evils": Larmor precession due to the geomagnetic field, atomic recoil due to radiation pressure, and transition saturation. We study their impacts and show that the return flux can be boosted by repumping (simultaneous excitation of the sodium D2a and D2b lines with 10-20% of the laser power in the latter). Conclusions: We strongly recommend the use of circularly polarized lasers and repumping. As a rule of thumb, the bandwidth of laser radiation in MHz (at each line) should approximately equal the launched laser power in Watts divided by six, assuming a diffraction-limited spot size.Comment: 15 pages, 12 figures, to be published in Astronomy & Astrophysics, AA/2009/1310

SLAMF Receptor Expression Identifies an Immune Signature That Characterizes Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown etiology, linked to alterations in both the innate and the adaptive immune system. Due to the heterogeneity of the clinical presentation, the diagnosis of SLE remains complicated and is often made years after the first symptoms manifest, delaying treatment, and worsening the prognosis. Several studies have shown that signaling lymphocytic activation molecule family (SLAMF) receptors are aberrantly expressed and dysfunctional in SLE immune cells, contributing to the altered cellular function observed in these patients. The aim of this study was to determine whether altered co-/expression of SLAMF receptors on peripheral blood mononuclear cells (PBMC) identifies SLE characteristic cell populations. To this end, single cell mass cytometry and bioinformatic analysis were exploited to compare SLE patients to healthy and autoimmune diseases controls. First, the expression of each SLAMF receptor on all PBMC populations was investigated. We observed that SLAMF1+ B cells (referred to as SLEB1) were increased in SLE compared to controls. Furthermore, the frequency of SLAMF4+ monocytes and SLAMF4+ NK were inversely correlated with disease activity, whereas the frequency SLAMF1+ CD4+ TDEM cells were directly correlated with disease activity. Consensus clustering analysis identified two cell clusters that presented significantly increased frequency in SLE compared to controls: switch memory B cells expressing SLAMF1, SLAMF3, SLAMF5, SLAMF6 (referred to as SLESMB) and circulating T follicular helper cells expressing the same SLAMF receptors (referred to as SLEcTFH). Finally, the robustness of the identified cell populations as biomarkers for SLE was evaluated through ROC curve analysis. The combined measurement of SLEcTFH and SLEB1 or SLESMB cells identified SLE patients in 90% of cases. In conclusion, this study identified an immune signature for SLE based on the expression of SLAMF receptors on PBMC, further highlighting the involvement of SLAMF receptors in the pathogenesis of SLE