X-ray diffraction as a tool for the determination of the structure of double-walled carbon nanotube batches

The average structure of double-walled carbon nanotube DWCNT samples can be determined by x-ray diffraction XRD. We present a formalism that allows XRD patterns of DWCNTs to be simulated and we give researchers the tools needed to perform these calculations themselves. Simulations of XRD patterns within this formalism are compared to experimental data obtained on two different DWCNT samples, produced by chemical vapor deposition or by peapod conversion i.e., high-temperature peapod annealing. For each sample, we are able to determine structural aspects such as the number of walls, the diameter distribution of inner and outer tubes, the intertube spacing, and the bundled structure

Démarche qualité et accompagnement des soins aux usagers de drogues - DEQUASUD:Rapport OFDT, REES

De par son objet et de par la méthodologie employée, l'étude DEQUASUD (DEmarche QUalité et Accompagnement des Soins aux Usagers de Drogues) constitue une première en France. S'attachant à évaluer la satisfaction retirée par les usagers de drogues et les médecins d'une prise en charge dans les cabinets de médecine générale du Réseau Micro-Structures d'Alsace (RMS) comparativement à la médecine générale classique, l'étude a aussi tenu compte des dépenses générées par ces deux stratégies d'accompagnement.Cette étude coût-utilité multi-critères multi-agents permet ainsi de rendre compte de la supériorité, en terme de coût-utilité, d'une prise en charge psycho-socio-sanitaire proposée par les micro-structures alsaciennes par rapport aux cabinets conventionnels. [Résumé de l'éditeur

Drotrecogin Alfa's Impact on Intensive Care Workload in Real Life Practice: A Propensity Score Approach

ABSTRACT Objectives: To estimate the impact of drotrecogin alfa (DA) on intensive care workload in an observational study while illustrating the use of propensity score (PS) matching to control for recruitment bias. Methods: PREMISS is a prospective, multicenter pre-post study. Its goal was to evaluate DA in the treatment of severe sepsis with multiple organ failure. Inclusions took place before (control patients) and after (DA-treated patients) the drug's market authorization. Workload was measured in euros using the French classification of medical procedures. It was compared between the groups via random effects gamma regression using two techniques: 1) regression adjusting for the patients' initial characteristics on the whole population; and 2) PS matching. A structural equation model was used to explore the pathways leading to a workload increase. Results: Drotrecogin alfa is estimated to increase intensive care unit (ICU) workload by 20% (P = 0.045) according to the multivariate model and 34% (P = 0.002) according to the PS-matched one. In the structural equation model fitted, only DA's direct effect on the occurrence of bleeding events reaches significance (P = 0.024). Conclusions: We found a significant effect of DA on ICU workload with both standard methods of adjustment and PS matching. This effect appears to be mainly due to DA's effect on bleeding events. The analysis illustrated the usefulness of PS methods in the analysis of observational data, as it leads to conclusions similar to the traditional multivariate regression approaches while avoiding making too many adjustments, allowing focusing on the treatment effect

La médecine libérale a-t-elle jamais existé ?

In a decentralised economy, prices serve two purposes : to generate revenue and to allocate resources. However the two sides of the same coin have been separated in social security systems. On the one hand, the revenue from health insurance no longer reflects the actual cost of health services provisions. On the other hand, expenditure does not reflect marginal benefits of these services. There is no limits to the greeds of the users and the blindness of the decision makers. Freedom of choice, in effect corresponds to the right to ignore the financial implications of the decision taken. The purpose of this article is to see how this principle was introduced and whose interest it serves.Le rôle des prix dans un système d'économie décentralisée est double : c'est un instrument de recouvrement des dépenses engagées, c'est une modalité de commande de l'affectation des ressources. Or, en matière de protection sociale, ces deux faces d'une même pièce ont été dissociées. Les recettes de l'assurance maladie ont cessé de refléter le coût de la fourniture des soins. Les dépenses de l'assurance maladie, c'est-à-dire les recettes des établissements et les revenus des médecins, ont été dissociées de la valeur du service rendu. Un tel système rend les usagers boulimiques et les décideurs aveugles. Le libre choix en matière de soins correspond en définitive au droit de décider sans prendre en compte les conséquences financières de ses actes. L'objet de cette étude est de voir comment et au bénéfice de qui un tel principe a été introduit.J. Launois Robert. La médecine libérale a-t-elle jamais existé ?. In: Politiques et management public, vol. 3, n° 4, 1985. Numéro spécial - Innovations et régulations dans les systèmes de santé (France - USA) (Numéro préparé par Emile Lévy et Béatrice Majnoni d'Intignano) sous la direction de Emile Lévy et Béatrice Majnoni d'Intignano. pp. 87-97

Cost-effectiveness analysis of rifaximin-α administration for the reduction of episodes of overt hepatic encephalopathy in recurrence compared with standard treatment in France

Background: Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome that occurs most often in a context of acute or chronic liver disease. Despite the seriousness of the pathology, only a few treatments have been developed for improving its management. Rifaximin-α is the first treatment that has been clinically developed for overt HE (OHE) episodes. Recent results of clinical studies demonstrated its significant improvement in the health-related quality of life. The objective of the current study was to estimate the long-term cost-effectiveness of rifaximin-α used in combination with lactulose compared with lactulose monotherapy in cirrhotic patients, who have experienced at least two prior OHE events. Methods: A Markov model was used to estimate rifaximin-α cost-effectiveness, evaluating it from the perspective of all contributors as recommended by French health technology assessment guidelines. Costs were based on current French treatment practices. The transition between health states was based on the reanalysis of the rifaximin-α pivotal clinical trials RFHE3001 and RFHE3002. The main outcome of the model was cost per quality adjusted life year (QALY). Results: The results indicate that rifaximin-α is a cost-effective treatment option with an incremental cost per QALY gained of €19,187 and €18,517 over two different time horizons (2 and 5 years). The robustness of the model was studied using probabilistic sensitivity analysis. Conclusion: For the societal willingness to pay threshold of €27,000 per QALY gained, rifaximin-α in combination with lactulose is a cost-effective and affordable treatment for patients who have experienced at least two prior overt HE episodes