Governance traditions and narratives of public sector reform in contemporary France.

This article explores the basic traditions of governance in contemporary France and the narratives of public sector reform associated with them. It should be stressed right from the outset that this article does not aim to describe the set of public sector reforms that have been implemented in France in the last ten years or so. Instead, the aim is to demonstrate the similarities and differences between the narratives of the left and the right with regard to these reforms and to show how these narratives help to explain the types of reform that have been enacted. The basic argument is that there is a certain commonality to both the left and the right with regard to their narratives of public sector reform. At the same time, though, there are differences of emphasis both within each tradition and between the two main traditions themselves. Except where indicated, all translations are the author's own

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Design and Dimensioning of Survivable SDH/SONET Networks

The planning of telecommunications networks raises various combinatorial optimization problems related to network design, routing of demands, multiplexing, etc. We provide in this paper an overview of such problems and a synthesis of the related literature, while introducing the field to non expert readers from both the operations research and telecommunications communities

Self-emulsifying drug delivery system developed by the HLB-RSM approach: Characterization by transmission electron microscopy and pharmacokinetic study

International audienceRecently, we developed a new approach to rationalize an optimized design for self-emulsifying drug delivery system (SEDDS) by introducing the HLB and the response surface as determinant factors in SEDDS development. The aim of this current paper is to assess the suitability of this HLB-RSM approach to enhance the oral bioavailability of BCS class II compounds using fenofibrate as drug model. Eight SEDDS formulations (I -> VIII) were pre-selected regarding their self-emulsification capacity and their effect on increasing in vitro drug release. They were firstly evaluated for their thermodynamic stability and zeta potential. Unstable SEDDS were discarded meanwhile the structural morphology of the stable ones (I, VI and VIII) was characterized using transmission electron microscopy (TEM). A pharmacokinetic study was then undertaken on male BALB/cJRj mices. The in vivo results showed a significant increase of fenofibrate absorption for all the three stable SEDDS formulations compared to the commercialized form, (LIPANTHYL micronized (R) (p < 0.05)). The highest enhancement was recorded for SEDDS I, where AUC and C-max values respectively increased by 2 and 4.4 folds. This justifies the fact that HLB-RSM approach could be considered as a promising method for the development of efficient and highly stable SEDDS aiming to increase the poor bioavailability of BCS class II molecules. (C) 2015 Elsevier B.V. All rights reserved

Conception of nanosized hybrid liposome/poloxamer particles to thicken the interior core of liposomes and delay hydrophilic drug delivery

International audienceLiposomes are nanocarriers composed of phospholipids, especially designed to potentially carry drugs. However, liposomes suffer in terms of leakage of small hydrophilic drugs. To control the release, a system with lipid shell and polymeric viscous core, namely Hybrid liposome/polymer inside (HLPin), has been designed. For this purpose, we setup a syringe pump apparatus equipped with homemade tubing system. HLPin formulation consisting of poloxamer (5% w/v) was found to be optimal when produced at injection rates of 5 mL. min(-1). Then, we tend to characterize the HLPin with DLS, TEM, TRPS, thermal analysis and densitometry in comparison with a polymer added after formation of the liposomes. The optimal formulation was evaluated for its stability and cytotoxicity. The selected conditions and composition resulted in nanocarriers which are highly reproducible with mono-disperse size distribution with an average size of 206 +/- 4.8 nm and a polydispersity index of 0.15 +/- 0.015. Densitometry and thermal analysis results confirmed the formation of HLPin. Interestingly, HLPin were stable over 2 months, produced no cytotoxicity and exhibited slow release of rhodamine and Doxorubicin in comparison to liposome formulation. Our homemade tubing system coupled with syringe pump apparatus achieved reproducible, precisely controlled production for the HLPin formulation which can be scale up

Aminoglycosides in Immunocompromised Critically Ill Patients With Bacterial Pneumonia and Septic Shock: A Post-Hoc Analysis of a Prospective Multicenter Multinational Cohort

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Multicentric evaluation of the impact of central tumour location when comparing rates of N1 upstaging in patients undergoing video-assisted and open surgery for clinical Stage I non-small-cell lung cancer

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