Effect of a French Experiment of Team Work between General Practitioners and Nurses on Efficacy and Cost of Type 2 Diabetes Patients Care

This study aims to assess the efficacy and the cost of a French team work experiment between nurses and GPs for the managing of type 2 diabetes patients. Our study was based on a case control study design in which we compare the evolution of process (standard follow-up procedures) and final outcomes (glycemic control), and the evolution of cost. The study is realized for two consecutive periods between type 2 diabetes patients followed within the team work experiment (intervention group) or by "standard" GPs (controlled group). After 11 months of follow-up, we showed that patients in the intervention group, compared with those in the controlled group, have more chances to remain or to become: correctly followed-up (with OR comprise between 2.1 to 6.8, pPrimary health care, Diabetes mellitus, Health care team, Comparative study, Outcome and process assessment, Cost analysis

Metabolic counterparts of sodium accumulation in multiple sclerosis: A whole brain 23Na-MRI and fast 1H-MRSI study

Increase of brain total sodium concentrations (TSC) is present in multiple sclerosis (MS), but its pathological involvement has not been assessed yet. To determine in vivo the metabolic counterpart of brain sodium accumulation. Whole brain Na-MR imaging and 3D- H-EPSI data were collected in 21 relapsing-remitting multiple sclerosis (RRMS) patients and 20 volunteers. Metabolites and sodium levels were extracted from several regions of grey matter (GM), normal-appearing white matter (NAWM) and white matter (WM) T lesions. Metabolic and ionic levels expressed as Z-scores have been averaged over the different compartments and used to explain sodium accumulations through stepwise regression models. MS patients showed significant Na accumulations with lower choline and glutamate-glutamine (Glx) levels in GM; Na accumulations with lower N-acetyl aspartate (NAA), Glx levels and higher Myo-Inositol (m-Ins) in NAWM; and higher Na, m-Ins levels with lower NAA in WM T lesions. Regression models showed associations of TSC increase with reduced NAA in GM, NAWM and T lesions, as well as higher total-creatine, and smaller decrease of m-Ins in T lesions. GM Glx levels were associated with clinical scores. Increase of TSC in RRMS is mainly related to neuronal mitochondrial dysfunction while dysfunction of neuro-glial interactions within GM is linked to clinical scores

The making heritage of "grands sites" : evolution of doctrines and transformation of lands : example of the symbolic Britanny littoral headlands

Cette thèse s’inscrit dans une perspective compréhensive des processus de patrimonialisation de grands sites naturels bretons, de leur découverte à leur réhabilitation, ici la pointe du Raz, le cap Fréhel et la côte sauvage de Quiberon. Ces promontoires littoraux, objets inventés au 19e siècle, sont devenus au fil du temps des supports d’oeuvres littéraires et picturales, d’introspection et de fascination exercée par la puissance des éléments marins. Ces lieux ont accueilli depuis les années 1950 des fréquentations touristiques de plus en plus importantes, ayant provoqué des phénomènes de mise à nu des sols, que l’administration de l’Environnement a jugé menaçants pour leur intégrité. Il y a une trentaine d’années, elle a donc décliné une politique de réhabilitation dont la matérialisation principale fut la conduite d’‘Opérations Grands Sites’. De quelle manière ces projets de réhabilitation sont-ils menés et selon quelles doctrines ? Comment prennent-ils en compte les différents usages et valeurs attribuées à ces patrimoines ? Cette thèse analyse les aménagements, désaménagements et réaménagements de ces sites, l’imbrication de la montée de la doctrine écologique et des jeux d’acteurs qui s’y développent, et, interroge leur incidence sur le patrimoine et les modalités de son appropriation, ce que nous appelons le processus de patrimonialisation. La première partie retrace la patrimonialisation des grands sites naturels emblématiques de France, leur invention (chapitre 1), les politiques publiques mises en place en vue de leur protection (chapitre 2 et 3), et se focalise sur nos terrains d’étude (chapitre 4). La seconde partie montre les évolutions du cadre doctrinal, organisationnel et normatif de l’action publique, favorisant la protection de l’environnement et l’aménagement touristique. Elle montre le renouvellement des principes d’action publique (chapitre 5) et les transformations des espaces induites par les doctrines et les jeux d’acteurs (chapitre 6 et 7). Enfin, la troisième partie aborde les effets de ces réhabilitations sur le patrimoine et le processus de patrimonialisation contemporains (chapitre 8 et 9) et propose une réflexion sur la dimension normative des opérations de réhabilitation : nous démontrons qu’elles sont constitutives du processus de patrimonialisation.This work analyzes in a comprehensive perspective the heritage making of the Brittanygreat sites, namely the point of Raz, the cape of Fréhel and the wild coast of Quiberon. These coastal headlands, objects invented in 19th century, became over time supports of literary and pictorial works, of introspection and fascination exercised by the power of the marine elements. Since the 1950s, aincrease of tourist attendances has led to the degradation of their ecosystems, that the administration of the Environment considered that’s a threat for their integrity. Thirty years ago, this administration introduced a policy of rehabilitation the main realization of which was the conduct of « Opérations Grands Sites ». How are these projects of rehabilitation led and according to which doctrines? How dothey take into account the various uses and the values attributed to these heritages? This thesis analyzes the land planning, dis-planning and re-planning of these sites, the rise of the ecological doctrine and stakeholders' interactions and questions their incidence about the heritage and the modalities of its appropriation, that we call the process of heritage making. The first part redraws the heritage making of the big symbolic natural sites of France, their invention (chapter 1), the public policies creation with the purpose of their protection (chapter 2 and3), and a more precisely a focus on our study fields (chapter 4). The second part shows the evolutionsof the doctrinal, organizational and normative dimension of the public action, favoring the environmental protection and the tourist development. It shows the renewal of the principles of publicaction (chapter 5) and the transformations of the spaces, which it led from stakeholders' interactions in presence (chapter 6 and 7). Finally, the third part approaches the effects of these rehabilitations on contemporary heritage and process of heritage making (chapter 8 and 9) and proposes a reflection on the normative dimension of the operations of rehabilitation. We make the demonstration that they area part of the process of heritage making

La patrimonialisation des grands sites : évolution des doctrines et transformation des espaces : exemple des promontoires littoraux emblématiques bretons

This work analyzes in a comprehensive perspective the heritage making of the Brittanygreat sites, namely the point of Raz, the cape of Fréhel and the wild coast of Quiberon. These coastal headlands, objects invented in 19th century, became over time supports of literary and pictorial works, of introspection and fascination exercised by the power of the marine elements. Since the 1950s, aincrease of tourist attendances has led to the degradation of their ecosystems, that the administration of the Environment considered that’s a threat for their integrity. Thirty years ago, this administration introduced a policy of rehabilitation the main realization of which was the conduct of « Opérations Grands Sites ». How are these projects of rehabilitation led and according to which doctrines? How dothey take into account the various uses and the values attributed to these heritages? This thesis analyzes the land planning, dis-planning and re-planning of these sites, the rise of the ecological doctrine and stakeholders' interactions and questions their incidence about the heritage and the modalities of its appropriation, that we call the process of heritage making. The first part redraws the heritage making of the big symbolic natural sites of France, their invention (chapter 1), the public policies creation with the purpose of their protection (chapter 2 and3), and a more precisely a focus on our study fields (chapter 4). The second part shows the evolutionsof the doctrinal, organizational and normative dimension of the public action, favoring the environmental protection and the tourist development. It shows the renewal of the principles of publicaction (chapter 5) and the transformations of the spaces, which it led from stakeholders' interactions in presence (chapter 6 and 7). Finally, the third part approaches the effects of these rehabilitations on contemporary heritage and process of heritage making (chapter 8 and 9) and proposes a reflection on the normative dimension of the operations of rehabilitation. We make the demonstration that they area part of the process of heritage making.Cette thèse s’inscrit dans une perspective compréhensive des processus de patrimonialisation de grands sites naturels bretons, de leur découverte à leur réhabilitation, ici la pointe du Raz, le cap Fréhel et la côte sauvage de Quiberon. Ces promontoires littoraux, objets inventés au 19e siècle, sont devenus au fil du temps des supports d’oeuvres littéraires et picturales, d’introspection et de fascination exercée par la puissance des éléments marins. Ces lieux ont accueilli depuis les années 1950 des fréquentations touristiques de plus en plus importantes, ayant provoqué des phénomènes de mise à nu des sols, que l’administration de l’Environnement a jugé menaçants pour leur intégrité. Il y a une trentaine d’années, elle a donc décliné une politique de réhabilitation dont la matérialisation principale fut la conduite d’‘Opérations Grands Sites’. De quelle manière ces projets de réhabilitation sont-ils menés et selon quelles doctrines ? Comment prennent-ils en compte les différents usages et valeurs attribuées à ces patrimoines ? Cette thèse analyse les aménagements, désaménagements et réaménagements de ces sites, l’imbrication de la montée de la doctrine écologique et des jeux d’acteurs qui s’y développent, et, interroge leur incidence sur le patrimoine et les modalités de son appropriation, ce que nous appelons le processus de patrimonialisation. La première partie retrace la patrimonialisation des grands sites naturels emblématiques de France, leur invention (chapitre 1), les politiques publiques mises en place en vue de leur protection (chapitre 2 et 3), et se focalise sur nos terrains d’étude (chapitre 4). La seconde partie montre les évolutions du cadre doctrinal, organisationnel et normatif de l’action publique, favorisant la protection de l’environnement et l’aménagement touristique. Elle montre le renouvellement des principes d’action publique (chapitre 5) et les transformations des espaces induites par les doctrines et les jeux d’acteurs (chapitre 6 et 7). Enfin, la troisième partie aborde les effets de ces réhabilitations sur le patrimoine et le processus de patrimonialisation contemporains (chapitre 8 et 9) et propose une réflexion sur la dimension normative des opérations de réhabilitation : nous démontrons qu’elles sont constitutives du processus de patrimonialisation

Révélation analytique d'une étude bibliographique France - U.S.A. sur la décennie 1975-1985

Les auteurs ont dépouillé dix années de travaux d'orthodontie parus dans certains périodiques spécialisés et analysent puis comparent leurs résultats les plus significatifs

Hemi-spectrum substitution after water signal fitting (HESWAF): an improvement of the modulus post-processing of MR spectra

International audienceOBJECTIVE: In a previous study, we have shown that modulus post-processing is a simple and efficient tool to both phase correct and frequency align magnetic resonance (MR) spectra automatically. Furthermore, this technique also eliminates sidebands and phase distortions. The advantages of the modulus technique have been illustrated in several applications to brain proton MR spectroscopy. Two possible drawbacks have also been pointed out. The first one is the theoretical decrease in signal-to-noise ratio (SNR) by a factor up to √2 when comparing the spectrum obtained after modulus versus conventional post-processing. The second pitfall results from the symmetrization of the spectrum induced by modulus post-processing, since any resonance or artifact located at the left of the water resonance is duplicated at the right of the water resonance, thus contaminating the region of the spectrum containing the resonances of interest. Herein, we propose a strategy in order to eliminate these two limitations. MATERIALS AND METHODS: Concerning the SNR issue, two complementary approaches are presented here. The first is based on the application of modulus post-processing before spatial apodization, and the second consists in substituting the left half of the spectrum by the fit of the water resonance before applying modulus post-processing. The symmetrization induced by modulus post-processing then combines the right half of the original spectrum containing the resonances of interest with the left half of the water fit, free of noise and artifacts. Consequently, the SNR is improved when compared to modulus post-processing alone. As a bonus, any artifact or resonance present in the left half of the original spectrum is removed. This solves the second limitation. RESULTS: After validation of the technique on simulations, we demonstrated that this improvement of the modulus technique is significantly advantageous for both in vitro and in vivo applications. CONCLUSION: By improving the SNR of the spectra and eliminating eventual contaminations, the new strategies proposed here confer an additional competitive advantage to the modulus post-processing technique

Frequently Asked Questions in Corporate Finance

International audienceThe definitive question and answer guide to understanding corporate finance From the team behind the popular corporate finance website, Vernimmen.com comes a concise guide to the subject, presented in an easy-to-use, highly accessible "question and answer" format. An essential reference for students of corporate finance and practising corporate financiers alike, Frequently Asked Questions in Corporate Finance answers key questions in financial engineering, valuation, financial policy, cost of capital, financial analysis, and financial management. Covering both the theory and practice of corporate finance, the book demonstrates how financial theory can be put to use solving practical problems. •What advantages are there to a business looking to spin off its divisions into subsidiaries? •Is there a formula that can be used to determine the change in normalised free cash flows? •What are the possible reasons behind a share buyback? What are the pros and cons of off-market share buy-back? Filled with the answers to all of the most common, and not so common, questions about corporate finance, the book presents authoritative, reliable information from a respected team of experts from the banking, corporate, and academic worlds.<br/