Which Capital Growth Index for the Paris Residential Market?

In this paper we address the issue of measuring price performance for the Paris residential market. Our main focus is on choosing the appropiate index or indices capable of efficiently capturing capital growth, capital risk, and identifying the main risk factors inherent in this specific market.We identifying three existing indices but show that they may not be completely appropriate to address our main goals. We therefore construct two complementary repeat sales indices: a Case & Shiller (1987) Weighted Repeat sales (WRS) index and a Factorial index using the Baroni, Barthélémy & Mokhrane (2001) approach. We use the CD-BIEN database that contains more than 220 000 repeta sales transactions for residential properties in Paris area covering the period 1983-2001 period.We estimate these two indices for the Paris and close surrounding area and compare them to different existing indices: (I) the square metre index provides by the Chambre des Notaires de Paris and INSEE, (II) the IDP indices, (III) the listed real estate index. OUR conclusions yield interesting implications concerning real estate risk and suggest the construction of jointly using the repeat sales and the factorial approachesReal estate indexes; valuation-based index; repaet sales; risk factors

A repeat sales index robust to small datasets

As suggested by D. Geltner, commercial properties indices have to be built using repeat sales instead of hedonic indices. The repeat sales method is a means of constructing real estate price indices based on a repeated observation of property transactions. These indices may be used as benchmarks for real estate portfolio managers. But the investors in general are also interested in introducing real estate performance in their portfolio to enhance the efficient frontier. Thus, expected return and volatility are the two key parameters. To create and to improve contracts on real estate indices, trend and volatility of these indices must be robust regarding to the periodicity of the index and the volume of transactions. This paper aims to test the robustness of the trend and volatility estimations for two indices: the classical Weighted Repeat Sales (Case & Shiller 1987) and a PCA factorial index (Baroni, Barthélémy and Mokrane 2007). The estimations are computed from a dataset of Paris commercial properties. The main findings are the trend and volatility estimates are biased for the WRS index and not for the PCA factorial index when the periodicity increases. Consequently, the level of the index at the end of the computing period is significantly different for various periodicities in the case of the WRS index. Globally, the PCA factorial seems to be more robust to the number of transactions. Firstly, we present the two methodologies and then the dataset. Finally we test the impact of the number of transactions per period on the trend and volatility estimates for each index and we give an interpretation of the results.Repeat sales indices, Index estimations, Transactions volume

The writer\u27s journey into solitude : self-discovery in Hayy Ibn Yaqzan, Robinson Crusoe and Friday

The idea of physical solitude often implies metaphysical solitude, and it is this spiritual state of detachment or self-enclosure that usually arouses the widest range of moral responses. Physical solitude is a metaphorical focus for an attitude that relates to self and society. In my thesis, however, I am primarily interested in the concept of solitude as a vehicle facilitating a journey of inward exploration into the mystifying labyrinth of the self in search of truth. In this sense, solitude becomes a condition enabling consciousness to achieve spiritual insight and truth with respect to the nature of self and world

COVID-19 herd immunity v. learning to live with the virus

Mutations of SARS-CoV-2 have been associated with increased transmissibility and occasionally reduced sensitivity to neutralising antibody activity induced by past ancestry virus infection or current COVID-19 vaccines. Nevertheless, COVID-19 vaccines have consistently demonstrated high efficacy and effectiveness against COVID-19 severe disease, hospitalisation and death, including disease caused by designated variants of concern. In contrast, COVID-19 vaccines are more heterogeneous in reducing the risk of infection and mild COVID- 19, and are modestly effective in interrupting virus transmission. Ongoing mutations of SARS-CoV-2 resulting in increased transmissibility and relative evasion of neutralising antibody activity induced by past virus infection or COVID-19 vaccines are likely. The duration of protection induced by COVID-19 vaccines is modelled to be relatively short in protecting against infection and mild COVID-19, but is likely to be 2 - 3 years against severe disease. Current experience from the UK and Israel demonstrates that even with high levels of COVID- 19 vaccine coverage (>85% of the adult population), resurgences with new variants of concern remain a strong probability. Nevertheless, such resurgences are not mirrored by high rates of hospitalisation and death compared with what was experienced in relatively COVID-19 vaccine-naive populations. Even though COVID-19 vaccines are unlikely to result in a herd immunity state, their ability to protect against severe COVID-19 and death could allow for a return to normalcy once a large enough proportion of the adult population in a country has been vaccinated

A cohort study evaluating the efficacy and safety of vedolizumab for patients, refractory to anti-TNF-α treatment in inflammatory bowel disease

Inflammatory bowel disease (IBD) is a chronic illness and is considered as one of the most challenging gastrointestinal diseases to manage. IBD involves both Crohn’s disease (CD) and ulcerative colitis (UC). The disease manifests by bouts of relapse and remission. Management approaches introduced over the years are still inadequate and induce a distinct response in individual patients. Such approaches focus mainly on controlling inflammation, employing a broad-spectrum of anti-inflammatory drugs or immunosuppressants agents as well as biologicals. Surgical intervention becomes necessary if the pharmacological treatment fails and disease-associated complications occur. Novel IBD treatments shift towards early therapeutic intervention to eliminate inflammation to prevent disease-related symptoms. Recent studies revealed that early use of the biological agents, which are also known as antibodies targeting tumor necrosis factor alpha (TNF-α-AB), can improve clinical outcomes by halting the development of the disease. Nonetheless, the efficacy of TNF-α-AB varies; approximately 10–30% of patients were found to be non-responsive to the initial therapy (primary non-response/PNR) and around 23–46% of patients became resistant to treatment over time and required an increased dosage (secondary loss of response/LOR). A higher dosage of medication might induce side-effects and/or a further LOR, leading to a discontinuation of the treatment. Therefore, new agents which mediate the immune response through directly targeting the intestinal mucosa with the help of the effector T-lymphocytes have been introduced. Vedolizumab (VDZ, targets α4β7 integrin), which received approval in 2014 for the management for both UC and CD, is such an agent. Nonetheless, data as far as mid-to long-term results are concerned is still limited. The aim of this study was to assess efficacy and safety of VDZ treatment of refractory IBD patients in daily clinical practice, and to evaluate the mid-to-long term outcome of these patients and their tolerance of VDZ treatment. The cohort-collected data were obtained from IBD patients who had started VDZ treatment between October 2014 and January 2016 in two academic IBD centres in Munich (Germany), the IBD Division at the University Hospital in Munich-Grosshadern and the IBD Division at the Municipal Hospital (“IsarKlinikum”). The primary end point of the study was declared as clinical remission in UC and CD patients at week 14 of treatment according to the Colitis Activity Index (CAI) and Crohn’s Disease Activity 6 Index (CDAI). The clinical response evaluation was based on C-reactive protein levels, white blood cell counts, and calprotectin levels. As part of the standardized follow-up protocol, patients were clinically assessed at baseline and after induction of VDZ treatment at weeks 2, 6 and 14. Data was collected at baseline and at week 14. Patients were followed during maintenance therapy until the end of the study. The assessment of clinical outcome together with the assessment of the IBD outcome regarding the efficacy and safety of VDZ were carried out by two senior gastroenterologists (Thomas Ochsenkühn and Fabian Schnitzler). Overall, 102 adult patients (56 with UC, 46 with CD) were enrolled in the study. All patients received VDZ as a treatment for IBD after being treated with at least one TNF-α-AB treatment. The indication for switch to VDZ treatment was either due to side effects from TNF-α-AB treatment or to being refractory to TNF-α-AB treatment. All patients received treatment according to an international-established protocol: dosage of 300 mg VDZ as an infusion over 30 minutes at baseline, repeated at week 2 and week 6 after treatment initiation, followed by 300 mg VDZ as maintenance therapy every 8 weeks. Our study showed that CD patients who were intolerant of or refractory to TNF-α-AB treatment seemed to benefit, however, not significantly, from VDZ treatment in terms of a slight improvement of clinical remission from a rate of 54.3% to 60.9%. This resulted in an achieved clinical remission of 6.6% (p=0.549). In terms of clinical response, the achieved reduction of active disease with a drop of ≥70 points of CDAI was 59.1%. Patients with UC who were intolerant or refractory to TNF-α-AB treatment seemed to significantly benefit from VDZ treatment with a considerable improvement in terms of clinical remission from a rate of 17.8% to 41.1%. This resulted in a significant achieved clinical remission of 23.3% (p<0.001). Regarding clinical response, the achieved reduction of active disease with a drop of CAI ≥ 3 points was 34.1%. In addition, among 42.1% of IBD patients who had initially received steroids as a complementary therapy, 24.5% of those patients were able to cease steroid treatment by the end of the study. We could also observe that VDZ therapy had no significant effect on C-reactive protein and white blood cell levels in either groups of patients (for CD p=0.447 and p=0.199 and for UC p=0.555 and p=0.266 respectively). On the other 7 side, Calprotectin levels were significantly decreased under VDZ treatment in UC patients (p=0.006) but not in CD patients (p=0.845). As far as medication related adverse events are concerned, only mild side effects appeared in 12.8% of all patients with malaise and headache being the most frequent of them. The presented study also provides clinical maintenance data on the treatment of refractory IBD with VDZ, with a median follow-up duration of approximately one year. VDZ showed acceptable clinical efficacy among the treatment-refractory cohort of 90 IBD patients, particularly those with UC. Most IBD patients (i.e. 87.5% of UC (n=43/49) and 85.3% of CD patients (n=35/41)) continued VDZ treatment for up one year which was the end of the follow-up. Furthermore, VDZ demonstrated a good safety profile without any severe adverse events or the need for discontinuation. In conclusion, VDZ appears to be a valuable choice in IBD patients in case of therapy failure or intolerance under TNF-α-AB treatment especially in UC patients. Further clinical studies are necessary to outline the role of VDZ treatment in daily clinical practice, not only in TNF-α-AB refractory cases but also in patients without any TNF-α-AB treatment before.Zu den chronisch-entzündlichen Darmerkrankungen (CED) gehören die Colitis ulcerosa (CU) und Morbus Crohn (MC). CED zeigen in den meisten Fällen einen rezidivierenden Verlauf und die verfügbaren Behandlungsstrategien sind was langfristige Therapieerfolge und kurative Intention noch immer unzureichend. Zudem zeigen diese ein unterschiedliches Ansprechen bei den einzelnen Patienten. Behandlungsziel der momentan verfügbaren therapeutischen Ansätze ist die frühzeitige Entzündungskontrolle durch Einsatz von antiinflammatorischen Medikamente, Immunsuppressiva oder Biologika. Ein chirurgischer Eingriff wird dann notwendig, wenn die medikamentöse Behandlung versagt und sich Komplikationen entwickeln. Moderne IBD-Behandlungen basieren sich auf eine frühe Intervention, um krankheitsbedingte Symptome zu beseitigen oder diese vorzubeugen. Studien deuten darauf hin, dass der Einsatz von Biologika, insbesondere von Antikörpern (Ak) gegen Tumor-Nekrose-Faktor alpha (TNF-α), den Krankheitsprogress verhindern und das Ergebnis verbessern können. Allerdings liegt der Wirkungsverlust und die Intoleranz gegenüber TNF-α-Ak Behandlungen von CED-Patienten bei etwa 30%. Daher wurden neue Medikamente entwickelt, die auf die Auswanderung von Effektor-T-Lymphozyten in die Darmschleimhaut abzielen. Vedolizumab (VDZ), ein Antikörper gegen das α4β7-Integrin ist ein solcher Wirkstoff, der 2014 die Zulassung für die Behandlung von CU und MC erhielt. Dennoch sind die verfügbaren Daten zum Einsatz und den dieses Wirkstoffs in der klinischen Praxis, insbesondere zu den Langzeitergebnissen begrenzt. Ziel der vorliegenden Studie ist, die Wirksamkeit und Sicherheit von VDZ bei der Behandlung von refraktären CED-Patienten in der täglichen Praxis zu untersuchen sowie das Langzeitergebnis dieser Patienten und die Verträglichkeit der VDZ-Behandlung zu evaluieren. Hierfür wurde eine retrospektive Analyse in zwei akademischen IBD-Zentren in München (Deutschland) (CED-Zentrum des Universitätsklinikums München-Großhadern und CED-Zentrum des IsarKlinikums) durchgeführt. CED-Patienten, die zwischen Oktober 2014 und Januar 2016 eine VDZ-Behandlung in diesen Zentren bekommen haben, wurden in die Analyse eingeschlossen. Als primärer Endpunkt wurde die klinische Remission bei CU- und MC-Patienten in der 14. Behandlungswoche entsprechend dem Crohn's Disease Activity Index (CDAI) und 9 Lichtiger Colitis Activity Index (CAI) definiert. Das klinische Ansprechen wurde bei jeder ambulanten „follow-up“- Untersuchung anhand der C-reaktiven-Protein-Werte im Serum, der Anzahl der weißen Blutkörperchen (Leukozytenanzahl), und der Calprotectin-Werte evaluiert und beurteilt. Im Rahmen des standardisierten Nachbeobachtungsprotokolls wurden die Patienten zu Beginn und nach Induktion der VDZ-Behandlung in den Wochen 2, 6 und 14 klinisch untersucht. Die Patienten wurden während der Erhaltungstherapie bis zum Ende der Nachbeobachtung verfolgt. Die klinische Beurteilung und die Bewertung des CED-Therapieergebnisses hinsichtlich der Wirksamkeit und Sicherheit von VDZ wurden von zwei leitenden Gastroenterologen durchgeführt (Thomas Ochsenkühn und Fabian Schnitzler). Insgesamt wurden 102 erwachsene Patienten (56 mit CU, 46 mit MC) in der Studie rekrutiert. Die Patienten erhielten VDZ als CED-Behandlung gemäß den internationalen Richtlinien und hatten zuvor eine Behandlung mit mindestens einer TNF-α-Ak Gabe erhalten. Die Umstellung auf die VDZ-Behandlung erfolgte aufgrund von Nebenwirkungen und/ oder einer Therapierefraktärität gegenüber TNF-α-Ak. Alle Patienten erhielten zu Beginn der Behandlung eine Dosis von 300 mg VDZ als Infusion über 30 Minuten. Diese Behandlung wurde in Woche 2 und Woche 6 nach Behandlungsbeginn wiederholt, gefolgt von 300 mg VDZ als Erhaltungstherapie alle 8 Wochen. Die wichtigsten Ergebnisse zum primären Endpunkt in der Woche 14 zeigten, dass Patienten mit MC, die intolerant oder refraktär gegenüber einer TNF-α-Ak -Behandlung waren, eine moderate Verbesserung durch die VDZ-Behandlung, jedoch nicht signifikant in Bezug zur klinischen Remission aufwiesen. Die klinische Remission stieg von 54,3 % auf 60,9 %, also einem Anstieg des Anteils der Patienten in klinischer Remission um 6, 6 % (p=0.549). In Bezug auf das klinische Ansprechen betrug die erreichte Reduktion der aktiven Erkrankung mit einem Rückgang der CDAI um ≥70 Punkte 59,1 %. Patienten mit UC hingegen, die intolerant oder refraktär zur Anti-TNF-α-Behandlung waren, profitierten nach 14 Wochen von der VDZ-Behandlung: Die klinische Remission stieg von 17,8 % % auf 41,1 %. Der Anstieg des Anteils der Patienten in klinischer Remission betrug somit 23,3 % (p<0.001). 10 In Bezug zur Aktivität der Erkrankung zeigen UC-Patienten, die intolerant oder refraktär zur TNF-α-Ak Behandlung waren, einen signifikanten Effekt: Die erreichte klinische “Response”-Rate mit einer Reduktion der aktiven Erkrankung um CAI ≥ 3 Punkte war 34,1 %. Ein weiteres Ergebnis dieser Studie war dass bei einem großen Anteil der CED-Patienten (42,1% des Kollektivs), die Steroide als ergänzende Therapie erhalten hatten, die Steroidbehandlung bis zum Studienende absetzen konnte. Weiterhin zeigte sich keine signifikante Auswirkung auf die Werte des C-reaktiven Proteins [MC (p=0,447), CU (p=0,555)] oder die Leukozytenzahl [MC (p=0,199), CU (p=0,266)] unter VDZ-Behandlung. Auf der anderen Seite wurde eine signifikante Regredienz der Calprotectin-Werte wurden durch die VDZ-Behandlung bei CU-Patienten (p=0,006) registriert, allerdings nicht bei CD-Patienten (p=0,845). Was das Nebenwirkungsprofil, angeht, wurden nur seltene und leichte Nebenwirkungen berichtet. Nur 12,8 % der Patienten waren betroffen, wobei Unwohlsein und Kopfschmerzen als häufigste Nebenwirkungen auftraten. In der vorliegenden Studie wurden zusätzlich Daten zur klinischen Erhaltungstherapie von refraktärer CED mit VDZ, mit einer medianen Nachbeobachtungsdauer von fast einem Jahr generiert. VDZ zeigte eine klinische Wirksamkeit bei behandlungsrefraktären CED-Patienten, insbesondere bei denen mit CU. Die meisten CED-Patienten, im Einzelnen 87,5 % der CU- (n=43/49) sowie 85,3 % der MC-Patienten (n=35/41) setzten die Behandlung mit VDZ bis zum Ende der Nachbeobachtungszeit fort. Zusammenfassend scheint VDZ eine geeignete alternative Behandlungsoption für die refraktäre CED, insbesondere im Fall einer Therapierefraktärität und/oder Intoleranz gegenüber einer Anti-TNF-α-Behandlung zu sein, vor allem bei Vorliegen einer CU. Weitere klinische Studien sind notwendig, um die Rolle der VDZ-Behandlung in der täglichen klinischen Praxis zu definieren, nicht nur bei TNF-α-Ak refraktären Fällen, sondern auch bei Patienten, die keine TNF-α-Ak-Therapie erhalten haben

Le brancardier, un manager ?

National audienceLe métier de brancardier n’est pas parmi les plus valorisés à l’hôpital. Pourtant, à y regarder de près, le niveau de complexité et d’autonomie est tout à fait remarquable. L’analyse de l’activité d’un brancardier a montré qu’il répondait à de nombreuses tâches implicites et qu’il prenait des décisions favorables à l’organisation des services et à l’interface avec le bloc. Sans son autonomie et sa capacité à faciliter le travail des soignants, les organisations de travail seraient moins fluides

Pneumococcal conjugate vaccine – a health priority

Pneumonia is a major cause of childhood mortality and morbidity. Streptococcus pneumoniae is the most important bacterial pathogen causing pneumonia in children. The HIV epidemic has increased the burden and severity of childhood pneumococcal pneumonia and invasive disease fortyfold. Pneumococcal conjugate vaccine (PCV) is a highly effective intervention to reduce invasive pneumococcal disease and pneumonia. Studies evaluating a 9-valent PCV in South Africa and The Gambia reported a 72 - 77% reduction in vaccineserotype- specific invasive disease in vaccinated children. As many of the pneumococcal serotypes associated with antibiotic resistance are included in PCV, vaccination has also been associated with a reduction in antimicrobial-resistant invasive disease. PCV may also reduce childhood mortality, especially in places with limited access to health care, as shown in Gambian study in which PCV reduced childhood mortality by 16%. In addition to the direct effects of PCV, there is a substantial reduction in disease burden through indirect protection of non-vaccinated populations. PCV is immunogenic in HIV-infected children and provides protection against invasive disease or pneumonia in a substantial number of children. Although the efficacy of PCV for prevention of invasive disease or pneumonia is lower in HIV-infected compared to -uninfected children, the overall burden of disease prevented is much greater in HIV-infected children because of the higher burden of pneumococcal disease in these children. Consequently, vaccine-preventable invasive disease is almost 60 times higher in HIV-infected compared to -uninfected children, while the reduction in pneumonia in HIV-infected children is 15 times greater. However, the long-term efficacy of PCV wanes in HIVinfected children who are not taking antiretroviral therapy, and booster doses are probably indicated. Although there is concern about the potential for replacement disease due to non-vaccine serotypes, a substantial and sustained reduction in invasive disease has occurred overall in populations with widespread childhood immunisation. Routine childhood immunisation is now the standard of care in most developed countries. However, PCV is much less accessible to children in developing countries due to cost and availability. Cost-effectiveness analysis indicates that use of PCV is potentially highly cost-effective, at tiered pricing, even in very low-income countries. Widespread availability and vaccination with PCV is urgently needed for all children under 2 years of age in South Africa. In addition, the use of PCV for all HIV-infected children under 9 years should be prioritised.South African Medical Journal Vol. 98 (6) 2008 pp. 463-46

How to do social distancing in a shack: COVID-19 in the South African context.

No Abstract