Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

The impartiality of arbitrators

Malgré l’importance de l’exigence d’impartialité et sa reconnaissance universelle, sa mise en œuvre en matière d’arbitrage reste entourée de nombreuses incertitudes. En effet, les normes sur l’impartialité de l’arbitre (ex. : standard du doute raisonnable sur l’impartialité) sont généralement trop vagues pour fournir des directives claires aux organes devant les appliquer dans des hypothèses très variées. Dès lors, une étude mérite d’être menée afin de fournir à l’organe chargé d’évaluer l’impartialité de l’arbitre un support lui permettant de mieux accomplir sa mission. Pour ce faire, nous commencerons par distinguer les deux conceptions envisageables de l’impartialité : une conception pure et consensuelle (résistance aux tentations de partialité) et une conception élargie et ambitieuse (ouverture d’esprit à l’égard du litige). Ensuite, nous examinerons les principales questions émanant de la pratique de l’arbitrage. Seront ainsi analysés : l’identification des risques de partialité de l’arbitre à partir de ses actes, liens et opinions préalables ; le degré d’impartialité du coarbitre ; la renonciation à invoquer le risque de partialité. En étudiant chaque question, nous mettrons en évidence ses enjeux (notamment le besoin de prendre en considération les exigences de l’efficacité et de la qualité de l’arbitrage ainsi que le « droit » de chaque partie de nommer un arbitre) pour pouvoir ensuite en envisager les réponses possibles, notamment en nous inspirant des solutions consacrées par la jurisprudence française et étrangère.Despite its importance and universal recognition, the principle of arbitrators’ impartiality is surrounded by many uncertainties, the main reason being that the applicable rules (e. g. reasonable doubts test) are often too vague to offer clear guidance to the authorities, given the diverse situations they have to apply them to. In order to provide them with a clearer guidance, there is a need to conduct a study on the arbitrators’ impartiality. To begin with, we will distinguish the two possible understandings of impartiality : the pure and consensual understanding (resistance to temptation to be partial) and the enlarged and ambitious understanding (open-mindedness towards the dispute’s issues). Then, we will study the practical issues stemming from arbitral practice. These issues revolve around : the assessment of impartiality on the basis of arbitrators’ acts, relationships and expressed views (the issue conflict question) ; the impartiality of party-appointed arbitrators ; the waiver of the right to invoke the risk of partiality. While studying each issue, we will highlight its stakes (especially the need to ensure the efficiency and quality of the arbitral justice as well as the need to preserve the “right” of each party to appoint an arbitrator) in order to contemplate possible answers, especially in the light of what has been decided in French and foreign case-law

Justice et politique dans l’Égypte post-Moubarak

En juillet 2013, la nomination du président de la Haute Cour constitutionnelle comme chef de l’État par intérim après l’éviction de Mohammed Morsi a pu être considérée comme la dernière étape d’un processus de judiciarisation du politique ou, pire, de politicisation du judiciaire. Elle a aussi été interprétée comme une revanche de la Haute Cour constitutionnelle contre le président Morsi qui avait voulu remettre en question ses attributions et son statut. Depuis la chute du président Moubarak..

Des justices en transition dans le monde arabe ?

Après avoir été l’espace de l’exception autoritaire, le monde arabe est devenu, au premier semestre de 2011, celui des « révolutions ». Au leitmotiv de l’incapacité congénitale des pays arabes d’accéder à la démocratie a succédé le discours sur les « printemps arabes » et l’effet de domino supposé de la « révolution tunisienne » qui, le 14 janvier 2011, avait chassé son « dictateur ». Or aujourd’hui, la plupart des régimes autoritaires sont largement parvenus à museler les mouvements de protestation. Pour autant, peut-on dire que ces révoltes arabes n’ont eu aucun effet sur les rapports entre le pouvoir politique et la justice ? Les contributions présentées dans cet ouvrage donnent des réponses contrastées à cette question. La chute du régime de Ben Ali a eu un effet différencié sur le réajustement des rapports entre justices et politique. Les contributions présentées ici rendent compte de la manière dont certains États de la région ont développé des politiques de justice destinées à répondre sélectivement aux pressions de changements politiques, tout en maintenant l’hégémonie des élites gouvernantes. À cet égard la Tunisie apparaît comme une exception dans la mesure où les rapports entre l’institution judiciaire et le pouvoir politique post-Ben Ali ont été largement redéfinis, mais sans pour autant que les gouvernements transitoires aient renoncé à subordonner le pouvoir judiciaire

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality