Epidemiological modelling of the 2005 French riots: a spreading wave and the role of contagion

As a large-scale instance of dramatic collective behaviour, the 2005 French riots started in a poor suburb of Paris, then spread in all of France, lasting about three weeks. Remarkably, although there were no displacements of rioters, the riot activity did travel. Access to daily national police data has allowed us to explore the dynamics of riot propagation. Here we show that an epidemic-like model, with just a few parameters and a single sociological variable characterizing neighbourhood deprivation, accounts quantitatively for the full spatio-temporal dynamics of the riots. This is the first time that such data-driven modelling involving contagion both within and between cities (through geographic proximity or media) at the scale of a country, and on a daily basis, is performed. Moreover, we give a precise mathematical characterization to the expression “wave of riots”, and provide a visualization of the propagation around Paris, exhibiting the wave in a way not described before. The remarkable agreement between model and data demonstrates that geographic proximity played a major role in the propagation, even though information was readily available everywhere through media. Finally, we argue that our approach gives a general framework for the modelling of the dynamics of spontaneous collective uprisings

Phase III multicenter clinical trial of the sialyl-TN (STn)-keyhole limpet hemocyanin (KLH) vaccine for metastatic breast cancer

PURPOSE. This double-blind, randomized, phase III clinical trial evaluated time to progression (TTP) and overall survival in women with metastatic breast cancer (MBC) who received sialyl-TN (STn) keyhole limpet hemocyanin (KLH) vaccine. Secondary endpoints included vaccine safety and immune response. EXPERIMENTAL DESIGN. The study population consisted of 1,028 women with MBC across 126 centers who had previously received chemotherapy and had had either a complete or a partial response or no disease progression. All women received one-time i.v. cyclophosphamide (300 mg/m(2)) 3 days before s.c. injection of 100 μg STn-KLH plus adjuvant (treatment group) or 100 μg KLH plus adjuvant (control group) at weeks 0, 2, 5, and 9. Subsequently, STn-KLH without adjuvant or KLH without adjuvant was then administered monthly for 4 months, and then quarterly until disease progression, without cyclophosphamide. RESULTS. STn-KLH vaccine was well tolerated; patients had mild to moderate injection-site reactions and reversible flu-like symptoms. Week-12 antibody testing revealed high specific IgG titers and a high rate of IgM-to-IgG seroconversion; the median IgG titers in STn-KLH recipients were 320 (anti-ovine submaxillary mucin) and 20,480 (anti-STn), with no detectable antimucin antibodies in the control group. The TTP was 3.4 months in the treatment group and 3.0 months in the control group. The median survival times were 23.1 months and 22.3 months, respectively. CONCLUSIONS. Although STn-KLH was well tolerated in this largest to date metastatic breast cancer vaccine trial, no overall benefit in TTP or survival was observed. Lessons were learned for future vaccine study designs

Quelles compétences peuvent être mobilisées par des patientes atteintes de cancer du sein durant leur parcours de soin ? Une enquête par entretiens auprès de patientes et de professionnels d’un centre de lutte contre le cancer

Introduction : En France, le parcours de soins en cancérologie est défini par le plan cancer 2007–2010 qui précise les étapes et les dispositifs. Si les recommandations de la Haute Autorité de Santé en 2007 et la loi française HPST du 21 juillet 2009 permettent un langage commun, elles ne précisent pas le parcours possible d'éducation du patient. Objectif : Préciser, dans un parcours de soin de sénologie, les compétences pouvant être acquises par les patientes atteintes de cancer du sein pour réaliser leurs auto -soins et s’adapter aux changements occasionnés par la maladie. Méthode : L’étude est réalisée au Centre de lutte contre le cancer de toulouse. Des entretiens semi-directifs sont établis auprès de patientes et de professionnels. Les patientes sont suivies par un oncologue dans le cadre d’un cancer du sein non métastatique. Les professionnels présentent une activité clinique auprès de patientes atteintes de cancer mammaire. La grille d’entretien est identique pour les patientes et les professionnels. Les verbatim ont fait l’objet d’une analyse catégorielle permettant l’identification d’éléments de compétences. Résultats : Douze entretiens auprès de patientes, 18 auprès de professionnels. Cent un éléments de compétences répertoriés. Les compétences qui recueillent le plus d’éléments sont des compétences d’adaptation à la maladie. Discussion : Globalement, les compétences s’orientent vers la résolution de problèmes en lien avec la gestion de l’émotion, de l’adaptation à la maladie. Les verbatim des patientes confortent des approches de la pédagogie par les compétences et permettent de projeter un parcours d’éducation en sénologie qui privilégie chez les patientes l’implantation de stratégies d’adaptation

Impact of uncertainty on cost-effectiveness analysis of medical strategies: The case of high-dose chemotherapy for breast cancer patients

International audienceObjectives: The object of this study was to determine, taking into account uncertainty on cost and outcome parameters, the cost-effectiveness of high-dose chemotherapy (HDC) compared with conventional chemotherapy for advanced breast cancer patients.Methods: An analysis was conducted for 300 patients included in a randomized clinical trial designed to evaluate the benefits, in terms of disease-free survival and overall survival, of adding a single course of HDC to a four-cycle conventional-dose chemotherapy for breast cancer patients with axillary lymph node invasion. Costs were estimated from a detailed observation of physical quantities consumed, and the Kaplan–Meier method was used to evaluate mean survival times. Incremental cost-effectiveness ratios were evaluated successively considering disease-free survival and overall survival outcomes. Handling of uncertainty consisted in construction of confidence intervals for these ratios, using the truncated Fieller method.Results: The cost per disease-free life year gained was evaluated at 13,074€, a value that seems to be acceptable to society. However, handling uncertainty shows that the upper bound of the confidence interval is around 38,000€, which is nearly three times higher. Moreover, as no difference was demonstrated in overall survival between treatments, cost-effectiveness analysis, that is a cost minimization, indicated that the intensive treatment is a dominated strategy involving an extra cost of 7,400€, for no added benefit.Conclusions: Adding a single course of HDC led to a clinical benefit in terms of disease-free survival for an additional cost that seems to be acceptable, considering the point estimate of the ratio. However, handling uncertainty indicates a maximum ratio for which conclusions have to be discussed

Epidemiological modelling of the 2005 French riots: a spreading wave and the role of contagion

Abstract As a large-scale instance of dramatic collective behaviour, the 2005 French riots started in a poor suburb of Paris, then spread in all of France, lasting about three weeks. Remarkably, although there were no displacements of rioters, the riot activity did travel. Access to daily national police data has allowed us to explore the dynamics of riot propagation. Here we show that an epidemic-like model, with just a few parameters and a single sociological variable characterizing neighbourhood deprivation, accounts quantitatively for the full spatio-temporal dynamics of the riots. This is the first time that such data-driven modelling involving contagion both within and between cities (through geographic proximity or media) at the scale of a country, and on a daily basis, is performed. Moreover, we give a precise mathematical characterization to the expression “wave of riots”, and provide a visualization of the propagation around Paris, exhibiting the wave in a way not described before. The remarkable agreement between model and data demonstrates that geographic proximity played a major role in the propagation, even though information was readily available everywhere through media. Finally, we argue that our approach gives a general framework for the modelling of the dynamics of spontaneous collective uprisings

Biosimilar filgrastim treatment patterns and prevention of febrile neutropenia: a prospective multicentre study in France in patients with solid tumours (the ZOHé study)

Abstract Background The ZOHé study was a prospective, non-interventional, multicentre study in France to assess the use of biosimilar filgrastim Zarzio® (Sandoz filgrastim) in routine clinical practice in patients at risk of neutropenia-inducing chemotherapy (CT). Methods Patients ≥ 18 years undergoing CT for a malignant disease and with a first prescription for Zarzio® were enrolled in two cohorts according to tumour type: solid tumour or haematological malignancy; results from the solid tumour cohort are reported here. Analyses primarily described the prescription and use of Zarzio® in current practice, and also included identification of factors linked to prescription for primary prophylaxis and comparison of Zarzio® use in relation to European Organisation for Research and Treatment of Cancer (EORTC) guidelines. Results Responses were obtained from 125 physicians and 1179 patients with solid tumours, allowing robust statistical analysis of the data. Use of Zarzio® in clinical practice was relatively standardised and followed label indication. The patient profile was in line with EORTC guidelines for granulocyte colony-stimulating factor (G-CSF) febrile neutropenia (FN) prophylaxis, and the majority of patients had ≥ 1 EORTC factor(s) for increased risk of febrile neutropenia. Some patients (10.8%) received Zarzio® despite receiving CT regimens categorised in guidelines as low (< 10%) FN risk (‘over prophylaxis’). Nearly half of patients’ CT regimens did not have a recommended FN risk category. Zarzio® was commonly initiated as primary prophylaxis; initiation in Cycle ≥ 2 of the current line of CT was associated more with a history of neutropenia. The safety profile of Zarzio® was confirmed. Conclusions Use of Zarzio® in routine clinical practice is generally in line with EORTC guidelines for prophylaxis of CT-induced neutropenia. Patient-related risk factors appear to be a stronger driver of clinicians’ decision to initiate Zarzio® than CT risk category for FN. The intrinsic risk of FN associated with a specific CT protocol is often miscategorised by physicians. In contrast to earlier reports of underuse of G-CSF prophylaxis, over prophylaxis is observed in a small subgroup of patients with FN risk of < 10%