Etude Sur Les Difficultés De Recouvrement Des Créances Dans Lespace Uemoa (Benin, Burkina-faso, Mali, Senegal)

Les créances publiques dues par l'Etat et les autres personnes de droit public sont irrécouvrables du fait des règles d'immunité d'exécution prévues par l'Acte uniforme de l'Organisation pour l'Harmonisation en Afrique du Droit des Affaires (OHADA), et cette situation accroît les difficultés de trésorerie des petites et moyennes entreprises et réduit leurs capacités financières de faire face, à leur tour, au remboursement de leurs dettes, particulièrement les avances bancaires

Sunitinib for metastatic progressive phaeochromocytomas and paragangliomas: results from FIRSTMAPPP, an academic, multicentre, international, randomised, placebo-controlled, double-blind, phase 2 trial

Background: No randomised controlled trial has ever been done in patients with metastatic phaeochromocytomas and paragangliomas. Preclinical and first clinical evidence suggested beneficial effects of sunitinib. We aimed to evaluate the safety and efficacy of sunitinib in patients with metastatic phaeochromocytomas and paragangliomas. Methods: FIRSTMAPPP is a multicentre, international, randomised, placebo-controlled, double-blind, phase 2 trial done at 14 academic centres across four European countries. Eligible participants were adults (aged ≥18 years) with sporadic or inherited progressive metastatic phaeochromocytomas and paragangliomas. Patients were randomly assigned (1:1) to receive either oral sunitinib (37·5 mg per day) or placebo. Randomisation was stratified according to SDHB status (mutation present vs wild type) and number of previous systemic therapies (0 vs ≥1). Primary endpoint was the rate of progression-free survival at 12 months according to real-time central review (Response Evaluation Criteria in Solid Tumours version 1.1). On the basis of a two-step Simon model, we aimed for the accrual of 78 patients, assuming a 20% improvement of the 12-month progression-free survival rate from 20% to 40%, to conclude that sunitinib is effective. Crossover from the placebo group was allowed. This trial is registered with ClinicalTrials.gov, number NCT01371201, and is closed for enrolment. Findings: From Dec 1, 2011, to Jan 31, 2019, a total of 78 patients with progressive metastatic phaeochromocytomas and paragangliomas were enrolled (39 patients per group). 25 (32%) of 78 patients had germline SDHx variants and 54 (69%) had used previous therapies. The primary endpoint was met, with a 12-month progression-free survival in 14 of 39 patients (36% [90% CI 23-50]) in the sunitinib group. In the placebo group, the 12-month progression-free survival in seven of 39 patients was 19% (90% CI 11-31), validating the hypotheses of our study design. The most frequent grade 3 or 4 adverse events were asthenia (seven [18%] of 39 and one [3%] of 39), hypertension (five [13%] and four [10%]), and back or bone pain (one [3%] and three [8%]) in the sunitinib and placebo groups, respectively. Three deaths occurred in the sunitinib group: these deaths were due to respiratory insufficiency, amyotrophic lateral sclerosis, and rectal bleeding. Only the latter event was considered drug related. Two deaths occurred in the placebo group due to aspiration pneumonia and septic shock. Interpretation: This first randomised trial supports the use of sunitinib as the medical option with the highest level of evidence for anti-tumour efficacy in progressive metastatic phaeochromocytomas and paragangliomas. Funding: French Ministry of Health, through the National Institute for Cancer, German Ministry of Education and Research, and the German Research Foundation within the CRC/Transregio 205/2, EU Seventh Framework Programme, and a private donator grant

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Nucleoside Reverse Transcriptase Inhibitor Resistance Mutations Associated with First-Line Stavudine-Containing Antiretroviral Therapy: Programmatic Implications for Countries Phasing Out Stavudine

Background The World Health Organization Antiretroviral Treatment Guidelines recommend phasing-out stavudine because of its risk of long-term toxicity. There are two mutational pathways of stavudine resistance with different implications for zidovudine and tenofovir cross-resistance, the primary candidates for replacing stavudine. However, because resistance testing is rarely available in resource-limited settings, it is critical to identify the cross-resistance patterns associated with first-line stavudine failure. Methods We analyzed HIV-1 resistance mutations following first-line stavudine failure from 35 publications comprising 1,825 individuals. We also assessed the influence of concomitant nevirapine vs. efavirenz, therapy duration, and HIV-1 subtype on the proportions of mutations associated with zidovudine vs. tenofovir cross-resistance. Results Mutations with preferential zidovudine activity, K65R or K70E, occurred in 5.3% of individuals. Mutations with preferential tenofovir activity, ≥two thymidine analog mutations (TAMs) or Q151M, occurred in 22% of individuals. Nevirapine increased the risk of TAMs, K65R, and Q151M. Longer therapy increased the risk of TAMs and Q151M but not K65R. Subtype C and CRF01_AE increased the risk of K65R, but only CRF01_AE increased the risk of K65R without Q151M. Conclusions Regardless of concomitant nevirapine vs. efavirenz, therapy duration, or subtype, tenofovir was more likely than zidovudine to retain antiviral activity following first-line d4T therap

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Variabilité des flux turbulents de surface au sein du bassin versant d'Ara au Bénin

La circulation atmosphérique en Afrique de l'Ouest est caractérisée par des vents de sud-ouest (mousson) pendant la saison humide et par des vents de nord-est (harmattan) pendant la saison sèche. Cette alternance des saisons est due aux variations de pression liée à l'état des surfaces (rugosité, albédo, végétation) en réaction au forçage solaire. Ces mêmes états de surface génèrent une variabilité de flux turbulents de surface et des circulations secondaires qui rendent complexes les analyses des mesures effectuées sur place en vue de documenter les interactions surface-atmosphère. La modélisation fine échelle (LES) couramment utilisée dans l'étude de la couche limite atmosphérique est requise pour pouvoir palier à ces difficultés en raison de sa capacité à prendre en compte les flux turbulents en 3D et sur topographie complexe. Notre site d'étude est le bassin versant d'ARA située au Nord du Bénin dans un contexte Soudanien avec des propriétés de surface variables. Une analyse climatique est effectuée sur la base des observations de radiosondage, de radar UHF et de stations au sol afin d'extraire des données composites représentatives des saisons sèche et humide. Ces données composites ont servi par la suite à forcer le modèle Méso-NH dans sa version LES. Pour pouvoir caractériser les échelles de longueur des flux turbulents de surface relatives aux saisons sèche et humide, les données standard de forçage de surface de Méso-NH que sont le relief GTOPO30 (1km de résolution) et la végétation ECOCLIMAP (1km de résolution) ont été respectivement remplacer par le SRTM (90m de résolution) et les données de SPOT/HRV (20m de résolution) reéchantillonné à 90m de résolution. A l'aide d'outils statistiques comme la variographie 2D et le suivi Lagrangien, il ressort que la variabilité spatiale de la chaleur sensible H est gouvernée par le couple vent-relief tandis que celle de la chaleur latente E est difficile à mettre en lien sur végétation hétérogène (SPOT/HRV) en saison sèche. En saison humide, la variabilité spatiale du champ H dépend du vent tandis que celle du champ E dépend de la végétation. Cette étude révèle dans tous les cas que les échelles caractéristiques de ces deux champs diffèrent dans les mêmes conditions de forçage de surface et atmosphérique.West Africa atmosphere circulation is characterized by south-westerly wind (monsoon regime) during the wet season and north-easterly wind (harmattan regime) during the dry season. This alternation of wind regime is due to surface pressure variability linked to surface heterogeneities. Surface heterogeneities generate surface flux variability, secondary circulation and make complex analysis when trying to document surface-atmosphere feedbacks. LES modelling usually used for boundary-layer studies due to its potential to take into account 3D turbulence over complex topography, is used here to overcome these difficulties. Our site of interest is located in north of Benin characterized by Soudanian climate and heterogeneous surface properties. Climate analysis are first performed with radiosoundings, UHF radar, and EC station data in order to extract composite profile representing dry and wet season.. These composite profiles are then used to force atmosphere part of the Méso-NH LES model. To characterize turbulent fluxes length scales relative to dry and wet season, standard surface forcing data with Méso-NH like GTOPO30 orography (1km ) and ECOCLIMAP vegetation (1km) are respectively replaced by SRTM (90m) and SPOT/HRV vegetation data (20m) resampled to 90m. Along with statistical tools like 2D variography and Lagrangian, we notice that during dry season on heterogeneous vegetation, sensible heat flux H is more driven by wind and orography while we not able to discuss the latent heat flux E case. During wet season with the same surface forcing, it appears that H is driven by wind while E is more dependent to vegetation variability. Our study concludes in all case that H and E are not characterized by the same length scale.SAVOIE-SCD - Bib.électronique (730659901) / SudocGRENOBLE1/INP-Bib.électronique (384210012) / SudocGRENOBLE2/3-Bib.électronique (384219901) / SudocSudocFranceF

Labour administration in sub-Saharan Africa: Functions and challenges in the light of ILO Convention No. 150

Based on a review of national legislation and the findings of their field-work, the authors assess the application of the Labour Administration Convention, 1978 (No. 150), in a sample of nine African countries. Their research focuses on three main issues: the relative importance given to each of the various functions of labour administration; the extension of those functions to workers in non-wage employment; and the shortage of human and material resources available to the administrations. In conclusion, the authors stress the current relevance and value of the ILO instrument, particularly for extending labour administration work to the informal economy

Labor de las administraciones del trabajo del África subsahariana y actualidad del Convenio núm. 150

Los autores hacen balance del cumplimiento de los principios del Convenio de la OIT sobre la administración del trabajo, 1978 (núm. 150), en un grupo seleccionado de países africanos. Se basan para ello en las legislaciones nacionales y en observaciones sobre el terreno. Los tres ejes de su investigación son: el peso relativo de las diversas funciones de esta administración; la atención que presta la misma a los trabajadores no asalariados, y la escasez de los recursos humanos y materiales disponibles. Como conclusión subrayan la actualidad y modernidad de este instrumento, sobre todo para la extensión de las actividades de la administración del trabajo al sector informal

Labor de las administraciones del trabajo del África subsahariana y actualidad del Convenio núm. 150

Los autores hacen balance del cumplimiento de los principios del Convenio de la OIT sobre la administración del trabajo, 1978 (núm. 150), en un grupo seleccionado de países africanos. Se basan para ello en las legislaciones nacionales y en observaciones sobre el terreno. Los tres ejes de su investigación son: el peso relativo de las diversas funciones de esta administración; la atención que presta la misma a los trabajadores no asalariados, y la escasez de los recursos humanos y materiales disponibles. Como conclusión subrayan la actualidad y modernidad de este instrumento, sobre todo para la extensión de las actividades de la administración del trabajo al sector informal