Les évaluations de coûts en santé sont-elles transférables ?

Cette étude de la transférabilité des résultats des évaluations de coûts en santé repose sur l'analyse en composantes principales et les distances euclidiennes. Elle permet de montrer si les résultats sont faiblement, moyennement ou largement transférables. Le recours à ces deux méthodes validées pour mesurer la transférabilité des résultats constitue, de ce point de vue, une démarche originale. Son opérationnalité est également démontrée dans le cadre d'un traitement innovant, la radiothérapie par ions carbone. Une analyse « globale » témoigne, par exemple, d'une forte distance entre l'Italie et les Pays-Bas. Tous facteurs confondus, les résultats sont donc faiblement transférables entre ces deux pays. Une analyse plus fine montre que les distances sont maximales et donc la transférabilité minimale pour les coûts des bâtiments et les paramètres organisationnels.cost ; economic assessment ; health ; oncology ; transferability

A new petrological and geophysical investigation of the present-day plumbing system of Mount Vesuvius

Article in PressInternational audienceA model of the electrical resistivity of Mt. Vesuvius has been elaborated to investigate the present structure of the volcanic edifice. The model is based on electrical conductivity measurements in the laboratory, on geophysical information, in particular, magnetotelluric (MT) data, and on petrological and geochemical constraints. Both 1-D and 3-D simulations explored the effect of depth, volume and resistivity of either one or two reservoirs in the structure. For each configuration tested, modeled MT transfer functions were compared to field transfer functions from field magnetotelluric studies. The field electrical data are reproduced with a shallow and very conductive layer (~0.5km depth, 1.2km thick, 5ohm.m resistive) that most likely corresponds to a saline brine present beneath the volcano. Our results are also compatible with the presence of cooling magma batches at shallow depths (~100ohm.m. According to a petro-physical conductivity model, such a resistivity value is in agreement either with a low-temperature, crystal-rich magma chamber or with a small quantity of hotter magma interconnected in the resistive surrounding carbonates. However, the low quality of MT field data at long periods prevent from placing strong constraints on a potential deep magma reservoir. A comparison with seismic velocity values tends to support the second hypothesis. Our findings would be consistent with a deep structure (8-10km depth) made of a tephriphonolitic magma at 1000°C, containing 3.5wt%H2O, 30vol.% crystals, and interconnected in carbonates in proportions ~45% melt - 55% carbonates

Mosquito magnet® liberty plus trap baited with octenol confirmed best candidate for Anopheles surveillance and proved promising in predicting risk of malaria transmission in French Guiana

BACKGROUND: In French Guiana, Mosquito Magnet(®) Liberty Plus trap baited with octenol (MMoct) has been proposed for sampling Anopheles darlingi after comparison with CDC light trap and Human landing catch (HLC). However, other available lures were not tested. The current study compared MMoct and MM baited with Lurex™ (MMlur) to HLC, and analysed entomological data from MMoct collection with malaria cases to facilitate malaria surveillance. METHODS: Two independent experiments were conducted during 2012 and 2013 in Saint-Georges town, French Guiana. The first experiment used Latin square design to compare MMoct and MMlur to HLC between 18:30 to 22:30 and 05:00 to 07:00. Parity rate was determined for An. darlingi from each sampling system. In the second experiment, a 24:00 hour collection was done for four consecutive days during the first week of each month and every four days for the rest of the month using MMoct. Portion of the 24 hour collection was dissected for parity rate. All anophelines were screened for Plasmodium infection by PCR. Data for number of malaria cases was analysed for association with density of An. darlingi. RESULTS: In the first experiment, 3,721 anopheline mosquitoes were collected over 21 nights. Of these, 95.7% was identified morphologically to five species and An. darlingi contributed 98.4%, mainly from HLC (75.1%, CI 95% [73.2-77.0]) than MMoct (14.1%, CI 95% [12.6-15.7]) and MMlur (10.8%, CI 95% [9.4-12.2]). Species richness was highest in HLC meanwhile species diversity index was greatest in MMoct. MMoct collected more parous An. darlingi than HLC (p < 0.0001) and MMlur (p = 0.0021). The second experiment amounted to 2035 females, 60.8% belonging to 10 species. Anopheles darlingi constituted 85.0% of the species and had parity rate of 52.3%. Specimens were uninfected with Plasmodium. Density of An. darlingi best correlated with malaria cases observed six weeks later (p = 0.0016; r = 0.4774). CONCLUSION: Though MMoct and MMlur performed well in sampling An. darlingi, MMoct captured more species and, therefore, would be useful for surveillance. Even if it collected mostly parous mosquitoes, MMoct proved useful in collecting entomological data required for predicting malaria emergence. It is a potential replacement for HLC

The Sorcerer’s cave in Saint-Cirq-du-Bugue (Dordogne, France): new readings. Report of the 2010 and 2011 campaigns

Two main reasons have led us to start again the study of the Sorcerer’s cave in Saint-Cirq-du-Bugue (Dordogne): first of all the real progress existing in recent years in the means available for the study of prehistoric parietal art, which had not been applied to the site; and secondly the discovery of vandalism on some of the art, which needed to be assessed precisely. The new campaign of tracings, as well as the attention given to understanding the making of the engravings in connection with the underground relief shapes allowed a better apprehension of the artists’ environment at the time of the making of the works of art, together with a more precise idea of the gestures and techniques used. Furthermore, during our first campaign in the autumn 2010, we were able to carry out a full topographic coverage of the cave associated with a precise sizing of all the engravings, in view of the future making of a digital site model. On most of the engravings studied up to date, it was possible to precise some of the ancient lines, to identify the position of the modern lines and to record the effects of the degradation agents associated to a rock support that is especially fragile in places. The main figure of the cave, the human ithyphallic figure, was newly interpreted (especially its head), which allowed us to underline the engraving of an equine whose back leg is partially superimposed to the engraving of the Sorcerer’s sex. The new engraving of a horse, up to date unnoticed, was also discovered. Finally, in the course of our investigations, it appeared essential to study the whole of the engravings as belonging to one composition stretched around a large fissure on the vault ‒ showing how important the natural shapes of the rock surfaces are in the organisation of the representations ‒ as well as to rethink the making of the decoration as the superimposition of drawings from different time periods

The Sorcerer’s cave in Saint-Cirq-du-Bugue (Dordogne, France): new readings. Report of the 2010 and 2011 campaigns

Two main reasons have led us to start again the study of the Sorcerer’s cave in Saint-Cirq-du-Bugue (Dordogne): first of all the real progress existing in recent years in the means available for the study of prehistoric parietal art, which had not been applied to the site; and secondly the discovery of vandalism on some of the art, which needed to be assessed precisely. The new campaign of tracings, as well as the attention given to understanding the making of the engravings in connection with the underground relief shapes allowed a better apprehension of the artists’ environment at the time of the making of the works of art, together with a more precise idea of the gestures and techniques used. Furthermore, during our first campaign in the autumn 2010, we were able to carry out a full topographic coverage of the cave associated with a precise sizing of all the engravings, in view of the future making of a digital site model. On most of the engravings studied up to date, it was possible to precise some of the ancient lines, to identify the position of the modern lines and to record the effects of the degradation agents associated to a rock support that is especially fragile in places. The main figure of the cave, the human ithyphallic figure, was newly interpreted (especially its head), which allowed us to underline the engraving of an equine whose back leg is partially superimposed to the engraving of the Sorcerer’s sex. The new engraving of a horse, up to date unnoticed, was also discovered. Finally, in the course of our investigations, it appeared essential to study the whole of the engravings as belonging to one composition stretched around a large fissure on the vault ‒ showing how important the natural shapes of the rock surfaces are in the organisation of the representations ‒ as well as to rethink the making of the decoration as the superimposition of drawings from different time periods

La grotte du sorcier à Saint-Cirq-du-Bugue (Dordogne, France) : nouvelles lectures. Bilan des campagnes 2010 et 2011

Les progrès réalisés ces dernières années dans les moyens mis à disposition pour étudier l’art pariétal préhistorique, ainsi que l’amer constat d’actes de vandalisme opérés sur certaines gravures de la grotte du Sorcier à Saint-Cirq-du-Bugue (Dordogne), nous ont conduits à reprendre l’étude de ce site majeur de l’art aquitain des populations de chasseurs-collecteurs. Cette nouvelle campagne de relevés, ainsi que l’attachement à comprendre l’exécution des gravures en lien avec les formes de relief souterrain, nous permettent de mieux appréhender l’environnement physique de la grotte au moment de la réalisation des œuvres, tout en nous faisant une idée plus précise des gestes et des techniques employés. Par ailleurs, nous avons pu réaliser lors de la première campagne, menée à l’automne 2010, la couverture topographique complète de la cavité associée à la cotation précise de l’ensemble des représentations, en vue de la réalisation future d’un modèle numérique de terrain.Sur la plupart des gravures réexaminées jusqu’alors, il nous a été possible de préciser certains tracés anciens, d’identifier la position des ajouts modernes et de constater les effets des altéragènes, associés à un support rocheux par endroits particulièrement vulnérable. La figure maîtresse de la grotte, cette représentation humaine ithyphallique, a fait l’objet d’une nouvelle lecture (notamment de la tête), qui a mis en évidence la gravure d’un équidé dont l’une des jambes arrière se superpose pour partie avec le tracé du sexe du « Sorcier ». Une nouvelle gravure figurant un équidé, jusque-là passée inaperçue, a également été découverte. Enfin, au fur et à mesure de nos investigations, il nous est apparu essentiel d’étudier l’ensemble des gravures comme appartenant à une composition se développant autour d’une large fissure présente à la voûte – signe de l’importance des formes naturelles des parois dans l’articulation des représentations –, ainsi que de repenser la constitution de son décor comme la superposition de tracés de différentes époques.Recent-years progress in the means available for the study of prehistoric parietal art as well as the bitter acknowledgement of vandalism on some engravings of the Sorcerer’s cave in Saint-Cirq-du-Bugue (Dordogne) led us to start again the study of this major site for the art of the hunters-gatherers of Aquitaine. The new campaign of tracings, as well as the attention given to understanding the making of the engravings in connection with the underground relief shapes allowed a better apprehension of the artists’ environment at the time of the making of the works of art, together with a more precise idea of the gestures and techniques used. Furthermore, during our first campaign in the autumn 2010, we were able to carry out a full topographic coverage of the cave associated with a precise sizing of all the engravings, in view of the future making of a numeric site model. On most of the studied engravings up to date, it was possible to precise some of the ancient lines, to identify the position of the modern lines and to record the effects of the degradation agents associated to a rock support that is especially fragile in places. The main figure of the cave, the human ithyphallic figure, was read anew (especially its head) which allowed us underlining the engraving of an equine whose back leg is partly superimposed to the engraving of the Sorcerer’s sex. The new engraving of a horse, up to date unnoticed, was also discovered. Finally, in the course of our investigations, it appeared essential to us to study the whole of the engravings as belonging to one composition stretched around a large crack on the vault - showing how important the natural shapes of the rock surfaces are in the organisation of the representations - as well as to rethink the making of the decoration as the superimposition of lines from different time periods

La grotte du sorcier à Saint-Cirq-du-Bugue (Dordogne, France) : nouvelles lectures. Bilan des campagnes 2010 et 2011

Les progrès réalisés ces dernières années dans les moyens mis à disposition pour étudier l’art pariétal préhistorique, ainsi que l’amer constat d’actes de vandalisme opérés sur certaines gravures de la grotte du Sorcier à Saint-Cirq-du-Bugue (Dordogne), nous ont conduits à reprendre l’étude de ce site majeur de l’art aquitain des populations de chasseurs-collecteurs. Cette nouvelle campagne de relevés, ainsi que l’attachement à comprendre l’exécution des gravures en lien avec les formes de relief souterrain, nous permettent de mieux appréhender l’environnement physique de la grotte au moment de la réalisation des œuvres, tout en nous faisant une idée plus précise des gestes et des techniques employés. Par ailleurs, nous avons pu réaliser lors de la première campagne, menée à l’automne 2010, la couverture topographique complète de la cavité associée à la cotation précise de l’ensemble des représentations, en vue de la réalisation future d’un modèle numérique de terrain.Sur la plupart des gravures réexaminées jusqu’alors, il nous a été possible de préciser certains tracés anciens, d’identifier la position des ajouts modernes et de constater les effets des altéragènes, associés à un support rocheux par endroits particulièrement vulnérable. La figure maîtresse de la grotte, cette représentation humaine ithyphallique, a fait l’objet d’une nouvelle lecture (notamment de la tête), qui a mis en évidence la gravure d’un équidé dont l’une des jambes arrière se superpose pour partie avec le tracé du sexe du « Sorcier ». Une nouvelle gravure figurant un équidé, jusque-là passée inaperçue, a également été découverte. Enfin, au fur et à mesure de nos investigations, il nous est apparu essentiel d’étudier l’ensemble des gravures comme appartenant à une composition se développant autour d’une large fissure présente à la voûte – signe de l’importance des formes naturelles des parois dans l’articulation des représentations –, ainsi que de repenser la constitution de son décor comme la superposition de tracés de différentes époques.Recent-years progress in the means available for the study of prehistoric parietal art as well as the bitter acknowledgement of vandalism on some engravings of the Sorcerer’s cave in Saint-Cirq-du-Bugue (Dordogne) led us to start again the study of this major site for the art of the hunters-gatherers of Aquitaine. The new campaign of tracings, as well as the attention given to understanding the making of the engravings in connection with the underground relief shapes allowed a better apprehension of the artists’ environment at the time of the making of the works of art, together with a more precise idea of the gestures and techniques used. Furthermore, during our first campaign in the autumn 2010, we were able to carry out a full topographic coverage of the cave associated with a precise sizing of all the engravings, in view of the future making of a numeric site model. On most of the studied engravings up to date, it was possible to precise some of the ancient lines, to identify the position of the modern lines and to record the effects of the degradation agents associated to a rock support that is especially fragile in places. The main figure of the cave, the human ithyphallic figure, was read anew (especially its head) which allowed us underlining the engraving of an equine whose back leg is partly superimposed to the engraving of the Sorcerer’s sex. The new engraving of a horse, up to date unnoticed, was also discovered. Finally, in the course of our investigations, it appeared essential to us to study the whole of the engravings as belonging to one composition stretched around a large crack on the vault - showing how important the natural shapes of the rock surfaces are in the organisation of the representations - as well as to rethink the making of the decoration as the superimposition of lines from different time periods

Prognostic factors in post-prostatectomy salvage radiotherapy setting with and without hormonotherapy: An individual patient data analysis of randomized trials from ICECaP database

Background: Early salvage radiotherapy (SRT) is the standard of care for biochemical recurrence post-prostatectomy but outcomes are heterogeneous. Objective: To develop a risk scoring system based on relevant standard-of-care clinico-pathological prognostic factors for patients treated with SRT with and without hormonal therapy (HT). Design, setting, and participants: The Intermediate Clinical Endpoints in Cancer of the Prostate (ICECaP) database included three randomized trials (Individual patients' data from 1647 subjects) assessing SRT (GETUG-AFU-16; NRG/RTOG-9601, and a subset of EORTC-22911). Outcome measurements and statistical analysis: Outcomes were clinical progression (CP). metastasis free-survival (MFS) and overall survival (OS). Clinico-pathological factors, including pathological Gleason Score (GS), PSA at SRT start, margin status, persistent PSA post-RP and time from RP to SRT were evaluated by multivariable models stratified by type of treatment. Results and limitations: On multivariable analysis PSA ≥ 0.5 ng/mL at SRT start, GS ≥ 8 and negative margin status were the three strongest prognostic factors. Three prognostic groups defined by number of these risk features (high risk: 2 or 3; intermediate risk: 1 and low risk: 0) were strongly associated with OS, MFS and CP outcomes with SRT alone or with HT. This prognostic group definition was also relevant for patients with persistent PSA post RP and for patients treated Conclusion: A risk score for patients receiving SRT with or without HT, using three standard-of-care clinico-pathological risk factors provides refined prognostic information for individual patient counselling. Patient summary: By using a composite score of pathology grading (Gleason Score), PSA at start of salvage radiation and margin status data, physicians can provide patients with more refined information on the risk of a second relapse after receiving radiation to the prostate bed after a prostatectomy for a rising or persistent PSA, both with and without hormonal therapy.</p

Role of brachytherapy in the treatment of cancers of the anal canal: Long-term follow-up and multivariate analysis of a large monocentric retrospective series

Background and purpose: There are few data on long-term clinical results and tolerance of brachytherapy in anal canal cancer. We present one of the largest retrospective analyses of anal canal cancers treated with external beam radiotherapy with/without (±) chemotherapy followed by a brachytherapy boost. Materials and methods: We performed a retrospective analysis of clinical results in terms of efficacy and toxicity. The impact of different clinical and therapeutic variables on these outcomes was studied. Results: From May 1992 to December 2009, 209 patients received brachytherapy after external beam radiotherapy ± chemotherapy. Of these patients, 163 were stage II or stage IIIA (UICC 2002) and 58 were N1-3. According to age, ECOG performance status (PS), and comorbidities, patients received either radiotherapy alone (58/209) or radiochemotherapy (151/209). The median follow-up was 72.8months. The 5- and 10-year local control rates were 78.6 and 73.9 %, respectively. Globally, severe acute and late G3-4 reactions (NCI-CTC scale v. 4.0) occurred in 11.2 and 6.3 % of patients, respectively. Univariate analysis showed the statistical impact of the pelvic treatment volume (p = 0.046) and of the total dose (p = 0.02) on the risk of severe acute and late toxicities, respectively. Only six patients required permanent colostomy because of severe late anorectal toxicities. Conclusion: After a long follow-up time, brachytherapy showed an acceptable toxicity profile and high local control rates in patients with anal canal cancer

Permanent 125I-seed prostate brachytherapy: early prostate specific antigen value as a predictor of PSA bounce occurrence

<p>Abstract</p> <p>Purpose</p> <p>To evaluate predictive factors for PSA bounce after ¹²⁵I permanent seed prostate brachytherapy and identify criteria that distinguish between benign bounces and biochemical relapses.</p> <p>Materials and methods</p> <p>Men treated with exclusive permanent ¹²⁵I seed brachytherapy from November 1999, with at least a 36 months follow-up were included. Bounce was defined as an increase ≥ 0.2 ng/ml above the nadir, followed by a spontaneous return to the nadir. Biochemical failure (BF) was defined using the criteria of the Phoenix conference: nadir +2 ng/ml.</p> <p>Results</p> <p>198 men were included. After a median follow-up of 63.9 months, 21 patients experienced a BF, and 35.9% had at least one bounce which occurred after a median period of 17 months after implantation (4-50). Bounce amplitude was 0.6 ng/ml (0.2-5.1), and duration was 13.6 months (4.0-44.9). In 12.5%, bounce magnitude exceeded the threshold defining BF. Age at the time of treatment and high PSA level assessed at 6 weeks were significantly correlated with bounce but not with BF. Bounce patients had a higher BF free survival than the others (100% versus 92%, p = 0,007). In case of PSA increase, PSA doubling time and velocity were not significantly different between bounce and BF patients. Bounces occurred significantly earlier than relapses and than nadir + 0.2 ng/ml in BF patients (17 vs 27.8 months, p < 0.0001).</p> <p>Conclusion</p> <p>High PSA value assessed 6 weeks after brachytherapy and young age were significantly associated to a higher risk of bounces but not to BF. Long delays between brachytherapy and PSA increase are more indicative of BF.</p