Applicabilité du scoring de crédit dans la micro-finance en contexte de données imprécises et incomplètes : l’apport des ensembles flous

The main objective of this research paper is to study the applicability of credit scoring in the field of microfinance when data is imprecise, incomplete and limited. In this perspective, fuzzy set theory, in particular the totally fuzzy and relative logic initiated by Cheli and Lemmi (1995), has been applied, which, identifying this imprecision and uncertainty in the data, has made it possible to propose classes of unidimensional and multidimensional fuzzy scoring indicators based on the definition of a membership function and a score per statistical unit. The results obtained using this method, for a sample of 116 customers of a local credit union of the Mutuelle Congolaise d'Epargne et de Crédit in Congo, in Brazzaville, who had taken out a loan, and for the three dimensions considered : loan amount, loan characteristics and relationship with the micro-finance institution, show a low general multidimensional fuzzy score, with the value of the membership function estimated at 0.35. This risk is primarily impacted by the three attributes associated with the loan characteristics dimension, namely : the credit purpose index (0.76), the interest rate (0.64) and the loan duration (0.61) ; indices still linked to the borrower's responsibility. The transition from the situation of men to that of women leads to a drop in these unidimensional indices. This suggests that, in the face of credit, women appear more responsible.La présente recherche s’intéresse à l’applicabilité du scoring de crédit dans le domaine de la micro-finance lorsque les données sont imprécises, incomplètes et limitées. Dans cette perspective, la théorie des ensembles flous, notamment la logique totalement floue et relative initiée par Cheli et Lemmi (1995), a été appliquée, laquelle a permis, identifiant cette imprécision et incertitude dans les données, de proposer des classes d’indicateurs de scores flous, unidimensionnels et multidimensionnels, basées sur la définition d'une fonction d’appartenance et un score par unité statistique. Les résultats obtenus par cette méthode, pour un échantillon de 116 clients d’une caisse locale de la Mutuelle Congolaise d’Epargne et de Crédit au Congo, à Brazzaville, ayant contracté un crédit, et pour les trois dimensions retenues : le montant de l’emprunt, les caractéristiques de l’emprunt et les relations avec l’institution demicro-finance, montrent un score général flou multidimensionnel bas, la valeur de la fonction d’appartenance est estimée à 0,35. Ce risque est surtout impacté par les trois attributs associés à la dimension caractéristiques de l’emprunt, notamment : l’indice de l’objet du crédit (0,69), le taux d’intérêt (0,64) et la durée de l’emprunt (0,61) ; indices restant liés à la responsabilité de l’emprunteur. Le passage de la situation des hommes à celle des femmes, entraînent une baisse de ces indices unidimensionnels. Ce qui laisse suggérer que, face au crédit, les femmes paraissent plus responsables

Long-term cellular immunity of vaccines for Zaire Ebola Virus Diseases

Recent Ebola outbreaks underscore the importance of continuous prevention and disease control efforts. Authorized vaccines include Merck’s Ervebo (rVSV-ZEBOV) and Johnson & Johnson’s two-dose combination (Ad26.ZEBOV/MVA-BN-Filo). Here, in a five-year follow-up of the PREVAC randomized trial (NCT02876328), we report the results of the immunology ancillary study of the trial. The primary endpoint is to evaluate long-term memory T-cell responses induced by three vaccine regimens: Ad26–MVA, rVSV, and rVSV–booster. Polyfunctional EBOV-specific CD4+ T-cell responses increase after Ad26 priming and are further boosted by MVA, whereas minimal responses are observed in the rVSV groups, declining after one year. In-vitro expansion for eight days show sustained EBOV-specific T-cell responses for up to 60 months post-prime vaccination with both Ad26-MVA and rVSV, with no decline. Cytokine production analysis identify shared biomarkers between the Ad26-MVA and rVSV groups. In secondary endpoint, we observed an elevation of pro-inflammatory cytokines at Day 7 in the rVSV group. Finally, we establish a correlation between EBOV-specific T-cell responses and anti-EBOV IgG responses. Our findings can guide booster vaccination recommendations and help identify populations likely to benefit from revaccination

Transplantation hépatique orthotopique (molécules de l'immunosuppression et évolution des protocoles thérapeutiques)

CAEN-BU Médecine pharmacie (141182102) / SudocLYON1-BU Santé (693882101) / SudocSudocFranceF

Satisfaction des parents accompagnateurs des enfants de moins de 5 ans pris en charge au centre médical de Kokologho au Burkina Faso

La satisfaction des usagers des centres médicaux (CM) au Burkina Faso n’est pas connue. Notre objectif était d´étudier le niveau de satisfaction et les facteurs associés des parents accompagnateurs des enfants de moins de 5 ans pris en charge au CM de Kokologho en 2018. Il s’est agi d’une étude transversale. Réalisée dans l’aire de santé du CM de Kokologho, les cibles étaient les parents accompagnateurs d’enfants de moins de 5 ans pour l´enquête ménage et pour les entretiens qualitatifs les représentants de la communauté, les agents de santé et les leaders administratifs et coutumiers. Les outils de collecte des données ont été construits à partir des référentiels (SAPHORA-job 2014, conseil Québécois d’Agrément 2005). Des scores de satisfaction, Odds Ratio ajustées et IC95 % ont été calculés. Des analyses thématiques ont été effectuées. Le niveau de satisfaction globale des parents accompagnateurs des enfants pris en charge au CM de Kokologho en 2018 était satisfaisant (70,6 %). Les dimensions étudiées étaient l’accueil (47,2 %), le respect (65,3 %), l’empathie (60,5 %), la confidentialité (73,8 %), la fiabilité (71,9 %), la rapidité (51,4 %), le confort (89,0 %), l’accessibilité géographique (97,5 %) et l’accessibilité financière (28,5 %). Le niveau d’instruction non scolarisé, le sexe féminin et la situation matrimoniale mariée étaient significativement associés à la satisfaction globale des parents. Les usagers sont satisfaits des services du CM de Kokologho. Cependant, des efforts doivent être faits pour améliorer l’accueil, la rapidité de l’offre de service et l’accessibilité financière.Mots-clés: Satisfaction - parents accompagnateurs - enfants - Burkina FasoEnglish AbstractIntroduction: The satisfaction of users of medical centers in Burkina Faso is not known. Our aim was to study the level of satisfaction and associated factors of the accompanying parents of children under five years taken care in Kokologho medical center in 2018. It was a cross-sectional study. Conducted in the Kokologho medical center health area, the targets were the accompanying parents of children under 5 years for the household survey and for the qualitative interviews community representatives, health workers and administrative and community leaders, customary. The data collection tools were built from the repositories (SAPHORA-job 2014, Conseil Québécois d'Agrément 2005). Satisfaction scores, adjusted Odds Ratio and 95% CI were calculated. Thematic analyzes were carried out. The overall level of satisfaction of the parents of the children in the Kokologho medical center in 2018 was satisfactory at 70.6%. The studied dimensions were patient reception (47.2%), respect (65.3%), empathy (60.5%), confidentiality (73.8%), reliability (71.9%), speed (51.4%), comfort (89.0%), geographical accessibility (97.5%) and affordability (28.5%). Level of education gender and marital status were significantly associated with overall parental satisfaction. Users are satisfied with the services in Kokologho medical center. However, to continue the structural transformation efforts of the district health system, efforts must be made to improve reception, speed of service delivery and affordability.Keywords: satisfaction - accompanying parents - children - Burkina Fas

Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study

Background: Current guidelines suggest the introduction of early nutrition support within the first 48 h of admission to the intensive care unit (ICU) for patients who cannot eat. In that context, we aimed to describe nutrition practices in the ICU and study the association between the introduction of early nutrition support ( 3 days were consecutively included and followed for 10 days. Their mortality was assessed at D28. We investigated the association between early nutrition (< 48 h) and mortality at D28 using univariate and multivariate propensity-score-weighted logistic regression analyses. Results: During the study period, 1206 patients were included. Early nutrition support was administered to 718 patients (59.5%), with 504 patients receiving enteral nutrition and 214 parenteral nutrition. Early nutrition was more frequently prescribed in the presence of multiple organ failure and less frequently in overweight and obese patients. Early nutrition was significantly associated with D28 mortality in the univariate analysis (crude odds ratio (OR) 1.69, 95% confidence interval (CI) 1.23–2.34) and propensity-weighted multivariate analysis (adjusted OR (aOR) 1.05, 95% CI 1.00–1.10). In subgroup analyses, this association was stronger in patients ≤ 65 years and with SOFA scores ≤ 8. Compared with no early nutrition, a significant association was found of D28 mortality with early enteral (aOR 1.06, 95% CI 1.01–1.11) but not early parenteral nutrition (aOR 1.04, 95% CI 0.98–1.11). Conclusions: In this prospective cohort study, early nutrition support in the ICU was significantly associated with increased mortality at D28, particularly in younger patients with less severe disease. Compared to no early nutrition, only early enteral nutrition appeared to be associated with increased mortality. Such findings are in contrast with current guidelines on the provision of early nutrition support in the ICU and may challenge our current practices, particularly concerning patients at low nutrition risk. Trial registration ClinicalTrials.gov Identifier: NCT02599948. Retrospectively registered on November 5th 2015.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Pyronaridine–artesunate or dihydroartemisinin–piperaquine versus current first-line therapies for repeated treatment of uncomplicated malaria: a randomised, multicentre, open-label, longitudinal, controlled, phase 3b/4 trial

International audienc

Partnership for Research on Ebola VACcination (PREVAC): protocol of a randomized, double-blind, placebo-controlled phase 2 clinical trial evaluating three vaccine strategies against Ebola in healthy volunteers in four West African countries

International audienceAbstract Introduction The Ebola virus disease (EVD) outbreak in 2014–2016 in West Africa was the largest on record and provided an opportunity for large clinical trials and accelerated efforts to develop an effective and safe preventative vaccine. Multiple questions regarding the safety, immunogenicity, and efficacy of EVD vaccines remain unanswered. To address these gaps in the evidence base, the Partnership for Research on Ebola Vaccines (PREVAC) trial was designed. This paper describes the design, methods, and baseline results of the PREVAC trial and discusses challenges that led to different protocol amendments. Methods This is a randomized, double-blind, placebo-controlled phase 2 clinical trial of three vaccine strategies against the Ebola virus in healthy volunteers 1 year of age and above. The three vaccine strategies being studied are the rVSVΔG-ZEBOV-GP vaccine, with and without a booster dose at 56 days, and the Ad26.ZEBOV,MVA-FN-Filo vaccine regimen with Ad26.ZEBOV given as the first dose and the MVA-FN-Filo vaccination given 56 days later. There have been 4 versions of the protocol with those enrolled in Version 4.0 comprising the primary analysis cohort. The primary endpoint is based on the antibody titer against the Ebola virus surface glycoprotein measured 12 months following the final injection. Results From April 2017 to December 2018, a total of 5002 volunteers were screened and 4789 enrolled. Participants were enrolled at 6 sites in four countries (Guinea, Liberia, Sierra Leone, and Mali). Of the 4789 participants, 2560 (53%) were adults and 2229 (47%) were children. Those < 18 years of age included 549 (12%) aged 1 to 4 years, 750 (16%) 5 to 11 years, and 930 (19%) aged 12–17 years. At baseline, the median (25th, 75th percentile) antibody titer to Ebola virus glycoprotein for 1090 participants was 72 (50, 116) EU/mL. Discussion The PREVAC trial is evaluating—placebo-controlled—two promising Ebola candidate vaccines in advanced stages of development. The results will address unanswered questions related to short- and long-term safety and immunogenicity for three vaccine strategies in adults and children. Trial registration ClinicalTrials.gov NCT02876328 . Registered on 23 August 2016