Un campus en mouvement : Les pratiques de mobilité des étudiant-e-s et du personnel de l'Université de Lausanne

Les universités génèrent d’importants flux de mobilité et la gestion des transports constitue un défi majeur pour leur fonctionnement. Cette recherche aborde cette problématique dans le cas de l’Université de Lausanne. Dans un premier temps, l’étude porte sur l’évolution du campus et de son accessibilité. Elle montre comment ce site suburbain a été relié au reste de l’agglomération et aborde les mesures prises pour réguler la mobilité. Deuxièmement, elle s’intéresse à la demande, soit aux choix modaux des 18’000 personnes qui travaillent et étudient à l’Université de Lausanne. Des enquêtes réalisées chaque année depuis 2005 permettent de mesurer les pratiques de mobilité et les différences au sein de la communauté universitaire. En conclusion sont esquissées les tendances qui influenceront à terme les flux de mobilité à destination du campus

Neoadjuvant eribulin mesylate following anthracycline and taxane in triple negative breast cancer: Results from the HOPE study

Background Eribulin mesylate (E) is indicated for metastatic breast cancer patients previously treated with anthracycline and taxane. We argued that E could also benefit patients eligible for neoadjuvant chemotherapy. Methods Patients with primary triple negative breast cancer 2 cm received doxorubicin 60 mg/m2 and paclitaxel 200 mg/m2 x 4 cycles (AT) followed by E 1.4 mg/m2 x 4 cycles. Primary endpoint was pathological complete response (pCR) rate; secondary and explorative endpoints included clinical/metabolic response rates and safety, and biomarker analysis, respectively. Using a two-stage Simon design, 43 patients were to be included provided that 4 of 13 patients had achieved pCR in the first stage of the study. Results In stage I of the study 13 women were enrolled, median age 43 years, tumor size 2–5 cm in 9/13 (69%), positive nodal status in 8/13 (61%). Main grade 3 adverse event was neutropenia (related to AT and E in 4 and 2 cases, respectively). AT followed by E induced clinical complete + partial responses in 11/13 patients (85%), pCR in 3/13 (23%). Median measurements of maximum standardized uptake value (SUVmax) resulted 13, 3, and 1.9 at baseline, after AT and E, respectively. Complete metabolic response (CMR) occurred after AT and after E in 2 and 3 cases, respectively. Notably, 2 of the 5 (40%) patients with CMR achieved pCR at surgery. Immunostaining of paired pre-/post-treatment tumor specimens showed a reduction of β-catenin, CyclinD1, Zeb-1, and c-myc expression, in the absence of N-cadherin modulation. The study was interrupted at stage I due to the lack of the required patients with pCR. Conclusions Despite the early study closure, preoperative E following AT showed clinical and biological activity in triple negative breast cancer patients. Furthermore, the modulation of β-catenin pathway core proteins, supposedly outside the domain of epithelial–mesenchymal transition, claims for further investigation. Trial registration EU Clinical Trial Register, EudraCT number 2012-004956-12

Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study

Objectives: To report mastectomy and reoperation rates in women who had breast MRI for screening (S-MRI subgroup) or diagnostic (D-MRI subgroup) purposes, using multivariable analysis for investigating the role of MRI referral/nonreferral and other covariates in driving surgical outcomes. Methods: The MIPA observational study enrolled women aged 18–80 years with newly diagnosed breast cancer destined to have surgery as the primary treatment, in 27 centres worldwide. Mastectomy and reoperation rates were compared using non-parametric tests and multivariable analysis. Results: A total of 5828 patients entered analysis, 2763 (47.4%) did not undergo MRI (noMRI subgroup) and 3065 underwent MRI (52.6%); of the latter, 2441/3065 (79.7%) underwent MRI with preoperative intent (P-MRI subgroup), 510/3065 (16.6%) D-MRI, and 114/3065 S-MRI (3.7%). The reoperation rate was 10.5% for S-MRI, 8.2% for D-MRI, and 8.5% for P-MRI, while it was 11.7% for noMRI (p ≤ 0.023 for comparisons with D-MRI and P-MRI). The overall mastectomy rate (first-line mastectomy plus conversions from conserving surgery to mastectomy) was 39.5% for S-MRI, 36.2% for P-MRI, 24.1% for D-MRI, and 18.0% for noMRI. At multivariable analysis, using noMRI as reference, the odds ratios for overall mastectomy were 2.4 (p < 0.001) for S-MRI, 1.0 (p = 0.957) for D-MRI, and 1.9 (p < 0.001) for P-MRI. Conclusions: Patients from the D-MRI subgroup had the lowest overall mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). This analysis offers an insight into how the initial indication for MRI affects the subsequent surgical treatment of breast cancer. Key Points: • Of 3065 breast MRI examinations, 79.7% were performed with preoperative intent (P-MRI), 16.6% were diagnostic (D-MRI), and 3.7% were screening (S-MRI) examinations. • The D-MRI subgroup had the lowest mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). • The S-MRI subgroup had the highest mastectomy rate (39.5%) which aligns with higher-than-average risk in this subgroup, with a reoperation rate (10.5%) not significantly different to that of all other subgroups

Residual capacity of a reinforced concrete grillage deck exposed to corrosion

Grillage decks made of reinforced concrete (RC) with more than 40–60 years of service life may exhibit localised areas of severe damage or even entire elements exceeding the serviceability limits. In these cases, it is essential to quickly and efficiently assess the structure’s safety margins, and, in the worst cases, to also verify whether the damaged deck’s residual bearing capacity is sufficient for it to be used as a platform for the repair works. This article proposes an assessment based on a non-linear RC finite element specialised in dealing with systems working in bending and torsion. The damage, measured at a particular time after construction, is modelled by a reduction of the reinforcement section, supposed to be induced by chlorides diffusion and investigated through a Cellular Automata algorithm. Such an approach is applied in studying a bridge deck, having an edge beam damaged by leakage of salted water from the road platform. The results give a thorough description of the structural behaviour and the deformed shapes help in understanding the redistribution process of the internal forces. These results may provide a reliable reference to plan proper maintenance actions as well as to establish a hierarchy of repairing and strengthening interventions

Nonlinear Analysis of a R.C. grillage deck exposed to corrosion

In this paper, an approach consisting in the analysis of the diffusion of the deterioration processes induced by aggressive agents, followed by the analysis of the damaged structure is presented. The damage process, induced by chloride diffusion, is modelled through a Cellular Automata algorithm. The structural analysis is based on R.C. spatial beam element, dealing with both mechanical and geometrical nonlinearities. The proposed method is applied to studying the structural response, both at the serviceability and ultimate limit states, of a damaged, 50-years-old R.C. grillage deck exhibiting a severe corrosion state. The analyses show how damage effects at a given time reduce the overall bearing capacity of the deck and how the internal forces redistribute from damaged to undamaged structural parts. Such a methodology may be useful both in designing new bridges, in estimating their performance over time under given environmental and service condition, and for existing bridges, in assessing their residual bearing capacity in the damaged state after a certain period from constructio

Early stage breast cancer follow-up in real-world clinical practice: the added value of cell free circulating tumor DNA

Purpose Physical examinations and annual mammography (minimal follow-up) are as effective as laboratory/imaging tests (intensive follow-up) in detecting breast cancer (BC) recurrence. This statement is now challenged by the availability of new diagnostic tools for asymptomatic cases. Herein, we analyzed current practices and circulating tumor DNA (ctDNA) in monitoring high-risk BC patients treated with curative intent in a comprehensive cancer center. Patients and methods Forty-two consecutive triple negative BC patients undergoing neoadjuvant therapy and surgery were prospectively enrolled. Data from plasma samples and surveillance procedures were analyzed to report the diagnostic pattern of relapsed cases, i.e., by symptoms, follow-up procedures and ctDNA. Results Besides minimal follow-up, 97% and 79% of patients had at least 1 non-recommended imaging and laboratory tests for surveillance purposes. During a median follow-up of 5.1(IQR, 4.1-5.9) years, 13 events occurred (1 contralateral BC, 1 loco-regional recurrence, 10 metastases, and 1 death). Five recurrent cases were diagnosed by intensive follow-up, 5 by symptoms, and 2 incidentally. ctDNA antedated disseminated disease in all evaluable cases excepted two with bone-only and single liver metastases. The mean time from ctDNA detection to suspicious findings at follow-up imaging was 3.81(SD, 2.68), and to definitive recurrence diagnosis 8(SD, 2.98) months. ctDNA was undetectable in the absence of disease and in two suspected cases not subsequently confirmed. Conclusions Some relapses are still symptomatic despite the extensive use of intensive follow-up. ctDNA is a specific test, sensitive enough to detect recurrence before other methods, suitable for clarifying equivocal imaging, and exploitable for salvage therapy in asymptomatic BC survivors

Circulating tumor cell clusters are frequently detected in women with early-stage breast cancer

The clinical relevance of circulating tumor cell clusters (CTC-clusters) in breast cancer (BC) has been mostly studied using the CellSearch\uae, a marker-dependent method detecting only epithelial-enriched clusters. However, due to epithelial-to-mesenchymal transition, resorting to marker-independent approaches can improve CTC-cluster detection. Blood samples collected from healthy donors and spiked-in with tumor mammospheres, or from BC patients, were processed for CTC-cluster detection with 3 technologies: CellSearch\uae, CellSieve\u2122 filters, and ScreenCell\uae filters. In spiked-in samples, the 3 technologies showed similar recovery capability, whereas, in 19 clinical samples processed in parallel with CellSearch\uae and CellSieve\u2122 filters, filtration allowed us to detect more CTC-clusters than CellSearch\uae (median number = 7 versus 1, p = 0.0038). Next, samples from 37 early BC (EBC) and 23 metastatic BC (MBC) patients were processed using ScreenCell\uae filters for attaining both unbiased enrichment and marker-independent identification (based on cytomorphological criteria). At baseline, CTC-clusters were detected in 70% of EBC cases and in 20% of MBC patients (median number = 2, range 0\u201320, versus 0, range 0\u201315, p = 0.0015). Marker-independent approaches for CTC-cluster assessment improve detection and show that CTC-clusters are more frequent in EBC than in MBC patients, a novel finding suggesting that dissemination of CTC-clusters is an early event in BC natural history