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Brasser les milliards de l’État grâce au carrousel de la TVA : un guide pratique avec la série D’argent et de sang de Xavier Giannoli
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A Randomized clinical trial evaluating the impact on survival and quality of life of 177Lutetium[Lu]-edotreotide versus everolimus in patients with neuroendocrine tumors of the lung and thymus: the LEVEL study (GETNE T-2217)
No full textInternational audienceBackground: Everolimus is the only approved therapy for patients with advanced neuroendocrine tumors (NET) of lung and thymus and new treatment options are urgently needed. Expression of somatostatin receptor 2 (SSTR2) is frequently seen in functional imaging in lung-NETs opening the opportunity to treat SSTR2 positive patients with radioligand therapies (RLT). Retrospective data suggest a potential meaningful benefit of RLT directed to SSTR2 in lung-NET patients.Methods: The LEVEL trial is a randomized, open-label, phase III international trial of 177Lu-edotreotide versus everolimus in patients with progressive, locally advanced or metastatic, and well/moderately differentiated NETs of lung (typical/atypical) or thymic origin. Patients could be treatment-naïve or have progressed (PD) on somatostatin analogues or ≤ 2 additional systemic treatments. Prior RLT or mTOR inhibitors are not permitted. Eligible patients are randomly assigned 3:2 to 6 cycles of 177Lu-edotreotide (total administered activity 7.5 ± 0.7 GBq / cycle) or to oral everolimus 10 mg once daily until PD or unacceptable toxicity. Only patients with positivity in somatostatin receptor imaging will be included. CT or MRI scans are performed every 12 weeks until PD. Blood samples are analyzed at baseline, at 1st tumor assessment, and at PD for pharmacodynamic endpoints. Archival tumor tissue samples will be analyzed for ancillary studies. The primary endpoint is progression-free survival (PFS) according to RECIST v1.1 based on local investigator assessment. Secondary endpoints include overall survival, overall response rate, safety, and quality of life (EORTC QLQ-C30). The expected sample size is 120 patients to demonstrate statistical significant risk reduction of 46.4% (HR = 0.536) in PFS with the experimental treatment using an overall 5% two-sided alpha error with 80% power. An interim PFS analysis was included using the Lan-DeMets with O'Brian-Fleming-like boundaries.Discussion: The LEVEL trial will investigate if 177Lu-edotreotide has the potential to be incorporated as a standard treatment option for patients with NETs from the lung and Thymus
Archives d'en bas : de la constitution à l'institutionnalisation
No full textPublication issue d'une journée d'étude "Archives d'en bas. Matri·patrimoines archivistiques et matri·patrimonialisation France/Canada" (2022 : Québec, Québec; Angers, France).International audienceSi le terme « patrimoine » amène immédiatement de nombreuses références, à l’exception des archives,le mot « archives », de son côté, mobilise un panel d’images associées rarement liées à l’idée de patrimoine. Généralement, les archives sont identifiées à la preuve, à la recherche historique et à la mémoire, ce qui tend à les distinguer de l’objet patrimonial. Toutefois, un dialogue entre les deux notions est possible quand les archives sont appréhendées plus largement à partir de leurs usages. Les journées d’étude « Archives d’en bas. Matri·patrimoines archivistiques et matri·patrimonialisation », tenues en juin 2022, à l’Université Laval (Québec) et à l’Université d’Angers (France), proposaient de s’intéresser à la patrimonialisation d’archives en dehors des institutions archivistiques. L’accent était mis sur les projets d’archivage, les acteurs, les stratégies, les politiques d’accompagnement, les pratiques et les ensembles archivistiques sous l’angle de la constitution de patrimoines sociaux ou ordinaires.Les textes réunis ici représentent, par des études de cas, une contribution à la pensée sur les archives par en bas pour l’archivistique francophone. Les réflexions s’organisent autour de deux notions principales. D’une part, l’autodétermination (empowerment) des groupes par la constitution d’archives d’associations ou par la collecte et l’exploitation des archives militantes. D’autre part, l’institutionnalisation, en mettant en lumière le chemin ambigu qui mène, ou non, à l’intégration des archives au sein d’institutions traditionnelles de conservation
Risk measures beyond quantiles
No full textInternational audienceThe use of quantiles forms the basis of the overwhelming majority of current risk management procedures. Yet, there exist alternative instruments of risk protection that are not (unlike quantiles) based solely on the frequency of tail observations and instead take their severity into account, while adhering to axiomatic requirements. These alternative risk measures have seen increasing interest in the past decade. The current state of development of risk measures beyond quantiles is discussed with a particular focus on three prominent classes: (i) Expected Shortfall (ES) and extremiles, part of the class of spectral and distortion risk measures, (ii) expectiles, which constitute a particular case of generalized M-quantiles, and (iii) systemic risk measures including Marginal Expected Shortfall (MES). A structured overview of their strengths and weaknesses with respect to axiomatic theory, estimation properties, and ease-of-use by risk practitioners will be given. In addition, challenges arising in the asymptotics and mathematical developments will be discussed and the use of each of the ES, extremile, expectile and MES risk measures will be illustrated with real data applications to storm losses in China, tornado losses in the United States, and financial returns series
Protéger la santé des riverains de carrières « au-delà des poussières sédimentables »
No full textInternational audienceThere are a number of health risks for people living near quarries, mainly respiratory and cardiovascular. These primarily result from airborne exposure to dust and other pollutants generated by the extraction of materials and processing activities. Protecting the health of residents is a public health issue and should be based on an integrated approach combining regulations, dust monitoring, community commitments, prevention programmes, and research. This approach should provide a framework for action by stakeholders, enabling them to meet the challenges they face in terms of preventing and controlling health risks for these populations. To this end, it is necessary to consider the mineralogical and chemical composition of these dusts, the associated health risks, and the various avenues for action. Based on the state of knowledge of these various topics, the French regulatory framework for dust monitoring should be reviewed from both a technical and an implementation standpoint. Recommendations are made to better protect the health of people living near quarries.Les risques sanitaires encourus par les personnes vivant à proximité des carrières sont multiples, principalement respiratoires et cardiovasculaires, qui découlent avant tout de l’exposition par voie aérienne aux poussières et autres polluants générés par les activités d’extraction et de traitement des matériaux. La protection de la santé des riverains relève de la sécurité sanitaire et devrait reposer sur une approche intégrée combinant réglementation, surveillance des poussières, engagement communautaire, programme de prévention et recherche, constituant ainsi un cadre d’action pour les parties prenantes pour relever les enjeux en termes de prévention et de contrôle des risques sanitaires pour ces populations. Pour cela, il est nécessaire de prendre en compte la composition minéralogique et chimique de ces poussières, les risques sanitaires qui leur sont associés et les différents leviers en termes d’action. Au regard des connaissances relatives à ces différents aspects, il apparaît que le dispositif réglementaire français de surveillance des poussières mérite d’être repensé tant du point de vue technique que dans ses modalités de mise en œuvre. Des recommandations sont formulées en ce sens pour mieux protéger la santé des riverains de carrière
Mareare in mari, edere in castro. Approvisionnement et consommation des animaux marins dans les résidences élitaires d’Aquitaine au Moyen Âge (Xe–XVe siècle)
No full textInternational audienc
E-bikes and travel behaviour change: systematic review of experimental studies with meta-analyses
No full textInternational audienceTransitioning from private cars to active modes of transport is key to reducing transport related greenhouse gases emissions and promoting physical activity. Electrically assisted bicycles, often referred to as e-bikes, play a pivotal role in facilitating this shift. However, the environmental and health benefits of e-bikes depend on the modes they substitute, with the highest benefits obtained when private cars are replaced. This systematic review and meta-analysis targets quasi-experimental (i.e. pre–post measures of travel behaviours without control group) and experimental (i.e. pre–post measures of travel behaviours with control groups) studies assessing the impact of acquiring an e-bike on overall travel behaviour changes expressed in both distances and mode share (in % of kilometres travelled). Ten studies, all conducted in Northern Europe, were included. Results from the narrative synthesis and meta-analysis show that: (i) when participants have access to an e-bike, either through a free loan programme or a purchase, they engage in e-cycling; the meta-analysis reveals a significant difference of 5 km travelled daily after the interventions between participants that got access to an e-bike compared to those from control groups with no e-bikes, reflecting a substantial increase of 26% in e-bike mode share; (ii) e-bikes can substitute for all other modes of transport, but car use appears to be the most affected in both the systematic review and meta-analyses difference (2.4 km fewer travelled per day by car between the intervention and control groups at follow-up, reflecting to a 10% decrease in car mode share); (iii) baseline travel behaviours may influence modal shift, with e-bikes substituting for the most prevalent means of transport in baseline. E-bikes have the potential to be a reliable and competitive alternative to cars in a healthier and more sustainable transport system and our study brings new empirical evidence to support this claim
Snowmaking's slippery slope: The effect of mountain reservoirs on water demand
No full textInternational audienceSnowmaking is the primary adaptation of winter tourism to climate change and requires increased water use in winter. However, water withdrawals during this period coincide with the mountain low-flow period, which can potentially cause conflicts with other human uses and ecosystems. To address concerns about water availability, the number of reservoirs is increasing. Ski lift operators promote these reservoirs as environmentally beneficial under their 'ecological engagement' commitments, arguing that they reduce the impact of snowmaking by shifting some water withdrawals to periods outside the low-flow season. In theory, mountain reservoirs should therefore support both economic activity and environmental sustainability. Using econometric analysis of data from 35 ski resorts across nine seasons, we show that reservoirs significantly increase water withdrawals during the low-flow period. By employing maximum likelihood estimation of fixed-effects dynamic panel data models, we find that a 1 % increase in reservoir capacity leads to a 0.28 % short-term increase in low-flow withdrawals (0.4 % in the long term), ceteris paribus. These findings inform ongoing discussions to ensure that current socioeconomic decisions do not lead to future water use conflicts in mountain socio-ecological systems
Explosion speed of continuous state branching processes indexed by the Esscher transform
No full textA branching process Z is said to be non conservative if it hits ∞ in a finite time with positive probability. It is well known that this happens if and only if the branching mechanism ϕ of Z satisfies 0+ dλ/|ϕ(λ)| < ∞. We construct on the same probability space a family of conservative continuous state branching processes Z (ε) , ε ≥ 0, each process Z (ε) having ϕ (ε) (λ) = ϕ(λ + ε) -ϕ(ε) as branching mechanism, and such that the family Z (ε) , ε ≥ 0 converges a.s. to Z, as ε → 0. Then we study the speed of convergence of Z (ε) , when ε → 0, referred to here as the explosion speed. More specifically, we characterize the functions f with lim ε→0 f (ε) = ∞ and such that the first passage times σ ε = inf{t : Z (ε) t ≥ f (ε)} converge toward the explosion time of Z. Necessary and sufficient conditions are obtained for the weak convergence and convergence in L 1 . Then we give a sufficient condition for the almost sure convergence.</div
Vécu des kinésithérapeutes en services d’urgences hospitalières : une enquête qualitative
No full textInternational audienceIntroduction. -The experiences of emergency physiotherapists (E-PT) have been extensively documented in English-speaking countries but not in France. This study aimed to describe the roles of E-PT and the associated obstacles and facilitators. Method. -Semi-directive interviews were carried out with E-PT. The interviews were transcribed and analysed to defi ne themes (sub-themes) using an inductive phemenological approach.Results. -Eleven E-PT were interviewed. Four main themes emerged: a wide variety of activities carried out by French E-PT, with respiratory and geriatric chief complaints (theme 1); E-PT requires expertise (theme 2); lack of awareness of E-PT abilities, visibility within the ED and the defi nition of 'E-PT' were seen as obstacles (theme 3); communication, the development of research and rethinking organisational aspects were mentioned as facilitators (theme 4). Discussion. -E-PT are involved in multiple situations, where they provide added value to the ED staff, in a highly specifi c, multidisciplinary environment, under pressure. These fi ndings are consistent with those in the literature. However, the delivery of E-PT for musculoskeletal/traumatic reasons is limited.</div