The lack of resources is often highlighted as the most important correlate of poor learning outcomes in developing countries. However, increasing school resources may not necessarily drive better ...learning if resources are not properly translated into learning outcomes. This paper investigates the efficient utilization of school resources to promote learning. It tries to better understand the extent to which efficiency plays a role in the relationship between school resources and learning outcomes. Applying the Data Envelopment Analysis methodology, an efficiency analysis is performed using the PASEC 2014 learning assessment that covers 10 francophone West and Central African countries. The results show that the efficiency of school resource utilization varies across countries and across schools within the same countries. The relationship between some of the key elements of school resources and learning is weak in the least efficient schools. This suggests that resources allocated to the least efficient schools should consider first addressing inefficiency issues. While efficiency drivers may vary depending on the country's specific contexts, findings show that student absenteeism, community engagement in school management, teaching time and school environment seem to play a role in school efficiency.
Monitoring the evolution of polar glaciers, ice caps and ice streams is of utmost importance because they constitute a good indicator of global climate change and contribute significantly to ongoing ...sea level rise. Accurate topographic surveys are particularly relevant as they reflect the geometric evolution of ice masses. Unfortunately, the precision and/or spatial coverage of current satellite missions (radar altimetry, ICESat) or field surveys are generally insufficient. Improving our knowledge of the topography of Polar Regions is the goal of the SPIRIT (SPOT 5 stereoscopic survey of Polar Ice: Reference Images and Topographies) international polar year (IPY) project. SPIRIT will allow (1) the acquisition of a large archive of SPOT 5 stereoscopic images covering most polar ice masses and, (2) the delivery of digital terrain models (DTM) to the scientific community.
Here, we present the architecture of this project and the coverage achieved over northern and southern polar areas during the first year of IPY (July 2007 to April 2008). We also provide the first accuracy assessments of the SPIRIT DTMs. Over Jakobshavn Isbrae (West Greenland), SPIRIT elevations are within ±6 m of ICESat elevations for 90% of the data. Some comparisons with ICESat profiles over Devon ice cap (Canada), St Elias Mountains (Alaska) and west Svalbard confirm the good overall quality of the SPIRIT DTMs although large errors are observed in the flat accumulation area of Devon ice cap. We then demonstrate the potential of SPIRIT DTMs for mapping glacier elevation changes. The comparison of summer-2007 SPIRIT DTMs with October-2003 ICESat profiles shows that the thinning of Jakobshavn Isbrae (by 30–40 m in 4 years) is restricted to the fast glacier trunk. The thinning of the coastal part of the ice stream (by over 100 m) and the retreat of its calving front (by up to 10 km) are clearly depicted by comparing the SPIRIT DTM to an ASTER April-2003 DTM.
Brentuximab vedotin was reported to be effective and safe against refractory/relapsed Hodgkin lymphoma in cohorts of between 12 to 102 patients. Herein we report our retrospective analysis of the ...French experience with brentuximab vedotin used alone to treat 240 refractory/relapsed Hodgkin lymphoma patients enrolled in a named patient program between 2011 and 2013. All patients had histologically documented CD30+ Hodgkin lymphoma; 74% had refractory disease or early relapses. After a median of 3 lines of chemotherapy, brentuximab vedotin was infused intravenously (1.8 mg/kg every 3 weeks). The primary endpoint was best response. Response at the end of treatment, its duration, survival data and toxicity profile were secondary endpoints. Patients received a median of 6 cycles; 68 underwent a consolidation thereafter. The best response was observed after a median of 4 cycles in 145 (60.4%) patients: 33.8% complete response/unconfirmed complete response, 26.7% partial response. Objective responses were observed as decreased (39.3%) in the 28 patients >60 years. The median response duration was 8.4 months. With median follow-up at 16.1 months, median progression-free survival was 6.8 months and this was significantly longer for patients transplanted after brentuximab vedotin (a median of 18,8 months); median overall survival was not reached. No death has been linked to brentuximab vedotin toxicity. The most common adverse events were peripheral sensory neuropathy (29.3%) and hematological toxicity. The results of this analysis support the previously reported brentuximab vedotin efficacy with manageable toxicity. Because of the short-term responses in most patients, a high-dose therapy with stem cell transplantation for responders should be considered as quickly as possible.
Reward-based wildflower strips are the most common approach for pollinator protection in high-income countries. Low- and middle-income countries cannot afford this practice. A promising pilot study ...in Uzbekistan introduced an alternative approach, Farming with Alternative Pollinators, focusing on farmers as target group, marketable habitat enhancement plants and a method-inherent incentive: higher income per surface achieved already in the first year. We hypothesized that higher income would be a replicable enabling factor across continents, but a knowledge-raising campaign would be necessary in many low- and middle-income countries. We assessed the replicability of the incentive with a small number of farmers in 2015-2016 in Morocco but focused on assessing if farmers have sufficient knowledge to recognize wild pollinators and use this approach. We conducted 766 interviews using a standardized questionnaire with randomly selected smallholder farmers in three culturally different farming societies of low- and middle-income countries (Morocco, Turkey and Benin). Farming with Alternative Pollinators induced higher income (75% (2015), 177% (2016)) also in Morocco. The trial and the survey show the indispensability of a knowledge-raising campaign as the second enabling factor. However, based on capacity building, Farming with Alternative Pollinators could have indeed high potential to promote pollinator protection in low- and middle-income countries.
Summary
Allogeneic haematopoietic stem‐cell transplantation (HSCT) is the only curative treatment for myelofibrosis. We report an analysis of the Société Française de Greffe de Moelle et de Thérapie ...Cellulaire (SFGM‐TC) registry including patients with myelofibrosis transplanted between 1997 and 2008. Potential risk factors affecting engraftment, non‐relapse mortality (NRM), overall survival (OS) and progression‐free survival (PFS) were analysed. One hundred and forty‐seven patients, aged 20–68 (median 53) years, diagnosed with primary (53%) or secondary myelofibrosis underwent HSCT; 59% of patients were transplanted from a matched sibling donor. The conditioning regimen was myeloablative in 31% of patients. Ninety percent of the patients engrafted. Factors affecting favourably engraftment were splenectomy before HSCT, human leucocyte antigen (HLA) matched sibling donor, peripheral stem cell use as source of stem cells and absence of pre‐transplant thrombocytopenia. Four‐year OS, PFS and NRM survival were 39% (95%confidence interval CI: 31–50), 32% (95%CI: 24–43) and 39% (95%CI 30–48), respectively. Multivariate analysis indicated that HLA‐identical sibling donor, chronic phase disease and splenectomy in men had favourable impact on OS.
(1) Background: COVID-19 has become a global pandemic and older patients present higher mortality rates. However, studies on the characteristics of this population set are limited. The objective of ...this study is to describe clinical characteristics and outcomes of older patients hospitalized with COVID-19. (2) Methods: This retrospective cohort study was conducted from March to May 2020 and took place in three acute geriatric wards in France. Older patients hospitalized for COVID-19 infections were included. We collected clinical, radiological, and laboratory outcomes. (3) Results: Ninety-four patients were hospitalized and included in the final analysis. Mean age was 85.5 years and 55% were female. Sixty-four (68%) patients were confirmed COVID-19 cases and 30 (32%) were probable. A majority of patients were dependent (77%), 45% were malnourished, and the mean number of comorbidities was high in accordance with the CIRS-G score (12.3 ± 25.6). The leading causes of hospitalization were fever (30%), dyspnea (28%), and geriatric syndromes (falls, delirium, malaise) (18%). Upon follow-up, 32% presented acute respiratory failure and 30% a geriatric complication. Frailty and geriatric characteristics were not correlated with mortality. Acute respiratory failure (
= 0.03) and lymphopenia (
= 0.02) were significantly associated with mortality. (4) Conclusions: Among older patients hospitalized with COVID-19, clinical presentations were frequently atypical and complications occurred frequently. Frailty and geriatric characteristics were not correlated with mortality.
Objectives:
Maternal age has been increasing for several decades with many of these late pregnancies between 40 and 45 years old. The main objective of this study is to assess whether maternal age is ...an independent factor of obstetric, fetal, and neonatal complications.
Patients and methods:
A monocentric, French study “exposed-unexposed” was conducted during 11 years in a maternity level IIB. Maternal and perinatal outcomes were studied using univariates and multivariate analysis. We compared women aged 40 and above in a 1:1 ratio with women of 25–35 years old.
Results:
One thousand nine hundred eighty-two women were 40 or older (mean age: 41.9) on the day of their delivery and compared to other 1,982 women who were aged between 25 and 35 years old (mean age: 30.7) Preeclampsia, gestational diabetes, were significantly higher in the study group (4.6 vs. 1.5% and 14.5 vs. 6.9%, respectively,
p
< 0.001). We found also a significant difference for gestational hypertension (3.1 vs. 1.1%
p
< 0.001), preterm birth (10.4 vs. 6.5%
p
< 0.001), cesarean (16.6 vs. 5.4% for scheduled cesarean, and 50.4 vs. 13.9% for emergency cesarean,
p
< 0.001) and fetal death
in utero
(2.1 vs. 0.5% in the study group,
p
< 0.001). These results were also significantly different in multivariate analysis.
Conclusion:
A pregnancy after 40 years old is worth considering today as far as the risk factors are controlled and understand by the patient and the obstetrician. However, they have a significantly higher risks of cesarean, preterm delivery, pre-eclampsia, gestational diabetes, and fetal death
in utero
(FDIU). It is therefore the responsibility of the obstetrician to inform correctly these women in a detailed way, to reassure them and to adapt the monitoring of their pregnancy accordingly.
The effects of L-asparaginase on hemostasis during induction chemotherapy are less defined in adults than in children. We, therefore, studied the effects of L-asparaginase in adult patients.
This was ...a retrospective analysis of 214 patients treated with L-asparaginase (7500 IU/m(2) x 6) for acute lymphoblastic leukemia or lymphoblastic lymphoma. Between day 1 of the induction course and discharge, clinical events, and biological and therapeutic modifications were reviewed.
Antithrombin and fibrinogen levels were lower than 60% and 1 g/L in 71% and 73% of patients, respectively. Twenty thromboses occurred in 9.3% of the patients; these patients had a median antithrombin level of 53% (range, 21-111) at the time of the event. Forty-two episodes of bleeding occurred in 31 patients with a median fibrinogen level of 1.3 g/L. Infusions of L-asparaginase were reduced or delayed in 64% of patients due to low fibrinogen and/or antithrombin levels. Fresh-frozen plasma, antithrombin and fibrinogen were infused in 31%, 41% and 52% of patients, respectively. The mean antithrombin and fibrinogen levels increased from 61% to 88% and from 1 to 1.4 g/L after infusion of antithrombin or fibrinogen respectively, while both levels remained unchanged after the infusion of fresh-frozen plasma. In patients who received antithrombin concentrates L-asparaginase injections were less frequently omitted or delayed (53% vs. 72%, p=0.005), the rate of thrombosis was lower (4.8% vs. 12.2%, p=0.04) and the disease-free survival was also reduced (p=0.05).
This retrospective study suggests that antithrombin concentrates may have a beneficial effect on the outcome of adults treated for acute lymphoblastic leukemia with L-asparaginase; prospective studies are essential to confirm this hypothesis.
Unrelated allogeneic transplantation for severe aplastic anemia is a treatment option after immunosuppressive treatment failure in the absence of a matched sibling donor. Age, delay between disease ...diagnosis and transplantation, and HLA matching are the key factors in transplantation decisions, but their combined impact on patient outcomes remains unclear. Using the French Society of Bone Marrow Transplantation and Cell Therapies registry, we analyzed all consecutive patients (n=139) who underwent a first allogeneic transplantation for idiopathic severe aplastic anemia from an unrelated donor between 2000 and 2012. In an adjusted multivariate model, age over 30 years (Hazard Ratio=2.39; P=0.011), time from diagnosis to transplantation over 12 months (Hazard Ratio=2.18; P=0.027) and the use of a 9/10 mismatched unrelated donor (Hazard Ratio=2.14; P=0.036) were independent risk factors that significantly worsened overall survival. Accordingly, we built a predictive score using these three parameters, considering patients at low (zero or one risk factors, n=94) or high (two or three risk factors, n=45) risk. High-risk patients had significantly shorter survival (Hazard Ratio=3.04; P<0.001). The score was then confirmed on an independent cohort from the European Group for Blood and Marrow Transplantation database of 296 patients, with shorter survival in patients with at least 2 risk factors (Hazard Ratio=2.13; P=0.005) In conclusion, a simple score using age, transplantation timing and HLA matching would appear useful to help physicians in the daily care of patients with severe aplastic anemia.
Objectives and methods
Chronic myelomonocytic leukemia (CMML) is a severe disease for which allogeneic stem cell transplantation (allo‐SCT) remains the only potentially curative treatment. We ...describe a retrospective study determining prognostic factors for outcome after allo‐SCT in consecutive 73 patients with CMML reported to the SFGM‐TC registry between 1992 and 2009.
Results
At diagnosis, median age was 53 yrs, and 36% patients had palpable splenomegaly (SPM). 48, 13, and 9 patients had good, intermediate, and poor risk karyotype, respectively, according to IPSS, 61% patients had CMML‐1, and 39% had CMML‐2. 41/31/1 cases had an HLA‐identical sibling, an unrelated and haploidentical donor, respectively. 43 patients received reduced‐intensity conditioning. With a median follow‐up of 23 month, acute grade 2–4 and chronic GVHD developed in 21 and 25 patients, respectively. The 3‐year OS, NRM (non‐relapse mortality),EFS, and CIR (cumulative incidence of relapse) were 32%, 36%, 29% and 35%, respectively. OS was not influenced by the CR status, marrow blasts% at allo‐SCT, prior treatments, and cGVHD. Using multivariate analysis, year of transplant < 2004 (YOT) (P = 0.005) was associated with higher NRM, YOT < 2004 (P = 0.04) and SPM at allo‐SCT (P = 0.02) with lower EFS, and YOT < 2004 (P = 0.03) and SPM at allo‐SCT (P = 0.04) with poorer OS.
Conclusions
Allogeneic stem cell transplantation is a valid treatment option for patients with CMML, and its outcome has improved with YOT > 2004. Splenomegaly seems to be a negative factor of OS and EFS in this series.
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