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result(s) for
"Blanc, A.P."
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Differences in HIV cure clinical trial preferences of French people living with HIV and physicians in the ANRS‐APSEC study: a discrete choice experiment
by
Lafeuillade, A.
,
Mora, Marion
,
Ragnaud, J.M.
in
Acquired immune deficiency syndrome
,
AIDS
,
AIDS (Disease)
2020
Introduction Despite the advent of HIV cure‐related clinical trials (HCRCT) for people living with HIV (PLWH), the risks and uncertainty involved raise ethical issues. Although research has provided insights into the levers and barriers to PLWH and physicians' participation in these trials, no information exists about stakeholders' preferences for HCRCT attributes, about the different ways PLWH and physicians value future HCRCT, or about how personal characteristics affect these preferences. The results from the present study will inform researchers' decisions about the most suitable HCRCT strategies to implement, and help them ensure ethical recruitment and well‐designed informed consent. Methods Between October 2016 and March 2017, a discrete choice experiment was conducted among 195 virally controlled PLWH and 160 physicians from 24 French HIV centres. Profiles within each group, based on individual characteristics, were obtained using hierarchical clustering. Trade‐offs between five HCRCT attributes (trial duration, consultation frequency, moderate (digestive disorders, flu‐type syndrome, fatigue) and severe (allergy, infections, risk of cancer) side effects (SE), outcomes) and utilities associated with four HCRCT candidates (latency reactivation, immunotherapy, gene therapy and a combination of latency reactivation and immunotherapy), were estimated using a mixed logit model. Results Apart from severe SE – the most decisive attribute in both groups – PLWH and physicians made different trade‐offs between HCRCT attributes, the latter being more concerned about outcomes, the former about the burden of participation (consultation frequency and moderate SE). These different trades‐offs resulted in differences in preferences regarding the four candidate HCRCT. PLWH significantly preferred immunotherapy, whereas physicians preferred immunotherapy and combined therapy. Despite the heterogeneity of characteristics within the PLWH and physician profiles, results show some homogeneity in trade‐offs and utilities regarding HCRCT. Conclusions Severe SE, not outcomes, was the most decisive attribute determining future HCRCT participation. Particular attention should be paid to providing clear information, in particular on severe SE, to potential participants. Immunotherapy would appear to be the best HCRCT candidate for both PLWH and physicians. However, if the risk of cancer could be avoided, gene therapy would become the preferred strategy for the latter and the second choice for the former.
Journal Article
Differences in HIV cure clinical trial preferences of French people living with HIV and physicians in the ANRS?APSEC study: a discrete choice experiment
by
Lafeuillade, A.
,
Mora, Marion
,
Sagaon?Teyssier, Luis
in
AIDS (Disease)
,
AIDS research
,
Care and treatment
2020
Despite the advent of HIV cure?related clinical trials (HCRCT) for people living with HIV (PLWH), the risks and uncertainty involved raise ethical issues. Although research has provided insights into the levers and barriers to PLWH and physicians' participation in these trials, no information exists about stakeholders' preferences for HCRCT attributes, about the different ways PLWH and physicians value future HCRCT, or about how personal characteristics affect these preferences. The results from the present study will inform researchers' decisions about the most suitable HCRCT strategies to implement, and help them ensure ethical recruitment and well?designed informed consent. Between October 2016 and March 2017, a discrete choice experiment was conducted among 195 virally controlled PLWH and 160 physicians from 24 French HIV centres. Profiles within each group, based on individual characteristics, were obtained using hierarchical clustering. Trade?offs between five HCRCT attributes (trial duration, consultation frequency, moderate (digestive disorders, flu?type syndrome, fatigue) and severe (allergy, infections, risk of cancer) side effects (SE), outcomes) and utilities associated with four HCRCT candidates (latency reactivation, immunotherapy, gene therapy and a combination of latency reactivation and immunotherapy), were estimated using a mixed logit model. Apart from severe SE ? the most decisive attribute in both groups ? PLWH and physicians made different trade?offs between HCRCT attributes, the latter being more concerned about outcomes, the former about the burden of participation (consultation frequency and moderate SE). These different trades?offs resulted in differences in preferences regarding the four candidate HCRCT. PLWH significantly preferred immunotherapy, whereas physicians preferred immunotherapy and combined therapy. Despite the heterogeneity of characteristics within the PLWH and physician profiles, results show some homogeneity in trade?offs and utilities regarding HCRCT. Severe SE, not outcomes, was the most decisive attribute determining future HCRCT participation. Particular attention should be paid to providing clear information, in particular on severe SE, to potential participants. Immunotherapy would appear to be the best HCRCT candidate for both PLWH and physicians. However, if the risk of cancer could be avoided, gene therapy would become the preferred strategy for the latter and the second choice for the former.
Journal Article
Deterministic Exit Time Control Problems With Discontinuous Exit costs
by
Blanc, Alain-Philippe
in
Applied sciences
,
Boundary conditions
,
Computer science; control theory; systems
1997
We study deterministic exit time control problems with discontinuous exit costs. When the exit cost$\\phi$is upper semicontinuous and there is an outer field on the boundary, we show that all the value functions have the same lowersemicontinuous envelope which is the unique lower semicontinuous viscosity solution of the associated Dirichlet problem. We also prove uniqueness results for the generalized Dirichlet problem for first-order Hamilton--Jacobi equations with convex Hamiltonians and with discontinuous boundary conditions, under some nondegeneracy conditions on the Hamiltonians on the boundary.
Journal Article
Cabozantinib in Patients with Advanced and Progressing Hepatocellular Carcinoma
2018
Among patients with hepatocellular carcinoma whose disease had progressed during receipt of sorafenib or other systemic therapy, median overall survival was 10.2 months with cabozantinib and 8.0 months with placebo. High-grade adverse events were as previously noted for the drug.
Journal Article
Can timber provision from Amazonian production forests be sustainable?
2019
Around 30 Mm3 of sawlogs are extracted annually by selective logging of natural production forests in Amazonia, Earth's most extensive tropical forest. Decisions concerning the management of these production forests will be of major importance for Amazonian forests' fate. To date, no regional assessment of selective logging sustainability supports decision-making. Based on data from 3500 ha of forest inventory plots, our modelling results show that the average periodic harvests of 20 m3 ha−1 will not recover by the end of a standard 30 year cutting cycle. Timber recovery within a cutting cycle is enhanced by commercial acceptance of more species and with the adoption of longer cutting cycles and lower logging intensities. Recovery rates are faster in Western Amazonia than on the Guiana Shield. Our simulations suggest that regardless of cutting cycle duration and logging intensities, selectively logged forests are unlikely to meet timber demands over the long term as timber stocks are predicted to steadily decline. There is thus an urgent need to develop an integrated forest resource management policy that combines active management of production forests with the restoration of degraded and secondary forests for timber production. Without better management, reduced timber harvests and continued timber production declines are unavoidable.
Journal Article
Tropical managed Forests Observatory: a research network addressing the future of tropical logged forests
by
Descroix, Laurent
,
Baraloto, Christopher
,
Medjibé, Vincent
in
Biodiversity
,
Bodembiologie
,
Bodembiologie en biologische bodemkwaliteit
2015
While attention on logging in the tropics has been increasing, studies on the long‐term effects of silviculture on forest dynamics and ecology remain scare and spatially limited. Indeed, most of our knowledge on tropical forests arises from studies carried out in undisturbed tropical forests. This bias is problematic given that logged and disturbed tropical forests are now covering a larger area than the so‐called primary forests. A new network of permanent sample plots in logged forests, the Tropical managed Forests Observatory (TmFO), aims to fill this gap by providing unprecedented opportunities to examine long‐term data on the resilience of logged tropical forests at regional and global scales. TmFO currently includes 24 experimental sites distributed across three tropical regions, with a total of 490 permanent plots and 921 ha of forest inventories.
Journal Article