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Chili : un passé trop vite passé

Article coécrit avec Franck GaudichaudInternational audienceFor many years, the memory of the Pinochet years and their political violence was banished from political and public life, held hostage to the political consensus that was negotiated between civilian society and the army. In 1998, the arrest of the former dictator in London and the ensuing mobilisation of interna- tional opinion changed the score and opened the floodgates of debate around the "official truth" that had been proclaimed by way of reconciliation. From the early 2000s, Pinochet's victims became audible, knocking on the doors of the law-courts, while Unidad Popular, which the regime had tried to banish from the collective memory, gradually returned to the forefront of the political and academic scene.Captive du consensus politique issu de la transition démocratique négociée entre civils et militaires, la mémoire des années Pinochet et de la violence politique qui les accompagna a longtemps été bannie de la vie politique et de l'espace public au Chili. En 1998, l'arrestation de l'ancien dictateur à Londres et la mobilisation internationale qu'elle entraîna ont toutefois changé la donne et permis de discuter la "vérité officielle" qui avait été proclamée en guise de réconciliation dans les premières années de la transition. Depuis le début des années 2000, les voix des victimes sont devenues audibles et frappent aux portes des tribunaux, tandis que l'Unité populaire, que les années Pinochet avaient tenté de bannir de la mémoire collective, revient lentement sur le devant de la scène politique et académique

Géographies de la mobilisation et territoires de la belligérance durant la Premiére Guerre mondiale

Prenant acte du fait que l’histoire globale de la Première Guerre mondiale n’en est encore qu’à ses balbutiements, cet article propose de « déseuropéaniser » l’historiographie du conflit en dépassant la dialectique des « centres » et des « périphéries » et en combinant les échelles spatiales de l’analyse. D’une part, il s’agit de déplacer le regard depuis les théâtres européens de la guerre vers des espaces communément considérés comme marginaux, mais dont l’éloignement de l’épicentre des combats n’empêcha pourtant pas qu’ils soient parcourus de tensions directement liées au conflit et qu’ils connaissent des mutations majeures entre 1914 et 1918. D’autre part, il convient également de placer la focale sur des objets de recherche tels que l’environnement, les ressources naturelles ou les diasporas, qui se prêtent particulièrement bien à des approches émancipées des cadres nationaux de la réflexion et permettent de restituer l’impact global de la Grande Guerre. De cette double démarche émergent ainsi les bases d’une nouvelle géographie des mobilisations et de la belligérance entre 1914 et 1918, susceptible de rendre compte du caractère authentiquement mondial que revêtit la Première Guerre mondiale et de la diversité des expériences vécues du conflit

Utilization of livers donated after circulatory death for transplantation - An international comparison.

BACKGROUND AND AIM Liver graft utilization rates are a hot topic due to the worldwide organ shortage and an increasing number of transplant candidates on waiting lists. Liver perfusion techniques have been introduced in several countries, and may help to increase the organ supply, as they potentially allow the assessment of livers before use. METHODS Liver offers were counted from donation after circulatory death (DCD) donors (Maastricht-type-III) arising during the past decade in eight countries, including Belgium, France, Italy, the Netherlands, Spain, Switzerland, UK, and US. Initial DCD-type-III liver offers were correlated with accepted, recovered and implanted livers. RESULTS A total number of 34`269 DCD livers were offered, resulting in 9`780 liver transplants (28.5%). The discard rates were highest in UK and US, ranging between 70 and 80%. In contrast, much lower DCD liver discard rates, e.g., between 30-40%, were found in Belgium, France, Italy, Spain and Switzerland. In addition, large differences were recognized in the use of various machine perfusion techniques, and in terms of risk factors in the cohorts of implanted livers. For example, the median donor age and functional donor warm ischemia were highest in Italy, e.g., >40minutes, followed by Switzerland, France, and the Netherlands. Importantly, such varying risk profiles of accepted DCD livers between countries did not translate into large differences in five-year graft survival rates, which ranged between 60-82% in this analysis. CONCLUSIONS We highlight a significant number of discarded and consequently unused DCD liver offers. Countries with more routine use of in- and ex-situ machine perfusion strategies showed better DCD utilization rates without compromised outcome. IMPACT AND IMPLICATIONS A significant number of Maastricht type III DCD livers are discarded across Europe and North America today. The overall utilization rate among eight Western countries is 28.5%, but varies significantly between 18.9% and 74.2%. For example, the median DCD III liver utilization in five countries, e.g., Belgium, France, Italy, Switzerland, and Spain is 65%, in contrast to 24% in the Netherlands, UK and US. Despite this, and despite different rules and strategies for organ acceptance and preservation, the one and five-year graft survival remains currently relatively comparable among all participating countries. Factors which impact on DCD liver acceptance rates include the national pre-selections of donors, before the offer is made, as well as cutoffs for key risk factors, including donor age and donor warm ischemia time. In addition, a highly varying experience with modern machine perfusion technology is noticed. In situ and ex situ liver perfusion concepts, and assessment tools for type III DCD livers before transplantation may be one key part for the observed differences in better DCD III utilization

Utilization of mechanical power and associations with clinical outcomes in brain injured patients: a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

Background: There is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes. Methods: In this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required mechanical ventilation (MV) ≥ 24 h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS). Results: We included 1217 patients (mean age 51.2 years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9 J/min [IQR 9.2-15.1], 13 J/min [IQR 10-17], and 14 J/min [IQR 11-20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9 J/min, aRR at 17 J/min was 1.22, 95% CI 1.14-1.30) and HD3 (1.38, 95% CI 1.23-1.53), reintubation on HD1 (1.64; 95% CI 1.57-1.72), and tracheostomy on HD7 (1.53; 95%CI 1.18-1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56-2.78) and HD3 (1.76; 95% CI 1.41-2.22). Conclusions: Exposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation

Chapitre VI. Nouvelles stratégies, nouvelles sociabilités : l’essor des réseaux maritainiens

Introduction La décennie qui mène de la fin de la guerre civile espagnole à la mise en sourdine des polémiques est décisive dans l’histoire du maritainisme en Amérique du Sud. Car au temps du rejet d’une philosophie politique qui mettrait en péril la catholicité latino-américaine correspond également celui de l’appropriation de cette philosophie par ceux qui ont continué, contre vents et marées, à se proclamer les disciples de Maritain. À la manière de ce que nous avons constaté pour les anné..

"Le 68 des catholiques latino-américains dans une perspective transatlantique"

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