Laïcité, fait religieux et société

La laïcité se tourne à nouveau du côté de Durkheim, penseur du fait religieux et de la cohésion sociale. Durkheim a contribué à l'élaboration de la morale laïque de la Troisième République en faisant prévaloir une morale de la société, liée à un socialisme réformiste et à un patriotisme exempt de nationalisme. Cette valorisation de l'existence sociale s'accompagne d'une prise en compte de l'importance capitale de la religion dans la société. Rationaliste convaincu, Durkheim donne accès à une dimension du religieux qui déborde le cadre des Églises et traduit le besoin de la société laïque de se retrouver autour de valeurs communes éprouvées comme sacrées. Le culte de la personne humaine en chacun est au cœur d'un individualisme moral, œuvre de la société démocratique moderne. Loin de légitimer tout ordre social, le parallélisme déconcertant de la divinité et de la société, contribue à une réévaluation de la solidarité, de la passion de la justice et de l'action collective, dans une société où les individus sont appelés à fournir librement les raisons explicatives de leur conduite.La laicidad se vuelve nuevamente hacia Durkheim, pensador del hecho religioso y de la cohesión social. Durkheim ha contribuido a la elaboración de la moral laica de la Tercera República haciendo prevalecer una moral de la sociedad, ligada a un socialismo reformista y a un patriotismo exento de nacionalismo. Esta valorización de la existencia social es acompañada por una toma de conciencia acerca de la importancia capital de la religión en la sociedad. Racionalista convencido, Durkheim se abre a una dimensión de lo religioso que desborda el marco de las iglesias y traduce la necesidad de la sociedad laica de encontrarse en torno de valores comunes experimentados como sagrados. El culto de la persona humana en cada uno está en el centro de un individualismo moral, obra de la sociedad democrática moderna. Lejos de legitimar todo orden social, el paralelismo desconcertante de la divinidad y de la sociedad contribuye a una reevaluación de la solidaridad, de la pasión por la justicia y de la acción colectiva, en una sociedad en la cual los individuos son llamados a proporcionar libremente las razones explicativas de su conducta

Ferdinand Buisson et l’individualisme

L’individualisme trouve naturellement sa place dans une société laïque fondée sur le libre consentement des individus. Ferdinand Buisson qui fut l’un des fondateurs de la laïcité française, a rencontré l’individualisme comme un élément constitutif et contradictoire de la laïcité. Si l’individualisme est récusé lorsqu’il enferme l’individu dans son égoïsme, il accompagne les combats pour la liberté de conscience. La République affranchit l’individu des pressions cléricales et des traditions ancestrales. La morale laïque tente la synthèse de la solidarité et de la responsabilité individuelle. Buisson n’oublie pas que la conviction qui anime le militant laïque est un principe d’individuation. Car chez ce protestant libéral, la visée de l’universalité humaine est portée par des individus singuliers.Individualism naturally finds its place in a secular society based on the free consent of individuals. Ferdinand Buisson, one of the founders of French secularism, understood individualism as both a constitutive and contradictory element of secularism. While he rejected secularism when it imprisoned the individual in his selfish self, he saw it as part and parcel of the struggle for the freedom of conscience. The Republic freed the individual from clerical control and ancestral traditions. Secular morality tried to operate a synthesis between solidarity and individual responsibility. Buisson did not forget that the conviction which motivated the secular activist was a principle of individuation. Indeed, for this liberal Protestant, the vision of human universalism was carried by single individuals.El individualismo encuentra naturalmente su lugar en una sociedad laica fundada en el libre consentimiento de los individuos. Ferdinand Buisson, quien fuera uno de los fundadores de la laicidad fracesa, considera al individualismo como un elemento constitutivo y contradictorio de la laicidad. Si el individualismo es criticado cuando encierra al individuo en su egoísmo, al mismo tiempo acompaña las luchas por la libertad de conciencia. La República libera al individuo de las presiones clericales y de las tradiciones ancestrales. La moral laica intenta la síntesis de la solidaridad y de la responsabilidad individual. Ferdinand Buisson no olvida que la convicción que anima al militante laico es un principio de individuación, ya que este protestante liberal considera que son los individuos singulares en quienes se encarna el alcance de la universalidad humana

Exercise capacity as an independent risk factor for adverse cardiovascular outcomes among nondiabetic and diabetic patients

Introduction: To investigate if decreased exercise capacity is an independent risk factor for major adverse cardiovascular events (MACE) in diabetics and nondiabetics. Material and methods The association of decreased exercise capacity (EC) during a treadmill exercise sestamibi stress test with MACE was investigated in 490 nondiabetics and 404 diabetics. Mean follow-up was 53 months. Results: Nondiabetics with a predicted EC < 85% had a higher prevalence of myocardial ischemia (34% vs. 19%, p = 0.0002), 2- or 3-vessel obstructive coronary artery disease (CAD) (31% vs. 13%, p = 0.016), myocardial infarction (MI) (17% vs. 7%, p = 0.0005), stroke (8% vs. 2%, p = 0.002), death (11% vs. 3%, p = 0.0002), and MI or stroke or death at follow-up (32% vs. 11%, p < 0.001) compared to nondiabetics with a predicted EC ≥ 85%. Diabetics with a predicted EC < 85% had a higher prevalence of myocardial ischemia (48% vs. 32%, p = 0.0009), 2- or 3-vessel obstructive CAD (54% vs. 28%, p = 0.001), MI (32% vs. 14%, p < 0.001), stroke (22% vs. 6%, p < 0.001), death (17% vs. 9%, p = 0.031), and MI or stroke or death at follow-up (65% vs. 27%, p < 0.001). Stepwise Cox regression analysis showed decreased EC was an independent and significant risk factor for MACE among nondiabetics (hazard ratio 3.3, p < 0.0001) and diabetics (hazard ratio 2.7, p < 0.0001). Conclusions: Diabetics and nondiabetics with decreased EC were at increased risk for MACE with nondiabetics and decreased EC at similar risk as diabetics with normal EC

O31 Integrative analysis reveals a molecular stratification of systemic autoimmune diseases

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Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Ferdinand Buisson (1841-1932), militant de la laïcité et de la paix

Ferdinand Buisson introduced the French school laws of the third Republic and chaired the parliamentary commission that prepared the law of 1905 concerning the separation of the Churches and the State. This servant of secularism was also a tireless champion of peace, which was recognized by the Nobel price that he received in 1927. Even though the harshness of the fight for secularism preserved Ferdinand Buisson from irenicism, the ideal of peace continued to inspire the thinking and action of this liberal protestant, who was a top-ranking civil servant of the Republic and the public school.Ferdinand Buisson est l’homme qui mit en place les lois scolaires de la troisième République et présida la commission parlementaire préparatoire à la loi de 1905 portant séparation des Églises et de l’État. Ce serviteur de la laïcité fut aussi un inlassable militant de la paix, consacré par le prix Nobel reçu en 1927. Si l’âpreté du combat laïque a prémuni Ferdinand Buisson de l’irénisme, l’idéal de paix est demeuré l’horizon de pensée et d’action de ce protestant libéral, grand commis de la République et de l’école populaire.Hayat Pierre. Ferdinand Buisson (1841-1932), militant de la laïcité et de la paix. In: Revue d'histoire et de philosophie religieuses, 85e année n°2, Avril-Juin 2005. pp. 235-251