Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Le paysage politique pour territorialiser l’action publique et les projets de développement : le cas de l’éolien au Québec

Industries and large infrastructures have been seen as a source of development for decades. This idea is although put into test by opponents of such projects. This paper is looking at conflicts raising around wind farms’ projects in eastern Canada. First, we will describe the settlement of this renewable energy in the province of Quebec, trough four phases. By doing so, we try to demonstrate that the conflicts gave rise to new planning practices supported by public authorities. We shall underline changes noticeable in regard of more classic practices in landscape domain. We will then discuss the questions that still remain concerning experts knowledge and governance practices. To conclude, we will underline how research investing political dimensions of landscape combined to regional studies could offer an understanding of relationships between modern societies and productive activities

Le paysage politique pour territorialiser l’action publique et les projets de développement : le cas de l’éolien au Québec

Industries and large infrastructures have been seen as a source of development for decades. This idea is although put into test by opponents of such projects. This paper is looking at conflicts raising around wind farms’ projects in eastern Canada. First, we will describe the settlement of this renewable energy in the province of Quebec, trough four phases. By doing so, we try to demonstrate that the conflicts gave rise to new planning practices supported by public authorities. We shall underline changes noticeable in regard of more classic practices in landscape domain. We will then discuss the questions that still remain concerning experts knowledge and governance practices. To conclude, we will underline how research investing political dimensions of landscape combined to regional studies could offer an understanding of relationships between modern societies and productive activities

La "qualité" du bassin d'Arcachon. De quoi parlons-nous? Trois enquêtes croisées auprès d'acteurs et d'usagers.

International audienc

L’écologisation, mise à l’épreuve ou nouveau registre de légitimation de l’ordre territorial ?: Une lecture à partir des particularités du débat conceptuel en France

International audienceOur aim is to contribute to a debate, initially framed in the french context, on how dominant principles of « territorialization » may be undergoing an ecological turn. Drawing on a critical review of the literature, we propose first an analytical framework built around three major nodes of the debate : materialities, narratives, organizations. We then test this framework on a diversity of case study areas, explored in the context of our respective research works. This leads us to identify three archetypical settings of the territorial effects of « greening » processes : « a-territorial », « alibi », « emancipatory ». We end by discussing how « greening » unevenly triggers and combines the tenets of territorialization, whether by consolidating or challenging the current « territorial order ».Notre objectif est de contribuer au débat concernant le renouvellement des principes de la territorialisation par l’écologisation, tel qu’engagé en France. Dans un premier temps, une revue critique de la littérature nous permet de construire une grille d’analyse autour de trois nœuds majeurs de ce débat : matérialité, récit et organisation d’acteurs. Dans un deuxième temps, nous éprouvons cette grille d’analyse sur une diversité de terrains explorés dans le cadre de nos recherches respectives. Ceci nous conduit à proposer trois configurations des effets territoriaux de l’écologisation : « a-territoriale », « alibi » et « émancipatrice ». Enfin, nous mettons en discussion la façon dont l’écologisation active et combine de manière différenciée les ressorts de la territorialisation, entre persistance et dépassement de l’ordre territorial

Quelle adaptation pour les sociétés riveraines des environnements fluvio-estuariens ? Trois regards sur les enjeux des étiages et inondations en Garonne-Gironde

[Departement_IRSTEA]Territoires [TR1_IRSTEA]DTAM [Axe_IRSTEA]DTAM-QT2-ADAPTATIONInternational audiencePrésentation du contexte de la recherche et des adaptations possibles