A strategy for monitoring systemic vulnerability to marine erosion and flooding

Littoralisation, or the concentration of people and activities in coastal areas, associated with the intrinsic mobility of coasts and with the context of climate change, tends to increase the vulnerability of coastal areas. This article presents a new interdisciplinary approach towards the concept of vulnerability that makes it possible to move beyond the nature/society dichotomy, and an inter-sectorial researcher-manager method for the development of a series of monitoring indicators for the four components of systemic vulnerability: hazards, stakes, management and representations. These indicators are precursors of an integrated observatory that will act as a source of data for research and inform public policy for coastal areas.Le phénomène de littoralisation du peuplement et des activités, associé à la mobilité intrinsèque des côtes et au contexte de changement climatique, tend à accroître la vulnérabilité des territoires côtiers. Cet article propose, d’une part, une approche interdisciplinaire renouvelée du concept de vulnérabilité permettant de dépasser la dichotomie nature/société. D’autre part, il présente une méthode intersectorielle chercheurs-gestionnaires de construction d’une série d’indicateurs de suivi des quatre composantes de la vulnérabilité systémique (aléa, enjeux, gestion et représentations). Ces indicateurs préfigurent un observatoire intégré, à la fois source de données pour la recherche, et au service des politiques publiques pour les territoires côtiers

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

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/)

A method for monitoring systemic vulnerability to marine erosion and sea-flooding

Coastal development, combined with the intrinsic mobility of coasts and the context of climate change, tends to increase the vulnerability of coastal territories. This article proposes, on one hand, a renewed interdisciplinary approach to the concept of vulnerability allowing to overcome the nature/society dichotomy. On the other hand, the paper presents an inter-sectoral researchers-managers approach to build a series of indicators to monitor the four components of systemic vulnerability (hazards, stakes, management and representations). These indicators lay the ground for an integrated observatory, source of data for research as well as to inform decisions regarding the adaptation of coastal territories.Le phénomène de littoralisation du peuplement et des activités, associé à la mobilité intrinsèque des côtes et au contexte de changement climatique, tend à accroître la vulnérabilité des territoires côtiers. Cet article propose, d’une part, une approche interdisciplinaire renouvelée du concept de vulnérabilité permettant de dépasser la dichotomie nature/société. D’autre part, il présente une méthode intersectorielle chercheurs-gestionnaires de construction d’une série d’indicateurs de suivi des quatre composantes de la vulnérabilité systémique (aléa, enjeux, gestion et représentations). Ces indicateurs préfigurent un observatoire intégré, à la fois source de données pour la recherche, et au service des politiques publiques pour les territoires côtiers

Une méthode de suivi de la vulnérabilité systémique à l’érosion et la submersion marines

International audienc

MOSAICISM IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE : A COMPREHENSIVE CLINICAL AND RADIOLOGICAL DESCRIPTION OF 15 CASES

International audienc

A candidate gene approach of the calcineurin pathway to identify variants associated with clinical outcomes in renal transplantation

© 2016 Future Medicine Ltd.Aim: To investigate the potential influence of variants in genes involved in the calcineurin pathway on the efficacy and toxicity of calcineurin inhibitors in renal transplantation. Materials & methods: Twenty-three polymorphisms in thirteen genes were tested in 381 renal transplant recipients receiving ciclosporin (n = 221) or tacrolimus (n = 160) and mycophenolate mofetil. Data were collected prospectively over the first year post-transplantation. Results: Multivariate survival analyses revealed no genetic associations with biopsy proven acute graft rejection and serious infections. Donor-recipient Cytomegalovirus mismatch was the only variable associated with serious infection. Conclusion: This large exploratory study casts doubts on the potential interest of genetic biomarkers related to CNI pharmacodynamics but associations with other phenotypes in transplantation deserve further studies

Semer le trouble

On étouffe. La situation n’est pas tenable. Nous courons à la catastrophe. L’effet de sidération paralyse les velléités d’action. Ce contre quoi nous avons des raisons de nous insurger semble se fondre dans un même mouvement global, une lame de fond irrépressible. Quels moyens possédons-nous pour semer le trouble dans la mécanique des rapports de domination ? Ce numéro fait appel à notre expérience collective des techniques de lutte et enquête sur les foyers de résistance qui s’élaborent et opposent aux gouvernementalités de nouvelles priorités, d’autres perspectives. Les collectifs travaillent leurs outils autant que leurs convictions ; ils suspendent le temps, par adaptation ou détournement de choses et de dispositifs. Comment la « mésentente », qui vient troubler l’idylle consensuelle de la politique, se trouve-t-elle instruite et équipée par les gestes et les instruments propres aux mouvements de lutte ? Ce numéro est élaboré dans le contexte de la mobilisation contre des réformes qui mettent en danger la vitalité de l’enseignement supérieur et de la recherche. Par cette matérialisation, en revue, d’un désaccord têtu, Techniques&Culture propose un répertoire non exhaustif des actions qui sèment et cultivent le trouble