81 research outputs found
Jeunes et syndicalisme : une intégration réussie? Analyse comparative de deux organisations syndicales du Québec
Cette recherche dresse un portrait de la situation de la relĂšve syndicale au QuĂ©bec et des tentatives des organisations syndicales pour stimuler la participation de leurs membres de moins de 30 ans. Elle brosse dâabord un aperçu des habitudes sociales, des valeurs et des caractĂ©ristiques en emploi des jeunes. Elle nuance et recadre ensuite la problĂ©matique des jeunes en ce qui concerne lâidentitĂ© collective quâils partagent instinctivement et les modalitĂ©s de socialisation Ă lâinterne façonnant leur participation. Cette recherche remet en question la fenĂȘtre de recrutement estimĂ©e oĂč les jeunes seraient en mesure dâentĂąmer leur participation dans les structures syndicales. Au demeurant, elle dĂ©crit lâampleur des innovations syndicales destinĂ©es Ă stimuler la participation des jeunes et dĂ©mystifie le mandat de lâune dâelle, les comitĂ©s jeunes, qui peuvent agir Ă la fois comme porte-parole de leur organisation, comme la voix des jeunes membres et comme pĂ©piniĂšre de la relĂšve syndicale.
Les donnĂ©es empiriques utilisĂ©es pour ce mĂ©moire proviennent dâune vingtaine de groupes de discussion et de huit entretiens semi-dirigĂ©s (n=228), tenus dans deux organisations syndicales dâimportance au QuĂ©bec, disposant dâun comitĂ© jeunes et organisĂ©s par les chercheures dâun projet de recherche plus vaste sur la participation syndicale des jeunes.
Nos rĂ©sultats dĂ©montrent en premier lieu une identitĂ© collective construite autour de la prĂ©caritĂ© et des injustices perçues par les nouveaux travailleurs. LâĂąge ne serait pas significatif dans la construction de lâidentitĂ© des jeunes qui semblent en phase de conquĂ©rir leur identitĂ©. En second lieu, le cadre strict de plusieurs modalitĂ©s de socialisation avait un effet inhibiteur sur la participation, favorisait des relations dâĂ©changes instrumentales et ne tenait pas compte de la sensibilitĂ© de cette nouvelle gĂ©nĂ©ration pour les interactions rĂ©ciproques avec leurs reprĂ©sentants syndicaux. Nous avons aussi observĂ© une utilisation limitĂ©e des nouvelles technologies, qui prĂ©sentent des potentialitĂ©s intĂ©ressantes en matiĂšre de transfert des connaissances de surcroĂźt. Par ailleurs, nos rĂ©sultats Ă lâĂ©gard de lâidentitĂ© collective observĂ©e et de la durĂ©e du processus de socialisation soulĂšvent des questionnements sur la pertinence mĂȘme des structures jeunes dans leurs paramĂštres actuels. Le parcours dâun jeune vers la militance syndicale apparaĂźt plus tardif quâescomptĂ©. Plus encore, la problĂ©matique jeunes met en lumiĂšre les tensions intrinsĂšques au mouvement syndical quant Ă la libre nĂ©gociation sociale des intĂ©rĂȘts dĂ©fendus et du consensus interne nĂ©cessaire Ă leur lĂ©gitimitĂ©.This research addresses the situation of QuĂ©becâs trade unionsâ youth and the trade unionsâ attempts to stimulate the participation of those under 30 years old. It also helps to describe social habits, values and characteristics at work of young workers. Then it qualifies and reframes the youth issue in terms of their shared identity and the socialization mechanisms shaping their participation. This research brings into question the actual recruitment window when young members could start participating into their unions. Finally, it describes some trade unionsâ strategies to stimulate youthâs participation and clarifies one of the, the youth committees, who not only have the mandate to act as the unionsâ spokesperson, but also as the youthâs voice from the inside and as a school for the trade unionsâ next generation of members.
The chosen qualitative methodology comes from twenty focus groups and eight semi-structured interviews (n=228) held in two notorious trade unions in QuĂ©bec which had youth committees and organized by the researchers of a larger research project on youthâs participation.
Our results show a collective identity built around precariousness and perceived unfair treatments by the newest workers. We found that age was not a significant factor in building collective identity and young members were still battling to express their own collective identity. Besides, it shows how the rigid frame of many socialization mechanisms had inhibiting effects on participation, positionned members in an instrumental relationship with their trade union and did not take into account this generationâs sensitivity for reciprocal interactions with their union representatives. We also observed weak engagement coming from trade unions towards new technologies, which seemed a great opportunity for knowledge transfer regarding the new generations of workers. In addition, our results about the observed collective identity and the actual duration of the socialization process bring into question the relevance of youth structures within their actual parameters. The journey of a young member towards union activism seemed to take more time than estimated. Moreover, the youth issue highlights inherent tensions to the labour movementâs social negotiation of the defended interests and the consensus needed for their legitimacy
Impact of Preoperative Chemotherapy Features on Patient Outcomes after Hepatectomy for Initially Unresectable Colorectal Cancer Liver Metastases: A LiverMetSurvey Analysis
Liver metastases; Liver resection; Preoperative chemotherapyMetĂĄstasis hepĂĄticas; ResecciĂłn hepĂĄtica; Quimioterapia preoperatoriaMetĂ stasis hepĂ tiques; ResecciĂł hepĂ tica; QuimioterĂ pia preoperatĂČriaBackground: Prognostic factors have been extensively reported after resection of colorectal liver metastases (CLM); however, specific analyses of the impact of preoperative systemic anticancer therapy (PO-SACT) features on outcomes is lacking. Methods: For this real-world evidence study, we used prospectively collected data within the international surgical LiverMetSurvey database from all patients with initially-irresectable CLM. The main outcome was Overall Survival (OS) after surgery. Disease-free (DFS) and hepatic-specific relapse-free survival (HS-RFS) were secondary outcomes. PO-SACT features included duration (cumulative number of cycles), choice of the cytotoxic backbone (oxaliplatin- or irinotecan-based), fluoropyrimidine (infusional or oral) and addition or not of targeted monoclonal antibodies (anti-EGFR or anti-VEGF). Results: A total of 2793 patients in the database had received PO-SACT for initially irresectable diseases. Short (<7 or <13 cycles in 1st or 2nd line) PO-SACT duration was independently associated with longer OS (HR: 0.85 p = 0.046), DFS (HR: 0.81; p = 0.016) and HS-RFS (HR: 0.80; p = 0.05). All other PO-SACT features yielded basically comparable results. Conclusions: In this international cohort, provided that PO-SACT allowed conversion to resectability in initially irresectable CLM, surgery performed as soon as technically feasible resulted in the best outcomes. When resection was achieved, our findings indicate that the choice of PO-SACT regimen had a marginal if any, impact on outcomes
A multicenter randomized-controlled trial of hypothermic oxygenated perfusion (HOPE) for human liver grafts before transplantation
Background & Aims: Machine perfusion is a novel method intended to optimize livers before transplantation. However, its effect on morbidity within a 1-year period after transplantation has remained unclear. Methods: In this multicenter controlled trial, we randomly assigned livers donated after brain death (DBD) for liver transplantation (LT). Livers were either conventionally cold stored (control group), or cold stored and subsequently treated by 1-2 h hypothermic oxygenated perfusion (HOPE) before implantation (HOPE group). The primary endpoint was the occurrence of at least one post-transplant complication per patient, graded by the Clavien score of â„III, within 1-year after LT. The comprehensive complication index (CCI), laboratory parameters, as well as duration of hospital and intensive care unit stay, graft survival, patient survival, and biliary complications served as secondary endpoints. Results: Between April 2015 and August 2019, we randomized 177 livers, resulting in 170 liver transplantations (85 in the HOPE group and 85 in the control group). The number of patients with at least one Clavien â„III complication was 46/85 (54.1%) in the control group and 44/85 (51.8%) in the HOPE group (odds ratio 0.91; 95% CI 0.50-1.66; p = 0.76). Secondary endpoints were also not significantly different between groups. A post hoc analysis revealed that liver-related Clavien â„IIIb complications occurred less frequently in the HOPE group compared to the control group (risk ratio 0.26; 95% CI 0.07-0.77; p = 0.027). Likewise, graft failure due to liver-related complications did not occur in the HOPE group, but occurred in 7% (6 of 85) of the control group (log-rank test, p = 0.004, Gray test, p = 0.015). Conclusions: HOPE after cold storage of DBD livers resulted in similar proportions of patients with at least one Clavien â„III complication compared to controls. Exploratory findings suggest that HOPE decreases the risk of severe liver graft-related events. Impact and implications: This randomized controlled phase III trial is the first to investigate the impact of hypothermic oxygenated perfusion (HOPE) on cumulative complications within a 12-month period after liver transplantation. Compared to conventional cold storage, HOPE did not have a significant effect on the number of patients with at least one Clavien â„III complication. However, we believe that HOPE may have a beneficial effect on the quantity of complications per patient, based on its application leading to fewer severe liver graft-related complications, and to a lower risk of liver-related graft loss. The HOPE approach can be applied easily after organ transport during recipient hepatectomy. This appears fundamental for wide acceptance since concurring perfusion technologies need either perfusion at donor sites or continuous perfusion during organ transport, which are much costlier and more laborious. We conclude therefore that the post hoc findings of this trial should be further validated in future studies.</p
A multicenter randomized-controlled trial of hypothermic oxygenated perfusion (HOPE) for human liver grafts before transplantation
Background & Aims: Machine perfusion is a novel method intended to optimize livers before transplantation. However, its effect on morbidity within a 1-year period after transplantation has remained unclear. Methods: In this multicenter controlled trial, we randomly assigned livers donated after brain death (DBD) for liver transplantation (LT). Livers were either conventionally cold stored (control group), or cold stored and subsequently treated by 1-2 h hypothermic oxygenated perfusion (HOPE) before implantation (HOPE group). The primary endpoint was the occurrence of at least one post-transplant complication per patient, graded by the Clavien score of â„III, within 1-year after LT. The comprehensive complication index (CCI), laboratory parameters, as well as duration of hospital and intensive care unit stay, graft survival, patient survival, and biliary complications served as secondary endpoints. Results: Between April 2015 and August 2019, we randomized 177 livers, resulting in 170 liver transplantations (85 in the HOPE group and 85 in the control group). The number of patients with at least one Clavien â„III complication was 46/85 (54.1%) in the control group and 44/85 (51.8%) in the HOPE group (odds ratio 0.91; 95% CI 0.50-1.66; p = 0.76). Secondary endpoints were also not significantly different between groups. A post hoc analysis revealed that liver-related Clavien â„IIIb complications occurred less frequently in the HOPE group compared to the control group (risk ratio 0.26; 95% CI 0.07-0.77; p = 0.027). Likewise, graft failure due to liver-related complications did not occur in the HOPE group, but occurred in 7% (6 of 85) of the control group (log-rank test, p = 0.004, Gray test, p = 0.015). Conclusions: HOPE after cold storage of DBD livers resulted in similar proportions of patients with at least one Clavien â„III complication compared to controls. Exploratory findings suggest that HOPE decreases the risk of severe liver graft-related events. Impact and implications: This randomized controlled phase III trial is the first to investigate the impact of hypothermic oxygenated perfusion (HOPE) on cumulative complications within a 12-month period after liver transplantation. Compared to conventional cold storage, HOPE did not have a significant effect on the number of patients with at least one Clavien â„III complication. However, we believe that HOPE may have a beneficial effect on the quantity of complications per patient, based on its application leading to fewer severe liver graft-related complications, and to a lower risk of liver-related graft loss. The HOPE approach can be applied easily after organ transport during recipient hepatectomy. This appears fundamental for wide acceptance since concurring perfusion technologies need either perfusion at donor sites or continuous perfusion during organ transport, which are much costlier and more laborious. We conclude therefore that the post hoc findings of this trial should be further validated in future studies.</p
A chemical survey of exoplanets with ARIEL
Thousands of exoplanets have now been discovered with a huge range of masses, sizes and orbits: from rocky Earth-like planets to large gas giants grazing the surface of their host star. However, the essential nature of these exoplanets remains largely mysterious: there is no known, discernible pattern linking the presence, size, or orbital parameters of a planet to the nature of its parent star. We have little idea whether the chemistry of a planet is linked to its formation environment, or whether the type of host star drives the physics and chemistry of the planetâs birth, and evolution. ARIEL was conceived to observe a large number (~1000) of transiting planets for statistical understanding, including gas giants, Neptunes, super-Earths and Earth-size planets around a range of host star types using transit spectroscopy in the 1.25â7.8 ÎŒm spectral range and multiple narrow-band photometry in the optical. ARIEL will focus on warm and hot planets to take advantage of their well-mixed atmospheres which should show minimal condensation and sequestration of high-Z materials compared to their colder Solar System siblings. Said warm and hot atmospheres are expected to be more representative of the planetary bulk composition. Observations of these warm/hot exoplanets, and in particular of their elemental composition (especially C, O, N, S, Si), will allow the understanding of the early stages of planetary and atmospheric formation during the nebular phase and the following few million years. ARIEL will thus provide a representative picture of the chemical nature of the exoplanets and relate this directly to the type and chemical environment of the host star. ARIEL is designed as a dedicated survey mission for combined-light spectroscopy, capable of observing a large and well-defined planet sample within its 4-year mission lifetime. Transit, eclipse and phase-curve spectroscopy methods, whereby the signal from the star and planet are differentiated using knowledge of the planetary ephemerides, allow us to measure atmospheric signals from the planet at levels of 10â100 part per million (ppm) relative to the star and, given the bright nature of targets, also allows more sophisticated techniques, such as eclipse mapping, to give a deeper insight into the nature of the atmosphere. These types of observations require a stable payload and satellite platform with broad, instantaneous wavelength coverage to detect many molecular species, probe the thermal structure, identify clouds and monitor the stellar activity. The wavelength range proposed covers all the expected major atmospheric gases from e.g. H2O, CO2, CH4 NH3, HCN, H2S through to the more exotic metallic compounds, such as TiO, VO, and condensed species. Simulations of ARIEL performance in conducting exoplanet surveys have been performed â using conservative estimates of mission performance and a full model of all significant noise sources in the measurement â using a list of potential ARIEL targets that incorporates the latest available exoplanet statistics. The conclusion at the end of the Phase A study, is that ARIEL â in line with the stated mission objectives â will be able to observe about 1000 exoplanets depending on the details of the adopted survey strategy, thus confirming the feasibility of the main science objectives.Peer reviewedFinal Published versio
2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy.
Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI
Maternal and fetal genetic effects on birth weight and their relevance to cardio-metabolic risk factors.
Birth weight variation is influenced by fetal and maternal genetic and non-genetic factors, and has been reproducibly associated with future cardio-metabolic health outcomes. In expanded genome-wide association analyses of own birth weight (nâ=â321,223) and offspring birth weight (nâ=â230,069 mothers), we identified 190 independent association signals (129 of which are novel). We used structural equation modeling to decompose the contributions of direct fetal and indirect maternal genetic effects, then applied Mendelian randomization to illuminate causal pathways. For example, both indirect maternal and direct fetal genetic effects drive the observational relationship between lower birth weight and higher later blood pressure: maternal blood pressure-raising alleles reduce offspring birth weight, but only direct fetal effects of these alleles, once inherited, increase later offspring blood pressure. Using maternal birth weight-lowering genotypes to proxy for an adverse intrauterine environment provided no evidence that it causally raises offspring blood pressure, indicating that the inverse birth weight-blood pressure association is attributable to genetic effects, and not to intrauterine programming.The Fenland Study is funded by the Medical Research Council (MC_U106179471) and
Wellcome Trust
Spatial and Temporal Tumoral Heterogeneity : Description and Therapeutical Consequences in Colorectal Cancer
LâhĂ©tĂ©rogĂ©nĂ©itĂ© tumorale (HT) est un trait caractĂ©ristique du cancer. Elle peut ĂȘtre rencontrĂ©e chez la majoritĂ© des tumeurs malignes solides, au travers de la clinique, la biologie, lâhistologie, et la gĂ©nĂ©tique. Au-delĂ de lâhĂ©tĂ©rogĂ©nĂ©itĂ© inter-patient, on distingue lâhĂ©tĂ©rogĂ©nĂ©itĂ© spatiale, qui regroupe lâhĂ©tĂ©rogĂ©nĂ©itĂ© au sein de la tumeur primitive, entre tumeur primitive et mĂ©tastases, entre mĂ©tastases, au sein dâune mĂ©tastase et lâhĂ©tĂ©rogĂ©nĂ©itĂ© temporelle, qui fait rĂ©fĂ©rence Ă lâĂ©volution de la tumeur au cours du temps de maniĂšre spontanĂ©e ou sous lâeffet des traitements. LâHT explique la survenue inĂ©luctable de la rĂ©sistance aux thĂ©rapies anticancĂ©reuses actuelles. Lâobjectif gĂ©nĂ©ral de cette thĂšse Ă©tait dâexplorer lâhĂ©tĂ©rogĂ©nĂ©itĂ© tumorale au plan clinique, histologique et gĂ©nĂ©tique en utilisant le modĂšle dâhĂ©patectomies pour mĂ©tastases dâorigine colo-rectales. Dans lâarticle 1, nous avons Ă©tudiĂ© la rĂ©ponse histologique Ă la chimiothĂ©rapie chez des patients opĂ©rĂ©s de mĂ©tastases hĂ©patiques colo-rectales aprĂšs chimiothĂ©rapie systĂ©mique ou intra-artĂ©rielle. Ainsi, nous avons montrĂ© que la rĂ©ponse histologique complĂšte Ă©tait plus souvent observĂ©e aprĂšs administration dâoxaliplatine par voie intra-artĂ©rielle et Ă©tait associĂ©e Ă un meilleur pronostic. Cependant la rĂ©ponse histologique complĂšte nâest observĂ©e que chez une minoritĂ© de patients. Nous avons Ă©mis lâhypothĂšse quâune rĂ©ponse histologique incomplĂšte reprĂ©sentent un groupe hĂ©tĂ©rogĂšne de patients, ayant des pronostics diffĂ©rents. Ceci nous a conduit Ă proposer dans lâarticle 2 une mĂ©thode reproductible pour Ă©valuer la rĂ©ponse histologique, incorporant taille et nombre de nodules. La relecture des lames de piĂšces dâhĂ©patectomie nous a conduit Ă observer une hĂ©tĂ©rogĂ©nĂ©itĂ© de la rĂ©ponse histologique au sein dâun mĂȘme patient (hĂ©tĂ©rogĂ©nĂ©itĂ© intermĂ©tastatique) et de lâaspect histologique (nĂ©crose, fibrose). Nous avons ensuite explorĂ© la valeur pronostique de cette hĂ©tĂ©rogĂ©nĂ©itĂ© et chercher Ă identifier les facteurs prĂ©dictifs de cette hĂ©tĂ©rogĂ©nĂ©itĂ©. Une rĂ©ponse dissociĂ©e (une diffĂ©rence de rĂ©ponse histologique > 50% entre deux nodules chez un mĂȘme patient) a Ă©tĂ© observĂ©e chez 20% des patients et ne modifiait pas le pronostic. Chez les patients ayant une hĂ©tĂ©rogĂ©nĂ©itĂ© pathologique, une discordance (mutation et absence de mutation pour les gĂšnes KRAS, BRAF, NRAS et PI3K) entre les mĂ©tastases a Ă©tĂ© mis en Ă©vidence dans 28% des patients analysĂ©s (article 3). Afin dâĂ©tudier lâhĂ©tĂ©rogĂ©nĂ©itĂ© gĂ©nĂ©tique selon le site tumoral et le type de prĂ©lĂšvements, nous avons utilisĂ© les donnĂ©es disponibles de la plateforme de biologie molĂ©culaire (article 4). Nous avons ainsi mis en Ă©vidence que les mĂ©tastases hĂ©patiques Ă©taient moins souvent mutĂ©es pour KRAS, NRAS, BRAF que les tumeurs primitives ou les lĂ©sions pulmonaires. Nous avons ensuite recherchĂ© une hĂ©tĂ©rogĂ©nĂ©itĂ© gĂ©nĂ©tique intra-mĂ©tastatique pour KRAS, NRAS, BRAF et PI3K au sein dâune mĂ©tastase hĂ©patique colo-rectale (article 5). Parmi les 54 patients ayant une tumeur unique analysable (2 prĂ©lĂšvements par tumeur), une discordance pour KRAS (N=2) et BRAF (N=1) a Ă©tĂ© mise en Ă©vidence chez 3 patients (5%). Lâensemble de ces travaux confirment que lâHT est observĂ©e Ă travers de nombreux points de vue. LâĂ©laboration de nouvelles stratĂ©gies de prise en charge du cancer devra prendre compte cet aspect.Tumor heterogeneity is a typical feature of cancer. It is observed in the majority of solid malignancies regardless of the point of view: clinical, biological, pathological, and genetic. Different levels of heterogeneity have been described: interpatient, spatial heterogeneity (within the primary tumor, between primary and distant lesion) and temporal heterogeneity (tumor evolution under the influence of treatment). Tumor heterogeneity widely explains the emergence of resistant clones to anticancer drugs. The objective of the current thesis was to explore tumor heterogeneity at a clinical, pathological and genetic level, by using the model of hepatectomy for colorectal liver metastases (CLM).In the article 1, we studied pathological response to chemotherapy in patients operated on for CLM after either systemic or intra-arterial hepatic oxaliplatin-based chemotherapy. We showed that complete pathological response was more often observed after intra-arterial chemotherapy and yield far better outcomes. However, complete response was observed in a minority of patients. We hypothesized that uncomplete pathological response encompass a large group of patients with different oncological outcomes. This lead us to propose a reproducible method (article 2) to assess pathological response, including size and number of nodules. Pathological review found heterogeneity in the response among nodules within the same patients and in the type of pathological features (necrosis, fibrosis). We then explore the prognostic value of pathological heterogeneity and sought to identify predictors of heterogeneity. A dissociated response (difference in pathological response > 50% between two nodules) was observed in XX and did not impact long-term outcomes. IN patients with dissociated response, genetic heterogeneity (mutation and no mutation for KRAS, NRAS, BRAF and PI3K) between metastases was shown in 28% of patients (article 3). To study genetic heterogeneity according to tumor location and the tumor tissue analyzed (specimen, biopsy), we used data from the department of molecular biology (article 4). We found that liver metastases were more often wild type for KRAS, NRAS, BRAF compared to lung metastases or primary tumors. In the article 5, we then sought to evaluate intrametastatic heterogeneity (KRAS, BRAF, NRAS, PI3K) within a single liver metastasis (2 samples per tumor). Among the 54 patients with single lesion analyzed, a discrepancy for KRAS (n=2) and BRAF (n=1) were observed un 3 patients (5%). This work confirms that tumor heterogeneity can be observed at various levels. Elaboration of new therapeutical strategies will have to take this aspect into consideration
Validation prospective de l impact de la pression portale et du gradient porto-cave sur le risque d insuffisance hépatique aprÚs hépatectomie majeure sur foie non cirrhotique
PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF
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