35 research outputs found
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 nonâcritically 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 (nâ=â257), ARB (nâ=â248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; nâ=â10), or no RAS inhibitor (control; nâ=â264) for up to 10 days.
MAIN OUTCOMES AND MEASURES The primary outcome was organ supportâfree 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 supportâfree days among critically ill patients was 10 (â1 to 16) in the ACE inhibitor group (nâ=â231), 8 (â1 to 17) in the ARB group (nâ=â217), and 12 (0 to 17) in the control group (nâ=â231) (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 supportâfree 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
Dynamic of sand intrusion networks emplacement in sedimentary basins : Impact on post-deposition evolution of reservoirs and associated network migration
Les intrusions sableuses (injectites) sont le plus souvent le produit de la remobilisation post-dĂ©positionnelle des sĂ©diments et de lâinjection du sable dans les roches environnantes. Bien que reconnues pour la premiĂšre fois il y a prĂšs de 200 ans, elles ne sont rĂ©ellement Ă©tudiĂ©es que depuis quelques dizaines dâannĂ©es, depuis que les concepts sur les environnements de dĂ©pĂŽt dans les domaines marins profonds nous permettent de mieux comprendre les processus de mise en place. Cependant, ces processus restent encore aujourdâhui relativement mal compris. Notre approche repose sur lâĂ©tude dâinjectites dans le bassin du Bas-Congo Ă partir de donnĂ©es de sismique et de puits que nous comparerons Ă un systĂšme fossile dans le bassin du sud-est de la France. Nous avons montrĂ© que :(1) Dans des systĂšmes de chenaux turbiditiques enfouis, les dĂ©pĂŽts de drapage sur les marges et terrasses de chenaux prĂ©sentent la mĂȘme signature gĂ©ophysique que les injectites de type « wing ». Finalement, le seul critĂšre sismique dâidentification des injectites est la prĂ©sence de rĂ©flexions sismiques sĂ©cantes vis-Ă -vis de la stratigraphie associĂ©e dans le meilleur des cas au soulĂšvement des rĂ©flecteurs sismiques sus-jacents. (2) Des injectites dâĂ©chelle sismique en forme de cĂŽne et dâassiette ont Ă©tĂ© identifiĂ©es dans le bassin du Bas-Congo. La remobilisation rĂ©sulte probablement des pressions anormales induites par lâeffet de flottabilitĂ© des hydrocarbures piĂ©gĂ©s dans les marges dâun lobe enfoui sous 160 m de sĂ©diment, puis de lâinjection soudaine du sable fluidisĂ© associĂ©e Ă la rĂ©activation de failles.(3) Un rĂ©seau dâinjectites (dykes, sills/wings et laccolites) sâest formĂ© dans le bassin Vocontien entre la fin de lâAlbien supĂ©rieur et/ou le dĂ©but du CĂ©nomanien, depuis un chenal turbiditique de lâAlbien infĂ©rieur-moyen. La mise en place rĂ©sulte probablement de la compartimentalisation prĂ©coce du chenal au cours de son enfouissement et de lâaugmentation du taux de sĂ©dimentation gĂ©nĂ©rant la surpression et de lâapport ultĂ©rieur dâimportante quantitĂ© de fluides profonds dĂ©clenchant lâinjection. Lâinjection du sable a Ă©tĂ© polyphasĂ©e : une premiĂšre injection a formĂ© des sills et une suivante des dykes. Les sills/wings et les dykes se sont propagĂ©s latĂ©ralement au chenal source sur environ 2 km et vers la surface sur environ 200 m, mettant en Ă©vidence une forte remobilisation latĂ©rale plutĂŽt que verticale, contrairement Ă lâidĂ©e classiquement admise Ă partir de lâinterprĂ©tation des donnĂ©es sismiques.(4) La formation de ce large rĂ©seau dâinjectites a Ă©tĂ© gouvernĂ© par des mĂ©canismes dâhydrofracturation. Par consĂ©quent, sa morphologie a Ă©tĂ© dĂ©pendante des hĂ©tĂ©rogĂ©nĂ©itĂ©s de la roche hĂŽte (milieu isotrope, fracturĂ©), des directions de palĂ©o-contraintes (Ï3 = NW-SE) et de la profondeur dâenfouissement de la source (300-600 m) au moment de lâinjection. LâĂ©tude de ce rĂ©seau fossile permet de dĂ©finir les relations entre morphologie du rĂ©seau injectĂ© et Ă©tat de contraintes au moment de lâinjection. Cette relation peut ĂȘtre extrapolĂ©e de façon Ă contraindre la morphologie des rĂ©seaux de subsurface au-delĂ de la visibilitĂ© sismique. (5) Les sables injectĂ©s dans des lithologies de faible permĂ©abilitĂ© tĂ©moignent dâun Ă©pisode dâĂ©chappement de fluide important dans les bassins Ă©tudiĂ©s mais ont aussi guidĂ© les fluides longtemps aprĂšs leur formation. Les injectites contribuent ainsi Ă lâinitiation Ă©pisodique et la pĂ©rennisation de migrations de fluides dans les bassins sĂ©dimentaires. Le processus dâinjection est associĂ© Ă lâĂ©chappement brutal de fluides, rĂ©sultant vraisemblablement dâun Ă©vĂšnement tectonique et/ou sĂ©dimentaire important, et lâarchitecture des rĂ©seaux dâinjectites est gouvernĂ©e par les palĂ©o-contraintes locales et les hĂ©tĂ©rogĂ©nĂ©itĂ©s de la roche hĂŽte. Par consĂ©quent, la caractĂ©risation des rĂ©seaux dâinjectites est une Ă©tape importante dans la comprĂ©hension de la plomberie des marges, c'est-Ă -dire lâĂ©volution post-dĂ©pĂŽt des bassins sĂ©dimentaires.Sand intrusions (or injectites) are most often the product of post-depositional remobilization of sand leading to its injection into the surrounding rocks. While injectites were recognized for the first time nearly 200 years ago, their emplacement process has been studied for a couple of decades only, since the concepts of deep sea depositional environments have allowed us to better understand their emplacement processes. However, these processes are still relatively poorly understood. Our approach is based on the study of injectites in the Lower Congo Basin from seismic and well data, which we compare to a fossil system in the SE France basin. We have shown that:(1) In buried turbidite channel systems draping deposits on the channel flanks and terraces of channels have the same geophysical signature as âwing-like' injectites. Finally, the only criterion for identifying seismic injectites is the presence of bedding-discordant seismic reflections, and in the best case the associated uplift of the overlying seismic reflectors.(2) Seismic-scale conical and saucer-shaped sand injectites have been identified in the Lower Congo Basin. The remobilization is likely due to overpressuring induced by the buoyancy effect of hydrocarbons trapped in the margins of a lobe buried underneath 160 m of sediment, followed by the sudden injection of fluidized sand associated with fault reactivation of faults (with a possible role of nearby salt diapirs).(3) A network of injectites (dykes, sills/wings and laccoliths) was formed in the Vocontian basin during the late Albian and/or early Cenomanian, from a lower-middle Albian turbidite channel. The emplacement is probably due to the early compartmentalization of the channel during its burial and the increase of the sedimentation rate generating overpressure; and the subsequent large influx of deep fluids triggering injection. The injection of sand was polyphased: a first episode formed the sills and another emplaced the dykes. Sills/wings and dykes propagated about 2 km laterally away from the parent sand body and about 200 m up to the surface, revealing a much more extended lateral than vertical reach, contrary to the classically accepted idea from the interpretation of seismic data.(4) The emplacement of this large network of injectites was governed by hydrofracturing. Therefore, its morphology is dependent on the host rock heterogeneity (isotropy, fractures), the paleo-stress orientation (Ï3 = NW-SE) and the burial depth of the source (300-600 m) at the time of injection. The study of this fossil network allows us to define the relationship between morphology of the injected network and stress state at the time of injection. This relationship can be extrapolated to constrain the morphology of subsurface networks beyond seismic visibility.(5) Sands injected into low permeability lithologies bear evidence to a major event of fluid escape in the studied basin, but also channeled fluids long after their formation. In this way, injectites both attest to specific episodes of fluid migration in sedimentary basins and contribute to long-lived re-routing of migrating fluids once emplaced.The injection of sand is associated with the sudden escape of fluids, probably resulting from a significant tectonic and/or sedimentary event; in addition, the architecture of injectite networks is governed by the local paleo-stress and heterogeneity in the host rock. Consequently, characterizing injectite networks is an important step in understanding the plumbing systems of continental margins, i.e. the post-depositional evolution of sedimentary basins
The State of legislation : contribution to the definition of the concept d'"Etat de droit" in french administrative law
VĂ©ritable dogme en droit interne et sâimposant comme un standard dans lâordre juridique international, le concept dâ« Ătat de droit » est dĂ©pourvu dâune signification clairement dĂ©terminĂ©e. DiffĂ©rentes conceptions sont admises et dĂ©pendent des acceptions de lâĂtat en question, dâune garantie hic et nunc de certains droits ainsi que dâune volontĂ© politique des gouvernants. Lâobjet de cette recherche sâattache au droit administratif, prĂ©cisĂ©ment au rĂŽle du juge administratif, comme vecteur de soumission de lâautoritĂ© de lâĂtat afin de promouvoir les droits et libertĂ©s fondamentales des administrĂ©s en France. Si rien ne prĂ©sageait une telle Ă©volution au nom de la raison dâĂtat, le Conseil dâĂtat, par une pensĂ©e politique (nĂ©o)libĂ©rale, sâest imposĂ© comme lâinstitution juridictionnelle majeure dans la construction du concept dâĂtat de droit administratif. Au moyen dâune interprĂ©tation formelle et substantielle du principe de lĂ©galitĂ©, lâĂtat de droit administratif lĂ©gitime lâaction publique des gouvernants tout en garantissant la sĂ©curitĂ© juridique des administrĂ©s. Cette liaison de lâĂtat et du droit administratif relĂšve dâune construction inĂ©puisable, apprĂ©hendĂ©e par lâĂtat de contentieux qui sâanalyse comme le kalĂ©idoscope des faits sociaux. Ce dernier rĂ©sulte dâune politique de la force, dâun conflit positif entre les Hommes, les institutions, les normes ou les pouvoirs instituĂ©s. Ainsi, en conciliant lâAutoritĂ© et la LibertĂ©, le concept dâĂtat de droit administratif rĂ©vĂšle le degrĂ© dâassujettissement de lâadministration au droit administratif. Le dĂ©veloppement objectif du concept dâĂtat de droit administratif est bĂąti par lâĂtat de justice et protĂ©gĂ© par lâĂtat lĂ©gal, au profit dâune justice administrative garante des valeurs rĂ©publicaines de lâĂtat. Le perfectionnement de lâĂtat de droit administratif par lâĂtat de contentieux est agencĂ© par lâĂtat dĂ©mocratique et rĂ©gulĂ© par lâĂtat global, en libĂ©rant lâadministrĂ© de toute servitude de la part de lâadministration. LâillibĂ©ralisme administratif sâestompe au profit dâune sociĂ©tĂ© de(s) droit(s), dâune juridicisation et dâun normativisme absolus, au dĂ©triment de lâĂtat.The Rule of law concept is a real domestic law dogma and has established itself as a norm in the international judicial order. It is beneft of a clearly defined signification. Different concepts are accepted and depend on the agreements of the state, on a hic et nunc warranty of some rights as well as the rulers political will. This study aims to consider the administrative law, and more specifically the administrative judgeâs role, as a means of control over the authority of the state so as to promote the rights and fundamental freedoms of the constituents in France. Even if nothing could portend such an evolution on the account of the state, the Conseil dâĂtat, through a (neo)liberal political influence, became major judicial institution which builds the concept of domestic rule. The administrative juridiction legitimizes the public action of the governments while ensuring the legal security of the constituents through a formal and substantive interpretation of the principle of legality. This relation on between the state and the administrative law state of litigation which can be analyzed as a kaleidoscope of social facts. This stems from a power policy, of a positive conflict between men, the institutions, the normes or the instituted powers. Therefore, by accommodating authority and freedom, the administrative jurisdiction exposes the extent to which the administration is subjected to the administrative law. The objective construction of the administrative Rule of law allows the setting up of an administrative justice, which guarantees the republican values of the State thanks to legal Justice and Legal State. The upgrading of the administrative Rule of law by the democracy provide some freedom to the people vis-Ă -vis the state. The lack of liberalism fades away in favour of a litigious society, juridification and normatism to the detriment of the state
L'éducation scientifique face à l'actualité : les principes de l'approche scientifique pour traiter l'information issue de la presse quotidienne
Ce travail s'intéresse aux principes élémentaires de l'approche scientifique, constitués principalement des attitudes scientifiques. Il cherche à mettre en évidence la corrélation entre la place accordée pour l'enseignement des principes élémentaires à l'école primaire par le département de l'instruction publique genevois et la fréquence et l'importance de ces principes dans une situation banale pour tout un chacun : la lecture de presse quotidienne. Je suppose qu'il existe un manque dans l'enseignement par rapport à ce que la population peut rencontrer dans des articles de la presse quotidienne. Mon travail cherche à faire le point sur la situation. Ce mémoire comprend une approche historique qui montre que la place de la science dans l'enseignement n'a jamais été évidente. Une analyse de la présence des principes élémentaires contenus dans le plan d'étude genevois de 2007 précédera une analyse des principes contenus dans des articles de presse quotidienne. La conclusion reviendra sur la corrélation entre les principes issus de ces deux sources
Dynamique de mise en place des réseaux d'intrusions sableuses dans les bassins sédimentaires: Impact sur l'évolution post-dépÎt des réservoirs et le réseau de migration associé
Sand intrusions (or injectites) are most often the product of post-depositional remobilization of sand leading to its injection into the surrounding rocks. While injectites were recognized for the first time nearly 200 years ago, their emplacement process has been studied for a couple of decades only, since the concepts of deep sea depositional environments have allowed us to better understand their emplacement processes. However, these processes are still relatively poorly understood. Our approach is based on the study of injectites in the Lower Congo Basin from seismic and well data, which we compare to a fossil system in the SE France basin. We have shown that: (1) In buried turbidite channel systems draping deposits on the channel flanks and terraces of channels have the same geophysical signature as 'wing-like' injectites. Finally, the only criterion for identifying seismic injectites is the presence of bedding-discordant seismic reflections, and in the best case the associated uplift of the overlying seismic reflectors. (2) Seismic-scale conical and saucer-shaped sand injectites have been identified in the Lower Congo Basin. The remobilization is likely due to overpressuring induced by the buoyancy effect of hydrocarbons trapped in the margins of a lobe buried underneath 160 m of sediment, followed by the sudden injection of fluidized sand associated with fault reactivation of faults (with a possible role of nearby salt diapirs). (3) A network of injectites (dykes, sills/wings and laccoliths) was formed in the Vocontian basin during the late Albian and/or early Cenomanian, from a lower-middle Albian turbidite channel. The emplacement is probably due to the early compartmentalization of the channel during its burial and the increase of the sedimentation rate generating overpressure; and the subsequent large influx of deep fluids triggering injection. The injection of sand was polyphased: a first episode formed the sills and another emplaced the dykes. Sills/wings and dykes propagated about 2 km laterally away from the parent sand body and about 200 m up to the surface, revealing a much more extended lateral than vertical reach, contrary to the classically accepted idea from the interpretation of seismic data. (4) The emplacement of this large network of injectites was governed by hydrofracturing. Therefore, its morphology is dependent on the host rock heterogeneity (isotropy, fractures), the paleo-stress orientation (Ăł3 = NW-SE) and the burial depth of the source (300-600 m) at the time of injection. The study of this fossil network allows us to define the relationship between morphology of the injected network and stress state at the time of injection. This relationship can be extrapolated to constrain the morphology of subsurface networks beyond seismicvisibility. (5) Sands injected into low permeability lithologies bear evidence to a major event of fluid escape in the studied basin, but also channeled fluids long after their formation. In this way, injectites both attest to specific episodes of fluid migration in sedimentary basins and contribute to long-lived re-routing of migrating fluids once emplaced. The injection of sand is associated with the sudden escape of fluids, probably resulting from a significant tectonic and/or sedimentary event; in addition, the architecture of injectite networks is governed by the local paleo-stress and heterogeneity in the host rock. Consequently, characterizing injectite networks is an important step in understanding the plumbing systems of continental margins, i.e. the post-depositional evolution of sedimentary basins.Les intrusions sableuses (ou injectites) sont le plus souvent le produit de la remobilisation post-dĂ©positionnelle des sĂ©diments et de l'injection du sable dans les roches environnantes. Bien que reconnues pour la premiĂšre fois il y a prĂšs de 200 ans, elles ne sont rĂ©ellement Ă©tudiĂ©es que depuis quelques dizaines d'annĂ©es, depuis que les concepts sur les environnements de dĂ©pĂŽt dans les domaines marins profonds nous permettent de mieux comprendre les processus de mise en place. Cependant, ces processus restent encore aujourd'hui relativement mal compris. Notre approche repose sur l'Ă©tude d'injectites dans le bassin du Bas-Congo a partir de donnĂ©es de sismique et de puits que nous comparerons a un systĂšme fossile dans le bassin du SE de la France. Nous avons montre que : (1) Dans des systĂšmes de chenaux turbiditiques enfouis, les dĂ©pĂŽts de drapage sur les marges et terrasses de chenaux prĂ©sentent la mĂȘme signature gĂ©ophysique que les injectites de type "wing". Finalement, le seul critĂšre sismique d'identification des injectites est la prĂ©sence de rĂ©flexions sismiques sĂ©cantes vis-a-vis de la stratigraphie associĂ©e dans le meilleur des cas au soulĂšvement des rĂ©flecteurs sismiques sus-jacents. (2) Des injectites d'Ă©chelle sismique en forme de cĂŽne et d'assiette ont Ă©tĂ© identifiĂ©es dans le bassin du Bas-Congo. La remobilisation rĂ©sulte probablement des pressions anormales induites par l'effet de flottabilitĂ© des hydrocarbures piĂ©gĂ©s dans les marges d'un lobe enfoui sous 160 m de sĂ©diment, puis de l'injection soudaine du sable fluidise associĂ©e a la rĂ©activation de failles (possible rĂŽle des diapirs de sel a proximitĂ©). (3) Un rĂ©seau d'injectites (dykes, sills/wings et laccolites) s'est formĂ© dans le bassin Vocontien entre la fin de l'Albien supĂ©rieur et/ou le dĂ©but du CĂ©nomanien, depuis un chenal turbiditique de l'Albien infĂ©rieur-moyen. La mise en place rĂ©sulte probablement de la compartimentalisation prĂ©coce du chenal au cours de son enfouissement et de l'augmentation du taux de sĂ©dimentation gĂ©nĂ©rant la surpression et de l'apport ulterieur d'importante quantitĂ© de fluides profonds dĂ©clenchant l'injection. L'injection du sable a Ă©tĂ© polyphasĂ©e : une premiĂšre injection a formĂ© des sills et une suivante des dykes. Les sills/wings et les dykes se sont propagĂ©s latĂ©ralement au chenal source sur environ 2 km et vers la surface sur environ 200 m, mettant en Ă©vidence une forte remobilisation latĂ©rale plutĂŽt que verticale, contrairement a l'idĂ©e classiquement admise a partir de l'interprĂ©tation des donnĂ©es sismiques. (4) La formation de ce large rĂ©seau d'injectites a Ă©tĂ© gouvernĂ©e par des mĂ©canismes d'hydrofracturation. Par consĂ©quent, sa morphologie a Ă©tĂ© dĂ©pendante des hĂ©tĂ©rogenĂ©itĂ©s de la roche hĂŽte (milieu isotrope, fracture), des directions de palĂ©o-contraintes (ÆĂ3 = NWSE) et de la profondeur d'enfouissement de la source (300-600 m) au moment de l'injection. L'Ă©tude de ce rĂ©seau fossile permet de dĂ©finir les relations entre morphologie du rĂ©seau injectĂ© et Ă©tat de contraintes au moment de l'injection. Cette relation peut ĂȘtre extrapolĂ©e de façon Ă contraindre la morphologie des rĂ©seaux de subsurface au-delĂ de la visibilitĂ© sismique. (5) Les sables injectĂ©s dans des lithologies de faible permĂ©abilitĂ© tĂ©moignent d'un Ă©pisode d'Ă©chappement de fluide important dans les bassins Ă©tudiĂ©s mais ont aussi guide les fluides longtemps aprĂšs leur formation. Les injectites contribuent ainsi a l'initiation Ă©pisodique et la pĂ©rennisation de migrations de fluides dans les bassins sedimentaires. Le processus d'injection est associĂ© a l'Ă©chappement brutal de fluides, rĂ©sultant vraisemblablement d'un Ă©vĂšnement tectonique et/ou sĂ©dimentaire important, et l'architecture des rĂ©seaux d'injectites est gouvernĂ© par les palĂ©o-contraintes locales et les hĂ©tĂ©rogĂ©nĂ©itĂ©s de la roche hĂŽte. Par consĂ©quent, la caractĂ©risation des rĂ©seaux d'injectites est une Ă©tape importante dans la comprĂ©hension de la plomberie des marges, c'est-a-dire l'Ă©volution post-dĂ©pĂŽt des bassins sĂ©dimentaires
Sand injectites network as a marker of the palaeoestress field, the structural framework and the distance to the sand source: Example in the Vocontian Basin, SE France
International audienceA large sand injectite network is very well exposed in the area of Bevons, Southeast France. The associated sandstone turbiditic channelâfill and the host marls are the AptianâAlbian rocks of the Vocontian Basin. The sand injection network is composed of dykes, sills and sedimentary laccoliths ranging in thickness from mm to pluriâm. The dykes and sills have vertical and horizontal lengths of up to and over 100 m and 1 km, respectively. Outcrop observations show that the architecture and morphology of the sand injectites in the marls is governed by the local stress field during injection, preâexisting faults, the hostârock lithology, compaction, and distance to the potential sand source(s). The main set of dykes is oriented N50â60° perpendicular to the minimum compressive stress Ï3 during sand injection. Two other sets of dykes are intruded along preâexisting synâsedimentary faults oriented N140â150° (set 2) and N90° (set 3) during the AptoâCenomanian interval. Sills and dykes thin laterally away from their potential sand sources and thin laterally away from them. The vertical thickness variations of the dykes and wings are more complex, as thinning away from the sand sources is often compensated by thickening toward the palaeoâsurface. Based on field observations and measurements, we characterized the 3D architecture of the sand injectites and showed that the injectites probably formed due to a forceful injection from an overpressured sand body sealed by lowâpermeability lithologies
From Innovation to Eco-Innovation: Co-Created Training Materials as a Change Driver for Research and Technology Organisations
International audienceThe concept of the circular economy has been a major driver in establishing new perspectives in innovation, product design and in technology management. Technological innovation in the context of a circular economy has become a factor of competitiveness, of success in national and European calls for projects, as well as a source of attractiveness for employees. A transition management is operating today in worldwide organisations from innovation intended to only provide additional economic incomes, to innovations that are willing to be sustainable by staying under the planetary boundaries limits and by satisfying some targeted societal needs. The term "eco-innovation" is among the most cited design for sustainability methods associated with this transformation. The required paradigm shift is a new challenge that technology-intensive organisations must handle with the companies and industries included in this socio-technical system. Such a paradigm shift cannot be achieved without adapting the innovation processes. Moreover, the concept and implementation of eco-innovation remain unclear, lacks in the validation and the experimentation processes are frequent. The overall approach therefore needs to be supported by practical tools and methods for design engineers and applied researchers.This article provides feedback on a project collaboration between a large public-funded research organisation (CEA: Alternative Energies and Atomic Energy Commission) and academic researchers from university (Grenoble Institute of Technology), with the aim of formalising an approach needed to conduct eco-innovation R&D projects. One of the levers in this perspective is the dissemination of applied knowledge (known-how) by providing training materials in order to make R&D engineers aware of the importance of innovation within the circular economy framework.This paper presents the process of development of such educational training conducted in a collaborative way. This training content has the ambition to empower engineers in developing a systemic vision and practical insights in four main topics: sustainability challenges, environmental impact assessment, circular economy vision, and eco-innovation methods. It was tested during pilot workshops and then transformed into an online format
Lâusine dans lâespace francilien
Si usiner, câest encore pour beaucoup travailler durement, on ne peut plus aujourdâhui porter le mĂȘme regard sur ce que ce terme Ă©voque. Lâusine qui, tout au long du xxe siĂšcle, a rythmĂ© les grands moments de lâHistoire, sâĂ©teint tout doucement. Aujourdâhui, le monde de lâusine symbolise une Ă©poque, celle de lâactivitĂ© industrielle des ouvriers, puis celle des licenciements de masse. Câest un monde de dur labeur, une histoire collective Ă comprendre de lâintĂ©rieur. Cet ouvrage, prenant Ă tĂ©moin lâespace francilien, nous explique le dĂ©veloppement de lâusine et de son activitĂ©. Il nous plonge dans le passĂ© des usines en dissĂ©quant son histoire, nous offre un regard pluriforme sur les nouvelles activitĂ©s liĂ©es aux restructurations. Il nous permet Ă©gale- ment de saisir, par exemple, comment les anciennes usines de Boulogne- Billancourt peuvent devenir une fondation dâart contemporain. Dans le cadre du programme pluri-formations de lâUniversitĂ© Paris I-PanthĂ©on Sorbonne (« Environnement francilien, de la gestion Ă la perception »), un groupe de chercheurs (Ă©conomistes, gĂ©ographes, historiens, plasticiens, esthĂ©ticiens, sociologues), sous lâĂ©gide du CERAP (Centre dâEtudes et de Recherches en Arts Plastiques) ont choisi que « lâUsine Ă chĂŽmage » sâempare de ce sujet lourd de signification. Alors que notre sociĂ©tĂ© est Ă lâheure de la « mondialisation » et que lâusine change de peau, ce thĂšme aurait pu nâentraĂźner quâun simple bilan scientifique. Il fait plus, il engage le dĂ©bat
Early versus differed arterial catheterisation in critically ill patients with acute circulatory failure: a multicentre, open-label, pragmatic, randomised, non-inferiority controlled trial: the EVERDAC protocol
International audienceIntroduction: The use of peripheral indwelling arterial catheter for haemodynamic monitoring is widespread in the intensive care unit and is recommended in patients with shock. However, there is no evidence that the arterial catheter could improve patient's outcome, whereas the burden of morbidity generated is significant (pain, thrombosis, infections). We hypothesise that patients with shock may be managed without an arterial catheter.Methods and analysis: The EVERDAC study is an investigator-initiated, pragmatic, multicentre, randomised, controlled, open-label, non-inferiority clinical trial, comparing a less invasive intervention (ie, no arterial catheter insertion until felt absolutely needed, according to predefined safety criteria) or usual care (ie, systematic arterial catheter insertion in the early hours of shock). 1010 patients will be randomised with a 1:1 ratio in two groups according to the strategy. The primary outcome is all-cause mortality by 28 days after inclusion. A health economic analysis will be carried out.Ethics and dissemination: The study has been approved by the Ethics Committee (ComitĂ© de Protection des Personnes Ăle de France V, registration number 61606 CAT 2, 19 july 2018) and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration number: NCT03680963
Comparaison des appareillages de photoémission et des logiciels de traitement - Echantillons d'argent et de polyéthylÚne téréphtalate (PET)
National audienc