Latino Communities in the United States: Place-Making in the Pre-World War II, Postwar, and Contemporary City

Scholarship on Latino communities in the United States has yet to catch up with the rapid growth of this ethnic population in the country. Understanding the Latino urban experience and developing plans to better respond to both the needs of Latino communities and their integration within society is not only relevant, but also urgently necessary. Using the city of Los Angeles as a main lens, in addition to a general look at the urban Southwest, we contribute to the scholarship on the subject with a review of literature on Latino communities. We structure the review as an assessment of the various challenges and opportunities for urban Latinos in the pre-war, postwar, and contemporary city. Focusing on space, culture, economy, and governance, we chart the various roles both the private and public sectors play in meeting these challenges. Our reading of the literature shows that particular government actions in the economic and governance domains in the past had positive impacts on Latino integration, and we call for a similar effort today in addressing contemporary challenges. We conclude by suggesting that future planning scholarship on Latino communities engage the wider urban studies literature, focus on emerging forms of urbanization, and call on planners to sustain increased academic and practical interest in the topic

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Approche d'assistance aux auteurs pour la réutilisation d'objets d'apprentissage

Cette thèse se situe dans le domaine de la création de contenus pédagogiques par une approche basée sur une structuration à base d objets d apprentissage et leur réutilisation au sein d objets plus complexes. Les modèles récents d objets pédagogiques comme SCORM ou SIMBAD permettent aux auteurs de construire de nouveaux objets par assemblage d objets existants. La difficulté pour les auteurs est de concevoir de tels objets en maitrisant la complexité de la composition et en pouvant garantir un haut niveau de qualité, y compris pédagogique. Nous proposons dans ce travail une approche d assistance aux auteurs basée sur un ensemble d outils d analyse permettant de mieux qualifier l objet composé et d en vérifier la conformité. Ces analyses portent tant sur le contenu de l objet, ses métadonnées notamment celles issues de la norme LOM, que sur la structure de composition elle-même. L objectif est de générer une cartographie détaillée sur l objet en question. Il s agit d offrir à l auteur des indicateurs divers et variés qui vont lui permettre d avoir une meilleur vue sur les différentes facettes de l objet d apprentissage en cours de conception. En particulier, il aura une analyse de la vue système et de la vue apprenant. Une fois que l analyse est satisfaisante, des métadonnées complémentaires sont calculées automatiquement par notre environnement en se basant sur les métadonnées éducatives des objets utilisés dans la composition de l objet. La composition d un objet peut être guidée par des règles de conformité. Celles-ci permettent de décrire certains critères structurels et sémantiques recherchés. Cette approche offre ainsi un moyen pour la promotion de la réutilisation des objets d apprentissage. Elle offre le support théorique et les éléments pratiques permettent de rendre la composition par réutilisation pleinement sous contrôle de l auteur et capable de produire par conséquence des objets d apprentissage respectant des critères de qualité.This thesis is situated in the e-learning domain and in the context of the authoring of educative content (composed learning objects) by reuse of learning objects. This approach is supported by many models like SCORM or SIMBAD. Using such as approach by authors still difficult due to the complexity of the composition process influencing the quality of the content especially from a pedagogical point of view. We propose in our research works an author assistance approach with a set of analysis tools which offer best understanding of the true nature of the composed learning object and its degree of conformity to the author, the model and the use context requirements. Analyses are applied to the learning object s content, educative metadata and composition structure. The goal is to generate a learning object s detailed cartography. Automatic generated indicators reveal details about the different facets of the composed learning object especially the system view and the learner view. If the analysis is satisfactory additional metadata are then automatically calculated by the tools based on the reused learning objects metadata. The learning object s composition can be guided by some conformity rules. Those rules can cover intended structural and semantic criterion. Our approach offers a support to promote the reuse of learning objects in an effective manner. It provides theoretical and practical elements allowing authors to control the authoring by reuse process. Consequently our approach allows authors to produce high quality composed learning objects.EVRY-INT (912282302) / SudocSudocFranceF

Temporal Trends in Transcatheter Aortic Valve Replacement in France: FRANCE 2 to FRANCE TAVI

International audienceBackground - Transcatheter aortic valve replacement (TAVR) is standard therapy for patients with severe aortic stenosis who are at high surgical risk. However, national data regarding procedural characteristics and clinical outcomes over time are limited. Objectives - The aim of this study was to assess nationwide performance trends and clinical outcomes of TAVR during a 6-year period. Methods - TAVRs performed in 48 centers across France between January 2013 and December 2015 were prospectively included in the FRANCE TAVI (French Transcatheter Aortic Valve Implantation) registry. Findings were further compared with those reported from the FRANCE 2 (French Aortic National CoreValve and Edwards 2) registry, which captured all TAVRs performed from January 2010 to January 2012 across 34 centers. Results - A total of 12,804 patients from FRANCE TAVI and 4,165 patients from FRANCE 2 were included in this analysis. The median age of patients was 84.6 years, and 49.7% were men. FRANCE TAVI participants were older but at lower surgical risk (median logistic European System for Cardiac Operative Risk Evaluation [EuroSCORE]: 15.0% vs. 18.4%; p < 0.001). More than 80% of patients in FRANCE TAVI underwent transfemoral TAVR. Transesophageal echocardiography guidance decreased from 60.7% to 32.3% of cases, whereas more recent procedures were increasingly performed in hybrid operating rooms (15.8% vs. 35.7%). Rates of Valve Academic Research Consortium-defined device success increased from 95.3% in FRANCE 2 to 96.8% in FRANCE TAVI (p < 0.001). In-hospital and 30-day mortality rates were 4.4% and 5.4%, respectively, in FRANCE TAVI compared with 8.2% and 10.1%, respectively, in FRANCE 2 (p < 0.001 for both). Stroke and potentially life-threatening complications, such as annulus rupture or aortic dissection, remained stable over time, whereas rates of cardiac tamponade and pacemaker implantation significantly increased. Conclusions - The FRANCE TAVI registry provided reassuring data regarding trends in TAVR performance in an all-comers population on a national scale. Nonetheless, given that TAVR indications are likely to expand to patients at lower surgical risk, concerns remain regarding potentially life-threatening complications and pacemaker implantation. (Registry of Aortic Valve Bioprostheses Established by Catheter [FRANCE TAVI]; NCT01777828)

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)