"Dissidentités" (la double absence / double appartenance de nouvellistes américains (1992-2003))

Notre thèse s'articule autour de l'identité en pointillés de nouvellistes américains. Nous y décrivons l'écriture des dé/possessions africaines américaines et amérindiennes, suite au déplacement contraint de leurs ancêtres, à travers les récits de Randall Kenan, Stéphanie Allen, Sherman Alexie et Susan Power. Nous décryptons ensuite les narrations des frontières créées par l'immigration symbolique entre le Mexique et les Etats-Unis de David Rice, Sergio Troncoso et Oscar Casares. Puis notre recherche souligne la mise en mots des entre-deux Caribéens par les émigrations du Cubano-Américain Vírgíl Sua rez, du Jamaïco-Américain Thomas Glave, de l'Haïtienne Américaine Edwidge Danticat et du Dominicain Américain Junot Díaz. Enfin nous nous attachons à l'expression des éclats formés par les émigrations asiatiques de Chine, du Vietnam, du Maharashtra et du Bengale de Lan Samantha Chang, Linh Dinh, Ginu Kamani et Jhumpa Lahiri. Nous abordons l'absence et l'appartenance simultanées à deux espaces par une approche des réinscriptions et des (dés)inscriptions de ces auteurs. Notre thèse explore leurs jeux d'écriture entre un discours collectif et leur voix intime. Ces nouvellistes relient un projet esthétique individuel à une réappropriation toute aussi personnelle des batailles pour les droits civiques de la décennie de leur naissance (1961-69). Loin d'accepter l'étiquette réductrice de littérature des minorités ou de devenir des porte-parole, ces écrivains refusent néanmoins de gommer leurs racines. A l'orée du 21e siècle, ils démystifient l'Amérique anglo-saxonne tout comme un certain communautarisme.This thesis studies short-stories by american writers born between 1961 and 1969, at the core of the debate over the civil rights. It presents the dual senses of absence and belonging as seen by Randall Kenan and Stephanie Allen (African-American authors), Sherman Alexie and Susan Power (native American), David Rice, Sergio Troncoso and Oscar Casares (Mexican-American), Vírgíl Suárez (Cuban American), Thomas Glave (Jamaican-American), Edwidge Danticat (Haitian-American), Junot Díaz (Dominican-American), Lan Samantha Chang (Chinese-American), Linh Dinh (Vietnamese-American), Ginu Kamani (Maharashtran-American), and Jhumpa Lahiri (Bengali-American). They respectively write about the dis/possessions of their African and native American ancestors' lands, the frontiers experienced through the symbolic Mexican immigrations, the 'in-betweens" shaped by Caribbean emigrations, and the fragments from Asia. Their collections, published between 1992 and 2003, tackle the implications of their inscriptions in the United States following their ancestors' forced displacement, their family's or their own (real or figurative) migration into the "American Dream". In these collections, they discuss what is at stake in the tension between a collective discourse and their intimate voice at the transition towards the 21st century. These writers put in the wake of the aesthetic aspect of their very personal style an original questioning on the estrangement ethnic minorities still undergo in the United States. These fifteen authors underline the need to debunk American myths and hyphenated identities but also their own minorities.ORLEANS-BU Lettres (452342103) / SudocSudocFranceF

Effect of Tocilizumab vs Usual Care in Adults Hospitalized With COVID-19 and Moderate or Severe Pneumonia

International audienceImportance Severe pneumonia with hyperinflammation and elevated interleukin-6 is a common presentation of coronavirus disease 2019 (COVID-19).Objective To determine whether tocilizumab (TCZ) improves outcomes of patients hospitalized with moderate-to-severe COVID-19 pneumonia.Design, Setting, and Particpants This cohort-embedded, investigator-initiated, multicenter, open-label, bayesian randomized clinical trial investigating patients with COVID-19 and moderate or severe pneumonia requiring at least 3 L/min of oxygen but without ventilation or admission to the intensive care unit was conducted between March 31, 2020, to April 18, 2020, with follow-up through 28 days. Patients were recruited from 9 university hospitals in France. Analyses were performed on an intention-to-treat basis with no correction for multiplicity for secondary outcomes.Interventions Patients were randomly assigned to receive TCZ, 8 mg/kg, intravenously plus usual care on day 1 and on day 3 if clinically indicated (TCZ group) or to receive usual care alone (UC group). Usual care included antibiotic agents, antiviral agents, corticosteroids, vasopressor support, and anticoagulants.Main Outcomes and Measures Primary outcomes were scores higher than 5 on the World Health Organization 10-point Clinical Progression Scale (WHO-CPS) on day 4 and survival without need of ventilation (including noninvasive ventilation) at day 14. Secondary outcomes were clinical status assessed with the WHO-CPS scores at day 7 and day 14, overall survival, time to discharge, time to oxygen supply independency, biological factors such as C-reactive protein level, and adverse events.Results Of 131 patients, 64 patients were randomly assigned to the TCZ group and 67 to UC group; 1 patient in the TCZ group withdrew consent and was not included in the analysis. Of the 130 patients, 42 were women (32%), and median (interquartile range) age was 64 (57.1-74.3) years. In the TCZ group, 12 patients had a WHO-CPS score greater than 5 at day 4 vs 19 in the UC group (median posterior absolute risk difference [ARD] −9.0%; 90% credible interval [CrI], −21.0 to 3.1), with a posterior probability of negative ARD of 89.0% not achieving the 95% predefined efficacy threshold. At day 14, 12% (95% CI −28% to 4%) fewer patients needed noninvasive ventilation (NIV) or mechanical ventilation (MV) or died in the TCZ group than in the UC group (24% vs 36%, median posterior hazard ratio [HR] 0.58; 90% CrI, 0.33-1.00), with a posterior probability of HR less than 1 of 95.0%, achieving the predefined efficacy threshold. The HR for MV or death was 0.58 (90% CrI, 0.30 to 1.09). At day 28, 7 patients had died in the TCZ group and 8 in the UC group (adjusted HR, 0.92; 95% CI 0.33-2.53). Serious adverse events occurred in 20 (32%) patients in the TCZ group and 29 (43%) in the UC group (P = .21).Conclusions and Relevance In this randomized clinical trial of patients with COVID-19 and pneumonia requiring oxygen support but not admitted to the intensive care unit, TCZ did not reduce WHO-CPS scores lower than 5 at day 4 but might have reduced the risk of NIV, MV, or death by day 14. No difference on day 28 mortality was found. Further studies are necessary for confirming these preliminary results.Trial Registration ClinicalTrials.gov Identifier: NCT0433180

Effect of anakinra versus usual care in adults in hospital with COVID-19 and mild-to-moderate pneumonia (CORIMUNO-ANA-1): a randomised controlled trial

International audienc

Sarilumab in adults hospitalised with moderate-to-severe COVID-19 pneumonia (CORIMUNO-SARI-1): An open-label randomised controlled trial

International audienc