Ann Intensive Care

Unlike for septic shock, there are no specific international recommendations regarding the management of cardiogenic shock (CS) in critically ill patients. We present herein recommendations for the management of cardiogenic shock in adults, developed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system by an expert group of the French-Language Society of Intensive Care (Société de Réanimation de Langue Française (SRLF)), with the participation the French Society of Anesthesia and Intensive Care (SFAR), the French Cardiology Society (SFC), the French Emergency Medicine Society (SFMU), and the French Society of Thoracic and Cardiovascular Surgery (SFCTCV). The recommendations cover 15 fields of application such as: epidemiology, myocardial infarction, monitoring, vasoactive drugs, prehospital care, cardiac arrest, mechanical assistance, general treatments, cardiac surgery, poisoning, cardiogenic shock complicating end-stage cardiac failure, post-shock treatment, various etiologies, and medical care pathway. The experts highlight the fact that CS is a rare disease, the management of which requires a multidisciplinary technical platform as well as specialized and experienced medical teams. In particular, each expert center must be able to provide, at the same site, skills in a variety of disciplines, including medical and interventional cardiology, anesthesia, thoracic and vascular surgery, intensive care, cardiac assistance, radiology including for interventional vascular procedures, and a circulatory support mobile unit

Epinephrine and short-term survival in cardiogenic shock : an individual data meta-analysis of 2583 patients

Correction Volume: 44 Issue: 11 Pages: 2022-2023 DOI: 10.1007/s00134-018-5372-9Catecholamines have been the mainstay of pharmacological treatment of cardiogenic shock (CS). Recently, use of epinephrine has been associated with detrimental outcomes. In the present study we aimed to evaluate the association between epinephrine use and short-term mortality in all-cause CS patients. We performed a meta-analysis of individual data with prespecified inclusion criteria: (1) patients in non-surgical CS treated with inotropes and/or vasopressors and (2) at least 15% of patients treated with epinephrine administrated alone or in association with other inotropes/vasopressors. The primary outcome was short-term mortality. Fourteen published cohorts and two unpublished data sets were included. We studied 2583 patients. Across all cohorts of patients, the incidence of epinephrine use was 37% (17-76%) and short-term mortality rate was 49% (21-69%). A positive correlation was found between percentages of epinephrine use and short-term mortality in the CS cohort. The risk of death was higher in epinephrine-treated CS patients (OR [CI] = 3.3 [2.8-3.9]) compared to patients treated with other drug regimens. Adjusted mortality risk remained striking in epinephrine-treated patients (n = 1227) (adjusted OR = 4.7 [3.4-6.4]). After propensity score matching, two sets of 338 matched patients were identified and epinephrine use remained associated with a strong detrimental impact on short-term mortality (OR = 4.2 [3.0-6.0]). In this very large cohort, epinephrine use for hemodynamic management of CS patients is associated with a threefold increase of risk of death.Peer reviewe

2021 roadmap for sodium-ion batteries

Abstract: Increasing concerns regarding the sustainability of lithium sources, due to their limited availability and consequent expected price increase, have raised awareness of the importance of developing alternative energy-storage candidates that can sustain the ever-growing energy demand. Furthermore, limitations on the availability of the transition metals used in the manufacturing of cathode materials, together with questionable mining practices, are driving development towards more sustainable elements. Given the uniformly high abundance and cost-effectiveness of sodium, as well as its very suitable redox potential (close to that of lithium), sodium-ion battery technology offers tremendous potential to be a counterpart to lithium-ion batteries (LIBs) in different application scenarios, such as stationary energy storage and low-cost vehicles. This potential is reflected by the major investments that are being made by industry in a wide variety of markets and in diverse material combinations. Despite the associated advantages of being a drop-in replacement for LIBs, there are remarkable differences in the physicochemical properties between sodium and lithium that give rise to different behaviours, for example, different coordination preferences in compounds, desolvation energies, or solubility of the solid–electrolyte interphase inorganic salt components. This demands a more detailed study of the underlying physical and chemical processes occurring in sodium-ion batteries and allows great scope for groundbreaking advances in the field, from lab-scale to scale-up. This roadmap provides an extensive review by experts in academia and industry of the current state of the art in 2021 and the different research directions and strategies currently underway to improve the performance of sodium-ion batteries. The aim is to provide an opinion with respect to the current challenges and opportunities, from the fundamental properties to the practical applications of this technology

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/)

Enhancement of the elimination of organic micropollutants from wastewater at secondary and tertiary stage

La présence de micropolluants dans tous les milieux aquatiques est aujourd'hui une préoccupation importante. La réduction des émissions de micropolluants organiques vers le milieu aquatique par les stations d'épuration (STEP) domestiques est donc un enjeu important. Ce travail porte sur l'amélioration du traitement de ces substances par les traitements secondaires et tertiaires des STEP. En premier lieu, l'objectif a été de mieux comprendre les processus d'élimination des micropolluants organiques lors de leur passage au sein d'un procédé de type boues activées aération prolongée (BA-AP). Notre travail a consisté à proposer un outil permettant de prévoir a priori le comportement de substances organiques en BA-AP par rapport à certaines de leurs propriétés physico-chimiques (i.e. constante de Henry, log Dow, structure moléculaire). La démarche adoptée a consisté à sélectionner des données de rendements d'élimination fiables et robustes, puis à les associer aux caractéristiques physico-chimiques des substances. La méthode développée est simple ; elle nécessite de connaitre uniquement des paramètres physico-chimiques facilement accessibles et la structure moléculaire des substances. Elle constitue donc une alternative crédible aux méthodes faisant intervenir la modélisation. Cette méthode permet une prédiction a priori du niveau de traitement d'une substance (rendement supérieur ou inférieur à 70%) par les traitements secondaires existants. Dans un second temps, l'objectif a été de proposer une étape de traitement tertiaire, spécifique à l'élimination de micropolluants organiques réfractaires aux traitements secondaires. Le procédé proposé est une filtration sur support fin spécifique capable de retenir par des processus d'adsorption les substances ciblés (i.e. phytosanitaires et substances pharmaceutiques dont l'élimination est insuffisante en traitement secondaire conventionnel). Une étude bibliographique a permis tout d'abord de dresser un état des lieux sur les adsorbants utilisés et leur capacité d'adsorption. Suite à cette étude, la zéolite et l'argile expansée ont été retenus ; les potentialités d'adsorption de ces deux matériaux ont été étudiées à l'échelle laboratoire (tests en réacteur fermé) et à l'échelle pilote (suivi des performances de réacteurs à garnissage drainé à écoulement horizontal). Les tests d'adsorption en réacteur fermé montrent que les matériaux choisis (argile expansée et zéolite) possèdent une potentialité pour adsorber les substances étudiées (14 substances soient 10 pharmaceutiques et 4 pesticides). Le suivi des réacteurs ouvert confortent les résultats obtenus en réacteur fermé et démontrent que les matériaux étudiés possèdent un potentiel pour l'adsorption des substances ciblées, et ce y compris dans des conditions de filtration lente, proches des conditions réelles. Les résultats obtenus démontrent le potentiel de matériaux minéraux microporeux à éliminer des micropolluants organiques de la phase dissoute et ainsi à se substituer au charbon actif, matériau onéreux et peu adapté aux petites collectivités.The aim of the present work was to propose solutions to reduce organic micropollutants emissions by wastewater treatment plants (WWTP). First, the objective was to improve the comprehension of micropollutants behaviour in nitrifying activated sludge process. The use of a reliable removal efficiency dataset allowed setting up a removal efficiency prediction method only from the micropollutants physico-chemical characteristics (i.e. log Kow, Henry constant and molecular structure). This method represents a first progress through a better micropollutants removal by the existing secondary WWTP. Second, the aim was to set up a tertiary stage process to enhance the removal of micropollutants refractory to conventional WWTP. This tertiary stage process is a filtration of the secondary effluent by adsorbent materials that could represent a credible alternative to expensive materials such as activated carbons. Experimental approaches at different scales (lab and pilot) demonstrated that some alternative materials such as expanded clay and zeolite have the potential to adsorb refractory substances (e.g. pesticids and pharmaceuticals) and thus to decrease the concentration of organic micropollutants in effluent

Théorie de l'indice et géométrie basique d'un feuilletage riemannien

Dans cette thèse nous étudions la géométrie basique des feuilletages riemanniens. Nous reprenons d abord le point de vue d A. El Kacimi sur les opérateurs différentiels transversalement elliptiques. Nous traitons le cas particulier des feuilletages par fibration et des feuilletages par suspension. Nous traitons également des exemples de calcul d indice basique et étudions les propriétés d invariance de la signature basique. Nous nous intéressons ensuite au cas d un feuilletage riemannien muni d une action de groupe de Lie compact. Nous montrons alors qu un opérateur différentiel basique transversalement elliptique au feuilletage et à l action du groupe admet un indice distributionnel basique. Nous traitons le cas particulier des actions libres et établissons les propriétés de multiplicativité et excision. Nous finissons par établir le lien avec le point de vue d A. El KacimiIn this paper we study the basic geometry of a Riemannian foliation. First we return on A. El Kacimi s point of view on transversally elliptic basic differential operator. We study the particular case of fibration and foliation defined by suspension. We study some examples of computation of basic index and study invariance property for the basic signature. After, we study a Riemannian foliation with the action of a compact Lie group. We prove then that a basic differential operator which is transversally elliptic to the foliation and to the group action has a distributional basic index. We study the particular case of free action and prove the multiplicativity and excision property. We end by study the link with El Kacimi s point of viewMETZ-SCD (574632105) / SudocSudocFranceF

Usage du modèle de Reason dans un cadre méthodologique contraint, pour l'argumentation de la mise en place de la sécurité construite par tous

International audienceThis publication describesan intervention conducted in the context of the master’s degree of Ergonomics from the CNAM of Paris. It took place in a particularsettingcombining both variouswork tasks withlong cycles andconstrained methodological environment. In order to offset the difficulties encountered during the analysis of work activity phase, we used Reason’s model both as a support decisiontoolfor the risks prevention related issues at stake in the work activity. This enabledmanagementtoadapttheir procedures in regards towork associated risks. Despite its original as arequest fortechnical investigation, theimpactsofsuchtoolsuccessfully transformedprior management guidelinesand lead to safety improvement.Cette publication présente une intervention conduite dans le cadre de l’obtention du Master d’ergonomie du CNAM de Paris. Elle s’est déroulée dans un environnement spécifique, combinant travail varié intervenant sur des temporalités longues et contraintes méthodologiques. Pour compenser les difficultés rencontrées lors de la phase d’analyse de l’activité, nous avons utilisé le modèle de Reason à la fois comme outil d’aide à l’analyse de l’activité et comme support de restitution des enjeux liés à la prévention des risques qui se jouaient dans l’activité. Cet outil a facilité le changement de regard des demandeurs sur le travail et les risques associés. En effet, malgré une demande portant uniquement sur des solutions techniques, les axes de transformations envisagés suite à la restitution couvraient également l’organisation de travail et les rôles de chacun dans l’amélioration de la sécurité

Accounting for research induced environmental impacts using life cycle assessment

Since the 1970's the number of scientific publications with sustainability as a keyword has increased from 1 in 1975 to 13,628 in 2019. Research, like all human endeavors, has impacts on the environment due to the activities required to generate the supporting data (i.e., use of vehicles, resources, and materials). Researchers have a responsibility to minimize their impacts as part of their work and to make environmentally responsible decisions. A life-cycle approach is currently the best-developed means of assessing the impact of a group or organization. This article presents a case study of organizational life cycle assessment (O-LCA) of a research project. The objectives of this study were to (i) estimate the impact of the project, focusing on travel. (ii) Use a post hoc approach to determine impact reduction opportunities. (iii) Apply O-LCA as a decision-making tool in project management of research and (iv) profile the environmental impact of the project using public data (manufacturers figures) and proprietary datasets. The results of this study indicate that the greatest impact arising from the project was due to commuting followed by conference and training attendance, fieldwork and meetings. Scenarios modeling, alternative vehicle use, flexible working arrangements and stakeholder events highlighted the reduction potential that could have been implemented as part of the project. O-LCA proved to be an appropriate tool for assessing the impact of a research group and that it has the potential to inform decisions and management of academic projects and events. It should be noted that the ability of research groups or personnel to bring about change might be limited, typically due to their placement within a larger organization (e.g., a higher education institute). The recent COVID-19 pandemic, has hastened the shift to remote working practices for many organizations. Recent surveys indicate that more than 80% of respondents would like to work remotely, at least some of the time, after the pandemic. This modal shift in working practices offers an immediate opportunity for environmental relief. It is recommended that O-LCA be incorporated into groups and organizations to support their decision-making practices to foster responsible and sustainable research.This work was supported by the MOREFISH (14SF872) and EcoAqua (17/KGS/004) projects.peer-reviewe