Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)

Purpose Thrombocytopenia (platelet count < 150 × 109/L) is common in intensive care unit (ICU) patients and is likely associated with worse outcomes. In this study we present international contemporary data on thrombocytopenia in ICU patients. Methods We conducted a prospective cohort study in adult ICU patients in 52 ICUs across 10 countries. We assessed frequencies of thrombocytopenia, use of platelet transfusions and clinical outcomes including mortality. We evaluated pre-selected potential risk factors for the development of thrombocytopenia during ICU stay and associations between thrombocytopenia at ICU admission and 90-day mortality using pre-specified logistic regression analyses. Results We analysed 1166 ICU patients; the median age was 63 years and 39.5% were female. Overall, 43.2% (95% confidence interval (CI) 40.4–46.1) had thrombocytopenia; 23.4% (20–26) had thrombocytopenia at ICU admission, and 19.8% (17.6–22.2) developed thrombocytopenia during their ICU stay. Non-AIDS-, non-cancer-related immune deficiency, liver failure, male sex, septic shock, and bleeding at ICU admission were associated with the development of thrombocytopenia during ICU stay. Among patients with thrombocytopenia, 22.6% received platelet transfusion(s), and 64.3% of in-ICU transfusions were prophylactic. Patients with thrombocytopenia had higher occurrences of bleeding and death, fewer days alive without the use of life-support, and fewer days alive and out of hospital. Thrombocytopenia at ICU admission was associated with 90-day mortality (adjusted odds ratio 1.7; 95% CI 1.19–2.42). Conclusion Thrombocytopenia occurred in 43% of critically ill patients and was associated with worse outcomes including increased mortality. Platelet transfusions were given to 23% of patients with thrombocytopenia and most were prophylactic.publishedVersio

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Des inégalités dans l’appropriation et l’utilisation de l’eau à Maracaibo (Venezuela) au mouvement socio-environnemental pour l’eau à Cochabamba (Bolivie)

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Eau et pouvoir. Les échelles des mouvements contestataires et révolutionnaires en Bolivie et au Venezuela

The appropriation of water production and supply mechanisms constitutes a strategic power issue for the control of the basic living conditions that have an impact both individual and collective. From a former national public sector to a private transnational appropriation, water services are now subject to contentious and revolutionaries movements who militate for a democratic organization of the power exercise. Who are the actors and what are the mechanisms responsible for the inequalities of access to water? At what scale(s) must be distributed resources and skills regarding the water services? Overall, in which political project of social transformation those claims fit into? In order to answer these questions, the research is divided in two parts: one is theoretical, while the other one takes a more empirical look. First of all, an analytic frame using an articulation of the marxian and foucaldian systems of thoughts has been made up to study domination and emancipation scales. Then, the question of analyzing the scalar dimension of the antiglobalization movement and the socialist revolutions in Bolivia and in Venezuela as emerged, considering that they both defend a democratization of the services and further the universalization of the access to water. Taking these contentious and revolutionaries movements "at their word" has implied studying the laws and discourses they produce (using a critical discourse analysis) and the collective action effects on the social reality (by making observations and conducting interviews) of actors involved in these socio-political processes.L'appropriation des mécanismes de production et de distribution de l'eau constitue un enjeu de pouvoir pour le contrôle des conditions de la vie, tant individuelle que collective. Suite à l'appropriation publique nationale puis privée transnationale des services de l'eau, des mouvements contestataires et révolutionnaires ont milité pour une organisation démocratique de l'exercice du pouvoir. Quels sont les acteurs et les mécanismes responsables des inégalités d'accès à l'eau ? A quelle(s) échelle(s) doivent être réparties les ressources et les compétences en matière de services de l'eau ? Plus globalement, dans quel projet politique de transformation sociale s'insèrent ces revendications sectorielles ? Afin de répondre à ces questions, la recherche a été organisée en deux grands moments, l'un théorique et l'autre empirique. Il s'est avéré tout d'abord nécessaire de construire un cadre d'analyse des échelles de la domination et de l'émancipation, à l'aide d'une articulation des systèmes de pensée marxien et foucaldien. Il s'est agi ensuite d'analyser la dimension scalaire du mouvement altermondialiste et des révolutions socialistes en Bolivie et au Venezuela, processus qui défendent une démocratisation de la prestation des services pour l'universalisation de l'accès à l'eau. " Prendre au mot " ces mouvements contestataires et révolutionnaires a impliqué de s'intéresser à la production discursive et juridique (analyse critique du discours) ainsi qu'aux effets de l'action collective sur la réalité sociale (observations et entretiens) des acteurs engagés dans ces processus sociopolitiques

Los sindicatos de la enseñanza superior frente a la "autonomía" neoliberal. Reflexiones a partir de las experiencias en la Universidad de Caen

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Le séminaire "Pratiques et pensées de l'émancipation" : expérimentation d'un commun politico-scientifique (de) précaire(s)

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Penser les échelles pour penser les luttes

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Mobilisations (de) précaires à l'Université. Permanence d'une cause et de pratiques de lutte

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