Les grands incendies de forêt en Méditerranée

Les incendies de forêt sont un phénomène récurrent en milieu méditerranéen. Chaque année, des milliers d’hectares de végétation partent en fumée dans l’indifférence quasi‑générale des riverains de la Grande Bleue. Lorsque des victimes sont enregistrées ou quand les flammes viennent lécher les faubourgs des plus grandes villes, la presse se saisit de l’information avant de basculer bientôt vers d’autres faits divers. La « banalité du mal » voudrait que le problème soit entièrement géré par des techniciens de l’aménagement, appuyés par des ingénieurs forestiers. Ce numéro de Méditerranée aborde la question des « grands » incendies par une approche géographique qui contraste avec les analyses écosystémiques ou climatologiques habituelles. La grille de lecture est volontairement anthropocentrée. Face à une urbanisation galopante, au développement de friches multiples, à une pression foncière et démographique accrue, et en dépit de la prolifération des zones de protection, les incendies apparaissent en effet comme une variable d’ajustement dans la régulation des rapports complexes entre territoires « anthropisés » et « naturels ». Ils révèlent des dysfonctionnements/déséquilibres chroniques en matière d’aménagement, de même qu’ils traduisent l’état des relations entre territoires centraux et marges « naturelles », proches ou lointaines. Indépendamment de leur emprise spatiale, les « grands » incendies sont ainsi considérés à hauteur de leur impact sur les sociétés méditerranéennes. Forest fires are a recurring phenomenon around the Mediterranean. Each year, thousands of square miles of vegetation burn without catching the attention of unconcerned populations neighboring the Big Blue. When victims are registered or when flames lick the outskirts of some major urban area, the information may temporarily make the headlines before other boring local news soon come back. The “banality of evil” implies that the problem is solved by planning technicians and other forest engineers. This issue of the Journal of Mediterranean Studies adopts a geographical approach of the “great” wildfires question, breaking with common analyses of ecosystems and climate change. The primary perspective is clearly anthropocentric. Beside the fast-paced urbanization, developing wastelands, heavy land and human pressure and despite the growing number of protection zones, wildfires serve as an adjustment variable regulating the complex relationship between anthropogenic and “natural” areas. They reveal chronic bugs/imbalances in land use planning and describe the state of relations between central places and “natural” margins, whatever close or far these might be. Independently from their spatial extent, wildfires shall be considered “great” relatively to their impact on Mediterranean societies

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 < 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)