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/)

Cultural Differences in Children’s White Lie-Telling Behaviour

This research explored cultural differences in children’s white lie-telling behaviour by comparing 4- to 5-year-old Anglo Canadian, Chinese Canadian, and Russian Canadian children. Two online experiments, a Reverse Rouge Task (Experiment 1) and an Art Rating Task (Experiment 2), put participants in politeness situations that prompted them to tell a white lie (or a blunt truth). Parental measures of collectivism and parenting style were also collected to explore children’s likelihood of white lie-telling in relation to these factors. The current data revealed that, contrary to our hypotheses, children’s likelihood of white lie-telling behaviour did not vary as a function of their cultural background or the presence/absence of a stated social consequence and was not predicted by parental collectivism or authoritarianism. Across both experiments, parental authoritativeness was positively associated with children’s likelihood of white lie-telling behaviour. These findings are discussed in relation to possible factors that might have accounted for the lack of cultural differences, and directions for future research are proposed.</p

Facteurs de satisfaction associés au bonheur de l'adulte

Over the past twenty years, numerous articles on the factors of satisfaction associated with happiness in adults have been published. Approximately forty of these studies seem of particular importance and can be categorized according to the following themes: personality; emotions; interpersonal relationships; social activities and leisure; work; educational level, socio-economic status and income; age; and gender. This article first presents a critical review of this literature. Beyond facilitating a better understanding of the relative contribution of each factor associated with happiness, this review makes suggestions for methodology and presents avenues for future research. It also offers applications which could be of use to professionals either in personal growth or the therapeutic context.Depuis vingt ans, on relève de nombreuses recherches empiriques portant sur les facteurs de satisfaction associés au bonheur de la personne adulte. Une quarantaine de ces études paraissent particulièrement pertinentes et peuvent être regroupées sous les thèmes suivants : la personnalité; les émotions; les relations interpersonnelles; les activités sociales et les loisirs; le travail; le niveau de scolarité, le statut socio économique et le revenu; l'âge; et le genre. Cet article vise d'abord à faire la recension critique des recherches. En plus de contribuer à une meilleure compréhension de l'apport respectif de chacun des facteurs de satisfaction liés au bonheur, cette recension offre des suggestions méthodologiques et dégage des pistes de recherche prometteuses. Diverses applications découlant de la recherche sont aussi présentées à l'intention des intervenants, que ce soit dans un contexte de développement personnel ou encore thérapeutique

La Grâce-Dieu où revit Port-Royal

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