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Le présent article explore la gouvernance de l'eau à travers une étude de cas sur la plaine de Berrechid au Maroc. Cette région subit une pression croissante sur ses eaux souterraines, exacerbée par l'augmentation des surfaces irriguées (maraîchage et fourrages) et un pompage intensif. Cette situation a conduit à une surexploitation de la nappe, avec un déficit annuel de 32 millions de mètres cubes. Basée sur des recherches menées dans le cadre d'un projet de la FAO et d'autres études complémentaires, l'analyse se concentre sur l'évolution du cadre réglementaire et institutionnel sur la gestion des eaux, ainsi que sur la complexité des interactions entre les divers acteurs, tant dans les cadres formels qu'informels. L'étude met en lumière les difficultés inhérentes à la mise en place d'une gestion participative des eaux souterraines, incluant l'application insuffisante des réglementations, le manque de consensus social et les défis de coordination entre les institutions. Bien que les récents contrats de concession à Berrechid représentent un pas vers une gestion participative, l'article questionne leur efficacité à long terme et souligne l'importance d'une réflexion approfondie pour assurer une gestion durable des ressources en eau. L'article conclut sur la nécessité d'une collaboration étroite entre tous les acteurs pour une transition vers une gestion durable de l'eau, soulignant que cette évolution nécessite un changement dans les perceptions et les pratiques, ainsi qu'un engagement politique soutenu. De plus, il est essentiel d'assurer un appui continu non seulement technique, mais aussi social, institutionnel et financier pour renforcer cette transition vers une gouvernance améliorée des ressources en eau.

Despite the attention given to the water–energy–food nexus, there is little field evidence of how this plays out for irrigators. This article analyses the diversity of irrigation system configurations and their related water and energy use in semi-arid Morocco, where groundwater-fed and pressurized drip irrigation, although supposedly thrifty, is energy intensive. The analysis relying on hydraulic calculations and multiple linear regressions was based on interviews, observations and measurements on irrigation systems in 25 farms. The results show that each farmer used between one and three pumps and up to two storage reservoirs to pump groundwater from up to 120 m deep borehole(s) and transfer it along a distance often exceeding 2 km to reach available fertile lands that are rented. Such distances had little effect on the system-wise energy consumption, varying between 4.62 and 4.88 kWh m−3, although the recycled car engines powering these irrigation systems were largely inefficient, consuming on average 2.5 kWh m−3. State subsidies encourage these water-intensive and energy-inefficient farming systems, increasing pressure on groundwater and land. These findings underline the importance of going beyond a strict nexus perspective, as expansion of the 'groundwater economy' is accompanied by conflicts over tenure and increasing inequalities in access to water that threaten the sustainability of irrigated agriculture.

Despite the attention given to the water–energy–food nexus, there is little field evidence of how this plays out for irrigators. This article analyses the diversity of irrigation system configurations and their related water and energy use in semi-arid Morocco, where groundwater-fed and pressurized drip irrigation, although supposedly thrifty, is energy intensive. The analysis relying on hydraulic calculations and multiple linear regressions was based on interviews, observations and measurements on irrigation systems in 25 farms. The results show that each farmer used between one and three pumps and up to two storage reservoirs to pump groundwater from up to 120 m deep borehole(s) and transfer it along a distance often exceeding 2 km to reach available fertile lands that are rented. Such distances had little effect on the system-wise energy consumption, varying between 4.62 and 4.88 kWh m−3, although the recycled car engines powering these irrigation systems were largely inefficient, consuming on average 2.5 kWh m−3. State subsidies encourage these water-intensive and energy-inefficient farming systems, increasing pressure on groundwater and land. These findings underline the importance of going beyond a strict nexus perspective, as expansion of the 'groundwater economy' is accompanied by conflicts over tenure and increasing inequalities in access to water that threaten the sustainability of irrigated agriculture.

In this contribution, a mathematical model allowing for the prediction of the AC surface arc propagation on polluted insulators under non-uniform electric field is proposed. The approach is based on the experimental concept of Claverie and Porcheron. The proposed model, which makes it possible to reproduce the surface electric discharge, includes a condition for arrest of the propagating discharge. The electric field at the tip of the discharge is the key parameter governing its random propagation. A finite element approach allows for mapping of the electric field distribution while the discharge propagation process is simulated in two dimensions. The voltage drop along the arc discharge path at each propagation step is also taken into account. The simulation results are validated against experimental data, taking into account several electro-geometric parameters (distance between electrodes, pollution conductivity, radius of high-voltage electrode, length of the plane electrode). Good agreement between computed and experimental results were obtained for various test configurations.

Dans un contexte de développement de l'agriculture irriguée et de surexploitation des eaux souterraines, le Maroc s'est lancé dans des processus de mise en place de contrats de nappe dans le but de responsabiliser les différents usagers et de les encourager à s'impliquer dans la gestion de ces nappes. C'est le cas pour la nappe de Berrechid où l'agence du bassin a initié ce processus depuis 2011. Plus récemment, elle a engagé un projet de concession pour le seul secteur agricole au profit de quatre associations d'usagers de l'eau agricole afin de débloquer le processus de contrat de nappe, qui n'a pas encore abouti. L'objectif de l'article est d'analyser les enjeux de gouvernance des eaux souterraines, révélés par ce processus de contrat de nappe. Pour ce faire, nous avons repris l'historique de la mise en place du contrat de nappe, puis du projet de concession. Aussi, nous avons mesuré les prélèvements des eaux souterraines pompées par les différentes catégories d'agriculteurs dans deux douars situés dans la plaine, pour ensuite nous interroger sur le positionnement de ces catégories d'agriculteurs dans la mise en place du projet de concession. Les résultats montrent que le processus de mise en place du contrat de nappe, même s'il n'a pas encore abouti, est révélateur des enjeux de gouvernance des eaux souterraines en pointant les prélèvements des eaux souterraines effectués par différentes catégories d'agriculteurs. Cependant, ces enjeux sont en même temps invisibilisés dans le processus quand les débats sont focalisés sur la consommation à l'hectare en laissant de côté, pour le moment, la maîtrise des superficies irriguées par exploitant. Notre analyse conduit à penser que la gouvernance de l'eau souterraine requiert la compréhension fine des eaux souterraines, de la diversité des usages et des catégories des agriculteurs, de leurs prélèvements d'eau souterraine et in fine du cadre institutionnel et juridique qui s'applique à cette ressource.

Au Maroc, l'exploitation individuelle des eaux souterraines a permis le développement rapide d'une agriculture irriguée intensive. Dans la plaine de Berrechid, la ressource est limitée et surexploitée. L'agence de bassin tente depuis une dizaine d'années de mettre en place une contractualisation avec différents acteurs pour réguler les prélèvements en eau souterraine à usage agricole. L'objectif de l'étude est d'analyser en quoi la catégorisation des agriculteurs, se distinguant par leur accès à l'eau et au foncier, et les interactions entre ces catégories d'agriculteurs, sont utiles pour penser la gouvernance de la nappe. Une fois la dynamique de l'agriculture irriguée retracée, des enquêtes ont permis d'établir une typologie d'agriculteurs, puis les arrangements et rivalités entre les différents types d'agriculteurs ont été caractérisés. Les résultats montrent que l'utilisation accrue des eaux souterraines a déclenché des rivalités pour l'accès à l'eau, ainsi que l'exclusion de certains agriculteurs dans un contexte de baisse de la nappe. Pour dépasser ces problèmes d'accès, certains agriculteurs mettent en place des arrangements coopératifs autour des différents facteurs de production (eau, terre, capital, savoir-faire, main-d'oeuvre). Cependant, ces arrangements accentuent, paradoxalement, la surexploitation de la nappe et les rivalités, et entraînent la poursuite et l'évolution des formes d'arrangements coopératifs. La compréhension fine de la nature des relations entre différents types d'agriculteurs peut permettre d'inclure une réflexion sur l'équité sociale dans le projet de concession aux associations de producteurs, qui pour le moment semble ignorer ces relations.

Dans un contexte de développement de l'agriculture irriguée et de surexploitation des eaux souterraines, le Maroc s'est lancé dans des processus de mise en place de contrats de nappe dans le but de responsabiliser les différents usagers et de les encourager à s'impliquer dans la gestion de ces nappes. C'est le cas pour la nappe de Berrechid où l'agence du bassin a initié ce processus depuis 2011. Plus récemment, elle a engagé un projet de concession pour le seul secteur agricole au profit de quatre associations d'usagers de l'eau agricole afin de débloquer le processus de contrat de nappe, qui n'a pas encore abouti. L'objectif de l'article est d'analyser les enjeux de gouvernance des eaux souterraines, révélés par ce processus de contrat de nappe. Pour ce faire, nous avons repris l'historique de la mise en place du contrat de nappe, puis du projet de concession. Aussi, nous avons mesuré les prélèvements des eaux souterraines pompées par les différentes catégories d'agriculteurs dans deux douars situés dans la plaine, pour ensuite nous interroger sur le positionnement de ces catégories d'agriculteurs dans la mise en place du projet de concession. Les résultats montrent que le processus de mise en place du contrat de nappe, même s'il n'a pas encore abouti, est révélateur des enjeux de gouvernance des eaux souterraines en pointant les prélèvements des eaux souterraines effectués par différentes catégories d'agriculteurs. Cependant, ces enjeux sont en même temps invisibilisés dans le processus quand les débats sont focalisés sur la consommation à l'hectare en laissant de côté, pour le moment, la maîtrise des superficies irriguées par exploitant. Notre analyse conduit à penser que la gouvernance de l'eau souterraine requiert la compréhension fine des eaux souterraines, de la diversité des usages et des catégories des agriculteurs, de leurs prélèvements d'eau souterraine et in fine du cadre institutionnel et juridique qui s'applique à cette ressource.

Au Maroc, l'exploitation individuelle des eaux souterraines a permis le développement rapide d'une agriculture irriguée intensive. Dans la plaine de Berrechid, la ressource est limitée et surexploitée. L'agence de bassin tente depuis une dizaine d'années de mettre en place une contractualisation avec différents acteurs pour réguler les prélèvements en eau souterraine à usage agricole. L'objectif de l'étude est d'analyser en quoi la catégorisation des agriculteurs, se distinguant par leur accès à l'eau et au foncier, et les interactions entre ces catégories d'agriculteurs, sont utiles pour penser la gouvernance de la nappe. Une fois la dynamique de l'agriculture irriguée retracée, des enquêtes ont permis d'établir une typologie d'agriculteurs, puis les arrangements et rivalités entre les différents types d'agriculteurs ont été caractérisés. Les résultats montrent que l'utilisation accrue des eaux souterraines a déclenché des rivalités pour l'accès à l'eau, ainsi que l'exclusion de certains agriculteurs dans un contexte de baisse de la nappe. Pour dépasser ces problèmes d'accès, certains agriculteurs mettent en place des arrangements coopératifs autour des différents facteurs de production (eau, terre, capital, savoir-faire, main-d'oeuvre). Cependant, ces arrangements accentuent, paradoxalement, la surexploitation de la nappe et les rivalités, et entraînent la poursuite et l'évolution des formes d'arrangements coopératifs. La compréhension fine de la nature des relations entre différents types d'agriculteurs peut permettre d'inclure une réflexion sur l'équité sociale dans le projet de concession aux associations de producteurs, qui pour le moment semble ignorer ces relations.

To address sustainability challenges of agro-ecosystems located in Mediterranean urban regions, this paper focuses on the multidisciplinary subject of urban agricultural systems. To better understand the diversity and dynamics of peri-urban agro-ecosystems and the main drivers of their sustainability, we compare six case studies located in Southern Europe (Montpellier, France; Pisa, Italy; Lisbon, Portugal; Athens, Greece) and the Maghreb (Constantine, Algeria; Meknes, Morocco). The research is based on fieldwork in each urban region (qualitative analysis) and literature analysis aimed to position each case study in its national and Mediterranean contexts. The comparison between local contexts indicates large discrepancies in the integration of environmental focus among the respective urban planning objectives. Generally, urbanization tends to accentuate agricultural diversity. The different forms of peri-urban agriculture evolve despite their persistent decline, and they also show a capacity to resist and even new growth in response to urban demand. (Résumé d'auteur)

To address sustainability challenges of agro-ecosystems located in Mediterranean urban regions, this paper focuses on the multidisciplinary subject of urban agricultural systems. To better understand the diversity and dynamics of peri-urban agro-ecosystems and the main drivers of their sustainability, we compare six case studies located in Southern Europe (Montpellier, France; Pisa, Italy; Lisbon, Portugal; Athens, Greece) and the Maghreb (Constantine, Algeria; Meknes, Morocco). The research is based on fieldwork in each urban region (qualitative analysis) and literature analysis aimed to position each case study in its national and Mediterranean contexts. The comparison between local contexts indicates large discrepancies in the integration of environmental focus among the respective urban planning objectives. Generally, urbanization tends to accentuate agricultural diversity. The different forms of peri-urban agriculture evolve despite their persistent decline, and they also show a capacity to resist and even new growth in response to urban demand.

To address sustainability challenges of agro-ecosystems located in Mediterranean urban regions, this paper focuses on the multidisciplinary subject of urban agricultural systems. To better understand the diversity and dynamics of peri-urban agro-ecosystems and the main drivers of their sustainability, we compare six case studies located in Southern Europe (Montpellier, France; Pisa, Italy; Lisbon, Portugal; Athens, Greece) and the Maghreb (Constantine, Algeria; Meknes, Morocco). The research is based on fieldwork in each urban region (qualitative analysis) and literature analysis aimed to position each case study in its national and Mediterranean contexts. The comparison between local contexts indicates large discrepancies in the integration of environmental focus among the respective urban planning objectives. Generally, urbanization tends to accentuate agricultural diversity. The different forms of peri-urban agriculture evolve despite their persistent decline, and they also show a capacity to resist and even new growth in response to urban demand.

OBJECTIVES: Due to organ shortage in lung transplantation (LTx), donation after circulatory death (DCD) has been implemented in several countries, contributing to an increasing number of organs transplanted. We sought to assess long-term outcomes after LTx with organs procured following circulatory death in comparison with those obtained from donors after brain death (DBD). METHODS: Between January 2007 and November 2013, 302 LTxs were performed in our institution, whereby 60 (19.9%) organs were retrieved from DCD donors. We performed propensity score matching (DCD: DBD = 1: 2) based on preoperative donor and recipient factors that were significantly different in univariate analysis. RESULTS: After propensity matching, there were no statistically significant differences between the groups in terms of demographics and preoperative donor and recipient characteristics. There were no significant differences regarding intraoperative variables and total ischaemic time. Patients from the DCD group had significantly higher incidence of primary graft dysfunction grade 3 at the end of the procedure (P = 0.014), and significantly lower pO(2)/FiO(2) ratio during the first 24 h after the procedure (P = 0.018). There was a trend towards higher incidence of the need for postoperative extracorporeal life support in the DCD group. Other postoperative characteristics were comparable. While the overall cumulative survival was not significantly different, the DCD group had significantly poorer results in terms of bronchiolitis obliterans syndrome (BOS)-free survival in the long-term follow-up. CONCLUSIONS: Long-term results after LTx with organs procured following DCD are in general comparable with those obtained after DBD LTx. However, patients transplanted using organs from DCD donors have a predisposition for development of BOS in the longer follow-up.

OBJECTIVES: Due to organ shortage in lung transplantation (LTx), donation after circulatory death (DCD) has been implemented in several countries, contributing to an increasing number of organs transplanted. We sought to assess long-term outcomes after LTx with organs procured following circulatory death in comparison with those obtained from donors after brain death (DBD). METHODS: Between January 2007 and November 2013, 302 LTxs were performed in our institution, whereby 60 (19.9%) organs were retrieved from DCD donors. We performed propensity score matching (DCD: DBD = 1: 2) based on preoperative donor and recipient factors that were significantly different in univariate analysis. RESULTS: After propensity matching, there were no statistically significant differences between the groups in terms of demographics and preoperative donor and recipient characteristics. There were no significant differences regarding intraoperative variables and total ischaemic time. Patients from the DCD group had significantly higher incidence of primary graft dysfunction grade 3 at the end of the procedure (P = 0.014), and significantly lower pO(2)/FiO(2) ratio during the first 24 h after the procedure (P = 0.018). There was a trend towards higher incidence of the need for postoperative extracorporeal life support in the DCD group. Other postoperative characteristics were comparable. While the overall cumulative survival was not significantly different, the DCD group had significantly poorer results in terms of bronchiolitis obliterans syndrome (BOS)-free survival in the long-term follow-up. CONCLUSIONS: Long-term results after LTx with organs procured following DCD are in general comparable with those obtained after DBD LTx. However, patients transplanted using organs from DCD donors have a predisposition for development of BOS in the longer follow-up.

The Synergy Micro-pump is the smallest implantable left ventricular assist device (LVAD) and provides partial flow support up to 4.25L/min. It was shown that early intervention with this device can provide substantial benefits to patients with severe heart failure not yet sick enough for a full-support LVAD. However, as it can be inserted via small incisions with no need for sternotomy or cardiopulmonary bypass, it might be beneficial for selected high-risk patients. The aim of this study was to evaluate the efficacy of the Synergy Micro-pump in patients in INTERMACS class 1-2. From February 2012 to August 2013, 13 patients with severe heart failure were supported with the Synergy Pocket Micro-pump. Patients were divided into two groups according to INTERMACS class: the high-risk group (INTERMACS class 1-2) and the low-risk group (INTERMACS class 3-4). There were seven patients in INTERMACS class 1-2 and six in INTERMACS class 3-4. Patient demographics, perioperative characteristics, and postoperative outcomes were compared. There were no statistically significant differences in patient demographics, and mean support time was 108 +/- 114 days in the high-risk group and 238 +/- 198 days in the low-risk group. Also, there were no significant differences in perioperative characteristics or in the rate of postoperative adverse events. The overall survival was comparable between the two groups (one late death in each group, log-rank P=0.608). Two patients from the high-risk group were upgraded to a full-support LVAD (P=0.462) after 65 +/- 84.9 days of mean support. One patient from the high-risk group and two patients from the low-risk group were successfully transplanted (P=0.559). The use of the Synergy Micro-pump in INTERMACS 1-2 patients is feasible and is associated with similar postoperative outcome as in patients in INTERMACS 3-4. Carefully selected patients with severe heart failure could benefit due to the small size of the pump; however, further studies and med

Dans les périmètres irrigués au Maroc, les exploitations agricoles de petite taille rencontrent des difficultés pour convertir individuellement leur équipement d'irrigation gravitaire en irrigation localisée, d'où l'intérêt pour une conversion collective. Les acteurs qui accompagnent cette conversion collective mettent souvent en avant les aspects techniques, au détriment d'un appui à la maturation de ces projets au niveau des groupes d'agriculteurs. L'article présente une grille pour l'analyse et le suivi de la maturation de projets collectifs de conversion à l'irrigation localisée. La grille a été testée dans le cas de projets de conversion collective situés dans les oasis au Maroc. La grille s'est révélée utile pour structurer un diagnostic initial, à partir duquel ont été organisés des ateliers et une visite de systèmes irrigués en irrigation localisée et pour évaluer les apprentissages des agriculteurs suite à ces activités. Cette grille pourrait aussi être utilisée dans le cas d'autres projets engageant un collectif d'acteurs. (Résumé d'auteur)

The purpose of this study was to evaluate gender differences regarding outcome after continuous-flow left ventricular assist device (cfLVAD) implantation. The study was a retrospective review of prospectively collected data. Included were 24 consecutive female cfLVAD recipients and 24 male recipients (62.5% HeartMate II, 37.5% HeartWare) who received their devices between July 2007 and May 2013. Subjects were matched using propensity score analysis based on age, diagnosis, body surface area, preoperative mechanical circulatory support, heart failure severity score (INTERMACS class), and comorbidities. Female patients were significantly sicker before operation. After propensity score matching, there were no statistically significant differences in demographics or clinical baseline characteristics between male and female LVAD recipients. Also, there was a trend towards a longer postoperative intensive care unit stay in the female group (median 9 days [interquartile range 5-17] versus 15 days [interquartile range 8-33]; P < 0.061) and higher postoperative bilirubin values (median 14 mmol/L [interquartile range 10-17] versus 21 mmol/L [interquartile range 13-30]). However, there were no significant differences between the two groups in terms of outcome (P < 0.569). The overall survival was comparable between the two groups (log rank P < 0.389). Half (50%) of female patients required inotropic support for more than 7 days compared with 21.7% in the male group (P < 0.048). Half (50%) of female recipients required short-term postoperative right ventricular assist device implantation compared with 16.7% in the male group (P < 0.014). In conclusion, cfLVAD implantation as a bridge to transplantation is associated with longer duration of inotropic support and higher requirement for postoperative mechanical right ventricular support in women with similar survival rates. Further studies are required to identify additional demographic and clinical factors that modulate outcomes

The purpose of this study was to evaluate gender differences regarding outcome after continuous-flow left ventricular assist device (cfLVAD) implantation. The study was a retrospective review of prospectively collected data. Included were 24 consecutive female cfLVAD recipients and 24 male recipients (62.5% HeartMate II, 37.5% HeartWare) who received their devices between July 2007 and May 2013. Subjects were matched using propensity score analysis based on age, diagnosis, body surface area, preoperative mechanical circulatory support, heart failure severity score (INTERMACS class), and comorbidities. Female patients were significantly sicker before operation. After propensity score matching, there were no statistically significant differences in demographics or clinical baseline characteristics between male and female LVAD recipients. Also, there was a trend towards a longer postoperative intensive care unit stay in the female group (median 9 days [interquartile range 5-17] versus 15 days [interquartile range 8-33]; P < 0.061) and higher postoperative bilirubin values (median 14 mmol/L [interquartile range 10-17] versus 21 mmol/L [interquartile range 13-30]). However, there were no significant differences between the two groups in terms of outcome (P < 0.569). The overall survival was comparable between the two groups (log rank P < 0.389). Half (50%) of female patients required inotropic support for more than 7 days compared with 21.7% in the male group (P < 0.048). Half (50%) of female recipients required short-term postoperative right ventricular assist device implantation compared with 16.7% in the male group (P < 0.014). In conclusion, cfLVAD implantation as a bridge to transplantation is associated with longer duration of inotropic support and higher requirement for postoperative mechanical right ventricular support in women with similar survival rates. Further studies are required to identify additional demographic and clinical factors that modulate outcomes

The purpose of this study was to evaluate the effects and outcome of continuous-flow left ventricular assist device (cf-LVAD) therapy in patients with preoperative acute hepatic failure. The study design was a retrospective review of prospectively collected data. Included were 42 patients who underwent cf-LVAD implantation (64.3% HeartMate II, 35.7% HeartWare) between July 2007 and May 2013 with preoperative hepatic failure defined as elevation of greater than or equal to two liver function parameters above twice the upper normal range. Mean patient age was 35 +/- 12.5 years, comprising 23.8% females. Dilated cardiomyopathy was present in 92.9% of patients (left ventricular ejection fraction 17.3 +/- 5.9%). Mean support duration was 511 +/- 512 days (range: 2-1996 days). Mean preoperative laboratory parameters for blood urea nitrogen, serum creatinine, total bilirubin, and alanine aminotransferase were 9.5 +/- 5.4 mg/dL, 110.3 +/- 42.8 mu mol/L, 51.7 +/- 38.3 mmol/L, and 242.1 +/- 268.6 U/L, respectively. All parameters decreased significantly 1 month postoperatively. The mean preoperative modified Model for Endstage Liver Disease excluding international normalized ratio score was 16.03 +/- 5.57, which improved significantly after cf-LVAD implantation to 10.62 +/- 5.66 (P < 0.001) at 7 days and 5.83 +/- 4.98 (P < 0.001) at 30 days postoperatively. One-year and 5-year survival was 75.9 and 48.1%, respectively. 21.4% of the patients underwent LVAD explantation for myocardial recovery, 16.7% were successfully transplanted, and 7.1% underwent LVAD exchange for device failure over the follow-up period. Patients with preexisting acute hepatic failure are reasonable candidates for cf-LVAD implantation, with excellent rates of recovery and survival, suggesting that cf-LVAD therapy should not be denied to patients merely on grounds of preoperative elevated liver enzymes/hepatopathy.

The purpose of this study was to evaluate the effects and outcome of continuous-flow left ventricular assist device (cf-LVAD) therapy in patients with preoperative acute hepatic failure. The study design was a retrospective review of prospectively collected data. Included were 42 patients who underwent cf-LVAD implantation (64.3% HeartMate II, 35.7% HeartWare) between July 2007 and May 2013 with preoperative hepatic failure defined as elevation of greater than or equal to two liver function parameters above twice the upper normal range. Mean patient age was 35 +/- 12.5 years, comprising 23.8% females. Dilated cardiomyopathy was present in 92.9% of patients (left ventricular ejection fraction 17.3 +/- 5.9%). Mean support duration was 511 +/- 512 days (range: 2-1996 days). Mean preoperative laboratory parameters for blood urea nitrogen, serum creatinine, total bilirubin, and alanine aminotransferase were 9.5 +/- 5.4 mg/dL, 110.3 +/- 42.8 mu mol/L, 51.7 +/- 38.3 mmol/L, and 242.1 +/- 268.6 U/L, respectively. All parameters decreased significantly 1 month postoperatively. The mean preoperative modified Model for Endstage Liver Disease excluding international normalized ratio score was 16.03 +/- 5.57, which improved significantly after cf-LVAD implantation to 10.62 +/- 5.66 (P < 0.001) at 7 days and 5.83 +/- 4.98 (P < 0.001) at 30 days postoperatively. One-year and 5-year survival was 75.9 and 48.1%, respectively. 21.4% of the patients underwent LVAD explantation for myocardial recovery, 16.7% were successfully transplanted, and 7.1% underwent LVAD exchange for device failure over the follow-up period. Patients with preexisting acute hepatic failure are reasonable candidates for cf-LVAD implantation, with excellent rates of recovery and survival, suggesting that cf-LVAD therapy should not be denied to patients merely on grounds of preoperative elevated liver enzymes/hepatopathy.

Les innovations paysannes conçues et/ou développées par des agriculteurs familiaux et d'autres acteurs du secteur informel proche, ont accompagné depuis 3 décennies le développement des cultures irriguées dans la plaine du Saïs (Maroc) et plus particulièrement le maraîchage. L'adaptation du système d'irrigation localisée ou " goutte à goutte " importé de l'étranger puis des grandes exploita-tions d'arboriculture, a été réalisée par ces agriculteurs en partenariat avec des artisans et des installateurs " infor-mels ". Elle a consisté à valoriser des équipements fabriqués localement et à rendre les systèmes d'irrigation mobiles et moins coûteux. Face à la raréfaction des eaux souterraines (profondeur de la nappe, moindre débit des puits), agricul-teurs et puisatiers ont conçu des systèmes de drainage basés sur des micro-galeries en fond de puits, moins cou-teux que l'installation de forages. Plus récemment, la ferti-gation organique basée sur la fabrication d'un purin dilué est venue compléter dans quelques exploitations familiales la fertigation minérale des arbres fruitiers et des cultures légumières. Ce dynamisme s'explique par (i) la proximité entre les agri-culteurs familiaux et les grandes entreprises de production pratiquant l'irrigation avec les techniques importées des pays du pourtour méditerranéen depuis plus longtemps, (ii) la présence d'un système d'innovation local, multi-acteurs et dynamique, et surtout (iii) le besoin de changer les pra-tiques culturales ou de s'adapter à de nouvelles contraintes ou opportunités. Partant de ces constats empiriques, nous proposons aux agronomes des structures d'appui au déve-loppement et de recherche de mieux prendre en considéra-tion ces innovations paysannes et les processus qui ont permis de les faire émerger. Cette reconnaissance des capa-cités d'innovation des agriculteurs interpelle les méthodes de conception dans le secteur agricole et plus largement la définition des politiques agricoles.

Les innovations paysannes conçues et/ou développées par des agriculteurs familiaux et d'autres acteurs du secteur informel proche, ont accompagné depuis 3 décennies le développement des cultures irriguées dans la plaine du Saïs (Maroc) et plus particulièrement le maraîchage. L'adaptation du système d'irrigation localisée ou " goutte à goutte " importé de l'étranger puis des grandes exploita-tions d'arboriculture, a été réalisée par ces agriculteurs en partenariat avec des artisans et des installateurs " infor-mels ". Elle a consisté à valoriser des équipements fabriqués localement et à rendre les systèmes d'irrigation mobiles et moins coûteux. Face à la raréfaction des eaux souterraines (profondeur de la nappe, moindre débit des puits), agricul-teurs et puisatiers ont conçu des systèmes de drainage basés sur des micro-galeries en fond de puits, moins cou-teux que l'installation de forages. Plus récemment, la ferti-gation organique basée sur la fabrication d'un purin dilué est venue compléter dans quelques exploitations familiales la fertigation minérale des arbres fruitiers et des cultures légumières. Ce dynamisme s'explique par (i) la proximité entre les agri-culteurs familiaux et les grandes entreprises de production pratiquant l'irrigation avec les techniques importées des pays du pourtour méditerranéen depuis plus longtemps, (ii) la présence d'un système d'innovation local, multi-acteurs et dynamique, et surtout (iii) le besoin de changer les pra-tiques culturales ou de s'adapter à de nouvelles contraintes ou opportunités. Partant de ces constats empiriques, nous proposons aux agronomes des structures d'appui au déve-loppement et de recherche de mieux prendre en considéra-tion ces innovations paysannes et les processus qui ont permis de les faire émerger. Cette reconnaissance des capa-cités d'innovation des agriculteurs interpelle les méthodes de conception dans le secteur agricole et plus largement la définition des politiques agricoles.

The Synergy Micro-pump is the smallest implantable left ventricular assist device (LVAD) and provides partial flow support up to 4.25L/min. It was shown that early intervention with this device can provide substantial benefits to patients with severe heart failure not yet sick enough for a full-support LVAD. However, as it can be inserted via small incisions with no need for sternotomy or cardiopulmonary bypass, it might be beneficial for selected high-risk patients. The aim of this study was to evaluate the efficacy of the Synergy Micro-pump in patients in INTERMACS class 1-2. From February 2012 to August 2013, 13 patients with severe heart failure were supported with the Synergy Pocket Micro-pump. Patients were divided into two groups according to INTERMACS class: the high-risk group (INTERMACS class 1-2) and the low-risk group (INTERMACS class 3-4). There were seven patients in INTERMACS class 1-2 and six in INTERMACS class 3-4. Patient demographics, perioperative characteristics, and postoperative outcomes were compared. There were no statistically significant differences in patient demographics, and mean support time was 108 +/- 114 days in the high-risk group and 238 +/- 198 days in the low-risk group. Also, there were no significant differences in perioperative characteristics or in the rate of postoperative adverse events. The overall survival was comparable between the two groups (one late death in each group, log-rank P=0.608). Two patients from the high-risk group were upgraded to a full-support LVAD (P=0.462) after 65 +/- 84.9 days of mean support. One patient from the high-risk group and two patients from the low-risk group were successfully transplanted (P=0.559). The use of the Synergy Micro-pump in INTERMACS 1-2 patients is feasible and is associated with similar postoperative outcome as in patients in INTERMACS 3-4. Carefully selected patients with severe heart failure could benefit due to the small size of the pump; however, further studies and med

The purpose of this study was to evaluate gender differences regarding outcome after continuous-flow left ventricular assist device (cfLVAD) implantation. The study was a retrospective review of prospectively collected data. Included were 24 consecutive female cfLVAD recipients and 24 male recipients (62.5% HeartMate II, 37.5% HeartWare) who received their devices between July 2007 and May 2013. Subjects were matched using propensity score analysis based on age, diagnosis, body surface area, preoperative mechanical circulatory support, heart failure severity score (INTERMACS class), and comorbidities. Female patients were significantly sicker before operation. After propensity score matching, there were no statistically significant differences in demographics or clinical baseline characteristics between male and female LVAD recipients. Also, there was a trend towards a longer postoperative intensive care unit stay in the female group (median 9 days [interquartile range 5-17] versus 15 days [interquartile range 8-33]; P < 0.061) and higher postoperative bilirubin values (median 14 mmol/L [interquartile range 10-17] versus 21 mmol/L [interquartile range 13-30]). However, there were no significant differences between the two groups in terms of outcome (P < 0.569). The overall survival was comparable between the two groups (log rank P < 0.389). Half (50%) of female patients required inotropic support for more than 7 days compared with 21.7% in the male group (P < 0.048). Half (50%) of female recipients required short-term postoperative right ventricular assist device implantation compared with 16.7% in the male group (P < 0.014). In conclusion, cfLVAD implantation as a bridge to transplantation is associated with longer duration of inotropic support and higher requirement for postoperative mechanical right ventricular support in women with similar survival rates. Further studies are required to identify additional demographic and clinical factors that modulate outcomes

The purpose of this study was to evaluate gender differences regarding outcome after continuous-flow left ventricular assist device (cfLVAD) implantation. The study was a retrospective review of prospectively collected data. Included were 24 consecutive female cfLVAD recipients and 24 male recipients (62.5% HeartMate II, 37.5% HeartWare) who received their devices between July 2007 and May 2013. Subjects were matched using propensity score analysis based on age, diagnosis, body surface area, preoperative mechanical circulatory support, heart failure severity score (INTERMACS class), and comorbidities. Female patients were significantly sicker before operation. After propensity score matching, there were no statistically significant differences in demographics or clinical baseline characteristics between male and female LVAD recipients. Also, there was a trend towards a longer postoperative intensive care unit stay in the female group (median 9 days [interquartile range 5-17] versus 15 days [interquartile range 8-33]; P < 0.061) and higher postoperative bilirubin values (median 14 mmol/L [interquartile range 10-17] versus 21 mmol/L [interquartile range 13-30]). However, there were no significant differences between the two groups in terms of outcome (P < 0.569). The overall survival was comparable between the two groups (log rank P < 0.389). Half (50%) of female patients required inotropic support for more than 7 days compared with 21.7% in the male group (P < 0.048). Half (50%) of female recipients required short-term postoperative right ventricular assist device implantation compared with 16.7% in the male group (P < 0.014). In conclusion, cfLVAD implantation as a bridge to transplantation is associated with longer duration of inotropic support and higher requirement for postoperative mechanical right ventricular support in women with similar survival rates. Further studies are required to identify additional demographic and clinical factors that modulate outcomes

The purpose of this study was to evaluate the effects and outcome of continuous-flow left ventricular assist device (cf-LVAD) therapy in patients with preoperative acute hepatic failure. The study design was a retrospective review of prospectively collected data. Included were 42 patients who underwent cf-LVAD implantation (64.3% HeartMate II, 35.7% HeartWare) between July 2007 and May 2013 with preoperative hepatic failure defined as elevation of greater than or equal to two liver function parameters above twice the upper normal range. Mean patient age was 35 +/- 12.5 years, comprising 23.8% females. Dilated cardiomyopathy was present in 92.9% of patients (left ventricular ejection fraction 17.3 +/- 5.9%). Mean support duration was 511 +/- 512 days (range: 2-1996 days). Mean preoperative laboratory parameters for blood urea nitrogen, serum creatinine, total bilirubin, and alanine aminotransferase were 9.5 +/- 5.4 mg/dL, 110.3 +/- 42.8 mu mol/L, 51.7 +/- 38.3 mmol/L, and 242.1 +/- 268.6 U/L, respectively. All parameters decreased significantly 1 month postoperatively. The mean preoperative modified Model for Endstage Liver Disease excluding international normalized ratio score was 16.03 +/- 5.57, which improved significantly after cf-LVAD implantation to 10.62 +/- 5.66 (P < 0.001) at 7 days and 5.83 +/- 4.98 (P < 0.001) at 30 days postoperatively. One-year and 5-year survival was 75.9 and 48.1%, respectively. 21.4% of the patients underwent LVAD explantation for myocardial recovery, 16.7% were successfully transplanted, and 7.1% underwent LVAD exchange for device failure over the follow-up period. Patients with preexisting acute hepatic failure are reasonable candidates for cf-LVAD implantation, with excellent rates of recovery and survival, suggesting that cf-LVAD therapy should not be denied to patients merely on grounds of preoperative elevated liver enzymes/hepatopathy.

The purpose of this study was to evaluate the effects and outcome of continuous-flow left ventricular assist device (cf-LVAD) therapy in patients with preoperative acute hepatic failure. The study design was a retrospective review of prospectively collected data. Included were 42 patients who underwent cf-LVAD implantation (64.3% HeartMate II, 35.7% HeartWare) between July 2007 and May 2013 with preoperative hepatic failure defined as elevation of greater than or equal to two liver function parameters above twice the upper normal range. Mean patient age was 35 +/- 12.5 years, comprising 23.8% females. Dilated cardiomyopathy was present in 92.9% of patients (left ventricular ejection fraction 17.3 +/- 5.9%). Mean support duration was 511 +/- 512 days (range: 2-1996 days). Mean preoperative laboratory parameters for blood urea nitrogen, serum creatinine, total bilirubin, and alanine aminotransferase were 9.5 +/- 5.4 mg/dL, 110.3 +/- 42.8 mu mol/L, 51.7 +/- 38.3 mmol/L, and 242.1 +/- 268.6 U/L, respectively. All parameters decreased significantly 1 month postoperatively. The mean preoperative modified Model for Endstage Liver Disease excluding international normalized ratio score was 16.03 +/- 5.57, which improved significantly after cf-LVAD implantation to 10.62 +/- 5.66 (P < 0.001) at 7 days and 5.83 +/- 4.98 (P < 0.001) at 30 days postoperatively. One-year and 5-year survival was 75.9 and 48.1%, respectively. 21.4% of the patients underwent LVAD explantation for myocardial recovery, 16.7% were successfully transplanted, and 7.1% underwent LVAD exchange for device failure over the follow-up period. Patients with preexisting acute hepatic failure are reasonable candidates for cf-LVAD implantation, with excellent rates of recovery and survival, suggesting that cf-LVAD therapy should not be denied to patients merely on grounds of preoperative elevated liver enzymes/hepatopathy.

In irrigation schemes in Morocco, it is difficult for individual small-scale farms to shift from surface to drip irrigation. Such cases represent an opportunity for a collective shift to drip irrigation. However, actors who provide support for a collective shift to drip irrigation tend to focus on technical issues and fail to help the project mature in farmers&39; groups, thus increasing the risk of failure. This article proposes a grid for analysing and monitoring projects concerning a collective shift to drip irrigation. The grid was tested in such projects in Moroccan oases and proved to be useful in obtaining an initial diagnosis. In turn, the diagnosis was used to design two workshops with farmers&39; groups and a visit to irrigation schemes where drip irrigation was already in use. The grid also proved useful to assess the learning of the farmers who participated in these activities. This analytical grid could also be used for other types of collective projects., SCOPUS: ar.j, info:eu-repo/semantics/published

Left ventricular assist devices (LVADs) are fast becoming standard of care for patients with advanced heart failure. However, despite continuous improvement in VAD technology, there remains a significant early postoperative morbidity and mortality in this extreme patient group. The aim of the current study was to explore the short-term outcomes and predictors for 90 day mortality in the patients after implantation of continuous-flow LVAD. Perioperative clinical, echocardiographic, hemodynamic, and laboratory data of 90 day survivors and nonsurvivors were collected and compared retrospectively. Multivariate logistic regression analysis was performed on univariate predictors for 90 day mortality with an entry criterion of p < 0.1. Between July 2006 and May 2012, 117 patients underwent implantation of a continuous-flow LVAD as a bridge to transplantation: 71 (60.7%) HeartMate II (Thoratec Corp, Pleasanton, CA) and 46 (39.3%) HVAD (HeartWare International, Framingham, MA). All-cause 90 day mortality was 17.1%. Multivariate analysis revealed higher preoperative central venous pressure (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.014-1.378; p = 0.033) and higher age (OR, 1.14; 95% CI, 1.01-1.38; p = 0.045) as the only independent predictors for 90 day mortality. Optimization of preoperative volume status, preload, and right heart function as well as age-based selection of candidates for LVAD support are the critical factors influencing early outcome after continuous-flow LVAD implantation.

Background. Lung transplantation (LTx) is significantly limited by donor organ shortage. Donor smoking history of more than 20 pack-years is considered an extended donor criterion. In this study, we retrospectively evaluated impact of donor smoking history and extent of smoking on midterm outcome after LTx. Methods. In all, 237 LTx were performed in our institution between 2007 and 2012. Patients were divided into three groups, receiving lungs from 53% nonsmoking donors, 29% smoking donors with fewer than 20 pack-years, and 18% heavy smokers with more than 20 pack-years. Results. Preoperative donor and recipient characteristics among the groups were comparable. However, donors from the heavy smokers group were significantly older (p < 0.001). The overall presence of abnormal histology (inflammation or metaplasia) in donor main bronchi samples increased with the extent of smoking but did not reach statistical significance (p = 0.211). Although metaplasia was found in significantly more donors from the heavy smokers group (p = 0.037), this did not translate into inferior outcomes for the recipients. There were no statistically significant differences in PaO2/FiO(2) ratio after LTx, duration of mechanical ventilation (p = 0.136), intensive care unit stay (p = 0.133), and total postoperative hospital stay (p = 0.322). One-year and three-year survival were comparable across all three groups (log rank p = 0.151). Prevalence of bronchiolitis obliterans syndrome (p = 0.616), as well as bronchiolitis obliterans syndrome free survival (p = 0.898) after LTx were also comparable. Conclusions. In our experience, history and extent of donor smoking do not significantly affect early and midterm outcomes after LTx. Although this finding does not obviate the need for longer-term observation, donor lungs from even heavy smokers may not per se contraindicate LTx and may provide a valuable avenue for expanding donor organ availability. (C) 2014 by The Society of Thoracic Surgeons

Post-cardiotomy cardiogenic shock (PCCS) results in substantial morbidity and mortality, whereas refractory cases require mechanical circulatory support. The aim of this study was to evaluate factors influencing survival during short-term ventricular assist support in PCCS. In total, 154 CentriMag(A (R)) (Thoratec; CA, USA) devices were implanted for cardiogenic shock between 2004 and 2011 out of which 31 were for PCCS. A retrospective review was performed in 31 PCCS patients who required the CentriMag short-term VAD as a bridge to decision. Survivors and non-survivors were compared with respect to pre- and intra-operative characteristics as well as duration of short-term VAD support. Mean duration of support was 11.7 +/- A 15.4 days (range 1-65 days). Seventeen (54.83 %) patients died on support, 14 (45.16 %) were weaned off or upgraded to long-term device, while 11 (35.5 %) were discharged home. The overall survival to myocardial recovery and device explantation, or upgrade to a long-term VAD, was 41.9 % (n = 13) at the study cutoff. EuroSCORE II was significantly higher in non-survivors as compared to survivors (p = 0.047). The duration of short-term VAD support was significantly longer in survivors (p < 0.001). The CentriMag is a versatile, safe and effective short-term circulatory support for patients with PCCS as a bridge to decision which enables longer support and better recovery of both heart and end-organ function and thus may improve the survival of PCCS patients. Lower EuroSCORE may be essential for myocardial recovery in PCCS.

OBJECTIVES: Lung transplantation (LTx) is a life-saving therapy for patients with end-stage lung disease. However, there remains a significant postoperative complication rate and mortality in this extreme patient group. The aim of the present study was to identify donor, recipient and perioperative risk factors for one-year mortality after LTx. METHODS: A total of 252 LTxs were performed in our institution between 2007 and 2013. Donor and recipient demographics and clinical characteristics of 1-year survivors and non-survivors were collected and compared retrospectively. Multivariate logistic regression analysis was performed on univariate predictors for 1-year mortality with an entry criterion of P < 0.05. RESULTS: Multivariate analysis revealed female-to-male transplantation (95% CI: 0.088-0.767; P = 0.015), lower pO(2)/FiO(2)-ratio at 72 h postoperatively (95% CI: 0.988-0.999; P = 0.024), need for postoperative extracorporeal membrane oxygenation (ECMO) support (95% CI: 0.035-0.658; P = 0.012) and on-pump technique (95% CI: 0.007-0.944; P = 0.045) as the only independent predictors for 1-year mortality. Mainly unplanned intraoperative conversion to cardiopulmonary bypass contributed to poorer survival in patients who underwent LTx using cardiopulmonary bypass (P < 0.001). CONCLUSIONS: Our results show that the unplanned use of CPB (conversion from off-to on-pump) might adversely affect outcome after LTx. Also, the negative impact of female-to-male transplantation should not be underestimated during recipient selection. Furthermore, poor early postoperative oxygenation, particularly with the need for extracorporeal oxygenation, might be a very strong negative prognostic factor after LTx.

OBJECTIVES: Various non-sternotomy approaches have been used for left internal mammary artery (LIMA) grafting in left single-vessel revascularization. The aim of this study was to evaluate the impact of three different non-sternotomy techniques on long-term outcomes after left single-vessel revascularization. METHODS: A total of 502 patients having single-vessel LAD disease treated from April 2003 to May 2013 by minimally invasive direct coronary artery bypass grafting (MIDCAB), endoscopically assisted coronary artery bypass grafting (EACAB) or robotically assisted direct coronary artery bypass grafting (RADCAB) were reviewed. In all cases, distal anastomoses were performed through anterolateral minithoracotomy incisions. In-hospital and long-term (10-year) outcomes were compared using standard and propensity score-adjusted analyses. RESULTS: One hundred and eighty-nine patients had MIDCAB, 76 had EACAB and 236 had RADCAB. After propensity score matching, RADCAB patients had significantly longer operative duration (P < 0.001), whereas MIDCAB and RADCAB patients had significantly higher incidence of postoperative angina over the follow-up (P = 0.034). The groups were comparable regarding in-hospital mortality and reintervention rate as well as incidence of myocardial infarction, reoperations, reinterventions and cardiac death. All groups showed comparable long-term survival (P = 0.943). CONCLUSIONS: MIDCAB, EACAB and RADCAB are associated with similar long-term survival and incidence of major adverse cardiac events (MACEs) in single-vessel surgical revascularization. However, the endoscopic approach was found to be free from the disadvantages of longer operating duration observed in RADCAB or higher incidence of angina and shorter freedom from MACEs observed in both MIDCAB and RADCAB groups.

Left ventricular assist devices (LVADs) are a routine treatment for patients with advanced heart failure as a bridge to transplantation. The aim of this study was to present our institutional experience and mid-term outcomes after implantation of 139 continuous-flow (cf) LVADs as a bridge to transplantation. One hundred and thirty-nine consecutive LVAD implantations were performed in our institution between July 2007 and August 2013. The mean age of the population was 44.0 +/- 13.7 years and 24 (17%) of the patients were female. A substantial number of the patients were on preoperative mechanical support: 35 (25%) with an intra-aortic balloon pump, 9 (6.5%) with an extracorporeal membrane oxygenator and 25 (18%) with previous LVAD, for LVAD exchange. The mean support duration was 514 +/- 481 days, whereas the longest support duration was 2493 days (> 6 years). The overall cumulative survival rate following cfLVAD implantation was 89% at 30 days, 76% at 1 year and 66% at 2 years (Fig. 1). There was a statistically significant difference in survival in favour of first LVAD implantation compared with VAD exchange: 91 vs 80% at 30 days, 79 vs 57% at 1 year and 70 vs 43% at 2 years (log-rank P = 0.010). Postoperatively, patients had a significant improvement in end-organ function 1 month after LVAD implantation. In addition, comparison of two different devices [HeartMate II (HM II) and HeartWare] using propensity score matching showed no significant differences in survival and most postoperative adverse events. However, patients supported with HM II required significantly more units of fresh frozen plasma (P = 0.020) with a trend towards a higher use of red blood cells (P = 0.094), and were also more likely to develop percutaneous site infections (P = 0.022). HM II and HeartWare cfLVADs have excellent early postoperative outcomes and good mid-term survival, despite a considerable number of patients needing VAD exchange.

Au Maroc, les subventions accordées par l'Etat constituent une forte incitation pour que les agriculteurs installent l'irrigation localisée. Cependant le rythme de reconversion est faible dans les périmètres de petite et moyenne hydraulique. Bien que la pertinence d'une reconversion collective des exploitations dans ces périmètres soit souvent reconnue, les superficies converties restent limitées. Malgré quelques tentatives dans le cadre d'expériences pilotes, il n'y a pas de démarche stabilisée d'accompagnement par les institutions de développement d'une telle reconversion collective. Le présent article propose des éléments pour une démarche d'accompagnement à la maturation des projets collectifs à l'irrigation localisée. Cette démarche a été conçue à partir de l'analyse a posteriori de plusieurs expériences de reconversion collective à l'irrigation localisée au Maroc. Cette démarche s'appuie sur l'utilisation d'une grille qui permet de diagnostiquer l'état initial de maturation du projet, mais aussi de suivre l'évolution de cette maturation. L'évaluation de ce niveau de maturation se fait suivant une liste de facteurs qualifiés d'essentiels, d'accélération et de stabilisation. Sont aussi proposés quelques principes et étapes qui pourraient structurer un accompagnement de ces projets.

Nous présentons ici une analyse des relations entre acteurs dans la conception et la réalisation de 8 projets du Pilier II à vocation arboricole, situés dans les provinces de Meknès, El Hajeb, Ifrane et Séfrou. Dans quelques projets, les agriculteurs ont activement négocié le contenu de ces projets, tandis que dans les autres cas, ils ont accepté un projet déjà conçu. La phase de réalisation de 8 projets du Pilier II à vocation arboricole, situés dans les provinces de Meknès, El Hajeb, Ifrane et Séfrou. Dan s quelques projets, les agriculteurs ont activement négocié le contenu de ces projets, tandis que dans les autres cas, ils ont accepté un projet déjà conçu. La phase de réalisation est marquée par la relation peu structurée entre entrepreneurs et agriculteurs, qui n'ont que peu de pouvoir d'action lorsqu'ils estiment que les entrepreneurs n'effectuent pas correctement les tâches prévues. Les projets ont permis de réaliser des plantations et, dans un cas, une amélioration des conditions de commercialisation de leur production (la composante de commercialisation n'était pas encore mise en oeuvre dans la plupart des projets étudiés). De plus, ces projets ont permis à certains collectifs d'agriculteurs de renforcer leurs capacités à définir des projets et les proposer à l'administration. Ceci justifie l'intérêt d'une réflexion au niveau des territoires, car ces nouvelles capacités ne concernent que quelques groupes d'agriculteurs disposant de ressources (formation, réseaux sociaux, etc.). Par ailleurs, certaines organisations professionnelles agricoles ont été conçues spécifiquement comme un moyen pour mener à bien les projets. Leur développement et leur pérennité méritent d'être plus mis au centre des actions de développement.

Les politiques publiques en faveur du logement et du droit de propriété privé des terres agricoles ainsi que la croissance économique ont favorisé l'urbanisation et l'accroissement des surfaces bâties dans les principales villes du Maroc dont Meknès. Cette urbanisation s'intensifie au détriment des terres à fort potentiel productif malgré les règlements pour la préservation des terres agricoles. Les agriculteurs familiaux situés en périphérie urbaine de Meknès ont fourni la grande majorité du foncier constructible à des prix intéressants pour les promoteurs. Les stratégies foncières des agriculteurs familiaux propriétaires du périurbain témoignent diversement de la prise en compte de la nouvelle donne foncière. Pour une majorité d'entre eux la vente des terres a permis des investissements dans différents secteurs (transport, commerce, ...) mais aussi dans l'agriculture : in situ avec l'arboriculture irriguée ou l'achat de terres loin de la ville. Enfin une petite minorité a préféré conserver sa terre afin d'éviter la vente à des intermédiaires et de profiter des prix les plus élevés possibles lorsque le promoteur sera pressé de construire. Le moteur de ce marché foncier est bien sûr le prix de vente qui reste très attractif en regard des revenus issus de l'activité agricole. Ces processus spéculatifs favorisent l'achat des terres de la plaine par des investisseurs ou des néo-agriculteurs loin du monde rural. Le jeu des acteurs non agriculteurs dans cette course à la terre est complexe car ils s'appuient sur les lois lorsqu'elles leurs sont favorables, les contournent voire les ignorent. L'ensemble de ces processus permet bien sûr aux classes moyennes et même peu aisées de disposer d'un logement. Mais l'accroissement du prix de la terre agricole fertile en zone périurbaine entraine celui du prix des terres de même qualité dans toute la plaine du Saïs et fragilise l'agriculture familiale marocaine pourvoyeuse d'emplois et garantissant l'approvisionnement alimentaire d

Au Maroc, les subventions accordées par l'Etat constituent une forte incitation pour que les agriculteurs installent l'irrigation localisée. Cependant le rythme de reconversion est faible dans les périmètres de petite et moyenne hydraulique. Bien que la pertinence d'une reconversion collective des exploitations dans ces périmètres soit souvent reconnue, les superficies converties restent limitées. Malgré quelques tentatives dans le cadre d'expériences pilotes, il n'y a pas de démarche stabilisée d'accompagnement par les institutions de développement d'une telle reconversion collective. Le présent article propose des éléments pour une démarche d'accompagnement à la maturation des projets collectifs à l'irrigation localisée. Cette démarche a été conçue à partir de l'analyse a posteriori de plusieurs expériences de reconversion collective à l'irrigation localisée au Maroc. Cette démarche s'appuie sur l'utilisation d'une grille qui permet de diagnostiquer l'état initial de maturation du projet, mais aussi de suivre l'évolution de cette maturation. L'évaluation de ce niveau de maturation se fait suivant une liste de facteurs qualifiés d'essentiels, d'accélération et de stabilisation. Sont aussi proposés quelques principes et étapes qui pourraient structurer un accompagnement de ces projets.

Nous présentons ici une analyse des relations entre acteurs dans la conception et la réalisation de 8 projets du Pilier II à vocation arboricole, situés dans les provinces de Meknès, El Hajeb, Ifrane et Séfrou. Dans quelques projets, les agriculteurs ont activement négocié le contenu de ces projets, tandis que dans les autres cas, ils ont accepté un projet déjà conçu. La phase de réalisation de 8 projets du Pilier II à vocation arboricole, situés dans les provinces de Meknès, El Hajeb, Ifrane et Séfrou. Dan s quelques projets, les agriculteurs ont activement négocié le contenu de ces projets, tandis que dans les autres cas, ils ont accepté un projet déjà conçu. La phase de réalisation est marquée par la relation peu structurée entre entrepreneurs et agriculteurs, qui n'ont que peu de pouvoir d'action lorsqu'ils estiment que les entrepreneurs n'effectuent pas correctement les tâches prévues. Les projets ont permis de réaliser des plantations et, dans un cas, une amélioration des conditions de commercialisation de leur production (la composante de commercialisation n'était pas encore mise en oeuvre dans la plupart des projets étudiés). De plus, ces projets ont permis à certains collectifs d'agriculteurs de renforcer leurs capacités à définir des projets et les proposer à l'administration. Ceci justifie l'intérêt d'une réflexion au niveau des territoires, car ces nouvelles capacités ne concernent que quelques groupes d'agriculteurs disposant de ressources (formation, réseaux sociaux, etc.). Par ailleurs, certaines organisations professionnelles agricoles ont été conçues spécifiquement comme un moyen pour mener à bien les projets. Leur développement et leur pérennité méritent d'être plus mis au centre des actions de développement.

Les politiques publiques en faveur du logement et du droit de propriété privé des terres agricoles ainsi que la croissance économique ont favorisé l'urbanisation et l'accroissement des surfaces bâties dans les principales villes du Maroc dont Meknès. Cette urbanisation s'intensifie au détriment des terres à fort potentiel productif malgré les règlements pour la préservation des terres agricoles. Les agriculteurs familiaux situés en périphérie urbaine de Meknès ont fourni la grande majorité du foncier constructible à des prix intéressants pour les promoteurs. Les stratégies foncières des agriculteurs familiaux propriétaires du périurbain témoignent diversement de la prise en compte de la nouvelle donne foncière. Pour une majorité d'entre eux la vente des terres a permis des investissements dans différents secteurs (transport, commerce, ...) mais aussi dans l'agriculture : in situ avec l'arboriculture irriguée ou l'achat de terres loin de la ville. Enfin une petite minorité a préféré conserver sa terre afin d'éviter la vente à des intermédiaires et de profiter des prix les plus élevés possibles lorsque le promoteur sera pressé de construire. Le moteur de ce marché foncier est bien sûr le prix de vente qui reste très attractif en regard des revenus issus de l'activité agricole. Ces processus spéculatifs favorisent l'achat des terres de la plaine par des investisseurs ou des néo-agriculteurs loin du monde rural. Le jeu des acteurs non agriculteurs dans cette course à la terre est complexe car ils s'appuient sur les lois lorsqu'elles leurs sont favorables, les contournent voire les ignorent. L'ensemble de ces processus permet bien sûr aux classes moyennes et même peu aisées de disposer d'un logement. Mais l'accroissement du prix de la terre agricole fertile en zone périurbaine entraine celui du prix des terres de même qualité dans toute la plaine du Saïs et fragilise l'agriculture familiale marocaine pourvoyeuse d'emplois et garantissant l'approvisionnement alimentaire d

Background. Lung transplantation (LTx) is significantly limited by donor organ shortage. Donor smoking history of more than 20 pack-years is considered an extended donor criterion. In this study, we retrospectively evaluated impact of donor smoking history and extent of smoking on midterm outcome after LTx. Methods. In all, 237 LTx were performed in our institution between 2007 and 2012. Patients were divided into three groups, receiving lungs from 53% nonsmoking donors, 29% smoking donors with fewer than 20 pack-years, and 18% heavy smokers with more than 20 pack-years. Results. Preoperative donor and recipient characteristics among the groups were comparable. However, donors from the heavy smokers group were significantly older (p < 0.001). The overall presence of abnormal histology (inflammation or metaplasia) in donor main bronchi samples increased with the extent of smoking but did not reach statistical significance (p = 0.211). Although metaplasia was found in significantly more donors from the heavy smokers group (p = 0.037), this did not translate into inferior outcomes for the recipients. There were no statistically significant differences in PaO2/FiO(2) ratio after LTx, duration of mechanical ventilation (p = 0.136), intensive care unit stay (p = 0.133), and total postoperative hospital stay (p = 0.322). One-year and three-year survival were comparable across all three groups (log rank p = 0.151). Prevalence of bronchiolitis obliterans syndrome (p = 0.616), as well as bronchiolitis obliterans syndrome free survival (p = 0.898) after LTx were also comparable. Conclusions. In our experience, history and extent of donor smoking do not significantly affect early and midterm outcomes after LTx. Although this finding does not obviate the need for longer-term observation, donor lungs from even heavy smokers may not per se contraindicate LTx and may provide a valuable avenue for expanding donor organ availability. (C) 2014 by The Society of Thoracic Surgeons

Left ventricular assist devices (LVADs) are fast becoming standard of care for patients with advanced heart failure. However, despite continuous improvement in VAD technology, there remains a significant early postoperative morbidity and mortality in this extreme patient group. The aim of the current study was to explore the short-term outcomes and predictors for 90 day mortality in the patients after implantation of continuous-flow LVAD. Perioperative clinical, echocardiographic, hemodynamic, and laboratory data of 90 day survivors and nonsurvivors were collected and compared retrospectively. Multivariate logistic regression analysis was performed on univariate predictors for 90 day mortality with an entry criterion of p < 0.1. Between July 2006 and May 2012, 117 patients underwent implantation of a continuous-flow LVAD as a bridge to transplantation: 71 (60.7%) HeartMate II (Thoratec Corp, Pleasanton, CA) and 46 (39.3%) HVAD (HeartWare International, Framingham, MA). All-cause 90 day mortality was 17.1%. Multivariate analysis revealed higher preoperative central venous pressure (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.014-1.378; p = 0.033) and higher age (OR, 1.14; 95% CI, 1.01-1.38; p = 0.045) as the only independent predictors for 90 day mortality. Optimization of preoperative volume status, preload, and right heart function as well as age-based selection of candidates for LVAD support are the critical factors influencing early outcome after continuous-flow LVAD implantation.

Post-cardiotomy cardiogenic shock (PCCS) results in substantial morbidity and mortality, whereas refractory cases require mechanical circulatory support. The aim of this study was to evaluate factors influencing survival during short-term ventricular assist support in PCCS. In total, 154 CentriMag(A (R)) (Thoratec; CA, USA) devices were implanted for cardiogenic shock between 2004 and 2011 out of which 31 were for PCCS. A retrospective review was performed in 31 PCCS patients who required the CentriMag short-term VAD as a bridge to decision. Survivors and non-survivors were compared with respect to pre- and intra-operative characteristics as well as duration of short-term VAD support. Mean duration of support was 11.7 +/- A 15.4 days (range 1-65 days). Seventeen (54.83 %) patients died on support, 14 (45.16 %) were weaned off or upgraded to long-term device, while 11 (35.5 %) were discharged home. The overall survival to myocardial recovery and device explantation, or upgrade to a long-term VAD, was 41.9 % (n = 13) at the study cutoff. EuroSCORE II was significantly higher in non-survivors as compared to survivors (p = 0.047). The duration of short-term VAD support was significantly longer in survivors (p < 0.001). The CentriMag is a versatile, safe and effective short-term circulatory support for patients with PCCS as a bridge to decision which enables longer support and better recovery of both heart and end-organ function and thus may improve the survival of PCCS patients. Lower EuroSCORE may be essential for myocardial recovery in PCCS.

OBJECTIVES: Various non-sternotomy approaches have been used for left internal mammary artery (LIMA) grafting in left single-vessel revascularization. The aim of this study was to evaluate the impact of three different non-sternotomy techniques on long-term outcomes after left single-vessel revascularization. METHODS: A total of 502 patients having single-vessel LAD disease treated from April 2003 to May 2013 by minimally invasive direct coronary artery bypass grafting (MIDCAB), endoscopically assisted coronary artery bypass grafting (EACAB) or robotically assisted direct coronary artery bypass grafting (RADCAB) were reviewed. In all cases, distal anastomoses were performed through anterolateral minithoracotomy incisions. In-hospital and long-term (10-year) outcomes were compared using standard and propensity score-adjusted analyses. RESULTS: One hundred and eighty-nine patients had MIDCAB, 76 had EACAB and 236 had RADCAB. After propensity score matching, RADCAB patients had significantly longer operative duration (P < 0.001), whereas MIDCAB and RADCAB patients had significantly higher incidence of postoperative angina over the follow-up (P = 0.034). The groups were comparable regarding in-hospital mortality and reintervention rate as well as incidence of myocardial infarction, reoperations, reinterventions and cardiac death. All groups showed comparable long-term survival (P = 0.943). CONCLUSIONS: MIDCAB, EACAB and RADCAB are associated with similar long-term survival and incidence of major adverse cardiac events (MACEs) in single-vessel surgical revascularization. However, the endoscopic approach was found to be free from the disadvantages of longer operating duration observed in RADCAB or higher incidence of angina and shorter freedom from MACEs observed in both MIDCAB and RADCAB groups.

Left ventricular assist devices (LVADs) are a routine treatment for patients with advanced heart failure as a bridge to transplantation. The aim of this study was to present our institutional experience and mid-term outcomes after implantation of 139 continuous-flow (cf) LVADs as a bridge to transplantation. One hundred and thirty-nine consecutive LVAD implantations were performed in our institution between July 2007 and August 2013. The mean age of the population was 44.0 +/- 13.7 years and 24 (17%) of the patients were female. A substantial number of the patients were on preoperative mechanical support: 35 (25%) with an intra-aortic balloon pump, 9 (6.5%) with an extracorporeal membrane oxygenator and 25 (18%) with previous LVAD, for LVAD exchange. The mean support duration was 514 +/- 481 days, whereas the longest support duration was 2493 days (> 6 years). The overall cumulative survival rate following cfLVAD implantation was 89% at 30 days, 76% at 1 year and 66% at 2 years (Fig. 1). There was a statistically significant difference in survival in favour of first LVAD implantation compared with VAD exchange: 91 vs 80% at 30 days, 79 vs 57% at 1 year and 70 vs 43% at 2 years (log-rank P = 0.010). Postoperatively, patients had a significant improvement in end-organ function 1 month after LVAD implantation. In addition, comparison of two different devices [HeartMate II (HM II) and HeartWare] using propensity score matching showed no significant differences in survival and most postoperative adverse events. However, patients supported with HM II required significantly more units of fresh frozen plasma (P = 0.020) with a trend towards a higher use of red blood cells (P = 0.094), and were also more likely to develop percutaneous site infections (P = 0.022). HM II and HeartWare cfLVADs have excellent early postoperative outcomes and good mid-term survival, despite a considerable number of patients needing VAD exchange.

OBJECTIVES: Lung transplantation (LTx) is a life-saving therapy for patients with end-stage lung disease. However, there remains a significant postoperative complication rate and mortality in this extreme patient group. The aim of the present study was to identify donor, recipient and perioperative risk factors for one-year mortality after LTx. METHODS: A total of 252 LTxs were performed in our institution between 2007 and 2013. Donor and recipient demographics and clinical characteristics of 1-year survivors and non-survivors were collected and compared retrospectively. Multivariate logistic regression analysis was performed on univariate predictors for 1-year mortality with an entry criterion of P < 0.05. RESULTS: Multivariate analysis revealed female-to-male transplantation (95% CI: 0.088-0.767; P = 0.015), lower pO(2)/FiO(2)-ratio at 72 h postoperatively (95% CI: 0.988-0.999; P = 0.024), need for postoperative extracorporeal membrane oxygenation (ECMO) support (95% CI: 0.035-0.658; P = 0.012) and on-pump technique (95% CI: 0.007-0.944; P = 0.045) as the only independent predictors for 1-year mortality. Mainly unplanned intraoperative conversion to cardiopulmonary bypass contributed to poorer survival in patients who underwent LTx using cardiopulmonary bypass (P < 0.001). CONCLUSIONS: Our results show that the unplanned use of CPB (conversion from off-to on-pump) might adversely affect outcome after LTx. Also, the negative impact of female-to-male transplantation should not be underestimated during recipient selection. Furthermore, poor early postoperative oxygenation, particularly with the need for extracorporeal oxygenation, might be a very strong negative prognostic factor after LTx.

A two-stage explantation of a left ventricular assist device (LVAD) was performed on 47 year old afro-american gentlemen with non-ischemic dilated cardiomyopathy (DCM) who was successfully bridged to recovery. After he suffered a stroke caused by a VAD thrombosis with embolisation, the VAD outflow graft was first ligated using minimally-invasive approach. Two months later, the device was explanted and a manufactured titanium plug was placed into the sewing ring. This stepwise procedure might be beneficial in cases of high thromboembolic risk and in patients who suffered a thromboembolic event previously.

L'article présente et analyse les changements de l'usage du sol en périphérie urbaine de Meknès au Maroc, dans un contexte de consommation de terres agricoles pourtant réputées fertiles et productives. La question de la préservation des terres agricoles situées à proximité du front d'urbanisation, si elle a été identifiée par les pouvoirs publics au Maroc, qu'ils soient nationaux ou locaux, n'est pas une préoccupation première de l'action publique, davantage centrée sur le développement économique et le logement des plus démunis. À Meknès, dans un contexte foncier complexe, la croissance urbaine s'opère sur des terres de haute qualité agronomique, au sein d'un marché très spéculatif. En guise d'illustration, l'article présente le cas particulier de la coopérative de la réforme agraire Naïji et des stratégies foncières de ses agriculteurs.

L'article présente et analyse les changements de l'usage du sol en périphérie urbaine de Meknès au Maroc, dans un contexte de consommation de terres agricoles pourtant réputées fertiles et productives. La question de la préservation des terres agricoles situées à proximité du front d'urbanisation, si elle a été identifiée par les pouvoirs publics au Maroc, qu'ils soient nationaux ou locaux, n'est pas une préoccupation première de l'action publique, davantage centrée sur le développement économique et le logement des plus démunis. À Meknès, dans un contexte foncier complexe, la croissance urbaine s'opère sur des terres de haute qualité agronomique, au sein d'un marché très spéculatif. En guise d'illustration, l'article présente le cas particulier de la coopérative de la réforme agraire Naïji et des stratégies foncières de ses agriculteurs.