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The article examines how to adapt the global production network (GPN) approach to situations of natural resource extraction. Based on an integration of a political ecology perspective into GPN research, we exemplarily apply the GPN framework to the primary sector. Based on extensive qualitative fieldwork regarding Argentine lithium mining and Brazilian soy agribusiness we illustrate that particularly a political ecological environmental perspective allows for a more nuanced and critical analysis of ambiguous local development outcomes. While from a purely economic development perspective in both cases the economic activity (integrated into GPNs) is celebrated as an imperative economic growth driver, our framework helps identify the emergence of unilateral dependencies, a decline of social autonomy and an unequal distribution of environmental risks.

Although the initial management of heart failure is essentially pharmacological, the use of mechanical circulatory support may become necessary in advanced forms. In cardiogenic shock, temporary mechanical circulatory support should be considered, while in more stable forms of advanced heart failure, implantation of a long-term left ventricular assist device (LVAD) can prolong survival and improve patient's quality of life. Recent improvements in LVAD technology have reduced post-implant complications, but the procedure is not without risk and requires close clinical follow-up., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

COVID19 altered and impacted medical and surgical practice around the world. Standard of care and routine procedures are disrupted. Majors shift in personnel, and ad hoc new team as well as delocalization and working with new infrastructures are further challenges to be dealt with. This review of three very unusual scenarios illustrates pitfalls and dangers harbored in the re-shaped landscape of COVID19 exemplifying the narrow path bridging from the medical and surgical comfort zone to uncharted territory and eventually leading to collateral damage., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Approximately 2% of adolescents and young adults display symptoms indicating a high risk for psychotic disorders. Apart from a risk of 20-35% of developing a psychotic disorder, these individuals show high rates of persisting mental health problems and functional impairment, even in the absence of a psychotic transition. Treatment in specialized centers can improve outcomes in these patients, but the need to provide timely access to care needs to be balanced against the risks of premature psychiatrization, stigmatization and unnecessary medication treatment. The transcantonal project PsyYoung aims to optimize early detection in young people, while at the same time minimizing unnecessary psychiatrization. This will be achieved through improved networking across the entire care chain and a stepped-care intervention approach., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Tetralogy of Fallot is the most frequent cyanotic congenital heart disease (1/10000 births). The first complete corrections have been done in the fifties, and we now have long-term follow-up studies, revealing the most frequent arrhythmias and anatomic substrates compromising the long-term survival of these patients. The purpose of this article is to review some of the long-term complications of these patients, who, even if they have been completely corrected, will never be cured.

We carried out a comparative study of various lipid parameters (apo AI and B, LpAI, Lp(a) and LpBCIII) in coronary heart disease patients (19 males and 4 females, mean age 61 +/- 11 years) and in controls (18 males and 14 females, mean age 55 +/- 3 years) selected so that cholesterol and triglycerides levels be beneath 6 and 2.3 mmol/l in both populations. Apo AI and B were analysed by immunonephelometry and lipoparticles by electroimmunodiffusion. Nonparametric statistics tests were performed on account of the small numbers in both groups. Our study confirms the protective effect of Lp AI but did not show an obvious superiority of Lp AI quantification compared to apo AI. It highlights the interest of Lp(a) as an independent and additional risk factor for atherogenesis: no obvious correlation with any other lipidic parameter was demonstrated. An increase in Lp(a) beyond 0.30 g/l increases atherogenic risk 2.5 fold. We did not show any benefit of LpBCIII quantification in 'normolipemic' coronary patients. In conclusion, a discriminant analysis including the apo B/apo AI and apo B/LpAI ratios and Lp(a) allows an accurate classification of 67% of the patients.

Over the last seven years, M-VAC combination chemotherapy has been used for: the treatment of transitional cell carcinoma with metastases (palliative indication) or to reduce operable T4a tumours (inductive, initial or preliminary indication), or before or after t for bladder cancers (neoadjuvant and adjuvant indications). The authors present their experience of 17 cases of stage T4a transitional cell carcinoma transformed into an operable stage by M-VAC. Those patients with regression of the tumour to a non-invasive stage at operation (patients with a good response) had a good prognosis. In contrast those patients with residual invasive tumour all died from their disease. A prospective comparative study was performed between total cystectomy alone and cystectomy completed by adjuvant M-VAC in patients with a worrying histology. This study was based on 49 cases up until December 1990. A significant improvement in the prognosis was observed in patients receiving adjuvant M-VAC. The recurrence-free survival was considerably prolonged in this second group (study suspended in November 1992). When metastases developed, palliative M-VAC only rarely prolonged survival.

A retrospective study of 534 bed-rests permitted us to specify the reasons of admissions and mortality in the hospital service of pediatrics, Port-Gentil, Gabon, from June 1985 to May 1986: a high mortality rate (7.5%) with, specially, diarrheas (46%) and proteinocaloric malnutrition (19%). The other reasons of mortality are constituted by infections and neonatal diseases. Priority in public health seems to be child welfare (vaccinations, primary health care in the whole province of Ogoue, health certificates...).

Thermography is an easy means of selecting patients in terms of vascular or psychological pathology in erectile dysfunction. The results are quite reliable, even though there are sometimes disagreements, or difficulties, in performing the examination (short penis or semi-horizontal at rest). It is nevertheless important to evaluate the results in conjunction with those of other non-traumatic investigations such as the Döppler effect, without seeking to oppose them, disagreements often being the source of useful information. Arteriography is far more traumatic and should be reserved for doubtful cases or those difficult to investigate.

The authors report on the results of their experience with surgery of the rheumatoid metatarsus (95 patients operated on--150 operations). The operation most frequently performed was the Lelievre metatarsian resection-alignment. They confirm the advantage of this type of surgery, which provides very handicapped patients with substantial relief, both of pain and of the functional troubles, despite the nature of the disease involved. Out of 80 patients operated on and followed up over a period of 2 to 14 years, and considering the correction of the deformities, the effect on pain and functional troubles, the authors report 103 very good and good results, and 18 poor results and failures. The good results obtained deteriorate only very little in the long run: after 10 years, the very good and good results involving effect on pain, has gone from 96 to 90%. On the other hand, as far as functional troubles are concerned, very good and good results go from 90% to 70%. The authors underline the advantage of a very through examination, in order to look for post-operatory risk factors (peripheral circulatory deficiency and poor resistance to infection). They insist for exercising great prudence when advising an operation consisting of the interposition of an endoprosthesis (Swanson's implant). Indeed, in subjects who are in any way fragile, delays in scarification, related to hematomas complicated or not with skin necrosis appear with increased frequency after interposition of the implant.

Acute intoxications with petroleum are frequent in children: we have seen 36 cases in a year in the General Hospital, Port-Gentil (Gabon), service of pediatrics. Pulmonary lesions are aggravated by vomitus; radiological signs appear after half an hour, interest the right side and are characterized by an interstitial syndrome. Evolution is always good with antibiotherapy. Prevention consists in health education.