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ImportanceBefore surgery, the best strategy for managing patients who are taking renin-angiotensin system inhibitors (RASIs) (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) is unknown. The lack of evidence leads to conflicting guidelines.ObjectiveTo evaluate whether a continuation strategy vs a discontinuation strategy of RASIs before major noncardiac surgery results in decreased complications at 28 days after surgery.Design, setting, and participantsRandomized clinical trial that included patients who were being treated with a RASI for at least 3 months and were scheduled to undergo a major noncardiac surgery between January 2018 and April 2023 at 40 hospitals in France.InterventionPatients were randomized to continue use of RASIs (n = 1107) until the day of surgery or to discontinue use of RASIs 48 hours prior to surgery (ie, they would take the last dose 3 days before surgery) (n = 1115).Main outcomes and measuresThe primary outcome was a composite of all-cause mortality and major postoperative complications within 28 days after surgery. The key secondary outcomes were episodes of hypotension during surgery, acute kidney injury, postoperative organ failure, and length of stay in the hospital and intensive care unit during the 28 days after surgery.ResultsOf the 2222 patients (mean age, 67 years [SD, 10 years]; 65% were male), 46% were being treated with angiotensin-converting enzyme inhibitors at baseline and 54% were being treated with angiotensin receptor blockers. The rate of all-cause mortality and major postoperative complications was 22% (245 of 1115 patients) in the RASI discontinuation group and 22% (247 of 1107 patients) in the RASI continuation group (risk ratio, 1.02 [95% CI, 0.87-1.19]; P = .85). Episodes of hypotension during surgery occurred in 41% of the patients in the RASI discontinuation group and in 54% of the patients in the RASI continuation group (risk ratio, 1.31 [95% CI, 1.19-1.44]). There were no other differences in the trial outcomes.Conclusions and relevanceAmong patients who underwent major noncardiac surgery, a continuation strategy of RASIs before surgery was not associated with a higher rate of postoperative complications than a discontinuation strategy.Trial registrationClinicalTrials.gov Identifier: NCT03374449.

Laser annealing was employed to trigger the solid-state reaction of a thin Co film (2.5 nm) with undoped Si. A metastable disilicide layer was obtained after one laser pulse close to the melt threshold. Its diffraction pattern, relaxed lattice parameter, and residual resisitivity are consistent with the formation of the defective CsCl structure. The CoSi2 phase was found after prolonging the thermal treatment with additional pulses or rapid thermal annealing. Because CoSi is skipped in the phase sequence, CoSi2 layers are more uniform in thickness, have an increased superconductivity and a reduced formation temperature. This approach is compatible with the SALICIDE process and can be used to form smooth contacts in superconducting or regular transistors. [ABSTRACT FROM AUTHOR]

Intestinal tissue-resident memory CD8 T cells (Trm) are non-recirculating effector cells ideally positioned to detect and react to microbial infections in the gut mucosa. There is an emerging understanding of Trm cell differentiation and functions, but their implication in inflammatory bowel diseases, such as Crohns disease (CD), is still unknown. Here, we describe CD8 cells in the human intestine expressing KLRG1 or CD103, two receptors of E-cadherin. While CD103 CD8 T cells are present in high numbers in the mucosa of CD patients and controls, KLRG1 CD8 T cells are increased in inflammatory conditions. Mucosal CD103 CD8 T cells are more responsive to TCR restimulation, but KLRG1 CD8 T cells show increased cytotoxic and proliferative potential. CD103 CD8 T cells originate mostly from KLRG1 negative cells after TCR triggering and TGFβ stimulation. Interestingly, mucosal CD103 CD8 T cells from CD patients display major changes in their transcriptomic landscape compared to controls. They express Th17 related genes including CCL20, IL22, and IL26, which could contribute to the pathogenesis of CD. Overall, these findings suggest that CD103 CD8 T cells in CD induce a tissue-wide alert increasing innate immune responses and recruitment of effector cells such as KLRG1 CD8 T cells.

In this study, we have conclusively used UV-nanosecond laser annealing (UV-NLA) as an alternative to classical rapid thermal annealing (RTA) for the formation of stable Ni-GeSn alloys. The phase formation sequence was similar to the one obtained with RTA. At low laser energy densities (ED) and after the consumption of Ni, the Ni-rich phase, Ni5(GeSn)3, was first obtained. This phase was followed, for higher ED, by the mono-stanogermanide phase Ni(GeSn). Surface wrinkles appeared at high ED, resulting in a sheet resistance ( $\text{R}_{\text {sh}}$ ) increase. Meanwhile, $\text{R}_{\text {sh}}$ variations were mainly governed by the phases that were present at lower ED. By combining various analyses, we did not see any Ni(GeSn) agglomeration or Sn segregation. The use of UV-NLA yielded thermally stable Ni(GeSn) contact layers.

Abstract Background In patients with septic shock, the impact of the mean arterial pressure (MAP) target on the course of mottling remains uncertain. In this post hoc analysis of the SEPSISPAM trial, we investigated whether a low-MAP (65 to 70 mmHg) or a high-MAP target (80 to 85 mmHg) would affect the course of mottling and arterial lactate in patients with septic shock. Methods The presence of mottling was assessed every 2 h from 2 h after inclusion to catecholamine weaning. We compared mottling and lactate time course between the two MAP target groups. We evaluated the patient’s outcome according to the presence or absence of mottling. Results We included 747 patients, 374 were assigned to the low-MAP group and 373 to the high-MAP group. There was no difference in mottling and lactate evolution during the first 24 h between the two MAP groups. After adjustment for MAP and confounding factors, the presence of mottling ≥ 6 h during the first 24 h was associated with a significantly higher risk of death at day 28 and 90. Patients without mottling or with mottling

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In order to assess their potential use as contact layers for Si photonics devices, Ni2P thin films were developed on a 300 mm platform. The Ni2P layers, obtained by magnetron sputtering of a Ni2P target, were stable and reproducible. The films were mainly composed of the hexagonal Ni2P phase with small amount of Ni12P5 impurities. The film density was 6.9 g/cm3 with a ratio of 62 at.% of Ni and 38 at.% of P. We implemented and integrated these Ni2P films on III-V structures to study their electrical properties on n-InP and p-InGaAs (i.e., n-doped and p-doped III-V/Si hybrid laser contact layers). The results obtained on p-InGaAs did not meet the requirements in terms of contact resistivity. On the other hand, due to its high thermal stability and low contact resistivities, Ni2P metallization exhibited the best results among the Ni-based metallizations studied for contacting n-InP layers, namely Ni, NiPt and Ni2P.

The reaction of a Ni 0.9 Pt 0.1 7 nm-thick thin film with the underlying Si(001) substrate as a function of the annealing temperature was studied using in situ XRD techniques as well as ex situ advanced XRD and TEM imaging on quenched samples. It was found that the Ni 0.9 Pt 0.1 /Si system initially evolves accordingly to diffusion controlled reactions via the development of nano-crystalline Ni-rich Ni 1 − x (Pt) Si x phases that combine the ability of fast kinetic growth and texture inheritance. The system remains then stable over some tens of degrees before Ni(Pt)Si nucleation occurs, once the related energetic barrier is overcome. It was additionally found that this newly observed phase sequence remains valid up to Ni 0.9 Pt 0.1 deposited layer thicknesses of about 16 nm, which is remarkable for such systems. [ABSTRACT FROM AUTHOR]

Lympho-epithelial interactions between intestinal T resident memory cells (Trm) and the epithelium have been associated with inflammatory bowel disease (IBD) activity. We developed ex vivo autologous organoid-mucosal T cell cocultures to functionally assess lymphoepithelial interactions in Crohn’s Disease (CD) patients compared to controls. We demonstrate the direct epithelial cell death induced by autologous mucosal T cells in CD patients but not in controls. These findings were positively correlated with T cell infiltration of the organoids. This potential was inhibited by limiting lympho-epithelial interactions through CD103 and NKG2D blocking antibodies. These data directly demonstrate for the first time the direct deleterious effect of mucosal T cells on the epithelium of CD patients. Such ex-vivo models are promising techniques to unravel the pathophysiology of these diseases and the potential mode of action of current and future therapies.

The first aim of this article is to present the link between the turnpike property and the singular perturbations theory: the first one being a particular case of the second one. Then, thanks to this link, we set up a new framework based on continuation methods for the resolution of singularly perturbed optimal control problems. We consider first the turnpike case, then, we generalize the approach to general control problems with singular perturbations (that is with fast but also slow variables). We illustrate each step with an example.

Abstract Background Anemia is a significant problem in patients on ICU. Its commonest cause, iron deficiency (ID), is difficult to diagnose in the context of inflammation. Hepcidin is a new marker of ID. We aimed to assess whether hepcidin levels would accurately guide treatment of ID in critically ill anemic patients after a prolonged ICU stay and affect the post-ICU outcomes. Methods In a controlled, single-blinded, multicenter study, anemic (WHO definition) critically ill patients with an ICU stay ≥ 5 days were randomized when discharge was expected to either intervention by hepcidin treatment protocol or control. In the intervention arm, patients were treated with intravenous iron (1 g of ferric carboxymaltose) when hepcidin was

Summary of the photographic exhibition Tribal Canoe Journeys : Naviguer vers la souveraineté at the Librairie La Géothèque, 14 rue Racine, Nantes, between 1st and 30th September 2021 and interview with the artist Joe wahalatsu? Seymour.

Self-assembly of diblock copolymers (BCP) into periodic arrays is a promising route to generate templates for the fabrication of nanoscopic elements, when one block is selectively removed. In cylindrical morphology polystyrene-block-poly(methyl methacrylate) (PS-b-PMMA) copolymer (BCP) films, the efficiency of different processes for removing the PMMA from cylinders is studied using grazing incidence small angle X-ray scattering (GISAXS), x-ray reflectivity and critical dimension scanning electron microscopy. The detailed analysis of the GISAXS patterns leads to the determination of the depth of cylindrical holes left by removal of the PMMA. It is found that the combination of a preliminary UV exposure followed by a wet treatment allows to remove totally the PMMA blocks. Furthermore, the optimization of both UV exposition time and solvent allows to preserve the PS matrix and interestingly for nanolithographic applications to decrease the process costs.

Through examples of recently produced American films belonging to different genres – neowestern, drama, comedy and even science fiction - this article intends to show that white (anti)-heroes are still present and central to the narrative, and are presented in the end as better Indians than the Indians themselves. More importantly, the way whiteness is represented can only be fully understood by analyzing the construction of the Indian characters who, like an intaglio portrait, shape the character of the White Savior, validating his existence and enhancing it. Today still, whiteness depends on the inherent subordination of Indianness and feeds on its disappearance.

Aux abords de la réserve fictive de Red Crow, les morts reviennent subitement à la vie. Seule la population autochtone semble immunisée contre l’épidémie et doit gérer la vague d’individus réfugiés blancs souhaitant se mettre à l’abri. Quand, au début des années 2010, le réalisateur mi’gmaq Jeff Barnaby imagine ce scénario, il est loin de penser que son film Blood Quantum sera tristement d’actualité lors de sa sortie prévue en mars 2020. S’il respecte les codes classiques du film d’horreur, derrière son apparence de pur divertissement, Blood Quantum insuffle également un sous-texte historique qui invite le public à interroger les relations tumultueuses du Canada envers les peuples autochtones depuis la colonisation. D’une réponse aux pandémies – passées, présentes et futures –, Blood Quantum devient alors une puissante métaphore historique assortie d’une critique environnementale et sociale plus globale dont l’onde de choc, dans le contexte actuel, peut atteindre tout le monde.

Business sustainability has been defined as meeting current needs while providing the ability of future generations to meet their own needs. However, few firms invest in practices geared at sustainability. In this article, we investigate how family ties to future generations via the intention of transgenerational succession can be associated with the adoption of sustainable practices. Using data from 281 wineries in the United States collected through a survey questionnaire, we show that ties to future generations, measured as the intention of the winery owner to pass down the winery to their children, are associated with the adoption of sustainable certification.

Abstract Background It is unknown whether the recommended mean arterial pressure (MAP) target of 65 mmHg during initial resuscitation of septic shock is sufficient to maintain cerebral perfusion. Thus, we tested the hypothesis that a higher MAP target in patients with septic shock may improve level of arousal. Methods We performed a post hoc exploratory analysis of the SEPSISPAM trial, which assessed the effect of a “high-target” level of MAP (80–85 mmHg) versus the recommended “low-target” MAP (65–70 mm Hg) on mortality in patients with septic shock. Among the 776 patients originally recruited in SEPSISPAM trial, we selected those who were mechanically ventilated and sedated and with available evaluation of arousal level assessed by the Richmond Agitation and Sedation Scale (RASS). Results We restricted our analysis to the period in which patients were treated with vasoactive drugs. Cumulative sedative drugs were assessed daily. A total of 532 patients were included in this study: 253 (47.6%) in the low-target group and 279 (52.4%) in the high-target group. Daily cumulative sedative drugs were similar in both groups. Compared to the low-target group, minimal and maximal RASS were significantly higher in the high-target group at day 2, 4 and 5. Furthermore, in order to consider the fact that multiple measures were done for each patient and to consider the global effect of time on these measures, we used a mixed linear regression and multivariate models: we confirmed that maximal RASS values were significantly higher in the high-target group. Conclusion In patients with septic shock who were mechanically ventilated and sedated, resuscitation with MAP target between 80 and 85 mmHg was associated with higher arousal level as compared to a MAP target between 65 and 70 mmHg.

This article investigates the effects of the COVID-19 outbreak on electoral participation. We study the French municipal elections that took place at the very beginning of the ongoing pandemic and held in over 9,000 municipalities on March 15, 2020. In addition to the simple note that turnout rates decreased to a historically low level, we establish a robust relationship between the depressed turnout rate and the disease. Using various estimation strategies and employing a large number of potential confounding factors, we find that the participation rate decreases with city proximity to COVID-19 clusters. Furthermore, the proximity has conditioned impacts according to the proportion of elderly -who are the most threatened- within the city. Cities with higher population density, where the risk of infection is higher, and cities where only one list ran at the election, which dramatically reduces competitiveness, experienced differentiated effects of distance.

Intestinal tissue-resident memory CD8 T cells (Trm) are non-recirculating effector cells ideally positioned to detect and react to microbial infections in the gut mucosa. There is an emerging understanding of Trm cell differentiation and functions, but their implication in inflammatory bowel diseases, such as Crohn's disease (CD), is still unknown. Here, we describe CD8 cells in the human intestine expressing KLRG1 or CD103, two receptors of E-cadherin. While CD103 CD8 T cells are present in high numbers in the mucosa of CD patients and controls, KLRG1 CD8 T cells are increased in inflammatory conditions. Mucosal CD103 CD8 T cells are more responsive to TCR restimulation, but KLRG1 CD8 T cells show increased cytotoxic and proliferative potential. CD103 CD8 T cells originate mostly from KLRG1 negative cells after TCR triggering and TGFβ stimulation. Interestingly, mucosal CD103 CD8 T cells from CD patients display major changes in their transcriptomic landscape compared to controls. They express Th17 related genes including CCL20, IL22, and IL26, which could contribute to the pathogenesis of CD. Overall, these findings suggest that CD103 CD8 T cells in CD induce a tissue-wide alert increasing innate immune responses and recruitment of effector cells such as KLRG1 CD8 T cells.

Electrical aging in lead zirconate titanate (PbZrxTi1−xO3) thin films has been intensively studied from a macroscopic perspective. However, structural origins and consequences of such degradation are less documented. In this study, we have used synchrotron radiation to evaluate the behavior of ferroelectric domains by X-ray diffraction (XRD). The sample was loaded with an AC triangular bias waveform between ±10 V with a number of cycle varying from one up to 108. At each step of the aging procedure, XRD spectra had been collected in situ during the application of an electric field on a capacitor. The fine analysis of the (200) pseudo-cubic peak structure allows to separate the evolution of the volume of a/c tetragonal and rhombohedral domains along the electrical biasing. Throughout the aging, both intrinsic and extrinsic responses of tetra and rhombohedral domains are altered, the behavior depending on the observed phase. This methodology opens up new perspectives in the comprehension of the aging effect in ferroelectric thin film.

Improving the thermal stability of Ni/GeSn intermetallics is of great importance to avoid surface degradation and Sn segregation. For this purpose, we studied the effects of pre-amorphization by ion implantation (PAI) of GeSn layers prior to metallization. The impact of Si, Ge, C, or Ge + C PAI was evaluated in terms of phase sequence, morpohological, and electrical evolution during the solid-state reaction. The overall phase sequence, followed by in situ x-ray diffraction, was comparable with or without PAI and went as follows: the Ni 5 (GeSn) 3 hexagonal phase was obtained first, followed by the mono-stanogermanide phase: Ni(GeSn). Nevertheless, the threshold temperature for phase formation varied. These variations, depending on the nature of the implanted ions, can be related to kinetic and/or thermodynamic factors as supported by the analysis of bibliography for silicides and germanides. Additionally, it was reported that the use of Si or Ge implantation did not significantly impacted the surface morphology of the layers. On the other hand, the implantation of C positively impacts the surface morphology evolution by delaying Sn long-range diffusion and Ni(GeSn) agglomeration. This trend was then highly beneficial for preserving electrical stability in an enhanced process window. [ABSTRACT FROM AUTHOR]

Thin films of superconducting V 3 Si were prepared by means of RF sputtering from a compound V 3 Si target at room temperature onto sapphire and oxide-coated silicon wafers, followed by rapid thermal processing under secondary vacuum. The superconducting properties of the films thus produced are found to improve with annealing temperature, which is ascribed to a reduction in defects in the polycrystalline layer. Critical temperatures (T c ) up to 15.3 K were demonstrated after thermal processing, compared to less than 1 K after deposition. The T c was always found to be lower on the silicon wafers, by on average 1.9 ± 0.3 K for the annealed samples. This difference, as well as a broadening of the superconducting transitions, is nearly independent of the annealing conditions. In situ XRD measurements reveal that the silicide layer becomes strained upon heating due to a mismatch between the thermal expansion of the substrate and that of V 3 Si. Taking into account the volume reduction due to crystallization, this mismatch is initially larger on sapphire, though stress relaxation allows the silicide layer to be in a relatively unstrained state after cooling. On oxidized silicon, however, no clear evidence of relaxation upon cooling is observed, and V 3 Si ends up with an out-of-plane strain of 0.3% at room temperature. This strain increases as the sample is cooled down to cryogenic temperatures, though the deformation of the polycrystalline layer is expected to be highly inhomogeneous. Taking into account also the reported occurrence of a Martensitic transition just above the critical temperature, this extrapolated strain distribution is found to closely match an existing model of the strain dependence of A-15 superconducting compounds. [ABSTRACT FROM AUTHOR]

Las opiniones de los expertos juegan un papel importante en el mercado gastronómico por las siguientes razones: la información es imperfecta y bastante costosa de adquirir; la calidad — en gran parte — es subjetiva y los consumidores necesitan que los expertos la definan. El número de manuales actualmente editados, su éxito (Michelín: 650,000 vendidos; CaultMillau: 200,000 vendidos) y el fuerte nivel de correlación generalmente obtenida entre los precios e índices o clasificaciones (0.63 en promedio) para esta clase de actividad ilu stran esta influencia. Sin expertos, la oferta y la demanda difícilmente concordarían. Por consiguiente, es relevante identificar los determinantes de estas evaluaciones de calidad y luego estimar su impacto respectivo. De acuerdo a los expertos, el arte de cocinar es el único determinante que ellos toman en cuenta cuando seleccionan y luego evalúan a los chefs. Para estos, el ambiente o entorno también aparece como un determinante y no el menos importante. ¿cuál es la mejor estrategia para llegar a ser un chef de "primer nivel"? ¿conseguiría Alain Ducasse, uno de los más famosos chefs franceses, el mismo nivel en un café al costado de la carretera como en un restaurante de lujo? Para responder estas interrogantes se estima una ecuación de calidad usando una base de datos original que concierne a 185 chefs franceses líderes, quienes han sido seleccionados en uno de los más famosos manuales franceses: CaultMillau (edición 2000). Los resultados muestran que hay dos estrategias para llegar a ser un "chef de primer nivel", pero que el arte de cocinar prevalece sobre el ambiente o entorno. Esto está de acuerdo con la observación de que algunos restaurantes gastronómicos tienden a invertir en forma excesiva en una ambientación lujosa.

Ni-GeSn based materials are promising in order to obtain contacts in complementary metal oxide semiconductor and Si photonic devices. In this work, a systematic and comprehensive study of the solid-state reaction between NiPt thin films and Ge0.9Sn0.1 layers is carried out. A particular focus is given on the impact of the addition of 10 at. % of Pt in Ni thin films. In situ X-ray diffraction and in-plane reciprocal space map measurements reveal a sequential growth in which the first phase appearing corresponds to a Ni-rich phase: (Ni0.9Pt0.1)5(Ge0.9Sn0.1)3. Then, at 245 °C, the Ni-rich phase vanishes to the benefit of the mono-stanogermanide phase (Ni0.9Pt0.1)(Ge0.9Sn0.1), which is unstable. At 360 °C, a more stable (Ni1–yPty)(Ge1–xSnx) phase is obtained concomitantly to the formation of PtSnx compounds. Finally, Sn segregation occurs at even higher temperatures. Even if Pt addition in Ni thin films complicates the phase formation sequence, it positively impacts the surface morphology and roughness, delays film agglomeration and Sn segregation, and stabilizes the electrical properties of the stanogermanide in a wide range of temperatures. [ABSTRACT FROM AUTHOR]