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To counteract the vasoplegia induced by spinal anesthesia (SA) and maintain blood pressure (BP) during cesarean delivery, phenylephrine is currently recommended, but norepinephrine might offer superior preservation of cardiac output. We aimed to compare the hemodynamic effects of phenylephrine and norepinephrine administered by manually adjusted continuous infusion during elective cesarean delivery.In this pragmatic, parallel-group, double-blind randomized controlled trial, 124 parturients scheduled for elective cesarean delivery under SA in a tertiary maternity in France, between February 2019 and December 2020, were randomized to receive norepinephrine at a starting rate of 0.05 μg·kg-1·min-1 (n = 62) or phenylephrine at a starting rate of 0.5 μg·kg-1·min-1 (n = 62). In both groups, the vasopressor infusion rate was then manually adjusted to maintain maternal systolic BP above 90% of the baseline value. The primary outcome, the change in cardiac index (CI) measured by thoracic bioreactance from SA to umbilical cord clamping, was analyzed through repeated measures analysis of variance and post hoc t tests. Secondary outcomes included maternal BP and neonatal outcomes.In the norepinephrine group, cardiac index was maintained between 90% and 100% of baseline from SA to umbilical cord clamping, whereas it was maintained at significantly lower values (81%-88%) in the phenylephrine group (P = .001). The percentage of elapsed time with a mean maternal BP65 mm Hg and with systolic BP80% of the baseline value was higher in the phenylephrine group: 2.9% (7.3) vs 0.5% (1.8) (absolute risk difference [ARD], -2.4%; 95% confidence interval, -4.4 to -0.5; P = .012) and 8.5% (16.6) vs 2.3% (5.2) (ARD, -6.2%; 95% confidence interval, -10.6 to -1.8; P = .006). Excluding parturients with gestational diabetes, severe neonatal hypoglycemia was more common in the phenylephrine group at 19.6% (9/46) vs 4.1% (2/49) (P = .02). The other neonatal outcomes did not differ significantly between the groups.When administered by manually adjusted infusion during SA for cesarean delivery, norepinephrine was associated with a higher CI; both infusions were effective for maintaining BP.

Background The clinical impact and outcomes of ventilator-associated pneumonia (VAP) have been scarcely investigated in patients with the acute respiratory distress syndrome (ARDS). Methods Patients admitted over an 18-month period in two intensive care units (ICU) of a university-affiliated hospital and meeting the Berlin criteria for ARDS were retrospectively included. The association between VAP and the probability of death at day 90 (primary endpoint) was appraised through a Cox proportional hazards model handling VAP as a delay entry variable. Secondary endpoints included (i) potential changes in the PaO2/FiO2 ratio and SOFA score values around VAP (linear mixed modelling), and (ii) mechanical ventilation (MV) duration, numbers of ventilator- and vasopressor-free days at day 28, and length of stay (LOS) in patients with and without VAP (median or absolute risk difference calculation). Subgroup analyses were performed in patients with COVID-19-related ARDS and those with ARDS from other causes. Results Among the 336 included patients (101 with COVID-19 and 235 with other ARDS), 176 (52.4%) experienced a first VAP. VAP induced a transient and moderate decline in the PaO2/FiO2 ratio without increase in SOFA score values. VAP was associated with less ventilator-free days (median difference and 95% CI, − 19 [− 20; − 13.5] days) and vasopressor-free days (− 5 [− 9; − 2] days) at day 28, and longer ICU (+ 13 [+ 9; + 15] days) and hospital (+ 11.5 [+ 7.5; + 17.5] days) LOS. These effects were observed in both subgroups. Overall day-90 mortality rates were 35.8% and 30.0% in patients with and without VAP, respectively (P = 0.30). In the whole cohort, VAP (adjusted HR 3.16, 95% CI 2.04–4.89, P P P = 0.80). Conclusions VAP is an independent predictor of 90-day mortality in ARDS patients. This condition exerts a limited impact on oxygenation but correlates with extended MV duration, vasoactive support, and LOS.

Les violences sexuelles commises contre des hommes au cours de conflits armes ont longtemps ete negligees. Elles ont ete reconnues par des activistes des droits de l’homme et quelques ong medicales dans les contextes de guerre en ex-Yougoslavie et a l’Est de la Republique du Congo. Puis, au debut des annees 2000, des etudes ont commence a se donner pour objectif a la fois d’enqueter sur ces formes de brutalite et d’expliquer le fait qu’elles aient ete si rarement considerees par les ong et les agences des Nations Unies. Nous examinons ces etudes et les explications qu’elles donnent aux approches exclusivement orientees sur les viols de femmes.

Les archives judiciaires constituent une source essentielle pour les etudes des sociabilites africaines en situation coloniale. Cet article prend appui sur l’analyse des proces tenus, entre 1923 et 1939, au tribunal du premier degre d’Abidjan, il vise a decrire les argumentations contradictoires par lesquelles femmes et hommes expliquent leurs differends dans l’espace du pretoire. Les registres issus des « juridictions indigenes » permettent egalement d’apprecier sur quels reperes se fondent les juges pour formuler leurs verdicts. L’analyse des registres d’audience revele une incertitude normative que les juges ont vocation de surmonter : l’article montre de quelle maniere.

Failure to address extreme environments constraints at the human-computer interaction level may lead to the commission of critical and potentially fatal errors. This experimental study addresses gaps in our current theoretical understanding of the impact of ±Gz accelerations and field dependency independency on task performance in human-computer interaction. It investigates the effects of ±Gz accelerations and field dependency independency on human performance in the completion of perceptual-motor tasks on a personal digital assistant (PDA). We report the results of a controlled experiment, conducted in an aerobatic aircraft under multiple ±Gz conditions, showing that cognitive style significantly impacts latency and accuracy in target acquisition for perceptual-motor tasks in altered ±Gz environments and propose design guidelines as countermeasures. Based on the results, we argue that developing design requirements taking into account cognitive differences in extreme environments will allow users to execute perceptual-motor tasks efficiently without unnecessarily increasing cognitive load and the probability of critical errors.

Parmi les facteurs conduisant a la guerre civile, le principal a ete, des les debuts du multipartisme en 1990 mais surtout depuis la mort de Felix Houphouet Boigny en 1993, la brutalite croissante du combat politique avec ses effets de division et d'entrainement dans l'opinion publique et dans les corps intermediaires. La consequence fut de politiser la societe ivoirienne a l'extreme par la montee des affrontements et la banalisation collective des pratiques de violence. L'auteur examine quelques debats et episodes significatifs de la vie politique ivoirienne. Ces derniers attestent de la gravite d’antagonismes exacerbes depuis des annees.

M. Le Pape — On Space and Race in A bidjan, 1903-1934. The idea of separated European and African housing was accepted in French colonial circles since the beginning of this century. However diverging practices and opinions obtained concerning the opportunity of isolating more or less absolu tely the European neighbourhood. This paper attempts to determine which European fractions were confronted in this controversy and to reconstruct their motivating forces., Le Pape Marc. De l'espace et des races à Abidjan, entre 1903 et 1934. In: Cahiers d'études africaines, vol. 25, n°99, 1985. Ségrégation spatiale, ségrégation sociale. pp. 295-307.

espanolLa escuela a todo precio. Estrategias educativas en la pequena-burguesia de Abidjan. En la Costa de Marfil, un conjunto de practicas oficiosas influyen en el funcionamiento del sistema de ensenanza, a tal punto que el no parece mas al modelo frances sobre el cual habia sido explicitamente concebido. Estas practicas —sea en terminos marfilianos «el corredor»— consisten en relaciones personales establecidas entre profesores y padres de alumnos ; estos ultimos obtienen, gracias a regalos de dinero y a sus relaciones, favores para sus hijos. Desde el principio de los anos 80, en razon de la recesion economica, la seleccion escolar se ha vuelto oficialmente mas severa y por tanto resulto una seleccion por el dinero aun mas intensa. A partir de biografias, este articulo analiza los comportamientos de los padres de alumnos frente a este sistema, comportamientos caracteristicos de las clases medias de Abidjan y a traves del estudio de sus estrategias conduce a una sociologia de las relaciones entre fracciones dominantes y fracciones dominadas desde 1960. EnglishSchooling at Any Price : Educational Strategies in the Abidjan Middle Class. In the Ivory Coast, a set of unofficial practices affects the functioning of the educational System so much that it scarcely resembles the French System on which it was explicitly modelled. These practices, known locally as «the corridor», consist of personal relationships between teachers and parents in which the latter secure preferential treatment for their children by means of gifts and personal influence. Since the early 1980s, because of the economic recession, academic selection has become officially more severe, leading to even more intense financial selection. On the basis of biographies, this article analyses the behaviour of parents towards this System, which is characteristic of the Abidjan middle classes, and, by studying these strategies, it opens up a sociology of the relations between dominant and dominated fractions in the Ivory Coast since independence. francaisL'ecole a tout prix. Strategies educatives dans la petite bourgeoisie d'Abidjan. En Cote-d'Ivoire, un ensemble de pratiques officieuses influencent le fonctionnement du systeme d'enseignement au point qu'il ne ressemble plus guere au modele francais sur lequel il avait ete explicitement concu. Ces pratiques —soit en termes ivoiriens, «le couloir»— consistent en rapports personnels etablis entre enseignants et parents d'eleves, ces derniers obtenant, grâce a des cadeaux d'argent et a leurs relations, des passe-droits pour leurs enfants. Depuis le debut des annees 80, en raison de la recession economique, la selection scolaire est devenue officiellement plus severe et il en est resulte une selection par l'argent encore plus intense. A partir de biographies, cet article analyse les comportements de parents face a ce systeme, comportements caracteristiques des classes moyennes d'Abidjan, et ouvre, a travers l'etude de leurs strategies, sur une sociologie des rapports entre fractions ivoiriennes dominantes et fractions dominees depuis 1960. DeutschSchule um jeden Preis Bildungsstrategie des Kleinburgertums von Abidjan. Das Bildungssystem der Elfenbeinkuste wird so stark von offiziosen Praktiken beeinflust, das es kaum noch dem franzosischen Modell ahnelt, nach dessen Vorbild es explizit aufgebaut wurde. Diese Praktiken — «Gang» nach der landesublichen Bezeichnung — bestehen in personlichen Be-ziehungen zwischen Lehrern und Eltern der Schiller. Durch Geldgeschenke und personliche Beziehungen last sich derart das schulische Weiterkommen der Kinder steuern. Unter dem Druck der Wirtschaftsrezession wurde die Schulauslese seit Beginn der 80er Jahre verscharft, was zu einer starkeren Auslese durch Geld gefuhrt hat. Anhand von Biographie n analysiert dieser Artikel das fur die Mittelklassen von Abidjan charakteristische Verhalten der Eltern gegenuber diesem System, und liefert mittels Analyse der Strategien dieser Klassen Ansatze zu einer Soziologie der Beziehungen zwischen herrschenden und beherrschten Fraktionen der Elfenbeinkuste seit 1960.

Botte Roger, Dreyfus Francine, Le Pape Marc, Vidal Claudine. Les relations personnelles de subordination dans les sociétés interlacustres de l'Afrique centrale. In: Cahiers d'études africaines, vol. 9, n°35, 1969. les relations de dépendance personnelle en afrique noire pp. 350-401.

Le Pape Marc. Les statuts d’une génération. Les déscolarisés d’Abidjan entre 1976 et 1986. In: Politique africaine, n°24, 1986. Côte d'Ivoire : la société au quotidien. pp. 104-112.

Enquete historique et genealogique montrant a quel point les savoirs et les pratiques actuelles concernant la repartition de l'espace habite et de l'espace social, le code de comportement et les obligations de respects, correspondent a une tradition ancienne, repandue et reconstruite sur la ruine de la tribu.

M. Le Pape - From 'Native' to 'Informal', 1955-1982. Studies of Third World urban economies have progressively evolved toward a bipolar distribution: on the one hand, an attempt to identify everywhere the empirical characteristics of a single generai System, the 'informai sector'; on the other hand, an explicitation of the various shapes of particular Systems. Unlike those authors who insist upon antinomies, we are undertaking the historicisation of'informai' objects and notions., Le Pape Marc. De l' « indigène » à l' « informel », 1955-1982. In: Cahiers d'études africaines, vol. 23, n°89-90, 1983. pp. 189-197.

Space in Abidjan : a sociography of mobility.— Casualty rates on the roads and lunch taken outside the family home are two consequences of the extension of transport network and increasing distances to work at Abidjan. How antithetic social behaviour is involved is investigated and analyzed by the authors., L'insécurité automobile, l'obligation de prendre ses repas hors de chez soi : deux situations d'Abidjan dues à l'allongement des distances. Les auteurs analysent comment ces deux situations impliquent des comportements sociaux antithétiques., Vidal Claudine,Le Pape MarcVidal Claudine, Le Pape Marc. Espaces abidjanais : sociographies de la mobilité. In: L'Espace géographique, tome 15, n°3, 1986. pp. 187-194.

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