Éditeur(s) : CRPLC : Centre de Recherche sur les Pouvoirs Locaux dans la Caraïbe
Extrait de : "La question de la gouvernance territoriale dans les régions et départements français d'Amérique" : journées d'étude, les 8 et 9 avril 2012. Campus de Troubiran
Description : la décentralisation serait plus un transfert de charges et de responsabilités que de compétences. Elle s'est accompagnée de lois et d'évaluations qui ont pour but d'optimiser les politiques locales. La contractualisation est ainsi un instrument juridique qui a toute sa place dans les projets de développements locaux. Seulement elle n'est pas qu'un partenariat mais d'avantage un rapport de fore, un assujettissement des collectivités locales à l'État. En effet, les intérêts entre les collectivités locales et l'état ne sont pas forcément convergents.
Siècle(s) traité(s) : 21
Droits : CC-BY-NC-ND - Attribution - Pas d'utilisation commerciale - Pas de modification
Permalien : http://www.manioc.org/fichiers/V12224
V12224

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
ISSN: 0003-4975

hal-01563338
http://hal.univ-brest.fr/hal-01563338
DOI : 10.1016/j.athoracsur.2016.03.093
PUBMED : 27262916

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Aims: The aims of this study were to compare short-and long-term outcomes for clinical T2N0 oesophageal cancer with analysis of (i) primary surgery (S) versus neoadjuvant therapy plus surgery (NS), (ii) squamous cell carcinoma and adenocarcinoma subsets; and (iii) neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy.Methods: Data were collected from 30 European centres from 2000 to 2010. Among 2944 included patients, 355 patients (12.1%) had cT2N0 disease; 285 (S) and 70 (NS), were compared in terms of short-and long-term outcomes. Propensity score matching analyses were used to compensate for differences in baseline characteristics.Results: No significant differences between the groups were shown in terms of in hospital morbidity and mortality. Nodal disease was observed in 50% of S-group at the time of surgery, with 20% pN2/N3. Utilisation of neoadjuvant therapy was associated with significant tumour downstaging as reflected by increases in pT0, pN0 and pTNM stage 0 disease, this effect was further enhanced with neoadjuvant chemoradiotherapy. After adjustment on propensity score and confounding factors, for all patients and subset analysis of squamous cell and adenocarcinoma, neoadjuvant therapy had no significant effect upon survival or recurrence (overall, loco-regional, distant or mixed) compared to surgery alone. There were no significant differences between neoadjuvant chemotherapy and chemoradiotherapy in short-or long-term outcomes.Conclusion: The results of this study suggest that a surgery alone treatment approach should be recommended as the primary treatment approach for cT2N0 oesophageal cancer despite 50% of patients having nodal disease at the time of surgery.
ISSN: 0959-8049

hal-01666517
https://hal.univ-lorraine.fr/hal-01666517
DOI : 10.1016/j.ejca.2015.11.024

Éditeur(s) : HAL CCSD
Résumé : International audience
The challenge is to implement research that can estimate the consequences ofclimate changes in terms of impact on terrestrial environments and resources.Emphasis should be placed on regions dependent on natural resources and forwhich demographic pressure is strong. Simulations obtained from climate modelprojections (using different Representative Concentration Pathways (RCPs))predict that the Mediterranean basin and its southern periphery are particularlyvulnerable to water resources and environmental impact (IPCC, AR5, 2013).An annual rainfall decrease by 30% is found for the projection period 2070-2099(IPCC, AR5, 2013) associated with a decrease in water resources by 30 to 50%(Milano, 2012). In addition, several studies using regional atmospheric modelsindicate an increase in the precipitation inter-annual variability with extremeevents and a spatial heterogeneous signature, superimposed on a decrease in thetotal precipitation amount (Giorgi and Lionello, 2008; Raible et al. 2010).Currently, regional climate projections are highly sensitive to the climate modelused. In particular, spatial resolution as well as local climate conditions seemto impact significantly on the simulations (Jacob et al. 2014).The Mediterranean region, at the interface between arid and temperate climateswith several mountainous areas, is a complex climate system affected by theinteractions between mid-latitude and sub-tropical processes. In this context,Morocco, located at the transition between a temperate climate to the North anda tropical climate to the south constitutes a key area for an impact and sensitivitystudy to global climate changes. The climate is influenced by the Atlantic Ocean,the Mediterranean Sea and the Sahara, together with a very steep orography inthe Atlas region. The precipitation distribution is therefore characterised by greatspatial variability, and exhibits a marked seasonality, a strong inter-annualvariability (Ouda et al. 2005) and in general a pronounced gradient from northto south and west to east. At a broader scale, Morocco is located on the subtropicalsubsidence path and between the Acores High and the Saharan Low (Agoussine,2003). Several studies have also identified strong links with inter-annualprecipitation variability and NAO index (Knippertz, 2003) as well as remoteclimate modes (Esper et al. 2007).Continental climate variability at a local/regional scale, if it is to be integratedin climate predictions, needs to be supported by long-term observation.Meteorological stations in Morocco provide climatic data mainly for the last40 years with only a few stations located in the mountainous region (Tramblayet al. 2012; 2013; Driouech et al. 2010). This climate database is also supportedby the IAEA network providing stations for which isotope tracers have beenapplied to daily/monthly rain and water vapour samples over 2 to 3 years between2000 and 2004. Besides the poor coverage of instrumented areas, lacustrinesystems can provide a climatic data set that offers access to short and long-termtime series of climate parameters when knowledge of modern lake water balanceis combined with lacustrine sedimentary-climate records. Lake sediment recordsideally provide high resolution climate/environmental information of the last10,000 years (Magny et al. 2013). This time interval (corresponding to theHolocene) is a key period to investigate short and long-term climate variabilityand to improve prediction in a warming climate.In this study we present an integrated approach focusing on a mountainous lake(Aguelmam Azigza). The modern lake system study is based on site monitoring(2012-2016) and available regional hydro-climatic data. These data show thatlake level changes during the instrumented period were mainly driven byprecipitation following the high inter-annual variability. These data are thencompared with accurately dated short sediment cores retrieved in the same lake.Micro-scale geochemical and sedimentological analyses of these sequencesenable us to identify various sedimentary facies that can be linked with periodsof high (low) lake levels over the past decades.
The Mediterranean Region under Climate ChangeLa méditerranée face au changement climatique

insu-01394690
https://hal-insu.archives-ouvertes.fr/insu-01394690
https://hal-insu.archives-ouvertes.fr/insu-01394690/document
https://hal-insu.archives-ouvertes.fr/insu-01394690/file/Vidaletal.2016-COP22-Chap1.pdf

Éditeur(s) : HAL CCSD Oxford University Press (OUP)
Résumé : International audience
OBJECTIVES: Tracheobronchial stenosis (TBS) is noted in 12-23% of patients with granulomatosis with polyangiitis (GPA), and includes subglottic stenosis and bronchial stenosis. We aimed to analyse the endoscopic management of TBS in GPA and to identify factors associated with the efficacy of endoscopic interventions. METHODS: We conducted a French nationwide retrospective study that included 47 patients with GPA-related TBS. RESULTS: Compared with patients without TBS, those with TBS were younger, more frequently female and had less frequent kidney, ocular and gastrointestinal involvement and mononeuritis multiplex. Endoscopic procedures included 137 tracheal and 50 bronchial interventions, mainly endoscopic dilatation, local steroid injection and conservative laser surgery, and less frequently stenting. After the first endoscopic procedure, the cumulative incidence of endoscopic treatment failure was 49% at 1 year, 70% at 2 years and 80% at 5 years. Factors significantly associated with a higher cumulative incidence of treatment failure were a shorter time from GPA diagnosis to endoscopic procedure [hazard ratio (HR) 1.08 (95% CI 1.01, 1.14); P = 0.01] and a bronchial stenosis [HR 1.96 (95% CI 1.28, 3.00); P = 0.002]. A prednisone dose ≥30 mg/day at the time of the procedure was associated with a lower cumulative incidence of treatment failure [HR 0.53 (95% CI 0.31, 0.89); P = 0.02]. CONCLUSION: TBS represents severe and refractory manifestations with a high rate of restenosis. High-dose systemic CSs at the time of the procedure and increased time from GPA diagnosis to bronchoscopic intervention are associated with a better event-free survival. In contrast, bronchial stenoses are associated with a higher rate of restenosis than subglottic stenosis.
ISSN: 1462-0324

hal-01155105
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01155105
DOI : 10.1093/rheumatology/kev129
PUBMED : 26001634