Background In the Île-de-France region (henceforth termed Greater Paris), extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) was considered early in the COVID-19 pandemic. We report ECMO network organisation and outcomes during the first wave of the pandemic. Methods In this multicentre cohort study, we present an analysis of all adult patients with laboratory-confirmed SARS-CoV-2 infection and severe ARDS requiring ECMO who were admitted to 17 Greater Paris intensive care units between March 8 and June 3, 2020. Central regulation for ECMO indications and pooling of resources were organised for the Greater Paris intensive care units, with six mobile ECMO teams available for the region. Details of complications (including ECMO-related complications, renal replacement therapy, and pulmonary embolism), clinical outcomes, survival status at 90 days after ECMO initiation, and causes of death are reported. Multivariable analysis was used to identify pre-ECMO variables independently associated with 90-day survival after ECMO. Findings The 302 patients included who underwent ECMO had a median age of 52 years (IQR 45−58) and Simplified Acute Physiology Score-II of 40 (31−56), and 235 (78%) of whom were men. 165 (55%) were transferred after cannulation by a mobile ECMO team. Before ECMO, 285 (94%) patients were prone positioned, median driving pressure was 18 cm H 2 O (14−21), and median ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen was 61 mm Hg (IQR 54−70). During ECMO, 115 (43%) of 270 patients had a major bleeding event, 27 of whom had intracranial haemorrhage; 130 (43%) of 301 patients received renal replacement therapy; and 53 (18%) of 294 had a pulmonary embolism. 138 (46%) patients were alive 90 days after ECMO. The most common causes of death were multiorgan failure (53 [18%] patients) and septic shock (47 [16%] patients). Shorter time between intubation and ECMO (odds ratio 0·91 [95% CI 0·84−0·99] per day decrease), younger age (2·89 [1·41−5·93] for ≤48 years and 2·01 [1·01−3·99] for 49–56 years vs ≥57 years), higher pre-ECMO renal component of the Sequential Organ Failure Assessment score (0·67, 0·55−0·83 per point increase), and treatment in centres managing at least 30 venovenous ECMO cases annually (2·98 [1·46–6·04]) were independently associated with improved 90-day survival. There was no significant difference in survival between patients who had mobile and on-site ECMO initiation. Interpretation Beyond associations with similar factors to those reported on ECMO for non-COVID-19 ARDS, 90-day survival among ECMO-assisted patients with COVID-19 was strongly associated with a centre's experience in venovenous ECMO during the previous year. Early ECMO management in centres with a high venovenous ECMO case volume should be advocated, by applying centralisation and regulation...

No abstract

RÉSUMÉ Dans un régime comme celui de la République populaire de Chine, où prévaut la suprématie d’un Parti-État unique, la politique et le politique constituent, a fortiori plus qu’ailleurs, la chasse gardée de l’élite dirigeante du pays, à savoir les cadres du Parti communiste. Cet article tente de saisir qui sont les élites politiques aux commandes de la Chine d’aujourd’hui à travers l’analyse du modus operandi de l’École des cadres du Parti de Shanghai. L’étude de cette institution, qui participe à la régulation de la circulation des élites et constitue l’un des lieux privilégiés de la transmission et de l’exercice du pouvoir, permet, par-delà son propre fonctionnement, d’éclairer la nature et le devenir même du régime. S’il apparaît que les forces modernisatrices, en assimilant davantage l’École du Parti à un institut d’administration publique, œuvrent à la professionnalisation du métier de cadre, c’est également et avant tout afin de mieux perpétuer l’hégémonie du Parti-État unique.

Based mainly on a Hong Kong-wide survey carried out in March-April 2021, while also drawing on a round of stakeholder interviews from July 2020 to December 2021, the article interprets the linked phenomena of trust and the smart city in the specific context of the Hong Kong Special Administrative Region. In the main body of the article, four angles are used to understand facets of trust-smart city relations, centred on characteristic trust, trust and technology, the role of intermediaries, and trust in government. The main findings of the survey centre around the data trust paradox (of high support for technology in a low-trust environment), the social impact of trust and mistrust (strongly correlated with age and political affiliation), and trust in the smart city as a weathervane of trust in government. Factors such as a digitally literate population, a decades-long investment in technology, and a substantial record of delivery provide solid reasons to believe that a strategic-technical narrative on the smart city might succeed where others have failed to convince.

Once known as a silent and even a model minority, hardworking and keeping a low profile, the Chinese community in Paris, one of the largest Chinese diasporic population in Europe, has organized several massive demonstrations since 2010 to demand police protection amid mounting security concerns. Based on qualitative methods combining ethnographic research, media analysis, observation of the collective actions, and interviews of key actors involved, this article analyses the evolution of these mobilizations and their aftermath, on a span of eight years from June 2010 to July 2018, aiming to comprehend the role of China's influence diplomacy in regard to the actions of overseas Chinese for security. There hasn't been any study on the role that overseas Chinese might play in China's foreign policy towards Europe.