Modelling the environment using graphs with behaviour: do you speak Ocelet?

International audienceEnvironmental modelling often implies defining elements that relate and interact with each other, in a system that evolves with time. Ocelet is a domain specific environmental modelling language that was designed around a limited set of key concepts chosen to help modellers focus on their model, while leaving the implementation to an automatic code generation phase. Here, we focus more specifically on a concept called Relation in Ocelet that allows to build graphs that describe which elements of the model interact, and how. It is designed to be used in combination with two other main concepts: Entities (elements of the model) and Scenarios (describing the temporal evolution). Every Ocelet Relation can express one specific point of view of a system and several Relations can be combined to integrate different points of view in the same model. By its diversity, points of view convey expressive power: with different expert views on a system, at different spatial scales, or an environment sensed by its different components. Moreover, in this versatile design, a Relation defined for one specific model can be reused in a different modelling context. Libraries of generic interaction behaviours can thus be developed for efficient and reliable modelling practices. An example is given to illustrate how interaction graphs can be built, manipulated, and reused using Ocelet. Finally, we give insight into the code generation phase that produces the simulator

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Ocelet: An Ontology-Based Domain Specific Language to Model Complex Domains

International audienceIn this work, we consider that the modeling of complex domains can be performed using Domain Specific Languages (DSL). The main principle of this approach consists in developing DSL primitives and to assemble them to model a certain domain. The ability to add new primitives into an existing model and to fine-tune it by replacing some of them provides a flexibility that is highly desirable in simulation intense fields. We have designed such a language, named textit{Ocelet}, which is tailored for dynamic landscape modeling. We consider that three important components may influence the adoption of this approach: a graphical user interface to build models in an efficient and user-friendly way, a solution to reason, e.g., consistency checking, about model primitives and a tool to facilitate the development of primitives repositories. In this paper, we emphasize that an ontology-based approach is adapted to design all these components. Moreover, a mapping between ontology and Ocelet elements is sufficient for its achievement and supports automatic transformations from one model to the other

Modelling the environment using graphs with behaviour: do you speak Ocelet?

International audienceEnvironmental modelling often implies defining elements that relate and interact with each other, in a system that evolves with time. Ocelet is a domain specific environmental modelling language that was designed around a limited set of key concepts chosen to help modellers focus on their model, while leaving the implementation to an automatic code generation phase. Here, we focus more specifically on a concept called Relation in Ocelet that allows to build graphs that describe which elements of the model interact, and how. It is designed to be used in combination with two other main concepts: Entities (elements of the model) and Scenarios (describing the temporal evolution). Every Ocelet Relation can express one specific point of view of a system and several Relations can be combined to integrate different points of view in the same model. By its diversity, points of view convey expressive power: with different expert views on a system, at different spatial scales, or an environment sensed by its different components. Moreover, in this versatile design, a Relation defined for one specific model can be reused in a different modelling context. Libraries of generic interaction behaviours can thus be developed for efficient and reliable modelling practices. An example is given to illustrate how interaction graphs can be built, manipulated, and reused using Ocelet. Finally, we give insight into the code generation phase that produces the simulator

Design of a domain specific language for modelling processes in landscapes

The modelling of processes that occur in landscapes is often confronted to issues related to the representation of space and the difficulty of properly handling time and multiple scales. In order to investigate these issues, a flexible modelling environment is required. We propose to develop such a tool based on a Domain Specific Language (DSL) that capitalises on the service-oriented architecture (SOA) paradigm. The modelling framework around the DSL is composed of a model building environment, a code generator and compiler, and a program execution platform. The DSL introduces five language elements (entity, service, relation, scenario and datafacer) that can be combined to offer a wide range of possibilities for modelling in space and time at different scales. When developing a model, model parts are either built using the DSL or taken from libraries of previously built ones, and adapted to the specific model. The practical usage of the DSL is illustrated first with the Lotka-Volterra model, and then with a landscape modelling experiment on the spread of a mosquito-borne disease in the Sahelian region of West Africa. An interesting characteristic of this approach is the possibility of adding new elements into an existing model, and replacing others with more appropriate ones, thus allowing potentially complex models to be built from simpler parts. (Résumé d'auteur