Frontière entre la mort et le mourir

Les notions de « mort » et de « mourir », parfois utilisées sans distinctions dans la littérature, font référence à deux dimensions fort différentes pour la personne en fin de vie, de même que pour toutes les personnes appelées à en prendre soin (intervenants de la santé, proches ou aidants naturels). Alors que la personne malade voit venir la mort, elle doit vivre son mourir. La mort succède ainsi au mourir, dans le temps. Par ailleurs, une réflexion d’ordre philosophique permet de préciser que la mort s’avère une ordonnance de la nature, elle est privation de la vie et un mystère. Et en tant que mystère, elle prendra forme selon les différentes croyances attribuées à l’immortalité de l’âme. Quant au mourir, il est l’épreuve par excellence d’une situation-limite. De plus, en dépit du caractère unique et individuel de cette expérience nouvelle pour tous, il assume différents visages. Si l’espoir de « connaître une belle mort » se conçoit aisément, le mourir n’en demeure pas moins le moment le plus tragique de l’existence humaine.The concepts of “death” and of “dying”, sometimes used indiscriminately in the literature, refer in fact to two quite different experiences for any person reaching the end of his or her life, as well as for those persons who take care of them (healthcare providers, for instance, or next of kin, or informal caregivers). While the sick person sees his or her death coming, she or he must on the other hand live through, as it were, their dying. In the course of time, death comes after dying. Moreover, philosophical reflection allows one to say that death is in line with an ordinance of nature, that it amounts to a deprivation of life and that it remains a mystery. Its mystery is met with the various beliefs relative to the immortality of the soul. As for dying, it has rightly been called a limit-situation, the ultimate test, in point of fact. This unique and individual new experience for us all has, besides, many faces. If the hope “to experience a good death” is easy to understand, dying does remain nevertheless the most tragic event for any human being

An ensemble neural network atmospheric correction for Sentinel-3 OLCI over coastal waters providing inherent model uncertainty estimation and sensor noise propagation

Accurate atmospheric correction (AC) is a prerequisite for quantitative ocean colour remote sensing and remains a challenge in particular over coastal waters. Commonly AC algorithms are validated by establishing a mean retrieval error from match-up analysis, which compares the satellite-derived surface reflectance with concurrent ground radiometric observations. Pixel-based reflectance uncertainties however, are rarely provided by AC algorithms and those for the operational Ocean and Land Colour Instrument (OLCI) marine reflectance product are not yet recommended for use. AC retrieval errors and uncertainties directly determine the quality with which ocean colour products can be estimated from the marine surface reflectance. Increasingly there is also the need for reflectance uncertainty products to be used as data assimilation inputs into biogeochemical models. This paper describes the development of a new coastal AC algorithm for Sentinel-3 OLCI that provides pixel-based estimation of the inherent model inversion uncertainty and sensor noise propagation. The algorithm is a full-spectral model-based inversion of radiative transfer (RT) simulations in a coupled atmosphere–ocean system using an ensemble of artificial neural networks (ANN) that were initialized differently during the training process, but composed of the same network architecture. The algorithm has been validated against in-situ radiometric observations across a wide range of optical water types, and has been compared with the latest EUMETSAT operational Level 2 processor IPF-OL-2 v7.01. In this analysis we found that the ensemble ANN showed improved performance over the operational Level 2 processor with a band-averaged (412–708 nm) mean absolute percentage error (MAPE) of 16% compared to 37% and a four-times lower band-averaged bias of -0.00045 sr-1. In the ensemble inversion process we account for three uncertainty components: (1) the total model variance that describes the variance of the data from the different ANNs, (2) the prediction variance of the mean, which is based on calculations of the RT simulations and (3) the instrument noise variance of the mean by propagating the OLCI spectral signal-to-noise ratios (SNR). To study algorithm performance and to quantify the contribution of the different uncertainty components to the total uncertainty, we applied the algorithm to an optically complex full resolution (FR) test scene covering coastal waters of the Great Barrier Reef, Australia. The uncertainties associated with the instrument noise variance were found to be two orders of magnitude lower than the uncertainty components of the prediction and total model variances. The overall largest uncertainty component in our uncertainty framework is attributed to the total model inversion error from averaging the responses of the slightly different adapted networks in the ensemble. The algorithm is made publicly available as a Python/C plugin for the Sentinel Application Platform (SNAP)

Comparison of two ActiGraph accelerometer generations in the assessment of physical activity in free living conditions.

International audienceUNLABELLED: ABSTRACT: BACKGROUND: The aim of this study was to compare physical activity measured using GT1M ActiGraph and GT3X ActiGraph accelerometers in free living conditions. FINDINGS: Twenty-five adults wore GT1M and GT3X Actigraph accelerometers simultaneously during a typical weekday of activity. Data were uploaded from the monitor to a computer at the end of test (one day). Previously established thresholds were used for defining time spent at each level of physical activity, physical activity was assessed at varying intensities comparing data from the two accelerometers by ANOVA and Bland and Altman statistical analysis. The concordance correlation coefficient between accelerometers at each intensity level was 0.99. There were no significant differences between accelerometers at any of the activity levels. Differences between data obtained in minutes with the GT1M accelerometer and the GT3X monitor were to 0.56, 0.36, 0.52 and 0.44% for sedentary, light, moderate and vigorous, respectively. The Bland and Altman method showed good agreement between data obtained for the two accelerometers. CONCLUSIONS: Findings suggest that the two accelerometers provided similar results and therefore the GT3X may be used in clinical and epidemiological studies without additional calibration or validation studies

Maintaining Fluoroquinolone Class Efficacy: Review of Influencing Factors

Previous experience with antimicrobial resistance has emphasized the importance of appropriate stewardship of these pharmacotherapeutic agents. The introduction of fluoroquinolones provided potent new drugs directed primarily against gram-negative pathogens, while the newer members of this class demonstrate more activity against gram-positive species, including Streptococcus pneumoniae. Although these agents are clinically effective against a broad range of infectious agents, emergence of resistance and associated clinical failures have prompted reexamination of their use. Appropriate use revolves around two key objectives: 1) only prescribing antimicrobial therapy when it is beneficial and 2) using the agents(s) with optimal activity against the expected pathogens(s). Pharmacodynamic principles and properties can be applied to achieve the latter objective when prescribing agents belonging to the fluoroquinolone class. A focused approach emphasizing “correct-spectrum” coverage may reduce development of antimicrobial resistance and maintain class efficacy

Integrating Escherichia coli Antimicrobial Susceptibility Data from Multiple Surveillance Programs

Collaboration between networks presents opportunities to increase analytical power and cross-validate findings. Multivariate analyses of 2 large, international datasets (MYSTIC and SENTRY) from the Global Advisory on Antibiotic Resistance Data program explored temporal, geographic, and demographic trends in Escherichia coli resistance from 1997 to 2001. Elevated rates of nonsusceptibility were seen in Latin America, southern Europe, and the western Pacific, and lower rates were seen in North America. For most antimicrobial drugs considered, nonsusceptibility was higher in isolates from men, older patients, and intensive care unit patients. Nonsusceptibility to ciprofloxacin was higher in younger patients, rose with time, and was not associated with intensive care unit status. In univariate analyses, estimates of nonsusceptibility from MYSTIC were consistently higher than those from SENTRY, but these differences disappeared in multivariate analyses, which supports the epidemiologic relevance of findings from the 2 programs, despite differences in surveillance strategies

CoastColour Round Robin data sets: A database to evaluate the performance of algorithms for the retrieval of water quality parameters in coastal waters

The use of in situ measurements is essential in the validation and evaluation of the algorithms that provide coastal water quality data products from ocean colour satellite remote sensing. Over the past decade, various types of ocean colour algorithms have been developed to deal with the optical complexity of coastal waters. Yet there is a lack of a comprehensive intercomparison due to the availability of quality checked in situ databases. The CoastColour Round Robin (CCRR) project, funded by the European Space Agency (ESA), was designed to bring together three reference data sets using these to test algorithms and to assess their accuracy for retrieving water quality parameters. This paper provides a detailed description of these reference data sets, which include the Medium Resolution Imaging Spectrometer (MERIS) level 2 match-ups, in situ reflectance measurements, and synthetic data generated by a radiative transfer model (HydroLight). These data sets, representing mainly coastal waters, are available from doi:10.1594/PANGAEA.841950. The data sets mainly consist of 6484 marine reflectance (either multispectral or hyperspectral) associated with various geometrical (sensor viewing and solar angles) and sky conditions and water constituents: total suspended matter (TSM) and chlorophyll a (CHL) concentrations, and the absorption of coloured dissolved organic matter (CDOM). Inherent optical properties are also provided in the simulated data sets (5000 simulations) and from 3054 match-up locations. The distributions of reflectance at selected MERIS bands and band ratios, CHL and TSM as a function of reflectance, from the three data sets are compared. Match-up and in situ sites where deviations occur are identified. The distributions of the three reflectance data sets are also compared to the simulated and in situ reflectances used previously by the International Ocean Colour Coordinating Group (IOCCG, 2006) for algorithm testing, showing a clear extension of the CCRR data which covers more turbid waters

The Relationship between Impulsive Choice and Impulsive Action: A Cross-Species Translational Study

Maladaptive impulsivity is a core symptom in various psychiatric disorders. However, there is only limited evidence available on whether different measures of impulsivity represent largely unrelated aspects or a unitary construct. In a cross-species translational study, thirty rats were trained in impulsive choice (delayed reward task) and impulsive action (five-choice serial reaction time task) paradigms. The correlation between those measures was assessed during baseline performance and after pharmacological manipulations with the psychostimulant amphetamine and the norepinephrine reuptake inhibitor atomoxetine. In parallel, to validate the animal data, 101 human subjects performed analogous measures of impulsive choice (delay discounting task, DDT) and impulsive action (immediate and delayed memory task, IMT/DMT). Moreover, all subjects completed the Stop Signal Task (SST, as an additional measure of impulsive action) and filled out the Barratt impulsiveness scale (BIS-11). Correlations between DDT and IMT/DMT were determined and a principal component analysis was performed on all human measures of impulsivity. In both rats and humans measures of impulsive choice and impulsive action did not correlate. In rats the within-subject pharmacological effects of amphetamine and atomoxetine did not correlate between tasks, suggesting distinct underlying neural correlates. Furthermore, in humans, principal component analysis identified three independent factors: (1) self-reported impulsivity (BIS-11); (2) impulsive action (IMT/DMT and SST); (3) impulsive choice (DDT). This is the first study directly comparing aspects of impulsivity using a cross-species translational approach. The present data reveal the non-unitary nature of impulsivity on a behavioral and pharmacological level. Collectively, this warrants a stronger focus on the relative contribution of distinct forms of impulsivity in psychopathology