Risk stratification of early admission to the intensive care unit of patients with no major criteria of severe community-acquired pneumonia: development of an international prediction rule

Introduction: To identify risk factors for early (< three days) intensive care unit (ICU) admission of patients hospitalised with community-acquired pneumonia (CAP) and not requiring immediate ICU admission, and to stratify the risk of ICU admission on days 1 to 3. Methods: Using the original data from four North American and European prospective multicentre cohort studies of patients with CAP, we derived and validated a prediction rule for ICU admission on days 1 to 3 of emergency department (ED) presentation, for patients presenting with no obvious reason for immediate ICU admission (not requiring immediate respiratory or circulatory support). Results: A total of 6560 patients were included (4593 and 1967 in the derivation and validation cohort, respectively), 303 (4.6%) of whom were admitted to an ICU on days 1 to 3. The Risk of Early Admission to ICU index (REA-ICU index) comprised 11 criteria independently associated with ICU admission: male gender, age younger than 80 years, comorbid conditions, respiratory rate of 30 breaths/minute or higher, heart rate of 125 beats/minute or higher, multilobar infiltrate or pleural effusion, white blood cell count less than 3 or 20 G/L or above, hypoxaemia (oxygen saturation < 90% or arterial partial pressure of oxygen (PaO2) < 60 mmHg), blood urea nitrogen of 11 mmol/L or higher, pH less than 7.35 and sodium less than 130 mEq/L. The REA-ICU index stratified patients into four risk classes with a risk of ICU admission on days 1 to 3 ranging from 0.7 to 31%. The area under the curve was 0.81 (95% confidence interval (CI) = 0.78 to 0.83) in the overall population. Conclusions: The REA-ICU index accurately stratifies the risk of ICU admission on days 1 to 3 for patients presenting to the ED with CAP and no obvious indication for immediate ICU admission and therefore may assist orientation decisions

Experimental performances of a battery thermal management system using a phase change material

International audienc

Smartphones benefits for psychics diseases

International audience1. Home Care Services: Needs and Limits Carpe Diem at Finistère and Agef, are two home care services specialized in providing support for people suffering from psychological or cognitive lnesses. Their services are targeted to people presenting neurodegenerative pathologies and those requiring support for intellectual, sensorial, and motor activities due to an illness (strokes, Parkinson’s disease, multiple sclerosis). Usually, patients of both home care services have expressed their interest on technologies [1] that could reduce their dependence on relatives or caregivers when going outside. Patients’ demand is usually for systems enabling localization and quick emergency intervention from an unnoticeable and non-stigmatic device. Their main objective is to feel autonomous when their body is letting them own and to alleviate the caregiver's burden. 2. A Collaborative Project. As an open platform, the Android Smartphone combined with sensors and Saas (Software as a Service) applications will now bring innovative services [2] to fragile people (elderly, disabled, people with chronic diseases or mental illness...). AlyaCom, in partnership with Carpe Diem and Agef, has developed a Machine to Machine Mediation Platform (M2M²P) which is able to provide a wide range of services to these people and to caregivers (emergency calls, information services, tracking and tracing services..). In this way, they are now able to create, around each fragile person, a customized ecosystem of inter-operable solutions, covering the needs of security, solidarity, and tele-monitoring. 3. Results People are no longer confined at home, they are free to move around with an attractive and modern mobile phone. Moreover, AlyaCom can provide a user interface (remotely tailored by caregivers) for people with visual or cognitive disabilities by taking advantage of the touch screen, sounds, and vibration of the Android Smartphone. [1] S. Pennec, " The technologies in the city, markers of strangeness of the old age or possible mediators of citizenship? ", The age and the power in question: age and decide in the city, Acts Roma CD and www.reiactis.org site, University of Rouen, October 8-9th, 2008. [2] A. Delattre, A. Thépaut, M.T. Segarra, M. L’Hostis, P.M. Chapon, "Android and geolocation at service of the elderly", International Society for Gerontechnology, 7th World Conference 27-30 may 2010, Vancouver, Canada

Understanding the relationships between heterogeneous microstructures and tensile properties through characterization of plastic strain localization in ti-6al-4v processed by wded.

International audienceWire Direct Energy Deposition (WDED) processes enable near-net-shape manufacturing with a high deposition rate and improved size capabilities as compared to powder-based additive manufacturing (AM) processes. They can be classified according to the employed heat source: a beam, either laser for Wire Laser AM (WLAM) or electron for Electron Beam AM (EBAM), or an arc welding for Wire Arc AM (WAAM). Prior studies have enabled us to limit the introduction of defects and contamination issues using WDED technologies. However, the process-inherited heterogeneous microstructures, including strong crystallographic textures, and consequences on anisotropy and variability in mechanical properties are still not fully understood. In particular, Heat Affected Zones (HAZ) are clearly observed in the material and their features are strongly related to the heat source and the scanning strategy. These HAZ are known to produce a highly heterogeneous microstructure at the millimetre scale with a gradient of α-lath thickness and clusters of crystallographic variants. While these areas are prone to a heterogeneous strain distribution, the relation with macroscopic ductility remains unclear for WDED processes. In the present work, deformation heterogeneity was studied in relation to microstructure to clarify the role of the HAZ-induced strain localization on tensile anisotropy. Digital image correlation (DIC) combined with electron back-scattered diffraction (EBSD) was employed for this purpose. In particular, spatial variations in lamella thickness and implications of Burgers Orientation Relationships were considered to understand the heterogeneous development of slip activity

Understanding the relationships between heterogeneous microstructures and tensile properties through characterization of plastic strain localization in ti-6al-4v processed by wded.

International audienceWire Direct Energy Deposition (WDED) processes enable near-net-shape manufacturing with a high deposition rate and improved size capabilities as compared to powder-based additive manufacturing (AM) processes. They can be classified according to the employed heat source: a beam, either laser for Wire Laser AM (WLAM) or electron for Electron Beam AM (EBAM), or an arc welding for Wire Arc AM (WAAM). Prior studies have enabled us to limit the introduction of defects and contamination issues using WDED technologies. However, the process-inherited heterogeneous microstructures, including strong crystallographic textures, and consequences on anisotropy and variability in mechanical properties are still not fully understood. In particular, Heat Affected Zones (HAZ) are clearly observed in the material and their features are strongly related to the heat source and the scanning strategy. These HAZ are known to produce a highly heterogeneous microstructure at the millimetre scale with a gradient of α-lath thickness and clusters of crystallographic variants. While these areas are prone to a heterogeneous strain distribution, the relation with macroscopic ductility remains unclear for WDED processes. In the present work, deformation heterogeneity was studied in relation to microstructure to clarify the role of the HAZ-induced strain localization on tensile anisotropy. Digital image correlation (DIC) combined with electron back-scattered diffraction (EBSD) was employed for this purpose. In particular, spatial variations in lamella thickness and implications of Burgers Orientation Relationships were considered to understand the heterogeneous development of slip activity

Risk stratification of early admission to the intensive care unit of patients with no major criteria of severe community-acquired pneumonia: development of an international prediction rule.

International audienceABSTRACT: INTRODUCTION: To identify risk factors for early (< three days) intensive care unit (ICU) admission of patients hospitalised with community-acquired pneumonia (CAP) and not requiring immediate ICU admission, and to stratify the risk of ICU admission on days 1 to 3. METHODS: Using the original data from four North American and European prospective multicentre cohort studies of patients with CAP, we derived and validated a prediction rule for ICU admission on days 1 to 3 of emergency department (ED) presentation, for patients presenting with no obvious reason for immediate ICU admission (not requiring immediate respiratory or circulatory support). RESULTS: A total of 6560 patients were included (4593 and 1967 in the derivation and validation cohort, respectively), 303 (4.6%) of whom were admitted to an ICU on days 1 to 3. The Risk of Early Admission to ICU index (REA-ICU index) comprised 11 criteria independently associated with ICU admission: male gender, age younger than 80 years, comorbid conditions, respiratory rate of 30 breaths/minute or higher, heart rate of 125 beats/minute or higher, multilobar infiltrate or pleural effusion, white blood cell count less than 3 or 20 G/L or above, hypoxaemia (oxygen saturation < 90% or arterial partial pressure of oxygen (PaO2) < 60 mmHg), blood urea nitrogen of 11 mmol/L or higher, pH less than 7.35 and sodium less than 130 mEq/L. The REA-ICU index stratified patients into four risk classes with a risk of ICU admission on days 1 to 3 ranging from 0.7 to 31%. The area under the curve was 0.81 (95% confidence interval (CI) = 0.78 to 0.83) in the overall population. CONCLUSIONS: The REA-ICU index accurately stratifies the risk of ICU admission on days 1 to 3 for patients presenting to the ED with CAP and no obvious indication for immediate ICU admission and therefore may assist orientation decisions

Histoire de l’Asie du Sud-Est

En Asie, la genèse des sociétés moderne s’effectue dans une crise permanente. Les transformations ont été introduites ou accélérées de façon plus ou moins forcée, par les états qui avaient fait des pays asiatiques leurs colonies ou les avaient placé dans leurs sphères d’influence économique, politique et culturelle. La soumission des peuples et de leur gouvernement a-t-elle jamais été réelle ? Elle n’a été toujours obtenue qu’à travers des guerres de conquête ; au-delà de celles-ci, les résistances, qu’elles aient été passives ou actives, n’ont pas cessé. La révolte est le réflexe primordial des peuples atteints dans leur indépendance mais plus encore dans l’intégrité de leur être culturel. C’est donc au plus profond de celui-ci que ces peuples puisent leurs références mobilisatrices, à la fois vigoureuses et vulnérables. Ces mythologies souffrent-elles de leur archaïsme ou davantage de ne pas avoir atteint l’universalité des doctrines et des méthodes impérialistes ? Apparemment les révoltes sont vouées à la défaite et, simultanément ou successivement, les réformes sont des tentatives d’éviter le retour des rébellions en réajustant partiellement les politiques aux revendications des groupes sociaux. Est-ce parce que les réformes n’atteignent jamais l’intégralité et la radicalité qu’elles échouent ou du moins perdent de leur efficacité? Les réformes manquées et les révoltes brisées inspirent les projets et les volontés révolutionnaires. La révolution vise au renversement d’une situation de fait mais est-ce sa seule radicalité qui lui insuffle sa force principale ? N’est-ce pas plutôt que les doctrines dont les révolutions s’inspirent : le nationalisme, le panasiatisme, l’islam, le communisme, ont en commum le dépassement des petites patries, des ethnies, des religions naturelles et des sectes. Grâce à elles, la révolution atteint la dimension universelle qui lui permet d’affronter l’impérialisme à armes égales ou presque. La réappropriation de l’indépendance nationale est accompagnée par le dessein de modernisation qui l’apparente à l’impérialisme mais lui permet de se poser en rival et en successeur légitime de ce dernier. C’est pourquoi la révolution, à son tour, engendre des structures qui ne feront pas nécessairement l’unanimité ; la révolte, la réforme et peut-être la révolution ou la contre-révolution existent, au moins virtuellement, dans la société révolutionnée. L’Asie du sud-est est une aire géographique, culturelle et politique beaucoup trop vaste pour que ce volume ait la prétention de la "couvrir". Les travaux rassemblés ici sont une première tentative d’exposer des études de cas sans prétention de théoriser. S’ils en appellent d’autres, ce livre aura prouvé son intérêt