Classification des potentiels évoqués par corrélation de Pearson dans une interface cerveau-ordinateur

National audienceDans cette communication, nous décrivons et évaluons les performances d'une technique d'apprentissage des coefficients d'un classifieur linéaire utilisé dans une interface cerveau-ordinateur. Les signaux de l'électroencéphalogramme d'un individu sont analysés au moyen de cette technique afin de mettre en évidence les réponses de ce dernier à des stimuli visuels. Le traitement et la classification des signaux sont utilisés afin d'implanter un système de communication palliative permettant à l'individu d'épeler des mots. Les performances de la méthode de classification ont été évaluées par une expérimentation sur huit personnes

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Crop Updates 2009 - Farming Systems

This session covers nineteen papers from different authors: Decision support technology 1. The use of high resolution imagery in broad acre cropping, Derk Bakker and Grey Poulish, Department of Agriculture and Food 2. Spraywise decisions – online spray applicatiors planning tool, Steve Lacy, Nufarm Australia Ltd 3. Testing for redlegged earthmite resistance in Western Australia, Svetlana Micic, Peter Mangano, Tony Dore and Alan Lord, Department of Agriculture and Food 4. Screening cereal, canola and pasture cultivars for Root Lesion Nematode (Pratylenchus neglectus), Vivien Vanstone, Helen Hunter and Sean Kelly,Department of Agriculture and Food Farming Systems Research 5. Lessons from five years of cropping systems research, WK Anderson, Department of Agriculture and Food 6. Facey Group rotations for profit: Five years on and where to next? Gary Lang and David McCarthy, Facey Group, Wickepin, WA Mixed Farming 7. Saline groundwater use by Lucerne and its biomass production in relation to groundwater salinity, Ruhi Ferdowsian, Ian Roseand Andrew Van Burgel, Department of Agriculture and Food 8. Autumn cleaning yellow serradella pastures with broad spectrum herbicides – a novel weed control strategy that exploits delayed germination, Dr David Ferris, Department of Agriculture and Food 9. Decimating weed seed banks within non-crop phases for the benefit of subsequent crops, Dr David Ferris, Department of Agriculture and Food 10. Making seasonal variability easier to deal with in a mixed farming enterprise! Rob Grima,Department of Agriculture and Food 11. How widely have new annual legume pastures been adopted in the low to medium rainfall zones of Western Australia? Natalie Hogg, Department of Agriculture and Food, John Davis, Institute for Sustainability and Technology Policy, Murdoch University 12. Economic evaluation of dual purpose cereal in the Central wheatbelt of Western Australia, Jarrad Martin, Pippa Michael and Robert Belford, School of Agriculture and Environment, CurtinUniversity of Technology, Muresk Campus 13. A system for improving the fit of annual pasture legumes under Western Australian farming systems, Kawsar P Salam1,2, Roy Murray-Prior1, David Bowran2and Moin U. Salam2, 1Curtin University of Technology; 2Department of Agriculture and Food 14. Perception versus reality: why we should measure our pasture, Tim Scanlon, Department of Agriculture and Food, Len Wade, Charles Sturt University, Megan Ryan, University of Western Australia Modelling 15. Potential impact of climate changes on the profitability of cropping systems in the medium and high rainfall areas of the northern wheatbelt, Megan Abrahams, Chad Reynolds, Caroline Peek, Dennis van Gool, Kari-Lee Falconer and Daniel Gardiner, Department of Agriculture and Food 16. Prediction of wheat grain yield using Yield Prophet®, Geoff Anderson and Siva Sivapalan, Department of Agriculture and Food 17. Using Yield Prophet® to determine the likely impacts of climate change on wheat production, Tim McClelland1, James Hunt1, Zvi Hochman2, Bill Long3, Dean Holzworth4, Anthony Whitbread5, Stephen van Rees1and Peter DeVoil6 1 Birchip Cropping Group, Birchip, Vic, 2Agricultural Production Systems Research Unit (APSRU), CSIRO Sustainable Ecosystems, Climate Adaptation Flagship, Qld, 3 AgConsulting, SA 4 Agricultural Production Systems Research Unit (APSRU), CSIRO Sustainable Ecosystems, Toowoomba Qld, 5 CSIRO Sustainable Ecosystems, SA, 6 Agricultural Production Systems Research Unit (APSRU), Department of Agriculture and Fisheries, Queensland 18. Simple methods to predict yield potential: Improvements to the French and Schultz formula to account for soil type and within-season rainfall, Yvette Oliver, Michael Robertson and Peter Stone, CSIRO Sustainable Ecosystems 19. Ability of various yield forecasting models to estimate soil water at the start of the growing season, Siva Sivapalan, Kari-Lee Falconer and Geoff Anderson, Department of Agriculture and Foo

The challenge of unprecedented floods and droughts in risk management

Risk management has reduced vulnerability to floods and droughts globally1,2, yet their impacts are still increasing3. An improved understanding of the causes of changing impacts is therefore needed, but has been hampered by a lack of empirical data4,5. On the basis of a global dataset of 45 pairs of events that occurred within the same area, we show that risk management generally reduces the impacts of floods and droughts but faces difficulties in reducing the impacts of unprecedented events of a magnitude not previously experienced. If the second event was much more hazardous than the first, its impact was almost always higher. This is because management was not designed to deal with such extreme events: for example, they exceeded the design levels of levees and reservoirs. In two success stories, the impact of the second, more hazardous, event was lower, as a result of improved risk management governance and high investment in integrated management. The observed difficulty of managing unprecedented events is alarming, given that more extreme hydrological events are projected owing to climate change3

Panta Rhei benchmark dataset: socio-hydrological data of paired events of floods and droughts

As the adverse impacts of hydrological extremes increase in many regions of the world, a better understanding of the drivers of changes in risk and impacts is essential for effective flood and drought risk management and climate adaptation. However, there is currently a lack of comprehensive, empirical data about the processes, interactions and feedbacks in complex human-water systems leading to flood and drought impacts. Here we present a benchmark dataset containing socio-hydrological data of paired events, i.e., two floods or two droughts that occurred in the same area. The 45 paired events occurred in 42 different study areas and cover a wide range of socio-economic and hydro-climatic conditions. The dataset is unique in covering both floods and droughts, in the number of cases assessed, and in the quantity of socio-hydrological data. The benchmark dataset comprises: 1) detailed review style reports about the events and key processes between the two events of a pair; 2) the key data table containing variables that assess the indicators which characterise management shortcomings, hazard, exposure, vulnerability and impacts of all events; 3) a table of the indicators-of-change that indicate the differences between the first and second event of a pair. The advantages of the dataset are that it enables comparative analyses across all the paired events based on the indicators-of-change and allows for detailed context- and location-specific assessments based on the extensive data and reports of the individual study areas. The dataset can be used by the scientific community for exploratory data analyses e.g. focused on causal links between risk management, changes in hazard, exposure and vulnerability and flood or drought impacts. The data can also be used for the development, calibration and validation of socio-hydrological models. The dataset is available to the public through the GFZ Data Services (Kreibich et al. 2023, link for review: https://dataservices.gfz-potsdam.de/panmetaworks/review/923c14519deb04f83815ce108b48dd2581d57b90ce069bec9c948361028b8c85/).</p

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Sleep and circadian rhythm disturbances following traumatic brain injury: the treatment and efficacy of melatonin supplementation

Traumatic brain injury (TBI) is a leading cause of ongoing disability in young and old people worldwide. Improvements in the acute management of TBI have resulted in a reduction in mortality rates, and this has led to a growth in the population of TBI patients. Although a large majority of TBI patients generally make a good physical recovery, outcome studies indicate that sleep disturbance is a common problem, with over 50% of those with moderate-to-severe TBI exhibiting difficulties years post injury. Disrupted sleep can often go untreated, impacting quality of life, contributing to ongoing cognitive dysfunction, as well as impeding rehabilitation and return to pre-injury activities. Evidence-based treatments are lacking, partly due to poor understanding of the pathophysiological mechanisms underpinning sleep disturbances following TBI. As such, this thesis aimed to: 1) Elucidate and characterise the objective and subjective sleep complaints following TBI relative to healthy controls, 2) Understand the roles of melatonin and circadian rhythms in the development of sleep disturbances and 3) Investigate the clinical efficacy and safety of melatonin supplementation to alleviate sleep disturbances following TBI. By way of a systematic literature search and meta-analysis, the current thesis examined objective and subjective sleep complaints in patients with TBI compared to healthy controls. This meta-analysis found that individuals with TBI experienced objectively shorter total sleep durations, increased wake after sleep onset and poorer sleep efficiency. Furthermore people with TBI reported greater subjective sleepiness and poorer perceived sleep quality. To investigate potential pathophysiological mechanisms underpinning sleep disturbances in individuals with TBI diagnosed with chronic insomnia, this thesis compared overnight salivary melatonin concentrations in patients with TBI with those of age- and gender-matched controls. This study found that overnight salivary melatonin concentrations were reduced by 42% in patients with TBI relative to controls. Furthermore, the timing of melatonin was delayed in patients with TBI and delayed melatonin onset was associated with poorer subjective sleep quality. In light of these findings, the current thesis examined the efficacy of exogenous melatonin supplementation in alleviating sleep disturbances in TBI patients diagnosed with chronic insomnia. By conducting a randomised, placebo-controlled, crossover clinical trial, the current thesis demonstrated that four weeks of melatonin supplementation significantly improved sleep quality and sleep efficiency as measured by the Pittsburgh sleep quality index and actigraphy, respectively. Additionally, a trend suggested that melatonin supplementation reduced actigraphic sleep onset latency. No improvements in daytime sleepiness were observed following melatonin supplementation. The findings of the current thesis are pertinent to the treatment and management of sleep complaints in individuals exhibiting sleep problems following TBI. Firstly, the current thesis corroborates subjective sleep complaints with objective measures of sleep quality. Secondly, the thesis suggests that reduced melatonin production and circadian misalignment may contribute to sleep disturbances in patients with TBI diagnosed with chronic insomnia. Finally, the current thesis provides evidence- to support the use of melatonin supplementation in alleviating chronic insomnia symptomatology following TBI