91 research outputs found
Dynamics of meromorphic maps with small topological degree I: from cohomology to currents
We consider the dynamics of a meromorphic map on a compact kahler surface
whose topological degree is smaller than its first dynamical degree. The latter
quantity is the exponential rate at which its iterates expand the cohomology
class of a kahler form. Our goal in this article and its sequels is to carry
out a conjectural program for constructing and analyzing a natural measure of
maximal entropy for each such map. Here we take the first step, converting
information about the linear action of the map on cohomology to invariant
currents with special geometric structure. We also give some examples and
identify some additional properties of maps on irrational surfaces and of maps
whose invariant cohomology classes have vanishing self-intersection.Comment: Final version, to appear in Indiana University Mathematics Journal.
Among other changes, discussion of polynomial maps is improve
Dynamics of meromorphic maps with small topological degree III: geometric currents and ergodic theory
We continue our study of the dynamics of mappings with small topological
degree on (projective) complex surfaces. Previously, under mild hypotheses, we
have constructed an ergodic ``equilibrium'' measure for each such mapping. Here
we study the dynamical properties of this measure in detail: we give optimal
bounds for its Lyapunov exponents, prove that it has maximal entropy, and show
that it has product structure in the natural extension. Under a natural further
assumption, we show that saddle points are equidistributed towards this
measure. This generalize results that were known in the invertible case and is,
to our knowledge, one among not very many instances in which a natural
invariant measure for a non-invertible dynamical system is well-understood.Comment: v3. Exposition improved. Final version, to appear in Ann. Scient. de
l'EN
Presentations of children to emergency departments across Europe and the COVID-19 pandemic: A multinational observational study
During the initial phase of the Coronavirus Disease 2019 (COVID-19) pandemic, reduced numbers of acutely ill or injured children presented to emergency departments (EDs). Concerns were raised about the potential for delayed and more severe presentations and an increase in diagnoses such as diabetic ketoacidosis and mental health issues. This multinational observational study aimed to study the number of children presenting to EDs across Europe during the early COVID-19 pandemic and factors influencing this and to investigate changes in severity of illness and diagnoses. Routine health data were extracted retrospectively from electronic patient records of children aged 18 years and under, presenting to 38 EDs in 16 European countries for the period January 2018 to May 2020, using predefined and standardized data domains. Observed and predicted numbers of ED attendances were calculated for the period February 2020 to May 2020. Poisson models and incidence rate ratios (IRRs), using predicted counts for each site as offset to adjust for case-mix differences, were used to compare age groups, diagnoses, and outcomes. Reductions in pediatric ED attendances, hospital admissions, and high triage urgencies were seen in all participating sites. ED attendances were relatively higher in countries with lower SARS-CoV-2 prevalence (IRR 2·26, 95% CI 1·90 to 2·70, p < 0.001) and in children aged <12 months (12 to <24 months IRR 0·86, 95% CI 0·84 to 0·89; 2 to <5 years IRR 0·80, 95% CI 0·78 to 0·82; 5 to <12 years IRR 0·68, 95% CI 0·67 to 0·70; 12 to 18 years IRR 0·72, 95% CI 0·70 to 0·74; versus age <12 months as reference group, p < 0.001). The lowering of pediatric intensive care admissions was not as great as that of general admissions (IRR 1·30, 95% CI 1·16 to 1·45, p < 0.001). Lower triage urgencies were reduced more than higher triage urgencies (urgent triage IRR 1·10, 95% CI 1·08 to 1·12; emergent and very urgent triage IRR 1·53, 95% CI 1·49 to 1·57; versus nonurgent triage category, p < 0.001). Reductions were highest and sustained throughout the study period for children with communicable infectious diseases. The main limitation was the retrospective nature of the study, using routine clinical data from a wide range of European hospitals and health systems. Reductions in ED attendances were seen across Europe during the first COVID-19 lockdown period. More severely ill children continued to attend hospital more frequently compared to those with minor injuries and illnesses, although absolute numbers fell. ISRCTN91495258 https://www.isrctn.com/ISRCTN91495258
Vaccine breakthrough hypoxemic COVID-19 pneumonia in patients with auto-Abs neutralizing type I IFNs
Life-threatening `breakthrough' cases of critical COVID-19 are attributed to poor or waning antibody response to the SARS- CoV-2 vaccine in individuals already at risk. Pre-existing autoantibodies (auto-Abs) neutralizing type I IFNs underlie at least 15% of critical COVID-19 pneumonia cases in unvaccinated individuals; however, their contribution to hypoxemic breakthrough cases in vaccinated people remains unknown. Here, we studied a cohort of 48 individuals ( age 20-86 years) who received 2 doses of an mRNA vaccine and developed a breakthrough infection with hypoxemic COVID-19 pneumonia 2 weeks to 4 months later. Antibody levels to the vaccine, neutralization of the virus, and auto- Abs to type I IFNs were measured in the plasma. Forty-two individuals had no known deficiency of B cell immunity and a normal antibody response to the vaccine. Among them, ten (24%) had auto-Abs neutralizing type I IFNs (aged 43-86 years). Eight of these ten patients had auto-Abs neutralizing both IFN-a2 and IFN-., while two neutralized IFN-omega only. No patient neutralized IFN-ss. Seven neutralized 10 ng/mL of type I IFNs, and three 100 pg/mL only. Seven patients neutralized SARS-CoV-2 D614G and the Delta variant (B.1.617.2) efficiently, while one patient neutralized Delta slightly less efficiently. Two of the three patients neutralizing only 100 pg/mL of type I IFNs neutralized both D61G and Delta less efficiently. Despite two mRNA vaccine inoculations and the presence of circulating antibodies capable of neutralizing SARS-CoV-2, auto-Abs neutralizing type I IFNs may underlie a significant proportion of hypoxemic COVID-19 pneumonia cases, highlighting the importance of this particularly vulnerable population
COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study
Background:
The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms.
Methods:
International, prospective observational study of 60â109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms.
Results:
âTypicalâ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (â€â18 years: 69, 48, 23; 85%), older adults (â„â70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each Pâ<â0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country.
Interpretation:
This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men
Risk of serious treatable neurological emergencies in children with febrile seizure : an example of use of electronical medical records in the purpose of clinical research
Entre 2 et 5% des enfants de 6 mois Ă 5 ans prĂ©sentent au moins un Ă©pisode de Crise dâĂpilepsie en contexte FĂ©brile (CEF). Bien que gĂ©nĂ©ralement bĂ©nignes, ces crises sont associĂ©es Ă un risque dâurgences neurologiques graves et curables dont lâĂ©limination requiert la rĂ©alisation dâexamens complĂ©mentaires douloureux et/ou irradiants. Actuellement, ce risque est Ă©valuĂ© en fonction de trois facteurs : lâĂąge de lâenfant, le caractĂšre simple ou complexe de la crise, et lâexamen clinique.Cette thĂšse avait pour objectif de tester lâhypothĂšse que parmi les enfants consultant pour une CEF, seuls ceux avec un examen clinique anormal prĂ©sentent un risque dâurgence neurologique grave et urgent. Pour ce faire, nous avons crĂ©Ă© un outil informatique permettant une recherche exhaustive de cas parmi un million de dossiers mĂ©dicaux informatisĂ©s dans sept services dâurgences pĂ©diatriques entre 2007 et 2011. Nous avons alors identifiĂ© : les visites dâenfants prĂ©sentant une CEF. Nous avons ensuite Ă©valuĂ© le risque dâurgence neurologique grave et curable associĂ© Ă ces visites, notamment lorsque lâexamen clinique au dĂ©cours Ă©tait normal. Nous nâavons retrouvĂ© aucune urgence neurologique grave et curable parmi les enfants consultant pour une CEF avec un examen clinique normal au dĂ©cours, quels que soient lâĂąge et les caractĂ©ristiques de la crise. Ce travail de thĂšse associĂ© aux donnĂ©es de la littĂ©rature confirme notre hypothĂšse et souligne la nĂ©cessitĂ© de recommandations quant Ă la prise en charge de ces enfants. Enfin, cette thĂšse constitue lâoccasion de mener une rĂ©flexion mĂ©thodologique quant Ă lâutilisation de dossiers mĂ©dicaux informatisĂ©s pour la recherche clinique.Febrile seizures (FS) affect 2% to 5% of children aged 6 months to 5 years of age. Although FS are usually benign, they are associated with serious treatable neurological emergencies. Nowadays, three factors are used to evaluate this risk: the age of the child, whether the FS is simple or complex and the features of the clinical exam. The performance of a lumbar puncture and an emergent neuroimaging are required in order to rule out these emergencies. However, a lumbar puncture is painful and neuroimaging is irradiant. The objective of this thesis was to investigate the hypothesis that among children experiencing a FS, only those with an abnormal clinical exam are at risk of serious, treatable neurological emergencies. We first created an informatics tool in order to exhaustively search for cases among more than one million electronic medical records from seven pediatric emergency departments (PED) between 2007 and 2011. Then, we identified visits of children with a FS. Finally, we evaluated the proportion of serious, treatable neurological emergencies associated with these visits, and more specifically with visits of children with a normal clinical exam.We found no serious treatable neurological emergencies among children visiting the ED for a FS with a normal clinical exam, whatever the age and the features of the seizure were. The studies described in this thesis associated with the available data in the literature support our hypothesis and highlight the need of guidelines regarding the management of these children. Finally, this thesis gives us the opportunity to discuss some considerations on the use of electronic medical records for clinical research
Risque d'urgence neurologique grave et curable parmi les enfants présentant une crise d'épilepsie en contexte fébrile : un exemple d'utilisation des dossiers médicaux informatisés des urgences pour la recherche clinique
Febrile seizures (FS) affect 2% to 5% of children aged 6 months to 5 years of age. Although FS are usually benign, they are associated with serious treatable neurological emergencies. Nowadays, three factors are used to evaluate this risk: the age of the child, whether the FS is simple or complex and the features of the clinical exam. The performance of a lumbar puncture and an emergent neuroimaging are required in order to rule out these emergencies. However, a lumbar puncture is painful and neuroimaging is irradiant. The objective of this thesis was to investigate the hypothesis that among children experiencing a FS, only those with an abnormal clinical exam are at risk of serious, treatable neurological emergencies. We first created an informatics tool in order to exhaustively search for cases among more than one million electronic medical records from seven pediatric emergency departments (PED) between 2007 and 2011. Then, we identified visits of children with a FS. Finally, we evaluated the proportion of serious, treatable neurological emergencies associated with these visits, and more specifically with visits of children with a normal clinical exam.We found no serious treatable neurological emergencies among children visiting the ED for a FS with a normal clinical exam, whatever the age and the features of the seizure were. The studies described in this thesis associated with the available data in the literature support our hypothesis and highlight the need of guidelines regarding the management of these children. Finally, this thesis gives us the opportunity to discuss some considerations on the use of electronic medical records for clinical research.Entre 2 et 5% des enfants de 6 mois Ă 5 ans prĂ©sentent au moins un Ă©pisode de Crise dâĂpilepsie en contexte FĂ©brile (CEF). Bien que gĂ©nĂ©ralement bĂ©nignes, ces crises sont associĂ©es Ă un risque dâurgences neurologiques graves et curables dont lâĂ©limination requiert la rĂ©alisation dâexamens complĂ©mentaires douloureux et/ou irradiants. Actuellement, ce risque est Ă©valuĂ© en fonction de trois facteurs : lâĂąge de lâenfant, le caractĂšre simple ou complexe de la crise, et lâexamen clinique.Cette thĂšse avait pour objectif de tester lâhypothĂšse que parmi les enfants consultant pour une CEF, seuls ceux avec un examen clinique anormal prĂ©sentent un risque dâurgence neurologique grave et urgent. Pour ce faire, nous avons crĂ©Ă© un outil informatique permettant une recherche exhaustive de cas parmi un million de dossiers mĂ©dicaux informatisĂ©s dans sept services dâurgences pĂ©diatriques entre 2007 et 2011. Nous avons alors identifiĂ© : les visites dâenfants prĂ©sentant une CEF. Nous avons ensuite Ă©valuĂ© le risque dâurgence neurologique grave et curable associĂ© Ă ces visites, notamment lorsque lâexamen clinique au dĂ©cours Ă©tait normal. Nous nâavons retrouvĂ© aucune urgence neurologique grave et curable parmi les enfants consultant pour une CEF avec un examen clinique normal au dĂ©cours, quels que soient lâĂąge et les caractĂ©ristiques de la crise. Ce travail de thĂšse associĂ© aux donnĂ©es de la littĂ©rature confirme notre hypothĂšse et souligne la nĂ©cessitĂ© de recommandations quant Ă la prise en charge de ces enfants. Enfin, cette thĂšse constitue lâoccasion de mener une rĂ©flexion mĂ©thodologique quant Ă lâutilisation de dossiers mĂ©dicaux informatisĂ©s pour la recherche clinique
Geometric properties of maximal psh functions
International audienc
Visite de non contre-indication Ă la pratique de la course Ă pied (pratique mĂ©dicale et avis des coureurs enquĂȘte rĂ©alisĂ©e au dĂ©part du marathon de Lyon 2005)
LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
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