Rheumatic Complete Atrioventricular Block: A Case Report

Acute rheumatic fever is a well-known disease that is still widely observed in developing countries, including our country Morocco. It is known that the majority of patients diagnosed with acute rheumatic fever display abnormalities of the conduction system; However, there are only a few case reports that describe severe impairment in the electrical conduction system. We describe a 21-year-old man who was diagnosed with acute rheumatic fever with complete atrioventricular block. In our patient, the diagnosis of acute rheumatic fever was established. 24-hour electrocardiography showed a paroxistic complete atrioventricular block. Penicillin prophylaxis was made, and salicylate treatment in an anti-inflammatory dose was initiated. The electrocardiographic abnormalities of the patient disappeared. Although rare, this diagnosis should be considered in patients with complete heart block, particularly when it is associated with other features of acute rheumatic fever. Conduction disorders associated with acute rheumatic fever often resolve following appropriate treatment without the need for permanent pacemaker placement

Relation structure/ facteur acentrique d'alcools et de phénols: approche algorithme génétique – régression linéaire multiple

Les facteurs acentriques de 18 composés hydroxylés (alcools, phénols), ont été corrélés linéairement avec 2 descripteurs moléculaires de type géométrique sélectionnés par algorithme génétique, parmi plus de 1600 calculés en utilisant le logiciel de modélisation moléculaire DRAGON. Les différentes statistiques établies (coefficient de détermination multiple et de prédiction ; racines des erreurs quadratiques moyennes ; test de randomisation) montrent la qualité, la robustesse et les bonnes capacités prédictives internes du modèle construit. Aucune observation aberrante ou influente n’a été relevée.Mots clés: Alcools et phénols – Représentation numérique de la structure chimique – Facteur acentrique – Régression linéaire multiple – Modèle RSP hybrideEnglish Title: Structure / acentric factor relationship of alcohols and phenols: genetic algorithm – multiple linear regression approachEnglish AbstractThe acentric factors of 18 hydroxy compounds (alcohols, phenols) were linearly correlated with 2 molecular descriptors of geometrical type selected by genetic algorithm, among more than 1600 derived from the molecular modeling software DRAGON. The different statistics calculated (multiple determination and prediction coefficients; roots of the mean quadratic errors; Y-scrambling) show the quality, the robustness and the good internal predictive capacity of the constructed model. No outliers or influential observation was found.Keywords: Alcohols and phenols – Numerical representation of chemical structure – Acentric factor – Multiple linear regression – Hybrid SPR mode

FLASH-RL: Federated Learning Addressing System and Static Heterogeneity using Reinforcement Learning

Federated Learning (FL) has emerged as a promising Machine Learning paradigm, enabling multiple users to collaboratively train a shared model while preserving their local data. To minimize computing and communication costs associated with parameter transfer, it is common practice in FL to select a subset of clients in each training round. This selection must consider both system and static heterogeneity. Therefore, we propose FLASH-RL, a framework that utilizes Double Deep QLearning (DDQL) to address both system and static heterogeneity in FL. FLASH-RL introduces a new reputation-based utility function to evaluate client contributions based on their current and past performances. Additionally, an adapted DDQL algorithm is proposed to expedite the learning process. Experimental results on MNIST and CIFAR-10 datasets have shown FLASH-RL's effectiveness in achieving a balanced trade-off between model performance and end-to-end latency against existing solutions. Indeed, FLASH-RL reduces latency by up to 24.83% compared to FedAVG and 24.67% compared to FAVOR. It also reduces the training rounds by up to 60.44% compared to FedAVG and +76% compared to FAVOR. In fall detection using the MobiAct dataset, FLASH-RL outperforms FedAVG by up to 2.82% in model's performance and reduces latency by up to 34.75%. Additionally, FLASH-RL achieves the target performance faster, with up to a 45.32% reduction in training rounds compared to FedAVG.Comment: Accepted in the 41st IEEE International Conference on Computer Design (ICCD 2023

Mineral fruit composition variation alongside Phoenix dactylifera L. cultivars dependently on geographical origin and agronomic traits.

Date palm gives fruits that make a significant human dietetic through great amounts of different sugars supplement and of minerals. Water, ash and six minerals contents were investigated in dates of 131 individual trees. The geographical effect in mineral content was carried out on tow cultivars, Deglet nour and Alig. New oases of Jerid region, compared to other origins, gave date of Deglet nour with the highest levels of the studied parameters except for the ash and the Calcium contents which were stable between oases. However, old oasis of Jerid region had fruit Alig with the upper levels in phosphorus (0.1 g/100g), sodium (54.76 ppm), magnesium (0.05 g/100g) and iron (0.77 mg/100g); but the lowest in total mineral content (1.75 g/100g) and manganese (0.14 mg/100g). The effect of agronomic traits (maturity period and fruit consistency) was studied basing on 38 different cultivars. Concerning the maturity period, fruits of early ripening cultivars exhibited an elevated concentration in iron (0.87 mg/100g) and calcium (0.024 g/100g) in comparison with those of later maturity cultivars which had the highest ash percent (1.59 g/100g). For the fruit consistency, soft fruits showed the greater Iron content (0.84 mg/100g) but the dry ones exhibited the highest potassium content (0.57 g/100g). These results proposed to consumers that they have to consider the provenance, the fruit consistency and the maturity period which looks as a good indicator for mineral content

Stakeholder perspectives on intensive support teams for adults with intellectual disabilities who display behaviour that challenges in England

BACKGROUND: Adults with intellectual disabilities often display behaviour that challenges that is a result of biological differences, psychological challenges, and lack of appropriate social support. Intensive Support Teams (IST) are recommended to support the care needs of this group and avoid hospitalisation. However, little attention has been paid to the perspectives of stakeholders who manage, work in, or use ISTs. METHOD: Interviews and focus groups were conducted with 50 stakeholders (IST service managers and professionals, adults with intellectual disabilities, and family and paid carers) of ISTs. Services operated according to one of two service models previously identified in ISTs in England (enhanced or independent). RESULTS: Thematic analysis identified accessible and flexible support, individualised care, and the involvement of carers and other relevant agencies in management plans and reviews as features of good IST care highlighted by all stakeholder groups. IST managers and professionals described the key challenges of current IST provision as unclear referral criteria, limited interfaces with other local services, and perceived threats associated with funding and staff retention. Findings were similar between the two IST models. CONCLUSIONS: ISTs are able to offer care and specialist support that is valued by families, service users and other care providers. However, they face several operational challenges that should be addressed if ISTs are to reach their potential along with community intellectual disability services in supporting adults with intellectual disabilities who display behaviour that challenges in the community

Evaluating specialist intensive support teams for adults with intellectual disabilities who display behaviours that challenge: The IST-ID mixed methods study

Background Intensive Support Teams (ISTs) are recommended for individuals with intellectual disabilities who display behaviours that challenge. However, there is currently little evidence about the clinical and cost effectiveness of IST models operating in England. Aims To investigate the clinical and cost effectiveness of IST models. Methods We carried out a cohort study to evaluate the clinical and cost-effectiveness of two previously identified IST models (independent and enhanced) in England. Adult participants (n=226) from 21 ISTs (10 independent and 11 enhanced) were enrolled. The primary outcome was change in challenging behaviour between baseline and 9 months measured by the Aberrant Behaviour Checklist-Community 2. Results We found no statistically significant differences between models for the primary outcome (adjusted β: 4.27; 95% CI: -6.34 to 14.87; p=0.430) or any secondary outcomes. Quality Adjusted Life Years (0.0158; 95% CI: -0.0088 to 0.0508) and costs (£3409.95; 95% CI: -£9957.92 to £4039.89) of the two models were comparable. Conclusions The study provides evidence that both models were associated with clinical improvement for similar costs at follow-up. We recommend that the choice of service model should rest with local services. Further research should investigate the critical components of IST care to inform the development of fidelity criteria, and policy makers should consider whether roll out of such teams should be mandated. Study registration number ClinicalTrials.gov NCT03586375 ; IRAS 239820; National Institute for Health Research (NIHR) Central Portfolio Management System (CPMS) 38554

Clinical and cost evaluation of two models of specialist intensive support teams for adults with intellectual disabilities who display behaviours that challenge: the IST-ID mixed-methods study

Background: Intensive support teams (ISTs) are recommended for individuals with intellectual disabilities who display behaviours that challenge. However, there is currently little evidence about the clinical and cost-effectiveness of IST models operating in England.// Aims: To investigate the clinical and cost-effectiveness of IST models.// Method: We carried out a cohort study to evaluate the clinical and cost-effectiveness of two previously identified IST models (independent and enhanced) in England. Adult participants (n = 226) from 21 ISTs (ten independent and 11 enhanced) were enrolled. The primary outcome was change in challenging behaviour between baseline and 9 months as measured by the Aberrant Behaviour Checklist-Community version 2.// Results: We found no statistically significant differences between models for the primary outcome (adjusted β = 4.27; 95% CI −6.34 to 14.87; P = 0.430) or any secondary outcomes. Quality-adjusted life-years (0.0158; 95% CI: −0.0088 to 0.0508) and costs (£3409.95; 95% CI −£9957.92 to £4039.89) of the two models were comparable. Conclusions The study provides evidence that both models were associated with clinical improvement for similar costs at follow-up. We recommend that the choice of service model should rest with local services. Further research should investigate the critical components of IST care to inform the development of fidelity criteria, and policy makers should consider whether roll out of such teams should be mandated

Stakeholder perspectives on intensive support teams for adults with intellectual disabilities who display behaviour that challenges in England

Background Adults with intellectual disabilities often display behaviour that challenges that is a result of biological differences, psychological challenges, and lack of appropriate social support. Intensive Support Teams (IST) are recommended to support the care needs of this group and avoid hospitalisation. However, little attention has been paid to the perspectives of stakeholders who manage, work in, or use ISTs. Method Interviews and focus groups were conducted with 50 stakeholders (IST service managers and professionals, adults with intellectual disabilities, and family and paid carers) of ISTs. Services operated according to one of two service models previously identified in ISTs in England (enhanced or independent). Results Thematic analysis identified accessible and flexible support, individualised care, and the involvement of carers and other relevant agencies in management plans and reviews as features of good IST care highlighted by all stakeholder groups. IST managers and professionals described the key challenges of current IST provision as unclear referral criteria, limited interfaces with other local services, and perceived threats associated with funding and staff retention. Findings were similar between the two IST models. Conclusions ISTs are able to offer care and specialist support that is valued by families, service users and other care providers. However, they face several operational challenges that should be addressed if ISTs are to reach their potential along with community intellectual disability services in supporting adults with intellectual disabilities who display behaviour that challenges in the community

Stakeholder views on the barriers and facilitators of psychosocial interventions to address reduction in aggressive challenging behaviour in adults with intellectual disabilities [version 2; peer review: 2 approved]

Background Success of psychosocial interventions in reducing aggressive challenging behaviour is likely to be related not only to mechanistic aspects but also to therapeutic and system factors. The study aims to examine the facilitators and barriers that influence whether psychosocial interventions for aggressive challenging behaviour in adults with intellectual disabilities lead to positive change. We conducted 42 semi-structured interviews with adults with intellectual disabilities who display aggressive challenging behaviour, family/paid carers, and professionals engaged in or delivering a psychosocial intervention across the UK. Data were analysed thematically using a framework approach. Stakeholders considered therapeutic and supportive relationships and personalised care as facilitating factors in addressing aggressive challenging behaviour. The operational structure of community intellectual disability services and conflicting expectations of professionals and carers were the main contextual barriers that impeded the implementation of psychosocial interventions in adults with intellectual disabilities. Findings highlight the valued components that maximise positive change in adults with intellectual disabilities who display aggressive challenging behaviour. Several operational adjustments including referral criteria, roles of professionals and workforce issues need to be addressed in services to maximise the implementation of psychosocial interventions leading to reduction in aggressive challenging behaviour in this population

Clinical and cost evaluation of two models of specialist intensive support teams for adults with intellectual disabilities who display behaviours that challenge: the IST-ID mixed-methods study

Background Intensive support teams (ISTs) are recommended for individuals with intellectual disabilities who display behaviours that challenge. However, there is currently little evidence about the clinical and cost-effectiveness of IST models operating in England. Aims To investigate the clinical and cost-effectiveness of IST models. Method We carried out a cohort study to evaluate the clinical and cost-effectiveness of two previously identified IST models (independent and enhanced) in England. Adult participants (n = 226) from 21 ISTs (ten independent and 11 enhanced) were enrolled. The primary outcome was change in challenging behaviour between baseline and 9 months as measured by the Aberrant Behaviour Checklist-Community version 2. Results We found no statistically significant differences between models for the primary outcome (adjusted β = 4.27; 95% CI −6.34 to 14.87; P = 0.430) or any secondary outcomes. Quality-adjusted life-years (0.0158; 95% CI: −0.0088 to 0.0508) and costs (£3409.95; 95% CI −£9957.92 to £4039.89) of the two models were comparable. Conclusions The study provides evidence that both models were associated with clinical improvement for similar costs at follow-up. We recommend that the choice of service model should rest with local services. Further research should investigate the critical components of IST care to inform the development of fidelity criteria, and policy makers should consider whether roll out of such teams should be mandated