29 research outputs found
Paysages gravés du Haut-Atlas marocain, ethnoarchéologie de l’agdal
Les paysages gravés du Haut-Atlas sont des alpages situés au-delà de 2000 mètres d’altitude. Depuis plus de quatre millénaires, une relation étroite entre gravures rupestres et transhumance est observée. L’analyse des documents gravés et des données archéologiques nous permet de caractériser cinq grandes séquences thématiques, qui se succèdent depuis le Néolithique final jusqu’à aujourd’hui. Les alpages de l’Atlas montrent aussi la continuité d’une pratique communautaire originale -l’agdal- qui exprime les valeurs cardinales de la société pastorale amazighe. Dans ces hauts lieux, le partage des ressources repose sur de nombreux rites et croyances, mis en scène dans l’art rupestre. Ainsi se dessine le contour de paysages culturels remarquables, dont la mise en patrimoine devient, aujourd’hui, urgente pour assurer leur préservation et protection
Combined Thoracic Ultrasound Assessment during a Successful Weaning Trial Predicts Postextubation Distress
International audienceBackground: Recent studies suggest that isolated sonographic assessment of the respiratory, cardiac, or neuromuscular functions in mechanically ventilated patients may assist in identifying patients at risk of postextubation distress. The aim of the present study was to prospectively investigate the value of an integrated thoracic ultrasound evaluation, encompassing bedside respiratory, cardiac, and diaphragm sonographic data in predicting postextubation distress.Methods: Longitudinal ultrasound data from 136 patients who were extubated after passing a trial of pressure support ventilation were measured immediately after the start and at the end of this trial. In case of postextubation distress (31 of 136 patients), an additional combined ultrasound assessment was performed while the patient was still in acute respiratory failure. We applied machine-learning methods to improve the accuracy of the related predictive assessments.Results: Overall, integrated thoracic ultrasound models accurately predict postextubation distress when applied to thoracic ultrasound data immediately recorded before the start and at the end of the trial of pressure support ventilation (learning sample area under the curve: start, 0.921; end, 0.951; test sample area under the curve: start, 0.972; end, 0.920). Among integrated thoracic ultrasound data, the recognition of lung interstitial edema and the increased telediastolic left ventricular pressure were the most relevant predictive factors. In addition, the use of thoracic ultrasound appeared to be highly accurate in identifying the causes of postextubation distress.Conclusions: The decision to attempt extubation could be significantly assisted by an integrative, dynamic, and fully bedside ultrasonographic assessment of cardiac, lung, and diaphragm functio
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