1,076 research outputs found
DELIRIUM IN OLDER PATIENTS UNDERGOING AORTIC VALVE REPLACEMENT : INCIDENCE, PREDICTORS, AND COGNITIVE PROGNOSIS
Introduction :
Le remplacement de valve aortique par voie percutanĂ©e (Transcatheter Aortic Valve Replacement = TAVR) est une procĂ©dure de plus en plus effectuĂ©e chez des patients ĂągĂ©s fragiles jusque-lĂ inĂ©ligibles pour un remplacement chirurgical (Surgical Aortic Valve Replacement = SAVR). Les objectifs de cette Ă©tude sont de dĂ©terminer lâincidence dâĂ©tat confusionnel aprĂšs un remplacement de valve aortique, les facteurs prĂ©dictifs de cet Ă©tat confusionnel et lâimpact de ce dernier sur les performances cognitives Ă trois mois de lâintervention.
MĂ©thode :
Cette Ă©tude prospective a inclus les patients (N=93) de â„70 ans ayant un remplacement de valve aortique, percutanĂ© (TAVR, N=66) ou chirurgical (SAVR, N=27), dans un centre mĂ©dical universitaire. LâĂ©tat confusionnel Ă©tait Ă©valuĂ© au moyen de la Confusion Assessment Method (CAM) aux jours postopĂ©ratoires 1,2,3 et 7. Les donnĂ©es socio-dĂ©mographiques, fonctionnelles, y compris les activitĂ©s instrumentales de la vie quotidienne (Instrumental activities of daily living=IADL), et les scores de risques chirurgicaux, notamment celui des chirurgiens thoraciques (Society of Thoracic Surgeons risk score=STS score) ont Ă©tĂ© rĂ©coltĂ©s Ă lâinclusion. LâĂ©valuation cognitive du patient (avec le « Mini-Mental Status »=MMSE) a Ă©tĂ© faite Ă lâinclusion et au contrĂŽle Ă 3 mois postopĂ©ratoire.
RĂ©sultats :
Un Ă©tat confusionnel est survenu chez 21 patients (23%), pour la plupart (20/21 patients, 95%) dans les 3 premiers jours aprĂšs lâintervention. Lâincidence de lâĂ©tat confusionnel Ă©tait infĂ©rieure chez les TAVR (13/66=20%) que chez les SAVR (8/27=30%), mais non significatif du point de vue statistique (p=.298). Les patients avec un Ă©tat confusionnel avaient des performances cognitives de base plus basses (mĂ©diane MMSE score 27.0±3.0 vs 28.0±3.0, p=.029), des performances dans les IADL plus basses (7.0 vs 8.0, p=.038) et un score de risque STS plus Ă©levĂ© (4.7±2.7 vs 2.9±2.3, p=.020). En analyses multivariĂ©es, les patients avec des scores STS intermĂ©diaires (score>3 to â€8) et Ă©levĂ©s (score>8) avaient un risque plus Ă©levĂ©, respectivement de 4.3 (95%CI 1.2-15.1, p=.025) et de 16.5 (95%CI 2.0-138.2, p=.010), de dĂ©velopper un Ă©tat confusionnel par rapport aux patient avec un score STS bas (scoreâ€3). Au suivi Ă 3 mois (N=77), les patients ayant dĂ©veloppĂ© un Ă©tat confusionnel postopĂ©ratoire avaient toujours un score de MMSE plus bas (27.0±8.0 vs 28.0±2.0, p=.007), mais cette diffĂ©rence nâĂ©tait pas significative aprĂšs ajustement pour le MMSE au baseline (ÎČ-coefficient 1.11, 95%CI [-3.03-0.80], p=.248).
Conclusions :
Un Ă©tat confusionnel est survenu chez environ 1 patient ĂągĂ© sur 5 aprĂšs un remplacement de valve aortique, principalement dans les 3 premiers jours suivant lâintervention. En plus des performances cognitives, le score de risque STS peut permettre dâidentifier les patient Ă risque dâĂ©tat confusionnel afin quâils bĂ©nĂ©ficient de mesures de prĂ©vention ciblĂ©es
Distance exams : can targeted warnings discourage cheating?
During the COVID-19 sanitary crisis of 2020, many exams were hastily moved to online mode. This revived a much-needed debate on the privacy issues of online proctoring of exams, while the validity and fairness of unproctored exams were increasingly questioned. In a randomized control trial, we send a targeted warning to half of the students who were identified as cheaters in previous exams. We then compare their cheating behavior at the final exam to the group of unwarned cheaters. Preliminary results show that the warning proves effective but does not completely annihilates cheating as the cheating strategies of some students become more sophisticated. We conclude that switching traditional exams to online mode should come with proctoring. When proctoring is not possible, credible and effective anti-cheating technologies should be deployed, together with adequate warnings
GridNet with automatic shape prior registration for automatic MRI cardiac segmentation
In this paper, we propose a fully automatic MRI cardiac segmentation method
based on a novel deep convolutional neural network (CNN) designed for the 2017
ACDC MICCAI challenge. The novelty of our network comes with its embedded shape
prior and its loss function tailored to the cardiac anatomy. Our model includes
a cardiac centerof-mass regression module which allows for an automatic shape
prior registration. Also, since our method processes raw MR images without any
manual preprocessing and/or image cropping, our CNN learns both high-level
features (useful to distinguish the heart from other organs with a similar
shape) and low-level features (useful to get accurate segmentation results).
Those features are learned with a multi-resolution conv-deconv "grid"
architecture which can be seen as an extension of the U-Net. Experimental
results reveal that our method can segment the left and right ventricles as
well as the myocardium from a 3D MRI cardiac volume in 0.4 second with an
average Dice coefficient of 0.90 and an average Hausdorff distance of 10.4 mm.Comment: 8 pages, 1 tables, 2 figure
A new approach for continual planning
International audienceDevising intelligent robots or agents that interact with humans is a major challenge for artificial intelligence. In such contexts, agents must constantly adapt their decisions according to human activities and modify their goal. In this extended abstract, we present a novel continual planning approach, called Moving Goal Planning (MGP) to adapt plans to goal evolutions. This approach draws inspiration from Moving Target Search (MTS) algorithms. In order to limit the number of search iterations and to improve its efficiency, MGP delays as much as possible the start of new searches when the goal changes over time. To this purpose, MGP uses two strategies: Open Check (OC) that checks if the new goal is still in the current search tree and Plan Follow (PF) that estimates whether executing actions of the current plan brings MGP closer to the new goal
Planifier lorsque le but change. Une approche inspirée de la recherche de cible mouvante
National audienceIn this paper, we propose a novel planner, called Moving Goal Planner (MGP) in order to adapt plans when the goal changes over time. This planner draws inspiration from Moving Target Search (MTS) algorithms. In order to limit the number of search iterations and to improve its efficiency, MGP delays as much as possible starting new searches when the goal changes. To this purpose, MGP uses two strategies: Open Check (OC) that checks if the new goal is still in the current search tree and Plan Follow (PF) that estimates whether executing the actions of the current plan brings MGP closer to the new goal. Moreover, MGP uses a parsimonious strategy to adapt incrementally the search tree at each new search that reduces the number of calls to the heuristic function and speeds up the search. Finally, we show evaluation results that demonstrate the effectiveness of our approach.Dans cet article, nous proposons un nouvel algorithme de planification temps réel ap- pelé MGP (Moving Goal Planning) capable de s'adapter lorsque le but évolue dynamiquement au cours du temps. Cet algorithme s'inspire des algorithmes de type Moving Target Search (MTS). Afin de réduire le nombre de recherches effectuées et améliorer ses performances, MGP retarde autant que possible le déclenchement de nouvelles recherches lorsque que le but change. Pour cela, MGP s'appuie sur deux stratégies : Open Check (OC) qui vérifie si le nouveau but est présent dans l'arbre de recherche déjà construit lors d'une précédente recherche et Plan Follow (PF) qui estime s'il est préférable d'exécuter les actions du plan courant pour se rapprocher du nouveau but plutÎt que de relancer une nouvelle recherche. En outre, MGP utilise une stratégie "conservatrice" de mise à jour incrémentale de l'arbre de recherche lui permettant de réduire le nombre d'appels à la fonction heuristique et ainsi d'accélérer la recherche d'un plan solu- tion. Finalement, nous présentons des résultats expérimentaux qui montrent l'efficacité de notre approche
A new approach for continual planning
International audienceDevising intelligent robots or agents that interact with humans is a major challenge for artificial intelligence. In such contexts, agents must constantly adapt their decisions according to human activities and modify their goal. In this extended abstract, we present a novel continual planning approach, called Moving Goal Planning (MGP) to adapt plans to goal evolutions. This approach draws inspiration from Moving Target Search (MTS) algorithms. In order to limit the number of search iterations and to improve its efficiency, MGP delays as much as possible the start of new searches when the goal changes over time. To this purpose, MGP uses two strategies: Open Check (OC) that checks if the new goal is still in the current search tree and Plan Follow (PF) that estimates whether executing actions of the current plan brings MGP closer to the new goal
Les immigrants au Japon passés au crible commun du jus fusionis
Le Japon a longtemps pratiquĂ© des politiques explicites ou implicites de puretĂ© ethnique, entraĂźnant des discriminations internes Ă lâĂ©gard de populations allogĂšnes ou impures (AĂŻnous, burakumin, okinawaiens, par exemple) et de comportements de mĂȘme type Ă lâĂ©gard de populations Ă©trangĂšres provenant dâun nombre restreint de pays en raison de vicissitudes historiques (CorĂ©e, BrĂ©sil). Aujourdâhui les conditions socio-Ă©conomiques dâun pays fortement vieillissant et Ă population dĂ©croissante face Ă la montĂ©e en puissance dâun voisin dix fois plus peuplĂ©, apportent cependant une certaine pression de nouvelles immigrations (Philippines, Chine). La rĂ©ticence historique japonaise semble pourtant perdurer par des pratiques, tant discriminatoires face Ă des immigrations « politiques » (du Moyen-Orient par exemple) quâĂ©conomiques en favorisant notamment le dĂ©veloppement de robots dâaide aux personnes ĂągĂ©es ou handicapĂ©es plutĂŽt que des aides familiales Ă©trangĂšres. La main-dâĆuvre « purement » japonaise accepte et prend des emplois manuels et de service quâen dâautres pays il faut confier Ă des populations immigrĂ©es ; le Japon fait fabriquer Ă lâextĂ©rieur ses vĂȘtements, etc., plutĂŽt que de le faire dans des usines accueillant des travailleurs Ă©trangers et cependant il nâa pas, au contraire, une balance commerciale manufacturiĂšre dĂ©ficitaire. La limitation de lâimmigration est donc bien rĂ©elle, elle est accompagnĂ©e dâun dĂ©passement des arguments Ă©conomiques employĂ©s ailleurs, par des solutions qui exigent des comportements spĂ©cifiques de la population. En revanche il semble ne pas y avoir de freins effectifs Ă lâafflux dâĂ©tudiants chinois qui forment de loin la premiĂšre population Ă©tudiante Ă©trangĂšre au Japon. Ici comme en dâautres domaines au regard des diffĂ©rents critĂšres, le Japon parait comme un cas « Ă part » des pays Ă haut revenu.For a long time, Japan has practiced written and unwritten ethnic purity policies. This has led to discrimination against non-native or impure populations (like the Ainu, Burakumin and Okinawans) and similar behaviour towards foreign nationals from certain countries (such as Korea or Brazil) as a result of past events. Today, however, the country is aging, the population is shrinking, and its extremely populous neighbour is growing in power. These changing socio-economic conditions have led to more pressure for new immigration (from the Philippines and China). Nevertheless, Japanese reticence has not disappeared, and can be seen in discriminatory practices targeting âpoliticalâ immigration (from the Middle East, for example) and economic practices (like encouraging the development of robots to help elderly or handicapped people instead of hiring foreign help). âPureâ Japanese workers accept manual and service jobs, and do not leave them to immigrants as often happens in other countries. Japan produces clothing and other products overseas rather than setting up factories that would employ foreign workers. And yet the country has a positive balance of trade in manufacturing. Limits on immigration are very real, and are accompanied by solutions requiring the population to act in certain ways, bypassing the economic arguments used elsewhere. However, it appears that there are no real limits to the inflow of Chinese students, who represent the largest foreign student group in Japan. In this domain and others, different factors would seem to indicate that Japan is once again an âexceptionâ amongst wealthy countries
Sex and gender in lung health and disease: more than just Xs and Ys
A new series explores the role of sex and gender-related factors in respiratory physiology, lung health, and across respiratory diseases https://bit.ly/3mP0BV
Les immigrants au Japon passés au crible commun du jus fusionis
Le Japon a longtemps pratiquĂ© des politiques explicites ou implicites de puretĂ© ethnique, entraĂźnant des discriminations internes Ă lâĂ©gard de populations allogĂšnes ou impures (AĂŻnous, burakumin, okinawaiens, par exemple) et de comportements de mĂȘme type Ă lâĂ©gard de populations Ă©trangĂšres provenant dâun nombre restreint de pays en raison de vicissitudes historiques (CorĂ©e, BrĂ©sil). Aujourdâhui les conditions socio-Ă©conomiques dâun pays fortement vieillissant et Ă population dĂ©croissante face Ă la montĂ©e en puissance dâun voisin dix fois plus peuplĂ©, apportent cependant une certaine pression de nouvelles immigrations (Philippines, Chine). La rĂ©ticence historique japonaise semble pourtant perdurer par des pratiques, tant discriminatoires face Ă des immigrations « politiques » (du Moyen-Orient par exemple) quâĂ©conomiques en favorisant notamment le dĂ©veloppement de robots dâaide aux personnes ĂągĂ©es ou handicapĂ©es plutĂŽt que des aides familiales Ă©trangĂšres. La main-dâĆuvre « purement » japonaise accepte et prend des emplois manuels et de service quâen dâautres pays il faut confier Ă des populations immigrĂ©es ; le Japon fait fabriquer Ă lâextĂ©rieur ses vĂȘtements, etc., plutĂŽt que de le faire dans des usines accueillant des travailleurs Ă©trangers et cependant il nâa pas, au contraire, une balance commerciale manufacturiĂšre dĂ©ficitaire. La limitation de lâimmigration est donc bien rĂ©elle, elle est accompagnĂ©e dâun dĂ©passement des arguments Ă©conomiques employĂ©s ailleurs, par des solutions qui exigent des comportements spĂ©cifiques de la population. En revanche il semble ne pas y avoir de freins effectifs Ă lâafflux dâĂ©tudiants chinois qui forment de loin la premiĂšre population Ă©tudiante Ă©trangĂšre au Japon. Ici comme en dâautres domaines au regard des diffĂ©rents critĂšres, le Japon parait comme un cas « Ă part » des pays Ă haut revenu.For a long time, Japan has practiced written and unwritten ethnic purity policies. This has led to discrimination against non-native or impure populations (like the Ainu, Burakumin and Okinawans) and similar behaviour towards foreign nationals from certain countries (such as Korea or Brazil) as a result of past events. Today, however, the country is aging, the population is shrinking, and its extremely populous neighbour is growing in power. These changing socio-economic conditions have led to more pressure for new immigration (from the Philippines and China). Nevertheless, Japanese reticence has not disappeared, and can be seen in discriminatory practices targeting âpoliticalâ immigration (from the Middle East, for example) and economic practices (like encouraging the development of robots to help elderly or handicapped people instead of hiring foreign help). âPureâ Japanese workers accept manual and service jobs, and do not leave them to immigrants as often happens in other countries. Japan produces clothing and other products overseas rather than setting up factories that would employ foreign workers. And yet the country has a positive balance of trade in manufacturing. Limits on immigration are very real, and are accompanied by solutions requiring the population to act in certain ways, bypassing the economic arguments used elsewhere. However, it appears that there are no real limits to the inflow of Chinese students, who represent the largest foreign student group in Japan. In this domain and others, different factors would seem to indicate that Japan is once again an âexceptionâ amongst wealthy countries
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