6 research outputs found
Optimiser le réchauffement chez le nouveau-né asphyxié soumis à l'hypothermie thérapeutique
L'encĂ©phalopathie hypoxique ischĂ©mique nĂ©onatale (EHI) reste la cause principale de mortalitĂ© chez le nouveau-nĂ© Ă terme. Un tiers des survivants vont dĂ©velopper des sĂ©quelles neurologiques, dont la paralysie cĂ©rĂ©brale (PC), l'Ă©pilepsie et un retard intellectuel. Afin d'amĂ©liorer leur pronostic, ces nouveau-nĂ©s sont soumis Ă l'hypothermie thĂ©rapeutique (HT) qui dĂ©bute au plus tard 6 heures aprĂšs la naissance, pour une durĂ©e totale de 72 heures, suivie d'un rĂ©chauffement graduel (0.5°C/h). Il a Ă©tĂ© dĂ©montrĂ© que cette thĂ©rapie Ă effet neuroprotecteur diminue considĂ©rablement l'Ă©tendue des lĂ©sions cĂ©rĂ©brales et la frĂ©quence des sĂ©quelles neurologiques. Or, des Ă©tudes animales suggĂšrent que l'hypothermie sans sĂ©dation avec opioĂŻdes n'est pas bĂ©nĂ©fique. Selon les observations qui ont Ă©tĂ© rĂ©alisĂ©es, les porcelets traitĂ©s avec la thĂ©rapie, mais sans lâadministration dâanalgĂ©sique ont manifestĂ© des signes dâinstabilitĂ©s et de tremblements exagĂ©rĂ©s. On ignorait jusquâĂ prĂ©sent dans quelle mesure ces rĂ©sultats tirĂ©s des expĂ©rimentations animales pouvaient ĂȘtre gĂ©nĂ©ralisables au nouveau-nĂ©.
Ainsi, mon projet de maĂźtrise vise Ă mieux comprendre les facteurs qui risquent de compromettre les effets bĂ©nĂ©fiques de la thĂ©rapie de refroidissement, dans le but dâoptimiser la neuroprotection et dâamĂ©liorer le dĂ©veloppement des nourrissons atteints dâEHI. Nous avons comme objectif principal dâĂ©valuer lâassociation entre les doses dâopioĂŻdes consommĂ©es pendant lâHT, le degrĂ©e de tremblement, et lâĂ©volution de lâindex de discontinuitĂ© Ă lâEEG au fil des 72h de lâHT, du rĂ©chauffement et jusquâĂ 12 heures post-HT. Pour rĂ©pondre Ă lâobjectif, nous avons conduit une Ă©tude chez 21 nouveau-nĂ©s avec EHI soumis Ă lâHT, et dont les principaux rĂ©sultats ont montrĂ© des associations significatives entre les fortes doses dâopioĂŻdes administrĂ©s Ă lâenfant (r = - 0.493, p = 0.023), les frissons rĂ©duits pendant lâHT (r = 0.513, p = 0.017) et lâamĂ©lioration du rythme cĂ©rĂ©brale dâEEG. Ces rĂ©sultats sont dĂ©crits de maniĂšre plus approfondie dans le Chapitre 2 qui prĂ©sente la version de lâarticle soumis Ă la revue Journal of Pediatrics, et le Chapitre 3 qui prĂ©sente un retour sur la littĂ©rature Ă la lumiĂšre de nos trouvailles. Quant au Chapitre 4, nous y Ă©laborons les possibilitĂ©s de perspectives futures et les retombĂ©es cliniques de nos rĂ©sultats. Ă long terme, nous espĂ©rons que nos travaux permettront lâouverture dâune nouvelle piste dâamĂ©lioration de la neuroprotection, en favorisant systĂ©matiquement une meilleure prise en charge de la douleur et du stress induit par le refroidissement.Neonatal hypoxic-ischemic encephalopathy (HIE) remains the leading cause of death and mortality in the term infant. A third of the survivors will develop neurological sequelae including cerebral palsy (CP), epilepsy and mental retardation. In order to improve their prognosis, these newborns undergo therapeutic hypothermia (TH), which begins no later than 6 hours after birth, maintained for a total duration of 72 hours and followed by gradual rewarming (0.5°C/h). This neuroprotective therapy has been shown to significantly decrease the extent of brain injury and the frequency of neurological sequelae. Results from animal studies revealed that ongoing hypothermia without proper anesthesia is not beneficial. Based on the observations that have been reported, piglets treated with TH with no analgesics have shown signs of instability and excessive tremors. Until now, the extent to which these results from animal experiments could be generalized to the newborn remained unknown.
Thus, the purpose of my masterâs project was to better understand the clinical factors that may compromise the beneficial effects of TH, in an attempt to optimize neuroprotection and improve the neurological outcome of HIE infants. Our main objective was to assess the associations between opioid doses consumed during TH, shivering recorded during TH, and the evolution of EEG discontinuity index over the course of TH, rewarming and up to 12 hours post-TH. To meet the objective, we conducted a study in 21 newborns with HIE undergoing TH, and the results have shown significant associations between high doses of opioid administered (r = - 0.493, p = 0.023), reduced shivering stress (r = 0.513, p = 0.017) and improved EEG background activity. The key findings of the study are described in more detail in Chapter 2, which presents the original manuscript submitted for publication to the âJournal of Pediatricsâ, and Chapter 3, which presents a review of the literature in light of our results. In Chapter 4, we discuss future perspectives and the clinical significance of our results. At last, we hope that our study will open up new avenues for improving neuroprotection, by systematically promoting a better management of pain and cooling-induced stress
Learning A Disentangling Representation For PU Learning
In this paper, we address the problem of learning a binary (positive vs.
negative) classifier given Positive and Unlabeled data commonly referred to as
PU learning. Although rudimentary techniques like clustering,
out-of-distribution detection, or positive density estimation can be used to
solve the problem in low-dimensional settings, their efficacy progressively
deteriorates with higher dimensions due to the increasing complexities in the
data distribution. In this paper we propose to learn a neural network-based
data representation using a loss function that can be used to project the
unlabeled data into two (positive and negative) clusters that can be easily
identified using simple clustering techniques, effectively emulating the
phenomenon observed in low-dimensional settings. We adopt a vector quantization
technique for the learned representations to amplify the separation between the
learned unlabeled data clusters. We conduct experiments on simulated PU data
that demonstrate the improved performance of our proposed method compared to
the current state-of-the-art approaches. We also provide some theoretical
justification for our two cluster-based approach and our algorithmic choices
PENGARUH DIAMOND FRAUD DAN TINGKAT RELIGIUITAS TERHADAP KECURANGAN AKADEMIK (STUDI PADA MAHASISWA S-1 DI LINGKUNGAN PERGURUAN TINGGI SE KOTA TERNATE)
Penelitian ini merupakan penelitian empiris dengan menggunakan disproportionate stratified random sampling. Data yang diperoleh dengan cara menyebarkan kuesioner kepada400 Orang mahasiswa yang tersebar di seluruh Program Studi dilingkungan Perguruang Tinggi Se Kota Ternate. Analisis data dilakukan dengan menggunakan analisis regresi berganda.Hasil Penelitiaan menunjukan bahwa; Tekanan berpengaruh terhadap tingkat kecurangan akademik, Kesempatan tidak berpengaruh terhadap Terhadap tingkat kecurangan akademik, Rasionalitas tidak berpengaruh terhadap terhadap tingkat kecurangan akademik, kapabilitas berpengaruh terhadap terhadap tingkat kecurangan akademik, religiuitas berpengaruh terhadap terhadap tingkat kecurangan akademik dan secara simultan Tekanan, Kesempatan, Rasionalitas, kapabilitas dan religiuitas berpengaruh terhadap tingkat kecurangan akademikKata Kunci: Diamond Fraud, Tingkat Religiuitas dan Perilaku Kecurangan Akademik
Proceedings of the 13th International Newborn Brain Conference: Neonatal Neurocritical Care, Seizures, and Continuous EEG monitoring
DETERMINAN EFEKTIVITAS AUDITOR INTERNAL PEMERINTAH (Studi Pada Kantor Inspektorat Provinsi Maluku Utara)
This study examines the determinants of the effectiveness of internal auditors at the Office of the Inspectorate of North Maluku. Specifically, this study tests; influence of professional expertise, quality of work, independence, perceived career path and top management influence of internal auditor on the effectiveness of internal audit. Analysis was conducted by using multiple regression analysis from 43 respondents. The results showed that; Professional expertise, quality of work, independence and career path affect the effectiveness of internal audit while top management support does not influence the effectiveness of internal audit
SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study
Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling.
Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty.
Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year.
Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population