Optimiser le réchauffement chez le nouveau-né asphyxié soumis à l'hypothermie thérapeutique

L'encéphalopathie hypoxique ischémique néonatale (EHI) reste la cause principale de mortalité chez le nouveau-né à terme. Un tiers des survivants vont développer des séquelles neurologiques, dont la paralysie cérébrale (PC), l'épilepsie et un retard intellectuel. Afin d'améliorer leur pronostic, ces nouveau-nés sont soumis à l'hypothermie thérapeutique (HT) qui débute au plus tard 6 heures après la naissance, pour une durée totale de 72 heures, suivie d'un réchauffement graduel (0.5°C/h). Il a été démontré que cette thérapie à effet neuroprotecteur diminue considérablement l'étendue des lésions cérébrales et la fréquence des séquelles neurologiques. Or, des études animales suggèrent que l'hypothermie sans sédation avec opioïdes n'est pas bénéfique. Selon les observations qui ont été réalisées, les porcelets traités avec la thérapie, mais sans l’administration d’analgésique ont manifesté des signes d’instabilités et de tremblements exagérés. On ignorait jusqu’à présent dans quelle mesure ces résultats tirés des expérimentations animales pouvaient être généralisables au nouveau-né. Ainsi, mon projet de maîtrise vise à mieux comprendre les facteurs qui risquent de compromettre les effets bénéfiques de la thérapie de refroidissement, dans le but d’optimiser la neuroprotection et d’améliorer le développement des nourrissons atteints d’EHI. Nous avons comme objectif principal d’évaluer l’association entre les doses d’opioïdes consommées pendant l’HT, le degrée de tremblement, et l’évolution de l’index de discontinuité à l’EEG au fil des 72h de l’HT, du réchauffement et jusqu’à 12 heures post-HT. Pour répondre à l’objectif, nous avons conduit une étude chez 21 nouveau-nés avec EHI soumis à l’HT, et dont les principaux résultats ont montré des associations significatives entre les fortes doses d’opioïdes administrés à l’enfant (r = - 0.493, p = 0.023), les frissons réduits pendant l’HT (r = 0.513, p = 0.017) et l’amélioration du rythme cérébrale d’EEG. Ces résultats sont décrits de manière plus approfondie dans le Chapitre 2 qui présente la version de l’article soumis à la revue Journal of Pediatrics, et le Chapitre 3 qui présente un retour sur la littérature à la lumière de nos trouvailles. Quant au Chapitre 4, nous y élaborons les possibilités de perspectives futures et les retombées cliniques de nos résultats. À long terme, nous espérons que nos travaux permettront l’ouverture d’une nouvelle piste d’amélioration de la neuroprotection, en favorisant systématiquement 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 master’s 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 “Journal of Pediatrics”, 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

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