Précision du monitorage non invasif de l'hemoglobinémie par oxymétrie pulsée chez les patients admis en réanimation pour hemorragie digestive grave

BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

La mescaline à travers l'oeuvre d'Henri Michaux

La mescaline, extraite du peyolt, un petit cactus du Mexique, était employée à des fins hallucinatoires ou curatives par les Indiens. Analogue de la sérotonine, de synthèse simple, drogue hallucinogène à dépendance psychique modérée, elle fait l'objet de recherches dans les années cinquante pour traiter les psychoses et induire une schizophrénie expérimentale. L'artiste Henri Michaux, en quête de sa propre intériorité, va trouver avec la mescaline un fabuleux moyen pour exploser dans son art. Misérable Miracle, L'Infini Turbulent, Paix dans les Brisements, Connaissance par les Gouffres, et Les Grandes Epreuves de L'Esprit vont rendre compte de ses expériences. Ses dessins mescaliniens, reflets du bouillonnement de ses émois internes et de sa nature individuelle, s'inscrivent avec force dans l'histoire de l'art informel des années cinquante.TOULOUSE3-BU Santé-Centrale (315552105) / SudocTOULOUSE3-BU Santé-Allées (315552109) / SudocSudocFranceF

Determinants and prognosis of high-sensitivity cardiac troponin T peak plasma concentration in patients hospitalized for non-cardiogenic shock

Purpose: The aim of this study was to assess the determinants and prognostic value of high-sensitivity cardiac troponin T peak plasma concentration in intensive care unit patients with non-cardiogenic shock. Material and methods: A prospective observational cohort study was conducted in a single intensive care unit between November 2014 and December 2015. Results: During the study period, 206 patients were hospitalized in the intensive care unit for non-cardiogenic shock and the median peak high-sensitivity cardiac troponin T was 55.1 [24.5–136] pg/mL. A multivariate analysis combining all variables showed that higher body mass index ( t  = 2.52, P  = 0.01), lower left ventricular systolic function ( t  = −2.73, P  = 0.007), higher white blood cell count ( t  = 3.72, P  = 0.0001), lower creatinine clearance ( t  = −2.84, P  = 0.0005), higher lactate level ( t  = 2.62, P  = 0.01) and ST-segment depression ( t  = 3.98, P  = 0.0001) best correlated with log 10 -transformed high-sensitivity cardiac troponin T peak plasma concentration. After multivariate analysis, the high-sensitivity cardiac troponin T peak was not associated with a significant reduction of in-hospital mortality (adjusted odds ratio = 0.99 (95% confidence interval: 0.93–1.02)). Conclusion: High-sensitivity cardiac troponin T elevation was very common in patients hospitalized for non-cardiogenic shock. The factors significantly associated with high-sensitivity cardiac troponin T peak plasma concentration were higher body mass index, decreased left ventricular systolic ejection fraction, higher leucocyte count, decreased renal function, increased lactate level, and ST-segment depression. The high-sensitivity cardiac troponin T peak was not significantly associated with in-hospital mortality in this setting

SENSITIVITY OF LV GRID PLANNING TO LOAD MODELLING

International audienceIn this paper, we propose an approach to deal with the impact of uncertainties on the decision criteria used by a planning operator. These uncertainties come from the models applied to network components and their associated assumptions, and they create discrepancies between the results of the studies in the literature. As there is no scientific consensus, network actors continue to keep and develop their own philosophy. The method we propose uses a Global Sensitivity Analysis to characterize the impact of any model on the decision criteria: we consider here the active and reactive powers of customer consumption and solar panel production, as well as the conductor impedances. We test several modelling hypotheses and assess their impact on a French low voltage network. Thanks to this work, we are able to measure the dependence of the decision criteria on the models considered in the LV grid planning process

The sustainable impact of an educational approach to improve the appropriateness of laboratory test orders in the ICU

International audienceINTRODUCTION: Few studies described strategies to improve the use of diagnostic tests in intensive care units (ICU). No study assessed whether their impact was sustained or not. In this study, we assessed whether a multi-faceted intervention for more appropriate use of laboratory testing can decrease the number of tests, is sustainable, is not associated with additional morbidity and represents a potential cost saving.MATERIAL AND METHODS: An open-label prospective cohort study in two separated units of the same medical intensive care unit (ICU) including respectively 3315 and 2392 consecutive patients. After the observation period (2010), a reduction in ICU A of unnecessary diagnostics tests as part of a program including senior supervisory of juniors' orders, encouragements for orders containment at each everyday round discussions (period 2; 2011). Period 3 (2012) consisted in the prolongation of the protocol as a routine care without supervision; Period 4 (2013) was a new period of observation without intervention. No modification was implemented in ICU B in periods 2-4.RESULTS: After the intervention, a decrease in the overall number of tests per ICU-patient-days (37.3±5.5 (baseline) to 15.2±3.2 (- 59%); p<0.0001) was observed. The total cost of the tests decreased from 239±41 to 104±28 euros per ICU-patient days; p<0.0001. The effect on laboratory test orders was sustainable in period 3 (-49%) and 4 (-30%). No significant secondary effect of the intervention was observed in period 2. In ICU B, there was no significant change in the overall laboratory test orders in between the periods.CONCLUSIONS: Laboratory test containment is effective, likely safe and sustainable provided that an educational program is repeatedly promoted, that it makes sense for the whole team, that senior and junior physicians are both committed in the program, and that encouragements for laboratory orders containment at each everyday round discussions

HARMONI at ELT: overview of the capabilities and expected performance of the ELT's first light, adaptive optics assisted integral field spectrograph.

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