Utilisation des outils numériques d'aide à la décision pour la gestion de l'eau

Le succès d'une gestion des écosystèmes naturels requiert une connaissance approfondie des différents processus qui interviennent et de leurs échelles de temps et d'espace particulières. Pour cette raison, les décideurs ont besoin d'analyser une vaste gamme de données et d'informations géographiques. Les modèles mathématiques, les systèmes d'informations géographi-ques et les systèmes experts sont capables de produire cette analyse, mais seule une minorité de gestionnaires les utilise actuellement. Cet article identifie quelques unes des raisons à l'origine de l'hésitation des gestionnaires à adopter de tels outils d'aide à la décision pour la gestion des ressources naturelles et propose une structure qui pourrait faciliter leur utilisation pour le processus de prise de décision. Cet exercice est réalisé à l'intérieur du contexte de la gestion intégrée par bassin. Une revue des systèmes d'aide à la décision est également présentée.Many methods of integrated or watershed management exist which account for the necessary biophysical and socio-economic factors at the watershed level. Some of these approaches are ecosystem oriented while others are socio-economically oriented. Whatever the definition, water management at the watershed level needs to account for a plenitude of variables related to the air, water, soil, biology, and economy. The successful management of natural ecosystems requires a thorough understanding of their characteristic time and spatial scales. Because of this, decision makers need to analyze a wide range of data and geographic information. Mathematical models, geographic information systems and expert systems are capable of performing this analysis, but only a minority of managers are currently using them. This paper identifies some of the reasons why ecosystem managers have been slow to adopt such decision support tools in natural resources management and proposes a framework to facilitate their use in the decision making process. This is done in an integrated watershed management context. A review of related decision support systems is also presented.Four types of decision-support tools are introduced : mathematical models, expert-systems, geographical information systems (GIS) and decision support systems (DSS). Mathematical models have long been used for simulation, prediction, and forecasting, however, they are often task specific and were rarely developed for management uses. GIS are more and more commonly being used for decision support as they become more affordable and user-friendly and are very well-suited for managing resources at a spatial scale. There exist many kinds of software ranging from a simple viewer used for cartographic purposes to complex GIS oriented toward spatial analysis and modelling. Expert systems are also interesting for decision support when specific goals are being considered. Finally, DSS are perhaps the digital tools most applicable to management purposes, often integrating one or more models, a GIS or expert system functionalities. There are two types of DSS : 1. Environmental Information Systems (EIS), and 2. Integrated Modelling Systems (IMS) EIS can be very user- friendly, relying heavily upon GIS and statistical functions.IMS also use GIS capabilities, but integrates several mathematical models as well. The level of integration between models varies considerably and the complexity of IMS are generally high.Two questions underlie the operational use of digital technologies for decision support. The first is whether or not such technology should be used at all, while the second is why such tools take time to be adopted by government and management agencies. The use of digital technologies is often required when the problem is complex and where there are a wide range of factors involved with different spatial and temporal scales. Three major constraints towards the implementation of decision support tools can be pinpointed :1. technology, 2. data, and 3. working organization. Technological constraints include cost, lack of user friendliness, and hardware problems, among other factors. Data constraints are mostly related to availability, cost, heterogeneity and volume. Finally, organization constraints pertain mostly to the manager's perception of the tool and the structural integration of the tool within the decision process.This paper proposes a 4-step approach to optimize the use of decision-support tools. The first step requires that managers and decision-makers clearly define their project, goals and budget, as well as, decide whether to use an integrated watershed management approach or a more discrete approach. This leads directly to the second step, which consists of choosing the most appropriate digital support tool. This requires communication between managers and scientists, and at this point, data gathering and integration should begin. The third phase consists of the development of a new tool or adaptation of an existing one within the context of the agency's management structure. The final step is the operational use of the decision support tool by the agency, following an initial trial period. The successful use of a decision support tool for management purposes depends on proper planning that accounts for all factors related to management needs, budget, data, ease of use, and organization integration

Effectiveness and safety of in vitro maturation of oocytes versus in vitro fertilisation in women with high antral follicle count : Study protocol for a randomised controlled trial

This work was supported by Ferring grant number 000323 and sponsored by My Duc Hospital.Peer reviewedPublisher PD

Role of PCSK5 Expression in Mouse Ovarian Follicle Development: Identification of the Inhibin α- and β-Subunits as Candidate Substrates

Inhibin and activin are essential dimeric glycoproteins belonging to the transforming growth factor-beta (TGFβ) superfamily. Inhibin is a heterodimer of α- and β-subunits, whereas activin is a homodimer of β-subunits. Production of inhibin is regulated during the reproductive cycle and requires the processing of pro-ligands to produce mature hormone. Furin is a subtilisin-like proprotein convertase (proconvertase) that activates precursor proteins by cleavage at basic sites during their transit through the secretory pathway and/or at the cell surface. We hypothesized that furin-like proconvertases are central regulators of inhibin α- and β-subunit processing within the ovary. We analyzed the expression of the proconvertases furin, PCSK5, PCSK6, and PCSK7 in the developing mouse ovary by real-time quantitative RT-PCR. The data showed that proconvertase enzymes are temporally expressed in ovarian cells. With the transition from two-layer secondary to pre-antral follicle, only PCSK5 mRNA was significantly elevated. Activin A selectively enhanced expression of PCSK5 mRNA and decreased expression of furin and PCSK6 in cultured two-layer secondary follicles. Inhibition of proconvertase enzyme activity by dec-RVKR-chloromethylketone (CMK), a highly specific and potent competitive inhibitor of subtilisin-like proconvertases, significantly impeded both inhibin α- and β-subunit maturation in murine granulosa cells. Overexpression of PC5/6 in furin-deficient cells led to increased inhibin α- and βB-subunit maturation. Our data support the role of proconvertase PCSK5 in the processing of ovarian inhibin subunits during folliculogenesis and suggest that this enzyme may be an important regulator of inhibin and activin bioavailability

Reexamining age, race, site, and thermometer type as variables affecting temperature measurement in adults – A comparison study

BACKGROUND: As a result of the recent international vigilance regarding disease assessment, accurate measurement of body temperature has become increasingly important. Yet, trusted low-tech, portable mercury glass thermometers are no longer available. Thus, comparing accuracy of mercury-free thermometers with mercury devices is essential. Study purposes were 1) to examine age, race, site as variables affecting temperature measurement in adults, and 2) to compare clinical accuracy of low-tech Galinstan-in-glass device to mercury-in-glass at oral, axillary, groin, and rectal sites in adults. METHODS: Setting 176 bed accredited healthcare facility, rural northwest US Participants Convenience sample (N = 120) of hospitalized persons ≥ 18 years old. Instruments Temperatures (°F) measured at oral, skin (simultaneous), immediately followed by rectal sites with four each mercury-glass (BD) and Galinstan-glass (Geratherm) thermometers; 10 minute dwell times. RESULTS: Participants averaged 61.6 years (SD 17.9), 188 pounds (SD 55.3); 61% female; race: 85% White, 8.3% Native Am., 4.2% Hispanic, 1.7 % Asian, 0.8% Black. For both mercury and Galinstan-glass thermometers, within-subject temperature readings were highest rectally; followed by oral, then skin sites. Galinstan assessments demonstrated rectal sites 0.91°F > oral and ≅ 1.3°F > skin sites. Devices strongly correlated between and across sites. Site difference scores between devices showed greatest variability at skin sites; least at rectal site. 95% confidence intervals of difference scores by site (°F): oral (0.142 – 0.265), axilla (0.167 – 0.339), groin (0.037 – 0.321), and rectal (-0.111 – 0.111). Race correlated with age, temperature readings each site and device. CONCLUSION: Temperature readings varied by age, race. Mercury readings correlated with Galinstan thermometer readings at all sites. Site mean differences between devices were considered clinically insignificant. Still considered the gold standard, mercury-glass thermometers may no longer be available worldwide. Therefore, mercury-free, environmentally safe low-tech Galinstan-in-glass may be an appropriate replacement. This is especially important as we face new, internationally transmitted diseases

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Preimplantation genetic testing guidelines of International Society of Reproductive Genetics

The International Society of Reproductive Genetics (ISRG) assembled a workgroup made up of clinicians, clinical laboratory directors, and scientists for the purpose of creating the guidelines for preimplantation genetic testing (PGT). The most up-to-date information and clinical insights for the optimal PGT practice were incorporated in these guidelines. Recommendations are provided for embryologists, medical geneticists, clinical laboratorians, and other healthcare providers to improve the wellbeing of patients seeking assisted reproductive treatment and their offspring

Pan-African Genetic Structure in the African Buffalo (Syncerus caffer): Investigating Intraspecific Divergence

The African buffalo (Syncerus caffer) exhibits extreme morphological variability, which has led to controversies about the validity and taxonomic status of the various recognized subspecies. The present study aims to clarify these by inferring the pan-African spatial distribution of genetic diversity, using a comprehensive set of mitochondrial D-loop sequences from across the entire range of the species. All analyses converged on the existence of two distinct lineages, corresponding to a group encompassing West and Central African populations and a group encompassing East and Southern African populations. The former is currently assigned to two to three subspecies (S. c. nanus, S. c. brachyceros, S. c. aequinoctialis) and the latter to a separate subspecies (S. c. caffer). Forty-two per cent of the total amount of genetic diversity is explained by the between-lineage component, with one to seventeen female migrants per generation inferred as consistent with the isolation-with-migration model. The two lineages diverged between 145 000 to 449 000 years ago, with strong indications for a population expansion in both lineages, as revealed by coalescent-based analyses, summary statistics and a star-like topology of the haplotype network for the S. c. caffer lineage. A Bayesian analysis identified the most probable historical migration routes, with the Cape buffalo undertaking successive colonization events from Eastern toward Southern Africa. Furthermore, our analyses indicate that, in the West-Central African lineage, the forest ecophenotype may be a derived form of the savanna ecophenotype and not vice versa, as has previously been proposed. The African buffalo most likely expanded and diverged in the late to middle Pleistocene from an ancestral population located around the current-day Central African Republic, adapting morphologically to colonize new habitats, hence developing the variety of ecophenotypes observed today