Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day mortality in critical care - An analysis of the OUTCOMEREA database

Introduction: Enterococcus species are associated with an increased morbidity in intraabdominal infections (IAI). However, their impact on mortality remains uncertain. Moreover, the influence on outcome of the appropriate or inappropriate status of initial antimicrobial therapy (IAT) is subjected to debate, except in septic shock. The aim of our study was to evaluate whether an IAT that did not cover Enterococcus spp. was associated with 30-day mortality in ICU patients presenting with IAI growing with Enterococcus spp. Material and methods: Retrospective analysis of French database OutcomeRea from 1997 to 2016. We included all patients with IAI with a peritoneal sample growing with Enterococcus. Primary endpoint was 30-day mortality. Results: Of the 1017 patients with IAI, 76 (8%) patients were included. Thirty-day mortality in patients with inadequate IAT against Enterococcus was higher (7/18 (39%) vs 10/58 (17%), p = 0.05); however, the incidence of postoperative complications was similar. Presence of Enterococcus spp. other than E. faecalis alone was associated with a significantly higher mortality, even greater when IAT was inadequate. Main risk factors for having an Enterococcus other than E. faecalis alone were as follows: SAPS score on day 0, ICU-acquired IAI, and antimicrobial therapy within 3 months prior to IAI especially with third-generation cephalosporins. Univariate analysis found a higher hazard ratio of death with an Enterococcus other than E. faecalis alone that had an inadequate IAT (HR = 4.4 [1.3-15.3], p = 0.019) versus an adequate IAT (HR = 3.1 [1.0-10.0], p = 0.053). However, after adjusting for confounders (i.e., SAPS II and septic shock at IAI diagnosis, ICU-acquired peritonitis, and adequacy of IAT for other germs), the impact of the adequacy of IAT was no longer significant in multivariate analysis. Septic shock at diagnosis and ICU-acquired IAI were prognostic factors. Conclusion: An IAT which does not cover Enterococcus is associated with an increased 30-day mortality in ICU patients presenting with an IAI growing with Enterococcus, especially when it is not an E. faecalis alone. It seems reasonable to use an IAT active against Enterococcus in severe postoperative ICU-acquired IAI, especially when a third-generation cephalosporin has been used within 3 months. © 2019 The Author(s)

Model-Based Function Mapping and Bandwidth Reservation for Mixed-Critical Adaptive Systems

Conference of 20th Euromicro Conference on Digital System Design, DSD 2017 ; Conference Date: 30 August 2017 Through 1 September 2017; Conference Code:130963International audienceThe new AutoSAR adaptive platform makes mixedcritical automotive systems able to adapt at runtime in response to hardware and software failures. However, mapping functions of these adaptive automotive systems to the hardware nodes and reserving their bandwidth are still major challenges. To tackle such major challenges, in this paper, we propose a model-based approach for the automatic identification of functions mapping and bandwidth reservation for the different configurations of an adaptive software system. The functions mapping and bandwidth reservation are performed by a Tabu search-based strategy. In this strategy, there is a temporal isolation between critical and non-critical functions. Thus, overruns of non-critical functions do not affect timing guarantees of critical functions, and the quality of service for the non-critical functions is maximized

A Model-Driven Approach for Validating Safe Adaptive Behaviors

Conference of 19th Euromicro Conference on Digital System Design, DSD 2016 ; Conference Date: 31 August 2016 Through 2 September 2016; Conference Code:124486International audienceAdaptive embedded software systems have the ability to adapt themselves in response to hardware/software failures at runtime. However, ensuring safe adaptive behaviors of these systems is a major challenge. In this paper, we propose an approach to facilitate the validation of such adaptive behaviors. To do so, an architecture description language for automotive embedded systems (EAST-ADL) is used for designing the software. The system design model is then used for generating the embedded software. To ensure that the system behaves correctly at runtime, its adaptive behavior is analyzed using fault injection and monitoring techniques on a virtual platform. This work is part of the European project SafeAdapt, which provides a novel architecture for adaptive systems in the automotive domain. It also describes a particular aspect, virtual validation, in the evolution of the EQUITAS project

Safe adaptation of vehicle software systems

International audienceThe promising advent of Fully Electric Vehicles (FEVs) also means a shift towards fully electrical control of the existing and new vehicle functions. In particular, critical X-by-wire functions require sophisticated redundancy solutions. As a result, the overall Electric/Electronic (E/E) architecture of a vehicle is becoming even more complex and costly. The SafeAdapt project provides an integrated approach for engineering such adaptive, complex and safe systems, ranging from tool chain support, reference architectures, system modeling and networking, up to early validation and verification. In this paper, we give an overview of the SafeAdapt project methodology. We also describe a particular aspect of the project which is the validation of the system adaptive behavior. To validate the adaptive behavior of a vehicle system, an architecture description language for automotive embedded systems (i.e. EAST-ADL) is used for designing the system. The system design model is then used for generating the embedded software. To ensure that the system behaves correctly at runtime, its adaptive behavior is analyzed using fault injection and monitoring techniques on a virtual platform

Towards a Safe Software Development Environment

Conference of 20th Euromicro Conference on Digital System Design, DSD 2017 ; Conference Date: 30 August 2017 Through 1 September 2017; Conference Code:130963International audienceIt is largely recognized that the architectures of embedded systems are becoming more and more complex both at hardware and software levels. Despite the significant advances in the development tools, developing the software of such systems while ensuring their safety is still a difficult task. In this paper, we propose an engineering methodology to ease the development of safe software systems. It consists of four main phases: system modelling and validation, code generation and integration, static code analysis, and dynamic code analysis. This methodology is realized using CEA LIST open-source development platforms: Papyrus, Frama-C, and UNISIM-VP. These platforms are results of many research and industrial projects such as FP7-SafeAdapt, FUI-EQUITAS, FP7-STANCE, CATRENE-OpenES, and FSN-SESAM Grids

The interest of coherence from radar SAR images in the follow-up of urban extensions of Focsani city (Romania)

peer reviewedUsually, the coherence image obtained by processing SAR (Synthetic Aperture Radar) images is indirectly used in the interferometry to identify and delimit different areas that disturb the phase of the radar wave. The phase plays the role of indicator and in the same time separator between areas where the elements within the pixel are unstable and the stable. Considering this principle, we use here these images with the purpose to follow the expansion of the city of Focşani, Romania (urban areas). The results show the very good coherence for the urban area, which appears in white in greyscale visualisation corresponding to maximum values of coherence. The analysis of the coherence images at different time intervals allowed us to characterise the stability of the Focşani city (without considerable extension) for almost 10 years (1995/2005). Instead, we distinguished many buildings that were multiplied towards the periphery and outside of the city. During the same period, we found out that in downtown, there were urban renovations represented by green spaces. We also found that the three pairs, which were processed by the image acquired the 01/31/2005 have a low coherence, which allows us to state that the rainfalls can be the cause of the incoherence. We also observed that the incoherence is more important within the pairs formed by ERS-1 and ERS2 than the pairs formed by ERS-2 and ERS-2, even if the time interval between them is 24 hours (the temporal decorrelation is null or identical). This study confirms the interest of the coherence image to identify the spatial and temporal decorrelations of the pairs processed by the interferometry technique (InSAR). The role of coherence images intervenes also to distinguish the urban areas from the green or water covered areas