Alzheimer's patient activity assessment using different sensors

International audiencePurpose: Older people population is expected to grow dramatically over the next 20 years (including Alzheimer's patients), while the number of people able to provide care will decrease. We present the development of medical and information and communication technologies to support the diagnosis and evaluation of dementia progress in early stage Alzheimer disease (AD) patients.Method: We compared video and accelerometers activity assessment for the estimation of older people performance in instrumental activities of daily living (IADL) and physical tests in the clinical protocol developed by the Memory Center of the Nice Hospital and the Department of Neurology at National Cheng Kung University Hospital - Taiwan. This clinical protocol defines a set of IADLs (e.g., preparing coffee, watching TV) that could provide objective information about dementia symptoms and be realistically achieved in the two sites observation room. Previous works studied accelerometers activity assessment for the detection of changes in older people gait patterns caused by dementia progress, or video-based event detection for personal self-care activities (ADLs)[1, 2, 3], but none has used both sensors for IADLs analysis. The proposed system uses a constraint-based ontology to model and detect events based on different sensors readings (e.g., 2D video stream data is converted to 3D geometric information that is combined with a priori semantic information, like defined spatial zones or posture estimations given by accelerometer). The ontology language is declarative and intuitive (as it uses natural terminology), allowing medical experts to define and modify the IADL models. The proposed system was tested with 44 participants (healthy=21, AD=23). A stride detection algorithm was developed by the Taiwanese team for the automatic acquisition of patients gait parameters (e.g., stride length, stride frequency) using a tri-axial accelerometer embedded in a wearable device. It was tested with 33 participants (healthy=17, Alzheimer = 16) during a 40 meters walking test. Results & Discussion: The proposed system detected the full set of activities of the first part of our clinical protocol (e.g., repeated transfer test, walking test) with a true positive rate of 96.9 % to 100%. Extracted gait parameters and automatically detected IADLs will be future analyzed for the evaluation of differences between Alzheimer patients at mild to moderate stages and healthy control participants, and for the monitoring of patients motor and cognitive abilities

Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA

Purpose: Whether the quality of the ethical climate in the intensive care unit (ICU) improves the identification of patients receiving excessive care and affects patient outcomes is unknown. Methods: In this prospective observational study, perceptions of excessive care (PECs) by clinicians working in 68 ICUs in Europe and the USA were collected daily during a 28-day period. The quality of the ethical climate in the ICUs was assessed via a validated questionnaire. We compared the combined endpoint (death, not at home or poor quality of life at 1 year) of patients with PECs and the time from PECs until written treatment-limitation decisions (TLDs) and death across the four climates defined via cluster analysis. Results: Of the 4747 eligible clinicians, 2992 (63%) evaluated the ethical climate in their ICU. Of the 321 and 623 patients not admitted for monitoring only in ICUs with a good (n = 12, 18%) and poor (n = 24, 35%) climate, 36 (11%) and 74 (12%), respectively were identified with PECs by at least two clinicians. Of the 35 and 71 identified patients with an available combined endpoint, 100% (95% CI 90.0–1.00) and 85.9% (75.4–92.0) (P = 0.02) attained that endpoint. The risk of death (HR 1.88, 95% CI 1.20–2.92) or receiving a written TLD (HR 2.32, CI 1.11–4.85) in patients with PECs by at least two clinicians was higher in ICUs with a good climate than in those with a poor one. The differences between ICUs with an average climate, with (n = 12, 18%) or without (n = 20, 29%) nursing involvement at the end of life, and ICUs with a poor climate were less obvious but still in favour of the former. Conclusion: Enhancing the quality of the ethical climate in the ICU may improve both the identification of patients receiving excessive care and the decision-making process at the end of life

La bronchopneumopathie chronique obstructive (bpco) en decompensation aigue

SCOPUS: re.jinfo:eu-repo/semantics/publishe

Successful treatment of a severe cyanide salts intoxication using hydroxocobalamine and thiosulfate: Case report and hemodynamic study

Organized by the Belgian Society of Intensive Care and Emergency Medicineinfo:eu-repo/semantics/nonPublishe

Survival after severe cyanide salts poisoning

info:eu-repo/semantics/nonPublishe

Environmental Risk Analysis for High-Rise Buildings In Belgium With The European Seveso Directives

How can new and existing High-Rise Buildings (HRB) be analyzed while taking into account environmental safety factors? HRB are generally controversial symbols in the city: they can easily be accepted or rejected according to national, cultural, societal or historical contexts. But what risks do inhabitants, environment and the neighborhood run? What safety factors should be taken into account for the HRB and the environment simultaneously? The toxic fumes released on 11th September during the fall of the Twin Towers affected residents and urban environment long after the disaster, which raised various questions about the HRB safety and associated risks.In the past HRB were mainly criticized for their urban integration. Today the safety factor due to their integration in high density environment cannot be overlooked any longer. The risk should be assessed for such buildings with regard to their impact on the environment or on the urban development. The purpose of this study is to propose a risk assessment model based on the European Seveso Directive and the FRAME methodology (Fire Risk Assessment Method for Engineering), a fire safety risks analysis method for HRB.The Seveso Directive established by the Council of the European Communities intends to prevent major accidents involving dangerous substances and to limit their consequences for Man and his environment. This Directive is applicable to all establishments directly containing dangerous substances or potentially producing them as a result of an accident (including domino effect). The European Countries must ensure that the operator draws up a document setting out his major-accident prevention policy and produces a safety report.Today, HRB are not considered as Seveso establishments due to the fact that no dangerous substances are stored, used or produced. However, should a fire or explosion occur, the environmental impact would be of the same nature. The proposed model integrates the various stages of external and internal HRB risks assessment, first deterministically then probabilistically. The study follows the incident scenario approach to determine hazard origins by event and fault tree use. Originally the FRAME method includes protection considerations for inhabitants, building and activities. A fourth component, the environmental factor, will be incorporated. This aspect includes urban neighbourhood, other HRB, roads and transport facilities and commercial and industrial activities. This environment factor will be included in the risk environment tool developed upon the FRAME method in order to obtain a global safety assessment report similar to those imposed for Seveso establishments.An existing Belgian HRB is used as a case study in order to test the risk assessment proposed tool. The HRB context will be presented and analyzed using the proposed risks analysis model. Different scenarios will be considered and reviewed for the studied case.info:eu-repo/semantics/publishe

Analyse critique de l'option d'implantation de nouveaux immeubles-tours

La construction de nouveaux Immeubles de Grande Hauteur (IGH) est-elle la réponse adéquate au manque d'espaces constructibles, aux défis des densités urbaines pour les grandes villes et aux problématiques des constructions durables ?Ce sujet est encore aujourd'hui l'objet de discussions auprès de divers acteurs politiques, économiques ou privés. Par le passé, ces IGH ont fortement été critiqués pour leur intégration dans la ville mais, à présent, l'aspect sécurité ne peut être négligé. En effet la conception d'un IGH ne peut être effectuée sans entreprendre une étude des risques liés à de telles constructions sur leur environnement ainsi que leur implication dans le développement futur. La contribution originale du présent travail est de proposer un modèle d'analyse de risques issu de la réglementation Seveso appliqué aux IGH, spécifiquement ceux présents sur le territoire de la Région de Bruxelles-Capitale. La proposition de ce modèle intègre les différentes étapes d'une analyse de risques, internes et externes, propres aux IGH par une première approche déterministe puis probabiliste. Il sera terminé par une première analyse de risques appliquée sur un immeuble bruxellois, la tour Brusilia. Mots clefs :Immeubles de Grande Hauteur, analyse de risques, approches déterministe et probabiliste, Seveso, environnementinfo:eu-repo/semantics/publishe

Hemodynamic and clinical response to three-day infusion of sulmazol (AR-L 115 BS) in severe congestive heart failure

Sulmazol (AR-L 115 BS) is a new positively inotropic drug with arterial and venous vasodilating properties. We studied the effects of sulmazol (three-day infusion) on clinical tolerance, hemodynamics, and blood gas levels in ten patients with severe chronic heart failure. The hemodynamic monitoring included a Swan-Ganz catheter in the pulmonary artery and a radial catheter. Blood gas levels were determined on samples of arterial and mixed venous blood. After 24 hours of infusion, there was a significant increase in cardiac index (2 to 2.5 L/min/sq m; p<0.005) and a signification decrease in pulmonary-wedge pressure (28 to 19 mm Hg; p<0.001) and in right atrial pressure (7 to 4 mm Hg; p<0.001) without significant changes in heart rate and systolic blood pressure. These benefical effects lasted during the three days of infusion. Oxygen delivery was significantly increased (350 to 443 ml/min/sq m; p<0.005) without significant change in arterial oxygen tension. The side effects included nausea, vomiting, anorexia, and mild thrombocytopenia. We conclude that sulmazol is a potent drug which may improve severely deteriorated left and right ventricular function in patients with chronic refractory heart failure without affecting the heart rate and the systolic blood pressure.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Acute severe intoxication with an unusual drug: Buflomedil (Loftyl)

Organized by the Belgian Society of Intensive Care and Emergency Medicineinfo:eu-repo/semantics/nonPublishe

Intégration des risques liés à l'environnement dans l'analyse critique de nouveaux immeubles-tours

Les Immeubles de Grande Hauteur (IGH), constructions emblématiques, font l'objet actuellement de nombreuses discussions concernant leur impact architectural, urbanistique et sociologique dans la ville, mais qu'en est-il exactement concernant celui de la sécurité et des risques qu'ils peuvent comprendre ?Par le passé, ces IGH ont été fortement critiqués pour leur intégration dans la ville mais, à présent, l'aspect sécurité ne peut être négligé. En effet la conception d'un IGH ne peut être effectuée sans entreprendre une étude des risques liés à de telles constructions sur leur environnement et inversement ainsi que leur implication dans le développement futur du milieu. La contribution originale du présent article est de proposer un modèle d'analyse de risques liés à l'environnement des IGH suivant une réglementation Seveso adaptée et spécifiquement ceux présents sur le territoire de la Région de Bruxelles-Capitale. La proposition de ce modèle intègre les différentes étapes d'une analyse de risques liés à l'environnement, propres aux IGH, par une première approche déterministe puis probabiliste.info:eu-repo/semantics/publishe