Un arbre de Markov sélectif en fréquence pour la détection de signaux transitoires à faible rapport signal à bruit

Nous nous intéressons dans cet article à l’extraction de comportements statistiques multirésolutions pour la caractérisation et la segmentation de signaux transitoires dans un contexte fortement bruité. Ces signaux de courte durée possèdent des composantes fréquentielles très localisées et fortement variables. Le choix du compromis temps/fréquence pour l’étude de ces signaux est donc crucial. Nous nous plaçons de ce fait dans le domaine transformé en paquets d’ondelettes, permettant une analyse fine des variations fréquentielles du signal. Nous proposons un modèle d’arbre de Markov original adapté à la décomposition en paquets d’ondelettes afin d’intégrer l’information multirésolution d’échelle en échelle dans un objectif de segmentation. Nous validons l’approche sur des signaux synthétiques, puis nous illustrons son intérêt applicatif dans un contexte biomédical liée à la détection de signaux transitoires dans les signaux pulmonaires.We deal in this paper with the extraction of multiresolution statistical signatures for the characterization of transient signals in strongly noisy contexts. These short-time signals have sharp and highly variable frequency components. The Time-Frequency analysis window to adopt is then a major issue. Thus we have chosen the wavelet packet domain due to its natural ability to provide multiple time-frequency resolutions. We propose a new oriented Markov model dedicated to the wavelet packet transform, which offers sharp analysis of frequency variations in a signal, locally in time and at several resolutions. We show its efficiency on synthetic signals and we then illustrate its applicative relevance in a biomedical context related to the detection of transient signals in pulmonary sounds

On source space resolution in EEG brain imaging for motor imagery

International audienceBrain source localization accuracy is known to be dependent on the EEG sensor placement over the head surface. In Brain-Computer Interfaces (BCI), according to the paradigm used, Motor Imagery (MI) and Steady-State Visual Evoked Potential (SSVEP) in particular, electrodes are not well distributed over the head, and their number is not standardized as in classical clinical applications. We propose in this paper a method for quantifying the expected quality of source localization with respect of the sensor placement, known as EEG montage. Our method, based on a subspace correlation metric, can be used to assess which brain sources can be distinguished (as they generate sufficiently different potentials on the electrodes), and also to identify regions/volumes in which precise source localization is impossible (i.e. all sources inside those regions could generate similar electrode potentials). In particular, for a MI dedicated montage, we show that source localization is less precise than for standard montages, although the local density of electrodes over the areas of interest is higher

Confidence-based Optimization for the Newsvendor Problem

We introduce a novel strategy to address the issue of demand estimation in single-item single-period stochastic inventory optimisation problems. Our strategy analytically combines confidence interval analysis and inventory optimisation. We assume that the decision maker is given a set of past demand samples and we employ confidence interval analysis in order to identify a range of candidate order quantities that, with prescribed confidence probability, includes the real optimal order quantity for the underlying stochastic demand process with unknown stationary parameter(s). In addition, for each candidate order quantity that is identified, our approach can produce an upper and a lower bound for the associated cost. We apply our novel approach to three demand distribution in the exponential family: binomial, Poisson, and exponential. For two of these distributions we also discuss the extension to the case of unobserved lost sales. Numerical examples are presented in which we show how our approach complements existing frequentist - e.g. based on maximum likelihood estimators - or Bayesian strategies.Comment: Working draf

Subsequent and simultaneous electrophysiological investigation of the retina and the visual cortex in neurodegenerative and psychiatric diseases: what are the forecasts for the medicine of tomorrow?

Visual electrophysiological deficits have been reported in neurodegenerative disorders as well as in mental disorders. Such alterations have been mentioned in both the retina and the cortex, notably affecting the photoreceptors, retinal ganglion cells (RGCs) and the primary visual cortex. Interestingly, such impairments emphasize the functional role of the visual system. For this purpose, the present study reviews the existing literature with the aim of identifying key alterations in electroretinograms (ERGs) and visual evoked potentials electroencephalograms (VEP-EEGs) of subjects with neurodegenerative and psychiatric disorders. We focused on psychiatric and neurodegenerative diseases due to similarities in their neuropathophysiological mechanisms. Our research focuses on decoupled and coupled ERG/VEP-EEG results obtained with black-and-white checkerboards or low-level visual stimuli. A decoupled approach means recording first the ERG, then the VEP-EEG in the same subject with the same visual stimuli. The second method means recording both ERG and VEP-EEG simultaneously in the same participant with the same visual stimuli. Both coupled and decoupled results were found, indicating deficits mainly in the N95 ERG wave and the P100 VEP-EEG wave in Parkinson’s, Alzheimer’s, and major depressive disorder. Such results reinforce the link between the retina and the visual cortex for the diagnosis of psychiatric and neurodegenerative diseases. With that in mind, medical devices using coupled ERG/VEP-EEG measurements are being developed in order to further investigate the relationship between the retina and the visual cortex. These new techniques outline future challenges in mental health and the use of machine learning for the diagnosis of mental disorders, which would be a crucial step toward precision psychiatry

Genome-Wide Association Study Identifies First Locus Associated with Susceptibility to Cerebral Venous Thrombosis

Objective Cerebral venous thrombosis (CVT) is an uncommon form of stroke affecting mostly young individuals. Although genetic factors are thought to play a role in this cerebrovascular condition, its genetic etiology is not well understood. Methods A genome-wide association study was performed to identify genetic variants influencing susceptibility to CVT. A 2-stage genome-wide study was undertaken in 882 Europeans diagnosed with CVT and 1,205 ethnicity-matched control subjects divided into discovery and independent replication datasets. Results In the overall case-control cohort, we identified highly significant associations with 37 single nucleotide polymorphisms (SNPs) within the 9q34.2 region. The strongest association was with rs8176645 (combined p = 9.15 x 10(-24); odds ratio [OR] = 2.01, 95% confidence interval [CI] = 1.76-2.31). The discovery set findings were validated across an independent European cohort. Genetic risk score for this 9q34.2 region increases CVT risk by a pooled estimate OR = 2.65 (95% CI = 2.21-3.20, p = 2.00 x 10(-16)). SNPs within this region were in strong linkage disequilibrium (LD) with coding regions of the ABO gene. The ABO blood group was determined using allele combination of SNPs rs8176746 and rs8176645. Blood groups A, B, or AB, were at 2.85 times (95% CI = 2.32-3.52, p = 2.00 x 10(-16)) increased risk of CVT compared with individuals with blood group O. Interpretation We present the first chromosomal region to robustly associate with a genetic susceptibility to CVT. This region more than doubles the likelihood of CVT, a risk greater than any previously identified thrombophilia genetic risk marker. That the identified variant is in strong LD with the coding region of the ABO gene with differences in blood group prevalence provides important new insights into the pathophysiology of CVT. ANN NEUROL 2021Peer reviewe

Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial

Background Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months. Interpretation Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke

One health, une seule santé

One Health, « Une seule santé », est une stratégie mondiale visant à développer les collaborations interdisciplinaires pour la santé humaine, animale et environnementale. Elle promeut une approche intégrée, systémique et unifiée de la santé aux échelles locale, nationale et mondiale, afin de mieux affronter les maladies émergentes à risque pandémique, mais aussi s'adapter aux impacts environnementaux présents et futurs. Bien que ce mouvement s’étende, la littérature en français reste rare. Traduit de l’anglais, coordonné par d’éminents épidémiologistes et s'appuyant sur un large panel d' approches scientifiques rarement réunies autour de la santé, cet ouvrage retrace les origines du concept et présente un contenu pratique sur les outils méthodologiques, la collecte de données, les techniques de surveillance et les plans d’étude. Il combine recherche et pratique en un seul volume et constitue un ouvrage de référence unique pour la santé mondiale

Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012

OBJECTIVE: To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008. DESIGN: A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. A stand-alone meeting was held for all subgroup heads, co- and vice-chairs, and selected individuals. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS: The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations as strong (1) or weak (2). The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Recommendations were classified into three groups: (1) those directly targeting severe sepsis; (2) those targeting general care of the critically ill patient and considered high priority in severe sepsis; and (3) pediatric considerations. RESULTS: Key recommendations and suggestions, listed by category, include: early quantitative resuscitation of the septic patient during the first 6 h after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm a potential source of infection (UG); administration of broad-spectrum antimicrobials therapy within 1 h of the recognition of septic shock (1B) and severe sepsis without septic shock (1C) as the goal of therapy; reassessment of antimicrobial therapy daily for de-escalation, when appropriate (1B); infection source control with attention to the balance of risks and benefits of the chosen method within 12 h of diagnosis (1C); initial fluid resuscitation with crystalloid (1B) and consideration of the addition of albumin in patients who continue to require substantial amounts of crystalloid to maintain adequate mean arterial pressure (2C) and the avoidance of hetastarch formulations (1B); initial fluid challenge in patients with sepsis-induced tissue hypoperfusion and suspicion of hypovolemia to achieve a minimum of 30 mL/kg of crystalloids (more rapid administration and greater amounts of fluid may be needed in some patients (1C); fluid challenge technique continued as long as hemodynamic improvement is based on either dynamic or static variables (UG); norepinephrine as the first-choice vasopressor to maintain mean arterial pressure ≥65 mmHg (1B); epinephrine when an additional agent is needed to maintain adequate blood pressure (2B); vasopressin (0.03 U/min) can be added to norepinephrine to either raise mean arterial pressure to target or to decrease norepinephrine dose but should not be used as the initial vasopressor (UG); dopamine is not recommended except in highly selected circumstances (2C); dobutamine infusion administered or added to vasopressor in the presence of (a) myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output, or (b) ongoing signs of hypoperfusion despite achieving adequate intravascular volume and adequate mean arterial pressure (1C); avoiding use of intravenous hydrocortisone in adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability (2C); hemoglobin target of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage (1B); low tidal volume (1A) and limitation of inspiratory plateau pressure (1B) for acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure (PEEP) in ARDS (1B); higher rather than lower level of PEEP for patients with sepsis-induced moderate or severe ARDS (2C); recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS (2C); prone positioning in sepsis-induced ARDS patients with a PaO (2)/FiO (2) ratio of ≤100 mm Hg in facilities that have experience with such practices (2C); head-of-bed elevation in mechanically ventilated patients unless contraindicated (1B); a conservative fluid strategy for patients with established ARDS who do not have evidence of tissue hypoperfusion (1C); protocols for weaning and sedation (1A); minimizing use of either intermittent bolus sedation or continuous infusion sedation targeting specific titration endpoints (1B); avoidance of neuromuscular blockers if possible in the septic patient without ARDS (1C); a short course of neuromuscular blocker (no longer than 48 h) for patients with early ARDS and a PaO (2)/FI O (2) 180 mg/dL, targeting an upper blood glucose ≤180 mg/dL (1A); equivalency of continuous veno-venous hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1B); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding in patients with bleeding risk factors (1B); oral or enteral (if necessary) feedings, as tolerated, rather than either complete fasting or provision of only intravenous glucose within the first 48 h after a diagnosis of severe sepsis/septic shock (2C); and addressing goals of care, including treatment plans and end-of-life planning (as appropriate) (1B), as early as feasible, but within 72 h of intensive care unit admission (2C). Recommendations specific to pediatric severe sepsis include: therapy with face mask oxygen, high flow nasal cannula oxygen, or nasopharyngeal continuous PEEP in the presence of respiratory distress and hypoxemia (2C), use of physical examination therapeutic endpoints such as capillary refill (2C); for septic shock associated with hypovolemia, the use of crystalloids or albumin to deliver a bolus of 20 mL/kg of crystalloids (or albumin equivalent) over 5-10 min (2C); more common use of inotropes and vasodilators for low cardiac output septic shock associated with elevated systemic vascular resistance (2C); and use of hydrocortisone only in children with suspected or proven "absolute"' adrenal insufficiency (2C). CONCLUSIONS: Strong agreement existed among a large cohort of international experts regarding many level 1 recommendations for the best care of patients with severe sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for this important group of critically ill patients

Analyse temps/fréquence pour l'identification de signatures pulmonaires par modèles de Markov cachés

Les bruits respiratoires sont employés par le médecin comme des indicateurs de l'état physiologique du patient et lui permettent d'établir son diagnostic. Néanmoins, leur interprétation fait intervenir une grande part de subjectivité, liée à la perceptionThe detection of abnormal respiratory sounds is still carried out by pulmonary auscultation using a stethoscope and implies limitations due to the subjectivity of this process. Indeed, it depends on the individual s own hearing, experience and its abilit

Analyse temps/fréquence pour l'identification de signatures pulmonaires par modèles de Markov cachés

Les bruits respiratoires sont employés par le médecin comme des indicateurs de l'état physiologique du patient et lui permettent d'établir son diagnostic. Néanmoins, leur interprétation fait intervenir une grande part de subjectivité, liée à la perception du médecin. C est pourquoi il est actuellement envisagée une analyse automatique de ces sons dans les buts d'assurer la formation des futurs médecins et d'identifier des pathologies pour l'aide au diagnostic. La structure du signal respiratoire se compose du bruit respiratoire normal sur lequel s'additionne éventuellement un son anormal qui peut être soit transitoire (un craquement, un crépitant), soit musical (un sibilant, un stridor) ou encore un mélange (squawk). Les méthodes développés dans ce travail de thèse concernent l'analyse multirésolution des signaux par des outils bayésiens dans le domaine des paquets d'ondelettes, associés à des modèles markoviens multivariés originaux adaptés au contexte difficile du traitement des sons pulmonaires. Nous proposons ainsi une méthodologie pour l'étude des signaux respiratoires, avec pour ambition la possibilité de traiter un large panel de cas pathologiques. Une méthode basée sur l'analyse multivariée du signal après recalage de portions d'intérêt du signal est présentée. Nous introduisons ensuite un nouveau graphe de Markov adapté à la décomposition en paquets d'ondelettes, dans le but d'une analyse multirésolution des signaux pulmonaires et d'une détection plus précise des caractéristiques statistiques de ces signaux particulièrement variables à la fois en temps et en fréquence.The detection of abnormal respiratory sounds is still carried out by pulmonary auscultation using a stethoscope and implies limitations due to the subjectivity of this process. Indeed, it depends on the individual s own hearing, experience and its ability to differentiate patterns. Nowadays, there is a clear need for a normalization of the diagnosis methodology and for the development of a common framework for all the medical community. In this context, much of the knowledge gained in recent years has resulted from the use of modern digital processing techniques, which leads to objective analysis and comparisons of respiratory sounds. Abnormal respiratory sounds are added to the normal breathing sounds and, according to the American Thoracic Society, they fall in two main categories : continuous sounds (Wheezes, Stridors) and discontinuous sounds (crackles). The methods developped in this thesis concern multiresolution analysis of the signals using bayesian tools in the wavelet packets domain, associated to original Markov models well adapted to the difficult context of lung sounds analysis. We then propose a methodology for the study of respiratory signals, with the ambition to be able to handle a wide panel of pathological cases. First, a method based on multivariate signal analysis after a scaling of interesting features is presented. We then introduce a new Markov graph adapted to the wavelet packet decomposition, with the aim of a multiresolution analysis of the lung signals and a more precise detection of the statistical characteristics of these highly unstable signals