Care management of the agitation or aggressiveness crisis in patients with TBI. Systematic review of the literature and practice recommendations

AbstractThe agitation crisis in the awakening phase after traumatic brain injury (TBI) is one of the most difficult behavioral disorders to alleviate. Current treatment options are heterogeneous and may involve excessive sedation. Practice guidelines are required by professionals in charge of TBI patients. Few reviews were published but those are old and based on expert opinions. The purpose of this work is to propose evidence-based guidelines to treat the agitation crisis.MethodsThe elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement. Guidelines were elaborated on the basis of a systematic and critical review of the literature.ResultsTwenty-eight articles concerning 376 patients were analyzed. Recommendations are: when faced with an agitation crisis, the management strategy implies to search for an underlying factor that should be treated such as pain, acute sepsis, and drug adverse effect (expert opinion). Physical restraints should be discarded when possible (expert opinion). Neuroleptic agent with a marketing authorization can be used in order to obtain a quick sedation so as to protect the patient from himself, closed ones or the healthcare team but the duration should be as short as possible (expert opinion). The efficacy of beta-blockers and antiepileptics with mood regulation effects like carbamazepine and valproate yield the most compelling evidence and should be preferably used when a background regimen is envisioned (grade B for beta-blocker and C for antiepileptics). Neuroleptics, antidepressants, benzodiazepines, buspirone may be prescribed but are considered second-line treatments (expert opinion).ConclusionThis study provides a strategy for treating the agitation crisis based on scientific data and expert opinion. The level of evidence remains low and published data are often old. New studies are essential to validate results from previous studies and test new drugs and non-pharmaceutical therapies

Une malformation médiastinale exceptionnelle (à propos d'une observation)

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Efficacité et tolérance du jus de canneberges dans la prévention des infections urinaires récidivantes chez le blessé médullaire hospitalisé/Caroline Parneix

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Detection and Recognition of Erasures in On-Line Captured Paper Forms

International audienceThis paper presents a method to automatically locate and recognize erasures in on-line captured handwritten documents in order to avoid a subsequent misrecognition of characters and words. We offer a comprehensive definition of the ambiguous concept of erasure in handwriting that results in a more accurate characterization of the different types of erasures. Thanks to this characterization, a preprocessing step, placed upstream of the word recognition engine, enables to classify through an MLP each couple of connected strokes as being an erasure or not using a low-level feature set. We evaluate our system on a real handwritten document database and show how our system can be tuned to operate in accordance with various recognition engines thus leading to high performance in erasure detection and recognition

Erasure Extraction in On-Line Captured Paper Forms

http://www.suvisoft.comIn this paper, we describe a preprocessing system which locates erasures in on-line captured handwritten documents. Our approach is conceived so as to be placed upstream of the handwritten recognition engine. This system classifies each couple of connected strokes using a low level feature set and a multi layer perceptron classifier. One part of this study gives an efficient definition of erasure, which results in splitting the two original classes of the problem into nineteen more accurate sub-classes. The tunable tolerance level of the system provides a good flexibility to operate in accordance with various recognition engines. We evaluate our system on a real document database and present encouraging performance results

Localisation des ratures dans les formulaires papier numérisés en ligne

International audienceDans cet article, nous présentons un système de prétraitement capable de localiser les ratures dans des documents papier manuscrits numérisés en ligne. Notre approche a été de concevoir un moteur de reconnaissance des ratures placé en amont de la reconnaissance d'écriture. Ce système classe des couples de strokes connectées, grâce à un ensemble de caractéristiques de bas niveau et un perceptron multi couches. Une partie de l'étude s'attache à produire une définition précise de la notion de rature, et aboutit à une subdivision des deux classes originelles du problème. Le système issu de cette première approche présente des performances encourageantes. Il bénéficie en outre d'un niveau de tolérance paramétrable lui permettant de s'adapter à différents moteurs de reconnaissance

Organisation territoriale de la filière méthanisation

National audienceWhy and how organize biogas plant on a territory?Pourquoi et comment se questionner sur l'organisation territoriale des unités de méthanisation

LES using a Discontinuous Galerkin Method: isotropic turbulence, channel flow and periodic flow

peer reviewe

Implicit LES of free and wall bounded turbulent flows based on the discontinuous Galerkin/symmetric interior penalty method

This paper presents the second validation step of a compressible discontinuous Galerkin solver with symmetric interior penalty (DGM/SIP) for the direct numerical simulation (DNS) and the large eddy simulation (LES) of complex flows. The method has already been successfully validated for DNS of an academic flow and has been applied to flows around complex geometries (e.g. airfoils and turbomachinery blades). During these studies, the advantages of the dissipation properties of the method have been highlighted, showing a natural tendency to dissipate only the under-resolved scales (i.e the smallest scales present on the mesh), leaving the larger scales unaffected. This phenomenon is further enhanced as the polynomial order is increased. Indeed, the order increases the dissipation at the largest wave numbers, while its range of impact is reduced. These properties are spectrally compatible with a subgrid-scale model, and hence DGM may be well suited to be used for an implicit LES (ILES) approach. A validation of this DGM/ILES approach is here investigated on canonical flows, allowing to study the impact of the discretisation on the turbulence for under-resolved computations. The first test case is the LES of decaying homogeneous isotropic turbulence (HIT) at very high Reynolds number. This benchmark allows to assess the spectral behaviour of the method for implicit LES. The results are in agreement with theory and are even slightly more accurate than other numerical results from literature, obtained using a pseudo-spectral (PS) method with a state-of-the-art subgrid-scale model. The second benchmark is the LES of the channel flow. Three Reynolds numbers are considered: Reτ=395, 590 and 950. The results are compared with DNS of Moser et al. and Hoyas et al., also using PS methods. Both averaged velocity and fluctuations are globally in good agreement with the reference, showing the ability of the method to predict equilibrium wall-bounded flow turbulence. To show that the method is able to perform accurate DNS, a DNS of HIT at Reλ=64 and a DNS of the channel flow at Reτ=180 are also performed. The effects of the grid refinement are investigated on the channel flow at Reτ=395, highlighting the improvement of the results when refining the mesh in the spanwise direction. Finally, the modification of the ILES parameters, that is the Riemann solver and of the SIP coefficient, is studied on both cases, showing a significant influence on the choice of the Riemann solver