Trans-radial coronary intervention (TCI) using 5-Fr versus 6-Fr guiding catheters in the setting of acute coronary syndrome (ACS)

Background: As in any vascular access the size of guiding catheter is an operator preference. Although multiple studies showed the use of 5-Fr versus 6-Fr guiding catheters for Transradial coronary intervention (TCI) have similar vascular safety profile and can be performed safely and successfully with both of them, the data comparing the 5-Fr vs 6-Fr guiding catheters for TCI in terms of fluoroscopy time, procedure time and contrast amount in the setting of ACS is limited. We conducted this study to compare the use of 5-Fr versus 6-Fr guiding catheters for TCI in the settings of ACS. Method: Our study is a single center, retrospective cohort study designed to compare the use of 5-Fr versus 6-Fr guiding catheters for TCI in the setting of ACS. In the period between July 2014 and July 2015, all patients who had previously undergone PCI with at least one stent being placed, utilizing a radial access, and using a 5Fr or 6Fr guiding catheter were included. No exclusion criteria were applied. The study was approved by Marshall University’s institutional review board. Results: There was a significant reduction in the volume of contrast medium used with the 5 Fr group compared to the 6 Fr group (130.66 +/- 3.46 ml vs. 166.25 +/- 10.05 ml in the 5 and 6 Fr groups, respectively; p < 0.001), fluoroscopy time (12.62 +/- 0.50 min vs. 16.61 +/- 1.28 min in the 5 and 6 Fr groups, respectively; p = 0.005) and there was also significant reduction in the procedure time in the 5 Fr group (38.74 +/- 1.27 min vs. 46.03 +/- 2.86 min in the 5 and 6 Fr groups, respectively; p = 0.023). Conclusion: TCI in the settings of ACS is safe and feasible, whether using 5 Fr or 6 Fr catheters. Our study concluded that using 5 Fr catheters for TCI could be preferred for patients presenting with ACS due to lower amount of contrast medium used and less fluoroscopy and procedure time. However, this is a single center retrospective study, so we suggest that large randomized controlled studies are needed

Ammonia vs. Lactic Acid in Predicting Positivity of Microbial Culture in Sepsis: The ALPS Pilot Study

Objective: The use of serum ammonia as a novel marker for sepsis compared to lactic acid levels in intensive care unit (ICU) patients. Design and Interventions: Single arm, prospective clinical trial to collect arterial blood samples from patients with sepsis. Serial ammonia and lactic acid levels were sent every six hours for a total of three days. Measurements and results: Compare mean levels of ammonia and lactic acid in terms of diagnosing sepsis and patient outcome, including length of stay and mortality. A total of 30 patients were enrolled in the pilot study. On admission, mean ammonia level was 35.7 μmol/L and lactic acid was 3.06 mmole/L. Ammonia levels checked at the end of day 2 (ammonia 2-4) and the beginning of day 3 (ammonia 3-1) were higher in patients who had a microbial culture-proven sepsis (p-values 0.029 and 0.002, respectively) compared to those without culture-positive sepsis. Ammonia levels did predict a longer hospital stay; ammonia level of more than 40 μmol/L had a mean hospital stay of 17.6 days vs. patients with normal levels who had a mean hospital stay of 9.62 days (p-value 0.0082). Conclusion: Elevated ammonia level can be a novel biomarker for sepsis, comparable to conventional markers. Ammonia levels have a prognostic utility as elevated levels were associated with longer hospital stay

XAI: Using Smart Photobooth for Explaining History of Art

The rise of Artificial Intelligence has led to advancements in daily life, including applications in industries, telemedicine, farming, and smart cities. It is necessary to have human-AI synergies to guarantee user engagement and provide interactive expert knowledge, despite AI’s success in "less technical" fields. In this article, the possible synergies between humans and AI to explain the development of art history and artistic style transfer are discussed. This study is part of the "Smart Photobooth" project that is able to automatically transform a user’s picture into a well-known artistic style as an interactive approach to introduce the fundamentals of the history of art to the common people and provide them with a concise explanation of the various art painting styles. This study investigates human-AI synergies by combining the explanation produced by an explainable AI mechanism with a human expert’s insights to provide reasons for school students and a larger audience

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

AQUAMan: QoE-driven cost-aware mechanism for SaaS acceptability rate adaptation

International audienceAs more interactive and multimedia-rich applications are migrating to the cloud, end-user satisfaction and her Quality of Experience (QoE) will become a determinant factor to secure success for any Software as a Service (SaaS) provider. Yet, in order to survive in this competitive market, SaaS providers also need to maximize their Quality of Business (QoBiz) and minimize costs paid to cloud providers. However, most of the existing works in the literature adopt a provider-centric approach where the end-user preferences are overlooked. In this article, we propose the AQUAMan mechanism that gives the provider a fine-grained QoE-driven control over the service acceptability rate while taking into account both end-users' satisfaction and provider's QoBiz. The proposed solution is implemented using a multi-agent simulation environment. The results show that the SaaS provider is capable of attaining the predefined acceptability rate while respecting the imposed average cost per user. Furthermore, the results help the SaaS provider identify the limits of the adaptation mechanism and estimate the best average cost to be invested per user

One-to-Many Multi-agent Negotiation and Coordination Mechanisms to Manage User Satisfaction

International audienceQuality of Experience (QoE) is defined as the measure of end-user satisfaction with the service. Existing works addressing QoE-management rely on a binary vision of end-user satisfaction. This vision has been criticized by the growing empirical evidence showing that QoE is rather a degree. The aim of this article is to go beyond this binary vision and propose a QoE management mechanism. In particular, we propose a one-to-many negotiation mechanism allowing the provider to undertake satisfaction management : to meet fine-grained user QoE goals, while still minimizing the costs. This problem is formulated as an optimization problem, for which a linear model is proposed. For reference, a generic linear program solver is used to find the optimal solution, and an alternative heuristic algorithm is devised in order to improve the responsiveness, when the system has to scale up with fast growing number of users. Both are implemented and experimentally evaluated against state-of-the-art one-to-many negotiation frameworks

Négociation multi-agent « un-à-plusieurs » et mécanismes de coordination pour la gestion de la satisfaction des utilisateurs d'un service

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AgentOil: A Multiagent-Based Simulation of the Drilling Process in Oilfields

International audienceOil&Gas have become the world’s most important source of energy since the mid-1950’s. For instance; Britain oilfields produce each year about 76 million tonnes of oil equivalent. This provides 76% of the UK’s total primary energy [5]. In oilfields wells, a drilling rig is used to create a bore-hole in the earth’s sub-surface with a Bottom Hole Assembly (BHA), which is a composition of several drilling tools with various functionalities, searching for natural resources

Towards a Real-time Mitigation of High Temperature while Drilling using a Multi-agent System

International audienceIn oilfield wells, while drilling for several kilometers below surface, high temperature damages the drilling tools. This costs money and time for tripping operations to change the damaged tool. Existing temperature mitigation techniques have several drawbacks including a long response time, analogue signal issues and human intervention. In this work, we empower the down-hole tools with a coordination mechanism to mitigate high temperature in soft real time by controlling a down-hole actuator through a voting process. The tools are represented by agents that control the sensors and actuators embedded in these tools. To implement the proposed system properly, a model of the drilling domain is constructed with all drilling mechanics and parameters, along with the well trajectory and temperature equations taken into consideration. The proposed model is implemented and tested using AgentOil, a multi-agent-based simulation tool, and the results are evaluated. Furthermore , the requirements of a real-time temperature mitigation system for Oil&Gas drilling operations are identified and the constraints of such systems are analyzed

One-to-many negotiation QoE management mechanism for end-user satisfaction

Quality of Experience (QoE) is defined as the measure of end-user satisfaction with the service. Most of the existing works addressing QoE-management rely on a binary vision of end-user satisfaction. This vision has been criticized by the growing empirical evidence showing that QoE is rather a degree. This article aims to go beyond the binary vision and propose a QoE management mechanism. We propose a one-to-many negotiation mechanism allowing the provider to undertake satisfaction management: to meet fine-grained user QoE goals, while still minimizing the costs. This problem is formulated as an optimization problem, for which a linear model is proposed. For reference, a generic linear program solver is used to find the optimal solution, and an alternative heuristic algorithm is devised to improve the responsiveness when the system has to scale up with a fast-growing number of users. Both are implemented and experimentally evaluated against state-of-the-art one-to-many negotiation frameworks