Combiner connaissances expertes, hors-ligne, transientes et en ligne pour l'exploration Monte-Carlo

National audienceNous combinons pour de l'exploration Monte-Carlo d'arbres de l'apprentissage arti- RÉSUMÉ. ficiel à 4 échelles de temps : – regret en ligne, via l'utilisation d'algorithmes de bandit et d'estimateurs Monte-Carlo ; – de l'apprentissage transient, via l'utilisation d'estimateur rapide de Q-fonction (RAVE, pour Rapid Action Value Estimate) qui sont appris en ligne et utilisés pour accélérer l'explora- tion mais sont ensuite peu à peu laissés de côté à mesure que des informations plus fines sont disponibles ; – apprentissage hors-ligne, par fouille de données de jeux ; – utilisation de connaissances expertes comme information a priori. L'algorithme obtenu est plus fort que chaque élément séparément. Nous mettons en évidence par ailleurs un dilemne exploration-exploitation dans l'exploration Monte-Carlo d'arbres et obtenons une très forte amélioration par calage des paramètres correspondant. We combine for Monte-Carlo exploration machine learning at four different time ABSTRACT. scales: – online regret, through the use of bandit algorithms and Monte-Carlo estimates; – transient learning, through the use of rapid action value estimates (RAVE) which are learnt online and used for accelerating the exploration and are thereafter neglected; – offline learning, by data mining of datasets of games; – use of expert knowledge coming from the old ages as prior information

Combiner connaissances expertes, hors-ligne, transientes et en ligne pour l'exploration Monte-Carlo

National audienceNous combinons pour de l'exploration Monte-Carlo d'arbres de l'apprentissage arti- RÉSUMÉ. ficiel à 4 échelles de temps : – regret en ligne, via l'utilisation d'algorithmes de bandit et d'estimateurs Monte-Carlo ; – de l'apprentissage transient, via l'utilisation d'estimateur rapide de Q-fonction (RAVE, pour Rapid Action Value Estimate) qui sont appris en ligne et utilisés pour accélérer l'explora- tion mais sont ensuite peu à peu laissés de côté à mesure que des informations plus fines sont disponibles ; – apprentissage hors-ligne, par fouille de données de jeux ; – utilisation de connaissances expertes comme information a priori. L'algorithme obtenu est plus fort que chaque élément séparément. Nous mettons en évidence par ailleurs un dilemne exploration-exploitation dans l'exploration Monte-Carlo d'arbres et obtenons une très forte amélioration par calage des paramètres correspondant. We combine for Monte-Carlo exploration machine learning at four different time ABSTRACT. scales: – online regret, through the use of bandit algorithms and Monte-Carlo estimates; – transient learning, through the use of rapid action value estimates (RAVE) which are learnt online and used for accelerating the exploration and are thereafter neglected; – offline learning, by data mining of datasets of games; – use of expert knowledge coming from the old ages as prior information

Prevalence of urinary incontinence in Andorra: impact on women's health.

BACKGROUND: Urinary incontinence (UI) is a frequent public health problem with negative social consequences, particularly for women. Female susceptibility is the result of anatomical, social, economic and cultural factors. The main objectives of this study are to evaluate the prevalence of UI in the female population of Andorra over the age of 15 and, specifically, to determine the influence of socio-demographic factors. A secondary aim of the study is to measure the degree of concern associated with UI and whether the involved subjects have asked for medical assistance, or not. METHODS: Women aged 15 and over, answered a self-administered questionnaire while attending professional health units in Andorra during the period November 1998 to January 2000. A preliminary study was carried out to ensure that the questionnaire was both understandable and simple. RESULTS: 863 completed questionnaires were obtained during a one year period. The breakdown of the places where the questionnaires were obtained and filled out is as follows: 32.4% – medical specialists' offices; 31.5% – outpatient centres served exclusively by nurses; 24% – primary care doctors' offices; 12% from other sources. Of the women who answered the questionnaire, 37% manifested urine losses. Of those,45.3% presented regular urinary incontinence (RUI) and 55.7% presented sporadic urinary incontinence (SporadicUI). In those women aged between 45 and 64, UI was present in 56% of the subjects. UI was more frequent among parous than non-parous women. UI was perceived as a far more bothersome and disabling condition by working, middle-class women than in other socio-economic groups. Women in this particular group are more limited by UI, less likely to seek medical advice but more likely to follow a course of treatment. From a general point of view, however, less than 50% of women suffering from UI sought medical advice. CONCLUSION: The prevalence of UI in the female population of Andorra stands at about 37%, a statistic which should encourage both health professionals and women to a far greater awareness of this condition

Efficacy of Anakinra in Refractory Adult-Onset Still's Disease: Multicenter Study of 41 Patients and Literature Review

Adult-onset Still's disease (AOSD) is often refractory to standard therapy. Anakinra (ANK), an interleukin-1 receptor antagonist, has demonstrated efficacy in single cases and small series of AOSD. We assessed the efficacy of ANK in a series of AOSD patients. Multicenter retrospective open-label study. ANK was used due to lack of efficacy to standard synthetic immunosuppressive drugs and in some cases also to at least 1 biologic agent. Forty-one patients (26 women/15 men) were recruited. They had a mean age of 34.4 ± 14 years and a median [interquartile range (IQR)] AOSD duration of 3.5 [2-6] years before ANK onset. At that time the most common clinical features were joint manifestations 87.8%, fever 78%, and cutaneous rash 58.5%. ANK yielded rapid and maintained clinical and laboratory improvement. After 1 year of therapy, the frequency of joint and cutaneous manifestations had decreased to 41.5% and to 7.3% respectively, fever from 78% to 14.6%, anemia from 56.1% to 9.8%, and lymphadenopathy from 26.8% to 4.9%. A dramatic improvement of laboratory parameters was also achieved. The median [IQR] prednisone dose was also reduced from 20 [11.3-47.5] mg/day at ANK onset to 5 [0-10] at 12 months. After a median [IQR] follow-up of 16 [5-50] months, the most important side effects were cutaneous manifestations (n = 8), mild leukopenia (n = 3), myopathy (n = 1), and infections (n = 5). ANK is associated with rapid and maintained clinical and laboratory improvement, even in nonresponders to other biologic agents. However, joint manifestations are more refractory than the systemic manifestations

Cut-offs and response criteria for the Hospital Universitario la Princesa Index (HUPI) and their comparison to widely-used indices of disease activity in rheumatoid arthritis

Objective To estimate cut-off points and to establish response criteria for the Hospital Universitario La Princesa Index (HUPI) in patients with chronic polyarthritis. Methods Two cohorts, one of early arthritis (Princesa Early Arthritis Register Longitudinal PEARL] study) and other of long-term rheumatoid arthritis (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide EMECAR]) including altogether 1200 patients were used to determine cut-off values for remission, and for low, moderate and high activity through receiver operating curve (ROC) analysis. The areas under ROC (AUC) were compared to those of validated indexes (SDAI, CDAI, DAS28). ROC analysis was also applied to establish minimal and relevant clinical improvement for HUPI. Results The best cut-off points for HUPI are 2, 5 and 9, classifying RA activity as remission if =2, low disease activity if >2 and =5), moderate if >5 and <9 and high if =9. HUPI''s AUC to discriminate between low-moderate activity was 0.909 and between moderate-high activity 0.887. DAS28''s AUCs were 0.887 and 0.846, respectively; both indices had higher accuracy than SDAI (AUCs: 0.832 and 0.756) and CDAI (AUCs: 0.789 and 0.728). HUPI discriminates remission better than DAS28-ESR in early arthritis, but similarly to SDAI. The HUPI cut-off for minimal clinical improvement was established at 2 and for relevant clinical improvement at 4. Response criteria were established based on these cut-off values. Conclusions The cut-offs proposed for HUPI perform adequately in patients with either early or long term arthritis

The comparative responsiveness of Hospital Universitario Princesa Index and other composite indices for assessing rheumatoid arthritis activity

Objective To evaluate the responsiveness in terms of correlation of the Hospital Universitario La Princesa Index (HUPI) comparatively to the traditional composite indices used to assess disease activity in rheumatoid arthritis (RA), and to compare the performance of HUPI-based response criteria with that of the EULAR response criteria. Methods Secondary data analysis from the following studies: ACT-RAY (clinical trial), PROAR (early RA cohort) and EMECAR (pre-biologic era long term RA cohort). Responsiveness was evaluated by: 1) comparing change from baseline (Delta) of HUPI with Delta in other scores by calculating correlation coefficients; 2) calculating standardised effect sizes. The accuracy of response by HUPI and by EULAR criteria was analyzed using linear regressions in which the dependent variable was change in global assessment by physician (Delta GDA-Phy). Results Delta HUPI correlation with change in all other indices ranged from 0.387 to 0.791); HUPI's standardized effect size was larger than those from the other indices in each database used. In ACT-RAY, depending on visit, between 65 and 80% of patients were equally classified by HUPI and EULAR response criteria. However, HUPI criteria were slightly more stringent, with higher percentage of patients classified as non-responder, especially at early visits. HUPI response criteria showed a slightly higher accuracy than EULAR response criteria when using Delta GDA-Phy as gold standard. Conclusion HUPI shows good responsiveness in terms of correlation in each studied scenario (clinical trial, early RA cohort, and established RA cohort). Response criteria by HUPI seem more stringent than EULAR''s

Computed digital absorptiometry of the hand: screening method of bone loss in postmenopausal women with RA

Dual energy x ray absorptiometry (DXA) is the most commonly used method of measuring bone mineral density (BMD); it has been shown to be a good predictor of the future risk of fracture.1Unfortunately, the generalised use of DXA is limited as it is expensive and time consuming, is not portable, and is available only in specialised clinics.#N##N#Computed digital absorptiometry (CDA) of the hand is a new bone densitometry technique, designed to assess the BMD of the middle phalanx of the third finger using a direct, automated measurement of x ray attenuation.2This technique is similar to radiographic absorptiometry but provides immediate results; in current radiographic absorptiometry, radiographs are sent to an off site processing centre and the results are received a few days later. CDA is cheap and quick. Its precision and accuracy seem to be acceptable, but its ability to discriminate between patients with osteoporosis and normal subjects, to predict risk of

Value of clinical factors in selecting postmenopausal women with rheumatoid arthritis for bone densitometry

OBJECTIVE—Criteria to decide which patients with rheumatoid arthritis (RA) should be examined by dual energy x ray absorptiometry (DXA) are currently not available. The rheumatologists from Amsterdam have proposed preliminary criteria based on clinical risk factors (age, disease activity, and functional status). These criteria are preliminary and not widely accepted but might be helpful in practice. The value of the proposal in a group of Spanish postmenopausal women with RA is analysed.
METHODS—DXA (lumbar spine and femoral neck) was performed in 128 patients recruited from a clinical setting, and the proposed criteria were applied. T and Z scores were established for a Spanish reference population.
RESULTS—The mean (SD) age of the patients was 61.3 (10.7) and mean duration of the postmenopausal period 14.5 (10.1) years. Mean duration of RA was 13.7 (7.7) years. Mean C reactive protein was 22 (21) mg/l; mean erythrocyte sedimentation rate 26 (18) mm/1st h; and mean Health Assessment Questionnaire score 1.25 (0.79). Ninety (70%) patients fulfilled the proposed criteria. Their sensitivity for the diagnosis of osteoporosis (T score ⩽−2.5 SD) was 86% and their specificity, 43%. Positive predictive value was 54% and negative predictive value, 79%.
CONCLUSIONS—The proposed criteria seem a good screening method for the selection of those patients with RA whose bone mineral density should be assessed as the sensitivity and negative predictive value are acceptable.