Le Projet SI–RIL et l’intégration de la technologie dans le réseau de la santé du Québec

Le Projet SI–RIL a pour objectif d’améliorer l’accessibilité, la rapidité et la continuité des services de santé à Laval en permettant un échange d’information clinique entre les établissements du réseau de la santé, les cliniques médicales et les services diagnostiques publics et privés de Laval. Ce projet bien qu’ayant reçu un avis favorable de la Commission d’Accès à l’Information du Québec soulève néanmoins certaines questions que le présent article vise à mettre de l’avantThe SI-RIL project has for objective to improve the accessibility, the speed and the continuity of health services in Laval by allowing a clinical exchange of information between the establishments of the health network, the private medical clinics and the public and private diagnostic services of Laval. Although the Commission d'accès à l’information du Québec issued a favorable opinion regarding the project, the Commission raises certain questions that this article aims to address

Élaboration et expérimentation d'une méthodologie agile permettant la migration vers une architecture orientée services en PME à l'aide d'OpenUP

Une architecture orientée services (Services-Oriented Architecture ou SOA) se base fréquemment sur les services Web. Souvent, les progiciels et les systèmes patrimoniaux ne supportent pas nativement les services Web. Une organisation aura la plupart du temps un historique technologique avec lequel elle devra composer. Pour ces raisons, l’implantation d’une SOA impliquera généralement la réingénierie de plusieurs composantes logicielles. Elle impliquera également une connaissance des processus et de l’architecture de l’entreprise. Les plus petites organisations n’ont pas toujours une documentation très élaborée des processus d’affaire de l’entreprise. Ce sont des organisations qui réagissent rapidement au changement. Afin de les encourager à utiliser une approche plus rigoureuse, il faut leur offrir des outils efficaces et légers. L’objectif de cette maîtrise est de concevoir une méthode légère et ouverte qui permettra aux PME d’implanter une architecture orientée services de manière itérative et incrémentale à l’aide des services Web et d’un cadre de développement agile. Cette méthode inclut des activités au niveau de l’entreprise afin d’aligner les projets SOA avec les besoins d’affaires et l’environnement technologique de l’entreprise. La stratégie utilisée pour réaliser cette méthode est d’identifier un ensemble de méthodes existantes qui abordent ces différents aspects, de les intégrer en une seule méthode documentée et de l’expérimenter. Dans le cadre de ce travail, un partenaire industriel a été sollicité afin de tester et valider la méthode. Des projets spécifiques ont été sélectionnés afin de faire la réingénierie de certaines composantes logicielles dans le but de migrer graduellement vers une SOA. Ces tests ont permis d’identifier des artéfacts particulièrement importants dans la méthode. De ces travaux découlent une nouvelle méthode ouverte intégrant les activités d’architecture d’entreprise, les activités orientées services et les activités de développement logiciel classique. Bien que plusieurs améliorations soient toujours possibles, la méthode élaborée dans le cadre de ces travaux est intégrée et documentée, que ce soit directement ou dans la littérature des méthodologies originales

Parameterized Algorithms for Finding Square Roots

We show that the following two problems are fixed-parameter tractable with parameter k: testing whether a connected n-vertex graph with m edges has a square root with at most n − 1 + k edges and testing whether such a graph has a square root with at least m − k edges. Our first result implies that squares of graphs obtained from trees by adding at most k edges can be recognized in polynomial time for every fixed k ≥ 0; previously this result was known only for k = 0. Our second result is equivalent to stating that deciding whether a graph can be modified into a square root of itself by at most k edge deletions is fixed-parameter tractable with parameter k

Incidence and main factors associated with early unplanned hospital readmission among French medical inpatients aged 75 and over admitted through emergency units

Background: among elderly patients, readmission in the month following hospital discharge is a frequent occurrence which involves a risk of functional decline, particularly among frail subjects. While previous studies have identified risk factors of early readmission, geriatric syndromes, as markers of frailty have not been assessed as potential predictors. Objective: to evaluate the risk of early unplanned readmission, and to identify predictors in inpatients aged 75 and over, admitted to medical wards through emergency departments. Design: prospective multi-centre study. Setting: nine French hospitals. Subjects: one thousand three hundred and six medical inpatients, aged 75 and older admitted through emergency departments (SAFES cohort). Methods: using logistic regressions, factors associated with early unplanned re-hospitalisation (defined as first unplanned readmission in the thirty days after discharge) were identified using data from the first week of hospital index stay obtained by comprehensive geriatric assessment. Results: data from a thousand out of 1,306 inpatients were analysed. Early unplanned readmission occurred in 14.2% of inpatients and was not related with sociodemographic characteristics, comorbidity burden or cognitive impairment. Pressure sores (OR=2.05, 95% CI = 1.0-3.9), poor overall condition (OR = 2.01, 95% CI = 1.3-3.0), recent loss of ability for self-feeding (OR = 1.9, 95% CI = 1.2-2.9), prior hospitalisation during the last 3 months (OR = 1.6, 95% CI = 1.1-2.5) were found to be risk factors, while sight disorders appeared as negatively associated (OR = 0.5, 95% CI = 0.3--0.8). Conclusions: markers of frailty (poor overall condition, pressure sores, prior hospitalisation) or severe disability (for self-feeding) were the most important predictors of early readmission among elderly medical inpatients. Early identification could facilitate preventive strategies in risk grou

Identification of a Proliferation Gene Cluster Associated with HPV E6/E7 Expression Level and Viral DNA Load in Invasive Cervical Carcinoma

Specific HPV DNA sequences are associated with more than 90% of invasive carcinomas of the uterine cervix. Viral E6 and E7 oncogenes are key mediators in cell transformation by disrupting TP53 and RB pathways. To investigate molecular mechanisms involved in the progression of invasive cervical carcinoma, we performed a gene expression study on cases selected according to viral and clinical parameters. Using Coupled Two-Way Clustering and Sorting Points Into Neighbourhoods methods, we identified a Cervical Cancer Proliferation Cluster composed of 163 highly correlated transcripts, many of which corresponded to E2F pathway genes controlling cell proliferation, whereas no primary TP53 targets were present in this cluster. The average expression level of the genes of this cluster was higher in tumours with an early relapse than in tumours with a favourable course (P=0.026). Moreover, we found that E6/E7 mRNA expression level was positively correlated with the expression level of the cluster genes and with viral DNA load. These findings suggest that HPV E6/E7 expression level plays a key role in the progression of invasive carcinoma of the uterine cervix via the deregulation of cellular genes controlling tumour cell proliferation. HPV expression level may thus correspond to a biological marker useful for prognosis assessment and specific therapy of the disease

Loss of independence in Katz's ADL ability in connection with an acute hospitalization: early clinical markers in French older people

Background: The preservation of autonomy and the ability of elderly to carry out the basic activities of daily living, beyond the therapeutic care of any pathologies, appears as one of the main objectives of care during hospitalization. Objectives: To identify early clinical markers associated with the loss of independence in elderly people in short stay hospitals. Methods: Among the 1,306 subjects making up the prospective and multicenter SAFEs cohort study (Sujet Agé Fragile: Évolution et suivi—Frail elderly subjects, evaluation and follow-up), 619 medical inpatients, not disabled at baseline and hospitalized through an emergency department were considered. Data used in a multinomial logistic regression were obtained through a comprehensive geriatric assessment (CGA) conducted in the first week of hospitalization. Dependency levels were assessed at baseline, at inclusion and at 30days using Katz's ADL index. Baseline was defined as the dependence level before occurrence of the event motivating hospitalization. To limit the influence of rehabilitation on the level of dependence, only stays shorter than 30days were considered. Results: About 514 patients were eligible, 15 died and 90 were still hospitalized at end point (n=619). Two-thirds of subjects were women, with a mean age of 83. At day 30 162 patients (31%) were not disabled; 61 (12%) were moderately disabled and 291 severely disabled (57%). No socio-demographic variables seemed to influence the day 30 dependence level. Lack of autonomy (odds ratio (OR)=1.9, 95% confidence interval (CI)=1.2-3.6), walking difficulties (OR=2.7, 95% CI=1.3-5.6), fall risk (OR=2.1, 95% CI=1.3-6.8) and malnutrition risk (OR=2.2, 95% CI=1.5-7.6) were found in multifactorial analysis to be clinical markers for loss of independence. Conclusions: Beyond considerations on the designing of preventive policies targeting the populations at risk that have been identified here, the identification of functional factors (lack of autonomy, walking difficulties, risk of falling) suggests above all that consideration needs to be given to the organization per se of the French geriatric hospital care system, and in particular to the relevance of maintaining sector-type segregation between wards for care of acute care and those involved in rehabilitatio

List coloring in the absence of a linear forest.

The k-Coloring problem is to decide whether a graph can be colored with at most k colors such that no two adjacent vertices receive the same color. The Listk-Coloring problem requires in addition that every vertex u must receive a color from some given set L(u)⊆{1,…,k}. Let Pn denote the path on n vertices, and G+H and rH the disjoint union of two graphs G and H and r copies of H, respectively. For any two fixed integers k and r, we show that Listk-Coloring can be solved in polynomial time for graphs with no induced rP1+P5, hereby extending the result of Hoàng, Kamiński, Lozin, Sawada and Shu for graphs with no induced P5. Our result is tight; we prove that for any graph H that is a supergraph of P1+P5 with at least 5 edges, already List 5-Coloring is NP-complete for graphs with no induced H

QUARITE (quality of care, risk management and technology in obstetrics): a cluster-randomized trial of a multifaceted intervention to improve emergency obstetric care in Senegal and Mali

<p>Abstract</p> <p>Background</p> <p>Maternal and perinatal mortality are major problems for which progress in sub-Saharan Africa has been inadequate, even though childbirth services are available, even in the poorest countries. Reducing them is the aim of two of the main Millennium Development Goals. Many initiatives have been undertaken to remedy this situation, such as the Advances in Labour and Risk Management (ALARM) International Program, whose purpose is to improve the quality of obstetric services in low-income countries. However, few interventions have been evaluated, in this context, using rigorous methods for analyzing effectiveness in terms of health outcomes. The objective of this trial is to evaluate the effectiveness of the ALARM International Program (AIP) in reducing maternal mortality in referral hospitals in Senegal and Mali. Secondary goals include evaluation of the relationships between effectiveness and resource availability, service organization, medical practices, and satisfaction among health personnel.</p> <p>Methods/Design</p> <p>This is an international, multi-centre, controlled cluster-randomized trial of a complex intervention. The intervention is based on the concept of evidence-based practice and on a combination of two approaches aimed at improving the performance of health personnel: 1) Educational outreach visits; and 2) the implementation of facility-based maternal death reviews.</p> <p>The unit of intervention is the public health facility equipped with a functional operating room. On the basis of consent provided by hospital authorities, 46 centres out of 49 eligible were selected in Mali and Senegal. Using randomization stratified by country and by level of care, 23 centres will be allocated to the intervention group and 23 to the control group. The intervention will last two years. It will be preceded by a pre-intervention one-year period for baseline data collection. A continuous clinical data collection system has been set up in all participating centres. This, along with the inventory of resources and the satisfaction surveys administered to the health personnel, will allow us to measure results before, during, and after the intervention. The overall rate of maternal mortality measured in hospitals during the post-intervention period (Year 4) is the primary outcome. The evaluation will also include cost-effectiveness.</p> <p>Trial Registration</p> <p>The QUARITE trial is registered on the Current Controlled Trials website under the number ISRCTN46950658 <url>http://www.controlled-trials.com/</url>.</p