Définition d'une fonction de pronostic des systèmes techniques multi composants prenant en compte les incertitudes à partir des pronostics de leurs composants

Face au défi des entreprises pour le maintien de leurs équipements au maximum de leur fiabilité, de leur disponibilité, de leur rentabilité et de leur sécurité au coût de maintenance minimum, des stratégies de maintenance telles que le CBM et le PHM ont été développées. Pour mettre en œuvre ces stratégies, comme pour la planification des activités de production il est nécessaire de connaître l’aptitude des systèmes à réaliser les futures tâches afin de réaliser le séquencement des opérations de production et de maintenance. Cette thèse présente les éléments d'une fonction générique qui évalue la capacité des systèmes techniques multi-composants à exécuter les tâches de production de biens ou de services assignées. Ce manuscrit présente une proposition de modélisation de systèmes techniques multi-composants représentant les différentes entités qui les composent, leurs états et leurs relations. Plusieurs types d’entités ont été identifiés. Pour chacun d’eux, des inférences sont proposées pour définir à l’intérieur du système l’aptitude de l’entité à accomplir les futures tâches de production à partir des évaluations de son état présent et futur et des évaluations des états présents et futurs des autres entités avec lesquelles elle est en relation. Ces évaluations des états présents et futurs sont basées sur l’exploitation de pronostics locaux des composants. Ces pronostics sont des prévisions qui intrinsèquement comportent des incertitudes pouvant être aléatoires ou épistémiques. La fonction proposée et les inférences prennent en compte ces deux formes d’incertitudes. Pour cela, les traitements et la fonction proposée exploite des éléments de la théorie de Dempster-Shafer. La modélisation des systèmes multi-composants pouvant être représentée sous la forme de graphes dont les états des nœuds dépendent de données comportant des incertitudes, des éléments des réseaux bayésiens sont également utilisés. Cette fonction fournit des indicateurs, sur l’aptitude de chaque entité du système à accomplir les futures tâches de production mais aussi indique les composants nécessitant une intervention afin d’améliorer cette aptitude. Ainsi, ces indicateurs constituent les éléments d'aide à la décision pour la planification des opérations de maintenance de façon conditionnelle et préventive, mais aussi pour la planification des opérations de production

Assessment method of the multicomponent systems future ability to achieve productive tasks from local prognoses

Conditioned-based maintenance and prognostics and health management enable to optimize maintenance by scheduling the necessary repairs and replacements of technical system components according to their present and future health states. The assessment of future health states is the prognostics and health management keystone. Many technical production systems are made of numerous components implementing their functions. A method to assess the ability of multicomponent systems to carry out future production tasks is proposed to provide decision supports for production and maintenance planning for a better compromise between their objectives. It is based on components prognoses. To handle inherent uncertainties of these prognoses, the method is based on the Dempster Shafer theory and Bayesian networks inferences. Local prognoses are categorized and transformed to be compliant to Dempster Shafer theory. Patterns of systems are identified for which inferences are defined. The patterns are then used to model systems and to assess their abilities to achieve future tasks. An identification of components that should first undergo maintenance is proposed. An example implementing a fictitious complex systems is presented to show how the provided decision supports can be used for production and maintenance planning purposes

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Definition of a generic prognostic function of technical multi-component systems taking into account the uncertainties of the predictions of their components

Face au défi des entreprises pour le maintien de leurs équipements au maximum de leur fiabilité, de leur disponibilité, de leur rentabilité et de leur sécurité au coût de maintenance minimum, des stratégies de maintenance telles que le CBM et le PHM ont été développées. Pour mettre en œuvre ces stratégies, comme pour la planification des activités de production il est nécessaire de connaître l’aptitude des systèmes à réaliser les futures tâches afin de réaliser le séquencement des opérations de production et de maintenance. Cette thèse présente les éléments d'une fonction générique qui évalue la capacité des systèmes techniques multi-composants à exécuter les tâches de production de biens ou de services assignées. Ce manuscrit présente une proposition de modélisation de systèmes techniques multi-composants représentant les différentes entités qui les composent, leurs états et leurs relations. Plusieurs types d’entités ont été identifiés. Pour chacun d’eux, des inférences sont proposées pour définir à l’intérieur du système l’aptitude de l’entité à accomplir les futures tâches de production à partir des évaluations de son état présent et futur et des évaluations des états présents et futurs des autres entités avec lesquelles elle est en relation. Ces évaluations des états présents et futurs sont basées sur l’exploitation de pronostics locaux des composants. Ces pronostics sont des prévisions qui intrinsèquement comportent des incertitudes pouvant être aléatoires ou épistémiques. La fonction proposée et les inférences prennent en compte ces deux formes d’incertitudes. Pour cela, les traitements et la fonction proposée exploite des éléments de la théorie de Dempster-Shafer. La modélisation des systèmes multi-composants pouvant être représentée sous la forme de graphes dont les états des nœuds dépendent de données comportant des incertitudes, des éléments des réseaux bayésiens sont également utilisés. Cette fonction fournit des indicateurs, sur l’aptitude de chaque entité du système à accomplir les futures tâches de production mais aussi indique les composants nécessitant une intervention afin d’améliorer cette aptitude. Ainsi, ces indicateurs constituent les éléments d'aide à la décision pour la planification des opérations de maintenance de façon conditionnelle et préventive, mais aussi pour la planification des opérations de production.One major challenge of companies consists in maintaining their technical production resources at the maximum level of reliability, availability, profitability and safety for a minimum maintenance cost, maintenance strategies such as CBM and PHM have been developed. To implement these strategies, as with production activity planning, it is necessary to know the ability of systems to perform future tasks to order production and maintenance operations. This thesis presents the generic function that evaluates the ability of multi-component technical systems to perform the production tasks of goods or services. This manuscript presents a proposal for the modelling of multi-component technical systems representing the different entities that compose them, their states and their relationships. Several types of entities have been identified. For each of them, inferences are proposed to define within the system the entity's ability to perform future production tasks based on its own assessment of its present and future state and the assessments of the present and future states of the other entities with which it is involved. These assessments of present and future states are based on the use of local prognoses of components. These prognoses are predictions that inherently involve uncertainties that may be aleatory or epistemic. The proposed function and inferences take into account these two kinds of uncertainty. To do this, the inferences and the proposed function uses elements of the Dempster-Shafer theory. Since the modelling of multi-component systems can be represented in the form of graphs whose node states depend on data with uncertainties, elements of Bayesian networks are also used. This function provides indicators on the ability of each system entity to perform future production tasks but also indicates the components that require maintenance to improve this ability. Thus, these indicators constitute the elements of decision support for the planning of maintenance operations in a conditional and preventive way, but also for the planning of production tasks

Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity

Background The impact of the COVID-19 pandemic on paediatric populations varied between high-income countries (HICs) versus low-income to middle-income countries (LMICs). We sought to investigate differences in paediatric clinical outcomes and identify factors contributing to disparity between countries.Methods The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) COVID-19 database was queried to include children under 19 years of age admitted to hospital from January 2020 to April 2021 with suspected or confirmed COVID-19 diagnosis. Univariate and multivariable analysis of contributing factors for mortality were assessed by country group (HICs vs LMICs) as defined by the World Bank criteria.Results A total of 12 860 children (3819 from 21 HICs and 9041 from 15 LMICs) participated in this study. Of these, 8961 were laboratory-confirmed and 3899 suspected COVID-19 cases. About 52% of LMICs children were black, and more than 40% were infants and adolescent. Overall in-hospital mortality rate (95% CI) was 3.3% [=(3.0% to 3.6%), higher in LMICs than HICs (4.0% (3.6% to 4.4%) and 1.7% (1.3% to 2.1%), respectively). There were significant differences between country income groups in intervention profile, with higher use of antibiotics, antivirals, corticosteroids, prone positioning, high flow nasal cannula, non-invasive and invasive mechanical ventilation in HICs. Out of the 439 mechanically ventilated children, mortality occurred in 106 (24.1%) subjects, which was higher in LMICs than HICs (89 (43.6%) vs 17 (7.2%) respectively). Pre-existing infectious comorbidities (tuberculosis and HIV) and some complications (bacterial pneumonia, acute respiratory distress syndrome and myocarditis) were significantly higher in LMICs compared with HICs. On multivariable analysis, LMIC as country income group was associated with increased risk of mortality (adjusted HR 4.73 (3.16 to 7.10)).Conclusion Mortality and morbidities were higher in LMICs than HICs, and it may be attributable to differences in patient demographics, complications and access to supportive and treatment modalities

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes

The value of open-source clinical science in pandemic response: lessons from ISARIC

International audienc