Clinically applicable deep learning for diagnosis and referral in retinal disease

The volume and complexity of diagnostic imaging is increasing at a pace faster than the availability of human expertise to interpret it. Artificial intelligence has shown great promise in classifying two-dimensional photographs of some common diseases and typically relies on databases of millions of annotated images. Until now, the challenge of reaching the performance of expert clinicians in a real-world clinical pathway with three-dimensional diagnostic scans has remained unsolved. Here, we apply a novel deep learning architecture to a clinically heterogeneous set of three-dimensional optical coherence tomography scans from patients referred to a major eye hospital. We demonstrate performance in making a referral recommendation that reaches or exceeds that of experts on a range of sight-threatening retinal diseases after training on only 14,884 scans. Moreover, we demonstrate that the tissue segmentations produced by our architecture act as a device-independent representation; referral accuracy is maintained when using tissue segmentations from a different type of device. Our work removes previous barriers to wider clinical use without prohibitive training data requirements across multiple pathologies in a real-world setting

Something less reduced person and full-fledged person : a distribued act with the impaired patient in a physical medecine and rehabilitation service

La thèse porte sur l’accompagnement de patients atteints de déficiences motrices handicapantes soumis à l’épreuve intime de soi à la suite d’une atteinte radicale du corps. Elle repose sur une enquête ethnographique, associant observations et entretiens, menée dans deux structures hospitalières du CHU de Saint-Etienne : le service de Soins de Rééducation Post Réanimation, dit SRPR et, pour une plus grande part, le service de Médecine Physique et Réadaptation, dit MPR. En présentant le travail de « recapacitation » de la personne à l’épreuve d’un nouveau corps devenu « non autonome », la thèse explore le travail relationnel entre les professionnels de santé et le patient au cours des soins et des activités de rééducation fonctionnelle, mais aussi la manière dont sont inclus les proches, afin d’infléchir la perception de la situation de handicap et de construire collectivement un projet acceptable de vie après le séjour en milieu hospitalier. Cette perspective donne à voir la manière dont, face aux fortes contraintes de l’épreuve intime de soi, la parole partagée devient ressource pour faire advenir les interactions et engager ainsi le patient dans la réappropriation intrasubjective de son corps et intersubjective de la continuité de son être. Une place importante est donnée au parcours des patients tétraplégiques, un cas extrême et à part dans la prise en charge des patients en MPR. La thèse présente une chronique du vécu de ces patients particuliers, et montre ainsi la spécificité des « étapes » passées, qui structurent l’expérience du corps « non autonome » et de la personne qui, devenue « dépendante », est incluse dans un collectif d’actants humains – les professionnels de santé, les proches mais aussi d’objets techniques, au sein duquel son agir est distribué. Le récit rend compte des temps et des moments vécus par ces patients dans ce collectif, au cours d’une prise en charge pouvant se compter en mois, voire en années, en déclinant les activités ordinaires des chambres, celles du plateau technique, celles des réunions de professionnels et enfin celles, exceptionnelles, d’un dispositif de rencontre ad hoc qui réunit un collectif d’anciens patients venus avec leurs conjointes et un patient tétraplégique et sa compagne afin de finaliser le projet de retour de ce dernier dans l’espace social ordinaire.The doctoral thesis focuses on the assistance of functional impaired patients passing throug a personal self experience following a severe physical injury. It is based on an ethnographic inquiry, combining observations and interviews that have been conducted in two hospital services of Saint-Etienne’s UH. The first service is the functional rehabilitation recovery service and, for the major part, the other is the physical medecine and rehabilitation service. In presenting the « recapacitation » work of a person experimenting a new « non autonomous » body, the thesis explores relations between the medical professionals and patients, during the care and functional rehabilitation activities, but also the way in which relatives are included, in order to impact the perception of the handicap situation and to build collectively an acceptable life project after the hospital stay. This perspective reveals how to confront strong constraints of personal self experience by sharing words, this last become as a ressource to bring into the interactions and thus to engage the patient in an intrasubjective reappropriation of his body and an intersubjective continuity of his being. An important place is given to the hospitalization of quadriplegic patients, which is an extreme case and apart in the patient’s care in the physical medecine and rehabilitation service. The thesis presents a chronicle of a lived experience of these particular patients and thus shows the specificity of the process taken place in order to structure the experience of non autonomous body and to the one who has become dependent, and included in a collective composed of human actors medical professionals, relatives but also technical objects in which his act is distribued. The narrative takes into consideration the time and the moments experienced by these patients in this collective, during the care which can be counted by months and sometimes by years, by describing the ordinary activities in the rooms, those of the technical installations, those of professional’s meetings, finally and exceptionally a meeting’s structure where a group of former patients come with their spouses and a quadriplegic patient accompanied by his partner, to finalize the project of his return to an ordinary social environment

Les industries du luxe en France: La mort silencieuse du geste artisanal

La mort silencieuse du geste artisanal Résumé Les savoir-faire artisanaux, indispensables à la survie de l'industrie du luxe française, disparaissent aujourd'hui faute de formations adaptées et de candidats aux métiers manuels. Alors que les petits acteurs du luxe cherchent désespérément à survivre, nous sommes aveuglés par les résultats des grands groupes et oublions les façonniers qui constituent le socle de cette industrie. Dans un pays en crise et malgré la bonne volonté des institutions publiques, le monde politique et l'opinion sont restés jusqu'ici dans l'indifférence et oublient le rayonnement potentiel de ce secteur profitable qui pourrait embaucher et mettre en valeur des savoir-faire ancestraux issus de nos terroirs. Les raisons de cette désaffection sont avant tout psychologiques : l'industrie du luxe, perçue comme frivole et élitiste, n'est aujourd'hui pas assumée par la société française, ce qui empêche l'Etat de considérer comme stratégique un secteur pourtant central dans son économie

Carbonates thermal decomposition kinetics and their implications in using Rock-Eval ® analysis for carbonates identification and quantification

International audienceIn 2014, Pillot et al. [Identification and quantification of carbonate species using Rock-Eval pyrolysis,Oil Gas Sci. Technol. – Rev. IFP 69, 341–349. https://doi.org/10.2516/ogst/2012036] proposed to use the Rock-Eval® method as a reliable tool to identify and quantify carbonates in solid samples from the CO2 flux emittedby their progressive thermal decomposition during programmed heating under oxidant atmosphere. Nevertheless,several phenomena associated with the thermal decomposition of carbonates were not explained by theseauthors. This paper attempts to explain these phenomena by adding 5 new carbonate species to the 9 studiedby Pillot et al. https://doi.org/10.2516/ogst/2012036 and by developing a kinetic approach to the thermaldecomposition of carbonates. It appears that the kinetics of thermal decomposition of most carbonates is notof order 1 but varies according to carbonate species. Consequently, the thermal decomposition temperature varieswith both the sample weight and the temperature rate applied. The thermal stability of simple carbonates isexplained by the electronegativity of the cations associated with the carbonate anion. Our study provides furtherinsights into the use of Rock-Eval for the identification and quantification of different carbonate species

La formation et les actions de prévention

Former les professionnels de santé en leur apportant des informations scientifiques solides est une priorité. Informer et donner des conseils pratiques permet de répondre aux inquiétudes de la population sur les perturbateurs endocriniens. Plan : - Le réseau Îsée et les perturbateurs endocriniens ;-- Le réseau, ses missions et réalisations ;-- Le réseau et les perturbateurs endocriniens ;- Agir pour bébé ;- Le programme Nesting : sensibiliser et protéger la santé des femmes enceintes et des enfants ;- Formation des professionnels de santé : les outils pour comprendre et agir ;-- Méthodologie d’élaboration ;-- Organisation et contenu ;-- Déploiement ;-- Perspectives ;- Améliorer la lisibilité de l’étiquetage des produits ménagers : ce que prévoit le PNSE 4 ;-- Améliorer la lisibilité de l’étiquetage des produits ménagers

Phylogenetic structure of body shape in a diverse inland ichthyofauna

Abstract Body shape is a fundamental metric of animal diversity affecting critical behavioral and ecological dynamics and conservation status, yet previously available methods capture only a fraction of total body-shape variance. Here we use structure-from-motion (SFM) 3D photogrammetry to generate digital 3D models of adult fishes from the Lower Mississippi Basin, one of the most diverse temperate-zone freshwater faunas on Earth, and 3D geometric morphometrics to capture morphologically distinct shape variables, interpreting principal components as growth fields. The mean body shape in this fauna resembles plesiomorphic teleost fishes, and the major dimensions of body-shape disparity are similar to those of other fish faunas worldwide. Major patterns of body-shape disparity are structured by phylogeny, with nested clades occupying distinct portions of the morphospace, most of the morphospace occupied by multiple distinct clades, and one clade (Acanthomorpha) accounting for over half of the total body shape variance. In contrast to previous studies, variance in body depth (59.4%) structures overall body-shape disparity more than does length (31.1%), while width accounts for a non-trivial (9.5%) amount of the total body-shape disparity

Integument-Specific Transcriptional Regulation in the Mid-Stage of Flax Seed Development Influences the Release of Mucilage and the Seed Oil Content

International audienceFlax (Linum usitatissimum L.) seed oil, which accumulates in the embryo, and mucilage, which is synthesized in the seed coat, are of great economic importance for food, pharmaceutical as well as chemical industries. Theories on the link between oil and mucilage production in seeds consist in the spatio-temporal competition of both compounds for photosynthates during the very early stages of seed development. In this study, we demonstrate a positive relationship between seed oil production and seed coat mucilage extrusion in the agronomic model, flax. Three recombinant inbred lines were selected for low, medium and high mucilage and seed oil contents. Metabolite and transcript profiling (1H NMR and DNA oligo-microarrays) was performed on the seeds during seed development. These analyses showed main changes in the seed coat transcriptome during the mid-phase of seed development (25 Days Post-Anthesis), once the mucilage biosynthesis and modification processes are thought to be finished. These transcriptome changes comprised genes that are putatively involved in mucilage chemical modification and oil synthesis, as well as gibberellic acid (GA) metabolism. The results of these integrative biology approach, suggest that transcriptional regulations of seed oil and fatty acid (FA) metabolism could occur in the seed coat during the mid-stage of seed development, once the seed coat carbon supplies have been used for mucilage biosynthesis and mechanochemical properties of the mucilage secretory cells