A Functional Reasoning Framework and Dependency Modeling Scheme for Mechatronics Conceptual Design Support

RÉSUMÉ La conception mécatronique est un processus de design pluridisciplinaire, il repose sur l'intégration synergique des domaines d’ingénierie mécanique, électrique, contrôle et logiciel pour concevoir des produits qui surpassent les autres produits en termes d'efficacité, de précision, de coût et de fiabilité. Toutefois, cela a un coût, la conception de systèmes multidisciplinaire est une tâche ardue qui exige beaucoup de coordination et de coopération entre les ingénieurs concepteurs. Beaucoup de ces difficultés ont été reportées dans les domaines académique et industriel. Il en ressort que la communication technique entre les concepteurs appartenant à diverses disciplines d’ingénierie se fait très difficilement et ce en raison de l'absence d'un langage commun pour représenter les différents concepts. Ceci entraîne des difficultés majeures à transférer les modèles et les informations pertinentes entre les domaines ce qui entrave la possibilité d’appliquer un processus de développement intégré (concurrent). Pourtant, d’une part, un processus de conception intégré et dynamique doit être suivi pour réduire le temps de conception du projet et ainsi réduire les couts et supporter l'innovation. D’autre part, la conception multidisciplinaire se traduit par l’introduction d’un grand nombre de dépendances durant la conception, rendant ainsi les activités de conception difficile à synchroniser entravant le processus intégré. En raison de l'absence d'outil de support informatique pour le design conceptuel, et l'importance de considérer les dépendances le plus tôt possible dans le processus de conception, un cadre de raisonnement fonctionnel en conjonction avec un système de modélisation des dépendances (liées au produit) ont été développés dans ce mémoire de maîtrise. Le cadre de raisonnement fonctionnel a été réalisé par la personnalisation du langage SysML (Systems Modeling Language), et par le développement d’un module d’extension (plug-in) dans l'outil de modélisation MagicDraw (No Magic, Inc.). Le plug-in intègre un système expert à base de règles (CLIPS : C Language Integrated Production System - NASA) qui permet d’encapsuler les connaissances d'ingénierie sous la forme de règles pour analyser et effectuer des tâches sur des diagrammes fonctionnels. Une nouvelle approche d'acquisition et une représentation schématique de dépendances ont été proposées. La notion de "méta-dépendances» a été introduite pour modéliser les dépendances qui sont partagées par un grand nombre d'éléments dans un même système.----------ABSTRACT Mechatronics is a multidisciplinary design process that relies on the synergic integration of mechanical, electrical, control, and software engineering to deliver products that outperform their competitors in terms of efficiency, precision, cost and reliability. However, this comes at a cost, designing multi-disciplinary systems is a challenging task that requires a lot of coordination and cooperation between designers. Several challenges are reported by both academic and industry-related literature. One of the most important is the tedious communication between engineering designers from various disciplines due to a lack of a common language to represent concepts. This leads to difficulties in transferring models and pertinent information between domains. To succeed in nowadays competitive markets, a concurrent and dynamic design process should be followed to reduce the project lead-time and spark innovation. However, such a process results in many dependencies as a consequence of multi-disciplinary design and it is often difficult to streamline the design activities. Due to the lack of existing computational support tools for conceptual design of mechatronics and the importance of taking dependencies (product related) into account as early as possible in the design process, a functional reasoning framework as well as a dependency modeling scheme were developed in this master thesis. The functional reasoning framework was realised by customizing the SysML (Systems Modeling Language) language and developing a plug-in in the modeling tool MagicDraw (No Magic, Inc.). The plug-in integrates the rule-based expert system CLIPS (C Language Integrated Production System - NASA) that allows encapsulating engineering knowledge in the form of rules to analyze and perform tasks on functional diagrams. A new acquisition method and representation scheme of dependencies was proposed in this master thesis. The concept of “meta-dependency” was introduced to model dependencies shared by a large number of elements in a same mechatronic system or sub-system. It allows engineering designers to efficiently and abstractly capture dependencies early in the deign process and reduces the number of relationships to be built manually between dependent elements in the system

Impact of the inpatient infectious disease consultations at a tertiary care university hospital

BACKGROUND: The role of the infectious disease specialist continues to evolve. The purpose of this study is to demonstrate the value of infectious disease consultation in the inpatient setting. METHODS: This is a prospective cohort study that took place in a tertiary care university hospital. During the period from April to June 2016, 224 cases of patients receiving antibiotics in the hospital with the request of an infectious diseases’ consultation, were evaluated. The following variables were assessed: the referring department, purpose of the consultation, the antibiotic used before requesting the infectious diseases consultation, the antibiotic modifications after the infectious disease’s visit, whenever the antibiotic usage was switched to a mono or bi-therapy. RESULTS: The most frequent requesting departments were Oncology (23.2%) and Urology (21.4%). The purpose of the consultations was diagnosis (29%), therapy (41%), both diagnosis and therapy (21%), and prophylaxis (9%). An infectious diseases consultation was given at a rate of 4.9 consultations per 100 hospitalized patients. Antibiotic was discontinued in 14.7% of cases. There was no indication for the antibiotic treatment in 11.6% of cases. Modifying the antibiotic therapy was done in 25.4% of cases. Adjusting the antibiotic dosage was done in only one case. Carbapenem antibiotics were discontinued in 31.6 % of cases and Quinolones discontinuation accounted for 22.7% of cases. CONCLUSION: Infectious disease consults contributed to the optimization of the diagnostic and therapeutic approaches for suspected or confirmed infections in hospitalized patients

Quality of life, treatment beliefs, and treatment satisfaction in children treated for primary immunodeficiency with SCIg

Despite the development of subcutaneous treatment, children and adolescents with primary immunodeficiency (PID) are vulnerable to a lower quality of life (QoL) than non-clinical participants. Comparisons have been offered in rare reports with limited sample sizes. No description is available of treatment beliefs and treatment satisfaction with standard tools. The objective of this study was to describe a large sample of patients with pediatric PID on QoL, treatment beliefs and satisfaction, and identify perceived benefits and issues of treatment both in children and parents. A mail-back survey was conducted in 60 patients with PID treated with subcutaneous Ig and their parents from a clinic in Montreal (QC, Canada). We used the standardized tools to assess for QoL levels, beliefs of necessity and concerns with treatment, and dimensions of satisfaction. We collected and coded perceived benefits and issues through open-ended questions. We found lower QoL in children with PID than in healthy non-clinical participants (median d = 0.40) and similar QoL levels to children with cancer (median d = 0.12). Participants considered their treatment as less necessary and able to control the illness and less convenient than patients with other conditions. Children were more prone to consider the treatment as convenient (69 vs. 47% p = .028) but reported more discomfort (24 vs. 10% p = .043) than parents. Results suggest a lower-than-expected QoL in pediatric PID. Aspects of the illness and treatment are probably unclear to patients and their families, as necessity beliefs were lower than expected. Educational strategies should be developed and assessed to address this issue

Subcutaneous Immunoglobulin Replacement Therapy with Hizentra® is Safe and Effective in Children Less Than 5 Years of Age.

BACKGROUND:Hizentra® (IGSC 20%) is a 20% liquid IgG product approved for subcutaneous administration in adults and children 2 years of age and older who have primary immunodeficiency disease (PIDD). There is limited information about the use of IGSC 20 % in very young children including those less than 5 years of age. METHODS:A retrospective chart review involved 88 PIDD infants and children less than 5 years of age who received Hizentra®. RESULTS:The mean age at the start of Hizentra® was 34 months (range 2 to 59 months). IGSC 20 % was administered weekly to 86 infants (two additional infants received twice weekly and three times weekly infusions, respectively) and included an average of 63 infusions (range 6-182) for an observation period up to 45.5 months. Infusion by manual delivery occurred in 15 patients. The mean dose was 674 mg/kg/4 weeks. The mean IgG level was 942 mg/dL while on IGSC 20 %, compared to a mean trough IgG level of 794 mg/dL (p < 0.0001) during intravenous or subcutaneous IgG administration prior to IGSC 20 %. Average infusion time was 47 (range 5-120) minutes, and the median number of infusion sites was 2 (range 1-4). Local reactions were mostly mild and observed in 36/88 (41%) children. No serious adverse events were reported. A significant increase in weight percentile (7 % ± 19.2, p = 0.0012) among subjects was observed during IGSC 20% administration. The rate of serious bacterial infections was 0.067 per patient-year while receiving IGSC 20%, similar to previously reported efficacy studies. CONCLUSIONS:Hizentra® is effective in preventing infections, and is well tolerated in children less than age 5 years

CMV reactivation in COVID-19 patients: pouring fuel on the fire

Severe SARS-CoV-2 infection could promote CMV reactivation, that further worsens disease prognosis. This study included admitted patients with recent COVID-19 for one year period in a tertiary hospital, having clinical criteria of CMV reactivation and positive CMV DNAemia. Fifteen of 559 COVID-19 patients were diagnosed with CMV reactivation (2.7%). 86.6% were male, with a mean age of 63.6 years. Immunodepression was significantly higher in the CMV positive group (p=0.008). Lymphopenia was significantly more important in patients who reactivated CMV (p=<0.001), whereas ferritin level (p=0.019) and IL-6 level (p=0.035) on admission appeared to be significantly lower in this group. There was no significant difference for COVID-19 treatments. ICU admission (p<0 .001) and bacterial infections (p<0.001) appeared to be significant for CMV reactivation. Also, the mortality was significantly higher in the CMV positive group (p=0.042). This study raises the possible incrimination of lymphopenia, immunosuppression, critical illness, and bacterial infections in CMV reactivation

Rapamycin as an Adjunctive Therapy for NLRC4 Associated Macrophage Activation Syndrome

Gain of function (GOF) mutations affecting the inflammasome component NLRC4 are known to cause early-onset macrophage activation syndrome (MAS) and neonatal enterocolitis. Here we report a patient with a NLRC4 GOF mutation presenting with neonatal MAS efficiently treated with a combination of anakinra and rapamycin. Through in vitro studies, we show that rapamycin reduces both IL-1β and IL-18 secretion by the patient's phagocytic cells. The reduction of cytokine secretion is associated with a reduction of caspase-1 activation regardless of the pathogen- or danger-associated molecular patterns triggering the activation of the inflammasome. This study suggests that patients with inherited auto-inflammatory disorders could benefit from an adjunctive therapy with rapamycin