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Arts du cirque et compétences scolaires
No full textInternational audienceEn quoi la pratique des arts du cirque peut-elle participer au développement de compétences scolaires ? Une proposition faite aux enseignants, à partir de techniques d'animation dédiées aux enfants avec des troubles du spectre de l'autisme (TSA)
Viral and immune dynamics of genital human papillomavirus infections in young women with high temporal resolution
No full textInternational audienceHuman papillomavirus (HPV) infections drive one in 20 new cancer cases, exerting a particularly high burden on women. Most anogenital HPV infections are cleared in less than two years, but the underlying mechanisms that favour persistence in around 10% of women remain largely unknown. Notwithstanding, it is precisely this information that is crucial for improving treatment, screening, and vaccination strategies. To understand viral and immune dynamics in non-persisting HPV infections, we set up an observational longitudinal cohort study with frequent on-site visits for biological sample collection. We enrolled 189 women aged from 18 to 25 and living in the area of Montpellier (France) between 2016 and 2020. We performed 974 on-site visits for a total of 1,619 months of follow-up. We collected data on virus load, local immune cell populations, local concentrations of cytokines, and circulating antibody titres. Using hierarchical Bayesian statistical modelling to simultaneously analyse the data from 164 HPV infections from 76 participants, we show that in two months after infection, HPV viral load in non-persisting infections reaches a plateau that lasts on average for 13 to 20 months (95% credibility interval) and is then followed by a rapid clearance phase. This first description of the dynamics of HPV infections comes with the identification of immune correlates associated with infection clearance, especially gamma-delta T cells and CXCL10 concentration. A limitation of this study on HPV kinetics is that many infection follow-ups are censored. Furthermore, some immune cell populations are difficult to label because cervical immunity is less well characterised than systemic immunity. These results open new perspectives for understanding the frontier between acute and chronic infections, and for controlling HPV-associated diseases, as well as for research on human cancers of infectious origin. Trial Registration: This trial was registered is registered at ClinicalTrials.gov under the ID NCT02946346 . This study has been approved by the Comité de Protection des Personnes (CPP) Sud Méditerranée I (reference number 2016-A00712-49); by the Comité Consultatif sur le Traitement de l’Information en matière de Recherche dans le domaine de la Santé (reference number 16.504); by the Commission Nationale Informatique et Libertés (reference number MMS/ABD/ AR1612278, decision number DR-2016–488), by the Agence Nationale de Sécurité du Médicament et des Produits de Santé (reference 20160072000007)
Incremental prognostic value of late gadolinium enhancement granularity using cardiac MRI in patients with hypertrophic cardiomyopathy
No full textInternational audienceIntroductionTo enhance risk stratification for sudden cardiac death (SCD), the European Society of Cardiology (ESC) has recently added the extent of late gadolinium enhancement (LGE) using cardiac MRI in the guidelines, setting a threshold at ≥ 15% of left ventricular mass. While previous studies have showed the prognostic value of LGE extent to predict all-cause mortality, the prognostic impact of additional LGE features is not well established.ObjectiveWe aimed to assess the incremental prognostic value of the granularity of LGE using cardiac MRI including extent, location, and pattern in patients with HCM to predict all-cause death.MethodBetween 2008 and 2021, all patients referred for HCM assessment using cardiac MRI, without history of coronary artery disease (CAD) or clinical history of myocarditis were prospectively recruited in two French centers. The outcome was all-cause death using the French National Registry of Death. The concept of “LGE granularity” was defined as a model combining LGE extent, location, and pattern. Using nested Cox proportional hazard models, the additional predictive value was assessed by C-statistic increment, continuous net reclassification improvement (NRI), integrative discrimination index (IDI) and global Chi2.ResultsAmong 2672 included patients (52 ± 7 years, 56% males), 862 (32%) had LGE. After a median (IQR) follow-up of 9 (7–11) years, 447 (17%) patients died. The presence of LGE was strongly associated with the risk of all-cause death (log-rank P < 0.001, Figure 1A). Even after adjustment for known prognosticators, the presence of LGE was still associated with all-cause death (adjusted hazard ratio (HR) 3.96, 95% CI: 3.26–4.80, P < 0.001). In the subgroup of patients with LGE (n = 862), survival curves showed that the “LGE granularity model” was associated with a higher risk of all-cause death (all P < 0.001, Figure 1B). A nested Cox model adjusted on known prognosticators showed that the LGE extent, location and pattern were all independently associated with all-cause death (all P < 0.001, Figure 1C). The “LGE granularity model” combining all these LGE features showed the best improvement in model discrimination and reclassification over and above known prognosticators (C-statistic improvement: 0.90; NRI = 41.9%; IDI = 13.2%, Chi2 global = 450, all P < 0.001; LR-test P < 0.001).ConclusionIn a large cohort of HCM, LGE granularity model (extent, location, and pattern of LGE) had an incremental prognostic value above traditional prognosticators to predict all-cause death
Geometry of Sparsity-Inducing Norms
No full textInternational audienceSparse optimization seeks an optimal solution with few nonzero entries. To achieve this, it is common to add to the criterion a penalty term proportional to the ℓ1-norm, which is recognized as the archetype of sparsity-inducing norms. In this approach, the number of nonzero entries is not controlled a priori. By contrast, in this paper, we focus on finding an optimal solution with at most~k nonzero coordinates (or for short, k-sparse vectors), where k is a given sparsity level (or ``sparsity budget''). For this purpose, we study the class of generalized k-support norms that arise from a given source norm. When added as a penalty term, we provide conditions under which such generalized k-support norms promote k-sparse solutions. The result follows from an analysis of the exposed faces of closed convex sets generated by k-sparse vectors, and of how primal support identification can be deduced from dual information. Finally, we study some of the geometric properties of the unit balls for the k-support norms and their dual norms when the source norm belongs to the family of ℓp-norms
Impact on clinical guideline adherence of Orient-COVID, a clinical decision support system based on dynamic decision trees for COVID19 management: A randomized simulation trial with medical trainees
No full textInternational audienceBackground: The adherence of clinicians to clinical practice guidelines is known to be low, including for the management of COVID-19, due to their difficult use at the point of care and their complexity. Clinical decision support systems have been proposed to implement guidelines and improve adherence. One approach is to permit the navigation inside the recommendations, presented as a decision tree, but the size of the tree often limits this approach and may cause erroneous navigation, especially when it does not fit in a single screen. Methods: We proposed an innovative visual interface to allow clinicians easily navigating inside decision trees for the management of COVID-19 patients. It associates a multi-path tree model with the use of the fisheye visual technique, allowing the visualization of large decision trees in a single screen. To evaluate the impact of this tool on guideline adherence, we conducted a randomized controlled trial in a near-real simulation setting, comparing the decisions taken by medical trainees using Orient-COVID with those taken with paper guidelines or without guidance, when performing on six realistic clinical cases. Results: The results show that paper guidelines had no impact (p=0.97), while Orient-COVID significantly improved the guideline adherence compared to both other groups (p<0.0003). A significant impact of Orient-COVID was identified on several key points during the management of COVID-19: ordering troponin lab tests, prescribing anticoagulant and oxygen therapy. A multifactor analysis showed no difference between male and female participants. Conclusions: The use of an interactive decision tree for the management of COVID-19 significantly improved the clinician adherence to guidelines. Future works will focus on the integration of the system to electronic health records and on the adaptation of the system to other clinical conditions
Interview avec le quotidien le SOLEIL
No full texthttps://urlz.fr/urmp?fbclid=IwY2xjawQBQeZleHRuA2FlbQIxMABicmlkETFQRlRBVWg0M281QlRLZWZhc3J0YwZhcHBfaWQQMjIyMDM5MTc4ODIwMDg5MgABHv8F3V7nkfGs_CqfbHuapzPPvSCF2zxbN5LlL6uA8rUouF-w2BMTGSRqpISy_aem_Kf8nrpvFAN7pVVjtLfwOA
