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Acute heart failure care – a consensus series of an international experts' group
No full textInternational audienceThe care of patients hospitalized for acute heart failure (AHF) has been largely unchanged from the early 1960s until a few years ago, consisting mainly of oxygen and diuretics supplemented sometimes by other vasoactive drugs. These treatments, although effective in the short term in controlling congestion, do not prevent early readmissions and death, occurring in over 30% of patients in the 6 months after an AHF hospitalization. In the last years, studies showed that AHF diagnosis can be improved, early diuretic care can be optimized, and early intensive therapy with combined drug regimens can reduce the rate of adverse outcomes. However, unlike acute coronary syndromes, where guidelines have existed since 1996, there are no separate detailed guidelines for AHF. In a series of four papers (International Expert Opinion Series on AHF Management) an international expert group highlights important aspects of AHF care where the evidence base to inform clinical practice is lacking. These papers focus on (1) diagnosis and treatment during prehospital and in the emergency department, (2) management during the first days of admission, (3) care before and after AHF discharge, and (4) hospitalized AHF management in patients presenting with cardiogenic shock, significant valvular disease, or end‐stage renal disease. These papers are not intended to serve as guidelines, but rather to suggest a framework for future recommendations for the diagnosis and treatment of AHF. In the current summary paper, we highlight the main considerations and key recommendations in each of the parts of AHF care
L’hyper-activation sensorielle du corps, une stratégiede survie à l’adolescence
No full textInternational audienceIntroduction :-Conduites ordaliques (prostitution, consommation massive de toxiques, fugues, deals, vols, violences., relations auto-et hétéro-destructrices…) d'adolescents « incasables, insaisissables » suivis par l'Aide Sociale à l'Enfance (ASE) ou placés en Maison d'Enfants à Caractère Social (MECS)Tentatives extrêmes de survie psychique à travers le corps. De fait, le corps hyper-activé peut devenir un moyen d'autoanesthésie sensorielle face à des souvenirs traumatiques anciens ou à des angoisses archaïques de morcellement psychiquePlus qu'une pathologie : stratégie défensive paradoxale.• Tentative simultanée de protéger la psyché, d'éviter l'effondrement narcissique, tout en rendant difficile l'accès à une subjectivation symbolique viable.</div
Analyzing the Impact of Low-Rank Adaptation for Cross-Domain Few-Shot Object Detection in Aerial Images
No full textInternational audienceThis paper investigates the application of LowRank Adaptation (LoRA) to small models for cross-domainfew-shot object detection in aerial images. Originally designedfor large-scale models, LoRA helps mitigate overfitting, makingit a promising approach for resource-constrained settings. Weintegrate LoRA into DiffusionDet, and evaluate its performanceon the DOTA and DIOR datasets. Our results show thatLoRA applied after an initial fine-tuning slightly improvesperformance in low-shot settings (e.g., 1-shot and 5-shot),while full fine-tuning remains more effective in higher-shotconfigurations. These findings highlight LoRA’s potential forefficient adaptation in aerial object detection, encouragingfurther research into parameter-efficient fine-tuning strategiesfor few-shot learning. Our code is available here: https://github.com/HichTala/LoRA-DiffusionDe
Large- limit of -invariant general sextic tensor model
No full textInternational audienceWe study a sextic tensor model where the interaction terms are given by all -invariant bubbles. The class of invariants studied here is thus a larger one that the class of the -invariant sextic tensor model. We implement the large limit mechanism for this general model and we explicitly identify the dominant graphs in the expansion. This class of dominant graphs contains tadpole graphs, melonic graphs but also new types of tensor graphs. Our analysis adapts the tensorial intermediate field method, previously applied only to the prismatic interaction, to all connected sextic interactions except the wheel interaction, which we treat separately using a cycle analysis
Predicting 1‐year heart failure hospitalization and mortality post‐discharge from the intensive cardiac care unit
No full textInternational audienceAbstract Aims Despite the high risk of rehospitalization for heart failure (HF) and death among patients admitted to the intensive cardiac care unit (ICCU), no accurate prediction score for these outcomes exists. We aimed to develop a risk score to predict unplanned HF hospitalization and death 1‐year post‐discharge in an unselected cohort of patients admitted to the ICCU. Methods Based on a national, multicentre study, we included all consecutive patients admitted to the ICCUs in 39 French centres from 7 to 22 April 2021. We randomly selected a training cohort of 21 centres ( n = 1008) to develop the ICCU‐HF score and a validation cohort of eight other centres ( n = 463). The primary composite outcome was unplanned hospitalization for HF and cardiovascular death at 1‐year follow‐up after discharge. Using the score, patients were stratified into three risk groups to evaluate the prognostic value. Results Using a least absolute shrinkage and selection operator (LASSO) regression approach, we identified seven predictors: left ventricular ejection fraction, significant valvular disease grade 2+, Killip score >1, NT‐proBNP, creatinine level, previous ventricular arrhythmia and use of inotropes during hospitalization. In 1471 patients (63 ± 15 years, 70% men), 99 (6.7%) experienced the primary outcome. The ICCU‐HF score outperformed NT‐proBNP, the strongest individual predictor (area under the curve [AUC] 0.77, 95% CI [0.71–0.83] vs. AUC 0.72, 95% CI [0.66–0.79], P = 0.008), demonstrating excellent performance with an AUC of 0.83 (95% CI: 0.77–0.89) to predict outcomes in the validation cohort. Compared with the low‐risk group, the intermediate‐risk and high‐risk groups had significantly higher risks of the composite outcome (HR 4.09, 95% CI [2.23–7.50], P < 0.001 and 12.69, 95% CI [7.02–22.95], P < 0.001), proving strong risk stratification capability of the ICCU‐HF score. Conclusions The ICCU‐HF score showed good performance in predicting the 1‐year risk of unplanned HF hospitalization and death in a large cohort of unselected patients admitted to the ICCU, with excellent results in the validation cohort. This score effectively stratifies patients into risk groups, enhancing its utility in clinical decision‐making
Prognostic Impact of Early Appropriate Antimicrobial Therapy in Critically Ill Patients With Nosocomial Pneumonia Due to Gram-Negative Pathogens: A Multicenter Cohort Study
No full textInternational audienceOBJECTIVES: To evaluate whether early appropriate antimicrobial therapy (EAAT) is associated with improved outcomes in critically ill patients with hospital-acquired pneumonia (HAP), ventilated HAP (vHAP), or ventilator-associated pneumonia (VAP) involving Gram-negative bacteria (GNB). DESIGN: Retrospective cohort study based on prospectively collected data. SETTING: Thirty-two French ICUs (OutcomeRéa network). PATIENTS: All patients with a first HAP, vHAP, or VAP due to GNB during their ICU stay. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The relationship between EAAT and day 28 all-cause mortality (primary endpoint) was explored through Cox proportional-hazard models, with subgroup analyses according to pneumonia types, causative GNB, features of EAAT, and the occurrence of septic shock at pneumonia diagnosis. The course of Sequential Organ Failure Assessment (SOFA) score values, the clinical cure rate at day 14, and the time to mechanical ventilation (MV) weaning and ICU discharge after pneumonia diagnosis were investigated as secondary endpoints. Among the 804 included patients, 495 (61.6%) received EAAT (single-drug, 25.4%; combination, 36.2%). Day 28 mortality was 32.6%. EAAT was not independently associated with this outcome (adjusted hazard ratio, 0.87; 95% CI, 0.67–1.12). This result was confirmed in subgroup analyses as in a second model considering all episodes of pneumonia occurring during the ICU stay. EAAT was not associated with a faster decrease in SOFA score values ( p = 0.11), a higher day 14 clinical cure rate (overall, 43.7%), or a shorter MV duration (cause-specific hazard ratio [HR] for extubation, 0.84; 95% CI, 0.69–1.01) or ICU stay (cause-specific HR for discharge alive, 0.85; 95% CI, 0.72–1.00). CONCLUSIONS: In this study, EAAT was not associated with a reduced day 28 mortality, a faster resolution of organ failure, a higher day 14 clinical cure rate, or a shorter time to MV weaning or ICU discharge in critically ill patients with HAP, vHAP, or VAP due to GNB. However, a prognostic benefit from EAAT cannot be ruled out due to lack of statistical power
Le cadrage populiste de problèmes publics dans les dystopies jeunesse des années 2010
No full textInternational audienceParticularly popular among young people in the 2010s, the dystopian movies The Hunger Games, Divergent, and The Maze Runner depict controversial issues, offering young people a gateway into the public sphere. Nevertheless, the framing of these public issues encourages the (re)production of populist discourse based on binary oppositions that simplify social reality, such as the structuring elite-people opposition, but also the resulting oppositions between women-culprits and men-victims, lies-truth, and city-suburbs.Particulièrement populaires chez les jeunes dans les années 2010, les films dystopiques Hunger Games, Divergente et Le Labyrinthe mettent en scène des controverses, offrant une porte d’entrée à la jeunesse au sein de l’espace public. Néanmoins, le cadrage de ces problèmes publics favorise la (re)production de discours populistes fondés sur des couples d’opposition binaires simplifiant la réalité sociale telle que celle, structurante, élite-peuple, mais aussi les oppositions femmes-coupables hommes-victimes, mensonge-vérité, et ville-périphérie, qui en découlent
La revue Partisans (et l'Amérique latine)
No full textInternational audienceThis text is a brief preview of an in-depth study that will be published in book form and addresses the relationship between the French magazine Partisans (and several of its key figures) and the political processes that took place in Latin America during the period of its publication (from 1961 to 1972). The aim of this article is to present both the publication and its editor, François Maspero, focusing on the case of the Cuban Revolution, given its relationship with the magazine's founding moment. It should be noted that this is the first academic research in Spanish dedicated exclusively to Partisans. In addition, both for the preparation of this text and for the entire project, we have had access to (and in physical form) of all 68 issues published by the magazine, material that has constituted the primary source of the work, an access that is practically unprecedented.Este texto constituye un breve adelanto de una investigación a profundidad que aparecerá en forma de libro y que aborda las relaciones de la revista francesa Partisans (y de varios de sus protagonistas) con los procesos políticos que se desarrollaron en Latinoamérica durante el periodo de su publicación (de 1961 a 1972). Así, el objetivo en este artículo es hacer una presentación tanto de la publicación como de su director, François Maspero, haciendo foco en el caso de la Revolución cubana, dada su relación con el momento fundacional de la revista. Hay que mencionar que ésta constituye la primera investigación académica en español dedicada exclusivamente Partisans. Además, tanto para la elaboración de este texto como para la totalidad del proyecto, se ha contado con el acceso y con la disponibilidad general de forma física de todos los 68 números que fueron publicados por la revista, material que ha constituido la fuente primaria del trabajo, un acceso que es prácticamente inédito.Ce texte constitue un bref aperçu d'une recherche approfondie qui paraîtra sous forme de livre et qui aborde les relations entre le revue française Partisans (et plusieurs de ses protagonistes) et les processus politiques qui se sont déroulés en Amérique latine pendant la période de sa publication (de 1961 à 1972). L'objectif de cet article est donc de présenter à la fois la publication et son directeur, François Maspero, en mettant l'accent sur le cas de la révolution cubaine, compte tenu de son lien avec la création du magazine. Il convient de mentionner qu'il s'agit de la première recherche universitaire en espagnol consacrée exclusivement à Partisans. En outre, tant pour l'élaboration de ce texte que pour l'ensemble du projet, nous avons eu accès et nous avons disposé de l'ensemble des 68 numéros publiés par la revue (à des exemplaires imprimés), qui ont constitué la source principale de ce travail, un accès pratiquement inédit