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Accurate diagnosis of heart failure and improved perioperative outcomes
No full textInternational audienceWith an ageing world population and increasing prevalence, heart failure is increasingly frequent as a comorbidity in operative patients, and its accurate preoperative diagnosis is essential to improve postoperative prognosis in patients undergoing noncardiac surgery. Use of electronic health records to assist in the accuracy of diagnosis and definition of an adjudicated heart failure reference standard could help guide intraoperative practice and improve outcomes in patients with heart failure
Revisiting the Barras Model in the Age of AI: Innovation Dynamics in the Insurance sector
No full textInternational audienc
Descendre de l’échelle. Pour une approche multidimensionnelle du projet ethnographique
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L’accueil de nouveau-nés évacués de Mayotte : tensions et redéfinition des pratiques et identités professionnelles en néonatologie à La Réunion
No full textInternational audienceDue to overcrowding at the neonatal unit in Mayotte, newborn babies are sometimes transferred to hospitals on Reunion Island, another French overseas territory. These transfers are by air via the EVASAN medical evacuation system. This article is based on research conducted in a Reunion neonatology ward that receives transferred newborns, accompanied or not by their mothers. The article explores the impact on the practices and professional identities of nurses and nursery auxiliaries. These new patients arrive in a ward with limited resources, resulting in an increased workload. The presence of the mothers is deemed necessary for the well-being of the children. However, their being there introduces a social dimension to the hospital. This creates ethical tensions and blurs professional boundaries within a context where these patients are not considered a priority. It is also assumed that their care will be temporary.En raison de la saturation du service de néonatologie du centre hospitalier de Mayotte, il arrive que des nouveau-nés de parents résidant à Mayotte soient transférés dans un centre hospitalier de La Réunion, par le dispositif d’évacuation sanitaire EVASAN. Cet article repose sur une recherche de terrain dans un service de néonatologie de La Réunion. Il explore les effets de l’accueil de ces nouveau-nés évacués, accompagnés ou non de leur mère, sur les pratiques et les identités professionnelles des infirmières et auxiliaires puéricultrices. L’arrivée de ces nouveaux publics, dans un service peu outillé pour les accueillir dans de bonnes conditions, se traduit par une surcharge de travail. La présence des mères, si elle est jugée nécessaire pour le bien-être de l’enfant, fait entrer la question du social à l’hôpital, engendrant tensions éthiques et brouillage des rôles professionnels, dans un contexte où ces publics apparaissent non prioritaires et où leur accueil est perçu comme provisoire
Hydrogen assisted crack propagation in a metallic polycrystalline aggregate
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Prediction of ideal orientations in velocity gradient-driven processes for large plastic deformations of crystals
No full textWe focus on the crystal lattice ideal orientations, also referred to as preferred or attractor orientations, in crystalline materials, and how they can be used to predict the final texture of polycrystals after manufacturing processes. The simplified crystal plasticity (CP) models used here capture the main features of microstructural evolution in monocrystalline and polycrystalline materials undergoing velocity-gradient-driven processes, without considering hardening or softening effects. The evolution of the lattice orientation is described by a nonlinear ordinary differential equation, and a linear stability analysis is performed to identify the permanent orientations that act as attractors (i.e., the ideal or preferred orientations). Although our linear stability analysis is generally applicable, it is detailed using a simplified two-dimensional model with three slip systems. This approach successfully predicts lattice orientation attractors for large strains by analyzing the interplay between deformation and rotation, initial orientation, and the interaction between different slip systems under applied loads. Three fundamental problems in CP illustrate the effectiveness of the theory: polycrystal deformation under homogeneous velocity gradient loading, void evolution under radial loading, and slip band formation in a monocrystal. High-resolution CP numerical simulations, enhanced using re-meshing techniques, provide further validation of our findings concerning the impact of initial crystallographic orientations, deformation mechanisms, and loading conditions on the evolution of orientation attractors and the final crystal texture
Challenges and needs before implementing routine pulse oximetry within primary care for sick children in West Africa: baseline assessment within the AIRE project
No full textInternational audienceBackground The Integrated Management of Childhood Illness (IMCI) guidelines are implemented within primary health centres (PHCs) in resource-limited settings. These symptom-based algorithms under-diagnose severe hypoxemia, which contributes to the under-five’mortality in sub-Saharan Africa. To improve the diagnosis and management of severe hypoxaemia, the Améliorer l’Identification des détresses Respiratoires chez l’Enfant (AIRE) project implemented the routine use of pulse oximetry (PO) within IMCI consultations in Burkina Faso, Guinea, Mali and Niger. We described the intervention sites and measured their capacity to offer IMCI care prior to project implementation. Methods A cross-sectional quantitative survey was conducted in all the AIRE PHCs and their district hospitals (DHs) from March to July 2020. Results Overall, 215 PHCs and 8 DHs were surveyed. Almost all the PHCs were public structures, mainly managed by nurses. At least one healthcare worker was IMCI trained in >99% of PHCs. At baseline, PO was available in only 2/215 (1%) PHCs and 4/8 (50%) DH. Median referral rate was estimated to 1.5% per PHC; 35/215 (16%) PHCs had functional ambulances for managing referrals to DHs, including two with mobile oxygen. IMCI consultations were free of fees in Burkina Faso and Niger, but charged for in Guinea and Mali (from US1). All the DHs had capacities to provide specialised paediatric care, although the use of PO was not systematic. Oxygen was available at all DHs except one. Parents of children requiring hospitalisation had to pay out of pocket costs ranging from US8.4 per day. Conclusions This survey highlights the weak adoption of IMCI guidelines in these settings, the absence of PO’s at PHC level and their low use at hospital level, as well as difficulties in managing severe cases, referral to hospital and accessing oxygen. It has guided the choice of the AIRE research PHCs and the upgrading of PHCs including IMCI training
Enhanced magnetic field sensitivity of shallow NV ensembles via high-temperature implantation
No full textInternational audienceDense and shallow ensembles of negatively charged nitrogen-vacancy centers (NV) with good optical and spin properties play a key role in the performance enhancement of diamond-based quantum sensors. Ion implantation enables precise control of NV depth and density. However, at high ion fluence, this method is limited by low NV creation yields and sample amorphization. Additionally, shallow NV spin properties deteriorate due to surface proximity. In this paper, we study N ion implantation at energies between 10 and 15 keV with fluences as high as 1e15 ions/cm2 at temperatures of 20, 400 and 800°C to investigate the influence of implantation temperature on lattice damage, NV creation yield and NV spin properties. Our results show that diamond maintains structural integrity at 800°C with fluences up to 1e15 ions/cm2 without amorphization. Furthermore, high-temperature implantation improves NV creation yields up to five times without compromising T2, T2 and T1, making it a promising approach to enhance the magnetic field sensitivity of NV ensembles
L'intervention des cabinets de conseil privés dans l'élaboration des politiques de santé publique : une revue exploratoire
No full textSi les sciences sociales ont mené de nombreuses recherches sur le rôle des cabinets de conseil privés dans les politiques publiques, on dispose de peu d'informations sur leur intervention dans la gestion des crises sanitaires et des épidémies. La pandémie de COVID-19 a révélé à quel point les administrations publiques du monde entier ont fait appel à ces cabinets. L'objectif de cette revue exploratoire de la littérature scientifique est d'identifier les recherches sur l'implication de ces cabinets dans la gestion des épidémies et des crises sanitaires depuis 2000. Méthodes. Cette revue répond à la question suivante : quels sont les résultats des recherches sur le rôle de ces cabinets, et quelles sont les méthodes de recherche et les catégories analytiques utilisées ? En suivant les étapes de la méthode PRISMA, nous avons identifié 24 références depuis 2000. Observations. Nous avons classé les analyses des auteurs sur le rôle joué par ces cabinets selon trois catégories analytiques : l'approche de gestion, le phénomène de consultocratie et le phénomène d'hybridation des élites. Seules deux références étaient explicitement liées au travail des cabinets de conseil dans le contexte des épidémies (par exemple, COVID-19). Les autres se sont concentrées sur les réformes de la santé publique. Cette conclusion confirme la rareté des données de recherche sur le rôle joué par les cabinets de conseil dans la gestion des épidémies. Conclusions. Cette revue fait état d'un point aveugle de la littérature scientifique et appelle à des recherches empiriques supplémentaires. Remarques à l'intention des praticiens L'intervention des cabinets de conseil pendant les épidémies reste un point aveugle de la recherche universitaire. La crise du COVID-19 a entraîné une augmentation significative de l'intervention des cabinets de conseil dans l'élaboration des politiques de santé. Trois catégories analytiques peuvent être utiles pour étudier les interventions des cabinets de conseil, à savoir : l'approche de la gestion, le phénomène de la consultocratie et le phénomène d'hybridation des élites. Le phénomène d'hybridation des élites constitue une approche heuristique prometteuse
The Massey Vanishing Conjecture for fourfold Massey products modulo
No full textInternational audienc