AUTOREGULATION CEREBROVASCULAIRE SOUS ANESTHESIE GENERALE

 En situation post-opératoire, les complications de type accident vasculaire cérébral (AVC), délires et confusions sont plus fréquemment observées chez les personnes âgées que chez les jeunes. L'âge a d'ailleurs été défini comme un facteur de risque d'atteinte cognitive post-­‐opératoire [14, 15]. Il a également été montré que pour diverses raisons expliquées ci-­‐dessus, le mécanisme d'AC était perturbé sous anesthésie générale par volatils [12]. Ainsi, l'AC étant moins fiable sous sédation, le DSC est moins constant et les variations de PPC peuvent être à l'origine d'épisodes ischémiques cliniquement silencieux. Il est alors légitime de se demander si l'atteinte du système d'AC sous anesthésie générale par volatil ne serait pas en lien avec les complications post-­‐ opératoires observées chez la personne âgée. L'objectif de l'étude est de déterminer le comportement du système d'AC et ses valeurs seuils sous anesthésie générale par volatil, chez la personne âgée comparativement au sujet jeune. Si une différence de seuil d'AC peut-­‐être mise en évidence entre les deux populations, il sera intéressant de voir si elle est applicable en clinique, ceci afin de prévenir les complications post-­‐opératoires. Peu de travaux ont été menés sur le lien entre le système d'AC et l'âge, qui plus est sous sédation par volatil. Et pourtant, avec le vieillissement de la population, le nombre d'anesthésie générale chez des patients âgés est en constante augmentation. Les AVC, à l'origine d'handicaps physiques et cognitifs majeurs, et leur prise en charge représentent un coût certain pour l'assurance maladie. Il devient donc de plus en plus urgent de comprendre le comportement du système d'AC chez la personne âgée sous anesthésie générale. Plus qu'un simple intérêt scientifique, cette étude est directement appliquée à la clinique et est pleinement d'actualité

Improvement of Neuroenergetics by Hypertonic Lactate Therapy in Patients with Traumatic Brain Injury Is Dependent on Baseline Cerebral Lactate/Pyruvate Ratio.

Energy dysfunction is associated with worse prognosis after traumatic brain injury (TBI). Recent data suggest that hypertonic sodium lactate infusion (HL) improves energy metabolism after TBI. Here, we specifically examined whether the efficacy of HL (3h infusion, 30-40 μmol/kg/min) in improving brain energetics (using cerebral microdialysis [CMD] glucose as a main therapeutic end-point) was dependent on baseline cerebral metabolic state (assessed by CMD lactate/pyruvate ratio [LPR]) and cerebral blood flow (CBF, measured with perfusion computed tomography [PCT]). Using a prospective cohort of 24 severe TBI patients, we found CMD glucose increase during HL was significant only in the subgroup of patients with elevated CMD LPR >25 (n = 13; +0.13 [95% confidence interval (CI) 0.08-0.19] mmol/L, p < 0.001; vs. +0.04 [-0.05-0.13] in those with normal LPR, p = 0.33, mixed-effects model). In contrast, CMD glucose increase was independent from baseline CBF (coefficient +0.13 [0.04-0.21] mmol/L when global CBF was <32.5 mL/100 g/min vs. +0.09 [0.04-0.14] mmol/L at normal CBF, both p < 0.005) and systemic glucose. Our data suggest that improvement of brain energetics upon HL seems predominantly dependent on baseline cerebral metabolic state and support the concept that CMD LPR - rather than CBF - could be used as a diagnostic indication for systemic lactate supplementation following TBI

Non-Ischemic Cerebral Energy Dysfunction at the Early Brain Injury Phase following Aneurysmal Subarachnoid Hemorrhage.

The pathophysiology of early brain injury following aneurysmal subarachnoid hemorrhage (SAH) is still not completely understood. Using brain perfusion CT (PCT) and cerebral microdialysis (CMD), we examined whether non-ischemic cerebral energy dysfunction may be a pathogenic determinant of EBI. A total of 21 PCTs were performed (a median of 41 h from ictus onset) among a cohort of 18 comatose mechanically ventilated SAH patients (mean age 58 years, median admission WFNS score 4) who underwent CMD and brain tissue PO2 (PbtO2) monitoring. Cerebral energy dysfunction was defined as CMD episodes with lactate/pyruvate ratio (LPR) >40 and/or lactate >4 mmol/L. PCT-derived global CBF was categorized as oligemic (CBF < 28 mL/100 g/min), normal (CBF 28-65 mL/100 g/min), or hyperemic (CBF 69-85 mL/100 g/min), and was matched to CMD/PbtO2 data. Global CBF (57 ± 14 mL/100 g/min) and PbtO2 (25 ± 9 mm Hg) were within normal ranges. Episodes with cerebral energy dysfunction (n = 103 h of CMD samples, average duration 7.4 h) were frequent (66% of CMD samples) and were associated with normal or hyperemic CBF. CMD abnormalities were more pronounced in conditions of hyperemic vs. normal CBF (LPR 54 ± 12 vs. 42 ± 7, glycerol 157 ± 76 vs. 95 ± 41 µmol/L; both p < 0.01). Elevated brain LPR correlated with higher CBF (r = 0.47, p < 0.0001). Cerebral energy dysfunction is frequent at the early phase following poor-grade SAH and is associated with normal or hyperemic brain perfusion. Our data support the notion that mechanisms alternative to ischemia/hypoxia are implicated in the pathogenesis of early brain injury after SAH

Time-Series Data Mining:A Review

Data mining refers to the extraction of knowledge by analyzing the data from different perspectives and accumulates them to form useful information which could help the decision makers to take appropriate decisions. Classification and clustering has been the two broad areas in data mining. As the classification is a supervised learning approach, the clustering is an unsupervised learning approach and hence can be performed without the supervision of the domain experts. The basic concept is to group the objects in such a way so that the similar objects are closer to each. Time series data is observation of the data over a period of time. The estimation of the parameter, outlier detection and transformation of the data are some ofthe basic issues in handling the time series data. An approach is given for clustering the data based on the membership values assigned to each data point compressing the effect of outlier or noise present in the data. The Possibilistic Fuzzy C-Means (PFCM) with Error Prediction (EP) are done for the clustering and noise identification in the time-series data

True Story: The HyFlex Experience Across Disciplines

Brightpoint’s HyFlex Pilot Program was a year-long project funded by the Online Virginia Network (OVN) to support faculty in the design and delivery of an actual HyFlex course. The cohort consisted of faculty who teach in the biology, architecture, early childhood, and web design disciplines. Participants worked in collaboration with one another and the Center for Teaching and Learning. In the following essay, members of the 2021-22 pilot cohort will reflect on their experiences learning and implementing a HyFlex approach in their courses. Each author will share challenges and successes as well as conclusions with implications for practice by colleagues statewide

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Women in the construction labor force: women's participation in the construction sector in India

Women are to be seen on most urban construction sites in India. While there is variation between countries as to how many women are employed as workers in construction, they are consistently confined to unskilled and low-paying jobs. We found little empirical work dealing with the factors that bring about and perpetuate the division of labor by gender on construction sites in India and elsewhere. This paper therefore attempts to identify the factors which make possible the participation of women in construction activity in India and which serve to perpetuate the division of labor that keeps women working at unskilled jobs. It argues that the structure of the construction industry in India and especially the practice of subcontracting provide incentives that make it attractive for employers to maintain women as a labor reserve to be used at certain periods of construction and to do tasks that men may refuse to do. This paper proposes that the subcontracting unit plays a central role in the level of skills of women workers. Subcontractors have little interest in increasing worker productivity. Since most members of the subcontracting unit including the subcontractor come from the same village and social setting, traditional norms defining the roles of men and women tend to be reinforced in the urban setting. The study is based on an extensive literature review and a field study involving interviews with twenty-three women workers on two construction sites in and near Bombay, India. The analysis of the data thus collected corroborates much of the information that was obtained through the literature review. Most of the women are unskilled workers Most of the women are associational migrants who came from rural areas and continue to maintain strong links with their native village. The influence of the subcontracting unit is seen in the presence of several families from the same village on the construction sites and in the reports of several women saying that they had been recruited by an agent. Experience does not give any occupational mobility to the women workers. There have been few efforts to train women in construction skills. In the case of India, migrant households are likely to continue to be hired on urban construction sites. If mechanization increases, it is the women in the unskilled work force who are most likely to be displaced. To prevent this, it is important to equip the women with skills. Efforts to increase the women’s level of skills should be initiated at the level of the subcontracting unit. Policies should therefore be directed towards providing incentives for subcontractors to create a skilled female work force.Master of Urban and Regional Plannin

Mobilisation des acteurs locaux et des habitants dans les démarches participatives des politiques publiques

Dieser Bericht von Studiumsende hat zum Ziel, einen auf den Berufserfahrungen eines Praktikums von Master 2 kritischen Blick zu bringen. Es handelt sich seitdem darum, die Problematik der Mobilisierung der örtlichen Schauspieler und der Bewohner in den Partizipationgängen der öffentlichen Politiken aufzugreifen. Dieser Bericht greift die Frage der Mobilisierung der Schauspieler und der Bewohner in den Partizipationgängen mit einem theoretischen Betrachtungsweise und einer Analyse der unterschiedlichen mit der Partizipationdemokratie verbundenen Begriffe auf. Der zweite Seite greift ein mehr berufliches Betrachtungsweise auf, wo die Frage der Mobilisierung der Schauspieler und der Bewohner in Hinblick auf 4 Studien analysiert sein wird: die Analyse der Sozialen Bedürfnisse von Seyssinet-Pariset, das Soziale Projekt der Gemeinschaft von Großraum Privas Centre Ardèche, das Projekt Territorium von Lunévillois und das Notizbuch 21 von SchiltigheimLa problématique est la mobilisation des acteurs locaux et des habitants dans les démarches participatives des politiques publiques. Par l'approche théorique et l'analyse des différentes notions, la démocratie participative sera étudiée. La seconde partie aborde une approche plus professionnelle où la question de la mobilisation des acteurs et des habitants sera analysée au regard de 4 études : l’analyse des besoins sociaux de Seyssinet-Pariset, le projet social de la Communauté d’Agglomération de Privas Centre Ardèche, le projet de territoire du Lunévillois et l’Agenda 21 de Schiltigheim

Rules in the kindergarten classroom: an ethnography

The purpose of this ethnographic venture was to explore the social interactions in a Kindergarten classroom with a focus on the rules in the classroom. Participant observations were conducted in a public school Kindergarten classroom for a period of three and a half months. Data were recorded through field notes, audiotape recordings and two semi-structured interviews with the classroom teacher. The presentation of discoveries along this journey includes a detailed description of a typical day in the classroom, a taxonomy of the classroom rules, and an elaboration of the process through which children understand the teacher created rules in the classroom. The importance of planning developmentally appropriate rules and affording children the opportunity to negotiate the meaning of the rules through dialogue has been stressed. These interpretations reinforce the importance of the constructivist approach to child development and learning. Implications for researchers and practitioners revolve around the redefinition of rules as tools for negotiation of individual differences among members of the classroom community.Ph. D