Bilateral symmetry of radial pulse in high-level tennis players : implications for the validity of central aortic pulse wave analysis

Rapport de synthèse Ce travail de thèse s'articule autour de l'importance de l'évaluation de la fonction vasculaire et des répercussions au niveau central, cardiaque, des perturbations du réseau vasculaire. Les maladies cardiovasculaires sont prédominantes dans notre société et causes de morbidité et mortalité importante. La mesure de la pression artérielle classique reste le moyen le plus utilisé pour suivre la santé des vaisseaux, mais ne reflète pas directement ce qui se passe au niveau du coeur. La tonométrie d'aplanation permet depuis quelques années de mesurer l'onde de pouls radial, et par le biais d'une fonction mathématique de transfert validée, il est possible d'en déduire la forme et Γ amplitude de l'onde de pouls central, donc de la pression aortique centrale. Cette dernière est un reflet bien plus direct de la post-charge cardiaque, et de nombreuses études cliniques actuelles s'intéressent à cette mesure pour stratifier le risque ou évaluer l'effet d'un traitement vasculaire. Toutefois, bien que cet outil soit de plus en plus utilisé, il est rarement précisé si la latéralité de la mesure joue un rôle, sachant que certaines propriétés des membres supérieurs peuvent être affectées par un usage préférentiel (masse musculaire, densité osseuse, diamètre des artères, capillarisation musculaire, et même fonction endothéliale). On a en effet observé que ces divers paramètre étaient tous augmentés sur un bras entraîné. Dès lors on peut se poser la question de l'influence de ces adaptations physiologiques sur la mesure indirecte effectuée par le biais du pouls radial. Nous avons investigué les deux membres supérieurs de sujets jeunes et sédentaires (SED), ainsi que ceux de sujets sportifs avec un développement fortement asymétrique des bras, soit des joueurs de tennis de haut niveau (TEN). Des mesures anthropométriques incluant la composition corporelle et la circonférence des bras et avant-bras ont montré que TEN présente une asymétrie hautement significative aux deux mesures entre le bras dominant (entraîné) et l'autre, ce qui est aussi présent pour la force de serrage (mesurée au dynamomètre de Jamar). L'analyse des courbes centrales de pouls ne montre aucune différence entre les deux membres dans chaque groupe, par contre on peut observer une différence entre SED et TEN, avec un index d'augmentation diastolique qui est 50 % plus élevé chez TEN. Les index d'augmentation systolique sont identiques dans les deux groupes. On peut retenir de cette étude la validité de la méthode de tonométrie d'aplanation quel que soit le bras utilisé (dominant ou non-dominant) et ce même si une asymétrie conséquente est présente. Ces données sont clairement nouvelles et permettent de s'affranchir de cette variable dans la mesure d'un paramètre cardiovasculaire dont l'importance est actuellement grandissante. Les différences d'index diastolique sont expliquées par la fréquence cardiaque et la vitesse de conduction de l'onde de pouls plus basses chez TEN, causant un retard diastolique du retour de l'onde au niveau central, phénomène précédemment bien décrit dans la littérature.

Pulse pressure variation-guided fluid therapy after cardiac surgery: A pilot before-and-after trial.

PURPOSE: The aim of this study is to study the feasibility, safety, and physiological effects of pulse pressure variation (PPV)-guided fluid therapy in patients after cardiac surgery. MATERIALS AND METHODS: We conducted a pilot prospective before-and-after study during mandatory ventilation after cardiac surgery in a tertiary intensive care unit. We introduced a protocol to deliver a fluid bolus for a PPV ≥13% for at least >10 minutes during the intervention period. RESULTS: We studied 45 control patients and 53 intervention patients. During the intervention period, clinicians administered a fluid bolus on 79% of the defined PPV trigger episodes. Median total fluid intake was similar between 2 groups during mandatory ventilation (1297 mL [interquartile range 549-1968] vs 1481 mL [807-2563]; P = .17) and the first 24 hours (3046 mL [interquartile range 2317-3982] vs 3017 mL [2192-4028]; P = .73). After adjusting for several baseline factors, PPV-guided fluid management significantly increased fluid intake during mandatory ventilation (P = .004) but not during the first 24 hours (P = .47). Pulse pressure variation-guided fluid therapy, however, did not significantly affect hemodynamic, renal, and metabolic variables. No serious adverse events were noted. CONCLUSIONS: Pulse pressure variation-guided fluid management was feasible and safe during mandatory ventilation after cardiac surgery. However, its advantages may be clinically small.

Organisational adaptation of multi-agent systems in a peer-to-peer scenario

Organisations in Multi-Agent Systems (MAS) have proven to be successful in regulating agent societies. Nevertheless, changes in agents' behaviour or in the dynamics of the environment may lead to a poor fulfilment of the system's purposes, and so the entire organisation needs to be adapted. In this paper we focus on endowing the organisation with adaptation capabilities, instead of expecting agents to be capable of adapting the organisation by themselves. We regard this organisational adaptation as an assisting service provided by what we call the Assistance Layer. Our generic Two Level Assisted MAS Architecture (2-LAMA) incorporates such a layer. We empirically evaluate this approach by means of an agent-based simulator we have developed for the P2P sharing network domain. This simulator implements 2-LAMA architecture and supports the comparison between different adaptation methods, as well as, with the standard BitTorrent protocol. In particular, we present two alternatives to perform norm adaptation and one method to adapt agents'relationships. The results show improved performance and demonstrate that the cost of introducing an additional layer in charge of the system's adaptation is lower than its benefits.

Detection of coronary thrombosis after multi-phase postmortem CT-angiography.

The aim of this study was to compare postmortem angiography-based, autopsy-based and histology-based diagnoses of acute coronary thrombosis in a series of medicolegal cases that underwent postmortem angiographies according to multiphase CT-angiography protocol. Our study included 150 medicolegal cases. All cases underwent native CT-scan, postmortem angiography, complete conventional autopsy and histological examination of the main organs and coronary arteries. In 10 out of the 150 investigated cases, postmortem angiographies revealed coronary arterial luminal filling defects and the absence of collateral vessels, suggesting acute coronary thromboses. Radiological findings were confirmed by autopsy and histological examinations in all cases. In 40 out of 150 cases, angiograms revealed complete or incomplete coronary arterial luminal filling defects and the presence of collateral vessels. Histological examinations did not reveal free-floating or non-adherent thrombi in the coronary arteries in any of these cases. Though postmortem angiography examination has not been well-established for the diagnosis of acute coronary thrombosis, luminal filling defects in coronary arteries suggesting acute thromboses can be observed through angiography and subsequently confirmed by autopsy and histological examinations.

Multi-sided Böhm-Bawerk assignment markets: the nucleolus and the core-center

En aquest treball mostrem que, a diferència del cas bilateral, per als mercats multilaterals d'assignació coneguts amb el nom de Böhm-Bawerk assignment games, el nucleolus i el core-center, i. e. el centre de masses del core, no coincideixen en general. Per demostrar-ho provem que donant un m-sided Böhm-Bawerk assignment game les dues solucions anteriors poden obtenir-se respectivament del nucleolus i el core-center d'un joc convex definit en el conjunt format pels m sectors. Encara més, provem que per calcular el nucleolus d'aquest últim joc només les coalicions formades per un jugador o m-1 jugadors són importants. Aquests resultats simplifiquen el càlcul del nucleolus d'un multi-sided ¿¿ohm-Bawerk assignment market amb un número molt elevat d'agents.

Symmetrically multilateral-bargained allocations in multi-sided assignment markets

[cat] Aquest treball tracta d’extendre la noció d’equilibri simètric de negociació bilateral introduït per Rochford (1983) a jocs d’assignació multilateral. Un pagament corresponent a un equilibri simètric de negociación multilateral (SMB) és una imputación del core que garanteix que qualsevol agent es troba en equilibri respecte a un procés de negociación entre tots els agents basat en allò que cadascun d’ells podria rebre -i fer servir com a amenaça- en un ’matching’ òptim diferent al que s’ha format. Es prova que, en el cas de jocs d’assignació multilaterals, el conjunt de SMB és sempre no buit i que, a diferència del cas bilateral, no sempre coincideix amb el kernel (Davis and Maschler, 1965). Finalment, responem una pregunta oberta per Rochford (1982) tot introduïnt un conjunt basat en la idea de kernel, que, conjuntament amb el core, ens permet caracteritzar el conjunt de SMB.

What the Law Requires Accessible Multi-family Housing in Iowa, Janaury 2001

For people with disabilities, however, housing options have been limited. Today, state and federal laws are changing this. Who will benefit? All of us. For “accessibility” is an issue that, at one time or another, affects us all. This is true whether _ temporarily or permanently _ we use wheelchairs, need grab bars, cannot climb stairs, require easy-to-reach shelves, or rely on easy-to-navigate living spaces. The primary purpose of accessible housing law is to prevent discrimination against people with disabilities, but the end result is a living environment that is more usable for everyone. For example, both the very young and the very old will find an accessible dwelling more comfortable. People with temporary limitations due to injury or illness will find it easier to live in. Such a home will be more welcoming to guests with disabilities.

A didática na perspectiva multi/intercultural em ação: construindo uma proposta

Este trabalho se situa no contexto da pesquisa Ressignificando a Didática na Perspectiva Multi/Intercultural, realizada com o apoio do Conselho Nacional de Pesquisas Tecnológicas, no período de 2003 a 2006. Teve por principal objetivo construir e desenvolver, em caráter exploratório, um curso de Didática dirigido à licenciatura em Pedagogia, na perspectiva multi/intercultural, com abordagem metodológica inspirada na pesquisa-ação. A experiência desenvolveu-se durante um semestre letivo e foi realizada pela equipe do Grupo de Pesquisas sobre Cotidiano Escolar, Educação e Cultura(s), composta por dez integrantes. Apoiou-se em ampla literatura sobre a temática, que vem sendo explorada pelo grupo desde 1996. Após descrição e análise do desenvolvimento do curso, são levantados questionamentos, tensões e desafios para a incorporação da interculturalidade nas práticas educativas, em torno dos seguintes eixos: múltiplas narrativas, alteridade e estranhamento, e desconstrução e resistência. Conclui reafirmando a relevância da temática abordada e a complexidade da proposta em discussão.

Enhanced pulse propagation in non-linear arrays of oscillators

The propagation of a pulse in a nonlinear array of oscillators is influenced by the nature of the array and by its coupling to a thermal environment. For example, in some arrays a pulse can be speeded up while in others a pulse can be slowed down by raising the temperature. We begin by showing that an energy pulse (one dimension) or energy front (two dimensions) travels more rapidly and remains more localized over greater distances in an isolated array (microcanonical) of hard springs than in a harmonic array or in a soft-springed array. Increasing the pulse amplitude causes it to speed up in a hard chain, leaves the pulse speed unchanged in a harmonic system, and slows down the pulse in a soft chain. Connection of each site to a thermal environment (canonical) affects these results very differently in each type of array. In a hard chain the dissipative forces slow down the pulse while raising the temperature speeds it up. In a soft chain the opposite occurs: the dissipative forces actually speed up the pulse, while raising the temperature slows it down. In a harmonic chain neither dissipation nor temperature changes affect the pulse speed. These and other results are explained on the basis of the frequency vs energy relations in the various arrays

Classification of urban multi-angular image sequences by aligning their manifolds

When dealing with multi-angular image sequences, problems of reflectance changes due either to illumination and acquisition geometry, or to interactions with the atmosphere, naturally arise. These phenomena interplay with the scene and lead to a modification of the measured radiance: for example, according to the angle of acquisition, tall objects may be seen from top or from the side and different light scatterings may affect the surfaces. This results in shifts in the acquired radiance, that make the problem of multi-angular classification harder and might lead to catastrophic results, since surfaces with the same reflectance return significantly different signals. In this paper, rather than performing atmospheric or bi-directional reflection distribution function (BRDF) correction, a non-linear manifold learning approach is used to align data structures. This method maximizes the similarity between the different acquisitions by deforming their manifold, thus enhancing the transferability of classification models among the images of the sequence.

CT dose optimization when changing to CT multi-detector row technology

The purpose of this article was to review the strategies to control patient dose in adult and pediatric computed tomography (CT), taking into account the change of technology from single-detector row CT to multi-detector row CT. First the relationships between computed tomography dose index, dose length product, and effective dose in adult and pediatric CT are revised, along with the diagnostic reference level concept. Then the effect of image noise as a function of volume computed tomography dose index, reconstructed slice thickness, and the size of the patient are described. Finally, the potential of tube current modulation CT is discussed.

Identity [R]Evolution: Multi-Disciplinary Perpectives

The identity [r]evolution is happening. Who are you, who am I in the information society? In recent years, the convergence of several factors - technological, political, economic - has accelerated a fundamental change in our networked world. On a technological level, information becomes easier to gather, to store, to exchange and to process. The belief that more information brings more security has been a strong political driver to promote information gathering since September 11. Profiling intends to transform information into knowledge in order to anticipate one's behaviour, or needs, or preferences. It can lead to categorizations according to some specific risk criteria, for example, or to direct and personalized marketing. As a consequence, new forms of identities appear. They are not necessarily related to our names anymore. They are based on information, on traces that we leave when we act or interact, when we go somewhere or just stay in one place, or even sometimes when we make a choice. They are related to the SIM cards of our mobile phones, to our credit card numbers, to the pseudonyms that we use on the Internet, to our email addresses, to the IP addresses of our computers, to our profiles... Like traditional identities, these new forms of identities can allow us to distinguish an individual within a group of people, or describe this person as belonging to a community or a category. How far have we moved through this process? The identity [r]evolution is already becoming part of our daily lives. People are eager to share information with their "friends" in social networks like Facebook, in chat rooms, or in Second Life. Customers take advantage of the numerous bonus cards that are made available. Video surveillance is becoming the rule. In several countries, traditional ID documents are being replaced by biometric passports with RFID technologies. This raises several privacy issues and might actually even result in changing the perception of the concept of privacy itself, in particular by the younger generation. In the information society, our (partial) identities become the illusory masks that we choose -or that we are assigned- to interplay and communicate with each other. Rights, obligations, responsibilities, even reputation are increasingly associated with these masks. On the one hand, these masks become the key to access restricted information and to use services. On the other hand, in case of a fraud or negative reputation, the owner of such a mask can be penalized: doors remain closed, access to services is denied. Hence the current preoccupying growth of impersonation, identity-theft and other identity-related crimes. Where is the path of the identity [r]evolution leading us? The booklet is giving a glance on possible scenarios in the field of identity.