La pandémie de Covid-19 a inscrit l’hôpital au coeur d’une crise sanitaire de cinétique longue. Le système de santé a dû dans un premier temps accepter cette notion de crise déstructurante et piloter ...dans l’incertitude. Un des enjeux majeurs était d’éviter la saturation du système, notamment l’accessibilité à la réanimation. À la demande de la cellule de crise du groupe hospitalier AP–HPSorbonne Université, l’équipe Dynamo a dû apporter des propositions permettant de libérer des places en réanimation. C’était la stratégie retenue pour éviter une mise en tension de l’hôpital. La cellule Dynamo, avec l’accord du directeur médical de crise, a ouvert un flux entre les réanimations expertes et des unités créées de novo (publiques et privées). Cette équipe est le fruit d’une préparation conjointe entre le département médico-universitaire DREAM et le service médical du RAID. Elle a permis d’organiser et d’effectuer dans de bonnes conditions sanitaires et sécuritaires le transfert d’une centaine de patients entre les réanimations d’Îlede- France. L’objectif était une répartition cohérente pour maintenir une capacité d’accueil dans les réanimations les plus spécialisées et impactées par l’intensité des soins. Pour cela, la cellule Dynamo a défini des critères médicaux de patients éligibles au transfert. La méthodologie utilisait quatre boucles indépendantes : le service demandeur, l’équipe de transfert, le vecteur de transfert et le service receveur. Cette organisation a offert agilité et autonomie. Nous publions ce retour d’expérience pour partager les bases méthodologiques et humaines de notre organisation afin d’inspirer d’autres cellules innovantes en cas de situations sanitaires exceptionnelles.
The COVID-19 pandemic has put the hospital infrastructure into the difficulty of a long time public health crisis. The health care system had to accept the concept of destructuring crisis and ultimately piloting with uncertainty. The key factor during the crisis was to avoid the saturation of the care system especially for the intensive care unit. Upon the hospital medical crisis unit request, the DYNAMO team was accountable to propose solutions for “outflow”. Under the crisis medical director’s green light, the DYNAMO unit has opened flow between the hospital intensive care unit and step down units created de novo (public and private). DYNAMO is the outcome of the collaboration and joint preparation between the university medical department DREAM and RAID Tactical medical unit allowing the use of technical tools and adding the tactical spirit into the hospital frame. This collaboration has supported the transfer in secure conditions of about 100 patients across the intensive care units with a consistent distribution of patients in order to maintain the most efficient intensive care units impacted by the crisis able to accept an influx of new patients. To achieve this, the DYNAMO team defined medical criteria to determine a patient’s eligibility to be transferred under the team transfer supervision. The methodology is formed by 4 independent loops: the requester service, the transfer team, the medium for transfer and the receiver service. This model appeared to be simple, agile and autonomous. We are delighted to share our lessons learned on the methodology and human organization with the emergency care community.
Introduction En Estrie (Québec, Canada) les maladies chroniques cardiométaboliques (MCCM) représentent un défi majeur de morbimortalité et un fardeau économique. Il existe plusieurs programmes ...multidisciplinaires de prévention et gestion des MCCM dans les 7 Centres de santé et services sociaux (CSSS). Cette étude a pour objectif d’évaluer la qualité technique des soins (QTS) des patients atteints des MCCM et d’identifier les déterminants liés à la QTS en Estrie Matériels et méthodes Étude transversale avec collecte rétrospective de 12 derniers mois des données administratives et des dossiers médicaux. Un échantillonnage aléatoire simple de 50 patients /programme/CSSS sera utilisé pour la sélection des dossiers des usagers avec une visite entre avril 2012 et 2013. Les indicateurs de prévention (mesures et conseils sur le poids et les saines habitudes de vie) et indicateurs spécifiques (suivi des paramètres clinico-biologiques et atteinte des cibles thérapeutiques) au diabète et maladie cardiovasculaire (MCV) sont calculés en utilisant le nombre d’indicateurs reçus vs attendus. Des régressions linéaires multiples, avec méthode Backward, sont réalisées pour identifier les caractéristiques des usagers et les facteurs organisationnelles et techniques des soins en lien avec le score de QTS en retenant dans le modèle les variables significatives au seuil de 25 % en univariée. Résultats Les 1 118 dossiers révisés, 462 sont diabétiques (DBT) et 353 ont une MCV avec un âge de 63 ± 2 ans, 50 % féminin. Le score de prévention est de 45 %, le score de QTS des DBT de 50 % et des MCV de 71 %. Tout d’abord le sexe masculin est en lien avec la QTS chez les DBT ( p = 0,03) et MCV ( p = 0,004). De plus, le score de QTS des DBT est en lien avec le nombre de médication ( p = 0,03), le lieu de la prise en charge ( p < 0,0001), le nombre de relance téléphonique ( p = 0,01), et de visites multidisciplinaires ( p < 0,0001). Or le score de QTS des MCV est en lien avec le score de prévention ( p < 0,0001), et le nombre de visites individuelles ( p = 0,007). Conclusion Ces résultats ont montré le portrait de la qualité des soins dans les CSSS de l’Estrie et ces informations ont été utile pour développer un cadre de référence régional intégré pour la prévention et la prise en charge des MCCM. Déclaration d’intérêt Les auteurs déclarent ne pas avoir d’intérêt direct ou indirect (financier ou en nature) avec un organisme privé, industriel ou commercial en relation avec le sujet présenté.
Introduction La prévalence du diabète en Estrie (Québec, Canada) est de 7,2 %. Un programme multidisciplinaire de prévention et prise en charge du diabète existe dans les 7 Centres de Santé et ...Services Sociaux (CSSS) de la région. Le Chronic Care Model y est utilisé comme modèle conceptuel pour favoriser qu’un patient activé et informé soit en interaction avec une équipe de santé préparée et proactive, afin d’avoir des résultats améliorés. Cette étude a pour objectif d’identifier les déterminants liés à la qualité organisationnelle des soins pour le diabète en première ligne. Matériels et méthodes Étude transversale utilisant le « Patient Assessment of Chronic Illness Care » (PACIC) pour évaluer la qualité organisationnelle des soins chez des usagers volontaires fréquentant les programmes des CSSS. De plus, la qualité interpersonnelle des soins, reflétée par la communication entre les patients et leur médecin (MD), et l’efficacité d’autogestion de maladie chronique (MC) sont mesurées par les questionnaires « Primary Care Assessment Survey » (PCAS) et Stanford. Des médianes sont calculées pour les scores des questionnaires. Des régressions linéaires multiples, avec méthode Backward, sont réalisées pour identifier les caractéristiques des usagers et les facteurs de qualité des soins en lien avec le score du PACIC en retenant dans le modèle les variables significatives au seuil de 25 % en univariée. Résultats Les 145 pré-diabétiques et diabétiques interrogés (âge 61 ± 9 ans, 54 % féminin) ont rapporté un score PACIC global de 4,1/5, une communication MD-patient de 9/10 et une efficacité d’autogestion de MC de 7,7/10. Les fac-teurs en lien avec le score PACIC concernent la communication MD-patient (Beta = 0,48, p < 0,0001) et l’efficacité d’autogestion de MC (Beta = 0,30, p = 0,01). Conclusion Ces résultats montrent des scores élevés du PACIC, de qualité interpersonnelle des soins et d’efficacité d’autogestion de MC, suggérant une bonne qualité organisationnelle des soins. Le score du PACIC est en lien à la qualité interpersonnelle des soins et l’efficacité d’autogestion de MC. Déclaration d’intérêt Les auteurs déclarent ne pas avoir d’intérêt direct ou indirect (financier ou en nature) avec un organisme privé, industriel ou commercial en relation avec le sujet présenté.
The development of an automatic telemedicine system for computer-aided screening and grading of diabetic retinopathy depends on reliable detection of retinal lesions in fundus images. In this paper, ...a novel method for automatic detection of both microaneurysms and hemorrhages in color fundus images is described and validated. The main contribution is a new set of shape features, called Dynamic Shape Features, that do not require precise segmentation of the regions to be classified. These features represent the evolution of the shape during image flooding and allow to discriminate between lesions and vessel segments. The method is validated per-lesion and per-image using six databases, four of which are publicly available. It proves to be robust with respect to variability in image resolution, quality and acquisition system. On the Retinopathy Online Challenge's database, the method achieves a FROC score of 0.420 which ranks it fourth. On the Messidor database, when detecting images with diabetic retinopathy, the proposed method achieves an area under the ROC curve of 0.899, comparable to the score of human experts, and it outperforms state-of-the-art approaches.
The detection of a wide range of substructures such as rings, cavities, and spirals has become a common outcome of high spatial resolution imaging of protoplanetary disks, both in the near-infrared ...scattered light and in the thermal millimetre continuum emission. The most frequent interpretation of their origin is the presence of planetary-mass companions perturbing the gas and dust distribution in the disk (perturbers), but so far the only bona fide detection has been the two giant planets carving the disk around PDS 70. Here, we present a sample of 15 protoplanetary disks showing substructures in SPHERE scattered-light images and a homogeneous derivation of planet detection limits in these systems. To obtain mass limits we rely on different post-formation luminosity models based on distinct formation conditions, which are critical in the first million years of evolution. We also estimate the mass of these perturbers through a Hill radius prescription and a comparison to ALMA data. Assuming that one single planet carves each substructure in scattered light, we find that more massive perturbers are needed to create gaps within cavities than rings, and that we might be close to a detection in the cavities of RX J1604.3-2130A, RX J1615.3-3255, Sz Cha, HD 135344B, and HD 34282. We reach typical mass limits in these cavities of 3–10
M
Jup
. For planets in the gaps between rings, we find that the detection limits of SPHERE high-contrast imaging are about an order of magnitude away in mass, and that the gaps of PDS 66 and HD 97048 seem to be the most promising structures for planet searches. The proposed presence of massive planets causing spiral features in HD 135344B and HD 36112 are also within SPHERE’s reach assuming hot-start models. These results suggest that the current detection limits are able to detect hot-start planets in cavities, under the assumption that they are formed by a single perturber located at the centre of the cavity. More realistic planet mass constraints would help to clarify whether this is actually the case, which might indicate that perturbers are not the only way of creating substructures.
Context. The consortium of the Spectro-Polarimetric High-contrast Exoplanet REsearch installed at the Very Large Telescope (SPHERE/VLT) has been operating its guaranteed observation time (260 nights ...over five years) since February 2015. The main part of this time (200 nights) is dedicated to the detection and characterization of young and giant exoplanets on wide orbits. Aims. The large amount of data must be uniformly processed so that accurate and homogeneous measurements of photometry and astrometry can be obtained for any source in the field. Methods. To complement the European Southern Observatory pipeline, the SPHERE consortium developed a dedicated piece of software to process the data. First, the software corrects for instrumental artifacts. Then, it uses the speckle calibration tool (SpeCal) to minimize the stellar light halo that prevents us from detecting faint sources like exoplanets or circumstellar disks. SpeCal is meant to extract the astrometry and photometry of detected point-like sources (exoplanets, brown dwarfs, or background sources). SpeCal was intensively tested to ensure the consistency of all reduced images (cADI, Loci, TLoci, PCA, and others) for any SPHERE observing strategy (ADI, SDI, ASDI as well as the accuracy of the astrometry and photometry of detected point-like sources. Results. SpeCal is robust, user friendly, and efficient at detecting and characterizing point-like sources in high contrast images. It is used to process all SPHERE data systematically, and its outputs have been used for most of the SPHERE consortium papers to date. SpeCal is also a useful framework to compare different algorithms using various sets of data (different observing modes and conditions). Finally, our tests show that the extracted astrometry and photometry are accurate and not biased.
Convolutional Neural Networks (CNNs) have proven to be extremely accurate for image recognition, even outperforming human recognition capability. When deployed on battery-powered mobile devices, ...efficient computer architectures are required to enable fast and energy-efficient computation of costly convolution operations. Despite recent advances in hardware accelerator design for CNNs, two major problems have not yet been addressed effectively, particularly when the convolution layers have highly diverse structures: (1) minimizing energy-hungry off-chip DRAM data movements; (2) maximizing the utilization factor of processing resources to perform convolutions. This work thus proposes an energy-efficient architecture equipped with several optimized dataflows to support the structural diversity of modern CNNs. The proposed approach is evaluated on convolutional layers of VGGNet-16 and ResNet-50. Results show that the architecture achieves a Processing Element (PE) utilization factor of 98% for the majority of <inline-formula> <tex-math notation="LaTeX">3\times 3 </tex-math></inline-formula> and <inline-formula> <tex-math notation="LaTeX">1\times 1 </tex-math></inline-formula> convolutional layers, while limiting latency to 396.9 ms and 92.7 ms when performing convolutional layers of VGGNet-16 and ResNet-50, respectively. In addition, the proposed architecture benefits from the structured sparsity in ResNet-50 to reduce the latency to 42.5 ms when half of the channels are pruned.
Context.
A large portion of stars is found to be part of binary or higher-order multiple systems. The ubiquity of planets found around single stars raises the question of whether and how planets in ...binary systems form. Protoplanetary disks are the birthplaces of planets, and characterizing them is crucial in order to understand the planet formation process.
Aims.
Our goal is to characterize the morphology of the GG Tau A disk, one of the largest and most massive circumbinary disks. We also aim to trace evidence for binary-disk interactions.
Methods.
We obtained observations in polarized scattered light of GG Tau A using the SPHERE/IRDIS instrument in the
H
-band filter. We analyzed the observed disk morphology and substructures. We ran 2D hydrodynamical models to simulate the evolution of the circumbinary ring over the lifetime of the disk.
Results.
The disk and also the cavity and the inner region are highly structured, with several shadowed regions, spiral structures, and streamer-like filaments. Some of these are detected here for the first time. The streamer-like filaments appear to connect the outer ring with the northern arc. Their azimuthal spacing suggests that they may be generated through periodic perturbations by the binary, which tear off material from the inner edge of the outer disk once during each orbit. By comparing observations to hydrodynamical simulations, we find that the main features, in particular, the gap size, but also the spiral and streamer filaments, can be qualitatively explained by the gravitational interactions of a binary with a semimajor axis of ~35 au on an orbit coplanar with the circumbinary ring.
In recent years, there has been intensive research into the direct detection of exoplanets. Data obtained in the future with high-contrast imaging instruments, optimized for the direct detection of ...giant planets, may be strongly limited by speckle noise. Specific observing strategies and data analysis methods, such as angular and spectral differential imaging, are required to attenuate the noise level and possibly to detect the flux of faint planets. Even though these methods are very efficient at suppressing the speckles, the photometry of faint planets is dominated by the speckle residuals. The determination of the effective temperature and surface gravity of the detected planets from photometric measurements in different bands is then limited by the photometric error on the planet flux. In this paper, we investigate this photometric error and the consequences on the determination of the physical parameters of the detected planets. We perform detailed end-to-end simulation with the caos-based software package for spectro-polarimetric high-contrast exoplanet research (SPHERE) to obtain realistic data representing typical observing sequences in the Y, J, H and Ks bands with a high-contrast imager. The simulated data are used to measure the photometric accuracy as a function of contrast for planets detected with angular and spectral+angular differential methods. We apply this empirical accuracy to study the characterization capabilities of a high-contrast differential imager. We show that the expected photometric performances will allow the detection and characterization of exoplanets down to a Jupiter mass at angular separations of 1.0 and 0.2 arcsec, respectively, around high-mass and low-mass stars with two observations in different filter pairs. We also show that the determination of the physical parameters of the planets from photometric measurements in different filter pairs is essentially limited by the error on the determination of the surface gravity.
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