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University of Technology of Compiègne, France

Othman S.B.,Ecole Centrale Lille | Hammadi S.,Ecole Centrale Lille | Quilliot A.,University Blaise Pascal | Martinot A.,Regional University Hospital of Lille | Renard J.-M.,University of Lille2
Studies in Health Technology and Informatics

Health organization management is facing a high amount of complexity due to the inherent dynamics of the processes and the distributed organization of hospitals. It is therefore necessary for health care institutions to focus on this issue in order to deal with patients' requirements and satisfy their needs. The main objective of this study is to develop and implement a Decision Support System which can help physicians to better manage their organization, to anticipate the overcrowding feature, and to establish avoidance proposals for it. This work is a part of HOST project (Hospital: Optimization, Simulation, and Crowding Avoidance) of the French National Research Agency (ANR). It aims to optimize the functioning of the Pediatric Emergency Department characterized by stochastic arrivals of patients which leads to its overcrowding and services overload. Our study is a set of tools to smooth out patient flows, enhance care quality and minimize long waiting times and costs due to resources allocation. So we defined a decision aided tool based on Multi-agent Systems where actors negotiate and cooperate under some constraints in a dynamic environment. These entities which can be either physical agents representing real actors in the health care institution or software agents allowing the implementation of optimizing tools, cooperate to satisfy the demands of patients while respecting emergency degrees. This paper is concerned with agents' negotiation. It proposes a new approach for multi-skill tasks scheduling based on interactions between agents. © 2015 IMIA and IOS Press. Source

Chandoul W.,Ecole Centrale Lille | Camus H.,Ecole Centrale Lille | Zoghlami N.,Ecole Centrale Lille | Hammadi S.,Ecole Centrale Lille | Martinot A.,Regional University Hospital of Lille
Proceedings - 2014 International Conference on Control, Decision and Information Technologies, CoDIT 2014

This work aims to assess the effective demand of healthcare treatment load in the Pediatric Emergency Department (PED) as a treatment time requested and focus on the treatment time remained. So we defined a metrics assessing the Total Demand Load (TDL) of healthcare treatment in the PED which is more robust to reflect the whole patients' healthcare demand than the simple attending patients count. In addition, we demonstrate that we have to avoid being limited on the physical presence of patients because a high occupancy rate does not necessarily mean that there is a high demand of healthcare treatment. This study was based on Length Of Stay (LOS) estimation according to the patient diagnostic and his number of additional tests. The patient process progression is modeled by a time buffer system allowing the instantly track of each patient. It is a way to improve the quality of service and information delivery. This method offers a priority mechanism, it is also a robust management and decision aided tool. Besides, the time buffers system will encourage physicians to respect the time needed for each patient profile suggested in order to maximize the objective of improving the performing. Such system will make them aware about three important points: The healthcare Treatment process progress, the eventual overflowing/ time excess, the eventual high acuity. From patients' viewpoint, it will reassure parents who can follow the healthcare treatment progression of their children instantly. © 2014 IEEE. Source

Daroux M.,Doctor Duchenne Hospital | Daroux M.,Regional University Hospital of Lille | Shenouda M.,Doctor Duchenne Hospital | Bacri J.-L.,Valenciennes Hospital | And 3 more authors.
Journal of Nephrology

Background: In patients with chronic kidney disease, vitamin D insufficiency is highly prevalent. It can be corrected by supplementation with either vitamin D2 or vitamin D3. Recent studies in patients without impaired kidney function suggest that vitamin D3 is more efficient than vitamin D2 in correcting vitamin D insufficiency. However, no direct comparison has been made in hemodialysis (HD) patients. Methods: Thirty-nine HD patients with serum 25-hydroxyvitamin D (25(OH)D) levels ≤20 ng/mL were enrolled in this comparative, prospective pilot study. They were divided into 3 groups and treated over a 3-month period. Each patient received oral doses of 200,000 international units (IU) vitamin D per month according to the following treatment schedule: (i) vitamin D2 in small fractionated doses at each HD session, 3 times per week (group D2S); (ii) vitamin D2 once a month (group D2M); or (iii) vitamin D3 once a month (group D3M). Changes in serum 25(OH)D levels were measured at the end of the study. Results: Posttreatment serum 25(OH)D levels increased significantly in all groups. The mean ± SD serum 25(OH)D value for group D3M patients (40 ± 13 ng/ mL) was significantly higher than that for groups D2M (25 ± 9 ng/mL, p<0.01) and D2S patients (25 ± 9 ng/ mL, p<0.01). Serum 25(OH)D increased to levels >30 ng/mL in 84% of group D3M patients, but in only 15% and 27% of group D2M and D2S subjects, respectively. Conclusion: Vitamin D3 is more effective than vitamin D2 in providing adequate 25(OH)D serum levels in HD patients. © 2012 Società Italiana di Nefrologia - ISSN 1121-8428. Source

Audrezet M.-P.,Institut Universitaire de France | Corbiere C.,University Hospital Necker Enfants Malades | Lebbah S.,University Hospital Necker Enfants Malades | Moriniere V.,University Hospital Necker Enfants Malades | And 25 more authors.
Journal of the American Society of Nephrology

Prenatal forms of autosomal dominant polycystic kidney disease (ADPKD) are rare but can be recurrent in some families, suggesting a common genetic modifying background. Few patients have been reported carrying, in addition to the familial mutation, variation(s) in polycystic kidney disease 1 (PKD1) or HNF1 homeobox B (HNF1B), inherited from the unaffected parent, or biallelic polycystic kidney and hepatic disease 1 (PKHD1) mutations. To assess the frequency of additional variations in PKD1, PKD2, HNF1B, andPKHD1 associated with the familialPKDmutation in earlyADPKD, these four geneswere screened in 42 patients with earlyADPKD in 41 families. Two patientswere associatedwith de novo PKD1 mutations. Forty patients occurred in 39 families with known ADPKD and were associated with PKD1 mutation in 36 families and with PKD2 mutation in two families (no mutation identified in one family). Additional PKD variation(s) (inherited from the unaffected parent when tested) were identified in 15 of 42 patients (37.2%), whereas these variations were observed in 25 of 174 (14.4%,P=0.001)patientswith adultADPKD.NoHNF1Bvariations or PKHD1biallelicmutationswere identified.These results suggestthat,at least insomepatients, the severity of the cystic disease is inversely correlated with the level of polycystin 1 function. Source

Ma Y.,Boston University | Ma Y.,U.S. Department of Agriculture | Follis J.L.,University of St. Thomas, Texas | Smith C.E.,U.S. Department of Agriculture | And 43 more authors.
American Journal of Clinical Nutrition

Background: DNA methylation is influenced by diet and single nucleotide polymorphisms (SNPs), and methylation modulates gene expression. Objective: We aimed to explore whether the gene-by-diet interactions on blood lipids act through DNA methylation. Design: We selected 7 SNPs on the basis of predicted relations in fatty acids, methylation, and lipids.We conducted a meta-analysis and a methylation and mediation analysis with the use of data from the CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology) consortium and the ENCODE (Encyclopedia of DNA Elements) consortium. Results: On the basis of the meta-analysis of 7 cohorts in the CHARGE consortium, higher plasma HDL cholesterol was associated with fewer C alleles at ATP-binding cassette subfamily A member 1 (ABCA1) rs2246293 (β = 20.6 mg/dL, P = 0.015) and higher circulating eicosapentaenoic acid (EPA) (β = 3.87 mg/dL, P = 5.62 1021). The difference in HDL cholesterol associated with higher circulating EPA was dependent on genotypes at rs2246293, and it was greater for each additional C allele (β = 1.69 mg/dL, P = 0.006). In the GOLDN (Genetics of Lipid Lowering Drugs and Diet Network) study, higher ABCA1 promoter cg14019050 methylation was associated with more C alleles at rs2246293 (β = 8.84%, P = 3.51 1018) and lower circulating EPA (β = 21.46%, P = 0.009), and the mean difference in methylation of cg14019050 that was associated with higher EPA was smaller with each additional C allele of rs2246293 (β = 22.83%, P = 0.007). Higher ABCA1 cg14019050 methylation was correlated with lower ABCA1 expression (r = 20.61, P = 0.009) in the ENCODE consortium and lower plasma HDL cholesterol in the GOLDN study (r = 20.12, P = 0.0002). An additional mediation analysis was meta-analyzed across the GOLDN study, Cardiovascular Health Study, and the Multi-Ethnic Study of Atherosclerosis. Compared with the model without the adjustment of cg14019050 methylation, the model with such adjustment provided smaller estimates of the mean plasma HDL cholesterol concentration in association with both the rs2246293 C allele and EPA and a smaller difference by rs2246293 genotypes in the EPA-associated HDL cholesterol. However, the differences between 2 nested models were NS (P > 0.05). Conclusion: We obtained little evidence that the gene-by-fatty acid interactions on blood lipids act through DNA methylation. © 2016 American Society for Nutrition. Source

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