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Les managers dans les marchés financiers / Managers in financial marketsGuynamant Chiabai, Béatrice 25 November 2011 (has links)
Les opérateurs de marchés sont des experts talentueux individualistes et opportunistes qui interviennent sous contrainte de temps dans un environnement centré sur la performance où l’argent et le risque constituent, outre le nerf de la guerre, une préoccupation de chaque instant. Dans ce jeu d’acteurs visant la croissance absolue mais dont les intérêts divergent parfois, quelle est la place du management ? Ce travail s’appuie sur un cadre théorique qui s’articule autour de la sociologie des professions et de la sociologie de la traduction ainsi que de la théorie des parties prenantes. Il mobilise également des théories relatives à la culture de la performance (Competing Value Framework de Quinn), au contexte de risque, d’incertitude et de crise (théorie des jeux), au management d’experts talentueux, individualistes et opportunistes (théories du management et compétition), aux relations à l’argent (théorie de l’action raisonnée et théorie de l’action située). Sur le plan théorique, nos apports sont de deux ordres : nous conjuguons sociologie de la traduction et théorie des parties prenantes ; nous abordons la compétition sous un angle non plus inter-organisationnel mais plutôt intra-organisationnel. L’enquête terrain s’articule autour d’une phase exploratoire (feedbacks de 70 managers ayant bénéficié de formations au management et 15 entretiens exploratoires) permettant la construction d’un questionnaire qui a trouvé écho auprès de 37 managers répondants. L’analyse des données obtenues prend la forme d’un codage à visée théorique réalisé avec l’aide du logiciel NVivo. Nos apports pour le terrain résident en une meilleure compréhension des règles du jeu et en la préconisation de remettre l’Humain au coeur du système, par des actions de développement des managers et de partage des bonnes pratiques ou par l’accès à l’actionnariat pour les managers (voire les collaborateurs clefs). / Market operators are individualistic and opportunistic talented experts involved under time pressure in an environment focused on performance, where money and risk are, in addition to the sinews of war, a constant concern. In this game, where all players focus on absolute growth but whose interests sometimes diverge, what is the role of management? This research study is based on a theoretical framework that focuses on the sociology of professions, the ANT (Action Network Theory) and the stakeholder theory. It also mobilizes theories related to the culture of performance (Competing Value Framework, Quinn), the context of risk, uncertainty and crisis (game theory), the management of individualistic and opportunistic talented experts, (management theories and competition), relationships to money (theory of reasoned action and theory of situated action). On the theoretical side, our contributions are twofold: we combine ANT and stakeholder theory, we address competition with an intra-organizational rather than an inter-organizational angle The field survey is based on an exploratory phase (feedback from 70 managers who received training sessions in management and 15 exploratory interviews) to build a questionnaire answered by 37 managers. Data are analyzed through a theorical coding process with the help of NVivo software Our contribution for the professionals is a better understanding of the rules and the recommendation to place People in the heart of the system, by developing management skills, sharing best practices or encouraging shareholding for managers (or key people).
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Exame e levantamento técnico pericial de locais de interesse à justiça criminal: abordagem descritiva e crítica / Examination and technical survey on sites of the criminal justices interest: descriptive and critical approachDel-Campo, Eduardo Roberto Alcântara 08 May 2009 (has links)
O panorama das ciências forenses no Brasil poderia ser mais auspicioso. O aumento incontrolável das dissensões sociais e da criminalidade comum, o crescimento de facções do crime organizado, o surgimento de novas modalidades de delitos, os desastres de massa e o incremento de novas tecnologias são fatores que apontam no sentido de uma maior demanda por exames periciais e da crescente complexidade dos trabalhos relacionados com as ciências forenses. Paradoxalmente, a falta de investimentos públicos na área, os baixos salários, a ausência de perspectiva profissional e o acúmulo de serviço são alguns dos fatores que claramente influenciam na queda de qualidade do trabalho técnico. Não se publicam mais obras de Criminalística e Medicina Legal no país. As revistas especializadas são poucas e os cursos de Direito paulatinamente vão destinando cada vez menos espaço para aquelas que, ao lado da formação jurídica específica, deveriam ser as matérias principais na formação do bacharel, especialmente daqueles que militam na área penal. Além disso, e exatamente pela natureza técnica da matéria, poucos são os questionamentos que recaem sobre a cadeia de custódia ou sobre a validade das provas periciais apresentadas pelos organismos públicos encarregados da prevenção e da repressão criminal. Este trabalho pretende apresentar uma breve revisão dos dispositivos que regulamentam a prova pericial no sistema processual penal, recentemente alterados pela Lei n. 11.690, de 09/06/08, a estrutura da polícia científica e os procedimentos periciais de levantamento dos locais de interesse à Justiça Criminal, desde o momento que antecede à perícia até a entrega do relatório técnico, apontando seus limites, deficiências e qualidades. / The overview of forensic sciences in Brazil could be more auspicious. The uncontrollable raise of social disagreements and common criminality, the increase of organized crime factions, the appearance of new forms of crime, mass disasters and improvement of new technologies are factors which leads to a sense of higher demand for expert examinations and an increasing complexity of works related to forensic sciences. Paradoxically, the absence of public investment in the area, the low wages, the lack of professional perspectives and the accrual of workload are some of the factors that clearly influence the decline of quality of technical works. There are few new publications about Criminalistics and Legal Medicine in Brazil. The specialized journals are few and law schools are gradually giving less space for those which, like specific legal matters, should be the main ones in the training of new lawyers, especially those who work with criminal law. Besides that, and exactly because of the technical nature of the matter, few are the questions which fall upon the chain of custody or the validity of the expert evidence shown by the public organisms which are responsible for the criminal prevention and repression. This dissertation intends to present a brief review of the articles that regulate the expert evidence in the criminal procedural law, recently altered by Law nº 11.690 of 09/06/08, and the structure of forensic science and the expert procedures to gather places of interest to the Criminal Justice, from the moment preceding the expertise until the delivery of the technical report, pointing out its limitations, shortcomings and qualities.
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Single Function Agents and their Negotiation Behavior in Expert SystemsDunskus, Bertram V. 05 November 1999 (has links)
"A Single Function Agent (SiFA) is a software agent, with only one function, one point of view, and one target object on which to act. For example, an agent might be a critic (function) of material (target) from the point of view of cost. This research investigates the possibilities and implications of the SiFA concept, and analyzes the definition language, negotiation language and negotiation strategies of the agents. After defining a domain-independent set of agent types we investigated negotiation, analyzing which pairs/groups of agents have reason to communicate, and what the information passed between them should be, as well as what knowledge was needed to support the negotiation. A library for the CLIPS expert system shell was built, which allows development of SiFA based expert systems from domain independent templates. We will present two such systems, one as implemented for the domain of ceramic component material selection and the other (in development) for simple sailboat design. The effect of negotiation on the design process and the results are discussed, as well as directions for future research into SiFAs."
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Perícia contábil judicial: um estudo acerca das sentenças prolatadas na cidade de São Paulo no primeiro semestre de 2015Silvestrin, Priscilla Silva 22 December 2015 (has links)
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Previous issue date: 2015-12-22 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The Accounting Science's mission is to assist decision making. The accounting reports are the instrument by which the water meter provides information that will serve as a resource to meet this purpose. Judicial accounting expertise serve a specific external user, which is the judge who has the task of resolving social conflicts installed with justice and equity. The main objective of this research is to analyze the performance of judicial accounting expertise in Sao Paulo in the first half of 2015. The study used based on the data made public by the São Paulo State Court of Justice relating to judicial decisions handed down in the period and procedural movements using quantitative methods. In addition to quantitative methodology, the paper presents literature, intended to clarify and bring concepts relating to Accounting and the science of law, which includes forensic accounting expert. From the collected data it is possible to realize the increase of judicial decisions in time and that the ratio between the number of sentences and those who have the term forensic accounting is on average 0.55% (zero point fifty-five percent). In decisions where there is mention of the term forensic accounting, in 46% (forty-six percent) of them, the judge denies the realization of forensic accounting, 23% (twenty three percent) the judge believes it would be the case achievement of expertise, but these were not required and 31% (thirty-one percent) was the approval of the accounting expert evidence. Of deferred and unrealized sentences, 11% (eleven percent) of cases, given up parts of the production of evidence, in 24% (twenty-four percent) the parties have not submitted enough documents to carry out the expertise and 65 % (sixty five percent), the parties failed to collect fees. The skills deferred and performed, 88% (eighty eight percent) there was no assistant coach, while in 12% (twelve percent) decisions there. From the decisions where there was contradictory regarding the accounting demonstration, it was found that the appointed experts, 12% (twelve percent) do not have active registration with the Regional Accounting Council and 82% (eighty two percent) did not It has registered curriculum in the Lattes platform / A Ciência Contábil tem por missão auxiliar a tomada de decisão. Os relatórios contábeis são o instrumento pelo qual o contador apresenta informações que servirão como subsídio para atender a esta finalidade. As perícias contábeis judiciais servem a um usuário externo específico, qual seja o juiz de direito, que possui a missão de dirimir conflitos sociais instalados com justiça e equidade. O objetivo central desta pesquisa é analisar a realização da perícia contábil judicial na cidade de São Paulo no primeiro semestre de 2015. O trabalho utilizou como base os dados tornados públicos pelo Tribunal de Justiça do Estado de São Paulo relativos às sentenças judiciais prolatadas no período e andamentos processuais utilizando métodos quantitativos. Além de metodologia quantitativa, o trabalho apresenta pesquisa bibliográfica, destinada a aclarar e aproximar conceitos relativos às Ciências Contábeis e à Ciência do Direito, onde se insere a perícia contábil judicial. A partir dos dados colhidos é possível perceber o aumento das decisões judiciais no tempo e que a razão entre o número de sentenças e àquelas que possuem o termo perícia contábil é em média 0,55% (zero vírgula cinquenta e cinco por cento). Nas decisões em que há menção ao termo perícia contábil, em 46% (quarenta e seis por cento) delas, o juiz nega a realização da perícia contábil, em 23% (vinte e três por cento) o juiz entende que seria o caso de realização de perícia, mas estas não foram requeridas e em 31% (trinta e um por cento) houve o deferimento da prova pericial contábil. Das sentenças deferidas e não realizadas, em 11% (onze por cento) dos casos, as partes desistiram da produção da prova, em 24% (vinte e quatro por cento) as partes não apresentaram documentos suficientes para a realização da perícia e em 65% (sessenta e cinco por cento), as partes deixaram de recolher honorários. Das perícias deferidas e realizadas, 88% (oitenta e oito por cento) não houve assistente técnico, ao passo que em 12% (doze por cento) das decisões houve. A partir das decisões em que houve contraditório com relação à manifestação contábil, constatou-se que dos peritos nomeados, 12% (doze por cento) não possui registro ativo junto ao Conselho Regional de Contabilidade e 82% (oitenta e dois por cento) não possui currículo cadastrado na plataforma Lattes
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A valoração da prova pericial no processo do trabalhoNicolau, Maira Ceschin 24 August 2012 (has links)
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Previous issue date: 2012-08-24 / The present study aims to analyze aspects of expert evidence and its
peculiarities in the process of work, especially when it comes to production and value.
In general, all chapters tackle the idea of the research developed over the
work.
The first chapter discusses the concept and development of systems of
evaluation of evidence, particularly the current ruling system: a system of rational
persuasion or conviction self motivated. In the second chapter, before entering the
concepts inherent in the expert evidence, attempts to trace the concepts of the general
theory of testing (concept, object, purpose), to later study of expert evidence, with its
concepts and meanings. Species and classification of expert evidence are discussed in
chapter three and four, respectively. The fifth chapter examines the actions and
procedures involving the execution of a skill, with emphasis on issues related to the
time of production of expert evidence, denial and rejection of expert evidence and the
expert report. In the sixth chapter, we discuss the question of determinant power
experts evidence in court. The seventh and final chapter, on the basis of the entire
approach taken in the previous chapters and regulation based on legal, doctrinal
teachings and jurisprudence, is exactly the problems and situations involving the need
or no experience and also transported, faces questioning over whether or not the judge
bound by its outcome, concluding at the end that in the case of the technical evidence,
the conclusion obtained by performing the same force the judge / O presente estudo tem por objetivo analisar os aspectos inerentes à prova
pericial e suas peculiaridades no processo do trabalho, principalmente quando se trata
de sua produção e valoração.
De modo geral, todos os capítulos buscam sedimentar a ideia central da
pesquisa desenvolvida ao longo do trabalho.
O primeiro capítulo aborda a noção e evolução dos sistemas de apreciação da
prova, com destaque para o sistema atual vigente: sistema da persuasão racional ou do
livre convencimento motivado. O segundo capítulo, antes de adentrar aos conceitos
inerentes à prova pericial, busca traçar noções sobre a teoria geral da prova (conceito,
objeto, finalidade), para após se aprofundar no estudo da prova pericial, com seus
conceitos e significados. As espécies e classificação da prova pericial são analisadas
no terceiro e quarto capítulo, respectivamente. O quinto capítulo estuda os atos e
procedimentos que envolvem a realização de uma perícia, com destaque para questões
que envolvem o momento da produção da prova pericial, o indeferimento e dispensa
da prova pericial e, ainda, o laudo pericial. No sexto capítulo, é abordada a questão do
poder instrutório do juiz na prova pericial. O sétimo e último capítulo, com base em
toda a abordagem feita nos capítulos anteriores, bem como com base no regramento
legal, nos ensinamentos doutrinários e na jurisprudência, trata exatamente das questões
e situações que envolvem a necessidade ou não da perícia e, ainda, em sendo esta
realizada, enfrenta o questionamento relativo a estar ou não o julgador vinculado ao
seu resultado, concluindo, ao final, que, por se tratar de prova técnica, à conclusão
obtida através da realização da mesma deve o juiz se vincular
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Harmonisation de l'information géo-scientifique de bases de données industrielles par mesures automatiques de ressemblance / Harmonization of geo-scientific information in industrial data bases, thanks to automatic similarity metricsFuga, Alba 05 January 2017 (has links)
Pour automatiser l’harmonisation des bases de données industrielles de navigation sismique, une méthodologie et un logiciel ont été mis en place. La méthodologie d’Automatisation des Mesures de Ressemblance (AMR), permet de modéliser et hiérarchiser les critères de comparaison servant de repères pour l’automatisation. Accompagné d’un ensemble de seuils de tolérance, le modèle hiérarchisé a été utilisé comme filtre à tamis dans le processus de classification automatique permettant de trouver rapidement les données fortement similaires. La similarité est mesurée par un ensemble de métriques élémentaires, aboutissant à des scores numériques, puis elle est mesurée de manière plus globale et contextuelle, notamment suivant plusieurs échelles : entre les attributs, entre les données, et entre les groupes. Ces évaluations de la similarité permettent à la fois au système expert de présenter des analyses précises automatisées et à l’expert géophysicien de réaliser des interprétations multicritères en faisant en environ deux jours le travail qu’il faisait en trois semaines. Les stratégies de classification automatique sont quant à elles adaptables à différentes problématiques, à l’harmonisation des données, mais aussi à la réconciliation des données ou au géo-référencement de documents techniques. Le Logiciel Automatique de Comparaisons (LAC) est une implantation de l’AMR réalisée pour les services de Data Management et de Documentation Technique de TOTAL. L’outil industrialisé est utilisé depuis trois ans, mais n’est plus en maintenance informatique aujourd’hui malgré son usage. Les nouvelles fonctionnalités d'imagerie de base de données qui ont été développées dans cette thèse n'y sont pas encore intégrées, mais devraient permettre une meilleure visualisation des phénomènes. Cette dernière manière de représenter les données, fondée sur la mesure de similarité, permet d’avoir une image assez claire de données lourdes car complexes tout en permettant de lire des informations nécessaires à l’harmonisation et à l’évaluation de la qualité des bases. Ne pourrait-on pas chercher à caractériser, comparer, analyser, gérer les flux entrants et sortants des bases de données, suivre leurs évolutions et tirer des modes d’apprentissage automatique à partir du développement de cette imagerie ? / In order to harmonize industrial seismic navigation data bases, a methodology and a software have been developed. The methodology of Similarity Measurement Automation provides protocols to build a model and a hierarchy for the comparison criteria that shall be used as points of reference for the automation. With its tolerance set of thresholds, the model has been used as a scaled filter within the automatic classification process which aim is to find as quickly as possible very similar data. Similarity is measured by combinations of elementary metrics giving scores, and also by a global and contextual procedure, giving access to three levels of results: similarity between attributes, between individuals, and between groups. Accurate automated analyses of the expert system as well as human interpretations on multiple criteria are now possible thanks to these similarity estimations, reducing to two days instead of three weeks the work of a geophysicist. Classification strategies have been designed to suit the different data management issues, as well as harmonization, reconciliation or geo-referencing. The methodology has been implemented in software for automatic comparisons named LAC, and developed for Data Management and Technical Documentation services in TOTAL. The software has been industrialized and has been used for three years, even if now there is no technical maintenance anymore. The last data base visualization functionalities that have been developed have not been integrated yet to the software, but shall provide a better visualization of the phenomena. This latest way to visualize data is based on similarity measurement and obtains an image of complex and voluminous data clear enough. It also puts into relief information useful for harmonization and data quality evaluation. Would it be possible to characterize, compare, analyze and manage data flows, to monitor their evolution and figure out new machine learning methods by developing further this kind of data base imaging?
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獨立專家系統與資料庫鬆散結合介面之研究 / The Study of An Interface for Loose Coupling of Independent Expert Systems and Databases黃允暐 Unknown Date (has links)
智慧型資料庫的研究重點,在於發展一個能結合專家系統的知識表達、推論及問題解決能力與資料庫的大量資料儲存管理能力的資訊系統。目前有四種主要類型的結合方式:(1)增強式的資料庫系統、(2)增強式的專家系統、(3)獨立專家系統與資料庫的鬆散結合、(4)專家資料庫。
由於目前企業中已有許多資料庫系統在運作之中,上述的結合方式以獨立專家系統與資料庫的鬆散結合方式較為合適,其它三類則因需要對現有系統配合新的架構加以修改,在成本效益上較不經濟。
因此,本論文針對獨立專家系統與資料庫的鬆散結合架構進行研究。首先從文獻中瞭解其它相關研究對結合所提出架構的優缺之處,而從資料庫的獨立性、專家系統的獨立性、系統的複雜度、系統的擴充性等四點考慮,提出一個較為獨立、有效率,且建立容易的系統架構。並以財務診斷此一特定應用領域,成功地發展出一套結合財務診斷專家系統與會計資料庫系統的雛形系統,驗證了本架構的可行性。最後並提出進一步的研究建議,以供後續研究參考。 / The reserach objective of the integration, of expert systems and database systems is to develope an information system which can integrate both the capabilities of ex-pert systems (inferencing and problem solving) and capabilities of databases (storing and managing of huge amount of data). There are four ways to integrate them: (1) enhanced databases, (2) enhanced expert systems; (3) loose coupling of independent expert systems and databases, (4) expert database systems.
Since there are many existing database systems, the loose coupling of independent expert system, and database is considered to be the most appropriate approach. The other three ways are not cost/benefit feasible because they need major modification of the curresn systems.
The focus of this reserach is on loose coupling of independent expert system and database. The strengthes and weaknesses of the relevent researchs are discov-ered through literature review. There are four major considerations in developing the architecture: database independency, expert system independency, system, complexity, system, extendibility. The proposed architecture is more independent, efficient, and easy to be bulit. This research has also built a prototype system coupling a financial diagnosis expert system, with an accounting database. The feasibility of the prototype has verified the usefulness of the proposed architecture. Future reasearch suggestions are also stated.
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The application of a knowledge based system to micro-electrode guided neurosurgeryHarley, Linda Rosemary 04 February 2004 (has links)
Parkinson's Disease can be treated by a micro-electrode guided neurosurgery called a Pallidotomy or Deep Brain Stimulus. A new software program, called Onetrack, is being developed and incorporates a three dimensional virtual model of the brain, a advanced digital signal processor and a knowledge based system (KBS). This thesis discusses the design and development of this KBS. The purpose of the KBS is to assist the surgical team in identifying the different anatomical structures and neuronal cell types of the brain. Therefore, improving the efficiency of the procedure.
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Selection of clinical trials [electronic resource] : knowledge representation and acquisition / by Savvas Nikiforou .Nikiforou, Savvas. January 2002 (has links)
Title from PDF of title page. / Document formatted into pages; contains 42 pages. / Thesis (M.S.C.S.)--University of South Florida, 2002. / Includes bibliographical references. / Text (Electronic thesis) in PDF format. / ABSTRACT: When medical researchers test a new treatment procedure, they recruit patients with appropriate health problems and medical histories. An experiment with a new procedure is called a clinical trial. The selection of patients for clinical trials has traditionally been a labor-intensive task, which involves matching of medical records with a list of eligibility criteria. A recent project at the University of South Florida has been aimed at the automation of this task. The project has involved the development of an expert system that selects matching clinical trials for each patient. / If a patient's data are not sufficient for choosing a trial, the system suggests additional medical tests. We report the work on the representation and entry of the related selection criteria and medical tests. We first explain the structureof the system's knowledge base, which describes clinical trials and criteria for selecting patients. We then present an interface that enables a clinician to add new trials and selection criteria without the help of a programmer. Experiments show that the addition of a new clinical trial takes ten to twenty minutes, and that novice users learn the full functionality of the interface in about an hour. / System requirements: World Wide Web browser and PDF reader. / Mode of access: World Wide Web.
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Développement d’un système d’administration de l’anesthésie en boucle ferméeCharabati, Samer 03 1900 (has links)
En salle d’opération, les tâches de l’anesthésiste sont nombreuses. Alors que l’utilisation de nouveaux outils technologiques l’informe plus fidèlement sur ce qui se passe pour son patient, ces outils font que ses tâches deviennent plus exigeantes. En vue de diminuer cette charge de travail, nous avons considérer l’administration automatique d’agents anesthésiques en se servant de contrôle en boucle fermée.
À cette fin, nous avons développé un système d’administration d’un agent anesthésique (le propofol) visant à maintenir à un niveau optimal la perte de conscience du patient pendant toute la durée d’une chirurgie. Le système comprend un ordinateur, un moniteur d’anesthésie et une pompe de perfusion. L’ordinateur est doté d’un algorithme de contrôle qui, à partir d’un indice (Bispectral IndexTM ou BIS) fournit par le moniteur d’anesthésie détermine le taux d’infusion de l’agent anesthésiant. Au départ, l’anesthésiste choisit une valeur cible pour la variable de contrôle BIS et l’algorithme, basé sur système expert, calcule les doses de perfusion de propofol de sorte que la valeur mesurée de BIS se rapproche le plus possible de la valeur cible établie.
Comme interface-utilisateur pour un nouveau moniteur d’anesthésie, quatre sortes d’affichage ont été considérés: purement numérique, purement graphique, un mélange entre graphique et numérique et un affichage graphique intégré (soit bidimensionnel). À partir de 20 scenarios différents où des paramètres normaux et anormaux en anesthésie étaient présentés à des anesthésistes et des résidents, l’étude des temps de réaction, de l’exactitude des réponses et de la convivialité (évaluée par le NASA-TLX) a montré qu’un affichage qui combine des éléments graphiques et numériques était le meilleur choix comme interface du système.
Une étude clinique a été réalisée pour comparer le comportement du système d’administration de propofol en boucle fermée comparativement à une anesthésie contrôlée de façon manuelle et conventionnelle où le BIS était aussi utilisé. Suite à l’approbation du comité d’éthique et le consentement de personnes ayant à subir des chirurgies générales et orthopédiques, 40 patients ont été distribués également et aléatoirement soit dans le Groupe contrôle, soit dans le Groupe boucle fermée. Après l’induction manuelle de propofol (1.5 mg/kg), le contrôle en boucle fermée a été déclenché pour maintenir l’anesthésie à une cible de BIS fixée à 45. Dans l’autre groupe, le propofol a été administré à l’aide d’une pompe de perfusion et l’anesthésiste avait aussi à garder manuellement l’indice BIS le plus proche possible de 45. En fonction du BIS mesuré, la performance du contrôle exercé a été définie comme excellente pendant les moments où la valeur du BIS mesurée se situait à ±10% de la valeur cible, bonne si comprise de ±10% à ±20%, faible si comprise de ±20% à ±30% ou inadéquate lorsque >±30%.
Dans le Groupe boucle fermée, le système a montré un contrôle excellent durant 55% du temps total de l’intervention, un bon contrôle durant 29% du temps et faible que pendant 9% du temps. Le temps depuis l’arrêt de la perfusion jusqu’à l’extubation est de 9 ± 3.7 min. Dans le Groupe contrôle, un contrôle excellent, bon, et faible a été enregistré durant 33%, 33% et 15% du temps respectivement et les doses ont été changées manuellement par l’anesthésiste en moyenne 9.5±4 fois par h. L’extubation a été accomplie après 11.9 ± 3.3 min de l’arrêt de la perfusion. Dans le Groupe boucle fermée, un contrôle excellent a été obtenu plus longtemps au cours des interventions (P<0.0001) et un contrôle inadéquat moins longtemps (P=0.001) que dans le Groupe contrôle.
Le système en boucle fermée d’administration de propofol permet donc de maintenir plus facilement l’anesthésie au voisinage d’une cible choisie que l’administration manuelle. / In the operating room, the anaesthetist performs numerous tasks. New technological tools better inform him about the state of the patient but render his task more demanding. To alleviate the anaesthetist workload, we have considered the automatic administration of anesthetic drugs using closed-loop control.
In this respect, we have developed a system for the administration of an anesthetic agent (propofol) in order to maintain loss of consciousness at an optimal level throughout a surgery. The system comprises a computer, an anaesthesia monitor and an infusion pump. A control algorithm installed on the computer determines the infusion rate of the hypnotic drug based on the Bispectral IndexTM (BIS) provided by the monitor. At first, the anaesthetist chooses a target value for the control variable BIS and the algorithm, which consists of an expert system, calculates the infusion doses of propofol in order to steer the measured BIS value closer to the target value.
For the user-interface of a novel anaesthesia monitor, four display types were considered: purely numeric, purely graphical, a mixed graphical and numerical and a bi-dimensional integrated graphical display. Based on 20 different scenarios where normal and abnormal anaesthesia parameters were presented to anaesthetists and residents, the study of the reaction time, response accuracy and user-friendliness (assessed by the NASA-TLX) showed that a mixed graphical and numerical display is the best preferred for the interface of the system.
A clinical study was conducted in order to compare the behaviour of the system of administering propofol in closed-loop to manually controlled anaesthesia guided by BIS. After Institutional Review Board approval and written consent, 40 patients undergoing orthopaedic or general surgery were randomly assigned to 2 groups of equal size. After manual propofol induction (1.5 mg/kg), closed loop control was used to maintain anesthesia at a target BIS of 45 (Closed-loop group); in the other group, propofol was administered manually using a syringe pump by an experienced anaesthesiologist in order to maintain a target BIS of 45 as closely as possible (Control group). The performance of the system was defined as excellent, good, poor or inadequate, when the BIS was within 10%, between 10 and 20%, between 20 and 30% or outside 30% of the target BIS, respectively.
In the Closed-loop group, the system showed excellent control during 55% of the total anaesthesia time, good control during 29% of the time and poor control during 9% of the time. The time from the end of infusion to extubation was 9 ± 3.7 min. In the Control group, excellent, good and poor control were noted during 33%, 33% and 15% of the time, respectively and doses were changed 9.5 ± 4 times per h. Extubation was achieved after 11.9 ± 3.3 min from the end of infusion. In the Closed-loop group, excellent control of anesthesia occurred significantly more often (P<0.0001) and inadequate control less often than in the Control group (P=0.001).
The present system of administering propofol in closed-loop maintains the anesthesia level closer to a given target than manual administration.
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