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Background: In the midst of the North American opioid crisis, identifying and intervening on drivers of high-risk opioid prescriptions is an important step towards reducing iatrogenic harm. Objectives: We aimed to identify factors associated with variations in high-risk opioid discharge prescriptions, following select surgical procedures, to guide future quality improvement initiatives. Methods: This retrospective cohort study analyzed 1322 patients who underwent select open pelvic and open abdominal surgeries between January 1 and December 31, 2017, in a tertiary health care centre in Montreal. Results: Patients who underwent open abdominal surgeries were prescribed significantly higher daily doses of morphine milligram equivalents (MME) (45 mg; interquartile range, 30-60), than patients who underwent either a caesarean delivery (20 mg, 20-20) or a hysterectomy (30 mg, 22-30). After adjustment for multiple potential confounders, abdominal surgery was associated with 4 times the odds of receiving more than 50 MME at hospital discharge compared with pelvic surgeries (odds ratio, 3.96; 95% confidence interval, 1.31-11.97). The availability of postoperative preprinted order sets with fixed high doses of opioids was also highly associated with the outcome. Conclusion: In our institution, some surgeries were more likely to receive high-risk opioid prescriptions at discharge. Efforts to optimize safer prescribing practices should address the creation and/or updating of preprinted order sets to reflect current best practice guidelines. This initiative could be overseen by hospital pharmacy and therapeutics committees.

The oil-and-gas industry is known to be part of the most safety-critical domains. Safety culture has prompted such companies to implement new systems to support decision-making. In this paper, we explore the use of digital twins to support situation awareness as a crucial part of real-time decisionmaking processes. Therefore, this paper presents requirements for the development of an eight components digital twin. Human-centered approach contributes to add useful information based on user needs and user experience to the usual theoretical process. This user-centered information helped shape both digital twin components and the situation awareness model.

Industrial digital transformation is bringing a need for new tools and concepts. However, designing such complex tools and concept requires methods to be correctly implemented. These methods are studied as part of system engineering to satisfy various identified goals, and more specifically human-system integration, which is the topic of this paper. This article introduces the method used to define key elements of human perception of reality called reality anchors to design scenarios to be tested in a digital twin prototype. This method goes from regulation study to user cognitive function analysis on the specific case of digital twin designing in oil-and-gas industry. This method highlighted the differences between theoretical process and the followed process as well as tools and competencies used to identify reality anchors. This knowledge will then be used to implement a new process to be implemented with a digital twin and scenarios to test the prototype using realistic simulation.

International audience; When responding to calls for tenders, companies must elaborate on relevant bids relative to the needs and expectations of customers (for example, in terms of price and delay). We built and deployed a knowledge-based system (KBS) to aid companies when developing bids. Based on a pre-defined generic bid model, a methodology to support companies when deploying the KBS is proposed in this paper. To capture, formalize, and reuse knowledge relevant to bids, a combination of several approaches, such as taxonomy, constraint satisfaction problem, and case-based reasoning, is proposed. The methodology is composed of five steps: Initialization, Specialization, Implementation, Exploitation, and Maintenance. A case study from a company building electrical parts of harbor lifting devices illustrates our proposal and allows validating the proposed methodology.

While the 7 million-head French sheep industry is contracting, the average herd size is rising, providing challenging issues to maintain and improve its productivity. Precision Livestock Farming has allowed the sheeps and herds to be equipped with sensors and has a result the amount of data to be processed by farmers has surged. We argue that in order for the farmers to take appropriate actions there is a need for the development of a decision support system that take into account not only real-time data but also expert knowledge. In this work, we first highlight the specific challenges presented by the field of precision sheep farming to the development of a Cyber-Physical and Human System. We then introduce a methodology to implement a decision support in this context.

This study was designed to determine the fatality rate of suspected cyclopeptide-containing mushroom ingestions reported to the National Poison Data System (NPDS).Although silibinin reportedly improves survival in suspected cyclopeptide-containing mushroom ingestions, the greater than 20% untreated fatality rate that is often cited is based on decades-old data. An ongoing open-label silibinin trial will likely use historical cases as comparators. A recent single poison control center (PCC) study showed a fatality rate of 8.3%. This study was designed to validate those findings in the NPDS.This study was an 11-year (1/1/2008-12/31/2018) retrospective review of suspected cyclopeptide-containing mushroom ingestions reported to NPDS. Inclusion and exclusion criteria were the same as the ongoing silibinin trial: Age2-years-old; history of eating foraged mushrooms; gastrointestinal symptoms within 48 h of mushroom ingestion; and aminotransferases above the upper limit of normal within 48 h after ingestion. Each original participating PCC confirmed eligibility, diagnosis, treatment, and outcome on included cases.During the study period, 8,953 mushroom exposures were reported to NPDS, of which 296 met inclusion criteria. The PCC survey response rate was 60% (28/47 PCCs), and the individual case response rate was 59% (174/296). Twenty-six cases were subsequently excluded leaving 148 included cases. The overall mortality rate was 8.8% (13/148). Mortality in silibinin/silymarin-treated vs untreated cases was 9.5% (4/42), vs 8.5% (9/106), respectively. A mycologist identified mushrooms in 16.9% of cases (25/148), of which 80% (20/25) were cyclopeptide-containing. Among these confirmed cases, the mortality rate was 10% (1/10) in both silibinin/silymarin-treated and untreated cases.The contemporary mortality rate of patients with presumed cyclopeptide-mushroom poisoning is only 8.8%. This likely represents improved supportive care for patients with acute liver injury and should be considered the current standard for historical controls in the United States.

Although anecdotal reports suggest that intravenous lipid emulsion (ILE) therapy is effective in a large variety of overdoses, the few controlled human trials published to date yielded disappointing results. Because of potential publication biases, there are few reports concerning the failure of ILE. The primary aim of this study was to identify fatal poisoning cases in the American Association of Poison Control Centers (AAPCC) National Poison Data System (NPDS) in which ILE was administered.We obtained an approved release of data from NPDS for years 2010-2015 in which the words "lipid," "ILE," or "fat" appeared in the narrative. Duplicate cases were excluded as were cases in which ILE was not clearly given. Case data were extracted by one author using a predetermined tool, and the information was confirmed by a second author. The timing of ILE administration was characterized into one of four categories: cardiac arrest, first line, last resort, or part of multiple therapies given simultaneously. Response to ILE and adverse events was recorded.Of the 826 cases retrieved from NPDS, 459 met final inclusion criteria. Over 50% of included cases involved either a calcium channel blocker or a beta-adrenergic antagonist. Of note, less than 25% of cases involved a substance for which the Lipid Emulsion Working Group found evidence to support its use. Most often, ILE was given along with multiple therapies (277 cases) or as a last resort (137 cases). In 127 cases, ILE was given during cardiac arrest. ILE was used as first line therapy in 34 cases. Response rates were reported as follows: no response (45%), unknown response (38%), transient/minimal response (7%), ROSC (7%), and immediate worsening (3%). Possible adverse reactions included: ARDS in 39 patients, lipemia causing a delay in laboratory evaluation in three cases, lipemia causing failure of a CRRT filter in two cases, worsening or new onset seizure in two cases, asystole immediately after administration in two cases, and fat embolism in one case.Within the Association of Poison Control Centers (AAPCC) National Poison Data System (NPDS), hundreds of cases exist in which ILE therapy was given and death occurred. In many of these cases, ILE was given prior to cardiovascular collapse. Although there is some suggestion of transient improvement in a small subset of cases, adverse effects are also reported. When taken in totality, the number of published cases of failed lipid emulsion therapy outnumbers the published instances of ILE success. Given all the uncertainty generated by case reports, the evaluation of the role and efficacy of ILE therapy in non-local anesthetic poisoning needs robust controlled clinical trials.

International audience; Refurbishing existing building into Near Zero Energy Building (NZEB) is a key objective for the European Union. In order to achieve high rate of conversion, new refurbishment process must allow Decision Makers (DMs) (architects or designers) to sort through an ever increasing list of new technologies while taking into account uncertain preferences from multiple stakeholders. A Decision Support System (DSS) based on Multi-Criteria Decision-Making (MCDM) approaches is proposed. The DSS enables the DMs to browse the solutions space by selecting the relevant criteria, order them by preferences and specify the granularity in the assessment of the technologies regarding each criteria. This DSS is based on a ranking algorithm that operates on multiple types of quantitative (continuous, discrete, or binary) and qualitative (nominative or ordinal) variables from technological and human sources. An online user interface allows the real-time exploration of the solution space. A sensitivity analysis of the algorithm is conducted to expose the influence of the ranking algorithm parameters and to demonstrate the robustness of this algorithm. The proposed DSS is eventually implemented and validated through a use case concerning the choice of insulating materials considering heterogeneous criteria that model sustainable constraints.

We emphatically agree with Mullins’ and Seger’s conclusion that understanding the true utility of intravenous lipid emulsion (ILE) therapy in orally poisoned patients requires well-designed randomi...

Intracranial hemorrhage (ICH) is the most deadly bleeding complication associated with anticoagulation. The efficacy of idarucizumab in treating dabigatran-associated ICH in the real world is uncer...

“© © 2019 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.”; International audience; Today, consumption patterns are changing: firstly, customers (private and industrial ones) want more and more products and services that can be personalized to their needs, and secondly, they are more and more willing to pay for usage of a product rather than ownership. Companies have therefore to adapt their catalog of solutions by putting on the market customizable and suitable solutions going from products to services, including all their possible combinations. The aim of this article is to propose a generic knowledge-based model, dedicated to commercial offers configuration, which can cope with all the diversity of solutions a company can deliver. Up to our knowledge, even if some works on product, service and product-service system exist, none is generic enough to support such commercial offer configuration while bidding. In this paper, after a brief state-of-the-art, the need of a generic model is set up. Then, a unified model is proposed and illustrated on use-cases coming from industrial situations.

ObjectivesAlthough alcohol withdrawal is common, the recognition of benzodiazepine-resistant alcohol withdrawal is a relatively new concept. To provide a framework for both literature review and future research, we assessed clinicians’ personal definition of resistant alcohol withdrawal.MethodWe developed a cross-sectional web-based survey. Administrators from collaborating toxicology and emergency medicine associations deployed the survey directly to their respective memberships. Only physicians, pharmacists, and other clinicians routinely treating alcohol withdrawal were eligible to participate. Respondents selected their preferred definition among the three most common author sources – JB Hack, NJ Benedict, D Hughes – or provided their own. Additional criteria to define resistant alcohol withdrawal were explored.Results384 individuals answered the survey. Respondents were mostly attending physicians (79%), in full-time practice (90%), in emergency medicine (70%), and from North America (90%). The majority (64%) described resistant alcohol withdrawal as a high benzodiazepine dosage. Seizures (26%) and persistent tachycardia (16%) were also main characteristics. The median dose to describe high benzodiazepine dose (n = 146) was 40 mg per hour of diazepam equivalents (IQR 20–50). Available definitions were ranked equally as the preferred one: Hack (27%); Benedict (28%); Hughes (28%).ConclusionOur results did not identify one single preferred definition for resistant alcohol withdrawal even though a high total dose of benzodiazepine is a major component. Hourly requirements of 40 mg of diazepam equivalents or more emerged as a possible threshold. These findings serve as a base to explore consensus guidelines or future research.

International audience; When responding to call for tenders, many bidding companies offer services. This paper focuses on how to model industrial services during the bidding process to be able to easily develop them. A product offer configuration model is presented, then a reflection about the extension of this model to service offers is conducted. A study of the literature about service definition is dealt and services characteristics are identified. Their impact on the product offer model is analyzed and new characteristics are introduced. This work makes possible to propose a typology to adapt the product offer model to services.

Early phases of product development are critical for next phases and impact the product definition. During bid process, suppliers generate offers for a customer that must both meet customer's requirements and be realizable in terms of technical aspects, costs and due date. Our aim is to propose a methodology for implementing a generic bid model, composed of context parameters, customer's requirements, the product i.e. technical solution, its delivery process, and associated risks. Key Performance Indicators allow to evaluate different solutions. The bid model is exploited with two different approaches. First, we use Constraint Satisfaction Problems to formalize expert knowledge and identify variables/constraints and relations. Second, we use case database to reuse past experiences. This model and the methodology are applied with a company developing harbour cranes. An initialisation phase allows to define existing bid process. Then, the generic model is adapted through a specialisation phase, using specific knowledge from company's experts. Finally, the specific model is implemented and tested in an implementation phase. Future work will be focused on a software tool development.

Precision livestock farming aims to improve the farm productivity and relies on a set of technological equipment producing data that must be collected, stored and analyzed and concern each animal and its environment. This new way of managing a farm is a prime area of application for research work on Cyber-Physical and Human Systems. The issue explored in this article is based on the observation that breeders face a considerable increase in the amount of data they must deal with. It is then necessary to develop a decision support system considering the "real time" data but also the expert knowledge to allow the farmers to act at best. In this work, we first highlight the specific challenges presented by the field of precision sheep farming to the development of a decision support system. We then introduce a methodology to implement decision support in this context., L'élevage de précision a pour objectif d'améliorer la productivité des exploitations agricoles et s'appuie sur un ensemble d'équipements technologiques qui produisent des données qu'il convient de collecter, stocker et analyser et qui concernent chaque animal et son environnement. Cette nouvelle façon de gérer une exploitation agricole constitue un domaine d'application privilégié pour les travaux de recherche sur les Cyber-Physical and Human Systems. La problématique explorée dans cet article part du constat que les éleveurs font face à une augmentation considérable de la quantité de données qu'ils doivent traiter. Il est alors nécessaire de mettre au point un système d'aide à la décision prenant en compte les données « temps réel » mais aussi la connaissance experte pour permettre aux éleveurs d'agir au mieux. Dans cette communication, nous mettons en évidence les défis spécifiques au développement d'un système d'aide à la décision pour le domaine de l'élevage de précision et nous présentons une méthodologie pour l'implémenter dans ce contexte.

Early onset acidosis from mitochondrial toxicity can be observed in massive acetaminophen poisoning prior to the development of hepatotoxicity. In this context, the efficacy of acetylcysteine to reverse mitochondrial toxicity remains unclear and hemodialysis may offer prompt correction of acidosis. Unfortunately, toxicokinetics of acetaminophen and acetylcysteine during extracorporeal treatments hemodialysis have seldom been described.An 18-year-old woman presented to the emergency department 60 minutes after ingestion of 100 g of acetaminophen, and unknown amounts of ibuprofen and ethanol. Initial assessment revealed an agitated patient. Her mental status worsened and she required intubation for airway protection. Investigations showed metabolic acidosis with lactate peaking at 8.6 mmol/L. Liver and coagulation profiles remained normal. Acetaminophen concentration peaked at 981 μg/ml (6496 μmol/L). Pending hemodialysis, the patient received 100 g of activated charcoal and an acetylcysteine infusion at 150 mg/kg over 1 hour, followed by 12.5 mg/kg/h for 4 hours. During hemodialysis, the infusion was maintained at 12.5 mg/kg/h to compensate for expected removal before it was decreased to 6.25 mg/kg for 20 hours after hemodialysis. The patient rapidly improved during hemodialysis and was discharged 48 hours post-admission.The acetaminophen elimination half-life was 5.2 hours prior to hemodialysis, 1.9-hours during hemodialysis and 3.6 hours post hemodialysis. The acetaminophen and acetylcysteine clearances by A-V gradient during hemodialysis were 160.4 ml/min and 190.3 ml/min, respectively. Hemodialysis removed a total of 20.6 g of acetaminophen and 17.9 g of acetylcysteine.This study confirms the high dialyzability of both acetaminophen and acetylcysteine. Hemodialysis appears to be a beneficial therapeutic option in cases of massive acetaminophen ingestion with coma and lactic acidosis. Additionally, these results suggest that the infusion rate of acetylcysteine must be more than double during hemodialysis to compensate for its ongoing removal and provide similar plasma concentrations to the usual acetylcysteine regimen.

The train transportation networks in northern countries are, during winter, affected by the frozen and freezing precipitations. The most affected part is the conductive rail denoted as the third rail. Although the two other rails are easily deiced, the third rail is only in contact with a conductive shoe that does not give enough force to properly remove the ice. This paper proposes a new comparative test to evaluate the required force to remove the ice on a scaled down rail under controlled conditions in a cold room. Experimentations have been performed under simulated freezing drizzle at −10 ​°C on a steel rail bare and covered with protection coatings or fluids. The results obtained have proven the efficiency of the test method for the comparison, the classification and the selection of the best candidate products for outdoor test campaigns.

Introduction: Hyperkalemia is a common electrolyte disturbance associated with morbidity and mortality. Commonly used therapies for hyperkalemia include IV calcium, sodium bicarbonate, insulin, beta-adrenergic agents, ion-exchange resins, diuretics and hemodialysis. This study aims to evaluate which treatments are more commonly used to treat hyperkalemia and to examine factors which influence those clinical decisions. Methods: This is a retrospective chart review of all cases of hyperkalemia encountered in 2017 at a Canadian adult ED. Potassium values were classified as mild (5.5 - 6.5 mEq/L), moderate (>6.5 - 7.5 mEq/L) and severe (>7.5 mEq/L). Treatment choices were then recorded and matched to hemodynamic stability, degree of hyperkalemia and ECG findings. More statistical methods to test correlation between treatment and specific variables will be performed over the next 2 months, including logistic regression to highlight potential determinants of treatment and Chi-square tests to verify randomness and to construct 95% confidence intervals. Results: 1867 ED visits were identified, of which 479 met the inclusion criteria. 89.1% of hyperkalemia cases were mild, 8.2% were moderate, and 2.7% were severe. IV insulin was used in 22.1% of cases, followed by Kayexalate in 20.5%, sodium bicarbonate in 12.3%, IV calcium in 9.4%, frusemide in 7.3%, salbutamol in 2.7%, and dialysis in 1.9%. Moderate and severe hyperkalemia were associated with higher use of insulin (79.5% and 64.3% respectively), IV calcium (41% and 64.3% respectively), sodium bicarbonate (56.4% and 85.7% respectively). Bradycardia was associated with higher insulin and IV calcium use (46.7% and 33.3% respectively). Hypotension was associated with a similar increase in use of insulin and IV calcium (34.2% and 23.7% respectively). There were only 15 cases of cardiac arrest in which sodium bicarbonate and IV calcium were more frequently used (80% and 60% respectively). Conclusion: This study demonstrates variability in the ED management of hyperkalemia. We found that Insulin and Kayexalate were the 2 most common interventions, with degree of hyperkalemia, bradycardia and hypotension influencing rates of treatment. Overuse of kayexalate for emergent treatment of hyperkalemia is evident despite weak supporting evidence. Paradoxically, beta adrenergic agents were underutilized despite their rapid effect and safer profile. The development of a widely accepted guideline may help narrow the differences in practice and potentially improve outcomes.

International audience; Product design greatly evolves for years, due to the increasing complexity of products, from simple monodisciplinary products to mechatronics systems then cyber-physical systems. Teams involved in the development of such systems are strongly interdisciplinary and require adequate engineering design methods. We propose hereafter a dedicated design process that integrates systems engineering approach, creativity tools and user-centered design methods. This design process has been implemented within a case study from e-health sector: a home-care provider asked us for developing and experimenting a ‘connected’ pillbox. After detailing main results of this development, we analyze them and propose methodological improvements. We finally conclude on some perspectives for studying engineering design in the context of global e-health systems.

Deicing using piezoelectric actuators is considered as a potential solution to the development of low-energy ice protection systems for rotorcraft. This type of system activates resonant frequencies of a structure using piezoelectric actuators to generate sufficient stress to break the bond between the ice and the substrate. First, a numerical method was validated to assist the design of such systems. Numerical simulations were performed for the case of a flat plate and validated experimentally. The model was then used to study important design parameters such as actuator positioning and activation strategies, and it was concluded that positioning actuators at antinode locations, and activating them in phase with those antinodes to obtain maximum displacements for a given vibration mode. The findings were then used to apply piezoelectric deicing to structures more representative of a helicopter rotor blade. The method was implemented on a thinned Bell 206 main rotor blade and a Bell 206 tail rotor blade. Deicing performance was demonstrated in an icing wind tunnel. Power input to the actuators was below 19 kW/m2 (12 W/inch2) for all structures.

During a bidding process, bidders have to submit offers that will suit the best to the customers' requirements. The OPERA project aims at developing method, model and tools to help bidders to develop more accurate offers. One of the major tasks during the bidding process is the elaboration of offers. In this paper, we present a first version of a constraint-based model for offers (bids) elaboration which gathers three types of data: (1) general data characterizing the potential customer and the overall contexts, (2) data defining the technical system and (3) data defining the delivery process relevant to the technical system. The system will be limited to a 3-level decomposition. The process is composed of activities characterized by a couple (resources, workload). Four end user companies are involved in the OPERA project: two in the industrial sector and the two others in the service one.

Part 10: Ontologies, Knowledge and Data Models; International audience; Management of the whole product lifecycle is a major stake that most companies have now integrated into their strategies. Research works have been focused on this asset but mainly for mechanical products. In previous work proposes a knowledge modelling approach in a mechanical context, centred on expert users’ collaboration. In this paper, we worked with an aeronautical company in charge of electrical maintenance. Its objective was to improve its business processes, from design phase to production phase, by developing a new PLM system, integrated to its electrical CAD software. Our research aim is to evaluate the genericity of previous knowledge modelling approach in this electrical context. We propose then an integrated knowledge model based on three dimensions: (electric) product modelling, (aeronautics retrofitting) process/project modelling and organization/collaboration modelling. We show how this model identifies generic vs expert knowledge and how ‘business rules’ can be defined to support collaboration and to reduce time of development process. Finally, we propose a global PLM system and we detail the impact on the collaborations and on the whole ‘product’ lifecycle. This PLM system is actually developed by an electrical CAD editor, ensuring the integration between CAD data and PLM database. We conclude on future work extending this first PLM system: a generic problem-solving approach for capitalizing and reusing knowledge then an augmented reality environment for using PLM product data during installation phase.

Intraosseous (IO) access is an established route of administration in resuscitation situations. Patients with serious poisoning presenting to the emergency department may require urgent antidote therapy. However, intravenous (IV) access is not always readily available.This study reviews the current evidence for IO administration of antidotes that could be used in poisoning. The primary outcome was mortality as a surrogate of efficacy. Secondary outcomes included hemodynamic variables, electrocardiographic variables, neurological status, pharmacokinetics outcomes, and adverse effects as defined by each article.A medical librarian created a systematic search strategy for Medline, subsequently translated to Embase, BIOSIS, PubMed, Web of Science, Cochrane, Database of Abstracts of Reviews of Effects (DARE), and the CENTRAL clinical trial register, all of which we searched from inception to 30 June 2016. Interventions included IO administration of selected antidotes. Articles included volunteer studies, poisoning, or other resuscitation contexts such as cardiac arrest, burns, dehydration, seizure, hemorrhagic shock, or undifferentiated shock. We considered all human studies and animal experiments to the exception of in vitro studies. Two reviewers independently selected studies, and a third adjudicated in case of disagreement. Three reviewers extracted all relevant data. Three reviewers evaluated the risk of bias and quality of the articles using specific scales according to each type of study design.A total of 47 publications (46 articles and one abstract) met our inclusion criteria and described IO administration of 13 different antidotes. These included one case series and 21 case reports describing 26 patients, and 25 animal experiments. Of those, seven human case reports and four animal experiments specifically reported the use of antidotes in poisoning. Human case reports suggested favorable outcomes with IO use of atropine, diazepam, hydroxocobalamin, insulin, lipid emulsion, methylene blue, phentolamine, prothrombin complex concentrate, and sodium bicarbonate. Clinical outcomes varied according to the antidote used. The only reported adverse event was ventricular tachycardia following IO naloxone. Regarding the animal experiments, IO administration of lipid emulsion and of hydroxocobalamin showed improved survival in bupivacaine-poisoned rats and in cyanide-intoxicated swine, respectively. Animal data also suggested an equivalent bio-availability between IO and IV administration for atropine, calcium chloride, dextrose 50%, diazepam, methylene blue, pralidoxime, and sodium bicarbonate. Adverse effect reporting of fat emboli after IO administration of sodium bicarbonate, for example, was conflicting due to the significant heterogeneity in the timing of lung examination across studies.The evidence supporting the use of IO route for the administration of antidotes in a context of poisoning is scarce. The majority of the evidence consists of case reports and animal experiments. Common antidotes such as acetylcysteine, fomepizole, and digoxin-specific antibody fragments have not been studied or reported with the use of the IO route. Despite the low-quality evidence available, IO access is a potential option for antidotal treatments in toxicological resuscitation when IV access is unavailable.

Objectives Acetaminophen (APAP) elixir is a widely used pediatric antipyretic medication. It has been shown that up to 30% of febrile children presenting to a large urban pediatric emergency department received inadequate APAP dosages at home with errors primarily due to age-based dosing. Parental education material in the form of weight-based dosing guides has been proposed; however, validation of current recommended APAP dosages using pharmacokinetic models is needed. This study used a mathematical model of APAP absorption to predict plasma concentrations and to compare them with the range required to reach and achieve antipyresis (10-20 μg/mL). Methods A common APAP preparation (Children's Tylenol Elixir) was tested (children aged 2-3 years, 10.9-15.9 kg). The manufacturer's suggested dose of 160 mg was compared with the standard 10 to 15 mg/kg dose range. Results The model predicts a peak plasma concentration between 6.38 and 8.55 μg/mL for 10 mg/kg dose and 9.57 and 12.8 μg/mL for 15 mg/kg dose. The manufacturer's suggested dose of 160 mg was tested across the limits of the weight range (10.9-15.9 kg). A peak plasma concentration between 9.36 and 12.6 μg/mL was found for the lower weight limit (10.9 kg child) and 6.42 to 8.61 μg/mL for the upper weight limit (15.9 kg child). Conclusions With the use of this model, the 10 mg/kg dose does not reach the plasma concentration value for antipyresis (10-20 μg/mL), whereas 15 mg/kg is adequate only if assuming a greater absorption constant. The 160 mg dose is effective only for children weighing 10.9 kg. Individual differences in drug bioavailability, volume of distribution, and absorption/elimination constants undoubtedly exist, and future studies directly measuring plasma APAP concentration and pharmacokinetics are needed. However, these results indicate that dosages for APAP in children should be weight based and manufacturers should review their dosing recommendations.

Decision makers, whether human or computer, using sensor networks to instrument information collecting necessary for decision, often face difficulties in assessing confidence granted to signals transmitted and received in the network. Several organizational (network architecture or nature, distance between sensors ...), internal (sensor reliability or accuracy ...) or external (impact of environment ...) factors can lead to measurement errors (false alarm, non-detection by misinterpretation of the analyzed signals, false-negative …). A system-embedded intelligence is then necessary, to compare the information received for the purpose of decision aiding based on margin of errors converted in confidence intervals. In this chapter, the authors present four complementary approaches to quantify the interpretation of signals exchanged in a network of sensors in the presence of uncertainty.