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#knowledge-base-construction #machine-learning #unfinished
Users can optionally provide throttlers, which act as hard filtering rules to reduce the number of candidates that are materialized. Throttlers are also Python functions, but rather than accepting spans of text as input, they operate on candidates, and output whether or not a candidate meets the specified condition.
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#knowledge-base-construction #machine-learning #unfinished
During develop- ment, labeling functions are iteratively improved through error analysis
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#machine-learning #management #software-engineering #unfinished

But we feel that publications are by no means the only mechanism for knowledge dissemina- tion: Googlers have also:

  • led the creation of over 1,000 open source projects,
  • contributed to various standards (for example, as editor of HTML5),
  • pro- duced hundreds of public APIs for ac- cessing our services.

In some cases, we have used these different channels in symbiotic ways, following up an initial publication describing the high-level ideas (MapReduce, GFS, BigTable) with open source implementations of particular aspects (Protocol Buffers). In other cases, projects have started as open source initiatives from day one, for example Android and Chromium.

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#machine-learning #software-engineering #unfinished
To be productionized, the model has to be adapted to the production environment. This could mean containerization of the model code or even transforming it to a high-performance language like Java or C++ ... The productionized version of the model has to be tested again in conjunction with other components of the overall architecture before it can be deployed to production.
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Sato,Wider,Windheuser_2019_Continuous-delivery_thoughtworks,com
test scripts — for example, for chatbots. The tests should be as automated as possible with the help of test environments, test scripts or test programs. Once a good model is found, it’s ready <span>to be productionized. The model has to be adapted to the production environment. This could mean containerization of the model code or even transforming it to a high-performance language like Java or C++ — either manually or using automatic transformation tools. The productionized version of the model has to be tested again in conjunction with other components of the overall architecture before it can be deployed to production. In production, we have to observe and monitor how the model behaves “in the wild”. Metrics like usage, model input, model output, and possible model bias are important information about




#regional
To reorganize the tax revenues and pay the country’s debts to European banking houses (emergency measures to pay the debts had precipitated the revolt), the colonial power set out to determine, for every square meter of the country’s agricultural land, the owner, the culti- vator, the quality of the soil, and the proper rate of tax. To collect, organize, and represent this information, the authorities decided to produce some- thing never achieved before, a “great land map of Egypt.” The map was in- tended not just as an instrument of administrative control or geographical knowledge, but as a means of recording complex statistical information in a centralized, miniaturized, and visual form
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#regional
In chapter 1, I present a complex story from the mid-twentieth century in which the forms of agency involved appear to be not only those of humans.
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#Buerger #Interne #Médecine #Thromboangéite #U2D #Vascularite
Thromboangiitis obliterans (TAO), also called Buerger's disease, is a nonatherosclerotic, segmental, inflammatory disease that most commonly affects the small to medium-sized arteries and veins of the extremities (upper and lower) [1-3].
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UpToDate
opics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Dec 2019. | This topic last updated: Sep 20, 2019. INTRODUCTION — <span>Thromboangiitis obliterans (TAO), also called Buerger's disease, is a nonatherosclerotic, segmental, inflammatory disease that most commonly affects the small to medium-sized arteries and veins of the extremities (upper and lower) [1-3]. Thromboangiitis obliterans is characterized by highly cellular and inflammatory occlusive thrombus with relative sparing of the blood vessel wall [4]. Patients are young smokers who pre




#Buerger #Interne #Médecine #Thromboangéite #U2D #Vascularite
Thromboangiitis obliterans is observed worldwide but is more common in countries where tobacco is heavily used, especially among people who make homemade cigarettes from raw tobacco (sometimes mixed with cannabis) [6]. As such, thromboangiitis obliterans is most prevalent in the Mediterranean, Middle East, and Asia [7,8].
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tobacco-related thromboangiitis obliterans. The epidemiology, clinical manifestations, diagnosis, and treatment of thromboangiitis obliterans are reviewed here. EPIDEMIOLOGY AND RISK FACTORS — <span>Thromboangiitis obliterans is observed worldwide but is more common in countries where tobacco is heavily used, especially among people who make homemade cigarettes from raw tobacco (sometimes mixed with cannabis) [6]. As such, thromboangiitis obliterans is most prevalent in the Mediterranean, Middle East, and Asia [7,8]. In other parts of the world, among patients with arterial occlusive disease, the prevalence varies widely, ranging from 0.5 to 5.6 percent in Western Europe, 15 to 66 percent in Korea a




#Buerger #Interne #Médecine #Thromboangéite #U2D #Vascularite
Thromboangiitis obliterans is observed worldwide but is more common in countries where tobacco is heavily used, especially among people who make homemade cigarettes from raw tobacco (sometimes mixed with cannabis) [6]. As such, thromboangiitis obliterans is most prevalent in the Mediterranean, Middle East, and Asia [7,8]
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tobacco-related thromboangiitis obliterans. The epidemiology, clinical manifestations, diagnosis, and treatment of thromboangiitis obliterans are reviewed here. EPIDEMIOLOGY AND RISK FACTORS — <span>Thromboangiitis obliterans is observed worldwide but is more common in countries where tobacco is heavily used, especially among people who make homemade cigarettes from raw tobacco (sometimes mixed with cannabis) [6]. As such, thromboangiitis obliterans is most prevalent in the Mediterranean, Middle East, and Asia [7,8]. In other parts of the world, among patients with arterial occlusive disease, the prevalence varies widely, ranging from 0.5 to 5.6 percent in Western Europe, 15 to 66 percent in Korea




#Buerger #Interne #Médecine #Thromboangéite #U2D #Vascularite
Men are more commonly affected than women. Of patients diagnosed with thromboangiitis obliterans, 70 to 91 percent are male and 11 to 30 percent are female [11]
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8,10]. Whether vaping (aerosol inhalation that includes nicotine or other substances) will affect the incidence is unknown. (See "Vaping and e-cigarettes", section on 'Adverse health effects'.) <span>Men are more commonly affected than women. Of patients diagnosed with thromboangiitis obliterans, 70 to 91 percent are male and 11 to 30 percent are female [11]. However, there are reports of increasing prevalence of disease in women, possibly due to the increasing use of cigarettes among women [5,10-17]. The majority of patients present before




#Buerger #Interne #Médecine #Thromboangéite #U2D #Vascularite
The majority of patients present before the age of 45
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t are male and 11 to 30 percent are female [11]. However, there are reports of increasing prevalence of disease in women, possibly due to the increasing use of cigarettes among women [5,10-17]. <span>The majority of patients present before the age of 45. Risk factors — The use of tobacco is essential for the initiation and progression of thromboangiitis obliterans [18-20]. There has never been a well-documented case of TAO in a patient




#Buerger #Interne #Médecine #Thromboangéite #U2D #Vascularite
Chronic anaerobic periodontal infection may also play a role in the development of thromboangiitis obliterans [26-28]. Nearly two thirds of patients with thromboangiitis obliterans have severe periodontal disease. In one study, DNA fragments associated with anaerobic bacteria were found within both the arterial lesions and oral cavities of patients with thromboangiitis obliterans [27]. However, the prevalence of periodontal disease in smokers without thromboangiitis obliterans is similarly high, and thus the association may be confounded
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. Thromboangiitis obliterans has also been reported in cigar smokers, marijuana users (cannabis arteritis), and those who use smokeless tobacco such as chewing tobacco and snuff [4,5,12,21-25]. <span>Chronic anaerobic periodontal infection may also play a role in the development of thromboangiitis obliterans [26-28]. Nearly two thirds of patients with thromboangiitis obliterans have severe periodontal disease. In one study, DNA fragments associated with anaerobic bacteria were found within both the arterial lesions and oral cavities of patients with thromboangiitis obliterans [27]. However, the prevalence of periodontal disease in smokers without thromboangiitis obliterans is similarly high, and thus the association may be confounded. PATHOPHYSIOLOGY — Thromboangiitis obliterans is a segmental inflammatory, nonatherosclerotic, occlusive vascular disease that affects the small and medium-sized arteries and veins of t




#Buerger #Interne #Médecine #Thromboangéite #U2D #Vascularite
The use of tobacco is essential for the initiation and progression of thromboangiitis obliterans [18-20]. There has never been a well-documented case of TAO in a patient who was proven not to be using tobacco or cannabis in some form (ie, as confirmed by measuring urine nicotine or cotinine levels and toxicology screen)
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ports of increasing prevalence of disease in women, possibly due to the increasing use of cigarettes among women [5,10-17]. The majority of patients present before the age of 45. Risk factors — <span>The use of tobacco is essential for the initiation and progression of thromboangiitis obliterans [18-20]. There has never been a well-documented case of TAO in a patient who was proven not to be using tobacco or cannabis in some form (ie, as confirmed by measuring urine nicotine or cotinine levels and toxicology screen). Patients are generally heavy cigarette smokers. In one study, patients diagnosed with thromboangiitis obliterans smoked an average of 23 years [20]. Thromboangiitis obliterans has also




#Buerger #Interne #Médecine #Thromboangéite #U2D #Vascularite

Three pathologic phases are described (picture 1) [30,32]:

● In the acute phase, inflammatory thrombi develop in the arteries and veins, typically of the distal extremities. The thrombus is occlusive, and polymorphonuclear leukocytes, microabscesses, and multinucleated giant cells may be present, but there is no evidence of fibrinoid necrosis [29,30]. Although the external elastic lamina may show some disruption, the internal elastic lamina is intact. (See 'Biopsy' below.)

● The intermediate (subacute) phase is characterized by progressive organization of the thrombus in the small to medium-sized arteries and veins. A prominent inflammatory infiltrate is still present within the thrombus but is less in the vessel wall.

● In the chronic phase, inflammation is no longer present and only organized thrombus and vascular fibrosis remain. The pathological appearance in the chronic phase is indistinguishable from all other types of occlusive arterial disease

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UpToDate
ore specifically, sparing of the internal elastic lamina [29,30]. Although the disease was recognized and the pathology described over 100 years ago, its pathogenesis is poorly understood [31]. <span>Three pathologic phases are described (picture 1) [30,32]: ●In the acute phase, inflammatory thrombi develop in the arteries and veins, typically of the distal extremities. The thrombus is occlusive, and polymorphonuclear leukocytes, microabscesses, and multinucleated giant cells may be present, but there is no evidence of fibrinoid necrosis [29,30]. Although the external elastic lamina may show some disruption, the internal elastic lamina is intact. (See 'Biopsy' below.) ●The intermediate (subacute) phase is characterized by progressive organization of the thrombus in the small to medium-sized arteries and veins. A prominent inflammatory infiltrate is still present within the thrombus but is less in the vessel wall. ●In the chronic phase, inflammation is no longer present and only organized thrombus and vascular fibrosis remain. The pathological appearance in the chronic phase is indistinguishable from all other types of occlusive arterial disease. Although smoking tobacco is central to the initiation, continuation, and recurrence of disease, the specific role of smoking in the pathogenesis of thromboangiitis is unknown. It is po




#Buerger #Interne #Médecine #Thromboangéite #U2D #Vascularite

Superficial thrombophlebitis — A migratory superficial thrombophlebitis can occur as a very early disease manifestation even before other symptoms and signs (picture 2), such as extremity pain or digital ischemia, become clinically evident. The phlebitis consists of tender nodules that follow a venous distribution and frequently parallels arterial disease activity [12,48].

When superficial nodules are present, they should be biopsied to establish a histologic diagnosis. (See 'Biopsy' below.)

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UpToDate
terial occlusive disease. Two or more extremities are usually involved [4,16]. A seasonal variation has also been reported with patients more likely to present in the winter [20]. Presentations <span>Superficial thrombophlebitis — A migratory superficial thrombophlebitis can occur as a very early disease manifestation even before other symptoms and signs (picture 2), such as extremity pain or digital ischemia, become clinically evident. The phlebitis consists of tender nodules that follow a venous distribution and frequently parallels arterial disease activity [12,48]. When superficial nodules are present, they should be biopsied to establish a histologic diagnosis. (See 'Biopsy' below.) The presence of superficial phlebitis distinguishes this disorder from other occlusive vascular diseases, though phlebitis may also be observed in Behçet syndrome. (See 'Differential di




#Buerger #Interne #Médecine #Thromboangéite #U2D #Vascularite
Cold sensitivity/Raynaud phenomenon — Another early manifestation is cold sensitivity with initial presentations of thromboangiitis obliterans more common in winter months. Secondary Raynaud phenomenon occurs in more than 40 percent of patients and may be asymmetric.
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ence of superficial phlebitis distinguishes this disorder from other occlusive vascular diseases, though phlebitis may also be observed in Behçet syndrome. (See 'Differential diagnosis' below.) <span>Cold sensitivity/Raynaud phenomenon — Another early manifestation is cold sensitivity with initial presentations of thromboangiitis obliterans more common in winter months. Secondary Raynaud phenomenon occurs in more than 40 percent of patients and may be asymmetric. The frequency of Raynaud phenomenon may depend upon the population studied [26]. (See "Clinical manifestations and diagnosis of Raynaud phenomenon".) Cold sensitivity may be due to mark




#Buerger #Interne #Médecine #Thromboangéite #U2D #Vascularite
Digital ischemia — Digital (toe, finger) ischemia is the most common presentation of thromboangiitis obliterans. Patients usually note pain, and subsequently the extremities, particularly the digits, may be characterized by either rubor or cyanosis. This discoloration has been termed "Buerger's color." Ischemia can progress to ulcerations in the upper or lower extremity (picture 2) with accompanying ischemic pain or gangrene of the fingers or toes (picture 3)
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ivity may be due to markedly increased muscle sympathetic nerve activity, which has been demonstrated in patients with TAO compared with control subjects, or it can be related to ischemia [49]. <span>Digital ischemia — Digital (toe, finger) ischemia is the most common presentation of thromboangiitis obliterans. Patients usually note pain, and subsequently the extremities, particularly the digits, may be characterized by either rubor or cyanosis. This discoloration has been termed "Buerger's color." Ischemia can progress to ulcerations in the upper or lower extremity (picture 2) with accompanying ischemic pain or gangrene of the fingers or toes (picture 3). ●In one review of 112 patients, 66 percent had ischemic ulcerations at the time of presentation [12]. ●Lower extremity ulcers occurred in 46 percent, upper extremity ulcers in 28 perce




#Buerger #Interne #Médecine #Thromboangéite #U2D #Vascularite
Other organ ischemia — Although thromboangiitis obliterans most commonly affects the small and medium arteries of the extremities, pathologic findings have been reported in cerebral, coronary, internal thoracic, renal, and mesenteric arteries [51-53]
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able from other vascular occlusive diseases. Foot claudication is often mistaken for an orthopedic problem. (See "Clinical features and diagnosis of lower extremity peripheral artery disease".) <span>Other organ ischemia — Although thromboangiitis obliterans most commonly affects the small and medium arteries of the extremities, pathologic findings have been reported in cerebral, coronary, internal thoracic, renal, and mesenteric arteries [51-53]. Symptoms from intestinal or multiorgan involvement are rare but have been reported [54,55]. Involvement of large vessels, such as the aorta and iliac arteries, is rare; occlusive disea




#Buerger #Interne #Médecine #Thromboangéite #U2D #Vascularite
Joint complaints — In a minority of patients, joint complaints may be the first indication of clinical disease. In one study, arthralgias and arthritis were reported in 12.5 percent of patients, typically in the preocclusive phase [48]. The most commonly affected joints were the wrists and knees. The duration of joint symptoms prior to the digital ischemia can be months to years. The joint manifestations of thromboangiitis obliterans do not lead to erosive arthritis and are frequently episodic, generally resolving within two weeks.
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55]. Involvement of large vessels, such as the aorta and iliac arteries, is rare; occlusive disease of these vessels is more likely to be due to atherosclerotic arterial occlusive disease [16]. <span>Joint complaints — In a minority of patients, joint complaints may be the first indication of clinical disease. In one study, arthralgias and arthritis were reported in 12.5 percent of patients, typically in the preocclusive phase [48]. The most commonly affected joints were the wrists and knees. The duration of joint symptoms prior to the digital ischemia can be months to years. The joint manifestations of thromboangiitis obliterans do not lead to erosive arthritis and are frequently episodic, generally resolving within two weeks. Physical examination — All patients should have a thorough history and physical including a detailed vascular examination. The extremities should be inspected for superficial venous nod




#Buerger #Interne #Médecine #Thromboangéite #U2D #Vascularite
Physical examination — All patients should have a thorough history and physical including a detailed vascular examination. The extremities should be inspected for superficial venous nodules and cords. The hands and feet examined for evidence of ischemia. Neurologic examination may document peripheral nerve involvement with sensory abnormalities in up to 70 percent of patients [4].
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gital ischemia can be months to years. The joint manifestations of thromboangiitis obliterans do not lead to erosive arthritis and are frequently episodic, generally resolving within two weeks. <span>Physical examination — All patients should have a thorough history and physical including a detailed vascular examination. The extremities should be inspected for superficial venous nodules and cords. The hands and feet examined for evidence of ischemia. Neurologic examination may document peripheral nerve involvement with sensory abnormalities in up to 70 percent of patients [4]. The physical examination alone cannot distinguish arterial occlusive disease due to thromboangiitis obliterans from other etiologies (table 1). Given that smoking is a common risk facto




#Buerger #Interne #Médecine #Thromboangéite #U2D #Vascularite

Clinical criteria — A clinical diagnosis can be established without the need for biopsy using the following commonly used criteria [59,60]:

● Age less than 45 years

● Current or recent history of tobacco use

● Distal extremity ischemia (objectively noted on vascular testing) (see 'Physical examination' above and 'Vascular testing' below)

● Typical arteriographic findings of thromboangiitis obliterans (see 'Vascular imaging' below)

● Exclusion of autoimmune disease, thrombophilia, diabetes, and proximal embolic sources (table 1) (see 'Laboratory studies' above)

Other criteria have been cited in the literature but are less commonly used [58,61-63]

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nodules to biopsy are not always present. A clinical diagnosis can be established based upon a scoring system using clinical, angiographic, histopathological, and exclusionary criteria [5,58]. <span>Clinical criteria — A clinical diagnosis can be established without the need for biopsy using the following commonly used criteria [59,60]: ●Age less than 45 years ●Current or recent history of tobacco use ●Distal extremity ischemia (objectively noted on vascular testing) (see 'Physical examination' above and 'Vascular testing' below) ●Typical arteriographic findings of thromboangiitis obliterans (see 'Vascular imaging' below) ●Exclusion of autoimmune disease, thrombophilia, diabetes, and proximal embolic sources (table 1) (see 'Laboratory studies' above) Other criteria have been cited in the literature but are less commonly used [58,61-63]. Biopsy — Biopsy is rarely needed but is the only means to establish a definitive diagnosis. Patients in whom there is suspicion for TAO who have subcutaneous nodules or superficial thr




#Buerger #Interne #Médecine #Thromboangéite #U2D #Vascularite
If there are no nodules and the patient fulfills the above criteria, a biopsy of an artery can be done, or examination of the vein or arteries in an amputated digit or limb may provide a diagnosis; however, this is rarely done
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or the presence of elevated anticardiolipin antibodies. Patients with antiphospholipid syndrome exhibit thrombus without inflammation, ruling out a diagnosis of thromboangiitis obliterans [46]. <span>If there are no nodules and the patient fulfills the above criteria, a biopsy of an artery can be done, or examination of the vein or arteries in an amputated digit or limb may provide a diagnosis; however, this is rarely done. DIFFERENTIAL DIAGNOSIS — Thromboangiitis obliterans is differentiated from other entities that cause vascular occlusive disease (table 1), the most common of which are presented briefl




#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

  • L'infléchissement ou la cassure du paramètre « taille » est du domaine plus spécifique de la spécialité endocrinologique.

  • L'infléchissement ou la cassure du paramètre « poids » est du domaine plus spécifique des spécialités gastroentérologique et nutritionnelle

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie
Au cours du premier trimestre, les nourrissons doivent prendre 25 g par jour ; au cours de la première année, 25 cm
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Flashcard 4896533122316

Question
sceau cylindrique du médecin Urlugaledina
Answer
[default - edit me]

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Flashcard 4896534170892

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#machine-learning #management #software-engineering #unfinished
Question
transi- tioning a project from an engineering team to the research team is an impor- tant mechanism for giving a project more time or resources, when [...].
Answer
the work is important more broadly than for a specific engineering team

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transi- tioning a project from an engineering team to the research team is an impor- tant mechanism for giving a project more time or resources, when the work is important more broadly than for a specific engineering team.

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

  • La sécrétion d'hormone de croissance hypophysaire est stimulée par la GHRH (d'origine hypo- thalamique) et la ghréline (d'origine stomacale). Elle est pulsatile.

  • La liaison de l'hormone de croissance à son récepteur induit la synthèse d'IGF-1 hépatique.
    L'IGF-1 ainsi libéré dans la circulation agit sur les tissus périphériques, notamment le cartilage de croissance. Sa sécrétion n'est pas pulsatile.
    La synthèse d'IGF-1 dépend également d'un bon état nutritionnel

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

La croissance est un phénomène continu (tableau 1.1) :

  • De la naissance à l'âge de 4 ans : phase de croissance rapide ; l'enfant se place sur son couloir de croissance génétique
  • De 4 ans à la prépuberté : phase de croissance linéaire (5–6 cm par an)
  • Au cours de la puberté : phase de croissance rapide (7–9 cm par an) jusqu'à l'acquisition de la taille adulte moyenne (chez les garçons : 177 cm ; chez les filles : 165 cm ; selon les courbes de l'OMS).

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie
La taille cible génétique se calcule avec la formule : (Moyenne des tailles du père et de la mère) + 6,5 cm si garçon ou – 6,5 cm si fille
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Flashcard 4896550685964

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Question

But we feel that [...] are by no means the only mechanism for knowledge dissemina- tion: Googlers have also:

  • led the creation of over 1,000 open source projects,
  • contributed to various standards (for example, as editor of HTML5),
  • pro- duced hundreds of public APIs for ac- cessing our services.

In some cases, we have used these different channels in symbiotic ways, following up an initial publication describing the high-level ideas (MapReduce, GFS, BigTable) with open source implementations of particular aspects (Protocol Buffers). In other cases, projects have started as open source initiatives from day one, for example Android and Chromium.

Answer
publications

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But we feel that publications are by no means the only mechanism for knowledge dissemina- tion: Googlers have also: led the creation of over 1,000 open source projects, contributed to various standards (for example,

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Flashcard 4896551734540

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#machine-learning #management #software-engineering #unfinished
Question

But we feel that publications are by no means the only mechanism for knowledge dissemina- tion: Googlers have also:

  • [...]
  • contributed to various standards (for example, as editor of HTML5),
  • pro- duced hundreds of public APIs for ac- cessing our services.
Answer
led the creation of over 1,000 open source projects,

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But we feel that publications are by no means the only mechanism for knowledge dissemina- tion: Googlers have also: led the creation of over 1,000 open source projects, contributed to various standards (for example, as editor of HTML5), pro- duced hundreds of public APIs for ac- cessing our services. In some cases, we have used these different channels

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Flashcard 4896552783116

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Question

But we feel that publications are by no means the only mechanism for knowledge dissemina- tion: Googlers have also:

  • led the creation of over 1,000 open source projects,
  • contributed to various [...] (for example, as editor of HTML5),
  • pro- duced hundreds of public APIs for ac- cessing our services.
Answer
standards

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But we feel that publications are by no means the only mechanism for knowledge dissemina- tion: Googlers have also: led the creation of over 1,000 open source projects, contributed to various standards (for example, as editor of HTML5), pro- duced hundreds of public APIs for ac- cessing our services. In some cases, we have used these different channels in symbiotic ways, following up

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Flashcard 4896553831692

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#machine-learning #management #software-engineering #unfinished
Question

But we feel that publications are by no means the only mechanism for knowledge dissemina- tion: Googlers have also:

  • led the creation of over 1,000 open source projects,
  • contributed to various standards (for example, as editor of HTML5),
  • [...].
Answer
pro- duced hundreds of public APIs for ac- cessing our services

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ns the only mechanism for knowledge dissemina- tion: Googlers have also: led the creation of over 1,000 open source projects, contributed to various standards (for example, as editor of HTML5), <span>pro- duced hundreds of public APIs for ac- cessing our services. In some cases, we have used these different channels in symbiotic ways, following up an initial publication describing the high-level ideas (MapReduce, GFS, BigTable) with open source

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Flashcard 4896555928844

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#machine-learning #management #software-engineering #unfinished
Question

But we feel that publications are by no means the only mechanism for knowledge dissemina- tion: Googlers have also:

  • led the creation of over 1,000 open source projects,
  • contributed to various standards (for example, as editor of HTML5),
  • pro- duced hundreds of public APIs for ac- cessing our services.

In some cases, we have used these different channels in symbiotic ways, [...].

Answer
following up an initial publication describing the high-level ideas (MapReduce, GFS, BigTable) with open source implementations of particular aspects (Protocol Buffers)

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to various standards (for example, as editor of HTML5), pro- duced hundreds of public APIs for ac- cessing our services. In some cases, we have used these different channels in symbiotic ways, <span>following up an initial publication describing the high-level ideas (MapReduce, GFS, BigTable) with open source implementations of particular aspects (Protocol Buffers). In other cases, projects have started as open source initiatives from day one, for example Android and Chromium. <span>

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

La croissance normale doit répondre aux critères suivants :

  • Régularité de la croissance et de la vitesse de croissance (fig. 1.1)
  • Concordance entre courbe pondérale et courbe staturale
  • Concordance (± 1,5 DS) avec la taille cible génétique

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

Définitions Définition d'un retard de croissance staturo-pondérale :

  • Taille inférieure à – 2 DS ou indice de masse corporelle (IMC) < 3 e percentile
  • Ralentissement de la vitesse de croissance
  • Croissance staturale ≤ – 1,5 DS par rapport à la taille cible génétique

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Flashcard 4896566414604

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#machine-learning #management #software-engineering #unfinished
Question
we have structured the Google environment as one where new ideas can be [...], rather than just debated.
Answer
rapidly verified through large-scale experiments on real data

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we have structured the Google environment as one where new ideas can be rapidly verified by small teams through large-scale experiments on real data, rather than just debated.

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

Bilan biologique initial minimal en cas de retard de croissance :

Suspicion d'insuffisance rénale ?

  • NFS
  • Ionogramme sanguin avec urée et créatinine
  • Réserve alcaline

Suspicion de maladie coeliaque ?

  • VS
  • Ferritine
  • lgA anti-transglutaminase
  • IgA totales

Suspicion d'hypothyroïdie ?

  • TSH
  • T4l

Suspicion de déficit en GH ?

  • IGF-1

Suspicion de syndrome de Turner ?

  • Caryotype si fille

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Flashcard 4896571133196

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#bert #knowledge-base-construction #nlp #unfinished
Question
R-BERT: Recently, deep neural networks have applied to relation classification. These methods usually use some [...] derived from lexical resources such as Word-Net or NLP tools such as dependency parsers and named entity rec- ognizers (NER).
Answer
features

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ave applied to relation classification (Socher et al., 2012; Zeng et al., 2014; Yu et al., 2014; dos Santos et al., 2015; Shen and Huang, 2016; Lee et al., 2019). These methods usually use some <span>features derived from lexical resources such as Word-Net or NLP tools such as dependency parsers and named entity rec- ognizers (NER). <span>

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Flashcard 4896572181772

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#bert #knowledge-base-construction #nlp #unfinished
Question
Recently, deep neural networks have applied to relation classification. These methods usually use some features derived from [...] or NLP tools such as dependency parsers and named entity rec- ognizers (NER).
Answer
lexical resources such as Word-Net

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ed to relation classification (Socher et al., 2012; Zeng et al., 2014; Yu et al., 2014; dos Santos et al., 2015; Shen and Huang, 2016; Lee et al., 2019). These methods usually use some features <span>derived from lexical resources such as Word-Net or NLP tools such as dependency parsers and named entity rec- ognizers (NER). <span>

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Flashcard 4896573230348

Tags
#bert #knowledge-base-construction #nlp #unfinished
Question
Recently, deep neural networks have applied to relation classification. These methods usually use some features derived from lexical resources such as Word-Net or NLP tools such as [...] and named entity rec- ognizers (NER)
Answer
dependency parsers

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Zeng et al., 2014; Yu et al., 2014; dos Santos et al., 2015; Shen and Huang, 2016; Lee et al., 2019). These methods usually use some features derived from lexical resources such as Word-Net or <span>NLP tools such as dependency parsers and named entity rec- ognizers (NER). <span>

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Probabilistic programming (PP) is a programming paradigm in which probabilistic models are specified and inference for these models is performed automatically.[1]
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Probabilistic programming - Wikipedia
is article relies too much on references to primary sources . Please improve this by adding secondary or tertiary sources . (December 2014) (Learn how and when to remove this template message ) <span>Probabilistic programming (PP) is a programming paradigm in which probabilistic models are specified and inference for these models is performed automatically.[1] It represents an attempt to unify probabilistic modeling and traditional general purpose programming in order to make the former easier and more widely applicable.[2][3] It can be used




#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie
Enfin, l'impact des facteurs psychologiques sur la croissance est illustré par le nanisme psycho-social, qui se caractérise par une mauvaise croissance staturopondérale chez un enfant ayant des apports nutritionnels suffisants mais en carence affective
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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

Toutes les pathologies chroniques sont susceptibles d'entraîner un retard de croissance.

Certaines peuvent être pauci-symptomatiques et doivent être recherchées systématiquement devant un retard de croissance inexpliqué, en particulier les pathologies rénales et la maladie cœliaque.

Il faut ainsi rechercher des antécédents d'infections urinaires répétées et mesurer la PA en cas de retard de croissance.

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Flashcard 4896586075404

Tags
#knowledge-base-construction #machine-learning #unfinished
Question
During develop- ment, labeling functions are [...]
Answer
iteratively improved.

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During develop- ment, labeling functions are iteratively improved through error analysis

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie
À la naissance, les enfants atteints d'hypothyroïdie congénitale ont une taille et un poids normaux pour leur âge gestationnel
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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie
Les hypothyroïdies acquises peuvent survenir à des âges variables (pic de survenue à l'adolescence).
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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

Les causes d'hypothyroïdies acquises de l'enfant sont :

  • La thyroïdite de Hashimoto (la plus fréquente) :
    • TSH est élevée
    • T4l est basse
    • Anticorps anti-TPO (anti-thyroperoxydase) et anti-Tg (anti-thyroglobuline) sont positifs
    • Tissu thyroïdien est hétérogène à l'échographie

  • Le déficit thyréotrope central (exceptionnel) secondaire à une tumeur de la région hypothalamo-hypophysaire
    • TSH est basse
    • T4l est basse

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Flashcard 4896590793996

Tags
#knowledge-base-construction #machine-learning #unfinished
Question
Fonduer uses a [...] with attention to represent textual features of relation candidates from the documents.
Answer
bidirectional LSTM

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Fonduer uses a bidirectional LSTM with attention to represent textual features of relation candidates from the documents.

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Flashcard 4896591842572

Tags
#knowledge-base-construction #machine-learning #unfinished
Question
Fonduer uses a bidirectional LSTM with attention to represent [...] of relation candidates from the documents.
Answer
textual features

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Fonduer uses a bidirectional LSTM with attention to represent textual features of relation candidates from the documents.

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

La courbe de croissance est très évocatrice et associe un ralentissement de la vitesse de croissance staturale avec une prise de poids excessive (fig. 1.1A).

Le diagnostic positif du syndrome de Cushing est réalisé par la mesure du cortisol libre sur 24 heures

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

Trois diagnostics à rechercher en cas de retard de croissance staturale avec prise pondérale concomitante :

  • Hypercorticisme
  • Hypothyroïdie
  • Tumeur hypothalamo-hypophysaire

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

Déficit en hormone de croissance

  • Le déficit en GH congénital n'entraîne pas d'altération de la taille de naissance
  • La croissance staturale s'infléchit entre les âges de 0 et 3 ans

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

(Déficit congénital en GH)

  • Les signes observés sont :
    • Les hypoglycémies, nécessitant une prise en charge urgente et un micropénis chez le garçon.
    • Chez l'enfant plus grand, le ralentissement statural peut être associé à un retard de maturation osseuse, une adiposité tronculaire, un faciès poupin avec une ensellure nasale marquée et un front bombé

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

Le diagnostic d'un déficit en hormone de croissance repose sur :

  • Le dosage basal de l'IGF-1, à interpréter en fonction de l'état nutritionnel et du stade pubertaire

  • L'évaluation du taux plasmatique d'hormone de croissance (GH) au cours d'un test de stimulation pharmacologique ou lors d'une hypoglycémie spontanée (chez le nouveau-né), évaluant la réserve hypophysaire en GH.
    On conclut à un déficit en GH si le pic de GH est inférieur à 20 mUI/L lors de deux tests de stimulation distincts

  • L'IRM cérébrale centrée sur la région hypothalamo-hypophysaire

  • L'âge osseux (à la recherche d'un retard de maturation

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

Retard simple de puberté

  • C'est la cause la plus fréquente de retard statural à l'adolescence.
  • Fréquent chez les garçons, il est rare chez les filles

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#machine-learning #software-engineering #unfinished
One potential pitfall in massive scale learning is that ag- gregate performance metrics may hide effects that are spe- cific to certain sub-populations of the data. For example, a small aggregate accuracy win on one metric may in fact be caused by a mix of positive and negative changes in dis- tinct countries, or for particular query topics. This makes it critical to provide performance metrics not only on the aggregate data, but also on various slicings of the data, such as a per-country basis or a per-topic basis. Because there are hundreds of ways to slice the data mean- ingfully, it is essential that we be able to examine a visual summary of the data effectively. To this end, we have de- veloped a high-dimensional interactive visualization called GridViz to allow comprehensive understanding of model per- formance.
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[unknown IMAGE 4896699583756] #has-images #machine-learning #software-engineering #unfinished
showing a set of slicings by query topic for two models in comparison to a control model. Metric values are rep- resented by colored cells, with rows corresponding to the model name and the columns corresponding to each unique slicing of the data. The column width connotes the impor- tance of the slicing, and may be set to reflect quantities such as number of impressions or number of clicks. The color of the cell reflects the value of the metric compared to a chosen baseline, which enables fast scanning for outliers and areas of interest, as well as visual understanding of the overall per- formance. When the columns are wide enough the numeric value of the selected metrics are shown. Multiple metrics may be selected; these are shown together in each row. A detailed report for a given cell pops up when the user mouse overs over the cell. Because there are hundreds of possible slicings, we have designed an interactive interface that allows the user to se- lect different slicing groups via a dropdown menu, or via a regular expression on the slicing name. Columns may be sorted and the dynamic range of the color scale modified to suite the data at hand. Overall, this tool has enabled us to dramatically increase the depth of our understanding for model performance on a wide variety of subsets of the data, and to identify high impact areas for improvement.
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Flashcard 4896705350924

Tags
#machine-learning #management #software-engineering #unfinished
Question
At Google, [...] has at its disposal the power of many internal services, allowing the team to quickly create complex and powerful products and services.
Answer
Even a small team

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Even a small team has at its disposal the power of many internal services, allowing the team to quickly create complex and powerful products and services. Design, testing, production, and maintenance pro

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Flashcard 4896706399500

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#machine-learning #management #software-engineering #unfinished
Question
At Google in 2012, even a small team has at its disposal the power of [...], allowing the team to quickly create complex and powerful products and services.
Answer
many internal services

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Even a small team has at its disposal the power of many internal services, allowing the team to quickly create complex and powerful products and services. Design, testing, production, and maintenance pro- cesses are simplified.

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Flashcard 4896709545228

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#machine-learning #management #software-engineering #unfinished
Question
At Google, [...] are simplified, allowing even small teams to quickly create complex and powerful products and services.
Answer
Design, testing, production, and maintenance pro- cesses

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Even a small team has at its disposal the power of many internal services, allowing the team to quickly create complex and powerful products and services. Design, testing, production, and maintenance pro- cesses are simplified.

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#knowledge-base-construction #machine-learning #unfinished
Fonduer requires that users specify labeling functions that label the candidates
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Fonduer requires that users specify labeling functions that label the candidates from Phase 2. Labeling functions in Fonduer are Python functions that take a candidate as input and assign + 1 to label it as “True,” −1 to label it as “False,” or 0 to abstain.

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

La plus fréquente des maladies osseuses constitutionnelles est la dyschondrostéose, due à une perte de fonction du gène SHOX (Short Stature Homeobox Gene), situé sur la région pseudo-autosomale du chromosome X.

C'est la délétion de ce gène qui est responsable de la petite taille du syndrome de Turner

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#knowledge-base-construction #machine-learning #unfinished
Labeling functions in Fonduer are Python functions that take a candidate as input and assign + 1 to label it as “True,” −1 to label it as “False,” or 0 to abstain.
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Fonduer requires that users specify labeling functions that label the candidates from Phase 2. Labeling functions in Fonduer are Python functions that take a candidate as input and assign + 1 to label it as “True,” −1 to label it as “False,” or 0 to abstain.

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Flashcard 4896717147404

Tags
#knowledge-base-construction #machine-learning #nlp #unfinished
Question
The use of a probabilistic program allows [...] in the text to be propagated through to the retrieved facts,
Answer
uncertainty

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The use of a probabilistic program allows uncertainty in the text to be propagated through to the retrieved facts,

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

L'hypotrophie, ou PAG, se définit comme : (entre autres)

  • Selon l'OMS : poids de naissance < 2 500 g ; cette définition a le désavantage de ne pas tenir compte du terme de naissance

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Flashcard 4896719244556

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#knowledge-base-construction #machine-learning #nlp #unfinished
Question
The use of a probabilistic program allows uncertainty in the text [...] the retrieved facts,
Answer
to be propagated through to

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie
Dans 90 % des cas d'enfants nés PAG, la taille se normalise dans les deux premières années de vie
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Flashcard 4896721341708

Tags
#knowledge-base-construction #machine-learning #nlp #unfinished
Question
The use of a probabilistic program allows uncertainty in the text to be propagated through to [...]
Answer
the retrieved facts,

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The use of a probabilistic program allows uncertainty in the text to be propagated through to the retrieved facts,

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Flashcard 4896725011724

Tags
#knowledge-base-construction #machine-learning #unfinished
Question
Users can optionally provide throttlers, which [...].
Answer
act as hard filtering rules to reduce the number of candidates.

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Users can optionally provide throttlers, which act as hard filtering rules to reduce the number of candidates that are materialized. Throttlers are also Python functions, but rather than accepting spans of text as input, they operate on candidates, and output whether or not a candidate meets the specified condition.

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Flashcard 4896726060300

Tags
#knowledge-base-construction #machine-learning #unfinished
Question
In Fonduer, throttlers are also Python functions, but rather than accepting spans of text as input, they operate on [...]
Answer
candidates

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ich act as hard filtering rules to reduce the number of candidates that are materialized. Throttlers are also Python functions, but rather than accepting spans of text as input, they operate on <span>candidates, and output whether or not a candidate meets the specified condition. <span>

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Flashcard 4896731565324

Tags
#knowledge-base-construction #machine-learning #unfinished
Question
In the Fonduer data model, each Cell links to [...]
Answer
both a Row and Column.

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Figure 1 contains one Section with three children: a Text for the document header, a Text for the description, and a Table for the table itself (with 10 Rows and 4 Columns). Each Cell links to <span>both a Row and Column. Texts and Cells contain Paragraphs and Sentences <span>

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Flashcard 4896733924620

Tags
#knowledge-base-construction #machine-learning #unfinished
Question
In the Fonduer document model, [...] contain Paragraphs and Sentences
Answer
Texts and Cells

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Section with three children: a Text for the document header, a Text for the description, and a Table for the table itself (with 10 Rows and 4 Columns). Each Cell links to both a Row and Column. <span>Texts and Cells contain Paragraphs and Sentences <span>

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Flashcard 4896734973196

Tags
#knowledge-base-construction #machine-learning #unfinished
Question
In the Fonduer data model Texts and Cells contain [...]
Answer
Paragraphs and Sentences

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ren: a Text for the document header, a Text for the description, and a Table for the table itself (with 10 Rows and 4 Columns). Each Cell links to both a Row and Column. Texts and Cells contain <span>Paragraphs and Sentences <span>

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie
Le craniopharyngiome représente environ 10 % des tumeurs intracrâniennes de l'enfant
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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

Les caractéristiques du retard de croissance du craniopharyngiome sont :

  • Début après 4 ans
  • Modification de la vitesse de croissance chez un enfant qui avait une croissance strictement normale auparavant (caractère acquis)

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

Pour affirmer le diagnostic de craniopharyngiome, il faut réaliser une imagerie hypophysaire :

  • En première intention : l'IRM hypothalamo-hypophysaire avec injection affirme la présence de la tumeur (intra- et/ou suprasellaire), sa structure (charnue, kystique) et apprécie les rapports de proximité, en particulier avec le chiasma (fig. 1.3A et B)
  • Le scanner de l'hypophyse est utile pour distinguer le craniopharyngiome des autres types de tumeurs hypophysaires : il permettra de visualiser des calcifications intratumorales, signe très spécifique de cette tumeur (fig. 1.3C)

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

Le syndrome de Turner associe pratiquement toujours :

  • Un retard de croissance prédominant sur la taille
  • Une insuffisance ovarienne responsable d'une absence de développement pubertaire et d'une infertilité

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

Les caractéristiques du retard de croissance du syndrome de Turner sont :

  • Un retard de croissance à début intra-utérin
  • Un retard statural qui s'aggrave au cours des années
  • Une absence d'accélération de la croissance à l'âge pubertaire (secondaire à l'insuffisance ovarienne)
  • Des signes osseux cliniques et radiologiques dus à la délétion du gène SHOX porté par le chromosome X

  • Une taille finale moyenne en l'absence de traitement à 142 cm en France

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

Turner - clinique :

  • Pendant l'enfance :
    • Ralentissement de la croissance et signes morphologiques :
      • Aspect général trapu avec un cou court bref et large
      • Pterygium colli
      • Implantation basse des cheveux et des oreilles
      • Épicanthus
      • Palais ogival

      • Thorax large avec écartement mamelonnaire
      • Cubitus valgus
      • Nævi pigmentaires multiples

      • Déformation de Madelung clinique et/ ou radiologique)

      • Infections ORL répétées

      • Intelligence le plus souvent normale (difficultés parfois pour les performances mathématiques) en dehors des formes avec chromosome X en anneau

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

Turner - clinique :

  • À la naissance : lymphœdème des extrémités (syndrome de Bonnevie-Ullrich) et nouveau-né PAG

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

Turner - clinique :

  • Chez l'adulte :
    • Petite taille
    • Signes morphologiques
    • Impubérisme et/ou aménorrhée et/ou infertilité

    • Surdité de perception.

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

La confirmation du diagnostic avec recherche de mosaïcisme, se fait par :

  • L'étude du nombre de chromosomes X par immunofluorescence in situ (FISH) sur 200 cellules
    OU
  • Caryotype standard avec analyse sur au moins 20 cellules

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

Turner - clinique :

  • Complications auto-immunes : thyroïdite de Hashimoto, maladie cœliaque, hépatite

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

Le DHMC est dû à un défaut de développement de l'hypophyse qui entraîne un défaut de formation et de fonction des cellules somatotropes, corticotropes, thyréotropes, gonadotropes et/ou lactotropes.

Le diabète insipide est exceptionnel.

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

(Déficit Hypophysaire Constitutionnel Multiple - DHMC)

Toutes les lignées antéhypophysaires ne sont pas forcément atteintes mais peuvent se dégrader progressivement au cours de la vie

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

(Déficit Hypophysaire Constitutionnel Multiple - DHMC)

En période néonatale (signes pas toujours tous présents) :

  • Hypoglycémie
  • Ictère prolongé
  • Micropénis, micro-orchidie et/ou cryptorchidie uni- ou bilatérale
  • Mauvaise prise de poids, difficultés alimentaires

  • NB : Poids et taille de naissance normaux.

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

(Déficit Hypophysaire Constitutionnel Multiple - DHMC)

Elles ne doivent pas retarder la mise en place du traitement chez l'enfant âgé de moins de 2 ans, qui est à risque d'hypoglycémie

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie

(Déficit Hypophysaire Constitutionnel Multiple - DHMC)

Évaluation des fonctions hypophysaires :

  • Fonction somatotrope : dosage de l'IGF-1, test de stimulation de l'hormone de croissance (à partir de 2 ans ou 12 kg)

  • Fonction gonadotrope : elle ne peut être évaluée qu'à un âge où l'axe gonadotrope est en principe activé (entre la naissance et 6 mois, puis à l'âge de la puberté)

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#51 #Cours #Croissance #Facultaires #Médecine #Pédiatrie
Le bilan clinique et paraclinique confirmera le déficit en hormone de croissance et l'atteinte d'au moins une autre lignée hypophysaire, signant ainsi le diagnostic de DHMC. Des études génétiques seront indiquées pour définir, si possible, le mécanisme
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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie

  • Chez le garçon :
    • FSH entraîne le développement du volume testiculaire
    • LH stimule la production de testostérone à l'origine du développement des caractères sexuels secondaires (verge, pilosité) ainsi que les modifications musculo-squelettiques.

  • Chez la fille :
    • LH et la FSH entraînent l'activation ovarienne et la production d'œstrogènes à l'origine du développement mammaire, utérovaginal et des OGE, puis l'apparition des premières règles (ménarche).

Le développement pileux est secondaire à la production d'androgènes gonadiques et surrénaliens.

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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie
L'augmentation systémique des hormones sexuelles induit une augmentation de la fréquence et de l'amplitude des pics de sécrétion de l'hormone de croissance (GH) ; la vitesse de croissance staturale s'accélère, permettant le pic de croissance pubertaire
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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie
Chez la fille Le début de la puberté est défini par l'apparition des seins (thélarche) qui survient physiologiquement entre les âges de 8 et 13 ans.
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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie
L'âge physiologique de ménarche (premières règles) survient en moyenne 2 ans après le début de la puberté (12,5 ans en moyenne)
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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie

Chez le garçon

Le début de la puberté est défini par l'augmentation de volume testiculaire (volume ≥ 4 mL ou longueur ≥ 25 mm) observé entre les âges de 9 ans et 14 ans

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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie

Chez le garçon :

Une gynécomastie transitoire modérée est fréquemment observée en début de puberté. Plus tardivement apparaissent la pilosité faciale et la mue de la voix (14–15 ans)

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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie

Stades de Tanner :

  • À noter que la pilosité axillaire (A) est cotée entre 1 et 3 selon son absence (1) ou son développement adulte (3).
  • Elle a peu d'intérêt
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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie

Croissance staturale :

  • L'accélération de la vitesse de croissance staturale débute dès les premiers signes pubertaires chez la fille (S2), de façon décalée chez le garçon (G3), et s'élève jusqu'à 8 à 10 cm par an.
  • La taille finale moyenne est en France de 165 cm pour les filles et 178 cm pour les garçons

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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie

L'apparition du sésamoïde du pouce est contemporaine du démarrage pubertaire, à un âge osseux de 11 ans chez la fille et de 13 ans chez le garçon.

Les cartilages de conjugaison sont soudés lorsque l'âge osseux est à 15 ans chez la fille et 17 ans chez le garçon.

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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie
Les âges limites de la puberté sont définis statistiquement (de – 2 DS à + 2 DS de l'âge), correspondant à 95 % de la population
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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie

Puberté précoce :

  • Développement mammaire avant l'âge de 8 ans chez la fille ou développement testiculaire avant l'âge de 9 ans chez le garçon
  • Avec accélération de la vitesse de croissance et avance de l'âge osseux.

Cette situation nécessite toujours une évaluation médicale

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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie

Retard pubertaire :

  • Absence de développement mammaire chez la fille après l'âge de 13 ans ou absence d'augmentation du volume testiculaire chez le garçon après l'âge de 14 ans
  • Absence d'achèvement de la puberté 4 ans après son début

  • La vitesse de croissance reste celle de l'enfance (d'où une différence de taille importante avec les pairs en cours de puberté)

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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie
Pubertés précoces centrales (les plus fréquentes)
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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie

  • Les pubertés précoces centrales (tableau 2.2) sont dues à la réactivation prématurée (lésionnelle ou non) de l'axe hypothalamo-hypophyso-gonadique.

  • Elles sont bien plus fréquentes chez les filles.
    Elles sont alors idiopathiques (IRM hypothalamo-hypophysaire normale) dans la majorité des cas.

  • Chez le garçon, elles sont plus rares, mais souvent reliées à une lésion intracrânienne (gliome des voies optiques avec ou sans NF1, hamartome hypothalamique)

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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie
Puberté précoce centrale : fréquente chez la fille et souvent idiopathique. Redouter toujours une tumeur intracrânienne, notamment chez le garçon
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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie
Les pubertés précoces périphériques sont totalement indépendantes de l'axe hypothalamo-hypophysaire et donc de la sécrétion des gonadotrophines : il s'agit d'une autonomie gonadique (syndrome de McCune-Albright, testotoxicose)
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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie

Données essentielles de l'examen clinique en cas de puberté précoce :

  • Antécédents familiaux
  • Stade de Tanner
  • Taches cutanées
  • Signes d'hyperandrogénie
  • Signes de processus tumoral cérébral évolutif.

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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie

(Puberté précoce)

Dosages hormonaux

Dosage des stéroïdes sexuels :

  • Testostérone chez le garçon
  • Œstradiol peu utile chez la fille (variations fortes)
    • La présence du développement mammaire signe la sécrétion d'œstradiol.
  • Dosage de l'inhibine B : augmentation au cours de la puberté.
  • Dosage des gonadotrophines :
    • Après stimulation (test au LH-RH)
    • Diagnostic et distinction entre pubertés précoces centrale et périphérique :
      • En faveur d'une cause centrale : valeurs élevées du pic de LH (> à celui de FSH)
      • En faveur d'une cause périphérique : valeurs indosables

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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie

(Puberté précoce)

Échographie pelvienne et surrénalienne chez la fille :

  • Élimination d'un processus tumoral
  • Appréciation de l'imprégnation œstrogénique : augmentation de la longueur du corps utérin (L > 35 mm)

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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie

Le syndrome de Klinefelter concerne 1,6 garçon pour 1 000.

  • Il n'entraîne en général pas de retard pubertaire mais plutôt une puberté traînante, avec absence de développement pubertaire complet.
  • La morphologie est eunuchoïde avec une gynécomastie fréquente.
  • La pilosité pubienne et la pilosité axillaire se développent, la verge s'allonge, mais les testicules ne dépassent pas 35 mm de longueur.
  • Le QI global est proche de la normale avec souvent un déficit dans le domaine verbal.
  • Le déficit gonadique s'accentue avec le temps et les hommes atteints sont infertiles.
  • Le caryotype le plus fréquent est 47,XXY

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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie

Causes les plus fréquentes de retards pubertaires d'origine périphérique :

  • Syndrome de Turner chez la fille
  • Syndrome de Klinefelter chez le garçon

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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie

(Retard pubertaire simple) :

Le diagnostic présomptif repose sur les arguments suivants :

  • Antécédents familiaux de puberté tardive
  • Infléchissement statural progressif < 1 DS (pas de cassure)
  • Retard d'âge osseux (AO < 13 ans chez le garçon, < 11 ans chez la fille)
  • Absence de signes évocateurs de tumeur intracrânienne ou de maladie chronique, absence d'antécédents de cryptorchidie bilatérale.

  • Dans le retard pubertaire simple, l'axe hypothalamo-hypophyso-gonadique n'est pas sorti de la quiescence de l'enfance (elle sera observée secondairement).
  • Si ce diagnostic est retenu, il est important de suivre l'enfant jusqu'au démarrage de la puberté.
    Le pronostic est bon sur le plan des développements pubertaire et statural

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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie

(Retard pubertaire)

Dosage des gonadotrophines :

  • FSH et LH à l'état basal
    • Distinction entre retards pubertaires central et périphérique :
      • En faveur d'une cause centrale : FSH et LH basses (mais aussi retard pubertaire simple)
      • En faveur d'une cause périphérique : FSH et LH élevées.

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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie

Âge osseux :

  • La puberté se produit à AO = 13 ans chez le garçon et AO = 11 ans chez la fille
  • Un impubérisme est toujours anormal si l'âge osseux est supérieur à ces âges

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#47 #Cours #Facultaires #Médecine #Puberté #Pédiatrie

Hypogonadisme hypogonadotrope : IRM cérébrale systématique.

Hypogonadisme hypergonadotrope : caryotype systématique

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#47 #Cours #Facultaires #Gynécologie #Médecine #Puberté
Les enfants adoptés, les enfants originaires d'Afrique noire ou les enfants obèses ont une puberté plus précoce que les enfants de la population générale
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#47 #Cours #Facultaires #Gynécologie #Médecine #Puberté

La pubarche, ou apparition de la pilosité pubienne, n'est pas un signe de puberté car elle est indépendante des gonadotrophines.

Elle est liée aux sécrétions surrénaliennes, appelée adrénarche

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#47 #Cours #Facultaires #Gynécologie #Médecine #Puberté
Une irrégularité des cycles lors des 2 premières années après la ménarche est physiologique
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#47 #Cours #Facultaires #Gynécologie #Médecine #Puberté

Le début de puberté coïncide avec l'apparition du sésamoïde du pouce, sur la radiographie d'âge osseux réalisée au poignet gauche chez les droitier(e)s.

  • Il existe à la puberté une accélération de la vitesse de croissance qui passe de 5–6 à 7–9 cm/an.
  • Le pic de croissance a lieu chez la fille vers l'âge de 12 ans et chez le garçon vers l'âge de 14 ans.
  • La croissance pubertaire totale est en moyenne de 20 cm chez les filles et de 25 cm chez les garçons.
  • La taille finale est atteinte en moyenne à l'âge de 16 ans chez la fille et à 18 ans chez le garçon

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#47 #Cours #Facultaires #Gynécologie #Médecine #Puberté
Les principaux retentissements de la puberté précoce au long cours sont la survenue d'une petite taille définitive et l'apparition de troubles psychosociaux
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