Tesi sul tema "Épidémiologie – statistiques et données numériques"
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Pirrachio, Romain. "Méthodologies d'inférence causale appliquées à l'analyse de données observationnelles de réanimation". Paris 7, 2012. http://www.theses.fr/2012PA077023.
Benefit of Intensive Care Unit cannot be evaluated by performing randomized controlled trials, and therefore rely on observational studies. Standard analyses cannot be used to draw causal conclusions. Hence, specific statistical methods have been developed over the past decades in order to draw causal conclusions from observational data. Most of these methods rely on modelling the probability of treatment, the most popular being the propensity score. The first part of the thesis is dedicated to a review of the literature focussing on the use of thèse methods in the major Anesthesiology and Critical Care journals. We then focussed on the potential limitations related to the use of the propensity score. We first evaluated the performance of this method in the context of small sample size or low prevalence of the treatment. We then evaluated the generalized propensity approach as an option for the estimation of treatments with more than two categories. The presence of time-dependant confoundings cannot be handled by propensity score methods. Therefore, we evaluated thé use of marginal structural model as an alternative to propensity score in case of time-dependant confoundings. Finally, because all methods based on probability-of-treatment models rely on the hypothesis of absence of unmeasured confoundings, the last section of this thesis was dedicated to the use of instrumental variable approach when the presence of unmeasured confoundings can be suspected
Resseguier, Noémie. "Méthodes de gestion des données manquantes en épidémiologie. : Application en cancérologie". Thesis, Aix-Marseille, 2013. http://www.theses.fr/2013AIXM5063.
The issue of how to deal with missing data in epidemiological studies is a topic which concerns every researcher involved in the analysis of collected data and in the interpretation of the results produced by these analyses. And even if the issue of the handling of missing data and of their impact on the validity of the results is often discussed, simple, but not always appropriate methods to deal with missing data are commonly used. The use of each of these methods is based on some hypotheses under which the obtained results are valid, but it is not always possible to test these hypotheses. The objective of this work was (i) to propose a review of various methods to handle missing data used in the field of epidemiology, and to discuss the advantages and disadvantages of each of these methods, (ii) to propose a strategy of analysis in order to study the robustness of the results obtained via classical methods to handle missing data to the departure from hypotheses which are required for the validity of these results, although they are not testable, and (iii) to propose some applications on real data of the issues discussed in the first two sections
Huart, Michaël. "Développement d'un système de surveillance épidémiologique des maladies infectieuses à partir des données des laboratoires de microbiologie de la région PACA". Thesis, Aix-Marseille, 2016. http://www.theses.fr/2016AIXM5044.
Infectious diseases are a major public health problem worldwide. Indeed, infectious diseases were the cause in 2004 to nearly 15 million deaths, whether for emerging pathogens, pathogens known to man for many years or even re-emerging pathogens (2004 Estimation of WHO). It has fallen since we moved, for example, 1.27 million cases of malaria in 2004 to 854,600 in 2013. This downward trend affecting most infectious diseases, but an increase is still the realm of possibility as the demonstrated by the recent outbreak of Ebola.To fight against these infectious diseases, many epidemiological surveillance tools have emerged worldwide. These systems are designed to detect and identify as early as possible of possible epidemic events to promote the warning to the competent authorities and the establishment of counter-measures. The objective of our work was to build and develop an epidemiological surveillance system from the microbiology laboratory data of the Provence-Alpes Côte d'Azur (PACA). This system should enable us to identify possible abnormal events weekly data from the different participating laboratories. The monitoring system has enabled us later to declare several warnings from the Regional Health Agency (ARS) PACA, enhance our work through publications and finally to promote the work of laboratories by providing them a feedback containing the main alarms of the week.The development and automation of the system through the creation of an IT platform developed within the Mediterranean Institute University Hospital Infection (IHU) and by increasing the number of participants and the extension of this system to other regions in France or other countries
Frévent, Camille. "Contribution to spatial statistics for high-dimensional and survival data". Electronic Thesis or Diss., Université de Lille (2022-....), 2022. http://www.theses.fr/2022ULILS032.
In this thesis, we are interested in statistical spatial learning for high-dimensional and survival data. The objective is to develop unsupervised cluster detection methods by means of spatial scan statistics in the contexts of functional data analysis in one hand and survival data analysis in the other hand. In the first two chapters, we consider univariate and multivariate functional data measured spatially in a geographical area. We propose both parametric and nonparametric spatial scan statistics in this framework. These univariate and multivariate functional approaches avoid the loss of information respectively of a univariate method or a multivariate method applied on the average of the observations during the study period. We study the new methods' performances in simulation studies before applying them on economic and environmental real data. We are also interested in spatial cluster detection of survival data. Although there exist already spatial scan statistics approaches in this framework in the literature, these do not take into account a potential correlation of survival times between individuals of the same spatial unit. Moreover, the spatial nature of the data implies a potential dependence between the spatial units, which should be taken into account. The originality of our proposed method is to introduce a spatial scan statistic based on a Cox model with a spatial frailty, allowing to take into account both the potential correlation between the survival times of the individuals of the same spatial unit and the potential dependence between the spatial units. We compare the performances of this new approach with the existing methods and apply them on real data corresponding to survival times of elderly people with end-stage kidney failure in northern France. Finally, we propose a number of perspectives to our work, both in a direct extension of this thesis in the framework of spatial scan statistics for high-dimensional and survival data, but also perspectives in a broader context of unsupervised spatial analysis (spatial clustering for high-dimensional data (tensors)), and supervised spatial learning (regression)
Micol, Romain. "Infections à Cryptococcus neoformans, à cytomégalovirus, au virus de l'hépatite B au sein d'une cohorte (2004-2007) de sujets cambodgiens infectés par le VIH : prévalence, morbidité et mortalité". Paris 5, 2010. http://www.theses.fr/2010PA05T018.
In order to demonstrate the practical value of early diagnosis of cryptococcosis, cytomegalovirus (CMV) infection, and hepatitis B virus (HBV) infection during HIV infection in Cambodia, a cohort of 441 Cambodian HIV-infected patients was recruited in 2004 and followed until 2007 in Phnom Penh, in the context of Médecins Sans Frontières and Médecins du Monde antiretroviral drug access programmes. Prevalences, morbidity and mortality were estimated. A high prevalence (59/327; 18. 0%; 95%CI = 13. 9%-22. 2%) of cryptococcosis was observed in patients with a CD4+ T lymphocyte count less than 200/mm3, and the clinical value of systematic screening for cryptococcal antigenemia was demonstrated, as it allows early treatment of infection (28. 8% of cases of cryptococcosis were diagnosed as a result of systematic screening for cryptococcal antigenemia). A cost-effectiveness study (costs in 2009) comparing two cryptococcosis intervention strategies in patients with CD4+ count < 100/mm3 showed that screening for cryptococcal antigenemia and treatment of positive patients presented a better cost-effectiveness ratio (Dollar 180/life year gained) than primary prophylaxis with fluconazole (compared to the absence of intervention). Furthermore, primary prophylaxis presented a reasonable cost effectiveness ratio (Dollar 511/life year gained) compared to the screening. The proportion of patients alive at one year was 71. 9% and 70. 0%, respectively, compared to 60. 7% in the absence of intervention. CMV infection (an opportunistic infection often neglected in poor countries due to the almost complete absence of diagnosis and treatment) was very frequently detected (by real-time PCR) in patients with CD4+ count < 50/mm3 (133/224; 59. 4%; 95%CI = 52. 9%-65. 8%) and was independently associated with excess mortality (highest risk of death for CMV PCR ≥ 4. 2 log10 copies/ml = 3. 6; 95%CI = 2. 0-6. 8). To investigate a pathophysiological basis for these results, HHV-6 replication was studied by quantitative PCR and protein cmvIL-10 screening was performed by quantitative ELISA for C. Neoformans (no association between HHV-6 and cryptococcal infections) and CMV infections (negative correlation between cmvIL-10 level and CD4+ count), respectively. Finally, the proportion of patients presenting active chronic hepatitis B was estimated (45/319; 14. 1%; 95%CI = 10. 3%-17. 9%) and the emergence of lamivudineresistant strains was modelled in the HIV-infected population (7. 8% in co-infected patients) and in the general population
Bédubourg, Gabriel. "Place des outils d'analyse des séries temporelles dans la surveillance épidémiologique pour la détection des épidémies et leur analyse : élaboration de nouveaux outils de détection et d'analyse étiologique des épidémies appliqués à la surveillance épidémiologique". Thesis, Aix-Marseille, 2018. http://www.theses.fr/2018AIXM0739.
Public health surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of data for use in public health action to reduce morbidity and mortality of health-related events and to improve health. One of its objectives is the detection of unusualevents, i.e. outbreaks, requiring the rapid implementation of countermeasures.The objectives of this work are: (i) to evaluate the main published statistical methods for outbreak detection commonly implemented in different public health surveillance systems, (ii) to propose a new approach based on the optimal combination of statistical methods foroutbreak detection and benchmark it to other methods; and (iii) develop a new statistical method for the etiological analysis of an outbreak from public health surveillance data routinely collected by the system. To achieve these objectives, as a first step, we evaluate the main statistical methods, from a published set of simulated public health surveillance data. Statistical methods have been evaluated for an operational purpose: for all simulated time series, we used the tuning parameters recommended by their authors for each algorithm when available. We propose sensitivity and specificity metrics suitable for these tools. Then we propose an original approach for outbreak detection based on combination of methods selected in the previous step. The performance of this approach is compared to the previous ones according to the methodology implemented in the first step.Finally, we propose a method for the etiological analysis of an outbreak from surveillance data by using statistical models suitable for time series analysis
Moyen, Nanikaly. "Epidémiologie des infections par les filovirus et arbovirus en République du Congo". Thesis, Aix-Marseille, 2015. http://www.theses.fr/2015AIXM5069.
The Republic of Congo (RC) where our work took place is a Central African country, sharing borders with the Democratic Republic of Congo, Central African Republic, Gabon, Cameroon, and Angola (Cabinda). In these countries the circulation of arboviruses is documented. In RC, there was little or no documentation on arboviruses prior to our work. We conducted studies of arbovirus seroprevalence in Congolese blood donors for different virus families. We also studied the epidemic caused by the chikungunya virus that prevailed in RC in 2011.Our work have highlighted the high rate of seroprevalence for incriminated major pathogens: 47.2% for Dengue, 27.8% for Yellow Fever, 24.4% for West Nile, 38.8% for Chikungunya and 7.9% for Rift Valley fever. These high seroprevalence rates indicate that these viruses actively circulate in Congo, although no epidemic has yet been reported for some viruses. We have also isolated and genetically characterized a strain named "Brazza_MRS1", belonging to the East Central and Southern African lineage, after the chikungunya epidemic in 2011. The RC has experienced several outbreaks caused by the Ebola virus. We have performed a filovirus seroprevalence study to attempt to better characterize the circulation of filoviruses in asymptomatic Congolese blood donors. The observed rate of seroprevalence of anti Ebola IgG was 2.5% overall (1.6% in Brazzaville, 4% in Pointe-Noire and 4% in rural areas). Identified epidemiological risk factors were the exposure to bats (p <0.001) and birds (p = 0.04). The seroprevalence rate of Marburg virus IgG was low (0.5%)
Abat, Cédric. "Développement de nouveaux outils informatiques de surveillance en temps réel des phénomènes anormaux basés sur les données de microbiologie clinique du laboratoire de la Timone". Thesis, Aix-Marseille, 2015. http://www.theses.fr/2015AIXM5029/document.
Although considered under control in the second half of the 20th century with the discovery of antimicrobials, infectious diseases remain a serious threat to humanity. Regardless of the state of knowledge we possess on these diseases, all remained unpredictable. To fight this phenomenon, many monitoring strategies have been developed leading to the implementation of various epidemiological surveillance computer programs to detect and identify, as soon as possible, abnormal events including epidemic phenomena. The initial objective of our work was to implement, within the Hospitalo-Universitaire Méditerranée Infection and based on the Microsoft Excel software, two new automated computer-based programs for the weekly automated epidemiological surveillance of abnormal epidemic events using clinical microbiological data from the Timone teaching hospital of of Assistance Publique- Hôpitaux de Marseille (AP-HM). Once completed, we then worked to develop a comprehensive monitoring structure incorporating the investigation and the validation of alarms emitted by the established surveillance systems, the transmission of alerts to the Regional Health Agency (ARS) of the Provence-Alpes Côte d'Azur (PACA), the public dissemination of confirmed abnormal events by publishing scientific articles, and the implementation of feedback and weekly epidemiological bulletins to inform local infectious diseases epidemiological surveillance actors
Vigan, Marie. "Modélisation de données longitudinales et de données d'événements répétés par des modèles non linéaires à effets mixtes : application à la maladie de Gaucher". Paris 7, 2014. http://www.theses.fr/2014PA077164.
Gaucher disease (GD) is a rare genetic disease. Different biomarkers are altered and patients also have bone events (BE). An enzymatic substitution treatment is available. To analyze the evolution of biomarkers, nonlinear mixed effects models are used and, for BE, frailty models. Those models require specific estimation methods that we assessed by simulation. For frailty models, we compared SAEM algorithm implemented in Monolix to the adaptative Gaussian quadrature (AGQ) implemented in SAS. We also evaluated the powers of the Wald test and the likelihood ratio test of a binary covariate. We then evaluated SAEM algorithm for joint models of longitudinal data and repeated events and evalue the power to detect the link between longitudinal data and repeated events. Results obtained for the estimation of parameters give us few biases and, for frailty models, results are comparable between SAEM and AGQ. We performed an epidemiological description of the French registry of GD. In treated patients, we used a pathophysiological model to describe the evolution of biomarkers under treatment and we analyzed the occurrence of repeated BE. We tested the link between biomarkers and the occurrence of BE. To have a BE before treatment increased three-fold the risk during treatment. We will continue this work with the use of the model we developed to individualize treatment doses
Pelat, Camille. "Nouveaux outils et nouvelles données pour la surveillance des maladies infectieuses". Phd thesis, Université Pierre et Marie Curie - Paris VI, 2010. http://tel.archives-ouvertes.fr/tel-00690501.
Meddeb, Line. "Méthodes de suivi de la santé des enfants nés après fécondation In Vitro : mise en place d'une cohorte monocentrique et évaluation de la croissance anthropométrique". Thesis, Aix-Marseille, 2015. http://www.theses.fr/2015AIXM5075.
Today, at least 5 million children worldwide were born following the enrollment of their parents in ART program. Infertility treatments have changed significantly; most often these changes took place outside traditional experimental protocols. The most striking event was when IVF with intracytoplasmic sperm injection (ICSI) was introduced in ART practices in 1995. The lack assessment of the health of children born after this technique remains the major weak in this discipline. We established a longitudinal monocentric follow-up study in Saint-Joseph Hospital (Marseille). The data were collected by asking parents to send copies of child health records and questionnaires filled out by them. This investigation is one of the few French studies involving a long-term follow- up to 5 years, in a large scale cohort. The study of BMI up to age 5 years didn’t show the suspected epigenetic influence of IVF reported in literature. Further investigations need to be conducted. It is important to build a coherent information system around the health of children born after IVF. The feasibility of collecting a series of data covering both maternal and conceptional environment, and child health indicators should be considered at the national level through the development of connection methods between different registers developed in France
Avillach, Paul. "Du système d'information clinique au système d'information épidémiologique : apport de l'intéropérabilité sémantique". Thesis, Aix-Marseille 2, 2011. http://www.theses.fr/2011AIX20697.
Medical information collected during clinical care must be re-used to address other more collective goals. In this context of re-using data from a clinical information system for epidemiological research, the objective of this work is to study the contribution of semantic interoperability across a number of practical situations we have met and discussed which illustrate the nature of semantic consistency problems associated with processing of medical data.Coexistence at a given time, of several semantic repositories should not be considered as an obstacle to interoperability. Generic tools can be designed and developed to move seamlessly from one component to another with as little loss of information as possible. The Unified Medical Language System (UMLS) is one of the semantic integration tools. Its use in this work shows the generality of this method and its potential for solving this class of semantic interoperability problems.The richness of each of the terminology can, when combined into a single pivot semantic repository, enrich the set of terminologies individually for a better representation of knowledge.Semantic interoperability improves the availability and quality of reusable data for public health research. It also enriches existing data. It provides access to new sources of data, aggregated in a valid manner, allowing benchmarking or richer analysis
Bonaldi, Christophe. "Analyse de clusters sur le temps : application en carcinologie et en épidémiologie". Montpellier 1, 2003. http://www.theses.fr/2003MON1T017.
Bougeard, Stéphanie. "Description et prédiction à partir de données structurées en plusieurs tableaux : Application en épidémiologie animale". Phd thesis, Université Rennes 2, 2007. http://tel.archives-ouvertes.fr/tel-00267595.
Drali, Rezak. "Poux humains : différenciation, distribution phylogéographique, host-switching et contrôle". Thesis, Aix-Marseille, 2014. http://www.theses.fr/2014AIXM5070/document.
Head louse (Pediculus humanus capitis) and body louse (Pediculus humanus humanus) are two indistinguishable ecotypes each occupying an ecological niche: hair for head louse and clothing for the body louse. Body louse represents a real threat to humans because of its role as vector for the transmission of three deleterious diseases namely epidemic typhus, trench fever and relapsing fever.In this thesis, we obtained concrete results that have led to scientific publications. Indeed, we (i) implemented a molecular tool to differentiate for the first time between head and body louse, (ii) we highlighted the existence of a fourth mitochondrial clade (Clade D) comprising head and body lice that can vectorize Bartonella quintana and Yersinia pestis, (iii) we traced human migration through the analysis of ancient lice from different periods and different area, (iv) we demonstrated for the first time that Pediculus mjobergi is genetically close to human louse and confirmed the hypothesis that initially Pediculus mjobergi was a human louse has been transferred to New World monkeys by the first humans who have reached the American continent thousands of years ago and (v) we have implemented a tool for detecting and monitoring the molecular resistance to permethrin of body lice that parasite sheltered homeless persons in Marseille. This tool was particularly useful in the clinical study we conducted to determine whether the use of long-lasting insecticide-treated underwear provides effective long-term protection against body lice in homeless persons
Lalloué, Benoît. "Méthodes d'analyse de données et modèles bayésiens appliqués au contexte des inégalités socio-territoriales de santé et des expositions environnementales". Phd thesis, Université de Lorraine, 2013. http://tel.archives-ouvertes.fr/tel-00943004.
Couris, Chantal Marie. "Les bases de données médico-administratives hospitalières comme source d'information permanente pour l'épidémiologie descriptive du cancer : méthodes d'estimation et de correction du nombre de cancers du sein incidents à l'hôpital". Lyon 1, 2001. http://www.theses.fr/2001LYO1T234.
Sandt, Christophe. "Identification de micro-organisme pathogènes impliqués dans les infections nosocomiales par spectroscopie infrarouge à transformée de Fourier et méthodes statistiques". Reims, 2003. http://www.theses.fr/2003REIMP204.
We have used Fourier transform-infrared spectroscopy (FTIR) in order to identify pathogenic microorganisms isolated in a clinical set-up. We demonstrated the usefulness of the technique in the typing of Candida albicans. By using this method, four clinical applications have been achieved: the epidemiological follow-up of HIV patients and ICU patients, the demonstration of a nosocomial transmission of a C. Albicans strain among neonates in a maternity ward and the follow-up of strains from a patient with recurrent systemic candidiasis. We have built a database containing more than 245 strains of GRAM- and 270 strains of GRAM+ pathogenic bacteria belonging to 11 genera and 18 species. Validation of the database yielded 84. 2% correct identification for GRAM- and 94. 7% correct identification for GRAM+. We used FTIR microspectroscopy to evaluate the early identification of pathogenic bacteria and yeasts. A total of 100 GRAM- and 60 GRAM+ strains, belonging to 9 genera and 15 species were included
Cucala, Lionel. "ESPACEMENTS BIDIMENSIONNELS ET DONNÉES ENTACHÉES D'ERREURS DANS L'ANALYSE DES PROCESSUS PONCTUELS SPATIAUX". Phd thesis, Université des Sciences Sociales - Toulouse I, 2006. http://tel.archives-ouvertes.fr/tel-00135890.
Marot, Julien. "Méthodes par sous-espaces et d'optimisation : application au traitement d'antenne, à l'analyse d'images, et au traitement de données tensorielles". Aix-Marseille 3, 2007. http://www.theses.fr/2007AIX30051.
This thesis is devoted to subspace-based and optimization methods, developed in array processing, image processing, tensor signal processing. Definitions concerning an array processing problem and high resolution methods are presented. We propose an optimization method applied to source detection in presence of phase distortions for a high number of sensors. We propose fast subspace-based methods for the estimation of straight line offset and orientation, several optimization methods to estimate distorted contours, nearly straight or circular. We provide a state-of-the art about multiway signal processing: truncation of the HOSVD, lower rank tensor approximation, multiway Wiener filtering. We propose a procedure for nonorthogonal tensor flattening, using the method presented in the first part
Sallah, Kankoe. "Diffusion spatio-temporelle des épidémies : approche comparée des modélisations mathématiques et biostatistiques, cibles d'intervention et mobilité humaine". Thesis, Aix-Marseille, 2017. http://www.theses.fr/2017AIXM0607.
In the first part of this thesis, we have developed a malaria transmission metamodel based on the susceptible-infected-resistant compartmental modeling framework (SIR) and taking into consideration human mobility flows between different villages in the Center of Senegal. Geographically targeted intervention strategies had been shown to be effective in reducing the incidence of malaria both within and outside of intervention areas. However, combined interventions targeting both vector and host, coordinated on a large scale are needed in regions and countries aiming to achieve malaria elimination in the short/medium term.In the second part we have evaluated different methods of estimating human mobility in the absence of real data. These methods included spatio-temporal traceability of mobile phones, mathematical models of gravity and radiation. The transport of the pathogen through the geographical space via the mobility of an infected subject is a major determinant of the spread of an epidemic. We introduced the impedance model that minimized the mean square error on mobility estimates, especially in contexts where population sets are characterized by their heterogeneous sizes.Finally, we have expanded the framework of assumptions underlying the calibration of the gravity models of human mobility. The hypothesis of a zero inflated distribution provided a better fit and a better predictability, compared to the classical approach not assuming an excess of zeros: Poisson, Quasipoisson
Abdallah, Mouhammed. "Vulnérabilité des ouvrages en maçonnerie à des mouvements de terrain : méthodologie d'analyse par méthodes statistiques et par plans d'expériences numériques sur les données de la ville de Joeuf". Thesis, Vandoeuvre-les-Nancy, INPL, 2009. http://www.theses.fr/2009INPL019N/document.
The context of our study concerns ground movements that may occur in Lorraine as a result of mining subsidence events and their impact on traditional masonry houses. When such an event occurs, houses suffer disorders resulting from efforts in the structure caused by the movement of the ground. The response that characterizes the state of the structure depends on the geometrical, physical and mechanical characteristics. However, the discontinuous nature of the masonry and the interactions complexity between masonry blocks makes it difficult to determine that response. The same is true about the soil-structure interaction. The purpose of this research is to study, by numerical modelling with the distinct element method, experimental design planning and response surfaces, the behaviour of masonry structures subjected to a typical mining subsidence event and to define from this study some criteria making possible the estimation of the vulnerability of all the buildings of a city. A first simplified analysis describes the principle of the used methodology which is then applied to the study of all houses of the city of Joeuf, used as a pilot site. This methodology is based on an analysis of the total length of the opened joints, which are considered as similar to cracks in the structure. Then, a typology analysis helps first to distinguish 4 groups (types) of houses which have similar characteristics. On each of these groups, the methodology is applied consistently, based on the geometrical characteristics of the houses facades and then leads to the formulation of vulnerability functions that use the technique of orthogonal regression
Douplat, Marion. "Les décisions de limitations et d'arrêts des thérapeutiques à l'épreuve de la temporalité des urgences : enjeux éthiques". Thesis, Aix-Marseille, 2018. http://www.theses.fr/2018AIXM0756.
Decisions of withholding or withdrawing life-sustaining treatments are frequent in emergency departments where death is an everyday reality. These decisions lead to ethical dilemmas for physicians, nurses, and relatives with regards to the timing of the emergency departments and the evolution of the French legislation in particular the law on the rights of the patients and the persons who are nearing the end of life. Moreover, the caregivers should have an ethical thinking-process in order to respect ethical principles such as autonomy, beneficence, non-malfeasance and justice. There seems to be a conflict between the emergency situation and the complexity of the decision-making process. There is only few data concerning the decisions of withholding or withdrawing life sustaining treatments especially about modality of these decisions and the implications for caregivers and relatives. Because of the lack of data, we decided to explore the physicians’ experience during the decision-making process in the emergency departments and the perception of the relatives after the decision of withholding or withdrawing life-sustaining treatment. Our study consists in three parts: a study which evaluates the physicians’ experience during the decision-making process; then, a study describing the relatives’ perception of the decisions of withholding or withdrawing life-sustaining treatments and finally a study about the involvement of general practitioners in the decision-making process
Masson, Jean-Baptiste. "Sigfried 2 : modèles de mélange censurés et autres méthodes statistiques pour la contribution d'indicateurs spatialisables de la qualité de l'air intérieur dans les logements français". Compiègne, 2012. http://www.theses.fr/2012COMP2003.
This Ph. D. Thesis is part of the CIRCE program (Cancer, regional and cantonal environmental inequalities) which aims at comparing maps of cancer occurrence with maps of environmental quality on the French territory. Our specific goal is to build geographic maps of the indoor air quality inside the homes, that are compatible with this approach. We adopted a two-step method: first, build typical profiles of indoor air pollution, then assess these classes’ local frequencies in predefined zones. In the first step, we developed an extension of classical clustering methods, based on Gaussian mixture models and the EM algorithm, to the case of (deterministically) censored data. In the second step, we used non-parametric discrimination tools based on binary decisions trees (CART). Unfortunately, the resulting trees have a very high prediction error rate. Even if known significant associations can be found between indoor pollution and some characteristics of the building and its occupants, it seems very hard to predict the profile, or even a single pollutant’s concentration, from those characteristics. However, our methodology has numerous advantages: simplicity of use, distinct steps enabling a steady control of the results, flexible choice of the variables, availability of a prediction error rate
Metzger, Marie-Hélène. "Infarctus du myocarde à Toulouse (France) et à Augsburg (Allemagne) : étude comparative de la mortalité, morbidité, létalité et prise en charge thérapeutique (données du registre Monica 1985-1989". Bordeaux 2, 1994. http://www.theses.fr/1994BOR23022.
Angoulvant, François. "Evaluation et amélioration de l'usage des antibiotiques aux urgences pédiatriques". Paris 7, 2013. http://www.theses.fr/2013PA077212.
Antibiotics are frequently prescribed in pediatric emergencies department, most often for acute respiratory infections. Faced with the growing problem of resistance to antibiotics, the evaluation and improvement of the antibiotic prescriptions is crucial. Indicators of antibiotic consumption in hospital and in in ambulatory settings existed for a long time. However, despite the weight of antibiotics' prescriptions in pediatric emergencies department, few studies were conducted in these settings. This Doctoral work was designed to evaluate and improve the use of antibiotics in pediatric emergency department. Our first objective was to develop indicators and tools relevant to assess qualitatively and quantitatively antibiotics' prescriptions in pediatric emergencies department. We have shown that simple indicators, such as the percentage of patients with acute respiratory infection treated by antibiotics, were useful to monitor the evolution of the antibiotic prescriptions during interventions to improve them. The methodology is based on the automated extraction of data from the medical record to collect hundreds of thousands cases in several sites. The second issue was the education of patients and familles to the proper use of antibiotics in pediatric emergencies department. We performed a randomized, controlled blind trial in which 300 children have been included. We have showri an improvement in satisfaction and knowledge about the proper use of antibiotics after a therapeutic education on this topic versus a control intervention
Jarry, Gabriel. "Analyse et détection des trajectoires d'approches atypiques des aéronefs à l'aide de l'analyse de données fonctionnelles et de l'apprentissage automatique". Thesis, Toulouse 3, 2020. http://www.theses.fr/2020TOU30284.
Improving aviation safety generally involves identifying, detecting and managing undesirable events that can lead to final events with fatalities. Previous studies conducted by the French National Supervisory Authority have led to the identification of non-compliant approaches presenting deviation from standard procedures as undesirable events. This thesis aims to explore functional data analysis and machine learning techniques in order to provide algorithms for the detection and analysis of atypical trajectories in approach from ground side. Four research directions are being investigated. The first axis aims to develop a post-op analysis algorithm based on functional data analysis techniques and unsupervised learning for the detection of atypical behaviours in approach. The model is confronted with the analysis of airline flight safety offices, and is applied in the particular context of the COVID-19 crisis to illustrate its potential use while the global ATM system is facing a standstill. The second axis of research addresses the generation and extraction of information from radar data using new techniques such as Machine Learning. These methodologies allow to \mbox{improve} the understanding and the analysis of trajectories, for example in the case of the estimation of on-board parameters from radar parameters. The third axis proposes novel data manipulation and generation techniques using the functional data analysis framework. Finally, the fourth axis focuses on extending the post-operational algorithm into real time with the use of optimal control techniques, giving directions to new situation awareness alerting systems
Retornaz, Frédérique. "Evaluation gériatrique et dépistage de la vulnérabilité chez les patients âgés atteints de cancer : limites et enjeux". Aix-Marseille 2, 2008. http://www.theses.fr/2008AIX20667.
Texier, Gaëtan. "Méthode d'évaluation des algorithmes de détection temporelle des épidémies dans le cadre de l'alerte précoce". Thesis, Aix-Marseille, 2016. http://www.theses.fr/2016AIXM5043.
The main goal of this work is to propose an assessment method to evaluate outbreak detection algorithm with the following characteristics: realistic, pragmatic, operational (easy to implement), validated and reproducible. This method will allow testing and evaluating outbreak detection algorithms with the objective to determine their features and limits. To reach this goal, firstly, we propose to model the surveillance process with their associated tasks, the decision-making and the use of ODA in real conditions. A work focused of uncertainty during the outbreak management and identification of possible tools to support the expert decision-making is presented.Secondly, because building a standardized dataset of evaluation is a prior before any evaluation, we proposed a new approach to simulate in few minutes, from published epidemics, realistic outbreak curve. We used a Monte-Carlo sampling approach to solved several problems non treated in literature and identified theχ²divergence to realized the quality control of data simulated. We also proposed a detailed and commented review on published evaluation metrics (>50). An example of ODA evaluation was realized by comparing several change point analysis (CPA) model and expert judgment while seeking to identify the complementarity between human and statistical tool in a goal of help to decision-making
Clarotto, Lucia. "Spatio-temporal prediction by stochastic partial differential equationsPrédiction spatio-temporelle par équations aux dérivées partielles stochastiques". Electronic Thesis or Diss., Université Paris sciences et lettres, 2023. http://www.theses.fr/2023UPSLM022.
In the task of predicting spatio-temporal fields in environmental science using statistical methods, introducing statistical models inspired by the physics of the underlying phenomena that are numerically efficient is of growing interest. Large space-time datasets call for new numerical methods to efficiently process them. The Stochastic Partial Differential Equation (SPDE) approach has proven to be effective for the estimation and the prediction in a spatial context. We present here the unsteady advection-diffusion SPDE which defines a large class of nonseparable spatio-temporal models. A Gaussian Markov random field approximation of the solution to the SPDE is built by discretizing the temporal derivative with a finite difference method (implicit Euler) and by solving the spatial SPDE with a finite element method (continuous Galerkin) at each time step. The Streamline Diffusion stabilization technique is introduced when the advection term dominates the diffusion. Computationally efficient methods are proposed to estimate the parameters of the SPDE and to predict the spatio-temporal field by kriging, as well as to perform conditional simulations. The approach is applied to solar radiation and wind speed datasets. Its advantages and limitations are discussed, and new perspectives for future work are envisaged, especially involving a nonstationary extension of the approach. As a further contribution of the PhD, the nonseparable generalization of the Gneiting class of multivariate space-time covariance functions is presented. The main potential of the approach is the possibility to obtain entirely nonseparable models in a multivariate setting, and this advantage is shown on a weather trivariate dataset. Finally, a review of some methods for approximate estimation and prediction for spatial and spatio-temporal data is proposed, motivated by the objective of reaching a trade-off between statistical efficiency and computational complexity. These methods proved to be effective for parameter estimation and prediction in the context of the "Spatial Statistics Competition for Large Datasets" organized by the King Abdullah University of Science and Technology (KAUST) in 2021 and 2022. Lastly, possible further research directions are discussed
Rommel, Cédric. "Exploration de données pour l'optimisation de trajectoires aériennes". Thesis, Université Paris-Saclay (ComUE), 2018. http://www.theses.fr/2018SACLX066/document.
This thesis deals with the use of flight data for the optimization of climb trajectories with relation to fuel consumption.We first focus on methods for identifying the aircraft dynamics, in order to plug it in the trajectory optimization problem. We suggest a static formulation of the identification problem, which we interpret as a structured multi-task regression problem. In this framework, we propose parametric models and use different maximum likelihood approaches to learn the unknown parameters.Furthermore, polynomial models are considered and an extension to the structured multi-task setting of the bootstrap Lasso is used to make a consistent selection of the monomials despite the high correlations among them.Next, we consider the problem of assessing the optimized trajectories relatively to the validity region of the identified models. For this, we propose a probabilistic criterion for quantifying the closeness between an arbitrary curve and a set of trajectories sampled from the same stochastic process. We propose a class of estimators of this quantity and prove their consistency in some sense. A nonparemetric implementation based on kernel density estimators, as well as a parametric implementation based on Gaussian mixtures are presented. We introduce the later as a penalty term in the trajectory optimization problem, which allows us to control the trade-off between trajectory acceptability and consumption reduction
Couffignal, Camille. "Variabilité de la réponse pharmacologique, modélisation et influence des plans expérimentaux". Electronic Thesis or Diss., Université Paris Cité, 2021. http://www.theses.fr/2021UNIP5250.
The increasing number of patients with chronic diseases, most of whom are subject to long-term treatment, justifies the exploration and characterisation of phenotypic and genetic factors of pharmacological response. The identification and estimation of the pharmacokinetic-pharmacodynamic variability involved in the response to a treatment are essential steps in this exploration to achieve precision medicine. We studied the re-introduction of β-blockers after cardiac surgery in a prospective multicentre cohort of patients receiving chronic β-blocker therapy and who underwent cardiac surgery. With a landmark analysis, we have shown the efficacy of reintroducing β-blockers 72 hours after cardiac surgery on the occurrence of atrial fibrillation. We modelled, using a population approach, the serum, erythrocyte and urine concentration data of once-daily sustained-release lithium in bipolar patients undergoing treatment for at least two years. A clinical research protocol was then written, with an optimization of sampling times, based on the pharmacokinetic model obtained, to characterise inter- and intra-individual variability and to identify predictive factors of the prophylactic response to lithium. We evaluated, by simulation, the impact of the crossover versus parallel design, as well as the choice of statistical model during the analysis, in pharmacogenetic studies evaluating two treatments (candidate and reference) when a genetic polymorphism increases or not the efficacy of the candidate treatment compared to the reference. The results of this simulation study show that the choice of the model and the choice of the experimental design strongly affect not only the type I error and the power to detect a gene-treatment interaction, but also the correct allocation of the treatment. This work reinforces the need to use adequate statistical tools and experimental designs in the analysis of a clinical trial or pharmacoepidemiological study to characterize and quantify the variability of the pharmacological response
Canovas, Ingrid. "Modélisation de la montée vers un état critique de la situation de basses eaux sous forçages naturel et anthropique en région méditerranéenne". Thesis, Avignon, 2016. http://www.theses.fr/2016AVIG1166/document.
Water and life are unequally distributed. This hinders the development of societies, and leads to situations of tension, whoseintensity and frequency vary according to climatic conditions, population density and according therefore to demand. With theongoing climate change and the rising water requirements (the stock dedicated to the natural environment), the level of tensionis likely to rise, such as the frequency of very low water. The French Mediterranean territories are particularly concerned withthe fragility of water resources during summertime (a little watered season, a strong tourist appeal, etc.). In addition, everymodification in the climate regime (the decreasing of rainfall inputs, etc.) would necessarily affect more the small catchmentwith very local resources, such as rivers and living areas which don’t benefit from the influence of major rivers (Rhone, Durance,etc.).The reflection on water scarcity can therefore be focused on the structure of such a risk (sequence of steps, the impact of onefactor on the others, etc.), and on the conditions that make the system reach an undesirable situation.The approach adopted here suggests to decline this particular approach to low water. Three objectives are here stated: (1) identifyand compile, within a specific database, the essential information to understand the phenomenon; (2) characterize the meanstate of low water from local situations and through robust statistical descriptors; (3) determine the terms of its evolution tocritical states.The whole work leads first to the development of a probabilistic modeling, which is designed to be deployed in different spatialscales and in dfferent times. The reflection is then extended to the methodological and technical arrangements that would allowthe development of analytical indicators and synthetic indexes for assessing the resource level of tension.The approach finally results in simple and intuitive digital tools, that can be mobilized for operational purposes such asdecision-making support for the implementation of anticipatory measures and regulation, and that can transferable to anyMediterranean territory
Sagara, Issaka. "Méthodes d'analyse statistique pour données répétées dans les essais cliniques : intérêts et applications au paludisme". Thesis, Aix-Marseille, 2014. http://www.theses.fr/2014AIXM5081/document.
Numerous clinical studies or control interventions were done or are ongoing in Africa for malaria control. For an efficient control of this disease, the strategies should be closer to the reality of the field and the data should be analyzed appropriately. In endemic areas, malaria is a recurrent disease. Repeated malaria episodes are common in African. However, the literature review indicates a limited application of appropriate statistical tools for the analysis of recurrent malaria data. We implemented appropriate statistical methods for the analysis of these data We have also studied the repeated measurements of hemoglobin during malaria treatments follow-up in order to assess the safety of the study drugs by pooling data from 13 clinical trials.For the analysis of the number of malaria episodes, the negative binomial regression has been implemented. To model the recurrence of malaria episodes, four models were used: i) the generalized estimating equations (GEE) using the Poisson distribution; and three models that are an extension of the Cox model: ii) Andersen-Gill counting process (AG-CP), iii) Prentice-Williams-Peterson counting process (PWP-CP); and (iv) the shared gamma frailty model. For the safety analysis, i.e. the assessment of the impact of malaria treatment on hemoglobin levels or the onset of anemia, the generalized linear and latent mixed models (GLLAMM) has been implemented. We have shown how to properly apply the existing statistical tools in the analysis of these data. The prospects of this work remain in the development of guides on good practices on the methodology of the preparation and analysis and storage network for malaria data
Dimanche, Vincent. "Compréhension fine du comportement des lignes des réseaux métro, RER ettramway pour la réalisation des études d’exploitabilité". Thesis, Reims, 2018. http://www.theses.fr/2018REIMS010.
Dense railway networks face significant saturation. And the balance between the theoretical offer and the growing demand imposes strong operability constraints. An imbalance will generate conflicting points such as bottlenecks with the effect of delays on the following trains. As the human factor influences the operation performance; taking it into account more accurately should improve understanding and modeling of railway lines to increase capacity without reducing passenger comfort. To fulfill this objective, we are working on an adapted visualization of the operating data and on their automated mining. These two solutions have been adapted and applied to the railway sector, particularly to the lines of rail networks operated by RATP. The "Visual Analytics" process, implemented in our work to meet these needs, encompasses the steps required to value the data, going from the preparation of the data to the expert analysis. This expert analysis is made through graphic representation and the use of data mining algorithms. Among these data mining algorithms, CorEx and Sieve allowed us to analyze operating data and then extract characteristics human behavior thanks to unsupervised learning based on a multivariate mutual information measure to. Finally, we propose an intuitive visualization of a large amount of data allowing their global integration and facilitating the overall diagnosis of the railway lines behavior
Lieury, Tiffany. "Transitoires calciques présynaptiques induits par dépolarisation membranaire : amélioration des méthodes dédiées à leur détection automatique et à leur analyse : Sur la réelle complexité de l'analyse des données d'imagerie calcique". Paris 5, 2011. http://www.theses.fr/2011PA05T048.
In neurons transient and local elevations of the intracellular free calcium ions concentration influence the excitability and the synaptic efficacy. In small axonal compartements, the dynamics of presynaptic calcium transients were shown to play a major role in the control of neurotransmitter release, and thus in the communication between neurons. Kinetics of presynaptic calcium transients are usually investigated by estimating parameters of interest on recorded data using different models of calcium dynamics, while the distribution of the data is assumed to be Normal with a constant variance. Unfortunately this assumption does not hold for data acquired with a CCD camera because of the photon noise, hence leading to unreliable parameter estimations. By adapting an existing CCD camera noise model, we have developed a correct statistical framework to reliably estimate the parameters of interest of 2 models of calcium dynamics. Based on the correct distribution of calcium imaging data acquired with a CCD camera, we propose a statistical method for an automated detection of signals of interest and adjust its parameters for the specific detection of high amplitude presynaptic calcium transients. Finally we adapt to calcium imaging data a novel method for denoising and clustering signals
Lominé, Franck. "Ecoulements de particules dans un milieu poreux". Phd thesis, Université Rennes 1, 2007. http://tel.archives-ouvertes.fr/tel-00198209.
Un dispositif expérimental a été mis au point pour étudier la dispersion latérale et le temps moyen de séjour d'un paquet de particules dans un milieu poreux. Nous avons en particulier déterminé la dépendance du temps moyen de transit en fonction du nombre de particules en écoulement, de la taille des particules et de la hauteur du milieu poreux. Nous avons également caractérisé la dépendance du coefficient de dispersion latéral vis-à-vis du nombre de particules transitant dans la structure poreuse.
Dans un deuxième temps, nous avons développé des modèles de simulations numériques basés sur les méthodes "Event-Driven" et "dynamique moléculaire de sphères molles". Ceux-ci nous ont permis de compléter l'étude expérimentale en analysant l'influence de divers paramètres supplémentaires. L'accès à l'intérieur du milieu poreux a permis une analyse plus fine de la dispersion des particules.
Enfin, nous avons abordé la possibilité d'utiliser le phénomène de percolation spontanée pour réaliser un mélangeur. Grâce à l'outil numérique, nous avons réalisé et caractérisé des mélanges de particules de tailles différentes. Nous avons alors montré que ce procédé s'avère être un moyen simple et efficace pour obtenir des mélanges homogènes de particules.
Berthe-Aucejo, Aurore. "Pharmacie clinique en pédiatrie : prescriptions inappropriées". Electronic Thesis or Diss., Université Paris Cité, 2021. http://www.theses.fr/2021UNIP5248.
The context of drug prescription in children is complex : physiological evolution and metabolic changes, off-label prescription, unsuitable dosage forms. Children are at greater iatrogenic risk than adults. A tool for detecting inappropriate prescriptions in paediatrics (POPI : Paediatric - Omission Prescriptions and Inappropriate prescriptions) has been developed. We retrospectively evaluated the prevalence of inappropriate prescriptions (IP) in community setting and in hospital. The prevalence of IP and omitted prescriptions (OP) were respectively 2.9% and 2.3% in emergency department and 12.3% and 6.1% in community setting. The reproducibility study showed excellent inter-judge agreement between doctors in the detection of IP and between pharmacists in the detection of OP. The IP and OP had a good agreement between the different healthcare professionals. Finally, we proposed an adaptation of our tool for use in worldwide. Of the 105 criteria evaluated, 80 criteria obtained more than 75% agreement after the first round, 16 items were modified and 25 were deleted. The final international POPI tool is composed of 73 IP and OP. The main reasons for modification or deletion were differences between the recommendations of the different countries and the unavailability of the drug. This work has allowed us to assess the prevalence of IP in paediatrics and to show that the tool is usable by different professionals. The ease of use of the tool was approved by the majority of users and they were ready to use it in their daily practice. This tool can help healthcare professionals to detect IP/OP and improve the medication management of children
Berger, Ludovic. "Modélisation de l'activité en chirurgie vasculaire". Thesis, Aix-Marseille 2, 2011. http://www.theses.fr/2011AIX20729/document.
The question of replacement of vascular surgeons for the future is of concern because of a large number of retirements. But the question of replacement only is not sufficient for a specialty that is primarily for older patients in the current context of increasing and aging of the French population.In order to meet the need for vascular surgery in the coming years, we initially performed an overview of the demographics of practitioners of the specialty and estimated the retirements. To take into account the evolution of the future activity, we have established a predictive model for the acts of carotid surgery, surgery of infrarenal abdominal aortic aneurysms and surgery of peripheral arterial disease, according to the aging population. This model applies the methods of the INSEE for acts collected in the Medicalised Information System Program database.We then refined it by including other parameters modifying workload evolution. We have calculated and applied a weighting factor obtained during the period of activity from 2000 to 2008. According to the model, the activity between 2008 and 2030 will increase by 38% in the studied procedures.The weighted projections predict an acts’ increase 30% between 2011 and 2025.From a purely mathematical point of view, the training needs of 120 surgeons would be to replace retirements, and 59 more surgeons because of the increased workload
Gautier, Isabelle. "Evolution quantitative et qualitative des protocoles d'essais cliniques présentés devant un comité d'éthique français". Thesis, Aix-Marseille, 2017. http://www.theses.fr/2017AIXM0660.
Methodological quality in clinical research is mandatory to ensure the reliability of medical experiments, with benefits for both practitioners and patients. This PhD thesis aims at measuring the quality of therapeutic trials submitted to the Ethics Committee of the South-East Region II, and its evolution over several years. Two comprehensive cross-sectional studies were conducted. The first explore the field of pediatric research, and aims at measuring the impact of the introduction of European Pediatric Regulation in 2007, on the evolution of the quantity and quality of trials in this field, given the low number of research in this population. The second analyzes the quality of randomized controlled trials using the JADAD score and seeks to identify the elements that influence it. These studies were conducted using the protocols submitted to the Ethics Committee, and not from a literature analysis. The concept of quality was first studied based on their ethical and scientific reliability. The various assessing tools proposed by the experts to measure the quality were appraised, which allowed the selection of the most methodologically scale adapted to this study. Conclusion: we show that the level of quality observed for pediatric trials is high, but was not influenced by the introduction of the European Regulation, which could, on the other hand, have led to an important increase in the number of pediatric trials. Regarding randomized controlled trials, a multivariate analysis allowed the identification of two statistically significant markers associated with high quality score of the protocol: the multicentric character of the research, and the drugs trials
Einaudi, De Siano Marie-Ange. "Comment les médecins perçoivent-ils la qualité de vie ? : Questionnement éthique en néonatologie". Thesis, Aix-Marseille, 2013. http://www.theses.fr/2013AIXM5101.
Extremely preterm children oucome is marked by the development of severe complications than can affect the quality of life of the children and their families. The coverage of these children brings decisional dilemma to physicians. While international data on preterm children quality of life are available, French preterm children quality of life remains unexplored. Quality of life is nevertheless a part of the ethical reflection of the professionals of perinatal period.Quality of life is a recent concept proposed as a criterion for evaluating care strategies but its use remains limited. Few published works have investigated the reasons for this limited use. In the field of prematurity, no data exploring these obstacles have been reported.Because of the lack of data on French preterm children quality of life and on the perception of physicians who manage preterm children, we decide to explore physicians’ perspective on the health related quality of life of extremely preterm children and the place of quality of life in ethical reflection in perinatal medicine.Our study consists in three parts: 1. A study describing health related quality of life of a cohort of French preterm children aged 6-10 years. 2. The study of physicians’ perception on health related quality of life assessment in preterm children. 3. The ethical approach of quality of life from the physicians’ perception
Nieto, Adrien. "La vie privée à l'épreuve de la relation de soin". Thesis, Montpellier, 2017. http://www.theses.fr/2017MONTD024/document.
The existence of legal mechanisms for the protection of privacy under common law is irrefutable. Those that the patient can claim during the care relationship remain unclear. The specific nature of this relationship, and the physical and moral impairments to privacy that are consumed in it - look, touch, nudity and the exchange of private information - justify a special framework and specific protections, existing but repensable, for accompany the stakes posed by the evolution and the modification of the care relationship. The emergence of new actors in health, with their own aspirations, undoubtedly modifies the objective and consequences of this relationship. Health data, an underestimated component of privacy, in that it n° longer passes only from the patient to the healthcare professional - and vice versa - must be framed, both the economic and political stakes associated with it . The "value" of privacy must be refocused, at a time when consumption, instantaneous exchange of information and “publicy” seem to have taken precedence over it
Fabre, Virginie. "Réponse démographique des Néandertaliens face aux pressions environnementales du stade isotopique 3 : approche par modélisation écologique". Thesis, Aix-Marseille 2, 2011. http://www.theses.fr/2011AIX20711/document.
The Neanderthal population lived and thrived in Europe during about 300ky in Middle Pleistocene. The causes of their disappearance about 30ky ago are strongly debated. Among the current hypotheses developed to explain this demographical crisis, competition with Modern humans, climate changes, epidemic diseases or demographical changes have often been evoked. The aim of this thesis was to re-analyse these assumptions and their determinants by using mathematical modelling. Models are used here to synthesize the data obtained by classical paleoanthropological studies and try to understand the complex and unknown phenomenon relative to the dramatic demographic fluctuation observed in Neanderthal populations during OIS3. Classical mathematical models are firstly used to analyse the influence of both demographical parameters and environmental stresses on the Neanderthal population. Next, we created new deterministic models more specified to the Neanderthal population. After checking the relevance of these models, we used them to analyse the demographical crisis of OIS3 and the information given by modelling have been checked with the information supplied by classical paleoanthropological, zooarchaeological and prehistorical studies. Our results allowed us to exclude the assumption of an epidemic disease or a climate change or even a resource competition as a cause of Neanderthal extinction whereas competition in a broad sense and above all demographic change could have led, under specific conditions, to Neanderthal demise. A demographic modification in the Neanderthal population across the time, in terms of fecundity or maturation speed, could be the reason of Neanderthals disappearance