209 research outputs found
Repenser lâaccompagnement des enseignants novices pour accroitre leur satisfaction professionnelle
Lâaugmentation de la charge de travail des enseignants novices (EN) et les problĂšmes de santĂ© au travail quâelle engendre sont significatifs des difficultĂ©s de lâentrĂ©e dans le mĂ©tier des EN. Pour y rĂ©pondre, des amĂ©nagements de la formation sont proposĂ©s sans que pour autant leurs retombĂ©es soient rĂ©ellement Ă©valuĂ©es. Lâobjet de cette Ă©tude, menĂ©e Ă partir dâune thĂ©orie de lâaction collective (Wittgenstein, 1996), se situe Ă ce niveau. En prenant comme dispositif support un amĂ©nagement de formation, cette Ă©tude montre principalement que sa mise en Ćuvre nâa que peu dâimpact sur la santĂ© au travail des EN. Deux rĂ©sultats majeurs Ă©tayent cette conclusion. Tout dâabord, les formateurs procĂšdent rarement Ă un enseignement ostensif de nouvelles rĂšgles relatives Ă ce qui pourrait ĂȘtre rĂ©alisĂ© en classe ainsi quâaux rĂ©sultats qui pourraient en ĂȘtre attendus. Autrement dit, les EN ne sont pas placĂ©s en situation de « mieux faire » (Clot, 2010) leur travail et par-lĂ mĂȘme dâen ĂȘtre satisfaits. Sans ces rĂšgles, les EN ne peuvent en effet interprĂ©ter, juger et in fine sâadapter aux diverses expĂ©riences vĂ©cues en sâengageant dans des actions singuliĂšres et attendues au sein de la communautĂ© professionnelle. Dâautre part, les formateurs ne considĂšrent jamais la situation de classe comme une situation de formation potentielle. Non amĂ©nagĂ©e, cette derniĂšre place rĂ©guliĂšrement les EN en situation dâinsatisfaction professionnelle aboutissant Ă du stress au travail.The increased workload of preservice teachers (PTs) and the work-related health problems this has often caused point to the substantial difficulties in becoming a teacher. One response has been to reorganize the teacher education program, although the consequences have not yet been closely evaluated. We do so in this study, from the perspective of collective action theory (Wittgenstein, 1996). In this examination of the recent modifications in teacher education programs, we conclude that the modifications have had little impact on PT workplace health, which is supported by the two major results. First, we found that teacher educators rarely provide ostensive teaching of new rules about what can be done in the classroom and what might then be expected. In other words, PTs are not placed in a situation of âdoing [their work] betterâ (Clot, 2010) and subsequently feeling greater job satisfaction. Yet without these rules, PTs cannot effectively interpret, judge and make fine adjustments to their many lived classroom experiences by undertaking the highly individualized actions expected by the teaching community. Second, teacher educators never consider the classroom situation as having the potential to train PTs. Because this aspect of teacher education remains undeveloped, PTs often feel job dissatisfaction, which eventually is expressed as workplace stress
Le travail des chefs dâĂ©tablissement avec les parents dâĂ©lĂšves : des activitĂ©s complexes Ă lâinterface entre leur hiĂ©rarchie et les enseignants
Si la formation des chefs dâĂ©tablissement en France est fortement balisĂ©e, rĂ©fĂ©rencĂ©e et dĂ©finie par un corpus de savoirs thĂ©oriques et pratiques, leurs activitĂ©s professionnelles quotidiennes nây sont pas spĂ©cifiquement abordĂ©es. Lâobjet de lâĂ©tude est donc de recenser, formaliser et analyser certaines de ces activitĂ©s, en particulier celles rĂ©alisĂ©es auprĂšs des parents dâĂ©lĂšves qui sont peu examinĂ©es dans la littĂ©rature. Inscrite dans un programme de recherche sur la formation professionnelle, lâĂ©tude a consistĂ© Ă analyser les rencontres entre deux chefs dâĂ©tablissement et des parents dâĂ©lĂšves. Chaque rencontre a Ă©tĂ© enregistrĂ©e et des entretiens dâautoconfrontation ont Ă©tĂ© menĂ©s avec un principal et une principale de collĂšge. Les rĂ©sultats montrent la complexitĂ© de leur travail dâune part, en raison de la diversitĂ© des activitĂ©s quâils mĂšnent avec les parents dâĂ©lĂšves (les convaincre, leur donner des exemples, leur donner des explications, leur affirmer lâidentitĂ© du collĂšge, rĂ©pondre Ă leurs questions et les associer) et, dâautre part, du fait que ces activitĂ©s sont mĂȘlĂ©es Ă dâautres activitĂ©s quâils conduisent avec les enseignants et/ou leur hiĂ©rarchie. La complexitĂ© de ces activitĂ©s des chefs dâĂ©tablissement Ă lâinterface entre leur hiĂ©rarchie et les enseignants est amplifiĂ©e par le contexte spĂ©cifique dâune rĂ©forme importante des enseignements. Sur la base dâune discussion de ces rĂ©sultats, des pistes en matiĂšre de recherches complĂ©mentaires Ă mener et dâamĂ©nagement des dispositifs de formation des chefs dâĂ©tablissement sont finalement proposĂ©es.Although the training of principals in France is strongly established, referenced and defined by a body of theoretical and practical knowledge, their daily professional activities are not specifically addressed. The purpose of this study is therefore to identify, formalize, and analyze some of these activities, particularly those involving contact with studentsâ parents, as they are underrepresented in current scholarship. As part of a research program dedicated to professional training, this study consists of analyzing the meetings between two principals and parents of students. Each meeting was recorded, and self-analysis interviews were carried out with these high school principals. The results demonstrate the complexity of their work: on the one hand, the intricacy is due to the diversity of the activities they undertake with studentsâ parents (convincing them, giving them examples, offering explanations, reaffirming their idea of the high schoolâs identity, responding to their questions, and bringing them together), and then on the other hand, it is because these activities are combined with others that they carry out with teachers and/or their supervisors. The complexity of the principalsâ activities as they work to interface between their supervisors and teachers is amplified by the specific context of a major teaching reform. Based on a discussion of these results, leads for future research and potential training tools for principals will be suggested
Effect of calcium aluminate cement variety on the hydration of portland cement in blended system
Pathogenesis, diagnosis and management of pneumorrhachis
Pneumorrhachis (PR), the presence of intraspinal air, is an exceptional but eminent radiographic finding, accompanied by different aetiologies and possible pathways of air entry into the spinal canal. By reviewing the literature and analysing a personal case of traumatic cervical PR after head injury, we present current data regarding the pathoanatomy, clinical and radiological presentation, diagnosis and differential diagnosis and treatment modalities of patients with PR and associated pathologies to highlight this uncommon phenomenon and outline aetiology-based guidelines for the practical management of PR. Air within the spinal canal can be divided into primary and secondary PR, descriptively classified into extra- or intradural PR and aetiologically subsumed into iatrogenic, traumatic and nontraumatic PR. Intraspinal air is usually found isolated not only in the cervical, thoracic and, less frequently, the lumbosacral regions but can also be located in the entire spinal canal. PR is almost exceptional associated with further air distributions in the body. The pathogenesis and aetiologies of PR are multifold and can be a diagnostic challenge. The diagnostic procedure should include spinal CT, the imaging tool of choice. PR has to be differentiated from free intraspinal gas collections and the coexistence of air and gas within the spinal canal has to be considered differential diagnostically. PR usually represents an asymptomatic epiphenomenon but can also be symptomatic by itself as well as by its underlying pathology. The latter, although often severe, might be concealed and has to be examined carefully to enable adequate patient treatment. The management of PR has to be individualized and frequently requires a multidisciplinary regime
The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology
Background & Aims: Acute decompensation (AD) of cirrhosis is defined as the acute development of ascites, gastrointestinal hemorrhage, hepatic encephalopathy, infection or any combination thereof, requiring hospitalization. The presence of organ failure(s) in patients with AD defines acute-on-chronic liver failure (ACLF). The PREDICT study is a European, prospective, observational study, designed to characterize the clinical course of AD and to identify predictors of ACLF. Methods: A total of 1,071 patients with AD were enrolled. We collected detailed pre-specified information on the 3-month period prior to enrollment, and clinical and laboratory data at enrollment. Patients were then closely followed up for 3 months. Outcomes (liver transplantation and death) at 1 year were also recorded. Results: Three groups of patients were identified. Pre-ACLF patients (n = 218) developed ACLF and had 3-month and 1-year mortality rates of 53.7% and 67.4%, respectively. Unstable decompensated cirrhosis (UDC) patients (n = 233) required â„1 readmission but did not develop ACLF and had mortality rates of 21.0% and 35.6%, respectively. Stable decompensated cirrhosis (SDC) patients (n = 620) were not readmitted, did not develop ACLF and had a 1-year mortality rate of only 9.5%. The 3 groups differed significantly regarding the grade and course of systemic inflammation (high-grade at enrollment with aggravation during follow-up in pre-ACLF; low-grade at enrollment with subsequent steady-course in UDC; and low-grade at enrollment with subsequent improvement in SDC) and the prevalence of surrogates of severe portal hypertension throughout the study (high in UDC vs. low in pre-ACLF and SDC). Conclusions: Acute decompensation without ACLF is a heterogeneous condition with 3 different clinical courses and 2 major pathophysiological mechanisms: systemic inflammation and portal hypertension. Predicting the development of ACLF remains a major future challenge. ClinicalTrials.gov number: NCT03056612. Lay summary: Herein, we describe, for the first time, 3 different clinical courses of acute decompensation (AD) of cirrhosis after hospital admission. The first clinical course includes patients who develop acute-on-chronic liver failure (ACLF) and have a high short-term risk of death â termed pre-ACLF. The second clinical course (unstable decompensated cirrhosis) includes patients requiring frequent hospitalizations unrelated to ACLF and is associated with a lower mortality risk than pre-ACLF. Finally, the third clinical course (stable decompensated cirrhosis), includes two-thirds of all patients admitted to hospital with AD â patients in this group rarely require hospital admission and have a much lower 1-year mortality risk
The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology
Acute decompensation (AD) of cirrhosis is defined as the acute development of ascites, gastrointestinal hemorrhage, hepatic encephalopathy, infection or any combination thereof, requiring hospitalization. The presence of organ failure(s) in patients with AD defines acute-on-chronic liver failure (ACLF). The PREDICT study is a European, prospective, observational study, designed to characterize the clinical course of AD and to identify predictors of ACLF. A total of 1,071 patients with AD were enrolled. We collected detailed pre-specified information on the 3-month period prior to enrollment, and clinical and laboratory data at enrollment. Patients were then closely followed up for 3 months. Outcomes (liver transplantation and death) at 1 year were also recorded. Three groups of patients were identified. Pre-ACLF patients (n = 218) developed ACLF and had 3-month and 1-year mortality rates of 53.7% and 67.4%, respectively. Unstable decompensated cirrhosis (UDC) patients (n = 233) required â„1 readmission but did not develop ACLF and had mortality rates of 21.0% and 35.6%, respectively. Stable decompensated cirrhosis (SDC) patients (n = 620) were not readmitted, did not develop ACLF and had a 1-year mortality rate of only 9.5%. The 3 groups differed significantly regarding the grade and course of systemic inflammation (high-grade at enrollment with aggravation during follow-up in pre-ACLF; low-grade at enrollment with subsequent steady-course in UDC; and low-grade at enrollment with subsequent improvement in SDC) and the prevalence of surrogates of severe portal hypertension throughout the study (high in UDC vs. low in pre-ACLF and SDC). Acute decompensation without ACLF is a heterogeneous condition with 3 different clinical courses and 2 major pathophysiological mechanisms: systemic inflammation and portal hypertension. Predicting the development of ACLF remains a major future challenge. ClinicalTrials.gov number: NCT03056612. Lay summary: Herein, we describe, for the first time, 3 different clinical courses of acute decompensation (AD) of cirrhosis after hospital admission. The first clinical course includes patients who develop acute-on-chronic liver failure (ACLF) and have a high short-term risk of death - termed pre-ACLF. The second clinical course (unstable decompensated cirrhosis) includes patients requiring frequent hospitalizations unrelated to ACLF and is associated with a lower mortality risk than pre-ACLF. Finally, the third clinical course (stable decompensated cirrhosis), includes two-thirds of all patients admitted to hospital with AD - patients in this group rarely require hospital admission and have a much lower 1-year mortality risk
PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis
Background & Aims: Acute decompensation (AD) of cirrhosis may present without acute-on-chronic liver failure (ACLF) (ADNo ACLF), or with ACLF (AD-ACLF), defined by organ failure(s). Herein, we aimed to analyze and characterize the precipitants leading to both of these AD phenotypes. Methods: The multicenter, prospective, observational PREDICT study (NCT03056612) included 1,273 non-electively hospitalized patients with AD (No ACLF = 1,071; ACLF = 202). Medical history, clinical data and laboratory data were collected at enrolment and during 90-day follow-up, with particular attention given to the following characteristics of precipitants: induction of organ dysfunction or failure, systemic inflammation, chronology, intensity, and relationship to outcome. Results: Among various clinical events, 4 distinct events were precipitants consistently related to AD: proven bacterial infections, severe alcoholic hepatitis, gastrointestinal bleeding with shock and toxic encephalopathy. Among patients with precipitants in the AD-No ACLF cohort and the AD-ACLF cohort (38% and 71%, respectively), almost all (96% and 97%, respectively) showed proven bacterial infection and severe alcoholic hepatitis, either alone or in combination with other events. Survival was similar in patients with proven bacterial infections or severe alcoholic hepatitis in both AD phenotypes. The number of precipitants was associated with significantly increased 90day mortality and was paralleled by increasing levels of surrogates for systemic inflammation. Importantly, adequate first-line antibiotic treatment of proven bacterial infections was associated with a lower ACLF development rate and lower 90-day mortality. Conclusions: This study identified precipitants that are significantly associated with a distinct clinical course and prognosis in patients with AD. Specific preventive and therapeutic strategies targeting these events may improve outcomes in patients with decompensated cirrhosis. Lay summary: Acute decompensation (AD) of cirrhosis is characterized by a rapid deterioration in patient health. Herein, we aimed to analyze the precipitating events that cause AD in patients with cirrhosis. Proven bacterial infections and severe alcoholic hepatitis, either alone or in combination, accounted for almost all (96-97%) cases of AD and acute-on-chronic liver failure. Whilst the type of precipitant was not associated with mortality, the number of precipitant(s) was. This study identified precipitants that are significantly associated with a distinct clinical course and prognosis of patients with AD. Specific preventive and therapeutic strategies targeting these events may improve patient outcomes. (c) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Prise en charge des voies aĂ©riennes â 1re partie â Recommandations lorsque des difficultĂ©s sont constatĂ©es chez le patient inconscient/anesthĂ©siĂ©
Circumstances in teacher education that allow preservice teachers to experience job satisfaction in the classroom : case study in physical education and sport
Alors que de nombreuses directives institutionnelles invitent Ă considĂ©rer la formation des enseignants novices (EN) comme un moyen dâaccroitre leur satisfaction professionnelle et in fine leur santĂ©, peu de travaux scientifiques ont rĂ©ellement Ă©tudiĂ© le caractĂšre effectif de ce type de considĂ©ration. Cette Ă©tude a donc pour objet premier dâanalyser, dans le cadre de situations de formation de type tutorat mixte impliquant tuteurs de terrain et formateurs universitaires, les circonstances de formation permettant dâaboutir Ă la satisfaction professionnelles des enseignants novices en situation de travail en classe. Cette Ă©tude sâinscrit dans un programme de recherche sur la formation professionnelle dont les soubassements Ă©pistĂ©mologiques sont issus dâune anthropologie culturaliste principalement inspirĂ©e de la philosophie analytique de Wittgenstein (2004). Elle a Ă©tĂ© menĂ©e dans le cadre dâun dispositif innovant de formation en alternance articulant de façon itĂ©rative des sĂ©quences de formation menĂ©es sous la forme dâentretiens de conseil pĂ©dagogique et des sĂ©quences de travail en classe. Les rĂ©sultats de cette Ă©tude permettent de situer trois principales circonstances de formation ayant permis dâaboutir Ă lâapprentissage de rĂšgles par les EN, voire Ă leur dĂ©veloppement professionnel et, par-lĂ mĂȘme, Ă leur satisfaction : (i) lâintĂ©rĂȘt pour les formateurs de « dĂ©-satisfaire » les EN avant de sâengager dans une activitĂ© dâenseignement de nouvelles rĂšgles, (ii) la nĂ©cessitĂ© pour les EN dâavoir une « exemplarisation » des rĂšgles enseignĂ©es qui sâancre dans leurs circonstances dâenseignement et, (iii) la nĂ©cessitĂ© pour les formateurs dâengager un vĂ©ritable travail dâaccompagnement des EN lors de leurs premiers suivis des rĂšgles prĂ©alablement enseignĂ©es. Sur la base dâune discussion de ces rĂ©sultats des pistes, en matiĂšre de recherches complĂ©mentaires Ă mener et de dispositifs innovants Ă mettre en Ćuvre, sont finalement proposĂ©es.Many institutional guidelines point out that teacher education programs can be a means to enhance the job satisfaction, and thereby the health, of preservice teachers (PTs). However, few studies have actually examined this proposition. This study therefore sought to determine the training circumstances that contribute to PTsâ satisfaction with their classroom work in the context of teacher education with teams composed of cooperating teachers and university supervisors. This study is part of a research program based on epistemological principles derived from cultural anthropology, which has been much inspired by the analytical philosophy of Wittgenstein (2004). The study was conducted within the framework of an innovative teacher education program that alternates sequences of PTsâ classroom work with sequences of supervisory meetings. The results indicate three main training circumstances that facilitated the PTsâ learning of the work rules, which in turn contributed to their professional development and thereby to their satisfaction: (i) the teacher educator team needs to âde-satisfyâ the PTs before engaging in the activity of teaching new work rules, (ii) the PTs need an âexemplificationâ of the new work rules that is rooted in their actual teaching circumstances, and (iii) the teacher education team needs to engage in a veritable work of supporting the PTs as they begin to follow the work rules that they have learned. The discussion of the results focuses on proposals for new directions in complementary research and innovative training methods
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