Using an Audience Response System Smartphone App to Improve Resident Education in the Pediatric Intensive Care Unit.

In the Pediatric Intensive Care Unit (PICU), most teaching occurs during bedside rounds, but technology now provides new opportunities to enhance education. Specifically, smartphone apps allow rapid communication between instructor and student. We hypothesized that using an audience response system (ARS) app can identify resident knowledge gaps, guide teaching, and enhance education in the PICU. Third-year pediatric residents rotating through the PICU participated in ARS-based education or received traditional teaching. Before rounds, experimental subjects completed an ARS quiz using the Socrative app. Concomitantly, the fellow leading rounds predicted quiz performance. Then, discussion points based on the incorrect answers were used to guide instruction. Scores on the pre-rotation test were similar between groups. On the post-rotation examination, ARS participants did not increase their scores more than controls. The fellow's prediction of performance was poor. Residents felt that the method enhanced their education whereas fellows reported that it improved their teaching efficiency. Although there was no measurable increase in knowledge using the ARS app, it may still be a useful tool to rapidly assess learners and help instructors provide learner-centered education

Tailoring strain in SrTiO3 compound by low energy He+ irradiation

The ability to generate a change of the lattice parameter in a near-surface layer of a controllable thickness by ion implantation of strontium titanate is reported here using low energy He+ ions. The induced strain follows a distribution within a typical near-surface layer of 200 nm as obtained from structural analysis. Due to clamping effect from the underlying layer, only perpendicular expansion is observed. Maximum distortions up to 5-7% are obtained with no evidence of amorphisation at fluences of 1E16 He+ ions/cm2 and ion energies in the range 10-30 keV.Comment: 11 pages, 4 figures, Accepted for publication in Europhysics Letter (http://iopscience.iop.org/0295-5075

Prediction of Red Clover Content in Mixed Swards by Near-Infrared Reflectance Spectroscopy

Because of the legume fixation capacity, their high protein content, digestibility and intake characteristics, more and more attention is paid to grassland clover content. In field experiments, clover content must often be determined, for example to quantify nitrogen flux or the best practices to manage such species (Stilmant et al., 2004). However hand sorting of clover and grass, even if accurate, is time-consuming and has a high labour cost. In comparison, accuracy of visual estimation of clover content, directly in the field, varies according to training and experience. Near-infrared reflectance spectroscopy (NIRS) has been proposed as a method for the rapid determination of sward botanical (Petersen et al., 1987; Pitman et al., 1991) and morphological composition (Leconte et al., 1999; Stilmant et al., 2005). This paper describes the performance of a NIRS calibration developed to characterise red clover (Trifolium pratense) content when associated to different grass species and this at different phenological stages

Rivalry and uncertainty in complementary investments with dynamic market sharing

We study the effects of revenue and investment cost uncertainty, as well non- preemption duopoly competition, on the timing of investments in two complementary inputs, where either spillover-knowledge is allowed or proprietary-knowledge holds. We find that the ex-ante and ex-post revenue market shares play a very important role in firms’ behavior. When competition is considered, the leader’s behavior departs from that of the monopolist firm of Smith (Ind Corp Change 14:639–650, 2005). The leader is justified in following the conventional wisdom (i.e., synchronous investments are more likely), whereas, the follower’s behavior departs from that of the conventional wisdom (i.e., asynchronous investments are more likely)

Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)

Purpose Thrombocytopenia (platelet count < 150 × 109/L) is common in intensive care unit (ICU) patients and is likely associated with worse outcomes. In this study we present international contemporary data on thrombocytopenia in ICU patients. Methods We conducted a prospective cohort study in adult ICU patients in 52 ICUs across 10 countries. We assessed frequencies of thrombocytopenia, use of platelet transfusions and clinical outcomes including mortality. We evaluated pre-selected potential risk factors for the development of thrombocytopenia during ICU stay and associations between thrombocytopenia at ICU admission and 90-day mortality using pre-specified logistic regression analyses. Results We analysed 1166 ICU patients; the median age was 63 years and 39.5% were female. Overall, 43.2% (95% confidence interval (CI) 40.4–46.1) had thrombocytopenia; 23.4% (20–26) had thrombocytopenia at ICU admission, and 19.8% (17.6–22.2) developed thrombocytopenia during their ICU stay. Non-AIDS-, non-cancer-related immune deficiency, liver failure, male sex, septic shock, and bleeding at ICU admission were associated with the development of thrombocytopenia during ICU stay. Among patients with thrombocytopenia, 22.6% received platelet transfusion(s), and 64.3% of in-ICU transfusions were prophylactic. Patients with thrombocytopenia had higher occurrences of bleeding and death, fewer days alive without the use of life-support, and fewer days alive and out of hospital. Thrombocytopenia at ICU admission was associated with 90-day mortality (adjusted odds ratio 1.7; 95% CI 1.19–2.42). Conclusion Thrombocytopenia occurred in 43% of critically ill patients and was associated with worse outcomes including increased mortality. Platelet transfusions were given to 23% of patients with thrombocytopenia and most were prophylactic.publishedVersio

Journal de Traumatologie du Sport

L'anxiété de re-blessure est une forme spécifique d'anxiété ressentie par les athlètes blessés lors de la rééducation ou de la reprise de leur pratique sportive. Si plusieurs outils permettent l'évaluation de cette anxiété, aucun n'existe actuellement en langue française. L'objectif de cette étude était d'adapter et de valider le Re-Injury Anxiety Inventory (RIAI), en langue française, d'en évaluer les propriétés psychométriques et de préciser les relations entre l'anxiété de re-blessure et des facteurs démographiques, sportifs et psychologiques. Méthode. – Après la création de l'outil suivant les étapes de validation transculturelle, 310 athlètes (dont 159 femmes) ayant subi des blessures ont répondu au RIAI-F ainsi qu'à des questionnaires d'état d'anxiété (STAI-Y), d'évaluation cognitive primaire du stress et de coping (ISCCS). Résultats. – Les analyses factorielles exploratoires et confirmatoires mettent en évidence une structure de 13 items répartis en trois dimensions intitulées : peur de se re-blesser (a=0,77), anxiété de contre-performance (a=0,86) et manifestations anxieuses (a=0,74). Les comparaisons effectuées au sein de l'échantillon montrent un niveau d'anxiété de re-blessure plus élevé chez les femmes, ainsi que chez les sportifs dont l'intensité de la pratique est supérieure ou égale à huit heures par semaine. Les corrélations indiquent que l'anxiété de re-blessure se distingue de l'état d'anxiété générale et qu'elle est principalement liée aux perceptions de menace (r = 0,31) et à la stratégie de coping de type « résignation » (r = 0,33). Conclusion. – Les propriétés psychométriques de l'outil sont satisfaisantes et permettent une meilleure compréhension des sous-dimensions de l'anxiété de re-blessure.Re-injury anxiety is a specific form of anxiety experienced by injured athletes before the return to sports. There is currently no tool able to measure this form of anxiety in French language. The purpose of this article is to validate a French version of RIAI, and assess its psychometric properties and precise the relation between re-injury anxiety and several demographic, sporting and psychological factors, in particular gender, the intensity of sporting practice, the cognitive assessment of stress and coping. Methods. – RIAI followed a process of back-translation for a French version (RIAI-F). Then, 310 injured or recently injured athletes (159 female) then answered the RIAI-F, as well as the anxiety survey (STAI-Y), the primary cognitive assessment survey and the coping survey (ISCCS). Results. – The exploratory and confirmatory factor analyses highlight a 13-items structure spread into three dimensions titled fear of re-injury (a=0.77), performance anxiety (a=0.86), and signs of anxiety (a=0.74). The comparisons made show a higher re-injury anxiety level among women, as well as athletes whose intensity of practice is exceeding or equal to eight hours per week. Correlations indicate that re-injury anxiety is positively linked to perceived threat (r = 0,31) and negatively linked to perceived challenge (r = -0,14). Coping strategy most strongly correlated to re-injury anxiety is resignation (r = 0,33). Conclusion. – The results obtained indicate that the psychometric properties of the tool are satisfying and allow a better comprehension of the sub-dimensions of re-injury anxiety

Radiation-induced bcc-fcc phase transformation in a Fe-3%Ni alloy

International audienceThe issue of neutron irradiation embrittlement of Reactor Pressure Vessel steels must be considered for Nuclear Power Plant life extension. This phenomenon partly arises from the existing interactions between dislocations and nanometric clusters composed of Cu, P, Si, Mn and Ni. The latter alloying element, playing a key role in the evolution of solute enriched clusters under irradiation, is the focus of this publication. To assess the effect of Ni on microstructure evolution under irradiation, particle accelerator based experiments were conducted. An under-saturated Fe3at.%Ni alloy was irradiated with self-ions, at 673 K, up to ∼1.2 dpa. Then, the microstructural damage was characterized, at the atomic scale, by conventional Transmission Electron Microscopy, Scanning Transmission Electron Microscopy coupled to Energy Dispersive X-ray Spectroscopy and Electron Energy Loss Spectroscopy, while chemical features were investigated by Atom Probe Tomography. Informations obtained by combining these coupled techniques provide evidence for the formation of a FCC phase, containing 25 at.%Ni, which can be either the disordered γ phase or the ordered L12 type Fe3Ni phase. The metastable or stable state of this FCC phase is discussed in the light of what is known from the literature. It is the first time that this BCC-FCC phase transformation is observed in an under-saturated α-FeNi alloy and this likely occurred via a Radiation Induced Precipitation (RIP) mechanism. Ni atom segregation is observed on cavities, dislocation lines and dislocation loops. The latter constitute nuclei for precipitates, leading to the formation of an additional segregation site for Ni: the precipitate FCC - matrix BCC nearly coherent interface. Similar mechanisms are argued to be operating also in high Ni RPV steels under neutron irradiation