Tribbles expression in cumulus cells is related to oocyte maturation and fatty acid metabolism.

International audienceIn mammals, the Tribbles family includes widely expressed serine-threonine kinase-like proteins (TRIB1, TRIB2 and TRIB3) that are involved in multiple biological processes including cell proliferation and fatty acid (FA) metabolism. Our recent studies highlighted the importance of FA metabolism in cumulus cells (CC) during oocyte maturation in vertebrates and reported a higher TRIB1 expression in CC surrounding in vivo mature oocytes as compared to immature ooocytes in mice and cows. The objective was to investigate Tribbles expression patterns in bovine CC during in vitro maturation (IVM) and to examine their roles in the cumulus-oocyte complex

Career changers and fast-track induction: teacher perspectives on their early professional development

In this article, the early professional development of mature, early career teachers who entered the profession via an employment-based route to teaching in England is presented and explored from the teachers’ own perspectives. From a larger sample in a longitudinal study, the development of four career changers is traced in detail, using a model of professional learning which highlights teaching and professional skills. There is some evidence that those who undertake the programme experience a smoother induction into teaching than those from more traditional routes, although the internship year itself is challenging and demands a high level of commitment and resilience on the part of the pre-service teachers. Contextual factors, such as school support and learning from experienced teachers, are vital in enabling early professional development and the absence of these can hinder learning and self-confidence. Findings are analysed with reference to the model, as well as research on teachers’ development, within a socio-cultural learning framework. The study makes a valuable contribution to knowledge about the professional development of mature entrants to teaching

Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2)

BACKGROUND: Whether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early first-line parenteral nutrition. METHODS: In this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned (1:1) to either parenteral nutrition or enteral nutrition, both targeting normocaloric goals (20-25 kcal/kg per day), within 24 h after intubation. Randomisation was stratified by centre using permutation blocks of variable sizes. Given that route of nutrition cannot be masked, blinding of the physicians and nurses was not feasible. Patients receiving parenteral nutrition could be switched to enteral nutrition after at least 72 h in the event of shock resolution (no vasopressor support for 24 consecutive hours and arterial lactate <2 mmol/L). The primary endpoint was mortality on day 28 after randomisation in the intention-to-treat-population. This study is registered with ClinicalTrials.gov, number NCT01802099. FINDINGS: After the second interim analysis, the independent Data Safety and Monitoring Board deemed that completing patient enrolment was unlikely to significantly change the results of the trial and recommended stopping patient recruitment. Between March 22, 2013, and June 30, 2015, 2410 patients were enrolled and randomly assigned; 1202 to the enteral group and 1208 to the parenteral group. By day 28, 443 (37%) of 1202 patients in the enteral group and 422 (35%) of 1208 patients in the parenteral group had died (absolute difference estimate 2·0%; [95% CI -1·9 to 5·8]; p=0·33). Cumulative incidence of patients with ICU-acquired infections did not differ between the enteral group (173 [14%]) and the parenteral group (194 [16%]; hazard ratio [HR] 0·89 [95% CI 0·72-1·09]; p=0·25). Compared with the parenteral group, the enteral group had higher cumulative incidences of patients with vomiting (406 [34%] vs 246 [20%]; HR 1·89 [1·62-2·20]; p<0·0001), diarrhoea (432 [36%] vs 393 [33%]; 1·20 [1·05-1·37]; p=0·009), bowel ischaemia (19 [2%] vs five [<1%]; 3·84 [1·43-10·3]; p=0·007), and acute colonic pseudo-obstruction (11 [1%] vs three [<1%]; 3·7 [1·03-13·2; p=0·04). INTERPRETATION: In critically ill adults with shock, early isocaloric enteral nutrition did not reduce mortality or the risk of secondary infections but was associated with a greater risk of digestive complications compared with early isocaloric parenteral nutrition. FUNDING: La Roche-sur-Yon Departmental Hospital and French Ministry of Health

Impact of early enteral versus parenteral nutrition on mortality in patients requiring mechanical ventilation and catecholamines: study protocol for a randomized controlled trial (NUTRIREA-2)

BACKGROUND: Nutritional support is crucial to the management of patients receiving invasive mechanical ventilation (IMV) and the most commonly prescribed treatment in intensive care units (ICUs). International guidelines consistently indicate that enteral nutrition (EN) should be preferred over parenteral nutrition (PN) whenever possible and started as early as possible. However, no adequately designed study has evaluated whether a specific nutritional modality is associated with decreased mortality. The primary goal of this trial is to assess the hypothesis that early first-line EN, as compared to early first-line PN, decreases day 28 all-cause mortality in patients receiving IMV and vasoactive drugs for shock. METHODS/DESIGN: The NUTRIREA-2 study is a multicenter, open-label, parallel-group, randomized controlled trial comparing early PN versus early EN in critically ill patients requiring IMV for an expected duration of at least 48 hours, combined with vasoactive drugs, for shock. Patients will be allocated at random to first-line PN for at least 72 hours or to first-line EN. In both groups, nutritional support will be started within 24 hours after IMV initiation. Calorie targets will be 20 to 25 kcal/kg/day during the first week, then 25 to 30 kcal/kg/day thereafter. Patients receiving PN may be switched to EN after at least 72 hours in the event of shock resolution (no vasoactive drugs for 24 consecutive hours and arterial lactic acid level below 2 mmol/L). On day 7, all patients receiving PN and having no contraindications to EN will be switched to EN. In both groups, supplemental PN may be added to EN after day 7 in patients with persistent intolerance to EN and inadequate calorie intake. We plan to recruit 2,854 patients at 44 participating ICUs. DISCUSSION: The NUTRIREA-2 study is the first large randomized controlled trial designed to assess the hypothesis that early EN improves survival compared to early PN in ICU patients. Enrollment started on 22 March 2013 and is expected to end in November 2015. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01802099 (registered 27 February 2013)

Constitutive relation error for FFT-based methods

International audienceSince their introduction by Moulinec and Suquet (1994, 1998), FFT-based methods have become popular alternatives to finite element methods (FEM) for the numerical homogenization of heterogeneous materials. They have been successfully applied to a variety of constitutive laws. Even geometric non-linearities can now be accounted for (Kabel et al., 2014). Theoretical analysis of this numerical technique has also greatly improved. Convergence of the iterative solvers is now well understood (Michel et al., 2001; Brisard & Dormieux, 2010; Zeman et al., 2010; Monchiet & Bonnet, 2012; Moulinec & Silva, 2014), as well as convergence with respect to the grid-size (Brisard & Dormieux, 2012; Schneider 2014). Alternative discretizations aiming at improving the quality of the solution (at fixed grid-size) have also been proposed (Brisard & Dormieux, 2012; Willot et al., 2014; Vondřec et al., 2015; Willot, 2015). However, this quality improvement is usually assessed in a qualitative way. Some progress has recently been made by Vondřec et al. (2015) towards quantitative analysis of the quality of the solution, but their approach is restricted to discretizations by trigonometric polynomials. In this talk, we present a strategy for the aposteriori error analysis of the numerical solution to the Lippmann–Schwinger equation. We use the framework of the error in constitutive relation, initially introduced by Ladevèze and Leguillon (1983) for the FEM. This requires to produce a kinematically admissible displacement field and a statically admissible stress field. We will show that a kinematically admissible displacement field can be efficiently reconstructed. Our approximation does not use trigonometric polynomials; rather it is local (Q1) in space (thus free of spurious Gibbs-like oscillations). Besides, the reconstructed displacement field has some properties that allow us to reuse standard techniques from the FEM world to produce a statically admissible stress field. A posteriori error estimates are then readily computed. Our strategy applies to any discretization/solver, which allows a quantitative comparison of the various FFT-based strategies proposed in the literature. This will be illustrated on a few examples, both in two and three dimensions