The impacts of blended learning design in first year medical studies.

International audienceIn the first year of medical studies in France, students prepare for a highly selective entrance exam limited by numerus clausus into the second year. We have discontinued live lectures, made maximum use of new information and communication technologies and introduced tutorials in an attempt to make the first year more equitable and to personalise teaching. The reform is based on blended learning with flipped classroom organized into a four-week cycles of different activities. Each cycle corresponds to a learning module. The teachers' and students' opinions were analysed to evaluate the reforms and allow teaching methods to be adapted accordingly. The student profiles at registration and success in the exams following the reform are described. The tutorial's notes are correlated to the final scores at the entrance exam. The keys to success seem to be modified by the reform providing greater equality of opportunity between students. The factors associated to success are baccalaureate highest grades, high School Specialisation (maths, physics or earth and life sciences) and repeating the first year class. The use of blended learning allows us to face the increase of student enrolment, and to facilitate the acceptance of these pedagogical methods for both students and teachers

Prescribing nonopioids in mechanically ventilated critically ill patients

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Diagnosis Accuracy of Transcutaneous Bilirubinometry in Very Preterm Newborns

International audienceTranscutaneous bilirubin (TcB) is a validated test for systematic screening of neonatal hyperbilirubinemia and monitoring term and near-term infants under phototherapy

Thermokinetic and Spectroscopic Mapping of Carbon Monoxide Adsorption on Highly Dispersed Pt/γ-Al 2 O 3

International audienceThe understanding and quantification of the CO adsorption modes and strength on ultradispersed platinum catalysts supported on γ-Al2O3 is of prominent importance for analytic and catalytic purposes. We report a multiscale experimental (AEIR, CO-TPD) and theoretical approach to provide vibrational properties, adsorption enthalpies, and desorption behaviors. First principles calculations on Pt13(CO)m/γ-Al2O3 and Pt(111) surface models (using various exchange-correlation functionals) provide a complementary view to experimental approches. Adsorption enthalpies computed with the RPBE functional appear to be the most compatible with the AEIR results. The occupation of top sites by CO dominates the behavior of supported Pt clusters. CO coverage reaches higher values in comparison to Pt(111) for similar operating conditions, and considerable cluster reconstruction is observed at high coverage. First principles calculations also confirm the IR assignment related to the various adsorption modes on top and bridge sites and demonstrate a particle size effect, lowering the frequency of linear adsorption at top sites with respect to extended Pt(111) surfaces. Finally, first principles-based microkinetic modeling of CO-TPD experiments shows that the adsorption strengths predicted on the small-size cluster by DFT are compatible with the experimental values. We discuss possible reasons for the experimental desorption pattern to be much broader than the computed pattern

Diagnosis Accuracy of Transcutaneous Bilirubinometry in Very Preterm Newborns

International audienceTranscutaneous bilirubin (TcB) is a validated test for systematic screening of neonatal hyperbilirubinemia and monitoring term and near-term infants under phototherapy

Fuliginochronology: a new way of studying fire events chronicles, examples of speleothem deposits as archives

International audienceThe micromorphological study of fireplaces becomes more and more common, but biases exist in the recording of fire events in hearth structures. In this presentation, we will introduce another method for studying fire as an artefact: the Fuliginochronology, from Latin fuliginosus, fuligo: soot, fuliginous, and from Greek khrônologia: chronology, which consists of studying the succession of soot deposits trapped in a matrix. Here we will only develop the cases of soot trapped in carbonate deposits and more specifically in speleothems. In the particular case of an archaeological site like a rock shelter or a cave, these fuliginous calcite deposits (i.e. stalagmite, parietal crust, flowstones) are a record of past human occupations, which can be enumerated (Vandevelde et al. 2017; 2018; Vandevelde et Dupuis 2017).This pioneer method is based on high-resolution observation of soot layers trapped in calcite deposits and of the speleothems themselves, coupled with complementary analyses (characterisation: SEM, Raman, FTIR, µLIBS). It will be presented through three different temporal context: first, the method will be defined on a long archaeological sequence of Palaeolithic context at Grotte Mandrin site (middle Rhône Valley, France); then it will be validated on modern cases (Han-sur-Lesse, Belgium; Arcy-sur-Cure, France; Villars, France; Postojna, Slovenia), and finally, the use of experimental approach at Grotte Mandrin site will help us to address a number of questions about formation of fuliginous speleothems and preservation of soot through the study of present day data. This last part will also allow us to try to overcome limitations of the method in some contexts

Fuliginochronology: a new way of studying fire events chronicles, examples of speleothem deposits as archives

International audienceThe micromorphological study of fireplaces becomes more and more common, but biases exist in the recording of fire events in hearth structures. In this presentation, we will introduce another method for studying fire as an artefact: the Fuliginochronology, from Latin fuliginosus, fuligo: soot, fuliginous, and from Greek khrônologia: chronology, which consists of studying the succession of soot deposits trapped in a matrix. Here we will only develop the cases of soot trapped in carbonate deposits and more specifically in speleothems. In the particular case of an archaeological site like a rock shelter or a cave, these fuliginous calcite deposits (i.e. stalagmite, parietal crust, flowstones) are a record of past human occupations, which can be enumerated (Vandevelde et al. 2017; 2018; Vandevelde et Dupuis 2017).This pioneer method is based on high-resolution observation of soot layers trapped in calcite deposits and of the speleothems themselves, coupled with complementary analyses (characterisation: SEM, Raman, FTIR, µLIBS). It will be presented through three different temporal context: first, the method will be defined on a long archaeological sequence of Palaeolithic context at Grotte Mandrin site (middle Rhône Valley, France); then it will be validated on modern cases (Han-sur-Lesse, Belgium; Arcy-sur-Cure, France; Villars, France; Postojna, Slovenia), and finally, the use of experimental approach at Grotte Mandrin site will help us to address a number of questions about formation of fuliginous speleothems and preservation of soot through the study of present day data. This last part will also allow us to try to overcome limitations of the method in some contexts

Duration of adrenal inhibition following a single dose of etomidate in critically ill patients.

International audienceOBJECTIVE: To determine the incidence and duration of adrenal inhibition induced by a single dose of etomidate in critically ill patients. DESIGN: Prospective, observational cohort study. SETTING: Three intensive care units in a university hospital. PATIENTS: Forty critically ill patients without sepsis who received a single dose of etomidate for facilitating endotracheal intubation. MEASUREMENTS AND MAIN RESULTS: Serial serum cortisol and 11beta-deoxycortisol samples were taken at baseline and 60 min after corticotropin stimulation test (250 microg 1-24 ACTH) at 12, 24, 48, and 72 h after etomidate administration. Etomidate-related adrenal inhibition was defined by the combination of a rise in cortisol less than 250 nmol/l (9 microg/dl) after ACTH stimulation and an excessive accumulation of serum 11beta-deoxycortisol concentrations at baseline. At 12 h after etomidate administration, 32/40 (80%) patients fulfilled the diagnosis criteria for etomidate-related adrenal insufficiency. This incidence was significantly lower at 48 h (9%) and 72 h (7%). The cortisol to 11beta-deoxycortisol ratio (F/S ratio), reflecting the intensity of the 11beta-hydroxylase enzyme blockade, improved significantly over time. CONCLUSIONS: A single bolus infusion of etomidate resulted in wide adrenal inhibition in critically ill patients. However, this alteration was reversible by 48 h following the drug administration. The empirical use of steroid supplementation for 48 h following a single dose of etomidate in ICU patients without septic shock should thus be considered. Concomitant serum cortisol and 11beta-deoxycortisol dosages are needed to provide evidence for adrenal insufficiency induced by etomidate in critically ill patients

Electronic Medication Regimen Complexity Index at admission and complications during hospitalization in medical wards: a tool to improve quality of care?

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Do patients still require admission to an intensive care unit after elective craniotomy for brain surgery?

International audienceBACKGROUND: After elective craniotomy for brain surgery, patients are usually admitted to an intensive care unit (ICU). We sought to identify predictors of postoperative complications to define perioperative conditions that would safely allow ICU bypass. METHODS: This observational cohort study enrolled 358 patients admitted to neuro-ICU after elective intracranial procedures. Postoperative complications were defined as unexpected events occurring within 24 hours of surgery that required imaging or treatment for neurologic deterioration. RESULTS: Fifty-two patients were transferred postoperatively to neuro-ICU with sedation and mechanical ventilation. Of the remaining 306 patients subjected to an attempt to awake and extubate in the operating room, 26 (8%) developed 1 postoperative complication, primarily a new motor deficit, unexpected awakening delay, or subsequent deterioration in consciousness. Four intracerebral hematomas required surgical evacuation and each of these was detected within 2 hours after surgery. Predictors of postoperative complications included failure to extubate the trachea in operating room [odds ratio 61.8; 95% confidence interval (CI) 12.2-312.5], and, to a lesser extent, a duration of surgery of more than 4 hours (odds ratio 3.3; 95% CI 1.4-7.8), and lateral positioning of the patient during the procedure (odds ratio 2.8, 95% CI 1.2-6.4). CONCLUSIONS: Our results encourage prospectively testing the hypothesis that patients with immediate, successful tracheal extubation after elective craniotomy for brain surgery, with a surgical duration of less than 4 hours in a nonlateral position could be monitored safely in the postanesthesia care unit before being discharged to a neurosurgical ward