Fidélité, équité et impact des mini entretiens multiples dans le processus de sélection des étudiants en santé en France

Context: The University of Angers (UA) created the PluriPASS cursus that replaced the PACES (première année commune aux études de santé/First year of common health studies) and introduced multiple mini-interviews (MMIs) in the selection process of students in France. This study is designed to evaluate MMI reliability, fairness and impact. Topics/materials/methods: Some 294 students attended the MMIs in June 2016. The MMIs were made up of four stations evaluating six competences. The following criteria (age, gender, novice/repeater, scholarship, parents’ socio-professional category, bachelor’s degree with honors, time of the evaluation and scenario) were examined using both univariate and multivariate analysis. The impact of the MMIs was evaluated following the limited-ranges method. Outcome: Cronbach’s alpha coefficients for the 6 evaluated competences ranged from 0.612 to 0.935. Males ranked better overall with MMIs (+ 27.4 pts; CI95% = [9,2; 45,7]). Students who were got their bachelor’s degree with high honors (“Très Bien” distinction, higher than 16/20) also had a better overall score (+ 30.41 pts ; CI95% = [14.75; 46.12]). There were no differences with respect to the other socio-demographic variables, and none regarding the different scenarios considered. Following the MMI follow-ups, 53 different students were excluded from the ranking in a study path. Conclusion: As part of the PluriPASS testing, MMIs were found to be coherent as well as educationally and selectively interesting. However, they require particular consideration to ensure fairness, both during implementation and in future research studies

Comparison of open and closed book test for admission in medical school

Introduction La maladie thromboembolique veineuse (MTEV) acquise à l’hôpital représente une part importante de morbi-mortalité évitable chez les patients hospitalisés en secteur médical. D’un autre côté, la thromboprophylaxie anticoagulante expose les patients à un risque hémorragique et majore les dépenses de santé. L’identification des patients hospitalisés à risque de MTEV est en cela cruciale. L’objectif de cette étude est d’évaluer de manière externe, les performances de 3 modèles de risque (score de Padua, Carpini et Improve) et de les comparer aux performances de l’âge pris isolément. Patients et méthodes Il s’agit d’une étude rétrospective sur une base de patients inclus prospectivement dans une étude randomisée en cluster sans intervention directe sur le patient. Les patients de plus de 40 ans, hospitalisé depuis les urgences en secteur médical plus de 48 h ont consécutivement été inclus et suivi à 3 mois. Les patients chez qui un diagnostic de MTEV avait été porté dans les 48 premières heures d’hospitalisation, ou ayant reçu un traitement anticoagulant pour une raison autre que la MTEV, ou encore ayant subi une chirurgie sous anesthésie générale ont été exclus. Les modèles de risques ont été calculés à posteriori. La réduction de mobilité a été déduite de la durée d’hospitalisation moins un jour. Le critère de jugement principal était la survenue d’un épisode thrombotique veineux symptomatique ou le décès brutal inexpliqué adjudiqué à 3 mois. Résultats Parmi les 14 910 patient éligibles, 14 659 (98,3) étaient évaluables. 263 (1,8 %) ont présenté une MTEV symptomatique ou un décès brutal inexpliqué. Les aires sous la courbe ROC étaient respectivement 0,60 [0,57–0,63], 0,62 [0,58–0,64] et 0,62 [0,59–0,65] pour les scores Caprini, Improve et Padua. Aucun de ces modèles n’a montré de performances supérieures à l’âge pris isolément (AUC 0,61 [0,58–0,64]). Ces résultats étaient similaires ne considérant que les évènements symptomatiques non fatals : (0,62 [0,58–0,66], 0,62 [0,58–0,66], 0,63 [0,59–0,67] et 0,58 [0,54–0,62]) ; ou dans le sous-groupe de patients ne recevant pas de thromboprophylaxie anticoagulante : 0,62 [0,58–0,67], 0,64 [0,60–0,68], 0,64 [0,59–0,68] et 0,66 [0,62–0,70] pour le score Caprini, Improve, Padua et l’âge, respectivement. Conclusion Les scores de Padua, Caprini et Improve ont des capacités de discrimination faible vis-à-vis de la MTEV acquise à l’hôpital, similaire à une évaluation se basant uniquement sur l’âge. Les meilleurs modèles de risque sont nécessaires

Developing consistent data and methods to measure the public health impacts of ambient air quality for Environmental Public Health Tracking: progress to date and future directions

Environmental Public Health Tracking (EPHT) staff at the state and national levels are developing nationally consistent data and methods to estimate the impact of ozone and fine particulate matter on hospitalizations for asthma and myocardial infarction. Pilot projects have demonstrated the feasibility of pooling state hospitalization data and linking these data to The United States Environmental Protection Agency (EPA) statistically based ambient air estimates for ozone and fine particulates. Tools were developed to perform case-crossover analyses to estimate concentration–response (C-R) functions. A weakness of analyzing one state at a time is that the effects are relatively small compared to their confidence intervals. The EPHT program will explore ways to statistically combine the results of peer-reviewed analyses from across the country to provide more robust C-R functions and health impact estimates at the local level. One challenge will be to routinely share data for these types of analyses at fine geographic and temporal scales without disclosing confidential information. Another challenge will be to develop C-R estimates which take into account time, space, or other relevant effect modifiers

Environnement électromagnétique résidentiel: Domaine des Radiofréquence

National audienc

Optimizing load transfer in multiwall nanotubes through interwall coupling: Theory and simulation

An analytical model is developed to determine the length scales over which load is transferred from outer to inner walls of multiwall carbon nanotubes (MWCNTs) as a function of the amount of bonding between walls. The model predicts that the characteristic length for load transfer scales as l similar to t root E/(mu) over bar, where t is the CNT wall spacing, E is the effective wall Young's modulus, and (mu) over bar is the average interwall shear modulus due to interwall coupling. Molecular dynamics simulations for MWCNTs with up to six walls, and with interwall coupling achieved by interwall sp(3) bonding at various densities, provide data against which the model is tested. For interwall bonding having a uniform axial distribution, the analytic and simulation models agree well, showing that continuum mechanics concepts apply down to the atomic scale in this problem. The simulation models show, however, that load transfer is sensitive to natural statistical fluctuations in the spatial distribution of the interwall bonding between pairs of walls, and such fluctuations generally increase the net load transfer length needed to fully load an MWCNT. Optimal load transfer is achieved when bonding is uniformly distributed axially, and all interwall regions have the same shear stiffness, implying a linear decrease in the number of interwall bonds with distance from the outer wall. Optimal load transfer into an n-wall MWCNT is shown to occur over a length of similar to 1.5nl. The model can be used to design MWCNTs for structural materials, and to interpret load transfer characteristics deduced from experiments on individual MWCNTs. (C) 2010 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved