In-training assessment using direct observation of single-patient encounters: a literature review

We reviewed the literature on instruments for work-based assessment in single clinical encounters, such as the mini-clinical evaluation exercise (mini-CEX), and examined differences between these instruments in characteristics and feasibility, reliability, validity and educational effect. A PubMed search of the literature published before 8 January 2009 yielded 39 articles dealing with 18 different assessment instruments. One researcher extracted data on the characteristics of the instruments and two researchers extracted data on feasibility, reliability, validity and educational effect. Instruments are predominantly formative. Feasibility is generally deemed good and assessor training occurs sparsely but is considered crucial for successful implementation. Acceptable reliability can be achieved with 10 encounters. The validity of many instruments is not investigated, but the validity of the mini-CEX and the ‘clinical evaluation exercise’ is supported by strong and significant correlations with other valid assessment instruments. The evidence from the few studies on educational effects is not very convincing. The reports on clinical assessment instruments for single work-based encounters are generally positive, but supporting evidence is sparse. Feasibility of instruments seems to be good and reliability requires a minimum of 10 encounters, but no clear conclusions emerge on other aspects. Studies on assessor and learner training and studies examining effects beyond ‘happiness data’ are badly needed

Living on Cold Substrata: New Insights and Approaches in the Study of Microphytobenthos Ecophysiology and Ecology in Kongsfjorden

Organisms in shallow waters at high latitudes are under pressure due to climate change. These areas are typically inhabited by microphytobenthos (MPB) communities, composed mainly of diatoms. Only sparse information is available on the ecophysiology and acclimation processes within MPBs from Arctic regions. The physico-chemical environment and the ecology and ecophysiology of benthic diatoms in Kongsfjorden (Svalbard, Norway) are addressed in this review. MPB biofilms cover extensive areas of sediment. They show high rates of primary production, stabilise sediment surfaces against erosion under hydrodynamic forces,and affect the exchange of oxygen and nutrients across the sediment-water interface. Additionally, this phototrophic community represents a key component in the functioning of the Kongsfjorden trophic web, particularly as a major food source for benthic suspension- or deposit-feeders. MPB in Kongsfjorden is confronted with pronounced seasonal variations in solar radiation, low temperatures, and hyposaline (meltwater) conditions in summer, as well as long periods of ice and snow cover in winter. From the few data available, it seems that these organisms can easily cope with these environmental extremes. The underlying physiological mechanisms that allow growth and photosynthesis to continue under widely varying abiotic parameters, along with vertical migration and heterotrophy, and biochemical features such as a pronounced fatty-acid metabolism and silicate incorporation are discussed. Existing gaps in our knowledge of benthic diatoms in Kongsfjorden, such as the chemical ecology of biotic interactions, need to be filled. In addition, since many of the underlying molecular acclimation mechanisms are poorly understood, modern approaches based on transcriptomics, proteomics, and/or metabolomics, in conjunction with cell biological and biochemical techniques, are urgently needed. Climate change models for the Arctic predict other multifactorial stressors, such as an increase in precipitation and permafrost thawing, with consequences for the shallow-water regions. Both precipitation and permafrost thawing are likely to increase nutrient-enriched, turbid freshwater runoff and may locally counteract the expected increase in coastal radiation availability. So far, complex interactions among factors, as well as the full genetic diversity and physiological plasticity of Arctic benthic diatoms, have only rarely been considered. The limited existing information is described and discussed in this review

Determination of ice flow velocity in Svalbard from ERS-1 interferometric observations (scientific paper)

Based on ERS-1 data recorded in autumn 1991,differential interferogrammes have allowed the determination of the ice flow of north-west Spitsbergen glaciers. The highest velocity of the d\u27Arodesbreen and the Fjortendejulibreen, observed in their equilibrium zone, was 3cm and 6.6cm per day, respectively. The large Kronebreen (700(km)^2) is fed by two plateaux, Isachsenfonna and Holtedahlfonna. Along the longitudinal axis of Isachsenfonna, the velocity was near constant, around 20cm per day over a distance of 20km, while the velocity on Holtedahlfonna increased from near zero in the higher basin to 52cm per day at 15km to the calving front. The obtained velocities were in excess of 48% of the annual average velocity measured by GPS at three locations. Interferometric pairs were obtained at the end of the ablation period when the presence of subglacial meltwater can still lead a high velocity. These relatively high rates of velocity indicate that the basal sliding of Isachsenfonna and Holtedahlfonna is important and that the glacier sole must be at the melting point down to the front. The present temperature distribution in the glacier is still possibly influenced by a surge, which occurred 130 years ago

Processus de transport à travers la barrière hémato-encéphalique

International audienc

Efficacité d'un traitement préopératoire par érythropoïétine, fer intraveineux et vitaminothérapie dans le cadre d'une chirurgie cardiaque programmée sur le taux d'hémoglobine préopératoire chez des patients présentant une anémie ferriprive :

Médecine (anesthésie réanimation)La réhabilitation améliorée après chirurgie cardiaque et la gestion personnalisée du sang constituent un élément essentiel de la prise en charge des patients en chirurgie cardiaque non urgente. L'administration exclusive de fer intraveineux n'est pas suffisante. Le protocole mis en place aux hôpitaux universitaires de Strasbourg consiste donc en l'administration de fer intraveineux associée à l'érythropoïétine et une vitaminothérapie B9/B12. Le but de notre étude est d'évaluer l'efficacité de cette quadrithérapie sur le taux d'hémoglobine préopératoire. Les patients inclus présentaient une anémie par carence martiale et avaient reçu la quadrithérapie avant leur chirurgie programmée. Trente patients présentant une anémie ferriprive et ayant reçu la quadrithérapie ont été inclus. L'association de fer, érythropoïétine et vitamines permet une hausse significative du taux d'hémoglobine préopératoire.Enhanced recovery after cardiac surgery and patient blood management are essential part of patients management in non urgent cardiac surgery. Exclusive admnistration of intravenous iron is not sufficient. The protocol set up at the University Hospitals of Strasbourg therefore consists of the administration of intravenous iron associated with erythropoietin and vitamin therapy B9/B12. The aim of our study is to evaluate the effectiveness of this quadritherapy on the preoperative hemoglobin level. The patients included presented an iron deficiency anemia and had received quadritherapy before their scheduled cardiac surgery. Thirty patients with iron deficiency anemia who received treatment were included. The combination of iron, erythropoietin and vitamins allows a significant increase of the preoperative hemoglobin level.Thèses et écrits académique