European Association of Cardiothoracic Anesthesiology and Intensive Care (EACTAIC) Fellowship Curriculum: Second Edition.

International audienceThis document represents the first update of the Cardiothoracic and Vascular Anaesthesia Fellowship Curriculum of the European Association of Cardiothoracic Anaesthesiology and Intensive Care. After obtaining feedback from exit interviews with fellows in training, graduate fellows, and program directors, 2 modified online Delphi procedures with questionnaires were conducted. A consensus was reached when two-thirds of responding committee members gave green or yellow ratings on a traffic light system, and >70% indicated strong agreement or agreement on a 5-point Likert scale. The new regulations include the following: (1) more flexibility in the fellows` rotation, as long as the total number of days, rotations, and cases are completed during the training year; (2) recommendation for strict compliance with national working-time guidelines; (3) no extension of fellowship training to compensate for annual and/or sick leave, unless the required minimum number of cases and rotations are not reached; (4) interruption of fellowship training for >12 months is allowed for personal or medical reasons; (5) introduction of a checklist for quantitative assessment of standard clinical skills; (6) recommendations for a uniform structure of exit interviews; (7) possibility of a 1-month training rotation in a postanesthesia care unit instead of an intensive care unit; and (8) provided all other requirements have been met, the allowance of progression from the basic training year to the advanced fellowship training year without first passing the transesophageal echocardiography examination

European Association of Cardiothoracic Anesthesiology and Intensive Care Pediatric Cardiac Anesthesia Fellowship Curriculum:First Edition

International audiencePediatric cardiac anesthesia is a subspecialty of cardiac and pediatric anesthesiology dedicated to the perioperative care of patients with congenital heart disease. Members of the Congenital and Education Subcommittees of the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) agreed on the necessity to develop an EACTAIC pediatric cardiac anesthesia fellowship curriculum. This manuscript represents a consensus on the composition and the design of the EACTAIC Pediatric Cardiac Anesthesia Fellowship program. This curriculum provides a basis for the training of future pediatric cardiac anesthesiologists by clearly defining the theoretical and practical requirements for fellows and host centers

The role of open abdomen in non-trauma patient : WSES Consensus Paper

The open abdomen (OA) is defined as intentional decision to leave the fascial edges of the abdomen un-approximated after laparotomy (laparostomy). The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). OA use remains widely debated with many specific details deserving detailed assessment and clarification. To date, in patients with intra-abdominal emergencies, the OA has not been formally endorsed for routine utilization; although, utilization is seemingly increasing. Therefore, the World Society of Emergency Surgery (WSES), Abdominal Compartment Society (WSACS) and the Donegal Research Academy united a worldwide group of experts in an international consensus conference to review and thereafter propose the basis for evidence-directed utilization of OA management in non-trauma emergency surgery and critically ill patients. In addition to utilization recommendations, questions with insufficient evidence urgently requiring future study were identified.Peer reviewe

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013

Attitude et idéologie syndicales : une analyse de tracts distribués à Renault-Billancourt

TRADE UNION ATTITUDES AND IDEOLOGY, by PHILIPPE BURTIN A study of 303 union and political tracts distributed in the Renault-Billancourt factories during the first half of 1974 reveals the broad outline of each union's action and positions and the relationships built up between them. New information concerning union attitudes and ideology are provided not so much by the quantitative study of claims and political problems, which is performed by codifying the topics dealt with using an analysis grid, as by the qualitative study of the specific subjects of strikes, solidarity, analyses of the crisis and the Presidential election. [Revue française de science politique XXVII (6), décembre 1977, pp. 915-931.]ATTITUDE ET IDÉOLOGIE SYNDICALES, par PHILIPPE BURTIN Une étude de trois cent trois tracts syndicaux et politiques, distribués aux usines Renault-Billancourt pendant le premier semestre 1974, permet de dégager les grands traits de l'action et des positions de chaque syndicat et des rapports qui se sont noués entre eux. Plus que l'étude quantitative des revendications et des problèmes politiques, réalisée au moyen d'une codification des thèmes abordés, grâce à une grille d'analyse, c'est l'étude qualitative des thèmes précis de la grève, de la solidarité, des analyses de la crise et des élections présidentielles, qui apporte des éléments nouveaux sur l'attitude et l'idéologie syndicales. [Revue française de science politique XXVII (6), décembre 1977, pp. 915-931.]Burtin Philippe. Attitude et idéologie syndicales : une analyse de tracts distribués à Renault-Billancourt. In: Revue française de science politique, 27ᵉ année, n°6, 1977. pp. 915-931

Figures de l'avarice et de l'usure dans les comédies (The Merchant of Venice de Shakespeare, Volpone de Jonson et L'Avare de Molière)

L émergence d un esprit capitaliste (Weber) en Angleterre et en France au tournant des XVIe-XVIIe siècles a favorisé la reconfiguration des rapports entre avaritia et cupiditas, qui déterminent tout le champ sémantique de l usure et de l intérêt. Cette thèse postule que cette évolution est sensible dans la comédie française et anglaise de l époque, et plus particulièrement chez les grands dramaturges qui ont marqué l imaginaire collectif en mettant en scène des personnages avares. À partir d un type comique issu à la fois du théâtre antique et du canon religieux bien établi dans l Occident chrétien, l appréhension nouvelle de l argent comme objet et comme signe permet de construire une véritable figure moderne de l avarice. Shylock, Volpone et Harpagon sont suspendus entre un or quasi divin, et l univers plus ou moins connu de l argent, qu ils pensent maîtriser grâce à leur trésor. S ils s intègrent parfaitement à la fluidité moderne des échanges économiques, culturels et sociaux, ils participent aussi à leur dévalorisation, par une activité et un discours proprement usuraires. Leur entourage tente de soumettre cette labilité (Simmel) suscitée par l économie de l usurier-avare à un nouvel ordre, cosmique, éthique ou politique. Le conflit se résout devant la justice, instance discriminatoire externe et prétexte à la mise en abyme du jugement social. L analyse finale de ces dénouements permet de comprendre le travail de chaque auteur sur la forme et la fonction du comique, à travers le texte, les genres, ou une esthétique de l espace. Elle montre que chacun s attache à valoriser l apport de son art au public dans une période de crise socio-économique.The emergence of a capitalist spirit (Weber) in England and France at the turn of the sixteenth and seventeenth centuries played a leading role in reconfiguring the relation between avaritia and cupiditas which determine the whole semantic field of usury and interest. This thesis postulates that this evolution is perceptible in French and British comedy at that time, in particular for some of the playwrights who staged miserly characters imprinted in our collective imagination. Starting from a comic type as common in Greek and Roman drama as it was in the well-established religious canon in the Christian West, a new understanding of money as object and as sign leads to the construction of a truly modern figure of avarice.Shylock, Volpone (Mosca) and Harpagon, hang on to a almost divine idea of gold and the more or less known world of money, medium they think they control through their treasure, and which is about to become the universal equivalent of any good. Those characters fit perfectly into this modern dynamic of economic, cultural and social exchanges, but they also contribute, with their strictly usurious speech, to its depreciation. Their entourage tries to tame this lability of values (Simmel) generated by the economy of the usurer-miser to a new order a cosmic, ethical or political order. Conflicts are resolved by a court of law, external discriminatory authority and pretext for the mise-en-abyme of social judgment. The analysis of these denouements allows one to understand the work of each author in the comic form and function, through the text, the genres, or an aesthetic of space. It shows how much each author strived to value the contribution of his art to the public, in a time of socio-economic crisis.NANTERRE-PARIS10-Bib. élec. (920509901) / SudocSudocFranceF

Coronal Photopolarimetry with the LASCO-C2 Coronagraph over 24 Years [1996 – 2019]

International audienceWe present an in-depth characterization of the polarimetric channel of the Large-Angle Spectrometric COronagraph/LASCO-C2 onboard the Solar and Heliospheric Observatory (SOHO). The polarimetric analysis of the white-light images makes use of polarized sequences composed of three images obtained though three polarizers oriented at +60∘, 0∘, and −60∘, complemented by a neighboring unpolarized image, and relies on the formalism of Mueller. The Mueller matrix characterizing the C2 instrument was obtained through extensive ground-based calibrations of the optical components and global laboratory tests. Additional critical corrections were derived from in-flight tests relying prominently on roll sequences of SOHO, on the basis of consistency criteria (e.g. the “tangential” direction of polarization), and from several applications, notably the time-dependent tomographic reconstruction of the coronal electron density. This took several years of effort, but resulted in the quasi-uninterrupted photopolarimetric analysis of the corona over two complete Solar Cycles 23 and 24, and the comparison with a variety of eclipse data obtained at different phases of these cycles. Our final results encompass the characterization of the polarization of the white-light corona, of its polarized radiance, of the two-dimensional electron density, and of the K-corona. The agreement with the eclipse data is excellent except for slight discrepancies affecting the innermost part of the C2 field of view. The present work leaves the two unpolarized components, F-corona and stray light, entangled and their complex separation will be dealt with in a follow-on article