The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning.

BACKGROUND: What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL). METHOD: The Analysis of Teaching of Medical Schools (AToMS) survey used detailed timetables provided by 25 schools with standard 5-year courses. Timetabled teaching events were coded in terms of course year, duration, teaching format, and teaching content. Ten schools used PBL. Teaching times from timetables were validated against two other studies that had assessed GP teaching and lecture, seminar, and tutorial times. RESULTS: A total of 47,258 timetabled teaching events in the academic year 2014/2015 were analysed, including SSCs (student-selected components) and elective studies. A typical UK medical student receives 3960 timetabled hours of teaching during their 5-year course. There was a clear difference between the initial 2 years which mostly contained basic medical science content and the later 3 years which mostly consisted of clinical teaching, although some clinical teaching occurs in the first 2 years. Medical schools differed in duration, format, and content of teaching. Two main factors underlay most of the variation between schools, Traditional vs PBL teaching and Structured vs Unstructured teaching. A curriculum map comparing medical schools was constructed using those factors. PBL schools differed on a number of measures, having more PBL teaching time, fewer lectures, more GP teaching, less surgery, less formal teaching of basic science, and more sessions with unspecified content. DISCUSSION: UK medical schools differ in both format and content of teaching. PBL and non-PBL schools clearly differ, albeit with substantial variation within groups, and overlap in the middle. The important question of whether differences in teaching matter in terms of outcomes is analysed in a companion study (MedDifs) which examines how teaching differences relate to university infrastructure, entry requirements, student perceptions, and outcomes in Foundation Programme and postgraduate training

Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise.

BACKGROUND: Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors. METHOD: Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail. RESULTS: Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs. CONCLUSIONS: Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety

Synthèse de pérosckites La1-xAxBO3 (A = Sr, Ag, Ce ; B = Mn, Cr ; 0 <= x <= 0,2) par des méthodes conventionnelles ou assistées par micro-ondes pour la combustion catalytiue du méthane et des suies

L objectif de cette étude a été de développer et d optimiser la préparation de catalyseurs à base de pérovskites La1-xAxBO3+ (A = Sr, Ag, Ce; B = Mn et Cr; 0 <= x <= 0,2) utilisées en combustion du méthane. Les catalyseurs ont été préparés, à pression atmosphérique ou sous pression (conditions hydrothermales), par des méthodes conventionnelles (co-précipitation) et non conventionnelles (sous micro-ondes). La méthode de préparation a un effet important sur les propriétés physico-chimiques des catalyseurs préparés et par conséquent affecte leur activité catalytique en combustion du méthane. La substitution d éléments actifs (Sr, Ag, Ce) dans les réseaux LaBO3 (B = Mn, Cr) permet d abaisser considérablement la température (T50) de combustion du méthane. Le système à base des oxydes lanthane-chrome existe sous différentes formes (LaCrO3, LaCr2O6, LaCrO3- La2O3 et LaCrO3-LaCr2O6) dont l obtention dépend du mode de synthèse utilisé. La teneur de la phase secondaire (LaCr2O6 ou La2O3) est fonction de l atmosphère, de la température et de la durée de calcination utilisées. Ces catalyseurs présentent des réductibilités différentes (mobilité des espèces oxygène variable) ce qui affecte leur activité en combustion du méthane ou des suies diesel. En effet la pérovskite LaCrO3 préparée par la méthode hydrothermale, très peu réductible et possédant une importante aire BET, conduit à une activité très importante en combustion des suies diesel (Tmax = 435C) mais présente une faible activité en combustion du méthane. Tous les catalyseurs à base de manganèse sont affectés par l empoisonnement par H2S, lequel provoque une diminution de l activité catalytique en combustion du méthane liée à la diminution du nombre des sites actifs. Ce dernier reste, toutefois appréciable dans le cas du catalyseur le plus actif La0.8Ag0.2MnO3+ préparé par la méthode hydrothermale assistée par micro-ondesThe objective of this study was to develop and to optimize the preparation of La1-xAxBO3+ perovskites catalysts (A = Sr, Ag, Ce; B = Mn or Cr; 0 <= x <= 0.2) used for methane combustion. Catalysts were prepared, at atmospheric pressure or under pressure (hydrothermal conditions), by conventional methods (co-precipitation) and non conventional methods such as microwaves irradiation. The method of preparation has an important effect on the physico-chemical properties of the prepared catalysts and affects consequently their catalytic activity in methane combustion. The substitution of active elements (Sr, Ag, Ce) in the networks of LaMnO3 and LaCrO3 allows to lower considerably the light-off temperature (T50) of methane combustion. The lanthanum-chromium oxides system exists under various forms: LaCrO3, LaCr2O6, LaCrO3- La2O3 and LaCrO3-LaCr2O6 whose obtaining depends on the used mode of synthesis. The content of the secondary phase (LaCr2O6 or La2O3) is dependent on the atmosphere, the temperature and the duration of calcination used. These catalysts present different reducibility (mobility of the oxygen species) which affects their activity in methane or diesel soot combustion. However, LaCrO3 perovskite, prepared using hydrothermal method which was found to be hardly reducible and possessing a great BET surface area, leads to an important activity in diesel soot combustion (Tmax = 435C) but shows low activity in methane combustion. All manganese based catalysts are affected by the poisoning by H2S, who provokes a decrease of the catalytic activity in combustion of the methane which is connected to the decrease of the number of the active sites. The latter remain, however noticeable in the case of the most active catalyst La0.8Ag0.2MnO3+ prepared using microwaves assisted hydrothermal synthesisLYON1-BU.Sciences (692662101) / SudocSudocFranceF

Flatfoot in Africa, the cirripede Chthamalus in the west Indian Ocean

Barnacles of the genus Chthamalus are commonly encountered rocky intertidal shores. The phylogeography of the different species in the Western Indian Ocean is unclear. Using morphological characteristics as well as the molecular markers mitochondrial cytochrome oxygenase subunit I (COI) and the nuclear sodium-potassium ATPase (NaKA), we identified four clades representing four species in the Western Indian Ocean and its adjacent seas. Among these species, a newly identified species, Chthamalus barilani, which was found in Madagascar, Zanzibar and Tanzania. Chthamalus from the coasts of Tanzania and Zanzibar is identified morphologically as C. malayensis, and clusters with C. malayensis from the Western Pacific and the Indo Malayan regions. C. malayensis is regarded as a group of four genetically differentiated clades representing four cryptic species. The newly identified African clade is genetically different from these clades and the pairwise distances between them justify the conclusion that it is an additional cryptic species of C. malayensis. This type of genetic analyses offers an advantage over morphological characterization and allowed us to reveal that another species, C. barnesi, which is known from the Red Sea, is also distributed in the Arabian Sea and the Persian Gulf. We could also confirm the presence of the South African species C. dentatus in the Mozambique channel. This represents the Northeastern limit of C. dentatus, which is usually distributed along the coast of southern Africa up to the Islands of Cape Verde in West Africa. Altogether, based on a combination of morphology and genetics, we distinct between four clusters of Chthamalus, and designate their distribution in the West Indian Ocean. These distinctions do not agree with the traditional four groups reported previously based merely on morphological data. Furthermore, these findings underline the importance of a combining morphological and genetics tools for constructing barnacle taxonomy

IL-34 Induces the Differentiation of Human Monocytes into Immunosuppressive Macrophages. Antagonistic Effects of GM-CSF and IFNγ

International audienceIL-34 is a recently identified cytokine that signals via the M-CSF receptor and promotes monocyte survival. Depending on the environment, monocytes can differentiate into macrophages (MQ) or dendritic cells (DC). A wide spectrum of MQ and DC subsets, with distinct phenotypes and functions, has been described. To date, the phenotype of monocytes exposed to IL-34 remains unexplored. We report here that IL-34 induces the differentiation of monocytes into CD14 high CD163 high CD1a 2 MQ (IL-34-MQ). Upon LPS stimulation, IL-34-MQ exhibit an IL-10 high IL-12 low M2 profile and express low levels of the costimulatory molecules CD80 and CD86. IL-34-MQ exhibit poor T cell costimulatory properties, and have potent immunosuppressive properties (decrease of TCR-stimulated T cell proliferation). For all the parameters analyzed, IL-34-MQ are phenotypically and functionally similar to M-CSF-MQ. IL-34 appears as efficient as M-CSF in inducing the generation of immunosuppressive MQ. Moreover, the generation of IL-34-MQ is mediated through the M-CSF receptor, is independent of endogenous M-CSF consumption and is potentiated by IL-6. In an attempt to identify strategies to prevent a deleterious M2 cell accumulation in some pathological situations, we observed that IFNc and GM-CSF prevent the generation of immunosuppressive MQ induced by IL-34. IFNc also switches established IL-34-MQ into immunostimulatory MQ. In conclusion, we demonstrate that IL-34 drives the differentiation of monocytes into immunosuppressive M2, in a manner similar to M-CSF, and that IFNc and GM-CSF prevent this effect

IL-34- and M-CSF-induced macrophages switch memory T cells into Th17 cells via membrane IL-1α

International audienceMacrophages orchestrate the immune response via the polarization of CD4+ T helper (Th) cells. Different subsets of macrophages with distinct phenotypes, and sometimes opposite functions, have been described. M-CSF and IL-34 induce the differentiation of monocytes into IL-10high IL-12low immunoregulatory macrophages, which are similar to tumor-associated macrophages (TAMs) in ovarian cancer. In this study, we evaluated the capacity of human macrophages induced in the presence of M-CSF (M-CSF macrophages) or IL-34 (IL-34 macrophages) and ovarian cancer TAMs to modulate the phenotype of human CD4+ T cells. Taken together, our results show that M-CSF-, IL-34 macrophages, and TAMs switch non-Th17 committed memory CD4+ T cells into conventional CCR4+ CCR6+ CD161+ Th17 cells, expressing or not IFN-gamma. Contrary, the pro-inflammatory GM-CSF macrophages promote Th1 cells. The polarization of memory T cells into Th17 cells is mediated via membrane IL-1α (mIL-1α), which is constitutively expressed by M-CSF-, IL-34 macrophages, and TAMs. This study elucidates a new mechanism that allows macrophages to maintain locally restrained and smoldering inflammation, which is required in angiogenesis and metastasis