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Toni T Kfoury,1,2 Mouna Ben Rehouma,2 Paul J Zetlaoui,1 Dan Benhamou,1 Jean Xavier Mazoit1,2 1Département d’Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud AP-HP, Paris, France; 2Laboratoire d’Anesthésie, Faculté de Médecine, INSERM UMR 1195, Université Paris-Sud, Paris, FranceCorrespondence: Jean Xavier MazoitLaboratoire d’Anesthésie, Faculté de Médecine, INSERM UMR 1195, Université Paris-Sud, 63 Rue Gabriel Péri, Bicêtre Cedex 94276, FranceEmail jean-xavier.mazoit@u-psud.frPurpose: Animal models of regional anaesthesia are useful for studying the effects of blocks and improve their efficacy. The aim of our experiments was to validate a multi-site paravertebral block in the rat.Material and methods: Dissection and indigo carmine dye injection were performed in five rats (3 rats were dissected and 2 were dye injected). In other groups (n=7rats/group), after inflammation inductive carrageenan injection in the abdominal wall, bupivacaine or saline was injected laterally to the spinal column at the T5, T10, L1, L4 and S1 level. The efficacy of the block on mechanical nociception was measured using von Frey hairs. In addition, we measured c-Fos immunoreactive nuclei in the cord.Results: The multi-site injection showed a perinervous distribution of the injected solution without intra-thoracic, intra-abdominal or epidural diffusion. Bilateral block with a relatively small volume of bupivacaine (0.5 mL) significantly increased the threshold to mechanical pain as compared to control (p=0.007) and significantly decreased the number of c-Fos immunoreactive nuclei in the posterior horn of the spinal cord (p

In the sequenced procedural context of the restricted competition in France where the program appears to be an essential link between the definition of the commission and the design work, a programming agency asked a research laboratory at a school of architecture to help it understand how architects use this document. What information caught their attention? What conditions do the designers feel must be met for the program to stimulate their creativity? This article presents the results of this research partnership, based on a qualitative survey conducted in 2019 and 2020 among 16 architects in charge of agencies, and refining the results of research conducted by the laboratory on a national scale on the conduct of competitions during the period 2006-2015. It shows that, over and above the problems posed by excessively vague or prescriptive commissions, architects are looking for signs of strong political support for the project and a prioritising of expectations. There is also an emerging need among designers to understand the foundations of the programmatic choices made and to appreciate their robustness, in order to make the most of the freedom given by the program and to be in a better position to transcend it. For their part, the professionals in charge of drawing up the program are often encouraged by the clients to produce prescriptions at the competition stage that commit them to design solutions without having to justify them, which fosters situations of mistrust.

The architecture competition is a high point of interaction between very diverse actors, architecture specialists or not. However, is it really an opportunity for exchange and shared learning? Based on surveys conducted in France and in several European countries on behalf of the French Ministry of Culture, this contribution aims to identify the conditions that foster the interactions inherent to competitions, the possible scope of these exchanges and the rationale behind them. When the competition is a chosen procedure, it is most often perceived as a moment of generating ideas that opens a professional debate and also addresses the general public. When it is mandatory, the competition is guided by another logic: that of ensuring the fairness and transparency of the joint choice of a project and a service provider as well as the legality of the contract concluded with the latter. Depending on the place given by decision-makers to this legal and contractual dimension, the nature and scope of the debates around the competition vary widely. If the legalistic approach dominates, it tends to limit interactions. However if the contracting authority adopts a more open approach to the competition, from programming to the dissemination and capitalisation of its results, it can make a real process of collective deliberation and favour the growth of shared competence.

This article presents the key findings of a study of a decade of architecture competitions practice in France. In the first part, it reports on the evolution of the use of this procedure compared to others, based on statistics of public tender notices published between 2006 and 2015. Then, based on the results of different surveys, the article analyses the points of view on this procedure expressed by project clients, programmers, architects and engineers, and elaborates on the key factors they mention: the mobilizing character of competitions; access to commissions; candidate selection procedures; the level of services required; approaches to notions of cost, quality and innovation; programming; research progressiveness. In fine the article presents several recommendations co-elaborated by the different research protagonists and aimed at improving the procedure as well as creating a partner monitoring system to inform public policy. Architecture Competition, Public Project Management, Architectural Design, Architects, Evaluation of Public Policy

In the Social Sciences today, there are a variety of ways to approach the various areas of investigation and a wide range of observational methods. Depending on academic background and research interests, researchers explore and emphasize certain approaches and categorizations at the expense of others in the implementation of their audiovisual investigations. These observations lead us to first question the definition of image in its connection to the object of research and its status and, secondly, to identify the diversity of current practices and uses. Indeed, the status of an image changes according to the media used and the contexts of reception. The circulation of images promotes exchange and connection between the various groups of actors. If we awkwardly accompany images, we risk unwittingly betraying their original meaning. Furthermore, there is the possibility of conflicts or unintended distortions linked to the activities of projection and identification. Our goal will be to propose a methodological framework and establish an initial model for all researchers in Communication Studies using the audiovisual method. Finally, the researcher accepts not only to properly conduct his research, but also to present an audiovisual project taking into account from the start advantages, constraints, issues of influence and scientific impact.

Objectives: Major abdominal surgery usually requires general anesthesia with tracheal intubation and may be supplemented with neuraxial anesthesia to provide intraoperative and postoperative pain relief. Attempts at using only neuraxial anesthesia for major abdominal surgery have often been shown to be poorly effective. This report demonstrates that laparoscopic colonic surgical procedures can be performed with ultrasound-guided blocks (bilateral transversus abdominal plane block and celiac plexus block) and intravenous sedation, while avoiding general or neuraxial anesthesia.Case Report: We report our preliminary experience in 3 patients (all American Society of Anesthesiologists physical status III) who underwent laparoscopic colonic surgery without general anesthesia. Intraoperative visceral analgesia was provided by single-injection ultrasound anterior celiac plexus block to which was added a bilateral subcostal transversus abdominal plane block to obtain parietal analgesia. Light intravenous sedation was added. Surgical exposure was satisfactory, and no patient complained of any symptom during the procedure. No adverse effect was recorded. Postoperative pain was minimal, and recovery was enhanced with mobilization and walking within hours after surgery. Patient satisfaction was excellent.Conclusions: To date, celiac plexus block has been used almost exclusively to relieve pancreatic cancer pain. This is the first report in which it is shown that major intra-abdominal surgery can be performed almost exclusively with regional anesthesia while avoiding adverse effects and problems associated with either general or neuraxial anesthesia. In addition, prolonged postoperative pain relief facilitated early recovery. [ABSTRACT FROM AUTHOR]