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Fiberoptic intubation for a difficult airway requires significant experience. Traditionally only normal airways were available for high fidelity bronchoscopy simulators. It is not clear if training on difficult airways offers an advantage over training on normal airways. This study investigates the added value of difficult airway scenarios during virtual reality fiberoptic intubation training. A prospective multicentric randomized study was conducted 2019 to 2020, among 86 inexperienced anesthesia residents, fellows and staff. Two groups were compared: Group N (control, n = 43) first trained on a normal airway and Group D (n = 43) first trained on a normal, followed by three difficult airways. All were then tested by comparing their ORSIM ® scores on 5 scenarios (1 normal and 4 difficult airways). The final evaluation ORSIM ® score for the normal airway testing scenario was significantly higher for group N than group D: median score 76% (IQR 56.5–90) versus 58% (IQR 51.5–69, p = 0.0039), but there was no difference in ORSIM ® scores for the difficult intubation testing scenarios. A single exposure to each of 3 different difficult airway scenarios did not lead to better fiberoptic intubation skills on previously unseen difficult airways, when compared to multiple exposures to a normal airway scenario. This finding may be due to the learning curve of approximately 5–10 exposures to a specific airway scenario required to reach proficiency.

We report the direct observation by x-ray diffraction of a photoinduced paraelectric-to-ferroelectric structural phase transition using monochromatic 100-picosecond synchrotron pulses. It occurs in tetrathiafulvalene-p-chloranil, a charge-transfer molecular material in which electronic and structural changes are strongly coupled. An optical 300-femtosecond laser pulse switches the material from a neutral to an ionic state on a 500-picosecond time scale and, by virtue of intrinsic cooperativity, generates self-organized long-range structural order. The x-ray data indicate a macroscopic ferroelectric reorganization after the laser irradiation. Refinement of the structures before and after laser irradiation indicates structural changes at the molecular level.

We present the detailed results of the investigation by x-ray diffraction of the photoinduced phase transition in the tris(α-picolylamine)iron(II) chloride–ethanol complex. This system undergoes a two-steps spin transition between a high spin state at room temperature and a low spin state at low temperature. The intermediate phase consists of stripes of high spin and low spin molecules. The x-ray diffraction data evidence the structural rearrangement at the molecular scale accompanying the photoinduced change of electronic state between the low-spin phase and the photo-steady high-spin one, which is similar to the stable one in the high temperature phase. The dynamical mechanism of the transformation is discussed with the observation of a domain nucleation process, associated with the coexistence of the stable and photoinduced phases.