Prescription médicamenteuse inappropriée: les nouveaux critères STOPP/START [Prescribing inappropriate medication: the new STOPP/START criteria].

Prescribing inappropriate medication (PIM) is a common public health problem. Mainly due to associated adverse drugs events (ADE), it results in major morbidity and mortality, as well as increased healthcare utilization. For a long time, the systematic review of medications prescribed appeared as a solution for limiting PIM and the ADE associated with such prescriptions. With this aim and since 2008, the list of STOPP-START criteria has appeared as attractive in its design, as well as logical and easy to use. The initial version has just been updated and improved. After having detailed all improvements provided to the 2008 version, we present the result of its adaptation into French language by a group of French-speaking expert from Belgium, Canada, France, and Switzerland.

Les critères STOPP/START.v2 : adaptation en langue française. [STOPP/START.v2 criteria: Adaptation into French language]

Objectif STOPP/START est un outil de détection de la prescription médicamenteuse potentiellement inappropriée chez la personne de 65 ans ou plus. La version initiale de 2008 vient d'être mise à jour et améliorée par ses auteurs. Nous en présentons l'adaptation et la validation en langue française. Méthodes L'adaptation en français de l'outil STOPP/START.v2 a été réalisée par deux experts, confirmée par la méthode de traduction-inverse, et finalisée d'après les commentaires de neufs évaluateurs francophones, gériatres, pharmaciens cliniciens, et médecin généraliste de quatre pays (France, Belgique, Suisse, Canada). La validation a été complétée par une analyse de concordance inter-juge (CCI) des critères STOPP/START.v2 appliqués à dix vignettes cliniques standardisées. Résultats Les 115 critères de STOPP/START.v2 en français sont, par rapport à la version originale anglaise, identiques par leur classification mais adaptés en termes de présentation (critères START.v2 commençant par la condition clinique, et accompagnés par une justification du caractère inapproprié de l'omission) voire de formulation de certains critères. Cette adaptation en français est validée par (i) la traduction-inverse montrant le respect du sens clinique de la version originale, (ii) l'identification semblable des critères lorsque appliqués à dix vignettes cliniques par les neuf évaluateurs, et (iii) le haut niveau de concordance de ces neuf évaluations tant pour STOPP.v2 (CCI 0,849) que pour START.v2 (CCI 0,921). Conclusion L'adaptation en langue française des critères STOPP/START.v2 fournit aux cliniciens un outil de détection de la prescription médicamenteuse potentiellement inappropriée chez les personnes de 65 ans et plus qui est logique, fiable et facile à utiliser. Objective STOPP/START is a screening tool to detect potentially inappropriate prescribing in persons aged 65 or older. Its Irish authors recently updated and improved the initially published version of 2008. We present the adaptation and validation into French language of this updated tool. Methods STOPP/START.v2 was adapted into French by two experts, then confirmed by a translation-back translation method and finalised according to the comments of nine French-speaking assessors - geriatricians, pharmacologists and a general physician - from four countries (France, Belgium, Switzerland, and Canada). The validation was completed by an inter-rater reliability (IRR) analysis of the STOPP/START.v2 criteria applied to 10 standardized clinical vignettes. Results In comparison to the original English version, the 115 STOPP/START.v2 criteria in French language classify in identical manner, but the presentation has been adjusted (START.v2 first specifies the clinical condition followed by an explanation of the inappropriateness of the prescription or omission). This adaptation into French language was validated by means of (i) the translation/back-translation, which showed that the French version complied with the clinical meaning of the original criteria; (ii) the similar screening results when applied by the nine specialists to the 10 cases; and (iii) the high level of inter-rater reliability of these 9 evaluations, for both STOPP (IRR 0.849) and START.v2 (IRR 0.921). Conclusion The adaptation into French of the STOPP/START.v2 criteria provides clinicians with a screening tool to detect potentially inappropriate prescribing in patients aged 65 and older that is more logical, more reliable and easier to use.

Vers une prescription médicamenteuse appropriée chez les patients âgés à l'aide de STOPP/START.v2

STOPP/START est un outil d'optimisation de la prescription médicamenteuse chez les patients âgés. Mis à jour en 2015, cet article en présente une adaptation pratique pour la médecine générale, en français (www.louvainmedical.be, page d'accueil, rubrique didactique: accès libre), ainsi que les critères les plus fréquemment rencontrés chez des patients âgés fragiles.

Fiscal sustainability across government tiers: an assessment of soft budget constraints

This paper analyses how fiscal adjustment comes about when both central and sub-national governments are involved in consolidation. We test sustainability of public debt with a fiscal rule for both the federal and regional government. Results for the German Länder show that lower tier governments bear a relatively smaller part of the burden of debt consolidation, if they consolidate at all. Most of the fiscal adjustment occurs via central government debt. In contrast, both the US federal and state levels contribute to consolidation of public finances.

Use of thin films obtained by plasma polymerization for grain protection and germination enhancement

In this work, preliminary results of the use of hydrophobic thin films obtained by plasma deposition to protect grains and seeds are presented: grains coated by the films did not present biological degradation when stored in a saturated water vapor environment, but had their germination accelerated in the presence of water. A model that explains the difference of behavior of the films when exposed to water in vapor form or in liquid form, based on the formation of microchannels within the film that lead to water uptake in seeds, is presented. The model was successfully tested using quartz crystal measurements, which showed that the microchannels within the films can favor the adsorption and permeation of water when the films are immersed in water.

Candidate counterparts to the soft gamma-ray flare in the direction od LSI+61303

A short duration burst reminiscent of a soft gamma-ray repeater/anomalous X-ray pulsar behaviour was detected in the direction of LS I +61 303 by the Swift satellite. While the association with this well known gamma-ray binary is likely, a different origin cannot be excluded. Aims. We explore the error box of this unexpected flaring event and establish the radio, near-infrared and X-ray sources in our search for any peculiar alternative counterpart. Methods. We carried out a combined analysis of archive Very Large Array radio data of LS I +61 303 sensitive to both compact and extended emission. We also reanalysed previous near infrared observations with the 3.5 m telescope of the Centro Astronómico Hispano Alemán and X-ray observations with the Chandra satellite. Results. Our deep radio maps of the LS I +61 303 environment represent a significant advancement on previous work and 16 compact radio sources in the LS I +61 303 vicinity are detected. For some detections, we also identify near infrared and X-ray counterparts. Extended emission features in the field are also detected and confirmed. The possible connection of some of these sources with the observed flaring event is considered. Based on these data, we are unable to claim a clear association between the Swift-BAT flare and any of the sources reported here. However, this study represents the most sophisticated attempt to determine possible alternative counterparts other than LS I +61 303.

A NOVEL POLYACRYLAMIDE-BASED HYDROGEL CROSSLINKED WITH CELLULOSE ACETATE AND PREPARED BY PRECIPITATION POLYMERIZATION

The synthesis of polyacrylamide-cellulose acetate hydrogels by precipitation polymerization in acetone solution is reported herein. These hydrogels exhibit smaller swelling ratios and larger compression moduli than homo polyacrylamide hydrogels. For cellulose acetate concentrations above 20 wt.%, hydrogels with N,N'-methylenebisacrylamide as a crosslinker exhibit swelling ratios and compression moduli similar to those of the hydrogels without the crosslinker. A possible explanation for this behavior is that cellulose acetate crosslinks polyacrylamide via free-radical reaction. The hydrogels obtained without the N,N'-methylenebisacrylamide crosslinker exhibit compression moduli up to 1.7 MPa, making them suitable for tissue engineering applications such as cartilage replacement.

Comparison of Potassium and Sodium Content in Diet and Non-Diet Soft Drinks by Using Capillary Electrophoresis with Capacitively Coupled Contactless Conductivity Detection

Capillary electrophoresis (CE) with capacitively coupled contactless conductivity detection (C4D) was used for determination of sodium and potassium concentrations in diet and non-diet soft drinks. Higher sodium concentrations were found in the diet samples due to the utilization of sodium salts of cyclamate and saccharine as sweeteners. The CE-C4D method can be used by food industries and health regulatory agencies for monitoring sodium and potassium content, not only in soft drink but in many others food products.

Rediscovering profitability in entrepreneurship : evidence from Finnish high-technology start-ups

Denna avhandling utmanar sambandet mellan tillväxt och lönsamhet. Lönsamhet, som borde vara företagens största prioritet har nästan totalt försvunnit från entreprenörskapsfältet. Istället har den blivit ersatt av en fokus på tillväxt och framförallt hög tillväxt. Den nuvarande allmänna normen verkar vara att tillväxt blint prioriteras över lönsamhet. Detta beror på det förvrängda sambandet mellan tillväxt och lönsamhet; antagandet att hög tillväxt förr eller senare kommer att leda till hög lönsamhet. Således ses tillväxt som ett mått på ett företags framgång och som ett mål värt att eftersträva. Det har blivit fokuset i allmän media och entreprenörskapsforskning, något beslutfattarna försöker stöda och uppmuntra, entreprenörerna vill uppnå och finansiärerna vill skapa. Allt detta, oftast på bekostnad av lönsamhet. Denna avhandling strävar efter att få en ändring på detta genom att utmana denna nuvarande norm. Avhandlingens empiriska del fokuserar sig på nya finska högteknologiföretag inom bio- och IT-branschen. Tillväxtfenomenet studeras i tre olika kontexter: forskningen (en analys på 118 artiklar i ledande entreprenörskaps och managementjournaler), praktiken (en finansiell analys på 1039 nya företag) och bland intressenternas perspektiv (23 intervjuer med entreprenörer, beslutsfattare, offentliga finansiärer och riskfinansiärer). Resultaten bekräftar en stark förvrängning av tillväxt och lönsamhet inom de tre studerade kontexterna. Den finansiella analysen bekräftar resultaten av senare forskning och visar att lönsamhet, istället för tillväxt, är förutsättningen för fortsatt lönsam tillväxt. Resultaten stämmer oberoende av företagens ålder. Det visas även att en ändring i strategisk position är osannolik och mycket svår att genomföra. Detta lyfter fram nödvändigheten för startade företag att fokusera sig på rätt saker genast från start; skapandet av en lönsam affärsmodell.

Start-up of horizontal anaerobic reactors with sludge blanket and fixed bed for wastewater treatment from coffee processing by wet method

In this study it was evaluated the start-up procedures of anaerobic treatment system with three horizontal anaerobic reactors (R1, R2 and R3), installed in series, with volume of 1.2 L each. R1 had sludge blanket, and R2 and R3 had half supporter of bamboo and coconut fiber, respectively. As an affluent, it was synthesized wastewater from mechanical pulping of the coffee fruit by wet method, with a mean value of total chemical oxygen demand (CODtotal) of 16,003 mg L-1. The hydraulic retention time (HRT) in each reactor was 30 h. The volumetric organic loading (VOL) applied in R1 varied from 8.9 to 25.0 g of CODtotal (L d)-1. The mean removal efficiencies of CODtotal varied from 43 to 97% in the treatment system (R1+R2+R3), stabilizing above 80% after 30 days of operation. The mean content of methane in the biogas were of 70 to 76%, the mean volumetric production was 1.7 L CH4 (L reactor d)-1 in the system, and the higher conversions were around at 0.20 L CH4 (g CODremoved)-1 in R1 and R2. The mean values of pH in the effluents ranged from 6.8 to 8.3 and the mean values of total volatile acids remained below 200 mg L-1 in the effluent of R3. The concentrations of total phenols of the affluent ranged from 45 to 278 mg L-1, and the mean removal efficiency was of 52%. The start-up of the anaerobic treatment system occurred after 30 days of operation as a result of inoculation with anaerobic sludge with active microbiota.

Horizontal pressures in cylindrical metal silos and comparison with different international standards

The focus of this research was to evaluate the horizontal pressures on a cylindrical metal silo of corrugated walls and flat bottom with 1.82m diameter and 5.4m high, and to compare the values with those obtained theoretically by the ISO 11697, EP 433 and AS 3774 standards. The silo was symmetrically filled and constant speed with wheat cv. soft red for two different height/diameter ratios (H/D) and was unloaded through three orifices with a diameter of 71.6mm, one concentric and two eccentrics. Horizontal pressures were measured on the walls of the silo at three positions using hydraulic type pressure cells. The results showed that shortly after the start of the unloading, there was a mass flow above the quota of H/D = 1.2, whereas below this quota funnel flow occurred. It can be said that the EP 433 standard was more appropriate to predict horizontal pressures in silos in H/D ratio = 1.0, with eccentric unloading. For the H/D ratio = 1.5, AS 3774 standard was the one that produced values closer to the experimental.

Start-up of anaerobic reactors for slaughterhouse wastewater treatment

This study aimed to evaluate the start-up of a horizontal anaerobic fixed bed reactor (HAFBR) followed by an upflow anaerobic sludge blanket (UASB) for the slaughterhouse wastewater treatment. HAFBR was filled with bamboo rings and had 1.2 m in length, 0.10 m in diameter and volume of 7.5 L. The UASB had the volume of 15 L. The HAFBR and UASB operated at organic loading rate and hydraulic retention time average of 8.46 and 3.77 kg m-3 d-1 of COD and 0.53 and 0.98 days, respectively. During 150 days of monitoring system it was found pH 6.8, relatively high values of bicarbonate alkalinity (> 1000 mg L-1) and reduced values of volatile acids (70 to 150 mg L-1), which afforded average removal efficiencies of COD total and total suspended solids of the order of 31 and 23% in HAFBR and 79% and 63% in UASB. It can be concluded that the generation and consumption of bicarbonate alkalinity and total volatile acids, thereby maintaining the pH during the study indicated stable operation of the reactors. The COD removal in the reactors was satisfactory especially when it considers that the assessment was conducted in a period of adaptation of organisms to the effluent and also the high organic load applied during this period.

Finnish Institutional Innovation Support Policies from Russian Entrepreneurs' Perspective: Establishing Cross-Border Technology Oriented Start-Up Firm

The purpose of this thesis is to study how Russian entrepreneurs perceive Finnish institutional environment and innovation support policies provided in the country, as well as to present a practical example in form of a case study of one technology oriented start-up firm which was established in Finland by Russian entrepreneurs. The empirical research of the thesis is conducted qualitatively in two parts. First part is conducted through online questionnaire with open questions in order to review the perceptions of Russian entrepreneurs in general. Second part is based on personal interviews with case company’s founders with the focus on the process of establishing the company in Finland. In the first part of the empirical research, five Russian start-up firms were contacted, and four responses were received. All of these responses were qualified for further analysis. The findings of the first part of the research reveal that Russian entrepreneurs have rather positive attitudes towards Finnish institutional innovation support policies. However, most of the entrepreneurs stated that they are unlikely to create their presence in Finland. As an outcome of the second part of the research, the process of establishing a case company in Finland is illustrated. In order to be able to establish companies in Finland, Russian entrepreneurs who have a permanent residence outside European Economic Area (EEA) are required to apply for a permission to perform business operations in the country. In addition, the established company must engage in improving the economical stand of the country by creating new work places, raising tax revenues, develop technologies and generate innovations in the country.

Dispersal and metacommunity dynamics in a soft-sediment benthic system : how well is the seafloor connected?

Connectivity depends on rates of dispersal between communities. For marine soft-sediment communities continued small-scale dispersal as post-larvae and as adults can be equally important in maintaining community composition, as initial recruitment of substrate by pelagic larvae. In this thesis post-larval dispersal strategies of benthic invertebrates, as well as mechanisms by which communities are connected were investigated. Such knowledge on dispersal is scarce, due to the difficulties in actually measuring dispersal directly in nature, and dispersal has not previously been quantified in the Baltic Sea. Different trap-types were used underwater to capture dispersing invertebrates at different sites, while in parallel measuring waves and currents. Local community composition was found to change predictably under varying rates of dispersal and physical connectivity (waves and currents). This response was, however, dependent on dispersal-related traits of taxa. Actively dispersing taxa will be relatively better at maintaining their position, as they are not as dependent on hydrodynamic conditions for dispersal and will be less prone to be passively transported by currents. Taxa also dispersed in relative proportions that were distinctly different from resident community composition and a significant proportion (40 %) of taxa were found to lack a planktonic larval life-stage. Community assembly was re-started in a large-scale manipulative field experiment over one year across several sites, which revealed how patterns of community composition (α-, β- and λ-diversity) change depending on rates of dispersal. Results also demonstrated that in response to small-scale disturbance, initial recruitment was by nearby-dominant species after which other species arrived from successively further away. At later assembly time, the number of coexisting species increased beyond what was expected purely by local niche requirements (species sorting), transferring regional differences in community composition (β-diversity) to the local scale (α-diversity, mass effect). Findings of this thesis complement more theoretical studies in metacommunity ecology by demonstrating that understanding how and when individuals disperse relative to underlying environmental heterogeneity is key to interpreting how patterns of diversity change across different spatial scales. Such information from nature is critical when predicting responses to, for example, different types of disturbances or management actions in conservation.