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.

Outer membrane vesicles from cold-adapted antarctic bacteria

Many Gram-negative, cold-adapted bacteria from the Antarctic environment produce large amounts of extracellular matter with potential biotechnological applications. Transmission electron microscopy (TEM) analysis after high-pressure freezing and freeze substitution (HPF-FS) showed that this extracellular matter is structurally complex, appearing around cells as a netlike mesh, and composed of an exopolymeric substance (EPS) containing large numbers of outer membrane vesicles (OMVs). Isolation, purification and protein profiling via 1D SDS-PAGE confirmed the outer membrane origin of these Antarctic bacteria OMVs. In an initial attempt to elucidate the role of OMVs in cold-adapted strains of Gram-negative bacteria, a proteomic analysis demonstrated that they were highly enriched in outer membrane proteins and periplasmic proteins associated with nutrient processing and transport, suggesting that the OMVs may be involved in nutrient sensing and bacterial survival. OMVs from Gram-negative bacteria are known to play a role in lateral DNA transfer, but the presence of DNA in these vesicles has remained difficult to explain. A structural study of Shewanella vesiculosa M7T using TEM and Cryo-TEM revealed that this Antarctic Gram-negative bacterium naturally releases conventional one-bilayer OMVs, together with a more complex type of OMV, previously undescribed, which on formation drags along inner membrane and cytoplasmic content and can therefore also entrap DNA.

Outer membrane vesicles from cold-adapted antarctic bacteria

Many Gram-negative, cold-adapted bacteria from the Antarctic environment produce large amounts of extracellular matter with potential biotechnological applications. Transmission electron microscopy (TEM) analysis after high-pressure freezing and freeze substitution (HPF-FS) showed that this extracellular matter is structurally complex, appearing around cells as a netlike mesh, and composed of an exopolymeric substance (EPS) containing large numbers of outer membrane vesicles (OMVs). Isolation, purification and protein profiling via 1D SDS-PAGE confirmed the outer membrane origin of these Antarctic bacteria OMVs. In an initial attempt to elucidate the role of OMVs in cold-adapted strains of Gram-negative bacteria, a proteomic analysis demonstrated that they were highly enriched in outer membrane proteins and periplasmic proteins associated with nutrient processing and transport, suggesting that the OMVs may be involved in nutrient sensing and bacterial survival. OMVs from Gram-negative bacteria are known to play a role in lateral DNA transfer, but the presence of DNA in these vesicles has remained difficult to explain. A structural study of Shewanella vesiculosa M7T using TEM and Cryo-TEM revealed that this Antarctic Gram-negative bacterium naturally releases conventional one-bilayer OMVs, together with a more complex type of OMV, previously undescribed, which on formation drags along inner membrane and cytoplasmic content and can therefore also entrap DNA.

Calculation of the critical crack size for cold form rectangular hollow section tube (CRHS) under bending load at -40º C temperature

To predict the capacity of the structure or the point which is followed by instability, calculation of the critical crack size is important. Structures usually contain several cracks but not necessarily all of these cracks lead to failure or reach the critical size. So, defining the harmful cracks or the crack size which is the most leading one to failure provides criteria for structure’s capacity at elevated temperature. The scope of this thesis was to calculate fracture parameters like stress intensity factor, the J integral and plastic and ultimate capacity of the structure to estimate critical crack size for this specific structure. Several three dimensional (3D) simulations using finite element method by Ansys program and boundary element method by Frank 3D program were carried out to calculate fracture parameters and results with the aid of laboratory tests (loaddisplacement curve, the J resistance curve and yield or ultimate stress) leaded to extract critical size of the crack. Two types of the fracture which is usually affected by temperature, Elastic and Elasti-Plastic fractures were simulated by performing several linear elastic and nonlinear elastic analyses. Geometry details of the weldment; flank angle and toe radius were also studied independently to estimate the location of crack initiation and simulate stress field in early stages of crack extension in structure. In this work also overview of the structure’s capacity in room temperature (20 ºC) was studied. Comparison of the results in different temperature (20 ºC and -40 ºC) provides a threshold of the structure’s behavior within the defined range.

Organic and total mercury determination in sediments by cold vapor atomic absorption spectrometry: methodology validation and uncertainty measurements

The purpose of the present study was to validate a method for organic Hg determination in sediment. The procedure for organic Hg was adapted from literature, where the organomercurial compounds were extracted with dichloromethane in acid medium and subsequent destruction of organic compounds by bromine chloride. Total Hg was performed according to 3051A USEPA methodology. Mercury quantification for both methodologies was then performed by CVAAS. Methodology validation was verified by analyzing certified reference materials for total Hg and methylmercury. The uncertainties for both methodologies were calculated. The quantification limit of 3.3 µg kg-1 was found for organic Hg by CVAAS.

Wind turbine operation in cold climate

The goal of the master‘s thesis is to determine and estimate ice accretion influence on the wind turbine blade performance. The thesis describes the technique of ice accretion calculation on the wind turbine blade and determination characteristics of the turbine with ice accreted. The methodology of the classic Blade Element Moment Theory was used. Iced blade experimental data was investigated in order to calculate blade with ice characteristics. The obtained results shows that iced blade power coefficient is lower than clean blade one. The heating system implementation shows that in the particular site in the Lapland region it is efficient.

Exiles and Constituents: Baltic Refugees and American Cold War Politics, 1948- 1960

This dissertation explores the complicated relations between Estonian, Latvian, and Lithuanian postwar refugees and American foreign policymakers between 1948 and 1960. There were seemingly shared interests between the parties during the first decade of the Cold War. Generally, Eastern European refugees refused to recognize Soviet hegemony in their homelands, and American policy towards the Soviet bloc during the Truman and Eisenhower administrations sought to undermine the Kremlin’s standing in the region. More specifically, Baltic refugees and State Department officials sought to preserve the 1940 non-recognition policy towards the Soviet annexation of the Baltic States. I propose that despite the seemingly natural convergence of interests, the American experiment of constructing a State-Private network revolving around fostering relations with exile groups was fraught with difficulties. These difficulties ultimately undermined any ability that the United States might have had to liberate the Baltic States from the Soviet Union. As this dissertation demonstrates, Baltic exiles were primarily concerned with preserving a high level of political continuity to the interwar republics under the assumption that they would be able to regain their positions in liberated, democratic societies. American policymakers, however, were primarily concerned with maintaining the non-recognition policy, the framework in which all policy considerations were analyzed. I argue that these two motivating factors created unnecessary tensions in American policy towards the Baltic republics in the spheres of psychological warfare as well as exile unity in the United States and Europe. Despite these shortcomings, I argue that out of the exiles’ failings was born a generation of Baltic constituents that blurred the political legitimacy line between exiles who sought to return home and ethnic Americans who were loyal to the United States. These Baltic constituents played an important role in garnering the support of the United States Congress, starting in the 1950s, but became increasingly influential after the 1956 Hungarian Revolution, despite the seemingly less important role Eastern Europe played in the Cold War. The actions of the Baltic constituents not only prevented the Baltic question from being forever lost in the memory hole of history, but actually created enough political pressure on the State Department that it was impossible to alter the long-standing policy of not recognizing the Soviet annexation of the Baltic States.

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.