A Data Mining Approach for the Identification of Adverse Drug Events (ADE) resulting from Drug-Drug Interactions (DDI) to improve pharmacovigilance

In the current study, epidemiology study is done by means of literature survey in groups identified to be at higher potential for DDIs as well as in other cases to explore patterns of DDIs and the factors affecting them. The structure of the FDA Adverse Event Reporting System (FAERS) database is studied and analyzed in detail to identify issues and challenges in data mining the drug-drug interactions. The necessary pre-processing algorithms are developed based on the analysis and the Apriori algorithm is modified to suit the process. Finally, the modules are integrated into a tool to identify DDIs. The results are compared using standard drug interaction database for validation. 31% of the associations obtained were identified to be new and the match with existing interactions was 69%. This match clearly indicates the validity of the methodology and its applicability to similar databases. Formulation of the results using the generic names expanded the relevance of the results to a global scale. The global applicability helps the health care professionals worldwide to observe caution during various stages of drug administration thus considerably enhancing pharmacovigilance

An approximate Bayesian computation approach to overcome biases that arise when using amplified fragment length polymorphism markers to study population structure

There is great interest in using amplified fragment length polymorphism (AFLP) markers because they are inexpensive and easy to produce. It is, therefore, possible to generate a large number of markers that have a wide coverage of species genotnes. Several statistical methods have been proposed to study the genetic structure using AFLP's but they assume Hardy-Weinberg equilibrium and do not estimate the inbreeding coefficient, F-IS. A Bayesian method has been proposed by Holsinger and colleagues that relaxes these simplifying assumptions but we have identified two sources of bias that can influence estimates based on these markers: (i) the use of a uniform prior on ancestral allele frequencies and (ii) the ascertainment bias of AFLP markers. We present a new Bayesian method that avoids these biases by using an implementation based on the approximate Bayesian computation (ABC) algorithm. This new method estimates population-specific F-IS and F-ST values and offers users the possibility of taking into account the criteria for selecting the markers that are used in the analyses. The software is available at our web site (http://www-leca.uif-grenoble.fi-/logiciels.htm). Finally, we provide advice on how to avoid the effects of ascertainment bias.

A formação do projeto teórico de Michel Pêcheux: de uma teoria geral das ideologias à análise do discurso

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

O Brasil na historiografia inglesa dos anos joaninos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Comparação de métodos de dimensionamento de muros em solo reforçado através de programas computacionais

Dans ces dernières années, plusieurs méthodes de dimensionnement d'ouvrages de soutènement en sol renforcé ont été développés, mais la doute c’est où l'utilisation de chacun d'eux se révèle plus avantageux? Ce travail a été conçu avec l'objectif de faire une étude d’un cas historiques d'un mur en remblais renforcé avec parement végétal de 27,6 mètres de haut, dont la conception a été analysé en utilisant une méthode de calcul et des logiciels informatiques spécifiques à l’utilisation dans le domaine géotechnique. Avec cette étudesont attendus de résultats capable de présenter les principales caractéristiques de chaque méthode et où il peut le mieux être appliquée

Prevalence and Predictors of Potential Drug-Drug Interactions in the Elderly: A Cross-Sectional Study in the Brazilian Primary Public Health System

Purpose. The primary objective of this study was to investigate the prevalence of clinically important potential drug-drug interactions (DDIs) in elderly patients attending the public primary health care system in Brazil. The secondary objective was to investigate possible predictors of potential DDIs. Methods. A cross-sectional study was carried out in 5 Brazilian cities located in the Ourinhos Micro-region, Sao Paulo State, between November 2010 and April 2011. The selected sample was divided according to the presence (exposed) or absence (unexposed) of one or more potential DDIs (defined as the presence of a minimum 5-day overlap in supply of an interacting drug pair). Data were collected from medical prescriptions and patients' medical records. Potential DDIs (rated major or moderate) were identified using 4 DDI-checker programs. Logistic regression analysis was used to study potential DDI predictors. Results. The prevalence of clinically important potential DDIs found during the study period was 47.4%. Female sex (OR = 2.49 [95% CI 2.29-2.75]), diagnosis of = 3 diseases (OR = 6.43 [95% CI 3.25-12.44]), and diagnosis of hypertension (OR = 1.68 [95% CI 1.23-2.41]) were associated with potential DDIs. The adjusted OR increased from 0.90 [95% CI 0.82-1.03] in patients aged 60 - 64 years to 4.03 [95% CI 3.79 - 4.28] in those aged 75 years or older. Drug therapy regimens involving = 2 prescribers (OR = 1.39 [95% CI 1.17-1.67]), = 3 drugs (OR = 3.21 [95% CI 2.78-3.59]), = 2 ATC codes (OR = 1.19 [95% CI 1.12-1.29]), = 2 drugs acting on cytochrome P450 (OR = 2.24 [95% CI 2.07-2.46]), and ATC codes B (OR = 1.89 [95% CI 1.05-2.08]) and C (OR = 4.01 [95% CI 3.55-4.57]) were associated with potential DDIs. Conclusion. Special care should be taken with the prescription and therapeutic follow-up of patients who present characteristics identified as predictors. Knowledge of potential DDI predictors could aid in developing preventive practices and policies that allow public health services to better manage this situation.

Incidence and Predictors of Adverse Drug Reactions Caused by Drug-Drug Interactions in Elderly Outpatients: A Prospective Cohort Study

Purpose. The primary objective of this study was to investigate the incidence of drug-drug interactions (DDIs) related to adverse drug reactions (ADRs) in elderly outpatients who attended public primary healthcare units in a southeastern region of Brazil. The secondary objective was to investigate the possible predictors of DDI-related ADRs. Methods. A prospective cohort study was conducted between November 1, 2010, and November 31, 2011, in the primary public healthcare system in the Ourinhos micro-region in Brazil. Patients who were at least 60 years old, with at least one potential DDI, were eligible for inclusion in the study. Eligible patients were assessed by clinical pharmacists for DDI-related ADRs for 4 months. The causality of DDI-related ADRs was assessed independently by four clinicians using three decisional algorithms. The incidence of DDI-related ADRs during the study period was calculated. Logistic regression analysis was used to study DDI-related ADR predictors. Results. A total of 433 patients completed the study. The incidence of DDI-related ADRs was 6.5%. A multivariate analysis indicated that the adjusted odds ratios (ORs) rose from 0.91 (95% confidence interval [CI] = 0.75-1.12, p = 0.06) in patients aged 65-69 years to 4.40 (95% CI = 3.00-6.12, p < 0.01) in patients aged 80 years or older. Patients who presented two to three diagnosed diseases presented lower adjusted ORs (OR = 0.93 [95% CI = 0.68-1.18, p = 0.08]) than patients who presented six or more diseases (OR = 1.12 [95% CI = 1.02-2.01, p < 0.01]). Elderly patients who took five or more drugs had a significantly higher risk of DDI-related ADRs (OR = 2.72 [95% CI = 1.92-3.12, p < 0.01]) than patients who took three to four drugs (OR = 0.93 [95% CI = 0.74-1.11, p = 0.06]). No significant difference was found with regard to sex (OR = 1.08 [95% CI 0.48-2.02, p = 0.44]). Conclusion. The incidence of DDI-related ADRs in elderly outpatients was significant, and most of the events presented important clinical consequences. Because clinicians still have difficulty managing this problem, highlighting the factors that increase the risk of DDI-related ADRs is essential. Polypharmacy was found to be a significant predictor of DDI-related ADRs in our sample.

Potential Drug-Drug Interactions in Prescriptions to Patients over 45 Years of Age in Primary Care, Southern Brazil

Background: Few cross-sectional studies involving adults and elderly patients with major DDIs have been conducted in the primary care setting. The study aimed to investigate the prevalence of potential drug-drug interactions (DDIs) in patients treated in primary care. Methodology/Principal Findings: A cross-sectional study involving patients aged 45 years or older was conducted at 25 Basic Health Units in the city of Maringa (southern Brazil) from May to December 2010. The data were collected from prescriptions at the pharmacy of the health unit at the time of the delivery of medication to the patient. After delivery, the researcher checked the electronic medical records of the patient. A total of 827 patients were investigated (mean age: 64.1; mean number of medications: 4.4). DDIs were identified in the Micromedex (R) database. The prevalence of potential DDIs and major DDIs was 63.0% and 12.1%, respectively. In both the univariate and multivariate analyses, the number of drugs prescribed was significantly associated with potential DDIs, with an increasing risk from three to five drugs (OR = 4.74; 95% CI: 2.90-7.73) to six or more drugs (OR = 23.03; 95% CI: 10.42-50.91). Forty drugs accounted for 122 pairs of major DDIs, the most frequent of which involved simvastatin (23.8%), captopril/enalapril (16.4%) and fluoxetine (16.4%). Conclusions/Significance: This is the first large-scale study on primary care carried out in Latin America. Based on the findings, the estimated prevalence of potential DDIs was high, whereas clinically significant DDIs occurred in a smaller proportion. Exposing patients to a greater number of prescription drugs, especially three or more, proved to be a significant predictor of DDIs. Prescribers should be more aware of potential DDIs. Future studies should assess potential DDIs in primary care over a longer period of time.

Adverse drug reactions caused by drug-drug interactions in elderly outpatients: a prospective cohort study

Although the prevalence of drug-drug interactions (DDIs) in elderly outpatients is high, many potential DDIs do not have any actual clinical effect, and data on the occurrence of DDI-related adverse drug reactions (ADRs) in elderly outpatients are scarce. This study aimed to determine the incidence and characteristics of DDI-related ADRs among elderly outpatients as well as the factors associated with these reactions. A prospective cohort study was conducted between 1 November 2010 and 31 November 2011 in the primary public health system of the Ourinhos micro-region, Brazil. Patients aged a parts per thousand yen60 years with at least one potential DDI were eligible for inclusion. Causality, severity, and preventability of the DDI-related ADRs were assessed independently by four clinicians using validated methods; data were analysed using descriptive analysis and multiple logistic regression. A total of 433 patients completed the study. The incidence of DDI-related ADRs was 6 % (n = 30). Warfarin was the most commonly involved drug (37 % cases), followed by acetylsalicylic acid (17 %), digoxin (17 %), and spironolactone (17 %). Gastrointestinal bleeding occurred in 37 % of the DDI-related ADR cases, followed by hyperkalemia (17 %) and myopathy (13 %). The multiple logistic regression showed that age a parts per thousand yen80 years [odds ratio (OR) 4.4; 95 % confidence interval (CI) 3.0-6.1, p < 0.01], a Charlson comorbidity index a parts per thousand yen4 (OR 1.3; 95 % CI 1.1-1.8, p < 0.01), consumption of five or more drugs (OR 2.7; 95 % CI 1.9-3.1, p < 0.01), and the use of warfarin (OR 1.7; 95 % CI1.1-1.9, p < 0.01) were associated with the occurrence of DDI-related ADRs. With regard to severity, approximately 37 % of the DDI-related ADRs detected in our cohort necessitated hospital admission. All DDI-related ADRs could have been avoided (87 % were ameliorable and 13 % were preventable). The incidence of ADRs not related to DDIs was 10 % (n = 44). The incidence of DDI-related ADRs in elderly outpatients is high; most events presented important clinical consequences and were preventable or ameliorable.

Sistemi tecnologici innovativi di involucro per il recupero del patrimonio edilizio recente. L'edilizia scolastica nel Comune di Bologna

La ricerca è volta a presentare un nuovo approccio integrato, a supporto di operatori e progettisti, per la gestione dell’intero processo progettuale di interventi di riqualificazione energetica e architettonica del patrimonio edilizio recente, mediante l’impiego di soluzioni tecnologiche innovative di involucro edilizio. Lo studio richiede necessariamente l’acquisizione di un repertorio selezionato di sistemi costruttivi di involucro, come base di partenza per l’elaborazione di soluzioni progettuali di recupero delle scuole appartenenti al secondo dopoguerra, in conglomerato cementizio armato, prevalentemente prefabbricate. Il progetto individua procedimenti costruttivi ecocompatibili per la progettazione di componenti prefabbricati di involucro “attivo”, adattabile ed efficiente, da assemblare a secco, nel rispetto dei requisiti prestazionali richiesti dalle attuali normative. La ricerca è finalizzata alla gestione dell’intero processo, supportato da sistemi di rilevazione geometrica, collegati a software di programmazione parametrica per la modellazione di superfici adattabili alla morfologia dei fabbricati oggetto di intervento. Tali strumenti informatizzati CAD-CAM sono connessi a macchine a controllo numerico CNC per la produzione industrializzata degli elementi costruttivi “su misura”. A titolo esemplificativo dell’approccio innovativo proposto, si formulano due possibili soluzioni di involucro in linea con i paradigmi della ricerca, nel rispetto dei principi di sostenibilità, intesa come modularità, rapidità di posa, reversibilità, recupero e riciclo di materiali. In particolare, le soluzioni innovative sono accomunate dall’applicazione di una tecnica basata sull’assemblaggio di elementi prefabbricati, dall’adozione di una trama esagonale per la tassellazione della nuova superficie di facciata, e dall’utilizzo del medesimo materiale termico isolante, plastico e inorganico, riciclato ed ecosostenibile, a basso impatto ambientale (AAM - Alkali Activated Materials). Le soluzioni progettuali proposte, sviluppate presso le due sedi coinvolte nella cotutela (Università di Bologna, Université Paris-Est) sono affrontate secondo un protocollo scientifico che prevede: progettazione del sistema costruttivo, analisi meccanica e termica, sperimentazione costruttiva, verifica delle tecniche di messa in opera e dei requisiti prestazionali.

APS-Inserateanalyse der eidgenössischen Abstimmungen vom 9. Februar 2014

Die vorliegende APS-Inserateanalyse beschäftigt sich mit den eidgenössischen Abstimmungen vom 9. Februar 2014. Im ersten Kapitel werden die drei Vorlagen (FABI, Volksinitiative zur Abtreibungsfinanzierung und Masseneinwanderungsinitiative) hinsichtlich allgemeiner Kriterien miteinander verglichen. Dabei werden zunächst mit der Intensität und der Ausrichtung der verschiedenen Inseratekampagnen die zwei Hauptindikatoren präsentiert. An-schliessend erfolgt die Analyse der Platzierung der Anzeigen nach Pressegattungen sowie zeitlichen und geografischen Aspekten. In den Kapiteln 2-4 stehen vorlagenspezifische Eigenschaften im Vordergrund. In einem ersten Schritt werden für jede Vorlage die meist verwendeten Inseratetypen vorgestellt. Danach wird auf den Inhalt sowie auf die AbsenderInnen der Hauptbotschaften eingegangen. Falls es die Anzahl der verfügbaren Inserate erlaubt, werden drittens die Determinanten der zentralen Botschaften mit Hilfe von statistischen Verfahren unter die Lupe genommen. Für die Masseneinwanderungsinitiative (Kapitel 4) wurde eine ausführliche Spezialanalyse durchgeführt, mit der die Kampagnen der beiden Lager nach spezifischer Mobilisierung untersucht werden. Das fünfte Kapitel schliesst mit einem Fazit.

Nuevas arquitecturas de transpondedores de microondas = New transponder architectures at microwave frequencies = Nouvelles architectures des transpondeurs d’hyperfréquences

En la última década, los sistemas de telecomunicación de alta frecuencia han evolucionado tremendamente. Las bandas de frecuencias, los anchos de banda del usuario, las técnicas de modulación y otras características eléctricas están en constante cambio de acuerdo a la evolución de la tecnología y la aparición de nuevas aplicaciones. Las arquitecturas de los transceptores modernos son diferentes de las tradicionales. Muchas de las funciones convencionalmente realizadas por circuitos analógicos han sido asignadas gradualmente a procesadores digitales de señal, de esta manera, las fronteras entre la banda base y las funcionalidades de RF se difuminan. Además, los transceptores inalámbricos digitales modernos son capaces de soportar protocolos de datos de alta velocidad, por lo que emplean una elevada escala de integración para muchos de los subsistemas que componen las diferentes etapas. Uno de los objetivos de este trabajo de investigación es realizar un estudio de las nuevas configuraciones en el desarrollo de demostradores de radiofrecuencia (un receptor y un transmisor) y transpondedores para fines de comunicaciones y militares, respectivamente. Algunos trabajos se han llevado a cabo en el marco del proyecto TECRAIL, donde se ha implementado un demostrador de la capa física LTE para evaluar la viabilidad del estándar LTE en el entorno ferroviario. En el ámbito militar y asociado al proyecto de calibración de radares (CALRADAR), se ha efectuado una actividad importante en el campo de la calibración de radares balísticos Doppler donde se ha analizado cuidadosamente su precisión y se ha desarrollado la unidad generadora de Doppler de un patrón electrónico para la calibración de estos radares. Dicha unidad Doppler es la responsable de la elevada resolución en frecuencia del generador de “blancos” radar construido. Por otro lado, se ha elaborado un análisis completo de las incertidumbres del sistema para optimizar el proceso de calibración. En una segunda fase se han propuesto soluciones en el desarrollo de dispositivos electro-ópticos para aplicaciones de comunicaciones. Estos dispositivos son considerados, debido a sus ventajas, tecnologías de soporte para futuros dispositivos y subsistemas de RF/microondas. Algunas demandas de radio definida por software podrían cubrirse aplicando nuevos conceptos de circuitos sintonizables mediante parámetros programables de un modo dinámico. También se ha realizado una contribución relacionada con el diseño de filtros paso banda con topología “Hairpin”, los cuales son compactos y se pueden integrar fácilmente en circuitos de microondas en una amplia gama de aplicaciones destinadas a las comunicaciones y a los sistemas militares. Como importante aportación final, se ha presentado una propuesta para ecualizar y mejorar las transmisiones de señales discretas de temporización entre los TRMs y otras unidades de procesamiento, en el satélite de última generación SEOSAR/PAZ. Tras un análisis exhaustivo, se ha obtenido la configuración óptima de los buses de transmisión de datos de alta velocidad basadas en una red de transceptores. ABSTRACT In the last decade, high-frequency telecommunications systems have extremely evolved. Frequency bands, user bandwidths, modulation techniques and other electrical characteristics of these systems are constantly changing following to the evolution of technology and the emergence of new applications. The architectures of modern transceivers are different from the traditional ones. Many of the functions conventionally performed by analog circuitry have gradually been assigned to digital signal processors. In this way, boundaries between baseband and RF functionalities are diffused. The design of modern digital wireless transceivers are capable of supporting high-speed data protocols. Therefore, a high integration scale is required for many of the components in the block chain. One of the goals of this research work is to investigate new configurations in the development of RF demonstrators (a receiver and a transmitter) and transponders for communications and military purposes, respectively. A LTE physical layer demonstrator has been implemented to assess the viability of LTE in railway scenario under the framework of the TECRAIL project. An important activity, related to the CALRADAR project, for the calibration of Doppler radars with extremely high precision has been performed. The contribution is the Doppler unit of the radar target generator developed that reveals a high frequency resolution. In order to assure the accuracy of radar calibration process, a complete analysis of the uncertainty in the above mentioned procedure has been carried out. Another important research topic has been the development of photonic devices that are considered enabling technologies for future RF and microwave devices and subsystems. Some Software Defined Radio demands are addressed by the proposed novel circuit concepts based on photonically tunable elements with dynamically programmable parameters. A small contribution has been made in the field of Hairpin-line bandpass filters. These filters are compact and can also be easily integrated into microwave circuits finding a wide range of applications in communication and military systems. In this research field, the contributions made have been the improvements in the design and the simulations of wideband filters. Finally, an important proposal to balance and enhance transmissions of discrete timing signals between TRMs and other processing units into the state of the art SEOSAR/PAZ Satellite has been carried out obtaining the optimal configuration of the high-speed data transmission buses based on a transceiver network. RÉSUMÉ Les systèmes d'hyperfréquence dédiés aux télécommunications ont beaucoup évolué dans la dernière décennie. Les bandes de fréquences, les bandes passantes par utilisateur, les techniques de modulation et d'autres caractéristiques électriques sont en constant changement en fonction de l'évolution des technologies et l'émergence de nouvelles applications. Les architectures modernes des transcepteurs sont différentes des traditionnelles. Un grand nombre d’opérations normalement effectuées par les circuits analogiques a été progressivement alloué à des processeurs de signaux numériques. Ainsi, les frontières entre la bande de base et la fonctionnalité RF sont floues. Les transcepteurs sans fils numériques modernes sont capables de transférer des données à haute vitesse selon les différents protocoles de communication utilisés. C'est pour cette raison qu’un niveau élevé d'intégration est nécessaire pour un grand nombre de composants qui constitue les différentes étapes des systèmes. L'un des objectifs de cette recherche est d'étudier les nouvelles configurations dans le développement des démonstrateurs RF (récepteur et émetteur) et des transpondeurs à des fins militaire et de communication. Certains travaux ont été réalisés dans le cadre du projet TECRAIL, où un démonstrateur de la couche physique LTE a été mis en place pour évaluer la faisabilité de la norme LTE dans l'environnement ferroviaire. Une contribution importante, liée au projet CALRADAR, est proposée dans le domaine des systèmes d’étalonnage de radar Doppler de haute précision. Cette contribution est le module Doppler de génération d’hyperfréquence intégré dans le système électronique de génération de cibles radar virtuelles que présente une résolution de fréquence très élevée. Une analyse complète de l'incertitude dans l'étalonnage des radars Doppler a été effectuée, afin d'assurer la précision du calibrage. La conception et la mise en oeuvre de quelques dispositifs photoniques sont un autre sujet important du travail de recherche présenté dans cette thèse. De tels dispositifs sont considérés comme étant des technologies habilitantes clés pour les futurs dispositifs et sous-systèmes RF et micro-ondes grâce à leurs avantages. Certaines demandes de radio définies par logiciel pourraient être supportées par nouveaux concepts de circuits basés sur des éléments dynamiquement programmables en utilisant des paramètres ajustables. Une petite contribution a été apportée pour améliorer la conception et les simulations des filtres passe-bande Hairpin à large bande. Ces filtres sont compacts et peuvent également être intégrés dans des circuits à micro-ondes compatibles avec un large éventail d'applications dans les systèmes militaires et de communication. Finalement, une proposition a été effectuée visant à équilibrer et améliorer la transmission des signaux discrets de synchronisation entre les TRMs et d'autres unités de traitement dans le satellite SEOSAR/PAZ de dernière génération et permettant l’obtention de la configuration optimale des bus de transmission de données à grande vitesse basés sur un réseau de transcepteurs.

Les mères avec un trouble de personnalité limite en protection de la jeunesse : un paradoxe entre les difficultés et les services

Une proportion significative de mères d’enfants pris en charge par la protection de la jeunesse souffrirait d’un trouble de personnalité limite (TPL). En effet, les difficultés parentales associées à ce trouble prédisposent davantage à des situations d’abus ou de négligence envers leurs enfants. Cependant, il existe peu d’information sur les difficultés et les besoins de ces mères dans ce contexte particulier. Cette étude qualitative a été réalisée auprès de 30 mères avec un TPL et dont au moins un enfant était suivi par le Centre jeunesse de Montréal-Institut universitaire. La présente étude a permis de mieux décrire les difficultés des mères en lien avec leur TPL, leurs enfants et leur situation conjugale. Leurs expériences des services en protection de la jeunesse ont révélé des suivis instables et peu adaptés à leurs difficultés. Les mères ont abordé l’importance des qualités relationnelles des intervenants à l’établissement d’une collaboration de la part des intervenants et l’importance de mettre en place des services spécifiquement dédiés aux parents. Il semblerait pertinent d’adapter les services de protection de la jeunesse afin d’inclure des interventions qui ciblent les difficultés spécifiques des parents qui ont un TPL, notamment en ce qui a trait à leurs habiletés parentales.

A.A. Milne - When We Were Very Young : cycle éclectique de chansons pour enfants, chanté par des enfants

Les fichiers qui accompagnent mon document on été réalisés avec les logiciels Microsoft Word et Finale.

A.A. Milne - When We Were Very Young : cycle éclectique de chansons pour enfants, chanté par des enfants

Les fichiers qui accompagnent mon document on été réalisés avec les logiciels Microsoft Word et Finale.