214: Interpreting troponin elevation in relation to symptom onset in intermediate-risk pulmonary embolism

BackgroundTroponin elevation in the setting of acute pulmonary embolism (PE) is of small magnitude and short duration and can go unnoticed in pts referred late after symptom onset.MethodsProspective, single-center registry of pts with confirmed intermediate-risk PE, defined as at least 1 echocardiographic finding of right ventricular (RV) dysfunction (endo-diastolic (EDRV)/left ventricular (EDLV) end-diastolic diameter ratio >=1 in the 4-chamber view, paradoxical septal systolic motion or pulmonary hypertension defined as RV/atrial gradient >30mmHg), or positive troponin test. Combined in-hospital endpoint was defined as death, non-fatal recurrent PE, or residual pulmonary vascular obstruction (RPVO) ≥35%.Results282 pts were included, age 66±14 years, 59% women, 174 (62%) referred ≤5 days after symptom onset, 108 (38%) after >5 days. Troponin elevation was observed in 126 (72%) treated within ≤5 days, in 60 (56%) treated after >5 days (p=0.004). A significant interaction was observed between time since symptom onset and both troponin elevation and persistence of EDRV/EDLV diameter ratio>1 at 48h. The negative predictive value of troponin elevation was 85% in patients treated within 5 days of symptoms, but fell to 70% in those admitted >5 days after symptom onset (p=0.002). Positive troponin was an independent predictor of adverse outcome (OR=1.43 [1.08-5.56]). ROC curves show that prognostic value of positive troponin test was higher in pts referred ≤5 days than in pts referred >5 days after symptom onset (p=0.01).ConclusionThere is a significant relation between troponin elevation and time since symptom onset in patients with intermediate-risk PE. Negative predictive value of troponin elevation is adequate in pts treated early (≤5 days) but is suboptimal in pts treated >5 days after symptom onset.TableResults<=5 days since symptom onset>5 days since symptom onsetpSensitivity72% (61.3-82.7)51% (42.4-59.6)0.005Specificity42% (44.5-49.5)47% (39.1-54.9)0.33PPV26% (18.4-33.6)30% (22.2-37.8)0.81NPV85% (78.4-91.6)70% (63-77)0.00

025 Benefit of Drug Eluting Stents over Bare Metal Stents after Rotational Atherectomy. A propensity score adjusted comparison in revascularization, mortality and MACE

RationaleRotational atherectomy makes possible to attempt small and calcified arteries while Drug Eluting Stents (DES) properties may reduce the restenosis process, rendering this combination attractive in selected cases. We compared 1year clinical outcome after rotational atherectomy following by either DES or Bare Metal Stents (BMS) implantation.MethodsSingle centre registry including all consecutive cases of rotational atherectomy use. Clinical follow-up was obtained in all patients. Propensity score for being treated with a DES was calculated using 18 clinical, angiographic and procedural variables. Comparison was adjusted on 4 strata of the propensity score.ResultsBetween 2002 and 2008, 223 patients were treated: 114 with BMS and 110 with DES. Most of the patients with BMS between 2002 and 2004 and later with DES. No significant difference was observed in clinical characteristics between groups: age 70 years, reference diameter 2.40±0.60mm, lesion length 10±9mm. Two cases of coronary perforation occurred, 7 lesion failure, and 12 transcient no-reflow. The use of GP2b3a inhibitors was similar in both groups, but, compared with BMS, patients in the DES group had longer duration of combination of aspirin and Clopidogrel. At one year, significantly lower rates of vessel revascularisation (2% vs 12%, p=0.005), of all cause mortality (5% vs 14%, p=0.05) and of MACE (10% vs 22%, p=0.02) were observed in the DES than in the BMS group. Adjustment on the strata of the propensity score did not change significantly these results (figure).ConclusionsDespite propensity score adjusted, this comparison has limitations. After rotational atherectomy we observed clear benefit for DES implantation over BMS on vessel revascularisation, mortality and MACE rates

Supporter le drapé: les entretiens du corps et du vêtement dans le mouvement dansé de Loïe Fuller et Ola Maciejewska

What is the cause of body movement? Is it only physical? Is it pure will? In her performances, Ola Maciejewska slightly shifts the terms of these questions which particularly concern contemporary living arts. By adapting the use of a specific accessory – a large piece of fabric or drapery – strongly inspired by Loïe Fuller’s avant-garde serpentine dance, she questions the interactions between body and artifact, human and non-human. What if a non-human movement or strength could influence, work, even reinvent body’s potentialities? Thanks to drapery, Maciejewska overcomes the traditional dichotomy between the body usually associated with activity and the inert accessory, both to feel and to test the body’s limits. She suggests the essential hybridity of our body as well as the no less essential subversive function of what we bear or wear.Ola Maciejewska est une performeuse polonaise dont le travail porte sur l’interaction entre les arts vivants et la mode, au moyen d’un accessoire dont la fonction dans ses chorégraphies est loin d’être superficielle : le drapé. S’inspirant des travaux de Loïe Füller et notamment de sa danse serpentine qu’elle repense à nouveaux frais, Ola Maciejewska accompagne sa production artistique d’une réflexion d’importance sur le rapport entre le corps et la matière textile. À travers le drapé, ce « non-humain » comme elle le nomme, c’est le corps humain et l’origine du mouvement qui sont interrogés, mettant à mal les dichotomies traditionnelles, notamment entre le corps actif comme support et le vêtement passif comme objet porté. C’est à cette fonction subversive du drapé que s’intéressera notre article en étudiant son influence sur les états du corps tels qu’ils apparaissent dans le mouvement dansé.Ola Maciejewska é uma performer polonesa cujo trabalho trata da interação entre as artes vivas e a moda, por meio de um acessório que, em suas coreografias, exerce um papel muito longe de ser superficial: o tecido drapeado. Inspirando-se nos trabalhos de Loïe Füller (sobretudo em sua dança serpentina, que repensa de uma nova maneira), Ola Maciejewska leva em paralelo com sua produção artística uma importante reflexão sobre a relação entre o corpo e a matéria têxtil. Através do tecido – esse “não humano”, como o denomina –, é o corpo humano e a origem do movimento que são interrogados, pondo fim às dicotomias tradicionais, principalmente àquelas entre o corpo ativo, enquanto suporte, e a roupa passiva, enquanto objeto que se porta. É sobre essa função subversiva do traje que tratará nosso artigo, estudando sua influência sobre os estados do corpo tal como aparecem no movimento dançado

Drapery or the infinite clothing. A philosophical enquiry into the imaginary of drapery in images, texts and objects from the classical age to the contemporary period

Facilement réduit à une curiosité artistique ou à un ornement insignifiant, le drapé est en marges des discours et des théories, quelle que soit la discipline considérée. Absolument banal et omniprésent, ne laissant aucune prise à la pensée par son foisonnement, ou radicalement original et intempestif, il échappe là aussi à une forme de théorisation qui ne se réduirait pas à l’énumération de cas exemplaires. Contre ce clivage forcé, ce travail interroge tout d’abord l’unité prétendue de ce terme, qui agrège derrière un singulier trompeur, une myriade de significations, d’usages et de valeurs rarement distinguées. Ces considérations lexicales n’épuisent pas la portée du terme, mais forgent en retour une méthode originale pour aborder cet objet fuyant, en faisant le pari de rendre compte de ses multiples dimensions dans les images, les textes et les objets. Dans la veine bachelardienne, c’est à partir du concept d’imaginaire que l’on se propose d’articuler ces différentes dimensions dans leur dynamique et leurs influences réciproques, permettant des distinctions aussi cruciales que celle entre le drapé et le voile, ou celle entre le drapé et le pli. On perçoit alors la dimension exploratoire d’un tel motif qui traverse les arts, les pratiques et les gestes, et qui interroge le discours philosophique lui-même sur l’usage des métaphores vestimentaires et leur visée, jusqu’à remettre en question ce préjugé majeur : ce n’est pas contre les images et les apparences que la philosophie est restée muette au sujet du vêtement, mais c’est à partir d’un discours imagé que la philosophie a discrètement fait du vêtement, son objet.Easily reduced to an artistic curiosity or an insignificant ornament, drapery is on the margins of discourse and theory, whatever the discipline considered. Absolutely banal and omnipresent, leaving no room for thought due to its abundance, or radically original and untimely, it also escapes a form of theorization that cannot not be reduced to the enumeration of exemplary cases. Against this forced division, this work first questions the alleged unity of this term, which aggregates behind a deceptive singularity, a myriad of meanings, uses and values rarely distinguished. These lexical considerations do not exhaust the scope of the term, but in return forge an original method for approaching this elusive object, by taking up the challenge of accounting for its multiple dimensions in images, texts and objects. In the Bachelardian vein, it is from the concept of the imaginary that we propose to articulate these different dimensions in their dynamics and their reciprocal influences, allowing distinctions as crucial as that between the drape and the veil, or that between the drape and the fold. We then perceive the exploratory dimension of such a motif, which crosses the arts, practices and gestures, and which interrogates the philosophical discourse itself on the use of clothing metaphors and their aim, to the point of questioning this major prejudice: it is not against images and appearances that philosophy has remained silent on the subject of clothing, but it is from an imagined discourse that philosophy has discreetly made clothing its object

Fit in buyer-supplier relationships: Examining compatibility and complementarity of culture, operations and resources in satisfactory buyer-supplier relationships

Purchasing function can aim to satisfy suppliers to obtain a preferred customer status with important suppliers to receive a preferential treatment. This research examines whether cultural compatibility, operational compatibility and resource complementarity of buyer and supplier do influence the supplier’s perception of the buyer and lead to a preferred customer status. A differentiation between direct and indirect procurement is made. The results show that cultural compatibility is an important influencing factor for achieving supplier satisfaction. Operational compatibility has shown an effect on preferred customer status in the context of indirect procurement, whereas resource complementarity has an effect for direct procurement

Note de synthèse

Jacobi Daniel, Schiele Bernard, Cyr Marie-France. Note de synthèse. In: Revue française de pédagogie, volume 91, 1990. pp. 81-111

Purchasing and innovation: Past, present and future of the field of research

International audienceThis paper introduces the special topic forum (STF) on purchasing and innovation. Presenting the findings from a systematic literature review, we take stock of the current state of the field, delineating themes, theories and methods, and identifying key trends over time. Our study shows a take-off in research on purchasing and innovation during the last decade. This has predominantly focused on private sector manufacturing firms although a recent expansion into public sector research is evident. Large-scale surveys and case studies are still the dominant research methods where the unit of analysis is typically the ‘firm’ or ‘project’. The findings also show how in the past the field was driven by questions on how purchasing can facilitate different types of innovation projects, seeking to derive practical implications, and rarely making explicit statements regarding theories applied; this still characterises much of the research but we find an increasing focus on theory development. We also see a shift in the type of technological innovation being investigated: past studies tended to focus on the role of purchasing in new product development (NPD) projects, which reflected a relatively low degree of technological uncertainty, but we see a trend towards innovation projects facing technological uncertainty. Research shows how this requires new ways of sourcing innovations and therefore new ways for purchasing to facilitate innovation sourcing. On the basis of the review, we offer our guidance for future research avenues to 1) carry out more research on procurement of innovation in the public sector; 2) consider new theories and research methods, and 3) go beyond firm-level or dyadic analysis to research networks and ecosystems. We conclude by introducing the papers in the STF