The Role of International Actors in Post-Communist Countries: Coercion or Persuasion? The Transfer of Hospital Design Standards by International Organizations and Private Firms

International audienceThis paper explores the role of international actors in post-communist transformation. Taking the case of hospital design standards, it explains how the national actors choose to leave aside the national regulations and to adopt foreign technical standards. The paper analyzes the adoption of Western countries' standards for the modernization of healthcare facilities in Ukraine and Moldova. An in-depth comparative case study of two projects revealed that national architects of these post-soviet countries use foreign standards. While the change of standards is a similar outcome in both cases, the international actors involved are different. Our findings suggest that while both international organizations and private actors diffuse foreign technical standards in post-soviet countries, the processes is rather different. Whereas international organizations dispose of coercive means to impose foreign solutions, private actors need to negotiate and to convince for their adoption. Drawing on recent debates on policy diffusion and transfer (Dolowitz and Marsh 2012; 2000, Simmons and al. 2008, Stone 2010, 2012), the results shed light on “carriers” of institutional arrangements among different political systems

Parametric FEM simulation of composite barrier FTJs under external bias at room temperature

A study on a parametrized model of a composite barrier FTJ (three-interface system, with a non-polar dielectric layer) under an external bias voltage and at room temperature, using FEM-based simulations, was performed. The approach involves the Thomas-Fermi model assuming incomplete screening of polarization charges for building the energy barrier profile, and numerically simulates the electron transport through the barrier by bias-voltage-dependent tunneling, using Tsu-Esaki formulation. That naturally include the temperature dependent contributions to the total current density. The TER coefficient and current densities are computed considering variation of a large set of parameters that describe the composite barrier FTJ system in realistic physical range of values with respect to a reference (prototypical) system. In this study, the parametric simulations were performed starting from selected data reported on the SRO/STO/BTO/SRO heterostructure. The most important results of our work can be stated as follows: i) The FEM simulations prove to be reliable approach when we are interested in the prediction of FTJ characteristics at temperatures close to 300 K, and ii) We show that several configurations with large TER values may be predicted, but at the expense of very low current densities in the ON state. We suggest that the results may be useful for assessing the FTJ performances at ambient temperature, as well as to design preoptimized FTJs by using different combinations of materials to comply with a set of properties of a specific model

Institutional Transfer from the European Union Actors to Ukraine and Moldova: the Case of Hospital Design

This article presents the main points of my PhD research on institutional change in Post- Soviet states. Looking at the case of the hospital design in Ukraine and Moldova, I examine the main actors and institutions that induced the process of change following the Soviet Union's collapse. The article consists of two parts. First, I introduce the theoretical framework to study the postsoviet transformations. In line with the historical institutionalism, I present the hypothesis that both Ukraine and Moldova developed similar institutional characteristics following their independence in 1991. The second hypothesis concerns the role of external actors in the observed changes. I challenge in particular the actions of international companies. I use the Europeanization and institutional transfer concepts to explore these exogenous sources of change. Second, I analyse the design processes of two hospital modernisation projects in Ukraine and Moldova. In a comparative perspective, I present the actors involved, the difficulties in modernising the hospital regarding the inherited paths as well as the solutions advanced in order to implement a change. An introduction to these case studies will allow conducting an in-depth study of the involvement of international actors in the post-soviet transformations. This article examines the process of institutional change in post-soviet countries since 1991 to 2010. It uses the growing body of literature on historical institutionalism, europeanisation and diffusion while exploring the presence of exogenous actors in the hospital design transformation in Moldova and Ukraine

Rapport d'étude : Les conflits d'intérêts au sein des comités d'expertise des agences fédérales américaines: Le cas de la FDA et de l'EPA

Ce rapport étudie la législation américaine en matière de conflits d'intérêts au sein de l'expertise publique en prenant le cas de deux agences fédérales américaine: la FDA (Food Drug Administration) et l'EPA (Environment Protection Agency). Le rapport s'appuie sur l'analyse approfondie de données qualitatives, collectées essentiellement sur place, dans le cadre d'un voyage d'étude de trois mois aux Etats-Unis : textes législatifs américains en matière d'éthique des fonctionnaires de l'exécutif, entretiens semi-directifs avec des hauts-responsables des agences fédérales et représentants du milieu associatif. Constitué en trois parties, le rapport présente dans un premier temps les principaux textes législatifs encadrant les conflits d’intérêts des experts aux Etats-Unis (loi FACA, dispositions du Code Pénal, Code de déontologie des fonctionnaires de l'Etat). Dans un deuxième temps, sont présentées les réglementations en matière de conflits d’intérêts émises spécifiquement par les agences fédérales EPA et FDA. Enfin, le rapport aborde les pratiques de gestion des conflits d’intérêts par les agences fédérales FDA et EPA. Les résultats de notre recherche empirique montrent que si de nombreux outils permettent d'encadrer et de gérer les conflits financiers, les agences fédérales disposent en revanche de moins d'outils et de ressources pour évaluer les autres types de conflits d’intérêts (avancement carrière, avantage professionnel pour son organisation, opinions personnelles engendrant un biais, croyances et convictions…)

The role of the cardiologist in non-cardiac surgery: perioperative management features

Scop: Managementul perioperator adecvat este esențial în prevenirea complicațiilor cardiovasculare, inclusiv decesul de cauza cardiacă Material și metode: Ghidul Societății Europene de Cardiologie (ESC) pentru evaluarea cardiaca si managentul în chirurgia noncardiaca (2022) elaborat in comun cu Societatea Europeana de Anesteziologie si Terapie Intensivă (ESAIC) Rezultate: Aprecierea riscului preoperator trebuie sa țină cont de combinația multiplilor factori: pe de o parte de categoria de risc a operației (mică/intermediară/înaltă) pe de alta parte de factorii intriseci ce țin de pacient, în special vârsta, simptomele, factorii de risc cardiovasculari, precum și bolile cardiace cunoscute. Persoanele până la 65 ani fără factori de risc cardiovasculari sau boli cardiace constituite nu necesită careva evaluare preoperatorie pentru intervenții cu risc scăzut și intermediar, iar la intervențiile cu risc înalt se va efectua electrocardiograma și biomarkerii cardiaci la persoanele peste 45 ani. Pentru persoanele peste 65 ani sau cei cu factori de risc cardiovasculari si o interventie cu risc intermediar/ inalt se va efectua electrocardiograma, biomarkerii cardiaci si se va aprecia capacitatea functionala, iar pentru pacientii cu boli cardiovasculare cunoscute suplimentar se va efectua si consultatia cardiologului, la necesitate evaluare in echipa multidisciplinara. Evaluarea biomarkerilor, in special troponina postoperator depisteaza la timp infarctul miocardic postprocedural, care in 85% cazuri este silentios, fara durere tipica. Decizia continuarii medicamentelor cardiace cronice, in special anticoagulatele/antitromboticele deseori reprezinta o provocare, fiind esentiala examinarea atenta a riscul de sangerare si riscul ischemic, precum si cunoasterea deplina a istoricului medical al pacientului. Concluzii: Pregătirea preoperatorie necesita examinarea atenta a profilului clinic al pacientului si conlucrare interdisciplinara.Aim: Adequate perioperative management is essential in preventing cardiovascular complications, including cardiac death, during and after non-cardiac surgery. Material and methods: 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery: developed by the task force for cardiovascular assessment and management of patients undergoing non-cardiac surgery of the European Society of Cardiology (ESC), endorsed by the European Society of Anaesthesiology and Intensive Care (ESAIC). Results: Cardiovascular risk assesment before non-cardiac surgery comprises a combination of multiple factors: on one hand there is the surgery risk category (low-risk, intermediate and high-risk) and on the other hand there are patient related risk factors to deal with, especially the patient's age, cardiovascular risk factors or even known cardiovascular disease. Individuals that are younger than 65 without any cardiovascular risk factors or known CVD do not need any additional investigations before a low- or intermediate risk surgery, while an ECG and cardiac biomarkers are warranted in those older than 45 before a high risk surgery. In individuals older than 65 or those with cardiovascular risk factors undergoing an intermediate or high risk surgery an ECG, cardiac biomarkers and functional capacity determination is necessary. Patients with known cardiovascular disease need a cardiology consult and sometimes a multidisciplinary team assessment. Dosing of cardiac biomarkers, especially cardiac troponins after surgery helps detect postprocedural myocardial infarction, which can be silent in 85% of cases - patients having no typical pain. Decisions concerning continuing chronic cardiac medication throughout the surgery, especially antithrombotic drugs, are usually quite challenging, as balancing bleeding and ischemic risks needs to be done after carefully studying the patient's history. Conclusion: Perioperative assessment requires a careful examination of the patient's clinical profile as well as interdisciplinary teamwork

Противовоспалительная терапия атеросклеротических и атеротромботических осложнений, экспериментальные данные и реальность.

Anti-inflammatory treatment in atherosclerosis and atherothrombosis, from experiment to realityMai mulți investigatori au venit cu diverse propuneri de tratament antiinflamator împotriva a mai multor markeri cunoscuți ai inflamației. Încercările terapeutice au variat de la agenți de spectru larg cum ar fi glucocorticoizii până la inhibiția anumitor căi și cascade foarte înguste. În pofida rezultatelor promițătoare a studiilor experimentale, studiilor preclinice și chiar trialurilor de faza a doua, toate obținând beneficii în reducerea complicațiilor post-infarct, majoritatea trailurilor clinice de faza a treia au eșuat. Cauzele acestor eșuări încă nu au fost bine explicate, sporind interesul față de acest subiect și demonstrând necesitatea încercărilor ulterioare de a găsi remedii ce ar putea fi incluse în tratamentul de bază al pacienților respectivi. Chiar și cele care au avut succes în studii clinice mari și au obținut rezultate de necrezut în reducerea evenimentelor repetate, mai au de parcurs încă o cale lungă și anevoioasă până a fi introduși în recomandările internaționale.Противовоспалительная терапия атеросклеротических и атеротромботических осложнений, экспериментальные данные и реальность

Листерии и листериоз

Listeries and its adjacent sicknesses are widely spread. In order to find listeries, in the republic of Moldova, laboratory researches are not conducted and the epidemiology ande the role of the listeries within the marginal pathology are not studied. The majority of the specialists are not enough informed about the biology of the listeries, their role, in the infectional pathology and about contemporan microbiological methods of the diagnosis of the listerioses. In this work-research we provide the contemporan classification of listeries we describe their morphobiological properties, including the morphology, their cultural and biochemical properties, their antigen structure, the factors of pathogen, the stability towards environment factors, we describe the sources of infection and the tools of transmission, the pathogenesis and the clinical forms. In the section of microbiological diagnosis we give a research – list of the samples from, the environment and from the sick persons, we indicate the methods of the laboratory diagnosis, and we present the main tests for determining the gender and for making the difference between the forms. In conclusion its a description of actual situation in Republic of Moldova.Листерии и вызываемые ими заболевания имеют повсеместное распространение. В Республике Молдова лабораторные исследования на выявление листерий не проводятся, эпидемиология и роль листерий в краевой патологии не изучены. Основная масса специалистов недостаточно информированы относительно биологии листерий, их роли в инфекционной патологии и в вопросах современных микробиологических методов диагностики листериозов. В настоящей работе дана современная классификация листерий, описаны их морфобиологические свойства, включая морфологию, культуральные, биохимические свойства, антигенная структура, факторы патогенности, устойчивость к факторам внешней среды, описаны источники инфекции и механизмы передачи, патогенез и клинические формы. В разделе микробиологической диагностики перечислены материалы исследуемые из внешней среды и от больного, указаны методы лабораторной диагностики, представлены основные тесты для определения рода и дифференциации видов. Описывается ситуация по данной проблеме в Республике Молдова

Cathodoluminescence from mechanically cracked porous silicon

Cathodoluminescence of porous silicon after mechanical damage with a tip has been studied in the scanning electron microscope. Mechanical damage results in the exposure of new surfaces related to fracture and to small particles appearing over the porous silicon layer. The freshly generated surfaces caused an increase of several orders of magnitude in the luminescence efficiency