Les interventions des institutions de Bretton Woods dans la sous-région d'Afrique Centrale : les exemples du Cameroun et du Gabon (1987-2007)

RESUME DE LA THESE Le but de cette thèse est d'analyser la réforme générale de l'Etat au Cameroun et au Gabon par les institutions de Bretton Woods sur une période de vingt ans (1987-2007). Pour ce faire, mon travail consiste à étudier le rôle majeur joué par les différentes mesures économiques impulsées dans les pays par le Fonds Monétaire International (FMI) et la Banque Mondiale. Il s'agit de voir si les différentes réformes d'ajustement que ces institutions ont imposé au Cameroun et au Gabon ont produit des effets positifs en vue de solution la crise économique qui s'y installait durablement et remettre ces Etats sur le sentier de la croissance et du développement. L'avènement de la crise économique qui sévissait dans les pays au milieu des années 1980 montrait que le modèle développementaliste expérimenté par ces Etats n'avait expérimenté contribué qu'à provoquer la paralysie de l'appareil de production. Les causes profondes résidaient dans l'omniprésence de l'Etat qui privilégiait une logique administrative au dépend de celle de production au point de nuire gravement aux politiques interventionnistes étatiques. A cela, s'ajoutaient d'autres facteurs endogènes et exogènes aux Etats comme la mauvaise gestion couplée à la forte corruption et au clientélisme politique, la contrebande et le dumping, l'effritement du secteur agricole dû au vieillissement des plantations et à la sous-mécanisation, l'explosion démographique, la détérioration des termes de l'échange, le chômage endémique et galopant, etc. En ayant recours aux réformes d'ajustement structurel du FMI et de la Banque Mondiale, les gouvernements camerounais et gabonais entendaient lutter contre les rigidités institutionnelles et les distorsions structurelles qui empêchaient leurs économies de répondre aux signaux du marché et d'accroître l'offre d'une part. Et, d'autre part, les réformes d'ajustement devaient permettre de renforcer la concurrence des produits sur les marchés, accroître les capacités d'adaptation des marchés de facteurs et améliorer l'efficacité et l'efficience du secteur public. Mais avant d'analyser les réformes d'ajustement dans les pays j'ai d'abord présenté dans une première partie, l'évolution sociopolitique et économique des deux pays. Cette partie donne à l'analyse une profondeur historique indispensable et rend compte de l'évolution des politiques sectorielles des Etats marquée par une phase de croissance (1960-1984), puis par une phase de décroissance ou de crise qui commence à partir de 1985. La seconde partie met en évidence les politiques d'ajustement structurelle principalement axées sur la régulation monétaire, financière et budgétaire, la réforme de la fonction publique, la réforme agricole, le désengagement de l'Etat du secteur productif national et les privatisations. Je termine cette seconde partie par un bilan contrasté que je dresse de l'impact de ces réformes dans les économies camerounaises et gabonaises. La troisième partie met en évidence les nouvelles orientations stratégiques des institutions de Bretton Woods en partant de l'agenda politique des réformes au Cameroun et au Gabon. Elle fait intervenir une batterie de réformes portant sur l'initiative Pays Pauvres Très Endettés (PPTE), les Documents de Stratégie pour la Réduction de la Pauvreté (DSRP), l'Evaluation Politique et Institutionnelle du Pays (EPIP) et la «Bonne Gouvernance». Cette thèse s'achève par une conclusion exhaustive mettant en évidence les insuffisances des modèles théoriques et conceptuels fondant l'ajustement structurel et la remise en cause des nouvelles stratégies de lutte contre la pauvreté impulsées par le FMI et la Banque Mondiale dans les pays d'une part. D'autre part, j'observe une faiblesse institutionnelle de l'Etat dans ces pays qui se résume à la mauvaise gouvernance ; à l'absence d'un cadre et des outils appropriés pour la gestion économique et stratégique du développement à long terme ; à l'impunité généralisée et à l'inefficacité des mesures de lutte contre la pauvreté ; à l'absence d'un Etat de droit et à l'autoritarisme des régimes en place.

Organisational reforms in active welfare states: A comparative analysis of the turn to 'single gateways' in Western Europe

Based on the case of reforms aimed at integrating the provision of income protection and employment services for jobless people in Europe, this thesis seeks to understand the reasons which may prompt governments to engage in large-scale organisational reforms. Over the last 20 years, several European countries have indeed radically redesigned the organisational structure of their welfare state by merging or bundling existing front-line offices in charge of benefit payment and employment services together into 'one-stop' agencies. Whereas in academic and political debates, these reforms are generally presented as a necessary and rational response to the problems and inconsistencies induced by fragmentation in a context of the reorientation of welfare states towards labour market activation, this thesis shows that the agenda setting of these reforms is in fact the result of multidimensional political dynamics. More specifically, the main argument of this thesis is that these reforms are best understood not so such from the problems induced by organisational compartmentalism, whose political recognition is often controversial, but from the various goals that governments may simultaneously achieve by means of their adoption. This argument is tested by comparing agenda-setting processes of large-scale reforms of coordination in the United Kingdom (Jobcentre Plus), Germany (Hartz IV reform) and Denmark (2005 Jobcentre reform), and contrasting them with the Swiss case where the government has so far rejected any coordination initiative involving organisational redesign. This comparison brings to light the importance, for the rise of organisational reforms, of the possibility to couple them with the following three goals: first, goals related to the strengthening of activation policies; second, institutional goals seeking to redefine the balance of responsibilities between the central state and non-state actors, and finally electoral goals for governments eager to maintain political credibility. The decisive role of electoral goals in the three countries suggests that these reforms are less bound by partisan politics than by the particular pressures facing governments arrived in office after long periods in opposition.

An evaluation of volume-based morphometry for prediction of mild cognitive impairment and Alzheimer's disease.

Voxel-based morphometry from conventional T1-weighted images has proved effective to quantify Alzheimer's disease (AD) related brain atrophy and to enable fairly accurate automated classification of AD patients, mild cognitive impaired patients (MCI) and elderly controls. Little is known, however, about the classification power of volume-based morphometry, where features of interest consist of a few brain structure volumes (e.g. hippocampi, lobes, ventricles) as opposed to hundreds of thousands of voxel-wise gray matter concentrations. In this work, we experimentally evaluate two distinct volume-based morphometry algorithms (FreeSurfer and an in-house algorithm called MorphoBox) for automatic disease classification on a standardized data set from the Alzheimer's Disease Neuroimaging Initiative. Results indicate that both algorithms achieve classification accuracy comparable to the conventional whole-brain voxel-based morphometry pipeline using SPM for AD vs elderly controls and MCI vs controls, and higher accuracy for classification of AD vs MCI and early vs late AD converters, thereby demonstrating the potential of volume-based morphometry to assist diagnosis of mild cognitive impairment and Alzheimer's disease.

France's Charter for the Environment : of Presidents, Principles and Environmental Protection

France amended its constitution in 2005 to include a Charter for the Environment. The Charter lays out France's commitment to supporting the right to a 'balanced environment'. This article first traces the Charter's origins to a legacy-building presidential initiative. Jacques Chirac decided to invest in a neglected policy domain in which his own majority had shown little interest. He was obliged to intervene repeatedly in order to bring this project to a successful conclusion. In doing so, he staked out environmental affairs as an area of potential presidential supremacy. Next, the content of the Charter is examined. In this document, French traditions of universalism come together with an international movement for anticipatory environmental protection. This is reflected in the constitutionalisation of the precautionary principle, which emerged as the most controversial part of the Charter. The debates this provoked tended to caricature a risk-management principle whose meaning has been carefully refined to forestall objections. Finally, the Charter's potential efficacy is analysed. The post-Charter record of legislative and judicial activity concerning the environment is meagre, but not wholly inauspicious.

Immersion communautaire à Lausanne : une autre façon d'enseigner la santé publique [Community immersion in Lausanne: a different approach to teaching public health?].

Teaching community medicine represents a significant challenge for medical schools, which tend to struggle to promote interest in the issue among students. In 2009, the Lausanne medical school introduced a "community immersion" module specifically designed to address the issue. The new module requires students working in small groups under the supervision of a tutor to investigate a health question of their choice. The investigation involves conducting interviews with stakeholders (health professionals, patients, politicians, etc.), carrying out a survey, and presenting the results of the investigation in a "congress". An external evaluation showed that the objectives of the initiative had been largely achieved, with an increase of interest in community medicine for over 50% of students (based on a total cohort of 150 students) and a high level of satisfaction for over 90% of students and tutors. This paper presents the results of the initiative and its use for promoting community-oriented medicine.

Citizen participation and the Lisbon Treaty : A legal perspective

How to "bring the [European] Union closer to its citizens" is a vexed and vital problem of European integration. Article 11 TEU on participatory democracy, recently introduced by the Lisbon Treaty, is meant to be part of the solution. The EU Economic and Social Committee has gone so far as to define this provision "a milestone on the road to a people's Europe that is real and feasible". This appears to be an overly optimistic assessment - partly because art. 11 relies heavily on the involvement of civil society organisations, which political science literature suggests is conceptually and/or practically irrelevant to citizen involvement; partly because it largely formalizes participatory practices that have been in existence for years without cognizable effects on citizen participation; and partly because even its most innovative element - the European citizens' initiative (ECI) - does not bring significant changes to the Union's constitutional arrangements in terms of redistributing decision-making power. In addition to that, secondary legislation places significant hurdles on the submission of ECIs and might prevent or delay their becoming a standard democratic practice. This is not to say that art. 11 TEU has no potential at all. Its insertion in the Treaty might provide impetus to rethink and develop past participatory practices, such as horizontal civil dialogue. Moreover, the effects of "popular input" in the form of ECIs on EU institutional dynamics is as yet unknown - and perhaps not negligible, to judge from the keen interest that the European Parliament and other bodies have demonstrated in "appropriating" it as a political asset. Finally, art. 11 raises the stakes of the Union's democratic challenge and might pressure EU institutions to make full use of its potential. Or, if eventually proved inadequate, art. 11 might constitute a constitutional experiment on the way to meaningful forms of direct democracy at EU level.

Influence of magnetic field strength and image registration strategy on voxel-based morphometry in a study of Alzheimer's disease.

Multi-centre data repositories like the Alzheimer's Disease Neuroimaging Initiative (ADNI) offer a unique research platform, but pose questions concerning comparability of results when using a range of imaging protocols and data processing algorithms. The variability is mainly due to the non-quantitative character of the widely used structural T1-weighted magnetic resonance (MR) images. Although the stability of the main effect of Alzheimer's disease (AD) on brain structure across platforms and field strength has been addressed in previous studies using multi-site MR images, there are only sparse empirically-based recommendations for processing and analysis of pooled multi-centre structural MR data acquired at different magnetic field strengths (MFS). Aiming to minimise potential systematic bias when using ADNI data we investigate the specific contributions of spatial registration strategies and the impact of MFS on voxel-based morphometry in AD. We perform a whole-brain analysis within the framework of Statistical Parametric Mapping, testing for main effects of various diffeomorphic spatial registration strategies, of MFS and their interaction with disease status. Beyond the confirmation of medial temporal lobe volume loss in AD, we detect a significant impact of spatial registration strategy on estimation of AD related atrophy. Additionally, we report a significant effect of MFS on the assessment of brain anatomy (i) in the cerebellum, (ii) the precentral gyrus and (iii) the thalamus bilaterally, showing no interaction with the disease status. We provide empirical evidence in support of pooling data in multi-centre VBM studies irrespective of disease status or MFS.

Common variants near MC4R are associated with fat mass, weight and risk of obesity.

To identify common variants influencing body mass index (BMI), we analyzed genome-wide association data from 16,876 individuals of European descent. After previously reported variants in FTO, the strongest association signal (rs17782313, P = 2.9 x 10(-6)) mapped 188 kb downstream of MC4R (melanocortin-4 receptor), mutations of which are the leading cause of monogenic severe childhood-onset obesity. We confirmed the BMI association in 60,352 adults (per-allele effect = 0.05 Z-score units; P = 2.8 x 10(-15)) and 5,988 children aged 7-11 (0.13 Z-score units; P = 1.5 x 10(-8)). In case-control analyses (n = 10,583), the odds for severe childhood obesity reached 1.30 (P = 8.0 x 10(-11)). Furthermore, we observed overtransmission of the risk allele to obese offspring in 660 families (P (pedigree disequilibrium test average; PDT-avg) = 2.4 x 10(-4)). The SNP location and patterns of phenotypic associations are consistent with effects mediated through altered MC4R function. Our findings establish that common variants near MC4R influence fat mass, weight and obesity risk at the population level and reinforce the need for large-scale data integration to identify variants influencing continuous biomedical traits.

Relationship between imaging biomarkers, age, progression and symptom severity in Alzheimer's disease.

The early diagnostic value of glucose hypometabolism and atrophy as potential neuroimaging biomarkers of mild cognitive impairment (MCI) and Alzheimer's disease (AD) have been extensively explored using [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) and structural magnetic resonance imaging (MRI). The vast majority of previous imaging studies neglected the effects of single factors, such as age, symptom severity or time to conversion in MCI thus limiting generalisability of results across studies. Here, we investigated the impact of these factors on metabolic and structural differences. FDG-PET and MRI data from AD patients (n = 80), MCI converters (n = 65) and MCI non-converters (n = 64) were compared to data of healthy subjects (n = 79). All patient groups were split into subgroups by age, time to conversion (for MCI), or symptom severity and compared to the control group. AD patients showed a strongly age-dependent pattern, with younger patients showing significantly more extensive reductions in gray matter volume and glucose utilisation. In the MCI converter group, the amount of glucose utilisation reduction was linked to the time to conversion but not to atrophy. Our findings indicate that FDG-PET might be more closely linked to future cognitive decline whilst MRI being more closely related to the current cognitive state reflects potentially irreversible damage.

La judiciarisation à l'épreuve de la démocratie directe. L'interdiction de construire des minarets en Suisse

Impulsée par des élus de l'UDC pour contourner des décisions politiques et judiciaires prises au niveau local, puis national, l'initiative populaire acceptée en 2009 visant l'interdiction de construire des minarets a réactivé la stigmatisation des musulmans établis en Suisse, ainsi qu'un ensemble de controverses opposant systématiquement, dans une configuration institutionnelle particulière, la démocratie directe aux droits fondamentaux, la « volonté populaire » au « pouvoir des juges », nationaux et internationaux. Polysémique, le concept de judiciarisation est appréhendé ici dans une perspective processuelle et relationnelle, non pas comme transfert vers l'arène judiciaire de questions politiques touchant la régulation publique du religieux, mais sous l'angle de la juridicisation de la controverse suscitée par l'initiative populaire que produit l'anticipation des décisions de justice dans les échanges politiques.

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies.

Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. 18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed Explanation and Elaboration document is published separately and is freely available on the Web sites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.

How early can we predict Alzheimer's disease using computational anatomy?

Computational anatomy with magnetic resonance imaging (MRI) is well established as a noninvasive biomarker of Alzheimer's disease (AD); however, there is less certainty about its dependency on the staging of AD. We use classical group analyses and automated machine learning classification of standard structural MRI scans to investigate AD diagnostic accuracy from the preclinical phase to clinical dementia. Longitudinal data from the Alzheimer's Disease Neuroimaging Initiative were stratified into 4 groups according to the clinical status-(1) AD patients; (2) mild cognitive impairment (MCI) converters; (3) MCI nonconverters; and (4) healthy controls-and submitted to a support vector machine. The obtained classifier was significantly above the chance level (62%) for detecting AD already 4 years before conversion from MCI. Voxel-based univariate tests confirmed the plausibility of our findings detecting a distributed network of hippocampal-temporoparietal atrophy in AD patients. We also identified a subgroup of control subjects with brain structure and cognitive changes highly similar to those observed in AD. Our results indicate that computational anatomy can detect AD substantially earlier than suggested by current models. The demonstrated differential spatial pattern of atrophy between correctly and incorrectly classified AD patients challenges the assumption of a uniform pathophysiological process underlying clinically identified AD.

Il voto ticinese sull'iniziativa 'contro l'immigrazione di massa' del 9 febbraio 2014

Riassunto Il presente studio verte sull'analisi del voto relativo all'iniziativa popolare 'contro l'immigrazione di massa' del 9 febbraio 2014. In particolare, l'analisi si concentra sul voto avvenuto nel Ticino, il cantone svizzero in cui l'iniziativa ha avuto maggiore sostegno. Lo studio si è avvalso di un'inchiesta d'opinione rappresentativa realizzata dall'Osservatorio della vita politica regionale dell'Università di Losanna presso 1.429 cittadini ticinesi nei giorni successivi allo scrutinio. Dopo una contestualizzazione del voto del 9 febbraio rispetto alla storia delle votazioni sui temi di politica estera e migratoria, l'analisi si è concentrata sulla partecipazione al voto. Il ricorso a tre modelli interpretativi (delle risorse, della competenza e della mobilitazione) ha permesso di mostrare come il voto del 9 febbraio sia caratterizzato in particolare modo dal senso del dovere, dall'interesse per la politica e dal legame di partito. L'analisi dell'orientamento di voto evidenzia l'influenza delle dimensioni economiche, politiche, identitarie, e soprattutto, alla stregua di altri voti nel passato recente di questo cantone, una forte tensione tra centro e periferia. Dall'analisi del voto del 9 febbraio emerge un forte timore che vede nel Ticino una 'doppia periferia', verso Berna e in relazione alla vicina Lombardia. Parole chiave: iniziativa popolare, partecipazione, orientamento di voto, centro-periferia. Résumé Cette étude porte sur l'analyse du vote sur l'initiative populaire 'contre l'immigration de masse' du 9 février 2014 et, plus précisément, sur le vote qui s'est déroulé au Tessin, canton suisse dans lequel l'initiative a obtenu le plus large soutien. L'étude a été menée à l'aide d'une enquête d'opinion représentative réalisée par l'Observatoire de la vie politique régionale de l'Université de Lausanne auprès de 1.429 citoyens tessinois dans les jours suivant le scrutin. Après une contextualisation du vote du 9 février par rapport à l'histoire des votations sur les thèmes de la politique étrangère et de l'immigration, l'analyse a porté sur la participation au vote. À ce propos, l'utilisation de trois modèles explicatifs (des ressources, de la compétence et de la mobilisation) a permis de dévoiler que le vote a été caractérisé plus particulièrement par le sens du devoir (habitus du vote), par l'intérêt pour la politique et par le lien avec un parti. L'analyse de l'orientation du vote montre l'influence des aspects économiques, politiques et identitaire ainsi que, à l'instar d'autres votations récemment passées dans le canton italophone, des raisons qui mettent en évidence une vision contrastée du Tessin et notamment le risque de devenir une 'double périphérie' par rapport à Berne et à la Lombardie. Mots-clés: initiative populaire, participation, choix du vote, centre-périphérie. Zusammenfassung Die vorliegende Studie analysiert das Abstimmungsverhalten anlässlich der eidgenössischen Volksinitiative 'Gegen Masseneinwanderung' vom 9. Februar 2014. Die Analyse beschränkt sich auf die Abstimmung im Kanton Tessin, wo die Initiative am stärksten unterstützt wurde. Die Studie wurde vom Observatorium des regionalen politischen Lebens der Universität Lausanne durchgeführt und basiert auf einer repräsentativen Umfrage, bei welcher 1429 Bürger des Kantons Tessin in den Tagen nach der Abstimmung teilnahmen. Zunächst wird die Abstimmung vom 9. Februar in Bezug auf die Geschichte verschiedener anderer Abstimmungen zum Thema Aussen- und Immigrationspolitik kontextualisiert. Die Analyse analysiert dann als erstes die Wahlbeteiligung: Der Gebrauch von drei Erklärungsmodellen (Ressourcen, Kompetenz und Mobilisierung) zeigt auf, dass der Entscheid, an der Abstimmung vom 9. Februar überhaupt teilzunehmen, vor allem von Pflichtbewusstsein, politischem Interesse und Parteibindung geprägt war. Das Abstimmungsverhalten selber war dann von ökonomischen und politischen Faktoren, von der eigenen Identität sowie insbesondere - und wie auch schon andere Abstimmungen in der jüngsten Vergangenheit des italienisch-sprechenden Kantons -von einer grossen Angst geprägt, dass das Tessin eine 'doppelte Peripherie' zwischen Bern und der Lombardei werden könnte. Stichwörter: Volksinitiative, Teilnahme, Abstimmungsverhalten, Zentrum-Peripherie Abstract This study focuses on the analysis of the federal vote on the popular initiative 'against mass immigration' of 9 February 2014. More precisely, the analysis focuses on the vote that took place in Ticino, the Swiss canton in which the popular initiative has received the widest support. The study was carried out by the Research Observatory for Regional Politics at the University of Lausanne using a representative survey among 1.429 citizens of Ticino during the days following the vote. After a contextualization of the vote of 9 February with respect to the history of referenda about foreign policy and immigration issues, the analysis first discusses voter turnout. In this regard, the use of three explanatory models (resources, expertise and mobilisation) reveals that participation in the vote of 9 February was especially characterized by one's sense of duty, political interest, and links with a political party. The decision how to vote was then influenced by economic, political and identity factors as well as - like other votes in the recent past in the Italian-speaking canton - the particular fear that Ticino would become a 'double periphery' vis-à-vis both Berne and Lombardy. Keywords: popular initiative, participation, vote, centre-periphery.

Anemia and chronic kidney disease are potential risk factors for mortality in stroke patients: a historic cohort study.

BACKGROUND: Chronic kidney disease (CKD) is associated to a higher stroke risk. Anemia is a common consequence of CKD, and is also a possible risk factor for cerebrovascular diseases. The purpose of this study was to examine if anemia and CKD are independent risk factors for mortality after stroke. METHODS: This historic cohort study was based on a stroke registry and included patients treated for a first clinical stroke in the stroke unit of one academic hospital over a three-year period. Mortality predictors comprised demographic characteristics, CKD, glomerular filtration rate (GFR), anemia and other stroke risk factors. GFR was estimated by means of the simplified Modification of Diet in Renal Disease formula. Renal function was assessed according to the Kidney Disease Outcomes Quality Initiative (K/DOQI)-CKD classification in five groups. A value of hemoglobin < 120 g/L in women and < 130 g/L in men on admission defined anemia. Kaplan-Meier survival curves and Cox models were used to describe and analyze one-year survival. RESULTS: Among 890 adult stroke patients, the mean (Standard Deviation) calculated GFR was 64.3 (17.8) ml/min/1.73 m2 and 17% had anemia. Eighty-two (10%) patients died during the first year after discharge. Among those, 50 (61%) had K/DOQI CKD stages 3 to 5 and 32 (39%) stages 1 or 2 (p < 0.001). Anemia was associated with an increased risk of death one year after discharge (p < 0.001). After adjustment for other factors, a higher hemoglobin level was independently associated with decreased mortality one year after discharge [hazard ratio (95% CI) 0.98 (0.97-1.00)]. CONCLUSIONS: Both CKD and anemia are frequent among stroke patients and are potential risk factors for decreased one-year survival. The inclusion of patients with a first-ever clinical stroke only and the determination of anemia based on one single measure, on admission, constitute limitations to the external validity. We should investigate if an early detection and management of both CKD and anemia could improve survival in stroke patients.

Agents anti-infectieux et fonction réna!e: vers des posologies sur mesure [Antimicrobial agents and renal elimination: towards individual dosage adjustment?].

The efficacy and safety of anti-infective treatments are associated with the drug blood concentration profile, which is directly correlated with a dosing adjustment to the individual patient's condition. Dosing adjustments to the renal function recommended in reference books are often imprecise and infrequently applied in clinical practice. The recent generalisation of the KDOQI (Kidney Disease Outcome Quality Initiative) staging of chronically impaired renal function represents an opportunity to review and refine the dosing recommendations in patients with renal insufficiency. The literature has been reviewed and compared to a predictive model of the fraction of drug cleared by the kidney based on the Dettli's principle. Revised drug dosing recommendations integrating these predictive parameters are proposed.