Cardiovascular risk factor control and outcomes in peripheral artery disease patients in the Reduction of Atherothrombosis for Continued Health (REACH) Registry

OBJECTIVES: To examine differences in risk factor (RF) management between peripheral artery disease (PAD) and coronary artery (CAD) or cerebrovascular disease (CVD), as well as the impact of RF control on major 1-year cardiovascular (CV) event rates. METHODS: The REACH Registry recruited >68000 outpatients aged >/=45 years with established atherothrombotic disease or >/=3 RFs for atherothrombosis. The predictors of RF control that were evaluated included: (1) patient demographics, (2) mode of PAD diagnosis, and (3) concomitant CAD and/or CVD. RESULTS: RF control was less frequent in patients with PAD (n=8322), compared with those with CAD or CVD (but no PAD, n=47492) [blood pressure; glycemia; total cholesterol; smoking cessation (each P<0.001)]. Factors independently associated with optimal RF control in patients with PAD were male gender (OR=1.9); residence in North America (OR=3.5), Japan (OR=2.5) or Latin America (OR=1.5); previous coronary revascularization (OR=1.3); and statin use (OR=1.4); whereas prior leg amputation was a negative predictor (OR=0.7) (P<0.001). Optimal RF control was associated with fewer 1-year CV ischemic symptoms or events. CONCLUSIONS: Patients with PAD do not achieve RF control as frequently as individuals with CAD or CVD. Improved RF control is associated with a positive impact on 1-year CV event rates.

"The need obliged us" : culture as capacity during the Hurricane Stan emergency response. A case study from Tectitan, Huehuetenango, Guatemala

A major deficiency in disaster management plans is the assumption that pre-disaster civil-society does not have the capacity to respond effectively during crises. Following from this assumption a dominant emergency management strategy is to replace weak civil-society organizations with specialized disaster organizations that are often either military or Para-military and seek to centralize decision-making. Many criticisms have been made of this approach, but few specifically addresses disasters in the developing world. Disasters in the developing world present unique problems not seen in the developed world because they often occur in the context of compromised governments, and marginalized populations. In this context it is often community members themselves who possess the greatest capacity to respond to disasters. This paper focuses on the capacity of community groups to respond to disaster in a small town in rural Guatemala. Key informant interviews and ethnographic observations are used to reconstruct the community response to the disaster instigated by Hurricane Stan (2005) in the municipality of Tectit��n in the Huehuetenango department. The interviews were analyzed using techniques adapted from grounded theory to construct a narrative of the events, and identify themes in the community���s disaster behavior. These themes are used to critique the emergency management plans advocated by the Guatemalan National Coordination for the Reduction of Disasters (CONRED). This paper argues that CONRED uncritically adopts emergency management strategies that do not account for the local realities in communities throughout Guatemala. The response in Tectit��n was characterized by the formation of new organizations, whose actions and leadership structure were derived from ���normal��� or routine life. It was found that pre-existing social networks were resilient and easily re-oriented meet the novel needs of a crisis. New or emergent groups that formed during the disaster utilized social capital accrued by routine collective behavior, and employed organizational strategies derived from ���normal��� community relations. Based on the effectiveness of this response CONRED could improve its emergency planning on the local-level by utilizing the pre-existing community organizations rather than insisting that new disaster-specific organizations be formed.

Kreditrisiken - Modellierung und Management: Ein ��berblick

Zusammenfassung Die Messung und Bewertung von Kreditrisiken stellt sich aktuell als ein sehr bedeutsames (Stichworte : Basel II, Solvency II, Kreditderivate) Gebiet dar. Allerdings hat sich hierbei keine einheitliche Vorgehensweise herausgebildet, sondern es existieren eine Vielzahl unterschiedlicher Ansatzpunkte und Modelle. Aus diesem Grund wird in dem vorliegenden ��berblicksaufsatz versucht, einen systematischen ��berblick ��ber Problemfelder, Modellierungsans��tze und Methoden des Risikomanagements im Kontext von Kreditrisiken zu geben. Nach einer einf��hrenden Charakterisierung von Kreditrisiken und einem Abriss ��ber Ratingsysteme werden zun��chst die vier grundlegenden Kategorien von Kreditrisikomodellen (statische Modellierung der Ausfallverteilung, Unternehmenswertmodelle, Intensit��tsmodelle und ratingbasierte Modelle) er��rtert. Sodann erfolgt eine Darstellung der wichtigsten Industriemodelle (Credit Risk+, KMV, Credit Metrics, Credit Portfolio View). Behandelt werden ferner die Grundz��ge von Basel II und die hierbei zugrunde liegende modelltheoretische Fundierung in Form von Einfaktormodellen sowie die Bewertung von ausfallbedrohten Zinstiteln. Abschlie��end wird auf Kreditderivate eingegangen.

A physical approach on flood risk vulnerability of buildings

The design of efficient hydrological risk mitigation strategies and their subsequent implementation relies on a careful vulnerability analysis of the elements exposed. Recently, extensive research efforts were undertaken to develop and refine empirical relationships linking the structural vulnerability of buildings to the impact forces of the hazard processes. These empirical vulnerability functions allow estimating the expected direct losses as a result of the hazard scenario based on spatially explicit representation of the process patterns and the elements at risk classified into defined typological categories. However, due to the underlying empiricism of such vulnerability functions, the physics of the damage-generating mechanisms for a well-defined element at risk with its peculiar geometry and structural characteristics remain unveiled, and, as such, the applicability of the empirical approach for planning hazard-proof residential buildings is limited. Therefore, we propose a conceptual assessment scheme to close this gap. This assessment scheme encompasses distinct analytical steps: modelling (a) the process intensity, (b) the impact on the element at risk exposed and (c) the physical response of the building envelope. Furthermore, these results provide the input data for the subsequent damage evaluation and economic damage valuation. This dynamic assessment supports all relevant planning activities with respect to a minimisation of losses, and can be implemented in the operational risk assessment procedure.

Avalanche related damage potential - changes of persons and mobile values since the mid-twentieth century, case study Galt��r

When determining risk related to natural hazard processes, many studies neglect the investigations of the damage potential or are limited to the assessment of immobile values like buildings. However, persons as well as mobile values form an essential part of the damage potential. Knowledge of the maximum number of exposed persons in an endangered area is of great importance for elaborating evacuation plans and immediate measures in case of catastrophes. In addition, motor vehicles can also be highly damaged, as was shown by the analysis of avalanche events. With the removal of mobile values in time as a preventive measure this kind of damage can be minimised. This study presents a method for recording the maximum number of exposed persons and monetarily assessing motor vehicles in the municipality of Galt��ur (Tyrol, Austria). Moreover, general developments of the damage potential due to significant socio-economic changes since the mid-twentieth century are pointed out in the study area. The present situation of the maximum number of persons and mobile values in the official avalanche hazard zones of the municipality is described in detail. Information on the number of persons is derived of census data, tourism and employment statistics. During the winter months, a significant increase overlaid by strong short-term fluctuation in the number of persons can be noted. These changes result from a higher demand of tourism related manpower as well as from varying occupancy rates. The number of motor vehicles in endangered areas is closely associated to the number of exposed persons. The potential number of motor vehicles is investigated by means of mapping, statistics on the stock of motor vehicles and the density distribution. Diurnal and seasonal fluctuations of the investigated damage potential are pointed out. The recording of the number of persons and mobile values in endangered areas is vital for any disaster management.

Managing Debris Flow Risks

Debris flows represent a widespread threat to villages and small towns in the Swiss Alps. For many centuries people ���managed��� such risks by trying to avoid hazardous areas. However, major debris flow and flood events in the last 25 years have revealed that the degree of freedom to engage in this type of risk management has substantially decreased. This became especially evident during the 1999 disasters in a number of places in Switzerland. The winter of that year was unusually wet. In February heavy snowfall triggered destructive avalanches. In May high temperatures caused heavy snowmelt, with excessive rainfall contributing more water to the already saturated soils. Landslides, debris flows and floods were triggered in many locations, including S��renberg. Hazard prevention and disaster management have a long tradition in Switzerland, although an integrated approach to risk management is rather new. Only in recent years have methods and tools been developed to assess hazards, define protection goals, and implement disaster reduction measures. The case of S��renberg serves as an example of how today's approaches to disaster reduction are implemented at the local level.

Challenges in the participatory assessment of sustainable management practices in dryland ecosystems under regime shifts

Regime shifts, defined as a radical and persistent reconfiguration of an ecosystem following a disturbance, have been acknowledged by scientists as a very important aspect of the dynamic of ecosystems. However, their consideration in land management planning remains marginal and limited to specific processes and systems. Current research focuses on mathematical modeling and statistical analysis of spatio-temporal data for specific environmental variables. These methods do not fulfill the needs of land managers, who are confronted with a multitude of processes and pressure types and require clear and simple strategies to prevent regime shift or to increase the resilience of their environment. The EU-FP7 CASCADE project is looking at regime shifts of dryland ecosystems in southern Europe and specifically focuses on rangeland and forest systems which are prone to various land degradation threats. One of the aims of the project is to evaluate the impact of different management practices on the dynamic of the environment in a participatory manner, including a multi-stakeholder evaluation of the state of the environment and of the management potential. To achieve this objective we have organized several stakeholder meetings and we have compiled a review of management practices using the WOCAT methodology, which enables merging scientific and land users knowledge. We highlight here the main challenges we have encountered in applying the notion of regime shift to real world socio-ecological systems and in translating related concepts such as tipping points, stable states, hysteresis and resilience to land managers, using concrete examples from CASCADE study sites. Secondly, we explore the advantages of including land users��� knowledge in the scientific understanding of regime shifts. Moreover, we discuss useful alternative concepts and lessons learnt that will allow us to build a participatory method for the assessment of resilient management practices in specific socio-ecological systems and to foster adaptive dryland management.

Financial Planning for College: What Parents Do To Prepare

This study explores reported parental financial college preparations and the amount parents have saved for college, with a goal of determining strategies used by different parents based on parental college aspirations and expectations for their child, as well as the highest reported parental and grandparental educational levels. Regression analysis indicates that parents' expectations, but not their aspirations, correspond to engagement in financial planning. Family education is strongly associated with taking some financial planning actions and the amount saved. The results may be helpful to those who are working to increase the effectiveness of disseminating college financial information to parents.

A proposed application of the attributable risk technique in the assessment of unmet need among newly organized populations

In the midst of health care reform, and as health care organizations reorganize to provide more cost-effective healthcare, the population is being shifted into new healthcare delivery systems such as health insurance purchasing alliances, and health maintenance organizations. These new models of delivery are usually organized within resource restricted and data limited environments. Health care planners are faced with the challenge of identifying priorities for preventive and primary care services within these newly organized populations (Medicare HMO, Medicaid HMO, etc.). The author proposes a technique usually employed in epidemiology--attributable risk estimation--as a planning methodology to establish preventive health priorities within newly organized populations. Illustrations of the methodology are provided utilizing the Texas 1992 population. ^

Patrimonio geol��gico. Identificaci��n, valoraci��n y gesti��n de sitios de inter��s geol��gico

En las investigaciones en Ciencias Geol��gicas, en nuestro pa��s y en especial en la Provincia de Buenos Aires, ha sido escaso el desarrollo relacionado con los sitios que requieran una preservaci��n y protecci��n especial. Sin embargo, son abundantes los sitios conocidos y nombrados en la bibliograf��a geol��gica que es necesario valorar y preservar como Patrimonio Geol��gico. El Patrimonio Geol��gico es un elemento m��s del patrimonio natural y constituye una parte importante de nuestra herencia natural. En la Conferencia de Par��s auspiciada por la UNESCO en 1972 sobre la protecci��n del patrimonio mundial, cultural y natural, algunos pa��ses pusieron en marcha investigaciones dirigidas hacia el conocimiento, su protecci��n y la puesta en valor, lo cual resulta un recurso de indudable significaci��n y una pieza clave para el desarrollo tur��stico de un territorio. Para conocer en forma exhaustiva el patrimonio geol��gico de un ��rea es indispensable realizar inventarios, archivar la informaci��n necesaria para su descripci��n y poder recoger datos de inter��s para mantener actualizados los inventarios. Los dise��os de las fichas presentan inconvenientes que se relacionan, en algunos casos, con que son muy sint��ticas y demasiado subjetivas, y en otros, muy detalladas y rigurosas.

Patrimonio geol��gico. Identificaci��n, valoraci��n y gesti��n de sitios de inter��s geol��gico

En las investigaciones en Ciencias Geol��gicas, en nuestro pa��s y en especial en la Provincia de Buenos Aires, ha sido escaso el desarrollo relacionado con los sitios que requieran una preservaci��n y protecci��n especial. Sin embargo, son abundantes los sitios conocidos y nombrados en la bibliograf��a geol��gica que es necesario valorar y preservar como Patrimonio Geol��gico. El Patrimonio Geol��gico es un elemento m��s del patrimonio natural y constituye una parte importante de nuestra herencia natural. En la Conferencia de Par��s auspiciada por la UNESCO en 1972 sobre la protecci��n del patrimonio mundial, cultural y natural, algunos pa��ses pusieron en marcha investigaciones dirigidas hacia el conocimiento, su protecci��n y la puesta en valor, lo cual resulta un recurso de indudable significaci��n y una pieza clave para el desarrollo tur��stico de un territorio. Para conocer en forma exhaustiva el patrimonio geol��gico de un ��rea es indispensable realizar inventarios, archivar la informaci��n necesaria para su descripci��n y poder recoger datos de inter��s para mantener actualizados los inventarios. Los dise��os de las fichas presentan inconvenientes que se relacionan, en algunos casos, con que son muy sint��ticas y demasiado subjetivas, y en otros, muy detalladas y rigurosas.

Patrimonio geol��gico. Identificaci��n, valoraci��n y gesti��n de sitios de inter��s geol��gico

En las investigaciones en Ciencias Geol��gicas, en nuestro pa��s y en especial en la Provincia de Buenos Aires, ha sido escaso el desarrollo relacionado con los sitios que requieran una preservaci��n y protecci��n especial. Sin embargo, son abundantes los sitios conocidos y nombrados en la bibliograf��a geol��gica que es necesario valorar y preservar como Patrimonio Geol��gico. El Patrimonio Geol��gico es un elemento m��s del patrimonio natural y constituye una parte importante de nuestra herencia natural. En la Conferencia de Par��s auspiciada por la UNESCO en 1972 sobre la protecci��n del patrimonio mundial, cultural y natural, algunos pa��ses pusieron en marcha investigaciones dirigidas hacia el conocimiento, su protecci��n y la puesta en valor, lo cual resulta un recurso de indudable significaci��n y una pieza clave para el desarrollo tur��stico de un territorio. Para conocer en forma exhaustiva el patrimonio geol��gico de un ��rea es indispensable realizar inventarios, archivar la informaci��n necesaria para su descripci��n y poder recoger datos de inter��s para mantener actualizados los inventarios. Los dise��os de las fichas presentan inconvenientes que se relacionan, en algunos casos, con que son muy sint��ticas y demasiado subjetivas, y en otros, muy detalladas y rigurosas.

Interview forms for integrating education for conservation in marine protected areas management in Colombia

Environmental Education (EE) is a key component in any marine protected area management. However, its visibility and action plans are still poorly developed and structured as a clear element in management procedures. The objective of this study is to contribute with a methodological route that integrates EE to the existing model of management planning and strategies, taking the Colombian National Natural Parks System as a case study. The creation of the route is proposed as a participatory research with different stakeholders in order to respond to the specific conservation needs and goals for the National Parks System. The EE national diagnosis has shown that its integration within the parks management structure is a first priority need, being a converging result on the two case studies on National Parks from the Pacific Coast of Colombia. The diagnosis also demonstrates that communication, participation, training and evaluation have to be reinforced, linking the community and stakeholders involved in the park management to the whole EE process. The proposed methodology route has been agreed upon by the National Parks staff and incorporates advice and recommendations from different stakeholders, in order to better include the park users. This step will help us to advance toward sustainable management in marine and coastal protected areas elsewhere, taking into account not only the biological but also the social-cultural prism. The main challenges in the management and conservation of coastal and marine ecosystems today are discussed.

Real Options: A Tool for Managing Technical Risk in a Mine Plan

NPV is a static measure of project value which does not discriminate between levels of internal and external risk in project valuation. Due to current investment project?s characteristics, a much more complex model is needed: one that includes the value of flexibility and the different risk levels associated with variables subject to uncertainty (price, costs, exchange rates, grade and tonnage of the deposits, cut off grade, among many others). Few of these variables present any correlation or can be treated uniformly. In this context, Real Option Valuation (ROV) arose more than a decade ago, as a mainly theoretical model with the potential for simultaneous calculation of the risk associated with such variables. This paper reviews the literature regarding the application of Real Options Valuation in mining, noting the prior focus on external risks, and presents a case study where ROV is applied to quantify risk associated to mine planning.