Grande fréquence des prescriptions médicamenteuses à visée cardiovasculaire potentiellement inappropriées dans la population âgée [Potentially inappropriate prescribing cardiovascular medications in the aged population: prospective study in a district hospital centre (France)].

OBJECTIVES: Cardiovascular disease is a leading cause of morbidity and mortality in the elderly population. We evaluated the adequacy of prescribing (miss and under used) with respect to STOPP-START criteria. METHODS: A sample of 100 patients hospitalized in cardiovascular specialty divisions (medicine or surgery) or in the different sectors making up the geriatric network (day-care hospital, short or rehabilitation ward, nursing home) has been considered. Drug prescriptions at the admission time were analysed. RESULTS: Eight hundred and seventy-four prescriptions were analysed. In 65% of patients, from 5 to 10 medications were prescribed and in 28% over 10. Fifty-four percent of patients had, at least, one potentially inappropriate prescription (PIP) by STOPP. Among them, 48% of PIP prescriptions contained 1, 41% 2 and 11% 3 or more. The omission of one medication according to START criteria concerned 57% of the sample. Among them, 46% had one omission, 44% 2 to 3 and 10% 4 omissions or over. The cardiovascular system is the one most concerned by the PIP. Whether 28.1% of the PIP by STOPP criteria concerned cardiovascular drugs, the omission of prescription, according to START criteria, was 41.8%. There was no significant difference between the different settings studied. There was no effect of age or sex on the impact of PIP (P>0.20) or being polymédiqué (P=0.44). According to the criteria STOPP-A, the prescription of antiplatelet (indication and dose) was highlighted. Prescribing omission also concerned antiplatelet agents but also statins in patients with atherosclerosis as well as antiplatelet and anticoagulant in patients with permanent atrial fibrillation and inhibitor of angiotensin converting enzyme (ACE) after myocardial infarction or with chronic heart failure. CONCLUSION: Potentially inappropriate prescribing medications were very common in elderly patients with cardiovascular conditions. They concerned as much as underusing of important drugs with potential benefits and prescribing commission of treatment that did not fit with patients' comorbidities and/or characteristics.

Courts and Courtly Cultures in Early Modern Italy and Europe: Models and Languages

This volume deals with the forms of propaganda and self-representation, through words and images, during the rise of the 'civiltà delle corti' and through processes typical of the time, such as confrontation, adaptation, competition and rivalry. This period, which marked the passage of Italian and European culture from the Middle Ages to the Renaissance, is fundamental in the development of Modern Europe, and it lasted up to the XVIII century and beyond. At the heart of many matters debated here lies the relationship between culture and politics. The formation of a 'Lombard identity', central to the Sinergia project which was the frame of the whole research and its conferences, is closely linked to this broad general context. It places the so called 'questione milanese' - above the traditional hierarchies 'Toscana oriented' - at the centre of many questions regarding Northern Italy as a whole, starting from the dissolution of the Medieval communes, through to the rise of the signorie, from the end of the XIII century and the beginning of the XIV century up to the early XVI century.

Determinants of the decision to appeal against motor bodily injury settlements awarded by Spanish trial courts

Automobile bodily injury disputes represent one of the main causes of litigation faced by Spanish Courts. In this paper a multinomial model is implemented to analyse which factors determine the decision to appeal against the verdicts of trial courts. Use of a dataset of motor insurance claims revealed differences between the determinants of a claimant’s decision to appeal and those of insurers. Among other results it is shown that discrepancies regarding the permanent disability sustained affect the insurer’s decision to appeal. In contrast, the claimant pays more attention to differences in the stated temporary disability. Conclusions are drawn regarding which factors could reduce the percentage of appealed cases.

Utilization of Automatic Meter Reading in the Improvement of a District Heating System

A district heating system comprises production facilities, a distribution network, and heat consumers. The utilization of new energy metering and reading system (AMR) is increasing constantly in district heating systems. This heuristic study shows how the AMR system can be exploited in finding optimization opportunities in district heating system. In this study, the district heating system is mainly considered from the viewpoint of operational optimization. The focus is on the core processes, heat production and distribution. Three objectives were set to this study. The first one was to examine general optimization opportunities in district heating systems. Second, to figure out the benefits of AMR for general optimization opportunities. Finally, to define a methodology for process improvement endeavors. This study shows, through a case study, the usefulness of AMR in specifying current deficiencies in a district heating system. Based on a literature review, the methodology for the improvement of business processes is presented. Additionally, some issues related to future competitiveness of district heating are concerned. As a conclusion, some optimization objectives are considered more desirable than others. Study shows that AMR is useful in the specification of optimization targets in the district heating system. Further steps in optimization process were not examined in detail. That would seem to be interesting topic for further studies.

Rural Food System Change in Tanzania during the Post-Ujamaa Era. A Case Study from Western Bagamoyo District

Food systems in Sub-Saharan Africa have been rapidly transforming during the recent decades with diverse outcomes on human development and environment. This study explores the food system change in rural villages in eastern Tanzania where subsistence agriculture has traditionally been the main source of livelihood. The focus is on the salient changes in the spatial dimensions and structural composition of the food system in the context of economic liberalization that has taken place after the end of the socialist ujamaa era in the mid-1980s. In addition, the linkages of the changes are examined in relation to food security, socio-economic situation, livelihoods, and local environment. The approach of the study is geographical, but also involves various multi-disciplinary elements, particularly from development studies. The research methods included thematic and questionnaire interviews, participatory tools, and the analysis of land use/ cover data and official documents. Several earlier studies that were made in the area during the late 1970s and 1980s provided an important reference base. The study shows that subsistence farming has lost its dominant role in food provisioning due to the declining productivity of land, livestock losses, and the increasing shift of labour to non-farm sectors. Also rapid population growth has added to the pressure on land and other natural resources. Despite the increasing need for money for buying marketed foods and other necessities, the nutritional situation shows improvement and severe malnutrition has diminished. However, the long-term sustainability of this transformation raises concerns. Firstly, the food security situation continues to be fragile and prone to shocks such as adverse climatic conditions, crop failures and price hikes. Secondly, the commodification of the food system and livelihoods in general is linked to rapid environmental degradation in the area, particularly the loss of soil fertility and deforestation. The situation calls for efforts that take more determined and holistic approaches towards sustainable development of the rural food system with particular focus on the role and viability of small-scale farming.

Delay reduction in courts of justice – possibilities and challenges of process improvement in professional public organizations

Delays in the justice system have been undermining the functioning and performance of the court system all over the world for decades. Despite the widespread concern about delays, the solutions have not kept up with the growth of the problem. The delay problem existing in the justice courts processes is a good example of the growing need and pressure in professional public organizations to start improving their business process performance.This study analyses the possibilities and challenges of process improvement in professional public organizations. The study is based on experiences gained in two longitudinal action research improvement projects conducted in two separate Finnish law instances; in the Helsinki Court of Appeal and in the Insurance Court. The thesis has two objectives. First objective is to study what kinds of factors in court system operations cause delays and unmanageable backlogs and how to reduce and prevent delays. Based on the lessons learned from the case projects the objective is to give new insights on the critical factors of process improvement conducted in professional public organizations. Four main areas and factors behind the delay problem is identified: 1) goal setting and performance measurement practices, 2) the process control system, 3) production and capacity planning procedures, and 4) process roles and responsibilities. The appropriate improvement solutions include tools to enhance project planning and scheduling and monitoring the agreed time-frames for different phases of the handling process and pending inventory. The study introduces the identified critical factors in different phases of process improvement work carried out in professional public organizations, the ways the critical factors can be incorporated to the different stages of the projects, and discusses the role of external facilitator in assisting process improvement work and in enhancing ownership towards the solutions and improvement. The study highlights the need to concentrate on the critical factors aiming to get the employees to challenge their existing ways of conducting work, analyze their own processes, and create procedures for diffusing the process improvement culture instead of merely concentrating of finding tools, techniques, and solutions appropriate for applications from the manufacturing sector

The Saima district Savonlinna-Kuopio

kuv., 11 x 17 cm

The most beautiful district of Finland

kuv., 11 x 17 cm

Victims’ status at international and hybrid criminal courts : victims’ status as witnesses, victim participants/civil parties and reparations claimants

Bestraffning av internationella brott vid internationella och hybrida straffrättsliga domstolar har traditionellt och huvudsakligen grundat sig på principen om retributiv (vedergällande) rättvisa och ackusatorisk process snarare än återuppbyggande rättvisa och en inkvisitorisk modell. Därav har brottsoffrens ställning vid dessa straffrättsliga domstolar begränsat sig till den som innehas av vittnen vid Tribunalen som behandlar brott som begåtts i det forna Jugoslavien (ICTY), Internationella krigsförbrytartribunalen för Rwanda (ICTR) och Specialdomstolen för Sierra Leone (SCSL). Internationella brottmålsdomstolen (ICC), å sin sida, har medfört en viktig förändring gällande brottsoffrens ställning i internationella straffrättsliga fora, vilket innebär att de från att ha betraktats endast i egenskap av vittnen nu även har en rätt att delta och lämna sina synpunkter (i egenskap av brottsofferdeltagare) samt kräva gottgörelse. Denna trend har fortsatt inom området för internationell straffrätt, vilket manifesterats vid hybridtribunaler som tillsatts efter ICC såsom Kambodjadomstolen (ECCC) vid vilken brottsoffer kan agera civilrättsliga parter och Specialdomstolen för Libanon (STL) där brottsoffer kan inneha en deltagande roll. Den föreliggande studien behandlar två huvudsakliga frågeställningar, av vilka den första lyder: Vilken ställning tillskrivs brottsoffren vid internationella domstolar och hybridtribunaler? I detta hänseende argumenterar författaren, sammanfattningsvis, för att brottsoffrens ställning vid internationella straffrättsliga domstolar och hybridtribunaler huvudsakligen tar sig uttryck på tre sätt, d.v.s. som brottsoffer i egenskap av vittnen, som brottsoffer i egenskap av deltagande brottsoffer/civilrättsliga parter samt som brottsoffer som kräver gottgörelse. Den andra frågeställningen för denna studie lyder: På vilket sätt fungerar brottsoffrens ställning som vittnen, brottsofferdeltagande/civilrättsliga parter och gottgörelsekrävande vid internationella och hybrida straffrättsliga domstolar? -------------------------------------------------------------------------------------------------------------------------------------------------- Kansainvälisten rikosten rankaiseminen kansainvälisissä rikostuomioistuimissa ja hybridituomioistuimissa on perinteisesti enimmäkseen perustunut retributiivisen oikeuden ja akkusatorisen menetelmän soveltamiseen pikemmin kuin restoratiivisen oikeuden ja inkvisitorisen menetelmän soveltamiseen. Niinpä uhrien asema kansainvälisissä rikostuomioistuimissa ja hybridituomioistuimissa on rajoittunut todistajan asemaan entisen Jugoslavian kansainvälisessä sotarikostuomioistuimessa (ICTY), Ruandan kansainvälisessä sotarikostuomioistuimessa (ICTR) ja Sierra Leonen erikoistuomioistuimessa (SCSL). Kansainvälisen rikostuomioistuimen (ICC) perustaminen on kuitenkin merkinnyt tärkeää muutosta uhrien asemaan kansainvälisen rikosoikeuden alalla siten, että kun uhrit aiemmin nähtiin vain todistajina, heillä on nyt myös mahdollisuus tuoda esiin omat näkökantansa (osallistumisoikeus) ja vaatia hyvitystä. Tämä suuntaus on jatkunut kansainvälisen rikosoikeuden alalla ICC:n jälkeen perustetuissa hybridituomioistuimissa, kuten Kambodzhan erityistuomioistuimessa (ECCC), missä uhrit voivat olla asianosaisen asemassa, sekä Libanonin erityistuomioistuimessa (STL), missä uhrit voivat osallistua prosessiin. Tämä tutkimus käsittelee kahta keskeistä kysymystä. Ensinnäkin: Mikä on rikoksen uhrien asema kansainvälisissä rikostuomioistuimissa ja hybridituomioistuimissa? Tutkimuksessa päädytään mm. siihen, että uhrien asema kansainvälisissä rikostuomioistuimissa ja hybridituomioistuimissa voi koostua pääosin kolmesta ulottuvuudesta eli uhrit todistajina, uhrit prosessiin osallistujina/asianosaisina ja uhrit hyvityksen hakijoina. Tutkimuksen toinen keskeinen kysymys on: Miten uhrien asema todistajina, prosessiin osallistujina/ asianosaisina ja hyvityksen hakijoina toimii kansainvälisissä rikostuomioistuimissa ja hybridituomioistuimissa?

Floristic composition of a conservation area in the Federal District of Brazil

Cerradão vegetation shares many species with savanna and forest areas and is one of the most vulnerable phytophysiognomies in the Cerrado (Brazilian savanna) biome. The floristic composition of the Cerradão Biological Reserve was examined between September/2007 and November/2008. A total of 282 species distributed among 194 genera and 75 families were encountered, demonstrating proportions of 0.91 herbaceous species and 0.54 shrub species for each tree species. Fabaceae, Asteraceae, Rubiaceae, Poaceae, Myrtaceae, Malpighiaceae, and Melastomataceae were the most species-rich families. Fully 72.3% of the species of this dystrophic cerradão were shared by cerrado and forest vegetations, while 60.43% were shared by other cerradão sites, although the largest proportion of species (91%) were shared with cerrado sensu stricto. No species was found to be exclusive to this cerradão site, but approximately 95% of all species were native to the Cerrado biome.

Human group C rotavirus in children with diarrhea in the Federal District, Brazil

Group C rotaviruses are fastidious in their in vitro cell culture requirements. Recent serosurveys indicate that antibody to group C rotavirus is present in 3-45% of the human population in certain geographic locations, suggesting that rotavirus group C infection is more prevalent than previously believed and that the low rate of detection of these agents is probably due to the lack of sensitive diagnostic assays. From March to December 1994, 406 fecal specimens were collected from children under five years of age who were outpatients at the emergency services of nine public hospitals in Brasília, Federal District, Brazil. In addition to the samples from children, one public outpatient unit requested virological investigation of a stool sample from an HIV-seropositive adult male with diarrhea of sudden onset. All samples were analyzed by enzyme immunoassay for group A rotavirus and adenovirus (EIARA) and by polyacrylamide gel electrophoresis (PAGE). One hundred and seven (26%) were positive for group A rotavirus. Four samples from children and the sample from the HIV-seropositive patient, although negative by EIARA, showed a group C rotavirus profile by PAGE and were positive for rotavirus by electron microscopy. Using specific VP6 and VP7 primers for group C rotavirus, a reverse transcriptase-polymerase chain reaction (RT-PCR) was performed and products were detected by agarose gel electrophoresis and ethidium bromide staining. These products were confirmed to be specific for group C rotavirus by using digoxigenin-oligonucleotide probes, Southern hybridization and chemiluminescent detection. The five positive group C rotavirus samples were detected in August (3 samples) and September (2 samples). To the best of our knowledge, this is the first report of group C rotavirus detected in the Federal District, Brazil and in an HIV-seropositive patient with acute gastroenteritis.