Composition and cost of drugs stored at home by elderly patients.

BACKGROUND: Elderly people often have multiple chronic diseases, are frequently treated by several physicians, and also use over-the-counter medications. Excessive prescribing, imperfect therapeutic adherence, treatment modifications after hospitalization, and oversized drug packages result in home storage of leftover drugs, resulting in a waste of healthcare resources. PATIENTS AND METHODS: All patients aged >/=75 years hospitalized for >24 hours during a 6-month period in an urban teaching hospital in Switzerland were eligible for inclusion in a study collecting sociodemographics, medical, functional, and psychosocial characteristics. Six months later, a research nurse visited the patients at home and recorded the names, number of tablets, and expiration dates of all open or intact drug packages, and the doses actually taken. Acquisition costs of these drugs were computed. RESULTS: One hundred ninety-five patients were included (127 women; mean age 82.2 +/- 4.8 y, range 75-96). They had a total of 2059 drugs (mean per patient 10.3 +/- 6.7, range per patient 1-42), corresponding to a total cost of (US) $62 826 (mean per patient 322 +/- 275, range per patient 10-1571). Self-reported drug intake was regular for 36% of the drugs (46.5% of total costs) and occasional for 11% (6.1%), whereas 35.7% (30.1%) had been stopped during the last month. Cardiovascular drugs amounted to 36.6% of the drugs and 55.5% of the costs. None of the patients' characteristics was significantly associated with a greater number of drugs and higher costs. CONCLUSIONS: Drugs stored at home by elderly patients were worth about $320 per patient. Only about one-third of these drugs were regularly taken. In the context of resources shortage, innovative solutions should be found to reduce the waste linked with drugs stopped in previous months.

Social and commercial entrepreneurship: same, different, or both?

Entrepreneurship has been the engine propelling much of the growth of the business sector as well as a driving force behind the rapid expansion of the social sector. This article offers a comparative analysis of commercial and social entrepreneurship using a prevailing analytical model from commercial entrepreneurship. The analysis highlights key similarities and differences between these two forms of entrepreneurship and presents a framework on how to approach the social entrepreneurial process more systematically and effectively. We explore the implications of this analysis of social entrepreneurship for both practitioners and researchers.

Linguagem fílmica: uma metáfora de comunicação para a análise dos discursos nas organizações

O objetivo da pesquisa aqui relatada foi investigar a linguagem fílmica como metáfora de comunicação para a análise dos discursos nas organizações. Trata-se de uma pesquisa qualitativa, com uso da estratégia de análise fílmica. Os dados foram coletados por meio da observação indireta e não participante, registrados em protocolo de observação. Foi utilizada a estratégia de análise de discurso do personagem do Rei George VI no filme comercial/artístico O discurso do rei; a análise documental do filme documentário The king speaks - "The true story behind the film" e a análise de conteúdo da obra literária biográfica O discurso do rei - "Como um homem salvou a monarquia britânica". Nos resultados, reforçou-se que o uso da linguagem fílmica, nesta pesquisa, contribui para o entendimento do fenômeno da comunicação nas organizações. Seu uso cria a oportunidade de simulação a partir de cenas que podem ser comparadas com dados inseridos no contexto organizacional, como metáforas, desde que haja cuidado com a dimensão afetiva envolvida no processo de significação fílmica. Sua utilização torna-se conveniente, desde que não se permita a escolha do filme pelo filme e que haja um alinhamento entre o filme escolhido e o construto que se pretende investigar.

Using environmental niche modeling to understand biological invasions in a changing world

L'activité humaine affecte particulièrement la biodiversité, qui décline à une vitesse préoccupante. Parmi les facteurs réduisant la biodiversité, on trouve les espèces envahissantes. Symptomatiques d'un monde globalisé où l'échange se fait à l'échelle de la planète, certaines espèces, animales ou végétales, sont introduites, volontairement ou accidentellement par l'activité humaine (par exemple lors des échanges commerciaux ou par les voyageurs). Ainsi, ces espèces atteignent des régions qu'elles n'auraient jamais pu coloniser naturellement. Une fois introduites, l'absence de compétiteur peut les rendre particulièrement nuisibles. Ces nuisances sont plus ou moins directes, allant de problèmes sanitaires (p. ex. les piqûres très aigües des fourmis de feu, originaires d'Amérique du Sud et colonisant à une vitesse fulgurante les USA, l'Australie ou la Chine) à des nuisances sur la biodiversité (p. ex. les ravages de la perche du Nil sur la diversité unique des poissons Cichlidés du Lac Victoria). Il est donc important de pouvoir prévenir de telles introductions. De plus, pour le biologiste, ces espèces représentent une rare occasion de pouvoir comprendre les mécanismes évolutifs et écologiques qui expliquent le succès des envahissantes dans un monde où les équilibres sont bouleversés. Les modèles de niche environnementale sont un outil particulièrement utile dans le cadre de cette problématique. En reliant des observations d'espèces aux conditions environnementales où elles se trouvent, ils peuvent prédire la distribution potentielle des envahissantes, permettant d'anticiper et de mieux limiter leur impact. Toutefois, ils reposent sur des hypothèses pas évidentes à démontrer. L'une d'entre elle étant que la niche d'une espèce reste constante dans le temps, et dans l'espace. Le premier objectif de mon travail est de comparer si la niche d'une espèce envahissante diffère entre sa distribution d'origine native et celle d'origine introduite. En étudiant 50 espèces de plantes et 168 espèces de Mammifères, je démontre que c'est le cas et que par corolaire, il est possible de prédire leurs distributions. La deuxième partie de mon travail consiste à comprendre quelles seront les interactions entre le changement climatiques et les envahissantes, afin d'estimer leur impact sous un climat réchauffé. En étudiant la distribution de 49 espèces de plantes envahissantes, je démontre que les montagnes, régions relativement préservée par ce problème, deviendront bien plus exposées aux risques d'invasions biologiques. J'expose aussi comment les interactions entre l'activité humaine, le réchauffement climatique et les espèces envahissantes menacent la vigne sauvage en Europe et propose des zones géographiques particulièrement adaptée pour sa conservation. Enfin, à une échelle beaucoup plus locale, je montre qu'il est possible d'utiliser ces modèles de niches le long d'une rivière à une échelle extrêmement fine (1 mètre), potentiellement utile pour rationnaliser des mesures de conservations sur le terrain. - Biodiversity is significantly negatively affected by human activity. Invasive species are one of the most important factors causing biodiversity's decline. Intimately linked to the era of global trade, some plant or animal species can be accidentally or casually introduced with human activity (e.g. trade or travel). In this way, these species reach areas they could never reach through natural dispersal. Once naturalized, the lack of competitors can make these species highly noxious. Their effect is more or less direct, from sanitary problems (e.g. the harmful sting of Fire Ants, originating from South America and now spreading throughout USA, China and Australia) or can affect biodiversity (e.g. the Nile perch, devastating the one of the richest hotspot of Cichlid fishes diversity in Lake Victoria). It is thus important to prevent such harmful introductions. Moreover, invasive species represent for biologists one of the rare occasions to understand the evolutionary and ecological mechanisms behind the success of invaders in a world where natural equilibrium is already disturbed. Environmental niche models are particularly useful to tackle this problematic. By relating species observation to the environmental conditions where they occur, they can predict the potential distribution of invasive species, allowing a better anticipation and thus limiting their impact. However, they rely on strong assumption, one of the most important being that the modeled niche remains constant through space and time. The first aim of my thesis is to quantify the difference between the native and the invaded niche. By investigating 50 plant and 168 mammal species, I show that the niche is at least partially conserved, supporting for reliable predictions of invasive' s potential distributions. The second aim of my thesis is to understand the possible interactions between climate change and invasive species, such as to assess their impact under a warmer climate. By studying 49 invasive plant species, I show that mountain areas, which were relatively preserved, will become more suitable for biological invasions. Additionally, I show how interactions between human activity, global warming and invasive species are threatening the wild grapevine in Europe and propose geographical areas particularly adapted for conservation measures. Finally, at a much finer scale where conservation plannings ultimately take place, I show that it is possible to model the niche at very high resolution (1 meter) in an alluvial area allowing better prioritizations for conservation.

"S'il vous plaît docteur, mettez-moi en arrêt"! Certificats médicaux pour raisons psychologiques ["Doctor please, give me a sick leave"!: medical certificates for psychological reasons].

General practitioners are regularly called to evaluate the psychological work capacity of patients. The implicit motivation behind the explicit reason for requesting a sick leave is linked to the subject's history and the way he transfers it in his professional life. An incapacity to work harbours a variety of challenges for the patient, the physician and their relationship. In order to get a better understanding of all the issues at stake, the doctor should understand the significances that represents the work to the patient and the consequences of a sick leave and its associated transference and countertransference issues.

Equilibrium of drops on inclined hydrophilic surfaces

Why does not gravity make drops slip down the inclined surfaces, e.g., plant leaves? The current explanation is based on the existence of surface inhomogeneities, which cause a sustaining force that pins the contact line. Following this theory, the drop remains in equilibrium until a critical value of the sustaining force is reached. We propose an alternative analysis, from the point of view of energy balance, for the particular case in which the drop leaves a liquid film behind. The critical angle of the inclined surface at which the drop slips down is predicted. This result does not depend explicitly on surface inhomogeneities, but only on the drop size and surface tensions. There is good agreement with experiments for contact angles below 90° where the formation of the film is expected, whereas for greater contact angles great discrepancies arise

Neuronal adaptation effects in decision making

Recently, there has been an increased interest on the neural mechanisms underlying perceptual decision making. However, the effect of neuronal adaptation in this context has not yet been studied. We begin our study by investigating how adaptation can bias perceptual decisions. We considered behavioral data from an experiment on high-level adaptation-related aftereffects in a perceptual decision task with ambiguous stimuli on humans. To understand the driving force behind the perceptual decision process, a biologically inspired cortical network model was used. Two theoretical scenarios arose for explaining the perceptual switch from the category of the adaptor stimulus to the opposite, nonadapted one. One is noise-driven transition due to the probabilistic spike times of neurons and the other is adaptation-driven transition due to afterhyperpolarization currents. With increasing levels of neural adaptation, the system shifts from a noise-driven to an adaptation-driven modus. The behavioral results show that the underlying model is not just a bistable model, as usual in the decision-making modeling literature, but that neuronal adaptation is high and therefore the working point of the model is in the oscillatory regime. Using the same model parameters, we studied the effect of neural adaptation in a perceptual decision-making task where the same ambiguous stimulus was presented with and without a preceding adaptor stimulus. We find that for different levels of sensory evidence favoring one of the two interpretations of the ambiguous stimulus, higher levels of neural adaptation lead to quicker decisions contributing to a speed–accuracy trade off.

Toward integrated management of cerebral aneurysms

In the last few years, some of the visionary concepts behind the virtual physiological human began to be demonstrated on various clinical domains, showing great promise for improving healthcare management. In the current work, we provide an overview of image- and biomechanics-based techniques that, when put together, provide a patient-specific pipeline for the management of intracranial aneurysms. The derivation and subsequent integration of morphological, morphodynamic, haemodynamic and structural analyses allow us to extract patient-specific models and information from which diagnostic and prognostic descriptors can be obtained. Linking such new indices with relevant clinical events should bring new insights into the processes behind aneurysm genesis, growth and rupture. The development of techniques for modelling endovascular devices such as stents and coils allows the evaluation of alternative treatment scenarios before the intervention takes place and could also contribute to the understanding and improved design of more effective devices. A key element to facilitate the clinical take-up of all these developments is their comprehensive validation. Although a number of previously published results have shown the accuracy and robustness of individual components, further efforts should be directed to demonstrate the diagnostic and prognostic efficacy of these advanced tools through large-scale clinical trials.

Mass casualty incidents with multiple burn victims: rationale for a Swiss burn plan.

INTRODUCTION: Mass casualty incidents involving victims with severe burns pose difficult and unique problems for both rescue teams and hospitals. This paper presents an analysis of the published reports with the aim of proposing a rational model for burn rescue and hospital referral for Switzerland. METHODS: Literature review including systematic searches of PubMed/Medline, reference textbooks and journals as well as landmark articles. RESULTS: Since hospitals have limited surge capacities in the event of burn disasters, a special approach to both prehospital and hospital management of these victims is required. Specialized rescue and care can be adequately met and at all levels of needs by deploying mobile burn teams to the scene. These burn teams can bring needed skills and enhance the efficiency of the classical disaster response teams. Burn teams assist with both primary and secondary triage, contribute to initial patient management and offer advice to non-specialized designated hospitals that provide acute care for burn patients with Total Burn Surface Area (TBSA) <20-30%. The main components required for successful deployments of mobile burn teams include socio-economic feasibility, streamlined logistical implementation as well as partnership coordination with other agencies including subsidiary military resources. CONCLUSIONS: Disaster preparedness plans involving burn specialists dispatched from a referral burn center can upgrade and significantly improve prehospital rescue outcome, initial resuscitation care and help prevent an overload to hospital surge capacities in case of multiple burn victims. This is the rationale behind the ongoing development and implementation of the Swiss burn plan.

Extratracheal biodegradable splint to treat life-threatening tracheomalacia.

A 9-month-old girl presented with life-threatening acute respiratory failure 1 week after the surgical correction of a double aortic arch, which was due to a severe bulging of the pars membranacea into the lumen of the trachea that produced a complete obstruction of the lower trachea. Under cardiopulmonary bypass, a Y-shaped posterior biodegradable splint was placed behind the trachea and sutured to the posterior trachea, and a simultaneous right aortic arch aortopexy was performed. Thereafter, the child recovered normal respiratory function. Follow-up bronchoscopy showed a posterior dip at the splint level and an asymptomatic persistent posterior compression of the right main bronchus.

Luovuus ja itsetuntemus ohjaajantyössä

This research deals with obstacles and opportunities with respect to creativity. It mainly focuses on the author's most meaningful discoveries as an individual and a professional in the field of theatre during the past two years of her education. The research is a description of that transitional phase in her life. Firstly, the research discusses creativity and presence. Secondly, it describes the author personally and professionally and compares her earlier and current ways of working. It contemplates the obstacles and opportunities considering her self-knowledge and creativity, and disucsses the problems she has faced on the way to freedom and well-being. Following this, the author presents the tools for increasing her creativity, self-knowledge and body awareness in theatre work: the Gestalt Method, Acting with the Inner Partner and the Authentic Movement. She discusses the relativity between overall well-being in life and the quality of theatre work. The final section of the present research discusses the process of directing the play Suurin on rakkaus in 2006. It deals with issues such as self-knowledge in directing, group management, the importance of terror and excitement in directing and ways of enduring both. The conclusion explanes the reasons behind the author's capability of working with small groups, with creative and passionate theatre workers. It also lists the benefits of exploring one's passions, cooperating with enthusiastic and creative artists and the pursuit for balance in art and in everyday life.

What do women do? World population growth and fertility patterns, 1960-2000

In this paper we attempt to describe the general picture reasons behind the world population explosion during the 20th century. In general we comment that if, according to some, at the end of the 20th century there were too many people, this was has a consequence of scientific innovation, circulation of information, and economic growth, leading to a dramatic improvement in life expectancies. Nevertheless, a crucial variable shaping differences in demographic growth is fertility. In this paper we identify as important exogenous variables affecting fertility female education levels, infant mortality, and racial identity and diversity. It is estimated that three additional years of schooling for mothers leads on average (at the world level ) to one child less per couple. Even if we can identify a worldwide trend towards convergence in demographic trends, the African case needs to be given more attention, not only because of its different demographic patterns, but also because this is the continent where the worldwide movement towards a higher quality of life has not yet been achieved for an important share of the world's population.

Bartók i els seus dos últims concerts

La idea inicial d’aquest projecte rau en el meu interès per aprofundir en dues obres: una, escrita per a viola, i l’altra, per a piano. La controvèrsia musicològica sobre l’autenticitat del Concert per a viola de Bartók, una obra cabdal dins del repertori d’aquest instrument, i la coincidència cronològica que aquest concert manté amb el Concert per a piano núm. 3 d’aquest mateix compositor han estat, finalment, el focus central de Bartók i els seus dos últims concerts. Mitjançant la informació extreta de llibres sobre el compositor, articles, tesis i partitures, les pàgines següents són el reflex del meu apropament als últims anys de la vida de Bartók, a la història que s’amaga darrere d’ambdues obres i als paral·lelismes que conté aquesta música.

La heroína trágica en la ópera : personajes femeninos de la tragèdie lyrique y el dramma per musica

El antiguo arte de la tragedia griega volvió a revivir entre las décadas de 1570 y 1580 gracias a la Camerata Florentina, que la convirtió en el punto de partida de un nuevo género: la opera. El gran interés del Renacimiento por revivir el drama del mundo clásico trae como consecuencia el nacimiento de la protagonista de nuestro estudio: la heroína trágica operística. El objetivo del proyecto es el análisis de los personajes femeninos de la tragedia clásica y su posterior conversión en heroínas de las óperas de inspiración clásica. La literatura griega creó una serie de personajes femeninos que adquirieron un protagonismo inusitado en la época y que, posteriormente, cautivaron a los compositores de ópera. A través de esta investigación trataremos de hallar las razones históricas, sociales, políticas o psicológicas que están detrás del origen de la heroína trágica. Igualmente se estudiarán las diversas características que fue desarrollando y que la definirían como personaje hasta que el mundo operístico la convirtió en la protagonista absoluta de la escena lírica.

Un regard sur la politique forestière suisse (essai)

In the form of an essay, the author proposes a review of the reasons behind the recent changes in forestry policy. He identifies two explanatory elements and goes into these in more detail: the loss in cohesion in sectorial forestry logic since the 1980s, and the internal division which has arisen on account of the failure to put through the partial revision of the Federal Forestry Law. Firstly, it is clear that forestry practice continues to function on a sectorial basis, even though the management of resources increasingly extends between sectors. Accordingly, he also sees forestry management as being restricted by exterior influences. Secondly, the dichotomy between production and protection weakens the forestry community. The author hopes forestry will be able to overcome these problems and thus become (once more) an influential political protagonist.