A Reappraisal in Sao Paulo, Brazil (2008) of "The Ecology of Medical Care:" The "One Per Thousand's Rule"

BACKGROUND AND OBJECTIVES: Medical ecology is a conceptual framework introduced in 1961 to describe the relationship and utilization of health care services by a given population. We applied this conception to individuals enrolled in a private health maintenance organization (HMO) in Sao Paulo, Brazil, with the aim of describing the utilization of primary health care, verifying the frequency of various symptoms, and identifying the roles of different health care sources. METHODS: This was a cross-sectional telephone survey among a random sample of people enrolled in a private HMO. We interviewed a random sample of non-pregnant adults over age 18 using 10 questions about symptoms and health care use during the month prior to interview. RESULTS: The final sample consisted of 1,065 participants (mean age 68 years, 68% female). From this sample, 424 (39.8%) reported the presence of symptoms, 311 (29.2%) had a medical office consult, 104 (9.8%) went directly to an emergency medical department, 63 (5.9%) were hospitalized, 22 (2.1%) used complementary medicine resources, seven (0.7%) were referred to home care, and one (0.1%) was admitted to an academic hospital. CONCLUSIONS: The proportion of study participants referred to an academic care center was similar to that observed in previous "medical ecology" studies in different populations.

'Beheading', Rule Manipulation and Fraud: The Approval of Election Results in Brazil, 1894-1930

Studies of electoral fraud tend to focus their analyses only on the pre-electoral or electoral phases. By examining the Brazilian First Republic (1889-1930), this article shifts the focus to a later phase, discussing a particular type of electoral fraud that has been little explored by the literature, namely, that perpetrated by the legislatures themselves during the process of giving final approval to election results. The Brazilian case is interesting because of a practice known as degola ('beheading') whereby electoral results were altered when Congress decided on which deputies to certify as duly elected. This has come to be seen as a widespread and standard practice in this period. However, this article shows that this final phase of rubber-stamping or overturning election results was important not because of the number of degolas, which was actually much lower than the literature would have us believe, but chiefly because of their strategic use during moments of political uncertainty. It argues that the congressional certification of electoral results was deployed as a key tool in ensuring the political stability of the Republican regime in the absence of an electoral court.

Liberalism, Marxism and Democratic Theory Revisited: Proposal of a Joint Index of Political and Economic Democracy

Liberalism and Marxism are two schools of thought which have left deep imprints in sociological, political and economic theory. They are usually perceived as opposite, rival approaches. In the field of democracy there is a seemingly insurmountable rift around the question of political versus economic democracy. Liberals emphasize the former, Marxists the latter. Liberals say that economic democracy is too abstract and fuzzy a concept, therefore one should concentrate on the workings of an objective political democracy. Marxists insist that political democracy without economic democracy is insufficient. The article argues that both propositions are valid and not mutually exclusive. It proposes the creation of an operational, quantifiable index of economic democracy that can be used alongside the already existing indexes of political democracy. By using these two indexes jointly, political and economic democracy can be objectively evaluated. Thus, the requirements of both camps are met and maybe a more dialogical approach to democracy can be reached in the debate between liberals and Marxists. The joint index is used to evaluate the levels of economic and political democracy in the transition countries of Eastern Europe.

Il contributo dell’Unione europea all’affermazione dello stato di diritto nella comunità internazionale

This thesis is aimed at analysing EU external relations from the perspective of the promotion of the rule of law in order to evaluate the effectiveness and consistency of its action within the international community. The research starts with an examination of the notion of the rule of law from a theoretical point of view. The first chapter initially describes the historical-political evolution of the establishment of the notion of the rule of law. Some of the most significant national experiences (France, the UK, Germany and Austria) are discussed. Then, the focus is put on the need to propose interpretations which explain the grounds of the rule of law, by highlighting the different formal and substantive interpretations. This philosophical-historical analysis is complemented by a reconstruction of how the notion of the rule of law was developed by the international community, with a view to searching a common notion at the international level by comparing theory and practice within the main international organisations such as the UN, OECD and the Council of Europe. Specific mention is made of the EU experience, whose configuration as a Community based on the rule of law is often debated, starting from the case law of the European Court of Justice. The second chapter deals with the conditionality policy and focuses on the development and scope of democratic conditionality according to the dominant approach of the doctrine. First, the birth of conditionality is analysed from an economic point of view, especially within international financial organisations and the different types of conditionality recreated in the scientific sector. Then an analysis is provided about the birth of democratic conditionality in the EC – in relation to its external relations – firstly as a mere political exercise to be then turned into a standardised system of clauses. Specific reference is made to the main scope of conditionality, that is to say enlargement policy and the development of the Copenhagen criteria. The third chapter provides further details about the legal questions connected to the use of democratic clauses: on the one hand, the power of the EC to include human rights clauses in international agreements, on the other, the variety and overlapping in the use of the legal basis. The chapter ends with an analysis of the measures of suspension of agreements with third countries in those rare but significant cases in which the suspension clause, included in the Lomè Convention first and in the Cotonou Agreement then, is applied. The last chapter is devoted to the analysis of democratic clauses in unilateral acts adopted by the European Union which affect third countries. The examination of this practice and the comparison with the approach analysed in the previous chapter entails a major theoretical question. It is the clear-cut distinction between conditionality and international sanction. This distinction is to be taken into account when considering the premises and consequences, in terms of legal relations, which are generated when democratic clauses are not complied with. The chapter ends with a brief analysis of what, according to the reconstruction suggested, can be rightly labelled as real democratic conditionality, that is to say the system of incentives, positive measures developed within the community GSP. The dissertation ends with a few general considerations about the difficulties experienced by the EU in promoting the rule of law. The contradictory aspects of the EU external actions are manifold, as well as its difficulties in choosing the most appropriate measures to be taken which, however, reflect all the repercussions and tension resulting from the balance of power within the international community. The thesis argues that it is difficult to grant full credibility to an entity like the EU which, although it proclaims itself as the guardian and promoter of the rule of law, in practice, is too often biased in managing its relations with third countries. However, she adds, we must acknowledge that the EU is committed and constantly strives towards identifying new spaces and strategies of action.

Neocostituzionalismo e positivizzazione dei valori

This doctoral thesis seeks to make a comprehensive analysis of neoconstitutionalism, studying their manifestations in constitutional law and doctrine. Neoconstitutionalism, as a new manifestation of constitutional phenomenon that emerged after World War II, is characterized by the need to take any legal possession of certain premises, materials of an immovable, coinciding with the fundamental human rights, which will fall outside the potential political majorities, and become its cornerstone. These assumptions are intended as safeguards needed to protect human dignity and the democratic system itself against anyone, even taking advantage of a power obtained democratically which intends to demolish the pillars of democracy and to establish tyranny. The Constitution is enshrined as a basic rule of real system, a repository of these fundamental rights, the observance by public authorities becomes inexcusable. This will involve a role for judicial review in its protection. Thus, supremacy of the constitution, deepening respect for and promotion of fundamental rights and role of constitutional judge as the guarantor of its validity are the bases of neoconstitutionalism, a legal phenomenon not only current, but evolving.

Monitoring Complex Processes to Verify System Conformance: A Declarative Rule-Based Framework

Over the last 60 years, computers and software have favoured incredible advancements in every field. Nowadays, however, these systems are so complicated that it is difficult – if not challenging – to understand whether they meet some requirement or are able to show some desired behaviour or property. This dissertation introduces a Just-In-Time (JIT) a posteriori approach to perform the conformance check to identify any deviation from the desired behaviour as soon as possible, and possibly apply some corrections. The declarative framework that implements our approach – entirely developed on the promising open source forward-chaining Production Rule System (PRS) named Drools – consists of three components: 1. a monitoring module based on a novel, efficient implementation of Event Calculus (EC), 2. a general purpose hybrid reasoning module (the first of its genre) merging temporal, semantic, fuzzy and rule-based reasoning, 3. a logic formalism based on the concept of expectations introducing Event-Condition-Expectation rules (ECE-rules) to assess the global conformance of a system. The framework is also accompanied by an optional module that provides Probabilistic Inductive Logic Programming (PILP). By shifting the conformance check from after execution to just in time, this approach combines the advantages of many a posteriori and a priori methods proposed in literature. Quite remarkably, if the corrective actions are explicitly given, the reactive nature of this methodology allows to reconcile any deviations from the desired behaviour as soon as it is detected. In conclusion, the proposed methodology brings some advancements to solve the problem of the conformance checking, helping to fill the gap between humans and the increasingly complex technology.

Prognostic value of the Geneva prediction rule in patients in whom pulmonary embolism is ruled out

The prognosis of patients in whom pulmonary embolism (PE) is suspected but ruled out is poorly understood. We evaluated whether the initial assessment of clinical probability of PE could help to predict the prognosis for these patients.

The pulmonary embolism rule-out criteria (PERC) rule does not safely exclude pulmonary embolism

The Pulmonary Embolism Rule-out Criteria (PERC) rule is a clinical diagnostic rule designed to exclude pulmonary embolism (PE) without further testing. We sought to externally validate the diagnostic performance of the PERC rule alone and combined with clinical probability assessment based on the revised Geneva score.