Qualified products list 2

The South Carolina Department of Transportation publishes Qualified Products Listings which include pre-qualified materials that may be used on construction and maintenance projects as specified in the project proposal. This document deals with qualified coarse aggregate sources. It is broken down by supplier, location name, SCDOT number, location, fineness modulus, absorption, specific gravity, bulk SSD and soundness loss.

SCDOT Qualified Product List 49 - Permanent Traffic Barrier Components

The South Carolina Department of Transportation publishes Qualified Products Listings which include pre-qualified materials that may be used on construction and maintenance projects as specified in the project proposal. This document deals with permanent traffic barrier components.

Humor político audiovisual en Colombia: de los gloriosos años noventa en televisión a internet como alternativa

El humor político alrededor del mundo ha sido un recurso para criticar el poder y la esfera política con la mordacidad que otros escenarios no permiten y con lenguajes que generan empatía con el público. En la capacidad de criticar a todos los poderes –y poderosos- por igual, sin condescendencias, recae la credibilidad de esa crítica, la cual se debe poder hacer sin censura en una sociedad pluralista y democrática. En Colombia, el humor político en televisión emergió y vivió su época dorada en la década de los noventa, hasta que su principal exponente, Jaime Garzón, fue asesinado. Este trabajo de grado buscó indagar por qué, a pesar de que nuevos productos de crítica política con humor surgieron en el país, hoy no hay ese tipo de oferta en la televisión abierta nacional. La respuesta a ese interrogante se pudo encontrar en múltiples factores, como un nuevo modelo económico en la industria de la televisión, un ambiente político polarizado y la ausencia o falta de promoción de talentos detrás de los libretos. Asimismo, en medio de esta coyuntura, se plantea que internet ha sido un vehículo para expresar, incluso de manera anónima, lo que miembros de la sociedad creen que anda mal con el poder y la política.

Evaluation of the evolution of the anthocyanins profile in red wine grape varieties in Alentejo

The flavonoids (including anthocyanins) are wine compounds with important anti-oxidant activity, protecting the cells against oxidative processes, preventing cardiovascular and neurodegenerative diseases, cancer, among others (Antoniolli et al. 2015; Castañeda-Ovando et al. 2009; Hosu et al. 2014; Huang et al. 2009; Kong et al. 2003). Anthocyanins in grapes at harvest are determinant to red wine quality and their development in the grape must be characterised in order to determine the most suitable date for the harvest. Thus the aim of this research is the evaluation of anthocyanins composition in two red wine grape varieties from véraison continuing through ripening. Anthocyanins were quantified by high resolution liquid chromatography (HPLC-DAD). Additionally, the total phenols content were quantified by UV-Vis Spectrometry. The anthocyanins’ profile evolution may be dependent on the variety and ripening phase. During ripening grape samples have shown an increase of coumaryl derivatives. This information may lead us to understand the anthocyanins biosynthesis pathway in different grape varieties. The development of anthocyanins from the véraison seems to follow a pattern that coincides with the increasing accumulation of soluble sugars.

Assessment of molecular sequences and enzyme activity of amylase trypsin inhibitors (ATIs) from a selection of ancient and modern grains

Wheat amylase-trypsin inhibitors (ATIs) are a family of wheat proteins, which play an important role in plant defence against pest attacks. ATIs are also of great interest for their impact on human health and recently ATIs have been identified as major stimulators of innate immune cells. In this study, ten selected wheat samples with different ploidy level and year of release were used for the agronomic trial, for in vitro enzymatic assays and for ATIs gene sequencing. Wheat samples were grown under organic farming management during three consecutive cropping years at two growing areas (Italy and USA). The PCA analysis performed on the deduced amino acid sequences of four representative ATIs genes (WMAI, WDAI, WTAI-CM3, CMx) evidenced that the ten wheat varieties can be differentiated on the basis of their ploidy level, but not with respect to ancient or recently developed wheat genotypes. The results from in vitro alpha-amylase and trypsin inhibitory activities showed high variability among the ten wheat genotypes and the contribution of the genotype and the cropping year was significant for both inhibitory activities. The hexaploid wheat genotypes showed the highest inhibitory activities. Einkorn showed a very low or even absent alpha-amylase inhibitory activity and the highest trypsin inhibitory activity. It was not possible to differentiate ancient and recently developed wheat genotypes on the basis of their ATIs activity. The weather conditions differently affected the two inhibitory activities. In both cultivation areas, higher precipitation and lower high mean temperatures correlated with lower alpha-amylase inhibitory activities, while there were different correlations considering trypsin inhibitory activity for the two growing areas. The protein content negatively correlated with both inhibitory activities in USA and Italy. This information can be important in the understanding of plant defence mechanisms in relation to the effect of both genotype and abiotic and biotic stress.

Lieu du crime, lieu de l’âme. La ville dans le roman noir contemporain (1995-2015) : Bologne, Limoges, Thessalonique

La thèse vise à analyser la représentation des villes de Bologne, Limoges et Thessalonique, dans le roman noir italien, français et grec contemporain (1995-2015). L'approche sociologique, anthropologique et géocritique domine dans la première partie de la thèse, tandis que, dans la deuxième partie, plus consacrée à l'analyse des textes, est utilisée une approche linguistique et stylistique basée sur les occurrences et la rhétorique, qui prend également en compte certains éléments de psychocritique. La réflexion se développe en deux étapes, plus un chapitre conclusif. Dans la première partie, les villes de Bologne, Limoges et Thessalonique sont analysées comme des villes noires, des lieux du crime à déchiffrer, sur la base de cinq caractéristiques : dilatation, déshumanisation, désorientation, déculturation, désindividualisation. Dans la deuxième partie, nous essayons de définir le défi des détectives contemporains : lire les villes, comme codes à déchiffrer, pour résoudre les crimes. L'interprétation de la ville se développe en cinq phases, spéculaires aux caractéristiques de la première partie : exploration, détection, reconstruction, identification, acceptation. À la fin de son enquête et du roman, le détective découvre que la ville est un vrai personnage, elle n’est pas seulement un lieu de crime mais aussi un lieu de l'âme, miroir du vécu des protagonistes. Les romans noirs contemporains de Bologne, Limoges et Thessalonique mettent en scène le conflit, peut-être insoluble, qui tourne autour de la définition de qui est la ville et donc de qui est l’individu et ils indiquent l'impossibilité d'une réponse définitive et rassurante. L'homme et la ville se confondent pour ne faire plus qu'un.

Determinazione gascromatografica di composti organici volatili e semi-volatili (VOCs e SVOCs) in poliolefine ed effetti delle condizioni di lavorazione

A relevant problem of polyolefins processing is the presence of volatile and semi-volatile compounds (VOCs and SVOCs) such as linear chains alkanes found out in final products. These VOCs can be detected by customers from the unpleasant smelt and can be an environmental issue, at the same time they can cause negative side effects during process. Since no previously standardized analytical techniques for polymeric matrix are available in bibliography, we have implemented different VOCs extraction methods and gaschromatographic analysis for quali-quantitative studies of such compounds. In literature different procedures can be found including microwave extraction (MAE) and thermo desorption (TDS) used with different purposes. TDS coupled with GC-MS are necessary for the identification of different compounds in the polymer matrix. Although the quantitative determination is complex, the results obtained from TDS/GC-MS show that by-products are mainly linear chains oligomers with even number of carbon in a C8-C22 range (for HDPE). In order to quantify these linear alkanes by-products, a more accurate GC-FID determination with internal standard has been run on MAE extracts. Regardless the type of extruder used, it is difficult to distinguish the effect of the various processes, which in any case entails having a lower-boiling substance content, lower than the corresponding virgin polymer. The two HDPEs studied can be distinguished on the basis of the quantity of analytes found, therefore the production process is mainly responsible for the amount of VOCs and SVOCs observed. The extruder technology used by Sacmi SC allows to obtain a significant reduction in VOCs compared to the conventional screw system. Thus, the result is significantly important as a lower quantity of volatile substances certainly leads to a lower migration of such materials, especially when used for food packaging.

Le terme pubbliche nella Grecia tardoantica. Architettura, funzioni e trasformazioni dello spazio sociale

Il presente lavoro si propone di concentrare la propria attenzione sulle terme pubbliche di età tardoantica – considerando l’insieme della letteratura scientifica disponibile e la necessità di un aggiornamento metodologico – comprese nelle provinciae dell’Hellas e di Creta, secondo i confini che possono essere tracciati sulla base del Synekdemos di Hierocles (§ 1). Il territorio di queste provinciae tardoantiche corrisponde all’incirca alle moderne regioni amministrative della Grecia Occidentale, della Grecia Centrale, dell’Attica e del Peloponneso per l’Ellade e dell’isola di Creta. In aggiunta all’indagine sulle caratteristiche architettoniche degli impianti, si è tentato di porre in rilievo le trasformazioni funzionali verificatesi in esse durante e dopo il loro utilizzo primario (§ 2). Oltre che sui singoli edifici (§ 2.1), l’indagine si è rivolta al contesto topografico di appartenenza. Le osservazioni raccolte sull’insieme del territorio descritto sono state inoltre messe a confronto con alcuni casi di studio rappresentati dalle città di Salonicco, Atene, Patrasso, Corinto e Gortina (§ 3). Si è cercato infine di sintetizzare i risultati emersi dalla ricerca, per contestualizzare il fenomeno termale tardoantico nell’ambito del suo sviluppo architettonico, dei mutamenti politici e urbanistici, dell’influenza del processo di cristianizzazione sulla società del periodo (§ 4).

The book of Qohelet. A digital scholarly edition of the hebrew text

The objective of the present dissertation is a born-digital critical edition of the Hebrew Old Testament book of Qohelet. The edition is based on an extensive collation of variant readings from indirect sources – the Septuagint, the Peshitta, the works of St. Jerome (the Vulgate and the Commentary), and the Targum – as well as from direct sources such as the Qumran fragments and Hebrew medieval manuscripts. The ultimate goal of the edition is (a) to reproduce the earliest textual form, the Archetype, that can be reconstructed on the basis of the available evidence; and (b) to propose a rehabilitation of the Original of the Author by resorting, when necessary, to conjectural emendation. We date the Archetype to the II century BCE, corresponding to the date of Hebrew fragments from Qumran, while we place the Original between the V and III centuries BCE. Unlike previous critical editions of Qohelet, ours follows the so-called eclectic model, which involves the reconstitution of a critical text and the preparation of an apparatus of secondary variants. Our edition includes, moreover, new data, taken both from primary literature, such as the recently published Göttingen Septuagint, and from up-to-date studies and critical commentaries on the text of Qohelet. The work is made up of five main parts: an introduction, which sets forth the rationale of the edition and the methodology adopted; the collation, where the variants are listed in their original language; the commentary, where they are extensively discussed; the critical text accompanied by the apparatus, which presents a selection of authentic Hebrew variants taken from the collation; and finally, a translation of the critical text. The edition uses the mark-up language of the Text Encoding Initiative (TEI). It is realized in pdf, via LaTeX, and will be available in digital form, via the TEI-Publisher editor.

Modelling additional costs caused by a new product feature

Työn tavoitteena oli mallintaa uuden tuoteominaisuuden aiheuttamat lisäkustannukset ja suunnitella päätöksenteon työkalu Timberjack Oy:n kuormatraktorivalmistuksen johtoryhmälle. Tarkoituksena oli luoda karkean tason malli, joka sopisi eri tyyppisten tuoteominaisuuksien kustannuksien selvittämiseen. Uuden tuoteominaisuuden vaikutusta yrityksen eri toimintoihin selvitettiin haastatteluin. Haastattelukierroksen tukena käytettiin kysymyslomaketta. Haastattelujen tavoitteena oli selvittää prosessit, toiminnot ja resurssit, jotka ovat välttämättömiä uuden tuoteominaisuuden tuotantoon saattamisessa ja tuotannossa. Malli suunniteltiin haastattelujen ja tietojärjestelmästä hankitun tiedon pohjalta. Mallin rungon muodostivat ne prosessit ja toiminnot, joihin uudella tuoteominaisuudella on vaikutusta. Huomioon otettiin sellaiset resurssit, joita uusi tuoteominaisuus kuluttaa joko välittömästi, tai välillisesti. Tarkasteluun sisällytettiin ainoastaan lisäkustannukset. Uuden tuoteominaisuuden toteuttamisesta riippumattomat, joka tapauksessa toteutuvat yleiskustannukset jätettiin huomioimatta. Malli on yleistys uuden tuoteominaisuuden aiheuttamista lisäkustannuksista, koska tarkoituksena on, että se sopii eri tyyppisten tuoteominaisuuksien aiheuttamien kustannusten selvittämiseen. Lisäksi malli soveltuu muiden pienehköjen tuotemuutosten kustannusten kartoittamiseen.

Promoting Healthy Lifestyles with Personalized, APOE Genotype Based Health Information: The Effects on Psychological-, Health Behavioral and Clinical Factors

There is an increasing demand for individualized, genotype-based health advice. The general population-based dietary recommendations do not always motivate people to change their life-style, and partly following this, cardiovascular diseases (CVD) are a major cause of death in worldwide. Using genotype-based nutrition and health information (e.g. nutrigenetics) in health education is a relatively new approach, although genetic variation is known to cause individual differences in response to dietary factors. Response to changes in dietary fat quality varies, for example, among different APOE genotypes. Research in this field is challenging, because several non-modifiable (genetic, age, sex) and modifiable (e.g. lifestyle, dietary, physical activity) factors together and with interaction affect the risk of life-style related diseases (e.g. CVD). The other challenge is the psychological factors (e.g. anxiety, threat, stress, motivation, attitude), which also have an effect on health behavior. The genotype-based information is always a very sensitive topic, because it can also cause some negative consequences and feelings (e.g. depression, increased anxiety). The aim of this series of studies was firstly to study how individual, genotype-based health information affects an individual’s health form three aspects, and secondly whether this could be one method in the future to prevent lifestyle-related diseases, such as CVD. The first study concentrated on the psychological effects; the focus of the second study was on health behavior effects, and the third study concentrated on clinical effects. In the fourth study of this series, the focus was on all these three aspects and their associations with each other. The genetic risk and health information was the APOE gene and its effects on CVD. To study the effect of APOE genotype-based health information in prevention of CVD, a total of 151 volunteers attended the baseline assessments (T0), of which 122 healthy adults (aged 20 – 67 y) passed the inclusion criteria and started the one-year intervention. The participants (n = 122) were randomized into a control group (n = 61) and an intervention group (n = 61). There were 21 participants in the intervention Ɛ4+ group (including APOE genotypes 3/4 and 4/4) and 40 participants in the intervention Ɛ4- group (including APOE genotypes 2/3 and 3/3). The control group included 61 participants (including APOE genotypes 3/4, 4/4, 2/3, 3/3 and 2/2). The baseline (T0) and follow-up assessments (T1, T2, T3) included detailed measurements of psychological (threat and anxiety experience, stage of change), and behavioral (dietary fat quality, consumption of vegetables, - high fat/sugar foods and –alcohol, physical activity and health and taste attitudes) and clinical factors (total-, LDL- HDL cholesterol, triglycerides, blood pressure, blood glucose (0h and 2h), body mass index, waist circumference and body fat percentage). During the intervention six different communication sessions (lectures on healthy lifestyle and nutrigenomics, health messages by mail, and personal discussion with the doctor) were arranged. The intervention groups (Ɛ4+ and Ɛ4-) received their APOE genotype information and health message at the beginning of the intervention. The control group received their APOE genotype information after the intervention. For the analyses in this dissertation, the results for 106/107 participants were analyzed. In the intervention, there were 16 participants in the high-risk (Ɛ4+) group and 35 in the low-risk (Ɛ4-) group. The control group had 55 participants in studies III-IV and 56 participants in studies I-II. The intervention had both short-term (≤ 6 months) and long-term (12 months) effects on health behavior and clinical factors. The short-term effects were found in dietary fat quality and waist circumference. Dietary fat quality improved more in the Ɛ4+ group than the Ɛ4- and the control groups as the personal, genotype-based health information and waist circumference lowered more in the Ɛ4+ group compared with the control group. Both these changes differed significantly between the Ɛ4+ and control groups (p<0.05). A long-term effect was found in triglyceride values (p<0.05), which lowered more in Ɛ4+ compared with the control group during the intervention. Short-term effects were also found in the threat experience, which increased mostly in the Ɛ4+ group after the genetic feedback (p<0.05), but it decreased after 12 months, although remaining at a higher level compared to the baseline (T0). In addition, Study IV found that changes in the psychological factors (anxiety and threat experience, motivation), health and taste attitudes, and health behaviors (dietary, alcohol consumption, and physical activity) did not directly explain the changes in triglyceride values and waist circumference. However, change caused by a threat experience may have affected the change in triglycerides through total- and HDL cholesterol. In conclusion, this dissertation study has given some indications that individual, genotypebased health information could be one potential option in the future to prevent lifestyle-related diseases in public health care. The results of this study imply that personal genetic information, based on APOE, may have positive effects on dietary fat quality and some cardiovascular risk markers (e.g., improvement in triglyceride values and waist circumference). This study also suggests that psychological factors (e.g. anxiety and threat experience) may not be an obstacle for healthy people to use genotype-based health information to promote healthy lifestyles. However, even in the case of very personal health information, in order to achieve a permanent health behavior change, it is important to include attitudes and other psychological factors (e.g. motivation), as well as intensive repetition and a longer intervention duration. This research will serve as a basis for future studies and its information can be used to develop targeted interventions, including health information based on genotyping that would aim at preventing lifestyle diseases. People’s interest in personalized health advices has increased, while also the costs of genetic screening have decreased. Therefore, generally speaking, it can be assumed that genetic screening as a part of the prevention of lifestyle-related diseases may become more common in the future. In consequence, more research is required about how to make genetic screening a practical tool in public health care, and how to efficiently achieve long-term changes.

What are the limitations on the wider therapeutic use of phage?

Bacterial resistance to antibiotics poses a serious health threat. Since research into new antibiotics is not progressing at the same rate as the development of bacterial resistance, widespread calls for alternatives to antibiotics have been made. Phage therapy is an ideal alternative candidate to be investigated. However the success of phage therapy may be hampered by a lack of investment support from large pharmaceutical companies, due to their narrow spectrum of activity in antibiotics, very large costs associated with clinical trials of the variety of phages needed, and regulatory requirements remaining unclear. Intellectual property is difficult to secure for therapeutic phage products for a variety of reasons, and patenting procedures vary widely between the US and the EU. Consequently, companies are more likely to invest in phage products for decontamination or veterinary use, rather than clinical use in humans. Some still raise questions as to the safety of phage therapy overall, suggesting the possibility of cytotoxicity and immunogenicity, depending on the phage preparation and route. On the other hand, with patients dying because of infections untreatable with conventional antibiotics, the question arises as to whether it is ethical not to pursue phage therapy more diligently. A paradigm shift about how phage therapy is perceived is required, as well as more rigorous proof of efficacy in the form of clinical trials of existing medicinal phage products. Phage therapy potential may be fulfilled in the meantime by allowing individual preparations to be used on a named-patient basis, with extensive monitoring and multidisciplinary team input. The National Health Service and academia have a role in carrying out clinical phage research, which would be beneficial to public health, but not necessarily financially rewarding.

On the extent of genetic variation for transpiration efficiency in sorghum

A glasshouse study examined 49 diverse sorghum lines for variation in transpiration efficiency. Three of the 49 lines grown were Sorghum spp, native to Australia; one was the major weed Johnson grass (Sorghum halepense), and the remaining 45 lines were cultivars of Sorghum bicolor. All plants were grown under non-limiting water and nutrient conditions using a semi-automatic pot watering system designed to facilitate accurate measurement of water use. Plants were harvested 56-58 days after sowing and dry weights of plant parts were determined. Transpiration efficiency differed significantly among cultivars. The 3 Australian native sorghums had much lower transpiration efficiency than the other 46 cultivars, which ranged from 7.7 to 6.0 g/kg. For the 46 diverse cultivars, the ratio of range in transpiration efficiency to its l.s.d. was 2.0, which was similar to that found among more adapted cultivars in a previous study. This is a significant finding as it suggests that there is likely to be little pay-off from pursuing screening of unadapted material for increased variation in transpiration efficiency. It is necessary, however, also to examine absolute levels of transpiration efficiency to determine whether increased levels have been found. The cultivar with greatest transpiration efficiency in this study (IS9710) had a value 9% greater (P < 0.05) than the accepted standard for adapted sorghum cultivars. The potential impact of such an increase in transpiration efficiency warrants continued effort to capture it. Transpiration efficiency has been related theoretically and experimentally to the degree of carbon isotope discrimination in leaf tissue in sorghum, which thus offers a relatively simple selection index. In this study, the variation in transpiration efficiency was not related simply to carbon isotope discrimination. Significant associations of transpiration efficiency with ash content and indices of photosynthetic capacity were found. However, the associations were not strong. These results suggest that a simple screening technique could not be based on any of the measures or indices analysed in this study. A better understanding of the physiological basis of the observed genetic differences in transpiration efficiency may assist in developing reliable selection indices. It was concluded that the potential value of the improvement in transpiration efficiency over the accepted standard and the degree of genetic variation found warrant further study on this subject. It was suggested that screening for genetic variation under water-limiting conditions may provide useful insights and should be pursued.

Report of a traineeship : audit of antidepressant prescribing in Primary and Mental Care: how to address appropriateness and keep a curb on costs. A tool suitable for all contexts?

RESUMO: Este é o relatório de um estágio realizado na Autoridade de Saúde Local de Bolonha com o objectivo de desenvolver capacidades e competências na área de projectos orientados para a avaliação com base epidemiológica. As prescrições de anti-depressivos aumentaram consideravelmente em todo o mundo durante as últimas décadas. O uso cada vez maior dos agentes mais dispendiosos desempenha um papel na subida do custo dos tratamentos. A Autoridade de Saúde Local de Bolonha implementou um processo de auditoria com o objectivo de melhorar a adequação das prescrições de pacientes externos, centrando-se em dois anti-depressivos de marca ainda protegidos por patente, Escitalopram e Duloxetine. Os Departamentos de Cuidados de Saúde Primários e de Cuidados de Saúde Mental, assim como o Departamento Farmacêutico e a Unidade de Gestão Clínica, estiveram envolvidos na fase de planeamento da auditoria. O grupo da auditoria, maioritariamente composto por médicos de clínica geral e psiquiatras, reuniu e analisou provas da eficácia e segurança dos anti-depressivos. Os dados sobre as prescrições das Unidades de Cuidados de Saúde Primários e dos Centros de Saúde Mental Comunitários da Autoridade de Saúde Local (866.294 habitantes) foram comparados, em particular as taxas de consumo de Escitalopram e Duloxetine. O grupo da auditoria definiu os standards a serem abordados, os indicadores a serem avaliados e as medidas a empreender para atingir os objectivos definidos. As directrizes do NICE sobre a depressão foram escolhidas como referência. O objectivo da auditoria foi definido como evitar o Escitalopram e Duloxetine como medicamentos de primeira escolha num tratamento anti-depressivo. De modo a verificar a eficácia das medidas empreendidas foi seleccionado um indicador, consistindo numa redução de 25% das prescrições de ambos os anti-depressivos na prática clínica de pacientes externos e numa redução de 20% da variabilidade nas Unidades de Cuidados de Saúde Primários. O relatório retrospectivo pré-auditoria (Janeiro a Abril de 2012) revelou que os tratamentos com anti-depressivos para pacientes externos eram prescritos pelos médicos de clínica geral em mais de90% dos casos. As medidas da auditoria foram implementadas entre Novembro de 2012 e Maio de 2013. Algumas medidas relevantes foram integradas com a revisão da auditoria, tais como reuniões educacionais de pequena escala com os médicos de clínica geral e psiquiatras, visitas de apoio do assessor de prescrições da Autoridade de Saúde Local aos médicos de clínica geral e Centros de Saúde Mental Comunitários, panfletos para profissionais com informação retirada das directrizes clínicas do NICE, implementação de um serviço de consulta na Web para médicos de clínica geral sobre provas relativas a anti-depressivos. O relatório de feedback é aguardado em Novembro de 2013 depois de se verificar nos standards atingidos a eficácia das medidas implementadas. Foi realizada uma análise SWOT para comprovar as forças e fraquezas, as oportunidades e ameaças do processo. Como identificação de fraquezas poderá ser útil identificar estratégias relevantes para melhoria interna, para que o conhecimento das ameaças possa amortizar factores que possam ter impactos adversos que fujam ao controlo do Departamento de Saúde Mental. Uma melhor compreensão das forças e das oportunidades facilita a consecução dos objectivos estabelecidos no projecto. O primeiro, mas não o último, resultado deste processo consistiu numa maior integração entre os Cuidados de Saúde Primários e de Saúde Mental, permitindo assim que a Autoridade de Saúde Local coloque as alterações em prática.------------ABSTRACT: This is the report of a traineeship held in the Local Health Authority of Bologna with the aim to develop skills and competencies in the field of epidemiogically based evaluation oriented projects. Antidepressants prescriptions have considerably increased all over the world in the last decades. The increasing use of the most expensive agents plays a part in the rising cost of treatments. The Local Health Authority of Bologna has implemented an audit process aimed at improving the appropriateness of outpatient prescriptions focusing on the two branded antidepressants still protected by patent, Escitalopram and Duloxetine. The Primary Care and the Mental Health Care Departments, as well as the Pharmaceutical Department and the Clinical Governance Unit, were involved in the planning phase of the audit. The audit group, mainly composed of general practitioners and psychiatrists, collected and analyzed scientific evidence on effectiveness and safety of antidepressants. Data on prescriptions of Primary Care Units and Community Mental Health Centers of the Local Health Authority (866.294 inhabitants) were compared, in particular consumption rates of Escitalopram and Duloxetine. The audit group defined the standards to be addressed, the indicators to be evaluated and the actions aimed at reaching the defined goals. NICE guidelines on depression were chosen as reference. The aim of the audit was settled as avoiding Escitalopram and Duloxetine as first choice drugs starting an AD treatment. In order to check the efficacy of the actions undertaken an indicator was selected, consisting in a reduction of 25% of prescriptions of both ADs in outpatient practice and in a 20% reduction of To develop skills and competencies across Primary Care Units. The pre-audit retrospective report (January-April 2012) showed that outpatient antidepressant treatments were prescribed by GPs in over 90% of cases. Audit actions were implemented between November 2012 and May 2013. Some relevant actions have been integrated with the audit review, such as small-scale educational meetings with GPs and psychiatrists, outreach visits of the LHA prescribing adviser to GPs and CMHCs,leaflets for professionals with information extracted from NICE clinical guidelines, implementation of a web consultation service for GPs about evidence on antidepressants. The feedback report is expected in November 2013 after checking through the standards attained the effectiveness of actions implemented. A SWOT Analysis was carried out to evidence the strengths and weaknesses, opportunities and threats of the process. As identification of weaknesses may be useful to identify relevant strategies for internal improvement, so the knowledge of threats can amortize factors that may have adverse impacts beyond the control of the Mental Health Department. Better understanding of the strengths and the opportunities facilitates the achievement of the goals set in the project. The first and not least upshot of this process has consisted in further integration between Primary and Mental Health Care, thus enabling the LHA to put the change into practice.

Statistics as a basis for discrimination in the insurance business

The European Court of Justice has held that as from 21 December 2012 insurers may no longer charge men and women differently on the basis of scientific evidence that is statistically linked to their sex, effectively prohibiting the use of sex as a factor in the calculation of premiums and benefits for the purposes of insurance and related financial services throughout the European Union. This ruling marks a sharp turn away from the traditional view that insurers should be allowed to apply just about any risk assessment criterion, so long as it is sustained by the findings of actuarial science. The naïveté behind the assumption that insurers’ recourse to statistical data and probabilistic analysis, given their scientific nature, would suffice to keep them out of harm’s way was exposed. In this article I look at the flaws of this assumption and question whether this judicial decision, whilst constituting a most welcome landmark in the pursuit of equality between men and women, has nonetheless gone too far by saying too little on the million dollar question of what separates admissible criteria of differentiation from inadmissible forms of discrimination.