884 resultados para Litmanen, Tapio: The struggle over risk


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Whilst some authors have portrayed the Internet as a powerful tool for business and political institutions, others have highlighted the potential of this technology for those vying to constrain or counter-balance the power of organizations, through e-collectivism and on-line action. What appears to be emerging is a contested space that has the potential to simultaneously enhance the power of organizations, whilst also acting as an enabling technology for the empowerment of grass-root networks. In this struggle, organizations are fighting for the retention of “old economy” positions, as well as the development of “new economy” power-bases. In realizing these positions, organizations and institutions are strategizing and manoeuvering in order to shape on-line networks and communications. For example, the on-line activities of individuals can be contained through various technological means, such as surveillance, and the structuring of the virtual world through the use of portals and “walled gardens”. However, loose groupings of individuals are also strategizing to ensure there is a liberation of their communication paths and practices, and to maintain the potential for mobilization within and across traditional boundaries. In this article, the unique nature and potential of the Internet are evaluated, and the struggle over this contested virtual space is explored.

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A widely diffused, engaged approach understands human rights as an opportunity to enhance moral progress. Less visible has a critical realm of research that reveals the often ambiguous social life of human rights discourses. This article draws on a specific case study from the intricate issue of how activism for Arab-Palestinian Bedouin citizens in Southern Israel engages with the global human rights discourse. It follows the implications of mobilization, focusing on events related to a campaign against house demolitions in informal,unrecognised settlements. The case shows how human rights discourses tend to silence the agency of political subjects, victimizing and patronizing those who seek emancipation. The ethnographic insights emphasize the role of a range of carnivalesque and spontaneous acts ofresistance, which subvert the patronizing implications of the human rights language.

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Abstract This thesis seeks to answer a number of questions concerning the deficit and debt in Canada. It focuses pri.arily on the federal level of government but with SOBe discussion of provincial governaent policy as well. In ~997, Canada's federal debt caae close ro six hundred billion dollars - $594 billion or 74.4 % of Gross Do.estic Product (GDP) to be exact. The purpose of this theses is threefold: To find out why Canada accu.ulated such a debt, to discover if there is a so-called debt crisis; and to discover if it is possible to preserve Canada's national welfare state given the financial restraints that have been adopted by both federal and provincial governments. Politicians are torn between economist' two contrasting views regarding deficits: Neo-Keynesian and neo-conservative. The neoKeynesian school focuses al1llOst exclusively on the short term stability of the economy and tends to dismiss concerns regarding the level of debt. Neo conservatives focus almost exclusively on the perceived costs of growth in the national debt and are willing to forego any stabilization benefits to ensure that the debt is controlled. These polar view do have one thing in coa.on; both confix-. that deficits influence govermaent policies. Both of these econoBic theories will have far-reaching influences on the federal gover1lJlJent's decision-making process. These economic theories will be discussed throughout this thesis.

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This article offers an analysis of a struggle for control of a women’s development project in Nepal. The story of this struggle is worth telling, for it is rife with the gender politics and neo-colonial context that underscore much of what goes on in contemporary Nepal. In particular, my analysis helps to unravel some of the powerful discourses, threads of interest, and yet unintended effects inevitable under a regime of development aid. The analysis demonstrates that the employment of already available discursive figures of the imperialist feminist and the patriarchal third world man are central to the rhetorical strategies taken in the conflict. I argue that the trans-discursive or “borderland” nature of development in general and women’s development in particular result in different constructions of “development” goals, means and actors based not only on divergent cultural categories but on historically specific cultural politics. I argue further that the apolitical discourse of development serves to cloak its inherently political project of social and economic transformation, making conflicts such as the one that occurred in this case not only likely to occur but also likely to be misunderstood.

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The phenomenon of sexually harassing telephone calls in the workplace has been studied only marginally. In the present study 106 employees working in call centres in Germany answered a questionnaire regarding their experiences of sexual harassment over the telephone. The following data are presented: description of the phenomenon, i.e. prevalence and characteristics, stress reactions of the victims, behavioural reactions and coping strategies, consequences and anticipated consequences; prediction of the stress reactions by characteristics of the situation; and employees' recommendations for coping with sexually harassing calls. It was found that the female employees were more often sexually harassed over the telephone at work than their male colleagues. Three out of four female employees had experienced sexually harassing telephone calls; in the majority of cases the harassers were men. Characteristic patterns of harassment included groaning, sexual insults, silence, and threats of sexual violence. Some 16% of the harassed female employees described these experiences as extremely stressful. If the harassment contained threats of sexual violence and groaning, the perceived physical response was stronger. Being subjected to sexual harassment over the telephone both at home and at work was a more severe stress than having the experience only in the workplace. In conclusion, employees' recommendations for coping with the occurrence of sexually harassing calls are described.

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This article explores the struggle for legitimation associated with the attempt to define the risk of Bt cotton, a genetically modified crop, in Andhra Pradesh, India. Beck asserts that, given the uncertainty associated with risk society, efforts to define risk are creating the need for a new political culture. This article argues that this political culture emerges from attempts to legitimate power within risk definition. This is examined using critical discourse analysis on interview excerpts with key figures in the Bt cotton debate. Legitimation is explored using the categories of legitimation developed by Van Leeuwen. These are (a) authorisation; (b) moral evaluation; (c) rationalisation; and (d) mythopoesis. The analysis highlights that the political culture which emerges in response to risk society is in a state of constant flux and contingent upon the ongoing struggle for legitimation with regard to the definition of risk.

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This study explores the perception of risk and the level of risk management implementation in the renewable sector. Risk management is emerging as a key issue due to the loss of confidence amongst banks, causing the attainment of financing to be difficult over the next few years. To attract financing, there is a fundamental requirement to manage risk in a way that minimizes the probability of a negative financial impact on the project. Miller and Lessard (2001) argue that successful projects are not selected but shaped with risk resolution in mind. Rather than evaluating projects at the outset based on projections of the full set of benefits, costs and risks over their lifetime, successful developers start with project ideas that have the potential of becoming viable. Therefore, this study bridges the gap that exists within the renewable sector in relation to risk management literature. This study succeeds through a detailed comparative case study analysis where two developers and two financiers were questioned through qualitative semi-structured interviews on the concept of risk management and its level implementation within the industry. It is believed that the growth in financed renewable energy projects depends on the adequate design and implementation of risk management to mitigate inherent project risks. However, this study revealed that are certain types of developers in existence within the renewable sector, which underestimate the magnitude of risk and view the development of projects as a ‘money racket’. Therefore, it can be concluded that perception of risk will also differ, causing risk and uncertainty to vary from project to project, resulting in investment reluctance to be associated with certain projects. The study originality lies in how it demonstrates to developers the concept of risk management, outlining the simplicity and benefits of implementing it in project development. Finally, this study contributes to the knowledge by enhancing the awareness and understanding of the presence and nature of risk in a RE project environment.

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Given the significant impact the use of glucocorticoids can have on fracture risk independent of bone density, their use has been incorporated as one of the clinical risk factors for calculating the 10-year fracture risk in the World Health Organization's Fracture Risk Assessment Tool (FRAX(®)). Like the other clinical risk factors, the use of glucocorticoids is included as a dichotomous variable with use of steroids defined as past or present exposure of 3 months or more of use of a daily dose of 5 mg or more of prednisolone or equivalent. The purpose of this report is to give clinicians guidance on adjustments which should be made to the 10-year risk based on the dose, duration of use and mode of delivery of glucocorticoids preparations. A subcommittee of the International Society for Clinical Densitometry and International Osteoporosis Foundation joint Position Development Conference presented its findings to an expert panel and the following recommendations were selected. 1) There is a dose relationship between glucocorticoid use of greater than 3 months and fracture risk. The average dose exposure captured within FRAX(®) is likely to be a prednisone dose of 2.5-7.5 mg/day or its equivalent. Fracture probability is under-estimated when prednisone dose is greater than 7.5 mg/day and is over-estimated when the prednisone dose is less than 2.5 mg/day. 2) Frequent intermittent use of higher doses of glucocorticoids increases fracture risk. Because of the variability in dose and dosing schedule, quantification of this risk is not possible. 3) High dose inhaled glucocorticoids may be a risk factor for fracture. FRAX(®) may underestimate fracture probability in users of high dose inhaled glucocorticoids. 4) Appropriate glucocorticoid replacement in individuals with adrenal insufficiency has not been found to increase fracture risk. In such patients, use of glucocorticoids should not be included in FRAX(®) calculations.

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AIMS: To estimate physical activity trajectories for people who quit smoking, and compare them to what would have been expected had smoking continued. DESIGN, SETTING AND PARTICIPANTS: A total of 5115 participants in the Coronary Artery Risk Development in Young Adults Study (CARDIA) study, a population-based study of African American and European American people recruited at age 18-30 years in 1985/6 and followed over 25 years. MEASUREMENTS: Physical activity was self-reported during clinical examinations at baseline (1985/6) and at years 2, 5, 7, 10, 15, 20 and 25 (2010/11); smoking status was reported each year (at examinations or by telephone, and imputed where missing). We used mixed linear models to estimate trajectories of physical activity under varying smoking conditions, with adjustment for participant characteristics and secular trends. FINDINGS: We found significant interactions by race/sex (P = 0.02 for the interaction with cumulative years of smoking), hence we investigated the subgroups separately. Increasing years of smoking were associated with a decline in physical activity in black and white women and black men [e.g. coefficient for 10 years of smoking: -0.14; 95% confidence interval (CI) = -0.20 to -0.07, P < 0.001 for white women]. An increase in physical activity was associated with years since smoking cessation in white men (coefficient 0.06; 95% CI = 0 to 0.13, P = 0.05). The physical activity trajectory for people who quit diverged progressively towards higher physical activity from the expected trajectory had smoking continued. For example, physical activity was 34% higher (95% CI = 18 to 52%; P < 0.001) for white women 10 years after stopping compared with continuing smoking for those 10 years (P = 0.21 for race/sex differences). CONCLUSIONS: Smokers who quit have progressively higher levels of physical activity in the years after quitting compared with continuing smokers.

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Angio-oedema (AE) is a known adverse effect of angiotensin converting enzyme inhibitor (ACE-I) therapy. Over the past several decades, evidence of failure to diagnose this important and potentially fatal reaction is commonly found in the literature. Because this reaction is often seen first in the primary care setting, a review was undertaken to analyse and document the keys to both diagnostic criteria as well as to investigate potential risk factors for ACE-I AE occurrence. A general review of published literature was conducted through Medline, EMBASE, and the Cochrane Database, targeting ACE-I-related AE pathomechanism, diagnosis, epidemiology, risk factors, and clinical decision making and treatment. The incidence and severity of AE appears to be on the rise and there is evidence of considerable delay in diagnosis contributing to significant morbidity and mortality for patients. The mechanism of AE due to ACE-I drugs is not fully understood, but some genomic and metabolomic information has been correlated. Additional epidemiologic data and clinical treatment outcome predictors have been evaluated, creating a basis for future work on the development of clinical prediction tools to aid in risk identification and diagnostic differentiation. Accurate recognition of AE by the primary care provider is essential to limit the rising morbidity associated with ACE-I treatment-related AE. Research findings on the phenotypic indicators relevant to this group of patients as well as basic research into the pathomechanism of AE are available, and should be used in the construction of better risk analysis and clinical diagnostic tools for ACE-I AE.

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Aims: The HR-NBL1 Study of the European SIOP Neuroblastoma Group (SIOPEN) randomised two high dose regimens to learn about potential superiority and toxicity profiles.Patients and Methods: At interim analysis 1483 high risk neuroblastoma patients (893 males) were included since 2002 with either INSS stage 4 disease (1383 pts) above 1 year, or as infants (59 pts) and stage 2&3 of any age (145 pts) with MYCN amplification. The median age at diagnosis was 2.9 years (1 month-19.9 years) with a median follow up of 3 years. Response eligibility criteria prior randomisation after Rapid Cojec Induction (J Clin Oncol, 2010) ± 2 courses of TVD (Cancer, 2003) included complete bone marrow remission and at least partial response at skeletal sites with no more than 3, but improved mIBG positive spots and a PBSC harvest of at least 3x10E6 CD34/kgBW. The randomised regimens were BuMel [busulfan oral till 2006, 4x150mg/m² in 4 ED; or intravenous use according to body weight as licenced thereafter; melphalan 140mg/m²/day) and CEM [carboplatinum ctn. infusion (4x AUC 4.1mg/ml.min/day, etoposid ctn. infusion (4x 338mg/m²/day or [4x 200mg/m²/day]*, melphalan (3x70mg/m²/day; 3x60mg/m²/day*;*reduced dosis if GFR< 100ml/min/1.73m²). Supportive care followed institutional guidelines. VOD prophylaxis included ursadiol, but randomised patients were not eligible for the prophylactic defibrotide trial. Local control included surgery and radiotherapy of 21Gy.Results: Of 1483 patients, 584 were being randomised for the high dose question at data lock. A significant difference in event free survival (3-year EFS 49% vs. 33%, p<0.001) and overall survival (3-year OS 61% vs. 48%, p=0.003) favouring the BuMel regimen over the CEM regimen was demonstrated. The relapse/progression rate was significantly higher after CEM (0.60±0.03) than after BuMel (0.48±0.03)(p<0.001). Toxicity data had reached 80% completeness at last analysis. The severe toxicity rate up to day 100 (ICU and toxic deaths) was below 10%, but was significantly higher for CEM (p= 0.014). The acute toxic death rate was 3% for BuMel and 5% for CEM (NS). The acute HDT toxicity profile favours the BuMel regimen in spite of a total VOD incidence of 18% (grade 3:5%).Conclusions: The Peto rule of P<0.001 at interim analysis on the primary endpoint, EFS was met. Hence randomization was stopped with BuMel as recommended standard treatment in the HR-NBl1/SIOPEN trial which is still accruing for the randomised immunotherapy question.