Managing and monitoring sustainable regional devolopment in alpine regions

Alpine landscape always has been affected by human economic activities. Traffic economy, tourism economy and industrial structure dominated by small and medium-sized enterprises have been the drivers of economy development as well as of changes in the alpine landscape throughout the last century. There have been tremendous influences of economic activities on special areas but also on the alpine landscape in general. For years numerous regions have been subjected to a strong structural change. Globalisation leads to an acceleration of this structural change. Also, globalisation leads to a fast transition of companies, branches and economies. This transformation is determined by the conversion of the core elements of economic activities, single companies. Companies and branches of the alpine economy have been affected heavily by this transformation process due to several reasons (former regulation, decline of transport costs, etc.). The regions try to influence the negative effects of this structural change in various ways. The results of their efforts are very different. Some regions manage to improve their economic situation whereas others get worse. It is an open question, which structural and procedural factors are responsible for these differences. There could be a gap between wishful thinking in policy making /development of regional strategies and the possibilities of economic development. All participation processes and works on regional strategies have to be based on a sound understanding of the possibilities to influence the economic development. Regional development has tremendously changed in the past few years. So, the question arises how regions are going to organise and manage their sustainable development in the long run. Therefore, appropriate management tools have to be designed. However the central question of the paper is, how regions manage to remain as attractive living spaces. If we knew, what strategies regions should apply and how they should change their strategies in the light of the growing influence of globalisation, we could be able to develop tools for future regional development, that could take the demands of sustainability better into account. Therefore, the paper focuses on the following four areas: - The long-term changes of the (economic) situation in peripheral regions of the Alps. What have been the most important sources of income/net value creation in the last years? How have factors like income, branches and work force developed? How has the created income and value been distributed to different branches and population groups - The effects of globalisation on relevant branches for peripheral regions (e.g. Tourism, agriculture and forestry, building and industry). Which effects of globalisation have been the most influential ones? What external effects have to be expected in alpine regions through these economic trends? - Evaluation of the regional strategies to cope with economic structural changes. It will be promising to examine the Regional Development Schemes. - Development of a management system for sustainable regional development in peripheral regions, which should be applicable as a standardized tool.

A prospective observational study comparing a non-operator dependent automatic PWV analyser to pulse pressure, in assessing arterial stiffness in hemodialysis.

BACKGROUND: Chronic kidney disease (CKD) accelerates vascular stiffening related to age. Arterial stiffness may be evaluated measuring the carotid-femoral pulse wave velocity (PWV) or more simply, as recommended by KDOQI, monitoring pulse pressure (PP). Both correlate to survival and incidence of cardiovascular disease. PWV can also be estimated on the brachial artery using a Mobil-O-Graph; a non-operator dependent automatic device. The aim was to analyse whether, in a dialysis population, PWV obtained by Mobil-O-Graph (MogPWV) is more sensitive for vascular aging than PP. METHODS: A cohort of 143 patients from 4 dialysis units has been followed measuring MogPWV and PP every 3 to 6 months and compared to a control group with the same risk factors but an eGFR > 30 ml/min. RESULTS: MogPWV contrarily to PP did discriminate the dialysis population from the control group. The mean difference translated in age between the two populations was 8.4 years. The increase in MogPWV, as a function of age, was more rapid in the dialysis group. 13.3% of the dialysis patients but only 3.0% of the control group were outliers for MogPWV. The mortality rate (16 out of 143) was similar in outliers and inliers (7.4 and 8.0%/year). Stratifying patients according to MogPWV, a significant difference in survival was seen. A high parathormone (PTH) and to be dialysed for a hypertensive nephropathy were associated to a higher baseline MogPWV. CONCLUSIONS: Assessing PWV on the brachial artery using a Mobil-O-Graph is a valid and simple alternative, which, in the dialysis population, is more sensitive for vascular aging than PP. As demonstrated in previous studies PWV correlates to mortality. Among specific CKD risk factors only PTH is associated with a higher baseline PWV. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02327962

The Finnish system of innovation - lessons for Switzerland?

Innovation has become a key element of the economic growth of highly developed countries. Moreover, it is an undisputed fact that Switzerland needs to strengthen its efforts at innovation. This has become clear, among other things in the message of the Federal Council, the Swiss government, which emphasises the promotion of education, research and technology for the years 2004 to 2007. Speedy implementation of technological and scientific potentials into innovative products and services is one of the primordial requirements to be competitive in the marketplace and, hence, to secure jobs. Primarily, this is a challenge to entrepreneurs. It is more demanding to launch into activities with innovative products and services, and greater risks are involved, than in the rationalisation of existing productions. Nevertheless, although entrepreneurial skills and qualities are at the fore with regard to successful innovative processes, the influence of the state with its framework should not be overlooked. It is well worth examining and reconsidering these factors from time to time.Comparing the Swiss innovation system with those of other countries can be a highly profitable exercise

Insuffisance renale chronique et medicaments antidiabetiques. [Chronic kidney disease and antidiabetic treatment]

Diabetic nephropathy is the leading cause of chronic renal failure (CRF) in Europe. About fifty percent of diabetic subjects develop microalbuminuria, which progresses towards established diabetic nephropathy in one third of patients. The treatment of type 2 diabetes in a patient with CRF is a challenge for the general practitioner, because of the accumulation of drugs and/or specific metabolites. Sulfonylureas are associated with an increased risk of hypoglycaemia. Biguanides may exceptionally cause life-threatening lactic acidosis. Glitazones have an interesting profile since they decrease microalbuminuria and blood pressure. However, their safety is not well defined in the context of CRF In the case of severe CRF, only insulin and repaglinide can be recommended

Hypernatriämie--wie weiter [Hypernatremia]

Hypernatremia is defined as an elevated serum sodium concentration. Usually hypernatremia is caused by a relative water deficit occurring with decreased thirst sensation and/or reduced water intake. In rare cases hypernatremia may be caused by excessive sodium intake. Severe hypernatremia can be dangerous and can lead to significant morbidity and mortality. Dangerous hypernatremia can occur in the newborn. Drugs that influence thirst sensation are the main cause of hypernatremia in adults and elderly patients. Hospitalization itself might be a risk factor for developing hypernatremia. Therapy consists in eliminating the causes of hypernatremia and in the specific management of body volume and electrolytes

Hypernatrémie: une question d'eau [Hypernatremia: a matter of water]

Hypernatremia is defined as a serum sodium concentration above the upper laboratory reference range, usually > 145 mmol/l. It is a common electrolyte disorder in the very young and the very old patient. Hospitalization itself is a risk factor for developing hypernatremia. Free water deficit is the main cause of this condition. It induces hyperosmolality and an intracellular dehydration. Clinical manifestations are mostly neurological but non-specific. A blood sample analysis is needed to establish the diagnosis. Hypernatremia is associated with a high mortality and morbidity. Treatment consists of correcting the underlying cause and the volume deficit. A brief review of this condition is proposed

Fragment d'une Rivière - la gare de Suidobashi (Tokyo, Japon)

Depuis sa fondation, Tokyo n'a pas arrêté de soumettre ses rivières et canaux à ses besoins changeant selon les époques. La ville s'est structurée grâce aux cours d'eau, qui étaient le principal réseau de transport. Pourtant, leur fonction ayant été remplacée par les systèmes modernes de transport (chemin de fer et autoroutes), les rivières ont perdu leur présence à la fois dans le tissu de la ville et dans l'esprit de l'habitant. Les rivières à Tokyo sont devenues des fragments dispersés dans le paysage urbain. Actuellement, la tendance s'inverse et se renforce la volonté de rendre aux cours d'eau la place qu'ils ont perdus dans la ville. En s'inscrivant dans ce courant, nous estimons que la réintégration des rivières doit passer par une prise de conscience de la part des personnes. La revalorisation devrait passer par la recherche d'un contact visuel mais aussi d'un accès direct, d'une utilisation des cours d'eau en tant que moyen de transport et ceci en lien avec les interfaces du réseau ferroviaire, l'actuel système référentiel de Tokyo. Nous proposons de créer une interface entre une gare ferroviaire et une station de bateau. Cette dernière se rattacherait à un circuit de transport sur l'eau, de caractère touristique, qui permettrait de découvrir la ville à partir d'un nouveau point de vue et de prendre conscience du fonctionnement en réseau des rivières. Cette intervention ponctuelle devrait avoir un effet catalyseur sur le reste de la nouvelle boucle mise en place. Le site choisi est le point de bifurcation de la rivière Kandagawa, qui, en se divisant, donne naissance à la rivière de Nihonbashigawa. La gare de Suidôbashi se trouve dans ce territoire particulier, entre deux rivières navigables, dont l'une est surmontée par l'autoroute et l'autre est longée par le chemin de fer. Elle est le point de rencontre des infrastructures structurant la ville. À l'échelle du quartier, elle se trouve entre un tissu dense d'habitation et le site accueillant le complexe du Tokyo Dome City avec son stade et son parc d'attraction. Le projet établit un contact direct à l'eau aux endroits des sorties de la gare, où les flux des gens convergent et se concentrent. Nous proposons donc de créer deux vides reliant les sorties de la gare aux rivières et un passage public couvert, au-dessous des rails rehaussés, connectant les deux espaces. Le projet crée quatre qualités d'espace distinctes: la gare en hauteur; une place vers Kandagawa où l'on longe la rivière; une place vers Nihonbashigawa offrant un accès direct à l'eau grâce à l'arrêt des bateaux; et le passage public, une galerie marchande à disposition des habitants et des visiteurs

Insuffisance rénale severe sur maladie des emboles de cholestérol: controverses thérapeutiques revisitées [Severe renal insufficiency secondary to renal cholesterol emboli: therapeutical options revisited]

Disseminated cholesterol crystal embolism is observed in elderly men with severe atherosclerosis. This syndrome may be triggered by arterial catheterizations, major vascular surgery, thrombolytic and/or anticoagulation treatment. Cutaneous signs, subacute renal insufficiency, a marked inflammatory syndrome and eosinophilia are common. Immunologic testing is normal except for hypocomplementaemia. The diagnosis may be confirmed by biopsy (skin, gastrointestinal or renal), and/or by a fundoscopic examination. The treatment consists in withdrawing all form of anticoagulation, proscribing vascular surgery and arterial catheterization, prescribing aspirin and statins, and controlling arterial blood pressure. Corticosteroids may be given in refractory cases. The prognosis of cholesterol crystal embolism is poor but may be improved by statins