The Barthel index: italian translation, adaptation and validation

The Barthel Index (BI) is widely used to measure disability also in Italy, although a validated and culturally adapted Italian version of BI has not been produced yet. This article describes the translation and cultural adaptation into Italian of the original 10-item version of BI, and reports the procedures for testing its validity and reliability. The cultural adaptation and validation process was based on data from a cohort of disabled patients from two different Rehabilitation Centers in Rome, Italy. Forward and backward translation method was adopted by qualified linguist and independent native English official translators. The scale obtained was reviewed by 20 experts in psychometric sciences. The Italian adapted version of the BI was then produced and validated. A total number of 180 patients were submitted to the adapted scale for testing its acceptability and internal consistency. The total time of compilation was 5 ± 2,6 minutes (range 3-10). Validation of the scale was performed by 7 trained professional therapists that submitted both the translated and the adapted versions to a group of 62 clinically stable patients (T-test=-2.051 p=0.05). The internal consistency by Cronbach’s alpha resulted equal to 0.96. Test – retest intra – rater reliability was evaluated on 35 cases; at test-retest was ICC=0.983 (95%IC: 0.967-0.992). This is the first study that reports translation, adaptation and validation of the BI in Italian language. It provides a new tool for professionals to measure functional disability when appraising Italian speaking disable patients in health and social care settings along the continuum of care

Perlindungan Hak Atas Tanah Ulayat Masyarakat Adat Gayo Di Kabupaten Bener Meriah

The existence of ulayat rights (communal right of disposal or customary associative right) in Indonesia is recognized and respected as it is stipulated in the 1945 Constitution; this recognition is confirmed in Law No. 5/1960 on the Agrarian Basic Regulation. Ulayat rights actually still exists and is not contrary to the national interest and to any higher legal provisions. The Regulation of the Agrarian Minister No. 5/1999 on the Guidance for Settling the Problems of ulayat rights in the Adat Community orders the establishment of Regional Regulation on the recognition and protection for ulayat rights in each area in which it still exists. In reality, not all areas in Indonesia, including ulayat rights in the Gayo community in Bener Meriah District, has Regional Regulation for it. The result of the research showed that the existence of ulayat rights in the Gayo community still exists; it is indicated by the existence of the subject of ulayat rights, that is, ulayat rights object and the legal relationship between the subject and the object of ulayat rights. On the other hand, there are also some obstacles from its legal substance, legal structure, and legal culture in recognizing and protecting ulayat rights. Bener Meriah District Administration has established Majelis Adat (Adat Council) through Bener Meriah District Qanun No.4/2010 on Organizational Structure and Work Structure of the Secretariat of the Extraordinary Committee in Bener Meriah District and has published Bener Meriah Qanun No. 5/2011 on the Appointment of Animal Breeding Locations (Peruweren) of Uber-Uber and Blang Paku in Bener Meriah

Использование модели трансформационного лидерства в управлении полицией

The police, as well as other government agencies is a rather conservative mechanism not prone to rapid changes of style, techniques and methods of work and management methods as well. Despite more than a four-year "experience" of police reform in Russia, the police, is still the subject of constant criticism both from policing practitioners and theorists. This article describes the "cooperative" management system. The goal of the proposed material to the reader is the opening for the Russian reader leadership practices of the German police. The authors suggest that familiarity with the data presented below will help the continued practice of reforming of the Russian police, as well as police forces of the Commonwealth of Independent States (CIS). Today, both in Europe and Russia the traditional authoritarian system management and administration of the force dominates the fact that due to authors does not meet modern requirements of a changing and globalizing society and in the Police Science there is almost complete lack of international studies and those present are very scattered and fragmentary. It seems that this material will be useful for the further work of managers in the Russian police and possibly other countries of the so-called the former Soviet Union.La policía, como otros organismos estatales, es un mecanismo bastante conservador, no propenso a cambios rápidos en el estilo, los métodos y los métodos de trabajo, así como los métodos de gestión. A pesar de más de cuatro años de "experiencia" en la reforma de la policía en Rusia, la policía sigue siendo objeto de críticas constantes por parte de la policía y los teóricos. Este artículo describe un sistema de gestión "cooperativo". El propósito del material ofrecido al lector es la divulgación de las prácticas líderes de la policía alemana para el lector ruso. Los autores sugieren que conocer los datos que se presentan a continuación ayudará a continuar la práctica de reformar la policía rusa, así como las fuerzas policiales de los países de la Comunidad de Estados Independientes (CEI). Hoy en día, tanto en Europa como en Rusia, el sistema autoritario tradicional de gestión y administración de fuerzas domina en que, según los autores, no cumple con los requisitos modernos de una sociedad de globalización cambiante, y casi no hay investigación internacional en ciencia policial. Este material será útil para el trabajo posterior de los gerentes de la policía rusa y, posiblemente, de otros países de la llamada antigua Unión Soviética.Полиция, как и другие государственные органы, является довольно консервативным механизмом, не склонным к быстрым изменениям стиля, приемов и методов работы, а также методов управления. Несмотря на более чем четырехлетний «опыт» реформирования полиции в России, полиция по-прежнему подвергается постоянной критике со стороны как полицейских, так и теоретиков. В данной статье описывается «кооперативная» система управления. Целью предлагаемого читателю материала является раскрытие для российского читателя лидерских практик немецкой полиции. Авторы предполагают, что знакомство с данными, представленными ниже, поможет продолжить практику реформирования российской полиции, а также сил полиции стран Содружества Независимых Государств (СНГ). Сегодня как в Европе, так и в России традиционная авторитарная система управления и администрирования сил доминирует в том, что, по мнению авторов, не отвечает современным требованиям изменяющегося общества глобализации, а в науке о полиции почти полностью отсутствуют международные исследования. Этот материал будет полезен для дальнейшей работы менеджеров российской полиции и, возможно, других стран так называемого бывшего Советского Союза

Sendai five years on: reflections on the role of international law in the creation and reduction of disaster risk

This article offers a critical examination of the position of the Sendai Framework for Disaster Risk Reduction 2015-2030 within international law. It is argued that any interrogation into the role of international law must begin not with existing disaster risk reduction (DRR) laws and policies, but rather with an enquiry into the nature of disaster risk and the role of international law in its creation and reduction. It is demonstrated how, while areas such as international human rights law can be utilized to enforce obligations in support of DRR, other areas – in particular international investment law – actively work to undermine DRR efforts. In order for international law to be a productive tool in the reduction of disaster risk international lawyers must engage with critical work in disaster studies in order to explore the role that the former has played – and can play – in creating and addressing hazards, vulnerabilities and capacities

Anaesthesiological strategies in elective craniotomy: randomized, equivalence, open trial – The NeuroMorfeo trial

<p>Abstract</p> <p>Background</p> <p>Many studies have attempted to determine the <it>"best" </it>anaesthetic technique for neurosurgical procedures in patients without intracranial hypertension. So far, no study comparing intravenous (IA) with volatile-based neuroanaesthesia (VA) has been able to demonstrate major outcome differences nor a superiority of one of the two strategies in patients undergoing elective supratentorial neurosurgery. Therefore, current practice varies and includes the use of either volatile or intravenous anaesthetics in addition to narcotics. Actually the choice of the anaestesiological strategy depends only on the anaesthetists' preferences or institutional policies.</p> <p>This trial, named NeuroMorfeo, aims to assess the equivalence between volatile and intravenous anaesthetics for neurosurgical procedures.</p> <p>Methods/Design</p> <p>NeuroMorfeo is a multicenter, randomized, open label, controlled trial, based on an equivalence design. Patients aged between 18 and 75 years, scheduled for elective craniotomy for supratentorial lesion without signs of intracranial hypertension, in good physical state (ASA I-III) and Glasgow Coma Scale (GCS) equal to 15, are randomly assigned to one of three anaesthesiological strategies (two VA arms, sevoflurane + fentanyl or sevoflurane + remifentanil, and one IA, propofol + remifentanil). The equivalence between intravenous and volatile-based neuroanaesthesia will be evaluated by comparing the intervals required to reach, after anaesthesia discontinuation, a modified Aldrete score ≥ 9 (primary end-point). Two statistical comparisons have been planned:</p> <p>1) sevoflurane + fentanyl vs. propofol + remifentanil;</p> <p>2) sevoflurane + remifentanil vs. propofol + remifentanil.</p> <p>Secondary end-points include: an assessment of neurovegetative stress based on (a) measurement of urinary catecholamines and plasma and urinary cortisol and (b) estimate of sympathetic/parasympathetic balance by power spectrum analyses of electrocardiographic tracings recorded during anaesthesia; intraoperative adverse events; evaluation of surgical field; postoperative adverse events; patient's satisfaction and analysis of costs.</p> <p>411 patients will be recruited in 14 Italian centers during an 18-month period.</p> <p>Discussion</p> <p>We presented the development phase of this anaesthesiological on-going trial. The recruitment started December 4^th, 2007 and up to 4^th, December 2008, 314 patients have been enrolled.</p

Role of urothelial cells in BCG immunotherapy for superficial bladder cancer

Intravesical instillation of Bacillus Calmette-Guérin (BCG) is used for the treatment of superficial bladder cancer, both to reduce the recurrence rate of bladder tumour and to diminish the risk of progression. Since its first therapeutic application in 1976, major research efforts have been directed to decipher the exact mechanism of action of the BCG-associated antitumour effect. Bacillus Calmette-Guérin causes an extensive local inflammatory reaction in the bladder wall. Of this, the massive appearance of cytokines in the urine of BCG-treated patients stands out. Activated lymphocytes and macrophages are the most likely sources of these cytokines, but at present other cellular sources such as urothelial tumour cells cannot be ruled out. Bacillus Calmette-Guérin is internalised and processed both by professional antigen-presenting cells and urothelial tumour cells, resulting in an altered gene expression of these cells that accumulates in the presentation of BCG antigens and secretion of particular cytokine

Preoperative elevation of serum C – reactive protein is predictive for prognosis in myeloma bone disease after surgery

We investigated whether preoperative levels of serum C-reactive protein (CRP) and its correlation with tumour clinicopathological findings adds prognostic information beyond the time of diagnosis in patients with myeloma bone disease (MM) to facilitate the surgical decision-making process. Six hundred and fifty-eight myeloma patients were evaluated retrospectively for surgery. Clinicopathological variables of patients who underwent surgery (n=71) were compared between patients with preoperative CRP ⩾6 mg l−1 and those with CRP <6 mg l−1. Univariate and multivariate analyses were performed to identify prognostic factors after surgery. Patients with an increase of CRP prior to surgery showed inferior survival compared to patients with normal levels. Patients with normal CRP levels at diagnosis but elevations prior to surgery do seem to have a similar unfavourable overall survival (OS) than patients with an increase both, at diagnosis and at surgery. Conversely, patients with normal CRP levels prior to surgery still have the best OS, irrespective of their basic values. Multivariate analysis revealed preoperative CRP levels above 6 mg l−1 Lactate dehydrogenase (LDH) above normal, and osteolyses in long weight bearing bones as independent predictors of survival. These findings suggest that in patients with MM serum levels of CRP increase during disease activity and might be significantly correlated with specific disease characteristics including adverse prognostic features such as osteolyses in long weight bearing bones. Thus, preoperative elevated CRP serum levels might be considered as independent predictor of prognosis and could provide additional prognostic information for the risk stratification before surgical treatment in patients with myeloma bone disease