La mondialisation de l’État de droit entre dislocation et recomposition : le cas du Codex Alimentarius et du droit transnational

Phénomène historique, protéiforme et polysémique, la mondialisation exerce une profonde infuence sur les phénomènes juridiques à l’échelle internationale. Source de « déformalisation » du droit, la mondialisation procède d’une logique difficilement saisissable en cette période de mutation traversée, entre autres, par une multiplication des acteurs normatifs et des espaces de régulation dans la société internationale. Ce phénomène diffus exerce son empire sur la forme et la substance même de la norme produite en érodant le rôle classique de producteur de normes reconnu à l’État au profit d’institutions internationales diverses dominées par la science ou l’économique, ou les deux à la fois. C’est le cas notamment des travaux de la Commission du Codex Alimentarius et de la lex mercatoria qui semblent avoir fait respectivement de la norme scientifque et du marché les standards de référence pour la validité d’une norme sur le plan international. Cette mise en concurrence de l’État par ces diverses logiques n’est pas sans conséquence pour l’État de droit, la démocratie et, à terme, pour le citoyen dans une société internationale mondialisée. La dislocation ainsi provoquée par la mondialisation entre l’État et les phénomènes juridiques provoquerait un double redéploiement du processus juridique marqué par l’autolimitation de l’État, c’est-à-dire son incapacité à participer effectivement aux processus normatifs. Ce double mouvement est caractérisé, d’un côté, par la multiplication des espaces normatifs et, de l’autre, par leur ordonnancement spontané et hétérarchique.Globalization — an historic phenomenon housing a concept with multifarious sizes, shapes and meanings — is exercising a profound influence on legal phenomena worldwide. As a source for the deformalization of the law, it issues from a hard-to-grasp logic in our times, an era of changes, characterized by a proliferation of often ad hoc normative initiatives and regulatory spheres of authority throughout the international community. This amorphous phenomenon exercises its empire over the form and very substance of enacted standards by undermining the classic legislative role of standards production enshrined in the State, the latter then yielding to various international institutions dominated by science, economics or both at once. A case in point is observed in the works of the Codex Alimentarius and the Lex Mercatoria Commission that seem to have respectively transformed the scientific and market standard for international standards validity into the benchmark standard. This challenge to State dominance by means of globalized multifarious logic is replete with consequences for the Rule of Law, democracy and in time, for citizens in a global community. The dislocation brought about by globalization between the State and legal phenomena will result in a duplication of legal processes characterized by State self-limitation, namely owing to its incapacity to effectively participate in normative processes. This duplication is further characterized by the proliferation of spheres of normative activities and by latter’s spontaneous and hierarchic instantiation

Relational benefits and customer satisfaction – a South African short-term insurance industry perspective

South African short-term insurers struggle to maintain and grow market share due to industry competitiveness and decreasing customer retention rates. One way of retaining customers is to establish and maintain long-term relationships with them. For relationships to last, customers should derive benefits from these relationships. It is furthermore professed that the relational benefits that customers gain from customer-business relationships positively impact customer satisfaction, which in turn enhances the quality of these relationships. This paper aims to determine whether relational benefits (confidence, social and special treatment benefits) predict customer satisfaction in the South African short-term insurance industry. Research focussing on customer relational benefits is limited, and such research has not been conducted within this industry or context. A quantitative, descriptive research design was undertaken and convenience sampling was used to select respondents. Data was collected by means of self-administered surveys from short-term insurance policy holders residing in Gauteng, South Africa. The results indicate that confidence benefits best predict customer satisfaction, followed by social and special treatment benefits. It is therefore recommended that, in order to improve customer satisfaction and maintain long-term relationships with customers, short-term insurers adapt their product and service offerings to include confidence, social and special benefits to customers.This article was co-written by P.G. Mostert before he joined the University of Pretoria.http://www.journals.co.za/content/journal/jcmanam2017Marketing Managemen

The interrelationship between service quality, relational benefits, customer satisfaction and behavioural intentions in the South African short-term insurance industry

South African short-term insurers operate in a highly competitive market but do not successfully differentiate themselves from competitors. One way differentiation can be achieved, is to adopt a customer-focused approach where short-term insurers engage in CRM initiatives such as providing quality services and relational benefits to satisfy customer needs and subsequently retain customers over the long term. This study investigates the effect of service quality and relational benefits on customer satisfaction, as well as the effect of customer satisfaction on behavioural intentions in the short-term insurance industry. A quantitative, descriptive research design was followed and convenience sampling was used to select respondents. Data was collected by means of self-administered surveys from shortterm insurance customers in Gauteng, South Africa. The results of the structural equation model indicate that service quality and relational benefits have a significant effect on customer satisfaction, which in turn has a significant effect on customers’ behavioural intentions. The paper also offers several managerial implications.This article was co-written by P.G. Mostert before he joined the University of Pretoria.http://www.unisa.ac.za/Default.asp?Cmd=ViewContent&ContentID=25784am2017Marketing Managemen

Economic Evaluation of Lupus Nephritis in the Systemic Lupus International Collaborating Clinics Inception Cohort Using a Multistate Model Approach.

OBJECTIVE: Little is known about the long-term costs of lupus nephritis (LN). The costs were compared between patients with and without LN using multistate modeling. METHODS: Patients from 32 centers in 11 countries were enrolled in the Systemic Lupus International Collaborating Clinics inception cohort within 15 months of diagnosis and provided annual data on renal function, hospitalizations, medications, dialysis, and selected procedures. LN was diagnosed by renal biopsy or the American College of Rheumatology classification criteria. Renal function was assessed annually using the estimated glomerular filtration rate (GFR) or estimated proteinuria. A multistate model was used to predict 10-year cumulative costs by multiplying annual costs associated with each renal state by the expected state duration. RESULTS: A total of 1,545 patients participated; 89.3% were women, the mean ± age at diagnosis was 35.2 ± 13.4 years, 49% were white, and the mean followup duration was 6.3 ± 3.3 years. LN developed in 39.4% of these patients by the end of followup. Ten-year cumulative costs were greater in those with LN and an estimated glomerular filtration rate (GFR)/minute ($310,579 2015 Canadian dollars versus$19,987 if no LN and estimated GFR \u3e60 ml/minute) or with LN and estimated proteinuria \u3e3 gm/day ($84,040 versus$20,499 if no LN and estimated proteinuria CONCLUSION: Patients with estimated GFR/minute incurred 10-year costs 15-fold higher than those with normal estimated GFR. By estimating the expected duration in each renal state and incorporating associated annual costs, disease severity at presentation can be used to anticipate future health care costs. This is critical knowledge for cost-effectiveness evaluations of novel therapies

Why can pulmonary vein stenoses created by radiofrequency catheter ablation worsen during and after follow-up ? A potential explanation

<p>Abstract</p> <p>Background</p> <p>Radiofrequency catheter ablation of excitation foci inside pulmonary veins (PV) generates stenoses that can become quite severe during or after the follow-up period. Since severe PV stenoses have most often disastrous consequences, it would be important to know the underlying mechanism of this temporal evolution. The present study proposes a potential explanation based on mechanical considerations.</p> <p>Methods</p> <p>we have used a mathematical-physical model to examine the cyclic increase in axial wall stress induced in the proximal (= upstream), non-stenosed segment of a stenosed pulmonary vein during the forward flow phases. In a representative example, the value of this increase at peak flow was calculated for diameter stenoses (DS) ranging from 1 to 99%.</p> <p>Results</p> <p>The increase becomes appreciable at a DS of roughly 30% and rise then strongly with further increasing DS value. At high DS values (e.g. > 90%) the increase is approximately twice the value of the axial stress present in the PV during the zero-flow phase.</p> <p>Conclusion</p> <p>Since abnormal wall stresses are known to induce damages and abnormal biological processes (e.g., endothelium tears, elastic membrane fragmentations, matrix secretion, myofibroblast generation, etc) in the vessel wall, it seems plausible that the supplementary axial stress experienced cyclically by the stenotic and the proximal segments of the PV is responsible for the often observed progressive reduction of the vessel lumen after healing of the ablation injury. In the light of this model, the only potentially effective therapy in these cases would be to reduce the DS as strongly as possible. This implies most probably stenting or surgery.</p

A geostatistical approach for quantification of contaminant mass discharge uncertainty using multilevel sampler measurements

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95058/1/wrcr11058.pd

Economic evaluation of damage accrual in an international SLE inception cohort using a multi-state model approach

OBJECTIVES: There is a paucity of data regarding healthcare costs associated with damage accrual in systemic lupus erythematosus (SLE). We describe costs associated with damage states across the disease course using multi-state modeling. METHODS: Patients from 33 centres in 11 countries were enrolled in the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort within 15 months of diagnosis. Annual data on demographics, disease activity, damage (SLICC/American College of Rheumatology (ACR) Damage Index [SDI]), hospitalizations, medications, dialysis, and selected procedures were collected. Ten-year cumulative costs (Canadian dollars) were estimated by multiplying annual costs associated with each SDI state by the expected state duration using a multi-state model. RESULTS: 1687 patients participated, 88.7% female, 49.0% of Caucasian race/ethnicity, mean age at diagnosis 34.6 years (SD 13.3), and mean follow up 8.9 years (range 0.6-18.5). Annual costs were higher in those with higher SDIs (SDI ≥ 5: $22 006 2019 CDN, 95$16 662, $27 350 versus SDI=0:$1833, 95% CI $1134,$2532). Similarly, 10-year cumulative costs were higher in those with higher SDIs at the beginning of the 10-year interval (SDI ≥ 5: $189 073, 95$142 318, $235 827 versus SDI=0:$21 713, 95% CI $13 639,$29 788). CONCLUSION: Patients with the highest SDIs incur 10-year cumulative costs that are almost 9-fold higher than those with the lowest SDIs. By estimating the damage trajectory and incorporating annual costs, damage can be used to estimate future costs, critical knowledge for evaluating the cost-effectiveness of novel therapies

Machine learning identifies clusters of longitudinal autoantibody profiles predictive of systemic lupus erythematosus disease outcomes

OBJECTIVES: A novel longitudinal clustering technique was applied to comprehensive autoantibody data from a large, well-characterised, multinational inception systemic lupus erythematosus (SLE) cohort to determine profiles predictive of clinical outcomes. METHODS: Demographic, clinical and serological data from 805 patients with SLE obtained within 15 months of diagnosis and at 3-year and 5-year follow-up were included. For each visit, sera were assessed for 29 antinuclear antibodies (ANA) immunofluorescence patterns and 20 autoantibodies. K-means clustering on principal component analysis-transformed longitudinal autoantibody profiles identified discrete phenotypic clusters. One-way analysis of variance compared cluster enrolment demographics and clinical outcomes at 10-year follow-up. Cox proportional hazards model estimated the HR for survival adjusting for age of disease onset. RESULTS: Cluster 1 (n=137, high frequency of anti-Smith, anti-U1RNP, AC-5 (large nuclear speckled pattern) and high ANA titres) had the highest cumulative disease activity and immunosuppressants/biologics use at year 10. Cluster 2 (n=376, low anti-double stranded DNA (dsDNA) and ANA titres) had the lowest disease activity, frequency of lupus nephritis and immunosuppressants/biologics use. Cluster 3 (n=80, highest frequency of all five antiphospholipid antibodies) had the highest frequency of seizures and hypocomplementaemia. Cluster 4 (n=212) also had high disease activity and was characterised by multiple autoantibody reactivity including to antihistone, anti-dsDNA, antiribosomal P, anti-Sjögren syndrome antigen A or Ro60, anti-Sjögren syndrome antigen B or La, anti-Ro52/Tripartite Motif Protein 21, antiproliferating cell nuclear antigen and anticentromere B). Clusters 1 (adjusted HR 2.60 (95% CI 1.12 to 6.05), p=0.03) and 3 (adjusted HR 2.87 (95% CI 1.22 to 6.74), p=0.02) had lower survival compared with cluster 2. CONCLUSION: Four discrete SLE patient longitudinal autoantibody clusters were predictive of long-term disease activity, organ involvement, treatment requirements and mortality risk