Île d’Hispaniola. Des voisins inégaux confrontés à des défis semblables : dégradation environnementale et migration

La République dominicaine et Haïti, qui partagent la même île et donc le même écosystème, sont confrontés aux mêmes défis environnementaux. L’île d’Hispaniola étant située sur le passage de tempêtes tropicales, les deux pays sont exposés aux catastrophes naturelles, aggravées par l’action des hommes. En Haïti, la quasi-totalité des forêts a disparu. Du côté dominicain, le problème de la déforestation et de l’érosion des sols se pose également, mais dans une moindre mesure. Cette recherche, antérieure au séisme qui a durement frappé Haïti début 2010, contribue à déterminer le poids de la dégradation environnementale dans les flux migratoires sur l'île d'Hispaniola

Migrationsprofil Westbalkan: Ursachen, Herausforderungen und Lösungsansätze

Die Studie (Working Paper 63) zeigt, dass die Wanderungsbewegungen in und aus der Westbalkanregion verschiedene Ursachen hatten und haben. Zu ihnen zählen neben den kriegerischen Auseinandersetzungen in den 1990er-Jahren u.a. die derzeitige schlechte wirtschaftliche Situation, ethnische Konflikte, reformbedürftige politische Systeme sowie weltweite Flüchtlingsbewegungen.The study focuses on migration in and from the Western Balkans region (Albania, Bosnia and Herzegovina, Kosovo, the Former Yugoslav Republic of Macedonia, Montenegro and Serbia) and the way it is handled by policy-makers. The region is characterised by a wide variety of migration processes and a large number of resulting challenges

Durchlaufzeiten in der Zentralen Notaufnahme – eine Prinzipal-Agenten-Analyse

Fast die Hälfte (42%) aller Patienten eines Krankenhauses durchläuft die Notaufnahme [31]. Die Reduktion langer Wartezeiten, verursacht u.a. durch Prozessineffizienzen [26], verspricht daher gerade in der Zentralen Notaufnahme (ZNA) besonders hohe Optimierungspotenziale. In der Literatur werden verschiedene Ineffizienzen genannt, z.B. „Verschwinden“ der Patienten in der Radiologie [5] oder social loafing [22]. Der vorliegende Beitrag vermutet Informationsasymmetrien zwischen den beteiligten Akteuren als Ursache. Vorgestellt wird eine Analyse der ZNA mittels der Prinzipal-Agenten-Theorie und das Design einer empirischen Untersuchung zum Nachweis der Reduktion von Informationsasymmetrien und der Durchlaufzeiten durch ein Monitoring System

The Use of Placebo and Non-Specific Therapies and Their Relation to Basic Professional Attitudes and the Use of Complementary Therapies among German Physicians - A Cross-Sectional Survey

We aimed to investigate the use of placebos ( e. g. saline injections) and non-specific treatments ( e. g. vitamin supplements in individuals without a relevant deficiency) among physicians working in private practices in Germany, and how such use is associated with the belief in and the use of complementary and alternative treatments, and basic professional attitudes. A four-page questionnaire was sent to nationwide random samples of general practitioners ( GP),internists and orthopaedists working in private practices. The response rate was 46% ( 935 of 2018). 24% of GPs, 44% of internists and 57% of orthopaedists had neither used pure placebos nor non-specific therapies in the previous 12 months. 11% percent of GPs, 12% of internists and 7% of orthopaedists had exclusively used pure placebos;30%,33% and 26%,respectively, had exclusively used non-specific therapies;35%,12% and 9% had used both. Age, sex and agreement to the statement that physicians should harness placebo effects were not significantly associated with any pattern of use. Exclusive use of pure placebos was associated with being a GP, being an internist, and having unorthodox professional views. In addition to these three factors, a lower use of CAM therapies and a wish for having more time was associated with the exclusive use of nonspecific therapies. Among physicians using both pure placebo and non-specific therapies, heterodox views were also somewhat more pronounced. However, associations were particularly strong for being a GP ( Odds ratio 11.6 ( 95%CI 6.41;21.3)) and having orthodox views ( Odds ratio 0.10 ( 95%CI 0.06;0.18)) among this group. In conclusion, the use of placebos and non-specific treatments varies strongly between medical specialties and is associated with basic professional attitudes. The findings support the view that the use of placebos and, in particular, of non-specific therapies is primarily a coping behaviour for difficult and uncertain situations

Acute kidney injury and tools for risk-stratification in 456 patients with hantavirus-induced nephropathia epidemica

BACKGROUND Puumala virus (PUUV) is the most common species of hantavirus in Central Europe. Nephropathia epidemica (NE), caused by PUUV, is characterized by acute kidney injury (AKI) and thrombocytopenia. The major goals of this study were to provide a clear clinical phenotyping of AKI in patients with NE and to develop an easy prediction rule to identify patients, who are at lower risk to develop severe AKI. METHODS A cross-sectional prospective survey of 456 adult patients with serologically confirmed NE was performed. Data were collected from medical records and prospectively at follow-up visit. Severe AKI was defined by standard criteria according to the RIFLE (Risk, Injury, Failure, Loss, End-stage kidney disease) classification. Fuller statistical models were developed and validated to estimate the probability for severe AKI. RESULTS During acute NE, 88% of the patients had AKI according to the RILFE criteria during acute NE. A risk index score for severe AKI was derived by using three independent risk factors in patients with normal kidney function at time of diagnosis: thrombocytopenia [two points; odds ratios (OR): 3.77; 95% confidence intervals (CI): 1.82, 8.03], elevated C-reactive protein levels (one point; OR: 3.02; 95% CI: 1.42, 6.58) and proteinuria (one point; OR: 3.92; 95% CI: 1.33, 13.35). On the basis of a point score of one or two, the probability of severe AKI was 0.18 and 0.28 with an area under the curve of 0.71. CONCLUSION This clinical prediction rule provides a novel and diagnostically accurate strategy for the potential prevention and improved management of kidney complications in patients with NE and, ultimately, for a possible decrease in unnecessary hospitalization in a high number of patient

Higher TIER bumble bees and solitary bees recommendations for a semi-field experimental design

The publication of the proposed EFSA risk assessment guidance document of plant protection products for pollinators highlighted that there are no study designs for non-Apis pollinators available. Since no official guidelines exist for semi-field testing at present, protocols were proposed by the ICPPR non-Apis working group and two years of ring-testing were conducted in 2016 and 2017 to develop a general test set-up. The ringtest design was based on the draft EFSA guidance document, OEPP/EPPO Guideline No. 170 and results of discussions regarding testing solitary bees and bumble bees during the meetings of the ICPPR non-Apis workgroup. Ring-tests were conducted with two different test organisms, one representative of a social bumble bee species (Bombus terrestris L; Hymenoptera, Apidae) and one representative of a solitary bee species (Osmia bicornis L; Hymenoptera, Megachilidae). The species are common species in Europe, commercially available and widely used for pollination services. Several laboratories participated in the higher-tier ring tests. 15 semi-field tests were conducted with bumble bees and 16 semi-field tests were done with solitary bees in 2016 and 2017. Two treatment groups were always included in the ringtests: an untreated control (water treated) and the treatment with dimethoate as a toxic reference item (optional other i.e. brood-affecting substances fenoxycarb or diflubenzuron). The toxic reference items were chosen based on their mode of action and long term experience in honey bee testing. A summary of the ringtest results will be given and the recommendations for the two semi-field test designs will be presented.The publication of the proposed EFSA risk assessment guidance document of plant protection products for pollinators highlighted that there are no study designs for non-Apis pollinators available. Since no official guidelines exist for semi-field testing at present, protocols were proposed by the ICPPR non-Apis working group and two years of ring-testing were conducted in 2016 and 2017 to develop a general test set-up. The ringtest design was based on the draft EFSA guidance document, OEPP/EPPO Guideline No. 170 and results of discussions regarding testing solitary bees and bumble bees during the meetings of the ICPPR non-Apis workgroup. Ring-tests were conducted with two different test organisms, one representative of a social bumble bee species (Bombus terrestris L; Hymenoptera, Apidae) and one representative of a solitary bee species (Osmia bicornis L; Hymenoptera, Megachilidae). The species are common species in Europe, commercially available and widely used for pollination services. Several laboratories participated in the higher-tier ring tests. 15 semi-field tests were conducted with bumble bees and 16 semi-field tests were done with solitary bees in 2016 and 2017. Two treatment groups were always included in the ringtests: an untreated control (water treated) and the treatment with dimethoate as a toxic reference item (optional other i.e. brood-affecting substances fenoxycarb or diflubenzuron). The toxic reference items were chosen based on their mode of action and long term experience in honey bee testing. A summary of the ringtest results will be given and the recommendations for the two semi-field test designs will be presented