1,019 research outputs found
Natuurlijk samenwerken tussen systemen: rennen of stilstaan?
No full textSteeds meer gemeenten in Nederland gaan de samenwerking aan, de één intensiever dan de ander. We zien herindelingen, fusies, samenwerkingsverbanden, gemeenschappelijke regelingen kriskras door het land opduiken. Gemeenten veranderen zo van vorm, terwijl zij gericht zijn op behoud van stabiliteit in een dynamisch bestuurlijk landschap. Dit onderzoek probeert inzichtelijk te maken wat de beweegredenen zijn van gemeenten, aan de hand van een specifieke casus: de samenvoeging van de organisaties van Voorschoten en Wassenaar. Wat spoorde hen aan tot veranderen? Hoe kan het zijn dat gemeenten kiezen voor samenwerking, en wat bedoelen zij werkelijk als wordt gezegd dat samenwerken „ betere? gemeenten voortbrengt?
Door middel van het fitness landschap is in dit onderzoek een manier gevonden om te visualiseren wat gemeenten aanspoort tot verandering, en hoe zij tijdelijk onzekerheid in hun omgeving kunnen reduceren door samen te werken. Daarmee kan dit onderzoek uitspraken doen over zowel het gebruik van een fitness landschap als model, als over het hoe en waarom van intergemeentelijke samenwerking
CARACTERIZAÇÃO MORFOLÓGICA DE PROGÊNIES NATIVAS DE GUARIROBA (Syagrus oleracea Becc.) NO ESTADO DE GOIÁS
No full textThe objective of this work was to characterize the population of Syagrus oleracea collected in 106 counties in Goias State. Plants showed, in average, six living leaves per plant and 83% of plants had between two and seven living leaves. The average of perimeter of the stem circumference, at 10cm above ground was 43 cm and the stem height had 203 cm. The population showed high variability regarding wit the evaluated characteristics.KEY-WORDS: Palm tree; bitter core palm; brazilian savanna; native plant.O objetivo deste trabalho foi caracterizar morfologicamente as progênies de uma população de guariroba (Syagrus oleracea) oriunda de 106 municípios do Estado de Goiás. A média geral das progênies foi de seis folhas vivas/planta e 83% das plantas apresentaram entre duas e sete folhas vivas. A média geral do comprimento da circunferência da estipe, a 10 cm do solo, foi 43 cm e a altura média da estipe foi 203 cm. A população apresentou grande variabilidade com relação às características consideradas. PALAVRAS-CHAVE: Palmeira; palmito amargo; cerrado; planta nativa
Heavy arv exposure and exhausted/limited arv options: predictors and clinical outcomes
No full textObjectives: People with HIV and extensive antiretroviral exposure may have limited/exhausted treatment options (LExTO) due to resistance, comorbidities, or antiretroviral-related toxicity. Predictors of LExTO were investigated in the RESPOND cohort. Methods: Participants on ART for at least 5 years were defined as having LExTO when switched to at least two anchor agents and one-third antiretroviral (any class), a two-drug regimen of two anchor agents (excluding rilpivirine with dolutegravir/cabotegravir), or at least three nucleoside reverse transcriptase inhibitors. Baseline was the latest of January 1, 2012, cohort enrolment or 5 years after starting antiretrovirals. Poisson regression modeled LExTO rates and clinical events (all-cause mortality, non-AIDS malignancy, cardiovascular disease [CVD], and chronic kidney disease [CKD]). Results: Of 23 827 participants, 2164 progressed to LExTO (9.1%) during 130 061 person-years follow-up (PYFU); incidence 1.66/100 PYFU (95% CI 1.59-1.73). Predictors of LExTO were HIV duration more than 15 years (vs. 7.5-15; adjusted incidence rate ratio [aIRR] 1.32; 95% CI 1.19-1.46), development of CKD (1.84; 1.59-2.13), CVD (1.64; 1.38-1.94), AIDS (1.18; 1.07-1.30), and current CD4+ cell count of 350 cells/μl or less (vs. 351-500 cells/μl, 1.51; 1.32-1.74). Those followed between 2018 and 2021 had lower rates of LExTO (vs. 2015-2017; 0.52; 0.47-0.59), as did those with baseline viral load of 200 cp/ml or less (0.46; 0.40-0.53) and individuals under 40. Development of LExTO was not significantly associated with clinical events after adjustment for age and current CD4, except CKD (1.74; 1.48-2.05). Conclusion: Despite an aging and increasingly comorbid population, we found declining LExTO rates by 2018-2021, reflecting recent developments in contemporary ART options and clinical management. Reassuringly, LExTO was not associated with a significantly increased incidence of serious clinical events apart from CKD
Is it safe to discontinue primary Pneumocystis jiroveci pneumonia prophylaxis in patients with virologically suppressed HIV infection and a CD4 cell count
No full textCurrent guidelines suggest that primary prophylaxis for Pneumocystis jiroveci pneumonia (PcP) can be safely stopped in human immunodeficiency virus (HIV)-infected patients who are receiving combined antiretroviral therapy (cART) and who have a CD4 cell count <200 cells/microL. There are few data regarding the incidence of PcP or safety of stopping prophylaxis in virologically suppressed patients with CD4 cell counts of 101-200 cells/microL
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No full textDeville, Winston - MARRIAGE CONTRACTS
Point Coupee No. 37 - 30 May 1778 Book 1778, No. 922
ANTOINE DOZA - under the tutorship of Arnaud Dubertrand, minor son of deceased
Antoine Doza and Cecile Frederic, native of Pointe Coupee
ANGELIQUE DESAUTEL - under the tutorship of Arnaud Dubertrand, minor dau of
Jacques Desautel and Anne Estephan Racancourt, native of Pointe Coupee
Wit: Arnaud Dubertrand; Bordelon, her uncle; Jean Pierre Le Doux; Bourgeat; Riche
IBID., No. 40-10 Nov 1778
NICHOLAS DESHOTELS - under the tutorship of Arnault Dubertrand, native of Point
Coupee, son of deceased Jacques Deshotel and deceased Anne Stephan
MARIANNE BREZA - under the tutorship of Pierre Descuir, native of Point Coupe
dau of deceased Joseph Breza and Antoine Lemoine
Wit: Arnault Dubertrand, curator; Antoine Bordelon; Antoine Doza; Joseph Lamirande
Ibid., No. 43 - 28 Nov 1778
CHARLES DU FOUR - native of the Riviere des Arkansas; son of deceased Jean du
Four and Marie Phillipe Decoux. Pierre Methode stipulates
ADRIENNE DESHOTEL - native of Pointe Coupee; dau of deceased Jaques Deshotels
and deceased dame Stephan Rocancourt. Arnault Dubertrand stipulates.
Wit: Arnault Dubertrant; Pierre Methode; Baptiste la Cour; Jean Baptiste Tuonoir
Ibid., No. 73 - 13 Jan 1789
ANTOINE DESAUTELS - native of Pointe Coupee, major son of Jacques Desautels and
Anne Stephan called Roquincour
ADELAIDE RICHER - dau of Frederic Richer and Marianne Porche, native of Point Coupee
/S/ J. Poydras CROIZET F FASTIE DANTILLY BERTIN FREDEREIC RICHER
RICHARD DE BIEUTORD ADELAIDE RICHE VALEREIN LE BLANC
Ibid., No. 82 - 10 Nov 1792
JEAN BAPTISTE LAFLEUR - age 22, native of Opelousas, son of Jacques La Fleur
and Marianne Fontenau
EULALIE DESHOTELLS - native of Pointe Coupee, age 22, dau of Antoine Deshotelle
and Anne Stepha
As universidades como novos atores da cooperação internacional para o desenvolvimento : o caso do Brasil
No full textDissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Sócio Econômico, Programa de Pós-graduação em Relações Internacionais, Florianópolis, 2013A inserção da universidade no Sistema Internacional de Cooperação para o Desenvolvimento (SICD) é um fenômeno recente e em expansão no mundo. Em alguns países observa-se a existência de políticas públicas especificamente voltadas para esta participação e identifica-se a formação de uma dimensão própria da Cooperação Internacional para o Desenvolvimento (CID) voltada para esse fenômeno, a da Cooperação Universitária para o Desenvolvimento (CUD), que corresponde ao conjunto de atividades que a universidade tem condições de realizar, baseada em suas competências básicas, em benefício dos países do Sul. A partir disso, o objetivo desta dissertação é analisar como o processo de inserção da universidade no SICD está ocorrendo no Brasil. Inicialmente considera-se que a universidade brasileira é admitida como um ator da Cooperação Internacional para o Desenvolvimento brasileira, mas que a Cooperação Universitária para o Desenvolvimento ainda é uma dimensão desconhecida entre os formuladores de políticas da área no Brasil, que não atribuem um tratamento específico à participação da universidade. Além disso, acredita-se que os fatores que levam a universidade brasileira a inserir-se no SICD são provenientes, sobretudo de estímulos externos à instituição. A verificação dessas questões é realizada através do método de estudo de caso, investigando a realidade da CUD brasileira no período de 2003 a 2012 e, em seguida, a da Universidade Federal de Santa Catarina, analisando-a a partir das atividades de CUD realizadas atualmente na instituição. Conclui-se a partir do estudo que a inserção da universidade brasileira no SICD é verificada no Brasil, mas a Cooperação Universitária para o Desenvolvimento ainda é uma dimensão desconhecida entre os formuladores de políticas da área no Brasil e mesmo entre as Instituições de Ensino Superior. Por fim, não é possível afirmar que a inserção da universidade seja influenciada sobretudo por fatores externos pois a universidade possui suas próprias atividades de CUD e há projetos dos quais ela participa a partir de sua iniciativa Abstract: The inclusion of the university in the international development cooperation system is a recent and growing phenomenon worldwide. In some countries it is observed the existence of public policies driven to this participation and it is identified the formation of a specific dimension of International Development Cooperation toward this phenomenon that is the University Development Cooperation, which corresponds to the set of activities that the university is able to perform, based on its own skills, in benefit of developing countries. The aim of this dissertation is to analyze how the university entry process in international development cooperation system is occurring in Brazil. Initially it is considered that the university is admitted as an actor by International Development Cooperation carried out by Brazil but the University Development Cooperation remains an unknown dimension among Brazilian policymakers. Furthermore, it is believed that the factors leading Brazilian university to enter into this system are external to the institution. To verify these assertions it is used the case study method through which it is analyzed the reality of Brazilian University Development Cooperation from 2003 to 2012 and then the case of a Brazilian university - Universidade Federal de Santa Catarina ? which analyzes its current activities on this area. It is concluded that it is verified the inclusion of Brazilian university in the international development cooperation system but the University Development Cooperation remains an unknown dimension among policymakers of the area in Brazil and that happens even between the universities. Finally, it is not possible to say that the inclusion of the university is mainly influenced by external factors because the university has its own University Development Cooperation activities and it participates in projects by its own will
Switching to dolutegravir plus rilpivirine versus maintaining current antiretroviral therapy regimen in virologically suppressed people with HIV-1 and the Lys103Asn (K103N) mutation: 48-week results from a randomised, open-label pilot clinical trial
No full textBackground: The combination of dolutegravir plus rilpivirine has been studied in people with virologically suppressed HIV with no previous history of treatment failure or resistance. We investigated the potential to maintain viral suppression with dolutegravir plus rilpivirine in people with Lys103Asn mutations whose HIV was previously managed with other treatment regimens. Methods: In this open-label pilot trial at 32 clinical sites in seven European countries, virologically suppressed, HBsAg-negative adults aged 18 years or older with HIV-1 and Lys103Asn mutations were randomly assigned (2:1) to switch to 50 mg dolutegravir plus 25 mg rilpivirine (given as a single tablet) once daily or to continue their current antiretroviral therapy regimen (control group). After 48 weeks, participants in the control group also switched to dolutegravir plus rilpivirine. Randomisation was stratified by country, and a computer-generated randomisation list with permuted blocks within strata was used to assign participants to treatment groups. The primary endpoints were virological failure (ie, two consecutive measurements of 50 copies or more of HIV RNA per mL at least 2 weeks apart) and virological suppression (the proportion of participants with fewer than 50 copies of HIV RNA per mL) at week 48 (week 96 data will be reported separately). Analyses were done in the modified intention-to-treat population, which included all participants who received at least one dose of the study medication. This trial is registered with ClinicalTrials.gov, NCT05349838, and EudraCT, 2017-004040-38. Findings: Between Nov 5, 2018, and Dec 9, 2020, 140 participants were enrolled and randomly assigned, 95 to the dolutegravir plus rilpivirine group and 45 to the control group. Virological failure was recorded in three participants (3·2%, 95% CI 0·7 to 9·0) in the the dolutegravir plus rilpivirine group and one (2·2%, 0·1 to 11·8) in the control group. The proportion of participants in whom virological suppression was maintained at week 48 was 88·4% (80·2 to 94·1) in the dolutegravir plus rilpivirine group versus 88·9% (75·9 to 96·3) in the control group (difference -0·5, -11·7 to 10·7). Significantly more adverse events were recorded in the dolutegravir plus rilpivirine group than in the control group (234 vs 72; p=0·0034), but the proportion of participants who reported at least one adverse event was similar between groups (76 [80%] of 95 vs 33 [73%] of 45; p=0·39). The frequency of serious adverse events was low and similar between groups. Interpretation: Virological suppression was maintained at week 48 in most participants with Lys103Asn mutations when they switched from standard regimens to dolutegravir plus rilpivirine. The results of this pilot study, if maintained when the week 96 data are reported, support conduct of a large, well-powered trial of dolutegravir plus rilpivirine. Funding: ViiV Healthcare
Videoconsultaties in de opvolging van patiënten met een chronische somatische aandoening : Synthese
No full text32 p.ill.,Op vraag van het RIZIV en CHU Namur ging het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) na welk effect videoconsultaties hebben op de gezondheid van de patiënten met een chronische lichamelijke aandoening. Ook werd nagegaan hoe videoconsultaties worden gebruikt in Nederland en Frankrijk. Het KCE stelde vast dat er vandaag geen wetenschappelijk bewijs is voor een verschil tussen videoconsultaties en ‘normale’ consultaties inzake effect op de gezondheid van de patiënten. Zorgverleners bleken wat huiverig om videoconsultaties te gebruiken. Ervaringen uit Nederland en Frankrijk leerden ook dat de invoering van videoconsultaties een lange weg is met veel hobbels. Tijdens de studie brak de coronacrisis uit, en werden de onderzoekers ingehaald door de realiteit. Consultaties op afstand via telefoon en beeldscherm werden plots overal toegelaten én terugbetaald, niet alleen in België, maar wereldwijd. Er wordt best van de huidige dynamiek gebruik gemaakt om dit soort ‘digitale’ zorg verder in te voeren, als een nuttige aanvulling op een face-to-face consultatie, niet om deze te vervangen. Daaraan zijn wel een aantal voorwaarden verbonden, waarvan de geïnformeerde toestemming van de patiënt een belangrijke is1. INLEIDING 5 -- 1.1. TECHNOLOGIE EN ONDERZOEK ZORGEN VOOR GEZONDHEIDSVERBETERING 5 -- 1.2. WAT IS TELEHEALTH? WAT IS DIGITALE ZORG? 5 -- 1.3. WAT HEBBEN WE ONDERZOCHT? 8 -- 1.4. HOE GINGEN WE TE WERK? 8 -- 2. WAT ZEGT DE WETENSCHAPPELIJKE LITERATUUR? 9 -- 2.1. HOE GINGEN WE TE WERK? 9 -- 2.2. GEEN BEWIJS DAT VIDEOCONSULTATIES BETER OF SLECHTER ZIJN DAN DE FACE-TO-FACE CONSULTATIE 9 -- 3. VIDEOCONSULTATIE IN BELGIË 10 -- 3.1. TALRIJKE TERMEN VOOR VIDEOCONSULTATIE 10 -- 3.2. GEBRUIK VÓÓR DE CORONACRISIS 10 -- 3.2.1. Adviezen van de Orde der Artsen 10 -- 3.2.2. Geen specifieke wetgeving 10 -- 3.2.3. Geen terugbetaling door de ziekteverzekering 11 -- 3.2.4. Privacy en beveiliging 11 -- 3.3. REEDS BESTAANDE PROJECTEN VÓÓR DE CORONACRISIS 11 -- 3.3.1. Vividoctor 11 -- 3.3.2. AXA Doctors Online 11 -- 3.3.3. SIMBA 12 -- 3.3.4. l'Observatoire de la Santé de la Province de Luxembourg 12 -- 3.3.5. Wit-Gele Kruis West-Vlaanderen 12 -- 3.4. DE CORONACRISIS ZORGDE VOOR EEN STROOMVERSNELLING 13 -- 3.4.1. Consultaties op afstand worden aangemoedigd … 13 -- 3.4.2. …en terugbetaald 13 -- 3.4.3. Tools en initiatieven 13 -- 3.4.4. Privacy en beveiliging 14 -- 4. VIDEOCONSULTATIE IN FRANKRIJK 15 -- 4.1. GEBRUIK VAN VIDEOCONSULTATIE 15 -- 4.2. WETTELIJKE VOORWAARDEN EN VERGOEDING 16 -- 4.3. WELKE ZORGVERLENERS MAKEN GEBRUIK VAN VIDEOCONSULTATIE? 17 -- 4.4. BELEMMERINGEN EN FACILITATOREN VOOR HET GEBRUIK VAN VIDEOCONSULTATIE 17 -- 4.4.1. Belemmeringen 18 -- 4.4.2. Verschillende maatregelen om videoconsultatie te ondersteunen 18 -- 4.5. TIJD VOOR EEN EVALUATIE 19 -- 5. VIDEOCONSULTATIE IN NEDERLAND 19 -- 5.1. OOK HIER VELE VERSCHILLENDE TERMEN 19 -- 5.2. GEBRUIK VAN VIDEOCONSULTATIE 19 -- 5.2.1. Al geruime tijd aangemoedigd door de overheid 19 -- 5.2.2. Spectaculaire toename tijdens de coronacrisis 20 -- 5.3. ALGEMENE EN BIJKOMENDE VOORWAARDEN 20 -- 5.3.1. In principe in alle zorgsituaties toegestaan 20 -- 5.3.2. Tijdens coronacrisis wegnemen van beperkingen 21 -- 5.4. VERGOEDING VAN VIDEOCONSULTATIE 21 -- 5.5. BELEMMERINGEN VOOR HET GEBRUIK VAN VIDEOCONSULTATIE 21 -- 5.6. HOE WORDEN DE BELEMMERINGEN AANGEPAKT? 23 -- 5.7. TOOLS, PLATFORMEN EN INITIATIEVEN 23 -- 5.8. CERTIFIËRING VAN TOOLS EN PLATFORMEN 23 -- 6. TOT SLOT 24 -- AANBEVELINGEN 26 -- REFERENTIES 3
About Oneself: De Se Thought and Communication
No full textInspired by Castañeda (1966, 1968), Perry (1979) and Lewis (1979) showed that a specific variety of singular thoughts, thoughts about oneself “as oneself” – de se thoughts, as Lewis called them – raise special issues, and they advanced rival accounts. Their suggestive examples raise the problem of de se thought – to wit, how to characterize it so as to give an accurate account of the data, tracing its relations to singular thoughts in general. After rehearsing the main tenets of two contrasting accounts – a Lewisian one and a Perrian one – in the first section of this paper, in the second I will present a proposal of my own, which is a specific elaboration of the Perrian account. In the first section I will indicate some weaknesses of Perry’s presentation of his view; the proposal I will articulate in the second overcomes them. I will conclude with a brief discussion of reasons for preferring one or another account, in particular regarding the issue of the communication of de se thoughts
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