Du Conseil Research Articles

Effectiveness of prescribing codes in reducing inappropriate proton pump inhibitors in ambulatory care

BackgroundHealth care deciders are aware of the inappropriate use of proton pump inhibitors (PPIs). To reduce inappropriate prescriptions, the Conseil du Médicament (CdM) issued a practice guideline and the Régie de l’Assurance Maladie du Quebec (RAMQ) asked prescribers to justify its use by writing a specific indication code for their patients to obtain drug coverage. ObjectivesThis study aimed to evaluate the effectiveness of the intervention by the RAMQ to reduce inappropriate PPI prescription. MethodsA cross-sectional quasi-experimental prospective study was performed in an emergency department. Patients aged 18 years or older were included in 2016 to 2017 and 2019 to 2021 in the pre- and postintervention group, respectively. The proportion of patients on PPI without an appropriate indication were identified from patient interviews and chart review. ResultsA total of 871 and 1475 patients were recruited in the pre- and postintervention groups. According to the CdM guideline, the proportion of inappropriate PPI prescription was 30.7% (n = 267) in the preintervention group and 49.1% (n = 724) in the postintervention group (P < 0.001). According to the RAMQ criteria, the proportion of inappropriate PPI prescription was of 76.1% (n = 663) and 81.4% (n = 1200) in the pre- and postintervention group, respectively (P < 0.001). ConclusionThis study highlights the ineffectiveness of the codes for PPI prescriptions in reducing inappropriate prescriptions. It seems that the obligation to write a code does not lead to a reassessment of PPI indication.

Counterfeiting at Le Clos-Paul in Charleville-Mézières (Ardennes, France). Reconstruction trial of a complex chaîne opératoire

The excavation of the copper cementation workshop “Le Clos-Paul” in Charleville-Mézières (Ardennes, France), executed by the Cellule d’archéologie du Conseil départemental des Ardennes, led to the finding of fragments of coinage moulds. Dating from the middle of the 3rd century AD, they are the only evidence of an opportunistic production of counterfeits without any direct link to the metallurgical activity of the site. The study of the moulds led to a series of experimentations aimed at understanding the counterfeiting activity in its entirety, from the preparation of the loam intended for moulds to the casting of coins.

« [L’]utilisateur du bataillon de jeunes Québécois » : le patronat québécois et les institutions universitaires, 1980-2012

Cet article s’intéresse à l’idéal universitaire de deux des plus grosses organisations patronales au Québec, le Conseil du patronat du Québec et la Chambre de commerce du Montréal métropolitain. En analysant les interventions de ces organisations de 1980 à 2012, nous mettons en lumière leur conception du rôle social de l’université et leurs principales demandes en matière d’enseignement et de recherche. Nous montrons d’abord que les chefs d’entreprises conçoivent les institutions universitaires comme des incubatrices à technologies nécessaires pour soutenir la « concurrence internationale » en contexte de libre-échange. Ensuite, nous soutenons que c’est cette conception de l’université et une idéologie fondamentalement néolibérale qui poussent le patronat à réclamer l’institutionnalisation des rapports universités-entreprises et la hausse des frais de scolarité, pour laquelle il se bat depuis 1986.

“She persisted in her revolt”: Between Slavery and Freedom in Saint-Domingue

This article argues that women of colour were particularly well placed to take advantage of the porous boundary between slavery and freedom, flexible categories that operated on a continuum. Through a fine-grained analysis of the legal case of Marie Victoire Morisseau, one of the few appeals from Saint-Domingue that reached the Conseil du roi in Versailles, this article inserts women of colour into debates over who had the authority to arbitrate the boundary between slavery and freedom. It concludes that slavery and freedom were gendered categories that were less absolute for women of colour than for men. They were more manipulable, more permeable and possible to traverse, and less about legal absolutes and documents that provided “proof” and more about social experience and lived reality.

Implementation of community sanctions and measures across Europe at the beginning of the twenty-first century

This study is based on a project aiming at a methodology to collect data on community sanctions and measures (CSM) and on a recent data collection wave by the European Sourcebook of Crime and Criminal Justice Statistics. The study evaluates the implementation of CSM across Europe and focuses on the integration of these sanctions into the criminal justice system; at the same time, it examines data availability and comparability. Since the types of available sanctions and measures and the underlying penal systems differ significantly between countries, our approach went beyond the national level and looked for a comparative European perspective. We extended the boundaries of the Council of Europe (CoE) Annual Penal Statistics [Statistiques Penales Annuelles du Conseil de l’Europe; or SPACE II project] and collected data on CSM at three different levels: at the prosecution stage (CSM imposed on an offender as a condition for a conditional disposal), at the sentencing level (CSM ordered by the court), and CSM supervised by probation and similar agencies. By analyzing the major forms of supervision and community service, we found data availability, especially at the level of the court and probation agencies, is quite good, and the importance of CSM in the sentencing policy of countries throughout Europe differs. Despite the diversity of legal concepts, a certain degree of convergence can be observed. Based on this, the potential for better criminal justice statistics revealed by this project can be used for improving the European-wide comparability of information in this field.

The Hospitaller’s Hand and the Conseil du Roi Charles

In the last years of the thirteenth century, the Conseil du Roi Charles, the first of a new genre of writing called the ‘recovery treatise’, was written by King Charles II in response to a call for such proposals by Pope Nicholas IV. The text was written in French and is now conserved in a single manuscript, Paris, Bibliothèque nationale de France, MS fonds français 6049. This manuscript was produced in Cyprus at the beginning of the fourteenth century by members of the Hospitaller Order, and contains documents of crucial importance to the Order. By considering the historical context of the work’s creation, this article argues for a new understanding of how the Conseil was produced, through an examination of the reasons why French was chosen as the language of the text; the participants in its redaction; and how it worked to support the political needs of both Charles II and his Hospitaller contemporaries.

Conditions d’accès à l’assistance médicale à la procréation et procréation post-mortem : l’appel des juges à la révision des lois de bioéthique ?

The legal requirements for access to medically assisted procreation are experiencing some praetorian damage as if they were no longer adapted to today's society. Recently, the “Assemblée du contentieux du Conseil d’État” came to “scratch” the spirit of Article L. 2141-2 of the Code of public health in its judgment of 31 May 2016 by ordering the Assistance Publique–Hôpitaux of Paris and the Biomedicine Agency to carry out the export of gametes of a deceased man in Spain. In its decision, the Conseil d’État do not respects the legal prohibition of export gametes filed in France and intended to be used abroad, for purposes that are prohibited in the country: the post-mortem procreation. The prohibition of posthumous reproduction, weakened by the recent decision of the Conseil d’État, is the result of a clearly stated and maintained will of the French legislature (Section 1). This additional Praetorian affect against legal conditions of access to medically assisted procreation generates inequalities and creates an unsustainable situation (Section 2).

Flawed evidence supporting the Metabolic Theory of Ecology may undermine goals of ecosystem-based fishery management: the case of invasive Indo-Pacific lionfish in the western Atlantic

Given its ability to yield predictions for very diverse phenomena based only on two parameters—body size and temperature—the Metabolic Theory of Ecology (MTE) has earned a prominent place among ecology’s efficient theories. In a seminal article, the leading proponents of the MTE claimed that the theory was supported by evidence from Pauly’s (On the interrelationships between natural mortality, growth parameters, and mean environmental temperature in 175 fish stocks. Journal Du Conseil International Pour L’Exploration de la mer 39:175–192) dataset on natural mortality, biomass, and environmental temperature for 175 fish stocks spanning tropical, temperate, and polar locations. We demonstrate that the evidence presented by the proponents of the MTE is flawed because it fails to account for the fact that Pauly re-estimated environmental temperatures for polar fish as ‘physiologically effective temperatures’ to correct for their ‘abnormally’ high natural (mass-corrected) mortalities, which on average turned out to be similar to (rather than lower than) the mortalities recorded for temperate fish. Failing to account for these modifications skews the coefficients from MTE regression models and wrongly validates predictions from the theory. It is important to point out these deficiencies given the broad appeal of the MTE as a theoretical framework for applied ecological research. In a recent application, the MTE was used to estimate biomass production rates of prey fish in a model of invasive Indo-Pacific lionfish (Pterois volitans and P. miles) predation in Bahamian reefs. We show that the MTE coefficients may lead to a drastic overestimation of prey fish mortality and productivity rates, leading to erroneous estimations of target densities for ecological control of lionfish stocks. A set of robust mortality-weight coefficients is proposed as an alternative to the MTE.

Dynamique de pouvoir dans l’espace régulatoire de l’audit légal en France (2003-2012)

Cet article s’intéresse à l’analyse de la dynamique de pouvoir qui a marqué l’espace régulatoire de l’audit légal à la suite de l’adoption de la Loi sur la Sécurité Financière en août 2003. À travers l’étude du processus par lequel le Haut Conseil du Commissariat aux Comptes (H3C) a établi et défendu son pouvoir, il met en évidence la façon dont ce dernier a interagi avec la profession de l’audit dans l’objectif d’imposer son rôle dans le processus de régulation de l’audit légal. Notre démarche est interprétative et repose sur une étude longitudinale basée sur 40 entretiens complétée par une étude documentaire sur la période 2003-2012.

Has Sverdrup's critical depth hypothesis been tested? Mixed layers vs. turbulent layers

AbstractSverdrup (1953. On conditions for the vernal blooming of phytoplankton. Journal du Conseil International pour l'Exploration de la Mer, 18: 287–295) was quite careful in formulating his critical depth hypothesis, specifying a “thoroughly mixed top layer” with mixing “strong enough to distribute the plankton organisms evenly through the layer”. With a few notable exceptions, most subsequent tests of the critical depth hypothesis have ignored those assumptions, using estimates of a hydrographically defined mixed-layer depth as a proxy for the actual turbulence-driven movement of the phytoplankton. However, a closer examination of the sources of turbulence and stratification in turbulent layers shows that active turbulence is highly variable over time scales of hours, vertical scales of metres, and horizontal scales of kilometres. Furthermore, the mixed layer as defined by temperature or density gradients is a poor indicator of the depth or intensity of active turbulence. Without time series of coincident, in situ measurements of turbulence and phytoplankton rates, it is not possible to properly test Sverdrup's critical depth hypothesis.

PHP108 - Consistency In Reimbursement Decisions At Canadian Hta Agencies: Inesss Versus Cdr

To compare the positive recommendation rate and agreement between CDR and INESSS. In Canada, eligible non-cancer prescription drugs approved by Health Canada are reviewed by 2 health technology assessment (HTA) agencies: the Common Drug Review (CDR) and the Institute national d’excellence en santé et en services sociaux (INESSS). CDR is part of the Canadian Agency for Drugs and Technologies in Health (CADTH), which makes reimbursement recommendations that are considered by provincial and federal plans, with the exception of Quebec, in making their formulary coverage decisions. In Quebec INESSS performs HTA and issues recommendations to the Regie d’assurance maladie Quebec (RAMQ). Prior to INESSS, HTA in Quebec was performed by the Conseil du Médicaments (CdM). Using our proprietary CDR Tracker®database we examined the recommendations by both agencies and compared recommendation positivity and congruence for all drugs which have been reviewed by CDR, up to December 31, 2013. We separately considered positive and negative recommendations by both agencies. The overall positivity rate for CDR recommendations in this period was 52%, compared to 66.9% for INESSS. Of the 275 recommendations issued by CDR, 143 were negative and INESSS agreed with CDR in 90% of these recommendations. 132 of CDR’s recommendations were negative, of which INESSS agreed in 48% of cases. INESSS has a higher positive recommendation rate and, possibly due to the broader scope for funding recommendations, frequently disagrees with CDR’s analysis, particularly when CDR’s recommendation is negative.

Cohort resonance: a significant component of fluctuations in recruitment, egg production, and catch of fished populations

Abstract Hjort (1914. Fluctuations in the great fisheries of northern Europe. Rapport et Procès-Verbaux des Réunions du Conseil Permanent International pour l'exploration de la Mer, XX: 1–228) identified two important aspects of the early life of fish as being important determinants of fluctuations in year-class strength: changes in nutrition and transport. He dismissed a third possible influence, changes in the abundance of the reproductive stock. Here, we describe how a recently discovered characteristic behaviour of age-structured populations termed cohort resonance, which does involve changes in adult abundance, can have a substantial effect on fluctuations in fished populations. Cohort resonance involves selectively greater sensitivity of age-structured populations to generational frequencies and to very low frequencies in the environmental signal influencing a population. This frequency-dependent selectivity has been shown to increase with fishing, as do the total amounts of variability in recruitment, egg production, and catch. Cohort resonance differs from other recent model mechanisms proposed to explain the observed increase in variability with fishing in that it does not require over-compensatory density-dependence. It stems from the compensatory ascending limb of the egg–recruit relationship, and is a characteristic of a stable population driven by a random environment. We demonstrate the differences in frequency selectivity and increases in variability with fishing among three different Pacific coast species with different longevity: coho salmon (Oncorhynchus kisutch; ∼3 years), Pacific hake (Merluccius productus; ∼25 years), and Pacific Ocean perch (Sebastes alutus; ∼90 years). The shortest lived, coho salmon is the most sensitive to environmental variability, but variability in egg production and catch both increase more rapidly with fishing in the longer-lived species. Understanding cohort resonance will aid in anticipation of predicted potential changes in the frequency content of the physical environment with changing climate (e.g. more frequent El Niños), and it provides a warning regarding the possible confounding of increasing sensitivity to slow change due to fishing with actual slow change of population parameters due to climate change. Our understanding of the role of cohort resonance in population variability will be enhanced by further identification of empirical examples. We describe some of the challenges in this effort.

A Second Flowering of the Old French Lais

The late Old French Lai de l’Ombre, Lai du Conseil, and Lai d’Amours represent a second flowering of the lais, very different from the first flowering under Marie de France in the last third of the twelfth century. Marie’s early successors were on the whole imitative of her, but these three late lais, written probably in the second decade of the thirteenth century, attained a second flowering of their own. They had relinquished the Breton material of the earlier lais, and did not concern themselves with men experiencing aventures. Instead, they interested themselves in the portrayal of women, especially women as the ones who controlled sexual relationships. They stand apart from the lais of their time in embracing the concept of love as essential to happiness and emotional fulfilment. Other lais around their time do not treat love so positively—some show it as primarily sexual desire, some show it as abortive or inappropriate, and some do not mention it at all. These three late lais briefly revitalized the genre in terms of their positive attitude to love, their originality, and their sophistication.

What is left for parties? An overview of party mandate in France 1981–2009

The review draws on the author’s recent book to explore the long-standing question of the influence of partisanship on policy implementation. Partisanship is traditionally expected to exert an influence on policy implementation, because, on the one hand, citizens perceive their vote as an expression of preference towards a certain set of policies, whereas, on the other, parties conceive policies as tools to differentiate themselves from one another in the electoral market. However, the consistence between parties’ preferences and the policies they enact is often questioned. I argue that party mandate is best understood as the correspondence between partisan and institutional agendas. Drawing on the Comparative Agendas Project data on Party Manifestos, Communiques du Conseil des Ministres and passed legislation (1981–2009), I show that party preferences matter but their influence on public policy is weak. Moreover, this study confirms that the institutional configuration has an impact on party mandate but exclusively with respect to the executive agenda. Finally, this research shows that French mainstream parties follow electoral business cycles, and party mandate appeared to be stronger in pre-electoral periods. The present research holds important implications for the study of the influence of parties on policymaking, on policy change and more in general for studies dealing with the quality of representative democracy.

Prison structure, inmate mortality and suicide risk in Europe

Suicide presents a major complication during imprisonment and greatly contributes to the high mortality rate of prisoners. All international studies have found increased suicide rates among prisoners compared to the general population. This study examines risk factors for suicide and mortality in prisoners using supranational data from the Council of Europe Annual Penal Statistics (Statistiques Penales Annuelles du Conseil du L'Europe or SPACE) from 1997 to 2008. Macrostructural risk factors for prison suicide are analyzed from this supranational data set and the identified indicators are further evaluated on the single country level. Sexual offenders, offenders charged with violent crimes and prisoners sentenced for short- and long-term imprisonment are considered to be at an elevated risk for suicide. In addition, prison mortality is associated with overcrowding.

November 4–5, 2011 Quebec City, Quebec, Canada: Congrès annuel 2011 du conseil professionnel de Diabète Québec

November 4–5, 2011 Quebec City, Quebec, Canada: Congrès annuel 2011 du conseil professionnel de Diabète Québec

90th Session of the Governing Council - Rome, 9-11 May 2011/90EME SESSION DU CONSEIL DE DIRECTION - ROME, 9-11 MAI 2011

90th Session of the Governing Council - Rome, 9–11 May 2011/90ÈME SESSION DU CONSEIL DE DIRECTION - ROME, 9-11 MAI 2011 Get access Uniform Law Review, Volume 16, Issue 4, December 2011, Pages 942–955, https://doi.org/10.1093/ulr/16.4.942 Published: 01 December 2011

Justice et procès dans deux histoires tragiques de François de Belleforest

Although Boaistuau and others often claimed to be describing actual events in their tragic novelle, François de Belleforest provided an important innovation when he included in his 1572 Cinquiesme tome des histoires tragiques two stories that presented him as an eyewitness and investigator. In this article, I study the ideological and political journey of an author who described two especially violent and disturbing events just a few months before the Saint Bartholomew massacre. Records in the Manuaux du conseil de Lausanne pertaining to the trial of Jean de Coignac, the protagonist of one of these tales, have allowed me to compare the function of Belleforest’s tales to that of the executions in effigy that magistrates often ordered in sixteenth century France.

Les médicaments onéreux et la justice intergénérationnelle

Among all categories of health expenditure in Canada, spending on drugs is the fastest growing. The factors at play in the increase in expenditure on drugs are essentially those related to the volume of use and the arrival of new drugs on the market. Some of these new drugs are very expensive. In fact, the costs of certain drugs threaten the continued existence of the Québec Prescription Drug Insurance Plan. In Québec, the Conseil du médicament (Drug Board) is responsible for recommending drugs to the Ministry of Health and Social Services to be put on the formulary of drugs covered by the public plan. In spite of pressure by various stakeholders, we believe that the rationing of drugs that are too expensive can achieve political legitimacy if it is based on a transparent justification that includes not only evidence-based criteria, but also ethical principles and values. For egalitarians, fairness in the supply of health care should be accomplished as a function of health care needs. But this concept of justice should also be extended to future generations. The balance of current and future needs should be achieved by determining what would be "reasonable access" through public consultations among experts and citizens.

Les médicaments onéreux et la justice intergénérationnelle

Among all categories of health expenditure in Canada, spending on drugs is the fastest growing. The factors at play in the increase in expenditure on drugs are essentially those related to the volume of use and the arrival of new drugs on the market. Some of these new drugs are very expensive. In fact, the costs of certain drugs threaten the continued existence of the Quebec Prescription Drug Insurance Plan. In Quebec, the Conseil du medicament (Drug Board) is responsible for recommending drugs to the Ministry of Health and Social Services to be put on the formulary of drugs covered by the public plan. In spite of pressure by various stakeholders, we believe that the rationing of drugs that are too expensive can achieve political legitimacy if it is based on a transparent justification that includes not only evidence-based criteria, but also ethical principles and values. For egalitarians, fairness in the supply of health care should be accomplished as a function of health care needs. But this concept of justice should also be extended to future generations. The balance of current and future needs should be achieved by determining what would be reasonable access through public consultations among experts and citizens.