The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Title from PDF of title page (University of Missouri--Columbia, viewed on November 13, 2009). Thesis advisor: Dr. Glenn Leshner. Includes bibliographical references.

213 f. / Submitted by Ana Valéria de Jesus Moura (anavaleria_131@hotmail.com) on 2013-05-24T15:56:06Z No. of bitstreams: 1 ILDO FUCS.pdf: 1163888 bytes, checksum: 4f73e82234ce039a396d0837150cbb92 (MD5) / Approved for entry into archive by Ana Valéria de Jesus Moura(anavaleria_131@hotmail.com) on 2013-05-24T15:57:24Z (GMT) No. of bitstreams: 1 ILDO FUCS.pdf: 1163888 bytes, checksum: 4f73e82234ce039a396d0837150cbb92 (MD5) / Made available in DSpace on 2013-05-24T15:57:24Z (GMT). No. of bitstreams: 1 ILDO FUCS.pdf: 1163888 bytes, checksum: 4f73e82234ce039a396d0837150cbb92 (MD5) Previous issue date: 2013 / O presente trabalho visa a discutir e analisar a aplicação da prescrição intercorrente no processo administrativo fiscal. Partiu-se de uma hipótese, segundo a qual, uma vez instaurado o contencioso administrativo-fiscal, a permanência da instrução por mais de 05 (cinco) anos, com ou sem impulso oficial, sem a conclusão do seu julgamento, faz ocorrer a prescrição intercorrente da pretensão do ente público em exigir o crédito tributário definitivamente constituído, com a devida extinção da obrigação tributária atribuída ao sujeito passivo. Para a construção de tal tese, foram identificados dois aspectos inerentes ao raciocínio prescritivo, quais sejam, o transcurso do tempo e a omissão do credor em fazer exigir a pretensão reconhecida. Como suporte ao tema desenvolvido, necessário se fez identificar e versar sobre: o tempo do Direito como um tempo finito; o auto de infração/notificação fiscal de lançamento como norma jurídica, individual e concreta, mas, antes de tudo, definitiva; bem como destacar o liame estabelecido entre a prescrição intercorrente e o princípio constitucional da segurança jurídica. Ao final, foram analisados não só os óbices, tanto doutrinários, quanto jurisprudenciais à tese estudada, como, também, as contribuições jurídicas que corroboram a hipótese verificada. / Salvador

A quantum system which evolves in time while interacting with an external environ- ment is said to be an open quantum system (OQS), and the influence of the environment on the unperturbed unitary evolution of the system generally leads to non-unitary dynamics. This kind of open system dynamical evolution has been typically modeled by a Standard Prescription (SP) which assumes that the state of the OQS is initially uncorrelated with the environment state. It is here shown that when a minimal set of physically motivated assumptions are adopted, not only does there exist constraints on the reduced dynamics of an OQS such that this SP does not always accurately describe the possible initial cor- relations existing between the OQS and environment, but such initial correlations, and even entanglement, can be witnessed when observing a particular class of reduced state transformations termed purity extractions are observed. Furthermore, as part of a more fundamental investigation to better understand the minimal set of assumptions required to formulate well defined reduced dynamical quantum maps, it is demonstrated that there exists a one-to-one correspondence between the set of initial reduced states and the set of admissible initial system-environment composite states when G-consistency is enforced. Given the discussions surrounding the requirement of complete positivity and the reliance on the SP, the results presented here may well be found valuable for determining the ba- sic properties of reduced dynamical maps, and when restrictions on the OQS dynamics naturally emerge.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Os Erros de MedicaÃÃo (EM) sÃo um importante desafio a ser superado na promoÃÃo do uso racional de medicamentos, fator contribuinte para o desenvolvimento de serviÃos de saÃde eficazes e seguros para os pacientes. EM podem ocorrer em vÃrias etapas da cadeia de utilizaÃÃo de medicamentos. No Brasil, pouco se conhece sobre o perfil dos erros e sobre a seguranÃa do processo de prescriÃÃo. Baseado na abordagem sistÃmica do erro foi realizado um estudo exploratÃrio, com determinaÃÃo da taxa de prevalÃncia de erros de prescriÃÃo clinicamente significativos (TPEPCS) e da taxa de seguranÃa do processo de prescriÃÃo de medicamentos (TSPPM) nas unidades de Cardiologia, Pneumologia e Pediatria de um hospital de referÃncia do CearÃ. No perÃodo de 20 de agosto a 03 de setembro de 2007, em dias alternados, foram analisadas 140 prescriÃÃes mÃdicas (PM), totalizando 1017 itens contendo medicamentos. A maioria das PM (75% - n=105) foram recebidas pelo serviÃo de farmÃcia no turno da tarde, 61,4% (n=86) pertencia a pacientes do sexo masculino e 22,2% (n=31) pertencia a pacientes com idade de 60 a 69 anos. No prontuÃrio dos pacientes das PM selecionadas, nÃo houve relato de alergia a medicamentos em 83,6% (n=117), nem registro do peso em 60% (n=84). Quanto aos componentes legais da prescriÃÃo, houve ausÃncia do registro do nÃmero do prontuÃrio em 63,3% (n=89), da unidade de internaÃÃo em 59,3% (n=83), do carimbo do prescritor em 28,6% (n=40) e da assinatura do mÃdico em 15% (n=21). Foram identificadas interaÃÃo medicamento-medicamento em 28,6% (n=40) das PM, interaÃÃo medicamento-alimento em 14,3% (n=20) e erros de prescriÃÃo clinicamente significativos (EPCS) em 25,9%, (n=30) sendo o mais recorrente a detecÃÃo de interaÃÃo medicamentosa potencialmente significante (26,61% - n=95). Boa parte dos medicamentos envolvidos nos EPCS (63,3% - n=201) pertenceu a classe terapÃutica de medicamentos cardiovasculares e houve a suspeita de ReaÃÃo Adversa a Medicamentos em apenas 1,8% (n=18) dos medicamentos prescritos. A denominaÃÃo mais utilizada na prescriÃÃo dos medicamentos foi a genÃrica (60,2% - n=612) e a concentraÃÃo nÃo foi prescrita em 56,4% (n=574) dos itens contendo medicamentos. Foi prescrito o diluente em 35,1% (n=65) dos medicamentos classificados como injetÃveis, enquanto nÃo foi prescrita a velocidade de infusÃo em 59,3% (n=121) dos injetÃveis e soluÃÃo para hidrataÃÃo. TambÃm foram prescritas informaÃÃes adicionais em 14,7% (n=150) dos itens contendo medicamentos e utilizadas abreviaturas em 97,6% (n=993) destes, sendo mais comum a abreviatura da via de administraÃÃo (36% - n=833). Ao final, foram calculadas a TPEPCS (35,10%) e TSPPM (64,9%), indicando a necessidade da reavaliaÃÃo do processo de prescriÃÃo e implementaÃÃo das estratÃgias educacionais. Portanto, a identificaÃÃo da taxas referidas constitui o primeiro passo na busca da prevenÃÃo de erros. PorÃm, para que ela possa estabelecer-se no Ãmbito hospitalar, sem propiciar um ambiente de puniÃÃes, faz-se necessÃrio que a responsabilidade pela seguranÃa do paciente seja vista como coletiva e que a abordagem sistÃmica do erro seja aplicada cotidianamente. / Medication errors are a great challenge to the rational use of drugs, which is a significant contributing factor to the development of effective and safe health assistance services to patients. Medication errors can occur at various stages in the drug use process. In Brazil, little is known about the profile of errors and the prescription process safety. In order to determine the prevalence rate of errors in prescribing clinically significant drugs (PREPCS) and the safety rate on prescription drug procedures (SRPDP), an exploratory study based on an approach in systematic error estimation was carried out at Cardiology, Pneumology and Pediatrics Units of a reference hospital in the State of CearÃ. From August 20 to September 3, 2007, on alternate days, 140 medical prescription â totaling 1,017 items containing drugs â were analyzed. Most medical prescriptions (75% - n=105) were received by the department of pharmacy in the afternoon shift; 61.4% (n=86) had been given to male patients and 22.2% (n=31) had been given to patients between 60 to 69 years of age. In 83.6% (n=117) of records of patients to whom the selected medical prescriptions had been given, no allergy to drugs were reported, and in 60% (n=84) of them the patientsâ weight was not informed. In regard to the legal components of the prescriptions, the patient record number was not informed in 63.3% (n=89) prescriptions; the hospital unit was not informed in 59.3% (n=83) prescriptions; the prescriberâs stamp was not stamped in 28.6% (n=40) prescriptions; and 15% (n=21) prescriptions had not been signed by the doctor. Drug-drug interactions were identified in 28.6% (n=40) medical prescriptions; drug-food interactions were identified in 14.3% (n=20) medical prescriptions; and clinically significant prescription errors (CSEP) were found in 25.9% (n=30) medical prescriptions, and the detection of potentially significant drug interactions (26.61% - n=95) was the most recurrent. Most drugs involved in CSEP (63.3% - n=201) belonged to a therapeutic class of cardiovascular medicines and there was suspicion of Adverse Drug Reaction in only 1.8% (n=18) of the prescription drugs. Generic names were most commonly used in the medical prescriptions (60.2% - n=612); and the concentration was not prescribed in 56.4% (n=574) of items containing drugs. The dilluent was prescribed in 35.1% (n=65) of injection drugs, while no infusion speed and hydration solution were prescribed in 59.3% (n=121) of injection drugs. Additional information was prescribed in 14.7% (n=150) of the items containing drugs; and abbreviations were used in 97.6% (n=993) of them, and administration routes were the most common abbreviations used (36% - n =833). And finally, the PREPCS (35.10%) and SRPDP (64.9%) were ascertained, thus indicating the need to reevaluate the process of prescribing and implementing educational strategies. Therefore, the identification of the aforesaid rates is the first step to be taken in order to prevent errors. However, in order to use them at hospitals without creating a punishment environment, the responsibility for the patientâs safety must be collective and an approach in systematic error estimation must be made regularly.

No description available.

Class of 2016 Abstract / Objectives: To identify stakeholder concerns regarding a potential requirement that all prescriptions include the reason for use or indication. Methods: This was a mixed methods study that employed focus groups. Participants were invited by the Chief Executive Officer (CEO) of the Arizona Pharmacy Association (AzPA) to attend focus groups via webinar. E-mail invites were sent to AzPA members and members of Arizona healthcare professional associations with prescriptive authority except for prescribers who care for animals. The discussion began with a PowerPoint presentation and then questions were presented to guide discussion. Afterwards, questionnaires were distributed through e-mail. Interval level data were analyzed using means and standard deviations. The commentary of the focus group discussion was summarized in themes. Results: Preliminary findings, from two focus groups with a total of seven participants, reflected the following concerns with the inclusion of the indication on prescriptions: compromise of patient privacy; technology capabilities; prescriber time; prescriber compliance; and prior authorization complications. The proposed benefits were: enhanced communication; better medication counseling; reduced prescribing errors; decreased controlled substance diversion; and increased accuracy of a prospective drug use review by pharmacists for patients with complicated disease states. Conclusions: In conclusion, stakeholders were concerned with the implementation of including the indication on prescription orders.

Magister Public Health - MPH / Background: South African medical scheme members needlessly purchase high cost originator prescription medicines which attract out of pocket co-payments at pharmacies. This is despite availability of low priced generic medicines that are paid for in full by medical schemes. Co-payments result from misalignment between prices of the dispensed medicine and that of the alternative medicine which appears on the medical scheme's formulary list and for which the scheme is prepared to pay for in full. To establish what factors caused such misalignment, perspectives of medical scheme members and key informants which included pharmacists, regulators and representatives of medical schemes were explored. The study focused on co-payments for prescription medicines dispensed at private sector retail pharmacies in Pretoria, South Africa. Aim: The aim of the study was to explore views about co-payments and identify factors that motivate and influence Pretoria medical scheme members to co-pay when purchasing prescription medicines at pharmacies, despite being insured by medical scheme insurance organizations. Methodology: An exploratory qualitative research study was performed. Semi-structured interviews were conducted among purposefully selected medical scheme members (12) and 9 key informants. Key informants consisted of dispensing pharmacists (6), regulators of health professionals and medical schemes (2) and a senior official (1) with experience in the regulation of medicines and operations within medical scheme organizations. From a total of twelve interviewed medical scheme members, eight were interviewed at preselected retail pharmacies after they had made a co-payment and the other four selected because they did not make a co-payment. To ensure diversity in views about co-payments and related factors, dispensing pharmacists, co-paying and non co-paying medical scheme members were accessed from six pharmacies that are located in two separate locations of different socioeconomic status in Pretoria, that is, the Pretoria East suburban area and Pretoria city centre which is close to Pretoria central station and taxi routes. Three pharmacies were identified from each of the two different geographical locations, one independent and two corporate pharmacies per socioeconomic area. One pharmacist was interviewed from each of the selected pharmacies and medical scheme members were accessed from across the six pharmacies. The remainder of the key informants such as the regulators, were interviewed during office hours at venues of their choice which included areas of work. A pilot study was conducted among medical scheme members and pharmacists to test the applicability of interview tools. All interviews were conducted face-to-face by the researcher and recorded. The electronic record was independently compared with the researcher's enhanced notes for data accuracy. Codes identified during data analysis were derived from the interview notes and recordings and translated into organized text for theme development in a manner that referenced them to each study objective. Themes were arrived at after combining similar codes which were noted as representing a particular description for use during data interpretation and report writing. Ethics: Ethical clearance was sought from the UWC Senate Research Committee and granted. Prior to conducting interviews, written consent was obtained from all participants. Research details were explained and also provided on the participant information sheet wherein voluntary participation was emphasized. Anonymity and confidentiality was maintained throughout. Results: All patients and pharmacists expressed confusion about the medical scheme rules and related co-payments. There were differing co-payment perspectives among scheme members depending on socioeconomic status, with affordability being a key factor among those of lower socio-economic status whilst convenience and lack of comprehensible information about co-payments was prioritised amongst those members of higher socioeconomic status. Key influences on patient's purchasing decisions were health professionals (both doctors and pharmacists), with friends, family members and advertisements less influential. Patients and medical schemes generally preferred to utilise large chain pharmacies and patients, in particular, had a poor perception of the quality of generics. In general, the first prescribed medicine was highly favoured by patients and this influenced medicine preferences during subsequent prescriptions, especially for non communicable disease (NCD) medicines. Pharmacists did not apply the generic substitution policy in a manner that benefited the consumer because the lowest priced generic was frequently not kept as pharmacy stock. Co-payments appeared to create a divide between corporate and independent pharmacies. Some regulators tended to blame patients, pharmacists and medical schemes rather than the lack of adequate enforcement of national policies and regulations. Inadequate monitoring and enforcement of pro-consumer policies were found to be the main factors that contributed to co-payments. Conclusions and Recommendations: The introduction of regulations on minimum requirements for stock available at private sector retail pharmacies should be considered to ensure availability of the lowest priced generic at all times. This would ensure that co-payments are reduced and the desired consumer benefits that should accrue from the existing generic substitution policy are realized and maximized. To prevent perception-based and self-initiated co-payment behavior among consumers, vigorous and continued education about the value and equivalence of generics should be championed at the highest level of government with the execution of this critical responsibility not left to those with profit driven motives. Consumers might benefit from extensive education about the purchasing choices made at pharmacies and, in particular, the negative financial consequences associated with choosing a preferred but highly priced originator versus a low cost generic medicine which is used to treat the same ailment. Enforcement of policies by dedicated government agencies could further protect consumers from preventable high cost of healthcare and of medicines in particular.

Class of 2011 Abstract / OBJECTIVES: Accidental ingestions of medications in children under five years old are an increasing problem faced by parents and caregivers. This study will determine which medications are most commonly ingested and which cause more harmful side effects. METHODS: A descriptive, retrospective study was performed by obtaining data from electronic patient charts from the Arizona Poison and Drug Information Center (APDIC). Subjects were selected if they were younger than five years old and had ingested a medication during 2009. Age and gender were analyzed by calculating percentages and means and comparing them using an independent t-test. Adverse effects of medications were compared using a Chi Square test. RESULTS: A total of 4,373 cases met inclusion criteria for analysis, including 2,019 females and 2,354 males. The average age of patients was 2.2 years. Of 3,275 cases (74.4%) involving OTC medications, 119 patients (3.6%) developed minor effects and 20 patients (0.6%) developed moderate effects. Of 1,129 children (25.6%) ingesting prescription medications, 78 patients (6.9%) developed minor effects, 35 patients (3.1%) developed moderate effects and 1 patient (0.1%) developed a major effect (p=0.003). CONCLUSION: Males were more likely to have unintentional ingestions than females. The incidence of OTC ingestions was higher than prescription ingestions. Toddlers tended to have more ingestions than infants or older children. Unintentional prescription medication ingestions resulted in significantly more adverse effects than unintentional OTC ingestions.

Pharmacists as members of health care teams, have a central role to play with respect to medication. The pharmaceutical care and cognitive services which pharmacists are able to provide can help prevent, ameliorate or correct medication-related problems. There are however many barriers to the provision of these services and one of the barriers commonly cited by pharmacists is the lack of remuneration for their expert services. The aim of this study is to ascertain if patients in South Africa are willing to pay for pharmacist-provided services which may reduce medication related problems, and thereby determine the perceived value of the pharmacist-provided services, by patients. The study will also seek to determine factors that influence willingness to pay (WTP), including financial status, gender, race, age and level of education. In addition the perceived value of the pharmacist‘s role in patient care, by third party payers (SA Medical Aid providers) and their WTP for pharmacist-provided services (such as DSM) on behalf of patients through their monthly premiums will also be investigated. The study was conducted as a two-phase process: the first phase focused on the opinions of patients and the second phase on the medical aid companies. In phase-1 a convenience sample of 500 patients was recruited by fifty community pharmacies distributed throughout the nine South African provinces. Data collection, consisting of telephonic administration of the questionnaires, was conducted and the survey responses were captured on a Microsoft Excel® spreadsheet. All the captured information was analyzed using descriptive statistics, box and whisker plots, analysis of variance (ANOVA) and regression analysis. In phase-2, medical aid schemes that are registered with the Council of Medical Schemes (CMSs) of South Africa were included in this research. A fifteen point questionnaire was completed electronically via e-mail by willing medical aid participants. Data was analyzed using descriptive statistics only. Only 233 or 88.6 percent, of the 263 participating respondents, were willing to pay at least one rand towards pharmacist-provided services. On average respondents were willing to pay R126.76 as out-of-pocket expenses. Respondents‘ WTP increased as the risk associated with medication-related problems was reduced due to pharmaceutical care intervention. Of the 263 respondents who took part in this research, fifty percent were willing to pay at least R100 for a risk reduction of 30 percent, R120 for a 60 percent reduction and approximately R150 for a greater than 90 percent risk reduction. It was also found that the respondents‘ willingness to pay was influenced by their age, earnings, racial grouping, employment status, medical aid status and their level of satisfaction with pharmacist-provided care services. Of the thirty-one open medical aid schemes only eight (25.8 percent) participated in the study. Findings indicate that all the participating medical aid respondents were unwilling to pay for pharmacist-provided care services, although they perceived pharmacists as very influential healthcare providers and as having a significant role to play in reducing medication-related problems. In conclusion it was found that majority of participants were willing to pay for pharmacist-provided services directed towards reducing risks associated with medication-related problems. Until pharmacists are able to prove pharmaceutical care‘s utility and cost-effectiveness to third-party payers, pharmacists must look to the patient for reimbursement.

Acquisitive prescription in Roman law and its reflection in modern private law codes Abstract Acquisitive prescription is a legal institute, which function is to reconcile state of fact with state of law. This institute served especially to acquire ownership for possessor of the thing by lapse of prescribed time, but it should also serve to acquire other laws, such as servitudes. This thesis focuses mainly on Roman law form of acquisitive prescription. In order to properly understand the concept it is essential to percept it in relation to a unique conception of Roman property law including all its specifics and differences from current view on ownership. First part of the thesis is dedicated to Roman ownership concept and its basic characteristics. Subsequent part describes the development through which the acquisitive prescription in Roman law proceeded during its existence. The thesis focuses on particular institutes such as usus auctoritas, usucapio, praescriptio longi temporis and praescriptio longissimi temporis. Firstly a form of acquisitive prescription in ancient and pre-classical era is investigated. The subject of interest here is the term of auctoritas. The next part of the thesis is focused on classical form of acquisitive prescription, where this type of acquisition was termed as usucapio. The...