Are designed landscapes conceived as geometric compositions or abstractions of nature incompatible with sustainable design? Does mimesis result in the only truly sustainable form in the landscape? This paper attempts to answer these questions by drawing on the observations of practitioners and educators in the field as well as investigating a range of built work for sustainable qualities. The built work is categorized according to four approaches to form genesis, geometric composition, abstractions of nature, mimesis, and combinations of the three. It is suggested here that there is no single formal strategy that must be used in order to achieve sustainability.

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Le patient âge fragile est un sujet a haut risque de fracture de hanche. Toutefois, il accede peu a l’organisation aux mesures prevenant la chute et rarement a l’approche diagnostique et therapeutique de l’osteoporose. Cette revue de la litterature porte sur les liens entre le syndrome de fragilite et le risque de fracture de hanche. Elle fut discutee lors d’une reunion d’un groupe de geriatres, d’endocronologues, de rhumatologues et de gynecologistes. Le concept de fragilite permet d’envisager une approche differente du risque de fracture de hanche des sujets âges. Des perspectives de prevention, d’organisation des soins specifiques semblent pertinentes au sein de cette population. Le modele classique, voulant que l’on traite individuellement chaque pathologie, se prete mal a la prise en charge du sujet fragile. L’approche diagnostique de l’osteoporose axee sur la majoration de la densite minerale osseuse (DMO) est necessaire mais probablement insuffisante dans cette population. L’objectif therapeutique ne peut pas se limiter a l’augmentation de la DMO. La prevention de la chute en ameliorant les facteurs determinant du syndrome de fragilite (force, statut nutritionnel, activite physique, cognition) sont des approches therapeutiques qui devraient limiter l’incidence des fractures. Des etudes supplementaires, orientees vers le sujet fragile, permettraient de mieux comprendre les effets de la prise en charge de la fragilite sur la fracture. En parallele, la prise en charge plus systematique de l’osteoporose devrait limiter le risque d’une personne âgee robuste de devenir fragile et d’une personne fragile de devenir dependante.

Fragilité, ostéoporose et fracture du col du fémur: causes, conséquences et perspectives thérapeutiques

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Fragilité, ostéoporose et fracture du col du fémur: causes, conséquences et perspectives thérapeutiques