Le r��le de l�����valuation ��conomique dans la pratique des m��decins de famille = The role of economic evaluation in the practice of family physicians

L�����valuation ��conomique en sant�� consiste en l���analyse comparative d���alternatives de services en regard �� la fois de leurs co��ts et de leurs cons��quences. Elle est un outil d���aide �� la d��cision. La grande majorit�� des d��cisions concernant l���allocation des ressources sont prises en clinique; particuli��rement au niveau des soins primaires. Puisque chaque d��cision est associ��e �� un co��t d���opportunit��, la non-prise en compte des consid��rations ��conomiques dans les pratiques des m��decins de famille peut avoir un impact important sur l���efficience du syst��me de sant��. Il existe peu de connaissances quant �� l���influence des ��valuations ��conomiques sur la pratique clinique. L���objet de la th��se est de comprendre le r��le de l�����valuation ��conomique dans la pratique des m��decins de famille. Ses contributions font l���objet de quatre articles originaux (philosophique, th��orique, m��thodologique et empirique). L���article philosophique sugg��re l���importance des questions de complexit�� et de r��flexivit�� en ��valuation ��conomique. La complexit�� est la perspective philosophique, (approche g��n��rale ��pist��mologique) qui sous-tend la th��se. Cette vision du monde met l���attention sur l���explication et la compr��hension et sur les relations et les interactions (causalit�� interactive). Cet accent sur le contexte et le processus de production des donn��es souligne l���importance de la r��flexivit�� dans le processus de recherche. L���article th��orique d��veloppe une conception nouvelle et diff��rente du probl��me de recherche. L���originalit�� de la th��se r��side ��galement dans son approche qui s���appuie sur la perspective de la th��orie sociologique de Pierre Bourdieu; une approche th��orique coh��rente avec la complexit��. Oppos�� aux mod��les individualistes de l���action rationnelle, Bourdieu pr��conise une approche sociologique qui s���inscrit dans la recherche d���une compr��hension plus compl��te et plus complexe des ph��nom��nes sociaux en mettant en lumi��re les influences souvent implicites qui viennent chaque jour exercer des pressions sur les individus et leurs pratiques. L���article m��thodologique pr��sente le protocole d���une ��tude qualitative de cas multiples avec niveaux d���analyse imbriqu��s : les m��decins de famille (niveau micro-individuel) et le champ de la m��decine familiale (niveau macro-structurel). Huit ��tudes de cas furent r��alis��es avec le m��decin de famille comme unit�� principale d���analyse. Pour le niveau micro, la collecte des informations fut r��alis��e �� l���aide d���entrevues de type histoire de vie, de documents et d���observation. Pour le niveau macro, la collecte des informations fut r��alis��e �� l���aide de documents, et d���entrevues de type semi-structur�� aupr��s de huit informateurs cl��s, de neuf organisations m��dicales. L���induction analytique fut utilis��e. L���article empirique pr��sente l���ensemble des r��sultats empiriques de la th��se. Les r��sultats montrent une int��gration croissante de concepts en ��conomie dans le discours officiel des organisations de m��decine familiale. Cependant, au niveau de la pratique, l'��conomisation de ce discours ne semble pas ��tre une repr��sentation fid��le de la r��alit�� puisque la tr��s grande majorit�� des participants n'incarnent pas ce discours. Les contributions incluent une compr��hension approfondie des processus sociaux qui influencent les sch��mes de perception, de pens��e, d���appr��ciation et d���action des m��decins de famille quant au r��le de l�����valuation ��conomique dans la pratique clinique et la volont�� des m��decins de famille �� contribuer �� une allocation efficiente, ��quitable et l��gitime des ressources.

Bioprocess Technology for Antagonistic Pseudomonas MCCB 102, 103,Micrococcus MCCB 104, and Evaluation of Synechocystis MCCB 114, 115 as Probiotics for the Management of Vibrio in Shrimp Culture Systems

National Centre for Aquatic Animal Health, School of Environmental Studies, Cochin University of Science and Technology

An evaluation of Primary health care system in Kerala

The thesis entitled An Evaluation of Primary Health Care System in Kerala. The present study is intended to examine the working of primary health care system and its impact on the health status of people. The hypothesis tested in the thesis includes, a. The changes in the health profile require reallocation of resources of primary health care system, b. Rate of utilization depends on the quality of services provided by primary health centers, and c. There is a significant decline in the operational efficiency of the primary health care system. The major elements of primary health care stated in the report of AlmaAta International Conference on Primary Health Care (WHO, 1994)��� is studied on the basis of the classification of the elements in to three: Preventive, Promotive, and Curative measures. Preventive measures include Maternal and Child Health Care including family Planning. Provision of water and sanitation is reviewed under promotive measures. Curative measures are studied using the disease profile of the study area. Collection of primary data was done through a sample survey, using pre-tested interview schedule of households of the study area. Multi stage random sampling design was used for selecting the sample. The design of the present study is both descriptive and analytical in nature. As far as the analytical tools are concerned, growth index, percentages, ratios, rates, time series analysis, analysis of variance, chi square test, Z test were used for analyzing the data. Present study revealed that no one in these areas was covered under any type of health insurance. Conclusion states that considering the present changes in the health profile, traditional pattern of resource allocation should be altered to meet the urgent health care needs of the people. Preventive and promotive measures like health education for giving awareness among people to change health habits, diet pattern, life style etc. are to be developed. Proper diagnosis and treatment of the disease at the beginning of the stage itself may help to cure majority of disease. For that, Public health policy must ensure the primary health care as enunciated at Alma- Ata international Conference. At the same time Public health is not to be treated as the sole responsibility of the government. Active community participation is an essential means to attain the goals.

Biostatistical evaluation and Management of sciaenid fishery with particular reference to Otolithes ruber (Schneider, 1801) andJohnieops sina (Cuvier, 1830) of Konkan coast

Fish, a natural resource, has received great attention from all over the world. since it provides a cheap protein, employment and income to the millions of people for centuries. So fishermen, industrialist and multinationals are trying to exploit the marine resources to their maximum benefit by using modern craft, advance fishing equipments and efficient gear. Fishery resources in the open system particularly in oceans, were considered to be unlimited. However, recent developments in the innovation of efficient craft and gear using well tested material fitted with modern equipments that have greatly enhanced the mobility of craft, agility of gear and the ability of equipments to locate fishery resources have proved otherwise. Hence as the exploitation increases with more effort entering the fishery, the catch per unit of fishing effort starts to decline due to the limitness of the resources. The heavy fishing pressure in the recent past led to commercial extinction of a number of stocks such as. the North Sea herring, California sardine, Japanese Sardine and Peruvian anchovy (FAO. 1968: Gulland, 1974). In India, seer fish from Palk-Bay declined due to uncontrolled fishing (Devaraj 1983).

Gesti��n de la actividad no presencial y autoevaluaci��n de competencias = Management of student learning outside the classroom and the self-evaluation of competences

La asignatura troncal ���Evaluaci��n Psicol��gica��� de los estudios de Psicolog��a y del estudio de grado ���Desarrollo humano en la sociedad de la informaci��n��� de la Universidad de Girona consta de 12 cr��ditos seg��n la Ley Org��nica de Universidades. Hasta el a��o acad��mico 2004-05 el trabajo no presencial del alumno consist��a en la realizaci��n de una evaluaci��n psicol��gica que se entregaba por escrito a final de curso y de la cual el estudiante obten��a una calificaci��n y revisi��n si se solicitaba. En el camino hacia el Espacio Europeo de Educaci��n Superior, esta asignatura consta de 9 cr��ditos que equivalen a un total de 255 horas de trabajo presencial y no presencial del estudiante. En los a��os acad��micos 2005-06 y 2006-07 se ha creado una gu��a de trabajo para la gesti��n de la actividad no presencial con el objetivo de alcanzar aprendizajes a nivel de aplicaci��n y soluci��n de problemas/pensamiento cr��tico (Bloom, 1975) siguiendo las recomendaciones de la Agencia para la Calidad del Sistema Universitario de Catalu��a (2005). La gu��a incorpora: los objetivos de aprendizaje, los criterios de evaluaci��n, la descripci��n de las actividades, el cronograma semanal de trabajos para todo el curso, la especificaci��n de las tutor��as programadas para la revisi��n de los diversos pasos del proceso de evaluaci��n psicol��gica y el uso del foro para el conocimiento, an��lisis y cr��tica constructiva de las evaluaciones realizadas por los compa��eros

Improvement of strategies for the management of fire blight (Erwinia amylovora). Evaluation and optimization of physical and chemical control methods, and use of decision support systems

El foc bacteri�� ��s una malaltia que afecta a plantes de la fam��lia de la ros��cies, causada pel bacteri Erwinia amylovora. El seu rang d'hostes inclou arbres fruiters, com la perera, la pomera o el codonyer, i plantes ornamentals de gran inter��s comercial i econ��mic. Actualment, la malaltia s'ha dispersat i es troba ��mpliament distribu��da en totes les zones de clima temperat del m��n. A Espanya, on la malaltia no ��s end��mica, el foc bacteri�� es va detectar per primer cop al 1995 al nord del pa��s (Euskadi) i posteriorment, han aparegut varis focus en altres localitzacions, que han estat convenientment eradicats. El control del foc bacteri��, ��s molt poc efectiu en plantes afectades per la malaltia, de manera que es basa en mesures encaminades a evitar la dispersi�� del patogen, i la introducci�� de la malaltia en regions no end��miques. En aquest treball, la termoter��pia ha estat avaluada com a m��tode d'eradicaci�� d'E. amylovora de material vegetal de propagaci�� asimptom��tic. S'ha demostrat que la termoter��pia ��s un m��tode viable d'eradicar E. amylovora de material de propagaci��. Gaireb�� totes les esp��cies i varietats de ros��cies mantingudes en condicions d'humitat sobrevivien 7 hores a 45 ��C i m��s de 3 hores a 50 ��C, mentre que m��s d'1 hora d'exposici�� a 50 ��C amb calor seca produ��a danys en el material vegetal i redu��a la brotaci��. Tractaments de 60 min a 45 ��C o 30 min a 50 ��C van ser suficients per reduir la poblaci�� ep��fita d'E. amylovora a nivells no detectables (5 x 102 ufc g-1 p.f.) en branques de perera. Els derivats dels fosfonats i el benzotiadiazol s��n efectius en el control del foc bacteri�� en perera i pomera, tant en condicions de laboratori, com d'hivernacle i camp. Els inductors de defensa de les plantes redueixen els nivells de malaltia fins al 40-60%. Els intervals de temps m��nims per aconseguir el millor control de la malaltia van ser 5 dies pel fosetil-Al, i 7 dies per l'etefon i el benzotiadiazol, i les dosis ��ptimes pel fosetil-Al i el benzotiadiazol van ser 3.72 g HPO32- L-1 i 150 mg i.a. L-1, respectivament. Es millora l'efic��cia del fosetil-Al i del benzotiadiazol en el control del foc bacteri��, quan es combinen amb els antibi��tics a la meitat de la dosi d'aquests ��ltims. Tot i que l'estrat��gia de barrejar productes ��s m��s pr��ctica i f��cil de dur a terme a camp, que l'estrat��gia de combinar productes, el millor nivell de control de la malaltia s'aconsegueix amb l'estrat��gia de combinar productes. Es va analitzar a nivell histol��gic i ultrastructural l'efecte del benzotiadiazol i dels fosfonats en la interacci�� Erwinia amylovora-perera. Ni el benzotiadiazol, ni el fosetil-Al, ni l'etefon van induir canvis estructurals en els teixits de perera 7 dies despr��s de la seva aplicaci��. No obstant, despr��s de la inoculaci�� d'E. amylovora es va observar en plantes tractades amb fosetil-Al i etefon una desorganitzaci�� estructural cel��lular, mentre que en les plantes tractades amb benzotiadiazol aquestes alteracions tissulars van ser retardades. S'han avaluat dos models (Maryblyt, Cougarblight) en un camp a Espanya afectat per la malaltia, per determinar la precisi�� de les prediccions. Es van utilitzar dos models per elaborar el mapa de risc, el BRS-Powell combinat i el BIS95 modificat. Els resultats van mostrar dos zones amb elevat i baix risc de la malaltia. Maryblyt i Cougarblight s��n dos models de f��cil ��s, tot i que la seva implementaci�� en programes de maneig de la malaltia requereix que siguin avaluats i validats per un per��ode de temps m��s llarg i en ��rees on la malaltia hi estigui present.

Land use for England and Wales: evaluation of management options to support 'good ecological status' in surface freshwaters

This paper analyses historic records of agricultural land use and management for England and Wales from 1931 and 1991 and uses export coefficient modelling to hindcast the impact of these practices on the rates of diffuse nitrogen (N) and phosphorus (P) export to water bodies for each of the major geo-climatic regions of England and Wales. Key trends indicate the importance of animal agriculture as a contributor to the total diffuse agricultural nutrient loading on waters, and the need to bring these sources under control if conditions suitable for sustaining 'Good Ecological Status' under the Water Framework Directive are to be generated. The analysis highlights the importance of measuring changes in nutrient loading in relation to the catchment-specific baseline state for different water bodies. The approach is also used to forecast the likely impact of broad regional scale scenarios on nutrient export to waters and highlights the need to take sensitive land out of production, introduce ceilings on fertilizer use and stocking densities, and controls on agricultural practice in higher risk areas where intensive agriculture is combined with a low intrinsic nutrient retention capacity, although the uncertainties associated with the modelling applied at this scale should be taken into account in the interpretation of model output. The paper advocates the need for a two-tiered approach to nutrient management, combining broad regional policies with targeted management in high risk areas at the catchment and farm scale.

A data collection case study supporting requirements oriented prediction and management in software developments

Consider the statement "this project should cost X and has risk of Y". Such statements are used daily in industry as the basis for making decisions. The work reported here is part of a study aimed at providing a rational and pragmatic basis for such statements. Of particular interest are predictions made in the requirements and early phases of projects. A preliminary model has been constructed using Bayesian Belief Networks and in support of this, a programme to collect and study data during the execution of various software development projects commenced in May 2002. The data collection programme is undertaken under the constraints of a commercial industrial regime of multiple concurrent small to medium scale software development projects. Guided by pragmatism, the work is predicated on the use of data that can be collected readily by project managers; including expert judgements, effort, elapsed times and metrics collected within each project.

Uptake pathways: the potential of Bayesian belief networks to assist the management, monitoring and evaluation of development-orientated research

The effectiveness of development assistance has come under renewed scrutiny in recent years. In an era of growing economic liberalisation, research organisations are increasingly being asked to account for the use of public funds by demonstrating achievements. However, in the natural resources (NR) research field, conventional economic assessment techniques have focused on quantifying the impact achieved rather understanding the process that delivered it. As a result, they provide limited guidance for planners and researchers charged with selecting and implementing future research. In response, ���pathways��� or logic models have attracted increased interest in recent years as a remedy to this shortcoming. However, as commonly applied these suffer from two key limitations in their ability to incorporate risk and assess variance from plan. The paper reports the results of a case study that used a Bayesian belief network approach to address these limitations and outlines its potential value as a tool to assist the planning, monitoring and evaluation of development-orientated research.

Interventions to promote healthy eating habits: evaluation and recommendations

Although in several EU Member States many public interventions have been running for the prevention and/or management of obesity and other nutrition-related health conditions, few have yet been formally evaluated. The multidisciplinary team of the EATWELL project will gather benchmark data on healthy eating interventions in EU Member States and review existing information on the effectiveness of interventions using a three-stage procedure (i) Assessment of the intervention's impact on consumer attitudes, consumer behaviour and diets; (ii) The impact of the change in diets on obesity and health and (iii) The value attached by society to these changes, measured in life years gained, cost savings and quality-adjusted life years. Where evaluations have been inadequate, EATWELL will gather secondary data and analyse them with a multidisciplinary approach incorporating models from the psychology and economics disciplines. Particular attention will be paid to lessons that can be learned from private sector that are transferable to the healthy eating campaigns in the public sector. Through consumer surveys and workshops with other stakeholders, EATWELL will assess the acceptability of the range of potential interventions. Armed with scientific quantitative evaluations of policy interventions and their acceptability to stakeholders, EATWELL expects to recommend more appropriate interventions for Member States and the EU, providing a one-stop guide to methods and measures in interventions evaluation, and outline data collection priorities for the future.

Value management and post-occupancy evaluation: closing the loop

This paper considers the relationship between value management and facilities management. The findings are particularly relevant to large client organisations which procure new buildings on a regular basis. It is argued that the maximum effectiveness of value management can only be achieved if it is used in conjunction with an ongoing commitment to post-occupancy evaluation. SMART value management is seen to provide the means of ensuring that an individual building design is in alignment with the client���s strategic property needs. However, it is also necessary to recognise that an organisation���s strategic property needs will continually be in a state of change. Consequentially, economic and functional under-performance can only be avoided by a regular performance audit of existing property stock in accordance with changing requirements. Such a policy will ensure ongoing competitiveness through organisational learning. While post-occupancy evaluation represents an obvious additional service to be provided by value management consultants, it is vital that the necessary additional skills are acquired. Process management skills and social science research techniques are clearly important. However, there is also a need to improve mechanisms for data manipulation. Success can only be achieved if equal attention is given to issues of process, structure and content.