L'impact du nouveau financement hospitalier sur les hôpitaux publics : exemple de l'Hôpital du Valais

L'objectif de ce mémoire est d'évaluer les conséquences du nouveau financement hospitalier de la LAMaI sur les hôpitaux publics et plus particulièrement sur l'Hôpital du Valais. Les nouvelles dispositions votées le 21 décembre 2007 par le Parlement ont pour but d'accroître la concurrence entre les hôpitaux et de mettre sur un pied d'égalité les établissements privés et publics. Ce document traite des principales modifications législatives et de leur entrée en vigueur, des nouveautés concernant le calcul des coûts et des tarifs à la charge de l'assurance obligatoire des soins avec l'inclusion des investissements et la nouvelle défmition des frais de formation, de l'introduction des forfaits par pathologie SwissDRG, des problématiques de l'ouverture des frontières cantonales et de la concurrence. Selon les hypothèses retenues, des effets peu importants sont à prévoir en Valais pour l'ouverture des frontières, la liste hospitalière et la répartition du tarif entre assureurs et cantons. Par contre on estime que la prise en compte des investissements augmentera les coûts de l'Hôpital du Valais de 5 à 13% alors les activités d'intérêt général se chiffrent entre 4 et 22 Mio. Les conséquences de l'introduction de la concurrence voulue par le législateur sont plus difficiles à évaluer, car elles dépendent de paramètres encore inconnus tels que le gain espéré et le comportement des parties. Une concurrence par les prix prétéritera les hôpitaux publics si leurs spécificités, telles que les urgences, les soins intensifs et l'obligation d'admission, ne sont pas prises en compte dans la structure tarifaire, le prix ou la planification. Le changement de comportement du patient, des assureurs, des médecins traitants voire des cantons ou des médias constitue également une inconnue qui pourrait avoir de fortes conséquences et contraindre les hôpitaux publics à développer leurs concepts de marketing et de communication. [Auteur, p. 2]

Who Is the Shrew? : Irony as deconstruction in The Taming of the Shrew

In this thesis William Shakespeare’s comedy The Taming of The Shrew is analyzed from a feminist perspective. It is argued that the female characters Katherina and Bianca are mainly constructed through language expressed by male characters as binary oppositions. By an act of deconstruction within the play, these images, or constructed representations, are adjusted and somewhat reversed in the end. In addition, it is shown how the Induction, an introductory part of the play, adds aspects of construction and deconstruction, which supports an ironic reading and a questioning of the constructed gender roles.

Studies on Some North American Shrew Cestodes

In spite of the importance of the various species of shrews to the biotic community, several aspects of their ecology remain very incompletely known. The helminths parasitic in the more conspicuous small mammals in North America have been studied more or less completely, but those occurring in shrews have been largely disregarded. This situation is particularly inappropriate when one considers that shrews often constitute the most abundant mammalian group in a given area. We have attempted to secure an adequate amount of shrew helminth material for study, and it is the purpose of this paper to present observations resulting from this work.

Phylogeographic Structure and Karyotypic Diversity of the Brazilian Shrew Mouse (Blarinomys breviceps, Sigmodontinae) in the Atlantic Forest

Blarinomys breviceps possesses cryptic and burrowing habits with poorly documented genetics and life history traits. Due to its rarity, only a few specimens and DNA sequences have been deposited in collections worldwide. Here, we present the most comprehensive cytogenetic and molecular characterization of this rare genus. Phylogenetic analyses based on partial cytochrome b sequences were performed, attempting to establish the relationships among individuals with distinct karyotypes along the geographic distribution of the genus in the Atlantic Forest. Classical and molecular cytogenetics, using banding patterns and FISH of telomeric and whole chromosome X-specific painting probes (obtained from the Akodontini Akodon cursor) were used to characterize and compare the chromosomal complements. Molecular phylogenetic analyses recovered 2 main geographically structured clades, northeastern and southeastern with pair-wise sequence divergences among specimens varying between 4.9 and 8.4%. Eight distinct karyomorphs are described: (A) 2n = 52 (50A, XX), (B) 2n = 52 (48A, XY+2Bs), (C) 2n = 45 (42A, XY+1B), (D) 2n = 43 (37A, XX+4Bs), (E) 2n = 37 (34A, XY+1B), (F) 2n = 34 (32A, XX), (G) 2n = 31 (27A, XX+2Bs), (H) 2n = 28 (26A, XY), all with the same number of autosomal arms (FNA = 50). Variation of 0-4 supernumerary chromosomes (Bs) presenting heterogeneity in morphology and distribution of interstitial telomeric sequences (ITSs) is reported. ITSs are also found in some metacentric autosomes. The phylogeographic separation between 2 major lineages with high levels of genetic divergence, and the wide karyotypic diversity indicate that B. breviceps is a diverse group that warrants taxonomic re-evaluation. Copyright (C) 2012 S. Karger AG, Basel