Co-evolution of Policy Sectors: Health Care and Public Health in five Countries

Cette thèse analyse la co-évolution de deux secteurs dans la politique de la santé: santé publique (public health) et soins aux malades (health care). En d'autres termes, la relation entre les dimensions curative et préventive de la politique de la santé et leur développement dans la durée. Une telle recherche est nécessaire car les problèmes de la santé sont complexes et ont besoin de solutions coordonnées. De plus, les dépenses de la santé ont augmenté sans arrt durant les dernières décennies. Un moyen de réduire une future augmentation des dépenses pourrait consister en davantage d'investissement dans des mesures préventives. En relation avec cette idée, ma recherche analyse les politiques de la santé publique et les soins aux malades de cinq pays: Allemagne, Angleterre, Australie, Etats-Unis et Suisse. En m'appuyant sur la littérature secondaire, des statistiques descriptives et des entretiens avec des experts et des politiciens, j'analyse la relation entre les deux secteurs depuis la fin du dix-neuvième siècle. En particulier, je me focalise sur la relation des deux champs sur trois niveaux: institutions, acteurs et politiques. Mes résultats montrent les similitudes et les différences d'évolution entre les cinq pays. D'un c^oté, lorsque la profession médicale est politiquement active et que le pays consiste en une fédération centralisée ou en un gouvernement unitaire, les deux secteurs sont intégrés au niveau institutionnel, ralliant les professions et groupes d'intérêt des deux secteurs la cause commune dans une activité politique. Par contre, dans tous les pays, les deux secteurs ont co-évolué vers une complémentarité malgré de la politisation des professions et la centralisation du gouvernement. Ces résultats sont intéressants pour la science politique en général car ils soulignent l'importance des professions pour le développement institutionnel et proposent un cadre pour l'analyse de la co-évolution des politiques publiques en général. -- This Ph.D. thesis analyzes the co-evolution of the health care and the public health sectors. In other words, the relation between preventive and curative health policy and its evolution over time. Such research is necessary, because current health problems are complex and might need coordinated solutions. What is more, health expenditures have increased continuously in the last decades. One way to slow down further increase in health spending could be to invest more in preventative health policies. Therefore, I am connecting individual health care and public health into a common analysis, taking Australia, Germany, Switzerland, the UK and the U.S. as examples. Based on secondary literature, descriptive statistics and interviews with experts and policymakers, I am analyzing how the two sectors' relations co-evolved between the late nineteenth and the early twenty-first century. Specifically, I am researching how health care and public health were related on the levels of institutions, actors and policies. My results show that there are differences and similarities in the co-evolution of policy sectors between these countries. On the one hand, when the medical profession was politically active and the country a centralized federation or a unitary state, there was institutional integration and common political advocacy of the sectors' interest groups and professions. On the other hand, in all countries, both sectors co-evolved towards complementarity, irrespectively of the politicization of professions and centralization of government. These findings are interesting for the political science literature at large, because they underline the importance of professions for institutional development and propose an analytical framework for analyzing the co-evolution of policy sectors in general.

The Role of the Subjectivist Position in the Probabilization of Forensic Science

This paper is concerned with the contribution of forensic science to the legal process by helping reduce uncertainty. Although it is now widely accepted that uncertainty should be handled by probability because it is a safeguard against incoherent proceedings, there remain diverging and conflicting views on how probability ought to be interpreted. This is exemplified by the proposals in scientific literature that call for procedures of probability computation that are referred to as "objective," suggesting that scientists ought to use them in their reporting to recipients of expert information. I find such proposals objectionable. They need to be viewed cautiously, essentially because ensuing probabilistic statements can be perceived as making forensic science prescriptive. A motivating example from the context of forensic DNA analysis will be chosen to illustrate this. As a main point, it shall be argued that such constraining suggestions can be avoided by interpreting probability as a measure of personal belief, that is, subjective probability. Invoking references to foundational literature from mathematical statistics and philosophy of science, the discussion will explore the consequences of this interdisciplinary viewpoint for the practice of forensic expert reporting. It will be emphasized that-as an operational interpretation of probability-the subjectivist perspective enables forensic science to add value to the legal process, in particular by avoiding inferential impasses to which other interpretations of probability may lead. Moreover, understanding probability from a subjective perspective can encourage participants in the legal process to take on more responsibility in matters regarding the coherent handling of uncertainty. This would assure more balanced interactions at the interface between science and the law. This, in turn, provides support for ongoing developments that can be called the "probabilization" of forensic science.

Wage inequality and economic growth in Mexican regions

Only a few studies have analysed the relationship between intraregional inequality and growth, although several studies have measured inequality at the regional level. The objective of this paper is to analyse the relationship between income (wage) inequality and economic growth in different regions of Mexico. We also try to identify factors that explain the variation of intra-regional inequality across Mexican regions and over time. Using macroeconomic databases and publicly available microdata, we apply techniques used in the fields of statistics and econometrics to obtain robust evidence on the relationship between growth and inequality. Our aim is to provide policy recommendations to support the design and implementation of growth-promoting measures thatavoid the exclusion of certain social groups. This paper provides reasons to use a spatial approach and an analysis of particular regions to avoid «one size fits all» policy recommendations.

Clinical and biochemical responses after Gamma Knife surgery for a dopamine-secreting paraganglioma: case report.

The efficacy of Gamma Knife surgery (GKS) in local tumor control of non-secreting paragangliomas (PGLs) has been fully described by previous studies. However, with regard to secreting PGL, only one previous case report exists advocating its efficacy at a biological level. The aims of this study were: 1) to evaluate the safety/efficacy of GKS in a dopamine-secreting PGL; 2) to investigate whether the biological concentrations of free methoxytyramine could be used as a marker of treatment efficacy during the follow-up. We describe the case of a 62-year-old man diagnosed with left PGL. He initially underwent complete surgical excision. Thirty months after, he developed recurrent biological and neuroradiological disease; the most sensitive biomarker for monitoring the disease, concentration of plasma free methoxytyramine, started to increase. GKS was performed at a maximal marginal dose of 16 Gy. During the following 30 months, concentration of free methoxytyramine gradually decreased from 0.14 nmol/l (2*URL) before GKS to 0.09 nmol/l, 6 months after GKS and 0.07 nmol/l at the last follow-up after GKS (1.1*URL), confirming the efficacy of the treatment. Additionally, at 30 months there was approximately 36.6% shrinkage from the initial target volume. The GKS treatment was safe and effective, this being confirmed clinically, neuroradiologically and biologically. The case illustrates the importance of laboratory tests taking into account methoxytyramine when analyzing biological samples to assess the biochemical activity of a PGL. In addition, the identification of methoxytyramine as a unique positive biomarker could designate it for the monitoring of tumor relapse after treatments, including Gamma Knife surgery.

Numerical Investigation of Flow Past a Circular Cylinder and in a Staggered Tube Bundle Using Various Turbulence Models

Transitional flow past a three-dimensional circular cylinder is a widely studied phenomenon since this problem is of interest with respect to many technical applications. In the present work, the numerical simulation of flow past a circular cylinder, performed by using a commercial CFD code (ANSYS Fluent 12.1) with large eddy simulation (LES) and RANS (κ - ε and Shear-Stress Transport (SST) κ - ω! model) approaches. The turbulent flow for ReD = 1000 & 3900 is simulated to investigate the force coefficient, Strouhal number, flow separation angle, pressure distribution on cylinder and the complex three dimensional vortex shedding of the cylinder wake region. The numerical results extracted from these simulations have good agreement with the experimental data (Zdravkovich, 1997). Moreover, grid refinement and time-step influence have been examined. Numerical calculations of turbulent cross-flow in a staggered tube bundle continues to attract interest due to its importance in the engineering application as well as the fact that this complex flow represents a challenging problem for CFD. In the present work a time dependent simulation using κ – ε, κ - ω! and SST models are performed in two dimensional for a subcritical flow through a staggered tube bundle. The predicted turbulence statistics (mean and r.m.s velocities) have good agreement with the experimental data (S. Balabani, 1996). Turbulent quantities such as turbulent kinetic energy and dissipation rate are predicted using RANS models and compared with each other. The sensitivity of grid and time-step size have been analyzed. Model constants sensitivity study have been carried out by adopting κ – ε model. It has been observed that model constants are very sensitive to turbulence statistics and turbulent quantities.

Terrain forms and spatial variability of soil properties in an area cultivatedwith citrus

The technique of precision agriculture and soil-landscape allows delimiting areas for localized management, allowing a localized application of agricultural inputs and thereby may contribute to preservation of natural resources. Therefore, the objective of this work was to characterize the spatial variability of chemical properties and clay content in the context of soil-landscape relationship in a Latosol (Oxisol) under cultivation of citrus. Soil samples were collected at a depth of 0.0-0.2 m in an area of 83.5 ha planted with citrus, as a 50-m intervals grid, with 129 points in concave terrain and 206 points in flat terrain, totaling 335 points. Values for the variables that express the chemical characteristics and clay content of soil properties were analyzed with descriptive statistics and geostatistical modeling of semivariograms for making maps of kriging. The values of range and kriging maps indicated higher variability in the shape of concave topography (top segment) compared with the shape of flat topography (slope and hillside segments below). The identification of different forms of terrain proved to be efficient in understanding the spatial variability of chemical properties and clay content of soil under cultivation of citrus.

Fragment size of corn silage according to the dry matter and forage harvester adjustments

In Brazil, the best results in milk production are found in the state of Paraná. Such results are reached through genetic selection of the animals and management of their diets, in which whole plant corn silage is widely used. Aiming the silage quality, it was evaluated the influence of dry matter content of the corn culture as forage and the harvester adjustments on the fragment size of whole plant corn silage. The fragment size of two corn hybrids silage (SPEED and 2B688) was evaluated using a 5x3 factorial, with 4 repetitions. The first factor was the harvest time of the plants (105, 108, 112, 118, and 123 days after sowing (DAS)), which determines the forage dry matter (DM) content. The second factor was the harvester adjustments (2, 6.5 and 11mm of theoretical fragment length (TFL)). The DM content did not affect the average fragment size of 2B688. For SPEED, however, the real fragment size decreased as the maturation of plants increased. The conclusion is that the DM content and harvester adjustments can affect the real fragment sizes, according to different plant genotypes. The alterations of the harvester adjustments resulted in different fragment sizes, however, it were different from those indicated by the manufacturer.

Applications of Industrial Statistics

This dissertation examines knowledge and industrial knowledge creation processes. It looks at the way knowledge is created in industrial processes based on data, which is transformed into information and finally into knowledge. In the context of this dissertation the main tool for industrial knowledge creation are different statistical methods. This dissertation strives to define industrial statistics. This is done using an expert opinion survey, which was sent to a number of industrial statisticians. The survey was conducted to create a definition for this field of applied statistics and to demonstrate the wide applicability of statistical methods to industrial problems. In this part of the dissertation, traditional methods of industrial statistics are introduced. As industrial statistics are the main tool for knowledge creation, the basics of statistical decision making and statistical modeling are also included. The widely known Data Information Knowledge Wisdom (DIKW) hierarchy serves as a theoretical background for this dissertation. The way that data is transformed into information, information into knowledge and knowledge finally into wisdom is used as a theoretical frame of reference. Some scholars have, however, criticized the DIKW model. Based on these different perceptions of the knowledge creation process, a new knowledge creation process, based on statistical methods is proposed. In the context of this dissertation, the data is a source of knowledge in industrial processes. Because of this, the mathematical categorization of data into continuous and discrete types is explained. Different methods for gathering data from processes are clarified as well. There are two methods for data gathering in this dissertation: survey methods and measurements. The enclosed publications provide an example of the wide applicability of statistical methods in industry. In these publications data is gathered using surveys and measurements. Enclosed publications have been chosen so that in each publication, different statistical methods are employed in analyzing of data. There are some similarities between the analysis methods used in the publications, but mainly different methods are used. Based on this dissertation the use of statistical methods for industrial knowledge creation is strongly recommended. With statistical methods it is possible to handle large datasets and different types of statistical analysis results can easily be transformed into knowledge.

The P48T germline mutation and polymorphism in the CDKN2A gene of patients with melanoma

CDKN2A has been implicated as a melanoma susceptibility gene in some kindreds with a family history of this disease. Mutations in CDKN2A may produce an imbalance between functional p16ink4a and cyclin D causing abnormal cell growth. We searched for germline mutations in this gene in 22 patients with clinical criteria of hereditary cancer (early onset, presence of multiple primary melanoma or 1 or more first- or second-degree relatives affected) by secondary structural content prediction, a mutation scanning method that relies on the propensity for single-strand DNA to take on a three-dimensional structure that is highly sequence dependent, and sequencing the samples with alterations in the electrophoretic mobility. The prevalence of CDKN2A mutation in our study was 4.5% (1/22) and there was a correlation between family history and probability of mutation detection. We found the P48T mutation in 1 patient with 2 melanoma-affected relatives. The patient descends from Italian families and this mutation has been reported previously only in Italian families in two independent studies. This leads us to suggest the presence of a mutational "hotspot" within this gene or a founder mutation. We also detected a high prevalence (59.1%) of polymorphisms, mainly alleles 500 C/G (7/31.8%) or 540 C/T (6/27.3%), in the 3' untranslated region of exon 3. This result reinforces the idea that these rare polymorphic alleles have been significantly associated with the risk of developing melanoma.

Characterization and analysis of the outcome of adults with acute myeloid leukemia treated in a Brazilian University hospital over three decades

We evaluated the outcome of 227 patients with acute myeloid leukemia during three decades (period 1 - 1980’s, N = 89; period 2 - 1990’s, N = 73; period 3 - 2000’s, N = 65) at a single institution. Major differences between the three groups included a higher median age, rates of multilineage dysplasia and co-morbidities, and a lower rate of clinical manifestations of advanced leukemia in recent years. The proportion of patients who received induction remission chemotherapy was 66, 75, and 85% for periods 1, 2, and 3, respectively (P = 0.04). The median survival was 40, 77, and 112 days, and the 5-year overall survival was 7, 13, and 22%, respectively (P = 0.01). The median disease-free survival was 266, 278, and 386 days (P = 0.049). Survival expectation for patients with acute myeloid leukemia has substantially improved during this 30-year period, due to a combination of lower tumor burden and a more efficient use of chemotherapy and supportive care.

Improving Cost-Efficiency and Reducing Environmental Impacts of Intermodal Transportation with Dry Port Concept – Major Rail Transport Corridor in Baltic Sea Region

Transportation plays a major role in the gross domestic product of various nations. There are, however, many obstacles hindering the transportation sector. Cost-efficiency along with proper delivery times, high frequency and reliability are not a straightforward task. Furthermore, environmental friendliness has increased the importance of the whole transportation sector. This development will change roles inside the transportation sector. Even now, but especially in the future, decisions regarding the transportation sector will be partly based on emission levels and other externalities originating from transportation in addition to pure transportation costs. There are different factors, which could have an impact on the transportation sector. IMO’s sulphur regulation is estimated to increase the costs of short sea shipping in the Baltic Sea. Price development of energy could change the roles of different transport modes. Higher awareness of the environmental impacts originating from transportation could also have an impact on the price level of more polluting transport modes. According to earlier research, increased inland transportation, modal shift and slowsteaming can be possible results of these changes in the transportation sector. Possible changes in the transportation sector and ways to settle potential obstacles are studied in this dissertation. Furthermore, means to improve cost-efficiency and to decrease environmental impacts originating from transportation are researched. Hypothetical Finnish dry port network and Rail Baltica transport corridor are studied in this dissertation. Benefits and disadvantages are studied with different methodologies. These include gravitational models, which were optimized with linear integer programming, discrete-event and system dynamics simulation, an interview study and a case study. Geographical focus is on the Baltic Sea Region, but the results can be adapted to other geographical locations with discretion. Results indicate that the dry port concept has benefits, but optimization regarding the location and the amount of dry ports plays an important role. In addition, the utilization of dry ports for freight transportation should be carefully operated, since only a certain amount of total freight volume can be cost-efficiently transported through dry ports. If dry ports are created and located without proper planning, they could actually increase transportation costs and delivery times of the whole transportation system. With an optimized dry port network, transportation costs can be lowered in Finland with three to five dry ports. Environmental impacts can be lowered with up to nine dry ports. If more dry ports are added to the system, the benefits become very minor, i.e. payback time of investments becomes extremely long. Furthermore, dry port network could support major transport corridors such as Rail Baltica. Based on an analysis of statistics and interview study, there could be enough freight volume available for Rail Baltica, especially, if North-West Russia is part of the Northern end of the corridor. Transit traffic to and from Russia (especially through the Baltic States) plays a large role. It could be possible to increase transit traffic through Finland by connecting the potential Finnish dry port network and the studied transport corridor. Additionally, sulphur emission regulation is assumed to increase the attractiveness of Rail Baltica in the year 2015. Part of the transit traffic could be rerouted along Rail Baltica instead of the Baltic Sea, since the price level of sea transport could increase due to the sulphur regulation. Both, the hypothetical Finnish dry port network and Rail Baltica transport corridor could benefit each other. The dry port network could gain more market share from Russia, but also from Central Europe, which is the other end of Rail Baltica. In addition, further Eastern countries could also be connected to achieve higher potential freight volume by rail.

Sensory profile and drivers of liking for grape nectar among smoker and nonsmoker consumers

Decreased gustatory and olfactory capacity is one of the problems caused by tobacco use. The objectives of this study were to determine the sensory profile of six grape nectar samples sweetened with different sweeteners and to verify the drivers of liking in two distinct consumer groups: smokers and nonsmokers. The sensory profile was constructed by twelve trained panelists using quantitative descriptive analysis (QDA). Consumer tests were performed with 112 smokers and 112 nonsmokers. Partial least squares regression analyses was used to identify the drivers of acceptance and rejection of the grape nectars among the two consumer groups. According to the QDA, the samples differed regarding six of the nineteen attributes generated. The absolute averages of the affective test were lower in the group of smokers; possibly because smoking influences acceptance and eating preferences, especially with regard to sweet foods. The results showed that the grape flavor was the major driver of preference for acceptance of the nectar, while astringency, wine aroma, bitterness and sweetness, and bitter aftertaste were drivers of rejection in the two groups of consumers, with some differences between the groups.

Finding Methods for Recognizing and Classifying Spare Part Criticality – Case Full Deposit Stripping Machines

The aim of this Master’s thesis is to find a method for classifying spare part criticality in the case company. Several approaches exist for criticality classification of spare parts. The practical problem in this thesis is the lack of a generic analysis method for classifying spare parts of proprietary equipment of the case company. In order to find a classification method, a literature review of various analysis methods is required. The requirements of the case company also have to be recognized. This is achieved by consulting professionals in the company. The literature review states that the analytic hierarchy process (AHP) combined with decision tree models is a common method for classifying spare parts in academic literature. Most of the literature discusses spare part criticality in stock holding perspective. This is relevant perspective also for a customer orientated original equipment manufacturer (OEM), as the case company. A decision tree model is developed for classifying spare parts. The decision tree classifies spare parts into five criticality classes according to five criteria. The criteria are: safety risk, availability risk, functional criticality, predictability of failure and probability of failure. The criticality classes describe the level of criticality from non-critical to highly critical. The method is verified for classifying spare parts of a full deposit stripping machine. The classification can be utilized as a generic model for recognizing critical spare parts of other similar equipment, according to which spare part recommendations can be created. Purchase price of an item and equipment criticality were found to have no effect on spare part criticality in this context. Decision tree is recognized as the most suitable method for classifying spare part criticality in the company.

Cooperative learning and elaborative interrogation: effects on children's learning

This experimental study examined the effects of cooperative learning and a question-answering strategy called elaborative interrogation ("Why is this fact true?") on the learning of factual information about familiar animals. Retention gains were compared across four study conditions: elaborative-interrogation-plus-cooperative learning, cooperative-learning, elaborative-interrogation, and reading-control. Sixth-grade students (n=68) were randomly assigned to the four conditions. All participants were given initial training and practice in cooperative learning procedures via three 45-minute sessions. After studying 36 facts about six animals, students' retention gains were measured via immediate free recall, immediate matched association, 30-day, and GO-day matched association tests. A priori comparisons were made to analyze the data. For immediate free recall and immediate matched association, significant differences were found between students in the three experimental conditions versus those in the control condition. Elaborative-interrogation and elaborativeinterrogation- plus-cooperative-learning also promoted longterm retention (measured via 30-day matched association) of the material relative to repetitive reading with elaborative-interrogation promoting the most durable gains (measured via GO-day matched association). The relationship between the types of elaborative responses and probability of subsequent retention was also examined. Even when students were unable to provide adequate answers to the why questions, learning was facilitated more so than repetitive reading. In general, generation of adequate elaborations was associated with greater probability of recall than was provision of inadequate answers. The findings of the study demonstrate that cooperative learning and the use of elaborative interrogation, both individually and collaboratively, are effective classroom procedures for facilitating children's learning of new information.

Adult Learning in the Transformational Environments of the Digital Revolution: Connecting Theory and Practice

The purpose of this study was to investigate the learning preferences and the post-secondary educational experiences of a group of Net-Gen adult learners, aged between 18 and 35, currently working in the knowledge economy workplace, and their assessment of how adequately they were prepared to meet the requirements of the knowledge economy workplace. This study utilized an explanatory mixed-method research design. Participants completed a questionnaire providing information on their self-reported learning style preferences, their use of digital tools for formal and informal learning, their use of digital technologies in postsecondary educational experiences, and their use of digital technologies in their workplace. Four volunteers from the questionnaire respondents were selected to participate in interviews based on the diversity of their experiences in higher education, including digital environments, and the diversity of their knowledge economy workplaces. Data collected from the questionnaire were analyzed for descriptive and demographic statistics, and categorized so that common patterns could be identified from information gathered from the online questionnaire and interviews. Findings based on this study indicated that these Net-Gen adult learners were fluent with all types of digital technologies in collaborative environments, expecting their educational experiences to provide a similar experience. Participants clearly expressed an understanding that digital/collaborative aptitudes are essential to successful employment in the knowledge economy workplace. The findings of this study indicated that the majority of participants felt that their post-secondary educational experiences did not adequately prepare them to meet the expectations of this type of working environment.