Évaluation du secteur communautaire du Service social de la Ville de Genève

Le Conseil administratif de la Ville de Genève a mandaté l'IDHEAP en tant qu'expert indépendant pour évaluer le secteur communautaire, une unité administrative rattachée au Service social. En prenant en considération les enjeux socio-sanitaires auxquels la Ville de Genève est confrontée, le concept d'étude proposé par l'Unité de politiques locales et d'évaluation de l'IDHEAP vise à établir un bilan de l'action du secteur communautaire, à déterminer la pertinence de cette action, son efficacité et son efficience, à tracer des perspectives en tenant compte notamment des prestations fournies par d'autres acteurs présents dans les domaines de la cohésion sociale et de la prévention socio-sanitaire, ainsi qu'à proposer des recommandations.

Service Concept Development - An Appoach for Professional Service Firm

Specific demand for service concept creation has come about from industrial organizations’ desire to find new and innovative ways to differentiate their offering by increasing the level of customer services. Providers of professional services have also demanded new concepts and approaches for their businesses as these industries have become increasingly competitive. Firms are now seeking better ways to understand and segment their customers, to ensure the delivery of quality services and strengthen their position in aggressively competitive markets. This thesis is intended to provide management consulting companies with a new work method that enables service concept creation in a business-to-business environment. The model defines the service concept as a combination of delivered value and the target customers; the third-dimension operating model is brought to the new system in testing of the service concept creation guidelines in the target organization. For testing, service concepts for a management consulting company are created. Service concepts are designed to serve as a solid foundation for further service improvements. Recommendations and proposals for further action related to service development in the target organization are presented, and recommendations to further improve the model created are given.

Universal Service Policies in Europe & Latam: Evidence on Bridging the Divide in Rural Areas

Broadband access is a key factor for economic and social development. However, providing broadband to rural areas is not attractive to private telecommunications operators due its low or zero investment return. To deal with broadband provision in rural areas, different governance systems based on private and public cooperation have appeared. This paper not only identifies and defines public and private cooperation models but also assesses their impact on overcoming the digital divide in rural areas. The results show that public ownership infrastructure under private management policy has had positive effects on reducing the broadband digital divide and being applied to areas with higher digital divide; subsides to private operators providers only positive effects on reducing broadband digital divide; but public infrastructure with public management programs did not. The results, obtained using quasi-experimental methods, suggest the importance of incentives and control mechanisms in broadband universal service provision plans.

Nanocarriers for DNA Vaccines: Co-Delivery of TLR-9 and NLR-2 Ligands Leads to Synergistic Enhancement of Proinflammatory Cytokine Release

Adjuvants enhance immunogenicity of vaccines through either targeted antigen delivery or stimulation of immune receptors. Three cationic nanoparticle formulations were evaluated for their potential as carriers for a DNA vaccine, and muramyl dipeptide (MDP) as immunostimulatory agent, to induce and increase immunogenicity of Mycobacterium tuberculosis antigen encoding plasmid DNA (pDNA). The formulations included (1) trimethyl chitosan (TMC) nanoparticles, (2) a squalene-in-water nanoemulsion, and (3) a mineral oil-in-water nanoemulsion. The adjuvant effect of the pDNA-nanocomplexes was evaluated by serum antibody analysis in immunized mice. All three carriers display a strong adjuvant effect, however, only TMC nanoparticles were capable to bias immune responses towards Th1. pDNA naturally contains immunostimulatory unmethylated CpG motifs that are recognized by Toll-like receptor 9 (TLR-9). In mechanistic in vitro studies, activation of TLR-9 and the ability to enhance immunogenicity by simultaneously targeting TLR-9 and NOD-like receptor 2 (NLR-2) was determined by proinflammatory cytokine release in RAW264.7 macrophages. pDNA in combination with MDP was shown to significantly increase proinflammatory cytokine release in a synergistic manner, dependent on NLR-2 activation. In summary, novel pDNA-Ag85A loaded nanoparticle formulations, which induce antigen specific immune responses in mice were developed, taking advantage of the synergistic combinations of TLR and NLR agonists to increase the adjuvanticity of the carriers used.

Targeting iron-mediated retinal degeneration by local delivery of transferrin.

Iron is essential for retinal function but contributes to oxidative stress-mediated degeneration. Iron retinal homeostasis is highly regulated and transferrin (Tf), a potent iron chelator, is endogenously secreted by retinal cells. In this study, therapeutic potential of a local Tf delivery was evaluated in animal models of retinal degeneration. After intravitreal injection, Tf spread rapidly within the retina and accumulated in photoreceptors and retinal pigment epithelium, before reaching the blood circulation. Tf injected in the vitreous prior and, to a lesser extent, after light-induced retinal degeneration, efficiently protected the retina histology and function. We found an association between Tf treatment and the modulation of iron homeostasis resulting in a decrease of iron content and oxidative stress marker. The immunomodulation function of Tf could be seen through a reduction in macrophage/microglial activation as well as modulated inflammation responses. In a mouse model of hemochromatosis, Tf had the capacity to clear abnormal iron accumulation from retinas. And in the slow P23H rat model of retinal degeneration, a sustained release of Tf in the vitreous via non-viral gene therapy efficently slowed-down the photoreceptors death and preserved their function. These results clearly demonstrate the synergistic neuroprotective roles of Tf against retinal degeneration and allow identify Tf as an innovative and not toxic therapy for retinal diseases associated with oxidative stress.

Stratégies de communication au service de la formation: quelques outils pratiques [Effective communication strategies to frame the trainer-trainee dialogue in the clinical setting].

Communication between trainer and trainee plays a central role in teaching and learning in the clinical environment. There are various strategies to frame the dialogue between trainee and trainer. These strategies allow trainers to be more effective in their supervision, which is important in our busy clinical environment. Communication strategies are well adapted to both in- and out-patient settings, to both under- and postgraduate contexts. This article presents three strategies that we think are particularly useful. They are meant to give feedback, to ask questions and to present a case.

Gestió dels residus alimentaris municipals procedents de les activitats comercials del municipi de Montmeló per tal de reduir, reutilitzar i reciclar-los

En el present treball es proposa com lluitar contra el malbaratament alimentari que es genera al llarg de tota la cadena alimentària, sent aquest degut a causa d'una planificació poc adequada. L'objectiu principal és planificar i implantar un sistema de gestió per tal de recuperar l'excedent alimentari que es genera als comerços i les indústries del municipi de Montmeló, elaborant així un protocol per tal de poder redistribuir aquest aliment als sectors de la població en situacions econòmiques més precàries. Com a objectius secundaris, es pretén conscienciar, fomentar i potenciar el treball en xarxa entre els diferents agents implicats, com ara: la ciutadania, les entitats socials (Càritas Parroquial Montmeló), sector privat (establiments alimentaris del municipi, mercat municipal, indústries del sector alimentari) i el sector públic (departament de serveis socials, medi ambient, comerç i brigada municipal). A l'hora de planificar i implantar un sistema de gestió per tal de recuperar l'excedent alimentari, s'ha analitzat i valorat el camí que hi realitza, des d'on es genera fins al beneficiari final. Aquest s'ha gestionat per etapes, en les que s'han identificat els generadors, el tipus i quantitat d'aliment que malbaraten. S'ha proposat un nou sistema de recollida d'informació i les pautes que han de seguir per garantir el bon estat de l'aliment com: una taula de conservació, un protocol de funcionament, un document d'entrega i una fitxa de control de les condicions d'higiene. Per tal d'assolir una bona coordinació entre totes les parts, s'han realitzat reunions conjuntes entre els generadors, serveis socials i Càritas on s'ha acabat signant un acord de col·laboració. Entre les conclusions més rellevants cal destacar que ha servit per establir un precedent d'aprofitament alimentari al municipi de Montmeló, aconseguint alimentar a un gran nombre de famílies amb greus problemes econòmics. A més s'ha arribat a disminuir la quantitat de residus generats, amb el conseqüent estalvi de recursos econòmics i materials on s'ha recuperat un total de 5.760 Kg d'aliments aptes pel consum.

Care delivery value chains for ophthalmic clinics in Switzerland

Perceived patient value is often not aligned with the emerging expenses for health care services. In other words, the costs are often supposed as rising faster than the actual value for the patients. This fact is causing major concerns to governments, health plans, and individuals. Attempts to solve the problem have habitually been on the operational effectiveness side: increasing patient volume, minimizing costs, rationing, or closing hospitals, usually resulting in a zero-sum game. Only few approaches come from the strategic positioning side and "competition" among hospitals is still perceived rather as a danger than as a chance to create a positive-sum game and stimulate patient value. In their 2006 book, "Redefining Health Care", the renowned Harvard strategy professor Michael E. Porter and hospital management expert Professor Elizabeth Olmsted Teisberg approach the challenge from the positive-sum perspective: they propose to form Integrated Practice Units (IPUs) and manage hospitals in a modern, patient value oriented way. They argue that creating value-based competition on results should have the same effect on the health care sector like transparency and competition turned other industries with out-dated management models (like recently the inert telecommunication industry) into highly competitive and customer value creating businesses. The objective of this paper is to elaborate Care Delivery Value Chains for Integrated Practice Units in ophthalmic clinics and gather a first feedback from Swiss hospital managers, ophthalmologists, and patients, if such an approach could be a realistic way to improve health care management. First, Porter's definition of competitiveness (distinction between operational effectiveness and strategic positioning) is explained. Then, the Care Delivery Value Chain is introduced as a key element for understanding value-based management, followed by three practice examples for ophthalmic clinics. Finally, recommendations are given how the Care Delivery Value Chain can be managed efficiently and how the obstacles of becoming a patient-oriented organization can be overcome. The conclusion is that increased transparency and value-based competition on results has the potential to change the mindset of hospital managers-which will align patient value with the emerging health care expenses. Early adapters of this management approach will gain a competitive advantage. [Author, p. 6]

Public and Private Production in a Mixed Delivery System: Regulation, Competition and Costs

Academics and policy makers are increasingly shifting the debate concerning the best form of public service provision beyond the traditional dilemma between pure public and pure private delivery modes, because, among other reasons, there is a growing body of evidence that casts doubt on the existence of systematic cost savings from privatization, while any competition seems to be eroded over time. In this paper we compare the relative merits of public and private delivery within a mixed delivery system. We study the role played by ownership, transaction costs, and competition on local public service delivery within the same jurisdiction. Using a stochastic cost frontier, we analyze the public-private urban bus system in the Barcelona Metropolitan Area. Our results suggest that private firms tendering the service have higher delivery costs than those incurred by the public firm, especially when transaction costs are taken into account. Tenders, therefore, do not help to reduce delivery costs. Our results suggest that under a mixed delivery scheme, which permits the co-existence of public and private production, the metropolitan government and the regulator can use private delivery to contain costs in the public firm and, at the same time, benefit from the greater flexibility of private firms for dealing with events not provided for under contract.

Gender diversity and innovation in manufacturing and service firms

Traditionally, researchers have considered the innovation process as being gender neutral. However, recently some studies have begun to take gender diversity into account as a determinant of firms’ innovation. This paper aims to analyse how the effect of gender diversity on innovation output at firm level is sensitive to team size. Using the Spanish PITEC (Panel de Innovación Tecnológica) from 2007 to 2012 for innovative manufacturing and service firms, we estimate a multivariate probit model to analyse how gender diversity both in R&D teams and in the total workforce affect product, process, marketing and organizational innovations. Our results show that gender-diverse teams increase the probability of innovating, and this capacity is positively related team size. Gender diversity, in both the R&D department and the total workforce, has a larger positive impact on the probability of carrying out product and organizational innovations in larger teams than it does in smaller teams. This effect is less clear-cut in the case of marketing and process innovation, where the impact is only significant for micro and small firms. Finally, size effects are of greater importance when we distinguish between the manufacturing and service sectors. JEL Code: O30, O31, J16