De la responsabilité individuelle aux priorités collectives. Une analyse institutionnaliste des politiques de la demande en santé

La notion d’aléa moral est le gold standard de la politique de la demande en santé et justifie les politiques de partage des coûts visant à faire payer le patient. Sous l’effet des critiques théoriques dont elle a fait l’objet, la notion d’aléa moral a été progressivement vidée de son ambition originelle pour en appeler à la moralisation du comportement du patient. Elle a débouché sur une segmentation des patients distinguant ceux qui doivent être mis à contribution financière au non de la responsabilité individuelle et ceux qui doivent être protégés de cette responsabilisation. Ce texte montre que la constitution d’ordres de priorité en matière de santé est peu compatible avec l’approche en termes d’aléa moral. Les ordres de priorité ne répondent pas à une conception instrumentale. Ils reposent sur des valeurs sociétales partagées et des préférences éthiques qui sont en opposition avec la conception standard de la responsabilité et la promotion de l’individualisme.

La stratégie sénégalaise du faire faire et la construction du sens de la gouvernance de l’éducation non formelle

Traduction du titre en anglais: Making sense of governance in non-formal education : A critical analysis of the Senegalese faire faire strategy

Los mandatos constitucionales sobre el derecho a la salud: implicaciones de equidad y eficiencia

El reconocimiento de los derechos sociales, económicos y culturales (DESC), es el segundo hito en materia de derechos humanos en el contexto internacional, después de la proclamación de los derechos civiles y políticos. Esta secuencia en el reconocimiento de los derechos humanos, ha llevado a clasificar los civiles y políticos como derechos de primera generación, y los DESC como de segunda generación. El reconocimiento de los DESC se materializa en su inclusión en los textos constitucionales de un buen número de países, o de su reconocimiento implícito aún sin estar incluido como un mandato constitucional

Extinction processes in hotspots of avian biodiversity and the targeting of pre-emptive conservation action

Hot spots of endemism are regarded as important global sites for conservation as they are rich in threatened endemic species and currently experiencing extensive habitat loss. Targeting pre-emptive conservation action to sites that are currently relatively intact but which would be vulnerable to particular human activities if they occurred in the future is, however, also valuable but has received less attention. Here, we address this issue by using data on Endemic Bird Areas (EBAs). First, we identify the ecological factors that affect extinction risk in the face of particular human activities, and then use these insights to identify EBAs that should be priorities for pre-emptive conservation action. Threatened endemic species in EBAs are significantly more likely to be habitat specialists or relatively large-bodied than non-threatened species, when compared across avian families. Increasing habitat loss causes a significant increase in extinction risk among habitat specialists, but we found no evidence to suggest that the presence of alien species/human exploitation causes a significant increase in extinction risk among large-bodied species. This suggests that these particular human activities are contributing to high extinction risk among habitat specialists, but not among large-bodied species. Based on these analyses, we identify 39 EBAs containing 570 species (24% of the total in EBAs) that are not currently threatened with severe habitat loss, but would be ecologically vulnerable to future habitat loss should it occur. We show that these sites tend to be poorly represented in existing priority setting exercises involving hot spots, suggesting that vulnerability must be explicitly included within these exercises if such sites are to be adequately protected.

Extinction processes in hot spots of avian biodiversity and the targeting of pre-emptive conservation action

Hot spots of endemism are regarded as important global sites for conservation as they are rich in threatened endemic species and currently experiencing extensive habitat loss. Targeting pre-emptive conservation action to sites that are currently relatively intact but which would be vulnerable to particular human activities if they occurred in the future is, however, also valuable but has received less attention. Here, we address this issue by using data on Endemic Bird Areas (EBAs). First, we identify the ecological factors that affect extinction risk in the face of particular human activities, and then use these insights to identify EBAs that should be priorities for pre-emptive conservation action. Threatened endemic species in EBAs are significantly more likely to be habitat specialists or relatively large-bodied than non-threatened species, when compared across avian families. Increasing habitat loss causes a significant increase in extinction risk among habitat specialists, but we found no evidence to suggest that the presence of alien species/human exploitation causes a significant increase in extinction risk among large-bodied species. This suggests that these particular human activities are contributing to high extinction risk among habitat specialists, but not among large-bodied species. Based on these analyses, we identify 39 EBAs containing 570 species (24% of the total in EBAs) that are not currently threatened with severe habitat loss, but would be ecologically vulnerable to future habitat loss should it occur. We show that these sites tend to be poorly represented in existing priority setting exercises involving hot spots, suggesting that vulnerability must be explicitly included within these exercises if such sites are to be adequately protected.

Violência nas escolas e políticas públicas: um estudo sobre a formulação do Sistema de Proteção Escolar e Cidadania

Sendo diversos os entendimentos sobre o que significa violência nas escolas e, consequentemente, sobre as possibilidades de intervenção por parte do poder público, como são formuladas as políticas que lidam com esse fenômeno? Pautada por esta pergunta, a presente pesquisa estrutura-se a partir de uma ampla revisão da literatura e de um estudo de caso sobre o processo de formulação do Sistema de Proteção Escolar e Cidadania, criado em 2009 pelo governo do estado de São Paulo. Os resultados apontam que o surgimento da política foi marcado por um modelo reativo de políticas públicas e que o processo de seu desenho apresentou elementos típicos de um modelo de política incremental. Verificou-se que a iniciativa foi capaz de fazer avançarem práticas e de introduzir algumas inovações na forma como as políticas públicas lidam com o tema; no entanto, as características impressas por seu processo de formulação limitam a possibilidade de que a política contribua para a construção de mudanças mais consistentes na realidade da violência nas escolas.

Rotinas organizacionais e a influência dos antecedentes internos e externos na variedade sequencial

Que fatores influenciam a variedade de sequências de tarefas componentes de rotinas organizacionais? Este estudo está focado em analisar como fatores antecedentes das execuções influenciam a variedade sequencial de rotinas organizacionais. Rotinas organizacionais conferem eficiência e coordenação aos processos organizacionais por meio da padronização e especialização das tarefas e de seus encadeamentos. A literatura suscita que altos níveis de variabilidade podem ser importantes para manter a flexibilidade nos processos organizacionais (Feldman e Pentland, 2003). A variedade sequencial é tida como a expressão mais fidedigna da diversidade de configurações das sequências de tarefas componentes de uma rotina organizacional. Este estudo propõe uma metodologia qualitativa de análise das fontes de variedade sequencial. Utiliza-se o quadro de referência proposto em Becker (2005b) que contempla os antecedentes complexidade da tarefa, interdependência da tarefa, pressão de tempo, incerteza pertencente à tarefa e mudança de agentes além de características e resultados. Para atingir este objetivo foram empreendidas duas observações em prontos-socorros de organizações paulistanas. A rotina organizacional de atendimento a pacientes em prontos- socorros é um processo relevante de ser estudado pois é principal forma de acesso dos pacientes a tratamentos nos dois hospitais analisados. Além disso, a rotina se mostra bastante eficiente e é caracterizada por atender padrões internacionais de qualidade de processo. Os dados foram sistematizados por uma análise de conteúdo adaptada ao estudo da variedade sequencial. Graças à essa análise foi possível identificar as fontes de variedade sequencial e discuti-las no contexto da literatura de rotinas organizacionais, foram identificadas quatro fontes principais: definição de prioridade ligada à pressão de tempo; necessidade de especialistas ligada à complexidade da tarefa; incremento de informações para diagnóstico e tratamento ligada à incerteza da tarefa; e, prolongar o tratamento ligada à incerteza e interdependência da tarefa. Não há evidências que a mudança de agentes influencia a variedade sequencial. Este estudo propõe que os antecedentes constituem dois grupos: antecedentes externos derivam de questões relativas à multiplicidade de condições dos pacientes como pressão de tempo e incerteza da tarefa. Antecedentes internos estão ligados à regras e recursos organizacionais como complexidade e a interdependência da tarefa.

Three-dimensional reconstruction of fracture surfaces: Area matching algorithms for automatic parallax measurements

This paper describes two solutions for systematic measurement of surface elevation that can be used for both profile and surface reconstructions for quantitative fractography case studies. The first one is developed under Khoros graphical interface environment. It consists of an adaption of the almost classical area matching algorithm, that is based on cross-correlation operations, to the well-known method of parallax measurements from stereo pairs. A normalization function was created to avoid false cross-correlation peaks, driving to the true window best matching solution at each region analyzed on both stereo projections. Some limitations to the use of scanning electron microscopy and the types of surface patterns are also discussed. The second algorithm is based on a spatial correlation function. This solution is implemented under the NIH Image macro programming, combining a good representation for low contrast regions and many improvements on overall user interface and performance. Its advantages and limitations are also presented.

The structural origin and biological function of pH-sensitivity in firefly luciferases

Firefly luciferases are called pH-sensitive because their bioluminescence spectra display a typical red-shift at acidic pH, higher temperatures, and in the presence of heavy metal cations, whereas other beetle luciferases (click beetles and railroadworms) do not, and for this reason they are called pH-insensitive. Despite many studies on firefly luciferases, the origin of pH-sensitivity is far from being understood. This subject is revised in view of recent results. Some substitutions of amino-acid residues influencing pH-sensitivity in firefly luciferases have been identified. Sequence comparison, site-directed mutagenesis and modeling studies have shown a set of residues differing between pH-sensitive and pH-insensitive luciferases which affect bioluminescence colors. Some substitutions dramatically affecting bioluminescence colors in both groups of luciferases are clustered in the loop between residues 223-235 (Photinus pyralis sequence). A network of hydrogen bonds and salt bridges involving the residues N229-S284-E311-R337 was found to be important for affecting bioluminescence colors. It is suggested that these structural elements may affect the benzothiazolyl side of the luciferin-binding site affecting bioluminescence colors. Experimental evidence suggest that the residual red light emission in pH-sensitive luciferases could be a vestige that may have biological importance in some firefly species. Furthermore, the potential utility of pH-sensitivity for intracellular biosensing applications is considered. © The Royal Society of Chemistry and Owner Societies.

Modelo de gerenciamento integrado de resíduos sólidos urbanos: uma contribuição ao planejamento urbano

Pós-graduação em Geociências e Meio Ambiente - IGCE

Running Head: Social Work Developments in Lithuania

Following the end of a half-century of Soviet occupation, Lithuania, like other former Soviet republics, has been in socio-economic disorder. Now that Lithuania is free, the system of social welfare is characterized by under-funded health services and pensions, and a large number of institutions. Semi-structured interviews were conducted with students and practitioners focusing on community development, using Lofland’s model of social setting analysis.Results indicate that the collaborative efforts successfully produced a revolutionary and successful social service program, a multi-generational living facility offering full-time social services to unwed mothers, infants, and elderly residents.This article is based upon the qualitative study of social work practitioners and social work students and chronicles the successes and difficulties encountered within the process of community development.

Capacity Building in the Use of Geospatial Tools for Natural Resource Management in Tajikistan: Inception report

The sustainable management of natural resources is a key issue for sustainable development of a poor, mountainous country such as Tajikistan. In order to strengthen its agricultural and infrastructural development efforts and alleviate poverty in rural areas, spatial information and analysis are of crucial importance to improve priority setting and decision making efficiency. However, poor access to geospatial data and tools, and limited capacity in their use has greatly constrained the ability of governmental institutions to effectively assess, plan, and monitor natural resources management. The Centre for Development and Environment (CDE) has thus been mandated by the World Bank Group to provide adequate technical support to the Community Agriculture and Watershed Management Project (CAWMP). This support consists of a spatial database on soil degradation trends in 4 watersheds, capacity development in and awareness creation about geographic information technology and a spatial data exchange hub for natural resources management in Tajikistan. CDE’s support has started in July 2007 and will last until December 2007 with a possible extension in 2008.

Youth population's health issues in Comal County, Texas

This study assesses adolescent's health issues in Comal County, TX. Adolescents are defined as youth between the ages of 12 to 17 years of age, who resided in Comal County during the time period of 2000 to 2007. The analysis focused on high risk behaviors including use of gateway drugs—tobacco and alcohol; illegal substance use; and reproductive health related indicators, including sexual activity, sexually transmitted diseases, and pregnancy. This study is based on the primary and secondary data collected as part of the 2008 Comal County Community Assessment. It compares findings from the primary data sources to extant data from four secondary data sources including: (1) The Centers for Disease Control & Prevention (national) Healthy People 2010; (2) The Centers for Disease Control & Prevention, Youth Risk Behavior Surveillance Survey, 2007; (3) The Texas Department of State Health Services, 2000 to 2007; and The Pride Survey (Local and Statewide). The methods are drawn from the literature on "rapid epidemiologic appraisal" (Annett H. & Rifkin S. B., 1988). The study focus on corroborating the perceptions, subjective concerns, opinions and beliefs of the Comal County key stakeholders and community participants with qualitative and quantitative indicators of health and well being. The value of this approach is to inform community leaders using a public health perspective and evidence in their decisions about priority setting and resources allocation activities for prevention of high risk behaviors and promotion of adolescent health and well being. ^

Funding the utilization of community health workers in Texas

Community health workers (CHWs) are volunteers or paid members of communities that perform outreach, patient assistance, health education, and assist in navigation of healthcare system amongst other duties. The utilization of CHWs in hospital and community setting provides health benefits to their communities while reducing cost to the overall healthcare system. ^ The general population of Texas lacks adequate access to primary care. An important indicator of such a crisis is excessive usage of emergency department services in Texas, especially by the large minority population within the state. Also, unmanaged chronic diseases have been shown to be correlated with the excessive usage of emergency services. According to a recent survey of 25 Houston metropolitan area hospitals, almost 54% of the ER visits could have been resolved in primary care settings. A Galveston based study also indicated that the ER usage was higher amongst African-Americans and Latinos. Meanwhile, 28.5% of the total ER visits were made by Latinos from the surrounding areas (Begley et al., 2007). There is substantial evidence present which indicates enormous cost-savings that CHWs have produced in Texas and nationwide through reduction in unnecessary ER visits along with better management of chronic diseases (Fedder et al, 2003). ^ This paper provides an analysis regarding the need and importance for sustainable and stable sources of funding for Community health workers (CHWs) in Texas utilizing Kingdon's model of Agenda Setting as framework. The policy analysis is also aimed at reporting on the policy process and actions taken by Children at Risk to address this critical issue. Children at Risk, a Houston based advocacy organization, has created a legislative proposal that calls on the Texas Health and Human Commission to apply for a Medicaid §§1115 waiver to provide sustainable sources of funding for CHWs, Rep. John Zerwas sponsored HB 2244 bill and it was filed on March 3, 2011. The bill would affect the use of CHWs in Texas in two ways: 1) through the establishment and operation of a program designed to train and educate CHWs 2) by creating a statewide training and certification advisory committee. The advisory committee is required in the bill to submit recommendations for providing sustainable funding and employment for CHWs. The HB 2244 failed to move out of the House Public Health committee. However, HB2244 was amended into HB 2610 introduced by Representative Guillen. The House Bill 2610 is geared towards establishing a community-based navigator program in order to assist individuals applying for public assistance through the Internet. The House Bill 2610 was signed by the Governor and will be effective September 1, 2011.^

A return-on-investment framework to identify conservation priorities in Africa

Environmental conservation activities must continue to become more efficient and effective, especially in Africa where development and population growth pressures continue to escalate. Recently, prioritization of conservation resources has focused on explicitly incorporating the economic costs of conservation along with better defining the outcomes of these expenditures. We demonstrate how new global and continental data that spans social, economic, and ecological sectors creates an opportunity to incorporate return-on-investment (ROI) principles into conservation priority setting for Africa. We suggest that combining conservation priorities that factor in biodiversity value, habitat quality, and conservation management investments across terrestrial, freshwater, and coastal marine environments provides a new lens for setting global conservation priorities. Using this approach we identified seven regions capturing interior and coastal resources that also have high ROI values that support further investment. We illustrate how spatially explicit, yet flexible ROI analysis can help to better address uncertainty, risk, and opportunities for conservation, while making values that guide prioritization more transparent. In one case the results of this prioritization process were used to support new conservation investments. Acknowledging a clear research need to improve cost information, we propose that adopting a flexible ROI framework to set conservation priorities in Africa has multiple potential benefits.