Modelling and estimating models of physician labour supply and productivity

Ma thèse s’intéresse aux politiques de santé conçues pour encourager l’offre de services de santé. L’accessibilité aux services de santé est un problème majeur qui mine le système de santé de la plupart des pays industrialisés. Au Québec, le temps médian d’attente entre une recommandation du médecin généraliste et un rendez-vous avec un médecin spécialiste était de 7,3 semaines en 2012, contre 2,9 semaines en 1993, et ceci malgré l’augmentation du nombre de médecins sur cette même période. Pour les décideurs politiques observant l’augmentation du temps d’attente pour des soins de santé, il est important de comprendre la structure de l’offre de travail des médecins et comment celle-ci affecte l’offre des services de santé. Dans ce contexte, je considère deux principales politiques. En premier lieu, j’estime comment les médecins réagissent aux incitatifs monétaires et j’utilise les paramètres estimés pour examiner comment les politiques de compensation peuvent être utilisées pour déterminer l’offre de services de santé de court terme. En second lieu, j’examine comment la productivité des médecins est affectée par leur expérience, à travers le mécanisme du "learning-by-doing", et j’utilise les paramètres estimés pour trouver le nombre de médecins inexpérimentés que l’on doit recruter pour remplacer un médecin expérimenté qui va à la retraite afin de garder l’offre des services de santé constant. Ma thèse développe et applique des méthodes économique et statistique afin de mesurer la réaction des médecins face aux incitatifs monétaires et estimer leur profil de productivité (en mesurant la variation de la productivité des médecins tout le long de leur carrière) en utilisant à la fois des données de panel sur les médecins québécois, provenant d’enquêtes et de l’administration. Les données contiennent des informations sur l’offre de travail de chaque médecin, les différents types de services offerts ainsi que leurs prix. Ces données couvrent une période pendant laquelle le gouvernement du Québec a changé les prix relatifs des services de santé. J’ai utilisé une approche basée sur la modélisation pour développer et estimer un modèle structurel d’offre de travail en permettant au médecin d’être multitâche. Dans mon modèle les médecins choisissent le nombre d’heures travaillées ainsi que l’allocation de ces heures à travers les différents services offerts, de plus les prix des services leurs sont imposés par le gouvernement. Le modèle génère une équation de revenu qui dépend des heures travaillées et d’un indice de prix représentant le rendement marginal des heures travaillées lorsque celles-ci sont allouées de façon optimale à travers les différents services. L’indice de prix dépend des prix des services offerts et des paramètres de la technologie de production des services qui déterminent comment les médecins réagissent aux changements des prix relatifs. J’ai appliqué le modèle aux données de panel sur la rémunération des médecins au Québec fusionnées à celles sur l’utilisation du temps de ces mêmes médecins. J’utilise le modèle pour examiner deux dimensions de l’offre des services de santé. En premierlieu, j’analyse l’utilisation des incitatifs monétaires pour amener les médecins à modifier leur production des différents services. Bien que les études antérieures ont souvent cherché à comparer le comportement des médecins à travers les différents systèmes de compensation,il y a relativement peu d’informations sur comment les médecins réagissent aux changementsdes prix des services de santé. Des débats actuels dans les milieux de politiques de santé au Canada se sont intéressés à l’importance des effets de revenu dans la détermination de la réponse des médecins face à l’augmentation des prix des services de santé. Mon travail contribue à alimenter ce débat en identifiant et en estimant les effets de substitution et de revenu résultant des changements des prix relatifs des services de santé. En second lieu, j’analyse comment l’expérience affecte la productivité des médecins. Cela a une importante implication sur le recrutement des médecins afin de satisfaire la demande croissante due à une population vieillissante, en particulier lorsque les médecins les plus expérimentés (les plus productifs) vont à la retraite. Dans le premier essai, j’ai estimé la fonction de revenu conditionnellement aux heures travaillées, en utilisant la méthode des variables instrumentales afin de contrôler pour une éventuelle endogeneité des heures travaillées. Comme instruments j’ai utilisé les variables indicatrices des âges des médecins, le taux marginal de taxation, le rendement sur le marché boursier, le carré et le cube de ce rendement. Je montre que cela donne la borne inférieure de l’élasticité-prix direct, permettant ainsi de tester si les médecins réagissent aux incitatifs monétaires. Les résultats montrent que les bornes inférieures des élasticités-prix de l’offre de services sont significativement positives, suggérant que les médecins répondent aux incitatifs. Un changement des prix relatifs conduit les médecins à allouer plus d’heures de travail au service dont le prix a augmenté. Dans le deuxième essai, j’estime le modèle en entier, de façon inconditionnelle aux heures travaillées, en analysant les variations des heures travaillées par les médecins, le volume des services offerts et le revenu des médecins. Pour ce faire, j’ai utilisé l’estimateur de la méthode des moments simulés. Les résultats montrent que les élasticités-prix direct de substitution sont élevées et significativement positives, représentant une tendance des médecins à accroitre le volume du service dont le prix a connu la plus forte augmentation. Les élasticitésprix croisées de substitution sont également élevées mais négatives. Par ailleurs, il existe un effet de revenu associé à l’augmentation des tarifs. J’ai utilisé les paramètres estimés du modèle structurel pour simuler une hausse générale de prix des services de 32%. Les résultats montrent que les médecins devraient réduire le nombre total d’heures travaillées (élasticité moyenne de -0,02) ainsi que les heures cliniques travaillées (élasticité moyenne de -0.07). Ils devraient aussi réduire le volume de services offerts (élasticité moyenne de -0.05). Troisièmement, j’ai exploité le lien naturel existant entre le revenu d’un médecin payé à l’acte et sa productivité afin d’établir le profil de productivité des médecins. Pour ce faire, j’ai modifié la spécification du modèle pour prendre en compte la relation entre la productivité d’un médecin et son expérience. J’estime l’équation de revenu en utilisant des données de panel asymétrique et en corrigeant le caractère non-aléatoire des observations manquantes à l’aide d’un modèle de sélection. Les résultats suggèrent que le profil de productivité est une fonction croissante et concave de l’expérience. Par ailleurs, ce profil est robuste à l’utilisation de l’expérience effective (la quantité de service produit) comme variable de contrôle et aussi à la suppression d’hypothèse paramétrique. De plus, si l’expérience du médecin augmente d’une année, il augmente la production de services de 1003 dollar CAN. J’ai utilisé les paramètres estimés du modèle pour calculer le ratio de remplacement : le nombre de médecins inexpérimentés qu’il faut pour remplacer un médecin expérimenté. Ce ratio de remplacement est de 1,2.

Le discours juridique dans la " société du risque ": Regard réflexif sur l'évolution de l'assurance et du principe de précaution en droit

Cette recherche propose une analyse critique du droit applicable à deux dimensions de la gestion des risques : l’indemnisation des dommages au moyen de l’assurance et la prévention des risques au moyen du principe de précaution. Dans une perspective interdisciplinaire, l’interaction du droit avec les rationalités politique, économique, scientifique et sociale est soulignée par l’opposition de deux théories : la Société du risque d’Ulrich Beck et la Société assurantielle de François Ewald. L’argumentation révèle les différentes significations de la limite de l’assurance privée en droit et les discours dissonants quant aux stratégies juridiques utilisées face aux risques. Le mémoire fournit ainsi des balises essentielles à la réflexion juridique critique. L’originalité de l’angle d’analyse, qui tient compte de l’évolution du droit en lien avec la modification de la rationalité politique survenue au XIXe siècle avec l’industrialisation des sociétés occidentales, permet d’enrichir l’épistémologie juridique. Il en découle entre autres une réflexion au sujet de l’évolution des conceptions théoriques du droit et de son rôle social escompté.

The Path between Pedagogy and Technology: Establishing a Theoretical Basis for the Development of Educational Game Environments

The power of computer game technology is currently being harnessed to produce “serious games”. These “games” are targeted at the education and training marketplace, and employ various key game-engine components such as the graphics and physics engines to produce realistic “digital-world” simulations of the real “physical world”. Many approaches are driven by the technology and often lack a consideration of a firm pedagogical underpinning. The authors believe that an analysis and deployment of both the technological and pedagogical dimensions should occur together, with the pedagogical dimension providing the lead. This chapter explores the relationship between these two dimensions, and explores how “pedagogy may inform the use of technology”, how various learning theories may be mapped onto the use of the affordances of computer game engines. Autonomous and collaborative learning approaches are discussed. The design of a serious game is broken down into spatial and temporal elements. The spatial dimension is related to the theories of knowledge structures, especially “concept maps”. The temporal dimension is related to “experiential learning”, especially the approach of Kolb. The multi-player aspect of serious games is related to theories of “collaborative learning” which is broken down into a discussion of “discourse” versus “dialogue”. Several general guiding principles are explored, such as the use of “metaphor” (including metaphors of space, embodiment, systems thinking, the internet and emergence). The topological design of a serious game is also highlighted. The discussion of pedagogy is related to various serious games we have recently produced and researched, and is presented in the hope of informing the “serious game community”.

The Plastic Coupled Map Lattice: a Novel Image‐processing Paradigm

Coupled map lattices (CML) can describe many relaxation and optimization algorithms currently used in image processing. We recently introduced the ‘‘plastic‐CML’’ as a paradigm to extract (segment) objects in an image. Here, the image is applied by a set of forces to a metal sheet which is allowed to undergo plastic deformation parallel to the applied forces. In this paper we present an analysis of our ‘‘plastic‐CML’’ in one and two dimensions, deriving the nature and stability of its stationary solutions. We also detail how to use the CML in image processing, how to set the system parameters and present examples of it at work. We conclude that the plastic‐CML is able to segment images with large amounts of noise and large dynamic range of pixel values, and is suitable for a very large scale integration(VLSI) implementation.

"It’s just very natural" – interpersonal knowledge as a didactical device in guided classroom conversations in religious education

This article investigates how teachers in religious education (RE) think and act as professionals while working with differences in religious and philosophy of life experiences and beliefs in class and trying to do this in respectful and inclusive ways. It analyses data from two research projects that were carried out in lower secondary school in Norway. The main research question is: What is the relationship between teachers’ contextual knowledge and knowledge of the child and how do these two dimensions of professional knowledge interact when religious education teachers try to strike a good balance between inclusion and productive learning in their teaching practice? The data analysed were drawn from three different data sets featuring three Norwegian religious education-teachers. The research was part of the EU-funded "REDCo"-project and the "Religious education and diversity" - project ["ROM"] funded by the Norwegian Research Council. The interviewees emphasized the potential of the religious education subject to contribute to a wider tolerance for difference and to support individual students in their identity management. The analysis shows, however, that considerable contextual awareness - of the classroom and of the local community - is needed to realize this potential. It also shows the importance of interpersonal knowledge between the teacher and each student if contextual awareness is to be effective in terms of inclusion, participation, wellbeing and good learning outcomes for all students.

Multiphase modeling of melting / solidification with high density variations using XFEM

La modélisation de la cryolite, utilisée dans la fabrication de l’aluminium, implique plusieurs défis, notament la présence de discontinuités dans la solution et l’inclusion de la difference de densité entre les phases solide et liquide. Pour surmonter ces défis, plusieurs éléments novateurs ont été développés dans cette thèse. En premier lieu, le problème du changement de phase, communément appelé problème de Stefan, a été résolu en deux dimensions en utilisant la méthode des éléments finis étendue. Une formulation utilisant un multiplicateur de Lagrange stable spécialement développée et une interpolation enrichie a été utilisée pour imposer la température de fusion à l’interface. La vitesse de l’interface est déterminée par le saut dans le flux de chaleur à travers l’interface et a été calculée en utilisant la solution du multiplicateur de Lagrange. En second lieu, les effets convectifs ont été inclus par la résolution des équations de Stokes dans la phase liquide en utilisant la méthode des éléments finis étendue aussi. Troisièmement, le changement de densité entre les phases solide et liquide, généralement négligé dans la littérature, a été pris en compte par l’ajout d’une condition aux limites de vitesse non nulle à l’interface solide-liquide pour respecter la conservation de la masse dans le système. Des problèmes analytiques et numériques ont été résolus pour valider les divers composants du modèle et le système d’équations couplés. Les solutions aux problèmes numériques ont été comparées aux solutions obtenues avec l’algorithme de déplacement de maillage de Comsol. Ces comparaisons démontrent que le modèle par éléments finis étendue reproduit correctement le problème de changement phase avec densités variables.

Escala de perceção dos alunos sobre o feedback dos professores: construção e validação

O presente estudo procura testar as propriedades psicométricas de um questionário que avalia (a) perceção do aluno sobre o feedback do professor; a identificação escolar do aluno; as trajetórias escolares (factos e expectativas) e; a perceção do aluno sobre o seu envolvimento escolar. O questionário foi aplicado a 1089 alunos dos 6º, 7º, 9º e 10º anos de escolaridade (M=13.4, DP=1.7), sendo que 52% são do sexo feminino. A amostra é composta por alunos essencialmente de nacionalidade portuguesa (95.9%). A partir dos resultados da análise factorial e seguindo o racional teórico, chegou-se a uma estrutura composta por oito dimensões principais. O QFITE apresenta bons índices de consistência interna, com sete das oito principais dimensões a obterem valores entre .77 e .89. Assim, as análises psicométricas realizadas revelam valores satisfatórios, concluindo-se que o QFITE é um instrumento útil e adequado para avaliar a identificação escolar dos alunos, o envolvimento comportamental escolar, e as perceções dos alunos sobre o feedback do professor.

Receptors, sparks and waves in a fire-diffuse-fire framework for calcium release

Calcium ions are an important second messenger in living cells. Indeed calcium signals in the form of waves have been the subject of much recent experimental interest. It is now well established that these waves are composed of elementary stochastic release events (calcium puffs or sparks) from spatially localised calcium stores. The aim of this paper is to analyse how the stochastic nature of individual receptors within these stores combines to create stochastic behaviour on long timescales that may ultimately lead to waves of activity in a spatially extended cell model. Techniques from asymptotic analysis and stochastic phase-plane analysis are used to show that a large cluster of receptor channels leads to a release probability with a sigmoidal dependence on calcium density. This release probability is incorporated into a computationally inexpensive model of calcium release based upon a stochastic generalization of the Fire-Diffuse-Fire (FDF) threshold model. Numerical simulations of the model in one and two dimensions (with stores arranged on both regular and disordered lattices) illustrate that stochastic calcium release leads to the spontaneous production of calcium sparks that may merge to form saltatory waves. Illustrations of spreading circular waves, spirals and more irregular waves are presented. Furthermore, receptor noise is shown to generate a form of array enhanced coherence resonance whereby all calcium stores release periodically and simultaneously.

Waves, bumps, and patterns in neural field theories

Neural field models of firing rate activity have had a major impact in helping to develop an understanding of the dynamics seen in brain slice preparations. These models typically take the form of integro-differential equations. Their non-local nature has led to the development of a set of analytical and numerical tools for the study of waves, bumps and patterns, based around natural extensions of those used for local differential equation models. In this paper we present a review of such techniques and show how recent advances have opened the way for future studies of neural fields in both one and two dimensions that can incorporate realistic forms of axo-dendritic interactions and the slow intrinsic currents that underlie bursting behaviour in single neurons.

Electrical and optical studies on carbon nanotube arrays

Single-walled carbon nanotubes (SWNTs) have been studied as a prominent class of high performance electronic materials for next generation electronics. Their geometry dependent electronic structure, ballistic transport and low power dissipation due to quasi one dimensional transport, and their capability of carrying high current densities are some of the main reasons for the optimistic expectations on SWNTs. However, device applications of individual SWNTs have been hindered by uncontrolled variations in characteristics and lack of scalable methods to integrate SWNTs into electronic devices. One relatively new direction in SWNT electronics, which avoids these issues, is using arrays of SWNTs, where the ensemble average may provide uniformity from device to device, and this new breed of electronic material can be integrated into electronic devices in a scalable fashion. This dissertation describes (1) methods for characterization of SWNT arrays, (2) how the electrical transport in these two-dimensional arrays depend on length scales and spatial anisotropy, (3) the interaction of aligned SWNTs with the underlying substrate, and (4) methods for scalable integration of SWNT arrays into electronic devices. The electrical characterization of SWNT arrays have been realized by polymer electrolyte-gated SWNT thin film transistors (TFTs). Polymer electrolyte-gating addresses many technical difficulties inherent to electrical characterization by gating through oxide-dielectrics. Having shown polymer electrolyte-gating can be successfully applied on SWNT arrays, we have studied the length scaling dependence of electrical transport in SWNT arrays. Ultrathin films formed by sub-monolayer surface coverage of SWNT arrays are very interesting systems in terms of the physics of two-dimensional electronic transport. We have observed that they behave qualitatively different than the classical conducting films, which obey the Ohm’s law. The resistance of an ultrathin film of SWNT arrays is indeed non-linear with the length of the film, across which the transport occurs. More interestingly, a transition between conducting and insulating states is observed at a critical surface coverage, which is called percolation limit. The surface coverage of conducting SWNTs can be manipulated by turning on and off the semiconductors in the SWNT array, leading to the operation principle of SWNT TFTs. The percolation limit depends also on the length and the spatial orientation of SWNTs. We have also observed that the percolation limit increases abruptly for aligned arrays of SWNTs, which are grown on single crystal quartz substrates. In this dissertation, we also compare our experimental results with a two-dimensional stick network model, which gives a good qualitative picture of the electrical transport in SWNT arrays in terms of surface coverage, length scaling, and spatial orientation, and briefly discuss the validity of this model. However, the electronic properties of SWNT arrays are not only determined by geometrical arguments. The contact resistances at the nanotube-nanotube and nanotube-electrode (bulk metal) interfaces, and interactions with the local chemical groups and the underlying substrates are among other issues related to the electronic transport in SWNT arrays. Different aspects of these factors have been studied in detail by many groups. In fact, I have also included a brief discussion about electron injection onto semiconducting SWNTs by polymer dopants. On the other hand, we have compared the substrate-SWNT interactions for isotropic (in two dimensions) arrays of SWNTs grown on Si/SiO2 substrates and horizontally (on substrate) aligned arrays of SWNTs grown on single crystal quartz substrates. The anisotropic interactions associated with the quartz lattice between quartz and SWNTs that allow near perfect horizontal alignment on substrate along a particular crystallographic direction is examined by Raman spectroscopy, and shown to lead to uniaxial compressive strain in as-grown SWNTs on single crystal quartz. This is the first experimental demonstration of the hard-to-achieve uniaxial compression of SWNTs. Temperature dependence of Raman G-band spectra along the length of individual nanotubes reveals that the compressive strain is non-uniform and can be larger than 1% locally at room temperature. Effects of device fabrication steps on the non-uniform strain are also examined and implications on electrical performance are discussed. Based on our findings, there are discussions about device performances and designs included in this dissertation. The channel length dependences of device mobilities and on/off ratios are included for SWNT TFTs. Time response of polymer-electrolyte gated SWNT TFTs has been measured to be ~300 Hz, and a proof-of-concept logic inverter has been fabricated by using polymer electrolyte gated SWNT TFTs for macroelectronic applications. Finally, I dedicated a chapter on scalable device designs based on aligned arrays of SWNTs, including a design for SWNT memory devices.

Continuum tensor network field states, path integral representations and spatial symmetries

A natural way to generalize tensor network variational classes to quantum field systems is via a continuous tensor contraction. This approach is first illustrated for the class of quantum field states known as continuous matrix-product states (cMPS). As a simple example of the path-integral representation we show that the state of a dynamically evolving quantum field admits a natural representation as a cMPS. A completeness argument is also provided that shows that all states in Fock space admit a cMPS representation when the number of variational parameters tends to infinity. Beyond this, we obtain a well-behaved field limit of projected entangled-pair states (PEPS) in two dimensions that provide an abstract class of quantum field states with natural symmetries. We demonstrate how symmetries of the physical field state are encoded within the dynamics of an auxiliary field system of one dimension less. In particular, the imposition of Euclidean symmetries on the physical system requires that the auxiliary system involved in the class' definition must be Lorentz-invariant. The physical field states automatically inherit entropy area laws from the PEPS class, and are fully described by the dissipative dynamics of a lower dimensional virtual field system. Our results lie at the intersection many-body physics, quantum field theory and quantum information theory, and facilitate future exchanges of ideas and insights between these disciplines.

Evolução da perceção de coesão, clima motivacional eficácia coletiva, e competência ao longo da época desportiva em equipas de hóquei em patins

Projeto de Investigação apresentado para a obtenção do grau de Mestre em Psicologia do Desporto e do Exercício

An exploratory study of the relationship between psychosocial hazard and ambulatory physiological response in higher education employees.

Purpose: as exposure to psychosocial hazard at work represents a substantial risk factor for employee health in many modern occupations, being able to accurately assess how employees cope with their working environment is crucial. As the workplace is generally accepted as being a dynamic environment consideration should be given to the interaction between employees and the acute environmental characteristics of their workplace. The aim of this study was to investigate the effects of both acute demand and chronic work-related psychosocial hazard upon employees through ambulatory assessment of heart rate variability and blood pressure. Design: a within-subjects repeated measures design was used to investigate the relationship between exposure to work-related psychosocial hazard and ambulatory heart rate variability and blood pressure in a cohort of higher education employees. Additionally the effect of acute variation in perceived work-related demand was investigated. Results: two dimensions of the Management Standards were found to demonstrate an association with heart rate variability; more hazardous levels of “demand” and “relationships” were associated with decreased SDNN. Significant changes in blood pressure and indices of heart rate variability were observed with increased acute demand.

Exotic dynamics in a firing rate model of neural tissue with threshold accommodation

Many of the equations describing the dynamics of neural systems are written in terms of firing rate functions, which themselves are often taken to be threshold functions of synaptic activity. Dating back to work by Hill in 1936 it has been recognized that more realistic models of neural tissue can be obtained with the introduction of state-dependent dynamic thresholds. In this paper we treat a specific phenomenological model of threshold accommodation that mimics many of the properties originally described by Hill. Importantly we explore the consequences of this dynamic threshold at the tissue level, by modifying a standard neural field model of Wilson-Cowan type. As in the case without threshold accommodation classical Mexican-Hat connectivity is shown to allow for the existence of spatially localized states (bumps) in both one and two dimensions. Importantly an analysis of bump stability in one dimension, using recent Evans function techniques, shows that bumps may undergo instabilities leading to the emergence of both breathers and traveling waves. Moreover, a similar analysis for traveling pulses leads to the conditions necessary to observe a stable traveling breather. In the regime where a bump solution does not exist direct numerical simulations show the possibility of self-replicating bumps via a form of bump splitting. Simulations in two space dimensions show analogous localized and traveling solutions to those seen in one dimension. Indeed dynamical behavior in this neural model appears reminiscent of that seen in other dissipative systems that support localized structures, and in particular those of coupled cubic complex Ginzburg-Landau equations. Further numerical explorations illustrate that the traveling pulses in this model exhibit particle like properties, similar to those of dispersive solitons observed in some three component reaction-diffusion systems. A preliminary account of this work first appeared in S Coombes and M R Owen, Bumps, breathers, and waves in a neural network with spike frequency adaptation, Physical Review Letters 94 (2005), 148102(1-4).

Da casta ao terroir

Pela importância atual – e crescente – que o vinho tem na economia portuguesa, pela margem existente para a apresentação de temas de reflexão que acrescentem valor ao posicionamento do setor, pela experiência pessoal e paixão pela área, decidi elaborar a minha dissertação numa temática enquadrável no setor do vinho, em particular no vinho Alvarinho proveniente do terroir que representa a Denominação de Origem Vinho Verde Sub-região de Monção e Melgaço. A estrutura deste estudo assenta em duas dimensões: a primeira, numa perspetiva local, assente na recente decisão de alargar a Denominação Origem Vinho Verde Alvarinho a todas as sub-regiões que integram a Região dos Vinhos Verdes, com efeitos em 2021. Pelo que se procurará mostrar a importância da relação desta casta com o seu terroir de origem e, perante esta interligação, qual o fator mais importante a utilizar na comunicação do vinho. A segunda prende-se com a dimensão internacional que se pretende para o Alvarinho no mercado dos grandes vinhos brancos mundiais, onde encontramos castas brancas de renome como a Chardonnay e a Riesling, face a esta exposição e à crescente aposta na casta a nível mundial, como agir perante a potencial ameaça que representa a entrada dos países do “Novo Mundo”. Posto isto, é neste contexto que se coloca a questão que está na génese desta dissertação: de que forma o terroir contribui como fator de diferenciação e de vantagem competitiva do Alvarinho produzido na Denominação de Origem Vinho Verde Sub-região Monção e Melgaço no mercado dos grandes vinhos brancos mundiais? Cuja resposta poderá em grande parte estar, no meu entendimento, na análise de um caso de sucesso, que nesta dissertação é representada pelo trabalho realizado em torno do Rieseling produzido no Vale de Mosel e que contribuiu para que este tivesse conquistado a sua reputação.