Le rôle de l’évaluation économique dans la pratique des médecins de famille = The role of economic evaluation in the practice of family physicians

L’évaluation économique en santé consiste en l’analyse comparative d’alternatives de services en regard à la fois de leurs coûts et de leurs conséquences. Elle est un outil d’aide à la décision. La grande majorité des décisions concernant l’allocation des ressources sont prises en clinique; particulièrement au niveau des soins primaires. Puisque chaque décision est associée à un coût d’opportunité, la non-prise en compte des considérations économiques dans les pratiques des médecins de famille peut avoir un impact important sur l’efficience du système de santé. Il existe peu de connaissances quant à l’influence des évaluations économiques sur la pratique clinique. L’objet de la thèse est de comprendre le rôle de l’évaluation économique dans la pratique des médecins de famille. Ses contributions font l’objet de quatre articles originaux (philosophique, théorique, méthodologique et empirique). L’article philosophique suggère l’importance des questions de complexité et de réflexivité en évaluation économique. La complexité est la perspective philosophique, (approche générale épistémologique) qui sous-tend la thèse. Cette vision du monde met l’attention sur l’explication et la compréhension et sur les relations et les interactions (causalité interactive). Cet accent sur le contexte et le processus de production des données souligne l’importance de la réflexivité dans le processus de recherche. L’article théorique développe une conception nouvelle et différente du problème de recherche. L’originalité de la thèse réside également dans son approche qui s’appuie sur la perspective de la théorie sociologique de Pierre Bourdieu; une approche théorique cohérente avec la complexité. Opposé aux modèles individualistes de l’action rationnelle, Bourdieu préconise une approche sociologique qui s’inscrit dans la recherche d’une compréhension plus complète et plus complexe des phénomènes sociaux en mettant en lumière les influences souvent implicites qui viennent chaque jour exercer des pressions sur les individus et leurs pratiques. L’article méthodologique présente le protocole d’une étude qualitative de cas multiples avec niveaux d’analyse imbriqués : les médecins de famille (niveau micro-individuel) et le champ de la médecine familiale (niveau macro-structurel). Huit études de cas furent réalisées avec le médecin de famille comme unité principale d’analyse. Pour le niveau micro, la collecte des informations fut réalisée à l’aide d’entrevues de type histoire de vie, de documents et d’observation. Pour le niveau macro, la collecte des informations fut réalisée à l’aide de documents, et d’entrevues de type semi-structuré auprès de huit informateurs clés, de neuf organisations médicales. L’induction analytique fut utilisée. L’article empirique présente l’ensemble des résultats empiriques de la thèse. Les résultats montrent une intégration croissante de concepts en économie dans le discours officiel des organisations de médecine familiale. Cependant, au niveau de la pratique, l'économisation de ce discours ne semble pas être une représentation fidèle de la réalité puisque la très grande majorité des participants n'incarnent pas ce discours. Les contributions incluent une compréhension approfondie des processus sociaux qui influencent les schèmes de perception, de pensée, d’appréciation et d’action des médecins de famille quant au rôle de l’évaluation économique dans la pratique clinique et la volonté des médecins de famille à contribuer à une allocation efficiente, équitable et légitime des ressources.

Marketing Management in Small Scale Industrial Units of Women Entrepreneurs in Kerala - A Study with Reference to Ernakulam District",

The women entrepreneurs, who set up business units with encouragement and institutional support, find it difficult to market their products. The marketing concept is yet to be grasped in its entirety. Women entrepreneurs especially find the marketing fiinctions difficult to carry out. Hence, this study is carried out to understand the marketing management in SSI units of women entrepreneurs

Designing context-aware adaptive units of learning based on IMS-LD standard

Learning contents adaptation has been a subject of interest in the research area of the adaptive hypermedia systems. Defining which variables and which standards can be considered to model adaptive content delivery processes is one of the main challenges in pedagogical design over e-learning environments. In this paper some specifications, architectures and technologies that can be used in contents adaptation processes considering characteristics of the context are described and a proposal to integrate some of these characteristics in the design of units of learning using adaptation conditions in a structure of IMS-Learning Design (IMS-LD) is presented. The key contribution of this work is the generation of instructional designs considering the context, which can be used in Learning Management Systems (LMSs) and diverse mobile devices

Extensión de la especificación IMS Learning Design desde la adaptación e integración de unidades de aprendizaje. `Extension of the IMS Learnin Design specification based on adaptation and integration of units of learning´.

La tesis se centra en el aprendizaje personalizado y en la integración de Unidades de Aprendizaje. El objetivo fundamental es mejorar la expresividad pedagógica de IMS-LD, refinando estructuras de modelado y arquitectura existentes y desarrollando estructuras complementarias que permitan una formalización más precisa, versátil y sencilla de procesos de aprendizaje adaptativo y de mecanismos y procesos de integración con sistemas de aprendizaje y otras especificaciones. En esta tesis se estudia la especificación desde la base, analizando su modelo de información y cómo se construyen Unidades de Aprendizaje. Se analiza la estructura de la especificación, basándose en un estudio teórico y una investigación práctica fruto del modelado de Unidades de Aprendizaje reales y ejecutables que proporcionan una información útil de base. A partir de este estudio, se analiza la integración de Unidades de Aprendizaje con otros sistemas y especificaciones, abarcando desde la integración mínima mediante un enlace directo hasta compartir variables y estados que permiten una comunicación en tiempo real de ambas partes. La conclusión es que IMS-LD necesita una reestructuración y modificación de ciertos elementos, así como la incorporación de otros nuevos, para mejorar una expresividad pedagógica y una capacidad de integración con otros sistemas de aprendizaje y estándares eLearning, si se pretenden alcanzar: la personalización del proceso de aprendizaje y la interoperabilidad real. La implantación de la especificación se vería mejorada si existieran unas herramientas de más alto nivel, preferiblemente con planteamiento visual, que permitieran un modelado sencillo por parte de los usuarios finales reales de este tipo de especificaciones, como son los profesores, los creadores de contenido y los pedagogos-didactas que diseñan la experiencia de aprendizaje.

Fifty years of international business theory and beyond

As the field of international business has matured, there have been shifts in the core unit of analysis. First, there was analysis at country level, using national statistics on trade and foreign direct investment (FDI). Next, the focus shifted to the multinational enterprise (MNE) and the parent’s firm specific advantages (FSAs). Eventually the MNE was analysed as a network and the subsidiary became a unit of analysis. We untangle the last fifty years of international business theory using a classification by these three units of analysis. This is the country-specific advantage (CSA) and firm-specific advantage (FSA) matrix. Will this integrative framework continue to be useful in the future? We demonstrate that this is likely as the CSA/FSA matrix permits integration of potentially useful alternative units of analysis, including the broad region of the triad. Looking forward, we develop a new framework, visualized in two matrices, to show how distance really matters and how FSAs function in international business. Key to this are the concepts of compounded distance and resource recombination barriers facing MNEs when operating across national borders.

Construction management research at the individual-level of analysis: current status, gaps and future directions

Individual-level constructs are seldom taken into consideration in construction management research relating to project performance. This is antithetical to the objectives of properly conceptualizing and contextualizing the research we do because many project performance outcomes, such as the extent of cooperation and level of communication or teamwork are influenced and moderated by individuals’ perceptions, values and behaviour. A brief review of the literature in organizational studies centred on culture, identity, empowerment and trust is offered. These constructs are then explored in relation to project performance issues and outcomes, and it is noted that they are predominantly studied at the project and industry levels. We argue that focusing these constructs at the individual unit of analysis has significant implications for project performance and therefore their effects need to be systematically accounted for in explanations of the success and failure of projects. Far from being prescriptive, the aim is to generate interest and awareness for more focused research at the individual level of analysis in order to add new insights and perspectives to critical performance questions in construction management. To this end, a research agenda is outlined, arguing that construction management research integrating individual-level constructs and broader, macro-contextual issues will help define and enhance the legitimacy of the field.

Zero-Dimensional Units of Ligand-Bridged Gallium-Sulfide Supertetrahedra

The synthesis and characterization of the first anions containing two gallium-sulfide supertetrahedra linked via an organic moiety are described.

The Genetics of Alzheimer`s Disease in Brazil: 10 Years of Analysis in a Unique Population

Alzheimer`s Disease (AD) is the most common type of dementia among the elderly, with devastating consequences for the patient, their relatives, and caregivers. More than 300 genetic polymorphisms have been involved with AD, demonstrating that this condition is polygenic and with a complex pattern of inheritance. This paper aims to report and compare the results of AD genetics studies in case-control and familial analysis performed in Brazil since our first publication, 10 years ago. They include the following genes/markers: Apolipoprotein E (APOE), 5-hidroxytryptamine transporter length polymorphic region (5-HTTLPR), brain-derived neurotrophin factor (BDNF), monoamine oxidase A (MAO-A), and two simple-sequence tandem repeat polymorphisms (DXS1047 and D10S1423). Previously unpublished data of the interleukin-1 alpha (IL-1 alpha) and interleukin-1 beta (IL-1 beta) genes are reported here briefly. Results from others Brazilian studies with AD patients are also reported at this short review. Four local families studied with various markers at the chromosome 21, 19, 14, and 1 are briefly reported for the first time. The importance of studying DNA samples from Brazil is highlighted because of the uniqueness of its population, which presents both intense ethnical miscegenation, mainly at the east coast, but also clusters with high inbreeding rates in rural areas at the countryside. We discuss the current stage of extending these studies using high-throughput methods of large-scale genotyping, such as single nucleotide polymorphism microarrays, associated with bioinformatics tools that allow the analysis of such extensive number of genetics variables, with different levels of penetrance. There is still a long way between the huge amount of data gathered so far and the actual application toward the full understanding of AD, but the final goal is to develop precise tools for diagnosis and prognosis, creating new strategies for better treatments based on genetic profile.

Paleomagnetic data and K-Ar ages from Mesozoic units of the Santa Marta massif: A preliminary interpretation for block rotation and translations

We report 6 K-Ar ages and paleomagnetic data from 28 sites collected in Jurassic, Lower Cretaceous and Paleocene rocks of the Santa Marta massif, to test previous hypothesis of rotations and translations of this massif, whose rock assemblage differs from other basement-cored ranges adjacent to the Guyana margin. Three magnetic components were identified in this study. A first component has a direction parallel to the present magnetic field and was uncovered in all units (D 352, I = 25.6, k = 57.35, a95 = 5.3, N = 12). A second component was isolated in Cretaceous limestone and Jurassic volcaniclastic rocks (D = 8.8, I = 8.3, k = 24.71, a95 = 13.7, N = 6), and it was interpreted as of Early Cretaceous age. In Jurassic sites with this component, Early Cretaceous K-Ar ages obtained from this and previous studies are interpreted as reset ages. The third component was uncovered in eight sites of Jurassic volcaniclastic rocks, and its direction indicates negative shallow to moderate inclinations and northeastward declinations. K-Ar ages in these sites are of Early (196.5 +/- 4.9 Ma) to early Late Jurassic age (156.6 +/- 8.9 Ma). Due to local structural complexity and too few Cretaceous outcrops to perform a reliable unconformity test, we only used two sites with (1) K-Ar ages, (2) less structural complexity, and (3) reliable structural data for Jurassic and Cretaceous rocks. The mean direction of the Jurassic component is (D = 20.4, I = -18.2, k = 46.9, a95 = 5.1, n = 18 specimens from two sites). These paleomagnetic data support previous models of northward along-margin translations of Grenvillian-cored massifs. Additionally, clockwise vertical-axis rotation of this massif, with respect to the stable craton, is also documented; the sense of rotation is similar to that proposed for the Perija Range and other ranges of the southern Caribbean margin. More data is needed to confirm the magnitudes of rotations and translations. (C) 2009 Elsevier Ltd. All rights reserved.

Precambrian geotectonic units of the Rio de La Plata craton

The main Precambrian tectonic units of Uruguay include the Piedra Alta tectonostratigraphic terrane (PATT) and Nico Perez tectonostratigraphic terrane (NPTT), separated by the Sarandi del Yi high-strain zone. Both terranes are well exposed in the Rio de La Plata craton (RPC). Although these tectonic units are geographically small, they record a wide span of geologic time. Therefore improved geological knowledge of this area provides a fuller understanding of the evolution of the core of South America. The PATT is constituted by low-to medium-grade metamorphic belts (ca. 2.1 Ga); its petrotectonic associations such as metavolcanic units, conglomerates, banded iron formations, and turbiditic deposits suggest a back-arc or a trench-basin setting. Also in the PATT, a late to post-orogenic, arc-related layered mafic complex (2.3-1.9 Ga), followed by A-type granites (2.08 Ga), and finally a taphrogenic mafic dike swarm (1.78 Ga) occur. The less thoroughly studied NPTT consists of Palaeoproterozoic high-grade metamorphic sequences (ca. 2.2 Ga), mylonites and postorogenic and rapakivi granites (1.75 Ga). The Brasiliano-Pan African orogeny affected this terrane. Neoproterozoic cover occurs in both tectonostratigraphic terranes, but is more developed in the NPTT. Over the past 15 years, new isotopic studies have improved our recognition of different tectonic events and associated processes, such as reactivation of shear zones and fluids circulation. Transamazonian and Statherian tectonic events were recognized in the RPC. Based on magmatism, deformation, basin development and metamorphism, we propose a scheme for the Precambrian tectonic evolution of Uruguay, which is summarized in the first Palaeoproterozoic tectonic map of the Rio de La Plata craton.

ALTERNATING UNITS AS FREE FACTORS IN THE GROUP OF UNITS OF INTEGRAL GROUP RINGS

Let G be a group of odd order that contains a non-central element x whose order is either a prime p >= 5 or 3(l), with l >= 2. Then, in U(ZG), the group of units of ZG, we can find an alternating unit u based on x, and another unit v, which can be either a bicyclic or an alternating unit, such that for all sufficiently large integers m we have that < u(m), v(m)> = < u(m)> * < v(m)> congruent to Z * Z.

A theoretical framework of analysis of accounting propensity in different religions

“Can accounting practices be analyzed in a religious system of beliefs framework?”- this paper discusses and develops a theoretical framework for answering the question based on Hofstede and Gray’s model and an analysis of accounting practices in an Islamic agenda. The paper has three purposes. First, it analyses Hofstede and Gray’s model of accounting practices derived from a cultural framework including authority, measurement, enforcement and disclosure. Then, it is argued that Hofstede’s cultural values drive to depict the Islamic societal values by referencing Holy books verses of Muslim; Koran. Third, the study utilizes the Islamic societal values by applying Gray’s model to develop a theory for determining Islamic accounting practices. The model developed here provides a reasonably sound explanation of how religion as one cultural factor affects accounting practices in different societies. In examining Islam as one of the influential religions in the world, the paper reasons that Islamic accounting configuration attends to statutory control in accounting authority, moderate in disclosure of financial information, uniformity in using accounting methods and principles, and optimism in regard to accounting measurements.

Small firms as social formations : relationships as the unit of analysis for eBusiness adoption research

Existing research concerning the adoption of Electronic Business (eBusiness) by small firms has primarily investigated the factors influencing their adoption decisions, with firms being the unit of analysis. In addition, the research assumes that it is primarily small firm owners, employees, trading partners, eBusiness product/service providers, government and business networks which influence adoption. This paper argues that small firms can more accurately be characterised as social formations whereby family, friends and social networks most likely play a significant, often overlooked, role. On this basis the paper argues that future research should include relationships within and external to small firms as the unit of analysis, not just the firm. The paper concludes by examining whether the theories commonly used to explore small firm eBusiness adoption are suitable for relationship-based research.

Ecotourism in Costa Rica: an economic framework of analysis

Costa Rica is a small Central American nation that has gained an international reputation as a leader in environmental conservation. This has formed the base for its highly successful and lucrative small-scale ecotourism industry. However, there are threats from high rates of deforestation and expanding large scale tourism that is trading on strong environmental credentials. This paper sets out an ecologically sustainable economic framework to firstly examine the Costa Rican experience, and then analyse lessons for general policy development of any ecotourism industry. The analysis is conducted from a political economy perspective on the trade-offs between small-scale and large-scale tourism.