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.

Chemical Evaluation of Selected Organics and Trace Metals in the Mangrove Macroflora Of Cochin

Mangroves are considered to play a significant role in global carbon cycling. Themangrove forests would fix CO2 by photosynthesis into mangrove lumber and thus decrease the possibility of a catastrophic series of events - global warming by atmospheric CO2, melting of the polar ice caps, and inundation of the great coastal cities of the world. The leaf litter and roots are the main contributors to mangrove sediments, though algal production and allochthonous detritus can also be trapped (Kristensen et al, 2008) by mangroves due to their high organic matter content and reducing nature are excellent metal retainers. Environmental pollution due to metals is of major concern. This is due to the basic fact that metals are not biodegradable or perishable the way most organic pollutants are. While most organic toxicants can be destroyed by combustion and converted into compounds such as C0, C02, SOX, NOX, metals can't be destroyed. At the most the valance and physical form of metals may change. Concentration of metals present naturally in air, water and soil is very low. Metals released into the environment through anthropogenic activities such as burning of fossils fuels, discharge of industrial effluents, mining, dumping of sewage etc leads to the development of higher than tolerable or toxic levels of metals in the environment leading to metal pollution. Of course, a large number of heavy metals such as Fe, Mn, Cu, Ni, Zn, Co, Cr, Mo, and V are essential to plants and animals and deficiency of these metals may lead to diseases, but at higher levels, it would lead to metal toxicity. Almost all industrial processes and urban activities involve release of at least trace quantities of half a dozen metals in different forms. Heavy metal pollution in the environment can remain dormant for a long time and surface with a vengeance. Once an area gets toxified with metals, it is almost impossible to detoxify it. The symptoms of metal toxicity are often quite similar to the symptoms of other common diseases such as respiratory problems, digestive disorders, skin diseases, hypertension, diabetes, jaundice etc making it all the more difficult to diagnose metal poisoning. For example the Minamata disease caused by mercury pollution in addition to affecting the nervous system can disturb liver function and cause diabetes and hypertension. The damage caused by heavy metals does not end up with the affected person. The harmful effects can be transferred to the person's progenies. Ironically heavy metal pollution is a direct offshoot of our increasing ability to mass produce metals and use them in all spheres of existence. Along with conventional physico- chemical methods, biosystem approachment is also being constantly used for combating metal pollution

Molecular effects on the cross section for pair production and their importance in the evaluation of the total photonuclear cross section of {^16}O in the {\delta-resonance} region

The screening correction to the coherent pair-production cross section on the oxygen molecule has been calculated using self-consistent relativistic wave functions for the one-center and two-center Coulomb potentials. It is shown that the modification of the wave function due to molecular binding and the interference between contributions from the two atoms have both sizeable effects on the screening correction. The so-obtained coherent pair-production cross section which makes up the largest part of the total atomic cross section was used to evaluate the total nuclear absorption cross section from photon attenuation measurements on liquid oxygen. The result agrees with cross sections for other nuclei if A-scaling is assumed. The molecular effect on the pair cross section amounts to 15 % of the nuclear cross section in the {\delta-resonance} region.

Economic evaluation of proposed pure and mixed stands in Central Vietnam highlands

In comparison with mixed forest stands, the cultivation of pure plantations in Vietnam entails serious ecological consequences such as loss of biodiversity and higher rate of soil erosion. The economic evaluation is elaborated between pure plantations and mixed forests where the fast-growing tree species are mixed with slow growing tree species which are planted in stripes separating the segments with fast-growing tree species (Acacia sp.). For the evaluation, the input values were used from local costs of goods, services and labour. The results show that the internal rate of return is the highest in the case of pure plantation in comparison with mixed forests – 86% to 77%(first planting pattern: Acacia sp. + noble hardwood species) and 54% (second planting pattern: Acacia + Dipterocarpus sp. + Sindora sp.). The average profit per hectare and year is almost five times higher in the case of mixed stands. The first planting pattern reaches 2,650 $, the second planting pattern 2,280 $ and the pure acacia plantation only 460 $. From an economic point of view, the cultivation of mixed forests that corresponds to the principles of sustainable forestry generates a good economical profit while maintaining habitat complexity and biodiversity.

Assembly Design and Evaluation in an Augmented Reality Environment

The technologies and methodologies of assembly design and evaluation in the early design stage are highly significant to product development. This paper looks at a promising technology to mix real components (e.g. physical prototypes, assembly tools, machines, etc.) with virtual components to create an Augmented Reality (AR) interface for assembly process evaluation. The goal of this paper is to clarify the methodologies and enabling technologies of how to establish an AR assembly simulation and evaluation environment. The architecture of an AR assembly system is proposed and the important functional modules including AR environment set-up, design for assembly (DFA) analysis and AR assembly sequence planning in an AR environment are discussed in detail.

How to improve the formal analytic reasoning and scientific motivation in the intellectual training of medical students

A review article of the The New England Journal of Medicine refers that almost a century ago, Abraham Flexner, a research scholar at the Carnegie Foundation for the Advancement of Teaching, undertook an assessment of medical education in 155 medical schools in operation in the United States and Canada. Flexner’s report emphasized the nonscientific approach of American medical schools to preparation for the profession, which contrasted with the university-based system of medical education in Germany. At the core of Flexner’s view was the notion that formal analytic reasoning, the kind of thinking integral to the natural sciences, should hold pride of place in the intellectual training of physicians. This idea was pioneered at Harvard University, the University of Michigan, and the University of Pennsylvania in the 1880s, but was most fully expressed in the educational program at Johns Hopkins University, which Flexner regarded as the ideal for medical education. (...)

AURPO Guidance - the safe use of lasers in research and education

AURPO Guidance - The safe use of lasers in research and education - Guidance note no.7, 2012 Edition

More women in informatics research and education

Speaker: Lynda Hardman Organiser: Time: 04/02/2015 12:30-13:30 Location: B32/3077 Abstract The challenges of addressing gender inequalities in science, technology, engineering, mathematics and medicine is widely acknowledged. We currently hold a bronze award and ECS is one of many academic units in the University which has gained Athena Swan Charter status. In this seminar, Professor Lynda Hardman, Chair of the Informatics Europe working group "Women in Informatics Research and Education” will be explaining the causes of issued underlying gender inequality and constructive routes to addressing this important agenda. In undertaking to commit to an action plan which is a prerequisite of gaining charter status, the University or academic department agreed to accept and incorporate the Athena Swan six principles listed below: * To address gender inequalities requires commitment and action from everyone, at all levels of the organisation * To tackle the unequal representation of women in science requires changing cultures and attitudes across the organisation * The absence of diversity at management and policy-making levels has broad implications which the organisation will examine * The high loss rate of women in science is an urgent concern which the organisation will address * The system of short-term contracts has particularly negative consequences for the retention and progression of women in science, which the organisation recognises * There are both personal and structural obstacles to women making the transition from PhD into a sustainable academic career in science, which require the active consideration of the organisation. This seminar is designed to provide an opportunity to explore these issues NOTE: Lynda will be basing here talk on some of the work she directed as chair of the "Women in Informatics Research and Education” working group. The purpose of the working group is to actively participate and promote actions that contribute to improve gender balance in Information and Communication Sciences and Technologies. The first concrete result of the working group's activities was the publication of the booklet "More Women in Informatics Research and Education" in 2013. The booklet is a compact source of clear and simple best practices to deans and heads of departments that aim to increase the participation of women as both students and employees in their institutions. Many tips included were also inspired by colleagues already in leading positions who have already implemented actions in their institutions to attract more women and ensure their continued participation in the organization at commensurate ratios with their male colleagues. The booklet is endorsed by the European Commission and features a foreword by Neelie Kroes, Vice-President of the European Commission, responsible for the Digital Agenda.

Research plan discussion: The socio-technical construction of MOOCs and educator practices in HE

In this seminar slot, we will discuss Steve's research aims and plan. Massive open online courses (MOOCs) have received substantial coverage in mainstream sources, academic media, and scholarly journals, both negative and positive. Numerous articles have addressed their potential impact on Higher Education systems in general, and some have highlighted problems with the instructional quality of MOOCs, and the lack of attention to research from online learning and distance education literature in MOOC design. However, few studies have looked at the relationship between social change and the construction of MOOCs within higher education, particularly in terms of educator and learning designer practices. This study aims to use the analytical strategy of Socio-Technical Interaction Networks (STIN) to explore the extent to which MOOCs are socially shaped and their relationship to educator and learning designer practices. The study involves a multi-site case study of 3 UK MOOC-producing universities and aims to capture an empirically based, nuanced understanding of the extent to which MOOCs are socially constructed in particular contexts, and the social implications of MOOCs, especially among educators and learning designers.

Occupational therapy and its relevance in social projects. relationships, learning and opportunities: collection of experiences of University of Alberta Mscot students in Bogotá, Colombia

Occupational therapists are equipped to promote wellbeing through occupation and to enable participation and meaningful engagement of people in their social and physical environments (WFOT, 2012). As such, the role of the occupational therapists is profoundly linked to the social, cultural and environmental characteristics of the contexts in which occupations take place. The central role that context plays in occupational performance creates an interesting dichotomy for the occupational therapist: on one hand, a profound understanding of cultural and social factors is required from the Occupational Therapy (OT) in order to develop a meaningful and successful collaboration with the person; on the other hand, the ability of the occupational therapists to recognize and explore the contextual factor of an occupation-person dyad transcends cultural and spatial barriers. As a result, occupational therapists are equipped to engage in international collaboration and practice, and as such face unique and enriching challenges. International fieldwork experiences have become a tool through which occupational therapists in training can develop the critical skills for understanding the impact of cultural and social factors on occupation. An OT student in an international fieldwork experience faces numerous challenges in leading a process that is both relevant and respectful to the characteristics of the local context: language, cultural perceptions of occupation and personhood, religious backgrounds, health care access, etc. These challenges stand out as ethical considerations that must be considered when navigating an international fieldwork experience (AOTA, 2009). For more than five years now, the Faculty of Rehabilitation Medicine (FRM) of the University of Alberta (UoFA) and the School of Medicine and Health Sciences at the Universidad del Rosario (UR), Bogota, Colombia, have sustained a productive and meaningful international collaboration. This collaboration includes a visit by Dr. Albert Cook, professor of the FRM and former dean, to the UR as the main guest speaker in the International Congress of Technologies for Disability Support (IBERDISCAP) in 2008. Furthermore, Dr. Cook was a speaker in the research seminar of the Assistive Technology Research Group of the Universidad del Rosario. Following Dr. Cook’s visit, Professors Liliana Álvarez and Adriana Ríos travelled to Edmonton and initiated collaboration with the FRM, resulting in the signing of an agreement between the FRM and the UR in 2009, agreement that has been maintained to this day. The main goal of this agreement is to increase academic and cultural cooperation between the UR and the UofA. Other activities have included the cooperation between Dr. Kim Adams (who has largely maintained interest and effort in supporting the capacity building of the UR rehabilitation programs in coordinating the provision of research placement opportunities for UR students at the UofA), an Assistive Technology course for clinicians and students led by Dr. Adams, and a research project that researched the use of basic cell phones to provide social interaction and health information access for people with disabilities in a low-income community in Colombia (led by Tim Barlott, OT, MSc, under the supervision of Dr. Adams). Since the beginning, the occupational therapy programs of the Universidad del Rosario and the University of Alberta have promoted this collaboration and have strived to engage in interactions that provide further development opportunities for students and staff. As part of this process, the international placement experience of UofA OT students was born under the leadership of: Claudia Rozo, OT program director at UR, placement and academic leadership of Elvis Castro and Angélica Monsalve, professors of the occupational therapy program at UR; and Dr. Lili Liu, OT department director at UofA, Cori Schmitz, Academic coordinator of clinical education at the UofA; and Tim Barlott and Liliana Álvarez leading the international and cross-cultural aspect of this collaboration.This publication summarizes and illustrates the process of international placement in community settings in Colombia, undertaken by occupational therapy students of the University of Alberta. It is our hope that this document can provide and document the ethical considerations of international fieldwork experience, the special characteristics of communities and the ways in which cultural and social competences are developed and help international students navigate the international setting. We also hope that this document will stimulate discussion among professional and academic communities about the importance and richness of international placement experiences and encourage staff and students to articulate their daily efforts with the global occupational therapy agenda.

Doing and using educational research : engaging researchers, practitioners and policy makers in productive partnerships. 'Haciendo y usando la investigación educativa : involucrando investigadores, docentes y diseñadores de políticas en asociaciones productivas'.

Resumen de la autora. Este artículo pertenece al monográfico 'John Elliott: su pensamiento y su influencia'

On the exhaustiveness of truncation and dropping strategies in many-to-many matching markets

We consider two–sided many–to–many matching markets in which each worker may work for multiple firms and each firm may hire multiple workers. We study individual and group manipulations in centralized markets that employ (pairwise) stable mechanisms and that require participants to submit rank order lists of agents on the other side of the market. We are interested in simple preference manipulations that have been reported and studied in empirical and theoretical work: truncation strategies, which are the lists obtained by removing a tail of least preferred partners from a preference list, and the more general dropping strategies, which are the lists obtained by only removing partners from a preference list (i.e., no reshuffling). We study when truncation / dropping strategies are exhaustive for a group of agents on the same side of the market, i.e., when each match resulting from preference manipulations can be replicated or improved upon by some truncation / dropping strategies. We prove that for each stable mechanism, truncation strategies are exhaustive for each agent with quota 1 (Theorem 1). We show that this result cannot be extended neither to group manipulations (even when all quotas equal 1 – Example 1), nor to individual manipulations when the agent’s quota is larger than 1 (even when all other agents’ quotas equal 1 – Example 2). Finally, we prove that for each stable mechanism, dropping strategies are exhaustive for each group of agents on the same side of the market (Theorem 2), i.e., independently of the quotas.

Bilingualism in education : aspects of theory, research and practice.

Esta concebido con un planteamiento integrador, en el que se tratan temas como el bilingüismo y el desarrollo cognitivo, programas de inmersión, la potenciación del papel de los estudiantes pertenecientes a minorías, la educación multicultural y no racista y la diversidad cultural y lingüística.

Learning objects management and evaluation in an e-learning environment. 'Objetos de gesti??n de aprendizaje y evaluaci??n en un entorno de e-learning'

Monogr??fico con el t??tulo: 'Estado actual de los sistemas e-learning'. Resumen basado en el de la publicaci??n

A review of research on working memory and its importance in education of the deaf

This independent study provides an overview of working memory as it pertains to deaf and hard of hearing students.