Financement et mode d'organisation des hôpitaux suisses : revue du recueil législatif de 1991 à 2009

Le financement des établissements de soins a connu dans le courant de l'année 2007 d'importants changements législatifs. De l'introduction de la tarification à l'activité sur la base des diagnostic-related groups (DRG) à la mise en concurrence directe des hôpitaux, qu'ils appartiennent au secteur public ou au secteur privé, de l'ingérence de la Confédération dans la planification hospitalière (jusque là domaine réservé des Cantons) à la mise au premier plan des critères de qualité dans l'évaluation des établissements hospitaliers, les exemples ne manquent pas pour illustrer le changement conceptuel auquel nous assistons. L'auteur de ces lignes, privilégiant l'approche historique à l'approche normative, s'est demandé quels étaient les prémices de ce changement législatif et s'est confronté aux différents textes qui ont émaillé les débats de ces vingt dernières années, qu'ils émanent du pouvoir exécutif (messages aux chambres fédérales, ordonnances d'application) ou du pouvoir législatif (textes de loi) afin d'en dégager la cohérence politique. Ce mémoire suit donc une ligne strictement chronologique. Il s'inspire des différents travaux parlementaires. A la lecture de ces textes, il apparaît que, pour les parlementaires, la question du financement des hôpitaux n'est qu'une partie, parfois essentielle, parfois accessoire, selon les époques et l'amplitude du champ d'application du document législatif, du financement des soins par l'assurance-maladie. Les grands principes qui régissent l'assurance-maladie s'appliquent donc nécessairement au financement des hôpitaux. Pour cette raison, il est apparu judicieux à l'auteur de ces lignes de ne pas séparer les deux problèmes et de se plonger dans un premier temps dans les débats qui ont eu cours lors de l'adoption de la nouvelle loi sur l'assurance-maladie (LAMaI) en 1994. [Auteur, p. 5]

Mode of interaction of the Gαo subunit of heterotrimeric G proteins with the GoLoco1 motif of Drosophila Pins is determined by guanine nucleotides.

Drosophila GoLoco motif-containing protein Pins is unusual in its highly efficient interaction with both GDP- and the GTP-loaded forms of the α-subunit of the heterotrimeric Go protein. We analysed the interactions of Gαo in its two nucleotide forms with GoLoco1-the first of the three GoLoco domains of Pins-and the possible structures of the resulting complexes, through combination of conventional fluorescence and FRET measurements as well as through molecular modelling. Our data suggest that the orientation of the GoLoco1 motif on Gαo significantly differs between the two nucleotide states of the latter. In other words, a rotation of the GoLoco1 peptide in respect with Gαo must accompany the nucleotide exchange in Gαo. The sterical hindrance requiring such a rotation probably contributes to the guanine nucleotide exchange inhibitor activity of GoLoco1 and Pins as a whole. Our data have important implications for the mechanisms of Pins regulation in the process of asymmetric cell divisions.

Seroprevalence of Coxiella burnetii and Brucella abortus among pregnant women.

Coxiella burnetii and Brucella abortus are two intracellular bacteria implicated in zoonotic miscarriage. In the present study, C. burnetii and B. abortus seroprevalence was compared among women from London with and without miscarriage. Coxiella burnetii seroprevalence was high (4.6%, 95% CI 2.8-7.1) despite the rare apparent exposure of this urban population. Only two patients exhibited anti-B. abortus antibodies. As a result of the risk of chronic Q fever with endocarditis and/or hepatitis, the mode of Coxiella burnetii infection in this population merits further investigation.

Quantitative performance of a quadrupole-orbitrap-MS in targeted LC-MS determinations of small molecules.

High-resolution mass spectrometry (HRMS) has been associated with qualitative and research analysis and QQQ-MS with quantitative and routine analysis. This view is now challenged and for this reason, we have evaluated the quantitative LC-MS performance of a new high-resolution mass spectrometer (HRMS), a Q-orbitrap-MS, and compared the results obtained with a recent triple-quadrupole MS (QQQ-MS). High-resolution full-scan (HR-FS) and MS/MS acquisitions have been tested with real plasma extracts or pure standards. Limits of detection, dynamic range, mass accuracy and false positive or false negative detections have been determined or investigated with protease inhibitors, tyrosine kinase inhibitors, steroids and metanephrines. Our quantitative results show that today's available HRMS are reliable and sensitive quantitative instruments and comparable to QQQ-MS quantitative performance. Taking into account their versatility, user-friendliness and robustness, we believe that HRMS should be seen more and more as key instruments in quantitative LC-MS analyses. In this scenario, most targeted LC-HRMS analyses should be performed by HR-FS recording virtually "all" ions. In addition to absolute quantifications, HR-FS will allow the relative quantifications of hundreds of metabolites in plasma revealing individual's metabolome and exposome. This phenotyping of known metabolites should promote HRMS in clinical environment. A few other LC-HRMS analyses should be performed in single-ion-monitoring or MS/MS mode when increased sensitivity and/or detection selectivity will be necessary.

The internal wave field in Sau reservoir : Observation and modeling of a third vertical mode

Water withdrawal from Mediterranean reservoirs in summer is usually very high. Because of this, stratification is often continuous and far from the typical two-layered structure, favoring the excitation of higher vertical modes. The analysis of wind, temperature, and current data from Sau reservoir (Spain) shows that the third vertical mode of the internal seiche (baroclinic mode) dominated the internal wave field at the beginning of September 2003. We used a continuous stratification two-dimensional model to calculate the period and velocity distribution of the various modes of the internal seiche, and we calculated that the period of the third vertical mode is ;24 h, which coincides with the period of the dominating winds. As a result of the resonance between the third mode and the wind, the other oscillation modes were not excited during this period

Aplicação de métodos quimiométricos na especiação de Cr(VI) em solução aquosa

The equilibria, the spectra and the identities of the species of Cr(VI) that are present in aqueous solution have long been an active subject of discussion in the literature. In this paper, three different chemometric methodologies are applied to sets of UV/Visible spectra of aqueous Cr(VI) solutions, in order to solve a chemical system where there is no available information concerning the composition of the samples nor spectral information about the pure species. Imbrie Q-mode factor analysis, followed by varimax rotation and Imbrie oblique projection, were used to estimate the composition of Cr(VI) equilibrium solutions and, by combining these results with the k-matrix method, to obtain the pure spectra of the species. Evolving factor analysis and self modeling curve resolution were used to confirm the number of the species and the resolution of the system, respectively. Sets of 3.3×10-4 and 3.3×10-5 mol L-1 Cr(VI) solutions, respectively, were analyzed in the pH range from 1 to 12. Two factors were identified, which were related to the chromate ion (CrO4(2-)) and bichromate ion (HCrO4-). The pK of the equilibrium was estimated as 5.8.

Improving Label Space Usage for Ethernet Label Switched Paths

Ethernet is becoming the dominant aggregation technology for carrier transport networks; however, as it is a LAN technology, native bridged ethernet does not fulfill all the carrier requirements. One of the schemes proposed by the research community to make ethernet fulfill carrier requirements is ethernet VLAN-label switching (ELS). ELS allows the creation of label switched data paths using a 12-bit label encoded in the VLAN TAG control information field. Previous label switching technologies such as MPLS use more bits for encoding the label. Hence, they do not suffer from label sparsity issues as ELS might. This paper studies the sparsity issues resulting from the reduced ELS VLAN-label space and proposes the use of the label merging technique to improve label space usage. Experimental results show that label merging considerably improves label space usage

On the interplay between Q^2 and t dependence in exclusive diffractive production of real photons and vector mesons in ep collisions

We show how the familiar phenomenological way of combining the Q2 (photon virtuality) and t (squared momentum transfer) dependences of the scattering amplitude in Deeply Virtual Compton Scattering (DVCS) [1, 2] and Vector Meson Production (VMP) [2] processes can be understood in an off-mass-shell generalization of dual amplitudes with Mandelstam analyticity [3]. By comparing different approaches, we managed also to constrain the numerical values of the free parameters.

An Interface Damage Model for the Simulation of Delamination Under Variable-Mode Ratio in Composite Materials

A thermodynamically consistent damage model for the simulation of progressive delamination under variable mode ratio is presented. The model is formulated in the context of the Damage Mechanics. The constitutive equation that results from the definition of the free energy as a function of a damage variable is used to model the initiation and propagation of delamination. A new delamination initiation criterion is developed to assure that the formulation can account for changes in the loading mode in a thermodynamically consistent way. The formulation proposed accounts for crack closure effets avoiding interfacial penetration of two adjacent layers aftercomplete decohesion. The model is implemented in a finite element formulation. The numerical predictions given by the model are compared with experimental results

Eliminació d'artefactes en EGG mitjançant l'ús de la Multivariate Empirical Mode Decomposition

La tècnica de l’electroencefalograma (EEG) és una de les tècniques més utilitzades per estudiar el cervell. En aquesta tècnica s’enregistren els senyals elèctrics que es produeixen en el còrtex humà a través d’elèctrodes col•locats al cap. Aquesta tècnica, però, presenta algunes limitacions a l’hora de realitzar els enregistraments, la principal limitació es coneix com a artefactes, que són senyals indesitjats que es mesclen amb els senyals EEG. L’objectiu d’aquest treball de final de màster és presentar tres nous mètodes de neteja d’artefactes que poden ser aplicats en EEG. Aquests estan basats en l’aplicació de la Multivariate Empirical Mode Decomposition, que és una nova tècnica utilitzada per al processament de senyal. Els mètodes de neteja proposats s’apliquen a dades EEG simulades que contenen artefactes (pestanyeigs), i un cop s’han aplicat els procediments de neteja es comparen amb dades EEG que no tenen pestanyeigs, per comprovar quina millora presenten. Posteriorment, dos dels tres mètodes de neteja proposats s’apliquen sobre dades EEG reals. Les conclusions que s’han extret del treball són que dos dels nous procediments de neteja proposats es poden utilitzar per realitzar el preprocessament de dades reals per eliminar pestanyeigs.

Readout electronics for low dark count pixel detectors based on geiger mode avalanche photodiodes fabricated in conventional CMOS technologies for future linear colliders

The high sensitivity and excellent timing accuracy of Geiger mode avalanche photodiodes makes them ideal sensors as pixel detectors for particle tracking in high energy physics experiments to be performed in future linear colliders. Nevertheless, it is well known that these sensors suffer from dark counts and afterpulsing noise, which induce false hits (indistinguishable from event detection) as well as an increase of the necessary area of the readout system. In this work, we present a comparison between APDs fabricated in a high voltage 0.35 µm and a high integration 0.13 µm commercially available CMOS technologies that has been performed to determine which of them best fits the particle collider requirements. In addition, a readout circuit that allows low noise operation is introduced. Experimental characterization of the proposed pixel is also presented in this work.

Low dark count geiger mode avalanche photodiodes fabricated in conventional CMOS technologies

Avalanche photodiodes operated in the Geiger mode present very high intrinsic gain and fast time response, which make the sensor an ideal option for those applications in which detectors with high sensitivity and velocity are required. Moreover, they are compatible with conventional CMOS technologies, allowing sensor and front-end electronics integration within the pixel cell. Despite these excellent qualities, the photodiode suffers from high intrinsic noise, which degrades the performance of the detector and increases the memory area to store the total amount of information generated. In this work, a new front-end circuit that allows low reverse bias overvoltage sensor operation to reduce the noise in Geiger mode avalanche photodiode pixel detectors is presented. The proposed front-end circuit also enables to operate the sensor in the gated acquisition mode to further reduce the noise. Experimental characterization of the fabricated pixel with the conventional HV-AMS 0.35µm technology is also presented in this article.

Estudos espectroscópicos e estruturais dos polímeros de coordenação 2D, ∞[Tb(DPA)(HDPA)] e ∞[Gd(DPA)(HDPA)]

This paper presents the synthesis of the coordination polymers ∞[Ln(DPA)(HDPA)] (DPA=2,6-pyridinedicarboxylate; Ln= Tb and Gd), their structural and spectroscopic properties. The structural study reveals that the ∞[Ln(DPA)(HDPA)] has a single Ln+3 ion coordinated with two H2DPA ligands in tridentade coordination mode, while two others H2DPA establish a syn-bridge with a symmetry-related Ln3+, forming a two-dimensional structure. The spectroscopic studies show that ∞[Tb(DPA)(HDPA)] compound has high quantum yield (q x≈ 50.0%), due to the large contribution of radiative decay rate. Moreover triplet level is localized sufficiently over the emitter level 5D4 of theTb3+ ion, avoiding a retrotransference process between these states.

Les Dimanches de la femme : supplément de la "Mode du jour"

1931/08/16 (N493).