Influence du financement sur la performance des systèmes de soins

La thèse a pour objectif d’étudier l’influence du financement des soins de santé sur la performance des systèmes de soins compte tenu des caractéristiques organisationnelles sanitaires des systèmes. Elle s’articule autour des trois objectifs suivants : 1) caractériser le financement des soins de santé à travers les différents modèles émergeant des pays à revenu élevé ; 2) apprécier la performance des systèmes de soins en établissant les divers profils apparaissant dans ces mêmes pays ; 3) examiner le lien entre le financement et la performance en tenant compte du pouvoir modérateur du contexte organisationnel des soins. Inspirée du processus de circulation de l’argent dans le système de soins, l’approche a d’abord consisté à classer les pays étudiés – par une analyse configurationnelle opérationnalisée par les analyses de correspondance multiples (ACM) et de classification hiérarchique ascendante (CHA) – dans des modèles types, chacun représentant une configuration particulière de processus de financement des soins de santé (article 1). Appliquée aux données recueillies auprès des 27 pays de l’OCDE à revenu élevé via les rapports Health Care in Transition des systèmes de santé des pays produits par le bureau Européen de l’OMS, la banque de données Eco-Santé OCDE 2007 et les statistiques de l’OMS 2008, les analyses ont révélé cinq modèles de financement. Ils se distinguent selon les fonctions de collecte de l’argent dans le système (prélèvement), de mise en commun de l’argent collecté (stockage), de la répartition de l’argent collecté et stocké (allocation) et du processus de paiement des professionnels et des établissements de santé (paiement). Les modèles ainsi développés, qui vont au-delà du processus unique de collecte de l’argent, donnent un portrait plus complet du processus de financement des soins de santé. Ils permettent ainsi une compréhension de la cohérence interne existant entre les fonctions du financement lors d’un éventuel changement de mode de financement dans un pays. Dans un deuxième temps, nous appuyant sur une conception multidimensionnelle de la performance des systèmes, nous avons classé les pays : premièrement, selon leur niveau en termes de ressources mobilisées, de services produits et de résultats de santé atteints (définissant la performance absolue) ; deuxièmement, selon les efforts qu’ils fournissent pour atteindre un niveau élevé de résultats de santé proportionnellement aux ressources mobilisées et aux services produits en termes d’efficience, d’efficacité et de productivité (définissant ainsi la performance relative) ; et troisièmement, selon les profils types de performance globale émergeant en tenant compte simultanément des niveaux de performance absolue et relative (article 2). Les analyses effectuées sur les données collectées auprès des mêmes 27 pays précédents ont dégagé quatre profils de performance qui se différencient selon leur niveau de performance multidimensionnelle et globale. Les résultats ainsi obtenus permettent d’effectuer une comparaison entre les niveaux globaux de performance des systèmes de soins. Pour terminer, afin de répondre à la question de savoir quel mode – ou quels modes – de financement générerait de meilleurs résultats de performance, et ce, dans quel contexte organisationnel de soins, une analyse plus fine des relations entre le financement et la performance (tous définis comme précédemment) compte tenu des caractéristiques organisationnelles sanitaires a été réalisée (article 3). Les résultats montrent qu’il n’existe presque aucune relation directe entre le financement et la performance. Toutefois, lorsque le financement interagit avec le contexte organisationnel sanitaire pour appréhender le niveau de performance des systèmes, des relations pertinentes et révélatrices apparaissent. Ainsi, certains modes de financement semblent plus attrayants que d’autres en termes de performance dans des contextes organisationnels sanitaires différents. Les résultats permettent ainsi à tous les acteurs du système de comprendre qu’il n’existe qu’une influence indirecte du financement de la santé sur la performance des systèmes de soins due à l’interaction du financement avec le contexte organisationnel sanitaire. L’une des originalités de cette thèse tient au fait que très peu de travaux ont tenté d’opérationnaliser de façon multidimensionnelle les concepts de financement et de performance avant d’analyser les associations susceptibles d’exister entre eux. En outre, alors que la pertinence de la prise en compte des caractéristiques du contexte organisationnel dans la mise en place des réformes des systèmes de soins est au coeur des préoccupations, ce travail est l’un des premiers à analyser l’influence de l’interaction entre le financement et le contexte organisationnel sanitaire sur la performance des systèmes de soins.

Performance Study of an Improved Legendre Moment Descriptor as Region-Based Shape Descriptor

This paper reports a novel region-based shape descriptor based on orthogonal Legendre moments. The preprocessing steps for invariance improvement of the proposed Improved Legendre Moment Descriptor (ILMD) are discussed. The performance of the ILMD is compared to the MPEG-7 approved region shape descriptor, angular radial transformation descriptor (ARTD), and the widely used Zernike moment descriptor (ZMD). Set B of the MPEG-7 CE-1 contour database and all the datasets of the MPEG-7 CE-2 region database were used for experimental validation. The average normalized modified retrieval rate (ANMRR) and precision- recall pair were employed for benchmarking the performance of the candidate descriptors. The ILMD has lower ANMRR values than ARTD for most of the datasets, and ARTD has a lower value compared to ZMD. This indicates that overall performance of the ILMD is better than that of ARTD and ZMD. This result is confirmed by the precision-recall test where ILMD was found to have better precision rates for most of the datasets tested. Besides retrieval accuracy, ILMD is more compact than ARTD and ZMD. The descriptor proposed is useful as a generic shape descriptor for content-based image retrieval (CBIR) applications

Microwave exfoliated reduced graphene oxide epoxy nanocomposites for high performance applications

Graphene has captured the attention of scientific community due to recently emerging high performance applications. Hence, studying its reinforcing effects on epoxy resin is a significant step. In this study, microwave exfoliated reduced graphene oxide (MERGO) was prepared from natural graphite for subsequent fabrication of epoxy nanocomposites using triethylenetetramine (TETA) as a curing agent via insitu polymerization. Thermogravimetric analysis (TGA), X-ray diffraction (XRD), Raman spectroscopy, Fourier transform infrared spectroscopy (FTIR), C13 NMR spectroscopy, X-ray photoelectron spectroscopy (XPS) and ultravioletevisible (UVevis) spectroscopy were employed to confirm the simultaneous reduction and exfoliation of graphene oxide. The reinforcing effect of MERGO on epoxy resin was explored by investigating its static mechanical properties and dynamic mechanical analysis (DMA) at MERGO loadings of 0 to 0.5 phr. The micro-structure of epoxy/MERGO nanocomposites was investigated using scanning electron microscope (SEM), transmission electron microscope (TEM) and XRD techniques. The present work reports an enhancement of 32%, 103% and 85% in tensile, impact and flexural strength respectively of epoxy by the addition of even 0.25 phr MERGO. At this loading elastic and flexural moduli also increased by 10% and 65%, respectively. Single-edge-notch three-point-Bending (SEN-TPB) fracture toughness (KIC) measurements were carried out where a 63% increase was observed by the introduction of 0.25 phr MERGO. The interfacial interactions brought about by graphene also benefited the dynamic mechanical properties to a large extent in the form of a significant enhancement in storage modulus and slightly improved glass transition temperature. Considerable improvements were also detected in dielectric properties. The epoxy nanocomposite also attained an ac conductivity of 10 5 S/m and a remarkable increase in dielectric constant. The simple and cost effective way of graphene synthesis for the fabrication of epoxy/MERGO nanocomposites may be extended to the preparation of other MERGO based polymer nanocomposites. This remarkable class of materials has thrown open enormous opportunities for developing conductive adhesives and in microelectronics

Comparing the performance of official and unofficial genetically modified cotton in India

Genetically modified (GM) cotton was approved for commercial cultivation in 2002. Hybrids to date have carried the Bt (Bacillus thuringiensis) gene, which confers resistance to Lepidoptera and certain Coleoptera. As well as "official" Bt hybrids (i.e., those that have gone through a formal approval process), there are "unofficial" Bt hybrids produced without such approval. The owners of the official hybrids, Monsanto-Mahyco, claim that the unofficial hybrids are not as good and could even damage the perception of Bt cotton amongst farmers. Anti-GM groups claim that neither type of Bt hybrid provides either yield or economic advantages over non-Bt hybrids. This paper reports the first study of official versus unofficial versus non-Bt hybrids in India (622 farmers in Gujarat State) with the specific aim of comparing one hypothesized ranking in terms of gross margin of (a) official Bt hybrids, (b) unofficial Bt hybrids, and (c) non-Bt hybrids. Results suggest that the official Bt varieties (MECH 12 and MECH 162) significantly outperform the unofficial varieties in terms of gross margin. However, unofficial, locally produced Bt hybrids can also perform significantly better than non-Bt hybrids, although second-generation (F2) Bt seed appears to have no yield advantage compared to non-Bt hybrids but can save on insecticide use. The paper explores some of the implications of this ranking.

Novel material combinations for enhanced infrared filter performance

The introduction of non-toxic fluride compounds as direct replacements for Thorium Fluoride (ThF4) has renewed interest in the use of low index fluoride compounds in high performance infrared filters. This paper reports the results of an investigation into the effects of combining these low index materials, particularly Barium Fluoride (BaF2), with the high index material Lead Telluride (PbTe) in bandpass and edge filters. Infrared filter designs using conventional and the new material ombination are compared, and infrared filters using these material combinations have been manufactured and have been shown to suffer problems with residual stress. A possible solution to this problem utilising Zinc Sulphide (ZnS) layers with compensating compressive stress is discussed.

Task design and second language performance: the effect of narrative type on learner output

This article reports on a detailed empirical study of the way narrative task design influences the oral performance of second-language (L2) learners. Building on previous research findings, two dimensions of narrative design were chosen for investigation: narrative complexity and inherent narrative structure. Narrative complexity refers to the presence of simultaneous storylines; in this case, we compared single-story narratives with dual-story narratives. Inherent narrative structure refers to the order of events in a narrative; we compared narratives where this was fixed to others where the events could be reordered without loss of coherence. Additionally, we explored the influence of learning context on performance by gathering data from two comparable groups of participants: 60 learners in a foreign language context in Teheran and 40 in an L2 context in London. All participants recounted two of four narratives from cartoon pictures prompts, giving a between-subjects design for narrative complexity and a within-subjects design for inherent narrative structure. The results show clearly that for both groups, L2 performance was affected by the design of the task: Syntactic complexity was supported by narrative storyline complexity and grammatical accuracy was supported by an inherently fixed narrative structure. We reason that the task of recounting simultaneous events leads learners into attempting more hypotactic language, such as subordinate clauses that follow, for example, while, although, at the same time as, etc. We reason also that a tight narrative structure allows learners to achieve greater accuracy in the L2 (within minutes of performing less accurately on a loosely structured narrative) because the tight ordering of events releases attentional resources that would otherwise be spent on finding connections between the pictures. The learning context was shown to have no effect on either accuracy or fluency but an unexpectedly clear effect on syntactic complexity and lexical diversity. The learners in London seem to have benefited from being in the target language environment by developing not more accurate grammar but a more diverse resource of English words and syntactic choices. In a companion article (Foster & Tavakoli, 2009) we compared their performance with native-speaker baseline data and see that, in terms of nativelike selection of vocabulary and phrasing, the learners in London are closing in on native-speaker norms. The study provides empirical evidence that L2 performance is affected by task design in predictable ways. It also shows that living within the target language environment, and presumably using the L2 in a host of everyday tasks outside the classroom, confers a distinct lexical advantage, not a grammatical one.

What happens to precocious readers’ performance by the age of 11 years?

This paper reports on the progress made by a group of fourteen 11-year-old children who had been originally identified as being precocious readers before they started primary school at the age of 5-years. The data enable comparisons to be made with the performance of the children when they were younger so that a six year longitudinal analysis can be made. The children who began school as precocious readers continued to make progress in reading accuracy, rate and comprehension, thereby maintaining their superior performance relative to a comparison group. However, their progress appeared to follow the same developmental trajectory as that of the comparison group. Measures of phonological awareness showed that there are long term, stable individual differences which correlated with all measures of reading. The children who were reading precociously early showed significantly higher levels of phonological awareness than the comparison children. In addition, they showed the same levels of performance on this task as a further group of high achieving young adults. A positive effect of being able to read at precociously early age was identified in the significantly higher levels of receptive vocabulary found amongst the these children. The analyses indicated that rises in receptive vocabulary resulted from reading performance rather than the other way round

The design of a semantics-oriented organisational performance measurement system

Current methods and techniques used in designing organisational performance measurement systems do not consider the multiple aspects of business processes or the semantics of data generated during the lifecycle of a product. In this paper, we propose an organisational performance measurement systems design model that is based on the semantics of an organisation, business process and products lifecycle. Organisational performance measurement is examined from academic and practice disciplines. The multi-discipline approach is used as a research tool to explore the weaknesses of current models that are used to design organisational performance measurement systems. This helped in identifying the gaps in research and practice concerning the issues and challenges in designing information systems for measuring the performance of an organisation. The knowledge sources investigated include on-going and completed research project reports; scientific and management literature; and practitioners’ magazines.

Using Delboeuf's illusion to improve point and click performance for older adults

Older computer users often exhibit poorer performance in point and click tasks on a computer than younger adults. This paper reports on the first phase of research that examines whether a visual illusion that makes an object appear to be larger (Delboeuf‟s Illusion), can help to improve point and click performance for older computer users. In this first phase, we look at the effect sizes for different configurations of the Delboeuf illusion. The study finds that the target size is overestimated by 8% for both older and younger adults in one configuration, and 12% for older adults in another configuration. The results will inform the design of a second phase, in which the configurations which demonstrate the largest effects will be investigated using a Fitts‟-style study of pointing performance.

Measuring Application Availability,Usage and Performance : Implementation of EnView System

The main objective for this degree project is to implement an Application Availability Monitoring (AAM) system named Softek EnView for Fujitsu Services. The aim of implementing the AAM system is to proactively identify end user performance problems, such as application and site performance, before the actual end users experience them. No matter how well applications and sites are designed and nomatter how well they meet business requirements, they are useless to the end users if the performance is slow and/or unreliable. It is important for the customers to find out whether the end user problems are caused by the network or application malfunction. The Softek EnView was comprised of the following EnView components: Robot, Monitor, Reporter, Collector and Repository. The implemented system, however, is designed to use only some of these EnView elements: Robot, Reporter and depository. Robots can be placed at any key user location and are dedicated to customers, which means that when the number of customers increases, at the sametime the amount of Robots will increase. To make the AAM system ideal for the company to use, it was integrated with Fujitsu Services’ centralised monitoring system, BMC PATROL Enterprise Manager (PEM). That was actually the reason for deciding to drop the EnView Monitor element. After the system was fully implemented, the AAM system was ready for production. Transactions were (and are) written and deployed on Robots to simulate typical end user actions. These transactions are configured to run with certain intervals, which are defined collectively with customers. While they are driven against customers’ applicationsautomatically, transactions collect availability data and response time data all the time. In case of a failure in transactions, the robot immediately quits the transactionand writes detailed information to a log file about what went wrong and which element failed while going through an application. Then an alert is generated by a BMC PATROL Agent based on this data and is sent to the BMC PEM. Fujitsu Services’ monitoring room receives the alert, reacts to it according to the incident management process in ITIL and by alerting system specialists on critical incidents to resolve problems. As a result of the data gathered by the Robots, weekly reports, which contain detailed statistics and trend analyses of ongoing quality of IT services, is provided for the Customers.

Does low-protein diet improve broiler performance under heat stress conditions?

Nutrition for broilers under high temperatures is extremely important for brazilian broiler chicken industry because the amounts of consumed nutrients and environmental temperature have great effects on bird performance and carcass quality. Among diet nutrients, protein has the highest heat increment; thus, during many years, diets with low protein level were recommended in order to reduce heat production in broiler chickens under heat stress. However, reports have shown that low-protein diets have negative effects on broiler performance when environmental temperature is high, because during heat stress, low food intake associated to a low diet protein induce amino acid deficiencies. Other studies have shown that broilers fed low-protein diets increase their energy requirement for maintenance with higher heat production. Thus, with the growth of broiler industry in tropical areas more challenges need to be faced by the farmers. So, both the ambient and nutritional conditions ought to be well managed to avoid negative effects on poultry production once they can affect the metabolism (body heat production under low temperature and body heat dissipation under high temperature) with consequence on poultry performance (meat and eggs).

EFFICIENCY of PNEUMATIC and HORIZONTAL PERFORATED DISK METER MECHANISM IN CORN NO-TILLAGE SEEDERS IN SOIL WITH DIFFERENT MOBILIZATION REPORTS

This work objectified to evaluate the efficiency of two meter mechanism of corn seeds when submitted to different forward speed and soil management system during the non-tillage seeding. It was used a factorial design in randomized blocks. The factors whose effects were examined were related to the seeders with pneumatic and horizontal disk meter mechanisms for the distribution of the seeds, to the set tractor-seeder forward speeds (4.4; 8.0 and 9.8 km h(-1)), and to the soil management system considering the corn no-tillage seeding over minimum tillage with chisel plow and the no-tillage system for the seeding of oat culture (Avena strigosa Schreb). It was verified that the forward speed didn't influence the initial and final stands of plants but it interfered in the regularity of longitudinal distribution of plants. The smallest speed provided the largest percentile of normal spacing between plants. The pneumatic meter mechanism presented better performance than the horizontal disk perforated in the longitudinal distribution of plants. About corn productivity aspect it's indifferent the recommendation of use for pneumatic and perforated horizontal disk meter mechanism of seeds.

Performance of a reciprocal shaker in mechanical dispersion of soil samples for particle-size analysis

A dispersão da amostra de solo é uma etapa fundamental da análise granulométrica, sendo realizada mediante o uso de dispersantes químicos e agitação mecânica. O objetivo deste trabalho foi avaliar a eficiência de mesa agitadora reciprocante de baixa rotação na dispersão mecânica de amostras de solos de diferentes classes texturais. Foram realizadas análises granulométricas em 61 amostras com quatro repetições, empregando o método da pipeta para determinação da fração argila e tamisagem para determinação das frações areia grossa, areia fina e areia total, sendo o silte determinado por diferença. Na avaliação de desempenho, os resultados obtidos com uso da mesa agitadora reciprocante (MAR) foram comparados com dados disponíveis para as mesmas amostras oriundos de relatórios do Ensaio de Proficiência IAC para Laboratórios de Análises de Solos - Prolab/IAC. Análises de acurácia foram realizadas com base nos valores dos intervalos de confiança definidos para cada fração granulométrica componente de cada amostra ensaiada. Indicadores gráficos também foram utilizados na comparação de dados, por meio de dispersão e ajuste linear. A estatística descritiva indicou preponderância de baixa variabilidade em mais de 90 % dos resultados obtidos para as amostras de texturas arenosa, média e argilosa e em 68 % dos obtidos para as amostras de textura muito argilosa, indicando boa repetibilidade dos resultados obtidos com a MAR. Média variabilidade foi mais frequentemente associada à fração silte, seguida da fração areia fina. Os resultados das análises de sensibilidade indicam acurácia de 100 % nas três frações granulométricas - areia total, silte e argila - para todas as amostras analisadas pertencentes às classes texturais muito argilosa, argilosa e média. Para as nove amostras de textura arenosa, a acurácia média foi de 85,2 %, e os maiores desvios ocorreram em relação à fração silte. Nas aproximações lineares, coeficientes de correlação igual (silte) ou superiores (areia total e argila) a 0,93, bem como diferenças menores do que 0,16 entre os coeficientes angulares das retas e o valor unitário, indicam alta correlação entre os resultados de referência (Prolab/IAC) e os obtidos nos ensaios com a MAR. Conclui-se pelo desempenho satisfatório da mesa agitadora reciprocante de baixa rotação para dispersão mecânica de amostras de solo de diferentes classes texturais para fins de análise granulométrica, permitindo recomendar o uso alternativo do equipamento quando se emprega agitação lenta. As vantagens do uso do equipamento nacional incluem o baixo custo, a possibilidade de análise simultânea de grande número de amostras e o uso de frascos comuns, de vidro ou de plástico, baratos e de fácil reposição.