婦產科醫師乃為目前人力短缺情形最為嚴重之科別，本研究首先欲觀察臺灣婦產科是否因為人力萎縮，使得產科醫師工作量提高？進一步討論產科醫師工作負荷量之增加，是否會偏向選擇較療程較簡易之醫療服務，即以剖腹接生方式取代自然接生。本研究利用健保資料庫之「住院醫療費用清單明細檔」，篩選2006年至2010年醫師接生之案件，發現從2006年至2009年，產科醫師平均接生次數有增加之趨勢。若以之衡量醫師工作量，產科醫師其工作負荷量確實有因人力減少而增加。另外，以固定效果模型估計結果皆發現，醫師工作量對剖腹產機率有正向顯著之影響，表示工作負荷量之增加確實會提高產科醫師採取剖腹接生之機率。支持本文對於工作負荷量增加會偏向選擇較簡單之醫療行為之預測。

Studies on relations between number of sessions and effect of psychotherapy have usually assumed a constant rate of change across different lengths of therapy, explained by a model called the dose-effect model. This assumption has been challenged by the good-enough level (GEL) model, which makes the prediction that the rate of change will vary as a function of total number of sessions. This study aimed to compare these models. We also assessed the relationship between reliable and clinically significant change (RCSI) and total dose of therapy. Participants were drawn from two datasets in the Swedish primary care (n = 640) and adult psychiatric care (n = 249). The participants made session-wise ratings on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM). Multilevel analyses indicated a better fit using the GEL-model, with some reservations concerning RCSI and patterns of change. The results may indicate a general lawful relationship that may have implications for future research, as well as psychotherapy practice and policy making.

In drug development clinical trials are designed to investigate whether a new treatment is safe and has the desired effect on the disease in the target patient population. Categorical endpoints, for example different ranking scales or grading of adverse events, are commonly used to measure effects in the trials. Pharmacokinetic/Pharmacodynamic (PK/PD) models are used to describe the plasma concentration of a drug over time and its relationship to the effect studied. The models are utilized both in drug development and in discussions with drug regulating authorities. Methods for incorporation of ordered categorical data in PK/PD models were studied using a non-linear mixed effects modelling approach as implemented in the software NONMEM. The traditionally used proportional odds model was used for analysis of a 6-grade sedation scale in acute stroke patients and for analysis of a T-cell receptor expression in patients with Multiple Sclerosis, where the results also were compared with an analysis of the data on a continuous scale. Modifications of the proportional odds model were developed to enable analysis of a spontaneously reported side-effect and to analyze situations where the scale used is heterogeneous or where the drug affects the different scores in the scale in a non-proportional way. The new models were compared with the proportional odds model and were shown to give better predictive performances in the analyzed situations. The results in this thesis show that categorical data obtained in clinical trials with different design and different categorical endpoints successfully can be incorporated in PK/PD models. The models developed can also be applied to analyses of other ordered categorical scales than those presented.

La tendance actuelle des organisations à développer des collaborations avec différentes parties prenantes a pour objectif de répondre à une complexité de plus en plus importante des produits et de favoriser l'innovation ; le tout sous de fortes pressions d'un environnement économique, liées aux exigences du développement durable, de l'accélération des cycles de vie, des normes qualité, etc. Les SIP tendent à garantir une transversalité entre l'ensemble des phases du cycle de vie produit ; répondant ainsi aux besoins d'amélioration de la qualité produit, de maîtrise des processus et de réduction des délais, tout en favorisant la collaboration. La complexité des processus collaboratifs liée à la gestion du cycle de vie du produit ne peut faire l’économie d’une réflexion sur les ressources engagées au regard des objectifs poursuivis, ni même d’une balance économique globale des coûts supportés. Ainsi les critères d’efficacité et d’efficience s’ajoutent aux critères les plus traditionnels du temps imparti et du degré de qualité visé. L'objectif de cette thèse consiste à définir une démarche méthodologique et applicative pour répondre à la question suivante : "Comment instrumenter le SIP pour analyser les activités menées au sein du système et déceler les freins au travail collaboratif ?". Ainsi, nous présentons dans cette thèse un cadre méthodologique et architectural permettant d'assurer un pilotage des processus collaboratifs dans les SIP. Il s'agit entre autre de mettre en place une expérience d'observation basée sur l’ingénierie des traces ; et de mener une réflexion sur la définition d'indicateurs permettant de mettre en place un contrôle de l'activité collaborative. La mise en œuvre effective de ces actions implique la définition d’une architecture complémentaire et générique adaptée à l'environnement du SIP. Finalement, le développement d'un prototype, intégré par la suite au SIP @udros, nous a permis de valider le cadre méthodologique et applicatif de cette thèse. / The current trend of organizations to develop partnerships with various stakeholders aims to respond to a rising complexity, of products and to foster innovation; all under great pressures of an economical environment, related to sustainability requirements, lifecycle acceleration, quality standards, etc. PLM systems tend to ensure the transversality within all the stages of product lifecycle; meeting the needs of product quality improvement, process control and delays reduction, while fostering collaboration. The complexity of collaborative processes related to the product lifecycle management cannot lean only on the engaged resources, or on the global balance between costs, budget, and receipts. Then efficacy and efficiency criterions come on top of the traditional ones (quality level, time, etc.). This thesis aims to propose a methodological and applicative approach responding to the following research question: “How can PLM System be « instrumented » in order to analyze the collaborative activities and to reveal the brakes causes?” We present in this thesis a methodological and architectural framework to ensure a collaborative process management in PLM System. The methodological framework leans on observation experiences based on tracks engineering (tracks generated by PLM system) and indicators definition supporting the control of the collaborative activity. The principal objective is to reduce risks by reacting in real time to the incidents or dysfunctions that may occur. The effective implementation of these actions involves the definition of a generic and complementary architecture suitable to the environment of the system. Finally, the development of a prototype, integrated then to the system @udros, allowed us to validate the methodological and architectural framework of this thesis.

This paper analyzes what factors influence the long-term interest rate, in order to give an understanding of why the government debt has increased in EU member states. It is a statistical study of panel data analyzed by the fixed effect model. The research of the 27 EU member states is based on secondary data from the European Commission; Eurostat and EconStats. The results by the fixed effect model show that government debt, budget deficit and presidential system are significant and have a positive relationship with the long- term interest rate. The growth rate is significant, having a negative relationship with the long-term interest rate and the financial crisis did not increase the long-term interest rate. The results were not entirely consistent with theories and previous studies.

Le traitement par éfavirenz, un médicament antirétroviral, a été associé avec des changements de profil lipidique potentiellement défavorables. Ce travail a abordé la question de savoir si ces effets dépendent des concentrations plasmatiques d’éfavirenz et, dans ce cas, si sa posologie pourrait être optimisée sans perte d'efficacité.Un modèle de pharmacocinétique de population a été développé à partir de données d’enfants infectés par le VIH. La simulation d’une population normalisée sous éfavirenz aux posologies recommandées montre que 15 % des enfants auraient des concentrations insuffisantes 12 heures après la prise, ce qui serait associé à un risque de la réplication virale de 23 %.Pour décrire la relation entre taux plasmatiques d'éfavirenz et changements de taux de cholestérol, des modèles de pharmacocinétique-pharmacodynamique (PK-PD) de réponse indirecte ont été développés. Le modèle sélectionné prédit que les taux d’éfavirenz individuels sont associés à une augmentation des lipoprotéines de haute densité sur 5 ans, et des lipoprotéines de basse densité durant 4 mois avec un retour progressif aux valeurs de base.Pour évaluer l’impact des concentrations d'éfavirenz sur l'efficacité, un modèle dynamique PK-PD a décrit la relation entre ces concentrations et l’évolution de la charge virale VIH et du taux de CD4. Un score d’efficacité a été développé sur la base d’hypothèses pharmacodynamiques pour prédire le risque de la réplication virale.L’utilisation de l’éfavirenz aux posologiques recommandées par la Food and Drug Administration aux Etats-Unis semble assurer une efficacité optimale et des changements potentiellement favorables dans les fractions de cholestérol. / As other antiretroviral drugs, treatment with efavirenz has been associated with potentially unfavorable lipid profile changes in adults and in children. The thesis addressed the question of whether these changes depend on efavirenz plasma concentrations and if dose adjustments could be envisioned without loss of efficacy.To estimate individual efavirenz exposure over 24 hours, a population pharmacokinetic model was developed using data from HIV infected children. Simulations for a normalized population receiving efavirenz dosed according recommendations predicted that 15% of children would have insufficient mid dose concentrations, associated with a 23% risk of viral replication.To describe the relationship between efavirenz concentrations and cholesterol changes, population pharmacokinetic-pharmacodynamic (PK-PD) indirect response models were developed. The selected model predicted that individual efavirenz concentrations were associated with an increase in high-density lipoprotein concentrations over 5 years but with an increase in low-density lipoprotein concentrations only during the first 4 months of treatment followed by a gradual return to baseline.To study the importance of efavirenz concentrations with regard to efficacy, a PK-PD dynamics model was developed to describe the relationship between concentrations and HIV RNA load and CD4 cell count evolutions. A score was defined based on a pharmacodynamic hypothesis to predict the risk of viral replication.Using US Food and Drug Administration dosing recommendations in children ensure optimal efficacy and potentially favorable changes in cholesterol fractions.

Indiana University-Purdue University Indianapolis (IUPUI) / Introduction: Increasing obesity in children leads to an increase in the risk of Type 2 diabetes (T2D). Therefore, it is important to promote healthier lifestyles in youths and encourage their caregivers(s) to provide a healthy lifestyle environment. The PowerHouse program focuses on improving food choices, increasing physical activity, and adopting behavior changes for the reduction of obesity and the prevention of T2D. Method: The aim of this study was to assess the effects of implementing the PowerHouse program on both clinical and quality of life outcomes in high-risk, low-income youth and their caregivers. Primary outcomes were BMI standard deviation and BMI percentile in youths. Secondary outcomes included physical activity of youths and quality of life for both youths and their caregivers. Attendance rates were also calculated. Linear effect mixed models were used to test for time effects for all outcomes. Results: Clinical outcomes did not improve over time, except for youth HbA1c (p-value = 0.0447). Some improvements in youth quality-of-life outcomes were noted: specifically, the Sports Index score of the Fels Physical Activity Questionnaire for Children (adjusted p-value = 0.0213) and the Physical Summary (p-value = 0.0407), Psychosocial Summary (p-value = 0.0167), and Total score (p-value = 0.0094) for the youth-reported Pediatric Quality of Life Inventory. Quality of life did not change over time for caregivers. For attendance, there was an improvement after the intervention was modified to improve access to fresh produce (p-value = 0.0002). Conclusion: HbA1c and quality of life improved over time for youth; however, there was not an improvement in caregiver outcomes over time. The data suggest that more time may be needed to see the full effects of the intervention, and/or that a booster intervention may be needed.

The Intergovernmental Panel on Climate Change 2018 highlights the importance of short-lived greenhouse gasses to combat global warming. This study explores the relationship between Gross Domestic Product per capita and methane per capita. The relationship is explored in relation to the Environmental Kuznets Curve theory where the subjects to examination used are High Income Countries and Low Income Countries based on United Nation classifications in 2019. In total 47 countries are examined where 30 countries are High Income Countries and 17 are Low Income Countries. The relationships are examined for the time periods 1970 to 2017 through Fixed Effect Models. To improve accuracy additional control variables are added: Population in agriculture (% of total employment), balance of payments and forest areas. With the added control variables, the time frame used in Fixed Effect Models changes to 1991 to 2017. The different Fixed Effect Models provide inverted U-shaped relationships for Low Income Countries and uncertain results for High Income Countries according to the Environmental Kuznets Curve.

The main purpose of the study is to identify household characteristics which can 1) distinguish between the chronic poor and transient poor and 2) be feasibly implemented as targeting criterion in poverty interventions. Data for this study was drawn from Mozambique's 2008/09 Household Budget Survey and consisted of 10,832 observations. This study fills a gap in the literature by structurally determining the impact of common shocks (drought, floods and cyclones, agricultural pests, illness, death, and theft) on 1) food expenditures at the household level and 2) poverty rates at the national level. The results of the study indicate that shocks are one of the key determinants of household food expenditures. The expected impact of shocks in aggregate increases the national poverty rate by 9%. However, the impact of specific shocks on household food expenditures varies across regions and households. Further, the variables which are strongly correlated with chronic poverty differ from the variables strongly correlated with transient poverty. These results suggest the need to both more rapidly identify and enroll households exposed to shocks in short-term social protection programs and continue to improve methods targeting the chronic poor in long-term programs. / Master of Science

本篇文章之研究目的，主要是探討台灣地區人口遷移受到各縣市的社會福利支出的影響究竟如何。本文將利用台灣23個縣市別的追蹤資料（panel data），涵蓋期間為1995年至2005年。採雙因子固定效果模型（two-way fixed-effect model）分析社會福利支出對於人口遷移，究竟存在著什麼樣的貢獻。於本研究中，將回顧現有文獻中，關於人口遷移之相關理論與實證文獻，且特別著重在以福利遷移（Welfare Migration）為研究主體之相關文獻。此外，本文也將清楚地介紹與說明，近幾年來台灣社會福利體制的發展，以及各縣市會福利支出水準與人口遷移間關係之現況。最後，為了進一步探討社會福利支出，對於男性與女性遷移者所產生之影響是否一致，本研究將建立三種實證模型。試圖更全面的探析台灣各縣市的社會福利支出，對於跨縣市的人口遷移之完整影響效果如何。本文主要的發現為，若某一地區每人可享之社會福利的程度高於鄰近的縣市，會吸引較多人口移入該地區。此外，女性移民較男性移民，受到社會福利支出之效果較為顯著。 / This study undertakes a study of cross-regional migration in Taiwan during the 1995 to 2005 period, particularly the effect of the social welfare system on migration decisions. The local places include the 23 cities and counties in Taiwan. Using data set from Taiwan-Fukien demographic fact book Republic of China and Expenditure conducted by Directorate-General of Budget. The hypothesis of this study is that movers would choose to the places with higher welfare to maximum their utilities. The empirical results from two-way fixed effect model support for the hypothesis that social welfare benefits influence migration decisions, especially for females.