所有權結構、支付制度與競爭係影響醫院績效之關鍵因子，本研究援用相關文獻之發現，推論出三項因素對醫院績效之關係，並以我國獨特之總額預算制度為研究對象，蒐集、串連與合併不同來源之資料，實證檢視衝量競爭與所有權結構對醫院營運績效與醫療品質之聯合效果。 台灣於民國91年7月實施醫院總額預算制度後，浮動點值制度之設計為醫院間引入了衝量競爭(即虛假價格競爭)，而結算後之點值則係反映出醫院間衝量競爭後之結果，醫院除了需面對支付點值所致之財務衝擊外，尚須面對自全民健保實行後，備受醫院詬病之核減制度之衝擊，因此，本文首先嘗試估算醫院受到核減與支付點值所致之財務衝擊程度。無論是國外或國內之研究，對於不同所有權結構醫院之績效表現是否有差異性，一直無法獲得一致性之結論，除了納入營運效率之績效指標外，本研究亦採用疾病別與醫院層級別之醫療品質指標來檢視不同所有權結構醫院之績效表現。更以考量核減與支付點值所致之財務衝擊程度，取代目前文獻僅以總額前、後之二元變數，評估財務衝擊程度對營運效率、醫療品質與財務績效之影響。最後，則是檢視總額預算制度下，醫院受到之財務衝擊度是否會縮小不同所有權結構醫院之營運效率與醫療品質表現之差距。 實證研究發現，不同所有權結構醫院之營運效率並未有顯著差異，但不同所有權結構醫院在某些疾病別品質指標(子宮肌瘤切除手術之住院超過7日機率與再入院率)與醫院層級品質指標(院內感染率與淨死亡率)表現上則有差異性；且公立或非營利醫院受到核減與支付點值之財務衝擊高於私立醫院，因此不同所有權結構醫院之行為與績效存有某些差異性。台灣的醫院在總額預算制度下，若受到之財務衝擊程度愈大，其營運效率會變差、醫療品質也受到負面之影響、財團法人醫院之醫務利益率與稅後淨利率也會降低，但現金流量比則會增加，故財務衝擊愈大，醫院之績效愈低。若同時考量財務衝擊度對不同所有權結構醫院之營運效率與醫療品質之聯合效果後，可發現財務衝擊雖然不會縮小公立(或非營利)醫院與私立醫院營運效率之差距，卻縮小公立(或非營利)醫院與私立醫院醫療品質之差距，故以台灣資料可部分支持「不同所有權結構醫院績效差距縮小之因素係競爭力量之崛起」之論點。 / Hospital ownership, payment system and competition are all key drivers to influence hospital performance. This research infer and depict the association of these three drivers from the related literature and empirically examined the effects of fictitious price competition due to the floating point-value system and ownership on hospital operational performance and quality of care by combing and merging different sources of data. Deduction rate of claim and the floating point-value system are the two controversial debates to the payment system. I attempt to estimate hospital financial pressures as precipitated by deduction rate of claim and floating point-value system. To investigate whether for-profit, not-for-profit, and government hospitals differ in operating performance and quality of care, five diagnose-level and two hospital-level quality indicators are selected. Different from prior research, the financial pressure is captured by hospital data instead of a binary variable (pre and post global budget) and I examine the effect of financial pressure on hospital operational efficiency, quality of care and financial performance. Finally, we test whether differences in operational efficiency and quality care among hospitals with different ownership forms will mitigate or narrow, as hospital financial pressure increases. The results show that for-profit, not-for-profit and government hospitals are far more alike than different in operational efficiency, but ownership affects not only the rate of readmission and the rate of the length of stay larger than 7 days of uterine myomectomy, but also the hospital-level quality indicators: the rate of nosocomial infection and hospital mortality rate. I also find higher financial pressure incurred at government or not-for-profit hospitals than for-profits hospitals. Given my findings, we conclude that hospital ownership status affect performance in terms of quality of care and financial pressure from rate of deduction and float point-value system. The study shows that financial pressure adversely affects operational efficiency and quality of care. As not-for proprietary hospital financial pressure increases, the profit margin and net profit ratio will decrease, but the cash flow ratio will increase. Nonetheless, deduction rate of claim and global budget has a negative impact on hospital performance. This research further considers the joint effect of financial pressure on difference between quality of care and efficiency of for-profit hospitals and the other two types. My results indicate that hospital financial pressure mitigates the difference of quality of care between for-profit hospital and not-for profit (or government) hospitals, but does not narrow the difference in quality of care between for-profit hospital and not-for profit (or government) hospitals. This finding partly supports that increased competition should force not-for-profit (or governmental) hospitals to be increasingly similar to their for-profit counterparts.

Le travail présenté dans cette thèse est consacré à la modélisation de la dynamique de locomotion des "soft robots", i.e. les systèmes multi-corps mobiles compliants. Ces compliances peuvent être localisées et considérées comme des liaisons passives du système,ou bien introduites par des flexibilités distribuées le long des corps. La dynamique de ces systèmes est modélisée en adoptant une approche Lagrangienne basée sur les outils mathématiques développés par l’école américaine de mécanique géométrique. Du point de vue algorithmique, le calcul de ces modèles dynamiques s’appuie sur un algorithme récursif et efficace de type Newton-Euler, ici étendu aux robots locomoteurs munis d’organes compliants. Poursuivant des objectifs de commande et de simulation rapide pour la robotique, l’algorithme proposé est capable de résoudre la dynamique externe directe ainsi que la dynamique inverse des couples internes. Afin de mettre en pratique l’ensemble de ces outils de modélisation, nous avons pris le vol battant des insectes comme exemple illustratif. Les équations non-linéaires qui régissent les déformations passives de l’aile sont établies en appliquant deux méthodes différentes. La première consiste à séparer le mouvement de l’aile en une composante rigide dite de "repère flottant" et une composante de déformation. Cette dernière est paramétrée dans le repère flottant par la méthode des modes supposés ici appliquée à l’aile vue comme une poutre d’Euler-Bernoulli soumise à la flexion et à la torsion. Quant à la seconde approche, les mouvements de l’aile n’y sont pas séparés mais directement paramétrés par les transformations finies rigides et absolues d’une poutre Cosserat. Cette approche est dite Galiléenne ou "géométriquement exacte" en raison du fait qu’elle ne requiert aucune approximation en dehors des inévitables discrétisations spatiale et temporelle imposées parla résolution numérique de la dynamique du vol. Dans les deux cas,les forces aérodynamiques sont prises en compte via un modèle analytique simplifié de type Dickinson. Les modèles et algorithmes résultants sont appliqués à la conception d’un simulateur du vol, ainsi qu’à la conception d’un prototype d’aile, dans le contexte du projet coopératif (ANR) EVA. / The objective of the present work is to model the locomotion dynamics of "soft robots", i.e. compliant mobile multi-body systems. These compliances can be either localized and treated as passive joints of the system, or introduced by distributed flexibilities along the bodies. The dynamics of these systems is modeled in a Lagrangian approach based on the mathematical tools developed by the American school of geometric mechanics. From the algorithmic viewpoint, the computation of these dynamic models is based on a recursive and efficient Newton-Euler algorithm which is extended here to the case of robots equipped with compliant organs. The proposed algorithm is compatible with control, fast simulation and real time robotic applications. It is able to solve the direct external dynamics as well as the inverse internal torque dynamics. The modeling tools and algorithms developed in this thesis are applied to one of the most advanced cases of compliante locomotion i.e. the flapping flight MAVs bio-inspired by insects. The nonlinear equations governing the passive deformations of the wing are derived using two different methods. In the first method, we separate the wing movement into a rigid component (which corresponds to the movements of a "floating frame"), and a deformation component. The latter one is parameterized in the floating frame using the assumed modes approach where the wing is considered as an Euler-Bernoulli beam undergoing flexion and torsion deformations. Regarding the second method, the wing movements are no longer separated but directly parameterize dusing rigid finite absolute transformations of a Cosserat beam. This method is called Galilean or "geometrically exact" because it does not require any approximation apart from the unavoidable spatial and temporal discretizations imposed by numerical resolution of the flight dynamics. In both cases, the aerodynamic forces are taken into account through a simplified analytical model. The resulting models and algorithms are used in the context of the collaborative project (ANR) EVA to develop a flight simulator, and to design wing prototype.

Simulações de sais de carbonato fundidos pelo método de Dinâmica Molecular (MD) foram efetuadas com o modelo polarizável de cargas flutuantes (FC). O modelo de cargas flutuantes implementa os efeitos de polarização pelo método de Lagrangiano estendido, onde as variáveis extras são as próprias cargas parciais do íon poliatômico. O modelo FC foi parametrizado por meio de cálculos ab inito, aplicado ao ânion carbonato. Cálculos de Química Quântica ab initio foram utilizados para corroborar o modelo proposto para o ânion carbonato. Os sistemas investigados consistem em misturas de carbonatos alcalinos fundidos, Li2CO3/K2CO3, os quais são utilizados como eletrólitos em células a combustível. As simulações MD foram utilizadas para verificar o efeito da polarização dos ânions sobre a estrutura e dinâmica do líquido. Estudamos o efeito da inclusão de polarização sobre a condutividade do eletrólito. / Simulations of molten carbonate salts by the method of Molecular Dynamics (MD) have been performed with the fluctuanting charge (FC) model. The FC model implements the effect of polarization by using method of extended Lagrangian, where the extra variables are the partial charges of the poliatomic ion. The FC model was parametrized by ab inito calculations os a single carbonate anion. Quantum Chemistry calculations bave been used to corroborate the model for the carbonate anion. The investigated systems consist of alkaline carbonate mixtures, Li2CO3/K2CO3, which are used as electrolytes in fuel cells. MD simulations have been used to verify polarization effects on structure and dynamics of the liquid. We study the effect of including anion polarization on the condutivity of the electrolyte.

No description available.

I evaluate four possible approaches the United States may take to address China's practice of undervaluing the renminbi: 1) a challenge under Article XV of the GATT and the associated IMF provisions; 2) countervailing duties; 3) antidumping measures; and 4) safeguard measures. I conclude that the first three approaches are unlikely to succeed; there are a number of legal and political obstacles to the pursuit of these remedies. While the current WTO safeguards regime is likely insufficient, a new safeguards regime can--and should--be developed. I review and critique Dani Rodrik's proposal for a new safeguards regime and set out my own basic blueprint for a significantly expanded safeguards regime, emphasizing that flexibility in the realm of international trade law would help to secure overall stability in international trade itself. In order to be effective shock absorbers, safeguards must become far more flexible.

I evaluate four possible approaches the United States may take to address China's practice of undervaluing the renminbi: 1) a challenge under Article XV of the GATT and the associated IMF provisions; 2) countervailing duties; 3) antidumping measures; and 4) safeguard measures. I conclude that the first three approaches are unlikely to succeed; there are a number of legal and political obstacles to the pursuit of these remedies. While the current WTO safeguards regime is likely insufficient, a new safeguards regime can--and should--be developed. I review and critique Dani Rodrik's proposal for a new safeguards regime and set out my own basic blueprint for a significantly expanded safeguards regime, emphasizing that flexibility in the realm of international trade law would help to secure overall stability in international trade itself. In order to be effective shock absorbers, safeguards must become far more flexible.

Im Rahmen dieser Arbeit werden haftstellen-basierte Speicherzellen als mögliche Alternative zum bestehenden Floating-Gate Konzept untersucht. Hierbei wird zunächst mittels Simulation und ausgewählten Messverfahren das Verständnis der Funktionsweise vertieft. Der darauffolgende Abschnitt befasst sich mit der Verbesserung der elektrischen Eigenschaften, basierend auf Änderungen der verwendeten Materialien und dem räumlichen Aufbau. Abschließend erfolgt die Untersuchung der Anwendbarkeit des Zellkonzeptes in hochdichten Zellenfeldern.

Phytoplankton blooms compromise the quality of freshwater ecosystems and the efficient processing of water by treatment works worldwide. This research aims to determine whether in-situ filamentous biofiltration processes mediated by living roots and synthetic filters as media can reduce or remove the phytoplankton loading (micro-algae and cyanobacteria) prior to a potable water treatment works intake. The underlying biofiltration mechanisms were investigated using field and laboratory studies. A novel macroscale biofilter with three plant species, named the "Living-Filter", installed in Farmoor II reservoir, UK, was surveyed weekly for physicochemical and biological variables under continuous flow conditions during 17 weeks. The efficiency of a mesoscale biofilter using the aquatic plant Phalaris arundinacea and synthetic filters, was tested with Microcystis aeruginosa under continuous flow conditions and in batch experiments. The 'simultaneous allelochemical method' was developed for quantifying allelochemicals from Phalaris in aqueous samples. Microscale studies were used to investigate biofilter allelochemical release in response to environmental stressors and Microcystis growth inhibition in filtered and unfiltered aqueous root exudate. Results demonstrate that the removal of phytoplankton biomass by physical mechanisms has a removal efficiency of ≤45% in the "Living-Filter" (filamentous biofilter plus synthetic fabric) and that the removal of Microcystis biomass using only biofilters was 25%. Chemical mechanisms that reduce Microcystis cell numbers are mediated by allelochemicals released from biofilter roots. Root exudate treatments on Microcystis revealed that Microcystis growth is inhibited by allelochemicals, not by nutrient competition, and that protists and invertebrates play a role in removing Microcystis. Filamentous biofilters can remove phytoplankton biomass by physical, chemical and biological mechanisms. Biofilters and synthetic filters in combination improve removal efficiency. Application of macroscale biofilters prior to potable water treatment works benefits the ecosystem. Plant properties, biofilter size to surface water ratio, and retention time must be considered to maximise the benefits of biofiltration processes.

Quand on veut évaluer ou manipuler une fonction mathématique f, il est fréquent de la remplacer par une approximation polynomiale p. On le fait, par exemple, pour implanter des fonctions élémentaires en machine, pour la quadrature ou la résolution d'équations différentielles ordinaires (ODE). De nombreuses méthodes numériques existent pour l'ensemble de ces questions et nous nous proposons de les aborder dans le cadre du calcul rigoureux, au sein duquel on exige des garanties sur la précision des résultats, tant pour l'erreur de méthode que l'erreur d'arrondi.Une approximation polynomiale rigoureuse (RPA) pour une fonction f définie sur un intervalle [a,b], est un couple (P, Delta) formé par un polynôme P et un intervalle Delta, tel que f(x)-P(x) appartienne à Delta pour tout x dans [a,b].Dans ce travail, nous analysons et introduisons plusieurs procédés de calcul de RPAs dans le cas de fonctions univariées. Nous analysons et raffinons une approche existante à base de développements de Taylor.Puis nous les remplaçons par des approximants plus fins, tels que les polynômes minimax, les séries tronquées de Chebyshev ou les interpolants de Chebyshev.Nous présentons aussi plusieurs applications: une relative à l'implantation de fonctions standard dans une bibliothèque mathématique (libm), une portant sur le calcul de développements tronqués en séries de Chebyshev de solutions d'ODE linéaires à coefficients polynômiaux et, enfin, un processus automatique d'évaluation de fonction à précision garantie sur une puce reconfigurable. / For purposes of evaluation and manipulation, mathematical functions f are commonly replaced by approximation polynomials p. Examples include floating-point implementations of elementary functions, integration, ordinary differential equations (ODE) solving. For that, a wide range of numerical methods exists. We consider the application of such methods in the context of rigorous computing, where we need guarantees on the accuracy of the result, with respect to both the truncation and rounding errors.A rigorous polynomial approximation (RPA) for a function f defined over an interval [a,b] is a couple (P, Delta) where P is a polynomial and Delta is an interval such that f(x)-P(x) belongs to Delta, for all x in [a,b]. In this work we analyse and bring forth several ways of obtaining RPAs for univariate functions. Firstly, we analyse and refine an existing approach based on Taylor expansions. Secondly, we replace them with better approximations such as minimax approximations, Chebyshev truncated series or interpolation polynomials.Several applications are presented: one from standard functions implementation in mathematical libraries (libm), another regarding the computation of Chebyshev series expansions solutions of linear ODEs with polynomial coefficients, and finally an automatic process for function evaluation with guaranteed accuracy in reconfigurable hardware.

Simulações de sais de carbonato fundidos pelo método de Dinâmica Molecular (MD) foram efetuadas com o modelo polarizável de cargas flutuantes (FC). O modelo de cargas flutuantes implementa os efeitos de polarização pelo método de Lagrangiano estendido, onde as variáveis extras são as próprias cargas parciais do íon poliatômico. O modelo FC foi parametrizado por meio de cálculos ab inito, aplicado ao ânion carbonato. Cálculos de Química Quântica ab initio foram utilizados para corroborar o modelo proposto para o ânion carbonato. Os sistemas investigados consistem em misturas de carbonatos alcalinos fundidos, Li2CO3/K2CO3, os quais são utilizados como eletrólitos em células a combustível. As simulações MD foram utilizadas para verificar o efeito da polarização dos ânions sobre a estrutura e dinâmica do líquido. Estudamos o efeito da inclusão de polarização sobre a condutividade do eletrólito. / Simulations of molten carbonate salts by the method of Molecular Dynamics (MD) have been performed with the fluctuanting charge (FC) model. The FC model implements the effect of polarization by using method of extended Lagrangian, where the extra variables are the partial charges of the poliatomic ion. The FC model was parametrized by ab inito calculations os a single carbonate anion. Quantum Chemistry calculations bave been used to corroborate the model for the carbonate anion. The investigated systems consist of alkaline carbonate mixtures, Li2CO3/K2CO3, which are used as electrolytes in fuel cells. MD simulations have been used to verify polarization effects on structure and dynamics of the liquid. We study the effect of including anion polarization on the condutivity of the electrolyte.