This is a qualitative study based on interviews with unit managers working by the entitlement law LSS, Act concerning Support and Service for Persons with Certain Functional Impairments. The purpose of this study is to get an understanding of how unit managers in the LSS area perceive, work with and have experience of user influence in their organizations. The implementation of previous research makes an easier understanding of what the professional role means for both the organization and the user of welfare services. The main result of the study shows that the unit managers have a significant role for the user influence and that user influence needs further development in their organizations. Unit managers work to equalize social differences and compensate for the user's care needs. User influence is therefore needed for users to be able to become as independent as possible.  The unit manager works according to organizational conditions and creates strategies while using their professional discretion. Which promotes participation and self-determination for the user and their way of life. The result fills a knowledge gap regarding the unit manager's professional role and work for and with user influence in practice within the law of LSS. The study's theoretical approach is based on the theories of human-treating organizations, social citizenship and a model that explains society views different levels of disability and the user's personal autonomy.

Cotutelle France-Québec / La médiation présente un fort potentiel dans la régulation des rapports entre patients et professionnels de santé et de nombreux bénéfices dans le domaine de la santé lequel se prête aisément à la mise en œuvre des modes amiables de règlement des différends. L’utilisation marginale de la médiation en santé invite alors à considérer les facteurs juridiques susceptibles de l’expliquer. Ce travail visait donc à déterminer, le cadre juridique optimal susceptible de favoriser le recours – ou promouvoir le développement – de la médiation extrajudiciaire dans les différends nés de la relation de soin. L’hypothèse étant que la faible efficacité incitative des législations applicables à la médiation en santé représente un facteur dissuasif à son utilisation, cette efficacité étant tributaire du degré d’adaptation de ces législations à la nature spécifique des différends en santé. Le travail s’appuie sur une analyse comparative franco-québécoise, le Québec et la France étant tous deux au diapason s’agissant d’encourager le recours à la médiation. Un cadre d’analyse pour juger de l’adéquation des législations québécoise et française applicables à la médiation en santé aux différends nés de la relation de soin a d’abord été dégagé de l’étude de la singularité de ces différends. La comparaison des corpus juridiques québécois et français a ensuite montré des différences dans l’appréhension de la médiation mais également des similarités notamment s’agissant des difficultés concernant son implantation dans le champ de la santé. Les démarches faites pour les surmonter à la fois se rejoignent et diffèrent puisqu’elles dépendent de deux paramètres : assurer un environnement favorable au recours et structurer les conditions de la fonction de médiation. Ainsi, l’environnement juridique, à la fois conceptuel et axé sur l’information, l’accompagnement et l’accessibilité des justiciables, et la formation des acteurs de la médiation en santé sont donc cruciaux pour son avenir dans le champ de la santé. En prenant appui sur les forces des cadres juridiques québécois et français, le modèle de référence de la médiation en santé proposé s’inscrit, d’abord, dans un cadre global plus large visant à insuffler une véritable culture de médiation. Ensuite, il repose sur une approche pragmatique et donc sur une conception de la médiation en santé « hybride » qui se détache de la définition communément adoptée par la doctrine. Ce cadre de référence propose de renouveler le champ d’application de la médiation par une approche centrée sur le concept de qualité et de sécurité de soins. Le potentiel de la médiation dans l’amélioration de la qualité et de la sécurité de soins est sûrement l’élément clé qui fonde la spécificité de cette médiation et sur lequel il conviendrait de davantage insister en tant que finalité explicite de cette médiation. La médiation en santé pourrait ainsi bénéficier d’un ancrage pérenne et s’insérer plus aisément dans le répertoire des pratiques institutionnelles. Par ailleurs, en tant qu’instrument au service de l’amélioration de la qualité de soins et de prévention des erreurs médicales, la médiation n’est plus seulement un instrument « curatif » de gestion de crise. Elle offre plutôt un panel d’options permettant de répondre à l’extrême diversité des besoins des parties au différend né de la relation de soin. Au travers de cette étude, nous montrons in fine l’existence d’un besoin accru de médiation au sein des deux systèmes de santé et de quelle manière le droit peut constituer un moteur essentiel pour promouvoir un certain modèle de médiation en santé et favoriser ou non son recours. / Mediation has great potential in the regulation of relations between patients and health professionals and many benefits in the health field, which lends itself easily to the implementation of alternative dispute resolution methods. The marginal use of mediation in the health field invites us to consider the legal factors that could explain it. The aim of this work was therefore to determine the optimal legal framework likely to encourage the use - or promote the development - of extrajudicial mediation in disputes arising from the care relationship. The hypothesis being that the low incentive efficiency of the legislations applicable to mediation in health represents a dissuasive factor to its use, this effectiveness being dependent on the degree of adaptation of these legislations to the specific nature of the disputes in health. The work is based on a comparative Franco-Quebec analysis, with both Quebec and France being in tune in terms of encouraging the use of mediation. An analytical framework for judging the adequacy of the Quebec and French legislation applicable to mediation in the health sector to disputes arising from the health care relationship was first identified by studying the singularity of these disputes. The comparison of the Quebec and French legal corpora then showed differences in the apprehension of mediation but also similarities, in particular with regard to the difficulties concerning its implementation in the health field. The steps taken to overcome them are both similar and different since they depend on two parameters: ensuring an environment favourable to recourse and structuring the conditions of the mediation function. Thus, the legal environment, both conceptual and focused on information, support and accessibility of litigants, and the training of the actors of mediation in health are crucial for its future in the health field. By building on the strengths of the Quebec and French legal frameworks, the proposed reference model for mediation in health is, first, part of a broader global framework aimed at instilling a true mediation culture. Secondly, it is based on a pragmatic approach and therefore on a conception of « hybrid » mediation in health care that is different from the definition commonly adopted by the doctrine. This reference framework proposes to renew the field of application of mediation by an approach centred on the concept of quality and safety of care. The potential of mediation in the improvement of the quality and safety of care is surely the key element that founds the specificity of this mediation and on which it would be advisable to insist more as an explicit purpose of this mediation. Mediation in health care could thus benefit from a perennial anchoring and be more easily inserted in the repertoire of institutional practices. Moreover, as an instrument for improving the quality of care and preventing medical errors, mediation is no longer just a "curative" instrument for crisis management. Rather, it offers a range of options to meet the extremely diverse needs of the parties to the dispute arising from the care relationship. Through this study, we show in fine the existence of an increased need for mediation within the two health systems and how the law can constitute an essential driving force to promote a certain model of mediation in health and to promote or not its recourse.

Tesis por compendio / [ES] Las redes sociales han provocado un gran cambio en la manera en la que los eventos deportivos son consumidos en la actualidad, ya que consiguen generar una conversación y ser aglutinadores de un seguimiento que en muchos casos era impensable a través de los medios tradicionales. Tanto para los grandes eventos y los deportes de masas, pero muy especialmente para los deportes minoritarios, también llamados de nicho, todas las acciones en medios digitales cobran gran importancia. En este contexto de medios sociales en el deporte, la red social Twitter genera grandes debates y se posiciona como líder de la conversación en torno a los diferentes temas de actualidad deportivos o para el seguimiento de temas deportivos más específicos. El dinamismo de Twitter se basa en la participación individual, propiciando que diferentes usuarios conduzcan la conversación social gracias a su capacidad de influir. Por ello identificar tanto las dimensiones y variables, como los usuarios con mayor capacidad de generar influencia en esta red social se considera de gran importancia. En nuestra tesis, utilizando de manera combinada dos metodologías como el SNA y el AHP se propone una medida de la influencia en Twitter basada en variables obtenidas de la propia plataforma de Twitter (número de tweets, número de retweets y número de seguidores) y otras calculadas a partir del Análisis de Redes Sociales (outdegree, indegree y PageRank). Para componer este índice se utilizó el Proceso de Jerarquía Analítica, y se analizaron dos ediciones de un evento deportivo de un deporte de nicho: el ciclismo en Pista. Analizando la conversación generada en torno al mundial de Londres 2016 bajo el hashtag oficial #TWC2016, y el mundial de Paises Bajos de 2018 con el hashtag de la ciudad organizadora #Apeldoorn2018 , se constató que la dimensión autoridad formada por las variables número de retweets y pagerank era la que mayor ponderación obtuvo, un 62%, frente a la popularidad con un 29% y la actividad con un 8,4%. Además se consiguió identificar a los usuarios más influyentes de cada uno de los eventos, concluyendo que las cuentas con mayor influencia en Twitter eran las relacionadas con los deportistas participantes y organización del evento. En los eventos se pudo comprobar la importancia de la participación de los organizadores en la conversación generada, ya que en el evento de Londres, donde el perfil organizador fue uno de los más influyentes fueron más de 55.000 los tweets registrados, frente a los 19.000 de Apeldoorn, donde el organizador ocupó posiciones muy inferiores en este ranking de la influencia. Nuestra investigación adquiere gran importancia en esta área de los deportes de nicho, ya que puede resultar de gran interés para el estudio de la dependencia y origen cultural y geográfico de los deportes de nicho, y cómo posibles organizaciones pueden identificar las cuentas más influyentes que pueden redundar positivamente en la generación de menciones y beneficios para posibles patrocinadores. De hecho en nuestra tesis se refleja la creación de diferentes clusters geográficos en torno a los deportistas de un mismo país, y la importancia de determinados perfiles para ampliar el tamaño de estos grupos. / [CA] Les xarxes socials han provocat un gran canvi en la manera com els esdeveniments esportius són consumits actualment, ja que aconsegueixen generar una conversa i ser aglutinadors d'un seguiment que en molts casos era impensable a través dels mitjans tradicionals. Tant per als grans esdeveniments i els esports de masses, però molt especialment per als esports minoritaris, també anomenats de nínxol, totes les accions en mitjans digitals cobren gran importància. En aquest context de mitjans socials a l'esport, la xarxa social Twitter genera grans debats i es posiciona com a líder de la conversa al voltant dels diferents temes d'actualitat esportius o per al seguiment de temes esportius més específics. El dinamisme de Twitter es basa en la participació individual, i propicia que diferents usuaris condueixin la conversa social gràcies a la seva capacitat d'influir. Per això identificar tant les dimensions i les variables com els usuaris amb més capacitat de generar influència en aquesta xarxa social es considera de gran importància. A la nostra tesi, utilitzant de manera combinada dues metodologies com el SNA i l'AHP es proposa una mesura de la influència a Twitter basada en variables obtingudes de la pròpia plataforma de Twitter (nombre de tweets, nombre de retweets i nombre de seguidors) i altres calculades a partir de l'Anàlisi de Xarxes Socials (outdegree, indegree i PageRank). Per compondre aquest índex es va fer servir el AHP i es van analitzar dues edicions d'un esdeveniment esportiu d'un esport de nínxol: el ciclisme de Pista. Analitzant la conversa generada al voltant del mundial de Londres 2016 sota el hashtag oficial #TWC2016, i el mundial de Països Baixos de 2018 amb el hashtag de la ciutat organitzadora #Apeldoorn2018 , es va constatar que la dimensió autoritat formada per les variables nombre de retweets i pagerank era la que més ponderació va obtener, amb un 62%, davant de la popularitat amb 29% i l'activitat amb el 8,4%. A més es va aconseguir identificar els usuaris més influents de cadascun dels esdeveniments, concloent que els comptes amb més influència a Twitter eren aquells relacionats amb els esportistes participants i l'organització de l'esdeveniment. En aquests esdeveniments es va poder comprovar la importància de la participació dels organitzadors en la conversa generada, només a l'esdeveniment de Londres, on el perfil de l'organitzador va ser un dels més influents, es van registrar més de 55.000 tuits, davant dels 19.000 de Apeldoorn , on l'organitzador va ocupar un lloc molt més baix en aquest rànquing de l' influència La nostra recerca adquireix gran importància en aquesta àrea dels esports de nínxol, ja que pot resultar de gran interès per a l'estudi de la dependència i l'origen cultural i geogràfic dels esports de nínxol, i com possibles organitzacions poden identificar els comptes més influents que poden redundar positivament en la generació de mencions i beneficis per a possibles patrocinadors. De fet, la nostra tesi reflecteix la creació de diferents clústers geogràfics al voltant d'esportistes d'un mateix país, i la importància d'alguns perfils per ampliar aquests grups. / [EN] Social networks have caused a great change in the way sporting events are currently consumed. They generate a conversation that in many cases was unthinkable through traditional media. Both for major events and mass sports, but especially for minority sports, also called niche sports, every action in digital media are very important. In this context of social media in sports, the social network Twitter generates great debates and positions itself as the leader of the conversation around the different current sports topics or for the monitoring of more specific sports topics. Twitter's dynamism is based on individual participation, allowing different users to lead the social conversation thanks to their ability to influence. Therefore, identifying both the dimensions and variables, as well as the users with the greatest ability to generate influence in this social network, is considered of great importance. In our thesis, using in a combined way two methodologies such as the SNA and the AHP, a measure of the influence on Twitter is proposed based on variables obtained from the Twitter platform (number of tweets, number of retweets and number of followers) and others calculated from the Social Network Analysis (outdegree, indegree and PageRank). To compose this index, the Analytical Hierarchy Process was used, and two editions of a sporting event of a niche sport were analyzed: Track cycling. Analyzing the conversation generated around the 2016 London World Championship under the official hashtag #TWC2016, and the 2018 Netherlands World Championship with the organizing city's hashtag #Apeldoorn2018 , it was found that the authority dimension formed by the variables number of retweets and pagerank was the one that obtained the highest weight, 62%, compared to popularity with 29% and activity with 8.4%. In addition, it was possible to identify the most influential users of each event, concluding that the accounts with the greatest influence on Twitter were those related to the participating athletes and the organization of the event. In these events, verifying the importance of the participation of the organizers in the generated conversation, was possible, just in the London event, where the organizer profile was one of the most influential, more than 55,000 tweets were registered, compared to 19,000 of Apeldoorn, where the organizer ranked much lower in this ranking of influence. Our research acquires great importance in this area of niche sports, since it can be of great interest for the study of the dependency and cultural and geographical origin of niche sports, and how potential organizations can identify the most influential accounts that can positively result in the generation of mentions and benefits for potential sponsors. In fact, our thesis reflects the creation of different geographical clusters around athletes from the same country, and the importance of some profiles to expand the size of these groups. / Lamirán Palomares, JM. (2022). La influencia en redes sociales durante los eventos deportivos: "Los casos de Twitter en los Mundiales de Ciclismo en Pista de Londres (Reino Unido) 2016, y Apeldoorn (Países Bajos) 2018" [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/190811 / Compendio

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Logistics and supply chain in the Architecture, Engineering and Construction (AEC) industry can be seen as coordinated collaboration that is subject to managerial risks. The managerial risks are mitigated by Building Information Modelling (BIM) and Geo-Information Science (GIS), which are two distinctive digital transformative tools which are revolutionizing and accelerating the AEC industry in recent years. Many gains have been achieved concerning the capacity of BIM and GIS to enable collaborative workflows that minimize data loss and reduce inefficiencies in construction. In the past decade, most scholarly literature on BIM and GIS integration for supply chain management have focused on coordination and visualization to improve supply chain operational efficiency. While BIM optimizes visualization and manages the data related to specific projects, GIS coordinates and manages the data related to the outside environment of the project. An integrated BIM-GIS adoption for Construction Supply Chain Management (CSCM) offers value propositions for client and contracting organizations as information/data is seamlessly shared among them to guide decision making at every phase of the construction project.  However, no detailed study has been conducted so far on assessments of the value creation 4D BIM-GIS brings to the AEC industry when espoused for CSCM. To fill this gap, this paper aims to identify and prioritize the value propositions to 4D BIM-GIS adoption for CSCM in the Swedish AEC industry. Based on the reflective perceptions and evaluations of the AEC industry, the paper demonstrated the varied opinions from current active users and those who are yet to adopt 4D BIM-GIS for CSCM. ‘Time savings, ‘Increased efficiency and productivity and ‘Improved communication and information sharing’ were ranked as topmost drivers for 4D BIM-GIS adoption. The paper recommends corporate level training as pivotal in familiarizing workers with the new techniques that combine BIM and GIS in AEC practice. / Logistik och försörjningskedjan inom arkitektur, teknik och konstruktion (ABE) kan ses som ett samordnat samarbete med överhängande ledningsrisker. Riskerna som hanteras kan mildras av Byggnadsinformationsmodellering (BIM) och Geografiskt informationssystem (GIS), som är två digitalt distinkta transformativa verktyg som revolutionerat och påskyndat ABE-sektorn de senaste åren. Många vinster har uppnåtts med avseende på kapaciteten av BIM och GIS, vilket har möjliggjort ett samarbetsflöde som minimerat dataförlust och minskat ineffektiviteten i byggandet. Under det senaste decenniet har den mest vetenskapliga litteraturen om BIM- och GIS-integration för ledning av försörjningskedjan fokuserat på samordning och visualisering för att förbättra effektiviteten i försörjningskedjan. BIM optimerar visualisering och hantering av data, relaterat till specifika projekt, medan GIS samordnar och hanterar data relaterat till projektets omgivning. En integrerad BIM-GIS-antagande för konstruktionsledningen av försörjningskedjan (CSCM) erbjuder värdeförslag för klient- och beställarorganisationer, eftersom information / data sömlöst delas mellan dem för att kunna guida beslutsfattandet i varje fas av byggprojektet. Emellertid har ingen detaljerad studie hittills genomförts om bedömningar av värdeskapandet som 4D BIM-GIS ger till ABE-sektorn när de används för CSCM. För att fylla denna kunskapslucka syftar denna studie till att identifiera och prioritera värdeförslag till 4D BIM-GIS-antagande för CSCM i den svenska ABE-sektorn. Baserat på de reflekterande uppfattningarna och utvärderingarna från ABE-sektorn, visar studien de olika åsikterna från de nuvarande aktiva användare och de som ännu inte har antagit 4D BIM-GIS för CSCM. ”Tidsbesparingar,” Ökad effektivitet och produktivitet” och ”Förbättrad kommunikation och informationsdelning” rankades som de främsta drivkrafterna för 4D BIM-GIS-antagande. Studien rekommenderar utbildning på företagsnivå som en central faktor för att bekanta sig med de nya teknikerna som kombinerar BIM och GIS i ABE-sektorn.

OBJECTIF : Un fréquent recours aux services de l'urgence hospitalière (SU) pour des troubles mentaux (TM) est coûteux pour les finances publiques, il contribue à l'engorgement des urgences, et n’améliore pas toujours l’état de santé de l’usager de ces services. Ce mémoire porte sur les raisons évoquées pour le recours fréquent aux SU par les patients qualifiés de grands utilisateurs (≥3 visites/an) et ayant des TM courants (TMC) (par ex. troubles dépressifs, troubles anxieux, troubles de comportement), des troubles liés aux substances psychoactives (TLS) (par ex. intoxication, troubles induits par une substance, dépendance) ou des TMC-TLS concomitants. Leurs perspectives sont comparées et les aspects identifiés par les patients comme aidant à réduire leur recours aux SU sont examinés. MÉTHODOLOGIE : S’inscrivant dans un projet de recherche d’envergure financé par les Instituts de recherche en santé du Canada (IRSC), les données de 42 grands utilisateurs des SU avec TMC, TLS ou TMC-TLS concomitants ont été collectées, en 2021-2022, basées sur des entrevues semi-dirigées et un examen des dossiers médicaux des patients. Le recrutement des patients s’est effectué dans deux SU du Québec (Canada). Cette étude qualitative s’est fondée sur l’analyse de contenu. RÉSULTATS : Globalement, les principales raisons évoquées expliquant le grand recours aux SU étaient rattachées à des facteurs liés au système de santé mentale (par ex. l’adéquation, l’accessibilité et la continuité des soins), aux profils des patients (par ex. les problèmes biopsychosociaux urgents et récurrents, les systèmes de soutien et les capacités individuelles) et aux pratiques professionnelles des cliniciens (par ex. leur connaissance et leur aisance avec les TM, la qualité des échanges avec les patients et la collaboration entre les cliniciens). Des interactions complexes entre ces différents facteurs sont rapportées et celles-ci semblent entraver le processus de III rétablissement des patients et perpétuent des cycles menant à une fréquente utilisation des SU. Quelques différences significatives ont aussi émergé entre les trois groupes de patients. Les patients souffrant de TMC se sont distingués par d'importantes barrières d’accès aux soins ambulatoires et des besoins non satisfaits, alors que les patients souffrant de TLS se sont démarqués principalement par leur manque de confiance dans les services ambulatoires, ainsi qu’en eux-mêmes, tandis que ceux souffrant de TMC-TLS par des problèmes de coordination des soins. CONCLUSION : Les résultats mettent en relief la nécessité d’investir davantage dans le système de santé mentale du Québec afin d’améliorer l’accès aux services ambulatoires, la collaboration entre les prestataires de soins et la continuité de soins diversifiés auprès des patients après l’utilisation des SU, ainsi que plus de traitements intégrés pour les TM-TLS. Les pratiques en santé mentale, fondées sur les données probantes, ont besoin d’être encore plus consolidées dans les soins primaires et conformément au modèle de soins chroniques. Ce qui inclus de meilleurs outils de détection précoce des TM et TLS, des modèles de soins par étapes, ainsi que des formations orientées vers le patient, pour la gestion des symptômes. Les grands utilisateurs des SU bénéficieraient ainsi d’une surveillance accrue, de l’élargissement des plans individualisés de soins et des gestionnaires de cas, ainsi que des formations continues en santé mentale offertes aux cliniciens des soins primaires. / AIMS: High emergency department (ED) use for mental disorders is costly for public finances, contributes to ED overcrowding and does not always improve the health status of the ED user. This dissertation investigates the reasons given for the frequent use of ED by patients qualified as high users (≥3 visits/year) and having common mental disorders (CMD) (e.g., depressive disorders, anxiety disorders, behavioral disorders), substance-related disorders (SRD) (e.g., intoxication, substance-induced disorders, dependance) or co-occurring CMD-SRD. Their perspectives are compared, and aspects identified by patients as helpful to reduce their ED use are examined. METHODOLOGY: As part of a large research project funded by the Canadian Institutes of Health Research (CIHR), data from 42 high ED users with CMD, SRD or co-occurring CMD-SRD were collected, between 2021-2022, based on semi-structured interviews and examination of patients’ medical records. Patients were recruited from two large ED in Quebec (Canada). This qualitative study was based on content analysis. RESULTS: Overall, the main reasons reported for high ED use were linked to factors related to the mental healthcare system (e.g., adequacy, accessibility and continuity of care), patient profiles (e.g., urgent and recurrent biopsychosocial problems, support systems and individual disabilities) and clinicians’ professional practices (e.g., knowledge and comfort with mental disorders, quality of exchanges with patients and collaboration between clinicians). Complex interplay between these different factors is reported, hindering patient recovery process and perpetuating cycles leading to high ED use. Few notable differences also emerged between the three groups of patients. Patients with CMD were faced with important barriers to outpatient care and unmet needs, while patients with SRD mostly distinguished by their lower trust in outpatient services, as well as in their self-efficacy, and those V with MD-SRD struggled with care coordination issues. CONCLUSION: Findings highlight the need for greater investment in Quebec’s mental healthcare system to improve access to outpatient care, collaboration between care providers and continuity of diversified care after ED use, with more integrated MD-SRD treatment. Evidence-based mental health practices need to be further consolidated in primary care and according to the chronic care model. This includes better MD and SRD early detection, stepped-care model along with patient symptoms management training could help prevent ED use. High ED users would also benefit more extensive monitoring, the deployment of individual care plan and case management, as well as more continuous mental health training for primary care clinicians.

Health economists, national decision-makers and global health specialists have been interested in calculating the cost of a disease for many years. Only more recently they started to generate more comprehensive frameworks and tools to estimate the full range of healthcare related costs of illness in a user’s perspective in resource-poor settings. There is now an ongoing trend to guide health policy, and identify the most effective ways to achieve universal health coverage. The user fee exemptions health financing schemes, which grounded the tuberculosis control strategy, have been designed to improve access to essential care for ill individuals with a low capacity to pay. After decades of functioning and substantial progress in tuberculosis detection rate and treatment success, this thesis analyses the extent of the coverage (financial and social protection) of two disease control programs in West Africa. Learning from the concept of the medical poverty trap (Whitehead, Dahlgren, et Evans 2001) and available framework related to the economic consequences of illness (McIntyre et al. 2006), a conceptual framework and a data collection tool have been developed to incorporate the direct, indirect and intangible costs and consequences of illness incurred by chronic patients. In several ways, we have sought to provide baseline for comprehensive analysis and standardized methodology to allow comparison across settings, and to contribute to the development of evidence-based knowledge.<p><p>To begin, filling a knowledge gap (Russell 2004), we have performed microeconomic research on the households’ costs-and-consequences-of-tuberculosis in Burkina Faso and Benin. The two case studies have been conducted both in rural and urban resource-poor settings between 2007 and 2009. This thesis provides new empirical findings on the remaining financial, social and ‘healthcare delivery related organizational’ barriers to access diagnosis and treatment services that are delivered free-of-charge to the population. The direct costs associated with illness incurred by the tuberculosis pulmonary smear-positive patients have constituted a severe economic burden for these households living in permanent budget constraints. Most of these people have spent catastrophic health expenditure to cure tuberculosis and, at the same time, have faced income loss caused by the care-seeking. To cope with the substantial direct and indirect costs of tuberculosis, the patients have shipped their families in impoverishing strategies to mobilize funds for health such as depleting savings, being indebted and even selling livestock and property. Damaging asset portfolios of the disease-affected households on the long run, the coping strategies result in a public health threat. In resource-poor settings, the lack of financial protection for health may impose inability to meet basic needs such as the rights to education, housing, food, social capital and access to primary healthcare. Special feature of our work lies in the breakdown of the information gathered. We have been able to demonstrate significant differences in the volume and nature of the amounts spent across the successive stages of the care-seeking pathway. Notably, pre-diagnosis spending has been proved critical both in the rural and urban contexts. Moreover, disaggregated cost data across income quintiles have highlighted inequities in relation to the direct costs and to the risk of incurring catastrophic health expenditure because of tuberculosis. As part of the case studies, the tuberculosis control strategies have failed to protect the most vulnerable care users from delayed diagnosis and treatment, from important spending even during treatment – including significant medical costs, and from hidden costs that might have been exacerbated by poor health systems. To such devastating situations, the tuberculosis patients have had to endure other difficulties; we mean intangible costs such as pain and suffering including stigmatization and social exclusion as a result of being ill or attending tuberculosis care facilities. The analysis of all the social and economic consequences for tuberculosis-affected households over the entire care-seeking pathway has been identified as an essential element of future cost-of-illness evaluations, as well as the need to conduct benefit incidence assessment to measure equity.<p><p>This work has allowed identifying a series of policy weaknesses related to the three dimensions of the universal health coverage for tuberculosis (healthcare services, population and financial protection coverage). The findings have highlighted a gap between the standard costs foreseen by the national programs and the costs in real life. This has suggested that the current strategies lack of patient-centered care, context-oriented approaches and systemic vision resulting in a quality issue in healthcare delivery system (e.g. hidden healthcare related costs). Besides, various adverse effects on households have been raised as potential consequences of illness; such as illness poverty trap, social stigma, possible exclusion from services and participation, and overburdened individuals. These effects have disclosed the lack of social protection at the country level and call for the inclusion of tuberculosis patients in national social schemes. A last policy gap refers to the lack of financial protection and remaining inequities with regards to catastrophic health expenditure still occurring under use fee exemptions strategies. Thereby, one year before 2015 – the deadline set for the Millennium Development Goals – it is a matter of priority for Benin and Burkina Faso and many other countries to tackle adverse effects of the remaining social, economic and health policy and system related barriers to tuberculosis control. These factors have led us to emphasize the need for countries to develop sustainable knowledge. <p><p>National decision-makers urgently need to document the failures and bottlenecks. Drawing on the findings, we have considered different ways to strengthen local capacity and generate bottom-up decision-making. To get there, we have shaped a decision framework intended to produce local evidence on the root causes of the lack of policy responsiveness, synthesize available evidence, develop data-driven policies, and translate them into actions.<p><p>Beyond this, we have demonstrated that controlling tuberculosis was much more complex than providing free services. The socio-economic context in which people affected by this disease live cannot be dissociated from health policy. The implications of microeconomic research on the households’ costs and responses to tuberculosis may have a larger scope than informing implementation and adaptation of national disease-specific strategies. They can be of great interest to support the definition of guiding principles for further research on social protection schemes, and to produce evidence-based targets and indicators for the reduction and the monitoring of economic burden of illness. In this thesis, we have build on prevailing debates in the field and formulated different assumptions and proposals to inform the WHO Global Strategy and Targets for Tuberculosis Prevention, Care and Control After 2015. For us, to reflect poor populations’ needs and experiences, global stakeholders should endorse bottom-up and systemic policy-making approaches towards sustainable people-centered health systems.<p><p>The findings of the thesis and the various global and national challenges that have emerged from case studies are crucial as the problems we have seen for tuberculosis in West Africa are not limited to this illness, and far outweigh the geographical context of developing countries.<p><p><p>Keywords: Catastrophic health expenditure, Coping strategies, Cost-of-illness studies, Direct, indirect and intangible costs, Evidence-based Public health, Financial and Social protection for health, Health Economics, Health Policy and Systems, Informed Decision-making, Knowledge translation, People-centered policy-making, Systemic approach, Universal Health Coverage<p> / Doctorat en Sciences de la santé publique / info:eu-repo/semantics/nonPublished

Public programming initiatives are considered an integral part of archival operations across the world because they support a greater use of archival records. In South Africa, public archival institutions are mandated in terms of section 5(1)(c) of the National Archives and Records Service of South Africa Act (Act No. 43 of 1996) (NARSSA Act), to reach out to the less privileged sectors of society, by making known information concerning records by means such as publications, exhibitions and lending of records. This also includes taking archives to young people, especially school learners. As a result, public archives repositories in South Africa have designed programmes to take archives to school learners for the purpose of creating future users and expanding the use of archival sources. Despite efforts to take archives to the people in South Africa, it would seem that public programming methods that repositories use at schools are not effective in creating awareness and promoting public archives to attract school learners. This qualitative study utilised semi-structured interviews and observation as data collection tools to investigate schools as conduits for taking public archives to learners in the Gauteng province of South Africa. The study targeted learners and teachers in schools which participated in the archival public programming in Gauteng province, as well as staff members of the National Archives and Records Service of South Africa (NARSSA) and Gauteng Provincial Archives responsible for public programming. The key findings suggest that the public archives repositories in Gauteng do not use technology, particularly social media, to market their services to school learners. The main method of taking archives to learners is through invitations and participation in the annual archives week, which do not yield any positive results, as learners do not visit the archives afterwards. It is recommended that NARSSA and Gauteng Provincial Archives consider using school learners who participated in archives week and are interested in archives to be ambassadors to further recommend the use of archives to potential users and their peers. Furthermore, collaboration between archivists and teachers from neighbouring schools should be considered by including school projects that involve the use of “archives’’. The study concludes that failure to adopt social media platforms to market archives would result in school learners not using archives. A further study covering all provinces in South Africa is recommended. / Information Science / M. inf. (Archival Science)

From the Proceedings of the 1972 Meetings of the Arizona Section - American Water Resources Assn. and the Hydrology Section - Arizona Academy of Science - May 5-6, 1972, Prescott, Arizona / Experimental and historical development of the systematic study of water is briefly reviewed to prove hydrology a science. The hydrology program at the university of Arizona is outlined, and details of the course 'water and the environment' are expounded. This introductory course is intended for non-scientific oriented students at this southwestern university. A reading list is provided for the class, and scientifically designed laboratory experiments are developed. The first semester includes discussion of world water inventory; occurrence of water; hydrologic cycle; interaction of oceanography, meteorology, geology, biology, glaciology, geomorphology and soils; properties of water (physical, biological, chemical), and resources development. The second semester discusses municipal, industrial and agricultural water requirements, surface, ground, imported and effluent water resources management; water law; economic, legal, political, and social water resource planning; ecological impact; patterns of use; and survival of man. Mathematical problems are reviewed along with ecological orientation of students.

Surveillance wireless sensor networks (WSNs) are highly vulnerable to the failure of the base station (BS) because attackers can easily render the network useless for relatively long periods of time by only destroying the BS. The time and effort needed to destroy the BS is much less than that needed to destroy the numerous sensing nodes. Previous works have tackled BS failure by deploying a mobile BS or by using multiple BSs, which requires extra cost. Moreover, despite using the best electronic countermeasures, intrusion tolerance systems and anti-traffic analysis strategies to protect the BSs, an adversary can still destroy them. The new BS cannot trust the deployed sensor nodes. Also, previous works lack both the procedures to ensure network reliability and security during BS failure such as storing then sending reports concerning security threats against nodes to the new BS and the procedures to verify the trustworthiness of the deployed sensing nodes. Otherwise, a new WSN must be re-deployed which involves a high cost and requires time for the deployment and setup of the new WSN. In this thesis, we address the problem of reliable recovery from a BS failure by proposing a new security architecture called Surveillance Security (SurvSec). SurvSec continuously monitors the network for security threats and stores data related to node security, detects and authenticates the new BS, and recovers the stored data at the new BS. SurvSec includes encryption for security-related information using an efficient dynamic secret sharing algorithm, where previous work has high computations for dynamic secret sharing. SurvSec includes compromised nodes detection protocol against collaborative work of attackers working at the same time where previous works have been inefficient against collaborative work of attackers working at the same time. SurvSec includes a key management scheme for homogenous WSN, where previous works assume heterogeneous WSN using High-end Sensor Nodes (HSN) which are the best target for the attackers. SurvSec includes efficient encryption architecture against quantum computers with a low time delay for encryption and decryption, where previous works have had high time delay to encrypt and decrypt large data size, where AES-256 has 14 rounds and high delay. SurvSec consists of five components, which are: 1. A Hierarchical Data Storage and Data Recovery System. 2. Security for the Stored Data using a new dynamic secret sharing algorithm. 3. A Compromised-Nodes Detection Algorithm at the first stage. 4. A Hybrid and Dynamic Key Management scheme for homogenous network. 5. Powerful Encryption Architecture for post-quantum computers with low time delay. In this thesis, we introduce six new contributions which are the followings: 1. The development of the new security architecture called Surveillance Security (SurvSec) based on distributed Security Managers (SMs) to enable distributed network security and distributed secure storage. 2. The design of a new dynamic secret sharing algorithm to secure the stored data by using distributed users tables. 3. A new algorithm to detect compromised nodes at the first stage, when a group of attackers capture many legitimate nodes after the base station destruction. This algorithm is designed to be resistant against a group of attackers working at the same time to compromise many legitimate nodes during the base station failure. 4. A hybrid and dynamic key management scheme for homogenous network which is called certificates shared verification key management. 5. A new encryption architecture which is called the spread spectrum encryption architecture SSEA to resist quantum-computers attacks. 6. Hardware implementation of reliable network recovery from BS failure. The description of the new security architecture SurvSec components is done followed by a simulation and analytical study of the proposed solutions to show its performance.