Made available in DSpace on 2014-06-12T15:53:28Z (GMT). No. of bitstreams: 2 arquivo5147_1.pdf: 1704608 bytes, checksum: 9349cd2e19d14f618f798e42efeaab3f (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2004 / In this work we address the conceptualisation of a Simulation Environment for the development of multi-physic simulators based on the Finite Element Method (FEM). Simulators are economical means of understanding and evaluating the performance of abstract and real-world systems. Our simulation perspective is the class of simulations for phenomena represented by a set of functions distributed in space and possibly in time, whose behaviour is based on the FEM. The importance of these simulators has to do with the effectiveness of the FEM, a general-purpose numerical method, which can easily be developed to analyse and solve various kinds of problems frequently found in human daily life, and in its power to provide accuracy and reliability in the solution of partial differential equations. FEM Simulations consider systems of possibly millions of algebraic equations, numerical integrations, mesh generations, matrix and vector manipulations, solutions of linear and non-linear systems, and so on. These features undoubtly justify the development of a specific computational environment. This work emphasizes the adaptation of software engineering practices and methodologies for organizing and reusing the specific domain of simulators formulated using the FEM. The work defines an environment and its architecture for the development of simulators. It also proposes some specific patterns for solving relevant problems of our domain of knowledge, and describes their application through a case study.

Resource withdrawal from unnecessary medical services is an important issue as the cost of health care continues to rise. In many countries, resource withdrawal is primarily determined by government policies that remove, restrict, reduce, or limit the availability of publically insured medical services. Ideally, resource withdrawal is the result of a careful assessment of clinical and economic evidence regarding a service’s safety and effectiveness in order to ensure that it is the most efficient use of resources. Despite advocacy for a routinized and systematic approach to the withdrawal of resources from medical services, research has indicated that political and social factors often influence government, resulting in decisions that are neither consistent nor transparent. In this dissertation I seek to understand factors that may influence resource withdrawal decisions in an attempt to promote a more routinized and systematic approach. In order to understand the resource withdrawal landscape and provide greater conceptual clarity, the first study in this dissertation identifies and explores its characteristics (antecedents, attributes, and outcomes). Definitions of two prominent terms, disinvestment, and rationing are proposed. In the second study, a qualitative analysis of two examples of resource withdrawal reveals how the characteristics of problem frames affect the shape and timing of government resource withdrawal policies. Findings support the proposition that the complexity of the story told within the problem frame affects the shape of the policy; while visibility affects the timing. In the third study, I analyzed the perspectives of key informants about the Choosing Wisely Canada (CWC) campaign, which has the aim of reducing unnecessary services by encouraging a discussion between physician and patient. Findings reveal that CWC was designed to address pressures from government, patients, and the public. However, CWC was not designed in a way that is expected to address the underlying reasons unnecessary services are provided, including limited time in the clinical encounter, patient demands, uncertainty in the care pathway, and physician fear of litigation. Results from all three studies help establish a common language, identify influences on government led resource withdrawal and reasons why CWC is unlikely to reduce unnecessary services. Together this thesis provides insights into some of the factors affecting resource withdrawal from medical services, and findings may be used to help assess ways to improve the formulation of resource withdrawal policies. / Dissertation / Doctor of Philosophy (PhD) / Currently several governments pay for unnecessary medical services, leading to suboptimal patient health outcomes and a waste of public resources. Several researchers and organizations have proposed methods to identify and assess medical services to determine if they are unnecessary; however, governments have been slow to adopt such methods on a routine basis. It is clear that evidence is rarely sufficient to motivate governments to withdraw resources from unnecessary medical services. Instead, governments are often influenced by social and political factors when they make such decisions. Through a better understanding of these factors, we may be able to find ways to incorporate evidence into governments’ decisions to withdraw resources from medical services. Qualitative methods were used to investigate how resource withdrawal is defined, factors influencing government resource withdrawal decisions in Ontario, and the effectiveness of Choosing Wisely Canada, an initiative led by the medical community to reduce unnecessary services.

Opinions on what is best way to provide more people in low income countries with adequate water and sanitation services have changed over time. A recent policy paradigm suggests that private companies should be involved in WSS service provision to improve the situation for those in need. This study looks at how issues of water supply and sanitation (WSS) have been confronted by the international donor community and how strategies to improve performance in this sector have changed from the early 1970’s up until today. The evolution of ideas and strategies are linked to overall development policies in order to better understand the forces that have shaped policy redirections in the sector. In addition, the case study of Ghana gives a preliminary picture of how donor policies have been played out in a national context. The concept of problem frames is used as an analytical tool in order to highlight how ideas change and replace each other but also to illustrate how problem frames are becoming more inclusive as new knowledge and experiences are gained. The study finds that while hardware knowledge such as engineering skills were put at the forefront to begin with, software matters such as capacity building and appropriate management of the sector gained increased attention with time. As the water challenge becomes increasingly framed as a matter of managing scarcity, the economic value of water is emphasized and private sector participation is promoted on a larger scale. With time the cross sectoral nature of the WSS issue gains increased attention as its overall impact on poverty reduction and environmental sustainability is emphasized. This holistic approach also contributes to an increased emphasis on sanitation as important to sustainable WSS systems and services. The case study of Ghana shows that all in all, institutional change within the Ghanaian WSS sector during the post independence era, mirror international policy trends. Power is moving out from the state in different directions and responsibilities are gradually hived off from the central organization to local authorities or other agencies working on specific issues. Subsidies on water tariffs are abolished and at the end of the period the private sector is also invited to act in the sector. However, recent trends indicate that as democracy deepens and civil society is growing stronger this also effects policy development in the Ghanaian WSS sector.

<p>Opinions on what is best way to provide more people in low income countries with adequate water and sanitation services have changed over time. A recent policy paradigm suggests that private companies should be involved in WSS service provision to improve the situation for those in need.</p><p>This study looks at how issues of water supply and sanitation (WSS) have been confronted by the international donor community and how strategies to improve performance in this sector have changed from the early 1970’s up until today. The evolution of ideas and strategies are linked to overall development policies in order to better understand the forces that have shaped policy redirections in the sector. In addition, the case study of Ghana gives a preliminary picture of how donor policies have been played out in a national context. The concept of problem frames is used as an analytical tool in order to highlight how ideas change and replace each other but also to illustrate how problem frames are becoming more inclusive as new knowledge and experiences are gained.</p><p>The study finds that while hardware knowledge such as engineering skills were put at the forefront to begin with, software matters such as capacity building and appropriate management of the sector gained increased attention with time. As the water challenge becomes increasingly framed as a matter of managing scarcity, the economic value of water is emphasized and private sector participation is promoted on a larger scale. With time the cross sectoral nature of the WSS issue gains increased attention as its overall impact on poverty reduction and environmental sustainability is emphasized. This holistic approach also contributes to an increased emphasis on sanitation as important to sustainable WSS systems and services.</p><p>The case study of Ghana shows that all in all, institutional change within the Ghanaian WSS sector during the post independence era, mirror international policy trends. Power is moving out from the state in different directions and responsibilities are gradually hived off from the central organization to local authorities or other agencies working on specific issues. Subsidies on water tariffs are abolished and at the end of the period the private sector is also invited to act in the sector. However, recent trends indicate that as democracy deepens and civil society is growing stronger this also effects policy development in the Ghanaian WSS sector.</p>