Cette thèse se propose d’étudier l’existence de freins au développement du marché privé de l’assurance dépendance en France. Nous étudions ici tour à tour trois candidats dans l’explication de ce faible développement : les préférences individuelles, les comportements d’auto-assurance et la myopie des agents. Pour cela, nous exploitons les enquêtes « Préférences et Patrimoine vis-à-vis du risque et du temps » et « Santé et protection sociale » qui ont toutes deux introduit des modules spécifiques dépendance dans les vagues d’enquêtes mobilisées dans cette thèse. Nos analyses économétriques confirment le rôle d’obstacle de ces trois déterminants de la demande d’assurance dépendance. Si l’existence d’une mauvaise perception du risque dépendance plaide pour l’intervention de l’Etat dans la relation des français à la planification de leurs pertes d’autonomie, le rôle des préférences individuelles et les comportements d’auto-assurance mis en évidence dans cette thèse révèle un choix économiquement rationnel de ne pas recourir à une assurance dépendance. / This thesis aims at better understanding long-term care insurance puzzle. Three determinants of the long-term care insurance market low development are studied here: individual preferences, self-insurance and myopia. To do so, we use two surveys that have introduced dependency-specific modules: “Preferences and patrimony against time and risk” and “Health Care and Insurance”. The results highlight the role of these three determinants of long-term care insurance demand in the low development of the market. If myopia advocate for a government intervention in French citizens long-term care planning, the impact of individual preference and self-insurance behaviors suggest that the nonpurchase of long-term care policies is economically rational.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18855号 / 医博第3966号 / 新制||医||1007(附属図書館) / 31806 / 京都大学大学院医学研究科医学専攻 / (主査)教授 河野 憲二, 教授 黒田 知宏, 教授 富樫 かおり / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Human vision is one of the most important senses, but recently near-sightedness is growing among the population. To investigate this progression, the pheripery of the eye is being studied. Therefore, new methods are developed to examine peripheral vision. This study compares two such instruments: A newly developed for commercial use (Double-Pass) is tested against an established lab setup (Hartmann-Shack Dual-Angle). Measurements of mean focus and astigmatism were taken both foveally and peripherally on 15 people, to examine if the two instruments give the same values. The comparison between the systems shows that a correlation exists, but the data handling algorithm of the Double-Pass system can be fine-tuned to obtain a more consistent result. In addition to this, a university course in optics is investigated in order to develop a homework assignment to make the students engage with the course material and get more students to pass the course. The choice of task is based on the most challenging concepts of previous exams, focusing on peer assessment and formative feedback. From this, a material was developed with a typical exam task combined with a proposed solution that the students used to give feedback to each other. The material was test-run with two former students and updated based on their comments. The assignment was appreciated, but seeing a peer’s assignment can be stressful if the students themselves feel unsure about the material. This will hopefully be avoided when given during the course, where the students can discuss with each other. The upcoming course round will test the assignment with a whole class. / Synen är ett av människans viktigaste sinnen, men den senaste tiden har närsynthet blivit allt vanligare. För att undersöka den ökade förekomsten av myopi utvecklas nya metoder för att undersöka synen i periferin, då denna verkar ge ledtrådar om uppkomsten av närsynthet. I denna studie görs en jämförelse mellan två sådana instrument, ett nyutvecklat mot kommersiellt bruk (Double-Pass) testas mot en etablerad labuppställning (Hartmann-Shack Dual-Angle). Mätningar av medelfokus och astigmatism gjordes både fovealt och periferiellt på 15 personer för att se om instrumenten ger samma resultat. Jämförelsen mellan systemen visar att en korrelation existerar, men att datahanteringsalgoritmen för Double-Pass instrumentet kan finjusteras för att få ett mer överensstämmande resultat. Utöver detta undersöks en universitetskurs i optik för att utveckla en hemuppgift som ska hjälpa studenterna att arbeta med kursmaterialet och hjälpa fler att klara kursen. Valet av uppgift grundar sig i vilka koncept som varit utmanande i tidigare tentor och fokus ligger på kamratbedömning och formativ återkoppling. Från detta utvecklades ett material med en tentatypisk uppgift kombinerat med ett lösningsförslag som studenterna använder för att ge återkoppling till varandra. Materialet testkördes med två tidigare studenter och uppdaterades efter deras kommentarer. Uppgiften uppskattades, men att se en kamrats uppgift kan vara stressande om studenterna själva känner sig osäkra på materialet. Detta undviks förhoppningsvis när uppgiften ges under en kurs då studenterna har möjlighet att diskutera med varandra. Uppgiften kommer testköras i helklass under kommande kursomgång.

La myopie est maintenant considérée comme un problème de santé publique. La forte myopie est associée à des pathologies oculaires comme le glaucome, les cataractes précoces et les problèmes de rétine. La longueur axiale de l’oeil, en plus de sa réfraction, sont des mesures importantes pour assurer le suivi de la progression myopique. Bien que ces variables aient été étudiées en position primaire, peu d’auteurs se sont penchés sur leur variation en périphérie. Ce mémoire a pour principal objectif d’étudier, chez des myopes, la variation de la longueur axiale du centre vers la périphérie de la rétine dans les méridiens horizontaux et verticaux. De plus, elle vise à investiguer si la relation qui existe entre la longueur axiale et la réfraction de l’oeil varie selon l’angle auquel ces variables sont mesurées. 53 participants (83% F; 25,6 ± 2,7 ans) ont été recrutés pour cette étude. Trente minutes après l’instillation de gouttes permettant la dilatation pupillaire, des mesures de longueurs axiales (Lenstar) et de réfractions (Grand Seiko WAM-5500) en position primaire et en périphérie ont été prises en rétine horizontale (10°, 20°, 30°) et verticale (5°, 10°) par rapport à la fovéa. Les résultats obtenus montrent une symétrie horizontale de la longueur axiale jusqu’à une excentricité de 20° et suggèrent une symétrie sur 360° jusqu’à 10°. L’analyse statistique a également permis de confirmer que la relation entre la longueur axiale et la réfraction demeurait la même jusqu’à 20° en nasal, alors qu’elle changeait significativement à 20° en rétine temporale. En comparant la rétine nasale à la rétine temporale, les relations obtenues à 10° étaient similaires, alors que les relations obtenues à 20° étaient différentes. En conclusion, la longueur axiale de l’oeil ainsi que sa relation avec la réfraction demeurent symétriques jusqu’à des angles qui varient entre 10 et 20 degrés. Ceci pourrait influencer la conception des produits optiques développés pour le contrôle de la progression de la myopie. / Today, myopia is considered a public health issue. High myopia is associated with eye pathologies such as glaucoma, early cataracts and retinal abnormalities. In fact, the axial length of the eye, in addition to its refraction, are important measures for monitoring myopic progression. Although these variables have been studied in the central retina, few authors have examined their variation in the peripheral retina. The main objective of this study is to evaluate the variation in the axial length from the center to the periphery of the retina in the horizontal and vertical meridians of myopes. In addition, it aims to investigate whether the relationship between axial length and refraction varies depending on the angle at which these variables are measured. 53 participants (83% F; 25.6 ± 2.7 years) were recruited for this study. Thirty minutes after instillation of drops causing pupillary dilation, measurements of central and peripheral axial lengths (Lenstar) and refractions (Grand Seiko WAM-5500) were taken on the horizontal (10°, 20°, 30°) and vertical (5°, 10°) meridians of the retina relative to the fovea. The results demonstrate horizontal symmetry of the axial length up to an eccentricity of 20° and suggest a symmetry over 360° up to an angle of 10°. Statistical analysis also confirmed that the relationship between axial length and refraction remained the same up to 20° nasally, while it changed significantly at 20° temporally. By comparing the nasal retina to the temporal retina, the relationships obtained at 10° were similar, while the relationships obtained at 20° were different. In conclusion, the axial length of the eye as well as its relation to refraction remain symmetrical up to angles varying between 10 and 20 degrees. This could influence the design of optical products developed for the control of the progression of myopia.

No description available.

MPH / Department of Public Health / See the attached abstract below

OBJETIVO: Avaliar comparativamente os resultados de duas técnicas de cirurgia refrativa de superfície com excimer laser, ceratectomia fotorrefrativa (PRK) e ceratectomia subepitelial borboleta assistida à laser (LASEKb). LOCAL: Hospital de Olhos Sadalla Amin Ghanem, Joinville, Santa Catarina, Brasil. MÉTODOS: Realizou-se um estudo prospectivo, randomizado e duplo-cego envolvendo 102 olhos de 51 pacientes. Cada paciente teve aleatoriamente um dos olhos operado com a técnica do PRK e o outro com LASEKb. Os pacientes foram acompanhados por 1 ano. RESULTADOS: Não houveram diferenças significativas entre os dois grupos na acuidade visual (AV) para longe, sem correção, (P = 0,5593). No 12o mês pós-operatório (PO), 98,04% dos olhos no grupo do PRK e 96,08% no grupo do LASEKb atingiram AV sem correção de 20/20. A previsibilidade, eficácia, segurança e estabilidade não apresentaram diferença estatisticamente significativa entre os grupos. O índice de segurança foi de 1 no PRK e 0,996 no LASEKb. Um olho do grupo do LASEKb perdeu uma linha de visão. A porcentagem de olhos que apresentou EE aos 12 meses na faixa de ±0,50 D foi de 94,1% no grupo do PRK e de 86,3% no grupo do LASEKb (P = 0,1883). Enquanto que na faixa de ±1,0 D foi de 100% no grupo do PRK e 98% no grupo do LASEKb (P = 0,3125). Não houve necessidade de reoperações. O tempo médio de cirurgia na técnica PRK foi de 304,86 + 58,77 segundos (aproximadamente 5 minutos) e na técnica LASEKb de 608,35 + 76,88 segundos (aproximadamente 10 minutos) (P < 0,001). O tempo médio de reepitelização no grupo do PRK foi de 4,35 ± 0,48 dias (variação, 4 a 5 dias) e no grupo do BLASEK foi de 4,75 ± 0,72 dias (variação, 4 a 6 dias) (P < 0,002). Os níveis de dor e o desconforto ocular PO não foram estatisticamente diferentes entre os grupos, entretanto houve uma tendência para menor dor no PRK (3,31 ± 4,09 vs 4,43 ± 4,27; P = 0,18). Houve uma redução estatisticamente significativa nos valores do teste de Schirmer em todas as avaliação PO, tanto no PRK (23,6 ± 8,1 vs 19,4 ± 10,1; P < 0,002) quanto no LASEKb (22,4 ± 8,7 vs 18,9 ± 9,7; P = 0,01), entretanto não houve diferença entre os grupos. A opacificação corneana (OC) PO foi pequena nos dois grupos. Somente no 1o mês foi observado diferença estatística entre os grupos, com maior intensidade da OC no grupo do LASEKb (0,18 ± 0,3881) quando comparado ao PRK (0,08 ± 0,2109) (P = 0,039936). A maior intensidade foi observada no 3o mês, com redução gradativa até o 12o mês. CONCLUSÃO: Dentro das condições deste estudo, conclui-se que o PRK e o LASEKb mostraram resultados semelhantes, exceto que o PRK apresentou menor tempo cirúrgico, reepitelização corneana mais rápida e menor OC no 30o PO. / PURPOSE: Comparatively evaluate the results of two techniques of surface excimer laser refractive surgery, photorefractive keratectomy (PRK) and butterfly laser-assisted subepithelial keratectomy (BLASEK). SETTING: Sadalla Amin Ghanem Eye Hospital, Joinville, Santa Catarina, Brazil. METHODS: This is a prospective, randomized and double-masked study including 102 eyes from 51 patients. Each patient was randomized to have one eye operated on with PRK and the other with BLASEK. Patients were followed for 1 year. RESULTS: There were no significant differences between the groups regarding uncorrected distant visual acuity (VA) (p= 0.5593). On the 12th post-operative (PO) month, 98.04% of the eyes in the PRK group and 96.08% in the BLASEK group reached uncorrected VA of 20/20. The predictability, efficacy, safety and stability did not present statically significant difference between groups. The safety index was of 1 for PRK and 0.996 for BLASEK. One eye of the BLASEK group lost one line on the 12th PO month. The percentage of the eyes that presented spherical equivalent at 12 months in the range of ±0.50 D was 94.1% in the PRK group and 86.3% in the BLASEK group (p = 0.1883). While in the range of ±1.0 D it was 100% in the PRK group and 98% in the BLASEK group (p = 0.3125). There were no retreatments. The mean surgical time was 304.86 + 58.77 seconds (approximately 5 minutes) in PRK and 608.35 + 76.88 seconds in BLASEK (approximately 10 minutes) (P < 0,001). The mean reepithelization time in the PRK group was 4.35 ± 0.48 days (range, 4 to 5 days), and in the BLASEK group was 4.75 ± 0.72 days (range, 4 to 6 days) (P < 0.002). Pain scores and ocular discomfort were not statistically different between groups, although there was a trend towards a lower pain level with PRK (3.31 ± 4.09 vs. 4.43 ± 4.27; P = 0.18). Schirmer test values were significantly reduced from preoperative levels through 12 months with both PRK (23.6 ± 8.1 vs. 19.4 ± 10.1; P < 0.002) and BLASEK (22.4 ± 8.7 vs. 18.9 ± 9.7; P = 0.01), however there was no difference between groups in any time point. Haze incidence was slight in both groups. Only in the 1st PO month statistical difference between the groups was observed, with higher intensity in the BLASEK group (0.18 ± 0.3881) when compared to the PRK (0.08 ± 0.2109) (p = 0.039936). The highest intensity was observed on the 3rd month, with gradual reduction until the 12th month. CONCLUSION: In the conditions of this study, it can be concluded that PRK and BLASEK showed similar results, except that PRK presented shorter surgical time, faster corneal reepithelization and less haze at 30th PO days.

Esta dissertação investiga a relação entre eficiência econômica e reclamações trabalhistas. Especificamente, neste trabalho desenvolvemos um modelo teórico baseado na Teoria dos Jogos que explica o funcionamento econômico dos casos de reclamações trabalhistas, com ênfase na escolha entre soluções negociadas ou litigiosas para as mesmas. O texto dá atenção especial ao sistema existente no Brasil das Câmaras de Conciliação Prévia. Também testamos empiricamente as conclusões teóricas do modelo, para obter apoio empírico às suas previsões. Com base nas evidências obtidas, sugerimos alguns aperfeiçoamentos para melhorar o funcionamento das regras de solução das reclamações trabalhistas para extrair maior eficiência econômica destes procedimentos. / This dissertation investigates the relationship between economic efficiency and labor complaints. Specifically, this work developed a theoretical model based on Games Theory which explains the economic functioning of labor complaints cases, with emphasis on the choice between negotiated or litigant solutions to them. The text gives special attention to the existing system in Brazil called Câmaras de Conciliação Prévia (Prior Conciliation Boards). Moreover, we also have tested empirically the conclusions of the theoretical model, aiming to find empirical support to its forecasts. Based on the evidence obtained, we suggest some improvements to the functioning of the labor complaints solution rules, in order to extract greater economic efficiency from these procedures.

Objetivos: Avaliar o desempenho visual(DV), por meio da AV logMAR de alto contraste, sensibilidade ao contaste(SC) e análise de frentes de onda(AFO), em míopes, com óculos e três LCG. Métodos: Estudo clínico e prospectivo, em 40 indivíduos míopes(-1,00D e -4,50D). Exames: AV logMAR de alto contraste, avaliação de SC e AFO. Resultados: A AFO detectou diferença na aberração de terceira ordem sem e com as LCG.. Em relação ao nível trifoil houve diferença entre com e sem LCG. Conclusões: Na avaliação do DV com óculos e com LCG, a AFO é uma medida mais sensível da função visual que a AV LogMAR de alto contraste e a SC. / Objective: to evaluate the visual performance(VP) by Visual acuity(VA)Logmar of high contrast, sensibility of contrast(SC) and wavefront (WF) in myopic patients correct with spectacles and 3 SCL Methods: prospective clinical trial was performed in 40 myopic patients(-1,00 D and -4,50 D). Exams: VA, WF and CS. Results: The WF analysis detected a significant difference in a third order aberration with and without SCL. There was significant difference related to trefoil coefficient in VP between with and without SCL. Conclusion: In VP evaluation with spectacles and SCL the wavefront analysis was more sensible measure of VP when compared with high contrast VA Logmar and CS.

Unterlassen die Vorstände deutscher Unternehmen wirtschaftlich sinnvolle Investitionen, um einer auf Quartalszahlen fokussierten Financial Community befriedigende Ergebnisse präsentieren zu können? In der vorliegenden Arbeit wird die Frage nach der Existenz von solch kurzfristigem Verhalten, bezeichnet als Managermyopie bzw. Managerial Myopia, sowie den Einflussfaktoren auf dieses Verhalten gestellt. Zur Beantwortung wurden eine postalische, anonymisierte Fragebogenumfrage unter den Finanzvorständen der CDAX-Unternehmen mit einer Rücklaufquote von 21% sowie teilstrukturierte Interviews durchgeführt. Die Ergebnisse liefern deutliche Hinweise auf die Existenz von kurzfristigem Verhalten. Die Faktoren Kapitalmarktdruck, Unternehmensgröße und Fremdkapitalquote besitzen einen statistisch messbaren Einfluss auf kurzfristiges Verhalten. Die Untersuchung liefert direkte Erkenntnisse über Kapitalmarktdruck, das tatsächlich ausgeübte Maß von kurzfristigem Verhalten und die aktuelle Debatte über die verpflichtende Einführung von Quartalsberichterstattung.