Bellbirds (Anthornis melanura) are one of two endemic honeyeaters in New Zealand. They are still common in many parts of the country, but also rare and absent in some areas where they were abundant before. Together with tui (Prosthemadera novaeseelandia) bellbirds are responsible for avian pollination of several native plants in New Zealand. Habitat fragmentation and geographical constraints prevent bellbirds from re-occupying formerly inhabited areas. After translocations birds often disperse; some just disappear, some are thought to fly back to their source site and probably many die. Supplementary feeding provides energy rich food, which helps to ensure birds are well-nourished until they can discover natural food sources at the release sites. Conspecific song playback as an attractant for many bird species can be used as public information about high habitat value and additionally lure birds to good food sources and nest sites. Artificial feeding stations were set up at 18 locations in Kennedy's Bush, Port Hills, Canterbury, New Zealand. Feeders filled with sugar water were available for five to six consecutive days and during observation hours the effect of song playback was tested. Variation in bird numbers resulting from experimental treatments was recorded using five-minute bird counts prior to treatments and additional counts every minute of observation time. Bellbird numbers varied strongly with habitat types, showing highest numbers for dense and tall bush areas and close to creeks and lowest for open areas besides pasture and in post-flowering flax fields. Bellbird numbers increased when song was broadcast, with the strongest effect in areas where bellbird numbers were moderate or low, but not in areas where bellbirds were absent. Feeding stations were not observed to be used by bellbirds. The strong response in bellbird numbers to conspecific song playback proved the attractiveness of song for bellbirds. Nevertheless, its function as a lure for bellbirds to artificial feeding stations was not shown. This contrasting result indicates that the use of bellbird song as an enticement for bellbirds has to be investigated further.

La dextérité, notamment la pince de précision (i.e., opposition pouce-index) est une fonction très développée chez l’homme. Elle est basée sur l’habileté à contrôler précisément et indépendamment les forces et mouvements des doigts en relation avec les contraintes de la tâche. Les muscles de la main responsables du mouvement des doigts sont gouvernés par le système corticospinal (CS) latéral. La principale source de ce système CS est l’aire motrice primaire (M1), laquelle possède des projections CS directes sur les motoneurones des muscles de la main. Cependant, d’autres projections CS en provenance des aires motrices non primaires ont été trouvées, notamment en provenance de l’aire motrice supplémentaire (SMA). Chez l’homme, la fonctionnalité de cette voie dans le contrôle habile des doigts a peu été étudiée. L’objectif de cette thèse est d’étudier, chez l’homme, l’implication des projections CS de la SMA lors de contrôle manuel précis de force. Pour ce faire, nous avons utilisé la stimulation magnétique transcrânienne (TMS) et l’électroencéphalographie (EEG).A travers différentes études, nous avons pu mettre en évidence l’importante implication de la SMA dans la dextérité. Il semblerait que cette aire puisse agir en parallèle à M1 en régulant directement l’excitabilité des motoneurones de la moelle épinière. En conclusion, nos résultats suggèrent que M1 et SMAp ont une influence directe et efficace sur la production de force pendant des tâches motrices manuelles fines. / Human dexterity is a highly developed function based on the ability to independently and precisely control forces and movements of the fingers related to the constraints of the task. Hand muscles for finger movements are steered by the lateral corticospinal (CS) system. The main source of this CS system is the primary motor area (M1), which has direct CS projections on motoneurons innervating hand muscles. Recently, CS projections from non-primary motor area have also been found, especially from the supplementary motor area (SMA). However, the functionality of this CS tract in human manual force control is little studied. The aim of this thesis was to study the implication of the CS projections from SMA in precision manual force control, using electroencephalography (EEG) and transcranial magnetic stimulation (TMS).Altogether, the results obtained in our different studies show the important implication of SMA in dexterity. It appears that this area can act in parallel with M1, directly influencing excitability of spinal motoneurons. We conclude that M1 and SMA both have direct and efficient influence on force production during fine manual motor tasks.

La présente étude se propose de théoriser la pratique de l’entrée payante dans le contrat. Elle peut être envisagée comme l’obligation monétaire préalable et déterminante imposée à l’une des parties, conditionnant la conclusion d’un contrat. La réunion sous ce seul vocable d’un certain nombre d’obligations précontractuelles permet de dégager une vision unitaire de la question, avant de s’attacher à leurs particularités. L’entrée payante connaît, de fait, diverses manifestations et ses justifications le sont tout autant. « Engagement » ou « supplément », la validité de ces obligations interroge nécessairement au regard du principe de la liberté contractuelle. Si l’on ne peut nier l’existence d’instruments juridiques susceptibles d’en assurer le contrôle, ce dernier demeure néanmoins non efficient. Dès lors, doit être sérieusement envisagée la création d’une norme générale encadrant ces pratiques. / This study intends to theorize the application of admission charge into contracts. It can be regarded as a preliminary and decisive monetary obligation imposed upon one of the parties, determining the finalization of the contract. The union of several pre-contractual duties under this sole term allows to put forward a unified vision of the question before going into particularities. De facto, admission charge is subject to various manifestations and so are its justifications. «Engagement» or «supplementary» pre-contractual monetary obligation issues continue to arise regarding the validity of these obligations in accordance with the principle of freedom of contract. While there can be no denying the existence of legal instruments likely to ensure its regulation, it remains inefficient nonetheless. Henceforth, creating a general standard to regulate such practices ought to be seriously considered.

Submitted by Silvania Godoi Ferreira (silvaniagodoi@globo.com) on 2017-01-13T01:42:23Z No. of bitstreams: 1 Dissertação SILVANIA GODOI FERREIRA.pdf: 9535692 bytes, checksum: bdb8772706642edce6d67b8c49088946 (MD5) / Approved for entry into archive by Janete de Oliveira Feitosa (janete.feitosa@fgv.br) on 2017-01-13T12:58:18Z (GMT) No. of bitstreams: 1 Dissertação SILVANIA GODOI FERREIRA.pdf: 9535692 bytes, checksum: bdb8772706642edce6d67b8c49088946 (MD5) / Made available in DSpace on 2017-01-23T13:13:19Z (GMT). No. of bitstreams: 1 Dissertação SILVANIA GODOI FERREIRA.pdf: 9535692 bytes, checksum: bdb8772706642edce6d67b8c49088946 (MD5) Previous issue date: 2016-11-04 / A racionalidade dos agentes econômicos e a hipótese de eficiência de mercado são pressupostos fundamentais da teoria moderna de finanças. Porém, estudos empíricos têm constatado que o comportamento dos investidores nem sempre se mostra racional em tomada de decisão envolvendo risco. A partir dos fundamentos de racionalidade limitada apresentados por Simon (1957) e, posteriormente, estudos desenvolvidos por Kahneman e Tversky (1974 e 1979) sobre vieses cognitivos frequentemente observados no comportamento humano e a perspectiva relativa em tomada de decisão, surgiu o campo de Finanças Comportamentais. Esta dissertação teve por objetivo investigar o efeito da heurística da ancoragem sobre os preços e a tomada de decisão em investimentos imobiliários em fundos de pensão. O setor brasileiro de fundos de pensão conta com 307 instituições e sua carteira imobiliária soma R$ 32,7 bilhões (março/2016). O mapeamento de riscos envolvidos no processo decisório de investimentos é de grande importância para os fundos de pensão cujo objetivo é gerir seu patrimônio para prover o pagamento de benefícios a seus participantes. Neste sentido, o estudo do efeito da heurística da ancoragem sobre os preços dos imóveis contribui como uma forma de identificação de risco para a tomada de decisão em relação a este tipo de investimento. O método de investigação utilizado foi baseado no modelo de mensuração desenvolvido por Jacowitz e Kahneman (1995), cujo objetivo é medir a extensão dos efeitos da ancoragem por meio de um índice de ancoragem (IA). A heurística da ancoragem foi testada, em outros estudos acadêmicos similares, para estimativa de preços de imóveis residenciais. A contribuição deste estudo foi ampliar a pesquisa para imóveis corporativos, categoria de ativo que compõe as carteiras de investimento imobiliários dos fundos de pensão. Os resultados apontaram que a heurística da ancoragem afeta, de forma significativa, a avaliação dos preços dos imóveis e o processo decisório em fundos de pensão. / The rationality of economic agents and the market efficiency hypothesis are fundamental assumptions of the modern finance theory. However, empirical studies have found that investors' behavior are not always rational in decision-making under risk. From the ground for bounded rationality presented by Simon (1957) and studies developed by Kahneman and Tversky (1974 and 1979) on cognitive biases often observed in human behavior and the relative perspective in decision-making, the field of behavioral finance emerged. This work aims to investigate the effect of anchoring heuristic on prices and decision-making in pension funds real estate investments. The pension funds sector has 307 institutions and its real estate portfolio reaches R$ 32.7 billion (March, 2016). Risk mapping involved in the investment decision-making process is of great importance for pension funds whose objective is to manage its assets to provide benefit payments to its participants. Thus, the study of the effect of anchoring heuristics on real estate prices contributes as a way of identifying risk for decision making in relation to this type of investment. The research method was based on the measurement model developed by Jacowitz and Kahneman (1995), which aims at measuring the extent of the anchoring effects by using an anchoring index (AI). The anchoring heuristic was tested in other similar academic studies to estimate residential property prices. The contribution of this study lays on extending the research to corporate real estate, asset category that makes up the real estate investment portfolios of pension funds. The results show that the anchoring heuristic significantly affect property price assessments and the decision-making process in pension funds.

Made available in DSpace on 2010-04-20T20:51:12Z (GMT). No. of bitstreams: 3 127144.pdf.jpg: 22926 bytes, checksum: f0072844d69084281a9c7092f970dac1 (MD5) 127144.pdf: 1287076 bytes, checksum: 7e0f27092b752813a38b17f36c8acaeb (MD5) 127144.pdf.txt: 218017 bytes, checksum: a230d57f4715dacbd3f269641e43f092 (MD5) Previous issue date: 2004-09-01T00:00:00Z / Ones of most important strategical decision that are placed for the Brazilian hospitals is how expand its activities for other markets which the same still not been covering. Several strategies are being adopted, and the opening of Satellites Units is one of them and has been adopted by a private hospital in São Paulo. Considering this fact, the objective of this study was to carry through a case study on one of these units, analysing the financial and marketing impacts caused by the implantation of the satellite unit. For this analysis, internal information of the unit had been raised and interviews had been carried through with some managers or people who had relationship with the process of implantation and management of the unit. Futhermore, usuaries had been also interviewed, with the aim to detect theirs perceptions of the unit. The results showed that the users are very satisfied with the Unit. However, there is a clear dissatisfaction in relation to the covering of the supplementary assistance sector. By this fact, it has an important restriction in the access to the unit, that is the main explanation for the negative financial results that the Unit is presenting since its implantation. Due to this results, the unit needs to improve the relationship between the hospital adminsitration and the supplementary health assistance companies in order to revert such situation. / Umas das importantes mais importantes decisões estratégicas que está sendo colocada para os hospitais brasileiros diz respeito à decisão de como expandir sua atuação para outros mercados-alvos no qual o mesmo ainda não tem uma boa cobertura. Diversas estratégias estão sendo adotadas, sendo que a abertura de Unidades Satélites é uma delas e que foi adotada por um hospital privado de grande porte do Estado de São Paulo. Sendo assim, o objetivo do trabalho foi realizar um estudo de caso sobre uma dessas unidades, procurando verificar os impactos financeiros e mercadológicos causados pela implantação da mesma. Para isso, foram levantadas informações internas da unidade e entrevistas foram realizadas com alguns gestores ou pessoas que de algumas forma estiveram relacionadas com o processo de implantação e gerenciamento. Além disso, também foram entrevistados usuários, procurando detectar a percepção dos mesmos sobre a Unidade. Os resultados mostraram que os usuários de modo geral estão muito satisfeitos com a Unidade em termos de atendimento. Entretanto, existe uma clara insatisfação com relação à cobertura do setor de assistência supletiva na Unidade. Em virtude desse fato, há uma restrição importante quanto ao acesso à mesma, o que é uma das mais fortes explicações para os resultados financeiros negativos que a Unidade vêm obtendo desde a sua implantação. Dessa forma, fazem-se necessárias melhorias no relacionamento hospital-operadoras a fim de reverter tal situação.

Vertical transmission of HIV is still a growing concern in South Africa. Breastfed infants are still at risk as HIV is present in breast milk, leaving HIV-positive mothers unsure of the best feeding option for their infants. However, there are various infant feeding techniques that HIV-positive mothers can use to supplement breastfeeding and flash-heat is one of them. Flash-heat is heat treating expressed breast milk to deactivate HIV for infant feeding. This study explored the possibility of HIV-positive mothers to practice flash-heating method for their infants exclusively for four months as a strategy to prevent vertical transmission of HIV. A descriptive, explorative and contextual design using a mixed method was used to obtain data from mothers in a post natal ward at Tembisa hospital. The mixed method used was useful in identifying the number of HIV-positive mothers who would adopt the flash-heat technique, the characteristics of mothers whom the technique could be promoted to, the factors that influence/affect the choice of infant feeding for these mothers, as well as their feelings associated with the feeding technique. Most (74%) mothers had a positive response to the flash-heat technique compared to 10% who were uncertain. They believed that heat treating their breast milk would result in their infants being HIV-free. In addition they believed that this method was cheaper than formula feeding and expressed positive feelings about touching their breast milk while expressing with no adverse feelings of expressing into a glass jar. Furthermore, findings of this study indicated that HIV-positive mothers in a public health facility would adopt flash-heat as an alternative infant feeding method. Thus practical guidelines to promote this feeding method were proposed. The proposed draft guidelines which promote the use of the flash-heat infant feeding method for HIV-positive mothers in public sector facilities will be communicated to relevant authorities such as the National Department of Health. These guidelines support the new policy shift to exclusive breastfeeding as a child survival strategy in South Africa. / Health Studies / D.Litt. et Phil. (Health Studies)

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-11-21T08:58:05Z No. of bitstreams: 1 Bruno Garbelini Chiquito.pdf: 1661155 bytes, checksum: 51c1d3fd662927bf2049fda1d247cd3c (MD5) / Made available in DSpace on 2018-11-21T08:58:05Z (GMT). No. of bitstreams: 1 Bruno Garbelini Chiquito.pdf: 1661155 bytes, checksum: 51c1d3fd662927bf2049fda1d247cd3c (MD5) Previous issue date: 2018-09-24 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / The present study aims to analyze the structure and legal and economic bases of the health insurance contract. In a first moment, we will analyze the historical evolution of the insurance operation in the world, its essential characteristics and its legal nature in order to show the economic base that underlies it with due note of the main obligations of the parties involved in this type of contract. In a second moment, comments are made on contractual developments to demonstrate the overcoming of individual interests in a favor of a free, fair, egalitarian and solidary society. The guidelines and mechanisms introduced by the Civil Code of 2002 will be studied in an attempt to better adapt the institutes of private law to social and economic evolution, with emphasis on the incidence of the fundamentally constitucional rights guaranteed in private law relations and institutes. Also detailed are the classic principles of insurance contracts, with emphasis on the accessory duties of the parties to the relationship and their relevant social interest. Finally, the structure, functioning, legal and economic aspects of health insurance contracts will be evaluated, in order to highlight the factors and problems that the sector faces due to the increasing increases in the insurance costs, creating alternatives to mitigate this problem, without going into detail in the aspecto related to the judicialization of health. The approach adopted is not only legalistic in the doctrinal sense, but rather, there was a great concern to explain the phenomenon from its historical origins, as well as to relate them to the causes that have shaped its features, guidelines and principles. The aim was to demonstrate the appropriate degree of state intervention on contractual freedom without detracting the attributes that are essential to it, emphasizing the role of the judge in the application of general clauses and principles, as well as in the necessary self-responsibility, solidarity and cooperation of the members of the relationship of insurance so that the contract transcends the intersubjective relationship and reaches a social pacification / O presente trabalho tem como objetivo analisar a estrutura e as bases jurídicas e econômicas do contrato de seguro relativo à saúde. Em um primeiro momento, analisa-se a evolução histórica da operação de seguro no mundo, suas características essenciais e sua natureza jurídica, de forma a evidenciar a base econômica que lhe fundamenta com o devido apontamento das principais obrigações das partes envolvidas nesse tipo de contrato. Em um segundo momento, são tecidos comentários a respeito da evolução contratual para demonstrar a superação dos interesses individuais em prol de uma sociedade livre, justa, igualitária e solidária. Ainda são estudadas as diretrizes e os mecanimos introduzidos pelo Código Civil de 2002, na tentativa de melhor adequar os institutos de direito privado à evolução social e econômica, com ênfase na incidência dos direitos fundamentais constitucionalmente assegurados nas relações e institutos de direito privado. Também são pormenorizados os princípios clássicos atinentes aos contratos de seguro, com ênfase nos deveres acessórios das partes integrantes da relação e no seu relevante interesse social. Por último, são avaliadas as estruturas, o funcionamento, os aspectos jurídicos e econômicos dos contratos de seguro saúde, de modo a ressaltar os fatores e os problemas a serem enfrentados pelo setor em razão do crescente aumento dos custos do seguro, criando alternativas para amenizar este problema, sem adentrar, pormenorizadamente, no aspecto relativo à judicialização da saúde. A abordagem adotada não é apenas legalista no sentido doutrinário, mas sim houve uma grande preocupação em explicar o fenômeno a partir de suas origens históricas, assim como relacioná-las às causas que teceram suas feições, diretrizes e princípios. Buscou-se evidenciar o grau adequado de intervenção estatal sobre a liberdade contratual sem descaracterizar os atributos que lhe são essenciais, ressaltando o papel do juiz na aplicação das cláusulas gerais e dos princípios, bem como na necessária autorresponsabilidade, solidariedade e coperação dos integrantes da relação de seguro para que o contrato transcenda a relação intersubjetiva e alcance uma pacificação social

Esta revisão de literatura é fruto de indagações sobre a mudança na postura do Estado brasileiro no que concerne à avaliação na atualidade. A temática desta pesquisa é a inserção da ferramenta da avaliação de desempenho da saúde no Brasil. Mais precisamente, o estudo traz uma análise dos índices de desempenho do subsistema público (IDSUS) e do índice elaborado pela Agência Nacional de Saúde (ANS) para avaliar o subsistema privado da saúde (IDSS). Dessa maneira, esta dissertação tem como objetivo analisar os programas de qualificação do sistema de saúde brasileiro através da avaliação do Índice de Desempenho da Saúde Suplementar (IDSS) e do Índice de Desempenho do SUS (IDSUS), considerando seus impactos na relação público-privado do setor saúde. Para dar conta desses objetivos, a pesquisa examinou os Programas de Qualificação do Sistema de Saúde Brasileiro tanto na sua face pública quanto na privada, utilizando as técnicas de análise documental e bibliográfica. A análise transcorreu a partir do levantamento de documentos oficiais e da literatura produzida sobre o tema. Além da leitura de documentos da Agência Nacional de Saúde (ANS), Ministério da Saúde (MS), Instituto de Estudos da Saúde Suplementar (IESS), Federação de Seguros (FENASEG), Associação Brasileira de Medicina de Grupos (ABRAMGE) e Instituto Brasileiro de Geografia e Estatística (IBGE), foram consultados trabalhos acadêmicos e selecionados textos jornalísticos que evidenciaram o processo de implantação e utilização do Programa de Qualificação da Saúde no Brasil. A dissertação então trouxe à tona, admitindo como base a análise do IDSUS recentemente criado e do IDSS, a necessidade de se rediscutir as finalidades das avaliações de desempenho propostas. Tanto o IDSS quanto o IDSUS são iniciativas pioneiras positivas que podem e devem ser aprimoradas, para que possam de fato instrumentalizar o controle social e o gestor na priorização e no planejamento das ações de saúde. O instrumento utilizado pela ANS foi considerado eficaz, democrático e participativo no que diz respeito ao alcance dos objetivos do Programa de Qualificação das Operadoras de Planos de Saúde. O mesmo conseguiu integrar pressupostos de modelos e instrumentos de gestão referenciados pela literatura como modernos e eficazes, como a gestão por resultados. Promoveu não só mais transparência ao subsistema privado, mas induziu, em certa medida, a concorrência do setor. Já em relação à face pública, percebeu-se que mesmo em face da jovialidade da proposta do IDSUS, o mesmo mapeou alguns pontos críticos do subsistema e apontou a necessidade de se trabalhar o setor de forma mais eficiente. Entretanto, esta pesquisa concluiu que ambos os movimentos de avaliação dos subsistemas público e privado não se completam, não dialogam como deveriam, evidenciando uma dificuldade em perceber e organizar o sistema como um todo. / This literature review arises from questions about the current change in attitude of the Brazilian State concerning evaluation. The theme of this research is the insertion of the tool for health performance assessment in Brazil. More specifically, the study offers an analysis of the performance indices of the public sub-system (IDSUS) and the index prepared by the National Health Agency (ANS) to evaluate the private health sub-system (IDSS). Thus, this work aims to analyze the training programs of the Brazilian health system by assessing the Performance Index of Supplementary Health (IDSS) and SUS Performance Index (IDSUS) considering their impacts on public-private relations in the health sector. To meet these objectives, the research examined the Qualification Programs in the Brazilian Health System in both its public and private sides, using the techniques of documentary analysis and literature review. The analysis proceeded from the survey of official documents and literature produced on the subject. Besides reading documents from the National Health Agency (ANS), Ministry of Health (MoH), Institute of Supplementary Health Studies (IESS), Insurance Federation (FENASEG), Brazilian Association of Medical Groups (ABRAMGE) and the Brazilian Institute of Geography and Statistics (IBGE), we consulted scholarly works and selected journalistic texts that showed the process of deployment and use of the Health Qualification Program in Brazil. The dissertation then brought up, based on the analysis of the newly created IDSUS and the IDSS, the need to revisit the purpose of performance assessment proposed. Both the IDSS and the IDSUS are positive pioneering initiatives that can and should be improved so that they can actually equip social control and managers in prioritizing and planning health actions. The instrument used by ANS was considered more effective, democratic and participatory with regard to achieving the objectives of the Qualification Program of Health Plans Operators. It integrated models and management tools referenced in the literature as modern and effective, such as management for results. It promoted not only more transparency to the private sub-system, but induced to some extent, competition in the industry. Regarding the public aspect, it was noticed that even considering the novelty of the IDSUS proposal, it mapped some critical aspects of sub-system and pointed out the need for the sector to work more efficiently. However, this research concluded that both assessment movements of public and private sub-systems do not connect, do not dialogue as they should, indicating a difficulty in perceiving and organizing the system as a whole.

Esta revisão de literatura é fruto de indagações sobre a mudança na postura do Estado brasileiro no que concerne à avaliação na atualidade. A temática desta pesquisa é a inserção da ferramenta da avaliação de desempenho da saúde no Brasil. Mais precisamente, o estudo traz uma análise dos índices de desempenho do subsistema público (IDSUS) e do índice elaborado pela Agência Nacional de Saúde (ANS) para avaliar o subsistema privado da saúde (IDSS). Dessa maneira, esta dissertação tem como objetivo analisar os programas de qualificação do sistema de saúde brasileiro através da avaliação do Índice de Desempenho da Saúde Suplementar (IDSS) e do Índice de Desempenho do SUS (IDSUS), considerando seus impactos na relação público-privado do setor saúde. Para dar conta desses objetivos, a pesquisa examinou os Programas de Qualificação do Sistema de Saúde Brasileiro tanto na sua face pública quanto na privada, utilizando as técnicas de análise documental e bibliográfica. A análise transcorreu a partir do levantamento de documentos oficiais e da literatura produzida sobre o tema. Além da leitura de documentos da Agência Nacional de Saúde (ANS), Ministério da Saúde (MS), Instituto de Estudos da Saúde Suplementar (IESS), Federação de Seguros (FENASEG), Associação Brasileira de Medicina de Grupos (ABRAMGE) e Instituto Brasileiro de Geografia e Estatística (IBGE), foram consultados trabalhos acadêmicos e selecionados textos jornalísticos que evidenciaram o processo de implantação e utilização do Programa de Qualificação da Saúde no Brasil. A dissertação então trouxe à tona, admitindo como base a análise do IDSUS recentemente criado e do IDSS, a necessidade de se rediscutir as finalidades das avaliações de desempenho propostas. Tanto o IDSS quanto o IDSUS são iniciativas pioneiras positivas que podem e devem ser aprimoradas, para que possam de fato instrumentalizar o controle social e o gestor na priorização e no planejamento das ações de saúde. O instrumento utilizado pela ANS foi considerado eficaz, democrático e participativo no que diz respeito ao alcance dos objetivos do Programa de Qualificação das Operadoras de Planos de Saúde. O mesmo conseguiu integrar pressupostos de modelos e instrumentos de gestão referenciados pela literatura como modernos e eficazes, como a gestão por resultados. Promoveu não só mais transparência ao subsistema privado, mas induziu, em certa medida, a concorrência do setor. Já em relação à face pública, percebeu-se que mesmo em face da jovialidade da proposta do IDSUS, o mesmo mapeou alguns pontos críticos do subsistema e apontou a necessidade de se trabalhar o setor de forma mais eficiente. Entretanto, esta pesquisa concluiu que ambos os movimentos de avaliação dos subsistemas público e privado não se completam, não dialogam como deveriam, evidenciando uma dificuldade em perceber e organizar o sistema como um todo. / This literature review arises from questions about the current change in attitude of the Brazilian State concerning evaluation. The theme of this research is the insertion of the tool for health performance assessment in Brazil. More specifically, the study offers an analysis of the performance indices of the public sub-system (IDSUS) and the index prepared by the National Health Agency (ANS) to evaluate the private health sub-system (IDSS). Thus, this work aims to analyze the training programs of the Brazilian health system by assessing the Performance Index of Supplementary Health (IDSS) and SUS Performance Index (IDSUS) considering their impacts on public-private relations in the health sector. To meet these objectives, the research examined the Qualification Programs in the Brazilian Health System in both its public and private sides, using the techniques of documentary analysis and literature review. The analysis proceeded from the survey of official documents and literature produced on the subject. Besides reading documents from the National Health Agency (ANS), Ministry of Health (MoH), Institute of Supplementary Health Studies (IESS), Insurance Federation (FENASEG), Brazilian Association of Medical Groups (ABRAMGE) and the Brazilian Institute of Geography and Statistics (IBGE), we consulted scholarly works and selected journalistic texts that showed the process of deployment and use of the Health Qualification Program in Brazil. The dissertation then brought up, based on the analysis of the newly created IDSUS and the IDSS, the need to revisit the purpose of performance assessment proposed. Both the IDSS and the IDSUS are positive pioneering initiatives that can and should be improved so that they can actually equip social control and managers in prioritizing and planning health actions. The instrument used by ANS was considered more effective, democratic and participatory with regard to achieving the objectives of the Qualification Program of Health Plans Operators. It integrated models and management tools referenced in the literature as modern and effective, such as management for results. It promoted not only more transparency to the private sub-system, but induced to some extent, competition in the industry. Regarding the public aspect, it was noticed that even considering the novelty of the IDSUS proposal, it mapped some critical aspects of sub-system and pointed out the need for the sector to work more efficiently. However, this research concluded that both assessment movements of public and private sub-systems do not connect, do not dialogue as they should, indicating a difficulty in perceiving and organizing the system as a whole.

Face à la finitude des ressources de la terre et de sa capacité d’absorption de la pollution, le développement d’écobétons pour un futur industrialisé durable représente un défi majeur de la science du béton moderne. En raison de sa nature hétérogène complexe, les propriétés macroscopiques du béton dépendent fortement des constituants de sa microstructure (ex. silicates de calcium hydratés [C–S–H], Portlandite, inclusions anhydres, porosité, agrégats, etc.). De plus, la nécessité d’une exploitation rapide et optimale des matériaux cimentaires émergents dans les applications industrielles demande de nos jours une meilleure compréhension de leurs particularités chimico-mécaniques à l’échelle micrométrique. Cette thèse vise à développer une méthode de pointe de couplage de la nanoindentation et de la spectroscopie quantitative aux rayons X à dispersion d'énergie (NI-QEDS), puis à fournir une caractérisation chimico-mécanique originale des phases microstructurales présentes dans les matrices réelles de ciments mélangés. La combinaison d’analyses NI-QEDS statistiques et déterministes a ainsi permis d’élargir la compréhension des systèmes avec ciment Portland et ajouts cimentaires (ACs) conventionnels ou alternatifs. Plus spécifiquement, l’étude des C–(A)–S–H (C–S–H incluant l’aluminium ou non) dans différents systèmes à base de ciments mélangés a montré des compositions différentes pour cet hydrate (variations dans les taux de Ca, Si, Al, S et Mg), mais ses propriétés mécaniques n’ont pas été significativement affectées par l’incorporation des ACs dans des dosages typiques. Les résultats présentés ont aussi démontré le rôle important des autres phases imbriquées dans la matrice de C–(A)–S–H, soit les inclusions anhydres dures (ex. le clinker et les ACs) et les autres hydrates tels que la Portlandite et les hydrates riches en aluminium (ex. les carboaluminates) avec des propriétés mécaniques plus élevées que celles des C–(A)–S–H. La thèse est basée sur cinq articles couvrant : (1) une analyse NI-EDS de systèmes incorporant des volumes élevés de pouzzolanes naturelles; (2) le développement de la méthode NI-QEDS; des analyses statistiques NI-QEDS (3) de systèmes avec cendres volantes et laitier, et (4) d’un système combinant ciment, calcaire et argile calcinée; et (5) une exploration déterministe NI-QEDS de systèmes conventionnels et alternatifs incorporant la poudre de verre, le métakaolin, le laitier ou la cendre volante. Finalement, en plus d’avancer les derniers modèles et méthodes micromécaniques, l’outil développé a fourni une perception chimico-mécanique originale des phases microstructurales et de leur arrangement. Le dévoilement de la signature chimico-mécanique de ces pâtes de ciments mélangés particulièrement complexes offre un savoir unique pour l’ingénierie des bétons de demain. / Abstract : Facing the limitedness of the earth’s resources and pollution absorption capacity, the development of eco-concrete for a sustainable industrialized future is one of the major challenges of modern concrete science. Due to its complex heterogeneous nature, the macro-scale properties of concrete strongly depend on the microstructure constituents (e.g., calcium-silicate-hydrates [C–S–H], Portlandite, anhydrous inclusions, porosity, aggregates, etc.). Moreover, the need for rapid and optimal exploitation of emerging binding materials in industrial applications urges today a better understanding of their chemo-mechanical features at the micrometer scale. This thesis aims at developing a state-of-the-art method coupling NanoIndentation and Quantitative Energy-Dispersive Spectroscopy (NI-QEDS), and providing an original chemo-mechanical characterization of the microstructure phases in highly heterogeneous matrices of real blended-cement pastes. The combination of statistical and deterministic NI-QEDS analysis approaches opened new research horizons in the understanding of Portland-cement systems incorporating conventional and alternative supplementary cementitious materials (SCMs). More specifically, the investigations of C–(A)–S–H (C–S–H including aluminum or not) in different blended-cement systems showed variable compositions for this hydrate (i.e., Ca, Si, Al, S and Mg contents), but the mechanical properties were not significantly affected by the incorporation of SCMs in typical dosages. The presented results also showed the important role of the other phases embedded in the C–(A)–S–H matrix, i.e., hard anhydrous inclusions (e.g., clinker and SCMs) and other hydrates such as Portlandite and Al-rich hydrates (e.g., carboaluminates) with mechanical properties higher than those of the C–(A)–S–H. The thesis is based on five articles focusing on: (1) the NI-EDS investigation of high-volume natural pozzolan systems; (2) the development of the NI-QEDS method; the statistical NI-QEDS analyses of (3) fly ash and slag blended-cement systems and of (4) a limestone-calcined-clay system; and (5) the deterministic NI-QEDS exploration of alternative and conventional systems incorporating glass powder, metakaolin, slag or fly ash. Finally, the developed tool not only advanced the latest micromechanical methods and models, but also provided original chemo-mechanical insights on the microstructure phases and their arrangement. Unveiling the chemo-mechanical signature of these highly-complex blended cement pastes further provided unique knowledge for engineering concretes for tomorrow.