L’intégration des services passe‑t‑elle par des fusions d’établissements?

Les modes d'organisation hérités d'une époque où dominait l'institutionnalisation des patients sont aujourd'hui caducs. La coordination des services, jadis effectuée à l'intérieur des murs d'un même établissement, relève dorénavant d'intervenants rattachés à des organisations différentes et pratiquant en des lieux différents. Une des difficultés que pose l'intégration de ces services est que les organisations mises à contribution continuent souvent de fonctionner de façon individualiste, ce qui va à l'encontre de l'objectif poursuivi. La solution la plus souvent avancée pour contourner ce cloisonnement consiste à renforcer l'intégration des organisations, ce qui devrait, à terme, favoriser l'intégration des services. Une des façons de réaliser cette intégration organisationnelle est de réduire le nombre d'organisations existantes, par exemple en fusionnant un certain nombre d'entre elles. C'est cette voie, celle de la hiérarchisation, qu'a empruntée la réforme du système québécois de la santé et des services sociaux effectuée au cours des années 1990. D'autres voies, dont celle de l'organisation en réseau, ont aussi été expérimentées durant cette période. Pour juger de la pertinence de ces options, nous proposons de renverser la perspective dominante selon laquelle l'intégration des services passe nécessairement par la mise en place de mécanismes d'intégration organisationnelle. Sans nier l'importance de ces derniers, nous mettons de l'avant que l'intégration des services exige avant tout la collaboration des praticiens qui les dispensent. Sous cet angle, la pertinence d'un mode d'intégration organisationnelle dépend de l'effet qu'il aura sur la capacité et la volonté des praticiens d'agir de façon concertée. Nous soumettons à cet égard que le fait de confier à une même autorité la gouverne des organisations existantes n'est pas la panacée que certains voudraient y voir.Is merging organizations the solution to service integration? Organizational models inherited from the time when institutionalizing patients was common practice are now obsolete. Service coordination, undergone earlier within a same institution, is now governed by professionnals linked to various organizations and different settings. One of the difficulties of integration of these services is that contributing organizations often continue to operate individually, consequently going against the pursued goal. The solution most often proposed to counter this compartimentalization consists in reinforcing integration of organizations, which will in time favor integration of various services. One of the ways to realize this organizational integration is to reduce the number of existing organizations, by merging for example, a certain number of them. It is this path of hierarchical organization that the Québec health care system has taken during the 1990. Other paths that of networking have also been experienced during the same period. To judge of the relevance of these options, the authors propose a reversal of the dominating perspective according to which service integration necessarily pass through installing mecanisms of organizational integration. Withought minimizing the importance of such mecanisms, the authors put forth that integration of services commands first and foremost collaboration between professional health workers. Through this angle, the relevance of an organizational integration model depends on the impact it will have on the capacity and willingness of health workers to work in a concerted way. The authors submit that the fact of giving to a sole authority the govern of existing organizations is not the panacea some would like to believe.¿Pasa la integración de servicios por fusiones de establecimientos? Los modos de organisación heredados de una época dominada por la institutionalisación de los patientes estan hoy caducos. La coordinación de servicios, antiguamente efectuada a dentro de un establecimiento, depende hoy de intervenantes quienes dependen de organisaciones diferentes y practican en lugares diferentes. Uno de los problemas que plantea la integración de servicios se encuentra en el hecho de que organismos contribuyendo siguen muchas veces funcionando de manera individualista, lo que va en contra del objectivo perseguido. La integración de organismos, la cual deberia favorecer la integración de servicios, es la solución más avanzada para dar la vuelta a este tabique. Para realizar esta integración de servicios se propone reducir el nombre de organizaciones con fusiones. La vía de jerarquización fue adoptada por la reforma del sistema quebequense de servicios de salud y de servicios sociales efectuada durante los años 1990. Otras vías, tal la organización en red, han sido tambien experimentadas durante esta perioda. Para jusgar de la pertinencia de estas opciones se propone de invertir la perspectiva dominante según la cual la integración de servicios pasa necesariamente por la puesta en lugar de mecanismos de integración organizacional. Sin negar la importancia de los últimos, propongamos que la integración de servicios requiere ante todo la colaboración de los prácticos. Así la pertinencia de un modo de integración organisacional depende del efecto que tendrá sobre la capacidad y la voluntad de los prácticos de actuar de manera concertada. Sometemos que el hecho de confiar a una sola autoridad la gubernancia de las organizaciones existantes no es la panacea que ciertos quisieran ver.A integração dos serviços passa pela fusão dos estabelecimentos? Os métodos de organização herdados da época em que dominava a institucionalização dos pacientes estão, atualmente, ultrapassados. A coordenação dos serviços, antigamente efetuada dentro dos muros de um mesmo estabelecimento, depende, a partir de agora, de assistentes ligados a organizações diferentes e trabalhando em locais diferentes. Uma das dificuldades da integração destes serviços encontra-se no fato de que as organizações participantes continuam sempre a funcionar de maneira isolada, o que prejudica o objetivo esperado. A solução mais freqüentemente proposta para contornar este isolamento seria reforçar a integração das organizações, que deveria, no futuro, favorecer a integração dos serviços. Uma das maneiras de realizar esta integração organizacional é reduzir o número de organizações existentes, por exemplo, fazendo a fusão de algumas delas. Foi este caminho, o da hierarquização, que escolheu a reforma do sistema quebequense da saúde e dos serviços sociais efetuada durante os anos 1990. Outros caminhos, como o da organização em rede, também foram experimentados durante este período. Para avaliar a pertinência destas opções, os autores propõem derrubar a perspectiva dominante, segundo a qual a integração dos serviços passa obrigatoriamente pela criação de mecanismos de integração organizacional. Sem negar a importância destes mecanismos, eles ressaltam que a integração dos serviços exige, antes de mais nada, a colaboração dos profissionais que os fornecem. Neste ponto de vista, a pertinência de um modo de integração organizacional depende do efeito que ele terá na capacidade e na vontade dos profisionais de trabalhar em harmonia uns com os outros. A este respeito, os autores destacam que o fato de confiar a uma só autoridade a direção das organizações existentes não é o remédio para todos os males que alguns gostariam que fosse

Effect of nitrogen-rich cell culture surfaces on type X collagen expression by bovine growth plate chondrocytes

Background: Recent evidence indicates that osteoarthritis (OA) may be a systemic disease since mesenchymal stem cells (MSCs) from OA patients express type X collagen, a marker of late stage chondrocyte hypertrophy (associated with endochondral ossification). We recently showed that the expression of type X collagen was suppressed when MSCs from OA patients were cultured on nitrogen (N)-rich plasma polymer layers, which we call "PPE:N" (N-doped plasma-polymerized ethylene, containing up to 36 atomic percentage (at.%) of N.Methods: In the present study, we examined the expression of type X collagen in fetal bovine growth plate chondrocytes (containing hypertrophic chondrocytes) cultured on PPE:N. We also studied the effect of PPE: N on the expression of matrix molecules such as type II collagen and aggrecan, as well as on proteases (matrix metalloproteinase-13 (MMP-13) and molecules implicated in cell division (cyclin B2). Two other culture surfaces, "hydrophilic" polystyrene (PS, regular culture dishes) and nitrogen-containing cation polystyrene (Primaria (R)), were also investigated for comparison.Results: Results showed that type X collagen mRNA levels were suppressed when cultured for 4 days on PPE: N, suggesting that type X collagen is regulated similarly in hypertrophic chondrocytes and in human MSCs from OA patients. However, the levels of type X collagen mRNA almost returned to control value after 20 days in culture on these surfaces. Culture on the various surfaces had no significant effects on type II collagen, aggrecan, MMP-13, and cyclin B2 mRNA levels.Conclusion: Hypertrophy is diminished by culturing growth plate chondrocytes on nitrogen-rich surfaces, a mechanism that is beneficial for MSC chondrogenesis. Furthermore, one major advantage of such "intelligent surfaces" over recombinant growth factors for tissue engineering and cartilage repair is potentially large cost-saving

Heat transfer in a swirling fluidized bed with Geldart type-D particles

A relatively new variant in fluidized bed technology, designated as the swirling fluidized bed (SFB), was investigated for its heat transfer characteristics when operating with Geldart type D particles. Unlike conventional fluidized beds, the SFB imparts secondary swirling motion to the bed to enhance lateral mixing. Despite its excellent hydrodynamics, its heat transfer characteristics have not been reported in the published literature. Hence, two different sizes of spherical PVC particles (2.61mm and 3.65mm) with the presence of a center body in the bed have been studied at different velocities of the fluidizing gas. The wall-to-bed heat transfer coefficients were measured by affixing a thin constant foil heater on the bed wall. Thermocouples located at different heights on the foil show a decrease in the wall heat transfer coefficient with bed height. It was seen that only a discrete particle model which accounts for the conduction between the particle and the heat transfer surface and the gas-convective augmentation can adequately represent the mechanism of heat transfer in the swirling fluidized bed

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements