Health status, Neighbourhood effects and Public choice: Evidence from France

Observation of socioeconomic statistics between different neighbourhoods highlights significant differences for economic indicators, social indicators and health indicators. The issue faced here is determining the origins of health inequalities: individual effects and neighbourhood effects. Using National Health Survey and French census data from the period 2002-2003, we attempt to measure the individual and collective determinants of Self-Reported Health Status (SRH). By using a principal component analysis of aggregated census data, we obtain three synthetic factors called: "economic and social condition", "mobility" and "generational" and show that these contextual factors are correlated with individual SRHs. Since the 80s, different French governments have formulated public policies in order to take into account the specific problems of disadvantaged and deprived neighbourhoods. In view to concentrating national assistance, the French government has created "zones urbaines sensibles" (ZUS) [Critical Urban Areas, CUA]. Our research shows that in spite of implementing public policy in France to combat health inequalities, by only taking into account the CUA criterion (the fact of being in a CUA or not), many inequalities remain ignored and thus hidden.Health, Neighbourhood Effect, Housing policy

Les territoires de sante : des approches regionales variees de ce nouvel espace de planification

Les paramètres majeurs de l'organisation et de la planification de l'offre de soins ont été considérablement modifiés dans le cadre de la réforme Hôpital 2007. Les schémas régionaux d'organisation sanitaire (SROS) de troisième génération couvrant la période 2006-2011 ont pour leur part été profondément rénovés. Ils sont dorénavant l'unique outil de planification, la carte sanitaire est supprimée et le territoire de santé devient le territoire pertinent de l'organisation des soins. De simple contenant il devient un élément structurant de l'offre. Ce changement sémantique correspond à une évolution importante de la place et la conception de l'espace dans la planification sanitaire. Nous montrons que la définition de ce nouvel instrument a été traitée de manière assez différenciée selon les régions. Un tiers des régions ont préféré stabiliser le découpage du SROS2 en maintenant le découpage précédent, en regroupant des secteurs ou encore en les modifiant à la marge mais la grande majorité a cherché à inventer les territoires de santé en développant une nouvelle méthodologie. Le résultat final aboutit à une légère augmentation du nombre de secteurs, avec sept territoires supplémentaires, et notamment des petits territoires de moins de 200 000 habitants. À la lecture des différents SROS, nous constatons que les régions se sont relativement bien emparées de certains concepts de ces nouveaux schémas tels que la flexibilité permise pour ces nouveaux territoires entre niveaux de soins, l'utilisation sans réserve des différentes natures de territoire (organisation, projet et concertation). Par contre, certaines activités comme la psychiatrie, le secteur médico-social ou la médecine de ville sont encore insuffisamment intégrés dans la réflexion territoriale globale.Planification, Territoires de santé, SROS, Système de santé, Organisation des soins, Géographie de la santé

Optical fibers with optimized profiles for parametric amplifiers

Orientador: Hugo Enrique Hernandez FigueroaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Eletrica e de ComputaçãoResumo: A proposta deste trabalho é projetar perfis de fibra óptica para uso em amplificadores paramétricos que, além de apresentarem uma banda larga, sejam também robustos em relação à fabricação. Implementamos um método eficiente de solução modal para fibras ópticas com perfis multicamadas para calcular a dispersão da fibra. Através de um algoritmo genético padrão, otimizamos os perfis para posicionar os zeros de dispersão no centro da banda de amplificação desejada e tornálos robustos a deformidades geométricas. Por fim, avaliamos o desempenho dos perfis obtidos comparando-os a perfis mais usuais na construção de amplificadores. Incluímos um modelo de flutuações nos parâmetros de fabricação das fibras para efetivamente demonstrar a evolução na robustez dos perfis otimizados. As avaliações foram feitas com base em dois métodos: o modelo de quatro ondas; e o SSFM (Split-Step Fourier Method), utilizado para validar o primeiro. Como resultados apresentamos: (a) perfis de fibras com propriedades otimizadas na construção de amplificadores paramétricos; e (b) dados estatísticos de nossos modelos sobre o efeito de flutuações geométricas na fabricação das fibras, e também, sobre o desempenho de amplificadores paramétricosAbstract: The proposal of this work is to design optical fiber profiles for parametric amplifiers both wideband, and robust with respect to fabrication. We implement an efficient method to compute the modes of multilayered optical fibers in order to calculate the fiber dispersion. Using a standard genetic algorithm, we optimize the profiles aiming at placing the zero dispersion wavelengths at the center of the desired amplification band, and making them robust to geometrical deformations. Finally, we evaluate the performance of the designed profiles against others more commonly employed in fiber amplifiers. We include a fluctuation model in the fiber fabrication parameters to effectively demonstrate the evolution in robustness in the optimized profiles. The evaluations were conducted based in two methods: the four-wave model, and the SSFM (Split-Step Fourier Method), used to validate the former. As results we present: (a) fiber profiles with optimized properties for parametric amplifier construction; and (b) statistical data collected from our models about the effects of geometric fluctuations in the fabrication of the fibers and also in the performance of parametric amplifiersMestradoTelecomunicações e TelemáticaMestre em Engenharia Elétric

Reflectionless quasiconformal carpet cloak via parameterization strategy

In this work the possibility of using both the parameterization function and the least squares method to achieve a quasiconformal carpet cloak via a transformation optical design is demonstrated. The parameterization strategy allows us to obtain a continuous interface around the media, and, therefore, the resulting structure is reflectionless. Polynomial series are added to the coordinate transformation functions, providing a number of degrees of freedom (DoF) without modifying the device boundary conditions. The anisotropy reduction effects over the coordinate transformation are analyzed for different numbers of DoF in the parameterization function. The method's connection with the Riemann mapping theorem is also studied. Our results indicate that anisotropy can be reduced to very close to zero with increasing DoF without incurring edge reflections around the carpet cloak321224882493CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE MINAS GERAIS - FAPEMIGnão temnão temnão te

Accessibilité aux médecins généralistes en France : les méandres de la construction des zones sous-dotées

International audienceFacing geographical imbalances in primary care, French authorities have been defining under-served areas since 2005. They are used to implement several measures to attract and retain general practitioners (GPs). During this period, 4 waves of under-served areas were determined and new measures were deployed by different public authorities (local authorities, state, national health insurance). We aim to show how the succession of these different waves of areas and the intervention of numerous actors can lead to reduce the efficiency of a policy. To illustrate this point, we analyse the history of the definition of under-served areas in GPS in France. The presentation highlights that the mix of different areas and of different measures could diminish the visibility of the policy with GPs. This also raises the question of the effectiveness of this policy to attract and retain GPs in under-served areas.Face à l'inégale répartition géographique des médecins, les pouvoirs publics ont défini depuis 2005 des zones sous-dotées pour y déployer des mesures permettant d'attirer et de maintenir ces professionnels de santé. La définition de ces zones s'est complexifiée au fur et à mesure que les dispositifs s'étoffaient et que de nouveaux acteurs s'emparaient de cette question (collectivités territoriales, État, Assurance maladie). L'objectif est ici de montrer comment la montée en puissance d'une politique publique conduit, de par la multiplicité des acteurs et des territoires afférents mobilisés, à en réduire la portée. Nous nous appuyons dans cette communication sur l'historique de la définition des zones sous-dotées en médecins généralistes libéraux en France. L'enchevêtrement des zonages et dispositifs qui en résulte réduit la lisibilité de la politique auprès des médecins concernés et pose ainsi la question de son efficacité

Optimization of the electromagnetic scattering problem based on the topological derivative method

A new optimization method based on the topological derivative concept is developed for the electromagnetic design problem. Essentially, the purpose of the topological derivative method is to measure the sensitivity of a given shape functional with respect to a singular domain perturbation, so that it has applications in many relevant fields such as shape and topology optimization for imaging processing, inverse problems, and design of metamaterials. The topological derivative is rigorously derived for the electromagnetic scattering problem and used as gradient descent direction to find local optima for the design of electromagnetic devices. We demonstrate that the resulting topology design algorithm is remarkably simple and efficient and naturally leads to binary designs, while depending only on the solution of the conventional finite element formulation fir electrodynamics. Finally, several numerical experiments in two and three spatial dimensions are presented to illustrate the performance of the proposed formulation27233358633605CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO CARLOS CHAGAS FILHO DE AMPARO À PESQUISA DO ESTADO DO RIO DE JANEIRO - FAPERJFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP302036/2018-0; 310512/2017-4; 408274/2018-2; 438272/2018-888881.311020/2018E-26/203.041/20172015/24517-8; 2016/19270-6; 2018/25339-

Three-dimensional quasi-conformal transformation optics through numerical optimization

In this paper we demonstrate the possibility to achieve 3-dimensional quasi-conformal transformation optics through parametrization and numerical optimization without using sliding boundary conditions. The proposed technique, which uses a quasi-Newton method, is validated in two cylindrical waveguide bends as design examples. Our results indicate an arbitrarily small average anisotropy can be achieved in 3D transformation optics as the number of degrees of freedom provided by the parametrization was increased. The waveguide simulations confirm modal preservation when the residual anisotropy is neglected24151646516470CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFINANCIADORA DE ESTUDOS E PROJETOS - FINEPFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE MINAS GERAIS - FAPEMIGFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPnão temnão temnão temnão temnão te

Territorialisation sanitaire et décentralisation : état des lieux et enjeux à partir du cas français

Ces dernières décennies, les transformations des systèmes de santé dans le monde se traduisent par des processus de territorialisation, sous-tendus par trois tendances principales : la régulation financière, le développement des partenariats et le transfert des compétences. Dans ce papier, nous resituons tout d’abord le processus de territorialisation dans le cadre plus général des questions de décentralisation, de gouvernance et de gouvernement. En se focalisant sur le cas français, nous analysons ensuite l’articulation entre la décentralisation dite fonctionnelle en santé et les processus plus généraux de décentralisation des institutions. Pour conclure, nous questionnons les enjeux opérationnels et organisationnels qui en découlent.In this paper, we focus on the common trends of transformations of health care systems in the world. Based on the identification of three logics that root these evolutions (financial regulation, development of cooperation and skill/power transfers), we define territorialization as a process. It refers to projects of planning for which actors implement strategies to produce controlled and bounded spaces. In this process, scales, distances enacted through instruments are involved for putting public policy into practice and space. These actions give rise to different forms of territorialization in which different modes of governance, government and uses are embedded. In a second part, we focus on the case of France and the ways instruments have been used to develop public policies. We insist on the disconnections between the political and administrative decentralization with the evolution of the health sector. The general trend of decentralization of French administration during the eighties is characterized by a greater proximity of public decision with citizen, which involves more action for local authorities. A structured vision of decentralization appears only at the beginning of 2010s based on potential differentiation of standard on the territory and the possibility for regions to provide guidance to others local authorities. During these periods, health sector remains on the sidelines of the legislative evolution. Although regional level was defined as the structuring level of organization for health care in the hospital law of 1991, regionalization of public health policy really operated in 2009 with the Patients, Health and Territories Law (HPST) creating regional health agencies. These ones, with the legal personality are a type of functional decentralization, which are submitted to state monitoring. Concentrating the decision-making power at the regional level and breaking down barriers between sectoral policies, this law simplified local organization of health sector governance. It is operated in a regional health plan which relies on contractual partnerships with a lot of actors including local authorities which became a major actor to decline the plan at the local level. In a third part, we discuss the stakes, options and problems that actors have to face in the current stage of decentralization. Combined with deconcentration of others services, overlapping, cross-financing occurred and involved lower clarity of administrative organization. Two major stakes are identified. Firstly, the capabilities for actors to form a wide coalition sharing objectives and keeping up with changes in stakeholder’s dynamics, like political changeovers and budget cuts. Secondly, a better coordination of actors, in order to create favorable conditions for cooperation and complementarities