The role of economic evaluation in the decision-making process of family physicians: design and methods of a qualitative embedded multiple-case study

<p>Abstract</p> <p>Background</p> <p>A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all studies on the use of economic evaluation in decision-making used a quantitative approach, and few investigated decision-making at the clinical level. An important question is whether economic evaluations affect clinical practice. The project is an intervention research study designed to understand the role of economic evaluation in the decision-making process of family physicians (FPs). The contributions of the project will be from the perspective of Pierre Bourdieu's sociological theory.</p> <p>Methods/design</p> <p>A qualitative research strategy is proposed. We will conduct an embedded multiple-case study design. Ten case studies will be performed. The FPs will be the unit of analysis. The sampling strategies will be directed towards theoretical generalization. The 10 selected cases will be intended to reflect a diversity of FPs. There will be two embedded units of analysis: FPs (micro-level of analysis) and field of family medicine (macro-level of analysis). The division of the determinants of practice/behaviour into two groups, corresponding to the macro-structural level and the micro-individual level, is the basis for Bourdieu's mode of analysis. The sources of data collection for the micro-level analysis will be 10 life history interviews with FPs, documents and observational evidence. The sources of data collection for the macro-level analysis will be documents and 9 open-ended, focused interviews with key informants from medical associations and academic institutions. The analytic induction approach to data analysis will be used. A list of codes will be generated based on both the original framework and new themes introduced by the participants. We will conduct within-case and cross-case analyses of the data.</p> <p>Discussion</p> <p>The question of the role of economic evaluation in FPs' decision-making is of great interest to scientists, health care practitioners, managers and policy-makers, as well as to consultants, industry, and society. It is believed that the proposed research approach will make an original contribution to the development of knowledge, both empirical and theoretical.</p

Fukushima Dai-ichi fuel debris retrieval analysis of aerosol emission and dispersion during simulants laser cutting

International audienceAssessing the production and dispersion of aerosols carrying contamination during corium laser cutting operations is IRSN's contribution to a research project undertaken jointly with ONET Technologies and CEA on behalf of the Mitsubishi Research Institute. The objective is to obtain quantified data for evaluating the risk of disseminating con-tamination when implementing this technique, over the next few years, in the process of decommissioning the dam-aged reactors at the Fukushima Dai-ichi plant

Modelling tritium adsorption and desorption from tungsten dust particles with a surface kinetic model

International audienceA kinetic surface model is presented and used to explain the loading and desorption kinetics of tritium retained in micrometre-sized tungsten (W) dust particles. The model describes the sticking of hydrogen isotopes from the gas phase to W surfaces and the desorption from W surfaces. The initial sticking coefficient is set to one and independent of the temperature. The activation energy for desorption depends on the hydrogen coverage of the surface and is parametrised with density functional theory (DFT) calculations for W(100), W(110) and W(111) surfaces. The DFT-parametrised model is successfully compared to experimental results showing that the amount of measured tritium as well as the desorption kinetic can be modelled with only tritium adsorbed on the surface of W dust particles. Then, the model is used to explore possible scenarios to remove the tritium from the W surfaces by exposing the tritiated surfaces to either deuterium and hydrogen. The simulations suggest that it can be possible to remove all the tritium trapped on the W surfaces even at room temperature as soon as the hydrogen or deuterium pressure is higher than the tritium pressure. This gives opportunity to build tritium removal scenarios for ITER

Characterization of dust particles produced in an all-tungsten wall tokamak and potentially mobilized by airflow

International audienceAt the starting of the shutdown of the AUG (ASDEX Upgrade: Axially Symmetric Divertor EXperiment) German tokamak, we collected particles deposited on the divertor surfaces by means of a dedicated device called “Duster Box”. This device allows to collect the particles using a controlled airflow with a defined shear stress. Consequently, the particles collected correspond to a potentially mobilizable fraction, by an airflow, of deposited dust. A total of more than 70,000 tungsten particles was, analysed showing a bimodal particle size distribution with a mode composed of flakes at 0.6 μm and a mode composed of spherical particles at 1.8 μm