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

ANALYSIS OF THE DISTRIBUTION OF PRESSURE UNDER THE FEET OF ELITE ALPINE SKI INSTRUCTORS

INTRODUCTION: Alpine skiing is a very popular recreational sport in many parts of the world. The sport has evolved greatly in the past 30 years, thanks in large part, to technological advances in the equipment being used by skiers. Thanks also to technological advances, previous research has been able to determine the forces and pressures involved in skiing in laboratory and/or static situations. However, due to the environment where the sport is performed, traditional biomechanical research equipment is not very well suited to skiing studies. The focus of the on-site research done to this point has been aimed towards ski racers. However, most recreational skiers are not racers. Thanks to recent developments in biomechanical instrumentation, research on alpine skiing can now be performed in on-piste situations. Therefore it would be of interest to determine what is happening under the feet of high level non-racers, such as ski instructors. Results from such a study, would allow to imrpove ski instrcution for all levels of skiers. METHODS: Three highly skilled ski instructors (CSIA level IV) consented to serve as subjects for this study. Their usual ski boots were fitted with pressure sensitive insoles linked to the PEDAR mobile system which they wore on their backs (Novel corporation, Munich). With their boots so equipped, the subjects performed a variety of turns of controlled radii on a groomed piste. The turn radii were controlled by markers on the snow surface, and were consistent with the guidelines of the Fédération Internationale de Ski, for turn size. Subjects skied on a groomed piste, while the PEDAR system recorded pressure data (sampling rate 50 Hz) onto a memory card. A video (60 Hz) recording of their ski runs was also made to facilitate analysis. RESULTS: What has come out of the results is that the pressure recorded under the feet can be quite high. The highest pressures were measured on the medial parts of the heel, as well as the medial parts of the forefoot (under first metatarsal). The center of pressure travelled from under the first metatarsal joint down to under the medial part of the heel of the skiers, as they progressed through the turn. These highest pressures reached up to 30 Newtons per square centimeter. Force-time histories revealed that forces of up to 3 times body weight were attained during high performance recreational skiing. CONCLUSIONS: It is quite likely that the type of equipment (skis and boots) worn by the subjects had an effect on the values obtained. The individual technical adjustments of the skiers may have also had an effect on the measurements. One thing is certain, the center of pressure moves from the front medial part of the foot, back towards the medial side of the heel as the skiers progress through the turns. These pressure areas are consistent with what was reported by Schaff et al.(1997). The forces that were obtained however, were higher than what is reported in Müller (1994). Findings from the current study should help in improving ski instruction for all skiers, since it provides instructors and coaches with quantitative data to support their teaching. REFERENCES: Müller, E. (1994). Analysis of the Biomechanical Characteristics of Different Swinging Techniques in Alpine Skiing, J. of Sports Sciences 12, 261-278. Schaff, P., Senner , V., Kaiser, F. (1997). Pressure Distribution Measurement for the Alpine Skier - from the Biomechanical High Tech Measurement to its Application as Swingbeep - Feedback System. In E. Müller et al., Skiing and Science, London, 159-172

One-Shot Decoupling

If a quantum system A, which is initially correlated to another system, E, undergoes an evolution separated from E, then the correlation to E generally decreases. Here, we study the conditions under which the correlation disappears (almost) completely, resulting in a decoupling of A from E. We give a criterion for decoupling in terms of two smooth entropies, one quantifying the amount of initial correlation between A and E, and the other characterizing the mapping that describes the evolution of A. The criterion applies to arbitrary such mappings in the general one-shot setting. Furthermore, the criterion is tight for mappings that satisfy certain natural conditions. Decoupling has a number of applications both in physics and information theory, e.g., as a building block for quantum information processing protocols. As an example, we give a one-shot state merging protocol and show that it is essentially optimal in terms of its entanglement consumption/production.Comment: v2: improved converse theorem, v3: published versio

Renyi generalizations of the conditional quantum mutual information

The conditional quantum mutual information $I(A;B|C)$ of a tripartite state $\rho_{ABC}$ is an information quantity which lies at the center of many problems in quantum information theory. Three of its main properties are that it is non-negative for any tripartite state, that it decreases under local operations applied to systems $A$ and $B$, and that it obeys the duality relation $I(A;B|C)=I(A;B|D)$ for a four-party pure state on systems $ABCD$. The conditional mutual information also underlies the squashed entanglement, an entanglement measure that satisfies all of the axioms desired for an entanglement measure. As such, it has been an open question to find R\'enyi generalizations of the conditional mutual information, that would allow for a deeper understanding of the original quantity and find applications beyond the traditional memoryless setting of quantum information theory. The present paper addresses this question, by defining different $\alpha$-R\'enyi generalizations $I_{\alpha}(A;B|C)$ of the conditional mutual information, some of which we can prove converge to the conditional mutual information in the limit $\alpha\rightarrow1$. Furthermore, we prove that many of these generalizations satisfy non-negativity, duality, and monotonicity with respect to local operations on one of the systems $A$ or $B$ (with it being left as an open question to prove that monotoniticity holds with respect to local operations on both systems). The quantities defined here should find applications in quantum information theory and perhaps even in other areas of physics, but we leave this for future work. We also state a conjecture regarding the monotonicity of the R\'enyi conditional mutual informations defined here with respect to the R\'enyi parameter $\alpha$. We prove that this conjecture is true in some special cases and when $\alpha$ is in a neighborhood of one.Comment: v6: 53 pages, final published versio

Catalytic Decoupling of Quantum Information

The decoupling technique is a fundamental tool in quantum information theory with applications ranging from quantum thermodynamics to quantum many body physics to the study of black hole radiation. In this work we introduce the notion of catalytic decoupling, that is, decoupling in the presence of an uncorrelated ancilla system. This removes a restriction on the standard notion of decoupling, which becomes important for structureless resources, and yields a tight characterization in terms of the max-mutual information. Catalytic decoupling naturally unifies various tasks like the erasure of correlations and quantum state merging, and leads to a resource theory of decoupling

One-Shot Decoupling

If a quantum system A, which is initially correlated to another system, E, undergoes an evolution separated from E, then the correlation to E generally decreases. Here, we study the conditions under which the correlation disappears (almost) completely, resulting in a decoupling of A from E. We give a criterion for decoupling in terms of two smooth entropies, one quantifying the amount of initial correlation between A and E, and the other characterizing the mapping that describes the evolution of A. The criterion applies to arbitrary such mappings in the general one-shot setting. Furthermore, the criterion is tight for mappings that satisfy certain natural conditions. One-shot decoupling has a number of applications both in physics and information theory, e.g., as a building block for quantum information processing protocols. As an example, we give a one-shot state merging protocol and show that it is essentially optimal in terms of its entanglement consumption/production

Catalytic Decoupling of Quantum Information

The decoupling technique is a fundamental tool in quantum information theory with applications ranging from thermodynamics to many-body physics and black hole radiation whereby a quantum system is decoupled from another one by discarding an appropriately chosen part of it. Here, we introduce catalytic decoupling, i.e., decoupling with the help of an independent system. Thereby, we remove a restriction on the standard decoupling notion and present a tight characterization in terms of the max-mutual information. The novel notion unifies various tasks and leads to a resource theory of decoupling

Hinduismo e cristianesimo in dialogo

Il volume presenta in modo sintetico non solo la ricchezza che la tradizione religiosa hindú racchiude in sé, ma anche le principali prospettive su cui si sta sviluppando il dialogo hindū-cristiano.- Indice #9-Introduzione, Andrea Pacini #13- Hinduismo: elementi fondamentali caratterizzanti la tradizione hindū, Stefano Piano #19- Dio nelle tradizioni religiose hindū, Francis X. D’Sa #39- L’uomo e la salvezza nella tradizione hindū, Mario Piantelli #59- Le pratiche religiose nello hinduismo, Kala Acharya #81- Hinduismo, modernità e politica nell’India contemporanea, Urvashi Butalia #109- Hinduismo e religioni universali. Relazioni storiche e prospettive attuali di dialogo, Anantanand Rambachan #121- Le visioni hindū di Cristo, Anand Amaladass S. J. #139- Un volto indiano per Gesù Cristo, Jacques Dupuis #165- Possibilità molteplici di dialogo fra cristiani e hindū, Thomas Matus #193- Bibliografia generale #20

Introductions of West Nile Virus Strains to Mexico

Complete genome sequencing of 22 West Nile virus isolates suggested 2 independent introductions into Mexico. A previously identified mouse-attenuated glycosylation variant was introduced into southern Mexico through the southeastern United States, while a common US genotype appears to have been introduced incrementally into northern Mexico through the southwestern United States