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41.
Jean Turgeon Patrick Sabourin 《Canadian public administration. Administration publique du Canada》1996,39(2):192-212
Sommaire: Depuis le début des années 1990, le système de santé québécois, comme celui des autres provinces, subit de profonds changements. lis se concrétisent sous la forme d'une reconfiguration majeure du système lui-meme, des services qu'il dispense et des structures qui le composent. L'article s'interesse a ce dernier aspect, plus particulierement sous l' angle des regroupements interétablissements. II appert que la Loi sur les services de santé et les services sociaux (1991, chap. 42) a bouleversé la configuration structurelle du réseau en forcant l'unification horizontale de plusieurs types d'établissements, tels les centres d'hébergement de soins de longue durée et les centres de réadaptation. Plus récemment, la décentralisation fonctionnelle accrue au profit des régies régionales de la santé et des services sociaux (rrsss), jumelée à l'annonce de compressions budgétaires sans précédent, a donné un second souffle à cette reconfiguration de structures. Une enquete a été menée a l'hiver 1995. Elle révèle qu'à ce moment, en plus des regroupements deja prévus dans la loi, un peu plus de 110 établissements socio-sanitaires, dont 60 centres hospitaliers, étaient également impliqués dans divers projets de regroupements allant de l'entente de services a la fusion. Depuis le printemps 1995, certaines rrsss étudient l' option des intégrations ou des fusions verticales, qui impliquent des établissements de mission différente. Or, une revue de la littérature démontre que l' efficacité et l' efficience de ces options ne sont pas clairement démontrées dans le secteur des soins de santé et qu'il vaudrait mieux envisager des formes moins contraignantes (partenariats, ententes de services, etc.) permettant de s'apprivoiser avant de songer au mariage. Abstract: Since the early 1990s, the Quebec health-care system, as those in other provinces, has undergone major changes. These changes involved a major reconfiguration of the system itself - its services and its structures. This article describes this reconfiguration and focuses on one particular aspect: the integration of services. The Health and Social Services Act, 1991 (c. 42) created havoc in the configuration of the system by imposing horizontal integration of several types of services, such as those of long-term care facilities and rehabilitation centres. More recently, this growing delegation in favour of the Regional Health and Social Services Boards (rhssbs) together with the announcement of unprecedented budget cuts, has led to further restructuring. A survey carried out during the winter of 1995 showed that 120 health-care establishments, including 60 hospitals, were involved in inter-establishment relationship projects, ranging from service agreements to mergers. Since the spring of 1995, some rhssbs have been studying the option of integration or of vertical mergers, i.e., how to integrate facilities with different services. However, a review of the literature shows that the effectiveness and efficiency of these options has not yet been clearly proven in the health-care sector, and that it would be wiser to consider, as a first stage, less constraining relationships (e.g., partnerships, service agreements, etc.) as a way of testing compatibility before getting involved in permanent partnerships. 相似文献
42.
Had Rousseau not been centrally concerned with freedom, some of the structural features of his political thought would be unaccountable. Above all, the notion of general will would not have become the core of his political philosophy. Rousseau's reasons for using 'general will' as his central political concept were essentially philosophical. The two terms of general will - 'will' and 'generality' - represent two main strands in his thought. 'Generality' stands for the rule of law, for civic education that draws us out of ourselves and towards the general (or common) good. 'Will' stands for Rousseau's conviction that civil association is 'the most voluntary act in the world', that 'to deprive your will of all freedom is to deprive your actions of all morality'. And if one could 'generalize' the will, so that it 'elects' only law, citizenship, and the common good, and avoids 'willful' self-love, then one would have a general will in Rousseau's particular sense. The distinctiveness of Rousseau's general will is further brought out through a comparison with Kant's 'good will' about which Rousseau would have felt severe doubts. 相似文献
43.
We show that temporal, spatial, and dyadic dependencies amongobservations complicate the estimation of covariance structuresin panel databases. Ignoring these dependencies results in covarianceestimates that are often too small and inferences that may bemore confident about empirical patterns than is justified bythe data. In this article, we detail the development of a nonparametricapproach, window subseries empirical variance estimators (WSEV),that can more fully capture the impact of these dependencieson the covariance structure. We illustrate this approach ina simulation as well as with a statistical model of internationalconflict similar to many applications in the international relationsliterature. 相似文献
44.
Patrick Hanafin 《Feminist Legal Studies》2006,14(3):329-352
This article examines how the recently introduced law on assisted reproduction in Italy, which gives symbolic legal recognition
to the embryo, came about, and how a referendum, which would have repealed large sections of it, failed. The occupation of
the legal space by the embryo is the outcome of a crusade by a well-organised alliance of theo-conservatives. These groups
see in reproductive medicine an uncontrolled interference with their notion of the natural order of things. Such a worldview
requires a total ban on stem cell research, limitation of access to reproductive technologies and repressive laws to govern
the area. This conservative dream scenario has come closer to being realised by the introduction of a law doing all of these
things in the name of the protection of “Life”. In the case of this law, the “life” to be protected is the embryo. In the
name of “Life”, scientific advances and individual liberty have been curbed. The politics of embryo citizenship is a politics
which values the yet to come over the here and now, purgation over pleasure, and the transcendent over the material. 相似文献
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50.
Massonnet G Buzzini P Jochem G Stauber M Coyle T Roux C Thomas J Leijenhorst H Van Zanten Z Wiggins K Russell C Chabli S Rosengarten A 《Journal of forensic sciences》2005,50(5):1028-1038
A collaborative study on Raman spectroscopy was carried out by members of the ENFSI (European Network of Forensic Science Institutes) European Fibres Group (EFG) on three dyed fibers: two red acrylics and one red wool. Raman instruments from six different manufacturers were tested as well as nine different laser wavelengths ranging from blue (lambda = 458 nm) to near infrared-NIR (lambda = 1064 nm). This represents the largest comparison study of Raman analytical parameters carried out on identical fiber samples. For the chosen fiber and dye samples, red lasers (lambda = 633 and 685 nm) gave the poorest spectral quality whereas blue (458 nm), green (514 nm) and near infrared lasers (785, 830 and 1064 nm) provided average results. Blue (488 nm) and green lasers (532 nm) globally gave the best quality spectra. Fluorescence problems were often encountered with some of the excitation wavelengths and therefore a flexible Raman instrument equipped with different lasers can be recommended to measure forensic fiber samples. The instrument should also be equipped with a Raman microscope in order to be able to focus on a single fiber. This study shows that Raman spectroscopy usually enables the identification of the main dye present in a colored fiber; however, minor dye components are much more difficult to detect. SERRS (Surface Enhanced Resonance Raman Scattering) techniques give an improvement of the dye's spectral intensity but no spectral improvement was observed for the two red acrylic and red wool fibers tested. 相似文献