Les enjeux de l'évaluation de la performance : Dépasser les mythes

Since the 1990s, most Western countries have equipped themselves with frameworks and tools to measure health organizations and systems' performance. Paradoxically, several theoretical, methodological and usage issues remain unresolved. Conceptually, the notion of performance is vague and not well rooted in theory. From a methodological perspective, we are faced with numerous measures that don't always meet reliability, validity and usefulness criteria and don't help to grasp the complexity of the concept. Finally, the assessment results are not fully used to continuously improve performance. This article focuses on analyzing these issues by deconstructing the myths that slow down the development of better‐suited frameworks to meet decision‐makers' needs. It also proposes innovations based on the global and integrated assessment model of health systems.     

Planned complex suicide: an unusual case

Abstract:  We report an unusual case of planned complex suicide. The victim was a woman aged 67 years, who was found dead in her bath in a state of advanced putrefaction. A plugged-in hairdryer was submerged in the water and the electrical fuses in the room had short-circuited. A kitchen knife lay below the body of the victim, whose left forearm bore incisions suggestive of wrist-cutting. At autopsy, no sign suggesting electrocution could be observed because of the advanced state of putrefaction of the body. Toxicological analysis revealed massive ingestion of tianeptine (blood concentration 15.5 mg/L). Although the exact cause of death could not be determined because of the state of the corpse, meticulous examination of the scene and information obtained from the victim's relatives led to the conclusion of suicide.     

Environmental Policy,Public Interest and Political Market

In this paper, we highlight the factorswhich influence governments in theirdecision to implement environmentalpolicies of varying degrees of severity. Wesubstantiate our arguments with analyticalevidence from the public interest theoryand the economic theory of regulation(``interest group theory''). We show, throughempirical analysis based on the policies of22 OECD countries, that pressure groupshave sufficient impact on environmentalregulation so that the economic theorypredominates over the public interesttheory.     

Determination of Sex: Interest of Frontal Sinus 3D Reconstructions

Frontal sinuses (FSs) have been studied in radiology, anthropology, and forensic anthropology. This study aimed to determine whether it was possible to predict the age and sex of an individual using FS volume. Sixty‐nine anonymized CT scans were imported to MIMICS 10.01^® software (Materialise N.V.), and each FS volume was calculated in mm³. There was an absence of significant difference between right and left FS volume (p = 0.173) and an absence of correlation between age and FS volume (Pearson's test; p = 0.705). Sexual dimorphism was significantly different (p = 0.001). However, the most discriminant datum for determining sex was found to be the total FS volume (sum of an individual's right and left FS volumes) with linear discriminant Fisher's function coefficients of ?2.759 for the male group and ?1.275 for the female group. With this model, 72.5% of our sample was correctly classified according to sex.     

Gender Determination of Adult Individuals by Three‐Dimensional Modeling of Canines

Gender determination is a fundamental issue in forensic anthropology. Many techniques based on bone and dental remains have been proposed. It is not always possible to implement the techniques using bones, but teeth are often perfectly preserved. It has been demonstrated that the canine has the greatest sexual dimorphism, and the aim of this work was to provide an easy and accurate dental technique for determining the gender in the absence of other skeletal elements. The sample was composed of 210 CT scans with four healthy canines. The 840 canines were modeled using MIMICS^® 10.01 software. The total volume of each tooth was determined. Seven mathematical models were determined by binary logistic regressions and ranked in order of relative performance. The seven proposed predictive models thus performed (0.910 ≤ AUC ≤ 0.938), with overall rates of correct predictions between 82.38 and 85.24%. The 4‐canine model is the most powerful for predicting the gender.     

Off-Label Prescribing by Psychiatrists: What is the Practitioner's Liability?

In psychiatry, the molecules available and the dosages recommended when a drug receives marketing authorization are not always adequate to treat patients with major behavioral disturbances. Off-label prescribing is frequent in this context, with regard to the indications and the dosages given as well as to the drug combinations used. However, if complications or death occur, the practitioner's liability may be engaged. The authors report three deaths attributed to off-label prescribing in psychiatry and which led to charges against the physicians. They review the precautions to be taken when prescribing in such conditions (no other possible treatment, existence of sound scientific evidence, consent obtained from the patient, or their legal representatives except in cases of force majeure) and the physician's liability if adverse events occur that could be attributed to off-label prescribing.     

Electrophysiological and Behavioral Responses of Thanatophilus sinuatus Fabricius (Coleoptera: Silphidae) to Selected Cadaveric Volatile Organic Compounds

Soon after death, carcasses release volatile chemicals that attract carrion insects including Silphidae. Nevertheless, it is not known which chemical cues are involved in the attractiveness of the carcass. So far, little information is available on the chemical ecology of carrion beetles, particularly concerning the subfamily of Silphinae. The biological role of selected cadaveric volatile organic compounds including dimethyldisulfide (DMDS), butan‐1‐ol, n‐butanoic acid, indole, phenol, p‐cresol, putrescine, and cadaverine on the silphine species, Thanatophilus sinuatus Fabricius, was investigated using both electrophysiological and behavioral techniques. Among the tested cadaveric compounds, butan‐1‐ol and DMDS elicited the strongest electroantennography (EAG) from both T. sinuatus male and female antennae. In a two‐arm olfactometer, males and females were significantly attracted to DMDS for both tested doses, whereas only males were attracted to p‐cresol at 100 ng. Putrescine was repellent to males at the dose of 1 μg.