864 resultados para drug-related problems (DRPs)
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We propose finite sample tests and confidence sets for models with unobserved and generated regressors as well as various models estimated by instrumental variables methods. The validity of the procedures is unaffected by the presence of identification problems or \"weak instruments\", so no detection of such problems is required. We study two distinct approaches for various models considered by Pagan (1984). The first one is an instrument substitution method which generalizes an approach proposed by Anderson and Rubin (1949) and Fuller (1987) for different (although related) problems, while the second one is based on splitting the sample. The instrument substitution method uses the instruments directly, instead of generated regressors, in order to test hypotheses about the \"structural parameters\" of interest and build confidence sets. The second approach relies on \"generated regressors\", which allows a gain in degrees of freedom, and a sample split technique. For inference about general possibly nonlinear transformations of model parameters, projection techniques are proposed. A distributional theory is obtained under the assumptions of Gaussian errors and strictly exogenous regressors. We show that the various tests and confidence sets proposed are (locally) \"asymptotically valid\" under much weaker assumptions. The properties of the tests proposed are examined in simulation experiments. In general, they outperform the usual asymptotic inference methods in terms of both reliability and power. Finally, the techniques suggested are applied to a model of Tobin’s q and to a model of academic performance.
Évaluation de l'impact clinique et économique du développement d'un traitement pour la schizophrénie
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Contexte : Les stratégies pharmacologiques pour traiter la schizophrénie reçoivent une attention croissante due au développement de nouvelles pharmacothérapies plus efficaces, mieux tolérées mais plus coûteuses. La schizophrénie est une maladie chronique présentant différents états spécifiques et définis par leur sévérité. Objectifs : Ce programme de recherche vise à: 1) Évaluer les facteurs associés au risque d'être dans un état spécifique de la schizophrénie, afin de construire les fonctions de risque de la modélisation du cours naturel de la schizophrénie; 2) Développer et valider un modèle de Markov avec microsimulations de Monte-Carlo, afin de simuler l'évolution naturelle des patients qui sont nouvellement diagnostiqués pour la schizophrénie, en fonction du profil individuel des facteurs de risque; 3) Estimer le coût direct de la schizophrénie (pour les soins de santé et autres non reliés aux soins de santé) dans la perspective gouvernementale et simuler l’impact clinique et économique du développement d’un traitement dans une cohorte de patients nouvellement diagnostiqués avec la schizophrénie, suivis pendant les cinq premières années post-diagnostic. Méthode : Pour le premier objectif de ce programme de recherche, un total de 14 320 patients nouvellement diagnostiqués avec la schizophrénie ont été identifiés dans les bases de données de la RAMQ et de Med-Echo. Les six états spécifiques de la schizophrénie ont été définis : le premier épisode (FE), l'état de dépendance faible (LDS), l’état de dépendance élevée (HDS), l’état stable (Stable), l’état de bien-être (Well) et l'état de décès (Death). Pour évaluer les facteurs associés au risque de se trouver dans chacun des états spécifiques de la schizophrénie, nous avons construit 4 fonctions de risque en se basant sur l'analyse de risque proportionnel de Cox pour des risques compétitifs. Pour le deuxième objectif, nous avons élaboré et validé un modèle de Markov avec microsimulations de Monte-Carlo intégrant les six états spécifiques de la schizophrénie. Dans le modèle, chaque sujet avait ses propres probabilités de transition entre les états spécifiques de la schizophrénie. Ces probabilités ont été estimées en utilisant la méthode de la fonction d'incidence cumulée. Pour le troisième objectif, nous avons utilisé le modèle de Markov développé précédemment. Ce modèle inclut les coûts directs de soins de santé, estimés en utilisant les bases de données de la Régie de l'assurance maladie du Québec et Med-Echo, et les coûts directs autres que pour les soins de santé, estimés à partir des enquêtes et publications de Statistique Canada. Résultats : Un total de 14 320 personnes nouvellement diagnostiquées avec la schizophrénie ont été identifiées dans la cohorte à l'étude. Le suivi moyen des sujets était de 4,4 (± 2,6) ans. Parmi les facteurs associés à l’évolution de la schizophrénie, on peut énumérer l’âge, le sexe, le traitement pour la schizophrénie et les comorbidités. Après une période de cinq ans, nos résultats montrent que 41% des patients seront considérés guéris, 13% seront dans un état stable et 3,4% seront décédés. Au cours des 5 premières années après le diagnostic de schizophrénie, le coût direct moyen de soins de santé et autres que les soins de santé a été estimé à 36 701 $ canadiens (CAN) (95% CI: 36 264-37 138). Le coût des soins de santé a représenté 56,2% du coût direct, le coût de l'aide sociale 34,6% et le coût associé à l’institutionnalisation dans les établissements de soins de longue durée 9,2%. Si un nouveau traitement était disponible et offrait une augmentation de 20% de l'efficacité thérapeutique, le coût direct des soins de santé et autres que les soins de santé pourrait être réduit jusqu’à 14,2%. Conclusion : Nous avons identifié des facteurs associés à l’évolution de la schizophrénie. Le modèle de Markov que nous avons développé est le premier modèle canadien intégrant des probabilités de transition ajustées pour le profil individuel des facteurs de risque, en utilisant des données réelles. Le modèle montre une bonne validité interne et externe. Nos résultats indiquent qu’un nouveau traitement pourrait éventuellement réduire les hospitalisations et le coût associé aux établissements de soins de longue durée, augmenter les chances des patients de retourner sur le marché du travail et ainsi contribuer à la réduction du coût de l'aide sociale.
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Le Québec reçoit chaque année un nombre croissant de travailleurs agricoles temporaires, à travers deux programmes : le Programme des travailleurs agricoles saisonniers (principalement Mexicains) et le Programme des travailleurs peu qualifiés (pour l’instant Guatémaltèques). Une de leurs caractéristiques communes est le lien fixe à l’employeur imposé aux travailleurs. Cette recherche analyse la conformité de cette disposition avec l’article 46 de la Charte québécoise qui garantit le droit à des conditions de travail justes et raisonnables. Un examen des effets du lien fixe démontre que celui-ci établit une dépendance forte des travailleurs envers leur employeur, aux niveaux légal (du fait de la possibilité du rapatriement anticipé en cas de problèmes liés au travail ou au comportement), financier (dû à la nomination des travailleurs année après année et au dépôt de sécurité imposé aux travailleurs guatémaltèques) et psychologique (soumission, crainte). L’interprétation de l’article 46 à la lumière du droit international des droits de la personne met en évidence la non conformité du lien fixe avec cette disposition. Or si l’objectif de cette mesure est de retenir la main-d’oeuvre dans le secteur agricole, il serait plus juste et raisonnable d’améliorer les conditions de travail de cette main-d’oeuvre plutôt que de l’asservir.
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From the introduction: Mexico is in a state of siege. In recent years, organized crime and drug-related violence have escalated dramatically, taking innocent lives and leaving the country mired in bloodshed. The Mexican government, under the leadership of President Felipe Calderón, has responded in part by significantly extending the reach of its security operations, deploying thousands of federal police officers and military troops to combat the activities of drug cartels, and collaborating with the United States on an extensive regional security plan known as the Mérida Initiative. In the midst of the security crisis, however, the government has somewhat paradoxically adopted judicial reforms that protect human rights and civil liberties rather than erode them, specifically the presumption of innocence standard in criminal proceedings and the implementation of oral trials. Assuming that the new laws on the books will be applied in practice, these reforms represent an important commitment on the part of the government to uphold human rights and civil liberties. This is in stark contrast to the infamous judicial reforms in Colombia—the institutionalization of anonymous or “faceless” prosecutions in special courts—implemented after a surge in leftist and cartel brutality, and the murders of several prominent public and judicial officials in the 1980s.
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The constructional activities in the coastal belt of our country often demand deep foundations because of the poor engineering properties and the related problems arising from weak soil at shallow depths.The soil profile in coastal area often consists of very loose sandy soils extending to a depth of 3 to 4 m from the ground level underlain by clayey soils of medium consistency.The very low shearing resistance of the foundation bed causes local as well as punching shear failure.Hence structures built on these soils may suffer from excessive settlements.This type of soil profile is very common in coastal areas of Kerala,especially in Cochin. Further,the high water table and limited depth of the top sandy layer in these areas restrict the depth of foundation thereby further reducing the safe bearing capacity.
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Quality related problems have become dominant in the seafood processing industry in Kerala. This has resulted in the rejection of seafood sent from India to many destinations. The latest being the total block listing of seafood companies from India from being exported to Europe and partial block listing by the US. The quality systems prevailed in the seafood industry in India were outdated and no longer in use in the developed world. According to EC Directive discussed above all the seafood factories exporting to European countries have to adopt HACCP. Based on this, EIA has now made HACCP system mandatory in all the seafood processing factories in India. This transformation from a traditional product based inspection system to a process control system requires thorough changes in the various stages of production and quality management. This study is conducted by the author with to study the status of the existing infrastructure and quality control system in the seafood industry in Kerala with reference to the recent developments in the quality concepts in international markets and study the drawbacks, if any, of the existing quality management systems in force in the seafood factories in Kerala for introducing the mandatory HACCP concept. To assess the possibilities of introducing Total Quality Management system in the seafood industry in Kerala in order to effectively adopt the HACCP concept. This is also aimed at improving the quality of the products and productivity of the industry by sustaining the world markets in the long run.
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The present study is intended to provide a new scientific approach to the solution of the worlds cost engineering problems encountered in the chemical industries in our nation. The problem is that of cost estimation of equipments especially of pressure vessels when setting up chemical industries .The present study attempts to develop a model for such cost estimation. This in turn is hoped would go a long way to solve this and related problems in forecasting the cost of setting up chemical plants.
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Given a graph G and a set X ⊆ V(G), the relative Wiener index of X in G is defined as WX (G) = {u,v}∈X 2 dG(u, v) . The graphs G (of even order) in which for every partition V(G) = V1 +V2 of the vertex set V(G) such that |V1| = |V2| we haveWV1 (G) = WV2 (G) are called equal opportunity graphs. In this note we prove that a graph G of even order is an equal opportunity graph if and only if it is a distance-balanced graph. The latter graphs are known by several characteristic properties, for instance, they are precisely the graphs G in which all vertices u ∈ V(G) have the same total distance DG(u) = v∈V(G) dG(u, v). Some related problems are posed along the way, and the so-called Wiener game is introduced.
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Magnetic Resonance Imaging play a vital role in the decision-diagnosis process of brain MR images. For an accurate diagnosis of brain related problems, the experts mostly compares both T1 and T2 weighted images as the information presented in these two images are complementary. In this paper, rotational and translational invariant form of Local binary Pattern (LBP) with additional gray scale information is used to retrieve similar slices of T1 weighted images from T2 weighted images or vice versa. The incorporation of additional gray scale information on LBP can extract more local texture information. The accuracy of retrieval can be improved by extracting moment features of LBP and reweighting the features based on users’ feedback. Here retrieval is done in a single subject scenario where similar images of a particular subject at a particular level are retrieved, and multiple subjects scenario where relevant images at a particular level across the subjects are retrieved
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Extensive grassland biomass for bioenergy production has long been subject of scientific research. The possibility of combining nature conservation goals with a profitable management while reducing competition with food production has created a strong interest in this topic. However, the botanical composition will play a key role for solid fuel quality of grassland biomass and will have effects on the combustion process by potentially causing corrosion, emission and slagging. On the other hand, botanical composition will affect anaerobic digestibility and thereby the biogas potential. In this thesis aboveground biomass from the Jena-Experiment plots was harvested in 2008 and 2009 and analysed for the most relevant chemical constituents effecting fuel quality and anaerobic digestibility. Regarding combustion, the following parameters were of main focus: higher heating value (HHV), gross energy yield (GE), ash content, ash softening temperature (AST), K, Ca, Mg, N, Cl and S content. For biogas production the following parameters were investigated: substrate specific methane yield (CH4 sub), area specific methane yield (CH4 area), crude fibre (CF), crude protein (CP), crude lipid (CL) and nitrogen-free extract (NfE). Furthermore, an improvement of the fuel quality was investigated through applying the Integrated generation of solid Fuel and Biogas from Biomass (IFBB) procedure. Through the specific setup of the Jena-Experiment it was possible to outline the changes of these parameters along two diversity gradients: (i) species richness (SR; 1 to 60 species) and (ii) functional group (grasses, legumes, small herbs and tall herbs) presence. This was a novel approach on investigating the bioenergy characteristic of extensive grassland biomass and gave detailed insight in the sward-composition¬ - bioenergy relations such as: (i) the most relevant SR effect was the increase of energy yield for both combustion (annual GE increased by 26% from SR8→16 and by 65% from SR8→60) and anaerobic digestion (annual CH4 area increased by 22% from SR8→16 and by 49% from SR8→60) through a strong interaction of SR with biomass yield; (ii) legumes play a key role for the utilization of grassland biomass for energy production as they increase the energy content of the substrate (HHV and CH4 sub) and the energy yield (GE and CH4 area); (iii) combustion is the conversion technique that will yield the highest energy output but requires an improvement of the solid fuel quality in order to reduce the risk of corrosion, emission and slagging related problems. This was achieved through applying the IFBB-procedure, with reductions in ash (by 23%), N (28%), K (85%), Cl (56%) and S (59%) and equal levels of concentrations along the SR gradient.
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The implementation of anti-drug policies that focus on illicit crops in the Andean countries faces many significant obstacles, one of which is the cultural clash it generates between the main stakeholders. On the one hand one finds the governments and agencies that attempt to implement crop substitution and eradication policies and on the other the peasant and natives communities that have traditionally grown and used coca or those peasants who have found in coca an instrument of power and political leverage that they never had before. The confrontation about coca eradication, alternative development and other anti-drug policies in coca growing areas transcends drug related issues and is part of a wider and deeper confrontation that reflects the long-term unsolved conflicts of the Andean societies. All Andean countries have stratified and fragmented societies in which peasants and Indians have been excluded from power. In Bolivia, Ecuador and Peru most peasants belong to native communities many of which have remained segregated from “white” society. The mixing of the races (mestizaje) in Colombia occurred early during the Conquest and Colony. Those of Indian descent became subservient to the Spanish and Creoles. The society that evolved was (and still is) highly hierarchical, authoritarian, and has subjacent racist values. The resulting political system has been exclusionary of large portions of the population. Among Indian communities coca has been used for millennia and its use has become an identity symbol of their resistance against what may be looked at as foreign invasion. “The Andean Indian chews coca because that way he affirms his identity as son and owner of the land that yesterday the Spaniard took away and today the landowner keeps away from him. To chew coca is to be Indian...and to quietly and obstinately challenge the contemporary lords that descend from the old encomenderos and the older conquistadors” (Vidart, 1991: 61, author’s translation). In Andean literature on illegal drugs as well as in seminars, colloquia and other meetings where drug policies are debated, complaints are frequently expressed about the treatment of coca in the same category as cocaine, heroin, morphine amphetamines and other “hard” drugs. The complainants assert that “coca is not cocaine” and that it is unfair to classify coca, a nature given plant which has been used for millennia in the Andes without significant negative effects on users, in the same category as man made psychotropic drugs. They also argue that coca has manifold social and religious meanings in indigenous cultures, that coca is sacred and that the requirement of the1961 Single Convention demanding that Bolivia and Peru completely eradicate coca within 25 years is limiting Indigenous communities in their freedom to practice their religions. In most debates about drug interdiction, the views of those who oppose that approach are not accepted as legitimate. Indeed, “prohibitionists” demonize drugs and those who oppose drug policies in Latin America frequently demonize the United States as the imperialist power that imposes them. This dual polarization is a main obstacle to establish a meaningful policy debate aimed at broadening the policy consensus necessary for successful policy implementation. This essay surveys the status of coca in the United Nations Conventions, explains why it is confusing, and how a few changes would eliminate some of the sources of conflict and help organize and control licit coca markets in the Andes. The current disorganized and weakly controlled legal coca market in Peru has been analyzed to demonstrate its deficiencies and to illustrate possible improvements in international drug control policies.
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El aumento de la cantidad de lodos y las dificultades inherentes a su aplicación agrícola y/o disposición en vertederos, hace necesario encontrar nuevas alternativas para su gestión. A nivel europeo, hoy en día se tiende hacia la aplicación de tratamientos térmicos (incineración, pirólisis y gasificación) que permiten una valoración energética de los lodos, si bien generan un residuo sólido que sigue siendo necesario gestionar. El problema medioambiental provocado por (malos) olores resulta difícil de abordar de una manera genérica, teniendo en consideración la propia naturaleza del olor y sus posibles causas. Los olores en las EDARs son provocados básicamente por la degradación de la materia orgánica en condiciones anaeróbicas y se detectan en todas las operaciones unitarias en diferentes niveles de concentración. Esta tesis incidiendo en ambos aspectos, tiene por objeto investigar la valorización de lodos como materiales precursores de adsorbentes/ catalizadores para la eliminación de olores en el entorno de las EDARs, maximizando la reutilización de los lodos. Para la realización de los experimentos se han seleccionado lodos procedentes de tres EDARs situadas en la región de Girona (SC, SB, SL) que difieren en cuanto al tratamiento de los lodos. Ambas muestras han sido caracterizadas con el fin de determinar las diferencias más importantes en los lodos de partida. Los parámetros de caracterización incluyen el análisis de composición química (análisis elemental e inmediato, determinación contenido en cenizas, medida pH, DRX, FT-IR, SEM / EDX) así como análisis de superficie (adsorción de N2 y CO2). En primer lugar los lodos caracterizados han sido sometidos a diferentes tratamientos térmicos de gasificación y pirólisis y los adsorbentes/ catalizadores obtenidos se han probado como adsorbentes para la eliminación de H2S. Como consecuencia de este estudio, se ha desechado el uso de uno de lodos (SC) puesto que se obtenían resultados muy similares a (SB), a continuación el estudio se centró en el lodo de SL. Con este objetivo se han preparado 12 muestras 6 de ellas pirolizadas y 6 gasificadas en el rango de temperaturas que comprende 600-1100 ºC. Posteriormente las muestras han sido caracterizadas y se ha determinado la capacidad de eliminación (x/M) del H2S. Los resultados muestran que hemos sido capaces de obtener unos materiales que si bien, presentan un bajo desarrollo de porosidad dan lugar a valores de capacidades de eliminación elevados y comparables a carbones y materiales adsorbentes comerciales (Centaur, Sorbalit). Las elevadas eficiencias de eliminación se atribuyen básicamente a la presencia de especies catalíticamente activas tales como los óxidos mixtos de calcio y hierro determinados por DRX en las muestras tratadas térmicamente. El segundo bloque de resultados se centra la mejora de las propiedades texturales de estos materiales adsorbentes. Con este objetivo se llevaron acabo procesos de activación física con CO2 y química con H3PO4 e hidróxidos alcalinos (NaOH y KOH), que hasta el momento no se había probado con este tipo de precursores. Los resultados indican que la activación física (CO2) y química (H3PO4) no son unos buenos métodos para la obtención de adsorbentes altamente porosos con este tipo de materia prima bajo las condiciones probadas, sin embargo la activación con hidróxidos alcalinos da lugar a materiales adsorbentes con superficies específicas de hasta 1600 m2g-1. En el caso de la activación con hidróxidos, tanto el incremento de la relación agente activante/ precursor como el incremento de la temperatura producen un descenso del rendimiento, al mismo tiempo que incrementan el valor de SBET. Los materiales resultantes de la activación con hidróxidos alcalinos se han probado como adsorbentes/ catalizadores para la eliminación de H2S. Los resultados indican que un incremento del área superficial no es indicativo de un aumento de la capacidad de eliminación dada la naturaleza ácida de estos materiales obtenidos. Con el fin de contrarrestar el efecto ácido de estos materiales se han realizado los mismos ensayos añadiendo NaOH al lecho de reacción llegando a valores de x/M de hasta 450 mgg-1. Posteriormente también se han realizado ensayos de eliminación de NH3 con algunas de estas muestras, y los resultados obtenidos de x/M son del orden de carbones activados comerciales. Los materiales adsorbentes obtenidos tras la activación con hidróxidos alcalinos se convierten en materiales muy atractivos para ser utilizados como adsorbentes/ catalizadores de múltiples contaminantes (COVs, Hg...).
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We give an overview on the development of "horizontal" European Committee for Standardisation (CEN) standards for characterising soils, sludges and biowaste in the context of environmental legislation in the European Union (EU). We discuss the various steps in the development of a horizontal standard (i.e. assessment of the possibility of such a standard, review of existing normative documents, pre-normative testing and validation) and related problems. We also provide a synopsis of European and international standards covered by the so-called Project HORIZONTAL. (C) 2004 Elsevier Ltd. All rights reserved.
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Habitat-based statistical models relating patterns of presence and absence of species to habitat variables could be useful to resolve conservation-related problems and highlight the causes of population declines. In this paper, we apply such a modelling approach to an endemic amphibian, the Sardinian mountain newt Euproctus platycephalus, considered by IUCN a critically endangered species. Sardinian newts inhabit freshwater habitat in streams, small lakes and pools on the island of Sardinia (Italy). Reported declines of newt populations are not yet supported by quantitative data, however, they are perceived or suspected across the species' historical range. This study represents a first attempt trying to statistically relate habitat characteristics to Sardinian newt occurrence and persistence. Linear regression analysis revealed that newts are more likely to be found in sites with colder water temperature, less riparian vegetation and, marginally, absence of fish. The implications of the results for the conservation of the species are discussed, and suggestions for the short-term management of newt inhabited sites suggested. (C) 2003 Elsevier Ltd. All rights reserved.
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Objective: To describe the use of a multifaceted strategy for recruiting general practitioners (GPs) and community pharmacists to talk about medication errors which have resulted in preventable drug-related admissions to hospital. This is a potentially sensitive subject with medicolegal implications. Setting: Four primary care trusts and one teaching hospital in the UK. Method: Letters were mailed to community pharmacists and general practitioners asking for provisional consent to be interviewed and permission to contact them again should a patient be admitted to hospital as a result of a medication error. In addition, GPs were asked for permission to approach their patients should they be admitted to hospital. A multifaceted approach to recruitment was used including gaining support for the study from professional defence agencies and local champions. Key findings: Eighty-five percent (310/385) of GPs and 62% (93/149) of community pharmacists responded to the letters. Eighty-five percent (266/310) of GPs who responded and 81% (75/93) of community pharmacists who responded gave provisional consent to participate in interviews. All GPs (14 out of 14) and community pharmacists (10 out of 10) who were subsequently asked to participate, when patients were admitted to hospital, agreed to be interviewed. Conclusion: The multifaceted approach to recruitment was associated with an impressive response when asking healthcare professionals to be interviewed about medication errors which have resulted in preventable drug-related morbidity.