Care delivery value chains for ophthalmic clinics in Switzerland

Perceived patient value is often not aligned with the emerging expenses for health care services. In other words, the costs are often supposed as rising faster than the actual value for the patients. This fact is causing major concerns to governments, health plans, and individuals. Attempts to solve the problem have habitually been on the operational effectiveness side: increasing patient volume, minimizing costs, rationing, or closing hospitals, usually resulting in a zero-sum game. Only few approaches come from the strategic positioning side and "competition" among hospitals is still perceived rather as a danger than as a chance to create a positive-sum game and stimulate patient value. In their 2006 book, "Redefining Health Care", the renowned Harvard strategy professor Michael E. Porter and hospital management expert Professor Elizabeth Olmsted Teisberg approach the challenge from the positive-sum perspective: they propose to form Integrated Practice Units (IPUs) and manage hospitals in a modern, patient value oriented way. They argue that creating value-based competition on results should have the same effect on the health care sector like transparency and competition turned other industries with out-dated management models (like recently the inert telecommunication industry) into highly competitive and customer value creating businesses. The objective of this paper is to elaborate Care Delivery Value Chains for Integrated Practice Units in ophthalmic clinics and gather a first feedback from Swiss hospital managers, ophthalmologists, and patients, if such an approach could be a realistic way to improve health care management. First, Porter's definition of competitiveness (distinction between operational effectiveness and strategic positioning) is explained. Then, the Care Delivery Value Chain is introduced as a key element for understanding value-based management, followed by three practice examples for ophthalmic clinics. Finally, recommendations are given how the Care Delivery Value Chain can be managed efficiently and how the obstacles of becoming a patient-oriented organization can be overcome. The conclusion is that increased transparency and value-based competition on results has the potential to change the mindset of hospital managers-which will align patient value with the emerging health care expenses. Early adapters of this management approach will gain a competitive advantage. [Author, p. 6]

On Recurrent and Deep Neural Networks

L'apprentissage profond est un domaine de recherche en forte croissance en apprentissage automatique qui est parvenu à des résultats impressionnants dans différentes tâches allant de la classification d'images à la parole, en passant par la modélisation du langage. Les réseaux de neurones récurrents, une sous-classe d'architecture profonde, s'avèrent particulièrement prometteurs. Les réseaux récurrents peuvent capter la structure temporelle dans les données. Ils ont potentiellement la capacité d'apprendre des corrélations entre des événements éloignés dans le temps et d'emmagasiner indéfiniment des informations dans leur mémoire interne. Dans ce travail, nous tentons d'abord de comprendre pourquoi la profondeur est utile. Similairement à d'autres travaux de la littérature, nos résultats démontrent que les modèles profonds peuvent être plus efficaces pour représenter certaines familles de fonctions comparativement aux modèles peu profonds. Contrairement à ces travaux, nous effectuons notre analyse théorique sur des réseaux profonds acycliques munis de fonctions d'activation linéaires par parties, puisque ce type de modèle est actuellement l'état de l'art dans différentes tâches de classification. La deuxième partie de cette thèse porte sur le processus d'apprentissage. Nous analysons quelques techniques d'optimisation proposées récemment, telles l'optimisation Hessian free, la descente de gradient naturel et la descente des sous-espaces de Krylov. Nous proposons le cadre théorique des méthodes à région de confiance généralisées et nous montrons que plusieurs de ces algorithmes développés récemment peuvent être vus dans cette perspective. Nous argumentons que certains membres de cette famille d'approches peuvent être mieux adaptés que d'autres à l'optimisation non convexe. La dernière partie de ce document se concentre sur les réseaux de neurones récurrents. Nous étudions d'abord le concept de mémoire et tentons de répondre aux questions suivantes: Les réseaux récurrents peuvent-ils démontrer une mémoire sans limite? Ce comportement peut-il être appris? Nous montrons que cela est possible si des indices sont fournis durant l'apprentissage. Ensuite, nous explorons deux problèmes spécifiques à l'entraînement des réseaux récurrents, à savoir la dissipation et l'explosion du gradient. Notre analyse se termine par une solution au problème d'explosion du gradient qui implique de borner la norme du gradient. Nous proposons également un terme de régularisation conçu spécifiquement pour réduire le problème de dissipation du gradient. Sur un ensemble de données synthétique, nous montrons empiriquement que ces mécanismes peuvent permettre aux réseaux récurrents d'apprendre de façon autonome à mémoriser des informations pour une période de temps indéfinie. Finalement, nous explorons la notion de profondeur dans les réseaux de neurones récurrents. Comparativement aux réseaux acycliques, la définition de profondeur dans les réseaux récurrents est souvent ambiguë. Nous proposons différentes façons d'ajouter de la profondeur dans les réseaux récurrents et nous évaluons empiriquement ces propositions.

Utilisation of IIR Tube Reclaim for Developing NR/IIR Blends

Butyl (IIR) tube reclaim (RR) was mixed with carbon black filled natural rubber (NR) compounds at various percentages. The blend containing a low percentage of RR was found to show improved ageing resistance and improved processability with out much reduction in the mechanical properties.

ANALYSIS, MODIFICATION, AND EVALUATION OF THE COLD FLOW PROPERTIES OF VEGETABLE OILS AS BASE OIL FOR INDUSTRIAL LUBRICANTS

Poor cold flow properties of vegetable oils are a major problem preventing the usage of many abundantly available vegetable oils as base stocks for industrial lubricants. The major objective of this research is to improve the cold flow properties of vegetable oils by various techniques like additive addition and different chemical modification processes. Conventional procedure for determining pour point is ASTM D97 method. ASTM D97 method is time consuming and reproducibility of pour point temperatures is poor between laboratories. Differential Scanning Calorimetry (DSC) is a fast, accurate and reproducible method to analyze the thermal activities during cooling/heating of oil. In this work coconut oil has been chosen as representative vegetable oil for the analysis and improvement cold flow properties since it is abundantly available in the tropics and has a very high pour point of 24 °C. DSC is used for the analysis of unmodified and modified vegetable oil. The modified oils (with acceptable pour points) were then subjected to different tests for the valuation of important lubricant properties such as viscometric, tribological (friction and wear properties), oxidative and corrosion properties.A commercial polymethacrylate based PPD was added in different percentages and the pour points were determined in each case. Styrenated phenol(SP) was added in different concentration to coconut oil and each solution was subjected to ASTM D97 test and analysis by DSC. Refined coconut oil and other oils like castor oil, sunflower oil and keranja oil were mixed in different proportions and interesterification procedure was carried out. Interesterification of coconut oil with other vegetable oils was not found to be effective in lowering the pour point of coconut oil as the reduction attained was only to the extent of 2 to 3 °C.Chemical modification by acid catalysed condensation reaction with coconut oil castor oil mixture resulted in significant reduction of pour point (from 24 ºC to -3 ºC). Instead of using triacylglycerols, when their fatty acid derivatives (lauric acid- the major fatty acid content of coconut oil and oleic acid- the major fatty acid constituents of monoand poly- unsaturated vegetable oils like olive oil, sunflower oil etc.) were used for the synthesis , the pour point could be brought down to -42 ºC. FTIR and NMR spectroscopy confirmed the ester structure of the product which is fundamental to the biodegradability of vegetable oils. The tribological performance of the synthesised product with a suitable AW/EP additive was comparable to the commercial SAE20W30 oil. The viscometric properties (viscosity and viscosity index) were also (with out additives) comparable to commercial lubricants. The TGA experiment confirmed the better oxidative performance of the product compared to vegetable oils. The sample passed corrosion test as per ASTM D130 method.

Lithium Containing Complex Metal Oxides and Metal phosphates:Investigations on their synthesis and various characterizations for rechargeable lithium battery applications

The work presented in the thesis is centered around two important types of cathode materials, the spinel structured LixMn204 (x =0.8to1.2) and the phospho -oIivine structured LiMP04 (M=Fe and Ni). The spinel system LixMn204, especially LiMn204 corresponding to x= 1 has been extensively investigated to understand its structural electrical and electrochemical properties and to analyse its suitability as a cathode material in rechargeable lithium batteries. However there is no reported work on the thermal and optical properties of this important cathode material. Thermal diffusivity is an important parameter as far as the operation of a rechargeable battery is concerned. In LixMn204, the electronic structure and phenomenon of Jahn-Teller distortion have already been established theoretically and experimentally. Part of the present work is an attempt to use the non-destructive technique (NDT) of photoacoustic spectroscopy to investigate the nature of the various electronic transitions and to unravel the mechanisms leading to the phenomenon of J.T distortion in LixMn204.The phospho-olivines LiMP04 (M=Fe, Ni, Mn, Co etc) are the newly identified, prospective cathode materials offering extremely high stability, quite high theoretical specific capacity, very good cycIability and long life. Inspite of all these advantages, most of the phospho - olivines especially LiFeP04 and LiNiP04 show poor electronic conductivity compared to LixMn204, leading to low rate capacity and energy density. In the present work attempts have been made to improve the electronic conductivity of LiFeP04 and LiNiP04 by adding different weight percentage MWNT .It is expected that the addition of MWNT will enhance the electronic conductivity of LiFeP04 and LiNiP04 with out causing any significant structural distortions, which is important in the working of the lithium ion battery.

Energy-Efficient Cluster based Routing Schemes for Static and Mobile Sensor Networks

The theme of the thesis is centred around one important aspect of wireless sensor networks; the energy-efficiency.The limited energy source of the sensor nodes calls for design of energy-efficient routing protocols. The schemes for protocol design should try to minimize the number of communications among the nodes to save energy. Cluster based techniques were found energy-efficient. In this method clusters are formed and data from different nodes are collected under a cluster head belonging to each clusters and then forwarded it to the base station.Appropriate cluster head selection process and generation of desirable distribution of the clusters can reduce energy consumption of the network and prolong the network lifetime. In this work two such schemes were developed for static wireless sensor networks.In the first scheme, the energy wastage due to cluster rebuilding incorporating all the nodes were addressed. A tree based scheme is presented to alleviate this problem by rebuilding only sub clusters of the network. An analytical model of energy consumption of proposed scheme is developed and the scheme is compared with existing cluster based scheme. The simulation study proved the energy savings observed.The second scheme concentrated to build load-balanced energy efficient clusters to prolong the lifetime of the network. A voting based approach to utilise the neighbor node information in the cluster head selection process is proposed. The number of nodes joining a cluster is restricted to have equal sized optimum clusters. Multi-hop communication among the cluster heads is also introduced to reduce the energy consumption. The simulation study has shown that the scheme results in balanced clusters and the network achieves reduction in energy consumption.The main conclusion from the study was the routing scheme should pay attention on successful data delivery from node to base station in addition to the energy-efficiency. The cluster based protocols are extended from static scenario to mobile scenario by various authors. None of the proposals addresses cluster head election appropriately in view of mobility. An elegant scheme for electing cluster heads is presented to meet the challenge of handling cluster durability when all the nodes in the network are moving. The scheme has been simulated and compared with a similar approach.The proliferation of sensor networks enables users with large set of sensor information to utilise them in various applications. The sensor network programming is inherently difficult due to various reasons. There must be an elegant way to collect the data gathered by sensor networks with out worrying about the underlying structure of the network. The final work presented addresses a way to collect data from a sensor network and present it to the users in a flexible way.A service oriented architecture based application is built and data collection task is presented as a web service. This will enable composition of sensor data from different sensor networks to build interesting applications. The main objective of the thesis was to design energy-efficient routing schemes for both static as well as mobile sensor networks. A progressive approach was followed to achieve this goal.

Estudo das associações significativas e fortes dos acidentes de trabalho com o efetivo laboral e com as horas trabalhadas

O presente artigo teve como base uma aula de mestrado, em laboratório de estatística, para posterior conceção de um artigo científico, em grupo, em 4 horas. Teve como objeto de estudo a variação dos acidentes de trabalho com o efetivo laboral, com as horas trabalhadas, com a duração média da jornada de trabalho. O objetivo científico foi pesquisar correlações entre variáveis. O objetivo didático foi demonstrar os passos do método científico e o objetivo pedagógico foi quebrar preconceitos sobre a dificuldade de produzir trabalho científico. Partindo de uma sumária revisão da literatura, colocaram-se hipóteses de investigação e prosseguiu-se para tratamento estatístico inferencial sobre os dados dos acidentes de trabalho com baixa médica, do efetivo médio laboral, das horas trabalhadas e da duração da jornada média de trabalho, de uma grande empresa, durante 20 anos consecutivos. Os resultados revelaram uma associação direta, estatisticamente significativa e forte, dos acidentes de trabalho às horas trabalhadas e ao efetivo. No caso da associação dos acidentes à duração média da jornada de trabalho, a associação é estatisticamente significativa, mas de intensidade moderada. Este ensaio permitiu também intrapolar e extrapolar, com reservas, os acidentes esperados em função de uma dada carga de trabalho. As competências desenvolvidas neste trabalho revelaram-se úteis para a produção de conhecimento científico, em geral, e para gestão da prevenção dos riscos laborais, em particular. / This article was based on a master class, in statistical laboratory, of 4 hours, for subsequent group production of a scientific paper. The object of study was the variation of occupational accidents with number of employees and with hours worked, as well as with the average duration of the workday. The scientific objective has been researching correlations between variables. The learning objective was to demonstrate the steps of the scientific method, and the educational objective was to break down prejudices about the difficulty of making scientific research. Starting from a brief literature review on the subject, research hypotheses were formulated. Then, it was done inferential statistics of data regarding occupational accidents with sick leave, average number of employees, hours worked per year, and average duration of the workday, of a large enterprise, during 20 years in a row. Results revealed that there is statistically significant and strong direct association between occupational accidents and hours worked, as well as between occupational accidents and number of employees. In the case of the association of accidents to the average duration of the workday, identical data analysis revealed this association is statistically significant, but of moderate intensity. This essay also enabled to interpolate and extrapolate, with proper caution, the accidents expected to occur in a given workload. The skills developed from this research proved to be useful to create scientific knowledge, as well as to manage labour risk prevention.

Study of photo-assisted electrochemical degradation of carbaryl at dimensionally stable anodes (DSA (R))

This paper presents the results concerning the degradation of the pesticide carbaryl comparing two methods: electrochemical (EC) and photo-assisted electrochemical (PAEC). The experimental variables of applied current density, electrolyte flow-rate and initial carbaryl concentration were investigated. The results demonstrate that the electrochemical degradation of carbaryl was greatly enhanced when simultaneous UV light was applied. The greatest difference between the PAEC and EC method was apparent when lower current densities were applied. The extent of COD removal was much enhanced for the combined method, independent of the applied current density. It should be noted that the complete removal of carbaryl was achieved with out the need to add NaCl to the reaction mixture, avoiding the risk of chlorinated organic species formation. (C) 2009 Elsevier B.V. All rights reserved.

The influence of lifestyle and gender on sickness absence in brazilian workers

Background: Despite an increasing body of knowledge concerning gender and lifestyle factors as determinants of sickness absence in well-developed countries, the relationship between these variables has not been elucidated in emerging economic power countries, where the burden of non-communicable diseases is particularly high. This study aimed to analyze the relationships among lifestyle-related factors and sick leave and to examine whether gender differences in sickness absence can be explained by differences in socio-demographic, work and lifestyle-related factors among Brazilian workers. Methods: In this longitudinal study with a one year follow-up among 2.150 employees of a Brazilian airline company, sick leave was the primary outcome of interest. Independent variables collected by interview at enrolment in the study were gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity and smoking). In addition, the risk for coronary heart disease was determined based on measurement of blood pressure, total cholesterol and glucose levels. The total number of days on sick leave during 12 months follow-up was available from the company register. Logistic regression analysis was used to determine the influence of socio-demographic, type of work and lifestyle-related factors on sick leave. Results: Younger employees, those with lower educational level, those who worked as air crew members and those with higher levels of stress were more likely to have sick leave. Body mass index and level of physical activity were not associated with sick leave. After adjustment by socio-demographic variables, increased odds for 10 or more days of sick leave were found in smokers (OR = 1.51, CI = 1.05-2.17), and ex-smokers (OR = 1.45, CI = 1.01-2.10). Women were more likely to have 10 or more days of sick leave. Gender differences were reduced mainly when adjusted for type of work (15%) and educational level (7%). Conclusions: The higher occurrence of sick leave among women than among men was partly explained by type of work and educational level. Our results suggest that type of work, a stressful life, and smoking are important targets for health promotion in this study population

Correlação entre os métodos de concepção, ocorrência e formas de tratamento das onfalopatias em bovinos: estudo retrospectivo

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Micropropagação de babosa (Aloe vera L.)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Avaliação da eficiência de adesão de um cimento resinoso autocondicionante (self-adhesive) sobre esmalte e dentina: efeito termociclagem e condicionamento dental : estudo in vitro

Pós-graduação em Odontologia Restauradora - ICT

Educação moral, escola e comunidade: uma relação (des)articulada?

Pós-graduação em Educação - FCT

Seletividade de sálvia (Salvia splendens) ao herbicida oxyfluorfen veiculado à palha de arroz

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Adenopatia cervical tuberculosa em crianças: aspectos epidemiológicos, clínicos e laboratoriais

A tuberculose constitui um sério problema de saúde pública, sendo o M. tuberculosis o principal agente da doença no Brasil. Entre as formas extra pulmonares, a ganglionar periférica é uma das mais freqüentes na infância, apesar de pouco estudada. Com o objetivo de avaliar a incidência e conhecer os aspectos epidemiológicos, clínicos e laboratoriais da tuberculose ganglionar foram atendidas no ambulatório do Hospital Ofir Loiola, no período de janeiro de 1995 a dezembro de 1996, 73 crianças entre 0-14 anos, de ambos os sexos, portadoras de linfadenopatia cervical. A amostra foi dividida em dois grupos: o primeiro constituído por 61 crianças com adenopatias de outras etiologias e o segundo formado de 12 pacientes com etiologia tuberculosa. Nesse período, para as adenopatias tuberculosas, a taxa anual de incidência na área metropolitana de Belém, por 100 mil habitantes, foi de 1,03 e para o grupo de outras etiologias a incidência foi de 4,27 e 6,15 para os anos de 1995 e 1996, respectivamente. Verificou-se que a maioria das adenopatias na infância foram inespecíficas (64,4%), entretanto, quando consideradas somente as de etiologia conhecida, o risco relativo de ser tuberculose foi de 1,17. A análise comparativa entre os dois grupos não revelou diferença estatisticamente significativa no que tange à faixa etária, sexo, estado nutricional, apresentação clínica inicial, cadeias ganglionares comprometidas e características dos linfonodos. Em ambos foi observado maior incidência em pré-escolares e no sexo masculino. O comprometimento do estado nutricional pode ter contribuído para o aumento da morbidade em 41,7% dos casos de tuberculose. A presença de massa cervical constitui a queixa principal nos dois grupos embora durante o exame tenha sido constatado comprometimento ganglionar generalizado em 75,1% das crianças com adenopatia tuberculosa. Quanto à duração dos sintomas, os casos de adenopatia tuberculosa foram atendidos a partir do primeiro mês de doença e tiveram como manifestação clínica abscesso frio em 25% dos casos. A fonte de infecção foi identificada em 1/3 dos pacientes. A reação tuberculínica com leitura >10mm foi positiva em 63,6% das crianças tuberculosas. Entre os exames bacteriológicos realizados, a cultura constituiu o elemento fundamental para o diagnóstico de tuberculose, obtendo-se 100% de positividade nos exames realizados; a baciloscopia foi de menor importância. O exame histopatológico com lesão granulomatosa compatível com tuberculose foi observado em 88,9% dos casos. O comprometimento pulmonar associado esteve presente em 27, 3% das crianças tuberculosas. A resposta à terapêutica com esquema padronizado pelo Ministério da Saúde foi satisfatória, não tendo sido observados efeitos colaterais aos medicamentos utilizados.