Comparing potentially avoidable hospitalization rates related to ambulatory care sensitive conditions in Switzerland: the need to refine the definition of health conditions and to adjust for population health status.

BACKGROUND: Regional rates of hospitalization for ambulatory care sensitive conditions (ACSC) are used to compare the availability and quality of ambulatory care but the risk adjustment for population health status is often minimal. The objectives of the study was to examine the impact of more extensive risk adjustment on regional comparisons and to investigate the relationship between various area-level factors and the properly adjusted rates. METHODS: Our study is an observational study based on routine data of 2 million anonymous insured in 26 Swiss cantons followed over one or two years. A binomial negative regression was modeled with increasingly detailed information on health status (age and gender only, inpatient diagnoses, outpatient conditions inferred from dispensed drugs and frequency of physician visits). Hospitalizations for ACSC were identified from principal diagnoses detecting 19 conditions, with an updated list of ICD-10 diagnostic codes. Co-morbidities and surgical procedures were used as exclusion criteria to improve the specificity of the detection of potentially avoidable hospitalizations. The impact of the adjustment approaches was measured by changes in the standardized ratios calculated with and without other data besides age and gender. RESULTS: 25% of cases identified by inpatient main diagnoses were removed by applying exclusion criteria. Cantonal ACSC hospitalizations rates varied from to 1.4 to 8.9 per 1,000 insured, per year. Morbidity inferred from diagnoses and drugs dramatically increased the predictive performance, the greatest effect found for conditions linked to an ACSC. More visits were associated with fewer PAH although very high users were at greater risk and subjects who had not consulted at negligible risk. By maximizing health status adjustment, two thirds of the cantons changed their adjusted ratio by more than 10 percent. Cantonal variations remained substantial but unexplained by supply or demand. CONCLUSION: Additional adjustment for health status is required when using ACSC to monitor ambulatory care. Drug-inferred morbidities are a promising approach.

Environmental assessment and biomonitoring of the Twelve Mile Creek watershed, Niagara Peninsula, Ontario

In light of the heavy reliance of the people of the Niagara Peninsula on the T\\'elve Mile Creek (TMC) watershed for recreational activities and for municipal and industrial uses ( e.g., drinking water, shipping and discharge of effluents), it was deemed prudent to assess the envirol1tnental health of the system by analysing the sediments total and exchangeable metal, and TPH contents. The MOEE has set guidelines with limits for the protection and management of aquatic sediments, and the sediments from the headwaters of the TMC have total metal and TPH (subset of O&G) contents well below the lower provincial limits. Areas of environmental concern where total metal contents in sediments, either individually or collectively, exceed the guideline, are the south side of Lake Gibson, the Old WeIland Canal, a segment of TMC just south of the QEW and Martindale Pond. The total metal content of sediments does not in all instances identify areas of biological concern. Instead, it has been found that the exchangeable metal fraction of sediments is a better indicator of metal availability and thus potential accumulation in organisms. In some instances, the exchangeable metal fraction agrees with the total metal fraction defining areas of environmental concern, but it does vary from site to site reflecting the natural variability of the ambient environment. Overall, the exchangeable metal fraction of sediments appears to be a better indicator of anthropogenic pollution and ecosystem impact. A histochemical study of Anodon.ta sp., Elliptio sp. and zebra mussels (Dreissena polyn'101pha) was done in conjunction with passive biomonitoring of zebra and quagga mussels (Dreissena bugensis) from the Twelve Mile Creek watershed and Lake 51. Clair (Jeanette's Creek, Chatham, Ontario). The highest concentrations of divalent metals such as Cu, Ni, Cd, and Zn, and trivalent Al appear to accumulate in gill and kidney tissues. Metal contents of organ tissues in Anodonta sp. vary with size class. Organ metal content varies among size classes, thus requiring consideration of size in biomonitoring studies. Shucked zebra and quagga mussel tissues, exhibited similar size class to Al content trends. In addition they reflected the Al content trends of top (approximately 10 cm) most sediments in the Twelve Mile Creek watershed. Quagga mussels appear to have higher Al concentrations than zebra mussels, thus suggesting that quagga mussels may be better passive biomonitors of AI. Cd content in zebra mussel tissues, seemed to increase with size class trends. This was not demonstrated in the quagga mussel tissues. This suggests that Cd may be regulated by quagga mussels and not by zebra mussels, and that zebra mussels may be better passivebiomonitors of Cd than are quagga mussels. Zebra mussel, quagga mussel, Anodonta sp., and Elliptio sp. were used in a two part, active (translocated) biomonitoring study of the Twelve Mile Creek watershed. There was no statistical difference in death rates between zebra and quagga mussels after 65 days of biomonitoring. However there does appear to be a difference of death rates between sites. Unfortunately the data base did not permit us to differentiate between sites. Relative to Port Colborne Harbour (Port Colborne, Ontario), the Twelve Mile Creek watershed appears to be elevated in bioavailable AI. An area near the terminus of the Twelve Mile Creek appears to be an area of environmental concern since mussels seemed to have accumulated relatively large concentrations of Cd, Zn, and Pb. In addition to possible metal loading from a nearby outfalls, or possible upstream outfalls, road salt runoff from storm sewers may have contributed to metal accumulation through cation exchanges processes. Similar trends in cumulative quagga mussel metal concentrations during the two time periods (65 and 159 days), suggest that quagga mussels may reach equilibrium within 65 days of translocation. Differences in bioaccumulated metal concentrations of the two dreissenid species demonstrate that active biomonitoring studies must use a variety of organisms to adequately assess the environmental situation of specific waterways and/or bodies.

Land Ownership, Working Capital, and the Agricultural Output: Egypt, 1913-1958.

A simple model is constructed in which short-term credit is needed to finance the purchase of inputs, in which there is bankruptcy risk, and in which we argue were important characteristics of Egyptian agriculture during the first half of this century, result in aggregate agricultural output being dependant on the distribution of land ownership. The main theorical insight is that aggregate agricultural output will be increased by a decrease in the inequality of the distribution of land ownership when returns to scale are decreasing. Testable short- and long-run empirical propositions are formulated and carefully tested on Egyptian data for the 1913-1958 period. We find that, controlling for factor inputs, there is no tradeoff between equity and efficiency for Egyptian agriculture - they go hand in hand in the short run.

Land Ownership, Working Capital, and the Agricultural Output: Egypt, 1913-1958.

A simple model is constructed in which short-term credit is needed to finance the purchase of inputs, in which there is bankruptcy risk, and in which we argue were important characteristics of Egyptian agriculture during the first half of this century, result in aggregate agricultural output being dependant on the distribution of land ownership. The main theorical insight is that aggregate agricultural output will be increased by a decrease in the inequality of the distribution of land ownership when returns to scale are decreasing. Testable short- and long-run empirical propositions are formulated and carefully tested on Egyptian data for the 1913-1958 period. We find that, controlling for factor inputs, there is no tradeoff between equity and efficiency for Egyptian agriculture - they go hand in hand in the short run.

Évaluation de la performance des structures des soins de santé primaires du district sanitaire de Labé (Guinée)

Contexte : En République de Guinée, depuis 1984, l’ensemble des structures de soins ont intégré le programme de Soins de santé primaires et Médicaments Essentiels (PEV/SSP/ME). Pour la réalisation de ce programme, d’importants efforts et des sommes des millions de dollars ont été investis, mais les indicateurs de santé du pays sont toujours des plus alarmants du monde (EDS- 2005). Objectif : Evaluer la performance des structures de soins de santé primaires (SSP) d’un district sanitaire guinéen à partir des documents administratifs suivi d’une enquête sur la satisfaction des prestataires et des bénéficiaires et des parties prenantes du district. Méthodologie : Il s’agit d’une étude descriptive de cas touchant 10 des 18 structures de soins de santé primaires du district sanitaire de Labé. Elle porte sur une analyse quantitative de résultats de 10 contrôles semestriels (2004-2009) et sur une analyse qualitative composée d’entretiens menés auprès de 308 bénéficiaires et de quelques membres des Comités de gestion des structures pour apprécier le niveau de performance des structures ciblées. Résultats : Toutes les structures publiques du district sanitaire sous étude étaient intégrées1. Malgré cela, la tendance moyenne des consultations affiche une allure sinusoïdale (fluctuante). Bien que la disponibilité, l’accessibilité, l’utilisation et la couverture adéquate et effective des services de Consultation Primaire Curative (CPC) et de Planification Familiale (PF) n’ont pas connu d’amélioration durant la période de 2004 à 2009. La tendance moyenne de la Consultation prénatale (CPN) et celle de la Vaccination (VA) se sont améliorées au cours de la période d’étude. Les prestataires de services SSP déclarent être assez satisfaits de leur formation mais ne le sont pas pour leur condition de travail surtout ceux du milieu rural (faible rémunération, environnement difficile), qualité moindre de la supervision et ruptures fréquentes de stock en médicaments essentiels. Pour les bénéficiaires, leur satisfaction se limite au respect de leurs valeurs culturelles et de leur interaction avec les prestataires de soins. Cependant, ils déplorent le long temps d’attente, la mauvaise qualité de l’accueil, les coûts élevés des prestations et le manque d’équité qui sont des facteurs qualifiés comme des éléments de contreperformance des structures. Pour les autorités et des parties prenantes, la rupture des stocks en médicaments essentiels, le manque d’équipements et la faible motivation des prestataires sont les facteurs majeurs qui entravent la performance des structures sanitaires, surtout en milieu rural. Conclusion : Malgré l’intégration du programme des SSP dans les structures de SSP du district sanitaire de Labé, on note encore une insuffisance de leur utilisation, la faiblesse de la couverture, le manque de suivi et supervision des structures Une étude actualisée et plus étendue pourrait mieux cerner le sujet.

Semiautomated 3D liver segmentation using computed tomography and magnetic resonance imaging

Le foie est un organe vital ayant une capacité de régénération exceptionnelle et un rôle crucial dans le fonctionnement de l’organisme. L’évaluation du volume du foie est un outil important pouvant être utilisé comme marqueur biologique de sévérité de maladies hépatiques. La volumétrie du foie est indiquée avant les hépatectomies majeures, l’embolisation de la veine porte et la transplantation. La méthode la plus répandue sur la base d'examens de tomodensitométrie (TDM) et d'imagerie par résonance magnétique (IRM) consiste à délimiter le contour du foie sur plusieurs coupes consécutives, un processus appelé la «segmentation». Nous présentons la conception et la stratégie de validation pour une méthode de segmentation semi-automatisée développée à notre institution. Notre méthode représente une approche basée sur un modèle utilisant l’interpolation variationnelle de forme ainsi que l’optimisation de maillages de Laplace. La méthode a été conçue afin d’être compatible avec la TDM ainsi que l' IRM. Nous avons évalué la répétabilité, la fiabilité ainsi que l’efficacité de notre méthode semi-automatisée de segmentation avec deux études transversales conçues rétrospectivement. Les résultats de nos études de validation suggèrent que la méthode de segmentation confère une fiabilité et répétabilité comparables à la segmentation manuelle. De plus, cette méthode diminue de façon significative le temps d’interaction, la rendant ainsi adaptée à la pratique clinique courante. D’autres études pourraient incorporer la volumétrie afin de déterminer des marqueurs biologiques de maladie hépatique basés sur le volume tels que la présence de stéatose, de fer, ou encore la mesure de fibrose par unité de volume.

Women Industrial Cooperatives- An Analysis of Its Structure, Performance and Growth in Kannur District

In the present study made an attempt to analyse the structure, performance and growth of women industrial cooperatives in kannur district, Kerala. The study encompasses all women industrial cooperatives registered at the district industries center, kannur and that currently exist. The women industrial cooperatives are classified into two ie; group with network and another group without network. In Kannur there are 54 units working as women industrial cooperatives. One of the main problems the women cooperatives face is the lack of working capital followed marketing problem. The competition between cooperatives and private traders is very high. The variables examined to analyse the performance of women industrial cooperatives in Kannur showed that there exists inter unit differences in almost all the variables. The financial structure structure shows that the short term liquidity of women cooperatives in Kannur favour more the units which have political networks; but the long term financial coverage is seen to be highly geared in this group, not because of a decline is net worth but due to highly proportionate increase in financial liabilities in the form of borrowings. The encouragement given by the government through financial stake and other incentives has been the major factor in the formation and growth of women cooperatives. As a result both productivity and efficiency improves in the cooperatives. In short the present study helped to capture the impact, role and dynamics of networking in general and socio political network in particular in relation to intra and inter unit differences on the structure, growth and performance of women industrial cooperatives societies in Kannur district

Investigations on the Effects of Petroleum Hydrocarbons on the Marine Bivalves Perna viridis (Linnaeus) and Sunetta scripta (Linne')

The thesis deals with different aspects connected with the distribution and toxicity of PHC in crude oils in the aquatic environment and marine molluscs. Information has been gathered and presented on the present status of research in the field based on a thorough review of recent literature. It is seen from the literature that the resident time of PHC becomes lesser and lesser when crude oil is discharged in large quantities into the coastal waters where excess oxygenation light penetration, temperature availability and strong tidal currents persist. This results in the reduction of the onslaught of oil pollution. This probably shows that taxic insult of crude oil in tropical shores will be relatively lesser than that occurring in temperate and boreal waters. However, there is no record of major episodal oil pollution comparable in quantum and extent to that of Torrey Canyon or Amoco Cadiz which prevents a more reliable analysis on the issue. Considerable controversy exists on the method of estimation of PHC in seawater. However, Ultra-violet fluorescence spectroscopy has been widely recommended as an analytical tool for the determination of total hydrocarbons. Similarly representation of values as chrysene equivalents has been recognised as the most reliable method of Quantum representation.

Propagation of Microwaves in the Troposphere with Potential Application to GPS based Navigation and Meteorology with emphasis on Indian region

Global Positioning System (GPS), with its high integrity, continuous availability and reliability, revolutionized the navigation system based on radio ranging. With four or more GPS satellites in view, a GPS receiver can find its location anywhere over the globe with accuracy of few meters. High accuracy - within centimeters, or even millimeters is achievable by correcting the GPS signal with external augmentation system. The use of satellite for critical application like navigation has become a reality through the development of these augmentation systems (like W AAS, SDCM, and EGNOS, etc.) with a primary objective of providing essential integrity information needed for navigation service in their respective regions. Apart from these, many countries have initiated developing space-based regional augmentation systems like GAGAN and IRNSS of India, MSAS and QZSS of Japan, COMPASS of China, etc. In future, these regional systems will operate simultaneously and emerge as a Global Navigation Satellite System or GNSS to support a broad range of activities in the global navigation sector.Among different types of error sources in the GPS precise positioning, the propagation delay due to the atmospheric refraction is a limiting factor on the achievable accuracy using this system. The WADGPS, aimed for accurate positioning over a large area though broadcasts different errors involved in GPS ranging including ionosphere and troposphere errors, due to the large temporal and spatial variations in different atmospheric parameters especially in lower atmosphere (troposphere), the use of these broadcasted tropospheric corrections are not sufficiently accurate. This necessitated the estimation of tropospheric error based on realistic values of tropospheric refractivity. Presently available methodologies for the estimation of tropospheric delay are mostly based on the atmospheric data and GPS measurements from the mid-latitude regions, where the atmospheric conditions are significantly different from that over the tropics. No such attempts were made over the tropics. In a practical approach when the measured atmospheric parameters are not available analytical models evolved using data from mid-latitudes for this purpose alone can be used. The major drawback of these existing models is that it neglects the seasonal variation of the atmospheric parameters at stations near the equator. At tropics the model underestimates the delay in quite a few occasions. In this context, the present study is afirst and major step towards the development of models for tropospheric delay over the Indian region which is a prime requisite for future space based navigation program (GAGAN and IRNSS). Apart from the models based on the measured surface parameters, a region specific model which does not require any measured atmospheric parameter as input, but depends on latitude and day of the year was developed for the tropical region with emphasis on Indian sector.Large variability of atmospheric water vapor content in short spatial and/or temporal scales makes its measurement rather involved and expensive. A local network of GPS receivers is an effective tool for water vapor remote sensing over the land. This recently developed technique proves to be an effective tool for measuring PW. The potential of using GPS to estimate water vapor in the atmosphere at all-weather condition and with high temporal resolution is attempted. This will be useful for retrieving columnar water vapor from ground based GPS data. A good network of GPS could be a major source of water vapor information for Numerical Weather Prediction models and could act as surrogate to the data gap in microwave remote sensing for water vapor over land.

Development and Analysis of Compact AMicrostrip Antennas

The practical applications of microstrip antennas for mobile systems are in portable or pocket-size equipment and in vehicles. Antennas for VHFIUHF handheld portable equipment, such as pagers, portable telephones and transceivers, must naturally be small in size, light in weight and compact in structure. There is a growing tendency for portable equipment to be made smaller and smaller as the demand for personal communication rapidly increases, and the development of very compact hand-held units has become urgent.In this thesis work, main aim is to develop a more and more reduced sized microstrip patch antenna. It is well known that the smaller the antenna size, the lower the antenna efficiency. During the period of work, three different compact circular sided microstrip patches are developed and analysed, which have a significant size reduction compared to standard circular disk antenna (the most compact one of the basic microstrip patch configurations), without much deterioration of its properties like gain, bandwidth and efficiency. In addition to this the interesting results, dual port operation and circular polarization are also observed for some typical designs of these patches. These make the patches suitable for satellite and mobile communication systems.The theoretical investigations are carried out on these compact patches. The empirical relations are developed by modifying the standard equations of rectangular and circular disk microstrip patches, which helps to predict the resonant frequencies easily.

Studies on the structural, electrical and magnetic properties of composites based on spinel ferrites

This thesis mainly deals with the preparation and studies on magnetic composites based on spinel ferrites prepared both chemically and mechanically. Rubber ferrite composites (RFC) are chosen because of their mouldability and flexibility and the ease with which the dielectric and magnetic properties can be manipulated to make them as useful devices. Natural rubber is chosen as the Matrix because of its local availability and possible value addition. Moreover, NR represents a typical unsaturated nonpolar matrix. The work can be thought of as two parts. Part l concentrates on the preparation and characterization of nanocomposites based on y-Fe203. Part 2 deals with the preparation and characterization of RFCs containing Nickel zinc ferrit In the present study magnetic nanocomposites have been prepared by ionexchange method and the preparation conditions have been optimized. The insitu incorporation of the magnetic component is carried out chemically. This method is selected as it is the easiest and simplest method for preparation of nanocomposite. Nanocomposite samples thus prepared were studied using VSM, Mossbauer spectroscopy, Iron content estimation, and ESR spectroscopy. For the preparation of RFCs, the filler material namely nickel zinc ferrite having the general formula Ni)_xZnxFez04, where x varies from 0 to 1 in steps of 0.2 have been prepared by the conventional ceramic techniques. The system of Nil_xZn"Fe204 is chosen because of their excellent high frequency characteristics. After characterization they are incorporated into the polymer matrix of natural rubber by mechanical method. The incorporation is done according to a specific recipe and for various Loadings of magnetic fillers and also for all compositions. The cure characteristics, magnetic properties and dielectric properties of these composites are evaluated. The ac electrical conductivity of both ceramic nickel zinc ferrites and rubber ferrite composites are also calculated using a simple relation. The results are correlated.

A study of the evolution and working of regulated markets in Tamilnadu

This study presents a detailed investigation of the origin and development of regulations in agricultural marketing in Tamil Nadu. It evaluates the method and process of regulation practised through the orgahisation of a chain of regulated markets in the State. The study also examines in detail the conceptual frame work behind state intervention and show the original concept has been modified subsequently to suit the changed conditions during the post-independence era of planning for economic development Specific objectives explained in the present study include the following: viz, a) The historical aspects that necessitated state intervention in agricultural marketing in the form of organising regulated markets and their evolution, b) The conceptual and organisational bases of regulated markets in Tamil Nadu. c) The impact of such regulations on the existing trade channels or systems.168 d) The performance and efficiency of regulated markets and their achievements. The study also has suggested some remedial measures to reorganise the present organisational pattern of regulated marketing in Tamil Nadu.

The Systematics, Distribution and Bionomics of Deep sea fishes beyond depth 200m along the South west coast of India

Reducing fishing pressure in coastal waters is the need of the day in the Indian marine fisheries sector of the country which is fast changing from a mere vocational activity to a capital intensive industry. It requires continuous monitoring of the resource exploitation through a scientifically acceptable methodology, data on production of each species stock, the number and characteristics of the fishing gears of the fleet, various biological characteristics of each stock, the impact of fishing on the environment and the role of fishery—independent on availability and abundance. Besides this, there are issues relating to capabilities in stock assessment, taxonomy research, biodiversity, conservation and fisheries management. Generation of reliable data base over a fixed time frame, their analysis and interpretation are necessary before drawing conclusions on the stock size, maximum sustainable yield, maximum economic yield and to further implement various fishing regulatory measures. India being a signatory to several treaties and conventions, is obliged to carry out assessments of the exploited stocks and manage them at sustainable levels. Besides, the nation is bound by its obligation of protein food security to people and livelihood security to those engaged in marine fishing related activities. Also, there are regional variabilities in fishing technology and fishery resources. All these make it mandatory for India to continue and strengthen its marine capture fisheries research in general and deep sea fisheries in particular. Against this background, an attempt is made to strengthen the deep sea fish biodiversity and also to generate data on the distribution, abundance, catch per unit effort of fishery resources available beyond 200 m in the EEZ of southwest coast ofIndia and also unravel some of the aspects of life history traits of potentially important non conventional fish species inhabiting in the depth beyond 200 m. This study was carried out as part of the Project on Stock Assessment and Biology of Deep Sea Fishes of Indian EEZ (MoES, Govt. of India).

A Novel Isoform of the Hepatic Antimicrobial Peptide, Hepcidin (Hepc-CB1), from a Deep-Sea Fish, the Spinyjaw Greeneye Chlorophthalmus bicornis (Norman, 1939): Molecular Characterisation and Phylogeny

Hepcidin is cysteine-rich short peptide of innate immune system of fishes, equipped to perform prevention and proliferation of invading pathogens like bacteria and viruses by limiting iron availability and activating intracellular cascades. Hepcidins are diverse in teleost fishes, due to the varied aquatic environments including exposure to pathogens, oxygenation and iron concentration. In the present study, we report a 87-amino acid (aa) preprohepcidin (Hepc-CB1) with a signal peptide of 24 aa, a prodomain of 39 aa and a bioactive mature peptide of 24 aa from the gill mRNA transcripts of the deep-sea fish spinyjaw greeneye, Chlorophthalmus bicornis. Molecular characterisation and phylogenetic analysis categorised the peptide to HAMP2-like group with a mature peptide of 2.53 kDa; a net positive charge (?3) and capacity to form b-hairpin-like structure configured by 8 conserved cysteines. The present work provides new insight into the mass gene duplication events and adaptive evolution of hepcidin isoforms with respect to environmental influences and positive Darwinian selection. This work reports a novel hepcidin isoform under the group HAMP2 from a nonacanthopterygian deep-sea fish, C. bicornis

Reinforcement Learning Solution for Unit Commitment Problem Considering Minimum Start Up and Shut Down Times

Unit Commitment Problem (UCP) in power system refers to the problem of determining the on/ off status of generating units that minimize the operating cost during a given time horizon. Since various system and generation constraints are to be satisfied while finding the optimum schedule, UCP turns to be a constrained optimization problem in power system scheduling. Numerical solutions developed are limited for small systems and heuristic methodologies find difficulty in handling stochastic cost functions associated with practical systems. This paper models Unit Commitment as a multi stage decision making task and an efficient Reinforcement Learning solution is formulated considering minimum up time /down time constraints. The correctness and efficiency of the developed solutions are verified for standard test systems