Développement d’outils de plaidoyer pour la lutte contre le diabète de type 2 en Afrique subsaharienne à partir de l’estimation des coûts de l’inaction et de l’action

La présente thèse, organisée en trois volets, poursuivait trois objectifs : i) Estimer les coûts médicaux directs du traitement du DT2 dans 4 pays d’Afrique subsaharienne et dans le cas du Mali, rapprocher ces coûts médicaux directs estimés aux dépenses effectives des patients diabétiques ; ii) Examiner le coût-efficacité des interventions de prévention basées sur la modification du mode de vie chez les sujets à haut risque du DT2; iii) Cerner la perception et les attitudes des acteurs de la santé sur les outils de plaidoyer développés dans le cadre du projet DFN et leur potentiel d’impact sur les décideurs. Dans le premier volet, il s’est agi d’estimer les coûts du DT2 et de ses complications au moyen d’un calculateur et de le mettre à l’épreuve au Bénin, au Burkina- Faso, en Guinée et au Mali. Les composantes de soins pour le DT2 et ses complications avaient été définies au préalable par une équipe de spécialistes, sur la base de leur expérience clinique et des lignes directrices existantes. Les prix ont été relevés dans deux structures hospitalières du secteur public et deux du privé. Les coûts ont été estimés sur une base annuelle pour le DT2 avec ou sans complications chroniques puis par épisode pour les complications aiguës. Dans le cas du Mali, ces coûts ont été rapprochés des dépenses de patients diabétiques d’après une précédente enquête transversale dans ce pays. Cette enquête portait sur 500 sujets diabétiques sélectionnés au hasard dans les registres. Les dépenses pour les soins des trois derniers mois avaient été relevées. Les déterminants des dépenses ont été explorés. Il ressort des différences de coûts dans le même secteur puis entre le secteur privé et le secteur public. Le coût minimum du traitement du DT2 sans complications dans le secteur public représentait entre 21% et 34% de PIB par habitant, puis entre 26% - 47% en présence de la rétinopathie et au-delà de 70% pour la néphropathie, la complication chronique la plus coûteuse. Les dépenses des sujets diabétiques enquêtés au Mali, étaient en deçà des coûts minima estimatifs des différentes complications excepté la rétinopathie et le DT2 sans complication. Les facteurs comme l’insulinothérapie, le nombre de complications et la résidence dans la capitale étaient significativement associés aux dépenses plus élevées des patients. Dans le second volet, la revue systématique a consisté à recenser les études d’évaluation économique des interventions de prévention du DT2 dans des groupes à haut risque par l’alimentation et/ou l’activité physique. Les interventions de contrôle de l’obésité comme facteur de risque majeur de DT2 ont également été considérées. Les études ont été sélectionnées dans les bases de données scientifiques en utilisant les mots clés et des critères prédéfinis. Les études originales publiées entre janvier 2009 et décembre 2014 et conduites en français, anglais ou espagnol étaient potentiellement éligibles. La liste de contrôle de « British Medical Journal » a servi à évaluer la qualité des études. Des 21 études retenues, 15 rapportaient que les interventions étaient coût-efficaces suivant les limites d’acceptabilité considérées. Six études étaient non concluantes, dont quatre destinées à la prévention du DT2 et deux, au contrôle de l’obésité. Dans le troisième volet, les perceptions d’utilisateurs potentiels de ce calculateur et d’un autre outil de plaidoyer, à savoir, l’argumentaire narratif expliquant la nécessité de se pencher sur la lutte contre le DT2 en Afrique, ont été évaluées dans une étude qualitative exploratoire. Les données ont été collectées au cours d’entretiens individuels avec 16 acteurs de la santé de quatre pays d’Afrique subsaharienne et un groupe de discussion avec 10 étudiants de master de nutrition à l’issue d’un atelier de formation sur le plaidoyer faisant appel à ces outils, au Bénin. Les entretiens ont été enregistrés, transcrits et codés à l’aide du logiciel QDA Miner. Les participants ont souligné la pertinence des outils pour le plaidoyer et la convivialité du calculateur de coûts. Il demeure cependant que le contexte politique marqué par la compétition des priorités, l’absence de cohésion entre les décideurs et un défaut de données notamment sur le coût-efficacité des interventions sont des freins à la priorisation du DT2 dans les politiques de santé en Afrique subsaharienne que les répondants ont relevés. L’étude confirme que le traitement du DT2 est financièrement inabordable pour un grand nombre de patients. Elle souligne que les dépenses des patients sont en deçà des coûts estimés pour un traitement approprié avec quelques exceptions. La prévention du DT2 basée le mode de vie est coût-efficace mais devrait être étudiée en Afrique. On peut espérer que la pertinence des outils de ce travail telle que relevée par les acteurs de santé se traduise par leur utilisation. Ceci pour susciter des interventions de prévention afin d’infléchir l’évolution du DT2 et son impact économique en Afrique subsaharienne.

Export Competitiveness of Software Industry In India

The study was motivated by the need to understand factors that guide the software exports and competitiveness, both positively and negatively. The influence of one factor or another upon the export competitiveness is to be understood in great depth, which is necessary to find out the industry’s sustainability. India is being emulated as an example for the success strategy in software development and exports. India’s software industry is hailed as one of the globally competitive software industry in the world. The major objectives are to model the growth pattern of exports and domestic sales of software and services of India and to find out the factors influencing the growth pattern of software industry in India. The thesis compare the growth pattern of software industry of India with respect to that of Ireland and Israel and to critically of various problems faced by software industry and export in India and to model the variables of competitiveness of emerging software producing nations

Vacuum-ultraviolet photochemically initiated modification of polystyrene surfaces: morphological changes and mechanistic investigations

Vacuum-ultraviolet (VUV) irradiation (kexc: 172 ± 12 nm) of polystyrene films in the presence of oxygen produced not only oxidatively functionalized surfaces, but generated also morphological changes. Whereas OH- and C=O-functionalized surfaces might be used for e.g. secondary functionalization, enhanced aggregation or printing, processes leading to morphological changes open new possibilities of microstructurization. Series of experiments made under different experimental conditions brought evidence of two different reaction pathways: introduction of OH- and C=O-groups at the polystyrene pathways is mainly due to the reaction of reactive oxygen species (hydroxyl radicals, atomic oxygen, ozone) produced in the gas phase between the VUV-radiation source and the substrate. However, oxidative fragmentation leading to morphological changes, oxidation products of low molecular weight and eventually to mineralization of the organic substrate is initiated by electronic excitation of the polymer leading to C–C-bond homolysis and to a complex oxidation manifold after trapping of the C-centred radicals by molecular oxygen. The pathways of oxidative functionalization or fragmentation could be differentiated by FTIR-ATR analysis of irradiated polystyrene surfaces before and after washing with acetonitrile and microscopic fluorescence analysis of the surfaces secondarily functionalized with the N,N,N-tridodecyl-triaza-triangulenium (TATA) cation. Ozonization of the polystyrene leads to oxidative functionalization of the polymer surface but cannot initiate the fragmentation of the polymer backbone. Oxidative fragmentation is initiated by electronic excitation of the polymer (contact-mode AFM analysis), and evidence of the generation of intermediate C-centred radicals is given e.g. by experiments in the absence of oxygen leading to cross-linking (solubility effects, optical microscopy, friction-mode AFM) and disproportionation (fluorescence).

Chemical Modification of Blends of Poly (Vinyl Chloride) With Linear Low Density Polyethylene

The effects of modifying blends of poly(vinyl chloride) (PVC) with linear low density polyethylene (LLDPE) by means of acrylic acid, maleic anhydride, phenolic resins and p-phenylene diamine were investigated. Modification by acrylic acid and maleic anhydride in the presence of dicumyl peroxide was found to be the most useful procedure for improving the mechanical behaviour and adhesion properties of the blend. The improvement was found to be due mainly to the grafting of the carboxylic acid to the polymer chains; grafting was found to be more effective in LLDPE/PVC blends than in pure LLDPE.

Modification of Butadiene -Acrylonitrile Rubber/ Poly(Vinyl Chloride) Blend Using Natural Rubber, Styrene-Butadiene Rubber, and Polybutadiene Rubber

Natural rubber, styrene-butadiene rubber, and polybutadiene rubber were used to replace part of the butadieneacrylonitrile rubber in a 70/30 butadiene-acrylonitrile rubber/ poly(vinyl chloride) blend. Such replacement up to 15% of the total weight of the blend improved the mechanical properties, while decreasing the cost of the blend. Styrenebutadiene rubber could replace butadiene-acrylonitrile rubber up to 30% of the total weight of the blend without deterioration in the mechanical properties.

Modification of Polychloroprene with Polyvinylchloride

Polychloroprene (neoprene) has been blended with polyvinylchloride (PVC) in different proportions using a new stabiliser system (magnesium oxide and zinc oxide with stearic acid) for PVC. The physical properties of the blends show that they can advantageously replace neoprene in many applications.

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.

A STUDY ON SOFTWARE DEVELOPMENT PROJECT RISK, RISK MANAGEMENT, PROJECT OUTCOMES AND THEIR INTER-RELATIONSHIP

This research was undertaken with an objective of studying software development project risk, risk management, project outcomes and their inter-relationship in the Indian context. Validated instruments were used to measure risk, risk management and project outcome in software development projects undertaken in India. A second order factor model was developed for risk with five first order factors. Risk management was also identified as a second order construct with four first order factors. These structures were validated using confirmatory factor analysis. Variation in risk across categories of select organization / project characteristics was studied through a series of one way ANOVA tests. Regression model was developed for each of the risk factors by linking it to risk management factors and project /organization characteristics. Similarly regression models were developed for the project outcome measures linking them to risk factors. Integrated models linking risk factors, risk management factors and project outcome measures were tested through structural equation modeling. Quality of the software developed was seen to have a positive relationship with risk management and negative relationship with risk. The other outcome variables, namely time overrun and cost over run, had strong positive relationship with risk. Risk management did not have direct effect on overrun variables. Risk was seen to be acting as an intervening variable between risk management and overrun variables.

Modification of Polypropylene/Glass Fiber Composites with Nanosilica

Poly(propylene) (PP) reinforced with short glass fiber was modified with precipitated nanosilica (pnS) by melt mixing. The weight of the glass fiber was varied by keeping the pnS at optimum level. The properties of the composites were studied using universal testing machine, dynamic mechanic analyser (DMA), differential Scanning calorimetry (DSC) and thermo gravimetric analyser (TGA). The amount of the glass fiber required for a particular modulus could be reduced by the addition of nanosilica.

A Multilingual Query Processing System using Software Agents

The goal of this work was developing a query processing system using software agents. Open Agent Architecture framework is used for system development. The system supports queries in both Hindi and Malayalam; two prominent regional languages of India. Natural language processing techniques are used for meaning extraction from the plain query and information from database is given back to the user in his native language. The system architecture is designed in a structured way that it can be adapted to other regional languages of India. . This system can be effectively used in application areas like e-governance, agriculture, rural health, education, national resource planning, disaster management, information kiosks etc where people from all walks of life are involved.

Fabrication of thin films and nano columnar structures of Fe-Ni amorphous alloys and modification of its surface properties by thermal annealing and swift heavy ion irradiation for tailoring the magnetic properties

Department of Physics, Cochin University of Science and Technology

Recyclable Short Fibre Reinforced Plastics PP/Nylon and HDPE/Nylon composites

The study shows that standard plastics like polypropylene and high density polyethylene can be reinforced by adding nylon short fibres. Compared to the conventional glass reinforced thermoplastics this novel class of reinforced thermoplastics has the major advantage of recyclability. Hence such composites represent a new spectrum of recyclable polymer composites. The fibre length and fibre diameter used for reinforcement are critical parameters While there is a critical fibre length below which no effective reinforcement takes place, the reinforcement improves when the fibre diameter decreases due to increased surface area.While the fibres alone give moderate reinforcement, chemical modification of the matrix can further improve the strength and modulus of the composites. Maleic anhydride grafting in presence of styrene was found to be the most efficient chemical modification. While the fibre addition enhances the viscosity of the melt at lower shear rates, the enhancement at higher shear rate is only marginal. This shows that processing of the composite can be done in a similar way to that of the matrix polymer in high shear operations such as injection moulding. Another significant observation is the decrease in melt viscosity of the composite upon grafting. Thus chemical modification of matrix makes processing of the composite easier in addition to improving the mechanical load bearing capacity.For the development of a useful short fibre composite, selection of proper materials, optimum design with regard to the particular product and choosing proper processing parameters are most essential. Since there is a co-influence of many parameters, analytical solutions are difficult. Hence for selecting proper processing parameters 'rnold flow' software was utilized. The orientation of the fibres, mechanical properties, temperature profile, shrinkage, fill time etc. were determined using the software.Another interesting feature of the nylon fibre/PP and nylon fibre/HDPE composites is their thermal behaviour. Both nylon and PP degrade at the same temperature in single steps and hence the thermal degradation behaviour of the composites is also being predictable. It is observed that the thermal behaviour of the matrix or reinforcement does not affect each other. Almost similar behaviour is observed in the case of nylon fibre/HDPE composites. Another equally significant factor is the nucleating effect of nylon fibre when the composite melt cools down. In the presence of the fibre the onset of crystallization occurs at slightly higher temperature.When the matrix is modified by grafting, the onset of crystallization occurs at still higher temperature. Hence it may be calculated that one reason for the improvement in mechanical behaviour of the composite is the difference in crystallization behaviour of the matrix in presence of the fibre.As mentioned earlier, a major advantage of these composites is their recyclability. Two basic approaches may be employed for recycling namely, low temperature recycling and high temperature recycling. In the low temperature recycling, the recycling is done at a temperature above the melting point of the matrix, but below that of the fibres while in the high temperature route. the recycling is done at a temperature above the melting points of both matrix and fibre. The former is particularly interesting in that the recycled material has equal or even better mechanical properties compared to the initial product. This is possible because the orientation of the fibre can improve with successive recycling. Hence such recycled composites can be used for the same applications for which the original composite was developed. In high temperature recycling, the composite is converted into a blend and hence the properties will be inferior to that of the original composite, but will be higher than that of the matrix material alone.

Information Discovery in Distributed Systems-A Novel Concept Based on Modelling of Information Elements

Sharing of information with those in need of it has always been an idealistic goal of networked environments. With the proliferation of computer networks, information is so widely distributed among systems, that it is imperative to have well-organized schemes for retrieval and also discovery. This thesis attempts to investigate the problems associated with such schemes and suggests a software architecture, which is aimed towards achieving a meaningful discovery. Usage of information elements as a modelling base for efficient information discovery in distributed systems is demonstrated with the aid of a novel conceptual entity called infotron.The investigations are focused on distributed systems and their associated problems. The study was directed towards identifying suitable software architecture and incorporating the same in an environment where information growth is phenomenal and a proper mechanism for carrying out information discovery becomes feasible. An empirical study undertaken with the aid of an election database of constituencies distributed geographically, provided the insights required. This is manifested in the Election Counting and Reporting Software (ECRS) System. ECRS system is a software system, which is essentially distributed in nature designed to prepare reports to district administrators about the election counting process and to generate other miscellaneous statutory reports.Most of the distributed systems of the nature of ECRS normally will possess a "fragile architecture" which would make them amenable to collapse, with the occurrence of minor faults. This is resolved with the help of the penta-tier architecture proposed, that contained five different technologies at different tiers of the architecture.The results of experiment conducted and its analysis show that such an architecture would help to maintain different components of the software intact in an impermeable manner from any internal or external faults. The architecture thus evolved needed a mechanism to support information processing and discovery. This necessitated the introduction of the noveI concept of infotrons. Further, when a computing machine has to perform any meaningful extraction of information, it is guided by what is termed an infotron dictionary.The other empirical study was to find out which of the two prominent markup languages namely HTML and XML, is best suited for the incorporation of infotrons. A comparative study of 200 documents in HTML and XML was undertaken. The result was in favor ofXML.The concept of infotron and that of infotron dictionary, which were developed, was applied to implement an Information Discovery System (IDS). IDS is essentially, a system, that starts with the infotron(s) supplied as clue(s), and results in brewing the information required to satisfy the need of the information discoverer by utilizing the documents available at its disposal (as information space). The various components of the system and their interaction follows the penta-tier architectural model and therefore can be considered fault-tolerant. IDS is generic in nature and therefore the characteristics and the specifications were drawn up accordingly. Many subsystems interacted with multiple infotron dictionaries that were maintained in the system.In order to demonstrate the working of the IDS and to discover the information without modification of a typical Library Information System (LIS), an Information Discovery in Library Information System (lDLIS) application was developed. IDLIS is essentially a wrapper for the LIS, which maintains all the databases of the library. The purpose was to demonstrate that the functionality of a legacy system could be enhanced with the augmentation of IDS leading to information discovery service. IDLIS demonstrates IDS in action. IDLIS proves that any legacy system could be augmented with IDS effectively to provide the additional functionality of information discovery service.Possible applications of IDS and scope for further research in the field are covered.