Bioethics’ Lack in Relation to Person-Centred User-Driven Health Systems Planning: A Call for Change

La tribune de l'éditeur / Editor's Soapbox

Essays on education and family planning

Le capital humain d’un pays est un facteur important de sa croissance et de son développement à long terme. Selon l’Unicef, ce capital humain est constitué en donnant à chaque enfant un bon départ dans la vie : non seule- ment la possibilité de survivre, mais aussi les conditions nécessaires pour se développer et réaliser tout son potentiel. Malheureusement, cet état de fait est loin d’être une réalité en Afrique Subsaharienne. En effet, selon toujours l’Unicef et sur la base d’enquêtes ménages dans 21 pays d’Afrique de l’Ouest et du Centre, c’est près de 32 millions d’enfants qui ont l’âge officiel d’être scolarisés, mais qui ne le sont pas. A ces chiffres, il faut ajouter 17 millions d’enfants scolarisés qui risquent fortement l’exclusion. De son Côté, l’OMS pointe du doigt la mauvaise santé des enfants dans cette région. Ainsi, les décès d’enfants sont de plus en plus concentrés en Afrique subsaharienne où les enfants ont plus de 15 fois plus de risques de mourir avant l’âge de cinq ans que les enfants des régions développées. Les difficultés économiques apparaissent comme la première explication des obstacles à l’amélioration du bien être des enfants aussi bien du côté de l’offre que de la demande. Cette thèse relie trois essais sur d’une part le lien entre conflit armés, l’éducation et la mortalité des enfants et d’autre part sur le lien entre fertilité et éducation des enfants en milieu urbain. Le premier chapitre identifie l’impact de la crise politico-militaire de la Côte d’Ivoire sur le bien être des enfants, en particulier sur l’éducation et la mor- talité infanto-juvénile en exploitant la variation temporelle et géographique de la crise. Il ressort de cette analyse que les individus qui vivaient dans les régions de conflit et qui ont atteint durant la crise, l’âge officiel d’entrer à l’école ont 10% moins de chance d’être inscrits à l’école. Les élèves qui habitaient dans des régions de conflit pendant la crise ont subit une diminu- tion du nombre d’années scolaire d’au moins une année. Les élèves les plus v vi âgés et qui sont susceptibles d’être au secondaire ont connu une décroissance du nombre d’année scolaire d’au moins deux années. Il ressort également que la crise ivoirienne a accru la mortalité infanto-juvénile d’au moins 3%. Mes résultats suggèrent également que la détérioration des conditions de vie et la limitation de l’utilisation des services de santé au cours du conflit con- tribuent à expliquer ces effets négatifs. Des tests de robustesse incluant un test de placebo suggèrent que les résultats ne sont pas dus à des différences préexistantes entre les régions affectées par le conflit et celles non affectées. Le deuxième chapitre étudie les disparités intra-urbaines en matière d’arbitrage entre le nombre d’enfant et la scolarisation des enfants en se focalisant sur le cas de Ouagadougou (Capitale du Burkina Faso). Dans cette ville, au moins 33% des deux millions d’habitants vivent dans des zones informelles (appelées localement des zones non-loties). Cette sous-population manque d’infrastructures socioéconomiques de base et a un niveau d’éducation très bas. Dans ce chapitre, prenant en compte la possible endogénéité du nombre d’enfants et en utilisant une approche "two-step control function" avec des modèles Probit, nous investiguons les différences de comportement des mé- nages en matière de scolarisation entre zones formelles et zones informelles. Nous nous focalisons en particulier sur l’arbitrage entre la "quantité" et la "qualité" des enfants. Compte tenu de l’hétérogénéité des deux types de zones, nous utilisons les probabilités prédites pour les comparer. Nos princi- pales conclusions sont les suivantes. Tout d’abord, nous trouvons un impact négatif de la taille de la famille sur le niveau de scolarisation dans les deux types de zone. Cependant, nous constatons que l’impact est plus aigu dans les zones informelles. Deuxièmement, si nous supposons que le caractère en- dogène du nombre d’enfants est essentiellement due à la causalité inverse, les résultats suggèrent que dans les zones formelles les parents tiennent compte de la scolarisation des enfants dans la décision de leur nombre d’enfants, mais ce ne est pas le cas dans les zones informelles. Enfin, nous constatons que, pour des familles avec les mêmes caractéristiques observables, la probabilité d’atteindre le niveau post-primaire est plus élevée dans les zones formelles que dans les zones informelles. En terme d’implications politique, selon ces résultats, les efforts pour améliorer la scolarisation des enfants ne doivent pas être dirigées uniquement vers les zones rurales. En plus de réduire les frais de scolarité dans certaines zones urbaines, en particulier les zones informelles, un accent particulier devrait être mis sur la sensibilisation sur les avantages de l’éducation pour le bien-être des enfants et leur famille. Enfin, du point vii de vue méthodologique, nos résultats montrent l’importance de tenir compte de l’hétérogénéité non observée entre les sous-populations dans l’explication des phénomènes socio-économiques. Compte tenu du lien négatif entre la taille de la famille et la scolarisation des enfants d’une part et les différences intra-urbaines de comportement des ménages en matière de scolarisation, le trosième chapitre étudie le rôle des types de méthodes contraceptives dans l’espacement des naissances en mi- lieu urbain. Ainsi, en distinguant les méthodes modernes et traditionnelles et en utilisant l’histoire génétique des femmes, ce chapitre fait ressortir des différences de comportement en matière de contraception entre les femmes des zones formelles et informelles à Ouagadougou (capitale du Burkina Faso). Les résultats montrent que les deux types de méthodes contraceptives aug- mentent l’écart des naissances et diminuent la probabilité qu’une naissance se produise moins de 24 mois après la précédente. Prendre en compte les caractéristiques non observées mais invariants avec le temps ne modifie pas significativement l’amplitude du coefficient de l’utilisation de la contracep- tion moderne dans les deux types de zone. Toutefois, dans la zone informelle, la prise en compte les effets fixes des femmes augmentent significativement l’effet des méthodes traditionnelles. Les normes sociales, la perception de la planification familiale et le rôle du partenaire de la femme pourraient expli- quer ces différences de comportement entre les zones formelles et informelles. Par conséquent, pour améliorer l’utilisation de la contraception et de leur efficacité, il est essentiel de hiérarchiser les actions en fonction du type de sous-population, même dans les zones urbaines.

Patient-specific model of a scoliotic torso for surgical planning

A method for the construction of a patient-specific model of a scoliotic torso for surgical planning via inter- patient registration is presented. Magnetic Resonance Images (MRI) of a generic model are registered to surface topography (TP) and X-ray data of a test patient. A partial model is first obtained via thin-plate spline registration between TP and X-ray data of the test patient. The MRIs from the generic model are then fit into the test patient using articulated model registration between the vertebrae of the generic model’s MRIs in prone position and the test patient’s X-rays in standing position. A non-rigid deformation of the soft tissues is performed using a modified thin-plate spline constrained to maintain bone rigidity and to fit in the space between the vertebrae and the surface of the torso. Results show average Dice values of 0.975 ± 0.012 between the MRIs following inter-patient registration and the surface topography of the test patient, which is comparable to the average value of 0.976 ± 0.009 previously obtained following intra-patient registration. The results also show a significant improvement compared to rigid inter-patient registration. Future work includes validating the method on a larger cohort of patients and incorporating soft tissue stiffness constraints. The method developed can be used to obtain a geometric model of a patient including bone structures, soft tissues and the surface of the torso which can be incorporated in a surgical simulator in order to better predict the outcome of scoliosis surgery, even if MRI data cannot be acquired for the patient.

Multimodal image registration of the scoliotic torso for surgical planning

Background This paper presents a method that registers MRIs acquired in prone position, with surface topography (TP) and X-ray reconstructions acquired in standing position, in order to obtain a 3D representation of a human torso incorporating the external surface, bone structures, and soft tissues. Methods TP and X-ray data are registered using landmarks. Bone structures are used to register each MRI slice using an articulated model, and the soft tissue is confined to the volume delimited by the trunk and bone surfaces using a constrained thin-plate spline. Results The method is tested on 3 pre-surgical patients with scoliosis and shows a significant improvement, qualitatively and using the Dice similarity coefficient, in fitting the MRI into the standing patient model when compared to rigid and articulated model registration. The determinant of the Jacobian of the registration deformation shows higher variations in the deformation in areas closer to the surface of the torso. Conclusions The novel, resulting 3D full torso model can provide a more complete representation of patient geometry to be incorporated in surgical simulators under development that aim at predicting the effect of scoliosis surgery on the external appearance of the patient’s torso.

Statistical model based 3D shape prediction of postoperative trunks for non-invasive scoliosis surgery planning

One of the major concerns of scoliosis patients undergoing surgical treatment is the aesthetic aspect of the surgery outcome. It would be useful to predict the postoperative appearance of the patient trunk in the course of a surgery planning process in order to take into account the expectations of the patient. In this paper, we propose to use least squares support vector regression for the prediction of the postoperative trunk 3D shape after spine surgery for adolescent idiopathic scoliosis. Five dimensionality reduction techniques used in conjunction with the support vector machine are compared. The methods are evaluated in terms of their accuracy, based on the leave-one-out cross-validation performed on a database of 141 cases. The results indicate that the 3D shape predictions using a dimensionality reduction obtained by simultaneous decomposition of the predictors and response variables have the best accuracy.

A physically based trunk soft tissue modeling for scoliosis surgery planning systems

One of the major concerns of scoliotic patients undergoing spinal correction surgery is the trunk's external appearance after the surgery. This paper presents a novel incremental approach for simulating postoperative trunk shape in scoliosis surgery. Preoperative and postoperative trunk shapes data were obtained using three-dimensional medical imaging techniques for seven patients with adolescent idiopathic scoliosis. Results of qualitative and quantitative evaluations, based on the comparison of the simulated and actual postoperative trunk surfaces, showed an adequate accuracy of the method. Our approach provides a candidate simulation tool to be used in a clinical environment for the surgery planning process.

Multimodal image fusion of anatomical structures for diagnosis, therapy planning and assistance

This paper provides an overview of work done in recent years by our research group to fuse multimodal images of the trunk of patients with Adolescent Idiopathic Scoliosis (AIS) treated at Sainte-Justine University Hospital Center (CHU). We first describe our surface acquisition system and introduce a set of clinical measurements (indices) based on the trunk's external shape, to quantify its degree of asymmetry. We then describe our 3D reconstruction system of the spine and rib cage from biplanar radiographs and present our methodology for multimodal fusion of MRI, X-ray and external surface images of the trunk We finally present a physical model of the human trunk including bone and soft tissue for the simulation of the surgical outcome on the external trunk shape in AIS.

A PVC plasticized membrane sensor for nickel ions

A new PVC membrane sensor, which is highly selective towards Ni (II) ions, has been developed using a thiophene-derivative Schiff base as the ionophore. The best performance was exhibited by the membrane having the composition percentage ratio of 5:3:61:31 (ionophore:NaTPB:DBP:PVC) (w=w), where NaTPB is the anion excluder, sodium tetraphenylborate and DBP is the plasticizing agent (dibutyl phthalate). The membrane exhibited a good Nernstian response for nickel ions over the concentration range of 1.0 10 1– 5.0 10 6M (limit of detection is 1.8 10 6 M) with a slope of 29.5 1.0mV per decade of activity. It has a fast response time of<20 s and can be used for a period of 4 months with good reproducibility. The sensor is suitable for use in aqueous solutions of a wide pH range of 3.2–7.9. The sensor shows high selectivity to nickel ions over a large number of mono-, bi- and trivalent cations. It has been successfully used as an indicator electrode in the potentiometric titration of nickel ions against EDTA and also for direct determination of nickel content in real samples – wastewater samples from electroplating industries and Indian chocolates.

A PVC Plasticized Membrane Sensor for Nickel Ions

A new PVC membrane sensor, which is highly selective towards Ni (II) ions, has been developed using a thiophene-derivative Schiff base as the ionophore. The best performance was exhibited by the membrane having the composition percentage ratio of 5:3:61:31 (ionophore:NaTPB:DBP:PVC) (w=w), where NaTPB is the anion excluder, sodium tetraphenylborate and DBP is the plasticizing agent (dibutyl phthalate). The membrane exhibited a good Nernstian response for nickel ions over the concentration range of 1.0 10 1– 5.0 10 6M (limit of detection is 1.8 10 6 M) with a slope of 29.5 1.0mV per decade of activity. It has a fast response time of<20 s and can be used for a period of 4 months with good reproducibility. The sensor is suitable for use in aqueous solutions of a wide pH range of 3.2–7.9. The sensor shows high selectivity to nickel ions over a large number of mono-, bi- and trivalent cations. It has been successfully used as an indicator electrode in the potentiometric titration of nickel ions against EDTA and also for direct determination of nickel content in real samples – wastewater samples from electroplating industries and Indian chocolates.

A PVC Plasticized Sensor for Ni(II) Ion Based on a Simple Ethylenediamine Derivative

new PVC membrane ion selective electrode which is highly selective towards Ni(II) ions was constructed using a Schiff base containing a binaphthyl moiety as the ionophore. The sensor exhibited a good Nernstian response for nickel ions over the concentration range 1.0 × 10–1 – 5.0 × 10–6 M with a lower limit of detection of 1.3 × 10–6 M. It has a fast response time and can be used for a period of 4 months with a good reproducibility. The sensor is suitable for use in aqueous solutions in a wide pH range of 3.6 – 7.4 and works satisfactorily in the presence of 25% (v/v) methanol or ethanol. The sensor shows high selectivity to nickel ions over a wide variety of cations. It has been successfully used as an indicator electrode in the potentiometric titration of nickel ions against EDTA and also for the direct determination of nickel content in real samples: effluent samples, chocolates and hydrogenated oils.

A Novel Potentiometric Sensor for the Determination of Nimesulide

A novel electrochemical sensor has been developed for the determination of nimesulide. The sensor is based on the NIM- molybdophosphoric acid (MPA) as the electroactive material in PVC matrix in presence of bis(2-ethyl hexyl) phthalate (BEP) as a plasticizer. The sensor showed a fast, stable, near Nernstian response for 1 × 10-2 –1 × 10-6 M NIM over the pH range 5 – 8 with a slope 55.6 ±0.5m V/decade and the response time is < 45 s. Selectivity coefficient data for some common ions show negligible interferences. The sensor was successfully applied for the determination of NIM in tablet and the results obtained are in good agreement with those obtained by the official method.

Economics of Human Resource Planning With Special Reference to Higher Education in Kerala

Ongoing changes in global economic structure along information revolution have produced an environment where knowledge and skills or education and training are considered increasingly valued commodities. This is based on the simple notion that nation’s economic progress is linked to education and training. This idea is embodied in the theory of human capital, according to which the knowledge and skill found in labour represents valuable resources for the market. Thus the important assumptions of the Human capital theory are 910 Human capital is an investment for future (2) More training and education leads to better work skills (3) Educational institutions play a central role in the development of human capital(4) the technological revolution is often cited as the most pressing reason why education and knowledge are becoming valuable economic commodities . The objectives of the present study are, the investment and institutional or structural framework of higher education in Kerala, the higher education market and the strengths and weakness of supply demand conditions , cost and the benefits of higher education in Kerala , impact of recent policy changes in higher education,need for expanding higher education market to solve the grave problem of Un employment on the basis of as systematic manpower planning and the higher education and its association with income and employment.

A fibre optic evanescent wave sensor for monitoring the rate of pulsed laser deposition of metal thin films

A novel sensing technique for the in situ monitoring of the rate of pulsed laser deposition (PLD) of metal thin films has been developed. This optical fibre based sensor works on the principle of the evanescent wave penetration of waveguide modes into the uncladded portion of a multimode fibre. The utility of this optical fibre sensor is demonstrated in the case of PLD of silver thin films obtained by a Q-switched Nd:YAG laser which is used to irradiate a silver target at the required conditions for the preparation of thin films. This paper describes the performance and characteristics of the sensor and shows how the device can be used as an effective tool for the monitoring of the deposition rate of silver thin films. The fibre optic sensor is very simple, inexpensive and highly sensitive compared with existing techniques for thin film deposition rate measurements

A fibre optic evanescent wave sensor for monitoring the rate of pulsed laser deposition of metal thin films

A novel sensing technique for the in situ monitoring of the rate of pulsed laser deposition (PLD) of metal thin films has been developed. This optical fibre based sensor works on the principle of the evanescent wave penetration of waveguide modes into the uncladded portion of a multimode fibre. The utility of this optical fibre sensor is demonstrated in the case of PLD of silver thin films obtained by a Q-switched Nd:YAG laser which is used to irradiate a silver target at the required conditions for the preparation of thin films. This paper describes the performance and characteristics of the sensor and shows how the device can be used as an effective tool for the monitoring of the deposition rate of silver thin films. The fibre optic sensor is very simple, inexpensive and highly sensitive compared with existing techniques for thin film deposition rate measurements.