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.

Reliability of a quantitative clinical posture assessment tool among persons with idiopathic scoliosis

Objective To determine overall, test–retest and inter-rater reliability of posture indices among persons with idiopathic scoliosis. Design A reliability study using two raters and two test sessions. Setting Tertiary care paediatric centre. Participants Seventy participants aged between 10 and 20 years with different types of idiopathic scoliosis (Cobb angle 15 to 60°) were recruited from the scoliosis clinic. Main outcome measures Based on the XY co-ordinates of natural reference points (e.g. eyes) as well as markers placed on several anatomical landmarks, 32 angular and linear posture indices taken from digital photographs in the standing position were calculated from a specially developed software program. Generalisability theory served to estimate the reliability and standard error of measurement (SEM) for the overall, test–retest and inter-rater designs. Bland and Altman's method was also used to document agreement between sessions and raters. Results In the random design, dependability coefficients demonstrated a moderate level of reliability for six posture indices (ϕ = 0.51 to 0.72) and a good level of reliability for 26 posture indices out of 32 (ϕ ≥ 0.79). Error attributable to marker placement was negligible for most indices. Limits of agreement and SEM values were larger for shoulder protraction, trunk list, Q angle, cervical lordosis and scoliosis angles. The most reproducible indices were waist angles and knee valgus and varus. Conclusions Posture can be assessed in a global fashion from photographs in persons with idiopathic scoliosis. Despite the good reliability of marker placement, other studies are needed to minimise measurement errors in order to provide a suitable tool for monitoring change in posture over time.

Theoretical Studies on Air Pollution Meteorology in South India

Man's inadvertent interference with the environment by way of indiscreL¢ industrflflization has led to the deteriorating air quality in the recent times. The search is on to find the remedies to confine the air pollution levels with in their thershold limits. Theoretical studies play A crucial role in the control and for abatment of air pollution. Improper siting of industry is one of the most common reasons for the increased levels of air pollution in urban environments. A proper and effective ecological planning is an essential first step for any region in order to reduce the effects of air pollution. By means of theoretical models one can obtain the pollutant distribution in any urban area, provided the necessary data are available with the help of which the sites for new industries could be suggested, given the emission inventory. Studies on air pollution meteorology serve and aid the planners to initate remedial actions to bring down the levels of pollution and also to out—line the control strategy. In the present thesis some theoretical studies on air pollution meteorology over South India are made. The thesis is divided into six chapters

Polyphase Implementation of Non-recursive Comb Decimators for Sigma-Delta A/D Converters

In a sigma-delta analog to digital (A/D) As most of the sigma-delta ADC applications require converter, the most computationally intensive block is decimation filters with linear phase characteristics, the decimation filter and its hardware implementation symmetric Finite Impulse Response (FIR) filters are may require millions of transistors. Since these widely used for implementation. But the number of FIR converters are now targeted for a portable application, filter coefficients will be quite large for implementing a a hardware efficient design is an implicit requirement. narrow band decimation filter. Implementing decimation In this effect, this paper presents a computationally filter in several stages reduces the total number of filter efficient polyphase implementation of non-recursive coefficients, and hence reduces the hardware complexity cascaded integrator comb (CIC) decimators for and power consumption [2]. Sigma-Delta Converters (SDCs). The SDCs are The first stage of decimation filter can be operating at high oversampling frequencies and hence implemented very efficiently using a cascade of integrators require large sampling rate conversions. The filtering and comb filters which do not require multiplication or and rate reduction are performed in several stages to coefficient storage. The remaining filtering is performed reduce hardware complexity and power dissipation. either in single stage or in two stages with more complex The CIC filters are widely adopted as the first stage of FIR or infinite impulse response (IIR) filters according to decimation due to its multiplier free structure. In this the requirements. The amount of passband aliasing or research, the performance of polyphase structure is imaging error can be brought within prescribed bounds by compared with the CICs using recursive and increasing the number of stages in the CIC filter. The non-recursive algorithms in terms of power, speed and width of the passband and the frequency characteristics area. This polyphase implementation offers high speed outside the passband are severely limited. So, CIC filters operation and low power consumption. The polyphase are used to make the transition between high and low implementation of 4th order CIC filter with a sampling rates. Conventional filters operating at low decimation factor of '64' and input word length of sampling rate are used to attain the required transition '4-bits' offers about 70% and 37% of power saving bandwidth and stopband attenuation. compared to the corresponding recursive and Several papers are available in literature that deals non-recursive implementations respectively. The same with different implementations of decimation filter polyphase CIC filter can operate about 7 times faster architecture for sigma-delta ADCs. Hogenauer has than the recursive and about 3.7 times faster than the described the design procedures for decimation and non-recursive CIC filters.

Wideband Low-Distortion Sigma-Delta ADC for WLAN

This work presents a wideband low-distortion sigmadelta analog-to-digital converter (ADC) for Wireless Local Area Network (WLAN) standard. The proposed converter makes use of low-distortion swing suppression SDM architecture which is highly suitable for low oversampling ratios to attain high linearity over a wide bandwidth. The modulator employs a 2-2 cascaded sigma-delta modulator with feedforward path with a single-bit quantizer in the first stage and 4-bit in the second stage. The modulator is designed in TSMC 0.18um CMOS technology and operates at 1.8V supply voltage. Simulation results show that, a peak SNDR of 57dB and a spurious free dynamic range (SFDR) of 66dB is obtained for a 10MHz signal bandwidth, and an oversampling ratio of 8.

A Multi-Mode Sigma-Delta ADC for GSM/WCDMA/ WLAN Applications

The demand for new telecommunication services requiring higher capacities, data rates and different operating modes have motivated the development of new generation multi-standard wireless transceivers. In multistandard design, sigma-delta based ADC is one of the most popular choices. To this end, in this paper we present cascaded 2-2-2 reconfigurable sigma-delta modulator that can handle GSM, WCDMA and WLAN standards. The modulator makes use of a low-distortion swing suppression topology which is highly suitable for wide band applications. In GSM mode, only the first stage (2nd order Σ-Δ ADC) is used to achieve a peak SNDR of 88dB with oversampling ratio of 160 for a bandwidth of 200KHz and for WCDMA mode a 2-2 cascaded structure (4th order) is turned on with 1-bit in the first stage and 2-bit in the second stage to achieve 74 dB peak SNDR with over-sampling ratio of 16 for a bandwidth of 2MHz. Finally, a 2-2-2 cascaded MASH architecture with 4-bit in the last stage is proposed to achieve a peak SNDR of 58dB for WLAN for a bandwidth of 20MHz. The novelty lies in the fact that unused blocks of second and third stages can be made inactive to achieve low power consumption. The modulator is designed in TSMC 0.18um CMOS technology and operates at 1.8 supply voltage

A Triple-mode Sigma-delta Modulator Design for Wireless Standards

This work presents a triple-mode sigma-delta modulator for three wireless standards namely GSM/WCDMA and Bluetooth. A reconfigurable ADC has been used to meet the wide bandwidth and high dynamic range requirements of the multi-standard receivers with less power consumption. A highly linear sigma-delta ADC which has reduced sensitivity to circuit imperfections has been chosen in our design. This is particularly suitable for wide band applications where the oversampling ratio is low. Simulation results indicate that the modulator achieves a peak SNDR of 84/68/68 dB over a bandwidth of 0.2/3.84/1.5 MHz with an oversampling ratio 128/8/8 in GSM/WCDMA/Bluetooth modes respectively

GA-based Optimization of a Fourth-order Sigma-delta Modulator for WLAN

Over-sampling sigma-delta analogue-to-digital converters (ADCs) are one of the key building blocks of state of the art wireless transceivers. In the sigma-delta modulator design the scaling coefficients determine the overall signal-to-noise ratio. Therefore, selecting the optimum value of the coefficient is very important. To this end, this paper addresses the design of a fourthorder multi-bit sigma-delta modulator for Wireless Local Area Networks (WLAN) receiver with feed-forward path and the optimum coefficients are selected using genetic algorithm (GA)- based search method. In particular, the proposed converter makes use of low-distortion swing suppression SDM architecture which is highly suitable for low oversampling ratios to attain high linearity over a wide bandwidth. The focus of this paper is the identification of the best coefficients suitable for the proposed topology as well as the optimization of a set of system parameters in order to achieve the desired signal-to-noise ratio. GA-based search engine is a stochastic search method which can find the optimum solution within the given constraints.

A Triple-Mode Feed-Forward Sigma-Delta Modulator Design For Gsm / Wcdma / Wlan Applications

This paper presents a cascaded 2-2-2 reconfigurable sigma-delta modulator that can handle GSM, WCDMA and WLAN standards. The modulator makes use of a low-distortion swing suppression topology which is highly suitable for wide band applications. In GSM mode, only the first stage (2nd order Σ-Δ ADC) is turned on to achieve 88dB dynamic range with oversampling ratio of 160 for a bandwidth of 200KHz; in WCDMA mode a 2-2 cascaded structure (4th order) is turned on with 1-bit in the first stage and 2-bit in the second stage to achieve 74 dB dynamic range with oversampling ratio of 16 for a bandwidth of 2MHz and a 2-2-2 cascaded MASH architecture with a 4-bit in the last stage to achieve a dynamic range of 58dB for a bandwidth of 20MHz. The novelty lies in the fact that unused blocks of second and third stages can be switched off taking into considerations like power consumption. The modulator is designed in TSMC 0.18um CMOS technology and operates at 1.8 supply voltage.

Synthesis, Characterization and Applications of Modified TiO2 Systems

This thesis is divided in to 9 chapters and deals with the modification of TiO2 for various applications include photocatalysis, thermal reaction, photovoltaics and non-linear optics. Chapter 1 involves a brief introduction of the topic of study. An introduction to the applications of modified titania systems in various fields are discussed concisely. Scope and objectives of the present work are also discussed in this chapter. Chapter 2 explains the strategy adopted for the synthesis of metal, nonmetal co-doped TiO2 systems. Hydrothermal technique was employed for the preparation of the co-doped TiO2 system, where Ti[OCH(CH3)2]4, urea and metal nitrates were used as the sources for TiO2, N and metals respectively. In all the co-doped systems, urea to Ti[OCH(CH3)2]4 was taken in a 1:1 molar ratio and varied the concentration of metals. Five different co-doped catalytic systems and for each catalysts, three versions were prepared by varying the concentration of metals. A brief explanation of physico-chemical techniques used for the characterization of the material was also presented in this chapter. This includes X-ray Diffraction (XRD), Raman Spectroscopy, FTIR analysis, Thermo Gravimetric Analysis, Energy Dispersive X-ray Analysis (EDX), Scanning Electron Microscopy(SEM), UV-Visible Diffuse Reflectance Spectroscopy (UV-Vis DRS), Transmission Electron Microscopy (TEM), BET Surface Area Measurements and X-ray Photoelectron Spectroscopy (XPS). Chapter 3 contains the results and discussion of characterization techniques used for analyzing the prepared systems. Characterization is an inevitable part of materials research. Determination of physico-chemical properties of the prepared materials using suitable characterization techniques is very crucial to find its exact field of application. It is clear from the XRD pattern that photocatalytically active anatase phase dominates in the calcined samples with peaks at 2θ values around 25.4°, 38°, 48.1°, 55.2° and 62.7° corresponding to (101), (004), (200), (211) and (204) crystal planes (JCPDS 21-1272) respectively. But in the case of Pr-N-Ti sample, a new peak was observed at 2θ = 30.8° corresponding to the (121) plane of the polymorph brookite. There are no visible peaks corresponding to dopants, which may be due to their low concentration or it is an indication of the better dispersion of impurities in the TiO2. Crystallite size of the sample was calculated from Scherrer equation byusing full width at half maximum (FWHM) of the (101) peak of the anatase phase. Crystallite size of all the co-doped TiO2 was found to be lower than that of bare TiO2 which indicates that the doping of metal ions having higher ionic radius into the lattice of TiO2 causes some lattice distortion which suppress the growth of TiO2 nanoparticles. The structural identity of the prepared system obtained from XRD pattern is further confirmed by Raman spectra measurements. Anatase has six Raman active modes. Band gap of the co-doped system was calculated using Kubelka-Munk equation and that was found to be lower than pure TiO2. Stability of the prepared systems was understood from thermo gravimetric analysis. FT-IR was performed to understand the functional groups as well as to study the surface changes occurred during modification. EDX was used to determine the impurities present in the system. The EDX spectra of all the co-doped samples show signals directly related to the dopants. Spectra of all the co-doped systems contain O and Ti as the main components with low concentrations of doped elements. Morphologies of the prepared systems were obtained from SEM and TEM analysis. Average particle size of the systems was drawn from histogram data. Electronic structures of the samples were identified perfectly from XPS measurements. Chapter 4 describes the photocatalytic degradation of herbicides Atrazine and Metolachlor using metal, non-metal co-doped titania systems. The percentage of degradation was analyzed by HPLC technique. Parameters such as effect of different catalysts, effect of time, effect of catalysts amount and reusability studies were discussed. Chapter 5 deals with the photo-oxidation of some anthracene derivatives by co-doped catalytic systems. These anthracene derivatives come underthe category of polycyclic aromatic hydrocarbons (PAH). Due to the presence of stable benzene rings, most of the PAH show strong inhibition towards biological degradation and the common methods employed for their removal. According to environmental protection agency, most of the PAH are highly toxic in nature. TiO2 photochemistry has been extensively investigated as a method for the catalytic conversion of such organic compounds, highlighting the potential of thereof in the green chemistry. There are actually two methods for the removal of pollutants from the ecosystem. Complete mineralization is the one way to remove pollutants. Conversion of toxic compounds to another compound having toxicity less than the initial starting compound is the second way. Here in this chapter, we are concentrating on the second aspect. The catalysts used were Gd(1wt%)-N-Ti, Pd(1wt%)-N-Ti and Ag(1wt%)-N-Ti. Here we were very successfully converted all the PAH to anthraquinone, a compound having diverse applications in industrial as well as medical fields. Substitution of 10th position of desired PAH by phenyl ring reduces the feasibility of photo reaction and produced 9-hydroxy 9-phenyl anthrone (9H9PA) as an intermediate species. The products were separated and purified by column chromatography using 70:30 hexane/DCM mixtures as the mobile phase and the resultant products were characterized thoroughly by 1H NMR, IR spectroscopy and GCMS analysis. Chapter 6 elucidates the heterogeneous Suzuki coupling reaction by Cu/Pd bimetallic supported on TiO2. Sol-Gel followed by impregnation method was adopted for the synthesis of Cu/Pd-TiO2. The prepared system was characterized by XRD, TG-DTG, SEM, EDX, BET Surface area and XPS. The product was separated and purified by column chromatography using hexane as the mobile phase. Maximum isolated yield of biphenyl of around72% was obtained in DMF using Cu(2wt%)-Pd(4wt%)-Ti as the catalyst. In this reaction, effective solvent, base and catalyst were found to be DMF, K2CO3 and Cu(2wt%)-Pd(4wt%)-Ti respectively. Chapter 7 gives an idea about the photovoltaic (PV) applications of TiO2 based thin films. Due to energy crisis, the whole world is looking for a new sustainable energy source. Harnessing solar energy is one of the most promising ways to tackle this issue. The present dominant photovoltaic (PV) technologies are based on inorganic materials. But the high material, low power conversion efficiency and manufacturing cost limits its popularization. A lot of research has been conducted towards the development of low-cost PV technologies, of which organic photovoltaic (OPV) devices are one of the promising. Here two TiO2 thin films having different thickness were prepared by spin coating technique. The prepared films were characterized by XRD, AFM and conductivity measurements. The thickness of the films was measured by Stylus Profiler. This chapter mainly concentrated on the fabrication of an inverted hetero junction solar cell using conducting polymer MEH-PPV as photo active layer. Here TiO2 was used as the electron transport layer. Thin films of MEH-PPV were also prepared using spin coating technique. Two fullerene derivatives such as PCBM and ICBA were introduced into the device in order to improve the power conversion efficiency. Effective charge transfer between the conducting polymer and ICBA were understood from fluorescence quenching studies. The fabricated Inverted hetero junction exhibited maximum power conversion efficiency of 0.22% with ICBA as the acceptor molecule. Chapter 8 narrates the third order order nonlinear optical properties of bare and noble metal modified TiO2 thin films. Thin films were fabricatedby spray pyrolysis technique. Sol-Gel derived Ti[OCH(CH3)2]4 in CH3CH2OH/CH3COOH was used as the precursor for TiO2. The precursors used for Au, Ag and Pd were the aqueous solutions of HAuCl4, AgNO3 and Pd(NO3)2 respectively. The prepared films were characterized by XRD, SEM and EDX. The nonlinear optical properties of the prepared materials were investigated by Z-Scan technique comprising of Nd-YAG laser (532 nm,7 ns and10 Hz). The non-linear coefficients were obtained by fitting the experimental Z-Scan plot with the theoretical plots. Nonlinear absorption is a phenomenon defined as a nonlinear change (increase or decrease) in absorption with increasing of intensity. This can be mainly divided into two types: saturable absorption (SA) and reverse saturable absorption (RSA). Depending on the pump intensity and on the absorption cross- section at the excitation wavelength, most molecules show non- linear absorption. With increasing intensity, if the excited states show saturation owing to their long lifetimes, the transmission will show SA characteristics. Here absorption decreases with increase of intensity. If, however, the excited state has strong absorption compared with that of the ground state, the transmission will show RSA characteristics. Here in our work most of the materials show SA behavior and some materials exhibited RSA behavior. Both these properties purely depend on the nature of the materials and alignment of energy states within them. Both these SA and RSA have got immense applications in electronic devices. The important results obtained from various studies are presented in chapter 9.

A generic polynomial solution for the differential equation of hypergeometric type and six sequences of orthogonal polynomials related to it

In this work, we present a generic formula for the polynomial solution families of the well-known differential equation of hypergeometric type s(x)y"n(x) + t(x)y'n(x) - lnyn(x) = 0 and show that all the three classical orthogonal polynomial families as well as three finite orthogonal polynomial families, extracted from this equation, can be identified as special cases of this derived polynomial sequence. Some general properties of this sequence are also given.

{2p_\pi}-{2p_\sigma} crossing in heavy symmetric ion-atom collisions: I. Level structure

Ab initio self-consistent DFS calculations are performed for five different symmetric atomic systems from Ar-Ar to Pb-Pb. The level structure for the {2p_\pi}-{2p_\sigma} crossing as function of the united atomic charge Z_u is studied and interpreted. Manybody effects, spin-orbit splitting, direct relativistic effects as well as indirect relativistic effects are differently important for different Z_u. For the I-I system a comparison with other calculations is given.

New calculations of P(b) curves for 1s_\sigma excitation in low-Z (Z\le10) ion-atom scattering

Ab initio fully relativistic SCF molecular calculations of energy eigenvalues as well as coupling-matrix elements are used to calculate the 1s_\sigma excitation differential cross section for Ne-Ne and Ne-O in ion-atom collisions. A relativistic perturbation treatment which allows a direct comparison with analogous non-relativistic calculations is also performed.