Advances in therapeutic risk management through signal detection and risk minimisation tool analyses

Les quatre principales activités de la gestion de risque thérapeutique comportent l’identification, l’évaluation, la minimisation, et la communication du risque. Ce mémoire aborde les problématiques liées à l’identification et à la minimisation du risque par la réalisation de deux études dont les objectifs sont de: 1) Développer et valider un outil de « data mining » pour la détection des signaux à partir des banques de données de soins de santé du Québec; 2) Effectuer une revue systématique afin de caractériser les interventions de minimisation de risque (IMR) ayant été implantées. L’outil de détection de signaux repose sur la méthode analytique du quotient séquentiel de probabilité (MaxSPRT) en utilisant des données de médicaments délivrés et de soins médicaux recueillis dans une cohorte rétrospective de 87 389 personnes âgées vivant à domicile et membres du régime d’assurance maladie du Québec entre les années 2000 et 2009. Quatre associations « médicament-événement indésirable (EI) » connues et deux contrôles « négatifs » ont été utilisés. La revue systématique a été faite à partir d’une revue de la littérature ainsi que des sites web de six principales agences réglementaires. La nature des RMIs ont été décrites et des lacunes de leur implémentation ont été soulevées. La méthode analytique a mené à la détection de signaux dans l'une des quatre combinaisons médicament-EI. Les principales contributions sont: a) Le premier outil de détection de signaux à partir des banques de données administratives canadiennes; b) Contributions méthodologiques par la prise en compte de l'effet de déplétion des sujets à risque et le contrôle pour l'état de santé du patient. La revue a identifié 119 IMRs dans la littérature et 1,112 IMRs dans les sites web des agences réglementaires. La revue a démontré qu’il existe une augmentation des IMRs depuis l’introduction des guides réglementaires en 2005 mais leur efficacité demeure peu démontrée.

A virtual reality approach to the study of visually driven postural control in developing and aging humans

L'être humain utilise trois systèmes sensoriels distincts pour réguler le maintien de la station debout: la somesthésie, le système vestibulaire, et le système visuel. Le rôle de la vision dans la régulation posturale demeure peu connu, notamment sa variabilité en fonction de l'âge, du type développemental, et des atteintes neurologiques. Dans notre travail, la régulation posturale induite visuellement a été évaluée chez des participants au développement et vieillissement normaux âgés de 5-85 ans, chez des individus autistes (développement atypique) âgés de 12-33 ans, ainsi que chez des enfants entre 9-18 ans ayant subi un TCC léger. À cet effet, la réactivité posturale des participants en réponse à un tunnel virtuel entièrement immersif, se mouvant à trois niveaux de vélocité, a été mesurée; des conditions contrôles, où le tunnel était statique ou absent, ont été incluses. Les résultats montrent que la réactivité (i.e. instabilité) posturale induite visuellement est plus élevée chez les jeunes enfants; ensuite, elle s'atténue pour rejoindre des valeurs adultes vers 16-19 ans et augmente de façon linéaire en fonction de l'âge après 45 ans jusqu'à redevenir élevée vers 60 ans. De plus, à la plus haute vélocité du tunnel, les plus jeunes participants autistes ont manifesté significativement moins de réactivité posturale comparativement à leurs contrôles; cette différence n'était pas présente chez des participants plus âgés (16-33 ans). Enfin, les enfants ayant subi un TCC léger, et qui étaient initialement modérément symptomatiques, ont montré un niveau plus élevé d'instabilité posturale induite visuellement que les contrôles, et ce jusqu'à 12 semaines post-trauma malgré le fait que la majorité d'entre eux (89%) n'étaient plus symptomatiques à ce stade. En somme, cela suggère la présence d'une importante période de transition dans la maturation des systèmes sous-tendant l'intégration sensorimotrice impliquée dans le contrôle postural vers l'âge de 16 ans, et d'autres changements sensorimoteurs vers l'âge de 60 ans; cette sur-dépendance visuelle pour la régulation posturale chez les enfants et les aînés pourrait guider l'aménagement d'espaces et l'élaboration d'activités ajustés à l'âge des individus. De plus, le fait que l'hypo-réactivité posturale aux informations visuelles chez les autistes dépende des caractéristiques de l'environnement visuel et de l'âge chronologique, affine notre compréhension des anomalies sensorielles propres à l'autisme. Par ailleurs, le fait que les enfants ayant subi un TCC léger montrent des anomalies posturales jusqu'à 3 mois post-trauma, malgré une diminution significative des symptômes rapportés, pourrait être relié à une altération du traitement de l'information visuelle dynamique et pourrait avoir des implications quant à la gestion clinique des patients aux prises avec un TCC léger, puisque la résolution des symptômes est actuellement le principal critère utilisé pour la prise de décision quant au retour aux activités. Enfin, les résultats obtenus chez une population à développement atypique (autisme) et une population avec atteinte neurologique dite transitoire (TCC léger), contribuent non seulement à une meilleure compréhension des mécanismes d'intégration sensorimotrice sous-tendant le contrôle postural mais pourraient aussi servir comme marqueurs sensibles et spécifiques de dysfonction chez ces populations. Mots-clés : posture, équilibre, vision, développement/vieillissement sensorimoteur, autisme, TCC léger symptomatique, réalité virtuelle.

Antibody Based Diagnostic for Detection Of Vibrios and their Biological Control using Antagonistic Bacteria in Macrobrachium Rosenbergii Larval Rearing Systems

The main objective of the work undertaken here was to develop an appropriate microbial technology to protect the larvae of M.rosenbergii in hatchery from vibriosis. This technology precisely is consisted of a rapid detection system of vibrios and effective antagonistic probiotics for the management of vibrios. The present work was undertaken with the realizations that to stabilize the production process of commercial hatcheries an appropriate, comprehensive and fool proof technology is required primarily for the rapid detection of Vibrio and subsequently for its management. Nine species of Vibrio have been found to be associated with larvae of M. rosenbergii in hatchery. Haemolytic assay of the Vibrio and Aeromonas on prawn blood agar showed that all isolates of V. alginolyticus and Aeromonas sp., from moribund, necrotized larve were haemolytic and the isolates of V.cholerae, V.splendidus II, V.proteolyticus and V.fluvialis from the larvae obtained from apparently healthy larval rearing systems were non-haemolytic. Hydrolytic enzymes such as lipase, chitinase and gelatinase were widespread amongst the Vibrio and Aeromonas isolates. Dominance of V.alginolyticus among the isolates from necrotic larvae and the failure in isolating them from rearing water strongly suggest that they infect larvae and multiply in the larval body and cause mortality in the hatchery. The observation suggested that the isolate V. alginolyticus was a pathogen to the larvae of M.rosenbergii. To sum up, through this work, nine species of Vibrio and genus Aeromonas associated with M.rosenbergii larval rearing systems could be isolated and segregated based on the haemolytic activity and the antibodies (PA bs) for use in diagnosis or epidemiological studies could be produced, based on a virulent culture of V.alginolyticus. This could possibly replace the conventional biochemical tests for identification. As prophylaxis to vibriosis, four isolates of Micrococcus spp. and an isolate of Pseudomonas sp. could be obtained which could possibly be used as antagonistic probiotics in the larval rearing system of M.rosenbergii.

Neurotransmitters Functional Balance in Neurodegenerative Disease Management:recent Advances

The recent developments in neurobiology have rendered new prominence and potential to study about the structure and function of brain and related disorders. Human behaviour is the net result of neural control of the communication between brain cells. Neurotransmitters are chemicals that are used to relay, amplify and modulate electrical signals between neurons and/or another cell. It mediates rapid intercellular communication through the nervous system by interacting with cell surface receptors. These receptors often trigger second messenger signaling pathways that regulate the activity of ion channels. The functional balance of different neurotransmitters such as Acetylcholine (Ach), Dopamine (DA), Serotonin (5-HT), Norepinephrine (NE), Epinephrine (EPI), Glutamate and Gamma amino butyric acid (GABA) regulates the growth, division and other vital functions of a normal cell / organism (Sudha, 1998). Any change in neurotransmitters' functional balance will result in the failure of cell function and may lead to the occurrence of diseases. Abnormalities in the production or functioning of neurotransmitters have been implicated in a number of neurological disorders like Schizophrenia, Alzheimer's, Epilepsy, Depression and Parkinson's disease. Changes in central and peripheral neuronal signaling system is also noted in diabetes, cancer, cell proliferation, alcoholism and aging. Elucidation of neurotransmitters receptor interaction pathways and gene expression regulation by second messengers and transcriptional factors in health and disease conditions can lead to new small molecules for development of therapeutic agents to improve neurological disease conditions. Increased awareness of the global effects of neurological disorders should help health care planners and the neurological community set appropriate priorities in research, prevention, and management of these diseases.

Development of Safety and Quality Management System in Shrimp Farming

Shrimp Aquaculture has provided tremendous opportunity for the economic and social upliftment of rural communities in the coastal areas of our country Over a hundred thousand farmers, of whom about 90% belong to the small and marginal category, are engaged in shrimp farming. Penaeus monodon is the most predominant cultured species in India which is mainly exported to highly sophisticated, quality and safety conscious world markets. Food safety has been of concem to humankind since the dawn of history and the concern about food safety resulted in the evolution of a cost effective, food safety assurance method, the Hazard Analysis Critical Control Point (HACCP). Considering the major contribution of cultured Penaeus monodon to the total shrimp production and the economic losses encountered due to disease outbreak and also because traditional methods of quality control and end point inspection cannot guarantee the safety of our cultured seafood products, it is essential that science based preventive approaches like HACCP and Pre requisite Programmes (PRP) be implemented in our shrimp farming operations. PRP is considered as a support system which provides a solid foundation for HACCP. The safety of postlarvae (PL) supplied for brackish water shrimp farming has also become an issue of concern over the past few years. The quality and safety of hatchery produced seeds have been deteriorating and disease outbreaks have become very common in hatcheries. It is in this context that the necessity for following strict quarantine measures with standards and code of practices becomes significant. Though there were a lot of hue and cry on the need for extending the focus of seafood safety assurance from processing and exporting to the pre-harvest and hatchery rearing phases, an experimental move in this direction has been rare or nil. An integrated management system only can assure the effective control of the quality, hygiene and safety related issues. This study therefore aims at designing a safety and quality management system model for implementation in shrimp farming and hatchery operations by linking the concepts of HACCP and PRP.

Legal Control of Fishing Industry in Kerala

This work is a study on ‘Legal Control of Fishing Industry in Kerala.Fishery and Fishery-related legislations are sought to be examined in the light of scientific opinion and judicial decisionsThis work is divided into five Part.The thrust of time Study is on the success of legislative measures in attempting to achieve socio-economic justice for the fishermen community.Fishing is more an avocation than an industry. It is basically the avocation of the artisanal or traditional fishermen who depend on it for their livelihood. As an ‘industry’, it is a generator of employment, income and wealth.The modern tendency in national legislations is to integrate legal proivisions relating to EEZ fisheries into the general fisheries legislation.Chartered fishing was introduced by the Central Government during 1977-78 to establish the abundance and distribution of fishery resources in Indian EEZ, for transfer of technology and for related purposes.Going by the provisions of Articles 61 and 62 of the U.N. Convention on the Law of the Sea, 1982, foreign fishing need be permitted in our EEZ area only if there is any surplus left after meeting our national requirements.Conservation of the renewable fishery resources should start with identification of the species, their habitats, feeding and breeding patterns, their classification and characteristics. Fishing patterns and their impact on different species and areas require to be examined and investigated.the Central Government, that the Kerala Marine Fishing Regulation Act, 1980 was passed.our traditional fishermen that our Governments in power in Kerala resorted to the appointment of Commissions after Commissions to enquire into the problems of resource management and conservation of the resources. The implementation of the recommendations of these Commissions is the need of the times.General infrastructure has increased to a certain extent in the fishery villages; but it is more the result of the development efforts of the State rather than due to increase in earnings from fishing. Fisherwomen ar e still unable to enjoy the status and role expected of them in the society and the family.Around 120 million people around the tuorld are economically dependent on fisheries. In developing countries like India, small-scale fishers are also the primary suppliers of fish, particularly for local consumption. A most important role of the fisheries sector is as a source of domestically produced food. Fish, as a food item, is a nutrient and it has great medicinal value.Consumers in our country face a dramatic rise in fish prices as our ‘fishing industry’ is linked with lucrative markets in industrial countries. Autonomy of States should be attempted to be maintained to the extent possible with the help and co-operation of the Centre. Regional co-operation of the coastal states interse and with the Centre should be attempted to be achieved under the leadership of the Centre in matters of regional concern. At time national level, a ifisheries management policy and plan should be framed in conformity with the national economic policies and plans as also keeping pace with the local and regional needs and priorities. Any such policy, plan and legislation should strive to achieve sustainability of the resources as well as support to the subsistence sector.

A study on community participation in disease control programmes, with references to control of filariasis in Alappuzha District

This thesis throws light on the influence of community in the social life of mankind. The study revolves round the fact that health care is by the people rather than health care is for the people. The thesis tries to analyze the role of community organizational social agencies in the control of Filariasis.The study examines the factors which influence community participation. and the effectiveness of health education in the control of Filariasis.the thesis emphasizes the effective tools and means of health education That helps to To evolve an appropriate method for the management of community Participation. The study shows that. A well informed community can participate successfully and meaningfully in disease control programmes.

Development of Total Quality Management System in Seafood (Freezing) Industry in Kerala

Quality related problems have become dominant in the seafood processing industry in Kerala. This has resulted in the rejection of seafood sent from India to many destinations. The latest being the total block listing of seafood companies from India from being exported to Europe and partial block listing by the US. The quality systems prevailed in the seafood industry in India were outdated and no longer in use in the developed world. According to EC Directive discussed above all the seafood factories exporting to European countries have to adopt HACCP. Based on this, EIA has now made HACCP system mandatory in all the seafood processing factories in India. This transformation from a traditional product based inspection system to a process control system requires thorough changes in the various stages of production and quality management. This study is conducted by the author with to study the status of the existing infrastructure and quality control system in the seafood industry in Kerala with reference to the recent developments in the quality concepts in international markets and study the drawbacks, if any, of the existing quality management systems in force in the seafood factories in Kerala for introducing the mandatory HACCP concept. To assess the possibilities of introducing Total Quality Management system in the seafood industry in Kerala in order to effectively adopt the HACCP concept. This is also aimed at improving the quality of the products and productivity of the industry by sustaining the world markets in the long run.

Financial planning and Control in public sector undertakings in kerala

Today India is seeking a speedy transformation of her semi-stagnant economy to a dynamic one by means of economic planning in a democratic set up. In the context of this growth oriented endeavour public sector has a vital role to play. After three decades of planned development, it has become important that India must make fresh appraisals on the role of public sector in the economic renaissance of the country. Almost no comprehensive study has been made on this vital segment of the economy vis-a-vis the growth economics. This study is an attempt to fill this need in a very modest way. It presents the subject in a new perspective. An earnest attempt is made to reveal the critical problems inhibiting the growth of the public sector from a new angle which focusses the spot-light on the economics of development.

Materials management in state transport undertakings in india with special reference to kerala state road transport corporation

Scientific studies on the materials management systems and practices actually followed in various organizations in India are rather limited. This is particularly true with respect to service industries. In this context ,the present study on the “materials management in state transport undertakings in India, with special reference to kerala state road corporation” assumes particular significance . This study, examines critically, the prevailing set up, procedures and practices of materials management in the Kerala state road transport corporation and compares them with the prevailing practices in other similar state transport undertakings. It indicates several areas for improvement with respect to the organization, materials planning, purchasing, store keeping and other aspects. It also seeks to develop a comprehensive inventory control system for KSRTC.

Socio economic factors influencing the persistence and control of filariasis in Kerala-A case study of malayan filariasis in Cherthala

In general the behavioural sciences have contributed very little to filariasis research.Man's actions in creating vector breeding sites have been noted and discussed frequently inthe frlariasis literature. but virtually no systematic studies of these fonns of behavior have been undertaken (Dunn. 1979). Human behavioural observations and inquires into values and attitudes atfecting behavior that inhibits or promotes vector breeding are essential if any progress is to be made in developing self help programmes of vector control. Therefore, a systematic study on the socio-economic aspect of the community is warranted before undertaking any control programme against filariasis. In view of this the present study has been carried out which reveals the knowledge, attitude and practice concerning the causation, transmission, treatment and control of the disease. Socio economic factors that influence the creation and maintenance of vector breeding habitats were identified. characterization and ranking of these sociological factors will be helpful in identifying the determinants of human behavioural changes towards the containment of the disease- Information on the existing indigenous perception of the disease and the factors that hinder the control will be useful in developing a sound strategy from the human angle, which can be put to practical use.

A Comparative Study Of The Organisation And Management Of Notihed Markets In Bangladesh With The Organisation And Management Of Regulated Markets In West Bengal India

For improving agricultural marketing, which has been discussed in the previous chapter, the Government has intervened in different ways. The direct regulatory role through the regulation of markets and market practices is one of the ways in which governmental intervention can improve agricultural marketing. This study is an enquiry of the direct regulatory role of the government through regulation of markets and market practices. By restructuring the operational methods and redesigning the existing physical markets, this system gives direct benefit to the cultivating class and protects them from the market manipulations of organised and powerful private traders. If traders do not continue their trade for the time being they will not be affected financially, because they are resourceful or financially solvent. On the other hand, Cultivators must sell their produce immediately after harvesting for the lack of additional facilities or to satisfy other needs for which finance is required. Another important reason is that Cultivators/farmers are not organised and because of lack of their organisation, they sell their produces individually. In this situation, a farmer is helpless when astute traders indulge in manipulations at the time of purchase of the produces. So it is the government's obligation to protect the interest of the farmers. Protection of the farmer/cultivator is necessary not only from the point of social justice but also from that of economic growth. If the farmers are assured of a remunerative or incentive price for their produce, they will get the inspiration to produce more and through more production, economy will be developed and the nation as a whole will be benefitted. This study will examine the management system of the markets through the direct regulatory role played by the governments to control markets and market practices in West Bengal and Bangladesh.

Receivable Management in Non Banking Finance Companies with Special Reference to Vehicle Financing

In the absence of entry barrier or regulatory restrictions, Non Banking Financial Companies frantically grew and accessed the public deposit without any regulatory control. The deposit of NBFCs grew from Rs. 41.9 crore in 1971 to 53116.0 crore in 1997. This growth was the result of a combined effect of increase in the number of NBFCs and increase in the amount of deposits. The deposits amazed as above was invested in various assets especially that in motor vehicles by these asset financing NBFCs. Various tactics were adopted by these NBFCs and their agents for recovering the receivable outstanding from such assets. Both central government and RBI were concerned about the protection of depositors‘ interest and various committees were set up to frame a comprehensive regulation for the functioning of these NBFCs.