Co-payment Strategies for Chronic Medications: A Qualitative and Comparative Analysis at European Level

The management of pharmacotherapy and the process of dispensing medicines is becoming critical in clinical pharmacy due to the increase of incidence and prevalence of chronic diseases, the complexity and customization of therapeutic regimens, the introduction of innovative and more expensive medicines, the unbalanced relation between expenditure and revenue as well as due to the lack of rationalization associated with medication use. For these reasons, co-payments emerged in Europe in the 70s and have been applied over the past few years in healthcare. Co-payments lead to a rationing and rationalization of user’s access under healthcare services and products, and simultaneously, to a qualification and improvement of the services and products for the end-user. This analysis, under hospital practices particularly and co-payment strategies in general, was carried out on all the European regions and identified four reference countries, that apply repeatedly this tool and with different approaches. The structure, content and adaptation of European co-payments were analyzed through 7 qualitative attributes and 19 performance indicators, and the results expressed in a scorecard, allowing to conclude that the German models (total score of 68,2% and 63,6% in both elected co-payments) can collect more compliance and effectiveness, the English models (total score of 50%) can be more accessible, and the French models (total score of 50%) can be more adequate to the socio-economic and legal framework. Other European models did not show the same quality and/or performance, so were not taken as a standard in the future design of co-payments strategies. In this sense, we can see in the co-payments a strategy not only to moderate the consumption of healthcare products and services, but especially to improve them, as well as a strategy to increment the value that the end-user assigns to these services and products, such as medicines.

Intersectional Bullying, LGBT Youth and the Construction of Power

This paper explores the impact of intersectional bullying of lesbian, gay, bisexual, transgender (LGBT) youth from a multi-layered experience perspective within bullying incidents at school. Present inclusionary measures at school may not be designed as a continuous process of finding better methods for responding to diversity, rather remain ‘fixed’ as singular solutions applied universally. This paper argues recognizing education through a lens of inclusion begins to realize most educational systems are poorly equipped to handle diversity.

Importance of Risk Assessment in Managers´ Decision-Making Process

Making decisions is the core of management and a result of conscious activities which is under way in a particular environment and concrete conditions. The managers decide about the goals, procedures and about the methods how to respond to the changes and to the problems which developed. Their decisions affect the effectiveness, quality, economy and the overall successfulness in every organisation. In spite of this fact, they do not pay sufficient attention to the individual steps of the decision-making process. They emphasise more how to cope with the individual methods and techniques of making decisions and forget about the way how to cope with analysing the problem or assessing the individual solution variants. In many cases, the underestimating of the analytical phase can lead to an incorrect assessment of the problem and this can then negatively influence its further solution. Based on our analysis of the theoretical solutions by individual authors who are dealing with this area and the realised research in Slovakia and also abroad we can recognise an insufficient interest of the managers to assess the risks in the decision-making process. The goal of this paper is to assess the risks in the managers´ decision-making process relating to the conditions of the environment, to the subject’s activity (the manager’s personality), to the insufficient assessment of individual variants for solving the problems but also to situations when the arisen problem is not solved. The benefit of this paper is the effort to increase the need of the managers to deal with the risks during the decision-making process. It is important for every manager to assess the risks in his/her decision-making process and to make efforts to take such decisions which reflect the basic conditions, states and development of the environment in the best way and especially for the managers´ decisions to contribute to achieving the determined goals of the organisation as effectively as possible.

Mapping Crime against Women in India: Spatio-Temporal Analysis, 2001-2012

Women are most vulnerable to crime despite occupying central position in shaping a society as the first teacher of children. In India too, having equal rights and constitutional safeguards, the incidences of crime against them are large and grave. In this context of crime against women, especially rape has been increasing over time. This paper explores the spatial and temporal aspects of crime against women in India with special reference to rape. It also examines the crime against women with its spatial, socio-economic and demographic associates using related data obtained from the National Crime Records Bureau India, Indian Census and other government sources of the Government of India. The simple statistical, choropleth mapping and other cartographic representation methods have been used to see the crime rates, spatio-temporal patterns of crime, and association of crime with its correlates.  The major findings are visible spatial variations across the country and are also in the rising trends in terms of incidence and rates over the reference period. The study also indicates that the geographical associations are somewhat observed. However, selected indicators of socio-economic factors seem to have no significant bearing on crime against women at this level.

Effect of Non-Crimp Fabric Structure on Mechanical Properties of Laminates

The textile preforms play a key role in providing the mechanical properties and gives the idea about selection parameter of preforms to improve the quality and performance of laminates. The main objectives of this work are to study the effect of non-crimp fabric preform structure in final properties of laminates. It has been observed that the multi-axial preform give better mechanical properties of laminates as compared to woven and biaxial fabrics. This study investigated the effect of different non-crimp glass preform structure on tensile strength, bending and compression properties of glass laminates. The different woven, bi-axial and multi-axial fabrics with similar GSM used to manufacture the laminates using polyester resin. The structural and mechanical properties of preform and laminates were studied using standard methods. It has been observed that the glass fabric geometry, including type of weaves, warps and filling density and number of layer plays significant role in deciding mechanical properties of laminates.

Sulfur Removal of Hydrocarbon Fuels Using Oxidative Desulfurization Enhanced by Fenton Process

A comprehensive development towards the production of ultra-clean fuels as a feed stoke is getting to raise due to the increasing use of diesel fuels and global air pollution. Production of environmental-friendly fuels can be achievable by some limited single methods and most integrated ones. Oxidative desulfurization (ODS) presents vast ranges of technologies possessing suitable characteristics with regard to the Fenton process. Using toluene as a model fuel feed with dibenzothiophene (DBT) as a sulfur compound under various operating conditions is the attempt of this study. The results showed that this oxidative process followed a pseudo-first order kinetics. Removal efficiency of 77.43% is attained under reaction time of 40 minutes with (Fe+2/H2O2) molar ratio of 0.05 in acidic pH environment. In this research, temperature of 50 °C represented the most influential role in proceeding the reaction.

The Determination of Aflatoxins in Paddy and Milled Fractions of Rice in Guyana: Preliminary Results

A survey was conducted in the five rice-growing regions in Guyana to determine the presence of aflatoxins in multiple fractions of rice in June/October 2015 growing season. The fractions were paddy, steamed paddy, cargo rice, white rice and parboiled rice. Samples were analyzed by High Performance Liquid Chromatography. A subset of the samples was further analyzed by enzyme-linked immunosorbent assay (ELISA) for concurrence. All analyses were conducted at the University of Missouri, USA. Of the 186 samples tested, 16 had aflatoxin concentrations greater than 20 ppb the recommended limit for aflatoxins in food according to the United States Food and Drug Administration. An additional three samples had aflatoxin B1 concentrations greater than the European Union Commission maximum levels for aflatoxin B1 in rice at 5 µg/kg and total aflatoxins (B1, B2, G1 and G2) at 10 µg/kg. The survey indicates that there is no widespread aflatoxin problem in rice in Guyana. The incidence of aflatoxins appears to be localized.

Characterisation of Fractions Extracted from Sorghum Byproducts

Sorghum byproducts, namely bran, stalk, and panicle are examples of lignocellulosic biomass. These raw materials contain large amounts of polysaccharides, in particular hemicelluloses, celluloses, and lignins, which if efficiently extracted, can be utilised for the development of a range of added value products with potential applications in agriculture and food packaging sectors. The aim of this study was to characterise fractions extracted from sorghum bran and stalk with regards to their physicochemical properties that could determine their applicability as food-packaging materials. A sequential alkaline extraction was applied for the isolation of cellulosic, hemicellulosic and lignin fractions from sorghum stalk and bran. Lignin content, phenolic content and antioxidant capacity were also investigated in the case of the lignin fraction. Thermal analysis using differential scanning calorimetry (DSC) and X-Ray Diffraction (XRD) revealed that the glass transition temperature (Tg) of cellulose fraction of the stalk was ~78.33 oC at amorphous state (~65%) and water content of ~5%. In terms of hemicellulose, the Tg value of stalk was slightly lower compared to bran at amorphous state (~54%) and had less water content (~2%). It is evident that hemicelluloses generally showed a lower thermal stability compared to cellulose, probably due to their lack of crystallinity. Additionally, bran had higher arabinose-to-xylose ratio (0.82) than the stalk, a fact that indicated its low crystallinity. Furthermore, lignin fraction had Tg value of ~93 oC at amorphous state (~11%). Stalk-derived lignin fraction contained more phenolic compounds (mainly consisting of p-coumaric and ferulic acid) and had higher lignin content and antioxidant capacity compared to bran-derived lignin fraction.

Effect of Chemical Modifier on the Properties of Polypropylene (PP) / Coconut Fiber (CF) in Automotive Application

Chemical modifier (Acrylic Acid) is used as filler treatment to improve mechanical properties and swelling behavior of polypropylene/coconut fiber (PP/CF) composites by creating more adherent bonding between CF filler and PP Matrix. Treated (with chemical modifier) and untreated (without chemical modifier) composites were prepared in the formulation of 10 wt%, 20 wt%, 30 wt%, and 40 wt%. The mechanical testing indicates that composite with 10 wt% of untreated composite has the optimum value of tensile strength, and the composite with chemical modifier shows the tensile strength was increased. By increasing of filler loading, elastic modulus was increased while the elongation at brake was decreased. Meanwhile, the swelling test discerned that the increase of filler loading increased the water absorption of composites and the presence of chemical modifier reduced the equilibrium water absorption percentage.

Application Reliability Method for Concrete Dams

Probabilistic risk analysis models are used to provide a better understanding of the reliability and structural failure of works, including when calculating the stability of large structures to a major risk in the event of an accident or breakdown. This work is interested in the study of the probability of failure of concrete dams through the application of reliability analysis methods including the methods used in engineering. It is in our case, the use of level 2 methods via the study limit state. Hence, the probability of product failures is estimated by analytical methods of the type first order risk method (FORM) and the second order risk method (SORM). By way of comparison, a level three method was used which generates a full analysis of the problem and involves an integration of the probability density function of random variables extended to the field of security using the Monte Carlo simulation method. Taking into account the change in stress following load combinations: normal, exceptional and extreme acting on the dam, calculation of the results obtained have provided acceptable failure probability values which largely corroborate the theory, in fact, the probability of failure tends to increase with increasing load intensities, thus causing a significant decrease in strength, shear forces then induce a shift that threatens the reliability of the structure by intolerable values of the probability of product failures. Especially, in case the increase of uplift in a hypothetical default of the drainage system.

Decontamination of Chromium Containing Ground Water by Adsorption Using Chemically Modified Activated Carbon Fabric

Chromium in the environment is considered as one of the most toxic elements probably next only to mercury and arsenic. It is acutely toxic, mutagenic and carcinogenic in the environment. Chromium contamination of soil and underground water due to industrial activities is a very serious problem in several parts of India covering Karnataka, Tamil Nadu, Andhra Pradesh etc. Functionally modified Activated Carbon Fabrics (ACF) offer targeted chromium removal from drinking water and industrial effluents. Activated carbon fabric is a light weight adsorbing material with high surface area and low resistance to fluid flow. We have investigated surface modification of ACF using various acids in the laboratory through batch as well as through continuous flow column experiments with a view to develop the optimum conditions for chromium removal. Among the various acids investigated, phosphoric acid modified ACF gave best results with a removal efficiency of 95% under optimum conditions. Optimum pH was around 2 – 4 with 2 hours contact time. Continuous column experiments with an effective bed contact time (EBCT) of 5 minutes indicated that breakthrough occurred after 300 bed volumes. Adsorption data followed a Freundlich isotherm pattern. Nickel adsorbs preferentially and sulphate reduces chromium adsorption by 50%. The ACF could be regenerated up to 52.3% using 3 M NaOH under optimal conditions. The process is simple, economical, energy efficient and applicable to industrial effluents and drinking water.

Physicochemical Stability of Pulse Spreads during Storage after Sous Vide Treatment and High Pressure Processing

Pulses are high in plant protein and dietary fiber, and contain slowly digestible starches. Innovative products from pulses could increase their consumption and benefit consumer health. This study was conducted to evaluate physicochemical stability of processed cowpea (Vigna unguiculata (L.) Walp. cv. Fradel) and maple pea (Pisum sativum var. arvense L. cv. Bruno) spreads at 5 °C temperature during 62-day storage. Physicochemical stability of pulse spreads was compared after sous vide treatment (80 °C/15 min) and high pressure processing (700 MPa/10 min/20 °C). Pulse spreads were made by homogenizing cooked pulses in a food processor together with salt, citric acid, oil, and bruschetta seasoning. A total of four different pulse spreads were studied: Cowpea spread without and with seasoning, maple pea spread without and with seasoning. Transparent PA/PE and light proof PET/ALU/PA/PP film pouches were used for packaging of pulse spreads under vacuum. The parameters investigated were pH, water activity and mass losses. Pulse spreads were tested on days 0, 15, 29, 42, 50, 57 and 62. The results showed that sous-vide treatment and high pressure processing had an insignificant influence on pH, water activity and mass losses after processing, irrespective of packaging material did not change (p>0.1). pH and water activity of sous-vide treated and high pressure processed pulse spreads in different packaging materials proved to be stable throughout the storage. Mass losses during storage accounted to 0.1% losses. Chosen sous-vide treatment and high pressure processing regimes and packaging materials are suitable to maintain consistent physicochemical quality of the new products during 62-day storage.

Quality of Life of the Beneficiaries of the Government’s Bolsa Família Program: A Case Study in Mateiros/TO/Brazil

The quality of life index, despite elucidating many discussions, the conceptual subjectivity of the term does not show precision, and consequently, many researchers seek to develop methods aiming to measure this concept, bringing it to a more concrete approach. In this study, the quality of life index method was used to analyze the population of Mateiros, Tocantins, Brazil for quality of life. After data collection, it was compared the quality of life index between the population and the group of beneficiaries of the Brazilian government assistance program Bolsa Família (Family Allowance). Some of the people interviewed receive financial aid from the federal government program Bolsa Família (22%). Comparisons were made among the final score of the quality of life index of the Mateiros population and the following factors: Gender, age, education, those working or not with tourism and those who receive or do not receive the Bolsa Família. It was observed that only the factor, Bolsa Família (p-score 0.0138), shows an association with quality of life improvement, noticing that those who have financial aid had a higher quality of life improvement than the rest of the population. It was concluded that, government assistance has shown a decisive element on the enhancement of Mateiros population quality of life, indicating that similar actions should be maintained.

Intensification of Ethyl Esters Synthesis Using a Packed-Bed Tubular Reactor at Supercritical Conditions

In the present study, the non-catalytic transesterification of soybean oil in continuous mode using supercritical ethanol were investigated. Experiments were performed in a packed-bed tubular reactor (PBTR) and variable studied were reaction temperature (523 K to 598 K), pressure (10 MPa to 20 MPa), oil to ethanol molar ratio (1:10 to 1:40) and water concentration (0 wt% to 10 wt% in ethanol). Results showed that ethyl esters yields obtained in the PBTR were higher (> 20 wt%) than those verified in a tubular reactor (TR), due to improved mass transfer conditions attained in the PBTR. Results demonstrated that temperature, pressure, oil to ethanol molar ratio and water concentration had a positive effect on fatty acid ethyl esters (FAEE) production in the experimental range investigated, with appreciable reaction yields (90 wt%) achieved at 598 K, 20 MPa, oil to ethanol molar ratio of 1:40 and 10 wt% of water concentration.

Production and Purification of Monosaccharides by Hydrolysis of Sugar Cane Bagasse in an Ionic Liquid Medium

The conversion of lignocellulosic waste materials, such as sugar cane bagasse, to biofuels such as ethanol has attracted significant interest as a potential element for transforming transport fuel supplies to totally renewable sources. However, the refractory nature of the cellulosic structure of lignocellulosic materials has impeded progress on developing an economic process, whereby the cellulose component may be effectively broken down to glucose monosaccharides and then purified to allow downstream fermentation. Ionic liquid (IL) treatment of lignocellulosic biomass has been shown to disrupt the crystalline structure of cellulose thus potentially enabling the cellulose to be more readily hydrolysed to monosaccharides. Furthermore, conventional hydrolysis of lignocellulosic materials yields byproducts that are inhibitors for efficient fermentation of the monosaccharides. However, selective extraction of monosaccharides from an aqueous/IL phase into an organic phase utilizing a combination of boronic acids and quaternary amines has shown promise as a purification process. Hydrolysis of sugar cane bagasse immersed in an aqueous solution with IL (1-ethyl-3-methylimidazolium acetate) was conducted at different pH and temperature below 100 ºC. It was found that the use of a high concentration of hydrochloric acid to acidify the solution inhibited the hydrolysis of bagasse. At high pH (i.e. basic conditions), using sodium hydroxide, catalyst yields were reduced for total reducing sugars (TRS) due to the rapid degradation of the sugars formed. For purification trials, a supported liquid membrane (SLM) apparatus was constructed, whereby a synthetic solution containing xylose and glucose in an aqueous IL phase was transported across a membrane impregnated with phenyl boronic acid/Aliquat 336 to an aqueous phase. The transport rate of xylose was generally higher than that of glucose indicating that a SLM scheme may not only be useful for purifying sugars from undesirable toxic compounds, but also for fractionating sugars to improve fermentation efficiency.

A Four-Year Study of Thyroid Carcinoma in Hail Region: Increased Incidence

Background and Objective: In most areas of the world, the incidence of thyroid cancer has been increasing over the last decade, mostly due to a combination of early detection of the neoplasm resulting from sensitive procedures and increased population exposure to radiation and unrecognized carcinogens. Methods: Cases of thyroid cancer have been retrieved from the cancer registry at King Khalid Hospital during the period from August 2012 to April 2016. Age, gender and histopathologic types have been recorded. Results: Thyroid carcinoma ranked as the second most common malignancy in females (25%) after breast cancer (31%). It constituted 20.8% of all newly diagnosed cancer cases. As for males, it ranked the 4th type of malignancy after gastrointestinal cancer, lymphomas and soft tissue sarcomas. Mean age for females and males was 38.7 +/- 13.2 and 60.25 +/- 11.5 years, respectively, and the difference between the two groups was statistically significant (p value = 0.0001). Fifty-five (82%) were papillary carcinomas including 10 follicular variant of papillary (FVPC), and eight papillary micro carcinomas (PMC) and two tall cell/oncocytic variants. Follicular carcinomas constituted two (3.1%), while two (3.1%) were anaplastic, and two (3.1%) were medullary. Conclusion: Thyroid cancer incidence in Hail is ranking as the 2nd most common female malignancy similar to other regions in the Kingdom. However, this high incidence contrasts with much lower rates worldwide.

Smart Trust Management for Vehicular Networks

Spontaneous networks such as VANET are in general deployed in an open and thus easily accessible environment. Therefore, they are vulnerable to attacks. Trust management is one of a set of security solutions dedicated to this type of networks. Moreover, the strong mobility of the nodes (in the case of VANET) makes the establishment of a trust management system complex. In this paper, we present a concept of ‘Active Vehicle’ which means an autonomous vehicle that is able to make decision about trustworthiness of alert messages transmitted about road accidents. The behavior of an “Active Vehicle” is modeled using Petri Nets.

Automatic Music Score Recognition System Using Digital Image Processing

Music has always been an integral part of human’s daily lives. But, for the most people, reading musical score and turning it into melody is not easy. This study aims to develop an Automatic music score recognition system using digital image processing, which can be used to read and analyze musical score images automatically. The technical approaches included: (1) staff region segmentation; (2) image preprocessing; (3) note recognition; and (4) accidental and rest recognition. Digital image processing techniques (e.g., horizontal /vertical projections, connected component labeling, morphological processing, template matching, etc.) were applied according to musical notes, accidents, and rests in staff notations. Preliminary results showed that our system could achieve detection and recognition rates of 96.3% and 91.7%, respectively. In conclusion, we presented an effective automated musical score recognition system that could be integrated in a system with a media player to play music/songs given input images of musical score. Ultimately, this system could also be incorporated in applications for mobile devices as a learning tool, such that a music player could learn to play music/songs.

Rubber Wood as a Potential Biomass Feedstock for Biochar via Slow Pyrolysis

Utilisation of biomass feedstock for biochar has received increasing attention because of their potential for carbon sequestration and soil amendment. The aim of this study is to investigate the characteristics of rubber wood as a biomass feedstock for biochar via slow pyrolysis process. This was achieved by using proximate, ultimate, and thermogravimetric analysis (TGA) as well as heating value, pH and lignocellulosic determination. Rubber wood contains 4.13 mf wt.% moisture, 86.30 mf wt.% volatile matter, 0.60 mf wt.% ash content, and 13.10 mf wt.% fixed carbon. The ultimate analysis shows that rubber wood consists of 44.33 mf wt.% carbon, 6.26 mf wt.% hydrogen, 19.31 mf wt.% nitrogen, 0.31 mf wt.% sulphur, and 29.79 mf wt.% oxygen. The higher heating value of rubber wood is 22.5 MJ/kg, and its lower heating value is 21.2 MJ/kg. At 27 °C, the pH value of rubber wood is 6.83 which is acidic. The lignocellulosic analysis revealed that rubber wood composition consists of 2.63 mf wt.% lignin, 20.13 mf wt.% cellulose, and 65.04 mf wt.% hemicellulose. The volatile matter to fixed carbon ratio is 6.58. This led to a biochar yield of 25.14 wt.% at 500 °C. Rubber wood is an environmental friendly feedstock due to its low sulphur content. Rubber wood therefore is a suitable and a potential feedstock for biochar production via slow pyrolysis.

Strategy in Controlling Rice-Field Conversion in Pangkep Regency, South Sulawesi, Indonesia

The national rice consumption keeps increasing along with raising income of the households and the rapid growth of population. However, food availability, particularly rice, is limited. Impacts of rice-field conversion have run cumulatively, as we can see on potential losses of rice and crops production, as well as work opportunity that keeps increasing year-by-year. Therefore, it requires policy recommendation to control rice-field conversion through economic, social, and ecological approaches. The research was a survey method intended to: (1) Identify internal factors; quality and productivity of the land as the cause of land conversion, (2) Identify external factors of land conversion, value of the rice-field and the competitor’s land, workforce absorption, and regulation, as well as (3) Formulate strategies in controlling rice-field conversion. Population of the research was farmers who applied land conversion at Pangkep Regency, South Sulawesi. Samples were determined using the incidental sampling method. Data analysis used productivity analysis, land quality analysis, total economic value analysis, and SWOT analysis. Results of the research showed that the quality of rice-field was low as well as productivity of the grains (unhulled-rice). So that, average productivity of the grains and quality of rice-field were low as well. Total economic value of rice-field was lower than the economic value of the embankment. Workforce absorption value on rice-field was higher than on the embankment. Strategies in controlling such rice-field conversion can be done by increasing rice-field productivity, improving land quality, applying cultivation technique of specific location, improving the irrigation lines, and socializing regulation and sanction about the transfer of land use.