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Safe and effective prescribing is one of the pillars of medical practice but is much more complicated than it seems. Many new prescribers find prescribing extremely challenging, and a plethora of independent, multidisciplinary prescribers are also seeking guidance. However, pharmacology textbooks are rarely practical. They warn to 'take care when prescribing erythromycin to a patient on warfarin, as the INR may rise'. But what should the prescriber actually do? Surviving Prescribing fulfils an important need by offering practical advice for real-world prescribing problems. The book complements existing educational resources but adds a new perspective. Written by experienced contributors from a variety of professional backgrounds, the content speaks directly to the problems routinely seen in hospital prescribing. And all in one, pocket-sized volume. Whether revising for the national Prescribing Safety Assessment, preparing for starting on the wards, or looking for a quick reference guide, this book is an essential companion.
The dry lowlands of Ethiopia are seasonally affected by long periods of low rainfall and, coinciding with rainfall in the Amhara highlands, flood waters which flow onto the lowlands resulting in damage to landscapes and settlements. In an attempt to convert water from storm generated floods into productive use, this study proposes a methodology using remote sensing data and geographical information system tools to identify potential sites where flood spreading weirs may be installed and farming systems developed which produce food and fodder for poor rural communities. First, land use land cover maps for the study area were developed using Landsat-8 and MODIS temporal data. Sentinel-1 data at 10 and 20 m resolution on a 12-day basis were then used to determine flood prone areas. Slope and drainage maps were derived from Shuttle RADAR Topography Mission Digital Elevation Model at 90 m spatial resolution. Accuracy assessment using ground survey data showed that overall accuracies (correctness) of the land use/land cover classes were 86% with kappa 0.82. Coinciding with rainfall in the uplands, March and April are the months with flood events in the short growing season (belg) and June, July and August have flood events during the major (meher) season. In the Afar region, there is potentially >0.55 m ha land available for development using seasonal flood waters from belg or meher seasons. During the 4 years of monitoring (2015–2018), a minimum of 142,000 and 172,000 ha of land were flooded in the belg and meher seasons, respectively. The dominant flooded areas were found in slope classes of <2% with spatial coverage varying across the districts. We concluded that Afar has a huge potential for flood-based technology implementation and recommend further investigation into the investments needed to support new socio-economic opportunities and implications for the local agro-pastoral communities.
Afar in Ethiopia is a drought prone area characterized by low rainfall, high temperature and suffering from flash flood emerging from adjacent mountains. We introduced a flood barrier, water spreading weirs (WSWs) in 2015 to convert floods to a productive use and assessed its effect in 2016 and 2017. WSWs resulted in deposition of sediments where sand deposition was higher in the upside of upstream weir whereas silt and clay deposition was prominent at the central location between the two weirs. There was a moisture gradient across farming fields with volumetric water content (VWC) at 20 cm depth varying between 10 and 22% depending on the relative position/distance of fields from the WSWs, consequently, effecting significant difference in yield between fields. There was a positive relationship between VWC made available by WSWs at planting and the yield (P < 0.001, r = 0.76) and biomass productivity (P < 0.005, r = 0.46). WSWs created differing farming zone following soil moisture regime, affecting grain and biomass yield. In good potential zones with high moisture content, the WSW-based farming enabled to produce up to 5 and 15 t ha−1 yr−1 of maize grain and biomass, respectively, while in low potential zones there was a complete crop grain failure. The system enabled pastoralists to produce huge amount of biomass and grain during Belg (short) and Meher (long) growing seasons that was stored and utilized during succeeding dry periods. Furthermore, the practice ensured a visible recovery of degraded rangelands. This was evident from the filling up of the riverbed as well as the two WSW wings with 1 m high and about 450 m length each with fertile sediment from Belg and Meher seasons of 2016 and 2017. Hence, future studies should analyze the sustainability and the potential of flood-based development at large scale.
This paper presents the computation of the safe working zone (SWZ) of a parallel manipulator having three degrees of freedom. The SWZ is defined as a continuous subset of the workspace, wherein the manipulator does not suffer any singularity, and is also free from the issues of link interference and physical limits on its joints. The proposed theory is illustrated via application to two parallel manipulators: a planar 3-R̲RR manipulator and a spatial manipulator, namely, MaPaMan-I. It is also shown how the analyses can be applied to any parallel manipulator having three degrees of freedom, planar or spatial.
In the United States, approximately 20% patients die annually during a hospitalization with an intensive care unit (ICU) stay. Each year, critical care costs exceed $82 billion, accounting for 13% of all inpatient hospital costs. Treatment of sepsis is listed as the most expensive condition in US hospitals, costing more than $20 billion annually. Electronic Medical Orders for Life-Sustaining Treatment (eMOLST) is a standardized documentation process used in New York State to convey patients’ wishes regarding cardiopulmonary resuscitation and other life-sustaining treatments. No study to date has looked at the effect of eMOLST as an advance care planning tool on ICU and hospital costs using estimates of direct costs. The objective of our study was to investigate whether signing of eMOLST results in any reduction in length of stay and direct costs for a community-based hospital in New York State.
A retrospective chart review was conducted between July 2016 and July 2017. Primary outcome measures included length of hospital stay, ICU length of stay, total direct costs, and ICU costs. Inclusion criteria were patients ≥65 years of age and admitted into the ICU with a diagnosis of sepsis. An independent samples t test was used to test for significant differences between those who had or had not completed the eMOLST form.
There were no statistical differences for patients who completed or did not complete the eMOLST form on hospital's total direct cost, ICU cost, total length of hospital stay, and total hours spent in the ICU.
Significance of results
Completing an eMOLST form did not have any effect on reducing total direct cost, ICU cost, total length of hospital stay, and total hours spent in the ICU.
Tricalcium phosphate (TCP) is a promising candidate in bone and dental tissue engineering applications. Though osteoconductive, its low osteoinductivity is a major concern. Trace elements addition at low concentrations are known for their impact on not only the osteoinductivity, but also physical and mechanical properties of TCP. Copper (Cu) is known for its role in vascularization and angiogenesis in biological systems. Here, we studied the effects of Cu addition on phase composition, porosity, microstructure and in vitro interaction with osteoblast (OB) cells. Our results showed that Cu stabilized the TCP structure, while no significant effect of microstructure and porosity was found. Cu at concentrations less than 1 wt.% did not have any cytotoxic effect while decreased proliferation of OBs were observed at 1 wt.% Cu doped TCP. Addition of Cu upregulated collagen type I and vascular endothelial growth factor expression in a dose dependent manner at early time-point. Furthermore, Cu reduced inflammatory gene expression by human osteoblasts. These findings show that addition of Cu to TCP may provide a therapeutic strategy that can be applied in bone tissue engineering applications.
It has long been recognised that substance use disorders and sexually transmitted infections (STIs) are common comorbid conditions. It is clear that treating one condition while leaving the other leads to increased morbidity and mortality in this patient population. However, engaging patients in treatment is extremely challenging, which is a huge public health concern. This article focuses on various sexually transmitted infections seen in the substance misuse population and means of primary, secondary and tertiary prevention.
Declaration of interest
•Be aware of the current extent of comorbidity between substance use disorders and STIs
•Learn about primary, secondary and tertiary prevention of STIs in people with substance use disorders
•Understand the links between high-risk sexual behaviour and illicit drug use, as shown by current evidence
For millions of poor people in the developing world, economic growth offers prospects for improved well-being. But what are the political and social conditions conducive to growth-oriented policies in poor democracies? This book addresses this highly consequential question by focusing on a specific empirical puzzle - policy variation across Indian states in the competition for private industrial investment, a phenomenon that came to the fore after the country adopted market reforms in 1991. Through the analysis of investment policies, this book offers a novel explanation, which links social identity, class, and economic policy outcomes. Its main findings highlight a link between pro-business policies and exclusionary political trends in India's high growth phase, and offer a sobering perspective on the current model of growth in the country. The book adds to our understanding of Indian political economy as well as to the dynamics of economic development in poor democracies.