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Adverse drug reactions, multimorbidity and polypharmacy: A prospective analysis of one month of medical admissions
Get PDFObjective To ascertain the burden and associated cost of adverse drug reactions (ADRs), polypharmacy and multimorbidity through a prospective analysis of all medical admissions to a large University teaching hospital over a one-month period. Design Prospective observational study.Setting Liverpool University Hospital Foundation NHS Trust, England.Participants All medical admissions with greater than 24-hour stay over a one-month period.Main outcome measures Prevalence of admissions due to an ADR and associated mortality. Prevalence and association of multimorbidity and polypharmacy with ADRs. Estimated local financial cost of admissions where ADR was a contributing or main reason for admission with projected costs for NHS in England. Results There were 218 identified patient admissions with an ADR giving a prevalence of 18.4%. The majority of these (90.4%) were ADRs that directly resulted in or contributed to admission. ADRs thus accounted for 16.5% of total admissions. Those with an ADR were on average taking more medicines (10.5 vs 7.8 p<0.01) and had more co-morbidities than those without an ADR (6.1 vs 5.2, p<0.01). Drugs most commonly implicated were diuretics, steroid inhalers, anticoagulants & antiplatelets, proton pump inhibitors, chemotherapeutic agents and antihypertensives. 40.4% of ADRs were classified avoidable or possibly avoidable. The mortality rate due to an ADR was 0.34%. The average length of stay for those with an ADR was 6 days. Direct one month cost to the Trust from ADR admissions was £490,716. Extrapolated nationally the projected annual cost to the NHS in England is 2.21 billion. Conclusion The local prevalence of admission and mortality from ADRs are higher than previously reported. Important factors that could be contributing to this include polypharmacy and multimorbidity. ADRs place a significant burden on patients and healthcare services with associated financial implications. Reducing inappropriate polypharmacy should be a major aim for preventing ADRs.<br/
The Apapacho Violence Prevention Parenting Program: Conceptual Foundations and Pathways to Scale
Get PDFViolence against children (VAC) is a major global issue with long-lasting negative consequences on individuals and societies. The present study presents a review of the literature on drivers of VAC and the core components of evidence-based violence prevention programs. Moreover, it analyzes the existing services and social infrastructure in Colombia to rigorously inform the design of the Apapacho violence prevention parenting program for families with children younger than five targeted toward Colombia. Findings indicate that (1) VAC in Colombia is a multidimensional issue with roots at the individual, family, community, and society levels, (2) evidence-based violence prevention programs share a common set of content and delivery strategies that could inform the components of the Apapacho program, and (3) there is an urgent need for scalable and flexible violence prevention programs for families with young children in Colombia. Considering existing evidence, the Apapacho violence prevention parenting program will be designed using ecological, developmental, and neuroscience-informed perspectives. This article concludes by presenting the initial components of the theory of change and discussing future directions for the design of the Apapacho program and other violence prevention interventions in LMICs.</p
Lakes in Hot Water: The Impacts of a Changing Climate on Aquatic Ecosystems
Get PDFOur planet is being subjected to unprecedented climate change, with far-reaching social and ecological repercussions. Below the waterline, aquatic ecosystems are being affected by multiple climate-related and anthropogenic stressors, the combined effects of which are poorly understood and rarely appreciated at the global stage. A striking consequence of climate change on aquatic ecosystems is that many are experiencing shorter periods of ice cover, as well as earlier and longer summer stratified seasons, which often result in a cascade of ecological and environmental consequences, such as warmer summer water temperatures, alterations in lake mixing and water levels, declines in dissolved oxygen, increased likelihood of cyanobacterial algal blooms, and the loss of habitat for native cold-water fisheries. The repercussions of a changing climate include impacts on freshwater supplies, water quality, biodiversity, and the ecosystem benefits that they provide to society
Fundamental Frequency Sequence Amplitude Estimator for Power and Energy Applications
Get PDFA grid-synchronization-based fundamental frequency positive-sequence (FFPS) and negative-sequence (FFNS) amplitudes estimation technique is proposed for unbalanced and distorted grid. In this technique, the sequence amplitudes are extracted by extracting the phase-angle of the FFPS and FFNS components. The extracted phase-angles have DC and double frequency AC components. The AC component is filtered out by using a Moving Average Filter (MAF) of appropriate window length. From the extracted phase-angle, the unknown frequency can be estimated by using a suitable controller. A frequency-fixed equidistant samples-based pre-loop filter is also applied to eliminate the effect of measurement offset. The proposed technique has a very simple structure and is easy to tune. Small-signal modeling-based stability analysis and gain tuning procedure are also provided. The proposed technique strikes a good balance between fast convergence and disturbance rejection capability. Comparative numerical simulation and experimental results with similar other techniques demonstrate the suitability and performance enhancement by the proposed technique
The Effects of Management on Biodiversity and Biogeochemistry of the Cors Goch Site, Anglesey
No full textMatch and training injury risk in semi-professional rugby union: a four-year study
Get PDFObjectiveTo describe medical-attention and time-loss injuries during matches and training in a Welsh Premiership Rugby Union team over four seasons.Study designProspective cohort observational study.MethodsSixty-nine players from one semi-professional Rugby Union team were observed. Injury incidence, severity, and burden were calculated. Location, type, and cause of injury were also determined.ResultsMedical-attention and time-loss injury incidence were greater for matches (incidence, 95% CI = 122.8, 108.9–138.4 and 99.8, 87.3–114.0) than training (incidence, 95% CI = 2.2, 1.8–2.6 and 1.7, 1.4–2.1) per 1000 player-hours. Whereas injury severity was similar for matches (time-loss ± SD = 24.9 ± 30.8 days) and training (time-loss ± SD = 22.4 ± 29.1 days), with injury burden greater for match-injuries (burden, 95% CI = 3148.8, 3019.8–6479.2) than training-injuries (burden, 95% CI = 49.7, 36.7–129.6). Lower-limb time-loss injuries were the most common during matches (incidence, 95% CI = 46.0, 37.9–55.9) and training (incidence, 95% CI = 1.3, 1.0–1.7) per 1000 player-hours, whilst upper-limb injuries were the most severe from matches (time-loss, 95% CI = 38.8, 28.3–44.4 days) and training (time-loss, 95% CI = 45.9, 17.5–52.7 days). The most prevalent cause of contact-injury was tackling (31%) with running (11%) the common cause of non-contact injury.ConclusionTime-loss match-injury incidence, severity, and burden were similar to those reported in the professional tier, with similar patterns for medical-attention and time-loss injuries observed for injury location, type, and inciting event. These figures are greater than previously reported for semi-professional Rugby Union, warranting further investigation at this level of play.<br/
A rapid review of the impact of office layout on employee health, productivity and sustainability
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Accuracy evaluation of hand-eye calibration techniques for vision-guided robots
Get PDFHand-eye calibration is an important step in controlling a vision-guided robot in applications like part assembly, bin picking and inspection operations etc. Many methods for estimating hand-eye transformations have been proposed in literature with varying degrees of complexity and accuracy. However, the success of a vision-guided application is highly impacted by the accuracy the hand-eye calibration of the vision system with the robot. The level of this accuracy depends on several factors such as rotation and translation noise, rotation and translation motion range that must be considered during calibration. Previous studies and benchmarking of the proposed algorithms have largely been focused on the combined effect of rotation and translation noise. This study provides insight on the impact of rotation and translation noise acting in isolation on the hand-eye calibration accuracy. This deviates from the most common method of assessing hand-eye calibration accuracy based on pose noise (combined rotation and translation noise). We also evaluated the impact of the robot motion range used during the hand-eye calibration operation which is rarely considered. We provide quantitative evaluation of our study using six commonly used algorithms from an implementation perspective. We comparatively analyse the performance of these algorithms through simulation case studies and experimental validation using the Universal Robot’s UR5e physical robots. Our results show that these different algorithms perform differently when the noise conditions vary rather than following a general trend. For example, the simultaneous methods are more resistant to rotation noise, whereas the separate methods are better at dealing with translation noise. Additionally, while increasing the robot rotation motionspan during calibration enhances the accuracy of the separate methods, it has a negative effect on the simultaneous methods. Conversely, increasing the translation motion range improves the accuracy of simultaneous methods but degrades the accuracy of the separate methods. These findings suggest that those conditions should be considered when benchmarking algorithms or performing a calibration process for enhanced accuracy