63 resultados para Area with a shortage of doctors

em CentAUR: Central Archive University of Reading - UK


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This paper presents the results of (a) On-farm trials (eight) over a two-year period designed to test the effectiveness of leguminous cover crops in terms of increasing maize yields in Igalaland, Nigeria. (b) A survey designed to monitor the extent of, and reasons behind, adoption of the leguminous cover crop technology in subsequent years by farmers involved, to varying degrees, in the trial programme. particular emphasis was placed on comparing adoption of leguminous cover crops with that of new crop varieties released by a non-governmental organization in the same area since the mid 1980s. While the leguminous cover crop technology boosted maize grain yields by 127 to 136% above an untreated control yield of between 141 and 171 kg ha(-1), the adoption rate (number of farmers adopting) was only 18%. By way of contrast, new crop varieties had a highly variable benefit in terms of yield advantage over local varieties, with the best average increase of around 20%. Adoption rates for new crop varieties, assessed as both the number of farmers growing the varieties and the number of plots planted to the varieties, were 40% on average. The paper discusses some key factors influencing adoption of the leguminous cover crop technology, including seed availability. Implications of these results for a local non-governmental organization, the Diocesan Development Services, concerned with promoting the leguminous cover crop technology are also discussed.

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Background Pharmacy aseptic units prepare and supply injectables to minimise risks. The UK National Aseptic Error Reporting Scheme has been collecting data on pharmacy compounding errors, including near-misses, since 2003. Objectives The cumulative reports from January 2004 to December 2007, inclusive, were analysed. Methods The different variables of product types, error types, staff making and detecting errors, stage errors detected, perceived contributory factors, and potential or actual outcomes were presented by cross-tabulation of data. Results A total of 4691 reports were submitted against an estimated 958 532 items made, returning 0.49% as the overall error rate. Most of the errors were detected before reaching patients, with only 24 detected during or after administration. The highest number of reports related to adult cytotoxic preparations (40%) and the most frequently recorded error was a labelling error (34.2%). Errors were mostly detected at first check in assembly area (46.6%). Individual staff error contributed most (78.1%) to overall errors, while errors with paediatric parenteral nutrition appeared to be blamed on low staff levels more than other products were. The majority of errors (68.6%) had no potential patient outcomes attached, while it appeared that paediatric cytotoxic products and paediatric parenteral nutrition were associated with greater levels of perceived patient harm. Conclusions The majority of reports were related to near-misses, and this study highlights scope for examining current arrangements for checking and releasing products, certainly for paediatric cytotoxic and paediatric parenteral nutrition preparations within aseptic units, but in the context of resource and capacity constraints.

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Objective To examine the impact of increasing numbers of metabolic syndrome (MetS) components on postprandial lipaemia. Methods Healthy men (n = 112) underwent a sequential meal postprandial investigation, in which blood samples were taken at regular intervals after a test breakfast (0 min) and lunch (330 min). Lipids and glucose were measured in the fasting sample, with triacylglycerol (TAG), non-esterified fatty acids and glucose analysed in the postprandial samples. Results Subjects were grouped according to the number of MetS components regardless of the combinations of components (0/1, 2, 3 and 4/5). As expected, there was a trend for an increase in body mass index, blood pressure, fasting TAG, glucose and insulin, and a decrease in fasting high-density lipoprotein cholesterol with increasing numbers of MetS components (P≤0.0004). A similar trend was observed for the summary measures of the postprandial TAG and glucose responses. For TAG, the area under the curve (AUC) and maximum concentration (maxC) were significantly greater in men with ≥ 3 than < 3 components (P < 0.001), whereas incremental AUC was greater in those with 3 than 0/1 and 2, and 4/5 compared with 2 components (P < 0.04). For glucose, maxC after the test breakfast (0-330 min) and total AUC (0-480 min) were higher in men with ≥ 3 than < 3 components (P≤0.001). Conclusions Our data analysis has revealed a linear trend between increasing numbers of MetS components and magnitude (AUC) of the postprandial TAG and glucose responses. Furthermore, the two meal challenge discriminated a worsening of postprandial lipaemic control in subjects with ≥ 3 MetS components.

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Wild bird feeding is popular in domestic gardens across the world. Nevertheless, there is surprisingly little empirical information on certain aspects of the activity and no year-round quantitative records of the amounts and nature of the different foods provided in individual gardens. We sought to characterise garden bird feeding in a large UK urban area in two ways. First, we conducted face-to-face questionnaires with a representative cross-section of residents. Just over half fed birds, the majority doing so year round and at least weekly. Second, a two-year study recorded all foodstuffs put out by households on every provisioning occasion. A median of 628 kcal/garden/day was given. Provisioning level was not significantly influenced by weather or season. Comparisons between the data sets revealed significantly less frequent feeding amongst these ‘keen’ feeders than the face-to-face questionnaire respondents, suggesting that one-off questionnaires may overestimate provisioning frequency. Assuming 100% uptake, the median provisioning level equates to sufficient supplementary resources across the UK to support 196 million individuals of a hypothetical average garden-feeding bird species (based on 10 common UK garden-feeding birds’ energy requirements). Taking the lowest provisioning level recorded (101 kcal/day) as a conservative measure, 31 million of these average individuals could theoretically be supported.

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Space weather effects on technological systems originate with energy carried from the Sun to the terrestrial environment by the solar wind. In this study, we present results of modeling of solar corona-heliosphere processes to predict solar wind conditions at the L1 Lagrangian point upstream of Earth. In particular we calculate performance metrics for (1) empirical, (2) hybrid empirical/physics-based, and (3) full physics-based coupled corona-heliosphere models over an 8-year period (1995–2002). L1 measurements of the radial solar wind speed are the primary basis for validation of the coronal and heliosphere models studied, though other solar wind parameters are also considered. The models are from the Center for Integrated Space-Weather Modeling (CISM) which has developed a coupled model of the whole Sun-to-Earth system, from the solar photosphere to the terrestrial thermosphere. Simple point-by-point analysis techniques, such as mean-square-error and correlation coefficients, indicate that the empirical coronal-heliosphere model currently gives the best forecast of solar wind speed at 1 AU. A more detailed analysis shows that errors in the physics-based models are predominately the result of small timing offsets to solar wind structures and that the large-scale features of the solar wind are actually well modeled. We suggest that additional “tuning” of the coupling between the coronal and heliosphere models could lead to a significant improvement of their accuracy. Furthermore, we note that the physics-based models accurately capture dynamic effects at solar wind stream interaction regions, such as magnetic field compression, flow deflection, and density buildup, which the empirical scheme cannot.

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The kinetics of uptake of gaseous N2O5 on submicron aerosols containing NaCl and natural sea salt have been investigated in a flow reactor as a function of relative humidity (RH) in the range 30-80% at 295±2K and a total pressure of 1bar. The measured uptake coefficients, γ, were larger on the aerosols containing sea salt compared to those of pure NaCl, and in both cases increased with increasing RH. These observations are explained in terms of the variation in the size of the salt droplets, which leads to a limitation in the uptake rate into small particles. After correction for this effect the uptake coefficients are independent of relative humidity, and agree with those measured previously on larger droplets. A value of γ=0.025 is recommended for the reactive uptake coefficient for N2O5 on deliquesced sea salt droplets at 298K and RH>40%.

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This paper introduces a simple futility design that allows a comparative clinical trial to be stopped due to lack of effect at any of a series of planned interim analyses. Stopping due to apparent benefit is not permitted. The design is for use when any positive claim should be based on the maximum sample size, for example to allow subgroup analyses or the evaluation of safety or secondary efficacy responses. A final frequentist analysis can be performed that is valid for the type of design employed. Here the design is described and its properties are presented. Its advantages and disadvantages relative to the use of stochastic curtailment are discussed. Copyright (C) 2003 John Wiley Sons, Ltd.