167 resultados para prescribing trends


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Crashes that occur on motorways contribute to a significant proportion (40-50%) of non-recurrent motorway congestion. Hence, reducing the frequency of crashes assist in addressing congestion issues (Meyer, 2008). Analysing traffic conditions and discovering risky traffic trends and patterns are essential basics in crash likelihood estimations studies and still require more attention and investigation. In this paper we will show, through data mining techniques, that there is a relationship between pre-crash traffic flow patterns and crash occurrence on motorways, compare them with normal traffic trends, and that this knowledge has the potentiality to improve the accuracy of existing crash likelihood estimation models, and opens the path for new development approaches. The data for the analysis was extracted from records collected between 2007 and 2009 on the Shibuya and Shinjuku lines of the Tokyo Metropolitan Expressway in Japan. The dataset includes a total of 824 rear-end and sideswipe crashes that have been matched with crashes corresponding traffic flow data using an incident detection algorithm. Traffic trends (traffic speed time series) revealed that crashes can be clustered with regards to the dominant traffic patterns prior to the crash occurrence. K-Means clustering algorithm applied to determine dominant pre-crash traffic patterns. In the first phase of this research, traffic regimes identified by analysing crashes and normal traffic situations using half an hour speed in upstream locations of crashes. Then, the second phase investigated the different combination of speed risk indicators to distinguish crashes from normal traffic situations more precisely. Five major trends have been found in the first phase of this paper for both high risk and normal conditions. The study discovered traffic regimes had differences in the speed trends. Moreover, the second phase explains that spatiotemporal difference of speed is a better risk indicator among different combinations of speed related risk indicators. Based on these findings, crash likelihood estimation models can be fine-tuned to increase accuracy of estimations and minimize false alarms.

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Natural disasters can have adverse effect on human lives. To raise the awareness of research and better combat future events, it is important to identify recent research trends in the area of post disaster reconstruction (PDR). The authors used a three-round literature review strategy to study journal papers published in the last decade that are related to PDR with specific conditions using the Scopus search engine. A wide range of PDR related papers from a general perspective was examined in the first two rounds while the final round established 88 papers as target publications through visual examination of the abstracts, keywords and as necessary, main texts. These papers were analysed in terms of research origins, active researchers, research organisations, most cited papers, regional concerns, major themes and deliverables, for clues of the past trends and future directions. The need for appropriate PDR research is increasingly recognised. The publication number multiplied 5 times from 2002 to 2012. For PDR research with a construction perspective, the increase is sixfold. Developing countries such as those in Asia attract almost 50% researchers' attention for regional concerns while the US is the single most concentrated (24%) country. Africa is hardly represented. Researchers in developed countries lead in worldwide PDR research. This contrasts to the need for expertise in developing countries. Past works focused on waste management, stakeholder analysis, resourcing, infrastructure issue, resilience and vulnerability, reconstruction approach, sustainable reconstruction and governance issues. Future research should respond to resourcing, integrated development, sustainability and resilience building to cover the gaps. By means of a holistic summary and structured analysis of key patterns, the authors hope to provide a streamlined access to existing research findings and make predictions of future trends. They also hope to encourage a more holistic approach to PDR research and international collaborations.

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Digital Human Models (DHM) have been used for over 25 years. They have evolved from simple drawing templates, which are nowadays still used in architecture, to complex and Computer Aided Engineering (CAE) integrated design and analysis tools for various ergonomic tasks. DHM are most frequently used for applications in product design and production planning, with many successful implementations documented. DHM from other domains, as for example computer user interfaces, artificial intelligence, training and education, or the entertainment industry show that there is also an ongoing development towards a comprehensive understanding and holistic modeling of human behavior. While the development of DHM for the game sector has seen significant progress in recent years, advances of DHM in the area of ergonomics have been comparatively modest. As a consequence, we need to question if current DHM systems are fit for the design of future mobile work systems. So far it appears that DHM in Ergonomics are rather limited to some traditional applications. According to Dul et al. (2012), future characteristics of Human Factors and Ergonomics (HFE) can be assigned to six main trends: (1) global change of work systems, (2) cultural diversity, (3) ageing, (4) information and communication technology (ICT), (5) enhanced competiveness and the need for innovation, and; (6) sustainability and corporate social responsibility. Based on a literature review, we systematically investigate the capabilities of current ergonomic DHM systems versus the ‘Future of Ergonomics’ requirements. It is found that DHMs already provide broad functionality in support of trends (1) and (2), and more limited options in regards to trend (3). Today’s DHM provide access to a broad range of national and international databases for correct differentiation and characterization of anthropometry for global populations. Some DHM explicitly address social and cultural modeling of groups of people. In comparison, the trends of growing importance of ICT (4), the need for innovation (5) and sustainability (6) are addressed primarily from a hardware-oriented and engineering perspective and not reflected in DHM. This reflects a persistent separation between hardware design (engineering) and software design (information technology) in the view of DHM – a disconnection which needs to be urgently overcome in the era of software defined user interfaces and mobile devices. The design of a mobile ICT-device is discussed to exemplify the need for a comprehensive future DHM solution. Designing such mobile devices requires an approach that includes organizational aspects as well as technical and cognitive ergonomics. Multiple interrelationships between the different aspects result in a challenging setting for future DHM. In conclusion, the ‘Future of Ergonomics’ pose particular challenges for DHM in regards to the design of mobile work systems, and moreover mobile information access.

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This paper provides an overview of key trends in juvenile detention in Australia, based on data contained in the Australian Institute of Criminology’s (AIC’s) Juveniles in Detention in Australia Monitoring Program database and then provides a discussion of two key trends in juvenile detention—the national increase in the proportion of juvenile detainees that is remanded (rather than sentenced) and the increase in the over-representation of Indigenous juveniles in detention.

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Human and ecosystem health impacts imposed by water pollution are a major problem in the urban areas of Sri Lanka. A primary source of pollutants to urban water sources is atmospheric particles. Hence, it is important to develop a detailed understanding of atmospheric particle characteristics, their sources of origin and the transport pathways. Several research studies have been conducted in Sri Lanka on atmospheric pollution and these studies have tended to differ in their scope, study region and the investigated pollutants. The objectives of this paper are: (1) to report the outcomes of a detailed state-of-art literature review of atmospheric pollution related studies in Sri Lanka to understand the current trends and (2) to discuss the future research activities necessary to generate the important knowledge required for the development of effective strategies to control the adverse impacts of atmospheric pollution on urban waterways.

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Bisphenol A (BPA or 4,4’-(propane-2,2-diyl)diphenol) is a chemical intermediate in the production of polycarbonate and epoxy resins, and used in a wide range of applications. BPA has attracted significant attention in the past decade due to its frequency of detection in human populations worldwide, demonstrated animal toxicity and potential impact on human health, particularly during critical periods of development. The aim of this study was to perform a preliminary assessment of age-related trends in urinary concentration and to estimate daily excretion of BPA in Australian children (aged (>0 – <5 years) and adults (≥15 – <75 years). This was achieved using 79 samples pooled by age and gender, created from 868 individual samples of convenience collected as part of routine, community-based pathology testing. Total BPA was analyzed using online-SPE-LC-MS/MS and detected in all samples with a range of 0.65 – 265 ng/ml. No significant differences were observed between males and females. A urine flow model was constructed from published values and used to provide an estimate of daily excretion per unit bodyweight for each pooled sample. The daily excretion estimates ranged from 26.2 – 18200 ng/kg-d for children; and 20.1 – 165 ng/kg-d for adults. Urinary concentrations and estimated excretion rates were inversely associated with age, and estimated daily excretion rates in infants and young children were significantly higher than in adults (geometric mean: 107 and 47.0 ng/kg-d, respectively). Higher excretion of BPA in children may be explained by their higher food consumption relative to body weight compared to adults and adolescents, and may also reflect alternative exposure pathways and sources. Keywords: bisphenol A, biomonitoring, children, urine flow, Australia

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Objectives Current evidence to support non-medical prescribing is predominantly qualitative, with little evaluation of accuracy, safety and appropriateness. Our aim was to evaluate a new model of service for the Australia healthcare system, of inpatient medication prescribing by a pharmacist in an elective surgery preadmission clinic (PAC) against usual care, using an endorsed performance framework. Design Single centre, randomised controlled, two-arm trial. Setting Elective surgery PAC in a Brisbane-based tertiary hospital. Participants 400 adults scheduled for elective surgery were randomised to intervention or control. Intervention A pharmacist generated the inpatient medication chart to reflect the patient's regular medication, made a plan for medication perioperatively and prescribed venous thromboembolism (VTE) prophylaxis. In the control arm, the medication chart was generated by the Resident Medical Officers. Outcome measures Primary outcome was frequency of omissions and prescribing errors when compared against the medication history. The clinical significance of omissions was also analysed. Secondary outcome was appropriateness of VTE prophylaxis prescribing. Results There were significantly less unintended omissions of medications: 11 of 887 (1.2%) intervention orders compared with 383 of 1217 (31.5%) control (p<0.001). There were significantly less prescribing errors involving selection of drug, dose or frequency: 2 in 857 (0.2%) intervention orders compared with 51 in 807 (6.3%) control (p<0.001). Orders with at least one component of the prescription missing, incorrect or unclear occurred in 208 of 904 (23%) intervention orders and 445 of 1034 (43%) controls (p<0.001). VTE prophylaxis on admission to the ward was appropriate in 93% of intervention patients and 90% controls (p=0.29). Conclusions Medication charts in the intervention arm contained fewer clinically significant omissions, and prescribing errors, when compared with controls. There was no difference in appropriateness of VTE prophylaxis on admission between the two groups.

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Purpose To determine the extent of rigid contact lens fitting worldwide and to characterize the associated demographics and fitting patterns. Methods Survey forms were sent to contact lens fitters in up to 40 countries between January and March every year for five consecutive years (2007 to 2011). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey form. Survey data collected between 1996 and 2011 were also analyzed to assess rigid lens fitting trends in seven nations during this period. Results Data were obtained for 12,230 rigid and 100,670 soft lens fits between 2007 and 2011. Overall, rigid lenses represented 10.8% of all contact lens fits, ranging from 0.2% in Lithuania to 37% in Malaysia. Compared with soft lens fits, rigid lens fits can be characterized as follows: older age (rigid, 37.3 ± 15.0 years; soft, 29.8 ± 12.4 years); fewer spherical and toric fits; more bifocal/multifocal fits; less frequent replacement (rigid, 7%; soft, 85%); and less part-time wear (rigid, 4%; soft, 10%). High-Dk (contact lens oxygen permeability) (36%) and mid-Dk (42%) materials are predominantly used for rigid lens fitting. Orthokeratology represents 11.5% of rigid contact lens fits. There has been a steady decline in rigid lens fitting between 1996 and 2011. Conclusions Rigid contact lens prescribing is in decline but still represents approximately 10% of all contact lenses fitted worldwide. It is likely that rigid lenses will remain as a viable, albeit increasingly specialized, form of vision correction.

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Prescribing errors remain a significant cause of patient harm. Safe prescribing is not just about writing a prescription, but involves many cognitive and decision-making steps. A set of national prescribing competencies for all prescribers (including non-medical) is needed to guide education and training curricula, assessment and credentialing of individual practitioners. We have identified 12 core competencies for safe prescribing which embody the four stages of the prescribing process – information gathering, clinical decision making, communication, and monitoring and review. These core competencies, along with their learning objectives and assessment methods, provide a useful starting point for teaching safe and effective prescribing.

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This is the eighth consecutive year that we have presented data from a survey of international contact lens prescribing in Contact Lens Spectrum. In this article we report on an assessment of 25,801 fits across 28 contact lens markets located in North America, Europe, the Middle East, Asia, and Africa. As in previous years, we opted for a prospective approach to this work. Up to 1,000 survey forms were randomly disseminated in each market to contact lens practitioners (ophthalmologists, optometrists, and/or opticians depending on the market), and information about the first 10 patients prescribed with lenses after receipt of paper or electronic survey forms was anonymously recorded.

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For the past nine years, we have described the current state of contact lens fitting worldwide in Contact Lens Spectrum. This year, we report on 24,642 lens fits in 27 markets. As in all previous years, coordinators in each market distributed up to 1,000 paper or electronic survey forms to contact lens practitioners who, in turn, collected information about their next 10 fits. Data were processed and checked in the survey administrative offices in Manchester, United Kingdom and in Waterloo, Canada.

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Globalisation is a concept that templates onto many aspects of the commercial world, and the contact lens field is no exception. The major international companies have worldwide distribution networks and supply lenses of the same product names and replacement frequencies to all nations, with a few minor adjustments for marketing and regulatory reasons. Small and mediumsized companies, often producing more specialist lenses, are also active in markets across the world.

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Along with other facets of commericialization, the contact lens market has become globalized during the past 30 years. The major international companies have worldwide distribution networks and supply lenses of the same product names and replacement frequencies to all nations, with a few minor adjustments for marketing and regulatory reasons. Small and medium-sized companies, often producing more specialized lenses, are also active in markets across the world.