960 resultados para Medicines alternatives
Resumo:
Veterinary medicines (VMs) from agricultural industry can enter the environment in a number of ways. This includes direct exposure through aquaculture, accidental spillage and disposal, and indirect entry by leaching from manure or runoff after treatment. Many compounds used in animal treatments have ecotoxic properties that may have chronic or sometimes lethal effects when they come into contact with non-target organisms. VMs enter the environment in mixtures, potentially having additive effects. Traditional ecotoxicology tests are used to determine the lethal and sometimes reproductive effects on freshwater and terrestrial organisms. However, organisms used in ecotoxicology tests can be unrepresentative of the populations that are likely to be exposed to the compound in the environment. Most often the tests are on single compound toxicity but mixture effects may be significant and should be included in ecotoxicology testing. This work investigates the use, measured environmental concentrations (MECs) and potential impact of sea lice treatments on salmon farms in Scotland. Alternative methods for ecotoxicology testing including mixture toxicity, and the use of in silico techniques to predict the chronic impact of VMs on different species of aquatic organisms were also investigated. The Scottish Environmental Protection Agency (SEPA) provided information on the use of five sea lice treatments from 2008-2011 on Scottish salmon farms. This information was combined with the recently available data on sediment MECs for the years 2009-2012 provided by SEPA using ArcGIS 10.1. In depth analysis of this data showed that from a total of 55 sites, 30 sites had a MEC higher than the maximum allowable concentration (MAC) as set out by SEPA for emamectin benzoate and 7 sites had a higher MEC than MAC for teflubenzuron. A number of sites that were up to 16 km away from the nearest salmon farm reported as using either emamectin benzoate or teflubenzuron measured positive for the two treatments. There was no relationship between current direction and the distribution of the sea lice treatments, nor was there any evidence for alternative sources of the compounds e.g. land treatments. The sites that had MECs higher than the MAC could pose a risk to non-target organisms and disrupt the species dynamics of the area. There was evidence that some marine protected sites might be at risk of exposure to these compounds. To complement this work, effects on acute mixture toxicity of the 5 sea lice treatments, plus one major metabolite 3-phenoxybenzoic acid (3PBA), were measured using an assay using the bioluminescent bacteria Aliivibrio fischeri. When exposed to the 5 sea lice treatments and 3PBA A. fischeri showed a response to 3PBA, emamectin benzoate and azamethiphos as well as combinations of the three. In order to establish any additive effect of the sea lice treatments, the efficacy of two mixture prediction equations, concentration addition (CA) and independent action ii(IA) were tested using the results from single compound dose response curves. In this instance IA was the more effective prediction method with a linear regression confidence interval of 82.6% compared with 22.6% of CA. In silico molecular docking was carried out to predict the chronic effects of 15 VMs (including the five used as sea lice control). Molecular docking has been proposed as an alternative screening method for the chronic effects of large animal treatments on non-target organisms. Oestrogen receptor alpha (ERα) of 7 non-target bony fish and the African clawed frog Xenopus laevis were modelled using SwissModel. These models were then ‘docked’ to oestradiol, the synthetic oestrogen ethinylestradiol, two known xenoestrogens dichlorodiphenyltrichloroethane (DDT) and bisphenol A (BPA), the antioestrogen breast cancer treatment tamoxifen and 15 VMs using Auto Dock 4. Based on the results of this work, four VMs were identified as being possible xenoestrogens or anti-oestrogens; these were cypermethrin, deltamethrin, fenbendazole and teflubenzuron. Further investigation, using in vitro assays, into these four VMs has been suggested as future work. A modified recombinant yeast oestrogen screen (YES) was attempted using the cDNA of the ERα of the zebrafish Danio rerio and the rainbow trout Oncorhynchus mykiss. Due to time and difficulties in cloning protocols this work was unable to be completed. Use of such in vitro assays would allow for further investigation of the highlighted VMs into their oestrogenic potential. In conclusion, VMs used as sea lice treatments, such as teflubenzuron and emamectin benzoate may be more persistent and have a wider range in the environment than previously thought. Mixtures of sea lice treatments have been found to persist together in the environment, and effects of these mixtures on the bacteria A. fischeri can be predicted using the IA equation. Finally, molecular docking may be a suitable tool to predict chronic endocrine disrupting effects and identify varying degrees of impact on the ERα of nine species of aquatic organisms.
Resumo:
Background
There is a growing body of evidence suggesting patients with life-limiting illness use medicines inappropriately and unnecessarily. In this context, the perspective of patients, their carers and the healthcare professionals responsible for prescribing and monitoring their medication is important for developing deprescribing strategies. The aim of this study was to explore the lived experience of patients, carers and healthcare professionals in the context of medication use in life-limiting illness.
MethodsIn-depth interviews, using a phenomenological approach: methods of transcendental phenomenology were used for the patient and carer interviews, while hermeneutic phenomenology was used for the healthcare professional interviews.
ResultsThe study highlighted that medication formed a significant part of a patient’s day-to-day routine; this was also apparent for their carers who took on an active role-as a gatekeeper of care-in managing medication. Patients described the experience of a point in which, in their disease journey, they placed less importance on taking certain medications; healthcare professionals also recognize this and refer it as a ‘transition’. This point appeared to occur when the patient became accepting of their illness and associated life expectancy. There was also willingness by patients, carers and healthcare professionals to review and alter the medication used by patients in the context of life-limiting illness.
ConclusionsThere is a need to develop deprescribing strategies for patients with life-limiting illness. Such strategies should seek to establish patient expectations, consider the timing of the discussion about ceasing treatment and encourage the involvement of other stakeholders in the decision-making progress.
The development of a core outcome set for medicines management interventions in people with dementia
Resumo:
Background Despite the importance placed on the concept of the multidisciplinary team in relation to intermediate care (IC), little is known about community pharmacists’ (CPs) involvement.
Objective To determine CPs’ awareness of and involvement with IC services, perceptions of the transfer of patients’ medication information between healthcare settings and views of the development of a CP–IC service.
Setting Community pharmacies in Northern Ireland.
Methods A postal questionnaire, informed by previous qualitative work was developed and piloted.
Main outcome measure CPs’ awareness of and involvement with IC. Results The response rate was 35.3 % (190/539). Under half (47.4 %) of CPs ‘agreed/strongly agreed’ that they understood the term ‘intermediate care’. Three quarters of respondents were either not involved or unsure if they were involved with providing services to IC. A small minority (1.2 %) of CPs reported that they received communication regarding medication changes made in hospital or IC settings ‘all of the time’. Only 9.5 and 0.5 % of respondents ‘strongly agreed’ that communication from hospital and IC, respectively, was sufficiently detailed. In total, 155 (81.6 %) CPs indicated that they would like to have greater involvement with IC services. ‘Current workload’ was ranked as the most important barrier to service development.
Conclusion It was revealed that CPs had little awareness of, or involvement with, IC. Communication of information relating to patients’ medicines between settings was perceived as insufficient, especially between IC and community pharmacy settings. CPs demonstrated willingness to be involved with IC and services aimed at bridging the communication gap between healthcare settings.
Resumo:
In modernen Unternehmen zählen fahrerlose Transportsysteme (FTS) zum Stand der Technik. Die am weitesten verbreitete Form solcher Systeme stellen spurgeführte Systeme dar. Durch die jahrzehntelange Entwicklung und den jahrzehntelangen Einsatz gelten solche Systeme als erprobt und robust. Allerdings werden sie, auf Grund minimaler Möglichkeiten auf ihre Umwelt zu reagieren, auch als unflexibel eingestuft. Aus diesem Grund wurde am Institut für Fördertechnik und Logistiksysteme (IFL) ein System entwickelt, welches vorausschauend fahren kann und somit in der Lage ist, in begrenzter Form, auf seine Umgebung zu reagieren.
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Report on a review of the Resource Enhancement and Protection (REAP) program and the Solid Waste Alternatives Program (SWAP) administered by the Department of Natural Resources (DNR) for the period July 1, 2009 through June 30, 2015
Resumo:
In February the U.S. 20 Corridor Development Study's Steering Committee met to review Report A. At that meeting the Committee selected seven alternatives to be evaluated from a cost and traffic perspective. This report, Report B, presents the cost and traffic evaluation of these seven alternatives. This Report B and its cost and traffic estimates will be reviewed at the next Steering Committee meeting. At that time it is possible that, based on the traffic and cost estimates, one or more of the alternatives will be eliminated from further consideration. After that meeting the Consultant will initiate the more in-depth analyses, including the economic feasibility
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Thesis (Ph.D.)--University of Washington, 2016-08
Resumo:
Inland flood risks are defined by a range of environmental and social factors, including land use and floodplain management. Shifting patterns of storm intensity and precipitation, attributed to climate change, are exacerbating flood risk in regions across North America. Strategies for adapting to growing flood risks and climate change must account for a community’s specific vulnerabilities, and its local economic, environmental, and social conditions. Through a stakeholder-engaged methodology, we designed an interactive decision exercise to enable stakeholders to evaluate alternatives for addressing specific community flood vulnerabilities. We used a multicriteria framework to understand what drives stakeholder preferences for flood mitigation and adaptation alternatives, including ecosystem-based projects. Results indicated strong preferences for some ecosystem-based projects that utilize natural capital, generated a useful discussion on the role of individual values in driving decisions and a critique of local environmental and hazard planning procedure, and uncovered support for a river management alternative that had previously been considered socially infeasible. We conclude that a multicriteria decision framework may help ensure that the multiple benefit qualities of natural capital projects are considered by decision makers. Application of a utility function can demonstrate the role of individual decision-maker values in decision outcomes and help illustrate why one alternative may be a better choice than another. Although designing an efficient and accurate multicriteria exercise is quite challenging and often data intensive, we imagine that this method is applicable elsewhere. It may be especially suitable to group decisions that involve varying levels of expertise and competing values, as is often the case in planning for the ecological and human impacts of climate change.
Resumo:
Les dernières décennies ont apporté de grandes transformations à l'élevage porcin, qui est dorénavant considérée comme une agro-industrie composée de quelques grands joueurs à l’échelle internationale. Ces changements structurels ont contribué à l’apparition de problèmes associés à la quantité croissante de lisier produite par le secteur porcin aux États-Unis. Certaines préoccupations environnementales telles que les impacts sur les eaux de surface et souterraine, les effets sur la qualité de l’air et des sols sont notamment soulevées. Par contre, lorsque la gestion et l’épandage du lisier sont faits de manière adéquate en prenant soin d’éviter toute forme de pollution, le lisier est un excellent engrais, riche en nutriments essentiels aux cultures. Actuellement, deux méthodes d’entreposage sont généralisées aux États-Unis : les fosses souterraines pour entreposer le lisier non-dilué et les lagunes ouvertes pour le lisier liquide. La majorité des producteurs valorisent toujours leur lisier par épandage aux champs. Malheureusement, les méthodes actuelles de gestion utilisées ne sont pas jugées durables, ni du point de vue environnemental, social ou économique. Pourtant, plusieurs pratiques durables et efficaces existent et peuvent être introduites de façon relativement simple comme entre autres, l’implantation de bandes riveraines et l’épandage du lisier en post-levée avec des engrais verts. De plus, la valorisation énergétique grâce à un digesteur anaérobie est une option forte intéressante en raison des avantages économiques qui peuvent découler de son utilisation. Pour le moment, ces méthodes restent toujours très marginales. Certains freins sont possiblement responsables de l’inaction face aux problèmes environnementaux causés par le lisier. Entre autres, le fait que les producteurs porcins soient maintenant sous contrats avec des firmes intégratrices, le monopole de certaines compagnies agroalimentaire et les emplois précaires offerts par les industries. Ainsi, après l’analyse de la gestion des lisiers aux États-Unis, plusieurs constats et recommandations ont pu être formulés : la nécessité de mettre en place une loi sur la qualité de l’air, les changements nécessaires au Clean Water Act, l’abolition des lagunes dans le but de mettre en place des méthodes plus durables telles les digesteurs anaérobies, la mise en place de moratoire pour les cheptels dans les régions avec des surplus d’éléments nutritifs dans le sol et enfin le retour graduel à une agriculture à plus petite échelle et locale.
Resumo:
This study explores whether a partial explanation for high antidepressant prescription rates is the failure of prescribers to recommend alternatives. 1,829 New Zealand adults were asked which of six non-pharmacological treatment approaches were recommended when prescribed anti-depressants. The majority (82%) received at least one recommendation and 32% received three or more, most commonly ‘Counsellor/Psychologist/Psychotherapist’ (74%) and Exercise Schedule (43%). It cannot, therefore, be concluded that failing to consider non-pharmacological treatments is a major cause of high prescribing rates. Being younger and more severely depressed were both positively related to number of recommendations. Psychiatrists made significantly more recommendations than GPs.