Trends and patterns of analgesic prescribing in Malaysian public hospitals from 2010 to 2016 : Tramadol predominately used

Purpose: To examine the trends of analgesic prescribing at public tertiary hospital outpatient settings and explore the patterns of their utilization in NSAIDs, tramadol and opioid patients. Patients and methods: This cross sectional study was conducted from 2010 to 2016 using the prescription databases of two tertiary hospitals in Malaysia. Prescriptions for nine NSAIDs (ketoprofen, diclofenac, celecoxib, etoricoxib, ibuprofen, indomethacin, meloxicam, mefenamic acid and naproxen), tramadol and five other opioids (morphine, fentanyl, oxycodone, dihydrocodeine, and buprenorphine) were included in this study. Annual number of patients and prescriptions were measured in repeat cross sectional estimates. Descriptive statistics and linear trend analysis were performed using Stata v13. Results: A total of 192747 analgesic prescriptions of the nine NSAIDs, tramadol, and five other opioids were prescribed for 97227 patients (51.8% NSAIDs patients, 46.6% tramadol patients, and 1.7% opioid patients) from 2010 to 2016. Tramadol (37.9%, n = 72999) was the most frequently prescribed analgesic followed by ketoprofen (17.5%, n=33793), diclofenac (16.2%, n = 31180), celecoxib (12.2%, n =23487), and other NSAIDs (<4.5%). All the analgesics were increased over time except for meloxicam, indomethacin, and mefenamic acid. Opioids, primarily morphine (2.2%, n = 4021) and oxycodone (0.5%, n = 1049), were prescribed the least but the rate of increase was the highest. Conclusion: Tramadol was the most frequently prescribed analgesic at hospital outpatient settings in Malaysia. Opioids were prescribed the least but noted the highest increase in utilization

MicroMotility: State of the art, recent accomplishments and perspectives on the mathematical modeling of bio-motility at microscopic scales

Mathematical modeling and quantitative study of biological motility (in particular, of motility at microscopic scales) is producing new biophysical insight and is offering opportunities for new discoveries at the level of both fundamental science and technology. These range from the explanation of how complex behavior at the level of a single organism emerges from body architecture, to the understanding of collective phenomena in groups of organisms and tissues, and of how these forms of swarm intelligence can be controlled and harnessed in engineering applications, to the elucidation of processes of fundamental biological relevance at the cellular and sub-cellular level. In this paper, some of the most exciting new developments in the fields of locomotion of unicellular organisms, of soft adhesive locomotion across scales, of the study of pore translocation properties of knotted DNA, of the development of synthetic active solid sheets, of the mechanics of the unjamming transition in dense cell collectives, of the mechanics of cell sheet folding in volvocalean algae, and of the self-propulsion of topological defects in active matter are discussed. For each of these topics, we provide a brief state of the art, an example of recent achievements, and some directions for future research

Method of Advancement Guidance on Planting Religious Value of Early Childhood in Bone

Research on counseling guidance methods for inculcating religious values in early childhood aims to determine the application of parental counseling guidance in inculcating religious values in early childhood in the family, as well as the obstacles experienced in the application of guidance carried out by families. Therefore, this research is a field research with a qualitative research type, it will focus on the interview method, observation, while the primary data for parents and early childhood, the research instrument itself, while the data analysis is data reduction, data presentation, drawing conclusions. The results showed that in the application of the counseling guidance method to the inculcation of religious values in early childhood, five methods were used, namely: the method of giving advice; in giving counsel gently and tactfully so that children may receive counsel, The exemplary method; the family should give a good example to the child, the method of habituation; it is necessary to make habituation to children so that children always do good and practice the goodness they know, Supervision Methods; carry out surveillance at all times, and the method of punishment; punish the child so that the child is aware of the mistakes that have been made. While the obstacles faced by the family are the influence of social media, and the child's social environment

Optimized energy recovery in line with balancing of an ATES

The present study explores the potential imbalance problem of the Aquifer Thermal Energy Storage (ATES) system at the Eindhoven University of Technology (TU/e) campus, Eindhoven. This ATES is one of the largest European aquifer thermal energy storage systems, and has a seasonal imbalance problem. Reasons for this issue may be the high cooling demand from laboratories, office buildings and the direct ATES cooling system. Annually, cooling towers use on average 250 MWh electricity for the removal of about 5 GWh of excess heat from the ATES to the surroundings. In addition, the TU/e uses a large amount of natural gas for heating purposes and especially for peak supplies. Recovering the surplus heat of the ATES, a CO2 Trans-critical Heat Pump (HP) system to cover particularly peak demands and total heating demand is proposed, modeled and optimized. The model is validated using data from International Energy Agency. Based on simulation results, 708294 nm3 of natural gas are saved where two different scenarios were considered for the ATES efficiency, cost saving and green house gas reduction. In scenario I, the COP of the ATES increased up to 50% by which K€ 303.3 energy cost and 1288.5 ton CO2 are saved annually. On the other hand, it will be shown that the ATES COP in Scenario II will improve up to 20%. In addition, the proposed energy recovery system results in a 606 ton CO2 -reduction and K€152.7 energy cost saving for the university each year