393 research outputs found
Contextual and interdependent causes of climate change adaptation barriers: Insights from water management institutions in Himachal Pradesh, India
Research on adaptation barriers is increasing as the need for climate change adaptation becomes evident. However, empirical studies regarding the emergence, causes and sustenance of adaptation barriers remain limited. This research identifies key contextual causes of adaptation barriers in water institutions in the mountainous Himalayan state of Himachal Pradesh in northern India. Semi-structured interviews were carried out with representatives from twenty-six key governmental, non-governmental, academic and research institutions in the State with responsibilities spanning domestic water supply, irrigation and hydropower generation, environmental monitoring and research. It identified low knowledge capacity and resources, policy implementation gaps, normative attitudes, and unavailability and inaccessibility of data and information compounded with weak interinstitutional networks as key adaptation barriers. Although these barriers are similar to those reported elsewhere, they have important locally-contextual root causes. For instance, inadequate resources result from fragmented resources allocation due to competing developmental priorities and the desire of the political leadership to please diverse electors, rather than climate scepticism. The identified individual barriers are found to be highly inter-dependent and closely intertwined which enables the identification of leverage points for interventions to maximise barrier removal. For instance, breaking down key barriers hindering accessibility to data and information, which are shaped by systemic bureaucracies and cultural attitudes, will involve attitudinal change through sensitisation to the importance of accurate and accessible data and information and the building trust between different actors, in addition to institutional structural changes through legislation and inter-institutional agreements. Approaching barriers as a system of contextually interconnected cultural, systemic, geographical and political underlying factors enriches the understanding of adaptation enablers, thereby contributing to achieving a better adapted society
Reconstruction of Post-Traumatic Bone Defect of the Upper-Limb with Vascularized Fibular Graft
Humerus shaft fracture complicated by radial nerve palsy: Is surgical exploration necessary?
Fractures of the humerus shaft often are complicated by radial nerve palsy. Controversy still exists in the treatment that includes clinical observation and eventually late surgical exploration or early surgical exploration. Algorithms have been proposed to provide recommendations with regard to management of the injuries. However, advantages and disadvantages are associated with each of these algorithms. The aim of this study was to analyze the indications of each treatment options and facilitate the surgeon in choosing the conduct for each lesion, proposing our own algorithm
Kualitas Penggunaan Antibiotik Pada Pasien Bedah Digestif Di Rsup Dr Kariadi Semarang
Background: Inapropiate use of antibiotic results in antibiotic resistance. Most antibiotic USAge in hospital is in surgery patients. This study was conducted to determine the quality USAge of antibiotic in digest-surgery patients in Kariadi hospital in July-December 2014.Method:This study used descriptive design with medical records of digestive surgery patients who used antibiotic in July-December 2014. Medical records that were obtained by random (simple random sampling) method, analyzed by Gyssens category.Results: There were 106 prescriptions from 36 medical records. The most USAge antibiotics are ceftriaxone, cefadroxil, and ciprofloxacin. The assessment of Gyssens's method showed that 16% were classified as rational use. 5,7% were irrational caused by too long USAge (IIIA), 0,9% irrational caused by too short timing, 23,6% irrational caused by there are narrower spectrum (IVD), 51,9% unknown indication (V), and 1,2% cannot be analyzed (VI). The type of therapy were reviewed as ADE (17,9%), ADET (0,9%), ADP (27,4%), and ADU (51,9%).Conslusion :Quality of antibiotic use in digestive surgery ward based on Gyssens is mostly irrationa
Analisis Toll Charge Using Atp/wtp for Kraksaan – Banyuwangi Toll Road
East Java is the second most populous province in Indonesia, based on census data given by Central Bureau of Statistics. The population density in East Java also in line with its density in the sector of transportation. The route has low safety level since there is PLTU Paiton that could affect the road user when there is work accident. To handle density and safety problem, a construction of Kraksaan-Banyuwangi toll was planned to support the Trans-Java Toll. In this construction plan, an investigation of ideal tariff based on user perception using ATP and WTP analysis was required. Data collection was done in Besuki sub-district with 2 locations of survey. The survey was conducted with the method of interview and closed questionnaire for 422 respondents. According to the graphic of relationship between those two methods, the result of respondents characteristic and ideal tariff of Kraksaan-Banyuwangi toll is acquired as follows: Group 1 Rp.625,00/Km, Group 2 Rp. 937.50/Km, Group 3 Rp. 1.250,00/Km, Group 4 Rp.1.562,50/Km, and Group 5 Rp. 1.875,00/Km. The ideal tariff obtained is deemed as low compared to toll tariff in the district of Surabaya, Gempol, Sidoarto and Mojokerto. The difference is regarded as normal considering the growth value of Kraksaan-Banyuwangi region that is still below the aforementioned districts– according to Central Bureau of Statistics (BPS). The low ideal tariff is also influenced by the perception of respondents towards the transportation density of the route that is still considered as normal. Since most of the respondents have never used any toll road before, they also assumed that alternative road / toll is still unimportant
Kesuburan Perairan Ditinjau dari Kandungan Klorofil-a Fitoplankton : Studi Kasus di Sungai Wedung, Demak
Perairan Sungai Wedung merupakan ekosistem pesisir yang banyak dimanfaatkan untuk berbagai kegiatan manusia. Hal tersebut tentunya berpengaruh terhadap kesuburan perairan Sungai Wedung. Kesuburan di perairan tersebut dipengaruhi oleh plankton, faktor kimia, fisika dan juga kandungan Klorofil-A. Pengukuran kandungan klorofil-a fitoplankton merupakan salah satu alat pengukuran kesuburan suatu perairan. Klorofil-a fitoplankton adalah suatu pigmen aktif dalam sel tumbuhan yang mempunyai peran penting dalam berlangsungnya proses fotosintesis perairan. Penelitian dilakukan pada bulan April – Mei 2013 di Sungai Wedung, Demak bertujuan untuk mengetahui aktivitas manusia terhadap sebaran klorofil-a, keterkaitan antara klorofil-a dan kelimpahan fitoplankton dan tingkat kesuburan perairan berdasarkan kandungan klorofil-a fitoplankton. Metode yang digunakan adalah metode studi kasus dengan teknik pengambilan sampel menggunakan metode “Sample Survey Method”. Hasil penelitian menunjukkan bahwa hasil analisis data klorofil menggunakan metode anova tersarang (nested anova) diperoleh nilai P untuk stasiun cukup besar sehingga tidak memberikan perbedaan yang nyata pada taraf kepercayaan 95 %. Akan tetapi perbedaan akan nyata pada taraf 90%. Hubungan antara klorofil-a dengan kelimpahan fitoplankton secara linear menunjukkan nilai keeratan yang tinggi dengan nilai koefisien korelasi sebesar 0,93 dan koefisien determinasi sebesar 0,8633 dimana 86% klorofil-a dipengaruhi oleh kelimpahan fitoplankton. Berdasarkan nilai rata-rata klorofil-a yang diperoleh sebesar 1,039863 mg/l dapat disimpulkan bahwa perairan Sungai Wedung tergolong kedalam perairan yang bersifat oligotrofik
An operational strategy to produce Bio-hydrogen : the use of digestate for process control
A semi-continuous digester was fed twice a day with a concentrated solution of glucose (100 g l-1) and monitored for a 30-days period, with the aim of testing the possibility of utilizing the digestate of a traditional biogas plant, after a heat-shock at 100\ubaC, for controlling process parameters (organic loading rate OLR, pH, volatile fatty acids VFA concentration), by adding it to the fresh substrate at a ratio R of the total feeding volume. The process resulted instable for OLR=10 gVS L-1and R=0.7, while more stable for OLR of 5 gVS L-1and R=0.85. The maximum bio-hydrogen production rate in stable conditions was 100 NmLH2 h-1 and the conversion yields were 1.7 - 1.8 molH2 mol-1glucose. The produced biogas showed always complete absence of methane
Age-specific prevalence of the different clinical presentations of AD and FTD in young-onset dementia
Background Studies have shown that the prevalence of all-variants Alzheimer's disease (AD) and frontotemporal dementia (FTD) both increase with age, even before the age of 65. However, it is not known whether their different clinical presentations all increase in prevalence with age in the same way.Methods We studied the prevalence of the different clinical presentations of young-onset AD and FTD by 5-year age groups in a population-based study identifying all dementia patients with a diagnosis of AD and FTD and symptoms onset before age 65 in the Modena province, Italy. By using regression models of cumulative occurrences, we also estimated age-specific prevalence and compared the growth curves of the clinical presentations.Results The prevalence of all-variants AD increased with age, from 18/1,000,000 in the 40-44 age group to 1411/1,000,000 in the 60-64 age group. The prevalence of all-variants FTD also increased with age, from 18/1,000,000 to 866/1,000,000. An estimation of age-specific prevalence functions of each clinical presentation showed that atypical non-amnestic AD and aphasic FTD grew the most in early ages, followed by the behavioural variant of FTD (bvFTD). Then, around the age of 60, amnestic AD took over and its age-specific prevalence continued to increase disproportionally compared to all the other clinical variants of AD and FTD, which, instead, started to decrease in prevalence.Conclusions Amnestic AD is the clinical presentation that increases the most with advancing age, followed by bvFTD, suggesting that there is a differential vulnerability to the effect of ageing within the same neurodegenerative disease
Postoperative trends and prognostic values of inflammatory and nutritional biomarkers after liver transplantation for hepatocellular carcinoma
11noPreoperative inflammatory biomarkers such as the Platelet-to-Lymphocyte Ratio (PLR) and the Neutrophil-to-Lymphocyte Ratio (NLR) strongly predict the outcome in surgically treated patients with hepatocellular carcinoma (HCC), while nutritional biomarkers such as the Controlling Nutritional Status (CONUT) and the Prognostic Nutritional Index (PNI) show an analogue prognostic value in hepatic resection (HR) but not in liver transplant (LT) cases. Data on the impact of LT on the inflammatory and nutritional/metabolic function are heterogeneous. Therefore, we investigated the post-LT trend of these biomarkers up to postoperative month (POM) 12 in 324 HCC patients treated with LT. Inflammatory biomarkers peaked in the early post-LT period but at POM 3 leveled off at values similar (NLR) or higher (PLR) than pre-LT ones. CONUT and PNI worsened in the early post-LT period, but at POM 3 they stabilized at significantly better values than pre-LT. In LT recipients with an overall survival >1 year and no evidence of early HCC recurrence, 1 year post-LT NLR and PNI independently predicted patient overall survival, while 1 year post-LT PLR independently predicted late tumor recurrence. In conclusion, at 1 year post-LT, the nutritional status of liver-transplanted HCC patients significantly improved while their inflammatory state tended to persist. Consequently, post-LT PLR and NLR maintained a prognostic value for LT outcome while post-LT CONUT and PNI acquired it.openopenopenPravisani R.; Mocchegiani F.; Isola M.; Lorenzin D.; Adani G.L.; Cherchi V.; De Martino M.; Risaliti A.; Lai Q.; Vivarelli M.; Baccarani U.Pravisani, R.; Mocchegiani, F.; Isola, M.; Lorenzin, D.; Adani, G. L.; Cherchi, V.; De Martino, M.; Risaliti, A.; Lai, Q.; Vivarelli, M.; Baccarani, U
Optimization of an Injectable Hydrogel Depot System for the Controlled Release of Retinal-Targeted Hybrid Nanoparticles
A drawback in the development of treatments that can reach the retina is the presence of barriers in the eye that restrain compounds from reaching the target. Intravitreal injections hold promise for retinal delivery, but the natural defenses in the vitreous can rapidly degrade or eliminate therapeutic molecules. Injectable hydrogel implants, which act as a reservoir, can allow for long-term drug delivery with a single injection into the eye, but still suffer due to the fast clearance of the released drugs when traversing the vitreous and random diffusion that leads to lower pharmaceutic efficacy. A combination with HA-covered nanoparticles, which can be released from the gel and more readily pass through the vitreous to increase the delivery of therapeutic agents to the retina, represents an advanced and elegant way to overcome some of the limitations in eye drug delivery. In this article, we developed hybrid PLGA-Dotap NPs that, due to their hyaluronic acid coating, can improve in vivo distribution throughout the vitreous and delivery to retinal cells. Moreover, a hydrogel implant was developed to act as a depot for the hybrid NPs to better control and slow their release. These results are a first step to improve the treatment of retinal diseases by protecting and transporting the therapeutic treatment across the vitreous and to improve treatment options by creating a depot system for long-term treatments
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