Effect of Standard Treatment Guidelines with or without Prescription Audit on Prescribing for Acute Respiratory Tract Infection (ARI) and Diarrhoea in some Thana Health Complexes (THCs) of Bangladesh

Inappropriate prescribing for ARI and diarrhoea is a serious health problem in many developing countries including Bangladesh. A baseline retrospective prescribing survey for ARI and diarrhoea have been conducted in randomly selected 60 thana health complexes (THCs) of Dhaka division of Bangladesh. In the 38 of 60 THCs, the prescribers did not comply with the standard treatment guidelines (STG) for ARI. They are marked as \u27unsatisfactory performers\u27. In these THCs unnecessary antibiotics were prescribed in more than 50% of the encounters. The study further revealed that in 26 THCs, comprising 41.6% of the 38 THCs, the situation was even worse regarding the indiscriminate use of antibiotics. In these THCs antibiotics were prescribed in \u3e or =72% of the encounters. For diarrhoea, only in 8.3% of the THCs antibiotics were prescribed in \u3e or =50% of the encounters. Encouragingly, most of the prescribers prescribed ORS. So the diarrhoea cases were dropped from the intervention. The 24 out of 26 worse performing THCs for ARI management, were grouped into three groups: Group-I (implementing STG+ Audit), Group-II (STG) and Group-III (no intervention, control). The prescribers of the THCs belonging to Group-I and Group-II received STG+Audit and STG only respectively as intervention(s). On the contrary, the prescribers of the THCs of Group-III (control) did not receive any intervention. It was observed that after the implementation of interventions the use of the unnecessary antibiotics to treat ARI was significantly reduced (p\u3c0.01) compared to pre-intervention period in Group-I (STG+Audit). In this group highly significant (p\u3c0.000) reduction in antibiotics use was achieved in 6 out of 8 THCs. The average reduction in antibiotic use in terms of encounters was 23.7 and 15.2% in the Group-I and Group-II respectively owing to the intervention(s). Significant reduction in antibiotic use in terms of THCs was 3 (out of 8 THCs) and 2 (out of 8 THCs) belonging to the Group-II and Group-III respectively. When compensated for the change in the control group, the reduction of antibiotic use in terms of encounters was 15.2 and 6.9% in the THCs of the Group-I and Group-II respectively due to introduction of the interventions. The study concludes that STG supported by prescription audit are highly effective interventions to change the prescribing behaviour of the prescribers for ARI in the THCs

A landscape review on biodiesel combustion strategies to reduce emission

The study presents state-of-the-art literature on biodiesel combustion strategies for improving engine performance and reducing emissions. The application of those strategies in compression ignition engines is a prominent approach to reducing harmful emissions. The literature reveals that biodiesel can significantly reduce CO, HC, and PM emissions. However, the higher NOxemission characteristics of biodiesel compared to fossil fuel is a concerning factor for its application. In addition, its physicochemical properties have also shown some complications during the combustion process. This article covers fundamental aspects, challenges, prospects, and the pros and cons of advanced biodiesel combustion strategies such as low-temperature combustion (LTC), chamber modifications, and injection modifications that directly influence combustion rate and emission formation. In addition, the exhaust gas after-treatment systems and the effect of operating parameters are briefly discussed and presented in this article. The study found that LTC strategies and retarded injection timing showed significant reductions in NOxemission in the leaner mixtures but with poor combustion control. Besides, chamber modifications and higher injection pressure showed better combustion through high turbulence and swirl rates, but leading to more NOxemission. The review critically analyzed those strategies and concluded that incorporating leaner mixture combustion with chamber modifications will form better combustion under low in-cylinder temperature conditions, favoring reducing the NOxemission. Finally, the study recommends that more studies are needed to obtain a low in-cylinder temperature atmosphere by altering the equivalence ratio and optimizing the chamber (geometry and nozzle) modifications and varying injection parameters with biodiesel to reduce emissions