Antibiotherapy management in respiratory infections in ambulatory in Tunisia

Acute respiratory tract infections are the commonest acute conditions managed in general practice and the main causes of antibiotic use. In Tunisia, the rates of antibiotic prescriptions remain high in general practice. In order to assess antibiotics prescribing practices of 23 general practitioners when facing an ENT or a respiratory tract infection, we conducted an observational study from February 1st, 2014 to November 25th, 2014. The study involved 374 patients, 45.6 mean age of years, among them 193 men (51.6%) and 174 (51.9%) with comorbidities. Tonsillitis, acute maxillary sinusitis and acute bronchitis are the main diagnosis, accounting for over 90% of ENT and respiratory tract infection. The diagnosis of these infections was based on clinical criteria, additional tests were prescribed for only 75 patients (20%). An antibiotic was prescribed for 360 patients (96.2%). β-lactams were the main prescribed class of antibiotics (58.3%). The antibiotic treatment was considered as inappropriate in 42.5% of prescriptions. The main causes were the prescription of amoxicillin-clavulanic acid during tonsillitis, non-antipneumococcal fluoroquinolones, when streptococci or streptococcus pneumoniae are presumed to be responsible for infection (tonsillitis, acute maxillary sinusitis, pneumonia), and unnecessary combination of antibiotics. A concomitant treatment was prescribed for 365 patients (97.6%). The most prescribed drugs were antipyretics (71.4%), corticosteroids (44.7%) and mucolytic (30.2%). The outcome was favorable in 333 cases (89%) and unfavorable in 26 cases (7.1%). The total average cost of an infectious episode was 79.776 ± 36.988 TND (45 ± 20 USD)., with a minimum and maximum values respectively 19.5 and 315.5 TND (35 to 558 USD). This study highlights the frequency of antibiotics prescription (96.2%) during supposed viral infections such as acute bronchitis, tonsillitis or when antibiotic prescription has to be debatable such as in acute otitis media, sinusitis maxillary or exacerbations of COPD. The over-use of antibiotics is an important concern in many countries of the region leading to emergence of bacterial resistance. National guidelines should be developed in order to promote rational use of antibiotics

Health care expenditure and GDP: An international panel smooth transition approach

In this paper, we investigate the potential threshold effects in the relationship between national expenditures on health care and national income. Using a panel threshold regression model, we derive country-specific and time-specific income elasticities for 17 OECD countries over the period 1975–2003. In contrast to many previous analyses, our empirical results show that health care is a necessity rather than a luxury. Further, the relationship between health expenditure and income seems rather nonlinear, changing over time and across countries

Health care expenditure and GDP: An international panel smooth transition approach

In this paper, we investigate the potential threshold effects in the relationship between national expenditures on health care and national income. Using a panel threshold regression model, we derive country-specific and time-specific income elasticities for 17 OECD countries over the period 1975–2003. In contrast to many previous analyses, our empirical results show that health care is a necessity rather than a luxury. Further, the relationship between health expenditure and income seems rather nonlinear, changing over time and across countries

In Vitro Culture and Selection Strategies for Selected Forage Grasses

Agronomy - Crop Scienc

Genotype by Environment Interaction Study of Bermudagrass Forage Yield in Oklahoma

Agronom

Health care expenditure and GDP: An international panel smooth transition approach

In this paper, we investigate the potential threshold effects in the relationship between national expenditures on health care and national income. Using a panel threshold regression model, we derive country-specific and time-specific income elasticities for 17 OECD countries over the period 1975–2003. In contrast to many previous analyses, our empirical results show that health care is a necessity rather than a luxury. Further, the relationship between health expenditure and income seems rather nonlinear, changing over time and across countries

System Analysis of a Hybrid Renewable Energy System

Renewable energies are important components of sustainable development. Indeed, coupled with a rational use of energy, they reduce the use of conventional energy systems based on resources of fossil and fissile origin, and so therefore the pressures environmental and socio-economic use. Renewable energy aims to offer an energy service to our society at an acceptable price. But on the other hand, the cost of this service has an impact on the local economy, the environment and society in general. Compared to conventional solutions, enhancement of renewable energy creates more jobs, strengthens the local economy, reduces the environmental impact and reduces the lust on the stocks of energy and therefore it is a source of peace. In this paper, we are interested in the study of a hybrid renewable energy system: wind – photovoltaic – accumulator. The objective of this paper is to propose a novel approach of system analysis based on the OOPP method (Objective Oriented Project Planning) of a hybrid renewable energy system.DOI:http://dx.doi.org/10.11591/ijece.v4i3.588

Computational Modeling for Dense Gas Dispersion for Variable Stability Classes

The spill of many chemicals such as Liquefied Natural Gas (LNG) on land or water results in its rapid vaporization and the formation of a dense cloud. The performance of a risk assessment for the spill of flammable chemicals requires the determination of the maximum downwind distance where the Lower Flammability limit (LFL) is reached. The modeling of such spills is usually divided in two parts: source term and atmospheric dispersion. The source term describes the cryogenic liquid release rate and conditions. The atmospheric dispersion describes the increasing cloud propagation downwind after the release and the extent of the LFL distance until a steady state is reached. The focus of this work is the preparation of a model for the atmospheric dispersion after the spill of LNG on land using Computational Fluid Dynamics (CFD). CFD is a model based on solving Navier Stokes equations (conservation equations of mass, momentum and energy) in a specific 3D domain. The use of CFD as a tool for the prediction of dense clouds dispersion and LFL distance calculation by industry and research institutions is increasing significantly because it provides an adequate description of the phenomena of dense gas flow, dispersion and it can handle complex geometries. The objective of this research project is to prepare a CFD scheme for vapor cloud dispersion resulting from accidental spill of cryogenic liquid on land using CFD (FLUENT) for medium scale LNG/LN2 spill experiments to be performed at the Ras Laffan Emergency and Safety College (RLESC). The validation of the CFD (FLUENT) model is performed using dense gas dispersion data from literature (Prairie Grass). There is a lack of dense gas dispersion modeling for the unstable class because of the complexity of velocity, temperature and turbulence equations for this class. This model should be able to predict the dense cloud vapors dispersion for different stability classes (neutral, stable and unstable). A crucial parameter in the modelling of the dispersion of the dense gas is the choice of the turbulence model. There is currently no agreement on which model performs better for this application. This work involves a sensitivity analysis of the dispersion results to determine the choice of the turbulence model. The focus will be on three turbulence models which are the most used for this application: standard k – ε , realizable k – ε and Reynolds Stress Model RSM. The results from the modeling of three sets of Prairie Grass experiments suggest a good agreement between the simulation and experimental results only for the centerline concentration and for the stable and neutral classes. For the unstable class, there is a considerable overprediction of the centerline concentration. This work includes an attempt to compare model predictions with experimental concentrations at each location. Only centerline concentrations or highest concentrations were considered in previous works. Form this comparison; all three models were unable to predict the concentration measurements accurately. The RSM model yields relatively the best results for atmospheric an dispersion modelling compared to the standard k-ε and realizable k-ε models. As a result, it is advised to use this model for this application

Social Capital and Health Relationship: What is the Evidence in MENA Countries?

This study investigates the influence of social capital on health by using simultaneous equation transversal data models for 14 MENA countries over the period 2012-2014. The results indicate a positive and proper causal effect of social capital on health confirming the circular and positive relationship between the two variables. These findings confirm that a higher educational attainment level and higher income seems to be an important determinant of trust and social participation that positively influence health at the individual and community levels. In addition, education and higher income levels would lead to healthier lifestyles and greater use of preventive services that policymakers might consider to targeting deprived groups to improve their health

Biología reproductiva de Diplodus sargus sargus en el golfo de Túnez (Mediterráneo)

The sexual activity of Diplodus sargus sargus in the Gulf of Tunis takes place from January to May. Spawning occurs in spring (March to May), as the water temperature rises from 15 to 18°C, just after the winter minimum. The spawning period increases as the latitude decreases. The overall male to female ratio was statistically different from unity. Size at sexual maturity (TL50) was 21 cm (4 years old). The length-weight relationship for all individuals was described by the following parameters: a = 0.015 and b = 3.051. D. s. sargus from the Gulf of Tunis is a rudimentary hermaphrodite with partial protandry.La actividad sexual de Diplodus sargus sargus del golfo de Túnez tiene lugar de enero a mayo. La puesta tiene lugar en primavera (marzo a mayo), cuando la temperatura del agua sube de 15 a 18°C, justo tras el mínimo invernal. A medida que la latitud decrece se observa un periodo reproductivo progresivamente más extenso. La relación machos/hembras fue significativamente distinta de uno. La talla de madurez sexual (TL50) fue 21 cm (4 años). La relación talla-peso para todos los individuos se describió por los siguientes parámetros: a = 0.015 y b = 3.051. D. s. sargus del golfo de Túnez es un a hermafrodita rudimentario con proterandría parcial.