Optimising medicines administration for patients with dysphagia in hospital:Medical or nursing responsibility?

Dysphagia is common—not only associated with stroke, dementia, Parkinson’s but also in many non-neurological medical problems—and is increasingly prevalent in ageing patients, where malnutrition is common and pneumonia is frequently the main cause of death. To improve the care of people with dysphagia (PWD) and minimise risk of aspiration and choking, the textures of food and drinks are frequently modified. Whilst medicines are usually concurrently prescribed for PWD, their texture is frequently not considered and therefore any minimisation of risk with respect to food and drink may be being negated when such medicines are administered. Furthermore, evidence is starting to emerge that mixing thickeners with medicines can, in certain circumstances, significantly affect drug bioavailability and therefore amending the texture of a medicine may not be straightforward. Research across a number of hospital trusts demonstrated that PWD are three times more likely to experience medication administration errors than those without dysphagia located on the same ward. Errors more commonly seen in PWD were missed doses, wrong formulation and wrong preparation through medicines alteration. Researchers also found that the same patient with dysphagia would be given their medicines in entirely different ways depending on the person administering the medicine. The alteration of medicines prior to administration has potential for patient harm, particularly if the medicine has been designed to release medicines at a pre-defined rate or within a pre-defined location. Alteration of medicines can have significant legal implications and these are frequently overlooked. Dispersing, crushing or mixing medicines can be part of, or misconstrued as, covert administration, thus introducing a further raft of legislation. Guidance within the UK recommends that following identification of dysphagia, the ongoing need for the medicine should be considered, as should the most appropriate route and formulation, with medicines alteration used as a last resort. The patient should be at the centre of any decision making. Evidence suggests that in the UK this guidance is not being followed. This article considers the clinical and legal issues surrounding administration of medicines to PWD from a UK perspective and debates whether medicines optimisation should be the primary responsibility of the prescriber when initiating therapy on the ward or the nurse who administers the medicine

Integrating Econometric Models of Australia's Livestock Industries: Implications for Forecasting and Other Economic Analyses

The perceived value of integrating small partial- equilibrium structural models of individual livestock industries into a comprehensive single-sector model is to take advantage of the interrelationships that are usually expressed by cross elasticities on both the supply and demand sides of these industries. Model integration should provide a more realistic representation of the livestock industries and an improved mechanism for industry analyses. However, model integration could also lead to increased error in model simulation that could reduce the value of the larger model for those purposes. Using forecasting as an example application, this paper investigates how the increased endogenisation of cross-commodity relationships in alternative structural econometric models of the Australian livestock industries affects the simulation performance of the larger model. Forecast accuracy and encompassing tests were used to investigate the value of model integration by comparing the accuracy of the models' forecasts and by testing for differences in the information contained in those forecasts. The general result was that combining the models did not adversely affect the forecasts from the integrated model and the encompassing tests indicated that the forecasts of the integrated and single models contained different information. Because the forecasts of the integrated model were not impaired relative to the single model forecasts, model integration was considered to be useful for forecasting and other types of economic analysis in the livestock industries.Structural econometric models, Model integration, Forecasting, Economic analysis, Livestock Production/Industries,

Enhancing the Role of Regional Development Banks

There are a number of important reasons why lending by regional or sub-regional development banks can and should play an important and valuable complementary role in the international development architecture. We look at the specific strengths of multilateral, regional and sub-regional development banks and drawing on the successful experience of the European Investment Bank and the Andean Development Corporation conclude that the time is now for creating new regional development banks and expanding existing ones. Creating new institutions or expanding existing ones will have very clear benefits, as for instance providing regional public goods which are currently undersupplied, such as regional infrastructure. Very large pools of savings and foreign exchange reserves originate in developing countries these days and therefore the potential for a significant expansion of regional or sub-regional development banks, with only or mainly developing country members has grown significantly. At the same time, it may be desirable to create new regional development banks where gaps exist, however too much duplication of services is not desirable.

Tax incentives for R&D

A long-standing concern surrounding the performance of the UK economy is its perceived failure to maintain the same technological pace as its competitors. Industrial research and development (R&D) expenditure as a proportion of GDP fell during the 1980s at a time when all other G7 countries increased the proportion of their output given over to R&D. This ratio is now lower in the UK than in most other G7 countries. If this world-wide trend toward more R&D indicates that industrial production is becoming increasingly science-based, then the UK may be in danger of becoming a relatively low-tech economy. One purpose of this article is to examine whether there is a rational basis for these fears.

Audit of Moving Image Education & Media Access Centres in Scotland

No abstract available

Dynamic general equilibrium analysis of improved weed management in Australia's winter cropping systems

A recent analysis indicated that the direct financial cost of weeds to Australia’s winter grain sectorwas approximately $A1.2bn in 1998–1999. Costs of thismagnitude represent a large recurring productivity loss in an agricultural sector that is sufficient to impact significantly on regional economies.Using amulti-regional dynamic computable general equilibrium model, we simulate the general equilibrium effects of a hypothetical successful campaign to reduce the economic costs of weeds. We assume that an additional$50m of R&D spread over five years is targeted at reducing the additional costs and reduced yields arising from weeds in various broadacre crops. Following this R&D effort, one-tenth of the losses arising from weeds is temporarily eliminated, with a diminishing benefit in succeeding years. At the national level, there is a welfare increase of $700m in discounted net present value terms. The regions with relatively high concentrations of winter crops experience small temporary macroeconomic gains.CGE modelling, dynamics, weed management, Crop Production/Industries,

Animal Efficiency in an Intensive Beef Production System

A stochastic input distance function is estimated to analyse the efficiency with which physical characteristics of individual lot-fed beef cattle in Australia are combined with conventional inputs to produce a final product possessing defined quality attributes. High mean technical efficiency estimates are reported for all animals and by breed. All partial output elasticities with respect to inputs are of expected sign. Of four outputs included in the analysis, carcass weight and moisture retention in meat after cooking have highly significant coefficients of expected sign, but two meat quality variables have coefficients of unexpected sign indicating that they decline as inputs increase. Some evidence is detected of scope economies between moisture retention in meat and the inverse of meat compression.efficiency, intensive agriculture, scope economies, Livestock Production/Industries, Q12, C51,

Sheep CRC Renewal Proposal: Economic Evaluation of the Proposed Scientific Themes

The Australian sheep industry and its associated research and development agencies have developed a proposal for the CRC for Sheep Industry Innovation. “Top-down” and “bottomup” procedures were used to assess the expected economic benefits from this proposal. Formal “with-CRC” and “without-CRC” scenarios were defined for each product and each research theme. Relevant costs were similarly defined. The requested investment by the Commonwealth and the Australian sheep industry in the CRC is assessed relative to a scenario where an alternative, lower cost research program into this industry is implemented. These extra resources have a discounted value of about $34 million over the 25-year period of this evaluation. These resources are sufficient to allow some new research components to be added to the portfolio, some existing components to produce better outcomes, and a more targeted approach to development and extension that speeds up and increases the adoption of the new technologies that are generated by the research program. The benefit from this extra investment and consequent research effort is estimated to be worth about$518 million in present value terms, which is far in excess of the marginal investment. Thus every $1 of these extra resources brought into the Australian sheep industry through funding the proposed CRC is expected to return around$15.30 to the industry in present value terms.wool, sheep meat, research and development, economic, evaluation, Australia, Agribusiness, Livestock Production/Industries, Production Economics, Research and Development/Tech Change/Emerging Technologies, Q160,

Biomass and reproduction of Pacific sardine (Sardinops sagax) off the Pacific northwestern United States, 2003–2005

The Pacific sardine (Sardinops sagax) is distributed along the west coast of North America from Baja California to British Columbia. This article presents estimates of biomass, spawning biomass, and related biological parameters based on four trawl-ichthyoplankton surveys conducted during July 2003 –March 2005 off Oregon and Washington. The trawl-based biomass estimates, serving as relative abundance, were 198,600 t (coefficient of variation [CV] = 0.51) in July 2003, 20,100 t (0.8) in March 2004, 77,900 t (0.34) in July 2004, and 30,100 t (0.72) in March 2005 over an area close to 200,000 km2. The biomass estimates, high in July and low in March, are a strong indication of migration in and out of this area. Sardine spawn in July off the Pacific Northwest (PNW) coast and none of the sampled fish had spawned in March. The estimated spawning biomass for July 2003 and July 2004 was 39,184 t (0.57) and 84,120 t (0.93), respectively. The average active female sardine in the PNW spawned every 20–40 days compared to every 6–8 days off California. The spawning habitat was located in the southeastern area off the PNW coast, a shift from the northwest area off the PNW coast in the 1990s. Egg production in off the PNW for 2003–04 was lower than that off California and that in the 1990s. Because the biomass of Pacific sardine off the PNW appears to be supported heavily by migratory fish from California, the sustainability of the local PNW population relies on the stability of the population off California, and on local oceanographic conditions for local residence

Economic benefits of public investment in weed management: the case of vulpia in south-eastern Australia’s temperate pasture areas

The present paper reports an economic evaluation of the long-term benefits to Australia of research by the Cooperative Research Centre for Weed Management Systems (CRC) into the improved management of vulpia , the major annual grass weed of temperate pastures in New South Wales and Victoria. Vulpia reduces livestock production by competition with more desirable pasture species, by the production of low quality feed at critical times of the grazing cycle, and by injury to animals. A 20-year stochastic benefit-cost analysis indicated that reducing the impacts of vulpia in these pastures produced a mean net present value of # A58.3 million and a mean benefit-cost ratio of 33:1. Temperate pasture zone wool producers would capture the largest shares of these benefits, Australian consumers would gain, but wool producers in the rest of Australia would suffer welfare losses from vulpia reductions in the temperate pasture zones.Agricultural and Food Policy, Farm Management,