Drug utilization pattern in patients of upper respiratory tract infections in pediatrics outpatient department at a tertiary care hospital

Background: Upper respiratory tract infections are the most common and frequently occurring infections in the pediatric population. These infections include conditions like common cold, laryngitis, pharyngitis, tonsillitis, acute rhinitis, acute rhinosinusitis and acute otitis media. Young children have an average of 6-8 colds per year, however 10 -15% of children have at least 12 infections per year. This study concentrates on prescription pattern of Upper Respiratory Tract Infections in children. primary objective was to study the prescription pattern of drugs used in URTI in pediatric outpatient department and the secondary objective was to determine whether the drugs being prescribed comply with those listed in the National list of essential medicines. Methods: This study was a Cross-sectional, observational study conducted at the Pediatric Outpatient Department in a tertiary care hospital, India. The data was collected from patients visiting Pediatrics OPD from June 2021 to December 2021 after taking written informed consent. Sample size was calculated to be 303. Results: Total 943 drugs were prescribed for 303 patients with an average of 3.11±1.15 drugs per prescription. Most common class of drugs prescribed was Antipyretics of which Paracetamol was the most common drug. Antibiotics were prescribed for 19.80% patients & combination of Amoxicillin and Clavulanic acid was the most common antibiotic prescribed. 68.29% drugs were prescribed by generic name. 43.16% drugs were prescribed from National List of Essential Medicines 2015. Conclusions: The study revealed that the majority of children suffering from URTI were below 5 years of age. Our study highlighted the prescribing

Locating the place and meaning of physical activity in the lives of young people from low-income, lone-parent families

Background: In the United Kingdom (UK), it is predicted that economic cuts and a subsequent increase in child poverty will affect those already on the lowest incomes and, in particular, those living in lone-parent families. As a result, the informal pedagogic encounters within the family that contribute to the development of physical activity-related values, beliefs and dispositions from a very early age will be affected. Therefore, it is vital that we gain an understanding of the place and meaning of physical activity in the lives of young people, as well as the informal pedagogic practices and the socio-cultural forces that influence individual agency. Purpose: Based on Bourdieu's key concepts, this paper explores the interplay of structural conditions and personal agency with regard to physical activity in the lives of young people from low-income, lone-parent families. Methods: This study reports on the voices of 24 participants (aged 11–14) from low-income, lone-parent families in the West Midlands, UK. These participants were engaged in paired, semi-structured interviews to explore issues of personal agency by listening to how they reported on their present lives, past experiences and future possibilities with regard to physical activity. All corresponding interview data were analysed using analytical induction. Findings: This paper suggests that young people exhibited diminished desires to engage in activity due to structural constraints of time, parents' work commitments and a lack of transport that resulted in engagement in sedentary alternatives. Informal pedagogic practices within these families were restricted due to the associated structural conditions of living in a lone-parent family. As such, young people's choice to not seek out physical activities when at home reflected a ‘taste for necessity’ resulting from a lack of cultural and economic capital, placing restrictions on physical activity opportunities that stemmed from their family doxa. Conclusions: To succeed in fostering dispositions and opportunities to participate in physical activity, we must engage with young people from low-income, lone-parent families from an early age. Certainly though, further consideration of the informal pedagogic practices within, and the demands on, lone-parent families is required when designing any intervention or policy that seeks to enhance their current circumstances and provide opportunities for engagement in a variety of contexts

Effects of climate and irrigation on GRACE-based estimates of water storage changes in major US aquifers

Understanding climate and human impacts on water storage is critical for sustainable water-resources management. Here we assessed climate and human drivers of total water storage (TWS) variability from Gravity Recovery and Climate Experiment (GRACE) satellites compared with drought severity and irrigation water use in 14 major aquifers in the United States. Results show that long-term variability in TWS tracked by GRACE satellites is dominated by interannual variability in most of the 14 major US aquifers. Low TWS trends in the humid eastern U.S. are linked to low drought intensity. Although irrigation pumpage in the humid Mississippi Embayment aquifer exceeded that in the semi-arid California Central Valley, a surprising lack of TWS depletion in the Mississippi Embayment aquifer is attributed to extensive streamflow capture. Marked storage depletion in the semi-arid southwestern Central Valley and south-central High Plains totaled ∼90 km ^3 , about three times greater than the capacity of Lake Mead, the largest U.S. reservoir. Depletion in the Central Valley was driven by long-term droughts (⩽5 yr) amplified by switching from mostly surface water to groundwater irrigation. Low or slightly rising TWS trends in the northwestern (Columbia and Snake Basins) US are attributed to dampening drought impacts by mostly surface water irrigation. GRACE satellite data highlight synergies between climate and irrigation, resulting in little impact on TWS in the humid east, amplified TWS depletion in the semi-arid southwest and southcentral US, and dampened TWS deletion in the northwest and north central US Sustainable groundwater management benefits from conjunctive use of surface water and groundwater, inefficient surface water irrigation promoting groundwater recharge, efficient groundwater irrigation minimizing depletion, and increasing managed aquifer recharge. This study has important implications for sustainable water development in many regions globally

Reusability of filtering facepiece respirators after decontamination through drying and germicidal UV irradiation.

During pandemics, such as the SARS-CoV-2, filtering facepiece respirators plays an essential role in protecting healthcare personnel. The recycling of respirators is possible in case of critical shortage, but it raises the question of the effectiveness of decontamination as well as the performance of the reused respirators. Disposable respirators were subjected to ultraviolet germicidal irradiation (UVGI) treatment at single or successive doses of 60 mJ/cm <sup>2</sup> after a short drying cycle (30 min, 70°C). The germicidal efficacy of this treatment was tested by spiking respirators with two staphylococcal bacteriophages (vB_HSa_2002 and P66 phages). The respirator performance was investigated by the following parameters: particle penetration (NaCl aerosol, 10-300 nm), scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FTIR), differential scanning calorimetry and mechanical tensile tests. No viable phage particles were recovered from any of the respirators after decontamination (log reduction in virus titre >3), and no reduction in chemical or physical properties (SEM, particle penetrations <5%-6%) were observed. Increasing the UVGI dose 10-fold led to chemical alterations of the respirator filtration media (FTIR) but did not affect the physical properties (particle penetration), which was unaltered even at 3000 mJ/cm <sup>2</sup> (50 cycles). When respirators had been used by healthcare workers and undergone decontamination, they had particle penetration significantly greater than never donned respirators. This decontamination procedure is an attractive method for respirators in case of shortages during a SARS pandemic. A successful implementation requires a careful design and particle penetration performance control tests over the successive reuse cycles

Pursuing concordance: moving away from paternalism

In the second of two articles exploring the value and application of concordance across nursing practice the discussion is aimed at clinical settings and patient groups where concordance may have been viewed as impractical. The author harnesses Cribb and Entwhistle's broader conception of shared decision making and the notion of decision-making capacity as a continuum to argue that concordance can be pursued effectively in challenging settings such as childcare practice, mental health and the care of older people. As in the first paper (McKinnon, 2013) the discussion is not limited to medicines management but remains engaged with all aspects of nursing practice. Legal and ethical frameworks, social participation theory and research across healthcare practice are sourced to argue for concordant approaches in the care of patients who may at times have compromised decision-making capacity. Ideas of direct and indirect concordance are explored. © 2014 MA Healthcare Ltd

Urinary ATP as an indicator of infection and inflammation of the urinary tract in patients with lower urinary tract symptoms

BACKGROUND: Adenosine-5'-triphosphate (ATP) is a neurotransmitter and inflammatory cytokine implicated in the pathophysiology of lower urinary tract disease. ATP additionally reflects microbial biomass thus has potential as a surrogate marker of urinary tract infection (UTI). The optimum clinical sampling method for ATP urinalysis has not been established. We tested the potential of urinary ATP in the assessment of lower urinary tract symptoms, infection and inflammation, and validated sampling methods for clinical practice. METHODS: A prospective, blinded, cross-sectional observational study of adult patients presenting with lower urinary tract symptoms (LUTS) and asymptomatic controls, was conducted between October 2009 and October 2012. Urinary ATP was assayed by a luciferin-luciferase method, pyuria counted by microscopy of fresh unspun urine and symptoms assessed using validated questionnaires. The sample collection, storage and processing methods were also validated. RESULTS: 75 controls and 340 patients with LUTS were grouped as without pyuria (n = 100), pyuria 1-9 wbc ?l(-1) (n = 120) and pyuria ?10 wbc ?l(-1) (n = 120). Urinary ATP was higher in association with female gender, voiding symptoms, pyuria greater than 10 wbc ?l(-1) and negative MSU culture. ROC curve analysis showed no evidence of diagnostic test potential. The urinary ATP signal decayed with storage at 23°C but was prevented by immediate freezing at ??-20°C, without boric acid preservative and without the need to centrifuge urine prior to freezing. CONCLUSIONS: Urinary ATP may have a role as a research tool but is unconvincing as a surrogate, clinical diagnostic marker

Optimising reproductive and child health outcomes by building evidence-based research and practice in South East Asia (SEA-ORCHID): study protocol

Background Disorders related to pregnancy and childbirth are a major health issue in South East Asia. They represent one of the biggest health risk differentials between the developed and developing world. Our broad research question is: Can the health of mothers and babies in Thailand, Indonesia, the Philippines and Malaysia be improved by increasing the local capacity for the synthesis of research, implementation of effective interventions, and identification of gaps in knowledge needing further research? Methods/Design The project is a before-after study which planned to benefit from and extend existing regional and international networks. Over five years the project was designed to comprise five phases; pre-study, pre-intervention, intervention, outcome assessment and reporting/dissemination. The study was proposed to be conducted across seven project nodes: four in South East Asia and three in Australia. Each South East Asian study node was planned to be established within an existing department of obstetrics and gynaecology or neonatology and was intended to form the project coordinating centre and focus for evidence-based practice activities within that region. Nine hospitals in South East Asia planned to participate, representing a range of clinical settings. The three project nodes in Australia were intended to provide project support. The intervention was planned to consist of capacity-strengthening activities targeted at three groups: generators of evidence, users of evidence and teachers of evidence. The primary outcome was established as changes in adherence to recommended clinical practices from baseline to completion of the project and impact on health outcomes. Discussion The SEA-ORCHID project was intended to improve care during pregnancy and the perinatal period of mothers and their babies in South East Asia. The possible benefits extend beyond this however, as at the end of this project there is hoped to be an existing network of South East Asian researchers and health care providers with the capacity to generalise this model to other health priority areas. It is anticipated that this project facilitate ongoing development of evidence-based practice and policy in South East Asia through attracting long-term funding, expansion into other hospitals and community-based care and the establishment of nodes in other countries.David J Henderson-Smart, Pisake Lumbiganon, Mario R Festin, Jacqueline J Ho, Hakimi Mohammad, Steve J McDonald, Sally Green and Caroline A Crowther for the SEA-ORCHID Study Grou

Learning to live together: a challenge for schools located in contexts of social vulnerability

Currently, there are many educational centres that demonstrate the need to promote initiatives to improve coexistence at school at the international level, especially in those located in contexts of social vulnerability. A socio-educational programme has been developed, applied and evaluated at a Singular Education Action Centre (Centro de Acción Educativa Singular - C.A.E.S) in the city of Valencia (Spain). To ascertain the programme's impact and possible generalization to other contexts, a quasi-experimental pretest-posttest design with a control group was used. Information was collected from 297 students and 54 teachers based on questionnaires assessing coexistence at school. The results obtained demonstrate the satisfactory functioning of the programme. The faculty and students from the experimental group affirm the importance of continuing to work in this direction to invest in creating a democratic school that firmly believes in coexistence and participation. Areas for improvement include the need to incorporate actions to increase family participation and develop strategies to facilitate the implementation of a more comprehensive programme

Global models underestimate large decadal declining and rising water storage trends relative to GRACE satellite data

Assessing reliability of global models is critical because of increasing reliance on these models to address past and projected future climate and human stresses on global water resources. Here, we evaluate model reliability based on a comprehensive comparison of decadal trends (2002-2014) in land water storage from seven global models (WGHM, PCR-GLOBWB, GLDAS NOAH, MOSAIC, VIC, CLM, and CLSM) to trends from three Gravity Recovery and Climate Experiment (GRACE) satellite solutions in 186 river basins (∼60% of global land area). Medians of modeled basin water storage trends greatly underestimate GRACE-derived large decreasing (≤-0.5 km3/y) and increasing (≥0.5 km3/y) trends. Decreasing trends from GRACE are mostly related to human use (irrigation) and climate variations, whereas increasing trends reflect climate variations. For example, in the Amazon, GRACE estimates a large increasing trend of ∼43 km3/y, whereas most models estimate decreasing trends (-71 to 11 km3/y). Land water storage trends, summed over all basins, are positive for GRACE (∼71-82 km3/y) but negative for models (-450 to -12 km3/y), contributing opposing trends to global mean sea level change. Impacts of climate forcing on decadal land water storage trends exceed those of modeled human intervention by about a factor of 2. The model-GRACE comparison highlights potential areas of future model development, particularly simulated water storage. The inability of models to capture large decadal water storage trends based on GRACE indicates that model projections of climate and human-induced water storage changes may be underestimated