The efficacy of two bupivacaine hydrochloride injection products

No Abstract

Reducing green tape or rolling back IA in Australia: What are found jurisdictions up to?

EIA has been practiced in Australia and the rest of the world for over 40 years, but despite its successes, EIA may now be facing its biggest challenge since it came into being in 1970 with the US National Environmental Policy Act. As Morgan (2012, 11) notes: “As governments look to stimulate economic growth and create employment in response to the current financial crisis, many are promoting a major expansion of physical infrastructure, encouraging resource development projects, and generally seeking to speed decision-making about development projects. Both EIA and SEA should be even more important in such circumstances, yet the moves taken in some countries to speed up decision-making may weaken the provisions for environmental protection, including impact assessment.” In this political and economic environment, EIA is under scrutiny. Proposed changes to the EU directive on EIA released in October 2012 contain ten changes to the Articles of the Directive, with six of these referring to either ‘streamlining’ EIA or introducing specific timeframes for parts of the EIA process (European Commission 2012). This scrutiny has not been restricted to economies in recession, but includes those that have avoided recession because of strong resources sectors. The same appears to be happening in Australia, and this paper reports on these and other possible ‘efficiency’ changes to EIA in Australia at both national and sub-national levels. We attempt to critically examine the nature of such changes and the risks that may be associated with their implementation. Changes to three of the sub-national EIA processes are reviewed in detail, as well as the proposed changes to the national EIA process. There is always room for more timely assessments, but a critical examination of the potential consequences of these “reforms” on the conduct of EIAs is needed, including whether these efficiency changes will deliver sound environmental management and sustainability-oriented decision-making

Bullying behaviors and victimization experiences among adolescent students: the role of resilience

The role of resilience in the relationship between bullying behaviours, victimisation experiences, and self-efficacy was examined. Three hundred and 93 (191 male, 202 female) adolescents (mean age = 15.88, SD = .64) from schools in Coimbatore, India completed scales to assess bullying behaviours and victimisation experiences, resilience, and self-efficacy. Multigroup SEM, with separate groups created according to participant sex, revealed that resilience mediated the relationship between bullying behaviours and self-efficacy in males. Males engaged in bullying behaviours and experienced victimisation more frequently than females. The findings of the study have implication for designing intervention programs to enhance resilience among adolescents and young adults to enable them to manage bullying behaviours

Irbesartan in Marfan syndrome (AIMS): a double-blind, placebo-controlled randomised trial

BACKGROUND: Irbesartan, a long acting selective angiotensin-1 receptor inhibitor, in Marfan syndrome might reduce aortic dilatation, which is associated with dissection and rupture. We aimed to determine the effects of irbesartan on the rate of aortic dilatation in children and adults with Marfan syndrome. METHODS: We did a placebo-controlled, double-blind randomised trial at 22 centres in the UK. Individuals aged 6-40 years with clinically confirmed Marfan syndrome were eligible for inclusion. Study participants were all given 75 mg open label irbesartan once daily, then randomly assigned to 150 mg of irbesartan (increased to 300 mg as tolerated) or matching placebo. Aortic diameter was measured by echocardiography at baseline and then annually. All images were analysed by a core laboratory blinded to treatment allocation. The primary endpoint was the rate of aortic root dilatation. This trial is registered with ISRCTN, number ISRCTN90011794. FINDINGS: Between March 14, 2012, and May 1, 2015, 192 participants were recruited and randomly assigned to irbesartan (n=104) or placebo (n=88), and all were followed for up to 5 years. Median age at recruitment was 18 years (IQR 12-28), 99 (52%) were female, mean blood pressure was 110/65 mm Hg (SDs 16 and 12), and 108 (56%) were taking β blockers. Mean baseline aortic root diameter was 34·4 mm in the irbesartan group (SD 5·8) and placebo group (5·5). The mean rate of aortic root dilatation was 0·53 mm per year (95% CI 0·39 to 0·67) in the irbesartan group compared with 0·74 mm per year (0·60 to 0·89) in the placebo group, with a difference in means of -0·22 mm per year (-0·41 to -0·02, p=0·030). The rate of change in aortic Z score was also reduced by irbesartan (difference in means -0·10 per year, 95% CI -0·19 to -0·01, p=0·035). Irbesartan was well tolerated with no observed differences in rates of serious adverse events. INTERPRETATION: Irbesartan is associated with a reduction in the rate of aortic dilatation in children and young adults with Marfan syndrome and could reduce the incidence of aortic complications

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

BACKGROUND: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study\u27s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines. METHODS: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation. FINDINGS: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p\u3c0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p\u3c0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile. INTERPRETATION: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction