Review article: assessing the costs of natural hazards - state of the art and knowledge gaps

Efficiently reducing natural hazard risks requires a thorough understanding of the costs of natural hazards. Current methods to assess these costs employ a variety of terminologies and approaches for different types of natural hazards and different impacted sectors. This may impede efforts to ascertain comprehensive and comparable cost figures. In order to strengthen the role of cost assessments in the development of integrated natural hazard management, a review of existing cost assessment approaches was undertaken. This review considers droughts, floods, coastal and Alpine hazards, and examines different cost types, namely direct tangible damages, losses due to business interruption, indirect damages, intangible effects, and the costs of risk mitigation. This paper provides an overview of the state-of-the-art cost assessment approaches and discusses key knowledge gaps. It shows that the application of cost assessments in practice is often incomplete and biased, as direct costs receive a relatively large amount of attention, while intangible and indirect effects are rarely considered. Furthermore, all parts of cost assessment entail considerable uncertainties due to insufficient or highly aggregated data sources, along with a lack of knowledge about the processes leading to damage and thus the appropriate models required. Recommendations are provided on how to reduce or handle these uncertainties by improving data sources and cost assessment methods. Further recommendations address how risk dynamics due to climate and socio-economic change can be better considered, how costs are distributed and risks transferred, and in what ways cost assessment can function as part of decision support

Colistin: recent data on pharmacodynamics properties and clinical efficacy in critically ill patients

Recent clinical studies performed in a large number of patients showed that colistin "forgotten" for several decades revived for the management of infections due to multidrug-resistant (MDR) Gram-negative bacteria (GNB) and had acceptable effectiveness and considerably less toxicity than that reported in older publications. Colistin is a rapidly bactericidal antimicrobial agent that possesses a significant postantibiotic effect against MDR Gram-negative pathogens, such as Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae. The optimal colistin dosing regimen against MDR GNB is still unknown in the intensive care unit (ICU) setting. A better understanding of the pharmacokinetic-pharmacodynamic relationship of colistin is urgently needed to determine the optimal dosing regimen. Although pharmacokinetic and pharmacodynamic data in ICU patients are scarce, recent evidence shows that the pharmacokinetics/pharmacodynamics of colistimethate sodium and colistin in critically ill patients differ from those previously found in other groups, such as cystic fibrosis patients. The AUC:MIC ratio has been found to be the parameter best associated with colistin efficacy. To maximize the AUC:MIC ratio, higher doses of colistimethate sodium and alterations in the dosing intervals may be warranted in the ICU setting. In addition, the development of colistin resistance has been linked to inadequate colistin dosing. This enforces the importance of colistin dose optimization in critically ill patients. Although higher colistin doses seem to be beneficial, the lack of colistin pharmacokinetic-pharmacodynamic data results in difficulty for the optimization of daily colistin dose. In conclusion, although colistin seems to be a very reliable alternative for the management of life-threatening nosocomial infections due to MDR GNB, it should be emphasized that there is a lack of guidelines regarding the ideal management of these infections and the appropriate colistin doses in critically ill patients with and without multiple organ failure

Kaliuretic effect of short-term theophylline in healthy subjects

In a two-way crossover non-randomized design, the kaliuretic effect of sustained-release theophylline (T) 300 mg every 12 h for 3 days was compared with furosemide (F) 40 mg once a day for 3 days, on the urinary potassium excretion rate of 10 healthy nonsmoker males. The individual base lines of urinary potassium excretion rate (UKER, mg/min); urine flow rate (UFR, ml/min) and the 24 h total potassium excretion were established during a control period of 4 weeks. The net, as defined in the text, UKER and UFR of F were significantly higher than those of T, 0.212 ± 0.111 versus 0.111 ± 0.040 mmol/min and 10.44 ± 3.46 versus 1.36 ± 0.62 ml/min, respectively. However, T duration time, of both UKER and UFR, were significantly longer than that of F 7.21 ± 1.48 versus 3.24 ± 1.08 h. There was no significant difference in the 24 h net total potassium excretion between T and F, i.e. 47.69 ± 15.46 versus 41.25 ± 22.97 mmol, respectively. Potassium monitoring for patients who are on acute T is recommended

Assessment of the physicochemical stability of all-in-one parenteral emulsions for neonates according to USP specifications

Background: The purpose of this study was to describe the methodology to assess the stability of all-in-one (AIO) parenteral nutrition admixtures, containing glucose, proteins, and lipids, to the standards of U.S. Pharmacopoeia (USP <729>). The influence of calcium and commercially available lipid emulsions and amino acid solutions were also examined. Methods: Four batches of 5 AIO admixtures containing calcium were compounded with commercially available lipid emulsions and amino acid solutions. Two of them contained calcium. Their stability was tested under conditions simulating clinical use. All the admixtures were assessed for criteria set by the USP <729>: (1) mean droplet diameter (MDD) and (2) percentage of volume weighted particles with diameter > 5 μm (PFAT5). Results: All admixtures were within the specifications set by the USP with respect to the MDD at 0, 24, and 48 hours, but only those batches lacking calcium met the benchmarks set by the pharmacopoeia, with respect to PFAT5, on the day of preparation. Conclusions: The presence of calcium destabilized the admixtures, while the use of different commercial ingredients altered the admixtures' characteristics. Only 1 batch of the AIO admixtures studied was found to be compliant with USP <729> standards. © 2013 American Society for Parenteral and Enteral Nutrition

Hydrogeological condition and water resources management in east Korinthia

378 σ.Η παρούσα διατριβή αναφέρεται στις υδρογεωλογικές συνθήκες που επικρατούν στο ανατολικό τμήμα του Νομού Κορινθίας. Στόχος της διατριβής ήταν η αποτύπωση της υφιστάμενης ποσοτικής και ποιοτικής κατάστασης των υπόγειων νερών της περιοχής έρευνας, με ταυτόχρονη ανάδειξη των κύριων παραγόντων που συνέβαλλαν στη διαμόρφωση αυτής. Η περιοχή έρευνας περιλαμβάνει το τμήμα του νομού Κορινθίας που απαρτίζεται από τις υδρολογικές λεκάνες του Ράχιανη (μέχρι Σπαθοβούνι), του Ξεριά Κορίνθου ή Ποταμιάς (μέχρι Σολωμό) και των ρεμάτων που αποστραγγίζονται προς τον Σαρωνικό κόλπο. Οι υδατικές ανάγκες της περιοχής έρευνας προσεγγίζουν τα 11x106m3 νερού, από τα οποία το 1x106m3, αντιστοιχεί στις ανάγκες ύδρευσης και τα 9x106m3, στην κάλυψη των αναγκών άρδευσης. Το βόρειο τμήμα δομείται γεωλογικά από μεταλπικούς σχηματισμούς, με παρεμβολές εξαρμάτων του αλπικού υποβάθρου, ενώ το νότιο δομείται σχεδόν καθ’ ολοκληρία από ανθρακικούς σχηματισμούς της ζώνης Ανατολικής Ελλάδας. Οι σχηματισμοί αυτοί είναι επωθημένοι επί του φλύσχη της ζώνης Τρίπολης στην περιοχή των Δερβενακίων. Κύριο χαρακτηριστικό της τεκτονικής μακροδομής της περιοχής είναι η ύπαρξη ρηγμάτων και ρηξηγενών ζωνών, με διεύθυνση Α-Δ, που χωρίζουν την περιοχή σε επιμέρους ρηξητεμάχη (τεκτονικά βυθίσματα και κέρατα), καθένα από τα οποία έχει τη δική του γεωδυναμική και παλαιογεωγραφική εξέλιξη κατά τη νεοτεκτονική περίοδο. Το μέσο ετήσιο ύψος βροχόπτωσης της περιοχής έρευνας για την περίοδο υδρολογικών ετών 1978-79 έως 2009-10, προσδιορίστηκε ίσο με 590mm. Από τα 270x106m3 του μέσου ετήσιου όγκου βροχόπτωσης το 67% αντιστοιχεί στη διεργασία της εξατμισοδιαπνοής, το 25% στην κατείσδυση και το 8% στην επιφανειακή απορροή. Στους μεταλπικούς σχηματισμούς της λοφώδους ζώνης, αναπτύσσεται μικρής, έως μέτριας τοπικά, δυναμικότητας υπόγεια υδροφορία. Η μέση ετήσια τροφοδοσία των υδροφόρων, οι οποίοι αναπτύσσονται κυρίως στις λεκάνες Ράχιανη και Ξεριά, είναι της τάξης των 9x106m3. Μέρος της ποσότητας αυτής, κυρίως στα περιθώρια των λεκανών, όπου τα πλευρικά κορήματα και τα κροκαλοπαγή επίκεινται απευθείας επί των υποκείμενων ασβεστολίθων, μεταγγίζονται και τροφοδοτούν τους καρστικούς υδροφόρους. Οι ανθρωπογενείς δραστηριότητες (αγροτικές καλλιέργειες, τρόπος διαχείρισης υγρών και στερεών αποβλήτων), έχουν συμβάλλει στη ρύπανση των υπόγειων νερών, η οποία εκφράζεται κυρίως με υψηλές τιμές νιτρικών ιόντων. Οι ανθρακικοί σχηματισμοί, βρίσκονται σε άμεση επαφή και υδραυλική επικοινωνία με τη θάλασσα του Σαρωνικού κόλπου στα ανατολικά, σε μήκος πολλών χιλιομέτρων. Το γεγονός αυτό, σε συνδυασμό με την βύθιση του επιπέδου βάσης της καρστικοποίησης 10δες μέτρα κάτω από το σημερινό επίπεδο της θάλασσας, έχει οδηγήσει στη φυσική υφαλμύρινση των καρστικών υδροφόρων, η οποία εντείνεται σε συνθήκες υπεράντλησης. Η καρστική υδροφορία εκφορτίζεται μέσω παράκτιων και υποθαλάσσιων πηγών στις ακτές του Σαρωνικού, με κύρια πεδία εκφόρτισης τους όρμους Αλμυρής και Κόρφου. Η μέση ετήσια τροφοδοσία των καρστικών υδροφόρων που εκφορτίζονται μέσω των ανωτέρω πηγών προσεγγίζει τα 63x106m3. Αξιοποίηση της καρστικής υδροφορίας, μέσω βαθιών γεωτρήσεων, υφίσταται μόνον στην περιοχή Σπαθοβουνίου για την κάλυψη κυρίως αναγκών άρδευσης και στην περιοχή Σοφικού για την κάλυψη αναγκών ύδρευσης. Η ανορθολογική εκμετάλλευση των γεωτρήσεων αυτών έχει οδηγήσει στην υφαλμύρινση του αντλούμενου νερού Τα ποιοτικά χαρακτηριστικά των υπόγειων νερών της περιοχής έρευνας καθορίζονται κυρίως από τη σύσταση των γεωλογικών σχηματισμών στους οποίους φιλοξενούνται και κυκλοφορούν. Στην καταλληλότητά τους για διάφορες χρήσεις επιδρούν άμεσα οι ανθρωπογενείς δραστηριότητες (γεωργικές καλλιέργειες, τρόπος διαχείρισης αποβλήτων) και το καθεστώς εκμετάλλευσης των υπόγειων υδροφόρων. Το μεγαλύτερο μέρος των υπόγειων νερών από υδροφόρους των μεταλπικών σχηματισμών, είναι ακατάλληλο για ανθρώπινη κατανάλωση, λόγω υψηλής συγκέντρωσης νιτρικών ιόντων. Καλής ποιότητας υπόγεια νερά εντοπίζονται στα περιθώρια των επιμέρους λεκανών. Επίσης, μεγάλο μέρος των υπόγειων νερών των καρστικών υδροφόρων είναι ακατάλληλο για ανθρώπινη κατανάλωση, λόγω υψηλής συγκέντρωσης ιόντων χλωρίου (υφαλμύρινση) και νιτρικών ιόντων. Κατάλληλα για ανθρώπινη κατανάλωση χαρακτηρίζονται τα υπόγεια νερά μέρους των καρστικών υδροφόρων στα βόρεια περιθώρια της ορεινής ζώνης, καθώς και σε περιοχές του καρστικού υδροφόρου της ορεινής ζώνης στις οποίες η εκμετάλλευση είναι συμβατή με τα υδραυλικά χαρακτηριστικά του υδροφόρου. Ως προς την καταλληλότητα για άρδευση, σύμφωνα με το σύστημα ταξινόμησης Richards, το μεγαλύτερο μέρος των υπόγειων νερών όλων των τύπων υδροφόρων χαρακτηρίζεται καλής έως μέτριας ποιότητας, που μπορούν να χρησιμοποιηθούν για άρδευση με περιορισμούς κυρίως όσον αφορά τις συνθήκες στράγγισης των αρδευόμενων εδαφών. Κακής ποιότητας για άρδευση χαρακτηρίζονται τα υπόγεια νερά των υδροφόρων που έχουν επηρεαστεί έντονα από τη θαλάσσια διείσδυση.This thesis refers to the hydrogeological conditions in the eastern part of the prefecture of Corinthia. The aim of this study was to survey the existing quantitative and qualitative status of groundwater in the study area, along with the main factors which contributed to the configuration. The study area includes part of the prefecture of Corinth, which consists of the basins of Rachiani (up to Spathovouni) of Xerias Corinth or Potamia (up to Solomos) and streams drained to the Saronic Gulf. The water needs of the study area are close to 11x106m3. A particular problem in the region is the affordability of water supply needs, as the majority of existing drills and wells are located in areas with high nitrate or salinization. Geomorphologically, the research area can be easily separated into two zones and the northern section of this is the southern margin of the tectonic trench of the Corinthian Gulf , while the southern section is part of the tectonic Arachnaio horn. The northern section consists of post-alpine formations with upstands of alpine background interferences, while the south is built almost entirely by carbonate formations of the eastern geotectonic of Greece zone. These formations are overthrusted on flysch of Gavrovo – Tripolis geotectonic zone in the region of Dervenakia. The main tectonic feature of macro-structures of the area is the existence of faults and fault zones on EW direction, which divide the area into individual fault segments (tectonic grabens and horns), each of which has its own paleogeographic and geodynamic evolution during the neotectonic time. Τhe average annual rainfall of the study area for the period of hydrological years 1978-79 to 2009-10, was found equal to 590mm. From 270x106 m3 of the average annual rainfall, 67% corresponds to the process of evapotranspiration, 25% to the infiltration and 8% to the runoff. Post-alpine formations in hilly area have small to moderate capacity of local underground aquifer, which is overexploited for the coverage of water supply and irrigation needs. The mean annual supply of the aquifers, which are mainly developed in the basins Rachiani and Xerias is 9x106m3. Part of this amount is transmitted to the karstic aquifers, mostly in the margins of the basins, where the lateral scree and conglomerates, overlay directly on the underlying limestones. Human activities (agriculture, systems of management of liquid and solid waste), have contributed to the pollution of groundwater, which is predominantly expressed in high levels of nitrates. The carbonate formations are in direct hydraulic contact and communication with the sea of the Saronic Gulf in the east, stretching several kilometers. This combined with the sinking of the base level of karstification due to rising water levels of tens of meters below the present sea level, , has led to the salinization of natural karst aquifers, which is intensified in conditions of over-pumping. The karstic aquifer discharges through coastal and submarine springs to the coasts of the Saronic Gulf, and the main discharge sites are the bays of Almiri and Korfos. The mean annual supply of karst aquifers, which discharged through the above springs, is approximately to the 63x106m3. Utilization of the karst aquifer through deep wells exists both in Spathovouni for irrigation purposes and in Sofiko area for water supply needs. The improper use of these wells has led to salinization of the water. The ground water quality in the study area is defined by the texture of the geological formations, in which the ground water is host to and circulates. The usability of the ground water for various uses is directly connected with human activities, such as cultivations and wastes management, as well as with the status of its exploitation. In general, the biggest amount of the ground water, which is pumped from aquifers of post alpine formations, is improper for consumption by human beings due to high consideration of nitric ions. On the other hand, ground waters of good quality are detected in the margins of the post alpine basins. Regarding the ground water of the karstic aquifers in the study area, most of it is improper for consumption by human beings due to high consideration of both chloride (salinity) and nitric ions. On the contrary, the water from karstic aquifers at the northern margins of the mountainous area, but also from the karstic aquifers of this area in which the exploitation is compatible with their hydraulic characteristics, is characterized as proper for consumption by human beings. Furthermore, taking into account the usability of the ground water for irrigation purposes, the biggest amount of the ground water from every type of aquifers in the study area is characterized as of good to medium quality, according to Richards’s classification system. The only restriction is referred to the drain conditions of the irrigated soil. Finally, as ground water of poor quality for irrigation purposes, can be characterized the water of the aquifers that have intensively influenced by sea intrusion.Κωνσταντίνος Σ. Μαρκαντώνη

Exploring knowledge and perceptions on generic drugs of final year pharmacy school students in Greece

Objectives: The economic crisis in Greece has triggered an extensive public debate about the use of generic drugs (generics). Despite their cost-saving potential, generic market penetration remains very low. This raises questions on awareness of, perception on and preference for generics by health-care professionals and patients. This is a descriptive study on the level of knowledge and attitudes towards generics of final year pharmacy school students in Greece. Methods: An electronic questionnaire was distributed to 173 senior pharmacy school students in three Universities in Greece. Responses were submitted electronically. Results: The majority of students knew that generics contain the same active ingredient as the originator products and are cheaper. Students were somehow concerned with safety and efficacy of generics. The majority of students agreed that pharmacists should probably recommend the use of generics, and indicated that prescribing and dispensing practices would largely depend on the profit margin. Despite more than half of the students expressing a positive attitude towards generics, they were inadequately educated on their features. Conclusion: It is critical to improve knowledge of and preference for generics amongst health-care professionals from early on if to build the trust required to increase generic market penetration and achieve measurable savings in pharmaceutical expenditure. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group