Administrative Reasons Research Articles

Risk Management as a tool of the Civil Emergency Lanning in the United Kingdom — Comparison with the Polish Approach

‘Europe which protects’ is a very important postulate which is presented by politicians, however, it is well known that the full responsibility for the safety and security of the citizens is the domain of each sovereign country. Therefore, international organisations, such as NATO and the EU, associating countries in one, more or less integrated structure, have only a supportive and facilitating role to this highly important process. This basically means that close cooperation between individual countries is a highly important matter in ensuring the vital aim of citizen protection, especially against major threats and hazards, triggered or impacting in the border context. Such cooperation is impossible as long as those nations do not know and understand each other’s systems. Furthermore, in gaining this understanding of the respective systems, the opportunity exists to learn from each other by implementing the best practices of each other’s realities. The article is an effort to contribute to this learning process by comparison of the risk management processes being a part of broader crisis and disaster management systems in the United Kingdom and Poland. The study was conducted by reviewing and analysing formal documentation and guidance as well as selected literature in this respect. Furthermore, the findings are based on many years of the authors’ experience working in these two systems, reinforced by hundreds of discussions with national experts in the field. As supportive input, selected results of a survey on civil emergency planning in Poland are also presented. The two surveyed systems revealed many similarities in the processes in place in both countries. In general, the purpose of their existence is the same, however, in some cases, there are different terms used or they vary slightly due to organisational or administrative reasons. Both adaptations and developments based on the experiences of the other system are possible, and sometimes even recommended.

DNA analysis in identifying mass disaster victims

Disaster victim identification is very important for legal, administration, and humanity reasons. Disasters include airplane crashes, fire disasters, volcanoes, hurricane, tornadoes, wars and flood. Methods of identification include visual identification, fingerprints, DNA analysis, personal objects and odontology. DNA analysis is an important method of disaster victim identification particularly when other methods of identification are not possible or not conclusive. The current article enumerates and reviews the role played by DNA analysis in identifying mass disaster victims. Keywords: DNA, Mass disaster, Forensic, Identification

Gentamicin plasma concentrations in hospitalized horses and retrospective minimal inhibitory concentrations of gram-negative equine pathogens.

The optimal dosage regimen of gentamicin in horses is still under investigation. The objectives of this study were to determine gentamicin plasma concentrations in hospitalized horses treated with 10mg/kg gentamicin (IV, q 24 h) and to determine whether a plasma concentration to minimum inhibitory concentration (MIC) ratio of 10:1 is reached for equine pathogens using this dose. Prospective clinical observational study; retrospective study on MICs of 131 gram-negative bacteria isolated from horses (2012-2015). University teaching hospital. Ninety-eight horses>6 months old, treated with gentamicin for their primary disease, consecutive samples. Plasma concentrations were measured 1hour (C1h ) and 20hours (C20h ) after gentamicin administration using fluorescence polarization. Presence of systemic inflammatory response syndrome (SIRS) and azotemia was recorded, as well as the reason for antimicrobial administration (primary disease) and whether administration was prophylactic or therapeutic. The target C1h of ≥20µg/mL gentamicin was reached in 90% of horses and was sufficient to reach a plasma concentration:MIC of 10:1 in 32 of 131 (24%) of gram-negative aerobic bacteria. A C20h ≤2µg/mL was reached in 97% horses. Therapeutic versus prophylactic administration, primary disease, azotemia, and systemic inflammatory response syndrome were not associated with a failure to reach a desired peak or trough. The gentamicin dose of 10mg/kg every 24hours should be further investigated and safety assessed because a target gentamicin plasma concentration of ≥20µg/mL was achieved in the majority of cases. Nephrotoxic side effects were not assessed. Individual drug monitoring should be performed because clinical factors are unreliable predictors of plasma concentrations. A gentamicin target concentration of ≥40µg/mL does not offer additional benefits compared to ≥20µg/mL, due to the bimodal distribution of resistance in bacterial isolates.

Form and Substance in Singapore Constitutional and Administrative Law

AbstractWhile Atiyah's and Summers’ concepts of form and substance in the context of constitutional law are often associated with constitutional interpretation, they can also be fruitfully applied to other areas of constitutional and administrative law. The intent of this paper is to apply the concepts of form and substance to Singapore constitutional and administrative law to illustrate that beyond constitutional interpretation, formalism is an apt description for several key areas of constitutional and administrative law doctrine and reasoning in Singapore, even to the extent of being formalistic. This article will argue that formalism in legal reasoning obtains in several important constitutional and administrative law doctrines in Singapore – specifically in the grounds of judicial review, ouster clause doctrine, and the rules on standing. This article will also evaluate the implications of these findings for the development of constitutional and administrative law in Singapore.

On Dolgan haŋa ‘One’s Elder Brother’s Wife’

Abstract Dolgan is essentially a dialect of Yakut, but for ethno-historical and administrative reasons counted as a separate language. One of the basic phonetic differences between Dolgan and Yakut is the h- (< s- < y- and č-) in Dolgan vs. s- (< y- and č-) in Yakut. In other words, the initial secondary s of Yakut developed further into h in Dolgan. Up to the present, only haŋas (< saŋas < *yeŋ(g)eč) with the diminutive suffix -s (< *-č) was known to us as the Dolgan word for ‘elder brother’s wife’. Now, we know the form haŋa without the diminutive suffix -s thanks to the fieldwork studies on Dolgan of the ASK REAL (The Altaic Society of Korea, Researches on the Endangered Altaic Languages).

Distinguishing the features of offenders who do and do not complete substance use treatment in corrections: Extending the reach of psychological services.

Approximately 80% of offenders serving sentences in Canadian federal institutions present a history of substance use that requires psychological services. Correctional substance use programs (SUPs) have been shown to be effective in reducing reconviction for offenders who complete all sessions. However, a significant proportion of offenders entering an SUP do not complete the program for offender-related reasons such as dropping out or suspension. The purpose of the present study was to examine the prevalence of SUP noncompletion and the extent to which offenders who do not complete because of offender-related reasons differ from completers and those who do not complete for administrative reasons (e.g., transferred, released, program cancelled) on demographics, offense characteristics, substance use severity, SUP exposure, criminogenic needs, risk of recidivism, reintegration potential, and institutional charges. The study considered 4,592 federally sentenced men offenders who were enrolled in an SUP. Results showed that noncompleters for offender reasons were younger, less educated, less motivated for intervention, more likely to have committed a violent crime, more likely to have incurred a serious charge while incarcerated, more likely to have presented severe substance use, and more likely to report an unstable employment history. There were relatively few differences between SUP completers and SUP noncompleters for administrative reasons. The results highlight that noncompleters for offender reasons present individual characteristics that might affect their responsivity to treatment. Identifying offenders presenting this specific profile and tailoring psychological services to facilitate their learning could help reduce program noncompletion and improve rehabilitation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The historical origins of old-age pension schemes

AbstractOld-age pensions are the most widespread social security programmes around the world. While many case studies have focused on the historical origins of old-age pensions, global and comparative studies are limited mainly due to missing data. To address this shortcoming, this article introduces the novel PENLEG dataset (Pension Legislation around the World, 1880–2010), which comprises data on: (1) the timing of the first pension introductions; (2) the pension design; (3) the mode of financing; (4) eligibility criteria; (5) benefit generosity and (6) coverage rates for all independent countries. Additionally, the article describes global pension patterns and highlights case evidence. It shows that economic development strategies, political incentives to bind citizens to the state, administrative reasons as well as colonial legacies and the Soviet model of social security have strongly affected the origins of old-age pensions.

Prevalence of Healthcare-Associated Infections and Antimicrobial Resistance in Rural Alberta Acute-Care Facilities

Background: Antibiotic-resistant organisms (AROs) are associated with greater disease severity and poor outcomes. Previous studies have investigated AROs and healthcare-associated infections (HAIs) within larger urban acute-care settings, but similar data for rural settings are scarce. In this stud, we aimed to fill this gap. Methods: Data on antimicrobial resistance (AMR), additional precautions and HAI were collected from 8 rural Alberta acute-care facilities over a 24-hour period from February 4–28, 2019. Data were gathered as part of the national Canadian, Rural, and Northern Acute Care Point Prevalence (CNAPP) survey. All inpatients on included units were reviewed. CNAPP protocol surveillance definitions were used. Results: In total, 961 patients were surveyed, of whom 94 of 961 (9.8%) were on additional precautions. Contact precautions only were most common (54 of 94, 57.4%) and were predominantly in place for MRSA (30 of 94, 31.9%). Of 961 patients, 100 (~10%) met the surveillance definitions for any infection. The most common infections were skin and soft-tissue infections (29 of 100, 29.0%) and bloodstream infections (28 of 100, 28.0%). An HAI occurred in 30 of 961 patients (3.1%); the most common HAIs were surgical site infections (8 of 30, 26.7%) and urinary tract infections (8 of 30, 26.7%). An antimicrobial was prescribed to 333 of 961 patients (34.6%) at the time of the survey, with ceftriaxone the most commonly prescribed (68 of 333, 20.4%). Most patients receiving an antimicrobial (237 of 333, 71.2%) did not meet the surveillance definition for any infection. The most common reason for any antimicrobial administration was empiric therapy (167 of 333, 50.1%). Conclusions: Investigations into antimicrobial use and the burden of HAIs in rural acute-care settings have been limited. In this study, we (1) established provincial baseline data for burden of disease in these facilities due to HAIs and (2) demonstrated that antimicrobial use is common, though most patients who were prescribed an antimicrobial did not meet study definitions for infection. It will be important to continue this type of surveillance in this understudied population to monitor the burden of HAIs over time, to establish antimicrobial utilization trends, and to continue to identify potential antimicrobial stewardship initiatives.Funding: NoneDisclosures: None

Dolor fantasma en niños y jóvenes amputados congénitos: prevalencia y características clínicas

Introducción: El dolor es una patología discapacitante, que en niños está siendo abordada en los últimos tiempos, siendo el dolor fantasma en amputa-dos congénitos una complicación impensada hace algunos años, considerando teorías que describían que carecían de la madurez biológica suficiente para experimentarlo. Actualmente, existe literatura que reconoce una prevalencia de dolor fantasma de 3,7 a 20% en la población de amputados congénitos. Objetivo general: Evaluar población de amputados congénitos del Instituto Teletón Santiago para determinar incidencia, prevalencia lápsica y caracterís-ticas clínicas del dolor fantasma. Pacientes y Métodos: Estudio descriptivo de prevalencia, con revisión de ficha clínica para registro de variables demográ-ficas y clínicas, y aplicación de encuesta telefónica al total de pacientes que asintieran y contaran con el consentimiento de sus padres. Se incluyó a todos los pacientes de 10 o más años; se excluyó a los con hipoacusia asociada o con imposibilidad administrativa para contactarlos. Resultados: 57 pacien-tes, edad promedio 18,6 años, 59,6% con deficiencia longitudinal. Ningún paciente presentó dolor fantasma en el último mes en la población estudiada. la prevalecia lápsica fue de 7,0%. Un 24,6% refirió además presentar sensa-ción fantasma alguna vez en su vida y un 5,3% haber presentado dolor en el último año. Conclusión: Existe dolor fantasma en la población de pacientes amputados congénitos en los rangos de prevalencia encontrados en la literatura internacional contribuyendo a la evidencia existente. Este es el primer estudio en nuestro país que evalúa dolor en deficiencias congénitas y constituye una línea de base para estudios adicionales.

Use of cefovecin in dogs and cats attending first-opinion veterinary practices in Australia

BackgroundCefovecin is a long-acting third-generation cephalosporin commonly used in veterinary medicine. Third-generation cephalosporins are critically important antimicrobials that should only be used after culture and susceptibility testing. The authors describe...

Diurnal Variation and Nursing Perspectives in Analgesic and Sedation Medication Administration to Mechanically Ventilated Children in a Single Pediatric ICU.

The primary objective of this study was to determine whether there was diurnal variation in the amount of analgesic and sedation medication administered to mechanically ventilated children in a single pediatric intensive care unit (PICU). The secondary objective was to evaluate nursing attitudes and practices regarding administration of these medications. This was a prospective, longitudinal cohort study of mechanically ventilated patients admitted to a single PICU. There were 46 mechanical ventilation courses included (305 paired day-night shifts). There was no significant diurnal variation found in the amount of analgesics and sedatives administered to mechanically ventilated patients. However, the reasons for administration differed between day and night shifts.

Extraction of Information Related to Drug Safety Surveillance From Electronic Health Record Notes: Joint Modeling of Entities and Relations Using Knowledge-Aware Neural Attentive Models.

BackgroundAn adverse drug event (ADE) is commonly defined as “an injury resulting from medical intervention related to a drug.” Providing information related to ADEs and alerting caregivers at the point of care can reduce the risk of prescription and diagnostic errors and improve health outcomes. ADEs captured in structured data in electronic health records (EHRs) as either coded problems or allergies are often incomplete, leading to underreporting. Therefore, it is important to develop capabilities to process unstructured EHR data in the form of clinical notes, which contain a richer documentation of a patient’s ADE. Several natural language processing (NLP) systems have been proposed to automatically extract information related to ADEs. However, the results from these systems showed that significant improvement is still required for the automatic extraction of ADEs from clinical notes.ObjectiveThis study aims to improve the automatic extraction of ADEs and related information such as drugs, their attributes, and reason for administration from the clinical notes of patients.MethodsThis research was conducted using discharge summaries from the Medical Information Mart for Intensive Care III (MIMIC-III) database obtained through the 2018 National NLP Clinical Challenges (n2c2) annotated with drugs, drug attributes (ie, strength, form, frequency, route, dosage, duration), ADEs, reasons, and relations between drugs and other entities. We developed a deep learning–based system for extracting these drug-centric concepts and relations simultaneously using a joint method enhanced with contextualized embeddings, a position-attention mechanism, and knowledge representations. The joint method generated different sentence representations for each drug, which were then used to extract related concepts and relations simultaneously. Contextualized representations trained on the MIMIC-III database were used to capture context-sensitive meanings of words. The position-attention mechanism amplified the benefits of the joint method by generating sentence representations that capture long-distance relations. Knowledge representations were obtained from graph embeddings created using the US Food and Drug Administration Adverse Event Reporting System database to improve relation extraction, especially when contextual clues were insufficient.ResultsOur system achieved new state-of-the-art results on the n2c2 data set, with significant improvements in recognizing crucial drug−reason (F1=0.650 versus F1=0.579) and drug−ADE (F1=0.490 versus F1=0.476) relations.ConclusionsThis study presents a system for extracting drug-centric concepts and relations that outperformed current state-of-the-art results and shows that contextualized embeddings, position-attention mechanisms, and knowledge graph embeddings effectively improve deep learning–based concepts and relation extraction. This study demonstrates the potential for deep learning–based methods to help extract real-world evidence from unstructured patient data for drug safety surveillance.

Right drug, wrong dosage: insights from the PAVE-AF antithrombotic study in older patients with atrial fibrillation

Optimal antithrombotic treatment of older patients is usually impeded by several prevailing misconceptions. The aim of our study was to assess the type, dosage and predictors of antithrombotic therapy in older patients with non-valvular atrial fibrillation (NVAF). PAVE-AF was a prospective, cross-sectional study, including NVAF patients ≥ 80 years from 30 participating centers. Demographic data, comorbidities and treatment patterns were documented in a single visit. Patients treated with non-vitamin K oral anticoagulants (NOACs) were further classified into three dosing categories (recommended, underdosing and overdosing). Among 1018 patients (85.4±4.0 years), 88.4% received anticoagulants (AC), 8% antiplatelets (AP) and 3.6% no treatment. The primary reason for AP administration was physician concern of bleeding followed by patient denial. Patients ≥90 years had two times greater probability to receive AP therapy compared to patients < 90 years. Among patients treated with AC, one third received vitamin K antagonists, while two thirds received NOACs [34.6% apixaban, 9.5% dabigatran and 22.6% rivaroxaban]. Independent predictors of AC prescription over AP or no treatment were low HAS-BLED score, hypertension, labile INR, permanent AF, absence of uncontrolled hypertension, prior stroke/systemic embolism, age and male gender. In total, 37% of NOAC recipients received inappropriate dosage, while the number of patients receiving recommended dosing differed significantly among NOAC subgroups (p < 0.001). In our study, a minority of older NVAF patients received AP or no therapy for stroke prevention. Among patients treated with anticoagulants, two thirds were on NOAC treatment, though with a considerable proportion of inappropriate dosing.

Survival of bDMARDs in bionaive patients with rheumatoid arthritis: data from a retrospective 12-month follow-up

Analysis of survival on biological therapy in previously bionaive patients with rheumatoid arthritis (RA) during the first year of therapy in real clinical practice. The retrospective study included 204 adult patients with RA. In the hospital, patients were first prescribed therapy with various biological disease-modifying antirheumatic drugs (bDMARDs): infliximab, adalimumab, etanercept, certolizumab pegol, tocilizumab, abatacept (ABA), rituximab (RTM). Patients were divided by age in accordance with the classification adopted by WHO. Clinical forms of RA were presented: RA, seropositive for rheumatoid factor, RA, seronegative for rheumatoid factor, RA with extra-articular manifestations, adult-oneset Stills disease, juvenile RA. The reasons for the cancellation of bDMARD during the first year of treatment were: insufficient effectiveness (including primary inefficiency), adverse events, administrative reasons, clinical and laboratory remission, death. A year after being included in the study, treatment was continued in 92 (45%) patients and was discontinued in 112 patients. The average time of treatment amounted to 0.750.33 years. The longest duration of treatment was in the RTM and ABA groups (0.920.22 and 0.830.29 years, respectively). In 56 (50%) patients, bDMARD was canceled due to insufficient effectiveness (including primary inefficiency), 28 patients (25%) due to the development of adverse reactions, 19 (17%) patients for administrative reasons, 7 (6.25%) patients due to drug remission. During the first year of therapy, there were 2 (1.75%) deaths due to severe comorbid conditions in patients, one of whom received RTM, the other tocilizumab. Study showed that 45% of patients with RA continue treatment with first-time bDMARD for more than 12 months. The most common reason for discontinuation of therapy was its lack of effectiveness. The best survival rate of bDMARDs was observed in RTM and ABA. When selecting bDMARD in each case, it is necessary to take into account the continuity at all stages of treatment.

Daily Workload And Service Profile Of Family Physicians In Turkey: A Snapshot Of One-Day Work

Objective: The study aims to determine the daily workload and to analyze the content of workload, to describe the service profile of FPs working in primary care in Turkey. Methods: The study design is descriptive and cross-sectional. A total of 28 FPs from 17 different cities were enrolled into the study. Two surveys, one inquiring the demographic properties of FPs participated and a second encounter form with 43 items inquiring all aspects of FPs’ workload were filled by the participants. Results: A total of 1,215 visits were reported. The average daily workload of FPs participating was 45.7± 16.8 visits. 92.5% of all patients were family physicians’ own registered patients while 7.5% of them were guests. A total of 1,610 RFEs were reported. We categorized them as prescription requests (451, 28%), clinical complaints (447, 27.8%), preventive medicine services (436, 27%), administrative reasons (161, %10) and other reasons (115, 7.2%). Essential hypertension and diseases of musculoskeletal system were the most common diagnoses in prescription requests. Sore throat and cough were the top two clinical complaints. Conclusions: FPs in Turkey are under severe pressure. Prescription requests account for an important percentage of this workload. Measures should be taken to lessen this burden.

The development of the privy council oath in Tudor England*

Abstract From the early thirteenth century to the present day, privy councillors have been required to swear an oath of office. This article demonstrates that at least four different council oaths were administered by chancery during the Tudor period, and that William Cecil drafted yet another revised oath in 1558, although this was never finished. The article compares the respective texts and explains the administrative and political reasons for each of the revisions. It goes on to examine evidence from these oaths that suggests developments in the conception of counsel in the sixteenth century. It concludes with transcriptions of the four operational oaths and the Cecilian draft.

Frequency of use and Indications for Beta-Blockers in Heart Failure with Preserved Ejection Fraction

Aim To evaluate trends in beta-blocker prescribing and incidence of possible reasons for beta-blocker administration, including arterial hypertension (AH), atrial fibrillation (AF), ischemic heart disease (IHD), and myocardial infarction, in participants of clinical studies enrolling patients with chronic heart failure with preserved ejection fraction (CHF-PEF).Material and methods A systematic literature search was performed in the PubMed and EMBASE databases. The study included RCSs of pharmacological therapies for patients with CHF-PEF conducted from 1993 through 2019. Studies of beta-blocker efficacy or those including a specific population (CHF-PEF+IHD or CHF-PEF+AH, etc.) were excluded from the analysis. Baseline characteristics of patients, incidence rate of beta-blocker prescribing, and prevalence of AH, AF, IHD, and MI were recorded. Trends in prevalence of concomitant diseases and the proportion of patients using beta-blockers by the year of enrollment to the study were analyzed with the Mann-Kendall test.Results 14 RCSs of 718 selected publications completely met the inclusion and exclusion criteria. Beta-blocker prescribing significantly increased between 1993 and 2019 (tau=0.51; p=0.014) and reached 80 % in recent studies. Furthermore, prevalence of IHD, MI, AH, and AF did not significantly change among the RCS participants (p&gt;0.05 for all). However, while for AH and AF, a tendency toward an increasing prevalence (tau=0.4; p=0.055 and tau=0.043; p=0.063, respectively) could be considered and became statistically significant for AF when the ALDO-DHF study was excluded from the analysis (tau=0.5; p=0.042), the MI prevalence tended to decrease (tau= -0.73; p=0.06).Conclusion Beta-blocker prescribing to patients upon inclusion into RCSs for CHF-PEF has significantly increased for the recent 20 years while the incidence of formal reasons for beta-blocker administration (AF, AH, MI, IHD) did not significantly change.

Treatment Mode Preferences in Psoriatic Arthritis: A Qualitative Multi-Country Study.

ObjectiveQualitative research exploring patient preferences regarding the mode of treatment administration for psoriatic arthritis (PsA) is limited. We report patient preferences and their reasons across PsA treatment modes.MethodsIn this global, cross-sectional, qualitative study, interviews were conducted with adult patients with PsA in Brazil, France, Germany, Italy, Spain, the UK, and the US. Patients were currently taking a disease-modifying antirheumatic drug (DMARD). Patients indicated the order and strength of preference (0–100; 100 = strongest) across four modes of treatment administration: oral (once daily), self-injection (weekly), clinic injection (weekly), and infusion (monthly); reasons for preferences were qualitatively assessed. Descriptive statistics were reported. Fisher’s exact tests and t-tests were conducted for treatment mode outcomes.ResultsOverall, 85 patients were interviewed (female, 60.0%; mean age, 49.8 years). First-choice ranking (%) and mean [standard deviation] preference points were: oral (49.4%; 43.9 [31.9]); self-injection (34.1%; 32.4 [24.8]); infusion (15.3%; 14.5 [20.0]); clinic injection (1.2%; 9.2 [10.0]). Of 48 (56.5%) patients with a strong first-choice preference (ie point allocation ≥60), 66.7% chose oral administration. Self-injection was most often selected as second choice (51.8%), clinic injection as third (49.4%), and infusion as fourth (47.1%). Oral administration was the first-choice preference in the US (88.0% vs 38.0% in Europe). The most commonly reported reason for oral administration as the first choice was speed and ease of administration (76.2%); for self-injection, this was convenience (75.9%). The most commonly reported reason for avoiding oral administration was concern about possible drug interactions (63.6%); for self-injection, this was a dislike of needles or the injection process (66.7%).ConclusionPatients with PsA preferred oral treatment administration, followed by self-injection; convenience factors were common reasons for these preferences. Overall, 43.5% of patients did not feel strongly about their first-choice preference and may benefit from discussions with healthcare professionals about PsA treatment administration options.

Use of antimicrobials in beef cattle: an observational study in the north of Italy

Antimicrobial resistance is a worldwide issue whereby a more prudent use of medications is needed, especially for those antimicrobials (AM) classified as ‘highest priority critically important antimicrobials’ (HPCIAs) which are likely contributors to the development of resistance. So far, data on antimicrobial use (AMU) in EU are mainly reported at sales level while information on real use, mostly in beef production, is poor. The most reliable indicator to measure AMU is the treatment incidence (TI100) calculated by using the Defined Daily Dose Animal (DDDA) as stated by the European Medicines Agency (EMA). Although Italy ranks second among EU countries with regard to the AM sales in livestock production, data on AMU of the Italian beef production is still lacking, whereby the aim of this study was to provide information on the current scenario of AMU in Italian beef cattle. Data were collected from January 2016 to April 2019 from specialized beef fattening farms located in the north of Italy yielding a final dataset of 1376 batches. Data on performance and AM agents used in the study were collected and TI100 indexes per batch were calculated according to both Italian and EMA’s DDDA. A Kruskal-Wallis test was used to check for differences between years and seasons. Results showed a significant variation between years and seasons with a reduction of TI100 based on Italian DDDA as time progressed (P < 0.05). However, about 40% of the total amount of treatments administered were HPCIAs with macrolides accounting for the 27.7% of the total amount. The most common reasons of administration of AM were respiratory diseases (68.9%) and lameness (17.6%). Penicillins was the class of AM used on the highest proportion of batches (84.4%) showing that broad-spectrum AM were widely exploited among herds. In summary, despite a general reduction of AMU in beef cattle over time, a great use of HPCIAs was still observed suggesting that AM stewardship for Italian beef production should pay particular emphasis on the reduction of HPCIAs use. This shows how overall knowledge on where efforts need to be optimized is important to develop targeted strategies for a more responsible AM stewardship. Results of the current study may also contribute to define national and EU benchmark criteria for AMU, as a comparison with studies carried out in other countries or on other food-producing sectors is still challenging to achieve.

Nasal Glucagon Delivery is More Successful than Injectable Delivery: A Simulated Severe Hypoglycemia Rescue

Objective: A severe hypoglycemia (SH) episode is an acute, high-stress moment for the caregivers of persons with diabetes (PWD). We compared the success rates of nasal glucagon (NG) and injectable glucagon (IG) administration for PWD-trained and untrained users in treating simulated SH episodes. Methods: Thirty-two PWD-trained users and 33 untrained users administered NG and IG to high-fidelity manikins simulating treatment of an SH emergency. Simulation rooms resembled common locations with typical diabetic supplies and stressor elements mimicking real-life SH environments. Success rate and time to administer glucagon were measured. Results: Of all the PWD-trained and untrained users, 58/64 (90.6%) could successfully deliver NG, while 5/63 (7.9%) could successfully deliver IG. For NG simulations, 28/31 (90.3%) PWD-trained users and 30/33 (90.9%) untrained users could successfully administer the dose (mean time 47.3 seconds and 44.5 seconds, respectively). For IG simulations, 5/32 (15.6%) PWD-trained users successfully injected IG (mean time 81.8 seconds), whereas none (0/31 [0%]) of the untrained users were successful. Reasons for unsuccessful administration of NG included oral administration and incomplete pushing of the device plunger. For IG, inability to perform reconstitution steps, partial dose delivery, and injection at an inappropriate site were the causes for failure. Conclusion: With or without training, the success rate for administering NG was 90.6%, whereas it was only 7.9% for IG. NG was easily and quickly administered even by untrained users, whereas training was necessary for successful administration of IG. NG may expand the community of caregivers who can help PWD during an SH episode. Abbreviations: IG = injectable glucagon; NG = nasal glucagon; PWD = person with diabetes; SH = severe hypoglycemia; T1D = type 1 diabetes; T2D = type 2 diabetes.