scholarly journals Optimising Seniors’ Metabolism of Medications and Avoiding Adverse Drug Events Using Data on How Metabolism by Their P450 Enzymes Varies with Ancestry and Drug–Drug and Drug–Drug–Gene Interactions

2020 ◽  
Vol 10 (3) ◽  
pp. 84
Author(s):  
Roger E. Thomas
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Adverse Drug Events ◽  
Meta Analysis ◽  
Gene Interactions ◽  
Rural And Remote ◽  
Remote Areas ◽  
Rural And Remote Areas ◽  
Enormous Variation ◽  
Using Data

Many individuals ≥65 have multiple illnesses and polypharmacy. Primary care physicians prescribe >70% of their medications and renew specialists’ prescriptions. Seventy-five percent of all medications are metabolised by P450 cytochrome enzymes. This article provides unique detailed tables how to avoid adverse drug events and optimise prescribing based on two key databases. DrugBank is a detailed database of 13,000 medications and both the P450 and other complex pathways that metabolise them. The Flockhart Tables are detailed lists of the P450 enzymes and also include all the medications which inhibit or induce metabolism by P450 cytochrome enzymes, which can result in undertreatment, overtreatment, or potentially toxic levels. Humans have used medications for a few decades and these enzymes have not been subject to evolutionary pressure. Thus, there is enormous variation in enzymatic functioning and by ancestry. Differences for ancestry groups in genetic metabolism based on a worldwide meta-analysis are discussed and this article provides advice how to prescribe for individuals of different ancestry. Prescribing advice from two key organisations, the Dutch Pharmacogenetics Working Group and the Clinical Pharmacogenetics Implementation Consortium is summarised. Currently, detailed pharmacogenomic advice is only available in some specialist clinics in major hospitals. However, this article provides detailed pharmacogenomic advice for primary care and other physicians and also physicians working in rural and remote areas worldwide. Physicians could quickly search the tables for the medications they intend to prescribe.

scholarly journals Rural primary care: a scoping review

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Bosmans ◽  
W G W Boerma ◽  
P P Groenewegen
Keyword(s):  
Primary Care ◽  
Scoping Review ◽  
Rural Areas ◽  
Grey Literature ◽  
Rural And Remote ◽  
Remote Areas ◽  
Rural Primary Care ◽  
Care Workers ◽  
Rural And Remote Areas ◽  
Access To Primary Care

Abstract Background Access to primary care is unequally distributed. Especially in rural and remote areas access to primary care services is problematic. As many countries, large and small, recognize the challenge of providing accessible and good quality primary care and implement different strategies to address this challenge, there are opportunities for cross-national learning. The main aim of this report is to provide information on best practices and solutions to counter the risk of a primary care vacuum in rural and remote areas. Methods In this scoping review of the literature on primary care in rural areas we made an inventory of evidence from research of the past 10 years. The research literature from January 2008 to June 2018 was captured through searches of the databases of Medline, Cochrane and EMBASE. In addition, we included relevant grey literature from within the WHO European region. Results The following four groups of strategies have been identified and can be used to address rural primary care shortages: substituting roles within multidisciplinary primary care teamssmart recruitment, retention and training strategies focused on staff in rural areasimplementing technological innovations in information and communicationas a short term solution: promoting the mobility of health care workers and patients Conclusions The evidence base with regard to interventions to improve access to primary care in rural areas is narrow, lacking sufficient methodologically sound research, making definitive conclusions about their effectiveness impossible. Additionally, the available evidence is biased towards programmes targeting physicians. Nevertheless, the literature does offer indications of promising intervention types, and provides valuable recommendations for their implementation. Key messages Implementation of strategies should always be accompanied by systematic monitoring of outcomes. Interventions should include primary care workers other than physicians.

scholarly journals A Possible Smart Metering System Evolution for Rural and Remote Areas Employing Unmanned Aerial Vehicles and Internet of Things in Smart Grids

Sensors ◽  
2021 ◽  
Vol 21 (5) ◽  
pp. 1627
Author(s):  
Giovanni Battista Gaggero ◽  
Mario Marchese ◽  
Aya Moheddine ◽  
Fabio Patrone
Keyword(s):  
Energy Consumption ◽  
Internet Of Things ◽  
Unmanned Aerial Vehicles ◽  
Smart Metering ◽  
Rural And Remote ◽  
Electrical Grid ◽  
Remote Areas ◽  
Aerial Vehicles ◽  
Consumption Data ◽  
Rural And Remote Areas

The way of generating and distributing energy throughout the electrical grid to all users is evolving. The concept of Smart Grid (SG) took place to enhance the management of the electrical grid infrastructure and its functionalities from the traditional system to an improved one. To measure the energy consumption of the users is one of these functionalities that, in some countries, has already evolved from a periodical manual consumption reading to a more frequent and automatic one, leading to the concept of Smart Metering (SM). Technology improvement could be applied to the SM systems to allow, on one hand, a more efficient way to collect the energy consumption data of each user, and, on the other hand, a better distribution of the available energy through the infrastructure. Widespread communication solutions based on existing telecommunication infrastructures instead of using ad-hoc ones can be exploited for this purpose. In this paper, we recall the basic elements and the evolution of the SM network architecture focusing on how it could further improve in the near future. We report the main technologies and protocols which can be exploited for the data exchange throughout the infrastructure and the pros and cons of each solution. Finally, we propose an innovative solution as a possible evolution of the SM system. This solution is based on a set of Internet of Things (IoT) communication technologies called Low Power Wide Area Network (LPWAN) which could be employed to improve the performance of the currently used technologies and provide additional functionalities. We also propose the employment of Unmanned Aerial Vehicles (UAVs) to periodically collect energy consumption data, with evident advantages especially if employed in rural and remote areas. We show some preliminary performance results which allow assessing the feasibility of the proposed approach.

scholarly journals Implementing transnational telemedicine solutions: A connected health project in rural and remote areas of six Northern Periphery countries

2013 ◽  
Vol 19 (1) ◽  
pp. 52-58 ◽  
Author(s):  
Monica Casey ◽  
Patrick S. Hayes ◽  
David Heaney ◽  
Lee Dowie ◽  
Gearoid ÓLaighin ◽  
...  
Keyword(s):  
Rural And Remote ◽  
Connected Health ◽  
Remote Areas ◽  
Rural And Remote Areas ◽  
Health Project

scholarly journals Development and performance evaluation of a Pedal Operated Seed Cleaner (POS-Cleaner)

2021 ◽  
Vol 3 (6) ◽  
Author(s):  
Wilber Akatuhurira ◽  
Peter Tumutegyereize ◽  
Isaac Oluk ◽  
Emmanuel Baidhe ◽  
Julia Kigozi ◽  
...  
Keyword(s):  
Smallholder Farmers ◽  
List Type ◽  
Centrifugal Fan ◽  
Rural And Remote ◽  
Value Addition ◽  
Remote Areas ◽  
Individual Family ◽  
Rural And Remote Areas ◽  
And Performance ◽  
Cleaning Methods

Abstract Traditional grain cleaning methods are labor-intensive, time-consuming, and yet very inefficient. The use of available mechanical seed cleaners is widely limited since they are expensive to own, operate, and maintain. A Pedal Operated Seed Cleaner (PoS-Cleaner) was developed and its performance evaluated. Appropriate engineering principles and methodologies were used in the sizing and construction of the machine. The cleaner consists of a bicycle-like pedaling system, hopper, a centrifugal fan, and three cleaning sieves which include two inside interlocking sieves (one sieve fixed and the other adjustable); whose meshes can be adjusted to be larger than the size of the unclean seeds by longitudinally translating the second sieve to achieve the appropriate seed size. This allows trapping of impurities larger than the seeds. Cleaning rates of 576.5 kg/h, 375.8 kg/h, and 377.4 kg/h for maize, beans, and groundnuts were obtained respectively. Maize, beans, and groundnuts had their highest cleaning efficiencies of 95.09%, 87.61%, and 81.67% at inner sieve sizes of 13 mm, 16 mm and 10 mm respectively, pedaling speed of 60 rpm. The PoS-Cleaner presents a more viable cleaning option for smallholder farmers in rural and remote areas with no access to the national grid, therefore producing high-quality seeds. This will eventually facilitate agricultural value addition and increase individual family incomes in Uganda. Article highlights A pedal operated multi-seed cleaner was developed. Achieved 5 times higher seed cleaning rates compared to traditional cleaning technologies. Attained higher separation efficiencies of seed and externalities compared to traditional technologies.

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