Workload Analysis of Pharmacy Technicians at Pharmacy Department of Universitas Padjadjaran Dental and Oral Hospital Using Workload Indicators of Staffing Needs

Job responsibilities are significantly accomplished with sufficient and appropriate labor, although it differs in various fields. A major challenge in health facilities involves the ability to balance the number of staff and workloads to ensure quality, effective and efficient performance. Developing countries continue to struggle, in terms of fulfilling these objectives, mainly due to limited resources and budget. Therefore, this study aimed to analyze the workload at the Pharmacy of Universitas Padjadjaran Dental and Oral Hospital (RSGM Unpad) using WHO’s workload indicators of staffing needs (WISN) technique. This study also applied a descriptive cross-sectional design and conducted the WISN methodology between May-September 2020. Subsequently, observations, discussions and interviews were used to generate relevant information from the hospital’s workforce and its 2019 records. The results showed the availability of 7 employees and an annual estimate of 97,440 minutes in work duration. As a consequence, the manpower demands for inpatient-outpatient and logistic-purchasing departments were 4 and 2 persons, respectively. The resulting WISN ratio was 1.17 (> 1), indicating an inadequate workload and staff number. Based on the WISN analysis, it is concluded that the pharmacy is overstaffed under the existing workload conditions. Therefore, employee redistribution and the development of pharmaceutical satellites towards enhancing effectiveness and efficiency are significantly recommended.

Abstract P437: Trends in Outcomes, and Length and Costs of Hospitalization in Patients With Intracerebral Hemorrhage in United States

Background: It remains unclear whether there is any improvement in outcomes of patients with intracerebral hemorrhage over the last decade. Objective: To determine trends pertaining in-hospital outcomes in patients with intracerebral hemorrhage using nationally representative data. Methods: We determined the national estimates of intracerebral hemorrhage admissions from 2005 to 2014 and associated in-hospital outcomes, length of stay, mortality, and cost incurred using the Nationwide Inpatient Survey (NIS) data. The NIS is the largest all-payer inpatient care database in the US and contains data from 986 hospitals approximating a 20% stratified sample of US hospitals. Outcome was classified as none to minimal disability, moderate to severe disability, and death based on discharge destination. Results: In the 10-year period, there were 70,637 admissions for intracerebral hemorrhage (annual estimate 80804 in 2005 to 109930 in 2014). There was a significant reduction in in-hospital mortality in patients with intracerebral hemorrhage from 30% to 23% (trend test, p < 0.0001). There was a trend towards increase in proportion of patients with moderate to severe disability (trend test, p < 0.097). The mean length of hospitalization increased from 8.58 days to 9.23 days (trend test, p < 0.0001) and cost of hospitalization increased from $50532.1 to $110932.1 (trend test, p < 0.0001). Conclusions: The mortality in patients with intracerebral hemorrhage has decreased but there is increased rates of moderate to severe disability, length of hospitalization, and hospitalization cost over the last decade.

Plastic Waste Management and Leakage in Latin America and the Caribbean

As of 2017, 8.3 billion metric tons of plastic had been produced worldwide. Since about 40% is used in things that are thrown away relatively quickly (packaging and single use items), 6.4 billion metric tons had already become discarded materials needing to be managed. Only 9% of these discarded materials were recycled globally. The annual estimate of plastic entering our oceans globally is 5 to 13 million metric tons (MMT) per year. Latin America and the Caribbean (LAC) has an extensive populated coast, 119,000 km of coastline and over 205 million people living within 50 km of that coastline. Waste management infrastructure is still under development in many countries. Economic growth without fully developed infrastructure can lead to increased plastic leakage. This report focuses on municipal solid waste as a source of plastic input into the environment in LAC. The reports estimates that total plastic waste available to enter the ocean in LAC in 2020 was 3.7 MMT . Under business-as-usual projections, the report anticipates that the regional quantity available to enter the oceans in 2030 will be 4.1 MMT and 4.4 MMT in 2050.

Economic Impact Assessment of Regulatory Changes: A Case Study of a Proposed New ICAO Standard for Contaminated Runways

The literature on economic impact assessments (EIA) of regulatory changes in the transport sector is scarce. This study examines how a change in the regulatory framework for air transport could affect transport costs. The case in question is the International Civil Aviation Organization (ICAO) State letter AN 4/1.2.26-16/19 that proposed to set a higher minimum friction on runways operated during slippery conditions. This may affect operations, particularly in the northern hemisphere. Four Norwegian airports that operate under severe winter conditions are used as examples. Sudden cancellations or transfers to another airport give additional costs per passenger, ranging from NOK 750 to NOK 5600 per return flight. If these results are generalized to all affected flights in Norway, the annual estimate is NOK 400–450 million. These numbers may not seem exorbitant. However, the costs are mainly borne by a limited number of airports. Some of them may have to close during winter, with severe consequences for local communities. This study illustrates how effects of a proposed regulatory change may be assessed in order to aid the decision-making process. The impacts on aviation safety are not considered. Data on aircraft accidents in Norway do not indicate significant effects from the proposed regulatory change.

Applied Strategy to Characterize the Energy Improvement Using PATs in a Water Supply System

Sustainable development has been an idea raised in recent years. The results are related to the improvement and the use of new technologies to maximize efficiency in water management. However, energy consumption has been increasing as a consequence of new management and uses of water. Especially in pressurized water distribution systems, the use of pressure reduction valves (PRVs) increases the water usage efficiency but it decreases the energy consumption efficiency, since the valves dissipate energy that could be recovered. This research presents a proposal of a recovery system based on the installation of pumps used as turbines (PATs). These machines are located in different points of the high-pressure water distribution system in the Valencia Metropolitan System (Spain). An annual estimate of the theoretical recoverable energy as well as the “ideal” pump for each point were proposed. The theoretical recovered energy value was 847,301 kWh/year for a specific analyzed point. Besides, the characteristic curves of the PATs from a selected point were determined, estimating an improvement in the sustainable indexes. The calculus of these green parameters showed that the implementation of this solution caused a reduction in consumed energy of 1.50 kWh/m3.

Estimating the incidence of abortion: using the Abortion Incidence Complications Methodology in Ghana, 2017

IntroductionInduced abortion is legally permitted in Ghana under specific conditions, but access to services that meet guidelines approved by government is limited. As part of a larger project comparing five methodologies to estimate abortion incidence, we implemented an indirect estimation approach: the Abortion Incidence Complications Methodology (AICM), to understand the incidence of abortion in Ghana in 2017.MethodsWe drew a nationally representative, two-stage, stratified sample of health facilities. We used information from 539 responding facilities to estimate treated complications stemming from illegal induced abortions, and to estimate the number of legal abortions provided. We used information from 146 knowledgeable informants to generate zonal multipliers representing the inverse of the proportion of illegal induced abortions treated for complications in facilities in Ghana’s three ecological zones. We applied multipliers to estimates of treated complications from illegal abortions, and added legal abortions to obtain an annual estimate of all induced abortions.ResultsThe AICM approach suggests that approximately 200 000 abortions occurred in Ghana in 2017, corresponding to a national abortion rate of 26.8 (95% CI 21.7 to 31.9) per 1000 women 15–49. Abortion rates were lowest in the Northern zone (18.6) and highest in the Middle zone (30.4). Of all abortions, 71% were illegal.ConclusionDespite Ghana’s relatively liberal abortion law and efforts to expand access to safe abortion services, illegal induced abortion appears common. A concurrently published paper compares the AICM-derived estimates presented in this paper to those from other methodological approaches.

Otobur in Action: Processing of various biodiversity data for botanical gardens; flowering calendar, herbarium digitization, propagation trials and scientific plant names

Over the past decade, great improvements have occurred in the field of biodiversity information technology. Data types such as geographic and phenological (e.g., blooming) characteristics of different specimens, which are used for the analysis of environmental issues, are steadily increasing on a large scale. Most herbaria and botanic gardens are involved in the digital compilations of such kinds of data to be able to transform them into meaningful results that can be used to tackle environmental problems (Leadlay and Greene 1998). These are usually in the form of high resolution images, along with tables displaying additional information about specimens, which are accessible over the internet. This study, will describe how we made an annual estimate of phenological data, constructing a flowering calendar of plants (Fig. 1) in the Nezahat Gökyiğit Botanik Bahçesi (NGBB), using Otobur (Loizeau et al. 2018). Otobur is a data management system developed under NGBB in Istanbul, which is accessible at https://www.otobur.org.tr. In addition to this, we also analyze our recorded data on the ongoing propagation effort of seedlings, in order to analyze and compare their prior germination success and mortality ratios (Fig. 2). This enables us to improve our procedures, and to find the most suitable techniques to apply in the most accurate propagation trials.

Anthropogenic sulfur dioxide emissions: 1850–2005

Sulfur aerosols impact human health, ecosystems, agriculture, and global and regional climate. A new annual estimate of anthropogenic global and regional sulfur dioxide emissions has been constructed spanning the period 1850–2005 using a bottom-up mass balance method, calibrated to country-level inventory data. Global emissions peaked in the early 1970s and decreased until 2000, with an increase in recent years due to increased emissions in China, international shipping, and developing countries in general. An uncertainty analysis was conducted including both random and systemic uncertainties. The overall global uncertainty in sulfur dioxide emissions is relatively small, but regional uncertainties ranged up to 30%. The largest contributors to uncertainty at present are emissions from China and international shipping. Emissions were distributed on a 0.5° grid by sector for use in coordinated climate model experiments.

Modeling global atmospheric CO₂ with improved emission inventories and CO₂ production from the oxidation of other carbon species

The use of global three-dimensional (3-D) models with satellite observations of CO2 in inverse modeling studies is an area of growing importance for understanding Earth's carbon cycle. Here we use the GEOS-Chem model (version 8-02-01) CO2 mode with multiple modifications in order to assess their impact on CO2 forward simulations. Modifications include CO2 surface emissions from shipping (~0.19 Pg C yr−1), 3-D spatially-distributed emissions from aviation (~0.16 Pg C yr−1), and 3-D chemical production of CO2 (~1.05 Pg C yr−1). Although CO2 chemical production from the oxidation of CO, CH4 and other carbon gases is recognized as an important contribution to global CO2, it is typically accounted for by conversion from its precursors at the surface rather than in the free troposphere. We base our model 3-D spatial distribution of CO2 chemical production on monthly-averaged loss rates of CO (a key precursor and intermediate in the oxidation of organic carbon) and apply an associated surface correction for inventories that have counted emissions of CO2 precursors as CO2. We also explore the benefit of assimilating satellite observations of CO into GEOS-Chem to obtain an observation-based estimate of the CO2 chemical source. The CO assimilation corrects for an underestimate of atmospheric CO abundances in the model, resulting in increases of as much as 24% in the chemical source during May–June 2006, and increasing the global annual estimate of CO2 chemical production from 1.05 to 1.18 Pg C. Comparisons of model CO2 with measurements are carried out in order to investigate the spatial and temporal distributions that result when these new sources are added. Inclusion of CO2 emissions from shipping and aviation are shown to increase the global CO2 latitudinal gradient by just over 0.10 ppm (~3%), while the inclusion of CO2 chemical production (and the surface correction) is shown to decrease the latitudinal gradient by about 0.40 ppm (~10%) with a complex spatial structure generally resulting in decreased CO2 over land and increased CO2 over the oceans. Since these CO2 emissions are omitted or misrepresented in most inverse modeling work to date, their implementation in forward simulations should lead to improved inverse modeling estimates of terrestrial biospheric fluxes.