OBJECTIVE Type 2 diabetes is increasingly common and associated with substantial morbidity and mortality. This study examines trends in the patterns and costs of drug treatment of type 2 diabetes ...from 1997 to 2012. RESEARCH DESIGN AND METHODS We conducted descriptive analyses of cross-sectional data using the IMS Health National Disease and Therapeutic Index, a nationally representative audit of ambulatory physician practices in the U.S. We focused on visits for diabetes among patients 35 years of age or older. We used the IMS Health National Prescription Audit of pharmacy dispensing to derive information about drug expenditures. RESULTS Ambulatory diabetes visits increased from 23 million treatment visits in 1997 (95% CI 21-25) to 35 million (32-37) in 2007 and declined to 31 million visits by 2012 (27-31). Between 1997 and 2012 biguanide use increased, from 23% (20-26) to 53% (50-56) of treatment visits. Glitazone use grew from 6% (4-8) in 1997 (41% 39-43 of all visits in 2005), but declined to 16% (14-18) by 2012. Since 2005, dipeptidyl peptidase-4 (DPP-4) inhibitor use increased steadily, representing 21% (18-23) of treatment visits by 2012. Glucagon-like peptide 1 (GLP-1) agonists accounted for 4% of treatment visits in 2012. Visits where two or more drug compounds were used increased nearly 40% from 1997 to 2012. Between 2008 and 2012, drug expenditures increased 61%, driven primarily by use of insulin glargine and DPP-4 inhibitors. CONCLUSIONS Declining sulfonylurea and glitazone use has been offset by increases in DPP-4 inhibitor use and, to a lesser degree, use of GLP-1 agonists. Treatment of diabetes has grown in complexity while older treatments continue to be replaced or supplemented by newer therapies.
Purpose
Inefficiencies in the power sector resulting from underinvesting and underselling reduce the ability of governments to adequately finance energy projects. The purpose of this paper is to ...explore mechanisms of energy financing, benefits and challenges associated with innovative financing of energy infrastructure as well as strategies to improve innovative financing of energy infrastructure.
Design/methodology/approach
Questionnaires were used to elicit responses from respondents. Seventy-eight responses were retrieved. Mean score ranking, Kruskal–Wallis test and discriminant validity were the analysis conducted.
Findings
Partial credit guarantee; partial risk guarantee; credit enhancement; and loan guarantees were the significant mechanisms. Production efficiency; reduce pressure on public budgets; access to management expertise; and self-sustainability of infrastructure facilities were the significant benefits. Lack of transparency and adequate data for risk assessment; high up-front cost; heterogeneity, complexity, and presence of a large number of parties; and lack of a clear benchmark for measuring investment performance were the severest challenges. Complete transparency and accountability; political stability and public view on private provision of energy infrastructure services; and macroeconomic environment were the significant strategies.
Practical implications
This study is beneficial to energy sector as the current government of Ghana hints on willingness to involve private sector in management of the power sector.
Originality/value
The novelty of this study is that it is a pioneering study in Ghana on innovative financing of energy infrastructure.
Background and Aims
Violence against female sex workers (FSWs) is a widespread phenomenon, especially in African nations like Ghana where sex work is outlawed primarily because of the pervasive ...worldview that sex work is a contravention of morality. Violence against FSWs deters them from accessing critical health services and heightens their risk of STIs including HIV infection. The study examined the prevalence and the associated factors of multiple indicators of violence against FSWs.
Methods
The study utilized a cross‐sectional secondary data from the 2015 Integrated Bio‐Behavioral Surveillance Survey conducted among FSWs and their nonpaying partners by Ghana AIDS Commission. We analysed data on a total of 4279 participants. Bivariate, and multivariable logistic regression analyses were utilized to identify factors associated with physical and sexual violence against FSWs. Data were analysed using Stata version 15.
Results
Of the 4279 FSWs, 433 (10%) and 1059 (25%) suffered physical and sexual violence, respectively. The predictors of physical violence are being a seater (adjusted odds ratio aOR = 0.53, 95% confidence interval CI: 0.36–0.74), aged ≥40 (aOR = 0.23, 95% CI: 0.08–0.64), nonuse of drugs (aOR = 0.56, 95% CI: 0.44–0.70), not using alcohol before sex (aOR = 0.69, 95% CI: 0.56–0.86) and petty business (aOR = 1.39, 95% CI: 1.05–1.82). Sexual violence was predicted by those aged 31–40 (aOR = 0.68, 95% CI: 0.49–0.94) and age ≥40 (aOR = 0.38, 95% CI: 0.22–0.66), currently married (aOR = 0.42, 95% CI: 0.27–0.67), having no living children (aOR = 0.69, 95% CI: 0.51–0.94), nonuse of drugs (aOR = 0.80, 95% CI: 0.68–0.94), and not using alcohol before sex (aOR = 0.74, 95% CI: 0.63–0.86). Region was associated with both physical and sexual violence. Both physical and sexual violence had negative consequences on consistency of condom use and condom failure among FSWs.
Conclusion
Physical and sexual violence against FSWs is pervasive, and a critical public health issue in Ghana. The identified associated factors could be considered as part of an overall strategy aimed at addressing the menace.
The evaluation of biochar application on the adsorption behavior of topramezone on soil under no-tillage (NT) and rotary tillage treatments (RT) has been assessed. Fourier Transform Infra-Red ...Spectrometry (FTIR), scanning electron microscopy (SEM), and Brunauer-Emmett-Teller) (BET) were used for the biochar characterization. Batch experiments were carried out in a laboratory to assess the adsorption of topramezone on soil through equilibrium and kinetic modeling under biochar addition. The clay content has been found to be higher under NT (18.24 ± 0.01) than under RT (15.91 ± 0.02). The total organic carbon was higher under NT. The topramezone adsorption equilibrium reached after 8 and 12 h, for NT and RT, respectively. The kinetic and thermodynamic analyses showed the adsorption under both treatments matched with pseudo-second-order kinetic and Langmuir models, respectively. After biochar addition, the pesticide adsorption capacity (40 < 25 < 15 °C) increased with decreasing temperature suggesting an exothermic adsorption process while negative values of Gibbs free energy (ΔG); -1848.07 and -366.531 J mol
; for the soil under NT and RT at 25 °C, respectively, indicated spontaneous adsorption. Negative entropy values (ΔS); -21.92 and -78.296 J mol
K
, for NT and RT, respectively, explained a decreased randomness process. The enthalpy was higher (
< 0.05) under RT (-23,274.6 J mol
) than under NT (-1313.73 J mol
). Conclusively, it was shown that the topramezone adsorption capacity was higher under NT, and biochar addition increased more pesticide adsorption under NT than under RT.
Fatigue is a feeling of tiredness or weakness that can be physical, mental or both. Interpretable machine learning methods can be used for inference while having the dimension of time series ...prediction for developing intelligent health systems to manage fatigue. The study explored forecasting perception and performance scores associated with fatigue manifestation using cardiac activity with generalized and personalized models at a forecast interval of 10-minutes during a cognitively fatiguing task. Participants underwent a 2-hour cognitively fatiguing working memory task with subjective fatigue responses obtained every 10-minutes. Participants’ performance was calculated over the 10-minute interval. Performance labeled models had the lowest mean absolute error for forecasting in both generalized and personalized models using Gradient Boosting Regression. This provides the ability to forecast performance decrease due to fatigue and to generate fatigue mitigation interventions to reduce fatigue-related injuries.
This systematic review documents current best practices, standards, and approaches for transportation safety data analytics. While standards exist for defining measures, there are few available ...standards or guides for processing driving and driver data. Standards are crucial for ensuring repeatability and appropriate cost-benefit decisions. The review identified 36 relevant studies describing behavioral and physiological measures. Most studies do not comprehensively report data processing steps. Of the studies that did report data processing steps, few analyzed the impact of decisions made during data processing on algorithm performance. Most studies were conducted in a controlled simulator environment and may not generalize to naturalistic settings. The findings show that driver behavior and physiological data show efficacy for detecting fatigue, distraction, stress, and driver errors. The results of these studies may necessitate additional data processing standards and future work should focus on measuring the effects of data decisions on model performance.
High application rates of dairy effluent and manure are often associated with nitrogen (N) leaching, which can affect groundwater quality. Here, we used a lysimeter to examine N leaching losses and ...biomass yield following application of dairy effluent and manure under wheat-maize cropping. The field experiment included seven treatments: no N fertilizer (Control); 200/300 kg N ha−1 synthetic N fertilizer only (wheat/maize) (CN); 100/150 kg N ha−1 synthetic N fertilizer plus 100/150 (DE1), 150/200 (DE2) and 250/350 (DE3) kg N ha−1 dairy effluent; 100/150 kg N ha−1 synthetic fertilizer plus 100/150 kg N ha−1 dairy manure (SM1); and 150/225 kg N ha−1 synthetic fertilizer plus 50/75 kg N ha−1 dairy manure (SM2). Compared with CN, DE1 treatment increased maize yield by 10.0 %, wheat N use efficiency (NUE) by 26.5 %, and wheat and maize N uptake by 7.7–16.3 %, while reduced N leaching by 22.4 % in wheat season and by 40.4 % in the maize season. In contrast, DE2 and DE3 treatment increased N leaching by 27.2–241 % and reduced NUE by 26.2–55.2 %. SM2 treatment increased yield and NUE by 8.8 % and 7.8 %, respectively, and reduced N leaching by 42.9 % during the wheat but not the maize season. Annual N leaching losses were 37.6 kg N ha−1 under CN treatment, but decreased to 27.4 kg N ha−1 under DE1. In contrast, N leaching increased to 52.8 and 84.1 kg N ha−1 under DE2 and DE3 treatment, respectively (P < 0.05). Meanwhile, under SM1 and SM2 treatment, N leaching decreased by 71.2 % and 32.0 %, respectively, compared with CN. These results suggest that replacing 50 % and 25 % synthetic N fertilizer with dairy farm effluent and manure could reduce N leaching losses but had varied effects on crop productivity under wheat-maize cropping.
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•Combintion of 50 % effluent N and 50 % synthetic fertilizer N reduced N leaching by 22.4 % in the wheat season, and by 40.4 % during the maize season.•Combintion of 50 % effluent N and 50 % synthetic fertilizer N at 200 kg N ha−1 increased maize yield.•Rate of effluent N at ≥ 150 (wheat) and 200 (maize) kg N ha−1 increased N leaching.•Replacing 25 % synthetic fertilizer N with manure N reduced N leaching by 42.9 % in wheat season.
Dairy farms produce considerable quantities of nutrient-rich effluent, which is generally stored before use as a soil amendment. Unfortunately, a portion of the dairy effluent N can be lost through ...volatilization during open pond storage to the atmosphere. Adding of covering materials to effluent during storage could increase contact with NH4+ and modify effluent pH, thereby reducing NH3 volatilization and retaining the effluent N as fertilizer for crop application. Here the mitigation effect of cover materials on ammonia (NH3) volatilization from open stored effluents was measured. A pilot-scale study was conducted using effluent collected at the Youran Dairy Farm Company Limited, Luhe County, Jiangsu, China, from 15 June to 15 August 2019. The study included seven treatments: control without amendment (Control), 30-mm × 25-mm corn cob pieces (CC), light expanded clay aggregate - LECA (CP), lactic acid (LA) and lactic acid plus CC (CCL), CP (CPL) or 20-mm plastic balls (PBL). The NH3 emission from the Control treatment was 120.1 g N m−2, which was increased by 38.1% in the CP treatment, possibly due to increased effluent pH. The application of CC reduced NH3 loss by 69.2%, compared with the Control, possibly due to high physical resistance, adsorption of NH4+ and effluent pH reduction. The lactic acid amendment alone and in combination with other materials also reduced NH3 volatilization by 27.4% and 31.0–46.7%, respectively. After 62 days of storage, effluent N conserved in the CC and CCL treatments were 21.0% and 22.0% higher than that in the Control (P < 0.05). Our results suggest that application of corn cob pieces, alone or in combination with lactic acid, as effluent cover could effectively mitigate NH3 volatilization and retain N, thereby enhancing the fertilizer value of the stored dairy effluent and co-applied as a soil amendment after two months open storage.
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•Corn cobs reduced NH3 volatilization during effluent storage by 69.2%.•Light expanded clay aggregate stimulated effluent NH3 volatilization by 38.1%.•Lactic acid amendment reduced effluent NH3 volatilization by 27.5%.•Corn cobs more efficiently retained effluent N during effluent storage.
Pollution of trace metals was evaluated in the soil and plant samples collected from lead–zinc smelting areas in Huixian of Northwest China. The soil samples from the arable lands surrounding the ...smelting sites contained high levels of Cd, Pb, and Zn, which were 6.59–237, 3.27–218 and 0.375–2.38 times respectively above the background values in the study areas, indicating a certain extent of spreading of trace metal pollution. The main causes to the dispersion of pollution were proposed to be the continuous wastewater irrigation and wind transport of dust. The geo-accumulation index (Igeo) revealed that Cd and Pb were heavy pollutants. The correlation analysis proved a correlation between soil properties and individual metal, suggesting the significant effect of soil properties on trace metal pollution. A two step sequential extraction showed that heavy metals were poorly labile under natural conditions. However, extraction with complexing agent generated significant amounts of metals, suggesting they were potentially mobilizable. The levels of Cu, Cd, Pb, and Zn in aerial parts of typical plants ranged from 0.048 to 19.9, 0.122 to 8.17, 11.1 to 48.6, and 0.646 to 85.8mgkg−1, respectively. The accumulation ability changed in an order as: Cd>Zn>Cu>Pb and a high level was detected in maize (Cd), ainsliaea (Cd), goosegrass herb (Zn), and poplar (Zn). Pb and Cd were potentially risky to local inhabitants. Apparently, some effective measures may be necessary to treat trace metal pollution in soil and to reduce metal translocation from soil to edible crops.
•Contamination of heavy metals was evaluated in the soil and plant samples from Pb–Zn smelting areas in Northwest of China.•Geo-accumulation index (Igeo) revealed that Cd and Pb in soil samples were heavy polluted.•Accumulation ability for trace metals in different local plant showed a tread in an order: Cd>Zn>Cu>Pb.•High concentrations have been found in the Maize, Ainsliaea, Goosegrass Herb, and Poplar.•In the present study, Pb and Cd pose a potential risk to the local inhabitants.
Purpose
The impact of dairy farm effluent and manure applications upon gas emissions from soil is of concern for agronomic, ecological, and environmental reasons. Yet it remains unclear how the ...optimized manure and effluent additions may affect gas (nitrous oxide (N
2
O), nitric oxide (NO), and ammonia (NH
3
)) emissions during wheat cultivation.
Materials and methods
We conducted a field experiment in Zhuzhen (Jiangsu), China, from November 2018 to May 2019 to examine the effects of effluent and manure on gas emissions from the wheat fields that had seven treatments (4 replicates, 28 plots): no fertilizer (control); inorganic fertilizer at a conventional application rate of 200 kg N ha
−1
(NPK); 100 kg N ha
−1
inorganic fertilizer plus 100 (DE1), 150 (DE2), and 250 (DE3) kg N ha
−1
farm dairy effluent; 100 kg N ha
−1
inorganic fertilizer plus 100 kg N ha
−1
farm dairy manure (SM1); and 150 kg N ha
−1
inorganic fertilizer plus 50 kg N ha
−1
farm dairy manure (SM2).
Results and discussion
Applying dairy effluent during the wheat season significantly (
P <
0.05) increased NH
3
emissions from 1.83 (NPK) to 3.81 kg N ha
−1
(DE1) and 11.4 kg N ha
−1
(DE3), probably due to elevated levels of soil NH
4
+
and pH, with no discernable impact on N
2
O emissions compared with NPK. The greater application of effluent in the DE3 treatment increased NO emissions significantly by 33.3% relative to NPK. The combined application of manure and urea significantly reduced N
2
O and NO emissions by 25.2–27.6% and 8.3–45.8%, respectively, but increased NH
3
emissions in the SM1 treatment by 73.8%, when compared with NPK.
Conclusions
Overall, our results suggest that replacing 25% of the current conventional chemical N application rate with dairy manure could considerably mitigate gas emissions in the wheat season.
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