GEMMOTHERAPY AND ITS USE IN PRACTISE Student: Škodová Adriana Tutor: PharmDr. Jitka Pokladníková, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, Czech Republic Introduction: Gemmotherapy or budding medicine is an herbal healing method, whose roots go back to the Middle Ages and folk healing. It uses germ-shaped parts of plants (especially buds) for the production of liqueur glycerin macerates, which are proven to contain larger quantities of some important substances with healing properties than adult parts of plants. Objectives: The aim of this work was to summarize basic information about gemmotherapy from available literature; to summarize the description of the traditional use of selected plants and gemmotherapeutics prepared therefrom; to provide a summary of studies based on evidence-based literature, especially with regard to content and confirmatory medicinal properties, adverse effects, drug interactions and contraindications. Methods: General information about gemmotherapy was mainly drawn from books available in the Czech language. Data collection took place from October 2016 to August 2017, and researches based on literature were mainly based on the electronic databases PubMed, Web of Science, Wiley Online Library,...

This study examines the safety effects of the improvements made on multi-lane arterials. The improvements were divided into two categories 1) corridor level improvements, and 2) intersection improvements. Empirical Bayes method, which is one of the most accepted approaches for conducting before-after evaluations, has been used to assess the safety effects of the improvement projects. Safety effects are estimated not only in terms of all crashes but also rear-end (most common type) as well as severe crashes (crashes involving incapacitating and/or fatal injuries) and also angle crashes for intersection improvements. The Safety Performance Functions (SPFs) used in this study are negative binomial crash frequency estimation models that use the information on ADT, length of the segments, speed limit, and number of lanes for corridors. And for intersections the explanatory variables used are ADT, number of lanes, speed limit on major road, and number of lanes on the minor road. GENMOD procedure in SAS was used to develop the SPFs. Corridor SPFs are segregated by crash groups (all, rear-end, and severe), length of the segments being evaluated, and land use (urban, suburban and rural). The results of the analysis show that the resulting changes in safety following corridor level improvements vary widely. Although the safety effect of projects involving the same type of improvement varied, the overall effectiveness of each of the corridor level improvements were found to be positive in terms of reduction in crashes of each crash type considered (total, severe, and rear-end) except for resurfacing projects where the total number of crashes slightly increased after the roadway section is resurfaced. Evaluating additional improvements carried out with resurfacing activities showed that all (other than sidewalk improvements for total crashes) of them consistently led to improvements in safety of multilane arterial sections. It leads to the inference that it may be a good idea to take up additional improvements if it is cost effective to do them along with resurfacing. It was also found that the addition of turning lanes (left and/or right) and paving shoulders were two improvements associated with a project�s relative performance in terms of reduction in rear-end crashes. No improvements were found to be associated with a resurfacing project�s relative performance in terms of changes in (i.e., reducing) severe crashes. For intersection improvements also the individual results of each project varied widely. Except for adding turn lane(s) all other improvements showed a positive impact on safety in terms of reducing the number of crashes for all the crash types (total, severe, angle, and rear-end) considered. Indicating that the design guidelines for this work type have to be revisited and safety aspect has to be considered while implementing them. In all it can be concluded that FDOT is doing a good job in selecting the sites for treatment and it is very successful in improving the safety of the sections being treated although the main objective(s) of the treatments are not necessarily safety related.

Objective: To evaluate the 5-year real-world benefit–risk profile of fingolimod in patients with relapsing–remitting MS (RRMS) in Germany. Methods: Post-Authorization Non-interventional German sAfety study of GilEnyA (PANGAEA) is a non-interventional realworld study to prospectively assess the effectiveness and safety of fingolimod in routine clinical practice in Germany. The follow-up period comprised 5 years. Patients were included if they had been diagnosed with RRMS and had been prescribed fingolimod as part of clinical routine. There were no exclusion criteria except the contraindications for fingolimod as defined in the European label. The effectiveness and safety analysis set comprised 4032 and 4067 RRMS patients, respectively. Results: At the time of the 5-year follow-up of PANGAEA, 66.57% of patients still continued fingolimod therapy. Annualized relapse rates decreased from baseline 1.5 ± 1.15 to 0.42 ± 0.734 at year 1 and 0.21 ± 0.483 at year 5, and the disability status remained stable, as demonstrated by the Expanded Disability Status Scale mean change from baseline (0.1 ± 2.51), the decrease of the Multiple Sclerosis Severity Score from 5.1 ± 2.59 at baseline to 3.9 ± 2.31 at the 60-months follow-up, and the percentage of patients with ‘no change’ in the Clinical Global Impression scale at the 60-months follow-up (78.11%). Adverse events (AE) occurring in 75.04% of patients were in line with the known safety profile of fingolimod and were mostly non-serious AE (33.62%) and non-serious adverse drug reactions (50.59%; serious AE 4.98%; serious ADR 10.82%). Conclusions: PANGAEA demonstrated the sustained beneficial effectiveness and safety of fingolimod in the long-term realworld treatment of patients with RRMS.

Background: This research explores whether rural Community Maternity Units (CMUs) contribute to NHS Scotland’s Quality Ambitions of safe, effective and person centred care. Currently there is no available recent evidence regarding the quality of this particular model of care in a rural setting. This research makes an important contribution given that most women are encouraged to access local maternity services. Design: An exploratory case study was used with a hermeneutic phenomenological approach to the qualitative data collection and analysis. Quantitiative data were collected and analysed to provide descriptive statistics. Methods: The study was conducted in three phases. In phase one a retrospective medical records review was undertaken to provide quantitative data on the care provided. Phase two was an observation of team meetings, interviews with staff and focus groups with stakeholders in roles aligned to the provision of care at the CMUs. In phase three observations of clinical encounters and interviews with women informed by aide memoire diaries were used. Findings: Maternity services provided by the CMU teams achieved a consistently high standard of safety and effectiveness when measured against national guidelines, standards and other evidence. The stakeholders appreciated the ability within these small teams to provide local, accessible services to women with effective support when required from tertiary services. The women valued person centred and relationship based continuity of antenatal carer, provided by compassionate named midwives, but were disappointed by the discontinuity when complications occurred. Conclusions: The CMUs’ physical position within the community, smallness of scale and the midwifery team’s ethos of normality within a socially based but medically inclusive service facilitated local access for most women to maternity care. This service provision addressed NHS Scotland’s Healthcare Quality Strategy of improving health and reducing inequalities for the people of Scotland. The role of the named midwife was key to providing high quality care by maintaining connections across contextual boundaries for women experiencing normal and complicated pregnancies. This research provides an original contribution to the study of rural maternity service provision in Scotland to help inform future sustainability and service development of rural CMUs.

No description available.

Traffic safety has been considered one of the most important issues in the transportation field. Crashes have caused extensive human and economic losses. With the objective of reducing crash occurrence and alleviating crash injury severity, major efforts have been dedicated to reveal the hazardous factors that affect crash occurrence. With these consistent efforts, both fatalities and fatality rates from road traffic crashes in many countries have been steadily declining over the last ten years. Nevertheless, according to the World Health Organization, the world still lost 1.24 million lives from road traffic crashes in the year of 2013. And without action, traffic crashes on the roads network are predicted to result in deaths of around 1.9 million people, and up to 50 million more people suffer non-fatal injuries annually, with many incurring a disability as a result of their injury by the year 2020. To meet the transportation needs, the use of expressways (toll roads) has risen dramatically in many countries in the past decade. In fact, freeways and expressways are considered an important part of any successful transportation system. These facilities carry the majority of daily trips on the transportation network. Although expressways offer high level of service, and are considered the safest among other types of roads, traditional toll collection systems may have both safety and operational challenges. The traditional toll plazas still experience many crashes, many of which are severe. Therefore, it becomes more important to evaluate the traffic safety impacts of using different tolling systems. The main focus of the research in this dissertation is to provide an up-to-date safety impact of using different toll collection systems, as well as providing safety guidelines for these facilities to promote safety and enhance mobility on expressways. In this study, an extensive data collection was conducted that included one hundred mainline toll plazas located on approximately 750 miles of expressways in Florida. Multiple sources of data available online maintained by Florida Department of Transportation were utilized to identify traffic, geometric and geographic characteristics of the locations as well as investigating and determination of the most complete and accurate data. Different methods of observational before-after and Cross-Sectional techniques were used to evaluate the safety effectiveness of applying different treatments on expressways. The Before-After method includes Naive Before-After, Before-After with Comparison Group, and Before-After with Empirical Bayesian. A set of Safety Performance Functions (SPFs) which predict crash frequency as a function of explanatory variables were developed at the aggregate level using crash data and the corresponding exposure and risk factors. Results of the aggregate traffic safety analysis can be used to identify the hazardous locations (hot spots) such as traditional toll plazas, and also to predict crash frequency for untreated sites in the after period in the Before-After with EB method or derive Crash Modification Factors (CMF) for the treatment using the Cross-Sectional method. This type of analysis is usually used to improve geometric characteristics and mainly focus on discovering the risk factors that are related to the total crash frequency, specific crash type, and/or different crash severity levels. Both simple SPFs (with traffic volume only as an explanatory variable) and full SPFs (with traffic volume and additional explanatory variable(s)) were used to estimate the CMFs and only CMFs with lower standard error were recommended. The results of this study proved that safety effectiveness was significantly improved across all locations that were upgraded from Traditional Mainline Toll Plazas (TMTP) to the Hybrid Mainline Toll Plazas (HMTP) system. This treatment significantly reduced total, Fatal-and-Injury (F+I), and Rear-End crashes by 47, 46 and 65 percent, respectively. Moreover, this study examined the traffic safety impact of using different designs, and diverge-and-merge areas of the HMTP. This design combines either express Open Road Tolling (ORT) lanes on the mainline and separate traditional toll collection to the side (design-1), or traditional toll collection on the mainline and separate ORT lanes to the side (design-2). It was also proven that there is a significant difference between these designs, and there is an indication that design-1 is safer and the majority of crashes occurred at diverge-and-merge areas before and after these facilities. However, design-2 could be a good temporary design at locations that have low prepaid transponder (Electronic Toll Collection (ETC)) users. In other words, it is dependent upon the percentage of the ETC users. As this percentage increases, more traffic will need to diverge and merge; thus, this design becomes riskier. In addition, the results indicated significant relationships between the crash frequency and toll plaza types, annual average daily traffic, and drivers* age. The analysis showed that the conversion from TMTP to the All-Electronic Toll Collection (AETC) system resulted in an average reduction of 77, 76, and 67 percent for total, F+I, and Property Damage Only (PDO) crashes, respectively; for rear end and Lane Change Related (LCR) crashes the average reductions were 81 and 75 percent, respectively. The conversion from HMTP to AETC system enhanced traffic safety by reducing crashes by an average of 23, 29 and 19 percent for total, F+I, and PDO crashes; also, for rear end and LCR crashes, the average reductions were 15 and 21 percent, respectively. Based on these results, the use of AETC system changed toll plazas from the highest risk sections on Expressways to be similar to regular segments. Therefore, it can be concluded that the use of AETC system was proven to be an excellent solution to several traffic operations as well as environmental and economic problems. For those agencies that cannot adopt the HMTP and the AETC systems, improving traffic safety at traditional toll plazas should take a priority. This study also evaluates the safety effectiveness of the implementation of High-Occupancy Toll lanes (HOT Lanes) as well as adding roadway lighting to expressways. The results showed that there were no significant impact of the implementation of HOT lanes on the roadway segment as a whole (HOT and Regular Lanes combined). But there was a significant difference between the regular lanes and the HOT lanes at the same roadway segment; the crash count increased at the regular lanes and decreased at the HOT lanes. It was found that the total and F+I crashes were reduced at the HOT lanes by an average of 25 and 45 percent, respectively. This may be attributable to the fact that the HOT lanes became a highway within a highway. Moreover adding roadway lighting has significantly improved traffic safety on the expressways by reducing the night crashes by approximately 35 percent. Overall, the proposed analyses of the safety effectiveness of using different toll collection systems are useful in providing expressway authorities with detailed information on where countermeasures must be implemented. This study provided for the first time an up-to-date safety impact of using different toll collection systems, also developed safety guidelines for these systems which would be useful for practitioners and roadway users.