Effectiveness of "Physician Prompt Clinical Decision Criteria" in Weaning Outcome Prediction for Neurocritical Patients.

Endotracheal intubation and invasive mechanical ventilation are fundamental components for the resuscitation of neurocritically ill patients to achieve various goals which include ensuring the protection of the airway, participating in tissue oxygen delivery and indirectly modulating cerebral vascular reactivity. The neurocritical patients demand special attention to their systemic involvement regarding weaning. Physician prompt clinical decision criteria (PPC) can play a better role in weaning of such patients. The aim of this study was to evaluate the effectiveness of 'Physician prompt clinical decision criteria' for successful weaning in neurocritical patients. This prospective observational study was conducted in the ICU, Department of Anaesthesia, Analgesia, Palliative & Intensive Care Medicine, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from March 2018 to April 2020. In total 100 neurocritical patients who fulfilled the inclusion criteria were taken as samples by informed written consent. The outcome was observed as successful weaning or as failed weaning. Finally, the existence of Standard extubation criteria (SEC) was compared with Physician prompt clinical decision criteria (PPC). Weaning was succeeded in 80.0% of patients and failed in 20.0% according to the Standard extubation criteria (SEC) while weaning was succeeded in 85.7% of patients and failed in 14.28% according to the Physician prompt clinical decision criteria (PPC). There were some differences in results but no significant differences were observed statistically between the groups in predicting the weaning outcome. Physician prompt clinical decision criteria were found to be 75.0% sensitive and specificity was 50.0%. Positive predictive value for Physician prompt clinical decision criteria was 85.70% with a Positive likelihood ratio for these criteria was 1.5 times. So, according to the study findings, accuracy of Physician prompt clinical decision criteria was 70.0%. According to the findings of this current study we can conclude that Physician prompt clinical decision criteria are an effective weaning readiness predictor in neurocritical patients.

Can Comprehensive Medical Reform Improve the Efficiency of Medical Resource Allocation? Evidence From China.

Objectives: To evaluate the impact of comprehensive medical reform on the efficiency of medical resource allocation in China. Methods: This study employs the Slacks-Based Measure- Directional Distance Function (SBM-DDF) to estimate the efficiency of medical resource allocation (MRAE) in China, using panel data from 30 provinces during 2009-2021. Moreover, a multi-period Difference in differences (DID) model is developed to explore the effect of the comprehensive medical reform pilot (CMRP) strategy on efficiency of medical resource allocation in China. Results: The results show that the average value of China's medical resources allocation efficiency is 0.861 during the sample period. Coastal area has a higher MRAE than that in the inland area. The DID results show that the comprehensive medical reform pilot strategy has a good, long-lasting impact on the efficiency of medical resource allocation. And the results remain valid after a series of robustness analysis. Additionally, the comprehensive medical reform policy has heterogeneous impact on efficiency of medical resource allocation. The promotion effect is only statistically significant in the eastern and central regions, the groups of higher MRAE and larger population size. Conclusion: China's comprehensive medical reform policy can effectively promote the improvement of regional efficiency of medical resource allocation.

Environmental and Health Impacts of Crop Residue Burning: Scope of Sustainable Crop Residue Management Practices.

The burning of crop residue in the open field has become a significant concern for climate change mitigation efforts worldwide. This practice has led to air quality impairment, smog, haze, heat waves, and different health problems. These could be avoided by adopting sustainable crop residue management practices (SCRMPs) and enabling farmers to engage in SCRMPs. Assessing the health effects at the household level is critical for understanding this problem and finding a solution. Using the primary dataset of 420 farmers from Punjab, Pakistan, we estimated the incurred impacts and costs of crop residue burning. We calculated the health and environmental benefits associated with adopting SCRMPs by comparing the two groups of farmers (adopters and non-adopters). Furthermore, we used a propensity score matching technique to measure the causal impact of SCRMPs adoption on health costs. The findings showed that a surprisingly large number of farmers are all aware of the adverse effects of residue burning, and many do not burn crop residues and instead use SCRMPs. This study found that households with chronic and non-chronic diseases become acute, and the severity increases during the burning period. They spend USD 13.37 to USD 8.79 on chronic and non-chronic diseases during the burning season, respectively. Consequently, the use of SCRMPs has a positive effect on healthcare costs. Our study findings highlight the meaningful implications for developing a new policy to promote the sustainable utilization of crop residues and enhance their adoption in Pakistan.

Simultaneous adoption of diversification and agricultural credit to manage catastrophic risk for maize production in Bangladesh.

Risk management strategies are made up of response variability that may lessen the likeliness of an unfavorable event occurring and/or decrease the damaging consequences if that event happens. To minimize the risk, farmers respond in three ways which are considered to be risk managing tools; these are production, marketing, and financial responses. This study aimed to look at the potential associations and effects of implementing multiple risk management techniques at the same time, as very limited number of research is available in this field. Stratified random sampling technique was used to collect 350 farmer's responses from four different agro-ecological districts of Bangladesh. This study applied bivariate and multinomial probit models to investigate the effects of social and farm features, farmers' views of disastrous risk, and their attitudes toward risk sources, as well as potential associations between diversification and agricultural credit as a risk management tool. The outcomes identified the correlation between adoptions of multiple risk management strategies and concluded that one risk management approach can convince farmers to follow another at the same time. Moreover, the outcomes observed that age, educational status, farm size, family returns, land ownership, and risk-opposed character of farmers were the most persuading aspects for adopting different risk management strategies. Besides, the results presented other interpretations and information which will clarify farmer's actions when it comes to handling various devastating risks and will also provide the policymakers with a platform to prepare for appropriate risk managing plans concerning farmers.

How indebted farmers perceive and address financial risk in environmentally degraded areas in Bangladesh.

In Bangladesh, the recent uncontrolled growth of industries near farmland and unplanned urbanization made the agricultural sector the most vulnerable and a massive threat to the food security of the country. Agricultural farms near to industrial zones face high production costs (poor air-water-soil quality, high labor cost) and low-profit margin (poor crop yield and crop loss due to frequent natural hazards). The government policy in this matter is not proper due to a lack of information. As a consequence, many of these farm owners adopt agricultural credit by themselves to manage the production cost. Basically, credit itself creates some other financial risks and the farmers needed to adopt different measures to handle these financial risks. In-depth research on this matter is important to improve the situation by providing relevant information that policymakers can plan an efficient policy framework. However, previous literature has overlooked this area of research. In this study, the researcher collected data on 400 rice farmers (debtors) from six different districts in greater Dhaka division (most degraded area in Bangladesh) and adopted probit model to analyze the influential factors affecting farmers' financial risk management adoption decision and to identify the correlations between these decisions. The empirical findings indicate that education, access to technologies, household income, savings, and distance from the industrial areas are the major factors that affect farmer's adoption choice and most of the farmers are risk-averse. Moreover, the adoption choice of one risk management tool may motivate farmers to adopt another.