Background: Hospital formularies are used to encourage the use of safe, ef-fective and most affordable medications. Institutions need to make provi-sions for non-formulary medicines (NFM) due to the dynamic nature of ...Background: Hospital formularies are used to encourage the use of safe, ef-fective and most affordable medications. Institutions need to make provi-sions for non-formulary medicines (NFM) due to the dynamic nature of dis-eases and their management. The aim of this study was to describe the pat-terns of non-formulary medicine prescriptions at the Nairobi Hospital, the reasons for their purchase as well as the duration taken to avail them. Methods: A descriptive review of all the non-formulary medicine prescrip-tions from January 2021 to June 2022. The medicines were listed and catego-rized according to the WHO Anatomical Therapeutic Chemical (ATC) classi-fication system. Correspondence between pharmacy and procurement was reviewed to understand the reason for the requests and the duration it took to avail the medicines. Results: A total of 183 NFM were purchased, with a general increase in the number from January 2021 to June 2022. Vitamins, Mineral supplements and General nutrients accounted for 41 (22.4%) of the NFM. Dermatologicals 27 (14.6%), Genito-urinary system drugs and sex hormones 20 (10.9%), Ophthalmologicals 14 (7.6%) and Antineoplastic and Immuno-modulating agents 12 (6.6%) were also frequently purchased out of formulary. The main reasons for NFM purchases were: having no therapeutic equivalents in the hospital formulary 72 (39.3%) and prescriber or patient preference 69 (37.7%). It took a median (IQR) of 4 (2 - 7) days for the phar-macy to avail these drugs;with 18.6% being availed in 1 day and 55.2% tak-ing more than 3 days. For the NFM where no alternative was available in the hospital formulary, sales amounted to USD 63,362 which was 79.1% of the value of all the NFM sales. Conclusion: There’s a need to regularly update the hospital formulary and to emphasize to the prescribers the importance of adhering to it, as much as possible.展开更多
Objective To determine whether the anti-inflammatory properties of Shuxiong Tablet (SXT) and the effective components group of SXT (ECGS) are equivalent and to assess the formulary rationality. Methods ECGS consisted ...Objective To determine whether the anti-inflammatory properties of Shuxiong Tablet (SXT) and the effective components group of SXT (ECGS) are equivalent and to assess the formulary rationality. Methods ECGS consisted of Panax notoginsen saponion (PNS), hydroxysafflor yellow A, and ferulic acid plus volatile oil of Ligusticum chuanxiong, which was based on the active ingredients and their ratios in SXT. We compared the anti-inflammatory actions of ECGS and SXT using the xylene-induced edema model and the carrageenan-induced edema model, as well as the analgesic activity of them using the acetic acid-induced writhing model. Moreover, cultured macrophages were incubated with media containing serum isolated from SXT-, ECGS-, or every component of ECGS-treated rats, to compare the depress effects on lipopolysaccharide (LPS)-stimulated NO production and inducible nitric oxide synthase (iNOS) expression. Results ECGS and SXT had equivalent anti-inflammatory actions and analgesic effects at an equipotent dosage in a dose-dependent manner. The drug-containing media could inhibit the LPS-stimulated NO production and iNOS expression in cultured macrophages. A 2 × 2 × 2 ANOVA revealed that three effective components could produce synergistic effect on the inhibition of NO production, and PNS was the capital component. Conclusion ECGS and SXT display an equivalent anti-inflammatory effect, and the formula follows traditional Chinese medicine compatibility principle, which shows obvious formulary rationality.展开更多
In micro electrical discharge machining （micro EDM）, it is difficult for servo controlling the narrow discharge gap with the characters of non-linear and quick change. In this paper, aiming at solving the problems a...In micro electrical discharge machining （micro EDM）, it is difficult for servo controlling the narrow discharge gap with the characters of non-linear and quick change. In this paper, aiming at solving the problems above, a self-adaptive fuzzy controller with formulary rule （SAFCFR） is presented based on the dual feedbacks composed by gap electric signal and discharge-ratio statistics. To ensure the properties of self-optimizing and fast stabilization, the formulary rule was designed with a tuning factor. In addition, the fast-convergence algorithms were introduced to adjust control target center and output scale factor. In this way, the normal discharge ratio can tend to the highest value during micro-EDM process. Experimental results show that the proposed algorithms are effective in improving the servo-control performance. According to the drilling-micro-EDM experiments, the machining efficiency is improved by 20% through applying SAFCFR. Moreover, SAFCFR is a prompt way to optimize parameters of discharge-gap servo control.展开更多
Transnational corporations(TNCs)act as unitary firms in an increasingly globalised economy,but taxes on their profits are levied by national states.Hence,international tax rules have from the start been riven by contr...Transnational corporations(TNCs)act as unitary firms in an increasingly globalised economy,but taxes on their profits are levied by national states.Hence,international tax rules have from the start been riven by contradictory approaches:ei-ther to determine the taxable profits attributable to each separate constituent entity of the TNC in their jurisdiction by comparing them with independent firms conducting a similar business,or to tax an appropriate share of the TNC’s global profits appor-tioned by factors reflecting its activities within the jurisdiction.The separate entity principle became dominant,especially with the adoption of the OECD Transfer Pricing Guidelines in 1995,but it gave a perverse incentive to TNCs to devise tax avoidance strategies,based on attributing high levels of profit to entities in countries where they would be taxed at low rates.The project on base erosion and profit shifting(BEPS)was mandated by the G20 to reform these rules so that TNCs could be taxed where their activities occur,signaling a return to the unitary principle.The latest proposals now adopt the principle of unitary taxation of TNCs,together with technical standards for formulary apportionment,but only as an overlay on top of existing rules based on the incompatible independent entity principle.A stable foundation for international tax depends on resolving this dilemma and agreeing a fair and balanced allocation of rights to tax TNCs’profits based on their real activities in each jurisdiction.展开更多
文摘Background: Hospital formularies are used to encourage the use of safe, ef-fective and most affordable medications. Institutions need to make provi-sions for non-formulary medicines (NFM) due to the dynamic nature of dis-eases and their management. The aim of this study was to describe the pat-terns of non-formulary medicine prescriptions at the Nairobi Hospital, the reasons for their purchase as well as the duration taken to avail them. Methods: A descriptive review of all the non-formulary medicine prescrip-tions from January 2021 to June 2022. The medicines were listed and catego-rized according to the WHO Anatomical Therapeutic Chemical (ATC) classi-fication system. Correspondence between pharmacy and procurement was reviewed to understand the reason for the requests and the duration it took to avail the medicines. Results: A total of 183 NFM were purchased, with a general increase in the number from January 2021 to June 2022. Vitamins, Mineral supplements and General nutrients accounted for 41 (22.4%) of the NFM. Dermatologicals 27 (14.6%), Genito-urinary system drugs and sex hormones 20 (10.9%), Ophthalmologicals 14 (7.6%) and Antineoplastic and Immuno-modulating agents 12 (6.6%) were also frequently purchased out of formulary. The main reasons for NFM purchases were: having no therapeutic equivalents in the hospital formulary 72 (39.3%) and prescriber or patient preference 69 (37.7%). It took a median (IQR) of 4 (2 - 7) days for the phar-macy to avail these drugs;with 18.6% being availed in 1 day and 55.2% tak-ing more than 3 days. For the NFM where no alternative was available in the hospital formulary, sales amounted to USD 63,362 which was 79.1% of the value of all the NFM sales. Conclusion: There’s a need to regularly update the hospital formulary and to emphasize to the prescribers the importance of adhering to it, as much as possible.
基金National Natural Science Foundation of China (30430790)
文摘Objective To determine whether the anti-inflammatory properties of Shuxiong Tablet (SXT) and the effective components group of SXT (ECGS) are equivalent and to assess the formulary rationality. Methods ECGS consisted of Panax notoginsen saponion (PNS), hydroxysafflor yellow A, and ferulic acid plus volatile oil of Ligusticum chuanxiong, which was based on the active ingredients and their ratios in SXT. We compared the anti-inflammatory actions of ECGS and SXT using the xylene-induced edema model and the carrageenan-induced edema model, as well as the analgesic activity of them using the acetic acid-induced writhing model. Moreover, cultured macrophages were incubated with media containing serum isolated from SXT-, ECGS-, or every component of ECGS-treated rats, to compare the depress effects on lipopolysaccharide (LPS)-stimulated NO production and inducible nitric oxide synthase (iNOS) expression. Results ECGS and SXT had equivalent anti-inflammatory actions and analgesic effects at an equipotent dosage in a dose-dependent manner. The drug-containing media could inhibit the LPS-stimulated NO production and iNOS expression in cultured macrophages. A 2 × 2 × 2 ANOVA revealed that three effective components could produce synergistic effect on the inhibition of NO production, and PNS was the capital component. Conclusion ECGS and SXT display an equivalent anti-inflammatory effect, and the formula follows traditional Chinese medicine compatibility principle, which shows obvious formulary rationality.
基金Supported by the National High Technology Research and Development Program of China （No. 2007AA04Z346） , the National Natural Science Foundation of China （ No. 50905094） and China Postdoctoral Science Foundation （ No. 20080440378, 200902097）.
文摘In micro electrical discharge machining （micro EDM）, it is difficult for servo controlling the narrow discharge gap with the characters of non-linear and quick change. In this paper, aiming at solving the problems above, a self-adaptive fuzzy controller with formulary rule （SAFCFR） is presented based on the dual feedbacks composed by gap electric signal and discharge-ratio statistics. To ensure the properties of self-optimizing and fast stabilization, the formulary rule was designed with a tuning factor. In addition, the fast-convergence algorithms were introduced to adjust control target center and output scale factor. In this way, the normal discharge ratio can tend to the highest value during micro-EDM process. Experimental results show that the proposed algorithms are effective in improving the servo-control performance. According to the drilling-micro-EDM experiments, the machining efficiency is improved by 20% through applying SAFCFR. Moreover, SAFCFR is a prompt way to optimize parameters of discharge-gap servo control.
文摘Transnational corporations(TNCs)act as unitary firms in an increasingly globalised economy,but taxes on their profits are levied by national states.Hence,international tax rules have from the start been riven by contradictory approaches:ei-ther to determine the taxable profits attributable to each separate constituent entity of the TNC in their jurisdiction by comparing them with independent firms conducting a similar business,or to tax an appropriate share of the TNC’s global profits appor-tioned by factors reflecting its activities within the jurisdiction.The separate entity principle became dominant,especially with the adoption of the OECD Transfer Pricing Guidelines in 1995,but it gave a perverse incentive to TNCs to devise tax avoidance strategies,based on attributing high levels of profit to entities in countries where they would be taxed at low rates.The project on base erosion and profit shifting(BEPS)was mandated by the G20 to reform these rules so that TNCs could be taxed where their activities occur,signaling a return to the unitary principle.The latest proposals now adopt the principle of unitary taxation of TNCs,together with technical standards for formulary apportionment,but only as an overlay on top of existing rules based on the incompatible independent entity principle.A stable foundation for international tax depends on resolving this dilemma and agreeing a fair and balanced allocation of rights to tax TNCs’profits based on their real activities in each jurisdiction.
