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In order to feed growing populations under scare water resources, a suitable technology that improves crop water productivity (CWP) is crucial. Precision agriculture that utilizes digital techniques such as unmanned aerial systems (UAS) can play a significant role in improving CWP. CWP is an important indicator that quantifies the effect of agricultural water management. To improve CWP, implementation of suitable methods for early detection of crop water stress before irreversible damage on crops occurs, is vital. Conventionally, farmers have relied on in situ measurements of soil moisture and weather variables for detecting crop water status for irrigation scheduling. This method is time consuming and does not account for spatial and temporal variability associated with crop water status. Hence, the aim of this study is to give an overview of the current and potential capabilities of UAS for crop water productivity in precision agriculture. Identified in this study are the factors as well as the technology that can improve CWP. UAS thermal remote sensing is found to be the most suitable technology for monitoring and assessing crop water status using certain indices. Determining a crop water stress index (CWSI) from thermal imagery has the potential to detect instantaneous variations of water status. CWSI obtained from UAS thermal imaging camera can be adapted for real-time irrigation scheduling for maximum crop water productivity.

Robust evidence from health policy research has the potential to inform policy-making, but studies have suggested that methodological shortcomings are abundant. We aimed to identify common methodological weaknesses in pharmaceutical pricing policy analyses. A systematic review (SR) of studies examining pharmaceutical pricing policies served as basis for the present analysis. We selected all studies that were included in the SR (n = 56), and those that were excluded from the SR due to ineligible study designs only (n = 101). Risk of bias was assessed and specific study design issues were recorded to identify recurrent methodological issues. Sixty-one percent of studies with a study design eligible for the SR presented with a high risk of bias in at least one domain. Potential interference of co-interventions was a source of possible bias in 53% of interrupted time series studies. Failing to consider potential confounders was the primary cause for potential bias in difference-in-differences, regression, and panel data analyses. In 101 studies with a study design not eligible for the SR, 32% were uncontrolled before-after studies and 23% were studies without pre-intervention data. Some of the methodological issues encountered may be resolved during the design of a study. Awareness among researchers on methodological issues will help improve the rigor of health policy research in general.

Land cover change is a pervasive force and it influences the relationship between precipitation (P) and actual evapotranspiration (AET). The study sought to determine variations in catchment scale AET attributable to land cover change over a grassland in the Eastern Cape, South Africa. Remotely sensed rainfall and AET data were used. Land cover maps for the study area were used to extract annual AET from the MOD16 ET product. The method of cumulative residuals was applied to link dynamics in AET with land cover change to enable the application of an appropriate map for retrieving AET. Rainfall and AET were subjected to the Mann- Kendall and Pettitt's tests. Grassland and built-up cover classes AET showed step changes (p

Due to the degeneration of water quality globally, water quality models could increasingly be utilised within water resource management. However, a lack of observed data as well as financial resources often constrain the number of potential water quality models that could practically be utilised. This study presents the Water Quality Systems Assessment Model (WQSAM). WQSAM directly utilises flow data generated by systems models to drive water quality simulations. The model subscribes to requisite simplicity by constraining the number of variables simulated as well as the processes represented to only those most important to water quality management, in this case, nutrients and salinity. The model application to the upper Olifants River catchment in South Africa is described. WQSAM was able to use the limited observed data to simulate representative frequency distributions of water quality, and the approach used within WQSAM was shown to be suitable for application to data scarce catchments.

Context In 2011, the World Health Organization (WHO) published the policy guidelines Ensuring Balance in National Controlled Substances Policies—Guidance for Availability and Accessibility of Controlled Medicines , presenting a revised version of the previous guidelines from 2000. Objectives To describe the consensus process that guided the revision of the guidelines. Methods A four-stage revision process was undertaken with a panel of 29 international experts from palliative care, public health, and harm reduction: 1) a qualitative inventory of required changes by means of a structured checklist, 2) & 3) a two-round online consensus Delphi process about the draft revision of the guidelines, and 4) a WHO advisory meeting for the discussion of remaining controversies and final issues. Results The qualitative inventory resulted in a draft revision of the guidelines meeting requirements on different levels, such as a broader focus and more accurate evidence. Operationalization of the guidelines was improved by specifying measures, procedures, and responsibilities. The Delphi procedure provided concrete indications for the rewording of both the guidelines and the associated text. During the advisory meeting, any persistent disagreements were systematically discussed to achieve consensus on the new version of the guidelines. Conclusion The four-stage multimethod consensus process resulted in a substantial revision to the WHO guidelines. This takes into account the increase in knowledge about opioid medication since the first edition of the guidelines. Disagreement emerging from the process underlines the complexity of preparing guidance because of the delicate balance between need and control.

Marketing authorization application dossiers of 17 orphan drugs (ODs) and 51 non-ODs evaluated by the European Medicines Agency (EMA) in the period 2009-2010 were compared. We aimed to identify whether any differences existed between ODs and non-ODs in number and type of deficits brought forward during the EMA review, regarding the clinical development plan, clinical outcome and medical need and studied whether these deficits were similarly associated with marketing approval in the EU. In 71% of the ODs dossiers and 65% of the non-ODs dossiers marketing approval was granted. Differences in deficits were found, but similarities in the way ODs and non-ODs were reviewed and marketing approval decisions were taken, underline that regulatory standards are equally high.

Background Previous studies have suggested that medicines prices in Europe converge over time as a result of policy measures such as external price referencing. Objective To explore whether ex-factory prices of on-patented medicines in Western European countries have converged over a recent period of time. Methods Prices of ten on-patent medicines in five years (2007, 2008, 2010, 2011, 2012) of 15 European countries were analyzed. The unit of analysis was the ex-factory price in Euro per defined daily dose (exchange rate indexed to 2007). A score (deviation from the average price) per country as well as the ranges were calculated for all medicines. Results The prices between countries and selected products varied to a great extent from as low as an average price of € 1.3/DDD for sitagliptin in 2010–2012 to an average of € 221.5/DDD for alemtuzumab in 2011. Between 2008 and 2012, a price divergence was seen which was fully driven by two countries, Germany (up to 27% more expensive than the average) and Greece (up to 32% cheaper than the average). All other countries had stable prices and centered around the country average. Prices of less expensive as well as expensive medicines remained relatively stable or decreased over time, while only the price of sirolimus relatively increased. Conclusions Our study period included the time of the recession and several pricing policy measures may have affected the prices of medicines. Instead of the expected price convergence we observed a price divergence driven by price changes in only two of the 15 countries. All other European countries remained stable around the country average. Further research is needed to expand the study to a bigger sample size, and include prescribing data and Eastern European countries.

The quantification of diffuse input loads of nutrients to rivers is a challenge due to limited observed data. This study aimed to develop a simple model that can relate in-stream nutrient concentrations due to diffuse sources with land cover categories within a catchment affecting a river reach. A previously developed point-diffuse model was used to distinguish the diffuse nutrient signature within South African Department of Water Affairs historical monitoring flow and water quality data for selected river gauges. The diffuse signature was related to land cover categories within respective catchments using Principal Component Analysis (PCA), and influential land cover categories were used to construct land cover models relating land cover categories with in-stream nutrient concentrations. Generally, the land cover categories affecting diffuse signatures of nutrients as indicated by PCA were expected. Using land cover information, the developed land cover models performed well in re-creating the diffuse in-stream nutrient signature as determined by the point-diffuse model.

Purpose: To explore the use of the biological tumour necrosis factor alpha (TNFalpha) inhibitors used in the treatment of rheumatoid arthritis as a measure of access to treatment with new medicines. In addition, characteristics both related to national health systems and spending will be assessed to explore possible differences in international utilisation. Methods: Data from four European countries were included: Ireland, The Netherlands, Norway and Portugal. Annual utilisation rates of TNFalpha inhibitors (2003-2007) were expressed as defined daily doses (DDD5)/1000 inhabitants/day. Qualitative data such as country characteristics, national health policy characteristics, guidelines were obtained from the literature. In addition, interviews were held with leading rheumatologists of each country to put obtained results into (cultural) context. Results: Utilisation of TNFalpha inhibitors varied widely from 0.32 (Portugal) to 1.89 (Norway) DDD5/1000 inhabitants/day (2007). A major driver for the utilisation of TNFalpha inhibitors seemed to be the country's total health expenditure (R-2 = 0.81). When the use of TNFalpha inhibitors became more established, the association seemed stronger. Differences in health expenditure were nevertheless not the only determinant of usage. Cultural aspects such as difference in recognition of guidelines also come into play when looking at differences in TNFalpha utilisation between countries. Conclusions: The prospects of patients receiving TNFalpha inhibitor treatment depend on the country where they are living. In case uniformity of management and treatment would be considered to provide health benefits, the extent and the causes of variation should feature prominently on future public health agendas. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

Three newborns with congenital tracheoesophageal fistula were treated by endoscopic laser coagulation. After radiologic and endoscopic diagnosis, laser coagulation of the mucosal layer of the fistula followed using Nd:YAG laser light transferred through an uncovered quartz fiber of 600 microns diameter. The successful and uneventful course in two cases contrasts with the incomplete obliteration in one case caused by inadequate energy application and/or early localized instillation of contrast medium for radiologic control examination. The advantages of this method include elimination of an operative procedure, exclusion of operative complications, and the possibility of repetition in recurrent cases. Care must be taken to prevent esophageal and tracheal damage by use of this method.

A method is described for the quantitative determination of aliphatic α-keto acids in urine after derivatization with o-phenylenediamine and bis(trimethylsilyl)trifluoroacetamide, α-Ketovaleric acid and α-ketocaprylic acid are used as internal standards. The chemical yield is 80–100%. At physiological concentrations, the coefficient of variation after repeated derivatizations is 4% for pyruvic acid and 14% for α-ketoglutaric acid. With mass spectrometric single-ion detection at mc = 217, 232 and 245, the biologically interesting aliphatic α-keto acids can be determined at very low levels in biological fluids.