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Parenteral antibiotic (PA) prescription pattern in a hospital will directly influence the annual budget allocation, development of bacterial resistance and occurrence of unnecessary adverse drug reactions if it is done with poor adherence to the standard guidelines of prescription. As specialist in the field we understand the need of conducting economic studies in relation to the cost and utility of PA prescription pattern. It will be helpful to predict the drug procurement plan for the next year and also to prevent unnecessary complications mentioned above. Objective: Our main objective was to analyze the cost/utility relationship of PA drugs which were used in medical wards in this hospital according to the top ten of the cost (TTTC) and the top ten of the consumption (TTCS). Materials and method : Aggregate data from the pharmacy record books were collected for year 2010 from indoor pharmacy. Unit prize was obtained from medical supplies division. Total quantity consumed by each medical ward was considered for analysis of the cost /utility relationship. Two top ten lists were prepared according to the cost and the consumption respectively for medical wards and the correlation was analyzed using non parametric testing with spearman test. Results: Regarding PA drugs used in this hospital, 7/10 PA drugs in TTTC are not included in the TTCS. Out of the total cost for TTTC, 82.6% of the cost had been spent for the PA drugs which are not in the TTCS and 17.5% of the cost of TTTC was used to purchase only three drugs from the TTCS. But these three drugs had contributed only 28% of top ten consumption. 72% of the PA drugs in TTCS were not costly drugs and highly consumed in medical wards. Correlation was significantly positive between cost and utility of PA drugs. ( r=-0.91,p<0.001) Conclusion: Majority of the consumed PA drugs are non-costly and it indicates the prescriptions had been done according to the rational guidelines including cost, availability and affordability. Correlation further confirms that majority of the PA consumption was low costly drugs. As most of the money had been spent to purchase highly expensive PA drugs for medical wards we suggest to review the clinical indications for these drugs with the microbiological evidence to be compatible with the allocated health budget for the hospital. This further suggests conducting the cost effective economic studies to evaluate the suitable drug alternatives for such indications.

We present new neutral mass density and crosswind observations for the CHAMP, GRACE, and GRACE-FO missions, filling the last gaps in our database of accelerometer-derived thermosphere observations. For consistency, we processed the data over the entire lifetime of these missions, noting that the results for GRACE in 2011–2017 and GRACE-FO are entirely new. All accelerometer data are newly calibrated. We modeled the temperature-induced bias variations for the GRACE accelerometer data to counter the detrimental effects of the accelerometer thermal control deactivation in April 2011. Further, we developed a new radiation pressure model, which uses ray tracing to account for shadowing and multiple reflections and calculates the satellite’s thermal emissions based on the illumination history. The advances in calibration and radiation pressure modeling are essential when the radiation pressure acceleration is significant compared to the aerodynamic one above 450 km altitude during low solar activity, where the GRACE and GRACE-FO satellites spent a considerable fraction of their mission lifetime. The mean of the new density observations changes only marginally, but their standard deviation shows a substantial reduction compared to thermosphere models, up to 15% for GRACE in 2009. The mean and standard deviation of the new GRACE-FO density observations are in good agreement with the GRACE observations. The GRACE and CHAMP crosswind observations agree well with the physics-based TIE-GCM winds, particularly the polar wind patterns. The mean observed crosswind is a few tens of m·s−1 larger than the model one, which we attribute primarily to the crosswind errors being positive by the definition of the retrieval algorithm. The correlation between observed and model crosswind is about 60%, except for GRACE in 2004–2011 when the signal was too small to retrieve crosswinds reliably.

Estimating global and multi-level Thermosphere Neutral Density (TND) is important for studying coupling processes within the upper atmosphere, and for applications like orbit prediction. Models are applied for predicting TND changes, however, their performance can be improved by accounting for the simplicity of model structure and the sampling limitations of model inputs. In this study, a simultaneous Calibration and Data Assimilation (C/DA) algorithm is applied to integrate freely available CHAMP, GRACE, and Swarm derived TND measurements into the NRLMSISE-00 model. The improved model, called 'C/DA-NRLMSISE-00', and its outputs fit to these measured TNDs, are used to produce global TND fields at arbitrary altitudes (with the same vertical coverage as the NRLMSISE-00). Seven periods, between 2003-2020 that are associated with relatively high geomagnetic activity selected to investigate these fields, within which available models represent difficulties to provide reasonable TND estimates. Independent validations are performed with along-track TNDs that were not used within the C/DA framework, as well as with the outputs of other models such as the Jacchia-Bowman 2008 and the High Accuracy Satellite Drag Model. The numerical results indicate an average 52%, 50%, 56%, 25%, 47%, 54%, and 63% improvement in the Root Mean Squared Errors of the short term TND forecasts of C/DA-NRLMSISE00 compared to the along-track TND estimates of GRACE (2003, altitude 490 km), GRACE (2004, altitude 486 km), CHAMP (2008, altitude 343 km), GOCE (2010, altitude 270 km), Swarm-B (2015, altitude 520 km), Swarm-B (2017, altitude 514 km), and Swarm-B (2020, altitude 512 km), respectively., (© 2023. The Author(s).)

Global estimation of thermospheric neutral density (TND) on various altitudes is important for geodetic and space weather applications. This is typically provided by models, however, the quality of these models is limited due to their imperfect structure and the sensitivity of their parameters to the calibration period. Here, we present an ensemble Kalman filter (EnKF)-based calibration and data assimilation (C/DA) technique that updates the model's states and simultaneously calibrates its key parameters. Its application is demonstrated using the TND estimates from on-board accelerometer measurements, e.g., those of the Gravity Recovery and Climate Experiment (GRACE) mission (at [Formula: see text] km altitude), as observation, and the frequently used empirical model NRLMSISE-00. The C/DA is applied here to re-calibrate the model parameters including those controlling the influence of solar radiation and geomagnetic activity as well as those related to the calculation of exospheric temperature. The resulting model, called here 'C/DA-NRLMSISE-00', is then used to now-cast TNDs and individual neutral mass compositions for 3 h, where the model with calibrated parameters is run again during the assimilation period. C/DA-NRLMSISE-00 is also used to forecast the next 21 h, where no new observations are introduced. These forecasts are unique because they are available globally and on various altitudes (300-600 km). To introduce the impact of the thermosphere on estimating ionospheric parameters, the coupled physics-based model TIE-GCM is run by replacing the O2, O1, He and neutral temperature estimates of the C/DA-NRLMSISE-00. Then, the non-assimilated outputs of electron density (Ne) and total electron content (TEC) are validated against independent measurements. Assessing the forecasts of TNDs with those along the Swarm-A ([Formula: see text] km), -B ([Formula: see text] km), and -C ([Formula: see text] km) orbits shows that the root-mean-square error (RMSE) is considerably reduced by 51, 57 and 54%, respectively. We find improvement of 30.92% for forecasting Ne and 26.48% for TEC compared to the radio occulation and global ionosphere maps (GIM), respectively. The presented C/DA approach is recommended for the short-term global multi-level thermosphere and enhanced ionosphere forecasting applications., (© 2022. The Author(s).)