Availability and use of long-acting insulin analogues including their biosimilars across Africa; findings and implications

Background: Prevalence rates of diabetes mellitus are growing across Africa with an appreciable number likely to be on insulin to manage their condition. This has significant implications on future morbidity and mortality exacerbated by high complication rates. Complication rates in patients requiring insulins are enhanced by hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve patient compliance. However, they are typically appreciably more expensive than human and other insulins in Africa, and continuing controversies surrounding their benefits limits their listing on national essential medicine lists (EMLs). Biosimilars can reduce the prices long-acting insulin analogues. This needs assessing. Methods: Mixed methods approach including documentation of insulin utilisation patterns and prices among a range of African countries. In addition, input from senior level government, academic, and healthcare professionals from across Africa on the current situation with long-acting insulin analogues as well as potential changes needed to enhance future funding of long-acting analogue biosimilars. Results: There is variable listing of long-acting insulin analogues on national EMLs across Africa due to their high prices and issues of affordability. Even when listed, utilisation of long-acting insulin analogues is limited by similar issues including affordability. Appreciably lowering the prices of long-acting insulin analogues via biosimilars should enhance future listing on EMLs and use accompanied by educational and other initiatives. However, this will require increased competition to lower prices. Conclusion: There are concerns with value and funding of long-acting insulin analogues across Africa including biosimilars. A number of activities have been identified to improve future funding and listing on EMLs

Challenges and innovations brought about by the Covid-19 pandemic regarding medical and pharmacy education especially in Africa and implications for the future

Background: Multiple measures introduced early to restrict COVID-19 have dramatically impacted the teaching of medical and pharmacy students, exacerbated by the lack of infrastructure and experience with e-learning at the start of the pandemic. In addition, the costs and reliability of the Internet across Africa pose challenges alongside undertaking clinical teaching and practical programmes. Consequently, there is a need to understand the many challenges and how these were addressed, given increasingly complex patients, to provide future direction. Method: An exploratory study was conducted among senior-level medical and pharmacy educators across Africa, addressing four key questions, including the challenges resulting from the pandemic and how these were dealt with. Results: Staff and student members faced multiple challenges initially, including adapting to online learning. In addition, concerns with the lack of equipment (especially among disadvantaged students), the costs of Internet bundles, and how to conduct practicals and clinical teaching. Multiple activities were undertaken to address these challenges. These included training sessions, developing innovative approaches to teaching, and seeking ways to reduce Internet costs. Robust approaches to practicals, clinical teaching, and assessments have been developed. Conclusions: Appreciable difficulties to teaching arising from the pandemic are being addressed across Africa. Research is ongoing to improve education and assessments

Housing: An Under-Explored Influence on Children’s Well-Being and Becoming

Research on housing has tended to focus on adult outcomes, establishing relationships between housing and a number of aspects of health and well-being. Research exploring the influence of housing on children has been more limited, and has tended to focus on adult concerns around risk behaviours, behavioural problems and educational attainment. While these outcomes are important, they neglect the impact of housing on children’s lives beyond these concerns. There are a number of reasons to believe that housing would play an important role in children’s well-being more broadly. Family stress and strain models highlight how housing difficulties experienced by adults may have knock on effects for children, while Bronfenbrenner’s ecological approach to human development emphasises the importance of children’s experiences of their environments, of which the home is among the most important. This paper summaries the existing evidence around housing and child outcomes, predominantly educational and behavioural outcomes, and argues for the extension of this work to consider the impact of housing on children’s lives more broadly, especially their subjective well-being

Corrosion behaviour of cobalt-based coatings with ruthenium additions in synthetic mine water

The corrosion behaviour of two cobalt-based coatings (ULTIMET™ and STELLITE™ 6) with zero, 0.3 and 0.6 wt% ruthenium were studied and compared with two cobalt-based bulk alloys (ULTIMET™ and STELLITE™ 6B) in synthetic mine water (pH values of 6, 3 and 1) using potentiodynamic polarisation. The coatings demonstrated wider ranges of passivation behaviour (from −250 mV to 750 mV) than the bulk alloys. The corrosion potential became more positive and the active-passive transition reduced with increased Ru. The best coating was STELLITE™ 6 with 0.6 wt% Ru, which exhibited the lowest corrosion rates: 3.6 μm/y at pH 6 and 6.4 μm/y at pH 3

Posttranslational modifications in the CP43 subunit of photosystem II

Photosystem II (PSII) catalyzes the light-driven oxidation of water and the reduction of plastoquinone; the oxidation of water occurs at a cluster of four manganese. The PSII CP43 subunit functions in light harvesting and mutations in the fifth luminal loop (E) of CP43 have established its importance in PSII structure and or assembly [Kuhn M. G. & Vermaas V. F. J. (1993) Plant Mol. Biol. 23 123–133]. The sequence A350PWLEPLR357 in luminal loop E is conserved in CP43 genes from 50 organisms. To map important posttranslational modifications in this sequence tandem mass spectrometry (MS MS) was used. These data show that the indole side chain of Trp-352 is posttranslationally modified to give mass shifts of +4 +16 and +18 daltons. The masses of the modifications suggest that the tryptophan is modified to kynurenine (+4) a keto- amino- hydroxy- (+16) derivative and a dihydro-hydroxy- (+18) derivative of the indole side chain. Peptide synthesis and MS MS confirmed the kynurenine assignment. The +16 and +18 tryptophan modifications may be intermediates formed during the oxidative cleavage of the indole ring to give kynurenine. The sitedirected mutations W352C W352L and W352A exhibit an increased rate of photoinhibition relative to wild type. We hypothesize that Trp-352 oxidative modifications are a byproduct of PSII water-splitting or electron transfer reactions and that these modifications target PSII for turnover. As a step toward understanding the tertiary structure of this CP43 peptide structural modeling was performed by using molecular dynamics. Originally published Proceedings of the National Academy of Sciences Vol. 99 No. 23 Nov 200