PBM and Pharmaceutical Company Mergers: Policy and Regulatory Implications

A recent trend in the pharmaceutical industry has been for large pharmaceutical companies to acquire or merge with PBMs (prescriptionlpharmacy-benefits-management companies). Merck started this trend in November 1993 by merging with a PBM named Medco; two other pharmaceutical giants have followed suit. Since such mergers are a recent phenomenon, their full-scale implications are as yet unknown and there is little regulation in place specifically to address their potential effects. This essay describes the current state of affairs of PBM-pharmaceutical company alliances and explores their implications for the pharmaceutical and health care industries and the players involved. It further discusses the regulatory bodies involved, the measures they have taken to date, and possible future courses of action

Laboratory leaching tests to investigate mobilisation and recovery of metals from geothermal reservoirs

The H2020 project “Combined Heat, Power and Metal extraction” (CHPM2030) aims at developing a novel technology which combines geothermal energy utilisation with the extraction of metals in a single interlinked process. In order to improve the economics of geothermal-based energy production, the project investigates possible technologies for the exploitation of metal-bearing geological formations with geothermal potential at depths of 3–4 km or deeper. In this way, the coproduction of energy and metals would be possible and could be optimized according to market demands in the future. This technology could allow the mining of deep ore bodies, particularly for critical metals, alongside power production, while minimizing environmental impact and costs. In this paper, we describe laboratory leaching experiments aimed at quantifying the relative rates and magnitudes of metal release and seeing how these vary with different fluids. Specific size fractions (250–500 μm) of ground mineralised rock samples were investigated under various pressures and temperatures up to 250 bar and 250°C. Initial experiments involved testing a variety of potential leaching fluids with various mineralised samples for a relatively long time (up to 720 h) in batch reactors in order to assess leaching effectiveness. Selected fluids were used in a flow-through reactor with shorter contact time (0.6 h). To ensure possible application in a real geothermal reservoir, a range of fluids were considered, from dilute mineral acid to relatively environmentally benign fluids, such as deionised water and acetic acid. The main findings of the study include fast reaction time, meaning that steady-state fluid compositions were reached in the first few hours of reaction and enhanced mobilisation of Ca, Cd, Mn, Pb, S, Si, and Zn. Some critical elements, such as Co, Sr, and W, were also found in notable concentrations during fluid-rock interactions. However, the amount of these useful elements released is much less compared to the common elements found, which include Al, Ca, Fe, K, Mg, Mn, Na, Pb, S, Si, and Zn. Even though concentrations of dissolved metals increased during the tests, some remained low, and this may present technical challenges for metal extraction. Future efforts will work toward attaining actual fluids from depth to more tightly constrain the effect of parameters such as salinity, which will also influence metal solubility

Antibiotic Prescriptions and Prophylaxis in Italian Children. Is It Time to Change? Data from the ARPEC Project.

BACKGROUND: Antimicrobials are the most commonly prescribed drugs. Many studies have evaluated antibiotic prescriptions in the paediatric outpatient but few studies describing the real antibiotic consumption in Italian children's hospitals have been published. Point-prevalence survey (PPS) has been shown to be a simple, feasible and reliable standardized method for antimicrobials surveillance in children and neonates admitted to the hospital. In this paper, we presented data from a PPS on antimicrobial prescriptions carried out in 7 large Italian paediatric institutions. METHODS: A 1-day PPS on antibiotic use in hospitalized neonates and children was performed in Italy between October and December 2012 as part of the Antibiotic Resistance and Prescribing in European Children project (ARPEC). Seven institutions in seven Italian cities were involved. The survey included all admitted patients less than 18 years of age present in the ward at 8:00 am on the day of the survey, who had at least one on-going antibiotic prescription. For all patients data about age, weight, underlying disease, antimicrobial agent, dose and indication for treatment were collected. RESULTS: The PPS was performed in 61 wards within 7 Italian institutions. A total of 899 patients were eligible and 349 (38.9%) had an on-going prescription for one or more antibiotics, with variable rates among the hospitals (25.7% - 53.8%). We describe antibiotic prescriptions separately in neonates ( = 30 days to <18 years old). In the neonatal cohort, 62.8% received antibiotics for prophylaxis and only 37.2% on those on antibiotics were treated for infection. Penicillins and aminoglycosides were the most prescribed antibiotic classes. In the paediatric cohort, 64.4% of patients were receiving antibiotics for treatment of infections and 35.5% for prophylaxis. Third generation cephalosporins and penicillin plus inhibitors were the top two antibiotic classes. The main reason for prescribing antibiotic therapy in children was lower respiratory tract infections (LRTI), followed by febrile neutropenia/fever in oncologic patients, while, in neonates, sepsis was the most common indication for treatment. Focusing on prescriptions for LRTI, 43.3% of patients were treated with 3rd generation cephalosporins, followed by macrolides (26.9%), quinolones (16.4%) and carbapenems (14.9%) and 50.1% of LRTI cases were receiving more than one antibiotic. For neutropenic fever/fever in oncologic patients, the preferred antibiotics were penicillins with inhibitors (47.8%), followed by carbapenems (34.8%), aminoglycosides (26.1%) and glycopeptides (26.1%). Overall, the 60.9% of patients were treated with a combination therapy. CONCLUSIONS: Our study provides insight on the Italian situation in terms of antibiotic prescriptions in hospitalized neonates and children. An over-use of third generation cephalosporins both for prophylaxis and treatment was the most worrisome finding. A misuse and abuse of carbapenems and quinolones was also noted. Antibiotic stewardship programs should immediately identify feasible targets to monitor and modify the prescription patterns in children's hospital, also considering the continuous and alarming emergence of MDR bacteria

Laboratory investigations of the physical parameters influencing the in situ leaching of tungsten

Tungsten leaching potential from geothermal reservoirs was investigated using a flow-through reactor with the characteristic physical properties of a geothermal reservoir. Tungsten minerals were tested at 200 °C, 250 °C and 300 °C, and 0.5 and 1.0 mL/min flow rates to determine the most favourable conditions for the mobilisation of tungsten. In situ leaching yielded tungsten concentrations of 1–182 mg/L in the leachates, with pure scheelite being the most effective in mobilising tungsten. The highest concentrations, which were obtained at 300 °C, were generally observed in the first 30–60 min because of the rapid fluid–rock interactions in the geothermal reservoir