The impact of international benchmarking on the price of immunosuppressive medicines for transplant recipients in South Africa

Background. External reference pricing (ERP) is an internationally applied pricing policy to regulate the price of medicines. In 2005, the South African (SA) Minister of Health published a Government Gazette of regulations relating to a transparent pricing system for medicines and scheduled substances, stating that the Minister must publish a methodology for conforming to international benchmarks. In May 2014, the most recent proposed benchmark methodology was published, detailing that international benchmarking of medicines (IBM) requires that the lowest price in a selected basket of countries (Australia, Canada, New Zealand, Spain and SA) be used as the ultimate price for the purposes of benchmarking of originator products.Objectives. To provide a broad observational basis for the use of IBM and the proposed countries as a pricing tool; the feasibility of using BRICS countries (Brazil, Russia, India, China and SA) as comparator countries; and a small sample comparison of local state tender pricing in relation to the IBM proposed basket of comparator country pricing. Immunosuppressant medicines for organ transplant patients were used for this comparison, as they are relatively expensive and there is reluctance to implement pricing and reimbursement policy options to contain their costs.Methods. Ex-manufacturer medicine pricing information for 2016, 2017 and 2018 was sourced for immunosuppressive medicines for SA (public and private sectors), Australia, New Zealand, Canada, Spain, Brazil and Russia. Unit prices were compared for products with the same international non-proprietary name (INN), strength, formulation and manufacturer. In most cases the products were matched on product name, bearing translation nuances in mind.Results. Across all 3 years, in the majority of products, ERP using the proposed basket of comparator countries Australia, New Zealand, Canada and Spain lowered the local private sector ex-manufacturer price of medicine. Similarly, for the majority of products comparing local pricing with that of available BRICS country pricing data, the comparison lowered the price. For 92% of products where a comparison could be made, the SA state tender price was the lowest available price.Conclusions. Conducting an ERP analysis consumes time and resources. However, it may prove to reduce a current or proposed medicine price and may be considered as one of a range of medicine pricing policies employed by a country. It should not be used in isolation from other medicine pricing and reimbursement policies.

Technological requirements for solutions in the conservation and protection of historic monuments and archaeological remains

Executive summary: This Study has discovered many achievements associated with European support for scientific and technological research for the protection and conservation of cultural heritage. The achievements to date are: 1. Creation of an active research community 2. A body of research of unparalleled and enviable international quality and character 3. Ongoing effectiveness of research beyond initial funding 4. Substantial rate of publication 5. Imaginative tools of dissemination and publication 6. Clear spin-offs and contribution to European competitiveness often going outside the European cultural heritage area 7. Contribution to emerging European legislation, for example, air quality management. The Study has also uncovered important research gaps associated with this field that have yet to begin to be investigated. It has also discovered the need for continuing fine scale advancement in areas where researchers have been active for a number of years. The overall picture is that European research in the field of cultural heritage protection must be put on a secure footing if it is to maintain its commanding lead over other regions of the world. This Study concludes that: 1. It would be invidious to attempt to separate basic and applied research in this area of research. Like any other scientific endeavour, this field needs to integrate basic and applied research if it is to continue to thrive. 2. Small, flexible, focused interdisciplinary teams responsive to European needs, must be sustained, promoted and celebrated as models of sustainability and that what is proposed under the European Research Area (ERA) for large and complex research projects, could inflict serious damage on this area of research. 3. Resources cannot be delegated to Member States because of the interdisciplinary nature of cultural heritage and the need for a co-ordinated pan-European perspective across this research that helps to define the essential character of European cultural heritage. National programmes only serve local needs, leading to loss of strategic output, lessening of competitiveness and risk of duplication. 4. A mechanism needs to be created to help researchers working in this field to communicate and exchange information with related sectors such as construction, urban regeneration, land reclamation and agriculture. 5. There is overwhelming agreement over the need for sustainable research funding for cultural heritage and for an iterative process of exchange among researchers, decision-makers and end-users in order to maximize benefits from project inception through to dissemination, audit and review. For all the reasons mentioned above, the most significant recommendation in this Report is the identification of the need for a European Panel on the Application of Science for Cultural Heritage (EPASCH)

Salmonella surveillance trends in porcine Salmonellae in GB: 1996- 2002

Comparison of serotype, phagetype prevalence and antimicrobial resistance profiles for 2002 with data from previous years shows an overall decrease in the number of Salmonella incidents in pigs. Nonetheless, the most frequently isolated serotypes remain unchanged, with an increase in S. Typhimurium incidents. The incidence of antimicrobial resistance for all Salmonella isolates from pigs during the study period showed increasing resistance trends to tetracycline and sulphamethoxazole/trimethoprim. However, the isolates remained sensitive to the majority of antibiotics in the screening panel

Volatile aldehydes in libraries and archives

Volatile aldehydes are produced during degradation of paper-based materials. This may result in their accumulation in archival and library repositories. However, no systematic study has been performed so far. In the frame of this study, passive sampling was carried out at ten locations in four libraries and archives. Despite the very variable sampling locations, no major differences were found, although air-filtered repositories were found to have lower concentrations while a non-ventilated newspaper repository exhibited the highest concentrations of volatile aldehydes (formaldehyde, acetaldehyde, furfural and hexanal). Five employees in one institution were also provided with personal passive samplers to investigate employees’ exposure to volatile aldehydes. All values were lower than the presently valid exposure limits. The concentration of volatile aldehydes, acetic acid, and volatile organic compounds (VOCs) in general was also compared with that of outdoor-generated pollutants. It was evident that inside the repository and particularly inside archival boxes, the concentration of VOCs and acetic acid was much higher than the concentration of outdoor-generated pollutants, which are otherwise more routinely studied in connection with heritage materials. This indicates that further work on the pro-degradative effect of VOCs on heritage materials is necessary and that monitoring of VOCs in heritage institutions should become more widespread

Developing health enhancing physical activity modules for higher and vocational education

Health enhancing physical inactivity is a growing concern leading to health problems in Europe and nationwide. WHO (2017) stated that the current levels of physical inactivity are the consequence of insufficient participation in physical activity and an increase in sedentary behavior. The British Heart Foundation (2015) also reported that 13 to 15 years in England were sedentary for six hours or more for both genders (boys = 24%, girls = 16%) on weekdays, and there was a spike of sedentary behaviour on weekend days with 43% of boys and 37% for this age group. The "Sport, Physical Education and Coaching for Health" (SPEACH) project, is an Erasmus+ Programme of the European Union (2015-2017). The key purpose of the project to prepare professional practitioners in higher and vocational education in the areas of Physical Education, Sports and Physical Activity to change behaviors of the citizens of Europe and increase physical activity. To achieve this, the project culminated in developing, validating, piloting and evaluating five Health Enhancing Physical Activity (HEPA) related modules, which may be embedded into existing education structures in the areas of Physical Education, Sports and Physical Activity. The design of the HEPA modules attempts to test a cutting edge multidisciplinary approach that bridges the gap between research / theory and practice (Armour, 2014). The needs analysis phase of the project comprised survey responses of 660 students in higher and vocational education studying Physical Education, Sports and Physical Activity from seven European countries; 14 interviewees with subject experts; and a focus group with professional and academic field experts. The results demonstrated that students in particular welcome a multidisciplinary approach for module content. The combination of “dual” content themes in modules was a key innovation that students responded favourably to, therefore HEPA modules covered themes such as changing behavior; personal leadership; physical activity for special target groups; health policy; linked to young people, their families and sport; management; nutrition, walking sports and healthy aging; and so on.. Surveyed students’ views of desirable pedagogy / didactics for these modules were practice oriented; training; internship / work based; group-and classroom based teaching. Three HEPA modules were piloted in a real-life setting in an intensive week of teaching (20 hours) each module to three groups of undergraduate students from Physical Education, Sports and Physical Activity from Europe that opted to participate in the pilot study. The developed HEPA modules were evaluated by students and staff; and the findings demonstrated relevance, enjoyment, flexibility and differentiated levels of instruction that will facilitate the embedding of any of these modules at vocational, bachelor as well as master level. These modules will be available online in an open resource that will facilitate free access, collaboration and cooperation of stakeholders in higher and vocational education in the areas of Physical Education, Sports and Physical Activity

Climate change mitigation strategies for mechanically controlled repositories: The case of The National Archives, Kew

A computer based building simulation model was developed to examine the energy load and environmental management in The National Archives Q1 repository building in Kew, UK to optimise environmental management and examine the impacts of climate change. The need to accurately simulate the hygrothermal environment inside the archive building which houses mainly paper-based records led to the choice of EnergyPlus as the modelling software. The study presents the simulation results of five environmental strategies which predict energy saving potential as high as 43% without significantly affecting the quality of the preservation environment. The effect of climate change is predicted to have little impact on the archive environment due to the filtering effect of the air conditioning system. On the other hand, an increase in total energy load by 15% and 24% is predicted under the worst case climate change scenario in 2050 and 2080, respectively, if the current environmental management practice is continued into the future. However, the identified energy saving strategies could represent possible mitigative solutions in reducing future energy load against the impact of climate change

Behavioural aspects of smoking (both passive and active) and alcohol consumption on the risk of myocardial infarction

Objectives: To investigate the effect of alcohol consumption and of passive and active smoking on the risk of myocardial infarction (MI). Methods: Data on 429 cases with MI and 434 controls was obtained through an interviewer-led questionnaire as part of the Maltese Acute Myocardial Infarction (MAMI) Study. Regular alcohol drinkers were defined as subjects having at least one drink per week for one year and binge drinkers as having six or more drinks on one occasion this last year. Current smokers were excluded from the analysis of passive smoking. Odds ratios (AdjOR) were adjusted for age, gender, smoking/drinking alcohol, hypertension, diabetes, hypercholesterolaemia and BMI. Results: Regular alcohol drinkers were protected against MI [AdjOR 0.6 (95%CI 0.4-0.8)]. The risk of MI associated with binge drinking varies with the frequency, reaching an AdjOR of 5.8 (95%CI 1.2-27.1) in daily binge drinkers. The AdjOR for current smokers was 3.1 (95%CI 2.0-4.9) and for ex-smokers 1.6 (95%CI 1.1-2.4). Passive smoking also increased the risk of MI [AdjOR 3.0 (95%CI 1.7-5.4)]. Passive smoke exposure in a home setting had a greater deleterious effect [AdjOR 2.8 (95%CI 1.6-4.7)] than exposure in a public setting [AdjOR 1.4 (95%CI 0.9-2.2)]. While periods of 1 hour or longer of passive smoke exposure were found to be deleterious in both the investigated settings, exposure for less than 1 hour was only a risk factor in a home setting. Conclusion: The effect of alcohol consumption on the risk for MI varies from protective to extremely deleterious depending on the frequency of drinking. Daily binge drinking is associated with a high risk of MI. Smoking, even passive smoking, is a risk factor of MI. The effect of passive smoking on the risk of MI is greater in a home than in a public setting

An advective mechanism for Deep Chlorophyll Maxima formation in southern Drake Passage

We observe surface and subsurface fluorescence-derived chlorophyll maxima in southern Drake Passage during austral summer. Backscatter measurements indicate that the deep chlorophyll maxima (DCMs) are also deep biomass maxima, and euphotic depth estimates show that they lie below the euphotic layer. Subsurface, offshore and near-surface, onshore features lie along the same isopycnal, suggesting advective generation of DCMs. Temperature measurements indicate a warming of surface waters throughout austral summer, capping the winter water (WW) layer and increasing off-shelf stratification in this isopycnal layer. The outcrop position of the WW isopycnal layer shifts onshore, into a surface phytoplankton bloom. A lateral potential vorticity (PV) gradient develops, such that a down-gradient PV flux is consistent with offshore, along-isopycnal tracer transport. Model results are consistent with this mechanism. Subduction of chlorophyll and biomass along isopycnals represents a biological term not observed by surface satellite measurements which may contribute significantly to the strength of the biological pump in this region

A Homogeneous Actor-Based Monitor Language for Adaptive Behaviour

This paper describes a structured approach to encoding monitors in an actor language. Within a configuration of actors, each of which publishes a history, a monitor is an independent actor that triggers an action based on patterns occurring in the histories. We define a monitor language based on linear temporal logic and show how it can be homogeneously embedded within an actor language. The approach is demonstrated through a number of examples and evaluated in terms of a real-world actor-based simulation