Deregulation and access to medicines: the Peruvian experience

How does the deregulation of medicine influence access to drugs? This paper provides an economic policy assessment of the effects of medicine deregulation drawing on the Peruvian experience between 1991 and 2006. As in other low-income countries, health insurance development is inadequate, drug expenditure is mostly paid out-of-pocket and approximately one third of the Peruvian population has limited access to ‘essential medicines’. Market deregulation in this context can exert an impact on prices and hence reduce access to medicines. Based on this evidence, we find that product and price deregulation of the medicines market appears to have reduced consumer trust of locally produced medicines, which in turn incentivised a switch to branded and more expensive drugs. The latter resulted in a further decreased access to medicines

The BLue Amazon Brain (BLAB): A Modular Architecture of Services about the Brazilian Maritime Territory

We describe the first steps in the development of an artificial agent focused on the Brazilian maritime territory, a large region within the South Atlantic also known as the Blue Amazon. The "BLue Amazon Brain" (BLAB) integrates a number of services aimed at disseminating information about this region and its importance, functioning as a tool for environmental awareness. The main service provided by BLAB is a conversational facility that deals with complex questions about the Blue Amazon, called BLAB-Chat; its central component is a controller that manages several task-oriented natural language processing modules (e.g., question answering and summarizer systems). These modules have access to an internal data lake as well as to third-party databases. A news reporter (BLAB-Reporter) and a purposely-developed wiki (BLAB-Wiki) are also part of the BLAB service architecture. In this paper, we describe our current version of BLAB's architecture (interface, backend, web services, NLP modules, and resources) and comment on the challenges we have faced so far, such as the lack of training data and the scattered state of domain information. Solving these issues presents a considerable challenge in the development of artificial intelligence for technical domains

Macroalgal morphogenesis induced by waterborne compounds and bacteria in coastal seawater

Axenic gametes of the marine green macroalga Ulva mutabilis Foyn (Ria Formosa, locus typicus) exhibit abnormal development into slow-growing callus-like colonies with aberrant cell walls. Under laboratory conditions, it was previously demonstrated that all defects in growth and thallus development can be completely abolished when axenic gametes are inoculated with a combination of two specific bacterial strains originally identified as Roseo-bacter sp. strain MS2 and Cytophaga sp. strain MS6. These bacteria release diffusible morphogenetic compounds (= morphogens), which act similar to cytokinin and auxin. To investigate the ecological relevance of the waterborne bacterial morphogens, seawater samples were collected in the Ria Formosa lagoon (Algarve, Southern Portugal) at 20 sampling sites and tidal pools to assess their morphogenetic effects on the axenic gametes of U. mutabilis. Specifically the survey revealed that sterile-filtered seawater samples can completely recover growth and morphogenesis of U. mutabilis under axenic conditions. Morphogenetic activities of free-living and epiphytic bacteria isolated from the locally very abundant Ulva species (i.e., U. rigida) were screened using a multiwell-based testing system. The most represented genera isolated from U. rigida were Alteromonas, Pseudoalteromonas and Sulfitobacter followed by Psychrobacter and Polaribacter. Several naturally occurring bacterial species could emulate MS2 activity (= induction of cell divisions) regardless of taxonomic affiliation, whereas the MS6 activity (= induction of cell differentiation and cell wall formation) was species-specific and is probably a feature of difficult-to-culture bacteria. Interestingly, isolated bacteroidetes such as Algoriphagus sp. and Polaribacter sp. could individually trigger complete Ulva morphogenesis and thus provide a novel mode of action for bacterial-induced algal development. This study also highlights that the accumulation of algal growth factors in a shallow water body separated from the open ocean by barrier islands might have strong implications to, for example, the wide usage of natural coastal seawater in algal (land based) aquacultures of Ulva

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Trimetallic catalyst based on PtRu modified by irreversible adsorption of Sb for direct ethanol fuel cells

In this work, PtRu/C-Sb materials prepared by adding a Sb salt to the ink of commercial PtRu/C were studied as catalysts for ethanol oxidation. The prepared trimetallic catalysts showed enhanced properties for ethanol oxidation trough a wide range of surface coverages. However, coverage higher than 0.7 of Sb on PtRu/C causes the decrease of the catalytic activity suggesting that specific sites composed by the 3 metals are necessary to achieve the highest performance. In situ Fourier Transformed Infrared Spectroscopy experiments were also performed to compare the reaction products of the bimetallic and trimetallic catalysts. The catalysts were also tested under fuel cell conditions. Also in this case, higher power densities, higher open circuit voltages and better stability than the bimetallic substrate were found. With this catalyst preparation method, the catalysts showed 2 times higher current densities than for the PtRu catalysts and 6 times better than for pure Pt anodes.Peer reviewe

On the behavior of the Pt(1 0 0) and vicinal surfaces in alkaline media

\u3cp\u3eWe address in this paper a voltammetric study of the charge transfer processes characteristic of Pt(1 0 0) and vicinal surfaces in alkaline media. The electrochemical behavior of a series of stepped surfaces of the type Pt(S)[n(1 0 0) × (1 1 1)] has been characterized using cyclic voltammetry at different pHs, charge displacement measurements and FTIR experiments for adsorbed CO. The results from these techniques allow assigning the different peaks appearing in the voltammogram to hydrogen and/or OH adsorption on the different sites of these surfaces, namely, terrace and step sites. Additionally, the potential of zero total charge (pztc) of the electrodes was determined. The resulting pztc values shift to more negative values when the step density increases on the surface up to n = 5. FTIR spectroscopy experiments have been used to monitor the adsorption of CO on the different surfaces as well as the consequent CO oxidation, accompanying a positive potential sweep. The oxidation of adsorbed CO on (1 0 0) terraces is catalyzed by the presence of the (1 1 1) steps. The FTIR spectra revealed that CO is mostly bonded in bridge configuration at low potentials interconverting to on-top when the electrode potential is increased.\u3c/p\u3