Acceptability and feasibility of a national essential medicines list in Canada: a qualitative study of perceptions of decision-makers and policy stakeholders.

BACKGROUND: Policy approaches have been considered to address inconsistent and inequitable prescription drug coverage in Canada, including a national essential medicines list. We sought to explore key factors influencing the acceptability and feasibility of an essential medicines list in Canada. METHODS: We conducted semi-structured interviews with decision-makers and other key stakeholders from government or pan-Canadian institutions, civil society and the private sector across Canada. We analyzed data using inductive thematic analysis and by applying Kingdon's Multiple Streams Framework to analyze the emergent themes deductively. RESULTS: We conducted 21 interviews before thematic saturation was achieved. We categorized emergent themes to describe the problem, the essential medicines list policy (including content and process), and politics. There was consensus among participants that prescription drug coverage was an important problem to address. Participants differed in their views on how to define essential medicines and concerns about what would be excluded from an essential medicines list. There was consensus on important features for a process to develop an essential medicines list: an independent decision-making body, use of defined selection criteria based on quality evidence, and clear communication of the purpose of the essential medicines list. Federal government financing and the broader pharmacare model, engagement of various interest groups and changing political agendas emerged as core political factors to consider if developing a Canadian essential medicines list. INTERPRETATION: Although stakeholders' views on the content of a Canadian essential medicines list varied, there was consensus on the process to formulate and implement an essential medicines list or common national formulary, including choosing medicines based on best evidence. Greater understanding is now needed on how patients, clinicians and the public perceive the concept of an essential medicines list

Selection of WHO-recommended essential medicines for non-communicable diseases on National Essential Medicines Lists.

BACKGROUND: Non-communicable diseases (NCDs) are the leading cause of death worldwide. Inadequate and inequitable access to essential NCD medicines is a major concern, particularly in low- and middle-income countries. National Essential Medicines Lists (EMLs) are important policy tools that indicate which medicines are prioritized as essential within a country's health system. This study sought to analyze a wide range of national essential medicines lists (EMLs) for their inclusion of priority non communicable disease (NCD) interventions recommended by the World Health Organization (WHO). METHODS: Three lists of WHO endorsed priority NCD interventions were included. A database with 137 national EMLs and the WHO EML was created from the WHO Repository and these EMLs were compared for listing of priority NCD interventions. RESULTS: Across 137 countries with national EMLs, the median percentage of 20 Best Buys interventions listed was 90% (IQR 80-95) and 31 Package of essential noncommunicable disease interventions (PEN) interventions listed was 94% (IQR 90-97), of 9 HEARTS interventions was 100% (IQR 89-100), and of the 43 unique interventions across the three priority lists was 88% (IQR 84-93). Less than 80% of the 43 interventions were listed by 22 (16%) countries and less than half of the interventions were listed by 2 countries: Angola (35%) and Cambodia (23%). Interventions listed on the fewest number of national EMLs were: influenza vaccine, HPV vaccine, hepatitis B vaccine, cervical cancer chemotherapy, codeine, promethazine, senna, and oxygen. CONCLUSION: Most NCD interventions have been prioritized in national policy in most cases. The majority of priority medicines for NCDs described within key WHO NCD technical packages are listed on nearly all national EMLs across 137 countries of all income levels. Most NCD interventions have been prioritized in national policy in most cases, but in some countries and for select interventions such as the HPV vaccine, prioritization may be reviewed

HI intensity mapping with the MIGHTEE survey: power spectrum estimates

Intensity mapping (IM) with neutral hydrogen is a promising avenue to probe the large scale structure of the Universe. With MeerKAT single-dish measurements, we are constrained to scales $>1$ degree, and this will allow us to set important constraints on the Baryon acoustic oscillations and redshift space distortions. However, with MeerKAT's interferometric observation, we can also probe relevant cosmological scales. In this paper, we establish that we can make a statistical detection of HI with one of MeerKAT's existing large survey projects (MIGHTEE) on semi-linear scales, which will provide a useful complementarity to the single-dish IM. We present a purpose-built simulation pipeline that emulates the MIGHTEE observations and forecast the constraints that can be achieved on the HI power spectrum at $z = 0.27$ for $k > 0.3$ $\rm{Mpc}^{-1}$ using the foreground avoidance method. We present the power spectrum estimates with the current simulation on the COSMOS field that includes contributions from HI, noise and point source models from the data itself. The results from our \textit{visibility} based pipeline are in good agreement to the already available MIGHTEE data. This paper demonstrates that MeerKAT can achieve very high sensitivity to detect HI with the full MIGHTEE survey on semi-linear scales (signal-to-noise ratio $> 7$ at $k=0.49$ $\rm{Mpc}^{-1}$) which are instrumental in probing cosmological quantities such as the spectral index of fluctuation, constraints on warm dark matter, the quasi-linear redshift space distortions and the measurement of the HI content of the Universe up to $z\sim 0.5$.Comment: 12 pages, 8 figures, Submitted to MNRAS, comments welcom

Sharks of the order Carcharhiniformes from the British Coniacian, Santonian and Campanian (Upper Cretaceous).

Bulk sampling of phosphate-rich horizons within the British Coniacian to Campanian (Upper Cretaceous) yielded very large samples of shark and ray teeth. All of these samples yielded teeth of diverse members of the Carcharhiniformes, which commonly dominate the fauna. The following species are recorded and described: Pseudoscyliorhinus reussi (Herman, 1977) comb. nov., Crassescyliorhinus germanicus (Herman, 1982) gen. nov., Scyliorhinus elongatus (Davis, 1887), Scyliorhinus brumarivulensis sp. nov., ? Palaeoscyllium sp., Prohaploblepharus riegrafi (Müller, 1989) gen. nov., ? Cretascyliorhinus sp., Scyliorhinidae inc. sedis 1, Scyliorhinidae inc. sedis 2, Pteroscyllium hermani sp. nov., Protoscyliorhinus sp., Leptocharias cretaceus sp. nov., Palaeogaleus havreensis Herman, 1977, Paratriakis subserratus sp. nov., Paratriakis tenuis sp. nov., Paratriakis sp. indet. and ? Loxodon sp. Taxa belonging to the families ?Proscylliidae, Leptochariidae, and Carcharhinidae are described from the Cretaceous for the first time. The evolutionary and palaeoecological implications of these newly recognised faunas are discussed

NOACs added to WHO’s essential medicines list: recommendations for future policy actions

The introduction of non-vitamin K antagonists oral anticoagulants, a class of medicines which includes dabigatran, apixaban, edoxaban and rivaroxaban, has resulted in improvements in the safety and efficacy of non valvular atrial fibrillation treatment for stroke prevention, with significant reductions in stroke, intracranial haemorrhage, and mortality. For these reasons, a team of World Heart Federation Emerging Leaders led efforts to add non-vitamin K antagonists oral anticoagulants to the World Health Organization’s Model List of Essential Medicines in 2019. Following the inclusion of this class of medicines in the Essential Medicines List, this editorial proposes several recommendations to improve the accessibility, affordability and acceptability of non-vitamin K oral anticoagulants, especially in low- and middle-income settings, in order to successfully manage non-valvular atrial fibrillation and to lower the risk of stroke

Continuous Symmetries of Difference Equations

Lie group theory was originally created more than 100 years ago as a tool for solving ordinary and partial differential equations. In this article we review the results of a much more recent program: the use of Lie groups to study difference equations. We show that the mismatch between continuous symmetries and discrete equations can be resolved in at least two manners. One is to use generalized symmetries acting on solutions of difference equations, but leaving the lattice invariant. The other is to restrict to point symmetries, but to allow them to also transform the lattice.Comment: Review articl

MIGHTEE-HI: the HI Size-Mass relation over the last billion years

We present the observed HI size-mass relation of $204$ galaxies from the MIGHTEE Survey Early Science data. The high sensitivity of MeerKAT allows us to detect galaxies spanning more than 4 orders of magnitude in HI mass, ranging from dwarf galaxies to massive spirals, and including all morphological types. This is the first time the relation has been explored on a blind homogeneous data set which extends over a previously unexplored redshift range of $0 < z < 0.084$, i.e. a period of around one billion years in cosmic time. The sample follows the same tight logarithmic relation derived from previous work, between the diameter ($D_{\rm HI}$) and the mass ($M_{\rm HI}$) of HI discs. We measure a slope of $0.501\pm 0.008$, an intercept of $-3.252^{+0.073}_{-0.074}$, and an observed scatter of $0.057$ dex. For the first time, we quantify the intrinsic scatter of $0.054 \pm 0.003$ dex (${\sim} 10 \%$), which provides a constraint for cosmological simulations of galaxy formation and evolution. We derive the relation as a function of galaxy type and find that their intrinsic scatters and slopes are consistent within the errors. We also calculate the $D_{\rm HI} - M_{\rm HI}$ relation for two redshift bins and do not find any evidence for evolution with redshift. These results suggest that over a period of one billion years in lookback time, galaxy discs have not undergone significant evolution in their gas distribution and mean surface mass density, indicating a lack of dependence on both morphological type and redshift.Comment: 10 pages, 5 figures, accepted for publication in MNRA

MIGHTEE-HI: The first MeerKAT HI mass function from an untargeted interferometric survey

We present the first measurement of the HI mass function (HIMF) using data from MeerKAT, based on 276 direct detections from the MIGHTEE Survey Early Science data covering a period of approximately a billion years ($0 \leq z \leq 0.084$). This is the first HIMF measured using interferometric data over non-group or cluster field, i.e. a deep blank field. We constrain the parameters of the Schechter function which describes the HIMF with two different methods: $1/\rm V_{\rm max}$ and Modified Maximum Likelihood (MML). We find a low-mass slope $\alpha=-1.29^{+0.37}_{-0.26}$, `knee' mass $\log_{10}(M_{*}/{\rm M_{\odot}}) = 10.07^{+0.24}_{-0.24}$ and normalisation $\log_{10}(\phi_{*}/\rm Mpc^{-3})=-2.34^{+0.32}_{-0.36}$ ($H_0 = 67.4$ kms$^{-1}$ Mpc$^{-1}$) for $1/\rm V_{\rm max}$ and $\alpha=-1.44^{+0.13}_{-0.10}$, `knee' mass $\log_{10}(M_{*}/{\rm M_{\odot}}) = 10.22^{+0.10}_{-0.13}$ and normalisation $\log_{10}(\phi_{*}/\rm Mpc^{-3})=-2.52^{+0.19}_{-0.14}$ for MML. When using $1/\rm V_{\rm max}$ we find both the low-mass slope and `knee' mass to be consistent within $1\sigma$ with previous studies based on single-dish surveys. The cosmological mass density of HI is found to be slightly larger than previously reported: $\Omega_{\rm HI}=5.46^{+0.94}_{-0.99} \times 10^{-4}h^{-1}_{67.4}$ from $1/\rm V_{\rm max}$ and $\Omega_{\rm HI}=6.31^{+0.31}_{-0.31} \times 10^{-4}h^{-1}_{67.4}$ from MML but consistent within the uncertainties. We find no evidence for evolution of the HIMF over the last billion years.Comment: 13 pages, 9 figures, accepted for publication in MNRA

Towards an ‘ordinary’ cosmopolitanism in everyday academic practice in higher education

In this article, we explore what cosmopolitanism looks like in particular institutional contexts in higher education and the sorts of conditions and pedagogic practices which nurture and sustain this within the overall running and administration of the institution. Cosmopolitanism is sometimes popularly assumed to refer to the global and the culturally diverse, rather as if encounters with different cultures and ethnicities from different geographical locations could add up to a cosmopolitan perspective. Our view of cosmopolitanism and our concern start from local and everyday occurrences or ‘ordinary cosmopolitanism’ in the context of higher education. We develop an understanding of cosmopolitanism as embedded practice in the particularities of local institutional contexts and administration and what cosmopolitanism means in the ‘local’. Small illustrative sketches are drawn on to exemplify aspects of ‘ordinary cosmopolitanism’ – what it is, why it is important and its enactment in everyday academic practice in higher education