Stated preferences of doctors for choosing a job in rural areas of Peru: a discrete choice experiment.

BACKGROUND: Doctors' scarcity in rural areas remains a serious problem in Latin America and Peru. Few studies have explored job preferences of doctors working in underserved areas. We aimed to investigate doctors' stated preferences for rural jobs. METHODS AND FINDINGS: A labelled discrete choice experiment (DCE) was performed in Ayacucho, an underserved department of Peru. Preferences were assessed for three locations: rural community, Ayacucho city (Ayacucho's capital) and other provincial capital city. Policy simulations were run to assess the effect of job attributes on uptake of a rural post. Multiple conditional logistic regressions were used to assess the relative importance of job attributes and of individual characteristics. A total of 102 doctors participated. They were five times more likely to choose a job post in Ayacucho city over a rural community (OR 4.97, 95%CI 1.2; 20.54). Salary increases and bonus points for specialization acted as incentives to choose a rural area, while increase in the number of years needed to get a permanent post acted as a disincentive. Being male and working in a hospital reduced considerably chances of choosing a rural job, while not living with a partner increased them. Policy simulations showed that a package of 75% salary increase, getting a permanent contract after two years in rural settings, and getting bonus points for further specialisation increased rural job uptake from 21% to 77%. A package of 50% salary increase plus bonus points for further specialisation would also increase the rural uptake from 21% to 52%. CONCLUSIONS: Doctors are five times more likely to favour a job in urban areas over rural settings. This strong preference needs to be overcome by future policies aimed at improving the scarcity of rural doctors. Some incentives, alone or combined, seem feasible and sustainable, whilst others may pose a high fiscal burden

Extraction of eco-friendly and biodegradable surfactant for inhibition of copper corrosion during acid pickling

A novel, cheap, less toxic, and easier-prepared gelatin surfactant is successfully used as corrosion inhibitor for the corrosion of copper in 0.1 M H 2 SO 4 at the temperature range: 25–55°C. The critical micelle concentration of the surfactant was determined from surface tension measurements. The inhibition efficiency was determined from potentiodynamic polarization and electrochemical impedance spectroscopy techniques. For surfactant acted by adsorption at copper/solution interface, an inhibition efficiency up to 68 was obtained at critical micelle concentration (70 ppm) of surfactant at 35°C. The free energy of adsorption was calculated and discussed. The surface parameters of gelatin surfactant were calculated and correlated to the inhibition efficiency. They were also calculated from its surface tension profile including: critical micelle concentration), maximum surface excess (Γ max ), and minimum surface area (A min ). The thermodynamic of micellization, free energies of micellization (ΔG mic ) and entropy of micellization, was calculated and discussed. The formation of compact and adherent monomolecular adsorbed film on copper substrate was confirmed

Development and characterization of miltefosine-loaded polymeric micelles for cancer treatment

Miltefosine presents antineoplastic activity but high hemolytic potential. Its use in cancer has been limited to treating cutaneous metastasis of breast cancer. To decrease hemolytic potential, we developed a formulation of miltefosine-loaded polymeric micelles (PM) of the copolymer Pluronic-F127. A central composite design was applied and the analysis of variance showed that the optimum level of hydrodynamic diameter and polydispersity index predicted by the model and experimentally confirmed were 29 nm and 0.105, respectively. Thermal analyses confirmed that miltefosine was molecularly dispersed within PM. Pluronic-F127 PM with miltefosine 80 μM presented a significant reduction of hemolytic effect (80%, p < 0.05) in comparison to free drug. In vitro assays against HeLa carcinoma cells demonstrated similar cytotoxicity to free miltefosine and PM. Our results suggest that, by lowering hemolytic potential, miltefosine-loaded Pluronic-F127 PM a promising alternative to broaden this drug use in cancer therapy, as well as of other alkylphosphocholines.Fil: Valenzuela Oses, Johanna K.. Universidade de Sao Paulo; BrasilFil: García, Mónica Cristina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Unidad de Investigación y Desarrollo en Tecnología Farmacéutica. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Unidad de Investigación y Desarrollo en Tecnología Farmacéutica; ArgentinaFil: Feitosa, Valker A.. Universidade de Sao Paulo; Brasil. Institute for Technological Research; BrasilFil: Pachioni Vasconcelos, Juliana A.. Universidade de Sao Paulo; BrasilFil: Gomes-Filho, Sandro M.. Universidade de Sao Paulo; BrasilFil: Lourenço, Felipe R.. Universidade de Sao Paulo; BrasilFil: Cerize, Natalia N.P.. Institute for Technological Research; BrasilFil: Bassères, Daniela S.. Universidade de Sao Paulo; BrasilFil: Rangel-Yagui, Carlota O.. Universidade de Sao Paulo; Brasi

Temperature‐Sensitive Magnetic Drug Carriers for Concurrent Gemcitabine Chemohyperthermia

We sought to improve the efficacy of gemcitabine (GEM) for the treatment of advanced pancreatic cancer via local hyperthermia potentiated via a multi-functional nanoplatform permitting both in vivo heating and drug delivery. Herein, we propose a chemohyperthermia approach to synergistically achieve high intra-tumoral drug concentrations while permitting concurrent hyperthermia for more effective tumor cell kill and growth inhibition. Drug delivery and hyperthermia were achieved using a hydroxypropyl cellulose (HPC) grafted porous magnetic drug carrier that is MRI visible to permit in vivo visualization of the biodistribution. These synthesized magnetic drug carriers produced strong T2 weighted image contrast and permitted efficient heating using low magnetic field intensities. The thermo-mechanical response of HPC permitted triggered GEM release confirmed during in vitro drug release studies. During in vitro studies, pancreatic cancer cell growth was significantly inhibited (~82% reduction) with chemohyperthermia compared to chemotherapy or hyperthermia alone. Using PANC-1 xenografts in nude mice, the delivery of injected GEM-loaded magnetic carriers (GEM-magnetic carriers) was visualized with both MRI and fluorescent imaging techniques. Chemohyperthermia with intra-tumoral injections of GEM-magnetic carriers (followed by heating) resulted in significant increases in apoptotic cell death compared to tumors treated with GEM-magnetic carriers injections alone. Chemohyperthermia with GEM-magnetic carriers offers the potential to significantly improve the therapeutic efficacy of gemcitabine for the treatment of pancreatic cancer. In vivo delivery confirmation with non-invasive imaging techniques could permit patient-specific adjustments therapeutic regimens for improve longitudinal outcomes