Measuring Access to Medicines: A Survey of Prices, Availability and Affordability in Shaanxi Province of China

Objective: To measure the prices and availability of selected medicines in Shaanxi Province after the implementation of new healthcare reform in 2009. Methods: Data on the prices and availability of 47 medicines were collected from 50 public and 36 private sector medicine outlets in six regions of Shaanxi Province, Western China using a standardized methodology developed by the World Health Organization and Health Action International from September to October 2010. Medicine prices were compared with international reference prices to obtain a median price ratio. Affordability was measured as the number of days’ wages required for the lowest-paid unskilled government worker to purchase standard treatments for common conditions. Findings: The mean availabilities of originator brands and lowest-priced generics were 8.9% and 26.5% in the public sector, and 18.1% and 43.6% in the private sector, respectively. The public sector procured generics and originator brands at median price ratios of 0.75 and 8.49, respectively, while patients paid 0.97 and 10.16. Final patient prices for lowest-priced generics and originator brands in the private sector were about 1.53 and 8.36 times their international retail prices, respectively. Public sector vendors applied high markups of 30.4% to generics, and 19.6% to originator brands. In the private sector, originator brands cost 390.7% more, on average, than their generic equivalents. Generic medicines were priced 17.3% higher in the private sector than the public sector. The lowest-paid government worker would need 0.1 day’s wages to purchase captopril for lowest-priced generics from private sector, while 6.6 days’ wages for losartan. For originator brands, the costs rise to 1.2 days’ wages for salbutamol inhaler and 15.6 days’ wages for omeprazole. Conclusions: The prices, availability and affordability of medicines in China should be improved to ensure equitable access to basic medical treatments, especially for the poor. This requires multi-faceted interventions, as well as the review and refocusing of policies, regulations and educational interventions

Spatial Pattern of Late Quaternary Shortening Rate in the Longmen Shan Foreland, Eastern Margin of the Tibetan Plateau

AbstractAs the eastern boundary of the Tibetan Plateau, Longmen Shan possesses a narrow thrust belt with steep topography but lacks matching Cenozoic foreland basin. Multiple kinetic models have been proposed to debate on the dominant mechanism of developing such range–foreland system. Crustal shortening rate is a feasible approach to test different tectonic models and estimate structural patterns. In this study, we focused on the deformation pattern and shortening rate of the complex foreland area of the southern Longmen Shan, which is comprised of the Xiongpo, Sansuchang, and Longquanshan anticlines. By the means of net-based RTK measurement and Quaternary chronology, we measured and dated the six-level terraces of the Qingyi River, which flows southeastward across this region. Excess area method was applied to calculate shortening rate. The results indicate that the Late Quaternary shortening rates of the Xiongpo anticline, Longquanshan anticline, and Sansuchang anticline are 1.01 mm/yr, 0.89 mm/yr, and 0.16 mm/yr, respectively. The total shortening rate of the foreland in southern Longmen Shan is 2.06 mm/yr. Consequently, a mechanical model was presented to show the tectonic pattern: the southern Longmen Shan is an actively expanding edge of the plateau, and the shortening is distributed to the three anticlines dominated by the foreland detachment system. This model supports that crustal shortening is the dominating force in the current orogenesis of the Longmen Shan. In addition, the along-strike variation of the Longmen Shan was further specified from the perspective of crustal shortening distribution. We propose that the southern Longmen Shan and its foreland basin are in a state of compression, while the northern Longmen Shan has both thrust and strike-slip characteristics

Access to aff ordable medicines after health reform: evidence from two cross-sectional surveys in Shaanxi Province,western China

Background Limited access to essential medicines is a global problem. Improving availability and aff ordability of essential medicines is a key objective of the National Essential Medicine Policy (NEMP) in China. In its initial implementation in 2009, the NEMP targeted primary hospitals with policies designed to increase availability of essential medicines and reduce patients’ economic burden from purchasing medicines. We assessed medicine availability and price during the early years of the health reform in Shaanxi Province in underdeveloped western China. Methods We undertook two public (hospitals) and private (pharmacy) sector surveys of prices and availability of medicines, in September, 2010 and April, 2012, by a standard methodology developed by WHO and Health Action International. We measured medicine availability in outlets at the time of the surveys and infl ation-adjusted median unit prices (MUPs), taking 2010 as the base year. We used general estimating equations to calculate the signifi cance of diff erences in availability from 2010 to 2012 and the Wilcoxon signed rank test to calculate the signifi cance of diff erences in adjusted median prices. Findings We collected data from 50 public sector hospitals and 36 private sector retail pharmacies in 2010 and 72 public hospitals and 72 retail pharmacies in 2012. Mean availability of surveyed medicines was low in both the public and private sectors; availability of many essential medicines decreased from 2010 to 2012, particularly in primary hospitals (from 27·4% to 22·3% for lowest priced generics; p<0·0001). The MUPs of originator brands and their generic equivalents decreased signifi cantly from 2010 to 2012 in primary hospitals in comparison with secondary and tertiary hospitals. In the public sector, the median adjusted patient price was signifi cantly lower in 2012 than in 2010 for 16 originator brands (diff erence –11·7%; p=0·0019) and 29 lowest-priced generics (–5·2%; p=0·0015); the median government procurement price for originator brands also decreased signifi cantly (–10·9%; p=0·0004), whereas the decrease in median procurement price for lowest-priced generics was not signifi cant (–4·9%; p=0·17). In the private sector, the median percentage decrease in price between 2010 and 2012 for 38 lowest-priced generics was 4·7% (IQR 6·3–13·2), compared with 7·9% (4·9–13·9) for 16 originator brands. Interpretation Although infl ation-adjusted medicine prices were numerically lower, there were concerning decreases in availability of lowest-priced generic medicines in both the public and private sectors in 2012 from already low availability in 2010. A long-term, stable, and consistent information system is needed to monitor eff ects of further implementation of the Chinese Essential Medicine Policy

Access to Paediatric Essential Medicines: A Survey of Prices, Availability, Affordability and Price Components in Shaanxi Province, China

Objective: To evaluate the prices and availability of paediatric essential medicines in Shaanxi Province, China. Methods: Price and availability data for 28 paediatric essential medicines were collected from 60 public hospitals and 60 retail pharmacies in six areas of Shaanxi Province using a standardised methodology developed by the World Health Organization and Health Action International, during November to December 2012. Affordability was measured as the number of days’ wages required for the lowest-paid unskilled government worker to purchase standard treatments for common conditions. Data on medicine price components were collected from hospitals, wholesalers and distributors to obtain price mark-ups. Findings: The mean availabilities of originator brands (OBs) and lowest-priced generics (LPGs) were 10.8% and 27.3% in the public hospitals and 11.9% and 20.6% in the private pharmacies. The public procurement and retail prices were 2.25 and 2.59 times the international reference prices (IRPs) for three OBs, and 0.52 and 0.93 times for 20 LPGs. In the private sector, the final prices for OBs and LPGs were 3.89 and 1.25 times their IRPs. The final price in the private sector was 2.7% lower than in the public sector for OBs, and 14.1% higher for LPGs. Generally, standard treatments cost less than 1 day’s wages in both sectors. Distribution mark-ups applied to brand salbutamol in Xi'an was 65.5%, and up to 185.3% for generic. Cumulative mark-ups for LPGs in Ankang were also high, from 33% to 50%. The manufacturer’s selling price is the largest contributor to the final price in both areas. Conclusions: The government should approve a list of national paediatric essential medicines. The availability, price and affordability of these should be improved in both public hospitals and private pharmacies to enable children to obtain effective treatment. Measures should be taken to improve the efficiency of the centralised medicine purchasing system

Planning Model for Integrated Energy Supply System in Park Level Regions Under the Energy Internet

With the reduction of traditional fossil fuels and the increasing severity of environmental issues, it is of great significance to study energy system planning and optimization models that complement and integrate multiple energy utilization methods in the context of the energy internet for building an integrated energy supply system. Firstly, this article divides the planning indicators of the regional integrated energy supply system into four categories based on the goal of “two highs and three lows”; Secondly, analyze the three key issues of exergy efficiency, economy, and multi energy coupling in regional integrated energy planning; Finally, a multi-objective planning model for regional integrated energy systems that takes into account equipment capacity planning and operation scheduling optimization is proposed, with the optimization objectives of minimizing the annual value of full life cycle cost and maximizing efficiency, and a double-layer optimization structure is designed for efficient solution

LogPrompt: Prompt Engineering Towards Zero-Shot and Interpretable Log Analysis

Automated log analysis is crucial in modern software-intensive systems for ensuring reliability and resilience throughout software maintenance and engineering life cycles. Existing methods perform tasks such as log parsing and log anomaly detection by providing a single prediction value without interpretation. However, given the increasing volume of system events, the limited interpretability of analysis results hinders analysts' trust and their ability to take appropriate actions. Moreover, these methods require substantial in-domain training data, and their performance declines sharply (by up to 62.5%) in online scenarios involving unseen logs from new domains, a common occurrence due to rapid software updates. In this paper, we propose LogPrompt, a novel zero-shot and interpretable log analysis approach. LogPrompt employs large language models (LLMs) to perform zero-shot log analysis tasks via a suite of advanced prompt strategies tailored for log tasks, which enhances LLMs' performance by up to 107.5% compared with simple prompts. Experiments on nine publicly available evaluation datasets across two tasks demonstrate that LogPrompt, despite using no training data, outperforms existing approaches trained on thousands of logs by up to around 50%. We also conduct a human evaluation of LogPrompt's interpretability, with six practitioners possessing over 10 years of experience, who highly rated the generated content in terms of usefulness and readability (averagely 4.42/5). LogPrompt also exhibits remarkable compatibility with open-source and smaller-scale LLMs, making it flexible for practical deployment

Reliability and validity of the Chinese version of St Andrew′s Nutrition Screening Instrument

Objective·To translate St Andrew′s Nutrition Screening Instrument (SANSI), and test its reliability and validity.Methods·With the consent of the authors, the SANSI was translated into Chinese in accordance with the "Brislin translation-back translation method" and the Chinese version underwent cross-cultural debugging. Five clinical medical staff were selected to a pre-survey on 10 patients, and the expression and structure of the scale items were fine-tuned according to the feedback. A total of 221 inpatients with mental disorders were selected by convenient sampling method in Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine as research objects from January to February 2022, and the general clinical data of these patients were collected. The correlation between the items in Part Ⅲ and the identified risks in that part was evaluated by Spearman correlation analysis, and some items were deleted according to the results. Eight experts in mental disorders or nutrition were selected to evaluate the items of Chinese version of SANSI, and then the content validation indexes (CVIs) were calculated. With the standard of Nutritional Risk Screening 2002 (NRS2002), Spearman correlation analysis was used to evaluate the calibration validity of Chinese version of SANSI. Cronbach′s α coefficient, split half reliability and inter-rater reliability (κ consistency coefficient) were used to evaluate the reliability of the Part Ⅲ of the scale.Results·Through literal translation, back translation, cross-cultural debugging and pre-investigation, Chinese version of SANSI was formed. Among the 221 patients with mental disorders, 174 (78.73%) were males, the mean age was (64.12±13.87) years, and the duration of diseases was (26.06±17.65) years. There were 128 cases of schizophrenia (57.92%), 75 cases of organic mental disorders (33.94%), 10 cases of mood disorders (4.52%) and 8 cases of other mental disorders (3.62%). According to the results of correlation analysis in Part Ⅲ, the original items 1, 3, and 10 were deleted. The correlation coefficients between the remaining 7 items and the risk degree in this part were 0.391－0.734 (all P0.05).Conclusion·Chinese version of SANSI has good reliability and validity for hospitalized patients with mental disorders

Transport evidence of superlattice Dirac cones in graphene monolayer on twisted boron nitride substrate

Strong band engineering in two-dimensional (2D) materials can be achieved by introducing moir\'e superlattices, leading to the emergence of various novel quantum phases with promising potential for future applications. Presented works to create moir\'e patterns have been focused on a twist embedded inside channel materials or between channel and substrate. However, the effects of a twist inside the substrate materials on the unaligned channel materials are much less explored. In this work, we report the realization of superlattice multi-Dirac cones with the coexistence of the main Dirac cone in a monolayer graphene (MLG) on a ~0.14{\deg} twisted double-layer boron nitride (tBN) substrate. Transport measurements reveal the emergence of three pairs of superlattice Dirac points around the pristine Dirac cone, featuring multiple metallic or insulating states surrounding the charge neutrality point (CNP). Displacement field tunable and electron-hole asymmetric Fermi velocities are indicated from temperature dependent measurements, along with the gapless dispersion of superlattice Dirac cones. The experimental observation of multiple Dirac cones in MLG/tBN heterostructure is supported by band structure calculations employing periodic moir\'e potential. Our results unveil the potential of using twisted substrate as a universal band engineering technique for 2D materials regardless of lattice matching and crystal orientations, which might pave the way for a new branch of twistronics.Comment: 13 pages, 4 figure

Acetylation Regulates Gluconeogenesis by Promoting PEPCK1 Degradation via Recruiting the UBR5 Ubiquitin Ligase

Protein acetylation has emerged as a major mechanism in regulating cellular metabolism. Whereas most glycolytic steps are reversible, the reaction catalyzed by pyruvate kinase is irreversible and the reverse reaction requires phosphoenolpyruvate carboxykinase (PEPCK1) to commit for gluconeogenesis. Here we show that acetylation regulates the stability of the gluconeogenic rate limiting enzyme PEPCK1, thereby modulating cellular response to glucose. High glucose destabilizes PEPCK1 by stimulating its acetylation. PEPCK1 is acetylated by the P300 acetyltransferase and this acetylation stimulates the interaction between PEPCK1 and UBR5, a HECT domain containing E3 ubiquitin ligase, therefore promoting PEPCK1 ubiquitinylation and degradation. Conversely, SIRT2 deacetylates and stabilizes PEPCK1. These observations represent an example that acetylation targets a metabolic enzyme to a specific E3 ligase in response to metabolic condition changes. Given that increased levels of PEPCK is linked with type II diabetes, this study also identifies potential therapeutic targets for diabetes

Temporal Variability of Cortical Gyral-Sulcal Resting State Functional Activity Correlates With Fluid Intelligence

The human cerebral cortex is highly convoluted as convex gyri and concave sulci. In the past decades, extensive studies have consistently revealed substantial differences between gyri and sulci in terms of genetics, anatomy, morphology, axonal fiber connections, and function. Although interesting findings have been reported to date to elucidate the functional difference between gyri and sulci, the temporal variability of functional activity, which could explain individual differences in learning and higher-order cognitive functions, and as well as differences in gyri and sulci, remains to be explored. The present study explored the temporal variability of cortical gyral-sulcal resting state functional activity and its association with fluid intelligence measures on the Human Connectome Project dataset. We found that the temporal variance of resting state fMRI BOLD signal was significantly larger in gyri than in sulci. We also found that the temporal variability of certain regions including middle frontal cortex, inferior parietal lobe and visual cortex was positively associated with fluid intelligence. Moreover, those regions were predominately located in gyri rather than in sulci. This study reports initial evidence for temporal variability difference of functional activity between gyri and sulci, and its association with fluid intelligence measures, and thus provides novel insights to understand the mechanism and functional relevance of gyri and sulci