Control of public expenditure on drug products in Bulgaria – Policies and outcomes

Aim: The aim of this study was to assess the economic performance of the application of the policy for negotiating discounts on drug products and agreements on the controlled access of patients in Bulgaria. Methods: The methodology involves comparison of the amounts of public spending on medicines in two periods – during the course of the analyzed drug policies (January 2007 – June 2009), and the period in which negotiations on the price of medicines and programs for the controlled access of the patients was discontinued (July 2009 – December 2012). Results: In Bulgaria, the government did not apply methods for controlling publicexpenditure on medicines bargaining price concessions from manufacturers andimplementing agreements on controlled access of patients after June 2009. This led to an annual increase in the expenditures on drug products for home treatment (on average, 17% for the period 2009-2012). Conclusion: This trend in Bulgaria will continue in the future since expenditure control only through price control by means of a reference system and the positive list of medicines is ineffective. There is a need for implementation of combined drug policies in Bulgaria in the form of negotiations on rebates with manufacturers and agreements on controlled access of patients and reference pricing

Public expenditure and drug policies in Bulgaria in 2014

Aim: The objective of this study was to provide an analysis of the factors which have a significant impact on the growth of public expenditure on medical products in Bulgaria. Methods: This research work consists of a critical analysis of the data reported by theNational Health Insurance Fund in Bulgaria on the stability of the healthcare insurance model and the implementation of the budget for 2014. Results: The results from the current analysis indicate that the growth of public expenditure is directly proportional to the number of reimbursed medical products and that the pattern of prescriptions including the innovative medical products mainly for the treatment of oncological and rare diseases has a significant impact on it. Conclusion: The reasons for the increase of public expenditure in Bulgaria include the non-transparent decisions in pricing and reimbursement of the products, the lack of guidelines for presenting pharmacological evidence and the lack of legislatively-defined drug policies for the management and control of the patterns of medical prescriptions

CHLAMYDIA TRACHOMATIS AND INFERTILITY

Almost one-quarter of 100 asymptomatic men under investigation for fertility has significant titres of lg-А antibodies (> 1:8) specific for Chlamydia trachomatis (CT) in seminal plasma. No clear association was evident between the presence of these antibodies and sperm quality. The female partners of men with consistently high serum or seminal plasma levels of Chlamydia-specific Ig A also exhibited a positive Ig-A reaction in serum without any clinical indications of infection. The study indicated that chronic asymptomatic infections with CT could be responsible for a large number of cases of infertility. It also implied that any men and women under investigation for infertility should be routinely screened with Chlamydial serology regardless of previous history and clinical finding

Enhancing the spectator experience: Integrating subtitle display in eXtended reality theatres

The rapid growth of virtual and augmented reality technologies, encapsulated by the term eXtended Reality (XR), has revolutionized the interaction with digital content, bringing new opportunities for entertainment and communication. Subtitles and closed captions are crucial in improving language learning, vocabulary acquisition, and accessibility, like understanding audiovisual content. However, little is known about integrating subtitle displays in extended re- ality theatre environments and their experience influence on the user. This study addresses this gap by examining subtitle placement and design attributes specific to XR settings. Building on previous research on subtitle placement, mainly in television and 360-degree videos, this project focuses on the differences between static and dy- namic subtitle variants. The study uses a comprehensive literature review, Virtual Reality (VR) theatre experiment, and analytics to investigate these aspects of subtitle integration in the specific case of a VR theatrical Greek play with subtitles. The results show that the comparison between the two variants is insignificant, and both implementations produce high scores. However, thematic analysis suggests the preference for static over the dynamic variant depends heavily on the specific context and the number of speakers in the scene. Since this study focuses on a monologue theatrical play, the next step in future work would be to explore a "multi-speaker" play

Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection:an international, multi-centre, prospective audit

Introduction: The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be determined. This study aimed to determine whether oral antibiotics combined with mechanical bowel preparation (MBP+Abx) was associated with a reduced risk of anastomotic leak when compared to mechanical bowel preparation alone (MBP) or no bowel preparation (NBP). Methods: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 Left Sided Colorectal Resection audit was performed. Patients undergoing elective left sided colonic or rectal resection with primary anastomosis between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Results: Of 3676 patients across 343 centres in 47 countries, 618 (16.8%) received MBP+ABx, 1945 MBP (52.9%) and 1099 patients NBP (29.9%). Patients undergoing MBP+ABx had the lowest overall rate of anastomotic leak (6.1%, 9.2%, 8.7% respectively) in unadjusted analysis. After case-mix adjustment using a mixed-effects multivariable regression model, MBP+Abx was associated with a lower risk of anastomotic leak (OR 0.52, 0.30–0.92, P = 0.02) but MBP was not (OR 0.92, 0.63–1.36, P = 0.69) compared to NBP. Conclusion: This non-randomised study adds ‘real-world’, contemporaneous, and prospective evidence of the beneficial effects of combined mechanical bowel preparation and oral antibiotics in the prevention of anastomotic leak following left sided colorectal resection across diverse settings. We have also demonstrated limited uptake of this strategy in current international colorectal practice

Evaluating the incidence of pathological complete response in current international rectal cancer practice

The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR by conventional pre-operative imaging.A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients treated by elective rectal resection were included. A pCR was defined as a ypT0 N0 EMVI negative primary tumour; a partial response represented any regression from baseline staging following chemoradiotherapy. The primary endpoint was the pCR rate. The secondary endpoint was agreement between post-treatment MRI restaging (yMRI) and final pathological staging.Of 2572 patients undergoing rectal cancer surgery in 277 participating centres across 44 countries, 673 (26.2%) underwent chemoradiotherapy and surgery. The pCR rate was 10.3% (67/649), with a partial response in 35.9% (233/649) patients. Comparison of AJCC stage determined by post-treatment yMRI with final pathology showed understaging in 13% (55/429) and overstaging in 34% (148/429). Agreement between yMRI and final pathology for T-stage, N-stage, or AJCC status were each graded as 'fair' only (n = 429, Kappa 0.25, 0.26 and 0.35 respectively).The reported pCR rate of 10% highlights the potential for non-operative management in selected cases. The limited strength of agreement between basic conventional post-chemoradiotherapy imaging assessment techniques and pathology suggest alternative markers of response should be considered, in the context of controlled clinical trials

Local authorities, human rights and the reception and integration of forced migrants in Greece and Italy

This dissertation yields insights into two rather recent, quickly expanding, and closely related research areas: the role of municipalities in the reception and integration of forced migrants, and the rise and proliferation of human rights cities. It comprises of five stand-alone and at the same time interrelated treatises that highlight the way local authorities in Greece and Italy contributed to the protection and fulfilment of forced migrants’ fundamental rights amidst and after 2015’s ‘long summer of migration’. It presents the results of an interdisciplinary desk and empirical research, which integrates conceptual and theoretical insights from migration and refugee studies, international human rights law, leadership studies, local government studies, urban policy-making, and crisis management literature. Overall, the dissertation highlights municipal attempts to design and implement policies that facilitate the short-term reception and long-term integration of forced migrants into local communities in a human rights-conforming way. Several aspects stand out: a) the reasons that prompt local authorities to engage in migration governance matters that fall outside their institutional mandate (e.g. local pragmatism, opportunities for local development); b) the protagonists behind instances of municipal policy activism in the reception and integration of forced migrants (mayors, municipal officials); c) the strategies that local authorities apply to strengthen the protection of forced migrants’ human rights on the ground (e.g., collaboration with civil society, international organisations); d) the motives behind local authorities’ engagement with human rights as law, practice, and discourse in the field of migration governance (e.g., political conflicts with higher levels of government). The findings demonstrate that local authorities, even when situated within very restrictive institutional and financial contexts, have significant potential to directly influence the on-the-ground governance of forced migration. A good example in this respect is the ‘against-all-odds’ municipal policy activism of the Thessaloniki in Greece. In addition, the findings highlight the relevance of mayoral leadership to improving forced migrants' reception conditions and strengthening the protection of their fundamental rights. Lastly, the findings show that at times when legal and institutional frameworks at higher levels underdeliver, local authorities and their political leaders can step in and effectively address human rights deficits in the field of migration – as in the case of the Italian city of Bologna. In conclusion, the dissertation offers several lessons for local-level politicians and practitioners, which can assist them in overcoming structural constraints and developing human rights-based strategies for the reception and integration of forced migrants. Among these are: the proactive use of discretion on behalf of mayors in the field of migration governance; broad coalition-building with like-minded partners, locally and transnationally, to access know-how and external funding; and the timely institutionalisation of project-based initiatives