Measuring antibiotic availability and use in 20 low- and middle-income countries

Objective To assess antibiotic availability and use in health facilities in low- and middle-income countries, using the service provision assessment and service availability and readiness assessment surveys. Methods We obtained data on antibiotic availability at 13 561 health facilities in 13 service provision assessment and 8 service availability and readiness assessment surveys. In 10 service provision assessment surveys, child consultations with health-care providers were observed, giving data on antibiotic use in 22 699 children. Antibiotics were classified as access, watch or reserve, according to the World Health Organization’s AWaRe categories. The percentage of health-care facilities across countries with specific antibiotics available and the proportion of children receiving antibiotics for key clinical syndromes were estimated. Findings The surveys assessed the availability of 27 antibiotics (19 access, 7 watch, 1 unclassified). Co-trimoxazole and metronidazole were most widely available, being in stock at 89.5% (interquartile range, IQR: 11.6%) and 87.1% (IQR: 15.9%) of health facilities, respectively. In contrast, 17 other access and watch antibiotics were stocked, by fewer than a median of 50% of facilities. Of the 22 699 children observed, 60.1% (13 638) were prescribed antibiotics (mostly co-trimoxazole or amoxicillin). Children with respiratory conditions were most often prescribed antibiotics (76.1%; 8972/11 796) followed by undifferentiated fever (50.1%; 760/1518), diarrhoea (45.7%; 1293/2832) and malaria (30.3%; 352/1160). Conclusion Routine health facility surveys provided a valuable data source on the availability and use of antibiotics in low- and middle-income countries. Many access antibiotics were unavailable in a majority of most health-care facilities

The Local Group Census: planetary nebulae in Sextans B

Five planetary nebulae (PNe) have been discovered in the nearby dwarf irregular galaxy. Emission line images were obtained using the Wide Field Camera of the 2.5m Isaac Newton Telescope (INT) at La Palma (Spain). The candidate PNe were identified by their point-like appearance and relatively strong [OIII] emission-line fluxes. They are located within a galactocentric distance of 2.8 arcmin, corresponding to 1.1 kpc at the distance of Sextans B. Luminosities are in the range 1800--5600Lsolar. Sextans B is one of the smallest dwarf irregular galaxies with a PN population. The number of PNe detected suggest an enhanced star formation rate between 1 and 5 Gyr ago.Comment: 7 pages, 2 figure

Gallus GBrowse: a unified genomic database for the chicken

Gallus GBrowse (http://birdbase.net/cgi-bin/gbrowse/gallus/) provides online access to genomic and other information about the chicken, Gallus gallus. The information provided by this resource includes predicted genes and Gene Ontology (GO) terms, links to Gallus In Situ Hybridization Analysis (GEISHA), Unigene and Reactome, the genomic positions of chicken genetic markers, SNPs and microarray probes, and mappings from turkey, condor and zebra finch DNA and EST sequences to the chicken genome. We also provide a BLAT server (http://birdbase.net/cgi-bin/webBlat) for matching user-provided sequences to the chicken genome. These tools make the Gallus GBrowse server a valuable resource for researchers seeking genomic information regarding the chicken and other avian species

HII regions within a compact high velocity cloud. A nearly star-less dwarf galaxy?

Within the SECCO survey we identified a candidate stellar counterpart to the Ultra Compact High Velocity Cloud (UCHVC) HVC274.68+74.70-123, that was suggested by Adams et al. (2013) as a possible mini-halo within the Local Group of galaxies. The spectroscopic follow-up of the brightest sources within the candidate reveals the presence of two HII regions whose radial velocity is compatible with physical association with the UVHVC. The available data does not allow us to give a definite answer on the nature of the newly identified system. A few alternative hypotheses are discussed. However, the most likely possibility is that we have found a new faint dwarf galaxy residing in the Virgo cluster of galaxies, which we name SECCO-1. Independently of its actual distance, SECCO-1 displays a ratio of neutral hydrogen mass to V luminosity of M_{HI}/L_V>= 20, by far the largest among local dwarfs. Hence, it appears as a nearly star-less galaxy and it may be an example of the missing links between normal dwarfs and the dark mini halos that are predicted to exist in large numbers according to the currently accepted cosmological model.Comment: Accepted for publication in ApJ Letters. Pdflatex, emulateapj.cls. 6 pages, 3 figures, 2 table

Consumption of oral antibiotic formulations for young children according to the WHO Access, Watch, Reserve (AWaRe) antibiotic groups: an analysis of sales data from 70 middle-income and high-income countries

Background The 2017 WHO Model List of Essential Medicines for Children (EMLc) groups antibiotics as Access, Watch, or Reserve, based on recommendations of their use as first-choice and second-choice empirical treatment for the most common infections. This grouping provides an opportunity to review country-level antibiotic consumption and a potential for stewardship. Therefore, we aimed to review 2015 levels of oral antibiotic consumption by young children globally. Methods We analysed wholesale antibiotic sales in 70 middle-income and high-income countries in 2015. We identified oral antibiotic formulations appropriate for use in young children (defined as child-appropriate formulations [CAFs]) using wholesale data from the IQVIA-Multinational Integrated Data Analysis System database, and we estimated 2015 antibiotic consumption in reference to the 2017 WHO EMLc Access, Watch, Reserve (AWaRe) antibiotic groups. We used three metrics for assessment of intra-country patterns: access percentage, defined as the number of CAF standard units of Access antibiotics divided by the total number of CAF standard units; amoxicillin index, defined as the number of amoxicillin CAF standard units divided by the total number of CAF standard units; and access-to-watch index, defined as the ratio of Access-to-Watch CAF standard units. Findings The overall median volume of CAF antibiotic standard units sold in 2015 per country was 74·5 million (IQR 12·4–210·7 million). The median access percentage among the 70 countries was 76·3% (IQR 62·6–84·2). The amoxicillin index was low (median 30·7%, IQR 14·3–47·3). The median access-to-watch index was 6·0 (IQR 3·1–9·8). CAF antibiotic consumption patterns were highly variable between the 70 countries, without a clear difference between high-income and middle-income countries. Interpretation Antibiotics in the Access group have a key role in treating young children globally. A simple combination of metrics based on the AWaRe groups can be informative on individual countries' patterns of antibiotic consumption and stewardship opportunities. These metrics could support countries in the development of programmes to improve access to core Access antibiotics, particularly amoxicillin. Funding Global Antibiotic R&D Partnership (German Federal Ministry of Health, Médecins Sans Frontières, Netherlands Ministry of Health, Welfare and Sport, and UK Department for International Development)

Global access to affordable direct oral anticoagulants

Poor control of cardiovascular disease accounts for a substantial proportion of the disease burden in developing countries, but often essential anticoagulant medicines for preventing strokes and embolisms are not widely available. In 2019, direct oral anticoagulants were added to the World Health Organization's WHO Model list of essential medicines. The aims of this paper are to summarize the benefits of direct oral anticoagulants for patients with cardiovascular disease and to discuss ways of increasing their usage internationally. Although the cost of direct oral anticoagulants has provoked debate, the affordability of introducing these drugs into clinical practice could be increased by: price negotiation; pooled procurement; competitive tendering; the use of patent pools; and expanded use of generics. In 2017, only 14 of 137 countries that had adopted national essential medicines lists included a direct oral anticoagulant on their lists. This number could increase rapidly if problems with availability and affordability can be tackled. Once the types of patient likely to benefit from direct oral anticoagulants have been clearly defined in clinical practice guidelines, coverage can be more accurately determined and associated costs can be better managed. Government action is required to ensure that direct oral anticoagulants are covered by national budgets because the absence of reimbursement remains an impediment to achieving universal coverage. Tackling cardiovascular disease with the aid of direct oral anticoagulants is an essential component of efforts to achieve the World Health Organization's target of reducing premature deaths due to noncommunicable disease by 25% by 2025

Classifying antibiotics in the WHO Essential Medicines List for optimal use—be AWaRe

International audienc

Smoking, haptoglobin and fertility in humans

A prospective study on two samples of consecutive puerperae (total n° 667) from two populations has been carried out in order to investigate the possible effect of smoking habit on relationship between fertility and haptoglobin phenotype

Nonequilibrium Quantum Thermodynamics of a Particle Trapped in a Controllable Time-Varying Potential

Many advanced quantum techniques feature non-Gaussian dynamics, and the ability to manipulate the system in that domain is the next stage in many experiments. One example of meaningful non-Gaussian dynamics is that of a double-well potential. Here we study the dynamics of a levitated nanoparticle undergoing the transition from a harmonic potential to a double well in a realistic setting, subjected to both thermalization and localization. We characterize the dynamics of the nanoparticle from a thermodynamic point of view, investigating the dynamics with the Wehrl entropy production and its rates. Furthermore, we investigate coupling regimes where the the quantum effect and thermal effect are of the same magnitude, and look at suitable squeezing of the initial state that provides the maximum coherence. The effects and the competitions of the unitary and the dissipative parts onto the system are demonstrated. We quantify the requirements to relate our results to a bonafide experiment with the presence of the environment, and discuss the experimental interpretations of our results in the end

The Local Group Census: planetary nebulae in IC 10, Leo A and Sextans A

In the framework of our narrow-band survey of the Local Group galaxies, we present the results of the search for planetary nebulae (PNe) in the dwarf irregular galaxies IC10, LeoA and SextansA. Using the standard on-band/off-band technique, sixteen new candidate PNe have been discovered in the closest starburst galaxy, IC10. The optical size of this galaxy is estimated to be much larger than previously thought, considering the location of the new PNe in an area of 3.6 kpc X 2.7 kpc. We also confirm the results of previous studies for the other two dwarf irregular galaxies, with the detection of one candidate PN in LeoA and another one in SextansA. We review the number of planetary nebulae discovered in the Local Group to date and their behaviour with metallicity. We suggest a possible fall in the observed number of PNe when [Fe/H]$<<$-1.0, which might indicate that below this point the formation rate of PNe is much lower than for stellar populations of near Solar abundances. We also find non-negligible metallicity effects on the [OIII] luminosity of the brightest PN of a galaxy.Comment: 10 pages, 4 figures, A&A accepte