Medicine prices, availability, and affordability in the Shaanxi Province in China: implications for the future.

PubMed

Jiang, Minghuan; Zhou, Zhongliang; Wu, Lina; Shen, Qian; Lv, Bing; Wang, Xiao; Yang, Shimin; Fang, Yu

2015-02-01

In 2009, China implemented the National Essential Medicines System (NEMS) to improve access to high-quality low-cost essential medicines. To measure the prices, availability and affordability of medicines in China following the implementation of the NEMS. 120 public hospitals and 120 private pharmacies in ten cities in Shaanxi Province, Western China. The standardized methodology developed by the World Health Organization and Health Action International was used to collect data on prices and availability of 49 medicines. Median price ratio; availability as a percentage; cost of course of treatment in days' wages of the lowest-paid government workers. In the public hospitals, originator brands (OBs) were procured at 8.89 times the international reference price, more than seven times higher than the lowest-priced generics (LPGs). Patients paid 11.83 and 1.69 times the international reference prices for OBs and generics respectively. A similar result was observed in the private pharmacies. The mean availabilities of OBs and LPGs were 7.1 and 20.0 % in the public hospitals, and 12.6 and 29.2 % in the private pharmacies. Treatment with OBs is therefore largely unaffordable, but the affordability of the LPGs is generally good. High prices and low availability of survey medicines were observed. The affordability of generics, but not OBs, is reasonable. Effective measures should be taken to reduce medicine prices and improve availability and affordability in Shaanxi Province.

Availability, prices and affordability of essential medicines in Haiti

PubMed Central

Chahal, Harinder Singh; St. Fort, Nazaire; Bero, Lisa

2013-01-01

Background Haiti is the poorest country in the Western Hemisphere and faces numerous challenges, including inadequate medication access for its residents. The objective of this study was to determine the availability, prices, and affordability of essential medicines in Haiti and compare these findings to other countries. Methods We conducted a cross–sectional nationwide survey in 2011 of availability and consumer prices of 60 essential medicines in Haiti using a standardized methodology developed by the World Health Organization and Health Action International. The survey was conducted in 163 medicine outlets in four health care sectors (public, retail, nonprofit and mixed sectors). Medicine prices were expressed as ratios relative to the International Reference Price. Affordability was calculated by comparing the costs of treatment for common conditions with the salary of the lowest paid government worker and was compared to available data from four Latin American countries. Results For generic medicines, the availability in public, retail, nonprofit and mixed sectors was 20%, 37%, 24% and 23% of medications, respectively. Most of the available medicines were priced higher than the International Reference Price. The lowest paid government worker would need 2.5 days’ wages to treat an adult respiratory infection with generic medicines from the public sector. For treatment of common conditions with originator brands (OB) purchased from a retail pharmacy, costs were between 1.4 (anaerobic bacterial infection) and 13.7 (hyperlipidemia) days’ wages, respectively. Treatment of pediatric bacterial infections with the OB of ceftriaxone from a retail pharmacy would cost 24.6 days’ wages. Prices in Bolivia, Colombia, Mexico and Nicaragua were frequently lower for comparable medications. Conclusions The availability of essential medicines was low and prices varied widely across all four sectors. Over 75% of Haitians live on less than US$ 2.00 /day; therefore, most

Policy approaches to improve availability and affordability of medicines in Mexico - an example of a middle income country.

PubMed

Moye-Holz, Daniela; van Dijk, Jitse P; Reijneveld, Sijmen A; Hogerzeil, Hans V

2017-08-01

The World Health Organization recommends establishing and implementing a national pharmaceutical policy (NPP) to guarantee effective and equitable access to medicines. Mexico has implemented several policy approaches to regulate the pharmaceutical sector, but it has no formal NPP. This article describes the approach that the Mexican government has taken to improve availability and affordability of essential medicines. Descriptive policy analysis of public pharmaceutical policy proposals and health action plans on the basis of publicly available data and health progress reports, with a focus on availability and affordability of medicines. The government has implemented pooled procurement, price negotiations, and an information platform in the public sector to improve affordability and availability. The government mainly reports on the savings that these strategies have generated in the public expenditure but their full impact on availability and affordability has not been assessed. To increase availability and affordability of medicines in the public sector, the Mexican government has resorted on isolated strategies. In addition to efficient procurement, price negotiations and price information, other policy components and pricing interventions are needed. All these strategies should be included in a comprehensive NPP.

Low utilisation of diabetes medicines in Iran, despite their affordability (2000-2012): a time-series and benchmarking study.

PubMed

Sarayani, Amir; Rashidian, Arash; Gholami, Kheirollah

2014-10-16

Diabetes is a major public health concern worldwide, particularly in low-income and middle-income countries (LMICs). Limited data exist on the status of access to diabetes medicines in LMICs. We assessed the utilisation and affordability of diabetes medicines in Iran as a middle-income country. We used a retrospective time-series design (2000-2012) and assessed national diabetes medicines' utilisation using pharmaceuticals wholesale data. We calculated defined daily dose consumptions per population days (DDDs/1000 inhabitants/day; DIDs) indicator. Findings were benchmarked with data from Organization for Economic Co-operation and Development (OECD) countries. We also employed Drug Utilization-90% (DU-90) method to compare DU-90s with the Essential Medicines List published by the WHO. We measured affordability using number of minimum daily wage required to purchase a treatment course for 1 month. Diabetes medicines' consumption increased from 4.47 to 33.54 DIDs. The benchmarking showed that medicines' utilisation in Iran in 2011 was only 54% of the median DIDs of 22 OECD countries. Oral hypoglycaemic agents consisted over 80% of use throughout the study period. Regular and isophane insulin (NPH), glibenclamide, metformin and gliclazide were the DU-90 drugs in 2012. Metformin, glibenclamide and regular/NPH insulin combination therapy were affordable throughout the study period (∼0.4, ∼0.1, ∼0.3 of minimum daily wage, respectively). While the affordability of novel insulin preparations improved over time, they were still unaffordable in 2012. The utilisation of diabetes medicines was relatively low, perhaps due to underdiagnosis and inadequate management of patients with diabetes. This had occurred despite affordability of essential diabetes medicines in Iran. Appropriate policies are required to address the underutilisation of diabetes medicines in Iran. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

Impact of price deregulation policy on the affordability of essential medicines for women's health: a panel data analysis.

PubMed

Liu, Junjie; Wang, Liming; Liu, Chenxi; Zhang, Xinping

2017-12-01

A new policy which required deregulation on prices of off-patent medicines for women's health during procurement was introduced in China in September 2015. The current study examines this policy's impact on the affordability of essential medicines for women's health. Based on product-level panel data, a fixed effect regression model is employed by using procurement records from Hubei Centralist Tender for Drug Purchase platform. In the model, Affordability was measured with prices. The Competition consists of two parts: generic competition and therapeutic class competition which are measured with generic competitors and therapeutic substitutes. Instrument variable is used to deal with endogeneity. The policy helped control prices of essential medicines for women's health. Generic competition helped control prices, however, therapeutic class competition caused higher prices. The new policy helped enhance the affordability of essential medicines for women's health as expected, which provides empirical evidence on price deregulation. Besides, generic competition is important in price control despite strict regulatory system in China.

Progress in increasing affordability of medicines for non-communicable diseases since the introduction of mandatory health insurance in the Republic of Moldova

PubMed Central

Ferrario, Alessandra; Chitan, Elena; Seicas, Rita; Sautenkova, Nina; Bezverhni, Zinaida; Kluge, Hans; Habicht, Jarno

2016-01-01

Background: To assess progress in improving affordability of medicines since the introduction of mandatory health insurance in the Republic of Moldova. Method: Using data from national health insurance, we estimate affordability of partially reimbursed medicines for the treatment of non-communicable diseases, and analyse which factors contributed to changes in affordability. Results: Affordability of subsidized medicines improved over time. In 2013, it took a median of 0.84 days of income for the lowest income quintile (ranging from 0 to 3.32 days) to purchase 1 month of treatment for cardiovascular conditions in comparison to 1.85 days in 2006. This improvement however was mainly driven by higher incomes rather than deeper coverage through the reimbursement list. Conclusion: If mandatory health insurance is to improve affordability of medicines for the Moldovan population, more funds need to be (re-)allocated to enable higher percentage coverage of essential medicines and efficiencies need to be generated within the health system. These should include a budget reallocation between secondary and primary care, strengthening primary care to manage chronic conditions and raise population awareness, implementation of evidence-based selection and quality use of medicines in both outpatient and inpatient settings, improving monitoring and regulation of prices and the supply chain; and alignment of national treatment guidelines and clinical practice with international best practices and evidence-based medicine. PMID:26830363

Progress in increasing affordability of medicines for non-communicable diseases since the introduction of mandatory health insurance in the Republic of Moldova.

PubMed

Ferrario, Alessandra; Chitan, Elena; Seicas, Rita; Sautenkova, Nina; Bezverhni, Zinaida; Kluge, Hans; Habicht, Jarno

2016-07-01

To assess progress in improving affordability of medicines since the introduction of mandatory health insurance in the Republic of Moldova. Using data from national health insurance, we estimate affordability of partially reimbursed medicines for the treatment of non-communicable diseases, and analyse which factors contributed to changes in affordability. Affordability of subsidized medicines improved over time. In 2013, it took a median of 0.84 days of income for the lowest income quintile (ranging from 0 to 3.32 days) to purchase 1 month of treatment for cardiovascular conditions in comparison to 1.85 days in 2006. This improvement however was mainly driven by higher incomes rather than deeper coverage through the reimbursement list. If mandatory health insurance is to improve affordability of medicines for the Moldovan population, more funds need to be (re-)allocated to enable higher percentage coverage of essential medicines and efficiencies need to be generated within the health system. These should include a budget reallocation between secondary and primary care, strengthening primary care to manage chronic conditions and raise population awareness, implementation of evidence-based selection and quality use of medicines in both outpatient and inpatient settings, improving monitoring and regulation of prices and the supply chain; and alignment of national treatment guidelines and clinical practice with international best practices and evidence-based medicine. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Low utilisation of diabetes medicines in Iran, despite their affordability (2000–2012): a time-series and benchmarking study

PubMed Central

Sarayani, Amir; Rashidian, Arash; Gholami, Kheirollah

2014-01-01

Objectives Diabetes is a major public health concern worldwide, particularly in low-income and middle-income countries (LMICs). Limited data exist on the status of access to diabetes medicines in LMICs. We assessed the utilisation and affordability of diabetes medicines in Iran as a middle-income country. Design We used a retrospective time-series design (2000–2012) and assessed national diabetes medicines’ utilisation using pharmaceuticals wholesale data. Methods We calculated defined daily dose consumptions per population days (DDDs/1000 inhabitants/day; DIDs) indicator. Findings were benchmarked with data from Organization for Economic Co-operation and Development (OECD) countries. We also employed Drug Utilization-90% (DU-90) method to compare DU-90s with the Essential Medicines List published by the WHO. We measured affordability using number of minimum daily wage required to purchase a treatment course for 1 month. Results Diabetes medicines’ consumption increased from 4.47 to 33.54 DIDs. The benchmarking showed that medicines’ utilisation in Iran in 2011 was only 54% of the median DIDs of 22 OECD countries. Oral hypoglycaemic agents consisted over 80% of use throughout the study period. Regular and isophane insulin (NPH), glibenclamide, metformin and gliclazide were the DU-90 drugs in 2012. Metformin, glibenclamide and regular/NPH insulin combination therapy were affordable throughout the study period (∼0.4, ∼0.1, ∼0.3 of minimum daily wage, respectively). While the affordability of novel insulin preparations improved over time, they were still unaffordable in 2012. Conclusions The utilisation of diabetes medicines was relatively low, perhaps due to underdiagnosis and inadequate management of patients with diabetes. This had occurred despite affordability of essential diabetes medicines in Iran. Appropriate policies are required to address the underutilisation of diabetes medicines in Iran. PMID:25324322

Availability and affordability of essential medicines for children in the Western part of Ethiopia: implication for access.

PubMed

Sado, Edao; Sufa, Alemu

2016-03-15

Essential medicines (EMs) are those medicines which satisfy the priority health care needs of the population. Although it is a fundamental human right, access to essential medicines has been a big challenge in developing countries particularly for children. WHO recommends assessing the current situations on availability and affordability of EMs as the first step towards enhancing access to them. Therefore, the aim of this study was to assess access to EMs for children based on availability, affordability, and price. We adapted the WHO and Health Action International tools to measure availability, affordability, and prices of EMs. We collected data on 22 EMs for children from 15 public to 40 private sectors' drug outlets in east Wollega zone. Availability was expressed as percentage of drug outlets per sector that stocked surveyed medicines on the day of data collection, and prices were expressed as median price ratio. Affordability was measured as the number of daily wages required for the lowest-paid government unskilled worker (1.04 US $per day) to purchase one standard treatment of an acute condition or treatment for a chronic condition for a month. The average availability of essential medicines was 43 % at public and 42.8 % at private sectors. Lowest priced medicines were sold at median of 1.18 and 1.54 times their international reference prices (IRP) in the public and private sectors, respectively. Half of these medicines were priced at 0.90 to 1.3 in the public sector and 1.23 to 2.07 in the private sector times their respective IRP. Patient prices were 36 % times higher in the private sector than in the public sector. Medicines were unaffordable for treatment of common conditions prevalent in the zone at both public and private sectors as they cost a day or more days' wages for the lowest paid government unskilled worker. Access to EMs to children is hampered by low availability and high price which is unaffordable. Thus, further study on larger scale is

Economical impact of plasma fractionation project in Iran on affordability of plasma-derived medicines.

PubMed

Cheraghali, A M; Aboofazeli, R

2009-12-01

In Iran all transfusion services are concentrated under authority of one public and centralized transfusion organization which has created the opportunity of using plasma produced in its blood centers for fractionation. In 2008 voluntary and non remunerated Iranian donors donated 1.8 million units of blood. This indicates a 25/1000 donation index. After responding to the needs for fresh plasma and cryoprecipitate each year about 150000 L of recovered plasma are reserved for fractionation. In an attempt to improve both blood safety profile and availability and affordability of plasma derived medicines, Iran's national transfusion service has entered into a contract fractionation agreement for surplus of plasma produced from donated blood by voluntary non remunerated donors. In order to ensure safety of product produced, Iran has chosen to collaborate with international fractionators based in highly regulated countries. The main objective of this study was to evaluate the impact of contract plasma fractionation on the affordability of the plasma derived medicines in Iran. During 2006-2008, Iran's contract fractionation project was able to produce 46%, 18% and 6% of IVIG, Albumin and FVIII consumed in Iran's market, respectively. In contrary to IVIG and Albumin, due to fairly high consumption of FVIII in Iran, the role of fractionation project in meeting the needs to FVIII was not substantial. However, Iran's experience has shown that contract plasma fractionation, through direct and indirect effects on price of plasma derived medicines, could substantially improve availability and affordability of such products in national health care system.

Availability, Price, and Affordability of Selected Essential Medicines for Chronic Diseases in 11 Countries of the Asia Pacific Region: A Secondary Analysis.

PubMed

Wang, Haipeng; Sun, Qiang; Vitry, Agnes; Nguyen, Tuan Anh

2017-05-01

Access to affordable essential medicines for noncommunicable, chronic diseases is critical in management of the diseases. This study aims to assess the availability, prices, and affordability of medicines for common chronic diseases in the Asia Pacific Region (APR). A secondary analysis of medicines price and availability data from the Health Action International's (HAI) database was undertaken using the standardized WHO/HAI methodology. The median availability of any medicine in the public sector was 35.5% compared with 56.7% in the private sector. Countries paid 1.4 times the International Reference Price to procure lowest-priced generics (LPGs) and 9.1 times for innovator brands (IBs). Patients would have to spend 2.3 and 0.4 day's wages to purchase one month's treatment of a chronic disease for IBs and LPGs, respectively in the private sector. These findings highlight the need to increase availability, reduce prices, and improve affordability of the medicines.

Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis.

PubMed

Cameron, A; Ewen, M; Ross-Degnan, D; Ball, D; Laing, R

2009-01-17

WHO and Health Action International (HAI) have developed a standardised method for surveying medicine prices, availability, affordability, and price components in low-income and middle-income countries. Here, we present a secondary analysis of medicine availability in 45 national and subnational surveys done using the WHO/HAI methodology. Data from 45 WHO/HAI surveys in 36 countries were adjusted for inflation or deflation and purchasing power parity. International reference prices from open international procurements for generic products were used as comparators. Results are presented for 15 medicines included in at least 80% of surveys and four individual medicines. Average public sector availability of generic medicines ranged from 29.4% to 54.4% across WHO regions. Median government procurement prices for 15 generic medicines were 1.11 times corresponding international reference prices, although purchasing efficiency ranged from 0.09 to 5.37 times international reference prices. Low procurement prices did not always translate into low patient prices. Private sector patients paid 9-25 times international reference prices for lowest-priced generic products and over 20 times international reference prices for originator products across WHO regions. Treatments for acute and chronic illness were largely unaffordable in many countries. In the private sector, wholesale mark-ups ranged from 2% to 380%, whereas retail mark-ups ranged from 10% to 552%. In countries where value added tax was applied to medicines, the amount charged varied from 4% to 15%. Overall, public and private sector prices for originator and generic medicines were substantially higher than would be expected if purchasing and distribution were efficient and mark-ups were reasonable. Policy options such as promoting generic medicines and alternative financing mechanisms are needed to increase availability, reduce prices, and improve affordability.

How Can Pricing and Reimbursement Policies Improve Affordable Access to Medicines? Lessons Learned from European Countries.

PubMed

Vogler, Sabine; Paris, Valérie; Ferrario, Alessandra; Wirtz, Veronika J; de Joncheere, Kees; Schneider, Peter; Pedersen, Hanne Bak; Dedet, Guillaume; Babar, Zaheer-Ud-Din

2017-06-01

This article discusses pharmaceutical pricing and reimbursement policies in European countries with regard to their ability to ensure affordable access to medicines. A frequently applied pricing policy is external price referencing. While it provides some benchmark for policy-makers and has been shown to be able to generate savings, it may also contribute to delay in product launch in countries where medicine prices are low. Value-based pricing has been proposed as a policy that promotes access while rewarding useful innovation; however, implementing it has proven quite challenging. For high-priced medicines, managed-entry agreements are increasingly used. These agreements allow policy-makers to manage uncertainty and obtain lower prices. They can also facilitate earlier market access in case of limited evidence about added therapeutic value of the medicine. However, these agreements raise transparency concerns due to the confidentiality clause. Tendering as used in the hospital and offpatent outpatient sectors has been proven to reduce medicine prices but it requires a robust framework and appropriate design with clear strategic goals in order to prevent shortages. These pricing and reimbursement policies are supplemented by the widespread use of Health Technology Assessment to inform decision-making, and by strategies to improve the uptake of generics, and also biosimilars. While European countries have been implementing a set of policy options, there is a lack of thorough impact assessments of several pricing and reimbursement policies on affordable access. Increased cooperation between authorities, experience sharing and improving transparency on price information, including the disclosure of confidential discounts, are opportunities to address current challenges.

Availability, prices and affordability of the World Health Organization's essential medicines for children in Guatemala.

PubMed

Anson, Angela; Ramay, Brooke; de Esparza, Antonio Ruiz; Bero, Lisa

2012-07-02

Several World Health Organization (WHO) initiatives aim to improve the accessibility of safe and effective medicines for children. A first step in achieving this goal is to obtain a baseline measure of access to essential medicines. The objective of this project was to measure the availability, prices, and affordability of children's medicines in Guatemala. An adaption of the standardized methodology developed by the World Health Organization and Health Action International (HAI) was used to conduct a cross sectional survey to collect data on availability and final patient prices of medicines in public and private sector medicine outlets during April and May of 2010. A subset of the public sector, Programa de Accesibilidad a los Medicamentos (PROAM), had the lowest average availability (25%) compared to the private sector (35%). In the private sector, highest and lowest priced medicines were 22.7 and 10.7 times more expensive than their international reference price comparison. Treatments were generally unaffordable, costing as much as 15 days wages for a course of ceftriaxone. Analysis of the procurement, supply and distribution of specific medicines is needed to determine reasons for lack of availability. Improvements to accessibility could be made by developing an essential medicines list for children and including these medicines in national purchasing lists.

Budget impact and cost-effectiveness: can we afford precision medicine in oncology?

PubMed

Doble, Brett

2016-01-01

Over the past decade there have been remarkable advancements in the understanding of the molecular underpinnings of malignancy. Methods of testing capable of elucidating patients' molecular profiles are now readily available and there is an increased desire to incorporate the information derived from such tests into treatment selection for cancer patients. This has led to more appropriate application of existing treatments as well as the development of a number of innovative and highly effective treatments or what is known collectively as precision medicine. The impact that precision medicine will have on health outcomes is uncertain, as are the costs it will incur. There is, therefore, a need to develop economic evidence and appropriate methods of evaluation to support its implementation to ensure the resources allocated to these approaches are affordable and offer value for money. The market for precision medicine in oncology continues to rapidly expand, placing an increased pressure on reimbursement decision-makers to consider the value and opportunity cost of funding such approaches to care. The benefits of molecular testing can be complex and difficult to evaluate given currently available economic methods, potentially causing a distorted appreciation of their value. Funding decisions of precision medicine will also have far-reaching implications, requiring the consideration of both patient and public perspectives in decision-making. Recommendations to improve the value proposition of precision medicine are, therefore, provided with the hopes of facilitating a better understanding of its impact on outcomes and the overall health budget.

Evaluating drug prices, availability, affordability, and price components: implications for access to drugs in Malaysia.

PubMed

Babar, Zaheer Ud Din; Ibrahim, Mohamed Izham Mohamed; Singh, Harpal; Bukahri, Nadeem Irfan; Creese, Andrew

2007-03-27

Malaysia's stable health care system is facing challenges with increasing medicine costs. To investigate these issues a survey was carried out to evaluate medicine prices, availability, affordability, and the structure of price components. The methodology developed by the World Health Organization (WHO) and Health Action International (HAI) was used. Price and availability data for 48 medicines was collected from 20 public sector facilities, 32 private sector retail pharmacies and 20 dispensing doctors in four geographical regions of West Malaysia. Medicine prices were compared with international reference prices (IRPs) to obtain a median price ratio. The daily wage of the lowest paid unskilled government worker was used to gauge the affordability of medicines. Price component data were collected throughout the supply chain, and markups, taxes, and other distribution costs were identified. In private pharmacies, innovator brand (IB) prices were 16 times higher than the IRPs, while generics were 6.6 times higher. In dispensing doctor clinics, the figures were 15 times higher for innovator brands and 7.5 for generics. Dispensing doctors applied high markups of 50%-76% for IBs, and up to 316% for generics. Retail pharmacy markups were also high-25%-38% and 100%-140% for IBs and generics, respectively. In the public sector, where medicines are free, availability was low even for medicines on the National Essential Drugs List. For a month's treatment for peptic ulcer disease and hypertension people have to pay about a week's wages in the private sector. The free market by definition does not control medicine prices, necessitating price monitoring and control mechanisms. Markups for generic products are greater than for IBs. Reducing the base price without controlling markups may increase profits for retailers and dispensing doctors without reducing the price paid by end users. To increase access and affordability, promotion of generic medicines and improved availability

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

PubMed Central

Jiang, Minghuan; Yang, Shimin; Yan, Kangkang; Liu, Jun; Zhao, Jun; Fang, Yu

2013-01-01

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

Measuring access to medicines: a survey of prices, availability and affordability in Shaanxi province of China.

PubMed

Jiang, Minghuan; Yang, Shimin; Yan, Kangkang; Liu, Jun; Zhao, Jun; Fang, Yu

2013-01-01

To measure the prices and availability of selected medicines in Shaanxi Province after the implementation of new healthcare reform in 2009. 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. 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. 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

Access to diagnostic tests and essential medicines for cardiovascular diseases and diabetes care: cost, availability and affordability in the West Region of Cameroon.

PubMed

Jingi, Ahmadou M; Noubiap, Jean Jacques N; Ewane Onana, Arnold; Nansseu, Jobert Richie N; Wang, Binhuan; Kingue, Samuel; Kengne, André Pascal

2014-01-01

To assess the availability and affordability of medicines and routine tests for cardiovascular disease (CVD) and diabetes in the West region of Cameroon, a low-income setting. A survey was conducted on the availability and cost of twelve routine tests and twenty medicines for CVD and diabetes in eight health districts (four urban and four rural) covering over 60% of the population of the region (1.8 million). We analyzed the percentage of tests and medicines available, the median price against the international reference price (median price ratio) for the medicines, and affordability in terms of the number of days' wages it would cost the lowest-paid unskilled government worker for initial investigation tests and procurement for one month of treatment. The availability of tests varied between 10% for the ECG to 100% for the fasting blood sugar. The average cost for the initial investigation using the minimum tests cost 29.76 days' wages. The availability of medicines varied from 36.4% to 59.1% in urban and from 9.1% to 50% in rural settings. Only metformin and benzathine-benzylpenicilline had a median price ratio of ≤ 1.5, with statins being largely unaffordable (at least 30.51 days' wages). One month of combination treatment for coronary heart disease costs at least 40.87 days' wages. The investigation and management of patients with medium-to-high cardiovascular risk remains largely unavailable and unaffordable in this setting. An effective non-communicable disease program should lay emphasis on primary prevention, and improve affordable access to essential medicines in public outlets.

Availability, Sales, and Affordability of Tobacco Cessation Medicines in Kerala, India.

PubMed

Sarma, Smitha; Harikrishnan, Sivadasanpillai; Baldridge, Abigail S; Devarajan, Raji; Mehta, Aashna; Selvaraj, Sakhtivel; Ali, Mohammed K; Mohanan, Padinhare P; Prabhakaran, Dorairaj; Huffman, Mark D

2017-11-01

India is the world's second largest consumer of tobacco, but tobacco cessation remains uncommon due, at least in part, to underutilization of cessation pharmacotherapy. We evaluated the availability, sales, and affordability of nicotine replacement therapy, bupropion, and varenicline in the South Indian state of Kerala to understand potential reasons for underutilization. From November 2016 to April 2017, we collected data on availability, inventory, and pricing of cessation medication through a cross-sectional survey of 199 public, semiprivate (Karunya), and private pharmacies across 5 districts in Kerala using World Health Organization/Health Action International methodology. Revenue and sales data were obtained from the latest Pharmatrac medication database. We assessed affordability using individual- and household-level income and expenditure data collected from November 2014 to November 2016 through the Acute Coronary Syndrome Quality Improvement in Kerala randomized trial. Cessation medications were not available in public hospitals (0%, n=58) nor in public specialty centers (0%, n=10) including those designated to provide cessation services. At least 1 cessation medicine was available at 63% of private pharmacies (n=109) and 27% of Karunya (semiprivate) pharmacies (n=22). Among the 75 pharmacies that stocked cessation medications, 96% had nicotine replacement therapy, 28% had bupropion, and 1% had varenicline. No outlets had sufficient inventory for a patient to purchase a 12-week treatment regimen. There were an estimated 253 270 treatment regimens sold throughout India and 14 092 in Kerala in 2013 to 2014. Treatment regimens cost 1.9 to 13.0× the median amount spent on smoked tobacco and between 8% and 52% of nonsubsistence income. Tobacco cessation medications are unavailable in the Kerala public sector and have limited availability in the private and semiprivate sectors. When available, medications are unaffordable for most patients. Addition of tobacco

Availability, prices and affordability of the World Health Organization’s essential medicines for children in Guatemala

PubMed Central

2012-01-01

Background Several World Health Organization (WHO) initiatives aim to improve the accessibility of safe and effective medicines for children. A first step in achieving this goal is to obtain a baseline measure of access to essential medicines. The objective of this project was to measure the availability, prices, and affordability of children’s medicines in Guatemala. Methods An adaption of the standardized methodology developed by the World Health Organization and Health Action International (HAI) was used to conduct a cross sectional survey to collect data on availability and final patient prices of medicines in public and private sector medicine outlets during April and May of 2010. Results A subset of the public sector, Programa de Accesibilidad a los Medicamentos (PROAM), had the lowest average availability (25%) compared to the private sector (35%). In the private sector, highest and lowest priced medicines were 22.7 and 10.7 times more expensive than their international reference price comparison. Treatments were generally unaffordable, costing as much as 15 days wages for a course of ceftriaxone. Conclusions Analysis of the procurement, supply and distribution of specific medicines is needed to determine reasons for lack of availability. Improvements to accessibility could be made by developing an essential medicines list for children and including these medicines in national purchasing lists. PMID:22747646

How the Trans Pacific Partnership Agreement could undermine PHARMAC and threaten access to affordable medicines and health equity in New Zealand.

PubMed

Gleeson, Deborah; Lopert, Ruth; Reid, Papaarangi

2013-10-01

New Zealand's Pharmaceutical Management Agency (PHARMAC) has been highly successful in facilitating affordable access to medicines through a combination of aggressive price negotiations, innovative procurement mechanisms, and careful evaluation of value for money. Recently the US government, through the establishment of a series of bilateral and plurilateral "free" trade agreements, has attempted to constrain the pharmaceutical access programs of other countries in order to promote the interests of the pharmaceutical industry. The Trans Pacific Partnership Agreement (TPPA) represents the latest example; through the TPPA the US is seeking to eliminate therapeutic reference pricing, introduce appeals processes for pharmaceutical companies to challenge formulary listing and pricing decisions, and introduce onerous disclosure and "transparency" provisions that facilitate industry involvement in decision-making around coverage and pricing of medicines (and medical devices). This paper argues that the US agenda, if successfully prosecuted, would be likely to increase costs and reduce access to affordable medicines for New Zealanders. This would in turn be likely to exacerbate known inequities in access to medicines and thus disproportionately affect disadvantaged population groups, including Māori and Pacific peoples. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Evaluating Drug Prices, Availability, Affordability, and Price Components: Implications for Access to Drugs in Malaysia

PubMed Central

Babar, Zaheer Ud Din; Ibrahim, Mohamed Izham Mohamed; Singh, Harpal; Bukahri, Nadeem Irfan; Creese, Andrew

2007-01-01

Background Malaysia's stable health care system is facing challenges with increasing medicine costs. To investigate these issues a survey was carried out to evaluate medicine prices, availability, affordability, and the structure of price components. Methods and Findings The methodology developed by the World Health Organization (WHO) and Health Action International (HAI) was used. Price and availability data for 48 medicines was collected from 20 public sector facilities, 32 private sector retail pharmacies and 20 dispensing doctors in four geographical regions of West Malaysia. Medicine prices were compared with international reference prices (IRPs) to obtain a median price ratio. The daily wage of the lowest paid unskilled government worker was used to gauge the affordability of medicines. Price component data were collected throughout the supply chain, and markups, taxes, and other distribution costs were identified. In private pharmacies, innovator brand (IB) prices were 16 times higher than the IRPs, while generics were 6.6 times higher. In dispensing doctor clinics, the figures were 15 times higher for innovator brands and 7.5 for generics. Dispensing doctors applied high markups of 50%–76% for IBs, and up to 316% for generics. Retail pharmacy markups were also high—25%–38% and 100%–140% for IBs and generics, respectively. In the public sector, where medicines are free, availability was low even for medicines on the National Essential Drugs List. For a month's treatment for peptic ulcer disease and hypertension people have to pay about a week's wages in the private sector. Conclusions The free market by definition does not control medicine prices, necessitating price monitoring and control mechanisms. Markups for generic products are greater than for IBs. Reducing the base price without controlling markups may increase profits for retailers and dispensing doctors without reducing the price paid by end users. To increase access and affordability

Peculiarities of organizing the construction of nuclear medicine facilities and the transportation of radionuclide

NASA Astrophysics Data System (ADS)

Telichenko, Valeriy; Malykha, Galina; Dorogan, Igor

2017-10-01

The article is devoted to the organization of construction of nuclear medicine facilities in Russia. The article describes the main methods of nuclear medical diagnostics, as well as the peculiarities of nuclear medicine facilities that determine the need for application of specific methods for organizing and managing the construction, methods of requirements management in the organization of construction of nuclear medicine facilities. Sustainable development of the transport of radioactive isotopes from the place of production to places of consumption is very important for the safety of the population. The requirements management system is an important and necessary component in organizing the construction of complex facilities, such as nuclear medicine facilities. The author developed and proposed a requirements management system for the design, construction and operation of a nuclear medicine facility, which provides for a cyclic sequence of actions. This system allows reducing the consumption of resources including material and energy during construction and operation of complex objects.

Affordability Approaches for Human Space Exploration

NASA Technical Reports Server (NTRS)

Holladay, Jon; Smith, David Alan

2012-01-01

The design and development of historical NASA Programs (Apollo, Shuttle and International Space Station), have been based on pre-agreed missions which included specific pre-defined destinations (e.g., the Moon and low Earth orbit). Due to more constrained budget profiles, and the desire to have a more flexible architecture for Mission capture as it is affordable, NASA is working toward a set of Programs that are capability based, rather than mission and/or destination specific. This means designing for a performance capability that can be applied to a specific human exploration mission/destination later (sometime years later). This approach does support developing systems to flatter budgets over time, however, it also poses the challenge of how to accomplish this effectively while maintaining a trained workforce, extensive manufacturing, test and launch facilities, and ensuring mission success ranging from Low Earth Orbit to asteroid destinations. NASA Marshall Space Flight Center (MSFC) in support of Exploration Systems Directorate (ESD) in Washington, DC has been developing approaches to track affordability across multiple Programs. The first step is to ensure a common definition of affordability: the discipline to bear cost in meeting a budget with margin over the life of the program. The second step is to infuse responsibility and accountability for affordability into all levels of the implementing organization since affordability is no single person s job; it is everyone s job. The third step is to use existing data to identify common affordability elements organized by configuration (vehicle/facility), cost, schedule, and risk. The fourth step is to analyze and trend this affordability data using an affordability dashboard to provide status, measures, and trends for ESD and Program level of affordability tracking. This paper will provide examples of how regular application of this approach supports affordable and therefore sustainable human space exploration

Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data.

PubMed

Attaei, Marjan W; Khatib, Rasha; McKee, Martin; Lear, Scott; Dagenais, Gilles; Igumbor, Ehimario U; AlHabib, Khalid F; Kaur, Manmeet; Kruger, Lanthe; Teo, Koon; Lanas, Fernando; Yusoff, Khalid; Oguz, Aytekin; Gupta, Rajeev; Yusufali, Afzalhussein M; Bahonar, Ahmad; Kutty, Raman; Rosengren, Annika; Mohan, Viswanathan; Avezum, Alvaro; Yusuf, Rita; Szuba, Andrzej; Rangarajan, Sumathy; Chow, Clara; Yusuf, Salim

2017-09-01

Hypertension is considered the most important risk factor for cardiovascular diseases, but its control is poor worldwide. We aimed to assess the availability and affordability of blood pressure-lowering medicines, and the association with use of these medicines and blood pressure control in countries at varying levels of economic development. We analysed the availability, costs, and affordability of blood pressure-lowering medicines with data recorded from 626 communities in 20 countries participating in the Prospective Urban Rural Epidemiological (PURE) study. Medicines were considered available if they were present in the local pharmacy when surveyed, and affordable if their combined cost was less than 20% of the households' capacity to pay. We related information about availability and affordability to use of these medicines and blood pressure control with multilevel mixed-effects logistic regression models, and compared results for high-income, upper-middle-income, lower-middle-income, and low-income countries. Data for India are presented separately because it has a large generic pharmaceutical industry and a higher availability of medicines than other countries at the same economic level. The availability of two or more classes of blood pressure-lowering drugs was lower in low-income and middle-income countries (except for India) than in high-income countries. The proportion of communities with four drug classes available was 94% in high-income countries (108 of 115 communities), 76% in India (68 of 90), 71% in upper-middle-income countries (90 of 126), 47% in lower-middle-income countries (107 of 227), and 13% in low-income countries (nine of 68). The proportion of households unable to afford two blood pressure-lowering medicines was 31% in low-income countries (1069 of 3479 households), 9% in middle-income countries (5602 of 65 471), and less than 1% in high-income countries (44 of 10 880). Participants with known hypertension in communities that had

Availability of medicines in public sector health facilities of two North Indian States.

PubMed

Prinja, Shankar; Bahuguna, Pankaj; Tripathy, Jaya Prasad; Kumar, Rajesh

2015-12-23

Access to free essential medicines is a critical component of universal health coverage. However availability of essential medicines is poor in India with more than two-third of the people having limited or no access. This has pushed up private out-of-pocket expenditure due to medicines. The states of Punjab and Haryana are in the process of institutionalizing drug procurement models to provide uninterrupted access to essential medicines free of cost in all public hospitals and health centres. We undertook this study to assess the availability of medicines in public sector health facilities in the 2 states. Secondly, we also ascertained the quality of storage and inventory management systems in health facilities. The present study was carried out in 80 public health facilities across 12 districts in Haryana and Punjab states. Overall, within each state 1 MC, 6 DHs, 11 CHCs and 22 PHCs were selected for the study. Drug procurement mechanisms in both the states were studied through document reviews and in-depth interviews with key stakeholders. Stock registers were reviewed to collect data on availability of a basket of essential medicines -92 at Primary Health Centre (PHC) level, 132 at Community Health Centre (CHC) level and 160 at tertiary care (District Hospital/Medical College) level. These essential medicines were selected based on the Essential Medicine List (EML) of the Department of Health (DOH). Overall availability of medicines was 45.2% and 51.1% in Punjab and Haryana respectively. Availability of anti-hypertensives was around 60% in both the states whereas for anti-diabetics it was 44% and 47% in Punjab and Haryana respectively. Atleast one drug in each of the categories including analgesic/antipyretic, anti-helminthic, anti-spasmodic, anti-emetic, anti-hypertensive and uterotonics were nearly universally available in public sector facilities. On the contrary, medicines such as thrombolytics, anti-cancer and endocrine medicines were available in less

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

PubMed Central

Wang, Xiao; Fang, Yu; Yang, Shimin; Jiang, Minghuan; Yan, Kangkang; Wu, Lina; Lv, Bing; Shen, Qian

2014-01-01

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. PMID:24595099

Access to paediatric essential medicines: a survey of prices, availability, affordability and price components in Shaanxi Province, China.

PubMed

Wang, Xiao; Fang, Yu; Yang, Shimin; Jiang, Minghuan; Yan, Kangkang; Wu, Lina; Lv, Bing; Shen, Qian

2014-01-01

To evaluate the prices and availability of paediatric essential medicines in Shaanxi Province, China. 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. 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. 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.

Quality use of antipsychotic medicines inresidential aged care facilities in New Zealand.

PubMed

Ndukwe, Henry C; Nishtala, Prasad S; Wang, Ting; Tordoff, June M

2016-12-01

INTRODUCTION Antipsychotic medicines are used regularly or when required in residential aged care facilities to treat symptoms of dementia, but have been associated with several adverse effects. AIM The aim of this study was to examine 'quality use' of antipsychotic medicines in residential aged care facilities in New Zealand, by surveying nurse managers. METHODS A cross-sectional survey was mailed to 318 nurse managers working in a nationally representative sample of aged care facilities. A purpose-developed, pre-tested, 22-item structured questionnaire was used to explore practice related to the quality use of antipsychotic medicines. RESULTS Overall, 31.4% of nurse managers responded to the survey. They mostly (88%) had ≥ 1 year's relevant work experience and 83% of facilities provided care for those within the range of 21 to 100 residents. Respondents reported that staff education on dementia management occurred early in employment. Two-thirds of participants reported non-pharmacological interventions were commonly used for managing challenging behaviours, while less than half (45%) cited administering antipsychotic medicine. Respondents reported 'managing behavioural symptoms' (81%) as one of the main indications for antipsychotic use. Frequently identified adverse effects of antipsychotic medicines were drowsiness or sedation (64%) and falls (61%). Over 90% reported general practitioners reviewed antipsychotic use with respect to residents' target behaviour 3-monthly, and two-thirds used an assessment tool to appraise residents' behaviour. DISCUSSION Staff education on dementia management soon after employment and resident 3-monthly antipsychotic medicine reviews were positive findings. However, a wider use of behavioural assessment tools might improve the care of residents with dementia and the quality use of antipsychotic medicines.

Is the Brazilian pharmaceutical policy ensuring population access to essential medicines?

PubMed Central

2012-01-01

Background To evaluate medicine prices, availability and affordability in Brazil, considering the differences across three types of medicines (originator brands, generics and similar medicines) and different types of facilities (private pharmacies, public sector pharmacies and “popular pharmacies”). Methods Data on prices and availability of 50 medicines were collected in 56 pharmacies across six cities in Southern Brazil using the World Health Organization / Health Action International methodology. Median prices obtained were divided by international reference prices to derive the median price ratio (MPR). Results In the private sector, prices were 8.6 MPR for similar medicines, 11.3 MRP for generics and 18.7 MRP for originator brands, respectively. Mean availability was 65%, 74% and 48% for originator brands, generics and similar medicines, respectively. In the public sector, mean availability of similar medicines was 2–7 times higher than that of generics. Mean overall availability in the public sector ranged from 68.8% to 81.7%. In “popular pharmacies”, mean availability was greater than 90% in all cities. Conclusions Availability of medicines in the public sector does not meet the challenge of supplying essential medicines to the entire population, as stated in the Brazilian constitution. This has unavoidable repercussions for affordability, particularly amongst the lower socio-economic strata. PMID:22436555

Is the Brazilian pharmaceutical policy ensuring population access to essential medicines?

PubMed

Bertoldi, Andréa Dâmaso; Helfer, Ana Paula; Camargo, Aline L; Tavares, Noêmia U L; Kanavos, Panos

2012-03-21

To evaluate medicine prices, availability and affordability in Brazil, considering the differences across three types of medicines (originator brands, generics and similar medicines) and different types of facilities (private pharmacies, public sector pharmacies and "popular pharmacies"). Data on prices and availability of 50 medicines were collected in 56 pharmacies across six cities in Southern Brazil using the World Health Organization / Health Action International methodology. Median prices obtained were divided by international reference prices to derive the median price ratio (MPR). In the private sector, prices were 8.6 MPR for similar medicines, 11.3 MRP for generics and 18.7 MRP for originator brands, respectively. Mean availability was 65%, 74% and 48% for originator brands, generics and similar medicines, respectively. In the public sector, mean availability of similar medicines was 2-7 times higher than that of generics. Mean overall availability in the public sector ranged from 68.8% to 81.7%. In "popular pharmacies", mean availability was greater than 90% in all cities. Availability of medicines in the public sector does not meet the challenge of supplying essential medicines to the entire population, as stated in the Brazilian constitution. This has unavoidable repercussions for affordability, particularly amongst the lower socio-economic strata.

Pricing and availability of some essential child specific medicines in Odisha.

PubMed

Swain, Trupti Rekha; Rath, Bandana; Dehury, Suhasini; Tarai, Anjali; Das, Priti; Samal, Rajashree; Samal, Satyajit; Nayak, Harshavardhan

2015-01-01

Continuous availability of affordable medicines in appropriate formulations is essential to reduce morbidity and mortality in children. Odisha an eastern Indian state records very high mortality of children. The study aims at documenting the availability and prices paid for purchasing essential child-specific medicines. The survey of 34 essential medicines was conducted in six randomly selected districts of Odisha. Data were collected from medicine outlets of the public, private, and other sector (Nongovernmental Organization [NGO]/mission sectors) of six randomly selected districts, using WHO/Health Action International medicine price collection methodology. For each medicine surveyed, data were collected on the highest and lowest-priced formulations available in each facility. Both public sector and other sector health facilities procure only one brand of medicines, mean percentage availability of medicines being 17% and 21.8%, respectively. In the private sector, the mean percentage availability of the high and lowest-priced medicines for a particular drug product was 10.8% and 38.5%, respectively. The public sector procurement price is 48% lower than international reference prices. In the private sector, high-priced, and low-priced products are sold at 1.83 and 1.46 times the international reference price, respectively. Substantial price variation was observed for some medicines across individual outlets. Medicines were found to cost 2.08 times their international reference price in NGO/mission sector facilities. The availability of children's medicines in public sector facilities of Odisha state is poor. Medicines for children cost relatively high in both private and NGO sectors compared to the international reference price. The availability medicines should be improved on an urgent basis to improve access of medicines for children of Odisha.

Availability and affordability of new medicines in Latin American countries where pivotal clinical trials were conducted.

PubMed

Homedes, Núria; Ugalde, Antonio

2015-10-01

To assess whether new pharmaceutical products approved by the United States Food and Drug Administration (FDA) in 2011 and 2012 were registered, commercialized and sold at affordable prices in the Latin American countries where they were tested. We obtained a list of new molecular entities (new pharmaceutical products) approved by the FDA in 2011 and 2012. FDA medical reviews indicated the countries where pivotal clinical trials had been conducted. The registration status of the products was obtained from pharmaceutical registers; pharmaceutical companies confirmed their availability in national markets and local pricing observatories provided the price of medicines in retail pharmacies. Affordability was assessed as the cost of a course of treatment as a proportion of monthly income. Information on safety and efficacy was gathered from independent drug bulletins. Of an expected 114 registrations, if the 33 products had been registered in all the countries where tested, only 68 (60%) were completed. Eight products were registered and commercialized in all countries but 10 had not been registered in any of the countries. With one exception, products for which we obtained pricing information ( n  = 18) cost more than the monthly minimum wage in all countries and 12 products cost at least five times the monthly minimum wage. Many pharmaceutical products tested in Latin America are unavailable and/or unaffordable to most of the population. Ethical review committees should consider the local affordability and therapeutic relevance of new products as additional criteria for the approval of clinical trials. Finally, clinical trials have opportunity costs that need to be assessed.

Pricing and availability of some essential child specific medicines in Odisha

PubMed Central

Swain, Trupti Rekha; Rath, Bandana; Dehury, Suhasini; Tarai, Anjali; Das, Priti; Samal, Rajashree; Samal, Satyajit; Nayak, Harshavardhan

2015-01-01

Objectives: Continuous availability of affordable medicines in appropriate formulations is essential to reduce morbidity and mortality in children. Odisha an eastern Indian state records very high mortality of children. The study aims at documenting the availability and prices paid for purchasing essential child-specific medicines. Materials and Methods: The survey of 34 essential medicines was conducted in six randomly selected districts of Odisha. Data were collected from medicine outlets of the public, private, and other sector (Nongovernmental Organization [NGO]/mission sectors) of six randomly selected districts, using WHO/Health Action International medicine price collection methodology. For each medicine surveyed, data were collected on the highest and lowest-priced formulations available in each facility. Results: Both public sector and other sector health facilities procure only one brand of medicines, mean percentage availability of medicines being 17% and 21.8%, respectively. In the private sector, the mean percentage availability of the high and lowest-priced medicines for a particular drug product was 10.8% and 38.5%, respectively. The public sector procurement price is 48% lower than international reference prices. In the private sector, high-priced, and low-priced products are sold at 1.83 and 1.46 times the international reference price, respectively. Substantial price variation was observed for some medicines across individual outlets. Medicines were found to cost 2.08 times their international reference price in NGO/mission sector facilities. Conclusions: The availability of children's medicines in public sector facilities of Odisha state is poor. Medicines for children cost relatively high in both private and NGO sectors compared to the international reference price. The availability medicines should be improved on an urgent basis to improve access of medicines for children of Odisha. PMID:26600637

How can states provide affordable pharmaceuticals to the underserved?

PubMed

Zara, Jane

2006-11-01

Advocates of drug price restrictions in the U.S. argue that pharmaceutical companies operate in an unregulated market, free to charge whatever price the market will bear. The pharmaceutical industry insists that these large profits are justified for investments toward discovering new life saving medicines. As innovation wanes, marketing costs soar, and drug profits rise, public interest advocates and state leaders are challenging this justification. This article examines current problems associated with the ability to procure affordable medicines, and examines mounting tensions between the federal government and the states, particularly regarding the states' ability to negotiate lower prices with drug manufacturers in light of the recent Medicare changes. It provides a brief survey of efforts underway to secure affordable pharmaceuticals for state's residents, addressing the history and feasibility of using compulsory licensing for producing affordable life-saving drugs with respect to public health, constitutional, eminent domain, and anti-trust issues.

Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data.

PubMed

Khatib, Rasha; McKee, Martin; Shannon, Harry; Chow, Clara; Rangarajan, Sumathy; Teo, Koon; Wei, Li; Mony, Prem; Mohan, Viswanathan; Gupta, Rajeev; Kumar, Rajesh; Vijayakumar, Krishnapillai; Lear, Scott A; Diaz, Rafael; Avezum, Alvaro; Lopez-Jaramillo, Patricio; Lanas, Fernando; Yusoff, Khalid; Ismail, Noorhassim; Kazmi, Khawar; Rahman, Omar; Rosengren, Annika; Monsef, Nahed; Kelishadi, Roya; Kruger, Annamarie; Puoane, Thandi; Szuba, Andrzej; Chifamba, Jephat; Temizhan, Ahmet; Dagenais, Gilles; Gafni, Amiram; Yusuf, Salim

2016-01-02

WHO has targeted that medicines to prevent recurrent cardiovascular disease be available in 80% of communities and used by 50% of eligible individuals by 2025. We have previously reported that use of these medicines is very low, but now aim to assess how such low use relates to their lack of availability or poor affordability. We analysed information about availability and costs of cardiovascular disease medicines (aspirin, β blockers, angiotensin-converting enzyme inhibitors, and statins) in pharmacies gathered from 596 communities in 18 countries participating in the Prospective Urban Rural Epidemiology (PURE) study. Medicines were considered available if present at the pharmacy when surveyed, and affordable if their combined cost was less than 20% of household capacity-to-pay. We compared results from high-income, upper middle-income, lower middle-income, and low-income countries. Data from India were presented separately given its large, generic pharmaceutical industry. Communities were recruited between Jan 1, 2003, and Dec 31, 2013. All four cardiovascular disease medicines were available in 61 (95%) of 64 urban and 27 (90%) of 30 rural communities in high-income countries, 53 (80%) of 66 urban and 43 (73%) of 59 rural communities in upper middle-income countries, 69 (62%) of 111 urban and 42 (37%) of 114 rural communities in lower middle-income countries, eight (25%) of 32 urban and one (3%) of 30 rural communities in low-income countries (excluding India), and 34 (89%) of 38 urban and 42 (81%) of 52 rural communities in India. The four cardiovascular disease medicines were potentially unaffordable for 0·14% of households in high-income countries (14 of 9934 households), 25% of upper middle-income countries (6299 of 24,776), 33% of lower middle-income countries (13,253 of 40,023), 60% of low-income countries (excluding India; 1976 of 3312), and 59% households in India (9939 of 16,874). In low-income and middle-income countries, patients with previous

"It's very complicated": a qualitative study of medicines management in intermediate care facilities in Northern Ireland.

PubMed

Millar, Anna N; Hughes, Carmel M; Ryan, Cristín

2015-06-02

Intermediate care (IC) describes a range of services targeted at older people, aimed at preventing unnecessary hospitalisation, promoting faster recovery from illness and maximising independence. Older people are at increased risk of medication-related adverse events, but little is known about the provision of medicines management services in IC facilities. This study aimed to describe the current provision of medicines management services in IC facilities in Northern Ireland (NI) and to explore healthcare workers' (HCWs) and patients' views of, and attitudes towards these services and the IC concept. Semi-structured interviews were conducted, recorded, transcribed verbatim and analysed using a constant comparative approach with HCWs and patients from IC facilities in NI. Interviews were conducted with 25 HCWs and 18 patients from 12 IC facilities in NI. Three themes were identified: 'concept and reality', 'setting and supply' and 'responsibility and review'. A mismatch between the concept of IC and the reality was evident. The IC facility setting dictated prescribing responsibilities and the supply of medicines, presenting challenges for HCWs. A lack of a standardised approach to responsibility for the provision of medicines management services including clinical review was identified. Whilst pharmacists were not considered part of the multidisciplinary team, most HCWs recognised a need for their input. Medicines management was not a concern for the majority of IC patients. Medicines management services are not integral to IC and medicine-related challenges are frequently encountered. Integration of pharmacists into the multidisciplinary team could potentially improve medicines management in IC.

Cost-effectiveness and affordability of community mobilisation through women's groups and quality improvement in health facilities (MaiKhanda trial) in Malawi.

PubMed

Colbourn, Tim; Pulkki-Brännström, Anni-Maria; Nambiar, Bejoy; Kim, Sungwook; Bondo, Austin; Banda, Lumbani; Makwenda, Charles; Batura, Neha; Haghparast-Bidgoli, Hassan; Hunter, Rachael; Costello, Anthony; Baio, Gianluca; Skordis-Worrall, Jolene

2015-01-01

Understanding the cost-effectiveness and affordability of interventions to reduce maternal and newborn deaths is critical to persuading policymakers and donors to implement at scale. The effectiveness of community mobilisation through women's groups and health facility quality improvement, both aiming to reduce maternal and neonatal mortality, was assessed by a cluster randomised controlled trial conducted in rural Malawi in 2008-2010. In this paper, we calculate intervention cost-effectiveness and model the affordability of the interventions at scale. Bayesian methods are used to estimate the incremental cost-effectiveness of the community and facility interventions on their own (CI, FI), and together (FICI), compared to current practice in rural Malawi. Effects are estimated with Monte Carlo simulation using the combined full probability distributions of intervention effects on stillbirths, neonatal deaths and maternal deaths. Cost data was collected prospectively from a provider perspective using an ingredients approach and disaggregated at the intervention (not cluster or individual) level. Expected Incremental Benefit, Cost-effectiveness Acceptability Curves and Expected Value of Information (EVI) were calculated using a threshold of $780 per disability-adjusted life-year (DALY) averted, the per capita gross domestic product of Malawi in 2013 international $. The incremental cost-effectiveness of CI, FI, and combined FICI was $79, $281, and $146 per DALY averted respectively, compared to current practice. FI is dominated by CI and FICI. Taking into account uncertainty, both CI and combined FICI are highly likely to be cost effective (probability 98% and 93%, EVI $210,423 and $598,177 respectively). Combined FICI is incrementally cost effective compared to either intervention individually (probability 60%, ICER $292, EIB $9,334,580 compared to CI). Future scenarios also found FICI to be the optimal decision. Scaling-up to the whole of Malawi, CI is of greatest

Parents' and guardians' perceptions on availability and pricing of medicines and healthcare for children in eThekwini, South Africa - a qualitative study.

PubMed

Perumal-Pillay, Velisha Ann; Suleman, Fatima

2017-06-19

Inadequate access to affordable essential medicines poses a challenge to achieving Universal Health Coverage. Access to essential medicines for children has been in the spotlight in recent research. However, information from the end users of medicines, i.e. patients is scarce. Obtaining information at a household level is integral to understanding how people access, obtain and use medicines. This study aimed to gather opinions and perceptions from parents/guardians on availability, affordability and quality of medicines and healthcare for children in SA. Eight Focus group discussions were held with 41 individuals in eThekwini, South Africa (SA), from September-November 2016. Participants were parents/guardians of children up to 12 years from different ethnicities, ages, gender, and socio-economic backgrounds. Key informants identified by the principal researcher recruited participants using snowball sampling. Focus group discussions were recorded, transcribed verbatim, coded by the first author, verified by the second author, reconciled for consensus and imported into NVIVO for data analysis. Medicines and healthcare facilities are accessible in urban and peri-urban areas in eThekwini. Medicines may not always be available in public sector facilities due to medicine shortages, compelling parents to purchase medicines from private sector pharmacies. Common medicines were perceived as affordable for most socio-economic groups except the 'Poor' group. Quality of medicines was perceived as 'good' especially if obtained from the private sector but sometimes perceived as 'poor' and viewed with suspicion when received from public sector clinics. Quality of healthcare was perceived as 'good' but requires improvement for both sectors. This is the first study in SA to report on parent/guardian perceptions on availability, affordability and quality of medicines and healthcare for children. It has the potential to be up-scaled to a country-wide investigation to paint a

Quality assurance in nuclear medicine facilities; availability of final recommendations--FDA. Notice.

PubMed

1985-05-13

The Food and Drug Administration (FDA) is announcing the availability of final recommendations prepared by its Center for Devices and Radiological Health (CDRH) on quality assurance programs in nuclear medicine facilities. The final recommendations include the agency's rationale for the recommendations as well as references that can be used as well as references that can be used as guides in conducting quality control monitoring. These final recommendations are available as a technical report in CDRH's radiation recommendations series. They are intended to encourage and promote the development of voluntary quality assurance programs in nuclear medicine facilities.

Availability and affordability of new medicines in Latin American countries where pivotal clinical trials were conducted

PubMed Central

Ugalde, Antonio

2015-01-01

Abstract Objective To assess whether new pharmaceutical products approved by the United States Food and Drug Administration (FDA) in 2011 and 2012 were registered, commercialized and sold at affordable prices in the Latin American countries where they were tested. Methods We obtained a list of new molecular entities (new pharmaceutical products) approved by the FDA in 2011 and 2012. FDA medical reviews indicated the countries where pivotal clinical trials had been conducted. The registration status of the products was obtained from pharmaceutical registers; pharmaceutical companies confirmed their availability in national markets and local pricing observatories provided the price of medicines in retail pharmacies. Affordability was assessed as the cost of a course of treatment as a proportion of monthly income. Information on safety and efficacy was gathered from independent drug bulletins. Findings Of an expected 114 registrations, if the 33 products had been registered in all the countries where tested, only 68 (60%) were completed. Eight products were registered and commercialized in all countries but 10 had not been registered in any of the countries. With one exception, products for which we obtained pricing information (n = 18) cost more than the monthly minimum wage in all countries and 12 products cost at least five times the monthly minimum wage. Conclusion Many pharmaceutical products tested in Latin America are unavailable and/or unaffordable to most of the population. Ethical review committees should consider the local affordability and therapeutic relevance of new products as additional criteria for the approval of clinical trials. Finally, clinical trials have opportunity costs that need to be assessed. PMID:26600609

Mapping the availability, price, and affordability of antiepileptic drugs in 46 countries.

PubMed

Cameron, Alexandra; Bansal, Amit; Dua, Tarun; Hill, Suzanne R; Moshe, Solomon L; Mantel-Teeuwisse, Aukje K; Saxena, Shekhar

2012-06-01

In low- and middle-income countries (LMICs), a large proportion of people with epilepsy do not receive treatment. An analysis of the availability, price, and affordability of antiepileptic drugs (AEDs) was conducted to evaluate whether these factors contribute to the treatment gap. Data for five AEDs (phenytoin, carbamazepine, valproic acid, phenobarbital, and diazepam) were obtained from facility-based surveys conducted in 46 countries using the World Health Organization/Health Action International (WHO/HAI) methodology. Outcome measures were percentage availability, ratios of local prices to international reference prices, and number of days' wages needed by the lowest-paid unskilled government worker to purchase treatment. Prices were adjusted for inflation/deflation and purchasing power parity. The average availability of generic AEDs in the public sector was <50% for all medicines except diazepam injection. Private sector availability of generic oral AEDs ranged from 42.2% for phenytoin to 69.6% for phenobarbital. Public sector patient prices for generic carbamazepine and phenytoin were 4.95 and 17.50 times higher than international reference prices, respectively, whereas private sector patient prices were 11.27 and 24.77 times higher, respectively. For both medicines, originator brand prices were about 30 times higher. The highest prices were observed in the lowest income countries. The lowest-paid government worker would need wages from 1-2.6 days' to purchase a month's supply of phenytoin, whereas carbamazepine would cost 2.7-16.2 days' wages. Despite its widespread use in LMICs, WHO/HAI survey data for phenobarbital was only available from a small number of countries. In LMICs, availability and affordability of AEDs are poor and may be acting as a barrier to accessing treatment for epilepsy. Ensuring a consistent supply of AEDs at an affordable price should be a priority. Wiley Periodicals, Inc. © 2012 International League Against Epilepsy.

Availability, price and affordability of cardiovascular medicines: A comparison across 36 countries using WHO/HAI data

PubMed Central

2010-01-01

Background The global burden of cardiovascular disease (CVD) continues to rise. Successful treatment of CVD requires adequate pharmaceutical management. The aim was to examine the availability, pricing and affordability of cardiovascular medicines in developing countries using the standardized data collected according to the World Health Organization/Health Action International methodology. Methods The following medicines were included: atenolol, captopril, hydrochlorothiazide, losartan and nifedipine. Data from 36 countries were analyzed. Outcome measures were percentage availability, price ratios to international reference prices and number of day's wages needed by the lowest-paid unskilled government worker to purchase one month of chronic treatment. Patient prices were adjusted for inflation and purchasing power, procurement prices only for inflation. Data were analyzed for both generic and originator brand products and the public and private sector and summarized by World Bank Income Groups. Results For all measures, there was great variability across surveys. The overall availability of cardiovascular medicines was poor (mean 26.3% in public sector, 57.3% private sector). Procurement prices were very competitive in some countries, whereas others consistently paid high prices. Patient prices were generally substantially higher than international references prices; some countries, however, performed well. Chronic treatment with anti-hypertensive medication cost more than one day's wages in many cases. In particular when monotherapy is insufficient, treatment became unaffordable. Conclusions The results of this study emphasize the need of focusing attention and financing on making chronic disease medicines accessible, in particular in the public sector. Several policy options are suggested to reach this goal. PMID:20534118

Availability, price and affordability of cardiovascular medicines: a comparison across 36 countries using WHO/HAI data.

PubMed

van Mourik, Maaike S M; Cameron, Alexandra; Ewen, Marg; Laing, Richard O

2010-06-09

The global burden of cardiovascular disease (CVD) continues to rise. Successful treatment of CVD requires adequate pharmaceutical management. The aim was to examine the availability, pricing and affordability of cardiovascular medicines in developing countries using the standardized data collected according to the World Health Organization/Health Action International methodology. The following medicines were included: atenolol, captopril, hydrochlorothiazide, losartan and nifedipine. Data from 36 countries were analyzed. Outcome measures were percentage availability, price ratios to international reference prices and number of day's wages needed by the lowest-paid unskilled government worker to purchase one month of chronic treatment. Patient prices were adjusted for inflation and purchasing power, procurement prices only for inflation. Data were analyzed for both generic and originator brand products and the public and private sector and summarized by World Bank Income Groups. For all measures, there was great variability across surveys. The overall availability of cardiovascular medicines was poor (mean 26.3% in public sector, 57.3% private sector). Procurement prices were very competitive in some countries, whereas others consistently paid high prices. Patient prices were generally substantially higher than international references prices; some countries, however, performed well. Chronic treatment with anti-hypertensive medication cost more than one day's wages in many cases. In particular when monotherapy is insufficient, treatment became unaffordable. The results of this study emphasize the need of focusing attention and financing on making chronic disease medicines accessible, in particular in the public sector. Several policy options are suggested to reach this goal.

Prices, Costs, and Affordability of New Medicines for Hepatitis C in 30 Countries: An Economic Analysis.

PubMed

Iyengar, Swathi; Tay-Teo, Kiu; Vogler, Sabine; Beyer, Peter; Wiktor, Stefan; de Joncheere, Kees; Hill, Suzanne

2016-05-01

New hepatitis C virus (HCV) medicines have markedly improved treatment efficacy and regimen tolerability. However, their high prices have limited access, prompting wide debate about fair and affordable prices. This study systematically compared the price and affordability of sofosbuvir and ledipasvir/sofosbuvir across 30 countries to assess affordability to health systems and patients. Published 2015 ex-factory prices for a 12-wk course of treatment were provided by the Pharma Price Information (PPI) service of the Austrian public health institute Gesundheit Österreich GmbH or were obtained from national government or drug reimbursement authorities and recent press releases, where necessary. Prices in Organisation for Economic Co-operation and Development (OECD) member countries and select low- and middle-income countries were converted to US dollars using period average exchange rates and were adjusted for purchasing power parity (PPP). We analysed prices compared to national economic performance and estimated market size and the cost of these drugs in terms of countries' annual total pharmaceutical expenditure (TPE) and in terms of the duration of time an individual would need to work to pay for treatment out of pocket. Patient affordability was calculated using 2014 OECD average annual wages, supplemented with International Labour Organization median wage data where necessary. All data were compiled between 17 July 2015 and 25 January 2016. For the base case analysis, we assumed a 23% rebate/discount on the published price in all countries, except for countries with special pricing arrangements or generic licensing agreements. The median nominal ex-factory price of a 12-wk course of sofosbuvir across 26 OECD countries was US$42,017, ranging from US$37,729 in Japan to US$64,680 in the US. Central and Eastern European countries had higher PPP-adjusted prices than other countries: prices of sofosbuvir in Poland and Turkey (PPP$101,063 and PPP$70,331) and of

Prices, Costs, and Affordability of New Medicines for Hepatitis C in 30 Countries: An Economic Analysis

PubMed Central

Tay-Teo, Kiu; Vogler, Sabine; Beyer, Peter; Wiktor, Stefan; de Joncheere, Kees; Hill, Suzanne

2016-01-01

Introduction New hepatitis C virus (HCV) medicines have markedly improved treatment efficacy and regimen tolerability. However, their high prices have limited access, prompting wide debate about fair and affordable prices. This study systematically compared the price and affordability of sofosbuvir and ledipasvir/sofosbuvir across 30 countries to assess affordability to health systems and patients. Methods and Findings Published 2015 ex-factory prices for a 12-wk course of treatment were provided by the Pharma Price Information (PPI) service of the Austrian public health institute Gesundheit Österreich GmbH or were obtained from national government or drug reimbursement authorities and recent press releases, where necessary. Prices in Organisation for Economic Co-operation and Development (OECD) member countries and select low- and middle-income countries were converted to US dollars using period average exchange rates and were adjusted for purchasing power parity (PPP). We analysed prices compared to national economic performance and estimated market size and the cost of these drugs in terms of countries’ annual total pharmaceutical expenditure (TPE) and in terms of the duration of time an individual would need to work to pay for treatment out of pocket. Patient affordability was calculated using 2014 OECD average annual wages, supplemented with International Labour Organization median wage data where necessary. All data were compiled between 17 July 2015 and 25 January 2016. For the base case analysis, we assumed a 23% rebate/discount on the published price in all countries, except for countries with special pricing arrangements or generic licensing agreements. The median nominal ex-factory price of a 12-wk course of sofosbuvir across 26 OECD countries was US$42,017, ranging from US$37,729 in Japan to US$64,680 in the US. Central and Eastern European countries had higher PPP-adjusted prices than other countries: prices of sofosbuvir in Poland and Turkey (PPP

Access to essential medicines to treat chronic respiratory disease in low-income countries.

PubMed

Bissell, K; Perrin, C; Beran, D

2016-06-01

Chronic respiratory diseases (CRDs) affect hundreds of millions of people. The United Nations 2011 meeting on non-communicable diseases (NCDs) marked a turning point in addressing this burden. The targets established following this meeting incorporated specific measures to address the availability and affordability of essential medicines. These are aligned with the sustainable development goals (SDGs) and the push for universal health coverage. However, essential medicines for CRDs remain unaffordable and unavailable to many. For asthma, the availability of medicines was respectively 30.1% and 43.1% in the public and private sectors. The maximum annual costs of treatment were US$102.10 for beclometasone, US$82.99 for salbutamol and US$1501.79 for budesonide, representing respectively 40%, 15% and 209% of per capita income in Malawi, Burkina Faso and Guinea. Multiple factors contribute to poor availability and affordability. Experience from human immunodeficiency virus/acquired immune-deficiency syndrome shows that medicines and care can be delivered in low-income countries and among the NCDs. A unique example of an effective mechanism for providing access to affordable essential CRD medicines is the Asthma Drug Facility. Working on the six health system building blocks proposed by the World Health Organization can help countries address not only problems regarding access to medicines, but also those hampering adequate care. Improving medicine supply systems, training, national guidelines, financing, research, data utilisation and models of care at the primary health care level will help. A CRD target (e.g., 50% reduction in asthma hospitalisations) as well as the use of asthma as a measure for health system effectiveness and CRDs as a tracer for SDGs would help focus global, national and local leadership.

The crisis in access to essential medicines in India: key issues which call for action.

PubMed

Bhargava, Anurag; Kalantri, S P

2013-01-01

The government is planning to introduce free generic and essential medicines in public health facilities. Most people in India buy healthcare from the private sector, a compulsion that accounts for a high proportion of healthcare-related expenditure. To reduce the burden of healthcare costs, the government must improve availability and affordability of generic and essential medicines in the market. It can do so because India's large pharmaceutical industry is a major source of generic medicines worldwide. In this article, we discuss three factors that have impeded access to generic and essential medicines: (1) mistaken notions among policymakers, prescribers and patients about branded drugs and generic drugs in India; (2) high prices of medicines due to the progressive dismantling of the system of regulation of medicine prices, and (3) a drug approval and regulatory system that allows medicines (including fixed dose combinations) of doubtful efficacy, rationale, safety and public health relevance to dominate the market at the cost of access to affordable generic and essential medicines. The consequences of ill-health and wasted expenditure on drugs raise issues of public health ethics.Improving access to essential medicines in India is an urgent public health and ethical imperative. This should include improved public provisioning, a system of regulation of drug prices, and an evidence-based drug approval process.

Supportive supervision for medicines management in government health facilities in Kiambu County, Kenya: a health workers' perspective.

PubMed

Agoro, Oscar Otieno; Osuga, Ben Onyango; Adoyo, Maureen

2015-01-01

Effective supportive supervision is widely recognized as essential for optimal management of medicines in government health facilities and also in contributing towards improved access and utilization of health services. This study sought to examine the extent supportive supervision for medicines management in government health facilities from a health worker perspective. A cross-sectional study was done targeting health workers managing medicines in government health facilities in Kiambu County. One hundred and thirty eight respondents took part in the study which explored the quality of supportive supervision from a health worker's perspective, and also examined the factors influencing their contentment with the level of supervision received. A statistical analysis was done using SPSS 21 and Excel 2013. Supervisory visits from all levels of health management were not regularly done, standard checklists were not routinely used, and action plans irregularly developed and followed up. Only 54 (38.6%) respondents were satisfied with the levels of supportive supervision that they received, with satisfaction significantly differing across the professional cadres, χ (2) (12, n = 138) = 29.762, p = .003; across the different tiers of health facilities, r s (138) = 0.341, p < .001; and with the education levels of the respondents, r s (138) = 0.381, p < .001. The study concluded that supportive supervision for medicines management that government health facilities received was still inadequate, and health workers were dissatisfied with the level of supervision that they received. The study recommends a review of the support supervision policy at the county level to address the unearthed inefficiencies and improve supervision for medicines management in government health facilities.

Patient Protection and Affordable Care Act: Potential Effects on Physical Medicine and Rehabilitation

PubMed Central

Boninger, Joseph W.; Gans, Bruce M.; Chan, Leighton

2012-01-01

The objective was to review pertinent areas of the Patient Protection and Affordable Care Act (PPACA) to determine the PPACA’s impact on physical medicine and rehabilitation (PM&R). The law, and related newspaper and magazine articles, was reviewed. The ways in which provisions in the PPACA are being implemented by the Centers for Medicare and Medicaid Services and other government organizations were investigated. Additionally, recent court rulings on the PPACA were analyzed to assess the law’s chances of successful implementation. The PPACA contains a variety of reforms that, if implemented, will significantly impact the field of PM&R. Many PPACA reforms change how rehabilitative care is delivered by integrating different levels of care and creating uniform quality metrics to assess quality and efficiency. These quality metrics will ultimately be tied to new, performance-based payment systems. While the law contains ambitious initiatives that may, if unsuccessful or incorrectly implemented, negatively impact PM&R, it also has the potential to greatly improve the quality and efficiency of rehabilitative care. A proactive approach to the changes the PPACA will bring about is essential for the health of the field. PMID:22459177

Availability of herbal medicines and medicinal plants in the primary health facilities of the state of São Paulo, Southeast Brazil: results from the National Program for Access and Quality Improvement in Primary Care.

PubMed

Caccia-Bava, Maria do Carmo Gullaci Guimarães; Bertoni, Bianca Waléria; Pereira, Ana Maria Soares; Martinez, Edson Zangiacomi

2017-05-01

This study aims to describe the availability of herbal medicines and medicinal plants in the primary care facilities in the state of São Paulo, Southeast Brazil, from the results of the first cycle of the National Program for Access and Quality Improvement in Primary Care (PMAQ). The PMAQ uses a national cross-sectional multicenter design, with data from 4,249 health facilities distributed among 645 municipalities of the state of São Paulo. Of these facilities, 467 (11%) had herbal medicines and/or medicinal plants. Among the 645 municipalities, 104 (16.1%) had at least one health facility that provided these drugs. We observed that the availability of herbal medicines is greater in larger cities with better social and economic conditions. Furthermore, we found that use of industrialized herbal medicines prevailed over that of vegetal drugs or compounded herbal medicines.

Low Prevalence of Substandard and Falsified Antimalarial and Antibiotic Medicines in Public and Faith-Based Health Facilities of Southern Malawi

PubMed Central

Khuluza, Felix; Kigera, Stephen; Heide, Lutz

2017-01-01

Substandard and falsified antimalarial and antibiotic medicines represent a serious problem for public health, especially in low- and middle-income countries. However, information on the prevalence of poor-quality medicines is limited. In the present study, samples of six antimalarial and six antibiotic medicines were collected from 31 health facilities and drug outlets in southern Malawi. Random sampling was used in the selection of health facilities. For sample collection, an overt approach was used in licensed facilities, and a mystery shopper approach in nonlicensed outlets. One hundred and fifty-five samples were analyzed by visual and physical examination and by rapid prescreening tests, that is, disintegration testing and thin-layer chromatography using the GPHF-Minilab. Fifty-six of the samples were analyzed according to pharmacopeial monographs in a World Health Organization-prequalified quality control laboratory. Seven out-of-specification medicines were identified. One sample was classified as falsified, lacking the declared active ingredients, and containing other active ingredients instead. Three samples were classified as substandard with extreme deviations from the pharmacopeial standards, and three further samples as substandard with nonextreme deviations. Of the substandard medicines, three failed in dissolution testing, two in the assay for the content of the active pharmaceutical ingredient, and one failed in both dissolution testing and assay. Six of the seven out-of-specification medicines were from private facilities. Only one out-of-specification medicine was found within the samples from public and faith-based health facilities. Although the observed presence of substandard and falsified medicines in Malawi requires action, their low prevalence in public and faith-based health facilities is encouraging. PMID:28219993

Rational use of medicines - Indian perspective!

PubMed

Mohanta, G P; Manna, P K

2015-01-01

Government developed policies and regulations for combating antimicrobial resistance, controlling the prices of medicines, establishing generic medicines stores and advocating for the need for improvement of medicine logistics at state level and prescription auditing system. There is wide variation in medicine procurement and management system among the states. Spending on medicines ranges from as small as 2% of health budget to as high as 17%. The procurement system varies from individual facilities to partial pooled procurement to complete centralised system.There are attempts of developing essential medicine lists, standard treatment guidelines and costing of treatment of common illnesses. Except for the few states, essential medicine list remains an ornamental showpiece. However, with apex court's intervention, the prices are now controlled for all 348 medicines listed in national list. The pharmaceutical companies continue to violate price regulations either through making the medicines at different strengths or new fixed dose combinations (FDCs). Perhaps the largest number of FDCs and many of them with no valid justification are available in the country. Decisions on compulsory licensing have made the new anticancer medicines affordable. Other countries have also benefited from this decision. While some progress has been made for appropriate use of medicines in public health facilities, there are little efforts in private sectors and at community levels. Availability of prescription medicines without much control and free drug advertising are other concerns. Like all other countries irrational use of medicines continues to be of concern in India despite of several attempts of improving use of medicines both in the health system as well as in community. But efforts continue to be made for improving the use of medicines!

Survey on the availability, price and affordability of selected essential medicines for non-communicable diseases in community pharmacies of Kathmandu valley.

PubMed

Shrestha, Rajeev; Ghale, Anish; Chapagain, Bijay Raj; Gyawali, Mahasagar; Acharya, Trishna

2017-01-01

The access to essential medicines for non-communicable disease treatment is unacceptably low worldwide. The fundamental right to health cannot be fulfilled without equitable access to essential medicines. A cross-sectional study was carried out in 94 community pharmacies of Kathmandu valley. Non-probability quota sampling method was adopted for the purpose. Village Development Committees with more than 5000 populations were included in the study. The availability of the selected essential medicines, their price and producer identity were observed. Data entry and analysis were carried out in Microsoft Excel and Statistical package for social science. The availability of the essential medicines was not 100% in Kathmandu valley. High competition and high price variation were seen in metformin 500 mg (254.6%) and atorvastatin 10 mg (327.6%). The study showed that maximum (54.7%) brands were manufactured in Nepal. Furthermore, atorvastatin 10 mg (0.6 day wage) was found to be quite expensive, and glibenclamide 5 mg (0.1 day wage) was the cheapest one for diabetes mellitus treatment for 1 month of treatment period compared to daily wages of other essential medicines. The availability of the selected essential medicines was found to be ununiform and insufficient in the entire region. High competition was observed in the products with high price variation, and the access to cost-effective brand was poor. Furthermore, it was found that government salary is affordable to treat non-communicable disease with the help of the essential medicines.

The global, centralized approach of the GAIN Premix Facility has made oil fortification in Indonesia more affordable.

PubMed

Jallier, Vincent; Guyondet, Christophe; Provent, Adeline; Laillou, Arnaud; Soekirman; Moench-Pfanner, Regina

2013-06-01

Access to high-grade micronutrients is a recurring challenge that often threatens the long-term sustainability of food fortification programs. To assess the efficiency of the Global Alliance for Improved Nutrition (GAIN) Premix Facility in procuring quality, affordable vitamin A for fortification of edible oil in Indonesia. A global approach to procurement of standard items was used by combining volumes across various demand streams in order to reduce the total cost of acquisition through economies of scale. The GAIN Premix Facility undertook a detailed analysis of vitamin A requirements across its existing customer base, which served as a basis for developing a reliable demand forecast. A consolidated, competitive tender was launched that resulted in the setting up of a long-term commercial agreement with the selected supplier to lock in the most competitive price for a given period of time. The direct benefit to oil manufacturers of fortifying with vitamin A is that the cost of fortification went down significantly compared with prices they would have been offered had they ordered vitamin A individually. In Indonesia, this consolidated procurement approach has allowed a 14.5% decrease in the unit price of vitamin A. The GAIN Premix Facility demonstrated its effectiveness in acting as a global procurement platform by aggregating demand across different customers and leveraging improved prices through increased volumes. Building on the success of this effort, the GAIN Premix Facility is replicating this global approach for procurement of other standard items being procured across fortification programs worldwide.

Use of psychotropic medicines in residential care facilities for older people in Hawke's Bay, New Zealand.

PubMed

Tucker, Marilyn; Hosford, Ian

2008-05-23

To audit the use of various categories of psychotropic medicines in residential care facilities in Hawke's Bay. Data on psychotropic medicines use for all residents in participating residential care facilities were extracted from community pharmacy records and analysed. These data were compared to a similar study performed in 1990. 54.7% of residents were prescribed one or more psychotropic medicines, a similar proportion to that recorded in 1990. The use of regular benzodiazepines reduced from 29.6% to 12.4% while the use of antidepressant medicines increased from 15.5% to 30.6%. Most residents on antipsychotic medicines are now on 'atypical' agents at relatively low doses, and overall use of antipsychotic medication has not changed significantly. The use of psychotropic medicines in Hawke's Bay, New Zealand does not differ much from other countries where similar audits have been performed. The increase in use of antidepressants is likely to reflect better diagnosis and management of depression in nursing homes. The use of benzodiazepines and sedative medication is probably still excessive.

Leveraging new information technology to monitor medicine use in 71 residential aged care facilities: variation in polypharmacy and antipsychotic use.

PubMed

Pont, Lisa G; Raban, Magda Z; Jorgensen, Mikaela L; Georgiou, Andrew; Westbrook, Johanna I

2018-06-08

The aim of this study was to use routinely collected electronic medicines administration (eMAR) data in residential aged care (RAC) to investigate the quality use of medicines. A cross-sectional analysis of eMAR data. 71 RAC facilities in New South Wales and the Australian Capital Territory, Australia. Permanent residents living in a participating facility on 1 October 2015. None. Variation in polypharmacy (≥5 medications), hyper-polypharmacy (≥10 medications) and antipsychotic use across facilities was examined using funnel plot analysis. The study dataset included 4775 long-term residents. The mean resident age was 85.3 years and 70.6% of residents were female. The median facility size was 60 residents and 74.3% were in metropolitan locations. 84.3% of residents had polypharmacy, 41.2% hyper-polypharmacy and 21.0% were using an antipsychotic. The extent of polypharmacy (69.75-100% of residents), hyper-polypharmacy (38.81-76.19%) and use of antipsychotic medicines (0-75.6%) varied considerably across the 71 facilities. Using eMAR data we found substantial variation in polypharmacy, hyper-polypharmacy and antipsychotic medicine use across 71 RAC facilities. Further investigation into the policies and practices of facilities performing above or below expected levels is warranted to understand variation and drive quality improvement.

Legal and policy foundations for global generic competition: Promoting affordable drug pricing in developing societies.

PubMed

Zapatero Miguel, Pablo

2015-01-01

The so-called 'TRIPS flexibilities' restated in 2001 by the World Trade Organization's Doha Declaration on TRIPS and Public Health offer a variety of policy avenues for promoting global price-based competition for essential medicines, and thus for improving access to affordable medicines in the developing world. In recent years, developing countries and international organisations alike have begun to explore the potentialities of global generic markets and competition generally, and also of using compulsory licensing to remedy anti-competitive practices (e.g. excessive pricing) through TRIPS-compatible antitrust enforcement. These and other 'pro-competitive' TRIPS flexibilities currently available provide the critical leverage and policy space necessary to improve access to affordable medicines in the developing world.

Malaria prevalence and treatment of febrile patients at health facilities and medicine retailers in Cameroon.

PubMed

Mangham, Lindsay J; Cundill, Bonnie; Achonduh, Olivia A; Ambebila, Joel N; Lele, Albertine K; Metoh, Theresia N; Ndive, Sarah N; Ndong, Ignatius C; Nguela, Rachel L; Nji, Akindeh M; Orang-Ojong, Barnabas; Wiseman, Virginia; Pamen-Ngako, Joelle; Mbacham, Wilfred F

2012-03-01

To investigate the quality of malaria case management in Cameroon 5 years after the adoption of artemisinin-based combination therapy (ACT). Treatment patterns were examined in different types of facility, and the factors associated with being prescribed or receiving an ACT were investigated. A cross-sectional cluster survey was conducted among individuals of all ages who left public and private health facilities and medicine retailers in Cameroon and who reported seeking treatment for a fever. Prevalence of malaria was determined by rapid diagnostic tests (RDTs) in consenting patients attending the facilities and medicine retailers. Among the patients, 73% were prescribed or received an antimalarial, and 51% were prescribed or received an ACT. Treatment provided to patients significantly differed by type of facility: 65% of patients at public facilities, 55% of patients at private facilities and 45% of patients at medicine retailers were prescribed or received an ACT (P = 0.023). The odds of a febrile patient being prescribed or receiving an ACT were significantly higher for patients who asked for an ACT (OR = 24.1, P < 0.001), were examined by the health worker (OR = 1.88, P = 0.021), had not previously sought an antimalarial for the illness (OR = 2.29, P = 0.001) and sought treatment at a public (OR = 3.55) or private facility (OR = 1.99, P = 0.003). Malaria was confirmed in 29% of patients and 70% of patients with a negative result were prescribed or received an antimalarial. Malaria case management could be improved. Symptomatic diagnosis is inefficient because two-thirds of febrile patients do not have malaria. Government plans to extend malaria testing should promote rational use of ACT; though, the introduction of rapid diagnostic testing needs to be accompanied by updated clinical guidelines that provide clear guidance for the treatment of patients with negative test results. © 2011 Blackwell Publishing Ltd.

Overdependence on For-Profit Pharmacies: A Descriptive Survey of User Evaluation of Medicines Availability in Public Hospitals in Selected Nigerian States.

PubMed

Ushie, Boniface Ayanbekongshie; Ugal, David Betelwhobel; Ingwu, Justin Agorye

2016-01-01

Lower availability of medicines in Nigerian public health facilities-the most affordable option for the masses-undermines global health reforms to improve access to health for all, especially the chronically ill and poor. Thus, a sizeable proportion of healthcare users, irrespective of purchasing power, buy medicines at higher costs from for-profit pharmacies. We examined user evaluation of medicine availability in public facilities and how this influences their choice of where to buy medicines in selected states-Cross River, Enugu and Oyo-in Nigeria. We approached and interviewed 1711 healthcare users using a semi-structured, interviewer-administered questionnaire as they exited for-profit pharmacies after purchasing medicines. This ensured that both clients who had presented at health facilities (private/public) and those who did not were included. Information was collected on why respondents could not buy medicines at the hospitals they attended, their views of medicine availability and whether their choice of where to buy medicines is influenced by non-availability. Respondents' mean age was 37.7±14.4 years; 52% were males, 59% were married, 82% earned ≥NGN18, 000 (US$57.19) per month, and 72% were not insured. Majority (66%) had prescriptions; of this, 70% were from public facilities. Eighteen percent of all respondents indicated that all their medicines were usually available at the public facilities, most (29%), some (44%) and not always available (10%). Reasons for using for-profit pharmacies included: health workers attitudes (43%), referral by providers (43%); inadequate money to purchase all prescribed drugs (42%) and cumbersome processes for obtaining medicines. Lower availability of medicines has serious implications for healthcare behavior, especially because of poverty. It is crucial for government to fulfill its mandate of equitable access to care for all by making medicines available and cheap through reviving and sustaining the drug revolving

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

PubMed

Fang, Yu; Wagner, Anita K; Yang, Shimin; Jiang, Minghuan; Zhang, Fang; Ross-Degnan, Dennis

2013-10-01

Limited access to essential medicines is a global problem. Improving availability and affordability 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. 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 inflation-adjusted median unit prices (MUPs), taking 2010 as the base year. We used general estimating equations to calculate the significance of differences in availability from 2010 to 2012 and the Wilcoxon signed rank test to calculate the significance of differences in adjusted median prices. 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 significantly from 2010 to 2012 in primary hospitals in comparison with secondary and tertiary hospitals. In the public sector, the median adjusted patient price was significantly lower in 2012 than in 2010 for 16 originator brands (difference -11·7%; p=0·0019) and 29 lowest-priced generics (-5·2%; p=0·0015); the median government procurement price for

Comparison of medicine availability measurements at health facilities: evidence from Service Provision Assessment surveys in five sub-Saharan African countries.

PubMed

Choi, Yoonjoung; Ametepi, Paul

2013-07-09

With growing emphasis on health systems strengthening in global health, various health facility assessment methods have been used increasingly to measure medicine and commodity availability. However, few studies have systematically compared estimates of availability based on different definitions. The objective of this study was to compare estimates of medicine availability based on different definitions. A secondary data analysis was conducted using data from the Service Provision Assessment (SPA)--a nationally representative sample survey of health facilities--conducted in five countries: Kenya SPA 2010, Namibia SPA 2009, Rwanda SPA 2007, Tanzania SPA 2006, and Uganda SPA 2007. For 32 medicines, percent of facilities having the medicine were estimated using five definitions: four for current availability and one for six-month period availability. 'Observed availability of at least one valid unit' was used as a reference definition, and ratios between the reference and each of the other four estimates were calculated. Summary statistics of the ratios among the 32 medicines were calculated by country. The ratios were compared further between public and non-public facilities within each country. Across five countries, compared to current observed availability of at least one valid unit, 'reported availability without observation' was on average 6% higher (ranging from 3% in Rwanda to 8% in Namibia), 'observed availability where all units were valid' was 11% lower (ranging from 2% in Tanzania to 19% in Uganda), and 'six-month period availability' was 14% lower (ranging from 5% in Namibia to 25% in Uganda). Medicine availability estimates vary substantially across definitions, and need to be interpreted with careful consideration of the methods used.

"Affordable" Private Schools in South Africa. Affordable for Whom?

ERIC Educational Resources Information Center

Languille, Sonia

2016-01-01

The paper sets out to challenge the notions of "affordable" private schools in the context of South Africa. It is guided by one main question: "affordable private schools for whom?" It argues that, contrary to claims by its public and private proponents, affordable private schools in South Africa do not cater for poor children.…

Current and Future Challenges in Point-of-Care Technologies: A Paradigm-Shift in Affordable Global Healthcare With Personalized and Preventive Medicine

PubMed Central

Heetderks, William J.; Pavel, Misha; Acharya, Soumyadipta; Akay, Metin; Mairal, Anurag; Wheeler, Bruce; Dacso, Clifford C.; Sunder, T.; Lovell, Nigel; Gerber, Martin; Shah, Milind; Senthilvel, S. G.; Wang, May D.; Bhargava, Balram

2015-01-01

This paper summarizes the panel discussion at the IEEE Engineering in Medicine and Biology Point-of-Care Healthcare Technology Conference (POCHT 2013) held in Bangalore India from Jan 16–18, 2013. Modern medicine has witnessed interdisciplinary technology innovations in healthcare with a continuous growth in life expectancy across the globe. However, there is also a growing global concern on the affordability of rapidly rising healthcare costs. To provide quality healthcare at reasonable costs, there has to be a convergence of preventive, personalized, and precision medicine with the help of technology innovations across the entire spectrum of point-of-care (POC) to critical care at hospitals. The first IEEE EMBS Special Topic POCHT conference held in Bangalore, India provided an international forum with clinicians, healthcare providers, industry experts, innovators, researchers, and students to define clinical needs and technology solutions toward commercialization and translation to clinical applications across different environments and infrastructures. This paper presents a summary of discussions that took place during the keynote presentations, panel discussions, and breakout sessions on needs, challenges, and technology innovations in POC technologies toward improving global healthcare. Also presented is an overview of challenges and trends in developing and developed economies with respect to priority clinical needs, technology innovations in medical devices, translational engineering, information and communication technologies, infrastructure support, and patient and clinician acceptance of POC healthcare technologies. PMID:27170902

Lean, Mean and Green: An Affordable Net Zero School

ERIC Educational Resources Information Center

Stanfield, Kenneth

2010-01-01

From its conception, Richardsville Elementary was designed to be an affordable net zero facility. The design team explored numerous energy saving strategies to dramatically reduce energy consumption. By reducing energy use to 19.31 kBtus annually, the net zero goal could be realized through the implementation of a solar array capable of producing…

Critical Value Reporting in Transfusion Medicine: A Survey of Communication Practices in US Facilities.

PubMed

Reese, Erika M; Nelson, Randin C; Flegel, Willy A; Byrne, Karen M; Booth, Garrett S

2017-05-01

While critical value procedures have been adopted in most areas of the clinical laboratory, their use in transfusion medicine has not been reviewed in detail. The results of this study present a comprehensive overview of critical value reporting and communication practices in transfusion medicine in the United States. A web-based survey was developed to collect data on the prevalence of critical value procedures and practices of communicating results. The survey was distributed via email to US hospital-based blood banks. Of 123 facilities surveyed, 84 (68.3%) blood banks had a critical value procedure. From a panel of 23 common blood bank results, nine results were selected by more than 70% of facilities as either a critical value or requiring rapid communication as defined by an alternate procedure. There was overlap among results communicated by facilities with and without a critical value procedure. The most frequently communicated results, such as incompatible crossmatch for RBC units issued uncrossmatched, delay in finding compatible blood due to a clinically significant antibody, and transfusion reaction evaluation suggestive of a serious adverse event, addressed scenarios associated with the leading reported causes of transfusion-related fatalities. American Society for Clinical Pathology, 2017. This work is written by US Government employees and is in the public domain in the US.

Changes in the availability and affordability of subsidised artemisinin combination therapy in the private drug retail sector in rural Ghana: before and after the introduction of the AMFm subsidy.

PubMed

Ansah, Evelyn K; Whitty, Christopher Jm; Bart-Plange, Constance; Gyapong, Margaret

2016-11-01

Most people with febrile illness are treated in the private drug retail sector. Ghana was among nine countries piloting the Global Fund Affordable Medicines Facility - malaria (AMFm). AMFm aimed to: increase artemisinin combination therapy (ACT) affordability; increase ACT availability; increase ACT use; and 'crowd out' artemisinin monotherapies. Three censuses were carried out 2 months before (2010), 2 months after and 2.5 years after (2013) the first co-paid ACTs to assess changes in antimalarial (AM) availability and price in private retail shops in a Ghanaian rural district to assess the sustainability of the initial gains. Supply, stock-out and cost were explored. Of 62 shops in the district, 56 participated with 398, 388 and 442 brands of AMs in the shops during the 3 censuses. The proportion of ACTs increased over the period while monotherapies reduced. Herbal-based AM preparations comprised 40-45% of AMs in stock with minimal variation over the period. ACTs were the most sold AM type for all ages but overall buying and selling prices of Quality Assured-ACTs increased by 40-100%. Initial gains in ACT availability were sustained, but not improved on 2.5 years after AMFm. Widespread availability of unproven herbal medicines is a concern; AMFm had little impact on this. © The Author 2016. Published by Oxford University Press Royal Society of Tropical Medicine and Hygiene.

Prevalence of herbal medicine use and associated factors among pregnant women attending antenatal care at public health facilities in Hossana Town, Southern Ethiopia: facility based cross sectional study.

PubMed

Laelago, Tariku; Yohannes, Tadele; Lemango, Fiseha

2016-01-01

The use of herbal medicine has been on increase in many developing and industrialized countries. More pregnant women use herbal remedies to treat pregnancy related problems due to cost-effectiveness of therapy and easy access of these products. We sought to assess the prevalence of herbal medicine use and associated factors among pregnant women attending antenatal clinics of public health facilities. Facility based cross sectional study was conducted among 363 pregnant women attending antenatal clinics from May to June 2015 at public health facilities in Hossana town, Hadiya zone, Southern Ethiopia. Pretested structured questionnaire was used to collect data from each study subject. Bivariate logistic regression analysis was used to see significance of association between the outcome and independent variables. Odds ratios at 95 % CI were computed to measure the strength of the association between the outcome and the independent variables. P-value <0.05 was considered as a statistically significant in multivariate analysis. Two hundred fifty eight (73.1 %) of pregnant women used herbal medicine during current pregnancy . The herbal medicines commonly taken during current pregnancy were ginger (55.8 %), garlic (69.8 %), eucalyptus (11.6 %), tenaadam (rutachalenssis) (26.4 %), damakesse (ocimumlamiifolium) (22.8 %), feto (3.5 %) and omore (3.1 %). Being students (AOR: (5.68, 95 % CI: (1.53, 21.13), second trimester of pregnancy (AOR: 0.22, 95 % CI: (0.08, 0.76), sufficient knowledge on herbal medicine (AOR: 0.37, 95 % CI: (0.19, 0.79), no formal education (AOR: 4.41, 95 % CI: (1.11, 17.56), primary education (AOR: 4.15, 95 % CI: (1.51, 11.45) and secondary education (AOR: 2.55, 95 % CI: (1.08,6.03) were significantly associated with herbal medicine use. The findings of this study showed that herbal medicine use during pregnancy is a common experience. Commonly used herbal medicines during current pregnancy were garlic, ginger, tenaadam, damakasse and

Dose equivalent rate constants and barrier transmission data for nuclear medicine facility dose calculations and shielding design.

PubMed

Kusano, Maggie; Caldwell, Curtis B

2014-07-01

A primary goal of nuclear medicine facility design is to keep public and worker radiation doses As Low As Reasonably Achievable (ALARA). To estimate dose and shielding requirements, one needs to know both the dose equivalent rate constants for soft tissue and barrier transmission factors (TFs) for all radionuclides of interest. Dose equivalent rate constants are most commonly calculated using published air kerma or exposure rate constants, while transmission factors are most commonly calculated using published tenth-value layers (TVLs). Values can be calculated more accurately using the radionuclide's photon emission spectrum and the physical properties of lead, concrete, and/or tissue at these energies. These calculations may be non-trivial due to the polyenergetic nature of the radionuclides used in nuclear medicine. In this paper, the effects of dose equivalent rate constant and transmission factor on nuclear medicine dose and shielding calculations are investigated, and new values based on up-to-date nuclear data and thresholds specific to nuclear medicine are proposed. To facilitate practical use, transmission curves were fitted to the three-parameter Archer equation. Finally, the results of this work were applied to the design of a sample nuclear medicine facility and compared to doses calculated using common methods to investigate the effects of these values on dose estimates and shielding decisions. Dose equivalent rate constants generally agreed well with those derived from the literature with the exception of those from NCRP 124. Depending on the situation, Archer fit TFs could be significantly more accurate than TVL-based TFs. These results were reflected in the sample shielding problem, with unshielded dose estimates agreeing well, with the exception of those based on NCRP 124, and Archer fit TFs providing a more accurate alternative to TVL TFs and a simpler alternative to full spectral-based calculations. The data provided by this paper should assist

Update on value-based medicine.

PubMed

Brown, Melissa M; Brown, Gary C

2013-05-01

To update concepts in Value-Based Medicine, especially in view of the Patient Protection and Affordable Care Act. The Patient Protection and Affordable Care Act assures that some variant of Value-Based Medicine cost-utility analysis will play a key role in the healthcare system. It identifies the highest quality care, thereby maximizing the most efficacious use of healthcare resources and empowering patients and physicians.Standardization is critical for the creation and acceptance of a Value-Based Medicine, cost-utility analysis, information system, since 27 million different input variants can go into a cost-utility analysis. Key among such standards is the use of patient preferences (utilities), as patients best understand the quality of life associated with their health states. The inclusion of societal costs, versus direct medical costs alone, demonstrates that medical interventions are more cost effective and, in many instances, provide a net financial return-on-investment to society referent to the direct medical costs expended. Value-Based Medicine provides a standardized methodology, integrating critical, patient, quality-of-life preferences, and societal costs, to allow the highest quality, most cost-effective care. Central to Value-Based Medicine is the concept that all patients deserve the interventions that provide the greatest patient value (improvement in quality of life and/or length of life).

Effect of the Affordable Medicines Facility--malaria (AMFm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data.

PubMed

Tougher, Sarah; Ye, Yazoume; Amuasi, John H; Kourgueni, Idrissa A; Thomson, Rebecca; Goodman, Catherine; Mann, Andrea G; Ren, Ruilin; Willey, Barbara A; Adegoke, Catherine A; Amin, Abdinasir; Ansong, Daniel; Bruxvoort, Katia; Diallo, Diadier A; Diap, Graciela; Festo, Charles; Johanes, Boniface; Juma, Elizabeth; Kalolella, Admirabilis; Malam, Oumarou; Mberu, Blessing; Ndiaye, Salif; Nguah, Samuel B; Seydou, Moctar; Taylor, Mark; Rueda, Sergio Torres; Wamukoya, Marilyn; Arnold, Fred; Hanson, Kara

2012-12-01

Malaria is one of the greatest causes of mortality worldwide. Use of the most effective treatments for malaria remains inadequate for those in need, and there is concern over the emergence of resistance to these treatments. In 2010, the Global Fund launched the Affordable Medicines Facility--malaria (AMFm), a series of national-scale pilot programmes designed to increase the access and use of quality-assured artemisinin based combination therapies (QAACTs) and reduce that of artemisinin monotherapies for treatment of malaria. AMFm involves manufacturer price negotiations, subsidies on the manufacturer price of each treatment purchased, and supporting interventions such as communications campaigns. We present findings on the effect of AMFm on QAACT price, availability, and market share, 6-15 months after the delivery of subsidised ACTs in Ghana, Kenya, Madagascar, Niger, Nigeria, Uganda, and Tanzania (including Zanzibar). We did nationally representative baseline and endpoint surveys of public and private sector outlets that stock antimalarial treatments. QAACTs were identified on the basis of the Global Fund's quality assurance policy. Changes in availability, price, and market share were assessed against specified success benchmarks for 1 year of AMFm implementation. Key informant interviews and document reviews recorded contextual factors and the implementation process. In all pilots except Niger and Madagascar, there were large increases in QAACT availability (25·8-51·9 percentage points), and market share (15·9-40·3 percentage points), driven mainly by changes in the private for-profit sector. Large falls in median price for QAACTs per adult equivalent dose were seen in the private for-profit sector in six pilots, ranging from US$1·28 to $4·82. The market share of oral artemisinin monotherapies decreased in Nigeria and Zanzibar, the two pilots where it was more than 5% at baseline. Subsidies combined with supporting interventions can be effective in

Medicine as a business.

PubMed

Matthews, Merrill

2004-09-01

There is a growing debate over whether medicine should function like a business, guided, as businesses are, by concerns such as profits and customer satisfaction. Of course, for-profit businesses already permeate medicine, and those businesses are not confused about their priorities: providing high quality goods and services people want, at affordable prices. These companies know that they must do well in order to continue doing good. Critics of the business model argue that the profit motive makes health care too expensive and that only by nationalizing the health care system can doctors provide high quality care at an affordable cost to society. However, a survey of journals and newspaper articles about the Canadian health care system, often cited as an anti-business model for U.S. reform, reveals that quality has suffered significantly under that system. Patients wait in long lines for health care, and sometimes cannot get help at all. This paper argues that incentives in the U.S. health care system are complicated, and that health care needs to work more like a business--not less. Doctors don't know whom they are serving--patients, insurers, employers or the government--because it is usually someone other than the patient who it paying the bill. The way to get the incentives structured properly is to allow patients to control more of their health care dollars--perhaps through a system of Medical Savings Accounts. Following the business model is the only way to ensure that medicine provides high quality services at affordable prices--just like every other sector of the economy.

Healthy Libraries Develop Healthy Communities: Public Libraries and their Tremendous Efforts to Support the Affordable Care Act

PubMed Central

Collins, Lydia N.

2015-01-01

This article is about the dedication of public library staff and my role as the Consumer Health Coordinator for the National Network of Libraries of Medicine, Middle Atlantic Region (NN/LM MAR) to support outreach efforts for health insurance enrollment under the Patient Protection and Affordable Care Act (ACA). ACA was created in order to ensure that all Americans have access to affordable health care. What we didn’t know is that public libraries across the nation would play such an integral role in the health insurance enrollment process. The National Network of Libraries of Medicine (NN/LM) worked closely with public libraries in order to assist with this new role. As we approach the second enrollment and re-enrollment periods, public libraries are gearing up once again to assist with ACA. PMID:25798077

Availability of essential medicines in Ethiopia: an efficiency-equity trade-off?

PubMed

Carasso, Barbara S; Lagarde, Mylene; Tesfaye, Addis; Palmer, Natasha

2009-11-01

To investigate the availability and cost of essential medicines in health centres in rural Ethiopia, and to explore if the fee waiver system protects patients from having to pay for medicines. The study took place in five health centres in rural Ethiopia. Availability and price of selected key essential medicines was established in the budget and special pharmacy of the health centre, as well as private outlets. Information on availability and cost of prescribed drugs was obtained through patient exit-interviews. Availability based of essential drugs at facility level was 91% based on a list of selected drugs vs. 84% based on prescriptions filled. However, less than half the prescribed drugs were obtained from the budget pharmacy, and one in six patients was forced to purchase drugs in the private sector, where drugs are roughly twice as expensive. The waiver system did not safeguard against having to pay for medicines. A revolving drug fund system in Ethiopia seems to improve availability of medicines, and can improve affordability by protecting people from purchasing drugs in the private sector. However, it may result in a parallel system, whereby the poor cannot access drugs if these are not available in the budget pharmacy. Equity is a concern in the absence of an adequate mechanism to protect the poor from catastrophic health expenditure.

Access to hepatitis C medicines

PubMed Central

Coppens, Delphi GM; Prasad, Tara L; Rook, Laurien A; Iyer, Jayasree K

2015-01-01

Abstract Hepatitis C is a global epidemic. Worldwide, 185 million people are estimated to be infected, most of whom live in low- and middle-income countries. Recent advances in the development of antiviral drugs have produced therapies that are more effective, safer and better tolerated than existing treatments for the disease. These therapies present an opportunity to curb the epidemic, provided that they are affordable, that generic production of these medicines is scaled up and that awareness and screening programmes are strengthened. Pharmaceutical companies have a central role to play. We examined the marketed products, pipelines and access to medicine strategies of 20 of the world’s largest pharmaceutical companies. Six of these companies are developing medicines for hepatitis C: AbbVie, Bristol-Myers Squibb, Gilead, Johnson & Johnson, Merck & Co. and Roche. These companies employ a range of approaches to supporting hepatitis C treatment, including pricing strategies, voluntary licensing, capacity building and drug donations. We give an overview of the engagement of these companies in addressing access to hepatitis C products. We suggest actions companies can take to play a greater role in curbing this epidemic: (i) prioritizing affordability assessments; (ii) developing access strategies early in the product lifecycle; and (iii) licensing to manufacturers of generic medicines. PMID:26549908

Access to hepatitis C medicines.

PubMed

Edwards, Danny J; Coppens, Delphi Gm; Prasad, Tara L; Rook, Laurien A; Iyer, Jayasree K

2015-11-01

Hepatitis C is a global epidemic. Worldwide, 185 million people are estimated to be infected, most of whom live in low- and middle-income countries. Recent advances in the development of antiviral drugs have produced therapies that are more effective, safer and better tolerated than existing treatments for the disease. These therapies present an opportunity to curb the epidemic, provided that they are affordable, that generic production of these medicines is scaled up and that awareness and screening programmes are strengthened. Pharmaceutical companies have a central role to play. We examined the marketed products, pipelines and access to medicine strategies of 20 of the world's largest pharmaceutical companies. Six of these companies are developing medicines for hepatitis C: AbbVie, Bristol-Myers Squibb, Gilead, Johnson & Johnson, Merck & Co. and Roche. These companies employ a range of approaches to supporting hepatitis C treatment, including pricing strategies, voluntary licensing, capacity building and drug donations. We give an overview of the engagement of these companies in addressing access to hepatitis C products. We suggest actions companies can take to play a greater role in curbing this epidemic: (i) prioritizing affordability assessments; (ii) developing access strategies early in the product lifecycle; and (iii) licensing to manufacturers of generic medicines.

Essential Medicines: An Indian Perspective

PubMed Central

Maiti, Rituparna; Bhatia, Vikas; Padhy, Biswa Mohan; Hota, Debasish

2015-01-01

The concept of defining essential medicines and establishing a list of them was aimed to improve the availability of affordable medicines for the world's poor. Access to essential medicines is a major determinant of health outcomes. Several countries have made substantial progress towards increasing access to essential medicines, but access to essential medicines in developing countries like India is not adequate. In this review we have tried to present the Indian scenario in respect to availability and accessibility of essential medicines over last one decade. To enhance the credibility of Indian healthcare system, procurement and delivery systems of essential medicines have to be strengthened through government commitment, careful selection, adequate public sector financing, efficient distribution systems, control on taxes and duties, and inculcating a culture of rational use of medicines in current and future prescribers. PMID:26435594

The Impact of the Affordable Care Act on Funding for Newborn Screening Services.

PubMed

Costich, Julia F; Durst, Andrea L

2016-01-01

The Affordable Care Act requires most health plans to cover the federal Recommended Uniform Screening Panel of newborn screening (NBS) tests with no cost sharing. However, state NBS programs vary widely in both the number of mandated tests and their funding mechanisms, including a combination of state laboratory fees, third-party billing, and other federal and state funding. We assessed the potential impact of the Affordable Care Act coverage mandate on states' NBS funding. We performed an extensive review of the refereed literature, federal and state agency reports, relevant organizations' websites, and applicable state laws and regulations; interviewed 28 state and federal officials from August to December 2014; and then assessed the interview findings manually. Although a majority of states had well-established systems for including laboratory-based NBS tests in bundled charges for newborn care, billing practices for critical congenital heart disease and newborn hearing tests were less uniform. Most commonly, birthing facilities either prepaid the costs of laboratory-based tests when acquiring the filter paper kits, or the facilities paid for the tests when the kits were submitted. Some states had separate arrangements for billing Medicaid, and smaller facilities sometimes contracted with hearing test vendors that billed families separately. Although the Affordable Care Act coverage mandate may offset some state NBS funding for the screenings themselves, federal support is still required to assure access to the full range of NBS program services. Limiting reimbursement to the costs of screening tests alone would undermine the common practice of using screening charges to fund follow-up services counseling, and medical food or formula, particularly for low-income families.

An international analysis of cigarette affordability

PubMed Central

Blecher, E; van Walbeek, C P

2004-01-01

Objective: To investigate how affordable cigarettes are in developed and developing countries, and to calculate by how much the affordability of cigarettes has changed between 1990 and 2001; and secondly, to investigate the relation between cigarette affordability and consumption. Design: Affordability was defined as the cost of cigarettes relative to per capita income. Trends in cigarette affordability, and affordability elasticities of demand, were estimated using regression techniques. Subjects: Seventy countries were investigated, of which 28 are categorised as high income developed countries, while 42 are categorised as developing countries. Cigarette prices were obtained for the main city/cities in the countries. Results: Despite the fact that cigarettes are more expensive in developed countries, the high levels of income make cigarettes more affordable in these countries vis-à-vis developing countries. Of the 28 developed countries, cigarettes became more affordable in 11 and less affordable in 17 countries during the 1990s. Of the 42 developing countries, cigarettes became more affordable in 24 and less affordable in 18 countries. Based on a cross sectional analysis, a 1% increase in the relative income price (the inverse of cigarette affordability) is expected to decrease cigarette consumption by between 0.49–0.57%. Conclusions: Cigarette affordability, more than just the price, determines cigarette consumption. While cigarettes have become more affordable in many developing countries, some developing countries (for example, South Africa, Poland, and Thailand) have implemented strong and effective tobacco control policies, and have been able to decrease cigarette consumption as a result. PMID:15564616

Affordability of the Health Expenditures of Insured Americans Before the Affordable Care Act.

PubMed

Nyman, John A; Trenz, Helen M

2016-02-01

Central to the Affordable Care Act is the notion of affordability and the role of health insurance in making otherwise unaffordable health care affordable. We used data from the 1996 to 2008 versions of the Medical Expenditure Panel Survey to estimate the portion of overall health care expenditures by insured respondents that would otherwise have been beyond their disposable incomes and assets. We found that about one third of insured expenditures would have been unaffordable, with a much higher percentage among publicly insured individuals. This result suggests that one of the main functions of insurance is to cover expenses that insured individuals would not otherwise be able to afford.

The Patient Protection and Affordable Care Act: A Primer for Hand Surgeons

PubMed Central

Adkinson, Joshua M.; Chung, Kevin C.

2014-01-01

The Affordable Care Act is the largest and most comprehensive overhaul of the United States healthcare industry since the inception of the Medicare and Medicaid. Contained within the 10 Titles are a multitude of provisions that will change how hand surgeons practice medicine and how they are reimbursed. It is imperative that surgeons are equipped with the knowledge of how this law will affect all physician practices and hospitals. PMID:25066853

Nanotechnology on a dime: building affordable research facilities

NASA Astrophysics Data System (ADS)

DiBattista, Jeff; Clare, Donna; Lynch, David

2005-08-01

Designing buildings to house nanotechnology research presents a multitude of well-recognized challenges to architectural and engineering design teams, from environmental control to spatial arrangements to operational functionality. These technical challenges can be solved with relative ease on projects with large budgets: designers have the option of selecting leading-edge systems without undue regard for their expense. This is reflected in the construction cost of many nanotechnology research facilities that run well into the hundreds of millions of dollars. Smaller universities and other institutions need not be shut out of the nanotechnology research field simply because their construction budgets are tens of millions of dollars or less. The key to success for these less expensive projects lies with making good strategic decisions: identifying priorities for the facility in terms of what it will is--and will not--provide to the researchers. Making these strategic decisions puts bounds on the tactical, technical problems that the design team at large must address, allowing them to focus their efforts on the key areas for success. The process and challenges of this strategic decision-making process are examined, with emphasis placed on the types of decisions that must be made and the factors that must be considered when making them. Case study examples of projects undertaken at the University of Alberta are used to illustrate how strategic-level decision-making sets the stage for cutting-edge success on a modest budget.

Paying for Cures: Perspectives on Solutions to the "Affordability Issue".

PubMed

Schaffer, Sarah Karlsberg; Messner, Donna; Mestre-Ferrandiz, Jorge; Tambor, Ellen; Towse, Adrian

2018-03-01

Curative therapies and other medicines considered "game-changing" in terms of health gain can be accompanied by high demand and high list prices that pose budget challenges to public and private payers and health systems-the so-called affordability issue. These challenges are exacerbated when longer term effectiveness, and thus value for money, is uncertain, but they can arise even when treatments are proven to be highly cost-effective at the time of launch. This commentary reviews innovative payment solutions proposed in the literature to address the affordability issue, including the use of credit markets and of staged payments linked to patient outcomes, and draws on discussions with payers in the United States and Europe on the feasibility or desirability of operationalizing any of the alternative financing and payment strategies that appear in the literature. This included a small number of semistructured interviews. We conclude that there is a mismatch between the enthusiasm in the academic literature for developing new approaches and the scepticism of payers that they can work or are necessary. For the foreseeable future, affordability pressures will continue to be handled by aggressive price bargaining, high co-pays (in systems in which this is possible), and restricting access to subgroups of patients. Of the mechanisms we explored, outcomes-based payments were of most interest to payers, but the costs associated with operating such schemes, together with implementation challenges, did not make them an attractive option for managing affordability. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

A Single-use Strategy to Enable Manufacturing of Affordable Biologics.

PubMed

Jacquemart, Renaud; Vandersluis, Melissa; Zhao, Mochao; Sukhija, Karan; Sidhu, Navneet; Stout, Jim

2016-01-01

The current processing paradigm of large manufacturing facilities dedicated to single product production is no longer an effective approach for best manufacturing practices. Increasing competition for new indications and the launch of biosimilars for the monoclonal antibody market have put pressure on manufacturers to produce at lower cost. Single-use technologies and continuous upstream processes have proven to be cost-efficient options to increase biomass production but as of today the adoption has been only minimal for the purification operations, partly due to concerns related to cost and scale-up. This review summarizes how a single-use holistic process and facility strategy can overcome scale limitations and enable cost-efficient manufacturing to support the growing demand for affordable biologics. Technologies enabling high productivity, right-sized, small footprint, continuous, and automated upstream and downstream operations are evaluated in order to propose a concept for the flexible facility of the future.

Patent and Exclusivity Status of Essential Medicines for Non-Communicable Disease

PubMed Central

Mackey, Tim K.; Liang, Bryan A.

2012-01-01

Objective The threat of non-communicable diseases (“NCDs”) is increasingly becoming a global health crisis and are pervasive in high, middle, and low-income populations resulting in an estimated 36 million deaths per year. There is a need to assess intellectual property rights (“IPRs”) that may impede generic production and availability and affordability to essential NCD medicines. Methods Using the data sources listed below, the study design systematically eliminated NCD drugs that had no patent/exclusivity provisions on API, dosage, or administration route. The first step identified essential medicines that treat certain high disease burden NCDs. A second step examined the patent and exclusivity status of active ingredient, dosage and listed route of administration using exclusion criteria outlined in this study. Materials We examined the patent and exclusivity status of medicines listed in the World Health Organization’s (“WHO”) Model List of Essential Drugs (Medicines) (“MLEM”) and other WHO sources for drugs treating certain NCDs. i.e., cardiovascular and respiratory disease, cancers, and diabetes. We utilized the USA Food and Drug Administration Orange Book and the USA Patent and Trademark Office databases as references given the predominant number of medicines registered in the USA. Results Of the 359 MLEM medicines identified, 22% (79/359) address targeted NCDs. Of these 79, only eight required in-depth patent or exclusivity assessment. Upon further review, no NCD MLEM medicines had study patent or exclusivity protection for reviewed criteria. Conclusions We find that ensuring availability and affordability of potential generic formulations of NCD MLEM medicines appears to be more complex than the presence of IPRs with API, dosage, or administration patent or exclusivity protection. Hence, more sophisticated analysis of NCD barriers to generic availability and affordability should be conducted in order to ensure equitable access to global

Patent and exclusivity status of essential medicines for non-communicable disease.

PubMed

Mackey, Tim K; Liang, Bryan A

2012-01-01

The threat of non-communicable diseases ("NCDs") is increasingly becoming a global health crisis and are pervasive in high, middle, and low-income populations resulting in an estimated 36 million deaths per year. There is a need to assess intellectual property rights ("IPRs") that may impede generic production and availability and affordability to essential NCD medicines. Using the data sources listed below, the study design systematically eliminated NCD drugs that had no patent/exclusivity provisions on API, dosage, or administration route. The first step identified essential medicines that treat certain high disease burden NCDs. A second step examined the patent and exclusivity status of active ingredient, dosage and listed route of administration using exclusion criteria outlined in this study. We examined the patent and exclusivity status of medicines listed in the World Health Organization's ("WHO") Model List of Essential Drugs (Medicines) ("MLEM") and other WHO sources for drugs treating certain NCDs. i.e., cardiovascular and respiratory disease, cancers, and diabetes. We utilized the USA Food and Drug Administration Orange Book and the USA Patent and Trademark Office databases as references given the predominant number of medicines registered in the USA. Of the 359 MLEM medicines identified, 22% (79/359) address targeted NCDs. Of these 79, only eight required in-depth patent or exclusivity assessment. Upon further review, no NCD MLEM medicines had study patent or exclusivity protection for reviewed criteria. We find that ensuring availability and affordability of potential generic formulations of NCD MLEM medicines appears to be more complex than the presence of IPRs with API, dosage, or administration patent or exclusivity protection. Hence, more sophisticated analysis of NCD barriers to generic availability and affordability should be conducted in order to ensure equitable access to global populations for these essential medicines.

Herbal medicine use among hypertensive patients attending public and private health facilities in Freetown Sierra Leone.

PubMed

James, Peter Bai; Kamara, Halimatu; Bah, Abdulai Jawo; Steel, Amie; Wardle, Jon

2018-05-01

This study aimed to determine the prevalence, determinants and pattern of herbal medicine use among hypertensive patients in Freetown. We conducted a cross-sectional study among hypertensive patients attending public and private health facilities in Freetown, Sierra Leone between August and October 2016. We analyzed the data using SPSS version 24. We used Chi-square, Fisher exact two-tailed test and regression analysis for data analysis. A p-value less than 0.05 was considered statistically significant. Out of 260 study participants, over half (n = 148, 56.9%) reported using herbal medicine for the treatment of hypertension alone or together with comorbid condition(s). The most commonly used herbal medicine among users were honey (n = 89, 33.3%), moringa (n = 80, 30.0%) and garlic (n = 73, 27.3%). No significant difference existed between users and non-users of herbal medicine with regards to socio-demographic and health-related factors. The majority (n = 241, 92.7%) of respondents considered herbal medicine beneficial if it was recommended by a healthcare provider yet 85.1% (n = 126) did not disclose their herbal medicine use to their health care provider. There is a high use of herbal medicines among hypertensive patients in Freetown, Sierra Leone. It is essential for healthcare providers to take heed of the findings of this study and routinely ask their patients about their herbal medicine use status. Such practice will provide the opportunity to discuss the benefits and risks of herbal medicine use with the aim of maximizing patient desired therapeutic outcomes. Copyright © 2018 Elsevier Ltd. All rights reserved.

Emerging Affordances in Telecollaborative Multimodal Interactions

ERIC Educational Resources Information Center

Dey-Plissonneau, Aparajita; Blin, Françoise

2016-01-01

Drawing on Gibson's (1977) theory of affordances, Computer-Assisted Language Learning (CALL) affordances are a combination of technological, social, educational, and linguistic affordances (Blin, 2016). This paper reports on a preliminary study that sought to identify the emergence of affordances during an online video conferencing session between…

Artemisinin, a miracle of traditional Chinese medicine.

PubMed

Kong, Ling Yi; Tan, Ren Xiang

2015-12-19

The 2015 Nobel Prize in Physiology or Medicine, shared by Professor Youyou Tu, focused worldwide attention on artemisinin, a natural product antimalarial drug inspired by traditional Chinese medicine (TCM). This is the first Nobel Prize in natural sciences presented to a Chinese scientist for her impactful research work in China in collaboration with other Chinese scientists. We are delighted to provide the background and implications of the discovery of artemisinin, along with our personal viewpoints toward the affordability of modern medicines from natural products.

[Structure of pain management facilities in Germany : Classification of medical and psychological pain treatment services-Consensus of the Joint Commission of the Professional Societies and Organizations for Quality in Pain Medicine].

PubMed

Müller-Schwefe, G H H; Nadstawek, J; Tölle, T; Nilges, P; Überall, M A; Laubenthal, H J; Bock, F; Arnold, B; Casser, H R; Cegla, T H; Emrich, O M D; Graf-Baumann, T; Henning, J; Horlemann, J; Kayser, H; Kletzko, H; Koppert, W; Längler, K H; Locher, H; Ludwig, J; Maurer, S; Pfingsten, M; Schäfer, M; Schenk, M; Willweber-Strumpf, A

2016-06-01

On behalf of the Medical/Psychological Pain Associations, Pain Patients Alliance and the Professional Association of Pain Physicians and Psychologists, the Joint Commission of Professional Societies and Organizations for Quality in Pain Medicine, working in close collaboration with the respective presidents, has developed verifiable structural and process-related criteria for the classification of medical and psychological pain treatment facilities in Germany. Based on the established system of graded care in Germany and on existing qualifications, these criteria also argue for the introduction of a basic qualification in pain medicine. In addition to the first-ever comprehensive description of psychological pain facilities, the criteria presented can be used to classify five different levels of pain facilities, from basic pain management facilities, to specialized institutions, to the Centre for Interdisciplinary Pain Medicine. The recommendations offer binding and verifiable criteria for quality assurance in pain medicine and improved pain treatment.

The patient protection and Affordable Care Act: a primer for hand surgeons.

PubMed

Adkinson, Joshua M; Chung, Kevin C

2014-08-01

The Affordable Care Act is the largest and most comprehensive overhaul of the United States health care industry since the inception of the Medicare and Medicaid. Contained within the 10 titles are a multitude of provisions that will change how hand surgeons practice medicine and how they are reimbursed. It is imperative that surgeons are equipped with the knowledge of how this law will affect all physician practices and hospitals. Copyright © 2014 Elsevier Inc. All rights reserved.

Undocumented and uninsured: aftereffects of the Patient Protection and Affordable Care Act.

PubMed

Agabin, Nataly; Coffin, Janis

2015-01-01

Although with the implementation of the Patient Protection and Affordable Care Act millions of previously uninsured American residents will gain access to healthcare coverage, millions more will remain uninsured due to the lack of mandatory state Medicaid expansion as well as mandates that forbid undocumented immigrants and legal residents of less than five years from purchasing insurance through the newly available market exchange. With limited options for healthcare coverage due to employment and lack of citizen status, undocumented immigrants rely heavily on funds provided by both Emergency Medicaid and Disproportionate Share Hospital programs. Through reevaluation of current funding, mandates forbidding access to market exchanges, and plans to further enable access to affordable health coverage, states have the unique opportunity to both aid their residents and relieve the financial burden on healthcare facilities and Emergency Medicaid funds.

Perceiving Affordances for Fitting through Apertures

ERIC Educational Resources Information Center

Ishak, Shaziela; Adolph, Karen E.; Lin, Grace C.

2008-01-01

Affordances--possibilities for action--are constrained by the match between actors and their environments. For motor decisions to be adaptive, affordances must be detected accurately. Three experiments examined the correspondence between motor decisions and affordances as participants reached through apertures of varying size. A psychophysical…

Graduates' Perceptions of Learning Affordances in Longitudinal Integrated Clerkships: A Dual-Institution, Mixed-Methods Study.

PubMed

Latessa, Robyn A; Swendiman, Robert A; Parlier, Anna Beth; Galvin, Shelley L; Hirsh, David A

2017-09-01

The authors explored affordances that contribute to participants' successful learning in longitudinal integrated clerkships (LICs). This dual-institutional, mixed-methods study included electronic surveys and semistructured interviews of LIC graduates who completed their core clinical (third) year of medical school. These LIC graduates took part in LICs at Harvard Medical School from 2004 to 2013 and the University of North Carolina School of Medicine-Asheville campus from 2009 to 2013. The survey questions asked LIC graduates to rate components of LICs that they perceived as contributing to successful learning. A research assistant interviewed a subset of study participants about their learning experiences. The authors analyzed aggregate data quantitatively and performed a qualitative content analysis on interview data. The graduates reported multiple affordances that they perceive contributed to successful learning in their LIC. The most reported components included continuity and relationships with preceptors, patients, place, and peers, along with integration of and flexibility within the curriculum. As LIC models grow in size and number, and their structures and processes evolve, learners' perceptions of affordances may guide curriculum planning. Further research is needed to investigate to what degree and by what means these affordances support learning in LICs and other models of clinical education.

[Affordability and availability of drugs for treatment of chronic diseases in the public health care system].

PubMed

Helfer, Ana Paula; Camargo, Aline Lins; Tavares, Noemia Urruth Leão; Kanavos, Panos; Bertoldi, Andréa Dâmaso

2012-03-01

To assess the affordability by workers of drugs used for treatment of chronic diseases, as well as the availability of the reference, similar, or generic forms of these drugs in the public health care system. We employed the methodology recommended by the World Health Organization (WHO) and Health Action International (HAI) for the standardized collection of information on selling prices in the private sector and availability in the public health care system of drugs in six cities in the state of Rio Grande do Sul, Brazil. Data were collected from November 2008 to January 2009. Affordability was estimated as the number of salary days required for a worker receiving the national minimum wage to buy, in a private pharmacy, the amount of medication required for one month of treatment. Availability was assessed by the presence of these drugs in public health care system facilities. Twenty-two public facilities and 30 private pharmacies were studied. Of 21 drugs used for the treatment of seven chronic disorders, only nine were available free of charge in the six cities. Mean availability ranged from 83.3% (São Leopoldo) to 97.6% (Caxias do Sul). Affordability ranged from 0.4 to 10.5 salary days for reference drugs, 0.2 to 8.4 salary days for similar drugs, and 0.3 to 3.8 salary days for generic drugs. The overall availability of the drugs surveyed was higher than the 80% recommended by WHO. However, some treatments were not available, or had limited availability in the public system. Concerning affordability, the number of salary days required to buy these drugs may affect the continuation of drug treatments for chronic diseases.

Medicine procurement in hospital pharmacies of Nepal: A qualitative study based on the Basel Statements.

PubMed

Shrestha, Mina; Moles, Rebekah; Ranjit, Eurek; Chaar, Betty

2018-01-01

Accessibility and affordability of evidence-based medicines are issues of global concern. For low-income countries like Nepal, it is crucial to have easy and reliable access to affordable, good-quality, evidence-based medicines, especially in the aftermath of natural or manmade disasters. Availability of affordable and evidence-based high quality medicines depends on the medicine procurement procedure, which makes it an important aspect of healthcare delivery. In this study, we aimed to investigate medicine procurement practices in hospital pharmacies of Nepal within the framework of International Pharmaceutical Federation [FIP] hospital pharmacy guidelines "the Basel Statements". We conducted semi-structured interviews with hospital pharmacists or procurement officers in hospital pharmacies of four major regions in Nepal to explore procurement practices. Data were collected until saturation of themes, analysed using the framework approach, and organised around the statements within the procurement theme of the Basel Statements. Interviews conducted with 53 participants revealed that the procurement guidelines of the Basel Statements were adopted to a certain extent in hospital pharmacies of Nepal. It was found that the majority of hospital pharmacies in Nepal reported using an expensive direct-procurement model for purchasing medicines. Most had no formulary and procured medicines solely based on doctors' prescriptions, which were heavily influenced by pharmaceutical companies' marketing strategies. Whilst most procured only registered medicines, a minority reported purchasing unregistered medicines through unauthorised supply-chains. And although the majority of hospital pharmacies had some contingency plans for managing medicine shortages, a few had none. Procurement guidelines of the Basel Statements were thus found to be partially adopted; however, there is room for improvement in current procurement practices in hospital pharmacies of Nepal. Adoption and

Medicine procurement in hospital pharmacies of Nepal: A qualitative study based on the Basel Statements

PubMed Central

Ranjit, Eurek

2018-01-01

Background Accessibility and affordability of evidence-based medicines are issues of global concern. For low-income countries like Nepal, it is crucial to have easy and reliable access to affordable, good-quality, evidence-based medicines, especially in the aftermath of natural or manmade disasters. Availability of affordable and evidence-based high quality medicines depends on the medicine procurement procedure, which makes it an important aspect of healthcare delivery. In this study, we aimed to investigate medicine procurement practices in hospital pharmacies of Nepal within the framework of International Pharmaceutical Federation [FIP] hospital pharmacy guidelines “the Basel Statements”. Method We conducted semi-structured interviews with hospital pharmacists or procurement officers in hospital pharmacies of four major regions in Nepal to explore procurement practices. Data were collected until saturation of themes, analysed using the framework approach, and organised around the statements within the procurement theme of the Basel Statements. Results Interviews conducted with 53 participants revealed that the procurement guidelines of the Basel Statements were adopted to a certain extent in hospital pharmacies of Nepal. It was found that the majority of hospital pharmacies in Nepal reported using an expensive direct-procurement model for purchasing medicines. Most had no formulary and procured medicines solely based on doctors’ prescriptions, which were heavily influenced by pharmaceutical companies’ marketing strategies. Whilst most procured only registered medicines, a minority reported purchasing unregistered medicines through unauthorised supply-chains. And although the majority of hospital pharmacies had some contingency plans for managing medicine shortages, a few had none. Conclusions Procurement guidelines of the Basel Statements were thus found to be partially adopted; however, there is room for improvement in current procurement practices in

Changes in Young Adult Primary Care Under the Affordable Care Act

PubMed Central

Ford, Carol A.; French, Benjamin; Rubin, David M.

2015-01-01

Objectives. We sought to describe changes in young adults’ routine care and usual sources of care (USCs), according to provider specialty, after implementation of extended dependent coverage under the Affordable Care Act (ACA) in 2010. Methods. We used Medical Expenditure Panel Survey data from 2006 to 2012 to examine young adults’ receipt of routine care in the preceding year, identification of a USC, and USC provider specialties (pediatrics, family medicine, internal medicine, and obstetrics and gynecology). Results. The percentage of young adults who sought routine care increased from 42.4% in 2006 to 49.5% in 2012 (P < .001). The percentage identifying a USC remained stable at approximately 60%. Among young adults with a USC, there was a trend between 2006 and 2012 toward increasing percentages with pediatric (7.6% vs 9.1%) and family medicine (75.9% vs 80.9%) providers and declining percentages with internal medicine (11.5% vs 7.6%) and obstetrics and gynecology (5.0% vs 2.5%) providers. Conclusions. Efforts under the ACA to increase health insurance coverage had favorable effects on young adults’ use of routine care. Monitoring routine care use and USC choices in this group can inform primary care workforce needs and graduate medical education priorities across specialties. PMID:26447914

Traditional Medicines in Africa: An Appraisal of Ten Potent African Medicinal Plants

PubMed Central

Mahomoodally, M. Fawzi

2013-01-01

The use of medicinal plants as a fundamental component of the African traditional healthcare system is perhaps the oldest and the most assorted of all therapeutic systems. In many parts of rural Africa, traditional healers prescribing medicinal plants are the most easily accessible and affordable health resource available to the local community and at times the only therapy that subsists. Nonetheless, there is still a paucity of updated comprehensive compilation of promising medicinal plants from the African continent. The major focus of the present review is to provide an updated overview of 10 promising medicinal plants from the African biodiversity which have short- as well as long-term potential to be developed as future phytopharmaceuticals to treat and/or manage panoply of infectious and chronic conditions. In this endeavour, key scientific databases have been probed to investigate trends in the rapidly increasing number of scientific publications on African traditional medicinal plants. Within the framework of enhancing the significance of traditional African medicinal plants, aspects such as traditional use, phytochemical profile, in vitro, in vivo, and clinical studies and also future challenges pertaining to the use of these plants have been explored. PMID:24367388

MEASUREMENTS OF THE IONISING RADIATION LEVEL AT A NUCLEAR MEDICINE FACILITY PERFORMING PET/CT EXAMINATIONS.

PubMed

Tulik, P; Kowalska, M; Golnik, N; Budzynska, A; Dziuk, M

2017-05-01

This paper presents the results of radiation level measurements at workplaces in a nuclear medicine facility performing PET/CT examinations. This study meticulously determines the staff radiation exposure in a PET/CT facility by tracking the path of patient movement. The measurements of the instantaneous radiation exposure were performed using an electronic radiometer with a proportional counter that was equipped with the option of recording the results on line. The measurements allowed for visualisation of the staff's instantaneous exposure caused by a patient walking through the department after the administration of 18F-FDG. An estimation of low doses associated with each working step and the exposure during a routine day in the department was possible. The measurements were completed by determining the average radiation level using highly sensitive thermoluminescent detectors. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Urban-rural inequality regarding drug prescriptions in primary care facilities - a pre-post comparison of the National Essential Medicines Scheme of China.

PubMed

Yao, Qiang; Liu, Chaojie; Ferrier, J Adamm; Liu, Zhiyong; Sun, Ju

2015-07-30

To assess the impact of the National Essential Medicines Scheme (NEMS) with respect to urban-rural inequalities regarding drug prescriptions in primary care facilities. A stratified two-stage random sampling strategy was used to sample 23,040 prescriptions from 192 primary care facilities from 2009 to 2010. Difference-in-Difference (DID) analyses were performed to test the association between NEMS and urban-rural gaps in prescription patterns. Between-Group Variance and Theil Index were calculated to measure urban-rural absolute and relative disparities in drug prescriptions. The use of the Essential Medicines List (EML) achieved a compliance rate of up to 90% in both urban and rural facilities. An overall reduction of average prescription cost improved economic access to drugs for patients in both areas. However, we observed an increased urban-rural disparity in average expenditure per prescription. The rate of antibiotics and glucocorticoids prescription remained high, despite a reduced disparity between urban and rural facilities. The average incidence of antibiotic prescription increased slightly in urban facilities (62 to 63%) and reduced in rural facilities (67% to 66%). The urban-rural disparity in the use of parenteral administration (injections and infusions) increased, albeit at a high level in both areas (44%-52%). NEMS interventions are effective in reducing the overall average prescription costs. Despite the increased use of the EML, indicator performances with respect to rational drug prescribing and use remain poor and exceed the WHO/INRUD recommended cutoff values and worldwide benchmarks. There is an increased gap between urban and rural areas in the use of parenteral administration and expenditure per prescription.

Social affordances and the possibility of ecological linguistics.

PubMed

Kono, Tetsuya

2009-12-01

This paper includes an effort to extend the notion of affordance from a philosophical point of view the importance of ecological approach for social psychology, ethics, and linguistics. Affordances are not always merely physical but also interpersonal and social. I will conceptualize affordance in general and social affordance in particular, and will elucidate the relation between intentional action and affordances, and that between affordances and free will. I will also focus on the relation between social institution and affordance. An extended theory of affordances can provide a way to analyze in concrete ways how social institution works as an implicit background of interpersonal interactions. Ecological approach considers social institution as the producer and maintainer of affordances. Social institutions construct the niches for human beings. Finally, I will argue the possibility of the ecological linguistics. Language is a social institution. The system of signs is the way to articulate and differentiate interpersonal affordances. Language acquires its meaning, i.e. communicative power in the interpersonal interactions, and interpersonal interactions, in turn, develop and are elaborated through the usage of signs. Communication is seen as never aimed to transmit inner ideas to others, but to guide and adjust the behaviors of others thorough articulating the affordance of responsible-ness.

Availability and use of essential medicines in China: manufacturing, supply, and prescribing in Shandong and Gansu provinces.

PubMed

Chen, Wen; Tang, Shenglan; Sun, Jing; Ross-Degnan, Dennis; Wagner, Anita K

2010-07-17

The current health care reform in China launched in 2009 tackles the problem of access to appropriate medicines for its 1.3 billion people by focusing on providing essential medicines to all. To provide evidence for the reform process, we investigated the manufacturing, purchasing, and prescribing of essential medicines in two provinces. We conducted surveys in 2007 of all manufacturers (n = 253) and of 59 purposively selected retail and 63 hospital pharmacies in Shandong and Gansu provinces to assess production and supply of products on the 2004 National Essential Medicines List (NEML), as well as factors underlying decision making about production and supply. We also reviewed prescriptions (n = 5456) in health facilities to calculate standard indicators of appropriate medicines use. Overall, manufacturers in Shandong and Gansu produced only 62% and 50%, respectively, of the essential medicines they were licensed to produce. Of a randomly selected 10% of NEML products, retail pharmacies stocked up to 60% of Western products. Median availability in hospital pharmacies ranged from 19% to 69%. Manufacturer and retail pharmacy managers based decisions on medicines production and stocking on economic considerations, while hospital pharmacy managers cited clinical need. Between 64% and 86% of prescriptions contained an essential medicine. However, overprescribing of antibiotics (34%-77% of prescriptions) and injectables (22%-61%) for adult non-infectious outpatient consultations was common. We found that manufacturers, retail pharmacies, and hospital pharmacies paid limited attention to China's 2004 NEML in their decisions to manufacture, purchase, and stock essential medicines. We also found that prescribing of essential medicines was frequently inappropriate. These results should inform strategies to improve affordable access to essential medicines under the current health care reform.

Affordable orphan drugs: a role for not-for-profit organizations.

PubMed

Davies, Elin H; Fulton, Emma; Brook, Daniel; Hughes, Dyfrig A

2017-07-01

The success of the Regulation on Orphan Medicinal Products in the European Union is evidenced by the 127 orphan drugs that have had market authorization since 2000. However, the incentives aimed at stimulating research and development have had the unintended consequence of increasing drug cost, resulting in many orphan drugs not being cost-effective. Orphan drugs command an increasing share of the pharmaceutical market and account for a disproportionate amount of healthcare expenditure. Orphan drug ownership by socially motivated, not-for-profit organizations may facilitate access to more affordable orphan drugs, for the benefit of patients and healthcare systems alike. This study aims to describe opportunities for such organizations to become orphan drug Market Authorization Holders. We reviewed data on the ownership of EMA designated and approved orphan drugs, identified funding opportunities and business models for not-for-profit organizations, and summarised relevant legal and policy documents concerning intellectual property rights and drug regulation. Using repurposed drugs as a paradigm, this narrative review navigates the regulatory hurdles, describes the legal context and identifies funding opportunities, in a bid to facilitate and encourage not-for-profit organizations to lead on the development of affordable orphan drugs. Although the regulatory steps required to obtain an MA for an orphan drug are numerous and challenging, they are not insurmountable and can be achieved by not-for-profit organizations that are socially motivated to reduce the costs of orphan drugs to the payers of healthcare. Opportunities for orphan drug development resulting in affordable products lie mainly with repurposed drugs. © 2017 The British Pharmacological Society.

Affordable Care Act Impact on Medicaid Coverage of Smoking-Cessation Treatments.

PubMed

McMenamin, Sara B; Yoeun, Sara W; Halpin, Helen A

2018-04-01

Four sections of the Affordable Care Act address the expansion of Medicaid coverage for recommended smoking-cessation treatments for: (1) pregnant women (Section 4107), (2) all enrollees through a financial incentive (1% Federal Medical Assistance Percentage increase) to offer comprehensive coverage (Section 4106), (3) all enrollees through Medicaid formulary requirements (Section 2502), and (4) Medicaid expansion enrollees (Section 2001). The purpose of this study is to document changes in Medicaid coverage for smoking-cessation treatments since the passage of the Affordable Care Act and to assess how implementation has differentially affected Medicaid coverage policies for: pregnant women, enrollees in traditional Medicaid, and Medicaid expansion enrollees. From January through June 2017, data were collected and analyzed from 51 Medicaid programs (50 states plus the District of Columbia) through a web-based survey and review of benefits documents to assess coverage policies for smoking-cessation treatments. Forty-seven Medicaid programs have increased coverage for smoking-cessation treatments post-implementation of the Affordable Care Act by adopting one or more of the four smoking-cessation treatment provisions. Coverage for pregnant women increased in 37 states, coverage for newly eligible expansion enrollees increased in 32 states, and 15 states added coverage and/or removed copayments in order to apply for a 1% increase in the Federal Medical Assistance Percentage. Coverage for all recommended pharmacotherapy and group and individual counseling increased from seven states in 2009 to 28 states in 2017. The Affordable Care Act was successful in improving and expanding state Medicaid coverage of effective smoking-cessation treatments. Many programs are not fully compliant with the law, and additional guidance and clarification from the Centers for Medicare and Medicaid Services may be needed. Copyright © 2018 American Journal of Preventive Medicine. Published

Does medicaid coverage matter?: A qualitative multi-state study of abortion affordability for low-income women.

PubMed

Dennis, Amanda; Manski, Ruth; Blanchard, Kelly

2014-11-01

Medicaid is designed to ensure low-income populations can afford health care. However, not all health services are covered by the program. Most state Medicaid programs restrict abortion coverage, though a small number of state programs offer such coverage. Little is known about how low-income women are affected by differing Medicaid coverage policies regarding abortion. We conducted in depth interviews with 98 low-income women who had abortions. We found that women's impressions about abortion costs and the availability of Medicaid coverage are generally accurate and that women rely predominantly on abortion facilities for confirmatory cost and coverage information. Additionally, when abortion is out of financial reach, women and the people in their lives experience numerous emotional and financial harms. Policies that aim to ensure abortion is affordable largely prevent these harms, though the availability of Medicaid coverage does not always guarantee access to affordable care. Findings can help advance evidence-based policies

Affordance Equivalences in Robotics: A Formalism

PubMed Central

Andries, Mihai; Chavez-Garcia, Ricardo Omar; Chatila, Raja; Giusti, Alessandro; Gambardella, Luca Maria

2018-01-01

Automatic knowledge grounding is still an open problem in cognitive robotics. Recent research in developmental robotics suggests that a robot's interaction with its environment is a valuable source for collecting such knowledge about the effects of robot's actions. A useful concept for this process is that of an affordance, defined as a relationship between an actor, an action performed by this actor, an object on which the action is performed, and the resulting effect. This paper proposes a formalism for defining and identifying affordance equivalence. By comparing the elements of two affordances, we can identify equivalences between affordances, and thus acquire grounded knowledge for the robot. This is useful when changes occur in the set of actions or objects available to the robot, allowing to find alternative paths to reach goals. In the experimental validation phase we verify if the recorded interaction data is coherent with the identified affordance equivalences. This is done by querying a Bayesian Network that serves as container for the collected interaction data, and verifying that both affordances considered equivalent yield the same effect with a high probability. PMID:29937724

Essential Medicine Utilization and Situation in Selected Ten Developing Countries: A Compendious Audit

PubMed Central

Haque, Mainul

2017-01-01

Medicine improves the quality of life and increases mean age of human beings as it fights against diseases. Accessibility to medicines is the fundamental right of every person. The principle of the essential medicines (EMs) is that a limited number of availability of medicine will promote to a better supply chain and rational prescribing to the rural and remote health centers for any developing countries. Furthermore, it was also expected that this concept will also ensure better procurement policy at lower costs, more in amount, with easier storage. Thereby, EMs will safeguard and improve distribution and dispensing of medicine. Correspondingly, motivational and dedicated training program regarding drug information and adverse drug reactions will boost up access to medicine and health-care. In addition, the selection of medicine from EM is the first step in the direction of the rational use of medicine and progress and ensuring the quality of health care. Thereafter, selection needs to be followed by appropriate use. Everyone should receive the right medicine, in an adequate dose for an adequate duration, with appropriate information and follow-up treatment, and at an affordable cost. The acceptance and implementation of World Health Organization-promoted EM policies in deferent countries have improved quality use of medicine in terms of accessibility and affordability, predominantly in developing countries. The corporations and teamwork among various participants of health care are instantly obligatory to progress equitable access to medicines in low- and middle-income countries. PMID:28852629

Collaborative Paradigm of Preventive, Personalized, and Precision Medicine With Point-of-Care Technologies.

PubMed

Dhawan, Atam P

2016-01-01

Recent advances in biosensors, medical instrumentation, and information processing and communication technologies (ICT) have enabled significant improvements in healthcare. However, these technologies have been mainly applied in clinical environments, such as hospitals and healthcare facilities, under managed care by well-trained and specialized individuals. The global challenge of providing quality healthcare at affordable cost leads to the proposed paradigm of P reventive, Personalized, and Precision Medicine that requires a seamless use of technology and infrastructure support for patients and healthcare providers at point-of-care (POC) locations including homes, semi or pre-clinical facilities, and hospitals. The complexity of the global healthcare challenge necessitates strong collaborative interdisciplinary synergies involving all stakeholder groups including academia, federal research institutions, industry, regulatory agencies, and clinical communities. It is critical to evolve with collaborative efforts on the translation of research to technology development toward clinical validation and potential healthcare applications. This special issue is focused on technology innovation and translational research for POC applications with potential impact in improving global healthcare in the respective areas. Some of these papers were presented at the NIH-IEEE Strategic Conference on Healthcare Innovations and POC Technologies for Precision Medicine (HI-POCT) held at the NIH on November 9-10, 2015. The papers included in the Special Issue provide a spectrum of critical issues and collaborative resources on translational research of advanced POC devices and ICT into global healthcare environment.

Collaborative Paradigm of Preventive, Personalized, and Precision Medicine With Point-of-Care Technologies

PubMed Central

2016-01-01

Recent advances in biosensors, medical instrumentation, and information processing and communication technologies (ICT) have enabled significant improvements in healthcare. However, these technologies have been mainly applied in clinical environments, such as hospitals and healthcare facilities, under managed care by well-trained and specialized individuals. The global challenge of providing quality healthcare at affordable cost leads to the proposed paradigm of P reventive, Personalized, and Precision Medicine that requires a seamless use of technology and infrastructure support for patients and healthcare providers at point-of-care (POC) locations including homes, semi or pre-clinical facilities, and hospitals. The complexity of the global healthcare challenge necessitates strong collaborative interdisciplinary synergies involving all stakeholder groups including academia, federal research institutions, industry, regulatory agencies, and clinical communities. It is critical to evolve with collaborative efforts on the translation of research to technology development toward clinical validation and potential healthcare applications. This special issue is focused on technology innovation and translational research for POC applications with potential impact in improving global healthcare in the respective areas. Some of these papers were presented at the NIH-IEEE Strategic Conference on Healthcare Innovations and POC Technologies for Precision Medicine (HI-POCT) held at the NIH on November 9–10, 2015. The papers included in the Special Issue provide a spectrum of critical issues and collaborative resources on translational research of advanced POC devices and ICT into global healthcare environment. PMID:28560119

What happened to anti-malarial markets after the Affordable Medicines Facility-malaria pilot? Trends in ACT availability, price and market share from five African countries under continuation of the private sector co-payment mechanism.

PubMed

Tougher, Sarah; Hanson, Kara; Goodman, Catherine

2017-04-25

The private sector supplies anti-malarial treatment for large proportions of patients in sub-Saharan Africa. Following the large-scale piloting of the Affordable Medicines Facility-malaria (AMFm) from 2010 to 2011, a private sector co-payment mechanism (CPM) provided continuation of private sector subsidies for quality-assured artemisinin combination therapies (QAACT). This article analyses for the first time the extent to which improvements in private sector QAACT supply and distribution observed during the AMFm were maintained or intensified during continuation of the CPM through 2015 in Kenya, Madagascar, Nigeria, Tanzania and Uganda using repeat cross-sectional outlet survey data. QAACT market share in all five countries increased during the AMFm period (p < 0.001). According to the data from the last ACTwatch survey round, in all study countries except Madagascar, AMFm levels of private sector QAACT availability were maintained or improved. In 2014/15, private sector QAACT availability was greater than 70% in Nigeria (84.3%), Kenya (70.5%), Tanzania (83.0%) and Uganda (77.1%), but only 11.2% in Madagascar. QAACT market share was maintained or improved post-AMFm in Nigeria, Tanzania and Uganda, but statistically significant declines were observed in Kenya and Madagascar. In 2014/5, QAACT market share was highest in Kenya and Uganda (48.2 and 47.5%, respectively) followed by Tanzania (39.2%), Nigeria (35.0%), and Madagascar (7.0%). Four of the five countries experienced significant decreases in median QAACT price during the AMFm period. Private sector QAACT prices were maintained or further reduced in Tanzania, Nigeria and Uganda, but prices increased significantly in Kenya and Madagascar. SP prices were consistently lower than those of QAACT in the AMFm period, with the exception of Kenya and Tanzania in 2011, where they were equal. In 2014/5 QAACT remained two to three times more expensive than the most popular non-artemisinin therapy in all countries except

The Transformation of Ergonomic Affordances into Cultural Affordances: The Case of the Alnuset System

ERIC Educational Resources Information Center

Chiappini, Giampaolo

2012-01-01

Is it possible to study the ergonomic affordances offered by a system designed for educational aims and their transformation into cultural affordances? To this purpose, what references can we adopt? This work describes the theoretical framework used to realise this study referring to AlNuSet, a system realised within the EC ReMath project to…

Patterns in Health Care Access and Affordability Among Cancer Survivors During Implementation of the Affordable Care Act.

PubMed

Nipp, Ryan D; Shui, Amy M; Perez, Giselle K; Kirchhoff, Anne C; Peppercorn, Jeffrey M; Moy, Beverly; Kuhlthau, Karen; Park, Elyse R

2018-06-01

Cancer survivors face ongoing health issues and need access to affordable health care, yet studies examining health care access and affordability in this population are lacking. To evaluate health care access and affordability in a national sample of cancer survivors compared with adults without cancer and to evaluate temporal trends during implementation of the Affordable Care Act. We used data from the National Health Interview Survey from 2010 through 2016 to conduct a population-based study of 30 364 participants aged 18 years or older. We grouped participants as cancer survivors (n = 15 182) and those with no reported history of cancer, whom we refer to as control respondents (n = 15 182), matched on age. We excluded individuals reporting a cancer diagnosis prior to age 18 years and those with nonmelanoma skin cancers. We compared issues with health care access (eg, delayed or forgone care) and affordability (eg, unable to afford medications or health care services) between cancer survivors and control respondents. We also explored trends over time in the proportion of cancer survivors reporting these difficulties. Of the 30 364 participants, 18 356 (57.4%) were women. The mean (SD) age was 63.5 (23.5) years. Cancer survivors were more likely to be insured (14 412 [94.8%] vs 13 978 [92.2%], P < .001) and to have government-sponsored insurance (7266 [44.3%] vs 6513 [38.8%], P < .001) compared with control respondents. In multivariable models, cancer survivors were more likely than control respondents to report delayed care (odds ratio [OR], 1.38; 95% CI, 1.16-1.63), forgone medical care (OR, 1.76; 95% CI, 1.45-2.12), and/or inability to afford medications (OR, 1.77; 95% CI, 1.46-2.14) and health care services (OR, 1.46; 95% CI, 1.27-1.68) (P < .001 for all). From 2010 to 2016, the proportion of survivors reporting delayed medical care decreased each year (B = 0.47; P = .047), and the proportion of those needing and not

Insulin prices, availability and affordability: a cross-sectional survey of pharmacies in Hubei Province, China.

PubMed

Liu, Chenxi; Zhang, Xinping; Liu, Chaojie; Ewen, Margaret; Zhang, Zinan; Liu, Guoqin

2017-08-24

Poor access to affordable insulin results in serious and needless complications and premature deaths for those with diabetes who need this essential medicine. To help address this issue, we assessed insulin availability, prices, affordability and price components in Hubei Province as China has the heaviest burden of diabetes globally. In 2016, insulin availability and price data was collected in the capital and five other cities. A total of 30 public sector outlets (hospitals and primary care institutions) and 30 private pharmacies were sampled, using an adaptation of the World Health Organization/Health Action International methodology, Data was collected for all human and analogue insulins in stock, then analyzed by type (prandial, basal or pre-mixed) and duration of action. Prices were expressed as Median Price Ratios (MPRs) to Australian PBS prices. Price components were tracked for five insulin products in two cities.. Affordability was assessed as the number of days' wages of the lowest paid unskilled government worker needed to purchase 10 ml 100 IU/ml (approximately 30 days' supply). Mean availability was highest in public hospitals for prandial (70%), basal (80%) and pre-mixed insulin (90%). In primary care institutions and private pharmacies mean availability ranged from 10% to 33%. Median prices of all insulin types were higher that Australian PBS prices in all three sectors for human and analogue insulins (ranging from1.36-2.59 times). Patients have to pay 4 to 16 days' wages to purchase a month's treatment depending on the insulin type and sector. The largest component of the patient price was the manufacturers' selling price (60%). Taxes in the form of import duties and VAT are applied in some sectors. The availability of insulin in primary care institutions and private retail pharmacies was very low in Hubei. Only public hospitals had good insulin availability. Insulin prices were high in all sectors making this life-saving medicine unaffordable

Committee on Veterinary Medicine at the Society for Medical Education: Skills Labs in Veterinary Medicine - a brief overview.

PubMed

Dilly, Marc; Gruber, Christian

2016-01-01

Since 2012, skills labs have been set up to teach practical skills at veterinary training facilities in the German-speaking world. In addition to didactic considerations, ethical points of view in terms of animal protection form the basis of the increasing significance of skills labs in veterinary medicine. Not least because of the quality standards in veterinary medicine training which apply across Europe, the link between veterinary medicine training facilities is particularly significant when it comes to the setting up and development of skills labs. The Committee on Veterinary Medicine is therefore not only interested in exchange and cooperation within veterinary medicine, but also sees an opportunity for mutual gain in the link with the Society for Medical Education Committee "Practical Skills".

Affording Sustainability: Adopting a Theory of Affordances as a Guiding Heuristic for Environmental Policy.

PubMed

Kaaronen, Roope O

2017-01-01

Human behavior is an underlying cause for many of the ecological crises faced in the 21st century, and there is no escaping from the fact that widespread behavior change is necessary for socio-ecological systems to take a sustainable turn. Whilst making people and communities behave sustainably is a fundamental objective for environmental policy, behavior change interventions and policies are often implemented from a very limited non-systemic perspective. Environmental policy-makers and psychologists alike often reduce cognition 'to the brain,' focusing only to a minor extent on how everyday environments systemically afford pro-environmental behavior. Symptomatic of this are the widely prevalent attitude-action, value-action or knowledge-action gaps, understood in this paper as the gulfs lying between sustainable thinking and behavior due to lack of affordances. I suggest that by adopting a theory of affordances as a guiding heuristic, environmental policy-makers are better equipped to promote policies that translate sustainable thinking into sustainable behavior, often self-reinforcingly, and have better conceptual tools to nudge our socio-ecological system toward a sustainable turn. Affordance theory, which studies the relations between abilities to perceive and act and environmental features, is shown to provide a systemic framework for analyzing environmental policies and the ecology of human behavior. This facilitates the location and activation of leverage points for systemic policy interventions, which can help socio-ecological systems to learn to adapt to more sustainable habits. Affordance theory is presented to be applicable and pertinent to technically all nested levels of socio-ecological systems from the studies of sustainable objects and households to sustainable urban environments, making it an immensely versatile conceptual policy tool. Finally, affordance theory is also discussed from a participatory perspective. Increasing the fit between local

Affording Sustainability: Adopting a Theory of Affordances as a Guiding Heuristic for Environmental Policy

PubMed Central

Kaaronen, Roope O.

2017-01-01

Human behavior is an underlying cause for many of the ecological crises faced in the 21st century, and there is no escaping from the fact that widespread behavior change is necessary for socio-ecological systems to take a sustainable turn. Whilst making people and communities behave sustainably is a fundamental objective for environmental policy, behavior change interventions and policies are often implemented from a very limited non-systemic perspective. Environmental policy-makers and psychologists alike often reduce cognition ‘to the brain,’ focusing only to a minor extent on how everyday environments systemically afford pro-environmental behavior. Symptomatic of this are the widely prevalent attitude–action, value–action or knowledge–action gaps, understood in this paper as the gulfs lying between sustainable thinking and behavior due to lack of affordances. I suggest that by adopting a theory of affordances as a guiding heuristic, environmental policy-makers are better equipped to promote policies that translate sustainable thinking into sustainable behavior, often self-reinforcingly, and have better conceptual tools to nudge our socio–ecological system toward a sustainable turn. Affordance theory, which studies the relations between abilities to perceive and act and environmental features, is shown to provide a systemic framework for analyzing environmental policies and the ecology of human behavior. This facilitates the location and activation of leverage points for systemic policy interventions, which can help socio–ecological systems to learn to adapt to more sustainable habits. Affordance theory is presented to be applicable and pertinent to technically all nested levels of socio–ecological systems from the studies of sustainable objects and households to sustainable urban environments, making it an immensely versatile conceptual policy tool. Finally, affordance theory is also discussed from a participatory perspective. Increasing the fit

Availability and use of essential medicines in China: manufacturing, supply, and prescribing in Shandong and Gansu provinces

PubMed Central

2010-01-01

Background The current health care reform in China launched in 2009 tackles the problem of access to appropriate medicines for its 1.3 billion people by focusing on providing essential medicines to all. To provide evidence for the reform process, we investigated the manufacturing, purchasing, and prescribing of essential medicines in two provinces. Methods We conducted surveys in 2007 of all manufacturers (n = 253) and of 59 purposively selected retail and 63 hospital pharmacies in Shandong and Gansu provinces to assess production and supply of products on the 2004 National Essential Medicines List (NEML), as well as factors underlying decision making about production and supply. We also reviewed prescriptions (n = 5456) in health facilities to calculate standard indicators of appropriate medicines use. Results Overall, manufacturers in Shandong and Gansu produced only 62% and 50%, respectively, of the essential medicines they were licensed to produce. Of a randomly selected 10% of NEML products, retail pharmacies stocked up to 60% of Western products. Median availability in hospital pharmacies ranged from 19% to 69%. Manufacturer and retail pharmacy managers based decisions on medicines production and stocking on economic considerations, while hospital pharmacy managers cited clinical need. Between 64% and 86% of prescriptions contained an essential medicine. However, overprescribing of antibiotics (34%-77% of prescriptions) and injectables (22%-61%) for adult non-infectious outpatient consultations was common. Conclusions We found that manufacturers, retail pharmacies, and hospital pharmacies paid limited attention to China's 2004 NEML in their decisions to manufacture, purchase, and stock essential medicines. We also found that prescribing of essential medicines was frequently inappropriate. These results should inform strategies to improve affordable access to essential medicines under the current health care reform. PMID:20637116

NREL Research Support Facility (RSF) Documentary

DOE Office of Scientific and Technical Information (OSTI.GOV)

Glover, Bill; Pless, Shanti; Torcellini, Paul

2010-01-01

The ideas and innovations that define NREL are now shaping the next generation of commercial office buildings. DOE's Research Support Facility at NREL, will set a new benchmark for affordable, sustainable commercial design and construction. The unique form of the RSF is driven by energy-saving strategies, many researched and advanced at NREL.

NREL Research Support Facility (RSF) Documentary

ScienceCinema

Glover, Bill; Pless, Shanti; Torcellini, Paul; Judkoff, Ron; Detamore, Drew; Telesmanich, Eric

2017-12-09

The ideas and innovations that define NREL are now shaping the next generation of commercial office buildings. DOE's Research Support Facility at NREL, will set a new benchmark for affordable, sustainable commercial design and construction. The unique form of the RSF is driven by energy-saving strategies, many researched and advanced at NREL.

The prices people pay for medicines in Zimbabwe.

PubMed

Gavaza, P; Simoyi, T; Makunike, B; Maponga, C C

2009-01-01

To collect, analyse and compare prices of medicines in different sectors and parts of the country and to compare them with the medicine prices in other countries. A prospective cross sectional study. Pharmacy outlets in Zimbabwe comprising 27 retail pharmacies, 23 dispensing doctors, eight public hospital pharmacies and seven municipal clinics. Median price ratios, 25th percentiles and 75th percentiles. Innovator brands in the private sector were priced 10 times the International References Prices (IRP) and more than three times the price of generic medicines. Dispensing doctors were charging the highest prices for medicines and the public sector had the least prices. The national procurement agency, NatPharm, procured medicines at prices slightly below the Management Sciences for Health (MSH) prices. Prices of medicines in the public sector were higher than average prices for medicines from seven other African countries. Medicine prices in Zimbabwe are high, a scenario that may compromise affordability and accessibility to medicines especially by the poor. Urgent steps are needed to reduce the level and effect of the high prices on the population, especially the poor.

Identifying priority medicines policy issues for New Zealand: a general inductive study

PubMed Central

Babar, Zaheer-Ud-Din; Francis, Susan

2014-01-01

Objectives To identify priority medicines policy issues for New Zealand. Setting Stakeholders from a broad range of healthcare and policy institutions including primary, secondary and tertiary care. Participants Exploratory, semistructured interviews were conducted with 20 stakeholders throughout New Zealand. Primary and secondary outcome measures The interviews were digitally recorded, transcribed and coded into INVIVO 10, then compared and grouped for similarity of theme. Perceptions, experiences and opinions regarding New Zealand's medicines policy issues were recorded. Results A large proportion of stakeholders appeared to be unaware of New Zealand's (NZ) medicines policy. In general, the policy was considered to offer consistency to guide decision-making. In the context of Pharmaceutical Management Agency's (PHARMAC's) fixed budget for procuring and subsidising medicines, there was reasonable satisfaction with the range of medicines available—rare disorder medicines being the clear exception. Concerns raised were by whom and how decisions are made and whether desired health outcomes are being measured. Other concerns included inconsistencies in evidence and across health technologies. Despite attempts to improve the situation, lower socioeconomic groups (including rural residents) Māori and Pacific ethnicities and people with rare disorders face challenges with regards to accessing medicines. Other barriers include, convenience to and affordability of prescribers and the increase of prescription fees from NZ$3 to NZ$5. Concerns related to the PHARMAC of New Zealand included: a constraining budget; non-transparency of in-house analysis; lack of consistency in recommendations between the Pharmacology and Therapeutics Advisory Committee. Constraints and inefficiencies also exist in the submission process to access high-cost medicines. Conclusions The results suggest reasonable satisfaction with the availability of subsidised medicines. However, some of the

Mapping actions to improve access to medicines for mental disorders in low and middle income countries.

PubMed

Barbui, C; Dua, T; Kolappa, K; Saraceno, B; Saxena, S

2017-10-01

In recent years a number of intergovernmental initiatives have been activated in order to enhance the capacity of countries to improve access to essential medicines, particularly for mental disorders. In May 2013 the 66th World Health Assembly adopted the World Health Organization (WHO) Comprehensive Mental Health Action Plan 2013-2020, which builds upon the work of WHO's Mental Health Gap Action Programme. Within this programme, evidence-based guidelines for mental disorders were developed, including recommendations on appropriate use of medicines. Subsequently, the 67th World Health Assembly adopted a resolution on access to essential medicines, which urged Member States to improve national policies for the selection of essential medicines and to promote their availability, affordability and appropriate use. Following the precedent set by these important initiatives, this article presents eleven actions for improving access and appropriate use of psychotropic medicines. A 4 × 4 framework mapping actions as a function of the four components of access - selection, availability, affordability and appropriate use - and across four different health care levels, three of which belong to the supply side and one to the demand side, was developed. The actions are: developing a medicine selection process; promoting information and education activities for staff and end-users; developing a medicine regulation process; implementing a reliable supply system; implementing a reliable quality-control system; developing a community-based system of mental health care and promoting help-seeking behaviours; developing international agreements on medicine affordability; developing pricing policies and a sustainable financing system; developing or adopting evidence-based guidelines; monitoring the use of psychotropic medicines; promoting training initiatives for staff and end-users on critical appraisal of scientific evidence and appropriate use of psychotropic medicines. Activating

[Quality of medicines in least developed countries].

PubMed

Videau, J Y

2006-12-01

Due to worsening economic conditions and poor enforcement of existing pharmaceutical and customs regulations, third world countries are faced with a growing threat from counterfeit and substandard medicines. With the expansion of illicit markets in urban areas, the sales of medicines of uncertain quality and origin are increasing. Most victims of this illicit trade are among the world's poorest populations that cannot afford to buy quality drugs through private-sector distribution channels. National pharmaceutical programs promoting universal access to essential generic medicines at reasonable cost are the key to curbing this problem. A system based on strict, rational pharmaceutical purchasing and distribution policies with quality assurance at every level of the supply chain is needed to guarantee that patients receive safe effective high quality healthcare products.

Pharmaceutical companies and global lack of access to medicines: strengthening accountability under the right to health.

PubMed

Grover, Anand; Citro, Brian; Mankad, Mihir; Lander, Fiona

2012-01-01

Many medicines currently available on the market are simply too expensive for millions around the world to afford. Many medicines available in the developing world are only available to a small percentage of the population due to economic inequities. The profit-seeking behavior of pharmaceutical companies exacerbates this problem. In most cases, the price reductions required to make drugs affordable to a broader class of people in the developing world are not offset by the resultant increase in sales volume. Simply stated, in most of the developing world, it is more profitable to sell drugs to the very wealthy at high prices than it is to sell cheaper drugs to a greater number of people. As a result, medicines remain unaffordable for the vast majority of people in many parts of the world. While this might be an acceptable outcome for certain commodities, such as luxury goods, it is completely unacceptable for life-saving medicines. Therefore, in order to effectively address the global lack of access to medicines, the role pharmaceutical companies play in the international intellectual property regime must be critically examined. © 2012 American Society of Law, Medicine & Ethics, Inc.

A Bootstrap Approach to an Affordable Exploration Program

NASA Technical Reports Server (NTRS)

Oeftering, Richard C.

2011-01-01

This paper examines the potential to build an affordable sustainable exploration program by adopting an approach that requires investing in technologies that can be used to build a space infrastructure from very modest initial capabilities. Human exploration has had a history of flight programs that have high development and operational costs. Since Apollo, human exploration has had very constrained budgets and they are expected be constrained in the future. Due to their high operations costs it becomes necessary to consider retiring established space facilities in order to move on to the next exploration challenge. This practice may save cost in the near term but it does so by sacrificing part of the program s future architecture. Human exploration also has a history of sacrificing fully functional flight hardware to achieve mission objectives. An affordable exploration program cannot be built when it involves billions of dollars of discarded space flight hardware, instead, the program must emphasize preserving its high value space assets and building a suitable permanent infrastructure. Further this infrastructure must reduce operational and logistics cost. The paper examines the importance of achieving a high level of logistics independence by minimizing resource consumption, minimizing the dependency on external logistics, and maximizing the utility of resources available. The approach involves the development and deployment of a core suite of technologies that have minimum initial needs yet are able expand upon initial capability in an incremental bootstrap fashion. The bootstrap approach incrementally creates an infrastructure that grows and becomes self sustaining and eventually begins producing the energy, products and consumable propellants that support human exploration. The bootstrap technologies involve new methods of delivering and manipulating energy and materials. These technologies will exploit the space environment, minimize dependencies, and

Access to Drugs and Out of Pocket Expenditure in Primary Health Facilities.

PubMed

Thapa, A K; Ghimire, N; Adhikari, S R

2016-09-01

The Government of Nepal promulgated health as a human right via Interim constitution and implemented Free Health Service Program in 2008 as a commitment to universalize basic health care services. So, the aim of this study was to understand reported access to medicine and health care services received by outpatients in public primary facilities. The study followed cross sectional study design. Two hundred and thirty-four For data 234 out patients were interviewed on the day of the field visit in March and October 2014 across 28 primary health facilities of seven purposively selected districts representing three ecological belts and five development regions of the country. Our study revealed that the average number of medicines prescribed per patient was 2.65 per case in primary public health facilities, of which 91.2% were dispensed. Around 86.6% dispensed medicines were appropriately labeled and 84% of outpatients had proper knowledge of dosage and timing of medicine use. Around 55.6% of outpatients purchased some or all prescribed medicines from nearby private facilities which were not available in public facilities. Around 40% of them travelled more than half an hour to reach the facility. The gap in medicines prescribed and dispensed, Out of Pocket expenditure coupled with opportunity cost of travelling, appear as hurdles in access to basic health care services. So increasing free medicines list in public primary facilities with all round the year availability might answer major part of the problem.

European School of Internal Medicine: a window of opportunity for RCP activities in Europe.

PubMed

Davidson, Chris; Higgens, Clare

2009-04-01

The Royal College of Physicians (RCP) is to host the European School of Internal Medicine for two years from 2009-10. This affords a unique opportunity for specialist registrars to exchange ideas about professional development and training and to make contacts with young internists from across Europe. Such links should prove useful for future RCP initiatives in European medicine.

Critical Care Implications of the Affordable Care Act

PubMed Central

Dogra, Anjali P.; Dorman, Todd

2015-01-01

Objectives To provide an overview of key elements of the Affordable Care Act (ACA). To evaluate ways in which the ACA will likely impact the practice of critical care medicine. To describe strategies that may help health systems and providers effectively adapt to changes brought about by the ACA. Data Sources and Synthesis Data sources for this concise review include search results from the PubMed and Embase databases, as well as sources relevant to public policy such as the text of the Patient Protection and Affordable Care Act and reports of the Congressional Budget Office (CBO). As all of the ACA's provisions will not be fully implemented until 2019, we also drew upon cost, population and utilization projections as well as the experience of existing state-based healthcare reforms. Conclusion The ACA represents the furthest reaching regulatory changes in the US healthcare system since the 1965 Medicare and Medicaid provisions of the Social Security Act. The ACA aims to expand health insurance coverage to millions of Americans and place an emphasis on quality and cost-effectiveness of care. From models which link pay and performance to those which center on episodic care, the ACA outlines sweeping changes to health systems, reimbursement structures, and the delivery of critical care. Staffing models that include daily rounding by an intensivist, palliative care integration, and expansion of the role of telemedicine in areas where intensivists are inaccessible are potential strategies that may improve quality and profitability of ICU care in the post-ACA era. PMID:26565630

No Role for Motor Affordances in Visual Working Memory

ERIC Educational Resources Information Center

Pecher, Diane

2013-01-01

Motor affordances have been shown to play a role in visual object identification and categorization. The present study explored whether working memory is likewise supported by motor affordances. Use of motor affordances should be disrupted by motor interference, and this effect should be larger for objects that have motor affordances than for…

12 CFR 1807.400 - Affordable housing-general.

Code of Federal Regulations, 2011 CFR

2011-01-01

... percent of Eligible Project Costs are attributable to housing units that meet the affordability... Project Costs must be attributable to housing units that meet the affordability qualifications set forth...

[The museum of the history of medicine in Varna].

PubMed

Bonnichon, Philippe; Kapincheva, Iskra

2007-01-01

The subject concerns the unrecognised European Bulgaria whose the alone museum of History of Medicine is worth of seeing. The 1869 building is of an ancient hospital which reminds of the hundred-year-old history of the modern Bulgaria. The miscellance of the objects, the strictness and the clearness of the show afford to follow through five rooms the development of Medicine as practice, art and science from Antiquity till the Second World War. The interest stemming from the general character of the museum is underlined by the constant references to the evolution of the Bulgarian Medicine. Then the local specific characteristics could totally integrate into the evolution of European Medicine. The role of France in the education of the first Bulgarian practitioners is worth reminding. The visitors get out of the museum through a delightful garden rich in Medicinal plants.

12 CFR 1291.12 - Affordable Housing Reserve Fund.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Affordable Housing Reserve Fund. 1291.12 Section 1291.12 Banks and Banking FEDERAL HOUSING FINANCE AGENCY HOUSING GOALS AND MISSION FEDERAL HOME LOAN BANKS' AFFORDABLE HOUSING PROGRAM § 1291.12 Affordable Housing Reserve Fund. (a) Deposits. If a...

Delivering High-Quality and Affordable Care Throughout the Cancer Care Continuum

PubMed Central

Shih, Ya-Chen Tina; Ganz, Patricia A.; Aberle, Denise; Abernethy, Amy; Bekelman, Justin; Brawley, Otis; Goodwin, James S.; Hu, Jim C.; Schrag, Deborah; Temel, Jennifer S.; Schnipper, Lowell

2013-01-01

The national cost of cancer care is projected to reach $173 billion by 2020, increasing from $125 billion in 2010. This steep upward cost trajectory has placed enormous an financial burden on patients, their families, and society as a whole and raised major concern about the ability of the health care system to provide and sustain high-quality cancer care. To better understand the cost drivers of cancer care and explore approaches that will mitigate the problem, the National Cancer Policy Forum of the Institute of Medicine held a workshop entitled “Delivering Affordable Cancer Care in the 21st Century” in October 2012. Workshop participants included bioethicists, health economists, primary care physicians, and medical, surgical, and radiation oncologists, from both academic and community settings. All speakers expressed a sense of urgency about the affordability of cancer care resulting from the future demographic trend as well as the high cost of emerging cancer therapies and rapid diffusion of new technologies in the absence to evidence indicating improved outcomes for patients. This article is our summary of presentations at the workshop that highlighted the overuse and underuse of screening, treatments, and technologies throughout the cancer care continuum in oncology practice in the United States. PMID:24127450

What is an affordance? 40 years later.

PubMed

Osiurak, François; Rossetti, Yves; Badets, Arnaud

2017-06-01

About 40 years ago, James J. Gibson coined the term "affordance" to describe the action possibilities offered to an animal by the environment with reference to the animal's action capabilities. Since then, this notion has acquired a multitude of meanings, generating confusion in the literature. Here, we offer a clear operationalization of the concept of affordances and related concepts in the field of tool use. Our operationalization is organized around the distinction between the physical (what is objectively observable) and neurocognitive (what is subjectively experienced) levels. This leads us to propose that motor control (dorso-dorsal system), mechanical knowledge (ventro-dorsal system) and function knowledge (ventral system) could be neurocognitive systems respectively involved in the perception of affordances, the understanding of mechanical actions and the storage of contextual relationships (three action-system model; 3AS). We end by turning to two key issues that can be addressed within 3AS. These issues concern the link between affordances and tool incorporation, and the constraints posed by affordances for tool use. Copyright © 2017 Elsevier Ltd. All rights reserved.

To be an affordable healthy house, case study Medan

NASA Astrophysics Data System (ADS)

Silitonga, Shanty

2018-03-01

House has a paramount meaning in human life. Provision of adequate housing will be able to improve the quality of life. Provision of an affordable house is a major step to fulfilling the needs of houses in the big city. Medan has built a lot of affordable houses, and mostly it takes place in the suburbs. Although the affordable house is for low-income people, it must be worthy of its physical condition, affordable in the budget and healthy for its users. House often saw only as physical alone, the provision of a house only to achieve solely in quantity regardless its quality. This study aims to examine the condition of affordable houses in the suburbs of Medan. The research method used qualitative descriptive, using indicator according to affordable healthy house standard according to the regulation in Indonesia and other related theories. This study took place in Medan by taking three areas in the suburbs of Medan. The results show that most affordable houses in the suburbs of Medan are unhealthy. There are several design recommendations for the houses to meet the affordable healthy house category; the most important is the addition of ventilation and window holes.

Calculating the affordability of antiretrovirals in St Lucia.

PubMed

Reddock, J R; Grignon, M

2013-01-01

The cost of antiretrovirals is borne by donors in many low- and middle-income countries, including St Lucia. Although donor involvement has facilitated access to antiretrovirals, donor engagement in HIV/AIDS has changed over the years. This paper assesses the affordability of antiretrovirals at the individual level if donors were no longer available to fund the cost of first and second-line antiretrovirals and a prospective third-line regimen. Various conceptions of affordability are reviewed using different assumptions of what is required to maintain a standard of living that would avoid individuals descending into poverty as a result of antiretroviral purchases. These concepts of affordability are operationalized using data from the Household Budgeting Survey conducted in St Lucia in 2005/2006. While there is a range of results for the affordability of first and second-line antiretrovirals depending on which standard of affordability is used, third-line antiretrovirals are unaffordable to more than 80% of the population across the four standards of affordability used - the national poverty line, 50% of median annual consumption, 10% of annual consumption and a proposed reasonable minimum standard.

Heritage Park Facilities PV Project

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hobaica, Mark

Project Objective: To procure a photovoltaic array (PV) system which will generate approximately 256kW of power to be used for the operations of the Aquatic Complex and the adjacent Senior Facility at the Heritage Park. This project complies with the EERE’s work and objectives by promoting the development and deployment of an energy system that will provide current and future generations with clean, efficient, affordable, and reliable energy.

Affordances and the musically extended mind.

PubMed

Krueger, Joel

2014-01-06

I defend a model of the musically extended mind. I consider how acts of "musicking" grant access to novel emotional experiences otherwise inaccessible. First, I discuss the idea of "musical affordances" and specify both what musical affordances are and how they invite different forms of entrainment. Next, I argue that musical affordances - via soliciting different forms of entrainment - enhance the functionality of various endogenous, emotion-granting regulative processes, drawing novel experiences out of us with an expanded complexity and phenomenal character. I argue that music therefore ought to be thought of as part of the vehicle needed to realize these emotional experiences. I appeal to different sources of empirical work to develop this idea.

The imperative for emergency medicine to create its own alternative payment model.

PubMed

Medford-Davis, Laura N

2017-06-01

Seven years after the Affordable Care Act legislated Alternative Payment Models, it is time for Emergency Medicine to find its place within this value-based trend by developing its own Alternative Payment Model. Copyright © 2017 Elsevier Inc. All rights reserved.

Avoidable challenges of a nuclear medicine facility in a developing nation

PubMed Central

Adedapo, Kayode Solomon; Onimode, Yetunde Ajoke; Ejeh, John Enyi; Adepoju, Adewale Oluwaseun

2013-01-01

The role of nuclear medicine in disease management in a developing nation is as impactful as it is in other regions of the world. However, in the developing world, the practice of nuclear medicine is faced with a myriad of challenges, which can be easily avoided. In this review, we examine the many avoidable challenges to the practice of nuclear medicine in a developing nation. The review is largely based on personal experiences of the authors who are the pioneers and current practitioners of nuclear medicine in a typical developing nation. If the challenges examined in this review are avoided, the practice of nuclear medicine in such a nation will be more effective and practitioners will be more efficient in service delivery. Hence, the huge benefits of nuclear medicine will be made available to patients in such a developing nation. PMID:24379527

Affordable Imaging Lab for Noninvasive Analysis of Biomass and Early Vigour in Cereal Crops

PubMed Central

2018-01-01

Plant phenotyping by imaging allows automated analysis of plants for various morphological and physiological traits. In this work, we developed a low-cost RGB imaging phenotyping lab (LCP lab) for low-throughput imaging and analysis using affordable imaging equipment and freely available software. LCP lab comprising RGB imaging and analysis pipeline is set up and demonstrated with early vigour analysis in wheat. Using this lab, a few hundred pots can be photographed in a day and the pots are tracked with QR codes. The software pipeline for both imaging and analysis is built from freely available software. The LCP lab was evaluated for early vigour analysis of five wheat cultivars. A high coefficient of determination (R2 0.94) was obtained between the dry weight and the projected leaf area of 20-day-old wheat plants and R2 of 0.9 for the relative growth rate between 10 and 20 days of plant growth. Detailed description for setting up such a lab is provided together with custom scripts built for imaging and analysis. The LCP lab is an affordable alternative for analysis of cereal crops when access to a high-throughput phenotyping facility is unavailable or when the experiments require growing plants in highly controlled climate chambers. The protocols described in this work are useful for building affordable imaging system for small-scale research projects and for education. PMID:29850536

An Affordability Comparison Tool (ACT) for Space Transportation

NASA Technical Reports Server (NTRS)

McCleskey, C. M.; Bollo, T. R.; Garcia, J. L.

2012-01-01

NASA bas recently emphasized the importance of affordability for Commercial Crew Development Program (CCDP), Space Launch Systems (SLS) and Multi-Purpose Crew Vehicle (MPCV). System architects and designers are challenged to come up with architectures and designs that do not bust the budget. This paper describes the Affordability Comparison Tool (ACT) analyzes different systems or architecture configurations for affordability that allows for a comparison of: total life cycle cost; annual recurring costs, affordability figures-of-merit, such as cost per pound, cost per seat, and cost per flight, as well as productivity measures, such as payload throughput. Although ACT is not a deterministic model, the paper develops algorithms and parametric factors that use characteristics of the architectures or systems being compared to produce important system outcomes (figures-of-merit). Example applications of outcome figures-of-merit are also documented to provide the designer with information on the relative affordability and productivity of different space transportation applications.

Alternatives to the ACA's Affordability Firewall.

PubMed

Nowak, Sarah A; Saltzman, Evan; Cordova, Amado

2016-05-09

The Affordable Care Act (ACA) was designed to increase health insurance coverage while limiting the disruption to individuals with existing sources of insurance coverage, particularly those with employer-sponsored insurance (ESI). To limit disruption to those with coverage, the ACA implements the employer mandate, which requires firms with more than 50 employees to offer health insurance or face penalties, and the individual "affordability firewall," which limits subsidies to individuals lacking access to alternative sources of coverage that are "affordable." This article examines the policy impacts of the affordability firewall and investigates two potential modifications. Option 1, which is the "entire family" scenario, involves allowing an exception to the firewall for anyone in a family where the family ESI premium contribution exceeds 9.5 percent of the worker's household income. In Option 2, the "dependents only" scenario, only dependents (and not the worker) become eligible for Marketplace subsidies when the ESI premium contribution exceeds 9.5 percent of the worker's household income. Relative to the ACA, RAND researchers estimate that nongroup enrollment will increase by 4.1 million for Option 1 and by 1.4 million for Option 2. However, the number without insurance only declines by 1.5 million in Option 1 and 0.7 million in Option 2. The difference between the increase in nongroup enrollment and the decrease in uninsurance is primarily due to ESI crowd-out, which is more pronounced for Option 1. Researchers also estimated that about 1.3 million families who have ESI and unsubsidized nongroup coverage under current ACA policy would receive Marketplace subsidies under the alternative affordability firewall scenarios. For these families, health insurance coverage would become substantially more affordable; these families' risk of spending at least 20 percent of income on health care would drop by more than two thirds. We additionally estimated that federal

Medicine price awareness in chronic patients in Belgium.

PubMed

Fraeyman, Jessica; Symons, Linda; De Loof, Hans; De Meyer, Guido R Y; Remmen, Roy; Beutels, Philippe; Van Hal, Guido

2015-02-01

Under increasing pressure to contain health expenditures governments across Europe have implemented policies to increase responsible medicine use, e.g. by increasing co-insurance paid for by patients. In times of austerity, how do chronic disease patients perceive the medicine price they have to pay? We used a mixed methods research design. First, we distributed a close-ended questionnaire among 983 chronic disease patients in 30 Flemish pharmacies. Second, we performed semi-structured interviews with 15 of these patients. We surveyed for knowledge on the prescription medicine they bought, as well as for their needs for information and their therapeutic compliance. Although patients express a lack (and a need) of information on prices during the consultation with the general practitioner (GP), (s)he hardly addresses medicine prices. Patients often only know the medicine price when they are at the pharmacy and patients need to decide to buy the medicine or not. This often results in patients taking the medicine when considered affordable within their social and financial context. It seems essential that patients are better informed about medicine prices as well as the constraints on physicians to prescribe cost-effectively. Therefore, medicine prices should be discussed more often during physician consults. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

What Does Electronic Conferencing Afford Distance Education?

ERIC Educational Resources Information Center

Barnes, Sally

2000-01-01

Discusses the use of technology for distance learning in higher education and examines the similarities and differences between face-to-face seminars and online discussions. Considers the concept of affordance in relation to information and communication technologies and distance education; and examines affordances of electronic conferencing and…

Results of 30 kWt Safe Affordable Fission Engine (SAFE-30) primary heat transport testing

NASA Astrophysics Data System (ADS)

Pedersen, Kevin; van Dyke, Melissa; Houts, Mike; Godfroy, Tom; Martin, James; Dickens, Ricky; Williams, Eric; Harper, Roger; Salvil, Pat; Reid, Bob

2001-02-01

The use of resistance heaters to simulate heat from fission allows extensive development of fission systems to be performed in non-nuclear test facilities, saving time and money. Resistance heated tests on the Safe Affordable Fission Engine-30 kilowatt (SAFE30) test article are being performed at the Marshall Space Flight Center. This paper discusses the results of these experiments to date, and describes the additional testing that will be performed. Recommendations related to the design of testable space fission power and propulsion systems are made. .

Innovative Approaches to Increase Access to Medicines in Developing Countries

PubMed Central

Stevens, Hilde; Huys, Isabelle

2017-01-01

Access to essential medicines is problematic for one third of all persons worldwide. The price of many medicines (i.e., drugs, vaccines, and diagnostics) is unaffordable to the majority of the population in need, especially in least-developed countries, but also increasingly in middle-income countries. Several innovative approaches, based on partnerships, intellectual property, and pricing, are used to stimulate innovation, promote healthcare delivery, and reduce global health disparities. No single approach suffices, and therefore stakeholders need to further engage in partnerships promoting knowledge and technology transfer in assuring essential medicines to be manufactured, authorized, and distributed in low- and middle-income countries (LMICs) in an effort of making them available at affordable and acceptable conditions. PMID:29270407

Dissociating Simon and affordance compatibility effects: silhouettes and photographs.

PubMed

Pappas, Zissis

2014-12-01

When a graspable object's handle is oriented to the same side as the response hand, responses are quicker and more accurate than when it is oriented to the opposite side. This effect has been attributed to the affordance of the object's handle (Tucker & Ellis, 1998). Recent findings suggest this effect results instead from an abstract spatial response code (i.e., Simon effect; Cho & Proctor, 2010). However, the stimuli used in these previous studies differ in the amount of object and environmental depth information they contain, which may be critical to conveying an affordance. This information could explain these disparate findings as well as dissociate Simon and affordance compatibility effects. Four experiments demonstrate that the Simon effect results from the absence of this information, as in a silhouette, and the affordance effect results from its presence, as in a photograph. A fifth experiment confirmed that modifying information associated with the affordance, rather than the modification itself, produced the effects observed in the previous experiments. These findings support the following: (a) the internal details of an object and environmental depth can dissociate Simon and affordance compatibility effects, (b) this information is necessary to convey the object's graspable affordance, and (c) the outer shape of the object is not sufficient to elicit an affordance effect. These findings are discussed in relation to the theory of embodied cognition. Copyright © 2014 Elsevier B.V. All rights reserved.

Manufacturing Affordability

DTIC Science & Technology

2011-10-01

Effective planning early in and throughout program develop - ment is critical to enabling manufacturing affordability. There is no silver bullet and no...unexpected lessons. “Gee, this stove is hot” may be an unexpected lesson for the toddler but should not be so for the adult. All production programs...in program design efforts from day 1 of Engineer- ing and Manufacturing Development , you should be seriously worried. A program that includes the

Report of the Committee To Study Affordability.

ERIC Educational Resources Information Center

Illinois State Board of Higher Education, Springfield.

This report addresses college affordability in Illinois from the student's perspective and makes specific recommendations to improve affordability at public institutions of higher education. The report also seeks to make students and their families more aware of the close connection between academic preparation, progress, and college costs. It…

Health insurance systems in five Sub-Saharan African countries: medicine benefits and data for decision making.

PubMed

Carapinha, João L; Ross-Degnan, Dennis; Desta, Abayneh Tamer; Wagner, Anita K

2011-03-01

Medicine benefits through health insurance programs have the potential to improve access to and promote more effective use of affordable, high quality medicines. Information is lacking about medicine benefits provided by health insurance programs in Sub-Saharan Africa. We describe the structure of medicine benefits and data routinely available for decision-making in 33 health insurance programs in Ghana, Kenya, Nigeria, Tanzania and Uganda. Most programs surveyed were private, for profit schemes covering voluntary enrollees, mostly in urban areas. Almost all provide both inpatient and outpatient medicine benefits, with members sharing the cost of medicines in all programs. Some programs use strategies that are common in high-income countries to manage the medicine benefits, such as formularies, generics policies, reimbursement limits, or price negotiation. Basic data to monitor performance in delivering medicine benefits are available in most programs, but key data elements and the resources needed to generate useful management information from the available data are typically missing. Many questions remain unanswered about the design, implementation, and effects of specific medicines policies in the emerging and expanding health insurance programs in Sub-Saharan Africa. These include questions about the most effective medicines policy choices, given different corporate and organizational structures and resources; impacts of specific benefit designs on quality and affordability of care and health outcomes; and ways to facilitate use of routine data for monitoring. Technical capacity building, strong government commitment, and international donor support will be needed to realize the benefits of medicines coverage in emerging and expanding health insurance programs in Sub-Saharan Africa. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Delivering modern, high-quality, affordable pathology and laboratory medicine to low-income and middle-income countries: a call to action.

PubMed

Horton, Susan; Sullivan, Richard; Flanigan, John; Fleming, Kenneth A; Kuti, Modupe A; Looi, Lai Meng; Pai, Sanjay A; Lawler, Mark

2018-05-12

Modern, affordable pathology and laboratory medicine (PALM) systems are essential to achieve the 2030 Sustainable Development Goals for health in low-income and middle-income countries (LMICs). In this last in a Series of three papers about PALM in LMICs, we discuss the policy environment and emphasise three crucial high-level actions that are needed to deliver universal health coverage. First, nations need national strategic laboratory plans; second, these plans require adequate financing for implementation; and last, pathologists themselves need to take on leadership roles to advocate for the centrality of PALM to achieve the Sustainable Development Goals for health. The national strategic laboratory plan should deliver a tiered, networked laboratory system as a central element. Appropriate financing should be provided, at a level of at least 4% of health expenditure. Financing of new technologies such as molecular diagnostics is challenging for LMICs, even though many of these tests are cost-effective. Point-of-care testing can substantially reduce test-reporting time, but this benefit must be balanced with higher costs. Our research analysis highlights a considerable deficiency in advocacy for PALM; pathologists have been invisible in national and international health discourse and leadership. Embedding PALM in LMICs can only be achieved if pathologists advocate for these services, and undertake leadership roles, both nationally and internationally. We articulate eight key recommendations to address the current barriers identified in this Series and issue a call to action for all stakeholders to come together in a global alliance to ensure the effective provision of PALM services in resource-limited settings. Copyright © 2018 Elsevier Ltd. All rights reserved.

Affordable Exploration of Mars: Recommendations from a Community Workshop

NASA Technical Reports Server (NTRS)

Thronson, Harley A.; Carberry, Chris; Cassady, R. Joseph; Cooke, Doug; Kirkpatrick, Jim; Perino, Maria Antonietta; Raftery, Michael; Westenberg, Artemis; Zucker, Richard

2014-01-01

There is a growing opinion that within two decades initial human missions to Mars are affordable under plausible budget scenarios, with sustained international participation, and --- especially --- without requiring those first missions to achieve a burdensome number of goals. In response to this view, a group of experts from the Mars exploration stakeholder communities attended the "Affording Mars" workshop at George Washington University in December 2013. Participants reviewed scenarios for proposed affordable and sustainable human and robotic exploration of Mars, the role of the International Space Station as the essential early step toward humans to Mars, possible "bridge" or "transition" missions in the 2020s, key capabilities required for affordable initial missions, international partnerships, and usable definitions of affordability and sustainability. We report here the findings, observations, and recommendations that were agreed to at that workshop. In the context of affordable early missions to Mars, we also discuss the recent report of the National Research Council on human space flight and a pair of recent scenarios that appear to promise reduced costs.

Affordability Funding Models for Early Childhood Services

ERIC Educational Resources Information Center

Purcal, Christiane; Fisher, Karen

2006-01-01

This paper presents a model of the approaches open to government to ensure that early childhood services are affordable to families. We derived the model from a comparative literature review of affordability approaches taken by government, both in Australia and internationally. The model adds significantly to the literature by proposing a means to…

Facile synthesis of electrophilic vinyl boranes: reactions of alkynyl-borates and diazonium salts.

PubMed

Zhao, Xiaoxi; Liang, Liyuan; Stephan, Douglas W

2012-10-21

Reactions of alkynylborate salts, easily derived from reaction of frustrated Lewis pairs with terminal alkynes, with diazonium salts to induce 1,1-carboboration affording a facile and efficient route to substituted electrophilic vinyl boranes.

Does economic incentive matter for rational use of medicine? China's experience from the essential medicines program.

PubMed

Chen, Mingsheng; Wang, Lijie; Chen, Wen; Zhang, Luying; Jiang, Hongli; Mao, Wenhui

2014-03-01

Before the new round of healthcare reform in China, primary healthcare providers could obtain a fixed 15 % or greater mark-up of profits by prescribing and selling medicines. There were concerns that this perverse incentive was a key cause of irrational medicine use. China's new Essential Medicines Program (EMP) was launched in 2009 as part of the national health sector reform initiatives. One of its core policies was to eliminate primary care providers' economic incentives to overprescribe or prescribe unnecessarily expensive drugs, which were regarded as consequences of China's traditional financing system for health institutions. The objective of the study was to measure changes in prescribing patterns in primary healthcare facilities after the removal of the economic incentives for physicians to overprescribe as a result of the implementation of the EMP. A comparison design was applied to 8,258 prescriptions in 2007 and 8,278 prescriptions in 2010, from 83 primary healthcare facilities nationwide. Indicators were adopted to evaluate medicine utilization, which included overall number of medicines, average number of Western and traditional Chinese medicines, pharmaceutical expenditure per outpatient prescription, and proportion of prescriptions that contained two or more antibiotics. We further assessed the use of medicines (antibiotics, infusion, hormones, and intravenous injection) per disease-specific prescription for hypertension, diabetes, coronary artery heart disease, bronchitis, upper respiratory tract infection, and gastritis. A difference-in-difference analysis was employed to evaluate the net policy effect. Overall changes in indicators were not found to be statistically significant between the 2 years. The results varied for different diseases. The number of Western drugs per outpatient prescription decreased while that of traditional Chinese medicines increased. Overuse of antibiotics remained an extensive problem in the treatment of many diseases

Introducing High School Students to Careers in Osteopathic Medicine.

PubMed

Wilson, Nedra F

2017-05-01

An aging population and expansion of health care coverage under the Patient Protection and Affordable Care Act have led to a predicted deficit of primary care physicians by 2025. In response, medical schools must develop new strategies to identify students early in their educational pathways to encourage exploration of careers in science, technology, engineering, and mathematics (STEM) fields, especially medicine. Oklahoma State University Center for Health Sciences developed 2 internship programs, Oklahoma Science Training and Research Students (OKStars) and Native OKStars, to introduce high school students to osteopathic medicine. Native OKStars was designed to encourage Native American students, who are underrepresented in STEM fields, to pursue osteopathic medicine. These programs provided students with a 6-week immersion in biomedical research, along with weekly discussion groups with mentors. Participant questionnaire responses suggested that these programs were effective in introducing them to careers in osteopathic medicine as well as other STEM fields.

[Organization of medical equipment and stock supply of military medical facilities and groups of Disaster Medicine Service of the Russian Defense Ministry in emergency situations].

PubMed

Korniushko, I G; Iakovlev, S V; Krasavin, K D; Lemeshkin, R N

2011-10-01

The article outlined the modern concept of medical equipment and stock supply of medical facilities and groups of Disaster Medicine Service of the Russian Defense Ministry involved into the remedial of the medical actions of emergency situations. The structure of the units of medical supplies in these conditions is presented.

Patient Protection and Affordable Care Act; establishment of the Multi-State Plan Program for the Affordable Insurance Exchanges. Final rule.

PubMed

2014-02-24

The U.S. Office of Personnel Management (OPM) is issuing a final rule implementing modifications to the Multi-State Plan (MSP) Program based on the experience of the Program to date. OPM established the MSP Program pursuant to the Affordable Care Act. This rule clarifies the approach used to enforce the applicable standards of the Affordable Care Act with respect to health insurance issuers that contract with OPM to offer MSP options; amends MSP standards related to coverage area, benefits, and certain contracting provisions under section 1334 of the Affordable Care Act; and makes non-substantive technical changes.

Simulation training for geriatric medicine.

PubMed

Mehdi, Zehra; Ross, Alastair; Reedy, Gabriel; Roots, Angela; Ernst, Thomas; Jaye, Peter; Birns, Jonathan

2014-08-01

Geriatric medicine encompasses a diverse nature of medical, social and ethical challenges, and requires a multidimensional, interdisciplinary approach. Recent reports have highlighted failings in the care of the elderly, and it is therefore vital that specialist trainees in geriatric medicine are afforded opportunities to develop their skills in managing this complex patient population. Simulation has been widely adopted as a teaching tool in medicine; however, its use in geriatric medicine to date has involved primarily role-play or discrete clinical skills training. This article outlines the development of a bespoke, multimodal, simulation course for specialist trainees in geriatric medicine. A 1-day multimodal and interprofessional simulation course was created specifically for specialist trainees in geriatric medicine, using six curriculum-mapped scenarios in which the patient perspective was central to the teaching objectives. Various simulation techniques were used, including high-fidelity human patient manikins, patient actors, with integrated clinical skills using part-task trainers, and role-play exercises. Debriefs by trained faculty members were completed after each scenario. Twenty-six candidates attended four similar courses in 2012. Quantitative analysis of pre- and post-course questionnaires revealed an improvement of self-reported confidence in managing geriatric scenarios (Z = 4.1; p < 0.001), and thematic analysis of candidate feedback was supportive of simulation as a useful teaching tool, with reported benefits for both technical and non-technical skills. Simulation is an exciting and novel method of delivering teaching for specialist trainees in geriatric medicine. This teaching modality could be integrated into the training curriculum for geriatric medicine, to allow a wider application. © 2014 John Wiley & Sons Ltd.

Housing Affordability And Children's Cognitive Achievement.

PubMed

Newman, Sandra; Holupka, C Scott

2016-11-01

Housing cost burden-the fraction of income spent on housing-is the most prevalent housing problem affecting the healthy development of millions of low- and moderate-income children. By affecting disposable income, a high burden affects parents' expenditures on both necessities for and enrichment of their children, as well as investments in their children. Reducing those expenditures and investments, in turn, can affect children's development, including their cognitive skills and physical, social, and emotional health. This article summarizes the first empirical evidence of the effects of housing affordability on children's cognitive achievement and on one factor that appears to contribute to these effects: the larger expenditures on child enrichment by families in affordable housing. We found that housing cost burden has the same relationship to both children's cognitive achievement and enrichment spending on children, exhibiting an inverted U shape in both cases. The maximum benefit occurs when housing cost burden is near 30 percent of income-the long-standing rule-of-thumb definition of affordable housing. The effect of the burden is stronger on children's math ability than on their reading comprehension and is more pronounced with burdens above the 30 percent standard. For enrichment spending, the curve is "shallower" (meaning the effect of optimal affordability is less pronounced) but still significant. Project HOPE—The People-to-People Health Foundation, Inc.

Stable and variable affordances are both automatic and flexible

PubMed Central

Borghi, Anna M.; Riggio, Lucia

2015-01-01

The mere observation of pictures or words referring to manipulable objects is sufficient to evoke their affordances since objects and their nouns elicit components of appropriate motor programs associated with object interaction. While nobody doubts that objects actually evoke motor information, the degree of automaticity of this activation has been recently disputed. Recent evidence has indeed revealed that affordances activation is flexibly modulated by the task and by the physical and social context. It is therefore crucial to understand whether these results challenge previous evidence showing that motor information is activated independently from the task. The context and the task can indeed act as an early or late filter. We will review recent data consistent with the notion that objects automatically elicit multiple affordances and that top-down processes select among them probably inhibiting motor information that is not consistent with behavior goals. We will therefore argue that automaticity and flexibility of affordances are not in conflict. We will also discuss how language can incorporate affordances showing similarities, but also differences, between the motor information elicited by vision and language. Finally we will show how the distinction between stable and variable affordances can accommodate all these effects. PMID:26150778

Precision medicine in acute myeloid leukemia: Hope, hype or both?

PubMed

Prasad, Vinay; Gale, Robert Peter

2016-09-01

Precision medicine is interchangeably used with personalized medicine, genomic medicine and individualized medicine. Collectively, these terms refer to at least 5 distinct concepts in the context of AML. 1st, using molecular or omics data (e.g. genomics, epigenomics, transcriptomics, proteomics) to delineate or define subtypes of AML. 2nd, using these data to select the best therapy for someone with an AML subtype, such as a person with a FLT3-mutation. 3rd, using these data to monitor therapy-response such as measurable residual disease [MRD]-testing. 4th, using results of MRD-testing to select from amongst therapy-options such as additional chemotherapy or a haematopoietic cell transplant. And 5th, using these data to identify persons with hereditary forms of AML with potential therapy and surveillance implications. Here, we review these 5 conceptions and delineate where precision medicine is likely to afford greatest hope and where instead our rhetoric may constitute hype. Copyright © 2016 Elsevier Ltd. All rights reserved.

Making Charter School Facilities More Affordable: State-driven Policy Approaches. Innovations in Education

ERIC Educational Resources Information Center

US Department of Education, 2008

2008-01-01

Securing appropriate facilities can be a significant challenge for those intending to open a charter school. Although, like all public schools, charter schools receive per-pupil dollars from the state, they generally receive considerably less. Additionally, because traditional public schools rely on their district to provide their school…

Urging Affordable Access to High-Value Cancer Drugs

Cancer.gov

This infographic highlights some of the main messages from the President’s Cancer Panel report Promoting Value, Affordability, and Innovation in Cancer Drug Treatment. The graphic includes the panel’s recommendations to maximize the value and affordability of cancer drug treatment.

The Role of Health Systems Factors in Facilitating Access to Psychotropic Medicines: A Cross-Sectional Analysis of the WHO-AIMS in 63 Low- and Middle-Income Countries

PubMed Central

McBain, Ryan; Norton, Daniel J.; Morris, Jodi; Yasamy, M. Taghi; Betancourt, Theresa S.

2012-01-01

Background Neuropsychiatric conditions comprise 14% of the global burden of disease and 30% of all noncommunicable disease. Despite the existence of cost-effective interventions, including administration of psychotropic medicines, the number of persons who remain untreated is as high as 85% in low- and middle-income countries (LAMICs). While access to psychotropic medicines varies substantially across countries, no studies to date have empirically investigated potential health systems factors underlying this issue. Methods and Findings This study uses a cross-sectional sample of 63 LAMICs and country regions to identify key health systems components associated with access to psychotropic medicines. Data from countries that completed the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) were included in multiple regression analyses to investigate the role of five major mental health systems domains in shaping medicine availability and affordability. These domains are: mental health legislation, human rights implementations, mental health care financing, human resources, and the role of advocacy groups. Availability of psychotropic medicines was associated with features of all five mental health systems domains. Most notably, within the domain of mental health legislation, a comprehensive national mental health plan was associated with 15% greater availability; and in terms of advocacy groups, the participation of family-based organizations in the development of mental health legislation was associated with 17% greater availability. Only three measures were related with affordability of medicines to consumers: level of human resources, percentage of countries' health budget dedicated to mental health, and availability of mental health care in prisons. Controlling for country development, as measured by the Human Development Index, health systems features were associated with medicine availability but not affordability. Conclusions

24 CFR 1000.102 - What are eligible affordable housing activities?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false What are eligible affordable housing activities? 1000.102 Section 1000.102 Housing and Urban Development Regulations Relating to... § 1000.102 What are eligible affordable housing activities? Eligible affordable housing activities are...

Defensive medicine: No wonder policymakers are confused.

PubMed

Kapp, Marshall B

2016-01-01

Discussions regarding defensive medical practice often result in proposals for public policy actions. Such proposals generally are premised on assumptions about defensive medicine, namely, that it (a) is driven by physicians' legal anxieties, (b) constitutes bad medical practice, (c) drives up health care costs, (d) varies depending on a jurisdiction's particular tort law climate, (e) depends on medical specialty and a physician's own prior experience as a malpractice defendant, and (f) is a rational response to actual legal risks confronting physicians. This article examines a sample of recent literature focusing on defensive medicine and finds that the messages conveyed vary widely, helping to explain the confusion experienced by many policymakers trying to improve the quality and affordability of health care.

Young children's tool innovation across culture: Affordance visibility matters.

PubMed

Neldner, Karri; Mushin, Ilana; Nielsen, Mark

2017-11-01

Young children typically demonstrate low rates of tool innovation. However, previous studies have limited children's performance by presenting tools with opaque affordances. In an attempt to scaffold children's understanding of what constitutes an appropriate tool within an innovation task we compared tools in which the focal affordance was visible to those in which it was opaque. To evaluate possible cultural specificity, data collection was undertaken in a Western urban population and a remote Indigenous community. As expected affordance visibility altered innovation rates: young children were more likely to innovate on a tool that had visible affordances than one with concealed affordances. Furthermore, innovation rates were higher than those reported in previous innovation studies. Cultural background did not affect children's rates of tool innovation. It is suggested that new methods for testing tool innovation in children must be developed in order to broaden our knowledge of young children's tool innovation capabilities. Copyright © 2017 Elsevier B.V. All rights reserved.

Learning Outcomes Afforded by Self-Assessed, Segmented Video-Print Combinations

ERIC Educational Resources Information Center

Koumi, Jack

2015-01-01

Learning affordances of video and print are examined in order to assess the learning outcomes afforded by hybrid video-print learning packages. The affordances discussed for print are: navigability, surveyability and legibility. Those discussed for video are: design for constructive reflection, provision of realistic experiences, presentational…

Essential medicines for emergency care in Africa.

PubMed

Broccoli, Morgan C; Pigoga, Jennifer L; Nyirenda, Mulinda; Wallis, Lee; Calvello Hynes, Emilie J

2018-04-07

Essential medicines lists (EMLs) are efficient means to ensure access to safe and effective medications. The WHO has led this initiative, generating a biannual EML since 1977. Nearly all countries have implemented national EMLs based on the WHO EML. Although EMLs have given careful consideration to many public health priorities, they have yet to comprehensively address the importance of medicines for treating acute illness and injury. We undertook a multistep consensus process to establish an EML for emergency care in Africa. After a review of existing literature and international EMLs, we generated a candidate list for emergency care. This list was reviewed by expert clinicians who ranked the medicines for overall inclusion and strength of recommendation. These medications and recommendations were then evaluated by an expert group. Medications that reached consensus in both the online survey and expert review were included in a draft emergency care EML, which underwent a final inperson consensus process. The final emergency care EML included 213 medicines, 25 of which are not in the 2017 WHO EML, but were deemed essential for clinical practice by regional emergency providers. The final EML has associated recommendations of desirable or essential and is subdivided by facility level. Thirty-nine medicines were recommended for basic facilities, an additional 96 for intermediate facilities (eg, district hospitals) and an additional 78 for advanced facilities (eg, tertiary centres). The 25 novel medications not currently on the WHO EML should be considered by planners when making rational formularies for developing emergency care systems. It is our hope that these resource-stratified lists will allow for easier implementation and will be a useful tool for practical expansion of emergency care delivery in Africa. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless

42 CFR 4.4 - Use of Library facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Use of Library facilities. 4.4 Section 4.4 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS NATIONAL LIBRARY OF MEDICINE § 4.4 Use of Library facilities. (a) General. The Library facilities are available to any...

42 CFR 4.4 - Use of Library facilities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Use of Library facilities. 4.4 Section 4.4 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS NATIONAL LIBRARY OF MEDICINE § 4.4 Use of Library facilities. (a) General. The Library facilities are available to any...

42 CFR 4.4 - Use of Library facilities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Use of Library facilities. 4.4 Section 4.4 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS NATIONAL LIBRARY OF MEDICINE § 4.4 Use of Library facilities. (a) General. The Library facilities are available to any...

42 CFR 4.4 - Use of Library facilities.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Use of Library facilities. 4.4 Section 4.4 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS NATIONAL LIBRARY OF MEDICINE § 4.4 Use of Library facilities. (a) General. The Library facilities are available to any...

42 CFR 4.4 - Use of Library facilities.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Use of Library facilities. 4.4 Section 4.4 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS NATIONAL LIBRARY OF MEDICINE § 4.4 Use of Library facilities. (a) General. The Library facilities are available to any...

Consequences of BBPs Affordability Initiative

DTIC Science & Technology

2016-04-30

qÜáêíÉÉåíÜ=^ååì~ä= ^Åèìáëáíáçå=oÉëÉ~êÅÜ= póãéçëáìã= tÉÇåÉëÇ~ó=pÉëëáçåë= sçäìãÉ=f= = Consequences of BBP’s Affordability Initiative Gregory Davis , Research...Initiative Gregory Davis , Research Staff Member, Institute for Defense Analyses Lawrence Goeller, Defense Acquisition Analyst, Institute for Defense...Consequences of BBP’s Affordability Initiative Gregory Davis —has been at the Institute for Defense Analyses (IDA) since 2006, conducting research on as

The Automaticity of Affordance of Dangerous Object.

PubMed

Zhao, Liang

2016-11-03

Objects observation automatically elicits the activation of a reach-to-grasp response specifically directed to interact with the object, which is termed affordance. Murphy, van Velzen, and de Fockert (2012) found that only when an irrelevant object receives sufficient attention, it can potentiate an action. However, it remains unclear whether the dangerous object would afford an action when it receives insufficient attention. In this study, we manipulated the perceptual load in a letter identification task. Participants were required to identify a target letter with the right or left hand while ignoring a neutral or dangerous graspable object. The target letter was presented either on its own (low perceptual load), alongside five non-target letters (high load), or alongside eight non-target letters (super high load). Under the low perceptual load, for both neutral and dangerous object, responses were faster when the action afforded by the ignored object was congruent (vs. incongruent) with the current target response (t(27) = 4.44, p < .001; t(27) = 7.99, p < .001, respectively). However, during the high perceptual load, for dangerous object, responses were slower when the action afforded by the ignored object was congruent (vs. incongruent) with the current target response (t(27) = 4.97, p < .001). There was not any effect for both neutral object and dangerous object under super high perceptual load. These results suggest the affordance of dangerous object is also sensitive to the perceptual load. An irrelevant dangerous object can't potentiate an action if it receives insufficient attention.

Conflict in object affordance revealed by grip force

PubMed Central

McBride, Jennifer; Sumner, Petroc; Husain, Masud

2011-01-01

Viewing objects can result in automatic, partial activation of motor plans associated with them—“object affordance”. Here, we recorded grip force simultaneously from both hands in an object affordance task to investigate the effects of conflict between coactivated responses. Participants classified pictures of objects by squeezing force transducers with their left or right hand. Responses were faster on trials where the object afforded an action with the same hand that was required to make the response (congruent trials) compared to the opposite hand (incongruent trials). In addition, conflict between coactivated responses was reduced if it was experienced on the preceding trial, just like Gratton adaptation effects reported in “conflict” tasks (e.g., Eriksen flanker). This finding suggests that object affordance demonstrates conflict effects similar to those shown in other stimulus–response mapping tasks and thus could be integrated into the wider conceptual framework on overlearnt stimulus–response associations. Corrected erroneous responses occurred more frequently when there was conflict between the afforded response and the response required by the task, providing direct evidence that viewing an object activates motor plans appropriate for interacting with that object. Recording continuous grip force, as here, provides a sensitive way to measure coactivated responses in affordance tasks. PMID:21824035

Diabetes and the Affordable Care Act

PubMed Central

Schade, David S.

2014-01-01

Abstract The Affordable Care Act—“Obamacare”—is the most important federal medical legislation to be enacted since Medicare. Although the goal of the Affordable Care Act is to improve healthcare coverage, access, and quality for all Americans, people with diabetes are especially poised to benefit from the comprehensive reforms included in the act. Signed into law in 2010, this massive legislation will slowly be enacted over the next 10 years. In the making for at least a decade, it will affect every person in the United States, either directly or indirectly. In this review, we discuss the major changes in healthcare that will take place in the next several years, including (1) who needs to purchase insurance on the Web-based exchange, (2) the cost to individuals and the rebates that they may expect, (3) the rules and regulations for purchasing insurance, (4) the characteristics of the different “metallic” insurance plans that are available, and (5) the states that have agreed to participate. With both tables and figures, we have tried to make the Affordable Care Act both understandable and appreciated. The goal of this comprehensive review is to highlight aspects of the Affordable Care Act that are of importance to practitioners who care for people with diabetes by discussing both the positive and the potentially negative aspects of the program as they relate to diabetes care. PMID:24927108

24 CFR 1000.101 - What is affordable housing?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false What is affordable housing? 1000.101 Section 1000.101 Housing and Urban Development Regulations Relating to Housing and Urban... URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Affordable Housing Activities § 1000.101 What is...

Affordance Templates for Shared Robot Control

NASA Technical Reports Server (NTRS)

Hart, Stephen; Dinh, Paul; Hambuchen, Kim

2014-01-01

This paper introduces the Affordance Template framework used to supervise task behaviors on the NASA-JSC Valkyrie robot at the 2013 DARPA Robotics Challenge (DRC) Trials. This framework provides graphical interfaces to human supervisors that are adjustable based on the run-time environmental context (e.g., size, location, and shape of objects that the robot must interact with, etc.). Additional improvements, described below, inject degrees of autonomy into instantiations of affordance templates at run-time in order to enable efficient human supervision of the robot for accomplishing tasks.

Improving perceptions of healthy food affordability: results from a pilot intervention.

PubMed

Williams, Lauren K; Abbott, Gavin; Thornton, Lukar E; Worsley, Anthony; Ball, Kylie; Crawford, David

2014-03-10

Despite strong empirical support for the association between perceived food affordability and dietary intake amongst families with a lower socioeconomic position (SEP), there is limited evidence of the most effective strategies for promoting more positive perceptions of healthy food affordability among this group. This paper reports findings from a pilot intervention that aimed to improve perceptions of healthy food affordability amongst mothers. Participants were 66 mothers who were the parents of children recruited from primary schools located in socioeconomically disadvantaged suburbs. Intervention group participants viewed a slideshow focussed on healthy snack food affordability that illustrated cheaper healthier alternatives to common snack foods as well as food budgeting tips and price comparison education. A mixed between-within ANCOVA was conducted to examine group differences in perceived affordability of healthy food across three time points. Results revealed no difference in perceived affordability of healthy food between the two groups at baseline whereas at post-intervention and follow-up, mothers in the intervention group perceived healthy food as more affordable than the control group. Focussing on education-based interventions to improve perceptions of healthy food affordability may be a promising approach that complements existing nutrition promotion strategies.

Behavior medicine specialist.

PubMed

Tuso, Phillip

2014-01-01

Total Health is a vision for the future and a strategy to prevent preventable disease, save lives, and make health care more affordable. Total Health means health of mind (behavior health) and health of body (physical health). To achieve Total Health we need healthy people in healthy communities. A behavior medicine specialist is a psychologist who works in the medical home with the primary care physician instead of in the Mental Health Department with a psychiatrist. The key to achieving Total Health will be to transform our current health care system from a focus on treating disease to a focus on preventing disease. This transformation will require complex behavior change interventions and services not usually provided in the medical home. The behavior medicine specialist will bring the knowledge and experience used to treat mental illness into the medical home to help the primary care physician improve the care of all patients in the medical home. The behavior medicine specialist will help improve outcomes in synergy with the primary care physician by universal screening of high-risk diseases, stepped care protocols, and efficient use of all resources available to care for patients in the medical home (health education classes, wellness coaches, and online social networking lifestyle management programs). These interventions should increase patient satisfaction, increase access to specialty care (psychiatry), and help us achieve Total Health.

Affordable Development and Qualification Strategy for Nuclear Thermal Propulsion

NASA Technical Reports Server (NTRS)

Gerrish, Harold P., Jr.; Doughty, Glen E.; Bhattacharyya, Samit K.

2013-01-01

Nuclear Thermal Propulsion (NTP) is a concept which uses a nuclear reactor to heat a propellant to high temperatures without combustion and can achieve significantly greater specific impulse than chemical engines. NTP has been considered many times for human and cargo missions beyond low earth orbit. A lot of development and technical maturation of NTP components took place during the Rover/NERVA program of the 60's and early 70's. Other NTP programs and studies followed attempting to further mature the NTP concept and identify a champion customer willing to devote the funds and support the development schedule to a demonstration mission. Budgetary constraints require the use of an affordable development and qualification strategy that takes into account all the previous work performed on NTP to construct an existing database, and include lessons learned and past guidelines followed. Current guidelines and standards NASA uses for human rating chemical rocket engines is referenced. The long lead items for NTP development involve the fuel elements of the reactor and ground testing the engine system, subsystem, and components. Other considerations which greatly impact the development plans includes the National Space Policy, National Environmental Policy Act, Presidential Directive/National Security Council Memorandum #25 (Scientific or Technological Experiments with Possible Large-Scale Adverse Environmental Effects and Launch of Nuclear Systems into Space), and Safeguards and Security. Ground testing will utilize non-nuclear test capabilities to help down select components and subsystems before testing in a nuclear environment to save time and cost. Existing test facilities with minor modifications will be considered to the maximum extent practical. New facilities will be designed to meet minimum requirements. Engine and test facility requirements are based on the driving mission requirements with added factors of safety for better assurance and reliability

Affordance Analysis--Matching Learning Tasks with Learning Technologies

ERIC Educational Resources Information Center

Bower, Matt

2008-01-01

This article presents a design methodology for matching learning tasks with learning technologies. First a working definition of "affordances" is provided based on the need to describe the action potentials of the technologies (utility). Categories of affordances are then proposed to provide a framework for analysis. Following this, a…

When worlds collide: medicine, business, the Affordable Care Act and the future of health care in the U.S.

PubMed

Wicks, Andrew C; Keevil, Adrian A C

2014-01-01

The dialogue about the future of health care in the US has been impeded by flawed conceptions about medicine and business. The present paper re-examines some of the underlying assumptions about both medicine and business, and uses more nuanced readings of both terms to frame debates about the ACA and the emerging health care environment. © 2014 American Society of Law, Medicine & Ethics, Inc.

Affordability Engineering: Bridging the Gap Between Design and Cost

NASA Technical Reports Server (NTRS)

Reeves, J. D.; DePasquale, Dominic; Lim, Evan

2010-01-01

Affordability is a commonly used term that takes on numerous meanings depending on the context used. Within conceptual design of complex systems, the term generally implies comparisons between expected costs and expected resources. This characterization is largely correct, but does not convey the many nuances and considerations that are frequently misunderstood and underappreciated. In the most fundamental sense, affordability and cost directly relate to engineering and programmatic decisions made throughout development programs. Systems engineering texts point out that there is a temporal aspect to this relationship, for decisions made earlier in a program dictate design implications much more so than those made during latter phases. This paper explores affordability engineering and its many sub-disciplines by discussing how it can be considered an additional engineering discipline to be balanced throughout the systems engineering and systems analysis processes. Example methods of multidisciplinary design analysis with affordability as a key driver will be discussed, as will example methods of data visualization, probabilistic analysis, and other ways of relating design decisions to affordability results.

A win-win solution?: A critical analysis of tiered pricing to improve access to medicines in developing countries.

PubMed

Moon, Suerie; Jambert, Elodie; Childs, Michelle; von Schoen-Angerer, Tido

2011-10-12

Tiered pricing - the concept of selling drugs and vaccines in developing countries at prices systematically lower than in industrialized countries - has received widespread support from industry, policymakers, civil society, and academics as a way to improve access to medicines for the poor. We carried out case studies based on a review of international drug price developments for antiretrovirals, artemisinin combination therapies, drug-resistant tuberculosis medicines, liposomal amphotericin B (for visceral leishmaniasis), and pneumococcal vaccines. We found several critical shortcomings to tiered pricing: it is inferior to competition for achieving the lowest sustainable prices; it often involves arbitrary divisions between markets and/or countries, which can lead to very high prices for middle-income markets; and it leaves a disproportionate amount of decision-making power in the hands of sellers vis-à-vis consumers. In many developing countries, resources are often stretched so tight that affordability can only be approached by selling medicines at or near the cost of production. Policies that "de-link" the financing of R&D from the price of medicines merit further attention, since they can reward innovation while exploiting robust competition in production to generate the lowest sustainable prices. However, in special cases - such as when market volumes are very small or multi-source production capacity is lacking - tiered pricing may offer the only practical option to meet short-term needs for access to a product. In such cases, steps should be taken to ensure affordability and availability in the longer-term. To ensure access to medicines for populations in need, alternate strategies should be explored that harness the power of competition, avoid arbitrary market segmentation, and/or recognize government responsibilities. Competition should generally be the default option for achieving affordability, as it has proven superior to tiered pricing for reliably

A win-win solution?: A critical analysis of tiered pricing to improve access to medicines in developing countries

PubMed Central

2011-01-01

Background Tiered pricing - the concept of selling drugs and vaccines in developing countries at prices systematically lower than in industrialized countries - has received widespread support from industry, policymakers, civil society, and academics as a way to improve access to medicines for the poor. We carried out case studies based on a review of international drug price developments for antiretrovirals, artemisinin combination therapies, drug-resistant tuberculosis medicines, liposomal amphotericin B (for visceral leishmaniasis), and pneumococcal vaccines. Discussion We found several critical shortcomings to tiered pricing: it is inferior to competition for achieving the lowest sustainable prices; it often involves arbitrary divisions between markets and/or countries, which can lead to very high prices for middle-income markets; and it leaves a disproportionate amount of decision-making power in the hands of sellers vis-à-vis consumers. In many developing countries, resources are often stretched so tight that affordability can only be approached by selling medicines at or near the cost of production. Policies that "de-link" the financing of R&D from the price of medicines merit further attention, since they can reward innovation while exploiting robust competition in production to generate the lowest sustainable prices. However, in special cases - such as when market volumes are very small or multi-source production capacity is lacking - tiered pricing may offer the only practical option to meet short-term needs for access to a product. In such cases, steps should be taken to ensure affordability and availability in the longer-term. Summary To ensure access to medicines for populations in need, alternate strategies should be explored that harness the power of competition, avoid arbitrary market segmentation, and/or recognize government responsibilities. Competition should generally be the default option for achieving affordability, as it has proven superior

The Influence of Affordability in Strategic Enrollment Management

ERIC Educational Resources Information Center

Pugh, Susan L.; Thompson, Roger J.

2008-01-01

In state houses around the country, one of the common higher education themes is affordability. As tuition costs have increased at rates exceeding that of inflation, students and families have pressed their legislative representatives to examine these increases. Affordability is a term used by various constituent groups, and its definition varies…

Monetary Value of a Prescription Assistance Program Service in a Rural Family Medicine Clinic

ERIC Educational Resources Information Center

Whitley, Heather P.

2011-01-01

Purpose: To quantify the monetary value of medications provided to rural Alabamians through provision of pharmaceutical manufacturer-sponsored prescription assistance programs (PAPs) provided by a clinical pharmacist in a private Black Belt family medicine clinic during 2007 and 2008. Methods: Patients struggling to afford prescription medications…

Availability of emergency obstetric care (EmOC) among public and private health facilities in rural northwest Bangladesh.

PubMed

Sikder, Shegufta S; Labrique, Alain B; Ali, Hasmot; Hanif, Abu A M; Klemm, Rolf D W; Mehra, Sucheta; West, Keith P; Christian, Parul

2015-01-31

Although safe motherhood strategies recommend that women seek timely care from health facilities for obstetric complications, few studies have described facility availability of emergency obstetric care (EmOC). We sought to describe and compare availability and readiness to provide EmOC among public and private health facilities commonly visited for pregnancy-related complications in two districts of northwest Bangladesh. We also described aspects of financial and geographic access to healthcare and key constraints to EmOC provision. Using data from a large population-based community trial, we identified and surveyed the 14 health facilities (7 public, 7 private) most frequently visited for obstetric complications and near misses as reported by women. Availability of EmOC was based on provision of medical services, assessed through clinician interviews and record review. Levels of EmOC availability were defined as basic or comprehensive. Readiness for EmOC provision was based on scores in four categories: staffing, equipment, laboratory capacity, and medicines. Readiness scores were calculated using unweighted averages. Costs of C-section procedures and geographic locations of facilities were described. Textual analysis was used to identify key constraints. The seven surveyed private facilities offered comprehensive EmOC compared to four of the seven public facilities. With 100% representing full readiness, mean EmOC readiness was 81% (range: 63%-91%) among surveyed private facilities compared to 67% (range: 48%-91%) in public facilities (p = 0.040). Surveyed public clinics had low scores on staffing and laboratory capacity (69%; 50%). The mean cost of the C-section procedure in private clinics was $77 (standard deviation: $16) and free in public facilities. The public sub-district facilities were the only facilities located in rural areas, with none providing comprehensive EmOC. Shortages in specialized staff were listed as the main barrier to EmOC provision in

Is laboratory medicine ready for the era of personalized medicine? A survey addressed to laboratory directors of hospitals/academic schools of medicine in Europe.

PubMed

Malentacchi, Francesca; Mancini, Irene; Brandslund, Ivan; Vermeersch, Pieter; Schwab, Matthias; Marc, Janja; van Schaik, Ron H N; Siest, Gerard; Theodorsson, Elvar; Pazzagli, Mario; Di Resta, Chiara

2015-06-01

Developments in "-omics" are creating a paradigm shift in laboratory medicine leading to personalized medicine. This allows the increase in diagnostics and therapeutics focused on individuals rather than populations. In order to investigate whether laboratory medicine is ready to play a key role in the integration of personalized medicine in routine health care and set the state-of-the-art knowledge about personalized medicine and laboratory medicine in Europe, a questionnaire was constructed under the auspices of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) and the European Society of Pharmacogenomics and Personalised Therapy (ESPT). The answers of the participating laboratory medicine professionals indicate that they are aware that personalized medicine can represent a new and promising health model, and that laboratory medicine should play a key role in supporting the implementation of personalized medicine in the clinical setting. Participants think that the current organization of laboratory medicine needs additional/relevant implementations such as (i) new technological facilities in -omics; (ii) additional training for the current personnel focused on the new methodologies; (iii) incorporation in the laboratory of new competencies in data interpretation and counseling; and (iv) cooperation and collaboration among professionals of different disciplines to integrate information according to a personalized medicine approach.

Inequalities in medicine use in Central Eastern Europe: an empirical investigation of socioeconomic determinants in eight countries.

PubMed

Vogler, Sabine; Österle, August; Mayer, Susanne

2015-11-05

Equitable access to essential medicines is a major challenge for policy-makers world-wide, including Central and Eastern European countries. Member States of the European Union situated in Central and Eastern Europe have publicly funded pharmaceutical reimbursement systems that should promote accessibility and affordability of, at least essential medicines. However, there is no knowledge whether socioeconomic inequalities exist in these countries. Against this backdrop, this study analyses whether socioeconomic determinants influence the use of prescribed and non-prescribed medicines in eight Central and Eastern European countries (Bulgaria, Czech Republic, Hungary, Latvia, Poland, Romania, Slovenia, Slovakia). Further, the study discusses observed (in)equalities in medicine use in the context of the pharmaceutical policy framework and the implementation in these countries. The study is based on cross-sectional data from the first wave of the European Health Interview Survey (2007-2009). Multivariate logistic regression analyses were carried out to determine the association between socioeconomic status (measured by employment status, education, income; controlled for age, gender, health status) and medicine use (prescribed and non-prescribed medicines). This was supplemented by a pharmaceutical policy analysis based on indicators in four policy dimensions (sustainable funding, affordability, availability and accessibility, and rational selection and use of medicines). Overall, the analysis showed a gradient favouring individuals from higher socioeconomic groups in the consumption of non-prescribed medicines in the eight surveyed countries, and for prescribed medicines in three countries (Latvia, Poland, Romania). The pharmaceutical systems in the eight countries were, to varying degrees, characterized by a lack of (public) funding, thus resulting in high and growing shares of private financing (including co-payments for prescribed medicines), inefficiencies in the

Changes in Self-reported Insurance Coverage, Access to Care, and Health Under the Affordable Care Act.

PubMed

Sommers, Benjamin D; Gunja, Munira Z; Finegold, Kenneth; Musco, Thomas

2015-07-28

The Affordable Care Act (ACA) completed its second open enrollment period in February 2015. Assessing the law's effects has major policy implications. To estimate national changes in self-reported coverage, access to care, and health during the ACA's first 2 open enrollment periods and to assess differences between low-income adults in states that expanded Medicaid and in states that did not expand Medicaid. Analysis of the 2012-2015 Gallup-Healthways Well-Being Index, a daily national telephone survey. Using multivariable regression to adjust for pre-ACA trends and sociodemographics, we examined changes in outcomes for the nonelderly US adult population aged 18 through 64 years (n = 507,055) since the first open enrollment period began in October 2013. Linear regressions were used to model each outcome as a function of a linear monthly time trend and quarterly indicators. Then, pre-ACA (January 2012-September 2013) and post-ACA (January 2014-March 2015) changes for adults with incomes below 138% of the poverty level in Medicaid expansion states (n = 48,905 among 28 states and Washington, DC) vs nonexpansion states (n = 37,283 among 22 states) were compared using a differences-in-differences approach. Beginning of the ACA's first open enrollment period (October 2013). Self-reported rates of being uninsured, lacking a personal physician, lacking easy access to medicine, inability to afford needed care, overall health status, and health-related activity limitations. Among the 507,055 adults in this survey, pre-ACA trends were significantly worsening for all outcomes. Compared with the pre-ACA trends, by the first quarter of 2015, the adjusted proportions who were uninsured decreased by 7.9 percentage points (95% CI, -9.1 to -6.7); who lacked a personal physician, -3.5 percentage points (95% CI, -4.8 to -2.2); who lacked easy access to medicine, -2.4 percentage points (95% CI, -3.3 to -1.5); who were unable to afford care, -5.5 percentage points (95% CI

Balancing adequacy and affordability?: Essential Health Benefits under the Affordable Care Act.

PubMed

Haeder, Simon F

2014-12-01

The Essential Health Benefits provisions under the Affordable Care Act require that eligible plans provide coverage for certain broadly defined service categories, limit consumer cost-sharing, and meet certain actuarial value requirements. Although the Department of Health and Human Services (HHS) was tasked with the regulatory development of these EHB under the ACA, the department quickly devolved this task to the states. Not surprisingly, states fully exploited the leeway provided by HHS, and state decision processes and outcomes differed widely. However, none of the states took advantage of the opportunity to restructure fundamentally their health insurance markets, and only a very limited number of states actually included sophisticated policy expertise in their decisionmaking processes. As a result, and despite a major expansion of coverage, the status quo ex ante in state insurance markets was largely perpetuated. Decisionmaking for the 2016 revisions should be transparent, included a wide variety of stakeholders and policy experts, and focus on balancing adequacy and affordability. However, the 2016 revisions provide an opportunity to address these previous shortcomings. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Improving access to medicines via the Health Impact Fund in India: a stakeholder analysis.

PubMed

McMullan, Patrick; Ajay, Vamadevan S; Srinivas, Ravi; Bhalla, Sandeep; Prabhakaran, Dorairaj; Banerjee, Amitava

2018-01-01

In India, 50-65% of the population face difficulties in accessing medicines. The Health Impact Fund (HIF) is a novel proposal whereby pharmaceutical companies would be paid based on the measured global health impact of their drugs. We conducted a key stakeholder analysis to explore access to medicines in India, acceptability of the HIF and potential barriers and facilitators at policy level. To conduct a stakeholder analysis of the HIF in India: to determine key stakeholder views regarding access to medicines in India; to evaluate acceptability of the HIF; and to assess potential barriers and facilitators to the HIF as a policy. In New Delhi, we conducted semi-structured interviews. There was purposive recruitment of participants with snowball sampling. Transcribed data were analysed using stakeholder analysis frameworks and directed content analysis. Participation rate was 29% (14/49). 14 semi-structured interviews were conducted among stakeholders in New Delhi. All participants highlighted access to medicines as a problem in India. There were mixed views about the HIF in terms of relevance and scaleability. Stakeholders felt it should focus on diseases with limited or no market and potentially incorporate direct investment in research. First, access to medicines is perceived to be a major problem in India by all stakeholders, but affordability is just one factor. Second, stakeholders despite considerable support for the idea of the HIF, there are major concerns about scaleability, generalisability and impact on access to medicines. Third, the HIF and other novel drug-related health policies can afford to be more radical, e.g. working outside the existing intellectual property rights regime, targeting generic as well as branded drugs, or extending to research and development. Further innovations in access to medicines must involve country-specific key stakeholders in order to increase the likelihood of their success.

Improving access to medicines via the Health Impact Fund in India: a stakeholder analysis

PubMed Central

McMullan, Patrick; Ajay, Vamadevan S.; Srinivas, Ravi; Bhalla, Sandeep; Prabhakaran, Dorairaj; Banerjee, Amitava

2018-01-01

ABSTRACT Background: In India, 50–65% of the population face difficulties in accessing medicines. The Health Impact Fund (HIF) is a novel proposal whereby pharmaceutical companies would be paid based on the measured global health impact of their drugs. We conducted a key stakeholder analysis to explore access to medicines in India, acceptability of the HIF and potential barriers and facilitators at policy level. Objectives: To conduct a stakeholder analysis of the HIF in India: to determine key stakeholder views regarding access to medicines in India; to evaluate acceptability of the HIF; and to assess potential barriers and facilitators to the HIF as a policy. Methods: In New Delhi, we conducted semi-structured interviews. There was purposive recruitment of participants with snowball sampling. Transcribed data were analysed using stakeholder analysis frameworks and directed content analysis. Results: Participation rate was 29% (14/49). 14 semi-structured interviews were conducted among stakeholders in New Delhi. All participants highlighted access to medicines as a problem in India. There were mixed views about the HIF in terms of relevance and scaleability. Stakeholders felt it should focus on diseases with limited or no market and potentially incorporate direct investment in research. Conclusions: First, access to medicines is perceived to be a major problem in India by all stakeholders, but affordability is just one factor. Second, stakeholders despite considerable support for the idea of the HIF, there are major concerns about scaleability, generalisability and impact on access to medicines. Third, the HIF and other novel drug-related health policies can afford to be more radical, e.g. working outside the existing intellectual property rights regime, targeting generic as well as branded drugs, or extending to research and development. Further innovations in access to medicines must involve country-specific key stakeholders in order to increase the likelihood

Patient Protection and Affordable Care Act; establishment of the multi-state plan program for the Affordable Insurance Exchanges.

PubMed

2013-03-11

The U.S. Office of Personnel Management (OPM) is issuing a final regulation establishing the Multi-State Plan Program (MSPP) pursuant to the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. Through contracts with OPM, health insurance issuers will offer at least two multi-State plans (MSPs) on each of the Affordable Insurance Exchanges (Exchanges). One of the issuers must be non-profit. Under the law, an MSPP issuer may phase in the States in which it offers coverage over 4 years, but it must offer MSPs on Exchanges in all States and the District of Columbia by the fourth year in which the MSPP issuer participates in the MSPP. This rule aims to balance adhering to the statutory goals of MSPP while aligning its standards to those applying to qualified health plans to promote a level playing field across health plans.

Construction Grants for Educational Facilities, Fiscal Years 1965-77. Health Manpower References.

ERIC Educational Resources Information Center

Berman, Bella U.; Rosenthal, Samuel

This publication provides information on construction assistance awarded to schools of medicine, osteopathic medicine, dentistry, optometry, pharmacy, podiatric medicine, veterinary medicine, public health, and nursing. In addition it provides data on grants awarded to schools of allied health, medical libraries, and health research facilities.…

Chaos in Western Medicine: How Issues of Social-Professional Status are Undermining Our Health

PubMed Central

Wilson, N. W.

2012-01-01

From the period immediately following the second world war, western (orthodox) medicine – both as a philosophy of medicine and as a professional guild of medical professionals actively practicing medicine – has made progress in leaps and bounds, especially considering the advances in technology and associated enterprises. Over the last thirty years, however, the practice of orthodox medicine has taken a turn for the worst despite progressive philosophies and tenets of basic practice as offered by the professional bodies that regulate how medicine is operated and implemented. Current healthcare environments are in a chaotic state of affairs, most notably due to issues involving affordability of medical professionals. It is argued that the social-professional status of medical doctors allow exorbitant and unreachable demands on governments for increased salaries. The title-based supremacy of doctors within the occupations domain is not supported by what they are offering society at large, and it compromises the ability of medical institutions and governments to provide better and more affordable healthcare. From a sociological point of view, this paper examines the social-religious history of such social class-based occupational power and dominance, and paves the way toward an overhaul of current medical education frameworks that proactively will ensure greater occupational equity in healthcare settings, across all healthcare disciplines tasked with patient care and improvement of healthcare services. In essence, doctoral titles should only be awarded after successful completion of postgraduate doctoral studies, and a new breed of medical professionals must emerge, able to contribute more meaningfully to the advancement of medicine as a profession, as well as toward increased standards of healthcare and improved health services delivery. PMID:23121737

Emotion regulation choice: the role of environmental affordances.

PubMed

Suri, Gaurav; Sheppes, Gal; Young, Gerald; Abraham, Damon; McRae, Kateri; Gross, James J

2017-09-01

Which emotion regulation strategy one uses in a given context can have profound affective, cognitive, and social consequences. It is therefore important to understand the determinants of emotion regulation choice. Many prior studies have examined person-specific, internal determinants of emotion regulation choice. Recently, it has become clear that external variables that are properties of the stimulus can also influence emotion regulation choice. In the present research, we consider whether reappraisal affordances, defined as the opportunities for re-interpretation of a stimulus that are inherent in that stimulus, can shape individuals' emotion regulation choices. We show that reappraisal affordances have stability across people and across time (Study 1), and are confounded with emotional intensity for a standardised set of picture stimuli (Study 2). Since emotional intensity has been shown to drive emotion regulation choice, we construct a context in which emotional intensity is separable from reappraisal affordances (Study 3) and use this context to show that reappraisal affordances powerfully influence emotion regulation choice even when emotional intensity and discrete emotions are taken into account (Study 4).

The ethics of the affordability of health insurance.

PubMed

Saloner, Brendan; Daniels, Norman

2011-10-01

In this essay we argue that the concept of affordable health insurance is rooted in a social obligation to protect fair equality of opportunity. Specifically, health insurance plays a limited but significant role in protecting opportunity in two ways: it helps keep people functioning normally and it protects their financial security. Together these benefits enable household members to exercise reasonable choices about their plans of life. To achieve truly affordable coverage, society must be able to contain the overall cost of health care, and health insurance must be progressively financed, meaning that those who are best able to pay for coverage should pay the largest share. While the recently passed Patient Protection and Affordable Care Act (ACA) falls short on both of these counts, we argue that it makes important contributions toward household affordability through the use of subsidies and regulations. The main shortcoming of the ACA is an insufficient protection against burdensome cost sharing, which we illustrate using several hypothetical scenarios. We conclude with recommendations about how to make opportunity-enhancing expansions to the current coverage subsidies.

Affordable CZT SPECT with dose-time minimization (Conference Presentation)

NASA Astrophysics Data System (ADS)

Hugg, James W.; Harris, Brian W.; Radley, Ian

2017-03-01

PURPOSE Pixelated CdZnTe (CZT) detector arrays are used in molecular imaging applications that can enable precision medicine, including small-animal SPECT, cardiac SPECT, molecular breast imaging (MBI), and general purpose SPECT. The interplay of gamma camera, collimator, gantry motion, and image reconstruction determines image quality and dose-time-FOV tradeoffs. Both dose and exam time can be minimized without compromising diagnostic content. METHODS Integration of pixelated CZT detectors with advanced ASICs and readout electronics improves system performance. Because historically CZT was expensive, the first clinical applications were limited to small FOV. Radiation doses were initially high and exam times long. Advances have significantly improved efficiency of CZT-based molecular imaging systems and the cost has steadily declined. We have built a general purpose SPECT system using our 40 cm x 53 cm CZT gamma camera with 2 mm pixel pitch and characterized system performance. RESULTS Compared to NaI scintillator gamma cameras: intrinsic spatial resolution improved from 3.8 mm to 2.0 mm; energy resolution improved from 9.8% to <4 % at 140 keV; maximum count rate is <1.5 times higher; non-detection camera edges are reduced 3-fold. Scattered photons are greatly reduced in the photopeak energy window; image contrast is improved; and the optimal FOV is increased to the entire camera area. CONCLUSION Continual improvements in CZT detector arrays for molecular imaging, coupled with optimal collimator and image reconstruction, result in minimized dose and exam time. With CZT cost improving, affordable whole-body CZT general purpose SPECT is expected to enable precision medicine applications.

Precision medicine--delivering the goods?

PubMed

Peer, Dan

2014-09-28

Personalized (or precision) medicine aims to individualize therapeutic interventions, based on OMICS data such as genomics, proteomics, metabolomics etc', profiling together with histopathological insights to the type, stage, and the grade of the disease, as well as on the potential response of a particular patient to a particular treatment regimen. With next generation sequencing technologies, it is now possible to identify all germline variants of an individual in an affordable cost and thus paving the way for clinicians to provide healthcare from an individual perspective. In this special issue of Cancer Letters termed "Trends in Personalized Cancer Research" we bring together physicians and scientists summarizing the state-of-the-art in precision medicine from hematological malignancies and solid tumors with the current gold standard diagnostic and therapy to basic and translational research utilizing nanotechnology and RNA interference strategies for future personalized theranostics in oncology. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Schizophrenia: An Impairment in the Capacity to Perceive Affordances

PubMed Central

Kim, Nam-Gyoon; Kim, Hakboon

2017-01-01

Phenomenological psychopathologists conceptualize schizophrenia as a self-disorder involving profound distortions of selfhood. For James Gibson, “to perceive the world is to coperceive oneself.” If the sense of self is disturbed in individuals with schizophrenia, this could also lead to disturbances in these individuals’ ability to perceive affordances, environmental properties taken with reference to the perceiver’s action capabilities (e.g., a rigid surface affording ‘walk-on-able,’ chairs ‘sit-on-able,’ and so on). To test this hypothesis, three experiments investigated schizophrenia patients’ affordance perception. Participants were presented with a photo of a common object on the computer and then asked to judge its secondary affordance (a non-designed function) in a two-choice reaction time task in Experiment 1 and in a yes/no task in Experiment 2. Schizophrenia participants performed less accurately and more slowly than controls. To rule out visual impairment as a contributing factor, in Experiment 3, participants identified physical properties (color, shape, material composition) of the objects. Schizophrenia participants were as accurate as controls and responded faster than in the previous experiments. Results suggest that the capacity to perceive affordances is likely impaired in people with schizophrenia, although the capacity to detect the object’s physical properties is kept intact. Inability to perceive affordances, those functionally significant properties of the surrounding environment, may help explain why schizophrenia patients may appear as somewhat detached from the world. PMID:28701973

The Affordance Template ROS Package for Robot Task Programming

NASA Technical Reports Server (NTRS)

Hart, Stephen; Dinh, Paul; Hambuchen, Kimberly

2015-01-01

This paper introduces the Affordance Template ROS package for quickly programming, adjusting, and executing robot applications in the ROS RViz environment. This package extends the capabilities of RViz interactive markers by allowing an operator to specify multiple end-effector waypoint locations and grasp poses in object-centric coordinate frames and to adjust these waypoints in order to meet the run-time demands of the task (specifically, object scale and location). The Affordance Template package stores task specifications in a robot-agnostic XML description format such that it is trivial to apply a template to a new robot. As such, the Affordance Template package provides a robot-generic ROS tool appropriate for building semi-autonomous, manipulation-based applications. Affordance Templates were developed by the NASA-JSC DARPA Robotics Challenge (DRC) team and have since successfully been deployed on multiple platforms including the NASA Valkyrie and Robonaut 2 humanoids, the University of Texas Dreamer robot and the Willow Garage PR2. In this paper, the specification and implementation of the affordance template package is introduced and demonstrated through examples for wheel (valve) turning, pick-and-place, and drill grasping, evincing its utility and flexibility for a wide variety of robot applications.

Program Affordability Tradeoffs

DTIC Science & Technology

2016-04-30

engineering, trade -studies, and risk assessment and management for a variety of civilian and DoD sponsors. She holds a master’s degree in mathematics...mph in as little as 2.8 seconds. Prius Model 2 fuel economy (MPG): 54 - 58 city | 50 - 53 highway Trade -Off Analysis Costs: $80,000...affordability trades  What is the impact to goals/missions/objectives of pursuing a lower cost, lower performing alternative? Is this impact

75 FR 60482 - Proposed Extension of Information Collection Request Submitted for Public Comment; Affordable...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-30

... Collection Request Submitted for Public Comment; Affordable Care Act Enrollment Opportunity Notice Relating to Dependent Coverage; Affordable Care Act Grandfathered Health Plan Disclosure and Recordkeeping Requirement; Affordable Care Act Rescission Notice; Affordable Care Act Patient Protections Notice; Affordable...

Designing Smart Objects to Support Affording Situations: Exploiting Affordance Through an Understanding of Forms of Engagement

PubMed Central

Baber, Chris

2018-01-01

In this paper I consider how the concept of “affordance” has been adapted from the original writings of Gibson and applied to interaction design. I argue that a clear understanding of affordance shifts the goal of interaction design from one of solely focusing on either the physical object or the capabilities of the person, toward an understanding of interactivity. To do this, I develop the concept of Forms of Engagement, originally proposed to account for tool use. Finally, I extend this concept to interacting with modified tangible user interfaces, or “animate objects.” These animate objects not only sense how they are being used, but also communicate with each other to develop a shared intent, and provide prompts and cues to encourage specific actions. In this way, the human-object-environment system creates affording situations in pursuit of shared intentions and goals. In order to determine when to provide prompts and cues, the objects need to have a model of how they ought to be used and what intention they are being used to achieve. Consequently, affordances become not only the means by which actions are encouraged but also the manner in which intentions are identified and agreed. PMID:29593601

Improving access to malaria medicine through private-sector subsidies in seven African countries.

PubMed

Tougher, Sarah; Mann, Andrea G; Ye, Yazoume; Kourgueni, Idrissa A; Thomson, Rebecca; Amuasi, John H; Ren, Ruilin; Willey, Barbara A; Ansong, Daniel; Bruxvoort, Katia; Diap, Graciela; Festo, Charles; Johanes, Boniface; Kalolella, Admirabilis; Mallam, Oumarou; Mberu, Blessing; Ndiaye, Salif; Nguah, Samual Blay; Seydou, Moctar; Taylor, Mark; Wamukoya, Marilyn; Arnold, Fred; Hanson, Kara; Goodman, Catherine

2014-09-01

Improving access to quality-assured artemisinin combination therapies (ACTs) is an important component of malaria control in low- and middle-income countries. In 2010 the Global Fund to Fight AIDS, Tuberculosis, and Malaria launched the Affordable Medicines Facility--malaria (AMFm) program in seven African countries. The goal of the program was to decrease malaria morbidity and delay drug resistance by increasing the use of ACTs, primarily through subsidies intended to reduce costs. We collected data on price and retail markups on antimalarial medicines from 19,625 private for-profit retail outlets before and 6-15 months after the program's implementation. We found that in six of the AMFm pilot programs, prices for quality-assured ACTs decreased by US$1.28-$4.34, and absolute retail markups on these therapies decreased by US$0.31-$1.03. Prices and markups on other classes of antimalarials also changed during the evaluation period, but not to the same extent. In all but two of the pilot programs, we found evidence that prices could fall further without suppliers' losing money. Thus, concerns may be warranted that wholesalers and retailers are capturing subsidies instead of passing them on to consumers. These findings demonstrate that supranational subsidies can dramatically reduce retail prices of health commodities and that recommended retail prices communicated to a wide audience may be an effective mechanism for controlling the market power of private-sector antimalarial retailers and wholesalers. Project HOPE—The People-to-People Health Foundation, Inc.

Affordances: Ten Years On

ERIC Educational Resources Information Center

Brown, Jill P.; Stillman, Gloria

2014-01-01

Ten years ago the construct, affordance, was rising in prominence in scholarly literature. A proliferation of different uses and meanings was evident. Beginning with its origin in the work of Gibson, we traced its development and use in various scholarly fields. This paper revisits our original question with respect to its utility in mathematics…

Evidence-based medicine: medical librarians providing evidence at the point of care.

PubMed

Yaeger, Lauren H; Kelly, Betsy

2014-01-01

Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. .. by best available external clinical evidence we mean clinically relevant research.' Health care reform authorized by the Affordable Care Act is based on the belief that evidence-based practice (EBP) generates cost savings due to the delivery of more effective care.2 Medical librarians, skilled in identifying appropriate resources and working with multiple complex interfaces, can support clinicians' efforts to practice evidence based medicine by providing time and expertise in articulating the clinical question and identifying the best evidence.

Aerospace medicine at Brooks AFB, TX: hail and farewell.

PubMed

Nunneley, Sarah A; Webb, James T

2011-05-01

With the impending termination of USAF operations at Brooks Air Force Base (AFB) in San Antonio, TX, it is time to consider its historic role in Aerospace Medicine. The base was established in 1917 as a flight training center for the U.S. Army Air Service and in 1926 became home to its School of Aviation Medicine. The school moved to San Antonio's Randolph Field in 1931, but in 1959 it returned to Brooks where it occupied new facilities to support its role as a national center for U.S. Air Force aerospace medicine, including teaching, clinical medicine, and research. The mission was then expanded to encompass support of U.S. military and civilian space programs. With the abrupt termination of the military space program in 1969, research at Brooks focused on clinical aviation medicine and support of advanced military aircraft while continuing close cooperation with NASA in support of orbital spaceflight and the journey to the Moon. Reorganization in the 1990s assigned all research functions at Brooks to the Human Systems Division and its successors, leaving to USAFSAM the missions related to clinical work and teaching. In 2002 the USAF and the city of San Antonio implemented shared operation of Brooks as a "City-Base" in the hope of deflecting threatened closure. Nevertheless, under continuing pressure to consolidate military facilities in the United States, the 2005 Base Closure and Realignment Commission ordered Brooks closed by 2011, with its aerospace medicine functions relocated to new facilities at Wright-Patterson AFB in Dayton, OH.

38 CFR 51.42 - Drugs and medicines for certain veterans.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Drugs and medicines for... Drugs and medicines for certain veterans. (a) In addition to per diem payments under § 51.40 of this part, the Secretary shall furnish drugs and medicines to a facility recognized as a State home as may...

38 CFR 51.42 - Drugs and medicines for certain veterans.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Drugs and medicines for... Drugs and medicines for certain veterans. (a) In addition to per diem payments under § 51.40 of this part, the Secretary shall furnish drugs and medicines to a facility recognized as a State home as may...

38 CFR 51.42 - Drugs and medicines for certain veterans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Drugs and medicines for... Drugs and medicines for certain veterans. (a) In addition to per diem payments under § 51.40 of this part, the Secretary shall furnish drugs and medicines to a facility recognized as a State home as may...

38 CFR 51.42 - Drugs and medicines for certain veterans.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Drugs and medicines for... Drugs and medicines for certain veterans. (a) In addition to per diem payments under § 51.40 of this part, the Secretary shall furnish drugs and medicines to a facility recognized as a State home as may...

38 CFR 51.42 - Drugs and medicines for certain veterans.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Drugs and medicines for... Drugs and medicines for certain veterans. (a) In addition to per diem payments under § 51.40 of this part, the Secretary shall furnish drugs and medicines to a facility recognized as a State home as may...

The Problem with Affordance

ERIC Educational Resources Information Center

Oliver, Martin

2005-01-01

This article reviews the concept of "affordance", a term widely used in the literature on learning and technology to try and explain the properties technologies have. It is argued that the concept has drifted so far from its origins that it is now too ambiguous to be analytically valuable. In addition, it is suggested that its origins in…

Affordability Tradeoffs Under Uncertainty Using Epoch-Era Analysis

DTIC Science & Technology

2013-09-30

Procedia Computer Science , Retrieved from: http://www.elsevier.com Bobinis, J., Haimowitz, J., Tuttle, P., & Garrison, C. (2012, October). Affordability...commercial products. Dr. Rhodes received her PhD in Systems Science from the T.J. Watson School of Engineering at Binghamton University. She serves on...components, evaluate feedback, and be adaptive to evolving system behaviors . As affordability is a concept evaluated over time, such a method can

Challenges of Integrating Affordable and Sustainable Housing in Malaysia

NASA Astrophysics Data System (ADS)

Syed Jamaludin, S. Z. H.; Mahayuddin, S. A.; Hamid, S. H. A.

2018-04-01

Developing countries including Malaysia have begun to comprehend the needs for affordable and sustainable housing development. The majority of the population is still aspiring for a comfortable, safe and reasonably priced house. Households in the low-middle income range face difficulties to find housing that can satisfy their needs and budget. Unfortunately, most of the housing development programs are considering affordability rather than sustainable aspects. Furthermore, developers are more interested in profit and neglect sustainability issues. Thus, the aim of this paper is to review the challenges in integrating affordable housing and sustainable practices in Malaysia. This paper is produced based on an extensive literature review as a basis to develop strategies of integrated affordable and sustainable housing in Malaysia. The challenges are divided into four sections, namely market challenges, professional challenges, societal challenges and technological challenges. The outcomes of this paper will assist in the decision making involving housing development and in enhancing quality of life for sustainable communities.

Integrating herbal medicine into mainstream healthcare in Ghana: clients' acceptability, perceptions and disclosure of use.

PubMed

Agyei-Baffour, Peter; Kudolo, Agnes; Quansah, Dan Yedu; Boateng, Daniel

2017-12-01

Although there are current efforts to integrate herbal medicine (HM) into mainstream healthcare in Ghana, there is paucity of empirical evidence on the acceptability and concurrent use of HM, in the formal health facilities in Ghana. This study sought to determine client perception, disclosure and acceptability of integrating herbal medicine in mainstream healthcare in Kumasi, Ghana. A cross-sectional study was conducted from May to August, 2015. Five hundred patients presenting at the outpatient departments of Kumasi South, Suntreso and Tafo Government Hospitals in Kumasi were randomly selected. Interviews were conducted with the use of structured questionnaires. A logistic regression analysis, using backward selection, was conducted to determine the influence of socio-demographic and facility related factors on the odds of using HM at the facility. All statistical tests were two-sided and considered significant at a p-value of <0.05. Majority of the study respondents were females (64.8%) and the median age was 36 years. Less than half, 42.2%, of the respondents utilized HM services when they visited the health facility. Reasons for using HM at the facility level included 'being effective' (24.4%), 'easy to access' (25.3%) and 'being comparatively cheaper' (16%). About 86% never disclosed previous use of HM to their health care providers. Socio-economic status and perception of service provision influenced use of herbal medicines. Respondents who rated themselves wealthy had increased odds of using herbal medicines at the health facility as compared to those who rated themselves poor (OR = 4.9; 95%CI = 1.6-15.3). This study shows that integration of herbal medicine is feasible and herbal medicines may be generally accepted as a formal source of healthcare in Ghana. The results of this study might serve as a basis for improvement and upscale of the herbal medicine integration programme in Ghana.

The Fidelity of ’Feel’: Emotional Affordance in Virtual Environments

DTIC Science & Technology

2005-07-01

The Fidelity of “Feel”: Emotional Affordance in Virtual Environments Jacquelyn Ford Morie, Josh Williams, Aimee Dozois, Donat-Pierre Luigi... environment but also the participant. We do this with the focus on what emotional affordances this manipulation will provide. Our first evaluation scenario...emotionally affective VEs. Keywords: Immersive Environments , Virtual Environments , VEs, Virtual Reality, emotion , affordance, fidelity, presence

Does Task Affordance Moderate Age-related Deficits in Strategy Production?

PubMed Central

Bottiroli, Sara; Dunlosky, John; Guerini, Kate; Cavallini, Elena; Hertzog, Christopher

2011-01-01

According to the task-affordance hypothesis, people will be more likely to use a specific strategy as tasks more readily afford its use. To evaluate this hypothesis, we examined the degree to which older and younger adults used a self-testing strategy to learn items, because previous studies suggest that age-related differences in the use of this powerful strategy vary across tasks. These tasks (words affixed to a board vs. pairs on flashcards) differentially afford the use of the self-testing strategy and may moderate the age-related effects on strategy use. Participants performed a recall-readiness task in which they continued to study items until they were ready for the criterion test. As predicted, self testing was used less often on tasks that least afforded its use. Namely, participants used self testing less when they studied single words affixed to a board than when they studied pairs on flashcards. Most important, age-related deficits in strategy use were greater for the former task and nonexistent for the latter one, suggesting that task affordance moderates age differences in strategy use. PMID:20552461

Does task affordance moderate age-related deficits in strategy production?

PubMed

Bottiroli, Sara; Dunlosky, John; Guerini, Kate; Cavallini, Elena; Hertzog, Christopher

2010-09-01

According to the task-affordance hypothesis, people will be more likely to use a specific strategy as tasks more readily afford its use. To evaluate this hypothesis, we examined the degree to which older and younger adults used a self-testing strategy to learn items, because previous studies suggest that age-related differences in the use of this powerful strategy vary across tasks. These tasks (words affixed to a board vs. pairs on flashcards) differentially afford the use of the self-testing strategy and may moderate the age-related effects on strategy use. Participants performed a recall-readiness task in which they continued to study items until they were ready for the criterion test. As predicted, self testing was used less often on tasks that least afforded its use. Namely, participants used self testing less when they studied single words affixed to a board than when they studied pairs on flashcards. Most important, age-related deficits in strategy use were greater for the former task and nonexistent for the latter one, suggesting that task affordance moderates age differences in strategy use.

Essential medicines are more available than other medicines around the globe.

PubMed

Bazargani, Yaser T; Ewen, Margaret; de Boer, Anthonius; Leufkens, Hubert G M; Mantel-Teeuwisse, Aukje K

2014-01-01

The World Health Organization (WHO) promotes the development of national Essential Medicines Lists (EMLs) in order to improve the availability and use of medicines considered essential within health care systems. However, despite over 3 decades of international efforts, studies show an inconsistent pattern in the availability of essential medicines. We evaluated and compared the availability of essential medicines, and medicines not included in national EMLs, at global and regional levels. Medicine availability in the public and private sector were calculated based on data obtained from national and provincial facility-based surveys undertaken in 23 countries using the WHO/HAI methodology. The medicines were grouped according to their inclusion ('essential') or exclusion (termed 'non-essential') in each country's EML current at the time of the survey. Availability was calculated for originator brands, generics and any product type (originator brands or generics) and compared between the two groups. Results were aggregated by WHO regions, World Bank country income groups, a wealth inequality measure, and therapeutic groups. Across all sectors and any product type, the median availability of essential medicines was suboptimal at 61·5% (IQR 20·6%-86·7%) but significantly higher than non-essential medicines at 27·3% (IQR 3·6%-70·0%). The median availability of essential medicines was 40·0% in the public sector and 78·1% in the private sector; compared to 6·6% and 57·1% for non-essential medicines respectively. A reverse trend between national income level categories and the availability of essential medicines was identified in the public sector. EMLs have influenced the provision of medicines and have resulted in higher availability of essential medicines compared to non-essential medicines particularly in the public sector and in low and lower middle income countries. However, the availability of essential medicines, especially in the public sector does not

Herbal diuretics in medieval Persian and Arabic medicine.

PubMed

Shoja, Mohammadali M; Tubbs, R Shane; Bosmia, Anand N; Fakhree, Mohammad A A; Jouyban, Abolghasem; Balch, Margaret Wood; Loukas, Marios; Khodadoust, Kazem; Khalili, Majid; Eknoyan, Garabed

2015-06-01

In accord with the notions of humoralism that prevailed in medieval medicine, therapeutic interventions, including diuretics, were used to restore the disturbed balance among the four humors of the human body: blood, phlegm, yellow bile, and black bile. Most diuretics were derived from plants. The primary textual reference on herbal diuretics was Dioscorides's De Materia Medica, which was written during the first century CE. The authors reviewed the medieval medical texts written in Persian and Arabic and compiled a list of 135 herbal diuretics used by the medieval medical authorities for treating various ailments. Between the 8th and 11th centuries CE, Middle Eastern physicians systematically reviewed extant books on medicine and pharmacotherapy and compiled new and expanded lists of herbal medicines, diuretics in particular. Furthermore, they introduced new chemical methods of extraction, distillation, and compounding in the use of herbal medicines. Several herbal remedies now are considered as potentially safe and affordable alternatives to chemical pharmaceuticals. Thus, research on medieval herbal therapies may prove to be relevant to the practice of current cardiovascular and renal pharmacotherapy. The authors propose that modern research methods can be employed to determine which of these agents actually are effective as diuretics.

Innovating affordable neonatal care equipment for use at scale.

PubMed

Sashi Kumar, V; Paul, V K; Sathasivam, K

2016-12-01

The care of small and sick neonates requires biomedical technologies, such as devices that can keep babies warm (radiant warmers and incubators), resuscitate (self-inflating bags), track growth (weighing scales), treat jaundice (phototherapy units) and provide oxygen or respiratory support (hoods, continuous positive airway pressure (CPAP) devices and ventilators). Until the 1990s, most of these products were procured through import at a high cost and with little maintenance support. Emerging demand and an informal collaboration of neonatologists, engineers and entrepreneurs has led to the production of good quality equipment of several high-volume categories at affordable cost in India. Radiant warmers, resuscitation bags, phototherapy units, weighing scales and other devices manufactured by Indian small-scale companies have enabled an expansion of neonatal care in the country, particularly in district hospitals, medical college hospitals and subdistrict facilities in the public sector as a part of the National Rural Health Mission. Indian products have acquired international quality standards and are even exported to developed nations. This paper captures this story of innovation and entrepreneurship in neonatal care.

Innovating affordable neonatal care equipment for use at scale

PubMed Central

Sashi Kumar, V; Paul, V K; Sathasivam, K

2016-01-01

The care of small and sick neonates requires biomedical technologies, such as devices that can keep babies warm (radiant warmers and incubators), resuscitate (self-inflating bags), track growth (weighing scales), treat jaundice (phototherapy units) and provide oxygen or respiratory support (hoods, continuous positive airway pressure (CPAP) devices and ventilators). Until the 1990s, most of these products were procured through import at a high cost and with little maintenance support. Emerging demand and an informal collaboration of neonatologists, engineers and entrepreneurs has led to the production of good quality equipment of several high-volume categories at affordable cost in India. Radiant warmers, resuscitation bags, phototherapy units, weighing scales and other devices manufactured by Indian small-scale companies have enabled an expansion of neonatal care in the country, particularly in district hospitals, medical college hospitals and subdistrict facilities in the public sector as a part of the National Rural Health Mission. Indian products have acquired international quality standards and are even exported to developed nations. This paper captures this story of innovation and entrepreneurship in neonatal care. PMID:27924105

Emerging Affordances in Videoconferencing for Language Learning and Teaching

ERIC Educational Resources Information Center

Dey-Plissonneau, Aparajita

2017-01-01

The theory of affordances (Gibson, 1977) came into focus in humancomputer interactions and ecological interactive design to explore design strategies to support the actor in direct perception of action possibilities in the operation of things. However, few studies have analysed the basis of affordances in the cultural-historical development of…

What's the Issue about Affordability of Public Higher Education?

ERIC Educational Resources Information Center

Goff, Donald Gary

This study compared and contrasted data reports of two national policy centers on the affordability of public higher education. The study examined cost findings of the National Center for Educational Statistics (NCES) and the major affordability findings of the National Center for Public Policy and Higher Education (NCPPHE). Both policy centers…

Making Sense of Biodiversity: The Affordances of Systems Ecology.

PubMed

Andersson, Erik; McPhearson, Timon

2018-01-01

We see two related, but not well-linked fields that together could help us better understand biodiversity and how it, over time, provides benefits to people. The affordances approach in environmental psychology offers a way to understand our perceptual appraisal of landscapes and biodiversity and, to some extent, intentional choice or behavior, i.e., a way of relating the individual to the system s/he/it lives in. In the field of ecology, organism-specific functional traits are similarly understood as the physiological and behavioral characteristics of an organism that informs the way it interacts with its surroundings. Here, we review the often overlooked role of traits in the provisioning of ecosystem services as a potential bridge between affordance theory and applied systems ecology. We propose that many traits can be understood as the basis for the affordances offered by biodiversity, and that they offer a more fruitful way to discuss human-biodiversity relations than do the taxonomic information most often used. Moreover, as emerging transdisciplinary studies indicate, connecting affordances to functional traits allows us to ask questions about the temporal and two-way nature of affordances and perhaps most importantly, can serve as a starting point for more fully bridging the fields of ecology and environmental psychology with respect to how we understand human-biodiversity relationships.

Accessibility and Affordability of Supermarkets: Associations With the DASH Diet.

PubMed

Mackenbach, Joreintje D; Burgoine, Thomas; Lakerveld, Jeroen; Forouhi, Nita G; Griffin, Simon J; Wareham, Nicholas J; Monsivais, Pablo

2017-07-01

It is unknown whether there is an interplay of affordability (economic accessibility) and proximity (geographic accessibility) of supermarkets in relation to having a Dietary Approaches to Stop Hypertension (DASH)-accordant diet. Data (collected: 2005-2015, analyzed: 2016) were from the cross-sectional, population-based Fenland Study cohort: 9,274 adults aged 29-64 years, living in Cambridgeshire, United Kingdom. Dietary quality was evaluated using an index of DASH dietary accordance, based on recorded consumption of foods and beverages in a validated 130-item, semi-quantitative food frequency questionnaire. DASH accordance was defined as a DASH score in the top quintile. Dietary costs (£/day) were estimated by attributing a food price variable to the foods consumed according to the questionnaire. Individuals were classified as having low-, medium-, or high-cost diets. Supermarket affordability was determined based on the cost of a 101-item market basket. Distances between home address to the nearest supermarket (geographic accessibility) and nearest economically-appropriate supermarket (economic accessibility) were divided into tertiles. Higher-cost diets were more likely to be DASH-accordant. After adjustment for key demographics and exposure to other food outlets, individuals with lowest economic accessibility to supermarkets had lower odds of being DASH-accordant (OR=0.59, 95% CI=0.52, 0.68) than individuals with greatest economic accessibility. This association was stronger than with geographic accessibility alone (OR=0.85, 95% CI=0.74, 0.98). Results suggest that geographic and economic access to food should be taken into account when considering approaches to promote adherence to healthy diets for the prevention of cardiovascular diseases and other chronic disease. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Quality differentials and reproductive health service utilisation determinants in India.

PubMed

Anand, Sandip; Sinha, R K

2010-01-01

This paper seeks to establish relationships between women's reproductive health service use, assessed longitudinally and by facility type, with service quality perceptions related to public or private health facilities. The study was mainly secondary and quantitative in nature. It included analysing data collected by the International Institute for Population Sciences (IIPS) and The Johns Hopkins University (JHU) as a follow-up study to the 1998-1999 National Family Health Survey (NFHS-2). The follow-up survey was carried out in Tamil Nadu, Maharashtra, Bihar and Jharkhand. In 2002-2003, these four states were selected to capture socio-economic and demographic variations. Analysis includes composite indices and logistic regression analysis. A scale was constructed to measure utilisation levels. Dimensions include: service proximity, doctor availability, waiting time, medicines, facility cleanliness, dignified treatment, privacy, service affordability and treatment effectiveness. Findings indicate that doctor availability, waiting time, cleanliness, privacy and affordability at private health facilities enhance the probability that a health facility will be used for any reproductive health purpose. At the combined states level, medicine availability and treatment effectiveness at public health facilities enhances service use. The major limitation is that the study includes only selected Indian states. The findings may enhance Indian service-quality policy. The paper's main contribution is that seemingly for the first time in India, healthcare service use has been measured longitudinally and then explained through service quality variables by comparing public and private health facilities.

Foregrounding Sociomaterial Practice in Our Understanding of Affordances: The Skilled Intentionality Framework.

PubMed

van Dijk, Ludger; Rietveld, Erik

2016-01-01

Social coordination and affordance perception always take part in concrete situations in real life. Nonetheless, the different fields of ecological psychology studying these phenomena do not seem to make this situated nature an object of study. To integrate both fields and extend the reach of the ecological approach, we introduce the Skilled Intentionality Framework that situates both social coordination and affordance perception within the human form of life and its rich landscape of affordances. We argue that in the human form of life the social and the material are intertwined and best understood as sociomateriality. Taking the form of life as our starting point foregrounds sociomateriality in each perspective we take on engaging with affordances. Using ethnographical examples we show how sociomateriality shows up from three different perspectives we take on affordances in a real-life situation. One perspective shows us a landscape of affordances that the sociomaterial environment offers. Zooming in on this landscape to the perspective of a local observer, we can focus on an individual coordinating with affordances offered by things and other people situated in this landscape. Finally, viewed from within this unfolding activity, we arrive at the person's lived perspective: a field of relevant affordances solicits activity. The Skilled Intentionality Framework offers a way of integrating social coordination and affordance theory by drawing attention to these complementary perspectives. We end by showing a real-life example from the practice of architecture that suggests how this situated view that foregrounds sociomateriality can extend the scope of ecological psychology to forms of so-called "higher" cognition.

Foregrounding Sociomaterial Practice in Our Understanding of Affordances: The Skilled Intentionality Framework

PubMed Central

van Dijk, Ludger; Rietveld, Erik

2017-01-01

Social coordination and affordance perception always take part in concrete situations in real life. Nonetheless, the different fields of ecological psychology studying these phenomena do not seem to make this situated nature an object of study. To integrate both fields and extend the reach of the ecological approach, we introduce the Skilled Intentionality Framework that situates both social coordination and affordance perception within the human form of life and its rich landscape of affordances. We argue that in the human form of life the social and the material are intertwined and best understood as sociomateriality. Taking the form of life as our starting point foregrounds sociomateriality in each perspective we take on engaging with affordances. Using ethnographical examples we show how sociomateriality shows up from three different perspectives we take on affordances in a real-life situation. One perspective shows us a landscape of affordances that the sociomaterial environment offers. Zooming in on this landscape to the perspective of a local observer, we can focus on an individual coordinating with affordances offered by things and other people situated in this landscape. Finally, viewed from within this unfolding activity, we arrive at the person’s lived perspective: a field of relevant affordances solicits activity. The Skilled Intentionality Framework offers a way of integrating social coordination and affordance theory by drawing attention to these complementary perspectives. We end by showing a real-life example from the practice of architecture that suggests how this situated view that foregrounds sociomateriality can extend the scope of ecological psychology to forms of so-called “higher” cognition. PMID:28119638

One Hand, Two Objects: Emergence of Affordance in Contexts

ERIC Educational Resources Information Center

Borghi, Anna M.; Flumini, Andrea; Natraj, Nikhilesh; Wheaton, Lewis A.

2012-01-01

Studies on affordances typically focus on single objects. We investigated whether affordances are modulated by the context, defined by the relation between two objects and a hand. Participants were presented with pictures displaying two manipulable objects linked by a functional (knife-butter), a spatial (knife-coffee mug), or by no relation. They…

24 CFR 572.120 - Affordability standards.

Code of Federal Regulations, 2010 CFR

2010-04-01

... (Continued) OFFICE OF ASSISTANT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT OF HOUSING AND... affordability. (1) The monthly expenditure for principal, interest, taxes, and insurance by an eligible family...

FACILITIES FOR EDUCATION IN VA HOSPITALS. FINAL REPORT.

ERIC Educational Resources Information Center

GREEN, ALAN C.; AND OTHERS

THIS STUDY WAS AUTHORIZED BY THE VA DEPARTMENT OF MEDICINE AND SURGERY FOR THE PURPOSE OF IDENTIFYING AND DETERMINING THE FACILITIES NEEDED TO PROPERLY HOUSE AND SUPPORT EDUCATION ACTIVITIES IN EXISTING AND FUTURE VA HOSPITALS AND TO PRODUCE ARCHITECTURAL GUIDANCE IN THE DESIGN OF THE FACILITIES. CURRENT PRACTICES AND SIGNIFICANT TRENDS IN MEDICAL…

Biomarker development in the precision medicine era: lung cancer as a case study.

PubMed

Vargas, Ashley J; Harris, Curtis C

2016-08-01

Precision medicine relies on validated biomarkers with which to better classify patients by their probable disease risk, prognosis and/or response to treatment. Although affordable 'omics'-based technology has enabled faster identification of putative biomarkers, the validation of biomarkers is still stymied by low statistical power and poor reproducibility of results. This Review summarizes the successes and challenges of using different types of molecule as biomarkers, using lung cancer as a key illustrative example. Efforts at the national level of several countries to tie molecular measurement of samples to patient data via electronic medical records are the future of precision medicine research.

Understanding the relationship between access to care and facility-based delivery through analysis of the 2008 Ghana Demographic Health Survey.

PubMed

Moyer, Cheryl A; McLaren, Zoë M; Adanu, Richard M; Lantz, Paula M

2013-09-01

To determine the types of access to care most strongly associated with facility-based delivery among women in Ghana. Data relating to the "5 As of Access" framework were extracted from the 2008 Ghana Demographic Health Survey and analyzed using multivariate logistic regression. In all, 55.5% of a weighted sample of 1102 women delivered in a healthcare facility, whereas 45.5% delivered at home. Affordability was the strongest access factor associated with delivery location, with health insurance coverage tripling the odds of facility delivery. Availability, accessibility (except urban residence), acceptability, and social access variables were not significant factors in the final models. Social access variables, including needing permission to seek healthcare and not being involved in decisions regarding healthcare, were associated with a reduced likelihood of facility-based delivery when examined individually. Multivariate analysis suggested that these variables reflected maternal literacy, health insurance coverage, and household wealth, all of which attenuated the effects of social access. Affordability was an important determinant of facility delivery in Ghana-even among women with health insurance-but social access variables had a mediating role. Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

A Review of Hepatoprotective Plants Used in Saudi Traditional Medicine

PubMed Central

Al-Asmari, Abdulrahman K.; Al-Elaiwi, Abdulrahman M.; Athar, Md Tanwir; Tariq, Mohammad; Al Eid, Ahmed; Al-Asmary, Saeed M.

2014-01-01

Liver disease is one of the major causes of morbidity and mortality across the world. According to WHO estimates, about 500 million people are living with chronic hepatitis infections resulting in the death of over one million people annually. Medicinal plants serve as a vital source of potentially useful new compounds for the development of effective therapy to combat liver problems. Moreover herbal products have the advantage of better affordability and acceptability, better compatibility with the human body, and minimal side effects and is easier to store. In this review attempt has been made to summarize the scientific data published on hepatoprotective plants used in Saudi Arabian traditional medicine. The information includes medicinal uses of the plants, distribution in Saudi Arabia, ethnopharmacological profile, possible mechanism of action, chemical constituents, and toxicity data. Comprehensive scientific studies on safety and efficacy of these plants can revitalise the treatment of liver diseases. PMID:25587347

Medical Care in a Free Clinic: A Comprehensive Evaluation of Patient Experience, Incentives, and Barriers to Optimal Medical Care with Consideration of a Facility Fee.

PubMed

Birs, Antoinette; Liu, Xinwei; Nash, Bee; Sullivan, Sara; Garris, Stephanie; Hardy, Marvin; Lee, Michael; Simms-Cendan, Judith; Pasarica, Magdalena

2016-02-19

Free and charitable clinics are important contributors to the health of the United States population. Recently, funding for these clinics has been declining, and it is, therefore, useful to identify what qualities patients value the most in clinics in an effort to allocate funding wisely. In order to identify targets and incentives for improvement of patients' health, we performed a comprehensive analysis of patients' experience at a free clinic by analyzing a patient survey (N=94). The survey also assessed patient opinions of a small facility fee, which could be used to offset the decrease in funds. Interestingly, our patients believed it is appropriate to be charged a facility fee (78%) because it increases involvement in their care (r = 0.69, p < 0.001) and self-respect (r = 0.66, p < 0.001). Incentives to medical care include continuity of care, faith-based care, having a patient medical provider partnership, and charging a facility fee. Barriers include affordable housing, transportation, medication, and accessible information. In order to improve medical care in the uninsured population, our study suggested that we need to: 1) offer continuity of medical care; 2) offer affordable preventive health screenings; 3) support affordable transportation, housing, and medications; and 4) consider including a facility fee.

Piecing Together the College Affordability Puzzle: Student Characteristics and Patterns of (Un)Affordability

ERIC Educational Resources Information Center

Welbeck, Rashida; Diamond, John; Mayer, Alexander; Richburg-Hayes, Lashawn

2014-01-01

The cost of attending college has risen sharply over the last 40 years. Although more credit and grant aid have been made available to students, there are still major gaps between aid and the cost of attendance for many students in the United States, all of whom are left to figure out whether they can afford the remaining costs associated with…

Availability, accessibility, and affordability of neurodiagnostic tests in 37 countries.

PubMed

McLane, Hannah C; Berkowitz, Aaron L; Patenaude, Bryan N; McKenzie, Erica D; Wolper, Emma; Wahlster, Sarah; Fink, Günther; Mateen, Farrah J

2015-11-03

To determine the availability, accessibility, and affordability of EEG, EMG, CSF analysis, head CT, and brain MRI for neurologic disorders across countries. An online, 60-question survey was distributed to neurology practitioners in 2014 to assess the presence, wait time, and cost of each test in private and public health sectors. Data were stratified by World Bank country income group. Affordability was calculated with reference to the World Health Organization's definition of catastrophic health expenditure as health-related out-of-pocket expenditure of >40% of disposable household income, and assessment of providers' perceptions of affordability to the patient. Availability of EEG and EMG is correlated with higher World Bank income group (correlation coefficient 0.38, test for trend p = 0.046; 0.376, p = 0.043); CSF, CT, and MRI did not show statistically significant associations with income groups. Patients in public systems wait longer for neurodiagnostic tests, especially MRI, EEG, and urgent CT (p < 0.0001). The mean cost per test, across all tests, was lower in the public vs private sector (US $55.25 vs $214.62, p < 0.001). Each drop in World Bank income group is associated with a 29% decrease in the estimated share of the population who can afford a given test (95% confidence interval -33.4, 25.2; p < 0.001). In most low-income countries surveyed, only the top 10% or 20% of the population was able to afford tests below catastrophic levels. In surveyed lower-middle-income countries, >40% of the population, on average, could not afford neurodiagnostic tests. Neurodiagnostic tests are least affordable in the lowest income settings. Closing this "diagnostic gap" for countries with the lowest incomes is essential. © 2015 American Academy of Neurology.

Affordances and the musically extended mind

PubMed Central

Krueger, Joel

2014-01-01

I defend a model of the musically extended mind. I consider how acts of “musicking” grant access to novel emotional experiences otherwise inaccessible. First, I discuss the idea of “musical affordances” and specify both what musical affordances are and how they invite different forms of entrainment. Next, I argue that musical affordances – via soliciting different forms of entrainment – enhance the functionality of various endogenous, emotion-granting regulative processes, drawing novel experiences out of us with an expanded complexity and phenomenal character. I argue that music therefore ought to be thought of as part of the vehicle needed to realize these emotional experiences. I appeal to different sources of empirical work to develop this idea. PMID:24432008

A successful experience of the Iranian blood transfusion organization in improving accessibility and affordability of plasma derived medicine.

PubMed

Chegini, Azita; Torab, Seyed Ardeshir; Pourfatollah, Ali Akbar

2017-02-01

Plasma is the liquid part of blood. It is estimated 21.6 million liters of plasma collect from Whole blood annually. From these plasma, 4.2 million liters transfuse, 8.1 million liters fractionate, 9.3 million liters waste. Nowadays, blood products and PDM (plasma derived medicine) consider as essential medicine in modern health care and transfusion medicine. Iranian blood transfusion organization as a non-profit organization was established in 1974 in order to centralize all blood transfusion activities from donor recruitment to distribution of blood components to hospitals. Iran is the only country in EMR region with the rate of 20-29.9 blood donations per 1000 population and reached 100% voluntary non-remunerated blood donation in 2007. RBCs and platelets demand are much more than FFPs so the IBTO was faced the surplus plasma that could cause surplus plasma wastage. Simultaneously, hospitals need more plasma derived medicine especially albumin, IVIG, factor VIII, factor IX. IBTO was faced the challenges such as Fractionators selection, Plasma volume shipment, Contract duration, Product profile, Multiple External audits, Cold chain maintenance, Transporting plasma across international borders, NAT test. To overcome plasma wastage and storage of PDM. IBTO involved toll manufacturing in 2005 and not only prevents plasma wastage but also save MOH (ministry of health) budget. Copyright © 2016. Published by Elsevier Ltd.

Affordance Analysis of Google+ Features: Advancing Teaching and Learning in Higher Education

ERIC Educational Resources Information Center

Zawawi, Boshra F.; Al Abri, Maimoona H.; Dabbagh, Nada

2017-01-01

This paper aims to analyze the affordances of the digital technology (DT) Google+. The analysis process was informed by the theory of affordances. Accordingly, this paper highlighted the different types of affordances of Google+ features, i.e., functional, cognitive, physical, sensory, emotional, and social. In addition, the authors reviewed…

Investigating cigarette affordability in 60 cities using the cigarette price‐daily income ratio

PubMed Central

Kan, Ming‐yue

2007-01-01

Objective To investigate cigarette affordability in 60 cities. Methods Affordability of cigarettes is defined as the ratio of the price of one pack of cigarettes to daily income (cigarette price‐daily income ratio: CPDIR). Daily income data were calculated using the mean of the seven occupations with the lowest daily wage, as listed in the 2006 Union Bank of Switzerland survey; cigarette prices in 2006 were sourced from the Economist Intelligence Unit. Results Cigarette affordability in most of the surveyed cities remains high. There is a tendency for cities with high income economies to have a high level of cigarette affordability. Most of the cities in Western Europe and South and North America have high cigarette affordability, whereas 66.7% of their counterparts in Eastern Europe have medium cigarette affordability. In Asia, all cities with high cigarette affordability belong to the group of upper middle to high income economies, except for the Philippines. In Africa, Johannesburg and Nairobi have high and medium levels of cigarette affordability, respectively. Conclusion Cigarette affordability for most of the sampled cities, especially those in high income economies, is high. There is room for increasing cigarette prices via tax increases. There is a risk that the increase in cigarette prices in newly emerging economies lags behind the high speed of economic growth being experiencing. Tax increases should be given high priority. PMID:18048622

Stem cell bioprinting for applications in regenerative medicine.

PubMed

Tricomi, Brad J; Dias, Andrew D; Corr, David T

2016-11-01

Many regenerative medicine applications seek to harness the biologic power of stem cells in architecturally complex scaffolds or microenvironments. Traditional tissue engineering methods cannot create such intricate structures, nor can they precisely control cellular position or spatial distribution. These limitations have spurred advances in the field of bioprinting, aimed to satisfy these structural and compositional demands. Bioprinting can be defined as the programmed deposition of cells or other biologics, often with accompanying biomaterials. In this concise review, we focus on recent advances in stem cell bioprinting, including performance, utility, and applications in regenerative medicine. More specifically, this review explores the capability of bioprinting to direct stem cell fate, engineer tissue(s), and create functional vascular networks. Furthermore, the unique challenges and concerns related to bioprinting living stem cells, such as viability and maintaining multi- or pluripotency, are discussed. The regenerative capacity of stem cells, when combined with the structural/compositional control afforded by bioprinting, provides a unique and powerful tool to address the complex demands of tissue engineering and regenerative medicine applications. © 2016 New York Academy of Sciences.

Developing Strategies for Affordable Bandwidth.

ERIC Educational Resources Information Center

Educause Quarterly, 2000

2000-01-01

Written by Educause's Net@EDU Broadband Pricing Working Group, this article discusses what institutions of higher education can do to develop good partnerships with broadband vendors in order to negotiate affordable pricing for increased bandwidth. Describes problems with the marketplace, examples from a few universities, and points to remember…

Affordances and Landscapes: Overcoming the Nature-Culture Dichotomy through Niche Construction Theory.

PubMed

Heras-Escribano, Manuel; De Pinedo-García, Manuel

2017-01-01

In this paper we reject the nature-culture dichotomy by means of the idea of affordance or possibility for action, which has important implications for landscape theory. Our hypothesis is that, just as the idea of affordance can serve to overcome the subjective-objective dichotomy, the ideas of landscape and ecological niche, properly defined, would allow us to also transcend the nature-culture dichotomy. First, we introduce an overview of landscape theory, emphasizing processual landscape theory as the most suitable approach for satisfying both cultural and naturalist approaches. After that, we introduce the idea of affordance and we analyze a tension between sociocultural and transcultural affordances (affordances that depend on cultural conventions and affordances that depend on lawful information and bodily aspects of agents). This tension has various implications for landscape theory and ecological niches. Our proposal is that sociocultural and transcultural aspects of affordances could be systematically accommodated if we apply niche construction theory (the theory that explains the process by which organisms modify their selective environments) as a methodological framework for explaining the emergence of ecological niches. This approach will lead us to an integrative account of landscapes as the products of the interaction between human and environmental elements, making it a clear example of a concept that transcends the nature-culture dichotomy.

Ethical and regulatory issues surrounding African traditional medicine in the context of HIV/AIDS.

PubMed

Nyika, Aceme

2007-04-01

It has been estimated that more than 80% of people in Africa use traditional medicine (TM). With the HIV/AIDS epidemic claiming many lives in Africa, the majority of people affected rely on TM mainly because it is relatively affordable and available to the poor populations who cannot afford orthodox medicine. Whereas orthodox medicine is practiced under stringent regulations and ethical guidelines emanating from The Nuremburg Code, African TM seems to be exempt from such scrutiny. Although recently there have been calls for TM to be incorporated into the health care system, less emphasis has been placed on ethical and regulatory issues. In this paper, an overview of the use of African TM in general, and for HIV/AIDS in particular, is given, followed by a look at: (i) the relative laxity in the application of ethical standards and regulatory requirements with regards to TM; (ii) the importance of research on TM in order to improve and demystify its therapeutic qualities; (iii) the need to tailor-make intellectual property laws to protect traditional knowledge and biodiversity. A framework of partnerships involving traditional healers' associations, scientists, policy makers, patients, community leaders, members of the communities, and funding organizations is suggested as a possible method to tackle these issues. It is hoped that this paper will stimulate objective and constructive debate that could enhance the protection of patients' welfare.

Hub and spoke model: making rural healthcare in India affordable, available and accessible.

PubMed

Devarakonda, Srichand

2016-01-01

Quality health care should be within everyone's reach, especially in a developing country. While India has the largest private health sector in the world, only one-fifth of healthcare expenditure is publically financed; it is mostly an out-of-pocket expense. About 70% of Indians live in rural areas making about $3 per day, and a major portion of that goes towards food and shelter and, thus, not towards health care. Transportation facilities in rural India are poor, making access to medical facilities difficult, and infrastructure facilities are minimal, making the available medical care insufficient. The challenge presented to India was to provide health care that was accessible, available and affordable to people in rural areas and the low-income bracket. The intent of this article is to determine whether the hub and spoke model (HSM), when implemented in the healthcare industry, can expand the market reach and increase profits while reducing costs of operations for organizations and, thereby, cost to customers. This article also discusses the importance of information and communications technologies (ICT) in the HSM approach, which the handful of published articles in this topic have failed to discuss. This article opts for an exploratory study, including review of published literature, web articles, viewpoints of industry experts, published journals, and in-depth interviews. This article will discuss how and why the HSM works in India's healthcare industry while isolating its strengths and weaknesses, and analyzing the impact of India's success. India's HSM implementation has become a paramount example of an acceptable model that, while exceeding the needs and expectations of its patients, is cost-effective and has obtained operational and health-driven results. Despite being an emerging nation, India takes the top spot in terms of affordability of ICT as well as for having the highest number of computer-literate graduates and healthcare workers in the world

Primary Care Sports Medicine: A Full-Timer's Perspective.

ERIC Educational Resources Information Center

Moats, William E.

1988-01-01

This article describes the history and structure of a sports medicine facility, the patient care services it offers, and the types of injuries treated at the center. Opportunities and potentials for physicians who wish to enter the field of sports medicine on a full-time basis are described, as are steps to take to prepare to do so. (Author/JL)

The Affordable Care Act: The Value of Systemic Disruption

PubMed Central

2013-01-01

It is important to recognize the political and policy accomplishments of the Patient Protection and Affordable Care Act (ACA), anticipate its limitations, and use the levers it provides strategically to address the problems it does not resolve. Passage of the ACA broke the political logjam that long stymied national progress toward equitable, quality, universal, affordable health care. It extends coverage for the uninsured who are disproportionately low income and people of color, curbs health insurance abuses, and initiates improvements in the quality of care. However, challenges to affordability and cost control persist. Public health advocates should mobilize for coverage for abortion care and for immigrants, encourage public-sector involvement in negotiating health care prices, and counter disinformation by opponents on the right. PMID:23409911

Affordance Realization in Climbing: Learning and Transfer.

PubMed

Seifert, Ludovic; Orth, Dominic; Mantel, Bruno; Boulanger, Jérémie; Hérault, Romain; Dicks, Matt

2018-01-01

The aim of this study was to investigate how the affordances of an indoor climbing wall changed for intermediate climbers following a period of practice during which hold orientation was manipulated within a learning and transfer protocol. The learning protocol consisted of four sessions, in which eight climbers randomly ascended three different routes of fixed absolute difficulty (5c on the French scale), as fluently as possible. All three routes were 10.3 m in height and composed of 20 hand-holds at the same locations on an artificial climbing wall; only hold orientations were altered: (i) a horizontal-edge route (H) was designed to afford horizontal hold grasping, (ii) a vertical-edge route (V) afforded vertical hold grasping, and (iii), a double-edge route (D) was designed to afford both horizontal and vertical hold grasping. Five inertial measurement units (IMU) (3D accelerometer, 3D gyroscope, 3D magnetometer) were attached to the hip, feet and forearms to analyze the vertical acceleration and direction (3D unitary vector) of each limb and hip in ambient space during the entire ascent. Segmentation and classification processes supported detection of movement and stationary phases for each IMU. Depending on whether limbs and/or hip were moving, a decision tree distinguished four states of behavior: stationary (absence of limb and hip motion), hold exploration (absence of hip motion but at least one limb in motion), hip movement (hip in motion but absence of limb motion) and global motion (hip in motion and at least one limb in motion). Results showed that with practice, the learners decreased the relative duration of hold exploration, suggesting that they improved affordance perception of hold grasp-ability. The number of performatory movements also decreased as performance increased during learning sessions, confirming that participants' climbing efficacy improved as a function of practice. Last, the results were more marked for the H route, while the D route

Preparation and use of plant medicines for farmers' health in Southwest Nigeria: socio-cultural, magico-religious and economic aspects.

PubMed

Mafimisebi, Taiwo E; Oguntade, Adegboyega E

2010-01-20

Agrarian rural dwellers in Nigeria produce about 95% of locally grown food commodities. The low accessibility to and affordability of orthodox medicine by rural dwellers and their need to keep healthy to be economically productive, have led to their dependence on traditional medicine. This paper posits an increasing acceptance of traditional medicine country-wide and advanced reasons for this trend. The fact that traditional medicine practitioners' concept of disease is on a wider plane vis-à-vis orthodox medicine practitioners' has culminated in some socio-cultural and magico-religious practices observed in preparation and use of plant medicines for farmers' health management. Possible scientific reasons were advanced for some of these practices to show the nexus between traditional medicine and orthodox medicine. The paper concludes that the psychological aspect of traditional medicine are reflected in its socio-cultural and magico-religious practices and suggests that government should fund research into traditional medicine to identify components of it that can be integrated into the national health system.

77 FR 36272 - SunShot Prize: America's Most Affordable Rooftop

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-18

... Most Affordable Rooftop Solar for public comment. Interested persons are encouraged to learn about the SunShot Prize: America's Most Affordable Rooftop rules at eere.energy.gov/solar/sunshot/prize.html.... Department of Energy, Office of Solar, 1000 Independence Avenue SW., Washington, DC 20585 FOR FURTHER...

A cross-sectional study of the availability and price of anti-malarial medicines and malaria rapid diagnostic tests in private sector retail drug outlets in rural Western Kenya, 2013.

PubMed

Kioko, Urbanus; Riley, Christina; Dellicour, Stephanie; Were, Vincent; Ouma, Peter; Gutman, Julie; Kariuki, Simon; Omar, Ahmeddin; Desai, Meghna; Buff, Ann M

2016-07-12

Although anti-malarial medicines are free in Kenyan public health facilities, patients often seek treatment from private sector retail drug outlets. In mid-2010, the Affordable Medicines Facility-malaria (AMFm) was introduced to make quality-assured artemisinin-based combination therapy (ACT) accessible and affordable in private and public sectors. Private sector retail drug outlets stocking anti-malarial medications within a surveillance area of approximately 220,000 people in a malaria perennial high-transmission area in rural western Kenya were identified via a census in September 2013. A cross-sectional study was conducted in September-October 2013 to determine availability and price of anti-malarial medicines and malaria rapid diagnostic tests (RDTs) in drug outlets. A standardized questionnaire was administered to collect drug outlet and personnel characteristics and availability and price of anti-malarials and RDTs. Of 181 drug outlets identified, 179 (99 %) participated in the survey. Thirteen percent were registered pharmacies, 25 % informal drug shops, 46 % general shops, 13 % homesteads and 2 % other. One hundred sixty-five (92 %) had at least one ACT type: 162 (91 %) had recommended first-line artemether-lumefantrine (AL), 22 (12 %) had recommended second-line dihydroartemisinin-piperaquine (DHA-PPQ), 85 (48 %) had sulfadoxine-pyrimethamine (SP), 60 (34 %) had any quinine (QN) formulation, and 14 (8 %) had amodiaquine (AQ) monotherapy. The mean price (range) of an adult treatment course for AL was $1.01 ($0.35-4.71); DHA-PPQ was $4.39 ($0.71-7.06); QN tablets were $2.24 ($0.12-4.71); SP was $0.62 ($0.24-2.35); AQ monotherapy was $0.42 ($0.24-1.06). The mean AL price with or without the AMFm logo did not differ significantly ($1.01 and 1.07, respectively; p = 0.45). Only 17 (10 %) drug outlets had RDTs; 149 (84 %) never stocked RDTs. The mean RDT price was $0.92 ($0.24-2.35). Most outlets never stocked RDTs; therefore, testing prior to

Affordances and Landscapes: Overcoming the Nature–Culture Dichotomy through Niche Construction Theory

PubMed Central

Heras-Escribano, Manuel; De Pinedo-García, Manuel

2018-01-01

In this paper we reject the nature–culture dichotomy by means of the idea of affordance or possibility for action, which has important implications for landscape theory. Our hypothesis is that, just as the idea of affordance can serve to overcome the subjective–objective dichotomy, the ideas of landscape and ecological niche, properly defined, would allow us to also transcend the nature–culture dichotomy. First, we introduce an overview of landscape theory, emphasizing processual landscape theory as the most suitable approach for satisfying both cultural and naturalist approaches. After that, we introduce the idea of affordance and we analyze a tension between sociocultural and transcultural affordances (affordances that depend on cultural conventions and affordances that depend on lawful information and bodily aspects of agents). This tension has various implications for landscape theory and ecological niches. Our proposal is that sociocultural and transcultural aspects of affordances could be systematically accommodated if we apply niche construction theory (the theory that explains the process by which organisms modify their selective environments) as a methodological framework for explaining the emergence of ecological niches. This approach will lead us to an integrative account of landscapes as the products of the interaction between human and environmental elements, making it a clear example of a concept that transcends the nature–culture dichotomy. PMID:29375426

User Facilities | Argonne National Laboratory

Science.gov Websites

, including biology and medicine. More than 7,000 scientists conduct experiments at Argonne user facilities Transformations IGSBInstitute for Genomics and Systems Biology IMEInstitute for Molecular Engineering JCESRJoint Science Center SBCStructural Biology Center Energy.gov U.S. Department of Energy Office of Science

29 CFR 1977.12 - Exercise of any right afforded by the Act.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 9 2012-07-01 2012-07-01 false Exercise of any right afforded by the Act. 1977.12 Section... OCCUPATIONAL SAFETY AND HEALTH ACT OF 1970 Specific Protections § 1977.12 Exercise of any right afforded by the... because of the exercise “of any right afforded by this Act.” Certain rights are explicitly provided in the...

29 CFR 1977.12 - Exercise of any right afforded by the Act.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 9 2014-07-01 2014-07-01 false Exercise of any right afforded by the Act. 1977.12 Section... OCCUPATIONAL SAFETY AND HEALTH ACT OF 1970 Specific Protections § 1977.12 Exercise of any right afforded by the... because of the exercise “of any right afforded by this Act.” Certain rights are explicitly provided in the...

29 CFR 1977.12 - Exercise of any right afforded by the Act.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 9 2011-07-01 2011-07-01 false Exercise of any right afforded by the Act. 1977.12 Section... OCCUPATIONAL SAFETY AND HEALTH ACT OF 1970 Specific Protections § 1977.12 Exercise of any right afforded by the... because of the exercise “of any right afforded by this Act.” Certain rights are explicitly provided in the...

29 CFR 1977.12 - Exercise of any right afforded by the Act.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 9 2013-07-01 2013-07-01 false Exercise of any right afforded by the Act. 1977.12 Section... OCCUPATIONAL SAFETY AND HEALTH ACT OF 1970 Specific Protections § 1977.12 Exercise of any right afforded by the... because of the exercise “of any right afforded by this Act.” Certain rights are explicitly provided in the...

Critical Value Reporting in Transfusion Medicine

PubMed Central

Reese, Erika M.; Nelson, Randin C.; Flegel, Willy A.; Byrne, Karen M.; Booth, Garrett S.

2017-01-01

Abstract Objectives: While critical value procedures have been adopted in most areas of the clinical laboratory, their use in transfusion medicine has not been reviewed in detail. The results of this study present a comprehensive overview of critical value reporting and communication practices in transfusion medicine in the United States. Methods: A web-based survey was developed to collect data on the prevalence of critical value procedures and practices of communicating results. The survey was distributed via email to US hospital-based blood banks. Results: Of 123 facilities surveyed, 84 (68.3%) blood banks had a critical value procedure. From a panel of 23 common blood bank results, nine results were selected by more than 70% of facilities as either a critical value or requiring rapid communication as defined by an alternate procedure. Conclusions: There was overlap among results communicated by facilities with and without a critical value procedure. The most frequently communicated results, such as incompatible crossmatch for RBC units issued uncrossmatched, delay in finding compatible blood due to a clinically significant antibody, and transfusion reaction evaluation suggestive of a serious adverse event, addressed scenarios associated with the leading reported causes of transfusion-related fatalities. PMID:28371931

75 FR 70160 - Affordable Care Act; Federal External Review Process; Request for Information

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-17

...-9986-NC] DEPARTMENT OF LABOR Employee Benefits Security Administration 29 CFR Part 2590 Affordable Care... Affordable Care Act, and its implementing regulations. DATES: Submit written or electronic comments by... processes under the Affordable Care Act; those comments are being collected and evaluated on a separate...

Providing Affordable Housing: Small Communities Benefit from Upgrading Dilapidated Homes.

ERIC Educational Resources Information Center

Hestekin, Kay

1991-01-01

Describes the Affordable Housing Opportunities Program (AHOP) created by the Eau Claire County Housing Authority in Wisconsin. The AHOP buys, renovates, and sells homes for prices below fair market value. This provides safe, sanitary housing for families who could not otherwise afford it. Describes the purchase, renovation, and sale of four…

System Concepts for Affordable Fission Surface Power

NASA Technical Reports Server (NTRS)

Mason, Lee; Poston, David; Qualls, Louis

2008-01-01

This paper presents an overview of an affordable Fission Surface Power (FSP) system that could be used for NASA applications on the Moon and Mars. The proposed FSP system uses a low temperature, uranium dioxide-fueled, liquid metal-cooled fission reactor coupled to free-piston Stirling converters. The concept was determined by a 12 month NASA/DOE study that examined design options and development strategies based on affordability and risk. The system is considered a low development risk based on the use of terrestrial-derived reactor technology, high efficiency power conversion, and conventional materials. The low-risk approach was selected over other options that could offer higher performance and/or lower mass.

Moral hazard and prescription medicine use in Australia--the patient perspective.

PubMed

Doran, Evan; Robertson, Jane; Henry, David

2005-04-01

All Australian citizens are provided affordable access to prescription medicines through the nation's system of universal pharmaceutical subsidies--the pharmaceutical benefits scheme. The rapid increase in pharmaceutical related expenditure has generated the concern that Australians are taking advantage of prescription subsidies and are using more medicines than are necessary, thereby creating a 'moral hazard'. This concern is predicated on a number of assumptions about patient behaviour rather than on empirical observation. These assumptions amount to a view that patients are consumers who treat prescription medicines as common goods subject to informed and rational calculation of the cost and benefits of their use. This paper reports the findings of an in-depth interview study undertaken to explore how prescription cost influences Australians' medicine use. Qualitative data were analysed to compare medicine users' descriptions of the role of prescription cost in medicine use against the assumptions that underlie the belief in moral hazard. Moral hazard did not appear to be significantly operating in the accounts of medicine use collected for this study. Interviewees' accounts of medicine use revealed an act characterised by ambivalence, a mix of desire and antipathy, faith and suspicion. Medicines appeared in interviewees' accounts as both pharmacologically and symbolically potent substances, which despite their familiarity as objects, are often mysterious to non-expert patients. Cost appeared as a secondary factor in patients' decision to access a prescription medicine. Using a prescription was predicated on the medicine being necessary, with necessity typically established by an expert doctor prescribing the medicine. Prescription medicines did not appear as 'common goods' where subsidised access motivates a 'consumer' to demand more or make the prospect of prescription use more attractive or necessary.

Technological advances in precision medicine and drug development.

PubMed

Maggi, Elaine; Patterson, Nicole E; Montagna, Cristina

New technologies are rapidly becoming available to expand the arsenal of tools accessible for precision medicine and to support the development of new therapeutics. Advances in liquid biopsies, which analyze cells, DNA, RNA, proteins, or vesicles isolated from the blood, have gained particular interest for their uses in acquiring information reflecting the biology of tumors and metastatic tissues. Through advancements in DNA sequencing that have merged unprecedented accuracy with affordable cost, personalized treatments based on genetic variations are becoming a real possibility. Extraordinary progress has been achieved in the development of biological therapies aimed to even further advance personalized treatments. We provide a summary of current and future applications of blood based liquid biopsies and how new technologies are utilized for the development of biological therapeutic treatments. We discuss current and future sequencing methods with an emphasis on how technological advances will support the progress in the field of precision medicine.

An informatics research agenda to support precision medicine: seven key areas

PubMed Central

Avillach, Paul; Benham-Hutchins, Marge; Breitenstein, Matthew K; Crowgey, Erin L; Hoffman, Mark A; Jiang, Xia; Madhavan, Subha; Mattison, John E; Nagarajan, Radhakrishnan; Ray, Bisakha; Shin, Dmitriy; Visweswaran, Shyam; Zhao, Zhongming; Freimuth, Robert R

2016-01-01

The recent announcement of the Precision Medicine Initiative by President Obama has brought precision medicine (PM) to the forefront for healthcare providers, researchers, regulators, innovators, and funders alike. As technologies continue to evolve and datasets grow in magnitude, a strong computational infrastructure will be essential to realize PM’s vision of improved healthcare derived from personal data. In addition, informatics research and innovation affords a tremendous opportunity to drive the science underlying PM. The informatics community must lead the development of technologies and methodologies that will increase the discovery and application of biomedical knowledge through close collaboration between researchers, clinicians, and patients. This perspective highlights seven key areas that are in need of further informatics research and innovation to support the realization of PM. PMID:27107452

Five Affordances of Computational Thinking to Support Elementary Mathematics Education

ERIC Educational Resources Information Center

Gadanidis, George

2017-01-01

With the increased focus on computational thinking (CT) in education, it is important to investigate the affordances that CT may offer to support teaching and learning. This paper outlines five affordances of CT that may support elementary mathematics education, whose conceptualization was refined in a year-long study involving eight Grades 3-4…

The U.S. health insurance marketplace: are premiums truly affordable?

PubMed

Graetz, Ilana; Kaplan, Cameron M; Kaplan, Erin K; Bailey, James E; Waters, Teresa M

2014-10-21

The Patient Protection and Affordable Care Act requires that individuals have health insurance or pay a penalty. Individuals are exempt from paying this penalty if the after-subsidy cost of the least-expensive plan available to them is greater than 8% of their income. For this study, premium data for all health plans offered on the state and federal health insurance marketplaces were collected; the after-subsidy cost of premiums for the least-expensive bronze plan for every county in the United States was calculated; and variations in premium affordability by age, income, and geographic area were assessed. Results indicated that-although marketplace subsidies ensure affordable health insurance for most persons in the United States-many individuals with incomes just above the subsidy threshold will lack affordable coverage and will be exempt from the mandate. Furthermore, young individuals with low incomes often pay as much as or more than older individuals for bronze plans. If substantial numbers of younger, healthier adults choose to remain uninsured because of cost, health insurance premiums across all ages may increase over time.

24 CFR 954.306 - Rental housing: qualification as affordable housing and income targeting.

Code of Federal Regulations, 2011 CFR

2011-04-01

... affordable housing and income targeting. 954.306 Section 954.306 Housing and Urban Development REGULATIONS... Affordability § 954.306 Rental housing: qualification as affordable housing and income targeting. (a) Rent... tenant; or (ii) A rent that does not exceed 30 percent of the adjusted income of a family whose gross...

In-Space Propulsion Assessment Processes and Criteria for Affordable Systems

NASA Technical Reports Server (NTRS)

Zapata, Edgar; Rhodes, Russel

1999-01-01

In a world of high launch costs to Low Earth Orbit (LEO), and of costs nearly twice as high to Geosynchronous Earth Orbit (GEO), it is clear that processes and criteria are required which will surface the path to greater affordability. Further, with propulsion systems making up a major part of the systems placed into multiple orbits, or beyond, it is clear that addressing propulsion systems for in-space propulsion (ISP) is a key part to breaking the barriers to affordable systems. While multitudes of Earth to Orbit transportation system efforts focus on reduced costs, the often neglected costs and related interactions of the in-space system equally require improvements that will enable broad end-to end customer affordability.

The Value of Full Correction: Achieving Excellent and Affordable Results.

PubMed

Kaplan, Julie Bass

2016-01-01

Patients often come to medical aesthetic offices with hopes to fully correct lost facial volume and achieve a natural appearance. Unfortunately, the cost per syringe of dermal filler can be a barrier to desired outcomes. Many aesthetic practitioners do the best they can with the amount of product the patient can afford, often falling short of the "wow" effect for the patient. This article describes what one office implemented to solve the conundrum of affordability while still allowing offices to cover its own financial realities. This tool can help patients achieve beautiful, natural, and affordable outcomes while helping offices advance in manufacturer's tiers, improve word-of-mouth advertising, and increase job satisfaction.

Access to Affordable Medicines Act

THOMAS, 111th Congress

Sen. Shaheen, Jeanne [D-NH

2009-10-14

Senate - 10/14/2009 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Health Professions Education Facilities in the Non-Profit Sector. 1973.

ERIC Educational Resources Information Center

Health Resources Administration (DHEW/PHS), Bethesda, MD. Bureau of Health Manpower.

In this study of the physical facilities of the nation's health professions schools, all schools of dentistry, medicine, optometry, osteopathy, pharmacy, podiatry, public health, and veterinary medicine, and all parent institutions of the schools, were surveyed in May of 1973. The major goals of this pioneering survey were to assess the nature and…

The reality of task shifting in medicines management- a case study from Tanzania.

PubMed

Wiedenmayer, Karin A; Kapologwe, Ntuli; Charles, James; Chilunda, Fiona; Mapunjo, Siana

2015-01-01

Tanzania suffers a severe shortage of pharmaceutical staff. This negatively affects the provision of pharmaceutical services and access to medicines, particularly in rural areas. Task shifting has been proposed as a way to mitigate the impact of health worker shortfalls.The aim of this study was to understand the context and extent of task shifting in pharmaceutical management in Dodoma Region, Tanzania. We explored 1) the number of trained pharmaceutical staff as compared to clinical cadres managing medicines, 2) the national establishment for staffing levels, 3) job descriptions, 4) supply management training conducted and 5) availability of medicines and adherence to Good Storage Practice. A cross-sectional study was conducted in 270 public health facilities in 2011. A pre-tested questionnaire was administered to the person in charge of the facility to collect data on staff employed and their respective pharmaceutical tasks. Availability of 26 tracer medicines and adherence to Good Storage Practice guidelines was surveyed by direct observation. The national establishments for pharmaceutical staffing levels and job descriptions of facility cadres were analysed. While required staffing levels in 1999 were 50, the region employed a total of only 14 pharmaceutical staff in 2011. Job descriptions revealed that, next to pharmaceutical staff, only nurses were required to provide dispensing services and adherence counselling. In 95.5% of studied health facilities medicines management was done by non-pharmaceutically trained cadres, predominantly medical attendants. The first training on supply management was provided in 2005 with no refresher training thereafter. Mean availability of tracer medicines was 53%, while 56% of health facilities fully met criteria of Good Storage Practice. Task shifting is a reality in the pharmaceutical sector in Tanzania and it occurs mainly as a coping mechanism rather than a formal response to the workforce crisis. In Dodoma Region

A new paradigm for retrieval medicine.

PubMed

Moloney, John

2018-06-12

A number of new time critical medical interventions are highly specialised. As such, they are not available in many hospitals and EDs. This necessitates transfer to another facility, which is often associated with some degree of delay. Processes to facilitate timely access to these interventions should aim to replicate or improve on that which would have been available should the patient have been in the community, and responded to, primarily, by an emergency medical service. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Analytical Tools for Affordability Analysis

DTIC Science & Technology

2015-05-01

function (Womer)  Unit cost as a function of learning and rate  Learning with forgetting (Benkard)  Learning depreciates over time  Discretionary...Analytical Tools for Affordability Analysis David Tate Cost Analysis and Research Division Institute for Defense Analyses Report Documentation...ES) Institute for Defense Analyses, Cost Analysis and Research Division,4850 Mark Center Drive,Alexandria,VA,22311-1882 8. PERFORMING ORGANIZATION

Relative Affordability of Health Insurance Premiums under CHIP Expansion Programs and the ACA.

PubMed

Gresenz, Carole Roan; Laugesen, Miriam J; Yesus, Ambeshie; Escarce, José J

2011-10-01

Affordability is integral to the success of health care reforms aimed at ensuring universal access to health insurance coverage, and affordability determinations have major policy and practical consequences. This article describes factors that influenced the determination of affordability benchmarks and premium-contribution requirements for Children's Health Insurance Program (CHIP) expansions in three states that sought to universalize access to coverage for youth. It also compares subsidy levels developed in these states to the premium subsidy schedule under the Affordable Care Act (ACA) for health insurance plans purchased through an exchange. We find sizeable variability in premium-contribution requirements for children's coverage as a percentage of family income across the three states and in the progressivity and regressivity of the premium-contribution schedules developed. These findings underscore the ambiguity and subjectivity of affordability standards. Further, our analyses suggest that while the ACA increases the affordability of family coverage for families with incomes below 400 percent of the federal poverty level, the evolution of CHIP over the next five to ten years will continue to have significant implications for low-income families.

A Retrospective Quantitative Assessment of Trichloroethylene Exposure of Workers at Aircraft Maintenance Facilities at Hill Air Force Base Through the Use of Modeling

DTIC Science & Technology

1994-09-01

affording me the right mix of freedom and guidance, thus making the entire thesis writing process truly rewarding and memorable. - Anthony 0...have been in clinical medicine and industrial processes . The use of TCE for medicinal purposes gained recognition beginning in 1942 when Langston...fumigant mixtures and as an extractant in the decaffeination of coffee (Royal Society of Chemistry, 1986:102). Today, the major use of TCE is in

Coding of navigational affordances in the human visual system

PubMed Central

Epstein, Russell A.

2017-01-01

A central component of spatial navigation is determining where one can and cannot go in the immediate environment. We used fMRI to test the hypothesis that the human visual system solves this problem by automatically identifying the navigational affordances of the local scene. Multivoxel pattern analyses showed that a scene-selective region of dorsal occipitoparietal cortex, known as the occipital place area, represents pathways for movement in scenes in a manner that is tolerant to variability in other visual features. These effects were found in two experiments: One using tightly controlled artificial environments as stimuli, the other using a diverse set of complex, natural scenes. A reconstruction analysis demonstrated that the population codes of the occipital place area could be used to predict the affordances of novel scenes. Taken together, these results reveal a previously unknown mechanism for perceiving the affordance structure of navigable space. PMID:28416669

Preparation and use of plant medicines for farmers' health in Southwest Nigeria: socio-cultural, magico-religious and economic aspects

PubMed Central

2010-01-01

Agrarian rural dwellers in Nigeria produce about 95% of locally grown food commodities. The low accessibility to and affordability of orthodox medicine by rural dwellers and their need to keep healthy to be economically productive, have led to their dependence on traditional medicine. This paper posits an increasing acceptance of traditional medicine country-wide and advanced reasons for this trend. The fact that traditional medicine practitioners' concept of disease is on a wider plane vis-à-vis orthodox medicine practitioners' has culminated in some socio-cultural and magico-religious practices observed in preparation and use of plant medicines for farmers' health management. Possible scientific reasons were advanced for some of these practices to show the nexus between traditional medicine and orthodox medicine. The paper concludes that the psychological aspect of traditional medicine are reflected in its socio-cultural and magico-religious practices and suggests that government should fund research into traditional medicine to identify components of it that can be integrated into the national health system. PMID:20089149

Podiatric Medical Education: The Physical Facilities.

ERIC Educational Resources Information Center

Rubin, Abe

1979-01-01

A gross inventory of the teaching and clinical learning resources of the five U.S. colleges of podiatric medicine is described. A descriptive breakdown is provided along with illustrations of facilities. Some categories included in space allocation data are instructional staff, administrative staff, laboratory, outpatient clinic, learning…

System engineering of complex optical systems for mission assurance and affordability

NASA Astrophysics Data System (ADS)

Ahmad, Anees

2017-08-01

Affordability and reliability are equally important as the performance and development time for many optical systems for military, space and commercial applications. These characteristics are even more important for the systems meant for space and military applications where total lifecycle costs must be affordable. Most customers are looking for high performance optical systems that are not only affordable but are designed with "no doubt" mission assurance, reliability and maintainability in mind. Both US military and commercial customers are now demanding an optimum balance between performance, reliability and affordability. Therefore, it is important to employ a disciplined systems design approach for meeting the performance, cost and schedule targets while keeping affordability and reliability in mind. The US Missile Defense Agency (MDA) now requires all of their systems to be engineered, tested and produced according to the Mission Assurance Provisions (MAP). These provisions or requirements are meant to ensure complex and expensive military systems are designed, integrated, tested and produced with the reliability and total lifecycle costs in mind. This paper describes a system design approach based on the MAP document for developing sophisticated optical systems that are not only cost-effective but also deliver superior and reliable performance during their intended missions.

The international translational regenerative medicine center.

PubMed

Alexis, Mardi de Veuve; Grinnemo, Karl-Henrik; Jove, Richard

2012-11-01

The International Translational Regenerative Medicine Center, an organizing sponsor of the World Stem Cell Summit 2012, is a global initiative established in 2011 by founding partners Karolinska Institutet (Stockholm, Sweden) and Beckman Research Institute at City of Hope (CA, USA) with a mission to facilitate the acceleration of translational research and medicine on a global scale. Karolinska Institutet, home of the Nobel Prize in Medicine or Physiology, is one of the most prestigious medical research institutions in the world. The Beckman Research Institute/City of Hope is ranked among the leading NIH-designated comprehensive cancer research and treatment institutions in the USA, has the largest academic GMP facility and advanced drug discovery capability, and is a pioneer in diabetes research and treatment.

Perceiving affordances in rugby union.

PubMed

Passos, Pedro; Cordovil, Rita; Fernandes, Orlando; Barreiros, João

2012-01-01

To succeed in competitive environments, players need to continuously adjust their decisions and actions to the behaviour of relevant others. Players' interactions demand ongoing decisions that are constrained by what is previously defined (e.g., coaches' prescriptions that establish 'what' to do) and by information that is available in the context and specifies not only 'what' the player should do, but also 'how', 'when' and 'where'. We describe what affordances emerge to the ball carrier as a consequence of changes in kinematic variables, such as interpersonal distances or distances to the nearest sideline. Changes in these variables determine whether and when different actions are possible. The ball carrier tended to perform a pass when the tackler was farthest from the sideline and the velocity of approach to the tackler did not seem to effect the ball carrier's decision. In the few episodes where the ball carrier moved forward instead of passing the ball, he was mainly influenced by contextual information, such as the variability of the players' distance to the nearest sideline. In sum, actors must be aware of the affordances of others that are specified by particular variables that become available just before decision-making.

Pedagogical Affordances of Multiple External Representations in Scientific Processes

NASA Astrophysics Data System (ADS)

Wu, Hsin-Kai; Puntambekar, Sadhana

2012-12-01

Multiple external representations (MERs) have been widely used in science teaching and learning. Theories such as dual coding theory and cognitive flexibility theory have been developed to explain why the use of MERs is beneficial to learning, but they do not provide much information on pedagogical issues such as how and in what conditions MERs could be introduced and used to support students' engagement in scientific processes and develop competent scientific practices (e.g., asking questions, planning investigations, and analyzing data). Additionally, little is understood about complex interactions among scientific processes and affordances of MERs. Therefore, this article focuses on pedagogical affordances of MERs in learning environments that engage students in various scientific processes. By reviewing literature in science education and cognitive psychology and integrating multiple perspectives, this article aims at exploring (1) how MERs can be integrated with science processes due to their different affordances, and (2) how student learning with MERs can be scaffolded, especially in a classroom situation. We argue that pairing representations and scientific processes in a principled way based on the affordances of the representations and the goals of the activities is a powerful way to use MERs in science education. Finally, we outline types of scaffolding that could help effective use of MERs including dynamic linking, model progression, support in instructional materials, teacher support, and active engagement.

12 CFR 1282.13 - Multifamily special affordable housing goal and subgoal.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 10 2014-01-01 2014-01-01 false Multifamily special affordable housing goal... AND MISSION ENTERPRISE HOUSING GOALS AND MISSION Housing Goals § 1282.13 Multifamily special affordable housing goal and subgoal. (a) Multifamily housing goal and subgoal. An Enterprise shall be in...

Affordances of instrumentation in general chemistry laboratories

NASA Astrophysics Data System (ADS)

Sherman, Kristin Mary Daniels

The purpose of this study is to find out what students in the first chemistry course at the undergraduate level (general chemistry for science majors) know about the affordances of instrumentation used in the general chemistry laboratory and how their knowledge develops over time. Overall, students see the PASCO(TM) system as a useful and accurate measuring tool for general chemistry labs. They see the probeware as easy to use, portable, and able to interact with computers. Students find that the PASCO(TM) probeware system is useful in their general chemistry labs, more advanced chemistry labs, and in other science classes, and can be used in a variety of labs done in general chemistry. Students learn the affordances of the probeware through the lab manual, the laboratory teaching assistant, by trial and error, and from each other. The use of probeware systems provides lab instructors the opportunity to focus on the concepts illustrated by experiments and the opportunity to spend time discussing the results. In order to teach effectively, the instructor must know the correct name of the components involved, how to assemble and disassemble it correctly, how to troubleshoot the software, and must be able to replace broken or missing components quickly. The use of podcasts or Web-based videos should increase student understanding of affordances of the probeware.

SPHERES National Lab Facility

NASA Technical Reports Server (NTRS)

Benavides, Jose

2014-01-01

SPHERES is a facility of the ISS National Laboratory with three IVA nano-satellites designed and delivered by MIT to research estimation, control, and autonomy algorithms. Since Fall 2010, The SPHERES system is now operationally supported and managed by NASA Ames Research Center (ARC). A SPHERES Program Office was established and is located at NASA Ames Research Center. The SPHERES Program Office coordinates all SPHERES related research and STEM activities on-board the International Space Station (ISS), as well as, current and future payload development. By working aboard ISS under crew supervision, it provides a risk tolerant Test-bed Environment for Distributed Satellite Free-flying Control Algorithms. If anything goes wrong, reset and try again! NASA has made the capability available to other U.S. government agencies, schools, commercial companies and students to expand the pool of ideas for how to test and use these bowling ball-sized droids. For many of the researchers, SPHERES offers the only opportunity to do affordable on-orbit characterization of their technology in the microgravity environment. Future utilization of SPHERES as a facility will grow its capabilities as a platform for science, technology development, and education.

77 FR 26046 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Affordable...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-02

... for OMB Review; Comment Request; Affordable Care Act Internal Claims and Appeals and External Review...) titled, ``Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non... provisions of the Affordable Care Act pertaining to internal claims and appeals, and the external review...

Approach to an Affordable and Productive Space Transportation System

NASA Technical Reports Server (NTRS)

McCleskey, Carey M.; Rhodes, Russel E.; Lepsch, Roger A.; Henderson, Edward M.; Robinson, John W.

2012-01-01

This paper describes an approach for creating space transportation architectures that are affordable, productive, and sustainable. The architectural scope includes both flight and ground system elements, and focuses on their compatibility to achieve a technical solution that is operationally productive, and also affordable throughout its life cycle. Previous papers by the authors and other members of the Space Propulsion Synergy Team (SPST) focused on space flight system engineering methods, along with operationally efficient propulsion system concepts and technologies. This paper follows up previous work by using a structured process to derive examples of conceptual architectures that integrate a number of advanced concepts and technologies. The examples are not intended to provide a near-term alternative architecture to displace current near-term design and development activity. Rather, the examples demonstrate an approach that promotes early investments in advanced system concept studies and trades (flight and ground), as well as in advanced technologies with the goal of enabling highly affordable, productive flight and ground space transportation systems.

[The fight against counterfeit medicines in Africa: experience and role of pharmacists].

PubMed

Chauvé, Martine

2008-12-01

The counterfeiting of medicines is a global scourge, which is particularly serious in the African continent. According to WHO estimations, whereas counterfeit medicines represent 1% of the market in developed countries, up to 30% of the medicines sold in African countries are counterfeit. Several factors may explain this high rate in Africa, from the weaknesses of legislation and controls, to the lack of affordability of medicines and the attitude of governments. A counterfeit medicine represents different levels of risk, depending if the active substance is present or not, if the dosage is the right one, if the product contains toxic substances, etc. In Africa, several examples sadly showed the terrible impact the use of counterfeit medicines may have (i.e. Nigeria, 1990, Niger, 1995). Pharmacists have a crucial role to play in fighting against the penetration of counterfeit medicines, both in securing the distribution chain, and in leading some actions towards patients. The FIP has produced some guidelines on this issue by adopting a statement (which was last updated in 2003) and by providing pharmacists with useful tools on its website. Several international organizations such as the CIOPF (International conference of French-speaking Orders) produced recommendations on this issue. However, the experience and expertise gained by national organizations from countries such as Côte d'Ivoire are also worth sharing and are presented here.

Developing affordable housing guidelines near rail transit in Los Angeles : final report.

DOT National Transportation Integrated Search

2016-12-01

Providing affordable housing and reducing greenhouse gases are common goals in cities worldwide. Transit-oriented development (TOD) can enable incremental progress on both fronts, by building affordable housing near transit and by providing alternati...

12 CFR 1282.13 - Multifamily special affordable housing goal and subgoal.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 9 2012-01-01 2012-01-01 false Multifamily special affordable housing goal and... MISSION ENTERPRISE HOUSING GOALS AND MISSION Housing Goals § 1282.13 Multifamily special affordable housing goal and subgoal. (a) Multifamily housing goal and subgoal. An Enterprise shall be in compliance...

12 CFR 1282.13 - Multifamily special affordable housing goal and subgoal.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Multifamily special affordable housing goal and... MISSION ENTERPRISE HOUSING GOALS AND MISSION Housing Goals § 1282.13 Multifamily special affordable housing goal and subgoal. (a) Multifamily housing goal and subgoal. An Enterprise shall be in compliance...

Treatment of Febrile illness with artemisinin combination therapy: prevalence and predictors in five African household surveys.

PubMed

Vialle-Valentin, Catherine E; LeCates, Robert F; Zhang, Fang; Ross-Degnan, Dennis

2015-01-01

To evaluate the determinants of compliance with national policies recommending Artemisinin Combination Therapy (ACT) for the treatment of uncomplicated malaria in the community. We used data from Gambia, Ghana, Kenya, Nigeria, and Uganda national household surveys that were conducted with a standardized World Health Organization (WHO) methodology to measure access to and use of medicines. We analyzed all episodes of acute fever reported in the five surveys. We used logistic regression models accounting for the clustered design of the surveys to identify determinants of seeking care in public healthcare facilities, of being treated with antimalarials, and of receiving ACT. Overall, 92% of individuals with a febrile episode sought care outside the home, 96% received medicines, 67% were treated with antimalarials, and 16% received ACT. The choice of provider was influenced by perceptions about medicines availability and affordability. In addition, seeking care in a public healthcare facility was the single most important predictor of treatment with ACT [odds ratio (OR): 4.64, 95% confidence intervals (CI): 2.98-7.22, P < 0.001]. Children under 5 years old were more likely than adults to be treated with antimalarials [OR: 1.28, CI: 0.91-1.79, not significant (NS)] but less likely to receive ACT (OR: 0.80, CI: 0.57-1.13, NS). Our results confirm the high prevalence of presumptive antimalarial treatment for acute fever, especially in public healthcare facilities where poor people seek care. They show that perceptions about access to medicines shape behaviors by directing patients and caregivers to sources of care where they believe medicines are accessible. The success of national policies recommending ACT for the treatment of uncomplicated malaria depends not only on restricting ACT to confirmed malaria cases, but also on ensuring that ACT is available and affordable for those who need it.

Framing access to medicines in developing countries: an analysis of media coverage of Canada's Access to Medicines Regime.

PubMed

Esmail, Laura C; Phillips, Kaye; Kuek, Victoria; Cosio, Andrea Perez; Kohler, Jillian Clare

2010-01-04

In September 2003, the Canadian government committed to developing legislation that would facilitate greater access to affordable medicines for developing countries. Over the course of eight months, the legislation, now known as Canada's Access to Medicines Regime (CAMR), went through a controversial policy development process and the newspaper media was one of the major venues in which the policy debates took place. The purpose of this study was to examine how the media framed CAMR to determine how policy goals were conceptualized, which stakeholder interests controlled the public debate and how these variables related to the public policy process. We conducted a qualitative content analysis of newspaper coverage of the CAMR policy and implementation process from 2003-2008. The primary theoretical framework for this study was framing theory. A total of 90 articles from 11 Canadian newspapers were selected for inclusion in our analysis. A team of four researchers coded the articles for themes relating to access to medicines and which stakeholders' voice figured more prominently on each issue. Stakeholders examined included: the research-based industry, the generic industry, civil society, the Canadian government, and developing country representatives. The most frequently mentioned themes across all documents were the issues of drug affordability, intellectual property, trade agreements and obligations, and development. Issues such as human rights, pharmaceutical innovation, and economic competitiveness got little media representation. Civil society dominated the media contents, followed far behind by the Canadian government, the research-based and generic pharmaceutical industries. Developing country representatives were hardly represented in the media. Media framing obscured the discussion of some of the underlying policy goals in this case and failed to highlight issues which are now significant barriers to the use of the legislation. Using the media to engage

Framing access to medicines in developing countries: an analysis of media coverage of Canada's Access to Medicines Regime

PubMed Central

2010-01-01

Background In September 2003, the Canadian government committed to developing legislation that would facilitate greater access to affordable medicines for developing countries. Over the course of eight months, the legislation, now known as Canada's Access to Medicines Regime (CAMR), went through a controversial policy development process and the newspaper media was one of the major venues in which the policy debates took place. The purpose of this study was to examine how the media framed CAMR to determine how policy goals were conceptualized, which stakeholder interests controlled the public debate and how these variables related to the public policy process. Methods We conducted a qualitative content analysis of newspaper coverage of the CAMR policy and implementation process from 2003-2008. The primary theoretical framework for this study was framing theory. A total of 90 articles from 11 Canadian newspapers were selected for inclusion in our analysis. A team of four researchers coded the articles for themes relating to access to medicines and which stakeholders' voice figured more prominently on each issue. Stakeholders examined included: the research-based industry, the generic industry, civil society, the Canadian government, and developing country representatives. Results The most frequently mentioned themes across all documents were the issues of drug affordability, intellectual property, trade agreements and obligations, and development. Issues such as human rights, pharmaceutical innovation, and economic competitiveness got little media representation. Civil society dominated the media contents, followed far behind by the Canadian government, the research-based and generic pharmaceutical industries. Developing country representatives were hardly represented in the media. Conclusions Media framing obscured the discussion of some of the underlying policy goals in this case and failed to highlight issues which are now significant barriers to the use of the

U.S. Alcohol Affordability and Real Tax Rates, 1950–2011

PubMed Central

Kerr, William C.; Paterson, Deidre; Greenfield, Thomas K.; Jones, Alison Snow; McGeary, Kerry Anne; Terza, Joseph V.; Ruhm, Christopher J.

2013-01-01

Background The affordability of alcoholic beverages, determined by the relationship of prices to incomes, may be an important factor in relation to heavy drinking, but little is known about how affordability has changed over time. Purpose To calculate real prices and affordability measures for alcoholic beverages in the U.S. over the period from 1950 to 2011. Methods Affordability is calculated as the percentage of mean disposable income required to purchase 1 drink per day of the cheapest spirits, as well as popular brands of spirits, beer and wine. Alternative income and price measures are also considered. Analyses were conducted in 2012. Results One drink per day of the cheapest brand of spirits required 0.29% of U.S. mean per capita disposable income in 2011 as compared to 1.02% in 1980, 2.24% in 1970, 3.61% in 1960 and 4.46% in 1950. One drink per day of a popular beer required 0.96% of income in 2010 compared to 4.87% in 1950, while a low-priced wine in 2011 required 0.36% of income compared to 1.05% in 1978. Reduced real federal and state tax rates were an important source of the declines in real prices. Conclusions Alcoholic beverages sold for off-premises consumption are more affordable today than at any time in the past 60 years; dramatic increases in affordability occurred particularly in the 1960s and 1970s. Declines in real prices are a major component of this change. Increases in alcoholic beverage tax rates and/or implementing minimum prices, together with indexing these to inflation could be used to mitigate further declines in real prices. PMID:23597808

NASA Affordable Vehicle Avionics (AVA): Common Modular Avionics System for Nano-Launchers Offering Affordable Access to Space

NASA Technical Reports Server (NTRS)

Cockrell, James

2015-01-01

Small satellites are becoming ever more capable of performing valuable missions for both government and commercial customers. However, currently these satellites can only be launched affordably as secondary payloads. This makes it difficult for the small satellite mission to launch when needed, to the desired orbit, and with acceptable risk. NASA Ames Research Center has developed and tested a prototype low-cost avionics package for space launch vehicles that provides complete GNC functionality in a package smaller than a tissue box with a mass less than 0.84 kg. AVA takes advantage of commercially available, low-cost, mass-produced, miniaturized sensors, filtering their more noisy inertial data with realtime GPS data. The goal of the Advanced Vehicle Avionics project is to produce and flight-verify a common suite of avionics and software that deliver affordable, capable GNC and telemetry avionics with application to multiple nano-launch vehicles at 1 the cost of current state-of-the-art avionics.

Making care affordable.

PubMed

Solomon, S

1999-01-01

The YRG Centre for AIDS Research and Education (CARE) in Chennai, India runs an integrated care program ensuring appropriate and affordable care to everyone who needs it. The program includes both voluntary counseling/testing and hospital/home-based care. YRG CARE developed several strategies for the care program, which include 1) different fees for an HIV test, 2) free counseling service, 3) different charges for other care services, 4) a subsidized pharmacy (involving purchasing drugs directly from manufacturers and wholesalers, ordering free samples from manufacturers, and acquiring drugs through the drug component of its clinical research projects, from overseas hospitals, and from YRG CARE hospital and community-based patients who have not used them), and 5) subsidized meals.

The financial hazard of personalized medicine and supportive care.

PubMed

Carrera, Pricivel M; Olver, Ian

2015-12-01

Personalized medicine is revolutionizing the delivery of oncological care, promising benefits both at the patient and health system levels. The cost of targeted therapies, unfortunately, is becoming more expensive and unaffordable. Where supportive care in cancer concerns the prevention and management of the adverse effects of cancer and its treatment and is the thrust of the Multinational Association of Supportive Care in Cancer, financing of and value in personalized medicine is an important area of research and engagement for the association. Discussing patients' concerns with and identifying those at most risk for the financial hazard of cancer treatment and offering financial counseling and assistance and/or referral to support networks are potential key areas for (exploring and providing) better supportive care. The time is now to turn the concern of patients and their carers, providers, and other advocates regarding the affordability of cancer treatment into a collective cause towards coordinated action.

Landscape and Health: Connecting Psychology, Aesthetics, and Philosophy through the Concept of Affordance.

PubMed

Menatti, Laura; Casado da Rocha, Antonio

2016-01-01

In this paper we address a frontier topic in the humanities, namely how the cultural and natural construction that we call landscape affects well-being and health. Following an updated review of evidence-based literature in the fields of medicine, psychology, and architecture, we propose a new theoretical framework called "processual landscape," which is able to explain both the health-landscape and the medical agency-structure binomial pairs. We provide a twofold analysis of landscape, from both the cultural and naturalist points of view: in order to take into account its relationship with health, the definition of landscape as a cultural product needs to be broadened through naturalization, grounding it in the scientific domain. Landscape cannot be distinguished from the ecological environment. For this reason, we naturalize the idea of landscape through the notion of affordance and Gibson's ecological psychology. In doing so, we stress the role of agency in the theory of perception and the health-landscape relationship. Since it is the result of continuous and co-creational interaction between the cultural agent, the biological agent and the affordances offered to the landscape perceiver, the processual landscape is, in our opinion, the most comprehensive framework for explaining the health-landscape relationship. The consequences of our framework are not only theoretical, but ethical also: insofar as health is greatly affected by landscape, this construction represents something more than just part of our heritage or a place to be preserved for the aesthetic pleasure it provides. Rather, we can talk about the right to landscape as something intrinsically linked to the well-being of present and future generations.

Landscape and Health: Connecting Psychology, Aesthetics, and Philosophy through the Concept of Affordance

PubMed Central

Menatti, Laura; Casado da Rocha, Antonio

2016-01-01

In this paper we address a frontier topic in the humanities, namely how the cultural and natural construction that we call landscape affects well-being and health. Following an updated review of evidence-based literature in the fields of medicine, psychology, and architecture, we propose a new theoretical framework called “processual landscape,” which is able to explain both the health-landscape and the medical agency-structure binomial pairs. We provide a twofold analysis of landscape, from both the cultural and naturalist points of view: in order to take into account its relationship with health, the definition of landscape as a cultural product needs to be broadened through naturalization, grounding it in the scientific domain. Landscape cannot be distinguished from the ecological environment. For this reason, we naturalize the idea of landscape through the notion of affordance and Gibson’s ecological psychology. In doing so, we stress the role of agency in the theory of perception and the health-landscape relationship. Since it is the result of continuous and co-creational interaction between the cultural agent, the biological agent and the affordances offered to the landscape perceiver, the processual landscape is, in our opinion, the most comprehensive framework for explaining the health-landscape relationship. The consequences of our framework are not only theoretical, but ethical also: insofar as health is greatly affected by landscape, this construction represents something more than just part of our heritage or a place to be preserved for the aesthetic pleasure it provides. Rather, we can talk about the right to landscape as something intrinsically linked to the well-being of present and future generations. PMID:27199808

Can NGOs regulate medicines markets? Social enterprise in wholesaling, and access to essential medicines.

PubMed

Mackintosh, Maureen; Chaudhuri, Sudip; Mujinja, Phares Gm

2011-02-28

Citizens of high income countries rely on highly regulated medicines markets. However low income countries' impoverished populations generally struggle for access to essential medicines through out-of-pocket purchase on poorly regulated markets; results include ill health, drug resistance and further impoverishment. While the role of health facilities owned by non-governmental organisations (NGOs) in low income countries is well documented, national and international wholesaling of essential medicines by NGOs is largely unstudied. This article describes and assesses the activity of NGOs and social enterprise in essential medicines wholesaling. The article is based on a set of interviews conducted in 2006-8 with trading NGOs and social enterprises operating in Europe, India and Tanzania. The analysis applies socio-legal and economic perspectives on social enterprise and market regulation. Trading NGOs can resist the perverse incentives inherent in medicines wholesaling and improve access to essential medicines; they can also, in definable circumstances, exercise a broader regulatory influence over their markets by influencing the behaviour of competitors. We explore reasons for success and failure of social enterprise in essential medicines wholesaling, including commercial manufacturers' market response; social enterprise traders' own market strategies; and patterns of market advantage, market segmentation and subsidy generated by donors. We conclude that, in the absence of effective governmental activity and regulation, social enterprise wholesaling can improve access to good quality essential medicines. This role should be valued and where appropriate supported in international health policy design. NGO regulatory impact can complement but should not replace state action.

Can NGOs regulate medicines markets? Social enterprise in wholesaling, and access to essential medicines

PubMed Central

2011-01-01

Background Citizens of high income countries rely on highly regulated medicines markets. However low income countries' impoverished populations generally struggle for access to essential medicines through out-of-pocket purchase on poorly regulated markets; results include ill health, drug resistance and further impoverishment. While the role of health facilities owned by non-governmental organisations (NGOs) in low income countries is well documented, national and international wholesaling of essential medicines by NGOs is largely unstudied. This article describes and assesses the activity of NGOs and social enterprise in essential medicines wholesaling. Methods The article is based on a set of interviews conducted in 2006-8 with trading NGOs and social enterprises operating in Europe, India and Tanzania. The analysis applies socio-legal and economic perspectives on social enterprise and market regulation. Results Trading NGOs can resist the perverse incentives inherent in medicines wholesaling and improve access to essential medicines; they can also, in definable circumstances, exercise a broader regulatory influence over their markets by influencing the behaviour of competitors. We explore reasons for success and failure of social enterprise in essential medicines wholesaling, including commercial manufacturers' market response; social enterprise traders' own market strategies; and patterns of market advantage, market segmentation and subsidy generated by donors. Conclusions We conclude that, in the absence of effective governmental activity and regulation, social enterprise wholesaling can improve access to good quality essential medicines. This role should be valued and where appropriate supported in international health policy design. NGO regulatory impact can complement but should not replace state action. PMID:21356076

Patient Protection and Affordable Care Act of 2010: a primer for neurointerventionalists.

PubMed

Manchikanti, Laxmaiah; Hirsch, Joshua A

2012-03-01

The Patient Protection and Affordable Care Act (the ACA, for short) became law on 23 March 2010. It represents the most significant transformation of the American healthcare system since Medicare and Medicaid. Essentials of ACA include: (1) a mandate for individuals and businesses requiring as a matter of law that nearly every American has an approved level of health insurance or pay a penalty; (2) a system of federal subsidies to completely or partially pay for the now required health insurance for ∼34 million Americans who are currently uninsured-subsidized through Medicaid and Exchanges; (3) extensive new requirements on the health insurance industry and (4) changes in the practice of medicine. The Act is divided into 10 titles. It contains provisions that went into effect starting on 21 June 2010 with many of the provisions going into effect in 2014 and later. The ACA goes well beyond insurance and payment reform. Practicing physicians will potentially be impacted by the Independent Payment Advisory Board and the Patient Centered Outcomes Research Institute.

Affordable Exploration of Mars: Recommendations from a Community Workshop on Sustainable Initial Human Missions

NASA Technical Reports Server (NTRS)

Thronson, Harley; Carberry, Chris; Cassady, R. J.; Cooke, Doug; Hopkins, Joshua; Perino, Maria A.; Kirkpatrick, Jim; Raftery, Michael; Westenberg, Artemis; Zucker, Richard

2013-01-01

There is a growing consensus that within two decades initial human missions to Mars are affordable under plausible budget assumptions and with sustained international participation. In response to this idea, a distinguished group of experts from the Mars exploration stakeholder communities attended the "Affording Mars" workshop at George Washington University in December, 2013. Participants reviewed and discussed scenarios for affordable and sustainable human and robotic exploration of Mars, the role of the International Space Station over the coming decade as the essential early step toward humans to Mars, possible "bridge" missions in the 2020s, key capabilities required for affordable initial missions, international partnerships, and a usable definition of affordability and sustainability. We report here the findings, observations, and recommendations that were agreed to at that workshop.

Access to medicines by patients of the primary health care in the Brazilian Unified Health System

PubMed Central

Álvares, Juliana; Guerra, Augusto Afonso; de Araújo, Vânia Eloisa; Almeida, Alessandra Maciel; Dias, Carolina Zampirolli; Ascef, Bruna de Oliveira; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Leite, Silvana Nair; Karnikowski, Margô Gomes de Oliveira; Costa, Karen Sarmento; Acurcio, Francisco de Assis

2017-01-01

ABSTRACT OBJECTIVE To evaluate the access to medicines in primary health care of the Brazilian Unified Health System (SUS), from the patients’ perspective. METHODS This is a cross-sectional study that used data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Services, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), conducted by interviews with 8,591 patients in cities of the five regions of Brazil. Evaluation of access to medicines used concepts proposed by Penshansky and Thomas (1981), according to the dimensions: availability, accessibility, accommodation, acceptability, and affordability. Each dimension was evaluated by its own indicators. RESULTS For the “availability” dimension, 59.8% of patients reported having full access to medicines, without significant difference between regions. For “accessibility,” 60% of patients declared that the basic health unit (UBS) was not far from their house, 83% said it was very easy/easy to get to the UBS, and most patients reported that they go walking (64.5%). For “accommodation,” UBS was evaluated as very good/good for the items “comfort” (74.2%) and “cleanliness” (90.9%), and 70.8% of patients reported that they do not wait to receive their medicines, although the average waiting time was 32.9 minutes. For “acceptability,” 93.1% of patients reported to be served with respect and courtesy by the staff of the dispensing units and 90.5% declared that the units’ service was very good/good. For “affordability,” 13% of patients reported not being able to buy something important to cover expenses with health problems, and 41.8% of participants pointed out the expense with medicines. CONCLUSIONS Results show 70%–90% compliance, which is compatible with developed countries. However, access to medicines remains a challenge, because it is still heavily compromised by the low availability of essential

Alcohol affordability and alcohol demand: cross-country trends and panel data estimates, 1975 to 2008.

PubMed

Nelson, Jon P

2014-04-01

Relatively little is known about cross-country differences in alcohol affordability or factors that determine differences in affordability over time. This information is potentially important for alcohol policy, especially policies that focus on higher taxes or prices to reduce total alcohol consumption. This study estimates cross-country alcohol consumption relationships using economic models incorporating income and prices and alternative models based on alcohol affordability. The data and analysis are restricted to higher income countries. Data for alcohol consumption per capita (ages 15+) are analyzed for 2 samples: first, 17 countries in the Organisation for Economic Co-operation and Development for the period 1975 to 2000; second, 22 countries in the European Union for the period from 2000 to 2008. Panel data models are utilized, with country and time fixed-effects to control for confounding influences. In economic demand models, covariates are real per capita income and real alcohol price indices. In affordability models, income is divided by prices to yield an index of alcohol affordability. Analysis of data trends reveals that much of the increase in affordability is due to rising real incomes, and not falling real prices. Economic models of demand perform slightly better statistically, but differences are not substantial as income and affordability are highly correlated. For both samples, exogenous rates of growth of alcohol consumption are negative. Price and income elasticities, on average, are within the range of prior estimates. Affordability elasticities are between 0.21 and 0.25. Although alcohol affordability is a valid concept statistically, its use in policy discussions tends to hide underlying causes of changes in affordability. A better approach is a comparison and analysis of trends and cross-country differences in real incomes and real alcohol prices together with the affordability index. Country-level analysis of income and price

Why the affordable care act needs a better name: 'Americare'.

PubMed

Sage, William M

2010-08-01

The culmination of a century's effort to enact universal coverage in the United States is a law with an uninspiring title, the Patient Protection and Affordable Care Act, and an even more awkward acronym, PPACA. The Obama administration has decided to call the legislation the Affordable Care Act, but the expansion of health coverage that the law sets in motion has no name, and therefore no identity. It badly needs one.

Affordance of Braille Music as a Mediational Means: Significance and Limitations

ERIC Educational Resources Information Center

Park, Hyu-Yong; Kim, Mi-Jung

2014-01-01

Affordance refers to the properties or designs of a thing that offer the function of the thing. This paper discusses the affordance of Braille music in terms of three notions: mediational means, mastery and appropriation, and focuses on answering the following three questions: (i) How do musicians with visual impairments (MVI) perceive Braille…

Investigation of public exposure resulted from the radioiodine delay tank facility of nuclear medicine department

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yusof, Mohd Fahmi Mohd, E-mail: mfahmi@usm.my; Ali, Abdul Muhaimin Mat; Abdullah, Reduan

The study is carried out to assess the exposure rate that could contribute to public exposure in a radioiodine ward delay tank facility of Radiotherapy, Oncology and Nuclear Medicine, Department, Hospital Universiti Sains Malaysia (HUSM). The exposure rate at several locations including the delay tank room, doorway and at the public walking route was measured using Victoreen 415P-RYR survey meter. The radioactive level of the {sup 131}I waste was measured using Captus 3000 well counting system. The results showed that exposure rate and total count of the delay tank sample increased when the radioiodine ward was fully occupied with patientmore » and reduced when the ward was vacant. Occupancy of radioiodine ward for two consecutive weeks had dramatically increased the exposure rate around the delay tank and radioactive level of {sup 131}I waste. The highest exposure rate and radioactive level was recorded when the ward was occupied for two consecutive weeks with 177.00 µR/h and 58.36 kcpm respectively. The exposure rate decreased 15.76 % when the door of the delay tank room was closed. The exposure rate at public walking route decreased between 15.58 % and 36.92 % as the distance increased between 1 and 3 m.« less

Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV

PubMed Central

Bossard, Claire; Verdonck, Kristien; Owiti, Philip; Casteels, Ilse; Mashako, Maria; Van Cutsem, Gilles; Ellman, Tom

2018-01-01

Stockouts of HIV commodities increase the risk of treatment interruption, antiretroviral resistance, treatment failure, morbidity and mortality. The study objective was to assess the magnitude and duration of stockouts of HIV medicines and diagnostic tests in public facilities in Kinshasa, Democratic Republic of the Congo. This was a cross-sectional survey involving visits to facilities and warehouses in April and May 2015. All zonal warehouses, all public facilities with more than 200 patients on antiretroviral treatment (ART) (high-burden facilities) and a purposive sample of facilities with 200 or fewer patients (low-burden facilities) in Kinshasa were selected. We focused on three adult ART formulations, cotrimoxazole tablets, and HIV diagnostic tests. Availability of items was determined by physical check, while stockout duration until the day of the survey visit was verified with stock cards. In case of ART stockouts, we asked the pharmacist in charge what the facility coping strategy was for patients needing those medicines. The study included 28 high-burden facilities and 64 low-burden facilities, together serving around 22000 ART patients. During the study period, a national shortage of the newly introduced first-line regimen Tenofovir-Lamivudine-Efavirenz resulted in stockouts of this regimen in 56% of high-burden and 43% of low-burden facilities, lasting a median of 36 (interquartile range 29–90) and 44 days (interquartile range 24–90) until the day of the survey visit, respectively. Each of the other investigated commodities were found out of stock in at least two low-burden and two high-burden facilities. In 30/41 (73%) of stockout cases, the commodity was absent at the facility but present at the upstream warehouse. In 30/57 (54%) of ART stockout cases, patients did not receive any medicines. In some cases, patients were switched to different ART formulations or regimens. Stockouts of HIV commodities were common in the visited facilities

Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV.

PubMed

Gils, Tinne; Bossard, Claire; Verdonck, Kristien; Owiti, Philip; Casteels, Ilse; Mashako, Maria; Van Cutsem, Gilles; Ellman, Tom

2018-01-01

Stockouts of HIV commodities increase the risk of treatment interruption, antiretroviral resistance, treatment failure, morbidity and mortality. The study objective was to assess the magnitude and duration of stockouts of HIV medicines and diagnostic tests in public facilities in Kinshasa, Democratic Republic of the Congo. This was a cross-sectional survey involving visits to facilities and warehouses in April and May 2015. All zonal warehouses, all public facilities with more than 200 patients on antiretroviral treatment (ART) (high-burden facilities) and a purposive sample of facilities with 200 or fewer patients (low-burden facilities) in Kinshasa were selected. We focused on three adult ART formulations, cotrimoxazole tablets, and HIV diagnostic tests. Availability of items was determined by physical check, while stockout duration until the day of the survey visit was verified with stock cards. In case of ART stockouts, we asked the pharmacist in charge what the facility coping strategy was for patients needing those medicines. The study included 28 high-burden facilities and 64 low-burden facilities, together serving around 22000 ART patients. During the study period, a national shortage of the newly introduced first-line regimen Tenofovir-Lamivudine-Efavirenz resulted in stockouts of this regimen in 56% of high-burden and 43% of low-burden facilities, lasting a median of 36 (interquartile range 29-90) and 44 days (interquartile range 24-90) until the day of the survey visit, respectively. Each of the other investigated commodities were found out of stock in at least two low-burden and two high-burden facilities. In 30/41 (73%) of stockout cases, the commodity was absent at the facility but present at the upstream warehouse. In 30/57 (54%) of ART stockout cases, patients did not receive any medicines. In some cases, patients were switched to different ART formulations or regimens. Stockouts of HIV commodities were common in the visited facilities. Introduction

Affordable Space Tourism: SpaceStationSim

NASA Technical Reports Server (NTRS)

2006-01-01

For over 5 years, people have been living and working in space on the International Space Station (ISS), a state-of-the-art laboratory complex orbiting high above the Earth. Offering a large, sustained microgravity environment that cannot be duplicated on Earth, the ISS furthers humankind s knowledge of science and how the body functions for extended periods of time in space all of which will prove vital on long-duration missions to Mars. On-orbit construction of the station began in November 1998, with the launch of the Russian Zarya Control Module, which provided battery power and fuel storage. This module was followed by additional components and supplies over the course of several months. In November 2000, the first ISS Expedition crew moved in. Since then, the ISS has continued to change and evolve. The space station is currently 240 feet wide, measured across the solar arrays, and 171 feet long, from the NASA Destiny Laboratory to the Russian Zvezda Habitation Module. It is 90 feet tall, and it weighs approximately 404,000 pounds. Crews inhabit a living space of about 15,000 cubic feet. To date, 90 scientific investigations have been conducted on the space station. New results from space station research, from basic science to exploration research, are being published each month, and more breakthroughs are likely to come. It is not all work on the space station, though. The orbiting home affords many of the comforts one finds on Earth. There is a weightless "weight room" and even a musical keyboard alongside research facilities. Holidays are observed, and with them, traditional foods such as turkey and cobbler are eaten, with lemonade to wash them down

Online Case-Based Discussions: Examining Coverage of the Afforded Problem Space

ERIC Educational Resources Information Center

Ertmer, Peggy A.; Koehler, Adrie A.

2014-01-01

Case studies hold great potential for engaging students in disciplinary content. However, little is known about the extent to which students actually cover the problem space afforded by a particular case study. In this research, we compared the problem space afforded by an instructional design case study with the actual content covered by 16…

Conflict between object structural and functional affordances in peripersonal space.

PubMed

Kalénine, Solène; Wamain, Yannick; Decroix, Jérémy; Coello, Yann

2016-10-01

Recent studies indicate that competition between conflicting action representations slows down planning of object-directed actions. The present study aims to assess whether similar conflict effects exist during manipulable object perception. Twenty-six young adults performed reach-to-grasp and semantic judgements on conflictual objects (with competing structural and functional gestures) and non-conflictual objects (with similar structural and functional gestures) presented at difference distances in a 3D virtual environment. Results highlight a space-dependent conflict between structural and functional affordances. Perceptual judgments on conflictual objects were slower that perceptual judgments on non-conflictual objects, but only when objects were presented within reach. Findings demonstrate that competition between structural and functional affordances during object perception induces a processing cost, and further show that object position in space can bias affordance competition. Copyright © 2016 Elsevier B.V. All rights reserved.

Physicians, the Affordable Care Act, and primary care: disruptive change or business as usual?

PubMed

Jacobson, Peter D; Jazowski, Shelley A

2011-08-01

The Patient Protection and Affordable Care Act 1 (ACA) presages disruptive change in primary care delivery. With expanded access to primary care for millions of new patients, physicians and policymakers face increased pressure to solve the perennial shortage of primary care practitioners. Despite the controversy surrounding its enactment, the ACA should motivate organized medicine to take the lead in shaping new strategies for meeting the nation's primary care needs. In this commentary, we argue that physicians should take the lead in developing policies to address the primary care shortage. First, physicians and medical professional organizations should abandon their long-standing opposition to non-physician practitioners (NPPs) as primary care providers. Second, physicians should re-imagine how primary care is delivered, including shifting routine care to NPPs while retaining responsibility for complex patients and oversight of the new primary care arrangements. Third, the ACA's focus on wellness and prevention creates opportunities for physicians to integrate population health into primary care practice.

Using task dynamics to quantify the affordances of throwing for long distance and accuracy.

PubMed

Wilson, Andrew D; Weightman, Andrew; Bingham, Geoffrey P; Zhu, Qin

2016-07-01

In 2 experiments, the current study explored how affordances structure throwing for long distance and accuracy. In Experiment 1, 10 expert throwers (from baseball, softball, and cricket) threw regulation tennis balls to hit a vertically oriented 4 ft × 4 ft target placed at each of 9 locations (3 distances × 3 heights). We measured their release parameters (angle, speed, and height) and showed that they scaled their throws in response to changes in the target's location. We then simulated the projectile motion of the ball and identified a continuous subspace of release parameters that produce hits to each target location. Each subspace describes the affordance of our target to be hit by a tennis ball moving in a projectile motion to the relevant location. The simulated affordance spaces showed how the release parameter combinations required for hits changed with changes in the target location. The experts tracked these changes in their performance and were successful in hitting the targets. We next tested unusual (horizontal) targets that generated correspondingly different affordance subspaces to determine whether the experts would track the affordance to generate successful hits. Do the experts perceive the affordance? They do. In Experiment 2, 5 cricketers threw to hit either vertically or horizontally oriented targets and successfully hit both, exhibiting release parameters located within the requisite affordance subspaces. We advocate a task dynamical approach to the study of affordances as properties of objects and events in the context of tasks as the future of research in this area. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Surgeon Reimbursements in Maxillofacial Trauma Surgery: Effect of the Affordable Care Act in Ohio.

PubMed

Khansa, Ibrahim; Khansa, Lara; Pearson, Gregory D

2016-02-01

Surgical treatment of maxillofacial injuries has historically been associated with low reimbursements, mainly because of the high proportion of uninsured patients. The Affordable Care Act, implemented in January of 2014, aimed to reduce the number of uninsured. If the Affordable Care Act achieves this goal, surgeons may benefit from improved reimbursement rates. The authors' purpose was to evaluate the effects of the Affordable Care Act on payor distribution and surgeon reimbursements for maxillofacial trauma surgery at their institution. A review of all patients undergoing surgery for maxillofacial trauma between January of 2012 and December of 2014 was conducted. Insurance status, and amounts billed and collected by the surgeon, were recorded. Patients treated before implementation of the Affordable Care Act were compared to those treated after. Five hundred twenty-three patients were analyzed. Three hundred thirty-four underwent surgery before implementation of the Affordable Care Act, and 189 patients underwent surgery after. After implementation of the Affordable Care Act, the proportion of uninsured decreased (27.2 percent to 11.1 percent; p < 0.001) and the proportion of patients on Medicaid increased (7.8 percent to 25.4 percent; p < 0.001). Overall surgeon reimbursement rate increased from 14.3 percent to 19.8 percent (p < 0.001). After implementation of the Affordable Care Act, we observed a significant reduction in the proportion of maxillofacial trauma patients who were uninsured. Surgeons' overall reimbursement rate increased. These trends should be followed over a longer term to determine the full effect of the Affordable Care Act.

Optics learning through affordable kit

DOE Office of Scientific and Technical Information (OSTI.GOV)

P, Anusha N, E-mail: anushnp@gmail.com, E-mail: chitrashaji@gmail.com, E-mail: aloksharan@gmail.com; Shaji, Chitra, E-mail: anushnp@gmail.com, E-mail: chitrashaji@gmail.com, E-mail: aloksharan@gmail.com; Sharan, Alok, E-mail: anushnp@gmail.com, E-mail: chitrashaji@gmail.com, E-mail: aloksharan@gmail.com

2014-10-15

An affordable kit which helps to understand some of the optical phenomena qualitatively and quantitatively is presented in this paper. It supplements optics taught in classes. The kit consists of equipments which are available in the market at nominal cost such as laser pointer, lenses, glass plates, razor blades, coins, ball bearing etc. Experiments which come under wave optics (interference and diffraction) and ray optics (reflection and refraction) are explained using this kit.

Affordable proteomics: the two-hybrid systems.

PubMed

Gillespie, Marc

2003-06-01

Numerous proteomic methodologies exist, but most require a heavy investment in expertise and technology. This puts these approaches out of reach for many laboratories and small companies, rarely allowing proteomics to be used as a pilot approach for biomarker or target identification. Two proteomic approaches, 2D gel electrophoresis and the two-hybrid systems, are currently available to most researchers. The two-hybrid systems, though accommodating to large-scale experiments, were originally designed as practical screens, that by comparison to current proteomics tools were small-scale, affordable and technically feasible. The screens rapidly generated data, identifying protein interactions that were previously uncharacterized. The foundation for a two-hybrid proteomic investigation can be purchased as separate kits from a number of companies. The true power of the technique lies not in its affordability, but rather in its portability. The two-hybrid system puts proteomics back into laboratories where the output of the screens can be evaluated by researchers with experience in the particular fields of basic research, cancer biology, toxicology or drug development.

Trauma and Hypothermia in Antarctica: An Emergency Medicine Marine Simulation Scenario

PubMed Central

Horwood, Chrystal; Skinner, Tate; Brown, Robert; Renouf, Tia; Dubrowski, Adam

2017-01-01

Simulation has been shown to improve both learner knowledge and patient outcomes. Many emergency medicine training programs incorporate simulation into their curricula to provide learners with experiences that are rare to encounter in practice, yet performance with a high degree of competence is critical. One rare encounter, which is depicted in the report, is the management of a trauma patient who was hypothermic after falling from an expedition vessel into the cold Southern Ocean. The unique scenario presented in this technical report incorporates CanMEDS learning objectives including the communicator, health advocate, and collaborator roles. Using medical simulation facilities, marine performance simulation facilities, and a video, this scenario provides teaching that is uncommon in traditional emergency medicine training. As such, it is valuable for trainees who intend to practice rural, remote, or expedition medicine, or provide coverage for ships and marine installations. PMID:28706765

Do Affordable Housing Projects Harm Suburban Communities? Crime, Property Values, and Taxes in Mount Laurel, NJ.

PubMed

Albright, Len; Derickson, Elizabeth S; Massey, Douglas S

2013-06-01

This paper offers a mixed-method analysis of the municipal-level consequences of an affordable housing development built in suburban New Jersey. Opponents of affordable housing development often suggest that creating affordable housing will harm surrounding communities. Feared consequences include increases in crime, declining property values, and rising taxes. To evaluate these claims, the paper uses the case of Mt. Laurel, NJ - the site of a landmark affordable housing legal case and subsequent affordable housing development. Employing a multiple time series group control design, we compare crime rates, property values, and property taxes in Mt. Laurel to outcomes in similar nearby municipalities that do not contain comparable affordable housing developments. We find that the opening of the affordable housing development was not associated with trends in crime, property values, or taxes, and discuss management practices and design features that may have mitigated potential negative externalities.

Do Affordable Housing Projects Harm Suburban Communities? Crime, Property Values, and Taxes in Mount Laurel, NJ

PubMed Central

Albright, Len; Derickson, Elizabeth S.; Massey, Douglas S.

2016-01-01

This paper offers a mixed-method analysis of the municipal-level consequences of an affordable housing development built in suburban New Jersey. Opponents of affordable housing development often suggest that creating affordable housing will harm surrounding communities. Feared consequences include increases in crime, declining property values, and rising taxes. To evaluate these claims, the paper uses the case of Mt. Laurel, NJ – the site of a landmark affordable housing legal case and subsequent affordable housing development. Employing a multiple time series group control design, we compare crime rates, property values, and property taxes in Mt. Laurel to outcomes in similar nearby municipalities that do not contain comparable affordable housing developments. We find that the opening of the affordable housing development was not associated with trends in crime, property values, or taxes, and discuss management practices and design features that may have mitigated potential negative externalities. PMID:27390552

American Heart Association Principles on the Accessibility and Affordability of Drugs and Biologics: A Presidential Advisory From the American Heart Association.

PubMed

Antman, Elliott M; Creager, Mark A; Houser, Steven R; Warner, John J; Konig, Madeleine

2017-12-12

Net US spending on pharmaceuticals reached $309.5 billion in 2015, an 8.5% increase from the year before, and is expected to reach between $370 and $400 billion by 2020. These current and projected levels have raised serious concerns by policy makers, providers, payers, and patient groups that they are unsustainable and threaten the affordability of and accessibility to much-needed therapies for patients. Two trends related to drugs/biologics and generic drugs/biosimilars underlie this overall increase in spending. First, the market entry prices of innovator pharmaceutical products, or brand drugs and biologics, are at levels that some assessments consider unaffordable to the healthcare system. Second, prices for some established generic drugs such as digoxin and captopril have seen sharp and rapid increases. As an evidence-based patient advocacy organization dedicated to improving the cardiovascular health of all Americans, the American Heart Association has a unique role in advocating for treatments, including medicines that are available, affordable, and accessible to patients. This advisory serves to lay out a set of principles that will guide association engagement in pursuit of this goal. © 2017 American Heart Association, Inc.

Educational Affordances of a Ubiquitous Learning Environment in a Natural Science Course

ERIC Educational Resources Information Center

Tan, Tan-Hsu; Lin, Min-Sheng; Chu, Yu-Ling; Liu, Tsung-Yu

2012-01-01

Educational affordances are worthy of being explored because the affordances of Information and Communication Technologies (ICT) provide the pedagogical effects for promoting cognitive acceleration, increasing the self-management of students, facilitating data collection, and presentation in science learning. This study aims to explore educational…

9 Tips for Affordable Student Trips

ERIC Educational Resources Information Center

Adams, Jonathan

2013-01-01

The trick to having a successful and affordable trip is planning ahead and planning thoroughly. Keep the spirits high and the costs low by following a well-traveled ensemble director's suggestions as presented in this article. These tips include finding local attractions that are unique to the city that the group will be visiting, looking at…

Pragmatic medicine in solid cancer: a translational alternative to precision medicine

PubMed Central

Brábek, Jan; Rosel, Daniel; Fernandes, Michael

2016-01-01

The precision medicine (PM) initiative is a response to the dismal outlook in solid cancer. Despite heterogeneity, common mechanistic denominators may exist across the spectrum of solid cancer. A shift from conventional research and development (R&D) toward PM will require conceptual and structural change. As individuals and as a society, we welcome innovation, but question change. We ask: In solid cancer, does PM identify and address the causes of prior failures, and, if so, are the proposed solutions feasible? And, when may we expect safer, more effective and affordable drugs in the clinic? Considerations that prompt a pragmatic rethink include a failure analysis of translational R&D in solid cancer suggesting that trials and regulations need to be aligned with the natural history of the disease. In successful therapeutic interventions in chronic, complex disease, surrogate markers and endpoints should be consistent with the Prentice’s criteria. In solid cancer, drug induced tumor shrinkage, is a drug effect and not a disease response; tumor shrinkage does not reflect nor predict interruption of the disease. Overall, we support a pragmatic, multidisciplinary, and collaborative R&D, and suggest that direction be set by clinical need and utility, and by questions, not answers. PM will prove worthwhile if it could improve clinical outcomes. The lag in therapeutics relative to diagnostics is a cause for confusion. Overdiagnosis adds to fear and harm, especially in the absence of effective interventions. A revised initiative that prioritizes metastasis research could replicate the successful HIV/AIDS model in solid cancer. A pragmatic approach may further translational efforts toward meaningfully effective, generally available, and affordable solutions. PMID:27103822

Active design in affordable housing: A public health nudge.

PubMed

Garland, Elizabeth; Garland, Victoria; Peters, Dominique; Doucette, John; Thanik, Erin; Rajupet, Sritha; Sanchez, Sadie H

2018-06-01

This pilot study investigates the impact of active design (AD) strategies on physical activity (PA) among adults living in two Leadership in Energy and Environmental Design (LEED) certified affordable housing developments in the South Bronx, New York. One building incorporates LEED Innovation in Design (ID) Credit: Design for Health through Increased Physical Activity. Tenants in an affordable housing building (AH) incorporating active design strategies completed PA self-assessments at their lease signing and one year later in 2015. Trained research assistants obtained body measurements. Residents of neighboring non-AD affordable housing (MCV) served as a comparison. Thirty four adults were recruited from AH and 29 from MCV, retention was 56% (n = 19) and 52% (n = 15) respectively at one year. The two groups' body mass index (BMI) and high-risk waist-to-hip ratio (WHR) were not statistically significantly different when analyzed as continuous variables, although BMI category had a greater decline at AH than at MCV (p = 0.054). There was a 31.5% increase in AH participants meeting MPA requirements and a statistically significant improvement in females (p = 0.031); while there was no change in the MCV participants overall or when stratified by gender. AH participants were significantly more likely to have reported increased stair use and less likely to have reported no change or decreased stair use than participants from MCV participants (p = 0.033). Housing has a role in individual health outcomes and behavior change, broad adoption of active design strategies in affordable housing is warranted to improve physical activity measures.

Access to diabetes care and medicines in the Philippines.

PubMed

Higuchi, Michiyo

2010-07-01

In the Philippines, diabetes is rapidly becoming a major public health issue, as in other low- and middle-income countries. Availability and affordability of care and medicines are crucial to control diabetes. This study describes the situations of diabetes patients and identifies possible barriers to diabetes care and medicines in the Philippines. Quantitative and qualitative data were collected from multilevel respondents using different semistructured questionnaires/checklists. The study revealed that many patients took intermittent medication based on their own judgment, and/ or selected certain pieces of medical advice, subjectively weighing symptoms against household budget. The current public health insurance scheme and decentralized health systems did not promote access to diabetes care. Investing in regular care is expected to be less expensive both for individuals and for society in the long-term. Insurance outpatient coverage and application of standard treatment/management guidelines will be of help to encourage providing and receiving regular care.

Acquisition Management for System of Systems: Affordability through Effective Portfolio Management

DTIC Science & Technology

2013-04-01

the management of strategic “ portfolios of systems” in military acquisitions; this includes application of Real Options (RO) theory and metrics such...Affordability Through Effective Portfolio Management Navindran Davendralingam and Daniel DeLaurentis Purdue University Published April 1, 2013...Systems: Affordability Through Effective Portfolio Management 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d

Approach to an Affordable and Sustainable Space Transportation System

NASA Technical Reports Server (NTRS)

McCleskey, Caey M.; Rhodes, R. E.; Robinson, J. W.; Henderson, E. M.

2012-01-01

This paper describes an approach and a general procedure for creating space transportation architectural concepts that are at once affordable and sustainable. Previous papers by the authors and other members of the Space Propulsion Synergy Team (SPST) focused on a functional system breakdown structure for an architecture and definition of high-payoff design techniques with a technology integration strategy. This paper follows up by using a structured process that derives architectural solutions focused on achieving life cycle affordability and sustainability. Further, the paper includes an example concept that integrates key design techniques discussed in previous papers. !

Concierge Medicine: A Viable Business Model for (Some) Physicians of the Future?

PubMed

Paul, David P; Skiba, Michaeline

Concierge medicine is a medical management structure that has been in existence since the 1990s. Essentially, a typical concierge medical practice limits its number of patients and provides highly personalized attention that includes comprehensive annual physicals, same-day appointments, preventive and wellness care, and fast, 24/7 response time. Concierge medicine has become popular among both physicians and patients/consumers who are frustrated by the limitations imposed by managed care organizations. From many physicians' perspectives, concierge medicine offers greater autonomy, the opportunity to return to a more manageable patient load, and the chance to improve their incomes that have declined because of increasingly lowered reimbursements for their services. From many patients'/consumers' perspectives, concierge medicine provides more immediate, convenient, and caring access to their primary care physicians and, regardless of their physician's annual retainer fee, the elimination of third-party insurance coverage costs and hassles. The major criticisms of the concierge medicine model come from some health care policy makers and experts, who believe that concierge medicine is elitist and its widespread implementation will increase the shortage of primary care physicians, which is already projected to become worse because of the Affordable Care Act's individual mandate, which requires everyone to have health insurance.Utilizing these topics as its framework, this article explains why concierge medicine's form of medical management is gaining ground, cites its advantages and disadvantages for stakeholders, and examines some of the issues that will affect its growth.

16 CFR 1061.8 - Information on the heightened degree of protection afforded.

Code of Federal Regulations, 2010 CFR

2010-01-01

... protection afforded. 1061.8 Section 1061.8 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL APPLICATIONS FOR EXEMPTION FROM PREEMPTION § 1061.8 Information on the heightened degree of protection afforded... State or local requirement provides a significantly higher degree of protection from the risk of injury...

24 CFR 1000.104 - What families are eligible for affordable housing activities?

Code of Federal Regulations, 2010 CFR

2010-04-01

... affordable housing activities? 1000.104 Section 1000.104 Housing and Urban Development Regulations Relating... Activities § 1000.104 What families are eligible for affordable housing activities? The following families... Indian area. (b) A non-low income Indian family may receive housing assistance in accordance with § 1000...

Self-organization, free energy minimization, and optimal grip on a field of affordances.

PubMed

Bruineberg, Jelle; Rietveld, Erik

2014-01-01

In this paper, we set out to develop a theoretical and conceptual framework for the new field of Radical Embodied Cognitive Neuroscience. This framework should be able to integrate insights from several relevant disciplines: theory on embodied cognition, ecological psychology, phenomenology, dynamical systems theory, and neurodynamics. We suggest that the main task of Radical Embodied Cognitive Neuroscience is to investigate the phenomenon of skilled intentionality from the perspective of the self-organization of the brain-body-environment system, while doing justice to the phenomenology of skilled action. In previous work, we have characterized skilled intentionality as the organism's tendency toward an optimal grip on multiple relevant affordances simultaneously. Affordances are possibilities for action provided by the environment. In the first part of this paper, we introduce the notion of skilled intentionality and the phenomenon of responsiveness to a field of relevant affordances. Second, we use Friston's work on neurodynamics, but embed a very minimal version of his Free Energy Principle in the ecological niche of the animal. Thus amended, this principle is helpful for understanding the embeddedness of neurodynamics within the dynamics of the system "brain-body-landscape of affordances." Next, we show how we can use this adjusted principle to understand the neurodynamics of selective openness to the environment: interacting action-readiness patterns at multiple timescales contribute to the organism's selective openness to relevant affordances. In the final part of the paper, we emphasize the important role of metastable dynamics in both the brain and the brain-body-environment system for adequate affordance-responsiveness. We exemplify our integrative approach by presenting research on the impact of Deep Brain Stimulation on affordance responsiveness of OCD patients.

An informatics research agenda to support precision medicine: seven key areas.

PubMed

Tenenbaum, Jessica D; Avillach, Paul; Benham-Hutchins, Marge; Breitenstein, Matthew K; Crowgey, Erin L; Hoffman, Mark A; Jiang, Xia; Madhavan, Subha; Mattison, John E; Nagarajan, Radhakrishnan; Ray, Bisakha; Shin, Dmitriy; Visweswaran, Shyam; Zhao, Zhongming; Freimuth, Robert R

2016-07-01

The recent announcement of the Precision Medicine Initiative by President Obama has brought precision medicine (PM) to the forefront for healthcare providers, researchers, regulators, innovators, and funders alike. As technologies continue to evolve and datasets grow in magnitude, a strong computational infrastructure will be essential to realize PM's vision of improved healthcare derived from personal data. In addition, informatics research and innovation affords a tremendous opportunity to drive the science underlying PM. The informatics community must lead the development of technologies and methodologies that will increase the discovery and application of biomedical knowledge through close collaboration between researchers, clinicians, and patients. This perspective highlights seven key areas that are in need of further informatics research and innovation to support the realization of PM. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association.

A human rights approach to the WHO Model List of Essential Medicines.

PubMed Central

Seuba, Xavier

2006-01-01

Since the first WHO Model List of Essential Medicines was adopted in 1977, it has become a popular tool among health professionals and Member States. WHO's joint effort with the United Nations Committee on Economic, Social and Cultural Rights has resulted in the inclusion of access to essential medicines in the core content of the right to health. The Committee states that the right to health contains a series of elements, such as availability, accessibility, acceptability and quality of health goods, services and programmes, which are in line with the WHO statement that essential medicines are intended to be available within the context of health systems in adequate amounts at all times, in the appropriate dosage forms, with assured quality and information, and at a price that the individual and the community can afford. The author considers another perspective by looking at the obligations to respect, protect and fulfil the right to health undertaken by the states adhering to the International Covenant of Economic, Social and Cultural Rights (ICESCR) and explores the relationship between access to medicines, the protection of intellectual property, and human rights. PMID:16710552

Measuring water affordability in developed economies. The added value of a needs-based approach.

PubMed

Vanhille, Josefine; Goedemé, Tim; Penne, Tess; Van Thielen, Leen; Storms, Bérénice

2018-07-01

In developed countries, water affordability problems remain up on the agenda as the increasing financial costs of water services can impede the realisation of an equal access to water. More than ever, public authorities that define water tariffs face the challenge of reconciling environmental and cost recovery objectives with equity and financial accessibility for all. Indicators of water affordability can be helpful in this regard. Conventional affordability indicators often rely on the actual amount that households spend on water use. In contrast, we propose a needs-based indicator that measures the risk of being unable to afford the amount of water necessary to fulfill essential needs, i.e. needs that should be fulfilled for adequate participation in society. In this paper we set forth the methodological choices inherent to constructing a needs-based affordability indicator. Using a micro-dataset on households in Flanders (Belgium), we compare its results with the outcomes of a more common actual expenses-indicator. The paper illustrates how the constructed needs-based indicator can complement existing affordability indicators, and its capacity to reveal important risk groups. Copyright © 2018 Elsevier Ltd. All rights reserved.

Responding to the Pandemic of Falsified Medicines

PubMed Central

Nayyar, Gaurvika M. L.; Attaran, Amir; Clark, John P.; Culzoni, M. Julia; Fernandez, Facundo M.; Herrington, James E.; Kendall, Megan; Newton, Paul N.; Breman, Joel G.

2015-01-01

Over the past decade, the number of countries reporting falsified (fake, spurious/falsely labeled/counterfeit) medicines and the types and quantities of fraudulent drugs being distributed have increased greatly. The obstacles in combating falsified pharmaceuticals include 1) lack of consensus on definitions, 2) paucity of reliable and scalable technology to detect fakes before they reach patients, 3) poor global and national leadership and accountability systems for combating this scourge, and 4) deficient manufacturing and regulatory challenges, especially in China and India where fake products often originate. The major needs to improve the quality of the world's medicines fall into three main areas: 1) research to develop and compare accurate and affordable tools to identify high-quality drugs at all levels of distribution; 2) an international convention and national legislation to facilitate production and utilization of high-quality drugs and protect all countries from the criminal and the negligent who make, distribute, and sell life-threatening products; and 3) a highly qualified, well-supported international science and public health organization that will establish standards, drug-quality surveillance, and training programs like the U.S. Food and Drug Administration. Such leadership would give authoritative guidance for countries in cooperation with national medical regulatory agencies, pharmaceutical companies, and international agencies, all of which have an urgent interest and investment in ensuring that patients throughout the world have access to good quality medicines. The organization would also advocate strongly for including targets for achieving good quality medicines in the United Nations Millennium Development Goals and Sustainable Development Goals. PMID:25897060

Monitoring the price and affordability of foods and diets globally.

PubMed

Lee, A; Mhurchu, C N; Sacks, G; Swinburn, B; Snowdon, W; Vandevijvere, S; Hawkes, C; L'abbé, M; Rayner, M; Sanders, D; Barquera, S; Friel, S; Kelly, B; Kumanyika, S; Lobstein, T; Ma, J; Macmullan, J; Mohan, S; Monteiro, C; Neal, B; Walker, C

2013-10-01

Food prices and food affordability are important determinants of food choices, obesity and non-communicable diseases. As governments around the world consider policies to promote the consumption of healthier foods, data on the relative price and affordability of foods, with a particular focus on the difference between 'less healthy' and 'healthy' foods and diets, are urgently needed. This paper briefly reviews past and current approaches to monitoring food prices, and identifies key issues affecting the development of practical tools and methods for food price data collection, analysis and reporting. A step-wise monitoring framework, including measurement indicators, is proposed. 'Minimal' data collection will assess the differential price of 'healthy' and 'less healthy' foods; 'expanded' monitoring will assess the differential price of 'healthy' and 'less healthy' diets; and the 'optimal' approach will also monitor food affordability, by taking into account household income. The monitoring of the price and affordability of 'healthy' and 'less healthy' foods and diets globally will provide robust data and benchmarks to inform economic and fiscal policy responses. Given the range of methodological, cultural and logistical challenges in this area, it is imperative that all aspects of the proposed monitoring framework are tested rigorously before implementation. © 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.

Ground-facilities at the DLR Institute of Aerospace Medicine for preparation of flight experiments

NASA Astrophysics Data System (ADS)

Hemmersbach, Ruth; Hendrik Anken, Ralf; Hauslage, Jens; von der Wiesche, Melanie; Baerwalde, Sven; Schuber, Marianne

In order to investigate the influence of altered gravity on biological systems and to identify gravisensitive processes, various experimental platforms have been developed, which are useful to simulate weightlessness or are able to produce hypergravity. At the Institute of Aerospace Medicine, DLR Cologne, a broad spectrum of applications is offered to scientists: clinostats with one rotation axis and variable rotation speeds for cultivation of small objects (including aquatic organisms) in simulated weightlessness conditions, for online microscopic observations and for online kinetic measurements. Own research concentrates on comparative studies with other kinds of methods to simulate weightlessness, also available at the institute: Rotating Wall Vessel (RWV) for aquatic studies, Random Positioning Machine (RPM; manufactured by Dutch Space, Leiden, The Netherlands). Correspondingly, various centrifuge devices are available to study different test objects under hypergravity conditions -such as NIZEMI, a slow rotating centrifuge microscope, and MUSIC, a multi-sample centrifuge. Mainly for experiments with human test subjects (artificial gravity), but also for biological systems or for testing various kinds of (flight-) hardware, the SAHC, a short arm human centrifuge -loaned by ESA -was installed in Cologne and completes our experimental scenario. Furthermore, due to our specific tasks such as providing laboratories during the German Parabolic Flight Experiments starting from Cologne and being the Facility Responsible Center for BIOLAB, a science rack in the Columbus module aboard the ISS, scientists have the possibility for an optimal preparation of their flight experiments.

Young adults' health care utilization and expenditures prior to the Affordable Care Act.

PubMed

Lau, Josephine S; Adams, Sally H; Boscardin, W John; Irwin, Charles E

2014-06-01

To examine young adults' health care utilization and expenditures prior to the Affordable Care Act. We used 2009 Medical Expenditure Panel Survey to (1) compare young adults' health care utilization and expenditures of a full-spectrum of health services to children and adolescents and (2) identify disparities in young adults' utilization and expenditures, based on access (insurance and usual source of care) and other sociodemographic factors, including race/ethnicity and income. Young adults had (1) significantly lower rates of overall utilization (72%) than other age groups (83%-88%, p < .001), (2) the lowest rate of office-based utilization (55% vs. 67%-77%, p < .001) and (3) higher rate of emergency room visits compared with adolescents (15% vs. 12%, p < .01). Uninsured young adults had high out-of-pocket expenses. Compared with the young adults with private insurance, the uninsured spent less than half on health care ($1,040 vs. $2,150/person, p < .001) but essentially the same out-of-pocket expenses ($403 vs. $380/person, p = .57). Among young adults, we identified significant disparities in utilization and expenditures based on the presence/absence of a usual source of care, race/ethnicity, home language, and sex. Young adults may not be utilizing the health care system optimally by having low rates of office-based visits and high rates of emergency room visits. The Affordable Care Act provision of insurance for those previously uninsured or under-insured will likely increase their utilization and expenditures and lower their out-of-pocket expenses. Further effort is needed to address noninsurance barriers and ensure equal access to health services. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Global Trends in the Affordability of Sugar-Sweetened Beverages, 1990-2016.

PubMed

Blecher, Evan; Liber, Alex C; Drope, Jeffrey M; Nguyen, Binh; Stoklosa, Michal

2017-05-04

The objective of this study was to quantify changes in the affordability of sugar-sweetened beverages, a product implicated as a contributor to rising rates of obesity worldwide, as a function of product price and personal income. We used international survey data in a retrospective analysis of 40 high-income and 42 low-income and middle-income countries from 1990 to 2016. Prices of sugar-sweetened beverages were from the Economist Intelligence Unit's World Cost of Living Survey. Income and inflation data were from the International Monetary Fund's World Economic Outlook Database. The measure of affordability was the average annual percentage change in the relative-income price of sugar-sweetened beverages, which is the annual rate of change in the proportion of per capita gross domestic product needed to purchase 100 L of Coca-Cola in each country in each year of the study. In 79 of 82 countries, the proportion of income needed to purchase sugar-sweetened beverages declined on average (using annual measures) during the study period. This pattern, described as an increase in the affordability of sugar-sweetened beverages, indicated that sugar-sweetened beverages became more affordable more rapidly in low-income and middle-income countries than in high-income countries, a fact largely attributable to the higher rate of income growth in those countries than to a decline in the real price of sugar-sweetened beverages. Without deliberate policy action to raise prices, sugar-sweetened beverages are likely to become more affordable and more widely consumed around the world.

78 FR 54069 - Patient Protection and Affordable Care Act; Program Integrity: Exchange, SHOP, and Eligibility...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-30

... Parts 147, 153, 155, et al. Patient Protection and Affordable Care Act; Program Integrity: Exchange... 147, 153, 155, and 156 [CMS-9957-F] RIN 0938-AR82 Patient Protection and Affordable Care Act; Program... Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as...

High Working Memory Load Increases Intracortical Inhibition in Primary Motor Cortex and Diminishes the Motor Affordance Effect.

PubMed

Freeman, Scott M; Itthipuripat, Sirawaj; Aron, Adam R

2016-05-18

Motor affordances occur when the visual properties of an object elicit behaviorally relevant motor representations. Typically, motor affordances only produce subtle effects on response time or on motor activity indexed by neuroimaging/neuroelectrophysiology, but sometimes they can trigger action itself. This is apparent in "utilization behavior," where individuals with frontal cortex damage inappropriately grasp affording objects. This raises the possibility that, in healthy-functioning individuals, frontal cortex helps ensure that irrelevant affordance provocations remain below the threshold for actual movement. In Experiment 1, we tested this "frontal control" hypothesis by "loading" the frontal cortex with an effortful working memory (WM) task (which ostensibly consumes frontal resources) and examined whether this increased EEG measures of motor affordances to irrelevant affording objects. Under low WM load, there were typical motor affordance signatures: an event-related desynchronization in the mu frequency and an increased P300 amplitude for affording (vs nonaffording) objects over centroparietal electrodes. Contrary to our prediction, however, these affordance measures were diminished under high WM load. In Experiment 2, we tested competing mechanisms responsible for the diminished affordance in Experiment 1. We used paired-pulse transcranial magnetic stimulation over primary motor cortex to measure long-interval cortical inhibition. We found greater long-interval cortical inhibition for high versus low load both before and after the affording object, suggesting that a tonic inhibition state in primary motor cortex could prevent the affordance from provoking the motor system. Overall, our results suggest that a high WM load "sets" the motor system into a suppressed state that mitigates motor affordances. Is an irrelevant motor affordance more likely to be triggered when you are under low or high cognitive load? We examined this using physiological measures

Impact of the Affordable Care Act on stem cell transplantation.

PubMed

Farnia, Stephanie; Gedan, Alicia; Boo, Michael

2014-03-01

The Patient Protection and Affordable Care Act, signed into law in 2010, will have a wide-reaching impact on the health care system in the United States when it is fully implemented in 2014. Patients will see increased access to care coupled with new insurance coverage protections as well as a minimum set of benefits mandated in each state known as essential health benefits. Providers are likely to see new forms of payment reform, particularly in the Medicare program, and narrower commercial provider networks. In addition, the composition of the health insurance market will broaden with the introduction of health insurance exchanges and expanded Medicaid populations in many states. Furthermore, the Patient Protection and Affordable Care Act calls for quality initiatives such as comparative effectiveness research to increase effective, appropriate and high-value care. This paper will review the main provisions of the Patient Protection and Affordable Care Act with specific attention to their impact on the field of Stem Cell Transplantation.

An Exploratory Study of Emotional Affordance of a Massive Open Online Course

ERIC Educational Resources Information Center

Cheng, Jeremy C. Y.

2014-01-01

This exploratory study examines emotional affordance of a massive open online course (MOOC). Postings in a discussion forum of a MOOC in computer science are analysed following a research design informed by virtual ethnography. Emotional affordance is investigated, focusing on non-achievement emotions which are not directly linked to achievement…

Virtues and values in medicine revisited: individual and global health.

PubMed

Benatar, Solomon; Upshur, Ross

2014-10-01

In response to the call from an international panel for 'much needed rethinking' about the goals and purposes of the education of healthcare professionals, we suggest that there must be an explicit account of the virtues and values that will inform healthcare practice in the 21st century. We propose that a renewed emphasis is needed on reviving the well-honed clinical skills and humanistic attributes in medicine as crucial for optimum affordable (and sustainable) care of individual patients. Analogous virtues should be linked to the quest for improving the health of whole populations, nationally and globally. © 2014 Royal College of Physicians.

Implementing the Affordable Care Act: Promoting Competition in the Individual Marketplaces.

PubMed

Cusano, David; Lucia, Kevin

2016-02-01

A main goal of the Affordable Care Act is to provide Americans with access to affordable coverage in the individual market, achieved in part by pro­moting competition among insurers on premium price and value. One primary mechanism for meeting that goal is the establishment of new individual health insurance marketplaces where consumers can shop for, compare, and purchase plans, with subsidies if they are eligible. In this issue brief, we explore how the Affordable Care Act is influencing competition in the individual marketplaces in four states--Kansas, Nevada, Rhode Island, and Washington. Strategies include: educating consumers and providing coverage information in one place to ease decision-making; promoting competition among insurers; and ensuring a level playing field for premium rate development through the rate review process.

Self-organization, free energy minimization, and optimal grip on a field of affordances

PubMed Central

Bruineberg, Jelle; Rietveld, Erik

2014-01-01

In this paper, we set out to develop a theoretical and conceptual framework for the new field of Radical Embodied Cognitive Neuroscience. This framework should be able to integrate insights from several relevant disciplines: theory on embodied cognition, ecological psychology, phenomenology, dynamical systems theory, and neurodynamics. We suggest that the main task of Radical Embodied Cognitive Neuroscience is to investigate the phenomenon of skilled intentionality from the perspective of the self-organization of the brain-body-environment system, while doing justice to the phenomenology of skilled action. In previous work, we have characterized skilled intentionality as the organism's tendency toward an optimal grip on multiple relevant affordances simultaneously. Affordances are possibilities for action provided by the environment. In the first part of this paper, we introduce the notion of skilled intentionality and the phenomenon of responsiveness to a field of relevant affordances. Second, we use Friston's work on neurodynamics, but embed a very minimal version of his Free Energy Principle in the ecological niche of the animal. Thus amended, this principle is helpful for understanding the embeddedness of neurodynamics within the dynamics of the system “brain-body-landscape of affordances.” Next, we show how we can use this adjusted principle to understand the neurodynamics of selective openness to the environment: interacting action-readiness patterns at multiple timescales contribute to the organism's selective openness to relevant affordances. In the final part of the paper, we emphasize the important role of metastable dynamics in both the brain and the brain-body-environment system for adequate affordance-responsiveness. We exemplify our integrative approach by presenting research on the impact of Deep Brain Stimulation on affordance responsiveness of OCD patients. PMID:25161615

Sanford Underground Research Facility - The United State's Deep Underground Research Facility

NASA Astrophysics Data System (ADS)

Vardiman, D.

2012-12-01

/LIDAR), surveying instruments, and surveying benchmarks and optical survey points. Currently an array of single and multipoint extensometers monitors the Davis Campus. A facility-wide micro seismic monitoring system is anticipated to be deployed during the latter half of 2012. This system is designed to monitor minor events initiated within the historical mined out portions of the facility. The major science programs for the coming five years consist of the MAJORANA DEMONSTRATOR (MJD) neutrinoless double beta decay experiment; the Large Underground Xenon (LUX) dark matter search, the Center for Ultralow Background Experiments at DUSEL (CUBED), numerous geoscience installations, Long-Baseline Neutrino Experiment (LBNE), a nuclear astrophysics program involving a low energy underground particle accelerator, second and third generation dark matter experiments, and additional low background counting facilities. The Sanford Lab facility is an active, U.S. based, deep underground research facility dedicated to science, affording the science community the opportunity to conduct unprecedented scientific research in a broad range of physics, biology and geoscience fields at depth. SURF is actively interested in hosting additional research collaborations and provides resources for full facility design, cost estimation, excavation, construction and support management services.

A Sea Change in Medicine: Current Shifts in the Delivery and Payment of Medical Care.

PubMed

Bruch, Richard

2016-01-01

The Patient Protection and Affordable Care Act and the Triple Aim are driving a shift toward value-based care. Significant financial risk is being transferred from commercial insurers and government payers to hospital systems and independent physician groups. Medicare has developed bundled payment programs, but legislative barriers still impede the implementation of value-based health care. ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

The high throughput biomedicine unit at the institute for molecular medicine Finland: high throughput screening meets precision medicine.

PubMed

Pietiainen, Vilja; Saarela, Jani; von Schantz, Carina; Turunen, Laura; Ostling, Paivi; Wennerberg, Krister

2014-05-01

The High Throughput Biomedicine (HTB) unit at the Institute for Molecular Medicine Finland FIMM was established in 2010 to serve as a national and international academic screening unit providing access to state of the art instrumentation for chemical and RNAi-based high throughput screening. The initial focus of the unit was multiwell plate based chemical screening and high content microarray-based siRNA screening. However, over the first four years of operation, the unit has moved to a more flexible service platform where both chemical and siRNA screening is performed at different scales primarily in multiwell plate-based assays with a wide range of readout possibilities with a focus on ultraminiaturization to allow for affordable screening for the academic users. In addition to high throughput screening, the equipment of the unit is also used to support miniaturized, multiplexed and high throughput applications for other types of research such as genomics, sequencing and biobanking operations. Importantly, with the translational research goals at FIMM, an increasing part of the operations at the HTB unit is being focused on high throughput systems biological platforms for functional profiling of patient cells in personalized and precision medicine projects.

Inefficient procurement processes undermine access to medicines in the Western Cape Province of South Africa.

PubMed

Magadzire, Bvudzai P; Ward, Kim; Leng, Henry M J; Sanders, David

2017-06-30

South Africa (SA) has experienced several stock-outs of life-saving medicines for the treatment of major chronic infectious and non-communicable diseases in the public sector. To identify the causes of stock-outs and to illustrate how they undermine access to medicines (ATM) in the Western Cape Province, SA. This qualitative study was conducted with a sample of over 70 key informants (frontline health workers, sub-structure and provincial health service managers). We employed the critical incident technique to identify significant occurrences in our context, the consequences of which impacted on access to medicines during a defined period. Stock-outs were identified as one such incident, and we explored when, where and why they occurred, in order to inform policy and practice. Medicines procurement is a centralised function in SA. Health service managers unanimously agreed that stock-outs resulted from the following inefficiencies at the central level: (i) delays in awarding of pharmaceutical tenders; (ii) absence of contracts for certain medicines appearing on provincial code lists; and (iii) suppliers' inability to satisfy contractual agreements. The recurrence of stock-outs had implications at multiple levels: (i) health facility operations; (ii) the Chronic Dispensing Unit (CDU), which prepacks medicines for over 300 000 public sector patients; and (iii) community-based medicines distribution systems, which deliver the CDU's prepacked medicines to non-health facilities nearer to patient homes. For instance, stock-outs resulted in omission of certain medicines from CDU parcels that were delivered to health facilities. This increased workload and caused frustration for frontline health workers who were expected to dispense omitted medicines manually. According to frontline health workers, this translated into longer waiting times for patients and associated dissatisfaction. In some instances, patients were asked to return for undispensed medication at a later

Water safety in healthcare facilities. The Vieste Charter.

PubMed

Bonadonna, L; Cannarozzi de Grazia, M; Capolongo, S; Casini, B; Cristina, M L; Daniele, G; D'Alessandro, D; De Giglio, O; Di Benedetto, A; Di Vittorio, G; Ferretti, E; Frascolla, B; La Rosa, G; La Sala, L; Lopuzzo, M G; Lucentini, L; Montagna, M T; Moscato, U; Pasquarella, C; Prencipe, R; Ricci, M L; Romano Spica, V; Signorelli, C; Veschetti, E

2017-01-01

The Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health (GISIO-SItI) and the Local Health Authority of Foggia, Apulia, Italy, after the National Convention "Safe water in healthcare facilities" held in Vieste-Pugnochiuso on 27-28 May 2016, present the "Vieste Charter", drawn up in collaboration with experts from the National Institute of Health and the Ministry of Health. This paper considers the risk factors that may affect the water safety in healthcare facilities and reports the current regulatory frameworks governing the management of installations and the quality of the water. The Authors promote a careful analysis of the risks that characterize the health facilities, for the control of which specific actions are recommended in various areas, including water safety plans; approval of treatments; healthcare facilities responsibility, installation and maintenance of facilities; multidisciplinary approach; education and research; regional and national coordination; communication.

Hypervelocity Impact Test Facility: A gun for hire

NASA Technical Reports Server (NTRS)

Johnson, Calvin R.; Rose, M. F.; Hill, D. C.; Best, S.; Chaloupka, T.; Crawford, G.; Crumpler, M.; Stephens, B.

1994-01-01

An affordable technique has been developed to duplicate the types of impacts observed on spacecraft, including the Shuttle, by use of a certified Hypervelocity Impact Facility (HIF) which propels particulates using capacitor driven electric gun techniques. The fully operational facility provides a flux of particles in the 10-100 micron diameter range with a velocity distribution covering the space debris and interplanetary dust particle environment. HIF measurements of particle size, composition, impact angle and velocity distribution indicate that such parameters can be controlled in a specified, tailored test designed for or by the user. Unique diagnostics enable researchers to fully describe the impact for evaluating the 'targets' under full power or load. Users regularly evaluate space hardware, including solar cells, coatings, and materials, exposing selected portions of space-qualified items to a wide range of impact events and environmental conditions. Benefits include corroboration of data obtained from impact events, flight simulation of designs, accelerated aging of systems, and development of manufacturing techniques.

Elementary Content Specialization: Models, Affordances, and Constraints

ERIC Educational Resources Information Center

Markworth, Kimberly A.; Brobst, Joseph; Ohana, Chris; Parker, Ruth

2016-01-01

Background: This study investigates the models of elementary content specialization (ECS) in elementary mathematics and science and the affordances and constraints related to ECS--both generally and in relation to specific models. Elementary content specialists are defined as full-time classroom teachers who are responsible for content instruction…

Medicines coverage and community-based health insurance in low-income countries

PubMed Central

Vialle-Valentin, Catherine E; Ross-Degnan, Dennis; Ntaganira, Joseph; Wagner, Anita K

2008-01-01

(e.g. Rwanda, Lao PDR) and the potential of CHI to improve medicines access and use, systematic research is needed on medicine benefits and their performance, including the impacts of CHI on access to, affordability, and use of medicines at the household level. PMID:18973675

Considerations for setting up an order entry system for nuclear medicine tests.

PubMed

Hara, Narihiro; Onoguchi, Masahisa; Nishida, Toshihiko; Honda, Minoru; Houjou, Osamu; Yuhi, Masaru; Takayama, Teruhiko; Ueda, Jun

2007-12-01

Integrating the Healthcare Enterprise-Japan (IHE-J) was established in Japan in 2001 and has been working to standardize health information and make it accessible on the basis of the fundamental Integrating Healthcare Enterprise (IHE) specifications. However, because specialized operations are used in nuclear medicine tests, online sharing of patient information and test order information from the order entry system as shown by the scheduled workflow (SWF) is difficult, making information inconsistent throughout the facility and uniform management of patient information impossible. Therefore, we examined the basic design (subsystem design) for order entry systems, which are considered an important aspect of information management for nuclear medicine tests and needs to be consistent with the system used throughout the rest of the facility. There are many items that are required by the subsystem when setting up an order entry system for nuclear medicine tests. Among these items, those that are the most important in the order entry system are constructed using exclusion settings, because of differences in the conditions for using radiopharmaceuticals and contrast agents and appointment frame settings for differences in the imaging method and test items. To establish uniform management of patient information for nuclear medicine tests throughout the facility, it is necessary to develop an order entry system with exclusion settings and appointment frames as standard features. Thereby, integration of health information with the Radiology Information System (RIS) or Picture Archiving Communication System (PACS) based on Digital Imaging Communications in Medicine (DICOM) standards and real-time health care assistance can be attained, achieving the IHE agenda of improving health care service and efficiently sharing information.

Catching up: Latino health coverage gains and challenges under the Affordable Care Act: results from the Commonwealth Fund Affordable Care Act Tracking Survey.

PubMed

Doty, Michelle M; Rasmussen, Petra W; Collins, Sara R

2014-09-01

For decades, Latinos have had the highest uninsured rates of any racial or ethnic group in the United States. Less than one year after the Affordable Care Act's health insurance marketplaces opened for enrollment, the overall Latino uninsured rate dropped from 36 percent to 23 percent, according to the Commonwealth Fund Affordable Care Act Tracking Survey, conducted April 9 to June 2, 2014. However, the high uninsured rate among Latinos in states that had not expanded their Medicaid program at the time of the survey--33 percent--remained statistically unchanged. These states are home to about 20 million Latinos, the majority of whom live in Texas and Florida.

NASA Affordable Vehicle Avionics (AVA). Common Modular Avionics System for Nanolaunchers Offering Affordable Access to Space; [Space Technology: Game Changing Development

NASA Technical Reports Server (NTRS)

Aquilina, Rudy

2017-01-01

Small satellites are becoming ever more capable of performing valuable missions for both government and commercial customers. However, currently these satellites can be launched affordably only as secondary payloads. This makes it difficult for the small satellite mission to launch when needed, to the desired orbit, and with acceptable risk. What is needed is a class of low-cost launchers, so that launch costs to low-Earth orbit (LEO) are commensurate with payload costs. Several private and government-sponsored launch vehicle developers are working toward just that-the ability to affordably insert small payloads into LEO. But until now, cost of the complex avionics remained disproportionately high. AVA (Affordable Vehicle Avionics) solves this problem. Significant contributors to the cost of launching nanosatellites to orbit are the avionics and software systems that steer and control the launch vehicles, sequence stage separation, deploy payloads, and telemeter data. The high costs of these guidance, navigation and control (GNC) avionics systems are due in part to the current practice of developing unique, single-use hardware and software for each launch. High-performance, high-reliability inertial sensors components with heritage from legacy launchers also contribute to costs-but can low-cost commercial inertial sensors work just as well? NASA Ames Research Center has developed and tested a prototype low-cost avionics package for space launch vehicles that provides complete GNC functionality in a package smaller than a tissue box (100 millimeters by 120 millimeters by 69 millimeters; 4 inches by 4.7 inches by 2.7 inches), with a mass of less than 0.84 kilogram (2 pounds. AVA takes advantage of commercially available, low-cost, mass-produced, miniaturized sensors, filtering their more noisy inertial data with real-time GPS (Global Positioning Satellite) data. The goal of the AVA project is to produce and light-verify a common suite of avionics and software that

The availability of essential medicines for mental healthcare in Sofala, Mozambique

PubMed Central

Wagenaar, Bradley H.; Stergachis, Andy; Rao, Deepa; Hoek, Roxanne; Cumbe, Vasco; Napúa, Manuel; Sherr, Kenneth

2015-01-01

Objective We assessed the availability of essential medicines for mental healthcare (MH) across levels of the public healthcare system to aid in future systems planning. Design Non-expired MH medications were assessed in 24 public health facilities and 13 district warehouses across Sofala Province, Mozambique, from July to August 2014. Medication categories included: antipsychotics, antidepressants, benzodiazepines, antiepileptics and mood stabilizers, and anticholinergics and antihistamines. Results Only 7 of 12 (58.3%) district warehouses, 11 of 24 (45.8%) of all health facilities, and 10 of 12 (83.3%) of facilities with trained MH staff had availability of at least one medication of each category. Thioridazine was the most commonly available antipsychotic across all facilities (9 of 24, 37.5%), while chlorpromazine and thioridazine were most common at facilities providing MH care (8 of 12, 66.7%). The atypical antipsychotic risperidone was not available at any facility or district warehouse. Amitriptyline was the most commonly available antidepressant (10 of 12 districts; 12 of 24 overall facilities; 9 or 12 MH facilities). Despite being on the national essential drug list, fluoxetine was only available at one quaternary-level facility and no district warehouses. Conclusions Essential psychotropic medicines are routinely unavailable at public health facilities. Current essential drug lists include six typical but no atypical antipsychotics, which is concerning given the side-effect profiles of typical antipsychotics. Ensuring consistent availability of at least one selective serotonin reuptake inhibitor should also be a priority, as they are essential for the treatment of individuals with underlying cardiovascular disease and/or suicidal ideation. Similar to successful task-sharing approaches used for HIV/AIDS, mid-level providers could be retrained and certified to prescribe and monitor first-line psychotropic regimens. PMID:26081970

Thresholds for decision-making: informing the cost-effectiveness and affordability of rotavirus vaccines in Malaysia.

PubMed

Loganathan, Tharani; Ng, Chiu-Wan; Lee, Way-Seah; Hutubessy, Raymond C W; Verguet, Stéphane; Jit, Mark

2018-03-01

with international tenders, but not at market prices. Thresholds representing marginal productivity are likely to be lower than those reflecting human capital and individual preference measures, and may be useful in determining affordable vaccine prices. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Understanding the adoption dynamics of medical innovations: affordances of the da Vinci robot in the Netherlands.

PubMed

Abrishami, Payam; Boer, Albert; Horstman, Klasien

2014-09-01

This study explored the rather rapid adoption of a new surgical device - the da Vinci robot - in the Netherlands despite the high costs and its controversial clinical benefits. We used the concept 'affordances' as a conceptual-analytic tool to refer to the perceived promises, symbolic meanings, and utility values of an innovation constructed in the wider social context of use. This concept helps us empirically understand robot adoption. Data from 28 in-depth interviews with diverse purposively-sampled stakeholders, and from medical literature, policy documents, Health Technology Assessment reports, congress websites and patients' weblogs/forums between April 2009 and February 2014 were systematically analysed from the perspective of affordances. We distinguished five interrelated affordances of the robot that accounted for shaping and fulfilling its rapid adoption: 'characteristics-related' affordances such as smart nomenclature and novelty, symbolising high-tech clinical excellence; 'research-related' affordances offering medical-technical scientific excellence; 'entrepreneurship-related' affordances for performing better-than-the-competition; 'policy-related' affordances indicating the robot's liberalised provision and its reduced financial risks; and 'communication-related' affordances of the robot in shaping patients' choices and the public's expectations by resonating promising discourses while pushing uncertainties into the background. These affordances make the take-up and use of the da Vinci robot sound perfectly rational and inevitable. This Dutch case study demonstrates the fruitfulness of the affordances approach to empirically capturing the contextual dynamics of technology adoption in health care: exploring in-depth actors' interaction with the technology while considering the interpretative spaces created in situations of use. This approach can best elicit real-life value of innovations, values as defined through the eyes of (potential) users

Refusal to enrol in Ghana's National Health Insurance Scheme: is affordability the problem?

PubMed

Kusi, Anthony; Enemark, Ulrika; Hansen, Kristian S; Asante, Felix A

2015-01-17

Access to health insurance is expected to have positive effect in improving access to healthcare and offer financial risk protection to households. Ghana began the implementation of a National Health Insurance Scheme (NHIS) in 2004 as a way to ensure equitable access to basic healthcare for all residents. After a decade of its implementation, national coverage is just about 34% of the national population. Affordability of the NHIS contribution is often cited by households as a major barrier to enrolment in the NHIS without any rigorous analysis of this claim. In light of the global interest in achieving universal health insurance coverage, this study seeks to examine the extent to which affordability of the NHIS contribution is a barrier to full insurance for households and a burden on their resources. The study uses data from a cross-sectional household survey involving 2,430 households from three districts in Ghana conducted between January-April, 2011. Affordability of the NHIS contribution is analysed using the household budget-based approach based on the normative definition of affordability. The burden of the NHIS contributions to households is assessed by relating the expected annual NHIS contribution to household non-food expenditure and total consumption expenditure. Households which cannot afford full insurance were identified. Results show that 66% of uninsured households and 70% of partially insured households could afford full insurance for their members. Enroling all household members in the NHIS would account for 5.9% of household non-food expenditure or 2.0% of total expenditure but higher for households in the first (11.4%) and second (7.0%) socio-economic quintiles. All the households (29%) identified as unable to afford full insurance were in the two lower socio-economic quintiles and had large household sizes. Non-financial factors relating to attributes of the insurer and health system problems also affect enrolment in the NHIS. Affordability

Integrating biomedical and herbal medicine in Ghana - experiences from the Kumasi South Hospital: a qualitative study.

PubMed

Boateng, Millicent Addai; Danso-Appiah, Anthony; Turkson, Bernard Kofi; Tersbøl, Britt Pinkowski

2016-07-07

Over the past decade there has been growing interest in the use of herbal medicine both in developed and developing countries. Given the high proportion of patients using herbal medicine in Ghana, some health facilities have initiated implementation of herbal medicine as a component of their healthcare delivery. However, the extent to which herbal medicine has been integrated in Ghanaian health facilities, how integration is implemented and perceived by different stakeholders has not been documented. The study sought to explore these critical issues at the Kumasi South Hospital (KSH) and outline the challenges and motivations of the integration process. Qualitative phenomenological exploratory study design involving fieldwork observations, focus group discussion, in-depth interviews and key informants' interviews was employed to collect data. Policies and protocols outlining the definition, process and goals of integration were lacking, with respondents sharing different views about the purpose and value of integration of herbal medicine within public health facilities. Key informants were supportive of the initiative. Whilst biomedical health workers perceived the system to be parallel than integrated, health personnel providing herbal medicine perceived the system as integrated. Most patients were not aware of the herbal clinic in the hospital but those who had utilized services of the herbal clinic viewed the clinic as part of the hospital. The lack of a regulatory policy and protocol for the integration seemed to have led to the different perception of the integration. Policy and protocol to guide the integration are key recommendations.

76 FR 20354 - Notice of Intent To Award Supplemental Affordable Care Act Funding

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-12

... Intent To Award Supplemental Affordable Care Act Funding Notice of Intent to award supplemental Affordable Care Act funding to support enhancement of an existing laboratory fellowship training program through funding opportunity CDC-RFA-HM10-1001, ``APHL--CDC Partnership for Quality Laboratory Practice...

Prevalence and determinants of use of complementary and alternative medicine by hypertensive patients attending primary health care facilities in Kinshasa, Democratic Republic of the Congo: a cross-sectional study.

PubMed

Lulebo, Aimée M; Mapatano, Mala A; Mutombo, Paulin B; Mafuta, Eric M; Samba, Gédéon; Coppieters, Yves

2017-04-08

In the Democratic Republic of the Congo the control of hypertension is poor, characterized by an increasing number of reported cases of hypertension related complications. Poor control of hypertension is associated with non-adherence to antihypertensive medication. It is well established that the use of complementary and alternative medicine is one of the main factors of non-adherence to antihypertensive medication. The aim of this study is to determine the prevalence and factors associated with the use of complementary and alternative medicine. A cross-sectional study was carried out at the Kinshasa Primary Health-care (KPHC) facilities network in November 2014. A structured interview questionnaire was administrated to a total of 280hypertensive patients. Complementary and alternative medicine were defined according to the National Institute of Health classification as a group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional medicine. Data were summarized using proportion and mean (with standard deviation). The student's t test and χ 2 test were used respectively for mean and proportion comparison. Logistic regression analysis identified determinants of the use of complementary and alternative medicine. The prevalence of use of complementary and alternative medicine was 26.1% (95% CI: 20.7% - 31.8%).Determinants of use of complementary and alternative medicine included misperception about hypertension curability (OR = 2.1; 95%CI: 1.1-3.7) and experience of medication side effects (OR = 2.9; 95%CI: 1.7-5.1). The use of CAM for hypertensive patients is a major problem; antihypertensives with fewer side effects must be emphasized. Religious leaders must become involved in the communication for behavioral change activities to improve the quality of life for hypertensive patients.

Hormesis as a mechanistic approach to understanding herbal treatments in traditional Chinese medicine.

PubMed

Wang, Dali; Calabrese, Edward J; Lian, Baoling; Lin, Zhifen; Calabrese, Vittorio

2018-04-01

Traditional Chinese medicine (TCM) has been long practiced and is becoming ever more widely recognized as providing curative and/or healing treatments for a number of diseases and physiological conditions. This paper posits that herbal medicines used in TCM treatments may act through hormetic dose-response mechanisms. It is proposed that the stimulatory (i.e., low dose) and inhibitory (i.e., high dose) components of the hormetic dose response correspond to respective "regulating" and "curing" aspects of TCM herbal treatments. Specifically, the "regulating" functions promote adaptive or preventive responses, while "curing" treatments alleviate the clinical symptoms. Patterns of hormetic responses are described, and the applicability of these processes to herbal medicines of TCM are explicated. It is noted that a research agenda aimed at elucidating these mechanisms and patterns would be expansive and complex. However, we argue its value, in that hormesis may afford something akin to a Rosetta Stone with which to interpret, translate, and explain TCM herbology in ways that are aligned with biomedical perspectives that could enable a more integrative approach to medicine. Copyright © 2017 Elsevier Inc. All rights reserved.

Traditional use of medicinal plants in south-central Zimbabwe: review and perspectives

PubMed Central

2013-01-01

Background Traditional medicine has remained as the most affordable and easily accessible source of treatment in the primary healthcare system of resource poor communities in Zimbabwe. The local people have a long history of traditional plant usage for medicinal purposes. Despite the increasing acceptance of traditional medicine in Zimbabwe, this rich indigenous knowledge is not adequately documented. Documentation of plants used as traditional medicines is needed so that the knowledge can be preserved and the utilized plants conserved and used sustainably. The primary objective of this paper is to summarize information on traditional uses of medicinal plants in south-central Zimbabwe, identifying research gaps and suggesting perspectives for future research. Methods This study is based on a review of the literature published in scientific journals, books, reports from national, regional and international organizations, theses, conference papers and other grey materials. Results A total of 93 medicinal plant species representing 41 families and 77 genera are used in south-central Zimbabwe. These plant species are used to treat 18 diseases and disorder categories, with the highest number of species used for gastro-intestinal disorders, followed by sexually transmitted infections, cold, cough and sore throat and gynaecological problems. Shrubs and trees (38% each) were the primary sources of medicinal plants, followed by herbs (21%) and climbers (3%). The therapeutic claims made on medicinal plants documented in south-central Zimbabwe are well supported by literature, with 82.8% of the plant species having similar applications in other regions of Zimbabwe as well as other parts of the world and 89.2% having documented biological and pharmacological properties. Conclusion This study illustrates the importance of traditional medicines in the treatment and management of human diseases and ailments in south-central Zimbabwe. Traditional medicines still play an important

Forecasting the Value of Podiatric Medical Care in Newly Insured Diabetic Patients During Implementation of the Affordable Care Act in California.

PubMed

Labovitz, Jonathan M; Kominski, Gerald F

2016-05-01

Because value-based care is critical to the Affordable Care Act success, we forecasted inpatient costs and the potential impact of podiatric medical care on savings in the diabetic population through improved care quality and decreased resource use during implementation of the health reform initiatives in California. We forecasted enrollment of diabetic adults into Medicaid and subsidized health benefit exchange programs using the California Simulation of Insurance Markets (CalSIM) base model. Amputations and admissions per 1,000 diabetic patients and inpatient costs were based on the California Office of Statewide Health Planning and Development 2009-2011 inpatient discharge files. We evaluated cost in three categories: uncomplicated admissions, amputations during admissions, and discharges to a skilled nursing facility. Total costs and projected savings were calculated by applying the metrics and cost to the projected enrollment. Diabetic patients accounted for 6.6% of those newly eligible for Medicaid or health benefit exchange subsidies, with a 60.8% take-up rate. We project costs to be $24.2 million in the diabetic take-up population from 2014 to 2019. Inpatient costs were 94.3% higher when amputations occurred during the admission and 46.7% higher when discharged to a skilled nursing facility. Meanwhile, 61.0% of costs were attributed to uncomplicated admissions. Podiatric medical services saved 4.1% with a 10% reduction in admissions and amputations and an additional 1% for every 10% improvement in access to podiatric medical care. When implementing the Affordable Care Act, inclusion of podiatric medical services on multidisciplinary teams and in chronic-care models featuring prevention helps shift care to ambulatory settings to realize the greatest cost savings.

Joint CDRH (Center for Devices and Radiological Health) and state quality-assurance surveys in nuclear medicine: Phase 2 - radiopharmaceuticals

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hamilton, D.R.; Evans, C.D.

The report discusses survey results on aspects of the quality assurance of radio-pharmaceuticals from 180 nuclear-medicine facilities in the United States. Data were collected from facilities in 8 states. Demographic information about nuclear-medicine operations and quality-assurance programs was gathered by state radiation-control-program personnel. The data collected from the survey show an incomplete acceptance of quality-assurance practices for radiopharmaceuticals. Most of the facilities in the survey indicated that, because an inferior radiopharmaceutical was prepared so infrequently, they did not believe it was cost-effective to perform extensive quality-assurance testing. The Center for Devices and Radiological Health hopes that the information from themore » survey will stimulate nuclear-medicine professionals and their organizations to encourage appropriate testing of all radiopharmaceuticals.« less

Energy poverty in healthcare facilities: a "silent barrier" to improved healthcare in sub-Saharan Africa.

PubMed

Ouedraogo, Nadia S; Schimanski, Caroline

2018-06-27

This paper addresses an important topic, energy poverty in healthcare facilities. We try to provide an interesting perspective on bringing together two SDGs. The SDG 7, which seeks to ensure access to affordable, sustainable, and modern energy for all, is interlinked with Goal 3 on Health. The literature studies as well as data on the subject are sparse. Nevertheless, a systematic documentation of the levels and variation in access to energy at the health-facility level is important for designing effective policies to improve the quality of healthcare and the ultimate health of the population. Using the 2012-2013 Senegal Service Provision Assessment (SCSPA), we assessed energy access in health facilities and health systems' performance. Data were also geocoded using ArcGIS 10.3 to give a snapshot of the situation.

Students' Affordance of Teleologic Explanations and Anthropomorphic Language in Eliciting Concepts in Physics

ERIC Educational Resources Information Center

Bautista, Romiro G.

2015-01-01

This study ascertains that the students' affordance of teleologic explanations and anthropomorphic language in eliciting concepts in Physics is influenced by their age and learning exposure and experience. Using Explicative-Reductive Method of Descriptive Research, this study focused on the determinants of students' affordance of…

Estimated costs of production and potential prices for the WHO Essential Medicines List

PubMed Central

Hill, Andrew M; Barber, Melissa J

2018-01-01

Introduction There are persistent gaps in access to affordable medicines. The WHO Model List of Essential Medicines (EML) includes medicines considered necessary for functional health systems. Methods A generic price estimation formula was developed by reviewing published analyses of cost of production for medicines and assuming manufacture in India, which included costs of formulation, packaging, taxation and a 10% profit margin. Data on per-kilogram prices of active pharmaceutical ingredient exported from India were retrieved from an online database. Estimated prices were compared with the lowest globally available prices for HIV/AIDS, tuberculosis (TB) and malaria medicines, and current prices in the UK, South Africa and India. Results The estimation formula had good predictive accuracy for HIV/AIDS, TB and malaria medicines. Estimated generic prices ranged from US$0.01 to US$1.45 per unit, with most in the lower end of this range. Lowest available prices were greater than estimated generic prices for 214/277 (77%) comparable items in the UK, 142/212 (67%) in South Africa and 118/298 (40%) in India. Lowest available prices were more than three times above estimated generic price for 47% of cases compared in the UK and 22% in South Africa. Conclusion A wide range of medicines in the EML can be profitably manufactured at very low cost. Most EML medicines are sold in the UK and South Africa at prices significantly higher than those estimated from production costs. Generic price estimation and international price comparisons could empower government price negotiations and support cost-effectiveness calculations. PMID:29564159

Rhythm as an affordance for the entrainment of movement.

PubMed

Cummins, Fred

2009-01-01

A general account of rhythm in human behaviour is provided, according to which rhythm inheres in the affordance that a signal provides for the entrainment of movement on the part of a perceiver. This generic account is supported by an explication of the central concepts of affordance and entrainment. When viewed in this light, rhythm appears as the correct explanandum to account for coordinated behaviour in a wide variety of situations, including such core senses as dance and the production of music. Speech may appear to be only marginally rhythmical under such an account, but several experimental studies reveal that speech, too, has the potential to entrain movement. (c) 2009 S. Karger AG, Basel.

Assessing the engineering performance of affordable net-zero energy housing

NASA Astrophysics Data System (ADS)

Wallpe, Jordan P.

The purpose of this research was to evaluate affordable technologies that are capable of providing attractive, cost-effective energy savings to the housing industry. The research did so by investigating the 2011 Solar Decathlon competition, with additional insight from the Purdue INhome. Insight from the Purdue INhome verified the importance of using a three step design process to design a net-zero energy building. In addition, energy consumption values of the INhome were used to compare and contrast different systems used in other houses. Evaluation of unbiased competition contests gave a better understanding of how a house can realistically reach net-zero. Upon comparison, off-the-shelf engineering systems such as super-efficient HVAC units, heat pump hot water heaters, and properly designed photovoltaic arrays can affordably enable a house to become net-zero. These important and applicable technologies realized from the Solar Decathlon will reduce the 22 percent of all energy consumed through the residential sector in the United States. In conclusion, affordable net-zero energy buildings can be built today with commitment from design professionals, manufacturers, and home owners.

Project definition study for the National Biomedical Tracer Facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Roozen, K.

The University of Alabama at Birmingham (UAB) has conducted a study of the proposed National Biomedical Tracer Facility (NBTF). In collaboration with General Atomics, RUST International, Coleman Research Corporation (CRC), IsoMed, Ernst and Young and the advisory committees, they have examined the issues relevant to the NBTF in terms of facility design, operating philosophy, and a business plan. They have utilized resources within UAB, CRC and Chem-Nuclear to develop recommendations on environmental, safety and health issues. The Institute of Medicine Panel`s Report on Isotopes for Medicine and the Life Sciences took the results of prior workshops further in developing recommendationsmore » for the mission of the NBTF. The IOM panel recommends that the NBTF accelerator have the capacity to accelerate protons to 80 MeV and a minimum of 750 microamperes of current. The panel declined to recommend a cyclotron or a linac. They emphasized a clear focus on research and development for isotope production including target design, separation chemistry and generator development. The facility needs to emphasize education and training in its mission. The facility must focus on radionuclide production for the research and clinical communities. The formation of a public-private partnership resembling the TRIUMF-Nordion model was encouraged. An advisory panel should assist with the NBTF operations and prioritization.« less

Information Dominance: Can We Afford It

DTIC Science & Technology

1997-03-01

dominate all campaign areas such as air and fire superiority. This paper focuses on information warfare (IW) and its subset, information dominance (ID...the U.S. need information dominance , especially offensively, against second and third world countries, or should it put resources into active defense...Does the U.S. need defensive and offensive modes of information dominance ; can we afford both? Are we headed for information ’overkill’ to gain

Patient Protection and Affordable Care Act

THOMAS, 111th Congress

Rep. Rangel, Charles B. [D-NY-15

2009-09-17

03/23/2010 Became Public Law No: 111-148. (TXT | PDF) (All Actions) Notes: H.R.4872 makes a number of health-related financing and revenue changes to this bill. Read together, this bill and the health care-related provisions of H.R.4872 are commonly referred to as the Affordable Care Act (ACA). Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

76 FR 20352 - Notice of Intent To Award Affordable Care Act (ACA) Funding

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-12

... Intent To Award Affordable Care Act (ACA) Funding Notice of Intent to award Affordable Care Act (ACA) funding to two Emerging Infections Program (EIP) grantees, the Connecticut Department of Public Health and... grantees' Fiscal Year (FY) 2011 non-competitive continuation applications under funding opportunity CI05...

Closing the Communal Gap: The Importance of Communal Affordances in Science Career Motivation

PubMed Central

Brown, Elizabeth R.; Thoman, Dustin B.; Smith, Jessi L.; Diekman, Amanda B.

2015-01-01

To remain competitive in the global economy, the United States (and other countries) is trying to broaden participation in science, technology, engineering, and mathematics (STEM) by graduating an additional 1 million people in STEM fields by 2018. Although communion (working with, helping, and caring for others) is a basic human need, STEM careers are often (mis)perceived as being uncommunal. Across three naturalistic studies we found greater support for the communal affordance hypothesis, that perceiving STEM careers as affording greater communion is associated with greater STEM career interest, than two alternative hypotheses derived from goal congruity theory. Importantly, these findings held regardless of major (Study 1), college enrollment (Study 2), and gender (Studies 1–3). For undergraduate research assistants, mid-semester beliefs that STEM affords communion predicted end of the semester STEM motivation (Study 3). Our data highlight the importance of educational and workplace motivational interventions targeting communal affordances beliefs about STEM. PMID:26806983

Closing the Communal Gap: The Importance of Communal Affordances in Science Career Motivation.

PubMed

Brown, Elizabeth R; Thoman, Dustin B; Smith, Jessi L; Diekman, Amanda B

2015-12-01

To remain competitive in the global economy, the United States (and other countries) is trying to broaden participation in science, technology, engineering, and mathematics (STEM) by graduating an additional 1 million people in STEM fields by 2018. Although communion (working with, helping, and caring for others) is a basic human need, STEM careers are often (mis)perceived as being uncommunal. Across three naturalistic studies we found greater support for the communal affordance hypothesis, that perceiving STEM careers as affording greater communion is associated with greater STEM career interest, than two alternative hypotheses derived from goal congruity theory. Importantly, these findings held regardless of major (Study 1), college enrollment (Study 2), and gender (Studies 1-3). For undergraduate research assistants, mid-semester beliefs that STEM affords communion predicted end of the semester STEM motivation (Study 3). Our data highlight the importance of educational and workplace motivational interventions targeting communal affordances beliefs about STEM.

An exploratory study on equity in funding allocation for essential medicines and health supplies in Uganda's public sector.

PubMed

Kusemererwa, Donna; Alban, Anita; Obua, Ocwa Thomas; Trap, Birna

2016-08-30

To ascertain equity in financing for essential medicines and health supplies (EMHS) in Uganda, this paper explores the relationships among government funding allocations for EMHS, patient load, and medicines availability across facilities at different levels of care. We collected data on EMHS allocations and availability of selected vital medicines from 43 purposively sampled hospitals and the highest level health centers (HC IV), 44 randomly selected lower-level health facilities (HC II, III), and from over 400 facility health information system records and National Medical Stores records. The data were analyzed to determine allocations per patient within and across levels of care and the effects of allocations on product availability. EMHS funding allocations per patient varied widely within facilities at the same level, and allocations per patient between levels overlapped considerably. For example, HC IV allocations per patient ranged from US$0.25 to US$2.14 (1:9 ratio of lowest to highest allocation), and over 75 % of HC IV facilities had the same or lower average allocation per patient than HC III facilities. Overall, 43 % of all the facilities had optimal stock levels, 27 % were understocked, and 30 % were overstocked. Using simulations, we reduced the ratio between the highest and lowest allocations per patient within a level of care to less than two and eliminated the overlap in allocation per patient between levels. Inequity in EMHS allocation is demonstrated by the wide range of funding allocations per patient and the corresponding disparities in medicines availability. We show that using patient load to calculate EMHS allocations has the potential to improve equity significantly. However, more research in this area is urgently needed. The article does not report any results of human participants. It is implemented in collaboration with the Uganda's Ministry of Health, Pharmacy Division.

Public expenditure for plasma-derived and recombinant medicinal products in Italy.

PubMed

Lanzoni, Monica; Candura, Fabio; Calizzani, Gabriele; Biffoli, Claudia; Grazzini, Giuliano

2013-09-01

In Italy, the supply of plasma-derived medicinal products funded by the National Health Service can be through public healthcare facilities, accredited pharmacies or toll fractionation agreements between Regions and the manufacturer. Pharmaceutical public expenditure includes the supply related to the first two channels and costs can significantly vary because of channel-specific price reductions. This paper describes 2011 public expenditure for plasma-derived medicinal products purchased on the market, as well as the cost analysis per active substance. Analysis of the usage of plasma-derived medicinal products and of the related expenditure in public facilities has been carried out using medicinal product traceability data. The analysis related to the accredited pharmacies channel has been carried out using quantities for every medicinal package recorded by Pharmacy Associations and applying reference prices in force on March 1(st), 2012 as well as discounts for the accredited pharmaceutical expenditure imposed by law. At national and regional level, total and total per capita expenditures on plasma-derived medicinal products by market channel and funded by the National Health Service are shown. Analysis was conducted considering the active substances in three groups: substances included in toll fractionation agreements, recombinant coagulation factors, and other substances not included in toll fractionation agreements. In 2011, the national expenditure estimate for plasma-derived and recombinant medicinal product acquisition on the market was about € 535 million. The purchased volumes and mean purchased prices per unit of each substance have a significant influence on the observed regional variability of the pharmaceutical public expenditure. A strategy of regional comparison aimed at both sharing a national range of reference for purchase prices and evaluating modalities for centralised purchasing is desirable.

Herbal medicines in Brazil: pharmacokinetic profile and potential herb-drug interactions

PubMed Central

Mazzari, Andre L. D. A.; Prieto, Jose M.

2014-01-01

A plethora of active compounds found in herbal medicines can serve as substrate for enzymes involved in the metabolism of xenobiotics. When a medicinal plant is co-administered with a conventional drug and little or no information is known about the pharmacokinetics of the plant metabolites, there is an increased risk of potential herb-drug interactions. Moreover, genetic polymorphisms in a population may act to predispose individuals to adverse reactions. The use of herbal medicines is rapidly increasing in many countries, particularly Brazil where the vast biodiversity is a potential source of new and more affordable treatments for numerous conditions. Accordingly, the Brazilian Unified Public Health System (SUS) produced a list of 71 plant species of interest, which could be made available to the population in the near future. Physicians at SUS prescribe a number of essential drugs and should herbal medicines be added to this system the chance of herb-drug interactions further increases. A review of the effects of these medicinal plants on Phase 1 and Phase 2 metabolic mechanisms and the transporter P-glycoprotein was conducted. The results have shown that approximately half of these medicinal plants lack any pharmacokinetic data. Moreover, most of the studies carried out are in vitro. Only a few reports on herb-drug interactions with essential drugs prescribed by SUS were found, suggesting that very little attention is being given to the safety of herbal medicines. Here we have taken this information to discuss the potential interactions between herbal medicines and essential drugs prescribed to Brazilian patients whilst taking into account the most common polymorphisms present in the Brazilian population. A number of theoretical interactions are pinpointed but more pharmacokinetic studies and pharmacovigilance data are needed to ascertain their clinical significance. PMID:25071580

Affordability as a discursive accomplishment in a changing National Health Service.

PubMed

Russell, Jill; Greenhalgh, Trisha

2012-12-01

Health systems worldwide face the challenges of rationing. The English National Health Service (NHS) was founded on three core principles: universality, comprehensiveness, and free at the point of delivery. Yet patients are increasingly hearing that some treatments are unaffordable on the NHS. We considered affordability as a social accomplishment and sought to explore how those charged with allocating NHS resources achieved this in practice. We undertook a linguistic ethnography to examine the work practices of resource allocation committees in three Primary Care Trusts (PCTs) in England between 2005 and 2012, specifically deliberations over 'individual funding requests' (IFRs)--requests by patients and their doctors for the PCT to support a treatment not routinely funded. We collected and analysed a diverse dataset comprising policy documents, legal judgements, audio recordings, ethnographic field notes and emails from PCT committee meetings, interviews and a focus group with committee members. We found that the fundamental values of universality and comprehensiveness strongly influenced the culture of these NHS organisations, and that in this context, accomplishing affordability was not easy. Four discursive practices served to confer legitimacy on affordability as a guiding value of NHS health care: (1) categorising certain treatments as only eligible for NHS funding if patients could prove 'exceptional' circumstances; (2) representing resource allocation decisions as being not (primarily) about money; (3) indexical labelling of affordability as an ethical principle, and (4) recontextualising legal judgements supporting refusal of NHS treatment on affordability grounds as 'rational'. The overall effect of these discursive practices was that denying treatment to patients became reasonable and rational for an organisation even while it continued to espouse traditional NHS values. We conclude that deliberations about the funding of treatments at the margins of NHS

Affordances and Constraints of a Blended Course in a Teacher Professional Development Program

ERIC Educational Resources Information Center

Bakir, Nesrin; Devers, Christopher; Hug, Barbara

2016-01-01

Using a descriptive research design approach, this study investigated the affordances and constraints of a graduate level blended course focused on science teaching and learning. Data were gathered from 24 in-service teacher interviews and surveys. Identified affordances included the structure and implementation of the course, the flexibility of…

An Overview of Facilities and Capabilities to Support the Development of Nuclear Thermal Propulsion

DOE Office of Scientific and Technical Information (OSTI.GOV)

James Werner; Sam Bhattacharyya; Mike Houts

Abstract. The future of American space exploration depends on the ability to rapidly and economically access locations of interest throughout the solar system. There is a large body of work (both in the US and the Former Soviet Union) that show that Nuclear Thermal Propulsion (NTP) is the most technically mature, advanced propulsion system that can enable this rapid and economical access by its ability to provide a step increase above what is a feasible using a traditional chemical rocket system. For an NTP system to be deployed, the earlier measurements and recent predictions of the performance of the fuelmore » and the reactor system need to be confirmed experimentally prior to launch. Major fuel and reactor system issues to be addressed include fuel performance at temperature, hydrogen compatibility, fission product retention, and restart capability. The prime issue to be addressed for reactor system performance testing involves finding an affordable and environmentally acceptable method to test a range of engine sizes using a combination of nuclear and non-nuclear test facilities. This paper provides an assessment of some of the capabilities and facilities that are available or will be needed to develop and test the nuclear fuel, and reactor components. It will also address briefly options to take advantage of the greatly improvement in computation/simulation and materials processing capabilities that would contribute to making the development of an NTP system more affordable. Keywords: Nuclear Thermal Propulsion (NTP), Fuel fabrication, nuclear testing, test facilities.« less

Inter-disciplinary focus groups on telephone medicine: a quality improvement initiative.

PubMed

Whitson, Heather E; Hastings, S Nicole; McConnell, Eleanor S; Lekan-Rutledge, Deborah A

2006-09-01

To identify opportunities for quality improvement in long-term care telephone medicine using a model of interdisciplinary focus groups. Descriptive pilot project. Extended Care and Rehabilitation Center (ECRC), Durham VA Medical Center, Durham, North Carolina. Eight of 20 registered or licensed practical nurses and 4 of 6 geriatric medicine fellows voluntarily participated in this quality improvement project. In two 45-minute focus groups, participants were asked to discuss 3 open-ended questions related to telephone medicine. Comments were recorded during the discussions; topical themes were identified by the authors. Participant comments could be categorized into 4 domains describing the characteristics of nurses and physicians who practice the best telephone medicine: (1) provides the appropriate medical component of patient care; (2) appreciates contextual issues; (3) respects the other party's time and resources; and (4) possesses a collaborative attitude. The focus groups identified 5 quality improvement goals: (1) better nursing assessment and provision of patient information; (2) minimization of non-urgent calls after hours; (3) more decisive physician action (or explanation of inaction); (4) better physician familiarity with facility policies/logistics; and (5) better communication/paging system. The discussion format allowed nurses and physicians to identify and respond to potential barriers to improving quality in each area. Nurses and physicians appreciate unique aspects of long-term care telephone medicine and identify distinct barriers to improving practice. Interdisciplinary focus groups were a productive step toward understanding the telephone medicine experience in our facility and developing quality improvement interventions for both nurses and physicians.

Regenerative Medicine Build-Out.

PubMed

Terzic, Andre; Pfenning, Michael A; Gores, Gregory J; Harper, C Michel

2015-12-01

Regenerative technologies strive to boost innate repair processes and restitute normative impact. Deployment of regenerative principles into practice is poised to usher in a new era in health care, driving radical innovation in patient management to address the needs of an aging population challenged by escalating chronic diseases. There is urgency to design, execute, and validate viable paradigms for translating and implementing the science of regenerative medicine into tangible health benefits that provide value to stakeholders. A regenerative medicine model of care would entail scalable production and standardized application of clinical grade biotherapies supported by comprehensive supply chain capabilities that integrate sourcing and manufacturing with care delivery. Mayo Clinic has rolled out a blueprint for discovery, translation, and application of regenerative medicine therapies for accelerated adoption into the standard of care. To establish regenerative medical and surgical service lines, the Mayo Clinic model incorporates patient access, enabling platforms and delivery. Access is coordinated through a designated portal, the Regenerative Medicine Consult Service, serving to facilitate patient/provider education, procurement of biomaterials, referral to specialty services, and/or regenerative interventions, often in clinical trials. Platforms include the Regenerative Medicine Biotrust and Good Manufacturing Practice facilities for manufacture of clinical grade products for cell-based, acellular, and/or biomaterial applications. Care delivery leverages dedicated interventional suites for provision of regenerative services. Performance is tracked using a scorecard system to inform decision making. The Mayo Clinic roadmap exemplifies an integrated organization in the discovery, development, and delivery of regenerative medicine within a growing community of practice at the core of modern health care. Regenerative medicine is at the vanguard of health care

Regenerative Medicine Build-Out

PubMed Central

Pfenning, Michael A.; Gores, Gregory J.; Harper, C. Michel

2015-01-01

Summary Regenerative technologies strive to boost innate repair processes and restitute normative impact. Deployment of regenerative principles into practice is poised to usher in a new era in health care, driving radical innovation in patient management to address the needs of an aging population challenged by escalating chronic diseases. There is urgency to design, execute, and validate viable paradigms for translating and implementing the science of regenerative medicine into tangible health benefits that provide value to stakeholders. A regenerative medicine model of care would entail scalable production and standardized application of clinical grade biotherapies supported by comprehensive supply chain capabilities that integrate sourcing and manufacturing with care delivery. Mayo Clinic has rolled out a blueprint for discovery, translation, and application of regenerative medicine therapies for accelerated adoption into the standard of care. To establish regenerative medical and surgical service lines, the Mayo Clinic model incorporates patient access, enabling platforms and delivery. Access is coordinated through a designated portal, the Regenerative Medicine Consult Service, serving to facilitate patient/provider education, procurement of biomaterials, referral to specialty services, and/or regenerative interventions, often in clinical trials. Platforms include the Regenerative Medicine Biotrust and Good Manufacturing Practice facilities for manufacture of clinical grade products for cell-based, acellular, and/or biomaterial applications. Care delivery leverages dedicated interventional suites for provision of regenerative services. Performance is tracked using a scorecard system to inform decision making. The Mayo Clinic roadmap exemplifies an integrated organization in the discovery, development, and delivery of regenerative medicine within a growing community of practice at the core of modern health care. Significance Regenerative medicine is at the

Global Trends in the Affordability of Sugar-Sweetened Beverages, 1990–2016

PubMed Central

Blecher, Evan; Liber, Alex C.; Nguyen, Binh; Stoklosa, Michal

2017-01-01

Introduction The objective of this study was to quantify changes in the affordability of sugar-sweetened beverages, a product implicated as a contributor to rising rates of obesity worldwide, as a function of product price and personal income. Methods We used international survey data in a retrospective analysis of 40 high-income and 42 low-income and middle-income countries from 1990 to 2016. Prices of sugar-sweetened beverages were from the Economist Intelligence Unit’s World Cost of Living Survey. Income and inflation data were from the International Monetary Fund’s World Economic Outlook Database. The measure of affordability was the average annual percentage change in the relative-income price of sugar-sweetened beverages, which is the annual rate of change in the proportion of per capita gross domestic product needed to purchase 100 L of Coca-Cola in each country in each year of the study. Results In 79 of 82 countries, the proportion of income needed to purchase sugar-sweetened beverages declined on average (using annual measures) during the study period. This pattern, described as an increase in the affordability of sugar-sweetened beverages, indicated that sugar-sweetened beverages became more affordable more rapidly in low-income and middle-income countries than in high-income countries, a fact largely attributable to the higher rate of income growth in those countries than to a decline in the real price of sugar-sweetened beverages. Conclusion Without deliberate policy action to raise prices, sugar-sweetened beverages are likely to become more affordable and more widely consumed around the world. PMID:28472607

Potential impact of Affordable Care Act-related insurance expansion on trauma care reimbursement.

PubMed

Scott, John W; Neiman, Pooja U; Najjar, Peter A; Tsai, Thomas C; Scott, Kirstin W; Shrime, Mark G; Cutler, David M; Salim, Ali; Haider, Adil H

2017-05-01

Nearly one quarter of trauma patients are uninsured and hospitals recoup less than 20% of inpatient costs for their care. This study examines changes to hospital reimbursement for inpatient trauma care if the full coverage expansion provisions of the Affordable Care Act (ACA) were in effect. We abstracted nonelderly adults (ages 18-64 years) admitted for trauma from the Nationwide Inpatient Sample during 2010-the last year before most major ACA coverage expansion policies. We calculated national and facility-level reimbursements and trauma-related contribution margins using Nationwide Inpatient Sample-supplied cost-to-charge ratios and published reimbursement rates for each payer type. Using US census data, we developed a probabilistic microsimulation model to determine the proportion of pre-ACA uninsured trauma patients that would be expected to gain private insurance, Medicaid, or remain uninsured after full implementation of the ACA. We then estimated the impact of these coverage changes on national and facility-level trauma reimbursement for this population. There were 145,849 patients (representing 737,852 patients nationwide) included. National inpatient trauma costs for patients aged 18 years to 64 years totaled US $14.8 billion (95% confidence interval [CI], 12.5,17.1). Preexpansion reimbursements totaled US $13.7 billion (95% CI, 10.8-14.7), yielding a national margin of -7.9% (95% CI, -10.6 to -5.1). Postexpansion projected reimbursements totaled US $15.0 billion (95% CI, 12.7-17.3), increasing the margin by 9.3 absolute percentage points to +1.4% (95% CI, -0.3 to +3.2). Of the 263 eligible facilities, 90 (34.2%) had a positive trauma-related contribution margin in 2010, which increased to 171 (65.0%) using postexpansion projections. Those facilities with the highest proportion of uninsured and racial/ethnic minorities experienced the greatest gains. Health insurance coverage expansion for uninsured trauma patients has the potential to increase national

A Burgeoning Crisis? A Nationwide Assessment of the Geography of Water Affordability in the United States

PubMed Central

Mack, Elizabeth A.; Wrase, Sarah

2017-01-01

While basic access to clean water is critical, another important issue is the affordability of water access for people around the globe. Prior international work has highlighted that a large proportion of consumers could not afford water if priced at full cost recovery levels. Given growing concern about affordability issues due to rising water rates, and a comparative lack of work on affordability in the developed world, as compared to the developing world, more work is needed in developed countries to understand the extent of this issue in terms of the number of households and persons impacted. To address this need, this paper assesses potential affordability issues for households in the United States using the U.S. EPA’s 4.5% affordability criteria for combined water and wastewater services. Analytical results from this paper highlight high-risk and at-risk households for water poverty or unaffordable water services. Many of these households are clustered in pockets of water poverty within counties, which is a concern for individual utility providers servicing a large proportion of customers with a financial inability to pay for water services. Results also highlight that while water rates remain comparatively affordable for many U.S. households, this trend will not continue in the future. If water rates rise at projected amounts over the next five years, conservative projections estimate that the percentage of U.S. households who will find water bills unaffordable could triple from 11.9% to 35.6%. This is a concern due to the cascading economic impacts associated with widespread affordability issues; these issues mean that utility providers could have fewer customers over which to spread the large fixed costs of water service. Unaffordable water bills also impact customers for whom water services are affordable via higher water rates to recover the costs of services that go unpaid by lower income households. PMID:28076374

A Burgeoning Crisis? A Nationwide Assessment of the Geography of Water Affordability in the United States.

PubMed

Mack, Elizabeth A; Wrase, Sarah

2017-01-01

While basic access to clean water is critical, another important issue is the affordability of water access for people around the globe. Prior international work has highlighted that a large proportion of consumers could not afford water if priced at full cost recovery levels. Given growing concern about affordability issues due to rising water rates, and a comparative lack of work on affordability in the developed world, as compared to the developing world, more work is needed in developed countries to understand the extent of this issue in terms of the number of households and persons impacted. To address this need, this paper assesses potential affordability issues for households in the United States using the U.S. EPA's 4.5% affordability criteria for combined water and wastewater services. Analytical results from this paper highlight high-risk and at-risk households for water poverty or unaffordable water services. Many of these households are clustered in pockets of water poverty within counties, which is a concern for individual utility providers servicing a large proportion of customers with a financial inability to pay for water services. Results also highlight that while water rates remain comparatively affordable for many U.S. households, this trend will not continue in the future. If water rates rise at projected amounts over the next five years, conservative projections estimate that the percentage of U.S. households who will find water bills unaffordable could triple from 11.9% to 35.6%. This is a concern due to the cascading economic impacts associated with widespread affordability issues; these issues mean that utility providers could have fewer customers over which to spread the large fixed costs of water service. Unaffordable water bills also impact customers for whom water services are affordable via higher water rates to recover the costs of services that go unpaid by lower income households.

Affordable Housing and the Empty Nester Boom.

ERIC Educational Resources Information Center

Hare, Patrick H.

One of the best ways to produce affordable housing is to address the needs of a group that has too much housing. A baby boom generation generates an empty nester boom. An empty nester boom means dramatic underutilization of the housing stock. If a small percentage of homeowners were to install an accessory apartment, they would have a significant…

Affordances of Instrumentation in General Chemistry Laboratories

ERIC Educational Resources Information Center

Sherman, Kristin Mary Daniels

2010-01-01

The purpose of this study is to find out what students in the first chemistry course at the undergraduate level (general chemistry for science majors) know about the affordances of instrumentation used in the general chemistry laboratory and how their knowledge develops over time. Overall, students see the PASCO(TM) system as a useful and accurate…

Are Selective Private and Public Colleges Affordable?

ERIC Educational Resources Information Center

Karikari, John A.; Dezhbakhsh, Hashem

2013-01-01

We examine college affordability under the existing pricing and financial aid system that awards both non need-based and need-based aid. Using data of freshmen attending a large number of selective private and public colleges in the USA, we find that the prices students actually pay for college have increased over time. Need-based grant aid has…

A Survey of Headache Medicine Specialists on Career Satisfaction and Burnout.

PubMed

Evans, Randolph W; Ghosh, Kamalika

2015-01-01

Physicians report increasing rates of career dissatisfaction and professional burnout, which may be related to the practice environment and subspecialty. There has never been a survey of professional burnout among headache medicine specialists. The aim of the present survey was to learn more about how headache medicine physicians are affected by these issues. An email survey was sent to 749 physician members of the American Headache Society with questions or statements about demographics, professional quality of life and satisfaction, future practice plans, and professional burnout using the Maslach Burnout Inventory. In a sample of 127 headache medicine specialists, 66 (57.4%) physicians reported symptoms of professional burnout reflected by high Emotional Exhaustion and/or high Depersonalization. There is widespread dissatisfaction with work schedules, government regulations, implementation of the Affordable Care Act, insurance company policies, malpractice concerns, patient telephone calls, and compensation. Sixty-two percent of respondents concur that headache medicine is becoming more complicated without patient benefit, 14% concur that headache medicine specialists are fairly compensated, and 59% would go into headache medicine again if they were fourth year medical students. In the next 1 to 3 years, 21.3% plan to cut back on hours, 14.2% plan to cut back on patients seen, and 12.6% plan to switch to a cash practice. Medicine and healthcare are changing in such a way that 33.9% concur that they will accelerate their retirement plans. Headache medicine specialists have one of the highest rates of burnout compared to other physician specialists, which is twice the rate of working adults. Physicians' age and practice environment and experience are related with their career satisfaction and professional burnout. Some attributes of career satisfaction can decrease burnout by reducing emotional exhaustion and depersonalization and by enhancing personal

Patient Protection and Affordable Care Act; health insurance market rules. Final rule.

PubMed

2013-02-27

This final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state-specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS).

Reducing the price of treatment for multidrug-resistant tuberculosis through the Global Drug Facility.

PubMed

Lunte, Kaspars; Cordier-Lassalle, Thierry; Keravec, Joel

2015-04-01

Many countries have limited experience of securing the best prices for drugs and have little negotiating power. This is particularly true for the complex, lengthy and expensive regimens used to treat multidrug-resistant tuberculosis. The Stop TB Partnership's Global Drug Facility is dedicated to improving worldwide access to antituberculosis medicines and diagnostic techniques that meet international quality standards. The Global Drug Facility is able to secure price reductions through competitive tendering among prequalified drug manufacturers and by consolidating orders to achieve large purchase volumes. Consolidating the market in this way increases the incentives for suppliers of quality-assured medicines. In 2013 the Global Drug Facility reduced the price of the second-line drugs it supplies for multidrug-resistant tuberculosis: the overall cost of the longest and most expensive treatment regimen for a patient decreased by 26% - from 7890 United States dollars (US$) in 2011 to US$ 5822 in 2013. The price of treatment for multidrug-resistant tuberculosis supplied by the Global Drug Facility was reduced by consolidating orders to achieve large purchase volumes, by international, competitive bidding and by the existence of donor-funded medicine stockpiles. The rise in the number of suppliers of internationally quality-assured drugs was also important. The savings achieved from lower drug costs could be used to increase the number of patients on high-quality treatment.

12 CFR 1282.19 - Affordability-Rent level definitions-tenant income is not known.

Code of Federal Regulations, 2010 CFR

2010-01-01

... very low-, low-, or moderate-income families where the income of the family in the dwelling unit is not known to the Enterprise, the affordability of the unit is determined based on unit size as follows: (a) For moderate-income, maximum affordable rents to count as housing for moderate-income families shall...

Medicaid program; appeals from cancellation of approval of Medicaid long-term care facilities--HCFA. Final rule.

PubMed

1988-08-18

This rule corrects an oversight by setting forth time limits for new issues that may be considered by an Administrative Law Judge (ALJ) during a hearing afforded a Medicaid skilled nursing facility (SNF) or intermediate care facility (ICF) because the Secretary proposes to cancel its approval under section 1910(c)(1) of the Social Security Act (the Act). This amendment is necessary because current rules do not take account of the fact that hearings under section 1910(c) of the Act (unlike Medicare hearings) may take place before the cancellation is put into effect. The purpose is to establish time limits appropriate to section 1910(c) situations.

A research facility for habitation questions to be built at the German Aerospace Center in Cologne: future challenges of Space medicine

PubMed Central

Koch, B; Gerzer, R

2008-01-01

For long term habitation in space and for living on Moon and Mars, many questions still need to be resolved. Such habitation questions include prevention of and rehabilitation from negative effects of weightlessness that are, in many instances, comparable to problems of aging people on Earth as well as of patients during and recovery from long term stays in bed. Therefore the DLR Institute of Aerospace Medicine has designed a concept for a research facility that will make it possible to join space research directly with terrestrial applications. From a strategic point of view, one major emphasis of :envihab is to form a closely interrelated network of scientists and the industry and the public. The project has been in the planning phase for several years. After an international architectural contest, the winning concept was selected in 2007 by a Jury with ESA participation. PMID:19048099

Tempting foods and the affordability axiom: Food cues change beliefs about the costs of healthy eating.

PubMed

Hill, Sarah E; Baskett, Kaily; Bradshaw, Hannah K; Prokosch, Marjorie L; DelPriore, Danielle J; Rodeheffer, Christopher D

2016-12-01

Many consumers report that healthy eating is more expensive than unhealthy eating (the affordability axiom). We hypothesize that endorsement of this belief may be driven by the motivation to eat unhealthy foods. We tested this hypothesis in three studies. Study 1 revealed that the affordability axiom is associated with poorer eating habits and higher Body Mass Index (BMI). Study 2 found that the presence of a tasty food cue in the environment increased endorsement of affordability axiom. Study 3 found that these effects were moderated by one's food intake goals. Food cues led non-dieters to increase endorsement of the affordability axiom, but had the opposite effect among those seeking to restrict their calorie intake. The affordability axiom might persist as a means of validating unhealthy food choices. Copyright © 2016 Elsevier Ltd. All rights reserved.

7 CFR 3565.352 - Preservation of affordable housing.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Preservation of affordable housing. 3565.352 Section 3565.352 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, DEPARTMENT OF AGRICULTURE GUARANTEED RURAL RENTAL HOUSING PROGRAM Project Management § 3565.352 Preservation...