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Substandard and falsified medicines pose significant risks to global health, including increased deaths, prolonged treatments, and growing drug resistance. Antimalarials are one of the most common medications to be of poor quality in low- and middle-income countries. We assessed the health and economic impact of substandard and falsified antimalarials for children less than 5 years of age in the Democratic Republic of the Congo, which has one of the world's highest malaria mortality rates. We developed an agent-based model to simulate patient care-seeking behavior and medicine supply chain processes to examine the impact of antimalarial quality in Kinshasa province and Katanga region. We simulated the impact of potential interventions to improve medicinal quality, reduce stockouts, or educate caregivers. We estimated that substandard and falsified antimalarials are responsible for $20.9 million (35% of $59.6 million; 95% CI: $20.7–$21.2 million) in malaria costs in Kinshasa province and $130 million (43% of $301 million; $129–$131 million) in malaria costs in the Katanga region annually. If drug resistance to artemisinin were to develop, total annual costs of malaria could increase by $17.9 million (30%; $17.7–$18.0 million) and $73 million (24%; $72.2–$72.8 million) in Kinshasa and Katanga, respectively. Replacing substandard and falsified antimalarials with good quality medicines had a larger impact than interventions that prevented stockouts or educated caregivers. The results highlight the importance of improving access to good quality antimalarials to reduce the burden of malaria and mitigate the development of antimalarial resistance.

The forthcoming World Health Organization road map for neglected tropical diseases (NTDs) 2021–2030 recognises the complexity surrounding control and elimination of these 20 diseases of poverty. It emphasises the need for a paradigm shift from disease-specific interventions to holistic cross-cutting approaches coordinating with adjacent disciplines. The One Health approach exemplifies this shift, extending beyond a conventional model of zoonotic disease control to consider the interactions of human and animal health systems within their shared environment and the wider social and economic context. This approach can also promote sustainability and resilience within these systems. To achieve the global ambition on NTD elimination and control, political will, along with contextualised innovative scientific strategies, is required. ; http://trstmh.oxfordjournals.org ; hj2021 ; Veterinary Tropical Diseases

The forthcoming World Health Organization road map for neglected tropical diseases (NTDs) 2021–2030 recognises the complexity surrounding control and elimination of these 20 diseases of poverty. It emphasises the need for a paradigm shift from disease-specific interventions to holistic cross-cutting approaches coordinating with adjacent disciplines. The One Health approach exemplifies this shift, extending beyond a conventional model of zoonotic disease control to consider the interactions of human and animal health systems within their shared environment and the wider social and economic context. This approach can also promote sustainability and resilience within these systems. To achieve the global ambition on NTD elimination and control, political will, along with contextualised innovative scientific strategies, is required.

Background: To assess the effect of policies supporting local medicine production to improve access to medicines. Methods: We adapted the WHO/HAI instruments measuring medicines availability and prices to differentiate local from imported products, then pilot tested in Ethiopia and Tanzania. In each outlet, prices were recorded for all products in stock for medicines on a country-specific list. Government procurement prices were also collected. Prices were compared to an international reference and expressed as median price ratios (MPR). Results: The Ethiopian government paid more for local products (median MPR = 1.20) than for imports (median MPR = 0.84). Eight of nine medicines procured as both local and imported products were cheaper when imported. Availability was better for local products compared to imports, in the public (48% vs. 19%, respectively) and private (54% vs. 35%, respectively) sectors. Patient prices were lower for imports in the public sector (median MPR = 1.18[imported] vs. 1.44[local]) and higher in the private sector (median MPR = 5.42[imported] vs. 1.85[local]). In the public sector, patients paid 17% and 53% more than the government procurement price for local and imported products, respectively. The Tanzanian government paid less for local products (median MPR = 0.69) than imports (median MPR = 1.34). In the public sector, availability of local and imported products was 21% and 32% respectively, with patients paying slightly more for local products (median MPR = 1.35[imported] vs. 1.44[local]). In the private sector, local products were less available (21%) than imports (70%) but prices were similar (median MPR = 2.29[imported] vs. 2.27[local]). In the public sector, patients paid 135% and 65% more than the government procurement price for local and imported products, respectively. Conclusions: Our results show how local production can affect availability and prices, and how it can be influenced by preferential purchasing and mark-ups in the public sector. Governments need to evaluate the impact of local production policies, and adjust policies to protect patients from paying more for local products.

Mit der Thematik Trans*- und Intergeschlechtlichkeit im Kindes- und jungen Erwachsenenalter beschäftigen sich die Autor*innen des vorliegenden Buches aus interdisziplinärer und multidimensionaler Perspektive. Die Beiträge sollen insbesondere pädagogischem und psychologischem Fachpersonal eine Handreichung beim Umgang mit inter- und trans*geschlechtlichen Kindern und Jugendlichen sein und unter anderem dabei helfen, deren spezifische Bedürfnisse, Interessen und Gefühlslagen besser zu verstehen.Über aktuelle Wandlungsprozesse und Forschungsergebnisse aus diesem Bereich informieren Vertreter*innen aus Psychologie, Soziologie, Biologie und Rechtswissenschaft. Sie alle streben eine differenzierte Informiertheit der Leser*innen an, um den wertschätzenden Umgang mit inter- und trans*geschlechtlichen Personen weiter zu fördern.Mit Beiträgen von Ulrich Klocke, Emily Laing, Alexander Naß, Eike Richter, Kurt Seikowski, Heinz-Jürgen Voß und Simon Zobel. Mit einem Grußwort von Petra Köpping

With the number of easily accessible ores depleting, alternate primary and secondary sources are required to meet the increasing demand of economically important metals. Whilst highly abundant, these materials are of lower grade with respect to traditional ores, thus highly selective and sustainable metal extraction technologies are needed to reduce processing costs. Here, we investigated the metal leaching potential of biogenic ammonia produced by a ureolytic strain of Lysinibacillus sphaericus on eight primary and secondary materials, comprised of mining and metallurgical residues, sludges and automotive shredder residues (ASR). For the majority of materials, moderate to high yields (30–70%) and very high selectivity (>97% against iron) of copper and zinc were obtained with 1 mol L−1 total ammonia. Optimal leaching was achieved and further refined for the ASR in a two-step indirect leaching system with biogenic ammonia. Copper leaching was the result of local corrosion and differences in leaching against the synthetic (NH4)2CO3 control could be accounted for by pH shifts from microbial metabolism, subsequently altering free NH3 required for coordination. These results provide important findings for future sustainable metal recovery technologies from secondary materials. ; This work was conducted under the financial support of the Strategic Initiative Materials in Flanders (SIM) (SBO-SMART: Sustainable Metal Extraction from Tailings, grant no. HBC.2016.0456) and the European Union's Horizon 2020 research and innovation programme, Metal Re-covery from Low-Grade Ores and Wastes Plus (METGROW+, grant no. 690088) . FV acknowledges support by the Flemish Agency for Inno-vation and Entrepreneurship (Vlaio) via a Baekeland PhD fellowship (HBC.2017.0224) and by the Research & Development Umicore Group. We would like to thank Pieter Ostermeyer and Karel Folens for assis-tance with thermodynamic modelling and CMET and ECOCHEM group members and SMART/METGROW+partners for valuable discussions throughout the projec.

PurposeThe UK Government-funded National Health Service (NHS) is experiencing significant pressures because of the complexity of challenges to, and demands of, health-care provision. This situation has driven government policy level support for transformational change initiatives, such as value-based health care (VBHC), through closer alignment and collaboration across the health-care system-life science sector nexus. The purpose of this paper is to evaluate the necessary antecedents to collaboration in VBHC through a critical exploration of the existing literature, with a view to establishing the foundations for further development of policy, practice and theory in this field.Design/methodology/approachA literature review was conducted via searches on Scopus and Google Scholar between 2009 and 2019 for peer-reviewed articles containing keywords and phrases "Value-based healthcare industry" and "healthcare industry collaboration". Refinement of the results led to the identification of "guiding conditions" (GCs) for collaboration in VBHC.FindingsFive literature-derived GCs were identified as necessary for the successful implementation of initiatives such as VBHC through system-sector collaboration. These are: a multi-disciplinarity; use of appropriate technological infrastructure; capturing meaningful metrics; understanding the total cycle-of-care; and financial flexibility. This paper outlines research opportunities to empirically test the relevance of the five GCs with regard to improving system-sector collaboration on VBHC.Originality/valueThis paper has developed a practical and constructive framework that has the potential to inform both policy and further theoretical development on collaboration in VBHC.

"Notice of the life of Mr. William Scot": p. [xi]-xxxii. "Notice of the life of Mr. John Forbes": p. [xxxiii]-lxiv. ; Edited for the Wodrow society by David Laing in co-operation with the Rev. James Anderson --cf. Preface. ; Includes index. ; Added title page; each section has half title page. ; Mode of access: Internet.