Is Australia ready for biosimilars?

The biosimilars market is potentially the single fastest growing pharmaceutical sector with an estimated worth of US$67bn in global sales by 2020. This market generally refers to larger molecule, biological, protein-based pharmaceuticals which have lost its patent. This has stimulated the emergence of non-conventional pharmaceutical investors such as Fujifilm and Samsung as well as host countries such as Brazil, Mexico, China, India, South Korea, Turkey and Russia, which view biosimilars as a key macroeconomic driver of growth. Internationally, the European Medicines Agency has led the regulation of the quality, safety and efficacy of biosimilars; however, many countries have developed their own biosimilar regulatory frameworks. Despite the similarity of these with European guidelines, differences do exist across jurisdictions and have implications for cross-jurisdictional registration and regulation. The consideration of biosimilar regulation, however, demands attention beyond quality, safety and efficacy. The potential implications of extended patent protection, international trade and globalisation require a congruent policy approach to their regulation. Notwithstanding the fact that Australia is a relatively small pharmaceutical market and that there are only 14 biosimilar products currently approved for use, Australia’s geographical proximity to pharm-emerging countries and its trade relation with the major pharmaceutical markets have positioned Australia in a unique position to influence international development and regulation of biosimilars. Australia’s National Medicines Policy (2000) potentially provides the foundation for a partnership approach to biosimilar regulation, minimise duplication of regulatory efforts while at the same time fostering a viable pharmaceutical industry.

Mortality attributable to smoking in Vietnamese men in 2008

Objective Smoking prevalence among Vietnamese men is among the highest in the world. Our aim was to provide estimates of tobacco attributable mortality to support tobacco control policies. Method We used the Peto–Lopez method using lung cancer mortality to derive a Smoking Impact Ratio (SIR) as a marker of cumulative exposure to smoking. SIRs were applied to relative risks from the Cancer Prevention Study, Phase II. Prevalence-based and hybrid methods, using the SIR for cancers and chronic obstructive pulmonary disease and smoking prevalence for all other outcomes, were used in sensitivity analyses. Results When lung cancer was used to measure cumulative smoking exposure, 28% (95% uncertainty interval 24–31%) of all adult male deaths (> 35 years) in Vietnam in 2008 were attributable to smoking. Lower estimates resulted from prevalence-based methods [24% (95% uncertainty interval 21–26%)] with the hybrid method yielding intermediate estimates [26% (95% uncertainty interval 23–28%)]. Conclusion Despite uncertainty in these estimates of attributable mortality, tobacco smoking is already a major risk factor for death in Vietnamese men. Given the high current prevalence of smoking, this has important implications not only for preventing the uptake of tobacco but also for immediate action to adopt and enforce stronger tobacco control measures.

Anatomical modelling of the pregnant radiotherapy patient

This study aimed to take existing anatomical models of pregnant women, currently used for radiation pro-tection and nuclear medicine dose calculations, and adapt them for use in the calculation of fetal dose from external beam radiotherapy (EBRT). The models investigated were ‘KATJA’, which was provided as an MCNPX geometry file, and ‘RPI-P6’, which was provided in a simple, voxelized bina-ry format. In-house code was developed, to convert both mod-els into an `egsphant’ format, suitable for use with DOSXYZnrc. The geometries and densities of the resulting phantoms were evaluated and found to accurately represent the source data. As an example of the use of the phantoms, the delivery of a cranial EBRT treatment was simulated using the BEAMnrc and DOSXYZnrc Monte Carlo codes and the likely out-of-field doses to the fetus in each model was calculated. The results of these calculations showed good agreement (with-in one standard deviation) between the doses calculated in KATJA and PRI-P6, despite substantial anatomical differ-ences between the two models. For a 36 Gy prescription dose to a 233.2 cm3 target in the right brain, the mean doses calcu-lated in a region of interest covering the entire uterus were 1.0 +/- 0.6 mSv for KATJA and 1.3 +/- 0.9 mSv for RPI-P6. This work is expected to lead to more comprehensive studies of EBRT treatment plan design and its effects on fetal dose in the future.

Does the technique employed for skin temperature assessment alter outcomes? A systematic review

Skin temperature is an important physiological measure that can reflect the presence of illness and injury as well as provide insight into the localised interactions between the body and the environment. The aim of this systematic review was to analyse the agreement between conductive and infrared means of assessing skin temperature which are commonly employed in in clinical, occupational, sports medicine, public health and research settings. Full-text eligibility was determined independently by two reviewers. Studies meeting the following criteria were included in the review: 1) the literature was written in English, 2) participants were human (in vivo), 3) skin surface temperature was assessed at the same site, 4) with at least two commercially available devices employed—one conductive and one infrared—and 5) had skin temperature data reported in the study. A computerised search of four electronic databases, using a combination of 21 keywords, and citation tracking was performed in January 2015. A total of 8,602 were returned. Methodology quality was assessed by 2 authors independently, using the Cochrane risk of bias tool. A total of 16 articles (n = 245) met the inclusion criteria. Devices are classified to be in agreement if they met the clinically meaningful recommendations of mean differences within ±0.5 °C and limits of agreement of ±1.0 °C. Twelve of the included studies found mean differences greater than ±0.5 °C between conductive and infrared devices. In the presence of external stimulus (e.g. exercise and/or heat) five studies foundexacerbated measurement differences between conductive and infrared devices. This is the first review that has attempted to investigate presence of any systemic bias between infrared and conductive measures by collectively evaluating the current evidence base. There was also a consistently high risk of bias across the studies, in terms of sample size, random sequence generation, allocation concealment, blinding and incomplete outcome data. This systematic review questions the suitability of using infrared cameras in stable, resting, laboratory conditions. Furthermore, both infrared cameras and thermometers in the presence of sweat and environmental heat demonstrate poor agreement when compared to conductive devices. These findings have implications for clinical, occupational, public health, sports science and research fields.

Mikä jatko-opiskelijaa motivoi? Tavoitteet ja tiedeyhteisö väitöskirjaprosessissa.

Motivation has an important role in academic learning for learning is regulated by motivation. Further motivation is centrally manifested by goals. Goals reflect values and regulate individual s orientation and what they strive for. In spite of the central role of motivation in academic learning, discussions on post-graduate education has somewhat overlooked motivational processes and concentrated on the excellence of performance. The aim of this study was to investigate what kind of goals PhD students have and how they experience their role in their own scientific community. It was also purpose to study how these goals and experienced roles are in relation with study each other, context, possible intentions of quitting studies and prolongation of studies. Furthermore, the aim was to investigate how different postgraduates differ in terms of how they experience their learning environment. The data was collected with the From PhD students to academic experts survey (Pyhältö & Lonka, 2006) from four complementary domains: medicine, arts, psychology and education. The survey consisted of both likert-scaled items and open ended questions. The participants were 601 postgraduate students. The goals and the experienced role in scientific community were analysed in terms of qualitative content analysis. The relation between goals and experienced role and background variables were tested using ?² and the differences between different postgraduate groups using one way analysis of variances (ANOVA). The results indicated that postgraduates goals varied based on whether they brought up goals related to the product (outcome of the thesis process), the process (thesis process as whole) or both the product and the process. Product goals consisted of for example career qualification and better status as process goals consisted for example of learning and influencing ones own discipline. The experienced role of the postgraduates differed in terms of whether the conception was organised, unorganised or controversial. Both the goals and the experienced roles were in relation with study context and commitment to the studies. The different postgraduate groups also differed in terms of how they experienced their own learning environment.

#20 [updated] Community wide interventions for increasing physical activity - Clinical Version

People who are physically active have higher levels of health related fitness, and a lower risk profile for developing a number of disabling medical conditions and chronic diseases. However, despite considerable evidence of the benefits of regular physical activity, global levels of physical inactivity remain stubbornly high. In response, governments are looking to find ways to increase the physical activity of their populations.

Identification of loci for migraine with aura

Common migraine, i.e. migraine with (MA) or without aura (MO), is a chronic neurological disorder affecting about 10% of the Caucasian population. In MA, migraine headache is preceded by visual, sensoric and/or dysphasic reversible aura symptoms. Twin and family studies have suggested a multifactorial mode of inheritance for common migraine, and a stronger genetic component for MA than for MO. Since there is no biological or genetic marker to identify common migraine, aura symptoms provide a distinctive character to identify those suspected of suffering from migraine. The aim of this study was to identify MA susceptibility loci in well-phenotyped migraine samples with familial predisposition using different gene mapping methods. Genes coding for endothelin1 and its receptors EDNRA and ENDRB are potential candidate genes for cortical spreading depression (CSD), which is considered to be the underlying mechanism of migraine aura. The role of these genes in MA was studied in 850 Finnish migraine cases and 890 control individuals. Rare homozygous EDNRA SNPs showed nominal association with MA and with the age of onset trait (20 years). This result was also detected in the pooled analysis on 648 German MA cases and 651 control individuals when the test was adjusted for gender and sample origin. Evaluation of SNP genotyping reactions with two different DNA polymerase enzymes ensured that the genotype quality was high, and thus the discovered associations are considered reliable. The role of the 19p13 region was studied in a linkage analysis of 72 Finnish MA families. This region contains two migraine-associated genes: CACNA1A, which is associated with a predisposition to a rare Mendelian form of MA, familial hemiplegic migraine (FHM), and the insulin receptor gene (INSR) that is associated with common migraine. No evidence of linkage between the 19p13 and MA was detected. A novel visual aura locus was mapped to chromosome 9q21-q22 with significant evidence of linkage using a genome-wide linkage approach in 36 Finnish MA families. Five additional, potential loci were also detected. The 9q21-q22 region has previously been linked to occipitotemporal lobe epilepsy and MA, both of which involve prominent visual symptoms. Our result further supports a shared background for these episodic disorders.

Geriatrisen lääkehoidon koulutustarpeet perusterveydenhuollossa - Moniammatillisen täydennyskoulutuksen suunnittelu LOST-alueen kotihoidon henkilöstölle

Sosiaali- ja terveysministeriön 2006 julkaiseman vanhustyön ja geriatrisen lääkehoidon kehittämistä koskevan selvityksen yhtenä tärkeänä huolenaiheena oli iäkkäiden lääkehoidon useat epäkohdat, kuten iäkkäitä hoitavien hoitajien lääkeosaamiseen liittyvät puutteet ja ongelmat. Yksi keino parantaa iäkkäitä hoitavien eri tahojen lääkehoito-osaamista on täydennyskoulutus, johon kaikilla sosiaali- ja terveydenhuollon ammattiryhmillä on oikeus ja velvollisuus. Täydennyskoulutuksella pystytään myös kehittämään organisaatioiden toimintaa ja tuottamaan uusia, parempia palveluita. Tutkimuksessa selvitettiin Lohjan, Siuntion, Inkoon ja Karjalohjan muodostaman sosiaali- ja terveydenhuollon yhteistoiminta-alueen LOSTin kotihoidon yksiköiden iäkkäiden lääkehoitoihin liittyviä koulutustarpeita. Tämän tutkimuksen avulla syvennettiin samalle tutkimusryhmälle tehdyn kyselytutkimuksen tuloksia. Tutkimusaineistona käytettiin LOST-alueen kotihoidon yksiköiden hoitajille (n=150) farmaseutin lopputyönä tehtyä kyselyaineistoa sekä työntekijöille (n=6) ja esimiehille (n=6) tehtyjä erillisiä ryhmäkeskusteluja. Lisäksi näkökulman laajentamiseksi ja moniammatillisuuden korostamiseksi aineistona käytettiin kotihoidon asiakkaita hoitavien lääkärien (n=4) teemahaastatteluja. Kyselyaineistosta analysoitiin erikseen sairaanhoitajien, lähihoitajien ja kodinhoitajien koulutustarpeet. Samat asiat nousivat esille kunkin ammattiryhmän tuloksissa. Tärkeimpinä lääkehoito-osaamiseen liittyvinä teoreettisina koulutettavina asioina kyselystä nousivat esille iäkkäiden farmakokinetiikka ja lääkkeiden käyttöön liittyvät erityispiirteet, lääkkeiden vaikutukset, lääkkeiden haittavaikutukset sekä lääkkeiden yhteisvaikutukset ja yhteensopivuus. Lisäksi teoreettisista taidoista nousi hoitotyön etiikkaan liittyvät tarkkuus ja huolellisuus työssä. Käytännön taidoista tärkeimpinä koulutettavina aiheina kyselystä nousivat asiakkaiden lääkehoidon ja voinnin seuranta, lääkkeiden jakaminen sekä lääkkeiden annosteluun liittyen se, että annostellaan oikeaa lääkettä ja vahvuutta, oikea annos ja oikeaan aikaan sekä oikeat antotavat. Ryhmäkeskusteluista ja lääkärien teemahaastatteluista haettiin syvempää ymmärrystä kyselyn tuloksiin. Yksi tärkeimmistä tämän laadullisen tutkimuksen löydöksistä oli kotihoidon yhteistyöhön liittyvät epäkohdat. Lääkehoitojen toteuttamista ja seurantaa voitaisiin tulosten perusteella parantaa lääkärien ja kotihoidon hoitajien yhteisellä koulutuksella. Tärkeimpiä sairauksia tai oireita, joihin hoitajat toivoisivat yhteisiä toimintakäytäntöjä, ovat diabetes, sydän- ja verisuonisairaudet, kipu, muistisairaudet sekä psyykensairaudet. Lisäksi koulutusaiheiksi tutkimuksesta nousivat iäkkäiden lääkehoidon erityispiirteet, lääkkeiden antoreitit ja lääkemuodot. Kyselyn sekä ryhmäkeskustelujen ja lääkärien teemahaastattelujen tuloksista tehtiin lopuksi synteesi, jonka lopputuloksena LOST-alueen kotihoidon hoitohenkilöstölle sekä kotihoidon lääkäreille koottiin yhteinen tarvelähtöinen täydennyskoulutussuunnitelma. Suunnitelma tehtiin aineistosta nousseiden koulutusaiheiden pohjalta, eikä siihen lisätty aiheita tutkimuksen ulkopuolelta.

A survey of indian logic from the point of view of computer science

Indian logic has a long history. It somewhat covers the domains of two of the six schools (darsanas) of Indian philosophy, namely, Nyaya and Vaisesika. The generally accepted definition of Indian logic over the ages is the science which ascertains valid knowledge either by means of six senses or by means of the five members of the syllogism. In other words, perception and inference constitute the subject matter of logic. The science of logic evolved in India through three ages: the ancient, the medieval and the modern, spanning almost thirty centuries. Advances in Computer Science, in particular, in Artificial Intelligence have got researchers in these areas interested in the basic problems of language, logic and cognition in the past three decades. In the 1980s, Artificial Intelligence has evolved into knowledge-based and intelligent system design, and the knowledge base and inference engine have become standard subsystems of an intelligent system. One of the important issues in the design of such systems is knowledge acquisition from humans who are experts in a branch of learning (such as medicine or law) and transferring that knowledge to a computing system. The second important issue in such systems is the validation of the knowledge base of the system i.e. ensuring that the knowledge is complete and consistent. It is in this context that comparative study of Indian logic with recent theories of logic, language and knowledge engineering will help the computer scientist understand the deeper implications of the terms and concepts he is currently using and attempting to develop.

Ethnobotany of the Monpa ethnic group at Arunachal Pradesh, India

Background: The present paper documents the uses of plants in traditional herbal medicine for human and veterinary ailments, and those used for dietary supplements, religious purpose, local beverage, and plants used to poison fish and wild animals. Traditional botanical medicine is the primary mode of healthcare for most of the rural population in Arunachal Pradesh. Materials and methods: Field research was conducted between April 2006 and March 2009 with randomly selected 124 key informants using semi-structured questionnaire. The data obtained was analyzed through informant consensus factor (F(IC)) to determine the homogeneity of informant's knowledge on medicinal plants. Results: We documented 50 plants species belonging to 29 families used for treating 22 human and 4 veterinary ailments. Of the medicinal plants reported, the most common growth form was herbs (40%) followed by shrubs, trees, and climbers. Leaves were most frequently used plant parts. The consensus analysis revealed that the dermatological ailments have the highest F(IC) (0.56) and the gastro-intestinal diseases have F(IC) (0.43). F(IC) values indicated that there was high agreement in the use of plants in dermatological and gastro-intestinal ailments category among the users. Gymnocladus assamicus is a critically rare and endangered species used as disinfectant for cleaning wounds and parasites like leeches and lice on livestocks. Two plant species (Illicium griffithii and Rubia cordifolia) are commonly used for traditional dyeing of clothes and food items. Some of the edible plants recorded in this study were known for their treatment against high blood pressure (Clerodendron colebrookianum), diabetes mellitus (Momordica charantia), and intestinal parasitic worms like round and tape worms (Lindera neesiana, Solanum etiopicum, and Solanum indicum). The Monpas of Arunachal Pradesh have traditionally been using Daphne papyracea for preparing hand-made paper for painting and writing religious scripts in Buddhist monasteries. Three plant species (Derris scandens, Aesculus assamica, and Polygonum hydropiper) were frequently used to poison fish during the month of June-July every year and the underground tuber of Aconitum ferrox is widely used in arrow poisoning to kill ferocious animals like bear, wild pigs, gaur and deer. The most frequently cited plant species; Buddleja asiatica and Hedyotis scandens were used as common growth supplements during the preparation of fermentation starter cultures. Conclusion: The traditional pharmacopoeia of the Monpa ethnic group incorporates a myriad of diverse botanical flora. Traditional knowledge of the remedies is passed down through oral traditions without any written document. This traditional knowledge is however, currently threatened mainly due to acculturation and deforestation due to continuing traditional shifting cultivation. This study reveals that the rural populations in Arunachal Pradesh have a rich knowledge of forest-based natural resources and consumption of wild edible plants is still an integral part of their socio-cultural life. Findings of this documentation study can be used as an ethnopharmacological basis for selecting plants for future phytochemical and pharmaceutical studies.

Anticancer property of Bryophyllum pinnata (Lam.) Oken. leaf on human cervical cancer cells

Background: Bryophyllum pinnata (B. pinnata) is a common medicinal plant used in traditional medicine of India and of other countries for curing various infections, bowel diseases, healing wounds and other ailments. However, its anticancer properties are poorly defined. In view of broad spectrum therapeutic potential of B. pinnata we designed a study to examine anti-cancer and anti-Human Papillomavirus (HPV) activities in its leaf extracts and tried to isolate its active principle. Methods: A chloroform extract derived from a bulk of botanically well-characterized pulverized B. pinnata leaves was separated using column chromatography with step-gradient of petroleum ether and ethyl acetate. Fractions were characterized for phyto-chemical compounds by TLC, HPTLC and NMR and Biological activity of the fractions were examined by MTT-based cell viability assay, Electrophoretic Mobility Shift Assay, Northern blotting and assay of apoptosis related proteins by immunoblotting in human cervical cancer cells. Results: Results showed presence of growth inhibitory activity in the crude leaf extracts with IC50 at 552 mu g/ml which resolved to fraction F4 (Petroleum Ether: Ethyl Acetate:: 50: 50) and showed IC50 at 91 mu g/ml. Investigations of anti-viral activity of the extract and its fraction revealed a specific anti-HPV activity on cervical cancer cells as evidenced by downregulation of constitutively active AP1 specific DNA binding activity and suppression of oncogenic c-Fos and c-Jun expression which was accompanied by inhibition of HPV18 transcription. In addition to inhibiting growth, fraction F4 strongly induced apoptosis as evidenced by an increased expression of the pro-apoptotic protein Bax, suppression of the anti-apoptotic molecules Bcl-2, and activation of caspase-3 and cleavage of PARP-1. Phytochemical analysis of fraction F4 by HPTLC and NMR indicated presence of activity that resembled Bryophyllin A. Conclusions: Our study therefore demonstrates presence of anticancer and anti-HPV an activity in B. pinnata leaves that can be further exploited as a potential anticancer, anti-HPV therapeutic for treatment of HPV infection and cervical cancer.

Silver nanoparticles modified nanocapsules for ultrasonically activated drug delivery

Novel ultrasound-sensitive nanocapsules were designed via layer-by-layer assembly (LbL) of polyelectrolytes for remote activated release of biomolecules/drug. Nanocapsules embedded with silver nanoparticles in the walls were synthesized by alternate assembly of poly(allylamine hydrochloride) (PAH) and dextran sulfate (DS) on silica template followed by nanoparticle synthesis and subsequent template removal thus yielding nanocapsules. The silver NPs were synthesized in situ within the capsule walls under controlled conditions. The nanocapsules were found to be well dispersed and the silver NPs were evenly distributed within the shell. FITC-dextran permeated easily into the capsules containing silver NP's due to the pores generated during the formation of NP's. When the loaded nanocapsules were sonicated, the presence of the silver NPs in the shell structure led to rupturing of the shell into smaller fragments thus releasing the FITC-dextran. Such nanocapsules have the potential to be used as drug delivery vehicles and offer the scope for further development in the areas of modern medicine, material science, and biochemistry. (C) 2012 Elsevier B.V. All rights reserved.

Network approaches to drug discovery

Introduction: Advances in genomics technologies are providing a very large amount of data on genome-wide gene expression profiles, protein molecules and their interactions with other macromolecules and metabolites. Molecular interaction networks provide a useful way to capture this complex data and comprehend it. Networks are beginning to be used in drug discovery, in many steps of the modern discovery pipeline, with large-scale molecular networks being particularly useful for the understanding of the molecular basis of the disease. Areas covered: The authors discuss network approaches used for drug target discovery and lead identification in the drug discovery pipeline. By reconstructing networks of targets, drugs and drug candidates as well as gene expression profiles under normal and disease conditions, the paper illustrates how it is possible to find relationships between different diseases, find biomarkers, explore drug repurposing and study emergence of drug resistance. Furthermore, the authors also look at networks which address particular important aspects such as off-target effects, combination-targets, mechanism of drug action and drug safety. Expert opinion: The network approach represents another paradigm shift in drug discovery science. A network approach provides a fresh perspective of understanding important proteins in the context of their cellular environments, providing a rational basis for deriving useful strategies in drug design. Besides drug target identification and inferring mechanism of action, networks enable us to address new ideas that could prove to be extremely useful for new drug discovery, such as drug repositioning, drug synergy, polypharmacology and personalized medicine.

Superstición y brujería en el Duranguesado a fines de la Edad Media: ¿Amboto 1507?

[ES] En este investigación se analiza el rico mundo de las supersticiones, de la magia, de la hechicería y de la brujería vasca medieval, centrándose especialmente en el foco de brujería que afectó a la comarca del Duranguesado y que ha pasado a la historiografía y a la tradición popular bajo el sobre nombre de brujas del Amboto.

A influência do discurso médico no poder punitivo

Esta dissertação discute a relação entre a medicina, a psiquiatria, a psicologia, o poder punitivo e o Direito Penal, bem como a influência que o discurso de uma produziu no outro, e vice versa. Defende a idéia de que a medicina é um espetáculo de poder que, acasalado com o poder punitivo, e interagindo com, e sobre, o indivíduo, invade e se apropria do seu corpo para, usando-o como instrumento de dominação política, discipliná-lo de acordo com a conveniência, sobretudo, da higiene e, naquela sua relação espúria com o poder punitivo, diferenciá-lo e controlá-lo social e penalmente. Sustenta, ainda, que, malgrado o acasalamento não tenha sido intencional, o Estado via na medicina o instrumento para reforçar o seu poder, enquanto essa via naquele o apoio para o seu espraiamento, embora Medicina e Estado tenham convergido, mas também divergido, por vezes tática e estrategicamente, porquanto nem sempre os dois poderes reconheceram o valor da aliança que haviam estabelecido. Então, defende a tese de que o Estado acatou a medicalização das suas ações políticas e admitiu o valor político das ações da medicina, e com vantagens para ambos que, dividindo o poder, conquistaram. É que, a medicina, mais rápida e mais adequada aos problemas salutares apresentados, ajudava-o a se imiscuir no corpo para a permanência parasitária daquela. E, para manter seu direito ao discurso, sustenta que a medicina reinventou constantemente uma necessidade para, diante dela, apresentar-se como única solução, tendo conseguido isso mediante a apresentação de uma retórica dominial eloquente, mas, sobretudo, tecnificada, é dizer, inacessível ao dominado. Com isso, a disciplina, o controle e a repressão do indivíduo, penal e medicamente, estavam prontas, pois, Direito e Medicina, aquele com a lei, esta com o remédio, juntos, dominaram e dominam os destinos do indivíduo, e da coletividade. Demonstrou, ainda, que os higienistas nunca se desocuparam de suas funções. E, por fim, que os princípios penais devem, independente da qualificação que se os dê, sempre refrear o poder punitivo.