Tailoring the Composition of BaxBO3 (B = Fe, Mn) Mixed Oxides as CO or Soot Oxidation Catalysts in Simulated GDI Engine Exhaust Conditions.

Mixed oxides with perovskite-type structure (ABO3) are promising catalysts for atmospheric pollution control due to their interesting and tunable physicochemical properties. In this work, two series of BaxMnO3 and BaxFeO3 (x = 1 and 0.7) catalysts were synthesized using the sol-gel method adapted to aqueous medium. The samples were characterized by µ-XRF, XRD, FT-IR, XPS, H2-TPR, and O2-TPD. The catalytic activity for CO and GDI soot oxidation was determined by temperature-programmed reaction experiments (CO-TPR and soot-TPR, respectively). The results reveal that a decrease in the Ba content improved the catalytic performance of both catalysts, as B0.7M-E is more active than BM-E for CO oxidation, and B0.7F-E presents higher activity than BF for soot conversion in simulated GDI engine exhaust conditions. Manganese-based perovskites (BM-E and B0.7M-E) achieve better catalytic performance than iron-based perovskite (BF) for CO oxidation reaction due to the higher generation of actives sites.

Design and validation of neuronal exocytosis blocking peptides as potential novel antiperspirants.

Thermoregulation and heat dissipation by sweat production and evaporation are vital for human survival. However, hyperhidrosis or excessive perspiration might affect people's quality of life by causing discomfort and stress. The prolonged use of classical antiperspirants, anticholinergic medications or botulinum toxin injections for persistent hyperhidrosis might produce diverse side effects that limit their clinical use. Inspired by botox molecular mode of action, we used an in silico molecular modelling approach to design novel peptides to target neuronal acetylcholine exocytosis by interfering with the Snapin-SNARE complex formation. Our exhaustive design rendered the selection of 11 peptides that decreased calcium-dependent vesicle exocytosis in rat DRG neurons, reducing αCGRP release and TRPV1 inflammatory sensitization. The most potent peptides were palmitoylated peptides SPSR38-4.1 and SPSR98-9.1 that significantly suppressed acetylcholine release in vitro in human LAN-2 neuroblastoma cells. Noteworthy, local acute and chronic administration of SPSR38-4.1 peptide significantly decreased, in a dose-dependent manner, pilocarpine-induced sweating in an in vivo mouse model. Taken together, our in silico approach lead to the identification of active peptides able to attenuate excessive sweating by modulating neuronal acetylcholine exocytosis, and identified peptide SPSR38-4.1 as a promising new antihyperhidrosis candidate for clinical development.

A Reporting Tool for Adapted Guidelines in Health Care: The RIGHT-Ad@pt Checklist.

BACKGROUND: Adaptation of existing guidelines can be an efficient way to develop contextualized recommendations. Transparent reporting of the adaptation approach can support the transparency and usability of the adapted guidelines. OBJECTIVE: To develop an extension of the RIGHT (Reporting Items for practice Guidelines in HealThcare) statement for the reporting of adapted guidelines (including recommendations that have been adopted, adapted, or developed de novo), the RIGHT-Ad@pt checklist. DESIGN: A multistep process was followed to develop the checklist: establishing a working group, generating an initial checklist, optimizing the checklist (through an initial assessment of adapted guidelines, semistructured interviews, a Delphi consensus survey, an external review, and a final assessment of adapted guidelines), and approval of the final checklist by the working group. SETTING: International collaboration. PARTICIPANTS: A total of 119 professionals participated in the development process. MEASUREMENTS: Participants' consensus on items in the checklist. RESULTS: The RIGHT-Ad@pt checklist contains 34 items grouped in 7 sections: basic information (7 items); scope (6 items); rigor of development (10 items); recommendations (4 items); external review and quality assurance (2 items); funding, declaration, and management of interest (2 items); and other information (3 items). A user guide with explanations and real-world examples for each item was developed to provide a better user experience. LIMITATION: The RIGHT-Ad@pt checklist requires further validation in real-life use. CONCLUSION: The RIGHT-Ad@pt checklist has been developed to improve the reporting of adapted guidelines, focusing on the standardization, rigor, and transparency of the process and the clarity and explicitness of adapted recommendations. PRIMARY FUNDING SOURCE: None.

Improving the Performance of BaMnO3 Perovskite as Soot Oxidation Catalyst Using Carbon Black during Sol-Gel Synthesis.

A series of BaMnO3 solids (BM-CX) were prepared by a modified sol-gel method in which a carbon black (VULCAN XC-72R), and different calcination temperatures (600-850 °C) were used. The fresh and used catalysts were characterized by ICP-OES, XRD, XPS, FESEM, TEM, O2-TPD and H2- TPR-. The characterization results indicate that the use of low calcination temperatures in the presence of carbon black allows decreasing the sintering effects and achieving some improvements regarding BM reference catalyst: (i) smaller average crystal and particles size, (ii) a slight increase in the BET surface area, (iii) a decrease in the macropores diameter range and, (iv) a lower temperature for the reduction of manganese. The hydrogen consumption confirms Mn(III) and Mn(IV) are presented in the samples, Mn(III) being the main oxidation state. The BM-CX catalysts series shows an improved catalytic performance regarding BM reference catalyst for oxidation processes (NO to NO2 and NO2-assisted soot oxidation), promoting higher stability and higher CO2 selectivity. BM-C700 shows the best catalytic performance, i.e., the highest thermal stability and a high initial soot oxidation rate, which decreases the accumulation of soot during the soot oxidation and, consequently, minimizes the catalyst deactivation.

The health and economic burden of smoking in 12 Latin American countries and the potential effect of increasing tobacco taxes: an economic modelling study.

BACKGROUND: Worldwide, smoking tobacco causes 7 million deaths annually, and this toll is expected to increase, especially in low-income and middle-income countries. In Latin America, smoking is a leading risk factor for death and disability, contributes to poverty, and imposes an economic burden on health systems. Despite being one of the most effective measures to reduce smoking, tobacco taxation is underused and cigarettes are more affordable in Latin America than in other regions. Our aim was to estimate the tobacco-attributable burden on mortality, disease incidence, quality of life lost, and medical costs in 12 Latin American countries, and the expected health and economic effects of increasing tobacco taxes. METHODS: In this modelling study, we developed a Markov probabilistic microsimulation economic model of the natural history, medical costs, and quality-of-life losses associated with the most common tobacco-related diseases in 12 countries in Latin America. Data inputs were obtained through a literature review, vital statistics, and hospital databases from each country: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Mexico, Paraguay, Peru, and Uruguay. The main outcomes of the model are life-years, quality-adjusted life-years, disease events, hospitalisations, disease incidence, disease cost, and healthy years of life lost. We estimated direct medical costs for each tobacco-related disease included in the model using a common costing methodology for each country. The disease burden was estimated as the difference in disease events, deaths, and associated costs between the results predicted by the model for current smoking prevalence and a hypothetical cohort of people in each country who had never smoked. The model estimates the health and financial effects of a price increase of cigarettes through taxes, in terms of disease and health-care costs averted, and increased tax revenues. FINDINGS: In the 12 Latin American countries analysed, we estimated that smoking is responsible for approximately 345 000 (12%) of the total 2 860 921 adult deaths, 2·21 million disease events, 8·77 million healthy years of life lost, and $26·9 billion in direct medical costs annually. Health-care costs attributable to smoking were estimated to represent 6·9% of the health budgets of these countries, equivalent to 0·6% of their gross domestic product. Tax revenues from cigarette sales cover 36·0% of the estimated health expenditures caused by smoking. We estimated that a 50% increase in cigarette price through taxation would avert more than 300 000 deaths, 1·3 million disease events, gain 9 million healthy life-years, and save $26·7 billion in health-care costs in the next 10 years, with a total economic benefit of $43·7 billion. INTERPRETATION: Smoking represents a substantial health and economic burden in these 12 countries of Latin America. Tobacco tax increases could successfully avert deaths and disability, reduce health-care spending, and increase tax revenues, resulting in large net economic benefits. FUNDING: International Development Research Centre (IDRC), Canada.

BaFe1-xCuxO3 Perovskites as Active Phase for Diesel (DPF) and Gasoline Particle Filters (GPF).

BaFe1-xCuxO3 perovskites (x = 0, 0.1, 0.3 and 0.4) have been synthetized, characterized and tested for soot oxidation in both Diesel and Gasoline Direct Injection (GDI) exhaust conditions. The catalysts have been characterized by BET, ICP-OES, SEM-EDX, XRD, XPS, H2-TPR and O2-TPD and the results indicate the incorporation of copper in the perovskite lattice which leads to: i) the deformation of the initial hexagonal perovskite structure for the catalyst with the lowest copper content (BFC1), ii) the modification to cubic from hexagonal structure for the high copper content catalysts (BFC3 and BFC4), iii) the creation of a minority segregated phase, BaOx-CuOx, in the highest copper content catalyst (BFC4), iv) the rise in the quantity of oxygen vacancies/defects for the catalysts BFC3 and BFC4, and v) the reduction in the amount of O2 released in the course of the O2-TPD tests as the copper content increases. The BaFe1-xCuxO3 perovskites catalyze both the NO2-assisted diesel soot oxidation (500 ppm NO, 5% O2) and, to a lesser extent, the soot oxidation under fuel cuts GDI operation conditions (1% O2). BFC0 is the most active catalysts as the activity seems to be mainly related with the amount of O2 evolved during an. O2-TPD, which decreases with copper content.

Terapia sustitutiva renal en pacientes mayores de 75 años / Renal replacement therapy in patients over 75 years old

Describimos la población de los afiliados del Instituto Nacional de Servicios Sociales para Jubilados y Pensionados de Buenos Aires (INSSJP), mayores de 75 años, en las diferentes modalidades de terapia sustitutiva renal. Se identificaron en el Sistema Nacional de Información de Procuración y Trasplante de la República Argentina (SINTRA) todos los afiliados mayores de 75 años que iniciaron terapia dialítica entre el 01/01/2011 y el 31/12/2015, y todos los mayores de 75 años que recibieron un trasplante renal en ese período. Un total de 3989 pacientes iniciaron terapia dialítica en dicho período. De ellos sólo 67 (1.7%) lo hicieron en diálisis peritoneal, 11 (0.3%) se inscribieron en lista de espera, y sólo 2 recibieron un trasplante renal. Se observó un aumento de la incidencia de pacientes de ese grupo etario, del 2011 al 2015 del 7% aproximadamente. Cuarenta pacientes mayores de 75 años recibieron un trasplante, veintidós de ellos (55%) se encontraban inscriptos en el Programa Old for Old. La mediana de sobrevida fue de 3.9 años (IC 95% 1.5 a 3.93) para los pacientes trasplantados. Al momento del fallecimiento, el 66% tenían injerto funcionante. La mediana de sobrevida en hemodiálisis fue 1.53 años (IC 95% 1.43 a 1.63), y 2.02 (IC 95% 1.5 a 3.2) en diálisis peritoneal. No hubo diferencias estadísticamente significativas entre hemodiálisis, diálisis peritoneal y trasplante, aunque se observó una supervivencia levemente mayor en esta última. En nuestro país es despreciable la cantidad de pacientes mayores de 75 años que acceden a diálisis peritoneal y trasplante, aunque de acuerdo a la bibliografía analizada, podría ser una muy buena opción de tratamiento para los mismos y consideramos que debería ampliarse su utilización

We describe the population of the affiliates of the National Institute of Social Services for Retirees and Pensioners of Buenos Aires (INSSJP), older than 75 years, in the different modalities of renal replacement therapy. All affiliates older than 75 who started dialysis therapy between 01/01/2011 and 12/31/2015 were identified in the National System of Procurement and Transplantation of the Argentine Republic (SINTRA), as well as all those older than 75 who received a kidney transplant in that period. A total number of 3989 patients started dialysis treatment during that period. Only 67 of them (1.7%) underwent peritoneal dialysis (PD); 11 (0.3%) were on the waiting list and just 2 of them received a kidney transplant. An increase of about 7% in the incidence of patients belonging to this age group was observed between 2011 and 2015. Forty patients older than 75 received a transplant, twenty-two of them (55%) were enrolled in the Old for Old Program. The median survival for patients who had had a transplant was 3.9 years (95% CI 1.5 to 3.93). At the time of death, 66% of them had a functioning graft. The median survival for hemodialysis was 1.53 years (95% CI 1.43 to 1.63), and 2.02 (95% CI 1.5 to 3.2) for peritoneal dialysis. There were no statistically significant differences among hemodialysis, peritoneal dialysis and transplantation, although a slightly higher survival was observed in the latter. In our country the number of patients older than 75 who access peritoneal dialysis and transplantation is negligible, although according to the publications analyzed, it could be a good treatment option for them and we believe that their use should be expanded

[Financial impact of smoking on health systems in Latin America: A study of seven countries and extrapolation to the regional level]. / Impacto económico del tabaquismo en los sistemas de salud de América Latina: un estudio en siete países y su extrapolación a nivel regional.

OBJECTIVE: Estimate smoking-attributable direct medical costs in Latin American health systems. METHODS: A microsimulation model was used to quantify financial impact of cardiovascular and cerebrovascular disease, chronic obstructive pulmonary disease (COPD), pneumonia, lung cancer, and nine other neoplasms. A systematic search for epidemiological data and event costs was carried out. The model was calibrated and validated for Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru, countries that account for 78% of Latin America's population; the results were then extrapolated to the regional level. RESULTS: Every year, smoking is responsible for 33 576 billion dollars in direct costs to health systems. This amounts to 0.7% of the region's gross domestic product (GDP) and 8.3% of its health budget. Cardiovascular disease, COPD, and cancer were responsible for 30.3%, 26.9%, and 23.7% of these expenditures, respectively. Smoking-attributable costs ranged from 0.4% (Mexico and Peru) to 0.9% (Chile) of GDP and from 5.2% (Brazil) to 12.7% (Bolivia) of health expenditures. In the region, tax revenues from cigarette sales barely cover 37% of smoking-attributable health expenditures (8.1% in Bolivia and 67.3% in Argentina). CONCLUSIONS: Smoking is responsible for a significant proportion of health spending in Latin America, and tax revenues from cigarette sales are far from covering it. The region's countries should seriously consider stronger measures, such as an increase in tobacco taxes.

Impacto económico del tabaquismo en los sistemas de salud de América Latina: un estudio en siete países y su extrapolación a nivel regional / Financial impact of smoking on health systems in Latin America: A study of seven countries and extrapolation to the regional level

RESUMEN Objetivo Estimar los costos médicos directos atribuibles al tabaquismo en los sistemas de salud de América Latina. Métodos Se utilizó un modelo de microsimulación para cuantificar el impacto económico en enfermedad cardiovascular y cerebrovascular, enfermedad pulmonar obstructiva crónica (EPOC), neumonía, cáncer de pulmón y otras nueve neoplasias. Se realizó una búsqueda sistemática de datos epidemiológicos y de costos de los eventos. El modelo se calibró y validó para Argentina, Bolivia, Brasil, Chile, Colombia, México y Perú, países que representan el 78% de la población de América Latina; luego se extrapolaron los resultados a nivel regional. Resultados Cada año el tabaquismo es responsable de 33 576 millones de dólares en costos directos para el sistema de salud. Esto equivale a 0,7% del producto interno bruto (PIB) de la región y a 8,3% del presupuesto sanitario. La enfermedad cardiovascular, la EPOC y el cáncer fueron responsables de 30,3%, 26,9% y 23,7% de este gasto, respectivamente. El costo atribuible al tabaquismo varió entre 0,4% (México y Perú) y 0,9% (Chile) del PIB y entre 5,2% (Brasil) y 12,7% (Bolivia) del gasto en salud. En la región, la recaudación impositiva por la venta de cigarrillos apenas cubre 37% del gasto sanitario atribuible al tabaquismo (8,1% en Bolivia y 67,3% en Argentina). Conclusiones El tabaquismo es responsable de una importante proporción del gasto sanitario en América Latina, y la recaudación impositiva por la venta de cigarrillos está lejos de llegar a cubrirlo. La profundización de medidas como el aumento de impuestos al tabaco debería ser seriamente considerada por los países de la región.

ABSTRACT Objective Estimate smoking-attributable direct medical costs in Latin American health systems. Methods A microsimulation model was used to quantify financial impact of cardiovascular and cerebrovascular disease, chronic obstructive pulmonary disease (COPD), pneumonia, lung cancer, and nine other neoplasms. A systematic search for epidemiological data and event costs was carried out. The model was calibrated and validated for Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru, countries that account for 78% of Latin America’s population; the results were then extrapolated to the regional level. Results Every year, smoking is responsible for 33 576 billion dollars in direct costs to health systems. This amounts to 0.7% of the region’s gross domestic product (GDP) and 8.3% of its health budget. Cardiovascular disease, COPD, and cancer were responsible for 30.3%, 26.9%, and 23.7% of these expenditures, respectively. Smoking-attributable costs ranged from 0.4% (Mexico and Peru) to 0.9% (Chile) of GDP and from 5.2% (Brazil) to 12.7% (Bolivia) of health expenditures. In the region, tax revenues from cigarette sales barely cover 37% of smoking-attributable health expenditures (8.1% in Bolivia and 67.3% in Argentina). Conclusions Smoking is responsible for a significant proportion of health spending in Latin America, and tax revenues from cigarette sales are far from covering it. The region’s countries should seriously consider stronger measures, such as an increase in tobacco taxes.

INFLUENCE OF HEALTH TECHNOLOGY ASSESSMENT AND ITS MEASUREMENT.

OBJECTIVES: The aim of this study was to obtain information on methods used to measure health technology assessment (HTA) influence, decisions that were influenced, and outcomes linked to HTA. METHODS: Electronic databases were used to locate studies in which HTA influence had been demonstrated. Inclusion criteria were studies that reliably reported consideration by decision makers of HTA findings; comparative studies of technology use before and after HTA; and details of changes in policy, health outcomes, or research that could be credibly linked to an HTA. RESULTS: Fifty-one studies were selected for review. Settings were national (24), regional (12), both national and regional (3) hospitals (9), and multinational (3). The most common approach to appraisal of influence was review of policy or administrative decisions following HTA recommendations (51 percent). Eighteen studies (35 percent) reported interview or survey findings, thirteen (26 percent) reviewed administrative data, and six considered the influence of primary studies. Of 142 decisions informed by HTA, the most common types were on routine clinical practice (67 percent of studies), coverage (63 percent), and program operation (37 percent). The most frequent indications of HTA influence were on decisions related to resource allocation (59 percent), change in practice pattern (31 percent), and incorporation of HTA details in reference material (18 percent). Few publications assessed the contribution of HTA to changing patient outcomes. CONCLUSIONS: The literature on HTA influence remains limited, with little on longer term effects on practice and outcomes. The reviewed publications indicated how HTA is being used in different settings and approaches to measuring its influence that might be more widely applied, such as surveys and monitoring administrative data.

Early awareness and alert activities in Latin America: current situation in four countries.

OBJECTIVES: The aim of this study was to briefly describe the current state of early awareness and alert (EAA) activities and systems in four Latin-American countries (Argentina, Brazil, Colombia, and Mexico). METHODS: Key informants were selected and completed an open questionnaire that included the following domains: current state of EAA activities and systems in each country, potential role for EAA systems in the health system, and future EAA projects that are currently being considered. RESULTS: In all four countries, health technology assessment (HTA) processes are used to prioritize the use of health resources, albeit at varying degrees and with different mechanisms and methodologies. EAA activities are still limited and there are virtually no institutions or units with specific functions explicitly devoted to EAA activity. However, most countries have developed some initial forms of EAA systems. Being in its initial stages there is no clear differentiation between these early awareness activities and other HTA functions, and no specific methodologies or processes are used to anticipate the emergence of new technologies. Consequently, early evaluation of technologies generally occurs in a reactive manner, after they have been introduced in the market and under the pressure of different stakeholders. CONCLUSIONS: There is growing awareness that the early identification and assessment of emerging technologies should be an integral part of HTA and the decision-making process. Many initiatives are currently focusing on building partnerships between the various regulatory bodies involved in the incorporation of technologies at national levels. It is reasonable to foresee that EAA activities will continue to develop and expand in the region.