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Background: An estimated 50% of suspected malaria cases in sub-Saharan Africa first seek care in the private sector, especially in private medicine retail outlets. Quality of care in these outlets is generally unknown but considered poor with many patients not receiving a confirmatory diagnosis or the recommended first-line artemisinin-based combination therapy (ACT). In 2010, a subsidy pilot scheme, the Affordable Medicines Facility malaria, was introduced to crowd out the use of monotherapies in favour of WHO-pre-qualified artemisinin-based combinations (WHO-PQ-ACTs) in the private health sector. The scheme improved the availability, market share, and cost of WHO-PQ-ACTs in countries like Nigeria and Uganda, but in 2018, the subsidies were halted in Nigeria and significantly reduced in Uganda. This paper presents findings from six retail audit surveys conducted from 2014 to 2021 in Nigeria and Uganda to assess whether the impact of subsidies on the price, availability, and market share of artemisinin-based combinations has been sustained after the subsidies were reduced or discontinued., Methods: Six independent retail audits were conducted in private medicine retail outlets, including pharmacies, drug shops, and clinics in Nigeria (2016, 2018, 2021), and Uganda (2014, 2019, 2020) to assess the availability, price, and market share of anti-malarials, including WHO-PQ-ACTs and non-WHO-PQ-ACTs, and malaria rapid diagnostic tests (RDTs)., Results: Between 2016 and 2021, there was a 57% decrease in WHO-PQ-ACT availability in Nigeria and a 9% decrease in Uganda. During the same period, non-WHO-PQ-ACT availability increased in Nigeria by 41% and by 34% in Uganda. The price of WHO-PQ-ACTs increased by 42% in Nigeria to $0.68 and increased in Uganda by 24% to $0.95. The price of non-WHO-PQ-ACTs decreased in Nigeria by 26% to $1.08 and decreased in Uganda by 64% to $1.23. There was a 76% decrease in the market share of WHO-PQ-ACTs in Nigeria and a 17% decrease in Uganda. Malaria RDT availability remained low throughout., Conclusion: With the reduction or termination of subsidies for WHO-PQ-ACTs in Uganda and Nigeria, retail prices have increased, and retail prices of non-WHO-PQ-ACTs decreased, likely contributing to a shift of higher availability and increased use of non-WHO-PQ-ACTs., (© 2024. The Author(s).)

Problem: Medical schools have implemented various ways to engage students in improving medical curricula. These systems, however, usually focus on the preclerkship curriculum, perhaps because medical students move through this phase of medical education synchronously, making it easier to collect student input. In contrast, clerkship and postclerkship curricula often lack similar levels of student engagement in program evaluation., Approach: To increase communication among students, faculty, and administration during the clinical years of medical education, the Student Curricular Board (SCB) at the University of Illinois College of Medicine's Chicago campus (UICOM-Chicago) developed a student-driven feedback model in 2016 that aimed to parallel the system previously implemented in the preclerkship years. Interested fourth-year students were selected by their peers to represent individual core clerkships, and they communicated regularly with clerkship directors about concerns from current clerkship students. Third-year students applied and were selected to represent their cohort of peers moving through clerkship tracks. Proposed changes and improvements were tracked via novel, student-driven SOAP-Education (SOAP-Ed) progress notes written throughout the academic year., Outcomes: In response to a program evaluation survey conducted after implementation of this pilot, third-year students said they felt that their feedback was taken seriously by faculty and administration. Furthermore, student feedback led to meaningful changes in core clerkship curricula and in the system used to gather clerkship feedback. Clerkship directors expressed appreciation for this partnership, and students said they gained valuable leadership experience and knowledge of curricular development., Next Steps: Current SCB members and curricular leadership plan to assess student and faculty perceptions of this system and its efficacy and work toward expansion to all UICOM campuses. Lessons learned from this student-driven model of feedback in third-year core clerkships will likely add to the conversation on how to better engage medical students as active stakeholders in their own education., (Copyright © 2020 by the Association of American Medical Colleges.)

Purpose: Clinical reasoning is often assessed through patient notes (PNs) following standardized patient (SP) encounters. While nonclinicians can score PNs using analytic tools such as checklists, these do not sufficiently encompass the holistic judgments of clinician faculty. To better model faculty judgments, the authors developed checklists with faculty-specified scoring formulas embedded in spreadsheets and studied the resulting interrater reliability (IRR) of nonclinician raters (SPs and medics) and student pass/fail status., Method: In Study 1, nonclinician and faculty raters rescored PNs of 55 third-year medical students across 5 cases of the 2017 Graduation Competency Examination (GCE) to determine IRR. In Study 2, nonclinician raters scored all notes of the 5-case 2018 GCE (178 students). Faculty rescored all notes of failing students and could modify formula-derived scores if faculty felt appropriate. Faculty also rescored and corrected scores of additional notes for a total of 90 notes (3 cases, including failing notes)., Results: Mean overall percent exact agreement between nonclinician and faculty ratings was 87% (weighted kappa, 0.86) and 83% (weighted kappa, 0.88) for Study 1 and Study 2, respectively. SP and medic IRRs did not differ significantly. Four students failed the note section in 2018; 3 passed after faculty corrections. Few corrections were made to nonfailing students' notes., Conclusions: Nonclinician PN raters using checklists and scoring rules may provide a feasible alternative to faculty raters for low-stakes assessments and for the bulk of well-performing students. Faculty effort can be targeted strategically at rescoring notes of low-performing students and providing more detailed feedback.

Pulmonary arterial hypertension is defined as a mean pulmonary arterial pressure greater than 25 mm Hg at rest or 30 mm Hg during physical activity. Pulmonary arterial hypertension is classified into subgroups, including idiopathic, heritable, and pulmonary arterial hypertension associated with other conditions. A detailed history, thorough physical examination, and most importantly, a high index of suspicion are essential to diagnosis. Evaluation includes echocardiography and exclusion of other causes of symptoms. Targeted laboratory testing can help identify the subgroup of pulmonary arterial hypertension. Right heart catheterization is required to confirm the diagnosis. Standard treatment options include oral anticoagulation, diuretics, oxygen supplementation, and for a small percentage of patients, calcium channel blockers. Newer treatments include prostacyclin analogues, endothelin receptor antagonists, and phosphodiesterase type 5 inhibitors. Combination therapy has been shown to improve pulmonary arterial pressure, but more research is needed. Interventional procedures for patients with pulmonary arterial hypertension include balloon atrial septostomy and lung transplantation.

Atypically high selectivity (alpha > 2) chiral separations have been observed on Pirkle type supports. These separations were examined in terms of their response to various modifiers, thermodynamic behavior and LSER modeling. Atypical thermodynamic and LSER results were observed along with large changes in selectivity between modifiers. The use of bulky modifiers gave increased selectivity resulting from dramatic increases in the retention of the second eluting enantiomer. These findings lead to the conclusion that increased retention is due to an inability of bulky modifers to penetrate a tight complex between selector and this enantiomer.

With temperature increases, selectivity of chiral separations decreases until enantiomers coelute at an isoelution temperature. Above this temperature, elution order should reverse and selectivity will increase with temperature. In this region, separation is termed "entropically driven". Entropically driven chiral separations hold the promise of being able to concurrently increase selectivity and column efficiency by means of increased temperature. The ability to achieve such separations is hindered by high isoelution temperatures. The isoelution temperature is determined by a balance of enthalpic and entropic contributions. A variety of mobile phase modifiers are evaluated for their ability to moderate these contributions. Results suggest that more use should be made of non-alcohol modifiers. The major barrier to entropically driven separations was found to be the nonspecific retention increase that is characteristic when the critical temperature is traversed. Use of hexane in place of CO(2) shifts the position of the retention increase away from the temperature range used in this study, and dramatically successful entropically driven chiral separations are obtained.

The effect of mobile phase additives is investigated for a variety of compounds under subcritical and supercritical conditions using packed columns. Retention of hydrogen bond donor/acceptor analytes was found to be more dependent on the presence of mobile phase additives than weak hydrogen bond acceptor analytes. The temperature and pressure of the mobile phase are major factors in the extent of this dependence. Consequently, selectivity between homologous compounds is dependent on both the additive used and the state of the mobile phase. Efficiency is nearly always improved by the presence of mobile phase additives, more so under supercritical conditions than under subcritical conditions. These observations suggest that surface molar excesses of mobile phase additives play a large part in the resulting character of the supercritical chromatographic system.

Chiral separations depend upon column efficiency and chiral selectivity. Supercritical fluid chromatography (SFC) has been shown to have pronounced advantages in chiral separations due to its enhanced column efficiency at normal flow rates. Examination of factors affecting selectivity in SFC is crucial to systematic chiral method development. Selectivity is a compromise between differences in enantiomeric binding enthalpy and disruptive entropic effects. Increased temperature will decrease the effect of differences in enantiomer binding enthalpy, eventually decreasing selectivity to a point where the enantiomers coelute. Extension of this thermodynamic theory predicts that further increases in temperature lead to selectivity values of less than 1.0, and elution order of the enantiomers reverses. In this region separations are said to be "entropically driven", and selectivity increases (decreases from 1.0) with temperature. Performing separations in this region is attractive because column efficiency is also expected to increase with temperature. Such entropically driven separations have been observed only in gas chromatography. Most data used to support the application of this theory in SFC have been generated at subcritical temperatures, while theory purports to predict behavior above the critical temperature (T(c)). This approach ignores the effects of traversing the critical temperature in SFC, which is known to have a variety of unpredictable consequences. Work presented here shows the effect of temperatures above T(c) on chromatographic behavior. Contrary to theory, capacity factors increase near T(c) and column efficiency declines. Use of pressures well above the critical pressure lessens these effects. In accordance with theory, selectivity does decrease with temperature through T(c) and isoelution temperatures and two instances of elution order reversal are observed here for the first time in SFC.

Sulfonamide drugs are extracted from feed and feed premixes by shaking with 0.15N HCl in 25% methanol. The extract is diluted, clarified, and chromatographed on a reverse phase C18 column. Mobile phases used are methanol-2% acetic acid (35 + 65) and acetonitrile-2% acetic acid (18 + 82) for sulfamethazine (SMT) and sulfathiazole (STZ), respectively. A solution of dimethylaminobenzaldehyde (DMAB) is added to the column eluate and the resulting sulfonamide-DMAB complex is detected at 450 nm. The method was tested for linearity, recovery, and precision across a broad sample range. Recovery was 100.6 +/- 2.3% and 96.3 +/- 1.6% for STZ and SMT, respectively. Linearity was excellent (r2 = 0.9985 for STZ and r2 = 0.9996 for SMT) as was within-day precision (RSD = 2.00% for STZ and 1.52% for SMT). The method was compared with the Bratton-Marshall colorimetric method. Analysis of 14 STZ and 15 SMT samples failed to detect any bias between the 2 methods. Some practical aspects of the use of this technique are discussed.

Cholecalciferol (vitamin D3) is extracted in acetonitrile on a Goldfisch apparatus, diluted to volume, and determined by reverse phase liquid chromatography (LC). The sum of the peak heights of pre-vitamin D3 and cis-vitamin D3 is used for quantitation. The method was tested for precision, linearity, and recovery. Quadruplicate analyses of 5 formulation samples gave relative standard deviations of 1.56-2.65%. Linearity was excellent with regression and correlation coefficients of 0.9997 and 0.9998, respectively. Recovery was 98.0 +/- 2.7%. The method is applicable to 0.075% cholecalciferol rodent baits.

Furazolidone is separated from finished feeds by acetone-water extraction on a Goldfisch apparatus. Extracting solvent is removed, and the residue is dissolved in dimethylformamide-5% tetraethylammonium bromide (1 +1), clarified, and chromatographed on a reverse phase C1 column. The mobile phase is CH3CN-2% acetic acid (20 + 80) with detection at 365 nm. The method was tested for linearity, recovery, and ruggedness, and compared with the AOAC colorimetric assay by using field samples containing 0.0055-0.055% furazolidone. Precision data suggest a cumulative relative standard deviation of 1.43% within days and 1.78% between days. The ruggedness test predicts a between-laboratory relative standard deviation of 3.67%. Recovery was 97.5 +/- 2.0% and linearity was excellent (r2 = 0.9994) up to 0.06% furazolidone. Premixes are extracted by shaking with dimethylformamide. An aliquot of the extract is diluted (1 + 1) with 5% tetraethylammonium bromide, clarified, and chromatographed.