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PharmD ; Access to safe, effective and good quality medicines is an evolving, complex and multifactorial challenge which has significant impact on public health and may contribute to health inequalities. This research aimed to develop a rational and prompt medicines accessibility framework. The objectives related to enhancing access to medicines were to: 1 Analyse retrospective queries and 2 Propose a framework to deal with access issues. The methodology involved two stages: 1 Analysing retrospectively access queries recorded at the Medicines Intelligence and Access Unit within the Malta Medicines Authority. A focus group was set up to identify patient-related barriers to access medicines and to develop a risk-based approach to assess lack of access alongside patient medicines needs. 2 Devising an innovative framework to enhance access to medicines by acquiring medicines intelligence and analysing real case scenarios. Observations and corresponding results progressed across the two stages: 1 All the 480 retrospective queries recorded at the Medicines Intelligence and Access Unit over a 60-month period (June 2014 and June 2019) were analysed. The focus group classified the access queries into four categories which were identified as barriers to access medicines: (i) safety (n=201, 42%) (ii) availability (n=143, 30%), (iii) pharmacoeconomic (n=97, 23%) and (iv) shortages (n=39, 8%). A risk-based approach was adopted to assess the outcomes of the access issues on patient medicines needs. The focus group recommended to classify risk by drawing on the classification of findings of the Good Manufacturing Practice quality management system and categorise risk as critical, major and other. 2 A scientific framework based on risk identification, access implications and medicines intelligence was devised to address access issues. Medicines intelligence on access issues was acquired through participation in fora and communication with the patient. Two hundred and nineteen critical risk access queries were evaluated through case scenarios in line with the category of barriers to access which was identified. Critical risk related to safety was due to adverse effects related to the change of the medicinal product manufacturer such as a generic or biosimilar medicine (n=12, 5.5%) and contamination of active pharmaceutical ingredients with nitrosamine impurities (n=175, 79.9%). The latter was associated with a disruptive occurrence and was identified as an outlier. Availability issues were critical when the medicine was not marketed (n=8, 4%) or not listed on the Government Formulary List (n=3, 1.4%). Pharmacoeconomic issues, classified as critical (n=4, 1.8%), were associated with the high cost of medicines. Critical risk related to shortages occurred due to disruptions in the supply chain (n=15, 6.8%) and withdrawal of the marketing authorisation (n=2, 0.9%). For each case scenario, patient-centered medicines intelligence interventions were recommended such as the proposal of a standard operating procedure for the inpatient pharmacy to prepare extemporaneous preparations of adrenaline injections instead of commercially unavailable adrenaline autoinjectors. An innovative framework to detect, address and mitigate access issues based on medicines intelligence and risk identification was developed to proactively enhance access to medicines in a personalised care approach. ; N/A

Falls are under-recognized as adverse drug events. Healthcare professionals are reluctant to withdraw fall-risk-increasing medications. The EuGMS Task and Finish group on fall-risk-increasing drugs (FRIDs) proposes in this paper its recommendations on dissemination of knowledge about, management of, and future research on FRIDs. Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.

Bioinformatics is an interdisciplinary research field that develops tools for the analysis of large biological databases, and, thus, the use of high performance computing (HPC) platforms is mandatory for the generation of useful biological knowledge. The latest generation of graphics processing units (GPUs) has democratized the use of HPC as they push desktop computers to cluster-level performance. Many applications within this field have been developed to leverage these powerful and low-cost architectures. However, these applications still need to scale to larger GPU-based systems to enable remarkable advances in the fields of healthcare, drug discovery, genome research, etc. The inclusion of GPUs in HPC systems exacerbates power and temperature issues, increasing the total cost of ownership (TCO). This paper explores the benefits of volunteer computing to scale bioinformatics applications as an alternative to own large GPU-based local infrastructures. We use as a benchmark a GPU-base

Intro -- ALCOHOL AND DRUG USE AMONG YOUTH -- ALCOHOL AND DRUG USE AMONG YOUTH -- CONTENTS -- PREFACE -- Chapter 1 ALCOHOL USE AMONG YOUTH∗ -- ABSTRACT -- INTRODUCTION -- SURVEILLANCE -- National Survey on Drug Use and Health (NSDUH) -- Youth Risk Behavior Survey (YRBS) -- Monitoring the Future (MTF) -- PREVALENCE -- LEGAL PERSPECTIVES -- Online Sales of Alcohol -- Judicial Activity Regarding Internet Wine Sales -- POLICY PERSPECTIVES -- Legislative Activity -- Institute of Medicine Recommendations -- Prohibit Alcohol Advertisements from Targeting Youth -- Increase Alcohol Prices Through Excise Taxes -- Public Awareness -- Enforcement -- REFERENCES -- Chapter 2 QUANTITY AND FREQUENCY OF ALCOHOL USE AMONG UNDERAGE DRINKERS∗ -- IN BRIEF -- PAST MONTH ALCOHOL USE -- NUMBER OF DAYS OF ALCOHOL USE IN THE PAST MONTH -- NUMBER OF DRINKS PER DAY IN THE PAST MONTH -- UNDERAGE DRINKERS VERSUS DRINKERS OF LEGAL AGE -- RESEARCH FINDINGS FROM THE SAMHSA 2005 AND 2006 NATIONAL SURVEYS ON DRUG USE AND HEALTH (NSDUHS) -- END NOTES -- Chapter 3 UNDERAGE ALCOHOL USE: FINDINGS FROM THE 2002-2006 NATIONAL SURVEYS ON DRUG USE AND HEALTH∗ -- HIGHLIGHTS -- Prevalence of Underage Drinking Behaviors in 2006 -- Trends in Underage Current and Binge Drinking -- Sociodemographic and Geographic Differences in Underage Drinking -- Alcohol Use Disorders among Persons Aged 12 to 20 -- Association of Underage Drinking with Parental Alcohol Use -- Social Context of Last Alcohol Use -- Location of Last Alcohol Use -- Sources of Alcohol -- Underage Drinking and Illicit Drug Use -- 1. INTRODUCTION -- 1.1. Background -- 1.2. General Information about NSDUH -- 1.3. Measures of Alcohol Use and Disorders -- 1.4. New Alcohol Use Items in the 2006 NSDUH -- 1.5. Measures of Demographic and Geographic Characteristics -- 1.6. Organization of This Report