National policies and programmes should be formulated and implemented in respect of international, legally binding agreements relevant to the human right to adequate food that have been ratified by the country, or to which the country is a party of. (...) Policy implementation principles are explicitly stated in the policy, and point to a clear commitment to respect and protect the human rights of all when implementing the policy.
Policy formulation, design and implementation at regional and national levels
The process of formulating a policy should conform to governance practices with strong links to human rights principles, as this raises the probability that the policy in actuality will be implemented in ways that contribute to the right to food. (...) In particular, Guidelines 2 (“Economic Development Policies”) and 3 (“Strategies”) are explicit about the obligations of the state to formulate policies and strategies that contribute to the progressive realization of the right to adequate food.
Language:English
Score: 593669.04
-
https://www.fao.org/right-to-f...s-of-work/policy-programme/en/
Data Source: un
National policies and programmes should be formulated and implemented in respect of international, legally binding agreements relevant to the human right to adequate food that have been ratified by the country, or to which the country is a party of. (...) Policy implementation principles are explicitly stated in the policy, and point to a clear commitment to respect and protect the human rights of all when implementing the policy.
Policy formulation, design and implementation at regional and national levels
The process of formulating a policy should conform to governance practices with strong links to human rights principles, as this raises the probability that the policy in actuality will be implemented in ways that contribute to the right to food. (...) In particular, Guidelines 2 (“Economic Development Policies”) and 3 (“Strategies”) are explicit about the obligations of the state to formulate policies and strategies that contribute to the progressive realization of the right to adequate food.
Language:English
Score: 593669.04
-
https://www.fao.org/right-to-f...s-of-work/policy-programme/ar/
Data Source: un
National policies and programmes should be formulated and implemented in respect of international, legally binding agreements relevant to the human right to adequate food that have been ratified by the country, or to which the country is a party of. (...) Policy implementation principles are explicitly stated in the policy, and point to a clear commitment to respect and protect the human rights of all when implementing the policy.
Policy formulation, design and implementation at regional and national levels
The process of formulating a policy should conform to governance practices with strong links to human rights principles, as this raises the probability that the policy in actuality will be implemented in ways that contribute to the right to food. (...) In particular, Guidelines 2 (“Economic Development Policies”) and 3 (“Strategies”) are explicit about the obligations of the state to formulate policies and strategies that contribute to the progressive realization of the right to adequate food.
Language:English
Score: 593669.04
-
https://www.fao.org/right-to-f...s-of-work/policy-programme/ru/
Data Source: un
It typically includes: the type of application equipment used, pesticide formulation, application rate, work rate, level of personal protection, etc.
(...) For indoor residual spraying: concentration of the a.i.in the formulation and the spray solution; additional data needed if the pesticide is volatile.
For space spraying: concentration of the a.i.in the formulation and the spray solution; dermal absorption percentage.
Language:English
Score: 593669.04
-
https://www.fao.org/pesticide-...ds/method-detail/zh/c/1187107/
Data Source: un
Correct) diagnoses
• Effects of “malnutrition” and low weight likely to capture HIV and non-HIV related mortality
CD4%, CD4 count and TLC values corresponding to 12-month risk of death of ~5%
(from HIV Paediatric Prognostic Markers Collaborative Study, HPPMCS)
Age CD4% CD4 Count TLC
<= 1 year 25-35% ~1000-1500 ~3,900-5700
1-3 years 15-25% ~500-800 ~2000-3,900
3-5 years 10-15% ~ 200-350 ~1500-2000
5-10 years 7-10% < 200 ~1000-1500
10+ years <7% < 200 ~1000
Antiretroviral Drugs Obstacles and Issues
Issues for dosing of ART in children
• Large variability in pharmacokinetic (PK) parameters – age (and PK data by age-group often sparse)
– effect of nutritional status, ethnicity
• Methods of dose calculation (per m2 or per kg)
• Formulations may not be bioequivalent – (liquid versus capsule – eg EFV)
• Ability to give with/without food (ddI, NFV)
Issues for dosing of antiretroviral drugs in children
• PK data by age group are sparse • Few data on the effect of race, nutritional status • Young children require higher doses • unclear when to change to adult doses • dose according to weight or surface area:
– somewhat arbitrary – where both available, may not correspond (eg NVP)
• Formulations may not be bio-equivalent (eg EFV)
Dose by weight or Body Surface Area (BSA)
• BSA relates to renal clearance: – drugs cleared by the kidney should be dosed by BSA – PK is not fully explained by variability in BSA – Newborns and premature babies need reduced doses
• BSA calculations crude: – require measurement of height and weight – subject to error (many reports in the literature):
• Normograms underestimate values in infants • Formulae are complex – calculator required:
– Most equations derived from well-nourished Caucasian children
• In 1998, the UK Children’s Cancer Group (UKCCSG) produced tables for estimating BSA based on weight alone
NNRTI dosing Recommendation
Nevirapine 300-400mg/m2 to max 400mg
7mg/kg if <8yr 4mg/kg if >8yr
Efaverenz 15mg/kgkg to max 600mg
(dose liquid according to weight bands)
0
200
400
600
800
1000
dm gm
2_ 10
1
0 10 20 30 40 50 dmgkg_101
90-110% reccommended <90% or >110% recommended
NVP
0
200
400
600
800
1000
D os
e (m
g/ m
2)
0 5 10 15 20 age
0-1 years 2-12 years 13+ years
NVP: DOSE per m2 by AGE
0
10
20
30
40
50
D os
e (m
g/ kg
)
0 5 10 15 20 age
0-1 years 2-12 years 13+ years
NVP: DOSE per ***KG*** by AGE
Obstacles for Pharmaceutical Companies
• Big Pharma: – Formulation difficulties (especially for PI’s) – ‘no business case’, especially to make several formulations – Extension of patent (FDA); Big stick (being proposed by
EU)
• Generic Companies: – Also need a business case – Lack of expertise and research ‘know-how’ – Pre-qualification issues
• Demand Forecasting
Antiretroviral drugs for children in resource-poor settings
• Scored tablets versus liquid formulations: – cost – storage and transport problems – shelf-life
• Fixed-dose combinations – simplification and compatibility with adult treatment – Many advantages – Need to vary doses of drugs with age and weight eg: Generic (3TC+d4T+NVP) combination tablets in
quarters will underdose for NVP if <15kg as well as being difficult to cut accurately
ART IN FIXED DOSE COMBINATIONS:
Adult Tablet Children Tablets
Adult Tablet Children Tablets d4T + 3TC + NVP
FORMULATIONS Adult: d4T (30 mg or 40mg), 3TC 150mg, NVP 200 mg)
"Junior" (10 - 30 Kg):d4T 12mg, 3TC 60mg, NVP 100 mg
Children "Baby" (3 – 10 Kg): d4T 6mg, 3TC 30mg, NVP 50mg
FDCs Advantages Disadvantages Efficacy/ Toxicity
•Reduced risk of wrong dose (over or under):
To prescribe To dispense To take or miss doses by
care-giver/child •Less risk of prescribing wrong regimens
•More difficult to alter doses: Dose escalation Child growth Toxicity Drug interactions
•Less flexibility in regimens •Need to combine drugs with similar half-lives. •Shelf-life determined by least stable
tolerability •Low pill/powder burden •Limited formulation choices
Simplified treatment
•Easier to manage supply, distribution, transportation
•? Greater risks of drug sharing tablets by adults
Cost / availability
•Decrease pharmacy and health professionals time • Should be cheaper to produce
•Incentives to produce •Pre-qualification requirements
Dosing Tables of ARVs for children
• Simple • Based on weight bands • Could be linked to Road to Health Chart
Weight Recommended daily dose (min-max)
Total daily
tablet Schedule D4T 3TC NVP
3-5kg 6-10 24-40 42-70 1 1/2 BD 6 30 50
5-7kg 10-14 40-56 70-98 2 1 BD 12 60 100
8-9kg 16-18 64-72 160- 174
3 1.5 BD* 18 90 150
10-14kg 20-28 80-112 180- 252
2 1 BD 24 120 200
15-19kg 30-36 120-152 240- 320
5 2.5 BD* 30 150 250
20-24kg 40-48 160-192 304- 376
3 1.5 BD* 36 180 300
25-29kg 50-58 200-232 400 4 2 BD 48 240 400
30-39kg 60 300 400 2 1 BID 60 300 400
40-49kg 60 300 400 2 1 BID 60 300 400
Daily dose of Baby Pedimune (d4T 6mg, 3TC 30mg, NVP 50mg)
Daily dose of Junior Pedimune (d4t 12mg, 3TC 60mg, NVP 100 mg)
Daily dose of Triomune 30
Range D4T 3TC NVP
50-59kg 60 300 400 2 1 BID 60 300 400
Challenges • Appropriate simple ART formulations and combinations
relevant to resource–poor settings urgently needed – Industry interest and accelerated PK research
• Integration of adult and paediatric treatment and care: FAMILY APPROACH
• Applying and Scaling-up what we already know: – Cotrimoxazole prophylaxis – Nutritional support
• Training in paediatric and family-based care for HIV
• Strengthen links between access to treatment and operational research to answer important questions about natural history and response to ART
5
10
15
D os
e (m
g/ kg
)
5 10 15 age
0-1 years 2-12 years 13+ years
TDF: DOSE per kg by AGE
10
20
30
40
50
D os
e (m
g/ kg
)
0 5 10 15 20 age
0-1 years 2-12 years 13+ years
EFV: DOSE per kg by AGE
Obstacles - Pre-Qualification • ‘National and or international regulatory and
prequalification procedures may discourage the production of specific paediatric ART formulations’
• WHO requirements – Shelf-life studies – Dissolution studies – Bio-equivalence Studies
– PK studies in children
Adherence to and tolerability of ARVs
• Tolerability of formulations varies with age
• Ability to give with/without food (ddI, NFV)
• Adherence depends on caregivers
200
400
600
800
1000
1200
dm gm
2_ 10
3
10 20 30 40 50 dmgkg_103
90-110% reccommended <90% or >110% recommended
EFV
200
400
600
800
1000
D os
e (m
g)
0 20 40 60 80 wgt
0-1 years 2-12 years 13+ years
EFV: DOSE (mg) by WGT ***BAND***
The Way Forward • HIV-infected children need advocates • Partnerships in care, research and training:
– Between adult, paediatric and obstetric services – Between and across countries
• Fast-tracking provision of appropriate ARV formulations and fixed dose drug combinations for children – Clinical/industry/research collaborations
• Operational research (requires partnerships and networks): – Cohort collaborations – Operational research questions on using ART in children – Psychosocial issues – Linked to capacity strengthening
• Linking prevention and treatment/care
Weight for age by CD4% 0
5 10
15 20
25 30
35 B
as el
in e
C D
4 pe
rc en
t
-12 -9 -6 -3 0 3 Baseline weight z-score
Single Antiretroviral Drugs for children
NRTI NNRTI PI Recommendation Recommendation Recommendation
ZDV 360mg/m2 to max 600mg
NVP 300-400mg/m2 to max 400mg
NFV 110-150mg/kg to max 2500mg
3TC 8mg/kg to max 300mg
EFV 15mg/kg to max 600mg
LPVr 460/115mg/m2 to max 800/200mg
ABC 16mg/kg to max 600mg
ddI 180mg/m2 to max 400mg
d4T 2mg/kg to max 80mg m
2 = (hgt*wgt/3600)½
Review dose at EVERY clinic visit – 3-monthly
Clinical, Psychosocial, Programmatic Obstacles and Issues for Paediatric ARVs
Obstacles to HIV Testing in Children
Death by time at risk(534 children > 1 year in the CHAP Trial, Lancet in press)
Clinical Paediatric WHO Staging
Mortality by New WHO stage at baseline(534 children >1 year in the CHAP trial)
New WHO Paediatric Staging
CD4%, CD4 count and TLC values corresponding to 12-month risk of death of ~5%(from HIV Paediatric Prognostic Markers Collabo
Antiretroviral DrugsObstacles and Issues
Issues for dosing of ART in children
Issues for dosing of antiretroviral drugs in children
Dose by weight or Body Surface Area (BSA)
Obstacles for Pharmaceutical Companies
Antiretroviral drugs for children in resource-poor settings
Dosing Tables of ARVs for children
Challenges
Obstacles - Pre-Qualification
Adherence to and tolerability of ARVs
The Way Forward
Weight for age by CD4%
Single Antiretroviral Drugs for children
Language:English
Score: 592092.8
-
https://www.who.int/3by5/en/5gibb.pdf
Data Source: un
[4] Toward a Single ICT Index Recommendations on the Formulation of a Flagship ICT Index for the ITU (draft)
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[4] Toward a Single ICT Index Recommendations on the Formulation of a Flagship ICT Index for the ITU (draft)
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[4]
Document :
ITU-D DAP2B.1.3 Contribution 4
Title :
Toward a Single ICT Index Recommendations on the Formulation of a Flagship ICT Index for the ITU (draft)
Date :
2007-11-16
Source :
STAT, ITU
Meeting :
2007-12-13
Access :
Public Document
Top - Feedback - Contact Us - Copyright © ITU 2008 All Rights Reserved Contact for this page : Webmaster
Updated : 2007-12-12
Language:English
Score: 591772.07
-
https://www.itu.int/md/D06-DAP2B.1.3-C-0004/en
Data Source: un
DSD :: Areas of Work :: NSDS - Technical Cooperation/Capacity Building
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Technical Cooperation/Capacity Building
National Support to the Formulation of National Sustainable Development Strategies in the Pacific: A Regional Approach
About Pacific SIDS Project
The Johannesburg Plan of Implementation from the World Summit on Sustainable Development (WSSD), as well as the Mauritius Strategy for the Further Implementation of the Programme of Action for the Sustainable Development of Small Island Developing States , called upon countries to formulate and begin implementation of NSDS by 2005.
In response to the inter-governmental decisions and in order to assist countries in achieving their NSDS goals and priorities, UNDESA in 2005 formulated a project “National Support to the Formulation of National Sustainable Development Strategies in the Pacific: a regional approach”, funded by the Government of Italy.
Language:English
Score: 591481.6
-
https://www.un.org/esa/dsd/dsd_aofw_nsds/nsds_techcoop.shtml
Data Source: un
Approve the Procedures for the Formulation and Placing of State Orders for the Supply of Production for State Purposes and Review of their Implementation" (in addendum).
2. Assign the functions of formulating government orders and coordinating the activities of state customers of placing state orders to the Ministry of the Economy.
3. (...) I. Formulation of state orders
1. State orders are formulated on the basis of state needs for production, determined by the Programmes of economic and social development for Ukraine.
2.
Language:English
Score: 591046.4
-
https://www.wto.org/english/th..._e/ukr_e/WTACCUKR26_LEG_27.pdf
Data Source: un
They will receive, by e-mail, the draft formulation and appraisal reports and will have the opportunity to respond.
The appraisal mission, scheduled for July 2002, will begin with delivery of the formulation report and a presentation of the terms of reference to the local preparation committee, which will thus be in a position to take an active part in designing PRODAM-II.
(...) Ben Senia; BOAD representative, Mr E.J.Boka (PRODAM cofinancing and supervision); the head of formulation mission, Mr Marc Lebrun, and all the members of the formulation mission; and the IFAD evaluation officer for Senegal, Mr J.
Language:English
Score: 591046.4
-
https://www.ifad.org/zh-TW/web...-project-in-matam-prodam-2004-
Data Source: un
Special attention for bridging an EC formulation to other sprayed formulations may therefore be required.
All formulations incorporated into the soil (e.g. GR, liquid formulations injected directly into the soil), except seed treatments.
All formulations used to treat seeds, including pre-treated seeds.
Language:English
Score: 591046.4
-
https://www.fao.org/pesticide-...ds/method-detail/zh/c/1300676/
Data Source: un