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Aedes aegypti is one of the most important disease vectors in the world. Because their gut is the first site of interaction with pathogens, it is important to understand A. aegypti gut physiology. In this study, we investigated the mechanisms of pH control in the midgut of A. aegypti females under different nutritional conditions. We found that unfed females have an acidic midgut (pH ~6). The midgut of unfed insects is actively maintained at pH 6 regardless of the ingestion of either alkaline or acidic buffered solutions. V-ATPases are responsible for acidification after ingestion of alkaline solutions. In blood-fed females, the abdominal midgut becomes alkaline (pH 7.54), and the luminal pH decreases slightly throughout blood digestion. Only ingested proteins were able to trigger this abrupt increase in abdominal pH. The ingestion of amino acids, even at high concentrations, did not induce alkalinisation. During blood digestion, the thoracic midgut remains acidic, becoming a suitable compartment for carbohydrate digestion, which is in accordance with the higher alpha-glucolytic activity detected in this compartment. Ingestion of blood releases alkalising hormones in the haemolymph, which induce alkalinisation in ex vivo preparations. This study shows that adult A. aegypti females have a very similar gut physiology to that previously described for Lutzomyia longipalpis. It is likely that all haematophagous Nematocera exhibit the same type of physiological behaviour. [ABSTRACT FROM AUTHOR]

Budget impact analysis (BIA) provides operational financial forecasts to implement new technologies in healthcare systems. There were no previous specific recommendations to conduct such analyses in Brazil. This paper reviews BIA methods for health technologies and proposes BIA guidelines for the public and private Brazilian healthcare system. The following recommendations were made: adopt the budget administrator's perspective; use a timeframe of 1 to 5 years; compare reference and alternative scenarios; consider the technology's rate of incorporation; estimate the target population by either an epidemiological approach or measured demand; consider restrictions on technologies' indication or factors that increase the demand for them; consider direct and averted costs; do not adjust for inflation or discounts; preferably, integrate information on a spreadsheet; calculate the incremental budget impact between scenarios; and summarize information in a budget impact report.