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Background: Globally, tuberculosis (TB) is the second major cause of death from infectious diseases, particularly in developing countries. A multidisciplinary approach to the management of TB may help to curb the disease burden.Objective: The objective of this study was to outline the perceptions of healthcare professionals and patients regarding the potential role of pharmacists in TB management in Pakistan.Method: This was a large-scale qualitative study conducted at the Chest Disease Unit (CDU) of the Bahawal Victoria Hospital (BVH), Punjab, Pakistan. Data were collected through semi-structured interviews with physicians, pharmacists, and patients recruited using a mix of convenient and snowball sampling. The sample size was decided through standard saturation point criteria. All interviews were audio recorded and transcribed verbatim. The data were analyzed to draw conclusions using a thematic analysis approach.Results: Analysis of the data yielded 19 categories and seven themes. Physicians considered pharmacists qualified healthcare professionals, whereas patients considered them merely dispensers. Inventory management and dispensing of medicines were considered as major responsibilities of pharmacists. Physicians were extremely overburdened and wanted to delegate certain duties to pharmacists, subject to their prior extensive trainings. However, most of the physicians were unaware of the legal scope of pharmacy practice in Pakistan. With regard to the potential duties of pharmacists, physicians, pharmacists, and patients (patients—upon explaining the potential roles during the interview) endorsed monitoring, counseling, medicine brand selection, dose adjustment, inventory management, dispensing, and polypharmacy assessment as their potential roles. In view of all stakeholders, the rationale for integrating pharmacists in TB management included overburdened physicians, sub-standard patient care, medication safety issues, and patient dissatisfaction. The healthcare professionals highlighted that the major barriers to integrating pharmacists within the TB management system were limited interest of regulatory authorities and policy makers, followed by inadequate training and experience-driven questionable competency of pharmacists.Conclusion: The study participants acknowledged the potential role of pharmacists in TB management. However, it was emphasized that healthcare policy makers should devise strategies to overcome the underlying barriers before assigning medicine-related clinical roles to pharmacists.

Climate change has caused a shift in aridity, particularly in the world’s dry regions, affecting several sectors, predominantly the agricultural and water resources. This research examined the climate change effects on crop water demand (CWD) in Syria during 1951–2010. Given the lack of observed data, this analysis relied on Global Precipitation Climatology Center (GPCC) precipitation and Climatic Research Unit (CRU) temperature. Potential evapotranspiration (PET) at each grid was estimated using the Penman–Monteith model and the CWD using the FAO-56 method. The analysis revealed that CWD in Syria increased during 1981 − 2010 compared to that during 1951 − 1980. The increase in CWD was found for grapes, tobacco, barley, and cotton, whereas the maximum changes were during April and May. The most remarkable changes in CWD were for barley, between − 20 and 40 mm. It showed a decreased CWD in the south and a rise in the north (0 − 40 mm). The CWD for wheat showed a decline in most parts of the country, except in the north. The increase in CWD for barley and wheat caused an increase in agricultural water stress in the region. Agriculture planning needs to be developed according to the expected future climate changes to maintain the agricultural production in the region.

The gut-liver axis is increasingly considered to play a vital part in the progression of chronic inflammatory gut and liver diseases. Hence, a detailed understanding of the local and systemic regulatory mechanisms is crucial to develop novel therapeutic approaches. In this review, we discuss in-depth the roles of regulatory T cells (Tregs) and mucosal-associated invariant T cells (MAITs) within the context of inflammatory bowel disease, primary sclerosing cholangitis, and non-alcoholic steatohepatitis. Tregs are crucial in maintaining peripheral tolerance and preventing autoimmunity. MAIT cells have a unique ability to rapidly recognize microbial metabolites and mount a local immune response and act as a 'biliary firewall' at the gut and biliary epithelial barrier. We also outline how current knowledge can be exploited to develop novel therapies to control the propagation of chronic gut- and liver-related inflammatory and autoimmune conditions. We specifically focus on the nature of the Tregs' cell therapy product and outline an adjunctive role for low-dose IL-2. All in all, it is clear that translational immunology is at crucial crossroads. The success of ongoing clinical trials in cellular therapies for inflammatory gut and liver conditions could revolutionize the treatment of these conditions and the lives of our patients in the coming years.

Additional file 1.

Additional file 1: Table S1. Study site wise distribution of study participants.

A capillary coated with mixed polymer brushes that shows switchability toward lysozyme adsorption was developed. This capillary was applied for the on-line preconcentration of lysozyme by capillary electrophoresis (CE) in order to enhance the detection sensitivity. First, poly(2-methyl-2-oxazoline) (PMOXA) and poly(acrylic acid) (PAA) were synthesized by cationic ring-opening polymerization and reversible addition-fragmentation chain transfer (RAFT) polymerization, respectively. Then, glycidyl methacrylate (GMA) and PMOXA were used to prepare poly(2-methyl-2-oxazoline)-random-glycidyl methacrylate (PMOXA-r-GMA) via radical copolymerization, and poly(acrylic acid)-block-poly(glycidyl methacrylate) (PAA-b-PGMA) was obtained by the RAFT polymerization of GMA and PAA. A mixed solution of PMOXA-r-GMA and PAA-b-PGMA at a certain mass ratio was then injected into the capillary. Subsequent annealing provided capillary materials coated with mixed polymer brushes based on PMOXA and PAA. X-ray photoelectron spectroscopy (XPS) analysis was performed to determine the surface composition of the capillary raw materials. When the mass concentration of the mixed solution was 20 g/L and the mass ratio of PMOXA-r-GMA and PAA-b-PGMA was 1:1, the carboxyl content in the coating increased with increasing chain length of PAA. Fluorescein isothiocyanate-labeled lysozyme (FITC-lysozyme) adsorption assay demonstrated that the coated capillary had switchable properties for lysozyme adsorption upon pH and ionic strength (

Immunizing human or animals with edible plants is an evolving tool that seems to grip countless potential. The selected/desired antigen of pathogens (HIV, tuberculosis etc) are inserted to the selected host plant by transformation technique to form a transgenic plant. Edible vaccines grip countless promise as a profi table, easily managing, can be store easily, unlikely or unable to fail and sociocultural gladly sustainable, particularly for the poor emerging nations.

This paper presents an innovative lean ergonomic tool (LET) for mental stress through facial muscle activity assessment. An image-processing tool has been developed based on the analysis of facial ...

Climate change has caused a shift in aridity, particularly in the dry regions of the world which may subsequently affect several sectors predominantly the agricultural and water resources. This research examined the climate change effects on crop water demand (CWD) in Syria over the period 1951–2010. Given the lack of observed data, this analysis relied on (GPCC) precipitation and (CRU) temperature data from 1951 to 2010. Potential Evapotranspiration (PET) at each grid was calculated using Penman-Monteith method and FAO-56 model was used to calculate the crop water demand (CWD). The analysis revealed that CWD in Syria increased from 1981 to 2010 when compared to 1951–1980.The increase in CWD has been found for all the crops except wheat, whereas the maximum changes are found during April, and May. The differences in CWD for Barley between the two periods were found to be in the range of -20 to 40 mm. A decrease in CWD observed in the south of the country. However, a rise in 0 to 20 mm range was also discovered in the north. The CWD for wheat was found to decline in most parts of the country. However, it was found to increase in the north. The increase in CWD for barley and wheat has increased agricultural water stress in the region. Several agriculture planning needs to be developed in accordance with the expected future climate changes in order to maintain the agricultural production in the region.

Supplemental Material, sj-pdf-4-inq-10.1177_00469580211036283 for Impact of Pharmacist-Led Interventions on Diabetes Management at a Community Pharmacy in Pakistan: A Randomized Controlled Trial by Muhammad Abubakar and Muhammad Atif in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Supplemental Material, sj-pdf-7-inq-10.1177_00469580211036283 for Impact of Pharmacist-Led Interventions on Diabetes Management at a Community Pharmacy in Pakistan: A Randomized Controlled Trial by Muhammad Abubakar and Muhammad Atif in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Supplemental Material, sj-pdf-2-inq-10.1177_00469580211036283 for Impact of Pharmacist-Led Interventions on Diabetes Management at a Community Pharmacy in Pakistan: A Randomized Controlled Trial by Muhammad Abubakar and Muhammad Atif in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Supplemental Material, sj-pdf-4-inq-10.1177_00469580211036283 for Impact of Pharmacist-Led Interventions on Diabetes Management at a Community Pharmacy in Pakistan: A Randomized Controlled Trial by Muhammad Abubakar and Muhammad Atif in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Additional file 1. Interview schema

Supplemental Material, sj-pdf-1-inq-10.1177_00469580211036283 for Impact of Pharmacist-Led Interventions on Diabetes Management at a Community Pharmacy in Pakistan: A Randomized Controlled Trial by Muhammad Abubakar and Muhammad Atif in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Additional file 1. COREQ checklist.

Supplemental Material, sj-pdf-6-inq-10.1177_00469580211036283 for Impact of Pharmacist-Led Interventions on Diabetes Management at a Community Pharmacy in Pakistan: A Randomized Controlled Trial by Muhammad Abubakar and Muhammad Atif in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Supplemental Material, sj-pdf-3-inq-10.1177_00469580211036283 for Impact of Pharmacist-Led Interventions on Diabetes Management at a Community Pharmacy in Pakistan: A Randomized Controlled Trial by Muhammad Abubakar and Muhammad Atif in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Supplemental Material, sj-pdf-3-inq-10.1177_00469580211036283 for Impact of Pharmacist-Led Interventions on Diabetes Management at a Community Pharmacy in Pakistan: A Randomized Controlled Trial by Muhammad Abubakar and Muhammad Atif in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Supplemental Material, sj-pdf-2-inq-10.1177_00469580211036283 for Impact of Pharmacist-Led Interventions on Diabetes Management at a Community Pharmacy in Pakistan: A Randomized Controlled Trial by Muhammad Abubakar and Muhammad Atif in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Supplemental Material, sj-pdf-5-inq-10.1177_00469580211036283 for Impact of Pharmacist-Led Interventions on Diabetes Management at a Community Pharmacy in Pakistan: A Randomized Controlled Trial by Muhammad Abubakar and Muhammad Atif in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Supplemental Material, sj-pdf-1-inq-10.1177_00469580211036283 for Impact of Pharmacist-Led Interventions on Diabetes Management at a Community Pharmacy in Pakistan: A Randomized Controlled Trial by Muhammad Abubakar and Muhammad Atif in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Supplemental Material, sj-pdf-5-inq-10.1177_00469580211036283 for Impact of Pharmacist-Led Interventions on Diabetes Management at a Community Pharmacy in Pakistan: A Randomized Controlled Trial by Muhammad Abubakar and Muhammad Atif in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Supplemental Material, sj-pdf-6-inq-10.1177_00469580211036283 for Impact of Pharmacist-Led Interventions on Diabetes Management at a Community Pharmacy in Pakistan: A Randomized Controlled Trial by Muhammad Abubakar and Muhammad Atif in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Additional file 2. Interview schema of physicians, pharmacists and patients.

In this study, we reported the biological approach to synthesis of ZnO nanorod (NR) on the reduced graphene oxide (RGO) for photocatalytic, antibacterial activity and hydrogen production under sunlight. Bacillus subtilis played a vital role in the production of biogenic ammonia from synthetic urine and utilized for the synthesis of ZnONR on the RGO sheet. The morphological study revealed that RGO sheets displayed a tremendous role in anchoring ZnONR. XRD patterns showed the ZnO crystal phase on the RGO sheets. XPS and Raman spectra confirmed that the bio-hydrothermal method as suitable for GO converted into RGO. The transient photocurrent and I/V measurement are exhibited as an increment on the RGO-ZnONR compared to ZnONR. The RGO-ZnONR composites showed excellent performance with decolorization of MB and textile dyes and efficient control of the E. coli and S. aureus. RGO-ZnONR exhibited remarkable noted as a higher photocatalytic hydrogen evolution rate (940 μmol/h/gcat) than the ZnONR (369.5 μmol/h/g cat). As a result of photocatalytic performance to correlate with sunlight intensity was extensively studied. RGO plays an essential role in interface electron transfer from sunlight to ZnONR for enhancing •OH radical formation to cleavage of dye color substance and eradicated bacterial cells.

Background Sepsis is a major contributor to neonatal mortality, particularly in low-income and middle-income countries (LMICs). WHO advocates ampicillin–gentamicin as first-line therapy for the management of neonatal sepsis. In the BARNARDS observational cohort study of neonatal sepsis and antimicrobial resistance in LMICs, common sepsis pathogens were characterised via whole genome sequencing (WGS) and antimicrobial resistance profiles. In this substudy of BARNARDS, we aimed to assess the use and efficacy of empirical antibiotic therapies commonly used in LMICs for neonatal sepsis. Methods In BARNARDS, consenting mother–neonates aged 0–60 days dyads were enrolled on delivery or neonatal presentation with suspected sepsis at 12 BARNARDS clinical sites in Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Stillborn babies were excluded from the study. Blood samples were collected from neonates presenting with clinical signs of sepsis, and WGS and minimum inhibitory concentrations for antibiotic treatment were determined for bacterial isolates from culture-confirmed sepsis. Neonatal outcome data were collected following enrolment until 60 days of life. Antibiotic usage and neonatal outcome data were assessed. Survival analyses were adjusted to take into account potential clinical confounding variables related to the birth and pathogen. Additionally, resistance profiles, pharmacokinetic–pharmacodynamic probability of target attainment, and frequency of resistance (ie, resistance defined by in-vitro growth of isolates when challenged by antibiotics) were assessed. Questionnaires on health structures and antibiotic costs evaluated accessibility and affordability. Findings Between Nov 12, 2015, and Feb 1, 2018, 36 285 neonates were enrolled into the main BARNARDS study, of whom 9874 had clinically diagnosed sepsis and 5749 had available antibiotic data. The four most commonly prescribed antibiotic combinations given to 4451 neonates (77·42%) of 5749 were ampicillin–gentamicin, ceftazidime–amikacin, piperacillin–tazobactam–amikacin, and amoxicillin clavulanate–amikacin. This dataset assessed 476 prescriptions for 442 neonates treated with one of these antibiotic combinations with WGS data (all BARNARDS countries were represented in this subset except India). Multiple pathogens were isolated, totalling 457 isolates. Reported mortality was lower for neonates treated with ceftazidime–amikacin than for neonates treated with ampicillin–gentamicin (hazard ratio [adjusted for clinical variables considered potential confounders to outcomes] 0·32, 95% CI 0·14–0·72; p=0·0060). Of 390 Gram-negative isolates, 379 (97·2%) were resistant to ampicillin and 274 (70·3%) were resistant to gentamicin. Susceptibility of Gram-negative isolates to at least one antibiotic in a treatment combination was noted in 111 (28·5%) to ampicillin–gentamicin; 286 (73·3%) to amoxicillin clavulanate–amikacin; 301 (77·2%) to ceftazidime–amikacin; and 312 (80·0%) to piperacillin–tazobactam–amikacin. A probability of target attainment of 80% or more was noted in 26 neonates (33·7% [SD 0·59]) of 78 with ampicillin–gentamicin; 15 (68·0% [3·84]) of 27 with amoxicillin clavulanate–amikacin; 93 (92·7% [0·24]) of 109 with ceftazidime–amikacin; and 70 (85·3% [0·47]) of 76 with piperacillin–tazobactam–amikacin. However, antibiotic and country effects could not be distinguished. Frequency of resistance was recorded most frequently with fosfomycin (in 78 isolates [68·4%] of 114), followed by colistin (55 isolates [57·3%] of 96), and gentamicin (62 isolates [53·0%] of 117). Sites in six of the seven countries (excluding South Africa) stated that the cost of antibiotics would influence treatment of neonatal sepsis. Interpretation Our data raise questions about the empirical use of combined ampicillin–gentamicin for neonatal sepsis in LMICs because of its high resistance and high rates of frequency of resistance and low probability of target attainment. Accessibility and affordability need to be considered when advocating antibiotic treatments with variance in economic health structures across LMICs. Funding The Bill & Melinda Gates Foundation.

Additional file 1.

Additional file 1. Interview protocol

The need of taxonomy is vital for knowledge sharing. This need has been portrayed by through-life engineering services/systems. This paper addresses this issue by repair process taxonomy development. Framework for repair process taxonomy was developed followed by its implementation. The importance of repair process taxonomy has been highlighted.

Brain is a central and pivotal organ of human body containing the highest lipids content next to adipose tissue. It works as a monitor for the whole body and needs an adequate supply of energy to maintain its physiological activities. This high demand of energy in the brain is chiefly maintained by the lipids along with its reservoirs. Thus, the lipid metabolism is also an important for the proper development and function of the brain. Being a prominent part of the brain, lipids play a vast number of physiological activities within the brain starting from the structural development, impulse conduction, insulation, neurogenesis, synaptogenesis, myelin sheath formation and finally to act as the signaling molecules. Interestingly, lipids bilayer also maintains the structural integrity for the physiological functions of protein. Thus, in light to all of these activities, lipids and its metabolism can be attributed pivotal for brain health and its activities. Decisively, the impaired/altered metabolism of lipids and its intermediates puts forward a key step in the progression of different brain ailments including neurodegenerative, neurological and neuropsychiatry disorders. Depending on their associated underlying pathways, they serve as the potential biomarkers of these disorders and are considered as necessary diagnostic tools. The present review discusses the role and level of altered lipids metabolism in brain diseases including neurodegenerative diseases, neurological diseases, and neuropsychiatric diseases. Moreover, the possible mechanisms of altered level of lipids and their metabolites have also been discussed in detail.

Supplementary_File_2 for Pediatric Antibiotic Pack Size Compliance With the Dosage Regimen: A Descriptive Study by Iram Malik, Muhammad Atif, Fatima Riaz, Saima Asghar and Nafees Ahmad in Therapeutic Innovation & Regulatory Science

Supplementary_File_5_Metronidazole for Pediatric Antibiotic Pack Size Compliance With the Dosage Regimen: A Descriptive Study by Iram Malik, Muhammad Atif, Fatima Riaz, Saima Asghar and Nafees Ahmad in Therapeutic Innovation & Regulatory Science

Supplementary_File_3_Clarithromycin for Pediatric Antibiotic Pack Size Compliance With the Dosage Regimen: A Descriptive Study by Iram Malik, Muhammad Atif, Fatima Riaz, Saima Asghar and Nafees Ahmad in Therapeutic Innovation & Regulatory Science

A grid tied inverter converts DC voltage into AC voltage, while synchronizing it with the supply line phase and frequency. This paper presents an efficient, robust, and easy-to-implement grid tie mechanism. First, the grid tie mechanism was simulated in software using LabVIEW and Multisim. Then, the whole system was practically implemented on hardware. A prototype hardware was developed to produce AC voltage from solar panels. Phase and frequency of the generated voltage were synchronized with those of a reference sinusoidal signal. The synchronization mechanism was digitally implemented on an FPGA, which also controlled the whole system. We achieved real time frequency matching with an improved Zero Crossing Detection (ZCD) technique. Phase matching was also achieved in real time using a modified Phase Locked Loop (PLL) algorithm, which retains stability while being simpler than the general PLL algorithm. Experiments demonstrated that the proposed grid tied system reliably synchronized the phase and frequency of the voltage generated by the implemented hardware with those of the reference grid voltage.

Supplementary_File_1 for Pediatric Antibiotic Pack Size Compliance With the Dosage Regimen: A Descriptive Study by Iram Malik, Muhammad Atif, Fatima Riaz, Saima Asghar and Nafees Ahmad in Therapeutic Innovation & Regulatory Science

Supplementary_File_6_Amixicillin for Pediatric Antibiotic Pack Size Compliance With the Dosage Regimen: A Descriptive Study by Iram Malik, Muhammad Atif, Fatima Riaz, Saima Asghar and Nafees Ahmad in Therapeutic Innovation & Regulatory Science

Supplementary_File_4_Cefotaxime for Pediatric Antibiotic Pack Size Compliance With the Dosage Regimen: A Descriptive Study by Iram Malik, Muhammad Atif, Fatima Riaz, Saima Asghar and Nafees Ahmad in Therapeutic Innovation & Regulatory Science

Supplementary_File_7_Gentamicin for Pediatric Antibiotic Pack Size Compliance With the Dosage Regimen: A Descriptive Study by Iram Malik, Muhammad Atif, Fatima Riaz, Saima Asghar and Nafees Ahmad in Therapeutic Innovation & Regulatory Science

Additional file 3: Table S3. Number of new and retreatment smear negative and smear positive pulmonary tuberculosis patients by treatment outcomes category (nâ =â 690).

Additional file 1: Table S1. Definition of treatment outcomes.

Additional file 2: Table S2. Treatment outcomes of all smear negative and smear positive pulmonary tuberculosis patients as per the Standard* Criteria (nâ =â 690).

Appendix S1. Study schema. (DOCX 45 kb)

Study inclusion/exclusion criteria. Table S2. WHO hospital indicators. Table S3. WHO prescribing, patient-care and supplemental indicators. Table S4. Availability of a set of key antimicrobials in the hospital stores on the day of study (Indicator No. 3). Table S5. Average number of days that a set of key antimicrobials is out of stock (Indicator No. 4). Table S6. Percentage of individual antimicrobial costs based on the total cost of antimicrobials (Indicator No. 5). Table S7. Prescribing patterns of single antimicrobials at the selected wards of the Bahawal Victoria Hospital. (DOCX 34Â kb)

Study inclusion/exclusion criteria. Table S2. WHO hospital indicators. Table S3. WHO prescribing, patient-care and supplemental indicators. Table S4. Availability of a set of key antimicrobials in the hospital stores on the day of study (Indicator No. 3). Table S5. Average number of days that a set of key antimicrobials is out of stock (Indicator No. 4). Table S6. Percentage of individual antimicrobial costs based on the total cost of antimicrobials (Indicator No. 5). Table S7. Prescribing patterns of single antimicrobials at the selected wards of the Bahawal Victoria Hospital. (DOCX 34Â kb)

Appendix S2. Interim Indicators for Monitoring Drug-Resistant Tuberculosis Programmes. (DOCX 27 kb)