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PurposeThis paper aims to provide a valid insight into consumers' minds while considering word of mouth (WOM), brand image and uniqueness as independent variables while considering the tourism industry as the primary stakeholder.Design/methodology/approachThe study adopts qualitative research methods and data collected from 1,033 respondents using convenience sampling methodology. The data are collected from different tourists spots in China and Pakistan. The PROCESS macro was utilized in this study using SPSS version 25.0 to inspect the impacts by using Model 4 and the conditional effects indirectly by utilizing Model 14.FindingsCustomer's intimacy, search for novel and unexplored destinations highlight WOM interactions and perceived service value. Service value, interactional justice and professional attitude of hotel management mediated all the given relationships significantly. The brand image does not mediate any significant associations. Perceived service value and brand image predict customer's loyalty, and WOM is the direct measure of their intentions, and these variables are market trend indicators. A tourist's response toward different destinations is described in this study with comparative analysis of Chinese and Pakistani tourists. The study results showed a significantly positive relationship between hotel management professional behavior, customer's loyalty, customer's intimacy and WOM.Research limitations/implicationsThe recruited population might not be represented as the broader and larger visitor population, resulting in restricting establishing tactics. Moreover, this study's results provide significant insight into a tourism industry, hence providing a chance to manage customer loyalty better.Social, managerial and theoretical implicationsThis study contributes significantly to the body of knowledge and provides remarkable insight from the managerial perspective. Interactional justice results in significant value for hotel management directors and top management, front desk staff and operatives and front level employees and managers. Consumer sensitivity of fairness in interpersonal dealings calls for behavioral changes in frontline employees, especially those directly dealing with hotel visitors. Hotel staff and management should formulate a system to deal with the demands and needs of visitors. It should describe the rights and obligations of visitors and ensure that each customer is treated equally and with respect. Customers should be motivated to read the survey questionnaires kept in their rooms and offer their views on the services provided. This strategy might increase the customers' sense of empowerment and leading to notions of fairness in individual encounters.Originality/valueThis study provides an insight into the customer's minds while considering essential variables that include WOM, brand image, perceived service value and uniqueness.

PurposeOrganizations are facing several challenges in the current challenging business environment. The current study explores how counterproductive work behavior (CWB) affects bio-medical companies' firm performance in Pakistan. The study considers the mediating role of organizational culture and its impact on CWB and a firm's performance.Design/methodology/approachData were collected through a self-administered questionnaire. For data collection, 300 questionnaires were distributed among employees working in biomedical companies. Statistical analysis such as descriptive statistics, Pearson moment correlation and structural equation modeling (SEM) techniques was used to analyze the study variable's relationship and its effect on the firm's performance.FindingsThe study results revealed that CWB and organizational culture significantly influence firm performance directly and indirectly. Moreover, organizational culture partially mediates the relationship between CWB and companies' performance.Originality/valueThe current study plays a significant role in the firm's policy directions. There are limited research and information accessible to biomedical firms in Pakistan. Counterproductive job habits wind up becoming something that significantly affects the firm performance. This research adds to human resource management, corporate management and the business strategy literature.

AZD9567 is a potent and selective nonsteroidal oral glucocorticoid receptor modulator. It is developed as an anti-inflammatory drug with improved safety profile compared with steroids like prednisolone. Throughout the clinical development of AZD9567, dose selection and data interpretation require a method for determining doses with the same anti-inflammatory effect as prednisolone. Equipotent doses of AZD9567 and prednisolone were defined by the same average inhibition of TNFα release, a biomarker of anti-inflammatory effect, measured in a lipopolysaccharide-stimulated whole blood ex vivo assay. Based on pharmacokinetic-pharmacodynamic models, TNFα dose-response relationships for AZD9567 and prednisolone were established. A comparison of the dose-response curves enabled estimation of an equipotency relationship. Specifically, 20 mg prednisolone was estimated to be equipotent to 40 mg AZD9567 (95% confidence interval: 29-54 mg). Static concentration-response analyses showed that the relative potencies for inhibition of TNFα release of AZD9567 and prednisolone were well aligned with several other pro-inflammatory cytokines.

BackgroundThis study aimed to assess the pediatric lisinopril doses using an adult physiological based pharmacokinetic (PBPK) model. As the empirical rules of dose calculation cannot calculate gender-specific pediatric doses and ignores the age-related physiological differences.MethodsA PBPK model of lisinopril for the healthy adult population was developed for oral (fed and fasting) and IV administration using PK-Sim MoBI® and was scaled down to a virtual pediatric population for prediction of lisinopril doses in neonates to infants, infants to toddler, children at pre-school age, children at school age and the adolescents. The pharmacokinetic parameters were predicted for the above groups at decremental doses of 20 mg, 10 mg, 5 mg, 2.5 mg, and 1.5 mg in order to accomplish doses producing the pharmacokinetic parameters, similar (or comparable) to that of the adult population. The above simulated pediatric doses were compared to the doses computed using the conventional four methods, such as Young’s rule, Clark’s rule, and weight-based and body surface area-based equations and the dose reported in different studies.ResultsThough the doses predicted for all subpopulations of children were comparable to those calculated by Young’s rule, yet the conventional methods overestimated the pediatric doses when compared to the respective PBPK-predicted doses. The findings of previous real time pharmacokinetic studies in pediatric patients supported the present simulated dose.ConclusionThus, PBPK seems to have predictability potential for pediatric dose since it takes into consideration the physiological changes related to age and gender.

Diffusing capacity for carbon monoxide (DLCO) was measured in a phase I single ascending dose study after inhalation of AZD8154 or placebo in healthy participants at baseline (DLCO

Background and purpose Human pharmacokinetic studies of lung-targeted drugs are typically limited to measurements of systemic plasma concentrations, which provide no direct information on lung target-site concentrations. We aimed to evaluate lung pharmacokinetics of commonly prescribed drugs by sampling different lung compartments after inhalation and oral administration. Experimental approach Healthy volunteers received single, sequential doses of either inhaled salbutamol, salmeterol, and fluticasone propionate (n=12), or oral salbutamol and propranolol (n=6). Each participant underwent bronchoscopies and gave breath samples for analysis of particles in exhaled air at two time points after drug administration (1 and 6, 2 and 9, 3 and 12, or 4 and 18 hours). Lung samples were taken via bronchosorption, bronchial brush, mucosal biopsy, and bronchoalveolar lavage during each bronchoscopy. Blood samples were taken during the 24 hours after administration. Pharmacokinetic profiles were generated by combining data from multiple individuals, covering all sample timings. Key results Pharmacokinetic profiles were obtained for each drug in lung epithelial lining fluid, lung tissue, and plasma. Inhalation of salbutamol resulted in approximately 100-fold higher concentrations in lung versus plasma. Salmeterol and fluticasone concentration ratios in lung versus plasma were higher still. Bronchosorption- and bronchoalveolar-lavage-generated profiles of inhaled drugs in epithelial lining fluid were comparable, whereas, for oral drugs, epithelial-lining-fluid concentrations appeared to be overestimated in bronchoalveolar-lavage-generated profiles. Conclusion and implications Combining pharmacokinetic data derived from multiple individuals and techniques sampling different lung compartments enabled generation of pharmacokinetic profiles for evaluation of lung targeting after inhaled and oral drug delivery.

Aims This 3-part, randomised, phase 1 first-in-human study (NCT03436316) investigated the safety, tolerability and pharmacokinetics (PK) of AZD8154, a dual phosphoinositide 3-kinase (PI3K) γδ inhibitor developed as a novel inhaled anti-inflammatory treatment for respiratory disease. Methods Healthy men, and women of nonchildbearing potential, were enrolled to receive single and multiple ascending inhaled doses of AZD8154 in parts 1 and 3 of the study, respectively, while part 2 characterised the systemic PK after a single intravenous (IV) dose. In part 1, participants received 0.1-7.7 mg AZD8154 in 6 cohorts. In part 2, participants were given 0.15 mg AZD8154 as an IV infusion. In part 3, AZD8154 was given in 3 cohorts of 0.6, 1.8 and 3.1 mg, with a single dose on Day 1 followed by repeated once-daily doses on Days 4-12. Results In total, 78 volunteers were randomised. All single inhaled, single IV and multiple inhaled doses were shown to be well tolerated without any safety concerns. A population PK model, using nonlinear mixed-effect modelling, was developed to describe the PK of AZD8154. The terminal mean half-life of AZD8154 was 18.0-32.0 hours. The geometric mean of the absolute pulmonary bioavailability of AZD8154 via the inhaled route was 94.1%. Conclusion AZD8154 demonstrated an acceptable safety profile, with no reports of serious adverse events and no clinically significant drug-associated safety concerns reported in healthy volunteers. AZD8154 demonstrated prolonged lung retention and a half-life supporting once-daily dosing.

mRNA can direct dose-dependent protein expression in cardiac muscle without genome integration, but to date has not been shown to improve cardiac function in a safe, clinically applicable way. Herein, we report that a purified and optimized mRNA in a biocompatible citrate-saline formulation is tissue specific, long acting, and does not stimulate an immune response. In small- and large-animal, permanent occlusion myocardial infarction models, VEGF-A 165 mRNA improves systolic ventricular function and limits myocardial damage. Following a single administration a week post-infarction in mini pigs, left ventricular ejection fraction, inotropy, and ventricular compliance improved, border zone arteriolar and capillary density increased, and myocardial fibrosis decreased at 2 months post-treatment. Purified VEGF-A mRNA establishes the feasibility of improving cardiac function in the sub-acute therapeutic window and may represent a new class of therapies for ischemic injury. Keywords: modRNA, mRNA, mRNA, VEGF, heart failure

After inhaled drug administration, pharmacokinetic (PK) data is typically limited to plasma concentrations and provides no direct information on lung target site levels. This study aims to increase understanding of regional lung PK of selected drugs by taking samples from various lung compartments using innovative sampling methods. Eighteen healthy volunteers were enrolled to either receive single doses of orally inhaled salbutamol (200µg), salmeterol (50µg) and fluticasone propionate (500µg) (n=12) or single oral doses of salbutamol (4 mg) and propranolol (40 mg) (n=6). Two bronchoscopies were performed in each subject. During each bronchoscopy 2 samples of bronchosorption, bronchial brush, mucosal biopsy and one bronchoalveolar lavage (BAL) were performed at different pre-specified times (1, 2, 3, 4, 6, 9, 12, 18 hours) after the drug administration. PK profiles of the model drugs were obtained for concentrations in human lung epithelial lining fluid and lung tissue, enabling insight into the spatial lung distribution of drugs after inhaled and oral administration (Fig. 1). Innovative study design with direct sampling from different compartments in lung provided high quality PK profiles in human lung and demonstrated extent of lung targeting following inhaled drug delivery.

Introduction: Measuring diffusing capacity of the lung for carbon monoxide (DLCO) facilitates the diagnosis, classification and monitoring of various lung diseases, and may also be used for safety signal detection in clinical drug development. However, other factors such as exercise, supine position, and diurnal variations may affect the gas transfer and impact the DLCO measurements. Aim: To measure DLCO in healthy subjects receiving a novel inhaled drug or placebo. Methods: In a Phase I, single ascending dose study, DLCO was measured at baseline (Day -1) and at follow up (Day 6) after inhalation the novel drug or placebo, cohort 1-6. For practical reasons, the DLCO measurements were performed at 11 am on Day -1 and at 9 am on Day 6. After Cohort 2, standardization of the assessments was introduced and the assessments were done at the same time of the day. Further adjustments were made from Cohort 4 ensuring the same timeframe between DLCO assessments and preceding meal. Results: Changes in DLCO from baseline to follow per cohort are presented in Table 1. A decline in DLCO was noted for all subjects in Cohort 1 and 2 including placebo. After standardization of timing of the assessment less variability was seen, some subjects had an increase while other had a decrease. No changes were observed in subjects’ spirometry measurements. Conclusions: When measuring DLCO in clinical studies, the procedures should be standardized with regards to time of the day and in relation to timing of factors such as diet and physical activity.

AZD8154 is an inhaled PI3Kgd inhibitor developed for treatment of asthma. This first in human study evaluate the safety, tolerability and PK of AZD8154 in healthy volunteers after inhalation of single ascending doses (Part 1) and characterized the systemic PK after an intravenous (IV) dose (Part 2). This was a randomized, single-blind, placebo-controlled and sequential group design study. In Part 1, subjects received AZD8154 target delivered doses of 0.1, 0.3, 0.9, 2.7, 5.4 and 7.7 mg via nebulisation respectively in six cohorts (6:2 active:placebo). In Part 2, 0.15 mg AZD8154 was administered IV to six subjects, after a wash-out period they were given 2.7 mg inhaled target delivered dose. Overall, single inhaled doses of AZD8154 up to target delivered dose 7.7 mg were well tolerated and no safety concerns were raised. A population PK model, using non-linear mixed effect modelling, was developed to describe the PK of AZD8154. The final PK model successfully described the trends and variability in the data. The PK of AZD8154 was characterized by an early rapid absorption phase with tmax occurring at 0.17 to 0.75 h, followed by a flat period of about 12 - 24 h, before declining in a typically mono-phasic manner. The systemic exposure of AZD8154 increased in a dose proportional manner. The terminal mean half-life was 18 to 29 h and the pulmonary bioavailability was on average 94%. In summary, AZD8154 displayed dose proportional PK characteristics in the dose range studied (0.1 to 7.7 mg) with a half-life potentially suitable for once-daily dosing and the data supports further evaluation in a multiple ascending dose study.

mRNA can direct dose-dependent protein expression in cardiac muscle without genome integration, but to date has not been shown to improve cardiac function in a safe, clinically applicable way. Herein, we report that a purified and optimized mRNA in a biocompatible citrate-saline formulation is tissue specific, long acting, and does not stimulate an immune response. In small- and large-animal, permanent occlusion myocardial infarction models, VEGF-A 165 mRNA improves systolic ventricular function and limits myocardial damage. Following a single administration a week post-infarction in mini pigs, left ventricular ejection fraction, inotropy, and ventricular compliance improved, border zone arteriolar and capillary density increased, and myocardial fibrosis decreased at 2 months post-treatment. Purified VEGF-A mRNA establishes the feasibility of improving cardiac function in the sub-acute therapeutic window and may represent a new class of therapies for ischemic injury.

The aim of this study was to characterize the blood-brain barrier (BBB) transport and pharmacokinetics-pharmacodynamics (PKPD) relationship of oxymorphone and to further elucidate its possible contribution to oxycodone analgesia. The BBB transport of oxymorphone was studied using microdialysis in male Sprague-Dawley rats. Samples from microdialysis blood and brain probes, brain tissue, and plasma were analyzed by liquid chromatography with tandem mass spectrometry. The effect was measured as tail-flick latency. The study consisted of a PKPD experiment with combined microdialysis and antinociceptive measurements (n = 8), and another antinociceptive effect experiment (n = 9) using a 10 times lower dose. The combined data were analyzed with an integrated PKPD model in nonlinear mixed effect modeling utilizing a specific method (M3) for handling missing PD observations. The concentration of unbound oxymorphone was higher in brain than in blood, with a ratio of 1.9 (RSE, 9.7%), indicating active uptake at the BBB. The integrated PKPD model described the oxymorphone BBB transport and PKPD relationship successfully, with an EC50 in the brain of 63 ng/mL, and the M3 method was able to address the issue of censored observations. Oxymorphone has active uptake transport at the BBB in rats, with moderate uptake clearance to the brain. Its contribution to analgesia after oxycodone administration is not significant.

The purpose of this study was to develop a whole-body physiologically based pharmacokinetic (WB-PBPK) model for ciprofloxacin for ICU patients, based on only plasma concentration data. In a next step, tissue and organ concentration time profiles in patients were predicted using the developed model. The WB-PBPK model was built using a non-linear mixed effects approach based on data from 102 adult intensive care unit patients. Tissue to plasma distribution coefficients (Kp) were available from the literature and used as informative priors. The developed WB-PBPK model successfully characterized both the typical trends and variability of the available ciprofloxacin plasma concentration data. The WB-PBPK model was thereafter combined with a pharmacokinetic–pharmacodynamic (PKPD) model, developed based on in vitro time-kill data of ciprofloxacin and Escherichia coli to illustrate the potential of this type of approach to predict the time-course of bacterial killing at different sites of infection. The predicted unbound concentration–time profile in extracellular tissue was driving the bacterial killing in the PKPD model and the rate and extent of take-over of mutant bacteria in different tissues were explored. The bacterial killing was predicted to be most efficient in lung and kidney, which correspond well to ciprofloxacin’s indications pneumonia and urinary tract infections. Furthermore, a function based on available information on bacterial killing by the immune system in vivo was incorporated. This work demonstrates the development and application of a WB-PBPK–PD model to compare killing of bacteria with different antibiotic susceptibility, of value for drug development and the optimal use of antibiotics . Electronic supplementary material The online version of this article (doi:10.1007/s10928-016-9486-9) contains supplementary material, which is available to authorized users.

Morphine has been predicted to show nonlinear blood-brain barrier transport at lower concentrations. In this study, we investigated the possibility of separating active influx of morphine from its efflux by using very low morphine concentrations and compared accelerator mass spectrometry (AMS) with liquid chromatography-tandem mass spectrometry (LC-MS/MS) as a method for analyzing microdialysis samples. A 10-min bolus infusion of morphine, followed by a constant-rate infusion, was given to male rats (n = 6) to achieve high (250 ng/ml), medium (50 ng/ml), and low (10 ng/ml) steady-state plasma concentrations. An additional rat received infusions to achieve low (10 ng/ml), very low (2 ng/ml), and ultralow (0.4 ng/ml) concentrations. Unbound morphine concentrations from brain extracellular fluid and blood were sampled by microdialysis and analyzed by LC-MS/MS and AMS. The average partition coefficient for unbound drug (K(p,uu)) values for the low and medium steady-state levels were 0.22 ± 0.08 and 0.21 ± 0.05, respectively, when measured by AMS [not significant (NS); p = 0.5]. For the medium and high steady-state levels, K(p,uu) values were 0.24 ± 0.05 and 0.26 ± 0.05, respectively, when measured by LC-MS/MS (NS; p = 0.2). For the low, very low, and ultralow steady-state levels, K(p,uu) values were 0.16 ± 0.01, 0.16 ± 0.02, and 0.18 ± 0.03, respectively, when measured by AMS. The medium-concentration K(p,uu) values were, on average, 16% lower when measured by AMS than by LC-MS/MS. There were no significant changes in K(p,uu) over a 625-fold concentration range (0.4-250 ng/ml). It was not possible to separate active uptake transport from active efflux using these low concentrations. The two analytical methods provided indistinguishable results for plasma concentrations but differed by up to 38% for microdialysis samples; however, this difference did not affect our conclusions.

It is essential to establish a useful validation method for newly generated humanized mouse models. The novel approach of combining our established species-specific protein quantification method combined with in vivo functional studies is evaluated to validate a humanized mouse model of P-gp/MDR1 efflux transporter. The P-gp substrates digoxin, verapamil and docetaxel were administered to male FVB Mdr1a/1b(+/+) (FVB WT), FVB Mdr1a/1b(-/-) (Mdr1a/1b(-/-)), C57BL/6 Mdr1a/1b(+/+) (C57BL/6 WT) and humanized C57BL (hMDR1) mice. Brain-to-plasma total concentration ratios (K-p) were measured. Quantitative targeted absolute proteomic (QTAP) analysis was used to selectively quantify the protein expression levels of hMDR1, Mdr1a and Mdr1b in the isolated brain capillaries. The protein expressions of other transporters, receptors and claudin-5 were also quantified. The K-p for digoxin, verapamil, and docetaxel were 20, 30 and 4 times higher in the Mdr1a/1b(-/-) mice than in the FVB WT controls, as expected. The K-p for digoxin, verapamil and docetaxel were 2, 16 and 2-times higher in the hMDR1 compared to the C57BL/6 WT mice. The hMDR1 mice had 63- and 9.1-fold lower expressions of the hMDR1 and Mdr1a proteins than the corresponding expression of Mdr1a in C57BL/6 WT mice, respectively. The protein expression levels of other molecules were almost consistent between C57BL/6 WT and hMDR1 mice. The P-gp function at the BBB in the hMDR1 mice was smaller than that in WT mice due to lower protein expression levels of hMDR1 and Mdr1a. The combination of QTAP and in vivo functional analyses was successfully applied to validate the humanized animal model and evaluates its suitability for further studies.

Diphenhydramine (DPHM) and oxycodone are weak bases that are able to form cations. Both drugs show active uptake at the blood-brain barrier (BBB). There is thus a possibility for a pharmacokinetic interaction between them by competition for the same uptake transport system. The experiments of the present study were designed to study the transport of DPHM across the BBB and its interaction with oxycodone in vitro and in vivo. In vitro ,t he interaction between the drugs was studied using conditionally immortalized rat brain capillary endothelial cells (TR-BBB13 cells). The in vivo relevance of the in vitro findings was studied in rats using brain and blood microdialysis. DPHM was actively transported across the BBB in vitro (TR-BBB13 cells). Oxycodone competitively inhibited DPHM uptake with a Ki value of 106 :M. DPHM also competitively inhibited oxycodone uptake with a Ki value of 34.7 :M. In rats, DPHM showed fivefold higher unbound concentration in brain interstitial fluid (ISF) than in blood, confirming a net active uptake. There was no significant interaction between DPHM and oxycodone in vivo. This accords with the results of the in vitro experiments because the unbound plasma concentrations that could be attained in vivo, without causing adverse effects, were far below the Ki values. © 2011 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 100:3912-3923, 2011

In this article, two significant elements in social media websites, system operation, and social technology are examined in connection to website visitors' online loyalty and interaction, namely, commitment and satisfaction, in neighborhood management through social media websites. A total of 287 social media users completed a systematic questionnaire. After confirmatory factor analysis, data were examined in AMOS 24 using structural equation modeling with bootstrap. The research showed that both variables indirectly influence website visitors' online loyalty and interaction via trust and satisfaction, but not directly. Online relationship quality characteristics impact the interaction pattern of social media users after changes in services applied by the respective organizations on their websites. As for managers, the research gives crucial data on user behavior in connection to new services launched by organizations on their websites and shows how value creation to the target audience may help them reduce costs and optimize revenues.