Load frequency control of multi-area power system incorporated renewable energy considering electrical vehicle effect using modified cascaded controller tuned by BESSO algorithm.

In power systems, load frequency control (LFC) matters significantly to achieve stability. Dealing with the fluctuations in the frequency of a multi-area power system becomes more challenging by incorporating additional energy resources. In this research, a multi-area power system is built by integrating thermal power systems with photovoltaic (PV) cells, wind turbines, and electric vehicles (EV). The addition of an electric vehicle "to a thermal power system which is integrated with a renewable energy source (RES)" increases the system productivity but also increases the system complexity, making it more problematic for LFC. Looking at the stability criteria for LFC, frequencies in two areas (Area-1 & Area-2) and tie-line power are considered for measurements. For the tuning of the proposed cascaded (1+PI)-PID controller, a new approach Bald Eagle Sparrow Search Optimization (BESSO) algorithm is implemented which is strongly inspired by nature. BESSO is a combination of bald eagle and sparrow searching techniques and performs comparatively better for fast convergence due to their strong food-seeking natural behavior to find the best solution for controller gains. Controller effects on multi-area systems are compared with the addition of PV, wind, and EV and resulting measurements meet the stability criteria with high accuracy even with the complexity of the system and also undertake a stability analysis to prove the performance by minimizing undershoot, overshoot, steady-state error and settling time for system frequencies and tie-line power. Simulation results are examined at different load-changing conditions. In contrast with similar combinations of PID controller with proposed cascaded (1+PI)-PID controller, it is claimed that the effect of the proposed controller is much finer and more reliable, even with electric vehicles to avoid system blackout caused by frequency fluctuations in interconnected power system.

Enhancing QoS of Telecom Networks through Server Load Management in Software-Defined Networking (SDN).

In the modern era, with the emergence of the Internet of Things (IoT), big data applications, cloud computing, and the ever-increasing demand for high-speed internet with the aid of upgraded telecom network resources, users now require virtualization of the network for smart handling of modern-day challenges to obtain better services (in terms of security, reliability, scalability, etc.). These requirements can be fulfilled by using software-defined networking (SDN). This research article emphasizes one of the major aspects of the practical implementation of SDN to enhance the QoS of a virtual network through the load management of network servers. In an SDN-based network, several servers are available to fulfill users' hypertext transfer protocol (HTTP) requests to ensure dynamic routing under the influence of the SDN controller. However, if the number of requests is directed to a specific server, the controller is bound to follow the user-programmed instructions, and the load on that server is increased, which results in (a) an increase in end-to-end user delay, (b) a decrease in the data transfer rate, and (c) a decrease in the available bandwidth of the targeted server. All of the above-mentioned factors will result in the degradation of network QoS. With the implementation of the proposed algorithm, dynamic active sensing server load management (DASLM), on the SDN controller, the load on the server is shared based on QoS control parameters (throughput, response time, round trip time, etc.). The overall delay is reduced, and the bandwidth utilization along with throughput is also increased.

A discursive presentation of community pharmacies: Premises, storage, staff, documentation and legal compliance.

Objectives: This study aimed to assess compliance with legal requirements, safe medication storage and staffing standards in community pharmacies in Punjab, Pakistan. Method: We conducted a three-step cross-sectional study using observations, questionnaires and face-to-face interviews in 544 systematically-selected community pharmacies. We used descriptive statistic and one-way ANOVA to assess the data. Results: Only 23 (4.2 %) pharmacies had accurate area and only 3.9 % had appropriate walls. In total, 23.3 % had glass-fronted shelves and 38.2 % had a glass door. More than half (53.8 %) had separate narcotics shelves and 43.0 % a separate shelf of expired medicines. Less than half (47.5 %) of the pharmacies were able to maintain hygiene. About 36.2 % of the pharmacies segregated different types of product. Drugs were protected from direct sunlight in most (61.3 %) pharmacies, but the refrigerator was working properly in less than half (43.4 %) and only a very small number (2.4 %) had an alternative power supply for the refrigerator. Only 37 (6.8 %) were able to maintain an appropriate room temperature. The vast majority (93.0 %) displayed a valid drug sale license, but a qualified person/pharmacist was only present in 4.8 %. The average number of employees was 4.2, and more than 71.0 % of staff had 10-12 years of formal education. Only 0.2 % of employees could explain term "PRN", although 57.3 % explained "IV" correctly. About 22.8 % replied correctly about the room temperature but the vast majority (97.6 %) did not know about cold chain temperature. The location of the pharmacy (p-value = 0.045) affected its performance. Conclusions: Noncompliance with legal requirements, unsafe drug storage and limited human resources reflect the poor enforcement of drug laws in Pakistan. The findings suggest that there is a need to strengthen inspection and management of community pharmacies.

Evaluating the Counseling Standards and Ability of Pharmacy Staff to Detect Antibiotic-Drugs Interactions: A Simulated Client Study from Pakistan.

Effective and safe medication use can be maximized by providing medication counseling, which aims to optimize therapeutic results. This approach improves the effectiveness of antibacterial treatment, reduces treatment expenses, and mitigates the emergence of antimicrobial resistance. No research from Pakistan has been previously documented. The purpose of this research was to evaluate both the quality of antibiotic counseling provided and the level of understanding exhibited by pharmacy employees with regard to interactions involving antibiotic medications. Using a simulated client method, two scenarios were used to assess 562 pharmacies that were systematically selected. Scenario 1 focused the counseling for use of prescribed medicines with non-prescribed antibiotics. Scenario2 indicated counseling provision for prescribed antibiotics that have possible antibiotic-drug interactions. The evaluation of counseling skills was also conducted. The analysis involved the use of descriptive statistics and chi-square tests. Only 34.1% of simulated clients received medication counseling directly; 45% received it on request. About 31.2% of clients were referred to a physician without counseling. The most frequently provided information was therapy dose (81.6%) and duration (57.4%). More than half (54.0%) of clients were asked about disease duration, but drug storage was ignored. Insufficient information was provided about side effects (1.1%) and antibiotic-drug interactions (1.4%). Most (54.3%) clients were instructed about dietary or lifestyle modifications. Only 1.9% of clients received information about drug administration route. No information was provided about other medication during therapy, effect of medicine withdrawal, and compliance to medication. The current level of antibiotic counseling within Pakistani community pharmacies is inadequate and requires the attention of medical authorities. Professional training of staff could improve counseling.

Effects of Inclusive Leadership on Quality of Care: The Mediating Role of Psychological Safety Climate and Perceived Workgroup Inclusion.

PURPOSE: The aim of the study is to investigate the multilevel effects of the inclusiveness of workgroup leaders on quality of care by intervening through a "psychological safety climate" at the group level and "perceived workgroup inclusion" at the individual level within professionally diverse workgroups of healthcare professionals. MATERIAL AND METHODS: Data are collected from 305 healthcare professionals nested in 61 workgroups and 305 patients treated by the same workgroups working in public-sector hospitals in Pakistan. Hypothesized relationships are tested through multilevel analyses using Mplus 7. RESULTS: The results of the study show that inclusive leadership can enhance the quality of care delivered by multiprofessional workgroups of healthcare professionals through perceived workgroup inclusion. Further, the psychological safety climate does not mediate the relationship between inclusive leadership and quality of care individually, but it transmits the effects of inclusive leadership through perceived workgroup inclusion on quality of care. CONCLUSION: The results of the study suggest that the inclusiveness of workgroup leaders, the psychological safety climate, and perceived workgroup inclusion can create safe and inclusive interpersonal mechanisms that play a key role in transmitting the positive effects of inclusive leadership on quality of care.

Optimal Energy Management System of IoT-Enabled Large Building Considering Electric Vehicle Scheduling, Distributed Resources, and Demand Response Schemes.

In the energy system, various sources are used to fulfill the energy demand of large buildings. The energy management of large-scale buildings is very important. The proposed system comprises solar PVs, energy storage systems, and electric vehicles. Demand response (DR) schemes are considered in various studies, but the analysis of the impact of dynamic DR on operational cost has been ignored. So, in this paper, renewable energy resources and storages are integrated considering the demand response strategies such as real-time pricing (RTP), critical peak pricing (CPP), and time of use (ToU). The proposed system is mapped in a linear model and simulated in MATLAB using linear programming (LP). Different case studies are investigated considering the dynamic demand response schemes. Among different schemes, results based on real-time pricing (58% saving) show more saving as compared to the CPP and ToU. The obtained results reduced the operational cost and greenhouse gas (GHG) emissions, which shows the efficacy of the model.

Conferring of drought tolerance in wheat (Triticum aestivum L.) genotypes using seedling indices.

Wheat is the most widely grown and consumed crop because of its economic and social benefits. This crop is more important globally for food and feed, and its productivity is particularly vulnerable to abiotic factors. In this study, 40 wheat genotypes were studied to access the drought tolerance level using completely randomized design (CRD) in 250 ml disposable cups through morpho-physiological attributes at seedling stage. The wheat germplasm was tested under normal and two drought stress level D1 (50% field capacity) and D2 (75% field capacity) for different seedling attributes such as germination percentage (GP), chlorophyll content (CC), shoot length (SL), root length (RL), shoot fresh weight (SFW), root fresh weight (RFW), seedling fresh weight (SDFW), shoot dry weight (SDW), root dry weight (RDW), relative water content (RWC), root/shoot ratio (RS), and seedling dry weight (SeDW). The results of analysis of variance (ANOVA) and spider analysis indicate that significant amount of genetic variation was present and behavior of studied germplasm showed different behavior in different environment. The correlation analysis showed that root length has significantly positive association with root/shoot ratio, dry weight, and fresh weight while negatively correlated with shoot length and relative water content. Based on the positively associated traits, the studied genetic material would improve genetic gain for drought tolerance. The multivariate analysis showed that out 13 principal components only five PCs were significant and has eigenvalue > 1, cumulatively showed 82.33, 83.07, and 97.34% of total variation under normal, D1 and D2 conditions, respectively. Significantly, the result of spider graph and multivariate analysis showed that genotypes G47, G48, G65, G68, and G80 performed well in all drought stress conditions and considered as drought-tolerant genotypes. The best performing genotypes can be used in future breeding programs. The selection on the bases of studied attributes is effective for development of drought-tolerant and high-yielding varieties for sustainable food security.

Scheduling and Sizing of Campus Microgrid Considering Demand Response and Economic Analysis.

Current energy systems face multiple problems related to inflation in energy prices, reduction of fossil fuels, and greenhouse gas emissions which are disturbing the comfort zone of energy consumers and the affordability of power for large commercial customers. These kinds of problems can be alleviated with the help of optimal planning of demand response policies and with distributed generators in the distribution system. The objective of this article is to give a strategic proposition of an energy management system for a campus microgrid (µG) to minimize the operating costs and to increase the self-consuming energy of the green distributed generators (DGs). To this end, a real-time based campus is considered that currently takes provision of its loads from the utility grid only. According to the proposed given scenario, it will contain solar panels and a wind turbine as non-dispatchable DGs while a diesel generator is considered as a dispatchable DG. It also incorporates an energy storage system with optimal sizing of BESS to tackle the multiple disturbances that arise from solar radiation. The resultant problem of linear mathematics was simulated and plotted in MATLAB with mixed-integer linear programming. Simulation results show that the proposed given model of energy management (EMS) minimizes the grid electricity costs by 668.8 CC/day ($) which is 36.6% of savings for the campus microgrid. The economic prognosis for the campus to give an optimum result for the UET Taxila, Campus was also analyzed. The general effect of a medium-sized solar PV installation on carbon emissions and energy consumption costs was also determined. The substantial environmental and economic benefits compared to the present situation have prompted the campus owners to invest in the DGs and to install large-scale energy storage.

Access to Insulin Products in Pakistan: A National Scale Cross-Sectional Survey on Prices, Availability, and Affordability.

Background: Diabetes is among the top ten most prevalent diseases in Pakistan, and the availability of medicines to treat the disease is vital for a great percentage of the country's population. Insulin was discovered a century ago; however, its access in several parts of the globe remains an issue. This study aims to evaluate prices, availability, and affordability (access components) of insulin and five comparator medicine access in Pakistan. Methods: A nationwide cross-sectional survey was conducted to evaluate the access to insulin and some comparator medicines in eight cities of Pakistan, using a modified WHO/HAI methodology. The survey included 80 medicine outlets, i.e., 40 private pharmacies and 40 public hospitals. Data for every unique insulin product available in the Pakistani market were obtained, including five comparator medicines. Percentage availability, median unit prices (MUPs), and affordability (the number of days' wages (NDWs) required for a month's course by the lowest-paid unskilled government worker) of all products were calculated, including originator brands (OBs) and biosimilar (BS) products. Results: Of all insulin products surveyed (n = 320), 87.5% were manufactured by foreign multinational companies (MNCs). None of the insulin products had an ideal availability of 80% in any of the surveyed health facilities. In the public sector, none of the insulin products had an availability of more than 50%. In the public sector, the overall availability of human insulin was 70% (including OB and BS). While in the private sector, the overall availability of human insulin was 90% and that of analog insulin was 62.5%. The analog insulin products were 72.8% costlier than the human insulin products. The median prices of BS insulin were 25.4% lower than the OB products, indicating that almost one-fourth of the cost could be saved by switching to BS human insulin from OB human insulin. All oral anti-diabetic medicines were found to be affordable, whereas none of the insulin was affordable. The NDWs for human and analog insulin were 1.38 and 5.06. Conclusion: In Pakistan, the insulin availability falls short of the WHO's benchmark of 80%. Insulin continues to be unaffordable in both private and government sectors. To increase insulin access, the government should optimize insulin procurement at all levels, promote local production, enforce biosimilar prescribing, and provide financial subsidies for these products.

Satellitome Analysis and Transposable Elements Comparison in Geographically Distant Populations of Spodoptera frugiperda.

Spodoptera frugiperda (fall armyworm) is a member of the superfamily Noctuoidea that accounts for more than a third of all Lepidoptera and includes a considerable number of agricultural and forest pest species. Spodoptera frugiperda is a polyphagous species that is a significant agricultural pest worldwide, emphasizing its economic importance. Spodoptera frugiperda's genome size, assembly, phylogenetic classification, and transcriptome analysis have all been previously described. However, the different studies reported different compositions of repeated DNA sequences that occupied the whole assembled genome, and the Spodoptera frugiperda genome also lacks the comprehensive study of dynamic satellite DNA. We conducted a comparative analysis of repetitive DNA across geographically distant populations of Spodoptera frugiperda, particularly satellite DNA, using publicly accessible raw genome data from eight different geographical regions. Our results showed that most transposable elements (TEs) were commonly shared across all geographically distant samples, except for the Maverick and PIF/Harbinger elements, which have divergent repeat copies. The TEs age analysis revealed that most TEs families consist of young copies 1-15 million years old; however, PIF/Harbinger has some older/degenerated copies of 30-35 million years old. A total of seven satellite DNA families were discovered, accounting for approximately 0.65% of the entire genome of the Spodoptera frugiperda fall armyworm. The repeat profiling analysis of satellite DNA families revealed differential read depth coverage or copy numbers. The satellite DNA families range in size from the lowest 108 bp SfrSat06-108 families to the largest (1824 bp) SfrSat07-1824 family. We did not observe a statistically significant correlation between monomer length and K2P divergence, copy number, or abundance of each satellite family. Our findings suggest that the satellite DNA families identified in Spodoptera frugiperda account for a considerable proportion of the genome's repetitive fraction. The satellite DNA families' repeat profiling revealed a point mutation along the reference sequences. Limited TEs differentiation exists among geographically distant populations of Spodoptera frugiperda.

Genome-wide association mapping of bread wheat genotypes for sustainable food security and yield potential under limited water conditions.

Determining the genetic basis of yield and water deficient tolerance in wheat is vital for wheat breeding programs. Herein, a genome-wide association study (GWAS) was performed for water deficient and yield-related attributes on wheat genotypes with high-density Illumina 90K Infinium SNP array. Major yield and drought-related attributes were phenotyped on a panel of Pakistani and foreign accessions grown in non-stressed and water deficient stressed environments during two crop cycles. Among all accessions, highly significant variations were shown in studied environments for examined characters. Water deficient conditions, reduced the wheat yield and had strong and positive correlation among relative water content and grain yield per plant. Population structure analyses based on 90,000 SNP data, classify the accessions into 4 sub-populations. Marker-trait association analyses (MTA) revealed that 134 significant SNPs were linked with yield and drought tolerance attributes. Pleotropic loci RAC875_s117925_244 and RAC875_c16333_340 located on chromosome 5A and 2A respectively, were significantly linked with relative water contents (RWC), cell membrane thermo-stability (CMT), grain per spike (GPS), spikelet per spike (SPS) and grain yield per plant (GYP). The markers Ra_c58279_684, BobWhite_c23828_341 and IAAV3414 located on chromosomes 2A, 6B and 7B respectively, showed pleotropic effects for RWC, GPS and GYP under both environments. The current experiment not only validated several MTAs reported in other studies but also discovered novel MTAs which significant under drought-stressed conditions. A total of 171 candidate genes were recognized that could be cloned and functionally characterized for the respective associated traits. For RWC and CMT, total 11 and 3 associated SNPs were mapped on coding DNA sequence (CDS) of the identified candidate genes. Isolation and characterization of the candidate genes herein mapped SNPs will be useful in discovering novel genes underpinning drought tolerance in bread wheat to fulfill the wheat demand and sustainable food security under limited water conditions.

Assessment of Adherence to the Core Elements of Hospital Antibiotic Stewardship Programs: A Survey of the Tertiary Care Hospitals in Punjab, Pakistan.

Background: To restrain antibiotic resistance, the Centers for Disease Control and Prevention (CDC), United States of America, urges all hospital settings to implement the Core Elements of Hospital Antibiotic Stewardship Programs (CEHASP). However, the concept of hospital-based antibiotic stewardship programs is relatively new in Low- and Middle-Income Countries. Aim: To appraise the adherence of the tertiary care hospitals to seven CEHASPs. Design and Setting: A cross-sectional study in the tertiary care hospitals in Punjab, Pakistan. Method: CEHASP assessment tool, (a checklist) was used to collect data from the eligible hospitals based on purposive sampling. The check list had 19 statements to cover seven CEHASPs: Hospital Leadership Commitment, Accountability, Pharmacy Expertise, Action (Implement Interventions to Improve Antibiotic Use), Tracking Antibiotic Use and Outcomes, Reporting Antibiotic Use and Outcomes, and Education. For each statement, a response of "YES", "NO" or "Under Process" constituted a score of 2, 0 and 1, respectively, where the higher the scores the better the adherence. Categorical variables were described through descriptive statistics, while independent t-test computed group differences. Result: A total of 68 hospitals (n = 33 public, n = 35 private) participated with a response rate of 79.1%. No hospital demonstrated "Perfect" adherence. Roughly half private (48.6%) and more than half public (54.5%) sector hospitals were "Poor" in adherence. Based on the mean score, there was no significant difference between the private and the public hospitals in terms of comparison of individual core elements. The two most neglected core elements emerged as top priority area were: Reporting Antibiotic Use and Outcomes and Tracking Antibiotic Use and Outcomes.Conclusion: The current response of Pakistan to implement hospital-based antibiotic stewardship programs is inadequate. This study points out significant gaps of practice both in public and private tertiary care hospitals. A majority of the core elements of antibiotic stewardship are either absent or "Under Process". The deficiency/priority areas mentioned require immediate attention of the concerned stakeholders in Pakistan.

A Conceptual Framework of the Way Forward to a Community Pharmacist-General Practitioner Collaborative Medication Therapy Management Model for Chronic Diseases in Malaysian Primary Care: A Qualitative Study.

BACKGROUND: There is a growing global interest in formulating such policies and strategic plans that help devise collaborative working models for community pharmacists (CPs) and general practitioners (GPs) in primary care settings. OBJECTIVE: To conceptualize a stakeholder-driven framework to improve collaboration between CPs and GPs in Malaysian primary care to effectively manage medicines in chronic diseases. DESIGN AND SETTING: A qualitative study that involved individual semi-structured interviews of the leadership of various associations, guilds, and societies representing CPs, GPs, and Nurses in Malaysia. METHODS: This study collected and reported data in accordance with the guidelines of the Consolidated Criteria for Reporting of Qualitative Studies. Key informants were recruited based on purposive (expert) sampling. Interviews were transcribed verbatim and data were coded based on the principles of thematic analysis in NVivo. RESULTS: A total of 12 interviews (5 CPs, 5 GPs, and 2 nurses) were conducted. Five themes emerged: Theme 1 highlighted a comparison of community pharmacy practice in Malaysia and developed countries; Theme 2 involved current practices in Malaysian primary care; Theme 3 encompassed the advantages of CP-GP collaboration in chronic diseases; Theme 4 highlighted the barriers which impede collaboration in Malaysian primary care; and Theme 5 delineated the way forward for CP-GP collaboration in Malaysia. CONCLUSION: The actionable insights obtained from the Malaysian stakeholders offered an outline of a framework to enhance collaboration between CPs and GPs in primary care. Generally, stakeholders were interested in CP-GP collaboration in primary care and identified many positive roles performed by CPs, including prescription review, adherence support, and patient education. The framework of the way forward includes: separation of CP and GP roles through a holistic revision of relevant legislation to grant an active role to CPs in chronic care; definition of protocols for collaborative practices; incentivization of both stakeholders (CPs and GPs); and design and implementation of an effective regulatory mechanism whereby the Malaysian Ministry of Health may take a leading role.

Impact of National Drug Pricing Policy 2018 on access to medicines in Lahore division, Pakistan: a pre-post survey study using WHO/HAI methodology.

OBJECTIVE: To evaluate the impact of new National Drug Pricing Policy (NDPP) 2018 on access to medicines in terms of prices, availability and affordability. DESIGN: Two cross-sectional surveys were undertaken before and after the launch of NDPP 2018, using a modified WHO/Health Action International (WHO/HAI) methodology. SETTING: Four districts of Lahore division, Pakistan. PARTICIPANTS: 16 public sector hospitals and 16 private sector retail pharmacies. MEASURES: The pre and post survey data on prices and availability of lowest price generics (LPGs) and originator brands (OBs) of 50 medicines were obtained by visiting the same public and private sector health facilities (n=32). Out of 50, 46 surveyed medicines were from the National Essential Medicines List. Inflation-adjusted median unit prices (MUPs) and median price ratios (MPRs) from 2019 were used for price comparison. Affordability was calculated in terms of number of days' wages required to get a standard treatment by the lowest paid unskilled government worker. RESULTS: The overall mean percent availabilities remained poor in both years, that is, far less than 80%. In the public sector, the mean percent availability of OBs improved from 6.8% to 33.1%, whereas, in the case of LPGs, it was reduced from 35.1% to 9%. In the private sector, the mean percent availability of both OBs and LPGs demonstrated slight improvements in 2019, that is, 55.0%-58.3% and 20.3%-32.3%. The adjusted MUPs and MPRs of OBs significantly increased by a median of 4.29% (Wilcoxon test p=0.001, p=0.0001), whereas the adjusted MUPs and MPRs of LPGs increased by a median of 15.7% (p=0.002, p=0.0002). Overall, the affordability of many medicines for common ailments was reduced significantly in 2019. CONCLUSIONS: The availability of medicines slightly improved, except in the case of LPGs, which was reduced in the public sector. The implementation of NDPP 2018 led to increase in drug prices, making the standard treatment for some of the most prevalent ailments unaffordable. So verily, the drug pricing policy must be reviewed to ensure access to essential medicines.

Knowledge, attitude and practices among consumers toward antibiotics use and antibiotic resistance in Swat, Khyber-Pakhtunkhwa, Pakistan.

Objective: Inappropriate use of antibiotics is one of the main causes of antibiotic resistance around the globe. The present study was aimed to assess the knowledge, attitude, and practices toward antibiotics and antibiotic resistance among consumers. Methods: A cross-sectional study was conducted from April 2019 to September 2019. The participants visiting community pharmacies to buy the antibiotics were approached by data collectors. The descriptive analysis, Kruskal Wallis, and Mann-Whitney statistical tests were used for data analysis through SPSS. Results: 399 participants at three pharmacies with male (n = 352, 88.2%), age (years) group between 34 to 41(n = 138, 34.6%), uneducated (n = 128, 32.1%), and higher education (n = 76, 19.0%) level of the participants were noted. Poor to moderate knowledge were observed; participants were unaware of the risk and misuse of antibiotics at all three pharmacies. By some means, a positive attitude noted, but the storage of antibiotics at home (Median = 2, IQR = 2) was preferred to use when needed. Most of the respondents didn't follow the actual dosage regimen as prescribed (n = 266, 66.7%, p < 0.05). Conclusion: A lack of knowledge and malpractices toward antibiotics use among consumers were observed. Education and awareness of the public about antibiotic resistance is the need of the hour.

Association of medication storage with diabetes control: A cross-sectional study from Saudi Arabia.

BACKGROUND: In addition to diet restriction and physical activity, diabetes mellitus is managed by the chronic use of medications that require appropriate storage conditions to maintain their stability and effectiveness. However, there is a lack of information regarding patients' knowledge of medication storage and practices in Saudi Arabia. Therefore, the objective of this study was to determine the diabetics' knowledge about medication storage requirements and to evaluate the impact of antidiabetic medications storage on the blood glucose levels. METHODS: This study was a cross-sectional in the form of an interviewer-guided interview using a close-ended questions. The study was conducted among patients diagnosed with diabetes at diabetic clinics of public hospitals and other diabetic specialized clinics in Hail region of Saudi Arabia, over a period of four months between January to April 2019. RESULTS: A total of 501 completed questionnaires were returned. Of the respondents, 51.5% were males and 48.5% were females. Of the total participants 52.7% never achieved normal blood glucose range, which was associated with health literacy and medication storage knowledge. Almost half of the participants stored the medication correctly and others have poor knowledge and practice of medication storage, of whom 7.8% always store their medicines in their cars. CONCLUSION: Almost half of the participants lack the knowledge of appropriate storage conditions of diabetes medications, which was shown to have a significant association with blood glucose levels.

Access to Essential Cardiovascular Medicines in Pakistan: A National Survey on the Availability, Price, and Affordability, Using WHO/HAI Methodology.

Objective: This national survey was aimed at measuring the access to cardiovascular disease (CVD) medicines in terms of their availability, price, and affordability in Pakistan. This was done by using the standard WHO/Health Action International (HAI) methodology. Methods: The price and availability data for 18 CVD medicines were collected from public sector hospitals (n = 40) and private sector retail pharmacies (n = 40) in eight cities of Pakistan. The outcome measures were availability (calculated as percentage of health facilities stocked with listed medicines), medicine price to the international reference price ratio (i.e., median price ratio (MPR)), and affordability (calculated as number of days' wages (NDWs) of the lowest paid unskilled government worker required to afford one-month treatment of a chronic disease). The affordability of standard treatment in Pakistan with four CVD drugs was compared with data from six other low and middle income countries (LMICs) using HAI database. Findings: The mean percent availability of CVD medicines was significantly low (p < 0.001) in the public sector as compared to the private sector, that is, 25.5% vs. 54.6% for originator brands (OBs) and 30.4% vs. 34.9% for lowest price generics (LPGs), respectively. For all OBs and LPGs, the inflation-adjusted mean MPR was 2.72 and 1, respectively. CVD medicines were found to be unaffordable with average NDWs of 6.4 and 2.2 for OBs and LPGs, respectively, that is, NDWs of more than 1. In international comparison with countries such as Sudan, Lebanon, Egypt, India, Afghanistan, and China, the affordability of standard treatment with selected CVD medicines (atenolol, amlodipine, captopril, and simvastatin) in Pakistan was found to be low. Overall, all four OBs and three out of four LPGs of selected CVD drugs were found unaffordable in Pakistan. Conclusion: This data indicated that the availability of selected CVD medicines was low in both public and private sector medicine outlets. Both OBs and LPGs were found unaffordable in the private sector, necessitating the redressal of pricing policies, structuring, and their implementation.

Perspective of Pakistani Physicians towards Hospital Antimicrobial Stewardship Programs: A Multisite Exploratory Qualitative Study.

Background: Antimicrobial resistance (AMR) is a global threat and the antimicrobial stewardship program (ASP) is a globally used tool to combat AMR. There is little information on the views among Pakistani physicians regarding AMR and the benefits of hospital antimicrobial stewardship implementation. This study was designed to explore the physicians' views about ASP. Methods: Qualitative face-to-face and telephonic interviews were conducted by using purposive sampling method with 22 physicians working in seven tertiary care public hospitals of Punjab, Pakistan. All interviews were audio recorded and transcribed verbatim. Qualitative software was used, and a thematic analysis was conducted. Results: Three broad themes were identified: (1) the growing concern of antimicrobial resistance in Pakistan, (2) the role(s) of healthcare professionals in antibiotic prescribing, and (3) managing antibiotic resistance in hospitals. Inadequate resources, poor healthcare facilities, and insufficiently trained medical staff were the major hurdles in ASP implementation in Pakistan. Conclusions: Our study found a poor familiarity of hospital ASP among physicians working in public sector tertiary care teaching hospitals, and a number of distinct themes emerged during this study that could be helpful in establishing the concept of hospital ASP in Pakistan. Overall, physicians showed a positive attitude towards the enforcement of ASP in all healthcare settings, including teaching hospitals.

Healthcare professionals' knowledge, attitude and acceptance of influenza vaccination in Saudi Arabia: a multicenter cross-sectional study.

BACKGROUND: All healthcare professionals (HCPs) are at high risk of influenza infection. Therefore, immunization is recommended for all HCPs. Due to safety and effectiveness concerns, HCPs have a low vaccination rate. This study was designed to explore the attitude, awareness and knowledge of HCPs toward vaccination for influenza. METHOD: A cross-sectional study was performed during October-November 2016. A total of 405 questionnaires were distributed in 8 major hospitals in Saudi Arabia. A validated questionnaire consisting of 31 questions and 5 sections was administered. Statistical Analysis Software (SAS®) version 9.2 was used to analyze the data. RESULTS: A total of 364 HCPs responded to the study survey, which is a response rate of 90%. A large proportion (61.8%) of participants were female. The majority of the participants were nurses (60.4%). More than half of the respondents (57.7%) were working in government-run hospitals. Among all the participants, approximately 67.6% of HCPs were vaccinated. The majority (84.1%) of HCPs believed that influenza vaccine prevents the flu. Furthermore, approximately 75% of participants believed that HCPs can be more susceptible to influenza infections than other people. The majority of participants (89.6%) knew the proper signs and symptoms of influenza. HCPs' belief that vaccination prevents influenza infection (OR = 3.93, 95% CI = 1.97-7.82), their awareness of the Scientific Committee for Influenza and Pneumococcal Vaccination (SCIPV)'s guidelines (OR = 2. 13, 95% CI = 1.16-3.90) and the presence of the standing orders regarding influenza vaccine (OR = 1.57, 95% CI = 1.01-3.21), were the predictors for receipt of influenza vaccine by HCPs. Many (58.0%) respondents believed that vaccine safety concerns is a major barrier to the vaccination of HCPs. Some misconceptions, such as influenza infection due to vaccination (42.3%) and incorrect perceptions about the symptoms of influenza in adults (50.5%), were found. CONCLUSION: The acceptance of and participation in influenza vaccination by HCPs in Saudi Arabia appears to have markedly increased in the 2016 season. Continuing evaluation of vaccination practices is necessary, and more training programs are needed in the future.