Knowledge, attitudes, and practices of community pharmacists toward the management of acne vulgaris in Palestine: a cross-sectional study

Background Acne vulgaris (AV) is a common dermatological disease affecting almost 85% of teenagers. Patients with AV usually present at community pharmacies during the early stages of their disease. Aim The aim of this study was to assess community pharmacists’ knowledge, attitudes, and practice toward AV management in West Bank in Palestine. Methods This study was a cross-sectional questionnaire-based study. The questionnaire included four sections: 1) demographic, 2) knowledge, 3) attitude and practice items related causes, and 4) treatment options and counseling during management of patients with AV. A convenience sampling method was implemented in this study. Parametric and non-parametric tests were used to compare different issues as appropriate. P < 0.05 were considered significant. Result A total of 270 community pharmacists were interviewed, and more than half (54.1%) were males. The study revealed that community pharmacists had an inadequate level of knowledge on management of AV; only 7.7% had high levels of knowledge. Pharmacists have positive attitude regarding AV management, but inadequate knowledge was reflected on their treatment practices; only 10% of participants independently dealt with AV without referral. Pharmacists with a low level of knowledge showed five times more referrals than those with a high level of knowledge (OR: 5.3; P < 0.001), and those with a bachelor degree showed three times more referrals than postgraduates (OR: 3.3; P < 0.001). Conclusion There is a demand to update dermatological knowledge of community pharmacists and encourage them to attend structured training programs about the management of AV.Funding source: None

Perturbations of a Universe Filled with Dust and Radiation

A first-order perturbation approach to $k=0$ Friedmann cosmologies filled with dust and radiation is developed. Adopting the coordinate gauge comoving with the perturbed matter, and neglecting the vorticity of the radiation, a pair of coupled equations is obtained for the trace $h$ of the metric perturbations and for the velocity potential $v$. A power series solution with upwards cutoff exists such that the leading terms for large values of the dimensionless time $\xi$ agree with the relatively growing terms of the dust solution of Sachs and Wolfe.Comment: 9 pp, typeset in late

Chelating ion-exchange Properties of Polyurethane Resin Derived from Thiazolo[5,4-D]Thiozole

3,6-dihydrothiazolo [5, 4-d] thiazole which supported on polyurethane was synthesized. The prepared compound was characterized by FTIR and 1H NMR spectroscopy. The chelating properties towards various metal ions Pb2+, Mn2+, Cr3+, Co3+and Cd+3 was examined. The effects of concentration of metal ions, time of extraction and pH as well as the recovery of ions have been studied. The results showed that the high activity order of resin to extract the metal ions is Pb2&gt; Cd+3 &gt; Mn2+&gt;Cr3+&gt; Co3+. Keywords: thiazole, polyurethane, chelating resin, chelating efficiency, coordination polymer

A global framework for action to improve the primary care response to chronic non-communicable diseases: a solution to a neglected problem.

BACKGROUND: Although in developing countries the burden of morbidity and mortality due to infectious diseases has often overshadowed that due to chronic non-communicable diseases (NCDs), there is evidence now of a shift of attention to NCDs. DISCUSSION: Decreasing the chronic NCD burden requires a two-pronged approach: implementation of the multisectoral policies aimed at decreasing population-level risks for NCDs, and effective and affordable delivery of primary care interventions for patients with chronic NCDs. The primary care response to common NCDs is often unstructured and inadequate. We therefore propose a programmatic, standardized approach to the delivery of primary care interventions for patients with NCDs, with a focus on hypertension, diabetes mellitus, chronic airflow obstruction, and obesity. The benefits of this approach will extend to patients with related conditions, e.g. those with chronic kidney disease caused by hypertension or diabetes. This framework for a "public health approach" is informed by experience of scaling up interventions for chronic infectious diseases (tuberculosis and HIV). The lessons learned from progress in rolling out these interventions include the importance of gaining political commitment, developing a robust strategy, delivering standardised interventions, and ensuring rigorous monitoring and evaluation of progress towards defined targets. The goal of the framework is to reduce the burden of morbidity, disability and premature mortality related to NCDs through a primary care strategy which has three elements: 1) identify and address modifiable risk factors, 2) screen for common NCDs and 3) and diagnose, treat and follow-up patients with common NCDs using standard protocols. The proposed framework for NCDs borrows the same elements as those developed for tuberculosis control, comprising a goal, strategy and targets for NCD control, a package of interventions for quality care, key operations for national implementation of these interventions (political commitment, case-finding among people attending primary care services, standardised diagnostic and treatment protocols, regular drug supply, and systematic monitoring and evaluation), and indicators to measure progress towards increasing the impact of primary care interventions on chronic NCDs. The framework needs evaluation, then adaptation in different settings. SUMMARY: A framework for a programmatic "public health approach" has the potential to improve on the current unstructured approach to primary care of people with chronic NCDs. Research to establish the cost, value and feasibility of implementing the framework will pave the way for international support to extend the benefit of this approach to the millions of people worldwide with chronic NCDs

Necessity and concerns about lipid-lowering medical treatments and risk factors for non-adherence: A cross-sectional study in Palestine

Aims: Strong evidence indicates that drugs reduce blood lipids and improve cardiovascular end-points, leading to their wide usage. However, the success of these drugs can be affected by poor patient's adherence to prescribed medication. This study aimed to evaluate medication adherence in patients with dyslipidaemia in association with patient beliefs about medicines. Methods: The study was conducted from January 2019 to July 2019 at the middle governmental primary healthcare clinics in Ramallah and Bethlehem cities, and used a cross-sectional design. Adherence was determined using the 4-item Morisky medication adherence scale, while beliefs were determined using the Beliefs about Medicines Questionnaire. Results: Of 220 patients, 185 agreed to participate in the study, resulting in a response rate of 84.1%. Of the participants, 106 (57.3%) were men, and almost half (88, 46.5%) were ≥56 years. Medication non-adherence was high (47.6%), but a majority (65.5%) reported believing their treatment to be necessary for their continued good health. Accordingly, the mean necessity score (17.3, SD 3.7) significantly outweighed (P < .001) the mean concerns score (14.0, SD 3.5). Multivariate regression demonstrated four variables to be significantly correlated with non-adherence: illiterate (OR = 2.52; CI: 0.9-4.3; P = .03), polypharmacy (OR = 3.18; CI: 1.9-5.7; P = .007), having comorbidity (OR = 3.10; CI: 2.2-4.6; P = .005) and having concerns about side effects (OR = 2.89; CI: 1.1-4.6, P = .04). Conclusion: Non-adherence among patients taking lipid-lowering agents was high despite most holding positive beliefs regarding medication necessity. This may be due to concern also being high. Physicians should identify and target high-risk patients and individualise their treatment plans in order to achieve adequate control of dyslipidaemia.We thank all workers at health clinics at Ramallah and Bethlehem who helped in finishing this study and also we thank the participants who willingly accepted to share for the purpose of this study

Revealing design complexity: Lessons from the Open University

Design is an inherently complex activity. Design thinking is cognitively complex and design practice is contextually complex. This has implications for university-level design education which has traditionally displayed clear distinctions between the full-time and part-time undergraduate sectors, particularly in their teaching and learning strategies. However, a number of pressures and trends are evident which suggest that these two sectors are moving closer together. One of the drivers in this phenomenon is the need for students to be exposed to realistic levels of design complexity. This paper examines complexity in design and draws some significant parallels between modern design practice in general and the production of a new undergraduate course at the Open University. Both are used to illuminate design complexity. The paper suggests that some of the tools, techniques and approaches of part-time, undergraduate, distance design education might usefully be exploited in more traditional, full-time course models

A Source and Drain Transient Currents Technique for Trap Characterisation in AlGaN/GaN HEMTs

The source/drain and gate induced charge trapping within an AlGaN/GaN high electron mobility transistor is studied, under normal device operation, by excluding self-heating effects, for the first time. Through direct measurement of current transients of both source and drain terminals, a characterisation technique has been developed to: (i) analyse the transient current degradations from μs to seconds, and (ii) evaluate the drain and gate induced charge trapping mechanisms. Two degradation mechanisms of current are observed: bulk trapping at a short time (1ms). The bulk charge trapping is found to occur during both ON and OFF states of the device when VDS>0V; where its trapping time constant is independent of bias conditions. In addition, the time constant of the slower current degradation is found to be mainly dependent on surface trapping and redistribution, not by the second heat transient

Comparing various multi-component global heliosphere models

Modeling of the global heliosphere seeks to investigate the interaction of the solar wind with the partially ionized local interstellar medium. Models that treat neutral hydrogen self-consistently and in great detail, together with the plasma, but that neglect magnetic fields, constitute a sub-category within global heliospheric models. There are several different modeling strategies used for this sub-category in the literature. Differences and commonalities in the modeling results from different strategies are pointed out. Plasma-only models and fully self-consistent models from four research groups, for which the neutral species is modeled with either one, three, or four fluids, or else kinetically, are run with the same boundary parameters and equations. They are compared to each other with respect to the locations of key heliospheric boundary locations and with respect to the neutral hydrogen content throughout the heliosphere. In many respects, the models' predictions are similar. In particular, the locations of the termination shock agree to within 7% in the nose direction and to within 14% in the downwind direction. The nose locations of the heliopause agree to within 5%. The filtration of neutral hydrogen from the interstellar medium into the inner heliosphere, however, is model dependent, as are other neutral results including the hydrogen wall. These differences are closely linked to the strength of the interstellar bow shock. The comparison also underlines that it is critical to include neutral hydrogen into global heliospheric models.Comment: 10 pages, 4 figures, submitted to a special section at A&A of an ISSI team "Determination of the physical Hydrogen parameters of the LIC from within the Heliosphere

Why the idea of framework propositions cannot contribute to an understanding of delusions

One of the tasks that recent philosophy of psychiatry has taken upon itself is to extend the range of understanding to some of those aspects of psychopathology that Jaspers deemed beyond its limits. Given the fundamental difficulties of offering a literal interpretation of the contents of primary delusions, a number of alternative strategies have been put forward including regarding them as abnormal versions of framework propositions described by Wittgenstein in On Certainty. But although framework propositions share some of the apparent epistemic features of primary delusions, their role in partially constituting the sense of inquiry rules out their role in helping to understand delusions

Low Source/Drain Contact Resistance for AlGaN/GaN HEMTs with High Al Concentration and Si-HP [111] Substrate

An optimized fabrication process of ohmic contacts is proposed to reduce the source/drain access resistance (RC) and enhance DC/RF performance of AlGaN/GaN HEMTs with a high Al concentration. We show that source/drain RC can be considerably lowered by (i) optimally etching into the barrier layer using Ar+ ion beam, and by (ii) forming recessed contact metallization using an optimized Ti/Al/Ni/Au (12 nm/200 nm/40 nm/100 nm) multilayers. We found that a low RC of ∼0.3 Ω.mm can be achieved by etching closer to the 2-Dimensional Electron Gas (2DEG) at an optimum etching depth, 75% of the barrier thickness, followed by a rapid thermal annealing at 850°C. This is due to the very small distance between the alloy and the 2DEG (higher electric field) as shown by 2D drift-diffusion simulations combined with Transmission Line Model (TLM) extractions