Identification of pharmaceutical residues in treated sewage effluent in Johor, Malaysia

The introduction of pharmaceutical residues into aquatic environment has threatened the livelihood of aquatic organisms worldwide. The entrance of these residues into the environment originates from sewage effluents discharged from domestic wastewater treatment plants. Up to date, their presence in the sewage effluent is not monitored in Malaysia. Therefore, this study aims to identify the presence of pharmaceutical residues in the effluent domestic sewage treatment plants employed in Johor Bahru, Malaysia. Briefly, ten pharmaceutical compounds, including acetaminophen, sulfathiazole, sulfamethazine, sulfamethoxazole, clarithromycin, trimethoprim, lincomycin, carbamazepine, naproxen and ibuprofen, were selected based on their worldwide consumption. Sewage samples from five different types of sewage treatment system were collected. The samples were filtered prior to solid-phase extraction. Finally, the extracted samples were analysed with LC-MS/MS. The analyses showed that only sulfathiazole was not present in all effluent samples. Acetaminophen recorded the highest concentration of 9299 ng/L in an Imhoff Tank. Meanwhile, the lowest concentration of pharmaceutical residue detected was sulfamethazine, i.e. 0.843 ng/L, in a sequencing batch reactor. Overall, six out from ten pharmaceutical residues were found in all sewage samples denoting the inefficiency of current biological treatment systems in removing trace pharmaceutical compounds from sewage

The Impact of Narrative Feedback, E-Learning Modules and Realistic Video and the Reduction of Misconception

Physics learning in universities utilized the Moodle-based e-learning media as an online learning platform. However, the effectiveness of remediating misconception using online media has not been widely researched. Therefore, this study was set to determine the level of misconception percentage reduction through the use of narrative feedback, the e-learning modules, and realistic video. The study was a quantitative approach with a quasi-experimental method involving 281 students who were taking basic physics courses in the Department of Physics, Chemistry, and Biology Education. The data collection used a three-tier diagnostic test based on e-learning at the beginning of the activity and after the treatment (posttest). The results of the data analysis with descriptive statistics show that the most significant treatment in reducing misconception percentage on the topic of free-fall motion was in the following order: narrative feedback, e-learning modules and realistic video. The misconception percentage reduction in the sub-concept of accelerated free- fall was effective for all types of the treatments

Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data

Background: Hypertension is considered the most important risk factor for cardiovascular diseases, but its control is poor worldwide. We aimed to assess the availability and affordability of blood pressure-lowering medicines, and the association with use of these medicines and blood pressure control in countries at varying levels of economic development. Methods: We analysed the availability, costs, and affordability of blood pressure-lowering medicines with data recorded from 626 communities in 20 countries participating in the Prospective Urban Rural Epidemiological (PURE) study. Medicines were considered available if they were present in the local pharmacy when surveyed, and affordable if their combined cost was less than 20% of the households' capacity to pay. We related information about availability and affordability to use of these medicines and blood pressure control with multilevel mixed-effects logistic regression models, and compared results for high-income, upper-middle-income, lower-middle-income, and low-income countries. Data for India are presented separately because it has a large generic pharmaceutical industry and a higher availability of medicines than other countries at the same economic level. Findings: The availability of two or more classes of blood pressure-lowering drugs was lower in low-income and middle-income countries (except for India) than in high-income countries. The proportion of communities with four drug classes available was 94% in high-income countries (108 of 115 communities), 76% in India (68 of 90), 71% in upper-middle-income countries (90 of 126), 47% in lower-middle-income countries (107 of 227), and 13% in low-income countries (nine of 68). The proportion of households unable to afford two blood pressure-lowering medicines was 31% in low-income countries (1069 of 3479 households), 9% in middle-income countries (5602 of 65 471), and less than 1% in high-income countries (44 of 10 880). Participants with known hypertension in communities that had all four drug classes available were more likely to use at least one blood pressure-lowering medicine (adjusted odds ratio [OR] 2·23, 95% CI 1·59–3·12); p<0·0001), combination therapy (1·53, 1·13–2·07; p=0·054), and have their blood pressure controlled (2·06, 1·69–2·50; p<0·0001) than were those in communities where blood pressure-lowering medicines were not available. Participants with known hypertension from households able to afford four blood pressure-lowering drug classes were more likely to use at least one blood pressure-lowering medicine (adjusted OR 1·42, 95% CI 1·25–1·62; p<0·0001), combination therapy (1·26, 1·08–1·47; p=0·0038), and have their blood pressure controlled (1·13, 1·00–1·28; p=0·0562) than were those unable to afford the medicines. Interpretation: A large proportion of communities in low-income and middle-income countries do not have access to more than one blood pressure-lowering medicine and, when available, they are often not affordable. These factors are associated with poor blood pressure control. Ensuring access to affordable blood pressure-lowering medicines is essential for control of hypertension in low-income and middle-income countries. Funding: Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Canadian Institutes of Health Research Strategy for Patient Oriented Research through the Ontario SPOR Support Unit, the Ontario Ministry of Health and Long-Term Care, pharmaceutical companies (with major contributions from AstraZeneca [Canada], Sanofi Aventis [France and Canada], Boehringer Ingelheim [Germany amd Canada], Servier, and GlaxoSmithKline), Novartis and King Pharma, and national or local organisations in participating countries