Gain More for Less: The Surprising Benefits of QoS Management in Constrained NDN Networks

Quality of Service (QoS) in the IP world mainly manages forwarding resources, i.e., link capacities and buffer spaces. In addition, Information Centric Networking (ICN) offers resource dimensions such as in-network caches and forwarding state. In constrained wireless networks, these resources are scarce with a potentially high impact due to lossy radio transmission. In this paper, we explore the two basic service qualities (i) prompt and (ii) reliable traffic forwarding for the case of NDN. The resources we take into account are forwarding and queuing priorities, as well as the utilization of caches and of forwarding state space. We treat QoS resources not only in isolation, but correlate their use on local nodes and between network members. Network-wide coordination is based on simple, predefined QoS code points. Our findings indicate that coordinated QoS management in ICN is more than the sum of its parts and exceeds the impact QoS can have in the IP world

Medication Sector in Qatar: Hand in Hand Facing the Blockade

Conference agend

Prevalence and genetic characterization of clinically relevant extended-spectrum β-lactamase-producing Enterobacterales in the Gulf Cooperation Council countries

IntroductionAmong Gram-negative bacteria (GNB), Enterobacterales (Enterobacterales), such as Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae), are the most clinically relevant pathogens in healthcare settings. Infections secondary to these pathogens are widely common but multidrug resistance (MDR) in Enterobacterales has become a significant challenge with increased morbidity, mortality, and cost of management. The escalating global prevalence of MDR in Enterobacterales has led to limited treatment options, raising an urgent need for novel antimicrobial therapy(s) and detailed studies exploring underlying resistance mechanisms. In Enterobacterales, the prime antimicrobial resistance mechanism against β-lactam antibiotics is mainly the production of β-lactamases, particularly extended-spectrum β-lactamases (ESBLs). Although the Gulf region is witnessing major challenges from infections secondary to MDR GNB, the extent of the problem has not been fully evaluated. Therefore, this review aims to address the prevalence and genetic characterization of ESBL-producing Enterobacterales in the Gulf Cooperation Council (GCC) countries.MethodsPubMed® (National Library of Medicine, Bethesda, MD, USA) search was conducted, which looked for academic articles discussing the epidemiology of MDR Enterobacterales in the GCC countries, published in the last 5 years.Results and conclusionsIn GCC countries there is a high prevalence rate of MDR Enterobacterales, particularly ESBLs. Prevalence rates of ESBL-producing Enterobacterales among the Enterobacterales in general clinical samples in the GCC region is 21.6%–29.3%, with a slightly higher prevalence rate in intensive care unit patients (17.3–31.3%) and in patients with urinary tract infections (25.2%–31.7%). ESBL carriers have also been noted in the general community. ESBL-producing Enterobacterales from the GCC region show high levels of resistance to ampicillin, aztreonam, third-/fourth-generation cephalosporins, fluoroquinolones, and trimethoprim-sulfamethoxazole. Intermediate resistance rates are observed against nitrofurantoin, piperacillin/tazobactam, and gentamicin, with increasing resistance observed against tigecycline. The isolates demonstrate low-level resistance to carbapenems, fosfomycin, colistin, and amikacin. Enterobacterales isolates that are concomitant ESBL producers and are carbapenem resistant have been increasingly reported and demonstrate alarmingly increased antibiotic resistance patterns compared with ESBL Enterobacterales. The most prevalent genes for ESBL resistance in the Enterobacterales isolates in the GCC region are: blaCTX-M (subtype group 1) followed by/co-dominated by blaTEM and blaSHV, whereas the most common carbapenem-resistant genes are blaOXA-48 and blaNDM-1

Economic impact of clinical pharmacist interventions in a general tertiary hospital in Qatar

Background With an increasingly strained health system budgets, healthcare services need to continually demonstrate evidence of economic benefits. This study sought to evaluate the economic impact of interventions initiated by clinical pharmacists in an adult general tertiary hospital. Methods A retrospective review of clinical pharmacist interventions was carried out throughout followup durations in March 2018, July/August 2018, and January 2019 in Hamad General Hospital (HGH) at Hamad Medical Corporation (HMC) in Qatar. The study included clinical pharmacy interventions data of patients admitted to the internal medicine, critical care, and emergency wards. Included interventions were documented by clinical pharmacists or clinical pharmacy specialists, and approved by physicians. Interventions by non-clinical pharmacists or with missing data were excluded. Adopting the perspective of HMC, we calculated the total economic benefit, which is the sum of the cost savings and the cost avoidance associated with the interventions. Cost savings was defined as the reduced cost of therapy associated with therapy changes minus the cost of intervention and cost avoidance was the cost avoided by eliminating the occurrence of adverse drug events (ADEs). Sensitivity analyses were performed to assess the robustness of results against uncertainties. Results A total of 852 interventions, based on 340 patients, were included. The analysis projected an annual total benefit of QAR 2,267,036 (USD 621,106) based on a negative cost-savings of QAR-175,139 (USD-47,983) and a positive cost avoidance of QAR741,898 (USD203,260) over the 3-month follow-up period. The uncertainty analysis demonstrated the robustness of outcomes, including a 100% probability of positive economic benefit. Conclusions The clinical pharmacist intervention was associated witScopu

Thermal modeling and hydrocarbon generation of the Late Jurassic-Early Cretaceous Chia Gara Formation in Iraqi Kurdistan region, northern Zagros Fold Belt

The Late Jurassic-Early Cretaceous Chia Gara Formation is an important oil-source rock in Iraqi Kurdistan region. Chia Gara source rock is characterised by high organic matter and sulphur content with Type II_S kerogen. 1D basin models were integrated with geological information and geochemical data from Chia Gara Fm at four well locations in Kurdistan region, northern Iraq. The models of the burial/thermal history indicate that Chia Gara Fm is presently in the peak-oil generation window and some oil cracked to gas during Late Eocene to Late Miocene time. Onset of oil-generation began during the Middle Paleocene- Early Oligocene (60–30 Ma). Oil was generated during the Late Eocene to Late Miocene (48–9 Ma). The models also suggest that the oil was expelled from Chia Gara source rock during the Late Eocene to Late Miocene (37–9 Ma), with a transformation ratio more than 50%. The high transformation ratio of more than 80% in two wells suggests that the generated oil was cracked to gas during the end of Middle Miocene time and continued to present day. The basin modeling results further suggest that Chia Gara Formation acts as a prolific petroleum-source rock and significant of oil and limited of gas have been generated and expelled to any nearby prospect reservoir rocks in the Kurdistan region. Keywords: Chia Gara Formation, Basin modeling, Petroleum generation history, Zagros Fold Belt Basin, North Ira

Development, translation, and validation of a bilingual questionnaire on unused medications in homes

Background: Unused medications in homes pose significant health, economic, and environmental risks. Patients are the medications end users and their knowledge, attitude, and practices (KAP) play an important role towards medication use, unuse and wastage. Thus, a valid instrument to reliably measure patients' KAP towards unused medications in homes may help manage the associated risks. Objective: To develop, translate, and validate a questionnaire for the assessment patients' KAP towards unused medications in Qatar homes (i.e., QUM-Qatar). Setting: This cross-sectional validation study was conducted among randomly selected outpatients visiting various public and private pharmacies in Qatar between September 2019 and February 2020. Method: Nine experts in the field of pharmacy practice with Qatar contextual background established the content validity of the instrument. The validity was quantified using content validity index (CVI). Furthermore, construct validity was performed using principal component analysis (PCA), whereas internal consistency reliability of items was determined using Cronbach's alpha. Statistical analyses were performed using STATA 15 statistical software. Main outcome measure: The psychometric properties of the QUM-Qatar assessment instrument. Results: An English/Arabic questionnaire was developed and validated. Content validity in the form of scale-level-CVI (S-CVI)/Average and S-CVI/UA was 0.88 and 0.84, respectively, suggesting adequate relevant content of the questionnaire. Variation explained by the multivariate model was 85.0% for knowledge, 94.8% for attitude, and 89.8% for practice. Cronbach's alpha coefficients were 0.68, 0.82, and 0.84, for knowledge, attitude, and practice domains, respectively. From the psychometric results obtained, the questionnaire's validity and reliability were attained. Conclusion: The QUM-Qatar instrument has acceptable psychometric properties and has the potential for future use in research and practice to assess KAP towards unused medications in Qatar and elsewhere. It may consequently help in improving medication use and mitigating the negative health, economic, and environmental impacts of unused medications. Impacts on practice. There is now a valid and reliable English/Arabic language questionnaire to assess patients' KAP towards unused medications. Policymakers can utilize this questionnaire to develop evidence-based policies and strategies for managing unused medications and their disposal. To improve medication use review, rational use of medicines, and adherence, it is necessary to consider patient-reported outcomes that may eventually reflect on saving health, economic resources, and environment. 2021 The AuthorsWe would like to express our heartfelt gratitude to Dr. Laith Abu-Raddad and special thanks to Ms. Hiam Chemaitelly for their analytical, result interpretation and infrastructure support provided under the Biostatistics, Epidemiology, and Biomathematics Research Core at Weill Cornell Medicine-Qatar. The statements made herein are solely the responsibility of the authors.Scopu

High efficacy and low toxicity of short-course oral valganciclovir as pre-emptive therapy for hematopoietic stem cell transplant cytomegalovirus infection

BACKGROUND: Cytomegalovirus (CMV) infection is a major infectious complication post-allogeneic hematopoietic stem cell transplantation (HSCT). CMV seropositivity in Eastern Mediterranean and certain Asian countries is reported to be close to 100%; hence, the need for effective pre-emptive treatment strategy that has low toxicity. Valganciclovir (VGC) is a prodrug of ganciclovir with high bioavailability. PATIENTS AND METHODS: HSCT patients with documented CMV infection (as defined by positive CMV antigenemia) were treated as outpatients with VGC at a starting dose of 900 mg twice daily for 1 week. Those who were antigenemia negative after one week received 900 mg once daily for another week and treatment was subsequently discontinued. Those who were positive after one week of therapy continued on the twice daily treatment schedule for another week and changed to a daily schedule once they converted to antigenemia negativity. RESULTS: From January 2004 to December 2007, 47 HSCT patients received preemptive treatment with VGC for 61 episodes of CMV infection. The antigenemia range was 1 to 700 infected cells/slide. Complete responses were observed in 92% and 97% after the 1st and 2nd week of treatment, respectively. Three percent of the episodes were considered refractory, requiring alternative therapy. No CMV disease was observed in this cohort. CONCLUSION: Neutropenia was the main observed toxicity, requiring granulocyte-colony stimulating factor in 8 episodes. Outpatient treatment of CMV infection with “short-course oral VGC” given as a one week twice daily treatment and one week once daily maintenance is a highly effective therapy with minimal toxicity. These results require validation in a larger, randomized study