Development of Ridge Ensemble Standardized Drought Index (RESDI) for improving drought characterization and future assessment.

Global warming upsets the environmental balance and leads to more frequent and severe climatic events. These extreme events include floods, droughts, and heatwaves. These widespread extreme events disrupt various sectors of ecosystems directly. However, among all these events, drought is one of the most prolonged climatic events that significantly destroys the ecosystem. Therefore, accurate and efficient assessment of droughts is necessary to mitigate their detrimental impacts. In recent years, several drought indices based on global climate models (GCMs) of Coupled Model Intercomparison Project Phase 6 (CMIP6) have been proposed to quantify and monitor droughts. However, each index has its advantages and limitations. As each index ensembles different models by using different statistical approaches, it is well known that the margin of error is always a part of statistics. Therefore, this study proposed a new drought index to reduce the uncertainty involved in the assessment of droughts. The proposed index named the Ridge Ensemble Standardized Drought Index (RESDI) is based on the innovative ensemble approach termed ridge parameters and distance-based weighting (RDW) scheme. And the development of this RDW scheme is based on two types of methods i.e., ridge regression and divergence-based method. In this research, we ensemble 18 different GCMs of CMIP6 using the RDW scheme. A comparative analysis of the RDW scheme is performed against the simple model average (SMA) and Bayesian model averaging (BMA) schemes at 32 locations on the Tibetan plateau. The comparison revealed that RDW has less mean absolute error (MAE) and root-mean-square error (RMSE). Therefore, the developed RESDI based on RDW is used to project drought properties under three distinct shared socioeconomic pathway (SSP) scenarios: SSP1-2.6, SSP2-4.5, and SSP5-8.5, across seven different time scales (1, 3, 7, 9, 12, 24, and 48). The projected data is then standardized by using the K-components Gaussian mixture model (K-CGMM). In addition, the study employs steady-state probabilities (SSPs) to determine the long-term behavior of drought. The outcome of this research shows that "normal drought (ND)" has the highest probability of occurrence under all scenarios and time scales.

Genderwise clinical response of antipsychotics among schizophrenic patients: a prospective observational study from Lahore, Pakistan.

OBJECTIVE: The study was aimed to evaluate the gender specific response to adherence and occurrence of side effects among schizophrenic patients in Lahore, Pakistan. METHODS: A prospective study was performed for a period of 1 year among 180 newly diagnosed schizophrenics, aged 20-60 years to observe the symptoms, medication adherence and side effects. Morisky-Green-Levine Scale was used to evaluate medication adherence, LUNSER for side effects and PANSS to measure positive and negative symptoms. Data were analyzed using SPSS. RESULTS: Positive symptoms (Male: Baseline 36.14 vs. endpoint 23.58, Female: 35.29 vs. 23.74) and negative symptoms (Males 27.9 vs. 20.05, Females 28.41 vs. 20.2) of schizophrenia were equally reduced after a follow up of 1 year in both the genders. Male population suffered more accumulative side effects (11.4 in males vs. 6.40 in females), extrapyramidal symptoms such as tardive dyskinesia and tremors (1.21 in males vs. 0.57 in females) and other side effects as compared to women (p ≤ .005). Males were found poorly adherent to antipsychotic treatment than females (93.3% in males vs. 6.7% in females (p ≤ .005). CONCLUSIONS: Prescribing practices should not overlook sex specific factors like hormonal changes, altered brain morphology and socioeconomic factors that may be responsible for the difference in the response to the course of schizophrenia.

Development of maximum relevant prior feature ensemble (MRPFE) index to characterize future drought using global climate models.

Drought is one of the foremost outcomes of global warming and global climate change. It is a serious threat to humans and other living beings. To reduce the adverse impact of drought, mitigation strategies as well as sound projections of extreme events are essential. This research aims to strengthen the robustness of anticipated twenty-first century drought by combining different Global Climate Models (GCMs). In this article, we develop a new drought index, named Maximum Relevant Prior Feature Ensemble index that is based on the newly proposed weighting scheme, called weighted ensemble (WE). In the application, this study considers 32 randomly scattered grid points within the Tibetan Plateau region and 18 GCMs of Coupled Model Intercomparison Project Phase 6 (CMIP6) of precipitation. In this study, the comparative inferences of the WE scheme are made with the traditional simple model averaging (SMA). To investigate the trend and long-term probability of various classes, this research employs Markov chain steady states probability, Mann-Kendall trend test, and Sen's Slope estimator. The outcomes of this research are twofold. Firstly, the comparative inference shows that the proposed weighting scheme has greater efficiency than SMA to conflate GCMs. Secondly, the research indicates that the Tibetan Plateau is projected to experience "moderate drought (MD)" in the twenty-first century.

Pattern of inappropriate antibiotic use among hospitalized patients in Pakistan: a longitudinal surveillance and implications.

Background: The inappropriate use of antibiotics in hospitals increases resistance, morbidity, and mortality. Little is currently known about appropriate antibiotic use among hospitals in Lahore, the capital city of Pakistan. Methods: Longitudinal surveillance was conducted over a period of 2 months among hospitals in Lahore, Pakistan. Antibiotic treatment was considered inappropriate on the basis of a wrong dosage regimen, wrong indication, or both based on the British National Formulary. Results: A total of 2022 antibiotics were given to 1185 patients. Out of the total prescribed, approximately two-thirds of the study population (70.3%) had at least one inappropriate antimicrobial. Overall, 27.2% of patients had respiratory tract infections, and out of these, 62.8% were considered as having inappropriate therapy. Cephalosporins were extensively prescribed among patients, and in many cases, this was inappropriate (67.2%). Penicillins were given to 283 patients, out of which 201 (71.0%) were prescribed for either the wrong indication or dosage or both. Significant variations were also observed regarding inappropriate prescribing for several antimicrobials including the carbapenems (70.9%), aminoglycosides (35.8%), fluoroquinolones (64.2%), macrolides (74.6%) and other antibacterials (73.1%). Conclusion: Educational interventions, institutional guidelines, and antimicrobial stewardship programs need to be developed to enhance future appropriate antimicrobial use in hospitals in Pakistan. Policies by healthcare and Government officials are also needed to minimize inappropriate antibiotic use.

Antibiotic Self-Prescribing Trends, Experiences and Attitudes in Upper Respiratory Tract Infection among Pharmacy and Non-Pharmacy Students: A Study from Lahore.

Pharmacists are the custodians of drugs; hence their education, training, behaviors and experiences would affect the future use of drugs at community and hospital pharmacies. Therefore, we aimed at evaluating the self-prescribing antibiotic trends, knowledge and attitudes among pharmacy and non-pharmacy students. We found that pharmacy students had higher risks of experiencing URIs related symptoms such as cough (RR; 1.7, p = 0.002), allergy (RR; 2.07, p = 0.03) and running nose (RR; 3.17, p<0.005), compared to non-pharmacy students -resulting in higher probabilities of selecting cough syrups (OR; 2.3, p<0.005), anti-histamines (OR; 1.8, p = 0.036) and anti-inflammatory/anti-pyretic (OR; 2.4, p<0.005) drugs. Likewise, bachelor's degree pupils (OR; 2, p = 0.045), urban area residents (OR; 2.44; p = 0.002) and pharmacy students (OR; 2.9, p<0.005) exhibited higher propensities of antibiotic self-use-notable classes include, b-lactams (45.9%) followed by macrolides (26.5%) and augmentin (28.94%), respectively. Surprisingly, pharmacy and non-pharmacy students had higher odds of using antibiotics in common cold (OR; 3.2, p<0.005) and pain (OR; 2.37, p = 0.015), respectively. Unlike non-pharmacy students, pharmacy students were likely to select alternative therapy, such as Joshanda (OR; 2.22, p = 0.011) and were well acquainted with antibiotic hazards, with 77% reduction in risk of antibiotics re-use. In conclusion, university students exhibited antibiotic self-prescribing trends in conditions that does not warrant their use, thus are irrational users. The pharmacy education confers very little benefit to rational self-prescribing practices among students, while non-pharmacy students are more vulnerable to repeated antibiotic usage. Thus, the educational and training modules should be designed for university students to disseminate targeted information regarding the potential hazards of antibiotic self-use and importance of consultation with qualified and registered medical doctor/pharmacist before starting with antibiotics.