A social enterprise model for TB detection and treatment through the private sector in Pakistan.

BACKGROUND: Existing models to increase TB case notifications from the private sector in Pakistan are financially unsustainable and have achieved modest success due to limited coverage. OBJECTIVE: To evaluate the impact of a social enterprise model (SEM) intervention on TB case detection in Karachi, Pakistan, and to assess its financial sustainability. METHODS: Purpose-built centres were established within the private sector that integrated TB screening, diagnostics and treatment and operated 12 hours per day with convenient locations to improve access. TB services were offered free of cost, and revenue generation took place through user fees from other diagnostics. Private providers with a focus on the informal sector were engaged through community workers to generate screening referrals. RESULTS: Overall 171,488 people were screened and 18,683 cases were notified, including 197 individuals with drug-resistant TB. Annual TB notifications in Karachi increased from 18,105 in 2014 to a maximum of 25,840 (40% increase). The proportion of cases in Karachi notified by the centres grew to 27% in 2020. Commercial revenue reached USD288,065 and enabled operating cost recovery of 15%. Average cost per TB case notified was USD203. CONCLUSION: The SEM intervention contributed a large proportion of notifications in Karachi and achieved modest cost recovery.

CONTEXTE: Les modèles existants visant à augmenter les notifications de cas de TB par le secteur privé au Pakistan ne sont pas viables financièrement et n'ont obtenu qu'un succès modeste en raison d'une couverture limitée. OBJECTIF: Évaluer l'impact d'un modèle déntreprise sociale (SEM, pour l'anglais « social entreprise model ¼) sur la détection des cas de TB à Karachi, au Pakistan, et évaluer sa viabilité financière. MÉTHODES: Des centres spécialisés ont été créés dans le secteur privé. Ils intègrent le dépistage, le diagnostic et le traitement de la TB et fonctionnent 12 heures par jour dans des lieux adaptés afin dén faciliter l'accès. Les services de lutte contre la TB étaient gratuits et les recettes provenaient des frais d'utilisation des autres diagnostics. Des prestataires privés, axés sur le secteur informel, ont été engagés par l'intermédiaire d'agents communautaires pour orienter les patients vers les services de dépistage. RÉSULTATS: Au total, 171 488 personnes ont été dépistées et 18 683 cas ont été notifiés, dont 197 personnes atteintes de TB résistante aux médicaments. Les notifications annuelles de TB à Karachi sont passées de 18 105 en 2014 à un maximum de 25 840 (augmentation de 40%). La proportion de cas à Karachi notifiés par les centres est passée à 27% en 2020. Les recettes commerciales ont atteint 288 065 USD et ont permis un recouvrement des coûts déxploitation de 15%. Le coût moyen par cas de TB notifié était de 203 USD. CONCLUSION: L'intervention SEM a contribué à une grande proportion de notifications à Karachi et a permis un modeste recouvrement des coûts.

Mechanical and frictional properties of coconut husk powder reinforced polymer immersed in a simulated acidic medium for oil/gas applications.

Polymeric materials are constantly exposed to aggressive environments, negatively impacting their mechanical and chemical properties. In salt, acid, or alkaline solutions, polymer materials degrade due to surface flaws, microcracks, or other irregularities. For the first time, this study considers the behaviour of coconut powder/coir-reinforced synthetic LDPE hybrid composite immersed in an aggressive (acidic) medium for 15, 30 and 45 days. The structural, mechanical, and frictional behaviour of the developed coir/coconut husk powder/LDPE hybrid composites were measured after ageing in hydrochloric acid (HCl) as potential materials for oil and gas applications. From the XRD patterns, the prominent reflections in the control samples increased with the acid ageing days, while less prominent reflections characterized the hybrid composites. The hardness of the reinforced samples immersed for 30 and 45 days (30B and 45A) showed the highest values of 0.28 Hv, while the control samples immersed for 15 days had the least hardness. The reinforced samples immersed for 15 and 30 days (15B and 30B) showed the lowest and highest fracture toughness, respectively. The control samples were observed to absorb little water after immersion for 144 h. The result showed that although the reinforced hybrid composites showed better mechanical properties, with an increase in the days of immersion in an aggressive medium, the properties became compromised compared to the un-reinforced samples. Hence, the applications of the produced reinforced polymers in the oil and gas industries may be limited.

Prognostic accuracy of qSOFA score, SIRS criteria, and EWSs for in-hospital mortality among adult patients presenting with suspected infection to the emergency department (PASSEM) Multicenter prospective external validation cohort study protocol.

BACKGROUND: Early identification of a patient with infection who may develop sepsis is of utmost importance. Unfortunately, this remains elusive because no single clinical measure or test can reflect complex pathophysiological changes in patients with sepsis. However, multiple clinical and laboratory parameters indicate impending sepsis and organ dysfunction. Screening tools using these parameters can help identify the condition, such as SIRS, quick SOFA (qSOFA), National Early Warning Score (NEWS), or Modified Early Warning Score (MEWS). We aim to externally validate qSOFA, SIRS, and NEWS/NEWS2/MEWS for in-hospital mortality among adult patients with suspected infection who presenting to the emergency department. METHODS AND ANALYSIS: PASSEM study is an international prospective external validation cohort study. For 9 months, each participating center will recruit consecutive adult patients who visited the emergency departments with suspected infection and are planned for hospitalization. We will collect patients' demographics, vital signs measured in the triage, initial white blood cell count, and variables required to calculate Charlson Comorbidities Index; and follow patients for 90 days since their inclusion in the study. The primary outcome will be 30-days in-hospital mortality. The secondary outcome will be intensive care unit (ICU) admission, prolonged stay in the ICU (i.e., ≥72 hours), and 30- as well as 90-days all-cause mortality. The study started in December 2021 and planned to enroll 2851 patients to reach 200 in-hospital death. The sample size is adaptive and will be adjusted based on prespecified consecutive interim analyses. DISCUSSION: PASSEM study will be the first international multicenter prospective cohort study that designated to externally validate qSOFA score, SIRS criteria, and EWSs for in-hospital mortality among adult patients with suspected infection presenting to the ED in the Middle East region. STUDY REGISTRATION: The study is registered at ClinicalTrials.gov (NCT05172479).