Qualitative validation of audiovisual educational material for use on rheumatoid arthritis patients

Medication compliance is critical to achieve therapeutic efficacy in patients with rheumatoid arthritis; however, among other factors, low patient-health literacy plays a negative role. Therefore, the development and validation of audiovisual educational material with the participation of health specialists and patients could lead to an improved level of compliance with treatment, while favoring its acceptance. To design and validate audiovisual educational material generated by a multidisciplinary and participative group of patients and health specialists. This study was carried out using a sequential methodology, including qualitative and quantitative techniques: (1) a non-participative observational study with patients and a non-systematic literature search were performed to identify conceptual topics. (2) Pilot videos were qualitatively assessed by patients and health specialists (focus groups and expert committees). (3) Improved versions of seven videos were quantitatively evaluated by patients and specialists following qualitative criteria of attraction, understanding, involvement, acceptance and induction of action. 74 patients with RA, 10 rheumatologists, 4 pharmacists and 2 medical anthropologists participated in the different phases of validation. A total of seven videos lasting 3 min each were generated, incorporating the most relevant suggestions by patients and healthcare professionals. The final version of the videos led to a mean compliance of 96.04 ± 5.2%, according to a representative group of patients and a mean 89.6 ± 9.4%, according to health professionals. With the participation of both patients and health specialists, seven audiovisual educational video recordings were developed and validated, reaching high levels of compliance in accordance with international criteria.

Removal efficiency, kinetic, and behavior of antibiotics from sewage treatment plant effluent in a hybrid constructed wetland and a layered biological filter

Sewage treatment plant (STP) is the major point source of antibiotic contamination, yet the advanced treatment of antibiotic polluted STP effluent has not been given necessary attention. This study is conducted to evaluate the removal efficiency, kinetic, and behavior of sulfonamides, quinolones, tetracyclines, and macrolides antibiotics from STP effluent in a hybrid constructed wetland (HCW) and a layered biological filter (LBF) at different hydraulic loading rates (HLRs). The results showed that the removal efficiency of antibiotics in all the HLRs was ranked as follow: quinolones of HCW (70-95%) > macrolides of HCW (58-77%) > tetracyclines of both systems (59-67%) > quinolones of LBF (28-64%) > macrolides of LBF (13-25%) > sulfonamides of both systems (<0%). The optimal HLR is 1.0 m/day for quinolones and 2.0 m/day for tetracyclines-macrolides in the HCW, and 6.4 m/day for quinolones-tetracyclines in the LBF, respectively. Although HCW performed better on the removal of most antibiotics, LBF exhibited stronger total loading toleration and higher removal loading ability to antibiotics. Among them, quinolones were markedly removed by multiple effect of substrate adsorption, microbial anaerobic degradation, and photolysis in the HCW (planted), and by filter sorption and interception in the LBF (unplanted); adsorption is the dominant elimination approach for tetracyclines in both systems; plant uptake plays a significant role on the removal of macrolides in the HCW.

Recent Opportunities and Challenges in Selective C-H Functionalization of Methyl Azaarenes: a Highlight from 2010 to 2020 Literatures

Azaarenes are unique scaffolds frequently found in pharmaceuticals. Herein, we have summarized the recent synthetic available methods in C-H functionalization of methylazaarenes from 2010 to 2020. Multiple approaches involving halogenation and alkylation via different methods, such as alkenylation, oxidative functionalization, and cyclization of the methylazaarenes will be discussed in this review.

Risks to aquatic environments posed by 14 pharmaceuticals as illustrated by their effects on zebrafish behaviour

The presence of pharmaceutical residues in aquatic ecosystems is a worldwide problem that may pose serious threats and challenges to the environment, especially to the safety of aquatic biota. In the present study, we investigated the effects of 14 environmentally relevant pharmaceutical compounds on individual and collective-related behaviours in juvenile zebrafish (Danio rerio) for 21 days. The tested concentrations of the compounds spanned three orders of magnitude. This study also compared the potential risks of these compounds in Chinese surface waters based on the data on their toxic effects or only on behavioural effects. In the case of individual behaviours, most antidepressants, but not anti-inflammatory agents or blood lipid-lowering agents, decreased fish locomotor activity (LMA) and individual social activity (IDS); however, all three classes of compounds induced significant disruptions in the light/dark transition locomotor response (LMR-L/D) performance, even at lower treatment levels (0.1-1 μg/L). Furthermore, collective behaviour (CLB) analysis suggested that most of the compounds significantly altered the group sociability of fish and frequently occurred at environmentally relevant concentrations. Finally, a risk assessment suggested that the presence of ibuprofen, fluoxetine, and venlafaxine in the surface waters of China poses a relatively high risk to fish, regardless of the risk ranking based on the data of the toxic or behavioural effects.

A 5-Year Analysis of Physician-Industry Interactions, Physician Gender, and Anti-VEGF Use in US Ophthalmologists

Purpose: To explore physician gender, industry payments, and prescribing habits of anti-vascular endothelial growth factor (VEGF) agents.Methods: Retrospective review of U.S. ophthalmologists prescribing and receiving industry payments for aflibercept and/or ranibizumab (brand anti-VEGF injections) between August 2013 to December 2017.Results: Men receiving industry payments were older and had longer post-residency experience than women (both P < .001). Men were more likely to receive industry payments (P = .01), receive >5 payments (P = .003), and receive payments totaling >$1000 (P = .008). Men administered more injections on average than women when receiving >3 industry payments (P < .001) or when receiving >$100 (P < .01). On multivariate analysis, years in practice, male gender, number of payments, and total value of payments were independent factors associated with the number of brand injections administered (all P < .001).Conclusions: A positive association between industry payments and brand anti-VEGF use was identified, however, causality was not determined. Gender bias may be present in physician-industry relationships.

Is there evidence for the racialization of pharmaceutical regulation? Systematic comparison of new drugs approved over five years in the USA and the EU

Recent decades have seen much interest in racial and ethnic differences in drug response. The most emblematic example is the heart drug BiDil, approved by the US Food and Drug Administration in 2005 for "self-identified blacks." Previous social science research has explored this "racialization of pharmaceutical regulation" in the USA, and discussed its implications for the "pharmaceuticalization of race" in terms of reinforcing certain taxonomic schemes and conceptualizations. Yet, little is known about the racialization of pharmaceutical regulation in the USA after BiDil, and how it compares with the situation in the EU, where political and regulatory commitment to race and ethnicity in pharmaceutical medicine is weak. We have addressed these gaps by investigating 397 product labels of all novel drugs approved in the USA (n = 213) and the EU (n = 184) between 2014 and 2018. Our analysis considered statements in labeling and the racial/ethnic categories used. Overall, it revealed that many labels report race/ethnicity demographics and subgroup analyses, but that there are important differences between the USA and the EU. Significantly more US labels specified race/ethnicity demographics, as expected given the USA's greater commitment to race and ethnicity in pharmaceutical medicine. Moreover, we found evidence that reporting of race/ethnicity demographics in EU labels was driven, in part, by statements in US labels, suggesting the spillover of US regulatory standards to the EU. Unexpectedly, significantly more EU labels reported differences in drug response, although no drug was restricted to a racial/ethnic population in a manner similar to BiDil. Our analysis also noted variability and inconsistency in the racial/ethnic taxonomy used in labels. We discuss implications for the racialization of pharmaceutical regulation and the pharmaceuticalization of race in the USA and EU.

Overview of "The Study in Risk-Based Manufacturing Environmental Control for Non-Sterile Drug Products"

To develop a guide of best practices for establishing appropriate controls on nonsterile manufacturing environments for pharmaceutical manufacturers, the Kansai Study Group of the Parenteral Drug Association Japan Chapter explored relevant issues in-depth and published the results of their study, "The Study in Risk-Based Manufacturing Environmental Control for Non-Sterile Drug Products" in the PDA Journal of GMP and Validation in Japan. This review summarizes the background of that study and the structure of the published article and, to help readers make the most of the contents, provides a table displaying the category, subject, problem statement, and points to consider of each topic discussed in the article, as well as examples of central topics (Appendices 1-3).

Detection of endocrine disrupting chemicals in Danio rerio and Daphnia pulex: Step-one, behavioral screen

Anthropogenic surface and ground water contamination by chemicals is a global problem, and there is an urgent need to develop tools to identify and elucidate biological effects. Contaminants of emerging concern (CECs) are not typically monitored or regulated and those with known or suspected endocrine disrupting potential have been termed endocrine disrupting chemicals (EDCs). Many CECs are known to be neurotoxic (e.g., insecticides) and many are incompletely characterized. Behavioral responses can identify chemicals with neuroactive properties, which can be relevant to EDC mechanisms (e.g., neuroendocrine disturbances). Two freshwater species, Daphnia pulex and Danio rerio, were evaluated for swimming behavior alterations resulting from 24-hr exposure to 9 CECs: triclosan, triclocarban, chlorpyrifos, dieldrin, 4-nonylphenol, bisphenol-A, atrazine, metformin, and estrone. This is the first step in the development of a bioassay for detecting estrogenic and/or anti-androgenic activity with the goal to evaluate complex mixtures of uncharacterized contaminants in water samples. The second step, described in a subsequent report, examines transcriptome alterations following chemical exposure. Significant differences in the swimming behavior response and sensitivity were found across chemicals within a species and across species for a given chemical in this unique optical bioassay system. In the concentration ranges studied, significant behavioral alterations were detected for 6 of 9 CECs for D. pulex and 4 of 9 CECs for D. rerio. These results underscore the utility of this bioassay to identify behavioral effects of sublethal concentrations of CECs before exploration of transcriptomic alterations for EDC detection.

Illicit Drugs as a Potential Risk to the Aquatic Environment of a Large Freshwater Lake after a Major Music Festival

The present study strengthens the view that residues of drugs of abuse may become widespread surface water contaminants following a local music festival. Overall, 10 illicit drugs were detected from the aquatic environment after the festival; cocaine and 3,4-methylenedioxymethamphetamine were present in the highest concentrations. The presence of illicit drugs and their metabolites over 3 monitored festival yr suggested that consumption of these drugs was temporally linked with events. Weather conditions seriously influenced detection of contaminants deriving from events at the lakeshore. Most of the illicit drugs retained their pharmacological activities, with a potentially adverse impact on wildlife. Environ Toxicol Chem 2021;40:1491-1498. © 2021 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Inhibition of swim bladder inflation in Japanese medaka (Oryzias latipes) embryos following exposure to select pharmaceuticals alone and in combination

This study leveraged the Japanese medaka fish embryo model for the assessment of effects of select contaminants on early development in fish. Fish embryos were exposed to various pharmaceutical contaminants including synthetic hormones and non-steroidal anti-inflammatory drugs and their effects on development were observed. Initial screening determined that swim bladder inflation failure was the most common endpoint detected. Swim bladder inflation failure was first explored in a study demonstrating that medaka require access to the air-water interphase to inflate their swim bladders in a time-dependent manner, and swim bladder inflation failure was correlated with mortality. Fish embryos were exposed 24-hours post fertilization until hatch to concentration ranges of various pharmaceutical contaminants including: 17β-estradiol, 17α-ethinylestradiol, and levonorgestrel (1 to 1000 µg/L), or diclofenac (0.32 to 100 mg/L). The main effect observed across all four compounds was a significant increase in failure of swim bladder inflation with increasing exposure concentration (24 to 72-hours post-hatch). Following single compound experiments combinatorial exposures using no-observed-effect concentrations were conducted. The main effect observed was a significant decrease in inflation success 24-hours post-hatch following a binary mixture of levonorgestrel and 17α-ethinylestradiol, as well as a significant decrease in swim bladder inflation success at all times following exposure to a quaternary mixture of all four compounds. This study demonstrated that embryonic exposure to pharmaceutical compounds, both alone and in combination, resulted in failure of swim bladder inflation in larval Japanese medaka.

Solar photocatalytic degradation of ibuprofen with a magnetic catalyst: Effects of parameters, efficiency in effluent, mechanism and toxicity evolution

The environmental-friendly photocatalytic process with a magnetic catalyst CoFe₂O₄/TiO₂ mediated by solar light for ibuprofen (IBP) degradation in pure water, wastewater effluent and artificial seawater was investigated systematically. The study aims to reveal the efficiency, the mechanism and toxicity evolution during IBP degradation. Hydroxyl radicals and photo-hole (h⁺) were found to contribute to the IBP decay. The presence of SO₄^2- showed no significant effect, while NO₃^- accelerated the photodegradation, and other anions including HCO₃^-, Cl^-, F^-, and Br^- showed significant inhibition. The removal efficiency was significantly elevated with the addition of peroxymonosulfate (PMS) or persulfate (PS) ([Oxidant]₀:[IBP]₀ = 0.4-4), with reaction rate of 5.3-13.1 and 1.3-2.9 times as high as the control group, respectively. However, the reaction was slowed down with the introduction of H₂O₂. A mathematic model was employed to describe the effect of ferrate, high concentration or stepwise addition of ferrate was suggested to play a positive role in IBP photodegradation. Thirteen transformation products were identified and five of them were newly reported. The degradation pathways including hydroxylation, the benzene ring opening and the oxidation of carbon were proposed. IBP can be efficiently removed when spiked in wastewater and seawater despite the decreased degradation rate by 41% and 56%, respectively. Compared to the IBP removal, mineralization was relatively lower. The adverse effect of the parent compound IBP to the green algae Chlorella vulgaris was gradually eliminated with the decomposition of IBP. The transformation product C178a which possibly posed toxicity to rotifers Brachionus calyciflorus can also be efficiently removed, indicating that the photocatalysis process is effective in IBP removal, mineralization and toxicity elimination.

Effects of environmental antidepressants on colour change and locomotor behaviour in juvenile shore crabs, Carcinus maenas

Juvenile crabs of Carcinus maenas thrive in coastal waters reputed to be the receptacle of continental pollution. Amongst the many pollutants encountered, antidepressants, such as fluoxetine (FLX) and venlafaxine (VEN), often detected at the ng•L^-1 range, are particularly worrying because of their action on the levels of monoamines, such as serotonin, noradrenaline and dopamine. In crustaceans, those monoamines are involved in colour change through their action on neuropeptide hormones. In addition, they are known to have a role in different behaviours, such as locomotion. Both colour change and locomotion are strategies used by juvenile crabs to hide and escape from predators. To investigate if the presence of antidepressants may alter behaviours of ecological importance, juvenile crabs were exposed to environmentally realistic concentrations of either 5 ng•L^-1 of FLX alone or in combination with VEN at 5 ng•L^-1. The ability to change colour depending on the environment and the locomotor activity of juvenile crabs were monitored weekly over 25 days. Animals exposed to antidepressants displayed a different pattern of colour change than the controls, especially those exposed to the combination of FLX and VEN at 5 ng•L^-1 each, and were less efficient to adapt to their environment, i.e., they were not as pale and not as dark as controls or crabs exposed to FLX at 5 ng•L^-1. Moreover, juvenile crabs exposed to the combination of antidepressants exhibited an enhanced locomotor activity throughout the exposure period with a higher velocity and distance moved as well as more time spend moving. The alteration of cryptic behaviours, such as colour change and locomotion by antidepressants persistently present in marine environment at low concentrations may have an impact on the survival of juvenile of C. maenas on the long term.

A review of combined sewer overflows as a source of wastewater-derived emerging contaminants in the environment and their management

Emerging contaminants such as pharmaceuticals, illicit drugs and personal care products can be released to the environment in untreated wastewater/stormwater mixtures following storm events. The frequency and intensity of combined sewer overflows (CSOs) has increased in some areas due to increasing urbanisation and climate change. Therefore, this review provides an up-to-date overview on CSOs as an environmental source of emerging contaminants. Other than compounds with high removal, those chiral species subject to enantioselective changes (i.e. degradation or inversion) during wastewater treatment can be effective markers of CSO discharge in the environment. A proposed framework for the selection of emerging contaminants as markers of CSOs is outlined. Studies have demonstrated that CSOs can be the main source of emerging contaminants with high removal efficiency during wastewater treatment (e.g. > 90%). However, the impact of CSOs on the environment is location specific and requires decision-making on their appropriate management at catchment level. This process would be aided by further studies on CSOs which incorporate the monitoring of emerging contaminants and their effects in the environment with those more routinely monitored pollutants (e.g. pathogens and priority substances). Mitigation and treatment strategies for emerging contaminants in CSOs are also discussed.

Towards a microfluidics platform for the continuous manufacture of organic and inorganic nanoparticles

In the last decade, microfluidics has opened new avenues for the synthesis of nanomaterials. However, the adoption of this production technique has been limited to a few high-value, low-production-volume organic nanoparticles. While there are several technical factors that can be attributed to this slow adoption, an important aspect to consider is the lack of a unified platform capable of producing a wide range of nanomaterials. In this work, we highlight a micro-mixing platform that can manufacture both organic and in-organic nanoparticles over a wide size range (nm-μm). We show that the platform can predictably and reproducibly create size and shape-controlled formulations with high homogeneity through input flow parameters. We further explore parallelization of this platform and discuss key technical constraints for high-volume production. We believe that the platform presented in this work can accelerate the adoption of nanomaterials relevant to a range of industries that encompass pharmaceutics, diagnostics, and cosmeceuticals.

Marine endophytic fungal metabolites: A whole new world of pharmaceutical therapy exploration

The growing threat arises due to diseases such as cancer and the infections around the world leading to a critical requirement for novel and constructive compounds with unique ways of action capable of combating these deadly diseases. At present, it is evident that endophytic fungi constitute an enormous as well as comparatively untapped source of great biodiversity that can be considered as a wellspring of effective novel natural products for medical, agricultural and industrial use. Marine endophytic fungi have been found in every marine plants (algae, seagrass, driftwood, mangrove plants), marine vertebrates (mainly, fish) or marine invertebrates (mainly, sponge and coral) inter- and intra-cellular without causing any palpable symptoms of illness. Since evolution of microbes and eukaryotes to a higher level, coevolution has resulted in specific interaction mechanisms. Endophytic fungi are known to influence the life cycle and are necessary for the homeostasis of their eukaryotic hosts and the chemical signals of their host have been shown to activate gene expression in endophytes to induce expression of endophytic secondary metabolites. Marine endophytic fungi are receiving increasing attention by chemists because of their varied and structurally unmatched compounds that have strong biological roles in life as lead pharmaceutical compounds, including anticancer, antiviral, insulin mimetic, antineurodegenerative, antimicrobial, antioxidant and immuno-suppressant compounds. Moreover, fungal endophytes proved to have different biological activities for exploitation in the environmental and agricultural sustainability.

Choices of chromatographic methods as stability indicating assays for pharmaceutical products: A review

Stability indicating assay describes a technique which is used to analyse the stability of drug substance or active pharmaceutical ingredient (API) in bulk drug and pharmaceutical products. Stability indicating assay must be properly validated as per ICH guidelines. The important components in a stability indicating assay include sensitivity, specificity, accuracy, reliability, reproducibility and robustness. A validated assay is able to measure the concentration changes of drug substance/API with time and make reliable estimation of the quantity of the degradation impurities. The drug substance is separated and resolved from the impurities. Pros and cons of HPLC, GC, HPTLC, CE and SFC were discussed and reviewed. Stability indicating assay may consist of the combination of chromatographic separation and spectroscopic detection techniques. Hyphenated system could demonstrate parallel quantitative and qualitative analysis of drug substances and impurities. Examples are HPLC-DAD, HPLC-FL, GC-MS, LC-MS and LC-NMR. The analytes in the samples are separated in the chromatography while the impurities are chemically characterised by the spectroscopy in the system. In this review, various chromatographic methods which had been employed as stability indicating assays for drug substance and pharmaceutical formulation were systematically reviewed, and the application of hyphenated techniques in impurities characterisation and identification were also discussed with supporting literatures.

Nano-scale selective and sensitive optical sensor for metronidazole based on fluorescence quenching: 1H-Phenanthro[9,10-d]imidazolyl-calix[4]arene fluorescent probe

It is crucial to determine and control the metronidazole (MET) ingredient in food and pharmaceuticals for human health and food safety. Even though many sensors have been previously reported to detect MET, there is still a need for a highly selective and sensitive, easy, fast, cost-effective sensor in this area. Herein, we report a fluorescent calix[4]arene derivative (PIMC) for highly selective and sensitive and facile and rapid MET detection based on fluorescence (FL) quenching. The highest FL quenching occurs when PIMC is exposed to MET solution at 400 nm (λ_ex = 340). Owing to the quenching efficacy of MET linearly up to 5.5 × 10⁴ nM was obtained a detection limit of 2.44 nM. Besides, interferences of other pharmaceuticals and ions on probe performance were investigated. The FL probe was successful in MET detection without the assistance of any separation techniques in a pharmaceutical sample (tablet) with an acceptable recovery of 101.3%. The applicability of the current probe as a paper-based sensor to MET detection has been successfully tested. As a result, the proposed probe presents a fast and suitable strategy to sensitive and selective detect MET and proves a good potential for practical applications, especially pharmaceutical preparations.

Traces of tramadol in water impact behaviour in a native European fish

Tramadol is a widely used analgesic with additional antidepressant and anxiolytic effects. This compound has been reported in continental waters reaching concentrations of µg/L as a consequence of its inefficient removal in sewage treatment plants and increasing use over time. In this study, European chubs (Squalius cephalus) were exposed to 1 µg/L of tramadol in water for 42 days with a subsequent 14 days of depuration. Our results revealed that chubs exposed to this analgesic underwent changes in their behaviour as compared to the control group. The behavioural outcome was also influenced by the individual concentration of tramadol in brain tissue. In particular, experimental fish presented anxiolytic-like effects, characterized by less bold and less social individuals. Exposed animals were less frequently out of the shelter and moved a shorter distance, indicating that they explored the new environment less during the boldness test. In the novel object recognition experiment, although they distinguished the new item, they examined it less and displayed a reduced activity. Shoal cohesion was disrupted as observed in an increased distance between individuals. After the depuration phase, this alteration remained whereas the boldness effect disappeared. Moreover, the degree of behavioural changes was correlated with the concentration of the substance in brain. According to our findings, chronic presence of tramadol in the environment can impact the fitness of exposed aquatic fauna by altering evolutionary crucial behaviours.

Functional properties of ovotransferrin from chicken egg white and its derived peptides: a review

With emerging trends in the food and pharmaceutical industries, potential applications of egg-derived bioactive compounds were recognized. Ovotransferrin is a major egg white functional protein responsible for multiple bioactivities. The objectives of this review are to provide scientific evidence of the functional properties of chicken ovotransferrin and its derived peptides and to identify future research approaches and applications. Various easy, economical, and non-toxic methods have been reported to produce ovotransferrin with high yield and purity, and chemical and enzymatic approaches have been employed to release bioactive peptides. The native ovotransferrin is known to have antimicrobial, antioxidant, anticancer, and immunomodulatory activities. The peptides produced from ovotransferrin also are reported to have antioxidant, antimicrobial, antihypertensive, and anticancer properties. However, little or no application of these compounds in the food and pharmaceutical areas is available yet. Therefore, the practical application of OTF in nutraceutical and pharmaceutical areas are among the emerging areas of research.

Introduction to emerging industrial applications of cannabis (Cannabis sativa L.)

The Italian Law of 22 November 2016 has legalized the cultivation of hemp, which drives the development of sustainable agriculture by generating new products with high added value in the new context of circular economy. Hemp cultivation is known for its low environmental impact, as hemp grows fast, suppresses weeds and does not need pesticides. It has no specialized parasites, favors pollination and improves the physical and chemical soil fertility. Recently, many countries have increased their interest in hemp (Cannabis Sativa L.), considering it as a climate-friendly crop that can mitigate climate change and desertification. For these reasons, hemp can be a new protagonist of Italian agriculture already oriented towards the objectives of EU 2030 which predicts 40% decrease in greenhouse gas emissions compared to 1990. The hemp cultivation can activate a new supply chain by allowing using different parts of the plant, benefiting farmers, environment, and human health. Indeed, although a very old plant, hemp will be one of the main protagonists of the green economy in the near future. Its seeds can be used by agri-food industry to produce flour, pasta, pastry and oil, while the stem through canapulo (woody part of stem) in green building sector. Its fiber (external part of stem) will find new applications in textile industry. As for its inflorescences and roots, thanks to the extraction of bioactive molecules, they will play an important role in the pharmaceutical and parapharmaceutical industry. Finally, only the medical sector with Δ⁹‐tetrahydrocannabinol (THC) extraction from inflorescence is not yet regulated by the aforementioned Italian Law.

Integrating sensors for monitoring blend content in a pharmaceutical continuous manufacturing plant

In a pharmaceutical manufacturing process, Critical Quality Attributes (CQAs) need to be monitored not only for the final product but also for intermediates. Blend uniformity of powders is one such attribute that needs to be measured to ensure the quality of the final product. Multiple in-line sensors were implemented within a Direct Compaction (DC) continuous tablet manufacturing line to monitor the blend content of the powders. In most cases, since the primary ingredient of interest is the active pharmaceutical ingredient (API), the concentration (potency) of the API was monitored/predicted over the course of manufacturing. For the calibration model building process, a unique setup involving dynamic powder spectral acquisition method was used. This setup was aimed at mimicking the powder flow characteristics within the manufacturing line, while at the same time utilizing a relatively small amount of powder. A Raman probe and a portable NIR were used concurrently at the exit of the blending process before the tableting stage. The performance of the two sensors and their respective models were evaluated in terms of accuracy, precision, operating range, measurement frequency, placement, reliability, robustness, and compared to predictions using gravimetric feed rates. Additionally, their performances were validated by off-line traditional analytical measurements.

Geographical accessibility of medicines: a systematic literature review of pharmacy mapping

BACKGROUND

Measuring access to medicines has often been limited to assessing availability and affordability, while little is known regarding other dimensions of access including geographical accessibility. Our study aims to provide a systematic review of literature on the accessibility of medicines by studying the geographical distribution of pharmacies using Spatial Analytical methods.

METHODS

As systematic review of scientific peer-reviewed literature between 2000 and 2018 was carried out using PubMed, Web of Science, Google Scholar, Google and the Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA). Data regarding pharmacy density, distance to pharmacies in relation of pharmacy to sociodemographic factors and pharmacy characteristics were extracted from studies that meet the inclusion criteria.

FINDINGS

Twenty papers fulfilled our inclusion criteria, of which only three were from middle income countries and rest from high-income economies. Pharmacy density per population was reported in 15 studies. Although geographical information was utilized in all studies, only 14 studies reported distance to pharmacies represented as Euclidean (straight line) distance. Disparities in accessibility was reported according to population income and rural or urban location. Seven studies described additional pharmacy characteristics including opening hours, presence of a pharmacist and delivery services.

CONCLUSIONS

Geographical accessibility is a key dimension of access to medicines. Pharmacy density per population is a relevant indicator to assess geographical accessibility which should be complemented by an equity analysis using socio-demographic information and population perception of accessibility.

Molecular biology interventions for activity improvement and production of industrial enzymes

Metagenomics and directed evolution technology have brought a revolution in search of novel enzymes from extreme environment and improvement of existing enzymes and tuning them towards certain desired properties. Using advanced tools of molecular biology i.e. next generation sequencing, site directed mutagenesis, fusion protein, surface display, etc. now researchers can engineer enzymes for improved activity, stability, and substrate specificity to meet the industrial demand. Although many enzymatic processes have been developed up to industrial scale, still there is a need to overcome limitations of maintaining activity during the catalytic process. In this article recent developments in enzymes industrial applications and advancements in metabolic engineering approaches to improve enzymes efficacy and production are reviewed.

Loss-in-weight feeding, powder flow and electrostatic evaluation for direct compression hydroxypropyl methylcellulose (HPMC) to support continuous manufacturing

Minimizing variability in the feeding process is important for continuous manufacturing since materials are fed individually and can impact the final product. This study demonstrates the importance of measuring powder properties and highlights the need to characterize the feeding performance both offline with multiple refills and in the intended configuration for the continuous manufacturing equipment. The standard grade hydroxypropyl methylcellulose (HPMC) had material buildup on the loss-in-weight feeder barrel from triboelectric charging and resulted in more mass flow excursions and failed refills which were not observed with the direct compression grades. The location of the electrostatic buildup changed when the feeder was connected to a hopper instead of feeding offline into a collection bucket. Overall, the direct compression HPMC exhibited better flow which resulted in more accurate loss-in-weight feeding with less excursions from the target mass flow and all refills were completed in the first attempt. The improvements with the direct compression HPMC would be beneficial when running any continuous process (wet granulation, roller compaction, or direct compression) or other processes where loss-in-weight feeding is utilized, such as melt extrusion or twin screw granulation.

The competitive effect of different chlorination disinfection methods and additional inorganic nitrogen on nitrosamine formation from aromatic and heterocyclic amine-containing pharmaceuticals

Amine-containing pharmaceuticals formed nitrosamines that are nitrogenous disinfection byproducts of public concerns due to their carcinogenicity. The objective of this study was to investigate the co-effect of additional inorganic nitrogen in different forms (ammonium, nitrite, and nitrate) and different disinfection approaches (chlorination, monochloramination, dichloramination, and two-step chlorination) on eight nitrosamine formation from four widely used pharmaceuticals. N-nitrosodimethylamine (NDMA) was the main species formed. The presence of N-nitrosomethylethylamine (NMEA), nitrosomorpholine (NMor), and N-nitrosopiperidine (NPip) was found in certain experiments. For one-step chlorination, the influential factors, in decreasing order of importance, were the molecular structural characteristics of the pharmaceutical, oxidation method, and presence and form of additional nitrogen. In four pharmaceuticals with comparative structures, the availability of amine intermediates during degradation was the key to higher nitrosamine yields. Monochloramine significantly enhanced nitrosamine formation from four pharmaceuticals. NDMA formation by adding hypochlorous acid and ammonium separately were lower than those during monochloramination. During two-step chlorination, NDMA formation was enhanced at certain pre-chlorine doses (e.g., a Cl/N molar ratio of 20 or 4). The pre-chlorine dose changed the Cl/N ratio. As the ratio was increased, the combined chlorine residual was formed and decreased. When the ratio was high, breakpoint chlorination possibly occurred enhancing NDMA formation. While NDMA formation was successfully inhibited by two-step chlorination, ammonium brought the NDMA yields of these pharmaceuticals back to the range observed in chloramination, suggesting the importance of ammonium control for limiting NDMA formation from pharmaceuticals during two-step chlorination.

Principles of pharmacoeconomic analysis: the case of pharmacist-led interventions

In the past years, several factors such as evidence-based healthcare culture, quality-linked incentives, and patient-centered actions, associated with an important increase of financial constraints and pressures on healthcare budgets, resulted in a growing interest by policy-makers in enlarging pharmacists' roles in care. Numerous studies have demonstrated positive therapeutic outcomes associated with pharmaceutical services in a wide array of diseases. Yet, the evidence of the economic impact of the pharmacist in decreasing total health expenditures, unnecessary care, and societal costs relies on well-performed, reliable, and transparent economic evaluations, which are scarce. Pharmacoeconomics is a branch of health economics that usually focuses on balancing the costs and benefits of an intervention towards the use of limited resources, aiming at maximizing value to patients, healthcare payers and society through data driven decision making. These decisions can be guide by a health technology assessment (HTA) process that inform governmental players about medical, social, and economic implications of development, diffusion, and use of health technologies - including clinical pharmacy interventions. This paper aims to provide an overview of the important concepts in costing in healthcare, including studies classification according to the type of analysis method (e.g. budget-impact analysis, cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis), types of costs (e.g. direct, indirect and intangible costs) and outcomes (e.g. events prevented, quality adjusted life year - QALY, disability adjusted life year - DALY). Other key components of an economic evaluation such as the models' perspective, time horizon, modelling approaches (e.g. decision trees or simulation models as the Markov model) and sensitivity analysis are also briefly covered. Finally, we discuss the methodological issues for the identification, measurement and valuation of costs and benefits of pharmacy services, and suggest some recommendations for future studies, including the use of Value of Assessment Frameworks.

Dairy farmer perceptions of antibiotic transport and usage in animal agriculture dataset

These data were from semi-structured interviews with dairy farmers. The content of the interviews focused on antibiotic transport and usage on dairy farms. Twenty-seven interviews were conducted in Central New York in 2019. Interviews were recorded and subsequently transcribed for qualitative thematic analysis. Qualitative coding analysis was preformed using ATLAS.ti and content filtered to ensure farmer anonymity. The dataset includes direct quotations from dairy farmers paired with farm and farmer characteristics. Quotations are subdivided thematically into the themes of disease prevention, antibiotic usage, non-antibiotic treatments, antibiotic transport, and environmental residue presence impacts, as structured in Georgakakos et al. [1]. Farm characteristics include management practice, farm size, and farm generation. Farm size was determined by number of lactating cows: small (0-50), medium-small (51-100), medium (101-500), medium-large (501-1000), and large (>1000). Farmer characteristics were farmer age categorized by birth year: Baby Boomer (1946-1964), Gen X (1965-1980), and Millennial (1981-1996). This dataset is particularly promising for longitudinal studies, incorporation of human behaviour into contaminant load models, or for recoding and analysis for themes other than those discussed by Georgakakos et al. [1].

A Review of Water-Resistant Cellulose-Based Materials in Pharmaceutical and Biomedical Application

BACKGROUND

Cellulose, huge reserves of natural polymers, have been widely applied in pharmaceutical and biomedicine fields due to its good biocompatibility, biodegradability, non-toxicity and excellent mechanical properties. At present, water-resistant metal-based and petroleum-based materials applied in medical field exists obvious problems of poor biocompatibility and high cost. Therefore, water-resistant cellulose-based materials with good biocompatibility and low price will become an attractive alternative. This review aims to summarize the preparation of water-resistant cellulose-based materials and their potential application in pharmaceutical and biomedical in recent years.

METHODS

Common hydrophobic treatments of cellulose fibers or paper were overviewed. The preparation, properties and applications of water-resistant cellulose-based materials in the pharmaceutical and biomedical fields were summarized.

RESULTS

Common hydrophobic treatments of cellulose fibers or paper were divided into chemical modification (graft polymerization, crosslinking, solution casting or dip-coating), physico-chemical surface modifications (plasma treatments, surface patterning, electrostatic spraying and electrowetting) and physical processing (electrostatic spinning, SAS process and 3D EHD printing). These hydrophobically processed cellulose fibers or paper could be prepared into various water-resistant cellulose-based materials and applied in pharmaceutical excipients, drug-loaded amphiphilic micelles, drug-loaded composite fibers, hydrophobic biocomposite film/coatings and paper-based detectors. They presented excellent water resistance and biocompatibility, low cytotoxicity and high drug loading ability, and stable drug release rate, etc., which could be used for water-insoluble drugs carriers, wound dressings, and medical testing equipment.

CONCLUSION

Currently, water-resistant cellulose-based materials were mainly applied in water-insoluble drugs delivery carriers, wound dressing and medical diagnosis and presented great application prospects. However, the contradiction between hydrophobicity and mechanical properties of these reported water-resistant cellulose-based materials limited their wider application in biomedicine such as tissue engineering. In the future, attention will be focused on the higher hydrophobicity of water-resistant cellulose-based materials with excellent mechanical properties. In addition, clinical medical research of water-resistant cellulose-based materials should be strengthened.

Efficient degradation of typical pharmaceuticals in water using a novel TiO2/ONLH nano-photocatalyst under natural sunlight

Photocatalytic degradation of typical pharmaceuticals in natural sunlight and in actual water is of great significance. In this study, the oxygen or nitrogen linked heptazine-base polymer (ONLH) was successfully incorporated with TiO₂ nanoparticles and formed a TiO₂/ONLH nanocomposite which was responded to the natural sunlight. Under natural sunlight, the TiO₂/ONLH can effectively degrade ten types of pharmaceuticals. In particular, fluoroquinolone containing N-piperazinyl, and cardiovascular drugs containing long aromatic side chains were easily degraded. The half-life of the best degradation performance of propranolol was less than 5 min. The rate constants of propranolol using the TiO₂/ONLH were approximately six- and eight-fold higher than those of pristine TiO₂ and ONLH, respectively. Two reactive species (OH and O₂^-) facilitated the rapid degradation of propranolol, which occurred primarily through the hydroxyl radical addition, ring-opening, and ipso substitution reactions. An acute toxicity test using luminescent bacteria indicated that the toxicity of the propranolol reaction solution gradually decreased with lower total organic carbon (TOC). According to the toxicity evaluation of monomer products, the TiO₂/ONLH also reduced the generation of toxic transformation products. The effects of actual water/wastewater have further shown the TiO₂/ONLH might be applied for the removal of pharmaceuticals in wastewater.

Implementation of a Human Renal Proximal Tubule on a Chip for Nephrotoxicity and Drug Interaction Studies

Proximal tubule epithelial cells (PTEC) are susceptible to drug-induced kidney injury (DIKI). Cell-based, two-dimensional (2D) in vitro PTEC models are often poor predictors of DIKI, probably due to the lack of physiological architecture and flow. Here, we assessed a high throughput, 3D microfluidic platform (Nephroscreen) for the detection of DIKI in pharmaceutical development. This system was established with four model nephrotoxic drugs (cisplatin, tenofovir, tobramycin and cyclosporin A) and tested with eight pharmaceutical compounds. Measured parameters included cell viability, release of lactate dehydrogenase (LDH) and N-acetyl-β-d-glucosaminidase (NAG), barrier integrity, release of specific miRNAs, and gene expression of toxicity markers. Drug-transporter interactions for P-gp and MRP2/4 were also determined. The most predictive read outs for DIKI were a combination of cell viability, LDH and miRNA release. In conclusion, Nephroscreen detected DIKI in a robust manner, is compatible with automated pipetting, proved to be amenable to long-term experiments, and was easily transferred between laboratories. This proof-of-concept-study demonstrated the usability and reproducibility of Nephroscreen for the detection of DIKI and drug-transporter interactions. Nephroscreen it represents a valuable tool towards replacing animal testing and supporting the 3Rs (Reduce, Refine and Replace animal experimentation).

Occurrence and fate of pharmaceuticals in a wastewater treatment plant from southeast of Spain and risk assessment

Pharmaceutical and personal care products (PPCPs) can be incorporated into ecosystems and pose potential environmental and health hazards. These pollutants are becoming omnipresent in the environment because they are introduced by several sources, being particularly important the contribution of human-derived pharmaceuticals. The presence of PPCPs in waters has received increasing attention in recent years, resulting in great concern regarding their occurrence, transformation, fate and environmental risk. For that reason, the pharmaceuticals carbamazepine (CBZ), diclofenac (DIC), ibuprofen (IBU), ketoprofen (KET) and naproxen (NPX) were measured in the waters and sludge of several parts of a double step activated sludge wastewater treatment plant (WWTP) from Murcia (Spain). With these results, the biological degradation constant, the sorption coefficient and the pharmaceutical removal were calculated. Possible risks to humans and ecosystems were also evaluated. These showed good degradation of IBU and NPX (74.4 and 84.9%, respectively), while CBZ didn't display any degradation. DIC was the compound most likely to be sorbed into the sludge (3.09 L kg^-1). The PPCPs removal in this double stage WWTP was compared to a previous data obtained in a WWTP of the same region with an activated sludge (single biological batch reactor). The results showed a decrease in the removal of the double stage plant, probably due to the lower hydraulic retention time employed. The study of the human and ecological risk quotients indicates a low risk of the selected pharmaceuticals (RQ < 0.1).

Tap water contamination: Multiclass endocrine disrupting compounds in different housing types in an urban settlement

Contamination of endocrine disrupting compounds (EDCs) in tap water is an emerging global issue, and there are abundant influencing factors that have an ambivalent effect on their transportation and fate. Different housing types vary in terms of water distribution system operation and design, water consumption choices, and other hydraulic factors, which potentially affect the dynamics, loadings, and partitioning of pollutants in tap water. Thus, this study analyzed 18 multiclass EDCs in tap water from different housing types (i.e., landed and high-rise) and the associated health risks. Sample analyses revealed the presence of 16 EDCs, namely hormones (5), pharmaceuticals (8), a pesticide (1), and plasticizers (2) in tap water, with the prevalent occurrence of bisphenol A up to 66.40 ng/L in high-rise housing. The presence of caffeine and sulfamethoxazole distribution in tap water was significantly different between landed and high-rise housings (t(152) = -2.298, p = 0.023 and t(109) = 2.135, p = 0.035). Moreover, the salinity and conductivity of tap water in high-rise housings were significantly higher compared to those in landed housings (t(122) = 2.411, p = 0.017 and t(94) = 2.997, p = 0.003, respectively). Furthermore, there were no potential health risks of EDCs (risk quotient < 1) estimated in different age groups via drinking water intake. However, EDC variation in different housing types requires simulation of the occurrence, transport, and fate of EDCs in the distribution system and investigation of the underlying factors for effective mitigation, prevention, and intervention.

Transcriptome-wide changes associated with the reproductive behaviour of male guppies exposed to 17α-ethinyl estradiol

Although many pharmaceutical compounds (and their metabolites) can induce harmful impacts at the molecular, physiological and behavioural levels, their underlying mechanistic associations have remained largely unexplored. Here, we utilized RNA-Seq to build a whole brain transcriptome profile to examine the impact of a common endocrine disrupting pharmaceutical (17α-ethinyl estradiol, EE2) on reproductive behaviour in wild guppies (Poecilia reticulata). Specifically, we annotated 16,791 coding transcripts in whole brain tissue in relation to the courtship behaviour (i.e. sigmoid display) of EE2 exposed (at environmentally relevant concentration of 8 ng/L for 28-days) and unexposed guppies. Further, we obtained 10,960 assembled transcripts matching in the non-coding orthologous genomes. Behavioural responses were assessed using a standard mate choice experiment, which allowed us to disentangle chemical cues from visual cues. We found that a high proportion of the RNAseq reads aligned back to our de novo assembled transcriptome with 80.59% mapping rate. Behavioural experiments showed that when males were presented only with female visual cues, there was a significant interaction between male treatment and female treatment in the time spent in the preference zone. This is one of the first studies to show that transcriptome-wide changes are associated with the reproductive behaviour of fish: EE2 exposed male guppies that performed high levels of courtship had a gene profile that deviated the most from the other treatment groups, while both non-courting EE2 and control males had similar gene signatures. Using Gene Ontology pathway analysis, our study shows that EE2-exposed males had gene transcripts enriched for pathways associated with altered immunity, starvation, altered metabolism and spermatogenesis. Our study demonstrates that multiple gene networks orchestrate courting behaviour, emphasizing the importance of investigating impacts of pharmaceuticals on gene networks instead of single genes.

Time-, dose- and transgenerational effects of fluoxetine on the behavioural responses of zebrafish to a conspecific alarm substance

Despite publication of numerous of papers, the effects of fluoxetine on fish behaviour remains mired in controversy and contradiction. One reason for this controversy is that fluoxetine displays distinct and opposing acute and chronic effects. A second reason is that most studies have been limited to two or at the most three concentrations. To address these deficiencies we exposed adult zebrafish, both single females and shoals consisting of one male and two females, to seven fluoxetine concentrations, ranging from 5 ng/L to 5 μg/L and measured their swimming behaviour, and response to a conspecific alarm substance (CAS) at seven, 14 and 28 days. We also measured the light startle response of unexposed F1 larvae at days seven and 28 post-hatch and the response to CAS at day 28. On day 7 fluoxetine decreased swimming speed at concentrations ≥500 ng/L. After addition of CAS fish exposed to 5, 500 and 1000 ng/L decreased swimming, while fish exposed to 10, 500 and 1000 ng/L significantly increased time motionless. On day 14 only fish exposed to 50 ng/L were significantly slower than controls before addition of CAS, but afterwards fish exposed to 5, 50, 1000 and 5000 ng/L showed significant differences from controls. On day 28 fish exposed to 50 and 5000 ng/L had slower average swimming speeds than controls before addition of CAS. After addition all fish except controls and those exposed to 500 ng/L showed decreased average speed. At seven days post-hatch, F1 larvae whose parents were exposed to 100 ng/L showed significantly higher activity than controls and those exposed to 500 ng/L fluoxetine showed lower activity in the light startle response. This study shows that the effects of fluoxetine vary with time and also in a non-monotonic manner. We suggest that the complex nature of the serotonergic system with multilateral effects at the genomic, biochemical and physiological levels interacting with environmental stimuli result in non-linear dose-response behavioural patterns.

Drug supply shortage in Nigeria during COVID-19: efforts and challenges

The COVID-19 pandemic has resulted in massive disruptions in global supply chains. Nigeria is particularly vulnerable with respect to pharmaceuticals since there is reduced local production and about 70% of the drug supply is imported creating a huge supply-demand disparity particularly in times like COVID-19. Nigeria is in need of huge quantities of quality-assured health commodities to effectively respond to the pandemic. Significant shortages of other essential medicines and medical products across the country could be imminent. Drug scarcity in Nigeria during the COVID-19 pandemic period is because of several accumulated factors, majorly as a result of global lockdown, decreased manufacturing, unaddressed regulatory affairs, poor access to resources by the population, lack of buffer stocks, security instability, and poor funding of the healthcare system. This situation if left unattended, could cause serious drawbacks to the health of the populace as well as the quality of life of Nigerians amid the COVID-19 Pandemic. Appropriate measures should be directed to ensure ethical processes on drug production, importation, pricing, and distribution to avoid such events during unavoidable scenarios, like the COVID-19 pandemic and other public health emergencies.

Magnetic nanoparticles in developing electrochemical sensors for pharmaceutical and biomedical applications

A revolutionary impact on the pharmaceutical and biomedical applications has been arisen in the few years to come as a result of the advances made in magnetic nanoparticles (MNPs) research. The use of MNPs opens wide opportunities in diagnostics, drug and gene delivery, in vivo imaging, magnetic separation, and hyperthermia therapy, etc. Besides, their possible integration in sensors makes them an ideal essential element of innovative pharmaceutical and biomedical applications. Nowadays, MNPs-based electrochemical sensors have attracted great attention to pharmaceutical and biomedical applications owing to their high sensitivity, stability. Selectivity towards the target as well as their simplicity of manufacture. Therefore, this review focus on recent advances with cutting-edge approaches dealing with the synthesis, design, and advantageous analytical performance of MNPs in the electrochemical sensors utilized for pharmaceutical and biomedical applications between 2015 and 2020. The challenges existing in this research area and some potential strategies/future perspectives for the rational design of electrochemical sensors are also outlined.

The impact of pharmaceutical innovation on the longevity and hospitalization of New Zealand cancer patients, 1998-2017

BACKGROUND

We investigate whether the cancer sites that experienced more pharmaceutical innovation in New Zealand had larger subsequent declines in premature mortality and hospitalization rates and larger subsequent increases in 5-year survival rates, controlling for changes in incidence.

RESEARCH DESIGN AND METHODS

We estimate the effects of the number of WHO ATC5 chemical substances and ATC4 chemical subgroups approved on the number of years of potential life lost before ages 85, 75, 65, 5-year relative survival rates, and the number of inpatient hospital discharges, by estimating difference-in-differences (2-way fixed-effects) models using aggregate longitudinal data on 23 cancer sites.

RESULTS

Substances/subgroups approved during 1985-2001 reduced the number of years of potential life lost before age 85 (YPLL85) in 2017 by 67%. Those substances/subgroups reduced YPLL75 and YPLL65 in 2017 by similar percentages. The odds of surviving at least 5 years after diagnosis are significantly positively related to the number of substances previously approved.

CONCLUSIONS

The cost per life-year before age 85 gained in 2017 from previous drug approvals did not exceed 1719 USD. The WHO considers interventions whose cost per quality-adjusted life-year gained is less than per capita GDP to be highly cost-effective; New Zealand's per capita GDP in 2017 was 42,260 USD. capita GDP in 2017 was 42,260 USD.

EXPERT OPINION

Pharmaceutical innovation-the introduction and use of new drugs-substantially increased cancer survival rates in New Zealand, and substantially reduced premature (before ages 85, 75, and 65) cancer mortality there during the period 1998-2017. Moreover, overall the new cancer drugs were highly costeffective. The drugs approved during 1985-2001 are estimated to have reduced the number of years of potential life lost before age 85 in 2017 by 244,876. Even if previous drug approvals increased the cost of hospital discharges and other medical costs, the cost per life-year before age 85 gained in 2017 from those approvals could not have exceeded 1719 USD.

Influence of pharmaceutical marketing mix strategies on physicians' prescribing behaviors in public and private hospitals, Dessie, Ethiopia: a mixed study design

Background

Prescription drugs constitute the primary source of revenue for the pharmaceutical industry. Most pharmaceutical companies commit a great deal of time and money to market in hopes of convincing physicians about their products. The objective of this study is to assess perceived influence of pharmaceutical marketing mix strategies on physicians’ prescribing behaviors in hospitals, Dessie, Ethiopia.

Methods

Mixed methods sequential explanatory design was employed in two public and three private hospitals. A cross-sectional study design was employed by including (136) physicians working in public and private hospitals. Percentage, mean, standard deviation, and multiple linear regressions were computed using Statistical Package for Social Science. In the second phase, the phenomenological design was employed to fully explore in-depth information. Purposive sampling was used to select key informants and 14 in-depth interviews were conducted by the principal investigator. Content analysis was performed using Nvivo 11 plus and interpretation by narrative strategies.

Results

The overall perceived influence of pharmaceutical marketing mix strategies in physicians’ prescribing behavior was 55.9%. The influence of promotion, product, place and price strategy perceived by physicians in their prescribing behavior was 83 (61%), 71(52.2%), 71 (52.2%), 80 (58.8%) respectively. There was a statistically significant difference among marketing mix strategies (β = 0.08, p = < 0.001). Determinants on the influence of physicians’ prescribing behavior were specialty (p = 0.01) and working areas (p = 0.04). The qualitative design also generates additional insights into the influence of pharmaceutical marketing mix strategies on physician prescribing behavior.

Conclusions

More than half of physicians perceived that pharmaceutical marketing mix strategies influence their prescribing behavior. The qualitative design also revealed that pharmaceutical marketing mix strategies influenced physicians prescribing behavior. Strengthening the regulation and maintaining ethical practice would help to rationalize the physicians’ prescribing practice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-10063-2.

Best practices for selection of excipients for paediatrics - Workshop reflection

The development of age appropriate formulations for the paediatric population has become one of the key areas of focus for the pharmaceutical industry - with a subsequent influence on excipient use. Selection of excipients with appropriate safety and tolerability is a major hurdle in paediatric formulation development. Various factors influence selection of excipients, including target age group, route of administration and dosage form. Evaluation of these factors and a clear rationale and justification is expected by the regulators when it comes to selecting excipients for paediatric formulation. Scientists are encouraged to apply the principle of benefit to risk balance to assess the suitability of excipients to the specific paediatric population for whom the formulation is intended. In order to understand how scientists approach the task of establishing the risk to benefit analysis, a workshop was organised by the European Paediatric Formulation Initiative (EuPFI) to reflect on the current scenario and the different practices employed by formulation scientists in the selection of excipients for paediatric formulations. Aspects assessed by regulators were also canvassed. Finally, the participants were asked to comment on how selecting excipients for use in paediatric formulations may differ from the considerations applied in selecting excipients for formulations for other age groups. Based on the workshop discussion, some recommendations and questions to consider emerged regarding the selection of excipients in paediatric drug development. These best practice recommendations provided a good starting point for a more systematic strategy for selecting excipients for paediatric formulation development.

Using QSAR Models to Predict Mitochondrial Targeting by Small-Molecule Xenobiotics Within Living Cells

Prediction of mitochondrial targeting, or prediction of exclusion from mitochondria, of small-molecule xenobiotics (biocides, drugs, probes, toxins) can be achieved using an algorithm derived from QSAR modeling. Application of the algorithm requires knowing the chemical structures of all ionic species of the xenobiotic compound in question, and for certain numerical structure parameters (AI, CBN, log P, pK _a, and Z) to be obtained for all such species. Procedures for specification of the chemical structures; estimation of the structure parameters; and application of the algorithm are described in an explicit protocol.

A Market Shaping Approach for the Biopharmaceutical Industry: Governing Innovation Towards the Public Interest

Enhancing research and development and ensuring equitable pricing and access to cutting-edge treatments are both vital to a biopharmaceutical innovation system that works in the public interest. However, despite delivering numerous therapeutic advances, the existing system suffers from major problems: a lack of directionality to meet key needs, inefficient collaboration, high prices that fail to reflect the public contribution, and an overly-financialized business model.

Achieving Equitable Access to Medicines and Health Services: A COVID-19-time Recalled Matter

In the 21^st century, while some people seek to use artificial intelligence for health services delivery, others have to surrender their health rights to meet basic needs. The gradient in health has become more pronounced in the COVID-19 crisis considering discrepancies in disease prevalence, geographical accessibility, availability, affordability, quality/safety of health services, and human resources. Through PubMed, GoogleScholar, Scopus, WHO, OECD, and UN databases, the English documents and global statistics were collected. Determining the role of health equity-related factors and introducing mechanisms to maintain regional and international justice in health, specifically during the COVID-19 pandemic, were among the core concepts of this paper. Social determinants of health (SDH), interregional and intraregional bodies are the main drivers of discrimination in health services. Governments should relish chief health strategists' role in possessing legitimacy, accountability, direction, transparent performance, fairness, and good governance in one word. Improving health literacy and telemedicine, providing income support, and reforming insurance where needed, are other national mechanisms to amend inequity. Among interregional issues, what is concerning is the matter of sanctions on access to health services, which is against the Universal Declaration of Human Rights. Shortage of vital medications, ventilators, test kits, COVID-19 vaccines, pharmaceutical raw materials, foreign currency, decreased national currency value, purchasing power parity, and quality/safety of health services resulted from such oppression. The article also provides practical suggestions, paving the way for re-establishing global solidarity and developing health justice in deprived regions.

Natural Insulin Sensitizers for the Management of Diabetes Mellitus: A Review of Possible Molecular Mechanisms

Diabetes mellitus is a growing health challenge globally which is increasing in epidemic proportion. Naturally occurring pharmacological agents are more likely to provide beneficial therapeutic effects without undesirable side effects compared to the synthetic agents. There is a growing evidence that some naturally occurring pharmacological agents derived from plants have potential antihyperglycemic effects. In this study, we have reviewed the molecular mechanism behind potential hypoglycemic properties of four well-known herbal-based agents, namely, ginger, curcumin, garlic, and cinnamon. Also, we present the related clinical data confirming experimental results aiming to develop novel therapeutic strategies based on these herbal agents potentially for the management of patients with diabetes.

A review on valorization of oyster mushroom and waste generated in the mushroom cultivation industry

A review of valorization of oyster mushroom species and waste generated in the mushroom cultivation is presented, with a focus on the cultivation and valorization techniques, conditions, current research status and particularly the hazard mitigation and value-added recovery of the waste mushroom substrate (WMS) - an abundant waste in mushroom cultivation industry. Based on the studies reviewed, the production rate of the present mushroom industry is inadequate to meet market demands. There is a need for the development of new mushroom cultivation methods that can guarantee an increase in mushroom productivity and quality (nutritional and medicinal properties). This review shows that the cylindrical baglog cultivation method is more advantageous compared with the wood tray cultivation method to improve the mushroom yield and cost efficiency. Approximately 5 kg of potentially hazardous WMS (spreading diseases in mushroom farm) is generated for production of 1 kg of mushroom. This encourages various valorization of WMS for use in agricultural and energy conversion applications, mainly as biocompost, plant growing media, and bioenergy. The use of WMS as biofertilizer has shown desirable performance compared to conventional chemical fertilizer, whilst the use of WMS as energy feedstock could produce cleaner bioenergy sources compared to conventional fuels.

The health scare of COVID-19 amidst pandemics and the immune-related pharmaceutical products spillovers in the USA

In view of the sector-wide effect of the nCOVID-19 pandemic in the USA and the probable effect on certain over-the-counter (OTC) pharmaceutical products, the current study examined potential inflation in the pharmaceutical industry arising from the pandemic-related uncertainty. In this case, the USA's producer price indexes vis-à-vis inflation of the immune-related pharmaceutical items: multivitamin, vitamins nutrients and hematinic (V-N-H), other vitamins (other-V), antidepressant, and antidiabetic were examined alongside the uncertainties arising from the world pandemic and economic policy. Thus, the (Diebold and Yilmaz in Int J Forecast 28(1): 57-66, 2012) result implied that the world pandemic uncertainty contributed a significantly huge shock to the examined pharmaceutical compounds, thus affirming the vulnerability of certain pharmaceuticals to pandemic-related uncertainty. The total spillover increased from 34.2% (with economic policy uncertainty) to 47.6% (when pandemic uncertainty is incorporated). In specific, there are negative net spillovers from the multivitamins, other vitamins, antidiabetic, and antidepressant especially due to high pandemic and economic policy uncertainties. However, the statistical evidence implied that higher uncertainty arising from the pandemic is responsible for the severity of shock received by the indicated pharmaceutical products as against economic policy uncertainty. Thus, a relevant policy inference is posited from the result of the study.

Occurrence and fate of antibiotics, antibiotic resistant genes (ARGs) and antibiotic resistant bacteria (ARB) in municipal wastewater treatment plant: An overview

The occurrence and fate of antibiotics and antibiotic resistant genes (ARGs) and antibiotic resistant bacteria (ARB) in Municipal Wastewater Treatment Plants (WWTPs) worldwide were reviewed. The prevalence of antibiotics in WWTPs among different periods (1999-2009 and 2010-2019) and geographical areas (Europe, America, Asia and Africa) was summarized, analyzed and evaluated. The classes of macrolides (clarithromycin, erythromycin/erythromycin-H₂O, azithromycin, roxithromycin), sulfonamides (sulfamethoxazole), trimethoprim, quinolones (ofloxacin, ciprofloxacin, norfloxacin) and tetracyclines (tetracycline) were the antibiotics most frequently detected, while bla (bla_CTXM, bla_TEM), sul (sul1, sul2), tet (tetO, tetQ, tetW) and ermB genes were the ARGs commonly reported in WWTPs. There was a positive correlation between antibiotics and ARGs commonly detected in WWTPs, except for β-lactam antibiotics and bla genes. The genes bla were found frequently, despite β-lactam antibiotics were seldom detected owing to the hydrolysis. Most of antibiotics had lower levels in the period 2010-2019 in Asian countries than that in period 1999-2009 in North American and European countries. In the effluent of secondary treatment, the concentration of trimethoprim was the highest (138 ng/L in median) and the concentration of other antibiotics remained at lower than 80 ng/L, while the relative abundance of ARGs ranged 2.9-4.6 logs (copies/mL, in median). Future researches on the development of effective antibiotic removal technologies, such as advanced oxidation processes, are suggested to focus on antibiotics frequently detected and their corresponding ARGs in WWTPs.

Public research funding and pharmaceutical prices: do Americans pay twice for drugs?

In the debate over prescription drug pricing, some pharmaceutical industry critics claim that U.S. taxpayers pay twice for costly therapies, because publicly supported research is a major contributor to drug discovery and American taxpayers are inadequately rewarded for their research investment due to high drug prices. In fact, the empirical evidence supporting these claims is weak, and the pay twice argument distracts from important efforts to ensure that impactful new drugs continue to be developed and made widely available to patients who need them.

Impact of changes in the methodology of external price referencing on medicine prices: discrete-event simulation

BACKGROUND

Several governments apply the policy of external price referencing (EPR), which considers the prices of a medicine in one or more other countries for the purpose of setting the price in the own country. Different methodological choices can be taken to design EPR. The study aimed to analyse whether, or not, and how changes in the methodology of EPR can impact medicine prices.

METHODS

The real-life EPR methodology as of Q1/2015 was surveyed in all European Union Member States (where applicable), Iceland, Norway and Switzerland through a questionnaire responded by national pricing authorities. Different scenarios were developed related to the parameters of the EPR methodology. Discrete-event simulations of fictitious prices in the 28 countries of the study that had EPR were run over 10 years. The continuation of the real-life EPR methodology in the countries as surveyed in 2015, without any change, served as base case.

RESULTS

In most scenarios, after 10 years, medicine prices in all or most surveyed countries were-sometimes considerably-lower than in the base case scenario. But in a few scenarios medicine prices increased in some countries. Consideration of discounts (an assumed 20% discount in five large economies and the mandatory discount in Germany, Greece and Ireland) and determining the reference price based on the lowest price in the country basket would result in higher price reductions (on average - 47.2% and - 34.2% compared to the base case). An adjustment of medicine price data of the reference countries by purchasing power parities would lead to higher prices in some more affluent countries (e.g. Switzerland, Norway) and lower prices in lower-income economies (Bulgaria, Romania, Hungary, Poland). Regular price revisions and changes in the basket of reference countries would also impact medicine prices, however to a lesser extent.

CONCLUSIONS

EPR has some potential for cost-containment. Medicine prices could be decreased if certain parameters of the EPR methodology were changed. If public payers aim to apply EPR to keep medicine prices at more affordable levels, they are encouraged to explore the cost-containment potential of this policy by taking appropriate methodological choices in the EPR design.

Multiobjective nonlinear model predictive control of pharmaceutical batch crystallizers

A rigorous multiobjective nonlinear model predictive control procedure is implemented in solving problems involving batch crystallizations. This technique does not involve the use of weighting functions and additional restrictive constraints. Three cases are considered. The first is the unseeded batch crystallization involving paracetamol, the second is the seeded batch crystallization concerning potassium nitrate while the third problem deals with a temperature controlled batch crystallizer that involves citric acid anyhydrate. The optimization language pyomo with GAMS interface is used to solve the problems.

Residence time distribution modelling and in line monitoring of drug concentration in a tablet press feed frame containing dead zones

The presence of a 'significant dead zone' in any continuous manufacturing equipment may affect the product quality and need to be investigated systematically. Dead zone will affect the residence time distribution (RTD) of continuous manufacturing and thus the mixing and product quality. Tablet press (feed frame) is one of unit operations that directly influence the critical quality attributes (CQA's). However, currently no systematic methods and tools are available to characterize and model the feed frame dead zone. In this manuscript, the RTD of the tablet press feed frame containing dead zone is investigated. Step-change experiments revealed that the feed frame could be expressed as a traditional continuous stirred tank model. The volume fractions of the dead zones are determined experimentally as well as using RTD model. In addition, an in-line NIR method for drug concentration monitoring inside the feed frame is also developed. The developed NIR calibration model enables to monitor the drug concentration precisely and detect the variation immediately with the probe positioned right above the left paddle. It is also found that the feed frame paddle speed slightly affects the predictive accuracy of NIR, while the die disc speed has no significant effect.