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This paper aims at proposing a Constraint-based Learning Estimation of Distribution Algorithm (EDA) to solve the Multi-Mode Resource Constrained Project Scheduling Problem (MMRCPSP). This problem is considered a combinatorial optimization problem and consists of a set of tasks to be carried out in an ordered way, limited availability of resources, and an execution mode for each task. Generally, traditional EDAs handle the constraints of the problem using strategies such as penalty, Pareto dominance, or others, without taking into account these constraints during the learning process. These traditional approaches usually cause the generation of infeasible solutions in each iteration. In this paper, an approach based on the constraints handling during the learning process of the probabilistic model is proposed. To validate the performance of the algorithms, the new approach in two scenarios is compared. First, in the solution of a set of classical optimization problems, where different EDAs are compared in terms of efficiency and efficacy. The second group of experiments is performed on a set of instances of the PSPLIB database. In this case, the proposed algorithm is compared with a traditional EDA and with other results reported in the bibliography. The experimental results demonstrate that the proposal outperforms both the results of traditional EDA and other EDA reported in the literature. [ABSTRACT FROM AUTHOR]

This article presents the physical, mechanical, optical, and radiation shielding properties of several articles discussing BaO-based glass systems prepared by the melt-quench technique. Specifically, the article discussed is an article that reports experimentally the effectiveness of BaO-based glass systems as shielding gamma-ray radiation at an energy of 0.662 MeV published since 2019. In addition, we also compare the theoretical effectiveness of several glass systems by recalculating using Phy- X/PSD based on the respective compositions reported by previous studies at several energies, namely: 0.284, 0.347, 0.662, 0.826, 1.173, 1.333, and 2.506 MeV. Based on the analysis, the Bi 2 O 3 –BaO–B 2 O 3 glass system is the best in terms of absorbing radiation. But it still needs to be developed to get the best physical, mechanical, and optical properties. With this article, scholars can more easily determine the composition of a BaO-based glass system to be applied as a more effective and high-quality radiation shield. • Evolution of gamma-ray radiation at an energy of 0.662 MeV published since 2019. • The theoretical effectiveness were calculated using Phy- X/PSD. at various energies. • The Bi2O3–BaO–B2O3 glass system is the best in terms of absorbing radiation. • Scholars easily determine composition BaO-based for effective radiation shield. • Physical, mechanical, and optical properties important in for BaO-based glass. [ABSTRACT FROM AUTHOR]

This paper provides a comprehensive bibliometric analysis to better understand the evolution of concrete composite as a radiation shielding research from when it was first published in 1949 to October 26, 2022. This study was conducted based on the Scopus database, and the publications analyzed a total of 541 documents. The data in this paper is visualized using the VOSviewer and Tableau to perform bibliometric analysis and scientific mapping. The analysis results show that published documents have continued to increase in recent years and are dominated by articles. Some countries show productivity and influence in their country/region with the broadest range of partners. This study presents the most contributed journals and the most frequently cited documents. In addition, keyword analysis was carried out to find the hotspots on this research topic. This paper helps scholars to understand the evolution of concrete composite as a radiation shielding research from a bibliometric perspective and inspires them to develop new concrete composite with high stability absorption properties from waste or natural material to replace concrete Lead (Pb)-based. • Evolution concrete composite as shielding research from 1949 to October 26, 2022. • Data perform using bibliometric analysis and scientific mapping. • To helps scholars, understand evolution of concrete composite as a radiation shield. • Bibliometric perspective help to develop new high absorption of concrete composite. • High stability from waste or natural material to replace concrete Lead (Pb)-based. [ABSTRACT FROM AUTHOR]

Occupational radiation exposure can occur due to various human activities, including the use of radiation in medicine. Occupationally exposed personnel surpassing 7.4 millions, and respresent the biggest single group of employees who are exposed to artificial radiation sources at work. This study compares the occupational radiation dose levels for 145 workers in four different hospitals located in the Aseer region in Saudi Arabia. The occupational exposure was quantified using thermoluminescence dosimeters (TLD-100). The levels of annual occupational exposures in targeted hospitals were calculated and compared with the levels of the international atomic energy agency (IAEA) Safety Standards. An average yearly cumulative dose for the two consecutive years. The average, highest and lowest resulted occupational doses under examination in this work is 1.42, 3.9 mSv and 0.72 for workers in various diagnostic radiology procedures. The resulted annual effective dose were within the IAEA approved yearly dose limit for occupational exposure of workers over 18, which is 20 mSv. Staff should be monitored on a regular basis, according to current practice, because their annual exposure may surpass 15% of the annual effective doses. • Annual occupational dose (Hp(10) were evaluated at four diagnostic radiology department. • Staff doses represent approximately 15% of the annual effective dose. • Students and trainees should be monitored on a regular basis, according to current practice. • Occupational exposure is comparable with the most previously published studies. [ABSTRACT FROM AUTHOR]

CT scanning deliver much higher radiation doses than planar radiological procedures, which puts patients to high risks. This study measures and evaluates patient doses during chest and abdomen computed tomography procedures. Particular attention is given to measuring the dose to the equivalent breast (mSv) and to estimate the associated risks of breast cancer to young female patients (15–35 years). Data was obtained from standard examinations from three hospitals. The measured values of CT dose indexes, CTDI (mGy) as well as exposure-related parameters were used for assessment. Breast and effective doses were extrapolated using a software. The results showed remarkable variations of the mean organ equivalent doses for similar CT examinations in the studied hospitals. This could be attributed to the variation in CT scanning imaging technique, and clinical indications. The average effective dose to the chest was 7.9 mSv (2.3–47.0 mSv) and for the abdomen the mean dose was 6.6 mSv, ranging from (3.3–27 mSv). The breast received equivalent doses from chest and abdomen procedures as follows: 10.2 (1.6–33 mSv) and 10.1(2.3–19 mS) Sv respectively. Each procedure yielded high risks of breast cancer for young females. Implementation of accurate referral criteria is recommended to avoid unnecessary breast radiation exposure. • Breast radiation doses for young females were evaluated during CT chest and abdomen procedures. • CT chest and abdomen procedures yielded high risks of breast cancer for young females. • Breast doses varied from 1.6 to 33 mSv during chest CT procedure. • Proper justification and optimization are recommended to save young females from potential radiogenic risks. [ABSTRACT FROM AUTHOR]

A significant source of ionizing radiation for medical use is computed tomography (CT). According to estimates, more than 84 million CT scans are carried out yearly in the US. Because the neck area contains several organs and tissues that are very sensitive to ionizing radiation, such as the thyroid gland, CT for the neck region is commonly done for a variety of clinical causes. This study's goal is to assess the patient doses to radiosensitive organs and effective doses received during the CT neck surgery in the pastAt Riyadh Care Hospital, a multislice CT (MSCT) system (Siemens Somatom Sensation, 64 slices/detector) was used to perform improved CT treatments on a total of 54 patients. Patient ages were 41.5–15.5 years old on average, with a wide variation (21–73). Using computer software based on Monte Carlo simulation, organ and effective dosages were assessed. The International Commission of Radiological Protection (ICRP) risk variables were used to calculate the patient's radiogenic risk for a particular organ. The patients' dose length product (DLP, mGy.cm) for CT neck examination were 993.3 ± 539.5 (267.3–2441.7). The mean and range of volume CT dose per slice (CTDIvol (mGy)) were 1.5 ± 3.9 (3.91–22.55). The overall effective dose (mSv) per procedure is ranged from 1.3 to 11.7 with a mean value 2.8 mSv. Patients' CT neck procedures have been repeated the procedure up to 7 times during the treatment course. The risk of malignancy is 1x10-6 CT procedure. The study showed that patients received wide discrepancies in patients' doses up to 9 times. Optimization of image acquisition protocol and scan length is necessary to reduce the unnecessary risk. • The effective and organ equivalent doses during neck CT procedure were studied. • Lens of the eye, salivary gland and thyroid gland received a high radiation dose. • The overall effective dose (mSv) per procedure is ranged from 1.3 to 11.7 • Patients' CT neck procedures have been repeated the procedure up to 7 times during the treatment course. [ABSTRACT FROM AUTHOR]

Artificial radiation is the primary radiogenic risk source to the general population. Medical field has been growing in Sudan. This study aims to estimate effective doses for adult patients from nuclear medicine examinations. The study involved 685 patients from five different hospitals in Sudan. In total, 300, 196, and 189 patients underwent renal, thyroid, and bone scans. All procedures were carried out using the Tc-99m radionuclide. Effective dose has been estimated using computer software depending on conductive activity. The results show that dose information for patients from thyroid, renal, and bone scan, for thyroid scan the patients' age was 42.82 ± 16.46 years, the patient's weight 68.58 ± 12.82 kg, the activity 4.75 ± 0.543 mCi and the effective dose for thyroid was 2.28 ± 0.26 mSv. For renal scan, the patients' age 45.19 ± 16.36 years, the weight 65.96 ± 13.78 kg, the activity 5.21 ± 1.166 mCi, and the effective dose 0.94 ± 0.211 mSv. For a bone scan, the patients' age was 57.59 ± 14.92 years, the patient's weight was 69.48 ± 13.71 kg, the activity 19.96 ± 2.11 mCi, and the effective dose for bone was 4.208 ± 0.443 mSv. The study revealed that the administered activity is independent of patient weight. Patients received unjustified exposure due to the high amount of administered activity. Implementation of national guidelines is necessary to improve the practice and patient safety. • Effective dose has been estimated for thyroid, renal and bone scan procedures. • Patients received the least effective dose during renal scan procedures. • The study revealed that the administered activity is independent of patient weight, according to the current protocol. • Proper optimization are recommended to save young from potential radiogenic risks. [ABSTRACT FROM AUTHOR]

Computed tomography (CT) are often used for adult and pediatric patients. This is basically due to its powerful diagnostic capabilities in providing the tiniest details of pathologies in the body. Nevertheless, this detailed and accurate imaging occurs at the expense of the high doses received by the patients, although in general, the benefits outweighs the risks precisely of malignancy. Pediatrics are radiosensitive more than adults due to their longer life expectancy and their rapidly dividing cells. This study aims at measuring and evaluating pediatric patient doses in four hospitals equipped with 16, 20 and 128 CT detectors. Forty-eight pediatric patients who underwent brain (72.7%) and abdomen (36.3%) Computed Tomography are included in this study. Data includes CTDI vol (mGy) and DLP (mGy.cm). CTDOSE computer software which is based on Monte Carlo simulations was used to calculate the effective and organ equivalent doses (mSv). The CTDIvol (mGy) per procedure range was 11.0–95.0 mGy for brain CT and 3.0–30.0 mGy for abdomen CT. DLP on the other hand ranged between 129.0 and 2510.0 mGy cm for brain CT and 84.0–1604.0 for abdomen CT. The high doses were attributed to the fact that the protocols used for pediatric patients were the adult protocols, not bearing in mind the high radio-sensitivity of the pediatrics. Establishing a protocol for pediatric CT is hence of great importance to prevent them from receiving unnecessary high doses which may eventually cause cancer. • The radiation doses during specific pediatric CT examinations in four hospitals were evaluated. • Patient dose per CT procedure ranged from 84.0 to 2510.0 mGy cm. • Adults protocols used for pediatric patients resulted in unnecessary exposure. • Standardizing imaging protocols during pediatric CT imaging is recommended. [ABSTRACT FROM AUTHOR]

Staff occupational radiation exposure is limited to 20 mSv annually to preclude tissue reaction and lower risk of cancer effect. Staff occupational exposure arises during the preparation, injection, and scanning of the patients. Recent studies reported that nuclear medicine personnel might exceed the annual dose limit in high workload and poor radiation protection circumstances. Therefore, an accurate estimation of the annual dose limit is recommended. The goal of this research is to calculate the cumulative external effective dose (mSv) per year for nuclear medicine physicians, technologists, and nurses at SPECT/CT department. A total of 15 staff worked in the nuclear medicine department at King Saud Medical City (KSMC), Riyadh, Saudi Arabia were evaluated for the last six years. 99mTc is used more frequently for most of the patients. The procedures include renal, cardiac scintigraphy procedures. Staff dose was quantified using calibrated thermoluminecnt dosimeters (TLD-100) with an automatic TLD reader (Harshaw 6600). Exposure to ionizing radiation was evaluated in terms of deep doses (Hp(10) were evaluated. The overall average and standard deviation of the external doses for nuclear medicine physicians, technologists' and nurses were 1.8 ± 0.7, 1.9 ± 0.6, 2.0 ± 0.9, 2.2 ± 0.8, 6.0 ± 2.8, and 3.6 ± 1.3 for the years 2015,2016,2017,2018,2019, and 2020, respectively. Technologists and nurses received higher doses of compared to the nuclear medicine physicians. Technologists and nurses involved in radionuclide preparation, patients' injection, and image acquisition. Staff annual exposure is below the annual dose limits; however, this external dose is considered high compared to the current workload. • Staff annual effective dose was estimated at nuclear medicine department equipped with two SPECT/CT systems. • External effective dose in terms of Hp(10) was monitored for six consecutive years. • Occupational exposure was quantified with thermoluminecnt dosimeters (TLD-100). • Technologists and nurses received higher doses than the nuclear medicine physicians. • Staff annual radiation from external exposure is 50% below the annual dose limits. [ABSTRACT FROM AUTHOR]

In interventional radiology attendant staff can be exposed to significant doses from the radiation scattered from the patient, giving rise to heterogeneous energy distribution, exposure occurring over extended periods of time. Protection of staff is a prime concern, also including reducing the risk of carcinogenesis. With only limited published studies available, as in for instance in regard to lens opacifications, further evaluation of staff exposures and assessment of radiation protection techniques and measures are crucial. Present study has sought to evaluate staff radiation exposure in a radiology department that performs interventional procedures. Annual occupational exposures were obtained for 32 personnel (6 females and 26 males) in a radiology department at a tertiary hospital. Personal dose equivalent H p (d) was measured in terms of H p (0.07) (shallow dose) and H p (10) (deep dose). The measurements were made over a period of two consecutive years, 2017 and 2018, use being made of TLD-100 thermoluminescent dosimeters. In units of mSv, the corresponding average annual dose equivalent and range for H p (10) and H p (0.07) were 4.6 ± 7.0 (0.1–25.5) and 5.1 ± 7.3 (0.1–25.5). Notably, 16% of staff received doses that were greater than the annual dose limit. Since H p (10) offers a conservative evaluation of effective dose, evaluation of the working environment is necessary in seeking to ensure dose values remain below annual dose limits. • Occupational exposure was measured at interventional radiology department. • Personal dose equivalent (H p (d) were measured in terms of H p (0.07) (shallow dose) and H p (10) (deep dose) were evaluated. • Staff exposures were measured using TLD-100 thermoluminecent dosimeters. • 16% of the staff received doses that were greater than the annual dose limit. • Variation in staff dose is due to workload and type of the procedure. [ABSTRACT FROM AUTHOR]

Ultrasonic manufacturing has emerged as a promising eco-friendly approach to synthesize lipid-based nanocarriers for targeted drug delivery. This study presents the novel ultrasonic preparation of lipid nanocarriers loaded with Scutellaria barbata extract, repurposed for anticancer and antibacterial use. High-frequency ultrasonic waves enabled the precise self-assembly of DSPE-PEG, Span 40, and cholesterol to form nanocarriers encapsulating the therapeutic extract without the use of toxic solvents, exemplifying green nanotechnology. Leveraging the inherent anticancer and antibacterial properties of Scutellaria barbata, the study demonstrates that lipid encapsulation enhances the bioavailability and controlled release of the extract, which is vital for its therapeutic efficacy. Dynamic light scattering and transmission electron microscopy analyses confirmed the increase in size and successful encapsulation post-loading, along with an augmented negative zeta potential indicating enhanced stability. A high encapsulation efficiency of 91.93% was achieved, and in vitro assays revealed the loaded nanocarriers' optimized release kinetics and improved antimicrobial potency against Pseudomonas aeruginosa, compared to the free extract. The combination of ultrasonic synthesis and Scutellaria barbata in an eco-friendly manufacturing process not only advances green nanotechnology but also contributes to sustainable practices in pharmaceutical manufacturing. The data suggest that this innovative nanocarrier system could provide a robust platform for the development of nanotechnology-based therapeutics, enhancing drug delivery efficacy while aligning with environmental sustainability., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Heavy metals can cause serious environmental and human health problems, and their removal from wastewater is critical to protect our planet and communities. This study investigated the ability of crushed pomegranate peel to remove mercury and cadmium ions from contaminated water as a function of different experimental parameters. The experimental results showed that the pH of the solution influenced the adsorptive removal of heavy metals, with the best performance observed at pH 4.8. Optimization studies and process balance modeling were performed to optimize the process for commercial use. The performance of pomegranate peel was compared with that of other materials, and the highest adsorption capacities for both cadmium (Ca (II)) and mercury (Hg (II)) ions were observed to be 89.59 and 42.125 mg/g, respectively. The results were interpreted using the Langmuir model, which provided the best fit to describe the behavior of the process., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Pancreatic cancer remains a significant health issue with limited treatment options. The tumor stroma, a complex environment made up of different cells and proteins, plays a crucial role in tumor growth and chemoresistance. Targeting tumor stroma, consisting of diverse non-tumor cells such as fibroblasts, extracellular matrix (ECM), immune cells, and also pre-vascular cells is encouraging for remodeling solid cancers, such as pancreatic cancer. Remodeling the stroma of pancreas tumors can be suggested as a strategy for reducing resistance to chemo/immunotherapy. Several studies have shown that phytochemicals from plants can affect the tumor environment and have anti-cancer properties. By targeting key pathways involved in stromal activation, phytochemicals may disrupt communication between the tumor and stroma and make tumor cells more sensitive to different treatments. Additionally, phytochemicals have immunomodulatory and anti-angiogenic properties, all of which contribute to their potential in treating pancreatic cancer. This review will provide a detailed look at how phytochemicals impact the tumor stroma and their effects on pancreatic tumor growth, spread, and response to treatment. It will also explore the potential of combining phytochemicals with other treatment options like chemotherapy, immunotherapy, and radiation., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Cold tumors lack antitumor immunity and are resistant to therapy, representing a major challenge in cancer medicine. Because of the immunosuppressive spirit of the tumor microenvironment (TME), this form of tumor has a low response to immunotherapy, radiotherapy, and also chemotherapy. Cold tumors have low infiltration of immune cells and a high expression of co-inhibitory molecules, such as immune checkpoints and immunosuppressive molecules. Therefore, targeting TME and remodeling immunity in cold tumors can improve the chance of tumor repression after therapy. However, tumor stroma prevents the infiltration of inflammatory cells and hinders the penetration of diverse molecules and drugs. Nanoparticles are an intriguing tool for the delivery of immune modulatory agents and shifting cold to hot tumors. In this review article, we discuss the mechanisms underlying the ability of nanoparticles loaded with different drugs and products to modulate TME and enhance immune cell infiltration. We also focus on newest progresses in the design and development of nanoparticle-based strategies for changing cold to hot tumors. These include the use of nanoparticles for targeted delivery of immunomodulatory agents, such as cytokines, small molecules, and checkpoint inhibitors, and for co-delivery of chemotherapy drugs and immunomodulatory agents. Furthermore, we discuss the potential of nanoparticles for enhancing the efficacy of cancer vaccines and cell therapy for overcoming resistance to treatment., (© 2024. The Author(s), under exclusive licence to Federación de Sociedades Españolas de Oncología (FESEO).)

The most prevalent inflammatory arthritis and a leading contributor to disability is rheumatoid arthritis (RA). Although it may not have arrived in Europe until the 17th century, it was present in early Native American communities several thousand years ago. Exosomes released by mesenchymal stem cells (MSCs) are highly immunomodulatory due to the origin of the cell. As a cell-free therapy, MSCs-exosomes are less toxic and elicit a weakened immune response than cell-based therapies. Exosomal noncoding RNAs (ncRNAs) are closely associated with a number of biological and functional facets of human health, especially microRNAs (miRNAs) and long noncoding RNAs (lncRNAs). Various exo-miRNAs and lncRNAs such as HAND2-AS1, miR-150-5p, miRNA-124a, and miR-320a lodged with MSC could be appropriate therapeutic ways for RA treatment. These MSC-derived exosomes affect RA disorders via different molecular pathways such as NFK-β, MAPK, and Wnt. The purpose of this review is to review the research that has been conducted since 2020 so far in the field of RA disease treatment with MSC-loaded exo-miRNAs and exo-lncRNAs., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The utilization of medicinal plant extracts in therapeutics has been hindered by various challenges, including poor bioavailability and stability issues. Nanovesicular delivery systems have emerged as promising tools to overcome these limitations by enhancing the solubility, bioavailability, and targeted delivery of bioactive compounds from medicinal plants. This review explores the applications of nanovesicular delivery systems in antibacterial and anticancer therapeutics using medicinal plant extracts. We provide an overview of the bioactive compounds present in medicinal plants and their therapeutic properties, emphasizing the challenges associated with their utilization. Various types of nanovesicular delivery systems, including liposomes, niosomes, ethosomes, and solid lipid nanoparticles, among others, are discussed in detail, along with their potential applications in combating bacterial infections and cancer. The review highlights specific examples of antibacterial and anticancer activities demonstrated by these delivery systems against a range of pathogens and cancer types. Furthermore, we address the challenges and limitations associated with the scale-up, stability, toxicity, and regulatory considerations of nanovesicular delivery systems. Finally, future perspectives are outlined, focusing on emerging technologies, integration with personalized medicine, and potential collaborations to drive forward research in this field. Overall, this review underscores the potential of nanovesicular delivery systems for enhancing the therapeutic efficacy of medicinal plant extracts in antibacterial and anticancer applications, while identifying avenues for further research and development., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: A major worldwide health issue is the rising frequency of resistance of bacteria.Drug combinations are a winning strategy in fighting resistant bacteria and might help in protecting the existing drugs.Monolaurin is natural compound extracted from coconut oil and has a promising antimicrobial activity against Staphylococcus.aureus. This study aims to examine the efficacy of monolaurin both individually and in combination with β-lactam antibiotics against Staphylococcus aureus isolates., Methods: Agar dilution method was used for determination of minimum inhibitory concentration (MIC) of monolaurin against S.aureus isolates. Scanning electron microscope (SEM) was used to detect morphological changes in S.aureus after treatment with monolaurin. Conventional and Real-time Polymerase chain reaction (RT-PCR) were performed to detect of beta-lactamase (blaZ) gene and its expressional levels after monolaurin treatment. Combination therapy of monolaurin and antibiotics was assessed through fractional inhibitory concentration and time-kill method., Results: The antibacterial activity of monolaurin was assessed on 115 S.aureus isolates, the MIC of monolaurin were 250 to 2000 µg/ml. SEM showed cell elongation and swelling in the outer membrane of S.aureus in the prescence of 1xMIC of monolaurin. blaZ gene was found in 73.9% of S.aureus isolates. RT-PCR shows a significant decrease in of blaZ gene expression at 250 and 500 µg/ml of monolaurin. Synergistic effects were detected through FIC method and time killing curve. Combination therapy established a significant reduction on the MIC value. The collective findings from the antibiotic combinations with monolaurin indicated synergism rates ranging from 83.3% to 100%.In time-kill studies, combination of monolaurin and β-lactam antibiotics produced a synergistic effect., Conclusion: This study showed that monolaurin may be a natural antibacterial agent against S. aureus, and may be an outstanding modulator of β-lactam drugs. The concurrent application of monolaurin and β-lactam antibiotics, exhibiting synergistic effects against S. aureus in vitro, holds promise as potential candidates for the development of combination therapies that target particularly, patients with bacterial infections that are nearly incurable., (© 2024. The Author(s).)

Background: In Pakistan, where the burden of communicable diseases remains high, the private sector accounts for 62% of health care provision., Aim: To describe the role of the private sector in communicable disease management in Pakistan and inform a more effective engagement towards achieving Universal Health Coverage., Methods: We searched the literature and available documents on policies, regulations and experiences in private health sector engagement in Pakistan. We interviewed policy level experts regarding the formulation of national health policies and plans and a sample of private providers using a structured questionnaire to assess their awareness of and engagement in communicable disease programmes., Results: Published reports described initiatives to engage the private sector in improving coverage for a package of care and programme-specific initiatives. Pakistan did not have a national policy for structural engagement, and regulations were limited. Policy level experts interviewed perceived the private sector as market-driven and poorly regulated. Thirty-nine percent of private sector providers interviewed were aware or had been trained in procedures or guidelines, and 23% of them had had their performance monitored by government., Conclusion: We recommend that the Ministry of Health provide overall vision for the operations of the public and private health sectors so that both sectors can complement each other towards the achievement of Universal Health Coverage, including for communicable diseases., (Copyright: © Authors 2024; Licensee: World Health Organization. EMHJ is an open access journal. All papers published in EMHJ are available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Competing Interests: Competing interests: None declared.

Background: Many countries in the Eastern Mediterranean Region (EMR) have developed packages of services for achieving Universal Health Coverage (UHC), however, policymakers, especially in resource-constrained countries, still face challenges in delivering equitable, efficient and sustainable health services., Aims: To provide guidance for EMR countries and develop packages of services for UHC., Methods: We used information gathered from narrative reviews, national experiences and expert consultations to develop step-by-step guidance for the development of national packages of services for the achievement of UHC by countries in the EMR., Results: The processes used to develop packages of services varied between EMR countries and these processes may not have involved all relevant stakeholders. We highlight in this paper the iterative processes, including several phases and steps, to be used by EMR countries for developing packages of services for UHC. These processes also make provision for continuous monitoring and revision to make necessary improvements as morbidity patterns evolve., Conclusion: Developing a package of services for the achievement of UHC is a significant milestone for EMR countries and it is central to shaping the healthcare system for effective delivery of services., (Copyright: © Authors 2023; Licensee: World Health Organization. EMHJ is an open access journal. This paper is available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

A series of N-4 piperazinyl ciprofloxacin derivatives as urea-tethered ciprofloxacin-chalcone hybrids 2a-j and thioacetyl-linked ciprofloxacin-pyrimidine hybrids 5a-i were synthesized. The target compounds were investigated for their antibacterial activity against S. aureus, P. aeruginosa, E. coli, and C. albicans strains, respectively. Ciprofloxacin derivatives 2a-j and 5a-i revealed broad antibacterial activity against either Gram positive or Gram negative strains, with MIC range of 0.06-42.23 µg/mL compared to ciprofloxacin with an MIC range of 0.15-3.25 µg/mL. Among the tested compounds, hybrids 2b, 2c, 5a, 5b, 5h, and 5i exhibited remarkable antibacterial activity with MIC range of 0.06-1.53 µg/mL against the tested bacterial strains. On the other hand, compounds 2c, 2e, 5c, and 5e showed comparable antifungal activity to ketoconazole against candida albicans with MIC range of 2.03-3.89 µg/mL and 2.6 µg/mL, respectively. Further investigations showed that some ciprofloxacin hybrids have inhibitory activity against DNA gyrase as potential molecular target compared to ciprofloxacin with IC 50 range of 0.231 ± 0.01-7.592 ± 0.40 µM and 0.323 ± 0.02 µM, respectively. Docking studies of compounds 2b, 2c, 5b, 5c, 5e, 5h, and 5i on the active site of DNA gyrase (PDB: 2XCT) confirmed their ability to form stable complex with the target enzyme like that of ciprofloxacin., (© 2022. The Author(s).)

Objective: This paper provides a systematic review of evidence of government purchase of health services from private providers through stand-alone contracting-out (CO) initiatives and CO insurance schemes (CO-I) on health service utilisation in Eastern Mediterranean Region (EMR) to inform universal health coverage 2030 strategies., Design: Systematic review., Data Sources: Electronic search of published and grey literature on Cochrane Central Register of Controlled Trials, PubMed, CINHAL, Google Scholar and web, including websites of ministries of health from January 2010 to November 2021., Eligibility Criteria: Randomised controlled trials, quasi-experimental studies, time series, before-after and endline with comparison group reporting quantitative utilisation of data across 16 low-income and middle-income states of EMR. Search was limited to publications in English or English translation., Data Extraction and Synthesis: We planned for meta-analysis, but due to limited data and heterogeneous outcomes, descriptive analysis was performed., Results: Several initiatives were identified but only 128 studies were eligible for full-text screening and 17 met the inclusion criteria. These included CO (n=9), CO-I (n=3) and a combination of both (n=5) across seven countries. Eight studies assessed interventions at national level and nine at subnational level. Seven studies reported on purchasing arrangements with non-governmental organisations, 10 on private hospitals and clinics. Impact on outpatient curative care utilisation was seen in both CO and CO-I, positive evidence of improved maternity care service volumes was seen mainly from CO interventions and less reported from CO-I, whereas data on child health service volume was only available for CO and indicated negative impact on service volumes. The studies also suggest pro-poor effect for CO initiatives, whereas there was scarce data for CO-I., Conclusion: Purchasing involving stand-alone CO and CO-I interventions in EMR positively impact general curative care utilisation, but lacks conclusive evidence for other services. Policy attention is needed for embedded evaluations within programmes, standardised outcome metrics and disaggregated utilisation data., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This Article Is Part of the Research Topic: 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict.', Problem: Many countries lacked rapid and nimble data systems to track health service capacities to respond to COVID-19. They struggled to assess and monitor rapidly evolving service disruptions, health workforce capacities, health products availability, community needs and perspectives, and mitigation responses to maintain essential health services., Method: Building on established methodologies, the World Health Organization developed a suite of methods and tools to support countries to rapidly fill data gaps and guide decision-making during COVID-19. The tools included: (1) a national "pulse" survey on service disruptions and bottlenecks; (2) a phone-based facility survey on frontline service capacities; and (3) a phone-based community survey on demand-side challenges and health needs., Use: Three national pulse surveys revealed persisting service disruptions throughout 2020-2021 (97 countries responded to all three rounds). Results guided mitigation strategies and operational plans at country level, and informed investments and delivery of essential supplies at global level. Facility and community surveys in 22 countries found similar disruptions and limited frontline service capacities at a more granular level. Findings informed key actions to improve service delivery and responsiveness from local to national levels., Lessons Learned: The rapid key informant surveys provided a low-resource way to collect action-oriented health services data to inform response and recovery from local to global levels. The approach fostered country ownership, stronger data capacities, and integration into operational planning. The surveys are being evaluated to inform integration into country data systems to bolster routine health services monitoring and serve as health services alert functions for the future., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Rivas-Morello, Horemans, Viswanathan, Taylor, Blanchard, Karamagi, Droti, Titi-Ofei, Nikiema, Traore, Kipruto, del Riego, Houghton, Salah, Alasfoor, Doctor, Tahirukaj, Tille, Zapata and O'Neill.)