IMPORTANCE Alteration in lung microbes is associated with disease progression in idiopathic pulmonary fibrosis. OBJECTIVE To assess the effect of antimicrobial therapy on clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS Pragmatic, randomized, unblinded clinical trial conducted across 35 US sites. A total of 513 patients older than 40 years were randomized from August 2017 to June 2019 (final follow-up was January 2020).INTERVENTIONS Patients were randomized in a 1:1 allocation ratio to receive antimicrobials (n = 254) or usual care alone (n = 259). Antimicrobials included co-trimoxazole (trimethoprim 160 mg/sulfamethoxazole 800 mg twice daily plus folic acid 5 mg daily, n = 128) or doxycycline (100 mg once daily if body weight <50 kg or 100 mg twice daily if Ն50 kg, n = 126). No placebo was administered in the usual care alone group. MAIN OUTCOMES AND MEASURESThe primary end point was time to first nonelective respiratory hospitalization or all-cause mortality. RESULTS Among the 513 patients who were randomized (mean age, 71 years; 23.6% women), all (100%) were included in the analysis. The study was terminated for futility on December 18, 2019. After a mean follow-up time of 13.1 months (median, 12.7 months), a total of 108 primary end point events occurred: 52 events (20.4 events per 100 patient-years [95% CI, 14.8-25.9]) in the usual care plus antimicrobial therapy group and 56 events (18.4 events per 100 patient-years [95% CI, 13.2-23.6]) in the usual care group, with no significant difference between groups (adjusted HR, 1.04 [95% CI, 0.71-1.53; P = .83]. There was no statistically significant interaction between the effect of the prespecified antimicrobial agent (co-trimoxazole vs doxycycline) on the primary end point (adjusted HR, 1.15 [95% CI 0.68-1.95] in the co-trimoxazole group vs 0.82 [95% CI, 0.46-1.47] in the doxycycline group; P = .66). Serious adverse events occurring at 5% or greater among those treated with usual care plus antimicrobials vs usual care alone included respiratory events (16.5% vs 10.0%) and infections (2.8% vs 6.6%); adverse events of special interest included diarrhea (10.2% vs 3.1%) and rash (6.7% vs 0%).CONCLUSIONS AND RELEVANCE Among adults with idiopathic pulmonary fibrosis, the addition of co-trimoxazole or doxycycline to usual care, compared with usual care alone, did not significantly improve time to nonelective respiratory hospitalization or death. These findings do not support treatment with these antibiotics for the underlying disease.

Karachi is the largest city of Pakistan. The temperature change in Karachi is studied in this research by analyzing the time series data of mean maximum temperature (MMxT), mean minimum temperature (MMiT) and mean annual temperature (MAT) from 1947 to 2005 (59 years). Data is analyzed in three parts by running linear regression and by taking anomalies of all time periods: (a) whole period from 1947-2005; (b) phase one 1947-1975 and (c) phase two 1976-2005. During 1947 to 2005 MMxT has increased about 4.6 • C, MMiT has no change and MAT has increased 2.25 • C. During 1947-1975, MMxT increased 1.9 • C, in this period there is −1.3 • C decrease in MMiT and MAT has raised upto 0.3 • C. During 1976-2005, the MMxT, MMiT and MAT increased 2.7 • C, 1.2 • C and 1.95 • C, respectively. The analysis shows significantly the role of extreme vulnerability of MMxT in rising the temperature of Karachi than the MMiT.

Purpose-The purpose of this paper is to explore the trends of changing temperature of Lahore in Pakistan due to invigorating urbanization process since 1950-2007. Design/methodology/approach-This research is designed by using the numerical time series data of mean minimum temperature (MMiT), mean maximum temperature (MMxT) and mean annual temperature (MAT). The growth in urban population, area and transportation are also evaluated by using the available data. Linear regression method is applied to investigate the results of change in temperature. Three different approaches to examine the MAT are testified; first as an entire period (1950-2007), and then by dividing the entire period into two equal phases as Phase I (1950-1974) and Phase II (1975-2207). MMiT and MMxT are analysed for the entire period without making any division. Findings-The results of the paper are significantly indicating an increase in MAT and MMiT which have risen up to 0.89 and 2.518C, respectively, while MMxT remained resolute throughout the study period. Change in MMiT is observed regular and brisk than other parameters of temperature. Increase in temperature in Phase I is observed only 0.0628C and in Phase II it is observed 0.948C. Research limitations/implications-This research can be further worked out by using different meteorological models to study the effects of urbanization on lower surface atmosphere and urban heat island effects in Lahore. Originality/value-By taking into consideration these results, the town planners and government can make different strategies to mitigate the urban effects on rising temperature in Pakistan.

Earthquakes are one among the highly dangerous geological hazards. The damage from earthquakes is greatly influenced by the local geological conditions. The history of Pakistan is full of severe earthquakes that caused the mass destruction at national scale. Major earthquake-affected areas in Pakistan are mainly concentrated in the north and western sections of the country. Site response analysis is an initial step towards seismic risk assessment. The present study aims at local site effects by acquiring data along 105 sites of Rawalpindi-Islamabad, the twin cities of federal capital of Pakistan, by applying H/V spectral ratio method. Out of the data acquired for 105 sites, data for 88 sites were considered reliable after observing reliability conditions determined by SESAME guidelines devised in 2004. Fundamental frequency f 0 of soft sediments, amplitude A 0 of corresponding H/V spectral ratios, thickness of soft sediments residing on the bedrock and soil vulnerability index K g over 88 reliable data sites within the study area were estimated and analysed. The results show that the fundamental frequency of the sediments reflects variation and lies within a wide range between 0.6 and 14.4 Hz. Similarly, amplification factor A 0 up to 5.5 was observed at a site. Overburden thickness of soft sediments H also indicates high variation and has been calculated in the range of 1.7-316.5 m. As far as K g is concerned, it is also highly variable and is lying in the range of 0.30-62.7. These results will help in designing a policy to mitigate the impact of seismic hazard in the study area.