Delivery Characteristics Research Articles

Preparation and Characterization of Ozonated Liposomes Loaded with Curcumin: A Potential Approach for Diabetic Retinopathy Treatment

Background: Limitations in drug penetration are overcome by nanotechnology, particularly liposomes, which enhance targeted administration of ocular medications. Liposomes can augment the therapeutic effects of curcumin, a natural compound with positive impacts on the retina. Treatments for eye diseases can also benefit from the antibacterial properties of ozonated oil liposomes. Objectives: This study aims to develop and evaluate ozonated liposomes loaded with curcumin for ocular drug delivery applications, specifically targeting diabetic retinopathy (DR). Methods: Liposomal nanoparticles were prepared using thin-film hydration, incorporating phospholipids, lecithin, cholesterol, ozonated oil, and curcumin. We assessed physicochemical properties including particle size, zeta potential, encapsulation efficiency (EE), and morphology. Drug release profiles and stability studies were also conducted. Results: The optimized liposomes showed a particle size of 84.77 nm, a zeta potential of -16.8 mV, and an EE of 94.73%. The formulation exhibited sustained curcumin release over 24 hours, reaching 82.09% cumulative release. Stability studies indicated minimal changes in key parameters over three months at room temperature. Conclusions: The developed ozonated liposomal formulation demonstrates promising characteristics for curcumin delivery, potentially enhancing its therapeutic efficacy in ocular applications, particularly for DR.

Impact of maternal muscle strength on cesarean delivery outcomes: a comparative study of nulliparous women.

This study explored the correlation between maternal muscle mass and strength and the mode of delivery in childbirth. Specifically, it focused on full-term nulliparous pregnant women, analyzing ultrasonographic measurements of the quadriceps femoris muscle together with serum myostatin levels and muscle strength as determined by a handgrip test. The aim was to discern whether these factors could influence the likelihood of delivering vaginally or via cesarean section. This study included 86 healthy nulliparous women at term, categorizing them into two groups based on their mode of delivery: vaginal delivery (58 women, Group 1) and cesarean section (28 women, Group 2). Comparative analyses of demographic information, delivery characteristics, ultrasonographic measurements of the quadriceps femoris, limb circumferences, handgrip strength, and serum myostatin concentrations were conducted. The findings revealed that women in Group 1 had less gestational weight gain but greater handgrip strength compared to Group 2. Additionally, women who underwent cesarean section due to nonprogressive labor had greater arm and calf circumferences relative to those who had vaginal deliveries. The data of this study suggest a trend whereby lower maternal muscle strength and mass are associated with a decreased likelihood of vaginal delivery in pregnant women.

Nanofiber power: Reinforcing in-situ hydrogel for enhanced rivastigmine delivery

Rivastigmine, used in the treatment of Alzheimer's disease (AD), faces challenges of poor stability and low permeability when delivered through conventional methods. To address these issues, rivastigmine-loaded nanofibers were systematically prepared via an electrospinning process utilizing the Design of Experiments (DoE) methodology and subsequently transformed into an in-situ hydrogel using the cold process method. Preliminary experiments determined optimal polymer concentration, ratio, and electrospinning parameters. A 32 factorial design optimized nanofibers, with polyvinyl alcohol (PVA) concentration (X1) and PVA: chitosan ratio (X2) as independent variables, and % cumulative drug release (Y1) and % entrapment efficiency (Y2) as dependent variables. Using the desirability model, the final batch achieved % cumulative drug release and % entrapment efficiency of 90.17 ± 2.64 and 91.46 ± 4.83 respectively. Fourier Transform Infrared Spectroscopy (FTIR) and X-ray diffraction (XRD) studies showed no significant excipient interactions. Field emission scanning electron microscopy (FE-SEM) analysis revealed nanofiber diameters of 160–230 nm. Findings demonstrated that the nanofiber-reinforced in-situ hydrogel exhibited significantly improved gelling capacity at 34.2 °C and increased spreadability (19.51 ± 1.75 cm2) compared to the hydrogel formulations without nanofibers. In-vitro and ex-vivo studies showed controlled rivastigmine release over 8 h. Additionally, enhanced mucoadhesion (236.7 ± 8.83 gm/cm2), pH compatibility (5.9 ± 0.12) with nasal fluid, and moisture resistance uptake highlight suitability for nasal drug delivery. Therefore, this approach offers an efficient delivery platform for rivastigmine with enhanced delivery characteristics and promising therapeutic potential.

Prevalence and risk factors for postpartum depression two months after cesarean delivery: a prospective multicenter study

BackgroundThe prevalence and risk factors of postpartum depression after cesarean delivery remain unclear. ObjectiveTo assess the prevalence of postpartum depression and its risk factors 2 months after cesarean delivery. MethodsProspective ancillary cohort study of the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery (TRAAP2) trial, conducted in 27 French hospitals in 2018-2020 and enrolling women undergoing cesarean delivery before or during labor at 34 or more weeks of gestation. After randomization, characteristics of the cesarean delivery, postpartum blood loss, and immediate postpartum period, including memories of delivery and postoperative pain, were prospectively collected. Women's characteristics, particularly any psychiatric history, were collected from medical records. Two months after childbirth, a postpartum depression provisional diagnosis was defined as a score of 13 or higher on the Edinburgh Postnatal Depression Scale, a validated self-administered questionnaire. The corrected prevalence of postpartum depression was calculated with the inverse probability weighting method to take nonrespondents into account. Multivariate logistic regression analyzed associations between potential risk factors and postpartum depression. A sensitivity analysis used an EPDS cutoff value of 11 or higher. ResultsThe questionnaire was returned by 2793/4431 women (63.0% response rate). The corrected prevalence of postpartum depression provisional diagnosis was 16.4% (95% confidence interval (CI), 14.9-18.0%) with an EPDS score of 13 or higher and 23.1% (95%CI, 21.4-24.9%) with a cutoff value of 11 or higher. Characteristics associated with a higher risk of postpartum depression were pre-pregnancy characteristics such as young age (aOR 0.83, 95%CI 0.74-0.93 for each 5-year increase in maternal age) and non-European country of birth (aOR 2.58, 95%CI 1.85-3.59 for North Africa; aOR 1.57, 95%CI 1.09-2.26 for Sub-Saharan Africa and aOR 1.99, 95%CI 1.28-3.10 for other country of birth; reference: Europe) and some aspects of the cesarean delivery, notably its timing and context, emergency before labor (aOR 1.70, 95%CI 1.15-2.50; reference: before labor without emergency) and during labor after induction of labor (aOR 1.36, 95%CI 1.03-1.84; reference: before labor without emergency). Also at higher risk were women reporting high intensity pain during the postpartum stay (aOR 1.73, 95%CI 1.32-2.26) and bad memories of delivery on day 2 postpartum (aOR 1.67, 95%CI 1.14-2.45). Conversely, women who had social support in the operating room had a lower risk of postpartum depression (aOR 0.73, 95%CI 0.53-0.97). ConclusionAround one woman in six had postpartum depression symptoms 2 months after cesarean delivery. Some cesarean-related obstetric factors may increase this risk: cesareans before labor for emergency situations or during labor after medically indicated induction of labor, severe postoperative pain and bad memories of delivery before discharge. Specific subgroups of at-risk women could benefit from early screening or intervention to reduce the onset of postpartum depression. Perinatal professionals should pay particular attention to postoperative pain management.

Adverse pregnancy outcomes attributable to overweight and obesity across maternal birth regions: a Swedish population-based cohort study

Whether there are differences in the contribution of overweight and obesity to adverse pregnancy outcomes between migrant and non-migrant women in high-income countries, which might increase health inequalities, remains unclear. Therefore, in this study, we aimed to estimate the contribution (including the proportion and number of attributable cases) of overweight and obesity to a wide range of adverse pregnancy outcomes in Swedish-born and migrant women. This population-based cohort study used nationwide population registries in Sweden. All outcomes and covariates were collected from the Medical Birth Register (delivery and maternal characteristics), National Patient Register (inpatient and specialised outpatient care), the Cause of Death Register (all deaths in Sweden), the Longitudinal Integrated Database for Health Insurance and Labour Market Studies (socioeconomic data), and the Total Population Register (maternal birth country data). Women with missing records of BMI at the first antenatal visit, country of birth, or covariates, were excluded from the study. BMI was measured during the first antenatal visit. Maternal country of birth was categorised into Sweden and seven super-regions. The proportion (ie, population attributable fractions [PAFs]) and the number of adverse pregnancy outcomes attributable to overweight and obesity were calculated, adjusting for maternal age, gestational age at first antenatal visit, maternal parity, smoking status, maternal somatic conditions, child's sex, socioeconomic and demographic variables. We identified 2 228 416 singleton pregnancies between Jan 1, 2000, and Dec 31, 2020 of 1 245 273 women. 254 778 (11·4%) pregnancies with missing records of BMI at the first antenatal visit, country of birth, or covariates were excluded, which resulted in a final analytical cohort of 1 973 638 pregnancies carried by 1 164 783 women. The overall mean maternal age of the study population was 30·8 years (SD 5·1). As estimated by PAFs, overweight and obesity contributed to a large proportion of adverse pregnancy outcomes: gestational diabetes (52·1% [95% CI 51·0-53·2]), large-for-gestational age (36·9% [36·2-37·6]), pre-eclampsia (26·5% [25·7-27·3]), low Apgar score (14·7% [13·5-15·9]), infant mortality (12·7% [9·8-15·7]), severe maternal morbidity (henceforth referred to as a near-miss event; 8·5% [6·0-11·0]), and preterm birth (5·0% [4·4-5·7]) in the total study population. PAFs varied between maternal birth regions. Interventions to reduce overweight and obesity have the potential to mitigate the burden of adverse pregnancy outcomes and possibly reduce inequalities in reproductive health. Therefore, public health practice and policy should prioritise efforts to prevent overweight and obesity among women of childbearing age. Swedish Research Council.

Development of erythromycin loaded PLGA nanoparticles for improved drug efficacy and sustained release against bacterial infections and biofilm formation

Bacterial infections are a common cause of sepsis, often leading to high patient mortality. Such infections are challenging to treat due to bacterial resistance to many existing drugs. Erythromycin (Ery) is a macrolide antibiotic used against bacterial infections with reported resistance. Recently, synthetic poly-lactide co-glycolic acid (PLGA) polymer nanoparticles (NPs) have displayed improved drug delivery characteristics and biocompatibility. In this study, PLGA-Ery NPs were synthesized by the o/w emulsion diffusion method, having a particle size of 159 ± 23 nm and displayed 71.89 % of encapsulation efficiency. The PLGA-Ery NPs showed 1.5, 2.1 and 1.5-fold improved MIC and antibacterial efficacy against E. coli, S. aureus, and P. aeruginosa, respectively than the pure drug. As illustrated by scanning electron microscopy, PLGA-Ery NPs caused damage to the bacterial cell walls. Furthermore, a surface coating with PLGA-Ery NPs on a glass surface showed efficient inhibition (>90 %) of the biofilm formation by P. aeruginosa, as determined by fluorescence microscopy and MTT assay. This study demonstrates that PLGA-Ery NPs can increase the efficiency of erythromycin and can suppress the growth and biofilm formation of P. aeruginosa. Such polymeric nanoparticles drug nanoformulations have potential as an antimicrobial and as a surface coating for medical devices.

Assessing pristine and metal doped C2N monolayer as a nanocarriers for anticancer drug

Theoretical research has introduced two-dimensional structures of thin sheets known as the pristine C2N monolayer and the Zn-doped C2N monolayer. These sheets show promise as nanocarriers for delivering the anticancer drug purinethol (PU). Through calculations of binding energy (Eb), it was observed that both the pristine C2N monolayer (−0.505 eV) and the Zn-decorated C2N monolayer (−0.762 eV) exhibit favorable characteristics for drug delivery. Eb values fall within range of physisorption, indicating their suitability as candidates for transporting drugs. An observed charge transfer (CT) of 0.035 e occurs in the Zn-decorated C2N monolayer, leading to a depletion of charge in the Zn-doped C2N monolayer system. The primary contributor to this charge loss is the Zn atom, which experiences a charge reduction of 0.035 e. To understand the phenomenon of drug release, the binding energy was recalculated under biological conditions, specifically in an acidic environment. The results indicate a decline in Eb (−0.218 eV) as well as a short recovery time, suggesting successful release of PU within body. The theoretical predictions we have made are expected to serve as inspiration for experimental researchers in their efforts to design drug delivery systems (DDSs) based on C2N monolayers.

Unintended Upper Uterine Wall Extensions at the Time of Cesarean Delivery: Risk Factors and Associated Adverse Maternal and Neonatal Outcomes.

This study aims to estimate the frequency of unintended upper uterine wall extensions during cesarean delivery (CD) and identify associated risk factors and adverse outcomes. A multicenter retrospective cohort study was conducted, including patients who underwent CD between 2005 and 2021. Demographic factors, obstetric history, CD indications, delivery and surgical characteristics, adverse maternal and neonatal outcomes were compared between those with unintended upper uterine wall extensions during CD and those without extensions. Crude and adjusted estimates (odds ratios [ORs] and 95% confidence intervals [CIs]) were used. Among 30,517 patients meeting inclusion criteria, 117 (0.4%) had an unintended upper uterine wall extension. In univariate analysis, upper uterine wall extensions were associated with higher rates of intrapartum CD, second-stage CD, unplanned or emergency CD, CD following failed vacuum delivery or trial of labor after CD, chorioamnionitis, prolonged labor, increased vaginal exams, lower fetal head station, and higher birth weight. During surgery, higher rates of general anesthesia, significant intraperitoneal adhesion, fetal malpresentation, and fetal extraction by the leg were observed. Multivariable analysis identified fetal extraction not by head (adjusted OR [aOR]: 9.17, 95% CI: 5.35-15.73), vertex fetal presentation (aOR: 3.65, 95% CI: 1.81-7.35), second-stage CD (aOR: 3.07, 95% CI: 1.24-7.59), and trial of labor after cesarean (aOR: 2.04, 95% CI: 1.08-3.84) as significant risk factors for unintended upper uterine wall extensions. Additionally, upper uterine wall extensions were associated with higher rates of maternal and neonatal complications, including longer operating times, excessive bleeding, postpartum hemorrhage, intraperitoneal drainage, blood product transfusion, puerperal fever, paralytic ileus, Apgar score < 7 at 1 and 5 minutes, and fetal intracranial hemorrhage. Our study identifies risk factors for unintended upper uterine wall extensions during CD. While these extensions are infrequent, their occurrence is associated with increased maternal and neonatal morbidity. · Unintended upper uterine wall extensions occur in 0.4% of cesarean deliveries.. · Significant risk factors include fetal extraction not by head and second-stage CD.. · Extensions are associated with increased maternal complications like excessive bleeding and prolonged surgery.. · Neonatal complications include lower Apgar scores and intracranial hemorrhage.. · Awareness of these risks is critical for improving cesarean delivery outcomes..

What We Know About the Peer Workforce and Economic Evaluation for Peer Recovery Support Services: A Systematic Review.

Peer recovery support services (PRSS) for substance use disorder (SUD) have expanded in the past 2 decades to be formally certified and reimbursed under Medicaid in almost every US state. This rapid expansion has been followed by a growth in research, but 2 persistent gaps remain: a lack of research on the peer workforce, and a lack of economic evaluation research. This systematic review examines the current literature on PRSS to summarize what is currently known about the SUD peer workforce and collect potential PRSS economic evaluation parameters, and clearly identify the current gaps in each category. PRISMA methods were followed and a PROSPERO protocol was registered (CRD42022323516). The search included a database search of peer-reviewed journal articles and dissertations, and also a hand-search of conference presentations and evaluation reports. Manuscripts were categorized as either workforce development-related and/or those containing potential economic evaluation parameters. Forty-two total manuscripts were included, with 22 related to the peer workforce and 26 containing potential economic evaluation parameters. Manuscripts with workforce-related findings covered peer worker characteristics, characteristics of PRSS delivery, or peer worker training-related outcomes. Economic evaluation parameters were primarily costs related to service utilization patters with some limited reporting on peer worker pay, as well as multiple sources that can be used to estimate averted medical costs. Effectiveness parameters were primarily substance use related, as virtually all quality of life and life functioning parameters are not readily convertible to estimating quality-adjusted life years. Future PRSS research can contribute to filling these gaps in the evidence base by addressing remaining questions about the interrelationship between peer worker job satisfaction, job tenure, and patient outcomes, as well as by using more consistent outcome measures, especially in the realm of quality of life and life functioning.

Tanshinone IIA Loaded Inhaled Polymer Nanoparticles Alleviate Established Pulmonary Fibrosis.

Idiopathic pulmonary fibrosis (IPF) is a fatal respiratory disease characterized by chronic, progressive scarring of the lung parenchyma, leading to an irreversible decline in lung function. Apart from supportive care, there is currently no specific treatment available to reverse the disease. Based on the fact that tanshinone IIA (TAN) had an effect on protecting against TGF-β1-induced fibrosis through the inhibition of Smad and non-Smad signal pathways to avoid myofibroblasts activation, this study reported the development of the inhalable tanshinone IIA-loaded chitosan-oligosaccharides-coated poly(lactic-co-glycolic acid) (PLGA) nanoparticles (CPN@TAN) for enhancing the pulmonary delivery of tanshinone IIA to treat pulmonary fibrosis. The CPN@TAN with a size of 206.5 nm exhibited excellent in vitro aerosol delivery characteristics, featuring a mass median aerodynamic diameter (MMAD) of 3.967 ± 0.025 μm and a fine particle fraction (FPF) of 70.516 ± 0.929%. Moreover, the nanoparticles showed good stability during atomization and enhanced the mucosal penetration capabilities. The results of confocal spectroscopy confirmed the potential of the nanoparticles as carriers that facilitated the uptake of drugs by NIH3T3, A549, and MH-S cells. Additionally, the nanoparticles demonstrated good in vitro biocompatibility. In a mouse model of bleomycin-induced pulmonary fibrosis, noninvasive inhalation of aerosol CPN@TAN greatly suppressed collagen formation and facilitated re-epithelialization of the destroyed alveolar epithelium without causing systemic toxicity compared with intravenous administration. Consequently, our noninvasive inhalation drug delivery technology based on polymers may represent a promising paradigm and open the door to overcoming the difficulties associated with managing pulmonary fibrosis.

The telehealth surge: Speech-language pathology mode of service delivery and consumer characteristics during COVID-19

Purpose To examine the characteristics of speech-language pathology (SLP) consumers prior to and during the COVID-19 pandemic, with respect to the mode of service delivery within a local health district in New South Wales, Australia, to inform future health service planning. Method Observational study examining SLP occasions of service data pre-COVID-19 (2019–2019; n = 6413) and during the COVID-19 pandemic (2020–2021; n = 6908). Spatial mapping and multilevel models were used to examine associations between sociodemographic characteristics, telehealth utilisation, and videoconferencing. Result During COVID-19, SLP occasions of service increased by 7.7% compared to pre-COVID-19. Model 1 found odds of adopting telehealth (telephone or videoconference) during COVID-19 were significantly higher for those aged 0–4 and 5–17 years compared to older age groups. Consumers in inner regional areas were significantly less likely to adopt telehealth than in major city areas, whereas females were significantly more likely to adopt telehealth. Those living in areas experiencing higher relative disadvantage were less likely to use telehealth. Model 2 found odds of adopting videoconferencing only were also significantly higher for the younger age groups (0–4 and 5–17 years) and females. Conclusion A rapid transition to a virtual model of care was critical to the successful delivery of SLP services during COVID-19. Immediate prioritisation and integration of targeted models of care, where suitability is high and benefits most likely to be experienced, is feasible.

Moving an exercise referral scheme to remote delivery during the Covid-19 pandemic: an observational study examining the impact on uptake, adherence, and costs

BackgroundExercise Referral Schemes (ERSs) have been implemented across Western nations to stimulate an increase in adult physical activity but evidence of their effectiveness and cost-effectiveness is equivocal. Poor ERS uptake and adherence can have a negative impact on effectiveness and cost-effectiveness and, if patterned by socio-demographic factors, can also introduce or widen health inequalities. Different modes of ERS delivery have the potential to reduce costs and enhance uptake and adherence. The primary aim of this study was to examine the effect of different programmes of ERS delivery on scheme uptake and adherence. Secondary aims were to examine the effect of socio-demographic factors on scheme uptake and adherence, and the impact of delivery mode on the expected resource and corresponding costs of delivering core parts of the programme.MethodsThis was an observational cohort study with cost analysis. Routine monitoring data covering a three-year period (2019–2021) from one large UK ERS (number of patients = 28,917) were analysed. During this period three different programmes of delivery were operated in succession: standard (all sessions delivered face-to-face at a designated physical location), hybrid (sessions initially delivered face-to-face and then switched to remote delivery in response to the Covid-19 pandemic), and modified (sessions delivered face-to-face, remotely, or a combination of the two, as determined on a case-by-case basis according to Covid-19 risk and personal preferences). Multi-level binary logistic and linear regression were performed to examine the effect of programme of delivery and socio-demographic characteristics on uptake and adherence. Cost data were sourced from regional-level coordinators and through NERS audits supplied by national-level NERS managers and summarised using descriptive statistics.ResultsThere was no effect of programme of delivery on scheme uptake. In comparison to those on the standard programme (who attended a mean of 23.1 exercise sessions) those on the modified programme had higher adherence (mean attendance of 25.7 sessions) while those on the hybrid programme had lower adherence (mean attendance of 19.4 sessions). Being older, or coming from an area of lower deprivation, increased the likelihood of uptake and adherence. Being female increased the chance of uptake but was associated with lower adherence. Patients referred to the programme from secondary care were more likely to take up the programme than those referred from primary care for prevention purposes, however their attendance at exercise sessions was lower. The estimated cost per person for face-to-face delivery of a typical 16-week cycle of the scheme was £65.42. The same cycle of the scheme delivered virtually (outside of a pandemic context) was estimated to cost £201.71 per person.ConclusionsThis study contributes new evidence concerning the effect of programme of delivery on ERS uptake and adherence and strengthens existing evidence concerning the effect of socio-economic factors. The findings direct the attention of ERS providers towards specific patient sub-groups who, if inequalities are to be addressed, require additional intervention to support uptake and adherence. At a time when providers may be considering alternative programmes of delivery, these findings challenge expectations that implementing virtual delivery will necessarily lead to cost savings.

Co-regulation of gelatin content and Hofmeister effect on 3D-printed high internal phase emulsion gel characteristics for resveratrol delivery

The study investigated the influence of gelatin (GE) content and the Hofmeister effect on the physicochemical, rheological, and printing properties of high internal phase emulsion (HIPE) gels. Incremental GE content introduced more triple helix structures (junction zones) in the continuous phase of HIPE. By soaking in a sodium citrate (Na3Cit)-glycerol-water solution, polymer chain bundling, hydrophobic interactions, and abundant hydrogen bonds between GE and glycerol further increased, achieving a more compact crosslinking density and internal network. The optimized HIPE-GE-Cit3- gel with 1.5 wt% GE displayed improved shape retention, generating smoother and firmer gels with enhanced freezing and heat resistance. Its excellent mechanical strength and viscoelasticity can resist large deformations and maintain reversible structures. HIPE-GE gel with 1.5 wt% GE demonstrated satisfactory printing suitability with clear outlines, favorable visual aesthetics, and minimal dimensional deviation. This post-soaking (Hofmeister effect) also eliminated rough surfaces and visible layered lines, improved mechanical properties and more elastic networks. The printed HIPE-GE1.5-Cit3- gel with higher rigidity and elasticity impeding molecular release, protected encapsulated resveratrol against degradation, especially from heat, and enhanced the release rate in the small intestine, achieving sustained release. This work produced customizable HIPE gels by 3D printing with multiple advantages to develop personalized nutraceutical carriers with high-temperature tolerance.

Maternal Characteristics and Prevalence of Infants Born Small for Gestational Age

Being born small for gestational age (SGA) is a risk factor for neonatal mortality and adverse outcomes in the short and long term. The maternal profile in China has substantially changed over the past decade, which may affect the risk of infants born SGA. To analyze the prevalence of infants born SGA from 2012 through 2020 and explore the association of maternal sociodemographic characteristics and other factors with that prevalence. This cross-sectional study examined data from the National Maternal Near Miss Surveillance System on women who delivered singleton live births at gestational ages of 28 to 42 weeks from January 1, 2012, through December 31, 2020, in China. Statistical analysis was performed from December 2022 to September 2023. Characteristics of delivery (year, region of country, and hospital level), mother (age, educational level, marital status, prenatal visits, parity, preexisting diseases, or prenatal complications), and newborn (birth weight, sex, and gestational age). Prevalence of infants born SGA stratified by severity and by region of the country, changes in prevalence based on log-linear Poisson regression with robust variance, and association of maternal characteristics with changes in prevalence of infants born SGA between 2012 and 2020 based on the Fairlie nonlinear mean decomposition. Among 12 643 962 births (6 572 548 [52.0%] male; median gestational age, 39 weeks [IQR, 38-40 weeks]), the overall weighted prevalence of infants born SGA was 6.4%, which decreased from 7.3% in 2012 to 5.3% in 2020, translating to a mean annual decrease rate of 3.9% (95% CI, 3.3%-4.5%). The prevalence of infants born SGA decreased from 2.0% to 1.2% for infants with severe SGA birth weight and from 5.3% to 4.1% for those with mild to moderate SGA birth weight. The mean annual rate of decrease was faster for infants with severe SGA birth weight than for those with mild to moderate SGA birth weight (5.9% [95% CI, 4.6%-7.1%] vs 3.2% [95% CI, 2.6%-3.8%]) and was faster for the less developed western (5.3% [95% CI, 4.4%-6.1%]) and central (3.9% [95% CI, 2.9%-4.8%]) regions compared with the eastern region (2.3% [95% CI, 1.1%-3.4%]). Two-thirds of the observed decrease in the prevalence of infants born SGA could be accounted for by changes in maternal characteristics, such as educational level (relative association, 19.7%), age (relative association, 18.8%), prenatal visits (relative association, 20.4%), and parity (relative association, 19.4%). Conversely, maternal preexisting diseases or prenatal complications counteracted the decrease in the prevalence of infants born SGA (-6.7%). In this cross-sectional study of births in China from 2012 to 2020, maternal characteristics changed and the prevalence of infants born SGA decreased. Future interventions to reduce the risk of infants born SGA should focus on primary prevention.

Data collection for microscopic modelling of urban parcel transport to and from establishments – empirical insights into city logistics in the region of Karlsruhe, Germany

City logistics plays a central role in supplying and disposing goods for establishments and residents in urban areas. However, the steadily rising demand for transporting goods puts cities under pressure. Hence, municipalities strive for alternative solutions for urban freight transport, especially parcel shipments on the first and last mile. Freight demand models are suitable to evaluate the transport-related effects of such solutions. However, developing those models requires a sufficient amount of data, which, to date, especially for establishments, cannot be covered in its necessary scope and accuracy by publicly available sources. Although parcel shipments to and from establishments make up to 40 % of the overall courier, express, and parcel market, these are often neglected in existing modelling approaches. Hence, in this study, we present a data collection concept for generating highly relevant data for the microscopic modelling of urban freight, i.e., parcel transport focusing on establishments. To reflect transport demand (i.e., establishments that need to have goods shipped) and transport supply (i.e., carriers that provide a transport service), a mixed-method approach is developed comprising complementary components. On the one hand, an online establishment survey is designed aiming to reveal disaggregated transport demand data for the subsequent modelling process. The survey focuses on the delivery and shipment characteristics of goods, such as temporal and spatial demand patterns. On the other hand, expert interviews are conceptualized to identify relevant patterns of transport supply carriers such as courier, express, and parcel service providers and shall further work as secondary data for the modelling process. The approach is applied in the region of Karlsruhe, Germany. It can be shown that the survey is generally suitable for generating freight transport data on a disaggregated level and that the mixed-method approach is capable of mutually validating the data obtained. However, our approach also emphasizes the necessity to conduct an establishment survey as a personal rather than a self-reporting interview, even if the costs are higher.

Predictors of maternal and neonatal outcomes in labors complicated by shoulder dystocia: a comparative analysis

IntroductionStudies investigating the risk factors associated with unfavorable maternal/neonatal outcomes in cases of shoulder dystocia are scarce. This study aims to uncover the predictive factors that give rise to unfavorable outcomes within the context of shoulder dystocia.Materials and methodsMedical records of pregnancies complicated by shoulder dystocia was obtained between 2008–2022 from a single tertiary center. This study involved the comparison of sociodemographic, sonographic, and delivery characteristics among pregnancies complicated by shoulder dystocia resulting in favorable vs. unfavorable maternal/neonatal outcomes.ResultsA total of 275 pregnancies were analyzed, with 111 (40.3%) classified as unfavorable outcomes and 164 (59.7%) as favorable outcomes. Employing a multivariable regression analysis, several independent associations were identified with unfavorable maternal/neonatal outcomes. Specifically, short maternal stature, pre-gestational diabetes, vacuum extraction, Wood’s screw maneuver, and macrosomia merged as significant predictors of unfavorable maternal/neonatal outcomes.ConclusionShort maternal stature, pre-gestational diabetes, vacuum extraction, Wood’s screw maneuver, and macrosomia may all contribute to poor maternal/neonatal outcomes in shoulder dystocia cases. This knowledge allows clinicians to improve their decision-making, patient care, and counseling.

Release of natural extracts from PVA and PVA-CMC hydrogel wound dressings: a power law swelling/delivery.

PVA hydrogels present many characteristics of the ideal dressing, although without antimicrobial properties. The present work aims to study the physical, mechanical and release characteristics of hydrogel wound dressings loaded with either of two natural herbal products, sage extract and dragon's blood. Fourier Transform Infrared Spectroscopy (FTIR), Differential Scanning Calorimetry (DSC) and tensile mechanical testing were used to investigate the structure and properties of the gels. Swelling and degradation tests were conducted according to ISO 10993-9. Release characteristics were studied using UV Spectrophotometry. PVA matrices incorporating sage extract or dragon's blood (DB) present hydrogen bonding between these components. PVA-CMC hydrogels containing sage present similar spectra to PVA-CMC alone, probably indicating low miscibility or interaction between the matrix and sage. The opposite is found for DB, which exhibits more pronounced interference with crystallinity than sage. DB and NaCMC negatively affect Young's modulus and failure strength. All samples appear to reach equilibrium swelling degree (ESD) in 24 h. The addition of DB and sage to PVA increases the gels' swelling capacity, indicating that the substances likely separate PVA chains. The inclusion of CMC contributes to high media uptake. The kinetics profile of media uptake for 4 days is described by a power-law model, which is correlated to the drug delivery mechanism. A PVA-CMC gel incorporating 15% DB, the highest amount tested, shows the most favorable characteristics for flavonoid delivery, as well as flexibility and swelling capacity.

Clinician Insights into Effective Components, Delivery Characteristics and Implementation Strategies of Ambulatory Palliative Care for People with Heart Failure: A Qualitative Analysis

To elicit perspectives from specialist palliative care (SPC) and cardiology clinicians concerning the necessary components, delivery characteristics and implementation strategies of successful ambulatory SPC for people with heart failure (HF). Palliative care is a recommended component of guideline-directed care for people with HF. However, optimal strategies to implement SPC within ambulatory settings are unknown. We conducted a qualitative descriptive study composed of semistructured interviews with SPC and cardiology clinicians at Veterans Affairs Medical Centers (VAMCs) with the highest number of ambulatory SPC consultations within the VA system among people with HF between 2021 and 2022. Clinicians were asked how they provided ambulatory SPC and what they felt were the necessary components, delivery characteristics and implementation strategies of care delivery. Interviews were analyzed using directed content analysis. We interviewed 14 SPC clinicians and 9 cardiology clinicians at 7 national VAMCs; 43% were physicians, and 48% were advanced-practice registered nurses/physician associates. Essential components of ambulatory SPC encompassed discussion of goals of care (eg, prognosis, advance directives) and connecting patients/caregivers to resources (eg, home care). Preferred delivery characteristics included integrated (ie, embedded) approaches to SPC delivery, standardized patient selection and referral procedures, and formalized procedures for handoffs to and from SPC. Strategies that addressed SPC implementation included deploying palliative champions, educating non-SPC clinicians on the value of ambulatory SPC for people with HF and developing ambulatory models through leadership support. Facilitating the broader adoption of ambulatory SPC among people with HF may be achieved by prioritizing these mutually valued and necessary features of SPC delivery.

Comparative analysis of lipid-peptide nanoparticles prepared via microfluidics, reverse phase evaporation, and ouzo techniques for efficient plasmid DNA delivery

In the current “era of lipid carriers,” numerous strategies have been developed to manufacture lipid nanoparticles (LNPs). Nevertheless, the potential impact of various preparation methods on the characteristics, use, and/or stability of these LNPs remains unclear. In this work, we attempted to compare the effects of three different preparation methods: microfluidics (MF), reverse phase evaporation (RV), and ouzo (OZ) on lipid-peptide NPs (LPNPs) as plasmid DNA delivery carriers. These LPNPs had the same components, namely DOTMA cationic lipid, DSPC, cholesterol, and protamine. Subsequently, we compared the LPNPs in terms of their physicochemical features, functionality as gene delivery vehicles in two distinct cell lines (NT2 and D1-MSCs), and finally, their storage stability over a six-month period.It was clear that all three LPNP formulations worked to deliver EGFP-pDNA while keeping cells alive, and their physicochemical stability was high for 6 months. However, the preparation technique had a significant impact on their physicochemical characteristics. The MF produced LPNPs with a lesser size, polydispersity index, and zeta potential than the other synthesis methods. Additionally, their DNA entrapment efficiency, cell viability, and functional stability profiles were generally superior. These findings provide new insights for comparing different manufacturing methods to create LPNPs with the desired characteristics for effective and safe gene delivery.

New Zein Protein Composites with High Performance in Phosphate Removal, Intrinsic Antibacterial, and Drug Delivery Capabilities.

Herein, poly(N-(4-aminophenyl)methacrylamide)-carbon nano-onions [abbreviated as PAPMA-CNOs (f-CNOs)] integrated gallic acid cross-linked zein composite fibers (ZG/f-CNOs) were developed for the removal/recovery of phosphate from wastewater along with controlled drug delivery and intrinsic antibacterial characteristics. The composite fibers were produced by Forcespinning followed by a heat-pressure technique. The obtained ZG/f-CNOs composite fibers presented several favorable characteristics of nanoadsorbents and drug carriers. The composite fibers exhibited excellent adsorption capabilities for phosphate ions. The adsorption assessment demonstrated that composite fibers process highly selective sequestration of phosphate ions from polluted water, even in the presence of competing anions. The ZG/f-CNOs composite fibers presented a maximum phosphate adsorption capacity (qmax) of 2500 mg/g at pH 7.0. This represents the most efficient phosphate adsorption system among all of the reported nanocomposites to date. The isotherm studies and adsorption kinetics of the adsorbent showed that the adsorption experiments followed the pseudo-second-order and Langmuir isotherm model (R2 = 0.9999). After 13 adsorption/desorption cycles, the adsorbent could still maintain its adsorption efficiency of 96-98% at pH 7.0 while maintaining stability under thermal and chemical conditions. The results mark significant progress in the design of composite fibers for removing phosphates from wastewater, potentially aiding in alleviating eutrophication effects. Owing to the f-CNOs incorporation, ZG/f-CNOs composite fibers exhibited controlled drug delivery. An antibiotic azithromycin drug-encapsulated composite fibers presented a pH-mediated drug release in a controlled manner over 18 days. Furthermore, the composite fibers displayed excellent antibacterial efficiency against Gram-positive and Gram-negative bacteria without causing resistance. In addition, zein composite fibers showed augmented mechanical properties due to the presence of f-CNOs within the zein matrix. Nonetheless, the robust zein composite fibers with inherent stimuli-responsive drug delivery, antibacterial properties, and phosphate adsorption properties can be considered promising multifunctional composites for biomedical applications and environmental remediation.