Delivery Options Research Articles

Identifies Current Trends in Vaginal Birth after Cesarean Section in IRAN: A Qualitative Study.

The growing prevalence of Cesarean Sections (CS), particularly repeated CS, is a major issue in contemporary midwifery. This study seeks to gain a comprehensive understanding of the experiences of pregnant women and specialists with vaginal delivery after CS, as well as the obstacles that may arise. From March 2020 to May 2021, 10 women, 12 midwives, and 8 obstetricians and obstetricians affiliated with Qom University of Medical Sciences were interviewed to investigate the experiences and challenges associated with Vaginal Birth After Cesarean section (VBAC). We used the content analysis method, and the sampling was purposive. Semi-structured interviews were conducted to collect data, which were then analyzed using qualitative content analysis based on conventional content analysis. The results show that subcategories "individual aspects of VBAC" and "family-social aspects of VBAC" formed "positive aspects of VBAC." Subcategories "self-efficacy" and "decision-making participation" formed the "empowerment for the woman." Subcategories "technical team challenges" and "woman's challenges" formed the main category of "upcoming challenges." Positive relationships, choice-making ability, and self-confidence impact a woman's decision to choose VBAC. Informing women of alternative delivery options after a CS and pursuing their dreams increases the likelihood of successful VBAC.

Exploring adolescent girls and young women's PrEP-user profiles: qualitative insights into differentiated PrEP delivery platform selection and engagement in Cape Town, South Africa.

Adolescent girls and young women (AGYW), a priority population for HIV prevention in Africa, show high interest but difficulty in sustained effective use of pre-exposure prophylaxis (PrEP). With ongoing PrEP scale-up focused on increasing access, it is important to understand what influences AGYW's choice of PrEP delivery platforms. The POWER implementation study in Cape Town provided PrEP between 2017 and 2020 to AGYW (16-25 years) from four differentiated delivery platforms: mobile clinic, government facility, courier delivery or community-based youth club. Healthcare providers at government and mobile clinics provided PrEP (initiation and refills) as part of comprehensive, integrated sexual and reproductive health services. Courier and youth club platforms provided light-touch PrEP refill services incorporating rapid HIV self-testing. We conducted in-depth interviews with a purposive sample of AGYW who had ≥3 months of PrEP-use and accessed ≥2 PrEP delivery platforms. The thematic analysis explored AGYW's preferences, decision-making and habits related to PrEP access to inform market segmentation. We interviewed 26 AGYW (median age 20) PrEP-users between November 2020 and March 2021. AGYW PrEP-users reported accessing different services with, 24 accessing mobile clinics, 17 courier delivery, 9 government health facilities and 6 youth clubs for their PrEP refills. Qualitative findings highlighted four potential behavioural profiles. The "Social PrEP-user" preferred PrEP delivery in peer spaces, such as youth clubs or adolescent-friendly mobile clinics, seeking affirmation and social support for continued PrEP use. The "Convenient PrEP-user" favoured PrEP delivery at easily accessible locations, providing quick (courier) or integrated contraception-PrEP refill visits (mobile and government clinic). The "Independent PrEP-user" preferred PrEP delivery that offered control over delivery times that fit into their schedule, such as the courier service. The "Discreet PrEP-user" highly valued privacy regarding their PrEP use (courier delivery) and avoided delivery options where unintentional disclosure was evident (youth club). Comfort with HIV self-testing had minimal influence on PrEP delivery choice. Market segmentation of AGYW characterizes different types of PrEP-users and has the potential to enhance tailored messaging and campaigns to reach specific segments, with the aim of improving sustained PrEP use and HIV prevention benefits.

DiGA in Primary Care and the Influence of Patient-Related Factors - Results of a Survey of Family Doctors.

In 2019, the Digital Healthcare Act created the legal basis for prescribable mobile health applications, referred to as DiGA (in German: Digitale Gesundheitsanwendungen), as a novel healthcare delivery option in Germany [1, 2]. The aim of this study is to analyze the use of DiGA in primary care, focusing on the influence of socio-demographic characteristics of family doctors (FDs) and patient-related factors. Pen-and-paper survey among 97 FDs in the district of Giessen, Hesse, Germany. 59.4% of surveyed FDs have already prescribed DiGA. The age and digital affinity of FDs as well as the location of their practice are significantly correlated with the level of information and willingness to use DiGA. Male und younger FDs rate their digital affinity higher. When deciding whether to prescribe DiGA, 72.9% of surveyed physicians take patient-related factors such as digital affinity, motivation, age and health literacy into consideration. Socio-demographic characteristics of FDs and patient-related factors have an influence on the use of DiGA.

Assessment of the in vitro acaricidal activity of Bravecto® (fluralaner) and a proposed orange oil-based formulation vehicle for the treatment of Sarcoptes scabiei

BackgroundSarcoptic mange is a serious animal welfare concern in bare-nosed wombats (Vombatus ursinus). Fluralaner (Bravecto®) is a novel acaricide that has recently been utilised for treating mange in wombats. The topical ‘spot-on’ formulation of fluralaner can limit treatment delivery options in situ, but dilution to a volume for ‘pour-on’ delivery is one practicable solution. This study investigated the in vitro acaricidal activity of Bravecto, a proposed essential oil-based diluent (Orange Power®), and two of its active constituents, limonene and citral, against Sarcoptes scabiei.MethodsSarcoptes scabiei were sourced from experimentally infested pigs. In vitro assays were performed to determine the lethal concentration (LC50) and survival time of the mites when exposed to varying concentrations of the test solutions.ResultsAll compounds were highly effective at killing mites in vitro. The LC50 values of Bravecto, Orange Power, limonene and citral at 1 h were 14.61 mg/ml, 4.50%, 26.53% and 0.76%, respectively. The median survival times of mites exposed to undiluted Bravecto, Orange Power and their combination were 15, 5 and 10 min, respectively. A pilot survival assay of mites collected from a mange-affected wombat showed survival times of < 10 min when exposed to Bravecto and Orange Power and 20 min when exposed to moxidectin.ConclusionsThese results confirm the acaricidal properties of Bravecto, demonstrate acaricidal properties of Orange Power and support the potential suitability of Orange Power and its active constituents as a diluent for Bravecto. As well as killing mites via direct exposure, Orange Power could potentially enhance the topical delivery of Bravecto to wombats by increasing drug penetration in hyperkeratotic crusts. Further research evaluating the physiochemical properties and modes of action of Orange Power and its constituents as a formulation vehicle would be of value.Graphical

Third Generation Solid Dispersion-Based Formulation of Novel Anti-Tubercular Agent Exhibited Improvementin Solubility, Dissolution and Biological Activity.

The long treatment period and development of drug resistance in tuberculosis (TB) necessitates the discovery of new anti-tubercular agents. The drug discovery program of the institute leads to the development of an anti-tubercular lead (IIIM-019), which is an analogue of nitrodihydroimidazooxazole and exhibited promising anti-tubercular action. However, IIIM-019 displays poor aqueous solubility (1.2µg/mL), which demands suitable dosage form for its efficient oral administration. In the present study, third generation solid dispersion-based formulation was developed to increase the solubility and dissolution of IIIM-019. The solubility profile of IIIM-019 using various polymeric carriers was determined and subsequently, PVP K-30 and P-407 were selected for preparation of binary and ternary solid dispersion. The third-generation ternary solid dispersion comprising PVP K-30 and P-407 revealed a remarkable enhancement in the aqueous solubility of IIIM-019. Physicochemical characterization of the developed formulations was done by employing FTIR spectroscopy, scanning electron microscopy, X-ray diffraction analysis, differential scanning calorimetry, and dynamic light scattering analysis. The dissolution study indicated an impressive release profile with the optimized formulation. The optimized formulation was further examined for cytotoxicity, cellular uptake, and hemolytic activity. The results indicated that the formulation had no apparent cytotoxicity on Caco-2 cells and was non-hemolytic in nature. Moreover, the optimized formulation showed significantly improved anti-tubercular activity compared to the native molecule. These findings showed that the developed third generation ternary solid dispersion could be a promising option for the oral delivery of investigated anti-tubercular molecule.

Improving Students Access to Primary Health Care Through School-Based Health Centers.

More than 20 million children in the United States lack access to primary health care. Research shows that students with regular access to physical and mental health services have fewer absences, are more social, less likely to participate in risky behaviors, have improved focus and higher test scores. School-based health centers (SBHCs) can be an important, valuable and viable health care delivery option to meet the full-range of primary health care needs of students where they spend the majority of their wake hours, ie, in school. Children in rural and other underserved communities, as well as those underinsured, non-insured, economically challenged, underserved, and the most vulnerable among us are especially at risk. This paper discusses the history, value, and importance of SBHCs from myriad perspectives, including physical and emotional wellbeing, academic and social success, and the promotion of a positive transition to adulthood. In addition, the authors' experiences that resulted in building the first SBHC in the Mid-Hudson Valley Region of New York State are shared. These experiences form the foundation for creating an important roadmap for individuals and school leaders that are interested in bringing a SBHC to their school and district.

Blended Learning Delivery Methods for a Sustainable Learning Environment: A Delphi Study

The outbreak of COVID-19 necessitated social distancing. Universities around the world were left with two options: a total suspension or a major reduction in students’ attendance. While the nature of many courses made it very difficult to teach them online, blended learning was the most suitable approach to teach these types of courses. Academics and educational institutions have realized the significance of blended learning not only as a response to immediate disruptions but also as a pivotal element in fostering a sustainable learning environment. However, designing successful blended learning courses requires making challenging decisions regarding the selection of the most appropriate delivery methods to achieve learning outcomes. To support higher education adoption of blended learning, this study identifies and rates the importance of the delivery methods that need consideration when designing a blended learning course. The aim is to assist academics to prioritize their delivery options and provide adaptable and resilient educational models. A Delphi study of two rounds was conducted to identify and rate the delivery methods. An expert panel of 19 academics with extensive experience in course design and online delivery was recruited. The findings indicate that online collaborative work and face-to-face collaborative work should be academics’ first delivery choices. Interestingly, face-to-face instructor-led learning was at the bottom of the list and rated well below all the other delivery methods.

Carbon reduction and understanding through simulation of transportation (CRUST) for e-commerce

Online shopping has replaced a substantial percentage of brick-and-mortar shopping in the last two decades, and many consumers remain uninformed about the CO2 emission impact for both. FedEx and ShopRunner have a unique combination of data that enables the simulation of e-commerce order delivery as well as passenger vehicle trips to brick-and-mortar locations. In this work, we study the potential distribution of CO2 emissions for customer trips to retail locations and contrast this with the impact of individual e-commerce orders on CO2 emissions for delivery routes. We do this by simulating the result of adding customers to delivery routes and also simulating likely customer routes to retailer locations. These two simulations allow us to directly compare the expected CO2 emissions for both methods of shopping. The scope of this work is correspondingly limited to the trade-off in last mile delivery emissions resulting from the choice of online shopping or traveling to a retailer. This work contributes to the discussion of CO2 emissions and commerce by simulating CO2 emissions for last-mile carrier delivery or pickup by an individual. The research done in this study concludes that, when considering last-mile delivery or pickup only under the specific scenarios used for the study, having purchases delivered likely has a lower CO2 impact than traveling to a store or location to pick up a product purchased online. In addition, survey results that were gathered as a part of this study indicate a consumer preference for environmentally friendly purchase options. We also show how this information can be estimated for presentation to customers during the checkout process in an understandable manner. This study provides practical information to supply chain companies and consumers, showing that shipping and delivery options can have a positive impact on CO2 emissions.

Caesarean delivery on maternal request: the perspective of the postpartum women

BackgroundCaesarean delivery on maternal request (CDMR) is an increasing delivery option among women. As such, we aimed to understand the reasons that led pregnant women to request a caesarean delivery.MethodsA phenomenological study was conducted with semi-structured interviews, in a convenience sample, for women who had undergone a CDMR between March and June 2023, in a public reference university hospital in Campinas, Brazil. The interviews were recorded, transcribed and subjected to thematic analysis, supported by Nvivo®, and Reshape®.ResultsWe interviewed eighteen women between 21 and 43 years of age. The reasons for C-section as their choice were: 1) fear of labour pain, 2) fear for safety due to maternal or fetal risks, 3) traumatic previous birth experiences of the patient, family or friends 4) sense of control, and 5) lack of knowledge about the risks and benefits of C-section.ConclusionsThe perception of C-section as the painless and safest way to give birth, the movement of giving voice and respecting the autonomy of pregnant women, as well as the national regulation, contribute to the increased rates of surgical abdominal delivery under request. Cultural change concerning childbirth and better counseling could support a more adequate informed decision-making about delivery mode.

Environmental sustainability and information sharing related to delivery options in the B2B2C context of e-commerce: evidence from a survey

Purpose This paper aims to explore the conditions in a business-to-business-to-consumer (B2B2C) context characterized by new technologies. Innovations enhance disintermediation and pursue sustainability goals that drive customers’ willingness to use eco-friendly delivery options, namely, parcel lockers – in e-commerce and their impacts in terms of communication and transparency along the supply network. Design/methodology/approach The study conducted an extensive survey in Italy and Germany, collecting 1,010 usable responses. Structural equation modelling was used to analyse the data with the aim of identifying the factors that drive customers’ willingness to use parcel lockers and the effect on customers’ behaviour as determined by the disclosure of information about the environmental performance of different delivery options. Findings The results highlight several factors affecting the willingness to use parcel lockers, namely, performance and effort expectancy, social influence, technology anxiety, hedonistic motivation and environmental knowledge. The results also demonstrate that the disclosure of information about the environmental performance of different delivery options influences customers’ behaviour. Research limitations/implications This paper faces several limitations, mostly related to the focus on just two countries, the use of cross-sectional data and the survey’s explicit reference to just one type of product. Nevertheless, the findings contribute to the discussion on the relevance of information sharing along the supply chain, providing favourable evidence in this regard. It also improves the stream of research concerning technology adoption in the context of e-commerce, highlighting factors that can lead consumers to use eco-friendly self-service technologies. Practical implications The results can support companies in understanding how they can design and manage the last mile of delivery to jointly achieve customer satisfaction, process efficiency and superior environmental performance. Originality/value This pioneering contribution studies the adoption of delivery solutions for e-commerce and its implications for the supply network.

Role of Metastasis-Directed Therapy in Genitourinary Cancers.

The treatment of oligometastatic genitourinary cancers is a rapidly advancing field with ablative radiotherapy as one of the critical treatment components. The oligometastatic disease state, which can be defined as 1-5 metastatic sites with a controlled primary, represents a distinct clinical state where comprehensive ablative local therapies may provide improved outcomes. Enhanced imaging has increased the number of patients identified with oligometastatic disease. Evidence for improved outcomes with metastasis-directed therapy (MDT) in oligometastatic genitourinary cancers is increasing, and previously published outcome data continues to mature with an increasing body of prospective data to inform the role of MDT in histology-specific settings or in the context of systemic therapy. In select patients, MDT can offer benefits beyond improved local control and allow for time off of systemic therapy, prolonged time until next therapy, or even the hope of cure. However, treatment decisions for locally ablative therapy must be balanced with consideration towards safety. There are exciting advances in technologies to target and adapt treatment in real-time which have expanded options for safer delivery and dose escalation to metastatic targets near critical organs at risk. The role of systemic therapies in conjunction with MDT and incorporation of tumor genetic information to further refine prognostication and treatment decision-making in the oligometastatic setting is actively being investigated. These developments highlight the evolving field of treatment of oligometastatic disease. Future prospective studies combining MDT with enhanced imaging and integrating MDT with evolving systemic therapies will enable the optimal selection of patients most likely to benefit from this "all-or-none" approach and reveal settings in which a combination of therapies could result in synergistic outcomes.

Predictors and Risks of Vaginal Birth after Cesarean Section: Insights from a Regional Referral Hospital in Uganda

Vaginal birth after cesarean section (VBAC) remains a topic of significant interest due to its potential benefits and associated risks. This retrospective cohort study aimed to identify predictors and risks associated with VBAC compared to elective repeat cesarean section (ERCD) among women delivering at Jinja Regional Referral Hospital in Uganda. We analyzed data from 384 women who had a previous cesareansection and delivered at the hospital between 2022 and 2023. Socio-demographic, obstetric, and medical characteristics were assessed for their association with successful VBAC using logistic regression. Risks of maternal morbidities between VBAC and ERCD groups were compared using Chi-square tests. The study found that BMI &lt;35 kg/m², birth weight &lt;3500g, spontaneous onset of labor, previous safe vaginal birth, and absence of diabetes mellitus were significant predictors of successful VBAC. Women undergoing TOLAC had a higher incidence of uterine rupture (p = 0.030), thromboembolism (p &lt; 0.001), and blood transfusion requirement (p &lt; 0.001) compared to ERCD. However, hysterectomy, hemorrhage, viscus injury, and pelvic floor trauma did not significantly differ between the two groups. Our findings highlight important predictors and risks associated with VBAC compared to ERCD in a regional referral hospital setting. Understanding these factors can aid clinicians in counseling women on their delivery options and managing potential risks associated with VBAC. Further research is warranted to explore strategies for optimizing VBAC outcomes while minimizing associated morbidities. Keywords: Maternal, Morbidity, Labor, Cesarean Section, Elective Repeat Cesarean Delivery, Jinja, Hospital

Development and Characterization of Enteric Polymer-based Solid Dispersion for Cholecalciferol Delivery

Background: The deficiency of vitamin D is a global concern affecting individuals of all age groups. Insufficient exposure to sunlight and disease conditions can lead to cholecalciferol (vitamin D3) deficiency. Objective: Cholecalciferol is a lipophilic crystalline molecule, and it is highly susceptible to degradation under environmental conditions, including light, temperature, and oxygen, and its degradation rate is high in the low pH range. Therefore, an enteric solid dispersion-based formulation was developed in the present study for the oral delivery of cholecalciferol. Method: Enteric polymer hydroxypropylmethylcellulose acetate succinate (HPMCAS)-based solid dispersion was developed and characterized by Fourier transform-infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), scanning electron microscopy (SEM), and X-ray diffraction analysis. The effect of various concentrations of cholecalciferol formulations on the viability of Caco-2 cells was determined using an MTT assay. A dissolution and stability study of the product was also performed. Result: An amorphous form of cholecalciferol in the solid dispersion was reported. The drug content of solid dispersions was in the order of 90%. The viability assay indicated that the surfactant used in the developed solid dispersion of cholecalciferol had no cytotoxic effect on Caco-2 cells. A dissolution study on enteric solid dispersion in two-stage dissolution under a biomimetic medium indicated the pHdependent release of cholecalciferol from the HPMCAS-based solid dispersion. Moreover, the stability study showed no significant changes in the cholecalciferol content in the developed formulation under storage at experimental conditions. Conclusion: The enteric solid dispersion of cholecalciferol was developed, which exhibited compatibility with Caco-2 cells, improved dissolution, and acceptable stability profile, and represented a potential option for efficient delivery of cholecalciferol.

Preferences and factors determining preferences for mode of delivery among primigravida mothers.

Childbirth is a beautiful life event, a unique personal experience for each woman. The study aimed to assess the preferences and factors determining preference for mode of delivery among primigravida mothers. A descriptive exploratory design was applied to explore the factors for preferring the mode of delivery among 250 antenatal mothers, selected by convenient sampling technique. A self-structured dichotomous questionnaire on preference and factors influencing preference for mode of delivery was used. Descriptive and inferential statistical analysis was done using SPSS 20 software. The majority of participants (98.4%) preferred vaginal delivery over elective cesarean section as a mode of delivery. The significant factor influencing preferences was speedy recovery after delivery (89.8%). However, significant factors for preferring the cesarean mode of delivery were the obstetrician's advice and the baby's safety (100%). The majority of women preferred a vaginal mode of delivery; they still undergo cesarean mode of delivery. Considering factors, there is a need to develop a positive attitude toward NVD and actions to create awareness toward a safe mode of delivery by building a mutual trust environment and increasing effective dissemination of correct and neutral delivery option advice.

462 Stem Cell-Loaded Implantable Intrathecal Bioreactors for the Treatment of Spinal Cord Injury: A Porcine Model Pilot Study

INTRODUCTION: Stem cells promote spinal cord injury (SCI) recovery by secreting paracrine factors that orchestrate endogenous healing mechanisms. However, effects in clinical trials are modest and there are no approved stem cell therapies to treat SCI. Major barriers include cell washout, immune attack, and oncogenic potential. METHODS: ITBs were implanted in three pigs. One pig received a cell-loaded ITB without injury (Cells), another received a cell-loaded ITB with injury (Cells + SCI), and another received a sham ITB with injury (SCI). SCIs were induced by weight drop at T5. ITBs were implanted cranial to the injury and sutured under the dura then loaded with human mesenchymal stem cells or sham cell media. Cerebrospinal fluid (CSF) was collected for 6 days following surgery through a lumbar drain. Cytokines in the CSF were measured by ELISA and the ITB was retrieved for cell viability staining. RESULTS: Upon retrieval, stem cells were alive on viability staining of the ITB. CSF levels of the pro-inflammatory cytokines IFNy and IL-1a were increased in the SCI condition compared to the Cells and Cells + SCI conditions. Pro-inflammatory cytokines peaked on post-operative day 5 and remained high. Anti-inflammatory cytokines IL-1ra, VEGF, and TGFβ were elevated in the SCI + Cells condition and depressed in the SCI condition compared to the Cells condition. Anti-inflammatory cytokines peaked on post-operative day 3 and decreased by day 6. CONCLUSIONS: In this pilot study, stem cells survived in an implantable ITB and altered cytokine levels in the CSF of pigs with SCI. Cell-loaded ITBs reduced pro-inflammatory cytokines and increased anti-inflammatory cytokines. Implantable ITBs warrant further study as they may represent a potential new delivery option for stem cell therapy.

Patient Education and Decision Support for Long-Acting Injectable HIV Antiretroviral Therapy: Protocol for Tool Development and Pilot Testing with Ryan White HIV/AIDS Program Medical Case Management Programs in New York.

Long-acting injectable (LAI) HIV antiretroviral therapy (ART) presents a major opportunity to facilitate and sustain HIV viral suppression, thus improving health and survival among people living with HIV and reducing the risk of onward transmission. However, realizing the public health potential of LAI ART requires reaching patients who face barriers to daily oral ART adherence and thus can clinically benefit from alternative treatment modalities. Ryan White HIV/AIDS Program Part A medical case management (MCM) programs provide an array of services to address barriers to HIV care and treatment among economically and socially marginalized people living with HIV. These programs have demonstrated effectiveness in improving engagement along the continuum of care, but findings of limited program impact on durable viral suppression highlight the need to further innovate and hone strategies to support long-term ART adherence. This study aims to adapt and expand Ryan White MCM service strategies to integrate LAI ART regimen options, with the larger goal of improving health outcomes in the populations that could most benefit from alternatives to daily oral ART regimens. In 3 phases of work involving patient and provider participants, this study uses role-specific focus groups to elicit perceptions of LAI versus daily oral ART; discrete choice experiment (DCE) surveys to quantify preferences for different ART delivery options and related supports; and a nonrandomized trial to assess the implementation and utility of newly developed tools at 6 partnering Ryan White HIV/AIDS Program Part A MCM programs based in urban, suburban, and semirural areas of New York. Findings from the focus groups and DCEs, as well as feedback from advisory board meetings, informed the design and selection of the tools: a patient-facing, 2-page fact sheet, including frequently asked questions and a side-by-side comparison of LAI with daily oral ART; a patient-facing informational video available on YouTube (Google Inc); and a patient-provider decision aid. Implementation outcomes, measured through provider interviews, surveys, and service reporting, will guide further specification of strategies to integrate LAI ART options into MCM program workflows. The study was funded in late April 2021 and received approval from the institutional review board in May 2021 under protocol 20-096. Focus groups were conducted in late 2021 (n=21), DCEs ran from June 2022 to January 2023 (n=378), and tools for piloting were developed by May 2023. The trial (May 2023 through January 2024) has enrolled >200 patients. This study is designed to provide evidence regarding the acceptability, feasibility, appropriateness, and utility of a package of patient-oriented tools for comparing and deciding between LAI ART and daily oral ART options. Study strengths include formative work to guide tool development, a mixed methods approach, and the testing of tools in real-world safety-net service settings. Clinicaltrials.gov NCT05833542; https://clinicaltrials.gov/study/NCT05833542. DERR1-10.2196/56892.

Development and Assessment of Hydroxypropyl Methylcellulose-Based Floating Tablets for Ciprofloxacin HCL Using Direct Compression Technique

The key findings and conclusions include: such as formulation approaches as aim and objective Development of floating tablets using sodium bicarbonate and HPMC aimed at enhancing gastric residence time for improved drug bioavailability. Physicochemical Compliances The formulated tablets met compliance standards for various physicochemical parameters, including dimensions, floating time, tablet density, and drug content. Method of Formulations F2, F5, and F6 displayed favorable drug release profiles, with the F7 formulation exhibiting excellent release characteristics. in the evaluation the drug release kinetics studies show Kinetic analysis revealed that F2, F5, F6, and F7 formulations followed the Korsmeyer–Peppas model, indicating non-Fickian diffusion with 'n' values ranging from 0.521 to 0.633 and the stability indicates the Optimal storage conditions for stability were determined as 2-8°C for 60 days. Formulations F2, F5, F6, and F7 demonstrated stability at room temperature, 40°C, and 2-8°C for 30 days, with refrigerated storage maintaining stability throughout the 60 days. In conclusion, the developed hydrodynamically balanced tablets of Ciprofloxacin HCl exhibit promising physicochemical characteristics, dissolution profiles, and stability. These tablets hold the potential for enhancing drug bioavailability, making them a viable option for localized drug delivery in the upper gastrointestinal tract.

UTERINE RUPTURE DURING PREGNANCY: A COMPREHENSIVE SYSTEMATIC REVIEW

Introduction: Uterine rupture, a rare but serious obstetric condition involving a tear through the uterine wall, has varying incidences globally, with scarred uteri, morbidly attached placenta, grand multiparity, and oxytocin use being common risk factors. This systematic review aims to comprehensively analyze the literature on uterine rupture during pregnancy, focusing on risk factors, geographical incidence variations, etiological patterns, impact of medical interventions, and maternal outcomes, with a goal to enhance understanding, identify preventive strategies, and improve clinical management. Method: The researchers in this study followed the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to ensure that their work met the required standards. This was done to ensure the precision and reliability of the conclusions derived from the research. Result: Our search produced 11 results. After looking at the titles and summaries, we found 9 papers that fit our criteria. At first, we excluded several articles because they were written in review style and case reports. But after reading the full papers carefully, we included five papers in our final analysis. These papers included a retrospective observational study, prospective study, and retrospective study. Conclusion: In conclusion, uterine rupture (UR) is a catastrophic event requiring heightened vigilance in pregnant women with high-risk factors to mitigate severe consequences for both obstetricians and patients. Trials of labor after cesarean (TOLAC), a safe delivery option, faces challenges in Shanghai and China, and the risk of uterine rupture emphasizes the need for evaluating dosages and duration of prostaglandins and oxytocin. Our series highlights the grave neonatal prognosis of uterine rupture, stressing the importance of timely management and recognizing fetal heart rate abnormalities. The URIDA investigation, the largest database on UR during pregnancy, reveals insights into the association between previous uterine surgery, leiomyoma, and UR, emphasizing the need for early diagnosis and immediate treatment to minimize complications and ensure favorable outcomes in both the index and subsequent pregnancies.

Abstract 7185: Long acting injectable FHD-609 micro-suspension: A potent BRD9 degrader with comparable efficacy, reduced frequency of dosing in preclinical models

Abstract Bromodomain-containing protein 9 (BRD9) is a unique component of the non-canonical Brahma-associated factor (ncBAF) complex, essential for cancer cells relying on this complex for survival. This makes it an attractive target for cancer treatment. In synovial sarcoma (SS), SS18-SSX fusion protein drives disease progression and integrates into BAF complexes, promoting tumor growth. Targeting BRD9 degradation is a potential therapeutic approach for SS tumors, as it depletes the essential SS18-SSX fusion protein upon which cancer cells depend for survival within the BAF complex. FHD-609, a potent heterobifunctional degrader of BRD9, has been administered intravenously (IV) in medical facilities twice weekly during clinical trials. In order to facilitate less frequent and more convenient patient-centric dosing, a long acting injectable formulation was developed that allows subcutaneous (SC) or intramuscular (IM) dosing every 4 weeks in preclinical studies. The formulation is an aqueous microsuspension containing the drug along with a polymer and surfactant which provides sustained release of FHD-609 upon injection. We compared the long acting injectable formulation dosed once every 4 weeks to the IV formulation dosed twice a week for the pharmacokinetic and pharmacodynamic properties, as well as the efficacy of the long in xenograft models of different sensitivities, including cell line-derived xenografts (CDX) and patient-derived xenografts (PDX). Our results showed that a single dose of the injectable suspension formulation was well-tolerated in mice and exhibited a significantly flatter PK profile than IV injection with a lower peak to trough ratio and detectable compound concentrations 4 weeks post dose. Moreover, it demonstrated comparable in vivo efficacy and BRD9 protein degradation to the standard intravenous (IV) administration. The long acting FHD-609 injectable formulation has the potential to offer better patient compliance and acceptance in clinical settings than IV dosing. The long acting injectable formulation provides a promising and effective drug delivery option for various protein degraders that are not orally bioavailable. Citation Format: Meiyun Lin, Ammar Adam, Abira Pyne Ramakrishnan, Hafiz Ahmad, Xiaohuan Wu, Brandon Antonakos, Chong-Hui Gu, Ashish Ramani, Victoria Amaral, Claudia Dominici, Qianhe Zhou, Mike Collins, Jessica Piel, Sal Topal, Brian Ethell, Kelly McKiernan, Scott Innis. Long acting injectable FHD-609 micro-suspension: A potent BRD9 degrader with comparable efficacy, reduced frequency of dosing in preclinical models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7185.

Telerehabilitation in Physical Therapist Practice: A Clinical Practice Guideline From the American Physical Therapy Association.

A clinical practice guideline on telerehabilitation was developed by an American Physical Therapy Association volunteer guideline development group consisting of international physical therapists and physiotherapists, a physician, and a consumer. The guideline was based on systematic reviews of current scientific literature, clinical information, and accepted approaches to telerehabilitation in physical therapist practice. Seven recommendations address the impact of, preparation for, and implementation of telerehabilitation in physical therapist practice. Research recommendations identify current gaps in knowledge. Overall, with shared decision-making between clinicians and patients to inform patients of service delivery options, direct and indirect costs, barriers, and facilitators of telerehabilitation, the evidence supports the use of telerehabilitation by physical therapists for both examination and intervention. The Spanish and Chinese versions of this clinical practice guideline, as well as the French version of the recommendations, are available as supplementary material (Suppl. Materials).