Inadequate Compliance Research Articles

The perspectives of stakeholders on the National Medicine Policy of Pakistan: a qualitative study

IntroductionThe National Medicine Policy (NMP) is crucial for setting the direction of a country’s action plan to achieve targeted healthcare goals.ObjectiveThis study aimed to explore the perceptions of different stakeholders regarding the current NMP of Pakistan.MethodsA qualitative study design was employed using purposive sampling to identify respondents. Semi-structured interviews were conducted with regulators (n = 6), manufacturers (n = 8), healthcare professionals (n = 9), and academicians (n = 7) until saturation was reached. Interviews were conducted at convenient times and locations, recorded, transcribed verbatim, and subjected to thematic analysis.ResultsMost stakeholders demonstrated expertise in policy-making and understood the basic concepts, need, and importance of the NMP. Six key themes were identified: general understanding of the NMP, existing regulatory framework and NMP, essential medicines and the current healthcare system, comparison of NMP with international standards, focus of NMP for better provision of healthcare, and recommendations for an effective NMP for Pakistan. Stakeholders emphasized the need for policies to set Standard Operating Procedures and direction, and noted that some frameworks require revision. There was consensus that the availability of essential medicines needs improvement and that the current healthcare system requires revamping, as the National Essential Medicine List is not fully implemented.ConclusionThe study concludes that NMP is integral to a robust healthcare system. However, Pakistan lacks an effective NMP despite extensive efforts in recent years. This deficiency is attributed to scarce resources, lack of political will and ownership, and inadequate compliance with performance-based indicators.

Impact of training dairy farm personnel on milking routine compliance, udder health, and milk quality

Among various farm procedures, an appropriate milking routine is crucial for reducing mastitis and enhancing milk safety and quality. However, inadequate compliance with milking routines remains a primary factor contributing to variability of milk quality among herds. Training farm workers is essential for ensuring compliance with milking routines, which directly impacts milk quality and udder health. In this study, we aimed to assess the impact of a training session on dairy farm workers' understanding of the milking routine, behavioral changes during milking, and subsequent effects on milk quality and udder health. Farm workers (n = 112) from 16 commercial dairy farms in Michigan and Ohio participated in the project. The training session was delivered using an active learning approach prioritizing group discussions, and focused on the pathogenesis, identification, and risk factors for mastitis, and the rationale and importance of each step in the milking routine. Pre- and post-training evaluations were conducted to measure changes in knowledge, parlor evaluations were performed to determine behavioral change, and data from clinical mastitis cases and bulk tank somatic cell count were used to estimate udder health and milk quality. Segmented and linear mixed regression analyses were used to assess the impact of the training intervention. Participants were mostly milking technicians (61.1%) with 70% of them having less than 1 year of experience and a median tenure in their jobs of 9 mo. Knowledge of the milking routine increased from 49.3% to 67.6% of correct answers after training. Based on parlor evaluations, the pre-milking disinfectant contact time increased by 9 s per cow. The percentage of milkings with inadequate preparation time decreased from 69% (before training) to 48% (after training). The proportion of insufficient teat coverage during post-milking disinfection decreased from 9.8% (77 out of 782) before training to 5.9% (34 out of 572) after training. There was a significant increase in clinical mastitis cases during the immediate week after the training. Additionally, the upward trend in bulk tank somatic cell count was halted. Our results suggest an improvement in overall mastitis identification and milk quality, underscoring the importance of targeted training programs for farm workers in improving milking routine compliance, enhancing milk quality, and promoting better udder health.

Deliberation on continuous spread of corruption in South Africa

Corruption is widely spread in South Africa and is against the norms of honestly, morals, values, ethics, and good governance. The reasons of corruption may be individual (personal greed for luxury, power, authority), organisational (inadequate monitoring and evaluation, reporting processes), legislative (no compliance), strategic (lack of ethical culture), to state a few. The study is aimed to find answers to the following guiding research question, such as: what is the extent of corruption in South Africa? The qualitative study utilised secondary sources through the literature review of articles and document review of annual/official reports to gather relevant information. The information was further assessed using document analysis. The findings show that corruption is spreading at every level of government, and even public and private sectors are getting exposed to cases of misconduct. The country has established various legislative frameworks to combat corruption. The objectives of anti-corruption frameworks are operationalised through the establishment of anti-corruption organistaions. Some of them are Corruption Watch; National Anti-Corruption Advisory Council; Financial Intelligence Centre; Organisation Undoing Tax Abuse; and National Anti-Corruption Hotline. The findings show that although there are anti-corruption measures in place, the inadequate compliance may create implementation gaps, hence corruption keeps on spreading at political level, bureaucratic offices, and even in municipalities. The study suggests policy measures to minimise the scope and spread of corruption.

Alleviating rheumatoid arthritis with a photo-pharmacotherapeutic glycan-integrated nanogel complex for advanced percutaneous delivery

The prospective of percutaneous drug delivery (PDD) mechanisms to address the limitations of oral and injectable treatment for rheumatoid arthritis (RA) is increasing. These limitations encompass inadequate compliance among patients and acute gastrointestinal side effects. However, the skin’s intrinsic layer can frequently hinder the percutaneous dispersion of RA medications, thus mitigating the efficiency of drug delivery. To circumvent this constraint, we developed a strontium ranelate (SrR)-loaded alginate (ALG) phototherapeutic hydrogel to assess its effectiveness in combating RA. Our studies revealed that this SrR-loaded ALG hydrogel incorporating photoelectrically responsive molybdenum disulfide nanoflowers (MoS2 NFs) and photothermally responsive polypyrrole nanoparticles (Ppy NPs) to form ALG@SrR-MoS2 NFs-Ppy NPs demonstrated substantial mechanical strength, potentially enabling delivery of hydrophilic therapeutic agents into the skin and significantly impeding the progression of RA. Comprehensive biochemical, histological, behavioral, and radiographic analyses in an animal model of zymosan-induced RA demonstrated that the application of these phototherapeutic ALG@SrR-MoS2 NFs-Ppy NPs effectively reduced inflammation, increased the presence of heat shock proteins, regulatory cluster of differentiation M2 macrophages, and alleviated joint degeneration associated with RA. As demonstrated by our findings, treating RA and possibly other autoimmune disorders with this phototherapeutic hydrogel system offers a distinctive, highly compliant, and therapeutically efficient method.

Connecting with fetus: The use of app-based fetal movement counting and experiences during pregnancy and birth

BackgroundPregnant people are often introduced to fetal movement counting to monitor the health of their fetus. This study aims to examine the impacts of app-based fetal movement counting on experiences during pregnancy and birth. MethodThis study used two types of secondary data including individual user's app use and their end of pregnancy survey data collected on the Count the Kicks (CTK) app. CTK is a free mobile app providing a virtual platform for pregnant people to conduct their daily kick counting. The study sample includes 1,147 pregnant people. Descriptive analyses were used to examine the number of kick counts using CTK and pregnant women's experiences with the app, their pregnancy, and childbirth. Bivariate analyses were used to examine the relationships between the frequency of kick counts and pregnant people's experience with their pregnancy and birth. Logistic regressions were used to model pregnant people's experiences: anxiety level related to their pregnancy and bonding with their baby. FindingsThe study found that there is inadequate compliance with daily fetal movement counting recommendations in third trimester among pregnant people. However, results showed that frequent use of fetal movement counting is associated with lower anxiety level related to their pregnancy, and more bonding with their baby. These positive pregnancy experiences are associated with healthy birth. ConclusionTo benefit from the impacts of fetal movement counting on positive pregnancy and birth experience, the app developers and public health agencies need to develop strategies to increase daily use of fetal movement counting.

8057 Unveiling Gender Dysphoria and Gender Change in a Large Cohort of DSD

Abstract Disclosure: R.L. Batista: None. M. Inacio: None. T.A. Bachega: None. N.L. Gomes: None. G. Madureira: None. M.C. Miranda: None. R.T. dallago: None. M.M. Ferrari: None. L.M. Lousada: None. J.A. Batatinha: None. E.F. Costa: None. M.P. Sircili: None. F. Denes: None. M.Y. Nishi: None. S. Domenice: None. B.B. Mendonca: None. Disorders/Differences of Sex Development (DSD) encompass a wide range of genetic conditions that affect sex development. Individuals with DSD may experience gender dysphoria and undergo gender changes throughout their lives. To analyze gender dysphoria and gender changes in individuals with DSD, we conducted a retrospective study involving all DSD cases from a single Brazilian tertiary medical center followed by a multidisciplinary team. We included 696 subjects considering their DSD diagnosis, sex assignment, age at DSD diagnosis, gender change, age at gender change, and phenotypic features. Among the three categories of DSD, chromosomal DSD was diagnosed in 264 subjects (135 with a 45,X karyotype, 101 mosaics with 45,X/46,Xi(Xq)), and three exhibited chimerism (all with ovotesticular DSD). Thirteen patients with chromosomal DSD and Y material were assigned as male, while two patients initially assigned as female underwent gender changes. Among the 258 subjects with 46,XY DSD, 69 had undetermined DSD, 64 had gonadal dysgenesis, 36 had 5-αRD2 deficiency, 18 had 17β-HSD3 deficiency, 11 had 17α-hydroxylase deficiency, 9 had Leydig cell hypoplasia, 25 had CAIS, 18 had PAIS, and 8 had AMH defects. Out of the 192 XY subjects with atypical genitalia, 89 (46%) were raised as female, and 13% changed from female to male, predominantly in cases of 5αRD2 deficiency (45%), followed by 17β-HSD3 deficiency (33%). Only 2.9% of those raised as male changed to female gender. Among the 46,XX DSD cases, congenital adrenal hyperplasia (CAH), mainly 21-hydroxylase deficiency, was diagnosed in 123 cases (115 initially assigned as female). Six cases of CAH resulted in gender changes from female to male, notably in the virilizing salt-wasting (VS) form (5/6; p=.004), all of which had a late onset of treatment (>2 years old) and poor compliance. Among the remaining 55 cases with 46,XX DSD, 24 had ovotesticular DSD (all with atypical genitalia), while 16 had 46,XX testicular DSD (seven with atypical genitalia); four cases underwent gender changes, with three changing from female to male. Twelve patients with 46,XX DSD had an undetermined diagnosis (all with atypical genitalia, three with syndromic features). Additionally, one patient had aromatase deficiency, one had POR deficiency, and one had glucocorticoid resistance syndrome. In conclusion, our study highlights a clear trend: gender changes, notably from female to male, were more prevalent in 46,XY DSD, particularly in 5αRD2 and 17β-HSD3 deficiencies. This underscores the importance of considering male sex assignment for individuals with these diagnoses. Additionally, factors such as the VS form of CAH, delayed treatment initiation, and inadequate compliance significantly contributed to female-to-male gender changes among 46,XX DSD cases. These findings offer critical insights guiding more effective and targeted interventions for DSD individuals. Presentation: 6/2/2024

Improving the targeting and therapeutic efficacy of anastrazole for the control of breast cancer: In vitro and in vivo characterization

Anastrazole (ASZ) is an effective aromatase inhibitor that is used for breast cancer treatment. Nevertheless, ASZ’s effectiveness is diminished due to its low water solubility, unregulated release, absence of targeting, and inadequate patient compliance. The goal of the research was to create a hydrogel formulation of ASZ-loaded invasomes (ALI) to enhance the solubility, permeability, targeting, and efficacy of ASZ while also sustaining its release for treatment of breast cancer. The optimized ALI formulation was determined to be 3%w/v phospholipid, 0.15%w/v cholesterol, 3%v/v ethanol, and 1 %v/v cineole based on the results of the pre-formulation study. After conducting in vitro characterization of the optimum formulation, it was combined with carbopol for in vivo examination of its anti-tumor efficacy in a rat model of 7, 12-dimethylbenzanthracene. Compared to free ASZ, ALI hydrogel increased its penetration by 10.67 times and prolonged its release by 64.02%. Compared to the control positive group, ALI hydrogel reduced tumor volume by 99.19% and mortality by 10.93%. The anti-tumor effect of the ALI hydrogel was demonstrated by its ability to accumulate more ASZ in tumors and reduce hypercellular tumors. Overall, transdermal ALI hydrogel shows potential as a promising approach for treating breast cancer.

Blood glucose control among type 2 diabetic farmers in Chinese resettlement areas: a mixed methods study

BackgroundDue to China’s rapid urbanization, many farmers have relocated to urban resettlement regions. There is limited research on the glycemic control of Type 2 diabetes mellitus (T2DM) farmers in these areas. This study examined their blood glucose control and its determinants.MethodsThis study took place from March 2021 to January 2022 in a resettlement community in Yiwu, Zhejiang Province, China. In the first phase, a quantitative survey of 181 T2DM farmers was conducted using a questionnaire to gather demographic data, blood glucose control status, disease cognition levels, and treatment compliance. Inclusion criteria were migrant workers with ≥ 3 months of residence and local household registration and T2DM patients who met the diagnostic criteria of the Chinese guidelines. In the second phase, qualitative research involved face-to-face, semi-structured interviews with 15 patients with varying blood glucose control levels to analyze their experiences.ResultsThe blood glucose control rate in this particular group was 27.62%, and the average disease cognition score was 2.5 ± 0.75. Many patients (67.96%) had inadequate treatment compliance, specifically in monitoring compliance (4.45 ± 1.92) and regular review compliance (3.58 ± 1.74).ConclusionThere is a need for tailored programs to improve glycemic control among resettled farmers. Enhancing disease awareness and treatment compliance through targeted education and support is crucial. Further studies are needed to evaluate different treatment regimens’ impact on glycemic control.Clinical trial numberNot applicable.

Blockchain-enabled EHR access auditing: Enhancing healthcare data security

In the realm of modern healthcare, Electronic Health Records EHR serve as invaluable assets, yet they also pose significant security challenges. The absence of EHR access auditing mechanisms, which includes the EHR audit trails, results in accountability gaps and magnifies security vulnerabilities. This situation effectively paves the way for unauthorized data alterations to occur without detection or consequences. Inadequate EHR compliance auditing procedures, particularly in verifying and validating access control policies, expose healthcare organizations to risks such as data breaches, and unauthorized data usage. These vulnerabilities result from unchecked unauthorized access activities. Additionally, the absence of EHR audit logs complicates investigations, weakens proactive security measures, and raises concerns to put healthcare institutions at risk. This study addresses the pressing need for robust EHR auditing systems designed to scrutinize access to EHR data, encompassing who accesses it, when, and for what purpose. Our research delves into the complex field of EHR auditing, which includes establishing an immutable audit trail to enhance data security through blockchain technology. We also integrate Purpose-Based Access Control (PBAC) alongside smart contracts to strengthen compliance auditing by validating access legitimacy and reducing unauthorized entries. Our contributions encompass the creation of audit trail of EHR access, compliance auditing via PBAC policy verification, the generation of audit logs, and the derivation of data-driven insights, fortifying EHR access security.

Improvement of non-adherence and reduction of BP values in patients with difficult-to-treat hypertension: the ATHAN clinical trial.

Hypertension treatment and blood pressure (BP) control reduce cardiovascular disease burden. However, prevalence of controlled BP is overall insufficient and lack of adherence to treatment is a suggested major contributor. This prospective, randomized clinical trial was designed to evaluate whether a specific 3-month (m) action plan to improve therapeutic adherence results in a decrease in BP. Patients with ambulatory 24 h-BP ≥ 130/80 mmHg despite receiving ≥2 antihypertensive drugs and with therapeutic non-compliance confirmed by antihypertensive drugs analyzed in urine were randomized (1:1) to receive a specific 3 m program to improve adherence (INT = intervention) or routine follow-up (C = control). Antihypertensive treatment was not modified and knowledge of non-adherence was only notified to patients randomized to the intervention group. Before randomization and at 3 m all patients underwent urinary screening for antihypertensive drugs and 24 h-ambulatory-BP monitoring. Forty-five patients (36% women, mean age: 58 ± 13 yr) were randomized. At 3 m, mean (95% CI) BP differences (INT vs. C) were 12.2 mmHg (4.3-20.8), adjusted-p = 0.032 and 8.7 mmHg (2.5-14.8), adjusted-p = 0.018 for 24 h-systolic and 24 h-diastolic BP, respectively. Differences (INT vs. C) for office SBP and DBP were 18.4 mmHg (6.8-30.1), adjusted-p = 0.005 and 15.7 mmHg (7.2-24.2), adjusted-p < 0.001. Non-detected antihypertensive drugs were median [IQR]: 40% [25-100] and 0% [0-20] at baseline and 3 m, respectively, in the INT group, and 33.3% [25-63.7] and 33.3% [23.8-57.9], in the C group (p < 0.001 for the 3-month between-group comparison). A combined action plan of notifying knowledge of non-adherence plus a 3-month specific nursing intervention to improve therapeutic adherence results in BP reduction in patients with inadequate therapeutic compliance.

Successful completion of orthodontic therapy in a patient with osteopetrosis: Case Report.

Orthodontic therapy in patients with osteopetrosis (OP) of the jaws has typically been contraindicated owing to the presence of poorly perfused and extremely compact bone, and the potential risk for infection and osteomyelitis. As such, completed orthodontic cases in association with OP have rarely been published. A patient aged 14 years 6 months, with no known diagnosis of OP, sought orthodontic assessment for anterior crowding. The patient exhibited a straight facial profile and increased mandibular facial height, competent lips, shallow mentolabial sulcus with mild mentalis strain, flat/reverse smile arc and wide buccal corridors on smiling. The patient had a Class I incisor relationship on Class I skeletal bases with bilateral Class I molars and Class II canine relationships. This was complicated by a crossbite involving the lateral incisors and a Bolton discrepancy due to small maxillary lateral incisors. A radiologic assessment revealed polyostotic OP of the oromaxillofacial complex. Treatment consisted of maxillary and mandibular fixed orthodontic therapy, bite turbos and elastics to level and align the dentition. Extractions of permanent teeth were not needed. At the conclusion of treatment, there was a slight left Class II malocclusion, with incomplete intercuspation on the left side due to tooth size discrepancy, possibly attributed to inadequate elastics compliance and the presence of osteopetrotic bone. The treatment was completed in 3 years, 1 year longer than anticipated. This report represents the second published account of a patient with OP successfully managed with comprehensive orthodontic care and without osseous complications. Obtaining cephalometric measurements on OP-affected patients may be imprecise owing to the presence of extremely dense bone and difficulty to identify bony landmarks. To reduce osteopetrotic sequelae, attending clinicians should consider reduced exertional orthodontic forces and closely monitor patients for adverse alveolar events.

The Stockholm Convention at a Crossroads: Questionable Nominations and Inadequate Compliance Threaten Its Acceptance and Utility.

Twenty years since coming into force, the Stockholm Convention has become a "living" global agreement that has allowed for the addition of substances that are likely, as a result of their long-range environmental transport (LRET), to lead to significant adverse effects. The recent listing of the phenolic benzotriazole UV-328 in Annex A and a draft nomination of three cyclic volatile methylsiloxanes (cVMS) for Annex B draw attention to the fact that many chemicals are subject to LRET and that this can lead to questionable nominations. The nomination of UV-328 and the draft nomination of cVMS also raise the spectre of regrettable substitutions. At the same time, atmospheric monitoring across the globe reveals that environmental releases of several unintentionally produced POPs listed in Annex C, such as hexachlorobenzene and hexachlorobutadiene, are continuing unabated, highlighting shortcomings in the enforcement of the minimum measures required under Article 5. There is also no evidence of efforts to substitute a chemical whose use has been known for three decades to unintentionally produce polychlorinated biphenyls. These developments need to be rectified to safeguard the long-term viability and acceptance of a global treaty of undeniable importance.

Examining the educational experiences of Behvarzes from the insufficient participation of some people in preventive measures against the COVID-19 pandemic: a lesson for the future

BackgroundThis study aims to explore the experiences of Behvarzes regarding the reasons behind the insufficient participation of some individuals with the preventive protocols established during the COVID-19 pandemic.MethodsA qualitative study was conducted from July 2021 to December 2022 using the conventional content analysis method. Purposive sampling was employed to select 14 Behvarzes working in villages covered by Kashan University of Medical Sciences. Data were collected through semi-structured in-depth individual interviews and analyzed using conventional content analysis.ResultsThe study identified seven subcategories which were grouped into two main categories of reasons for inadequate compliance with health protocols by some individuals. These include: (1) Intentional non-compliance with preventive protocols, with the following subcategories: perceived obligation and adherence to social customs, denial of risk, belief in external health locus of control, and fear and distrust of prevention and treatment methods. (2) Unintentional non-compliance with preventive protocols, with the following subcategories: insufficient or contradictory information, negligence, and inevitability.ConclusionThe findings suggest that ensuring compliance with health guidelines is not a one-size-fits-all approach. providing empowerment and obstacle removal solutions to those forced to violate preventive protocols for various reasons are all critical components of successful interventions. Also, cultural familiarity can aid in the design of appropriate interventions to address these challenges.

Healthcare providers' perceptions and experiences of kangaroo mother care for preterm infants in four neonatal intensive care units in China: a qualitative descriptive study.

Kangaroo mother care (KMC) is an evidence-based intervention that can effectively reduce morbidity and mortality in preterm infants, but it has yet to be widely implemented in health systems in China. Most qualitative studies on KMC for preterm infants focused on the experiences and influencing factors from the perspective of preterm infant parents, while neglecting the perspective of healthcare providers, who played a critical role in guiding KMC practice. Therefore, this study aimed to explore the perceptions and experiences of healthcare providers regarding their involvement in KMC implementation for preterm infants to promote the contextualized implementation of KMC. A descriptive qualitative approach was adopted. A purposive sampling was used to select healthcare providers involved in KMC implementation in the neonatal intensive care units (NICUs) as participants from four tertiary hospitals across four cities in Zhejiang Province, China. Face-to-face semi-structured interviews were conducted to collect information. Thematic analysis was employed to analyze the data. Seventeen healthcare professionals were recruited, including thirteen nurses and four doctors in the NICUs. Four themes and twelve subthemes emerged: different cognitions based on different perspectives (acknowledged effects and benefits, not profitable economically), ambivalent emotions regarding KMC implementation (gaining understanding, gratitude and trust from parents, not used to working under parental presence, and concerning nursing safety issues), barriers to KMC implementation (lack of unified norms and standards, lack of systematic training and communication platform, insufficient human resources, and inadequate parental compliance) and suggestions for KMC implementation (improving equipment and environment, strengthening collaboration between nurses and doctors, and support from hospital managers). Despite acknowledging the clinical benefits of KMC, the lack of economic incentives, concerns about potential risks, and various barriers hindered healthcare providers' intrinsic motivation to implement KMC in NICUs in China. To facilitate the effective implementation of KMC, hospital managers should provide bonuses and training programs for healthcare providers, while giving them recognition and encouragement to enhance their motivation to implement KMC.

Effectiveness of maxillary arch expansion using clear aligners in adult patients: a systematic review and meta-analysis

Abstract Introduction Invisalign, introduced by Align Technology, Inc. in 1997, is a system of clear plastic aligners that provides aesthetic orthodontic treatment plus treatment customisation. Created using impressions or intraoral digital scans, patients wear and sequentially exchange removable, 0.75 mm thick polyurethane appliances. The aligners improve smile appearance, correct dentoalveolar posterior crossbites, increase arch length, relieve crowding, and provide more space for tooth alignment. Dentoalveolar expansion is a preferred alternative to interproximal tooth reduction when treating a patient using the Invisalign clear appliance. Materials and methods The present review systematically searched electronic databases for prospective and retrospective studies on dentoalveolar expansion using clear aligner therapy in human subjects. The quality of the studies was assessed using the revised Cochrane risk of bias tool. Results A high risk of bias was noted in the systematic evaluation of five human trials comprising 254 healthy individuals. The most frequent cause of bias was found to be patient selection. Patient attrition was caused by age-related issues, inadequate compliance, and the lack of blinded outcome evaluation, underscoring the need for better research protocols. Conclusion The present study examined maxillary arch expansion in adult patients who received clear aligner therapy. It was found that the efficiency of expansion at the completion of an aligner treatment sequence may be marginally better than at the completion of an expansion treatment due to the hysteresis (the difference between the predicted and actual results of expansion) of Invisalign appliances, which enhances effectiveness and generates the greatest expansion in the first and second premolar region.

Sustained release of brimonidine from conjunctival sac insert to reduce intraocular pressure for glaucoma treatment

ABSTRACT Background Glaucoma is one of the major irreversible blinding eye diseases in the world. Reducing intraocular pressure (IOP) is the primary treatment option, and taking eye drops daily is the common method. However, short drug duration and poor bioavailability of eye drops may lead to unsatisfied therapeutic effects and inadequate patient compliance. Methods A brimonidine-loaded silicone rubber insert (BRI@SR@PT) was prepared by loading brimonidine into a surface-modified silicone rubber ring, followed by polydopamine/thermoplastic polyurethane coatings. The physical properties, in vitro cytocompatibility and drug release of BRI@SR@PT were investigated. The BRI@SR@PT was administrated in the conjunctival sac of rabbit eyes, and its in vivo drug release, IOP-lowering efficacy and biosafety were assessed. Results The BRI@SR@PT presented great thermal stability and excellent elasticity. The BRI@SR@PT was able to release BRI sustainably for 28 days with little toxicity in vitro. Compared to BRI eye drops, the BRI@SR@PT effectively lowered IOP for 21 days based on the sustained BRI release with great biosafety when administrated in conjunctival sac of rabbit eyes in a noninvasive fashion. Conclusions The conjunctival sac insert (BRI@SR@PT), as a promising drug-delivery platform, may provide a sustained IOP-lowering treatment for patients with ocular hypertension or glaucoma, without the need for invasive procedures.

Institutional vulnerability to urban flood risk management: A case study of the 7·20 flooding disaster in Zhengzhou, China

AbstractThe ‘vulnerability’ approach highlights institutional factors as the primary drivers of flooding risk. However, the intricate connections between institutional vulnerability and urban flood disaster risk have not been extensively explored until now. This study aims to address this gap by examining the case of the 7·20 heavy rainfall disaster in Zhengzhou. Employing a hybrid analysis methodology that integrates text coding, fault tree analysis and analytic hierarchy process methods, the study seeks to identify and assess the distinct contributions of various institutional factors and their interplay, culminating in ineffective urban flood risk management. In contrast to previous research findings that emphasize the determinant role of policy‐making and organizational coordination, this study demonstrates that inadequate legislative compliance constitutes the root cause determining the ineffectiveness of urban flood risk management. It is further exacerbated by insufficient policy attention, resulting in inadequate allocation of resources that ensure the legislative quality, risk coping skills and knowledge and stakeholders' coordination and collaboration. By emphasizing the significance of legislative compliance and policy attention, the study offers a fresh conceptual perspective to understand the factors influencing the efficiency of urban flood risk management. It provides valuable insights to develop targeted countermeasures for mitigating similar urban flood risks in the future.

A retrospective regulatory analysis of FDA recalls carried out by pharmaceutical companies from 2012 to 2023

To introduce products in the US market, pharmaceutical companies must first obtain FDA clearance. Manufacturers might recall a product if it poses a risk of damage or violates FDA regulations. This study investigates the types, causes and consequences of recalls, as well as FDA participation and suitable recall strategies. We relied on the FDA website to gather recall data sets from 2012 to 2023, collecting information on the date of issuance, company and type of violation. The most frequent causes for recalls were sterility issues and inadequate compliance with current good manufacturing practices (cGMP). An examination of sterility recalls revealed two primary causes: a lack of assurance in sterility (accounting for 48% of recalls) and instances of non-sterility (making up 45% of recalls). A thorough examination of cGMP recalls revealed five primary types of violations: process control issues, inadequate storage practices, manufacturing problems, the presence of nitroso-amine impurities and concerns regarding stability. The findings demonstrate that sterility and cGMP compliance are FDA priorities. Pharmaceutical companies must, therefore, enhance quality compliance and create effective quality management systems that oversee the manufacturing process, quality control, personnel training and documentation to avoid these recalls. Companies should establish an internal compliance checklist and be prepared for the rectification process.

Radiation safety compliance awareness among healthcare workers exposed to ionizing radiation

BackgroundIn recent years, there has been a marked growth in the use of ionizing radiation in medical imaging for both diagnosis and therapy, which in turn has led to increased radiation exposure among healthcare workers.AimThe purpose of this study was to assess the level of safety compliance awareness among healthcare workers exposed to ionizing radiation.Research designA descriptive cross-sectional design was used for this investigation.SettingThis study was conducted online, using social media sites such as WhatsApp, Instagram, and Facebook.SubjectsA purposive sample of 384 Egyptian healthcare workers was enrolled in the current study.ToolA safety compliance awareness questionnaire was used in this study to collect pertinent data.ResultsThe result of this study showed that 65.4% and 64.1% of the studied sample chose the correct answers that mammography and CT scans involve the use of x-rays. However, 64.3% and 67.2% of the studied sample chose the wrong answers, saying that MRI and Ultrasound involve the use of X-rays. Moreover, 47.14%, 43.5%, and 57% of the studied sample never used a dosimeter, did not follow dosimeter controls, and did not wear a lead collar.ConclusionMost of the healthcare workers studied had poor knowledge about radiation exposure safety. Moreover, most of the healthcare workers in the current study demonstrated inadequate practice compliance concerning radiation protection procedures.RecommendationShould encourage hospital training programs to include radiation safety topics in their training plans for healthcare workers.

Demographic and Diagnostic Factors in Physical Therapy Attendance.

Introduction Physical therapy (PT) is an effective nonoperative treatment for various orthopedic diagnoses. However, patients may have many reasons to dismiss PT, including favoringanother intervention for their injury, time constraints, transportation, and cost. This dismissal of PT may contribute to inadequate patient compliance. This study aimed to elucidate patient compliance with a basic PT prescription and whether PT led to subjective injury improvement. Methods This is a retrospective study of patients observed in Stony Brook Orthopedic clinics from 08/01/2022 to 12/23/2022. Patients prescribed PT received a phone call six weeks after the PT prescription. The primary outcome was patient attendance at PT. Secondary outcomes were subjective; symptomatic improvement was listed asbetter, worse, or the same. Chi-square testing was used to compare outcomes. Results A total of 100 patients were enrolled in the study. Patients prescribed PT following surgery were more likely to attend compared to patients prescribed PT as a primary treatment (P value=0.027). The association between attendance at PT and a change in subjective symptoms (better, worse, same) was not significant. Patients' age, sex, and chronicity of injury were not significant factors in PT attendance. Of the 40 patients who did not attend PT, 14 cited time constraints, 11 utilized self-directed treatment, three cited insurance, two cited transportation, and 10 cited other reasons. Conclusions Overall, postoperative patients were more likely to attend PT compared to patients prescribed PT as a primary treatment. Factors such as age, sex, and chronicity of injury did not affect whether a patient attended PT. Of the patients enrolled, 71% stated subjective improvement in symptoms, but there was no association between symptoms and PT attendance. This study highlights the characteristics of those patient factors that may influence PT compliance and underscores the importance of further research into the population most likely to attend and benefit from PT.