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Phenotypic flexibility (reversible phenotypic change) enables organisms to couple internal, ontogenetic responses with external, environmental cues. Phenotypic flexibility also provides organisms with the capacity to buffer stereotypical internal, developmental processes from unpredictable external, ecological events. Echinoids exhibit dramatic phenotypic flexibility in response to variation in exogenous nutrient supplies. The extent to which echinoids display this flexibility has been explored incompletely and research hitherto has been conducted predominantly on larval structures and morphologies. We investigated experimentally the extent to which the primordial juvenile, the developing rudiment, can exhibit the first phase in phenotypic flexibility among individuals. We report for the first time on rudiment regression and complete resorption as a response to starvation during larval development in the sea urchin Strongylocentrotus droebachiensis (O.F. Muller, 1776) and identify a developmental 'window of opportunity' within which this can occur. Based on our observations and previous suggestions, we speculate that sea urchin rudiments might provide means of buffering development during unfavorable conditions. Key words: canalization, development, ecology, evolution, flexibility, ontogeny, phylogeny, phenotypic plasticity, sea urchin, Strongylocentrotus droebachiensis. La flexibilité phénotypique (les changements phénotypiques réversibles) permet aux organismes d'arrimer des réactions ontogéniques internes à des signaux environnementaux externes. Elle fournit également aux organismes la capacité de protéger des processus développementaux internes stéréotypés des effets d'évènements écologiques externes non prévisibles. Les échinoides font preuve d'une remarquable flexibilité phénotypique en réaction aux variations des apports de nutriments exogènes. L'ampleur de cette flexibilité chez les échinoïdes n'a été qu'incomplètement explorée et la recherche à ce jour a porté principalement sur les structures et la morphologie des larves. Nous avons étudié expérimentalement la mesure dans laquelle le juvénile primordial, le rudiment en développement, peut présenter la première phase de flexibilité phénotypique entre individus. Nous faisons état, pour la première fois, d'une régression et d'une résorption complète du rudiment en réaction au manque de nourriture durant le développement de larves chez l'oursin Strongylocentrotus droebachiensis (O.F. Müller, 1776) et délimitons une << fenêtre favorable >> du développement durant laquelle cela peut se produire. Sur la base de nos observations et de suggestions antérieures, nous postulons que les rudiments d'oursin pourraient fournir des moyens de protéger le développement en période de conditions défavorables. [Traduit par la Rédaction] Mots-clés: canalisation, développement, écologie, évolution, flexibilité, ontogenèse, phylogénie, plasticité phénotypique, oursin, Strongylocentrotus droebachiensis., Introduction Most echinoids (e.g., sea urchins, sand dollars, sea biscuits, and heart urchins) develop through stages in which bilaterally symmetric 'pluteus' larvae grow structures required for nutrient acquisition and, thereby [...]

Objective: Aim of present studies to reduce the particle size, increase the surface area with increase permeation of drug and modify release of drug at specific site hence dose and dose frequency may be decreased, thereby obtaining greater therapeutic efficacy. Experimental Work: Present study has been involved to prepare microemulsion of a poorly water-soluble drug, Bifonazole. Before the formulation of Bifonazole microemulsion, perform the Pre formulation study. Find out maximum solubility of Bifonazole in oils, surfactants and co-surfactants was evaluated to identify potential excipients. The microemulsion area were selected through the construction of the pseudo ternary phase diagrams by phase titration method. Results & Discussion: A 3² full factorial design was applied to examine the combined effect of two formulation variables, each at 3 levels and the possible 9 combinations of Bifonazole ME were prepared. Optimized ME was prepared and incorporated into gelling agent added as gel matrix to convert microemulsion into microemulgel. Microemulsion and microemulgel evaluated by %transmittance, viscosity, pH, Density, conductivity, TEM, particle size, Zeta potential, surface tension, refractive index, In-vitro diffusion study. Physical appearance, viscosity, spread ability, extrudability measurement, syneresis measurement, comparison with marketed product, antifungal activity and accelerated stability studies. From FTIR and DSC study found there is no interaction between drug and excipient. On the bases of pseudo ternary phase diagram has been found that the system consisting of capryol 90, tween 80 and PEG 400 showed good emulsifying property at Smix ratio 4:1. Microemulsion formulation F10 was optimized on the basis of %Transmittance, viscosity, %cumulative drug release (3 hrs). On the basis of physical examination viscosity, pH and spread ability result Diffusion Study, Sensitivity Study on animal and Kinetic Model Study of gel. Gel formulation was optimized batch that contains 1% carbopol as gelling agent. These above results indicate itraconazole loaded microemulgel drug delivery system may be promising vehicle for topical delivery of Bifonazole. [ABSTRACT FROM AUTHOR]

In present research work we prepared and studied the Material Attributes (CMAs) such as drug permeation, drug release, etc. of Aceclofenac imbibed in Transdermal Delivery System approach known as Transdermal patches. Transdermal patches of Aceclofenac were prepared by solvent evaporation method using PVA (film former polymer), Oleic acid (permeation enhancer), Dibutyl phthalate (plasticizer) and solvents like methanol and chloroform. The physicochemical characteristics of each batch formulation, such as thickness, flatness, weight fluctuation, drug content, folding durability, moisture content, and moisture absorption, were all acceptable. The data on in-vitro release showed that drug release from the transdermal patch are affected by the various type and concentration of polymer. Effect of oleic acid used as permeation enhancer have been checked on in-vitro permeation of drug which shows that as the concentration of penetration enhancer increased drug permeation also increased. The outcome of this study shows that the difficulty related to Aceclofenac on oral administration like gastric side effects and dissolution rate limited can be overcome by applying Aceclofenac topically in the form of transdermal patch. [ABSTRACT FROM AUTHOR]

The article provides information on the study "Denial of Abortion Because of Provider Gestational Age Limits in the U.S." by Ushma D. Upadhyay and colleagues, which examined the factors influencing delay in seeking abortion and the outcomes for women denied abortion care because of gestational age limits at abortion facilities. Topics discussed include methodology of the study, reasons for delay and access barriers, and factors associated with obtaining an abortion after being denied one.

Objective: Colon targeting would be valuable for delivery of anticancer drugs like capecitabine, a prodrug, which is enzymatically converted to fluorouracil (antimetabolite) in a tumor by thymidine phosphorylase, where it inhibits DNA synthesis, and slows down the growth of tumor tissues of the colon. The major objective of this study was to prepare compression coated tablets by using moringa gum as a carrier based on a microbially triggered mechanism to target colonic cancer; so that adverse effects associated with oral administration of the drugs can be minimized. The most important object in such a dosage form was to target the drug to the colon by providing the minimal amount of the drug release in the physiological environment of the upper GI tract. Methods: The preparation of compressed coated tablets was done using moringa gum and HPMCK100M as the coating material followed by optimization by ANOVA using 32 full factorial design, whereby the weight of total coat on core (X1) and % of MG present in coat (X2) were taken as independent variables, and % drug release in upper GIT (Rel5h) was taken as a response. Prepared tablets were evaluated for in vitro characterizations including hardness, weight variation, friability, drug content, and dissolution study in the presence or absence of 4%w/v rat cecal content and stability. Results: Formulation (C8) of moringa gum: HPMC K100M with 500 mg coat weight containing 50% of gum was found to be a promising batch because it had restricted the drug release in upper GIT (LT 10%), and when it reached the colon, there was a complete drug release in the presence of rat cecal content which might get acted upon moringa gum showing its suitability as a colon targeting carrier. The stability study of C8 formulation revealed that there was an insignificant change in the characteristics of tablets after the storage at 400 C for 1 month. Conclusion: Based on the results obtained, it was found that moringa gum would be an alternative as a carrier for colon in the form of compression coated tablets. [ABSTRACT FROM AUTHOR]

Rapid, precise, accurate ad specific UV spectrophotometric method using simultaneous equation method developed for simultaneous determination of lornoxicam (LOR) and eperisone (EPE) in synthetic mixture. Signals were measured at 275nm for lornoxicam and 312nm for eperisone respectively. Both the drugs are validated for a conc. range for 8-12 μg/ml. the method shows good reproducibility and recovery with % relative standard deviation less than 2%. Several methods were reported for determination of lornoxicam and eperisone. The present study illustrates the development of a simple, precise, reproducible and economical UV method for simultaneous of LOR and EPE in synthetic mixture. [ABSTRACT FROM AUTHOR]

A Stability indicating RP-HPLC was developed and validated for determination of Cefuroxime Sodium (CEF) and Potassium Clavulanate (PCA). The RP-HPLC has shown adequate separation for Cefuroxime Sodium and Potassium Clavulanate from its degradation products. The separation was achieved on Hypersil BDS C18 column (250x4.6 mm i.d., 5 particle size) using a mobile phase composition of Acetonitrile: Phosphate buffer Ph4.5 (75: 25) with a flow rate of 1ml/min. Injection volume 20μl and wavelength of detection was kept at 275 nm the retention time of Cefuroxime sodium and Potassium Clavulanate were 3.06 and 7.63min respectively. Linearity was observed over concentration range of 10-40 μg/ ml for Cefuroxime Sodium and 6-20 μg/ml for Potassium Clavulanate. The mean recovery was found to be 100.08±0.68% and 99.95±0.67% for Cefuroxime Sodium and Potassium Clavulanate respectively The limit of detection was 0.34μg/ml and the limit of quantification was 0.112μg/ml for Cefuroxime Sodium and the limit of detection was 0.097μg/ml and the limit of quantification was 0.292μg/ml for Potassium Clavulanate. Cefuroxime Sodium and Potassium Clavulanate does not undergo any degradation so it can be said that Cefuroxime sodium and Potassium Clavulanate is stable to forced degradation conditions. This Method is simple, versatile, and reliable hence it can be used as stability indicating analytical Method for determination of Cefuroxime Sodium and Potassium Clavulanate in bulk and Marketed formulation. [ABSTRACT FROM AUTHOR]

A simple, specific, accurate and precise reversed phase High Performance Liquid Chromatographic method was developed for the simultaneous determination of Eperisone Hydrochloride and Diclofenac sodium, using a Enable C18 (250 × 4.6 mm i.d.) column and mobile phase composed of 0.05M K2HPO4 : ACN (55:45) pH 3.0 adjusted with o- phosphoric acid and at flow rate of 1.0 ml/min. The retention times of Eperisone Hydrochloride and Diclofenac sodium were found to be 6.163 min and 3.507 min, respectively. Linearity was established for Eperisone Hydrochloride(EPE) and Diclofenac sodium(DICLO) in the range of 15-45 μg/ml and 10-30 μg/ml, respectively. The percentage recoveries of Eperisone Hydrochloride and Diclofenac sodium were found to be in the range of 99.329±0.093 % and 99.306 ± 0.292 %, respectively. The correlation coefficients for both components were found to be 0.998. The developed methods were validated according to ICH guidelines and values of accuracy, precision and other statistical analysis were found to be in good accordance with the prescribed values. This method can be successfully employed for simultaneous quantitative analysis of Eperisone Hydrochloride and Diclofenac sodium in combined dosage form. [ABSTRACT FROM AUTHOR]

A simple, economic, selective, precise, and stability-indicating RP-HPLC method for analysis of Levosulpiride and Pantoprazole sodium was developed and validated according to ICH guidelines. The quantification of the drug was carried out using Hypercil BDS C18 250mm×4.6mm×5μm or its equivalent in isocratic mode, with mobile phase comprising of Water: Acetonitrile: Triethylamine (60: 40: 0.25 v/v/v) the flow rate was 1ml/min and the detection was carried at 225 nm. The retention time for Levosulpiride and Pantoprazole sodium was found to be 3.597 and 5.147min respectively. The percentage assay for Levosulpiride and Pantoprazole sodium was found to be 99.56% and 98.44% respectively. The method was also applied for the determination of Levosulpiride and Pantoprazole sodium in the presence of their degradation products formed under variety of stress conditions. Proposed method was validated for precision, accuracy, linearity range, specificity and robustness. [ABSTRACT FROM AUTHOR]

In recent years more people throughout world are turning to use medicinal plant products in healthcare system. Worldwide need of alternative medicine has resulted in growth of natural product markets and interest in traditional systems of medicine.[1] Herbal drug technology is used for converting botanicals materials into medicines, where standardization and quality control with proper integration of modern scientific techniques and traditional knowledge is important. [2] Thus it becomes necessary to evaluate the health claims of these agents and to develop standards of quality and manufacture. The herbal industry needs to follow strict guidelines and regulations are needed. Products from many species of Commiphora have been used for various purposes, sometimes as timber, building material, and natural fencing, but more often valued for the aromatic resins produced by several members of the genus. "Myrrh", the common name for these dried resins, is fragrant and has been used both as fragrance and for medicinal purposes (e.g., Balsam of Mecca, C. gileadensis. [3] The generic epithet is derived from Greek 'kommis' and 'phora' meaning gum bearer. [4] Myrrh has been used as an ingredient for perfumes, incense and cosmetics for thousands of years. According to ancient Greek legend, Greek soldiers carried myrrh with them to treat battle wounds. Myrrh oil is also considered the holy oil of the Jewish faith and is mentioned throughout the Old and New Testament in the Bible. [5] This review article is written to gather as much information as possible on the drug Commiphora myrrha and its various species which has been published in various journals. [ABSTRACT FROM AUTHOR]

Petroleum ether, Chloroform, ethanol and water extracts of Lagenaria siceraria, Momordica charantia and Chenopodium ambrosioides were prepared separately and evaluated for antibacterial activity against Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Klebisella species by cup-plate method (lawn and pour) and Disc diffusion method. Ethanol and Chloroform extracts (100 /ml) extracts showed significant activity against the tested microorganism in comparison with the standard Streptomycin and Amikacin. Various tests for physico chemical evaluation and phyto-chemical screening were carried out. Determination of foreign matter, ash value, extractive values, swelling index, foaming index, loss on drying and fluorescence analysis, bulk density and tapped density to assure the purity of drugs were evaluated .The extracts showing the positive activity can be formulated individually or in combination as internal or external dosage forms. In this regard there is great scope for developing new herbal formulation for treating bacterial infections using the above mentioned herbal combination. Further scope exists for research with formulation and development, safety and efficacy. This kind of study can generate more such ideas for re-inviting and using well known herbs in combination to treat more diseases. [ABSTRACT FROM AUTHOR]

Any research work should have high level of Rigor and Relevance. The uses of more and more medicinal plants require the monitoring agencies to have data of standardization to compare the Sdrug with the authenticated parameters. WHO and Govt. of India have intention to include more and more number of medicinal plants into standard monograph. We at B. M. Shah College of Pharmaceutical Education and Research, Modasa have tried to work on one potential herb, A. bracteosa Wall. ex Benth., F. Labiatae. Before working for the plant we have tried to collect as much information as possible. Ajuga bracteosa belongs to family Lamiaceae (Labiatae) which is a large family comprising of 266 genera. The genus Ajuga consists of 301 species. A. bracteosa is distributed in subtropical and temperate regions from Kashmir to Bhutan, Pakistan, Afghanistan, China and Malaysia. 70% ethanol extract of Ajuga bracteosa possess significant and promising anti-inflammatory activity. Ethanolic extract of Ajuga bracteosa leaves demonstrates a dose-dependent chemosuppression during early and in established infections. The plant is astringent and used as tonic and in the treatment of agues. The leaf extract is for blood purification. The juice of the root is used in the treatment of diarrhoea and dysentery. According to Asia Pacific Medicinal Plant Database the leaves are regarded as stimulant, diuretic and tonic. The extract is used to cure swollen wounds, bites of insects, eye troubles, diseases of bladder, as well as tumors. The microscopic features of the plant are also included in the present work. [ABSTRACT FROM AUTHOR]

Plants are a great source of medicines, especially in traditional medicine, which are useful in the treatment of various diseases. Tylophora indica is a climbing perennial plant indigenous to India. It is grows wild in the southern and eastern region. It has longstanding reputation as a remedy for asthma. The leaves of Tylophora indica are included in Bengal pharmacopeia since 1884. It is said to have laxative, expectorant, diaphoretic (Sweating) and purgative (Vomiting) properties. It has been used for the treatment of various respiratory problems. It has reputation as an alternative and as a blood purifier, often used in rheumatism and syphilitic rheumatism. Root or leaf powder is used in diarrohea, dysentery and intermittent fever. It is an expectorant and administered in respiratory infections, bronchitis and whooping cough. Dried leaves are emetic, diaphoretic and expectorant. It is regarded as one of the best indigenous substitute for ipecacuanha, so it was considered as Indian ipecacuahna in the latter half of the 19th century. Other problems including allergies, bronchitis and colds, as well as dysentery and osteoarthritis pain. Tylophora has increasingly popular for treatment in asthma, based on its traditional use for this purpose. Tylophora indica is also still recommended for some of its other traditional uses, including hay fever, bronchitis and the common cold. [ABSTRACT FROM AUTHOR]

Abortion cost can be a significant financial burden and a barrier to care. The Hyde Amendment prevents Federal funding from being used for abortion care, forcing many low-income people to pay for abortion out of pocket rather than using their Medicaid coverage. Current data on self-pay abortion costs are limited to national estimates or small sample sizes. We provide data on trends in self-pay abortion costs by region for medication abortion and first and second trimester procedures using a national database of abortion clinics in the United States. We also examine the proportion of clinics that accept any type of insurance. We used data from University of California San Francisco (UCSF)/Advancing New Standards in Reproductive Health (ANSIRH's) abortion facility database which includes data on publicly advertising abortion clinics and is updated each year. We used Chrome browser's incognito mode to search for clinics by State and City using the key words: "Abortion clinic in [State]", "Abortion clinic in [City]" for all cities with a population of 100,000 or larger in each state, and the 3 largest cities for states that did not have a city of that size. We examined links to clinics from the first 3 pages of results for states and first 2 pages for cities. We then conducted mystery shopper phone calls to clinics to supplement any missing data not found on facility web pages. Mystery callers did not make clinic appointments. Clinics were only included if they reported being open and providing abortions for a given year. Abortion training sites such as teaching hospitals were only included if they publicly advertised abortion services. To estimate mean costs of abortion for clinics that gave a range of prices for a certain abortion type (e.g., second trimester) we first averaged the prices for that procedure type per clinic. Then, clinic mean prices were averaged by region to develop regional means. We reported the number and percentage of clinics in each region that reported accepting any insurance. We identified 751 to 776 publicly advertising abortion clinics per year in the United States: 776 in 2017, 751 in 2018, 758 in 2019, and 765 in 2020. The national mean self-pay price for medication abortion increased from $511 in 2017 to $644 in 2020. Mean price for medication abortion varied greatly by region, the lowest cost in 2020 being $489 in the South Atlantic and the highest being $873 in the Pacific. Nationally, mean first-trimester aspiration abortion costs also increased over time, from $489 to $715 between 2017 and 2020. Mean price for first-trimester aspiration abortion varied greatly by region, with the lowest cost in 2020 being $493 in the South Atlantic and the highest cost being $1191 in New England. In contrast, mean second trimester abortion costs decreased nationally, from $1180 in 2017 to $1068 in 2020. This decrease was mostly concentrated in the Pacific, East North Central, and New England regions, while other regions saw an increase in the same period. There was a sharp national decline in the proportion of clinics that accepted insurance from 88% to 80% between 2018 and 2019, which was sustained in 2020. This decline was observed in all regions. An improved understanding of patient costs for an abortion and how that varies by region and state is a crucial first step to reducing financial barriers and to inform public and private insurance coverage policy. Abortion costs are increasing over time, while the proportion of clinics that accept insurance is decreasing. This may be because public and private insurance reimbursement rates do not cover the full costs of providing abortion care. Insurance reimbursement rates must be increased to reflect actual clinic costs. Additionally, repealing the Hyde Amendment would have profound impacts on people who have abortions in the United States. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic brought new attention to medication abortion because it does not require direct physical contact between patient and clinical staff. No-test approaches for medication abortion preserve the usual standard of care, except that they replace the in-person ultrasound or physical exam before the abortion with other evidence-based methods to assess the patient's duration of pregnancy and screen for ectopic pregnancy. Early in the pandemic, a no-test sample protocol was published to offer guidance for clinical practice. However, little has been published on the safety and efficacy outcomes of no-test approaches. Through webinars and personal contacts, we invited US-based clinics that had adopted the no-test medication abortion protocol to join the study. A no-test medication abortion was defined as not having a preabortion ultrasound or physical exam. Participating clinics abstracted data from medical records of all patients who received a no-test medication abortion and entered them into a REDCap database. We conducted descriptive analyses of the clinic protocols and the patient sample. We also developed a multilevel, multivariable model that accounted for clustering at the clinic-level to estimate the adjusted odds of medication abortion failure and adverse events. We included 11 clinics, 4 of which contributed some data from the TelAbortion Study. Clinics shared data on 791 patients served from Jan. 1 to Dec. 31, 2020. Among all patients, 58.1% received mifepristone in person and 41.9% received it by mail. At mifepristone provision, patients' pregnancy durations ranged from 27 to 74 days; 36.4% were <=42 days, 45.3% were 43 to 56 days, 16.4% were 57 to 70 days, and 1.9% were >71 days. We received at least some follow-up data for 626 patients (79.1%) and excluded 14 patients who did not take mifepristone. Of the remaining 612 patients, 5 (0.8%) experienced serious adverse events defined as hospital admission, abdominal surgery and blood transfusion. One patient had a confirmed ectopic pregnancy and was admitted to a hospital for salpingectomy 9 days after provision of mifepristone (included as a serious adverse event). Abortion outcome data were available for 394 patients (64.4%). Overall, 94.7% (95% CI: 92.0% to 96.7%) of patients had a complete abortion with <1600 mcg of misoprostol, without an aspiration, procedure, or more mifepristone and misoprostol. 2 patients had suspected or confirmed ongoing pregnancies. Outcomes were similar for those who received medications in-person and those who received them by mail. No-test medication abortion with either in-person pick up or mailing of medications is effective and safe, with outcomes similar to rates found in the published literature. Moreover, omitting tests reduce COVID-19 risk and conform with FDA REMS requirements when combined with in-person pick up. Follow up rates (64.4%) with the NTMA approach were similar to other medication abortion protocols. Combining no-test medication abortion protocols with mailing of medications to patients would support public health efforts for those who want to avoid a clinic visit. [ABSTRACT FROM AUTHOR]

We sought to assess the frequency of attempted self-managed abortion among pregnant people considering an abortion and searching for a provider on the internet. We conducted a national prospective cohort study using a novel recruitment method—recruiting people searching for abortion care on Google. Advertisements for the study were displayed in search results. We utilized a stratified sampling design recruiting by state to assure representation from all states. Participants were eligible if they reported being pregnant and considering abortion. They completed an online baseline survey and another 4 weeks later. Attempted self-managed abortion was assessed with the question: "Did you take or try to do any of the following to try to end this pregnancy?" with a closed-ended list of methods and an open-ended "other" option. Multiple checks for fraudulent responses were conducted and any suspected cases were removed. We modeled the odds of attempting self-managed abortion using multivariable logistic regression with random effects for state of residence. Among 856 participants with follow-up data, 23% (95% CI: 20%-25%) reported taking or trying something to end this pregnancy, some reported multiple methods. 10% reported using misoprostol, 5% reported using emergency contraception after confirming pregnancy, 19% reported using another medicine or herb, 4% reported hurting themselves, 2% reported using illegal drugs or alcohol, and 4% reported another method. In a separate question, 2% of respondents (n=20, or 5% of all participants who had abortions) reported buying pills online and successfully self-managing their abortions. Participants who were pregnant and still seeking abortion at 4 weeks were more likely to have attempted self-management (26%) than those still pregnant and planning to carry to term (13%, p = 0.003). In an adjusted model, younger age and college education were associated with higher rates of attempts and black race was associated with lower rates. Rates of attempted self-managed abortion are high among people searching online for abortion, especially those facing barriers to abortion care. Many are using more subtle attempts at ending pregnancy, and such attempts may be underreported in previous estimates on self-managed abortion. There is clear demand for ways to end pregnancy without a clinic visit. [ABSTRACT FROM AUTHOR]

No-test telehealth medication abortion reduces or eliminates pre-abortion ultrasound and in-person testing and is proving to be as safe, acceptable, and effective as in-person care. However, ectopic pregnancy remains a primary concern about the telehealth model. Ectopic pregnancy is a rare but serious life-threatening pregnancy complication, and we lack evidence about how ectopic pregnancies are diagnosed and treated in the no-test telehealth context. Filling a notable research gap, we describe the clinical presentation and experiences of people seeking telehealth medication abortion who were subsequently suspected or confirmed to have had an ectopic pregnancy. From June 2022 through March 2023, we recruited patients who sought medication abortion from January 2022-March 2023 at seven virtual telehealth abortion clinics in the U.S. who were suspected or confirmed to have had an ectopic pregnancy. Clinics shared an eligibility survey link with patients with a suspected ectopic pregnancy. People who were eligible and interested in participating scheduled an interview with a researcher. Interviews were conducted over the phone, audio recorded, and transcribed and lasted approximately 45 minutes (range 35-80 minutes). We used an iterative grounded theory approach to analyze interview transcripts and identify salient themes. We interviewed 15 people ages 21-41 living in 11 states; 14 had a confirmed ectopic pregnancy (11 located in the fallopian tube, 2 cesarean scar, and 1 unconfirmed location). People chose telehealth abortion care because of its privacy, affordability, convenience or because it was their only option. When presenting for abortion care, most had no ectopic pregnancy symptoms or risk factors. Two had spotting and one had an IUD removed earlier in the pregnancy by her primary care provider, who did not diagnose the ectopic with ultrasound and told her the pregnancy was "where it should be." Seven never took the medications because they experienced bleeding, pain symptoms, and/or were referred for ectopic pregnancy care by the telehealth provider. One participant with symptoms chose not to take the medications because her OB/GYN who performed an ultrasound told her she was not pregnant. Among the people who took the medications, all experienced no or light bleeding after taking the medications and 4 experienced excruciating or "dull" abdominal pain leading them to seek further care. Participants perceived telehealth abortion care to sometimes facilitate earlier ectopic pregnancy treatment and perceived ectopic pregnancy care to be fragmented and to sometimes delay treatment. Findings suggest that no-test telehealth abortion care does not delay and sometimes facilitates earlier detection and treatment of ectopic pregnancy. Reliance on ultrasound does not eliminate the risk of missed ectopic pregnancy. Fragmented care and ultrasounds that miss the ectopic pregnancy can lead to ectopic pregnancy treatment delays. Strategies are needed to address challenges experienced with fragmented care to facilitate timely diagnosis and treatment of ectopic pregnancy. [ABSTRACT FROM AUTHOR]

Background: In 2014, Louisiana passed a law requiring abortion providers to have hospital admitting privileges. This law is temporarily on hold while a court case challenging it continues. We aimed to describe the population who would be affected if the law goes into effect and how closures of between three and five Louisiana abortion facilities would affect the distance Louisiana women would need to travel for an abortion.Study Design: We abstracted patient data from three of the five Louisiana abortion care facilities in the year before the law was scheduled to take effect. We then estimated distance traveled and distances women would need to travel if clinics close.Findings: Half (53%) of women who had an abortion had no education beyond high school, most were black (62%) or white (30%), three fourths (73%) had a previous live birth, and most (89%) were having a first-trimester abortion. Seventy-nine percent resided in Louisiana and 15% in Texas. The parishes in which abortion patients resided had lower median income and higher percentage poverty than the Louisiana average. Abortion patients residing in Louisiana traveled a mean distance of 58 miles each way for an abortion. If all Louisiana facilities close, the mean distance women would need to travel would more than triple to 208 miles, and the proportion of Louisiana women of reproductive age who live more than 150 miles from an abortion facility would increase from 1% to 72%.Conclusion: The admitting privileges law will likely significantly increase the distance Louisiana women need to travel for an abortion. This burden is likely to disproportionately affect Louisiana's more vulnerable residents.Implications: If all Louisiana abortion facilities close due to Louisiana's hospital admitting privileges law, the mean distance women would need to travel for an abortion would more than triple from 58 to 208 miles. Louisiana's law would thus present a considerable burden on many Louisiana women, particularly those who are more vulnerable. [ABSTRACT FROM AUTHOR]