Transformation of Australian Community Pharmacies Into Good Clinical Practice Compliant Trial Pharmacies for HIV Pre-Exposure Prophylaxis.

Background: In Australia, clinical trial drugs are conventionally dispensed through clinical trial pharmacies only, while community pharmacies dispense drugs approved by Australia's regulatory body. A large HIV pre-exposure prophylaxis study aimed to deliver clinical trial drug through community pharmacies to improve convenience and mimic real world prescribing. This paper describes the process of making community trials compliant with good clinical practice and reports outcomes of delivering clinical trial drug through community pharmacies. Methods: Eight community and four clinical trial pharmacies across three Australian states were approached to participate. A good clinical practice checklist was generated and pharmacies underwent a number of changes to meet clinical trial pharmacy requirements prior to study opening. Changes were made to community pharmacies to make them compliant with good clinical trial practice including; staff training, structural changes, and implementing monitoring of study drug and prescribing practices. Study drug was ordered through standard clinical trial processes and dispensed from study pharmacies by accredited pharmacists. Throughout the trial, record logs for training, prescriber signature and delegation, temperature, participant, and drug accountability were maintained at each pharmacy. The study team monitored each log and delivered on-site training to correct protocol variations. Results: Each pharmacy that was approached agreed to participate. All community pharmacies achieved good clinical practice compliance prior to dispensing study drug. Over the course of the study, 20,152 dispensations of study drug occurred, 83% of these occurred at community pharmacies. Only 2.0% of dispensations had an error, and errors were predominantly minor. On five occasions a pharmacist who was not accredited dispensed study drug. Conclusions: Community based pharmacies can undergo training and modifications to achieve good clinical practice compliance and dispense clinical trial study drug. Community based pharmacies recorded few variations from study protocol. Community based pharmacies offer a useful alternative to clinical trial pharmacies to increase convenience for study participants and expanded use of these pharmacies should be considered for large clinical trials, including HIV prevention trials.

Aromatic character of planar boron-based clusters revisited by ring current calculations.

The planarity of small boron-based clusters is the result of an interplay between geometry, electron delocalization, covalent bonding and stability. These compounds contain two different bonding patterns involving both σ and π delocalized bonds, and up to now, their aromaticity has been assigned mainly using the classical (4N + 2) electron count for both types of electrons. In the present study, we reexplored the aromatic feature of different types of planar boron-based clusters making use of the ring current approach. B3(+/-), B4(2-), B5(+/-), B6, B7(-), B8(2-), B9(-), B10(2-), B11(-), B12, B13(+), B14(2-) and B16(2-) are characterized by magnetic responses to be doubly σ and π aromatic species in which the π aromaticity can be predicted using the (4N + 2) electron count. The triply aromatic character of B12 and B13(+) is confirmed. The π electrons of B18(2-), B19(-) and B20(2-) obey the disk aromaticity rule with an electronic configuration of [1σ(2)1π(4)1δ(4)2σ(2)] rather than the (4N + 2) count. The double aromaticity feature is observed for boron hydride cycles including B@B5H5(+), Li7B5H5 and M@BnHn(q) clusters from both the (4N + 2) rule and ring current maps. The double π and σ aromaticity in carbon-boron planar cycles B7C(-), B8C, B6C2, B9C(-), B8C2 and B7C3(-) is in conflict with the Hückel electron count. This is also the case for the ions B11C5(+/-) whose ring current indicators suggest that they belong to the class of double aromaticity, in which the π electrons obey the disk aromaticity characteristics. In many clusters, the classical electron count cannot be applied, and the magnetic responses of the electron density expressed in terms of the ring current provide us with a more consistent criterion for determining their aromatic character.

Zoonotic Ancylostoma ceylanicum infection detected by endoscopy.

We report a case of Ancylostoma ceylanicum infection detected by endoscopy. It was diagnosed and confirmed using polymerase chain reaction (PCR) and DNA sequencing. The patient is a 58-year-old Malaysian woman who lives in a rural area, where uncontrolled populations of stray and semidomesticated dogs live in close proximity with humans.