Pharmacist Prescriptive Authority for Epinephrine Auto-Injectors in Idaho

Objective: To describe recent legislation in Idaho that granted pharmacists autonomous prescriptive authority for epinephrine auto-injectors. Practice Innovation: States have taken action to increase access to epinephrine auto-injectors by allowing them to be stocked and prepositioned at locations where individuals may encounter allergens. All 50 states have allowed schools to maintain stock supplies of epinephrine auto-injectors and 26 states have allowed other entities, such as summer camps, daycare centers, gymnasiums, and restaurants to begin stocking product as well. In 2016, legislation in Idaho pursued entity stocking while simultaneously granting pharmacists autonomous prescriptive authority for epinephrine auto-injectors. Results: Idaho legislation granted prescriptive authority for pharmacists for epinephrine auto-injectors not just for individual patients, but also for authorized entities. No collaborative practice agreement is necessary. To receive an epinephrine auto-injector, an agent or employee of an authorized entity must present proof that they have completed an appropriate training program. Pharmacists are provided liability protections when prescribing in good faith to an authorized entity. Conclusion: Idaho’s legislation provides a potential model for pharmacist prescriptive authority for epinephrine auto-injectors that other states may consider pursuing in the years ahead.   Type: Commentar

Pharmacy Technician-Administered Vaccines: On Perceptions and Practice Reality

Doucette and Schommer recently surveyed U.S. community pharmacy technicians on their willingness to perform tasks including the administration of vaccines. They found that 47.1% of technicians reported they were “unwilling” to administer a vaccine, although this finding must be placed into proper context. The first nationwide survey of U.S. pharmacist perceptions on immunizations in 1998 revealed only 2.2% of pharmacist respondents had administered adult vaccines and only 0.9% had administered childhood vaccines. They also found pharmacists to be “slightly negative on administering immunizations” with many perceived barriers. Nonetheless, pharmacist-provided immunizations have been an unqualified public health success. The theory of planned behavior (TPB) predicts intention from attitude and perceived behavioral control, among other factors. Given low involvement, exposure, and perceived behavioral control to administer vaccinations, technicians’ attitudes or willingness to participate from the Doucette and Shommer study can be regarded as quite positive. Given the results of a successful pilot project in Idaho and that subjective norms and perceived behavioral control will likely shift upward, one can only expect technicians’ willingness to participate in vaccinations to become more favorable and ultimately become a success

Reproductive and Sexual Healthcare Needs Among Adults with Disabilities as Perceived by Social Workers

People with disabilities often experience unique gynecological and reproductive healthcare needs, which may be exacerbated by their experience of sexual victimization. Previous research on adolescents with disabilities found that social workers held beneficial roles in supporting their clients to make empowered decisions concerning sexual healthcare, pregnancy, and parenting. This study aimed to assess the reproductive and sexual health needs of adults with various disabilities from the perspectives of their social workers. Eleven social workers working primarily with adults with various disabilities were interviewed using a phenomenological study design to offer their perspectives of the sexual and reproductive health needs of their clients. Interviews were transcribed and analyzed; themes and subthemes were identified. According to social workers, (1) adults with disabilities experienced distinctive reproductive healthcare interactions and challenges, including specific needs that were uniquely related to risks for sexual victimization and (2) social workers performed several roles in supporting sexual and reproductive healthcare of these clients, including education and brokering. Social workers demonstrated the need to support clients within a biopsychosocial framework since their biological, psychological, and social needs intersected to either restrain or empower their reproductive health. Social workers played key roles in supporting their clients in reproductive and sexual health decision-making, yet appeared to struggle to address ethical dilemmas, especially those related to ensuring their clients’ well-being and self-determination. Secondly, the results of this study made a connection between challenges in adults with disabilities’ receipt of health wellness exams and histories of sexual victimization

Genome-by-Trauma Exposure Interactions in Adults With Depression in the UK Biobank

IMPORTANCE: Self-reported trauma exposure has consistently been found to be a risk factor for major depressive disorder (MDD), and several studies have reported interactions with genetic liability. To date, most studies have examined gene-environment interactions with trauma exposure using genome-wide variants (single-nucleotide variations [SNVs]) or polygenic scores, both typically capturing less than 3% of phenotypic risk variance. OBJECTIVE: To reexamine genome-by-trauma interaction associations using genetic measures using all available genotyped data and thus, maximizing accounted variance. DESIGN, SETTING, AND PARTICIPANTS: The UK Biobank study was conducted from April 2007 to May 1, 2016 (follow-up mental health questionnaire). The current study used available cross-sectional genomic and trauma exposure data from UK Biobank. Participants who completed the mental health questionnaire and had available genetic, trauma experience, depressive symptoms, and/or neuroticism information were included. Data were analyzed from April 1 to August 30, 2021. EXPOSURES: Trauma and genome-by-trauma exposure interactions. MAIN OUTCOMES AND MEASURES: Measures of self-reported depression, neuroticism, and trauma exposure with whole-genome SNV data are available from the UK Biobank study. Here, a mixed-model statistical approach using genetic, trauma exposure, and genome-by-trauma exposure interaction similarity matrices was used to explore sources of variation in depression and neuroticism. RESULTS: Analyses were conducted on 148 129 participants (mean [SD] age, 56 [7] years) of which 76 995 were female (52.0%). The study approach estimated the heritability (SE) of MDD to be approximately 0.160 (0.016). Subtypes of self-reported trauma exposure (catastrophic, adult, childhood, and full trauma) accounted for a significant proportion of the variance of MDD, with heritability (SE) ranging from 0.056 (0.013) to 0.176 (0.025). The proportion of MDD risk variance accounted for by significant genome-by-trauma interaction revealed estimates (SD) ranging from 0.074 (0.006) to 0.201 (0.009). Results from sex-specific analyses found genome-by-trauma interaction variance estimates approximately 5-fold greater for MDD in male participants (0.441 [0.018]) than in female participants (0.086 [0.009]). CONCLUSIONS AND RELEVANCE: This cross-sectional study used an approach combining all genome-wide SNV data when exploring genome-by-trauma interactions in individuals with MDD; findings suggest that such interactions were associated with depression manifestation. Genome-by-trauma interaction accounts for greater trait variance in male individuals, which points to potential differences in depression etiology between the sexes. The methodology used in this study can be extrapolated to other environmental factors to identify modifiable risk environments and at-risk groups to target with interventions

Classicalization and Unitarity

We point out that the scenario for UV completion by "classicalization", proposed recently is in fact Wilsonian in the classical Wilsonian sense. It corresponds to the situation when a field theory has a nontrivial UV fixed point governed by a higher dimensional operator. Provided the kinetic term is a relevant operator around this point the theory will flow in the IR to the free scalar theory. Physically, "classicalization", if it can be realized, would correspond to a situation when the fluctuations of the field operator in the UV are smaller than in the IR. As a result there exists a clear tension between the "classicalization" scenario and constraints imposed by unitarity on a quantum field theory, making the existence of classicalizing unitary theories questionable.Comment: Some clarifications and refs added. Accepted as a JHEP publication; 12 page

Discovery of Small-Molecule Enhancers of Reactive Oxygen Species That are Nontoxic or Cause Genotype-Selective Cell Death

Elevation of reactive oxygen species (ROS) levels has been observed in many cancer cells relative to nontransformed cells, and recent reports have suggested that small-molecule enhancers of ROS may selectively kill cancer cells in various in vitro and in vivo models. We used a high-throughput screening approach to identify several hundred small-molecule enhancers of ROS in a human osteosarcoma cell line. A minority of these compounds diminished the viability of cancer cell lines, indicating that ROS elevation by small molecules is insufficient to induce death of cancer cell lines. Three chemical probes (BRD5459, BRD56491, BRD9092) are highlighted that most strongly elevate markers of oxidative stress without causing cell death and may be of use in a variety of cellular settings. For example, combining nontoxic ROS-enhancing probes with nontoxic doses of l-buthionine sulfoximine, an inhibitor of glutathione synthesis previously studied in cancer patients, led to potent cell death in more than 20 cases, suggesting that even nontoxic ROS-enhancing treatments may warrant exploration in combination strategies. Additionally, a few ROS-enhancing compounds that contain sites of electrophilicity, including piperlongumine, show selective toxicity for transformed cells over nontransformed cells in an engineered cell-line model of tumorigenesis. These studies suggest that cancer cell lines are more resilient to chemically induced increases in ROS levels than previously thought and highlight electrophilicity as a property that may be more closely associated with cancer-selective cell death than ROS elevation.Chemistry and Chemical Biolog

The Star Formation History of Galaxies Measured from Individual Pixels. I. The Hubble Deep Field North

We analyze the photometric information contained in individual pixels of galaxies in the Hubble Deep Field North (HDFN) using a new technique, _pixel-z_, that combines predictions of evolutionary synthesis models with photometric redshift template fitting. Each spectral energy distribution template is a result of modeling of the detailed physical processes affecting gas properties and star formation efficiency. The criteria chosen to generate the SED templates is that of sampling a wide range of physical characteristics such as age, star formation rate, obscuration and metallicity. A key feature of our method is the sophisticated use of error analysis to generate error maps that define the reliability of the template fitting on pixel scales and allow for the separation of the interplay among dust, metallicity and star formation histories. This technique offers a number of advantages over traditional integrated color studies. As a first application, we derive the star formation and metallicity histories of galaxies in the HDFN. Our results show that the comoving density of star formation rate, determined from the UV luminosity density of sources in the HDFN, increases monotonically with redshift out to at least redshift of 5. This behavior can plausibly be explained by a smooth increase of the UV luminosity density with redshift coupled with an increase in the number of star forming regions as a function of redshift. We also find that the information contained in individual pixels in a galaxy can be linked to its morphological history. Finally, we derive the metal enrichment rate history of the universe and find it in good agreement with predictions based on the evolving HI content of Lyman-alpha QSO absorption line systems.Comment: Accepted for publication in the Astronomical Journal. Full resolution figures available at http://www.stsci.edu/~aconti/pixelz.htm

Investigations into the photophysical and electronic properties of pnictoles and Their pnictenium counterparts

The reaction of phosphole/arsole starting materials with a series of halide abstraction reagents afforded their respective phosphenium/arsenium complexes. UV–vis absorption and luminescence studies on these cations showed interesting emission profiles, which were found to be dependent upon counterion choice. The addition of a reductant to the phosphole reagent garnered a dimeric species with a central P–P bond, which when heated was found to undergo homolytic bond cleavage to produce an 11π radical complex. Electron paramagnetic resonance (EPR), supported by density functional theory (DFT) calculations, was used to characterize this radical species