Improving Physician Office Quality Measures by Evaluating Statin Prescribing in Type 2 Diabetic Patients

Abstract Objective The focus of this study was to evaluate the impact of pharmacist’ intervention on quality metrics focusing on patients with a diagnosis of diabetes mellitus type II (T2DM) not currently prescribed statin therapy. Methods This retrospective cohort investigational study was conducted in four lowest performing office locations of a nineteen regional primary care physician group practice. Inclusion criteria were diagnosis of T2DM without active statin therapy. Data was excluded from analysis for patients younger than age 40 or older than age 75, or if the most recent LDL documented was less than 70 mg/dL. Recommendations for initiation of statin therapy were sent electronically to the patient’s primary care physician via EMR software. Results Preliminary screening in March 2018 demonstrated a total of 2206 patients diagnosed with T2DM, for which 790 patients were not actively prescribed statin therapy. 468 patients were identified as eligible for statin therapy. Endpoint analysis in November 2018 showed that of the initial 468 patients who were eligible for a statin, 74 had been prescribed a statin, and 23 patients fell out of study criteria. Implications The efficacy of statin interventions is supported by the practice entity’s improvement in STAR ratings for the Medicare Advantage populations, in which two major payer groups saw increases in statin use in diabetes measures. Standard of care combined with pharmacist-led interventions correlated to a 4-STAR rating for the practice entity as of October 2018. Pharmacists can play an important role in helping physicians meet these quality metrics

Absorption Characteristics and Quantum Yields of Singlet Oxygen Generation of Thioguanosine Derivatives

6–Thioguanine (1a) is considered to be photochemotherapeutic agents due to its specific characteristics of photosensitivity to UVA light and singlet molecular oxygen generation. To extend its phototherapeutic ability, two related thioguanines, 8–thioguanine (2a) and 6,8–dithioguanine (3a), have been designed and explored. Since the solubility of these thioguanines in dehydrated organic solvents is too poor to study, their tri–acetyl–protected ribonucleosides, i.e. 2’,3’,5’–tri–O–acetyl–6–thioguanosine (1c), 2’,3’,5’–tri–O–acetyl–8–thioguanosine (2c) and 2’,3’,5’–tri–O–acetyl–6,8–dithioguanosine (3c) were prepared and investigated. The absorption maxima of 1c, 2c and 3c in acetonitrile were found at longer wavelengths than that of un–thiolated guanosine (4c). Especially, 3c has the longest wavelength for absorption maximum and the highest value in terms of molar absorption coefficient among all thio–nucleobases and thio–nucleosides reported. These absorption properties were also well reproduced by quantum chemical calculations. Quantum yields of singlet oxygen generation of 2c and 3c were determined by near–infrared emission measurements to be as large as that of 1c. These results suggest that the newly synthesized thioguanosines, in particular 3c, can be further developed as a potential photosensitive agent for light–induced therapies

Tricycles and Trapdoors: A Mixed Methods Study of Exclusionary Discipline in Preschools

Extensive empirical literature demonstrates that exclusionary school discipline (e.g., suspension, expulsion) is a source of persistent educational inequity in the United States. Since the early 2000’s, the prevalence and disproportionate impacts of exclusionary discipline have been observed in early care and education settings (e.g., preschools). Policy and practice interventions targeting exclusionary discipline in early childhood contexts are gaining traction at local, state, and federal levels. Yet, absent descriptions of the scope of exclusionary practices and how structural factors relate to practitioner use of exclusionary discipline in preschools, current measures, policy frameworks, and school-based interventions may dismiss a complex architecture of exits from early learning and care. Furthermore, in the context of increasing regulation, it is possible that forms of extra-exclusionary discipline proliferate. Guided by a desire-based epistemological stance grounded in womanist anti-carceral praxis and critical theoretical perspectives, I conceptualize extra-exclusionary discipline as the array of methods of exclusion that operate in covert, unconventional, and undocumented ways to achieve the same exclusionary ends as regulated discipline measures.This mixed methods convergent dissertation, therefore, aims to (a) elucidate a typology of “trapdoor” exits via extra-exclusionary discipline, and (b) explore underlying structural factors that influence these extra-exclusionary outcomes. To meet these aims, this dissertation addresses three research questions using data from a study conducted by an interdisciplinary research team as part of a multi-team, multi-study research-practice partnership between the University of California, Berkeley’s Graduate School of Education and a large school district in a large city on the West Coast. Specifically, I investigated (a) whether unmeasured common factors account for variance in measured extra-exclusionary discipline variables; (b) what themes and associated underlying dimensions emerge from interview narratives; and (c) the extent to which themes and associated underlying dimensions cohere between the quantitative and qualitative strands of this study. The target population was 190 individuals who were employed to work professionally with children and families at preschool sites in the school district (e.g., teachers, administrators, staff). The quantitative strand of this dissertation involved conducting exploratory factor analysis on data from a survey experiment (n = 60) with vignettes about “Terrell,” a Black boy. The survey sample was majority racially/ethnically minoritized and/or multiracial (83%), female (89%), and teachers (77%), with diverse educational attainment and years of experience in their professional roles in the school district, specifically, and working with children, in general. The qualitative strand of this dissertation involved an integrated analysis of narrative data derived from interviews (n = 24) focused on participants’ perspectives and experiences negotiating challenges in their in-person and virtual classrooms. Similar to the survey sample, the interview sample was majority racially/ethnically minoritized and/or multiracial (88%), female (88%), and teachers (71%), with diverse educational attainment and years of experience in their professional roles in the school district, specifically, and working with children, in general. Merging the quantitative and qualitative results as an integrated framework of “inside-out” perspectives yields a rich description of salient themes of extra-exclusionary discipline and key underlying dimensions.The results indicate that the quantitative and qualitative strands of this dissertation tell complementary stories that elucidate extra-exclusionary trapdoors and underlying structural factors. First, in the quantitative strand, models with two- and three-factor solutions were sequentially evaluated according to several pre-specified guidelines. The two-factor model, which used principal axis factor extraction and oblique (oblimin) rotation, was the most parsimonious solution and demonstrated acceptable model fit. The results suggest that underlying dimensions of extra-exclusion are distinguished by correction and treatment. Second, the qualitative results expand an understanding of trapdoor themes and underlying factors, illustrating characteristic dynamism and complexity of extra-exclusionary discipline. Narrative data illuminate five distinct themes, which constitute a typology of extra-exclusionary trapdoors in preschool contexts: disenrollment, early release, in-school, referral, and virtual measures. Within these themes of trapdoors, underlying dimensions at the child, family, and school levels reveal the complete picture of the implications of a fragmented early education system on fundamental issues of access and inclusion in preschool. Participants’ narratives demonstrate that measures of extra-exclusion mitigate “disruptive,” “unsafe,” and altogether deviant children; are sharpened by friction and distrust in the family-school relationship; and are cemented by an under-resourced and disconnected system. Taken together, participants’ narratives illustrate how extra-exclusionary trapdoors and associated underlying dimensions shine a light on precarity spanning every level of the preschool ecological system. Finally, the merged results expand knowledge about the conceptualization and measurement of extra-exclusionary discipline, drafting a sophisticated blueprint of structural and ecological factors concealing trapdoors within a racialized carceral continuum. This dissertation makes several novel contributions to the knowledge base. Most importantly, it is the first known conceptual and empirical investigation of a typology of covert, undocumented, and unregulated forms of extra-exclusionary discipline and associated underlying dimensions. The primary data collected at multiple timepoints as part of a research-practice partnership implemented during the COVID-19 pandemic is a particular strength of this research. Little is known about the dimensionality of exclusionary discipline amid in-person and distance learning contexts; this dissertation addresses both. Descriptions of extra-exclusionary discipline and associated underlying dimensions add precision to research, policy frameworks, and practice interventions to address a robust architecture of trapdoor exits from early care and education settings. The findings from this dissertation should motivate systems-change partnerships that target hidden, systemic sources of exclusion rather than downstream symptoms of exclusion such as disparities or disproportionalities in discipline outcomes