Pharmacists’ Opinions on the Implementation of HIV and HepC Point-of-Care-Testing in a U.S. Pharmacy Chain

Background: The role of community pharmacists continues to expand with immunizations, medication therapy management, and point-of-care testing (POCT). Current guidelines recommend that Human Immunodeficiency Virus (HIV) and Hepatitis C (HCV) testing become integrated into routine care. Current guidelines recommend all people aged 13-64 be tested for HIV at least once in their lifetime, with those at higher risk for HIV tested at least annually.1 Regarding HCV, current guidelines recommend a one-time HCV test in persons born from 1945 to 1965, as well as other individuals based on exposures, behaviors, and conditions or circumstances that increase HCV infection risk.2 Currently available HIV and HCV treatment regimens are safe and highly effective. With HCV, successful treatment can halt disease progression to cirrhosis, end-stage liver disease, and hepatocellular carcinoma.3 POCT in community pharmacy offers an ideal location due to its accessibility, convenience, and lower cost to patients who might not otherwise be tested. However, HIV and HCV screenings are not routinely conducted by community pharmacists due to many barriers. Though many barriers to HIV and HCV POCT have been identified at the patient, provider, and institutional level, little is known about pharmacist-perceived barriers. It is worth noting that the barrier of state legislation limiting POCT in pharmacies has been resolved – currently 49 states have some form of statute that allows for delegation of prescriptive authority between a prescriber and community pharmacist.4 Though this removed barrier means increased availability of POCT, as the studies above have demonstrated, the mere availability of POCT is not enough for its implementation. Objective: The main objective of this study is to identify pharmacist-perceived barriers and their level of confidence in performing community pharmacy-based POCT for HIV and HCV. Methods: A cross-sectional survey was sent to all pharmacists working in a regional grocery store chain to evaluate their opinions and attitudes toward the implementation of POCT for HIV and HCV. The electronic survey questions consisted of Likert scale, select-all-that-apply, yes/no and no open-ended questions. Results: The perceived barriers to implementation of HIV and HCV POCT in a community setting identified by pharmacists include staffing, time to conduct test, patient out-of-pocket cost, and discussion of positive results. Pharmacists’ perceived level of confidence was greatest with providing basic education and incorporating HIV and HCV POCT into workflow; whereas discussion of a positive result was perceived as less confident.  Conclusions: While this survey determined pharmacist support for the implementation of HIV and HCV POCT, additional studies are needed before effective implementation of HIV and HCV POCT in a community pharmacy chain.   Article Type: Original Researc

Association of NIPA1 repeat expansions with amyotrophic lateral sclerosis in a large international cohort

NIPA1 (nonimprinted in Prader-Willi/Angelman syndrome 1) mutations are known to cause hereditary spastic paraplegia type 6, a neurodegenerative disease that phenotypically overlaps to some extent with amyotrophic lateral sclerosis (ALS). Previously, a genomewide screen for copy number variants found an association with rare deletions in NIPA1 and ALS, and subsequent genetic analyses revealed that long (or expanded) polyalanine repeats in NIPA1 convey increased ALS susceptibility. We set out to perform a large-scale replication study to further investigate the role of NIPA1 polyalanine expansions with ALS, in which we characterized NIPA1 repeat size in an independent international cohort of 3955 patients with ALS and 2276 unaffected controls and combined our results with previous reports. Meta-analysis on a total of 6245 patients with ALS and 5051 controls showed an overall increased risk of ALS in those with expanded (>8) GCG repeat length (odds ratio = 1.50, p = 3.8×10-5). Together with previous reports, these findings provide evidence for an association of an expanded polyalanine repeat in NIPA1 and ALS

Effects of Intercooling and Inter-Stage Heat Recovery on the Performance of Two-Stage Transcritical CO2 Cycles for Residential Heating Applications

Due to the harmful effects of synthetic refrigerants, such as chlorofluorocarbons (CFCs) and hydrochlorofluorocarbons (HCFCs)n the environment, natural refrigerants like carbon dioxide (CO2) have been attracting great interest. The higher inter-stage superheating of CO2 makes it difficult to predict the effects of the intercooling on heating performance of a two-stage transcritical CO2 cycle. In addition, very little is known about the potential of inter-stage heat rejection recovery in the heating performance enhancement of this cycle. In order to explore the effects of intercooling and inter-stage heat rejection recovery potential, three “sub-cycles”—(1) a sub-cycle with heat recovery, (2) a sub-cycle without heat recovery, and (3) a sub-cycle without intercooling—were modeled in Engineering Equation Solver (EES) software for three commonly-used two-stage transcritical cycles: (1) an intercooler cycle, (2) a flash cycle, and (3) a split cycle. Then, the discharge pressure and intermediate pressure were simultaneously optimized. Based on the optimization results, the heating performance of the sub-cycles for each cycle were compared. The results demonstrate that the incorporation of intercooling without heat recovery was detrimental to the heating performance in comparison to the absence of intercooling. It is also clear that there is a great potential for heating performance improvement through inter-stage heat recovery

Relación entre el consumo de drogas y maltrato infantil entre estudiantes universitarios de la universidad en Colombia

Esta investigación examina la relación entre el uso de drogas en estudiantes de una Universidad Pública en Villavicencio, Colombia, y su relación con el maltrato durante la niñez, utilizando como referente teórico la perspectiva bioecológica. Estudio exploratorio retrospectivo, con una muestra de 313 estudiantes de pregrado. El 10.2% de los encuestados refiere haber sido maltratado en la Infancia y la violencia de mayor uso fue la violencia física seguida de la violencia psicológica. El 56.9% de las estudiantes encuestados han consumido sustancias psicoactivas en algún momento de la vida, y su inicio entre los 13 y los 18 años. Se evidencia maltrato en la infancia con manifestaciones de agresiones físicas, al igual que el consumo de sustancias psicoactivas, pero no se observa una relación estadísticamente significativa entre maltrato durante la infancia y el consumo de sustancias psicoactivas en la muestra estudiada

Latin America’s new regional architecture : a cooperative or segmented regional governance complex?

In Latin America the repercussions of the proliferation and overlapping of regional organizations are discussed widely. This article examines the opposing views on this process. Some authors postulate that an exhaustion of integration in Latin America will end up in segmented regionalism and hemispheric disintegration. Others endorse a variable geometry of integration that facilitates intraregional cooperation and minimizes the risk of veto players and zero-sum politics. The article takes Latin America as a vantage point to analyse the topic of interacting and overlapping regional organizations from a more general perspective. It asks about the conditions under which the proliferation and overlapping of regional organizations might have positive or negative effects (on regional integration and cooperation). Additionally, it advocates broadening the analytical focus and replacing the analytical concepts of regional integration and cooperation with the analytical concept of regional governance. Regional governance more adequately captures and integrates different patterns of regional cooperation and different regional projects that result in overlapping regional organizations. Instead of looking at the proliferation of regional organizations from a perspective of fragmentation, this article contends that the focus should be redirected to analysing how different regional organizations interact. Regional interaction patterns can vary between synergistic, cooperative, conflictive, or segmented regional governance (complexes). In an initial application of this analytical scheme, the article summarizes the changing regional cooperation patterns in South America since 1990. In the conclusions it outlines some preliminary ideas for a future research agenda on regional governance (complexes)