Co-located Retail Clinics and Pharmacies: An Opportunity to Provide More Primary Care.

This paper proposes that co-located retail clinics (RCs) and community pharmacies can increase opportunities to provide more accessible, affordable, and patient-friendly primary care services in the United States. RCs are small businesses of about 150-250 square feet with a clientele of about 10-30 patients each day and most frequently staffed by nurse practitioners (NPs). Community pharmacies in the U.S. at ~67,000 far outnumber RCs at ~2800, thereby opening substantial opportunity for growth. Community pharmacies and pharmacists have been working to increase on-site clinical services, but progress has been slowed by the relative isolation from other practitioners. An ideal merged facility based on an integrated platform is proposed. NPs and pharmacists could share functions that fulfill documented consumer preferences and still maintain separate practice domains. Potential benefits include a broader inventory of clinical services including laboratory tests, immunizations, patient education, and physical assessment, as well as better patient access, interprofessional training opportunities, and economies related to the use of resources, day-to-day operations, and performance metrics. Challenges include the availability of sufficient, appropriately trained staff; limitations imposed by scope of practice and other laws; forging of collaborative relationships between NPs and pharmacists; and evidence that the merged operations provide economic benefits beyond those of separate enterprises

Inserting Pharmacists in Primary Care Roles in an Ambulatory Care Setting

In this report, we suggest how pharmacy personnel may be used to alleviate some of the pressures currently impacting health system administrators. We look back to the role(s) of the hospital pharmacy and the hospital pharmacist historically and outline changes that have occurred and how these changes may be helpful to address several problem areas in the ambulatory care venue

Use of liquefied cold temperature dimethyl ether for extraction of pigments from fresh vegetable tissues

Dimethyl ether (DME) is known as a useful precursor to other organic compounds and is a promising alternative fuel without issues of toxicity, production, infrastructure, and transportation as is the case with various other fuels. Recently, DME has attracted the attention of scientists and engineers since it behaves as a subcritical solvent or a low-temperature solvent applicable for the extraction of organic molecules from bio-materials. This paper presents the extraction of chlorophylls and carotenoids from green peel and yellow cortex of Japanese squash, spinach leaves and carrot roots using low-temperature liquefied DME. Spectroscopic and fluorescence analyses of the extracted pigments revealed that chlorophylls were successfully extracted by liquefied DME from green materials (squash peel and spinach leaves). HPLC analysis further confirmed that chlorophylls extracted include both chlorophylls a and b. By using liquefied DME, carotenoids were extracted from all vegetable samples examined. The performance of DME as a novel pigment extracting agent is confirmed in this work and its use as a “green” solvent, as opposed to conventional solvents, for the preparation and extraction of various plant pigments is highly encouraged from an environmental point of view

Neuronal apoptosis by HIV-1 Vpr: contribution of proinflammatory molecular networks from infected target cells

Background: Human immunodeficiency virus type 1 (HIV-1) induces neuronal dysfunction through host cellular factors and viral proteins including viral protein R (Vpr) released from infected macrophages/microglia. Vpr is important for infection of terminally differentiated cells such as macrophages. The objective of this study was to assess the effect of Vpr in the context of infectious virus particles on neuronal death through proinflammatory cytokines released from macrophages.Methods: Monocyte-derived macrophages (MDM) were infected with either HIV-1 wild type (HIV-1wt), Vpr deleted mutant (HIV-1{increment}Vpr) or mock. Cell lysates and culture supernatants from MDMs were analyzed for the expression and release of proinflammatory cytokines by quantitative reverse transcription-PCR and enzyme-linked immunosorbent assay respectively. Mitogen-activated protein kinases (MAPK) were analyzed in activated MDMs by western blots. Further, the effect of Vpr on neuronal apoptosis was examined using primary neurons exposed to culture supernatants from HIV-1wt, HIV-1{increment}Vpr or mock-infected MDMs by Annexin-V staining, MTT and Caspase - Glo® 3/7 assays. The role of interleukin (IL)-1β, IL-8 and tumor necrosis factor (TNF)-α on neuronal apoptosis was also evaluated in the presence or absence of neutralizing antibodies against these cytokines.Results: HIV-1{increment}Vpr-infected MDMs exhibited reduced infection over time and specifically a significant downregulation of IL-1β, IL-8 and TNF-α at the transcriptional and/or protein levels compared to HIV-1wt-infected cultures. This downregulation was due to impaired activation of p38 and stress-activated protein kinase (SAPK)/c-Jun N-terminal kinase (JNK) in HIV-1{increment}Vpr-infected MDMs. The association of SAPK/JNK and p38 to IL-1β and IL-8 production was confirmed by blocking MAPKs that prevented the elevation of IL-1β and IL-8 in HIV-1wt more than in HIV-1{increment}Vpr-infected cultures. Supernatants from HIV-1{increment}Vpr-infected MDMs containing lower concentrations of IL-1β, IL-8 and TNF-α as well as viral proteins showed a reduced neurotoxicity compared to HIV-1wt-infected MDM supernatants. Reduction of neuronal death in the presence of anti-IL-1β and anti-IL-8 antibodies only in HIV-1wt-infected culture implies that the effect of Vpr on neuronal death is in part mediated through released proinflammatory factors.Conclusion: Collectively, these results demonstrate the ability of HIV-1{increment}Vpr to restrict neuronal apoptosis through dysregulation of multiple proinflammatory cytokines in the infected target cells either directly or indirectly by suppressing viral replication. © 2012 Guha et al.; licensee BioMed Central Ltd

Appearance of vascular endothelial growth factor (VEGF) in femoral head in the growing rat

In this study, we examined the appearance of vascular endothelial growth factor (VEGF) in the femoral head of the growing rat using an immunocytochemical technique. Our results showed VEGF-immunopositive cells existed in the inner region and peripheral region of the femoral head at each developmental stage. In the 19-day-old fetus, immunopositive mesenchymal cells were demonstrated in the peripheral region of the femoral head. At 1 to 10 days after birth, VEGF immunoreactivities were observed in the osteoblasts, osteoclasts, periosteum, perichondrium and cartilage matrix of the femur. At 15 days after birth, VEGF immunoreactive chondrocytes appeared in the apex area of the femoral head. In this stage, the femoral head is still constituted by chondrocytes and no apparent vascular formation has been observed. Thereafter, the immunopositive chondrocytes in the femoral head increased in number. The penetration of capillaries was recognized within the ligament of the femoral head at 60 days after birth. The results indicate that some chondrocytes in the femoral head produce VEGF before the beginning of ossification, and that VEGF may play an important role in the penetration of blood vessels into the femoral head from the ligament of the femoral head