Advanced Practice Pharmacists: a retrospective evaluation of the efficacy and cost of ClinicaL Pharmacist PractitionErs managing ambulatory Medicare patients in North Carolina (APPLE-NC)

Abstract Background Clinical Pharmacist Practitioners are advanced practicing pharmacists in North Carolina that provide disease-specific management. The purpose of this retrospective cohort study was to compare the efficacy and charges from referrals to a Clinical Pharmacist Practitioner by the primary care provider, to those managed by a primary care provider alone. Methods Patients were separated into cohorts depending if they had at least two appointments with a Clinical Pharmacist Practitioner from November 2008 to November 2011. A primary care provider saw all patients at least twice during the study period. Cohorts were then matched by age, gender, and disease states. Medicare billed data was evaluated from outpatient visits related to hypertension, diabetes mellitus, and peripheral neuropathy, as well as emergency department visits and inpatient admissions. Cost of medications was estimated using 2009 AWP data corresponding to medication histories within the electronic medical record. Efficacy was defined as ability to reach disease state goal determined using national guidelines and reduction in pain score. Efficacy was analyzed by difference-in-differences test and all other numerical data tested by paired t-tests. Results The Clinical Pharmacist Practitioners cohort experienced more outpatient visits (1338 vs. 858, p < 0.001), fewer emergency department visits (115 vs. 190, p < 0.05), and similar inpatient admissions (88 vs. 117, p > 0.05) than the primary care providers cohort, respectively. The Clinical Pharmacist Practitioners cohort showed changes in charges of +22.6 % for outpatient visits, −45.5 % emergency department visits, and −13.2 % inpatient admissions relative to the primary care provider cohort. There was no difference in average daily medication cost (Clinical Pharmacist Practitioners $38.52 vs. primary care providers$38.23, p = 0.97) or achievement of disease state goals. Conclusion APPLE-NC demonstrated that through referrals, Clinical Pharmacist Practitioners provide services comparable in charges and efficacy to primary care providers. Consequently, the current increased need for primary care practitioners can be met in part by increasing the utilization of advanced practice pharmacists for chronic disease management. Trial registration This does not apply for this retrospective cohort study

Surfactant Protein-A Suppresses Eosinophil-Mediated Killing of Mycoplasma pneumoniae in Allergic Lungs

Surfactant protein-A (SP-A) has well-established functions in reducing bacterial and viral infections but its role in chronic lung diseases such as asthma is unclear. Mycoplasma pneumoniae (Mp) frequently colonizes the airways of chronic asthmatics and is thought to contribute to exacerbations of asthma. Our lab has previously reported that during Mp infection of non-allergic airways, SP-A aides in maintaining airway homeostasis by inhibiting an overzealous TNF-alpha mediated response and, in allergic mice, SP-A regulates eosinophilic infiltration and inflammation of the airway. In the current study, we used an in vivo model with wild type (WT) and SP-A−/− allergic mice challenged with the model antigen ovalbumin (Ova) that were concurrently infected with Mp (Ova+Mp) to test the hypothesis that SP-A ameliorates Mp-induced stimulation of eosinophils. Thus, SP-A could protect allergic airways from injury due to release of eosinophil inflammatory products. SP-A deficient mice exhibit significant increases in inflammatory cells, mucus production and lung damage during concurrent allergic airway disease and infection (Ova+Mp) as compared to the WT mice of the same treatment group. In contrast, SP-A deficient mice have significantly decreased Mp burden compared to WT mice. The eosinophil specific factor, eosinophil peroxidase (EPO), which has been implicated in pathogen killing and also in epithelial dysfunction due to oxidative damage of resident lung proteins, is enhanced in samples from allergic/infected SP-A−/− mice as compared to WT mice. In vitro experiments using purified eosinophils and human SP-A suggest that SP-A limits the release of EPO from Mp-stimulated eosinophils thereby reducing their killing capacity. These findings are the first to demonstrate that although SP-A interferes with eosinophil-mediated biologic clearance of Mp by mediating the interaction of Mp with eosinophils, SP-A simultaneously benefits the airway by limiting inflammation and damage

Bio-chemical leaching of kaolinite-hematite-boehmite type bauxite ore

248-252Low grade bauxites of Severo-Onezhsky and Sredne-Timansky deposits of Russia have been evaluated for their amenability towards bioleaching. Two microbial isolates of Bacillus genera have been isolated in Zak medium and enriched to conduct leaching experiments of bauxites. The bacteria are chosen due their specific ability to secrete exo-polysaachrides (EPS), which is believed to be very beneficial in dissolution-cum-flocculation of aluminosilicates. The microbes have been able to leach nearly 50% alumina and nearly 10-35% SiO2 and Fe2O3. Chemical leaching experiments with citric and oxalic acids on bauxite leaching result in a maximum extraction of aluminum to be nearly 39% at elevated concentrations of leaching agents and 2-8 hours residence time. </span

Bio-chemical leaching of kaolinite-hematite-boehmite type bauxite ore

Low grade bauxites of Severo-Onezhsky and Sredne-Timansky deposits of Russia have been evaluated for their amenability towards bioleaching. Two microbial isolates of Bacillus genera have been isolated in Zak medium and enriched to conduct leaching experiments of bauxites. The bacteria are chosen due their specific ability to secrete exo-polysaachrides (EPS), which is believed to be very beneficial in dissolution-cum-flocculation of aluminosilicates. The microbes have been able to leach nearly 50% alumina and nearly 10-35% SiO2 and Fe2O3. Chemical leaching experiments with citric and oxalic acids on bauxite leaching result in a maximum extraction of aluminum to be nearly 39% at elevated concentrations of leaching agents and 2-8 hours residence time

Alteration of surfactant levels during inflammation and infection.

<p><b>A</b>) SP-A or <b>B</b>) SP-D levels were determined by densitometry of Western blots of BAL samples of untreated, Ova only (day 28 of our model) or Ova+Mp (day 28 of our model). n = 2 experiments with 3–4 mice/group each.</p