Survey of California Pharmacists\u27 Awareness of and Readiness for the New Authorities Granted by SB 493: A Pilot Study

The recent passing of Senate Bill (SB) 493 – effective on January 1, 2014 – addresses a primary care provider shortage in California by declaring pharmacists as health care providers and authorizing new roles for them in patient care. The aims of this pilot study were to examine California registered pharmacists’ awareness and knowledge of the expanded authorities granted by SB 493 as well as to assess their perception of their own readiness to exercise these new authorities. A cross-sectional, observational study was designed, and a 40-question survey was administered electronically through Qualtrics to adjunct faculty, clinical faculty, and alumni of Touro University California College of Pharmacy. All participants were aware of this new legislation. Through their responses to Likert-scale questions, pharmacists’ self-perceived readiness for each new authority was discovered. A Kruskal-Wallis test revealed no statistically significant difference among the three subgroups’ self-perceived readiness to exercise most of the new authorities, except initiating and administering vaccinations independently to those older than three years old without a physician’s collaborative practice protocol (p = 0.0123). The lower degree of self-perceived readiness to provide immunizations independently reported by adjunct faculty might have been due to not being certified as immunizers, reflecting the need to be educated on administration of vaccinations

Is it safe? Talking to teens with HIV/AIDS about death and dying: a 3-month evaluation of Family Centered Advance Care (FACE) planning ? anxiety, depression, quality of life

Purpose To determine the safety of engaging HIV-positive (HIV+) adolescents in a Family Centered Advance Care (FACE) planning intervention. Patients and methods We conducted a 2-armed, randomized controlled clinical trial in 2 hospital-based outpatient clinics from 2006?2008 with HIV+ adolescents and their surrogates (n = 76). Three 60?90 minutes sessions were conducted weekly. FACE intervention groups received: Lyon FCACP Survey©, the Respecting Choices¬ interview, and completion of The Five Wishes©. The Healthy Living Control (HLC) received: Developmental History, Healthy Tips, Future Planning (vocational, school or vocational rehabilitation). Three-month post-intervention outcomes were: completion of advance directive (Five Wishes©); psychological adjustment (Beck Depression, Anxiety Inventories); quality of life (PedsQL?); and HIV symptoms (General Health Self-Assessment). Results Adolescents had a mean age, 16 years; 40% male; 92% African-American; 68% with perinatally acquired HIV, 29% had AIDS diagnosis. FACE participants completed advance directives more than controls, using time matched comparison (P \u3c 0.001). Neither anxiety, nor depression, increased at clinically or statistically significant levels post-intervention. FACE adolescents maintained quality of life. FACE families perceived their adolescents as worsening in their school (P = 0.018) and emotional (P = 0.029) quality of life at 3 months, compared with controls. Conclusions Participating in advance care planning did not unduly distress HIV+ adolescents

Biological variation in HbA1c predicts risk of retinopathy and nephropathy in type 1 diabetes

WSTĘP. Autorzy niniejszej pracy założyli, że ryzyko powikłań mikronaczyniowych w badaniu Diabetes Control and Complications Trial (DCCT) jest uwarunkowane zarówno zmiennością hemoglobiny glikowanej (HbA1c), zależną od średniego stężenia glukozy we krwi (MBG, mean blood glucose), jak i biologiczną zmiennością osobniczą HbA1c. MATERIAŁ I METODY. Wartości MBG i HbA1c, oznaczone u uczestników badania DCCT (n = 1441) podczas wizyt odbywających się co 3 miesiące, poddano analizie według modelu liniowej regresji wieloczynnikowej. W celu oceny zmienności biologicznej podczas każdej wizyty obliczono indeks glikacji hemoglobiny (HGI, hemoglobin glycation index = wartość zmierzona HbA1c&#8211; wartość przewidywana HbA1c), aby ocenić biologiczną zmienność, opierając się na kierunkowych odchyleniach zmierzonej HbA1c od wartości przewidywanej na podstawie MBG. Populację podzielono w zależności od średnich wartości HGI podczas trwania badania na 3 części: o wysokim, średnim i niskim HGI. Dla poszczególnych grup przeprowadzono analizę z zastosowaniem modelu proporcjonalnego hazardu Coxa w celu porównania ryzyka wystąpienia oraz rozwoju retinopatii i nefropatii w zależności od MBG, wieku, sposobu leczenia, grupy prewencji pierwotnej lub interwencji i czasu trwania cukrzycy. WYNIKI. Współczynnik prawdopodobieństwa oraz analizy HGI w testach t podważają twierdzenie, że wartość HbA1c zależy jedynie od MBG. Podczas 7-letniej obserwacji u pacjentów z wysokimi wartościami HbA1c (wyższymi niż oczekiwane) było 3-krotnie wyższe ryzyko retinopatii (30 vs. 9%; p < 0,001) i 6-krotnie wyższe ryzyko nefropatii (6 vs. 1%, p < 0,001) w porównaniu z grupą o niskim HGI. WNIOSKI. Osobnicza biologiczna zmienność HbA1c, odmienna i niezależna od zmienności HbA1c warunkowanej średnią glikemią, występuje niewątpliwie u chorych na cukrzycę typu 1 biorących udział w badaniu DCCT. Ponadto jest silnym czynnikiem ryzyka rozwoju cukrzycy. Określenie procesów odpowiedzialnych za biologiczną zmienność HbA1c mogłoby prowadzić do stworzenia nowych kierunków leczenia hipoglikemizującego oraz opóźniającego powikłania i postęp choroby.INTRODUCTION. We hypothesized that biological variation in HbA1c, distinct from variation attributable to mean blood glucose (MBG), would predict risk for microvascular complications in the Diabetes Control and Complications Trial (DCCT). MATERIAL AND METHODS. A longitudinal multiple regression model was developed from MBG and HbA1c measured in the 1,441 DCCT participants at quarterly visits. A hemoglobin glycation index (HGI = observed HbA1c&#8211;predicted HbA1c) was calculated for each visit to assess biological variation based on the directional deviation of observed HbA1c from that predicted by MBG in the model. The population was subdivided by thirds into high-, moderate-, and low- HGI groups based on mean participant HGI during the study. Cox proportional hazard analysis compared risk for development or progression of retinopathy and nephropathy between HGI groups controlled for MBG, age, treatment group, strata, and duration of diabetes. RESULTS. Likelihood ratio and t tests on HGI rejected the assumption that HbA1c levels were determined by MBG alone. At 7 years&#8217; follow-up, patients in the high-HGI group (higher than-predicted HbA1c) had three times greater risk of retinopathy (30 vs. 9%; P < 0.001) and six times greater risk of nephropathy (6 vs. 1%; P < 0.001) compared with the low- HGI group. CONCLUSIONS. Between-individual biological variation in HbA1c, which is distinct from that attributable to MBG, was evident among type 1 diabetic patients in the DCCT and was a strong predictor of risk for diabetes complications. Identification of the processes responsible for biological variation in HbA1c could lead to novel therapies to augment treatments directed at lowering blood glucose levels and preventing diabetes complications

The hemoglobin glycation index identifies subpopulations with harms or benefits from intensive treatment in the ACCORD Trial. Diabetes care 2015;38:1067-1074

This study tested the hypothesis that intensive treatment in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial disproportionately produced adverse outcomes in patients with diabetes with a high hemoglobin glycation index (HGI = observed HbA1c − predicted HbA1c)

Occupational Exposure to Pfiesteria Species in Estuarine Waters Is Not a Risk Factor for Illness

BACKGROUND: Exposure to the dinoflagellate Pfiesteria has, under certain circumstances, been associated with deficits in human learning and memory. However, uncertainties remain about the health risk of chronic, low-level exposures (as seen among occupationally exposed commercial fishermen), particularly in light of studies suggesting that Pfiesteria strains are widespread in the estuarine environment in the U.S. mid-Atlantic region. METHODS: We selected an initial cohort of 152 persons, including 123 persons with regular, occupational exposure to the Chesapeake Bay; 107 of the cohort members were followed for the full four summer “seasons” of the study. Cohort members were questioned biweekly about symptoms, and data were collected about the areas of the bay in which they worked. These latter data were matched with data on the presence or absence of Pfiesteria in each area, based on polymerase chain reaction analysis of > 3,500 water samples. Cohort members underwent neuropsychological testing at the beginning and end of each summer season. RESULTS: No correlation was found between work in an area where Pfiesteria was identified and specific symptomatology or changes on neuropsychological tests. CONCLUSIONS: Although high-level or outbreak-associated exposure to Pfiesteria species (or specific strains within a species) may have an effect on health, routine occupational exposure to estuarine environments in which these organisms are present does not appear to pose a significant health risk

Expression of an S phase-stabilized version of the CDK inhibitor Dacapo can alter endoreplication

In developing organisms, divergence from the canonical cell division cycle is often necessary to ensure the proper growth, differentiation, and physiological function of a variety of tissues. An important example is endoreplication, in which endocycling cells alternate between G and S phase without intervening mitosis or cytokinesis, resulting in polyploidy. Although significantly different from the canonical cell cycle, endocycles use regulatory pathways that also function in diploid cells, particularly those involved in S phase entry and progression. A key S phase regulator is the Cyclin E-Cdk2 kinase, which must alternate between periods of high (S phase) and low (G phase) activity in order for endocycling cells to achieve repeated rounds of S phase and polyploidy. The mechanisms that drive these oscillations of Cyclin E-Cdk2 activity are not fully understood. Here, we show that the Drosophila Cyclin E-Cdk2 inhibitor Dacapo (Dap) is targeted for destruction during S phase via a PIP degron, contributing to oscillations of Dap protein accumulation during both mitotic cycles and endocycles. Expression of a PIP degron mutant Dap attenuates endocycle progression but does not obviously affect proliferating diploid cells. A mathematical model of the endocycle predicts that the rate of destruction of Dap during S phase modulates the endocycle by regulating the length of G phase. We propose from this model and our in vivo data that endo S phase-coupled destruction of Dap reduces the threshold of Cyclin E-Cdk2 activity necessary to trigger the subsequent G-S transition, thereby influencing endocycle oscillation frequency and the extent of polyploidy

Practical guidance for clinical microbiology laboratories: Viruses causing acute respiratory tract infections

Respiratory viral infections are associated with a wide range of acute syndromes and infectious disease processes in children and adults worldwide. Many viruses are implicated in these infections, and these viruses are spread largely via respiratory means between humans but also occasionally from animals to humans. This article is an American Society for Microbiology (ASM)-sponsored Practical Guidance for Clinical Microbiology (PGCM) document identifying best practices for diagnosis and characterization of viruses that cause acute respiratory infections and replaces the most recent prior version of the ASM-sponsored Cumitech 21 document, Laboratory Diagnosis of Viral Respiratory Disease, published in 1986. The scope of the original document was quite broad, with an emphasis on clinical diagnosis of a wide variety of infectious agents and laboratory focus on antigen detection and viral culture. The new PGCM document is designed to be used by laboratorians in a wide variety of diagnostic and public health microbiology/virology laboratory settings worldwide. The article provides guidance to a rapidly changing field of diagnostics and outlines the epidemiology and clinical impact of acute respiratory viral infections, including preferred methods of specimen collection and current methods for diagnosis and characterization of viral pathogens causing acute respiratory tract infections. Compared to the case in 1986, molecular techniques are now the preferred diagnostic approaches for the detection of acute respiratory viruses, and they allow for automation, high-throughput workflows, and near-patient testing. These changes require quality assurance programs to prevent laboratory contamination as well as strong preanalytical screening approaches to utilize laboratory resources appropriately. Appropriate guidance from laboratorians to stakeholders will allow for appropriate specimen collection, as well as correct test ordering that will quickly identify highly transmissible emerging pathogens

Analysis and functional classification of transcripts from the nematode Meloidogyne incognita

BACKGROUND: Plant parasitic nematodes are major pathogens of most crops. Molecular characterization of these species as well as the development of new techniques for control can benefit from genomic approaches. As an entrée to characterizing plant parasitic nematode genomes, we analyzed 5,700 expressed sequence tags (ESTs) from second-stage larvae (L2) of the root-knot nematode Meloidogyne incognita. RESULTS: From these, 1,625 EST clusters were formed and classified by function using the Gene Ontology (GO) hierarchy and the Kyoto KEGG database. L2 larvae, which represent the infective stage of the life cycle before plant invasion, express a diverse array of ligand-binding proteins and abundant cytoskeletal proteins. L2 are structurally similar to Caenorhabditis elegans dauer larva and the presence of transcripts encoding glyoxylate pathway enzymes in the M. incognita clusters suggests that root-knot nematode larvae metabolize lipid stores while in search of a host. Homology to other species was observed in 79% of translated cluster sequences, with the C. elegans genome providing more information than any other source. In addition to identifying putative nematode-specific and Tylenchida-specific genes, sequencing revealed previously uncharacterized horizontal gene transfer candidates in Meloidogyne with high identity to rhizobacterial genes including homologs of nodL acetyltransferase and novel cellulases. CONCLUSIONS: With sequencing from plant parasitic nematodes accelerating, the approaches to transcript characterization described here can be applied to more extensive datasets and also provide a foundation for more complex genome analyses

Cohort Studies of Health Effects among People Exposed to Estuarine Waters: North Carolina, Virginia, and Maryland

A variety of human symptoms have been associated with exposure to the dinoflagellate Pfiesteria and have been grouped together into a syndrome termed "possible estuary-associated syndrome." Prospective cohort studies of health effects associated with exposure to estuarine waters that may contain Pfiesteria spp. and related organisms are in progress in North Carolina, Virginia, and Maryland. The three studies recruited cohorts of 118-238 subjects who work or engaged in recreation in estuary waters. Baseline health and neuropsychological evaluations are conducted, and study subjects are followed prospectively for 2-5 years with periodic assessments of health and performance on a battery of neuropsychological tests. Health symptoms and estuary water exposure are recorded by telephone interviews or diaries every 1-2 weeks. Water quality information, including measurements of Pfiesteria spp., is collected in the areas where the subjects are working. Because it is not possible to measure individual exposure to Pfiesteria or a toxin produced by this organism, these studies examine surrogate exposure measures (e.g., time spent in estuary waters, in a fish kill area, or in waters where Pfiesteria DNA was detected by molecular amplification). Preliminary analyses of the first 2 years (1998-2000) of data indicate that none of the three ongoing cohorts have detected adverse health effects. However, there have not been any reported fish kills associated with Pfiesteria since the studies began, so it is possible that none of the study subjects have been exposed to toxin-producing Pfiesteria spp