Pharmacists’ social authority to transform community pharmacy practice

Leaders in the profession of pharmacy have articulated a vision of pharmacists as providers of patient-centered care (PCC) services and the Doctor of Pharmacy was established as the required practice degree to achieve this vision. Pharmacist-provided PCC services have been shown to reduce medication costs and improve patient compliance with therapies. While community pharmacists are capable of, and are ideally placed for, providing PCC services, in fact they devote most of their time to prescription dispensing rather than direct patient care. As professionals, community pharmacists are charged with protecting society by providing expert services to help consumers manage risks associated with drug therapies. Historically pharmacists fulfilled this responsibility by accurately dispensing prescription medications, verifying doses, and allergy checking. This limited view of pharmacy practice is insufficient in light of the modern view of pharmacists as providers of PCC. The consumers’ view of community pharmacy as a profession represents a barrier to transforming the basis of community pharmacy from product distribution to providing PCC services. Community pharmacists are conferred with social authority to dictate the manner in which their professional services are provided. Pharmacists can therefore facilitate the transition to PCC as the primary function of community pharmacy by exercising their social authority to engage consumers in their roles in the new patient-pharmacist relationship. Each pharmacist must decide to provide PCC services. Suggestions for initiating PCC services in community pharmacy are offered

A cancer cell-line titration series for evaluating somatic classification.

BackgroundAccurate detection of somatic single nucleotide variants and small insertions and deletions from DNA sequencing experiments of tumour-normal pairs is a challenging task. Tumour samples are often contaminated with normal cells confounding the available evidence for the somatic variants. Furthermore, tumours are heterogeneous so sub-clonal variants are observed at reduced allele frequencies. We present here a cell-line titration series dataset that can be used to evaluate somatic variant calling pipelines with the goal of reliably calling true somatic mutations at low allele frequencies.ResultsCell-line DNA was mixed with matched normal DNA at 8 different ratios to generate samples with known tumour cellularities, and exome sequenced on Illumina HiSeq to depths of >300×. The data was processed with several different variant calling pipelines and verification experiments were performed to assay >1500 somatic variant candidates using Ion Torrent PGM as an orthogonal technology. By examining the variants called at varying cellularities and depths of coverage, we show that the best performing pipelines are able to maintain a high level of precision at any cellularity. In addition, we estimate the number of true somatic variants undetected as cellularity and coverage decrease.ConclusionsOur cell-line titration series dataset, along with the associated verification results, was effective for this evaluation and will serve as a valuable dataset for future somatic calling algorithm development. The data is available for further analysis at the European Genome-phenome Archive under accession number EGAS00001001016. Data access requires registration through the International Cancer Genome Consortium's Data Access Compliance Office (ICGC DACO)

A Force and Displacement Self-Sensing Piezoelectric MRI-Compatible Tweezer End Effector with an On Site Calibration Procedure

Copyright © IEEEDOI: http://dx.doi.org/10.1109/TMECH.2013.2257827Copyright © IEEEThis paper describes a self-sensing technique for a piezoelectrically driven magnetic resonance imaging (MRI)-compatible tweezer style end effector, suitable for robot assisted MRI guided surgery. Nested strain amplification mechanisms are used to amplify the displacement of the piezo actuators to practical levels for robotics. By using a hysteretic piezoelectric model and a two port network model for the compliant nested strain amplifiers, it is shown that force and displacement at the tweezer tip can be estimated if the input voltage and charge are measured. One piezo unit is used simultaneously as a sensor and an actuator, preserving the full actuation capability of the device. An on-site calibration procedure is proposed that calibrates the combined electromechanical model without requiring specific loading conditions on the inner piezoelectric actuators. Experimental validation shows an average of 12% error between the self-sensed and true values

Utilization and Costs of Compounded Medications for Commercially Insured Patients, 2012 – 2013

Background: Although compounding has a long-standing tradition in clinical practice, insurers and pharmacy benefit managers have instituted policies to decrease claims for compounded medications, citing questions about their safety, efficacy, high costs, and lack of Food and Drug Administration (FDA) approval. There are no reliable published data on the extent of compounding by community pharmacists nor the fraction of patients who use compounded medications. Prior research suggests that compounded medications represent a relatively small proportion of prescription medications, but these surveys were limited by small sample sizes, subjective data collection methods, and low response rates. Objective: To determine the number of claims for compounded medications, on a per user per year (PUPY) basis, and the average ingredient cost of these claims among commercially insured patients in the United States (US) for 2012 and 2013. Methods: This study used prescription claims data from a nationally representative sample of commercially insured members whose pharmacy benefits were managed by a large pharmacy benefit management company. A retrospective claims analysis was conducted from January 1, 2012 through December 31, 2013. Annualized prevalence, cost, and utilization estimates were drawn from the data. All prescription claims were adjusted to 30-day equivalents. Data mining techniques (association rule mining) were employed in order to identify the most commonly combined ingredients in compounded medications. Results: The prevalence of compound users was 1.1% (245,285) of eligible members in 2012 and 1.4% (323,501) in 2013, an increase of 27.3%. Approximately 66% of compound users were female and the average age of a compound user was approximately 42 years throughout the study period. The geographic distribution of compound user prevalence was consistent across the US. Compound users’ prescription claims increased 36.6%, from approximately 7.1 million to approximately 9.7 million prescriptions from 2012 to 2013. The number of claims for compounded medications increased by 34.2% from 486,886 to 653,360 during the same period. PUPY utilization remained unchanged at 2 prescriptions per year from 2012 to 2013. The most commonly compounded drugs were similar for all adult age groups, and represented therapies typically indicated for chronic pain or hormone replacement therapy. The average ingredient cost for compounded medications increased by 130.3% from $308.49 to$710.36 from 2012 to 2013. The average ingredient cost for these users’ non-compounded prescriptions increased only 7.7%, from $148.75 to$160.20. For comparison, the average ingredient cost for all prescription users’ claims was $81.50 in 2012, and increased by 3.8$84.57 in 2013. Conclusions: Compound users represented 1.4% of eligible members in 2013. The average ingredient cost for compound users’ compounded prescriptions ($710.36) was greater than for non-compounded prescriptions ($160.20). The one-year increase in average compounded prescription costs (130.3%) was also greater than for non-compounded prescriptions (7.7%). Although prevalence of compound users and the PUPY utilization for compounded prescriptions increased only slightly between 2012 and 2013, the mean and median cost of compounded medications increased dramatically during this time. Text mining revealed that drug combinations characteristic of topical pain formulations were among the most frequently compounded medications for adults

The elastic modulus of fetal cranial bone: A first step towards an understanding of the biomechanics of fetal head molding

Fetal head molding is the change in shape of the fetal head due to forces of labor. The biomechanics of this process are poorly understood. To understand it better, classical engineering structural analysis is being applied to analyze the process. A fundamental part of this analysis is to describe the mechanical properties of the constituent materials, a knowledge which has been lacking for fetal cranial bone.As a first step toward defining the mechanical properties, 86 specimens of fetal cranial bone obtained from specimens ranging in estimated gestational age from 25 to 40 weeks were tested in three-point bending. In addition, 12 specimens from a 6-yr-old calvarium were tested for comparative purposes. The data indicate that the elastic modulus is highly sensitive to gestational age and fiber orientation. Elastic modulus values for specimens with parallel fiber orientation are in the range of 1.65 x 103 MPa for preterm bone to 3.86 x 103 MPa for term bone. The results are discussed with respect to the limitations of the test method. Finally, clinical inferences are made.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23344/1/0000286.pd

Fetal head molding: An investigation utilizing a finite element model of the fetal parietal bone

Fetal head molding is the change in head shape due to the forces of labor. Previous investigations of the molding process have been largely qualitative in nature. In order to provide a first step toward a quantitative description of the deformations of the fetal head, a finite element analysis of the parietal bone of the fetal skull is performed. The structural geometry of the bone is derived from orthogonal radiographs of a full term anatomical specimen. Load and material parameters are taken from previous investigations. The bone is modeled using 63 thin shell elements from the SAP IV element library. Scaled models of preterm parietal bone are compared to term bone models.The results indicate that the models undergo deformations which are qualitatively similar to those seen in normal labor. The preterm parietal bone model exhibits deformations 2-4 times greater than the term bone model for the same load distribution. The significance of these results and their relationship to the molding process are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23348/1/0000291.pd

A Systematic Review of Quantitative Resilience Measures for Water Infrastructure Systems

Over the past few decades, the concept of resilience has emerged as an important consideration in the planning and management of water infrastructure systems. Accordingly, various resilience measures have been developed for the quantitative evaluation and decision-making of systems. There are, however, numerous considerations and no clear choice of which measure, if any, provides the most appropriate representation of resilience for a given application. This study provides a critical review of quantitative approaches to measure the resilience of water infrastructure systems, with a focus on water resources and distribution systems. A compilation of 11 criteria evaluating 21 selected resilience measures addressing major features of resilience is developed using the Axiomatic Design process. Existing gaps of resilience measures are identified based on the review criteria. The results show that resilience measures have generally paid less attention to cascading damage to interrelated systems, rapid identification of failure, physical damage of system components, and time variation of resilience. Concluding the paper, improvements to resilience measures are recommended. The findings contribute to our understanding of gaps and provide information to help further improve resilience measures of water infrastructure systems

Page turning and image size in a digital music stand

This paper investigates attributes of the electronic display of sheet music necessary for the development of a digital music stand. We explore the two conflicting goals of minimising page turning effort and maximising the readability of images by conducting two user experiments. In our first experiment participants trialed various page turning methods through a sight-reading exercise, and filled out a questionnaire upon completion. In the second experiment participants viewed music at different sizes while listening to an audio rendition of the piece, and were asked to note any mistakes that occured in the played audio. Results from our experimentations showed that scrolling techniques did not work as well as page replacement methods, and that some reduction in the size of the music displayed is possible without significantly degrading reader accuracy

Impacts of elevation data spatial resolution on two-dimensional dam break flood simulation and consequence assessment

A grid resolution sensitivity analysis using a two-dimensional flood inundation model has been presented in this paper. Simulations for 6 dam breaches located randomly in the United States were run at 10,30,60,90, and 120 meter resolutions. The dams represent a range of topographic conditions, ranging from 0% slope to 1.5% downstream of the dam. Using 10 meter digital elevation model (DEM) simulation results as the baseline, the coarser simulation results were compared in terms of flood inundation area, peak depths, flood wave travel time, daytime and nighttime population in flooded area, and economic impacts. The results of the study were consistent with previous grid resolution studies in terms of inundated area, depths, and velocity impacts. The results showed that as grid resolution is decreased, the relative fit of inundated area between the baseline and coarser resolution decreased slightly. This is further characterized by increasing over prediction as well as increasing under prediction with decreasing resolution. Comparison of average peak depths showed that depths generally decreased as resolution decreased, as well as the velocity. It is, however, noted that the trends in depth and velocity showed less consistency than the inundation area metrics. This may indicate that for studies in which velocity and depths must be resolved more accurately (urban environments when flow around buildings is important in the calculation of drag effects), higher resolution DEM data should be used. Perhaps the most significant finding from this study is the perceived insensitivity of socio-economic impacts to grid resolution. The difference in population at risk (PAR) and economic cost generally remained within 10% of the estimated impacts using the high resolution DEM. This insensitivity has been attributed to over estimated flood area and associated socio-economic impacts compensating for under estimated flooded area and associated socio-economic impacts. The United States has many dams that are classified as high-hazard potential that need an emergency action plan (EAP). It has been found that the development of EAPs for all high-hazard dams is handicapped due to funding limitations. The majority of the cost associated with developing an EAP is determining the flooded area. The results of this study have shown that coarse resolution dam breach studies can be used to provide an acceptable estimate of the inundated area and economic impacts, with very little computational cost. Therefore, the solution to limited funding may be to perform coarse resolution dam breach studies on high-hazard potential dams and use the results to help prioritize the order in which detailed EAPs should be developed