Practical Strategies for Pharmacist Integration with Primary Care: A Workbook.

This workbook is a practical set of tips and resources to assist pharmacists in providing clinical pharmacy services to primary care providers and their patients. The content was written based on experiences in Vermont in 2014, however the topics should generalize to pharmacists in other areas

Influence of condimental stock foods on the digestibility of a corn ration fed to swine.

Every stock food manufacturer claims that his particular brand of food will give greater gains or cheaper gains when fed in addition to a ration than that ration will give when fed alone. This claim is based upon the assumption that the spices, seeds, barks, roots, and herbs of which each food is said to be “scientifically compounded,” either directly stimulate the glands of the stomach and intestines which have to do the work of digesting and assimilating the ration; or else that the compounds act indirectly on these glands by toning up the entire animal system, purifying the blood, etc.

Sources of human urinary epinephrine

Sources of human urinary epinephrine. The kidney is a likely source for some urinary epinephrine (E) since adrenalectomized animals and humans continue to excrete urinary E and the human kidney contains E synthesizing enzymes. We studied subjects during an intravenous infusion of 3H-E to determine the fraction of urinary E derived from the kidney. Eight normal subjects (CON) and 5 older, heavier hypertensives (OHH) ate a light breakfast along with ascorbic acid supplementation and had intravenous and arterial lines placed. They received an infusion of 3H-E and had an oral water load. During the final hour of 3H-E infusion, urine and arterial blood samples were collected for 3H-E and E levels. After the 3H-E infusion was abruptly discontinued, arterial blood samples were collected to measure 3H-E kinetics. The total body clearance of 3H-E was about 2,500ml/min from plasma and clearance of 3H-E to urine was about 170ml/min. CON had plasma E levels of 43 ± 4 pg/ml. Their predicted rate of clearance of E from plasma to urine of 7,471 ± 865 pg/min was less than (P = 0.018) the actual urinary E excretion of 15,037 ± 2,625 pg/min. Thus, 43 ± 9% of urinary E in CON was apparently derived from renal sources and not filtered from blood. Among OHH 85 ± 4% of urinary E was derived from the kidney, significantly (P < 0.01) different from CON. The OHH also produced much more urinary E than predicted from plasma 3H-E clearance into urine (P = 0.03). A major fraction of urinary E is not filtered from the blood stream but is apparently derived from the kidney. A small fraction of urinary E may be derived from E stored in nerve endings along with norepinephrine, but this probably represents less than 2% of urinary E. Renal cleavage of E sulfate into E may be another potential source of urinary E. Some, and perhaps most, urinary E not filtered from the bloodstream is derived from renal N-methylation of norepinephrine as the human kidney has two enzymes capable of converting norepinephrine to E. In conclusion, a major portion of urinary E is derived from the kidney and not filtered from the bloodstream. This is an important factor in the interpretation of urine E levels. Renal E could alter renal blood flow, electrolyte reabsorption, and renin release prior to excretion into urine

On the Reprocessing and Reanalysis of Observations for Climate

The long observational record is critical to our understanding of the Earth s climate, but most observing systems were not developed with a climate objective in mind. As a result, tremendous efforts have gone into assessing and reprocessing the data records to improve their usefulness in climate studies. Many challenges remain, such as tracking the improvement of processing algorithms and limited spatial coverage. Reanalyses have fostered significant research, yet reliable global trends in many physical fields are not yet attainable, despite significant advances in data assimilation and numerical modeling. Communication of the strengths, limitations and uncertainties of reprocessed observations and reanalysis data, not only among the community of developers, but also with the extended research community, including the new generations of researchers and the decision makers is crucial for further advancement of the observational data records. WCRP provides the means to bridge the different motivating objectives on which national efforts focus

Collective excitation spectrum of a disordered Hubbard model

We study the collective excitation spectrum of a d=3 site-disordered Anderson-Hubbard model at half-filling, via a random-phase approximation (RPA) about broken-symmetry, inhomogeneous unrestricted Hartree-Fock (UHF) ground states. We focus in particular on the density and character of low-frequency collective excitations in the transverse spin channel. In the absence of disorder, these are found to be spin-wave-like for all but very weak interaction strengths, extending down to zero frequency and separated from a Stoner-like band, to which there is a gap. With disorder present, a prominent spin-wave-like band is found to persist over a wide region of the disorder-interaction phase plane in which the mean-field ground state is a disordered antiferromagnet, despite the closure of the UHF single-particle gap. Site resolution of the RPA excitations leads to a microscopic rationalization of the evolution of the spectrum with disorder and interaction strength, and enables the observed localization properties to be interpreted in terms of the fraction of strong local moments and their site-differential distribution.Comment: 25 pages (revtex), 9 postscript figure

Melarsoprol cyclodextrin inclusion complexes as promising oral candidates for the treatment of human African trypanosomiasis

Human African trypanosomiasis (HAT), or sleeping sickness, results from infection with the protozoan parasites &lt;i&gt;Trypanosoma brucei&lt;/i&gt; (&lt;i&gt;T.b.&lt;/i&gt;) &lt;i&gt;gambiense&lt;/i&gt; or &lt;i&gt;T.b.rhodesiense&lt;/i&gt; and is invariably fatal if untreated. There are 60 million people at risk from the disease throughout sub-Saharan Africa. The infection progresses from the haemolymphatic stage where parasites invade the blood, lymphatics and peripheral organs, to the late encephalitic stage where they enter the central nervous system (CNS) to cause serious neurological disease. The trivalent arsenical drug melarsoprol (Arsobal) is the only currently available treatment for CNS-stage &lt;i&gt;T.b.rhodesiense&lt;/i&gt; infection. However, it must be administered intravenously due to the presence of propylene glycol solvent and is associated with numerous adverse reactions. A severe post-treatment reactive encephalopathy occurs in about 10% of treated patients, half of whom die. Thus melarsoprol kills 5% of all patients receiving it. Cyclodextrins have been used to improve the solubility and reduce the toxicity of a wide variety of drugs. We therefore investigated two melarsoprol cyclodextrin inclusion complexes; melarsoprol hydroxypropyl-&#846;-cyclodextrin and melarsoprol randomly-methylated-&#946;-cyclodextrin. We found that these compounds retain trypanocidal properties &lt;i&gt;in vitro&lt;/i&gt; and cure CNS-stage murine infections when delivered orally, once per day for 7-days, at a dosage of 0.05 mmol/kg. No overt signs of toxicity were detected. Parasite load within the brain was rapidly reduced following treatment onset and magnetic resonance imaging showed restoration of normal blood-brain barrier integrity on completion of chemotherapy. These findings strongly suggest that complexed melarsoprol could be employed as an oral treatment for CNS-stage HAT, delivering considerable improvements over current parenteral chemotherapy

Phosphorylation of synaptic GTPase-activating protein (synGAP) by polo-like kinase (Plk2) alters the ratio of its GAP activity toward HRas, Rap1 and Rap2 GTPases

SynGAP is a Ras and Rap GTPase-activating protein (GAP) found in high concentration in the postsynaptic density (PSD) fraction from mammalian forebrain where it binds to PDZ domains of PSD-95. Phosphorylation of pure recombinant synGAP by Ca^(2+)/calmodulin-dependent protein kinase II (CaMKII) shifts the balance of synGAP's GAP activity toward inactivation of Rap1; whereas phosphorylation by cyclin-dependent kinase 5 (CDK5) has the opposite effect, shifting the balance toward inactivation of HRas. These shifts in balance contribute to regulation of the numbers of surface AMPA receptors, which rise during synaptic potentiation (CaMKII) and fall during synaptic scaling (CDK5). Polo-like kinase 2 (Plk2/SNK), like CDK5, contributes to synaptic scaling. These two kinases act in concert to reduce the number of surface AMPA receptors following elevated neuronal activity by tagging spine-associated RapGAP protein (SPAR) for degradation, thus raising the level of activated Rap. Here we show that Plk2 also phosphorylates and regulates synGAP. Phosphorylation of synGAP by Plk2 stimulates its GAP activity toward HRas by 65%, and toward Rap1 by 16%. Simultaneous phosphorylation of synGAP by Plk2 and CDK5 at distinct sites produces an additive increase in GAP activity toward HRas (∼230%) and a smaller, non-additive increase in activity toward Rap1 (∼15%). Dual phosphorylation also produces an increase in GAP activity toward Rap2 (∼40–50%), an effect not produced by either kinase alone. As we previously observed for CDK5, addition of Ca^(2+)/CaM causes a substrate-directed doubling of the rate and stoichiometry of phosphorylation of synGAP by Plk2, targeting residues also phosphorylated by CaMKII. In summary, phosphorylation by Plk2, like CDK5, shifts the ratio of GAP activity of synGAP to produce a greater decrease in active Ras than in active Rap, which would produce a shift toward a decrease in the number of surface AMPA receptors in neuronal dendrites

Cruise Report: EX-17-11 Gulf of Mexico 2017 (ROV and Mapping)

From November 29, 2017 to December 21, 2017, the NOAA Office of Ocean Exploration and Research (OER) and partners conducted a telepresence-enabled ocean exploration expedition on NOAA Ship Okeanos Explorer to collect critical baseline data and information and to improve knowledge about unexplored and poorly understood deepwater areas of the Gulf of Mexico. The Gulf of Mexico 2017 (EX-17-11) expedition was part of a series of expeditions between 2017 and 2018 that explored deepwater areas in the Gulf of Mexico. During 23 days at sea, 17 remotely operated vehicle (ROV) dives were completed off the Western Florida Escarpment and in the central and western Gulf of Mexico. Over 93 hours of ROV bottom time were logged at depths between 300 and 2,321 meters. Over 20,000 square kilometers of seafloor were mapped. A total of 138 biological and 11 geological samples were collected. The expedition gathered over 280,000 live video views worldwide and the OER website received over 35,600 views. A core onshore science team of over 80 participants from around the world collaborated and supported real-time ocean exploration science. The data associated with this expedition have been archived and are publicly available through the NOAA Archives