The Impact of Objective Quality Ratings on Patient Selection of Community Pharmacies: A Discrete Choice Experiment and Latent Class Analysis

Background: Pharmacy-related performance measures have gained significant attention in the transition to value-based healthcare. Pharmacy-level quality measures, including those developed by the Pharmacy Quality Alliance, are not yet publicly accessible. However, the publication of report cards for individual pharmacies has been discussed as a way to help direct patients towards high-quality pharmacies. This study aimed to measure the relative strength of patient preferences for community pharmacy attributes, including pharmacy quality. Additionally, this study aimed to identify and describe community pharmacy market segments based on patient preferences for pharmacy attributes. Methods: This study elicited patient preferences for community pharmacy attributes using a discrete choice experiment (DCE) among a sample of 773 adults aged 18 years and older. Six attributes were selected based on published literature, expert opinion, and pilot testing feedback. The attributes included hours of operation, staff friendliness/courtesy, pharmacist communication, pharmacist willingness to establish a personal relationship, overall quality, and a drug-drug interaction specific quality metric. Participants responded to a block of ten random choice tasks assigned by Sawtooth v9.2 and two fixed tasks, including a dominant and a hold-out scenario. The data were analyzed using conditional logit and latent class regression models, and Hierarchical Bayes estimates of individual-level utilities were used to compare preferences across demographic subgroups. Results: Among the 773 respondents who began the survey, 741 (95.9%) completed the DCE and demographic questionnaire. Overall, study participants expressed the strongest preferences for quality-related pharmacy attributes. The attribute importance values (AIVs) were highest for the specific, drug-drug interaction (DDI) quality measure, presented as, “The pharmacy ensured there were no patients who were dispensed two medications that can cause harm when taken together,” (40.3%) and the overall pharmacy quality measure (31.3%). The utility values for 5-star DDI and overall quality ratings were higher among women (83.0 and 103.8, respectively) than men (76.2 and 94.5, respectively), and patients with inadequate health literacy ascribed higher utility to pharmacist efforts to get to know their patients (26.0) than their higher literacy counterparts (16.3). The best model from the latent class analysis contained three classes, coined the Quality Class (67.6% of participants), the Relationship Class (28.3%), and the Convenience Class (4.2%). Conclusions: The participants in this discrete choice experiment exhibited strong preferences for pharmacies with higher quality ratings. This finding may reflect patient expectations of community pharmacists, namely that pharmacists ensure that patients are not harmed by the medications filled at their pharmacies. Latent class analysis revealed underlying heterogeneity in patient preferences for community pharmacy attributes

Predictors of job satisfaction among pharmacists: A regional workforce survey

Background: Job satisfaction affects organizational outcomes including performance and retention. The pharmacy job satisfaction literature points to several predictors of job satisfaction, but educational debt and various work settings have not been previously examined. Objectives: To identify predictors of Virginia pharmacists\u27 job satisfaction. Methods: This cross-sectional study used data from the 2018 Virginia Pharmacist Workforce Survey. Of 15,424 registered pharmacists, 13,962 (90.5%) completed the survey. Pharmacists who reported being employed and working in Virginia in the previous year (2017) were included in the analysis (n = 6042). Data were summarized using descriptive statistics. Multiple logistic regression identified predictors of job satisfaction. Results: Respondents were primarily female (66.3%), Pharm.D. degree holders (65.5%), with a 14.8-year average work experience. Most pharmacists (86%) reported being very/somewhat satisfied with their job. Educational debt was not significantly associated with job satisfaction. Significant predictors of job satisfaction included: being female (aOR = 1.28, 95% CI 1.08, 1.52); working \u3c30 (aOR = 1.80, 95% CI 1.14, 2.84), 30–39 (aOR = 1.47, 95% CI 1.02, 2.11), or 40–49 (aOR = 1.42, 95% CI 1.02, 1.98) versus ≥50 h per week; earning an annual income of \u3c$50,000 (aOR = 0.60, 95$150,000 (aOR = 2.05, 95% CI 1.30, 3.23) versus $100,000–$149,999; working in an independent community pharmacy (aOR = 3.72, 95% CI 2.54, 5.44), health system (aOR = 3.81, 95% CI 2.78, 5.22), clinic-based pharmacy (aOR = 4.39, 95% CI 2.18, 8.83), academia (aOR = 5.20, 95% CI 1.97, 13.73), benefits administration (aOR = 3.64, 95% CI 1.71, 7.74), long-term home and home health/infusion (aOR = 1.71, 95% CI 1.10, 2.67), mass merchandiser community (aOR = 0.79, 95% CI 0.62, 0.99), or manufacturer and wholesale distributor (aOR = 3.46, 95% CI 1.97, 6.08) versus chain community pharmacy. Conclusions: Overall, Virginia pharmacists reported high job satisfaction. Pharmacists working in chain community pharmacy reported lower satisfaction relative to other settings. Being female, having a high annual income, and working for less hours was associated with improved job satisfaction

Biochemical and clinical response after umbilical cord blood transplant in a boy with early childhood-onset beta-mannosidosis.

BACKGROUND: Deficiency in the enzyme β-mannosidase was described over three decades ago. Although rare in occurrence, the presentation of childhood-onset β-mannosidase deficiency consists of hypotonia in the newborn period followed by global development delay, behavior problems, and intellectual disability. No effective pharmacologic treatments have been available. METHODS: We report 2-year outcomes following the first umbilical cord blood transplant in a 4-year-old boy with early childhood-onset disease. RESULTS: We show restoration of leukocyte β-mannosidase activity which remained normal at 2 years posttransplant, and a simultaneous increase in plasma β-mannosidase activity and dramatic decrease in urine-free oligosaccharides were also observed. MRI of the brain remained stable. Neurocognitive evaluation revealed test point gains, although the magnitude of improvement was less than expected for age, causing lower IQ scores that represent a wider developmental gap between the patient and unaffected peers. CONCLUSION: Our findings suggest that hematopoietic cell transplant can correct the biochemical defect in β-mannosidosis, although preservation of the neurocognitive trajectory may be a challenge

Foxc1 is required by pericytes during fetal brain angiogenesis

Summary Brain pericytes play a critical role in blood vessel stability and blood–brain barrier maturation. Despite this, how brain pericytes function in these different capacities is only beginning to be understood. Here we show that the forkhead transcription factor Foxc1 is expressed by brain pericytes during development and is critical for pericyte regulation of vascular development in the fetal brain. Conditional deletion of Foxc1 from pericytes and vascular smooth muscle cells leads to late-gestation cerebral micro-hemorrhages as well as pericyte and endothelial cell hyperplasia due to increased proliferation of both cell types. Conditional Foxc1 mutants do not have widespread defects in BBB maturation, though focal breakdown of BBB integrity is observed in large, dysplastic vessels. qPCR profiling of brain microvessels isolated from conditional mutants showed alterations in pericyte-expressed proteoglycans while other genes previously implicated in pericyte–endothelial cell interactions were unchanged. Collectively these data point towards an important role for Foxc1 in certain brain pericyte functions (e.g. vessel morphogenesis) but not others (e.g. barriergenesis)

Dietary nitrate and diet quality: An examination of changing dietary intakes within a representative sample of Australian women

Dietary nitrate is increasingly linked to a variety of beneficial health outcomes. Our purpose was to estimate dietary nitrate consumption and identify key dietary changes which have occurred over time within a representative sample of Australian women. Women from the 1946–1951 cohort of the Australian Longitudinal Study on Women’s Health with complete food frequency questionnaire data for both 2001 and 2013 were included for analysis. Dietary nitrate intakes were calculated using key published nitrate databases. Diet quality scores including the Australian Recommended Food Score, the Mediterranean Diet Score and the Nutrient Rich Foods Index were calculated along with food group serves as per the Australian Dietary Guidelines. Wilcoxon matched pairs tests were used to test for change in dietary intakes and Spearman’s correlations were used to examine associations. In our sample of 8161 Australian women, dietary nitrate intakes were on average 65–70 mg/day, and we detected a significant increase in dietary nitrate consumption over time (+6.57 mg/day). Vegetables were the primary source of dietary nitrate (81–83%), in particular lettuce (26%), spinach (14–20%), beetroot (10–11%), and celery (7–8%) contributed primarily to vegetable nitrate intakes. Further, increased dietary nitrate intakes were associated with improved diet quality scores (r = 0.3, p \u3c 0.0001). Although there is emerging evidence indicating that higher habitual dietary nitrate intakes are associated with reduced morbidity and mortality, future work in this area should consider how dietary nitrate within the context of overall diet quality can facilitate health to ensure consistent public health messages are conveyed

Redefining the multidimensional clinical phenotypes of frontotemporal lobar degeneration syndromes

The syndromes caused by frontotemporal lobar degeneration (FTLD) have highly heterogenous and overlapping clinical features. There has been great progress in the refinement of clinical diagnostic criteria in the last decade, but we propose that a better understanding of aetiology, pathophysiology and symptomatic treatments can arise from a transdiagnostic approach to clinical phenotype and brain morphometry. In a cross-sectional epidemiological study, we examined 310 patients with a syndrome likely to be caused by frontotemporal lobar degeneration, including behavioural variant frontotemporal dementia (bvFTD), the non-fluent (nfvPPA), semantic (svPPA) variants of primary progressive aphasia, progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). We also included patients with logopenic primary progressive aphasia (lvPPA) and those who met criteria for PPA but not one of the three subtypes. To date, forty-nine patients have a neuropathological diagnosis. A principal component analysis identified symptom dimensions that broadly recapitulated the core features of the main clinical syndromes. However, the subject-specific scores on these dimensions showed considerable overlap across the diagnostic groups. Sixty-two percent of participants had phenotypic features that met the diagnostic criteria for more than one syndrome. Behavioural disturbance was prevalent in all groups. Forty-four percent of patients with CBS had PSP-like features and thirty percent of patients with PSP had CBS-like features. Many patients with PSP and CBS had language impairments consistent with nfvPPA while patients with bvFTD often had semantic impairments. Using multivariate source-based morphometry on a subset of patients (n=133), we identified patterns of co-varying brain atrophy that were represented across the diagnostic groups. Canonical correlation analysis of clinical and imaging components found three key brain-behaviour relationships that revealed a continuous spectrum across the cohort rather than discrete diagnostic entities. In the forty-six patients with longitudinal follow up (mean 3.6 years) syndromic overlap increased with time. Together, these results show that syndromes associated with FTLD do not form discrete mutually exclusive categories from their clinical features or structural brain changes, but instead exist in a multidimensional spectrum. Patients often manifest diagnostic features of multiple disorders and deficits in behaviour, movement and language domains are not confined to specific diagnostic groups. It is important to recognise individual differences in clinical phenotype, both for clinical management and to understand pathogenic mechanisms. We suggest that the adoption of a transdiagnostic approach to the spectrum of FTLD syndromes provides a useful framework with which to understand disease progression, heterogeneity and treatment.This work was funded by the Holt Fellowship (AGM), British Academy (KAT, PF160048), Wellcome Trust (JBR, 103838), the PSP Association, the Medical Research Council, the National Institute for Health Research Cambridge Biomedical Research Centre and Cambridge Brain Bank; and the Cambridge Centre for Parkinson Plus

Research and Analysis of Fisheries in Illinois

Reports on progress and results for the following project objectives: sport fish population and sport fishing metrics; enhanced field sampling of sport fish populations; determination of factors affecting fishing quality; coordination with ongoing fisheries research projects; support for and enhance of web interface; fishes of Champaign County; recovery of urban stream sport fisheries.Illinois Department of Natural Resources, Division of Fisheries, Federal Aid Project F-69-R Segment 28unpublishednot peer reviewedOpe

Serum Concentrations of Organochlorine Pesticides and Growth among Russian Boys

Background: Limited human data suggest an association of organochlorine pesticides (OCPs) with adverse effects on children’s growth

A Translational Pharmacology Approach to Predicting Outcomes of Preexposure Prophylaxis Against HIV in Men and Women Using Tenofovir Disoproxil Fumarate With or Without Emtricitabine

Background. A novel translational pharmacology investigation was conducted by combining an in vitro efficacy target with mucosal tissue pharmacokinetic (PK) data and mathematical modeling to determine the number of doses required for effective human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP)