The Relationship Between Clinical Pharmacy and Adequate Medication Reconciliation and Acute Rejection Treatment for Renal Transplant Patients

The purpose of this systematic review is to determine how clinical transplant pharmacists affect changes in medication reconciliation and changes in rejection. A database search was done using PubMed, Scopus, Embase, Cochrane Review, and clinicaltrials.gov, and the final number of papers in the review included 4 studies. Eligible studies included adult kidney transplant recipients in the US, Canada, Brazil, or Australia and were published in English. The intervention was any pharmacist-led intervention, and the outcomes of interest were number of medication reconciliations completed and number of acute rejections. Included studies show that clinical transplant pharmacist interventions contributed to more medication reconciliations, with fewer medication errors occurring. Also, there were fewer acute rejections when patients received pharmaceutical care. All data was statistically significant (p <0.05) except the data provided for one of the acute rejection studies, which had a p-value of 0.213. However, the results from this review were inconclusive given the validity of the studies included in the review and the high level of bias in each study. There is potential for pharmacist-led interventions to positively impact medication reconciliation and acute rejection in kidney transplant patients and this review emphasizes the need for future research on this topic.Master of Public Healt

Salsalate treatment improves glycemia without altering adipose tissue in nondiabetic obese hispanics.

ObjectiveSalsalate treatment has well-known effects on improving glycemia, and the objective of this study was to examine whether the mechanism of this effect was related to changes in adipose tissue.MethodsA randomized double-blind and placebo-controlled trial in obese Hispanics (18-35 years) was conducted. The intervention consisted of 4 g day(-1) of salsalate (n = 11) versus placebo (n = 13) for 4 weeks. Outcome measures included glycemia, adiposity, ectopic fat, and adipose tissue gene expression and inflammation.ResultsIn those receiving salsalate, plasma fasting glucose decreased by 3.4% (P &lt; 0.01), free fatty acids decreased by 42.5% (P = 0.06), and adiponectin increased by 27.7% (P &lt; 0.01). Salsalate increased insulin AUC by 38% (P = 0.01) and HOMA-B by 47.2% (P &lt; 0.01) while estimates of insulin sensitivity/resistance were unaffected. These metabolic improvements occurred without changes in total, abdominal, visceral, or liver fat. Plasma markers of inflammation/immune activation were unchanged following salsalate. Salsalate had no effects on adipose tissue including adipocyte size, presence of crown-like structures, or gene expression of adipokines, immune cell markers, or cytokines downstream of NF-κB with the exception of downregulation of IL-1β (P &lt; 0.01).ConclusionsFindings suggest that metabolic improvements in response to salsalate occurred without alterations in adiposity, ectopic fat, or adipose tissue gene expression and inflammation

Socio-demographic predictors of gender inequality among heterosexual couples expecting a child in south-central Uganda

Background: Gender inequality is a pervasive problem in sub-Saharan Africa, and has negative effects on health and development. Objective: Here, we sought to identify socioeconomic predictors of gender inequality (measured by low decision-making power and high acceptance of intimate partner violence) within heterosexual couples expecting a child in south-central Uganda. Method: We used data from a two-arm cluster randomized controlled HIV self-testing intervention trial conducted in three antenatal clinics in south-central Uganda among 1,618 enrolled women and 1,198 male partners. Analysis included Cochran Mantel-Haenzel, proportional odds models, logistic regression, and generalized linear mixed model framework to account for site-level clustering. Results: Overall, we found that 31.1% of men had high acceptance of IPV, and 15.9% of women had low decision-making power. We found religion, education, HIV status, age, and marital status to significantly predict gender equality. Specifically, we observed lower gender equality among Catholics, those with lower education, those who were married, HIV positive women, and older women. Conclusion: By better understanding the prevalence and predictors of gender inequality, this knowledge will allow us to better target interventions (increasing education, reducing HIV prevalence in women, targeting interventions different religions and married couples) to decrease inequalities and improve health care delivery to underserved populations in Uganda

Common and distinct neural features of social and non-social reward processing in autism and social anxiety disorder

Autism spectrum disorders (ASDs) and social anxiety disorder (SAD) are both characterized by social dysfunction, but no study to date has compared neural responses to social rewards in ASDs and SAD. Neural responses during social and non-social reward anticipation and outcomes were examined in individuals with ASD (n = 16), SAD (n = 15) and a control group (n = 19) via functional magnetic resonance imaging. Analyses modeling all three groups revealed increased nucleus accumbens (NAc) activation in SAD relative to ASD during monetary reward anticipation, whereas both the SAD and ASD group demonstrated decreased bilateral NAc activation relative to the control group during social reward anticipation. During reward outcomes, the SAD group did not differ significantly from the other two groups in ventromedial prefrontal cortex activation to either reward type. Analyses comparing only the ASD and SAD groups revealed greater bilateral amygdala activation to social rewards in SAD relative to ASD during both anticipation and outcome phases, and the magnitude of left amygdala hyperactivation in the SAD group during social reward anticipation was significantly correlated with the severity of trait anxiety symptoms. Results suggest reward network dysfunction to both monetary and social rewards in SAD and ASD during reward anticipation and outcomes, but that NAc hypoactivation during monetary reward anticipation differentiates ASD from SAD

Doctor of Philosophy

dissertationGallium nitride (GaN) is an increasingly important semiconductor material showing promising properties for nanomaterial applications. Here the microscopic origins of highly photoactive visible spectra resulting from individual gallium nitride (GaN) triangular crosssection nanowires (NWs) are analyzed with sub- and above-gap photoexcitation using time-resolved measurements, photoluminescence excitation spectroscopy, hyperspectral overlapping and nonoverlapping confocal microscopy, and atomic force microscope (AFM) measurements. Time-dependent measurements show longer lifetimes for electrons producing redder emitted wavelengths and for higher laser excitation energies. Additionally, the spectrum shifts strongly to the blue when the excitation intensity is increased. These observations are consistent with a qualitative model in which the photoluminescence results from excitation into a broad manifold of surface or defect-associated states which are rapidly populated at high excitation intensity and strongly coupled to each other via nonradiative relaxation. This manifold of defect states may contain the oft-cited GaN green and yellow luminescence bands as wavelength dependent data suggest that the fitted amplitudes of these bands decay over time. Confocal measurements reveal delocalized emission along the entire NW with spectral fringes often observed at the NW ends, corresponding to etalon modes. Nonoverlapping confocal measurements and Lumerical simulations suggest that laser excitation photons couple into the NW cavity at the NW ends, producing strong localized fluorescence along the entire length. Fluorescence is also coupled into the cavity where the geometry of the tapered NW effectively filters the emission spectra. These observations suggest that GaN NWs could be used as a nanodirectional spectral filter

A Pilot Study of the Effects of Mindfulness-Based Cognitive Therapy on Positive Affect and Social Anxiety Symptoms

Randomized controlled trials have demonstrated that mindfulness-based cognitive therapy (MBCT) is efficacious in reducing residual depressive symptoms and preventing future depressive episodes (Kuyken et al., 2016). One potential treatment effect of MBCT may be improvement of positive affect (PA), due to improved awareness of daily positive events (Geschwind et al., 2011). Considering social anxiety disorder (SAD) is characterized by diminished PA (Brown et al., 1998; Kashdan, 2007), we sought to determine whether MBCT would reduce social anxiety symptoms, and whether this reduction would be associated with improvement of PA deficits. Adults (N = 22) who met criteria for varied anxiety disorders participated in a small, open-label trial of an 8-week manualized MBCT intervention. Most participants presented with either a diagnosis (primary, secondary, or tertiary) of generalized anxiety disorder (GAD) (N = 15) and/or SAD (N = 14) prior to treatment, with eight individuals meeting diagnostic criteria for both GAD and SAD. We hypothesized participants would demonstrate improvements in social anxiety symptoms, which would be predicted by improvements in PA, not reductions in negative affect (NA). Results of several hierarchical linear regression analyses (completed in both full and disorder-specific samples) indicated that improvements in PA but not reductions in NA predicted social anxiety improvement. This effect was not observed for symptoms of worry, which were instead predicted by decreased NA for individuals diagnosed with GAD and both decreased NA and increased PA in the entire sample. Results suggest that MBCT may be efficacious in mitigating social anxiety symptoms, and this therapeutic effect may be linked to improvements in PA. However, further work is necessary considering the small, heterogeneous sample, uncontrolled study design, and exploratory nature of the study

Corneal Changes and Strategies to Improve Survival of Hypomorphic Collagen VII-Deficient Mice for the Study of Ocular Dystrophic Epidermolysis Bullosa.

Ophthalmic study of collagen CVII hypomorphic mice is uniquely challenging due to the strain\u27s published survival rate to weaning of 24%. Because chronic ocular fibrosis requires time to develop, optimizing the survival rate is of critical importance. In this study, standard husbandry practices were enhanced by the addition of sterilized diet and drug delivery gels, acidified water, irradiated food pellets, cellulose fiber bedding, minimal handling, removal of siblings within 2-3 wk from birth, and a preferred housing location. Survival rates per breeding cycle, sex, weight, and cause of early euthanasia were recorded and analyzed over 43 mo. Overall, 49% of mice survived to weaning and 76% of weaned mice survived to 20 wk of age. Corneal opacities were seen in 65% of mice by 20 wk, but only 10% of eyes showed the sustained opacification that was indicative of fibrosis. Corneal opacities occurred at the same rate as in humans with epidermolysis bullosa. 66% of the mice showed weight loss at 11 wk. Males required early euthanasia 4 times more often than did females. Euthanasia was required for urinary obstruction due to penile prolapse in 88% of males. With our enhanced care protocol, hypomorphic mice in our colony survived at twice the published rate. With this revised husbandry standard, experiments planned with termination endpoints of 14 wk for males and 17 wk for females are more likely to reach completion