The Pivotal Role of the Pharmacist in a Primary Care Office

Abstract The profession of pharmacy has evolved from a dispensing role to an interdisciplinary clinical role in patient care. One area of patient care expertise is Medication Therapy Management (MTM), which includes services such as pharmacotherapy, medication therapy reviews, disease management, immunizations and other clinical services. In various studies, pharmacists conducting MTM have shown improved patient outcomes in community pharmacy and hospital settings. Amidst the valuable services all healthcare professionals are providing, increasing medical costs and consequences have become overwhelming, leading to negative patient outcomes. A lack of primary care physicians (PCPs) may contribute to these distressing facts. Gaps in communication between hospital, PCPs and community pharmacies also contribute to negative patient outcomes. Pharmacists can bridge the gap in miscommunication and help improve patient outcomes. Thus far in practice, pharmacists have had a limited role in primary care settings. The objective of this study is to determine if the addition of pharmacists providing clinical services (i.e. MTM) in a primary care setting can support the prescribers’ patient care demands. For this observational, exploratory research, the primary care settings under study will be all Federally Qualified Health Centers (FQHCs) in Ohio. IRB approval will be acquired before contact is made with participants. The contact person from each FQHC has been identified from the HRSA Office of Pharmacy Affairs. A script will be used to gather email addresses for the manager, physician, nurse and pharmacist, if available, from the contact person. A Qualtrics survey will be administered to these participants via email. The purpose of this study is to establish components of patient care in a primary care office, specifically FQHCs, that other medical professionals identify as lacking, which pharmacists can provide. A consent form, information about the study and a link to the survey will be provided in an email. The survey will include demographic, open-ended and 5-point Likert-type scale (1=strongly agree, 5=strongly disagree) questions. Reliability and validity of the survey will be established by a thorough search of the literature and expert review. Submitted answers will be analyzed with the appropriate statistical tests

BAT AGN spectroscopic survey - XV: the high frequency radio cores of ultra-hard X-ray selected AGN

We have conducted 22 GHz radio imaging at 1 arcsec resolution of 100 low-redshift AGN selected at 14–195 keV by the Swift-BAT. We find a radio core detection fraction of 96 per cent, much higher than lower frequency radio surveys. Of the 96 radio-detected AGN, 55 have compact morphologies, 30 have morphologies consistent with nuclear star formation, and 11 have sub-kpc to kpc-scale jets. We find that the total radio power does not distinguish between nuclear star formation and jets as the origin of the radio emission. For 87 objects, we use optical spectroscopy to test whether AGN physical parameters are distinct between radio morphological types. We find that X-ray luminosities tend to be higher if the 22 GHz morphology is jet-like, but find no significant difference in other physical parameters. We find that the relationship between the X-ray and core radio luminosities is consistent with the L_R/L_X ∼ 10⁻⁵ of coronally active stars. We further find that the canonical fundamental planes of black hole activity systematically overpredict our radio luminosities, particularly for objects with star formation morphologies

TcT_c suppression in co-doped striped cuprates

We propose a model that explains the reduction of $T_c$ due to the pinning of stripes by planar impurity co-doping in cuprates. A geometrical argument about the planar fraction of carriers affected by stripe pinning leads to a a linear $T_c$ suppression as a function of impurity concentration $z$. The critical value $z_c$ for the vanishing of superconductivity is shown to scale like $T_c^2$ in the under-doped regime and becomes universal in the optimally- and over-doped regimes. Our theory agrees very well with the experimental data in single- and bi-layer cuprates co-doped with Zn, Li, Co, etc...Comment: 4 pages, 4 figure

The evolution of social philopatry in female primates

The transition from solitary life to sociality is considered one of the major transitions in evolution. In primates, this transition is currently not well understood. Traditional verbal models appear insufficient to unravel the complex interplay of environmental and demographic factors involved in the evolution of primate sociality, and recent phylogenetic reconstructions have produced conflicting results. We therefore analyze a theoretical model for the evolution of female social philopatry that sheds new light on the question why most primates live in groups. In individual-based simulations, we study the evolution of dispersal strategies of both resident females and their offspring. The model reveals that social philopatry can evolve through kin selection, even if retention of offspring is costly in terms of within-group resource competition and provides no direct benefits. Our model supports the role of predator avoidance as a selective pressure for group-living in primates, but it also suggests that a second benefit of group-living, communal resource defense, might be required to trigger the evolution of sizable groups. Lastly, our model reveals that seemingly small differences in demographic parameters can have profound effects on primate social evolution

Spin orthogonality catastrophe in two-dimensional antiferromagnets and superconductors

We compute the spectral function of a spin S hole injected into a two-dimensional antiferromagnet or superconductor in the vicinity of a magnetic quantum critical point. We show that, near van Hove singularities, the problem maps onto that of a static vacancy carrying excess spin S. The hole creation operator is characterized by a new boundary anomalous dimension and a vanishing quasiparticle residue at the critical point. We discuss possible relevance to photoemission spectra of cuprate superconductors near the anti-nodal points.Comment: (v1) 4 pages, 2 figures; field theory afficionados - see also cond-mat/0011233; (v2) added figure of Monte Carlo data; (v3) corrected typo

Litteratur.

Intet resum

BAT AGN spectroscopic survey - XV: the high frequency radio cores of ultra-hard X-ray selected AGN

We have conducted 22 GHz radio imaging at 1 arcsec resolution of 100 low-redshift AGN selected at 14–195 keV by the Swift-BAT. We find a radio core detection fraction of 96 per cent, much higher than lower frequency radio surveys. Of the 96 radio-detected AGN, 55 have compact morphologies, 30 have morphologies consistent with nuclear star formation, and 11 have sub-kpc to kpc-scale jets. We find that the total radio power does not distinguish between nuclear star formation and jets as the origin of the radio emission. For 87 objects, we use optical spectroscopy to test whether AGN physical parameters are distinct between radio morphological types. We find that X-ray luminosities tend to be higher if the 22 GHz morphology is jet-like, but find no significant difference in other physical parameters. We find that the relationship between the X-ray and core radio luminosities is consistent with the L_R/L_X ∼ 10⁻⁵ of coronally active stars. We further find that the canonical fundamental planes of black hole activity systematically overpredict our radio luminosities, particularly for objects with star formation morphologies

Different reactions to adverse neighborhoods in games of cooperation

In social dilemmas, cooperation among randomly interacting individuals is often difficult to achieve. The situation changes if interactions take place in a network where the network structure jointly evolves with the behavioral strategies of the interacting individuals. In particular, cooperation can be stabilized if individuals tend to cut interaction links when facing adverse neighborhoods. Here we consider two different types of reaction to adverse neighborhoods, and all possible mixtures between these reactions. When faced with a gloomy outlook, players can either choose to cut and rewire some of their links to other individuals, or they can migrate to another location and establish new links in the new local neighborhood. We find that in general local rewiring is more favorable for the evolution of cooperation than emigration from adverse neighborhoods. Rewiring helps to maintain the diversity in the degree distribution of players and favors the spontaneous emergence of cooperative clusters. Both properties are known to favor the evolution of cooperation on networks. Interestingly, a mixture of migration and rewiring is even more favorable for the evolution of cooperation than rewiring on its own. While most models only consider a single type of reaction to adverse neighborhoods, the coexistence of several such reactions may actually be an optimal setting for the evolution of cooperation.Comment: 12 pages, 5 figures; accepted for publication in PLoS ON

Quantum impurity dynamics in two-dimensional antiferromagnets and superconductors

We present the universal theory of arbitrary, localized impurities in a confining paramagnetic state of two-dimensional antiferromagnets with global SU(2) spin symmetry. The energy gap of the host antiferromagnet to spin-1 excitations, \Delta, is assumed to be significantly smaller than a typical nearest neighbor exchange. In the absence of impurities, it was argued in earlier work (Chubukov et al. cond-mat/9304046) that the low-temperature quantum dynamics is universally and completely determined by the values of \Delta and a spin-wave velocity c. Here we establish the remarkable fact that no additional parameters are necessary for an antiferromagnet with a dilute concentration of impurities, n_{imp} - each impurity is completely characterized by a integer/half-odd-integer valued spin, S, which measures the net uncompensated Berry phase due to spin precession in its vicinity. We compute the impurity-induced damping of the spin-1 collective mode of the antiferromagnet: the damping occurs on an energy scale \Gamma= n_{imp} (\hbar c)^2/\Delta, and we predict a universal, asymmetric lineshape for the collective mode peak. We argue that, under suitable conditions, our results apply unchanged (or in some cases, with minor modifications) to d-wave superconductors, and compare them to recent neutron scattering experiments on YBCO by Fong et al. (cond-mat/9812047). We also describe the universal evolution of numerous measurable correlations as the host antiferromagnet undergoes a quantum phase transition to a Neel ordered state.Comment: 36 pages, 12 figures; added reference