The National Status of Pharmacists’ Ability to Prescribe Hormonal Contraceptives

The scope of practice for pharmacists first expanded in California and Oregon with the ability to prescribe hormonal contraceptives to patients in their communities. Since 2016, over 33 states now allow for pharmacist prescribing of birth control in their pharmacy practice laws. 90% of Americans live within 5 miles of a retail pharmacy, making community pharmacies an accessible resource who may otherwise be unable to access contraceptives. The gap in care experienced by certain patient populations is now being filled by pharmacists with their ability to prescribe birth control

Prevalence of Caffeine Dependency and Daytime Fatigue Amongst Undergraduate Students

Caffeine is considered a legal drug with a main function of acting as a stimulant. The recommended daily dose of caffeine is up to 400 mg, however, most college students consume on average 800 mg per day (Mcllavian et al., 2013). Amongst American college students, caffeine is considered one of five most commonly consumed drugs, being compared with alcohol, marijuana, opioids, and sedatives (American Addictions Center, 2019). Within this population, there is a lack of knowledge regarding the adverse effects of caffeine and its potential impact of alertness versus sleepiness. Existing literature on this topic has shown that caffeine can decrease overall energy (Young & Benton, 2013). It was found that 53% of college students self-report fatigue and daytime sleepiness (Roth, 2015). Daytime fatigue is shown to negatively impact academic achievement, attention span, decision making, function, and quality of life (2015). This research aimed to understand the relationship between daytime sleepiness and caffeine consumption at a mid-sized southern university, measured by the Epworth Sleepiness Scale (Johns, 1991) and the Caffeine Dependency Inventory (Sabau & Beiglböck, 2020). It was hypothesized to have a positive correlation between caffeine consumption and daytime sleepiness. It is anticipated that those who consume high amounts of caffeinated drinks will show high levels of daytime sleepiness. The results of this study have implications for creating potential interventions in college students to decrease caffeine consumption and increase energy and attention throughout the day

Are there enormous age-trends in stable carbon isotope ratios of oak tree rings?

We test a recent prediction that stable carbon isotope ratios from UK oaks will display age-trends of more than 4‰ per century by measuring >5400 carbon isotope ratios from the late-wood alpha-cellulose of individual rings from 18 modern oak trees and 50 building timbers spanning the 9th to 21st centuries. After a very short (c.5 years) juvenile phase with slightly elevated values, the number of series that show rising and falling trends is almost equal (33:35) and the average trend is almost zero. These results are based upon measuring and averaging the trends in individual time-series; the ‘mean of the slopes’ approach. We demonstrate that the more conventional ‘slope of the mean’ approach can produce strong but spurious ‘age-trends’ even when the constituent series are flat, with zero slope and zero variance. We conclude that it is safe to compile stable carbon isotope chronologies from UK oaks without de-trending. The isotope chronologies produced in this way are not subject to the ‘segment length curse’, which applies to growth measurements, such as ring width or density, and have the potential to retain very long-term climate signals

Implementation and evaluation of a sari surveillance system in a tertiary hospital in Scotland in 2021/2022

Objective: To set up and evaluate a new surveillance system for severe acute respiratory infection (SARI) in Scotland. Study design: Cross-sectional study and evaluation of surveillance system. Methods: The SARI case definition comprised patients aged 16 years or over with an acute respiratory illness presentation requiring testing for influenza and SARS-CoV-2 and hospital admission. Data were collected from SARI cases by research nurses in one tertiary teaching hospital using a bespoke data collection tool from November 2021 to May 2022. Descriptive analyses of SARI cases were carried out. The following attributes of the surveillance system were evaluated according to Centers for Disease Control and Prevention (CDC) guidelines: stability, data quality, timeliness, positive predictive value, representativeness, simplicity, acceptability and flexibility. Results: The final surveillance dataset comprised 1163 records, with cases peaking in ISO week 50 (week ending 19/12/2021). The system produced a stable stream of surveillance data, with the proportion of SARI records with sufficient information for effective surveillance increasing from 65.4% during the first month to 87.0% over time. Similarly, the proportion where data collection was completed promptly was low initially, but increased to 50%–65% during later periods. Conclusion: SARI surveillance was successfully established in one hospital, but for a national system, additional sentinel hospital sites across Scotland, with flexibility to ensure consistently high data completeness and timeliness are needed. Data collection should be automated where possible, and demands on clinicians minimised. SARI surveillance should be embedded and resourced as part of a national respiratory surveillance strategy

Attention! A good bedside test for delirium?

peer-reviewedBackground Routine delirium screening could improve delirium detection, but it remains unclear as to which screening tool is most suitable. We tested the diagnostic accuracy of the following screening methods (either individually or in combination) in the detection of delirium: MOTYB (months of the year backwards); SSF (Spatial Span Forwards); evidence of subjective or objective 'confusion'.Methods We performed a cross-sectional study of general hospital adult inpatients in a large tertiary referral hospital. Screening tests were performed by junior medical trainees. Subsequently, two independent formal delirium assessments were performed: first, the Confusion Assessment Method (CAM) followed by the Delirium Rating Scale-Revised 98 (DRS-R98). DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria were used to assign delirium diagnosis. Sensitivity and specificity ratios with 95% CIs were calculated for each screening method.Results 265 patients were included. The most precise screening method overall was achieved by simultaneously performing MOTYB and assessing for subjective/objective confusion (sensitivity 93.8%, 95% CI 82.8 to 98.6; specificity 84.7%, 95% CI 79.2 to 89.2). In older patients, MOTYB alone was most accurate, whereas in younger patients, a simultaneous combination of SSF (cutoff 4) with either MOTYB or assessment of subjective/objective confusion was best. In every case, addition of the CAM as a second-line screening step to improve specificity resulted in considerable loss in sensitivity.Conclusions Our results suggest that simple attention tests may be useful in delirium screening. MOTYB used alone was the most accurate screening test in older people.PUBLISHEDpeer-reviewe

Chronic Obstructive Pulmonary Disease and Lung Cancer: Underlying Pathophysiology and New Therapeutic Modalities

Chronic obstructive pulmonary disease (COPD) and lung cancer are major lung diseases affecting millions worldwide. Both diseases have links to cigarette smoking and exert a considerable societal burden. People suffering from COPD are at higher risk of developing lung cancer than those without, and are more susceptible to poor outcomes after diagnosis and treatment. Lung cancer and COPD are closely associated, possibly sharing common traits such as an underlying genetic predisposition, epithelial and endothelial cell plasticity, dysfunctional inflammatory mechanisms including the deposition of excessive extracellular matrix, angiogenesis, susceptibility to DNA damage and cellular mutagenesis. In fact, COPD could be the driving factor for lung cancer, providing a conducive environment that propagates its evolution. In the early stages of smoking, body defences provide a combative immune/oxidative response and DNA repair mechanisms are likely to subdue these changes to a certain extent; however, in patients with COPD with lung cancer the consequences could be devastating, potentially contributing to slower postoperative recovery after lung resection and increased resistance to radiotherapy and chemotherapy. Vital to the development of new-targeted therapies is an in-depth understanding of various molecular mechanisms that are associated with both pathologies. In this comprehensive review, we provide a detailed overview of possible underlying factors that link COPD and lung cancer, and current therapeutic advances from both human and preclinical animal models that can effectively mitigate this unholy relationship

Loss of C-5 Sterol Desaturase Activity Results in Increased Resistance to Azole and Echinocandin Antifungals in a Clinical Isolate of Candida parapsilosis

Among emerging non-albicans Candida species, Candida parapsilosis is of particular concern as a cause of nosocomial bloodstream infections in neonatal and intensive care unit patients. While fluconazole and echinocandins are considered effective treatments for such infections, recent reports of fluconazole and echinocandin resistance in C. parapsilosis indicate a growing problem. The present study describes a novel mechanism of antifungal resistance in this organism affecting susceptibility to azole and echinocandin antifungals in a clinical isolate obtained from a patient with prosthetic valve endocarditis. Transcriptome analysis indicated differential expression of several genes in the resistant isolate, including upregulation of ergosterol biosynthesis pathway genes ERG2, ERG5, ERG6, ERG11, ERG24, ERG25, and UPC2. Whole-genome sequencing revealed that the resistant isolate possessed an ERG3 mutation resulting in a G111R amino acid substitution. Sterol profiles indicated a reduction in sterol desaturase activity as a result of this mutation. Replacement of both mutant alleles in the resistant isolate with the susceptible isolate's allele restored wild-type susceptibility to all azoles and echinocandins tested. Disruption of ERG3 in the susceptible and resistant isolates resulted in a loss of sterol desaturase activity, high-level azole resistance, and an echinocandin-intermediate to -resistant phenotype. While disruption of ERG3 in C. albicans resulted in azole resistance, echinocandin MICs, while elevated, remained within the susceptible range. This work demonstrates that the G111R substitution in Erg3 is wholly responsible for the altered azole and echinocandin susceptibilities observed in this C. parapsilosis isolate and is the first report of an ERG3 mutation influencing susceptibility to the echinocandins

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Effects of Caffeine Consumption on Physiological Markers of Stress

An article that appeared in JASS, issue 2019Caffeine is known to be used by college students to help stay awake, focus and increase academic performance. Caffeine’s biological mechanisms are fairly well-understood, but its effect on a stress response should be better explored. The purpose of this study is to examine the effect of caffeine on key physiological indicators of stressblood pressure (BP), heart rate (HR), and electrodermal activity (EDA)- in healthy college students. Forty-five students participated in this experiment, which began with baseline measurements of the three variables mentioned, followed by a stressor in the form of a brief math test, and a retesting of those three variables. The participants also completed a brief questionnaire to determine their caffeine usage, and were sorted into different groups based on their caffeine consumption. Statistically significant interactions could not be shown for most of the variables; however, there was a significant difference in the change of systolic blood pressure in participants when divided based on their intake of caffeine on the day of the experiment. Participants who consumed very high levels of caffeine (286mg and above) on the day of the experiment had a greater increase in systolic blood pressure than those who had less caffeine. High caffeine consumption is therefore correlated with a larger increase in systolic blood pressure in response to stress

Census 2020 | Consider This… with Cathy Wyatt

Next month, households across the country will be invited to participate in this. Simply put, a Census is a head count of every person living in the United States, something the U.S. Constitution requires we do every ten years. Why? To help guide planning across the country and in our own communities. Learn what Nebraska is doing to help increase reporting, especially in the hard to reach counties