Online Self-testing Resources Prepared by Peer Tutors as a Formative Assessment Tool in Pharmacology Courses

Objective. To assess the effectiveness of optional online quizzes written by peer tutors in a pharmacology course for doctor of pharmacy students. Methods. Online quizzes were written by peer tutors for second-year pharmacy students. Quizzes reflected the material taught during lecture and were in a format similar to that of the examinations. Data related to performance on each quiz and each examination were collected throughout the semester. At the end of the semester, students and peer tutors were surveyed to gather information on the utility and success of the quizzes. Results. Students taking online quizzes performed significantly better on examinations than those who did not take quizzes. In addition, students received higher scores on examinations than when practicing with the quizzes. Surveys suggest that students liked the quizzes and felt they increased their confidence and performance on examinations. Conclusion. The quizzes were beneficial to student performance on examinations as well as student perception of performance and confidence going into the examinations. Quizzes were also beneficial learning experiences for peer tutors

Identifying Patterns in Health Care Disparities and Barriers to Health Care in Rural Tanzania

Tanzania is a country in East Africa with a population of 55 million people. HIV/AIDs, malaria and nutritional deficiencies claim the lives of many each year across Tanzania. The World Health Organization (WHO) reported in 2013 that approximately 70 percent of the population of Tanzania live in more rural areas where access to healthcare, health education, and medications for these diseases may be limited. The objective of this study was to illuminate significant health disparities in rural Tanzania based on literature and direct observations to identify barriers to quality health care. A comprehensive literature evaluation was completed on reports published on healthcare and health statistics in Tanzania from 1995 to present using Google Scholar and PubMed searches. This information was compared to direct observations, clinic evaluations and pharmacy inventories completed during a two week service program to villages in rural Tanzania. During this two-week trip, local health systems were directly observed and publicly available information about healthcare disparities in the region was recorded. Inventories of major diseases treated, services offered, and medications at two hospitals, one medical clinic and two pharmacies were recorded in the towns of Iringa and Ipalamwa, Tanzania. Despite the need, many rural villages, like Ipalamwa, have no functional health clinic and limited pharmacies available to its people, preventing necessary care. In 2013 in Tanzania, there were 159 deaths per 100,000 people due to HIV/AIDs. Observations made in Iringa and Ipalamwa revealed that despite local pharmacies, antiretroviral therapies are not readily available. The WHO reported that 44 people per 100,000 people die every year from malaria and that in all regions of Tanzania, malaria is a major cause of health services for all ages. Observations made in rural Tanzania reveal that government run pharmacies only offer limited medications for malaria treatment, primarily Artequick (artemisinin/piperaquine), Lumiter (artemether/lumefantrine), and Coartem D (artemether/ lumefantrine). From 2010-2011 it was reported that for children in Tanzania under the age of 5 years old, 13.6 percent were underweight, 6.6 percent experienced wasting, and finally 38.4 percent experienced stunting. Initial observations indicate that rates in rural areas well over 50 percent. Rural Tanzanian locations like Iringa are the highest producing maize regions and diet in the areas observed consists mainly of carbohydrate rich foods, such as corn and rice. Nutrient-rich food groups are avoided or sold for income or because of cultural beliefs. Due to geographic location in rural regions of Tanzania, lack of resources present a barrier to health care. Lack of access to HIV/AIDs and malaria treatment raise concern. Due to the abundance of maize-heavy diets in rural settings, many have an imbalanced diet which leads to nutritional deficiencies and stunting. Despite access to other sources of food, many people do not take advantage due to lack of knowledge and cultural beliefs. Identification of unique issues in rural Tanzania along with specific barriers is critical as this will allow for programs and interventions to be more targeted in rural settings

Expanding the Role of Peer Tutors Through the Use of Online Quizzes

Peer tutors are commonly used in higher education as a way to provide additional resources for student learning. Self‐testing, a type of formative assessment tool, provides students with a study tool that can help identify areas of weakness that require focus. Despite their usefulness, this type of additional learning resource can often be time consuming for faculty members, limiting its successful use across multiple courses. The use of peer tutors has been investigated and shown to provide advantages to both students utilizing tutoring services and tutors alike. Educating peer tutors to be involved in the academic process by preparing study materials for students, such as selftesting quizzes, increases thei

Educating pharmacists and the public about the role of over-the-counter medications in the management of Autism Spectrum Disorders

Over-the-counter (OTC) medications are used by various populations as an adjunct to help improve various aspects of life, such as sleep cycles, disease prevention, and mood. The purpose of this study is to compile all of the available data from human trials of over-the-counter medications used in patients with Autism Spectrum Disorders (ASD). OTCs have been used in the treatment of ASD to minimize social impairments, suppress repetitive behaviors, and enhance quality of sleep to improve daytime behaviors. Ultimately, the main objectives of this project are to educate pharmacists and the public (both patients and their families) about the role of over-the-counter medications in the treatment and management of ASD

Stability of Extemporaneously Prepared Sodium Benzoate Oral Suspension

The stability of extemporaneously prepared sodium benzoate oral suspension in cherry syrup and Ora-Sweet was studied. Oral solutions of 250-mg/mL sodium benzoate were prepared in either cherry syrup or Ora-Sweet. To a beaker, 50 grams of Sodium Benzoate Powder USP was dissolved and filtered, the solution was divided equally into two parts, and each aliquot was added into two separate calibrated 100-mL amber vials. In the first vial, cherry syrup was added to make a final volume of 100 mL. In the second vial, Ora-Sweet was added to give a final volume of 100 mL. This process was repeated to prepare three solutions of each kind and all were stored at room temperature. A 250-µL sample was withdrawn immediately after preparation and again at 7, 14, 28, 60, and 90 days for each sample. At each time point, further dilution was made to an expected concentration of 0.25 mg/mL with sample diluent, and the samples were assayed in triplicate by stability-indicating high-performance liquid chromatography. Stability was defined as the retention of at least 90% of the initial concentration. At least 92% of the initial concentration of sodium benzoate in cherry syrup and at least 96% of the sodium benzoate in Ora-Sweet remained throughout the 90-day study period. There were no detectable changes in color and no visible microbial growth in any sample. Extemporaneously compounded suspensions of sodium benzoate in cherry syrup or Ora-Sweet were stable for at least 90 days when stored in a 4-oz amber plastic bottle at room temperature in reduced lighting

Fructose Alters Cell Survival and Gene Expression in Microglia and Neuronal Cells Lines

Purpose: Microglia are macrophages that are found primarily in the CNS and play a crucial role in maintaining a healthy brain by engulfing invading microorganisms, releasing inflammatory mediators, and pruning dead cells. Microglia can become activated in response to certain stimuli which causes them to transition into a pro-inflammatory state, and can sometimes become chronically activated which can result in neuronal damage. Studies have shown a causal relationship between this activation and sugars such as fructose and glucose. We sought to understand the role of sugars in microglial activation and the subsequent effects on neuron health. Methods: Rat microglia (HAPI) and neuronal (B35) cell lines were treated with varying concentrations of fructose (25 mM, 12.5 mM, and 6.25 mM) or glucose (25 mM and 12.5 mM)as a positive control to determine their effects on the cells. Following treatment and incubation for 3 or 24 hours, the cells were analyzed using an MTT assay to measure cell survival or real-time polymerase chain reaction (RT-PCR) to measure gene expression levels. Effects of fructose were measured in HAPI microglia after direct treatment with the sugar. The genes investigated by the RT-PCR in the HAPI cells included: glucose transporter 5 (GLUT5), and the inflammatory markers high mobility group box 1 (HMGB1), and prostaglandin E receptor 2 (Ptger2). To evaluate the effects of microglial activation on neuronal function, the B35 neurons were treated either directly with sugars or with the supernatant collected from fructose-treated HAPI microglia. This allows examination of the effects of soluble neuron-injury factors released by microglia. The genes investigated by RT-PCR in B35 neurons included nuclear factor-κB (NFκB) and enolase 2 (Eno2). Results: Cell survival assays showed that 24-hour direct fructose treatment increased B35 cell survival by up to 13%, while groups treated with microglia supernatant increased cell survival by up to 33%. In HAPI microglia, 3 hours of treatment with fructose caused GLUT5 expression to be suppressed by up to 32% in all treatment groups except for 6.25 mM fructose, while Ptger2 and HMGB1 expression was increased by as much as 65% and 15%, respectively. After 24-hours of treatment with fructose, the HAPI microglia showed a maximum of 80% increased expression of HMGB1, while Ptger2 expression was mostly unchanged. In B35 neurons, 3 hours of treatment with fructose caused a decrease of up to 26% in NFκB and an increase of up to 46% in Eno2 expression. Conclusion: Cell survival results indicate that the microglia may provide a short term protective effect on the B35 neurons. However, data from the gene expression assays show evidence of cellular dysfunction in neurons and pro-inflammatory activity in microglia which may lead to neuronal death on a longer timeline. As seen in the gene expression results, microglia had increased expression of pro-inflammatory genes and B35 neuronal cells had increased expression of markers of cellular damage. Future studies will further explore the effects of fructose on expression of other genes and examine the effects on neuron survival at later time points

Altered Cell-surface Receptor Levels Result from Fructose Advanced Glycation End Product-Induced Inflammation

Objective: As a result of the heightened reactivity fructose demonstrates compared to glucose and our current knowledge of glucose advanced glycation end-products, the aim of this research was to further elucidate the proinflammatory pathways involved in the response to fru-AGE exposure, including the effects of fru-AGEs on cell-surface receptor expression. We hypothesized that once microglia were activated in response to fru-AGE exposure, there would be an increase in the expression of RAGE and TLR4 to facilitate the proinflammatory cascade

An Examination of the Effects of Atorvastatin and Parathyroid Hormone on Osteoblast Activity

HMG-CoA reductase inhibitors, also known as statins, are a ubiquitous class of medication used for lowering cholesterol. In-vitro and animal studies have suggested that statins can activate osteoblast differentiation and have anabolic effects on bones; however, observational and experimental studies in humans have shown conflicting results.1-5 The exact mechanism of statins on bone growth is unknown; however, there are several hypotheses. The “Lipid Hypothesis” (Figure 1) suggests that lipid oxidation leads to activation of PPARγ, and production of isoprostanes including isoPGF2α and isoPGEα. PPARγ is associated with inhibition of osteoblast differentiation, while isoprostanes markers are associated with the induction of osteoclast differentiation and inhibition of osteoblast differentiation. This led to the the hypothesis that statins can decrease lipid oxidation, which can inhibit the action of PPARγ and isoprostane-mediated bone loss.6 The “statins hypothesis” (Figure 2) suggests that the anabolic bone activity of statins is due to the induction of osteoblast differentiation, suppression of osteoblast apoptosis and inhibiting osteoclastogenesis. Statins inhibits HMG-CoA reductase, which decrease the productions of isoprenoids farnesyl pyrophosphate (FPP) and Geranylgeranyl pyrophosphate (GGPP). The decrease in FPP and GGPP leads to upregulation of bone morphogenetic protein-2 (BMP-2) downstream, stimulating bone formation by increasing mesenchymal condensation. Statins inhibit osteoblast apoptosis by upregulating TGFβ/Smad3 kinases signaling. It also decreases osteoclastogenesis by upregulating osteoprotegerin (OPG), a decoy receptor that binds to RANKL to inhibit osteoclast differentiation.

Stability of Extemporaneously Prepared Sodium Benzoate Oral Solution

Purpose: Sodium benzoate (NaC7H5O2), a common food preservative, is the salt form of benzoic acid. It is used as an alternative treatment in patients with hepatic encephalopathy or urea cycle disorders as it is believed help stimulate ammonia removal via a non-urea cycle based pathway. Despite its use, sodium benzoate is not an FDA approved medication and has no commercially available oral formulations, although an IV formulation is available in combination with sodium phenylacetate (Ammonul®). The objectives of this study were to prepare a sodium benzoate solution and determine the stability of an extemporaneously prepared oral solution over a 90-day period. Methods: An oral solution of sodium benzoate was prepared and a 1 ml sample was withdrawn from each bottle immediately after preparation and at 7 and 14 days and assayed for drug concentration by stability-indicating high performance liquid chromatography. Stability of sodium benzoate solution will be defined as maintenance of greater than or equal to 90 percent of the initial concentration. Results: The sodium benzoate maintained 96% and 93% of the initial concentrationt at 7 and 14 days, respectively. Therefore, sodium benzoate oral solution in cherry syrup is stable for a minimum of 14 at room temperature

Effects of Fructose-Derived Advanced Glycation End Products on Acetylation of Histones in the Brain

Objective: The objective of this study was to determine the effects of fructose and their advanced glycation end products (fru-AGES) on histone acetylation in microglia, the immune cells of the brain. Significance: Fru-AGES primarily form as a result of non-enzymatic reactions between fructose and proteins. One result is inflammation in the brain, which can be directly correlated to increased microglia activity. Microglial activity has been shown to be associated with the acetylation of histones, resulting in a change in transcription of inflammatory genes. Elucidation of a direct link between fructose, fru-AGES and histone acetylation would increase understanding the pathophysiology of inflammatory disorders such as Alzheimer’s disease. Experimental Procedures: An immortalized rat microglial cell line was treated in vitro with control media, fru-AGES or fructose. Histone acetylation was analyzed indirectly through activity of histone deacetlyase (HDAC) using the HDAC Glo I/II Assay (Promega). Chemiluminescent product formation was measuring with a spectrophotometer. Results Obtained: Both treatments with fructose and fru-AGES showed an increase in HDAC activity compared to control by up to 35% and 20%, respectively, correlating to a decrease in global histone acetylation. This is contradictory to initial expectations, as a decrease in acetylation could result in a decrease in transcription of genes . Despite causing an initial inflammatory response, fructose and fru-AGES appear to suppress overall gene transcription. Conclusion: Previous data show that exposure of microglia to fructose and fru-AGES results in a pro-inflammatory activated state. However, at the level of gene transcription, microglia may be desensitized and less able to respond in the long term