Pharmacists’ social authority to transform community pharmacy practice

Leaders in the profession of pharmacy have articulated a vision of pharmacists as providers of patient-centered care (PCC) services and the Doctor of Pharmacy was established as the required practice degree to achieve this vision. Pharmacist-provided PCC services have been shown to reduce medication costs and improve patient compliance with therapies. While community pharmacists are capable of, and are ideally placed for, providing PCC services, in fact they devote most of their time to prescription dispensing rather than direct patient care. As professionals, community pharmacists are charged with protecting society by providing expert services to help consumers manage risks associated with drug therapies. Historically pharmacists fulfilled this responsibility by accurately dispensing prescription medications, verifying doses, and allergy checking. This limited view of pharmacy practice is insufficient in light of the modern view of pharmacists as providers of PCC. The consumers’ view of community pharmacy as a profession represents a barrier to transforming the basis of community pharmacy from product distribution to providing PCC services. Community pharmacists are conferred with social authority to dictate the manner in which their professional services are provided. Pharmacists can therefore facilitate the transition to PCC as the primary function of community pharmacy by exercising their social authority to engage consumers in their roles in the new patient-pharmacist relationship. Each pharmacist must decide to provide PCC services. Suggestions for initiating PCC services in community pharmacy are offered

Acoustic Room Compensation Using Local PCA-based Room Average Power Response Estimation

Acoustic room compensation techniques, which allow a sound reproduction system to counteract undesired alteration to the sound scene due to excessive room resonances, have been widely studied. Extensive efforts have been reported to enlarge the region over which room equalization is effective and to contrast variations of room transfer functions in space. A speaker-tuning technology "Trueplay" allows users to compensate for undesired room effects over an extended listening area based on a spatially averaged power response of the room, which is conventionally measured using microphones on portable devices when users move around the room. In this work, we propose a novel system that leverages measured speaker echo path self-responses to predict the room average power responses using a local PCA based approach. Experimental results confirm the effectiveness of the proposed estimation method, which further leads to a room compensation filter design that achieves a good sound similarity compared to the reference system with the ground-truth room average power response while outperforming other systems that do not leverage the proposed estimator.Comment: 5 pages, 7 figures, to appear in IWAENC 202

Utilization and Costs of Compounded Medications for Commercially Insured Patients, 2012 – 2013

Background: Although compounding has a long-standing tradition in clinical practice, insurers and pharmacy benefit managers have instituted policies to decrease claims for compounded medications, citing questions about their safety, efficacy, high costs, and lack of Food and Drug Administration (FDA) approval. There are no reliable published data on the extent of compounding by community pharmacists nor the fraction of patients who use compounded medications. Prior research suggests that compounded medications represent a relatively small proportion of prescription medications, but these surveys were limited by small sample sizes, subjective data collection methods, and low response rates. Objective: To determine the number of claims for compounded medications, on a per user per year (PUPY) basis, and the average ingredient cost of these claims among commercially insured patients in the United States (US) for 2012 and 2013. Methods: This study used prescription claims data from a nationally representative sample of commercially insured members whose pharmacy benefits were managed by a large pharmacy benefit management company. A retrospective claims analysis was conducted from January 1, 2012 through December 31, 2013. Annualized prevalence, cost, and utilization estimates were drawn from the data. All prescription claims were adjusted to 30-day equivalents. Data mining techniques (association rule mining) were employed in order to identify the most commonly combined ingredients in compounded medications. Results: The prevalence of compound users was 1.1% (245,285) of eligible members in 2012 and 1.4% (323,501) in 2013, an increase of 27.3%. Approximately 66% of compound users were female and the average age of a compound user was approximately 42 years throughout the study period. The geographic distribution of compound user prevalence was consistent across the US. Compound users’ prescription claims increased 36.6%, from approximately 7.1 million to approximately 9.7 million prescriptions from 2012 to 2013. The number of claims for compounded medications increased by 34.2% from 486,886 to 653,360 during the same period. PUPY utilization remained unchanged at 2 prescriptions per year from 2012 to 2013. The most commonly compounded drugs were similar for all adult age groups, and represented therapies typically indicated for chronic pain or hormone replacement therapy. The average ingredient cost for compounded medications increased by 130.3% from $308.49 to$710.36 from 2012 to 2013. The average ingredient cost for these users’ non-compounded prescriptions increased only 7.7%, from $148.75 to$160.20. For comparison, the average ingredient cost for all prescription users’ claims was $81.50 in 2012, and increased by 3.8$84.57 in 2013. Conclusions: Compound users represented 1.4% of eligible members in 2013. The average ingredient cost for compound users’ compounded prescriptions ($710.36) was greater than for non-compounded prescriptions ($160.20). The one-year increase in average compounded prescription costs (130.3%) was also greater than for non-compounded prescriptions (7.7%). Although prevalence of compound users and the PUPY utilization for compounded prescriptions increased only slightly between 2012 and 2013, the mean and median cost of compounded medications increased dramatically during this time. Text mining revealed that drug combinations characteristic of topical pain formulations were among the most frequently compounded medications for adults

Differences in Rate of Perceived Exertion and Workload Intensity in Males and Females during Submaximal Arm and Leg Ergometry

International Journal of Exercise Science 15(4): 1222-1235, 2022. Purpose: Arm ergometry (AE) is necessitated for individuals unable to perform leg ergometry (LE) exercise. This study explored gender differences in RPE and workload (WL) during AE and LE at submaximal target heart rates (THR). Methods: 35 healthy college-aged individuals were randomly allocated to begin exercise on either AE or LE. Participants exercised on both modes with increasing WL to achieve submaximal THRs of 110, 120, 130, 140 and 150 beats per minute (bpm). Factorial ANOVAs tested for differences in RPE and WL. Results: No significant differences were found in RPE between genders, as well as between arm and leg exercise (p \u3e 0.001). For WL, a significant main effect was found for mode with LE greater than AE (p \u3c 0.001), and gender, with males greater than females (p \u3c 0.001). A significant interaction effect was also found for HR and mode, with a greater increase in WL during LE compared to AE in both genders (p = 0.001). Conclusions: Exercise specialists typically prescribe exercise based on a chosen THR. The results of this study provide meaningful data on mean RPE and WL responses that a given THR elicits for ergometry. The finding of no differences in RPE between AE and LE informs the clinician that at any given submaximal THR, similar RPE scores can be expected during AE and LE. Further research is warranted to investigate differences in wider populations

GEANT: detector description and simulation tool

As the scale and complexity of High Energy Physics experiments increase, simulation studies require more and more care and become essential to design and optimise the detectors, develop and test the reconstruction and analysis programs, and interpret the experimental data. GEANT is a system of detector description and simulation tools that help physicists in such studies

Connecdenn, a novel DENN domain-containing protein of neuronal clathrin-coated vesicles functioning in synaptic vesicle endocytosis

Clathrin-coated vesicles (CCVs) are responsible for the endocytosis of multiple cargo, including synaptic vesicle membranes. We now describe a new CCV protein, termed connecdenn, that contains an N-terminal DENN (differentially expressed in neoplastic versus normal cells) domain, a poorly characterized protein module found in multiple proteins of unrelated function and a C-terminal peptide motif domain harboring three distinct motifs for binding the α-ear of the clathrin adaptor protein 2 (AP-2). Connecdenn coimmunoprecipitates and partially colocalizes with AP-2, and nuclear magnetic resonance and peptide competition studies reveal that all three α-ear-binding motifs contribute to AP-2 interactions. In addition, connecdenn contains multiple Src homology 3 (SH3) domain-binding motifs and coimmunoprecipitates with the synaptic SH3 domain proteins intersectin and endophilin A1. Interestingly, connecdenn is enriched on neuronal CCVs and is present in the presynaptic compartment of neurons. Moreover, connecdenn has a uniquely stable association with CCV membranes because it resists extraction with Tris and high-salt buffers, unlike most other CCV proteins, but it is not detected on purified synaptic vesicles. Together, these observations suggest that connecdenn functions on the endocytic limb of the synaptic vesicle cycle. Accordingly, disruption of connecdenn interactions with its binding partners through overexpression of the C-terminal peptide motif domain or knock down of connecdenn through lentiviral delivery of small hairpin RNA both lead to defects in synaptic vesicle endocytosis in cultured hippocampal neurons. Thus, we identified connecdenn as a component of the endocytic machinery functioning in synaptic vesicle endocytosis, providing the first evidence of a role for a DENN domain-containing protein in endocytosis

Abundant copy-number loss of CYCLOPS and STOP genes in gastric adenocarcinoma

Background Gastric cancer, a leading cause of cancer death worldwide, has been little studied compared with other cancers that impose similar health burdens. Our goal is to assess genomic copy-number loss and the possible functional consequences and therapeutic implications thereof across a large series of gastric adenocarcinomas. Methods We used high-density single-nucleotide polymorphism microarrays to determine patterns of copy-number loss and allelic imbalance in 74 gastric adenocarcinomas. We investigated whether suppressor of tumorigenesis and/or proliferation (STOP) genes are associated with genomic copy-number loss. We also analyzed the extent to which copy-number loss affects Copy-number alterations Yielding Cancer Liabilities Owing to Partial losS (CYCLOPS) genes–genes that may be attractive targets for therapeutic inhibition when partially deleted. Results The proportion of the genome subject to copy-number loss varies considerably from tumor to tumor, with a median of 5.5 %, and a mean of 12 % (range 0–58.5 %). On average, 91 STOP genes were subject to copy-number loss per tumor (median 35, range 0–452), and STOP genes tended to have lower copy-number compared with the rest of the genes. Furthermore, on average, 1.6 CYCLOPS genes per tumor were both subject to copy-number loss and downregulated, and 51.4 % of the tumors had at least one such gene. Conclusions The enrichment of STOP genes in regions of copy-number loss indicates that their deletion may contribute to gastric carcinogenesis. Furthermore, the presence of several deleted and downregulated CYCLOPS genes in some tumors suggests potential therapeutic targets in these tumors.Singapore. Ministry of Health (Duke-NUS Signature Research Programs)Singapore. Agency for Science, Technology and ResearchSingapore-MIT Allianc

Electric field-controlled synthesis and characterisation of single metal-organic-framework nanoparticles

Achieving control over the size distribution of metal organic framework (MOF) nanoparticles is key to biomedical applications and seeding techniques. Electrochemical control over the nanoparticle synthesis of the MOF, HKUST‐1, is achieved using a nanopipette injection method to locally mix Cu 2+ salt precursor and benzene tricarboxylate (BTC 3‐ ) ligand reagents, form MOF nanocrystals, and collect and characterise them on a TEM grid. In situ analysis of the size and translocation frequency of HKUST‐1 nanoparticles is demonstrated, using the nanopipette to detect resistive pulses as nanoparticles form. Complementary modelling of mass transport in the electric field, enables particle size to be estimated and explains the feasibility of particular reaction conditions, including inhibitory effects of excess BTC 3‐ . These new methods should be applicable to a variety of MOFs, and scaling up synthesis possible via arrays of nanoscale reaction centres, for example using nanopore membranes

Observing the Forest Canopy with a New Ultra-Violet Compact Airborne Lidar

We have developed a new airborne UV lidar for the forest canopy and deployed it in the Landes forest (France). It is the first one that: (i) operates at 355 nm for emitting energetic pulses of 16 mJ at 20 Hz while fulfilling eye-safety regulations and (ii) is flown onboard an ultra-light airplane for enhanced flight flexibility. Laser footprints at ground level were 2.4 m wide for a flying altitude of 300 m. Three test areas of ∼500 × 500 m2 with Maritime pines of different ages were investigated. We used a threshold method adapted for this lidar to accurately extract from its waveforms detailed forest canopy vertical structure: canopy top, tree crown base and undergrowth heights. Good detection sensitivity enabled the observation of ground returns underneath the trees. Statistical and one-to-one comparisons with ground measurements by field foresters indicated a mean absolute accuracy of ∼1 m. Sensitivity tests on detection threshold showed the importance of signal to noise ratio and footprint size for a proper detection of the canopy vertical structure. This UV-lidar is intended for future innovative applications of simultaneous observation of forest canopy, laser-induced vegetation fluorescence and atmospheric aerosols