A Pharmacist-Led, Patient-Centered Program Incorporating Motivational Interviewing for Behavior Change to Improve Adherence Rates and Star Ratings in a Medicare Plan.

INTRODUCTION:The Medicare 5-star quality rating system was designed to drive improvements in Medicare quality and to increase accountability among Medicare plans. Medicare star ratings provide significant bonuses for plans that improve medication adherence. Envolve's pharmacy division, Envolve Pharmacy Solutions, which provides services for Medicare Advantage Prescription Drug plans, developed an in-house medication therapy management (MTM) program to improve adherence rates and subsequent star ratings. As part of this program, Envolve invested in motivational interviewing (MI) as a means to improve adherence to antihypertensives, antihyperlipidemics, and antidiabetics but recognized the need for additional staff training to ensure pharmacist success with MI techniques. Thus, Envolve engaged a consultant to help train pharmacists and evaluate the program. This best practices article describes the implementation of an MI program and subsequent changes in patient adherence and star ratings. PROGRAM DESCRIPTION:A pharmacist-led, patient-centered adherence program incorporating MI for behavior change was developed and implemented at Envolve. The program used didactic learning, coaching and skills assessments, and a train-the-trainer (TtT) intervention. This approach resulted in improved adherence rates in all 3 therapeutic classes immediately. In addition, a quality improvement process was incorporated to evaluate the improvements in adherence with this new program over 24 months. OBSERVATIONS:Key findings of the program are as follows: (a) the program increased adherence rates 5-9 percentage points (chi-square tests for all plans and drug classes measured, P < 0.05) over 5 years and improved Medicare star ratings by 1-2 stars; (b) there is a need for support of pharmacy MTM managers to ensure continued success of the program; and (c) there is value in a TtT program for managers that allows them to provide continuous evaluation and feedback to staff for improvement. IMPLICATIONS:Each year, as the Medicare star ratings system matures and plans are held more accountable for improving adherence measures, high star ratings become more difficult to attain. This MI TtT program for pharmacists allows for rapid cycle change in response to these challenges. DISCLOSURES:Funding was provided by Envolve Pharmacy Solutions, which contracted with the University of California, San Francisco (UCSF), School of Pharmacy for the development and implementation of the motivational interviewing and train-the-trainer programs described in this best practices article. Spears, Erkens, and Misquitta are employees of Envolve Pharmacy Solutions. Stebbins and Cutler are faculty in the Department of Clinical Pharmacy at the UCSF School of Pharmacy, who were contracted through Envolve Pharmacy Solutions to provide consulting services for this best practice

The Vehicle, Spring 1994

Table of Contents Thoughts in the IGASue Songerpage 6 The Cries of an Innocent Tea BagWojnarowski Yvonnepage 7 Proud HarpySusan Eisenhourpage 8 Bus Number TwoMindy Glazepage 9 My Home TownScott Langenpage 10 MemoriesMaggie Willpage 11 Vase (Artwork)Gail Valkerpage 12 The Last HuntMark Kannmacherpage 13 Corn DanceJulia A. Canhampage 14 Untitled (Photography)Rachel Corbettpage 14 Paradise (Artwork)Gail Valkerpage 15 Holding Back A ScreamElise Kirarpage 16 poetry isJonathan W. Iwanskipage 17 loveCatherine DeGraafpage 18 The OneTim Rileypage 18 Reading His Words on a Frosty EveningTom McGrathpage 19 UntitledBob Newellpage 19 The Ice StormMindy Glazepage 20 UntitledJonathan W. Iwanskipage 21 Untitled (Photography)Rachel Corbettpage 23 cityscapeChris Pomeroypage 24 Untitled (Photography)Rachel Corbettpage 25 Quarter Pound TemptationBryan Levekpage 26 Photograph (Artwork)Gail Valkerpage 29 Don\u27t Talk to StrangersJon Montgomerypage 30 Untitled (Photography)Rachel Corbettpage 33 Charleston, U.S.A. (Artwork)Gail Valkerpage 34 Fun With Nature (Artwork)Gail Valkerpage 34https://thekeep.eiu.edu/vehicle/1064/thumbnail.jp

Bostonia

Founded in 1900, Bostonia magazine is Boston University's main alumni publication, which covers alumni and student life, as well as university activities, events, and programs

Accumulation of the transcription factor ABA-insensitive (ABI)4 is tightly regulated post-transcriptionally

ABA-INSENSITIVE (ABI)4 is a transcription factor implicated in response to ABA in maturing seeds, and seedling responses to ABA, salt, and sugar. Previous studies have shown that ABI4 transcripts are high in seeds and in seedlings exposed to high concentrations of glucose and, to a lesser extent, osmotic agents and ABA, but that transcript levels are very low through most of vegetative growth. This study examined ABI4 protein accumulation indirectly, using transgenic lines expressing fusions to GFP and GUS. The GFP fusions were active, but undetectable visually or immunologically. Comparison of transcript and activity levels for GUS expression showed that inclusion of the ABI4 coding sequence reduced the ratio of activity to transcript ∼40-fold when driven by the CaMV 35S promoter, and nearly 150-fold when controlled by the ABI4 promoter. At least part of this discrepancy is due to proteasomal degradation of ABI4, resulting in a half-life of 5–6 h for the ABI4–GUS fusion. Comparison of the spatial localization of transcripts and fusion proteins indicated that the protein preferentially accumulated in roots such that transcript and protein distribution had little similarity. The components mediating targeting to the proteasome or other mechanisms of spatial restriction have not yet been identified, but several domains of ABI4 appear to contribute to its instability

Wide-area mapping of small-scale features in agricultural landscapes using airborne remote sensing

Natural and semi-natural habitats in agricultural landscapes are likely to come under increasing pressure with the global population set to exceed 9 billion by 2050. These non-cropped habitats are primarily made up of trees, hedgerows and grassy margins and their amount, quality and spatial configuration can have strong implications for the delivery and sustainability of various ecosystem services. In this study high spatial resolution (0.5 m) colour infrared aerial photography (CIR) was used in object based image analysis for the classification of non-cropped habitat in a 10,029 ha area of southeast England. Three classification scenarios were devised using 4 and 9 class scenarios. The machine learning algorithm Random Forest (RF) was used to reduce the number of variables used for each classification scenario by 25.5 % ± 2.7%. Proportion of votes from the 4 class hierarchy was made available to the 9 class scenarios and where the highest ranked variables in all cases. This approach allowed for misclassified parent objects to be correctly classified at a lower level. A single object hierarchy with 4 class proportion of votes produced the best result (kappa 0.909). Validation of the optimum training sample size in RF showed no significant difference between mean internal out-of-bag error and external validation. As an example of the utility of this data, we assessed habitat suitability for a declining farmland bird, the yellowhammer (Emberiza citronella), which requires hedgerows associated with grassy margins. We found that ∼22% of hedgerows were within 200 m of margins with an area >183.31 m2. The results from this analysis can form a key information source at the environmental and policy level in landscape optimisation for food production and ecosystem service sustainability

UNCOVER: Illuminating the Early Universe -- JWST/NIRSpec Confirmation of z>12z > 12 Galaxies

Observations of high-redshift galaxies provide a critical direct test to the theories of early galaxy formation, yet to date, only four have been spectroscopically confirmed at $z>12$. Due to strong gravitational lensing over a wide area, the galaxy cluster field Abell~2744 is ideal for searching for the earliest galaxies. Here we present JWST/NIRSpec observations of two galaxies: a robust detection at $z_{\rm spec} = 12.393^{+0.004}_{-0.001}$, and a plausible candidate at $z_{\rm spec} = 13.079^{+0.013}_{-0.001}$. The galaxies are discovered in JWST/NIRCam imaging and their distances are inferred with JWST/NIRSpec spectroscopy, all from the JWST Cycle 1 UNCOVER Treasury survey. Detailed stellar population modeling using JWST NIRCam and NIRSpec data corroborates the primeval characteristics of these galaxies: low mass ($\sim 10^8~{\rm M_\odot}$), young, rapidly-assembling, metal-poor, and star-forming. Interestingly, both galaxies are spatially resolved, having lensing-corrected rest-UV effective radii on the order of 300-400 pc, which are notably larger than other spectroscopically confirmed $z \gtrsim 12$ systems. The observed dynamic range of $z \gtrsim 12$ size spans over an order of magnitude, implying a significant scatter in the size-mass relation at early times. Deep into the epoch of reionization, these discoveries elucidate the emergence of the first galaxies.Comment: submitted to ApJL; 13 pages, 4 figures, 2 table

UNCOVER: The growth of the first massive black holes from JWST/NIRSpec -- spectroscopic confirmation of an X-ray luminous AGN at z=10.1

The James Webb Space Telescope is now detecting early black holes (BHs) as they transition from "seeds" to supermassive BHs. Recently Bogdan et al. (2023) reported the detection of an X-ray luminous supermassive BH, UHZ-1, with a photometric redshift at $z > 10$. Such an extreme source at this very high redshift provides new insights on seeding and growth models for BHs given the short time available for formation and growth. Harnessing the exquisite sensitivity of JWST/NIRSpec, here we report the spectroscopic confirmation of UHZ-1 at $z = 10.073 \pm 0.002$. We find that the NIRSpec/Prism spectrum is typical of recently discovered z~10 galaxies, characterized primarily by star-formation features. We see no clear evidence of the powerful X-ray source in the rest-frame UV/optical spectrum, which may suggest heavy obscuration of the central BH, in line with the Compton-thick column density measured in the X-rays. We perform a stellar population fit simultaneously to the new NIRSpec spectroscopy and previously available photometry. The fit yields a stellar mass estimate for the host galaxy that is significantly better constrained than prior photometric estimates ($M_*\sim 1.4^{+0.3}_{-0.4} \times 10^8 M_\odot$). Given the predicted BH mass ($M_{\rm BH}\sim10^7-10^8 M_\odot$), the resulting ratio of $M_{\rm BH}/M_*$ remains two to three orders of magnitude higher than local values, thus lending support to the heavy seeding channel for the formation of supermassive BHs within the first billion years of cosmic evolution.Comment: 9 pages, 4 figures, submitted to ApJL. Minor text correction

UNCOVER: A NIRSpec Identification of a Broad-line AGN at z = 8.50

Deep observations with the James Webb Space Telescope (JWST) have revealed an emerging population of red pointlike sources that could provide a link between the postulated supermassive black hole seeds and observed quasars. In this work, we present a JWST/NIRSpec spectrum from the JWST Cycle 1 UNCOVER Treasury survey of a massive accreting black hole at z = 8.50 displaying a clear broad-line component as inferred from the Hβ line with FWHM = 3439 ± 413 km s−1, typical of the broad-line region of an active galactic nucleus (AGN). The AGN nature of this object is further supported by high ionization, as inferred from emission lines, and a point-source morphology. We compute a black hole mass of and a bolometric luminosity of Lbol ∼ 6.6 × 1045 erg s−1. These values imply that our object is accreting at ∼40% of the Eddington limit. Detailed modeling of the spectral energy distribution in the optical and near-infrared, together with constraints from ALMA, indicate an upper limit on the stellar mass of , which would lead to an unprecedented ratio of black hole to host mass of at least ∼30%. This is orders of magnitude higher compared to the local QSOs but consistent with recent AGN studies at high redshift with JWST. This finding suggests that a nonnegligible fraction of supermassive black holes either started out from massive seeds and/or grew at a super-Eddington rate at high redshift. Given the predicted number densities of high-z faint AGN, future NIRSpec observations of larger samples will allow us to further investigate galaxy–black hole coevolution in the early Universe

A Novel Fluorescent Imaging Agent for Diffuse Optical Tomography of the Breast: First Clinical Experience in Patients

Purpose: This is the first clinical evaluation of a novel fluorescent imaging agent (Omocianine) for breast cancer detection with diffuse optical tomography (DOT). Procedures: Eleven women suspected of breast cancer were imaged with DOT at multiple time points (up to 24 h) after receiving an intravenous injection of Omocianine (doses 0.01 to 0.1 mg/kg bodyweight). Breast MRI was obtained for comparison. Results: Histopathology showed invasive cancer in ten patients and fibroadenoma in one patient. With the lowest dose of Omocianine, two of three lesions were detected; with the second dose, three of three lesions were detected; with the two highest doses, none of five lesions were detected. Lesion location on DOT showed excellent agreement with MRI. Optimal lesion-tobackground signals were obtained after 8 h. No adverse events occurred. Conclusions: Lowest doses of Omocianine performed best in lesion detection; DOT using a lowdose fluorescent agent is feasible and safe for breast cancer visualization in patients