Evaluation of a two-way, HIPAA-compliant text-messaging platform in a health system specialty pharmacy

PDJ Clark, PharmD, PGY1 Pharmacy Practice ResidentAdam Saulles, PharmD, CSP, BCACP; Tara Berkson, PharmD, BCACP Providence Health and Services, Portland, Oregon Evaluation of a two-way, HIPAA-compliant text-messaging platform in a health system specialty pharmacy Specialty medications, including those used to treat Multiple Sclerosis (MS), represent a growing proportion of prescription drug expenditures in the United States. MS is a chronic, progressive condition that requires maintenance therapy with disease-modifying medications. Many patients with MS rely on specialty pharmacies to obtain, dispense, and perform the necessary monitoring for these complex medication regimens. A study performed in 2017 by Munsell et al, demonstrated that only ~50% of patients with MS are adherent to prescribed regimens when initiating disease-modifying therapy. Routine pharmacy outreach could potentially help improve medication adherence in a population at high risk of disease progression secondary to non-adherence. Prior to July 2019, this health system specialty pharmacy only contacted MS patients via phone call to perform refill coordination and pharmacist follow-up. This strategy has been effective, but is not without flaws. Oftentimes, patients prefer not to receive phone calls or are unavailable during pharmacy business hours. This can lead to repeat outreach phone calls from caregivers and gaps in therapy. In July 2019, a HIPAA-compliant messaging platform was implemented. With this program, patients can respond to refill inquiries at their convenience and provide typed responses to medication-related safety, adherence, and efficacy follow-up questions sent by specialty pharmacists. This project seeks to identify whether implementation of the aforementioned messaging platform has had a quantifiable benefit on patient outreach and workflow outcomes within a health system specialty pharmacy setting. This single center, retrospective cohort analysis evaluated adult patients with a diagnosis of MS and at least 2 dispenses of disease-modifying medications. Data was collected via the electronic health record and the implemented text messaging application. The primary outcome is time between pharmacy technician outreach and medication refill. Secondary outcomes include medication adherence reported as medication possession ratio (MPR), the proportion of patients enrolled in the specialty pharmacy’s patient management program, patient satisfaction, and pharmacy phone call volume. Between group differences were described using simple descriptive statistics and T-tests, where applicable. A total of 335 patient had fills prior to and post-implementation of the text messaging platform, and 313 had multiple fills in each category, allowing for calculation of MPR. Response time (HH:MM ± 95% Confidence interval) was significantly decreased with utilization of text-message refill reminders (32:03 ± 7:09 vs 68:34 ± 11:37; phttps://digitalcommons.psjhealth.org/pharmacy_PGY1/1002/thumbnail.jp

First Recorded Mating Flight of the Hypogeic Ant, Acropyga epedana, with its Obligate Mutualist Mealybug, Rhizoecus colombiensis

On 26-July, 2005 a mating aggregation of Acropyga epedana Snelling (Hymenoptera: Formicidae) was observed in the Chiricahua Mountains in south-eastern Arizona. This is the first record of a mating flight of A. epedana, the only nearctic member of this pantropical genus. Mating behavior was observed, newly mated queens were collected, and a complete colony was excavated. New information is reported on the natural history and mating behavior of the species. The identity of a mealybug mutualist, Rhizoecus colombiensis (Homoptera: Rhizoecinae) is confirmed. Reproductive females participating in flights all carried mealybugs between their mandibles, indicating a vertical transfer of mealybugs with their ant hosts. No captured foundresses survived long in captivity, most likely due to the death of their mealybugs. The colony excavated had a single queen, though polygyny is common in the genus. Nearly all workers within the nest were heavily parasitized by mites, although males or gynes were not parasitized. These natural history observations are discussed with regard to this poorly understood mutualistic relationship between Acropyga ants and their mealybug partners

A novel targeted/untargeted GC-Orbitrap metabolomics methodology applied to Candida albicans and Staphylococcus aureus biofilms

Introduction: Combined infections from Candida albicans and Staphylococcus aureus are a leading cause of death in the developed world. Evidence suggests that Candida enhances the virulence of Staphylococcus—hyphae penetrate through tissue barriers, while S. aureus tightly associates with the hyphae to obtain entry to the host organism. Indeed, in a biofilm state, C. albicans enhances the antimicrobial resistance characteristics of S. aureus. The association of these microorganisms is also associated with significantly increased morbidity and mortality. Due to this tight association we hypothesised that metabolic effects were also in evidence. Objectives: To explore the interaction, we used a novel GC-Orbitrap-based mass spectrometer, the Q Exactive GC, which combines the high peak capacity and chromatographic resolution of gas chromatography with the sub-ppm mass accuracy of an Orbitrap system. This allows the capability to leverage the widely available electron ionisation libraries for untargeted applications, along with expanding accurate mass libraries and targeted matches based around authentic standards. Methods: Optimised C. albicans and S. aureus mono- and co-cultured biofilms were analysed using the new instrument in addition to the fresh and spent bacterial growth media. Results: The targeted analysis experiment was based around 36 sugars and sugar phosphates, 22 amino acids and five organic acids. Untargeted analysis resulted in the detection of 465 features from fresh and spent medium and 405 from biofilm samples. Three significantly changing compounds that matched to high scoring library fragment patterns were chosen for validation. Conclusion: Evaluation of the results demonstrates that the Q Exactive GC is suitable for metabolomics analysis using a targeted/untargeted methodology. Many of the results were as expected: e.g. rapid consumption of glucose and fructose from the medium regardless of the cell type. Modulation of sugar-phosphate levels also suggest that the pentose phosphate pathway could be enhanced in the cells from co-cultured biofilms. Untargeted metabolomics results suggested significant production of cell-wall biosynthesis components and the consumption of non-proteinaceous amino-acids

Timing and documentation of key events in neonatal resuscitation

Only a minority of babies require extended resuscitation at birth. Resuscitations concerning babies who die or who survive with adverse outcomes are increasingly subject to medicolegal scrutiny. Our aim was to describe real-life timings of key resuscitation events observed in a historical series of newborns who required full resuscitation at birth. Twenty-seven babies born in our centre over a 10-year period had an Apgar score of 0 at 1 min and required full resuscitation. The median (95% confidence interval) postnatal age at achieving key events were commencing cardiac compressions, 2.0 (1.5–4.0) min; endotracheal intubation, 3.8 (2.0–6.0) min; umbilical venous catheterisation 9.0 (7.5–12.0) min; and administration of first adrenaline dose 10.0 (8.0–14.0) min. Conclusion: The wide range of timings presented from real-life cases may prove useful to clinicians involved in medical negligence claims and provide a baseline for quality improvements in resuscitation training

Liver-Targeting of Interferon-Alpha with Tissue-Specific Domain Antibodies

PMCID: PMC3581439This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Lab Retriever: a software tool for calculating likelihood ratios incorporating a probability of drop-out for forensic DNA profiles

BACKGROUND: Technological advances have enabled the analysis of very small amounts of DNA in forensic cases. However, the DNA profiles from such evidence are frequently incomplete and can contain contributions from multiple individuals. The complexity of such samples confounds the assessment of the statistical weight of such evidence. One approach to account for this uncertainty is to use a likelihood ratio framework to compare the probability of the evidence profile under different scenarios. While researchers favor the likelihood ratio framework, few open-source software solutions with a graphical user interface implementing these calculations are available for practicing forensic scientists. RESULTS: To address this need, we developed Lab Retriever, an open-source, freely available program that forensic scientists can use to calculate likelihood ratios for complex DNA profiles. Lab Retriever adds a graphical user interface, written primarily in JavaScript, on top of a C++ implementation of the previously published R code of Balding. We redesigned parts of the original Balding algorithm to improve computational speed. In addition to incorporating a probability of allelic drop-out and other critical parameters, Lab Retriever computes likelihood ratios for hypotheses that can include up to four unknown contributors to a mixed sample. These computations are completed nearly instantaneously on a modern PC or Mac computer. CONCLUSIONS: Lab Retriever provides a practical software solution to forensic scientists who wish to assess the statistical weight of evidence for complex DNA profiles. Executable versions of the program are freely available for Mac OSX and Windows operating systems. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12859-015-0740-8) contains supplementary material, which is available to authorized users

Experimental evidence for the preservation of U-Pb isotope ratios in mantle-recycled crustal zircon grains

Zircon of crustal origin found in mantle-derived rocks is of great interest because of the information it may provide about crust recycling and mantle dynamics. Consideration of this requires understanding of how mantle temperatures, notably higher than zircon crystallization temperatures, affected the recycled zircon grains, particularly their isotopic clocks. Since Pb2+ diffuses faster than U4+ and Th+4, it is generally believed that recycled zircon grains lose all radiogenic Pb after a few million years, thus limiting the time range over which they can be detected. Nonetheless, this might not be the case for zircon included in mantle minerals with low Pb2+ diffusivity and partitioning such as olivine and orthopyroxene because these may act as zircon sealants. Annealing experiments with natural zircon embedded in cristobalite (an effective zircon sealant) show that zircon grains do not lose Pb to their surroundings, although they may lose some Pb to molten inclusions. Diffusion tends to homogenize the Pb concentration in each grain changing the U-Pb and Th-Pb isotope ratios proportionally to the initial 206Pb, 207Pb and 208Pb concentration gradients (no gradient-no change) but in most cases the original age is still recognizable. It seems, therefore, that recycled crustal zircon grains can be detected, and even accurately dated, no matter how long they have dwelled in the mantle.This paper has been financed by the Spanish Grants CGL2013-40785-P and CGL2017-84469-P

Bayesian modeling of recombination events in bacterial populations

Background: We consider the discovery of recombinant segments jointly with their origins within multilocus DNA sequences from bacteria representing heterogeneous populations of fairly closely related species. The currently available methods for recombination detection capable of probabilistic characterization of uncertainty have a limited applicability in practice as the number of strains in a data set increases. Results: We introduce a Bayesian spatial structural model representing the continuum of origins over sites within the observed sequences, including a probabilistic characterization of uncertainty related to the origin of any particular site. To enable a statistically accurate and practically feasible approach to the analysis of large-scale data sets representing a single genus, we have developed a novel software tool (BRAT, Bayesian Recombination Tracker) implementing the model and the corresponding learning algorithm, which is capable of identifying the posterior optimal structure and to estimate the marginal posterior probabilities of putative origins over the sites. Conclusion: A multitude of challenging simulation scenarios and an analysis of real data from seven housekeeping genes of 120 strains of genus Burkholderia are used to illustrate the possibilities offered by our approach. The software is freely available for download at URL http://web.abo.fi/fak/ mnf//mate/jc/software/brat.html

Evaluation of a New Balloon Catheter for Difficult Calcified Lesions in Infrainguinal Arterial Disease: Outcome of a Multicenter Registry

The purpose of this study was to assess the technical performance and immediate procedure outcome of a new balloon catheter in the treatment of calcified lesions in infrainguinal arterial disease. Seventy-five patients with infrainguinal arterial disease were prospectively entered into the registry. The catheter (ReeKross Clearstream, Ireland) is a 5- to 6-Fr balloon catheter with a rigid shaft intended for enhanced pushability. Only technical procedural outcome was recorded. Treated calcified lesions (range: 5–30 cm), assessed angiographically, were located in the superficial femoral, popliteal, and crural arteries. In 67 patients the lesion was an occlusion. Guidewire passage occurred subintimally in 68 patients. In 24 patients a standard balloon catheter was chosen as first treatment catheter: 5 failed to cross the lesion, 8 balloons ruptured, and in 11 patients there was an inadequate dilatation result. In only one of the five patients did subsequent use of the ReeKross catheter also fail in lesion crossing. The ReeKross was successful as secondary catheter in the other 23 cases. In 50 patients the ReeKross was used as primary catheter. In total the ReeKross crossed the lesions in 74 patients. After passage and dilatation with this catheter in 73 patients (1 failed true-lumen reentry), 19 had >30% residual lesions, of which 11 were not treated and 8 were successfully stented. No ReeKross balloons ruptured. We conclude that in the treatment of difficult calcified lesions in arterial stenotic or occlusive disease, the choice of a high-pushability angioplasty catheter, with more calcification-resistant balloon characteristics, like the ReeKross, warrants consideration