Implementation of a Clinical Pharmacist in a Hemodialysis Facility: A Quality Improvement Report

Rationale & Objective: Hemodialysis (HD) patients have complicated disease states, placing them at higher risk for medication-related problems, medication discrepancies, and nonadherence. The objective of this study is to evaluate the impact of a clinical pharmacist in a single HD facility by assessing the efficacy of medication reconciliation in HD patients and evaluating the potential impact on a single health care system. Study Design: Retrospective study. Setting & Participants: Greenfield Health Systems, a wholly owned subsidiary of Henry Ford Health, operates 14 HD facilities throughout Southeast Michigan. The West Pavilion facility is located in Detroit, MI. Patients with end-stage kidney disease included in the study had a minimum of 4 encounters with the clinical pharmacist or pharmacy interns between August 2017 and October 2018. Exposure: A clinical pharmacist performed medication reconciliation and medication reviews with HD patients to assess medication-related problems and identify gaps in care. Interventions made by the pharmacist were prespecified through a collaborative practice agreement. Outcomes: To evaluate the impact of a clinical pharmacist in an HD facility by assessing the efficacy of medication reconciliation in HD patients and evaluating the potential impact on this health system through an estimated cost avoidance. Analytical Approach: Descriptive statistics were used to collect medication-related problems and classified based on a modified Hepler-Strand approach. Results: There were 1,403 medication-related problems, with an average of 8.96 medication-related problems per patient. Adherence was the most common medication-related problem (31%). Antihypertensive medication was the most common drug class in which the pharmacist intervened (37%), followed by vitamin D analogues and calcimimetics (29%). A projected total of US $447,355 was saved. Limitations: Retrospective analysis of observational data and descriptive statistics with the potential for residual bias and confounding. Conclusions: Pharmacists in HD facilities have a positive influence on HD patients through medication management that results in cost savings

Detection of a Substantial Molecular Gas Reservoir in a brightest cluster galaxy at z = 1.7

We report the detection of CO(2-1) emission coincident with the brightest cluster galaxy (BCG) of the high-redshift galaxy cluster SpARCS1049+56, with the Redshift Search Receiver (RSR) on the Large Millimetre Telescope (LMT). We confirm a spectroscopic redshift for the gas of z = 1.7091+/-0.0004, which is consistent with the systemic redshift of the cluster galaxies of z = 1.709. The line is well-fit by a single component Gaussian with a RSR resolution-corrected FWHM of 569+/-63 km/s. We see no evidence for multiple velocity components in the gas, as might be expected from the multiple image components seen in near-infrared imaging with the Hubble Space Telescope. We measure the integrated flux of the line to be 3.6+/-0.3 Jy km/s and, using alpha_CO = 0.8 Msun (K km s^-1 pc^2)^-1 we estimate a total molecular gas mass of 1.1+/-0.1x10^11 Msun and a M_H2/M_star ~ 0.4. This is the largest gas reservoir detected in a BCG above z > 1 to date. Given the infrared-estimated star formation rate of 860+/-130 Msun/yr, this corresponds to a gas depletion timescale of ~0.1Gyr. We discuss several possible mechanisms for depositing such a large gas reservoir to the cluster center -- e.g., a cooling flow, a major galaxy-galaxy merger or the stripping of gas from several galaxies -- but conclude that these LMT data are not sufficient to differentiate between them.Comment: accepted for publication in ApJ Letter

The Phase Space and Stellar Populations of Cluster Galaxies at z ~ 1: Simultaneous Constraints on the Location and Timescale of Satellite Quenching

We investigate the velocity vs. position phase space of z ~ 1 cluster galaxies using a set of 424 spectroscopic redshifts in 9 clusters drawn from the GCLASS survey. Dividing the galaxy population into three categories: quiescent, star-forming, and poststarburst, we find that these populations have distinct distributions in phase space. Most striking are the poststarburst galaxies, which are commonly found at small clustercentric radii with high clustercentric velocities, and appear to trace a coherent ``ring" in phase space. Using several zoom simulations of clusters we show that the coherent distribution of the poststarbursts can be reasonably well-reproduced using a simple quenching scenario. Specifically, the phase space is best reproduced if satellite quenching occurs on a rapid timescale (0.1 < tau_{Q} < 0.5 Gyr) after galaxies make their first passage of R ~ 0.5R_{200}, a process that takes a total time of ~ 1 Gyr after first infall. We compare this quenching timescale to the timescale implied by the stellar populations of the poststarburst galaxies and find that the poststarburst spectra are well-fit by a rapid quenching (tau_{Q} = 0.4^{+0.3}_{-0.4} Gyr) of a typical star-forming galaxy. The similarity between the quenching timescales derived from these independent indicators is a strong consistency check of the quenching model. Given that the model implies satellite quenching is rapid, and occurs well within R_{200}, this would suggest that ram-pressure stripping of either the hot or cold gas component of galaxies are the most plausible candidates for the physical mechanism. The high cold gas consumption rates at z ~ 1 make it difficult to determine if hot or cold gas stripping is dominant; however, measurements of the redshift evolution of the satellite quenching timescale and location may be capable of distinguishing between the two.Comment: 10 pages, 4 figures, submitted to the Ap

Peroxisome proliferator-activated receptor -β/δ, -γ Agonists and resveratrol modulate hypoxia induced changes in nuclear receptor activators of muscle oxidative metabolism

PPAR-α, PPAR-β, and PPAR-γ, and RXR in conjunction with PGC-1α and SIRT1, activate oxidative metabolism genes determining insulin sensitivity. In utero, hypoxia is commonly observed in Intrauterine Growth Restriction (IUGR), and reduced insulin sensitivity is often observed in these infants as adults. We sought to investigate how changes in oxygen tension might directly impact muscle PPAR regulation of oxidative genes. Following eight days in culture at 1 oxygen, C2C12 muscle myoblasts displayed a reduction of PGC-1α, PPAR-α, and RXR-α mRNA, as well as CPT-1b and UCP-2 mRNA. SIRT1 and PGC-1α protein was reduced, and PPAR-γ protein increased. The addition of a PPAR-β agonist (L165,041) for the final 24 hours of 1 treatment resulted in increased levels of UCP-2 mRNA and protein whereas Rosiglitazone induced SIRT1, PGC-1α, RXR-α, PPAR-γ, CPT-1b, and UCP-2 mRNA and SIRT1 protein. Under hypoxia, Resveratrol induced SIRT1, RXR-, PPAR- mRNA, and PPAR- and UCP-2 protein. These findings demonstrate that hypoxia alters the components of the PPAR pathway involved in muscle fatty acid oxidative gene transcription and translation. These results have implications for understanding selective hypoxia adaptation and how it might impact long-term muscle oxidative metabolism and insulin sensitivity. Copyright © 2010 Timothy R. H. Regnault et al

The effect of climate change on Dreissena polymorpha, a multiregional invasive species in North America

To study the effect of climate change across different latitudinal gradients on an aquatic invasive species in North America, filtration rates of Dreissena polymorpha were examined as part of a manipulative experiment. We took into consideration three regions across North America that the Intergovernmental Panel on Climate Change (IPCC) predicts to experience different increases in temperature by the year 2100. These three climates were simulated at the University of Michigan Biological Station in Pellston, MI and used as habitats for D. polymorpha. The effect of climate change was taken into consideration by measuring the chlorophyll A concentration at current average lake temperatures and temperatures adjusted for climate change predictions. We found that only the trials run at the mid-latitudinal region (Douglas Lake of Pellston, MI) showed a significant difference between D. polymorpha filtration rates at current and predicted climate change temperatures. We did not see a significant difference in filtration rates between the environments at current and predicted climate change temperatures at the higher (Flindt Lake of Ignace, ON) or lower (Lake Placid of Lake Placid, FL) latitudinal region. In addition, we examined the differences in D. polymorpha filtration rates due to increased temperature between the three latitudinal regions. Upon analysis of our data, we did not find a significant difference in this respect.http://deepblue.lib.umich.edu/bitstream/2027.42/64578/1/Jilek_Sookhai_Yee_Lande_2009.pd

Furthering the Growth of Cloud Computing by Providing Privacy as a Service

The evolution of Cloud Computing as a viable business solution for providing hardware and software has created many security concerns. Among these security concerns, privacy is often overlooked. If Cloud Computing is to continue its growth, this privacy concern will need to be addressed. In this work we discuss the current growth of Cloud Computing and the impact the public sector and privacy can have in furthering this growth. To begin to provide privacy protection for Cloud Computing, we introduce privacy constraints that outline privacy preferences. We propose the expansion of Cloud Service Level Agreements (SLAs) to include these privacy constraints as Quality of Service (QoS) levels. This privacy QoS must be agreed upon along with the rest of the QoS terms within the SLA by the Cloud consumer and provider. Finally, we introduce Privacy as a Service (PraaS) to monitor the agreement and provide enforcement if necessary