bluuebunny/crossref_metadata_2025 huggingface dataset:
Likelihood Maximization and Moment Matching in Low SNR Gaussian Mixture Models
Authors: Katsevich Anya , Bandeira Afonso S.
Published: April 2022

We derive an asymptotic expansion for the log‐likelihood of Gaussian mixture models (GMMs) with equal covariance matrices in the low signal‐to‐noise regime. The expansion reveals an intimate connection between two types of algorithms for parameter estimation: the method of moments and likelihood optimizing algorithms such as Expectation‐Maximization (EM). We show that likelihood optimization in the low SNR regime reduces to a sequence of least squares optimization problems that match the moments of the estimate to the ground truth moments one by one. This connection is a stepping stone towards the analysis of EM and maximum likelihood estimation in a wide range of models. A motivating application for the study of low SNR mixture models is cryo‐electron microscopy data, which can be modeled as a GMM with algebraic constraints imposed on the mixture centers. We discuss the application of our expansion to algebraically constrained GMMs, among other example models of interest. © 2022 The Authors. Communications on Pure and Applied Mathematics published by Wiley Periodicals LLC.
Upcycling Plastic Wastes into Value‐Added Products by Heterogeneous Catalysis
Authors: Tan Tian , Wang Wei , Zhang Kai , Zhan Zixiang , Deng Weiping , Zhang Qinghong , Wang Ye
Published: April 2022

Plastics are playing essential roles in the modern society. The majority of them enter environment through landfilling or discarding after turning into wastes, causing severe carbon loss and imposing high risk to ecosystem and human health. Currently, physical recycling serves as the primary method to reuse plastic waste, but this method is limited to thermoplastic recycling. The quality of recycled plastics gradually deteriorates because of the undesirable degradation in the recycling process. Under such background, catalytic upcycling, which can upgrade various plastic wastes into value‐added products under mild conditions, has attracted recent attention as a promising strategy to treat plastic wastes. This Review highlights recent advances in the development of efficient heterogeneous catalysts and useful strategies for upcycling plastics into liquid hydrocarbons, arene compounds, carbon materials, hydrogen, and other value‐added chemicals. The functions of catalysts and the reaction mechanisms are discussed. The key factors that influence the catalytic performance are also analyzed.
Neighborhood rough set‐based route selection for mobile ad hoc networks
Authors: Sudhakar Tharuman , Sambath Kumar Sethuraman , Ravi Vinayakumar , Ramalingam Rajakumar , Dua Sonu
Published: April 2022

The main aim of this paper is to address the problem of redundant broadcast packets using the extension of rough set concept. In general, a rough set is a mathematical tool for dealing with issues of uncertainty. In MANET, mobile nodes are moving from one place to another place in a simulation environment; hence, it creates uncertainty issues. Due to the fast mobility of mobile nodes, network metrics such as bandwidth and hop count vary. The findings were useful in identifying and improving the network's performance. The proposed NRS‐based route selection approach has been compared with conventional techniques such as rough set, covering rough set (CRS). The reduced control packets are obtained using pruning concept based on selection of one‐hop and two‐hop nodes. Eventually, the proposed approach proved that it attains a higher throughput (85%), reducing the route request packets (3406) and delay of data transmission (0.02274 s). Also, two well‐known ad hoc routing protocols were used such as Dynamic Source Routing (DSR) and Ad Hoc On‐Demand Distance Vector (AODV) protocols.
An enhanced distance and residual energy‐based congestion aware ant colony optimization routing for vehicular ad hoc networks
Authors: Ramamoorthy Raghu , Thangavelu Menakadevi
Published: April 2022

Due to the ad hoc nature of vehicular ad hoc networks (VANETs), routing in VANETs is challenging. Using an energy‐efficient shortest path without congestion (EESPWC) increases routing efficiency by satisfying specific parameters (high throughput, high packet delivery ratio, low overhead, low end‐to‐end delay, low packet loss ratio, and low energy consumption). In this work, enhanced distance and residual energy‐based congestion aware ant colony optimization (EDR‐CAACO) for VANETs is proposed to find an EESPWC. The proposed EESPWC produces high throughput and high packet delivery ratio with low overhead and low delay. In EDR‐CAACO, the roulette wheel selects the EESPWC based on the link's fitness values. The fitness value is computed based on the pheromone level of the link. The enhanced ACO (ant colony optimization) of the proposed model relies on the distance, residual, and congestion levels of the vehicles to estimate pheromone levels. For path selection, the roulette wheel relies on links that have the highest fitness value. The combination of high fitness value links provides an energy‐efficient non‐congested shortest route. The simulation results prove that the overall performance of EDR‐CAACO is better than Improved Distance Based Ant Colony Optimization Routing (IDBACOR), Fuzzy‐based Ant colony optimization (F‐ANT), ant colony optimization routing algorithm (ARA), and AntNet in terms of throughput, routing overhead, packet delivery ratio, end to end delay, and packet loss rate.
Focus on affordability, student support leads to enrollment growth
Authors: Hope Joan
Published: April 2022

A few years ago, members of the board asked Ryan Smith, President of the University of Rio Grande and Rio Grande Community College in Ohio, what his biggest worry was. He told them he was concerned the institution would run out of space in the residence halls. At the time, Rio Grande had about 180 residents and capacity for 500 to live on campus.
Recent Progress and Prospects on Dendrite‐free Engineerings for Aqueous Zinc Metal Anodes
Authors: Jiang Jiangmin , Li Zhiwei , Pan Zhenghui , Wang Shijing , Chen Yaxin , Zhuang Quanchao , Ju Zhicheng , Zhang Xiaogang
Published: April 2022

Rechargeable zinc‐ion batteries with mild aqueous electrolytes are one of the most promising systems for large‐scale energy storage as a result of their inherent safety, low cost, environmental‐friendliness, and acceptable energy density. However, zinc metal anodes always suffer from unwanted dendrite growth, leading to low Coulombic efficiency and poor cycle stability and during the repeated plating/stripping processes, which substantially restrict their further development and application. To solve these critical issues, a lot of research works have been dedicated to overcoming the drawbacks associated with zinc metal anodes. In this overview, the working mechanisms and existing issues of the zinc metal anodes are first briefly outlined. Moreover, we look into the ongoing processes of the different strategies for achieving highly stable and dendrite‐free zinc metal anodes, including crystal engineering, structural engineering, coating engineering, electrolyte engineering, and separator engineering. Finally, some challenges being faced and prospects in this field are provided, together with guiding significant research directions in the future.
Resilience assessment methods for hospitals subjected to earthquakes: State of the art
Authors: Yu Peng , Zhai Changhai , Liu Jin , Pei Shunshun , Song Zhuoru , Xie Lili
Published: April 2022

Hospitals play essential roles in modern communities in the lives of people. During and after earthquakes, they are supposed to be resilient and provide continued medical and social services. Resilience assessment methods are essential for determining hospitals' resilience levels, and the results will provide a direct basis and foundation for the design of new hospitals and retrofit optimization of existing hospitals. This paper reviews the resilience assessment methods and performance measures for hospitals subjected to earthquakes. Current assessment methods are divided into indicator‐ and functionality‐based categories, and the performance measures for quantifying the functionality of hospitals are classified into availability, productivity, quality, and hybrid. This study will assist stakeholders and managers in understanding available assessment methods.
Life‐cycle seismic fragility of a cable‐stayed bridge considering chloride‐induced corrosion
Authors: Lu Xiaoluo , Wei Kai , He Haifeng , Qin Shunquan
Published: April 2022

The coastal or sea‐crossing bridges located in seismic regions are experiencing long‐term chloride‐induced corrosion in their life cycles and have a high risk of suffering from strong earthquakes. Thus, the fragilities of these bridges must be properly evaluated under the multiple hazards of corrosion and earthquake. Conventional fragility assessment requires expensive computational efforts despite extensive applications in previous research. To this end, this paper proposes a life‐cycle fragility analysis framework based on the endurance time method to investigate the deterioration impact on the seismic fragility of bridges. An example sea‐crossing cable‐stayed bridge is utilized as a case study and modeled by OpenSees considering different service years. The life‐cycle fragility curves of the example bridge are generated using the artificial endurance time series. Fragility analysis results show that the proposed method is capable of assessing the life‐cycle seismic fragility of the bridge with high efficiency. The bearing shows a higher damage probability than the pylon and pier. As the service time increases, the structural deterioration has a marginal impact on the system fragility of the bridge, while the component fragility varies across different components. The structural deterioration results in beneficial effects on the pylon and the bearing at the pylon but exerts adverse effects on the pier and the bearing at the pier.
Edible bird's nest inhibits the inflammation and regulates the immunological balance of lung injury mice by SO2
Authors: Zeng Hongliang , Jian Yeye , Xie Yong , Fan Qunyan , Chang Qing , Zheng Baodong , Zhang Yi
Published: April 2022

The purpose was to investigate effect of edible bird's nest (EBN) on the immunological properties of mice with lung injury induced by sulfur dioxide (SO2). In mice, SO2 exposure caused symptoms that included a cough, tiredness, and weight loss. Administering EBN improved the immunological function of mice with lung injury in a dose‐dependent manner, leading to recovery of the lung tissue and increasing thymus and spleen indices. IL‐2 and IFN‐γ in the serum by Th1 cells in response to EBN played a leading role in cellular immune regulation. Moreover, a medium dose of EBN regulated the immune stress response, inhibited apoptosis of splenic lymphocytes, and promoted cellular immunity. EBN inhibited production of IL‐8 and MDA and upregulated mRNA expression of atrophin‐1 and cyclooxygenase‐2 in lung tissue. EBN attenuates the lung injury induced by SO2 in mice through a mechanism that involves the inhibition of inflammation and regulation of immunological balance.
Lactic acid bacteria isolated from Kazakh traditional fermented milk products affect the fermentation characteristics and sensory qualities of yogurt
Authors: Li Hui , Gao Jiaxing , Chen Wenbo , Qian Chengjing , Wang Yong , Wang Jing , Chen Lishui
Published: April 2022

Lactic acid bacteria (LAB) play a crucial role in the development of the taste, texture, and aroma of traditional fermented milk products. Five LABs from Kazakh traditionally prepared dairy products showed continuous subculture stability, as well as proper acidification and coagulation ability. They were identified as Pediococcus pentosaceus (1–5, 1–7), Enterococcus faecium (1–19), and Lactobacillus plantarum (1–12, 1–15). Their coagulation time and acidity values ranged from 5.97 to 12.78 h and 76.47 to 89.39°T. Yogurts prepared with L. plantarum were more condensed and textural integrity than those with P. pentosaceus and E. faecium. Determination of the volatile compound profiles suggested a higher diversity of volatile compounds than the control. The sensory evaluation presented positive overall sensory quality scores for the yogurts prepared with 1–12 and 1–15. The results provide additional information regarding the contributions of native LABs to the unique flavor and sensory qualities of traditionally prepared milk products. They may help to select starters or adjunct starters for developing distinctive, traditional nomadic fermented milk to satisfy consumer demand and increase market acceptability.
Are organic acids really related to the sour taste difference between Chinese black tea and green tea?
Authors: Zhang Xiang , Du Xiao , Li Ying‐zheng , Nie Cong‐ning , Wang Cong‐ming , Bian Jin‐lin , Luo Fan
Published: April 2022

Sour is an important taste in some foods, beers, and teas; organic acids, in particular, are thought to play a key role in the formation of the sour taste of beer. It has been generally thought that organic acids also contribute to some teas tasting sour. In this study, through sensory evaluation experiments with black tea (BT) and green tea (GT), the difference in the sour taste of BT and GT was quantitatively characterized. Then the organic acids in the two types of tea were identified and quantified via high‐performance liquid chromatography (HPLC) with taste activity value (TAV) analysis. The results showed that both teas had 12 identical common organic acids (including 11 taste‐active components), but the results of the TAV analysis were not consistent with those of the sensory evaluation. Therefore, there is no direct relationship between organic acids and the acidity in BT and GT. It is related to the interaction between organic acids and other substances, pH value, or other sour substances in tea infusions. The mechanism of the disappearance of sourness in tea infusions was also discussed. These results help us to understand the correlation between tastes in teas.
Effects of nebulized epinephrine in association with hypertonic saline for infants with acute bronchiolitis: A systematic review and meta‐analysis
Authors: Pereira Renan A. , Oliveira de Almeida Versiéri , Zambrano Mariana , Zhang Linjie , Amantéa Sérgio L.
Published: April 2022

Background

Nebulized epinephrine and hypertonic saline have been extensively studied in infants with acute bronchiolitis, with conflicting results.

Aims

To evaluate the efficacy on length of stay (LOS), clinical severity scores (CSS), oxygen saturation (SaO2), and safety profile of nebulized epinephrine plus hypertonic saline (HS) in infants with acute bronchiolitis.

Materials & Methods

This is a systematic review and meta‐analysis. Outcomes were represented by mean differences (MD) or standard mean differences (SMD) and 95% confidence intervals (CIs) were utilized.

Results

Eighteen trials were systematically selected and 16 of them contributed to the meta‐analysis (1756 patients). Overall, a modest but significant positive impact was observed of the combination therapy on LOS (MD of –0.35 days, 95% CI −0.62 to −0.08, p = 0.01, I2 = 91%). Stratification by time of CSS assessment unveiled positive results in favor of the combination therapy in CSS assessed 48 and 72 h after the admission (SMD of −0.35, 95% CI −0.62 to −0.09, p = 0.008, I2 = 41% and SMD of −0.27, 95% CI −0.50 to −0.04, p = 0.02, I2 = 0%, respectively). No difference in SaO2 was observed. Additional data showed a consistent safety profile, with a low rate of adverse events (1%), most of them mild and transient.

Conclusion

Low‐quality evidence from this systematic review suggests that nebulized epinephrine plus HS may be considered as a safe and efficient therapy for decreasing LOS and CSS in infants with acute bronchiolitis, especially in those who require hospitalization for more than 48 h.
High glucose enhances lipopolysaccharide‐induced inflammation in cultured BV2 microglial cell line
Authors: Hung Hao‐Chang , Tsai Sheng‐Feng , Sie Shih‐Ren , Kuo Yu‐Min
Published: April 2022

Introduction

Diabetes mellitus emerges as a global health crisis and is related to the development of neurodegenerative diseases. Microglia, a population of macrophages‐like cells, govern immune defense in the central nervous system. Activated microglia are known to play active roles in the pathogenesis of neurodegenerative diseases.

Methods

This study aimed to investigate the effects of high glucose on low‐dose lipopolysaccharide (LPS)‐induced activations of inflammation‐related signaling molecules in cultured BV2 microglial cells.

Results

Compared to cells cultured in the normal glucose medium (NGM, 5.5 mM), the LPS‐induced activation of NF‐κB lasted longer in cells cultured in high glucose medium (HGM, 25 mM). HGM also enhanced the expression of inducible nitric oxide synthase (iNOS). Among the mitogen‐activated protein kinases, HGM enhanced the LPS‐induced phosphorylation of p38 without affecting the phosphorylation of Erk1/2 or JNK. BV2 cells cultured in HGM expressed higher levels of TLR4 than those cells cultured in NGM.

Conclusion

High glucose aggravated LPS‐induced inflammatory responses of microglia via enhancing the TLR4/p38 pathway and prolonging the activation of NF‐κB/iNOS signaling. Controlling blood glucose levels is advised to manage neuroinflammation and related neurodegenerative diseases.
Open account, import decision and financial constraints: A cross‐country firm‐level study
Authors: Nguyen Van Tien , Doan Ngoc Thang
Published: April 2022

This paper uses cross‐country firm‐level data to investigate the influence of an open account on import decisions of firms facing financial constraints. In the open account method, buyers pay after shipment. We employ the sector‐location average as an instrumental variable to deal with the endogeneity problem. Our empirical results provide evidence that an open account positively affects import possibility, particularly, in large‐sized financially‐constrained firms. Our findings imply that large‐sized firms possess more bargaining power than small‐ and medium‐sized firms when negotiating payment terms in importing contracts, especially under severe financial constraints. These findings may suggest several vital implications for the import promotion policy.
Maternal and neonatal death surveillance and response in Liberia: An assessment of the implementation process in five counties
Authors: Compaoré Rachidatou , Millogo Tieba , Ouedraogo Adja M. , Tougri Halima , Ouedraogo Leopold , Tall Fatim , Kouanda Seni
Published: April 2022

Objective

To evaluate the implementation of the maternal and neonatal death surveillance and response (MNDSR) system at county level in Liberia.

Methods

Secondary analysis of data from a cross‐sectional study carried out in March 2016, using both quantitative and qualitative methods to collect data in five counties based on set criteria. Three health facilities were selected in each county through the Health Management Information System (HMIS) by random sampling. The evaluation was also carried out in one catchment community per health facility and at the county referral hospital. Primary data were collected through individual interviews and a review of MNDSR tools and structure. Data were analyzed using thematic analysis.

Results

Implementation of the MNDSR system was very low in the five counties. Only two out of the five counties were currently conducting MNDSR. MNDSR guidelines and standard operating procedures were not available at the county level. Only 12 (23.5%) health facilities had a maternal and neonatal death review committee. Less than a quarter of the assessed community members could correctly give the definition of a maternal or neonatal death.

Conclusion

The MNDSR system is weak in Liberia, at county, health facility, and community levels. Strong national commitment is needed in collaboration with diverse partners for successful implementation of the system.
Outcome of pregnancies with first‐trimester increased nuchal translucency and cystic hygroma in a tertiary maternity hospital in United Arab Emirates
Authors: Narava Sumalatha , Balbir Singh Sushma , Barpanda Samikshyamani , Bricker Leanne
Published: April 2022

Objective

To study the outcome of pregnancies with first‐trimester increased nuchal translucency and cystic hygromas.

Methodology

Retrospective study of 132 pregnancies with first‐trimester increased nuchal translucency and cystic hygromas, between January 2015 to December 2018 at Corniche Hospital, Abu Dhabi, UAE. Fetal karyotyping, detailed ultrasound at 18–22 weeks and fetal echocardiography were offered to all women. Adverse outcomes included miscarriage, intrauterine fetal death, termination of pregnancy, neonatal death and structural abnormalities.

Results

Of the 132 pregnancies, 13 had NT > 95th percentile, 89 had NT ≥3 mm and 30 had cystic hygroma. Among 13 pregnancies with NT > 95th centile, 7.6% had abnormal karyotype. Among 89 pregnancies with NT ≥3 mm, 29.2% had abnormal karyotype, 13.4% miscarriage, 7.8% underwent TOP, 5.6% intrauterine fetal death, 1.1% neonatal death and 14.6% had structural abnormalities. Among 30 pregnancies with cystic hygroma, 40% had abnormal karyotype, 20% miscarriage, 13.3% TOP, 13.3% intrauterine fetal death, 6.6% had neonatal death and 20% had structural abnormalities.

Conclusion

In our study, karyotype abnormalities increased with increasing nuchal translucency with highest risk in fetuses with cystic hygromas. Increased nuchal translucency was associated with adverse pregnancy outcome, which was higher in the group with NT≥6 mm and cystic hygromas.
Mobilizing pharmacists to address the opioid crisis: A joint opinion of the ambulatory care and adult medicine practice and research networks of the American College of Clinical Pharmacy
Authors: Coon Scott A. , Hill Lucas G. , Hutchison Robert W. , Arnold Lindsay M. , Jarrett Jennie B. , Ottney Anne R. , Oung Alvin B. , Painter Nathan A. , Smith Michael A. , Stranges Paul M. , Tran Tran H. , McFee Winans Amanda R. , Bratberg Jeffrey P.
Published: April 2022

The opioid crisis represents one of the largest failures of our current health care system as it continues to claim lives at an unprecedented rate and has caused a devastating range of preventable morbidity. Although the availability of highly potent synthetic opioids has amplified the urgency of the crisis for patients and communities, this problem has evolved over several decades. Pharmacists are in a position to offer many potential solutions due to their widespread accessibility, extensive drug knowledge, and integration into various health care settings. This opinion paper challenges the status quo by calling on all pharmacists to embrace evidence‐based opioid stewardship and harm reduction practices, contribute to the medical management of opioid use disorder, and address the misconceptions and prejudices that serve as barriers to effective, compassionate patient care. Regardless of practice setting or available resources, pharmacists can take deliberate and impactful steps to address the opioid crisis. Some pharmacists may be positioned to implement innovative and far‐reaching pharmacist‐led clinical services, while others may simply begin with careful consideration of the language they use when speaking to and about patients with substance use disorders. To optimize patient outcomes, the ineffective laws, regulations, and policies that negatively impact pain and addiction care must be addressed so that evidence‐based solutions can be widely disseminated. Pharmacists must aggressively advocate for the removal of barriers preventing high‐level clinical practice or policies that perpetuate patient harm and abandonment. Finally, there must be support for continued research on pain and opioid use disorder treatments and services, as well as the impacts of harm reduction practices and pharmacist‐led clinical services, so that resources can be allocated effectively.
Impact of discharge education by clinical pharmacists on patients' adherence to post‐percutaneous coronary intervention medications: A retrospective cohort study using real‐world data
Authors: Rahhal Alaa , Mahfouz Ahmed , Al‐Amri Maha , Aljundi Amer , Khir Fadi , Hamid Yousra , Alyafei Sumaya , Arabi Abdul Rahman
Published: April 2022

Background

Secondary prevention post myocardial infarction by optimizing secondary prevention cardiovascular medications is important; however, adherence to these medications is essential to achieve benefits. Nevertheless, the impact of education provided by clinical pharmacists to patients post primary percutaneous coronary intervention (PCI) has not yet been evaluated in a real‐world context.

Methods

This retrospective observational cohort study aimed to assess the impact of education provided by clinical pharmacists compared with other health care providers on adherence to post‐PCI medications and clinical outcomes among patients with ST‐elevation myocardial infarction (STEMI). This study included all patients admitted with STEMI to Heart Hospital in Qatar between 1 January 2016 and 31 December 2018. Adherence was assessed by medication availability 80% of the time, which was monitored by the rate of prescription refill in the year after discharge.

Results

A total of 1334 patients were included. The majority of patients included were male (96%) and Asian (78%), with a mean age of 51 years. Only 26% of the study population were educated by clinical pharmacists, while the remaining were educated by other health care professionals upon discharge. Adherence to aspirin, P2Y12 inhibitors, statins, and beta‐blockers was significantly better among patients who were educated by clinical pharmacists (aspirin, 59% vs 47%; adjusted odds ratio [aOR], 1.5; 95% confidence interval [CI], 1.1‐1.9; P = .002; P2Y12 inhibitor, 58% vs 47%; aOR, 1.5; 95% CI, 1.1‐1.9; P = .004; statin, 55% vs 46%; aOR, 1.3; 95% CI, 1.0‐1.7; P = .038; beta‐blocker, 46% vs 37%; aOR, 1.4; 95% CI, 1.1‐1.8; P = .018). However, there was no difference in re‐hospitalization for acute coronary syndrome or all‐cause mortality among patients who were educated by clinical pharmacists upon discharge compared with those who were educated by other health care providers.

Conclusion

Medication counseling provided by clinical pharmacists significantly improved adherence to post‐PCI medications among patients with STEMI.
Letters of reference for PGY1 pharmacy residency candidates: A survey of residency program directors and opinion statement
Authors: Skrupky Lee P. , Dy‐Boarman Eliza A. , Gurgle Holly E. , Isaacs Alex N. , McCreary Erin K. , Nisly Sarah A. , Paloucek Frank , Peterson David M. , Smith Andrew , Schramm Garrett E. ,   The Education and Training Practice and Research Network
Published: April 2022

Introduction

Although letters of reference (LORs) are required for postgraduate year one (PGY1) residency applications and used to distinguish between candidates, an evaluation of residency program director (RPD) perceptions and values surrounding LORs has not been described.

Objective

The aim of the study was to describe PGY1 RPDs' processes, values, and perceptions surrounding LORs.

Methods

This was a cross‐sectional descriptive survey. After assessing content validity, the Education and Training Practice and Research Network (PRN) taskforce sent a 25‐item electronic survey to 1266 PGY1 RPDs. Survey questions captured program demographics, LOR requirements, processes for LOR review, and perceptions about the value of LORs. Two open‐ended questions solicited suggestions for LORs and the existing standardized form; responses were evaluated via thematic analysis.

Results

A total of 291 (24%) programs completed the survey. LORs were rated as extremely or quite valuable by 82% of respondents and moderately valuable by 16% of respondents. Scoring rubrics for LOR evaluation were used by 79% of programs, and performance ratings were reported to impact interview consideration by a majority of programs. Accuracy, detailed comments, and inclusion of specific candidate strengths and areas for improvement were rated as extremely or quite important characteristics by 90% or more of respondents. Specific strengths were reported to be present in LORs more than half of the time by 81% of programs; however, accuracy, detailed comments, and inclusion of specific areas for improvement were only reported to be present about half the time or less by 41%, 63%, and 63% of respondents. Among 207 suggestions submitted to improve LOR utility, common themes included a desire for LOR authors to have candid discussions with candidates prior to letter writing, to contextualize their relationship with the candidate, and provide honest and specific assessments.

Conclusion

LORs remain highly valued by PGY1 RPDs during application review. Several notable findings were observed, resulting in recommendations for LOR authors, residency applicants, and the standardized LOR form.
Prescribing and documentation by critical care clinical pharmacy specialists with around‐the‐clock staffing: A single‐center evaluation
Authors: Westmoreland Kearsten , Bovio Franck Jessica , Franck Andrew J.
Published: April 2022

Introduction

Evidence supports pharmacists as essential team members in the intensive care unit (ICU). Data are limited for pharmacist prescribing and documentation, ideal pharmacist staffing, and timing of clinical pharmacy activities in the ICU.

Objective

The purpose of this evaluation was to assess the frequency, timing, and most common areas of prescribing and documentation for critical care clinical pharmacy specialists (CPSs) in a single medical center with around‐the‐clock staffing.

Methods

A Veterans Affairs (VA) medical center implemented a collaborative practice model in which CPSs provide direct ICU patient care around the clock. Direct patient care activities are provided for two ICUs with three multidisciplinary teams (medical, surgical, and cardiovascular), the nutrition support team, and emergency response teams. Documentation through an electronic health record progress note is required any time a CPS performs a patient encounter and uses prescriptive authority. A retrospective evaluation was performed to evaluate critical care CPS patient encounters and clinical interventions from October 1, 2016 through September 30, 2020.

Results

Cumulatively, 78 622 CPS clinical interventions requiring prescriptive authority were made during 17 938 documented encounters. For clinical interventions, 40 897 (52.0%) were during daytime hours and 37 725 (48.0%) were after‐hours. Of the documented encounters, 10 461 (58.3%) were during daytime hours compared with 7477 (41.7%) after‐hours. Medication‐related prescribing interventions accounted for 57 400 (73.0%) of the interventions, while 6931 (8.8%) were nonpharmacologic and 14 291 (18.2%) were additional interventions. The most common disease states for prescribing interventions included Anticoagulation (13.8%), Infectious Diseases (13.1%), Cardiovascular (10.5%), Nutrition/Gastrointestinal (6.6%), Neuropsychiatric (5.3%), Endocrine (4.3%), Nephrology (3.5%), and Pulmonary (1%).

Conclusion

This evaluation provides details of prescribing and documentation by critical care CPSs with an around‐the‐clock staffing model. This may be useful for ICU clinicians and administrators considering expanding critical care pharmacy services.
Adaptation of clinical pharmacy services to meet patient care needs during the COVID‐19 pandemic
Authors: Danelich Ilya M. , Thomson Lynda , Alberto Judith , Bonanni Shirley , Buckler Rebecca , Foley John , Phillips Samantha , Rall Braden , Thoma Brandi , Merli Geno , Wordell Cindy
Published: April 2022

The coronavirus disease 2019 (COVID‐19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 has challenged health systems to find innovative ways of delivering patient care while protecting staff from infection with the virus. As the COVID‐19 pandemic has continued to evolve establishing “hot spots” in various areas of the country, clinicians have learned more about caring for these patients. This has required the Department of Pharmacy at Thomas Jefferson University Hospital to constantly update the approach it has taken during this time, and the guidance which is provided for the pharmaceutical care of these patients. Because Philadelphia was in the initial stages of the pandemic within the United States, operations within the Department of Pharmacy at Thomas Jefferson University Hospital needed to be redesigned. This brief report provides an example of the swift changes that were made in the pharmacy practice model at a large academic medical center. Herein we describe the impact of the pandemic on the Department of Pharmacy at Thomas Jefferson University Hospital with a focus on clinical and operations aspects. The areas that will be highlighted in this report represent areas that required rapid and transformational change to the operations and/or clinical care in order to protect the health of pharmacists and allow them to continue to provide the necessary level of patient care.
What is the ideal clinical pharmacy practice model? A satisfaction comparative study
Authors: Al‐Jazairi Abdulrazaq , Hijazi Hala , Samarkandi Hadeel , Akhras Nathem , Devol Edward , Hamasni Ibrahim
Published: April 2022

Introduction

Current pharmacy practice models vary. Unit‐based pharmacists are in charge of patients in specific locations, placing emphasis on timely order verification. In contrast, service‐based pharmacists are assigned to multidisciplinary teams who provide consultations without order verification duties. Hybrid‐based pharmacists provide clinical activities in addition to half‐day order verification. There are conflicting opinions regarding the ideal model in providing care. Currently, there are limited studies comparing these approaches in a specialized health care system.

Objectives

The primary objective of this study is to compare staff satisfaction; nurses, physicians, pharmacist peers, patients, and self‐satisfaction, with respect to the three models.

Methods

This is a prospective study conducted in a tertiary care facility comparing different pharmacy practice models by assessing the satisfaction of different members of the health care team through satisfaction surveys. Assuming 15% difference, 116 observations were required for each arm. Secondary end points compared the number of medication errors reported, clinical interventions documented, order verification, adverse drug reactions reported, protocol/guideline reviews, and total parenteral nutrition orders entered as well as nonformulary reviews within each model. The study was approved by Research Advisory Council.

Results

A total of 377 surveys were collected. In the total general average of overall satisfaction, unit‐based model achieved a rate of 70.61%, service‐based 69.84%, and the hybrid model 59.9%. Both unit and service‐based models had a higher overall satisfaction when compared to hybrid model; unit‐based (70.61% vs 59.97%, P = .005), service‐based (69.84% vs 59.97%, P = .009). Nurses and patients favored unit‐based pharmacists with a satisfaction rate of 72% and 89%, respectively. The unit‐based pharmacists were the most satisfied, 76%, compared to their peers in other models.

Conclusion

Based on this study, the majority of the surveyed cohort, including nurses, patients, and self‐surveyed pharmacists, favored the unit‐based model.
Pharmacists' perceptions on patient care services and social determinants of health within independent community pharmacies in an enhanced services network
Authors: Daly Christopher J. , Costello Jessica , Mak Anna , Quinn Bryan , Lindenau Ryan , Jacobs David M.
Published: April 2022

Background

Health care is transitioning from fee‐for‐service towards value‐based care. Community pharmacies are providing an increasing number of patient care services (PCS) that improve medication adherence, medication knowledge, and overall patient health. The provision of these services may differ based on the socioeconomic characteristics of the patient population. There is a lack of information on PCS delivery in independent community pharmacies and how these services are provided to underserved populations.

Objectives

The objectives of this study were to: (a) Evaluate the current level of commitment and readiness of independent community pharmacies in delivering PCS, and (b) Assess community pharmacists' perceptions of addressing social barriers and health disparities among underserved populations.

Methods

This was a cross‐sectional electronic survey distributed to independent community pharmacies who were members of a pharmacy advocacy or PCS organization in New York State.

Results

One‐hundred and twenty‐five surveys were distributed, with 65 responses (52% response rate) from a high proportion of pharmacy owners (75%). A majority of pharmacies (53%) devoted more than 10 hours per week to PCS, such as immunizations and home delivery. Many pharmacies (47.7%) were willing to devote more than 20 hours per week to PCS with proper reimbursement and were willing to hire additional staff to support these services. Most pharmacies did not use their pharmacy software to target patients for PCS, instead enrolling via staff recommendation or self‐referral. Many pharmacies (48%) reported that greater than 30% of their patient population experienced social‐related barriers including low income and transportation issues. Pharmacies addressed social barriers by offering tailored services towards patient needs.

Conclusions

Independent community pharmacies remain diligent and actively involved in delivering PCS. Many pharmacy patients experience social‐related barriers towards care, and pharmacies are responding by offering tailored services. Further research is needed on the implementation and economic sustainability of PCS in community pharmacy settings.
Postgraduate year two ambulatory care residency program evaluation with a tool for assessing ambulatory care pharmacist practice
Authors: Wesling Megan , Schumacher Christie , Liu Jiajun , Kliethermes Mary Ann , Borchert Jill S.
Published: April 2022

Introduction

A standardized set of required competency areas, goals, and objectives are used in accreditation to create consistency in learning experiences across programs. The individual postgraduate year two (PGY‐2) ambulatory care residency program is subsequently tasked with designing activities to achieve the defined goals and objectives, which may lead to variability in the constructed activities across residency programs.

Objectives

The primary objective of this study was to describe (define, assess, and stratify) the current landscape of direct patient care activities provided within PGY‐2 ambulatory care residency program training environments.

Methods

This was a national, descriptive, cross‐sectional study using the Tool for Assessing Ambulatory Care Pharmacist Practice (TAAPP). The TAAPP questionnaire was disseminated via electronic mail to PGY‐2 ambulatory care Residency Program Directors (RPDs) meeting inclusion criteria. RPDs were requested to complete the questionnaire and disseminate it further to two preceptors of required rotations and all 2017‐2018 residents.

Results

In total, 108 responses were received out of a possible 595 and 10 were excluded due to the respondents not meeting inclusion criteria or the questionnaire was incomplete. Ninety‐eight (16.5% response rate) underwent descriptive and statistical analysis. Fifty‐two participants (53%) indicated they provide a comprehensive or broad delivery of direct patient care, 44 respondents (45%) provide activities within a moderate scope of practice, and 2 respondents (2%) engage in a narrow scope of practice. Forty‐seven of the pharmacists (36%) stated they were functioning under a disease state specific collaborative practice agreement (CPA), 40 (31%) under a broad or comprehensive CPA, 24 (19%) under a protocol‐driven, and 13 (10%) under a medication‐specific agreement.

Conclusion

Variability in PGY‐2 ambulatory care residency programs was found with just half of participants functioning under a broad scope of pharmacist practice. Opportunities exist for programs to further standardize and advance program training environments.
Current and future state of clinical pharmacist‐led precision medicine initiatives
Authors: Tillman Emma M. , Beavers Craig J. , Afanasjeva Janna , Momary Kathryn M. , Strnad Kyle G. , Yerramilli Aparna , Williams Anne M. , Smith Brooke A. , Florczykowski Brittany , Fahmy Monica
Published: April 2022

This white paper evaluates the current and future state of clinical pharmacist‐led precision medicine initiatives, focusing on an overview of pharmacogenomics (PGx) in three key areas: clinical practice, education, and research. These key facets are described in detail, followed by a review of potential and perceived barriers concerning PGx and recommendations for the clinical pharmacist's role in overcoming these barriers. This paper reviews the current state of clinical pharmacist‐led precision medicine and presents a vision for the future of pharmacy practice in this quickly evolving field.
Implementation and evaluation of a virtual objective structured clinical examination for pharmacy students
Authors: Hsia Stephanie L. , Zhou Crystal , Gruenberg Katherine , Trinh Trang D. , Assemi Mitra
Published: April 2022

Introduction

The University of California, San Francisco (UCSF) School of Pharmacy employs Objective Structured Clinical Examinations (OSCEs) to assess students' skills. The Coronavirus disease 2019 (COVID‐19) pandemic made in‐person OSCEs infeasible. This article describes the implementation and evaluation of a two‐station virtual OSCE (vOSCE) for first‐year pharmacy students.

Methods

A summative vOSCE was conducted in June 2020 using Zoom and ExamSoft. Faculty and residents served as standardized patients (SPs) and evaluated student performance. Students and SPs were surveyed on their perceptions post‐vOSCE. A mixed methods analysis was conducted, incorporating thematic analysis of survey responses and quantitative analyses of student performance on the virtual vs in‐person OSCE.

Results

Ninety‐six (75%) students and 17 SPs (94.4%) completed the survey. Students and SPs (69% vs 88%, P = .10) felt that vOSCEs were acceptable alternatives for demonstrating knowledge, communication, and telehealth skills. SPs felt that in‐person OSCEs were more effective to assess communication skills and ability to conduct in‐person encounters (P < .05). Qualitative comments from students and SPs corroborated these differences, emphasizing limitations of vOSCEs for demonstrating nonverbal skills, and additional considerations regarding exam administration and assessment. Students who failed an OSCE generally had lower median communication scores (P < .01). Technological difficulties, before OSCE performance, and before telehealth experience were not associated with passing the vOSCE (P > 0.05).

Discussion

The virtual environment did not seem to negatively impact student performance. However, students and SPs felt vOSCEs may be less effective to demonstrate and assess nonverbal communication. To address these limitations, future implementation of vOSCEs may include providing students with instruction on nonverbal telehealth skills and SP training on virtual assessment of nonverbal communication skills.
Medication therapy problems identified by pharmacists conducting telephonic comprehensive medication management within a team‐based at‐home care program
Authors: Graybill Margo , Duboski Vanessa , Webster Leeann , Kern Melissa , Wright Eric , Graham Jove , Blanchard Carrie , Gionfriddo Michael R.
Published: April 2022

Introduction

Comprehensive Medication Management (CMM) is a collaborative patient‐centered approach to medication optimization. We recently implemented telephonic CMM as part of a multidisciplinary team within a team‐based at‐home care program. The objective of this study was to describe the type and frequency of medication therapy problems (MTPs) identified by pharmacists delivering CMM as part of this program, as well as the acceptance rates of the recommendations made to rectify them.

Methods

We conducted a retrospective chart review of all patients receiving CMM within the program between December 12, 2018 and December 31, 2019. We identified and classified MTPs based on the framework developed by the Pharmacy Quality Alliance. Descriptive statistics were used to determine the quantity of MTPs, as well as the acceptance rates of the recommendations.

Results

We identified 307 patients who received CMM. Of these patients, 58% were female (178/307) and 96% identified as White (296/307). Average age was 72 years old (SD 13). On average, pharmacists identified 4 MTPs/patient with a 35% acceptance rate (431/1228) for their recommendations. Of those accepted, pharmacists were able to resolve 185 (43%) of these MTPs on their own while providers resolved the remaining 246 (57%) MTPs. Acceptance of MTPs was more likely if patients were spoken to (38.4% vs 29.5%, relative risk [RR] = 1.30, 95% CI 1.10‐1.54, P = .002).

Conclusions

Pharmacists were able to identify several MTPs when conducting telephonic CMM within a team‐based at‐home care program. These MTPs and their associated recommendations however, often failed to be resolved. Recommendations were more likely to be resolved if patients were spoken to, highlighting the importance of engaging the patient as part of CMM. Future studies should examine ways to improve intervention acceptance as well as the clinical and economic impact of changes made as a result of telephonic CMM and MTP identification.
Reactive oxygen species‐mediated activation of NLRP3 inflammasome associated with pyroptosis in Het‐1A cells induced by the co‐exposure of nitrosamines
Authors: Liu Qiwei , Zhao Chao , Zhou Jingjing , Zhang Hu , Zhang Ying , Wang Shizhi , Pu Yuepu , Yin Lihong
Published: April 2022

Nitrosamines were a class of important environmental carcinogens associated with digestive tract neoplasms. As the early toxic effect of nitrosamines, inflammatory response participated in the malignant transformation of cells and promoted the occurrence and development of tumors. However, the role of NLRP3 inflammasome in the nitrosamines‐induced inflammatory response was unclear. In this study, the human esophageal epithelial cells (Het‐1A) were used to explore potential mechanisms of the activation of NLRP3 inflammasome under co‐exposure to nine nitrosamines commonly found in drinking water at the doses of 0, 4, 20, 100, 500, and 2500 ng/mL. The results showed that nitrosamines stimulated activation of the NLRP3 inflammasome and induced cellular oxidative damage in a dose‐dependent manner. Pretreatment of reactive oxygen species scavenger N‐acetyl‐L‐cysteine (NAC), particularly mitochondrial reactive oxygen species (mtROS) scavengers Mito‐TEMPO, effectively inhibited the activation of NLRP3 inflammasome, suggesting that nitrosamines could mediate the activation of NLRP3 inflammasome via mtROS. Furthermore, we found that nitrosamines co‐exposure also promoted cell pyroptosis through the NLRP3/caspase‐1/GSDMD pathway, which was demonstrated by adding the caspase‐1 inhibitor Z‐YVAD‐FMK and constructing NLRP3 downregulated Het‐1A cell line. This study revealed the underlying mechanism of the activation of NLRP3 inflammasome initiated by nitrosamines co‐exposure and provided new perspectives on the toxic effects of nitrosamines.