bluuebunny/crossref_metadata_2025 huggingface dataset:
The management success of the invasive late goldenrod (Solidago giganteaAiton.) in a nature conservation area is strongly related to site, control measures and environmental factors
Authors: Hall Rea Maria , Urban Bernhard , Kaul Hans-Peter
Published: April 2022

The late goldenrod (Soldiago giganteaAiton; Asteraceae) is one of the most abundant invasive species in various types of habitats. Its long-creeping plagiotropic rhizomes enable the plant to build up dense, monospecific stands within a short time. Particularly in nature conservation areas, the invasion of goldenrod can cause severe disruptions in the naturally occuring mutualims between plants, insects and higher trophic levels, subsequently impeding the achievement of nature conservation goals. As management options of goldenrod in nature conservation areas are limited, this three-year study aimed to test the effectiveness of three management treatments (two-time mowing, triticale cultivation, and reverse rotary cutting) on four different sites in the Austrian Donau-Auen National Park. The number and height of goldenrod shoots were recorded three times a year on twelve permanent trial plots on each site to test for the effectiveness of the treatments. In addition, vegetation surveys were performed to observe the recovery potential of native plant species. Even though the three-years mowing and the triticale cultivation reduced goldenrod by 95.6% and 97.2% resp., we could find no relation between the effectiveness of the treatment and the intensity of disturbance created by the control option. On the contrary, with a reduction of only 5.4% in goldenrod density the most intensive treatment, the rotary cutting, showed the lowest efficiency. The highest positive effect on the re-establishment of native plant species was recorded with two mowing events per year. Even though the study revealed that certain management options have the potential to effectively reduce goldenrod and to simultaneously increase the establishment success of native species, results can only be seen as so-called snapshots. For example, as shown on site EJW one unforeseeable wild boar digging event transformed a 84.5% reduction into a 4.7% increase in goldenrod density. Therefore, a proper and regular monitoring is essential to be able to react to the effects of unpredictable events that can have severe impact on vegetation dynamics.
Exposure of adult sea urchin Strongylocentrotus intermedius to stranded heavy fuel oil causes developmental toxicity on larval offspring
Authors: Wang Xuanbo , Li Xishan , Xiong Deqi , Ren Hang , Chen Huishu , Ju Zhonglei
Published: April 2022

Heavy fuel oil (HFO) spills pose serious threat to coastlines and sensitive resources. Stranded HFO that occurs along the coastline could cause long-term and massive damage to the marine environment and indirectly affect the survival of parental marine invertebrates. However, our understanding of the complex associations within invertebrates is primarily limited, particularly in terms of the toxicity effects on the offspring when parents are exposed to stranded HFO. Here, we investigated the persistent effects on the early development stage of the offspring following stranded HFO exposure on the sea urchin Strongylocentrotus intermedius. After 21 d exposure, sea urchins exhibited a significant decrease in the reproductive capacity; while the reactive oxygen species level, 3-nitrotyrosine protein level, protein carbonyl level, and heat shock proteins 70 expression in the gonadal tissues and gametes significantly increased as compared to the controls, indicating that HFO exposure could cause development toxicity on offspring in most traits of larval size. These results suggested that the stranded HFO exposure could increase oxidative stress of gonadal tissues, impair reproductive functions in parental sea urchins, and subsequently impact on development of their offspring. This study provides valuable information regarding the persistent toxicity effects on the offspring following stranded HFO exposure on sea urchins.
Efficacy of Extract Derived from Desiccated Carrot (Daucus carota subsp.sativus) against Oral Microflora: An In-vitro Study
Authors: Rajamanickam Preethi , Felicita Sumathi
Published: April 2022

Introduction: Fixed orthodontic appliances with its various components cause inaccessible areas for plaque and make tooth cleaning difficult. Several chemical formulations have been used for mechanical cleaning, but due to their unpleasant side-effects researchers now concentrate on herbal drugs. Aim: To determine the antibacterial effect of carrot extract on Lactobacillus, Aggregatibacter actinomycetemcomitans and Streptococcus mutans. Materials and Methods: This was an in-vitro study conducted to determine the antibacterial activity of Daucus carota subsp. sativus (carrot) extract against Lactobacillus, Aggregatibacter actinomycetemcomitans and Streptococcus mutans. A 500 grams of healthy and mature carrots were cleaned, washed and peeled then dried in a hot air oven at 40°C for 5 days and then ground. Ground powder was mixed with distilled water and ethanol to obtain the aqueous and ethanolic extract respectively. The antimicrobial activity of these extracts was studied using well diffusion methods in culture plates under three different concentrations. Antimicrobial activity was studied by measuring the area of inhibition. Cytotoxic activity of the samples was also assessed. Kruskal-Wallis test was performed to compare antimicrobial activity of aqueous and ethanolic extract mouthwash. Results: Aqueous mouthwash showed moderate antimicrobial activity without statistically significant difference against S.mutans (p-value=0.06), Lactobacillus sp. (p-value=0.7), or A. Actinomycetemcomitans (p-value=0.16) microbes, at three different concentrations. Ethanolic extract had moderate antimicrobial activity against all the three microorganisms, but more significant at 100 microlitre concentrations with a p-value of 0.03 against S. mutans. The cytotoxic effects of the ethanolic and aqueous mouthwashes were less cytotoxic at minimal concentrations. Conclusion: Extract derived from Daucus carota was proven to possess antimicrobial activity against S.mutans, A.actinomycetemcomitans and Lactobacillus. Further research is required to advocate its efficacy at lower concentrations.
The Impact of Financial Depth and Banking Indicators on Economic Growth in the Gulf Countries: An Analytical Study
Authors: A. Aljarallah Ruba
Published: April 2022

Recognition of the main drivers of economic growth of a nation is crucial to implement sound policies and regulations that enable economies to improve and progress. One of the key drivers of any strategy for economic growth is the development of the financial sector. The financial sector and its institutions play a significant role in increasing economic growth by supporting creativity and innovation, accumulating private wealth, directing savings into beneficial investments, offering different opportunities for investors, enhancing productivity, and improving the stability of the economy. The present study identifies the role of financial depth and banking indicators as a development of the financial sector in determining economic growth in the Gulf Countries (GC) from 2000 to 2018. For this purpose, the Generalized method of moments (GMM) approach is used. The results indicate that Bank Credits to the private sector are significantly contributing to the economic growth but the bank cost and deposit money banks' assets hurt economic growth in GC. Since the negative impact of credit to government and state enterprises on growth is revealing the phenomenon of crowding out, it is recommended that the governments in GC should promote credit to the private sector instead of borrowing themselves to remove the crowding-out effect.
Tuberculosis: Stop It with Effective Treatment
Authors: Santosh Kumar R. , Pushp Divya
Published: April 2022

Aim: Tuberculosis is one of the oldest human diseases, dating back over 17,000 years based totally on molecular proof. Despite modern diagnostic and treatment approaches, people continue to suffer from tuberculosis, and it tops the list of ten deadly infectious diseases in the world, second only to the Human Immunodeficiency Virus. TB is a worldwide pandemic, as per World Health Organization (WHO).It tops the causes of death among HIV-positive individuals. In this review we assess the challenges faced due to tuberculosis and its management and the strategies adopted to tackle it.Because of the dearth of number one health-care infrastructure in rural regions of several states which includes Health care provided privately not regulated nicely, which ends up in First- and second-line anti-TB drugs are widely used irrationally; infection with human immune deficiency virus; loss of political will; and, The most crucial, the corrupt management are all fundamental demanding situations in India's combat against tuberculosis. Another rising danger to TB eradication is multidrug-resistant tuberculosis (MDR-TB), which is the outcome of a failing or deteriorating TB control programme. The World Health Organization's "STOP TB" policy aims to eradicate tuberculosis as a public health hazard by 2050.
Study on the formulations for Topical Skin Protectant against Liquid-Phase Chemical Warfare Agents
Authors: Kim Sang Woong , Seo Dong Sung , Son Hong Ha , Yu Chi Ho , Joe Hae Eun , Cho Young
Published: April 2022

Chemical warfare agents(CWA) such as nerve agents and vesicating agents show lethality by skin contamination. Skin protection, therefore, is one of the top priorities to deal with the growing threat from CWA. In an attempt to develop the most effective topical skin protectant(TSP), candidate substances including PFPE(perfluorinated polyether), PTFE(polytetrafluoroethylene), glycerin, and polysaccharides were evaluated in forms of various formulations against nerve agent simulant DMMP(dimethylmethyl phosphonate) penetration. The protective efficacy of the formulation against DMMP penetration was estimated as the onset time of color change of the KM9 chemical agent detection paper. Based on this study, it was found that several PFPE- and glycerin-based formulations exhibit remarkably superior efficacy as a protective cream. This protective cream is expected to be used as TSP for military application after further research.
Imaging Features of Calcium Pyrophosphate Deposition Disease: Consensus Definitions From an International Multidisciplinary Working Group
Authors: Tedeschi Sara K. , Becce Fabio , Pascart Tristan , Guermazi Ali , Budzik Jean‐François , Dalbeth Nicola , Filippou Georgios , Iagnocco Annamaria , Kohler Minna J. , Laredo Jean‐Denis , Smith Stacy E. , Simeone F. Joseph , Yinh Janeth , Choi Hyon , Abhishek Abhishek
Published: April 2022

Objective

To develop definitions for imaging features being considered as potential classification criteria for calcium pyrophosphate deposition (CPPD) disease, additional to clinical and laboratory criteria, and to compile example images of CPPD on different imaging modalities.

Methods

The American College of Rheumatology and European Alliance of Associations for Rheumatology CPPD classification criteria Imaging Advisory Group (IAG) and Steering Committee drafted definitions of imaging features that are characteristic of CPPD on conventional radiography (CR), conventional computed tomography (CT), dual‐energy CT (DECT), and magnetic resonance imaging (MRI). An anonymous expert survey was undertaken by a 35‐member Combined Expert Committee, including all IAG members. The IAG and 5 external musculoskeletal radiologists with expertise in CPPD convened virtually to further refine item definitions and voted on example images illustrating CR, CT, and DECT item definitions, with ≥90% agreement required to deem them acceptable.

Results

The Combined Expert Committee survey indicated consensus on all CR definitions. The IAG and external radiologists reached consensus on CT and DECT item definitions, which specify that calcium pyrophosphate deposits appear less dense than cortical bone. The group developed an MRI definition and acknowledged limitations of this modality for CPPD. Ten example images for CPPD were voted acceptable (4 CR, 4 CT, and 2 DECT), and 3 images of basic calcium phosphate deposition were voted acceptable to serve as contrast against imaging features of CPPD.

Conclusion

An international group of rheumatologists and musculoskeletal radiologists defined imaging features characteristic of CPPD on CR, CT, and DECT and assembled a set of example images as a reference for future clinical research studies.
All opinions are not equal: Toward a consensual approach to the development of drug policy
Authors: Wong Gabriel T. W. , Manning Matthew
Published: April 2022

Drug policy has been subjected to much scrutiny from different stakeholder groups who present sometimes very different opinions on solutions to address a problem. Reconciling such differences, that are underpinned by both anecdotal and empirical evidence, is a priority yet to be fully achieved. In this study, we examine: (i) whether differences exist among actor groups regarding their perceived importance in policymaking; (ii) whether those who dominate the decision process value the input of laypeople or minority actors; and (iii) whether differences exist, with regard to i and ii, between study sites (i.e. Australia and Hong Kong) that have markedly different drug strategies. Overall, differential preference weightings between dominant groups reveal a strong influence of political orientation. Results suggest that decisions made by health professionals were regarded as the most important, while most of the respondent groups gave a low preference toward policy decisions made by law enforcers. Dominant groups also tend to discount the inputs of laypeople and other minority groups. Our study highlights the importance for policy actor groups to consider such a differential weighting of inputs when synthesising knowledge and gathering opinions for the development of drug policy.
Effect of Imaging Markers on Reperfusion Therapy in Basilar Artery Occlusion
Authors: Yan Shenqiang , Zhou Ying , Zhao Yuqi , Wang Feng , Tao Anyang , Zhou Lin , Pan Mengxiong , Zhong Genlong , Hu Lingzhi , Jiang Xuanfei , Mao Xinlei , Tang Huan , Wang Jianwei , Qian Shuxia , Sun Jingping , Gong Xiaoxian , Zhong Wansi , Lou Min ,   CASE II investigators
Published: April 2022

Objective

We aimed to investigate the effectiveness of endovascular therapy (EVT) versus intravenous thrombolysis (IVT) in patients with basilar artery occlusion (BAO), based on the information of advanced imaging.

Methods

We analyzed data of stroke patients with radiologically confirmed BAO within 24 hours. BAO subjects were categorized into “top‐of‐the‐basilar” syndrome (TOBS) and other types. An initial infarct size of <70ml and a ratio of ischemic tissue to infarct volume of ≥1.8 was defined as “target mismatch.” The primary outcome was a good outcome, defined as a modified Rankin Scale score of 0 to 3 at 3 months. Propensity score adjustment and inverse probability of treatment weighting (IPTW) propensity score methods were used.

Results

Among 474 BAO patients, 93 (19.6%) were treated with IVT prior to EVT, 91 (19.2%) were treated with IVT alone, 95 (20.0%) were treated with EVT alone, and 195 (41.1%) were treated with antithrombotic therapy. In IPTW analyses, we found no benefit of EVT over IVT for good outcome in either TOBS patients (odds ratio = 1.08, 95% confidence interval [CI] = 0.88–1.31) or those with other types (odds ratio = 1.13, 95% CI = 0.94–1.36). However, in patients with other types, if there existed a target mismatch, EVT was independently related to good outcome (odds ratio = 1.46, 95% CI = 1.17–1.81).

Interpretation

The “target mismatch profile” seems to be a possible candidate selection standard of EVT for those with other types of BAO. Future studies should separate TOBS from other types of BAO, and try to use advanced imaging. ANN NEUROL 2022;92:97–106
Isolation of Circulating Tumor Cells to Diagnose Melanoma and Evaluate the Efficacy of Surgical Resection Using Melanoma‐Specific Microsystem
Authors: Kang Yoon-Tae , Mutukuri Anusha , Hadlock Thomas , Fairbairn Heather , Carle Taylor R. , Fouladdel Shamileh , Murlidhar Vasudha , Kramer Aaron , Reguera Monica De Silva , Azizi Ebrahim , Durham Alison , Mclean Scott A. , Nagrath Sunitha
Published: April 2022

Melanoma is one of the most aggressive skin cancers due to its potential to metastasize widely in the body. The risk of metastasis is increased with later detection and increased thickness of the primary lesion, thus early identification/surgical removal is critical for higher survival rates. Recent advances in liquid biopsy have proposed less‐invasive alternatives for cancer diagnosis and monitoring using minimal invasion at sample collection, and circulating tumor cells (CTCs) have been considered a promising blood‐based surrogate marker of primary tumors. Herein, the melanoma‐specific OncoBean platform (MelanoBean) conjugated with melanoma specific antibodies is used. From the comprehensive studies based on change in the number and characteristics of CTCs/CTCs‐clusters pre‐ and post‐surgical treatment, this work demonstrates that melanoma patients (n = 45) at all stages (I–IV) have a noticeable number of CTCs as well as CTC‐clusters compared to healthy donors (n = 9) (p = 0.0011), and surgical treatment leads to a significant decrease in the CTC number (p < 0.0001). The CTCs recovered from the device undergo molecular profiling for melanoma‐associated genes expression using multiplexed qRT‐PCR, demonstrating the ability to monitor molecular signature through treatment. The presented MelanoBean and the comprehensive approach will empower prognostic value of CTCs in melanoma in much larger cohort studies.
An Extremely Low‐Frequency Vortex Magnetic Field Modifies Protein Expression, Rearranges the Cytoskeleton, and Induces Apoptosis of a Human Neuroblastoma Cell Line
Authors: Aparicio‐Bautista Diana I. , Chávez‐Valenzuela Daniel , Ambriz‐Álvarez Giovanni , Córdova‐Fraga Teodoro , Reyes‐Grajeda Juan P. , Medina‐Contreras Óscar , Rodríguez‐Cruz Fanny , García‐Sierra Francisco , Zúñiga‐Sánchez Patricia , Gutiérrez‐Gutiérrez Antonio M. , Arellanes‐Robledo Jaime , Basurto‐Islas Gustavo
Published: April 2022

Homogeneous extremely low‐frequency electromagnetic fields (ELF‐EMFs) alter biological phenomena, including the cell phenotype and proliferation rate. Heterogenous vortex magnetic fields (VMFs), a new approach of exposure to magnetic fields, induce systematic movements on charged biomolecules from target cells; however, the effect of VMFs on living systems remains uncertain. Here, we designed, constructed, and characterized an ELF‐VMF‐modified Rodin's coil to expose SH‐SY5Y cells. Samples were analyzed by performing 2D‐differential‐gel electrophoresis, identified by MALDI‐TOF/TOF, validated by western blotting, and characterized by confocal microscopy. A total of 106 protein spots were differentially expressed; 40 spots were downregulated and 66 were upregulated in the exposed cell proteome, compared to the control cell proteome. The identified spots are associated with cytoskeleton and cell viability proteins, and according to the protein–protein interaction network, a significant interaction among them was found. Our data revealed a decrease in cell survival associated with apoptotic cells without effects on the cell cycle, as well as evident changes in the cytoskeleton. We demonstrated that ELF‐VMFs, at a specific frequency and exposure time, alter the cell proteome and structurally affect the target cells. This is the first report showing that VMF application might be a versatile system for testing different hypotheses in living systems, using appropriate exposure parameters.© 2022 Bioelectromagnetics Society.
Accelerating the Photocatalytic Atom Transfer Radical Addition Reaction Induced by Bi2O3 with Amines: Experiment and Computation
Authors: Riente Paola , Fianchini Mauro , Pericàs Miquel A. , Noël Timothy
Published: April 2022

Metal oxide semiconductors are widely used in photocatalysis for the sustainable synthesis of fine chemicals and fuels. However, the mechanisms and the actual catalytically active species involved in these photocatalytic processes are not yet fully understood. Herein, we reveal that the addition of certain amines can effectively accelerate the photocatalytic atom transfer radical addition (ATRA) reaction by stabilizing a soluble Bi‐species formed through a reaction between Bi2O3 and diethyl bromomalonate using either N, N‐dimethylformamide (DMF) or dimethyl sulfoxide (DMSO) as a solvent. Moreover, thermodynamic calculations revealed that N, N, N’, N’‐tetramethylethylenediamine (TMEDA), and DMF yield the most stable complexes [(κ2‐TMEDA)2BiBr3], ultimately accelerating the formation of the targeted ATRA product.
Kreide und Feuerstein – ungleiche Geschwister
Authors: Sicker Dieter
Published: April 2022

Reisen Sie gern? Oft hat man dabei unerwartete Erlebnisse, die irgendwie mit Chemie zu tun haben und chemisches Lehrbuchwissen wird ungeahnt erweitert. Es verknüpft sich mit Geschichte und Geschichten, unbekannten Anwendungen, praktischen Handgriffen und dem realen Leben anderer Menschen. Über solche kleinen Wunder soll diese Serie berichten. Kommen Sie diesmal mit auf die Insel Rügen. Wir gehen aber nicht an die breiten Strände im Osten mit feinem Sand, sondern erst an die Steilküste des Nationalparks Jasmund im Nordosten mit Stubbenkammer und Königsstuhl und dann ins Landesinnere, dorthin, wo man seit 300 Jahren Kreide abbaut.
Toward Economical and Sustainable Production of Renewable Plastic: Integrative System‐Level Analyses
Authors: Kim Hyunwoo , Kim Jiyong , Won Wangyun
Published: April 2022

2,5‐Furandicarboxylic acid (FDCA) is one of the promising renewable plastic monomers enabling to address several environmental issues, instead of petroleum‐based terephthalic acid (TPA). In this study, an integrative process for the co‐production of FDCA and furfural as well as activated carbon was developed, and the economic feasibility and environmental sustainability for the proposed process were evaluated. In the proposed process, there were major four catalytic conversion reactions: (1) hydrolysis of biomass to its derivatives (cellulose, hemicellulose, and lignin), (2) dehydration of hemicellulose to furfural, (3) dehydration of cellulose to 5‐hydroxymethylfurfural (HMF), and (4) successive oxidation of HMF to FDCA. Particularly, a heat exchanger network coupled with a heat pump was established to minimize the utility consumption, thereby reducing 72 % of the heating requirement. Techno‐economic analysis revealed that the minimum selling price of FDCA was $1380 ton−1, which is comparable to that of petroleum‐based TPA ($1445 ton−1). Uncertainty analysis using the Monte Carlo simulation method was employed to quantify the risk associated with the unforeseen market condition. From the life‐cycle assessment, we observed that the proposed process is more environmentally sustainable than conventional TPA production in terms of climate change and fossil depletion metrics.
Affinity groups foster engagement with families
Authors: McCarthy Claudine
Published: April 2022

Keeping your students’ parents/families engaged with your institution can play a critical role in student success.
In vitro investigation of the effect of food texture, particle size, and viscosity on gastric disintegration and emptying
Authors: Kong Fanbin , Tran Do Duc Huy
Published: April 2022

The objective of this study was to investigate the influence of particle size, texture, and gastric viscosity on food gastric disintegration and emptying rates. In vitro dynamic gastric digestion was conducted for carrots using a dynamic gastric simulation model. The changes in the texture of carrots and other foods as indicated by bulk resistance, the percent solids emptied, and the particle size distribution were used as parameters to study disintegration kinetics and emptying patterns. The influence of viscosity on food emptying was studied on both indigestible particles (amberlite beads) and digestible solids (carrots). The results indicated medium‐size carrot particles (1.40–2.00 mm) had a greater disintegration and a higher amount of emptying rate when compared to larger (2.00–3.34 mm) and smaller (1.14–1.40 mm) carrot particles. A high correlation exists between the final bulk resistance after 120 min digestion and the amount of solids emptied. Increasing viscosity up to values 8.20 Pa·s improved the particle dispersion for amberlite and carrots and increased rates of solids emptying, while further increase in viscosity hindered emptying of amberlite and carrot solids. The variable emptying rates of both indigestible and digestible solids with viscosity were described with a mathematical model based on particle‐emptying coefficient.
Safety of microvascular free tissue transfer reconstruction of the head and neck in the setting of chronic pharmacologic immunosuppression
Authors: Wang Ray , Horwich Peter , Sandulache Vlad C. , Hernandez David J. , Hornig Joshua , Graboyes Evan M. , Liou Nelson E. , Skoner Judith , Haskins Angela D. , Ranasinghe Viran , Day Terry A. , Sturgis Erich M. , Huang Andrew T.
Published: April 2022

Background

Patients on chronic pharmacologic immunosuppressive therapy are at increased risk of wound infection and complications after surgery. There is a paucity of data examining perioperative complications after microvascular free tissue transfer (MVFTT) reconstruction of the head and neck in this patient population.

Methods

Retrospective cohort study performed at two tertiary referral centers between August 2016 and May 2020.

Results

Nine hundred and seventy‐nine patients underwent MVFTT during the study period; of these 47 (5%) patients were taking chronic immunosuppressive medications. The most common indications for immunosuppression were solid organ transplant and autoimmune disease. Fourteen (30%) patients had surgical complications within 30 days of surgery: 8 (17%) wound dehiscences, 6 (12%) hematomas, and 2 (4%) surgical site infections. There was one total and one partial flap failure with a 30‐day reoperation rate of 4%.

Conclusions

MVFTT of the head and neck appears to be safe in patients on chronic pharmacologic immunosuppression.
Position paper on critical care pharmacy services (executive summary): 2020 update
Authors: Lat Ishaq , Paciullo Christopher , Daley Mitchell J. , MacLaren Robert , Bolesta Scott , McCann Jennifer , Stollings Joanna L. , Gross Kendall , Foos Sarah A. , Roberts Russel J. , Acquisto Nicole M. , Taylor Scott , Bentley Michael , Jacobi Judith , Meyer Tricia A.
Published: April 2022

Objectives

To provide a multiorganizational statement to update the statement from a paper in 2000 about critical care pharmacy practice and makes recommendations for future practice.

Design

The Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health‐Systems Pharmacists convened a joint task force of 15 pharmacists representing a broad cross‐section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (>66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting, and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development.

Main results

There are 82 recommendation statements: forty‐four original recommendations and 38 new recommendation statements. Thirty‐four recommendations were made for patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations are in the domain of training and education and eight recommendations regarding professional development.

Conclusions

The statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.
Pharmacy residency directors' concerns with implementing in‐training examinations in pharmacy residencies
Authors: Longyhore Daniel S.
Published: April 2022

Introduction

The use of in‐training examinations as formative assessment in graduate medical education is commonplace and performance has varying degrees of positive correlation with physician performance on future board certification examinations. Such a formative tool does not exist in graduate pharmacy education and may be a useful tool to consider developing and implementing into pharmacy residency programming.

Objectives

To evaluate the concerns of residency program directors (RPDs) should they be faced with implementing an in‐training examination into their postgraduate year 1 (PGY1) pharmacy residency program.

Methods

The concerns‐based adoption model framework was used to conduct a mixed‐methods evaluation of RPDs' concerns about in‐training examinations in pharmacy residency training. RPDs from the eastern United States were invited to participate in a 35‐item survey, followed by a scripted interview to learn about their concerns with the idea of examination integration.

Results

Twenty‐four program directors completed the stages of concern (SOC) quantitative survey and seven continued on to complete the levels of use qualitative interview. Survey data identified that program directors were in the informational stage, requiring more information and understanding before implementing such an assessment tool. The qualification of their survey responses contained themes of equality and equity between participating programs, the difference between summative and formative assessment, and curriculum changes that would accompany such a programmatic change. All participants were in the early SOC and had not actively sought information about this practice before being part of this research.

Conclusion

Significant efforts will be required to inform RPDs about in‐training examinations and formative assessment practices leading up to the implementation of such a practice in graduate pharmacy education.
Pursuing postgraduate pharmacy training in the United States for international pharmacy graduates: Approaches, current status, challenges, and future perspectives
Authors: Badreldin Hisham A. , Thabit Abrar K. , Almangour Thamer A. , Alessa Mohammed , Eljaaly Khalid , Fanikos John , Katz Michael
Published: April 2022

Aims

This paper aims to describe the procedures and current status regarding the pursuit of postgraduate pharmacy training in the United States for international pharmacy graduates. Also, it highlights some of the challenges those individuals may face throughout their journey and provides future perspectives.

Methods

To describe the procedures regarding the pursuit of postgraduate pharmacy training in the United States, we searched and summarized the information in public online platforms, such as the National Matching System, National Association of Boards of Pharmacy, and many others. To describe the current status, we searched the publicly available American Society of Health‐System Pharmacists residency online directory and the American College of Clinical Pharmacy fellowship online directory for programs offered to international pharmacy graduates.

Results

Two main pathways were identified to pursue postgraduate pharmacy training in the United States for international pharmacy graduates. Of the currently available residency training programs, we identified 16 programs that offer postgraduate year one and eight programs that offer postgraduate year two positions for international pharmacy graduates. We identified 64 fellowship programs in the American College of Clinical Pharmacy fellowship directory. However, the directory does not provide information on whether or not these fellowship programs will accept international pharmacy graduates.

Conclusion

In order to pursue postgraduate training in the United States, international pharmacy graduates face several logistical, administrative, and immigration obstacles. This is the first article to describe the current status, provide guidance on the approaches to pursue postgraduate pharmacy training in the United States, address some of the challenges, and provide several recommendations to be considered in the future.
Scalability of a remote advanced pharmacy practice experience with post‐graduate year one pharmacy resident preceptors
Authors: Smithburger Pamela L. , Kobulinsky Lawrence R. , Kreider Madeline , Yourich Bryan E. , Seybert Amy L.
Published: April 2022

Introduction

Due to suspension of onsite clinical instruction due to the coronavirus disease 2019 (COVID‐19) pandemic, a remote acute care rotation was created to provide students with an Advanced Pharmacy Practice Experience (APPE) and post graduate year one (PGY‐1) pharmacy residents with an opportunity to gain experience in precepting roles.

Objective

The objectives of this study were to evaluate student knowledge, clinical skills, communication, student satisfaction, and PGY‐1 pharmacy resident acceptance of this remote rotation and fulfillment of residency precepting objectives.

Methods

A five‐week remote acute care APPE rotation was created with pharmacy residents serving as co‐preceptors. A written evaluation and intermittent clinical examination (ICE) were deployed at baseline and conclusion to assess student knowledge, clinical skills, and communication. Student surveys assessed perceived skill improvement, satisfaction, and assessment of rotation and resident preceptors. Surveys were also utilized to evaluate resident perceived attainment of precepting objectives and residency program fulfillment of precepting requirements.

Results

Thirty‐four students and 10 residents participated in the rotation. Student knowledge and clinical skills increased from baseline (41 out of 60 [31‐52] vs 50 [43‐55]; P < .001) and the ICE (36 out of 70 [18‐55] vs 59.5 [43‐70]; P < .001). There was a statistically significant increase at rotation conclusion in resident rating of extreme competence or extreme comfort in 45% of domains assessed.

Conclusion

A remote APPE rotation is an effective approach to deliver an APPE rotation and can be successfully used to further student knowledge and provide PGY‐1 pharmacy residents a precepting opportunity to advance their precepting skills when onsite experiences are limited.
Impact of a health‐system longitudinal advanced pharmacy practice experience on student growth and postgraduate career placement
Authors: Triboletti Jessica S. , Jung Carolyn M. , Seither Amy L. , Walroth Todd A.
Published: April 2022

While most longitudinal advanced pharmacy practice experiences (LAPPEs) include sequential core rotations, programs vary regarding additional elements offered. Pharmacy residency programs have become increasingly competitive with applicants outnumbering available positions. LAPPEs can help students improve their candidacy for postgraduate training while also benefiting health systems.

Objective

To describe the health‐system perspective of a LAPPE designed to build professional skills in students to best prepare them for subsequent career pursuits.

Methods

Students enrolled in the Eskenazi Health (EH) LAPPE were asked to complete pre‐ and postprogram assessments regarding career interests, strengths, areas for improvement, and goals. Students were also asked to rank their comfort level with 27 clinical skills in four categories. Additionally, a survey was distributed to all program alumni to gather demographic and qualitative data.

Results

In the 9 years since inception, 52 students have enrolled in the EH LAPPE. Of the 44 program graduates surveyed, 41 responded (93%). Of these, 95% completed postgraduate training in 18 different states and two obtained jobs directly following graduation. The majority (54%) applied for a postgraduate year one (PGY1) residency at our institution, of which 11 (27%) matched for at least 1 year of residency training. A total of 32 students completed the pre‐ and postprogram skills assessments which demonstrated a statistically significant increase in comfort level in all 27 skills, with a median increase of 1.5 on a 4‐point scale. Clinical research, mentors, and mock interviews were identified as most helpful to program alumni.

Conclusions

The EH LAPPE can serve as an example for health‐systems wishing to institute a similar program. Students experienced perceived growth and increased confidence in various patient care activities, and successful career placement suggests that students benefited from career preparation elements of the LAPPE. LAPPEs can provide benefits to health systems through student contributions and should be considered by sites looking for growth and unique precepting opportunities.
Measuring health care quality: Implications, threats, and opportunities for clinical pharmacists
Authors: Ramachandran Sujith , Galdo John A. , Urick Benjamin Y. , Farley Joel F.
Published: April 2022

The Patient Protection and Affordable Care Act of 2010 has helped usher in an era of focus on health care quality and quality improvement. Since then, a variety of programs has driven quality improvement throughout the health care system using a combination of incentives and penalties. Many studies have demonstrated the value of integrating clinical pharmacist services into interdisciplinary models of care for the purpose of moving the needle on performance measures. The implementation of quality‐linked reimbursement programs has the greatest potential to meaningfully improve quality of care and reduce costs. However, the benefits of quality measures are dependent on their implementation into measurement systems and their application into clinical practice. Common threats to quality measurement in pharmacy practice may arise due to misapplication of health plan‐related measures to evaluate pharmacy services. Additionally, the core concepts related to novel reimbursement models have not adequately percolated into the formal education of practicing pharmacists. Therefore, the goal of this article is to help educate and raise awareness about the current quality landscape and present opportunities and directions for pharmacists to demonstrate their value in interdisciplinary health care teams. This article is broadly divided into four sections—first, we provide an introduction to quality measurement and its application to clinical pharmacists. Second, we elaborate on the development and endorsement of quality measures and measurement systems. Third, we present clinical scenarios of patient care—set in inpatient, ambulatory care, and community practice settings—that engage pharmacists in the context of quality measurement and evaluate the implications, threats, and opportunities for clinical pharmacists in each of these scenarios. Finally, we present recommendations for future advocacy, measurement, and leadership for pharmacist involvement in the quality landscape.
Endocrine pharmacotherapy education in United States colleges and schools of pharmacy
Authors: Shealy Kayce M. , Phillips Cynthia M. , Bzowyckyj Andrew S. , Gupta Vasudha , Guyton Justinne , Westberg Sarah M. , Cai Chao , Trujillo Jennifer , Goldman Jennifer D.
Published: April 2022

Background

As Doctor of Pharmacy (Pharm.D.) curricula are revised, it is important to identify what to retain and prioritize; previous studies have not evaluated the endocrine content within curricula at United States (U.S.) schools and colleges of pharmacy.

Objective

To determine the breadth of endocrine instruction and assessment within preadvanced pharmacy practice experience (pre‐APPE) coursework in the clinical sciences across U.S. Pharm.D. programs.

Methods

A cross‐sectional survey‐based study of U.S. schools and colleges of pharmacy was completed evaluating the 2018 to 19 academic year. Data were summarized using descriptive statistics. Categorical variables were assessed using Chi‐square or Fisher's exact tests and ordinal variables were evaluated using Mann‐Whitney U and Kruskal‐Wallis tests, with a priori significance set at .05. The study was approved by the Presbyterian College Institutional Review Board with exempt status.

Results

Fifty‐eight of 142 (40.8%) programs participated. Contact hours for required endocrine content varied, with 57% responding with more than 30 hours. Among 15 topics, only types 1 and 2 diabetes and thyroid disorders were required at all programs. For two‐thirds of the topics, the perception of topic importance differed between programs that cover and those that do not cover the topic (P <.05). The most common assessment strategies included case studies (100%), multiple choice questions (97%), SOAP note writing, and skills demonstrations (72% each). The most common diabetes‐related Entrustable Professional Activities (EPAs) were: evaluating drug therapy, following guidelines, and educating patients (98% each). The most commonly cited barrier to including more endocrine topics was lack of curricular time (88%).

Conclusions

Inconsistency in endocrine content within curricula at U.S. PharmD programs includes topics covered, contact hours, and perception of topic importance. Respondents consistently noted their methods appropriately educated student pharmacists to develop diabetes‐related EPAs. Development of a standardized endocrine curricula could establish minimal competencies for APPE‐readiness.
Implementation of defined criteria for clinical pharmacists in a pediatric cardiac transplant ambulatory clinic
Authors: Kiskaddon Amy L. , Brown Brian K. , Carapellucci Jennifer , Wisotzkey Bethany L. , Asante‐Korang Alfred
Published: April 2022

Introduction

The United Network of Organ Sharing (UNOS) bylaws and Centers for Medicare and Medicaid Services (CMS) accreditation standards require that transplant centers have a pharmacist. However, there are no established guidelines and there is a paucity of literature describing pharmacists in the pediatric ambulatory setting.

Objective

This project aims to describe the activities of pediatric clinical pharmacists in an ambulatory pediatric cardiac transplant clinic.

Methods

This is a single‐center pilot project describing pediatric clinical pharmacist interventions before (phase I) and after (phase II) implementation of comprehensive and standardized clinical activities. The list of defined key clinical activities was developed using UNOS and CMS accreditation standards, an evaluation of the literature, and cardiac transplant team feedback.

Results

Prior to a defined list of clinical activities, pediatric clinical pharmacists saw 74 unique patients during 174 patient encounters and recorded 240 interventions (phase I). Following implementation of standard activities, pediatric clinical pharmacists saw 81 unique patients during 225 patient encounters and recorded 510 interventions (phase II). The development of defined key activities led to a 129.4% increase in documented interventions per patient encounter. Interventions with the greatest increase included: medication schedule (phase I, 13.2%; phase II, 37.3%; P < .001), medication dose adjustment (phase I, 5.7%; phase II, 22.2%; P < .001), outpatient pharmacy coordination (phase I, 1.1%; phase II, 15.6%; P < .001), medication discontinuation (phase I, 0.6%; phase II, 9.3%; P < .001), and medication adherence education (phase I, 0%; phase II, 6.2%; P < .001).

Conclusion

There was a significant increase in the number and variety of medication‐related interventions after the development and implementation of defined key clinical activities for pediatric clinical pharmacists in a pediatric cardiac transplant ambulatory care clinic.
The light‐dependent daily cycle of ovulation in the oviparous medaka fish, Oryzias latipes (Atherinomorpha: Beloniformes: Adrianichthyidae) artificially pregnant with developing embryos
Authors: Iwamatsu Takashi , Oda Shoji , Kobayashi Hirokuni , Parenti Lynne R. , Fluck Richard A. , Yasuda Takako , Nakane Kouzo
Published: April 2022

In the oviparous medaka fish, Oryzias latipes, mature spermatozoa that were artificially introduced into the ovarian cavity retaining ovulated eggs could internally fertilize these eggs. This enabled us to examine the effect of ovarian gestation on the ovulation cycle. Most freshly ovulated eggs could be internally fertilized in the ovarian cavity. Yet eggs ovulated 24 h after single insemination remained unfertilized in the ovarian cavity. Artificially pregnant females persisted in a daily cycle of ovulation, which occurred shortly before the onset of light under the present reproductive conditions. Females continuously ovulated a certain number of eggs despite ovarian gestation, that is, the presence of embryos within the ovarian cavity. Repeated cycles of ovulation led to crowding in the ovarian cavity because the group of fertilized eggs, with their hardened egg envelope (chorion or zona radiata), plugged the genital orifice. The development of fertilized eggs was retarded and ceased around the initiation stage of blood circulation, but when they were transferred from the ovarian cavity into regular saline, they regained their ability to develop normally up to hatching. These results show that in oviparous female medaka, ovarian gestation exerted little effect on the time of ovulation and the number of ovulated eggs.
急激な経過を辿った重症熱性血小板減少症候群（severe fever with thrombocytopenia syndrome: SFTS）の1例(A fatal case of severe fever with thrombocytopenia syndrome (SFTS))
Authors: (Hironori Matsumoto) 松本 紘典 , (Kensuke Umakoshi) 馬越 健介 , (Naoki Moriyama) 森山 直紀 , (Suguru Annen) 安念 優 , (Satoshi Kikuchi) 菊池 聡 , (Jun Takeba) 竹葉 淳 , (Mayuki Aibiki) 相引 眞幸
Published: April 2022

2013年に日本国内において重症熱性血小板減少症候群（severe fever with thrombocytopenia syndrome: SFTS）の発生が確認されて以来，その発生報告は増えている。今回，急激な多臓器不全の進行から短期間で死亡に至った重症のSFTSの1例を経験したので，病理解剖結果を加え報告する。症例は85歳の女性で，山中での農作業の3日目に，嘔吐症状にて発症した。速やかに対症療法が開始されたが，全身状態は悪化した。併発した播種性血管内凝固症候群に対する抗凝固療法や，血球貪食症候群に対するステロイド投与を含め集中治療を行ったが，改善せず，受傷から12日目に死亡した。病理解剖では，リンパ節や肝臓などのリンパ球に高コピーのSFTSウイルスが認められ，重症度が高いことが示唆された。また，末梢血の異型リンパ球やリンパ節でみられた多数のリンパ球はB細胞リンパ球であり，重篤なSFTSの病勢との関連が示唆された。今後，さらなる症例集積による病態の解明が必要である。
高齢敗血症患者における炎症と免疫抑制の病態生理(Pathophysiology of inflammation and immunosuppression in the elderly after sepsis)
Authors: (Shigeaki Inoue) 井上 茂亮 , (Nobuo Watanabe) 渡邊 伸央 , (Nanami Mizushima) 水嶋 七実 , (Sadaki Inokuchi) 猪口 貞樹
Published: April 2022

本邦では急激な高齢化の進行に伴い，高齢者の敗血症患者が激増している。一般に高齢者の敗血症は予後不良と言われているものの，その病態生理・機序は十分解明されていない。加齢に伴う免疫機能変化は「免疫老化（immunosenescence）」と呼ばれ，主に抗原特異的な応答を担う獲得免疫機能の低下を引き起こす。一方，高齢者では自己免疫性疾患の罹患率が上昇し，慢性炎症素因も指摘されている。高齢者では過剰炎症と免疫抑制が密接に関わっていることが指摘されているものの，敗血症患者におけるその病態生理は十分解明されていない。筆者らの検討では，65歳未満の成人敗血症患者と比較して65歳以上の高齢敗血症患者のT細胞は疲弊しており，活性抑制受容体の増加，IL–2の産生障害，活性化や増殖障害が明らかになった。また成人と比較して，高齢敗血症患者では血清IL–6値が第1～6病日まで有意に高値を示した（p<0.01）。さらに，高齢敗血症患者ではICU入室後2～4週間後の細菌培養陽性率が有意に増加し，Acinetobactor属やS. Maltophiliaの喀痰培養における陽性率が増加していた。また成人と比較して，高齢敗血症患者の90日後生存率は有意に低下していた。以上より，高齢者における敗血症後90日後死亡率は約4倍であり，その原因の一つとして敗血症直後からの過剰な炎症と免疫抑制による亜急性期の二次感染率の増加が関係している可能性がある。免疫機能が破綻した高齢敗血症患者では感染や炎症が遷延し重症化しやすいため，速やかかつ正確な敗血症診断と集学的な治療をドラスティックに展開することが望ましい。