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Total elbow replacement (TER) is an accepted treatment for complex intra-articular distal humerus fractures in elderly patients. Distal humeral hemiarthroplasty (HA) is also a potential surgical option for unreconstructable fractures and avoids the concerns regarding mechanical wear and functional restrictions associated with TER. In the current literature, there are limited data available to compare the revision rates of HA and TER for the treatment of fracture. We used data from a large national arthroplasty registry to compare the outcome of HA and TER undertaken for fracture/dislocation and to assess the impact of demographics and implant choice on revision rates. Data obtained from the Australian Orthopaedic Association National Joint Replacement Registry from May 2, 2005, to December 31, 2021, included all procedures for primary elbow replacement with primary diagnosis of fracture or dislocation. The analyses were performed using Kaplan-Meier estimates of survivorship and hazard ratios (HRs) from Cox proportional hazards models. There were 293 primary HA and 631 primary TER procedures included. The cumulative percentage revision (CPR) rate at 9 years was 9.7% for HA (95% confidence interval [CI] 6.0, 15.7), and 11.9% (95% CI 8.5, 16.6) for TER. When adjusted for age and gender, there was a significantly higher risk of revision after 3 months for TER compared to HA (HR 2.47, 95% CI 1.22, 5.03, P =.012). There was no difference in the rate of revision for patients aged <55 years or ≥75 years when HA and TER procedures were compared. In primary TER procedures, loosening was the most common cause of revision (3.6% of primary TER procedures), and the most common type of revision in primary TER involved revision of the humeral component only (2.6% of TER procedures). TER has a higher rate of first revision for loosening compared to HA (HR 4.21, 95% CI 1.29, 13.73; P =.017). In HA procedures, instability (1.7%) was the most common cause for revision. The addition of an ulna component was the most common type of revision (2.4% of all HA procedures). For the treatment of distal humerus fractures, HA had a lower revision rate than TER after 3 months when adjusted for age and gender. Age <55 or ≥75 years was not a risk factor for revision when HA was compared to TER. Loosening leading to revision is more prevalent in TER and increases with time. In HA, the most common type of revision involved addition of an ulna component with preservation of the humeral component. [ABSTRACT FROM AUTHOR]

Background: Ensuring opportunities exist to dispose of unused or unwanted drugs that are appropriate, accessible, and affordable is critical to avoid misuse and lasting harm to the environment.Objective: The objectives of this study were to identify state statutes promulgated in all 50 states and the District of Columbia (DC) facilitating disposal of unused or unwanted drugs in the community setting and assess their characteristics.Methods: A retrospective review of state statutes in all 50 U.S. states and DC between October 2020 and May 2022 was conducted. Statutes using terms "drug and disposal or collection" and that were intended to facilitate disposal of unused or unwanted drugs were included. Drug donation programs or repositories, drug returns to the pharmacy, charitable clinics, and others not intended to dispose or unused or unwanted drugs were excluded. Publicly available resources and Westlaw, a legal resource, were used to identify state statutes. Descriptive statistics were used to describe the findings.Results: Of the 50 U.S. states and DC, we found that most states enacted a statute pertaining to drug disposal (63%; n = 32) as of May 2022. Of states with a drug disposal statute, few had funding mechanisms or required pharmacy participation. Most statutes specified the type of product that may be accepted for disposal, what site may accept them, and who may dispose of the product. Few states specified which health care provider or other individual may accept the product(s) for disposal.Conclusion: Most states have enacted statutes facilitating drug disposal, but their characteristics varied widely. Opportunities may exist at the state level to further incentivize proper drug disposal, and further research is needed to measure possible effects of these state statutes. [ABSTRACT FROM AUTHOR]

Background: The opioid epidemic continues to have a significant negative impact on public health in the United States. Community pharmacies represent an important care setting in confronting the opioid epidemic. However, they continue to be an underutilized care access point. Pharmacy technicians are often the first and most frequent pharmacy personnel to interact with people receiving a prescription for opioid medications. There is a paucity of studies conducted with pharmacy technicians as it pertains to interactions with these patients.Objectives: To explore community pharmacy technicians' roles and their personal experiences when interacting with patients who are receiving a prescription for opioid medications.Methods: A qualitative design was employed in use of focus groups (FGs) conducted virtually across several regions of the United States. Audio recordings of U.S. FGs were transcribed verbatim and imported via Dedoose (v2.0, Dedoose, Manhattan Beach, CA,) for further data assessment using thematic analysis. The researchers used the Consolidated Criteria for Reporting Qualitative Research.Results: In total, 46 pharmacy technicians participated in 8 FGs. The average length of time for FG was 56 minutes. The mean for the work experience was 7 years, with a range of 1 to 44. Of 46 subjects, 34 were working in a community setting, and the rest were in a hospital setting. Most of the subjects practiced in Tennessee and California at the time of the study. Two themes emerged from the data: "Interactions between pharmacy technicians and patients who are using opioid prescriptions," and "Interactions between pharmacy technicians and the pharmacy team while dispensing opioid prescriptions."Conclusion: Pharmacy technicians serve as a key health care system touchpoint in the community pharmacy. Although pharmacy technicians are exposed to people receiving a prescription for opioid medications, they feel under-resourced and ill-quipped to adequately serve this patient population. [ABSTRACT FROM AUTHOR]

Amphibians are currently considered to be covered by pesticide Environmental Risk Assessment schemes by surrogacy assumptions of exposure and susceptibility based on typical laboratory test species such as fish, mammals, and birds. While multiple reviews have shown for this approach to be adequate in the case of aquatic stages, the same cannot be definitively stated for terrestrial stages. Concerns have risen that exposure of amphibians is likely to be highly influenced by dermal absorption, primarily due to the high permeability of their skin and the lack of a protective layer, such as fur or feathers. It is thus hypothesized that dermal uptake could be a significant route of exposure. Consequently, it is necessary to determine the relative importance of different exposure routes that might affect the integrated toxicity outcome for terrestrial amphibian life-stages. Here, a one-compartment Toxicokinetic model was derived and tested using a publicly available dataset containing relevant exposure and uptake information for juvenile anurans exposed to 13 different pesticides. Modelled body burdens were then compared to measured burdens for a total of 815 individuals. Overall, a good concordance between modelled and measured values was observed, with the predicted and measured body burdens differing by a factor of 2 on average (overall R2 of 0.80 and correlation coefficient of 0.89), suggesting good predictivity of the model. Accordingly, the model predicts realistic body burdens for a variety of frog and toad species, and overall, for anurans. As the model includes rehydration (implicit in the evaluated studies) but currently does not account for metabolism, it can be seen as a worst-case assessment. We suggest toxicokinetic models, such as the one here presented, could be used to characterize dermal exposure in amphibians, screen for pesticides of concern, and prioritize risk assessment efforts, whilst reducing the need for de novo vertebrate testing. [Display omitted] • A one compartment Toxicokinetic (TK) model is described for anurans. • The model allows to extrapolate body burdens after exposure to contaminated soil. • On average, model predictions deviated from measured data by a factor of 2. • Only in 1% of cases, estimates underestimated exposure by > 10x compared to measured data. • The model could be used to reduce the need de novo vertebrate testing. [ABSTRACT FROM AUTHOR]

Competence in drug information (DI) skills fosters the application of evidence-based medicine (EBM) principles. However, concern exists about whether there is adequate DI preparation in curricula. This report describes the development, implementation, and evaluation of a team project utilizing the critically appraised topic (CAT) approach in a DI course. To assess abilities and skills in DI and EBM principles, student teams (N = 26) were assigned DI requests. A grading rubric based on the validated EBM Critical Presentation Evaluation Tool was used to evaluate each team's project. As a secondary measure, students completed pre-and post-class self-efficacy assessments describing their confidence in DI processes. Twenty-six team posters were submitted with a mean project rubric score of 43 out of 50 points (86%). One hundred one of 172 students (59% response rate) completed the pre- and post-self-efficacy surveys, and results revealed gains in confidence for MEDLINE searching skills, properly citing sources, and knowing where to go next if the answer could not be found in a tertiary resource (all P <.001). The majority of respondents noted their teams collaborated to achieve project goals, actively participated, were open and accepting of others' ideas, and were satisfied with group interactions. Student team creation of DI responses via CATs are an innovative way to introduce, measure, and enhance DI skills in a didactic classroom setting. Fostering DI skills prepares pharmacy students for evidenced-based pharmacy practice. [ABSTRACT FROM AUTHOR]

Entrustable professional activities (EPAs) denote activities and tasks students should be able to perform by graduation irrespective of their practice setting. Formulary decision-making includes several core EPA related skills, such as utilization of drug information, written, and verbal skills. The objective of this study was to describe an EPA supporting task aimed at improving utilization of evidence-based medicine skills and its impact on student self-perceived confidence, rating of skills needed, and competence. Teams comprised of six to seven students were assigned a drug and instructed to complete the following activities: (1) background literature search, (2) drug monograph, (3) five-min presentation to simulate a live pharmacy and therapeutics (P&T) committee meeting, and (4) vote on a formulary drug in each drug class. Students completed a pre/post five-point Likert scale self-efficacy survey and a perceived importance survey. A scoring rubric assessed monograph and presentation elements (max points 30). Survey items were analyzed using Wilcoxon signed-rank test. Descriptive statistics were used for assignment grades. One hundred ninety students completed the pre/post self-efficacy and perceived importance survey. Confidence showed statistically significant improvement (P <.001) in nine target skill areas. In ranking importance, all 12 assessed skills exhibited a statistically significant increase following the activity. A mock P&T activity represents an innovative way to evaluate an EPA supporting task that allows students to improve their evidence-based analysis, written, and verbal communication skills. [ABSTRACT FROM AUTHOR]

Objectives: The role of community pharmacists continues to evolve to meet the changing medication-related needs of patients in the United States, requiring a fundamental shift in the pharmacist's workflow and tasks including medication dispensing and medication therapy management (MTM). To compare community pharmacists' current and idealized time allocation. Barriers to, and potential facilitators of, typical and specific pharmacist functions are also reported, with an emphasis on MTM practices. A secondary objective included interpreting how pharmacists perceived the value of social determinants of health to the MTM process.Methods: Community pharmacists practicing in Tennessee were surveyed online with 3 distinct foci: time allocation and delegation, MTM barriers, and the perceived value of health-related and social data to the MTM process. For the first 2 sections, the respondents provided responses in 2 different scenarios: (1) current workflow and (2) an idealized workflow. Paired Wilcoxon signed-rank and chi-square tests compared the responses to workday items, and Spearman correlations assessed the relationships between preferences and perceived barriers.Results: The pharmacists reported spending the largest share of time verifying product (32.8% [SD 19.28]), and most indicated that they spent no time in either point-of-care testing (POCT) or physical patient assessment. In an ideal work environment, more patient-focused roles would be preferred (e.g., health screening, POCT, MTM, and vaccinations), with more than 80% indicating that they would delegate register activities, data entry, and product verification to technicians. In performing MTM, the pharmacists indicated that they would prefer delegating more data collection and patient management activities to technicians to reserve time for patient assessment and care plan creation. Key barriers to MTM included a lack of time, staff support, and patients' willingness to participate.Conclusion: Ideally, pharmacists would prefer to do no prescription filling or selling or register activities. Facilitating community pharmacy practice evolution will require focusing on building teams around support personnel. [ABSTRACT FROM AUTHOR]

Background: With the evolving roles of pharmacy technicians in the United States, the profession has attempted to define a national standard. Community pharmacy employers to-date have preferred on-the-job training to formal, accredited training programs or credentialing, however, limited evidence exists on the perceived needs of pharmacy technicians in the United States compared to those of community pharmacy employers.Objectives: The aims of this study were to explore: 1) community pharmacy employer perceptions of associated benefits and perceived value of pharmacy technician certification and 2) needs of employers related to pharmacy technician attitudes and knowledge, skills and abilities (KSAs).Methods: Using a semi-structured interview guide, researchers interviewed 7 community pharmacy employers within top management teams in a variety of community pharmacy settings. The data were analyzed for themes using the human capital vs. signal theory.Results: Employers and managers generally saw both attitude and KSAs as vital to success. However, given a choice between experience and attitude, attitude was preferred. There was general agreement that certified technicians offered more value to their organization, however gaps in certified technician KSAs were noted (i.e., lack of day-to-day practical skills, vaccination screening, motivating patients to change behaviors, patient communication and workflow management).Conclusions: New emerging directions for certification now exist due to the rapidly shifting pharmacy landscape, which is revolves around new and expanded clinical patient care services. This shifting landscape has exposed gaps, reinforced strengths, and uncovered potential new opportunities and needs related to technician certification. [ABSTRACT FROM AUTHOR]

The United States healthcare system faces immense challenges related to cost, quality, and access. As the pharmacy profession addresses these challenges by shifting toward a practice model centered around direct patient care clinical services, a competent and capable technician workforce is needed to support the roles of pharmacists. Until recently, little focus has been paid to pharmacy technicians or their role as they relate to practice model change. With ongoing pharmacist practice transformation, an approach that ensures uniform technician education, training, registration, and certification is vital to support a practice model designed to transform medication management across the continuum of care. The purpose of this commentary is three-fold: to review the history of pharmacy technician training and practice, discuss current and future technician practice models, and examine workforce development implications. [ABSTRACT FROM AUTHOR]

Although frequently examined as a target organ for non-endocrine toxicity, histopathological evaluation of the liver is becoming a routine component of endocrine disruption studies that utilize various fish species as test subjects. However, the interpretation of microscopic liver findings can be challenging, especially when attempting to distinguish adverse changes associated with endocrine disrupting substances from those caused by systemic or direct hepatic toxicity. The purpose of this project was to conduct a critical assessment of the available peer-reviewed and grey literature concerning the histopathologic effects of reproductive endocrine active substances (EAS) and non-endocrine acting substances in the livers of fish models, and to determine if liver histopathology can be used to reliably distinguish endocrine from non-endocrine etiologies. The results of this review suggest that few compound-specific histopathologic liver effects have been identified, among which are estrogen agonist-induced increases in hepatocyte basophilia and proteinaceous intravascular fluid in adult male teleosts, and potentially, decreased hepatocyte basophilia in female fish exposed to substances that possess androgenic, anti-estrogenic, or aromatase inhibitory activity. This review also used published standardized methodology to assess the credibility of the histopathology data in each of the 117 articles that reported liver effects of treatment, and consequently it was determined that in only 37% of those papers were the data considered either highly credible or credible. The outcome of this work highlights the value of histopathologic liver evaluation as an investigative tool for EAS studies, and provides information that may have implications for EAS hazard assessment. [ABSTRACT FROM AUTHOR]

Objectives: Postgraduate training, dual degrees, and board certifications are credentials viewed by academic pharmacy communities and professional organizations as positive assets for those seeking pharmacist jobs; however, a key question merits further investigation: do these views match employer expectations? The primary objective of this study was to identify the most common qualifications employers require as stated in job advertisements.Methods: Pharmacist job postings from the aggregate jobs website Indeed.com were evaluated for the 20 largest metropolitan areas in the United States. Search criteria included: pharmacist, full-time, and within a 50-mile radius of the metropolitan area. Positions were excluded if they were not pharmacist specific, did not require a pharmacy degree, were part-time, or were temporary. Required and preferred qualifications were collected in the following categories: practice type, experience needed, training, certification, and desired skills.Results: Six hundred and eleven of 1356 postings met inclusion criteria. Positions were classified as community (113), health-system (264), industry (149), academia (9), or other (76). Four hundred and six (66.4%) required a minimum of a Bachelor's of Pharmacy degree, while 174 (28.4%) required a Doctor of Pharmacy degree. Experience was required for 467 positions (range of 6 months to 14 years). Postgraduate training was required for 73 positions (66 residency/7 fellowship). One job required a Master's degree, type unspecified. BPS certifications were required for 7 positions (1.1%) and preferred for 22 positions (3.6%). Certifications and skills most required by employers were verbal and written skills (248), Microsoft Office proficiency (93), immunization certifications (51), and Basic Life Support/Cardiopulmonary Resuscitation certifications (37).Conclusion: Postgraduate training, dual degrees, and board certification were not significant factors in the qualification criteria for the positions identified. The qualifications most often required by employers were experience and skills. Our findings indicated that employers wanted many soft skills that cannot be quantified. [ABSTRACT FROM AUTHOR]

Objective This study quantifies and describes student self-assessment approaches in colleges of pharmacy across the United States. Methods Faculty members identified as assessment directors from college websites at U.S. colleges of pharmacy were electronically surveyed. Prior to distribution, feedback and question validation was sought from select assessment directors. Surveys were distributed and recorded, via Qualtrics ® survey software and analyzed in Microsoft Excel ® . Results Responses were received from 49 colleges of pharmacy (n = 49/134, 37% response rate). The most commonly used strategies were reflective essays (n = 44/49, 90%), portfolios (n = 40/49, 82%), student self-evaluations (n = 35/49, 71%) and questionnaires/surveys/checklists (n = 29/49, 59%). Out of 49 submitted surveys, 35 programs noted students received feedback on self-assessment. Feedback came most commonly from faculty (n = 31/35, 88%). Thirty-four programs responded regarding self-assessment integration including fifteen colleges (n = 15/34, 44%) that integrated self-assessment both into the curriculum and co-curricular activities, while 14 (n = 14/34, 41%) integrated self-assessment exclusively into the curriculum, and five (n = 5/34, 15%) used self-assessment exclusively in co-curricular activities. Discussion and conclusions Student self-assessment is a critical first step of the Continuing Professional Development (CPD) process. Colleges and schools of pharmacy use a wide variety of methods to develop this skill in preparing future practitioners. [ABSTRACT FROM AUTHOR]

Abstract: To use and implement an assessment scheme for the evaluation of endocrine disrupting properties of chemicals in ecotoxicology, the types of effect need to be agreed. Effects that merit further consideration in this context should fulfil the following three criteria: caused by an endocrine mode of action, be adverse, and be relevant at the population level to reflect the protection goal of ecotoxicological assessments. Thereafter, a comparison of effect values, regardless of the causative mechanisms, should be made, firstly to determine if endocrine toxicity generates the lowest endpoint within a taxon, and secondly if it is the lowest endpoint compared to that of other taxa living in the same compartment. These comparisons inform on two levels of specificity and determine if endocrine-mediated side-effects determine the ecotoxicological profile of a chemical. Various quantitative measures for the assessment of potency are also presented, which could assist in determining how to handle substances in the risk assessment when a regulatory concern is identified. Finally, derogation criteria should be defined for compounds that were designed as endocrine disruptors for non-vertebrates and those for which there is ‘negligible exposure’. This paper discusses and provides proposals on how to apply these concepts for assessment of substances. [Copyright &y& Elsevier]

Highlights: [•] Solvent carriers are discussed in terms of the practical, statistical and regulatory considerations. [•] Analysis using a database of 141 responses (endpoints) from 73 experiments. [•] Conditional strategy to control choice is recommended. [•] Wherever possible a solvent should not be employed or at least the concentration minimized. [Copyright &y& Elsevier]

Abstract: Purpose: A 24-month longitudinal academic learning experience as part of a combined postgraduate year one and postgraduate year two (PGY1/PGY2) pharmacotherapy residencies to prepare residents for an academic career is described. Summary: A longitudinal academic learning experience was developed to provide an opportunity for residents to gain valuable experience in teaching, scholarly activity, professional service, and leadership development activities in addition to learning the process of integrating these activities into their daily responsibilities. Teaching experiences include didactic lectures, small-group facilitation, precepting, and course coordination. Residents participate in college and institution committees and are encouraged to become active in professional service through local, regional, and national pharmacy organizations. Peer-review, as well as manuscript development and submission, is also a focus of this experience. Finally, leadership skills are nurtured through readings, discussions, and faculty interviews. The 24-month longitudinal nature of this experience enables repetition and incorporation of feedback to further hone their academic abilities. Conclusion: Through the longitudinal academic learning experience, residents are given the opportunity to learn and practice skills vital to success in a clinical faculty position. Benefits of this program extend beyond the residents to preceptors and the institution. [Copyright &y& Elsevier]

Abstract: Fish in vivo screening methods to detect endocrine active substances, specifically interacting with the hypothalamic–pituitary–gonadal axis, have been developed by both the Organization for Economic Co-operation and Development (OECD) and United States Environmental Protection Agency (US-EPA). In application of these methods, i.e. regulatory testing, this paper provides a proposal on the setting of test concentrations using all available acute and chronic data and also discusses the importance of avoiding the confounding effects of systemic toxicity on endocrine endpoints. This guidance is aimed at reducing the number of false positives and subsequently the number of inappropriate definitive vertebrate studies potentially triggered by effects consequent to systemic, rather than endocrine, toxicity. At the same time it provides a pragmatic approach that maximizes the probability of detecting an effect, if it exists, thus limiting the potential for false negative outcomes. [Copyright &y& Elsevier]

Abstract: Purpose: This study quantifies variation in radiation treatment plan quality for plans generated by a population of treatment planners given very specific plan objectives. Methods and Materials: A “Plan Quality Metric” (PQM) with 14 submetrics, each with a unique value function, was defined for a prostate treatment plan, serving as specific goals of a hypothetical “virtual physician.” The exact PQM logic was distributed to a population of treatment planners (to remove ambiguity of plan goals or plan assessment methodology) as was a predefined computed tomographic image set and anatomic structure set (to remove anatomy delineation as a variable). Treatment planners used their clinical treatment planning system (TPS) to generate their best plan based on the specified goals and submitted their results for analysis. Results: One hundred forty datasets were received and 125 plans accepted and analyzed. There was wide variability in treatment plan quality (defined as the ability of the planners and plans to meet the specified goals) quantified by the PQM. Despite the variability, the resulting PQM distributions showed no statistically significant difference between TPS employed, modality (intensity modulated radiation therapy versus arc), or education and certification status of the planner. The PQM results showed negligible correlation to number of beam angles, total monitor units, years of experience of the planner, or planner confidence. Conclusions: The ability of the treatment planners to meet the specified plan objectives (as quantified by the PQM) exhibited no statistical dependence on technologic parameters (TPS, modality, plan complexity), nor was the plan quality statistically different based on planner demographics (years of experience, confidence, certification, and education). Therefore, the wide variation in plan quality could be attributed to a general “planner skill” category that would lend itself to processes of continual improvement where best practices could be derived and disseminated to improve the mean quality and minimize the variation in any population of treatment planners. [Copyright &y& Elsevier]

Biconformal supergravity models provide a new gauging of the superconformal group relevant to the Maldacena conjecture. Using the group quotient method to biconformally gauge SU(2,2&z.sfnc;N), we generate a 16-dim superspace. We write the most general even- and odd-parity actions linear in the curvatures, the bosonic sector of which is known to descend to general relativity on a 4-dim manifold. [Copyright &y& Elsevier]

: BackgroundSpermicides containing nonoxynol-9 (N-9) may increase HIV transmission. In women, intravaginal N-9 is found in the uterus shortly after its insertion. Exposure of the female upper reproductive tract to N-9 may alter epithelial integrity, thereby increasing HIV transmission risk. Our goal was to characterize the histological effects of N-9 on uterine epithelium in an animal model.: MethodsFemale mice were exposed to intravaginal or intrauterine Advantage-S™ (N-9), Replens™, K-Y® jelly or water. After various exposure times, mice were sacrificed and stained uterine tissue sections were analyzed by a pathologist blinded to treatment.: ResultsIntravaginal and intrauterine N-9 administration resulted in disruption of uterine epithelium compared to Replens, K-Y jelly or water. N-9 caused rapid (within 10 min), focal, uterine epithelial sloughing and complete epithelial loss within 24 h. Epithelial regeneration began 48 h after exposure N-9 and was completely restored within 72 h; the new epithelial layer, however, was composed of cuboidal cells instead of normally present columnar cells. In addition, hemorrhage and necrosis were present are all time points examined.: ConclusionsOur results demonstrate for the first time that N-9 has a deleterious effect on uterine epithelium. Although these results were observed in a mouse model, similar disruption of the upper reproductive tract epithelium in women by N-9 may facilitate HIV infection and serve as an unrecognized portal of human HIV transmission. [Copyright &y& Elsevier]

Our groups have had a long-term interest in utilizing bacterial systems in the characterization of bioactivation and detoxication reactions catalyzed by cytochrome P450 (P450) and glutathione transferase (GST) enzymes. Bacterial systems remain the first choice for initial screens with new chemicals and have advantages, including high-throughput capability. Most human P450s of interest in toxicology have been readily expressed in Escherichia coli with only minor sequence modification. These enzymes can be readily purified and used in assays of activation of chemicals. Bicistronic systems have been developed in order to provide the auxiliary NADPH-P450 reductase. Alternative systems involve these enzymes expressed together within bacteria. In one approach, a lac selection system is used with E. coli and has been applied to the characterization of inhibitors of P450s 1A2 and 1B1, as well as in basic studies involving random mutagenesis. Another approach utilizes induction of the SOS (umu) response in Salmonella typhimurium, and systems have now been developed with human P450s 1A1, 1A2, 1B1, 2C9, 2D6, 2E1, and 3A4, which have been used to report responses from heterocyclic amines. S. typhimurium his reporter systems have also been used with GSTs, first to demonstrate the role of rat GST 5-5 in the activation of dihalomethanes. These systems have been used to compare these GSTs with regard to activation of dihaloalkanes and potential toxicity. [Copyright &y& Elsevier]

Reports that if freshwater toxicity data are related to saltwater toxic effects in a systematic and predictable way, the former can be used to predict the latter. Identification of theoretical relationships between freshwater and saltwater; Need to examine species parity and representativeness for each chemical substance to avoid bias.

Objectives: Tennessee has one of the highest rates of opioid prescribing in the United States; therefore, the objectives of this study were to examine availability, pricing, and pharmacist-initiated recommendations of naloxone in retail community pharmacies in Eastern and Western Tennessee; to identify the most common barriers to naloxone dispensing and strategies to improve access; and to determine regional differences in access to naloxone.Design: A cross-sectional survey conducted via telephone.Setting and Participants: All retail community pharmacies located in the most populous counties in the eastern and western regions of Tennessee were eligible for inclusion, as were all retail community pharmacies in the 5 counties in each region that had the highest rates of opioid prescriptions (316 pharmacies identified in 12 counties).Outcome Measures: Outcome measures included availability, price, and pharmacist-initiated recommendations of naloxone products, barriers to dispensing, and suggestions to improve naloxone access. Survey responses were summarized as descriptive statistics. Chi-square, independent samples t test, and inductive content analysis were conducted.Results: Response rate was 56.3%. Most participants (92.7%) reported that naloxone (Narcan) was available from their pharmacies at a mean cash price of $132.49, with no statistically significant differences between regions. The most commonly reported barrier was cost (70.2%). When queried about recommendations to various groups at a high risk of overdose, as advised by the U.S. Department of Health and Human Services, 42.1% to 69.1% of pharmacies reported recommending naloxone to at least 50% of high-risk patients. Suggestions to increase naloxone access included lowering the cost and improving naloxone-related education for patients, pharmacists, and other providers.Conclusion: Although Narcan was widely available, cost was a frequently cited barrier to dispensing. Pharmacist-initiated recommendations for coprescribing and dispensing naloxone to patients at a high risk of overdose were limited. Addressing cost issues in addition to increasing patient and pharmacist education concerning the use and benefit of naloxone were suggested to improve naloxone access. [ABSTRACT FROM AUTHOR]

Secondary sexual characteristics (SSCs) are important features that have evolved in many fish species because of inter-individual competition for mates. SSCs are crucial not only for sexual selection, but also for other components of the reproductive process and parental care. Externally, they are especially clear in males (for instance, tubercles, fatpad, anal finnage, colouration) but are also externally present in the females (for instance, ovipositor). These characters are under hormonal control and as such there has been much interest in incorporating them as measures in fish test methods to assess the potential endocrine activity of chemicals. Here we describe the external SSCs in typical laboratory test species for endocrine testing - fathead minnow (Pimephales promelas), Japanese medaka (Oryzias latipes), zebrafish (Danio rerio) and the three-spined stickleback (Gasterosteus aculeatus L.). We also provide some examples and discuss the utility of SSC responses to the endocrine activity of chemicals in the field and the laboratory. This paper is not aimed to provide a comprehensive review of SSCs in fish but presents a view on the assessment of SSCs in regulatory testing. Due to the current regulatory importance of establishing an endocrine mode-of-action for chemicals, we also consider other, non-endocrine factors that may lead to SSC responses in fish. We conclude with recommendations for how the assessment of SSCs in fish could be usefully incorporated into the endocrine hazard and risk assessment of chemicals. [ABSTRACT FROM AUTHOR]

Objectives: To compare viewpoints of nationally certified and noncertified technicians and explore the perceived value of technician certification in the job performance domains of medication safety, skills and abilities, experience, engagement and satisfaction, and productivity.Methods: A cross-sectional survey of pharmacy technicians, from 6 states representing 4 regions of the United States, was conducted. Technician mailing lists were purchased from Boards of Pharmacy, and randomly selected technicians were sent survey invitations. Surveys were completed via Qualtrics and analyzed with the use of SAS.Results: Six hundred seventy-six technicians (547 certified, 103 noncertified, and 26 previously certified) responded to the survey (9.4% response rate). Certified technicians reported significantly higher confidence rating for desire to take on new responsibilities (P < 0.01; Cohen d 0.45) and plans to remain in the pharmacy field (P = 0.01, Cohen d 0.35), lower rating for leaving the job in the next 12 months (P < 0.01; Cohen d 0.35), and perceived lower rate of medication errors (P < 0.01; Cohen d 0.35) compared with other technicians in the work setting. The majority of respondents stated confidence in performing the "final check" on another technician's preparation of a new or refill medication if allowed. Both certified and noncertified technicians noted dissatisfaction with pay. The majority of respondents reported that they spent none of or less than 10% of their workday assisting pharmacists with medication therapy management (MTM) sessions, immunizations, or point-of-care tests; however, 71 respondents specifically described how they assist pharmacists with MTM.Conclusion: Results from our survey sample indicate that certified technicians have a stronger organizational and career commitment and desire to take on new roles. A majority of respondents noted dissatisfaction with pay but feel a sense of pride in their work. Both groups were confident in their abilities needed for tech-check-tech product verification. [ABSTRACT FROM AUTHOR]

Purpose Modern radiation oncology treatments are typically associated with a certain level of acute or long-term complications. Whenever a new treatment is introduced into clinical practice, a clinician may have reason to question whether certain side effects occur more frequently in his or her patients than reported in the published literature. However, the clinician, lacking rigorous statistical methods to answer this question, may not draw the correct conclusion until treating a larger number of patients than necessary. Methods and materials We propose a Bayesian framework to calculate (1) the probability that the rate of an adverse event (AE) is above a certain threshold and (2) the number of AEs to be observed before we can conclude with a certain confidence level that the AE rate is above a threshold. Both questions will be answered based on the formulation of a posterior distribution of the AE rate given the observed data. The proposed method does not rely on large sample assumptions, and the computation of the solution is quick and straightforward. The proposed methods are illustrated in 2 clinical scenarios. Results We tabulated the probability that an AE rate is greater than a threshold for a given number of patients experiencing events from an observed number of patients. In addition, we developed a free online interactive tool to facilitate the implementation of the method. Conclusions The proposed method, including the presented tables and the online tool, provides clinicians with a practical means of determining if his or her patients are experiencing a greater (or lower) number of complications than expected. How to use the statistical result to guide a clinical decision depends upon the specifics of the clinical condition and the available treatment alternatives. [ABSTRACT FROM AUTHOR]

An abstract of the article "Synthesis of Bile Acid Coenzyme A Thioesters in the Amino Acid Conjugation of Bile Acids," by Erin M. Shonsey and colleagues is presented.

[Display omitted] • We propose a decision logic to identify thyroid disruption in aquatic vertebrates. • The decision logic is evidence-based and includes internationally agreed guidelines. • Thyroid-mediated effect patterns must consider consistency and directions of changes. • The weight-of-evidence considers mode-of-action and population relevance assessments. • The decision logic supports regulatory assessments while minimising animal testing. According to the World Health Organisation and European Commission definitions, substances shall be considered as having endocrine disrupting properties if they show adverse effects, have endocrine activity and the adverse effects are a consequence of the endocrine activity (using a weight-of-evidence approach based on biological plausibility), unless the adverse effects are not relevant to humans or non-target organisms at the (sub)population level. To date, there is no decision logic on how to establish endocrine disruption via the thyroid modality in non-mammalian vertebrates. This paper describes an evidence-based decision logic compliant with the integrated approach to testing and assessment (IATA) concept, to identify thyroid-mediated effect patterns in aquatic vertebrates using amphibians as relevant models for thyroid disruption assessment. The decision logic includes existing test guidelines and methods and proposes detailed considerations on how to select relevant assays and interpret the findings. If the mammalian dataset used as the starting point indicates no thyroid concern, the Xenopus Eleutheroembryonic Thyroid Assay allows checking out thyroid-mediated activity in non-mammalian vertebrates, whereas the Amphibian Metamorphosis Assay or its extended, fixed termination stage variant inform on both thyroid-mediated activity and potentially population-relevant adversity. In evaluating findings, the response patterns of all assay endpoints are considered, including the direction of changes. Thyroid-mediated effect patterns identified at the individual level in the amphibian tests are followed by mode-of-action and population relevance assessments. Finally, all data are considered in an overarching weight-of-evidence evaluation. The logic has been designed generically and can be adapted, e.g. to accommodate fish tests once available for thyroid disruption assessments. It also ensures that all scientifically relevant information is considered, and that animal testing is minimised. The proposed decision logic can be included in regulatory assessments to facilitate the conclusion on whether substances meet the endocrine disruptor definition for the thyroid modality in non-mammalian vertebrates. [ABSTRACT FROM AUTHOR]