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This paper reports an electrophoresis-based microfluidic ion nutrient sensor for the detection of anions in soil solution samples. The sensor is able to analyze the concentration of various anions in extracted soil solutions with high sensitivity as well as high specificity, while it is an approach requiring no labels. The electrophoretic microchip integrates a pair of in-plane conductivity detection microelectrodes. A programmable high voltage power supply unit was designed to achieve precise control over voltage potentials needed for sample and buffer injection and ion separation. An electrical conductivity detector was designed to extract and process the changes in conductivity due to the arrivals of separated anions at the electrodes at various times. An arrival time serves to identify an anionic species, while the peak height indicates the concentration. A soil water extraction device was also designed to extract the soil solution analyte from the bulk soil, by applying vacuum suction. Only a minute amount of solution (on the order of $\mu$ L) is needed for the electrophoretic measurement. Extracted soil solutions were analyzed for ionic concentrations to demonstrate the feasibility of using this microfluidic sensor, showing a limit of detection of about $\mu$ M.

For many tissues, single resident stem cells grown in vitro under appropriate three-dimensional conditions can produce outgrowths known as organoids. These tissues recapitulate much of the cell composition and architecture of the in vivo organ from which they derive, including the formation of a stem cell niche. This has facilitated the systematic experimental manipulation and single-cell, high-throughput imaging of stem cells within their respective niches. Furthermore, emerging technologies now make it possible to engineer organoids from purified cellular and extracellular components to directly model and test stem cell-niche interactions. In this Review, we discuss how organoids have been used to identify and characterize stem cell-niche interactions and uncover new niche components, focusing on three adult-derived organoid systems. We also describe new approaches to reconstitute organoids from purified cellular components, and discuss how this technology can help to address fundamental questions about the adult stem cell niche.

Disseminated sporotrichosis may present with inflammatory arthritis and cutaneous ulcerations that mimic noninfectious skin conditions such as pyoderma gangreonsum (PG). Sporotrichosis must therefore be ruled out before administering immunosuppressive agents for PG. Furthermore, dimorphic fungi such as sporotrichosis may grow as yeast in bacterial cultures, even before fungal cultures become positive. We present a case of disseminated cutaneous and osteoarticular sporotrichosis mimicking PG and describe the differential diagnosis and the diagnostic and treatment approach to this condition.

Objectives: To compare 3 methods of detecting potential diversion of controlled substances (CS) by health care personnel from inpatient units in a large, academic medical center. Methods: Three different reports were retrospectively analyzed and evaluated to determine which employees are “high-risk” for diversion over a 30-day period using defined criteria. Reports were derived from automated dispensing machines (ADMs), purchased third-party software (TPS), and the electronic health record (EHR). The primary outcome was the percentage of employees in each report who were deemed to be high-risk for CS diversion (positive predictive value [PPV]). Secondary outcomes included the number of false positives and description of high-risk users on each report. Descriptive statistics were used to analyze differences between methods. Results: The PPV was highly variable between reports. The PPVs among the ADM, TPS, and EHR reports were 3.28%, 6.82%, and 23.88%, respectively. False positives were high among all reports (96.72%, 93.18%, and 76.12% for the ADM, TPS, and EHR reports, respectively). Conclusions: A report from the EHR has the highest PPV to detect high-risk employees who may be diverting CS. However, false positives were high for all reports, indicating that significant improvements are needed in the development of accurate and reliable software to detect potential and actual CS diversion.

We investigate source characteristics and emission dynamics of volatile organic compounds (VOCs) in a single-family house in California utilizing time- and space-resolved measurements. About 200 VOC signals, corresponding to more than 200 species, were measured during eight weeks in summer and five in winter. Spatially resolved measurements, along with tracer data, reveal that VOCs in the living space were mainly emitted directly into that space, with minor contributions from the crawlspace, attic or outdoors. Time-resolved measurements in the living space exhibited baseline levels far above outdoor levels for most VOCs; many compounds also displayed patterns of intermittent short-term enhancements (spikes) well above the indoor baseline. Compounds were categorized as "high-baseline" or "spike-dominated" based on indoor-to-outdoor concentration ratio and indoor mean-to-median ratio. Short-term spikes were associated with occupants and their activities, especially cooking. High-baseline compounds indicate continuous indoor emissions from building materials and furnishings. Indoor emission rates for high-baseline species, quantified with 2-h resolution, exhibited strong temperature dependence and were affected by air-change rates. Decomposition of wooden building materials is suggested as a major source for acetic acid, formic acid, and methanol, which together accounted for ~75% of the total continuous indoor emissions of high-baseline species. This article is protected by copyright. All rights reserved.

As spending on medications in the United States increases with each passing year, the need for drug pricing transparency by manufacturers also increases. Drug spending, excluding rebates and discounts, was $309.5 billion in 2015, up 8.5% from 2014. Drug pricing transparency has been a topic of debate across the health care system. This column reviews the issue of drug pricing and emphasizes the need for transparency in this area. We will discuss factors that influence drug pricing, policies and ways to reduce the rising costs of drugs, and the role of pharmacy leaders in managing this problem. A multitude of factors are driving the country to spend more and more on medications; pharmacy leaders can employ various strategies to counteract this escalation of drug prices. After reviewing this article, the pharmacy director will have an increased ability to address drug pricing issues with stakeholders as they develop patient-centered pharmacy services.

The changing landscape of health care mirrors that of health-system pharmacy, with pharmacists' scope of practice and provider status being the most significant changes. This creates new roles and opportunities; many of these roles are considered to be nontraditional in today's practice. This article reviews some new roles for pharmacy leaders that provide different career options and pathways. Nontraditional career opportunities discussed include expanded consulting roles in pricing analytics and drug pricing programs (contracting, 340B programs), pharmacogenomics patient consult services and clinics, specialty drug pharmacies, and compounding pharmacy services. To continue to develop high-performing pharmacy departments, pharmacy directors should recognize these roles and ensure they are clearly defined and managed. With the advent of these nontraditional opportunities, pharmacy departments can further expand their ability to provide advanced patient-centered pharmacy services.

Critical care medicine has grown from a small group of physicians participating in patient care rounds in surgical and medical intensive care units (ICUs) to a highly technical, interdisciplinary team. Pharmacy's growth in the area of critical care is as exponential. Today's ICU requires a comprehensive pharmaceutical service that includes both operational and clinical services to meet patient medication needs. This article provides the elements for a business plan to justify critical care pharmacy services by describing the pertinent background and benefit of ICU pharmacy services, detailing a current assessment of ICU pharmacy services, listing the essential ICU pharmacy services, describing service metrics, and delineating an appropriate timeline for implementing an ICU pharmacy service. The structure and approach of this business plan can be applied to a variety of pharmacy services. By following the format and information listed in this article, the pharmacy director can move closer to developing patient-centered pharmacy services for ICU patients.

Purpose The privileging of pharmacists for clinical activities and the impact that privileging has on enhancing the scope of pharmacy practice in health systems are reviewed. Summary Health-system pharmacists or pharmacy leaders must gain a thorough understanding of the credentialing and privileging process as they broaden their scope of practice. Clinical privileging affords an expanded scope of practice that is recognized at the institutional level and formally elevates the pharmacist to that of a nonphysician provider. The installation of privileging processes is expected to take many months to complete for individual institutions and should begin now in anticipation of provider status. Model institutions, including Truman Medical Centers, Johns Hopkins Hospital, and The Ohio State University Wexner Medical Center, are highlighted in this article and provide their individual approach to clinical privileging that can be applied to other institutions. The development and evaluation of these programs have given valuable insight into how this individual approach translates to health systems across the country and how the pharmacy profession can continue to unite to convey the value of pharmacists in improving patient care. Conclusion In preparation for the potential approval of pharmacist provider status across the United States, it is essential that pharmacists are privileged by the medical staff at their respective institution. Clinical privileges must be strategically developed with a focus on cost and quality aims and meeting the needs of patients. Implementation and maintenance of high-performing pharmacy privileging programs require both successful leadership and management skills and an understanding of the interprofessional nature of healthcare.

Purpose Implementation and refinement of an integrated electronic “trigger tool” for detecting adverse drug events (ADEs) is described. Methods A three-month prospective study was conducted at a large medical center to test and improve the positive predictive value (PPV) of an electronic health record–based tool for detecting ADEs associated with use of four “trigger drugs”: the reversal agents flumazenil, naloxone, phytonadione, and protamine. On administration of a trigger drug to an adult patient, an electronic message was transmitted to two pharmacists, who reviewed cases in near real time (typically, on the same day) to detect actual or potential ADEs. In phase 1 of the study, any use of a trigger drug resulted in an alert message; in subsequent phases, the alerting criteria were narrowed on the basis of clinical criteria and laboratory data with the goal of refining the trigger tool’s PPV. Results A total of 87 drug administrations were reviewed during the three-month study period, with 27 ADEs detected. PPV values in phases 1, 2, and 3 were 0.33, 0.21, and 0.36, respectively. The relatively low overall PPV of the trigger tool was largely attributable to false-positive trigger messages associated with phytonadione use (such messages were reduced from 35 in phase 1 to 7 in phase 3). Conclusion Evaluation and refinement of an electronic trigger tool based on detecting the use of the reversal agents flumazenil, naloxone, phytonadione, and protamine found an overall PPV of 0.31 during a three-month study period.

Tissues are the organizational units of function in metazoan organisms. Tissues comprise an assortment of cellular building blocks, soluble factors, and extracellular matrix (ECM) composed into specific three-dimensional (3-D) structures. The capacity to reconstitute tissues in vitro with the structural complexity observed in vivo is key to understanding processes such as morphogenesis, homeostasis, and disease. In this article, we describe DNA-programmed assembly of cells (DPAC), a method to fabricate viable, functional arrays of organoid-like tissues within 3-D ECM gels. In DPAC, dissociated cells are chemically functionalized with degradable oligonucleotide "Velcro," allowing rapid, specific, and reversible cell adhesion to a two-dimensional (2-D) template patterned with complementary DNA. An iterative assembly process builds up organoids, layer-by-layer, from this initial 2-D template and into the third dimension. Cleavage of the DNA releases the completed array of tissues that are captured and fully embedded in ECM gels for culture and observation. DPAC controls the size, shape, composition, and spatial heterogeneity of organoids and permits positioning of constituent cells with single-cell resolution even within cultures several centimeters long. © 2016 by John Wiley & Sons, Inc.

Leaders in health-system pharmacy are challenged to maintain the highest quality pharmacy service at the lowest cost. Clinical pathways are evidence-based road maps that assist in reducing variations in clinical practice. Integration of clinical pathways within the electronic health record further helps to facilitate evidence-based practice. This article reviews the evolution of the clinical pathways, describes their clinical and economic impact, and identifies ways pharmacy directors can successfully implement these pathways into their institutions. Pharmacy directors can utilize their skills in this area or task clinical pharmacists to serve as members of the clinical pathway development team to further enhance patient-centered pharmacy services.

The human breast undergoes lifelong remodeling in response to estrogen and progesterone, but hormone exposure also increases breast cancer risk. Here, we use single-cell analysis to identify distinct mechanisms through which breast composition and cell state affect hormone signaling. We show that prior pregnancy reduces the transcriptional response of hormone-responsive (HR+) epithelial cells, whereas high body mass index (BMI) reduces overall HR+ cell proportions. These distinct changes both impact neighboring cells by effectively reducing the magnitude of paracrine signals originating from HR+ cells. Because pregnancy and high BMI are known to protect against hormone-dependent breast cancer in premenopausal women, our findings directly link breast cancer risk with person-to-person heterogeneity in hormone responsiveness. More broadly, our findings illustrate how cell proportions and cell state can collectively impact cell communities through the action of cell-to-cell signaling networks.

Background: New practitioner pharmacists enter the workplace with an array of knowledge and skills ready to engage in patient care. However, obtaining a first postgraduate position or earning a desired promotion poses a challenge when the candidate pool is filled with many similarly skilled professionals. Objective: Educate new practitioner pharmacists on ways to pitch their new skills and make a memorable first impression among their competition. Methods: This article aims to (1) enhance their career prospects by practicing their soft skills, (2) develop strategies to build credibility and creating a personal brand and (3) describe efforts to showcase their professional identity. Conclusions: Preceptors and mentors can help by providing effective feedback to new pharmacists in efforts to improve performance and enhance soft skills.

Background: The Director’s Forum series is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health-systems. This article focuses on leadership strategies for managing organizational change within a pharmacy department. Objective: The goals of this article are to describe the foundations of pharmacy organizational structure changes and strategies to efficiently and effectively manage the associated change. Methods: This article will aim to (1) describe the organizational structure change process, (2) list known rules to follow when redesigning an organizational structure, (3) briefly describe the organizational change at the Ohio State Wexner Medical Center, and (4) describe leadership strategies to overcome potential challenges of organizational changes. Conclusion: The strategies discussed in this article and proposed sample template for organizational change process may be used by a pharmacy department in an effort to restructure their department.

A follow-up survey of leadership staffing shows that nearly 80% of pharmacy leaders (pharmacy directors, deans, faculty, managers, and supervisors) are retiring in the next 10 years. Those who are delaying retirement are opting for part-time consulting work, traditional staff pharmacy jobs, or partial teaching appointments. There are various ways for leaders to transition into retirement; this transition can be early, delayed, or completed in a step-wise manner. Planning effectively for retirement in regard to finances and living situation is a first step to being able to make a contribution in retirement. Retirement can be an important time to continue making a difference in health system pharmacy through pharmacy education, practice, consulting, research, scholarship, and philanthropy. Whatever aspect the retiring pharmacy leader chooses, they can continue to make a difference by influencing other leaders in their mission to develop patient-centered pharmacy services.

This paper presents a nonlinear vibration energy harvester, which combines a nonlinear bistable broadband piezoelectric cantilever used to transduce ambient vibration energy, with synchronized capture for efficient harvesting over broadband sources. An accurate model of the bistable transducer, that augments the Butterworth van Dyke model to capture the external magnetic force added as a bias to the external vibrations, is presented. Its validity has been demonstrated through physical implementation and experimental validation against simulation of the mathematical model. For efficient extraction of the transduced energy, nonlinear extraction circuits, namely synchronous charge extraction (SCE) and parallel synchronized switch harvesting on inductor (SSHI), are employed. The switching in these circuits is implemented using a fully self-propelled, low-power electronic breaker circuit, capable of detecting extrema in the waveform to perform switching. Both simulated and experimental power outputs from the bistable harvester have been presented, with the SCE and parallel-SSHI providing average outputs with more than 100-fold increase over the harvested power reported in the literature for the same input, and further, even more significant gains are observed for broadband excitations.

On March 28, 2014, The United States Pharmacopeia and The National Formulary (USP-NF) published USP General Chapter Hazardous Drugs–Handling in Healthcare Settings, as open for public comment in the USP Pharmacopeial Forum (PF) 40(3). Pharmacy directors must be proactive in understanding the impact that USP will have on their processes for preparing sterile products. USP General Chapter pertains to the compounding of both hazardous and nonhazardous drugs. USP serves as a new standard to guide the handling of hazardous drugs in order to protect patients, health care personnel, and the environment. USP describes hazardous drug handling related to the receipt, storage, compounding, dispensing, administration, and disposal of both sterile and nonsterile products and preparations. Regardless of all of the requirements listed in USP , there is no substitute for disciplined, consistent work practices regarding proper sterile technique. This point should be emphasized with all compounding personnel. Even if one is compounding in the most compliant USP cleanroom, improper technique can negate all the benefits of the physical structures. Pharmacy leaders at every level will play a key role in assisting an organization to achieve timely compliance with USP standards. Until the standard becomes official, it is important for pharmacists to become familiarized with the latest draft to identify potential barriers to compliance and to strategize a plan to overcome barriers. Although complying with USP may seem to be a daunting task, it can be manageable if approached in a systematic organized way.

The profession of pharmacy is currently experiencing transformational change in health system practice models with pharmacists' provider status. Gaining buy-in and support of stakeholders in medicine, nursing, and other advocates for patient care is critical. To this end, building momentum to advance the profession will require experimentation with and utilization of more efficient ways to disseminate relevant information. Traditional methods to communicate can be inefficient and painstakingly slow. Health care providers are turning to social media to network, connect, engage, educate, and learn. Pharmacy leaders can use social media as an additional tool in the leadership toolkit. This article of the Director's Forum shows how social media can assist pharmacy leaders in further developing patient-centered pharmacy services.

Managing conflict among a variety of people and groups is a necessary part of creating a high performance pharmacy department. As new pharmacy managers enter the workforce, much of their success depends on how they manage conflict. The goal of this article is to provide a guide for the pharmacy director on conflict in the workplace. By evaluating each type of conflict, we can learn how to respond when it occurs. Resolving conflict requires a unique and individualized approach, and the strategy used may often be based on the situational context and the personality of the employee or manager. The more that pharmacy leaders can engage in conflict resolution with employees and external leaders, the more proactive they can be in achieving positive results. If pharmacy directors understand the source of conflicts and use management strategies to resolve them, they will ensure that conflicts result in a more effective patient-centered pharmacy service.

Issues facing pharmacy leaders in 2015 include practice model growth and the role of pharmacy students, clinical privileging of health-system pharmacists and provider status, medication error prevention, and specialty pharmacy services. The goal of this article is to provide practical approaches to 4 issues facing pharmacy leaders in 2015 to help them focus their department's goals. This article will address (1) advances in the pharmacy practice model initiative and the role of pharmacy students, (2) the current thinking of pharmacists being granted clinical privileges in health systems, (3) updates on preventing harmful medication errors, and (4) the growth of specialty pharmacy services. The sample template of a strategic plan may be used by a pharmacy department in 2015 in an effort to continue developing patient-centered pharmacy services.

Purpose An innovative model for measuring the operational productivity of medication order management in inpatient settings is described. Methods Order verification within a computerized prescriber order-entry system was chosen as the pharmacy workload driver. To account for inherent variability in the tasks involved in processing different types of orders, pharmaceutical products were grouped by class, and each class was assigned a time standard, or “medication complexity weight” reflecting the intensity of pharmacist and technician activities (verification of drug indication, verification of appropriate dosing, adverse-event prevention and monitoring, medication preparation, product checking, product delivery, returns processing, nurse/provider education, and problem-order resolution). The resulting “weighted verifications” (WV) model allows productivity monitoring by job function (pharmacist versus technician) to guide hiring and staffing decisions. A 9-month historical sample of verified medication orders was analyzed using the WV model, and the calculations were compared with values derived from two established models—one based on the Case Mix Index (CMI) and the other based on the proprietary Pharmacy Intensity Score (PIS). Results Evaluation of Pearson correlation coefficients indicated that values calculated using the WV model were highly correlated with those derived from the CMI-and PIS-based models ( r = 0.845 and 0.886, respectively). Relative to the comparator models, the WV model offered the advantage of less period-to-period variability. Conclusion The WV model yielded productivity data that correlated closely with values calculated using two validated workload management models. The model may be used as an alternative measure of pharmacy operational productivity.

Medication errors continue to be a concern of health care providers and the public, in particular how to prevent harm from medication mistakes. Many health care workers are afraid to report errors for fear of retribution including the loss of professional licensure and even imprisonment. Most health care workers are silent, instead of admitting their mistake and discussing it openly with peers. This can result in further patient harm if the system causing the mistake is not identified and fixed; thus self-denial may have a negative impact on patient care outcomes. As a result, pharmacy leaders, in collaboration with others, must put systems in place that serve to prevent medication errors while promoting a “Just Culture” way of managing performance and outcomes. This culture must exist across disciplines and departments. Pharmacy leaders need to understand how to classify behaviors associated with errors, set realistic expectations, instill values for staff, and promote accountability within the workplace. This article reviews the concept of Just Culture and provides ways that pharmacy directors can use this concept to manage the degree of error in patient-centered pharmacy services.

The utilization of a bismuth-substituted iron garnet as a magne-to-optic faraday rotator (MOFR) has been reported for all-optical networking purposes as well as for other applications [1 – 5]. When a significantly large magnetic field is applied to the MOFR, it will enter a saturated state. Once the material is saturated, the magnetic domains can become pinned into place [6]. In the past, unpinning the magnetic domains, and moving the MOFR material back into a desaturated state was a difficult task. This paper will present methods for unpinning the MOFR material, allowing the material to become desaturated.

Pulsed magnetic field generation circuits find varied applications inclusive of biological applications [1, 2], magnetic resonance imaging (MRI) [3], transcranial magnetic stimulation (TMS) [4] and magneto-optical switching [5]. In this work, a low field, low frequency (< 5MHz), pulsed magnetic field generation circuit suited for unilateral nuclear magnetic resonance (NMR) applications is presented. A magnetic flux density of approximately 1000G is generated using an inductive load with a FET-based switch. The inductive load resonates at a frequency of 5MHz which is the precession frequency of 1H protons in a magnetic flux of 1000G. The designed circuit can be tuned to operate at resonant frequencies of other chemical species. In this paper, the design parameters and operation of a prototype pulsed field generator will be discussed.

Homogeneous magnetic fields are desirable in nuclear magnetic resonance (NMR) experiments for detecting the presence of nuclear species accurately. However, some applications such as oil well logging [1], perform NMR experiments in inhomogeneous magnetic fields with lower spatial accuracy [2–5]. Achieving improvements in spatial features requires a better understanding of the field profiles in such inhomogeneous fields. Therefore, in this paper, the magnetic field variations introduced due to a one-sided magnet are simulated and studied. A magnetic and a non-magnetic object are placed in the near field of a permanent magnet. Sections of the magnet's near-field region depicting the field decay and variations along different directions are analyzed. Prior NMR measurements do indicate that minor field variations affect the response of the magnetic moments from region to region leading to undesirable peak broadening in the frequency spectrum. However, field variations can be advantageous if the magnetic field profile is pre-mapped and changes in field profiles by placing known nuclei are pre-estimated. Pre-estimation would lead to a improved understanding of spatial resolution. This technique would also be useful for medical imaging purposes where different methods are utilized to obtain improved spatial resolution and contrast between different tissues/matter.

In this work, the design of a pulsed magnetic field generator, with user-selective pulsed modulation frequency is described. The ability to operate at various frequencies (single-frequency below 10 MHz) makes the system valuable to several areas such as medical treatments and pulsed switching systems. In this work, the pulsed magnetic field generator is designed to create localized field effects in portable magnetic resonance systems. Users may operate at a Larmor precession frequency between 100 kHz - 10 MHz and can achieve high currents through the load. Certain tunability can also be obtained by varying the load inductance or switching device conditions. In summary, this paper will describe the design considerations and challenges for portable monophasic pulsed magnetic field systems.

This paper describes a novel approach to designing a high-current magnetic field generator (HCMFG) with adjustable pulse width for transcranial magnetic stimulation applications. Challenges for robust and practical design are introduced. A few of the main possible solutions for designing versatile and powerful pulses are introduced and discussed. Finally, future improvement in functionality of the HCMFG is proposed.

To deal with the pressures in health care that stress clinical excellence and profitability, health systems are increasingly recruiting physician executives or physicians in leadership and management positions. Physicians occupy less than 5% of all hospital leadership positions, but there is an apparent increase in the recruitment of physician executives. With the growth in the number of physician executives, pharmacy leaders must capitalize on their existing clinical relationship and apply it to health care leadership and management. By focusing on developing an executive presence, by clearly describing a patient-centered strategy and vision for pharmacy, and by nurturing the existing clinical relationships, the pharmacy director can work with physician executives to promote patient-centered pharmacy services.

The Director's Forum is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems by providing practical information on various leadership topics. Pharmacists are bound to practice in the best interest of the patient and are obligated to act with integrity and in an ethical manner. Pharmacy directors and their leadership staff are additionally bound to manage their department with integrity. Staff often scrutinize the pharmacy director's actions, giving the director a feeling of “life in a fishbowl.” Every action of the leader is judged in the context of personal integrity or their individual commitment to moral, spiritual, and ethical values. The objective of this article is to describe how a pharmacy leader manages this responsibility. This article addresses the pharmacy leader's obligations to act with integrity, reviews key integrity concerns in pharmacy leadership, and provides guidance for leading and managing in the context of ethics and integrity. Pharmacy directors must always be aware that they are open to both department and public scrutiny if they do not conduct themselves in a professional manner. Being accountable for their actions and maintaining a high standard of integrity, leaders can keep the focus of their departments on the goal of patient-centered pharmacy services.

A novel on-board solution for a robust, accurate and self-calibrating soil moisture and nutrient sensor with inbuilt wireless transmission and reception capability is presented. The sensor can make real time and accurate measurement of subsurface soil moisture and nutrients and is ideally suited to act as a node in a network spread over a large area. It works on the principle of impedance spectroscopy. Impedance measurement at multiple frequencies is done by comparing the amplitude and phase of signals incident on and reflected from the soil in proximity of the sensor. A distributed transmission line model for the on-board connections is employed to improve the accuracy of measurements. Variations in temperature and surroundings are accounted by realizing a built-in self-calibrating mechanism which operates on the standard short-open-load technique. This also accounts for the parasitic impedance of the board in the measurements to minimize the errors. Measurements of both real and imaginary parts of soil impedance at multiple frequencies give the sensor an ability to detect variations in ionic concentrations other than soil moisture content. A switch-controlled multiple power mode transmission and reception is provided to support highly energy efficient medium access control.

In 2013, the Director's Forum published our assessment of issues facing pharmacy leaders to assist pharmacy directors in planning for the year ahead. The issues include health care reform and the Affordable Care Act, the American Society of Health-System Pharmacists Pharmacy Practice Model Initiative, the health care workforce, patients’ perceptions of pharmacists, and the changing landscape of pharmacy education. Based on our environmental scan, the issues addressed in 2013 are pertinent to a department's plan for 2014. The goal of this article is to provide practical approaches to each of these issues to help pharmacy directors focus their department's goals for 2014 to support the development of patient-centered pharmacy services. This column will address (1) strategies to reduce medication costs and generate new pharmacy revenue streams, (2) innovative approaches to improving medication safety and quality, (3) steps to advance the clinical practice model, and (4) ways to create mutually beneficial student experiences.

The Director's Forum guides pharmacy leaders in establishing patient-centered services in hospitals and health systems. 2013 marked the 50th anniversary of the publication of the Mirror to Hospital Pharmacy, which was a comprehensive study of hospital pharmacy services in the United States. This iconic textbook was co-authored by Donald Francke, Clifton J. Latiolais, Gloria N. Francke, and Norman Ho. The Mirror's results profiled hospital pharmacy of the 1950s; these results established goals for the profession in 6 paradigms: (1) professional philosophy and ethics; (2) scientific and technical expansion of health-system pharmacy; (3) development of administrative and managerial acumen; (4) increased practice competence; (5) wage and salary commensurate with professional responsibilities; and (6) health-system pharmacy as a vehicle for advancing the profession as a whole. This article critically reviews our progress on the last of 3 goals. An understanding of the profession's progress on these goals since the seminal work of the Mirror provides directors of pharmacy a platform from which to develop strategies to enhance patient-centered pharmacy services.

The Director’s Forum guides pharmacy leaders in establishing patient-centered services in hospitals and health systems. August 2013 marked the 50th anniversary of the publication of the Mirror to Hospital Pharmacy, which was a comprehensive study of hospital pharmacy services in the United States. This iconic textbook was co-authored by Donald Francke, Clifton J. Latiolais, Gloria N. Francke, and Norman Ho. The Mirror profiled hospital pharmacy of the 1950s and established goals for the profession in 6 paradigms: (1) professional philosophy and ethics, (2) scientific and technical expansion of health-system pharmacy, (3) development of administrative and managerial acumen, (4) increased practice competence, (5) wage and salary compensation commensurate with professional responsibilities, and (6) health-system pharmacy as a vehicle for advancing the profession as a whole. This article critically reviews the profession’s progress on the first 3 goals; an article in the January 2014 issue of Hospital Pharmacy will review the final 3 goals. An understanding of the profession’s progress on these goals since the seminal work of the Mirror provides directors of pharmacy a platform from which to develop strategies to enhance patient-centered pharmacy services.

Purpose Consensus recommendations to help ensure safe insulin use in hospitalized patients are presented. Summary Insulin products are frequently involved in medication errors in hospitals, and insulin is classified as a high-alert medication when used in inpatient settings. In an initiative to promote safer insulin use, the American Society of Health-System Pharmacists (ASHP) Research and Education Foundation convened a 21-member panel representing the fields of pharmacy, medicine, and nursing and consumer advocacy groups for a three-stage consensus-building initiative. The panel’s consensus recommendations include the following: development of protocol-driven insulin order sets, elimination of the routine use of correction/sliding-scale insulin doses for management of hyperglycemia, restrictions on the types of insulin products stored in patient care areas, and policies to restrict the preparation of insulin bolus doses and i.v. infusions to the pharmacy department. In addition, the panelists recommended that hospitals better coordinate insulin use with meal intake and glucose testing, prospectively monitor the coordination of insulin delivery and rates of hypoglycemia and hyperglycemia, and provide standardized education and competency assessment for all hospital-based health care professionals responsible for insulin use. Conclusion A 21-member expert panel convened by the ASHP Foundation identified 10 recommendations for enhancing insulin-use safety across the medication-use process in hospitals. Professional organizations, accrediting bodies, and consumer groups can play a critical role in the translation of these recommendations into practice. Rigorous research studies and program evaluations are needed to study the impact of implementation of these recommendations.

Solid organ transplant recipients are prescribed a high number of medications, increasing the potential for medication errors. Barcode-assisted medication administration (BCMA) is technology that reduces medication administration errors. An observational study was conducted at an academic medical center solid organ transplant unit before and after BMCA implementation. Medication accuracy was determined and administration errors were categorized by type and therapeutic class of medication. A baseline medication administration error rate of 4.8% was observed with wrong dose errors representing 78% of the errors. During the post-BCMA period the medication administration error rate was reduced by 68% to 1.5% (P = .0001). Wrong dose errors were reduced by 67% (P = .001), and unauthorized medication administrations were reduced by 73%. Steroids were associated with the highest error rate. The results of this study suggest that routinely adopting BCMA has the potential to reduce medication administration errors in transplant patients.

The Director's Forum provides directors of pharmacy practical ways to develop patient-centered pharmacy services. Pharmacy directors must understand the key issues facing their departments and incorporate strategies for these issues as part of their strategic planning process. Health care reform and the Affordable Care Act require that departments operate efficiently and closely monitor their drug expense. The American Society of Health-System Pharmacists’ Pharmacy Practice Model Initiative will serve as a valuable resource during 2013 to enhance the pharmacy practice model. By using their health care workforce, particularly pharmacy technicians, in an innovative way, pharmacy directors will allow the pharmacists to increase their clinical activity. By promoting the role of the hospital pharmacist to patients, directors will help to improve patients’ understanding of their medications and increase their satisfaction with their care. Finally by changing the activities of pharmacy students in practice models, the patient care role of the pharmacist can be expanded. Through a greater understanding of the issues facing them and their effect on the operations of the pharmacy, pharmacy directors will learn effective ways to develop patient-centered pharmacy services.

Video recordings of the speeches given at the summit, synchronized with slides, are available with the full text of this article at [www.ajhp.org][1]. In November 2010, the American Society of Health-System Pharmacists (ASHP) kicked off its Pharmacy Practice Model Initiative (PPMI) with the PPMI

Experiments were conducted at the California Air Resources Board Haagen-Smit Laboratory to understand changes in vehicle emissions in response to stricter emissions standards over the past 25 years. Measurements included a wide range of volatile organic compounds (VOCs) for a wide range of spark ignition gasoline vehicles meeting varying levels of emissions standards, including all certifications from Tier 0 up to Partial Zero Emission Vehicle. Standard gas chromatography (GC) and high performance liquid chromatography (HLPC) analyses were employed for drive-cycle phase emissions. A proton-transfer-reaction mass spectrometer measured time-resolved emissions for a wide range of VOCs. Cold-start emissions occur almost entirely in the first 30-60 s for newer vehicles. Cold-start emissions have compositions that are not significantly different across all vehicles tested and are markedly different from neat fuel. Hot-stabilized emissions have varying importance depending on species and may require a driving distance of 200 miles to equal the emissions from a single cold start. Average commute distances in the U.S. suggest the majority of in-use vehicles have emissions dominated by cold starts. The distribution of vehicle ages in the U.S. suggests that within several years only a few percent of vehicles will have significant driving emissions compared to cold-start emissions.

Cells decide whether to grow and divide by integrating internal and external signals. Non-autonomous cell growth and proliferation occurs when microenvironmental signals from neighboring cells, both physical and secreted, license this decision. Understanding these processes is vital to developing an accurate framework for cell-cell interactions and cellular decision-making, and is useful for advancing new therapeutic strategies to prevent dysregulated growth. Here, we review some recent examples of non-autonomous cell growth in the mammary gland and tumor cell proliferation.

This paper reports on an efficient and convenient method of patterning nanostructures on the cleaved facet of an optical fiber. The fabrication method utilizes ultraviolet (UV) assisted nanoimprint lithography in which the fiber tip is pressed against a stamp carrying nanoscale patterns, and then is exposed to UV radiation. The novelty of this work lies in utilizing simpler fabrication steps with better control over angle of contact at the fiber tip, which leads to rapid formation of nanostructures with well-defined features. An array of nanoposts are patterned at fiber tip and coated with titanium oxide to work as a guided mode resonant (GMR) device. The sensitivity of the fiber-tip GMR device to surrounding refractive index is 183.3 nm per refractive index unit. The proposed nanofabrication method offers a promising approach to develop remote fiber-optic sensors with intrinsic optical beam alignment for detecting the presence of subtle concentration of analytes at the fiber tip.

This paper reports on an electrophoresis based microfluidic ion nutrient sensor for the detection of anions in soil solution samples. The device offers the capability to analyze concentration of various ions in extracted soil samples in a rapid and sensitive way. The polydimethylsiloxane-glass electrophoretic microchip features microfluidics for sample and buffer solution manipulation and in-plane contactless conductivity detection electrodes. An external programmable high voltage power supply system was built to achieve precise electrophoretic control during sample/buffer injection and separation steps. A simple detection circuit was used to extract and transfer detection signals for further analysis. Soil samples were extracted and analyzed for ions to determine feasibility of using this sensor as a rapid analysis method for monitoring ions in soil solutions of an agriculture system. The identity of the detection peaks was also confirmed by simulation.

Important and influential pharmacy organization leadership positions, such as president, board member, or committee chair, are volunteer positions and require a commitment of personal and professional time. These positions provide excellent opportunities for leadership development, personal promotion, and advancement of the profession. In deciding to assume a leadership position, interested individuals must consider the impact on their personal and professional commitments and relationships, career planning, employer support, current and future department projects, employee support, and personal readiness. This article reviews these factors and also provides an assessment tool that leaders can use to determine their readiness to assume leadership positions. By using an assessment tool, pharmacy leaders can better understand their ability to assume an important and influential leadership position while achieving job and personal goals.

Big Data refers to datasets that are so large and complex that traditional methods and hardware for collecting, sharing, and analyzing them are not possible. Big Data that is accurate leads to more confident decision making, improved operational efficiency, and reduced costs. The rapid growth of health care information results in Big Data around health services, treatments, and outcomes, and Big Data can be used to analyze the benefit of health system pharmacy services. The goal of this article is to provide a perspective on how Big Data can be applied to health system pharmacy. It will define Big Data, describe the impact of Big Data on population health, review specific implications of Big Data in health system pharmacy, and describe an approach for pharmacy leaders to effectively use Big Data. A few strategies involved in managing Big Data in health system pharmacy include identifying potential opportunities for Big Data, prioritizing those opportunities, protecting privacy concerns, promoting data transparency, and communicating outcomes. As health care information expands in its content and becomes more integrated, Big Data can enhance the development of patient-centered pharmacy services.

The Director's Forum is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. This article focuses on the pharmacy department annual report. The annual report is an effective tool for advancing a department's practice model; it describes the framework of the department's plan and lists accomplishments in a specific time period. The annual report can also be a valuable tool in growing the pharmacy practice model by highlighting a future vision based on the past year's results. The annual report can have various formats depending on the target audience, but it is key to develop a report that is easy to read and simply describes the values of the pharmacy programs throughout the year. If thoughtfully developed, formatted, and distributed, the annual report can be a valuable tool in helping the pharmacy director to develop patient-centered services.

A new method for magnetic field generation is presented that enhances the reliability of fiber-based interferometric switches. Suitable switching technologies have been proposed and implemented, but magneto-optic (MO) materials have shown promise in realizing all-optical switching with reasonable power, loss, and switching speed. However, bottlenecks in field generation drivers have limited the performance of MO devices in fiber-based switches. Improving the design of the field generation system will enhance this technology, ultimately realizing practical and reliable solutions. Conventional drivers in MO switching devices utilize one coil with a low number of turns to quickly magnetize the MO material. This, in effect, leads to a fast optical rise time. However, the optical fall time is determined by the response of the MO material and the decay rate of any trapped magnetic energy in the coil, which can be sluggish. The proposed design achieves fast optical fall time by better controlling the demagnetization of the MO material. In this paper, the design of the magnetic field generation system is presented and compared to other recently proposed systems, the electrical system is characterized, and the reliability of the optical output is investigated.