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PurposeA collaborative pharmacist-primary care provider (PharmD-PCP) team approach to medication-therapy management (MTM), with pharmacists initiating and changing medications at separate office visits, holds promise for the cost-effective management of hypertension, but has not been evaluated in many systematic trials. The primary objective of this study was to examine blood pressure (BP) control in hypertensive patients managed by a newly formed PharmD-PCP MTM team versus usual care in a university-based primary care clinic.MethodsThis randomized, pragmatic clinical trial was conducted in hypertensive patients randomly selected for PharmD-PCP MTM or usual care. In the PharmD-PCP MTM group, pharmacists managed drug-therapy initiation and monitoring, medication adjustments, biometric assessments, laboratory tests, and patient education. In the usual-care group, patients continued to see their PCPs. Participants were aged ≥ 18 years, were diagnosed with hypertension, had a most recent BP measurement of ≥ 140/≥ 90 mm Hg (≥ 130/≥ 80 mm Hg if codiagnosed with diabetes mellitus), were on at least 1 antihypertensive medication, and were English speaking. The primary outcome was the difference in the mean change from baseline in systolic BP at 6 months. Secondary outcomes included the percentage achieving therapeutic BP goal and the mean changes from baseline in diastolic BP and low- and high-density lipoprotein cholesterol.FindingsA total of 166 patients were enrolled (69 men; mean age, 67.7 years; PharmD-PCP MTM group, n = 75; usual-care group, n = 91). Mean reduction in SBP was significantly greater in the PharmD-PCP MTM group at 6 months (-7.1 [19.4] vs +1.6 [21.0] mm Hg; P = 0.008), but the difference was no longer statistically significant at 9 months (-5.2 [16.9] vs -1.7 [17.7] mm Hg; P = 0.22), based on an intent-to-treat analysis. In the intervention group, greater percentages of patients who continued to see the MTM pharmacist versus those who returned to their PCP were at goal at 6 months (81% vs 44%) and at 9 months (70% vs 52%). No significant between-group differences in changes in cholesterol were detected at 6 and 9 months; however, the mean baseline values were near recommended levels. The PharmD-PCP MTM group had significantly fewer PCP visits compared with the usual-care group (1.8 [1.5] vs 4.2 [1.0]; P < 0.001).ImplicationsA PharmD-PCP collaborative MTM service was more effective in lowering BP than was usual care at 6 months in all patients and at 9 months in patients who continued to see the pharmacist. Incorporating pharmacists into the primary care team may be a successful strategy for managing medication therapy, improving patient outcomes and possibly extending the capacity of primary care. ClinicalTrials.gov identifier: NCT01973556.

This study revealed that wildlife law enforcement in Uttar Pradesh, India is facing several challenges, making it ineffective. The study aimed to identify these challenges and examine the enforcement strategies employed by wildlife officers. Officers were given a questionnaire, which revealed that they mostly relied on deterrence tactics to enforce laws by detecting and punishing violators. In Uttar Pradesh, a total of 746 cases of wildlife crime were registered, making it a major concern in North India. According to the NCR Bureau report, since 2016, Uttar Pradesh has accounted for more than 25% of the country's wildlife crime cases. Out of the total cases registered, 551 were pending in the department, 91 cases were pending in court, and 108 were compound cases. According to our observations, most of the respondents were male, accounting for 58.5%, while females comprised the remaining 41.5%. The age distribution of the respondents was as follows: 45.7% were between 36-49 years old, and 22.8% were middle-aged or older. Most of the respondents had over 10 years of experience in the field and had extensive knowledge about wildlife. When it came to educational qualifications, 41.5% had completed high school, 31.1% had undergraduate degrees, and 11.2% had graduate degrees. Most of the respondents had passed the elementary Certificate of Education. Based on their academic qualifications or work experience, 57.3% of the respondents claimed to know wildlife and forests, while 6.9% declared expertise in law and biology, respectively. Although respondents may use a combination of strategies to enforce laws, the survey results show a higher mean score for deterrence strategy (M = 5.05, SD = .396) in both states compared to compliance strategy (M = 4.43, SD = .621) and responsive regulation (M = 3.61 SD = .561). These findings could be valuable in developing capacity-building programs for wildlife officers and helping decision-makers at the state and federal levels allocate resources to wildlife authorities. [ABSTRACT FROM AUTHOR]

Plums are nutraceutically rich and have health-promoting properties. To produce high-quality fruits, it is important to monitor them at harvest. This study illustrates the potential of nondestructive laser-induced fluorescence and confocal micro Raman spectroscopy for monitoring the ripening of plums. The fluorescence profile indicates that as fruit ripens, the intensity of the fluorescence of chlorophyll at 685 and 730 nm decreases with increase in the intensity ratio (F685/F730) of these bands. These observations reveal that as fruit ripens, there is a gradual loss of chlorophyll. In order to get further insight into pigment dynamics, the Raman spectra of the fruit were analyzed. The Raman spectra of pre and post-ripe stages of fruits show that as the fruit ripens, there is a prominent increase in the intensity of anthocyanin bands accompanied by subsequent decrease in the intensity of the carotenoid bands. The spectral analysis reveals that the ripening is associated with a decrease in the chlorophyll and carotenoid content with subsequent increase in anthocyanins. The results of this study highlight the utility of laser-induced fluorescence and confocal micro-Raman spectroscopy for the rapid, sensitive, and nondestructive monitoring of plum ripening. [ABSTRACT FROM AUTHOR]

Background and Objective: Lenacapavir (LEN) is a novel, first-in-class, multistage, selective inhibitor of human immunodeficiency virus type 1 (HIV-1) capsid function recently approved for the treatment of HIV-1 infection in heavily treatment-experienced adults with multidrug-resistant HIV-1 infection. The purpose of this multicohort study was to evaluate the pharmacokinetics, metabolism, excretion, safety, and tolerability of LEN following a single intravenous (IV) infusion of 10 mg LEN or 20 mg [14C]LEN in healthy participants. Methods: Twenty-one healthy adult participants were enrolled into the study and received either a single IV dose of 10 mg LEN (n = 8 active, n = 3 placebo; cohort 1) or a single IV dose of 20 mg [14C]LEN containing 200 µCi (n = 10; cohort 2). Blood, urine, and feces samples (when applicable) were collected after dosing, and radioactivity (cohort 2) was assessed using liquid scintillation counting in both plasma and excreta. LEN in plasma was quantified by liquid chromatography (LC) tandem mass spectroscopy (MS/MS) method bioanalysis. Metabolite profiling in plasma and excreta were performed using LC-fraction collect (FC)-high-resolution MS and LC-FC-accelerator mass spectrometry in plasma. Results: Between the 10 mg and 20 mg doses of LEN, the observed plasma exposure of LEN doubled, while the elimination half-life was similar. Following administration of 20 mg [14C]LEN (200 µCi), the mean cumulative recovery of [14C] radioactivity was 75.9% and 0.24% from feces and urine, respectively. The mean whole [14C] blood-to-plasma concentration ratio was 0.5–0.7, which showed a low distribution of LEN to red blood cells. Intact LEN was the predominant circulating species in plasma (representing 68.8% of circulating radioactivity), and no single metabolite contributed to > 10% of total radioactivity exposure through 1176 h postdose. Similarly, intact LEN was the most abundant component (32.9% of administered dose; 75.9% of recovered dose) measured in feces, with metabolites accounting for trace amounts. These results suggest metabolism of LEN is not a primary pathway of elimination. Of the metabolites observed in the feces, the three most abundant metabolites were direct phase 2 conjugates (glucuronide, hexose, and pentose conjugates), with additional metabolites formed to a lesser extent via other pathways. The administered LEN IV doses were generally safe and well-tolerated across participants in this study. Conclusions: The results of this mass balance study indicated that LEN was majorly eliminated as intact LEN via the feces. The renal pathway played a minor role in LEN elimination (0.24%). In addition, no major circulating metabolites in plasma or feces were found, indicating minimal metabolism of LEN. [ABSTRACT FROM AUTHOR]

Abstract Background In recent years waterpipe smoking has become a popular practice amongst young adults in eastern Mediterranean countries, including Iran. The aim of this study was to assess waterpipe smoking perceptions and practices among first-year health sciences university students in Iran and to identify factors associated with the initiation and maintenance of waterpipe use in this population. Results Out of 371 first-year health sciences students surveyed, 358 eight students completed a self-administered questionnaire in the classrooms describing their use and perceptions towards waterpipe smoking. Two hundred and ninety six responders met study inclusion criteria. Waterpipe smoking was common among first-year health sciences university students, with 51% of students indicating they were current waterpipe smokers. Women were smoking waterpipes almost as frequently as men (48% versus 52%, respectively). The majority of waterpipe smokers (75.5%) indicated that the fun and social aspect of waterpipe use was the main motivating factor for them to continue smoking. Of waterpipe smokers, 55.3% were occasional smokers, using waterpipes once a month or less, while 44.7% were frequent smokers, using waterpipes more than once a month. A large number of frequent waterpipe smokers perceived that waterpipe smoking was a healthier way to use tobacco (40.6%) while only 20.6% thought it was addictive. Compared to occasional smokers, significantly more frequent smokers reported waterpipe smoking was relaxing (62.5% vs. 26.2%, p = 0.002), energizing (48.5% vs. 11.4%, p = 0.001), a part of their culture (58.8% vs. 34.1%, p = 0.04), and the healthiest way to use tobacco (40.6% vs. 11.1%, p = 0.005). Conclusions Social and recreational use of waterpipes is widespread among first-year health sciences university students in Iran. Women and men were almost equally likely to be current waterpipe users. Public health initiatives to combat the increasing use of waterpipes among university students in Iran must consider the equal gender distribution and its perception by many waterpipe smokers as being a healthier and non-addictive way to use tobacco.

The rapid urbanization observed in Asian tropics has resulted in extensive landscape transformations, giving rise to novel challenges such as conflicts of interest among citizens and threats to biodiversity. To facilitate informed urban management policies, there is a pressing need for contemporary land use and cover maps that provide precise insights into the evolving landscape. In this paper, we present the city of Bengaluru, India (covering an area of 365,879 ha) as a case study. We introduce an open-source-driven pipeline method capable of generating an updated 11-class land cover map at a high resolution of 10 m, achieving a global F1 score of 0.82. Notably, our proposed pipeline represents a pioneering solution that effectively addresses the persistent issue of cloud cover caused by monsoons, enhancing the utility of such maps for urban management, and planning in rapidly evolving regions. [ABSTRACT FROM AUTHOR]