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We describe the new ENDF/B-VIII.0 evaluated nuclear reaction data library. ENDF/B-VIII.0 fully incorporates the new IAEA standards, includes improved thermal neutron scattering data and uses new evaluated data from the CIELO project for neutron reactions on 1H, 16O, 56Fe, 235U, 238U and 239Pu described in companion papers in the present issue of Nuclear Data Sheets. The evaluations benefit from recent experimental data obtained in the U.S. and Europe, and improvements in theory and simulation. Notable advances include updated evaluated data for light nuclei, structural materials, actinides, fission energy release, prompt fission neutron and γ-ray spectra, thermal neutron scattering data, and charged-particle reactions. Integral validation testing is shown for a wide range of criticality, reaction rate, and neutron transmission benchmarks. In general, integral validation performance of the library is improved relative to the previous ENDF/B-VII.1 library.

Unitarity, the mathematical expression of the conservation of probability in multichannel reactions, is an essential ingredient in the development of accurate nuclear reaction networks appropriate for nucleosynthesis in a variety of environments. We describe our ongoing program to develop a "unitary reaction network" for the big-bang nucleosynthesis environment and look at an example of the need and power of unitary parametrizations of nuclear scattering and reaction data. Recent attention has been focused on the possible role of the 9B compound nuclear system in the resonant destruction of 7Li during primordial nucleosynthesis. We have studied reactions in the 9B compound system with a multichannel, two-body unitary R-matrix code (EDA) using the known elastic and reaction data, in a four-channel treatment. The data include elastic 6Li(3He, 3He)6Li differential cross sections from 0.7 to 2.0 MeV, integrated reaction cross sections for energies from 0.7 to 5.0 MeV for 6Li(3He,p)8Be* and from 0.4 to 5.0 MeV for the 6Li(3He,d)7Be reaction. Capture data have been added to the previous analysis with integrated cross section measurements from 0.7 to 0.825 MeV for 6Li(3He,γ) 9B. The resulting resonance parameters are compared with tabulated values from TUNL Nuclear Data Group analyses. Previously unidentified resonances are noted and the relevance of this analysis and a unitary reaction network for big-bang nucleosynthesis are emphasized. © Owned by the authors, published by EDP Sciences, 2014.

Introduction: Studies have shown positive clinical outcomes in chronic conditions, such as hypertension, through pharmacist-delivered medication therapy management and medication adherence services. Given the need for social distancing during the COVID-19 pandemic, increased utilization of telepharmacy strategies has been employed for managing blood pressure control. Methods: A retrospective single-center cohort study that compared in-person pharmacist visits and telepharmacy visits in primary care patients with hypertension via electronic chart review from January 2018 to July 2022. Subjects were included who were at least 18 years of age with hypertension. Comparator groups were patients who underwent an in-person pharmacy (pre-COVID-19) visit vs a telepharmacy visit (post-COVID-19). The primary outcome was the number of patients with controlled blood pressure based on a blood pressure goal of less than or equal to 130/80 following telepharmacy visit vs in-person visit. Medication adherence, pharmacist intervention, incidence of antihypertensive side-effects, and blood pressure maintenance based on a goal of ≤140/90 were also evaluated. Results: A total of 77 patients were included. There was no difference in the primary outcome following in person pharmacy visits compared to telepharmacy visits ( P = .690). There was also no difference found for the secondary endpoints of blood pressure goal less than or equal to 140/90 mmHg ( P = .481), medication adherence ( P = 1.00), or antihypertensive adverse events ( P = .344). Conclusion: Telepharmacy visits had a nonsignificant change in blood pressure control when compared to in-person visits. Results suggest that the utilization of either in-person or telepharmacy strategies benefit the management of hypertension., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Sodium-glucose cotransporter-2 inhibitors have been shown to have significant metabolic, renal, and atherosclerotic cardiovascular disease benefits. Recent randomized controlled trials have extended these benefits to patients with heart failure. In fact, the robust findings from these studies in patients with any type of heart failure have led to the incorporation of this drug class in currently updated evidence-based guidelines for this condition. However, given the novelty in utilizing these agents in heart failure, there is uncertainty regarding place in therapy and sequencing in treatment. As such, this review aims to summarize existing literature to guide practitioners regarding the use of these agents in the management of heart failure., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The designation of health care providers is limited to physicians, physician assistants, nurse practitioners, certified nurse midwives, nurse anesthetists, clinical psychologists, dietitians, and social workers. Pharmacists are not federally recognized health care providers and, therefore, are not eligible for cognitive service reimbursements. This commentary explains the intentions of adding pharmacists as Medicare Part B providers, evaluates current state pharmacist provider status, and calls pharmacists, technicians, and other key stakeholders to advocate on behalf of the profession of pharmacy. If federal provider status is granted to pharmacists, patients will gain better access to care, health spending will decline, and physician lead care teams will have an expert in medications readily available for consultation or other medication-related needs. Reimbursement would provide more resources to administer these needed services to more patients in areas with limited access to health care resources., (Copyright © 2023 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Background: Pharmacist-led telehealth services have resulted in improvements in several disease states, including diabetes and conditions requiring anticoagulation. Pharmacists who used telehealth methods to follow up with their patient have noticed an increase in medication adherence., Methods: Using PubMed and EBSCO secondary databases, inclusion criteria were any peer-reviewed study design such as randomized controlled trials, literature reviews, systematic reviews, and cohort studies published within the last 10 years. Search terms included pharmacist, telemedicine, telehealth, cardiovascular disease, and medication adherence ., Results: Seventeen articles were reviewed. Most pharmacist interventions for patients with hypertension involving telemedicine, E-Health, or remote monitoring were performed in the outpatient setting. The primary target of most studies consisted of improving medication adherence., Conclusion: Pharmacist services play an integral role in maintaining medication adherence among the hypertensive population. Telehealth is an effective method of communication with patients to ensure their health is maintained, minimizing barriers of access to care.

Background: Pharmacy graduates should be prepared to provide patient care in a variety of healthcare settings as members of an interprofessional collaborative team. College-based pharmacy call centers can serve as settings to promote interprofessional practice through didactic and experiential coursework. An elective course, Team-Based Medication Management Practices, was developed to provide student pharmacists the opportunity to learn about pharmacy-led services within value-based care models and to prepare them for interprofessional care by incorporating experiential activities within a college-based call center., Educational Activity: A two-credit elective course was offered to third-year pharmacy students. The course was delivered through a combination of didactic lectures and experiential activities within a college-based pharmacy call center, with modules focused on medication adherence, medication therapy management, and transitions of care. A survey was administered to students at the end of the course to evaluate perceptions., Findings: Six students enrolled in the elective and completed the survey. Most students "strongly agreed" or "agreed" that they gained a better understanding of interprofessional care within value-based care models and pharmacy services that can be provided within a college-based call center while acquiring patient care skills. The role of telehealth in the delivery of pharmacist-led patient care services is likely to continue expanding as a result of the COVID-19 pandemic and it will become increasingly important to train students to provide these services., (Copyright © 2021 Elsevier Inc. All rights reserved.)

We reviewed the various antithrombotic therapies available to treat peripheral artery disease (PAD). A literature review using the PubMed and MEDLINE databases used the following keywords: antithrombotic therapy, anticoagulation, peripheral artery disease, and peripheral vascular disease. Randomized studies written in English that assessed the use of antithrombotic therapy in patients with PAD were evaluated. PAD is a worldwide condition that limits blood flow in the lower extremities, leading to a risk of major adverse cardiovascular events and major adverse limb events. Antithrombotic therapy is necessary to prevent these complications, and the choice of therapy depends upon the stage of disease progression. For symptomatic patients in the beginning stage, single antiplatelet therapy (SAPT) is the preferred therapy, specifically, aspirin. For patients undergoing endovascular revascularization, the preferred therapy is dual antiplatelet therapy using aspirin and clopidogrel combined for at least the first month followed by long-term SAPT. For patients undergoing surgical revascularization, the preferred choice of therapy depends upon the type of graft used, with better results obtained with antiplatelet therapy for prosthetic grafts and anticoagulation for venous grafts. New studies have shown that therapy using both antiplatelets and anticoagulation in the form of aspirin plus low-dose rivaroxaban can reduce complications in all three patient populations, which has paved the way for future studies featuring direct oral anticoagulants with the potential to change current guideline recommendations., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG part of Springer Nature.)

Transitions of care has emerged as a point of vulnerability in global health care systems, which can lead to potential avoidable medical errors. In the United States, pharmacist-led transitions of care programs are increasing in number, with many hospitals offering discharge prescription services. However, the required training for these positions remains unclear. With the lack of accreditation standards by the American Society of Health-System Pharmacists for transitions of care as a post-graduate year 2 specialty, this leads to the unanswered question: Which pharmacists are qualified for the growing number of transitions of care positions? Whether trained in a formal transitions of care specialty residency or not, pharmacists as a profession should reassess the proper qualifications needed to provide transitions of care services. One central message remains clear in that having a pharmacist on any interdisciplinary team who is knowledgeable about inpatient and community settings and administrative tasks involved in transitions of care while understanding optimal evidence-based recommendations would appear to be an important piece to the puzzle.

Objective: To assess the impact of pharmacist-led transitions of care program on 30-day readmission rates in the accountable care organization (ACO) primary care setting., Design: Retrospective cohort study., Setting: Two primary care provider (PCP) offices with an ACO in South Florida., Patients, Participants: Adult Medicare patients who completed a post-discharge follow-up visit at two primary care offices within an ACO from July to December 2017., Interventions: To supplement postdischarge visits with a PCP, the pharmacy services were also provided two days per week with a PCP. The comparator groups were patients who only saw a PCP or those who saw a PCP and pharmacist., Main Outcome Measurements: The primary outcome was hospital readmission or emergency department visit within 30 days., Results: A total of 190 subjects were included. There were 113 patients in the PCP group and 77 patients in the PCP/pharmacist group. There was a reduction in the primary outcome when comparing the PCP-only versus PCP/pharmacist groups (6.2% versus 3.9%; P = 0.74)., Conclusion: Involving pharmacists in patient transitions of care in the primary care setting may be beneficial as previous studies have demonstrated. Further studies evaluating pharmacy services in emerging health care models are needed in order to most effectively utilize the expertise of the pharmacy team.

In recent months, the coronavirus pandemic has significantly affected almost every industry in the United States, including health care and higher education. Faculty and students at colleges and schools of pharmacy nationwide have needed to quickly adapt as the delivery of curricula has shifted to primarily online format. Additionally, experiential rotations have been significantly affected as practice settings such as hospitals and outpatient clinics have limited students' interactions with patients or stopped allowing students on-site altogether. Our commentary will explore strategies that have been employed by experiential education coordinators and pharmacy preceptors from various settings to navigate experiential education during these difficult times while ensuring students successfully meet requirements for graduation. These will include descriptions of transitioning advanced pharmacy practice experiences (APPEs) to virtual format, how to safely involve students in the care of COVID-19 patients, and managing scheduling issues.

We report the first precision measurement of the parity-violating asymmetry in the direction of proton momentum with respect to the neutron spin, in the reaction ^{3}He(n,p)^{3}H, using the capture of polarized cold neutrons in an unpolarized active ^{3}He target. The asymmetry is a result of the weak interaction between nucleons, which remains one of the least well-understood aspects of electroweak theory. The measurement provides an important benchmark for modern effective field theory and potential model calculations. Measurements like this are necessary to determine the spin-isospin structure of the hadronic weak interaction. Our asymmetry result is A_{PV}=[1.55±0.97(stat)±0.24(sys)]×10^{-8}, which has the smallest uncertainty of any hadronic parity-violating asymmetry measurement so far.

Background: Patient assistance programs, including medication management and counseling, have the potential to improve care in chronic disease states with complex therapies. Incorporating technology as a tool to foster adherence is becoming more commonplace in practice., Objectives: The purpose of this report is to identify barriers of medication adherence and review the impact of patient assistance programs and technology on medication adherence., Methods: A literature search was conducted in secondary databases, PubMed/MEDLINE and EBSCOhost of peer-reviewed systematic reviews, experimental, quasi-experimental, and observational reports published in English within the last fifteen years. Terms searched included patient assistance program, pharmacist role, technology, adherence or compliance, income and health., Results: Ten studies met our prespecified criteria. Male sex, several self-reported chronic diseases, negative expectancy of treatment, engagement in polypharmacy, financial hardships and lower education level correlated with lower medication adherence. Patient care assistance programs and utilization of technology (e.g., use of a mobile application) improved medication adherence., Conclusions: Patient assistance programs and technological tools, such as mobile applications,are necessary resources in improvingmedication adherence., Competing Interests: Conflict of Interest: We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties., (© Individual authors.)

Background and Purpose: The American Council of Pharmaceutical Education (ACPE) standards emphasize that pharmacy graduates should be "practice- and team-ready," and the American Society for Health-System Pharmacists (ASHP) Task Force on accountable care organizations (ACOs) states that curricula at pharmacy schools should be evaluated and reworked to prepare students to practice effectively as members of the health care team within ACOs. The objective of this study was to describe the development of an ACO-based advanced pharmacy practice experience (APPE) rotation block, clinical activities and interventions completed by students during the experience, and perceptions of students, patients, and physician preceptors regarding the experience., Educational Activity and Setting: The rotation block was within outpatient ACO offices and consisted of a four-week rotation with one pharmacy faculty, immediately followed by a four-week elective experience in a different office with a physician serving as primary preceptor., Findings: Eight students completed the rotation block between August 2017 and April 2018. Students documented a total of 1299 clinical activities and 65 interventions. Medication reconciliation and recommendations to initiate a medication were the most commonly completed activities and interventions documented. The experience was positively perceived among surveyed students, patients, and physician preceptors., Summary: The rotation block was successfully implemented with a positive response from students, patients, and physician preceptors. As a result, the program has expanded in accordance with ACPE Standards to create "practice- and team-readiness" among graduates and expose students to interdisciplinary care within ACOs and other settings., Competing Interests: Declaration of competing interest None., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Full calculations of six-nucleon reactions with a three-body final state have been elusive and a long-standing issue. We present neutron spectra from the T(t,2n)α (TT) reaction measured in inertial confinement fusion experiments at the OMEGA laser facility at ion temperatures from 4 to 18 keV, corresponding to center-of-mass energies (E_{c.m.}) from 16 to 50 keV. A clear difference in the shape of the TT-neutron spectrum is observed between the two E_{c.m.}, with the ^{5}He ground state resonant peak at 8.6 MeV being significantly stronger at the higher than at the lower energy. The data provide the first conclusive evidence of a variant TT-neutron spectrum in this E_{c.m.} range. In contrast to earlier available data, this indicates a reaction mechanism that must involve resonances and/or higher angular momenta than L=0. This finding provides an important experimental constraint on theoretical efforts that explore this and complementary six-nucleon systems, such as the solar ^{3}He(^{3}He,2p)α reaction.

What Is Known and Objective: Hypertension, a major risk factor for adverse cardiovascular events, such as stroke and myocardial infarction, affects 80 million American adults. The aetiology of hypertension is multifaceted and difficult to identify. Dopamine receptors, especially those in the kidneys, play a role in blood pressure regulation, and alterations in their function can cause hypertension. The objective of this review was to investigate the association between the use of dopamine antagonists with hypertension focusing especially on second-generation antipsychotics, like clozapine that is D4 receptor antagonist., Methods: A literature review was conducted using MEDLINE, Ovid, Science Direct, Web of Science and Cochrane Database of Systematic Reviews databases with keywords:hypertension, hypotension, renin-angiotensin-aldosterone system, dopaminergic receptors, blood pressure, antipsychotics. Inclusion criteria were human or animal studies, systematic reviews, meta-analyses, randomized controlled trials, case report/series, published in selected for inclusion., Results and Discussion: All 5 dopamine receptor subtypes (ie D1, D2, D3, D4 and D5) regulate sodium excretion and BP. The D1, D3 and D4 receptors interact directly with the renin-angiotensin-aldosterone system, whereas D2 and D5 receptors directly interact with the sympathetic nervous system to regulate BP. Use of dopaminergic agonists or antagonists could therefore disturb the regulation of BP by dopamine receptors., What Is New and Conclusion: Based upon this review, individuals on antipsychotic agents, particularly clozapine, should be routinely monitored for hypertension, and addition of antihypertensive agents such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) is indicated if hypertension occurs., (© 2017 John Wiley & Sons Ltd.)

The American Diabetes Association announced in 2012 that 86 million Americans were diagnosed with prediabetes compared to 79 million in 2010. Prediabetes + Me (PreDiaMe) is an innovative educational programme developed by pharmacy students at Nova Southeastern University College of Pharmacy, which provides collaborative interprofessional care for patients with prediabetes. A literature review using EBSCOhost, EMBASE, and MEDLINE databases searching the terms education, health services, interprofessional team, and prediabetes was conducted. Human studies published in English between 2006 and 2016 were included. Investigators interviewed a community pharmacist and a consultant pharmacist certified in diabetes education. Based on these interviews and the literature found, PreDiaMe was created to unite healthcare professionals through a three-step community outreach programme. The goal of PreDiaMe is to identify patients at risk of prediabetes, to decrease the prevalence of type 2 diabetes mellitus (T2DM), to reduce healthcare costs, and to improve the quality of life for patients with prediabetes. PreDiaMe benefits patients with prediabetes, the healthcare system, and pedagogy as it aims to decrease in the prevalence and economic burden and increase health outcomes of patients with prediabetes while being used as a tool to provide integrative education in health professional programmes.

Few-body nuclear physics often relies upon phenomenological models, with new efforts at the ab initio theory reported recently; both need high-quality benchmark data, particularly at low center-of-mass energies. We use high-energy-density plasmas to measure the proton spectra from ^{3}He+T and ^{3}He+^{3}He fusion. The data disagree with R-matrix predictions constrained by neutron spectra from T+T fusion. We present a new analysis of the ^{3}He+^{3}He proton spectrum; these benchmarked spectral shapes should be used for interpreting low-resolution data, such as solar fusion cross-section measurements.

Background: Hospitals that provide early postdischarge follow-up after heart failure (HF) hospitalization tend to have lower rates of readmission. However, HF postdischarge (bridge) clinics have not been extensively evaluated., Objective: To assess the impact of a pharmacist-managed HF bridge clinic in a veteran population., Methods: HF patients hospitalized from November 2010 to August 2013 were identified. Retrospective chart review was conducted of 122 HF patients seen at bridge clinic compared with 122 randomly selected HF patients not seen at this clinic (usual care). Primary end point was 90-day all-cause readmission and death. Secondary outcomes were 30-day all-cause readmission and death, time to first postdischarge follow-up, first all-cause readmission., Results: Bridge clinic patients were at higher baseline risk of readmission and death; other characteristics were similar. 90-day death and all-cause readmission trended lower in bridge clinic patients (adjusted hazard ratio [HR] = 0.64; 95% CI = 0.40-1.02; P = 0.06). Time to first follow-up was shorter in bridge clinic patients (11 ± 6 vs 20 ± 23 days; P < 0.001); time to first all-cause readmission trended longer (40 ± 20 vs 33 ± 25days; P = 0.11). 30-day death and all-cause readmission was significantly lower in bridge clinic patients (adjusted HR = 0.44; 95% CI = 0.22-0.88; P = 0.02)., Conclusions: In veteran patients hospitalized for HF, pharmacist-managed HF bridge clinic significantly reduced the time to initial follow-up compared with usual care. Improved short-term outcomes and trend toward improvement of longer-term outcomes in bridge clinic patients was shown.

Background: The accountable care organization (ACO) is an innovative health care delivery model centered on value-based care. ACOs consisting of primary care providers are increasingly becoming commonplace in practice; however, medication management remains suboptimal., Program Description: As experts in medication management, pharmacists perform direct patient care and assist in the transition from one provider to another, which places them in an ideal position to manage multiple aspects of patient care. Pharmacist-provided care has been shown to reduce drug expenditures, hospital readmissions, length of stay, and emergency department visits. Although pharmacists have become key team members of interdisciplinary teams within traditional care settings, their role has often been overlooked in the primary care-based ACO. In 2015, Nova Southeastern University College of Pharmacy founded the Accountable Care Organization Research Network, Services, and Education (ACORN SEED), a team of pharmacy practice faculty dedicated to using innovative approaches to patient care, while providing unique learning experiences for pharmacy students by partnering with ACOs in the South Florida region. Five opportunities are presented for pharmacists to improve medication use specifically in primary care-based ACOs: medication therapy management, annual wellness visits, chronic disease state management, chronic care management, and transitions of care., Observations: Several challenges and barriers that prevent the full integration of pharmacists into primary care-based ACOs include lack of awareness of pharmacist roles in primary care; complex laws and regulations surrounding clinical protocols, such as collaborative practice agreements; provider status that allows compensation for pharmacist services; and limited access to medical records. By understanding and maximizing the role of pharmacists, several opportunities exist to better manage the medication-use process in value-based care settings., Implications/recommendations: As more organizations realize benefits and overcome barriers to the integration of pharmacists into patient care, programs involve pharmacists will become an increasingly common approach to improve outcomes and reduce the total cost of care and will improve the financial viability of primary care-based ACOs., Disclosures: No outside funding supported this research. The authors report no conflicts of interest related to this manuscript. Study concept and design were contributed by Joseph, Hale, and Eltaki, with assistance from the other authors. Prados and Jones took the lead in data collection and data interpretation and analysis, with assistance from the other authors. The manuscript was written primarily by Joseph and Hale, along with the other authors, and revised primarily by Seamon and Gernant, along with the other authors.

Objective: To review the efficacy and safety of pharmacological and nonpharmacological strategies used to treat primary orthostatic hypotension (OH)., Data Sources: A literature review using PubMed and MEDLINE databases searching hypotension, non-pharmacological therapy, midodrine, droxidopa, pyridostigmine, fludrocortisone, atomoxetine, pseudoephedrine, and octreotide was performed., Study Selection and Data Extraction: Randomized or observational studies, cohorts, case series, or case reports written in English between January 1970 and November 2016 that assessed primary OH treatment in adult patients were evaluated., Data Synthesis: Based on the chosen criteria, it was found that OH patients make up approximately 15% of all syncope patients, predominantly as a result of cardiovascular or neurological insults, or offending medication. Nonpharmacological strategies are the primary treatment, such as discontinuing offending medications, switching medication administration to bedtime, avoiding large carbohydrate-rich meals, limiting alcohol, maintaining adequate hydration, adding salt to diet, and so on. If these fail, pharmacotherapy can help ameliorate symptoms, including midodrine, droxidopa, fludrocortisone, pyridostigmine, atomoxetine, sympathomimetic agents, and octreotide., Conclusions: Midodrine and droxidopa possess the most evidence with respect to increasing blood pressure and alleviating symptoms. Pyridostigmine and fludrocortisone can be used in patients who fail to respond to these agents. Emerging evidence with low-dose atomoxetine is promising, especially in those with central autonomic failure, and may prove to be a viable alternative treatment option. Data surrounding other therapies such as sympathomimetic agents or octreotide are minimal. Medication management of primary OH should be guided by patient-specific factors, such as tolerability, adverse effects, and drug-drug and drug-disease interactions.

Idiopathic recurrent pericarditis (IRP) can be challenging to treat. Even after guideline-directed first-line treatment consisting of aspirin (ASA) or a nonsteroidal antiinflammatory drug (NSAID) in combination with colchicine therapy, recurrences still occur in greater than 20% of patients. Many patients then require treatment with long-term corticosteroids, which is not a favorable option due to their short- and long-term adverse effects. Because it is theorized that the pathophysiology of IRP may possess autoimmune sequelae, the use of immunotherapy for the treatment of IRP has emerged. In this review, we describe the literature associated with immunotherapy used to treat IRP in an adult population as well as provide an overview of the safety and monitoring parameters for each agent. The most common immunotherapies used after patients have had multiple recurrences of IRP are anakinra, intravenous immunoglobulin (IVIG), and azathioprine. In most cases, these immunotherapies are adjunctive therapy, with the goal of tapering and discontinuing immunosuppressive corticosteroids. After reviewing the data, anakinra resulted in more patients discontinuing corticosteroids and prevented further recurrences of pericarditis. IVIG resulted in symptom resolution and no further recurrences in most of the patients. Azathioprine was associated with more than half of patients becoming recurrence free; however, many patients required a restart of corticosteroids due to recurrence. Clinicians should be aware of the adverse effects of immunotherapy, ranging from mild gastrointestinal events to risk of infection and serious blood dyscrasias that may require diligent monitoring. The use of immunotherapy for the treatment of adults with IRP should be restricted to patients who have multiple recurrences. Ideally, immunotherapy would be adjunctive to first-line combination therapy with ASA/NSAID plus colchicine, with the goal of tapering and discontinuing immunosuppressive corticosteroids. Furthermore, clinicians should consider cost, drug-drug and drug-disease interactions, and safety, as well as the quality of the retrospective evidence before considering any immunotherapy., (© 2017 Pharmacotherapy Publications, Inc.)

Aim: The β 1 -adrenergic receptor (AR) Arg389Gly polymorphism affects efficacy of its procontractile signaling in cardiomyocytes and carriers' responses to β-blockers. To identify molecular mechanisms underlying functional differences between Arg389 and Gly389 β 1 ARs, we examined their binding to β-arrestins (βarr-1 and -2), which mediate β 1 AR signaling, in neonatal rat ventricular myocytes., Methods: We tested the β 1 AR-βarr interaction via β 1 AR immunoprecipitation followed by βarr immunoblotting., Results: βarr1 binds both variants upon isoproterenol, carvedilol or metoprolol treatment in neonatal rat ventricular myocytes. Conversely, the potentially beneficial in the heart βarr2 only interacts with the Arg389 receptor in response to isoproterenol or carvedilol., Conclusion: Arg389 confers unique βarr2-interacting tropism to the β 1 AR in cardiac myocytes, potentially underlying this variant's gain-of-function phenotype and better clinical responses to β-blockers.

Vasospastic angina is a diagnosis of exclusion that manifests with signs and symptoms, which overlap with obstructive coronary artery disease, most often ST-segment elevation myocardial infarction. The pharmacotherapy that is available to treat vasospastic angina can help ameliorate angina symptoms. However, the etiology of vasospastic angina is ill-defined, making targeted pharmacotherapy difficult. Most patients receive pharmacotherapy that includes calcium channel blockers and/or long-acting nitrates. This article reviews the efficacy and safety of the pharmacotherapy used to treat vasospastic angina. High-dose calcium channel blockers possess the most evidence, with respect to decreasing angina incidence, frequency, and duration. However, not all patients respond to calcium channel blockers. Nitrates and/or alpha1-adrenergic receptor antagonists can be used in patients who respond poorly to calcium channel blockers. Albeit, evidence for use of nitrates and alpha1-adrenergic receptor antagonists in vasospastic angina is not as robust as calcium channel blockers and can exacerbate adverse effects when added to calcium channel blocker therapy. Despite having a clear benefit in patients with obstructive coronary artery disease, the benefit of beta-adrenergic receptor antagonists, statins, and aspirin remains unclear. More data are needed to elucidate whether or not these agents are beneficial or harmful to patients being treated for vasospastic angina. Overall, the use of pharmacotherapy for the treatment of vasospastic angina should be guided by patient-specific factors, such as tolerability, adverse effects, drug-drug, and drug-disease interactions., (© The Author(s) 2016.)

Purpose: This investigation evaluated the incidence, severity, and harm of adverse drug reactions (ADRs) associated with antipsychotic use for intensive care unit (ICU) delirium., Methods: In this prospective, observational study patients were screened for development of delirium with the Intensive Care Delirium Screening Checklist (ICDSC). An ICDSC score of ≥4 was considered delirious. Patients with delirium were screened daily for ADRs. Suspected ADRs were evaluated for drug causality using 3 published, objective assessment tools. Suspected ADRs were considered positive when 2 of 3 instruments had an agreement rating of "possible" or greater. ADR severity was defined as "mild/moderate" or "severe" using the National Cancer Institute's Common Terminology Criteria for Adverse Events scale. A modified National Coordinating Council Medication Error Reporting Index for Categorizing Errors categorized ADRs into "no harm" or "harmful.", Results: Of 90 patients with delirium, 56 received antipsychotics. Ten suspected ADRs occurred attributed to antipsychotic use. QTc prolongation was the most observed ADR (50%). Patients with ADRs had higher mean Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (P = .038). Patients who received haloperidol experienced more severe (P = .048) ADRs., Conclusions: ADRs were observed in 18% of patients having delirium treated with antipsychotics with about half considered severe or harmful. A risk versus benefit assessment is needed before initiating antipsychotic therapy in ICU patients., (© The Author(s) 2015.)

Introduction: Proper psychiatric evaluation of patients necessitates that the clinician be vigilant in ruling out secondary causes of symptoms, such as substance-induced symptoms. Immunoassay-type urine drug screens (UDSs) offer clinicians rapid drug screen results, ease of use, and inexpensive cost. Unfortunately, these screens are not without their limitations. This review aims to outline the nuances and limitations of immunoassay UDSs and to provide the clinician with information that facilitates more accurate interpretation of UDS results. Specifically, false positive results associated with psychiatric medications and the availability and methods for acquisition of commercialized UDS masking agents will be reviewed., Methods: A literature review was conducted to identify false positive UDSs associated with psychiatric medications. References for each article identified were also reviewed. Additionally, a Google® search was conducted to identify commercially available preparations used to mask UDS results and the methods of acquisition of these products., Results: A total of 14 articles were identified using PubMed. No articles for mood stabilizing agents were identified. Entering the phrase how to pass a drug test into Google® search yielded about 12.6 million results, and select references were reviewed based on relevance and user reviews., Discussion: Several psychiatric medications are documented as potential sources of false positive UDSs. Additionally, several agents are available for consumer purchase that may result in false negative UDSs. The clinician must be vigilant in interpreting immunoassay UDS results and should utilize more advanced forms of testing as clinically appropriate.

Several nonpharmacologic strategies for orthostatic hypotension exist including avoiding large carbohydrate-rich meals; limiting alcohol consumption; maintaining adequate hydration; adding salt to foods; and using compression stockings, tilt-table exercises, or abdominal binders. If these fail, however, only limited evidence-based pharmacologic treatment options are available including the use of fludrocortisone, midodrine, pyridostigmine, and droxidopa as well as pseudoephedrine, ocetreotide, and atomoxetine. This report discusses a case of atomoxetine use for 10 weeks in an elderly patient with primary orthostatic hypotension. An 84-year-old man with long-standing primary orthostatic hypotension presented to our ambulatory cardiology pharmacotherapy clinic after several unsuccessful pharmacologic therapies including fludrocortisone, midodrine, and pyridostigmine. Nonpharmacologic strategies were also implemented. Atomoxetine was initiated, and the patient showed gradual improvements in symptoms and blood pressure control over the course of 10 weeks. Our data suggest that low-dose atomoxetine is an effective and safe agent for symptom improvement and blood pressure control in elderly patients with primary orthostatic hypotension., (© 2015 Pharmacotherapy Publications, Inc.)

Objective: To determine effects of pituitary pars intermedia dysfunction (Cushing's disease) and age on fecal egg count and time to egg reappearance after anthelmintic treatment in horses residing in similar environments., Design: Cross-sectional study., Animals: 29 healthy horses (4 to 35 years old) and 13 horses with PPID (13 to 33 years old)., Procedures: Fecal egg counts were performed by use of a modified Wisconsin flotation method at 2-week intervals before and after ivermectin treatment., Results: Horses with PPID had higher fecal egg counts before and 8, 10, and 12 weeks after ivermectin treatment, compared with counts for site-matched healthy horses. There was no difference in the period for < 90% reduction in fecal egg counts between the 2 groups. Age did not affect fecal egg counts at any time point., Conclusions and Clinical Relevance: For similar environmental conditions, horses with PPID were more likely to have higher fecal egg counts than were healthy horses. Therefore, horses with PPID may need to have a more aggressive parasite prevention program than do healthy horses. Age did not affect fecal egg counts or time to egg reappearance after anthelmintic treatment, which suggested age alone does not likely require special consideration when designing a parasite control program for adult horses.

We describe a new method to treat low-energy scattering problems in few-nucleon systems, and we apply it to the five-body case of neutron-alpha scattering. The method allows precise calculations of low-lying resonances and their widths. We find that a good three-nucleon interaction is crucial to obtain an accurate description of neutron-alpha scattering.

Neutron cross sections for nonelastic and elastic reactions on a range of elements have been evaluated for incident energies up to 150 MeV. These cross sections agree well with experimental cross section data for charged-particle production as well as neutron and photon production. Therefore they can be used to determine kerma coefficients for calculations of energy deposition by neutrons in matter. Methods used to evaluate the neutron cross sections above 20 MeV, using nuclear model calculations and experimental data, are described. Below 20 MeV, the evaluated cross sections from the ENDF/B-VI library are adopted. Comparisons are shown between the evaluated charged-particle production cross sections and measured data. Kerma coefficients are derived from the neutron cross sections, for major isotopes of H, C, N, O, Al, Si, P, Ca, Fe, Cu, W, Pb, and for ICRU-muscle, A-150 tissue-equivalent plastic, and other compounds important for treatment planning and dosimetry. Numerous comparisons are made between our kerma coefficients and experimental kerma coefficient data, to validate our results, and agreement is found to be good. An important quantity in neutron dosimetry is the kerma coefficient ratio of ICRU-muscle to A-150 plastic. When this ratio is calculated from our kerma coefficient data, and averaged over the neutron energy spectra for higher-energy clinical therapy beams [three p (68) + Be beams, and a d (48.5) + Be beam], a value of 0.94 +/- 0.03 is obtained. Kerma ratios for water to A-150 plastic, and carbon to oxygen, are also compared with measurements where available.

An ICRU report entitled "Nuclear Data for Neutron and Proton Radiotherapy and for Radiation Protection" is in preparation. The present paper presents an overview of this report, along with examples of some of the results obtained for evaluated nuclear cross sections and kerma coefficients. These cross sections are evaluated using a combination of measured data and the GNASH nuclear model code for elements of importance for biological, dosimetric, beam modification and shielding purposes. In the case of hydrogen both R-matrix and phase-shift scattering theories are used. In the report neutron cross sections and kerma coefficients will be presented up to 150 MeV and proton cross sections up to 250 MeV. An IAEA Consultants' Meeting was also convened to examine the "Status of Nuclear Data needed for Radiation Therapy and Existing Data Development Activities in Member States". Recommendations were made regarding future endeavours.

Data from a pool of 150 patients with systemic lupus erythematosus (SLE) were used to evaluate the clinical usefulness and specificity of the solid phase C1q radioimmunoassay (SPC1q RIA) for circulating immune complexes (CIC). We found that the assay results correlated with the severity of lupus nephritis but that they did not adequately reflect or predict disease activity so as to directly influence decisions regarding treatment. In addition, the contribution of non-IC reactants to the assay results was found to be of some concern. Finally, we could not demonstrate the presence of anti-DNA antibodies in CIC from patients with SLE.

Biopsies of apparently normal skin were obtained from 30 unselected patients with systemic lupus erythematosus. The immunoglobulin class distribution of the immune deposits at the dermal-epidermal junction was determined in order to assess associated disease patterns and to investigate the possibility that the immunoglobulin classes in the skin were an indication of the classes of serum anti-native DNA antibodies. Biopsy specimens containing IgG deposits were obtained from 10 patients with more active disease and a greater incidence of glomerulonephritis than those patients with only IgM deposits or negative biopsies. However, in this unselected group of patients the immunoglobulin class of the immune deposits did not necessarily indicate the class of serum anti-native DNA antibodies. Therefore biopsy of clinically uninvolved skin will not always identify SLE patients with an immunological restriction to IgM antibody production.

Spontaneous in vitro IgA synthesis by peripheral blood mononuclear cells (PBMC) of patients with IgA nephropathy was elevated; 419 +/- 71 ng/10(6) cells (Mean +/- SEM) compared with controls; 217 +/- 35 (P less than 0.02). Pokeweed mitogen (PWM) stimulated IgA synthesis was also elevated in patients; 4326 +/- 1140 ng/10(6) cells (Mean +/- SEM) versus 1458 +/- 406 (P less than 0.02) but the PWM stimulation index for patients did not differ significantly from that of the controls. Concanavalin A (Con A) suppression of PWM stimulated IgA synthesis resulted in the generation of similar quantities of IgA by PBMC from both patients and controls but the percentage suppression was significantly elevated in patients; 87 +/- 5 (Mean +/- SEM) versus 58 +/- 10 (P less than 0.05). Synthesis of IgG and IgM followed the same pattern as that described for IgA. T and B cells from patients and controls were cultured alone and in various co-culture permutations. Enriched B cells of patients demonstrated a selectively increased capacity for IgA production; 266 +/- 106 ng/5 X 10(5) cells (Mean +/- SEM) compared with controls; 42 +/- 9 (P less than 0.01) and this parameter correlated significantly with serum IgA concentrations (R = 0.77, P less than 0.05). Overall analysis of co-culture data showed no significant difference between the influences of autologous, control or patient T cells on immunoglobulin synthesis by normal B cells. Autolymphocytotoxic antibodies were not detected and, compared with controls, patient sera had no differential effect on numbers of IgA producing cells generated in culture.(ABSTRACT TRUNCATED AT 250 WORDS)