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

In the Sacramento Valley (California, USA), rice (Oryza sativa L.) fields are an economically important crop and productive habitats for the mosquito species Culex tarsalis and Anopheles freeborni. Since 2010, approximately 150 km2 of conventional and 16 km2 of organic rice have been grown in Sacramento and Yolo Counties. These fields are often within mosquito flight-range of both rural towns and urban centers. Culex tarsalis are highly competent vectors of West Nile virus, and An. freeborni are aggressive, mammalophagic, nuisance biters. The Sacramento–Yolo Mosquito and Vector Control District provides mosquito control for the two counties in its jurisdiction. The principles of Integrated Pest Management are used to control mosquitoes in rice growing areas, relying upon a range of surveillance and control interventions. Larvae are controlled by limiting habitats that enable development of immature mosquitoes while balancing agricultural and wildlife needs, applying larvicides, and the use of Gambusia affinis (mosquitofish). Adult mosquitoes are controlled by ultra-low volume pesticide applications. The program was assessed for larval and adult mosquito control efficacy and areas of programmatic improvement identified. Because rice fields are productive habitats for mosquitoes, complete elimination of the habitat is not a feasible goal, thus efforts are aimed at interrupting disease transmission and reducing the number of mosquitoes that traverse into populated areas.

Objective. To survey pharmacists, including those who make or contribute to hiring decisions, regarding certificate training programs and specifically about a primary care certificate for pharmacists. Methods. We conducted a cross-sectional survey of pharmacist registrants of the Office of Continuing Professional Development at the University of Tennessee Health Science Center College of Pharmacy’s listserve, including both hiring and non-hiring pharmacists. The 40-question survey probed perceptions of various types of postgraduate training and the design of a primary care certificate training program for pharmacists. Data were collected between November and December 2020. Results. A total of 230 pharmacists participated in this study (14% response rate), and most reported practicing in the community (n=126, 57%). Nearly half of the respondents reported making or contributing to hiring decisions of other pharmacists (n=94, 41%), and, of those, most reported that completion of a primary care certificate program by a candidate would increase their likelihood of hiring that candidate (n=50, 78%). Both groups (hiring and non-hiring pharmacists) most commonly reported that a primary care certificate training program should be 30 hours total and 12 weeks in length, ranked communication as the most important topic to be included, and indicated the didactic and simulation/experiential components should be similarly weighted. Conclusions. Pharmacists, including those who make or contribute to hiring decisions, reported valuing certificate training programs. Developing a certificate training program that is at least 30 hours in length over 12 weeks may serve as an opportunity to address gaps in primary care in the United States.

Direct numerical simulations (DNS) are performed of a cantilevered stator blade to identify the unsteady and turbulent flow structure within compressor tip flows. The simulations were performed with clearances of 1.6 and 3.2 percent of chord. The results show that the flow both within the gap and at the exit on the suction side are highly unsteady phenomena controlled by fine-scale turbulent structures. The signature of the classical tip leakage vortex is a consequence of time-averaging and does not exist in the true unsteady flow. Despite the complexity, we are able to replicate the flow within the tip-gap using a validated quasi-three-dimensional model. This enables a wide range of quasi-3D DNS simulations to study the effects of blade tip corner radius and Reynolds number. Tip corner radius is found to radically alter the unsteady flow in the tip; it affects both separation bubble size and shape, as well as transition mechanisms in the tip flow. These effects can lead to variations in tip mass flow of up to10 percent and a factor of2 variation in dissipation within the tip gap.

Histopathologic examination of lungs afflicted by chronic lung allograft dysfunction (CLAD) consistently shows both mononuclear cell (MNC) inflammation and mesenchymal cell (MC) fibroproliferation. We hypothesize that interleukin 6 (IL-6) trans-signaling may be a critical mediator of MNC-MC crosstalk and necessary for the pathogenesis of CLAD. Bronchoalveolar lavage (BAL) fluid obtained after the diagnosis of CLAD has approximately twofold higher IL-6 and soluble IL-6 receptor (sIL-6R) levels compared to matched pre-CLAD samples. Human BAL-derived MCs do not respond to treatment with IL-6 alone but have rapid and prolonged JAK2-mediated STAT3 Tyr705 phosphorylation when exposed to the combination of IL-6 and sIL-6R. STAT3 phosphorylation within MCs upregulates numerous genes causing increased invasion and fibrotic differentiation. MNC, a key source of both IL-6 and sIL-6R, produce minimal amounts of these proteins at baseline but significantly upregulate production when cocultured with MCs. Finally, the use of an IL-6 deficient recipient in a murine orthotopic transplant model of CLAD reduces allograft fibrosis by over 50%. Taken together these results support a mechanism where infiltrating MNCs are stimulated by resident MCs to release large quantities of IL-6 and sIL-6R which then feedback onto the MCs to increase invasion and fibrotic differentiation.

Summary Background Alterations in the respiratory microbiome are common in chronic lung diseases, correlate with decreased lung function, and have been associated with disease progression. The clinical significance of changes in the respiratory microbiome after lung transplant, specifically those related to development of chronic lung allograft dysfunction (CLAD), are unknown. The aim of this study was to evaluate the effect of lung microbiome characteristics in healthy lung transplant recipients on subsequent CLAD-free survival. Methods We prospectively studied a cohort of lung transplant recipients at the University of Michigan (Ann Arbor, MI, USA). We analysed characteristics of the respiratory microbiome in acellular bronchoalveolar lavage fluid (BALF) collected from asymptomatic patients during per-protocol surveillance bronchoscopy 1 year after lung transplantation. For our primary endpoint, we evaluated a composite of development of CLAD or death at 500 days after the 1-year surveillance bronchoscopy. Our primary microbiome predictor variables were bacterial DNA burden (total 16S rRNA gene copies per mL of BALF, quantified via droplet digital PCR) and bacterial community composition (determined by bacterial 16S rRNA gene sequencing). Patients' lung function was followed serially at least every 3 months by spirometry, and CLAD was diagnosed according to International Society of Heart and Lung Transplant 2019 guidelines. Findings We analysed BALF from 134 patients, collected during 1-year post-transplant surveillance bronchoscopy between Oct 21, 2005, and Aug 25, 2017. Within 500 days of follow-up from the time of BALF sampling, 24 (18%) patients developed CLAD, five (4%) died before confirmed development of CLAD, and 105 (78%) patients remained CLAD-free with complete follow-up. Lung bacterial burden was predictive of CLAD development or death within 500 days of the surveillance bronchoscopy, after controlling for demographic and clinical factors, including immunosuppression and bacterial culture results, in a multivariable survival model. This relationship was evident when burden was analysed as a continuous variable (per log10 increase in burden, HR 2·49 [95% CI 1·38–4·48], p=0·0024) or by tertiles (middle vs lowest bacterial burden tertile, HR 4·94 [1·25–19·42], p=0·022; and highest vs lowest, HR 10·56 [2·53–44·08], p=0·0012). In patients who developed CLAD or died, composition of the lung bacterial community significantly differed to that in patients who survived and remained CLAD-free (on permutational multivariate analysis of variance, p=0·047 at the taxonomic level of family), although differences in community composition were associated with bacterial burden. No individual bacterial taxa were definitively associated with CLAD development or death. Interpretation Among asymptomatic lung transplant recipients at 1-year post-transplant, increased lung bacterial burden is predictive of chronic rejection and death. The lung microbiome represents an understudied and potentially modifiable risk factor for lung allograft dysfunction. Funding US National Institutes of Health, Cystic Fibrosis Foundation, Brian and Mary Campbell and Elizabeth Campbell Carr research gift fund.

The isentropic exponent is one of the most important properties affecting gas dynamics. Nonetheless, its effect on turbine performance is not well known. This paper discusses a series of experimental and computational studies to determine the effect of isentropic exponent on the flow field within a turbine vane. Experiments are performed using a newly modified transient wind tunnel that enables annular cascade testing with a wide range of working fluids and operating conditions. For the present study, tests are undertaken using air, CO2, R134a, and argon, giving a range of isentropic exponent from 1.08 to 1.67. Measurements include detailed wall static pressures that are compared with computational simulations. Our results show that over the range of isentropic exponents tested here, the loss can vary between 20% and 35%, depending on vane exit Mach number. The results are important for future turbines operating with real-gas effects and/or those where high gas temperatures can lead to variations in the isentropic exponent.

Resume Objectif Evaluer la prevalence des troubles visuels dans une population pediatrique scolarisee en reseau d’education prioritaire en France. Patients et methodes Le projet pilote PlanVue® a ete concu pour detecter et prendre en charge les troubles visuels des enfants scolarises dans les reseaux d’education prioritaire de Nanterre, France. Au cours de cette etude pilote, 515 enfants de 4 a 13 ans ont beneficie a l’ecole, entre janvier et mars 2019, d’un examen de la fonction visuelle consistant en une evaluation globale du comportement visuel, une mesure de l’acuite visuelle de chaque œil, une evaluation de la refraction objective par photoscreening, et la recherche d’un strabisme. En cas d’examen anormal, defini par une vision alteree ou selon un algorithme etabli sur les anomalies retrouvees, les enfants etaient adresses a un ophtalmologiste. Resultats Une alteration de mesure de l’acuite visuelle a ete retrouvee chez 20 % des eleves. Sur les 515 enfants depistes, 22 % ont ete orientes vers un ophtalmologiste. Parmi ces enfants, 13 % presentaient une amblyopie, 73 % presentaient une ametropie spherique, 57 % presentaient un astigmatisme et 2 % presentaient un strabisme. Sur l’ensemble de la population depistee, 12 % des enfants necessitaient une correction optique et n’en etaient pas pourvus. Conclusion Cette etude confirme la prevalence elevee des troubles refractifs non corriges chez les enfants d’âge scolaire. Un programme de depistage realise en milieu scolaire par des professionnels paramedicaux peut permettre de reduire considerablement la proportion de troubles visuels non corriges et leurs consequences.

Background Rapid Diagnostic Clinics (RDC) are being expanded nationally by NHS England. Guy’s RDC established a pathway for GPs and internal referrals for patients with symptoms concerning for malignancy not suitable for a site-specific 2WW referral. However, little data assessing the effectiveness of RDC models are available in an English population. Methods We evaluated all patients referred to Guy’s RDC between December 2016 and June 2019 (n = 1341) to assess the rate of cancer diagnoses, frequency of benign conditions and effectiveness of the service. Results There were 96 new cancer diagnoses (7.2%): lung (16%), haematological (13%) and colorectal (12%)—with stage IV being most frequent (40%). Median time to definitive cancer diagnosis was 28 days (IQR 15–47) and treatment 56 days (IQR 32–84). In all, 75% were suitable for treatment: surgery (26%), systemic (24%) and radiotherapy (14%). Over 180 serious non-neoplastic conditions were diagnosed (35.8%) of patients with no significant findings in two-third of patients (57.0%). Conclusions RDCs provide GPs with a streamlined pathway for patients with complex non-site-specific symptoms that can be challenging for primary care. The 7% rate of cancer diagnosis exceeds many 2WW pathways and a third of patients presented with significant non-cancer diagnoses, which justifies the need for rapid diagnostics. Rapid Diagnostic Centres (RDCs) are being rolled out nationally by NHS England and NHS Improvement as part of the NHS long-term plan. The aim is for a primary care referral pathway that streamlines diagnostics, patient journey, clinical outcomes and patient experience. This pilot study of 1341 patients provides an in-depth analysis of the largest single RDC in England. Cancer was diagnosed in 7% of patients and serious non-cancer conditions in 36%—justifying the RDC approach in vague symptom patients.

This paper investigates the surface boundary layer and wake development of a compressor blade at a range of low Reynolds number from 45000 to 120000. Experiments in a miniature linear compressor cascade facility have been performed with detailed surface pressure measurements and flow visualization to track variations in the separation bubble size. These have been combined with high resolution pneumatic pressure and hot wire probe traverses in the downstream wake. High fidelity DNS simulations have been completed on the same compressor blade section across the same range of operating conditions. The results show that large laminar separation bubbles exist on both blade surfaces. As Reynolds number increases, these separation bubbles shorten in length and reduce in thickness. Correspondingly, the downstream wake narrows, although the peak wake loss coefficient remains approximately constant. As the Reynolds number is increased from 45000 to 120000 the bubble length on the suction side reduced from 48% to 28% chord and on the pressure side reduced from 35% to 20% chord, while the loss coefficient reduced from 9% to 5%. The flow features are examined further within the high-fidelity computations, which reveal the dependence of the wake turbulence on the laminar separation bubbles. The separation bubbles are found to generate turbulent kinetic energy, which convects downstream to form the outer part of wake. As Re increases, a shorter bubble produces less turbulence in the outer part of the boundary layer leading to a narrower wake. However, the trailing edge separation is largely independent of Reynolds number, leading to the constant peak loss coefficient observed. The overall loss is shown to vary linearly with the total turbulence production, and this depends on the size of the separation bubbles. Overall, this research provides new insight into the connection between the blade surface flow field and the wake characteristics at low Reynolds number. The findings suggest that changes that minimize the extent of the blade separation bubbles could provide significant improvements to both the steady and unsteady properties of the wake.

Norepinephrine exerts powerful influences on the metabolic, neuroprotective and immunoregulatory functions of astrocytes. Until recently, all effects of norepinephrine were believed to be mediated by receptors localized exclusively to the plasma membrane. However, recent studies in cardiomyocytes have identified adrenergic receptors localized to intracellular membranes, including Golgi and inner nuclear membranes, and have shown that norepinephrine can access these receptors via transporter-mediated uptake. We recently identified a high-capacity norepinephrine transporter, organic cation transporter 3 (OCT3), densely localized to outer nuclear membranes in astrocytes, suggesting that adrenergic signaling may also occur at the inner nuclear membrane in these cells. Here, we used immunofluorescence and western blot to show that β

Earleaf acacia (Acacia auriculiformis A.Cunn. ex Benth) is a fast-growing, evergreen tree from Australia that was introduced into the United States as an ornamental plant, but it has become a serio...

Mosquito pesticides effectively control vectors of human disease but have numerous unintended consequences. These may include adversely affecting non-target species such as weed biological control ...

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

Objectives To describe the practice analysis undertaken by a task force convened by the American Board of Pediatrics Pediatric Critical Care Medicine Sub-board to create a comprehensive document to guide learning and assessment within Pediatric Critical Care Medicine. Design An in-depth practice analysis with a mixed-methods design involving a descriptive review of practice, a modified Delphi process, and a survey. Setting Not applicable. Subjects Seventy-five Pediatric Critical Care Medicine program directors and 2,535 American Board of Pediatrics Pediatric Critical Care Medicine diplomates. Interventions A practice analysis document, which identifies the full breadth of knowledge and skill required for the practice of Pediatric Critical Care Medicine, was developed by a task force made up of seven pediatric intensivists and a psychometrician. The document was circulated to all 75 Pediatric Critical Care Medicine fellowship program directors for review and comment and their feedback informed modifications to the draft document. Concurrently, data from creation of the practice analysis draft document were also used to update the Pediatric Critical Care Medicine, was developed by a task force made up of seven pediatric intensivists and a psychometrician. The document was circulated to all 75 Pediatrics Pediatric Critical Care Medicine fellowship program directors for review and comment and their feedback informed modifications to the draft document. Concurrently, data from creation of the practice analysis draft document were also used to update the Pediatric Critical Care Medicine content outline, which was sent to all 2,535 American Board of Pediatrics Pediatric Critical Care Medicine diplomates for review during an open-comment period between January 2019 and February 2019, and diplomate feedback was used to make updates to both the content outline and the practice analysis document. Measurements and main results After review and comment by 25 Pediatric Critical Care Medicine program directors (33.3%) and 619 board-certified diplomates (24.4%), a comprehensive practice analysis document was created through a two-stage process. The final practice analysis includes 10 performance domains which parallel previously published Entrustable Professional Activities in Pediatric Critical Care Medicine. These performance domains are made up of between three and eight specific tasks, with each task including the critical knowledge and skills that are necessary for successful completion. The final practice analysis document was also used by the American Board of Pediatrics Pediatric Critical Care Medicine Sub-board to update the Pediatric Critical Care Medicine content outline. Conclusions A systematic approach to practice analysis, with stakeholder engagement, is essential for an accurate definition of Pediatric Critical Care Medicine practice in its totality. This collaborative process resulted in a dynamic document useful in guiding curriculum development for training programs, maintenance of certification, and lifetime professional development to enable safe and efficient patient care.

Colleges of pharmacy are optimally positioned to train the entire pharmacy team, including pharmacists and pharmacy support personnel, for five reasons: (1) ability to provide comprehensive workforce development, (2) utilization of established faculty expertise, (3) harnessing of existing infrastructure, (4) affording opportunities for intraprofessional education, and (5) supporting institutional growth and reputability. As the emphasis of training shifts towards team-based approaches and expanded responsibilities for team members, ensuring the existing and future pharmacy workforce is equipped to serve their communities becomes increasingly important. Thus, colleges of pharmacy should consider offering a pharmacy technician training program to meet the needs of their community and the profession.