Search

Background The roles of pharmacy technicians in clinical practice are being explored. Medication prior authorizations (PAs) from insurers can lead to delays in pharmacotherapy. Objective To assess the efficiency of our clinical pharmacy technicians in processing PAs for medications. Practice description Outpatient clinics in a comprehensive health care provider group. Practice innovation PA requests are routed to technicians for initial data collection. Clinical pharmacists can review their work before submission. Evaluation methods Clinical pharmacy staff in 4 clinics recorded information about PA requests from January 21, 2020, to April 21, 2020. In 3 of the clinics, PA requests were primarily processed by clinical pharmacy technicians. In another clinic, requests were processed by a clinical pharmacist. Information collected included the date the request was received, outcomes (e.g., approval, therapy change, or nonapproval), and the date of final outcome. Descriptive statistics were prepared, including number of requests that were approved, number of business days between request and decision, and final outcome. Results Overall, 720 PA requests were received. Of these, 88.6% were approved with first response, and 673 (93.5%) were eventually approved. Median time to first response was 0 business days, regardless of clinic. In 75% of cases, first response was within 1 business day. PA characteristics varied across clinics; however, PA approval percentages were comparable (91.2%–94.3%). Conclusion In an assessment of clinical pharmacy technicians' efficiency in responding to pharmacy plan PA requests, more than 90% were approved, often within one business day. Our results must be interpreted in light of local factors and a virus pandemic during the study. However, results of requests handled by technicians were similar to results when the requests were handled by a clinical pharmacist. Clinical pharmacy technicians can be efficient and cost-effective in this role.

The magnitude of how rapidly the COVID-19 virus could spread and infect others facilitated the need for a rapid COVID-19 test, accessible and affordable for both children and adults worldwide. As a result, an infected patient can quickly quarantine and isolate to slow the spread. Our research group has determined VOCs associated with COVID-19 and has built a prototype gas analysis system similar to a breathalyzer for detecting gasses of COVID-19. Some of the symptoms like headaches, coughing, and diarrhea result in an inflammatory response to create a unique variety of gasses like acetone, hydrogen, and carbon monoxide that can be detected when they are exhaled through a person’s breath. A sample of a person’s breath is first collected in a chamber when a patient breaths into the valve, the gas sensors then detect a voltage change when they contact a COVID-19 target gas. The concentration in parts-per-million is calculated based on the non-linear resistance ratio of the target gas and clean air. Log-based scale calculations and post-data processing calibrate the sensors to increase the accuracy and selectivity. Finally, the voltages and PPM of the target gas concentration data is stored in a computer database and sensor coding reveals the resulting breath pattern signature of COVID-19. At just under $15.00 United States Dollars (USD), test results are just a breath away, within seconds of taking the test and even before leaving the doctor’s office. Although, this system may also be modified to sniff out other pathogens of disease, spoiled meats, and ripened fruit, we are dedicated to build a gas sensor platform for low cost, noninvasive, and rapid detection of the breath pattern signature of COVID-19, in an attempt to slow the spread of the global health threat of infection and in turn to help save lives. Breath analysis systems serve as a noninvasive means for disease screening. Our objective is to utilize this prototype to obtain a database of H2, CO, NO, Acetone and Alcohol concentrations, whereby, COVID patient breath samples are compared to healthy individual breath samples using our breath analysis system prototype. This system is configured for measuring the aforementioned gas concentrations in ppm and recording the data to a text file in a computer database for subsequent analysis. The data obtained from this study is critical to the development of this system.

Bone marrow derived stem cells express biomarkers capable of facilitating adhesion to the cell culturing microenvironment, thereby, influencing their proliferation, migration, and differentiation. In particular, biological biomarkers of mesenchymal stem cells include, but are not limited to, CD14-, CD19-, CD34-, CD45-, CD29, CD44, CD73+, CD90+, CD105+, CD106, CD166, Stro-1, and HLADR. The relationship between the stem cell biology and the materials and methods forming a cell culturing microenvironment serves as a critical aspect in the successful adhesion and growth within two-dimensional cell culture microenvironments such as polystyrene, laminin, fibronectin, or poly-L-lysine and within three-dimensional cell culture microenvironments such as hydrogel, ceramic, collagen, polymer based nanofibers, agitation, forced floating, and hang drop systems. Further, electrical stimulation of the stem cells may be implemented during the cell culturing process to measure stem cell growth and to determine stem cell viability. In addition, electrical stimulation of implanted stem cells may facilitate tracking by measuring stem cell migration distance and travel area. Although many biochemical and inflammatory biomarkers are expressed based on severity in stroke including, but not limited to, Interluken-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and glutamate (Glu), current methodologies of stem cell directing lack localization and biological effector specificity. Biological effector bound magnetic particle stem cells may serve as a potential treatment method in ischemic stroke. In particular, a stem cell biomarker may be configured to communicate with inflammatory biomarkers, thus, more efficiently delivering the stem cells to site specific areas having the most severely affected in-vivo biochemical microenvironments.

BACKGROUND: Staphylococcus aureus has been implicated in the pathophysiology of eczema, allergic rhinitis, asthma, and food allergy. S aureus is a marker of more severe eczema, which is a risk factor for food sensitization/allergy. Therefore it might be that the association between S aureus and food allergy in eczematous patients is related to eczema severity.OBJECTIVE: We sought to investigate the association of S aureus colonization with specific IgE (sIgE) production to common food allergens and allergies in early childhood independent of eczema severity. We additionally determined the association of S aureus colonization with eczema severity and persistence.METHODS: In Learning Early About Peanut Allergy (LEAP) study participants eczema severity was assessed, and skin/nasal swabs were cultured for S aureus. Sensitization was identified by measuring sIgE levels. Peanut allergy was primarily determined by means of oral food challenge, and persistent egg allergy was primarily determined by using skin prick tests.RESULTS: Skin S aureus colonization was significantly associated with eczema severity across the LEAP study, whereas at 12 and 60 months of age, it was related to subsequent eczema deterioration. Skin S aureus colonization at any time point was associated with increased levels of hen's egg white and peanut sIgE independent of eczema severity. Participants with S aureus were more likely to have persistent egg allergy and peanut allergy at 60 and 72 months of age independent of eczema severity. All but one of the 9 LEAP study consumers with peanut allergy (9/312) were colonized at least once with S aureus.CONCLUSION: S aureus, independent of eczema severity, is associated with food sensitization and allergy and can impair tolerance to foods. This could be an important consideration in future interventions aimed at inducing and maintaining tolerance to food allergens in eczematous infants.

SESSION TITLE: Disaster Medicine Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Over the last 20 years, multiple global viral threats have been encountered, however, maybe none as far-reaching as COVID-19 In 2003, 21% of SARS cases involved healthcare workers (HCWs) and similar rates were observed for H1N1 and MERS In studies that followed, elevated infection rates among HCWs were attributed to lack of proper personal protective equipment (PPE), improper training, and confusion surrounding infection control policy HCWs at our institution expressed high stress levels regarding their own safety and the safety of their families Although the COVID-19 pandemic is still evolving, its infectivity rate amongst HCWs seems comparable, with Italian HCWs constituting 20% of infections as of March 21, 2020 The purpose of our project was to assess the impact of our pandemic preparedness project on HCWs competence and confidence METHODS: Our institution has an established biocontainment unit (BCU), one of only a few in Pennsylvania A multi-disciplinary team comprised of representatives from our BCU, critical care, nursing as well as respiratory therapy developed a multi-modal, interactive teaching session to equip our frontline HCWs Each session was comprised of COVID-19 clinical updates, details on our institutional response, and simulation for donning and doffing PPE We created pre-post intervention surveys to measure competency and the intervention’s impact on HCWs confidence Competency was determined by correct identification of isolation zones, proper order for donning and doffing PPE and identification of aerosolizing procedures HCWs confidence level was obtained by subjective questioning Pre-and Post-survey analysis was performed using Student’s t-test and one-sided Fisher’s exact test RESULTS: A total of 123 participants signed in during training and 114 (92 7%) answered pre-surveys while 92 (74 8%) completed post-surveys Our participants represented a large portion of frontline HCWs including respiratory therapists, nursing, advanced practitioners, house staff and attending physicians from surgical and non-surgical fields A significant improvement was noted across all domains (p < 0 001);isolation zone identification (pre M = 0 26, SD = 0 44;post M = 0 80, SD = 0 40), donning and doffing (pre M = 0 25, SD = 0 44;post M = 0 74, SD = 0 44), aerosolizing procedures (pre M = 0 37, SD = 0 48;post M = 0 84, SD = 0 34), and provider confidence (pre M = 0 14, SD = 0 35;post M = 0 85, SD = 0 36) CONCLUSIONS: After our COVID-19 preparedness training, HCWs experienced improvement in competency and confidence CLINICAL IMPLICATIONS: In a pandemic, there is no room to assume preparedness and timely implementation of training with similar renewal requirements to BLS and ACLS may be prudent to maintain confidence and competency DISCLOSURES: No relevant relationships by John Harahus, source=Web Response No relevant relationships by Tara Little, source=Web Response no disclosure on file for Frank Lodeserto;No relevant relationships by Alexis MacDonald, source=Web Response No relevant relationships by Tiffany Miller, source=Web Response no disclosure submitted for Mary Jane Reed;No relevant relationships by Amy Reiner, source=Web Response No relevant relationships by Kenneth Snell, source=Web Response

BACKGROUND: Early introduction of dietary peanut in high-risk infants with severe eczema, egg allergy, or both prevented peanut allergy at 5 years of age in the Learning Early About Peanut Allergy (LEAP) study. The protective effect persisted after 12 months of avoiding peanuts in the 12-month extension of the LEAP study (LEAP-On). It is unclear whether this benefit is allergen and allergic disease specific.OBJECTIVE: We sought to assess the effect of early introduction of peanut on the development of allergic disease, food sensitization, and aeroallergen sensitization.METHODS: Asthma, eczema, and rhinoconjunctivitis were diagnosed based on clinical assessment. Reported allergic reactions and consumption of tree nuts and sesame were recorded by questionnaire. Sensitization to food allergens and aeroallergens was determined by means of skin prick testing and specific IgE measurement.RESULTS: A high and increasing burden of food allergen and aeroallergen sensitization and allergic disease was noted across study time points; 76% of LEAP participants had at least 1 allergic disease at 60 months of age. There were no differences in allergic disease between LEAP groups. There were small differences in sensitization and reported allergic reactions for select tree nuts, with levels being higher in the LEAP consumption group. Significant resolution of eczema and sensitization to egg and milk occurred in LEAP participants and was not affected by peanut consumption.CONCLUSION: Early consumption of peanut in infants at high risk of peanut allergy is allergen specific and does not prevent the development of other allergic disease, sensitization to other food allergens and aeroallergens, or reported allergic reactions to tree nuts and sesame. Furthermore, peanut consumption does not hasten the resolution of eczema or egg allergy.

Background: Approximately half of college students who completed the National College Health Assessment 2013 indicated a greater need for health-related information. University-based smartphone applications may help students better access this information. Purpose: This study describes the needs assessment, development, and formative evaluation of a smartphone application designed to link students to health promotion information and on-campus resources at a public university. Methods: An online survey was administered to 219 students. A smartphone application was subsequently developed also considering feedback from selected campus leaders. A focus group was conducted with 9 students to assess opinions about the application prototype. Results: The 3 most common health topics participants selected as most important to them were stress management, nutrition/diet, and physical activity/fitness. Students thought the application prototype was beneficial to the campus community and the topics included were help...

Thanatin is an inducible 21-residue antimicrobial peptide (AMP) derived from the insect Podisus maculiventris. Thanatin and its analogs have bactericidal activity against gram-positive and gram-negative bacteria, including antibiotic resistant strains. Due to the lack of hemolytic action, thanatin is a good candidate for therapeutic use, as evidenced by its ability to fight sepsis in mice. However, the mode of action of thanatin remains unexplored. Introduction of the respiratory poison carbonyl cyanide m-chlorophenyl hydrazone (CCCP) inhibits AMP induced death, suggesting that the bacterial respiratory pathway is targeted. In this study, biotinylated S-thanatin was used to determine a minimum inhibitory concentration (MIC) in Escherichia coli. Biotinylated S-thanatin showed comparable killing activity to the non-biotinylated peptide, 8μg/mL vs. 4μg/mL, respectively. Next, the killing activity of biotinylated S-thanatin was determined for cultures of E. coli grown under anaerobic, aerobic and respiratory dependent conditions. Anaerobic growth was shown to inhibit thanatin-induced microbial death, and respiratory dependent increased sensitivity. Currently, we are using biotinylated S-thanatin in an affinity purification assay to isolate the intracellular target to be analyzed using matrix assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectroscopy.

Two studies were conducted in order to determine the impact computer games had on the cognitive performance. Study 1 evaluated a measure of cognition, which incorporates aspects of short-term working memory, visual attention, mathematical decision making, and auditory perception. Study 2 measured the cognitive performance between those who did not play video games versus those who played either a violent or non-violent video game. Results from Study 1 indicate participants needed approximately four trials to reach asymptotic performance on the cognitive measure. Results of Study 2 showed that participants who did not play any video game did not have a change in their cognitive performance, while those who played either a violent or non-violent video game had an increase in their cognitive performance.

Sub-micrometer and nano-size catalytic particles are significantly more reactive than their bulk counterparts and can be used to enhance the performance of catalytic combustors. Their high specific surface areas (typically 1−200 m2/g) and unique morphologies contribute to their enhanced reactivity. Differences in adsorbed species and/or their distributions may also play an important role yet are not clear. The purpose of this study is to quantify the effects of particle size, catalyst loading, and flow residence time on the reactivity of methanol−air premixtures over dispersed platinum (Pt) nanoparticles. As such, experiments were conducted in an atmospheric flow tube reactor seeded with 2−5, 200, and 500 nm Pt particles distributed on a substrate made from deactivated fused silica wool. Temperature measurements and exhaust gas species analyses were obtained for the different size particles, catalyst loadings, and flow conditions. Materials characterization of the particles was also conducted, and scannin...

Superparamagnetic iron oxide nanoparticles, including magnetite (Fe3 O4 ), are widely used in applications such as targeted drug delivery, magnetic resonance imaging, tissue engineering, gene therapy, hyperthermic malignant cell treatment, and cell membrane manipulation. These nanoparticles are particularly interesting for in vivo and in vitro applications since they do not exhibit magnetic behavior once the magnetic field has been removed. In the current work, superparamagnetic iron oxide nanoparticles were produced using a flame synthesis method, which provides significant advantages over other material synthesis processes such as solgel processing, chemical vapor deposition, and laser ablation. Flame synthesis allows control of particle size, size distribution, phase and composition by altering flame operating conditions. Flame synthesis is further capable of commercial production rates with minimal post-processing of the final product materials. This study focuses on the interaction of flame synthesized iron oxide nanoparticles with porcine aortic endothelial cells and compares the results to those obtained using commercially available iron oxide nanoparticles. The materials characteristics of the flame synthesized iron oxide nanoparticles, including morphology, elemental composition, particle size, were analyzed by electron microscopy (TEM, ESEM, EDS), and Raman Spectroscopy. The data verified production of a heterogenous mixture of hematite and magnetite nanoparticles, which exhibit superparamagnetic properties. Monodisperse iron oxide particles of 6–12 nm diameter and aggregated clusters of these 6–12nm nanoparticles have been synthesized. Nanoparticle biocompatibility was assessed by incubating flame synthesized and commercially available iron oxide nanoparticles with endothelial cells for 24 hours. Both alamar blue and Live/Dead cell assays showed no significant toxicity difference between flame synthesized and commercially available nanoparticles. Cells exposed to both types of nanoparticles maintained membrane integrity, as indicated by minimal lactase dehydrogenase release. Endothelial cells imaged by ESEM and confirmed by EDS demonstrated that uncoated flame synthesized nanoparticles are ingested into cells in a similar manner to commercially available nanoparticles. These data suggest that flame synthesized iron oxide nanoparticles are comparable to commercially available nanoparticles for biological applications. Flame synthesis has the advantage of a relatively simple synthesis process with higher purity products and lower time and energy manufacturing costs. Future work will include functionalizing the nanoparticle surfaces for specific biological applications, including specific cell targeting and bioactive factor delivery.Copyright © 2008 by ASME

Nanocatalytic particles of Gold (Au), Platinum (Pt), and Palladium (Pd) are highly reactive at room-temperature and can be used to generate heat in micro-scale devices for portable power generation. No pre-heating is required for light-off and high steady-state operating temperatures can be sustained with high density alcohol-air premixtures. Preliminary experiments conducted in our lab and those reported by Hu and co-workers at Oak Ridge National Lab have measured peak operating temperatures ∼ 300–500 degrees Celsius using near-stoichiometric methanol/air and ethanol/air premixtures at ambient initial temperature and atmospheric pressure. The effect of particle size, morphology, mass loading, and flow residence time are reported for different mixture stoichiometries. Temperature measurements and gas species analyses are also tabulated. Interestingly, smaller particles were observed to be less reactive than larger particles for the same mass loadings for select conditions. Materials characterization of the particles has also been conducted to characterize the specific surface area of the catalyst and evaluate the importance of particle sintering, morphology changes, and particle distribution.Copyright © 2007 by ASME

This report describes a curricular experience that introduces the basics of practice management to third-year family medicine students. The curriculum includes evidence-based medicine, managed care concepts and terminology, financial management terms and concepts, laws and legal issues, and insurance and coding.In 1999-2000, a three-session practice management curriculum was implemented in five family medicine third-year clerkship rotations at the University of North Carolina at Chapel Hill, Wilmington site. The learning activities included readings, a "quiz show" game, and a patient practice-centered project.Students reported greater knowledge and confidence in the selected topics. The practice management curriculum was positively evaluated overall.This interactive learning module for the family medicine students begins the process of incorporating practice management skills and knowledge.