Investigating the methods and characteristics of the trafficking of performance and image enhancing drugs in Australia

INTRODUCTION

Using case law, the aims of this study were to document the methods for trafficking of performance and image-enhancing drugs (PIED) into Australia, and the characteristics of individuals and groups involved.

METHODS

Data was collected from judges' sentencing comments. Searches were conducted using the Australasian Legal Information Institute database across all states in Australia, for the period of January 2010 to December 2021. After removing duplicates and cases which did not meet the inclusion criteria, 31 cases were included in the analysis.

RESULTS

Across the 31 cases, 37 individuals were named as being involved in the supply and/or trafficking of PIEDs, with three cases involving an unknown number of individuals. One case named four actors involved in the supply and/or trafficking of PIEDs, three cases involved three actors, four cases involved two actors and 17 cases involved one actor. In 20 of the 31 cases, individuals operated alone. Over half (19 of the 37) of the individuals were health professionals. The majority (n = 17) of cases involved prescription as the method of acquisition, while seven cases involved the importation of PIEDs.

DISCUSSION AND CONCLUSION

The small number of cases identified, with the majority involving only a single actor, and half of the cases involving those in the medical profession. The findings suggest that discrete occurrences of trafficking involves individuals or small groups that do not appear to be linked to large-scale networks or networks involving the supply and trafficking of other illicit substances.

Advancing Public Health through Community Pharmacy Practice

The overarching goal of public health is to advance the health of individuals, communities, and populations [...].

Multilevel network interventions: Goals, actions, and outcomes

COVID-19 has resulted in dramatic and widespread social network interventions across the globe, with public health measures such as distancing and isolation key epidemiological responses to minimize transmission. Because these measures affect social interactions between people, the networked structure of daily lives is changed. Such largescale changes to social structures, present simultaneously across many different societies and touching many different people, give renewed significance to the conceptualization of social network interventions. As social network researchers, we need a framework for understanding and describing network interventions consistent with the COVID-19 experience, one that builds on past work but able to cast interventions across a broad societal framework. In this theoretical paper, we extend the conceptualization of social network interventions in these directions. We follow Valente (2012) with a tripartite categorization of interventions but add a multilevel dimension to capture hierarchical aspects that are a key feature of any society and implicit in any network. This multilevel dimension distinguishes goals, actions, and outcomes at different levels, from individuals to the whole of the society. We illustrate this extended taxonomy with a range of COVID-19 public health measures of different types and at multiple levels, and then show how past network intervention research in other domains can also be framed in this way. We discuss what counts as an effective network, an effective intervention, plausible causality, and careful selection and evaluation, as central to a full theory of network interventions.

Beyond Contraception: Pharmacist Roles to Support Maternal Health

While contraception prescribing by pharmacists has seen rapid growth in recent years, pharmacist-provided services that can impact maternal health encompass more than just contraception. Each phase of maternal health-preconception, pregnancy, and post-pregnancy-has unique needs, and pharmacists are well equipped to provide services to meet those needs and are more accessible than other healthcare providers. While pharmacist-provided maternal health services may lead to significant savings to the healthcare system, additional research to more fully capture the value of pharmacist-provided maternal health services is needed. Robust implementation of a pharmacist-provided maternal health services program will require partnerships between providers, payers, and pharmacists. Infant and maternal mortality, preterm birth, and unintended pregnancies are significant public health issues, and pharmacists should be seen as a capable workforce who can provide needed maternal health care and serve as a gateway into the healthcare system for those capable of pregnancy.

Birth Control Use and Access Including Pharmacist-Prescribed Contraception Services during COVID-19

The COVID-19 pandemic influenced health care with effects on contraception access emerging. The study objectives were to analyze pandemic impacts on birth control (BC) use and access; and evaluate perceptions of pharmacist-prescribed BC. A 50-item survey was distributed by 31 Michigan community pharmacies to women aged 18-45 over a three-month period. The survey link was also posted on two websites. 147 surveys were analyzed. Respondents were 29 ± 7.9 years old, primarily white (77%) and straight (81%). Fifty-eight percent of respondents used prescription BC, mostly to prevent pregnancy (84%) with oral pills (76%) being the most common formulation. Some BC users (25%) were worried about BC access and 27% had difficulty taking BC regularly. Half of the respondents (50%) would likely use pharmacist-prescribed BC if available, with advantages being more convenient than visiting a doctor's office (71%) and easier access (69%). The major concern about pharmacist-prescribed BC was women not receiving PAP smears and screenings (61%). Respondents reported high confidence (72%) in pharmacist-prescribed BC and believe it would help prevent unintended pregnancies (69%). Some respondents experienced altered BC use and access. Half of the respondents supported pharmacist-prescribed BC. Pharmacist-prescribed BC could help solve pandemic-related access problems.

An Empirical Comparison of the Profiles of Security Threat Group Offenders with General Offenders

Datasets of offender attributes, both pre-custody and in-custody, were provided by the Correctional Service of Canada with the goal of exploring whether Security Threat Group (STG) offenders (informally, gang members of various kinds) differ in any systematic way from other offenders. For pre-custody attributes, we show that the entire offender population varies along two almost independent axes, one associated with affinity for violence, and the other with affinity for substance abuse. Within this structure, STG offenders are characteristically less extreme, in either direction, than the general offender population. For approximately two dozen attributes, STG offenders, as a group, tend to have higher values; for a few, they tend to have lower values. For in-custody attributes, the entire offender population forms a triangular structure whose vertices represent: passivity; violence and troublemaking; and involvement in programs leading to partial release. The differences between the STG offender population and the general offender population are small. An offender who is placed at the high end of the propensity for violence axis and/or the high end of the substance abuse axis based on pre-custody attributes is much more likely to be involved in incidents, grievances, and violence while in custody. This may have implications for risk stratification of incoming offenders.

Pharmacy technician-administered immunizations: A five-year review

In October 2020, the U.S. Department of Health and Human Services (HHS) issued guidance authorizing trained pharmacy technicians in all states to administer immunizations. Given that this action is temporary, it will be necessary for states to adopt their own legislation or regulations to sustain these efforts beyond the coronavirus pandemic. At least 11 different immunization administration training programs have emerged for pharmacy technicians. An increasing number of publications have emerged on pharmacy technician immunization administration, demonstrating the ability to train technicians and have them safely administer immunizations in practice. Supervising pharmacists reported initial hesitancy but strong acceptance of delegating this task after experience in practice. States should look to expand and make permanent the authority of pharmacy technicians to ensure these benefits can continue to be realized after the HHS guidance expires.

Opioid use disorder: Calling pharmacists to action for better preconception and pregnancy care

Opioid use disorder (OUD) in women of child-bearing potential is problematic in the United States. This has resulted in increasing risk for adverse maternal outcomes, neonatal abstinence syndrome, fetal and neonatal harm, prolonged hospitalizations, and increased health care costs. Pharmacists in all practice settings have opportunities to provide preconception and pregnancy care to prevent and manage OUD. Given pharmacists' scope of practice and expertise, key roles include assessing patients for OUD; mitigating exposure; educating patients regarding potential infant effects; recommending contraceptive methods and counseling on proper use; ensuring safe breastfeeding with concurrent medications; and linking patients to needed services. Through patient counseling, medication management, and harm reduction interventions, pharmacists can work to combat this public health crisis. To encourage increased uptake of pharmacists into these roles, more needs to be done to reimburse pharmacists for these important services and quantify their impact on patient and population health outcomes.

Evaluation of an American Sign Language co-curricular training for pharmacy students

BACKGROUND AND PURPOSE

With a prevalence of about one million d/Deaf and Hard of Hearing (HOH) patients that utilize American Sign Language (ASL) and the strong potential for communication barriers to adversely influence patient care outcomes, strategies must be developed to support health care professionals and students in learning to better care for d/Deaf and HOH patients. The primary objective of this project was to implement and assess a co-curricular course focused on helping student pharmacists become more confident and comfortable in communicating with d/Deaf and HOH patients.

EDUCATIONAL ACTIVITY AND SETTING

The co-curricular course (ASL for the Pharmacy Professional) consisted of four 90-min classes, each covering different words/phrases and Deaf cultural competence. Students were taught basic ASL including the alphabet, numbers, vocabulary, and sentence structure. Deaf culture and d/Deaf patient interaction was also covered. Students interacted with a Deaf physician over Skype and with d/Deaf and HOH individuals from the local community.

FINDINGS

Pre- and post-surveys that contained an identical set of questions were administered before and after course completion. Surveys assessed confidence and level of comfort of first- and second-professional year student pharmacists surrounding Deaf culture and interacting with d/Deaf and HOH patients. Following the course, students reported significantly improved confidence in communicating with d/Deaf patients directly and with a translator.

SUMMARY

Following completion of a co-curricular ASL course, doctor of pharmacy students perceived an increase in confidence in working with d/Deaf and HOH patients. Program logistics were simplified through collaboration with an outside entity.

Pharmacist Consult Reports to Support Pharmacogenomics Report Interpretation

Background

The clinical implementation of pharmacogenomics (PGx) has often involved teams that include pharmacists. PGx laboratories often provide baseline information within the laboratory report that is based on Food and Drug Administration and Clinical Pharmacogenomics Implementation Consortium guidance, but information is often provided independent of concurrent disease states or medication use, among other clinical factors. Major challenges to widescale implementation of PGx include lack of physician experience or confidence in interpreting the data. The purpose of this paper is to describe how pharmacists can help further personalize PGx information and identify clinical recommendations for a given patient.

Methods

This work was performed as a secondary objective of a study evaluating genetic biomarkers of opioid addiction risk. This portion of the study utilized a descriptive analysis of pharmacist consult reports that consist of individualized, patient-level clinical recommendations that take into account current medications, current health conditions, and PGx data. A panel of 60 common PGx targets were tested among patients being treated for chronic pain or opioid use disorder (OUD). A pharmacist consult report was generated and compared with standard laboratory reporting of general PGx information.

Results

Of the 252 patients, PGx reports for 198 (78.6%) contained red and/or yellow clinical decision support flags for medications with actionable or informative PGx guidance for currently prescribed medications. Pharmacists recommended modifications to current prescriptions for 31 (53%) of the patients with actionable flags and 17 (12%) of the patients with informative flags. Drug classes most commonly included medications for cardiology, depression and anxiety, pain (opioids) and gastrointestinal management. Taken together, 24.2% of the actionable and informative flags had immediate clinical value based on the pharmacist’s review. An additional 217 (86%) received one or more clinical recommendations not related to PGx.

Conclusion

While PGx provides another opportunity for pharmacotherapy personalization, PGx data must be considered within the context of other patient-specific factors. Pharmacists were able to streamline the PGx report flags and identify other pharmacotherapy interventions following application of patient-specific data, thereby developing a brief report of recommendations for the patient’s prescriber(s). Engaging clinical pharmacists in the PGx clinical decision process may help to facilitate more widespread PGx implementation.

Barriers, solutions, and effect of using pharmacogenomics data to support opioid prescribing

Opioid use and misuse are continued issues facing clinicians across all aspects of health care. As clinicians struggle to effectively manage opioid prescribing, pharmacogenomics (PGx) further offers the prescriber an improved ability to understand the potential for an individual patient's genetics to influence opioid efficacy and safety. When PGx data are available at the point of initial prescribing, clinicians can apply that data to drug therapy selection. However, barriers continue to exist relative to PGx data sharing and interpretation, which have created difficulties for widespread PGx implementation. This article briefly describes potential barriers to PGx data integration, strategies to overcome those barriers, and the potential positive effect of successful data sharing on opioid prescribing. Prescription drug monitoring programs (PDMPs) have been successfully operationalized to share controlled substance prescribing data across health care settings. Such data sharing enables clinicians to, among other things, better understand risks associated with misuse. Because a relatively limited volume of PGx data is currently pertinent to opioid prescribing, such PGx data could be added to PDMPs as a way to communicate genetic information within current technology platforms. Not only would this integrate into existing clinical workflow models where PDMP data are accessed at this point of prescribing and/or dispensing, but associated clinical guidance for PGx data interpretation in the context of opioids could be integrated into the workflow process. Such clinical decision support could be provided directly through the PDMP interface for uniformity or could be provided via systems that access PDMP data. Clinical, economic, and policy implications of the inclusion of PGx data within PDMPs are also discussed. Through harnessing PDMP for data sharing, multiple barriers to PGx implementation could be mitigated, and clinicians may have better access to PGx data to optimize opioid prescribing. DISCLOSURES: No outside funding supported this study. Bright has a patent pending related to opioid use disorder risk assessment that includes genetic information and was a collaborator on funded research projects with pharmacogenomics-related companies. Petry has been a consultant to the North Dakota Department of Health and has received grants from IGNITE I and IGNITE II (NIH), unrelated to this work. The other authors are aware of no financial conflicts of interest.

Patient perceptions of pharmacogenomic testing in the community pharmacy setting

BACKGROUND

In order to optimize community pharmacist roles and patient outcomes, a better understanding of patient perceptions of pharmacogenomic (PGx) testing may be helpful for successful integration into community pharmacy practice.

OBJECTIVE

The objective of this study was to identify patient perceptions related to PGx testing in the community pharmacy setting.

METHODS

Semi-structured, face-to-face interviews were conducted with adults ≥18 years of age to gather their perceptions of PGx testing. Interview participants were taking either an antiplatelet agent or a selective serotonin reuptake inhibitor listed in Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines and were patients at one of two community pharmacies in West Michigan. Interview questions were designed to follow the Theory of Planned Behavior and to take into account existing literature on patient perceptions of PGx. Interviews were recorded, transcribed by a third party transcription service, coded by a team of three researchers to identify themes, and analyzed using nVivo qualitative analysis software.

RESULTS

A total of 19 interviews were conducted over a period of 16 days in June 2016. Upon preliminary evaluation, four themes related to patient perceptions of PGx testing were consistently observed across multiple interviews: 1) trust, 2) experience, 3) risk/benefit, and 4) clarity.

CONCLUSIONS

Semi-structured patient interviews revealed four themes related to PGx testing in the community pharmacy setting. These themes may influence the desire to pursue PGx testing. Future research may seek to identify how community pharmacists can communicate with patients about PGx in the context of these themes to empower patients to make positive health care decisions.

Faculty Perceptions of Entrustable Professional Activities to Determine Pharmacy Student Readiness for Advanced Practice Experiences

Objective. To quantify pharmacy faculty members' perceptions of the importance of entrustable professional activities (EPAs) and the expected level of entrustment that should be achieved to determine APPE readiness. Methods. Entrustable professional activities define the core skills and tasks expected of new pharmacy graduates and may serve as a logical framework for determining pharmacy student readiness to begin advanced pharmacy practice experiences (APPEs). A five-question survey was distributed to all faculty members, staff members, and administrators at Ferris State University College of Pharmacy. Respondents were asked to rate 18 statements mapped to 12 EPAs on the perceived importance of each statement and the expected level of entrustment students should achieve to determine readiness for APPEs. Thresholds were used to determine consensus for importance and level of entrustment for each statement. Results. Of the 44 faculty members surveyed, 28 (63.6%) responded. A strong consensus was reached on the level of importance for 16 of 18 statements (89%), while two statements demonstrated moderate consensus (11%). No strong consensus was identified on levels of entrustment. Seven (39%) of 18 statements demonstrated moderate entrustment consensus and 11 (61%) statements demonstrated little consensus. Conclusion. Strong consensus was identified regarding which EPAs are important to determine students' APPE readiness; however, no strong consensus was found when evaluating levels of entrustment. Lack of consensus regarding entrustment raises several questions that require further study and clarification as the implementation of EPAs continues throughout the Academy.

Performance evaluation of a self-administered home oral glucose tolerance test kit in a controlled clinical research setting

AIM

To evaluate the performance of the current, pre-production version of a novel home oral glucose tolerance test (Home OGTT) device when administered by trained research nurses, compared with a reference laboratory glucose analyser and a second laboratory analyser, incorporating a sample processing delay to simulate normal practice.

METHODS

One hundred women (aged 19-48 years), with and without known glucose intolerance were recruited. Following an overnight fast, participants attended for a 75-g OGTT. A fasting capillary sample was applied to the Home OGTT device with a corresponding venous sample collected and measured immediately on the reference YSI 2300 stat plus analyser, and following a 1-h delay on the Randox Daytona Plus analyser. The sampling process was repeated 2 h after the oral glucose load.

RESULTS

Some 97% of tested devices gave complete data for analysis. Good agreement was observed between the reference glucose analyser and the Home OGTT device, with the Home OGTT device displaying a small negative bias (-0.18 mmol/l, -1.75 to 1.39 mmol/mol; -1.0%, -26.4% to 24.5%; absolute and relative mean, 95% limits of agreement). When classified as normal glucose tolerant or glucose intolerant, the Home OGTT device showed 100% and 90% sensitivity, and 99% and 99% specificity using fasting plasma glucose and 2-h glucose respectively. Similar sensitivity (100% and 100%) and specificity (96% and 99%) for fasting plasma glucose and 2-h glucose were observed using the secondary analyser.

CONCLUSIONS

The novel Home OGTT device was reliable and easy to use and showed excellent agreement with two separate laboratory analysers. The Home OGTT offers potential as an effective alternative for clinic-based OGTT testing.

Precision Medicine in Oncology Pharmacy Practice

<p>The objective of this review is to provide an overview of the components, process and resources available to apply precision medicine strategies to drug therapy in cancer medicine, with an emphasis on oncology pharmacy practice. Precision medicine initiatives in oncology take into account individual variability in genes, environment and lifestyle factors. Genomic assays of patient tumors is now the standard of care in oncology and recommendations for targeted drug therapies are often formulated by interprofessional teams. Pharmacogenomics (PGx) is a component of precision medicine based on polymorphisms that impact medication selection and/or dosing. Several oncolytic agents used in the treatment of cancer and supportive care have pharmacogenomic-based dosing recommendations to minimize potential toxicities. Several resources are reviewed here to guide treatment options in oncology as they relate to somatic mutations and PGx. Examples include: OncoKB is a precision oncology knowledge base that offers evidence-based information for somatic mutations. The Clinical Pharmacogenetics Implementation Consortium provides PGx-based guidelines for several oncolytic therapies used to treat cancer and for supportive care. Pharmacists can be integral members of the interprofessional team in many practicesettings in precision medicine. Involvement can include membership in molecular tumor boards, PGx dosing services and provide patient education.</p><p><strong>Conclusion. </strong>Precision medicine is a rapidly evolving field in oncology that requires an interprofessional approach of drug therapy experts.</p>

Preconception care needs among female patients of childbearing age in an urban community pharmacy setting

OBJECTIVES

To perform a needs assessment with the use of evidence-based core indicators developed by the Preconception Health and Heath Care (PCHHC) Initiative Clinical Workgroup and Centers for Disease Control and Prevention (CDC) to describe the preconception care needs among female patients of a community pharmacy.

METHODS

Women of childbearing age received a paper survey in either English or Spanish containing questions about patient demographics, health status, and pregnancy considerations. On completion of the survey, patient medication history data were retrospectively gathered from the medication profile and vaccination status on select vaccines was determined using the Michigan vaccination reporting system.

RESULTS

Ninety-nine surveys were completed. The median age was 30 years (range 18-44). Of survey participants, 77.8% indicated that they were sexually active, 70.7% had an abnormal body mass index, 78.8% were missing documentation of one or more recommended vaccinations, 66.7% were not taking any form of daily folic acid supplementation, and 49.5% were using at least 1 medication with potential teratogenic effects.

CONCLUSION

A preconception health needs assessment conducted in a community pharmacy with female patients of childbearing age found multiple opportunities for intervention such as improving daily folic acid supplementation and ensuring appropriate management of medications with potential teratogenic effects. Each of the preconception care needs assessed can be addressed through services provided by community pharmacists.

The source and diversion of pharmaceutical drugs for non-medical use: A systematic review and meta-analysis

BACKGROUND

The non-medical use (NMU) of pharmaceutical drugs is an increasing public health concern. This systematic review consolidates current knowledge about how pharmaceutical drugs are obtained for NMU and the processes and people involved in diversion.

METHODS

Peer-reviewed and grey literature databases were searched for empirical studies published between 1996 and 2017 that examined the source or diversion of pharmaceutical opioids, sedatives or stimulants for NMU in countries with reported misuse problems. Pooled prevalence meta-analyses using random effects models were used to estimate the prevalence of medical and non-medical sourcing reported by end-users, and gifting, selling and trading by various populations.

RESULTS

This review synthesizes the findings of 54 cross-sectional studies via meta-analyses, with a remaining 95 studies examined through narrative review. Pharmaceutical drugs are primarily sourced for NMU from friends and family (57%, 95% CI 53%-62%, I² = 98.5, n = 30) and despite perceptions of healthcare professionals to the contrary, illegitimate practices such as doctor shopping are uncommon (7%, 95% CI 6%-10%, I² = 97.4, n = 29). Those at risk of diversion include patients displaying aberrant medication behaviors, people with substance use issues and students in fraternity/sorority environments. Sourcing via dealers is also common (32%, 95% CI 23%-41%, I² = 99.8, n = 25) and particularly so among people who use illicit drugs (47%, 95% CI 35%-60%, I² = 99.1, n = 15). There is little to no organized criminal involvement in the pharmaceutical black market.

CONCLUSION

Pharmaceutical drugs for NMU are primarily sourced by end-users through social networks. Future research should examine how dealers source pharmaceutical drugs.

Measuring Offenders' Belief in the Possibility of Desistance

This article describes the use of a questionnaire to measure offenders' belief in the likelihood of their making a successful re-entry into society after having committed crime, a "belief in redeemability" (BIR) as described by Maruna and King. The 37 items for the scale were taken from statements by offenders about their prospects of making good. This set of items was tested with a pilot group of offenders recruited from clients on parole or on supervised bonds at community corrections offices in metropolitan Sydney, Australia, and their responses were coded to yield a score we called the "BIR" score. We found that scores displayed variance skewed toward an optimistic view, and we then used the items in a card sort task with a panel of graduate psychologists to explore whether the panel could identify underlying components of the broader BIR. There was a measure of agreement on three underlying components and these were further tested using five raters. We called the components that emerged the following: Belonging, Agency, and Optimism; Cronbach's alphas for these indicated acceptable internal consistency. The results are discussed in terms of their congruence with findings in the literature and their use in correctional practice.

An Approach for the Development and Implementation of an Assessment Tool for Interprofessional Education Learning Activities

The Accreditation Council for Pharmacy Education Standards 2016 state that colleges of pharmacy must assess student achievement and readiness to contribute as a member of an interprofessional collaborative patient care team. There are a limited number of assessment tools available to achieve this part of the Standards. The purpose of this Case Study Report is to describe the process that one college of pharmacy took to develop an interprofessional education (IPE) assessment tool to be used for their longitudinal assessment approach for IPE in the didactic portion of the curriculum. Strategies for the development of an assessment tool are provided through three themes: continuous refinement, collaboration and streamlining. Next steps for the implementation of the assessment tool, as well as evaluating its validity and reliability, are discussed.   Type: Case Study

Should Pharmacy Technicians Administer Immunizations?

Purpose. To describe the potential role for pharmacy technicians in administering immunizations – limited for this discussion to specifically inserting the needle into the patient’s arm and pressing down on the plunger – at the discretion of a supervising pharmacist as a way to enhance patient care and workflow efficiency. Summary. Pharmacy technicians currently play an important role in facilitating pharmacy-based immunization programs. Technicians routinely perform non-clinical tasks related to pharmacy-based immunizations, though nearly all states prohibit technicians from administering vaccines. Several studies demonstrate that untrained laypersons can safely administer intranasal or intradermal vaccines, and laypersons routinely administer medications through intramuscular or subcutaneous routes (e.g., patients with diabetes or rheumatic conditions). It stands to reason that a trained pharmacy technician could perform comparably on these techniques that laypersons have mastered. One state has adopted rules to allow pharmacy technicians to administer immunizations if the technician has completed specific training on administration techniques and on basic life support. This task is performed at the discretion of the supervising pharmacist, and the pharmacist would still be responsible for clinical aspects of immunizing such as prescribing the right vaccine to the right patient. Additional considerations factoring into the decision as to whether or not to involve pharmacy technicians in immunization administration are also summarized. Conclusion. If safety can be reasonably assured through training and supervision, it may be appropriate to delegate vaccine administration to appropriately trained pharmacy technicians. Such delegation may enhance workflow efficiency, which may confer added value for patient care and potentially improve access to community pharmacy-based immunizations.   Type: Commentary

Certification of New Standard Reference Material 2806b Medium Test Dust in Hydraulic Fluid

A new material has been certified to become Standard Reference Material (SRM) 2806b - Medium Test Dust in Hydraulic Fluid. SRM 2806b consists of trace polydisperse, irregularly shaped mineral dust particles suspended in hydraulic fluid. The certified values of SRM 2806b are the projected area circular-equivalent diameters of the collected dust particles from the hydraulic fluid. The dimensional measurements were determined from the area of the collected dust particles using images obtained from automated scanning electron microscopy (SEM) followed by image analysis. An automated SEM and an automated image analysis software allowed the processing of over 29 million particles. The dimensional calibration of the SEM images (actual length per pixel and thus the actual projected diameters) are traceable to the NIST Line Scale Interferometer (LSI) through a NIST calibrated Geller MRS-4XY pitch standard. The certified diameters are correlated with the numeric concentration of particles greater than each diameter, referred to as the cumulative number size distribution. SRM 2806b is intended to be used to calibrate liquid-borne optical particle counters in conjunction with the reference method ISO 11171:2010.

Four Themes to Enhanced Interprofessional Education Integration: Lessons Learned from Early Implementation and Curricular Redesign

With the release of the Accreditation Council for Pharmacy Education (ACPE) Standards 2016, interprofessional education (IPE) has become more formalized and needs to be embedded into the curricula of colleges and schools of pharmacy. While IPE is not new to the practice and training of pharmacists, the call for IPE has become more robust over the last several years creating challenges to widespread implementation. The purpose of this Case Study Report is to describe a twelve-year progression of IPE implementation at a college of pharmacy without an academic medical center. Focused strategies for the development, integration, and expansion of IPE are provided through the context of four themes: working through program differences; collaborators and effective collaboration; attention to implementation planning; and prebriefing and debriefing. Each theme is defined and reviewed using specific examples and lessons learned. Finally, in consideration of the ACPE Standards 2016, potential next steps are discussed.   Type: Case Study

Long-term effects of stock transfers: synergistic introgression of allochthonous genomes in salmonids

The genus Salmo was employed as a model to study introgression of genes between species due to secondary contacts. Seven microsatellite loci, the LDH-C1* locus and the 5S ribosomal DNA were studied. Results showed the mutually enhanced introgression of allochthonous genomes into southern European salmonids. This phenomenon appears to go beyond a simple consequence of the altered behaviour of domestic individuals. Invasions of autochthonous genomes by allochthonous genes would be enhanced by human activities such as stock transfers, which would simultaneously promote allochthonous and allospecific (from other species) introgressions in a synergistic process in Atlantic salmon Salmo salar and brown trout Salmo trutta. As a minor result, the data do not support the value of the microsatellite locus SsaD486 as a species-specific marker.

How profitable is methamphetamine dealing in Australia?

INTRODUCTION

The illicit drug trade is the largest in value among global illicit commodities, at some $320 billion US dollars, according to the UN World Drug Report. Endeavours to control such a large illicit market would be enhanced by improved understanding of the economics of the trade. However, due to its illicit nature many aspects of the illicit drug market are largely unknown. This study explored one economic aspect of illicit drug dealing, profitability, with the aim of developing a better picture of the financial gains from illicit drug dealing.

METHODS

Data were obtained from judges sentencing remarks, key informants from law enforcement, and other published reports which detail the prices paid for methamphetamine in Australia. The financial margins attained from non-crystal methamphetamine dealing in Australia were calculated by examining the best fit for the relationship between prices and quantities: in this case a power law.

RESULTS

If it is assumed that a single deal is divided ("cut") between 4 times and 20 times before selling to the next customer, the mark-ups can range from 24% to 59%. The mark-ups appear low compared with those found in US research, but similar to those found in UK research.

CONCLUSIONS

To our knowledge, this is the first attempt to analyse profitability of methamphetamine dealing in Australia. The findings of this study will help in understanding the motivations and decisions of drug dealers, and potentially assist drug law enforcement agencies to design better strategies to dismantle supply chain linkages which generate excessive profits.

Complete mitochondrial control region sequences indicate a distinct variety of brown trout Salmo trutta in the Aral Sea

Complete sequencing of the mtDNA control region (CR) from five specimens of brown trout Salmo trutta from the Amu Darya River identified two novel haplotypes belonging to the Danubian lineage. This finding supports the long-standing hypothesis that brown trout in the Aral Sea represent a distinct genetic stock and also illustrates the benefits that complete sequencing of the CR can provide for elucidating phylogeographic relationships.

Surgical intervention of complex endo-perio lesions

Complex endo-perio lesions are infrequent, but pose treatment dilemmas. The lesions are complex with bone loss involving adjacent teeth that are not part of the initial endodontic lesion. The aggressive bone loss is not clearly understood and apparently has some differences from the usual apical periodontitis.

Food web responses to augmenting the entomopathogenic nematodes in bare and animal manure-mulched soil

Factorial treatments of entomopathogenic nematodes (EPN) and composted, manure mulches were evaluated for two years in a central Florida citrus orchard to study the post-application biology of EPN used to manage the root weevil, Diaprepes abbreviatus. Mulch treatments were applied once each year to study the effects of altering the community of EPN competitors (free-living bactivorous nematodes) and antagonists (nematophagous fungi (NF), predaceous nematodes and some microarthro-pods). EPN were augmented once with Steinernema riobrave in 2004 and twice in 2005. Adding EPN to soil affected the prevalence of organisms at several trophic levels, but the effects were often ephemeral and sometimes inconsistent. EPN augmentation always increased the mortality of sentinel weevil larvae, the prevalence of free-living nematodes in sentinel cadavers and the prevalence of trapping NF. Subsequent to the insecticidal effects of EPN augmentation in 2004, but not 2005, EPN became temporarily less prevalent, and fewer sentinel weevil larvae died in EPN-augmented compared to non-augmented plots. Manure mulch had variable effects on endoparasitic NF, but consistently decreased the prevalence of trapping NF and increased the prevalence of EPN and the sentinel mortality. Both temporal and spatial abundance of NF were inversely related to the prevalence of Steinernema diaprepesi, whereas Heterorhabditis zealandica prevalence was positively correlated with NF over time. The number of weevil larvae killed by EPN was likely greatest in 2005, due in part to non-target effects of augmentation on the endemic EPN community in 2004 that occurred during a period of peak weevil recruitment into the soil.

Tools and procedures for quantitative microbeam isotope ratio imaging by secondary ion mass spectrometry

In this work we demonstrate the use of secondary ion mass spectrometry (SIMS) combined with the Lispix image processing program (Bright 1995) to generate quantitative isotope ratio images from a test sample of a calcium-aluminum rich inclusion from the Allende meteorite that is known to contain discrete mineral grains with perturbed Mg isotopic ratios. Using 19.5 keV impact O- primary ion bombardment and detection of positive secondary ions, microbeam imaging SIMS has allowed us to identify, from the isotope ratio images, enrichments in the 26Mg/24Mg isotope ratio of approximately 5-15% in selected mineral grains. Using custom image processing software, each isotopic ratio image is corrected on an individual pixel basis for a number of factors including detector dead-time, mass bias effects, and isobaric interferences. We have developed procedures for correlating the isotopic images with polarized optical microscopy so that targeted mineral grains could be identified for further SIMS analysis. Finally, additional image processing tools have been developed to allow for pixel-by-pixel evaluation of the influence of detector dead-time and count rate errors on the isotopic ratio images and for correlation of the isotopic images with elemental distribution maps.

Caffeine consumption and weekly sleep patterns in US seventh-, eighth-, and ninth-graders

OBJECTIVE

To survey caffeine use by seventh-, eighth-, and ninth-graders and relate its use to age, sex, sleep characteristics, and day of week

METHODS

Students kept a daily, 2-week diary of their sleep times and use of caffeine containing drinks and foods. Data were analyzed by fitted multiple regression models

RESULTS

A total of 191 students participated. Caffeine intake ranged between 0 and 800 mg/d. Mean use over 2 weeks ranged up to 379.4 mg/d and averaged 62.7 mg/d (corrected for underrepresentation in our sample of boys, who consumed more caffeine). Higher caffeine intake in general was associated with shorter nocturnal sleep duration, increased wake time after sleep onset, and increased daytime sleep. SLEEP PATTERNS: Mean bedtime was 10:57 PM, and mean wake time was at 7:14 AM. Older children delayed bedtime longer on weekends, and younger ones had longer nightly sleep durations. Sleep duration lengthened on weekends, reflecting the combined effects of the circadian timing system and a mechanism that regulates the duration of sleep. Caffeine (soda) consumption also increased on weekends, for reasons that may be primarily social

CONCLUSIONS

Regardless of whether caffeine use disturbed sleep or was consumed to counteract the daytime effect of interrupted sleep, caffeinated beverages had detectable pharmacologic effects. Limitation of the availability of caffeine to teenagers should therefore be considered.

A comparison of HIV/AIDS knowledge among high school freshmen and senior students

Statistical data show that heterosexual transmission of AIDS among teenagers is a significant problem. The purpose of this study was to assess and compare the level of knowledge concerning HIV/AIDS among high school freshmen- and senior-level students and to determine the association between certain demographic variables and the students' knowledge level. A convenience sample of 169 freshmen and 274 senior high school students were surveyed at a local area high school (N = 443). A 49-item knowledge questionnaire, used by the high school district HIV/Abstinence program, and a demographic questionnaire developed by the investigators were used to collect the data. The findings revealed that both the freshmen and senior students had several misconceptions about HIV/AIDS, including the modes of transmission, the sure way of preventing the sexual transmission, donating blood, and the usual causes of death for people with AIDS. A comparison of the mean knowledge scores among freshmen and senior students indicated there was no significant difference among the two groups. The mean knowledge score of the seniors was significantly affected by whether they had received HIV/AIDS education. However, this was not the case for the freshmen. African American students, especially the female students, had significantly lower knowledge scores than other ethnic groups.

Spatial and temporal trends and effects of contaminants in the Canadian Arctic marine ecosystem: a review

Recent studies have added substantially to our knowledge of spatial and temporal trends of persistent organic pollutants and heavy metals in the Canadian Arctic marine ecosystem. This paper reviews the current state of knowledge of contaminants in marine biota in the Canadian Arctic and where possible, discusses biological effects. The geographic coverage of information on contaminants such as persistent organochlorines (OCs) (PCBs, DDT- and chlordane-related compounds, hexachlorocyclohexanes, toxaphene) and heavy metals (mercury, selenium, cadmium, lead) in tissues of marine mammal and sea birds is relatively complete. All major beluga, ringed seal and polar bear stocks along with several major sea bird colonies have been sampled and analysed for OC and heavy metal contaminants. Studies on contaminants in walrus are limited to Foxe Basin and northern Québec stocks, while migratory harp seals have only been studied recently at one location. Contaminant measurements in bearded seal, harbour seal, bowhead whale and killer whale tissues from the Canadian Arctic are very limited or non-existent. Many of the temporal trend data for contaminants in Canadian Arctic biota are confounded by changes in analytical methodology, as well as by variability due to age/size, or to dietary and population shifts. Despite this, studies of OCs in ringed seal blubber at Holman Island and in sea birds at Prince Leopold Island in Lancaster Sound show declining concentrations of PCBs and DDT-related compounds from the 1970s to 1980s then a levelling off during the 1980s and early 1990s. For other OCs, such as chlordane, HCH and toxaphene, limited data for the 1980s to early 1990s suggests few significant declines in concentrations in marine mammals or sea birds. Temporal trend studies of heavy metals in ringed seals and beluga found higher mean concentrations of mercury in more recent (1993/1994) samples than in earlier collections (1981-1984 in eastern Arctic, 1972-1973 in western Arctic) for both species. Rates of accumulation of mercury are also higher in present day animals than 10-20 years ago. Cadmium concentrations in the same animals (eastern Arctic only) showed no change over a 10-year period. No temporal trend data are available for metals in sea birds or polar bears. There have been major advances in knowledge of specific biomarkers in Canadian Arctic biota over the past few years. The species with the most significant risk of exposure to PCBs and OC pesticides may be the polar bear which, based on comparison with EROD activity in other marine mammals (beluga, ringed seal), appears to have elevated CYP1A-mediated activity. The MFO enzyme data for polar bear, beluga and seals suggest that even the relatively low levels of contaminants present in Arctic animals may not be without biological effects, especially during years of poor feeding.

Is small bowel bacterial overgrowth of pathogenic significance in persistent diarrhea?

Bacterial overgrowth in the upper small intestine is postulated to cause persistent diarrhea. We compared the fecal and upper intestinal flora in 82 patients with persistent diarrhea aged < or = 36 months and weight-for-length < or = 90% of National Center for Health Statistics standards (NCHS) and 39 non-diarrheal children with age < or = 36 months, nutritionally matched with the patients and residing in the same environment. In the age groups < or = 12 months and > 12 months the duodenal fluid bacterial counts > or = 10(5)/ml were found with similar frequency in patients and controls for aerobic (p = 0.33; p = 0.1) and anaerobic (p = 1.0; p = 1.0) bacteria. However, the duodenal isolation rates of any aerobic bacteria (p < 0.05) without regard to counts and Enterobacteriaceae (p = 0.06) were higher in patients than in controls. Colonization with Enterobacteriaceae was directly correlated with increased stool weight over a 7-day observation period (p < 0.05; p < 0.01). One or more pathogens were isolated in the feces of 58% of the patients and 43.8% of the controls. Enteroadherent E. coli of the localized [EAEC-L] (p < 0.01) and aggregative [EAggEC] (p = 0.22) phenotypes were isolated more commonly from the feces of patients. The duodenal fluid detection rates for Klebsiella were significantly greater (p < 0.01) in patients, while Giardia lamblia was detected more commonly in the duodenal fluid of controls (p < 0.01). The presence of specific pathogens in the feces did not seem to be related to the extent of small bowel colonization.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of Ca(2+)-related events in glucose-stimulated desensitization of insulin secretion

The spontaneous decline of insulin secretion (third phase) that occurs under a variety of secretory conditions is well documented and suggests a general impairment or desensitization of the secretory process. We have examined several aspects of Ca2+ flux as well as regulators of Ca-linked second messenger events in freshly isolated rat islets chronically stimulated with glucose over 24 h, a period that encompasses initial (hour 1), peak (hour 3), and subsequent impaired or desensitized (hour 20-22) secretion. In islets incubated for these periods in HB104 medium with 22 mM glucose, 45Ca2+ uptake did not vary (12.6 +/- 1.6 vs. 10.2 +/- 1.7 vs. 13.2 +/- 3.4 pmol Ca2+/islet.10 min at 1, 3, and 22 h, respectively). Chronic incubation in 2 mM glucose reduced total Ca2+ uptake at each of the time periods, but, again, uptake did not change with desensitization (9.8 +/- 1.4 vs. 6.6 +/- 2.1 vs. 7.8 +/- 2.3 pmol Ca2+/islet.10 min). In 11 mM glucose, the Ca channel antagonist verapamil (1-10 microM) reduced insulin secretion by 55-80% in a dose-dependent manner over 1-3 h; islets continuously exposed to verapamil escaped inhibition by 20 h even at the highest concentration. However, in islets first exposed to 10 microM verapamil only during 20-22 h, hourly insulin secretion was suppressed 25%, 45%, and 33% at 20, 21, and 22 h, respectively, indicating that glucose-desensitized islets were still sensitive to further inhibition of Ca channels. Staurosporine (1 microM), an inhibitor of protein kinase-C activity, progressively inhibited glucose-stimulated insulin secretion from 48% at 1 h to more than 80% by 3 h; again, this inhibitory effect was lost by 20 h of chronic staurosporine. When staurosporine was first administered at 20 h, insulin secretion was modestly suppressed and returned to control values in the next hour. With continuous glucose, the islet response to positive stimulation of endogenous C-kinase activity by carbachol was maintained. The Ca/calmodulin inhibitor trifluoroperazine also inhibited insulin secretion by 75-80% during 1-3 h and continued to exert inhibitory effects through 23 h of continuous administration. We conclude that even though insulin secretion has desensitized to glucose, 1) Ca2+ entry is unchanged and is still regulated by glucose, 2) voltage-dependent Ca channels are still sensitive to blockade by acute verapamil, but can desensitize to chronic verapamil; 3) stimulus-enhanced C-kinase activity may be especially labile during glucose-induced desensitization, while 4) possible Ca/calmodulin potentiation of secretion persists through the three secretory phases.(ABSTRACT TRUNCATED AT 400 WORDS)