Pharmacists' perceptions of pharmacy technician occupational values.

Background: Pharmacy technician scope of practice has expanded in recent years to attempt to alleviate the responsibility burden placed on pharmacists in some states. However, little research has examined the ways in which pharmacists attempt to persuade technicians to take on additional roles. Management literature has identified the importance of understanding employee values in crafting persuasive role expansion messaging. Objectives: Identify the occupational values which pharmacists believe are the most important to pharmacy technicians when attempting to craft messages aimed at increasing technician involvement in advanced roles. Methods: Semi-structured interviews were conducted with pharmacists across multiple practice settings to identify how important they believe nine selected occupational values are to pharmacy technicians. Average scores for each of the nine values were calculated and examined to identify potential differences between the two overarching types of occupational values: intrinsic and extrinsic. Results: Pharmacists indicated that they believed that technicians are more extrinsically motivated than intrinsically motivated. Pharmacists believed that technicians had higher levels of extrinsic occupational values as opposed to intrinsic occupational values (3.920 vs. 3.113). The most important values to technicians as perceived by pharmacists were the income of the job and the hours of the jobs (average score of 4.85 and 4.75, respectively). The chance to be helpful to others and society was the only intrinsic value with an average score >3.5. Additionally, pharmacists indicated that technicians were not properly compensated for their work, which furthered illustrated the perceived importance of extrinsic motivators. Finally, when it came to crafting messaging around role expansion, pharmacists believed it was important to tailor their messaging to the technician they were speaking to. Conclusion: Pharmacists looking to craft role expansion messaging to their technicians are more likely to utilize extrinsic occupational values as motivators instead of using intrinsic values.

College student behaviors and preferences in community pharmacies.

Objective: The primary goal of conducting this research was to gain insight into what characteristics of a community pharmacy college students may find appealing and how community pharmacies can tailor their services toward college students. Participants: The survey was distributed to 3,000 college students at The University of Mississippi from various schools and majors across campus. A total of 188 students participated by completing questions from the survey. Methods: The research was performed by using a cross-sectional online survey, and basic descriptive statistics, including frequency counts were used to characterize the findings. Statistical analyses, including crosstabs and chi-square analyses, were used to determine if there were any significant (p < 0.05) associations between characteristics such as pharmacy preferences and other variables. Results: Results of this survey indicated that the majority of respondents have used a community pharmacy in the past six months, and a small number of participants are interested in using a pharmacy for more than the sole reason of filling a prescription. Results also showed that insurance and convenience were the two most influential factors in choosing a community pharmacy. Conclusion: The findings presented in this study show a number of opportunities for community pharmacies to improve the health of college students and their communities.

Pharmacy Technician Efficacies and Workforce Planning: A Consensus Building Study on Expanded Pharmacy Technician Roles.

The expansion of pharmacy technician scope of practice in recent years, though remaining somewhat contentious, has afforded multiple opportunities for pharmacy technicians to provide additional assistance within the pharmacy. However, much of the research examining this growth has focused on specific tasks, which were determined by either the researchers themselves or the respective state boards of pharmacy. This study aimed to gain a better understanding of what expanded tasks pharmacists believe technicians should have an increased role in performing. A consensus-building research methodology was used to survey practicing pharmacists to determine which tasks those pharmacists believed technicians should take an increased role in performing. This study used modified Delphi techniques to build consensus among panels of both hospital and community pharmacists regarding 20 setting-specific technician tasks. Results of our study indicated that both hospital and community pharmacists believed technicians should have an increased involvement in performing tasks which are more related to the operations of the pharmacy rather than tasks which are more clinical in nature. This finding illustrates a belief among a segment of pharmacists that expanded roles for technicians should do more to alleviate the managerial and operational burden placed on pharmacists, potentially allowing pharmacists to take on increased clinical roles.

The Impact of Leadership Program Formatting on Perceived Development Within Pharmacy Cohorts.

Objective. To assess the impact of variable leadership development program formats on perceived participant growth.Methods. In 2020, the Phi Lambda Sigma national office began offering national Leader Academies to members, while University of South Florida Health Taneja College of Pharmacy simultaneously offered a Leader Academy program to its Phi Lambda Sigma students. Both programs used virtual leadership development tools from GiANT Worldwide, but differed in meeting frequency, content focus, and participant diversity. A 17-question pre- and postsurvey was developed from the Emotional Intelligence Leadership Inventory. Descriptive and inferential statistics were used to compare the cohorts.Results. Twenty-two respondents in the national cohort (66.7% response rate) and 15 in the single-institution cohort (100% response rate) were included. There was more diversity in age, ethnicity, and previous education in the national cohort. Significant improvements in perceived growth were noted in almost all areas. The only decrease noted was the national cohort response to "I strive to improve myself." The overall change in mean response values was generally higher for the single-institution cohort. Qualitative data supported these results and showed more notable references to emotional intelligence in the national cohorts (∼50%) as compared to the single-institution cohort (<25%).Conclusion. Study results suggest that participation in a longitudinal leadership development program, regardless of cohort format, leads to perceived participant improvement in three categories. However, perceived benefit within each of these categories may vary depending on the cohort. Future studies are needed to further evaluate specific leadership arenas and validate the leadership assessment tool.

Barriers and best practices related to documentation of electronic care plans: A survey of community-based pharmacies in 4 states.

BACKGROUND: The provision of enhanced services within community-based pharmacy is increasing. However, an opportunity remains to improve efficient documentation of services, and barriers to implementation exist. Electronic care (eCare) planning is the act of using health information technology to submit a pharmacist eCare plan for a patient encounter, similar to a Subjective, Objective, Assessment, Plan note. OBJECTIVE: The primary objective was to identify barriers and best practices related to documentation of eCare plans within community-based pharmacies participating in 4 Community Pharmacy Enhanced Services Networks (CPESN). METHODS: One of two 24-question electronic surveys was distributed to pharmacies in CPESN Florida, Georgia, Mississippi, and Ohio. Pharmacies submitting fewer than 10 eCare plans in the previous quarter received a survey to assess barriers to implementation; pharmacies submitting 10 or more eCare plans received a survey to assess best practices for implementation. Surveys remained open for 14 days, with a reminder sent on days 7 and 12. Data were analyzed using descriptive statistics. An independent-samples t test assessed for between-group differences in the overall knowledge. RESULTS: A total of 63 responses were received (Barriers = 19; Best Practices = 44). Best Practices pharmacies earned a higher overall knowledge score than Barriers pharmacies (9.26 vs. 7.26 out of 13 points, P = 0.001). Frequently reported barriers were staffing resources (n = 11, 57.9%), perceived time commitment (n = 8, 42.1%), and lack of payment (n = 8, 42.1%). Most Best Practices pharmacies agreed or strongly agreed that they involve pharmacists (n = 36, 81.8%) and student pharmacists (n = 33, 75.5%) in eCare planning processes. Common foci of eCare plans by Best Practice pharmacies were medication synchronization (n = 35, 79.5%), drug therapy problems (n = 29, 65.9%), adherence assessment (n = 28, 63.6%). CONCLUSIONS: A difference in knowledge and perceptions exists between pharmacies who regularly eCare plan and those who do not. Observed trends in knowledge, perceptions, barriers, and best practices should be used to create a training to increase eCare planning quality and consistency.

Making the Shift from Research to Commercial Orchards: A Case Study in Aphid-Peach Tree Interactions as Affected by Nitrogen and Water Supplies.

Peach orchards are intensively sprayed crops, and alternative methods must be found to replace pesticides. We intend here to evaluate if limiting water and nitrogen (N) supply could be effective in controlling aphid infestation in commercial orchards. N and water supply were therefore either unrestricted or restricted by 30% only for water, or for both water and N, in 2018 and 2019 on trees of two contrasting varieties. Natural infestations (green peach aphid, mealy plum aphid, leaf curl aphid) were monitored regularly at tree and shoot level. Infested and control shoots were compared for their development during the infestation period, their apex concentrations of total N, amino acids, non-structural carbohydrates, and polyphenols at infestation peak. At tree level, limiting both water and N supplies decreased the proportion of infested shoots by 30%, and the number of trees hosting the most harmful specie by 20 to 50%. Limiting only N supplies had almost no effect on infestation severity. At shoot level, the apex N concentration of infested shoots was stable (around 3.2% dry weight) and was found to be independent of treatment, variety, and year. The remaining biochemical variables were not affected by infestation status but by variety and year. Shoot development was only slightly affected by treatment. Aphids colonized the most vigorous shoots, being those with longer apical ramifications in 2018 and higher growth rates in 2019, in comparison with the controls. The differences were, respectively, 40 and 55%. It was concluded that a double restriction in water and N could limit, but not control, aphid infestations in commercial orchards.

Chemical and growth traits of the peach tree may induce higher infestation rates of the green peach aphid, Myzus persicae (Sulzer).

BACKGROUND: The green peach aphids, Myzus persicae, are a predominant pest in peach orchards as they can alter fruiting and shoot development for several years. This aphid developed resistance against pesticides. Among the alternative control strategies is the reduction of the trees' attractiveness to aphids. In order to identify the plant variables related to plant susceptibility, young peach trees were submitted to various supplies of water and nitrogen, and then artificially infested with aphids. Shoot development, plant water potential and aphid abundance were then monitored on a weekly basis. The apex concentrations in total N, amino acids, soluble sugars and polyphenols were determined at infestation start and infestation peak. RESULTS: Until infestation peak, the thermal time requests for aphid development were independent of infestation severity. The aphid populations then collapsed more rapidly on the low infested shoots than on the high infested ones. Aphid abundances appeared to be positively related to shoot development (leaf expansion and secondary ramification), to shoot growth (stem length and diameter) and to apex concentrations in amino acids and non-structural carbohydrates (NSC). Polyphenols had the opposite effect. CONCLUSION: Peach susceptibility to aphids depends on shoot development and apex composition, and could be lowered by decreasing the water and nitrogen inputs. © 2019 Society of Chemical Industry.

Measuring systematic changes in invasive cancer cell shape using Zernike moments.

We study the shape characteristics of osteosarcoma cancer cell lines on surfaces of differing hydrophobicity using Zernike moments to represent cell shape. We compare the shape characteristics of four invasive cell lines with a corresponding less-invasive parental line on three substrates. Cell shapes of each pair of cell lines are quite close and display overlapping characteristics. To quantitatively study shape changes in high-dimensional parameter space we project down to principal component space and define a vector that summarizes average shape differences. Using this vector we find that three of the four pairs of cell lines show similar changes in shape, while the fourth pair shows a very different pattern of changes. We find that shape differences are sufficient to enable a neural network to classify cells accurately as belonging to the highly invasive or the less invasive phenotype. The patterns of shape changes were also reproducible for repetitions of the experiment. We also find that shape changes on different substrates show similarities between the eight cells studied, but the differences were typically not enough to permit classification. Our paper strongly suggests that shape may provide a means to read out the phenotypic state of some cell types, and shape analysis can be usefully performed using a Zernike moment representation.

Metronomic cyclophosphamide activation of anti-tumor immunity: tumor model, mouse host, and drug schedule dependence of gene responses and their upstream regulators.

BACKGROUND: Cyclophosphamide (CPA) can activate immunogenic tumor cell death, which induces immune-based tumor ablation and long-term anti-tumor immunity in a syngeneic C57BL/6 (B6) mouse GL261 glioma model when CPA is given on a 6-day repeating metronomic schedule (CPA/6d). In contrast, we find that two other syngeneic B6 mouse tumors, LLC lung carcinoma and B16F10 melanoma, do not exhibit these drug-induced immune responses despite their intrinsic sensitivity to CPA cytotoxicity. METHODS: To elucidate underlying mechanisms, we investigated gene expression and molecular pathway changes associated with the disparate immune responsiveness of these tumors to CPA/6d treatment. RESULTS: Global transcriptome analysis indicated substantial elevation of basal GL261 immune infiltration and strong CPA/6d activation of GL261 immune stimulatory pathways and their upstream regulators, but without preferential depletion of negative immune regulators compared to LLC and B16F10 tumors. In LLC tumors, where CPA/6d treatment is shown to be anti-angiogenic, CPA/6d suppressed VEGFA target genes and down regulated cell adhesion and leukocyte transendothelial migration genes. In GL261 tumors implanted in adaptive immune-deficient scid mice, where CPA/6d-induced GL261 regression is incomplete and late tumor growth rebound can occur, T cell receptor signaling and certain cytokine-cytokine receptor responses seen in B6 mice were deficient. Extending the CPA treatment interval from 6 to 9 days (CPA/9d) - which results in a strong but transient natural killer cell response followed by early tumor growth rebound - induced fewer cytokines and increased expression of drug metabolism genes. CONCLUSIONS: These findings elucidate molecular response pathways activated by intermittent metronomic CPA treatment and identify deficiencies that characterize immune-unresponsive tumor models and drug schedules.

CpG-1826 immunotherapy potentiates chemotherapeutic and anti-tumor immune responses to metronomic cyclophosphamide in a preclinical glioma model.

Cyclophosphamide administered on an intermittent metronomic schedule induces strong immune-dependent regression in several glioma models. Here we investigate whether this immunogenic chemotherapy can be potentiated by combination with the immune stimulatory TLR9 agonist CpG-1826. CpG-1826 treatment of GL261 gliomas implanted in immune competent mice induced tumor growth delay associated with increased tumor recruitment of macrophages and B cells. Anti-tumor responses varied between individuals, with CpG-1826 inducing robust tumor growth delay in ~50% of treated mice. Both high and low CpG-1826-responsive mice showed striking improvements when CpG-1826 was combined with cyclophosphamide treatment. Tumor-associated macrophages, B cells, dendritic cells, and cytotoxic T cells were increased, T regulatory cells were not induced, and long-term GL261 glioma regression with immune memory was achieved when CpG-1826 was combined with either single cyclophosphamide dosing (90 mg/kg) or metronomic cyclophosphamide treatment (two cycles at 45 mg/kg, spaced 12-days apart). B16F10 melanoma, a low immunogenic tumor model, also showed enhanced immune and anti-tumor responses to cyclophosphamide/CpG-1826 chemoimmunotherapy, but unlike GL261 tumors, did not regress. TLR9-based immunotherapy can thus be effectively combined with immunogenic cyclophosphamide treatment to enhance immune-based anti-tumor responses, even in poorly immunogenic cancer models.

Reducing readmissions using teach-back: enhancing patient and family education.

This article describes a quality improvement initiative, implemented by a patient education workgroup within a tertiary Magnet® facility. The project focused on the association between inadequate care transitions in patients with heart failure and subsequent costly readmissions. The teach-back initiative was piloted with patients hospitalized with heart failure, because of this population's high risk of readmission. Learning outcomes included documented improvements in patients' understanding of their disease and reduced readmission rates.

The early spring N uptake of young peach trees (Prunus persica) is affected by past and current fertilizations and levels of C and N stores.

In deciduous trees, shoot development in early spring is assumed to be achieved mainly at the expense of nitrogen (N) stores. Indeed, the possible compensation for poor autumn N storage by early spring N uptake has been little studied. We therefore determined the dynamics of spring N uptake in relation to spring N supply, carbon and N storage and shoot development. Young peach trees (Prunus persica L. Batsch, cv. 'GF305') were raised outdoors in a hydroponic set-up during the spring and summer, with an excessive N supply. During the autumn, half of the trees were then N limited. The following spring, the N supply remained either high or low, or changed from high to low or low to high. Between 6 March and 13 May, N uptake was measured automatically on an hourly basis, while shoot growth was monitored once a week. These in situ measurements were completed by three destructive harvests to assess organ composition in N and total non-structural carbohydrates (TNC). Until the end of April, N uptake was dependent on the autumn N treatment, being higher in trees that had been N limited in the autumn. Total non-structural carbohydrate mobilization was also higher in those trees that had lost at least 17 g TNC by 24 April, while TNC levels in non-limited trees remained stable or even rose. Shoot development, estimated by the number of elongated axes and leaves per axis, was also slightly delayed by an N limitation in autumn. After 24 April, N uptake rates increased notably under all treatments and was determined by the spring N supply. In trees receiving a high N supply in the spring, the uptake rates also displayed marked short-term variations. That reduced the differences between treatments and by 13 May no differences could be evidenced between the trees in terms of organ biomass and TNC and N contents, whatever the treatment. We concluded that in the early spring, N uptake may compensate for a deficit of N storage insofar as large quantities of TNC can be mobilized for that purpose.

Formalizing an integrative, multidisciplinary cancer therapy discovery workflow.

Although many clinicians and researchers work to understand cancer, there has been limited success to effectively combine forces and collaborate over time, distance, data, and budget constraints. Here we present a workflow template for multidisciplinary cancer therapy that was developed during the 2nd Annual Workshop on Cancer Systems Biology sponsored by Tufts University, Boston, Massachusetts, in July 2012. The template was applied to the development of a metronomic therapy backbone for neuroblastoma. Three primary groups were identified: clinicians, biologists, and quantitative scientists (mathematicians, computer scientists, and engineers). The workflow described their integrative interactions; parallel or sequential processes; data sources and computational tools at different stages as well as the iterative nature of therapeutic development from clinical observations to in vitro, in vivo, and clinical trials. We found that theoreticians in dialog with experimentalists could develop calibrated and parameterized predictive models that inform and formalize sets of testable hypotheses, thus speeding up discovery and validation while reducing laboratory resources and costs. The developed template outlines an interdisciplinary collaboration workflow designed to systematically investigate the mechanistic underpinnings of a new therapy and validate that therapy to advance development and clinical acceptance.