Contributing factors for career goal advancement of pharmacy learners in the Black, Indigenous, and People of Color community.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: To explore factors influencing career goals and goal attainment for pharmacy learners (eg, students, residents, fellows) who identify as part of the Black, Indigenous, and People of Color (BIPOC) community. METHODS: In late 2021 and early 2022, US-based pharmacy learners were invited to participate in two focus groups. In the first focus group, participants were asked to reflect on career goal influences, barriers, and facilitators. In the second focus group, participants were asked to provide suggestions for educational institutions and healthcare organization improvement to support career goal attainment for learners in the BIPOC community. Focus group transcripts were coded using both deductive and inductive coding and thematic analysis. RESULTS: Fifteen learners were included in the first round of focus group, and 10 learners were included in the second. The most common career goal motivators were self-efficacy factors. Barriers and facilitators were often closely related. The most common barriers were financial, lack of representation, and lack of support. Common facilitators included mentorship and informal networking opportunities. Participants suggested multiple strategies for educational institutions and healthcare organizations to support BIPOC learner success, including genuine investment, representation, financial support, improved access to professional development opportunities, partnering with other professional organizations, and prioritizing diversity, equity, and inclusion (DEI) initiatives. CONCLUSION: Institutions should prioritize effective, positive mentoring relationships and exposure to BIPOC professionals. Training programs and associations should consider improving financial support and lowering the cost of involvement to reduce barriers. All stakeholders should prioritize DEI in their organizational culture to promote career advancement of BIPOC learners and professionals.

Evaluation of chemotherapy preparation processes: Volumetric method reliability and gravimetric method utility within 5 US hospitals.

PURPOSE: The primary aim of this study was to investigate the accuracy of the volumetric method for intravenous (IV) preparations and explore the utility of gravimetric methods in the medication preparation process within multiple institutions. Secondary outcomes of this study were syringe size percent variations and impact on drug expenditures. METHODS: A prospective, noninterventional, multisite study was conducted between March 2015 and December 2016 to generate baseline estimates of accuracy and precision in the volumetric medication preparation process. Five hospitals in the United States were recruited for study participation. During the data collection process, technicians were required to measure the syringe at 3 different points: when the new empty syringe was connected to a closed-system transfer device (CSTD), when the filled syringe containing the prepared dose of medication was connected to a CSTD, and when the used syringe with residual medication was connected to a CSTD. The actual dose of drug dispensed (in mg) was divided by the specific gravity of the medication to determine the actual volume of medication dispensed. RESULTS: A total of 4,443 compounded sterile products representing 60 medications across 5 hospitals were eligible for the study. Of the evaluated preparations, 91.92% were within 5% of the prescribed dose and 96.56% were within 10% of the prescribed dose. The outliers ranged from -144.10% to 233.72%. CONCLUSION: The potential for significant over- and undertreatment of an individual patient receiving IV chemotherapy exists, indicating the need for an additional measurement method, such as real-time gravimetric verification, to ensure an accurate dose is administered to every patient.

Late Acute Rejection After Allograft Limbal Stem Cell Transplantation: Evidence for Long-Term Donor Survival.

PURPOSE: To describe the clinical presentation and management of late (>3.0 years) acute graft rejection in keratolimbal allograft (KLAL) recipients. METHODS: This was a multicenter, retrospective observational case series. Six eyes of 6 patients with ocular surface transplant at a mean age of 36.2 years were seen at 3 tertiary referral centers for acute graft rejection between 2007 and 2013. Main outcome measures included strength of systemic immunosuppression (SI) at the time of rejection, time to rejection, and clinical presentation of rejection. RESULTS: Preoperative diagnoses included total limbal stem cell deficiency because of aniridia (n = 2) or chemical injury (n = 4). After an initially successful outcome, patients experienced late acute graft rejection at a mean time of 67.8 ± 24.1 months (range: 41-98) after KLAL while receiving suboptimal levels of SI because of medication taper (n = 5) or noncompliance (n = 1). Objective findings included an epithelial rejection line (n = 6), edema (n = 2), corneal epithelial irregularities (n = 2), and neovascularization (n = 1). Antirejection management consisted of topical corticosteroids (n = 6) and augmentation of SI therapy (n = 5). CONCLUSIONS: These cases of late acute graft rejection in KLAL patients support the notion that allodonor cells can persist over the long run and remain at risk for immunologic rejection. It further underscores the fact that long-term success with KLAL may require extension of SI beyond the first few years, albeit at lower levels individualized to each patient.

Did BICEP2 see vector modes? First B-mode constraints on cosmic defects.

Scaling networks of cosmic defects, such as strings and textures, actively generate scalar, vector, and tensor metric perturbations throughout the history of the Universe. In particular, vector modes sourced by defects are an efficient source of the cosmic microwave background B-mode polarization. We use the recently released BICEP2 and POLARBEAR B-mode polarization spectra to constrain properties of a wide range of different types of cosmic strings networks. We find that in order for strings to provide a satisfactory fit on their own, the effective interstring distance needs to be extremely large--spectra that fit the data best are more representative of global strings and textures. When a local string contribution is considered together with the inflationary B-mode spectrum, the fit is improved. We discuss implications of these results for theories that predict cosmic defects.

Evidence for massive neutrinos from cosmic microwave background and lensing observations.

We discuss whether massive neutrinos (either active or sterile) can reconcile some of the tensions within cosmological data that have been brought into focus by the recently released Planck data. We point out that a discrepancy is present when comparing the primary CMB and lensing measurements both from the CMB and galaxy lensing data using CFHTLenS, similar to that which arises when comparing CMB measurements and SZ cluster counts. A consistent picture emerges and including a prior for the cluster constraints and BAOs we find that for an active neutrino model with three degenerate neutrinos, ∑m(ν)=(0.320±0.081) eV, whereas for a sterile neutrino, in addition to 3 neutrinos with a standard hierarchy and ∑m(ν)=0.06 eV, m(ν,sterile)(eff)=(0.450±0.124) eV and ΔN(eff)=0.45±0.23. In both cases there is a significant detection of modification to the neutrino sector from the standard model and in the case of the sterile neutrino it is possible to reconcile the BAO and local H0 measurements. However, a caveat to our result is some internal tension between the CMB and lensing and cluster observations, and the masses are in excess of those estimated from the shape of the matter power spectrum from galaxy surveys.

Patients with homonymous hemianopia become visually qualified to drive using novel monocular sector prisms.

Patients with homonymous hemianopia (HH) often fail to meet visual field (VF) requirements for a driver's license. We describe 2 patients with complete HH, who met the minimum VF requirements for driving using a novel, high-power, monocular sector prism system. Baseline VFs were assessed using automated and kinetic perimetry. Patients were fitted with glasses and press-on 57-PD peripheral monocular sector prisms placed on the lens ipsilateral to the VF defect above and below the visual axis with prisms oriented obliquely. Kinetic perimetry was reassessed both monocularly and binocularly, with and without prisms. The 2 patients had 95° and 82° angle of continuous, horizontal, binocular VF. With the use of the prism system, the binocular VF increased to 115° and 112° angles. Both patients reported improvement in quality of life and each holds a valid driver's license and has successfully operated a motor vehicle without any restrictions or accidents. These findings suggest that the addition of oblique 57-PD prisms to the ipsilateral spectacle lens above and below the visual axis for patients with complete HH can significantly increase horizontal VF, which may help an individual become visually qualified to obtain a driver's license.

Repeatability of retrobulbar blood flow velocity measured using color Doppler imaging in the Indianapolis Glaucoma Progression Study.

PURPOSE: Determine the repeatability of color Doppler imaging (CDI) measurements in patients with open-angle glaucoma (OAG). PATIENTS AND METHODS: We performed a cross-sectional, observational study of OAG patients participating in the Indianapolis Glaucoma Progression Study. Retrobulbar blood flow velocities and Pourcelot's vascular resistance index (RI) measured with CDI were examined. Two baseline measurements were obtained 1 to 2 weeks apart at the same time of day for all participants. Peak systolic and end diastolic blood flow velocities (PSV/EDV) were measured in the ophthalmic (OA), central retinal (CRA), and nasal and temporal short posterior ciliary arteries (N/TPCA) and RI was calculated. Intraclass correlation coefficient (ICC) between the 2 baselines was calculated. RESULTS: One hundred and sixteen patients with OAG [mean age 65.9 y (SD 10.9 y), 60% female] were examined in both baseline visits. In the OA, the intraobserver ICC for the PSV, EDV, and RI were all above 0.82. In the CRA, the intraobserver ICC for the PSV and RI were both above 0.8, whereas the EDV was 0.64. The intraobserver ICC in the N/TPCA for the PSV, EDV, and RI ranged from 0.71 to 0.88. The interobserver ICC was similar to the intraobserver ICC for the OA and the CRA but was lower than 0.7 in the EDV and RI of the T/NPCA. CONCLUSIONS: Blood flow velocities and calculated vascular resistance of the OA, CRA, and PCAs conducted within 2 weeks in patients with OAG are repeatable. Intraobserver CDI measurements were found more reproducible than interobserver CDI analysis.

Goldmann applanation tonometry and dynamic contour tonometry are not correlated with central corneal thickness in primary open angle glaucoma.

PURPOSE: To compare intraocular pressure (IOP) measured by Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT) and assess their relationship to central corneal thickness (CCT) in patients with primary open angle glaucoma (OAG). PATIENTS AND METHODS: GAT, DCT, and CCT were assessed in 116 patients with OAG [mean age 65.9 (10.5); 59% female] participating in the Indianapolis Glaucoma Progression Study. GAT and DCT were measured in a randomized order followed by CCT (ultrasonic corneal pachymetry) during a single study visit. Bland-Altman plots were used to evaluate the limits of agreement between tonometery methodologies whereas multivariate regression analysis was used to evaluate the influence of CCT on GAT and DCT IOP measurements. RESULTS: IOP values obtained by DCT and GAT showed a strong positive correlation in patients with OAG (r=0.93; P<0.001). Mean IOP measured with DCT [18.4 (5.1) mm Hg] was significantly higher (P<0.001) than GAT IOP measurements [16.5 (4.5) mmHg]. CCT did not seem to influence either GAT or DCT measurements (r=0.1025, P=0.16; r=0.05, P=0.46), respectively. The Bland-Altman data showed that the amount of disagreement between IOP assessment techniques varied, suggesting a proportional bias. CONCLUSIONS: In this group of patients with OAG, there was a strong correlation between GAT and DCT measurements of IOP. IOP measured with DCT was consistently higher than IOP measured with GAT. Neither GAT nor DCT measurements were correlated with CCT. This data suggests that factors other than CCT may be involved in the tendency of DCT to produce higher measures of IOP than GAT.

Feasibility of creating a normative database of colour Doppler imaging parameters in glaucomatous eyes and controls.

BACKGROUND AND AIMS: Colour Doppler imaging (CDI) is a frequently cited methodology for quantifying ocular blood flow velocities. This investigation reviews the feasibility of creating a normative database of CDI parameters in glaucoma patients and controls. A literature search was conducted for CDI studies involving glaucomatous eyes. Using data from these studies, a weighted mean was derived for the peak systolic velocity, end diastolic velocity and Pourcelot's resistive index in the ophthalmic, central retinal and posterior ciliary arteries. A multivariate analysis was performed to identify whether methodological characteristics contributed to the inter-study variance in CDI values. Data from 3061 glaucoma patients and 1072 controls were included. The mean values for glaucomatous eyes were within one standard deviation of the values for controls for most CDI parameters. Gender mix (p=0.043), intraocular pressure status (p=0.017), frequency of the ultrasound transducer (p=0.02) and whether the patients were on antihypertensive therapy (p=0.004) contributed to the variance. Methodological differences create inter-study variance in CDI values, complicating the construction of a normative database and limiting its utility. Because the mean values for glaucomatous and normal eyes have overlapping ranges, caution should be used when classifying glaucoma status based on a single CDI measurement.

Update and critical appraisal of combined timolol and carbonic anhydrase inhibitors and the effect on ocular blood flow in glaucoma patients.

Topical hypotensive therapy with both timolol and carbonic anhydrase inhibitors has been shown to be efficacious at reducing intraocular pressure. Many prospective studies have also suggested that carbonic anhydrase inhibitors augment ocular blood flow and vascular regulation independent of their hypotensive effects. Although consistent in their findings, these studies must be cautiously interpreted due to the limitations of study design and specific blood flow imaging modalities. The purpose of this review is to appraise and critically evaluate the current body of literature investigating the effects of combined treatment with topical carbonic anhydrase inhibitors and timolol in patients with glaucoma with respect to ocular blood flow, visual function, and optic nerve head structure.

Combined treatment of intravitreal bevacizumab and intravitreal triamcinolone in patients with retinal vein occlusion: 6 months of follow-up.

PURPOSE: To report 6 months of results of combined treatment of intravitreal bevacizumab and triamcinolone in patients with retinal vein occlusion (RVO). STUDY DESIGN/METHODS: Retrospective consecutive case series. Intravitreal bevacizumab (1.25 mg) combined with intravitreal triamcinolone (2 mg) was injected to 16 patients with RVO: eight with branch retinal vein occlusion (BRVO) and eight with central retinal vein occlusion (CRVO). Patient's charts were reviewed for age, sex, previous ocular interventions, duration of follow-up, number of intraocular injections, intraocular pressure (IOP) and central macular thickness measured by optical coherence tomography (OCT). We included only patients that completed 6 months of follow-up. RESULTS: Mean age and number of injections were 72.9 +/- 11.99 years, and 2 +/- 0.81 respectively. In eight patients with CRVO, initial visual acuity was logMAR 1.09 +/- 0.67 and mean visual acuity at 1, 3 and 6 months was logMAR 0.98 +/- 0.55 (p = 0.59), 1.33 +/- 1.05 (p = 0.4) and 1.4 +/- 1.2 (p = 0.34) respectively. In eight patients with BRVO, initial visual acuity was logMAR 1.025 +/- 0.58 and mean visual acuity at 1, 3, and 6 months was 0.56 +/- 0.21 (p = 0.05), 0.61 +/- 0.17 (p = 0.03) and 0.66 +/- 0.34 (p = 0.12) respectively. Mean initial central macular thickness for the whole group was 527 +/- 182 microm and mean central macular thickness at 6 months was 379 +/- 156 microm (p < 0.001). CONCLUSION: This study suggests that combined treatment with intravitreal bevacizumab and intravitreal triamcinolone improves structural outcome in patients with retinal vein occlusion. In our study, the combination of triamcinolone acetonide and bevacizumab offered no advantage over previously published results with intravitreal bevacizumab injections alone for improving vision at 6 months.

Can we avoid dark energy?

The idea that we live near the center of a large, nonlinear void has attracted attention recently as an alternative to dark energy or modified gravity. We show that an appropriate void profile can fit both the latest cosmic microwave background and supernova data. However, this requires either a fine-tuned primordial spectrum or a Hubble rate so low as to rule these models out. We also show that measurements of the radial baryon acoustic scale can provide very strong constraints. Our results present a serious challenge to void models of acceleration.

Use of a void network model to correlate porosity, mercury porosimetry, thin section, absolute permeability, and NMR relaxation time data for sandstone rocks.

The Pore-Cor void network model is used to construct stochastic realizations of the void structures of five sandstone samples of varying lithography. A close match was achieved to experimental porosity and mercury intrusion curves. The samples were resin impregnated and the fragments of voids revealed in thin sections photographed by backscatter electron microscopy at two magnifications. The sizes of these pore fragments matched those derived from a simulated microtoming of the network model much more closely than the sizes derived from the traditional capillary bundle approximation. Absolute permeabilities of the network were calculated by finding the flow capacity of the entire flow network, based on parametrized Navier Stokes equations with Klinkenberg correction, applied to each pore-throat-pore arc. A match to the experimental trend was obtained, although the network model considerably underestimated the experimental values. The results were also compared with the semiempirical equations of Thomson et al. and Kozeny and Carmen modified to accept thin section image analysis. Finally, the simulated pore and throat size distributions were compared to proton NMR transverse (T2) spin-echo relaxation times. Although the shapes of the distributions differed markedly, the mean values trended together. The capillary bundle approximation, however, gave a poor match to the NMR data.