Effect of community pharmacist-provided patient education of partial fill availability for acute opioid prescriptions.

BACKGROUND: More than 191 million opioid prescriptions were filled in the United States during 2017, and studies have shown that patients often have leftover medication. OBJECTIVES: To (1) measure the percentage filled as partial quantities and the percentage subsequently filled to completion; (2) determine which medications are filled as partial, completion, and full fills; and (3) identify patient reasons and demographics for partial, completion, and full fills. PRACTICE DESCRIPTION: Two pharmacies of a national community pharmacy chain in Richmond, VA. PRACTICE INNOVATION: Virginia law allows prescriptions to be filled in partial quantities as long as the total quantity does not exceed the written quantity and the remaining portions are filled within 30 days of the written date. Pharmacists developed an intervention to educate patients about the option to fill opioid prescriptions as a partial quantity. EVALUATION METHODS: Retrospective analysis of drug utilization reports to identify the impact of the pharmacist intervention for acute, nonmaintenance opioid prescriptions filled as partial, completion, or full fill during a 5-month period. Patient demographics and reasons for choosing a partial or full fill were collected using surveys completed at prescription pickup. RESULTS: A total of 25.6% of included prescriptions were partially filled, and of these, only 31.9% were filled to completion. Hydrocodone-acetaminophen was the most common prescription, 35.8% full, 28.3% partial, and 36.4% completion fills. Patients' motivation was driven by the pharmacist's suggestion (48.5%) for partial fill and desire to have the medication if needed (36.6%) for full fill. CONCLUSION: Pharmacist offer of partial filling of acute opioid prescriptions may lead patients to partially fill prescriptions, and patients cited the pharmacist suggestion as a motivator.

Pharmacist impact on pneumococcal polysaccharide vaccination rates in patients with diabetes in a national grocery chain pharmacy.

OBJECTIVES: To evaluate the impact of pharmacist education and intervention on pneumococcal polysaccharide (PPSV23) vaccination rates in patients with diabetes in a national grocery chain pharmacy and assess patient awareness and barriers to receiving the PPSV23 vaccine. METHODS: Prospective interventional 4-month study in 3 grocery chain pharmacies targeted patients aged between 19 years and 64 years who filled a medication for diabetes 90 days before the study period. Immunization status was verified with pharmacy records and the Virginia Immunization Information System. A note was added to the profile of patients who did not have a record of PPSV23 immunization to alert the pharmacist to provide patient education about the vaccine the next time the patient presented to the pharmacy. Patients who received education either accepted or declined the recommendation for the vaccine and completed a voluntary survey assessing awareness and barriers to receiving the vaccine. Vaccination rates were calculated before and after pharmacist intervention. RESULTS: Pharmacists provided education to 126 out of the 321 patients potentially eligible to receive the vaccine. For patients receiving the intervention, 51 patients were excluded, 7 patients refused the survey, and 68 patients completed the survey. Twelve patients accepted the pharmacist's recommendation to receive the vaccine. Of patients who completed the survey, 83.6% had type 2 diabetes, 61.8% were men, 77.9% were Caucasian, and the mean age was 51.5 years. More than one-half of the patients (54%) were not aware of the recommendation to receive the PPSV23 vaccine, and 46% of patients wanted to discuss it with their primary care provider. The PPSV23 vaccination rate was 28.6% before pharmacist education and increased to 31.8% after intervention. CONCLUSION: Pharmacist education increased PPSV23 vaccination rates at the pharmacy, and the primary barrier identified for patients receiving the vaccine was that the patients wanted to discuss the recommendation with their provider.

Community-Based Pharmacy Practice Innovation and the Role of the Community-Based Pharmacist Practitioner in the United States.

Community-based pharmacy practice is evolving from a focus on product preparation and dispensing to becoming a health care destination within the four walls of the traditional community-based pharmacy. Furthermore, community-based pharmacy practice is expanding beyond the four walls of the traditional community-based pharmacy to provide care to patients where they need it. Pharmacists involved in this transition are community-based pharmacist practitioners who are primarily involved in leading and advancing team-based patient care services in communities to improve the patient health. This paper will review community-based pharmacy practice innovations and the role of the community-based pharmacist practitioner in the United States.

Publisher Correction: Self-assembly of nanostructured glass metasurfaces via templated fluid instabilities.

In the version of this Article originally published, the volume, article number and year of ref. 32 were incorrect; they should have read 31, 1802348 (2019). This has now been corrected.

Self-assembly of nanostructured glass metasurfaces via templated fluid instabilities.

Modern devices require the tuning of the size, shape and spatial arrangement of nano-objects and their assemblies with nanometre-scale precision, over large-area and sometimes soft substrates. Such stringent requirements are beyond the reach of conventional lithographic techniques or self-assembly approaches. Here, we show nanoscale control over the fluid instabilities of optical thin glass films for the fabrication of self-assembled all-dielectric optical metasurfaces. We show and model the tailoring of the position, shape and size of nano-objects with feature sizes below 100 nm and with interparticle distances down to 10 nm. This approach can generate optical nanostructures over rigid and soft substrates that are more than tens of centimetres in size, with optical performance and resolution on a par with advanced traditional lithography-based processes. To underline the potential of our approach, which reconciles high-performance optical metasurfaces and simple self-assembly fabrication approaches, we demonstrate experimentally and via numerical simulation sharp Fano resonances with a quality factor, Q, as high as ∼300 in the visible for all-dielectric nanostructures, to realize protein monolayer detection.

Advanced Multimaterial Electronic and Optoelectronic Fibers and Textiles.

The ability to integrate complex electronic and optoelectronic functionalities within soft and thin fibers is one of today's key advanced manufacturing challenges. Multifunctional and connected fiber devices will be at the heart of the development of smart textiles and wearable devices. These devices also offer novel opportunities for surgical probes and tools, robotics and prostheses, communication systems, and portable energy harvesters. Among the various fiber-processing methods, the preform-to-fiber thermal drawing technique is a very promising process that is used to fabricate multimaterial fibers with complex architectures at micro- and nanoscale feature sizes. Recently, a series of scientific and technological breakthroughs have significantly advanced the field of multimaterial fibers, allowing a wider range of functionalities, better performance, and novel applications. Here, these breakthroughs, in the fundamental understanding of the fluid dynamics, rheology, and tailoring of materials microstructures at play in the thermal drawing process, are presented and critically discussed. The impact of these advances on the research landscape in this field and how they offer significant new opportunities for this rapidly growing scientific and technological platform are also discussed.

Information and Communication Technologies Interest, Access, and Use: Cross-Sectional Survey of a Community Sample of Urban, Predominantly Black Women.

BACKGROUND: Information and communication technologies (ICT) offer the potential for delivering health care interventions to low socioeconomic populations who often face barriers in accessing health care. However, most studies on ICT for health education and interventions have been conducted in clinical settings. OBJECTIVE: The aim of this study was to examine access to and use of mobile phones and computers, as well as interest in, using ICT for receipt of behavioral health information among a community sample of urban, predominately black, women with low socioeconomic status. METHODS: Participants (N=220) were recruited from hair salons and social service centers and completed audio-computer assisted self-interviews. RESULTS: The majority of the participants (212/220, 96.3%) reported use of a cell phone at least weekly, of which 89.1% (189/212) used smartphones and 62.3% (137/220) reported computer use at least weekly. Of the women included in the study, 51.9% (107/206) reported using a cell phone and 39.4% (74/188) reported using a computer to access health and/or safety information at least weekly. Approximately half of the women expressed an interest in receiving information about stress management (51%-56%) or alcohol and health (45%-46%) via ICT. Smartphone ownership was associated with younger age (odds ratio [OR] 0.92, 95% CI 0.87-0.97) and employment (OR 5.12, 95% CI 1.05-24.95). Accessing health and safety information weekly by phone was associated with younger age (OR 0.96, 95% CI 0.94-0.99) and inversely associated with higher income (OR 0.42, 95% CI 0.20-0.92). CONCLUSIONS: Our findings suggest that ICT use, particularly smartphone use, is pervasive among predominantly black women with low socioeconomic status in urban, nonclinical settings. These results show that ICT is a promising modality for delivering health information to this population. Further exploration of the acceptability, feasibility, and effectiveness of using ICT to disseminate behavioral health education and intervention is warranted.

Superelastic Multimaterial Electronic and Photonic Fibers and Devices via Thermal Drawing.

Electronic and photonic fiber devices that can sustain large elastic deformation are becoming key components in a variety of fields ranging from healthcare to robotics and wearable devices. The fabrication of highly elastic and functional fibers remains however challenging, which is limiting their technological developments. Simple and scalable fiber-processing techniques to continuously codraw different materials within a polymeric structure constitute an ideal platform to realize functional fibers and devices. Despite decades of research however, elastomeric materials with the proper rheological attributes for multimaterial fiber processing cannot be identified. Here, the thermal drawing of hundreds-of-meters long multimaterial optical and electronic fibers and devices that can sustain up to 500% elastic deformation is demonstrated. From a rheological and microstructure analysis, thermoplastic elastomers that can be thermally drawn at high viscosities (above 103 Pa s), allowing the encapsulation of a variety of microstructured, soft, and rigid materials are identified. Using this scalable approach, fiber devices combining high performance, extreme elasticity, and unprecedented functionalities, allowing novel applications in smart textiles, robotics, or medical implants, are demonstrated.

Analysis of immune-related genes during Nora virus infection of Drosophila melanogaster using next generation sequencing.

Drosophila melanogaster depends upon the innate immune system to regulate and combat viral infection. This is a complex, yet widely conserved process that involves a number of immune pathways and gene interactions. In addition, expression of genes involved in immunity are differentially regulated as the organism ages. This is particularly true for viruses that demonstrate chronic infection, as is seen with Nora virus. Nora virus is a persistent non-pathogenic virus that replicates in a horizontal manner in D. melanogaster. The genes involved in the regulation of the immune response to Nora virus infection are largely unknown. In addition, the temporal response of immune response genes as a result of infection has not been examined. In this study, D. melanogaster either infected with Nora virus or left uninfected were aged for 2, 10, 20 and 30 days. The RNA from these samples was analyzed by next generation sequencing (NGS) and the resulting immune-related genes evaluated by utilizing both the PANTHER and DAVID databases, as well as comparison to lists of immune related genes and FlyBase. The data demonstrate that Nora virus infected D. melanogaster exhibit an increase in immune related gene expression over time. In addition, at day 30, the data demonstrate that a persistent immune response may occur leading to an upregulation of specific immune response genes. These results demonstrate the utility of NGS in determining the potential immune system genes involved in Nora virus replication, chronic infection and involvement of antiviral pathways.

Semiconducting Nanowire-Based Optoelectronic Fibers.

The recent ability to integrate semiconductor-based optoelectronic functionalities within thin fibers is opening intriguing opportunities for flexible electronics and advanced textiles. The scalable integration of high-quality semiconducting devices within functional fibers however remains a challenge. It is difficult with current strategies to combine high light absorption, good microstructure and efficient electrical contact. The growth of semiconducting nanowires is a great tool to control crystal orientation and ensure a combination of light absorption and charge extraction for efficient photodetection. Thus far, however, leveraging the attributes of nanowires has remained seemingly incompatible with fiber materials, geometry, and processing approaches. Here, the integration of semiconducting nanowire-based devices at the tip and along the length of polymer fibers is demonstrated for the first time. The scalable thermal drawing process is combined with a simple sonochemical treatment to grow nanowires out of electrically addressed amorphous selenium domains. First principles density-functional theory calculations show that this approach enables to tailor the surface energy of crystal facets and favors nanowire growth along a preferred orientation, resulting in fiber-integrated devices of unprecedented performance. This novel platform is exploited to demonstrate an all-fiber-integrated fluorescence imaging system, highlighting novel opportunities in sensing, advanced optical probes, and smart textiles.

Investigation of a sensing approach based on a rapid reduction of azide to selectively measure bioavailability of H2S.

A new reaction-based sensor (AHS) was synthesized for quantitative detection of H2S. AHS showed a high selectivity and sensitivity toward H2S over other thio-containing molecules, or reducing reagents with high abundance in living cells. In the presence of H2S, significant fluorescence enhancement (17-fold) was observed due to the reduction of the azide on AHS. The absorption (362 nm) and fluorescence emission (557 nm) of reduced AHS showed a highly linear correlation to H2S level, which were used to measure concentration of H2S in the range of 0-100 µM.