Transitioning From Consult-Based to Automatic Pharmacy-Driven Vancomycin Management: Results From a Single, Primary Care Center.

OBJECTIVE: The transition to area under the curve (AUC) vancomycin monitoring requires substantial updates in pharmacy policies and procedures. The study facility was tasked with transitioning from a consult-based collaborative agreement to an automatic pharmacist management policy on all intravenous (IV) vancomycin orders. The purpose of this quality assessment (QA) study was to evaluate the effectiveness of this transition. METHODS: The primary outcome was the proportion of patients with pharmacist assessment of pharmacokinetics and dosing with documentation in IV vancomycin treated patients from January-June 2020. Secondary outcomes included the proportion of AUC24 levels within therapeutic range, the incidence of acute kidney injury (AKI) and treatment failures in patients treated ≥72 hours compared to a historical, trough-based cohort. RESULTS: There were 88 patients in the QA analysis with 100% having a pharmacist assessment with documentation. There were 34 patients treated ≥72 hours in the AUC group, 36 in the trough-based group. AUC24 fell within desired range in 45% of monitored patients. Rates of AKI (9% vs 11%, p = 0.75) and treatment failures were similar (3% vs 0%, p = 0.3). CONCLUSION: The transition from consult-based to an automatic pharmacy management agreement was successful with similar safety and efficacy compared to a historical trough-based cohort.

Coccolith dissolution within copepod guts affects fecal pellet density and sinking rate.

The most common biomineral produced in the contemporary ocean is calcium carbonate, including the polymorph calcite produced by coccolithophores. The surface waters of the ocean are supersaturated with respect to calcium carbonate. As a result, particulate inorganic carbon (PIC), such as calcite coccoliths, is not expected thermodynamically to dissolve in waters above the lysocline (~4500-6000 m). However, observations indicate that up to 60-80% of calcium carbonate is lost in the upper 500-1000 m of the ocean. This is hypothesized to occur in microenvironments with reduced saturation states, such as zooplankton guts. Using a new application of the highly precise 14C microdiffusion technique, we show that following a period of starvation, up to 38% of ingested calcite dissolves in copepod guts. After continued feeding, our data show the gut becomes increasingly buffered, which limits further dissolution; this has been termed the Tums hypothesis (after the drugstore remedy for stomach acid). As less calcite dissolves in the gut and is instead egested in fecal pellets, the fecal pellet sinking rates double, with corresponding increases in pellet density. Our results empirically demonstrate that zooplankton guts can facilitate calcite dissolution above the chemical lysocline, and that carbon export through fecal pellet production is variable, based on the feeding history of the copepod.

Detecting the unexpected: a research framework for ocean acidification.

The threat that ocean acidification (OA) poses to marine ecosystems is now recognized and U.S. funding agencies have designated specific funding for the study of OA. We present a research framework for studying OA that describes it as a biogeochemical event that impacts individual species and ecosystems in potentially unexpected ways. We draw upon specific lessons learned about ecosystem responses from research on acid rain, carbon dioxide enrichment in terrestrial plant communities, and nitrogen deposition. We further characterize the links between carbon chemistry changes and effects on individuals and ecosystems, and enumerate key hypotheses for testing. Finally, we quantify how U.S. research funding has been distributed among these linkages, concluding that there is an urgent need for research programs designed to anticipate how the effects of OA will reverberate throughout assemblages of species.

Early exposure of bay scallops (Argopecten irradians) to high CO2 causes a decrease in larval shell growth.

Ocean acidification, characterized by elevated pCO2 and the associated decreases in seawater pH and calcium carbonate saturation state (Ω), has a variable impact on the growth and survival of marine invertebrates. Larval stages are thought to be particularly vulnerable to environmental stressors, and negative impacts of ocean acidification have been seen on fertilization as well as on embryonic, larval, and juvenile development and growth of bivalve molluscs. We investigated the effects of high CO2 exposure (resulting in pH = 7.39, Ω(ar) = 0.74) on the larvae of the bay scallop Argopecten irradians from 12 h to 7 d old, including a switch from high CO2 to ambient CO2 conditions (pH = 7.93, Ω(ar) = 2.26) after 3 d, to assess the possibility of persistent effects of early exposure. The survival of larvae in the high CO2 treatment was consistently lower than the survival of larvae in ambient conditions, and was already significantly lower at 1 d. Likewise, the shell length of larvae in the high CO2 treatment was significantly smaller than larvae in the ambient conditions throughout the experiment and by 7 d, was reduced by 11.5%. This study also demonstrates that the size effects of short-term exposure to high CO2 are still detectable after 7 d of larval development; the shells of larvae exposed to high CO2 for the first 3 d of development and subsequently exposed to ambientCO2 were not significantly different in size at 3 and 7 d than the shells of larvae exposed to high CO2 throughout the experiment.

Effects of aestivation and starvation on the neutral lipid and phospholipid content of Biomphalaria glabrata infected with Schistosoma mansoni.

The effects of aestivation or starvation on the neutral lipid and phospholipid content of Biomphalaria glabrata patently infected with Schistosoma mansoni were determined by high-performance thin-layer chromatography-densitometry. Infected-aestivated snails were maintained in a moist chamber at 24 +/- 1 C and a relative humidity of 98 +/- 1%. Infected-starved snails were maintained in artificial spring water (ASW) at 23 +/- 1 C without exogenous food. Infected snails (the controls) were maintained in ASW at 23 +/- 1 C and fed lettuce ad libitum. The 3 groups were maintained in the laboratory for 7 days, and then the lipids from the digestive gland-gonad complex (DGG) were extracted and analyzed by class. Infected-aestivated snails exhibited greater mortality rate and weight loss after 7 days than did the infected-starved snails. The steryl ester concentration in the infected-starved snails was significantly increased (P = 0.010) compared with the controls but not compared with infected-aestivated snails; the concentration of phosphatidylcholine in infected-aestivated snails was significantly decreased (P = 0.007) compared with the controls but not when compared with the infected-starved snails. Aestivation or starvation had a significant effect on the concentration of certain lipid classes in the DGG of B. glabrata infected with S. mansoni.

Effects of various larval digeneans on the calcium carbonate content of the shells of Helisoma trivolvis, Biomphalaria glabrata, and Physa sp.

The calcium carbonate concentrations in the shells of Helisoma trivolvis and Physa sp. naturally infected with larval trematodes and Biomphalaria glabrata experimentally infected with larval trematodes were analyzed quantitatively. The larval trematode-snail relationships studied were H. trivolvis infected with larval Echinostoma trivolvis and Physa sp. infected with various larval digeneans, and B. glabrata infected with Echinostoma caproni or Schistosoma mansoni. The calcium carbonate concentrations of the shells of infected snails and uninfected cohorts and of the water in which the snails were maintained were determined by ion exchange chromatography. No significant differences in the calcium carbonate concentrations of shells of infected versus uninfected snails were found. The shells of B. glabrata infected with E. caproni contained significantly less calcium carbonate than the shells of uninfected B. glabrata. The hypercalcification hypothesis, i.e., larval trematodes induce an increase in the calcium concentrations in the shells of their snail hosts, was not upheld in any of the snail-larval digenean systems studied herein.