Towards a comprehensive characterization of spatio-temporal dependence of light-induced electromagnetic forces in dielectric liquids.

The interaction of localized light with matter generates optical electrostriction within dielectric fluids, leading to a discernible change in the refractive index of the medium according to the excitation's light profile. This optical force holds critical significance in optical manipulation and plays a fundamental role in numerous photonic applications. In this study, we demonstrate the applicability of the pump-probe, photo-induced lensing (PIL) method to investigate optical electrostriction in various dielectric liquids. Notably, the thermal and nonlinear effects are observed to be temporally decoupled from the electrostriction effects, facilitating isolated observation of the latter. Our findings provide a comprehensive explanation of optical forces in the context of the recently introduced microscopic Ampère electromagnetic formalism, which is grounded in the dipolar approximation of electromagnetic sources within matter and characterizes electrostriction as an electromagnetic-induced stress within the medium. Here, the optical force density is re-obtained through a new Lagrangian approach.

Diversification and Expansion of Clinical Pharmacy Services: Is it Time for Senior Care Pharmacists to Step Into the Light?

According to the American Board of Medical Specialties, there were 7,123 certified geriatricians practicing in the United States in 2021. The Health Resources and Services Administration estimates a shortage of 27,000 geriatricians in 2025. Only 43% of geriatrics fellowship spots were filled in 2022. With this forthcoming decrease in medical providers, the role of the senior care pharmacist must expand and diversify to provide an equitable level of care that older patients will need-especially with the expansion of antipsychotic, antimicrobial, and opioid stewardship programs. Senior care pharmacists possess a diverse range of skills and knowledge that are indispensable to the health care team. It is time to move beyond the consultant role, expanding both clinically and operationally, to provide the quality health care that older patients need.

The Essential Role of Senior Care Pharmacists in Antimicrobial Stewardship: An Updated Position Statement on Behalf of the American Society of Consultant Pharmacists and the Society of Infectious Diseases Pharmacists.

Senior care pharmacists are well-positioned to lead and drive antimicrobial stewardship (AMS) initiatives, not only through audit and data collection, but also through communication, collaboration, and cooperation with prescribers and nurses to influence prescribing behaviors. Senior care pharmacists are in a unique position to take a leadership role within the interprofessional team to achieve AMS goals. They should engage with the interprofessional team to promote the judicious and appropriate use of antimicrobials at their practice sites. This position statement is an update of the 2017 version by the American Society of Consultant Pharmacists (ASCP) Antimicrobial Stewardship and Infection and Prevention Control Committee and the Society of Infectious Diseases Pharmacists (SIDP).

Chronic Obstructive Pulmonary Disease, Part 5: Clinical Pearls for Comorbid COPD.

Chronic obstructive pulmonary disease (COPD) is often diagnosed with other comorbid conditions. This can complicate therapy overall by contributing to adverse events leading to poor outcomes to not only COPD, but other comorbid conditions. This manuscript will discuss common comorbid conditions often seen with COPD, update vaccination recommendations for COPD patients, and provide information regarding smoking cessation in COPD. The senior care pharmacist has an important role where they can recommend medication adjustments to potentially avoid these adverse events, immunize their patients appropriately, and provide assistance with smoking cessation to improve not only COPD outcomes but outcomes associated with other comorbid conditions.

Evaluation of pharmacy student empathy scores before and after a geriatrics advanced pharmacy practice experience (APPE).

INTRODUCTION: Empathy from healthcare providers is associated with improved patient care and satisfaction, resulting in increased emphasis on empathy in pharmacy school curricula. Previous studies showed improvement in pharmacy student empathy after older adult-specific simulation activities in the didactic setting, but no such data exist for the practice environment. This study's purpose was to evaluate the impact of a geriatrics advanced pharmacy practice experience (APPE) on pharmacy student empathy toward older adults. METHODS: All fourth-year pharmacy students in a geriatrics APPE at one of four participating sites were offered to participate in the study at the beginning of the rotation. Empathy was measured at baseline and end of the rotation using the Kiersma-Chen Empathy Scale (KCES). Wilcoxon matched-pairs signed-ranks test was used to test differences from pre- to post-rotation. RESULTS: Fifty-four of the 110 eligible students opted to participate in the study, and 46 completed both the pre- and post-surveys. Most students were female (55.6%), and the average age was 27.3 years. Mean empathy scores for all students increased significantly by 4.89 points (z = 4.17, P < .001, d = 0.97). Specific KCES items related to handling other's feelings and viewing another person's perspective also significantly improved. CONCLUSIONS: Empathy is a key component to professional development in healthcare students, and a geriatrics APPE provides an opportunity for students to grow this soft skill. Although further study is warranted, older adult focused rotations may be considered by schools of pharmacy to aid in preparing "graduate-ready" pharmacists.

The Risk and Clinical Implications of Antibiotic-Associated Acute Kidney Injury: A Review of the Clinical Data for Agents with Signals from the Food and Drug Administration's Adverse Event Reporting System (FAERS) Database.

Antibiotic-associated acute kidney injury (AA-AKI) is quite common, especially among hospitalized patients; however, little is known about risk factors or mechanisms of why AA-AKI occurs. In this review, the authors have reviewed all available literature prior to 1 June 2022, with a large number of AKI reports. Information regarding risk factors of AA-AKI, mechanisms behind AA-AKI, and treatment/management principles to decrease AA-AKI risk were collected and reviewed. Patients treated in the inpatient setting are at increased risk of AA-AKI due to common risk factors: hypovolemia, concomitant use of other nephrotoxic medications, and exacerbation of comorbid conditions. Clinicians should attempt to correct risk factors for AA-AKI, choose antibiotic therapies with decreased association of AA-AKI to protect their high-risk patients, and narrow, when clinically possible, the use of antibiotics which have decreased incidence of AKI. To treat AKI, it is still recommended to discontinue all offending nephrotoxic agents and to renally adjust all medications according to package insert recommendations to decrease patient harm.

Wolbachia Impacts Anaplasma Infection in Ixodes scapularis Tick Cells.

The specific interactions of members of tick bacterial microbiota and their effects on pathogen transmission remains relatively unexplored. Here, we introduced a novel Wolbachia infection type into Ixodes scapularis tick cells and examined the antipathogenic effects on the intracellular pathogen Anaplasma phagocytophilum. An increase in A. phagocytophilum replication was observed in Wolbachia-infected tick cells. However, Wolbachia infection densities decreased when cells were serially passaged and ultimately the infection was lost. Host-cell immune response was also examined as an additional factor that could have affected A. phagocytophilum replication in Wolbachia-infected cells. In early passages post-Wolbachia infection, a decreased immune response was observed, but in later passages of cells with low Wolbachia densities, there was no change in the immune response. The results are discussed in relation to the importance of studying the interactions of the tick microbiota, the host cell, and the pathogen and the development of novel tick and tick-borne disease-control approaches.

Oseltamivir-Induced Neuropsychiatric Event in an Older Person: A Case Report.

BACKGROUND: Oseltamivir is an effective agent for both the treatment and prevention of influenza, and its use is increasing. The package insert indicates that delirium and delirium-like events have been reported with the use of oseltamivir during postmarketing surveillance. The reports of neuropsychiatric events associated with oseltamivir are mainly in younger patients. To our knowledge, this is the first reported case of oseltamivirassociated neuropsychiatric events occurring with oseltamivir prophylaxis in an older adult.
CASE PRESENTATION: A 74-year-old male with a history of mild neurocognitive disorder was given oseltamivir prophylaxis in the setting of an influenza outbreak during his rehabilitation facility stay and developed newfound psychiatric symptoms after administration of oseltamivir for influenza prophylaxis because of institutional outbreak. The patient recovered completely after cessation of oseltamivir.
CONCLUSION: We hope that our case report highlights the importance of careful consideration when prescribing oseltamivir prophylaxis in older people with or without previous history of neurocognitive disorder.

Management of Extended-Spectrum Beta-Lactamase Urinary Tract Infections: Diagnostic and Treatment Considerations for the Older Adult.

OBJECTIVE: To review the treatment options for extended-spectrum beta-lactamase (ESBL) urinary tract infections (UTIs) in the long-term care facility setting.
DATA SOURCES: A PubMed search from January 1, 1990, through December 31, 2018, using terms "extended spectrum beta lactamase" and "urinary tract infection" was performed. Current guidelines, drug databases, and manufacturer package inserts were also used.
STUDY SELECTION: All English-language articles during the above time frame appearing in these searches were reviewed for relevance to this paper. In addition, their bibliographies were reviewed to identify any articles not originally identified.
DATA SYNTHESIS: ESBL UTIs are a growing concern in the long-term care facility as these pathogens are becoming more prevalent. Patients residing in long-term care facilities have fewer treatment modalities because of medication administration and care issues. This review highlights the data on different antibiotics and their efficacy toward ESBLs in the setting of UTI.
CONCLUSIONS: Despite the challenges and limitations, there are still options for clinicians to provide optimal care, including antibiotics with different routes of administration, as well as different administration techniques. Clinicians can be successful with treating ESBL UTIs in older adults.

A review of citalopram dose restrictions in the treatment of neuropsychiatric disorders in older adults.

INTRODUCTION: Neuropsychiatric disorders affect millions of older adults. Despite this, there are relatively few older adults included in clinical trials evaluating treatments for psychiatric disorders. Citalopram has been evaluated in older adults with neuropsychiatric disorders and has largely been found beneficial, making the 2011 US Food and Drug Administration (FDA) safety advisory on citalopram extremely impactful. METHODS: A literature search was completed using the PubMed database. Results were limited to clinical trials conducted in older adults that were published in English. RESULTS: Review of the literature confirms the efficacy of citalopram in depression, anxiety, depression associated with Parkinson disease, and behavioral and psychological symptoms of dementia. Additionally, no adverse cardiac outcomes have been described related to citalopram. DISCUSSION: The FDA's evidence for applying this safety advisory to citalopram is minimal and largely based on surrogate markers, such as the QTc interval rather than clinical and safety outcomes. Citalopram is known to increase the QTc, but this increase has not been linked to adverse cardiac outcomes. The evidence for efficacy and against adverse outcomes suggests that a reevaluation of the dosing restrictions in older adults with neuropsychiatric disorders is needed.

Invasive infection caused by Klebsiella pneumoniae is a disease affecting patients with high comorbidity and associated with high long-term mortality.

Klebsiella pneumoniae (KP) is after Escherichia coli (EC) the most common gram-negative species causing invasive infections. Herein, we analyzed risk factors and prognosis in invasive infections caused by KP versus EC, in an area with low antimicrobial resistance. Moreover, we compared antimicrobial resistance and relative prevalence of KP and EC (KP/EC-ratio) in different European countries, using EARS-Net data. Adult patients admitted to Karolinska University Hospital 2006-2012 with invasive infection caused by KP (n = 599) were matched regarding sex and age with patients infected by EC. The medical records were retrospectively reviewed. Comorbidity was adjusted for with multivariable analysis. European data were retrieved from the EARS-Net database. No differences were observed in 7- and 30-day mortality between the groups. The 90-day mortality was significantly higher in the KP cohort (26% versus 17%, p<0.001), but not after adjusting for comorbidity. Malignancy was seen in 53% of the patients with KP versus 38% with EC, OR 1.86 (1.34-2.58). A significant increase in the rate of ESBL-production was observed in EC, but not in KP. The KP/EC-ratio remained stable. In contrast, European data showed increasing percentages of isolates non-susceptible to third-generation cephalosporins in EC and KP, and increasing KP/EC-ratio. Invasive infection caused by KP is a disease affecting patients with high comorbidity and associated with high 90-d mortality. The stable KP/EC-ratio and low occurrence of antimicrobial resistance in data from Karolinska University Hospital compared to aggregate data from 20 EARS-Net countries could be related to absence of clonal spread of multidrug-resistant KP.

Associations of independent living and labor force participation with impairment indicators in schizophrenia and bipolar disorder at 20-year follow-up.

BACKGROUND: Since the Iowa 500 study, residential and occupational status have been frequently used as indicators of everyday achievements in research on schizophrenia and bipolar disorder. The relationships of residential and occupational status with impairment in multiple domains including physical health indicators across these two diagnoses, however, have rarely been studied. We examined these relationships at the 20-year follow-up assessment of a first-admission sample. METHODS: We included 146 participants with schizophrenia and 87 with bipolar disorder with psychosis who participated in the 20-year follow-up of the Suffolk County Mental Health Project. In addition to interviewer-based ratings of employment and residential independence, we examined self-reported impairment derived from the WHODAS, standard measures of current psychopathology, indicators of obesity, as well as performance-based measures of physical and cognitive functioning. RESULTS: Participants with bipolar disorder were more likely to live independently and be gainfully employed; they also performed significantly better on each indicator of impairment apart from balance ability. In both groups, unemployment, but not residential independence, was associated with greater self-reported disability on the WHODAS. Residential independence, gainful employment, and subjective disability were also associated with better physical functioning. Across the two groups, psychiatric symptoms and physical functioning were the major determinants of subjective disability. DISCUSSION: People with psychotic bipolar disorder were more likely to be gainfully employed and living independently than participants with schizophrenia but as a group, much less frequently than population standards. Interventions aimed at physical fitness may have the potential to improve both objective functioning and perceived disability.

Toolkit for US colleges/schools of pharmacy to prepare learners for careers in academia.

INTRODUCTION: The objective of this article is to provide an academic toolkit for use by colleges/schools of pharmacy to prepare student pharmacists/residents for academic careers. METHODS: Through the American Association of Colleges of Pharmac (AACP) Section of Pharmacy Practice, the Student Resident Engagement Task Force (SRETF) collated teaching materials used by colleges/schools of pharmacy from a previously reported national survey. The SRETF developed a toolkit for student pharmacists/residents interested in academic pharmacy. RESULTS: Eighteen institutions provided materials; five provided materials describing didactic coursework; over fifteen provided materials for an academia-focused Advanced Pharmacy Practice Experiences (APPE), while one provided materials for an APPE teaching-research elective. SRETF members created a syllabus template and sample lesson plan by integrating submitted resources. Submissions still needed to complete the toolkit include examples of curricular tracks and certificate programs. DISCUSSION AND CONCLUSIONS: Pharmacy faculty vacancies still exist in pharmacy education. Engaging student pharmacists/residents about academia pillars of teaching, scholarship and service is critical for the future success of the academy.

Methods Used by Colleges and Schools of Pharmacy to Prepare Student Pharmacists for Careers in Academia.

Objective. To identify the methods used by US colleges and schools of pharmacy to prepare student pharmacists for academic careers. Method. An 18-item survey instrument was developed and distributed to US colleges and schools of pharmacy. Representatives were asked about faculty responsibilities, experiences in academia currently offered to student pharmacists, and representatives' perception of their student pharmacists' preparedness for careers in academia, including barriers in current programming. Results. Representatives from 96 colleges/schools responded. The vast majority (96%) provided academia-focused advanced pharmacy practice experiences (APPEs), 40% provided didactic coursework in academia, 28% offered a longitudinal research track, and 42% offered academia-focused independent studies. Teaching methods and creating learning objectives were the most common pedagogical content, while assessment activities were diverse. Time was the most prevalent barrier to providing training for academic careers; however, degree of student pharmacist interest, faculty inexperience, and lack of leadership support were also commonly reported. Conclusions: Colleges and schools of pharmacy vary in the extent to which they prepare student pharmacists for careers in academia. Advanced pharmacy practice experiences were the most common method of training offered. Standardization of training for academia may better promote this career path to student pharmacists.

Frequent acquisition of low-virulence strains of ESBL-producing Escherichia coli in travellers.

OBJECTIVES: International travel is a risk factor for intestinal colonization with ESBL-producing Enterobacteriaceae (EPE). This prospective cohort study focuses on molecular features of and risk factors for travel-acquired EPE. METHODS: Rectal swabs and survey data were collected from 188 Swedes travelling to four regions of high EPE prevalence. Samples were plated onto selective agars. ESBL producers were determined using phenotypic methods. Molecular characterization regarding virulence factors and phylogenetic grouping of ESBL-producing Escherichia coli was done using PCR. Isolates were also screened for the plasmid-mediated colistin resistance gene mcr-1. RESULTS: Among 175 pre-travel EPE-negative participants, 32% were positive upon return. No carbapenemase-producing Enterobacteriaceae were found, but one CTX-M-producing E. coli harboured mcr-1 (travel to Thailand). Most E. coli strains (43.1%) belonged to phylogroup A and were rarely associated with extraintestinal infections and a few (9.2%) expressed uropathogenicity pap genes. During 10-26 months of follow-up, no clinical infections were observed. Colonization rates varied by visited region: the Indian subcontinent, 49.2%; northern Africa, 44.0%; South-East Asia, 19.1%; and Turkey, 9.5%. Travellers' diarrhoea (OR 2.5, P = 0.04) or antimicrobial treatment during the trip (OR 5.9, P = 0.02) were both independent risk factors for EPE colonization. CONCLUSIONS: EPE acquired during travel have seemingly low pathogenicity, possibly indicating a low risk of clinical infection. Pre-travel advice should emphasize avoiding unnecessary antibiotic treatment during travel.

Challenges with Diagnosing and Managing Sepsis in Older Adults.

Sepsis in older adults has many challenges that affect rate of septic diagnosis, treatment, and monitoring parameters. Numerous age-related changes and comorbidities contribute to increased risk of infections in older adults, but also atypical symptomatology that delays diagnosis. Due to various pharmacokinetic/pharmacodynamic changes in the older adult, medications are absorbed, metabolized, and eliminated at different rates as compared to younger adults, which increases risk of adverse drug reactions due to use of drug therapy needed for sepsis management. This review provides information to aid in diagnosis and offers recommendations for monitoring and treating sepsis in the older adult population.

Mirtazapine-Associated Hypertriglyceridemia and Hyperglycemia.

The patient is a 75-year-old male who was admitted to the long-term care unit because of advancing dementia and was being treated with mirtazapine to improve his mood and stimulate his appetite. This case report outlines an interesting occurrence of hypertriglyceridemia followed by hyperglycemia, which resembled diabetes mellitus and required insulin therapy. The patient continued to have elevated triglyceride levels that persisted despite discontinuation of mirtazapine therapy.

Update on managing generalized anxiety disorder in older adults.

With the recent updates to the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5), there are many questions on how to care for older adults with generalized anxiety disorder (GAD) and other psychiatric conditions. The current article reviews the new changes to the DSM-5 for diagnosis of GAD, discusses new anxiety assessment scales that are validated in older adults, evaluates pharmacological agents that have been studied in older adults for GAD treatment, and provides monitoring recommendations to help those who provide care to older adults experiencing GAD.

Use of an interactive trivia game to increase knowledge and awareness of appropriate antibiotic use in community-dwelling older adults: a pilot survey.

OBJECTIVE: To assess change in knowledge and awareness of upper respiratory-tract infections (URTIs), and appropriate antibiotic use in community-dwelling older adults. DESIGN: Single group, pre- and post-test study. SETTING: Two independent senior living communities in Baltimore City and Baltimore County, Maryland. PARTICIPANTS: Older adults eligible to receive housing or other social services as defined by the study sites. INTERVENTION: Use of an interactive trivia game to educate older adults about URTIs. A 15-item pre- and postsurvey was administered to assess change in knowledge. OUTCOME MEASURES: Average change in pre- and postsurvey scores. RESULTS: Thirty-two seniors participated in the game intervention, with 18 completing both surveys. There was no significant difference in the total mean pre- versus postsurvey scores. Average scores of pre- and postsurveys were 9.28 and 9.17, respectively, out of 15 points (95% confidence interval 0.65 +/- 1.414; P = 0.76). Upon review of individual survey questions, two specific areas showed a significant improvement on postsurvey scores compared with baseline. Participants showed significant improvement, however, in knowledge regarding symptoms that may require the use of an antibiotic (P = 0.02) and symptomatic management of URTI symptoms (P = 0.045). CONCLUSIONS: Based on survey results, we learned more about older adults' knowledge regarding URTIs, antibiotic use, and strategies to provide education to community-dwelling geriatric adults. The game was effective in teaching older adults about symptom management and symptoms that may require an antibiotic.

Faecal carriage of extended-spectrum ß-lactamase-producing Enterobacteriaceae is common 12 months after infection and is related to strain factors.

We aimed to determine the duration of faecal carriage of extended-spectrum ß-lactamase (ESBL) -producing Enterobacteriaceae (EPE) in patients with clinical infection caused by an EPE, to study host strains during carriage, and to identify factors associated with prolonged carriage. Patients (n = 61) were followed with faecal samples and questionnaires about antimicrobial treatment and risk factors for EPE, 1, 3, 6 and 12 months after EPE infection. The EPE isolates were subjected to ESBL genotyping, epidemiological typing with pulsed-field gel electrophoresis and PCR-based replicon typing. Escherichia coli isolates were analysed with PCR for phylogrouping, detection of pabB (ST131) and virulence content. Patient-related and strain-related variables were compared for carriers and non-carriers at 12 months. Carriage of EPE was observed in 51 of 61 (84%) patients after 1 month, 36 of 61 (66%) after 3 months, 31 of 61 (55%) after 6 months and 26 of 61 (43%) after 12 months. Of the 26 carriers at 12 months, five had previous negative samples. In 17 of 61 patients, ESBL was found in a new bacterial species and/or strain during carriage. Among E. coli, 14 of 49 belonged to the international clone ST131. Phylogroup B2 and CTX-M-gr.-9 were associated with being carriers at 12 months (OR 4.3, 95% CI 1.1-16.3 and OR 6.4, 95% CI 1.3-30.9, respectively). In conclusion, EPE carriage is common 12 months after infection and persisting carriage may be associated with E. coli phylogroup B2 and CTX-M-gr.-9. The host strain frequently changes throughout carriage and negative samples do not imply eliminated carriage.