Risk assessment and genetic counseling for hematologic malignancies-Practice resource of the National Society of Genetic Counselors.

Hematologic malignancies (HMs) are a heterogeneous group of cancers impacting individuals of all ages that have been increasingly recognized in association with various germline predisposition syndromes. Given the myriad of malignancy subtypes, expanding differential diagnoses, and unique sample selection requirements, evaluation for hereditary predisposition to HM presents both challenges as well as exciting opportunities in the ever-evolving field of genetic counseling. This practice resource has been developed as a foundational resource for genetic counseling approaches to hereditary HMs and aims to empower genetic counselors who encounter individuals and families with HMs in their practice.

Implementation and evaluation of an interprofessional prescription writing workshop with a simulated electronic prescribing activity for preclerkship medical students.

BACKGROUND: Prescription writing skills are essential for physician practice. This study describes the development and implementation of a curricular intervention focused on improving the knowledge and confidence of preclerkship medical students' prescription writing practices utilizing an interprofessional education model, with a focus on electronic prescribing. METHODS: Medicine and Pharmacy Faculty from a large, urban university collaborated to develop the content of the workshop and a simulation platform was used for the e-prescribing activity. Second-year medical students attended a mandatory in-person workshop facilitated by fourth-year pharmacy students. A pre and post knowledge test and confidence survey were used to assess students' knowledge, confidence, and satisfaction. Outcomes from the knowledge test were evaluated with paired-samples proportions tests, and confidence survey data was evaluated with paired t-tests and Wilcoxon signed-rank tests in a pre-post study design. RESULTS: Students demonstrated a significant increase in prescription writing knowledge and confidence after completing the workshop. On the pre-test, 7% of students (21/284) completed the electronic prescribing assessment correctly and 51% of students (149/295) completed it correctly on the post-test. All items on the confidence survey showed a significant increase in pre- versus post-survey comparisons (p < 0.001). CONCLUSIONS: This interprofessional prescription writing workshop facilitated by pharmacy students shows promise for improving the knowledge and confidence of prescription writing and electronic prescribing practices in preclerkship medical students.

Selective Polyprotein Processing Determines Norovirus Sensitivity to Trim7.

Noroviruses are a leading cause of gastroenteritis worldwide, yet the molecular mechanisms of how host antiviral factors restrict norovirus infection are poorly understood. Here, we present a CRISPR activation screen that identifies mouse genes which inhibit murine norovirus (MNV) replication. Detailed analysis of the major hit Trim7 demonstrates a potent inhibition of the early stages of MNV replication. Leveraging in vitro evolution, we identified MNV mutants that escape Trim7 restriction by altering the cleavage of the viral NS6-7 polyprotein precursor. NS6, but not the NS6-7 precursor, directly binds the substrate-binding domain of Trim7. Surprisingly, the selective polyprotein processing that enables Trim7 evasion inflicts a significant evolutionary burden, as viruses with decreased NS6-7 cleavage are strongly attenuated in viral replication and pathogenesis. Our data provide an unappreciated mechanism of viral evasion of cellular antiviral factors through selective polyprotein processing and highlight the evolutionary tradeoffs in acquiring resistance to host restriction factors. IMPORTANCE To maximize a limited genetic capacity, viruses encode polyproteins that can be subsequently separated into individual components by viral proteases. While classically viewed as a means of economy, recent findings have indicated that polyprotein processing can spatially and temporally coordinate the distinct phases of the viral life cycle. Here, we present a function for alternative polyprotein processing centered on immune defense. We discovered that selective polyprotein processing of the murine norovirus polyprotein shields MNV from restriction by the host antiviral protein Trim7. Trim7 can bind the viral protein NS6 but not the viral precursor protein NS6-7. Our findings provide insight into the evolutionary pressures that define patterns of viral polyprotein processing and uncover a trade-off between viral replication and immune evasion.

Daily dynamics of contrasting spring algal blooms in Santa Monica Bay (central Southern California Bight).

Protistan algae (phytoplankton) dominate coastal upwelling ecosystems where they form massive blooms that support the world's most important fisheries and constitute an important sink for atmospheric CO2 . Bloom initiation is well understood, but the biotic and abiotic forces that shape short-term dynamics in community composition are still poorly characterized. Here, high-frequency (daily) changes in relative abundance dynamics of the metabolically active protistan community were followed via expressed 18S V4 rRNA genes (RNA) throughout two algal blooms during the spring of 2018 and 2019 in Santa Monica Bay (central Southern California Bight). A diatom bloom formed after wind-driven, nutrient upwelling events in both years, but different taxa dominated each year. Whereas diatoms bloomed following elevated nutrients and declined after depletion each year, a massive dinoflagellate bloom manifested under relatively low inorganic nitrogen conditions following diatom bloom senescence in 2019 but not 2018. Network analysis revealed associations between diatoms and cercozoan putative parasitic taxa and syndinean parasites during 2019 that may have influenced the demise of the diatoms, and the transition to a dinoflagellate-dominated bloom.

An Unmet Need Meets an Untapped Resource: Pharmacist-Led Pathways for Hypertension Management for Emergency Department Patients.

PURPOSE OF REVIEW: The purpose of this review is to describe the role of the pharmacist in innovative pathways of care for hypertension (HTN) management for emergency department (ED) patients, particularly in under-resourced communities. Due to intersecting socioeconomic and personal health risk factors, these patients bear a disproportionate share of cardiovascular disease, yet often have limited access to high-quality primary care. RECENT FINDINGS: Recent meta-analyses demonstrate a clear advantage associated with pharmacist-physician collaborative models over traditional physician-only care in achieving blood pressure control. However, no prior study has evaluated use of pharmacist-led follow-up for ED patients with uncontrolled blood pressure (BP). Thus, we developed a pharmacist-driven transitional care clinic (TCC) that utilizes a collaborative practice agreement with ED physicians to improve HTN management for ED patients. We have successfully implemented the TCC in a high-volume urban ED and in a pilot study have shown clinically relevant BP reductions with our collaborative model. The use of pharmacist-led follow-up for HTN management is highly effective. Novel programs such as our TCC, which extend the reach of such a model to ED patients, are promising, and future studies should focus on implementation through larger, multicenter, randomized trials. However, to be most effective, policy advocacy is needed to expand pharmacist prescriptive authority and develop innovative financial models to incentivize this practice.

Evaluation of a student pharmacist-led depression screening program in a community pharmacy.

Introduction: One in 5 adults in the United States have depression and are at risk for suicide, the 11th leading cause of death in the United States. Community pharmacy settings are ideal for increasing access to mental health services. Our objectives were to assess PHQ-9 scores and evaluate participant satisfaction in a student pharmacist-led depression screening program in a community pharmacy. Methods: Student pharmacists trained in mental health first aid recruited participants 18 to 90 years old in a community pharmacy to complete the PHQ-9 and provided mental health education, referrals, and resources. A 2-week follow-up was completed, and participants reported on actions taken since the initial visit. Descriptive statistics, independent t tests, and χ 2 tests were used in data analysis. Results: Twelve depression screening events were held, and 70 participants completed the screenings. The mean age was 52 years, and 75.7% were female. PHQ-9 scores ranged from 0 to 24 with an average of 3.96. Most participants (92.9%) reported the depression screening program was helpful. More than 90% of participants completed the 2-week follow-up, and 92.3% reported being comfortable seeking mental health services from a pharmacist. About half (53.8%) reported reading the educational materials, 24.6% helped a friend or family member, and 16.9% made an appointment with their health care provider. Discussion: Student pharmacists successfully provided depression screenings and mental health education in a community pharmacy. Most participants had low PHQ-9 scores, found the program helpful, and are willing to utilize mental health services in a community pharmacy.

pUdOs: Concise Plasmids for Bacterial and Mammalian Cells.

The plasmids from the Université d'Ottawa (pUdOs) are 28 small plasmids each comprising one of four origins of replication and one of seven selection markers, which together afford flexible use in Escherichia coli and several related gram-negative bacteria. The promoterless multicloning site is insulated from upstream spurious promoters by strong transcription terminators and contains type IIP or IIS restriction sites for conventional or Golden Gate cloning. pUdOs can be converted into efficient expression vectors through the insertion of a promoter at the user's discretion. For example, we demonstrate the utility of pUdOs as the backbone for an improved version of a Type III Secretion System reporter in Shigella. In addition, we derive a series of pUdO-based mammalian expression vectors, affording distinct levels of expression and transfection efficiency comparable to commonly used mammalian expression plasmids. Thus, pUdOs could advantageously replace traditional plasmids in a wide variety of cell types and applications.

A Qualitative Analysis of Community Participants' Experiences with a Virtual Interprofessional Team Visit (vIPTV) with Healthcare Students.

Healthcare students must develop essential interprofessional skills to provide efficient, safe, and effective patient-centered care. To ensure students receive the proper training to develop these skills, an interprofessional team visit (IPTV) program was established at a large urban university in 2011. The program involved teams of students from nine disciplines conducting home visits with community participants to provide patient-centered care and educational resources. During the COVID-19 pandemic, the IPTV program transitioned to a virtual delivery first piloted in 2020. The aims of this study were to evaluate the community participants' experiences with virtual IPTV (vIPTV), identify benefits and challenges related to transitioning from in-person to virtual delivery, and utilize participants' feedback to improve the IPTV program. Focus groups with 39 total participants were conducted in seven different sessions during December 2021 and January 2022. Qualitative analysis of the data showed that participants value the IPTV program, had positive experiences with the virtual delivery, and desire personalized interactions. Community participant's feedback can enhance virtual educational experiences for healthcare students' training.

Physiology governing diatom vs. dinoflagellate bloom and decline in coastal Santa Monica Bay.

Algal blooms on the Southern California coast are typically dominated by diatom and dinoflagellate taxa, and are governed by their physiological responses to environmental cues; however, we lack a predictive understanding of the environmental controls underlying the establishment and persistence of these distinct bloom events. In this study, we examined gene expression among the numerically dominant diatom and dinoflagellate taxa during spring upwelling bloom events to compare the physiological underpinnings of diatom vs. dinoflagellate bloom dynamics. Diatoms, which bloomed following upwelling events, expressed genes related to dissolved inorganic nitrogen utilization, and genes related to the catabolism of chitin that may have prolonged their bloom duration following nitrogen depletion. Conversely, dinoflagellates bloomed under depleted inorganic nitrogen conditions, exhibited less variation in transcriptional activity, and expressed few genes associated with dissolved inorganic nutrients during their bloom. Dinoflagellate profiles exhibited evidence of proteolysis and heterotrophy that may have enabled them to bloom to high abundances under depleted inorganic nutrients. Taken together, diatom and dinoflagellate transcriptional profiles illustrated guild-specific physiologies that are tuned to respond to and thrive under distinct environmental "windows of opportunity."

Comparison of student pharmacists' performance on in-person vs. virtual OSCEs in a pre-APPE capstone course.

INTRODUCTION: Objective structured clinical examinations (OSCEs,) provided in-person or virtually, assess student pharmacist readiness for advanced pharmacy practice experiences (APPEs). During the COVID-19 pandemic in 2020, it was necessary for many educators to design and implement virtual OSCEs (vOSCEs). Impact on student performance utilizing in-person vs. vOSCE has not been well evaluated. The objective of this study was to determine if a difference existed in student performance when comparing in-person vs. vOSCE in a third year (P3) pharmacy pre-APPE capstone course. METHODS: In winter 2019, four in-person OSCE stations were designed and implemented in a pre-APPE P3 capstone course. In winter 2021, the same four stations were transitioned into vOSCE stations. Assessment (summative) data from similar student cohorts from OSCE 2019 were compared vOSCE 2021 stations using Mann-Whitney U test. RESULTS: There was no meaningful difference found when comparing student performance on in-person OSCE vs. vOSCE. There was no significant difference for the number of students offered remediation. For most stations, performance improved from formative to summative assessments. CONCLUSIONS: Providing vOSCEs to assess students' skills in a pre-APPE P3 capstone course is a reasonable alternative to in-person OSCEs.

A Qualitative Analysis of Older Adults' Views of Healthcare Provider Attributes and Communication Skills.

Understanding factors that improve patients' healthcare experiences are essential for healthcare providers (HCPs) caring for older adults (OAs). Previous data supports that effective patient-centered care leads to a better understanding of patients' experiences, values, and preferences. The aim of this study was to evaluate OAs views of HCPs attributes and communication skills to better understand patient's views about their HCP interactions. Qualitative analysis of the data revealed five key themes that emerged: professionalism, patient rapport, patient-centered care, empathy, and communication. Addressing and optimizing performance in these areas could improve patient experiences and support enhanced training for healthcare students.

Near-Complete Proviral Genome Sequence of Reticuloendotheliosis Virus Isolated from an Attwater's Prairie Chicken (Tympanuchus cupido attwateri).

We report the near-complete proviral genome sequence of a reticuloendotheliosis virus isolated and propagated from an endangered Attwater's prairie chicken (Tympanuchus cupido attwateri) during a 2016-2017 outbreak at a captive breeding facility.

Implementation of Outpatient Pharmacist-led Hypertension Management for Under-Resourced Patients: A Pilot Study.

BACKGROUND: The purpose of this study was to implement and evaluate a pharmacist-led hypertension (HTN) program for under-resourced patients discharged from the emergency department (ED) or screened at community health events who are lacking a regular primary care provider (PCP) relationship. METHODS: This was a single arm, prospective, pilot study to recruit patients from the Detroit Medical Center (DMC) Sinai Grace Hospital (SGH) ED and community health events. The outpatient pharmacist-led transitional care clinic (TCC) was implemented through a collaborative practice agreement (CPA) with ED physicians. Eligible patients 18 to 60 years with elevated blood pressure (BP) (> 140/90 mmHg) and lacking a PCP relationship were referred to the TCC for HTN management. The primary outcome measure was change in systolic and diastolic BP (SBP and DBP). Difference in BP values was evaluated using Wilcoxon Signed Ranks test and descriptive statistics were used to explain demographic data. RESULTS: There were 116 patients enrolled May 2017 to August 2018; 44 (37.9%) completed visit one [cohort 1], 30 (25.9%) completed at least three visits [cohort 2], and 16 (13.8%) completed five visits [cohort 3]. Most patients were African American (AA) 97.7%, 47.8% were male, and an average of 42.11 (SD 9.70) years. For cohorts 2 and 3, there was significant reduction in BP between TCC visits one and two and the reduction was maintained through five visits for patients that remained in the study. Patients who completed five visits (n=16) showed a significant change from visit one to visit five in SBP of -23 mmHg (p=0.002) and achieved BP goal with an average SBP 139 mmHg (SD 19.33) and DBP 90 mmHg (SD 10.17). CONCLUSION: The pharmacist-led TCC was successfully implemented. Outpatient pharmacists collaborating with ED physicians increased access to HTN management with a positive impact on BP outcomes in an under-resourced population.

UCYN-A/haptophyte symbioses dominate N2 fixation in the Southern California Current System.

The availability of fixed nitrogen (N) is an important factor limiting biological productivity in the oceans. In coastal waters, high dissolved inorganic N concentrations were historically thought to inhibit dinitrogen (N2) fixation, however, recent N2 fixation measurements and the presence of the N2-fixing UCYN-A/haptophyte symbiosis in nearshore waters challenge this paradigm. We characterized the contribution of UCYN-A symbioses to nearshore N2 fixation in the Southern California Current System (SCCS) by measuring bulk community and single-cell N2 fixation rates, as well as diazotroph community composition and abundance. UCYN-A1 and UCYN-A2 symbioses dominated diazotroph communities throughout the region during upwelling and oceanic seasons. Bulk N2 fixation was detected in most surface samples, with rates up to 23.0 ± 3.8 nmol N l-1 d-1, and was often detected at the deep chlorophyll maximum in the presence of nitrate (>1 µM). UCYN-A2 symbiosis N2 fixation rates were higher (151.1 ± 112.7 fmol N cell-1 d-1) than the UCYN-A1 symbiosis (6.6 ± 8.8 fmol N cell-1 d-1). N2 fixation by the UCYN-A1 symbiosis accounted for a majority of the measured bulk rates at two offshore stations, while the UCYN-A2 symbiosis was an important contributor in three nearshore stations. This report of active UCYN-A symbioses and broad mesoscale distribution patterns establishes UCYN-A symbioses as the dominant diazotrophs in the SCCS, where heterocyst-forming and unicellular cyanobacteria are less prevalent, and provides evidence that the two dominant UCYN-A sublineages are separate ecotypes.

Emerging Topics in Vaccine Therapeutics for Adolescents and Adults: An Update for Immunizing Pharmacists.

Vaccine therapeutics and the practice of immunization provision are ever-changing. As pharmacy-based immunization services continue to flourish in the United States, more and more patients are requesting both routine and travel vaccines in community pharmacies. However, vaccine recommendations from the Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices (CDC/ACIP) can sometimes differ from product-specific US Food and Drug Administration (FDA)-indicated uses. In addition, changes in vaccine schedules, product availability, and disease outbreaks can present immunizing pharmacists with scenarios requiring a high level of clinical judgment. Thus, it is of paramount importance that all immunizing pharmacists maintain competency in the most recent evidence in vaccine therapeutics, as well as practice standards for vaccine provision and administration. This review provides an update of the most recent literature surrounding emerging topics in adolescent and adult immunizations-highlighting influential studies and recent developments in the prevention of herpes zoster, human papillomavirus (HPV), measles, mumps, rubella (MMR), meningococcal disease, tetanus, diphtheria, and pertussis. Key concepts discussed include the emergence of the new recombinant zoster vaccine (RZV), meningococcal vaccine product selection, MMR revaccination during disease outbreaks, tetanus vaccine product selection, and duration of pertussis immunity with vaccination.

Detection of Reticuloendotheliosis Virus in Muscovy Ducks, Wild Turkeys, and Chickens in Brazil.

Reticuloendotheliosis viruses (REVs) are known to cause immunosuppressive and oncogenic disease that affects numerous avian species. Reticuloendotheliosis viruses are present worldwide and recently have been reported in South America with cases of infected commercial flocks in Argentina. We surveyed for the presence of REV in birds from a state in the northern region of Brazil using real-time PCR. We report here the presence of REV in Brazil, detected in Muscovy Ducks (Cairina moschata), Wild Turkeys (Meleagris gallopavo), and chickens (Gallus gallus) at a relatively high prevalence (16.8%). Phylogenetic analysis indicated a close relationship of these strains to variants in the US. This study provides evidence of REV in the Amazon biome and provides a baseline for future surveillance of the virus in the region and throughout Brazil.

Discovery of several thousand highly diverse circular DNA viruses.

Although millions of distinct virus species likely exist, only approximately 9000 are catalogued in GenBank's RefSeq database. We selectively enriched for the genomes of circular DNA viruses in over 70 animal samples, ranging from nematodes to human tissue specimens. A bioinformatics pipeline, Cenote-Taker, was developed to automatically annotate over 2500 complete genomes in a GenBank-compliant format. The new genomes belong to dozens of established and emerging viral families. Some appear to be the result of previously undescribed recombination events between ssDNA and ssRNA viruses. In addition, hundreds of circular DNA elements that do not encode any discernable similarities to previously characterized sequences were identified. To characterize these 'dark matter' sequences, we used an artificial neural network to identify candidate viral capsid proteins, several of which formed virus-like particles when expressed in culture. These data further the understanding of viral sequence diversity and allow for high throughput documentation of the virosphere.

Survey of Reticuloendotheliosis Virus in Wild Turkeys (Meleagris gallopavo) in Texas, USA.

Reticuloendotheliosis virus (REV) is an immunosuppressive and sometimes oncogenic avian retrovirus that establishes lifelong infection in a wide range of avian species. REV-infected wild birds roaming near at-risk captive flocks, such as is the case for the highly endangered Attwater's Prairie Chicken (APC; Tympanuchus cupido attwateri), could act as a reservoir for viral transmission. In wild birds, prevalence rates of REV are low and appearance of associated disease is uncommon. During 2016-17, nearly half of all captive adult APC mortality at Fossil Rim Wildlife Center captive breeding facility in Glen Rose, Texas, US was attributed to REV infection. The unusually high REV prevalence rate prompted us to survey for this virus in wild galliforms throughout the region. From 2016-17, 393 blood samples collected from two subspecies of Wild Turkeys (Meleagris gallopavo) were tested for REV proviral DNA through amplification of the viral 3' long terminal repeat and segments of the viral pol gene. In REV-affected counties, 5% (5/98) of native Rio Grande Wild Turkeys (Meleagris gallopavo intermedia) were identified as REV-positive. In addition, we detected REV in one of 62 Eastern Wild Turkeys (Meleagris gallopavo silvestris) that had been imported during conservation efforts. To better determine protective measures, continued surveillance, including collection and genetic analysis of REV-infected samples, is necessary to identify sources of REV outbreaks in captive APC flocks.

Pharmacists' knowledge, support, and perceived roles associated with providing naloxone in the community.

INTRODUCTION: Prior to the Michigan naloxone standing order legislation, a sample of Michigan pharmacists was surveyed to (1) identify gaps in knowledge regarding naloxone: (2) assess supportive attitudes towards the standing order and; (3) determine perceived pharmacist roles when providing naloxone. METHODS: A 37-item survey was emailed to Michigan Pharmacist Association members (n = 2757), July to August 2016. Responses to knowledge, supportive attitude, and perceived roles items were analyzed using descriptive statistics and logistic regression. Significance set at p < 0.05. RESULTS: The useable response was 8% (n = 211), 92% white, 54% female, aged 46.5 ± 14.6 years. Knowledge: Eighty-five percent (179/211) agreed laypersons can administer naloxone. Sixty-four percent could identify an opioid overdose and 74% agreed with required pharmacist naloxone education; yet 20% had education. Supportive attitude: Eighty-seven percent (184/211) supported the standing order. Perceived role: Fifty-six percent agreed with responsibility for following patients after providing naloxone. Predictors of agreement were rural practice location (OR = 2.5; 95% CI 1.2-5.0, p = 0.01), and requiring naloxone education (OR = 3.0; 95% CI 1.3-6.8, p = 0.007). Having a Doctor of Pharmacy versus a Bachelor of Science Pharmacy degree decreased odds of agreement by 43.5% (OR = 0.435; 95% CI 0.221-0.857, p = 0.016). DISCUSSION: Timing of survey may explain the low number of trained respondents. The increased willingness of BS Pharmacists to follow patients may reflect longer practice and closer community ties. Limitations include low generalizability and small sample. CONCLUSION: A small representative sample of Michigan pharmacists is knowledgeable regarding naloxone and has supportive attitudes towards the standing order.