Scaling technician product verification: Contextual analysis for developing an implementation strategy for a large community pharmacy chain.

OBJECTIVE: To identify facilitators and barriers of early implementation of a technician product verification (TPV) program in a large community pharmacy chain. METHODS: A mixed-methods (surveys, semistructured interviews, and nondisguised direct observation) approach was used to ascertain facilitators and barriers to implementation and to subsequently develop a scalable implementation strategy with the aim to accelerate TPV scalability across a large community pharmacy chain in states where it is permitted. One-on-one staff interviews and observations provided qualitative data to identify facilitators and barriers to TPV. A Web-based survey was used to gather perceptions on a variety of implementation strategies that would make use of identified facilitators and work to overcome identified barriers. RESULTS: During the mixed-method study, 3 key themes emerged: TPV is a complex intervention whose implementation is facilitated by both adaptability and trialability and is highly dependent on state practice regulations; the implementation climate of the pharmacy organization serves as a facilitator to TPV; and individual beliefs about TPV change over time as implementation experience increases. CONCLUSION: TPV is an expansion of the technician role that allows the profession of pharmacy to increase the provision of clinical activities by delegation of a nonclinical-based task. Early adopters of TPV recognize that verification is a task that is increasingly automated by mail-order pharmacies and that verification may no longer be considered a pharmacist task. Pharmacies in this study tended to revert to comfortable, traditional workflow at the first sign of distress. To be successful in the future, TPV should be thought of as the primary workflow procedure and not as an option. TPV is a service that will require staff buy-in, patience, and championship.

Real-time toxicity and metabolic activity tracking of human cells exposed to Escherichia coli O157:H7 in a mixed consortia.

Escherichia coli O157:H7 is a significant human pathogen that is continually responsible for sickness, and even death, on a worldwide scale. While the pathology of E. coli O157:H7 infection has been well studied, the effect of it's multiple resulting cytotoxic mechanisms on host metabolic activity has not been well characterized. To develop a more thorough understanding of these effects, several bioluminescence assays were evaluated for their ability to track both toxicity and host metabolic activity levels in real-time. The use of continuously autobioluminescent human cells was determined to be the most favorable method for tracking these metrics, as its self-sufficient autobioluminescent phenotype was unaffected by the presence of the infecting bacteria and its signal could be measured without cellular destruction. Using this approach, it was determined that infection with as few as 10 CFU of E. coli O157:H7 could elicit cytotoxic effects. Regardless of the initial infective dose, an impact on metabolic expression was not observed until bacterial populations reached levels between 5 × 10(5) and 1 × 10(6) (R(2) = 0.933), indicating that a critical bacterial infection level must be reached prior to the onset of cytotoxic effects. Supporting this hypothesis, it was found that cells displaying infection-mediated metabolic activity reductions could recover to wild type metabolic activity levels if the infecting bacteria were removed prior to cell death. These results indicate that rapid treatment of E. coli O157:H7 infection could serve to limit host metabolic impact and reduce overall host cell death.

Cloning and functional characterizations of an apoptogenic Hid gene in the Scuttle Fly, Megaselia scalaris (Diptera; Phoridae).

Although the mechanisms of apoptotic cell death have been well studied in the fruit fly, Drosophila melanogaster, it is unclear whether such mechanisms are conserved in other distantly related species. Using degenerate primers and PCR, we cloned a proapoptotic gene homologous to Head involution defective (Hid) from the Scuttle fly, Megaselia scalaris (MsHid). MsHid cDNA encodes a 197-amino acid-long polypeptide, which so far is the smallest HID protein. PCR analyses revealed that the MsHid gene consists of four exons and three introns. Ectopic expression of MsHid in various peptidergic neurons and non-neuronal tissues in Drosophila effectively induced apoptosis of these cells. However, deletion of either conserved domain, N-terminal IBM or C-terminal MTS, abolished the apoptogenic activity of MsHID, indicating that these two domains are indispensable. Expression of MsHid was found in all life stages, but more prominently in embryos and pupae. MsHid is actively expressed in the central nervous system (CNS), indicating its important role in CNS development. Together MsHID is likely to be an important cell death inducer during embryonic and post-embryonic development in this species. In addition, we found 2-fold induction of MsHid expression in UV-irradiated embryos, indicating a possible role for MsHid in UV-induced apoptosis.