The loss of OPA1 accelerates intervertebral disc degeneration and osteoarthritis in aged mice.

NP cells of the intervertebral disc and articular chondrocytes reside in avascular and hypoxic tissue niches. As a consequence of these environmental constraints the cells are primarily glycolytic in nature and were long thought to have a minimal reliance on mitochondrial function. Recent studies have challenged this long-held view and highlighted the increasingly important role of mitochondria in the physiology of these tissues. However, the foundational understanding of mechanisms governing mitochondrial dynamics and function in these tissues is lacking. We investigated the role of mitochondrial fusion protein OPA1 in maintaining the spine and knee joint health in mice. OPA1 knockdown in NP cells altered mitochondrial size and cristae shape and increased the oxygen consumption rate without affecting ATP synthesis. OPA1 governed the morphology of multiple organelles, including peroxisomes, early endosomes and cis-Golgi and its loss resulted in the dysregulation of NP cell autophagy. Metabolic profiling and 13C-flux analyses revealed TCA cycle anaplerosis and altered metabolism in OPA1-deficient NP cells. Noteworthy, Opa1AcanCreERT2 mice with Opa1 deletion in disc and cartilage showed age-dependent disc degeneration, osteoarthritis, and vertebral osteopenia. Our findings underscore that OPA1 regulation of mitochondrial dynamics and multi-organelle interactions is critical in preserving metabolic homeostasis of disc and cartilage.

Individual Optimization of Reproductive Investment and the Cost of Incubation in a Wild Songbird.

AbstractDespite avid interest in life history trade-offs and the costs of reproduction, evidence that increased parental allocation reduces subsequent breeding productivity is mixed. This uncertainty may be attributable to environmental heterogeneity in space and time, necessitating experiments across a range of ecological contexts. Over three breeding seasons, we cross-fostered clutches between nests to manipulate incubation duration in a wild population of Carolina wrens, a species in which only females incubate, to test for a cost of incubation on current and future reproduction. Prolonged incubation affected maternal productivity in a manner dependent on the current environment and initial investment in eggs, suggesting that incubation is optimized according to other components of reproduction and individual quality. Effects of incubation duration on foster nestling condition varied between years, being costly in one, beneficial in another, and neutral in the third. The proportion of young fledged, females' probability of breeding again within seasons, and subsequent clutch sizes all declined with increasing incubation effort-effects that became more pronounced as seasons progressed. Therefore, costs of incubation were almost entirely dependent on maternal quality and environmental variation, illustrating the importance of conducting experiments across a range of environmental settings for understanding the costs of reproduction and evolution of life histories.

OPA1 protects intervertebral disc and knee joint health in aged mice by maintaining the structure and metabolic functions of mitochondria.

Due to their glycolytic nature and limited vascularity, nucleus pulposus (NP) cells of the intervertebral disc and articular chondrocytes were long thought to have minimal reliance on mitochondrial function. Recent studies have challenged this long-held view and highlighted the increasingly important role of mitochondria in the physiology of these tissues. We investigated the role of mitochondrial fusion protein OPA1 in maintaining the spine and knee joint health in aging mice. OPA1 knockdown in NP cells altered mitochondrial size and cristae shape and increased the oxygen consumption rate without affecting ATP synthesis. OPA1 governed the morphology of multiple organelles, and its loss resulted in the dysregulation of NP cell autophagy. Metabolic profiling and 13 C-flux analyses revealed TCA cycle anaplerosis and altered metabolism in OPA1-deficient NP cells. Noteworthy, Opa1 AcanCreERT2 mice showed age- dependent disc, and cartilage degeneration and vertebral osteopenia. Our findings suggest that OPA1 regulation of mitochondrial dynamics and multi-organelle interactions is critical in preserving metabolic homeostasis of disc and cartilage. Teaser: OPA1 is necessary for the maintenance of intervertebral disc and knee joint health in aging mice.

Practitioner Burnout and Productivity Levels in Skilled Nursing and Assisted Living Facilities, Part 1: A Descriptive Quantitative Account.

IMPORTANCE: Understanding burnout among practitioners in skilled nursing facilities (SNFs) and assisted living facilities (ALFs) while considering contextual factors may lead to practices that enhance therapist and patient satisfaction as well as quality of care. OBJECTIVE: To examine productivity standards and burnout in the context of setting and role, as reported by therapy practitioners in geriatric settings, and to explore relationships between productivity standards and perceived ethical pressures. DESIGN: Cross-sectional online survey with descriptive data. PARTICIPANTS: Practitioners (N = 366) included occupational therapists, physical therapists, speech-language pathologists, and occupational and physical therapy assistants working in SNFs and ALFs in the United States. A survey integrating the Maslach Burnout Inventory: Human Services Survey for Medical Personnel (MBI-HSS) and questions addressing demographics and contextual factors was distributed via social media. RESULTS: Of 366 practitioners, 20.5% were burned out, exhibiting extreme scores for Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) on the MBI-HSS. Significant relationships between productivity requirements and EE, DP, and PA, after accounting for covariates, were evident. Significant relationships between productivity standards and five of the six ethically questionable behaviors existed. Role affected productivity requirements, specifically between therapists and assistants, whereas setting did not. CONCLUSIONS AND RELEVANCE: Productivity standards and related pressures are associated with concerning aspects of burnout among practitioners working in geriatric settings. Advocating for change in defining productivity and incorporating positive support in the work environment may assist in reducing burnout and turnover rates and improve patient satisfaction and care. Plain-Language Summary: This research highlights the prevalence of burnout and perceived pressures related to productivity requirements among occupational therapy practitioners working in skilled nursing and assisted living facilities.

Implementation of a mobile health clinic framework for Hepatitis C virus screening and treatment: a descriptive study.

Background: Although treatment for Hepatitis C Virus (HCV) is effective, individuals face access barriers. The utility of mobile health clinics (MHC), effective mechanisms for providing healthcare to underserved populations, is understudied for HCV-related interventions. We aimed to describe implementation of, and factors associated with, screening and treatment via MHCs. Methods: Clemson Rural Health implemented a novel MHC program to reach and treat populations at-risk for HCV with a focus on care for uninsured individuals. We examined HCV screening and treatment initiation/completion indicators between May 2021 and January 2023. Findings: Among 607 individuals screened across 31 locations, 94 (15.5%) tested positive via antibody and viral load testing. Treatment initiation and completion rates were 49.6% and 86.0%, respectively. Among those screened, the majority were male (57.5%), White (61.3%; Black/Hispanic: 28.2%/7.7%), and without personal vehicle as primary transportation mode (54.4%). Injection drug use (IDU) was 27.2% and uninsured rate was 42.8%. Compared to HCV-negative, those infected included more individuals aged 30-44 (52.1% vs. 36.4%, p = 0.023), male (70.2% vs. 55.2%, p = 0.009), White (78.5% vs. 60.2%, p < 0.0001), without personal vehicle (58.5% vs. 43.5%, p = 0.028), IDU (83.7% vs. 21.0%, p < 0.0001), and uninsured (61.2% vs. 48.8%, p = 0.050). Uninsured rates were higher among those initiating compared to not initiating treatment (74.5% vs. 45.3%, p = 0.004). Interpretation: The MHC framework successfully reaching its target population: at-risk individuals with access barriers to healthcare. The high HCV screening and treatment initiation/completion rates demonstrate the utility of MHCs as effective and acceptable intervention settings among historically difficult-to-treat populations. Funding: Gilead Sciences, Inc., and SC Center for Rural and Primary Healthcare.

Cartilage-specific Sirt6 deficiency represses IGF-1 and enhances osteoarthritis severity in mice.

OBJECTIVES: Prior studies noted that chondrocyte SIRT6 activity is repressed in older chondrocytes rendering cells susceptible to catabolic signalling events implicated in osteoarthritis (OA). This study aimed to define the effect of Sirt6 deficiency on the development of post-traumatic and age-associated OA in mice. METHODS: Male cartilage-specific Sirt6-deficient mice and Sirt6 intact controls underwent destabilisation of the medial meniscus (DMM) or sham surgery at 16 weeks of age and OA severity was analysed at 6 and 10 weeks postsurgery. Age-associated OA was assessed in mice aged 12 and 18 months of age. OA severity was analysed by micro-CT, histomorphometry and scoring of articular cartilage structure, toluidine blue staining and osteophyte formation. SIRT6-regulated pathways were analysed in human chondrocytes by RNA-sequencing, qRT-PCR and immunoblotting. RESULTS: Sirt6-deficient mice displayed enhanced DMM-induced OA severity and accelerated age-associated OA when compared with controls, characterised by increased cartilage damage, osteophyte formation and subchondral bone sclerosis. In chondrocytes, RNA-sequencing revealed that SIRT6 depletion significantly repressed cartilage extracellular matrix (eg, COL2A1) and anabolic growth factor (eg, insulin-like growth factor-1 (IGF-1)) gene expression. Gain-of-function and loss-of-function studies in chondrocytes demonstrated that SIRT6 depletion attenuated, whereas adenoviral overexpression or MDL-800-induced SIRT6 activation promoted IGF-1 signalling by increasing Aktser473 phosphorylation. CONCLUSIONS: SIRT6 deficiency increases post-traumatic and age-associated OA severity in vivo. SIRT6 profoundly regulated the pro-anabolic and pro-survival IGF-1/Akt signalling pathway and suggests that preserving the SIRT6/IGF-1/Akt axis may be necessary to protect cartilage from injury-associated or age-associated OA. Targeted therapies aimed at increasing SIRT6 function could represent a novel strategy to slow or stop OA.

Equine-assisted services for individuals with substance use disorders: a scoping review.

The implementation of equine-assisted services (EAS) during treatment for psychological disorders has been frequently documented; however, little is known about the effect of EAS on outcomes for populations with substance use disorder (SUD). The purpose of this scoping review was to synthesize existing literature reporting the effects of EAS when incorporated into SUD treatment. This review followed guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for scoping reviews. A search of four databases (MEDLINE/PubMed, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Academic OneFile) identified studies reporting quantitative and/or qualitative data for an EAS intervention that was implemented among a population receiving treatment for and/or diagnosed with SUD. Of 188 titles, 71 underwent full-text assessment and six met inclusion criteria. Three additional articles were identified through other sources. Quantitative data suggested a potential positive effect of EAS on SUD treatment retention and completion as well as participants' mental health; however, studies were limited by small sample sizes. Qualitative data indicated that in addition to participants developing bonds with the horses and perceiving EAS as welcomed breaks from traditional treatment, they experienced increased self-efficacy, positive emotional affect, and SUD treatment motivation. Due to methodological limitations and an overall dearth of available studies, the effectiveness of EAS as adjuncts to SUD treatment is inconclusive. Additional research is necessary before supporting broad implementation of EAS as adjuncts to SUD treatment.

Rationale, design, and methodology of a randomized pilot trial of an integrated intervention combining computerized behavioral therapy and recovery coaching for people with opioid use disorder: The OVERCOME study.

Background: Opioid use disorder (OUD) has led to a staggering death toll in terms of drug-related overdoses. Despite the demonstrated benefits and effectiveness of buprenorphine, retention is suboptimal, and patients typically present with high rates of ongoing polysubstance use during treatment. A pilot trial provided preliminary support for the efficacy of computer-based cognitive-behavioral therapy (CBT4CBT) as an add-on to buprenorphine in reducing substance use. Recovery coaching services provided by individuals with substance use experience and successful recovery have also shown to positively influence recovery outcomes for people with OUD by increasing buprenorphine initiation and reducing opioid use. Methods: The OVERCOME study is a randomized clinical trial (RCT) aimed to tests an integrated intervention combining CBT4CBT and Recovery Coaching relative to treatment-as-usual (TAU) among individuals with OUD on buprenorphine. The primary outcome measure is the percentage of samples with any drug tested as positive at each research visit conducted during treatment (visits 1 to 8). Secondary outcomes include the percentage of samples with any drug tested as positive at 1- and 3- month follow-up and retention to buprenorphine at 3- month follow-up. Results: We describe the rationale, design, and methodology of the OVERCOME Study. Conclusion: This trial will provide evidence of the efficacy of an integrated intervention combining CBT4CBT and Recovery Coaching for reducing substance use and increasing buprenorphine adherence which has the potential to reduce mortality among people with OUD.

Effectiveness of peer recovery support services on stages of the opioid use disorder treatment cascade: A systematic review.

BACKGROUND: Peer recovery support services (PRSS) have been increasingly incorporated during the recovery process for opioid use disorder (OUD), yet little is known about the effects of PRSS on clinical outcomes of individuals who misuse opioids. This study systematically synthesized existing literature reporting the effectiveness of PRSS interventions on stages of the OUD treatment cascade. METHODS: A search conducted on five databases identified studies from database inception to January 26th 2021 that evaluated the effects of PRSS on PRSS engagement, medication for OUD (MOUD) initiation, MOUD retention, opioid and non-opioid misuse, and remission. Characteristics of PRSS interventions, study design, and clinical outcomes were extracted. Methodological quality was assessed with the quality assessment tool for quantitative studies by the Effective Public Health Practice Project. RESULTS: Of 123 titles, 22 were subjected to full-text review and 12 ultimately met inclusion criteria. Only two studies were randomized control trials, half compared the outcomes of PRSS participants to those of a counterfactual group. Most PRSS were unstandardized and broadly described, involving linkage to treatment (91.7%) or follow-up support (91.7%). MOUD initiation was reported the most often (66.7%), followed by PRSS engagement (33.3%) and opioid use (25.0%). No studies reported findings for MOUD retention or remission. Findings for available outcomes were inconsistent and difficult to compare due to the heterogeneity of PRSS interventions and methodological limitations. CONCLUSION: Effectiveness of PRSS interventions on stages of the OUD treatment cascade remain inconclusive. Additional research is necessary before supporting the implementation of PRSS on a broad scale.

Parental favoritism in a wild bird population.

In most taxa with altricial young, offspring solicit food from their parents using a combination of visual and acoustic stimuli, but exactly what these young are communicating, and how selection shapes parental responses, remains unresolved. Theory posits that parents' interpretation and response to begging should vary with the likelihood of a return on their investment. We tested this in a wild population of prothonotary warblers (Protonotaria citrea), predicting that parents bias food non-randomly toward certain individuals within their broods depending on both the size and number of offspring. We observed parent-offspring interactions and detected strong dependence between brood size and nestling size in shaping parental responses to begging. Larger siblings were less likely to solicit food during feeding events than their smaller siblings, but they received a disproportionate share from parents in nests containing fewer-than-average young, whereas the smaller-than-average nestlings were disproportionately fed in broods containing a greater-than-average number of young. These findings suggest that parents respond to begging signals according to multiple social cues, favoring the stronger siblings with greater survival prospects when few copies of their genes are present, but overtly favoring runts to ensure whole-brood survival when capable of fledging more young. Future experimental studies may shed light on the contributions of parental decision-making and memory, how young nestlings learn in parent-offspring communication systems, and the adaptive significance of these behaviors.

Does Emotion Regulation Mediate the Relation Between Family-of-Origin Violence and Intimate Partner Violence?

Family-of-origin violence (FOV), including child maltreatment and exposure to interparental violence during childhood, is frequently cited as a risk factor for intimate partner violence (IPV) in adulthood. Emotion regulation (ER) difficulties have been linked to FOV and to IPV, but research has not identified the role of ER as a mechanism by which past exposure to FOV predicts current IPV. The current study examines whether greater FOV predicts ER difficulties, whether these difficulties can explain/mediate the relationship between FOV and IPV, and whether the process differs according to the gender of parent-child dyads. Emerging adult participants (475 women, 145 men) aged 18 to 30 years, who were in a current romantic relationship lasting at least 3 months, completed measures of past FOV, current difficulties in ER, and IPV perpetrated and experienced in current intimate relationships. ER difficulties mediated the relationship between FOV and current IPV; however, differences among specific types of FOV and gender were noted. Results support an intergenerational transmission of family violence and suggest that parent-child gender dyads influence this process.

Bridging Systems to Implement HIV/STI Programming Within the Juvenile Justice System: Strengths and Challenges of a Local Change Team Approach.

Justice-involved youth are at risk for HIV/STIs but do not access services. The complex challenges of improving the delivery of health-related services within juvenile justice (JJ) settings warrant exploration of strategies to close this service gap. This study describes the successes and challenges of utilizing a local change team (LCT) strategy comprising JJ and health agency staff to implement HIV/STI programming in JJ settings, across six counties in six states in the U.S. Five focus groups comprising n = 28 JJ and health agency staff who served as LCT members were conducted. Results demonstrated the structured nature of the collaborative process and strength of commitment among LCT members were necessary for successful implementation of HIV/STI programming. The use of LCTs comprising membership of JJ and (behavioral) health systems has broader applicability to other health and behavioral health issues faced by youth on probation that JJ staff may feel ill equipped to address.

Reconceptualization of emotion regulation: strategy use, flexibility, and emotionality.

BACKGROUND AND OBJECTIVES: Previous research has identified associations between emotion regulation strategy use patterns and emotional and behavioral functioning outcomes. The current study examined the construct of ER by integrating ER strategy use with flexibility to use strategies and overall level of experienced emotion to determine patterns of ER functioning. DESIGN: Self-report data regarding strategy use, flexibility, and affect intensity was collected from undergraduate psychology students (N = 380). METHODS: A latent profile analysis (LPA) was used to identify a profile structure of ER. Multivariate Analysis of Variance (MANOVA) was used to examine the effect of ER profile on the following outcomes: ER difficulties, internalizing problems, and externalizing behaviors. RESULTS: The LPA supported a 3-profile and a 6-profile model. MANOVA results indicated that the 3-profile model and the 6-profile model predicted outcomes of ER difficulties and internalizing and externalizing behaviors. CONCLUSIONS: The 3-profile model demonstrated greater separation of profiles than the 6-profile model, whereas the 6-profile model demonstrated more nuanced profiles than the 3-profile model. Overall, our results suggest that integrating strategy use, flexibility, and emotionality yields profiles of ER that can be used for better prediction of functioning than using strategy use alone.

Confidence in skills applied to patient care among PharmD students in telehealth medication management programs versus other settings.

INTRODUCTION: Exposure to medication therapy management (MTM) courses has demonstrated to increase student pharmacist's confidence in the application of patient care skills. The purpose of this study was to evaluate the effects of student pharmacists' work experience in a telehealth MTM program, versus hospital or community settings, on their confidence in skills applied in patient care. METHODS: This was a cross-sectional multicenter survey. Confidence in patient care among student pharmacists was assessed between those who worked in a telehealth MTM program versus other settings. The data was evaluated using Chi-Square, Fisher exact, unpaired-t, Kruskal-Wallis, and Mann-Whitney U tests. RESULTS: 282 surveys were completed. First-year student pharmacists who worked in the telehealth MTM programs, versus other settings, were more confident in the provision of a comprehensive medication review (CMR) (p < .001), interviewing patients (p < .001), identifying medication errors (p < .001), and making therapeutic recommendations to patients (p = .04) and prescribers (p = .04). Second and third-year student pharmacists who worked in telehealth MTM programs, versus other settings, were more confident in the provision of a CMR (p ≤ .005). Fourth-year student pharmacists who worked in the telehealth MTM programs, versus other settings, were more confident in the provision of a CMR (p = .003), interviewing patients (p = .02), and identifying medication errors (p = .04). CONCLUSION: Student pharmacists' participation in a telehealth MTM program may markedly increase their confidence in skills applied in patient care. MTM work experience should be offered to student pharmacists during their PharmD programs to enhance their confidence in the provision of patient care.

The Effect of Plan Type and Comprehensive Medication Reviews on High-Risk Medication Use.

BACKGROUND: In 2007, the Centers for Medicare & Medicaid Services (CMS) instituted a star rating system using performance outcome measures to assess Medicare Advantage Prescription Drug (MAPD) and Prescription Drug Plan (PDP) providers. OBJECTIVE: To assess the relationship between 2 performance outcome measures for Medicare insurance providers, comprehensive medication reviews (CMRs), and high-risk medication use. METHODS: This cross-sectional study included Medicare Part C and Part D performance data from the 2014 and 2015 calendar years. Performance data were downloaded per Medicare contract from the CMS. We matched Medicare insurance provider performance data with the enrollment data of each contract. Mann Whitney U and Spearman rho tests and a hierarchical linear regression model assessed the relationship between provider characteristics, high-risk medication use, and CMR completion rate outcome measures. RESULTS: In 2014, an inverse correlation between CMR completion rate and high-risk medication use was identified among MAPD plan providers. This relationship was further strengthened in 2015. No correlation was detected between the CMR completion rate and high-risk medication use among PDP plan providers in either year. A multivariate regression found an inverse association with high-risk medication use among MAPD plan providers in comparison with PDP plan providers in 2014 (beta = -0.358, P < 0.001) and 2015 (beta = -0.350, P < 0.001), the CMR completion rate in 2015 (beta = -0.221, P < 0.001), and enrollee population size in 2015 (beta = -0.203, P = 0.001). CONCLUSIONS: This study found that MAPD plan providers and higher CMR completion rates were associated with lower use of high-risk medications among beneficiaries. DISCLOSURES: No outside funding supported this study. Silva Almodovar reports a fellowship funded by SinfoniaRx, Tucson, Arizona, during the time of this study. The other authors have nothing to disclose.

Peer, social media, and alcohol marketing influences on college student drinking.

OBJECTIVE: To investigate how alcohol marketing and peers may promote college students' alcohol use through social media. PARTICIPANTS: College students (N = 682) aged 18 to 22 years from a large Southern university completed paper surveys in April 2014. METHODS: Structural equation modeling was used to investigate relationships among variables as well as moderation by gender and race. RESULTS: Drinking behavior was directly related to perceived norms and attitudes toward alcohol that develop, in part, from direct and indirect interactions with their online and offline peers, as well as engagement with alcohol-related content on social media. Gender and ethnicity moderated some effects. CONCLUSIONS: College student drinking is influenced by friends' alcohol-related content posted on social networking sites and by greater engagement with traditional and online alcohol marketing. College campus alcohol misuse interventions should include components to counter peer influences and alcohol marketing on social media.

Impact of telephonic comprehensive medication reviews on patient outcomes.

OBJECTIVES: The majority of studies on medication therapy management (MTM) have focused on the conduct of in-person comprehensive medication reviews (CMRs). Although face-to-face MTM services may be the most well-known mode of delivery, there are other ways CMRs can be implemented as part of an MTM service. Specifically, telephonic CMR is an alternative method of offering MTM services that many patients may welcome. The purpose of this commentary was to highlight current findings regarding the impact of telephonic CMRs as a component of MTM services on health outcomes. STUDY DESIGN: Review of available literature analyzing the impact of telephonic CMRs on health outcomes. METHODS: PubMed was used to identify studies published between January 1980 and December 2016 using the search terms medication therapy management (MTM), telephonic MTM, comprehensive medication reviews, and targeted medication reviews. This search was limited to publications in English. Case reports were excluded. RESULTS: CMRs conducted telephonically as part of an MTM program may potentially reduce healthcare expenditures, hospitalizations, and mortality. CONCLUSIONS: Although study results have shown telephonic CMRs to be an effective way to enhance patient care and reduce healthcare expenditures, the components of telephonic MTM programs that make them most effective and the population on which they have the greatest impact are unknown. Moving forward, further evaluation of these programs is necessary to determine which specific factors, such as access to patient electronic health records, patient follow-up frequency, and the use of collaborative practice agreements, are most vital to improving patient outcomes.

Managerial skills of new practitioner pharmacists within community practice.

OBJECTIVES: To identify managerial skills required in community pharmacy practice, explore new practitioners' previous exposure to these skills, and assess new practitioners' perceived preparedness to take on managerial responsibilities. METHODS: A survey was developed with the use of Qualtrics and distributed by state pharmacy associations using a convenience sample of pharmacists from Iowa, Kentucky, Michigan, Ohio, and Pennsylvania. Pharmacists not practicing in a community pharmacy setting at the time of the study were excluded. New practitioners were defined as pharmacists practicing for no more than 10 years. RESULTS: A total of 168 pharmacists completed the survey. More than one-half (56%) of respondents self-reported being in a managerial position, and 90% of respondents thought that managerial skills were always or very often necessary. At graduation, 15% of respondents rated their managerial skill proficiency to be high to very high, with this increasing to 57% at current point in their career. When comparing managers versus non-managers, 78% of skills assessed showed higher utilization in managers. Interestingly, only 44% of skills showed a higher proficiency in managers. Finally, 88% of respondents thought that their managerial skills could be improved. CONCLUSION: New practitioners in community practice reported a high utilization of managerial skills, as well as improved proficiency throughout their careers. These skills are important in both community pharmacy training and practice. Managers reported higher utilization of managerial skills, but that utilization did not always correlate with proficiency. This highlights the need to further identify and improve managerial skills during pharmacy education and as part of ongoing continuing professional development.