Combining Passive Sampling with Suspect and Nontarget Screening to Characterize Organic Micropollutants in Streams Draining Mixed-Use Watersheds.

Organic micropollutants (OMPs) represent an anthropogenic stressor on stream ecosystems. In this work, we combined passive sampling with suspect and nontarget screening enabled by liquid chromatography-high-resolution mass spectrometry to characterize complex mixtures of OMPs in streams draining mixed-use watersheds. Suspect screening identified 122 unique OMPs for target quantification in polar organic chemical integrative samplers (POCIS) and grab samples collected from 20 stream sites in upstate New York over two sampling seasons. Hierarchical clustering established the co-occurrence profiles of OMPs in connection with watershed attributes indicative of anthropogenic influences. Nontarget screening leveraging the time-integrative nature of POCIS and the cross-site variability in watershed attributes prioritized and confirmed 11 additional compounds that were ubiquitously present in monitored streams. Field sampling rates for 37 OMPs that simultaneously occurred in POCIS and grab samples spanned the range of 0.02 to 0.22 L/d with a median value of 0.07 L/d. Comparative analyses of the daily average loads, cumulative exposure-activity ratios, and multi-substance potentially affected fractions supported the feasibility of complementing grab sampling with POCIS for OMP load estimation and screening-level risk assessments. Overall, this work demonstrated a multi-watershed sampling and screening approach that can be adapted to assess OMP contamination in streams across landscapes.

Organic Micropollutants in New York Lakes: A Statewide Citizen Science Occurrence Study.

The widespread occurrence of organic micropollutants (OMPs) is a challenge for aquatic ecosystem management, and closing the gaps in risk assessment of OMPs requires a data-driven approach. One promising tool for increasing the spatiotemporal coverage of OMP data sets is through the active involvement of citizen volunteers to expand the scale of OMP monitoring. Working collaboratively with volunteers from the Citizens Statewide Lake Assessment Program (CSLAP), we conducted the first statewide study on OMP occurrence in surface waters of New York lakes. Samples collected by CSLAP volunteers were analyzed for OMPs by a suspect screening method based on mixed-mode solid-phase extraction and liquid chromatography-high resolution mass spectrometry. Sixty-five OMPs were confirmed and quantified in samples from 111 lakes across New York. Hierarchical clustering of OMP occurrence data revealed the relevance of 11 most frequently detected OMPs for classifying the contamination status of lakes. Partial least squares regression and multiple linear regression analyses prioritized three water quality parameters linked to agricultural and developed land uses (i.e., total dissolved nitrogen, specific conductance, and a wastewater-derived fluorescent organic matter component) as the best combination of predictors that partly explained the interlake variability in OMP occurrence. Lastly, the exposure-activity ratio approach identified the potential for biological effects associated with detected OMPs that warrant further biomonitoring studies. Overall, this work demonstrated the feasibility of incorporating citizen science approaches into the regional impact assessment of OMPs.

Provision of Clinical Preventive Services by Community Pharmacists.

Community pharmacists are highly accessible health care professionals, providing opportunities for partnerships with other health care and public health professionals to expand the population's access to clinical preventive services. To document examples of the community pharmacist's role in providing clinical preventive services to the general population, we conducted PubMed searches using the key word "community pharmacy" and key words from the US Preventive Services Task Force recommendations rated A or B. We present 4 descriptive summaries of clinical preventive services that can be offered by community pharmacists. Community pharmacists can provide clinical preventive services such as providing education, conducting screenings, and making referrals to improve population health.

Self-testing and self-management of warfarin anticoagulation therapy in geriatric patients.

Although anticoagulation therapy with warfarin is necessary for many patients, the burden of frequent clinic visits for monitoring of therapy can pose a potential problem for some older adults. As self-monitoring of warfarin therapy has grown in popularity, a recent meta-analysis has reviewed data relating to self-testing and self-management of anticoagulation therapy. This same study also analyzed outcomes in the elderly, finding a potential benefit for self-monitoring in this population. This potential benefit, combined with the difficulties many elderly patients have attending clinic visits because of a lack of mobility or unavailability of transportation, makes self-monitoring of warfarin a viable option for carefully selected elderly patients. Pharmacists can play a vital role in educating patients about self-monitoring of oral anticoagulation therapy as well as identifying those elderly patients who are good candidates for its use.

New statin labeling requirements: an overview.

As pharmacists advocate for appropriate use of medications to ensure safety and efficacy for patients, labeling requirements for medications should be considered before patients start new therapies or make changes to their current therapies. In early 2012, the Food and Drug Administration released new mandatory labeling requirements for HMG-CoA reductase inhibitors (more commonly known as "statins") regarding hepatic dysfunction, cognitive impairment, and glycemic control. These requirements are based on a combination of studies, adverse-event reporting databases, and literature reviews. Pharmacists should be prepared to advocate for patient safety and be ready to inform patients and other health care providers of the new labeling requirements and the role pharmacists can play in altering current statin therapy.

Impact of a pharmacist-directed educational program on the long-term knowledge and use of folic acid among college women: a 12-month follow-up study.

UNLABELLED: Few studies have examined the impact of educational interventions on participants' long-term knowledge and use of folic acid for prevention of neural tube defects (NTD). OBJECTIVE: The objective of this pilot study was to evaluate changes in knowledge and behaviors in a sample of college women one year after such a program. METHODS: Female students of a residential college campus voluntarily attended the event, which was advertised to the campus community as a women's health seminar. Participants completed a multiple-choice test assessing knowledge of folic acid and NTD and frequency of multivitamin use before and immediately after a 30-minute oral presentation. Following 3 reminder messages sent via email or mail, knowledge and multivitamin use were re-assessed 1-month and 12-months post-intervention. RESULTS: Thirty-two college women participated in the educational intervention; 27 (84%) completed the 12-month post-test. At 12 months, statistically significant increases in knowledge from baseline remained for questions pertaining to food high in folic acid (p=0.023); completion of spinal column (p=0.011); and 2 questions on NTD prevention (p=0.044). Increases in knowledge regarding recommended daily allowance of folic acid (p=0.817) and difficulty in receiving adequate folic acid from diet alone (p=0.617) were not statistically significant from baseline. Regular multivitamin use (≥4 times per week) was not statistically significantly increased from baseline (p=0.592). CONCLUSIONS: Although it was encouraging that the women retained much of the information learned during the program, it appears that the changes in multivitamin use seen at 1-month were not sustained at 12-months. Further study with larger groups of college women is recommended.

Design and implementation of a pharmacist-directed preventive care program.

PURPOSE: The design and implementation of pharmacist-directed preventive care services within a university-based, employee health and wellness clinic are described. SUMMARY: Ohio Northern University (ONU) HealthWise is a multidisciplinary employee health and wellness clinic located on the campus of ONU that offers medication therapy management, disease management, nutrition counseling, and physical wellness coaching services. A pharmacist-directed preventive care program based on recommendations from the U.S. Preventive Services Task Force (USPSTF) was designed for incorporation into the clinic. Using an electronic search tool provided by USPSTF, pharmacists are able to provide a review of recommended preventive services that are appropriate for each individual patient. Whenever possible, pharmacists within the clinic perform the screenings and other interventions that are recommended by USP-STF; when necessary, patients are referred to other health care providers to receive recommended interventions. To date, nine patients have participated in the preventive care program. For these nine patients 112 recommendations have been reviewed by pharmacists in the clinic. Of these, 16 were found to be inappropriate after further discussion with the patients and 36 were verified as already completed by the patient, resulting in a total of 60 unmet recommendations. Of these 60, 52 recommendations were met through interventions by the pharmacist in the clinic, while 5 possible screenings were declined by patients and 3 unmet recommendations required referral to a provider outside of the clinic. CONCLUSION: A pharmacist-directed preventive care service offered within an employee health clinic helped ensure that employees receive appropriate screenings and preventive care according to current guidelines.

Knowledge and use of folic acid among college women: a pilot health promotion program led by pharmacy students and faculty.

UNLABELLED: As pharmacists and pharmacy students are increasingly called upon to assume roles in public health activities, it is important to recognize unique opportunities to educate community members on health, wellness, and disease prevention. OBJECTIVE: To evaluate the impact of a pilot health promotion program on college women's knowledge regarding folic acid and prevention of neural tube defects (NTD) and frequency of multivitamin use. METHODS: A health promotion program was developed by a pharmacy student and two pharmacy faculty members that included an oral presentation and reminder messages. A multiple-choice test assessing knowledge of folic acid and NTD and frequency of multivitamin use was given to participants before and immediately after the presentation. Participants then received a reminder message regarding folic acid once a week for three weeks. Knowledge and multivitamin use were reassessed four weeks post-intervention. RESULTS: Thirty-two college women voluntarily attended the oral presentation. Twenty-five women (78.2%) completed the four-week post-test. Compared to the pre-test, there were statistically significant increases in average test score (p<0.0001) and correct responses to questions regarding folic acid and NTD (p<0.05 for each question). Participants reported a statistically significant increase in regular (≥4 times/week) multivitamin use (p=0.023). CONCLUSION: Participants in the pilot health promotion program demonstrated a statistically significant increase in knowledge about folic acid and frequency of multivitamin use. A similarly-modeled health promotion program may be an effective way of increasing folic acid and NTD knowledge and changing behaviors of multivitamin use in college women.