Student Pharmacist Perspectives of a Remote Ambulatory Care and Community Pharmacy Dual-Cohort APPE.

OBJECTIVE: The primary aim of the study is to describe the development and implementation of a remote required ambulatory care and required community pharmacy dual-cohort Advanced Pharmacy Practice Experience (APPE) rotation from the student pharmacist perspective. The secondary objective is to identify elements of a remote APPE to integrate into traditional onsite rotations. METHODS: An electronic post-survey was developed to evaluate rotation effectiveness based on the Center for the Advancement of Pharmacy Education (CAPE) outcomes, and to identify rotation attributes to inform future rotations. Students from different graduating classes on rotation between April and June 2020 participated in the survey. Likert-scale, ranked-response, and fixed-answer-choice questions were analyzed using descriptive statistics, and comparisons between cohorts and rotation groups were completed using the Chi-squared statistic (alpha .05). Open-ended questions were assessed for recurring themes. Study was exempted by university's Institutional Review Board. RESULTS: Twenty-four of 45 invited students completed the survey (53% response rate). Of the surveyed CAPE outcomes, agreement was highest (95.7%) that the rotation improved students' abilities within 1.1 Learner, 2.2 Manager, and 4.4 Professional subdomains. Diversity of experiences and topic discussions were elements most frequently identified for inclusion in future rotations. CONCLUSION: Student feedback was largely positive and indicated the remote APPE rotation experience was meaningful and improved abilities on key CAPE outcomes. Although remote rotations are unique, aspects including diverse learning experiences and preceptor collaboration may be considered for integration into traditional onsite rotations.

Rabbit Bot Fly Furuncular, Tracheopulmonary, and Human Bot Fly Infestations in Connecticut (Oestridae: Cuterebrinae).

Endemic and tropical human bot infestations are relatively uncommon or unreported in the United States. We report two cases in Connecticut: an unusual furuncular and respiratory myiasis by the rabbit bot Cuterebra buccata (Fab.) (Diptera: Oestridae) in a 74-yr-old male and a case of human bot fly, Dermatobia hominis (L.) (Diptera: Oestridae), myiasis in a 4-yr-old female with a tropical travel history with her family. Identification of C. buccata was based morphologically, in part, on spinal armature and further corroborated by DNA sequencing of the mitochondrial COI gene and comparison to the National Center for Biotechnology Information GenBank DNA sequence database. The resulting annotated sequence data were deposited into the National Center for Biotechnology Information GenBank. The unique medical aspects, and limitations and specifics on bot fly larval habits and identification are discussed.

Human immunoglobulin G responses to Cimex lectularius L. saliva.

AIMS: To investigate the immunoglobulin (Ig) G response after being fed upon by Cimex lectularius L. METHODS AND RESULTS: Participants were fed upon by three male C lectularius insects weekly for a month. Blood was obtained before the feeding and at the last feeding, which was used for immunoblots against bed bug salivary gland extract, with antihuman Immunoglobulin G (IgG) secondary antibodies. No consistent IgG changes developed in 11 humans serially fed upon by C lectularius. Two participants had new IgG responses to proteins at molecular weights of approximately 12-13 kDa, and one had an IgG response to a protein at approximately 40 kDa. At the last study visit, more intense IgG bands to proteins at molecular weights of 12-13 kDa had developed in 55% of participants (6/11) and at molecular weights of ≈30, ≈40 and ≈70 kDa in 45% (5/11) compared with the first study visit. Nitrophorin and apyrase were the most common C lectularius proteins identified with liquid chromatography-tandem mass spectrometry in both crushed bed bug salivary gland extract and post-bed bug feeding extract. CONCLUSIONS: Human participants did not have consistent IgG responses to crushed C lectularius salivary gland extract.

Xenointoxication of a Rabbit for the Control of the Common Bed Bug Cimex lectularius L. Using Ivermectin.

Human bed bug infestations have undergone a recent global resurgence. The human antiparasitic drug ivermectin has been proposed as a strategy to help control bed bug infestations, but in vivo data are lacking. We allowed separate populations of the common bed bug, Cimex lectularius L., to feed once on a rabbit before and after it was injected subcutaneously with 0.3 mg/kg of ivermectin, and bed bug morbidity and mortality were recorded. Ivermectin levels in the rabbit were measured using high-performance liquid chromatography and mass spectroscopy. Ivermectin blood levels of ∼2 ng/mL caused reductions in bed bug fecundity, and levels of >8 ng/mL caused bed bug death and long-term morbidity including reductions in refeeding, mobility, reproduction, and molting. Gut bacterial cultures from the fed bed bugs showed that ivermectin altered the bed bug gut microbiome.

A screen of pharmaceutical drugs for their ability to cause short-term morbidity and mortality in the common bed bug, Cimex lectularius L.

The common bed bug, Cimex lectularius L., is a hematophagous ectoparasite that preferentially feeds on humans. Pharmaceuticals present in a person's blood may adversely affect C. lectularius when it feeds. We fed >10,000 C. lectularius on blood samples containing more than 400 different drug doses and drug combinations using an in vitro feeding system to determine insect mortality. The majority of drug doses approximated the peak plasma concentration in humans taking those drugs. Twenty-one drugs were found to cause >17% 12-14-day mortality compared to 8.5% mortality in the control (p < 0.05), but postliminary testing of three of the drugs, famotidine, ethambutol, and primaquine, did not demonstrate an increase in C. lectularius mortality. We also tested 23 drugs for their effects on C. lectularius fecundity. The results may have implications for understanding C. lectularius population dynamics in an infestation.

Neuraminidase-based recombinant virus-like particles protect against lethal avian influenza A(H5N1) virus infection in ferrets.

Avian influenza A (H5N1) viruses represent a growing threat for an influenza pandemic. The presence of widespread avian influenza virus infections further emphasizes the need for vaccine strategies for control of pre-pandemic H5N1 and other avian influenza subtypes. Influenza neuraminidase (NA) vaccines represent a potential strategy for improving vaccines against avian influenza H5N1 viruses. To evaluate a strategy for NA vaccination, we generated a recombinant influenza virus-like particle (VLP) vaccine comprised of the NA protein of A/Indonesia/05/2005 (H5N1) virus. Ferrets vaccinated with influenza N1 NA VLPs elicited high-titer serum NA-inhibition (NI) antibody titers and were protected from lethal challenge with A/Indonesia/05/2005 virus. Moreover, N1-immune ferrets shed less infectious virus than similarly challenged control animals. In contrast, ferrets administered control N2 NA VLPs were not protected against H5N1 virus challenge. These results provide support for continued development of NA-based vaccines against influenza H5N1 viruses.

The First Evidence of Nanism in Ixodes (Ixodes) scapularis (Acari: Ixodidae), Found Parasitizing a Human Host.

Ixodes scapularis Say 1821, the primary vector of several human pathogens in the northeastern and upper Midwestern United States, has considerable genetic and morphological variation throughout its range. Recently, developmental or teratological abnormalities have been observed in this species for the first time, further complicating morphological identification. Here, we report the first evidence of nanism (dwarfism) in I. scapularis, found parasitizing a human host. We used molecular methods and scanning electron microscopy to identify the specimen. Morphological identification confirmed that the specimen is substantially smaller, approximately half the size, than a typical I. scapularis female. Here we discuss the recent reports of teratological abnormalities in I. scapularis, particularly from the Hudson River valley region of the northeastern United States, and highlight the need for additional studies of teratology in this important species and its potential implications in disease transmission.

Risk aversion and willingness to pay for water quality: The case of non-farm rural residents.

Stated choice experiments are used to investigate the economic valuation of rural residents living in the province of Quebec for water quality improvements. In Quebec, rural residents played an important role in the setting of stricter environmental regulations. Unlike most stated choice experiments about the valuation of improvements in water quality, this study explicitly accounts for risk in the design and analysis of choice experiments. Risk in phosphorus and coliform reductions is introduced through a three-point uniform distribution in the choice sets. The results show greater support for constant absolute risk aversion preferences than for constant relative risk aversion. Rural residents value coliform and phosphorus reductions and the more educated ones are particularly willing to see the government tax farmers and taxpayers to secure such reductions. As the science improves and risk in water quality outcomes decrease and as the political weight of non-farm rural residents increase, it should be easier for governments to replace voluntary cost-share programs by polluter-payer programs.

MERS-CoV spike nanoparticles protect mice from MERS-CoV infection.

The Middle East respiratory syndrome coronavirus (MERS-CoV) was first discovered in late 2012 and has gone on to cause over 1800 infections and 650 deaths. There are currently no approved therapeutics or vaccinations for MERS-CoV. The MERS-CoV spike (S) protein is responsible for receptor binding and virion entry to cells, is immunodominant and induces neutralizing antibodies in vivo, all of which, make the S protein an ideal target for anti-MERS-CoV vaccines. In this study, we demonstrate protection induced by vaccination with a recombinant MERS-CoV S nanoparticle vaccine and Matrix-M1 adjuvant combination in mice. The MERS-CoV S nanoparticle vaccine produced high titer anti-S neutralizing antibody and protected mice from MERS-CoV infection in vivo.

On the subtle tuneability of cellulose hydrogels: implications for binding of biomolecules demonstrated for CBM 1.

Cellulose-based hydrogel materials prepared by regeneration from cellulose solutions in ionic liquids, or ionic liquid containing solvent mixtures (organic electrolyte solutions), are becoming widely used in a range of applications from tissue scaffolds to membrane ionic diodes. In all such applications knowledge of the nature of the hydrogel with regards to porosity (pore size and tortuosity) and material structure and surface properties (crystallinity and hydrophobicity) is critical. Here we report significant changes in hydrogel properties, based on the choice of cellulose raw material (α- or bacterial cellulose - with differing degree of polymerization) and regeneration solvent (methanol or water). Focus is on bioaffinity applications, but the findings have wide ramifications, including in biomedical applications and cellulose saccharification. Specifically, we report that the choice of cellulose and regeneration solvent influences the surface area accessible to a family 1 carbohydrate-binding module (CBM), CBM affinity for the cellulose material, and rate of migration through the hydrogel. By regenerating bacterial cellulose in water, a maximum accessible surface area of 33 m2 g-1 was achieved. However, the highest CBM migration rate, 1.76 µm2 min-1, was attained by regenerating α-cellulose in methanol, which also resulted in the maximum affinity of the biomolecule for the material. Thus, it is clear that if regenerated cellulose hydrogels are to be used as support materials in bioaffinity (or other) applications, a balance between accessible surface area and affinity, or migration rate, must be achieved.

Toxicity and potential utility of ivermectin and moxidectin as xenointoxicants against the common bed bug, Cimex lectularius L.

The recent resurgence of the common bed bug Cimex lectularius L. throughout western industrialized nations has been facilitated in part by the insect becoming pesticide-resistant. Novel control strategies, including xenointoxication, should be considered to combat C. lectularius. Ivermectin, a U.S. Food and Drug Administration (FDA)-approved treatment for several human parasites, and the antiparasitic drug moxidectin, currently being explored in human clinical trials, were evaluated for efficacy against C. lectularius. Results showed that C. lectularius fed on ivermectin or moxidectin blood concentrations of >25 ng/mL and had significantly higher mortality (50-100 %) than controls (0-6 %) by day 13. Bed bugs that survived a blood meal containing >2.5 ng/mL of ivermectin suffered long-term sequelae including reduced fecundity, feeding difficulty, and incomplete ecdysis. Some insects that survived a blood meal containing ≤75 ng/mL moxidectin were able to feed and reproduce.

Paederus dermatitis in a seafarer diagnosed via telemedicine collaboration.

Seafarers are traveling workers, subject to unique exposures and generally isolated from adequate medical care. This case report of paederus dermatitis diagnosed at sea highlights the importance of a multidisciplinary diagnostic approach and telecommunication in providing remote medical advice to isolated traveling workers such as seafarers.

Prevalence of Disordered Eating and Its Association With Emotion Regulation in Female College Athletes.

The number of females participating in college sports in the U.S. has increased in last two decades. While female college athletes might be at a high risk, research examining disordered eating in this population is limited and difficult to summarize due to differences in methodologies. Factors contributing to disordered eating in female college athletes are not well established, but emotional regulation may be a potential correlate. The main purpose of this study was to examine the prevalence of disordered eating and explore potential differences between weight-sensitive and less weight-sensitive sports in a sample of female college athletes. The second purpose was to examine emotional regulation, body dissatisfaction, sport type, a family history of eating disorder, and BMI as potential predictors of disordered eating. The Eating Attitudes Test-26 and the Minnesota Eating Behavior Survey were used to estimate disordered eating prevalence in a sample of 151 athletes. Emotion regulation was assessed by the Difficulties in Emotion Regulation Scale. The prevalence of disordered eating was 6.6% and 10.6%, respectively, with no differences by sport type. The multiple regression model explained 11% of the EAT-26 variance, F(5, 150) = 3.74, p < .01. Greater emotional regulation difficulties (ß = .174, t = 2.191, p = .03) and body dissatisfaction (ß = .276, t = 2.878, p = .005) were significant predictors of disordered eating. Further examination of emotional regulation and body dissatisfaction in relation to disordered eating in female college athletes is warranted.

Recombinant virus-like particles elicit protective immunity against avian influenza A(H7N9) virus infection in ferrets.

In March 2013, diagnosis of the first reported case of human infection with a novel avian-origin influenza A(H7N9) virus occurred in eastern China. Most human cases have resulted in severe respiratory illness and, in some instances, death. Currently there are no licensed vaccines against H7N9 virus, which continues to cause sporadic human infections. Recombinant virus-like particles (VLPs) have been previously shown to be safe and effective vaccines for influenza. In this study, we evaluated the immunogenicity and protective efficacy of a H7N9 VLP vaccine in the ferret challenge model. Purified recombinant H7N9 VLPs morphologically resembled influenza virions and elicited high-titer serum hemagglutination inhibition (HI) and neutralizing antibodies specific for A/Anhui/1/2013 (H7N9) virus. H7N9 VLP-immunized ferrets subsequently challenged with homologous virus displayed reductions in fever, weight loss, and virus shedding compared to these parameters in unimmunized control ferrets. H7N9 VLP was also effective in protecting against lung and tracheal infection. The addition of either ISCOMATRIX or Matrix-M1 adjuvant improved immunogenicity and protection of the VLP vaccine against H7N9 virus. These results provide support for the development of a safe and effective human VLP vaccine with potent adjuvants against avian influenza H7N9 virus with pandemic potential.

An insect cell derived respiratory syncytial virus (RSV) F nanoparticle vaccine induces antigenic site II antibodies and protects against RSV challenge in cotton rats by active and passive immunization.

Post-infectious immunity to respiratory syncytial virus (RSV) infection results in limited protection as evidenced by the high rate of infant hospitalization in the face of high titer, maternally derived RSV-specific antibodies. By contrast, RSV fusion (F) glycoprotein antigenic site II humanized monoclonal antibodies, palivizumab and motavizumab, have been shown to reduce RSV-related hospitalization in infants. Immunogenicity and efficacy studies were conducted in cotton rats comparing a recombinant RSV F nanoparticle vaccine with palivizumab and controlled with live RSV virus intranasal immunization and, formalin inactivated RSV vaccine. Active immunization with RSV F nanoparticle vaccine containing an alum adjuvant induced serum levels of palivizumab competing antibody (PCA) greater than passive administration of 15 mg/kg palivizumab (human prophylactic dose) in cotton rats and neutralized RSV-A and RSV-B viruses. Immunization prevented detectable RSV replication in the lungs and, unlike passive administration of palivizumab, in the nasal passage of challenged cotton rats. Histology of lung tissues following RSV challenge showed no enhanced disease in the vaccinated groups in contrast to formalin inactivated 'Lot 100' vaccine. Passive intramuscular administration of RSV F vaccine-induced immune sera one day prior to challenge of cotton rats reduced viral titers by 2 or more log10 virus per gram of lung and nasal tissue and at doses less than palivizumab. A recombinant RSV F nanoparticle vaccine protected lower and upper respiratory tract against both RSV A and B strain infection and induced polyclonal palivizumab competing antibodies similar to but potentially more broadly protective against RSV than palivizumab.

Purified coronavirus spike protein nanoparticles induce coronavirus neutralizing antibodies in mice.

Development of vaccination strategies for emerging pathogens are particularly challenging because of the sudden nature of their emergence and the long process needed for traditional vaccine development. Therefore, there is a need for development of a rapid method of vaccine development that can respond to emerging pathogens in a short time frame. The emergence of severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003 and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in late 2012 demonstrate the importance of coronaviruses as emerging pathogens. The spike glycoproteins of coronaviruses reside on the surface of the virion and are responsible for virus entry. The spike glycoprotein is the major immunodominant antigen of coronaviruses and has proven to be an excellent target for vaccine designs that seek to block coronavirus entry and promote antibody targeting of infected cells. Vaccination strategies for coronaviruses have involved live attenuated virus, recombinant viruses, non-replicative virus-like particles expressing coronavirus proteins or DNA plasmids expressing coronavirus genes. None of these strategies has progressed to an approved human coronavirus vaccine in the ten years since SARS-CoV emerged. Here we describe a novel method for generating MERS-CoV and SARS-CoV full-length spike nanoparticles, which in combination with adjuvants are able to produce high titer antibodies in mice.

How many people inject insulin? UK estimates from 1991 to 2010.

AIMS: We set out to estimate the prevalence rate of insulin use in the UK population, the total number of people in the UK who use insulin, the proportion of users with type 1 and type 2 diabetes and changes between 1991 and 2010. METHODS: Patients receiving prescriptions for insulin were identified in the Clinical Practice Research Datalink and attributed a diagnosis of type 1 or type 2 diabetes. The annual prevalence of insulin use was calculated and applied to population data. RESULTS: The crude prevalence rate of insulin use increased from 2.43 (95% CI 2.38-2.49) per 1000 population in 1991 to 6.71 (6.64-6.77) per 1000 in 2010. The largest change was an increase in the prevalence of insulin users with a diagnosis of type 2 diabetes from 0.67 (0.64-0.70) to 4.34 (4.29-4.39) per 1000 population. The absolute number using insulin increased from 137 000 people (121 000-155 000) in 1991 to 421 000 (400 000-444 000) in 2010. The proportion taking insulin alone (as against combination with oral agents) decreased from 97% in the first decade to 37% in the second. CONCLUSION: The number of people using insulin trebled between 1991 and 2010, largely due to a considerable increase in the number of people with type 2 diabetes using insulin.