Pharmacoinformatics-enabled Interventions Improved Care Coordination and Identified Pharmacy-Related Safety Issues in a Multicultural Medicare Population.

BACKGROUND: Compared to White populations, multicultural older adults experience more gaps in preventive care (e.g., vaccinations, screenings, chronic condition monitoring), social determinants of health barriers (e.g., access to care, language, transportation), and disparities and inequities (e.g., comorbidities, disease burden, and health care costs). OBJECTIVES: This study aims to describe an informatics-based approach used to execute and evaluate results of a member-centric, pharmacoinformatics-informed engagement program to deliver culturally tailored microinterventions to close medication-related gaps in care utilizing multidisciplinary care coordination that leverages the expanded role of the pharmacist. The operational framework will be described, and the influence of the medication use processes will be reported in a multicultural Medicare Advantage cohort. METHODS: A pharmacoinformatics framework was leveraged to conduct a retrospective, observational cohort analysis of the program. Claims data were used to evaluate the influence of medication use process microinterventions from a large Medicare Advantage cohort of members who self-identify as Black and/or Hispanic, and have type 2 diabetes mellitus and/or hypertension, and meet eligibility criteria for multidisciplinary (e.g., nursing and pharmacy) care management (CM) and received pharmacy referral from January 1, 2022, through September 30, 2023. RESULTS: A total of 3,265 Medicare Advantage members (78.3% Black and 21.7% Hispanic) received CM and pharmacy referral. Pharmacovigilance reviews conducted during this timeframe identified 258 acute events that escalated member CM. Provider outreach (n = 185) informed of safety issues (drug duplication, n = 48; drug interactions, n = 21; drug-disease interactions, n = 5; noncompliance and/or dosing issues, n = 27). Outreach to members (n = 160) and providers (n = 164) informed of open quality-related measure gaps for medication adherence. CONCLUSION: The application of pharmacoinformatics by a payor-led multicultural clinical program demonstrated quality improvements in Medicare Advantage member identification including risk stratification, timely outreach for pharmacy-related safety issues, and improved efficiency of multidisciplinary care coordination involving medication use process workflows.

Planetary Protection Assessment of Radioisotope Thermoelectric Generator (RTG)-Powered Landed Missions to Ocean Worlds: Application to Enceladus.

Landed missions to icy worlds with a subsurface liquid water ocean must meet planetary protection requirements and ensure a sufficiently small likelihood of any microorganism-bearing part of the landed element reaching the ocean. A higher bound on this likelihood is set by the potential for radioisotope thermoelectric generator (RTG) power sources, the hottest possible landed element, to melt through the ice shell and reach the ocean. In this study, we quantify this potential as a function of three key parameters: surface temperature, ice shell thickness (i.e., heat flux through the shell), and thickness of a porous (insulating) snow or regolith cover. Although the model we describe can be applied to any ocean world, we present results in the context of a landed mission concept to the south polar terrain of Saturn's moon Enceladus. In this particular context, we discuss planetary protection considerations for landing site selection. The likelihood of forward microbial contamination of Enceladus' ocean by an RTG-powered landed mission can be made sufficiently low to not undermine compliance with the planetary protection policy.

Science Objectives for Flagship-Class Mission Concepts for the Search for Evidence of Life at Enceladus.

Cassini revealed that Saturn's Moon Enceladus hosts a subsurface ocean that meets the accepted criteria for habitability with bio-essential elements and compounds, liquid water, and energy sources available in the environment. Whether these conditions are sufficiently abundant and collocated to support life remains unknown and cannot be determined from Cassini data. However, thanks to the plume of oceanic material emanating from Enceladus' south pole, a new mission to Enceladus could search for evidence of life without having to descend through kilometers of ice. In this article, we outline the science motivations for such a successor to Cassini, choosing the primary science goal to be determining whether Enceladus is inhabited and assuming a resource level equivalent to NASA's Flagship-class missions. We selected a set of potential biosignature measurements that are complementary and orthogonal to build a robust case for any life detection result. This result would be further informed by quantifications of the habitability of the environment through geochemical and geophysical investigations into the ocean and ice shell crust. This study demonstrates that Enceladus' plume offers an unparalleled opportunity for in situ exploration of an Ocean World and that the planetary science and astrobiology community is well equipped to take full advantage of it in the coming decades.

The root of anomalously specular reflections from solid surfaces on Saturn's moon Titan.

Saturn's moon Titan has a methane cycle with clouds, rain, rivers, lakes, and seas; it is the only world known to presently have a volatile cycle akin to Earth's tropospheric water cycle. Anomalously specular radar reflections (ASRR) from Titan's tropical region were observed with the Arecibo Observatory (AO) and Green Bank Telescope (GBT) and interpreted as evidence for liquid surfaces. The Cassini spacecraft discovered lakes/seas on Titan, however, it did not observe lakes/seas at the AO/GBT anomalously specular locations. A satisfactory explanation for the ASRR has been elusive for more than a decade. Here we show that the ASRR originate from one terrain unit, likely paleolakes/paleoseas. Titan observations provide ground-truth in the search for oceans on exoearths and an important lesson is that identifying liquid surfaces by specular reflections requires a stringent definition of specular; we propose a definition for this purpose.

Protein Stability in Titan's Subsurface Water Ocean.

Models of Titan predict that there is a subsurface ocean of water and ammonia under a layer of ice. Such an ocean would be important in the search for extraterrestrial life since it provides a potentially habitable environment. To evaluate how Earth-based proteins would behave in Titan's subsurface ocean environment, we used molecular dynamics simulations to calculate the properties of proteins with the most common secondary structure types (alpha helix and beta sheet) in both Earth and Titan-like conditions. The Titan environment was simulated by using a temperature of 300 K, a pressure of 1000 bar, and a eutectic mixture of water and ammonia. We analyzed protein compactness, flexibility, and backbone dihedral distributions to identify differences between the two environments. Secondary structures in the Titan environment were found to be less long-lasting, less flexible, and had small differences in backbone dihedral preferences (e.g., in one instance a pi helix formed). These environment-driven differences could lead to changes in how these proteins interact with other biomolecules and therefore changes in how evolution would potentially shape proteins to function in subsurface ocean environments.