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Climate Justice
No full textNo little bit of climate change can be overlooked and action has never been as urgently needed as today. There is seemingly no end to the list of problems that have come about due to the detrimental effects climate change has caused in our environment. In every one of these climate change related causes, noticing how the underprivileged are more vulnerable is unavoidable. Thus, preparing resiliency strategies to be put in- to practice before future climate events is necessary in order to avoid potentially catastrophic impacts to our economy, environment and society. We will need to see more adaptive policies implemented in biodiversity, technology, finance, health and many others before we will become a proper climate resilient society
Comparison of Broth Microdilution Versus MicroScan Walkaway Antimicrobial Susceptibility Testing in Predicting Enterococcus Faecalis Penicillin Susceptibilities
No full textBackground: Borderline-penicillin-resistant Enterococcus faecalis decreases the activity of first-line treatment ampicillin-ceftriaxone. As borderline-penicillin resistance rates exceed 25% in New York City, E. faecalis penicillin susceptibility must be accurately identified. This study compares the accuracy of rapid MicroScan Walkaway system to gold standard broth microdilution (BMD) in predicting E. faecalis penicillin susceptibility by minimum inhibitory concentration (MIC). Methods: A total of 227 E. faecalis clinical blood isolates across two medical centers (Albany, NY; New York, NY) were assessed for penicillin susceptibility using BMD, per CLSI standards, and MicroScan Walkaway. Isolates were classified as penicillin-resistant (MIC ≥16 μg/mL) or - susceptible (MIC ≤8 μg/mL) in accordance with CLSI. Susceptible isolates were further classified as borderline-resistant (MIC 4-8 μg/mL) or susceptible (MIC ≤2 μg/mL). Essential agreement was calculated by counting isolates with MICs identical to or one dilution from BMD values, while categorical agreement involved counting isolates matching BMD’s susceptibility classifications. Essential and categorical agreements were analyzed to identify very major errors (MicroScan susceptible, BMD resistant), major errors (MicroScan resistant, BMD susceptible), or minor errors (borderline-resistant by one method but not the other). Acceptable performance was defined as ≤1.5% very major, ≤3.0% major, or ≤10% minor errors. Conclusion: Based on BMD, 74.9% of isolates were susceptible, 25.1% were borderline-resistant and none were resistant. Based on MicroScan, 81% of isolates were susceptible, 16.7% were borderline-resistant and 0.9% were resistant. MicroScan more often underestimated MICs (20.7%) than overestimated (7.9%). Essential agreement was obtained in 97.4% of isolates. Per CLSI breakpoints, 99.1% of isolates had categorical agreement, with two major errors identified (0.9%). When considering borderline-resistant isolates, categorical agreement was 89.4%, with one major error (0.4%) and 23 minor errors (10.1%). Based on CLSI breakpoint, MicroScan displayed acceptable performance, but it does not demonstrate acceptable performance in predicting borderline-resistant penicillin MICs
In-vitro time-kill assays and semi-mechanistic pharmacokinetic-pharmacodynamic modeling of a beta-lactam antibiotic combination against enterococcus faecalis: Optimizing dosing regimens for the geriatric population
Get PDFPharmacokinetic-pharmacodynamic (PKPD) modeling and simulation have emerged as pivotal tools in drug development and usage. Such models characterize typical trends in data and quantify the variability in relationships among dose, concentration, and desired effects. For antibacterial applications, models characterizing bacterial growth and antibiotic-induced bacterial killing offer insight into interactions between antibiotics, bacteria, and the host. Simulations from these models predict outcomes for untested scenarios, refine study designs, and optimize dosing regimens.
Enterococcus faecalis, a significant opportunistic bacterial pathogen with increasing clinical relevance, is commonly found in the gastrointestinal tract but can lead to severe infection, such as endocarditis. Treatments for E. faecalis endocarditis involves combination antibiotic therapy, such as beta-lactam antibiotics and aminoglycosides. However, due to the toxicity of aminoglycosides, the primary treatment is typically double beta-lactam therapy—ampicillin and ceftriaxone. Eradicating an E. faecalis infection typically requires a lengthy six-week course of antibiotic treatment. However, keeping patients in hospitals for such an extended duration is impractical. Therefore, the objective of this thesis project is to explore the extension of double beta-lactam therapy to outpatient antibiotic treatment (OPAT). This approach is gaining importance due to the rising risks of hospital-acquired infections and escalating healthcare expenses. Leveraging the stability of penicillin G, which can be stored at room temperature for extended periods, makes it a promising candidate for OPAT, offering potential benefits in terms of both efficacy and cost-effectiveness. Despite limited evidence for penicillin G plus ceftriaxone, this research successfully bridges the gap through in-vitro time-kill assays and the subsequent development of a semi-mechanistic model for this antibiotic combination against E. faecalis isolates.
This dissertation research evaluated 21 clinical strains of E. faecalis isolated from infected patients\u27 blood, sourced from Mount Sinai Health System and a hospital in Detroit as part of Dr. Jaclyn Cusumano’s American Association of Pharmacists (AACP) new investigator award research project. The first aim was to conduct susceptibility testing on these isolates. This testing played a pivotal role in guiding antibiotic therapy by determining a drug\u27s minimum inhibitory concentration (MIC) for a specific bacterial strain, offering insight into its effectiveness. The project highlights the importance of knowing a patient\u27s strain susceptibility since it influences the dosing regimen or treatment strategy. After susceptibility testing using broth microdilution techniques, strains were categorized as highly susceptible (MIC ≤ 2 μg/ml) or less susceptible (MIC = 4 μg/ml) to penicillin G.
The next phase of the project involved in-vitro time-kill assays—a gold standard method for testing antibiotic concentrations and synergy in combination therapies. All 21 patient isolates were tested with penicillin G monotherapy and in combination with ceftriaxone, along with testing ampicillin and ceftriaxone combination therapies for comparison. It was noted that both combinations showed efficacy for strains highly susceptible to penicillin G (MIC ≤ 2 μg/ml), exhibiting bactericidal and synergistic activity. However, both treatments demonstrated poor performance for the less susceptible strains (MIC = 4 μg/ml). This observation focuses on the importance of in-vitro pharmacodynamic studies in understanding antibiotic action dynamics, forming the basis for the semi-mechanistic model. These 24-hour time-kill assays strongly suggested further investigation into the penicillin G and ceftriaxone combination, while considering the differential effects of the combination on more and less susceptible strains. Semi-mechanistic models were created for two out of the twenty-one tested strains, one with high susceptibility and another with lower susceptibility, with the goal of understanding the bacterial growth and drug kill effect in greater detail along with testing different dosing regimens.
Following the typical progression of constructing a semi-mechanistic PK-PD model, a bacterial sub-model was created by employing intensive sampling during time-kill assays. This approach enabled the comprehension of the complete bacterial growth dynamics for both strains. By employing non-linear least squares regression within RStudio, the predictive model was effectively fitted to the observed data, providing estimates of essential bacterial growth parameters. The utilization of the Gompertz growth model yielded a remarkably close match between predicted and observed data, giving confidence in the accuracy of the estimated growth parameters.
Subsequently, the focus shifted to obtaining the most suitable pharmacodynamic (PD) parameters to accurately encapsulate the drug\u27s antibacterial effects. This necessitated the use of a mathematical model. A widely employed model for this purpose is the Sigmoidal Emax model—an empirical model that is widely published. This model emerged as a valuable tool for formalizing the interpretation of experimental data and understanding the influence of altering penicillin G concentrations, both individually and in conjunction with ceftriaxone.
Leveraging the data analysis capacity of RStudio, nonlinear least squares regression analysis was used to intricately fit the sigmoidal Emax equation to the observed data. This led to obtaining vital parameters, including Emax (maximum effect), EC50 (half-maximal effective concentration), and the sigmoidicity factor. Subsequent evaluation of goodness of fit based visual predictive checks and low standard errors in estimated parameters confirmed the favorable alignment between the predicted model and observed data.
Physiologically based pharmacokinetic (PBPK) modeling and simulation stands as a well-established approach that bridges insights from preclinical studies to clinical outcomes. By combining drug-specific information with a comprehensive understanding of physiological and biological processes at the organism level, PBPK models mechanistically depict the behavior of drugs within biological systems. This enables the a priori simulation of drug concentration-time profiles. What distinguishes PBPK modeling is its unique capability to account for physiological variations within specific populations, offering predictive insights into pharmacokinetics tailored to those groups. This thesis project ventured into two vital applications of PBPK models: extrapolating novel clinical scenarios and exploring pharmacokinetics in special populations, particularly the geriatric demographic.
With the aim of comprehending the pharmacokinetics of penicillin G and ceftriaxone, the project leveraged the Simcyp® Simulator, a modeling and simulation tool that is widely used in drug development. This platform pools the anatomical, physiological, drug-related, and trial design parameters to generate plasma drug concentration profiles. The simulated concentrations were compared against published data, with the fold error—a ratio of simulated to observed values—serving as a benchmark for model accuracy. Typically, predictions within a fold error range of 0.5 to 2 are deemed acceptable.
Upon verification within the healthy population, the models were extended to geriatric subjects utilizing the Simcyp® population library. The same fold error criteria were applied, and the models adeptly predicted concentrations across both young and elderly populations. Remarkable differences in pharmacokinetics were seen in the geriatric cohort compared to a young adult population. Notably, for penicillin G, the AUC increased by 46% in the elderly due to an almost 47% decline in total clearance, stemming from a 49% reduction in glomerular filtration rate (GFR).
Further expanding the PBPK model for penicillin G, the inclusion of a pharmacodynamic (PD) component led to the final goal of this project. Lua scripting in Simcyp® was utilized to build the PD model. This model used an equation that combined the bacterial growth model with the drug\u27s inhibitory effect via the Emax model. The impacts of monotherapy and combination were explored through the modulation of PD parameters. Consequently, when co-administered with ceftriaxone, kill rates for penicillin G increased, and IC50 values decreased, indicative of ceftriaxone\u27s augmentative effect. The free (unbound) plasma concentration-time profile from the developed PBPK model was linked as input to the PD model, facilitating testing and simulation of diverse penicillin G dosing regimens.
Notably, penicillin G, a time-dependent beta-lactam antibiotic, exhibited a strong correlation with the PK/PD index %fT\u3eMIC (% of the dosing interval with a free concentration above MIC). This was especially pertinent for high-susceptibility strains, wherein continuous infusion of penicillin G led to the most significant reduction in bacterial density, irrespective of combination therapy or monotherapy. However, for low-susceptibility strains, the scenario differed, revealing that reliance on a single PK/PD index is not all-encompassing.
For the geriatric population, the PBPK-PD model aligned with literature-backed dosing modifications for penicillin G. For highly susceptible strains, increasing the dosing interval or reducing the dose resulted in comparable reductions in bacterial density. Conversely, in low7 susceptibility strains, even an increase in AUC within the geriatric demographic failed to eradicate the bacteria.
In summary, this comprehensive thesis journey navigates through the in-vitro bacterial studies and pharmacokinetic-pharmacodynamic (PKPD) modeling and simulation. This project sheds light on the ability to integrate in-vitro data with PBPK models which not only predict untested scenarios but also help dosing strategies. Overall, by addressing the clinical challenge of E. faecalis infections, the project showcased the extension of double beta-lactam therapy to penicillin G and ceftriaxone combination through a stepwise development of semi-mechanistic PK/PD model
The effects of attachment insecurity and cognitive flexibility on mentalization in psychotherapists
Get PDFThe wounded healer concept suggests that one\u27s therapeutic ability is rooted in one\u27s own experiences of pain and suffering. The present study used this concept as a theoretical framework from which to explore issues related to therapist insecure attachment and therapist skill. It examined the role of therapist cognitive flexibility in the relationship between therapist attachment insecurity and therapist mentalization capacity. Participants were 158 therapists from different clinical fields of study and varying levels of clinical experience who completed an online protocol. Results indicated that avoidant attachment negatively predicted mentalization capacity, validating in a therapist sample what previous studies have demonstrated with non-therapist samples. Additionally, results showed that when therapists’ self-reported cognitive flexibility was high, the relationship between attachment anxiety and mentalization was negative, such that as attachment anxiety increased, mentalization capacity decreased. This was contrary to expectations. Finally, correlations revealed no relationships among a self-report, a neuropsychological, and an observer-rated measure of cognitive flexibility. This study was the first to validate the use of the Emotion Card Sort Test (ECST; Deveney & Deldin, 2006) (a modified version of the Wisconsin Card Sorting Test using emotional stimulus words) to assess cognitive flexibility in therapists. Additionally, it was the first to validate the use of the Reflective Functioning Scale (RFS; Fonagy et al., 1998) to code the Five-Minute Speech Sample (FMSS; Gottschalk & Gleser, 1969) in a therapist population. Implications for psychotherapy and psychotherapy training as well as study limitations and future directions for research are discussed
When east meets west: Filial modes and family functioning in second-generation Chinese-Americans
Get PDFDue to the global trend of population aging and the growing issue of elder care, research on filial norms are being conducted around the world (e.g., Lowenstein & Daatland, 2006). The current study is the first to examine filial piety in a sample of second-generation Chinese-Americans and added to the filial piety literature in four ways. First, the study confirmed both the two-factor structure of the Dual Filial Piety Scale (DFPS) with second-generation Chinese-Americans using a confirmatory factor analysis, with four items representing Reciprocal Filial Piety (RFP) and four items representing Authoritarian Filial Piety (AFP). Second, the study confirmed the identified four modes of filial interaction as conceptualized by Yeh and Bedford (2004): Absolute/Balanced (high RFP and AFP), Reciprocal (high RFP and low AFP), Authoritarian (low RFP and high AFP), and Non-Filial (low RFP and AFP). However, the study did not replicate Yeh and Bedford’s (2004) findings regarding differences in the four types of parent-child conflict amongst the four identified filial modes, where the Non-Filial mode did not have significantly different Demands Conflict with Desires (DCD) and Unreasonable Behavior (UB) type of parent-child conflict when compared to the other filial modes; the Balanced mode did not have significantly different DCD and UB types of parent-child conflict than the Reciprocal mode; and the Balanced mode did not report the lowest level of all four parent-child conflicts. Third, the study found significant differences in family functioning among the four identified filial modes. Fourth, this study found that a person’s mode of filial interaction and family functioning can be captured by their early memories. These findings highlight the importance of considering the concurrent influence of RFP and AFP to assess an individual’s overall family functioning
Predicting Gratitude Based on Personality Traits: A Meta-Analysis
Get PDFResearch demonstrates benefits of gratitude, ranging from health to behavior. Interventions can increase it, but gratitude also has trait-like properties. Although investigations of gratitude control for personality, the relationship of gratitude and other personality traits can provide insight into the nature of gratitude. We systematically searched PsycINFO, PsycArticles, PubMed, Scopus, and Web of Science according for empirical articles published in English prior to February 8, 2024. Out of 43 included studies, we examined thirty published studies that included correlations between gratitude and the dimension of the Big Five. Confidence intervals computed across studies suggest that gratitude is related with each dimension of the Big Five, with personality accounting for between 1.8% (neuroticism) and 8.6% (agreeableness) of the variance in gratitude. Additional analyses that examined how gratitude was measured suggest that measurement of gratitude moderates the association between gratitude and openness but not between gratitude and other personality traits. Results are discussed in terms of implications for the nature of gratitude. It is hoped that this collaborative project between librarian and faculty will serve as a model, encouraging more librarians to participate in systematic reviews and meta-analysis projects
TRANSFORMATIONAL LEADERSHIP BEHAVIORS OF DEPARTMENT LEADERS AS A PREDICTOR OF COLLECTIVE TEACHER EFFICACY
Get PDFResearchers generally credit Albert Bandura for providing the theoretical framework for studying collective teacher efficacy. Research shows that principals using transformational leadership behaviors significantly impact collective teacher efficacy. Policies, such as Every Student Succeeds Act, increasingly put pressure on school districts to improve student achievement or lose funding. Supporting literature and research shows that improving collective teacher efficacy improves student performance regardless of student socioeconomic status. Therefore, a department leader’s ability to increase collective teacher efficacy amongst staff directly influences the student achievement within their school district. This researcher investigated the relationship between transformational leader behaviors of department leaders and collective teacher efficacy. The Multi-Factor Leadership Questionnaire, developed by Bass and Avolio and the Collective Teacher Efficacy Scale short form, developed by Goddard and Hoy were distributed in two counties in New York state to determine if a correlation existed between the perceived department leader’s leadership style and the level of collective efficacy of the teacher. Evidence from the study indicates that transformational leadership behaviors and contingent reward behaviors associated with transactional leadership show statistical significance in improving collective teacher efficacy. This research will help school leaders and policymakers better expend resources fostering collective teacher efficacy. Lastly, it demonstrated the importance of department leaders and leadership behaviors that improve collective teacher efficacy, thereby improving student achievement
An ex-vivo investigation of the effect of skin conditioning with formulation vehicles on the dermal disposition of diphenhydramine perfused directly into the dermis
No full textIt is well known that the composition/excipients of a topical dermatological drug product (TDDP) affect the permeation of an active pharmaceutical ingredient (API) through the skin. While it is generally accepted that the vehicle mostly modulates the release of the API from the product, little is known whether the vehicle might also influence the kinetics of the API within the skin itself. In one attempt to answer this question, we developed an ex-vivo model using pig ear and a retrodialysis/microdialysis technique to deliver the API directly into dermis and measure the API dermal pharmacokinetics (dPK). We compared the dPK of a model API, Diphenhydramine (DPH), between the untreated skin (control) and the skin conditioned with common components of topical drug products (TDP) such as: jojoba oil, ethanol, glycerin, and petrolatum USP.
Fresh, full thickness pig ear were cut in 5x15 cm rectangles. In each trial, two pieces of skin were placed on a cellulose membrane atop of (37 ℃, pH 7.4) bath with the inner ear facing up. Eight microdialysis probes (1.7 cm dialysis window) were inserted in pair in each piece of skin. Then an adhesive chamber was placed on top of three pairs of probes and the cavity filled with 3 mL of vehicle, whereas the fourth pair served as control. In each trial, two vehicles were tested, three replicates each. Ethanol and jojoba oil were studied in 3 trials while petrolatum USP and glycerin were studied in another 3 trials. The application sites of the vehicles were randomized from one trial to another. Each microdialysis probe was perfused with a solution of DPH (10 µg/mL) in normal saline (NS) for 6 hours (retrodialysis or delivery phase) then the solution was switched to plain NS and sampling continued for an additional 12.5 hours (“disappearance” or microdialysis phase). Flow rate was 0.5 µL/min and samples were taken at 2, 3, 4, 6 time points over the first 6 hours and every 2 hours for the remainder of the experiment. The experiment was run for a total of 18.5 hours. Dialysate samples were analyzed with a validated HPLC assay. Probe depth and the corresponding total skin thickness for each probe were measured before and after the experiment with ultrasound. The “elimination rate constant” (z) was calculated from LN-transformed data collected from the terminal phase. Here, the elimination would be most correctly termed as disappearance since there is no blood circulation in an ex-vivo model. Dermis clearance (CL) was calculated as:
= 2−6 / 2−6
Where Dose is the dose delivered by retrodialysis during the 2-6 hr period and AUC is the corresponding area under the curve. Finally, apparent volume of distribution (Vd) was calculated as Vd = CL/z. One-way ANOVA was performed on the LN-transformed parameters; elimination half-life (HL), Vd, and CL. The P-value set for this analysis was 0.05.
Dermal pharmacokinetics parameters of DPH when treating the skin with jojoba oil or ethanol and petrolatum USP or glycerin were calculated. It was observed that HL of DPH was significantly decreased when skin was conditioned with petrolatum USP, ethanol, and jojoba oil compared to unconditioned skin. However, conditioning the skin with glycerin did not have any significant effect on the dermal HL of DPH compared to unconditioned skin. This study has shown that dermal formulation excipients may influence API’s disposition through the modulation of skin micro-structure
The Effects of Fearful vs. Dismissive Avoidance on Relationship Satisfaction in Gay and Lesbian Individuals: Early Maladaptive Schemas as a Mediating Factor
No full textResearch suggests that avoidant attachment plays an important role in the unique mental health and relational challenges faced by sexual minorities; however, few studies investigate differences between dismissive and fearful avoidant attachment in gay and lesbian individuals. The aim of the current study is to explore the mechanisms by which different types of attachment avoidance impact relationship satisfaction in gay and lesbian individuals. A sample of 262 gay- and lesbian-identifying participants between 18 and 69 years of age (M = 35.42, SD = 9.69) were recruited online and completed a series of questionnaires about their attachment style, relationship satisfaction, and early maladaptive schemas (EMS). We hypothesized that the relationship between dismissive avoidant attachment and relationship satisfaction would be significantly mediated by a) disconnection and rejection EMS and b) impaired limits EMS. Conversely, we hypothesized that the relationship between fearful avoidant attachment and relationship satisfaction would be significantly mediated by a) disconnection and rejection EMS and b) over-vigilance and inhibition EMS. Significant paths were found from both fearful and dismissive avoidance to decreased relationship satisfaction by disconnection and rejection EMS; however, neither over-vigilance and inhibition EMS nor impaired limits EMS mediated the relationship between types of avoidance and relationship satisfaction. Results and implications are dis- cussed
Assessment of Pharmacy Students’ Interest in a Pharmacy Technology and Automation Certificate Program
No full textIntroduction
Pharmacy automation has become an integral part of pharmacy practice, leveraging advanced technologies to improve the accuracy of medication dispensing and patient safety outcomes. Equipping pharmacy students with knowledge and skills related to pharmacy automation will better prepare them for optimizing workflows as future pharmacists. This study aimed to evaluate PharmD students\u27 interest in a voluntary pharmacy technology and automation certificate program.
Methods
In September 2023, an anonymous survey was distributed to third-year pharmacy students at LIU Pharmacy. The survey comprised of a maximum of 28 questions and was administered through CampusLabs: Baseline. The questionnaire collected students’ demographics and assessed their prior experience using pharmacy automation technology. Additional questions concerned students’ level of interest in completing a pharmacy technology and automation certificate program and in specific pharmacy automation topics.
Results
Of 172 third-year students, 155 (90%) responded to the survey. Fifty-one students (33%) possessed a prior academic degree and 16 (10%) were enrolled in a shared-credit program. Seventy-seven (50%) students planned to pursue additional training or education after completing the PharmD program. Of 153 respondents, 107 (70%) reported previous experience with pharmacy automation technology and rated their level of experience as beginner (20%), intermediate (51%), advanced (22%), or expert (7%). Exposure to pharmacy automation technology primarily occurred through introductory pharmacy practice experiences (66%) and/or through working in a pharmacy setting (52%). Of 153 respondents, 146 (95%) expressed interest in completing the program. Motivations for participation included enhancing effectiveness and versatility as future practitioners (64%) and increasing the likelihood of securing pharmacist positions post-graduation (61%).
Conclusion
Almost all PharmD students surveyed expressed interest in completing a certificate pro- gram in pharmacy technology and automation. These findings reflect students’ recognition of the expanding role of automated technology in pharmacy practice. Study insights will guide the program\u27s development to better serve pharmacy students