Atrazine is an herbicide that is widely used in crop production at about 70 million pounds per year in the United States. Its widespread use has led to contamination of groundwater and other aquatic systems. It has resulted in many serious environmental and human health issues. This study focuses on the identification and characterization of a single-stranded DNA (ssDNA) aptamer that binds to atrazine. In this study, a variation of the systematic evolution of ligands by exponential enrichment (SELEX) process was used to identify an aptamer, which binds to atrazine with high affinity and specificity. This SELEX focused on inducing the aptamer’s ability to change conformation upon binding to atrazine, and stringent negative target selections. After 12 rounds of in vitro selection, the ssDNA aptamer candidate R12.45 was chosen and truncated to obtain a 46-base sequence. The binding affinity, specificity, and structural characteristics of this truncated candidate was investigated by using isothermal titration calorimetry, circular dichroism (CD) analysis, SYBR Green I (SG) fluorescence displacement assays, and gold nanoparticles (AuNPs) colorimetric assays. The truncated R12.45 candidate aptamer bound to atrazine with high affinity (Kd = 3.7 nM) and displayed low cross-binding activities on structurally related herbicides. In addition, CD analysis data indicated a target induced structural stabilization. Finally, SG assays and AuNPs assays showed nonconventional binding activities between the truncated R12.45 aptamer candidate and atrazine, which warrants future studies.

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Purpose Describe patient-, clinician-, system-, and community-level interventions for pain management developed and employed by 9 healthcare systems across the United States and report on lessons learned from the implementation of these interventions. Summary The high cost associated with pain coupled with the frequent use of opioid analgesics as primary treatment options has made novel pain management strategies a necessity. Interventions that target multiple levels within healthcare are needed to help combat the opioid epidemic and improve strategies to manage chronic pain. Patient-level interventions implemented ranged from traditional paper-based educational tools to videos, digital applications, and peer networks. Clinician-level interventions focused on providing education, ensuring proper follow-up care, and establishing multidisciplinary teams that included prescribers, pharmacists, nurses, and other healthcare professionals. System- and community-level interventions included metric tracking and analytics, electronic health record tools, lockbox distribution for safe storage, medication return bins for removal of opioids, risk assessment tool utilization, and improved access to reversal agents. Conclusion Strategies to better manage pain can be implemented within health systems at multiple levels and on many fronts; however, these changes are most effective when accepted and widely used by the population for which they are targeted.

Objective Community pharmacists are often the first healthcare professional encountered following discharge from a hospital, but what extent of services provided is not fully described across a variety of community pharmacy settings. Our objective was to capture and report recommendations made by community pharmacists during a transitions of care interventional study and to determine if visit‐related factors affected the risk of readmission. Methods The content of pharmacists' notes were analyzed from encounters during a transitions of care interventional study for patients discharged from a hospital with five high‐risk conditions (heart failure, acute myocardial infarction, diabetes, pneumonia, or chronic obstructive pulmonary disease), where the primary purpose of the intervention was to enhance inpatient and community pharmacist communication to improve patient care. Summary statistics were utilized to describe the content of pharmacist notes and actions, and a Cox proportional hazards model was used to test for the impact of several patient or visit‐related characteristics on the risk of 90‐day readmissions. Results As part of an interventional study, patients spent an average of 9 minutes (standard deviation [SD] 6.9) with pharmacists during each visit and had three visits on average within 90‐day of discharge. Responses to checklist questions were documented on 99% of notes, and pharmacists provided recommendations 58% of the time. Recommendations varied by condition with the most frequent being adherence (10%), vaccinations (8%), and disease monitoring (7%). In multivariate models, readmission was higher among patients with highest comorbidity (hazard ratio [HR] = 10.18, 95% confidence interval [CI], 3.53‐29.36), two or more medications added at discharge (HR = 3.83, 95% CI, 1.49‐9.82), or vaccine gaps (HR = 3.51, 95% CI, 1.09‐11.33). Conclusions In a transitions of care service, community pharmacists actively engaged patients and caregivers at regular intervals, providing largely patient‐oriented recommendations during relatively short consultation encounters. Patient and visit‐related items associated with higher readmission risk such as higher comorbidity, medication additions, and incomplete vaccinations signal opportunity for community pharmacist‐led interventions to improve care of patients in the postdischarge period.

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Introduction: Access to healthcare is a problem in the United States, exacerbated by inefficient system processes that warrant innovative reengineering solutions like centralized telehealth services.Objective: The aim of this study is to describe the genesis and evolution of a centralized pharmacy telehealth center ("TelePharmacy") at Geisinger, an integrated health delivery system.Methods: Descriptive statistics on the operations and impact of the TelePharmacy program were performed from inception in August 2017 to November 2020 using electronic health record data. In addition, a survey of clinic staff prior to and after initial TelePharmacy roll-out was conducted to assess the impact on time spent on medication-related activities and satisfaction with the service.Results: TelePharmacy completed over two million refills, resulting in a decreased workload for 40% of clinic staff. TelePharmacy pharmacists identified and rectified 3372 medication therapy problems over a 12-month period. Over the first 3.5 years, TelePharmacy expanded into other clinical areas such as anticoagulation, transitions of care, and urinary tract infection management. Conclusion:Geisinger was able to initiate and expand services offered by a centralized pharmacy telehealth center and positively impact care team burden.