Whole polished rice grains were ground using cryogenic and hammer milling to understand the mechanisms of degradation of starch granule structure, whole (branched) molecular structure, and individual branches of the molecules during particle size reduction (grinding). Hammer milling caused greater degradation to starch granules than cryogenic milling when the grains were ground to a similar volume-median diameter. Molecular degradation of starch was not evident in the cryogenically milled flours, but it was observed in the hammer-milled flours with preferential cleavage of longer (amylose) branches. This can be attributed to the increased grain brittleness and fracturability at cryogenic temperatures, reducing the mechanical energy required to diminish the grain size and thus reducing the probability of chain scission. The results indicate, for the first time, that branching, whole molecule, and granule structures of starch can be independently altered by varying grinding conditions, such as grinding force and temperature.

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Objective. To educate third-year pharmacy students about the role of pharmacists in the opioid crisis and measure their knowledge, confidence, and attitudes towards opioids and opioid overdose. Methods. All third-year students (n5130) enrolled in a Doctor of Pharmacy (PharmD) degree program participated in opioid overdose and naloxone education and training followed by a three-part laboratory session that included mock naloxone counseling, case-based discussion of the Prescription Drug Monitoring Program (PDMP), and equianalgesic opioid dose conversion scenarios. A pre-and postassessment focused on the individual's clinical knowledge, confidence, and attitudes about opioid overdose management and naloxone use was administered before and after the laboratory session to evaluate the student's baseline understanding and experience compared to learning gains from the session. An evaluation of the laboratory session was also conducted. Results. Upon completion, 99% percent of students rated the opioid laboratory as excellent (59%) or good (40%). Students believed the laboratory was stimulating (93%), relevant to pharmacy practice (96%), and contributed to their professional development (97%), and that the information provided was at an appropriate level (98%). Knowledge-based assessments improved in the areas of PDMP timely reporting, differentiating between naloxone devices, and naloxone administration technique. Student attitudes toward managing opioid overdoses improved on a majority of items. The majority of students agreed they had enough information to help them manage an opioid overdose (88.5%) and denied the need for additional training (61.5%). Conclusion. An active-learning laboratory helped to improve pharmacy students' knowledge, confidence, and attitudes with regard to opioids and the use of naloxone to treat a patient who has overdosed.

BackgroundWeb-based surveys (WBS) are increasingly applied in epidemiological studies as an appealing alternative to traditional survey methods. Rapid data collection, reduced expenditure and ease of access to large populations are some of the clear advantages of online surveys. However, WBS are still subject to limitations in terms of sample size, response rate and other additional biases compared to traditional survey methods. In the present study, we seek to validate data on food allergy (FA) in two independent sample populations collected from a WBS, and compare it to a paper-based survey (PBS).MethodsData collected from two survey modes were compared by hypothesis testing for independent sample population. The WBS included 1185 respondents, while the PBS included 9039 respondents.ResultsOverall, the data from the WBS were comparable to the PBS conducted over the same period of time in Vietnamese adults. There were no effects of different survey modes on the lifetime prevalence of doctor-diagnosed FA (5.7%; P = 0.7795, β = 0.05) and IgE-mediated FA (5.8%; P = 0.9590, β = 0.05). Both surveys showed the dominance of seafood allergy in this population (up to 2.6%), followed by beef allergy. Close correlation was seen in the patterns of FAs and different clinical symptoms. The contribution of family history of allergic diseases and place of residence to FA were confirmed in both surveys.ConclusionsThe consistency of the WBS results with the PBS indicates a promising application of online surveys as an economic and validated model for future epidemiological studies, specifically in developing countries.Electronic supplementary materialThe online version of this article (10.1186/s40413-018-0195-2) contains supplementary material, which is available to authorized users.

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Background: Food allergy (FA) is a serious, costly and growing health problem worldwide. FA occurs in both children and adults; however, there is a paucity of information on FA prevalence and its clinical features in the adult population, especially in Asia. We sought to assess the prevalence of FAs in Vietnamese adults and the distribution of offending food items among different regions throughout Vietnam.Methods: A nationwide, cross-sectional, population-based survey was conducted among University students aged 16-50 years. We used a structured, anonymous questionnaire, which was modified from recently published FA epidemiologic studies and based on European Academy of Allergy and Clinical Immunology (EAACI) guidelines, to collect data on FA prevalence, clinical presentations, and implicated food groups. Statistical analysis was performed to generate the prevalence of self-reported and doctor-diagnosed FA and to examine the association of key environmental factors and FA incidence in this population.Results: Of the 14,500 surveys distributed, a total of 9,039 responses were returned, resulting in a response rate of 62.4%. Among participants who reported food-induced adverse reactions, 48.0% have repeated reactions. 18.0% of the participants perceived FA symptoms, but less than half of them sought medical services for confirmation (37.9%). Stratifying for true FA symptoms, the prevalence of self-reported FA was 11.8% and of doctor-diagnosed FA, 4.6%. The most common doctordiagnosed FA was to crustacean (3.0%; 95% CI, 2.6-3.3), followed by fish (1.6%; 95% CI, 1.3-1.8), mollusk (1.3%; 95% CI, 1.0-1.5) and beef (1.0%; 95% CI, 0.8-1.2). The prevalence of doctordiagnosed FA differed among participants living in urban (6.5%) and rural regions (4.9%) (P < 0.001). Atopic family history was the strongest predictor for FA (odds ratio 8.0; 95% CI, 6.2-10.4).Conclusions: Seafood allergy among adults is predominant in Vietnam, followed by beef, milk, and egg, while peanut, soy, and tree nut allergy are much less common. Populations in rural regions have considerably less FA; however, the protective environmental factors have yet to be identified.

Background: Pharmacists are increasingly fulfilling roles on primary care teams, yet business models for pharmacist services in these settings have not been optimized. This study describes how an ambulatory care pharmacy department implemented various billing methods to generate revenue for pharmacist services. Objectives: (1) Describe pharmacist-delivered billable and non-billable services; and (2) Assess the impact of various billing methods on the return-on-investment (ROI) for billable services. Methods: This study was conducted from September 2016 to August 2017 in Virginia. Pharmacist time spent performing billable encounters using current procedural technology (CPT) codes (e.g., incident-to a physician, annual wellness visits) was calculated. Encounters eligible for the hospital-based facility (G0463) and chronic care management (CCM) codes were considered to be potentially billable services. The ROI was calculated for billable and potentially billable services. Results: A total of 948.3 hours (0.46 full-time equivalents (FTE)), 17% of all clinical services, were billed using CPT codes. This resulted in a total revenue of $173,638.66. Missed revenue from not billing for the G0463 and CCM codes was $68,268.37. The cost of pharmacist services for 0.46 FTE was $78,613.08, resulting in a ROI for billed pharmacist services of 1.2:1. The ROI increased to 1.6:1 when considering potentially billable services. Conclusion: It is feasible to have a positive ROI for billable pharmacist services. To achieve a sustainable business model, there must be a high volume of billable services. G0463 and CCM codes are often underutilized, yet represent significant opportunities in revenue for pharmacist services and should be pursued.