Sarilumab is an alternative to biologic DMARDs or targeted synthetic DMARDs in patients with moderate to severely active RA who have not responded adequately to prior conventional synthetic DMARDs or tumor necrosis factor-α inhibitors.

Manganese (Mn) toxicity in crops is a serious problem in Hawaii, especially Kauai and Oahu, where most soils are highly weathered. To devise a management strategy to control Mn toxicity, a greenhouse experiment was conducted on an acid (pH 4.4) Oxisol (Wahiawa series) having 15g·kg-1 total Mn. Factorial combinations of lime (0, 2.0, and 4.0 g·kg-1 CaCO3) and two composts (made from chicken manure and from sewage sludge at 0, 5, and 10 g·kg-1) were applied to the soil, which was subsequently planted to watermelon (Citrullus lanatus Thunb. `Crimson Sweet'). Our preliminary results showed that: 1) liming reduced Mn extractability and phytoavailability, but the reduction in Mn per unit increase in pH was much less than predicted by theory; 2) for good watermelon growth, soluble Mn, as extracted by the saturated paste method, should be <2.0 mg·L-1 corresponding to a soil pH >5.7; 3) unlike the saturated-paste extractable Mn, the Mehlich3-extractable Mn varied less with pH in a given soil series than between soil series; 4) effects of composts on Mn toxicity varied with compost properties, especially their Ca content and pH altering capacity; and 5) the diagnostic criteria for Mn toxicity in watermelon are tentatively proposed as: leaf Mn >1000 mg·kg-1 and leaf Ca/Mn ratio (g·g-1) <25.

Abaloparatide, which has less effect on osteoclasts, is an alternative to teriparatide in patients with postmenopausal osteoporosis who are at high risk for fractures or who have failed antiresorptive therapy based on initial clinical studies and economic modeling.

Objective. To describe an ambulatory care introductory pharmacy practice experience (IPPE) in medication safety monitoring conducted remotely at the University for first-or second-year pharmacy students in collaboration with a Department of Veterans Affairs (VA) Health Care System. Methods. A module in medication safety was piloted as part of a required, one-unit IPPE in ambulatory care. Veterans prescribed methotrexate, sulfasalazine or mineralocorticoid receptor antagonists require ongoing laboratory monitoring to screen for adverse drug effects. Working remotely at the school under the direct supervision of VA clinical pharmacists, students accessed electronic health records (EHR), ordered laboratory tests under the prescriber's name, documented notes in the EHR and sent laboratory reminder letters to patients. Students completed a brief survey at the beginning and end of the course; differences were compared using Wilcoxon signed rank test. Results. During a 15-week course, following a two-week orientation, three sessions were devoted to the medication safety module. Fifty-eight students reviewed 148 patient records, including non-VA electronic records and ordered laboratory tests for 79 patients. Comparing baseline and course-completion surveys, students reported statistically significant changes in their ability to monitor laboratory tests, use a non-simulated EHR to perform patient care, and explain the role of a clinical dashboard to conduct population health activities. Conclusion.Conducting an ambulatory care IPPE course remotely enabled 58 pharmacy students to participate in medication safety monitoring for ambulatory patients.