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1.  Functional status, life-space mobility, and quality of life: a longitudinal mediation analysis 
Using the Wilson–Cleary model of patient outcomes as a conceptual framework, the impact of functional status on health-related quality of life (HRQoL) among older adults was examined, including tests of the mediation provided by life-space mobility.
Participants were enrollees in a population-based, longitudinal study of mobility among community-dwelling older adults. Data from four waves of the study equally spaced approximately 18 months apart (baseline, 18, 36, and 54 months) were used for participants who survived at least 1 year beyond the 54-month assessment (n = 677). Autoregressive mediation models using longitudinal data and cross-sectional mediation models using baseline data were evaluated and compared using structural equation modeling.
The longitudinal autoregressive models supported the mediating role of life-space mobility and suggested that this effect is larger for the mental component summary score than the physical component summary score of the SF-12. Evidence for a reciprocal relationship over time between functional status, measured by ADL difficulty, and life-space mobility was suggested by modification indices; these model elaborations did not alter the substantive meaning of the mediation effects. Mediated effect estimates from longitudinal autoregressive models were generally larger than those from cross-sectional models, suggesting that mediating relationships would have been missed or were potentially underestimated in cross-sectional models.
These results support a mediating role for life-space mobility in the relationship between functional status and HRQoL. Functional status limitations might cause diminished HRQoL in part by limiting mobility. Mobility limitations may precede functional status limitations in addition to being a consequence thereof.
PMCID: PMC3618999  PMID: 23161329
Wilson; Cleary model; Activities of daily living; Mobility; SF-12; Longitudinal mediation; Autoregressive mediation modeling
2.  Do statins improve outcomes in patients with asthma on inhaled corticosteroid therapy? A retrospective cohort analysis 
BMJ Open  2012;2(3):e001279.
Animal studies and clinical trials have examined the potential benefits of statins in asthma management with contradictory results. The objective of this study was to determine if asthma patients on concurrent statins are less likely to have asthma-related hospitalisations.
A retrospective cohort study using Mississippi Medicaid data for 2002–2004.
Asthma patients ≥18 years were identified using the ICD9 code 493.xx from 1 July 2002 through 31 December 2003. The index date for an exposed subject was any date within the identification period, 180 days prior to which the subject had at least one inhaled corticosteroid prescription and at least an 80% adherence rate to statins. Asthma patients on inhaled corticosteroids, but not on statins, were selected as the unexposed population. The two groups were matched and followed for 1 year beginning the index date.
Main outcomes measures
Patient outcomes in terms of hospitalisations and ER visits were compared using conditional logistic regression.
After matching, there were 479 exposed subjects and 958 corresponding unexposed subjects. The odds of asthma-related hospitalisation and/or emergency room (ER) visits for asthma patients on concurrent statins were almost half the odds for patients not on statins (OR=0.55; 95% CI (0.37 to 0.84); p=0.0059). Similarly, the odds of asthma-related ER visits were significantly lower for patients on statins (OR=0.48; 95% CI (0.28 to 0.82); p=0.0069).
The findings suggest beneficial effects of statins in asthma management. Further prospective investigations are required to provide more conclusive evidence.
Article summary
Article focus
Statins have been shown to have promising therapeutic potential in mediating anti-inflammatory processes in animal model studies as well as clinical trials of rheumatoid arthritis, autoimmune encephalomyelitis, inflammatory colitis and psoriasis.
Along the same line of reasoning, recently there has been some discussion regarding the use of statins in asthma management in addition to inhaled corticosteroid therapy.
The purpose of this study was to investigate the beneficial effects of statins on asthma outcomes using the Mississippi Medicaid claims database.
Key messages
The findings suggest that statins may be beneficial in asthma management.
The study accounts for several additional potential confounders not previously explored in the other observational studies.
Strengths and limitations of this study
The study uses a propensity score-matched cohort study design, which in itself should take into account potential confounding effects.
The study was conducted using Medicaid claims data, and therefore, there is a possibility of misclassification due to coding errors during claims processing.
PMCID: PMC3364455  PMID: 22619271
3.  The Science of Safety Curriculum in US Colleges and Schools of Pharmacy 
Objective. To describe the integration of science of safety (SoS) topics in doctor of pharmacy (PharmD) curricula of US colleges and schools of pharmacy.
Methods. A questionnaire that contained items pertaining to what and how SoS topics are taught in PharmD curricula was e-mailed to representatives at 107 US colleges and schools of pharmacy.
Results. The majority of the colleges and schools responding indicated that they had integrated SoS topics into their curriculum, however, some gaps (eg, teaching students about communicating risk, Food and Drug Administration [FDA] Sentinel Initiative, utilizing patient databases) were identified that need to be addressed.
Conclusions. The FDA and the American Association of Colleges of Pharmacy (AACP) should continue to collaborate to develop resources needed to ensure that topics proposed by the FDA in their SoS framework are taught at all colleges and schools of pharmacy.
PMCID: PMC3175655  PMID: 21969727
medication safety; pharmacy education; curriculum; science of safety
4.  Perspectives on Educating Pharmacy Students About the Science of Safety 
Objective. To identify opinions about pharmacy graduates’ science of safety (SoS) educational needs.
Methods. Semi-structured interviews were performed with 25 educators and researchers at US pharmacy colleges and schools and 5 individuals from associations engaged in drug safety-related issues.
Results. Themes that emerged from the 30 interviews with key informants included: pharmacists should meet minimum SoS requirements; medication safety education is inconsistent; and barriers exist to improving SoS curricula. Student deficiencies noted included the lack of: student acceptance of a “culture of safety”: ability to effectively communicate verbally about medication safety; knowledge of the drug development process; and quality improvement skills. Key informants did not agree on how to address these gaps.
Conclusions. While educators, researchers, and other leaders in drug safety-related issues thought that US colleges and schools of pharmacy covered portions of SoS well, there were perceived deficiencies. Minimum standards should be set to assist with curricular adoption of SoS.
PMCID: PMC3175660  PMID: 21969728
medication safety; patient safety pharmacy education; science of safety; education
5.  Teaching the Science of Safety in US Colleges and Schools of Pharmacy 
This paper provides baseline information on integrating the science of safety into the professional degree curriculum at colleges and schools of pharmacy. A multi-method examination was conducted that included a literature review, key informant interviews of 30 individuals, and in-depth case studies of 5 colleges and schools of pharmacy. Educators believe that they are devoting adequate time to science of safety topics and doing a good job teaching students to identify, understand, report, manage, and communicate medication risk. Areas perceived to be in need of improvement include educating pharmacy students about the Food and Drug Administration's (FDA's) role in product safety, how to work with the FDA in post-marketing surveillance and other FDA safety initiatives, teaching students methods to improve safety, and educating students to practice in interprofessional teams. The report makes 10 recommendations to help pharmacy school graduates be more effective in protecting patients from preventable drug-related problems.
PMCID: PMC3138345  PMID: 21769153
safety; curriculum; pharmacy education; FDA; quality
6.  Cardiovascular Risk Associated with Interactions among Polymorphisms in Genes from the Renin-Angiotensin, Bradykinin, and Fibrinolytic Systems 
PLoS ONE  2010;5(9):e12757.
Vascular fibrinolytic balance is maintained primarily by interplay of tissue plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1). Previous research has shown that polymorphisms in genes from the renin-angiotensin (RA), bradykinin, and fibrinolytic systems affect plasma concentrations of both t-PA and PAI-1 through a set of gene-gene interactions. In the present study, we extend this finding by exploring the effects of polymorphisms in genes from these systems on incident cardiovascular disease, explicitly examining two-way interactions in a large population-based study.
Methodology/Principal Findings
Data from the population-based PREVEND study in Groningen, The Netherlands (n = 8,138) were analyzed. The effects of the polymorphisms and their interactions on cardiovascular events were analyzed via Cox proportional hazards models. There was no association between five of the six polymorphisms singly and risk of cardiovascular disease. There was a significant main effect for the ACE I/D polymorphism for both dominant and additive coding schemes. There were significant interactions between the following polymorphism pairs even after adjustment for known risk factors: ACE I/D & PAI-1 4G/5G (p = 0.012), BDKRB2 C181T & ACE I/D (p = 0.016), BDKRB2 C58T & ACE I/D (p = 0.025), BDKRB2 exon 1 I/D & AT1R A1166C (p = 0.017), and BDKRB2 C58T & AT1R A1166C (p = 0.015).
This study suggests possible interactions between genes from the RA, bradykinin, and fibrinolytic systems on the risk of cardiovascular disease, extending previous research that has demonstrated that interactions among genes from these systems influence plasma concentrations of both t-PA and PAI-1. Further explorations of these interactions are needed.
PMCID: PMC2939877  PMID: 20856803
7.  Instrument to Measure Psychological Contract Violation in Pharmacy Students 
To adapt and evaluate an instrument that measures perceived psychological contract violations in pharmacy students by schools and colleges of pharmacy.
A psychological contract violations measure was developed from existing literature and the 1997 ACPE Guidelines and pilot-tested with second-year pharmacy students at 2 schools of pharmacy. A revised measure then was administered to second-year pharmacy students at 6 schools of pharmacy. Using a 5-point Likert-type scale, participants were asked to indicate the level of obligations they received compared to what was promised by the school of pharmacy.
Exploratory factor analysis on the psychological contract violations measure was conducted using principal components analysis resulting in 7 factors, which led to a revised measure with 26 items. Using a sample of 339 students, the proposed 7-factor measurement model was tested using confirmatory factor analysis. In general, the results supported the hypothesized model. The final 23-item scale demonstrated both reliability and validity. Some students perceived certain aspects of the psychological contract that exists with their school of pharmacy were being violated.
The psychological contract violations measure may serve as a valuable tool in helping to identify areas where their students believe that schools/colleges of pharmacy have not fulfilled promised obligations.
PMCID: PMC2933016  PMID: 21045949
psychological contract violation; measure development; pharmacy students; obligations
8.  The Predictive Utility of Nontraditional Test Scores for First-Year Pharmacy Student Academic Performance 
To determine the value of employing the Learning and Study Strategies Inventory (LASSI), Defining Issues Test (DIT), and Watson-Glaser Critical Thinking Appraisal (WGCTA) in predictive models for first-year pharmacy student academic performance.
Six years of pharmacy student admission and progression data were evaluated. Additional predictive validity offered by these variables over a model of prepharmacy grade point average and pharmacy college admission test (PCAT) score was examined.
None of the 3 measures offered the ability to predict first-semester or first-year academic performance over and above GPA and PCAT.
The LASSI, DIT, and WGCTA do not appear to assess abilities that are directly related to academic performance; however, these instruments may be useful in assessing other student attributes that are highly desirable for the practice of pharmacy.
PMCID: PMC1803690  PMID: 17332854
Learning and Study Strategies Inventory (LASSI); Defining Issues Test (DIT); Watson-Glaser Critical Thinking Appraisal (WGCTA); academic progression, admission requirements, grade point average (GPA); pharmacy college admission test (PCAT), performance, admission
9.  On the Significance of the Extractable Collagens 
This investigation has sought to determine the significance of the wide range of extractable collagen fractions which appear to exist in growing connective tissues and to determine their position in the process of fibrogenesis. Carrageenin granulomata were induced in guinea pigs and, after injection of 14C-glycine, this tissue and skin from the same animal were subjected to successive extractions with neutral salt solutions of increasing ionic strength, citrate buffer pH 3.6, and to gelatinization. The specific activity of these fractions was determined at various time intervals. At 8 hours it was found that the specific activity decreased with increasing ionic strength of the neutral salts and was still lower in the citrate extracts and gelatin. At 36 hours the situation was almost completely reversed except that the citrate extract and gelatin still had the lowest activities. The data from skin were more clear cut than that from the granuloma and the reasons for this are discussed. It is concluded that at any given time in developing connective tissue, there is a continuous spectrum of collagen aggregates of varying degrees of strength of cross-linkage, dependent upon the time that has elapsed since their constituent molecules were synthesized. The various extraction media used remove a particular cross-section of these aggregates depending upon their disaggregating power. These extracts will thus be biologically heterogeneous. The fraction extracted with 0.14 M NaCl will contain the collagen molecules most recently synthesized and in this respect can be considered the earliest form of extracellular collagen.
PMCID: PMC2224869  PMID: 14406281

Results 1-9 (9)