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Objectives: To describe the views of pharmacists and student pharmacists regarding (1) aspects of life and experiences that provide professional and personal satisfaction and fulfillment, (2) causes of stress, and (3) needs related to maintaining satisfaction and fulfillment., Design: A generic qualitative research design was used for collecting data from 380 pharmacists and 332 student pharmacists who wrote responses to an online survey hosted by the American Pharmacists Association (APhA) from November 17 to December 2, 2018, using standard data collection procedures applied by that organization. APhA uses its member and affiliate data files as its sampling frame and limits the number of contacts per year for each person in those files. De-identified responses from those who volunteered to write comments were sent to the research team for analysis. A conventional content analysis approach was applied for analysis of the text. Analysts convened to discuss emergent themes and develop operational descriptions. Key segments of text that best represented each theme were identified. Personal presuppositions were disclosed and were useful for developing group consensus for theme identification and description. Rigor was supported through assessment of credibility, confirmability, intercoder checking, transferability, inductive thematic saturation, and authenticity., Setting and Participants: Participants are in the design since data already collected., Outcome Measures: Not applicable., Results: Findings showed that pharmacists and student pharmacists are able to recognize and pursue achievement, recognition, responsibility, advancement, relationship, esteem, self-actualization, meaning, and accomplishment in both their professional and personal lives. However, external factors such as "workism" and individual factors such as "moral distress" were identified as areas of improvement that are needed for well-being and resilience., Conclusion: Pharmacists' basic human needs are being met, but to improve well-being and resilience for pharmacists in both their professional and personal lives, there is a need for addressing both the external factors and individual factors that they encounter., (Copyright © 2020 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Objectives: The American Pharmacists Association (APhA) convened the Biologics and Biosimilars Stakeholder Conference on November 30, 2016, in Washington DC. The objectives of the Conference were to determine the key issues and challenges within the marketplace for biologics, follow-on biologics (FOBs), and biosimilars, identify potential roles and responsibilities of pharmacists regarding biologic and biosimilar medications, and identify actions or activities that pharmacists may take to optimize the safe and cost-effective use of biologics and biosimilars., Data Sources: National thought leaders and stakeholder representatives, including individuals from the Food and Drug Administration, Centers for Medicare and Medicaid Services, a private third-party payer, manufacturers, and several national organizations of health care professionals, participated in the conference. Information shared by this group was supplemented with relevant legal and regulatory information and published literature., Summary: Biologics play a valuable role in the treatment of numerous health conditions, but their associated costs, which tend to be greater than those of small-molecule drugs, place a burden on the health care system. Biosimilars (both noninterchangeable and interchangeable) are highly similar copies of the originator biologic and offer the potential to reduce costs and improve patient access to biological products by increasing treatment options and creating a more competitive market. Despite the potential benefits of biosimilars, certain factors may limit their uptake. The conference participants explored issues that different stakeholders think influence the use of biologics, including biosimilars, in the United States. Barriers included technology, prescriber-pharmacist communication, legislation and regulations, limited patient and health care practitioner knowledge of biological products, patient and health care practitioner perceptions of biosimilars, and evolving science or lack of long-term data. After participants identified issues, they discussed strategies to address these concerns, including the need to enhance the education of pharmacists, prescribers, and patients regarding biologic products, including biosimilars and FOBs; the passage of state laws and regulations that do not impede the use of biosimilars, including interchangeable biosimilars; the use of product-specific tracking information in electronic health records and surveillance systems; bidirectional communication among pharmacists, prescribers, and other members of the care team to support pharmacovigilance and the maintenance of accurate patient records; and the development of evidence-based third-party payer policies., Conclusion: Patient access to safe and cost-effective treatments is an important goal for the health care system. As the availability and use of biosimilars, including those determined to be interchangeable, increases, their potential to lower costs and improve patient access to treatment grows. However, the extent of such growth is, in part, dependent on various stakeholders' decisions to provide, pay for, or use these products in a safe and thoughtful manner. Ongoing stakeholder collaboration, educational activities, and review of current government or payer policies are required to optimize the uptake of biological products, including biosimilars., (Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Objectives: The Community Pharmacy Residency Program (CPRP) Planning Committee convened to develop a vision and a strategic action plan for the advancement of community pharmacy residency training. Aligned with the profession's efforts to achieve provider status and expand access to care, the Future Vision and Action Plan for Community-based Residency Training will provide guidance, direction, and a strategic action plan for community-based residency training to ensure that the future needs of community-based pharmacist practitioners are met., Data Sources: National thought leaders, selected because of their leadership in pharmacy practice, academia, and residency training, served on the planning committee. The committee conducted a series of conference calls and an in-person strategic planning meeting held on January 13-14, 2015. Outcomes from the discussions were supplemented with related information from the literature. Results of a survey of CPRP directors and preceptors also informed the planning process., Summary: The vision and strategic action plan for community-based residency training is intended to advance training to meet the emerging needs of patients in communities that are served by the pharmacy profession. The group anticipated the advanced skills required of pharmacists serving as community-based pharmacist practitioners and the likely education, training and competencies required by future residency graduates in order to deliver these services. The vision reflects a transformation of community residency training, from CPRPs to community-based residency training, and embodies the concept that residency training should be primarily focused on training the individual pharmacist practitioner based on the needs of patients served within the community, and not on the physical location where pharmacy services are provided., Conclusion: The development of a vision statement, core values statements, and strategic action plan will provide support, guidance, and direction to the profession of pharmacy to continue the advancement and expansion of community-based residency training., (Published by Elsevier Inc.)

Objective: To improve key indicators of diabetes care by expanding a proven community-based model of care throughout high-risk areas in the United States., Design: Observational, multisite, pre-post comparison study., Setting: Federally qualified health centers, free clinics, employer worksites, community pharmacies, departments of health, physician offices, and other care facilities in 25 communities in 17 states from June 2011 through January 2013., Participants: 1,836 patients disproportionately affected by diabetes representing diverse ethnicities, insurance statuses, and social and economic backgrounds., Intervention: Pharmacists were integrated into local, interdisciplinary diabetes care teams and provided customized diabetes education and medication consultations to patients., Main Outcome Measures: Clinical measures included glycosylated hemoglobin (A1C), body mass index, systolic and diastolic blood pressures, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, and total cholesterol. Process measures included smoking status, eye examination status, foot examination status, and influenza vaccine status., Results: Pharmacist patient care services for those underserved or disproportionately affected by diabetes resulted in a statistically significant and clinically relevant decrease in mean A1C levels (-0.8%). Other outcome indicators were below target levels at baseline and decreased significantly but not by clinically relevant amounts (LDL-C, -7.1 mg/dL; triglycerides, -23.7 mg/dL, and total cholesterol, -8.8 mg/dL). The mean increase in HDL-C (+0.6 mg/dL) was not statistically significant or clinically relevant. Among evaluable patients who were not at target for process measures at baseline, 51.7% of 453 patients received eye examinations, 72.0% of 271 patients received foot examinations, 41.7% of 307 patients received influenza vaccinations, and 9.3% patients of 270 quit smoking during the project. Of the communities involved in the study, 92% intend to sustain pharmacists' services., Conclusion: Project, Impact: Diabetes results show significant improvement in patients' clinical outcomes and demonstrate that all patients, even those with tremendous barriers to appropriate diabetes care, benefit from patient-centered, interdisciplinary health care teams that include pharmacists.

Objectives: To identify the current challenges and opportunities in compensation and recognition for pharmacist-provided immunizations across the lifespan and to establish guiding principles for pharmacist-provided immunization compensation and recognition., Data Sources: 22 stakeholders gathered on June 29, 2011, at the American Pharmacists Association (APhA) headquarters in Washington, DC, for a meeting on immunization compensation that was convened by APhA and the Academy of Managed Care Pharmacy. Participants included representatives from community pharmacy practices (chain, grocery, and independent), employers, national consumer health and advocacy organizations, national pharmacy and public health organizations, health plan representatives, pharmacy benefit managers, and health information technology, standards, and safety organizations. Key immunization leaders from TRICARE Management Activity, the Centers for Medicare & Medicaid Services, the National Vaccine Program Office of the Department of Health & Human Services, and the Centers for Disease Control and Prevention (CDC) also participated in the meeting., Summary: The increased numbers of pharmacists providing vaccination services and the availability of pharmacist-provided immunizations to populations in need of vaccines has continued to increase. This has resulted in a rise in the percentage of patients who receive vaccines at pharmacies. Pharmacists are now working to lever-age their ability to identify people with key risk factors (e.g., diabetes, heart disease or previous myocardial infarction), encourage them to receive their CDC-recommended vaccinations, and administer the required vaccine. Challenges and opportunities in compensation and recognition for pharmacist-provided immunizations across the adult lifespan persist. Variability in state practice acts, reimbursement and compensation processes and systems, and mechanisms for documentation of vaccine services create substantial differences in how pharmacist-provided immunizations are delivered throughout the United States., Conclusion: Pharmacist-provided immunizations are clinically sound, are cost effective, are readily accessible, and support our nation's public health goals. Pharmacists have demonstrated that patient vaccination rates have improved through expansion of pharmacist-provided immunizations. The profession should continue efforts to collaborate with other immunization stakeholders and expand a pharmacist scope of practice that is built around a uniform and recognized standard of immunization provision and that supports the provision of all CDC-recommended vaccines through pharmacy-provided immunizations.

Objective: The purpose of this initiative was to establish a Coordinating Council to Improve Collaboration in Supporting Patients with Alzheimer's Disease. The Council convened on March 5-6, 2008, in Washington, DC. The American Pharmacists Association (APhA) Foundation, in conjunction with leading national experts in Alzheimer's disease (AD), assessed the level of care and services currently provided by pharmacists to AD patients and developed this "blueprint document" for how they might be more effective in helping patients and family caregivers manage the burden of this devastating disease., Data Source: A premeeting survey of Council members was conducted to elicit their perceptions regarding the needs and challenges facing AD patients and their family caregivers and to gain insights as to what roles pharmacists could and should be playing to help manage drug therapy and enhance the quality of life in patients with AD., Summary: AD is one of the most significant health crises that will be faced in the United States over the next 30 years. Currently, it is the sixth leading cause of death in the country. The findings of the Council confirmed that pharmacists are playing important roles in the management of AD but can expand these roles., Conclusion: Pharmacists are accessible, trusted, and respected resources. Increased pharmacist involvement in the care of individuals with AD could improve clinical outcomes and family caregiver quality of life. With the expected increase in the number of individuals diagnosed with AD, the resources and services to care for and support this population will be even further taxed. Innovative approaches for expanding pharmacist involvement in AD should be developed to maximize the difference pharmacists can make in the lives of those who suffer from the disease.

There is mounting evidence that human muscles have discrete partitions. In an effort to accurately assess how the control to each of the three heads (designated as A-C) of the lateral gastrocnemius (LG) muscle might be organized, we performed exploratory studies in five subjects each of whom was provided 30 random angular and linear perturbations while standing on a balance platform in each of three experiments. The responses from each LG head were recorded with strategically-placed fine-wire electrodes and, after correction for variation in distance to each recording site, latency to activation and the sequence of recruitment for each LG head were determined. Within individual subjects, the same LG head was first recruited. The C-head was recruited first during linear perturbations between subjects and across sessions, but the overall recruitment pattern was different between subjects. The fact that a consistent, selective response was seen during dynamic linear but not angular perturbations suggests that a more consistent strategy of inter-partition response may be engaged for the former perturbation. This behaviour may be caused by use of the LG C-head to assist the medial gastrocnemius to control ankle plantar flexion and pronation during the shearing forces generated with linear translations. Further exploration into the relationship between selective activation of muscle partitions in the presence of defined movement conditions appears justified.

The structures of the 6-deoxytalose-containing O-specific polysaccharides from the O45 antigen, an O45-related antigen (O45rel), and the O66 antigen (lipopolysaccharides, LPSs) of Escherichia coli were elucidated by chemical characterization and by one- and two-dimensional 1H and 13C NMR spectroscopy. The O45 and O45-related polysaccharides have the following general structure: [formula: see text] For the O45 antigen, X is alpha-D-FucpNAc and for the O45-related antigen, X is beta-D-GlcpNAc. The structure of the O66 polysaccharide is [formula: see text]

Structures for the N-acetylneuraminic acid (Neu5Ac)-containing O56 and O24 polysaccharides of Escherichia coli have been reported previously. During these studies unusual chemical shifts had been observed for the NMR signals for H-3eq and C-3 of the Neu5Ac residues of both polysaccharides. In further pursuing this phenomenon, we have reinvestigated the O56 and O24 polysaccharides as well as derived oligosaccharides by one- and two-dimensional NMR spectroscopy. The results showed that structures of both polysaccharides (PSs) had to be modified and formulated as [formula: see text] 2D ROESY spectra revealed a strong NOE between H-3eq of Neu5Ac and the protons of the side-chain sugar (H-3 and H-5 of alpha-D-Gal p in the O56 PS and H-3 of alpha-D-Glc p in the O24 PS) and also between H-3ax of Neu5Ac and H-3 of beta-D-Glc p in the main chain. This indicated a close spatial association of the seven-linked alpha-Neu5Ac and the side-chain residues alpha-D-Gal p (O56 PS) and alpha-D-Glc p (O25 PS), respectively. The strong long-range spatial contacts caused the unusual chemical shifts of H-3eq and C-3 of Neu5Ac.

The polysaccharide moiety of the O16 antigen (lipopolysaccharide) consists of D-glucopyranose, D-galactofuranose, L-rhamnopyranose, and 2-acetamido-2-deoxy-D-glucopyranose in the molar ratios 1:1:1:1. It is O-acetylated with one acetyl group per repeating unit. One- and two-dimensional NMR spectroscopy of the polysaccharide before and after O-deacetylation showed that the O16 polysaccharide has the structure [formula: see text]

Two distinct forms of the O6 antigen (LPS) from E. coli were analysed using 1H and 13C NMR spectroscopy. Their structures were found to be [formula: see text] In the O6-specific polysaccharide from E. coli O6:K2 and O6:K13, X is beta-D-Glc p, as had previously been shown for the O6 polysaccharide from E. coli O6:K15; in the O6 specific polysaccharide from E. coli O6:K54, X is beta-D-Glc pNAc.

The polysaccharide moiety of the O83 antigen (lipopolysaccharide, LPS) consists of D-glucose, D-galactose, 2-acetamido-2-deoxy-D-glucose, and D-glucuronic acid in the molar ratios 1:2:1:1. Methylation analysis of the polysaccharide and derived oligosaccharides as well as one- and two-dimensional 1H and 13C NMR spectroscopy of the polysaccharide at pD 1 and 6 showed that the O83 polysaccharide has the primary structure-->6)-alpha-D-Glc p-(1-->4)-beta-D-Glc pA-(1-->6)-beta-D-Gal p-(1-->4)-beta-D- Gal p-(1-->4)-beta-D-Glc pNAc-(1-->.

The polysaccharide moiety of the O22-antigen (lipopolysaccharide, LPS) consists of 2-acetamido-2-deoxy-D-galactose, D-glucuronic acid, D-glucose, and D-galactose in the molar ratios 2:1:1:1. Methylation analysis as well as 1D and 2D NMR spectroscopy showed that the O22 polysaccharide has the primary structure [formula: see text]

Two distinct forms of the O4 antigen (LPS) from E. coli were analysed by 1H and 13C NMR spectroscopy. Both consisted of D-glucose, L-rhamnose, 2-acetamido-2,6-dideoxy-L-galactose (L-FucNAc), and 2-acetamido-2-deoxy-D-glucose. Their structures were found to be [formula: see text]. In the O4-specific polysaccharide from E. coli O4:K3, O4:K6, and O4:K12, X is alpha-D-Glcp. In the O4 specific polysaccharide from E. coli O4:K52, the rhamnose residue is not substituted (X = H).

The polysaccharide moiety of the O23 antigen (lipopolysaccharide) consists of D-glucose, D-galactose, 2-acetamido-2-deoxy-D-glucose, and 2-acetamido-2-deoxy-D-galactose in the molar ratios 2:1:2:1. Methylation analysis of the polysaccharide as well as one- and two-dimensional 1H and 13C NMR spectroscopy of the polysaccharide and a trisaccharide obtained by Smith degradation showed that the O23 polysaccharide has the primary structure [formula: see text].

The K10 antigen from Escherichia coli O11:K10:H10 consists of equimolar amounts of rhamnose and 4,6-dideoxy-4-malonylaminoglucose [Qui4NMal; 4-(2-carboxyacetamido)-4,6-dideoxyglucose]. Methylation analysis and 1 and 2D NMR spectroscopy showed that the K10 capsular polysaccharide has the structure [formula: see text]

The O56 polysaccharide moiety of the O56 antigen (LPS) consists of D-glucose, D-galactose, 2-acetamido-2-deoxy-D-glucose, and N-acetylneuraminic acid in the molar ratios 1:1:1:1. Methylation analysis, periodate oxidation, mild acid hydrolysis, as well as 1H and 13C NMR spectroscopy showed that the O56 polysaccharide has the primary structure [formula: see text]

The capsular polysaccharide (K98 antigen) of E. coli O7:K98:H6 contains rhamnose, glucuronic acid, and acetate in the molar ratios 3:1:0.6. Methylation analysis, oligosaccharide analysis, and 1D- and 2D-n.m.r. spectroscopy revealed the polysaccharide to be a glucuronic acid-substituted rhamnan with the structure [formula; see text] Of the 3-linked rhamnose residues, approximately 60% are O-acetylated at position 2.

The structure of the K24 antigen of Escherichia coli O83:K24:H31 was elucidated by determination of composition and by 1H-, 13C-, and 31P-n.m.r. spectroscopy of the polymer and of a Kdo-glycerol (Gro) glycoside, obtained by mild alkaline hydrolysis and subsequent incubation with alkaline phosphatase. The K24 antigen has the repeating unit----7)-alpha-Kdop-(2----1)-Gro-(3-P. In the polymer, 56% of the repeating units are O-acetylated at C-4 of Kdo, approximately 28% at C-5 of Kdo, and approximately 16% are not acetylated.

The K16-antigen from E. coli Rk 21510 (O7:K16:H-) is shown to consist of the repeating unit ----2)-beta-D-Ribf-(1----3)-beta-D-Ribf-(1----5)-alpha-Kd op-(2---- of which approximately 33% is O-acetylated at position 3 of the 2-linked ribose.

The capsular K11 antigen of Escherichia coli contains glucose, fructose, and phosphate in the molar ratios 2:1:1, and a backbone of -4)-beta-D-glucopyranosyl-(1----4)-alpha-D-glucopyranosyl phosphate-(1----to which beta-D-fructofuranose is linked at position 3 of the beta-D-glucopyranosyl residue. The fructose, which is the immunodominant sugar of the K11 antigen, is released from the polysaccharide under mild acidic conditions (70 degrees, pH 5.0).

The structures of the capsular K18, K22, and K100 antigens of E. coli O23:K18:H15, O23:K22:H15, and O75:K100:H5, respectively, were elucidated by determination of composition, 1H-, 13C-, and 31P-n.m.r. spectroscopy, periodate oxidation, alkaline hydrolysis followed by incubation with alkaline phosphatase, and methylation analysis of the polymers and their neutral fragmentation products. The polymers are poly(ribosyl-ribitol phosphates) related to the capsular antigen of H. influenzae (Hib). The K22 antigen has the repeating unit -P-2)-beta-Rib-(1----2)-RibOH-(5-, and the K18 antigen has the same polymer chain with partial 3-O-acetylation of the ribose moiety. The K100 antigen consists of repeating units of -P-3)-beta-Rib-(1----2)-RibOH-(5- and seems to have a secondary structure different from that of the other antigens. Together with the Hib capsular antigens, the structure of which was reported as -P-3)-beta-Rib-(1----1)-RibOH-(5-, these capsular antigens represent a structurally related group of capsular polymers.

The chemical structure of the K14-antigenic polysaccharide (K14 antigen) of Escherichia coli 06:K14:H31 was elucidated by determination of the composition, 1H- and 13C-n.m.r. spectroscopy, periodate oxidation, and study of the oligosaccharides obtained by partial hydrolysis. The polysaccharide consists of [O-(2-acetamido-2-deoxy-beta-D-galactopyranosyl)-(1 leads to 5)-O-(3-deoxy-beta-D-manno-octulopyranosylonic acid)-(2 leads to 6)] repeating units, approximately 60% of the octonic acid units being O-acetylated and approximately 10% O-propionylated at O-8. The sequence of acetylated and propionylated residues is not known. The serologically-specific part of the K14 antigen residues in the polysaccharide part.

The structure of the K95 antigenic capsular polysaccharide (K95 antigen) of Escherichia coli O75:K95:H5 was elucidated by determination of the composition, 1H- and 13C-n.m.r. spectroscopy, periodate oxidation, and methylation analysis. The K95 polysaccharide, which contains furanosidic 3-deoxy-D-manno-2-octulosonic acid (KDOf) residues, consists of----3)-beta-D-Rib-(1----8)-KDOf-(2----repeating units, has a molecular weight of approximately 25,000 (approximately 65 repeating units), and is randomly O-acetylated (1 acetyl group per repeating unit at unknown positions).

The structure of the K40 antigenic capsular polysaccharide (K40 antigen) of E. coli O8:K40:H9 was elucidated by determination of the composition, 1H- and 13C-n.m.r. spectroscopy, periodate oxidation and Smith degradation, and methylation analysis. The K40 polysaccharide consists of [(O-beta-D-glucopyranosyluronic acid)-(1----4)-O-(2-acetamido-2-deoxy-alpha-D-glucopyranosyl)-(1----6)-O -(2-acetamido-2-deoxy-alpha-D-glucopyranosyl)-(1----4)] repeating units. All of the glucuronic acid residues are substituted amidically with L-serine.

The structure of the O-specific side-chain of the lipopolysaccharide from Escherichia coli O:7 has been investigated, using n.m.r. spectroscopy, methylation analysis, partial hydrolysis, and Smith degradation as the principal methods. It is concluded that the polysaccharide is constructed of repeating pentasaccharide units having the structure (formula; see text) where D-QuipNAc stands for 4-acetamido-4,6-dideoxy-D-glucopyranose. The 13C-n.m.r. spectrum of the polysaccharide has been interpreted completely.

The structure of the capsular K74 antigen of E. coli H702c (O44:K74:H18) was elucidated by determination of the composition, 1H- and 13C-n.m.r. and c.d. spectroscopy, periodate oxidation, and methylation analysis of the polysaccharide and of a trisaccharide obtained by mild acid hydrolysis. The K74 antigen has the repeating unit----3)-beta-D-Ribf-(1----2)-beta-D-Ribf-(1----6)-beta-++ +KDOf-(2----. Of the repeating units, approximately 65% are O-acetylated, most probably at C-2 of the 3-linked ribose.

The K3-antigenic capsular polysaccharide (K3 antigen) of Escherichia coli contains L-rhamnose, a 4-deoxy-2-hexulosonic acid, and an O-acetyl group in the molar ratio of 3:1:1. The backbone consists of a ----2)-O-alpha-L-rhamnopyranosyl-(1----3)-O-alpha-L-rhamnopyranosyl-(1----3)-O-alpha-L-rhamnopyranosyl-(1---- repeating unit. Either one of the 3-linked L-rhamnopyranosyl residues of each repeating unit may be substituted at O-2 with a 4-deoxy-2-hexulosonic acid, an isomer of the furanosyl form of KDO, about 90% of which is acetylated at 0-6. The 4-deoxy-2-hexulosonic acid residue is linked to the L-rhamnan backbone in a very labile linkage which is split by 1% acetic acid (30 min, 100 degrees). The K3 polysaccharide has a molecular weight of approximately 38,000, corresponding to approximately 60 repeating units.

The structure of the K54-antigenic polysaccharide (K54 antigen) of Escherichia coli O6:K54:H10 was elucidated by determination of the composition, 1H- and 13C-n.m.r. spectroscopy, periodate oxidation, and a study of the oligosaccharides obtained by partial hydrolysis with acid. The K54 polysaccharide consists of----3)-beta-D-glucosyluronic acid-(1----3)-alpha-L-rhamnosyl-(1----repeating-units. Of the glucuronic acid residues, approximately 85% are substituted in the ratio 9:1 with L-threonine and L-serine amidically linked to the carboxyl group. The K54 polysaccharide has a molecular weight of approximately 160,000, corresponding to approximately 380 repeating-units.