Background: There is limited information describing pharmacist participation in prophylactic enoxaparin monitoring in the surgical intensive care unit (SICU). Objective: Our study sought to: 1) characterize pharmacist recommendations for enoxaparin monitoring in trauma patients admitted to the SICU, 2) describe the frequency that medical providers accept pharmacist recommendations for enoxaparin monitoring in trauma patients admitted to the SICU, and 3) illustrate the frequency that trauma patients admitted to our SICU service achieve anti-factor Xa trough concentrations (AFXa-TRs) of 0.11 - 0.20 IU/mL following pharmacist recommendation to adjust prophylactic enoxaparin dosing. Methods: Adult patients who had an AFXa-TR drawn after at least three consecutive prophylactic enoxaparin doses between June 1, 2017 and March 1, 2018 were identified through chart review and included in this study. Patients were excluded based on the following criteria: 1) age less than 18 years, 2) anti-factor Xa (AFXa) level not representative of a trough concentration, 3) AFXa-TR not representative of steady state concentration, and 4) non-trauma based prophylactic enoxaparin dosing. This study was exempt from IRB review. Results: The final analysis consisted of 42 patients. A pharmacist provided at least one recommendation in 97.6% (41/42) of trauma patients with enoxaparin monitoring during their SICU stay. In total, a pharmacist made 170 recommendations, mean of 4.2 (SD 1.8) recommendations per patient. Recommendations were: 1) obtain an AFXa-TR, n=90; 2) adjust enoxaparin dose based on AFXa-TR, n=58; and 3) maintain enoxaparin dose based on AFXa-TR, n=22. Medical providers accepted 89.4% (152/170) of pharmacist recommendations for enoxaparin monitoring. Dose adjustments were made in 33 patients following pharmacist recommendation; of these, 27 had a repeat AFXa-TR following at least one dose adjustment. Target AFXa-TRs were achieved in 19/27 patients, indicating 70.4% had recommended AFXa concentrations. Conclusions: Pharmacists provided recommendations for prophylactic enoxaparin monitoring and dose adjustment in trauma patients admitted to the SICU. Medical providers regularly accepted pharmacist recommendations and trauma patients commonly achieved target AFXa-TR following pharmacist recommendation for dose adjustment. Further research is required to identify the optimal enoxaparin dose for VTE prophylaxis in trauma patients.

Cryptococcus neoformans is an opportunistic fungal pathogen that is ubiquitous in the environment. It causes a deadly meningitis that is responsible for over 180,000 deaths worldwide each year, including 15% of all AIDS-related deaths. The high mortality rates for this infection, even with treatment, suggest a need for improved therapy. Unique characteristics of C. neoformans may suggest directions for drug discovery. These include features of three structures that surround the cell: the plasma membrane, the cell wall around it, and the outermost polysaccharide capsule. We review current knowledge of the fundamental biology of these fascinating structures and highlight open questions in the field, with the goal of stimulating further investigation that will advance basic knowledge and human health.

Desde o trabalho inicial em saúde pública de Charles Wagley em Gurupá, na década de 1940, seguido dos estudos etnográficos pioneiros que desenvolveu com Eduardo Galvão, há uma linha regular de antropólogos conduzindo pesquisas nessa comunidade. Como resultado desta atividade, existem atualmente livros, dissertações, teses, artigos e relatórios de pelo menos 17 autores/organizações diferentes (a maioria antropólogos), e aproximadamente 15 anos de pesquisa coletiva em campo. Neste artigo, examinamos como nossa pesquisa atual, como terceira geração seguindo os passos de Wagley, começou com a base e ampliou sua pesquisa original em diversas áreas, como saúde pública, trabalho infantil, a influência da mídia e o impacto potencial da barragem de Belo Monte.

Ever since Charles Wagley's initial public health work in Gurupá in the 1940s, followed by his and Eduardo Galvão's pioneering ethnographic studies, there has been a steady stream of anthropologists conducting research in the community. As a result of this activity, to date there are books, dissertations, theses, articles, and reports from at least 17 different authors/organizations (mostly anthropologists) and approximately 15 years of collective on-site research. In this article we examine how our current research as the third generation following in Wagley's footsteps builds upon and expands his original research in areas ranging from public health, child labor, the influence of media, and the potential impact of the Belo Monte Dam.