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Vol 14 No. 2 Spring 2017

Spring 2017

Pharmacy Journal of New England

Immunization Update for 2017 Indemnification: Rx and the Law Retirees Should Have Spending Plans: Financial Forum

The Future of Pharmacy: Students from University of St.Joseph participate in Pharmacy Day at the Maine State Capitol Legislative Office Building.


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Pharmacy Journal

Vol 14 No. 2 Pharmacy Journal of New England • Spring 2017

of New England New Leadership for MPhA

Editors

Dear Readers,

Managing Editor

Spring has sprung in New England...finally! The Massachusetts Pharmacists Association has undergone some significant changes as I joined the staff as your new Executive Vice President at the end of April, replacing your longtime exec David Johnson. I have big shoes to fill indeed! My background is in Association Management, primarily non-profit medical associations. I have also worked with technology organizations including web analytics groups and cyber security organizations. Ultimately, I have found non-profit management of healthcare associations to be the most rewarding and have spent nine of my twelve years working with associations in healthcare. My goals are to help expand the MPhA membership base, enhance relationships with corporate sponsors, advocate for the legislation important to all pharmacists, identify opportunities for collaboration with other Massachusetts associations, and expand educational and networking opportunities. I am based out of our Woburn office and I welcome you to stop in. I am looking forward to growing our relationship and working closely with the CPA to produce another outstanding New England Pharmacists Convention this fall.

Lindsay De Santis Executive Vice President Massachusetts Pharmacists Association

Lindsay De Santis Margherita R. Giuliano, R.Ph., CAE Ellen Zoppo CPA

Design & Production Kathy Harvey-Ellis

The Pharmacy Journal of New England is owned and published by the Massachusetts Pharmacists Association and the Connecticut Pharmacists Association. Opinions expressed by those of the editorial staff and/or contributors do not necessarily reflect the views or policies of the publisher. Readers are invited to submit their comments and opinions for publication. Letters should be addressed to the Editor and must be signed with a return address. For rates and deadlines, contact the Journal at (860) 563-4619. Pharmacy Journal of New England 35 Cold Spring Road, Suite 121 Rocky Hill, CT 06067-3167 members@ctpharmacists.org

Submitting Articles to the Pharmacy Journal of New England™ The Pharmacy Journal of New England™ is the product of a partnership between the Connecticut Pharmacists Association and the Massachusetts Pharmacists Association. The Journal is a quarterly publication. All submitted articles are subject to peer review. In order to maintain confidentiality, authors’ names are removed during the review process. Article requirements must conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (Ann Intern Med 1982;96 (1part1):766-71). We strongly encourage electronic submissions. PJNE does not assume any responsibility for statements made by authors.

Please submit manuscripts to: PJNE 35 Cold Spring Rd., Suite 121 Rocky Hill, CT 06067 or email to: ezoppo@ctpharmacists.org

Contents 02

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US News

Pictured on the cover, L to R: Marghie Giuliano, Executive VP of CPA; Lynn Pezzullo of RIPA; and Susan Holden of MPhA

New England States Feature: Review of Recent Advisory Committee on Immunization Practices’ (ACIP) Recommendations and Changes to Immunization Schedules for the 2017 Year Pharmacy Marketing Group: Rx and the Law, Financial Forum From the Colleges

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U.S. News With 20 Treatment-Related Deaths in U.S. Clinical Drug Trials, Watchdog Group Files Amendment to FDA Citizen Petition Unreliable drug testing practices put the lives of clinical trial participants at risk, contends Center for Responsible Science Los Angeles, Calif. — With at least 20 treatment-related deaths in clinical drug trials between May 2016 and April 2017, Center for Responsible Science (CRS) has updated its July 2015 citizen petition, also adding a declaration from the father of a 24-year-old patient who died two days after receiving an experimental cancer therapy developed by Juno Therapeutics. The amendment, filed before the latest death was reported, urges the Food and Drug Administration (FDA) to amend 29 regulations to allow the preclinical test method most predictive of human response to be used during drug testing. Current regulations mandate the use of animal models, even if there are human-relevant tests that could predict toxicity that animal tests may miss. Treatment-Related Clinical Trial Deaths • Juno Therapeutics – On May 24, 2016, 24-year-old clinical trial participant Max Vokhgelt died from cerebral edema, likely brought on by a cytokine storm in a phase II trial for

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a chimeric antigen receptor T-Cell (CAR-T) therapy (which uses a patient’s T cells that are changed in the laboratory so they will attack cancer cells). After review of that event, Juno and FDA concluded that a change in trial protocol was not warranted at that time. Max’s death was not reported until July 13, 2016, after two more participants died from cerebral edema. FDA issued a clinical hold of the trial on July 7, 2016, but lifted the hold just five days later based on Juno’s assertion that the chemotherapy preconditioning agent (fludarabine) in combination with the CAR-T therapy had caused the deaths. Juno resumed the trial without fludarabine, and two more clinical trial participants died from cerebral edema in November 2016. “My son was the first to die of cerebral edema in the Juno trial,” said Max’s father, Michael Vokhgelt. “I believe in the promise of CAR-T therapy, but if traditional tests don’t always predict deadly toxicities, drug sponsors must be allowed to use more predictive tests that better predict what happens to clinical trial participants. It is FDA’s responsibility to protect human health and safeguard the public from dangerous drugs. Shouldn’t all available tests to predict safety be used? I don’t want another family to go through what my family went through.”


Pharmacy Journal of New England • Spring 2017

• Ziopharm – On July 14, 2016, three deaths were reported that occurred in a phase I trial for a gene therapy for brain tumors. • Seattle Genetics – In late December 2016, four more deaths from hepatoxicity in a cancer drug trial prompted FDA to issue a clinical hold. • Stemline Therapeutics – In February 2017, Stemline Therapeutics announced the death of one patient in a phase II trial for blastic plasmacytoid dendritic cell neoplasm (BPDCN). This was the third death from capillary leak syndrome in this trial. In March, a fourth death was announced. • Kite Pharma – In December 2016, Kite Pharma announced there had been three treatment-related deaths in their ZUMA1 CAR-T trial. On May 8, 2017, Kite reported another death in its ZUMA trial, this time from cerebral edema. Despite their potential as a breakthrough cancer cure, there are serious safety concerns related to CAR-T cell therapies. Lack of relevant animal models for safety testing has been exemplified by numerous serious adverse events in studies using CAR-T engineered cells. It is essential that this promising cancer therapy be tested in human-relevant test methods to more specifically determine the safety risks before it is tested in humans. There are human-relevant test methods that can predict cytokine release syndrome and inflammation-related adverse events, including cerebral edema. CAR-T therapies could be tested in this platform in combination with any

preconditioning drugs. However, due to current FDA regulations, the animal tests are required. It’s clear that traditional animal tests could not predict the deadly cerebral edema that killed five in the Juno ROCKET trial. Given what is known, CRS strongly encourages FDA to allow the test that most reliably predicts what will happen in humans, instead of insisting only on long-standing animal models. Lives at Stake “With the recent documented failure of animal-based preclinical test methods to predict safety in humans, and the tragedy of at least 20 treatment-related deaths in clinical trials, it is more urgent than ever that FDA update regulations to broaden drug sponsors’ options to use the most predictive tests available,” said CRS President Dr. Neil Wilcox. “FDA’s adoption of these conservative amendments to Investigational New Drug (IND) and Investigational Device Exemption (IDE) regulations should happen now. The lives of clinical trial participants are at stake.” The 20 deaths reflect what has been reported in the media and some Securities and Exchange Commission (SEC) filings. Because most of what the public can learn about clinical trial deaths and FDA clinical holds comes from press releases issued by drug sponsors, the actual number is likely higher. The Center for Responsible Science is a nonpartisan, nonprofit organization advocating for more modern and predictive test methods in drug development.

When First Time Treatment Fails: Navigating New Treatment Paradigms in Relapsed/Refractory Myeloma •

A complimentary online program from the University of Texas MD Anderson Cancer Center and MediCom Worldwide, Inc.

Adapted from live meeting series

Gives continuing education credits Visit the full program here. 3


New England Connecticut

President’s Message It is that time of year when trees begin to blossom, the greenery starts to liven up and the streets look vibrant with people venturing out with the arrival of warmer weather. As we welcome spring we are reminded that spring comes with the idea of rejuvenation, renewal, and regrowth of a new generation. At Connecticut Pharmacists Association our tradition in welcoming Spring Bahar Matusik, PharmD has been to usher the warmer CPA President, 2016-17 and longer days with friends and colleagues supporting the new generation of pharmacists. Each May, our partners at the Connecticut Pharmacists Foundation sponsor a Wine Tasting event to raise funds for the annual pharmacy student scholarships. These scholarships are so important not only because they ease financial burden for students, but also because they allow students to do things for their careers, which they might otherwise not have the means to be able to. There are many reasons to support student scholarship and most people have different causes that are near and dear to their heart. CPF has various scholarships established for students pursuing careers in the field of Pharmacy. Specifically, there are five scholarships of $1,000.00 each which are awarded annually. Scholarship applicants must be enrolled in the Professional Pharmacy curriculum at an accredited school or college of pharmacy at the time of their application. Also, along with their application must submit an essay, a letter of recommendation from an instructor of pharmacy or dean of their school and provide a copy of their official transcripts. At some point in our lives we have all benefited from the generosity of the generation before us and it is now our turn to “pay it forward” in the cycle of giving and 4

receiving. We all know that contributing to the future success of a student has many benefits that go far beyond the actual contribution itself, but did you know your contribution can also benefit you? As a matter of fact, a Harvard Business School Professor and colleagues have shown in a study that spending as little as $5 on someone else leads to demonstrable increases in happiness. This year’s event took place at the Arrigoni Winery in Portland, CT on Saturday May 20th 2017. We thank those who came to celebrate our profession, support a new generation pharmacists, enjoy the company of friends and colleagues and also increase our happiness!

Respectfully, F. Bahar Matusik, PharmD, BCPS CPA President


Pharmacy Journal of New England • Spring 2017

Massachusetts

We are excited to work with Lindsay to strengthen our membership and communication. She has great innovative ideas and has been incredibly helpful thus far. During her first week as EVP, she tackled the Spring CE Conference head-on.

Dear Colleagues,

The Spring Conference was a success! Attorney General Maura Healey offered valuable insight into the opioid crisis, and she is interested in working with pharmacists to combat this issue that hits so many close to home. Healey praised the work that pharmacists are doing and encourages our use of the PMP. We had excellent speakers throughout the day and thank them all for their time and expertise with their presentations.

President’s Message

MPhA has been quite busy with our Foundation Wine Tasting, Meet & Greet at APhA in San Francisco, Spring Conference, and the transition in our Executive Vice President. It has been an honor to have David Johnson as our Executive Vice President of MPhA for the past 8+ years. Dave has taken the lead on behalf of MPhA working robustly with legislators in passing bills to move the pharmacy profession forward; notable regulations include bills allowing pharmacists and physicians to engage in collaborative drug therapy management (CDTM) and allowing pharmacist and pharmacy interns to immunize. We are grateful for all he has done for MPhA, and we wish him the best in his new position as the Director of the Prescription Monitoring Program (PMP) at the Department of Public Health (DPH). Not enough words can describe how grateful we are to have had him by our side, and we look forward to collaborating with him in his new role at the DPH. As we bid adieu to Dave, we welcome Lindsay De Santis as our new Executive Vice President! Lindsay comes with over a decade of association management experience, specifically non-profit medical associations. Since 2011, she worked at the Professional Relations and Research Institute (PRRI) Association Management Company and served as an Executive Director for six medical specialty organizations. She was responsible for membership growth and retention through marketing and research, secured multi-year sponsorship for her associations, developed educational modules for continuing medical education, managed educational webinars, worked on strategic directions and Board governance, and managed events for national conferences up to 500 people.

Many have been asking about our Face of Pharmacy event. At a recent meeting at the State House regarding S.1240 on Pharmacists as Healthcare Providers between Senator Moore, Dennis Lyons, and several of our board members, Senator Moore signed on to host our MPhA Face of Pharmacy, on October 10, 2017. Lastly, congratulations to all the 2017 pharmacy graduates! A new, exciting chapter in your life is beginning. Many of you will be apprehensive and this is okay. Don’t be afraid to ask questions and challenge yourself. You are your biggest advocate. Continue to stay involve with the Association and network with other pharmacists at our MPhA conferences to build upon your new professional career. Sincerely, Alicia Mam daCunha, PharmD, BCACP, AE-C MPhA President, 2016-17

Save the Date - Face of Pharmacy October 10, 2017

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New England States

continued

The MPhA Foundation Held a Wine Tasting Fundraiser on April 6 at the Boston Winery. A great time was had by all!

Pictured above from L to R: Todd Brown, Saad Dinno, and Joseph Ferullo

Pictured above from L to R: Karen Horbowicz, PharmD; Dave Johnson, Former MPhA EVP; and Alicia Mam DaCunha, MPhA President

MPhA held its annual Spring Conference on April 28 at the Four Points by Sheraton in Norwood.

Attorney General Maura Healey is pictured with MPhA’s Board of Directors. L to R front: Barbara Perry, Karen Horbowicz, Alicia Mam daCunha, Attorney General Maura Healey, Delilah Barnes, Lindsay De Santis; L to R back: Alkiviadis Nacopoulos, Matthew Machado, Kathy Keough, Herb Capron, Kerry McGee

Left: Professor Nathaniel Rickles with a poster on medication adherence funded by the Patient Centered Outcomes Research Institute (PCORI).

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Pharmacy Journal of New England • Spring 2017

New Hampshire NHPA Cosponsors a Luncheon for Our Legislators Prepared by Candace Heath, 2017 PharmD Candidate On April 4, 2017, the pharmacy associations in NH (NHPA, NHSHP and NHiPA) co-sponsored a luncheon for our NH legislators at Tandy’s in Concord, NH. The overall goal of this event was to inform our Senators and members of the House of Representatives of the value that pharmacists have in different practice settings. During this presentation, the legislators were educated on the overall objectives and missions of three pharmacy associations. Board members from the pharmacy associations gave a presentation to the legislators on how the educational requirements for pharmacy have evolved over the last 15 years. The evolution of pharmacy practice from a “lick, stick and pour” activity to involvement in patient care activities, such as disease state management was also highlighted. A Q&A session followed the presentation; many of the legislators had great questions about our profession. The event was extremely successful and we hope that we can continue to educate our community on the importance of pharmacists in today’s society. We look forward to hosting this event each year!

New Hampshire Legislative Update Prepared by Elizabeth C. Sargent, Sheehan Phinney Capital Group The legislators are working steadily to finish their policy bills in this 2017 legislative session so they can shift their focus to the budget. Among the top priorities in the budget regarding pharmacy is the NH Prescription Drug Monitoring Program, which is requesting $115,000 to cover a shortfall to run the program. Here is a status of bills that will affect the practice of pharmacy in NH. House Bill 264 – Establishing a commission to study allowing pharmacists to prescribe or make available via

Above, From left to right (front row): Kristine Willett, Cheryl Durand. Second row from left to right: David Rochefort, Representative John Fothergill, Senator Jeff Woodburn, and David Depiero.

protocol oral contraceptives and certain related medications. Sponsored by Rep. Murphy, this bill was amended in its final form to create a commission to study allowing pharmacists to prescribe oral contraceptives and certain other medications. NHPA has a seat on the Commission. Signed by the Governor on April 25, 2017. The first meeting of the Study Commission will be held within 45 days, House Bill 455-FN - Relative to the practices of pharmacy benefit managers. Sponsored by Rep. Hennessey, this bill prohibits pharmacy benefit managers from requiring providers to attain accreditation, credentialing, or licensing other than by the pharmacy board or other state or federal entity. NHPA testified in support of this bill. Passed the House. A public hearing was held on April 18, 2017 in the Senate. The committee has not taken any action yet House Bill 469 – Establishing a continuous quality improvement (CQI) program for pharmacies. Sponsored by Rep. Schmidt, this bill would require licensed pharmacies to establish continuous quality improvement rograms to identify weaknesses in processes and systems and 7


New England States

continued

make appropriate corrections. This bill is a request of the NH Board of Pharmacy. NHPA testified in support of this bill. Passed the House on March 8, 2017. A public hearing was held in the Senate on April 6, 2017. The committee has not taken any action yet. SB 64 – Establishing a committee to study medication synchronization. Sponsored by Senator Carson, this bill would establish a committee to study medication synchronization. The general court notes that medication synchronization is increasingly being recognized as a tool that can improve adherence when patients are on a regular chronic medication regimen. NHPA signed in support of this bill. Signed by the Governor on April 17, 2017. The first meeting of the Study Committee will be held within 45 days.

Senate Bill 234 – Relative to hypodermic syringes and needles containing residual amounts of controlled drugs and authorizing the operation of syringe service programs in New Hampshire. Sponsored by Senator Gray, this bill would authorize the operation of syringe service programs in New Hampshire. It also authorizes persons other than pharmacists to dispense hypodermic syringes and needles and allows them to be sold in retail establishments other than pharmacies. This legislation is part of an overall strategy to combat the opioid crisis here in New Hampshire. NHPA monitored this bill. Passed the Senate. A public hearing was held on April 11, 2017 in the House. Committee Report: Ought to Pass with Amendment

Senate Bill 65 – Relative to vaccines administered by pharmacists. Sponsored by Senator Guida, this bill would add hepatitis A, hepatitis B, Tdap, MMR, and meningococcal vaccines to the list of vaccines that pharmacists are allowed to administer in NH. NHPA signed in support of this bill. Passed the Senate. Passed the House on May 4th, 2017. The bill will now head to the Governor’s desk for signature. Senate Bill 150 - Relative to pharmacist administration of vaccines. Sponsored by Senator Soucy, at the request of the students at Massachusetts College of Pharmacy and Health Sciences, this bill would allow pharmacy student interns to immunize, under the supervision of the pharmacist, the vaccinations currently allowed by state law. NHPA testified in support of this bill. Passed the Senate. Passed the House on April 20, 2017. The bill will now head to the Governor’s desk for signature.

Pictured above, at the SB 150 House Hearing, from L to R: Lorraine Radick, Armand Kounga, Meghan Stanton, Elizabeth Sargent (NHPALobbyist), Stephen Gibson, Candace Heath, and Harriet Petrulio.

Pictured to the right, at the SB 150 House Hearing, from L to R, back row: Cheryl Durand, Ha Nguyen, Chukwuemeka Ugorji, Kakylie Love, Jenny Chang, Ami Neeper, Titpisot Vorn (aka Nita), Molly Ennis, Tesia Sabat, and Peter Kutcher. Front Row from Left to Right: Lorraine Radick, Kimberly Wallace, Gabby Hill, Meghan Stanton, and Harriet Petrulio.

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Pharmacy Journal of New England • Spring 2017

Maine MPA Hosted One-Day Spring CE Program at Husson University The Maine Pharmacy Association (MPA) held a one-day continuing education (CE) event at Husson University in Bangor, Maine on April 1, 2017. The event was well attended by pharmacy personnel from across the state. Six hours of continuing education credit were provided and included presentations on Completing Assessment of Risk in the Community Pharmacy (Patricia Kienle, RPh, MPA, FASHP), an Immunization Update (2 CEs, Kenneth “Mac” McCall, PharmD, BCGP and Brooke Cowles, PharmD), the VA Maine Opioid Safety Initiative (Emily Stoukides, PharmD, Alisa Hughes-Stricklett, PharmD, BCPS, and Brett Glasheen, PharmD, Infectious Diseases (Anthony Casapao, PharmD), and a 2017 Law Update (Greg Cameron, BS, RPh).

Legislative Update LD 455: Tobacco Cessation Services by Pharmacists MPA is pleased to announce that the Maine Health and Human Services Committee voted LD 455 a unanimous ‘ought to pass’ as amended on April 12, 2017. LD 455 (as amended) would enable pharmacists to order over-the-counter nicotine replacement therapy, provide tobacco cessation counseling to patients, and subsequently be reimbursed by the MaineCare program for these services. MPA considers this bill to be an advancement in public health policy since it increases access to smoking cessation products. LD 456: An Act to Increase Access to Vaccinations and LD 572: An Act to Amend the Laws Governing the Practice of Pharmacy The Maine pharmacy community stood united and advocated for our profession in support of LD 456 and LD 572. Unfortunately, our strong show of support at the public hearings on March 7, 2017 did not convert into a positive outcome at the legislative work session and both bills were tabled. LD 456 would allow authorized pharmacists to

Pictured above, L to R presenting: Emily Stoukides, PharmD, Alisa Hughes-Stricklett, PharmD, BCPS, and Brett Glasheen, PharmD.

administer certain vaccines to a person 11 years of age and older, instead of 18 years of age and older as in current law. LD 572 amends the definitions of “Pharmacist” and “Practice of Pharmacy” to specify that our profession provides health care services.

Sesqicentennial to Take Place in Portland October 13-15, 2017 A reminder that the Maine Pharmacy Association (MPA) is celebrating its 150 year anniversary in 2017. To mark this special occasion, MPA has partnered with the Maine Society of Health-System Pharmacists and the American Pharmacists Association (APhA) Academy of Student Pharmacists to host a joint meeting the weekend of October 13-15, 2017. This premier 3-day event will be held at the Holiday Inn By the Bay in Portland, Maine and offers excellent educational and networking opportunities Multiple hours of continuing education will be presented in addition to tracks for CPR recertification, Medication Therapy Management certification, and pharmacy technicians. MPA is excited to welcom current APhA President Dr. Nancy Alvarez, PharmD, BCPS, FAPhA, as Keynote Speaker for this can’t-miss meeting. For more information, visit our website at: www.mparx.com 9


2015 Recipients of the “Bowl of Hygeia” Award

Dan McConaghy Alabama

Tom Van Hassel Arizona

Nicki Hilliard Arkansas

Robert Shmaeff California

Sherman Gershman Connecticut

Kevin Musto Delaware

Fritz Hayes Florida

Ron Stephens Georgia

Kerri Okamura Hawaii

Steven Bandy Illinois

Jane Krause Indiana

Richard Hartig Iowa

Robert Nyquist Kansas

Larry Stovall Kentucky

Lloyd Duplantis Louisiana

Kenneth McCall Maine

Butch Henderson Maryland

Paul Jeffrey Massachusetts

Derek Quinn Michigan

Jenny Houglum Minnesota

Robert Wilbanks Mississippi

Richard Logan Missouri

Gayle Hudgins Montana

Heather Mooney Nevada

Richard Crowe New Hampshire

Edward McGinley New Jersey

Amy Bachyrycz New Mexico

Benjamin Gruda New York

David Moody North Carolina

Kevin Oberlander North Dakota

Danny Bentley Ohio

Gordon Richards, Jr. Oklahoma

Ann Zweber Oregon

Thomas Mattei Pennsylvania

Deborah Newell Rhode Island

Sharm Steadman South Carolina

Renee Sutton South Dakota

Mac Wilhoit Tennessee

Jim Cousineau Texas

Marvin Orrock Utah

John Beckner Virginia

Gregory Hovander Washington

Terri Smith Moore Washington DC

David Flynn West Virginia

Brian Jensen Wisconsin

Randy Harrop Wyoming

The “Bowl of Hygeia”

The Bowl of Hygeia award program was originally developed by the A. H. Robins Company to recognize pharmacists across the nation for outstanding service to their communities. Selected through their respective professional pharmacy associations, each of these dedicated individuals has made uniquely personal contributions to a strong, healthy community. We offer our congratulations and thanks for their high example. The American Pharmacists Association Foundation, the National Alliance of State Pharmacy Associations and the state pharmacy associations have assumed responsibility for continuing this prestigious recognition program. All former recipients are encouraged to maintain their linkage to the Bowl of Hygeia by emailing current contact information to awards@naspa.us. The Bowl of Hygeia is on display in the APhA Awards Gallery located in Washington, DC.

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Boehringer Ingelheim is proud to be the Premier Supporter of the Bowl of Hygeia program.


Feature Review of Recent Advisory Committee on Immunization Practices’ (ACIP) Recommendations and Changes to Immunization Schedules for the 2017 Year by Joseph Rosano, PharmD Candidate 2017 and Jennifer Girotto, PharmD

Introduction Each year, the Centers for Disease Control and Prevention (CDC) provides recommendations after they are discussed and voted on by the Advisory Committee on Immunization Practices.(1,2). This February these updated pediatric and adult recommendations were published and posted on their website. The purpose of this article is to summarize the changes to the Immunization Schedules and categorize the changes made.

Schedule Appearance The pediatric schedule has been significantly changed. Specifically, they have again merged the whole pediatric population (i.e. 0 through 18 years) onto a one-page schedule, but they have now for the first time added a medical indications chart. 1 This medical indications section has been added to help clarify that most children with common medical conditions should be vaccinated on schedule. It also provides guidance explaining which medical conditions should be either precaution or contraindication to vaccinations. Further, it identifies which medical conditions

Pharmacy Journal of New England • Spring 2017

should result in the patients receiving additional doses of specific vaccinations. 1

Influenza For the 2017-2018 season the trivalent influenza vaccine will contain, per WHO recommendations, an A/Michigan/45/2015 (H1N1)pdm09-like virus; an A/Hong Kong/4801/2014 (H3N2)like virus; and a B/Brisbane/60/2008-like virus It was also recommended that quadrivalent vaccines containing two influenza B viruses contain the above three viruses and a B/ Phuket/3073/2013-like virus. 3 These antigens are essentially the same as those included in the current 2016-2017 vaccine. 6 That being said, it is important to remind patients that they will still need to get the vaccine as it is not effective enough to last more than one season.6 Information specific to the 2017-2018 year and the recommendations for influenza vaccination updates will be available in late summer 2017.

Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP)/ Tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) The CDC recommends that the DTaP vaccine be administered at 2, 4, 6, and 15 to 18 months with a fifth dose at 4 to 6 years. There have been many questions that have arisen, likely due to confusion of the timing of the fourth dose because so many other vaccines are administered at 2, 4, 6, and 12 to 15 months of age. Therefore the CDC has provided clarification about the inadvertently early-administered fourth dose of DTaP. They state that the fourth dose does not need to be readministered if it was administered at least four months after the third dose of DTaP and the child is 12 months of age or older.1 New data for the administration of Tdap in pregnancy has also been provided. They continue to recommended that pregnant women of any age receive the Tdap vaccine between gestational weeks 27-36. Where the change exists, based on new data maximizing the passive antibody transfer of pertussis protection, is that now there is a preference to administer it in the earlier part of this gestational age period (i.e. 27 to 29 weeks). 1,2 11


Feature

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Hepatitis B There have been two minor changes to the Hepatitis B vaccine recommendations. First, due to poor rates of babies receiving their birth dose of hepatitis B vaccine, it is now recommended that it should be administered within 24 hours of birth. 1 Secondly, the CDC has provided clarifications for vaccination in patients with chronic liver disease. Specifically, they provided clarification on those that should be vaccinated. These groups include those infected with Hepatitis C virus as well as those diagnosed with cirrhosis, fatty liver disease alcoholic liver disease, or autoimmune hepatitis, and anyone who has liver function tests (AST or ALT) more than twice the upper limit of normal. 2

Human Papillomavirus (HPV) In October 2016, the FDA approved a new two-dose regimen for Gardasil9 (9vHPV) in patients 9 to 15 years old. 4 This new 2 dose regimen is administered at zero and 6 to 12 months. After the vaccine received its approval here in the US, and it is the only HPV vaccine currently marketed, the CDC has also changed its recommendations to a 2 dose series in immunecompetent patients 9 to 15 years old. Three doses (at times 0, 2, and 6 months) are still recommended for patients who have reached their 15th birthday, those of any age who are immunocompromised, as well as those who have received the second dose prior to 6 months after the first dose. 1,2 Likely in an effort to get children vaccinated before their 15th birthday, the CDC have modified their recommendation stating now that children aged 9 or 10 years old can be vaccinated, even in the absence of a high-risk condition. 1

Meningococcal Patients with HIV account for 2% of all patients diagnosed with meningococcal disease. This new data demonstrates that HIV patients have a 5 to 24 fold, higher rate of meningococcal disease than the general population. 5 As a result, the CDC have added a new recommendation that patients 2 months old and older that are infected with HIV should routinely receive a meningococcal conjugate vaccine that covers the A, C, W 135, and Y strains. If the patient is between 2 months and 2 years old, they should generally receive the MenACWY-CRM (Menveo) Dosing for MenACWY-CRM in this age 12

group is at 2, 4, 6, and 12 to 15 months of age. This MenACWYCRM vaccine is preferred, as it does not interfere with the response to the pneumococcal conjugate vaccine, while the MenACWY-D (Menactra) does. If MenACWY-D is needed in this age group it should only be given 4 weeks after completion of the pneumococcal conjugate vaccination. 1,5 There is no preference for one MenACWY vaccine (either MenACWY-CRM or MenACWY-D) for patients who are at least 2 years old and who have completed their pneumococcal vaccination at least 4 week prior. These patients are recommended to receive a 2 dose primary series of the MenACWY vaccine, due to their immunosuppressed state followed by age-appropriate booster dosing. 1,5 Additionally, although not FDA approved in patients 55 years old or greater, the CDC now recommends a MenACWY conjugate vaccine over the polysaccharide vaccine for high risk patients in this population. 2, 5 In addition to changes in recommendations for the MenACWY vaccine, the CDC also provides guidance for labeling changes for one of the MenB vaccines. The changes are due to a recent FDA labeling change on Trumenba.7 The CDC is recommending using a 2 dose series when there is no current outbreak for healthy adolescents. They still recommend that all other patients receive the 3 dose series of the vaccine. 1, 2

Polio Although the polio vaccine is not routinely seen in practice at this time, the CDC has provided clarification on the timing and administration of OPV (oral poliovirus vaccine) and IPV (inactivated poliovirus vaccine). If a patient presents with previous history of Polio immunization(s) and assessment of vaccination status needs to be made further information is available at www.cdc.gov.

References: 1. Robinson CL, Romero JR, Kempe A, Pellegini C. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger – United States, 2017. MMWR Morb Mortal Wkly Rep 2017;66:134-135. 2. Kim DK, Riley LE, Harriman KH, Hunter P, Bridges CB. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2017. MMWR Morb Mortal Wkly Rep 2017;66:136– 138 3. World Health Organization. Recommended Composition


Pharmacy Journal of New England • Spring 2017

of Influenza Virus Vaccines for Use in the 2017-2018 Northern Hemisphere Influenza Season. March 2017. Accessed March 29, 2017 Available at: http://www.who.int/influenza/vaccines/virus/ recommendations/201703_recommendation.pdf?ua=1 4. Gardisil®9(package insert]. Whitehouse Station, NJ. Merck Sharp & Dohme Corp. 2014. 5. MacNeil JR, Rubin LG, Patton M, Ortega-Sanchez IR, Martin SW. Recommendations for Use of Meningococcal Conjugate Vaccines in HIV-Infected Persons — Advisory Committee on Immunization Practices, 2016. MMWR Morb Mortal Wkly Rep 2016;65:1189–1194. 6. Centers for Disease Control and Prevention. Frequently Asked Flu Questions 2016-2017 Influenza Season Centers for Disease Control and Prevention. Accessed March 23,2017 Available at: https://www.cdc.gov/flu/about/season/flu-season-2016-2017. htm

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7. Trumenba® [package insert]. Philadelphia, PA. Wyeth Pharmaceuticals Inc. 2014.

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13


Pharmacy Marketing Group

Rx and the Law By: Don R. McGuire Jr., R.Ph, JD

This series, Pharmacy and the Law, is presented by Pharmacists Mutual Insurance Company and your State Pharmacy Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

Indemnification John from Anytown Pharmacy is negotiating to become the supplier of prescriptions and other pharmacy services to the county jail. As a possible vendor to the county, John is presented with a contract covering this relationship. One of the paragraphs is entitled, “Indemnification.” John reads through the paragraph, but he doesn’t really understand it. In his eagerness to win the contract, John signs it and returns it to the county. What is Indemnification and was it wise for John to agree to it before he understood it? Indemnification is “. . . the obligation [or duty] resting on one person to make good any loss or damage another has incurred or may incur by acting at his request or for his benefit.” It is also known as a Hold Harmless agreement. What it boils down to is if the county gets sued for something Anytown Pharmacy has done wrong, Anytown Pharmacy will defend the county. This can account for significantly higher defense costs, such as attorney fees, to be incurred by Anytown Pharmacy. The pharmacy may also be paying the county’s portion of any judgment in the case. Indemnity agreements can be one-sided or mutual. A mutual indemnity agreement provides for each party to protect the other. However, a one-sided agreement requires only one party has to protect the other. This is a very important distinction and could result in significant costs for the indemnifying party. Anytown Pharmacy should review the agreement to ascertain what it provides. Many vendor agreements as presented do not provide for mutual indemnity. Another important part of the review is to know what acts qualify for indemnification. Most commonly, indemnification is provided for breach of contract. Other actions that can be covered by indemnification include negligent acts, grossly 14

negligent acts, wanton & reckless acts, intentional acts, and criminal acts. These are listed in an ascending order of seriousness under the law. Part of the pharmacy’s negotiations should be the types of acts that are covered by the indemnification agreement. This is important because many parties entering into such agreements assume that their insurance will take care of this indemnification. However, this is not always true as most insurance policies will likely not provide any coverage for breach of contract, intentional acts or criminal acts. The insurance policy is a contract between the pharmacy and the insurance company and it is unaffected by any contract between Anytown Pharmacy and the county. Any promises to indemnify made by the pharmacy that are not covered by insurance will have to be paid by the pharmacy. The acts are not the only key element in the Indemnification agreement. The types of indemnity payments provided can also be listed. Examples of these payments include: any and all losses, claims, expenses, fines, penalties, damages, judgments or liabilities. Again, there may be payments promised within the Indemnification agreement that are not covered by insurance, such as fines and penalties. The Indemnification agreement may also provide the procedure that the party requesting indemnification has to follow in order to qualify contractually. This usually involves promptly notifying the other party and providing relevant documents to them. The party asking for indemnification has to cooperate in the defense of the claim with the other party and may have input into the choice of the lawyer who will defend the case. The choice of lawyer can be critical to the success of your case, but this language has the potential to create a disagreement when it comes time to make the choice. Depending on the language contained in the county’s contract, John may have made an expensive promise because he didn’t fully understand what he was agreeing to in promising to indemnify the county. Obviously, if nothing goes wrong, the issue is moot. But hope is not the best risk management strategy. Careful review of the content of the entire contract, including indemnification requirements, before signing it is a more reliable strategy.


Pharmacy Journal of New England • Spring 2017

Financial Forum Retirees Should Have Spending Plans

Without such strategies, they can risk going through their savings too fast Every day, articles appear urging people to save for retirement. These articles are so prevalent that it may seem like retirement planning is entirely about getting people to save. Actually, retirement planning concerns much more than that. It has another aspect well worth discussing: the eventual spending of all of that money that has been accumulated. Too few Americans coordinate their retirement spending. Earlier this year, Ameriprise asked more than 1,300 savers aged 55-75 if they had a drawdown strategy in mind for the future. Nearly two-thirds of the pre-retirees surveyed did not. A third of the retired respondents to the survey also lacked spending plans.1 In retirement, inattention to household spending can have serious consequences. A newly retired couple can travel too much, eat out too frequently, and live it up to such a degree that its savings can be drawn down abruptly. That danger is heightened if a couple’s investments start to perform poorly. A spending plan may help retirees guard against this kind of crisis. Another case occurs when a retiree household becomes overconfident in its decently performing portfolio and its middling level of savings. A decade or so into retirement without a spending plan, that household finds its investment and bank accounts dwindling mysteriously fast. Sunday brunches give way to $3.99 baconand-egg specials, and the golf clubs stay in the garage all year. A plan for drawing down retirement savings in moderation when retirement starts might help such a couple maintain its quality of life longer. There is no standardized retirement drawdown strategy. Each retired household (and its retirement planner) must arrive at one specific to its savings, investment mix, income requirements, and age. There are some basic principles, however, that may help in configuring the spending plan. It makes sense for many retirees to tap their taxable brokerage accounts as a first step in a drawdown strategy. This allows

assets held within tax-advantaged retirement accounts (such as IRAs) more time to grow and compound. By doing this, a retiree can effectively realize a tax break – money coming out of a traditional IRA is taxed as regular income, whereas long-term capital gains are taxed between zero and 20%.1,2 Of course, Roth IRA withdrawals are never taxed, provided you have followed IRS rules. That brings up another factor in planning retirement spending – what can be done with regard to asset location and tax efficiency before retirement.2 A retiree with a larger traditional IRA may want to consider a Roth conversion of some or all of those IRA assets before age 70. In the fifties or sixties, an IRA owner may be at or near peak earnings, so handling the tax bite that comes with such a conversion may be comparatively easier than it would be during retirement. Another tactic is to take earlier, voluntary withdrawals from accounts that would demand Required Minimum Withdrawals (RMDs) beginning at age 70½. These voluntary withdrawals, which would occur before the start of RMDs, would leave an IRA owner with lower RMDs (and less taxable income) in the future. Retirement spending should never be treated casually. A spending strategy may play a crucial role in preserving a retired household’s quality of life. Citations 1 - cnbc.com/2016/03/02/spending-in-retirement-is-a-balancing-act.html [3/2/16] 2 - investopedia.com/ask/answers/102714/how-are-ira-withdrawals-taxed.asp [10/17/16]

Congratulations to all the 2017 pharmacy graduates this spring from Northeastern University (May 5), MCPHS Universities (May 6), and Western New England University (May 20-21)! On behalf of the MPhA Board of Directors, we wish you success as you continue to build your career and professional connections. We look forward to networking with many of you at our New England Pharmacy Convention! 15


From the Colleges University of Connecticut School of Pharmacy New Faculty Member Adrian Hernandez Joins U Conn School of Pharmacy Adrian Hernandez could be forgiven if he sometimes has to check the schedule on his smartphone to make sure he’s in the right place at the right time. An international traveler with colleagues, family, and a broad range of research interests across the globe, his fluency in several languages comes in handy as he navigates his way through far-flung airports. Hernandez joined the School of Pharmacy in November 2016 as associate professor of comparative effectiveness and outcomes research. He is part of the Health Outcomes Policy and Evidence Synthesis (HOPES) Group – a multidisciplinary cohort of faculty with specific interest in promoting optimal health outcomes through the use of systematic review and meta-analysis of data, economic modeling, clinical trials, and observational research. In addition, he teaches two graduate level courses in research and patient assessment.

Family commitments eventually led Hernandez back to Peru and a teaching and research position at the Universidad Peruana de Ciencias Aplicadas (UPC) in Lima. However, a chance meeting he’d had with Craig Coleman, Professor of Pharmacy Practice and Co-Director of UConn’s EvidenceBased Practice Center within the HOPES Group, ultimately changed his professional trajectory. “Craig and I were both doing poster presentations at American Heart Association conference in Orlando back in 2011, and it immediately became apparent that we shared many research interests. Over the years we stayed in touch and even collaborated on a number of papers,” Hernandez says.

A native of Peru where he earned his MD at the San Fernando School of Medicine, the Universidad Nacional Mayor de San Marcos, his academic career then took him to Rotterdam, The Netherlands, where he earned a Ph.D. in clinical epidemiology.

When the HOPES Group had a position that closely matched his area of expertise, Hernandez decided to apply for it. That led to an offer and the rest, as they say, is history. He and his wife Yuani, also a physician, arrived in Hartford late last year and immediately put down roots.

“As a young doctor,” he says, “I was totally committed to a career as a clinician. But I wanted to know more, and when I read research studies I was aware that my understanding of the data was only superficial. At that time, the government of the Netherlands was offering scholarships to foreign students interested in research training. I was accepted at Erasmus University and awarded a scholarship to study for my master’s degree in clinical epidemiology. I ended up staying on for a master’s in clinical research in cardiovascular diseases followed by a Ph.D. The decision to stay on for further study was life changing.”

Hernandez comments that, all in all, moving to Connecticut has been an easy transition. “It’s been almost like coming to work with long-time friends,” he smiles. “Everyone has been very welcoming and they even laugh at my jokes.”

In Rotterdam, Hernandez’s major advisor was Ewout 16

Steyerberg, a world-renowned expert in predictive modeling techniques. When Steyerberg was approached by Michael Kattan, also a highly regarded expert in the same field who was looking for a research fellow for a short-term project based in New York City, Hernandez got the call. This successful collaboration subsequently led him to join Kattan at the Cleveland Clinic in 2007 where he worked for five years, honing his skills as assistant professor of medicine and clinical epidemiologist in the Department of Quantitative Health Sciences.


Pharmacy Journal of New England • Spring 2017

Jeannette Wick Earns Adjunct Faculty Award On Wednesday, April 5th Jeannette Wick ’79 (Pharm) added another honor to her already impressive resume when she was named recipient of UConn’s Center for Excellence in Teaching and Learning’s (CETL) Adjunct Faculty Award for 2017. In a real sense, she has come full circle. When Wick graduated from UConn’s School of Pharmacy she embarked on a career that includes time spent as a registered pharmacist in Connecticut and Hawaii, working as Senior Clinical Research Pharmacist at the National Cancer Institute, and serving as Public Health Service Officer in Charge, Commission on Mental Health Services/Saint Elizabeths Hospital in Washington, D.C. Along the way, she picked up some awards. These include a Department of Defense Civilian Commendation in 1987, the Surgeon General’s Exemplary Service Medal in 1992 and again in 1996, the American Pharmacists Association Oneto-One Counseling Award in 2004, and the UConn School of Pharmacy’s Distinguished Alumnus award in 2005. Beginning in 2011 and continuing to the present, Wick has been Visiting Professor and Research Specialist in UConn’s Schools of Pharmacy and Nursing. In that capacity she has inspired students such as Minna Lee ’17 (PharmD) who wrote in a letter of recommendation for the CETL award, “Professor Wick is an advocate for motivational learning. She understands the value of keeping students engaged … no matter the practice setting, she never hesitates to listen and extend her hand to support her students.” And from Erin Emonds, ‘18 (PharmD) “Professor Wick demonstrated an interest in engaging with her students from the first day when we went over the syllabus … by involving the class and applying the management principles she was about to teach, Professor Wick initiated her style of constant class participation which continued throughout the year.” The student feedback is reaffirming. It’s every educator’s dream to make a difference. But still, after a distinguished career, why not just continue to take assignments as a

freelance medical writer where she’s in control of her own time and space? Or, to devote her energy to the Alaskan Malamute newsletter that earned her the Dogwriter’s Association of America award for Best Newsletter in 2015? It turns out, that’s just not Wick’s style. “I teach because it’s fun,” she says, “and every class is remarkably different. I’ve had classes that are quiet and some that are especially collegial and others that are filled with humor. The class dynamic changes every year and that’s what helps make teaching so worthwhile and personally rewarding.” Among the courses she teaches are Clinical Science II (aka ‘Bugs and Drugs’), a required pharmacology class for students in the School of Nursing that covers infectious diseases and their treatments, and Current Topics in Pharmacy and Careers in Pharmacy for the School of Pharmacy. But perhaps her favorite course is Pharmacy Practice Management, a two-credit introduction to the nuts and bolts of management and supervision that is required of pharmacy majors. “This is a class that almost no pharmacy major really wants to take,” she says, “because they don’t think of themselves as needing any business acumen. But I’m able to show them that as medical professionals they will always have some supervisory responsibility.” And, she continues, “It’s always fascinating to see how students react when they learn just how much pharmacists have to pay in income taxes or how much overhead is required to pay employee benefits. They learn about the importance of developing solid people skills no matter where their careers take them. “This is news they can use and one of my favorite things as a teacher is to receive notes from former students thanking me for introducing them to some of the real world issues that they use every single day.” Wick says she was surprised and delighted to be selected as the winner of the adjunct teaching award, but Mike White, head of the Department of Pharmacy Practice who initiated the nomination to CETL says he wasn’t surprised at all. He says, “I nominated Jeanette for this award because 17


From the Colleges

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she has been so passionate about helping our pharmacy students succeed for many years. She does her best in the classroom every day so students have a valuable and meaningful experience that will serve them well after graduation. She pushes them to work hard and doesn’t accept less than their best.”

Wick joins faculty Craig Coleman, Lauren Schlesselman and Mike White who were previously designated UConn CETL Teaching Fellows. “Instilling knowledge and passion to help those in need are a hallmark of our department as evidenced by these university teaching awards,” White says.

Massachusetts College of Pharmacy and Health Sciences – Boston Dear Colleagues, On behalf of President Charles Monahan and Provost George Humphrey, I bring you greetings from the School of Pharmacy Boston at MCPHS University. I trust you are all well and are enjoying the New England spring weather. I would like to share some recent updates and accomplishments with you involving our faculty and students

Presentations/Awards At this year’s APhA meeting, Jennifer Goldman, Pharm.D, Professor of Pharmacy Practice, and Dhiren Patel, Pharm.D, Associate Professor of Pharmacy Practice, presented a Pharmacy Times Continuing Education session at the American Pharmacists Association’s (APhA) 2017 Annual Meeting & Exposition in San Francisco.

Best Wishes, Paul DiFrancesco, Dean

Faculty Spotlight Congratulations to Snehal Bhatt, Associate Professor of Pharmacy Practice, who was recently awarded the title “Fellow” of American Society of Health-System Pharmacists (ASHP) in recognition of excellence achieved in pharmacy practice. FASHP designation recognizes those pharmacists who have successfully demonstrated sustained commitment or contributions to excellence in practice for at 18

least 10 years, contributed to the total body of knowledge in the field, demonstrated active involvement and leadership in ASHP, and who have been actively involved in and committed to educating practitioners and others.

The program focused on combining treatment with basal insulin and glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes. Lisa Padgett, Pharm.D, Assistant Professor of Pharmacy Practice, gave a podium presentation entitled “Precepting in the MAGIC (Mount Auburn Geriatric Interdisciplinary Consultation) Clinic.” Catherine Taglieri, Assistant Professor of Pharmacy Practice, Monica Chuong, Associate Professor of Pharmaceutical Sciences, Gary Tataronis, Associate Professor of Statistics, Amee Mistry, Associate Professor of Pharmacy Practice and Steven Kerr, Professor and Chair, Department of Pharmaceutical Sciences, presented a poster entitled “Comparison of Omeprazole Oral Suspensions Compounded by Two Different Methods: The Commonly Used Extemporaneous Method and a Commercial Compounding K.” In addition, the MCPHS University APhA-ASP Chapter won two Region l awards at the meeting for Operation Immunization


Pharmacy Journal of New England • Spring 2017

and Operation Heart.

Student Achievements Phi Lambda Sigma Honors New Members On January 25, Phi Lambda Sigma (PLS), the national pharmacy leadership society, honored its new members with an Induction Ceremony at the Hampshire House in Boston. PLS welcomed 10 new student members and three faculty, with all being recognized for their active involvement in advancing the profession forward through exemplary actions and leadership. Madeline Acquilano, Seena Chokshi, Heba Edrees, Nataly Estrin, Amit Hirani, Joseph Oliva, Kerilyn Petrucci, Jayanth Shekhar, Olivia Taylor, and Kendalyn Thompson, were all honored as new student initiates. Dr. William McCloskey, Professor of Pharmacy Practice, Dr. Christy Harris, Associate Professor of Pharmacy Practice, and Dr. David Schnee, Associate Professor of Pharmacy Practice, were recognized and inducted for their leadership and contributions to the profession as distinguished faculty. John Fanikos, an MCPHS alumnus and Executive Director of Pharmacy at Brigham and Women’s Hospital, delivered the Keynote Address. Rho Chi Holds Induction Ceremony

Memorial Lecturer was Marilyn K. Speedie, Dean of the University of Minnesota College of Pharmacy. A total of 72 PharmD students from the Class of 2019, three Postbaccalaureate students from the Class of 2017, and three Graduate students were inducted. The faculty inductee was Suzanne Dinsmore, PharmD. MCPHS University Pharmaceutical Business and Science Society’s Annual Recognition Dinner The guest speakers at the Pharmaceutical Business and Science Society’s Annual Recognition Dinner in White Hall on the Boston campus were Ms. Eryka Wilson, Business Operations Manager at Cutis Pharma, and Professor Bernard Tyrrell. There were seven certificates of accomplishment presented to the top students including: Certificate of Excellence in Leadership: Fabiola Hyppolite and Sara Ketchum Certificate of Excellence in Research: Christina Galyuk Certificate of Excellence in Service: Yanlan Huang Certificate of Excellence in Academic Excellence: Kiana Fontes, Anh Thi Ngoc Nguyen, and Sara Ketchum

The MCPHS University–Boston Psi Chapter of the Rho Chi Academic Honor Society in Pharmacy held its Induction Ceremony on March 18 at the Hyatt Regency in Cambridge, Mass. The William E. Hassan Jr. Distinguished Rho Chi

Pictured: Sara Ketchum and Bernard Tyrrell

19


From the Colleges

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Massachusetts College of Pharmacy and Health Sciences – Worcester/ Manchester Dear Colleagues, The SOP-W/M had a busy and successful spring 2017 semester. Faculty and P1 and P2 students are looking forward to a break before our summer semester starts May 15. Our graduates will be completing their APPE

answer period that was followed by a lunch and additional discussion.

rotations soon and are excited about the residency, fellowship and employment opportunities that await them. We are looking forward to The MCPHS University Commencement ceremonies that will take place on May 6 at Gillette Stadium. Best wishes for a successful summer! Sincerely, Anna K. Morin, PharmD Interim Dean and Professor of Pharmacy Practice

Rho Chi Honor Society and Phi Lambda Sigma Leadership Society Induction Ceremonies On April 6, the induction ceremonies and dinner celebration for Rho Chi (Gamma Pi Chapter) and Phi Lambda Sigma (Gamma Gamma Chapter) took place in the ballroom at 10 Lincoln Square in Worcester. The SOP-W/M is proud of the 62 Rho Chi inductees and the 31 Phi Lambda Sigma inductees who will work closely with faculty preceptors and society officers to continue the tradition of academic excellence, leadership and community service that both of these prestigious pharmacy societies promote.

Guest Speaker on the Opioid Crisis in America On April 10, MCPHS University was pleased to have Sam Quinones, a journalist, storyteller, former LA Times reporter, and author of Dreamland: The True Tale of America’s Opiate Epidemic speak to the SOP-W/M faculty and the class of 2018. Mr. Quinones addressed the class regarding his experiences while writing his book and allowed for a lively question-and20

Pictured above, L to R: Pictured left to right: Evan Horton, Associate Professor of Pharmacy Practice; Sam Quinones, Author; Caroline Zeind, Associate Provost for Academic and International Affairs, Chief Academic Officer – Worcester/ Manchester; Anna Morin, Dean SOP-W/M

Faculty Poster Presentations Ollessongo R, and Acquaah-Mensah GK. An Exploratory Study of Gene Expression in Triple Negative Breast Cancer. 2017 Cold Spring Harbor Laboratory meeting on Systems Biology: Networks; March 2017. Acquaah-Mensah, GK. Suppressed Oxidative Stress Response and Aryl Hydrocarbon Receptor Expression Associated with Tumor Biology in Blacks Relative to Whites. In: The Toxicologist: Supplement to Toxicological Sciences, 150 (1), 56th Annual Meeting of the Society of Toxicology; March 2017. Friel CJ, Lahoz MR, Bond I. Educating Pre-teens About Lead Poisoning, Teaching Prevention 2017: Aligning Curriculum to Achieve Health Equity, Annual Meeting of the Association for Prevention Teaching and Research, Savannah, GA; April 5-7, 2017.


Pharmacy Journal of New England • Spring 2017

Varghese JJ, Dietle A, Lewicki L, Campanale MC, Ostroff JL. A retrospective cohort study examining the feasibility of funding a hepatitis C clinic through a federally qualified health center with a 340b pharmacy. American Pharmacists Association Annual Meeting and Exposition San Francisco, CA; March 2017. (Resident Poster) Jaberizadeh L, Towle J, Dietle A, Abel C, Dunican K. Assessment of the Performance and Perspective of Students in a Distance Education Accelerated Pharmacy Program in a Flipped Classroom Self-Care Therapeutics Course. American Pharmacists Association Annual Meeting and Exposition, San Francisco, CA; March 2017. (Student Poster) Abel C, Durand C. Students Teaching Students: Assessment of Student-Facilitated Soft Skills Educational Sessions. American Pharmacists Association Annual Meeting and Exposition, San Francisco, CA; March 2017. Towle J, Pervanas H, Amaral M. Student perceptions of an online flipped classroom teaching approach in a medication safety elective. American Pharmacists Association Annual Meeting and Exposition, San Francisco, CA; March 2017.

Northeast Regional Discussion Group (AACP-NERDG) Annual Meeting, Farmington, CT; April 20th, 2017.

Faculty Presentations Jessica McCabe, Marthe-Anne Monagle, Carl Oliveri, Robert Smethers, Chase Smith, Dan Tzizik, Rob O’Dwyer. Supporting Student Veterans at MCPHS University. MCPHS University Faculty Development Committee Seminar; January 4th, 2017. Chase Smith and Timothy Aungst. Teaching & Learning with Office 365 Seminar. MCPHS University Faculty Development Committee Seminar, MCPHS University; March 16th, 2017. Timothy Aungst and Janice McCallum Tech SandBox: Metro west Innovations Hub Life Sciences Sig April 24, 2017 “mHealth and why it’s hot or not – a Fireside Chat”. Linda Spooner and Paulina Deming. Specialty Considerations in Managing Patients with Hepatitis C Infection. Platform Presentation; American Pharmacists Association Annual Meeting and Exposition, San Francisco, CA; March 2017.

Lowe K, Hor K, Kim D, Smith C. Synthetic Studies of a Triazolopyrazine Scaffold as Part of the Open Source Malaria Project. American Association of Pharmaceutical Scientists One of the highlights of the NEPC for our members is the Annual Installation and Awards Banquet, where we honor those who have made exceptional contributions to the profession of pharmacy. We are now accepting nominations for the following awards: •

Bowl of Hygeia

Nathan Goldberg Award

Distinguished Young Pharmacist

Excellence in Innovation

Cardinal Health Generation Rx Champions Award

MPhA Pharmacy Industry Award

Pharmacy Technician of the Year

Visit the MPhA website, http://www.masspharmacists.org/awards.html for information and a nomination form. Please submit all nominations to MPhA Executive Vice President Lindsay De Santis at ldesantis@masspharmacists.org, by June 30, 2017. 21


From the Colleges

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University of New England Art Meets Microbiology in Innovative UNE College of Pharmacy Course For many pharmacy students, finding time to pursue creative outlets in the midst of scientific studies can be a challenge. However, in the new Advanced Infectious Diseases elective course at the UNE College of Pharmacy, both disciplines are an integral part of the curriculum. Students in the class have been exploring microbial art, also known as agar art. Using agar as a medium for artwork was explored by the Scottish scientist Alexander Fleming, best known for his role in developing penicillin. Fleming was also a painter who blended his two passions by creating designs with bacteria in petri dishes. The bacteria and fungi used were species that naturally produce colored pigments, and the agar contained nutrients resulting in color production when certain microorganisms were grown on it. In recent years, the concept of mixing art with science has grown in popularity, as demonstrated by the American Society for Microbiology’s development of the international Agar Art Contest. Now in its third year, the 2016 contest received over 115 entries from 26 countries, with designs ranging from a wolf to a beer stein. Inspired by the competition, George Allen, Pharm.D., associate professor and chair of the Department of Pharmacy Practice and Joel Coon, Pharm.D., assistant clinical professor in the College of Pharmacy decided to incorporate microbial art into their Advanced Infectious George Allen, PharmD. Diseases course this fall. Eight third-year Doctor of Pharmacy students used a chromogenic medium that was developed to allow differentiation of pathogenic bacteria that typically cause urinary tract infections. A palette of 10 colors, each produced by a different bacterial species, was used as “paint.” Among the bacteria used were Acinetobacter baumannii (an important cause of hospital-acquired infections), which produces a beige color when grown on this agar, Escherichia coli (a very common cause of urinary

22

tract infections), which produces a pink color, and Klebsiella pneumoniae (an increasingly serious threat to public health because of the emergence of antimicrobial resistance), which produces a metallic blue color. The students completed the work in phases, first developing ideas for their artwork. Some drew templates on paper for tracing, while others painted directly on the agar. When it came time to paint, the students used fine brushes and solutions of each bacterium to create their designs on each agar plate. They examined their plates the next day, finding that the bacteria had grown into the images they had painted. Finished designs included a lighthouse, flowers, butterflies and a beach scene. “The class enabled students to not only broaden their knowledge of infectious diseases and microbiology, but to work creatively in the process,” Allen said.

UNE Pharmacy Students Present Research at ASHP Midyear Conference Seventeen fourth-year pharmacy students took part in the American Society of Health-System Pharmacists’ (ASHP) Midyear Clinical Meeting and Exhibition, presenting their research at the conference’s poster session. Among the presenters were Kristen Sciarra and Haley Duong, who discussed their investigation of “Antimicrobial stewardship at an acute psychiatric facility: Compliance with clinical guidelines for urinary tract infection, upper respiratory tract infection and skin and soft tissue infections.” They found

Above, pictured from L to R: Kristen Sciarra, Devon Sherwood and Haley Duong.


Pharmacy Journal of New England • Spring 2017

that there was a high compliance rate with guidelines at the facility, but that additional efforts should be made to ensure 100% compliance. Brooke Cowles, Pharm.D. ’16, currently a PGY-1 resident at UNE, presented on “Effectiveness of a medication synchronization program on propotion of days covered (PDC) scores and Medicare Part D medication-related adherence metrics.” The ASHP Midyear Clinical Meeting is the largest gathering of pharmacists in the world and is attended by more than 20,000 pharmacy professionals from 86 countries. The meeting is focused on improving patient care and provides pharmacy practitioners with an opportunity to update their knowledge, learn about the latest technologies and network with colleagues.

UNE’s Don Olins Honored with Symposium for Revolutionary DNA Research Don Olins, Ph.D., research professor in the College of Pharmacy, has been recognized with a symposium in celebration of his 80th birthday and his groundbreaking DNA research. The conference was held at the German Cancer Research Center (DKFZ), where Don and his wife Ada Olins, a research professor in the College of Pharmacy, have held laboratory and guest scientist positions since the 1970s. Titled “Chromatin - From Beads on a String to FourDimensional Nuclear Architecture,” the program focused on the Olinses’ contributions to the field of chromatin structure. Colleagues from Israel, the United Kingdom, the Czech Republic and the United States were in attendance, presenting on topics including genome architecture mapping and mitotic chromosome formation and structure. Don and Ada Olins concluded the symposium with a talk on “Epichromatin: Nucleosomes at the Surface,” in which they discussed their recent research into the DNA composition of epichromatin, the structure of chromatin on the nuclear surface. The Olinses first worked at the DKFZ in 1979, when Don received an award from the Alexander von Humboldt Foundation. This funded his work in the laboratory of Werner W. Franke, a world renowned cell biologist. In 1997, Ada received a Humboldt stipend and worked in the laboratory

of Peter Lichter, known for many important contributions to nuclear architecture and cancer research. The Olinses have since returned to Heidelberg almost every year as guest scientists, spending three months working in the labs of Peter Lichter, Harald Herrmann-Lerdon and Jörg Langowski. The Olinses’ most recognized contribution to the field was Don and Ada Olins their 1973 discovery of the nucleosome, the first level of DNA packaging in the nucleus. The nucleosome is fundamental to higher levels of chromatin packaging, and is the site of chemical modifications that possess genetic regulatory functions. Since this finding, their research has concerned nuclear function and architecture as well as chromatin structure.

UNE’s Emily Dornblaser Published in Leading Pharmacy Education Journal Emily Dornblaser, Pharm.D., M.S., BCPS, assistant professor and critical care specialist in the College of Pharmacy, has been published in Currents in Pharmacy Teaching and Learning. This bi-monthly publication is dedicated to high quality, peer-reviewed scholarship and contains articles from a variety of disciplines relevant to pharmacy education. Titled “A needs assessment of pharmacokinetic skills performed on advanced pharmacy practice experiences by student pharmacists,” Dornbaser’s research focused on Pharmacokinetic (PK) calculations, an important competency for pharmacy students, as well as therapeutic drug monitoring (TDM). Currently, there is little to guide which medications should be included in pharmacy curricula. Additionally, many new medications require TDM—but not PK 23


From the Colleges

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calculations—to ensure safe use. Dornblaser looked to quantify which medications are most frequently encountered by pharmacy students during advanced pharmacy practice experiences (APPE’s) and to what extent PK calculations or TDM were completed by students while on APPE’s at the University of New England. After surveying fourth-year students at the conclusion of their APPE’s, she found that PK calculations occurred most frequently on institutional rotations. Vancomycin and aminoglycosides were the two most common medications pharmacy students were asked to perform PK calculations for while on APPE’s. Therapeutic drug monitoring occurred most frequently on institutional rotations. Therapeutic drug monitoring also occurred more often than pharmacokinetic monitoring on ambulatory care rotations.

More than 70 UNE Pharmacy Students Receive Hospice Certification Training For the second consecutive year, students from the UNE chapter of the American College of Clinical Pharmacy (ACCP) have participated in a hospice certification program. In the four-hour training, Donna Teague, volunteer coordinator for Beacon Hospice in South Portland, spoke to students about hospice history and care, while reinforcing the importance of volunteers in the hospice setting. At the conclusion of the session, interested students applied to become nationally certified as hospice volunteers in direct patient care. Following the successful completion of an application and reference checks, the students received their official certification.

UNE Pharmacy Students Host Sixth Annual UNE Pharmacy Students Advocate for Provider Status at Public Hearing in Maine Mall Health Fair Augusta On February 5, 2017, members of UNE’s Student National Pharmaceutical Association (SNPhA) convened at the Maine Mall for the sixth annual Health Fair. One of their biggest health fairs to date, the event brought together 16 student volunteers and six professors who provided a variety of offerings to the greater Portland community.

UNE pharmacy and dental medicine students spread awareness on several issues, including smoking cessation, stroke prevention, chronic kidney disease, health legislation, diabetes, HIV/AIDS, immunizations and chronic pain. Staff from the Frannie Peabody Center, Maine’s largest communitybased HIV/AIDS organization, were also on hand to provide information to visitors. SNPhA members in attendance included Class of ’18 pharmacy students Christina Fields, Brittany Shofner, Whitney Sargent, Kayla Harris, Ashley Chace, Stephanie Villasis, Gabe Lipman, Kelly Sawyer and Marina Izzi. Students from the Class of ’19 included Lindsey Simmons, Yvonne Vughosi, Patricia Afram, Neva Gross, AJ Golash and Sara Stafford. “Overall, we were able to spread a lot of education to the community,” said Christina Fields, president of UNE’s SNPhA chapter. “This event brings us one step closer to reaching our main goal of serving the underserved.” 24

In a show of support for two bills designed to expand the role of pharmacists in Maine, students and faculty from the UNE College of Pharmacy traveled to Augusta for a public hearing on March 7, 2017. The hearing included a discussion of two bills: LD 572 and LD 456. LD 572 would begin the process of updating Maine’s pharmacy laws by amending the definitions of “pharmacist” and “practice of pharmacy.” This bill recognizes the role of pharmacists in today’s healthcare systems, specifying that a pharmacist is an “individual provider of health care services licensed by this State to engage in the practice of pharmacy.” In addition, it defines the practice of pharmacy as the provision of health care services. LD 456 expands access to vaccination services for teens and preteens by allowing the administration of certain vaccines by a pharmacist to a person 11 years of age and older, instead of 18 years and older as is the current law. To obtain a vaccination, the person would be required to have a valid prescription, treatment protocol or written standing order from an authorized practitioner in Maine. College of Pharmacy students in attendance included Nick Jalbert (‘17), Jordann Coiley (‘20), Martin Kisang (‘17), Ashley Woon (‘17), Jodi McCaffrey (‘17), Sarah Bond (‘17), Stephanie Villasis (‘18), Jordan Bundy (‘17), and Kyung Rim (‘17).


Pharmacy Journal of New England • Spring 2017

Kenneth McCall, BSPharm, Pharm.D., CGP, associate professor for the Department of Pharmacy Practice; Emily Dornblaser, Pharm.D., M.S., BCPS, assistant professor and critical care specialist in the College of Pharmacy; and Anne Cowles, Applied Exercise Science Class of 2010, M.P.H. ‘15, U-ExCEL fitness director, also took part in the public hearing. Pharmacy student Stephanie Villasis described the experience as both insightful and thrilling. “You could see the sea of white coats mixed in with members of the community and others in opposition of the bill. I feel as though hearing the testimonies from pharmacy, medical and nursing fields gave a perspective of what the bill would provide if it were passed.”

Kayla Harris and George Allen of the UNE College of Pharmacy Named AACP Walmart Scholars Kayla Harris (COP, ’18), and faculty mentor George Allen, Pharm.D., associate professor and chair of the Department of Pharmacy Practice in the College of Pharmacy, have been selected as scholarship winners in the American Association of Colleges of Pharmacy (AACP) Walmart Scholars Program. Designed to further strengthen the skills of top pharmacy students, this competitive program was developed specifically for students planning to pursue a career in academic pharmacy. It provides $1,000 scholarships to 85 pharmacy students and their faculty mentors from AACP member institutions. The scholarship will cover the cost of attendance at the 2017 AACP Annual Meeting and AACP Teachers Seminar in Nashville, Tennessee.

UNE College of Pharmacy Announces Paul Abramowitz as Hooding Ceremony Speaker Paul W. Abramowitz, Pharm.D., Sc.D. (Hon), FASH spoke at the hooding ceremony for the UNE Collegeof Pharmacy on May 21st. Abramowitz is currently the chief executive officer of the American Society of Health-System Pharmacists (ASHP). Prior to joining ASHP in September 2011, Abramowitz worked in hospitals and health systems for 34 years. At the University of Iowa Hospitals and Clinics, he served as associate hospital director for professional services and chief pharmacy officer.

Above: UNE students meet at a provider status hearing in Augusta.

He was a professor at the University of Iowa College of Pharmacy and held prior positions as director of pharmacy and associate professor at the Medical College of Virginia and the University of Minnesota. Abramowitz received a bachelor’s degree in chemistry and biology from Indiana University, a bachelor’s degree in pharmacy from the University of Toledo, a Pharm.D. from the University of Michigan, and completed his residency at the University of Michigan Medical Center. In addition to serving as treasurer of ASHP from 2007-10 and as ASHP president in 1993-94, he chaired the board of the ASHP Research and Education Foundation, the Iowa Board of Pharmacy and the Iowa Statewide Poison Control Center. Abramowitz has actively combined practice, teaching and research throughout his career. He has lectured and published extensively, focusing on the effect that quality pharmacy care can have on improving outcomes of care and reducing costs, developing new care models, reducing adverse drug events and expanding comprehensive pharmacy care to the ambulatory setting. In 2010, he was a recipient of the Alumni Distinguished Lifetime Achievement Award from the University of Michigan College of Pharmacy; and in 2013, the Honorary Degree of Doctor of Science from the University of Toledo. In 2015, he was recognized as one of Washington’s Trending Association Leaders by Bisnow.

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From the Colleges

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University of St. Joseph Message from the Dean

Posters and Presentations

Greetings to All!

Malm T. “Naloxone in the News: Why It’s Making Headlines.” Connecticut Society of Health-System Pharmacy, Winter Continuous Education Program. Hartford, CT. January 2017.

We, at University of Saint Joseph School of Pharmacy, are excited about graduating our fourth Pharm.D. class. A number of our graduating students have already secured choice residencies and jobs. In light of another truly successful academic year, we want to thank you again for your well wishes and support! Best, Dean Joseph R. Ofosu Dean, University of St. Joseph School of Pharmacy

News University of Saint Joseph School of Pharmacy sponsored the Morning Coffee Break at the February 2, 2017 Connecticut Pharmacists Association Mid-Winter Conference at the Aqua Turf in Southington, CT. Several USJ pharmacy students are shown here with their sponsorship sign.

Pictured below from L to R are: L-R: Erin Strong, Benjamin Lao, Victoria Gancarczyk, Dr. Kristen Sterling, Dr. Jamie Jensen.

Wiskirchen DE. “Outpatient Antibiotic Stewardship: Opportunities for the Pharmacist.” Connecticut Pharmacists Association Mid-Winter Conference. Southington, CT. February 2017. Le V, Singh R, Ninan S, Grover O and Mandela P. “Drosophila melanogaster; a new animal model for antidepressant drug screening.” Presented a poster at Neuron Conference regional Meeting at Quinnipiac University on February 26, 2017. Howell BA, Vu VM, Lao B, Malm T. “An Intervention to Identify and Address Barriers to Naloxone Prescribing in an Internal Medicine Residency Primary Care Clinic.” Society of General Internal Medicine, Regional Meeting. Boston, MA. March 2017. DeGennaro LP. “ Diabetes Update.” Connecticut Advanced Practice Registered Nurse Society Annual Meeting. Hartford, CT. April 2017.

On March 7, 2017, Pharmacy Day was held at the State Capitol Legislative Office Building. Approximately one dozen USJ School of Pharmacy students were in attendance. The students appreciated time spent with the legislators discussing issues in the pharmacy profession.

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Above, students pose at Pharmacy Day at the State Capitol Legislative Office Building.


Pharmacy Journal of New England • Spring 2017

Jessica McAllister. Platform Presentation “The cancer cell killing compound E49 inhibits the WEE1 checkpoint kinase” at the Eastern Colleges Science Conference, Wilkes University, Wilkes-Barre, PA, April 1, 2017. Research advisor: Mark Sweezy Natalia Echeverry. Platform Presentation “Synthesis of homoepibatidine derivatives utilizing substituted dienophiles” at the Eastern Colleges Science Conference, Wilkes University, Wilkes-Barre, PA, April 1, 2017. Research advisor: Stephen Slauson M.A. Kemp. Platform Presentation “Formation of epibatidine models from dihydropyridine and aryl-containing dienophiles” at the Eastern Colleges Science Conference, Wilkes University, Wilkes-Barre, PA, April 1, 2017. Research advisor: Stephen Slauson M. Lam. Platform Presentation “Lewis acid promoted DielsAlder reaction to synthesize epibatidine analogs” at the Eastern Colleges Science Conference, Wilkes University, Wilkes-Barre, PA, April 1, 2017. Research advisor: Stephen Slauson Ashley Bill. Platform Presentation “The Novel PiperazinoEnaminones (JOAB series) as suppressants of ProInflammatory Mediators” at the Eastern Colleges Science Conference, Wilkes University, Wilkes-Barre, PA, April 1, 2017. Research advisor: Ola Ghoneim Ashley Bill. Platform Presentation “Structure Activity Relationship of Novel Piperazino-Enaminones (JOAB series) as Pro-Inflammatory Cytokine suppressants” at USJ Symposium Day, April 5, 2017. Research advisor: Ola Ghoneim Nicole Studniarski. Platform Presentation “Investigating the Physio-Chemical Compatibility of Indomethacin with PEG 6000 Using Differential Scanning Calorimetry and HPLC Studies”. USJ Symposium Day, April 5, 2017. Research advisor: Sanjay Gayakwad Barniak M, Burke M. Poster Presentation “Preparation of albumin nanoparticles for drug delivery applications”, USJ Symposium Day, April 5, 2017. Research Advisor: Sanjay Gayakwad.

Le V, Singh R, Ninan S, Grover O “Drosophila a new alternative for high throughput screening of antidepressant drugs.” Poster presentation for USJ Symposium Day, April 5, 2017. Advisor: Prashant Mandela Aquilato A: “JODI-19 as an anti-inflammatory agent in allergic asthma”. Poster presentation for USJ Symposium Day, April 5, 2017. Research Advisor: Doreen Szollosi Victoria Lucero: “Nuclear translocation of NF-κB in LPSstimulated macrophages after treatment with JODI compounds.” Poster presentation for USJ Symposium Day, April 5, 2017. Research Advisor: Doreen Szollosi Francis I. “Synthesis of novel anilino and benzylamino enaminones as potential anticonvulsant agents.” Poster accepted for USJ Symposium Day, April 5, 2017. Research Advisor: Ivan Edafiogho Copeland S. “Functionalizing the Epibatidine Scaffold to Aide in Smoking Cessation.” Platform presentation accepted for USJ Symposium Day, April 5, 2017. Research advisor: Stephen Slauson. Bobea C. “Natural Product Extraction: Vitamin K1 from Kale Utilizing Kitchen Appliances.” Poster accepted for USJ Symposium Day, April 5, 2017. Research advisor: Stephen Slauson. Ghoneim OA. Platform Presentation “A small molecule approach for Autism Spectrum Disorder; N-arylpiperazine as key intermediates towards developing bi-functional serotonergic ligands”, American Association of Pharmaceutical Sciences, Northeast Regional Discussion Group AAPS-NERDG, Farmington, CT, April 20, 2017 Bill A, Jackson P, Aquilato A, Szollosi DE, Edafiogho IO, Ghoneim OA. Poster presentation “Synthesis and Biological Activity of the JOAB series as novel pro-inflammatory cytokines suppressants”, American Association of Pharmaceutical Sciences, Northeast Regional Discussion Group AAPS-NERDG, Farmington, CT, April 20, 2017.

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Pjne spring 2017  

PJNE Spring 2017

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