The complexities of elexacaftor/tezacaftor/ivacaftor therapeutic drug monitoring in a person with cystic fibrosis and pulmonary disease.

Therapeutic drug monitoring (TDM) of elexacaftor/tezacaftor/ivacaftor (ETI) remains challenging due to a lack of clarity around the parameters that govern ETI plasma concentrations, whilst the use of concomitant CYP3A inducers rifabutin and rifampicin is not recommended. We present the complexities of TDM for ETI performed in a person with cystic fibrosis and refractory pulmonary disease. Utilising National Association of Testing Authorities (NATA) accredited assays and target considerations published by the Therapeutic Goods Administration (TGA), Australia, ETI plasma concentration variability was monitored over the course of an acute admission with added complexity from an antibiotic regimen including rifabutin, a moderate cytochrome P450 3A (CYP3A) inducer, and clofazimine, a mild CYP3A inhibitor.

Barriers to and facilitators of buprenorphine dispensing for opioid use disorder: Evidence from focus groups in Appalachian Kentucky.

Background: As efforts to increase buprenorphine prescribing continue to intensify, pharmacy dispensing plays an important role in access to essential medications for opioid use disorder. Existing survey research suggests stigma and regulatory concerns are barriers to pharmacists dispensing buprenorphine, but facilitators are less clear, as are in-depth perceptions of pharmacists regarding buprenorphine.

Objective: To assess barriers and facilitators to buprenorphine dispensing in Appalachian Kentucky using a series of focus groups with pharmacy employees.

Medication disposal within reach: Assessing implementation of permanent disposal receptacles in community pharmacies.

Background: Availability of medication disposal receptacles is critical to curbing nonmedical opioid use and diversion; however, availability in community pharmacies is sparse. The objective of this study was to describe implementation of the community pharmacy medication disposal program offered by the HEALing Communities Study in Kentucky (HCS-KY) using the EPIS (Exploration, Preparation, Implementation, and Sustainment) framework.

Methods: Sixteen counties participated in the HCS-KY from 1/1/2020-12/31/2023.

Four approaches to setting soil health targets and thresholds in agricultural soils.

Soil health is a key concept in worldwide efforts to reverse soil degradation, but to be used as a tool to improve soils, it must be definable at a policy level and quantifiable in some way. Soil indicators can be used to define soil health and quantify the degree to which soils fulfil expected functions. Indicators are assessed using target and/or threshold values, which define achievable levels of the indicators or functions.