Armstrong White (joinrobert23)

s for patients, a lack of equity, and a poor organizational culture. In addition, the study identified a lack of means of communicating urgent imaging findings and a lack of promptness and timeliness to care from the consultant radiologists. Conclusion The low level of care of medical imaging services observed in Ghana is reflected in the large number of barriers to quality care identified in this study. Most barriers identified are in the capacity and sustainability, timeliness, and effective communication dimensions of quality of care. The findings have important implications for policy makers. Improvement in these areas will enable optimization of care and in improving the overall medical imaging care delivery system.Background Current dosing strategies of CFTR modulators are based on serum pharmacokinetics, but drug concentrations in target tissues such as airway epithelia are not known. Previous data suggest that CFTR modulators may accumulate in airway epithelia, and serum pharmacokinetics may not accurately predict effects of chronic treatment. Methods CF (F508del homozygous) primary human bronchial epithelial (HBE) cells grown at air-liquid interface were treated for 14 days with ivacaftor plus lumacaftor or ivacaftor plus tezacaftor, followed by a 14-day washout period. At various intervals during treatment and washout phases, drug concentrations were measured via mass spectrometry, electrophysiological function was assessed in Ussing chambers, and mature CFTR protein was quantified by Western blotting. Results During treatment, ivacaftor accumulated in CF-HBEs to a much greater extent than either lumacaftor or tezacaftor and remained persistently elevated even after 14 days of washout. CFTR activity peaked at 7 days of treatment but diminished with further ivacaftor accumulation, though remained above baseline even after washout. Conclusions Intracellular accrual and persistence of CFTR modulators during and after chronic treatment suggest complex pharmacokinetic and pharmacodynamic properties within airway epithelia that are not predicted by serum pharmacokinetics. Direct measurement of drugs in target tissues may be needed to optimize dosing strategies, and the persistence of CFTR modulators after treatment cessation has implications for personalized medicine approaches.The future of community pharmacy has always been a matter of concern for academics and practitioners alike. Recently, a paper published in this Journal brought to the discussion the importance of new technologies, such as Artificial Intelligence and Blockchain, and the emergence of market forces like Amazon or Google, to the future of the pharmacy profession. In this commentary, we offer our view about the subject, specifically focusing in the practice area of Community Pharmacy. Our choice takes into account the fact that this by far the most numerous group within the profession, and where the fear of redundancy has always been looming since the start of the Industrial Revolution. Envisioned technologies will become a reality, but by now are not mature enough to be the disrupters everyone expects. Moreover, without major shifts in the legal environment regulating the organization of health care and the provision of medicines, big players will find it difficult to substitute pharmacies. As for pharmacists, they have always adapted to the challenges presented by technological revolutions. We argue that for the coming Patient Centred era, it is more important to continue to focus on the sustainability of an enhanced role for community pharmacists, providing services that highlight pharmacists' social role, measuring outcomes, and managing populations' health.Vibration-controlled transient elastography-based FibroScan (Echosens, Paris, France) is today considered the reference device for non-invasive assessment of liver stiffness, and has been found to be a good surrogate marker of liver fibrosis. One major issue when using VCTE™ is the necessity to