Saturday morning coffee [August 8 2015]

“Power is like being a lady… if you have to tell people you are, you aren’t.” – Margaret Thatcher

The mug below comes from Six Flags Magic Mountain down in Valencia, California. If you like roller coasters, then this is the place for you. They have some of the best in the business, and my kids love to ride them. We used to go down there a few times a year, but haven’t had the opportunity in a while. It was nice to have a little reckless fun for a change. One of the longtime landmark rides at Magic Mountain was the Colossus, billed as the tallest and fastest wooden roller coaster in the world. Something happened in 2014 and Six Flags did some major work on the coaster. It’s no longer the wooden beast it was, but rather a hybrid wood and steel roller coaster called Twisted Colossus. The new ride features barrel roll inversions, and a near-vertical drop. And when I say near-vertical drop, I mean near vertical. It got my heat racing. Should have brought the GoPro.

Mission: Impossible – Rogue Nation was #1 at the box office last weekend, pulling down more than $55 million in its opening effort. It’s going to do well as everyone seems to have good things to say about the movie. It’ll get some stiff competition from Fantastic Four this weekend. The final tally should be interesting. Most everything I’ve read so far leads me to believe that Fantastic Four should do well enough to take the #1 spot, but not by much. I guess time will tell, but so far reviews for Fantastic Four haven’t been kind.

Chemistry World: “A recent theoretical study into caffeinated drinks has dispelled a long-held hypothesis; besides directly masking the flavour of caffeine, additives were found to influence our taste perception via a direct caffeine–additive interaction, rather than affecting the water structure around the caffeine molecules….By combining two methods [the author] reveals that the major contribution comes from the direct caffeine–additive interaction, not an additive’s indirect effect on water structure, as previously thought.” – I prefer my coffee black, but sometimes I’ll add cream, or milk, or some type of sweetener. While it’s interesting to understand the chemistry behind the change, I’ll settle for knowing that it tastes good.

I’m currently in a love-hate relationship with Windows 10. I love many things about the new OS, such as the notification center and Cortana. I like the look and feel, although I never had an issue with the UX/UI of Windows 8.1. The location of things has changed, which is driving me a bit nuts. It’ll take some getting used to. One issue is that I have several machines in the house. Currently only my Yoga 2 Pro is running Windows 10. The upgrade isn’t without its issues, however. Many of the problems I blame on Lenovo for lack of driver updates; my touchpad and screen have been acting weird, and my machine has trouble waking from sleep on occasion. And don’t even get me started on what Microsoft did to my beloved OneDrive. Ugh!

This just makes sense to me: using drones to deliver medications, supplies, lab specimens, etc.

Benchmarks: “Stutz started a treatment called pembrolizumab at the University of California, Los Angeles’ Jonsson Comprehensive Cancer Center. This so-called immunotherapy taught Stutz’s own immune cells to fight his disease.” – Immunotherapy is having a tremendous impact on the way we treat cancer. If we don’t find a way to cure it, we’re on our way to treating it as a chronic disease instead of a death sentence.

MNT: “We’ve created a nanocapsule that contains a clot-busting drug. The drug-loaded nanocapsule is coated with an antibody that specifically targets activated platelets, the cells that form blood clots.” According to the article the nanocapsule breaks open in response to thrombin at targeted clot site. “The study uses nanotechnology to approach the problem of how to deliver clot-busting drugs to the precise location of the clot…In their paper, the researchers describe how they developed a nano-sized capsule that responds to thrombin by breaking open and releasing the enclosed clot-busting drug once it reaches the site of the blood clot.” The obvious advantage to delivering drugs with pinpoint accuracy is the ability to utilize lower doses and limit unwanted side effects. Pretty cool stuff.

The Wirecutter recently named the Lenovo Thinkpad T450s their best business laptop. “Most people don’t need one, but if I had to get a no-BS, reliable laptop for everyday work—and an ultrabook just wouldn’t cut it—I’d get the $1,470 configuration of the Lenovo ThinkPad T450s, the model with 1920×1080 screen, backlit keyboard, 12 GB of RAM, and 512GB SSD. It’s the business laptop we recommend after more than 30 hours of research and testing.” I’m in the market for a new machine. While my Yoga 2 Pro is a sexy ultrabook with great specs, it’s not a desktop replacement nor is it a road-worthy machine. The T450s is on my short list, however I’m still reeling from my not-so-great-experience with Lenovo support.

Medscape Pharmacists updated their Antiretroviral Therapy for HIV Infection article with data from trials. Worth a look. Antiretroviral therapy is very interesting from a pharmacist’s perspective. There have been some amazing developments over the years. Think about this, when I graduated from pharmacy school in 1997 there were four drugs used to treat HIV. No, really, four. And the side effect profile of those drugs was nothing to laugh at. We’ve come a long way since then.

Drug Topics has an interesting article by Dennis Miller, RPh on errors in retail pharmacy. The article walks through some interesting conversation around ‘careful’ versus ‘reckless’ pharmacists, and how we should differentiate. “I have the greatest sympathy for those pharmacists who are extremely careful in filling prescriptions yet occasionally make a mistake for any of the following reasons: severe understaffing, inadequate number of competent techs, 12-hour shifts, no meal breaks, no bathroom breaks, etc. On the other hand, should we feel sympathy for those of our colleagues who are a real threat to the public safety? Are there some pharmacists who clearly deserve to be punished for errors?” Legitimate questions. Here’s the bottom line, there are good pharmacists, and there are bad pharmacists. It’s no different than any other profession in healthcare. I’ve always tried to be diligent during my career, but that doesn’t mean I haven’t make my share of mistakes. Who get to decide if my mistakes were from failure in the system, or a lack of focus? Tough call.

In keeping with errors, there’s another recent article from Crazy RxMan on the subject. While the author isn’t in defense of errors, he lays out a narrative that discusses the complex process of filling a prescription. “The average patient has no idea what’s involved at the pharmacy. People only see the pharmacy from the outside, much like we only see my son’s head poking out from the sand in the picture… and have no idea that there’s so much involved in the filling of their prescription.” Sometimes it’s really simple, but other times the process can be quite involved.

I was visiting hospitals in the Bay Area this week collecting data on a new project when a Pharmacy Director that I was speaking with made reference to the headache he was having because of the recent problem with BD syringes. What problem? I hadn’t heard anything. Well it turns out that some hospital pharmacists have reported potency issues with certain medications prepared in advance in 3 mL or 5 mL BD syringes, most notably fentaNYL citrate. There are reports of significant loss of potency after 48 hours. That’s a major problem. According to an ISMP report “One hospital sent 3 syringes of diluted fentaNYL 10 mcg/mL to an outside laboratory for testing. At 48 hours, the potency had declined to 67% on average, and by day 6, the potency was at 55%. Another hospital tested syringes of fentaNYL 5 mcg/mL in 3 mL syringes and found a range of potencies between 10% and 70%. Retesting at two other laboratories showed similar results.” Whoa! These are the kind of things that keep a pharmacist up at night. What the heck, BD! This is going to have a ripple effect. I wouldn’t be surprised if someone overreacted and developed new regulations around unit dosing fentaNYL in syringes. Mark my words.

Ever wonder how Donald Trump gets around? Here’s a video showing his 757. Life’s tough. And just think, I get all excited when I get an economy plus seat on United, i.e. when my knees aren’t in my chest. The video is from 2011, so I have to assume there have been upgrades since then.

Google recently updated their search feature to let people know when a restaurant is too busy. “Google said it is intended to steer customers away from long lines. The tech giant anonymously crowdsources data from consenting smartphone users through the Google Maps app, much like it already does to determine traffic conditions on the road.” I’m down with that. I hate waiting at restaurants. Wonder when they’ll roll this out to movie theater lines? (source: Fast Company)

Jon Stewart concluded a 16 year run on the Daily Show this week when his final episode aired on August 6. I thought Stewart was great, but I never really watched the show. Once in a while Lori and I would catch an episode when we heard there was something of interest, but that’s about it. Stewart will be replaced by Trevor Noah. Who? Exactly.

NFL opening day is less than a month away. Interesting note: the snippet I use for the NFL season kickoff countdown below used to show a digital clock. Now I don’t see it. Wonder what changed? Regardless, football season is almost here. I’m stoked.

Have a great weekend everyone.