Medicine and Health Sciences Commons^™

Effectiveness Of Empiric Carbapenem Versus Non-Carbapenem Therapy For Extended-Spectrum Β-Lactamase Producing Enterobacterales Infections In Non-Intensive Care Unit Patients: A Real-World Investigation In A Hospital With High-Prevalence Of Extended-Spectrum Β-Lactamase Producing Enterobacterales, Amy Y. Kang, Mary Elkomos, Danny Pham, Michelle Guerrero, Deborah Kupferwasser, Loren G. Miller

Pharmacy Faculty Articles and Research

Objective:

To investigate whether empiric carbapenem therapy, compared to empiric non-carbapenem therapy, was associated with improved clinical outcomes among hospitalized, non-intensive care unit (ICU) patients with extended-spectrum β-lactamase (ESBL)-producing Enterobacterales infections.

Methods:

We performed a retrospective cohort study of adult, non-ICU patients admitted with ESBL-producing Enterobacterales infections. Primary outcome was time to clinical stability from the first empiric antibiotic dose. Secondary outcomes were early clinical response and 30-day all-cause hospital readmission. We used multivariate regression methods to examine time to clinical stability.

Results:

Of the 142 patients, 59 (42%) received empiric carbapenems and 83 (58%) received empiric …

Perceptions Of Metabolic Syndrome Management Utilization In Relation To Patient Experience And Health-Related Quality Of Life, Olajide Adekunle, Jon C. Schommer, Yun Wang, Ismaeel Yunusa, Marc L. Fleming, Enrique Seoane-Vazquez, Lawrence M. Brown

Pharmacy Faculty Articles and Research

Background

One factor for the poor health outcomes among adult people with metabolic syndrome (MetS) is poor utilization of disease management resources, which may be attributable to prior experience with pharmacists (PEwP) and perceptions of disease management resource utilization (PMU). Therefore, understanding patients' experience could be critical to improving their perceptions and promoting health outcomes.

Objectives

The study explored the influence of PEwP and PMU on the health-related quality of life (HRQoL) of people with MetS.

Methods

Data on perceptions of healthcare, medication, and pharmacy services utilization, PEwP, and HRQoL were collected using validated tools via an electronic survey. Chi-square …

Hpv Vaccine Knowledge, Attitudes, Beliefs, And Behaviors Among Community College Students: A Scoping Review, E. Pittman, D. Barker, S. Veeramachaneni, B. Suttles, M. Nagra, A. Ford-Wade, M. Kang, H. Allen, M. Barnard

Faculty and Student Publications

Background: Human Papillomavirus is the most common sexually transmitted infection in the United States. Approximately 42.5 million individuals in the U.S. are infected with disease-associated HPV and 13 million new cases occur every year. It is estimated that 85% of sexually active adults will be infected with HPV at some point during their lifetime. Most individuals infected with HPV are asymptomatic and clear the virus without any complications. However, in some individuals, the virus persists. Prolonged HPV infection has been associated with six different types of cancer and genital warts. There are approximately 37,000 cases of HPV-associated cancers diagnosed annually …

Proteomic Characterization And Cytotoxic Potential Of Proteins From Cuscuta (Cuscuta Epithymum (L.) Crude Herbal Product Against Mcf-7 Human Breast Cancer Cell Line, Umaima Akhtar, Yamna Khurshid, Bishoy El-Aarag, Basir Syed, Ishtiaq A. Khan, Keykavous Parang, Aftab Ahmed

Pharmacy Faculty Articles and Research

Background

The burden of breast cancer, the second leading cause of death worldwide, is increasing at an alarming rate. Cuscuta, used in traditional medicine for different ailments, including cancer, is known for containing phytochemicals that exhibit anticancer activity; however, the bioactivities of proteins from this plant remain unexplored. This study aimed to screen the cytotoxic potential of proteins from the crude herbal product of Cuscuta epithymum(L.) (CE) harvested from the host plants Alhagi maurorum and Medicago sativa.

Methods

The proteins from CE were extracted using a salting-out method, followed by fractionation with a gel filtration chromatography column. Gel-free shotgun …

What Can Pharmacists Do To Reduce Drug Abuse?, Saul E. Alvarado-Rosario

College of Pharmacy Student Research

This review paper provides an overview of the current status of substance abuse, involving both illicit drugs and medically regulated medications. Although global statistics are considered, the primary focus is the substance abuse crisis within the United States. Through review of experimental and observational peer-reviewed articles, this report examines the definition of substance abuse, demographic impacts, and governmental interventions, with particular emphasizes on the role of the pharmacy profession and individual pharmacists in addressing this widespread issue.

Pour Une Diffusion Éthique Des Connaissances De La Médecine Traditionnelle: L’Intersection De La Culture Yoruba Et Des Besoins Médicaux, Isabel Sala

CISLA Senior Integrative Projects

No abstract provided.

Oncology Treatment Plan Updates In Epic-Beacon, Rose Dimarco, Pharmd, Bcps, Bcop, Gloria Espinosa, Mat, Pharmd, Bcop, Kelly Miskovsky, Pharmd, Bcop, Gina Hemmert, Pharmd

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

Background

In Medical Oncology, the utilization of EPIC-Beacon Treatment Plans is integral for prescribing and administering cancer treatments. These treatment plans typically consist of anticancer infusion medications (chemotherapy, immunotherapy, etc.), supportive care medications, required laboratory orders, and other monitoring recommendations to ensure that patients receive safe and effective care. In 2017, TJUH transitioned from Varian’s Aria to EPIC’s electronic medical record system. Since then, there has not been a formal review of existing plans, and there are many inconsistencies between plans in different cancer types.

Problem Statement:

• Currently, there is not a formal process for review of existing treatment plans, …

Non-Alcoholic Fatty Liver Disease: Role Of Pnpla3 And Its Association With Environmental Chemicals, Shakil A. Saghir, Ata Abbas, Saleh Alfuraih, Ajay Sharma, Jean Latimer, Yadollah Omidi, Rais Ansari

Pharmacy Faculty Articles and Research

Globally, non-alcoholic fatty liver disease (NAFLD) is on the rise with 30-32%, 27-33%, 35-48%, 36%, 9-20%, and 36-38% prevalence in Asia, Europe, North America, South America, Africa, and Australia, respectively. Approximately, 5-10% of NAFLD proceeds to hepatitis called non-alcoholic steatohepatitis (NASH). NASH often progresses to liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Precise mechanism(s) for the development of HCC is not fully understood in NAFLD and NASH patients. Higher insulin levels in type 2 diabetes (T2D) can result in lipolysis of adipose tissue activating lipid synthesizing enzymes such as fatty acid synthase and stearoyl-CoA desaturase-1, resulting in lipid accumulation in …

Synthesis Of Thermoresponsive Poly(N-Isopropyl Acrylamide) Based Core-Shell And Hollow Shell Nanogel With Tunable Core And Shell Thickness, Mohamad Hijazi, Molla R. Islam

Student Scholar Symposium Abstracts and Posters

Nanogels have emerged as a notably safer and more effective means for drug delivery, primarily due to their adjustable drug-loading capabilities. Hollow-core nanoparticles offer some unique properties that are desirable for drug delivery applications. Initially, silica core nanoparticles were synthesized using the Stöber process at different temperatures where Tetraethoxysilane (TEOS) undergoes hydrolysis in the presence of ethanol and then a condensation reaction to form silica nanoparticles. Scanning Electron Microscopy (SEM) and Optical Microscopy (OM) analysis revealed that the size of silica core particles varied with the synthesis temperature (300 nm at 30°C to 150 at 60°C). The core silica particles …

Predicting Ffar4 Agonists Using Structure-Based Machine Learning Approach Based On Molecular Fingerprints, Zaid Anis Sherwani, Syeda Sumayya Tariq, Mamona Mushtaq, Ali Raza Siddiqui, Mohammad Nur-E-Alam, Aftab Ahmed, Zaheer Ul-Haq

Pharmacy Faculty Articles and Research

Free Fatty Acid Receptor 4 (FFAR4), a G-protein-coupled receptor, is responsible for triggering intracellular signaling pathways that regulate various physiological processes. FFAR4 agonists are associated with enhancing insulin release and mitigating the atherogenic, obesogenic, pro-carcinogenic, and pro-diabetogenic effects, normally associated with the free fatty acids bound to FFAR4. In this research, molecular structure-based machine-learning techniques were employed to evaluate compounds as potential agonists for FFAR4. Molecular structures were encoded into bit arrays, serving as molecular fingerprints, which were subsequently analyzed using the Bayesian network algorithm to identify patterns for screening the data. The shortlisted hits obtained via machine learning protocols …

Broad-Spectrum Activity Of Membranolytic Cationic Macrocyclic Peptides Against Multi-Drug Resistant Bacteria And Fungi, Sandeep Lohan, Anastasia G. Konshina, Rakesh K. Tiwari, Roman G. Efremov, Innokentiy Maslennikov, Keykavous Parang

Pharmacy Faculty Articles and Research

The emergence of multidrug-resistant (MDR) strains causes severe problems in the treatment of microbial infections owing to limited treatment options. Antimicrobial peptides (AMPs) are drawing considerable attention as promising antibiotic alternative candidates to combat MDR bacterial and fungal infections. Herein, we present a series of small amphiphilic membrane-active cyclic peptides composed, in part, of various nongenetically encoded hydrophilic and hydrophobic amino acids. Notably, lead cyclic peptides 3b and 4b showed broad-spectrum activity against drug-resistant Gram-positive (MIC = 1.5–6.2 µg/mL) and Gram-negative (MIC = 12.5–25 µg/mL) bacteria, and fungi (MIC = 3.1–12.5 µg/mL). Furthermore, lead peptides displayed substantial antibiofilm action comparable …

The Dual-Targeted Fusion Inhibitor Clofazimine Binds To The S2 Segment Of The Sars-Cov-2 Spike Protein, Matthew Freidel, Pratiti Vakhariya, Shalinder Sardarni, Roger Armen

College of Pharmacy Faculty Papers

Clofazimine and Arbidol have both been reported to be effective in vitro SARS-CoV-2 fusion inhibitors. Both are promising drugs that have been repurposed for the treatment of COVID-19 and have been used in several previous and ongoing clinical trials. Small-molecule bindings to expressed constructs of the trimeric S2 segment of Spike and the full-length SARS-CoV-2 Spike protein were measured using a Surface Plasmon Resonance (SPR) binding assay. We demonstrate that Clofazimine, Toremifene, Arbidol and its derivatives bind to the S2 segment of the Spike protein. Clofazimine provided the most reliable and highest-quality SPR data for binding with S2 over the …

Aspects Of Pharmaceutical Networks, Hannah Rita Joseph, Afia L. Rahaman, Kaya Wilson

ENGL 1102 Showcase

The theme of our anthology is different drugs and processes of drug usage in the result how the various aspects of the pharmaceutical companies. We analyze the quality of health that Americans receive from certain parts of the health care industry. We have focused on informing and analyzing the increase of insulin prices, and how that affects Americans everyday lives. The delivery methods of medical cannabis, how each method is effective, and how they are administered. As well as pharmaceutical scams and how it affects elderly people, who rely on medication.

Apigenin Alleviates Autistic-Like Stereotyped Repetitive Behaviors And Mitigates Brain Oxidative Stress In Mice, Petrilla Jayaprakash, Dmytro Isaev, Keun-Hang Susan Yang, Rami Beiram, Murat Oz, Bassem Sadek

Biology, Chemistry, and Environmental Sciences Faculty Articles and Research

Studying the involvement of nicotinic acetylcholine receptors (nAChRs), specifically α7-nAChRs, in neuropsychiatric brain disorders such as autism spectrum disorder (ASD) has gained a growing interest. The flavonoid apigenin (APG) has been confirmed in its pharmacological action as a positive allosteric modulator of α7-nAChRs. However, there is no research describing the pharmacological potential of APG in ASD. The aim of this study was to evaluate the effects of the subchronic systemic treatment of APG (10–30 mg/kg) on ASD-like repetitive and compulsive-like behaviors and oxidative stress status in the hippocampus and cerebellum in BTBR mice, utilizing the reference drug aripiprazole (ARP, 1 …

Harnessing Exosomes As A Platform For Drug Delivery In Breast Cancer: A Systematic Review For In Vivo And In Vitro Studies, Abdulwahab Teflischi Gharavi, Saeed Irian, Azadeh Niknejad, Keykavous Parang, Mona Salimi

Pharmacy Faculty Articles and Research

Breast cancer remains a significant global health concern, emphasizing the critical need for effective treatment strategies, especially targeted therapies. This systematic review summarizes the findings from in vitro and in vivo studies regarding the therapeutic potential of exosomes as drug delivery platforms in the field of breast cancer treatment. A comprehensive search was conducted across bibliographic datasets, including Web of Science, PubMed, and Scopus, using relevant queries from several related published articles and the Medical Subject Headings Database. Then, all morphological, biomechanical, histopathological, and cellular-molecular outcomes were systematically collected. A total of 30 studies were identified based on the Preferred …

Academic Performance Among Pharmacy Students Using Virtual Vs. Face-To-Face Team-Based Learning, Osama A. Shoair

Pharmacy Faculty Publications and Presentations

Introduction

This study compares pharmacy students’ performance using face-to-face (FTF) team-based learning (TBL) vs. virtual TBL across multiple courses and different academic levels while accounting for student demographic and academic factors.

Methods

The study included pharmacy students from different academic levels (P1–P3) who were enrolled in three didactic courses taught using FTF TBL and virtual TBL. Multiple generalized linear models (GLMs) were performed to compare students’ performance on individual readiness assurance tests (iRATs), team readiness assurance tests (tRATs), team application exercises (tAPPs), summative exams, and total course scores using FTF TBL vs. virtual TBL, adjusting for students’ age, sex, race, …

Spring 2024 Edition, Southwestern Oklahoma State University

The Sig

Sig Spring 2024 Edition

GREETINGS FROM THE DEAN'S OFFICE!

I wish everyone a happy Spring and I hope you enjoy the latest edition of the Sig .

2nd Place Contest Entry: Physician Visits For Patients With Diabetes By Gender, Age And Race In The United States, Daniel Umoru, Olajide Adekunle, Adeola Bakare

Eric M. Scandrett Graduate Library Research Prize

This is Daniel Umoru, Olajide Adekunle, and Adeola Bakare's submission for the 2024 Eric M. Scandrett Graduate Research Prize, which won second place. It contains their essay on using library resources, their bibliography, and a summary of their research project (with Dr. Lawrence "LB" Brown) on the complex demographic landscape of diabetes prevalence in the United States.

Daniel, Adeola, and Olajide are doctoral students in the School of Pharmacy at Chapman University. Their faculty mentor is Dr. Enrique Seoane-Vazquez.

An Injectable In Situ Forming Collagen/Alginate/Caso4 Composite Hydrogel For Tissue Engineering Applications: Optimization, Characterization And In Vitro Assessments, Samar A. Salim, Samar A. Salim

Nanotechnology Research Centre

In situ injectable hydrogels are effectively employed to fill irregular cavitary bone defects with initiating bone growth in targeted areas. Herein, an injectable composited hydrogel composed of collagen and alginate cross-linked in situ using different concentrations of calcium sulfate (0.15, 0.3 and 0.6%, wt./v) was synthesized. Recently, CaSO4 is frequently supported as a bone graft material for bone regeneration, owing to its biocompatibility and osteoconductive properties. Moreover, hydroxyapatite (Hap) after salinization-step by (3-Aminopropyl) triethoxysilane (APTES) was incorporated for further enhancing the osteoconductive property of injected hydrogels. All fabricated hydrogels were characterized by SEM, FTIR and XRD analyses. While physiochemical characteristics …

“The Role Of Artificial Intelligence In The Pharmaceutical Field: Enhancing Therapeutic Outcomes And Repurposing Through The Acceleration Of Drug Discovery”, Tonivie Valeriano

Belmont University Research Symposium (BURS)

The development of new drugs and their repurposing have considerably benefited the field of pharmacy. It will not only affect the pharmaceutical sector but also its diverse facets of health will be significantly influenced. Yet, the development of innovative medical treatments necessitated a lengthy period of expectancy for human survival. Individual survival rates were decreasing over time before the development of the treatment. Humanity has a limited lifespan. Moreover, investments in new drugs often go unnoticed because of the prolonged and complex process of drug research and development (R&D). In the future of pharmacy, artificial intelligence will continue to have …

Methionyl-Trna Synthetase Synthetic And Proofreading Activities Are Determinants Of Antibiotic Persistence, Whitney N. Wood, Miguel Angel Rubio, Lorenzo Eugenio Leiva, Gregory J. Phillips, Michael Ibba

Biology, Chemistry, and Environmental Sciences Faculty Articles and Research

Bacterial antibiotic persistence is a phenomenon where bacteria are exposed to an antibiotic and the majority of the population dies while a small subset enters a low metabolic, persistent, state and are able to survive. Once the antibiotic is removed the persistent population can resuscitate and continue growing. Several different molecular mechanisms and pathways have been implicated in this phenomenon. A common mechanism that may underly bacterial antibiotic persistence is perturbations in protein synthesis. To investigate this mechanism, we characterized four distinct metG mutants for their ability to increase antibiotic persistence. Two metG mutants encode changes near the catalytic site …

Characterizing Antibiotic Regimen Modification Behavior, Patient Characteristics, And Outcomes For Patients With Gram-Negative Bacterial Infections, A Retrospective Single-Center Study, Jason Yamaki, Mirna Mikhail, Richard Beuttler, Philip Robinson, Emre Yücel, Alexandre H. Watanabe

Pharmacy Faculty Articles and Research

Few studies describe the frequency of antibiotic regimen modification behaviors in the acute care setting. We sought to ascertain patient and treatment characteristics, details of regimen modification, and clinical outcomes with antibiotic modifications. This retrospective study included patients admitted to Hoag Memorial Hospital from 1 January 2019–31 March 2021 with a complicated infection caused by a Gram-negative organism resistant to extended-spectrum cephalosporins or with the potential for resistance (AmpC producers). A total of 400 patients were included. The predominant sources were bloodstream (33%), urine (26%), and respiratory (24%), including patients with multiple sources. The most isolated organisms were Pseudomonas spp. …

Modulation Of Hippocampal Protein Expression By A Brain Penetrant Biologic Tnf-Α Inhibitor In The 3xtg Alzheimer’S Disease Mice, Nataraj Jagadeesan, G. Chuli Roules, Devaraj V. Chandrashekar, Joshua Yang, Sanjana Kolluru, Rachita K. Sumbria

Pharmacy Faculty Articles and Research

Background

Biologic TNF-α inhibitors (bTNFIs) can block cerebral TNF-α in Alzheimer’s disease (AD) if these macromolecules can cross the blood–brain barrier (BBB). Thus, a model bTNFI, the extracellular domain of type II TNF-α receptor (TNFR), which can bind to and sequester TNF-α, was fused with a mouse transferrin receptor antibody (TfRMAb) to enable brain delivery via BBB TfR-mediated transcytosis. Previously, we found TfRMAb-TNFR to be protective in a mouse model of amyloidosis (APP/PS1) and tauopathy (PS19), and herein we investigated its effects in mice that combine both amyloidosis and tauopathy (3xTg-AD).

Methods

Eight-month-old female 3xTg-AD mice were injected intraperitoneally with …

Association Between Expedited Review Designations And The Us Or Global Burden Of Disease For Drugs Approved By The Us Food And Drug Administration, 2010–2019: A Cross-Sectional Analysis, Matthew J. Jackson, Gregory Vaughan, Fred D. Ledley

Natural & Applied Sciences Faculty Publications

Pharmaceutical innovation can contribute to reducing the burden of disease in human populations. This research asks whether products approved by the US Food and Drug Administration (FDA) from 2010 to 2019 and expedited review programmes incentivising development of products for serious disease were aligned with the US or global burden of disease.

Limonene Exerts Anti-Inflammatory Effect On Lps-Induced Jejunal Injury In Mice By Inhibiting Nf-Κb/Ap-1 Pathway, Sarmed H. Kathem, Yasameen Sh. Nasrawi, Shihab H. Mutlag, Surya M. Nauli

Pharmacy Faculty Articles and Research

The human gastrointestinal system is a complex ecosystem crucial for well-being. During sepsis-induced gut injury, the integrity of the intestinal barrier can be compromised. Lipopolysaccharide (LPS), an endotoxin from Gram-negative bacteria, disrupts the intestinal barrier, contributing to inflammation and various dysfunctions. The current study explores the protective effects of limonene, a natural compound with diverse biological properties, against LPS-induced jejunal injury in mice. Oral administration of limonene at dosages of 100 and 200 mg/kg was used in the LPS mouse model. The Murine Sepsis Score (MSS) was utilized to evaluate the severity of sepsis, while serum levels of urea and …

Implementing Services For Pediatric Cystic Fibrosis Treatment In A Community Hospital., Paige Grube, Heather Nichols, Sarah Ferrell Pharmd, Denise Gilham Pnp, Allyson Gaylor Pharmd, Bcpps, Karen Dunkelberger Bs Pharm, Mshi, Cpps

Pharmacy Residency

This project aimed to describe how the pharmacy department prepared to care for pediatric patients with cystic fibrosis, a new population being cared for at the institution.

PURPOSE: Our community hospital was recently charged with providing care for pediatric people with cystic fibrosis (PwCF). Pediatric PwCF generally need a higher level of care than is required by other pediatric patients cared for at our institution. This project aimed to prepare the pharmacy department to care for this specialized population safely and efficiently.

SUMMARY: The implementation process was divided into 3 phases to accomplish the larger purpose. These phases were as …

A Novel Micropeptide, Slitharin, Exerts Cardioprotective Effects In Myocardial Infarction, Ahmed G. E. Ibrahim, Alessandra Ciullo, Shukuro Yamaguchi, Chang Li, Travis Antes, Xaviar Jones, Liang Li, Ramachandran Murali, Innokentiy Maslennikov, Niveda Sundararaman, Daniel Soetkamp, Eugenio Cingolani, Jennifer Van Eyk, Eduardo Marbán

Pharmacy Faculty Articles and Research

Purpose: Micropeptides are an emerging class of proteins that play critical roles in cell signaling. Here, we describe the discovery of a novel micropeptide, dubbed slitharin (Slt), in conditioned media from Cardiosphere-derived cells (CDCs), a therapeutic cardiac stromal cell type.

Experimental design: We performed mass spectrometry of peptide-enriched fractions from the conditioned media of CDCs and a therapeutically inert cell type (human dermal fibrobasts). We then evaluated the therapeutic capacity of the candidate peptide using an in vitro model of cardiomyocyte injury and a rat model of myocardial infarction.

Results: We identified a novel 24-amino acid micropeptide …

Six-Month Report Assessing The Feasibility And Effectiveness Of Amniotic Membrane Injections In Patients With Short, Anterior, Urethral Strictures, Nicholas Pryde, Jack Vernocke, Aron Liaw, Michael Sessine, Nivedita Dhar

Medical Student Research Symposium

Introduction: Urethral stricture treatment has high recurrence rates and adjunct injectable agents have been explored. Amniotic membranes (AM) promote apoptosis of pro-inflammatory cells, prevent differentiation of pro-fibrotic cells, and decrease scar formation. These tissues generated interest in reconstructive urethral surgery. Thus, we performed urethral dilation combined with micronized AM injection in urethral scar tissue for treatment of urethral stricture.

Materials and Methods: Adult males with strictures ≤12Fr in diameter and ≤2 cm in length, International Prostate Symptom Score (IPSS) ≥11 and maximum flowrate <15 ml/s. Reconstituted 100mg micronized AM was injected at the time of urethral dilation. Primary study end point was anatomical success (≥14Fr by cystoscopy) at 6 months. Secondary end points were questionnaires, flow rate, and post void residual. Outcomes assessed at baseline, 5 days, 14 days, 3 months, and 6 months post-injection. Safety was analyzed.

Results: Ten men, mean age of 52 ± 15 years, were included. There were 7 patients with …

January / February / March 2024, Randy Curry, Cindy Brooks

RURAL ROCKS

This is the January, February, and March issue of Rural Rocks from the SWOSU College of Pharmacy.

Considering Returns On Federal Investment In The Negotiated “Maximum Fair Price” Of Drugs Under The Inflation Reduction Act: An Analysis, Edward W. Zhou, Paula G. Chaves Da Silva, Debbie Quijada, Fred D. Ledley

Natural & Applied Sciences Faculty Publications

The Inflation Reduction Act (IRA) of 2022 contained landmark provisions authorizing government to negotiate a “maximum fair price” for selected Medicare Part D drugs considering the manufacturer’s research and development costs, federal support for discovery and development, the extent to which the drugs address unmet medical needs, and other factors. This working paper describes federal investment in the discovery and development of the ten drugs selected for price negotiation in the first year of the IRA as well as the health value created through Medicare Part D spending on these drugs. We identified $11.7 billion in NIH funding for basic …