bluuebunny/crossref_metadata_2025 huggingface dataset:
Production of Free Radicals Arising from the Surface Activity of Minerals and Oxygen. Part Ii. Arsenides, Sulfides, and Sulfoarsenides of Iron, Nickel, and Copper
Authors: Costa Dominique , Guignard Joelle , Pezerat Henri
Published: May 2017

The excess incidence of lung cancers observed in metallic mines other than iron mines probably can be correlated not only to radioactivity, but also to dust pollution. The present work investigates the role of surface properties of sulfides and arsenides, which are present in metal mines, in oxidizing mechanisms capable of inducing oxidative stress and, possibly, of participating in carcinogenesis. Using added spin-trapping agent followed by ESR spectroscopy, it was observed that nickel and copper arsenides can be very active in the oxidation of formate or DMSO, by reducing the oxygen dissolved in a cell-free medium. Sulfides, on the other hand, are not active, except for the iron sulfides, which are very active as an air-aged powder. The process of activation and rendering the particle surface passive was investigated. Surface dissolution and moderate grinding were found to be activating factors, while air-aging generally rendered the particle surface passive. The critical factor in determining activity is the availability of reducing species of iron, copper, or nickel on the surface of the minerals.
Testicular Effects of Bis (2-Methoxyethyl) Ether in the Adult Male Rat
Authors: Cheever Kenneth L. , Weigel Walter W. , Richards Donald E. , Lal Jag B. , Plotnick Harry B.
Published: May 2017

The onset of testicular pathology in the rat and possible recovery over an 8-week period were evaluated after the administration of up to 20 daily oral doses of bis(2-methoxyethyl) ether (diglyme) at 5.1 mmol/kg bw (684 mg/kg bw). Primary and secondary spermatocyte degeneration and spermatidic giant cells were observed after six to eight treatments. In addition, the testes-to-body weight ratio was significantly reduced by the tenth day of treatment and continued to be depressed eight weeks after discontinuation of the treatment. Testicular LDH-X activity, a pachytene spermatocyte marker enzyme, was significantly decreased in animals by the eighteenth day of treatment with diglyme.
In Vitro Effect of Copper on the Stromal Cells of Bone Marrow in Rats
Authors: Miszta Helena
Published: May 2017

The effect of copper in form of copper sulphate (CuSO4 × 5 H2O) was studied in the bone marrow cells of rats of Wistar strain in an in vitro culture. Evident differences between tissue cultures of the bone marrow cells were observed between the control and experimental groups. In the experimental group, the CFU-F colonies appeared as early as in 3rd day while in the control group in 5th day. Loosely arranged fibroblasts, macrophages and adipocytes also showed quantitative differences between groups. An increase in mean corpuscular hemoglobin (MCH) was also found in periphral blood of experimental animals.
Cancer Policy Framework for: Public Health Assessment of Carcinogens in the Environment
Authors: Derosa Christopher T. , Stevens Yee-Wan , Johnson Barry L.
Published: May 2017

Cancer remains at the forefront of public health concerns in the United States and throughout the world. Over the past 20 years a wide range of federal agencies and other organizations have been involved in developing policy statements, classification strategies, and assessment methods to address carcinogenesis and health risks. Each of these documents was developed in response to issues confronted by those organizations in pursuing their mission, often as a direct function of legislative mandates.

In pursuing its mandated responsibilities, the Agency for Toxic Substances and Disease Registry (ATSDR) must address public health concerns associated with exposure to carcinogens in the context of all available relevant information. This information includes both technical data as well as science policy positions adopted by the range of organizations with programs germane to the assessment and/or regulation of carcinogens. Because of distinct differences in perspective, practice, and policy dictated by the mandated activities of these organizations and the rapidly evolving understanding of carcinogenesis, apparently divergent positions may be reflected in their conclusions.

The differences outlined above, coupled with requests from the public, other agencies, and the private sector for a statement reflecting the Agency's position on science and science policy issues related to cancer, prompted the development of this policy. This document is intended to serve as a framework to guide the Agency in its programs and actions regarding carcinogens and to harmonize such efforts with those of other federal agencies and relevant organizations. This framework reflects an assessment of current practice within the Agency and defines the appropriate roles of conclusions derived by other groups, professional judgment, and emerging scientific principles in ATSDR's public health assessments of exposures to carcinogens. This Cancer Policy Framework is not intended to encompass the development of operational guidelines per se, although the Agency recognizes the utility of such efforts. A central theme of this Cancer Policy Framework is the use of risk analysis as an organizing construct based on sound biomedical and other scientific judgment to define plausible exposure ranges of concern rather than single numerical conclusions that may convey an artificial sense of precision. The development and use of innovative tools for exposure and dose response assessment (with particular emphasis on molecular epidemiology) are also endorsed.
Teratogenic Potential of FD&C RED NO. 3 When given by Gavage
Authors: Collins T.F.X. , Black T.N. , Ruggles D.I.
Published: May 2017

FD&C Red No. 3 (erythrosine) is a commonly used food additive. As part of a series of studies on the potential fetal developmental effects of food colors, FD&C Red No. 3 was administered by gavage to pregnant Osborne-Mendel rats at daily dose levels of 15, 30, 100, 200, 400, or 800 mg/kg on days 0-19 of gestation. Control animals were given distilled water by gavage. On gestation day 20, the animals were euthanized and cesarean sections were performed. During the entire treatment period, feed consumption by the animals given 400 mg/kg doses was increased significantly; the increases in the animals given 30 or 800 mg/kg were of borderline significance. The only significant increase in maternal weight gain, on days 0-7 in the animals given 30 mg/kg, was considered a random occurrence. No dose-related changes were seen in maternal clinical findings, implantations, fetal viability, or fetal size (weight and length). No fetal terata were seen, and neither skeletal nor visceral development was affected. FD&C Red No. 3 was neither fetotoxic nor teratogenic at 800 mg/kg when given by gavage.
Health Status by Social Class and/or Minority Status: Implications for Environmental Equity Research
Authors: Montgomery Laura E. , Carter-Pokras Olivia
Published: May 2017

Much of the epidemiologic research in the United States has been based only on the categories of age, sex and race; thus, race has often been used in health statistics as a surrogate for social and economic disadvantage. Few multivariate analyses distinguish effects of components of social class (such as economic level) from the relative, joint, and independent effects of sociocultural identifiers such as race or ethnicity.

This paper reviews studies of social class and minority status differentials in health, with a particular emphasis on health status outcomes which are known or suspected to be related to environmental quality and conditions which increase susceptibility to environmental pollutants. Sociodemographic data are presented for the U.S. population, including blacks, Asian American/Pacific Islanders, American Indian/Alaska Natives, and Hispanics. Four areas of health status data are addressed: mortality, health of women of reproductive age, infant and child health, and adult morbidity. Conceptual and methodological issues surrounding various measures of position in the system of social strata are discussed, including the multidimensionality of social class, in the context of the importance of these issues to public health research. Whenever possible, multivariate studies that consider the role of socioeconomic status in explaining racial/ethnic disparities are discussed.
Susceptibility to Environmental Pollutants among Minorities
Authors: Rios Richard , Poje Gerald V. , Detels Roger
Published: May 2017

Susceptibility to environmental pollutants involves both biological and nonbiobgical factors. Individuals belonging to minority groups are much more likely to be subject to a number of these factors. This paper examines biological susceptibility of minorities to environmental pollutants and provides specific examples of susceptibility resulting from: genetic makeup; occupation; other factors such as compromised health status, exposure to mixtures of pollutants, substance abuse, and unemployment; and social inequality of access to health care, education, and communication skills. Recommendations are made for specific actions and for additional studies.
Environmental Justice for all: Community Perspectives on Health and Research
Authors: Bullard Robert D. , Wright Beverly H.
Published: May 2017

Some individuals, groups, and communities are at special risk from environmental threats. This is especially the case for low income persons, the working class, and people of color whose health may be imperiled by lead in their houses, pollution in their neighborhoods, and hazards in their workplace. Moreover, many of their children face potential health threats in the parks where they play. The environmental justice perspective unmasks the ethical and political questions of “who gets what, why, and in what amounts.” An environmental and public health strategy is needed to ensure that all Americans are protected.
Hazardous Wastes, Hazardous Materials and Environmental Health Inequity
Authors: Soliman Magdi R. I. , Derosa Christopher T. , Mielke Howard W. , Bota Kofi
Published: May 2017

This paper reviews issues associated with the equity of locating hazardous waste sites and hazardous materials. Reports and case studies indicate that hazardous waste sites and the locations of hazardous materials are disproportionately situated near minority communities, especially African-American communities. This inequitable placement of hazardous waste sites is of concern, since exposure to toxic waste can adversely affect human health.

Proximity to these sites may place these minority communities at higher risk of developing cancers and respiratory, cardiovascular, and neurological diseases, and of incurring increased levels of individual and family stress. The health of persons in minority communities near hazardous waste sites is further compromised by their lack of access to adequate health care.

The potential health risks borne by racial and ethnic minorities and by low income communities as a consequence of exposure to toxic waste constitutes environmental inequity. In order to decrease the burden of these risks, we recommend developing environmental policies that address environmental inequity; conducting detailed demographic and health studies that assess the impact of exposure to toxic waste on minority populations; and devising educational programs to sensitize professional service providers and prevent exposure by community residents. This paper identifies research needs and opportunities.
Reproductive and Neurobehavioral Effects of Amaranth Administered to Mice in Drinking Water
Authors: Tanaka Toyohito
Published: May 2017

The color additive amaranth was given in the drinking water at levels of 0 (control), 0.025, 0.075, and 0.225% from 5 weeks of age in F0 generation until F1 generation mice were weaned, with selected reproductive, developmental and behavioral parameters being measured. Amaranth had little adverse effect upon litter size, litter weight and sex ratio. Average body weight in both sexes of the F1 mice was significantly increased in the 0.025% group in both sexes. Survival index at postnatal day (PND) 21 was reduced in the 0.025% amaranth group. For the neurobehavioral parameters, surface righting at PND 4 in fernale offspring and olfactory orientation in both sexes were significantly affected by treatment. Several parameters of movement activity of male offspring at 3 weeks of age were affected in amaranth 0.075% group, but those of female offspring were similar in all groups. The dose levels of amaranth in this study produced a little adverse effect on behavioral development in mice.
The Health Effects of Living near Cement Kilns; A Symptom Survey in Midlothian, Texas
Authors: Legator Marvin S. , Singleton Chantele R. , Morris Debra L. , Philips Donna L.
Published: May 2017

Cement kilns are major sources of toxic air emissions. Regulations based on demonstrated concentrations of specific chemicals, and risk assessments with inherent limitations and uncertainties, are the current methods of preventing exposure to ‘unsafe’ emission levels. Monitoring data are frequently incomplete. These limitations mandate that residents residing near cement kilns be evaluated for adverse health effects. This study reports findings from a symptom survey conducted in Midlothian, Texas, which adds to the limited but growing body of knowledge showing that persons living near cement kilns are experiencing increased respiratory effects. This cross-sectional study uses randomized sampling and an extensive health questionnaire, covering 12 physiological systems, to determine differences in reported health symptoms between the study community (Midlothian, Texas, n = 58) and the reference community (Waxahachie, Texas, n = 54). Findings indicate significant elevations in reported respiratory symptoms in the study community (p-value 0.002). Although the comparatively small sample size is a limitation, the fact that only ‘respiratory effects’ were highly significant supports the efficacy of this investigation. Respiratory effects would be the major anticipated outcome from the known exposures under investigation. This specificity of response (i.e., elevation in respiratory symptoms only), indicates that ‘response bias’ was not a significant factor in this study.
The Relationship between Maternal and Fetal Effects following Maternal Organophosphate Exposure during Gestation in the Rat
Authors: Astroff A. Barry , Young Angela D.
Published: May 2017

Organophosphates, a widely used class of insecticidal compounds, have been shown to cross the placental barrier, and thus potentially affect the developing fetus. This study compared the maternal and fetal effects, including cholinesterase inhibition, following gestational exposure to six organophosphates: tribufos, oxydemeton-methyl, azinphos-methyl, fenamiphos, isofenphos, and fenthion in the Sprague- Dawley rat. All test compounds were administered via oral gavage on gestation days 6-15. Maternal cholinesterase activities (plasma, PChe; erythrocyte, RChe; and brain, BChe) were measured on gestation days 16 and 20, and fetal brain cholinesterase activity was measured on gestation day 20. Effects on gestational parameters (clinical signs, food consumption, and body weight) in adult rats, when observed, were only observed at the highest dose tested for each compound. The inhibition of maternal cholinesterase activities associated with these clinical findings was, for all compounds, always greater than 20%. Moreover, cholinesterase activities were inhibited at dose levels below that which elicited clinical effects. Statistically significant inhibition of at least two of the three cholinesterase enzymes (PChe, RChe, or BChe) was observed on gestation day 16, 24 h following exposure, with all of the organophosphates tested. By gestation day 20, the inhibition of cholinesterase activity was reduced; however, the high dose for all test compounds (except BChe in fenamiphos-treated dams) continued to demonstrate statistically significant inhibition of RChe and BChe. Despite significantly affected cholinesterase activity in the dams, no remarkable effects on fetal BChe were observed with any test compound. No embryotoxicity or teratogenicity were observed with any of the test compounds. These results demonstrate that for the six organophosphates tested: (1) inhibition of maternal cholinesterase activity was the most sensitive indicator of organophosphate exposure; (2) the level of cholinesterase inhibition associated with clinical findings was always greater than 20%; and (3) no effect on fetal Cholinesterase activity (BChe) was observed, even at dose levels that continued to demonstrate significant inhibition of maternal Cholinesterase activity.
Chronic Illnesses and Depressive Symptoms Among Older People: Functional Limitations as a Mediator and Self-Perceptions of Aging as a Moderator
Authors: Han Jina
Published: May 2017

Objective: This research examined the mediation of functional limitations in the relationship between chronic illnesses and depressive symptoms among older Americans along with tests for the moderation of self-perceptions of aging. Method: Data from the Health and Retirement Study (2008, 2010, and 2012) were used. Longitudinal mediation models were tested using a sample of 3,382 Americans who responded to psychosocial questions and were over 65 years old in 2008. Results: Functional limitations mediated the linkage between chronic illnesses and depressive symptoms. Negative self-perceptions of aging exacerbated the effects of chronic illnesses on depressive symptoms. Discussion: Health care professionals should be aware of depressive symptoms in older adults reporting chronic illnesses and particularly in those reporting functional limitations. To decrease the risk of depressive symptoms caused by chronic illnesses, negative self-perceptions of aging may need to be challenged.
Rewards and Impacts of Participation in a Gerontology Extension Program
Authors: Hougland James G. , Turner Howard B. , Hendricks Jon
Published: May 2017

Because involvement in specific organizations typically is part of a general pattern of social participation, understanding the effects of activity in a particular realm is difficult. A 1985 program designed to make the skills of retired professionals available to public service agencies provided an opportunity to follow volunteers during various stages of their participation. It also permitted an assessment of the impact of their volunteer work in this program on changes in their morale, self-esteem, and alienation as well as the extent of their participation in other voluntary activities. It was predicted that the effects of voluntary action would vary according to the participants' reasons for volunteering, their perceptions of their success in serving the agencies, and the number of opportunities they had for demonstrating their competencies. Analysis suggested that participants responded positively but not dramatically to opportunities for meaningful social participation.
Local Action on Behalf of Local Collectives in the U.S. and Israel: How Different are Leaders from Members in Voluntary Associations?
Authors: Friedmann Robert R., , Florin Paul, , Wandersman Abraham, , Meier Ron,
Published: May 2017

While leadership in voluntary organizations is important to the understanding of voluntary action, not enough is known about differences between leaders and members in voluntary organizations. This study explored the differences between leaders and members in local voluntary organizations in the U.S. and Israel. Using discriminant function analysis on demographic characteristics, social psychological variables, and cost-benefit relationships it was found that leaders differ significantly from members in several of these areas. Patterns of greatest similarity were found between the American and Israeli participants on the social psychological variables. Gender distinguished members from leaders in Israel; occupation and education did so in the U.S. A very significant finding in the area of costs and benefits was that leaders perceived their activism as more costly than did members; leaders viewed costs to their participation as being equal to benefits while members perceived more benefits than costs.
An Image Scale for Nonprofit Voluntary Organizations
Authors: Bonner P. Greg , George William R.
Published: May 2017

An inventory of scale items for a tailormade semantic differential is developed to measure the image of nonprofit voluntary organizations. The sixty-three items yield twelve first-order factors. Second-order factor analysis provides unifying constructs within the domain of voluntary organizations' image. Coefficient alpha reliability estimates indicate a highly reliable measurement scale.
Synchronization characteristics of a rotor-pendula system in multiple coupling resonant systems
Authors: Fang Pan , Hou Yongjun
Published: May 2017

The problem is motivated by observations of a rotor-pendula system, which derived from a new shale shaker. To grasp the dynamic characteristics of the shale shaker, the key research is exploring the synchronous mechanism for the system, since synchronous state between rotors is closely related to the dynamic characteristics of the system. In this paper, the dynamic equation of the rotor-pendula system is firstly derived by applying Lagrange’s equations. Through Laplace’s transformation method, the approximate responses of the system in synchronous state are obtained, which is determined coupling coefficients and synchronous state of the system. Then, the synchronous balance equation and the stability criterion of the system are obtained with Poincaré method on which stable phase difference and synchronous behavior can be ascertained. To verify the correctness of the theoretical analysis, numerical simulations are implemented by Runge–Kutta method, and it is shown that the synchronous behavior is determined by the geometry parameters, coupling coefficients, and rotor rotation direction.
Dynamic optimization method with applications for machine tools based on approximation model
Authors: Li TJ , Ding XH , Cheng K , Wu T
Published: May 2017

Natural frequencies and modal shapes of machine tools have position-dependent characteristics owing to their dynamic behaviors changing with the positions of moving parts. It is time-consuming and difficult to evaluate the dynamic behaviors of machine tools and their machining accuracy at different positions. In this paper, a Kriging approximation model coupled with finite element method is proposed to substitute the dynamic equations for obtaining the position-dependent natural frequencies of a machine tool, as well as relative positions between the tool and the workpiece during the machining process. Based on the proposed method, dynamic performance optimization design of the machine tool is conducted under the condition of minimum relative positions. Three case studies are illustrated to demonstrate the implementation of the proposed method.
Experimental vibro-acoustic analysis of the gear rattle induced by multi-harmonic excitation
Authors: Brancati Renato , Rocca Ernesto , Siano Daniela , Viscardi Massimo
Published: May 2017

The paper reports a wide vibro-acoustic experimental investigation of the gear rattle phenomenon induced by multi-harmonic excitation. The analysis is performed by using different measurement techniques which allow some of the significant parameters in this type of investigation to be acquired on a specific test rig: the angular rotations of the gears by using encoders; the accelerations obtained from a triaxial accelerometer; the sound pressure level determined by employing both acoustic microphones; the correct evaluation of the acoustic sources by utilizing a p–v sound intensity probe. Performance indices were adopted to compare the dynamic behaviours of the system with respect to some parameters, such as the speed of the pinion, the fluctuations in the speed of the pinion and the lubrication conditions. The results of the comparative analysis show very good agreement between the vibro-acoustic measurements and the results from the encoder-based method; this has helped us to interpret the physical behaviour of the gear pair with respect to the impacts occurring between the teeth during the different phases of the phenomenon. Moreover, the study indicates interesting aspects of the effects of multi-harmonic excitation on the rattle phenomenon, with particular attention to the influence of lubrication on the reduction in the rattle noise.
Late-Holocene palaeoenvironments of Southern Crimea: Soils, soil-climate relationship and human impact
Authors: Lisetskii Fedor N , Stolba Vladimir F , Pichura Vitalii I
Published: May 2017

Occupying 4% of Crimea’s territory, the sub-Mediterranean landscapes of Southern Crimea stand out for their distinct soil-climatic conditions and record of human activity. This paper presents the results of study of the newly formed and well-dated soils from 21 archaeological sites, making it possible to build a soil chronosequence covering the last 2.3 ka. To study the natural processes on an intra-secular scale, short series of instrumental meteorological observations were extended, based on dendrochronological records, to a total of 160 years, and the time series of solar activity and energy for pedogenesis were correlated. These data are collated with a 4.2-ka Lake Saki varve record, which was re-analysed applying the DFT spectrum analysis method, with three distinct phases in relative secular variations in precipitation being identified. The phase of a relative climatic stability with moderate variations in precipitation (3.2–1.25 ka BP) was followed by the period of increased moisture (from 1.25 ka BP), unparalleled since the Late Bronze Age. Given the decisive role of increased moisture in the climate-controlled energy expenditures for pedogenesis, in the dynamics of vegetation cover and human ways of life, the identification of these periods contributes to a better understanding of soil–climate relationship and cause-and-effect for nonlinear change in the settlement and landscape history of the region.
Concern and Maintenance During Twilight Years
Authors: Banjare Pallavi , Pradhan Jalandhar , Dwivedi Rinshu , Mahapatra S.S. , Debata Bikash Ranjan
Published: May 2017

The present article focuses on the perception of elderly regarding younger generation in rural Odisha. Data for this study were collected from the rural areas of Bargarh district using semi-structured interview schedule. For this study, 310 males and females were interviewed by using systematic sampling technique. Various issues like condition of the aged in context of respect and care have been taken into consideration. Other factors like their level of satisfaction from the care provided by their children and how they perceive today’s youth has been analysed. ANOVA was conducted to see which socio-demographic variables have the most significant effect on the perception of elderly later, factor analysis is used and the results show that the elderly have a negative perception regarding the younger generation. Results show that the elderly feels that today’s youth is selfish and least bothered about their needs and demands.
Modeling and simulation of hydrogels for the application as finger grippers
Authors: Attaran Abdolhamid , Keller Karsten , Wallmersperger Thomas
Published: May 2017

A chemo-electro-mechanical continuum model developed previously by the authors is utilized in this article to simulate electrically driven hydrogels for the application as finger grippers. To that end, a system consisting of an anionic gel and a cationic gel immersed in NaCl solution bath is discretized and numerically solved. An electric field is then applied between two electrodes on top and bottom of the simulation domain. For the numerical treatment of this study, the finite element method is exploited. By gradual increase in the electric potential between the two electrodes, the bending movement of the gels is realized. The process leading to bending of the gels is elaborated in detail in this article. It is concluded that our approach proves to be a practical tool for simulation of the closing and opening mechanism of a finger gripper stimulated by electric field.
“Then They Trust You …”
Authors: Love Marsha , Tendick-Matesanz Felipe , Thomason Jane , Carter Davine , Glassman Myra , Zanoni Joseph
Published: May 2017

The home care workforce, already at 2.7 million caregivers, will become the nation’s fastest growing occupation by 2024 as the senior boom generation accelerates the demand for in home services to meet its long-term care needs. The physically challenging work of assisting clients with intimate, essential acts of daily living places home care workers (HCWs) at risk for musculoskeletal disorders (MSDs); yet, HCWs typically receive little formal job training and may lack appropriate assistive devices. In this qualitative pilot study, HCW focus groups described workplace MSD risk factors and identified problem-solving strategies to improve ergonomic conditions. The results revealed that HCWs rely on their behavioral insights, self-styled communications skills and caring demeanor to navigate MSD risks to themselves and increase clients’ physical independence of movement. We suggest changes in employer and government policies to acknowledge HCWs as valued team members in long-term care and to enhance their effectiveness as caregivers.
Occupational Safety and Health in the Temporary Services Industry
Authors: Bonney Tessa , Forst Linda , Rivers Samara , Love Marsha , Pratap Preethi , Bell Tim , Fulkerson Sean
Published: May 2017

Workers in the temporary staffing industry face hazardous working conditions and have a high risk of occupational injury. This project brought together local workers’ centers and university investigators to build a corps of Occupational Health Promoters (OHPs) and to test a survey tool and recruitment methods to identify hazards and raise awareness among workers employed by temporary staffing companies. OHPs interviewed ninety-eight workers employed by thirty-three temporary agencies and forty-nine client companies, working mainly in shipping and packing, manufacturing, and warehousing sectors. Surveys identified workplace hazards. OHPs reported two companies to OSHA, resulting in several citations. Partners reported greater understanding of occupational safety and health challenges for temporary workers and continue to engage in training, peer education, and coalition building.
Pentamidine Therapy in Renal Failure: Case Report and Literature Review
Authors: Fitzsimmons William E , Luskin Susan S.
Published: May 2017

The literature lacks adequate dosing guidelines for modifying pentamidine therapy in renal failure. This report describes a patient in renal failure undergoing intermittent peritoneal dialysis who is treated with pentamidine for Pneumocystis carinii pneumonia. Data on pentamidine's disposition are reviewed.
Compatibility of Clindamycin Phosphate with Aztreonam in Polypropylene Syringes and with Cefoperazone Sodium, Cefonicid Sodium, and Cefuroxime Sodium in Partial-Fill Glass Bottles
Authors: Marble Dwight A. , Bosso John A. , Townsend Raymond J.
Published: May 2017

The stability and compatibility of clindamycin phosphate admixed with four beta-lactams, an experimental monobactam (aztreonam), and three cephalosporins (cefoperazone sodium, cefonicid sodium, and cefuroxime sodium), were studied. Aztreonam alone and the combination of clindamycin phosphate-aztreonam were prepared in duplicate polypropylene syringes. Each cephalosporin antibiotic as well as the three clindamycin phosphate-cephalosporin combinations were admixed in duplicate 100 ml partial-fill glass bottles containing either dextrose 5% in water or NaCl 0.9%. All solutions were examined, antibiotic concentrations were determined, and pH was measured at the time of admixture and 1, 4, 8, 12, 24, and 48 hours later. The solutions were maintained at room temperature under fluorescent lighting for the length of the study. Antibiotic concentrations were determined by drug-specific high performance liquid chromatographic assays. Significant instability or incompatibility was defined as a decrease in concentration of greater than ten percent relative to the initial concentration measured at the time of admixture. All antibiotics were stable for 48 hours. In the combination studies, clindamycin was stable for 48 hours, both in partial-fill glass bottles and syringes. Aztreonam, cefoperazone, cefonicid, and cefuroxime were also stable for 48 hours.
Absorption of Intraperitoneal Antibiotics
Authors: Morse Gene D. , Apicella Michael A. , Walshe John J.
Published: May 2017

The treatment of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) usually includes the repeated administration of intraperitoneal (ip) antibiotics. The initial segment of this study (15 noninfected CAPD patients) examined the ip administration of four structurally different agents that represent the common types of antibiotics prescribed for peritonitis: an aminoglycoside (tobramycin), a glycopeptide (vancomycin), a beta-lactam (cefamandole), and an oxa-beta-lactam (moxalactam). Subsequently, 16 CAPD patients with peritonitis received either vancomycin (30 mg/kg) or cefamandole (1 g) in two liters of dialysate over a six-hour dwell period. Vancomycin and cefamandole were absorbed more rapidly in patients with peritonitis as indicated by a more rapid decline in dialysate concentrations, and higher serum concentrations that occurred earlier than in the noninfected patients. Although a higher percentage of the ip dose of vancomycin and cefamandole was absorbed during peritonitis, peak serum concentrations at the end of the drug administration dwell period were not significantly different. Numerous factors influence the absorption of ip antibiotics, including the dialysate drug concentration, the dwell period, protein binding, distribution volume, and presence or absence of peritonitis.
Documenting the Clinical Pharmacist's Activities: Back to Basics
Authors: Strand Linda M. , Cipolle Robert J. , Morley Peter C.
Published: May 2017

The profession of pharmacy has applied the term “documentation” to count activities that more closely approximate descriptive protocols or administrative reports. This extended nonclinical use of the term documentation has resulted in the profession losing sight of a necessary step in the development, justification, and successful implementation of clinical pharmacy services. An instrument that helps to standardize the documentation of a clinical pharmacist's database, patient-care activities, and therapeutic plans is presented. This process, the pharmacist's workup of drug therapy (PWDT), consists of the following six interrelated steps: (1) establish a comprehensive patient-specific database; (2) identify patient-specific, drug-related problems; (3) describe desired therapeutic outcomes; (4) list all therapeutic alternatives that might produce the desired outcomes; (5) select the drug recommendation(s) that most likely will result in the desired outcomes; and (6) establish a plan for therapeutic drug monitoring that documents that desired effects occur and undesired effects are minimized.

A formative method of documenting the clinical pharmacist's activities such as the PWDT must be functional on a daily basis in order to generate meaningful summative management reports.
Postmarketing Surveillance Methodologies
Authors: Edlavitch Stanley A.
Published: May 2017

This article describes and discusses the strengths and limitations of the major pharmacoepidemiologic methodologies employed in postmarketing drug surveillance and describes the current status of the U.S. surveillance system. The main methodologies employed in postmarketing drug surveillance include controlled clinical trials, observational epidemiologic studies (cohort, case-control, cross-sectional), demographic methods, drug utilization surveys, spontaneous reports, and automated databases linking medications and disease. Examples of pharmacoepidemiologic studies using each of these methodologies are presented. When a question arises about the efficacy and/or safety of a marketed drug, typically a mixture of these study methodologies is employed. The article concludes with a brief discussion of the role of the Food and Drug Administration, pharmaceutical manufacturers, and academic institutions in initiating and conducting postmarketing drug studies.
Therapeutic Substitution in the Health Maintenance Organization Outpatient Environment
Authors: Doering Paul L. , Russell Wayne L. , McCormick William C. , Klapp Deborah L.
Published: May 2017

Health maintenance organizations (HMO) are growing in number as a cost-effective way of providing health care. In some, stringent formulary management policies including programs authorizing therapeutic substitution are practiced. Under this concept a drug that has been previously determined to be therapeutically equivalent to a second drug, even though it is not chemically equivalent to the prescribed drug, is automatically dispensed without contacting the prescriber.

This study was undertaken to learn the extent and conditions under which therapeutic substitution is being practiced in the HMO setting. A survey was sent to all HMO in the U.S. inquiring into the operation of the pharmacy services. Specific focus was on the operation of the formulary and the policies and procedures being followed. The main goal was to learn how many programs authorize therapeutic substitution, what drugs are allowed, and what procedures are followed once the substitution is made.

Of the 481 surveys sent out, 192 (40 percent) usable responses were received. Results indicate that 30.5 percent of HMO pharmacy plans allow therapeutic substitution. These programs were most likely to be of the staff-model or the group-model and least likely to be of the independent practice association type. HMO with an inhouse pharmacy more frequently had policies allowing therapeutic substitution than those using outside pharmacy services.
Influence of Enteral Feedings on Phenytoin Sodium Absorption from Capsules
Authors: Nishimura Lyn Y. , Armstrong Edward P. , Plezia Patricia M. , Iacono Robert P.
Published: May 2017

The influence of enteral feedings (with Ensure) on the absorption of phenytoin sodium from capsules was studied. Six healthy adult volunteers were given a single dose of phenytoin capsules 400 mg po on two occasions. Blood specimens were collected for 48 hours after each dose. In a randomized, crossover fashion, each subject completed the following two phases: (1) phenytoin without enteral feedings, and (2) concomitant enteral feedings before phenytoin and continued at 100 ml/h for ten hours. The areas under the concentration versus time curves from 0-48 hours (AUCo-48) were not significantly different between the two phases (p > 0.5). The percent relative bioavailability of phenytoin with enteral feedings was 101.7 percent. This study suggests that enteral feedings do not affect the serum concentrations of phenytoin after a single dose given in capsule form.
Tocainide: A Severe Adverse Reaction
Authors: Dunn James M. , Groth Paul E. , DeSimone Anne
Published: May 2017

Tocainide is a primary analog of lidocaine with antiarrhythmic properties used to treat ventricular rhythm disorders. A 76-year-old man with benign paroxysmal premature ventricular contractions was treated with tocainide and developed a generalized maculopapular lupoid eruption, bleeding from the lips and gingivae, vertigo, gross tremors of the extremities, fever, and short-term memory loss, which required hospitalization. The patient recovered slowly over three months with no permanent sequelae after discontinuing the drug and receiving rigorous supportive care. His excellent physical status and absence of concomitant illness contributed to an uneventful recovery. Tocainide is a potent cardioactive drug with a long biological half-life and should be used with caution.
Appropriateness of the Use of Serum Lithium Assays
Authors: Karki Shyam D. , Holden J.M.C.
Published: May 2017

The performance of 222 lithium assays was studied in a psychiatric hospital to determine if their use was appropriate and therapeutically beneficial. Charts of all patients whose serum lithium levels were measured in a month were reviewed to determine whether the assays were indicated, whether they were performed correctly, and whether the dosage was adjusted appropriately. Of the assays reviewed, 16 percent were performed for inappropriate indications and 98 percent were drawn at correct times. Of 157 assays that should not have resulted in a dosage change, 8 changes were made; of 63 assays that should have resulted in a dosage change, only 23 changes were made. Inappropriate orders for assays cost the hospital $5016 per year. If routine serum lithium assay monitoring is changed to a three-month frequency, the total cost savings would be $16 632 per year. Clinical pharmacists with specialized knowledge of clinical pharmacokinetics should work with physicians and treatment teams in monitoring serum drug assays to ensure appropriateness of assay request, more complete interpretation of results, and proper follow-up.
Effect of Influenza Vaccine on Chronic Warfarin Therapy
Authors: Bussey Henry I. , Saklad Judith J.
Published: May 2017

Whether influenza vaccination causes a prolongation in the prothrombin time (PT) and produces bleeding complications in patients receiving chronic warfarin therapy is a clinically important controversy. The degree of anticoagulation during chronic warfarin therapy of 33 patients was assessed before and after vaccination with trivalent types A and B influenza vaccine. Three patients were excluded because of inadequate PT data before vaccination and one patient was unavailable for follow-up after vaccination. Data from five additional patients were excluded from statistical analysis because the warfarin dose was changed within one week of vaccination. PT values obtained at zero to two weeks, three to four weeks, and two, three, and four months after vaccination were compared with each patient's prevaccination baseline value. PT values following vaccination were unchanged except for a decrease that occurred during the first two weeks (p < 0.05). Complications did not require dosage adjustments and were limited to minor nose bleeds or bruises occurring in two patients before and three patients after vaccination. These data suggest a decrease rather than an increase in PT values following vaccination, and do not support the existence of a serious warfarin-vaccine interaction. The possibility that an occasional patient may experience such an interaction cannot be excluded, but none was seen in these patients.
Prescribing Authority for Pharmacists as Viewed by Organized Pharmacy, Organized Medicine, and the Pharmaceutical Industry
Authors: Segal Richard , Grines Lorelei L.
Published: May 2017

This study identifies attitudes of organized pharmacy, organized medicine, and the pharmaceutical industry about prescribing authority for pharmacists. A questionnaire designed to assess the impact of a legislative bill permitting a pharmacist in an organized health care setting to initiate or modify drug therapy was mailed to state pharmacy associations, state hospital pharmacy associations, state pharmacy boards, state medical associations, Pharmaceutical Manufacturers Association (PMA)-member manufacturers, and non-PMA-member generic manufacturers. Responses from 194 of the 307 invited organizations were used. The six organization types viewed the impact of the legislative bill differently (p < 0.05). Hospital pharmacy associations and boards of pharmacy, to a lesser extent, supported the legislative bill; non-PMA-member generic manufacturers and state pharmacy associations were relatively neutral. The medical associations and the PMA-member companies opposed the passage of the bill. Furthermore, medical associations believed that the bill would not be passed in the majority of states in the next five years.
Handling Considerations for Cancer Chemotherapeutic Agents
Authors: Melamed Andra J. , Kleinberg Michael L.
Published: May 2017

Since the introduction of antineoplastic agents in the 1940s, there have been reports of the effects of these agents on workers who have had prolonged contact with them. The Regional Oncology Drug Information Center (RODIC) at Memorial Sloan-Kettering Cancer Center receives numerous inquiries nationwide regarding our policies and procedures for handling antineoplastic agents. In August 1987, RODIC conducted a computerized literature search on the handling of antineoplastic agents and the risks to hospital employees coming in contact with these agents. We used the MEDLINE system from 1966 to the present, limiting the search to English-language articles. This article provides a comprehensive bibliography on the handling of antineoplastic agents.
Evaluation of the Contribution of Clinical Pharmacists: Inpatient Care and Cost Reduction
Authors: Hatoum Hind T. , Hutchinson Richard A. , Witte Kenneth W. , Newby George P.
Published: May 2017

Clinical pharmacists in this study hospital reported 1027 interventions in patient drug therapy over two time periods of three and two weeks, respectively. These interventions were subjected to self and peer reviews and to cost-avoidance evaluation. The most frequent type of intervention was recommendations related to drug selection (29.6 percent). Recommendations were not implemented by physicians in only 10.2 percent of the cases. The perceived impact of these interventions on the quality, cost, or both was found by the peer reviewers to occur in 58.5, 16.1, and 25.6 percent of the cases, respectively. Also, when peer reviewed for clinical significance, 983 of these interventions were judged to improve drug therapy to an acceptable level based on the professional literature, and 36 were deemed very significant in terms of saving patients' lives or preserving major organ functions. Of the 983 interventions rendering drug therapy to an appropriate level, 398 were deemed to have cost-avoidance impact; of this number a 25 percent random sample was subjected to cost-avoidance evaluation. Realized cost-avoidance averaged $242 for each intervention implemented. When extrapolated annually, $364 900 was the net realized cost-avoidance after discounting for the cost of providing clinical pharmacy services. An average cost-avoidance of $860.50 was calculated for each intervention made by pharmacists, but not followed by physicians, for an annual potential cost-avoidance of $532 650. In all, clinical pharmacists had the potential to save $897 550 annually in hospital resources if all their interventions had been accepted and implemented.
Pharmacoepidemiology Methods for Identifying and Quantifying Behavioral Effects of Neuropharmacological Agents
Authors: Zito Julie Magno , Craig Thomas J.
Published: May 2017

The possibilities and limitations of the pharmacoepidemiologic methods of determining neuropharmacologic drug efficacy and safety in psychiatric patients are discussed in this review. Such methods can improve both the scientific evaluation and clinical practice aspects of our knowledge of these drugs by providing: (1) incidence rates of drug usage and adverse events from computerized information on large populations; (2) quantitative methods for risk-to-benefit assessments that incorporate multiple outcome measures, provide long-term effectiveness and safety data, and use statistical methods to distinguish drug-induced from illness-based behaviors; and (3) systematic epidemiologic approaches to resolving dilemmas that involve the political and social context in which neuropharmacological drugs are used.