bluuebunny/crossref_metadata_2025 huggingface dataset:
Epiluminescent Microscopy Predicts the Efficacy of Intense Pulsed Light Treatments in Asian Skin
Authors: Neel Victor A. , Nyugen Natalie , Iwasaki Julie , Moy Ronald L.
Published: June 2017

Introduction:

Facial dyschromias, particularly in Asian skin, represent a challenge to cosmetic surgeons. Intense pulsed light (IPL) has been reported to clear a number of pigmentary alterations, but we have found the results variable and the efficacy of treatment difficult to predict.

Objective:

To use epiluminescent microscopy (ELM) to predict the clearing of clinically pigmented lesions in Asian patients undergoing “fotofacials” with IPL.

Methods:

Clinically similar pigmented lesions on the face were photographed with standard techniques and with ELM before, during, and after multiple IPL treatments in 5 patients. Patients and physicians were asked to grade cosmetic improvement after 5 sequential treatments. ELM photographs were then evaluated after treatment to correlate clinical success with the type of lesion.

Results:

ELM was able to discriminate among several clinically similar lesions. Lentigines responded to IPL treatments, whereas macular seborrheic keratoses, melasma, and junctional nevi responded poorly.

Conclusion:

Careful evaluation of pigmented lesions in Asian skin before IPL treatment can predict the efficacy of treatment.
Megaliposuction: A Staged Event
Authors: Schmerler Elliott
Published: June 2017

Introduction:

Concerns about the safety of patients undergoing liposuction have led to recent guidelines from the American Academy of Cosmetic Surgery to not remove more than 5 L of total supranatant fat during one procedure.

Case Report:

Patients A and B had 10.3 and 6.2 L of fat removed, respectively, without postoperative complications.

Conclusions:

The staging method described here is for large patients presenting for liposuction in whom more than 5 L of total supranatant fat is expected. Staging is one way to perform megaliposuction while possibly reducing risk to the patient and to the surgeon.
In Vitro Stability of Polyether and Polycarbonate Urethanes
Authors: Tanzi M. Cristina , Farè Silvia , Petrini Paola
Published: June 2017

The in vitro structural stability of poly-ether-urethanes (PEUs) and poly-carbonate-urethanes (PCUs) was examined under strong acidic (HNO3) or alkaline (NaClO) oxidative conditions and in presence of a constant strain state.

Polyurethane (PU) samples were represented by sheets solvent-cast from commercial pellets or by tubular specimens cut from commercial catheters. The specimens were strained at 100% uniaxial elongation over appropriate extension devices and completely immersed into the oxidative solutions at 50'C for 7-14 days. The changes induced by the oxidative treatments were then evaluated by molecular weight analysis, tensile mechanical tests, and scanning electron microscopy. In the experiments with solvent-cast samples, the PEU Pellethane was degraded more in the alkaline oxidative conditions and mainly in the absence of an applied uniaxial stress. All the tested PCUs were, on the contrary, more affected by the acidic oxidative agent. All the PCUs proved to have overall better stability than the PEU. The susceptibility to oxidation was also dependent on the shape and bulk/surface organisation acquired by the same polymer during its processing. When the oxidative test was applied to catheters made of a PEU and a PCU, the results confirmed the better stability of poly-carbonate-urethanes.
In Vivo and in Vitro Stability of Modified Poly(Urethaneurea) Blood Sacs
Authors: Liu Q. , Runt J. , Felder G. , Rosenberg G. , Snyder A. J. , Weiss W. J. , Lewis J. , Werley T.
Published: June 2017

In the present study, we investigate the in vivo and in vitro stability of modified poly(urethaneurea) (BioSpan MS/0.4) blood sacs. Blood sacs were utilized primarily in left ventricular assist devices that were implanted in calves for times ranging from 5 to 160 days. Cyclic testing in vitro was also conducted on similar sacs. Various analytical methods were employed to characterize the sacs after in vivo or in vitro service and corresponding retained "control" sacs. These methods included ATR-FTIR spectroscopy, scanning electron microscopy and gel permeation chromatography. In general, the characteristics of implanted and in vitro cycled sacs were similar to their control sacs. Thermal and microtensile properties were unchanged after testing. The same was true for the ATR-FTIR spectra, indicating relative chemical stability for the time frames explored here. The only significant changes occurred in molecular weight and gross surface morphology. A modest increase in weight average molecular weight was observed for most implanted blood sacs, indicating some type of chain extension or branching reaction in vivo. Although the surface morphologies of implanted blood sacs were often similar to their control sacs, we sometimes observed limited pitting on the nonblood contacting surfaces in regions of the sac that experience maximum bending during service.
Hemorheological Parameters for Biocompatibility Evaluation
Authors: Nageswari K. , Banerjee R. , Gupte R. V. , Puniyani R. R.
Published: June 2017

Biomaterials have been extensively used for various clinical applications. Since blood is very sensitive to the presence of any foreign substances, testing for hemocompatibility is a major part of biocompatibility evaluation. At present, blood viscosity parameters are being used as screening tests for biomaterial compatibility. Successful use of these parameters will help eliminate many in-compatible materials from being subjected to extensive testing. In this study, we evaluated the blood viscosity parameters (n = 10)-whole blood viscosity, plasma viscosity, red cell rigidity, hematocrit, and biochemical parameters (total proteins and albumin). A significant increase in hemorheological parameters after incubation with material was found to be an indicator of incompatibility.
The Birth of the Mother: A Reading of Luke 2:1-20 in Conversation with Some Recent Feminist Theory on Pregnancy and Birth
Authors: Elvey Anne
Published: June 2017

In conversation with feminist interpretations of pregnancy and birth this article offers a re-reading of Luke 2:1-20. The article sets out to read this passage with an eye to the representation and narrative function of the mother - especially the body of the mother - both before and after birth. The focus is on the transformation of the mother, Mary of Nazareth. The article considers ways in which the narrative represents three births: the birth of the child, a birth to or for the shepherds and the birth of the mother. These births suggest a logic of gestation, which finds its paradigm in the connective “keeping” (2:19, 51) activity of Mary. In Luke 2:1-20 the birth of the child is also the birth of the mother as a keeping woman.
God Beyond Theism? Bishop Spong, Paul Tillich and the Unicorn
Authors: Dawes Gregory W.
Published: June 2017

John Shelby Spong has recently advocated belief in a “God beyond theism”. While rejecting traditional theism, he also distinguishes his position from atheism. Spong suggests that there is a divine reality, which may be described as “being itself” and which reveals itself in our commitment to unconditional ideals. It is argued that this notion of God is vacuous, the product of a confused belief that “being” is a characteristic of individual beings which may be universalised. Belief in such a God is also unmotivated, since there exist naturalistic explanations of the phenomena to which Spong appeals.
Assessing the Spong Phenomenon
Authors: Watson Nigel
Published: June 2017

This article attempts to account for the astonishing diversity of reactions to Bishop John Shelby Spong. It argues that, while Spong is undoubtedly reaching many people both inside and outside the churches, in his treatment of some of the central doctrines of the Christian Faith he poses some false either/ors.
The Footprint in the Sand: Providence, Invention, and Alterity in Robinson Crusoe
Authors: Curkpatrick Stephen
Published: June 2017

Robinson Crusoe reflects a theological world in transition - from Protestant piety to a world of “Enlightenment Man” colonising all under a benevolent (deist) Providence. Hence, the story depicts two forms of providence, pietist and deist, vying for dominance, yet never separable in Crusoe's experience. Further bifurcating tensions surface after a significant turning point in the narrative - the discovery of an enigmatic footprint in the sand. This discovery is antithetical to Crusoe's residue of Puritan sensibilities - with its utter trust in God's sovereignty, and it is incommensurate with the sensibilities of Enlightenment Man - with his circumscribed world of reason. Discovery of the footprint exposes an antipathy to the other, which becomes a hallmark of modern individuality, propriety, and counter-inventiveness under the rubric of Providence. The story implicitly calls for a further theological dimension, that neither pietist nor rational sensibilities are able to deliver, which can open possibilities of inventive providence in the face of alterity.
The Library of the Fathers
Authors: Cooper Austin
Published: June 2017

The Oxford Movement in the nineteenth century sought to emphasise the nature of the Church of England as “Catholic”, continuing the work of the Incarnation throughout all times and places. Part of this theological and historical polemic involved being in harmony with the writers of the early Christian centuries, the Fathers of the Church. John Henry Newman, John Keble, Richard Hurrell Froude, and (later) Edward Bouverie Pusey, appealed to the Fathers of the Church from the beginning of the Movement. This eventually blossomed into an ambitious programme for translating the works of the Fathers into English, many of them for the first time. “The Library of the Fathers”, as it was called, was a major contribution to historical and theological studies. It had an influence well beyond the narrow confines of a church “party” or movement.
Juan Luis Segundo and Australian Theology
Authors: Wilcken John
Published: June 2017

This essay falls into two parts. In the first there is a brief discussion of the emergence of Liberation Theology in Latin America in 1960s and 1970s, and its challenge to the European and North American academic theology which has dominated the Christian world. The liberation theologians adopted a different methodology, which they saw to be required by the situations of massive injustice and poverty which they found around them. Juan Luis Segundo presented his understanding of the hermeneutical circle, and showed how commitment to the humanisation of the continent leads to new interpretations of Scripture. In the second part of the essy the application of this method to Australian theology is considered. The situation of Aboriginal people is taken as an example. The effect on Aboriginal people of the coming of white settlers raises challenging questions for Christian theology and biblical interpretation.
Life in the Spirit as Life In-Between
Authors: Robinson John W.
Published: June 2017

This essay draws upon a well-established theological vision of the Spirit as “God in-between” to develop two ongoing conversations concerning the locus of the contemporary spiritual quest The first section, “Life between Father and Son”, introduces von Balthasar's idea that the Spirit both holds open and bridges over the Father-Son relationship, thereby securing a place for the world in God. The second section, “Life between Friday and Sunday”, relates this picture of the Spirit to a discussion that suggests life in the world after the Shoah is situated on Holy Saturday (the “day between”). The third section, “Life between a rock and the deep blue sea”, utilises the above framework to indicate an alternative to the predominant view that the locus for the Australian spiritual quest is either at the centre (the desert) or on the margins (the sea).
Daniel: God, Humans and Earth
Authors: Gardner Anne
Published: June 2017

This article explores the role of “Earth” in Daniel in the light of the hermeneutic of the Earth Bible series. Earth is mentioned in the book of Daniel thirty three times and yet, on a surface reading, Daniel does not appear to be concerned with Earth as an entity. A closer reading though, demonstrates that Earth is part of a trinity of God, Humans and Earth. Certain key passages lead to this conclusion: they are Dan 3:31(4:1); 8:5; 8:18; 10:9, 15. Dan 8:5, in particular, is misunderstood by scholars, but recognition of its true import throws light upon the significance of Earth. When humans are not in right relationship with God, Earth suffers but when humans align themselves with Earth, and thus with God, all bounties flow.
What Athens Has to Do with Jerusalem: The Wisdom of Reason, the Publics of Theology
Authors: McDowell John
Published: June 2017

This paper, specifically composed to provide a vision for theology in the University of Newcastle NSW, offers a series of reflections that suggest first, that at present the very idea of a “university” is itself under pressure and in danger of becoming meaningless; secondly, that theology, conceived broadly through a pedagogical model of paideia, can engage in critical conversation over the identity of the university; and, thirdly, that theology, as a university discipline, can be properly ordered in terms of an ongoing conversation.
“God's Capellmeister”: The Proclamation of Scripture in the Music of J. S. Bach
Authors: Loewe Andreas
Published: June 2017

In his musical retelling of Scripture, Johann Sebastian Bach-was motivated by Martin Luther's insight that the combination of music and message, sermo et vox, was an instrument that could effect profound change of hearts and minds [WA 50: 372, 1]. This article assesses the way in which Bach understood his own calling as one of “God's Capellmeister” in presenting and proclaiming the word of God through music.
A Metaphorical Walk through Scripture in an Ecological Age
Authors: Wainwright Elaine
Published: June 2017

Current ecological questions and crises have given rise to a profound critique of the biblical story and its function within contemporary society. This article takes account of that critique as a key element in our creation of the “new story” essential for our age. It also explores ways in which the biblical story makes a significant contribution to that “new story”.
Beyond Suspicion? The Fatherhood of God in the Fourth Gospel
Authors: Lee Dorothy A.
Published: June 2017

This discussion of fatherhood in John's Gospel shows the importance of a hermeneutic of suspicion in reinterpreting the text within new hermeneutical frameworks. Suspicion, unlike alienation, is part of an ongoing dialogue between text and reader. It does not foreclose on future possibilities for affirmation in creative re-readings of the text. While it cannot of itself deliver new interpretations, its challenging questioning can open frontiers within the text, exposing horizons of meaning that only a creative hermeneutic of affirmation can grasp. In this sense, suspicion and affirmation belong together as two sides of the same interpretative coin. The same dynamic is operative in grasping the anti-patriarchal nature of fatherhood in the Fourth Gospel.
Toward the Twenty-First Century: Law Enforcement Training Now and Then
Authors: Cox Barbara G. , Moore Richter H.
Published: June 2017

The twenty-first century will present challenges to law enforcement that will make the past years' look tame. Society will become increasingly multi-cultural and multilingual; we are far more heterogeneous than ever before. During the recent decades, we have experienced population growth, racial diversity, and increased ethnicity in our society. Twenty-first century law enforcement must be prepared to deal with the diversities and complexness of our ever changing society. Qualified law enforcement personnel with adequate educational backgrounds and sufficient training is a necessity to meet the challenges they will face each day. This National Study will provide some ideas on law enforcement training and education in the United States and some insight of whether present standards will meet the twenty-first century needs.
The Security Survey: Creating A Proactive Foundation for Campus Crime Prevention
Authors: Richards George E.
Published: June 2017

Crime on American campuses is an issue of concern to students, parents, staff and community leaders. While various methods of crime prevention and security have been initiated by campus communities, both large and small, little attention has been placed on the importance of the security survey as a vehicle for developing proactive crime prevention strategies and allocation of university resources. This article reviews applicable literature and substantively defines the necessary components for a campus security survey and its proper implementation.
Policewomen, Policemen, or Both?: Recruitment and Training Implications for Responses to Woman Battering
Authors: Belknap Joanne
Published: June 2017

Since the 1970s, police training and recruitment has been impacted by two feminist concerns: the low number of female officers and charges of ineffective responses to women victims of male violence. This study analyzes 324 law enforcement officers' responses as to whether policewomen, policemen, or a combination are best suited to respond to woman battering overall, battering victims, and batterers. In addition, the analysis accounts for the relationship between officers' demographic characteristics and their responses. In short, the findings of this study suggest that policemen are less enthusiastic about policewomen's contributions to policing woman battering, than policewomen are of policemen's contributions. Further, the only demographic characteristics related to the officers' responses are their sex and departmental affiliation. (Officers' race, age, education, rank, shift, years of experience, and SES were unrelated to their responses.)
The Clientele of a Child and Family Mental Health Agency: Empirically Derived Household Clusters and Practice Implications
Authors: Mattaini Mark A. , Grellong Bruce A. , Abramovitz Robert
Published: June 2017

Social workers and other mental health professionals have developed and applied a number of typologies of family types in clinical practice, as well as for program planning. Most such taxonomies have emerged from theory and practice, but few are based on more than two or three dimensions or have been rigorously tested empirically. In this study of a representative sample of 625 households from which clients of a child and family mental health and social services agency come, inductive cluster analysis extracted eight discrete household clusters. The household types included (a) high-aversive households, (b) isolated (mostly single-adult) households, (c) multideficit households, (d) families experiencing circumscribed problems, (e) households with family problems but substantial external supports, (f) extremely isolated families, (g) seriously stressed families with significant strengths, and (h) significant family-functioning problems. Demographic factors and other stressors associated with these clusters were also examined Clinical and programmatic implications of these findings are presented, along with suggestions for further systematic replications in other settings.
Interactions of CNS Drugs Psychotherapeutic Agents — The Antianxiety Drugs
Authors: Hartshorn Edward A.
Published: June 2017

A review of the literature of drug interactions of the antianxiety agents yields little of clinical significance. Recorded drug interactions of this group involve primarily meprobamate, chlordiazepoxide, and diazepam. The only interaction of note with meprobamate is the development of tolerance partially as a result of microsomal enzyme induction by meprobamate, chronic alcohol ingestion, and possibly some other agents. Of the benzodiazepine interactions, the one of most serious note is the incidence of respiratory depression and/or hypotension which occurs when diazepam is given intravenously for convulsions after prior parenteral administration of a barbiturate. The benzodiazepine derivatives may inhibit diphenylhydantoin metabolism. Hence, patients on diphenylhydantoin therapy should be closely monitored when the benzodiazepine anti-anxiety agents are introduced to or deleted from the therapeutic regimen.
Activities of the Clinical Pharmacist Practicing in the Office of a Family Practitioner
Authors: Perry Paul J. , Hurley Stephen C.
Published: June 2017

The activities of a clinical pharmacist within a primary care facility are measured in a time-motion study. This type of practice allows the pharmacist an opportunity to provide many patient-care services normally unavailable at community pharmacies. The innovative services are described in detail to establish how they produce savings of physician time and to imply how they improve patient care. The activities of the clinical pharmacist are compared to those of the community pharmacist. The indications are that a significant difference exists between the activities of the community pharmacist and a clinical pharmacist working within the office of a physician.
Tartrazine Revisited
Authors: Cohon Monte S.
Published: June 2017

A compilation of tartrazine (FD and C No. 5) containing drugs from major pharmaceutical manufacturers in the United States of America appears.

Characteristics of tartrazine, spectrum of its use, incidence of allergic reactions and relationship with other food and drug dyes are discussed, as are the clinical manifestations of such reactions. The importance of coercive tartrazine disclosure, as well as the disclosure of other excipients and additives by the Food and Drug Administration is emphasized.
Drug Utilization Review Current Status and Relationship to Assuring Quality Medical Care
Authors: Knoben James E.
Published: June 2017

Drug utilization is expected to increase in the years ahead, thereby fostering the use of cost control and quality assurance mechanisms in the form of drug utilization/peer review. An overview of the current status of drug utilization review (DUR) is presented, and an examination is made in terms of the relationship of DUR to assuring quality medical care. For the most part, existing drug utilization review systems are centrally based and retrospectively screen drug claims “by exception”, using quantity standards of appropriateness. The primary deficiency of current programs is the relative lack of “quality measures”, and secondarily, the need to integrate drug utilization review into the overall medical care review process. Recommendations for demonstration and research efforts are given.
A Benzquinamide-Induced Extrapyramidal Reaction
Authors: Grove William R. , Bender John F. , Fortner Clarence L. , Strauss Gary , Wiernik Peter H.
Published: June 2017

A case report of a patient who developed an extrapyramidal reaction following the parenteral administration of benzquinamide. This reaction has not been previously reported. Prior to this, the patient had reacted similarly to prochlorperazine. Diphenhydramine was useful in reversing the reaction on both occasions.
The Patient-Pharmacist Interaction in Two Ambulatory Settings — It's Relationship to Patient Satisfaction and Drug Misuse
Authors: Ludy Judith Ann , Gagnon Jean Paul , Caiola Stephen M.
Published: June 2017

Seventy-five clinic outpatients were randomly assigned to a Satellite Pharmacy with a private consultation room or a centralized Traditional Pharmacy with an open-window setting. A comparison of the patient-pharmacist interaction and its relationship to the patient's satisfaction with pharmacy services and his drug-taking behavior was measured by the use of two questionnaires.

A significant difference was found in the quantity of consultation activities performed by the pharmacists in the two settings. Patients were significantly more satisfied with the Satellite Pharmacy and seemed to favor the private setting over the open-window. Patient satisfaction was significantly correlated with the waiting time, the amount of time spent with the pharmacist, the total activities received during the interaction, and satisfaction with hospital services in general.

Medication errors were not significantly different for the two patient groups when measured by verbal reports but compliance scores were significantly different for those patients taking drugs for which a tablet count could be done. Although analysis of the data showed a significant difference for only one measure of drug-taking behavior, improvement of drug use as a result of the interaction with the pharmacist in the Satellite Pharmacy was suggested. Compliance scores for regularly scheduled drugs correlated with the financial status of the patient, total interaction activities, and interaction time. Financial status, satisfaction with the drug, and the day of the second interview were significantly correlated with the PRN compliance scores.
Promised Land or Tower of Babel?
Authors: Campbell William H.
Published: June 2017

Any Response to the Millis Commission Report must be flavored by the numerous interactions with colleagues, editorial comments in journals, and observations of pharmacy which have occurred since this report was released. In fact, it is doubtful whether any pharmacy organization of any size has not participated in an organized effort to understand the substance and implications of this report. Because this effort continues amid conflict, controversy, and contradiction, I must believe the profession is struggling to understand the commission's message. This confusion may be reduced by placing the report in a historical — And perhaps irreverent — Perspective.
Nitrofurantoin Pneumonitis
Authors: Simonson William , Stennett Douglass J. , Hall Clifford A.
Published: June 2017

A case of acute nitrofurantoin induced pneumonitis is reported. The various pulmonary toxicities of nitrofurantoin are also discussed.
Considerations for a Pediatric Pharmaceutical Patient Care Service
Authors: Lamy Peter P. , Riley Arthur N.
Published: June 2017

Pharmaceutical Patient Care Services to the ambulant pediatric patient will only be effective if special considerations are given to the patient's peculiarities. From the very young to the adolescent, each presents with special problems. Often, they cannot communicate effectively. Their health status frequently depends on the health behavior of the mother. Adolescents, in particular, present many unique medical and social problems. Pediatric patients receive fewer prescription medications than do adult patients, but drugs are administered frequently in the clinic. More often than not, nonprescription drugs are prescribed. This study could not document any particular physician concern with patient education or compliance.
A Case Attributed to Cefazolin and a Review of the Literature
Authors: Gardner Marie E. , Fritz William L. , Hyland Robert N.
Published: June 2017

Generalized convulsions developed in a uremic patient who had received massive doses of cefazolin which resulted in a measured serum level of greater than 512 mcg/ml of drug after dialysis. Pathophysiologic mechanisms which could have contributed to the symptoms are discussed. Physicians prescribing cefazolin and other cephalosporins need to be aware of this potential complication of therapy and adjust doses accordingly in renal failure.
Phenytoin 300 MG Daily — Not a Dose for Everyone
Authors: Baars Ronald E. , Rapp Robert P. , Young Byron , Canafax Daniel
Published: June 2017

Phenytoin serum levels were compared in a crossover study of a new 300 mg capsule form and three 100 mg capsules administered once daily. The new 300 mg capsule was equivalent to three 100 mg capsules in efficacy of seizure control and maintenance of phenytoin serum levels. This standard 300 mg dose produced a grand mean drug serum level of 7.63 mcg/ml and was below 10 mcg/ml in 15 to 20 patients. The authors recommend monitoring of phenytoin serum levels and clinical response, to detect needed dosage adjustments for optimum therapeutic benefit from phenytoin and to avoid toxic side effects.
Estimation of Pharmacokinetic Parameters at Steady-State in Patients
Authors: Crow James W. , Gibaldi Milo
Published: June 2017

A method to characterize the pharmacokinetics of a drug in a patient receiving it chronically is proposed. In principle, such characterization may be carried out by obtaining one or more drug concentration in plasma-time values from several different dosing intervals, combining the data to create a composite dosing interval representative of the steady-state situation and fitting the data to an appropriate equation. The method was evaluated using simulated data based on the average pharmacokinetic parameters of theophylline in children. Reasonable estimates of the elimination rate constant and apparent volume of distribution may be obtained, but the estimation of the absorption rate constant presents formidable problems. The method appears to be most useful for obtaining very accurate estimates of total clearance.
Effect of Clinical Pharmacy Services on the Quality of Family Practice Physician Prescribing and Medication Costs
Authors: Chrischilles Elizabeth A. , Helling Dennis K. , Aschoff Carl R.
Published: June 2017

This study assessed the impact of physician exposure to clinical pharmacy services on the appropriateness of physician prescribing and on medication costs. Two study sites were used: FPC (primary resident training office without clinical pharmacist) and PMC (satellite office with clinical pharmacist). The same physicians provided care at both study sites. Exposed patient encounters were selected from encounters during each resident's rotation at the PMC satellite. Unexposed patient encounters were selected from encounters at the FPC immediately prior to each resident's exposure to clinical pharmacy services. A blind review panel evaluated case abstracts of the patient encounters for appropriateness of drug choice, daily dosage, dosing interval, duration of treatment, clarity of instructions, and monitoring data; potential severity of the patient problem; and difficulty of the clinical decision. After adjusting for covariables (potential severity, difficulty, patient age, sex, Medicaid status, therapeutic category, and type of medical problem), physician-patient encounters in which family practice residents were exposed to clinical pharmacy services were rated significantly more appropriate for choice of drug prescribed, daily dosage chosen, dosing interval selected, clarity of prescription instructions, and monitoring data. Costs of acute medications, as measured by average wholesale price per day, per dose, and per treatment course, were also significantly lower for clinical pharmacy-exposed physician-patient encounters.
Nimodipine in the Treatment of Subarachnoid Hemorrhage
Authors: Yasuda Sally Usdin , Tietze Karen J.
Published: June 2017

Nimodipine, a calcium-channel antagonist with a relatively selective vasodilatory effect on cerebral blood vessels, has recently been approved for improvement of neurologic deficits due to spasm following subarachnoid hemorrhage. Nimodipine has low oral bioavailability (2.7–27.9 percent), a short half-life (2 h), is highly protein bound (98–99 percent), and is hepatically metabolized. Clinical studies have evaluated topical, intravenous, and oral administration of nimodipine for the treatment of cerebral artery spasm associated with subarachnoid hemorrhage. These studies document some benefit of the drug in reducing the occurrence of severe neurologic deficit, although this effect is not universal. Few adverse effects have been noted. Further studies are necessary to evaluate the pharmacologic and pharmacokinetic characteristics, the appropriate dose and route of administration, adverse effects, drug interactions, and the therapeutic efficacy of nimodipine before routine use can be recommended.
Ofloxacin: A Review
Authors: Smythe Maureen A. , Rybak Michael J.
Published: June 2017

Ofloxacin is a new fluorinated quinolone antibiotic with a broad spectrum of activity against a variety of gram-positive and -negative bacteria including Enterobacteriaceae, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus. In addition, ofloxacin has significant activity against Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycobacterium tuberculosis and this may give rise to new indications for the class of quinolone antibiotics. Clinical trials to date have demonstrated the efficacy of ofloxacin in the treatment of lower respiratory tract infections, urinary tract infections, and sexually transmitted diseases. Adverse effects to ofloxacin are usually mild and include gastrointestinal, central nervous system, and hypersensitivity reactions. Significant drug interactions with ofloxacin have not been reported.
Steroid-Specific Effects of Ketoconazole on Corticosteroid Disposition: Unaltered Prednisolone Elimination
Authors: Ludwig Elizabeth A. , Slaughter Richard L. , Savliwala Mohammed , Brass Corstiaan , Jusko William J.
Published: June 2017

Ketoconazole inhibits the clearance of methylprednisolone by 60 percent and extends cortisol suppression beyond that produced by methylprednisolone alone. This study examined prednisolone pharmacokinetics and cortisol suppression in four healthy male volunteers following administration of prednisone 20 mg. Studies were performed with and without ketoconazole 200 mg po for six days. Blood samples were obtained serially over 24 hours and serum prednisone, prednisolone, and cortisol concentrations were determined by HPLC. Prednisolone clearance before and after ketoconazole therapy was not significantly different (160 ±38 vs. 148 ±23 mL/h/kg). In addition, no significant differences were found in mean residence time (5.03 ±0.69 vs. 6.18 ±1.77 h), terminal slope (0.23 ±0.03 vs. 0.19 ±0.05 h−1), or volume of distribution (0.79±0.11 vs. 0.84±0.12 L/kg). The ratio of cortisol area under the concentration versus time curve (AUC) 0–24 hours after prednisone administration to the AUC under baseline conditions was used as a measure of adrenal suppression. This ratio was not significantly different after prednisolone with and without ketoconazole (0.40 ±0.10 vs. 0.45 ±0.03). Renal excretion of prednisone and prednisolone was not significantly changed with ketoconazole. Based on this preliminary study, ketoconazole minimally alters prednisolone clearance in contrast to the significant ketoconazole–methylprednisolone interaction previously reported.
Anaphylactic Reaction to Streptokinase with First Exposure: Case Report and Review of the Literature
Authors: Bednarczyk Edward M. , Sherlock Susan C. , Farah Michel G. , Green Jeffrey A.
Published: June 2017

Thrombolytic therapy has become an accepted part of the management of acute myocardial infarction. One agent with widespread use in this setting is streptokinase. We report the case of a 62-year-old man who experienced an anaphylactic reaction with cardiopulmonary arrest immediately after receiving streptokinase 1.5 million units iv administered for an acute anterior wall myocardial infarction. The patient had no history of prior exposure to streptokinase, chronic allergic reactions, or reactive airway disease. Five other cases of anaphylaxis to streptokinase are also reviewed.
Carbamazepine Toxicity Precipitated by Intravenous Erythromycin
Authors: Mitsch Rita A.
Published: June 2017

The ability of erythromycin to inhibit the hepatic metabolism of carbamazepine causes carbamazepine toxicity. The severity of this drug interaction has been proposed to be related to the dose of erythromycin. The introduction of oral erythromycin produces a two- to fourfold increase in the carbamazepine serum concentration and the resultant toxic manifestations. Carbamazepine toxicity and a more marked increase in carbamazepine serum concentration were observed in a patient treated with intravenous erythromycin.
Patient-Controlled Analgesia: A Review of Effectiveness of Therapy and an Evaluation of Currently Available Devices
Authors: Rapp Robert P. , Bivins Brack A. , Littrell Robert A. , Foster Thomas S.
Published: June 2017

Patient-controlled analgesia (PCA) is a major advance in the management of pain in postoperative and cancer patients. The success of PCA has resulted in a proliferation of marketed devices to administer small bolus doses of parenteral pain-control drugs at fixed intervals controlled by the patient with the push of a button. Because patients demonstrate marked individual variation in pain medication requirements, PCA devices should be able to accommodate rapidly changing requirements for drugs with a minimum amount of effort on behalf of health care personnel. Crude electronic devices were developed in the late 1960s and the early 1970s and usually consisted of a syringe pump connected to some sort of timing device. Most modern PCA devices marketed in the past five years are much more sophisticated devices that are microprocessor based and some newer devices even generate hard copy for a permanent record of drug administration. Although many such devices are available (including a totally disposable PCA device), few have undergone extensive clinical evaluation. A review of the literature shows many devices are available for use without a single publication to document the safety and utility of the device in the routine patient care situation. Use of the PCA method of pain control will grow, and all hospital-based health care personnel should become familiar with their use and limitations.
Acyclovir Use and its Surveillance in a General Population
Authors: Hartzema Abraham G. , Porta Miquel S. , Tilson Hugh H. , Johnson Richard E. , Mullooly John P. , Valanis Barbara G. , Andrews Elizabeth B. , Tilson Hugh H.
Published: June 2017

This study examined the extent and patterns of use of acyclovir in a health maintenance organization (HMO) population. The development and implementation of a system to survey acyclovir users for possible acute adverse effects is also described. Acyclovir users were members of Kaiser Permanente (KP), Northwest Region, who received one or more prescriptions for acyclovir from an automated outpatient prescription system over a two-year period (1986 and 1987). KP members with genital herpes were identified from the automated Outpatient Utilization System, which abstracts medical record data from a random sample of about two percent of KP members. Acyclovir users with hospital admissions were identified from the automated KP hospital discharge abstract system. During the two years, there were 2940 users who received a total of 6182 prescriptions for acyclovir; 47 percent used oral acyclovir and 56 percent of prescriptions were for the oral dosage form. Females received two-thirds of the prescriptions, and people 15 through 45 years of age received 80 percent of the prescriptions. The estimated incidence density of oral acyclovir usage was 2.3/1000 KP members. Most oral acyclovir prescriptions were for the treatment of genital herpes. More than 60 percent of the prescriptions appeared to be for first treatment, more than 30 percent for repeat treatment, and about 6 percent for continuing treatment. Hospitalizations of oral acyclovir users appeared to be unrelated to the use of the drug.
Sodium Loading Treatment for Amphotericin B-Induced Nephrotoxicity
Authors: Gardner Martha L. , Godley Paul J. , Wasan Suman M.
Published: June 2017

The increased frequency and duration of antifungal treatment with amphotericin B in immunocompromised patients has stimulated a great deal of research into the mechanisms of its nephrotoxic effects and treatment modalities designed to attenuate these effects. A review of amphotericin B-induced nephrotoxicity, the underlying pathophysiologic mechanisms, and the role of salt loading as a means of minimizing renal impairment are described. Both animal and human studies regarding the efficacy of sodium loading are presented as well as a case report describing the use of salt supplementation over a prolonged course of therapy.
Detecting Drug Interactions: A Review of the Literature
Authors: Jankel Charlotte A. , Speedie Stuart M.
Published: June 2017

This article provides a historic overview of drug interaction screening and reviews 19 studies that have sought to measure the frequency of drug interactions. Differences in study designs, methodologies, and definitions contribute to considerable variation in the reported incidence rates, which ranged from 2.2 to 70.3 percent for all potential drug interactions. The percentage of patients actually experiencing symptoms that could be attributed to a drug interaction, however, ranged from 0 to 11.1 percent. The relative importance of drug interactions as a clinical problem remains unclear. Screening programs that do more than simply identify large numbers of patients who receive potentially interacting drug combinations without indicating which subpopulations of these individuals are likely to be harmed by the drugs have not yet been developed.
Quinapril: A New Second-Generation Ace Inhibitor
Authors: Cetnarowski-Cropp Anne B.
Published: June 2017

Quinapril is a new non-sulfhydryl angiotensin-converting enzyme (ACE) inhibitor. The drug undergoes hepatic hydrolysis into its major active diacid metabolite, quinaprilat, and two minor inactive metabolites. On a weight basis quinaprilat is three times as potent an ACE inhibitor as quinapril. Approximately 60 percent of an oral dose of quinapril is absorbed. In contrast with captopril, the absorption of quinapril is unaffected by food. Peak serum concentrations of quinapril and quinaprilat are achieved within one and two hours, respectively. Approximately 61 percent of an orally administered dose is excreted in the urine, principally as quinaprilat. The elimination half-life of quinaprilat is three hours, but is prolonged up to 11 hours in patients with renal dysfunction. Quinapril dose reduction is recommended in patients with a creatinine clearance of 0.50 mL/sec or less. In the elderly the elimination of quinaprilat is reduced and correlates well with renal function. In patients with cirrhosis the hydrolysis of quinapril to quinaprilat is impaired resulting in lower plasma quinaprilat concentrations and up to a two-fold increase in quinapril half-life. Quinaprilat has a strong binding capacity to tissue ACE allowing for once-daily dosing. The recommended starting dose for quinapril is 20 mg/d. The nature and incidence of adverse reactions to quinapril are similar to those of enalapril and captopril. Quinapril's antihypertensive efficacy is equal to that of captopril and enalapril. A small number of patients with congestive heart failure (CHF) have been treated with quinapril. Preliminary data indicate that quinapril is an equally effective therapeutic alternative to presently available ACE inhibitors in the treatment of CHF. Quinapril, a second-generation ACE inhibitor, has not been shown to offer significant clinical advantage over enalapril. In formulary evaluations quinapril may be considered therapeutically equivalent to enalapril.
Sertraline: A New Specific Serotonin Reuptake Blocker
Authors: Guthrie Sally K.
Published: June 2017

Sertraline hydrochloride is a new naphthylamino compound that specifically blocks neuronal reuptake of serotonin. It is currently available in the United Kingdom and under review in the US. Sertraline follows first-order kinetics, with a plasma elimination half-life of 24–26 hours. It is highly bound to plasma proteins and has a large volume of distribution. Multicenter studies conducted by the manufacturer have shown sertraline to be efficacious in the treatment of depression and obsessive-compulsive disorder. The daily dose will range from 50 to 200 mg/d for the treatment of depression. The adverse-effect profile differs greatly from the tricyclic antidepressants, but is similar to that of fluoxetine. The most prominent adverse effects are gastrointestinal (nausea, diarrhea/loose stools, dyspepsia).
Tryptophan Toxicity: A Pharmacoepidemiologic Review of Eosinophilia-Myalgia Syndrome
Authors: Hartzema Abraham G. , Porta Miquel S. , Tilson Hugh H. , Milburn Diane S. , Myers Carol W.
Published: June 2017

Tryptophan, an essential amino acid commercially available as a dietary supplement, has been implicated in the development of a new and potentially fatal clinical entity: eosinophiliamyalgia syndrome (EMS). EMS reached epidemic proportions in the US in late 1989 and early 1990, with 1536 cases and 27 deaths reported as of August 1990. Features of the syndrome include intense, debilitating myalgias and marked peripheral eosinophilia. Vasculitis, neuropathy, and pulmonary involvement also may be observed but are not pathognomonic. Death typically ensues from ascending polyneuropathy with resulting paralysis and respiratory arrest. Treatment involves discontinuation of tryptophan ingestion. Administration of prednisone may not always alleviate or reverse the symptoms. Recovery is generally slow. The etiology of EMS has been traced to a contaminant in the bulk manufacturing process of tryptophan by a single Japanese company. Efforts are currently underway to confirm the structure of the contaminant by laboratory synthesis and to define its biologic and toxic effects using an animal model for EMS.
Economic policy measures for reducing the environmental impact of tourism
Authors: Smeral Egon
Published: June 2017

Measures for reducing the environmental impact of tourism can be taken at the micro-and/or regional level as well as at the macro level of an economy. At the micro- and/or regional level, measures to regulate tourism include assigning quotas or setting fees for endangered areas. Important additional tasks are the development of approaches to solve regional traffic congestion problems and the implementation of visitor management schemes. Macro-policy measures include the implementation of energy taxes, the collection of ‘eco fees', the restructuring of the working process towards more time flexibility and the promotion of service industries. Evaluation of these different strategies for reducing the environmental impact of tourism must also consider that society is not yet ready to accept measures that impact too deeply or too swiftly. Given this, it seems more realistic to put together an optimal bundle of different measures having a low impact at the beginning of their implementation, the impact could then be increased gradually from year to year.
High Performance Work Practices in Indian Organisations: Exploration and Employees’ Awareness
Authors: Punia B.K. , Garg Naval
Published: June 2017

In this age of high performance, the term ‘performance’ not only inscribes productivity or profitability but also deals with human aspect of work, too. High performance work practices (HPWPs) are largely viewed as a mechanism for value creation and value enhancement of employees, employer and the organisation as well. The present article attempts to access the awareness level of employees of the HPWPs. In all, 35 dimensions of HPWPs were identified by the researchers and the awareness level was assessed on a 5-point scale. The categorisation of HPWPs has been done by applying factor analysis, and the variations in awareness level have been studied by applying t-test. Significant gender variations in employee awareness have emerged on ‘psycho-strengthening HPWPs’, and the sectoral variations in employee awareness have emerged on the ‘employee empowerment HPWPs’. In rest of the HPWPs, no significant variations in employee awareness emerged on any of the basis.
Book Review: Technical Analysis Ideal for Beginners
Authors: Swain Kirti Ranjan
Published: June 2017

Technical Analysis Ideal for Beginners,2010, Mumbai: Capital Market Publishers India Pvt. Ltd, pp. 218, ₹500.00.