bluuebunny/crossref_metadata_2025 huggingface dataset:
Failure Modes in Unidirectional Composites under Transverse Loading
Authors: Tandon G. P. , Kim R. Y. , Dutton R. E.
Published: June 2017

This paper reports on our attempts to demonstrate potential failure modes under combined thermal and transverse loading of unidirectional composites and to validate the predictions of an analytical model through careful design and testing of composite specimens. Several fiber/matrix combinations are being considered with appropriate variations of the fiber-matrix interfacial bond strength and processing conditions. The interfacial bond strength is reduced in one set of specimens by applying a release agent to the surface of the fiber prior to its incorporation in the matrix. Curing is done both at room and at elevated temperature to account for thermal residual stresses induced from the mismatch in the coefficients of thermal expansion of the constituents. The experimental technique including specimen preparation, test procedures and detection of the sequence of failure events is described. The correlation between the experimental and analytical results is fairly reasonable.
3D Finite Element Analysis of Multiple Transverse Cracking in Hybrid Cross-Ply Composite Laminates
Authors: Kumar N. Venu , Pradhan B. , Rao N.
Published: June 2017

This paper presents the analysis of multiple transverse cracking in hybrid composite laminates subjected to uniaxial loading. The 3D finite element method has been used for evaluating the strain energy release rates and stiffness reductions in different glass/epoxy and graphite/epoxy hybrid cross-ply composite laminates as the transverse crack extends in the width direction. The procedure is based on the computation of strain energy in the laminates with a simulated crack and its extension for incremental applied strains. Results are presented for various combinations of crack lengths and crack densities.
Dependence of the Reinforcement Anisotropy on a Three Dimensional Resin Flow Observed by X-Ray Radioscopy
Authors: Bréard J. , Saouab A. , Bouquet G.
Published: June 2017

We described an experimental technique, which can be used to measure simultaneously the three principal permeabilities of fiber reinforcement made of short or long fibers. This original technique utilizes the X-Ray radioscopy for detecting the position of the liquid front inside of the preform. An analysis of the different experimental results allowed us to measure, explain and justify the influence of the various parameters related to the flow conditions, the mold geometry and the reinforcement material structure. The experimental study proves that this technique is not limited by high anisotropy factors. We obtain good agreement between results of this visualization technique and numerical simulation of the resin flow.
Finite Element Analysis of Three-Dimensional RTM Process
Authors: Deb Manas K. , Reddy Mahender P. , Mayavaram Ravisankar S. , Baumann Carlos E.
Published: June 2017

This paper presents the mathematical theory, computational algorithm and numerical results from a finite element based Resin Transfer Molding (RTM) model, a process that involves resin impregnation of fiber preforms. The uniqueness of the present approach is that unlike the conventional methods, it treats the flow of resin and air as a two-phase flow in a porous media. The formulations are done in 3D without introducing approximations in the thickness direction. This approach enables the user to model the macrolevel physics better, formulates accurate filling of complex parts that may be thick or contain inserts, predicts air entrapment, and has the ability to incorporate heat transfer in both filled and unfilled regions.
Plastic Deformation of Fiber Coating in Polymer Matrix Composites under Hygrothermal Loading
Authors: Upadhyay P. C. , Gupta G. Srinivas , Lyons D. W.
Published: June 2017

This paper is concerned with the study of elasto-plastic deformation of the coating, and consequently, the changes in the states of stress in the constituent phases of a unidirectional fiber reinforced polymer matrix composite (PMC) under uniform thermal, hygral and hygrothermal loadings. A four-phase composite cylinder assemblage (CCA) model has been used for the analysis. The coating interphase between the fiber and the matrix has been taken to be of lower modulus and lower yield stress value than that of the matrix. Only those combinations of temperature and moisture content are considered which give rise to plastic deformation in the coating, other phases still remaining elastic. Plastic behaviour of the coating has been idealized by taking a linear work-hardening constitutive relation.
A Comparison of the Murray-TAT and a New Thematic Apperception Test for Urban Hispanic Children
Authors: Costantino Guiseppe , Malgady Robert G. , Vazquez Carmen
Published: June 2017

Minority children's lack of responsiveness to projective tests has been attributed to underlying verbal deficits versus productivity on the TAT and the TEMAS (Tell-me-a-story), a new TAT depicting ethnic minority figures, cultural themes, and urban backgrounds. Results indicated that children were more responsive to TEMAS pictures than TAT pictures, and this effect was more enhanced for females than males. Children were more likely to respond in Spanish to the TEMAS and to switch from English on the TAT to Spanish on the TEMAS. Results support earlier findings of increased responsiveness of minority children to culturally relevant stimuli and also suggest a promising instrument for assessment of minority children.
Clinical Applications of the 532-nm Diode Laser for the Treatment of Facial Telangiectasia and Pigmented Lesions: Literature Review, History, and Discussion of Clinical Experience
Authors: Niamtu Joseph
Published: June 2017

Introduction:

Facial telangiectasias are common lesions resulting from multiple factors. Multiple therapies and devices have been used for the treatment of facial telangiectasia with varied success and complication rates. The 532-nm diode (diode-pumped, frequency-doubled Nd:YAG) laser is compared with other laser and nonlaser modalities for the office-based cosmetic surgery practice.

Materials and Methods:

This article provides a literature review and examines the history of laser treatment of facial telangiectasia and the evolution of modern laser therapy. Clinical experience is also detailed in the treatment of facial telangiectasia and pigmented lesions.

Results:

532-nm diode lasers are lightweight, extremely portable systems that are effective in the treatment of facial telangiectasia and various pigmented lesions. When compared to other popular modalities and laser wavelengths, the 532-nm diode laser can successfully treat facial telangiectasia and some pigmented facial lesions with less chance of collateral tissue damage and resultant complications.

Discussion:

The 532-nm diode laser is representative of technological innovations that enable small, lightweight, and affordable lasers to be used by the office-based cosmetic surgeon. Distinct advantages are evident when it is compared with other wavelength lasers. Because of the smaller spot size and depth of penetration, this laser also has treatment limitations; however, it provides a welcomed addition to the armamentarium for the surgeon treating facial ectatic and pigmented lesions.

Conclusion:

Because of its demonstrated clinical effectiveness, ease of use, and lack of resultant purpura, as well as affordability and portability, this laser is well suited for the office-based cosmetic practice.
Enhancement of Neovascularization in Regenerating Skeletal Muscle by the Sustained Release of Erucamide from a Polymer Matrix
Authors: Mitchell Christopher A. , Davies Marilyn J. , Grounds Miranda D. , McGeachie John K. , Crawford Geoffrey J. , Hong Ye , Chirila Traian V.
Published: June 2017

The angiogenic agent erucamide (cis-13-docosenamide), incorporated into a polymeric biomaterial (Elvax® 40P, a copolymer of ethylene and vinyl acetate), was used to determine whether angiogenesis can be increased in the regenerating skeletal muscle, and whether the enhanced revascularization improves the new muscle formation. The angiogenic nature of this lipid was confirmed in a rat cornea-micropocket assay, prior to insertion of small strips of the polymer containing either 3 μg, 30 μg, 300 μg erucamide or only polymer as a control into the mid-region of crush-injured tibialis anterior (TA) muscles of forty-five adult male BALB/c mice. All TA muscles were sampled ten days after injury and analyzed morphometrically. Statistical analyses of the mean blood vessel area density in lesions from twelve perfused TA muscles (three from each of the erucamide-treated or control group), revealed a dose-dependent angiogenic effect of erucamide: a dosage of 3 μg increased mean blood vessel area density to 5.1% compared to 2.0% in controls, due to numerous large caliber, thin-walled vessels, whereas the mean vessel area density in both the 30-μg (3.5%) and 300-μg (1.5%) doses were similar to controls. However, at all three doses tested, erucamide did not significantly alter the degree of new muscle formation, connective tissue deposition, or removal of necrotic debris.
The Creep Behavior of Acrylic Denture Base Resins
Authors: Sadiku Emmanuel Rotimi , Biqtidara Frank Olusesan
Published: June 2017

The creep behavior of acrylic dental base resins, at room temperature and at different loading conditions, has been examined. The behaviors of these resins are similar to that of "commercial perspex" at room temperature over a period of 1000 seconds. The pseudo-elastic moduli of the blends of PMMA/PVC show a significant increase compared with PMMA alone. The addition of the PVC powder to the heat-cured acrylic resin increased the time-dependent elastic modulus. This increase in elastic modulus is advantageous in the production of denture based resins of improved mechanical properties.
Clinical Study with Recombinant Interferon Gamma versus Interferon Alpha-2C in Patients with Condylomata Acuminata
Authors: Reichel Romeo P , Fitz Rudolf , Neumann Reinhold , Pohl-Markl Helga , Pichler Evelyn , Hoffer Zita , Budiman Robert
Published: June 2017

A multi-centre, randomized, open-label trial was conducted to evaluate the safety and efficacy of recombinant interferon (rIFN) alpha-2c versus rIFN gamma in patients with recurrent or persistent condylomata acuminata (CA). Thirty-three such patients were treated either with 6 μg rIFN alpha-2c or with 0.1 mg rIFN gamma (both equivalent to 2×10E6 IU), single dose, subcutaneously 3 times a week for 6 weeks. In case of no complete clearance at week 10, a second course of treatment with the other type of rIFN was given. There was no significant difference in the complete clearance proportions at week 10 between the two treatment groups (3/16 vs 6/17). No relapses occurred in these patients during the 16 weeks' follow-up. Further clearances during the follow-up resulted in a total complete clearance proportion of 14/33 at the end of study. The treatment was well tolerated. Repeated interferon therapy has its place in treating persistent or recurrent condylomas.
Chlamydia Trachomatis Antigen Detection by Chlamydiazyme Combined with Chlamydia Blocking Reagent Verification
Authors: Zeeberg Barbro , Thelin Ingrid , Schalén Claes
Published: June 2017

Several options exist for the detection of chlamydial infection in a routine laboratory setting. Enzyme immuno assay (EIA) technology offers rapid turn around of results and is less technically demanding than chlamydial cell culture. In addition, recently introduced EIA confirmatory reagents have the potential to improve the accuracy of EIA detection. We have evaluated one such confirmatory reagent (Chlamydia Blocking Reagent®, Abbott Laboratories) to determine the accuracy of the Chlamydiazyme® EIA with special regard to interpretation of low absorbance values. An initial series of 192 male urethral specimens showed that use of a lowered cut off level (absorbance value 0.05) compared with that recommended by the manufacturer increased sensitivity of the EIA from 0.73 to 0.83, thus motivating studies on this interpretative modification. Of 1101 EIA reactive specimens, 65% were determined to be chlamydia positive by the Chlamydia Blocking Reagent. The proportion of female cervical specimens that did not confirm positive was elevated compared with male urethral specimens, 43% vs. 5.7% respectively. In samples yielding absorbance from the recommended cut off level to 0.05 (approximately 50% below), the corresponding figures were 78% and 14% respectively. In 85 selected EIA reactive samples, examination by a direct immunofluorescence staining assay (DFA) (MicroTrak®, Syva Inc.) revealed elementary bodies in 85% of 67 blocking test positive and in 24% of 18 blocking test negative samples. The possibility that Gram-negative bacteria were responsible for unconfirmed EIA reactive specimens was investigated using bacterial suspensions. While EIA reactivity was noted with several strains for Gram-negative bacteria, both the blocking reagent and DFA correctly verified the absence of chlamydial antigen. We conclude that confirming Chlamydiazyme initial reactive samples with the Chlamydia Blocking Reagent improved the accuracy of chlamydial detection by identifying false positive specimens. Furthermore, by including confirmatory testing, a lower cut off level than recommended by the manufacturer seems applicable, at least for male urethral samples, thus increasing sensitivity of the Chlamydiazyme EIA.
Value of Bacteriological Screening of Urine Samples from HIV Infected Patients
Authors: Bain Marion , Emmanuel F X S , Willocks Lorna , Cowan Frances , Brettle R P
Published: June 2017

A retrospective analysis of the results of bacteriological examination of all urine samples from adult HIV infected patients admitted to the City Hospital, Edinburgh during the year 1 April 1988 to 31 March 1989 was made to assess the usefulness of this investigation in HIV positive patients without clinical evidence of urinary tract infection.
The Challenge of Ecojustice Readings for Christian Theology
Authors: Habel Norman C.
Published: June 2017

This article expounds the principles of interpretation and praxis that have inspired the Earth Bible project. It first sets out a general hermeneutic of ecojustice, showing how it embodies and applies to the Earth the principles of suspicion and retrieval currently operative in biblical interpretation from a social justice and feminist standpoint. The paper then expounds the six principles of an ecojustice hermeneutic: the principles of intrinsic worth, interconnectedness, voice, resistance, purpose, and mutual custodianship. In each case the paper shows how interpretation from an ecojustice standpoint requires radical reassessment in the interpretation of familiar texts and poses challenges to theology.
Looking Both Ways or in Multiple Directions: Doing/Teaching Theology in Context into the Twenty-First Century
Authors: Wainwright Elaine
Published: June 2017

Aotearoa New Zealand is uniquely connected, by both history and ocean, to Oceania and its many island nations, peoples and cultures. Doing theology at the beginning of the twenty-first century in such a location provides, therefore, a particular challenge. This article explores the multi-dimensional nature of this challenge and its foundation in the very process that shaped and shapes the biblical tradition and its ongoing interpretation.
What's in a Name? Book Titles in the Torah and Former Prophets
Authors: Goswell Gregory
Published: June 2017

All the biblical books have received names, and these names guide or misguide the reader who seeks to make sense of what is read. Using the four possible functions of a title as posited by Gérard Genette, this article surveys and evaluates from a hermeneutical point of view the alternative names assigned to the nine books that make up the Torah and Former Prophets. The various titles influence reading and suggest ways of understanding the particular book. They are in effect a commentary upon the biblical text. In so far as a title highlights one feature of a book but ignores another (whether it focuses on form or content), no title is neutral nor can it simply be taken for granted. Titles are an element of the paratext of Scripture that fossilise alternative ways in which previous generations of readers have understood the text. They can also help to generate new and improved ways of reading an ancient text.
Songs of the Australian Landscape: The Art and Spirituality of Rosalie Gascoigne
Authors: Keller Judith
Published: June 2017

This article focuses upon the central motifs and symbols of the Australian abstract artist Rosalie Gascoigne (1917-1999) in an attempt to uncover the spirituality in her work, and to connect this with Australian spirituality and with spirituality in the wider Christian tradition. The author proposes such a connection to be the fruit of bringing to bear the religious imagination upon Gascoigne's work, that is, a capacity to attend to the contemplative, creative and sacramental layers in it. Such a capacity invites a response to the artist's work that is ultimately religious. For Australia to be known as land of the spirit ( Terra spiritus), theologians cannot neglect the work of artists such as Rosalie Gascoigne.
God's Transcendence and Compassion
Authors: Mostert Christiaan
Published: June 2017

This article considers the arguments for and against the notion that God suffers. It explores the theological arguments that support affirmations of divine impassibility and passibility respectively; especially as these are articulated in patristic discussions of divine apatheia and contemporary treatments by theologians such as David Bentley Hart and Robert Jenson. The article affirms the importance of reciprocity as a part of our understanding of the God-world relation and suggests that, from the perspective of time, the notion of divine suffering while not constituting the last word, nonetheless might be the “telling word” that the gospel compels us to use.
Hellenism and the Abandonment of Particularism in Jesus and Paul
Authors: Loader William
Published: June 2017

Recent research has been reminding us of the extent of the Hellenisation of Galilee. This calls for a reassessment of the possible impact upon Jesus of life in a crosscultural context. The traditions about his sitting lightly towards certain aspects of the Torah should be seen against this background. We should also consider the possible influence of popular critiques of religion. The latter may well have had an impact on Paul's thought as he grappled with the role of Torah. The origins of Christianity need to be seen in the context of such major cultural shifts and discussions of the particular and the universal in religion.
Derrida and God: Opening a Conversation
Authors: Homer Robyn
Published: June 2017

The work of Jacques Derrida has promoted much controversy, and a theological application of Derrida's way of thinking has frequently been seen to be impossible. Yet since Derrida's concern is chiefly with the impossible, and since the question of God provokes what is impossible for thought, it may be that Derrida is an important participant in theological conversations. Derrida's understanding that metaphysical thought inevitably undoes itself does not forbid us from thinking, but makes us more sensitive to what resists thought. His writings on negative theology suggest the possibility that thought might be marked by what escapes it. Yet the aporia — what cannot be thought — is not to be resolved by proof but by decision, which leaves open the possibility of religious faith. Religion is a response to what remains secret and the attestation of the secret before the Other.
Divine Intervention and the New Physics
Authors: Gwynne Paul
Published: June 2017

Traditional understandings of the Christian faith have included the notion that God acts within history at certain times and places in a way, or to a degree, that God does not at other moments. Never without controversy, this notion of particular divine action is still the subject of debate. This article focuses on one aspect of the contemporary discussion -namely the implications for particular divine action which arise from certain recent developments in the field of physics. Although the notions of general providence and miracle are not necessarily threatened, and may even be aided, by a strict determinism, the category of special providence seems to require some degree of indeterminism in the world. If non-miraculous, particular divine action is not to be restricted to the human arena alone, the search for signs of ontological indeterminism at subhuman levels of reality which complement human freedom is a laudable venture. A number of scientific developments in physics during the twentieth century prove to be encouraging in this respect; at least, they call into question the rigid determinism that was associated with classical, Newtonian mechanics.
Transforming Police Leadership in the '90s
Authors: Bennett Brad R.
Published: June 2017

As society changes at a rapid pace it becomes apparent that government must respond and change as well. In light of the Rodney King “Incident” in Los Angeles in March, 1991, and its aftermath a year later, the need for change in law enforcement is very evident. Police organizations can no longer carry on with their traditional approaches to the delivery of police services. Before exterior changes can be made, however, police leaders need to closely examine how they manage their organizations. This paper examines where police leadership is today and suggests where it should be headed in the future. Called for is a “Transformation” away from a traditional authoritarian management style to a leadership model that builds an organizational culture based on values, ethics, and a partnership with employees.
Frequency of Training in Less-than-Lethal Force Tactics and Weapons: Results of a Two-State Survey
Authors: Ross Darrell L. , Jones Mark
Published: June 2017

Failing to train police officers in the use of less-than-lethal force tactics and equipment increases the police department's liability risk. Police officers in Michigan and North Carolina (N=482) responded to a questionnaire pertaining to the training their departments have provided in less-than-lethal force tactics and equipment since graduating from the police academy. A number of respondents were unaware that their department had a non-deadly force policy, and a majority of those who were aware of a policy had never been tested in its contents. Patrol officers as a group had received training in a less timely manner than supervisors. Suggestions for formulating training strategies are provided.
Role of a Pharmacist in Improving Rational Drug Therapy as Part of the Patient Care Team
Authors: Smith William E.
Published: June 2017

The pharmacist's role in improving rational drug therapy when he is a part of the patient care team is to guarantee the patient the proper use of the best drugs available. Experience at the University of California San Francisco Medical Center has proven to the nursing and medical staffs, as well as to pharmacists that a need for the pharmacist in the clinical area does exist. The author maintains that new drug distribution systems allow the pharmacist to perform new duties in the patient care area and that the clinical pharmacist will be an important participant in drug information retrieval and dissemination in the hospital.
Phenformin Induced Lactic Acidosis: A Case Report and Review of the Literature
Authors: Gong William C. , Kato Donald B.
Published: June 2017

A case report of a patient who developed lactic acidosis following a phenformin overdose is presented. The patient was successfully treated by intravenous administration of sodium bicarbonate and did not have any further problems.

A review of the literature concerning phenformin induced lactic acidosis, treatment modalities and a discussion of the mechanisms involved is presented.
Interactions of CNS Drugs: Psychotherapeutic Agents—The Antipsychotic Drugs
Authors: Hartshorn Edward A.
Published: June 2017

Aspects of the pharmacology of the phenothiazine antipsychotic agents pertinent to possible interactions are reviewed. Pharmacokinetic interactions of possible clinical importance are the interference with the absorption of the phenothiazines by antacids, reversal of the hypotensive effect of guanethidine by psychotropic drugs, blockade of the effects of levodopa in Parkinson's disease, and stimulation of phenothiazine-metabolizing enzymes by phenobarbital. Pharmacologically, phenothiazines may potentiate certain depressant effects of other CNS depressants or add to the anticholinergic side effects of a number of other drugs. The phenothiazines appear to antagonize both the CNS stimulant and the anorexic effects of amphetamines and related substances. Other reactions of possible concern are the phenothiazine-induced hypoglycemia, the relationship of lithium toxicity to sodium intake, and the number of false positive pregnancy tests in patients on phenothiazine therapy.
Comparative Stability of Antibiotic Admixtures in Minibags and Minibottles
Authors: Dinel B. A. , Ayotte D. L. , Behme R. J. , Black B. L. , Whitby J. L.
Published: June 2017

With the increasing use of minibags/minibottles in intravenous admixture programs for the intermittent intravenous administration of antibiotics, a need existed for comparative stability data on these relatively concentrated unit-dose admixtures. Most admixture stability studies have involved the use of large volume infusions. Accordingly, a study was conducted to determine the stability of minibag/minibottle admixtures of frequently prescribed antibiotics.

Test samples were obtained for all admixtures prepared in minibags/minibottles containing 0.9 percent normal saline and 5 percent dextrose in water and stored at 5–6 C° and 21–23 C° over a 24-hour period. All antibiotic admixtures were analyzed by a quantitative microbiological assay using an agar-gel diffusion technique. Determinations of pH were also conducted on all test samples.

No significant difference in antibiotic stability was observed between minibags or minibottles. Cephalothin sodium, gentamicin sulfate, carbenicillin disodium, erythromycin gluceptate, penicillin G potassium, cefazolin sodium, rolitetracycline base and cloxacillin sodium were found to be sufficiently stable for 24-hours under the test conditions. Ampicillin sodium in a 2 percent concentration was found to be stable for 24-hours when prepared in 0.9 percent normal saline and stored at 5 C° or 21 C°.

It was not possible to correlate changes in pH with antibiotic activity.
Magnifying the Impact of Clinical Practice by Automated Drug Reviews
Authors: Jinks Martin , Hirschman Joseph L.
Published: June 2017

About ten percent of total Medicaid expenditures are for drugs. Because a growing share of drug costs, and the consequences of their misuse, are being derived from tax dollars, those in government are seeking methods to hold drug-related expenditures down. The problems of high drug costs and drug misutilization have been clearly documented and indicate a need for effective drug utilization review (DUR). This need is especially acute in ambulatory patient populations, which suffer from a lack of good drug use control due to a general inability to reliably track ambulatory drug use patterns. The advent of government reimbursed drug benefits, which require compilation of all recipient drug claims regardless of the number of pharmacist or physician providers involved, and the pressures of drug cost control and drug use problems, have led to the creation and growth of a new health industry, the fiscal intermediary (FI). The FI combines expertise in electronic data processing (EDP) with knowledge of the drug delivery system. In this business milieu, new and unique opportunities have emerged for the clinically-trained pharmacist. This paper reviews the various levels of drug utilization review (DUR) employed by FIs, from elementary quantitative computer screens to highly sophisticated professional and peer review functions. The potential role of the clinically trained pharmacist in assuring the practice of optimal therapeutics across broad, ambulatory patient populations is illustrated. Specifically, the clinical pharmacist's functions in DUR problem identification, drug use criteria setting, DUR criteria evaluation, and as drug information resource person to the peer review networks, are discussed.
Clinical Pharmacy Services in a Community Hospital
Authors: Bunting Barry A.
Published: June 2017

An example is given of the implementation of a clinical pharmacy service program in a community hospital. The need for establishing an efficient drug distribution system is discussed, and the feasibility of utilizing clinically motivated staff pharmacists is presented. A method of limiting the number of patients admitted to the clinical pharmacy service program is also given.
Physical Assessment of the Nose and Oral Cavity
Authors: Longe R. Leon , Calvert Jon C.
Published: June 2017

This article presents the basic facts, concepts and methods of physical assessment of the nose, mouth, and their related structures. A case study and discussion illustrate the application of this material.
Drug-Induced Metabolic Disorders and Parenteral Nutrition in the Intensive Care Unit: A Pharmaceutical and Metabolic Perspective
Authors: Dasta Joseph F. , Driscoll David F.
Published: June 2017

Since its inception, the field of parenteral nutrition has continued to evolve requiring the expertise of several health care disciplines. This feature has made nutrition support unique among clinical subspecialties. As a member of this team, the pharmacist plays a critical role in the provision of sterile admixtures, compatible nutritional formulations, and cost-effective, therapeutically equivalent strategies. The pharmacist has become more involved in the clinical care of the patient, with particular emphasis on the development of drug-induced metabolic disorders. The multitude of drugs prescribed to hospitalized patients increases the potential for serious metabolic disturbances. This is especially true in the critical care setting where sudden changes in metabolism (e.g., acid-base homeostasis, fluid and electrolyte balance) may result in profoundly negative effects. The critical care setting also represents the most sensitive period of hospitalization where even subtle changes in metabolic homeostasis may assume major clinical significance. Early recognition of offending agents and the institution of appropriate intervention may avert serious iatrogenic diseases. The nutrition support team is in a unique position to address many such disorders through selective manipulation of the various components in the parenteral nutrient admixture. The ability of the pharmacist to recognize the development of drug-induced metabolic disorders lends further support for clinical pharmacy in nutrition support services.
Loratadine: A Nonsedating Antihistamine with Once-Daily Dosing
Authors: Barenholtz Hedva A. , McLeod Donald C.
Published: June 2017

Loratadine is an addition to the class of nonsedating antihistamines which includes terfenadine, astemizole, and acrivastine. Loratadine is chemically related to the tricyclic antidepressants. Animal data have shown that insignificant amounts of loratadine enter the brain, and it has a threefold greater affinity for peripheral as compared with central histamine1-receptors. Loratadine has one main metabolite, descarbethoxyloratadine, which is four times more active than the parent drug. Loratadine reaches peak plasma concentration in 1–2 hours; the metabolite does so in 3–4 hours. Their respective elimination half-lives are about 10 and 20 hours. Onset of action is within 1 hour and duration is at least 24 hours. Once-daily dosing is recommended. Generally, loratadine is as efficacious as existing antihistamines in relieving symptoms of allergic rhinitis, urticaria, and in suppressing wheal formation. Reports of sedation and other adverse reactions are no more frequent than found with placebo. Tachyphylaxis has not been noted in humans, and there is minimal potential for drug interactions based on animal data. Loratadine and terfenadine have comparable therapeutic applications. Both have shown minimal adverse effects, but loratadine has a quicker onset and longer duration of action. These two agents are useful for acute allergic reactions. In contrast, astemizole has an onset of action of several days and is most useful for prophylactic treatment of seasonal allergies.
Foreign Drug Identification
Authors: Murdoch Lu-Ann L.
Published: June 2017

The references used by a major Canadian drug information center to identify foreign drug products are described. Guidelines are provided for handling foreign drug identification requests, including the collection of background information and the management of specific problems likely to be encountered during the identification process. Useful methods of building a foreign drug identification reference library are also suggested.
Intraoperative Complications in Patients Receiving Amiodarone: Characteristics and Risk Factors
Authors: Perkins Mark W. , Dasta Joseph F. , Reilley Thomas E. , Halpern Pinchas
Published: June 2017

This article reviews amiodarone's adverse cardiovascular properties, concentrating on those in surgical patients, and evaluates several potential risk factors. Amiodarone has negative inotropic and chronotropic properties as well as peripheral vasodilating properties that may manifest as bradycardia, reduced cardiac output, and hypotension. These reactions are clinically important during surgery, because of resistance to pharmacologic resuscitation and an increased mortality rate. Potential risk factors include ventricular dysfunction, rapid infusion rate, hypocalcemia, cardiopulmonary bypass, general anesthesia, concurrent negative inotropic or chronotropic drugs, and an elevated serum amiodarone or desethylamiodarone concentration. The following measures may decrease the risk of intraoperative adverse reactions in amiodarone-treated patients. The serum calcium concentration should be at the physiologic level and the serum amiodarone and digoxin concentrations should be in the therapeutic range. Negative inotropic and chronotropic agents should be discontinued when possible. A temporary cardiac pacemaker may prevent intraoperative hypotension due to bradycardia. Amiodarone may be discontinued before surgery to minimize the risk of intraoperative complications, but this decision should balance the potential for amiodarone-associated intraoperative complications against the risk of arrhythmia recurrence and the delay of surgery.
A Variant of the Chemotherapy-Associated Erythrodysesthesia Syndrome Related to High-Dose Cyclophosphamide
Authors: Matsuyama Joy R. , Kwok Karl K.
Published: June 2017

A 33-year-old woman with stage IIIA non-Hodgkin's lymphoma unresponsive to ten cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) developed a variant of the chemotherapy-associated erythrodysesthesia syndrome following high-dose cyclophosphamide and radiation in preparation for an autologous bone marrow transplant. The patient first complained of a new rash on her fingers and toes on day 6 after her first dose of cyclophosphamide. Unlike the previous case reports in which patients presented with a palmar-plantar erythema, this patient's rash occurred on the dorsal aspects of her hands and feet, and not on her palms and soles. After evaluation by a dermatologist she was diagnosed as having a variant of palmar-plantar erythema induced by cyclophosphamide.
Convulsions Induced by Aminocaproic Acid Infusion
Authors: Rabinovici Reuben , Heyman Ayelet , Kluger Yoram , Shinar Eilat
Published: June 2017

Aminocaproic acid is a widely used antifibrinolytic agent. Serious adverse effects associated with its use are rare, but we report on a patient with liver disease and cirrhosis who experienced a grand mal seizure during the intravenous administration of aminocaproic acid. Clinicians should be alert to the occurrence of this adverse effect in patients with no previous neurological problems.
Sensory/Mixability Preference Evaluation of Cholestyramine Powder Formulations
Authors: Shaefer Mark S. , Jungnickel Paul W. , Miwa Linda J. , Marquis Norman R. , Hutton Gary D.
Published: June 2017

This double-blind, crossover trial compared the sensory and product preparation characteristics of two cholestyramine powder preparations. The study involved 100 healthy volunteers, aged 22–65 (mean 42 years). Questran, a currently marketed product containing sucrose as a sweetener, was compared with Questran Light, a new formulation substituting aspartame for 90 percent of the sucrose. Comparisons were conducted with the two products mixed in water and orange juice. The subjects expressed a significant overall preference for the new formulation mixed in either water (77 percent) or orange juice (80 percent) (p<0.01 in both comparisons). Subjects expressed an overwhelming preference for the old product (99 percent) with respect to ease of preparation, although the ratings of the new product were generally neutral rather than negative. The new product is somewhat more difficult to prepare compared with the old cholestyramine preparation, but offers significantly increased patient acceptance based on sensory evaluations.
Bioimpedance Assessment of Antipyrine Pharmacokinetics before and after Enzyme Induction
Authors: Pilla Alison M. , Zarowitz Barbara J. , Svensson Craig K. , Peterson Edward L. , Popovich John
Published: June 2017

Bioimpedance (BI) technology, a noninvasive method of measuring body composition, has been previously used to develop a predictive model for metabolic clearance under basal conditions. The present investigation was conducted to assess the ability of BI-derived models to predict drug disposition in a perturbed system. An antipyrine pharmacokinetic and impedance analysis of 15 healthy male subjects was performed before and on the 14th day of phenobarbital administration (i.e., after enzyme induction). The all subsets multiple regression technique was used to develop preinduction models for clearance (Cl), (p = 0.021, R2 = 0.654) and volume of distribution at steady-state (Vdss) (p = 0.001, R2 = 0.867), using demographic and mean BI parameters. The preinduction Cl model significantly underestimated postinduction measurements and was not predictive of changes in CI. The preinduction Vdss model was predictive of postinduction Vdss. It appears that the BI-derived model is unable to predict perturbations in metabolic clearance caused by enzyme induction.
Cimetidine-Associated Adverse Reaction
Authors: Drea Edward J. , Mutnick Alan H. , Lam Wilfred , Palazzolo Dominic P.
Published: June 2017

Cimetidine, a histamine2-receptor antagonist, is used in the treatment and prophylaxis of peptic ulcer disease. Its use is relatively free of serious adverse reactions and only a few accounts of hypersensitivity exist. We report a case of intravenous cimetidine-associated adverse reaction characterized by junctional rhythm, bradycardia, and hypotension apparently not secondary to rapid intravenous cimetidine infusion. The adverse reaction was reproduced upon rechallenge. No previous accounts of this reaction appear clearly defined in the literature nor have such reactions been confirmed by rechallenge.
Experience with Home Aerosolized Pentamidine Treatment in Patients with Aids
Authors: Choy Fred N. , Wilson Diane C. , Willcox Gordon S. , Crocker Kathleen S.
Published: June 2017

Pneumocystis carinii pneumonia (PCP) is the most frequent opportunistic infection in patients with AIDS and is the most common cause of death in these patients. Conventional parenteral trimethoprim/sulfamethoxazole or parenteral pentamidine treatment is often not completed because of frequent incidence of adverse reactions. Aerosolized pentamidine appears to be better tolerated and is considered an alternative treatment for PCP in both hospital and community settings. This report describes our experience with 34 patients with AIDS who received aerosolized pentamidine at home. All patients were over 18 years old and had received either parenteral or aerosolized pentamidine within a medically supervised setting before home treatment was initiated. The Respigard II nebulizer system powered by an oxygen source was used as the delivery system. All patients took two puffs of metaproterenol sulfate 10 minutes prior to two 15-minute sessions of pentamidine inhalation. No relapse or adverse reactions were observed in patients. Large randomized clinical trials currently are underway to compare the value of aerosolized pentamidine with other forms of treatment for PCP.
Seizure Activity Associated with Antipsychotic Therapy
Authors: Cold Julie A. , Wells Barbara G. , Froemming Judy H.
Published: June 2017

Approximately one percent of patients receiving antipsychotic medications develop seizure activity. In addition, approximately seven percent of epileptic patients develop chronic psychosis requiring antipsychotic treatment. A history of antipsychotic-induced seizures in patients exhibiting florid psychosis should not preclude the use of antipsychotic medications. Different antipsychotics affect the seizure threshold in varying degrees, and the least epileptogenic agents should be selected for this population. Predisposing factors and other risk factors associated with antipsychotic-induced seizures are identified. Guidelines for the use of antipsychotic medications in psychotic patients with a history of seizures are presented.
Anistreplase: A Novel Thrombolytic Agent for Acute Myocardial Infarction
Authors: Marinac Jacqueline S. , North Donald S. , Stringer Kathleen A.
Published: June 2017

Anistreplase, a modified congener of streptokinase, is a recently approved thrombolytic agent used in the treatment of acute myocardial infarction (AMI). Clinical studies have demonstrated anistreplase to be equally efficacious as intracoronary streptokinase when given within four hours of the onset of chest pain. Thirty units, given as a single bolus intravenous injection, result in reperfusion rates of approximately 60–70 percent. The adverse-effect profile of anistreplase compares favorably with that of streptokinase, with hemorrhagic complications being the most serious. Anistreplase has two distinct advantages over both streptokinase and alteplase: (1) it can be administered as a single bolus intravenous injection and (2) it has a longer half-life which may result in decreased reocclusion rates. Anistreplase therapy is associated with reductions in both short- and long-term mortality and has been shown to preserve left ventricular function. A large, long-term, comparative clinical trial (Third International Study of Infarct Survival or ISIS-III) investigating morbidity and mortality rates with streptokinase, alteplase, and anistreplase is ongoing, as is a direct comparative study against alteplase alone (TEAM-3, Multicenter Thrombolytic Trials of Eminase in Acute Myocardial Infarction).
Flutamide: An Antiandrogen for Advanced Prostate Cancer
Authors: Goldspiel Barry R. , Kohler David R.
Published: June 2017

Flutamide is a nonsteroidal pure antiandrogen that acts by inhibiting the uptake and/or binding of dihydrotestosterone to the target cell receptor, thus interfering with androgen action. Flutamide is well absorbed orally and extensively metabolized; its active metabolite, 2-hydroxyflutamide, is formed rapidly and excreted almost entirely by the kidneys. Clinical studies in prostate cancer patients have demonstrated efficacy with flutamide monotherapy in patients who had received no prior treatment, in untreated patients with combined androgen blockade concomitantly with a luteinizing hormone-releasing hormone (LHRH)-agonist, and in relapsed patients. A randomized, placebo-controlled trial demonstrated a 26 percent increase in median survival for patients treated with leuprolide plus flutamide compared with leuprolide plus placebo. When given as monotherapy and in combination with an LHRH-agonist, flutamide is well tolerated. The usual adverse effects are gynecomastia and mild diarrhea when given as a single agent. In combination with an LHRH-agonist, hot flashes, loss of libido, impotence, mild nausea and vomiting, gynecomastia, and diarrhea are commonly reported. However, only diarrhea occurred more frequently in patients treated with leuprolide plus flutamide than in those treated with leuprolide plus placebo. Flutamide is indicated in combination with an LHRH-agonist (e.g., leuprolide) as initial therapy in metastatic (stage D2) prostate cancer. The usual dose is 250 mg po tid given at eight-hour intervals and started concurrently with the LHRH-agonist. Formulary addition is recommended.
Idioventricular Rhythm: Hypervagotonia Associated with Placebo
Authors: Cutler Neal R. , Heller Allen H. , Kurtz Neil M. , Sramek John J. , Lynch Thomas E. , Zolnouni Parvaneh P. , Gandhi Dipeshkumar K. , Sawin Suzanne
Published: June 2017

We report a case of hypervagotonia manifested by idioventricular rhythm in a healthy, athletic man who participated in a Phase I study of an investigational calcium-channel blocker. Upon breaking the study's double-blind study code, it was discovered that the subject had received placebo. We discuss this unusual finding and the implications of including athletic subjects in safety/tolerance studies.
Antimicrobial Prophylaxis in Coronary Bypass Surgery: A Critical Appraisal
Authors: Thompson Dennis F. , Raebel Marsha A. , Ariano Robert E. , Zhanel George G.
Published: June 2017

The literature has been examined to assess the optimal prophylactic antimicrobial regimen for patients undergoing coronary bypass surgery. Antimicrobial surgical prophylaxis should be based on the two main potential pathogens, Staphylococcus epidermidis and S. aureus. It is unclear whether the prophylactic use of antimicrobials can or should be guided by in vitro antimicrobial susceptibility testing; data from well-performed clinical trials should be evaluated. The data fail to demonstrate consistently a significant difference within the cephalosporin class of antimicrobials with regard to prevention of infectious complications. Although it does not reach statistical difference, the trend with respect to efficacy appears to be cefuroxime, then cefamandole, and then cefazolin. The lack of significant difference among antimicrobials suggests an institution-individualized approach to the selection of the optimal antimicrobial for prophylaxis. For our facilities we recommend the following regimen: cefazolin sodium 1–2 g iv q8h for two days. There are not enough data at this time to recommend less than two days of antimicrobial prophylaxis for this type of surgery. In addition, aminoglycosides provide no added benefit when added to cephalosporins.
Clofazimine: A Review of its Use in Leprosy and Mycobacterium Avium Complex Infection
Authors: Garrelts James C.
Published: June 2017

This article reviews the chemistry, pharmacology, spectrum of activity, pharmacokinetics, clinical efficacy in leprosy and Mycobacterium avium complex (MAC) infection, adverse effects, drug interactions, and special considerations of clofazimine. The drug is active in vivo against M. leprae and in vitro against MAC. In addition, it possesses antiinflammatory and immunosuppressive properties. Clinical studies support the efficacy of clofazimine as a part of multidrug therapy in treating leprosy. It also appears to reduce the incidence and severity of erythema nodosum leprosum reactions that often occur during the treatment of leprosy. Efficacy in treating MAC infection in patients with AIDS is not well documented, despite the use of clofazimine in combination with other agents. A few patients have responded symptomatically and by clearing their mycobacteremia, although there is no evidence that mortality is reduced. Clofazimine is well tolerated, at least when doses ≤100 mg/d are used. Adverse reactions include discoloration of the skin, self-limiting gastrointestinal intolerance, severe and life-threatening abdominal pain and organ damage due to clofazimine crystal deposition, and asymptomatic discoloration of the eye. Clofazimine should be considered for formulary inclusion.