bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental investigation into a new hybrid-forming process: Incremental stretch drawing
Authors: Tandon Puneet , Sharma Om Namah
Published: May 2016

Incremental sheet metal forming is an evolving process, which is suitable for the production of limited quantities of sheet metal components. The main advantages of this process over conventional forming processes are reduced setup cost and manufacturing lead time, as it eliminates the need of special purpose dies, improves formability, reduces forming forces, and provides process flexibility. The objective of this work is to investigate a new hybrid-forming process, which intends to combine incremental sheet metal forming with deep drawing process and has been named as “incremental stretch drawing.” A number of setups and fixtures were developed to carry out experiments to achieve incremental stretch drawing and understand the mechanism of the process. This process addresses some of the challenges of incremental sheet metal forming, that is, limited formability in terms of forming depth, especially at steeper wall angles and subsequent thinning of sheet. It is observed that the proposed process is able to reduce thinning as much as about 300%, considering same forming depth for incremental sheet metal forming and incremental stretch drawing processes. Improvement in formability, in terms of forming depths, also has been observed to be near about 100% in particular cases.
New controllable and near net bar fine-cropping system
Authors: Zhong Bin , Zhao Shengdun , Cai Bin , Zhao Xuzhe , Zhang Chuanwei
Published: May 2016

In this article, a new controllable and near net low-stress bar fine-cropping system was proposed and developed by combined using the stress concentration effect of the prefabricated V-groove and the propagation crack. The bar fine-cropping experiments were successfully carried out using a new proposed cropping load control strategy. Although the level of the stress intensity factor range [Formula: see text] greatly influences the cropping time and the cross-section quality, the cropped-billets can be directly used for the precision forging industry without additional machining.
A practical method to account for seal friction in aircraft hydraulic actuator preliminary design
Authors: Agarwal Naresh Kumar , Lawson Craig P
Published: May 2016

Seals are used in hydraulic actuators or any other hydraulic devices to prevent passing of hydraulic fluid from one chamber to another, or to prevent external leakage and entry of any foreign contaminants. The primary function of any hydraulic actuator is to efficiently use hydraulic power to drive a load experienced during movement of control surfaces or movable aircraft structure. Efficient sealing helps in achieving this, but with its own friction which should be as minimal as possible. Thus, the estimation of seal friction force has crucial significance in hydraulic actuators, especially in flight control actuators that demand high performance and dynamic behavior characteristics while efficiently driving the load. This paper details the methodology adopted for theoretical estimation of total seal friction force of actuator as well as description of experimental test set-up and test method followed to record the total friction value at different positions of the actuator. The theoretical estimation was done using empirical formulae and graphs for predicting seal friction force by considering the effects of seal squeeze, hydraulic pressure, seal dimensions, seal material and then interpolating the same for the specific type of seals used. An experimental study is also presented in this paper, which can be conducted to validate the theoretically estimated value after building up of development prototypes. The validation is necessary as seal friction force calculation during design phase is an approximation and accurate friction of every seal is difficult to measure as it depends on a number of parameters. Thus, this paper explains the subject issue with the help of a case study which provides the theoretical estimation as well as its validation through an experiment to study this significant aspect of a hydraulic actuator design.
Clinicopathologic characteristics of HIV/AIDS-related plasmablastic lymphoma
Authors: Wang Di , Zheng Ye , Zeng Dong , Yang Yuexiang , Zhang Xiaonan , Feng Yanling , Lu Hongzhou
Published: May 2016

Plasmablastic lymphoma is a rare and aggressive B cell lymphoma that is considered to be strongly associated with HIV infection. This article explores the histological morphology and immunohistochemical characteristics of HIV/AIDS-related plasmablastic lymphoma with the goal of improving the diagnosis and treatment of this rare tumor. According to criteria of the World Health Organization Classification of Tumors of Hematopoietic and Lymphoid Tissues (2008), six plasmablastic lymphoma cases admitted to the Shanghai Public Health Clinical Center were comprehensively analyzed with conventional hematoxylin-eosin staining, immunohistochemical staining and in situ hybridization. The morphological features of six tumors were consistent with PBL. Immunohistochemical staining showed that all six cases were negative for CD19, CD20, and CD79a, and positive for OCT-2, BOB-1, VS38c, and melanoma ubiquitous mutated 1. The Ki67 proliferation index was higher than 90% in all six cases. In situ hybridization indicated that four cases were EBER-positive. In addition, three cases had C-MYC translocation rearrangement. Our results showed that the immunophenotypes of PBL vary, which makes PBL diagnosis difficult. Therefore, morphological characteristics, immunophenotypic markers, and clinical data should be used in combination to enable an accurate diagnosis, especially in the presence of immunophenotypic variation, as this approach will facilitate timely treatment.
Aerodynamic performance of helical Savonius wind rotors with 30° and 45° twist angles: Experimental and numerical studies
Authors: Anbarsooz M
Published: May 2016

In this study, the aerodynamic performance of helical Savonius rotors with 30° and 45° twist angles have been investigated experimentally and numerically and compared with the conventional rotor with zero twist. This comparison has been performed at two Reynolds number of 1.50 × 105 and 1.84 × 105 (corresponding to wind velocities of 7.3 and 9 m/s) on Savonius type rotors with an aspect ratio of 1.0. Numerical simulations have been performed using the ANSYS-Fluent commercial software using the sliding-mesh method for considering the rotation of the turbine. The experimental measurements, however, are performed at an open-circuit wind tunnel facility. Results show that the maximum power coefficient of the helical rotors are less than the conventional rotor, in a manner that this coefficient decreases from 0.12 to 0.11, when the conventional rotor is replaced with the helical rotor having 45° twist angle. However, the helical rotors have a more uniform time variations of the torque coefficient. The maximum power coefficient for all the rotors has occurred at the tip speed ratio of 0.7. The good agreement observed between the numerical and experimental results revealed the suitability of the employed numerical scheme for predicting the aerodynamic performance of Savonius-type wind turbines.
A censored quantile regression approach for the analysis of time to event data
Authors: Xue Xiaonan , Xie Xianhong , Strickler Howard D
Published: May 2016

The commonly used statistical model for studying time to event data, the Cox proportional hazards model, is limited by the assumption of a constant hazard ratio over time (i.e., proportionality), and the fact that it models the hazard rate rather than the survival time directly. The censored quantile regression model, defined on the quantiles of time to event, provides an alternative that is more flexible and interpretable. However, the censored quantile regression model has not been widely adopted in clinical research, due to the complexity involved in interpreting its results properly and consequently the difficulty to appreciate its advantages over the Cox proportional hazards model, as well as the absence of adequate validation procedure. In this paper, we addressed these limitations by (1) using both simulated examples and data from National Wilms’ Tumor clinical trials to illustrate proper interpretation of the censored quantile regression model and the differences and the advantages of the model compared to the Cox proportional hazards model; and (2) developing a validation procedure for the predictive censored quantile regression model. The performance of this procedure was examined using simulation studies. Overall, we recommend the use of censored quantile regression model, which permits a more sensitive analysis of time to event data together with the Cox proportional hazards model.
Effective properties of coated fiber composites with piezoelectric and piezomagnetic phases
Authors: Sladek Jan , Sladek Vladimir , Pan Ernian
Published: May 2016

The finite element method is proposed to analyze coated fiber composites with piezoelectric and piezomagnetic phases. The computational homogenization technique is applied for fiber composites with magnetoelectroelastic properties to determine effective material parameters. The evolution of the magnetoelectroelastic fields at the macroscopic level is resolved through the incorporation of the microstructural response. The microstructural analyses are performed on the representative volume element, where essential physical geometrical information about the microstructural components is included. Circular cross section of fibers is considered in numerical analyses. A thin coating layer is considered on the surface of the piezoelectric fiber which is embedded in the piezomagnetic matrix. Influence of the coating layer on the effective material properties is analyzed.
Purpose-Led Organization
Authors: White Andrew , Yakis-Douglas Basak , Helanummi-Cole Heli , Ventresca Marc
Published: May 2016

Antony Jenkins, whose tenure as CEO/chairman at Barclays makes his name synonymous with “purpose-led leadership,” speaks in this interview about a working conception of purpose to inform key decisions for large organizations and about the internal and external challenges these organizations face while implementing purpose. We interviewed him at Oxford in February 2016. He draws our attention to (a) how purpose and performance go hand-in-hand, (b) the importance of recognizing purpose at the individual level and how that gets integrated into the organization’s purpose, and (c) the steps in becoming a purposeful organization that involve challenging the fear of short-term loss and aspiring to employ performance measures that stretch beyond our sense of control. He offers pieces of hard-won advice for an organization attempting a purpose-led transformation and shares his philosophy on how to do so starting with individuals.
Enlarged finite strain modelling incorporating adiabatic shear banding and post-localization microvoiding as shear failure mechanisms
Authors: Longère Patrice , Dragon André
Published: May 2016

The adiabatic shear banding and its consequences are considered here as deterioration mechanisms incorporated in the dynamic plasticity modelling for high-strength metallic materials following earlier contributions of the present authors. A three-dimensional finite deformation model, starting from a specific scale postulate and devoted to cover a wide range of dissipative phenomena including adiabatic shear banding-related material instabilities, is further developed here. The developments concerned are based on recent experimental evidence and include explicitly post-localization void-sheet formation and growth in the wake of a band cluster. The model enlarged in this way allows for a more detailed description of a late pre-failure stage of shear-dominated deformation. Some model calibration and numerical implementation items are discussed.
Micromechanics model of gas saturated coal weakened by elliptical microcracks
Authors: Ren Zhongjun , Wan Ling , Peng Xianghe
Published: May 2016

Based on the analysis of the deformation and growth of a representative elliptical microcrack with arbitrary orientation and geometrical size embedded in a representative volume element subjected to triaxial stress and pore pressure, the additional compliance tensor induced by an embedded opening/closed elliptical microcrack is derived. Assuming numerous elliptical microcracks, and introducing an appropriate probability density function to describe the distribution of orientation and geometrical size of microcracks, the additional compliance tensor induced by microcracks system is analyzed in Taylor’s scheme, and a three-dimensional micromechanics model for gas saturated coal materials is obtained. The validity of the proposed micromechanics model is verified by the agreement between the theoretical and experimental results of gas saturated coal under triaxial compression. The effect of pore pressure and confining pressure on the damage behavior induced by microcracks is investigated. The calculations show microcracks of coal under higher pore pressure will be more inclined to slide and grow, and induce larger additional strain in the last deformation stage.
Influence of temperature and strain rate on the longitudinal compressive crashworthiness of 3D braided composite tubes and finite element analysis
Authors: Wu Xianyan , Zhang Qian , Gu Bohong , Sun Baozhong
Published: May 2016

This article reports the longitudinal compressive crashworthiness of three-dimensional four-step circular braided carbon/epoxy composite tubes at temperatures of 23, −50, and −100℃ under strain rate ranging from 340 to 760/s both experimentally and finite element analysis. The experimental results showed that the compression strength, stiffness, and specific energy absorption increased with the decrease in temperature and with the increase in strain rate. It also showed that, the compressive damage morphologies were sensitive to the change in temperature and strain rate. A coupled thermal-mechanical numerical analysis was conducted to find the thermo/mechanical coupling effect on the compressive crashworthiness of the three-dimensional composite tube. The temperature distributions in the braided preform and the resin during the impact compression were also calculated through finite element analysis. From the finite element analysis results, the inelastic heat generation was seen to be more in the preform than the matrix and its distribution and accumulation led to the damage progress along the loading direction.
Non-destructive inspection of initial defects of PA6.6-GF50/aluminum self-piercing riveted joints and damage monitoring under mechanical static loading
Authors: Gay Amandine , Roche Jean-Michel , Lapeyronnie Patrick , Valiorgue Frédéric , Bertrand Philippe
Published: May 2016

A self-piercing riveting process is used to join a thermoplastic composite sheet of PA6.6-GF50 with an aluminum alloy sheet 5182 O. Two shapes of self-piercing rivet are tested: the countersunk rivet and the button head rivet. Non-destructive inspections by pulse thermography and post-mortem cross-section observations are made to assess the damage that might have occurred during the rivet piercing process. The manufacturing defects are characterized and the possible causes for their emergence are explained. Then, single-lap joint tests were carried out to determine the best joint in terms of its mechanical strength. These tests were also instrumented by various monitoring techniques such as passive thermography, digital image correlation, and acoustic emission to clarify the joint damaging behavior. Non-destructive inspections by pulse thermography are finally correlated with the thermal fields acquired by passive thermography during the mechanical test to improve the understanding of the damage mechanisms and their criticality.
Adaptive concurrent three-level multiscale simulation for trans-scale process from material mesodamage to structural failure of concrete structures
Authors: Sun Bin , Li Zhaoxia
Published: May 2016

A new multiscale method is developed to simulate the trans-scale process of concrete structures from material mesodamage to structural failure with three-level model which, respectively, describe nonkey, key, and damaged regions. Adaptive level change criteria coupled in the method ensures level change due to evolving damage without user intervention in the computation. As a case study, the trans-scale damage process of a concrete cantilever beam and reinforced concrete (RC) frame structure is simulated. It shows that the method can be used to reveal the failure mechanisms of concrete structures from the view of mesoscale with lower cost.
Successful Treatment of Apparent Methicillin-Resistant S. Aureus Endocarditis with Gentamicin and Cephalothin
Authors: Greenlaw Cal W. , Ott Franklin B.
Published: May 2016

A pediatric patient with Staphylococcus aureus endocarditis was treated unsuccessfully with methicillin 74 mg/kg/day as an initial dosage and 185 mg/kg/day as a maximum dosage over a 21-day period. Treatment failure was a result of apparent methicillin resistance, which may have been induced by the initial use of suboptimum methicillin dosages. The methicillin was discontinued and the patient became afebrile within six hours of receiving a combination of cephalothin and gentamicin. Combination therapy was continued for a total of 42 days, with eventual trough serum MBC dilutions of 1:32 and gentamicin and cephalothin dosages of 2.7 and 166 mg/kg/day respectively.

The patient was cured without any adverse sequelae. The rapid improvement in this patient's condition and his cure after receiving the combination therapy was probably due to the synergistic activity of gentamicin and cephalothin against S. aureus.
A Summary of Current Information, Mechanisms and Treatment
Authors: Inoue Fumio
Published: May 2016

Adverse reactions and the possible mechanisms of the reactions caused by antipsychotics are reviewed. The mechanisms of many of these adverse reactions have not been elucidated to date, hence there have been inconsistent approaches to the problem. Complicated symptoms of the reactions, especially exacerbation of the mental state, are often considered to be a part of the psychosis under treatment. Some of the reactions are temporary, or the patient may develop tolerance to them so that an additional drug may not be necessary.

It is suggested that use of the minimum dosage of antipsychotics, avoidance of polypharmacy, and close observation of the patient constitute the best approach to the prevention of unwanted reactions.
Allopurinol Hypersensitivity
Authors: Burkle Wayne S.
Published: May 2016

Allopurinol-induced hypersensitivity reactions may involve multiple organ systems. Milder forms consist of uncomplicated dermatological lesions, while the more severe type may involve toxic epidermal necrolysis, renal impairment and hepatic disturbances.

A case is presented which represents the milder form of the reaction. In addition to discussing the salient features of this case, the pertinent data from all reported cases of the more severe hypersensitivity reactions are analyzed in an attempt to identify predisposing factors and prognostic indicators.
Hypokalemic Periodic Paralysis — The Syndrome and its Treatment
Authors: Jerome Micky
Published: May 2016

Hypokalemic periodic paralysis (hypoKPP) is a genetically determined disease characterized by episodic decreases in serum potassium levels accompanied by muscle weakness or paralysis. A case is reported and a review of the literature presented.

Current evidence suggests that the primary defect associated with hypoKPP resides either in the muscle cell membranes or in the cellular metabolism and gives rise to a conduction defect which results in muscle paralysis. A variety of drugs have been employed to correct the cellular abnormality, including supplemental potassium, diuretics, propranolol and diazoxide. To date the most effective therapy is acetazolamide, which induces a mild metabolic acidosis thought to stabilize the cellular membrane against intracellular shifts of potassium ions.
Phencyclidine Psychosis
Authors: Richards Mark L. , Perry Paul J. , Liskow Barry I.
Published: May 2016

A case of prolonged psychotic behavior is described of a 20-year-old female following the ingestion of an illicitly obtained powder probably containing phencyclidine.

The various psychiatric manifestations of phencyclidine intoxications are reviewed. The benefit of treating the toxic phase with psychotropic drugs is questionable. Hospitalization, supportive measures and urine acidification appear to be the treatments of choice for patients experiencing a toxic psychosis caused by phencyclidine.
Multi-Drug-Resistant Pulmonary Tuberculosis
Authors: Guernsey Brock G. , Alexander Michael R.
Published: May 2016

A case of multiple-drug-resistant pulmonary tuberculosis (TB) is presented. The patient's refusal to complete a course of drug therapy culminated in numerous relapses, treatment failures, and finally, death.

Noncompliant drug behavior is probably the major cause of treatment failure. Supervised intermittent and short-course regimens can be utilized when patients demonstrate poor cooperation in self-medication programs.

Resistance to first-line agents complicates retreatment of TB. Drug selection in these cases should be based on the results of sensitivity studies, and effective regimens frequently require the use of more toxic secondary agents. Although published guidelines for appropriate treatment of TB are available, inappropriate therapy continues to occur.

Resistant organisms can be transmissible and virulent, and patients infected with them may serve as infector pools that produce new cases of primary resistance. The control of resistant TB depends on our ability to identify these individuals and to insure that they comply with effective drug regimens.
An Innovative Dental Pharmacy Practice
Authors: Walker John A. , Helling Dennis K.
Published: May 2016

A dental pharmacy was established in 1973 by the College of Pharmacy and the College of Dentistry at the University of Iowa. Staffed by a pharmacist, the Dental Pharmacy provides traditional and clinical pharmacy services to dental patients and practitioners. Treatment protocols for SBE antibiotic prophylaxis, oral candidiasis, and aphthous and Sutton's lesions have been jointly developed, utilizing the pharmacist in chronic dental disease management. Product selection and dosage regimen determination of fluoride preparations, patient counseling, and drug information are among the pharmacy services offered. The Dental Pharmacy is a unique interprofessional approach to improving patient care and student education. It has successfully demonstrated that the professions of pharmacy and dentistry can contribute to the achievement of each other's goals.
Physical Assessment of the Neck and its Related Structures
Authors: Longe R. Leon , Taylor A. Thomas , Calvert Jon C.
Published: May 2016

This article reviews the anatomy and physiology necessary to perform a physical assessment of the neck. Illustrations, a case report and a discussion of drug therapy for treatment of hyperthyroidism demonstrate the clinical pharmacy application of the material.
Benign Liver Tumors and Oral Contraceptive Therapy
Authors: Warren Betty L. , Bellward Gail D.
Published: May 2016

Clinical data obtained from 1972–1978 on 107 cases of oral-contraceptive-steroid-associated hepatic adenomas is presented in tabular form. Although a cause-and-effect relationship has not been definitively established, experimental evidence that supports an etiological role of contraceptive steroids in the production of benign liver tumors is described. Based on metabolic and toxicity studies, a mechanism is postulated whereby contraceptive steroid therapy may result in induced activities of drug metabolizing enzymes. In certain circumstances, increased levels of activated metabolites may irreversibly bind to hepatic macromolecules and produce altered cell growth. The possible promoter role of oral contraceptive steroids in tumor formation is discussed.
Dobutamine: A New Agent for the Management of Cardiac Decompensation
Authors: Park Glen D. , Covinsky Joel O.
Published: May 2016

Dobutamine is a new inotropic agent being promoted for short-term, parenteral treatment of adults with “cardiac decompensation due to depressed contractility resulting either from organic heart disease or from cardiac surgical procedures.” Pharmacologically, it most resembles the effects of low-dose epinephrine, but with fewer beta-2 adrenergic effects. The reported advantage of dobutamine over other currently available inotropic catecholamines is that, with dobutamine, cardiac output is increased with less concurrent heart rate increase or arrhythmia potential.

Dobutamine has been compared to three other drugs in congestive heart failure: isoproterenol, nitroprusside, and dopamine. Isoproterenol appears to produce a greater increase in heart rate than dobutamine; nitroprusside produces a greater decrease in capillary wedge pressure and mean arterial pressure than dobutamine, but produces the same increase in cardiac index. Except for differences in effects on pulmonary capillary wedge pressure, dobutamine and dopamine demonstrate parallel effects up to a dose of 5 μg/kg/min of dopamine. Above this dose, changes in heart rate, arrhythmias (PVCs), and peripheral resistance differentiate the two drugs.

Based on available data, dobutamine appears to have hemodynamic advantages over dopamine in congestive heart failure, but these advantages are not seen in postsurgical cardiac depression. At this time, dobutamine cannot be recommended over other agents for use in the acute MI patient.
Beclomethasone Dipropionate Aerosol: Patient Consultation Recommendations
Authors: Fischer Richard G. , Kuhn John G.
Published: May 2016

Patient administration errors in the use of beclomethasone dipropionate aerosol are frequent. Asthmatics once labeled “treatment failures” on this aerosol may only need adequate consultation to achieve therapeutic results. Pharmacists should monitor for patient noncompliance and provide instruction and follow-up on the use of beclomethasone dipropionate aerosol.

Common administration errors associated with this drug are described, along with information patients should receive to obtain optimal benefits.
Clonidine — Recurrent Apnea following Overdose
Authors: Grabert Brian , Conner Christopher S. , Rumack Barry H. , Peterson Robert G.
Published: May 2016

Recurrent episodes of apnea are described in two children following overdosage of clonidine. Respiratory depression and apnea requiring intubation may not occur for up to 2½ hours following ingestion of clonidine. Hypotension was absent in one case, suggesting opposition to centrally mediated effects by peripheral alpha-agonistic activity in the presence of high serum concentrations of clonidine. General symptoms and treatment of clonidine overdosage are discussed.
Combination Mesoridazine-and Benztropine Mesylate-Induced Paralytic Ileus
Authors: Wade Lance “C” , Ellenor Gary L.
Published: May 2016

Drug-induced paralytic or adynamic ileus can result from additive anticholinergic effects of various medications. Two cases of drug-induced paralytic ileus are reported (one in which the outcome was death) possibly due to a combination of mesoridazine and benztropine mesylate.
A Method for Post-Marketing Screening of Adverse Reactions to Drugs Initial Results
Authors: Knapp Deanne E. , Zax Brian B. , Rossi Allen C. , O'Neill Robert T.
Published: May 2016

The FDA is pilot-testing a methodology for signaling previously unsuspected relationships between drugs and important adverse events. This method uses data it receives through the FDA spontaneous reporting program. Reviewing drugs used primarily on an outpatient basis, this screening methodology focuses on “tracer” adverse events and the organization of these reactions into body/functional systems. This review process enables a clinical evaluator to perceive more easily the clinically important drug-adverse event patterns. The method can incorporate drug use data; this enables a drug's proportional share of specific adverse events, relative to its therapeutic class, to be compared to its respective proportional share of drug use. The assumption is that the adverse event distribution of drugs in a therapeutic class should be the same as the distribution of drug use in that class, if all drugs in the class were to carry the same risk.

Actual examples of drug-adverse event associations signaled by the screening method are presented. The potential uses of this methodology in other settings, and under other data situations, are discussed.
Perspectives on Medical Specialization
Authors: Schondelmeyer Stephen W. , Kirking Duane M.
Published: May 2016

The role of specialization in pharmacy practice is an important issue confronting the profession today. The historical evolution of specialization in American medicine is presented. Medicine, while not a complete model of specialization, probably has the most mature structure of any profession. Pharmacy, in directing its own specialization process, can learn from medicine's experience.

Emergence of specialties is a function of both social and technological change. An increase in the knowledge base and an expanding technology stimulated physicians to specialize. The narrowing technical interests of the medical specialist led to the formation of elite specialty societies. While these organizations initially moved to develop specialty education and training programs, later they came to have a significant impact on the entire medical profession. A major decision for medicine was the requirement that all physicians receive the same general medical education — the M.D. degree — prior to entering specialty training. Advanced specialty training through internship and residency programs predominated over programs offered by degree-granting institutions. Attempts by state agencies to license medical specialists were defeated, and a system of certification by specialty boards has flourished.

The specialization process in pharmacy, however, has not developed to the same extent as in medicine. The process in pharmacy has been characterized by a lack of coordination between involved organizations and institutions. If specialization is to enhance the individual specialties, the profession of pharmacy, and the public interest, it must be developed as a planned, rather than a random, process.
The Pharmacist Practitioner Training Program
Authors: Copeland Gary P. , Apgar David A.
Published: May 2016

Since 1973, the Indian Health Service has been training pharmacists to provide primary care to patients in an expanded role, including the compilation of complete medical histories, physical examination, diagnosis, and treatment of outpatients with selected acute and chronic illnesses. This article discusses the evolution of the Pharmacist Practitioner Training Program, the training and experience received through this program, and the utilization of graduates in the clinical setting.
Perceived Clinical Significance of Consultant Pharmacist Recommendations in the Skilled Nursing Facility
Authors: Lamy Peter P. , Miller Douglas A. , Lucarotti Richard L. , Vlasses Peter H. , Krigstein David J. , McKercher Patrick L.
Published: May 2016

In an attempt to determine if pharmacists could make significant contributions to SNF patient care in the area of disease management, the drug therapy of the residents of two SNFs was reviewed once monthly for six months by two clinical pharmacist consultants. Pharmacist-identified problems and recommendations were communicated in writing to the medical staff by means of a communication form attached to the patient's chart. Nearly 72 percent of the recommendations made were accepted by the SNF physicians.

Descriptions of the cases and corresponding recommendations were distributed to review-panel physicians. These physicians were asked to agree or disagree with the pharmacists' suggestions, and to rate the clinical significance of each recommendation using a modified Likert scale. The clinical pharmacist-consultants were perceived to have had a significant input into disease management in SNF patients.
The Characteristics of Eosinophilia in a Series of Intravenous Methylphenidate Abusers
Authors: Hayashi Robert J. , Gill Mark A. , Kern Jack W. , Miyao Theresa E. , Racki Anthony J.
Published: May 2016

Seven cases of intravenous methylphenidate abuse are reviewed. A dramatic increase in absolute eosinophil count is noted, which decreases after discontinuation of the drug. Frequent associated complaints are pulmonary symptoms and fevers. The etiology of the eosinophilia is unknown. Mechanisms may include a hypersensitivity reaction to methylphenidate or an allergic reaction to the tablet fillers or diluents. The eosinophilia appears to resolve without complications.
Phenytoin Hypersensitivity Reaction: Hepatic necrosis
Authors: Koren James F. , Randall Gordon R. , Kincaid R. Samuel , Brown James R.
Published: May 2016

A 47-year-old black male treated with phenytoin for generalized seizures developed a generalized maculopapular rash approximately three weeks after starting therapy. In addition, fever, jaundice, diffuse lymphadenopathy, and elevated liver function enzymes resulted. A liver biopsy revealed hepatic necrosis. Treatment with oral prednisone 60 mg/d led to a resolution of the patient's clinical symptomatology and a normalization of his liver function enzymes in approximately two weeks. An updated review of the literature involving phenytoin-induced hepatic dysfunction is discussed, as well as both the postulated mechanisms causing the reaction, and therapeutic modalities of treatment.
A Look at the Educational Responsibilities and Cost Impact of the Docent Clinical Pharmacist
Authors: Covinsky Joel O. , Hamburger Stephen , Twin Edward J.
Published: May 2016

One innovation at Truman Medical Center, the primary teaching hospital of the University of Missouri-Kansas City, is the addition of the clinical pharmacist as a full-time member of the patient-care and educational teams. These practitioner-educators share responsibility for the patients' drug therapies and for the provision of instruction in basic pharmacology and pharmacotherapeutics in the medical school. Examination of the cost impact of these practitioners in separate studies indicates that they reduce drug costs. The unique pharmacology program provided solely by these clinical pharmacists is both well received and successful.
Effectiveness of a Cephalosporin Education Program —A Pharmacy Education Program
Authors: Sohn Catherine Angell , Wolter Heather A. , McSweeney Gail W.
Published: May 2016

In October, 1977, a cephalosporin drug-use review and an educational program were initiated to maximize savings in the pharmacy budget at UCSF and to revise the formulary to include only one parenteral cephalosporin. The results of the drug-use review were presented to the Pharmacy and Therapeutics Committee where our proposal for an education campaign to encourage appropriate dosing of cefazolin was approved. An explanatory document comparing cephalosporin costs and equivalency was developed for hospital-wide distribution. Pharmacy staffs were informed of program objectives to coordinate education efforts. Physician education was undertaken via document and personal contact with pharmacy personnel. A drug-use review one month after institution of the cephalosporin education program showed marked changes in physician prescribing habits, with greater impact on services where pharmacists were members of the medical rounding team. A change to appropriate dosage prescribing of cefazolin resulted in significant cost savings to the pharmacy budget. These findings resulted in formulary revision to cefazolin as the single cephalosporin available at UCSF. Because cefazolin is available from more than one manufacturer, we were able to obtain a lower bid price the following year, thus realizing an additional cost savings.
Impact of Patient-Specific Drug Interaction Information on Physician Prescribing Patterns
Authors: Adams Thomas R. , Murray William J. , Hull J. Heyward
Published: May 2016

Patient exposure to potential anticoagulant drug interactions was identified by computerized drug-therapy surveillance, as part of a peer-review program. To evaluate the response of clinicians provided with data on the potential drug interactions, 119 “exposed” patients were randomly divided and assigned to study or control groups. Physicians prescribing for the 60 study patients were informed of the potential problem by letter and were furnished with information on the drug interaction, while the 59 control patients were only monitored. Physicians provided with the information made statistically more changes in drug therapy than those not informed ( p < 0.05). Over 75 percent of study-patient physicians responding to a questionnaire accompanying the drug interaction data indicated that the service was useful and should be expanded to other drugs. Application of methods similar to that used in this study should offer drug utilization review committees an effective approach to improving drug therapy.
Some Comments on the Evaluation of Bioavailability Data
Authors: Koup Jeffrey R. , Gibaldi Milo
Published: May 2016

Intrasubject variability in the systemic clearance of a drug from one treatment to the next in a randomized crossover bioavailability study reduces the ability to differentiate dosage forms with respect to the extent or relative extent of drug absorption. The most commonly used method to reduce this intrasubject variability is a half-life correction first proposed in 1967. The mathematical basis of the half-life correction is reviewed, and it is shown that this correction requires the implicit assumptions that the change in half-life from one treatment to the next quantitatively reflects the change in systemic clearance and that there is no change in apparent volume of distribution. The limitations of this assumption are considered. It is concluded that the half-life correction should be evaluated in all cases where the variability in half-life is random, and applied if it results in a significant decrease in the standard deviation associated with the average measure of bioavailability. On the other hand, if there is a significant difference or strong indication of a difference in half-life between treatments, the half-life correction should not be applied, for it can lead to misinterpretation. Examples illustrating this problem are presented.
Activity of Antibiotic Admixtures Subjected to Different Freeze-Thaw Treatments
Authors: Holmes C. J. , Ausman R. K. , Walter C. W. , Kundsin R. B.
Published: May 2016

The freezing of antibiotic admixtures has been proposed as a potentially useful method by which the efficiency of admixture services might be improved. The time involved in thawing, however. has discouraged the implementation of this practice. This study describes a technique of thawing frozen antibiotic admixtures contained in minibags in commercially available microwave ovens. A quantitative microbiological agar gel diffusion assay was employed to determine the effect of such treatment on the antibiotic activity of the admixture. Admixtures containing cephalothin sodium, cefazolin sodium, cefamandole nafate, cefoxitin sodium, penicillin G potassium, ampicillin sodium, oxacillin sodium, carbenicillin disodium, and gentamicin sulfate in dextrose 5% solution were frozen at — 20°C for 30 days. The admixtures were assayed immediately before freezing, and again after either thawing technique: that is, upon exposure of the minibags to room temperature air or to microwave radiation. Assays were also performed 8 and 24 hours after thawing in order to assess antibiotic stability following each freeze-thaw treatment.

It was discovered that, with the exception of ampicillin sodium, each of the antibiotics studied could be frozen and thawed as described without significant loss of activity, and were stable for 24 hours after thawing.

The application of a freeze microwave-thaw technique to central admixture services can be seen as a cost-effective method of circumventing many of the problems associated with existing programs.
Captopril in Refractory Malignant Hypertension
Authors: Zappacosta Anthony R. , Vlasses Peter H. , Ferguson Roger K.
Published: May 2016

The blood pressure of a 36-year-old male with malignant hypertension could not be controlled adequately by as many as eight concurrent oral and parenteral antihypertensive agents administered over a three-week period. These agents included the potent vasodilating agent minoxidil. Only after the initiation of captopril, an oral angiotensin converting enzyme inhibitor, was his blood pressure normalized.
Continuing Education for the Improvement of Professional Intervention in Patient Care
Authors: Moore Richard L.
Published: May 2016

Continuing education has a vital and unique role to play in enabling the practitioner to maintain professional competence. The contributions of continuing education supplement formal preparatory education and practice experience. The future for pharmacy continuing education is tied to the transition currently underway as pharmacy emphasizes involvement in patient care. The Pharm.D.'s affect on the pharmacist, acceptance of the pharmacist in a new role, preparation of pharmacists to deal with an aging population, and capitalizing on the movement toward health promotion are all challenges that face continuing pharmacy educators.
A Novel, Experiential Course in Applied Pharmacokinetics
Authors: Murphy John E. , Robinson J. Daniel , Gammill George D.
Published: May 2016

An experiential course in applied pharmacokinetics is discussed. Objectives of the course and methods for conducting such a course are described. Results of student recommendations concerning patients' dosage regimens, along with the types of recommendations made, are outlined.

Methods of instruction designed to increase clinical knowledge may best be accomplished through actual patient contact. It appears that this course is well accepted and can be adapted for use in various settings.
Renal Tubular Necrosis and Liver Damage
Authors: Grinblat Joseph , Lewitus Zigmund , Rosenfeld Joseph
Published: May 2016

A 40-year-old woman developed renal tubular necrosis and liver injury following ingestion of acetaminophen 1 g 12 days after halothane anesthesia. The possibility of a synergistic association between halothane and acetaminophen, and of probable hepatic and renal damage occurring after a low dose of acetaminophen, as well as the possibility of renal tubular necrosis induced by halothane are discussed.
Clinical Pharmacokinetics of Heparin
Authors: Raasch Ralph H.
Published: May 2016

The pharmacokinetic literature regarding heparin is reviewed, and suggestions regarding the therapeutic use of this anticoagulant are provided. Various kinetic parameters for heparin have been reported, including half-life of pharmacological (anticoagulant) effects using in vitro clotting time tests, and half-life and clearance of heparin using assays of heparin activity. Heparin half-life is shorter, and clearance is greater, in patients with pulmonary emboli compared to patients with deep venous thrombosis. However, heparin infusion rates may be similar regardless of type of thromboembolic disease to achieve a given pharmacological endpoint. The difference in in vitro clotting time test responses among patients given similar amounts of heparin is a most significant variable in determining heparin dosing regimens, and makes continued monitoring of heparin dosage and the associated in vitro clotting time test response necessary for the rational use of this drug.
Acne and Antibiotics
Authors: Vermorken A.J.M. , Goos C.M.A.A.
Published: May 2016

Acne vulgaris is a disorder of the skin which begins with the accumulation of sebum in the sebaceous duct. The pressure built up by the accumulated sebum can rupture the duct. Diffusion of the sebum, particularly of its fatty acids, into the skin brings about an inflammatory reaction often accompanied by an infection. Besides causing infection, the bacteria produce lipases that stimulate the inflammatory processes by hydrolyzing the sebum into fatty acids. These effects can be attributed to both Corynebacterium acnes and Staphylococcus epidermidis. The way in which both oral and topical antibiotics can be used in, the treatment of acne is reviewed. The possibility for combined local treatment with an antibiotic and an antiandrogen is discussed.
Clinical Pharmacist Intervention in an Extended Care Facility
Authors: Mutnick Alan H. , Swanson Larry N.
Published: May 2016

A four-month study was conducted at an extended care facility to determine if Jelliffe's method of digoxin dosing yielded a lower incidence of digoxin toxicity without loss of therapeutic efficacy, as compared with an established way of dosing.

The study was divided into two phases. During both phases, all patients at an extended care facility taking oral digoxin were monitored for signs and symptoms of both digoxin intoxication and digoxin underdosage. The same patients were studied in both phases, and the number and frequency of observations made on these patients was also identical. Serum digoxin, potassium, and creatinine levels, and electrocardiograms were obtained monthly to aid in the documentation of digoxin underdosage or toxicity. In Phase I (control), the patients' digoxin regimens were determined by physician order without any pharmacist intervention. In Phase II (study), all patients were dosed based upon the calculations made by the clinical pharmacist using Jelliffe's method.

Clinical pharmacist intervention with the use of Jelliffe's method for digoxin dosing yielded a statistically significant decrease in toxicity and a decreased incidence of digoxin underdosage in Phase II as compared with Phase I, without any compromise in therapy.
Consumer Reactions to Differing Amounts of Written Drug Information
Authors: Morris Louis A. , Kanouse David E.
Published: May 2016

Four prototype patient package inserts (PPIs) for erythromycin were tested in an analog study using 325 individuals drawn from a college community. There was no difference in the total amount of knowledge communicated by the different PPIs, but results for individual test items suggest (1) that more explicit information may be better recalled, and (2) that longer PPIs may aid in information integration, whereas shorter PPIs may aid in pure recall of facts. PPIs containing elaboration on why drug effects occur were rated by the subjects as more “accurate.” Subjects tended to rate PPIs that provided behavioral instructions on what to do if certain drug effects occurred as designed to promote better care.
Phenytoin-Induced Hyperglycemia
Authors: Britton H. Lynn , Schwinghammer Terrence L.
Published: May 2016

Phenytoin, known to cause hyperglycemia in diabetic and non-diabetic patients, was chronically administered to a chlorpropamide-controlled diabetic patient. Admitted to the hospital with a blood glucose of 461 mg/dL and a β-ketone level of 113 mg/dL, the patient's condition could not be controlled with increasing daily dosages of NPH insulin and regular insulin coverage. Within five days of discontinuing the phenytoin, the blood sugars began to decline, leading to decreasing insulin requirements. Prior to discharge, the patient was changed from insulin to chlorpropamide. Follow-up during subsequent clinic visits has revealed well-controlled blood sugar levels.