bluuebunny/crossref_metadata_2025 huggingface dataset:
Lack of Personal, Social and Cosmic Integration: Original Sin from an Eschatological Perspective
Authors: Novello Henry L.
Published: June 2017

This essay critically examines traditional formulations of the doctrine of original sin in Western theology and the contemporary “situationist” and “personalist” reformulations of the doctrine in the search for an adequate understanding of original sin that acknowledges both the evolutionary view of the world and Jesus Christ risen as the new “emergent whole” in evolutionary history. The negative portrayal of original sin as a situational privation of sanctifying grace and the positive portrayal of original sin as rebellion against God are both held to be valid and complementary, but it is argued that only a thoroughly eschatological perspective can illuminate the state of the human condition which is destined for a supernatural end in the Risen One. The essay concludes with the proposition that original sin is best thought of in terms of the lack of personal, social and cosmic integration that humans invariably experience in this life, and that the person of the risen Christ saves us from this complex state of privation by elevating us to a “higher nature” that represents a “new creation”.
God in Translation
Authors: Veling Terry A.
Published: June 2017

Translation, like the art of interpretation, necessarily involves an original. This suggests that originality lies at the heart of every translation; there must be some spark of originality that inspires or ignites our efforts toward deeper or better understandings. The relationship between originality and translation is not only concerned with a “text” and a “reader”, but also between “I and thou” and all that addresses and reveals itself to me in its “thou-like” originality. This essay considers the relationship between translation and the “original” and their intimate and yet unfathomable bond.
Conquest and Dispossession: Justice, Joshua, and Land Rights
Authors: Habel Norman
Published: June 2017

This study compares four contemporary theories of justice (desert, contract, rights, and empowerment) with four motifs from the Book of Joshua (the land as entitlement, the dispossession of the Canaanites, the covenants with Israel, and the dilemma of empowerment). These comparisons raise questions about the justification of the conquest of indigenous peoples, like the Australian Aboriginals, and the ideology of Joshua in a post-New Testament context.
Without Parts or Passions? The Suffering God in Anglican Thought
Authors: Reid Duncan
Published: June 2017

Over the past hundred years Anglican thought has questioned the traditional doctrine of God's impassibility. The cross of Christ reveals an eternal suffering in God. But how can a suffering God be a source of hope? It can be argued that God, in the very act of creation, renounced any impassibility God may have enjoyed. It is only a suffering God who can stand in relation to a created other and who can therefore hold out hope to creation.
Sex-Related Offenses and Fear of Crime on Campus
Authors: McCreedy Kenneth R. , Dennis Brent G.
Published: June 2017

This paper is part of a larger study of reported and unreported crime on the campus of East Carolina University. The survey was conducted during the Spring of 1994, and involved a total sample of 760 respondents. Those questions dealing with rape, other sexual offenses, stalking, and lewd phone calls were used to determine the level of both reported and unreported incidents, and the relationship of such experiences to the students' overall fear of crime, and avoidance of night classes. Overall, students exhibited an extremely high concern about crime. Students who reported having received lewd and/or threatening phone calls were the most concerned and reluctant to take night classes.
A Cost Effectiveness Comparison of a Pharmacist Using Three Methods for Identifying Possible Drug Related Problems
Authors: Dick M. Lawrence , Winship Henry W. , Wood George C.
Published: June 2017

A study was carried out to determine the cost effectiveness of a pharmacist in identifying possible drug-related problems (PDRPs) using three methods: Chart reviews, rounding with physicians, and patient drug profiles. The clinical significance of the PDRPs was also determined.

The type of drug-related problems being sought and the parameters to determine clinical significance of the PDRPs detected were defined.

The patient drug profile system was the most productive and the least expensive method for screening for PDRPs. However, only 14 percent of those detected by this method were clinically significant PDRPs. Over half of the PDRPs identified while rounding with physicians were clinically significant. This method had many advantages the patient drug profile system lacked. The chart review method produced the median of productivity, cost, and significance.
Drugs and Nutrition
Authors: Yosselson Shimona
Published: June 2017

A review of the literature depicting the effects of drugs as they relate to proper nutrition is presented. Emphasis is placed upon the suggested mechanism for the interaction that takes place between the drug and the nutrient with the effect of the former on the nutrient's absorption and fate in, and excretion from, the body. The clinical significance of such interactions is pointed out with the proper method of preventing them or of diminishing their undesirable consequences.
Evaluation of the Utilization of Medication Profiles
Authors: Nelson Arthur A. , Hutchinson Richard A. , Mahoney Dennis , Ringstrom James
Published: June 2017

The objective of this study was to evaluate the effectiveness of community pharmacists in monitoring drug-drug interactions with the use of medication profiles. A random sample of pharmacies was visited to obtain information on the type of record system maintained and demographic and attitude data from the practitioners. A trained shopper then visited each pharmacy twice, first with a prescription for Coumadin® and then with a prescription for phenobarbital. Only one of the 48 pharmacists notified the prescribing physician of the drug interaction, even though most of the practitioners said they scanned their patients' profiles prior to dispensing new prescriptions. A substantial percentage of the practitioners had also completed a continuing education course dealing with drug interactions during the previous 24 months.
Frequent Toxicity from IV Aminophylline Infusions in Critically Ill Patients
Authors: Hendeles Leslie , Bighley Lyle , Richardson Robert H. , Hepler Charles D. , Carmichael Jan
Published: June 2017

Use of recommended IV aminophylline dosage regimens in 48 older, acutely ill, hospitalized patients with chronic obstructive pulmonary disease (COPD) resulted in excessive plasma theophylline concentrations in 29 percent of these patients.

A mean dose of 0.89 mg/kg/hr produced a plasma concentration which ranged from 7 to 52 mcg/ml with a mean of 21.9 mcg/ml. Plasma theophylline concentration was determined spectrophotometrically from plasma samples drawn at least 12 hours after a loading dose and initiation of a constant infusion. Severity of toxicity strongly correlated with the plasma theophylline concentration in 18 patients. Nausea and/or vomiting preceded life-threatening drug-induced arrhythmias and seizures less than half the time. Tachycardia was found to be the most consistent symptom associated with toxicity. These patients had lower plasma clearances than otherwise healthy younger adult asthmatics and healthy volunteers. Toxicity and identifiable risk factors for excessive plasma levels strongly correlated with reduced plasma clearance. Dosage modifications based upon plasma clearances from COPD patients without concurrent functional abnormalities and those with liver dysfunction and cardiac decompensation ranged from 0.7 to 0.12 mg/kg/hr. This study clearly demonstrates the poor correlation between dose and plasma concentration and the strong relationship between toxicity and plasma concentration. These results as well as those previously reported mandate that the relatively simple, rapid and inexpensive theophylline plasma measurement be used in all patients receiving IV aminophylline for longer than 24 hours in order to prevent toxicity.
Clinical Experience with Minocycline Reactions
Authors: Grill Frank J. , Rigdon Don L. , Jarrah Azmi S.
Published: June 2017

A report is given of high incidence of vestibular and other reactions due to minocycline when used prophylactically for suspected meningococcal meningitis. Noncompliance and work loss due to the severity of the side effects should be strongly considered before minocycline is used for this indication.
Interaction of Chloral Hydrate and Furosemide
Authors: Pevonka M. Peter , Yost Richard L. , Marks Ronald G. , Howell William S. , Stewart Ronald B.
Published: June 2017

Untoward reactions were recently reported in six patients following the concomitant administration of chloral hydrate orally and furosemide intravenously. A retrospective epidemiologic study was initiated to evaluate this report. Medication records of adult medical and pediatric patients who received care at Shand's Teaching Hospital from July, 1969 to May, 1975 were scanned by computer to identify patients exposed to either chloral hydrate or flurazepam and furosemide. Five thousand two hundred and sixty-two patients were found to have received furosemide alone or in combination with either chloral hydrate or flurazepam. Computer records of these patients were reviewed to identify patients who received either chloral hydrate or flurazepam and then, in the twenty-four hours following the administration of the sedative-hypnotic, received furosemide. This procedure resulted in a final study population consisting of 43 patients who received both chloral hydrate and furosemide. Medical records of the study group and three control groups were then reviewed to determine if untoward symptoms similar to those reported previously were evident. One patient in the study group exhibited symptoms of the reaction and two patients were identified as having possible reactions. No patient in any of the control groups exhibited manifestations of the reaction.
Characteristics of Outpatient Medications and Implications with Hospitalizations
Authors: Hood Jerry C. , Murphy John E. , Gee Joseph C.
Published: June 2017

A series of 839 patients who entered Bayfront Medical Center with their own medications was studied to determine the number of mislabeled, unlabeled, and unidentifiable medications. Thirty-four percent of the patients entered with improperly labeled medications. Such medications accounted for 23 percent of the total medications (2398) involved.

In reviewing the disposition of patients involved in the study, it was found that the general study population exhibited a mortality rate of 3.38 percent compared to the hospital mortality of 3.7 percent during the same period. Of the 28 patients in the study who expired, 15 (53.6 percent) were from the group who entered with improperly labeled medications.

The results emphasize the high incidence of improperly labeled drugs possessed by patients at the time of admission, and indicate the possibility of this being associated with increased mortality. The results also underline the responsibility of the pharmacist in informing the physician of the status and characteristics of such medications.
Physical Assessment of the Ear — The Auditory and Vestibular System
Authors: Longe R. Leon , Calvert Jon C.
Published: June 2017

This article presents the basic methods and knowledge necessary for the clinical pharmacist to assess drug action on the auditory and vestibular systems of the ear. An example of its application is discussed. A competency test will be provided for self-evaluation of the material.
Evaluation of Clinical Pharmacy Services on a Polydrug Detoxification Unit
Authors: Steiner Gilbert A. , Swanson Larry N. , Henderson H. Richard , Schooff Kenneth G.
Published: June 2017

A five month study was undertaken to evaluate the role played by a clinically trained pharmacist on a polydrug detoxification unit. A total of 69 patients were included in the study. Four parameters were investigated in the evaluation. These sought to document the pharmacist's ability to: (1) evaluate degree of dependence; (2) develop, monitor and adjust detoxification protocols; (3) monitor and treat general medical needs; and (4) educate patients in the area of drug abuse. Based on the results of this investigation, it is concluded that a clinically trained pharmacist can be a beneficial addition to such a detoxification unit.
Serum Inhibitory and Bactericidal Activity of Ciprofloxacin following Intravenous Administration
Authors: Dudley Michael N. , Mandler Hilary D. , Mayer Kenneth H. , Zinner Stephen H.
Published: June 2017

Serum inhibitory and bactericidal titers were measured in nine healthy volunteers following single iv doses of ciprofloxacin 100, 150, and 200 mg. The median peak serum bactericidal titer (5 minutes following completion of a 30-minute infusion) against two highly susceptible strains of Escherichia coli ranged between 1:64 and 1:1024 and titers exceeded 1:8 for six hours for all dose levels. The bactericidal titers against two strains of Pseudomonas aeruginosa and a methicillin-resistant strain of Staphylococcus aureus were considerably lower, the median peak being 1:2 at all dose levels. Measured inhibitory and bactericidal titers at five minutes and one hour postinfusion were significantly greater than those predicted (measured serum ciprofloxacin concentration to minimum inhibitory concentration [MIC] or minimum bactericidal concentration [MBC]) for only one strain of E. coli. Intravenous doses of ciprofloxacin 100–200 mg produce high and sustained serum bactericidal titers against highly susceptible bacteria; considerably lower levels of activity are seen against bacteria having higher MICs and MBCs but still considered susceptible to the drug.
Cardiac Dysrhythmia with the Use of Clonidine in Explosive Disorder
Authors: Dawson Peter M. , Zanden Jeanne A. Vander , Werkman Sidney L. , Washington Reginald L. , Tyma Thomas A.
Published: June 2017

Clonidine has been used in the management of hypertension in adults with few cases of cardiac dysrhythmia reported. These appear to occur most frequently in association with preexisting cardiac disease or toxic concentrations of the drug. We observed a case of clonidine-induced bradycardia and irregular firing of the sinoatrial node in a child who does not have cardiac disease given low doses of the drug in the treatment of intermittent explosive disorder.
Cost Effectiveness of Two Interventions for Reducing Outpatient Prescribing Costs
Authors: Steele Malcolm A. , Bess David T. , Franse Valerie L. , Graber Stanley E.
Published: June 2017

This prospective, randomized, controlled trial, based in a Veterans Administration Hospital general medicine clinic, compared the cost effectiveness of two behaviorally oriented interventions designed to reduce physicians' drug prescribing costs. Clinical pharmacists visited one group of 11 physicians during weekly clinic sessions to counterdetail the prescribing of certain targeted drugs. A second group of 10 physicians were given data each week comparing their individual prescribing costs to those of their colleagues (peer-comparison feedback). A control group of 10 physicians received neither intervention. Written patient-specific suggestions for cost-effective prescribing were employed in both intervention groups. Baseline prescribing costs were monitored through the hospital's computer during a three-month, preintervention period and a seven-month intervention period. The 2026 written suggestions made by the doctors of pharmacy resulted in 613 (30.3 percent) prescribing changes, including deletion, substitution, or change in dosage of targeted drugs. There were no intergroup differences in the response to written suggestions. However, the group receiving face-to-face visits from the clinical pharmacists achieved lower average prescription costs than the control group during seven of eight months. Intergroup differences were statistically significant (p < 0.05) during three of the last five months of the study. The face-to-face meeting intervention was cost-effective, saving $478 per physician over seven months after accounting for Pharm.D. salary costs. There was no significant decrease in the number of prescriptions written by the face-to-face group compared with the control group, suggesting that drug substitution rather than deletion was the method used by physicians to lower drug costs. No savings resulted from the use of peer-comparison feedback. We conclude that personal visits by a Pharm.D. are a cost-effective technique for reducing physicians' prescribing costs, and are superior to peer-comparison feedback.
Orthostatic Hypotension: Therapeutic Alternatives for Geriatric Patients
Authors: Davis T. Allen , Delafuente Jeffrey C.
Published: June 2017

Symptomatic orthostatic hypotension is a serious problem in the elderly because it can precipitate falls and fractures, myocardial infarctions, and strokes. Several disorders may cause symptomatic orthostatic hypotension including age-related changes in physiology, disorders of the autonomic nervous system, drugs, and a decrease in circulating blood volume. Orthostatic hypotension is defined as a fall in systolic pressure of at least 20–30 mm Hg and a fall in diastolic pressure of at least 10–15 mm Hg upon rising, with symptoms of cerebral ischemia. Management includes a search for reversible causes as well as nonpharmacologic and pharmacologic therapies. No single agent has been universally successful in relieving the symptoms of orthostatic hypotension. Trials of single agents or combinations of agents are needed to identify the most appropriate therapy for individual patients.
Impact of Education by Clinical Pharmacists on Physician Ambulatory Care Prescribing of Generic versus Brand-Name Drugs
Authors: Erramouspe John
Published: June 2017

The physician prescribing of generic versus brand-name drugs to ambulatory care patients was compared between the time periods before and after rendering clinical pharmacist education. Copies of all written outpatient prescriptions were used for the comparison. Physicians significantly increased their generic prescribing after clinical pharmacist education.
Idiopathic Thromboembolism Associated with Triphasic Oral Contraceptives
Authors: Miwa Linda J. , Edmunds Ann L. , Shaefer Mark S. , Raynor Stephen C.
Published: June 2017

Oral contraceptives are one of the most effective and widely used of the reversible contraceptive methods. Thromboembolic disease associated with the use of oral contraceptives has been widely reported. In recent years, attempts to understand the pathogenesis of oral contraceptive-induced thromboembolic disease have found a correlation between larger estrogen doses and increased risk for a thrombotic event. Because the newer triphasic oral contraceptives provide effective contraception with a method of administration that mimics normal hormonal fluctuations during the menstrual cycle, some prescribers may infer that these products are associated with a decreased incidence of adverse effects over alternative oral contraceptives. We present two cases of idiopathic thromboembolism associated with the use of a triphasic oral contraceptive with a discussion of the proposed pathogenic mechanisms for these events.
Malabsorption of Flucytosine in a Pediatric Patient with Shwachman Syndrome
Authors: Harper Karen J. , Sawyer William T.
Published: June 2017

The malabsorption of drugs from the gastrointestinal tract in patients with pancreatic insufficiency is not well documented in the literature. We describe a case of flucytosine malabsorption in a pediatric patient with Shwachman syndrome, a rare disease in the pediatric age group characterized by pancreatic insufficiency. A significant increase in serum concentrations of flucytosine was noted when the drug was administered in a lipophilic vehicle, possibly due to enhanced absorption.
Comparison of Linear Regression Methods When Both Variables Contain Error: Relation to Clinical Studies
Authors: Parish Roy C.
Published: June 2017

Five common linear regression methods were evaluated for their ability to determine the correct values of slope and intercept of a known function after random errors were added to x and y. The error variances were controlled to simulate research problems commonly studied by linear regression. The total error of each method was assessed by the absolute value of the bias in the estimate of slope. Whenever differences among methods were observed, the mean of the slope determined by two reciprocal techniques performed as well as or better than orthogonal regression, regression of y upon x, or x upon y. All the methods studied appeared to perform equally well when x and y errors were heteroscedastic or when the data set was small (n = 7). Regression of y upon x was equal or superior to other methods when n = 7 or n = 20 and y and x errors were homoscedastic. When the data set was large (n = 50) and the error in x greater than that in y, the standard method (regression of y upon x) was inferior to all other methods. It is suggested that linear regression by the traditional method of y upon x (a method present in many hand-held calculators) is appropriate in the majority of clinical situations, but when n is large and errors in x are much larger than those in y, orthogonal regression or the averaging method may be preferable.
Hyperventilation-Induced Reduction in Cerebral Blood Flow: Assessment by Positron Emission Tomography
Authors: Bednarczyk Edward M. , Rutherford William F. , Leisure Gregory P. , Munger Mark A. , Panacek Edward A. , Miraldi Floro D. , Green Jeffrey A.
Published: June 2017

The use of positron emission tomography (PET) has been well documented as a relatively noninvasive method of measuring cerebral blood flow (CBF), both globally and regionally. The utility of readily detecting alterations in CBF is apparent, particularly when applied to the evaluation of therapeutic interventions thought to influence CBF. We report the effects of hypocapnia, an experimental condition of known cerebral vasoconstriction, in ten normal volunteers. Subjects had brain blood flow evaluated utilizing H215O as the positron emitter before and after approximately five minutes of hyperventilation. Baseline CBF was measured as a mean ± SD of 61.2 ± 16.3 mL/min/100 g of tissue. Mean baseline arterial blood gas values were PaO2 107.4 ± 14 mm Hg, PaCO2 37.7 ± 0.89 mm Hg, and pH 7.39 (calculated from mean [H+]). Post hyperventilation, global CBF was measured as 31.1 ± 10.8 mL/min/100 g. Mean arterial blood gas values were PaO2 141.7 ± 21 mm Hg, PaCO2 19.7 ± 5 mm Hg, and pH 7.63 (calculated from mean [H+]). CBF decreased by a mean of 49.5 ± 11 percent. Data analysis using the Student's t-est showed a significant change over baseline in PaCO2 (p<0.001) and CBF (p<0.001), in the hyperventilated state. Correlations were noted between the decrease in CBF and change in PaCO2 (r = 0.81) as well as between hyperventilation PaCO2 and the change in CBF (r=0.97). We conclude that, as measured by PET, CBF decreases significantly during a state of artificial hyperventilation to a degree consistent with results seen using other methods. PET appears to be a valuable tool in the assessment of interventions that could influence CBF.
Interaction between Theophylline and Mexiletine
Authors: Ueno Kazuyuki , Miyai Kazuyoshi , Seki Takeshi , Kawaguchi Yoshihiro
Published: June 2017

Drugs influencing hepatic microsomal enzyme systems, such as mexiletine, may affect the elimination pattern of theophylline. The three patients reported here had a history of asthma and premature ventricular contractions, and were receiving theophylline therapy. A few days after starting the coadministration of mexiletine and theophylline, theophylline serum concentrations increased about twofold over concentrations during theophylline therapy. In one case, theophylline serum concentrations increased by 2.6 fold, and the patient developed nausea and anorexia. Mexiletine serum concentrations did not change. It seems that with mexiletine therapy, lower doses of theophylline may be required and careful monitoring of serum concentrations is necessary.
Therapeutic Drug Monitoring Services at Kyushu University Hospital in Japan
Authors: Ieiri Ichiro , Higuchi Shun , Nakao Yasushi , Yukawa Eiji , Ohtsubo Kenji , Yoshikawa Manabu , Aoyama Toshinobu
Published: June 2017

Quantitative evaluation of the therapeutic drug monitoring services (TDMS) provided in Kyushu University Hospital from August 1981 to April 1989 was performed. Since 1982, the annual number of assay requests was about 4300–4400, but the annual number of clinical pharmacokinetic consultation services (CPCS) showed a tendency to increase. Antiepileptics were the drugs for which CPCS were most often performed (26.3 percent of the population given drugs for which TDMS was available); digoxin, lithium, and theophylline followed. Preparation of one consultation required 1.5–2.5 hours. Our TDMS team consists of eight members. In 1988, the average time per week spent for CPCS and TDMS was 8.2 and 11.3 hours per member, respectively. Thus, the number of pharmacists performing CPCS and TDMS was 1.2 and 1.7 full-time equivalents, respectively.
Evaluation of Pharmacists' Practice in Patient Education When Dispensing a Metered-Dose Inhaler
Authors: Mickle Timothy R. , Self Timothy H. , Farr Glen E. , Bess David T. , Tsiu Sandra J. , Caldwell Felix L.
Published: June 2017

Improper inhalation technique with beta-agonist metered-dose inhalers (MDIs) decreases efficacy of the bronchodilator. The success of demonstrating the correct technique and the pharmacist's role in patient education has been reported. To obtain information regarding the routine patient education practice of pharmacists when dispensing a beta-agonist MDI (albuterol), the following study was performed. Fifty-two prescriptions for an albuterol MDI were presented to 52 randomly chosen community pharmacists in three Tennessee cities. Twenty-six independent and 26 chain pharmacies were evaluated. Pharmacists' practice with regard to patient education, instruction, and demonstration of the correct usage of the MDI was observed and recorded. Overall, 13 percent of the pharmacists initially offered to educate the patient-investigator (PI) regarding the correct usage of the MDI without being asked for information. Fifty-three percent of pharmacists offered information only upon being asked specifically how to use the MDI. Of the pharmacists who offered to educate the PI, 71 percent discussed less than half of the eight steps correctly. Only 1 of the 52 pharmacists actually demonstrated MDI inhalation technique, and this in response to a request. No pharmacist asked the PI to perform the technique while he/she observed. No pharmacist offered information on delivery enhancement devices. Our results demonstrate that few pharmacists educate patients on the correct usage of an MDI, and that many pharmacists are not aware of the correct technique.
A Case of Lisinopril-Induced Lithium Toxicity
Authors: Baldwin Charlene M. , Safferman Allan Z.
Published: June 2017

We describe a patient who developed lithium toxicity when lisinopril was substituted for clonidine. Possible mechanisms of angiotensin-converting enzyme (ACE) inhibitor-induced lithium toxicity are discussed. Aggressive serum lithium concentration monitoring and a reduction in the dose of lithium is advised when using ACE inhibitors because of disturbances and shifts in fluid and electrolyte balance.
A Profile of Alcohol and Prescription Drug Abuse in a High-Risk Community-Based Elderly Population
Authors: Jinks Martin J. , Raschko Raymond R.
Published: June 2017

Substance abuse among the elderly is relatively common but often remains undetected or ignored by health and social workers. Psychosocial and health factors related to the aging process are the major contributors to alcoholism and other drug abuse. It is estimated that between two and ten percent of individuals over the age of 60 suffer from alcoholism. This article profiles alcohol and prescription drug abuse among the geriatric clientele of Elderly Services of Spokane (ESS), a division of the Spokane (Washington) Community Mental Health Center. In addition to traditional channels, ESS uses a unique gatekeeper network to identify high-risk, community-based elderly. Elderly persons referred by gatekeepers are regarded as “hidden” elderly and at highest risk; notably, 37 percent of ESS clients are referred via this mechanism. Case management records of 1668 ESS clients were reviewed for a history of alcoholism, and a total of 161 persons (9.6 percent) were diagnosed with either primary or secondary alcohol abuse. Fifty subjects (about five percent of the average active ESS caseload) were referred for prescription drug abuse. Misused prescription drug classes were sedative-hypnotics, antianxiety agents, and analgesics. Diazepam, codeine, meprobamate, and flurazepam were the top four agents, and 92 percent of the subjects were found to have a duration of prescription drug abuse in excess of five years. A 60 percent correlation between prescription drug abuse and previous or active alcoholism was found. Additional characteristics of the geriatric study population are discussed in detail, including specific psychosocial factors, source of referral, age, gender, living situation, marital status, psychiatric history, and presence of polypharmacy.
Comparative Efficacy of Intravaginal Prostaglandin E2 in the Gel and Suppository Forms for Cervical Ripening
Authors: Gauger Laura J. , Curet Luis B.
Published: June 2017

Thirty-seven patients admitted for labor induction and presenting with unfavorable cervical features were randomized in a single-blind fashion to receive either 3 mg of prostaglandin E2 in an intravaginal gel or a 2-mg dose in a vaginal suppository. With the aid of previously reported placebo data, the intent was to compare the two dosage forms in terms of their ability to promote cervical ripening, and to see which dosage form was more effective in terms of influencing the overall incidence of cesarean section. The two groups showed a comparable improvement (α = 0.05) in cervical condition over that of the placebo group, with the mean Bishop score increasing by 2.0 points in the gel group, 2.5 points in the suppository group, and 0.7 points in the placebo group. As the suppository contained a lower dose of drug than the gel, the data support the concept that the type of drug vehicle and dosage form are important variables affecting product performance. No statistically significant difference in the incidence of cesarean section was noted between the two groups or between either group and placebo. This may be attributable to the small sample size and the relatively high proportion of women diagnosed as having cephalopelvic disproportion/failure to progress. Additional studies are warranted.
Lidocaine Absorption and Metabolism after Oropharyngeal Application in Young and Young-Elderly Adults
Authors: Watson William A. , Sands Mark F. , Barlow Jared C. , Lener Michelle E. , Wilton John H.
Published: June 2017

The purpose of this study was to evaluate the effect of age on lidocaine absorption and metabolism after application to the oropharynx and vocal cords in a manner similar to preparation for flexible fiberoptic bronchoscopy. Five healthy volunteers were studied in each of two age groups: from 25 to 37 and 60 to 68 years of age. Each volunteer had a total of lidocaine 300 mg administered as a gargle, gel, or directly to the vocal cords. Blood samples and expectorant were collected to determine concentrations of lidocaine and its metabolites, monoethylglycinxylidide (MEGX) and glycinxylidide (GX). No differences in peak plasma lidocaine concentrations, 2.09±1.28 μmol/L(1 μg/mL = 4.27 μmol/L) in young subjects, and 2.35 ±0.85 μmol/L in young-elderly subjects, or lidocaine AUC were seen between the two age groups. Lidocaine recovered in expectorant ranged from 96 to 168 mg. This study suggests that, over the age range studied, increased age does not impair lidocaine absorption from the oropharynx or lidocaine metabolism when topical lidocaine is used during flexible fiberoptic bronchoscopy.
Fludarabine: A Review
Authors: Hood Michele A. , Finley Rebecca S.
Published: June 2017

The new fluorinated adenine analog, fludarabine, has been tested for efficacy in many tumor types over the past ten years. Two other similar nucleoside analogs are currently available for commercial use. Cytarabine is used principally as an antileukemic agent, and vidarabine as an antiviral. Unlike vidarabine, fludarabine is resistant to deactivation by adenosine deaminase. Data from Phase I and II trials suggest that fludarabine is potentially effective in a number of leukemias, including acute lymphocytic leukemia, acute nonlymphocytic leukemia, and chronic lymphocytic leukemia (CLL). Unfortunately, the doses required to achieve adequate response in the acute leukemias (>75mg/m2) were above the maximum tolerated dose, resulting in intolerable granulocytopenia, thrombocytopenia, and a life-threatening neurotoxic syndrome. In CLL, however, the dose required to achieve a satisfactory response is well within tolerated limits. Long-term survival statistics are not yet available, but historical perspective strongly correlates response to other agents with increased survival times. Toxicities seen at dose regimens of 15–40 mg/m2/d for five consecutive days include somnolence, metabolic acidosis, confusion, fatigue, nausea, vomiting, increase in serum creatinine and aminotransferase concentrations, and pulmonary and hepatic abnormalities. Mild to severe hematologic toxicity has been observed at all dose levels.
Ciprofloxacin in Patients with Mycobacterial Infections: Experience in 15 Patients
Authors: Kahana Leo M. , Spino Michael
Published: June 2017

In vitro and animal investigations have demonstrated the antimycobacterial activity of some fluoroquinolones, including ciprofloxacin, but information regarding their clinical usefulness in mycobacterial infections is sparse. This article presents treatment results of 11 patients with tuberculosis and 4 with atypical mycobacterial infections. They were treated with combinations of ciprofloxacin and one or two other antituberculosis agents. Susceptibility of the infecting organisms to ciprofloxacin was determined in 14 of the 15 patients: in 12 of them, minimum inhibitory concentrations ranged between 0.31 and 1.25 μg/mL, suggesting a good level of activity. Serum concentrations of ciprofloxacin, sampled one hour after dosing and measured by a specific HPLC assay, revealed considerable variability (range 0.22–8.41 μ/mL). Serial plasma samples taken under controlled conditions suggested that a decreased rate of absorption was responsible for low one-hour concentrations in one of the subjects. Adverse reactions to ciprofloxacin were few and included nausea in four patients, crystalluria in one, and febrile reaction in another. A satisfactory response in terms of clinical and radiologic improvement, bacteriologic conversion, and absence of relapse was seen in 13 of the 14 patients who completed an adequate course of therapy. A controlled clinical trial of this promising antimycobacterial agent is needed.
Comparative Attitudes to Verbal and Written Medication Information among Hospital Outpatients
Authors: Harvey John L. , Plumridge Richard J.
Published: June 2017

This study was undertaken to assess the comparative preference of pharmacy outpatients for verbal and written medication information and to identify factors that might influence these preferences. Two hundred forty-seven consecutive, literate outpatients presenting with a prescription for a penicillin were enrolled in the study and given standardized verbal counseling by a pharmacist and a medication information leaflet. Assessment was made at initial presentation and by a prepaid mail questionnaire completed anonymously by the patient at home. Preferences were analyzed by age, sex, and number of medications prescribed. A response rate of 63 percent (155/247) was obtained. Low recall of physician instruction (11 percent) was recorded. Respondent preferences were for pharmacist counseling (30.4 percent), leaflet (20.6 percent), both of these (44.5 percent), or neither/uncertain (4.5 percent). The only factor having a statistically significant effect on these preferences was age (31–55 y), which influenced preference for a leaflet. Patient opinion of each leaflet section is presented. Patient preference for a leaflet or verbal counseling with a leaflet provides further evidence that leaflets should be widely used.
Phenytoin Hypersensitivity Syndrome: A Case Report
Authors: Howard Patricia A. , Engen Phillip L. , Dunn Marvin I.
Published: June 2017

We report a life-threatening case of phenytoin hypersensitivity syndrome, a rare reaction primarily characterized by fever, skin eruptions, lymphadenopathy, eosinophilia, and hepatotoxicity. The reaction developed in a 27-year-old black man with surgically corrected tetralogy of Fallot who was treated with phenytoin for one month for exercise-induced sustained ventricular tachycardia. Phenytoin therapy was discontinued and the patient was treated with intravenous methylprednisolone; the therapy was later converted to oral prednisone. Clinical improvement was noted five days after admission and the patient was discharged on hospital day 14. This adverse reaction usually develops within six weeks of starting phenytoin therapy and may be fatal in up to 40 percent of the patients who develop hepatotoxicity. Early recognition of this relatively rare reaction is essential to prevent serious and potentially fatal complications.
Overview of Synergy with Reference to Double Beta-Lactam Combinations
Authors: Hopefl Alan W.
Published: June 2017

Combination antimicrobial therapy is used to expand the bacterial coverage over a single agent, to prevent the emergence of resistant organisms, to decrease toxicity by allowing lower doses of both agents, or for synergy. Synergy is one of the most common of these reasons, especially in serious infections. The introduction of new broad-spectrum beta-lactam antimicrobials has led to their combination in the treatment of seriously ill patients. Whereas a combination of an aminoglycoside and a beta-lactam antimicrobial is frequently synergistic, much less is known about synergy between combinations of beta-lactams. In vitro testing shows most combinations of two beta-lactams to be indifferent or additive in their effects; rarely does synergy occur. Antagonism can sometimes be seen, particularly with combinations involving cefoxitin or imipenem, especially if the treated organism is Enterobacter or Pseudomonas. Results of clinical trials comparing double beta-lactam (DBL) therapy with aminoglycoside/beta-lactam combinations show no difference in clinical response rates. Highly active DBL combinations may substitute for standard aminoglycoside-containing regimens in certain situations, even though they are not reliably synergistic. However, in the treatment of seriously ill patients such combinations may be less desirable.
Nicotinamide N-Methyltransferase in Health and Cancer
Authors: Ramsden David B , Waring Rosemary H , Barlow David J , Parsons Richard B
Published: June 2017

Over the past decade, the roles of nicotinamide N-methyltransferase and its product 1-methyl nicotinamide have emerged from playing merely minor roles in phase 2 xenobiotic metabolism as actors in some of the most important scenes of human life. In this review, the structures of the gene, messenger RNA, and protein are discussed, together with the role of the enzyme in many of the common cancers that afflict people today.
Report: Event impact measurement in Auckland, New Zealand
Authors: Ryan Chris
Published: June 2017

Economic multiplier studies are known to possess both conceptual and practical problems in their calculation. Nonetheless, the public sector continues to develop models because of a need to assess return on public sector expenditure. This report briefly outlines an attempt being made by Auckland City Council to develop a model that meets its needs.
Performance-enhancing drugs, sport and corporate governance—Lessons from an Australian football club
Authors: Nichol Matt , Duffy Mike
Published: June 2017

Performance-enhancing or ‘supplements’ usage in sport presents a challenge for sporting clubs and leagues internationally and is, in large part, a legal and governance issue. The authors argue that the increasing commercialization of sport points to the conclusion that it is better that corporate governance has a significant role to play in modern sporting clubs in avoiding such problems. The recent experience of the Essendon Australian Rules Football Club is examined at some length as are the corporate governance practices of other Australian Football League clubs. The article concludes with recommendations for improvements to corporate governance practice in sporting clubs, including increased use of independent directors and board subcommittees.
Trade Liberalisation and Price Volatility: An Econometric Investigation
Authors: Kumar Santhosh P.K. , Lagesh M.A. , Saleena N.J.
Published: June 2017

This article empirically analyses the impact of trade liberalisation on major cash crops of India. Trade liberalisation in agriculture can be acceptable only if developing countries can be convinced of its benefits as this sector provides food security and livelihood to large sections of the population. This study takes a different approach to model volatility of agricultural crop prices facing farmers using time series models to enquire whether trade liberalisation has indeed increased unpredictability of prices. The Generalised Autoregressive Conditional Hetroscedasticity (GARCH) models were found to perform well in forecasting volatility, but food crops did not show any significant sign in this direction, though two commercial crops were found to have shown increased volatility.
Green Supply Chain Management: A Potent Tool for Sustainable Green Marketing
Authors: Sarkar A.N.
Published: June 2017

The concept of ‘Greening’ is intrinsically linked to offsetting and abatement of greenhouse gas (GHG) emissions, resulting largely from fossil fuel–based and energy-intensive industrial operations and various anthropogenic actions. ‘Kyoto Protocol’ pioneered the concept of mandatory reduction and compliance of GHG reduction norms applicable for major polluting nations in the world by 2012 and beyond. This prompted the corporate world to go in for introduction and commercialisation of ‘clean’ and ‘green technologies’ to mass produce and market wide-ranging green products. This had in turn led to the concept of Green Marketing. The concept of Green Supply Chain Management (GSCM) has been a parallel development to push the green products in an ever-expanding market with huge future potential—given growing customer consciousness towards eco-friendly green products and changing lifestyles. The article reviews and analyses different dimensions and facets of GSCM, including the evolution of the concept, approaches of building the constructs of GSCM, implementation strategy, linkage with transport systems, ‘Lean’ concept in supply chain management (SCM), green innovations and sustainability issues of GSCM and Green Logistics strategies for evolving integrated GSCM system.
Developing and Testing a Hierarchical Model of Customer Perceived Service Quality for Life Insurance Services
Authors: Mittal Sanjiv , Gera Rajat , Singhvi S.R.
Published: June 2017

The article attempts to empirically test a multi-dimensional and multi-level hierarchical structure of service quality in Life Insurance services in India. The study draws evidence from India to develop and compare a second-order hierarchical model with a first-order model to draw better insight into the determinants and structure of perceived service quality in Indian Life Insurance services. Five component dimensions of perceived service quality were extracted through exploratory factor analysis from a list of initially generated 38 items of service quality from literature and expert review. The five dimensional structure was then tested through confirmatory factor analysis using first-order and second-order reflective model to determine the best model of perceived service quality. The second-order reflective model was found to be of better fit based on indices of fit using AMOS ver 4.0 software. The results showed that both the first-order and hierarchical second-order models are of excellent fit after some modification based on modification indices. The second-order model was however accepted for interpretation of results since it has relatively better fit (significantly lower chi-square value and better fit indices values) and is a more parsimonious model. The results thus provide support for a multi-dimensional and multi-level hierarchical structure of service quality as suggested by Brady and Cronin ( 2001 ), third in Life Insurance services in India. The results show that perceived service quality of Life insurance services is a multi-dimensional second-order construct consisting of the primary dimensions of Service Delivery, Sales Agent Quality, Tangibles, Value and Core Service.
How do Pre-slowdown Financial Characteristics Impact the Firms’ Relative Financial Performance during Economic Recession? An Empirical Investigation
Authors: Mahajan Priyansha , Singh Fulbag
Published: June 2017

In this era of globalisation and worldwide integration, the entire world is treated as one nation, without any geographical boundaries and hence, we are no more immune to the events happening outside our country ( Suresh, 2009 ). While the subprime crisis emanated in the US, but because of globalisation its adverse impact travelled deep around the globe, triggering economic recession and uncertainty in the global economy ( Kolasa, Rubaszek & Taglioni, 2009 ). The latest recession has affected Indian economy and its corporate sector to a great extent. Therefore, there is a sharp need to examine what characteristics did companies exhibit that made them more (or less) vulnerable to recession. In this light, the present article is an unpretentious attempt to examine the impact of firms’ pre-slowdown characteristics on firms’ relative financial performance between slowdown period and pre-slowdown period.
Cross-cultural Validity of Ryff’s Well-being Scale in India
Authors: Malla Sweta Srivastava
Published: June 2017

The study was aimed at measuring and cross-validating the constructs of 84-items scale developed by Carol Ryff on psychological well-being, in India. The scale developed by Carol Ryff is a widely used instrument designed to measure six dimensions of psychological well-being. For the purpose of checking the validity of this scale, data was collected from 270 Indian male respondents located in northern part of the country. On the basis of factor analysis, it was found that there existed three factors as against six suggested by Ryff. This difference may be attributed to the difference in culture that exists between US and India. The factors in the current study were subsequently re-named as Personal Growth and Satisfying Self-Concept (PGSC), Purpose and Development in Life (PDL) and Continuous Learning and Growth in Life (CLGL). It may be interpreted that Ruff’s scale does not have as many as six distinct dimensions, and researchers should be cautious in interpreting its subscales, especially in non-western countries.