bluuebunny/crossref_metadata_2025 huggingface dataset:
Multi-Objective Siting Planning for a Regional Hazardous Waste Treatment Center
Authors: Koo Ja-Kong , Shin Hang-Sik , Yoo Hee-Chan
Published: October 2007

Considering the trade-offs among the multiple objectives of economic efficiency, environmental risk, equity and administrative ease, the siting of a central treatment facility is attempted—a difficult but essential task in the regional hazardous waste management. For the quantification of each objective, the mathematical equations are formulated. Furthermore, the framework of the multi-objective planning technique in which the WRAP (Waste Resources Allocation Program) and Fuzzy Set theory are utilized is developed, to determine the appropriate alternative for the siting of long life public sector facility. As a case study, the developed technique is applied to the selection of the best site in the southwestern part of Korea, where the third new regional hazardous waste treatment center will be located. The effectiveness of multi-objective planning has been demonstrated, and the social and political factors affecting the siting are successfully quantified in a monetary value.
Waste Management in Copenhagen: Principles and Trends
Authors: Larsen Ib , Børrild Kit
Published: October 2007

The increase in volumes of waste, and the difficulties of finding suitable locations for landfill sites within the borders of Copenhagen municipality, along with the need for treatment of oil and chemical waste, resulted in the erection in the early 1970s of two large waste-to-energy plants and a large centralized plant for the treatment of oil and chemical waste. Ten years later, however, it became evident that the then structure was not sufficient to face rapidly emerging problems. A number of pollution cases in Denmark which emerged during the early 1980s, proved that oil and chemical waste was being transported illegally to landfills instead of being disposed of in compliance with the obligatory system, thus becoming a threat to groundwater and drinking water supplies in Copenhagen. At the same time, waste-to-energy plants were facing pollution problems such as the emission of dioxin and large quantities of hydrochloric acid, which contribute to acidification and forest death.

As a response to the increasing problems in relation to both waste incineration and deposits, new regulations from the Ministry of the Environment allowed future sanitary landfills to be located only near the coast or in areas documented to be composed of an impermeable layer of clay. New regulation also defined conditions for flue gas cleansing. However, it was clear that pollution problems combined with increases in volumes of waste called for a much firmer administration and a stronger influence on the waste flow. From February 1989 the municipalities have undertaken the obligation to assign all waste producers the means to dispose of their waste. How Copenhagen municipality has solved the problems is discussed.
Scavenging Solid Wastes in Dar Es Salaam, Tanzania
Authors: Yhdego Michael
Published: October 2007

This paper deals with the scavenging of solid wastes in Dar es Salaam, Tanzania. It presents the generation, collection and disposal of wastes and the results of the scavenged wastes. Moreover, the socio-economic, health and organizational problems facing the scavengers are discussed. Three industries which use scavenged items as their raw materials have been surveyed and it is shown that the contribution by scavengers is high. The paper then analyses the raw materials and the employment which is generated by scavenging.
Anaerobic Digestion of Municipal Solid Waste: Thermophilic vs. Mesophilic Performance At High Solids
Authors: Cecchi Franco , Pavan Paolo , Alvarez Joan Mata , Bassetti Angelo , Cozzolino Ciro
Published: October 2007

High solids anaerobic digestion of the mechanically sorted organic fraction of municipal solid waste under mesophilic and thermophilic conditions is reported. The semi-dry thermophilic process has a gas production rate two to three times the mesophilic process and nearly complete biodegradation. A 3 m3 stirred digester, feeding organic waste at 16-23% solids, was operated at hydraulic (volumetric) retention times decreasing from 15-8 days, and at organic loading rates increasing from 6 to 14 kg volatile solids m-3 day-1. An economic evaluation favours the thermophilic over the mesophilic process.
Selection of Human Consumables for Future Space Missions
Authors: Bourland Charles T. , Smith Malcolm C.
Published: October 2007

Consumables for human spaceflight include oxygen, water, food and food packaging, personal hygiene items, and clothing. This paper deals with the requirements for food and water, and their impact on waste product generation. Just as urbanization of society has been made possible by improved food processing and packaging, manned spaceflight has benefitted from this technology. The downside of this technology is increased food package waste product. Since consumables make up a major portion of the vehicle onboard stowage and generate most of the waste products, selection of consumables is a very critical process. Food and package waste comprise the majority of the trash generated on the current shuttle orbiter missions. Plans for future missions must include accurate assessment of the waste products to be generated, and the methods for processing and disposing of these wastes.
The Hygienic Aspects of Wastewater Reuse
Authors: Cooper Robert C.
Published: October 2007

Historically drinking water contaminated with wastewater discharged from nearby communities has been a major public health problem whose solution was directed towards the treatment of drinking water rather than of the source of contamination. The increased need for deliberate wastewater reuse has stimulated greater interest in the ability of wastewater treatment processes to produce a product in which the risk of infection, upon reuse, is reduced to an acceptable level. A brief overview of the disease agents involved, human dose-response considerations, microbial standards, and treatment plant reliability is presented. Selected experiences with the question as to how our terrestrial experience can be applicable to advanced life support systems is addressed.
Physical and Chemical Processes for Solid Waste Treatment Applied To a Crewed Space Habitat
Authors: Savage George M.
Published: October 2007

Solid wastes can be processed for material and energy recovery using a number of unit operations and system approaches. The selection and configuration of unit operations and systems depends upon the characteristics of the wastes to be processed and the uses for recovered secondary materials and for recovered energy forms. The discussion focuses on the types of materials and forms of energy potentially recoverable from solid wastes, waste processing and conversion systems, and design considerations.
Technology Tradeoffs Related To Advanced Mission Waste Processing
Authors: Slavin Thomas J. , Oleson Melvin W.
Published: October 2007

Manned missions to the Moon and Mars will produce waste, both in liquid and solid form, from the day-to-day life-support functions of the mission—even considering a "closed" physico-chemical life support approach. An "open" life support system configuration, even one reliant on in situ resources, would result in even more waste being produced. The solution for short term missions appears to be either to store these wastes on-site or to convert them to useful products needed by other systems such as methane, water and gases which could be used for propulsion. The solution for longer term missions appears to be to incorporate their use within the life support system itself by making them a part of a closed ecological life-support system where nearly all materials are recycled.

This paper discusses briefly the extent and impact of the life-support system waste production problem for a lunar base for different life support system configurations, including the impact of using in situ resources to meet life support requirements. It then discusses in more detail trade-offs among six of the currently funded physico-chemical waste processing technologies being considered for use in space.
Processes for Water Reclamation
Authors: Dean Robert B.
Published: October 2007

Water treatments fall into two broad classes; those that remove or destroy specific classes of pollutants, i.e. color, metal ions, hardness, sediment, bacteria, etc., and those that remove water from nearly all of the pollutants. The first class includes sedimentation, biological treatment by microbes, chemical precipitation, adsorption on active carbon or ion exchange resins, and disinfection. The second class includes distillation, freezing and reverse osmosis (RO). The first class are the least expensive in terms of energy and have a long history of successful use on a large scale to reclaim water containing sewage. Most of the second group are energy intensive and have been used primarily on a moderate scale. All processes, except disinfection, leave a residual sludge or brine that contains a substantial quantity of water.

Many of the problems of treating waste water for reuse on Earth stem from the fact that waste water carries pathogenic organisms from one location to another and may spread disease over long distances. In a closed group, such as in a Space Station, there are so many other routes for transfer of microorganisms, i.e. in the air, on surfaces, by hand-to-mouth, that undue emphasis on disinfection of water is inappropriate. Successful examples of water reuse on Earth are reviewed in terms of their possible application in space.
Minimizing Waste Polymers in Space
Authors: Tesoro Giuliana
Published: October 2007

Waste polymers, essentially plastic packages, make up a significant fraction of solid wastes in a crewed space habitat. While logistic limitations preclude consideration of recovery/recycling technologies that have proven viable on Earth, the challenge in space is to provide materials and processes that minimize the volume of stored waste plastics and which allow recovery at the completion of a mission.
Biofilms and the Survival of Opportunistic Pathogens in Recycled Water
Authors: Boyle Michael , Ford Tim , Maki James S. , Mitchell Ralph
Published: October 2007

Microorganisms are likely to develop an organic film on pipes, water reservoirs and filters used for waste water reclamation during extended missions in space. These biofilms can serve to protect and concentrate potentially pathogenic microorganisms. Our investigation has emphasized the survival strategy of opportunistic pathogenic bacteria in distilled water. Pseudomonas aeruginosa and Staphylococcus aureus were used as test organisms. Cultures were incubated at 10°, 25° and 37°C. No viable Staphylococcus cells were detected after the first week of incubation. P. aeruginosa, however, survived in distilled water up to 5 months at all three temperatures tested. The starved cells were able to form a biofilm layer on stainless steel. The cells exhibited a negative surface charge. The charge may be involved in the adhesion of this bacterium to metal substrata. We are currently investigating the importance of adhesion in the survival of this and other potential human pathogens found in water recycling systems.
Performance Characteristics of a Low Sludge Bioreactor for Wastewater Treatment
Authors: Petrie Glenn E. , Lupton F. Stephen
Published: October 2007

An immobilized microbial cell system was developed and tested for the treatment of industrial wastewater. A consortium of selected aerobic microorganisms was immobilized onto several different support matrices in a packed bed reactor configuration and operated in a continuous process mode. Comparison of the support matrices showed only small differences in treatment efficiency, but significant differences in sludge production and process stability. Porous polymer supports were highly resistant to feedstream upsets and produced 80% lower sludge solids as compared with non-porous supports. These results were seen at both the benchtop and pilot plant scale for treatment of complex industrial waste streams. This technology was applied, in preliminary experiments, to the treatment of a model waste stream simulating wastewater from a Controlled Ecological Life-Support System (CELSS).
Terrestrial Approaches To Integration of Waste Treatment
Authors: Oswald William J.
Published: October 2007

Solar energy driven physical, chemical and biological recycling of nutrients is the characteristic of the Earth-Sun system which permits life on earth to continue. Natural recycle of nutrients on Earth may literally require thousands or even millions of years to be complete, but for modern civilization to continue on Earth or in space, mankind must take charge of, and accelerate, the recycle of all essentials of life. In this paper we describe studies of two accelerated recycle systems; a solar powered energy system and an integrated feed lot. Both systems require special infrastructures permitting the accelerated physical, chemical and biological processing to occur. These systems do not integrate respiratory carbon dioxide as must be done in a complete closed ecological life support system (CELSS). The Algatron, a more complete system involving microalgal bacterial waste treatment with water, oxygen and carbon dioxide recycle was designed for use in Space Stations over 20 years ago.
Waste Treatment Integration in Space
Authors: Baresi Larry , Kern Roger
Published: October 2007

The circumstances and criteria for space-based waste treatment bioregenerative life-support systems differ in many ways from those needed in terrestrial applications. In fact, the term "waste" may not even be appropriate in the context of nearly closed, cycling, ecosystems such as those under consideration. Because of these constraints there is a need for innovative approaches to the problem of "materials recycling". Hybrid physico-chemico-biological systems offer advantages over both strictly physico-chemico or biological approaches that would be beneficial to material recycling. To effectively emulate terrestrial cycling, the use of various microbial consortia ("assemblies of interdependent microbes") should be seriously considered for the biological components of such systems. This paper will examine the use of consortia in the context of a hybrid-system for materials recycling in space.
Techniques for the Fabrication of Geomembrane Filled Seams
Authors: Carson David A. , Landreth Robert E.
Published: October 2007

Geomembranes employed to overlay the excavation for landfills must be seamed together on-site at the landfill. To ensure the integrity of the containment system of the landfill, these sheets or blankets must be carefully seamed. Present methods in common use are: extrusion fillet welding, where the extrudate is placed over the edge of the seam; extrusion flat welding, where the extrudate is placed between the two sheets to be joined; hot wedge seaming, a thermal fusion bonding, where an electrically heated wedge melts the sheets to be joined, after which a roller applies pressure to ensure the seal; hot air seaming, where hot air between the sheets melt the surfaces to be joined; chemical fusion, where a liquid chemical is applied between the two sheets to be joined; and chemical adhesive, where a dissolved bonding agent (adherent) is applied between the two sheets to be joined. This paper is a review of the technology involved in forming the seams by each method.
Airborne Contaminants At Waste Treatment Plants
Authors: Rahkonen Päivi
Published: October 2007

Airborne contaminants in Finnish waste treatment plants were studied at two plants using mainly manual sorting and one incineration plant. Air samples were analysed for mesophilic and thermotolerant bacteria, mesophilic fungi, endotoxin, dust and heavy metals (lead, cadmium). The concentrations of mesophilic bacteria in the working air of the waste treatment plants were under 2 × 104 colony forming units (cfu) m-3 and the concentrations of mesophilic fungi were under 7 × 104 cfu m-3. There was no seasonal variation in the concentrations of bacteria, but the concentrations of fungi were highest in autumn at the waste incineration plant. The concentrations of microbes recorded with two sampling methods, the Andersen and Nuclepore filter methods, differed but were usually of the same order of magnitude. The identified bacteria did not include any potent pathogens. In manual sorting the level of organic dust reached 38 mg m-3, whereas the 8-h hygiene limit value for organic dust is 5 mg m-3 and the 15-min hygiene limit value is 10 mg m-3. The endotoxin levels were all below 30 ng m-3 and the concentrations of heavy metals were low.
Seasonal Effects On Anaerobic Digestion of the Source Sorted Organic Fraction of Municipal Solid Waste
Authors: Cecchi Franco , Mata-Alvarez Joan , Pavan Paolo , Vallini Giovanni , De Poli Fabrizio
Published: October 2007

The effects of seasonal temperature change on the quality of easily degradable organic matter in municipal solid waste was monitored and the related influence on the anaerobic digester performance examined. It was verified that increased external temperature caused the transformation of the ethanol contained in the source-sorted organic fraction of municipal solid waste fed to the digester, into acetate. This transformation has been associated with a remarkable effect on the process kinetics of substrate utilization. Thus, the kinetic constant for the first order substrate utilization model in the summer (external temperature greater than 18-20°C) doubled with respect to the winter, although the digester was held at 35±2°C throughout.
Poly(Malic Acid) Part I— Preparation and Polymerization of Benzyl Malolactonate
Authors: Johns Douglas B. , Lenz Robert W. , Vert Michel
Published: October 2007

The benzyl ester of the β-lactone of malic acid was synthesized from bromosuccinic acid and polymerized both in bulk and in solution by anionic and cationic initiators and by a heterogeneous catalyst. Anionic polymerization reactions yielded polymers with weight average molecular weights as high as 50,000 as determined by GPC, and with narrow molecular weight distributions. The benzyl ester polymers were readily converted to poly(malic acid) by hydrogenolysis without loss in molecular weight. Poly(malic acid) is being evaluated as a biodegradable, bioresorbable component in drug delivery systems, particularly as a non-toxic, slow release carrier for covalently bound drugs.
Biodegradable Polymers Poly(amide-urethanes) [1]
Authors: Huang Samuel J. , Roby Mark S.
Published: October 2007

Poly(amide-urethanes) with long repeating units were prepared from 2-aminoethanol, α,ω-alkylene dicarboxylic acid chlorides, and 1.6-diisocyanatohexane. These partially crystalline polymers undergo slow hydrolysis when suspended in buffered water but were found to be more readily degraded by the enzyme subtilisin.
Uses and Abuses of Electrophysiologic Testing in the Management of Ventricular Arrhythmias
Authors: Josephson Mark E. , Kadish Alan H.
Published: October 2007

The use of clinical electrophysiologic studies has evolved dramatically since Scherlag and colleagues [1] first reported His bundle recording in humans in 1969 and Wellens [2] demonstrated that pro grammed electrical stimulation could reproduce clinical ventricular arrhythmias. In addition to ar rhythmia diagnosis and serial drug testing, new mo dalities, including surgical therapy and devices for arrhythmia treatment, have been developed in the past few years.
Analytic Reviews: Electrophysiologic Testing in the Intensive Care Unit
Authors: Nalos Peter C. , Myers Mark R. , Gang Eli S. , Peter Thomas , Mandel William J.
Published: October 2007

The role of electrophysiologic concepts and procedures in managing patients with potentially life-threatening ar rhythmias in the intensive care unit is discussed. These patients may be survivors of sudden cardiac arrest or myocardial infarction or may be admitted for syncope or sustained or nonsustained ventricular tachycardia. The value of electrophysiologic testing is discussed in terms of the distinction between wide QRS complex tachycardias that are supraventricular or ventricular in origin and those in which preexcitation syndromes may be important. Drug-induced ventricular arrhythmias are discussed, with specific emphasis on torsades de pointes. Finally, the use of His bundle recordings in pa tients with atrioventricular conduction disturbances is discussed. The methodology of electrophysiologic test ing, including stimulation protocols and interpretation of results, is described.
Long-term Care Facilities: Distribution and Reimbursement Systems
Authors: Mead Robert A.
Published: October 2007

There are several types of drug distribution systems available for use in long-term care facilities. They include floor stock, traditional, unit-dose, and modified unit-dose systems. There are advantages and disadvantages to each system, all of which can have an impact on pharmacy, nursing, and long-term care facility residents. Other services that can be provided by pharmacies include emergency services and drug supplies; controlled drug handling, accounting and disposition procedures; automatic stop order policies; and computer and formulary services. In order to continue providing services to a long-term care facility, a pharmacy must be adequately reimbursed. The most important part of a reimbursement system is developing a pricing method. The amount that a pharmacy is reimbursed should include the drug acquisition cost, cost of dispensing, and a net profit. Drug acquisition cost can include average wholesale price, actual acquisition cost, or a hybrid of these amounts, an estimated acquisition cost. The total costs involved in operating the prescription department should be computed in order to arrive at a cost of dispensing. Net profit should be an equitable amount that will allow the pharmacy to remain financially solvent. Types of reimbursement systems include private payment, where the individual resident reimburses the pharmacy, and third party payment, where agencies such as Medicaid, private insurance companies, and, in the near future, Medicare, reimburse the pharmacy.

A major component of nursing home pharmacy services is the drug distribution system. There are various types of distribution systems, which differ in many ways. A key factor in the provision of pharmacy services to nursing homes is reimbursement. This article will discuss the different types of drug distribution systems available, as well as the various methods of reimbursement for pharmaceutical products and services.
The Consultant Pharmacist's Role in Long-term Care Facilities
Authors: Brown Charles H.
Published: October 2007

As the elderly portion of the US population continues to grow at an alarming rate, it is expected that the extent of their drug utilization will also escalate proportionately. The typical geriatric patient often presents with multiple medical disorders that are being treated with multiple drugs. With the elderly, as the number of medications increase numerically, the incidence of adverse drug reactions may increase exponentially. At times, one drug may be prescribed to treat the adverse effects of another medication. Studies show that the cost benefits of having consultant pharmacists conduct drug regimen reviews on patients in long-term care facilities resulted in a savings of $220 million. These cost savings resulted from the influence of consultant pharmacists decreasing the number of drugs per patient, amount of nursing time spent on drug administration, number of hospitalizations resulting from adverse effects, and overall cost of medical care. These data influenced the development of federal regulations that now require pharmacists to perform monthly drug regimen reviews on all patients residing in either intermediate or skilled nursing facilities. In addition to clinical drug therapy monitoring, the consultant pharmacist also participates in the infection control and pharmaceutical services committees and presents in-service training programs to the nursing staff. In performing various clinical and administrative functions, the consultant pharmacist must be able to work with other health care personnel in improving pharmaceutical services and patient care. As a result, there will be an even greater need in the near future for pharmacists who have been clinically trained to evaluate drug therapy in the elderly.
Cost Savings: The Value of the Pharmacist
Authors: Cooper James W.
Published: October 2007

The cost savings of consultant pharmacy practice and drug-related problems and care outcomes of dealing with the geriatric patients at all levels of care are reviewed. The consultant pharmacist has been shown to decrease overall drug costs, adverse drug reactions, and drug-related hospitalizations and mortality, while improving the quality of drug therapy and actually lowering drug monitoring costs. Problems and issues yet to be resolved are presented along with recommendations for improved quality of pharmacy services and education.
Psychoactive Drug Misuse in Long-Term Care: Some Contributing Factors
Authors: Sherman David S.
Published: October 2007

Surveys have identified inappropriate psychoactive drug prescribing patterns as a major problem in the care of nursing home residents. Residents without a documented history of mental illness often receive drugs intended to treat psychiatric problems. One of the greatest areas of misuse of these drugs is in the treatment of agitation in elderly demented residents. For example, although this purpose is likely the most common reason antipsychotic drugs are used in the nursing home setting, no well designed study has yet demonstrated that these agents are effective for this problem. Elderly individuals are particularly sensitive to the adverse effects of psychoactive drugs. Due to the gradual or insidious onset of some adverse effects, psychoactive drug toxicity may often be underestimated. The most serious example of a clinically underrecognized adverse effect of psychoactive drugs is tardive dyskinesia. Misinterpretation of certain nursing home residents' behaviors may lead to medication with tranquilizing drugs when other approaches may be safer and more effective. Excessive use of psychoactive drugs is not only physically harmful, but also encourages an apathetic attitude toward implementation of more humane ways of dealing with behaviorally disturbed nursing home residents.
Geriatric Teams in the Long-term Care Facility
Authors: Ramsey Ruthanne R.
Published: October 2007

Geriatric teams have emerged as an accepted method of health care delivery to the elderly patient in ambulatory and acute inpatient settings. As one model of specialized health care teams, geriatric teams vary in structure, membership, and type. The purposes may be diverse, ranging from providing primary care to multidimensional functional and diagnostic assessment. Geriatric teams have convincingly demonstrated benefit to the care of the elderly. Overcoming significant barriers to their formation, geriatric teams are beginning to develop in long-term care facilities as a result of economic and educational pressures. However, the unique environment and needs of the long-term care facility have resulted in differences in leadership, membership, and structure of long-term care teams. Pharmacist involvement in the long-term care geriatric team could benefit the facility, patient care, and the profession. The key to future involvement by pharmacists in teams appears to depend on their interest, ability to acquire necessary skills, and demonstration of unique professional contributions.
Clinical Software in Long-term Care Consultant Pharmacy Practice
Authors: Sherman James A.
Published: October 2007

As evidenced in 1985, and confirmed through preliminary analysis of a 1988 survey, 96.3% of long-term care (LTC) providers were using computers in providing dispensing services. It is the challenge of using this current tecnhology to merge existing drug management (prescription processing) and clinical applications that identifies the frontier of computerized pharmacy practice. Software programs are currently available that enable the consultant to uniformly apply set indicator criteria without ommission or human memory lapse to all LTC resident drug regimens. It is the degree to which these drug regimen review software programs may be integrated with prescription processing software, and the extent that the programs exceed the indicators that may be used in evaluating their impact and value. This value may be reflected in decreased consultant pharmacist review time, patient benefit, physician response, perceived administrator/nursing home benefits, and the usefulness of reports and outcome statistics generated. The advantages, disadvantages, guidelines for software evaluation, and currently available clinical programs are presented in order to provide accurate information to those consultant pharmacists seeking to expand or implement new computer based clinical services.
Ethics in Geriatric Research
Authors: Schechter Bruce M.
Published: October 2007

As the need for more information on age-related clinical pharmacology grows, there will be an increased emphasis on research involving elderly individuals. Ethical concerns surrounding the protection of elderly research subjects is increasingly a topic of debate. The increased vulnerability of institutionalized elderly, recruitment and retention of elderly subjects, and informed consent are important issues that affect the conduct of research in this population. Investigators should be aware of the special problems associated with research in the older population and be prepared to deal with these before embarking on a research project. This article provides the pharmacy practitioner with an introduction to the basic ethical principles relating to the conduct of research involving the elderly and gives an overview of some of the important problems that may be encountered. Issues such as autonomy, competence, informed consent, proxy, and rights of privacy are outlined. Circumstances in which elderly patients are deserving of special protections when participating in a research project are discussed and potential guidelines for addressing the unique problems surrounding research in the elderly are offered.
Drug Therapy in Pregnancy and Lactation
Authors: Frey Bruce M. , O'Donnell James
Published: October 2007

The use of drugs in pregnant and lactating women requires a thorough understanding of the unique interactions between the mother, fetus/infant, and the pharmacologic agents that are used in therapy. Any agent that is consumed by a woman may have adverse effects on the fetus/infant. This article will summarize those factors that should be considered. There exists a paucity of data and information for most drugs relative to pregnancy and lactation. Conclusions that can be drawn remain speculative, and the use of any drug during pregnancy and lactation requires extreme caution. Factors involved in fetal drug exposure include the dynamic changes of maternal physiology related to drug absorption, distribution, metabolism, and excretion. Placental transfer of drug occurs with almost all agents, each to varying degrees. The notion that the placenta provides an impervious barrier must be dismissed. The least understood of factors involving potential fetal harm is teratogenicity. The mechanisms and types of teratogenic agents, poorly understood in humans, is discussed. Most drugs appear in the breast milk and, therefore, carry some degree of potential harm. Minimizing exposure is a goal that can be obtained when taking into account the maternal physiology, basic pharmacokinetic factors, physiochemical interactions between drug and membranes, and the chemical composition of breast milk.
Hospice Care: A New Opportunity for Pharmacists
Authors: Arter Stephen G. , Lipman Arthur G.
Published: October 2007

Hospices are programs of care for patients who have advanced, irreversible diseases and life expectancies that are measurable in weeks and months as opposed to years. The first hospice in the United States was started in 1974 as a National Cancer Institute demonstration project. Since that time, approximately 1,700 programs have been started in this country. Most hospice care is provided in the patients' homes. The focus of care is the relief of pain and other symptoms. Hospice is interdisciplinary and medically directed. Pharmacists are important members of hospice teams. This article will describe the development of hospice programs in this country, how pharmacists might become involved in hospice care, and the roles that pharmacists play in hospice programs. A variety of pharmacist expertise, including clinical skills, drug information capabilities, management, and compounding, are needed by hospice programs. Hospice presents a challenging and professionally rewarding practice for many pharmacists today. Many more pharmacists are needed.
High-Technology Home Pharmacotherapy, I: An Overview of Antiinfective and Antineoplastic Therapies
Authors: Bennett Mary A. , Allen Ronald D.
Published: October 2007

Home care has evolved into a highly technical support system caring for the more acutely ill patient who requires specialized medical attention. Almost every drug is a candidate for home-care administration if adequate patient selection and monitoring criteria are met. Home parenteral antimicrobial therapy has progressed beyond simple intravenous (IV) drip administration. New routes and techniques, and unusual doses and intervals are commonly encountered. Newer infusion devices have enabled antibiotic and other therapies to be accomplished more easily. Parenteral chemotherapy at home has been given by some unusual routes and administered continuously. Management of the potentially severe side effects of antineoplastic therapy has also been successfully accomplished in the home. This article addresses the considerations for initiating home parenteral therapy and provides an overview of the management of antimicrobial and antineoplastic therapies at home.
Pain Management in the Home-Care and Hospice Patient
Authors: Lipman Arthur G.
Published: October 2007

Pain is one of the most common clinical complaints of home-care patients. As sicker patients are being sent home earlier due to federally mandated prospective reimbursement for hospitals, more patients in pain are being treated at home. However, pain is frequently not well managed even though we usually have the necessary treatment modalities to do so. This is due largely to most health care professionals lacking up-to-date information on the pathophysiology of pain and the pharmacology of analgesic drugs. There is a need for pharmacists to educate both health professionals and patients on appropriate drug therapy for pain management. Pain is a perception with physical and emotional components. Acute pain, chronic benign pain, and chronic malignant pain differ and often require different treatment. Drugs are one of several treatment modalities that are important in pain management. Titration of analgesics to effect is important. For chronic pain, time-contingent dosing is important. Relative analgesic doses and dosing schedules are reviewed. Some drugs other than analgesics that can be useful in pain management are discussed. Patients with terminal illness often have great emotional burdens, which can complicate pain management. Some common reasons for unsuccessful pain management are described.
The Nature of Addictive Diseases
Authors: Collins Allan C.
Published: October 2007

Drug addiction and addictions to foods, sex, gambling, exercise, and many other things are widespread in modern societies. Addiction or dependence are terms used to describe persistent psychoactive drug use, but these terms also can be applied to other forms of repetitive behaviors. Many of these repetitive behaviors are regulated by specific regions of the brain that are influenced by drugs. Consequently, drug addiction may involve effects on systems that are involved in regulating forms of addiction that are necessary for the maintenance of life. Addictions also seem to be regulated by genetic factors. Because drug addiction may influence the activities of systems that evolved to regulate behaviors necessary to survive (ie, eating and drinking) and because individuals may differ in addict-ability for a given drug caused by genetic reasons, addiction should be considered as a disease and therapy should be developed with this concept in mind.
Methadone Maintenance in the Treatment of Narcotics Addiction
Authors: Tommasello Anthony C.
Published: October 2007

Despite numerous studies documenting its success, methadone maintenance is an often misunderstood and frequently maligned treatment approach for heroin addiction. By taking 40 to 60 mg of methadone orally every day, heroin addicts are able to achieve a degree of stability in their lives allowing them to pursue productive goals while decreasing risky behaviors such as needle sharing and street drug use. Strict admission criteria for methadone maintenance are spelled out in Food and Drug Administration regulations, and those ineligible for methadone maintenance must avail themselves of other forms of treatment. The emergence of Narcotics Anonymous is an encouraging development for heroin addicts who achieve abstinence through a variety of new pharmacotherapeutic options.
The Impact of Controlled Substance Federal Regulation on the Practice of Pharmacy
Authors: Branding Frederick H.
Published: October 2007

The federal Controlled Substances Act requires all registrants, including pharmacists, to keep complete, accurate, and detailed records of the acquisition and disposition of all controlled substances. These records are to be maintained in a readily retrievable manner in order that they may be inspected, verified, and copied by inspectors of the Drug Enforcement Administration. When dispensing controlled substances, pharmacists have a statutorily imposed corresponding responsibility to verify that all prescriptions for controlled substances have been issued by a prescriber in the usual course of that prescriber's legitimate medical practice. Violations of the Controlled Substances Act and regulations can subject pharmacists to a variety of sanctions, ranging from an administrative letter of admonition to a civil fine, forfeiture, or criminal prosecution.
Pharmacy Services in a Hypertension Clinic
Authors: Covey Douglas F. , Shackelford Diane D. , Geck Wallace E.
Published: October 2007

Roles for pharmacists are evolving rapidly in the ambulatory care setting. This is primarily due to increasing inpatient costs with a resultant shifting of costs to the outpatient section. This shift has subsequently presented larger numbers of patients and sicker patients to the outpatient setting. This article describes the involvement of a clinical pharmacist in a multidisciplinary hypertension clinic. Detailed are the procedures used to evaluate a patient from consult to discharge, and the responsibilities of the clinical pharmacist, the clinic physician, and the nurse practitioner are reviewed. Finally, methods of documentation and quality assurance are outlined.
Cost Containment Strategies in Managed Care Pharmacy Programs
Authors: Reissman Debi L.
Published: October 2007

Over the past several years prescription drug costs have been escalating at a rate higher than any other single medical expense. For this reason, managed care entities have been focusing much more attention on their prescription drug programs and searching for the magical answer of how to reduce or at least control the spiraling costs. The following article illustrates one author's views and experiences in the management of prescription drug programs. Although the topics discussed in this article are not meant to be all inclusive, several major cost containment strategies, including benefit design, pharmacy network, reimbursement levels, member copayments, formulary systems, physician incentives and others, are highlighted.
Drug Formulary: The Cornerstone of a Managed Pharmacy Program
Authors: Bruzek Richard J. , Dullinger Debra
Published: October 2007

Drug formularies have migrated from the inpatient hospital environment to the ambulatory outpatient setting. Although formularies in use by managed health care organizations may vary widely in their design, they have quickly become the cornerstone of the managed pharmacy benefit. A carefully designed formulary can direct drug use to the safest and most efficacious products that may ultimately lower total drug costs. Other managed health care drug formulary considerations are presented. A method is described to develop a drug formulary. The drug evaluation matrix (DEM) provides a systematic, reproducible drug selection process based on efficacy, safety, and cost. DEM allows the user to assign different weights to these factors during the drug evaluation process. The product of DEM is a drug formulary that is therapeutically complete, consistent with accepted medical practice and maximizes cost efficiencies achievable from a drug formulary.
A Review and Analysis of the Medicaid Prudent Pharmaceutical Purchasing Bill and Its Impact on Managed Care Pharmacy
Authors: Stubbings JoAnn , Hatoum Hind T.
Published: October 2007

The Medicaid Prudent Pharmaceutical Purchasing Bill is designed to improve Medicaid patients' access to medications in return for signed rebate agreements from pharmaceutical manufacturers. The legislation also recognizes and attempts to develop the potential clinical role of pharmacy through mandates for drug utilization review, patient counseling, and electronic claims processing for Medicaid patients. Managed care pharmacy has a distinct advantage in the achievement of these clinical roles; it has already implemented drug utilization review and has electronic claims capabilities. This article reviews the legislation and describes the potential impact of the law on managed care pharmacy practice. The government is a major player in terms of setting health policy and trends in this country, and managed care pharmacy departments should be keenly aware of the legislative impact on overall future pharmacy trends. The potential exists for other government agencies and eventually the private sector to require and reimburse for provisions similar to those described in the Medicaid legislation. Managed care pharmacists should take a special interest in ensuring that the demonstration projects and studies mandated by the legislation show positive documentation of pharmacists' intervention so that eventually pharmacists will be properly compensated for such services in the public and private sectors.
Considerations in the Treatment of Patients With Acquired Immunodeficiency Syndrome at Home
Authors: Matsumoto Sandra A. , Seideman Mary Frances
Published: October 2007

The rapidly growing acquired immunodeficiency syndrome (AIDS) population faces frequent, expensive hospitalization due to the debilitating sequelae of the disease. Home care offers these patients an opportunity to receive or complete their therapy in comfortable surroundings, allowing them to realize the psychosocial and financial benefits of outpatient care. A myriad of sophisticated drug therapies has been successfully administered in the home setting. Therapy for frequently occurring opportunistic infections often requires treatment with highly toxic drugs such as amphotericin, pentamidine, and ganciclovir. With thorough patient training and diligent monitoring by the home-care pharmacist and nurse, these agents can be safely administered at home. Conventional and investigational chemotherapy and immunomodulator therapy, such as interferon or erythropoietin, can also be administered at home. Providing total parenteral nutrition to AIDS patients is a controversial treatment modality, but if indicated, it can also be accomplished at home. Outpatient pain management has allowed many patients with terminal or chronic illnesses to minimize time spent in hospitals or extended care facilities, and it can offer the same advantages to patients with AIDS. The psychosocial ramifications of AIDS and its impact on patients and health care professionals must be understood in order to effectively provide total patient care at home. The challenge to the home-care pharmacist is to acquire and maintain a comprehensive knowledge of the treatment options currently available for the management of AIDS.
Intertextual quanta in formula and translation
Authors: Knutsson Pétur
Published: October 2007

Halldora B. Bjornsson's Icelandic translation of Beowulf (Bjömsson 1983) shares with other examples of textual transmission between closely related languages a tendency to transcend the exigencies of formal cognation by exploiting non-cognate correspondences which echo the forms of the original (cf. Kndtsson 1995). This article examines examples of this phenomenon in Bjdmsson's translation, treating them as intertextual connections between source and translation which cannot be adequately defined without invoking known formulaic relationships with other Anglo- Saxon and Old Norse poems. Bj6msson was widely read in Old Norse but was not familiar with Old English texts other than Beowulf. This article suggests that the formulaic links between the Old English corpus and Bjornsson's translation cannot be adequately explained by the Old Norse connection. A more promising approach is to treat them as autonomous echoic phenomena occurring as discrete and quantifiable surface strings which become activated as intertextualities when they are invoked as such.
Code switching and style shifting as markers of liminality in literature
Authors: Hess Natalie
Published: October 2007

This article focuses on the artistic function of code switching in literature. In particular, it showcases code switching as a marker of liminality - the state of creative in-betweenness which serves as an underpinning for unconscious literary designs. Particular examples of liminality in literature are illustrated through the works of John Steinbeck, Harper Lee, and Charlotte Bronte. The states of transition that form the central core of the works analysed are bolstered through the use of code switching, which.underscores the love/hate alliances, gender placements, and cultural dissonances of literary craft.
A poetics of engagement in E.L. Doctorow's Ragtime
Authors: Spencer Luke
Published: October 2007

Ragtime (1985 [1975]) is contextualised among Doctorow's other 1970s novels as an attempt to challenge received ideas about his country's past. The novel's formal strategy for expressing Doctorow's radical critique of modem American experience- what he calls 'a poetics of engagement' - is examined through close attention to the formal and linguistic handling of speech. Three key passages of dialogue are quoted at length and analysed for what they reveal of the social - and, hence, ideological- embeddedness of utterances and those who speak them. The interdependence of private and public discourse is related to issues of reproduction, repetition and inescapability which the novel also addresses. Finally, it is argued that Doctorow's unflinching engagement with negative socio-linguistic forces culminates in a courageous admission of political paralysis.
Indirectness, rhetoric and interpretative use: communicative strategies in Browning's My Last Duchess
Authors: MacMahon Barbara
Published: October 2007

In this article I use a relevance theory framework to examine the intricacies of the communicative situation at work in Browning's My Last Duchess. I focus on the rhetorical nature of indirectness, as well as suggesting that the relevance-theoretic concepts of interpretive and echoic use can provide a useful means of re-theorising the use of voice in literature. In particular I show that authorial distance from the Duke of Ferrara's monologue in My Last Duchess can be accounted for in the same way as a speaker's dissociation from propositions expressed in ironic utterances. In addition I explore the ambivalent potential of both irony and authorial distance. I argue that relevance theory, in its recognition of the possible disjunction between what is said and what is communicated, is a model which overcomes some of the inadequacies of earlier pragmatic approaches to literature.