bluuebunny/crossref_metadata_2025 huggingface dataset:
Myeloid cells are tunable by a polyanionic polysaccharide derivative and co-determine host rescue from lethal virus infection
Authors: Li Sandra , Starckx Sofie , Martens Erik , Dillen Chris , Lamerant-Fayel Nathalie , Berghmans Nele , Gouwy Mieke , van Pel Melissa , Heremans Hubertine , Kieda Claudine , Fibbe Willem E , Billiau Alfons , Van Damme Jo , Opdenakker Ghislain
Published: August 2010

Chlorite-oxidized oxyamylose protects in a model of acute lethal virus infection with chemo-attracted phagocytes as antiviral leukocytes.

Insight into molecular and cellular mechanisms of innate immunity is critical to understand viral pathogenesis and immunopathology and might be exploited for therapy. Whereas the molecular mechanisms of the IFN defense are well established, cellular mechanisms of antiviral immunity are only emerging, and their pharmacological triggering remains unknown. COAM is a polysaccharide derivative with antiviral activity but without comprehension about its mechanism of action. The COAM mixture was fractionated, and prophylactic treatment of mice with COAM polymers of high MW resulted in a conversion from 100% lethal mengovirus infection to an overall survival rate of 93% without obvious clinical sequelae. Differential and quantitative analysis of peritoneal leukocytes demonstrated that COAM induced a profound influx of neutrophils. Selective cell depletion experiments pointed toward neutrophils and macrophages as key effector cells in the rescue of mice from lethal mengovirus. COAM was able to induce mRNA and protein expression of the mouse neutrophil chemokine GCP-2. Binding of GCP-2 to COAM was demonstrated in solution and confirmed by SPR technology. Although COAM was not chemotactic for neutrophils, COAM-anchored muGCP-2 retained chemotactic activity for human and mouse neutrophils. In conclusion, this study established that COAM rescued mice from acute and lethal mengovirus infection by recruiting antiviral leukocytes to the site of infection, as proposed through the induction, binding, and concentration of endogenous chemokines. These findings reinforce the role of neutrophils and macrophages as critical cells that can be manipulated toward antiviral defense.
Tools and techniques for understanding the fundamentals of automotive sound quality
Authors: Jennings P A , Dunne G , Williams R , Giudice S
Published: August 2010

Understanding the sounds that create the most positive subjective and emotional responses for customers and, importantly, linking this knowledge to objective engineering specifications is a major challenge. This paper presents research to create the tools and techniques to achieve this. It starts with work carried out to understand the language of sound perception and a means to capture it succinctly. Two perceptual dimensions were established that enabled the positioning of current, competitor, and target vehicles in a subjective space to be determined. Early work involved the study of fixed sounds, both real and simulated, in a listening room. However, this approach has been improved by enhancing the level of context and interactivity. Perception of the sounds of on-road cars is affected by stimuli for other senses (e.g. visual and vibrational), and the fact that an assessor is also concentrating on driving. Furthermore, drivers experience a full range of vehicle sounds, rather than fixed stimuli. The development and use of interactive simulation tools are therefore introduced. They provide a more confident assessment of preferences but also allow a greater understanding of the contributing factors to these preferences, e.g. those aspects of real-world driving that are most important in forming overall impressions of vehicle sound.
Determination of the Wear of Internal Combustion Engine Components Based on Measurement of the Oil Spectrum
Authors: Zhang Y , Wang J , Ai F-X
Published: August 2010

Spectroscopy is commonly used to analyse the wear of internal combustion engines. However, it can only measure the density of elements in abrasive dusts mixed in lubricants and not the exact amount of wear of specific engine components. In this paper, measurement of the oil spectrum is used to obtain the concentrations of elements in a lubricant. An appropriate numerical method is developed to process the acquired data and to obtain the actual wear of each running component. Experiments are conducted to verify the efficiency of this method.
Characteristics of the ignition and combustion of biodiesel fuel spray injected by a common-rail injection system for a direct-injection diesel engine
Authors: Kuti O A , Xiangang W G , Zhang W , Nishida K , Huang Z H
Published: August 2010

The effect of injection pressures at 100 MPa and 200 MPa respectively on the ignition and combustion characteristics of biodiesel fuel spray injected by a common-rail injection system for a direct-injection diesel engine was investigated. Two biodiesel fuels (namely biodiesel fuel from palm oil (BDFp) and biodiesel fuel from cooking oil (BDFc)) and JIS#2 diesel fuel were utilized in this research. The Mie scattering technique was used to characterize both the non-evaporating and the evaporating spray formation processes. The OH chemiluminescence technique was used to determine the ignition and the lift-off length of the combusting flame. Two-colour pyrometry was applied for the soot formation processes. At all injection pressures, the biodiesel fuels (especially BDFp) gave a longer spray tip penetration and a smaller spray angle under the non-evaporating conditions while the liquid-phase penetration length was longer for the biodiesel fuels than for diesel under the evaporating conditions. From estimation using a simplified model for air entrainment by the sprays, the BDFp and BDFc exhibited lower mass ratios of air to fuel than diesel did. The ignition delay was longest for the BDFc while it was shortest for the BDFp. Both the experimental and the predicted flame lift-off lengths for the BDFp were the shortest, indicating the least percentage of entrained stoichiometric air upstream. There was no significant difference between the integrated and averaged KL factors at 100 MPa injection pressure for the BDFc and diesel fuels. At 200 MPa, the BDFc presented much lower integrated and averaged KL factors than diesel did. The averaged flame temperatures of the BDFc were found to be lower than that of diesel. The oxygen content in the BDFc played a significant role in the soot formation in comparison with the oxygen from the percentage of stoichiometric air entrained upstream of the lift-off length.
Handling benefits of steering a third axle
Authors: Williams D E
Published: August 2010

This work examines the steady state handling effect of steering the rear axle of a three-axle vehicle in terms of the equivalent wheelbase and understeer. These quantities are derived from steady state conditions of a three-axle vehicle model which is analogous to the two-axle model. It is found that a very simple rear-axle steer control strategy improves both the equivalent wheelbase and the understeer. The expected improvement is larger on low-friction surfaces. The equivalent wheelbase of the rear-axle-steered vehicle calculated from the steady state condition of the dynamic equations of motion equals the intuitively expected kinematic result and was demonstrated on a test vehicle, validating the three-axle steady state handling model's ability to predict the rear-axle-steering performance.
Optimizing the shape parameters of radial basis functions: An application to automobile crashworthiness
Authors: Acar E
Published: August 2010

Radial basis functions (RBFs) are approximate mathematical models that can mimic the behaviour of rapidly changing and computationally expensive simulations, such as finite element simulations for predicting automobile crash responses. The most popular way of selecting optimal RBF shape parameters is based on minimizing the global cross-validation error (CVE). Solving this optimization problem may lead to the construction of globally accurate RBF models, but the shape parameters are assumed to be constant over the entire design space. On the other hand, having flexible shape parameters that can change over the design space may allow the local behaviour to be captured better, thereby improving the accuracy. Thus, optimizing the RBF shape parameters based on minimization of the pointwise CVE rather than the global CVE is proposed in this paper. Three benchmark mathematical functions followed by an automobile crash problem are used to evaluate the effectiveness of the proposed method. It is found that the RBF models based on the minimum pointwise CVE outperform the RBF models based on the minimum global CVE.
The Effect of Adverse Pressure Gradient on the Structure of Turbulent Boundary Layer
Authors: Khoshnevis A B , Farzaneh-Gord M , Hariri S
Published: August 2010

The effects of adverse pressure gradient (APG) on turbulent boundary layer flow are studied in this article using numerical methods. The values of pressure gradient are simulated by Clauser's parameter (β). The non-linear eddy-viscosity model (NLEVM) assumption has been employed to model turbulence. Moreover, applications have shown non-linear model to be far more reliable than the linear eddy-viscosity model (LEVM), particularly in flows subjected to APG and in other situations where normal straining is a major contributor to stress generation. Based on numerical solutions, turbulent intensity and turbulent shear stress and also mean velocity are calculated. The results show that the characteristics of turbulent boundary layer flows with APGs differ significantly from those of zero-pressure-gradient ordinary boundary layers. The numerical results show that more changes in the turbulent structure are induced directly by APG. The turbulent intensities and turbulent shear stress are increased by the effect of APG compared with flat plates under the same conditions. The numerical results also unveiled that the APG causes flow to be destabilized. The rate of integral parameters of the boundary layer such as momentum thickness and displacement thickness is increased as APG parameter increases and also when compared with the flat plate case. To validate the numerical results, a comparison has been made with previous experimental values and direct numerical simulation (DNS) data. Generally, good agreement has been obtained between numerical and measured values.
Co-Ordinated Rendezvous of Unmanned Air Vehicles to a Formation Using a Sliding Mode Approach
Authors: Harl N , Balakrishnan S N
Published: August 2010

A method for the co-ordinated rendezvous of a team of unmanned air vehicles (UAVs) to a formation through the use of sliding mode control is presented. The focus of this work is on the scenario where three ‘follower’ UAVs must rendezvous in a desired formation about a ‘Leader’ UAV in a finite time. An assumption is made that each UAV only receives knowledge of the bounds of the manoeuvres that the other UAVs are performing. By not requiring manoeuvre information to be constantly available, a level of robustness to possible communication outages between UAVs is obtained. The proposed method also guarantees that the formation will be achieved in a finite time through the use of a concept of sliding mode terminal guidance (SMTG). SMTG takes advantage of the finite-time reaching phase of sliding mode to ensure that any desired constraint can be fulfilled in a finite time.
Aeroelastic Characteristics of Slender Wing/Bodies with Freeplay Non-Linearities
Authors: Arévalo F , García-Fogeda P
Published: August 2010

This article presents a time domain approach to the flutter analysis of a missile-type wing/body configuration with concentrated structural non-linearities. The missile wing is considered fully movable and its rotation angle contains the structural freeplay-type non-linearity. Although a general formulation for flexible configurations is developed, only two rigid degrees of freedom are taken into account for the results: pitching of the whole wing/body configuration and wing rotation angle around its hinge. An unsteady aerodynamic model based on the slender-body approach is used to calculate aerodynamic generalized forces. Limit-cycle oscillations and chaotic motion below the flutter speed are observed in this study.
Effects of surface texture size on the tribological properties of slideways
Authors: Ogawa H , Sasaki S , Korenaga A , Miyake K , Nakano M , Murakami T
Published: August 2010

The effects of surface texture on the tribological properties of slideways were investigated experimentally. The authors designed an experimental apparatus for evaluating textured surfaces using specimens of a practical size (82 mm × 82 mm) considering the slideways used for machine tools which are one of the application fields for their research. The evaluated textures were dimple and groove textures, and their diameters and widths varied from 50 μm to 1 mm. The textures were processed by sandblasting as it is one of the alternative methods applied in industry. For comparison with the conventional textures, scraped surfaces were also evaluated. The friction coefficient and the film thickness were measured under the conditions of plane contact, and lubricating with the oil to clarify the effects of the textured pattern. The experimental results showed that the friction coefficient of the textured surfaces was smaller than that of the flat surfaces in the mixed lubrication regime. Regarding the mechanisms of friction reduction by texture types, the authors think that the dimples played the role of oil reservoir, and the parallel grooves prevented side leakage of the lubricating oil.
Elastohydrodynamic lubrication analysis of metal-on-metal hip implants with complex structures using the finite-element method
Authors: Meng Q E , Liu F , Jin Z M
Published: August 2010

Various complex structures are employed in different metal-on-metal (MOM) hip prostheses for different purposes. For the elastohydrodynamic lubrication (EHL) study of these prostheses, the elastic deformation calculation is not a trivial task due to the effect of complex structures. The finite-element method (FEM) is an attractive approach for solving these problems because of its flexibility in handling complex geometries. Moreover, the availability of high-level ready-to-use finite-element commercial software may facilitate the modelling of complex structures and thereby reduce the time spent on implementing the analysis. In this study, a numerical method was developed to solve the EHL problems of MOM hip prostheses with complex structures. In this method, the elastic deformation was calculated from the product of the flexibility matrix of the lubrication nodes and the nodal force. The flexibility matrix was obtained by inverting the stiffness matrix, which was obtained through finite-element analysis using commercial software. The nodal force was obtained by transferring the hydrodynamic pressure according to the isoparametric element definition. This method was validated for a typical 28 mm diameter MOM total hip replacement. The effects of the structures of the femoral head, the wall thickness of the cup, as well as the bone quality of patients on lubrication performance of MOM hip resurfacing prostheses were subsequently investigated.
Sliding wear of weld layers with application to cane mill shaft rebuilding
Authors: Coronado J J , Holguín C A , Rodríguez S A
Published: August 2010

Three welding procedures used to rebuild worn shafts in sugar cane mills were ana-lysed: two submerged arc welding processes and one flux cored arc welding (FCAW) process. Sliding wear tests were in accordance with ASTM G 77 standard, using rings of welding material, blocks of bronze SAE 67, and oil as lubricant. The worn surfaces of rings and blocks were analysed by scanning electron microscopy to determine the wear mechanisms. High contact pressure, high operating temperature, and low relative speed were applied in sliding wear tests to match the conditions in sugar cane mills. Transferred material and evidence of adhesive junctions were detected. Additionally, hardened fragments produced abrasive grooves on the worn surfaces. The welding deposits that presented strong adhesion on the worn surface showed higher mass loss than the materials that presented more abrasive characteristics. Plastic mechanical properties were measured and related to the mass loss. The tested materials presented similar hardness but different yield stress and hardening coefficient. A relationship between wear, strain hardening coefficient, and yield stress was found. The welding deposit that presented the highest hardening coefficient showed the highest mass loss, with evidence of severe adhesion on the worn surface.
Research on the Rotational Fretting Wear of Ti6Al4V Alloy against Silicon Nitride
Authors: Clement V , Mo J L , Zhu M H , Shen M X , Zhou Z R
Published: August 2010

The rotational fretting of Ti6Al4V titanium alloy flat against silicon nitride (Si3N4) ceramics ball has been investigated by using a special rotational fretting wear test rig. Under various parameters of normal load and angular displacement amplitude, three fretting regimes were observed (i.e. partial slip regime, mixed fretting regime, and slip regime), corresponding to the different evolutions of the running condition at the contact interface. The micro-examination of the wear scars revealed an accumulation of plastic deformation within the centre of the wear scars in the gross slip condition. The damage mechanisms in the different fretting regimes were analysed in detail. The results showed that the mechanisms were quite different in the different fretting regimes.
Experimental investigation to study the performance of solid lubricants in turning of AISI1040 steel
Authors: Vamsi Krishna P , Srikant R R , Rao D N
Published: August 2010

Machining is one of the most fundamental and indispensable processes of the manufacturing industry. The heat generated in the cutting zone during machining is critical in deciding the workpiece quality. Though cutting fluids are widely employed to carry away the heat in machining, their usage poses threat to ecology and the health of workers. Hence, there arises a need to identify eco-friendly and user-friendly alternatives to conventional cutting fluids. Modern tribology has facilitated the use of solid lubricants. The present work features a specific study of the application of solid lubricants in turning of AISI1040 steel with carbide tool. Results show considerable improvement in reducing the cutting forces, coefficient of friction between chip and tool interface, average tool flank wear, and the surface roughness of the machined surface with solid lubricants. Among the selected lubricating conditions boric acid performed well compared to graphite. Chip thickness ratio is also evaluated to study the lubricating action of selected solid lubricants during turning.
A study on the effect of road friction on driveline vibrations
Authors: Bartram M , Mavros G , Biggs S
Published: August 2010

The aim of this article is to assess the influence of the tyre/road contact interface on driveline vibrations. The mode shapes of a vehicle driveline are obtained and analysed, initially using three tyre models: a simple torsional spring, linear slip, and relaxation length-based models. Additionally, a fully transient load- and slip-dependent non-linear relaxation length model is incorporated into the driveline to determine the dynamic response on different surfaces. Simulations of pull-away manoeuvres on various surfaces are carried out. The halfshaft torque in each case is analysed and conclusions drawn on the effect of tyre dynamics on the frequency and intensity of driveline vibrations. In order to investigate the influence of higher-frequency tyre dynamics, a model incorporating tyre belt inertia is simulated for the same cases. It is found that the higher-order dynamics introduced by the tyre belt result in additional frequencies in the response, as well as differences in response amplitude. Using the non-linear relaxation length and belt inertia models it is observed that low-μ surfaces promote driveline vibrations at higher and more numerous frequencies compared with the typical shuffle response observed on a high-μ surface. It is shown that this frequency migration can be physically explained by considering the effect of decoupling between driveline and vehicle on low-μ surfaces. It is also shown that the observed frequencies can be predicted by appropriately modified linear models.
High prevalence of multidrug-resistant strains of Vibrio cholerae, in a cholera outbreak in Tehran–Iran, during June–September 2008
Authors: Ranjbar Mitra , Rahmani Elham , Nooriamiri Abas , Gholami Hossein , Golmohamadi Ali , Barati Hojatollah , Rajabifar Dina , Barati Somayeh , Sabet Mahdiyeh Shafiee , Zamiri Alaleh , Haghighi Sama , Taifehashemi Pariva , Nojomi Marziyeh
Published: August 2010

Following the occurrence of suspected cases of Vibrio cholerae in Karaj in 2008, this study was conducted in order to determine whether or not the cases were infected with cholera and, if so, to describe the prevalence of serotypes, route of transmission and the antimicrobial resistance profile. In this cross-sectional study, 6505 rectal swabs were collected from patients with acute gastroenteritis. Serotypes and biotypes of the isolates were determined by standard procedures. The antimicrobial susceptibility of 45 Inaba and 30 non-agglutinating (NAG) strains was determined. From 6505 specimens, 110 (1.69%) were defined as V. cholerae, including 70 (63.3%) V. cholerae O1 serotype Inaba biotype El Tor and 40 (36.4%) NAG Vibrios. The case fatality rate was 0.9%. Inaba strains were 100% resistant to nalidixic acid and amoxicillin, 95.7% resistant to trimethoprim-sulfamethoxazole, 91.3% resistant to furazolidone while the highest frequency of resistance in NAG Vibrios was 77.4% to erythromycin. The lowest resistance rate belonged to ciprofloxacin to which just one NAG strain was resistant. Results suggests an increase in resistance of V. cholerae to several antibiotics. Ciprofloxacin can still be used as first-line treatment of cholera in this region.
Maalox Brand Name Extension Causes Confusion Near Sight/Sound Dead Hit! Omacor–Amicar Look-alike Tylenol Packets
Authors: Cohen Michael R.
Published: August 2010

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below.

Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or USP ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL-SAFE or via E-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.
Phenobarbital Provides Effective Sedation for a Select Cohort of Adult ICU Patients Intolerant of Standard Treatment: A Brief Report
Authors: Fraser Gilles L. , Riker Richard R.
Published: August 2010

Purpose

Critically ill patients are occasionally resistant to, or become intolerant of, standard sedating agents. We describe our experience using phenobarbital (PB) as an alternative sedative in a select cohort of patients.

Methods

Medical records of adult patients treated with PB for sedation were retrospectively reviewed. Patients receiving barbiturates for seizures, brain injury, or drug withdrawal protocols were excluded. Data are presented as mean ± standard deviation or median (range).

Results

Seven patients were treated with PB after failing standard medications due to refractory agitation (five patients) or propylene glycol toxicity (two patients). Patients were 35 ± 10-years-old, six were female (86%), APACHE II was 16 ± 5, ICU stay was 16 (8 to 88) days, and all seven patients survived. Four patients were initially sedated with lorazepam (mean daily dose = 163 mg), two with propofol (mean dose = 51 mcg/kg/min), and one with both. All seven received fentanyl for analgesia. Patients were switched to PB on ICU day-6 (3 to 50) with 240 (60 to 490) mg given the first day in divided doses. Subsequent doses were titrated to desired response, typically Sedation Agitation Scale (SAS) 3. PB was continued for 6 (3 to 21) days. Quality of sedation appeared similar when assessed with average SAS of 3.5 pre vs 3.7 post, as well as, by the absence of both oversedation (SAS less 3) and medical device removal. Hemodynamic derangements were not noted, and four patients were extubated while receiving PB.

Conclusions

PB provides adequate sedation and may be an alternative for patients intolerant or unresponsive to standard agents.
Docetaxel, Doxorubicin, and Cyclophosphamide (TAC) for Breast Cancer
Authors: Solimando Dominic A. , Waddell J. Aubrey
Published: August 2010

The increasing complexity of cancer chemotherapy heightens the requirement that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy. It will also serve as a review of various agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics should be addressed to Dominic A. Solimando, Jr., President, Oncology Pharmacy Services, Inc., 4201 Wilson Blvd #110-545, Arlington, VA 22203, E-mail: OncRxSvc@aol.com ; or J. Aubrey Waddell, Associate Professor, University of Tennessee College of Pharmacy; Oncology Pharmacist, Pharmacy Department, Blount Memorial Hospital, 907 East Lamar Alexander Parkway, Maryville, TN 37804; E-mail: james_waddell@bell-south.net .
The Implementation of a Personnel Training and Assessment Program for New Standards in the US Pharmacopeia General Chapter <797> Pharmaceutical Compounding of Sterile Preparations
Authors: Trapskin Philip J. , Reagan Rebecca , Hite Kimberley , Armitstead John A.
Published: August 2010

Purpose

The US Pharmacopeia (USP) general Chapter <797> sets standards for personnel training and assessment of aseptic manipulation skills. We describe the implementation of a training and assessment program to meet these standards at an academic medical center.

Methods

Exempt approval by the University of Kentucky Institutional Review Board was granted. All pharmacy personnel responsible for compounding sterile preparations were included. Participants completed three computer-based learning modules (CBLs) related to mathematics skills, aseptic manipulations, and USP <797>. Participants were given an online test, prior to viewing a CBL (pretest) and after completion of a CBL (posttest). Mean pre- and posttest scores were analyzed using a paired Student's t-test. A proctored practical examination involved manipulations of sterile fluid culture media (media-fill challenge) to assess aseptic manipulation skills. Culture media were incubated at room temperature for 14 days and monitored for growth.

Results

A significant increase was found in mean percentage of correct answers for pre- and posttest scores for the aseptic manipulation (85% vs 93%; P < 0.05) and USP <797> (78% vs 90%; P < 0.001) CBLs. The mean percentage of correct answers on the mathematics test was 92%. The results of the media-fill challenge revealed that 4 of the 84 (4.2%) proctored assessments were contaminated.

Conclusion

This personnel training and assessment program meets the requirements of USP <797>. The use of CBLs was effective in teaching and assessing participants on the theoretical and practical principles of aseptic manipulations. The proctored practical assessment meets USP <797> requirements for medium-risk level media-fill challenge tests.
Ramelteon
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: August 2010

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and CD ROM forms and are available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The January 2006 monograph topics are deferasirox, nelarabine, sitaxsentan, sorafenib, and decitabine. The DUE is on deferasirox
Establishing a Patient-Centered Philosophy of Pharmacy Practice
Authors: Weber Robert J. , Sanborn Michael
Published: August 2010

This article begins the “Director's Forum,” a series of articles designed to guide pharmacy leaders in establishing patient-centered services in hospitals. As stated in Dr. Cada's Editorial which introduces this series, we hope to answer key questions that pharmacy directors face and provide others with information to foster growth in pharmacy leadership. The articles in this column will build on one another and, when put together, will serve as a “tool kit” to develop patient-centered pharmacy services in hospitals of all sizes. Examples of topics in future Director's Forums will include establishing clinical service priorities, justifying clinical pharmacist positions, implementing a patient safety program, and budgeting for patient-centered services.
Medication Therapy Management and the Medicare Prescription Drug Benefit
Authors: Teagarden J. Russell
Published: August 2010

Managed care pharmacists are involved formally with the interface between the delivery and financing of health care; their work thus entails an accountability for both elements. Interpreted broadly, managed care pharmacists are pharmacists working within the sphere of a health care system, health care purchaser, health insurer, managed care organization, or benefit administration agency. Patients, the pharmacy profession, and society are best served by this broad interpretation, because the interdependency of financing and delivery is inextricably linked to the achievement of good health outcomes. This continuing feature will explore contemporary issues facing managed care pharmacists.
Daptomycin–Dactinomycin Confusion; Oral Liquid Given IV; Misspelling Leads to Mix-Up; Duragesic-12
Authors: Cohen Michael R.
Published: August 2010

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below.

Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or USP ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL-SAFE or via E-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.
Carmustine, Cisplatin, Dacarbazine, and Tamoxifen (Dartmouth Regimen) for Metastatic Melanoma
Authors: Waddell J. Aubrey , Solimando Dominic A.
Published: August 2010

The increasing complexity of cancer chemotherapy heightens the requirement that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy. It will also serve as a review of various agents, both commercially available and investigational, used to treat malignant diseases.
Chemotherapy Dose Limits Set by Users of a Computer Order Entry System
Authors: Dubeshter Brent , Griggs Jennifer , Angel Cynthia , Loughner John
Published: August 2010

Objective

The elimination of dosing errors related to chemotherapy administration remains an elusive goal. Computerized order entry reduces errors but is not widely used. One problem in implementing computer dose checking is the lack of standardized dose limits. We evaluated the dose limits set for chemotherapeutic agents by users of a computer order entry system.

Methods

Oncology practices from 82 sites using a computer order entry system submitted data via the Web to a central data warehouse on 280,047 drug administrations for 16,976 patients. Data were blinded to patient and site but included the diagnosis, age, chemotherapy regimens, dosages, and dose adjustments. Dose limits, set by users at each location, were assessed. For commonly used regimens, the range of customary doses was also assessed.

Results

The mean dose limit was less than that for a body surface area (BSA) of 2.2 meter squared in 43/44 (98%) of the drugs dosed according to BSA. This user set dose limit was exceeded in only 3% of drug administrations.

Conclusion

In setting computerized dose limits, most oncologists use a dose limit below that for a BSA of 2.2 meters squared. This user set limiting dose was rarely exceeded, with 97% of dosages below the limits set in this computer order entry system.
IV Medication Safety Software Implementation in a Multihospital Health System
Authors: Cassano Angela T.
Published: August 2010

A number of technological advances are becoming incorporated into institutional pharmacy practice in order to reduce the frequency and severity of medication errors. One of these has great promise. They deal with intravenous (IV) medication safety systems, wherein customized drug software is interfaced with “intelligent” infusion pumps. This paper describes the implementation and initial evaluation of Hospira's MedNet decision support infusion software in a five-hospital health care system in Pennsylvania. All of the steps are reviewed (identification of stakeholders, evaluation of software capabilities, evaluation of institution-specific practices, decisions regarding standard operating procedures, writing of the drug libraries, and preparation for “going live”) in detail. In addition, the initial results of the system are described, especially with respect to potential medication errors avoided. The well-documented medication error avoidance potential of such systems has proven useful in a clinical setting.
Metabolic Support of the Thermally Injured Patient
Authors: Dickerson Roland N.
Published: August 2010

Nutrition Support Pharmacist features issues pertinent to the practice of clinical pharmacy in the area of nutritional support. The column is edited by Dr. Roland Dickerson, Professor of Pharmacy, University of Tennessee Health Science Center; Memphis, TN. Address correspondence to Dr. Roland N. Dickerson, University of Tennessee Health Science Center, 26 South Dunlap St., Memphis, TN 38163.

This article provides a summary of our approach to the nutritional management of the thermally injured patient. However, it must be pointed out that there are other alternative effective evidence-based approaches to managing this problematic patient population. There are numerous exceptions to the above outlined guidelines that the astute clinician must be able to identify. However, for the beginning reader, this approach will provide a sound foundation upon which to build their practice in the management of these difficult patients.
Another Fatal Case of Hyperphosphatemia Associated with a Phosphosoda Bowel Preparation; Intravenous Immune Globulin Causes Myocardial Infarction; Hepatotoxicity Due to Acarbose Therapy; Mitochondrial Toxicity with Linezolid; Venlafaxine and the Rapid Development of Anasarca; Neuropathy Exacerbated by Rituximab Therapy; Drug-Related Emergency Department Visits in an Elderly Population; House Staff Report on Adverse Events and Their Causes
Authors: Shuster Joel
Published: August 2010

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the FDA's medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers. Write to Dr. Shuster at ISMP, 1800 Byberry Road, Suite 810, Huntingdon Valley, PA 19006 (call 215-947-7797; fax 215-914-1492; E-mail joel.shuster@temple.edu ). Your report will be published anonymously unless otherwise requested. This feature is provided by the Institute for Safe Medication Practices in cooperation with the FDA's medWatch Program and Temple University School of Pharmacy. ISMP is an FDA medWatch partner.
Tadalafil: Raynaud Phenomenon
Authors: Generali Joyce , Cada Dennis J.
Published: August 2010

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Wolters Kluwer Health. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form, so the reader can easily identify the scope of information available. A summary of the data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments regarding “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Evaluation of Turnaround Time for Medication Order Processing with Use of a Novel Scanning System
Authors: Carswell Jody L. , Dipiro Cecily V. , Gomez Tad A. , Phillips Marjorie S. , Herrington Ben
Published: August 2010

Purpose

The efficiency in turn around time for medication order processing and level of compliance with the Pharmacy's Service Level Agreement with Nursing were assessed using a novel scanning system developed by the Information Services Department at the Medical College of Georgia Health System.

Methods

Two phases: Phase 1 assessed medication turn around time for a nursing unit prior to implementation of OrderComm. Phase 2 assessed medication turn around time post implementation of OrderComm. Evaluating points for both phases included order entry time (time the order reaches the pharmacy to entry into computer), order entry to delivery (time it takes for medication to become available to the nursing staff), and order completion time (time the order reaches the pharmacy to the time it becomes available to the nursing staff). Both phases occurred over 5 days on the dayshift (8 AM to 5 PM).

Results

Average order entry time for phase 1 was 43 minutes (SD = 28.22 min, N = 96) and for phase 2 was 9.4 minutes (SD = 13.12min, N = 95). Average order completion time was 44 minutes (SD = 30.03 min, N = 96) for phase 1 and 14.2 minutes (SD = 20.01 min, N = 95) for phase 2. Based on Service Level Agreement criteria, only 71% of Pyxis orders met goal in phase 1 compared to 98% in phase 2.

Conclusion

Use of a novel scanning system had a positive impact on pharmacy services. With the use of OrderComm, the Pharmacy Department can now meet the agreements outlined with nursing in the Service Level Agreement.
Lidocaine/Tetracaine Patch
Authors: Cada Dennis J. , Arnold Barbara , Levien Terri , Baker Danial E.
Published: August 2010

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and CD ROM forms and are available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The March 2006 monograph topics are conivaptan hydrochloride injection, abatacept, sorafenib tosylate, lenalidomide, and tetanus toxoid, reduced diptheria toxoid, and acellular pertussis vaccine absorbed (Tdap). The DUE is on conivaptan.
Nelarabine; Sorafenib
Authors: Waddell J. Aubrey , Solimando Dominic A.
Published: August 2010

The increasing complexity of cancer chemotherapy heightens the requirement that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy. It will also serve as a review of various agents, both commercially available and investigational, used to treat malignant diseases.
Adalimumab: Psoriatic Arthritis
Authors: Generali Joyce , Cada Dennis J.
Published: August 2010

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Wolters Kluwer Health. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form, so the reader can easily identify the scope of information available. A summary of the data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments regarding “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Association of Mortality Risk with High Serum Digoxin Concentrations
Authors: Rising Susanne E. , Welch Justin M. , Koo Ji M.
Published: August 2010

Background

There are data suggesting a possible association of serum digoxin concentrations (SDC) and risk of mortality in patients treated with digoxin.

Objective

To determine whether SDCs in the therapeutic range of 1.2 to 2 ng/mL increase the risk of mortality when compared to a lower range of 0.5 to 1.1 ng/mL.

Methods

Retrospective cohort study to compare the risk of mortality in male patients with SDCs less than 1.2 ng/mL to patients with SDCs of 1.2 to 2 ng/mL.

Results

A total of 261 male patients were included, 191 (73%) had SDCs in the low range (0.5 to 1.1 ng/mL), and 70 (27%) had SDCs in the high range (at least 1.2 to 2 ng/mL). A high SDC showed a significant increase in risk for mortality with a hazard ratio (HR) of 1.656; 95 % HR confidence interval, 1.153 to 2.38; P = 0.0063.

Conclusion

Our results showed an increased risk of mortality in the high SDC group (1.2 to 2 ng/mL). This study's findings are consistent with the results of a post hoc evaluation of SDC in male patients in the DIG trial. 1 A prospective trial is warranted to confirm our findings.
Opportunities for Optimizing Pantoprazole Therapy in Patients with Acute Upper Gastrointestinal Bleeding
Authors: Saran Mandeep K. , Loewen Peter S. , Zed Peter J.
Published: August 2010

Purpose

To evaluate the appropriateness of intravenous (IV) pantoprazole in subjects presenting with signs suspicious of acute gastrointestinal bleeding (AGIB) and to identify opportunities for optimizing its use.

Methods

Retrospective health record review of subjects receiving IV pantoprazole for suspected or confirmed AGIB was conducted at two affiliated teaching hospitals.

Results

Of the 175 subjects enrolled, 157 (90%) received a diagnostic endoscopy. The median time to endoscopy was 18.5 hours, and the median time to start pantoprazole was 6.9 hours. Thirty-seven subjects (21%) did not receive the appropriate pantoprazole dose of 80 mg bolus followed by 8 mg/h infusion, and 22 high-risk subjects (33%) received less than 60 hours of IV pantoprazole. The median duration of pantoprazole following endoscopy for low-risk subjects was 21.1 hours.

Conclusion

Opportunities to optimize the use of IV pantoprazole include initiating therapy quickly at the appropriate dosing regimen, continuing the infusion for 72 hours in patients with high-risk bleeds, and discontinuing the infusion promptly once a high-risk AGIB is ruled out.
Core Competencies in Hospital Pharmacy - Intravenous Admixtures
Authors: Sanborn Michael
Published: August 2010

The next several Director's Forum articles will focus on core practices or competencies in hospital pharmacy practice. This series of articles will discuss the key fundamentals, resources, challenges, and opportunities associated with drug dispensing. Future core competency forums will include discussions on medication ordering, intravenous admixtures, data analysis, and regulatory requirements.

In Director's Forum, we hope to answer key questions that pharmacy directors face and provide others with information to foster growth in pharmacy leadership. The articles in this column will build on one another and, when put together, will serve as a “tool kit” to develop patient-centered pharmacy services in hospitals of all sizes. Examples of topics in future Director's Forums will include establishing clinical service priorities, justifying clinical pharmacist positions, implementing a patient safety program, and budgeting for patient-centered services.