bluuebunny/crossref_metadata_2025 huggingface dataset:
Hybrid fuzzy position/force control by adaptive network-based fuzzy inference system for robot manipulator mounted on oscillatory base
Authors: Lin Jonqlan , Lin Chun-Chiang
Published: September 2013

This study considered the hybrid position/force control of robots with an oscillatory base. The objective when controlling such a system is to control the contact force between the environment and the object in the constrained directions. The auxiliary control input laws with the ANFIS tuning methodology were successfully applied to robot manipulators mounted on an oscillatory base to provide hybrid position/force control. Linguistic fuzzy information from human knowledge was incorporated into the fuzzy system, which was equipped with a training algorithm. The advantage of the proposed control scheme is that only select control inputs are needed to select control inputs for task space trajectory tracking. In other words, such a system does not require the redesign of the vibration damping controller. Tracking performance comparison is also presented for the proposed control scheme and the other existing control techniques. It is shown that the proposed fuzzy control scheme offers several implementation advantages such as less steady-state errors, reduced effect of overshoot, and a fast convergent rate in real-time verification. The experimental results of this study confirmed the efficiency of the proposed control design and its feasibility for use in various mechanical systems, including mobile robots, gantry cranes, underwater robots, and other dynamic systems mounted on oscillatory bases and used to perform constrained motion tasks.
Adaptive control design for Arneodo chaotic system with state constraint
Authors: Tang Li , Liu Lei , Liu Yan-Jun
Published: September 2013

This article focuses on the adaptive control problem for Arneodo chaotic systems. It is considered a phenomenon of single state constraint for the systems. In the proposed scheme, the barrier Lyapunov function approach was successfully used to prevent the single state from violating constraint conditions. In the current circumstances, a great many of the results for chaotic systems neglect the situation of constraint. Finally, it is proved that all the signals in the Arneodo chaotic system are bounded. A representative example is proposed in numerical simulations compared with existing results. The performance of the proposed control scheme was validated by using a simulated example.
Wave propagation technique for free vibration analysis of annular circular and sectorial membranes
Authors: Bahrami Arian , Ilkhani Mohammad Reza , Bahrami Mansour Nikkhah
Published: September 2013

Wave propagation is one of the famous approaches for analyzing the vibration of solid structures. Literature reviews show that most bodies analyzed with this approach are one-dimensional waveguide structures. In this paper, the free vibration of annular circular and sectorial membranes are analyzed using the wave propagation approach. Firstly, the propagation and reflection matrices are derived. Then, a concise and systematic approach for obtaining the natural frequencies is presented which can be a reference for future studies. The solution obtained by this method is exactly the same as those derived by the classical method.
Youth Who Sexual Offended
Authors: Chu Chi Meng , Koh Li Lian , Zeng Gerald , Teoh Jennifer
Published: September 2013

There has been an increased focus on understanding youth sexual offending in recent years, but there has been limited empirical research on the causes, pathways, and treatment of youth who have sexually offended—especially within a non-Western context. The Good Lives and Self-Regulation Models have often been used to understand and rehabilitate adult sexual offenders, but (unfortunately) there is scant research on youth who sexually offended using these models. The present study aims to describe the different primary goods that are associated with youth sexual offending behaviors in an Asian context. In addition, the study sought to explore whether the age of victim (child vs. nonchild) and nature of sexual offense (penetrative vs. nonpenetrative) influenced the youth’s engagement in offense pathways. The results suggest that pleasure, relatedness, and inner peace were the primary human goods that were most sought after by a sample of 168 youth who sexually offended in Singapore. In addition, offender classification (in relation to the age of victim and nature of sexual offense) influenced the pathways to sexual offending. Therefore, these findings have important clinical implications for assessment, management, and intervention planning for youth who sexually offended.
‘You have to choose a novel’: The biopolitics of critical management education
Authors: Śliwa Martyna , Sørensen Bent Meier , Cairns George
Published: September 2013

In this article, we engage empirically with the biopolitical nature of pedagogic practice in critical management education. We do so through considering the effects of employing literary fiction in an introductory management and organization module taught to master’s degree students in a UK business school. We see the deployment of fictional literature in teaching as a way of consciously intervening in this biopolitical predicament. By urging students to work with fictional literature that has been part of their personal past, we encourage them to develop a ‘care of the self’. In the analysis, we first discuss the pedagogic process of the module, reflecting on our own presumptions and behaviours. Second, on the basis of students’ assignments, we analyse the outcome of their learning. In the concluding discussion, we argue that the fact that critical management education is already biopolitical does not preclude the possibility for it to renew educational practice. We suggest that as a result of the potential for creative self-formation offered by the use of literary fiction, transformation of both students and educators is possible.
Monitoring oil film regimes with acoustic emission
Authors: Hamel Mhmod , Addali Abdulmajid , Mba David
Published: September 2013

The major purpose of a gear lubricant is to provide adequate oil film thickness to reduce and prevent gear tooth surface failures. Real-time monitoring for gear failures is important in order to predict and prevent unexpected failures which would have a negative impact on the efficiency, performance and safety of the gearbox. This paper presents experimental results on the influence of specific oil film thickness on acoustic emission activity for operational helical gears. Variation in film thickness during operations was achieved by spraying liquid nitrogen onto the rotating gear wheel. The experimental results demonstrated a clear relationship between the root mean square value of the acoustic emission signal and the specific film thickness. The findings demonstrate the potential of acoustic emission technology to quantify lubrication regimes on operational gears.
Party novelty
Authors: Litton Krystyna
Published: September 2013

In this study, I propose a more differentiated conceptualization of party novelty that shifts from the age of party, and viewing newness in terms of organizational youthfulness (how close to birth, how far removed from death), to something more complex, i.e. the ‘newness’ of party leaders, programmes, names, etc. Thus, this concept supplements the understanding of novelty in strictly organizational terms proposing to consider also other elements. I call it a ‘thick’ conceptualization of party novelty. I argue that, in a given electoral cycle, any party is new to some degree. I propose to measure party novelty considering changes of party attributes and changes of party structural affiliation. I present the Party Novelty Database, which records changes in national parties participating in the EU parliamentary elections from 1989 to 2009. I show that party novelty exists and varies. In more than 80 percent of cases, parties changed themselves in various ways and to varying degree, with Italy and France showing the highest levels of novelty and Finland and Sweden the lowest over the period considered. In conclusion, I suggest the ways in which the concept and the measure of party novelty can be used to explain political phenomena.
Interactive party effects on electoral performance
Authors: Koev Dan
Published: September 2013

While the rise of right-wing populism in West European politics has received considerable attention in academic circles, the equivalent phenomenon in Central and Eastern Europe (CEE) remains understudied. I address this gap by examining the factors contributing to right-wing populist party success in CEE. I argue that the success of such parties is best explained by the presence of salient ethnic minority parties. I propose that successful ethnic minority parties heighten the salience of ethno-nationalist divisions within a state, creating electoral demand for parties of the populist right. Political elites capitalize on the fear generated by the presence of strong minority parties and channel it into electoral support for the populist right. Performing statistical analysis on an original dataset of 108 CEE elections, I find evidence that the electoral performance of right-wing populist parties is influenced by the performance of ethnic minority parties and their participation in government.
Local candidate lists
Authors: Åberg Martin , Ahlberger Christer
Published: September 2013

Using Sweden as an example, we propose the hypothesis that local candidate lists rest on a different rationale compared to national party lists, more specifically a rationality that has developed as a result of an altered relationship between the local and national levels and is expressed in terms of localism. The emergence of new local lists is most likely an effect of the challenges to the welfare state posed in the past 40 years. However, although local lists are essentially a recent phenomenon, our examples suggest that their existence can also be explained in terms of historical patterns of dissent from and resistance to state intervention at the local level.
The enactment of knowledge translation: a study of the Collaborations for Leadership in Applied Health Research and Care initiative within the English National Health Service
Authors: D’Andreta Daniela , Scarbrough Harry , Evans Sarah
Published: September 2013

Objectives

We contribute to existing knowledge translation (KT) literature by developing the notion of ‘enactment’ and illustrate this through an interpretative, comparative case-study analysis of three Collaborations for Leadership in Applied Health Research and Care (CLAHRC) initiatives. We argue for a focus on the way in which the CLAHRC model has been ‘enacted’ as central to the different KT challenges and capabilities encountered.

Methods

A comparative, mixed method study created a typology of enactments (Classical, Home-grown and Imported) using qualitative analysis and social network analysis.

Results

We identify systematic differences in the enactment of the CLAHRC model. The sources of these different enactments are subsequently related to variation in formative interpretations and leadership styles, the implementation of different governance structures, and the relative epistemic differences between the professional groups involved.

Conclusions

Enactment concerns the creative agency of individuals and groups in constituting a particular context for their work through their local interpretation of a particular KT model. Our theory of enactment goes beyond highlighting variation between CLAHRCs, to explore the mechanisms that influence the way a particular model is interpreted and acted upon. We thus encourage less focus on conceptual models and more on the formative role played by leaders of KT initiatives.
The expression of depression among Javanese patients with major depressive disorder: A concept mapping study
Authors: Brintnell E. Sharon , Sommer Ryan W. , Kuncoro Bambang , Setiawan G. Pandu , Bailey Patricia
Published: September 2013

In this study, we explored the presentation of clinical depression in Java, Indonesia. Interviews were conducted with 20 Javanese patients (male and female) with major depressive disorder from both lower and higher socioeconomic levels. The recruited participants came from provincial and private mental health hospitals in the cities of Solo, Yogykarta (Jogja), Jakarta, and Malang on the island of Java, Indonesia. Concept mapping methodology using multidimensional scaling and hierarchical cluster analysis was used to identify underlying themes in the expression of depressive phenomena in this Indonesian population. The results identified themes that grouped into six clusters: interpersonal relationships, hopelessness, physical/somatic, poverty of thought, discourage, and defeat. Findings give support to the view that culture influences the expression of Indonesian depressive phenomenology, which nevertheless has some common roots with Western clinical pictures of the disorder. Cultural influences may mask symptoms of the disorder to clinicians. Diagnostic and assessment tools must be carefully selected to ensure they address culturally specific expressions of depression.
Performance of straight-run naphtha single- and two-stage combustion modes from low to high load
Authors: Yang Hongqiang , Shuai Shijin , Wang Zhi , Wang Jianxin , Xu Hongming
Published: September 2013

Double injection strategies with single-stage heat release and two-stage heat release process of straight-run naphtha were investigated on a single-cylinder diesel engine from low to high load. The two-stage combustion strategy is realized by split spray and combustion events around the compression top dead center with a dominant feature of “Combust After Injection End, Inject After Combustion End” to ensure the premixed compression ignition. The single-stage combustion is realized by the “spray–spray–combustion” process with the start of combustion separated from the end of injection. The straight-run naphtha has a research octane number of 58.8, and the compression ratio and displacement of the test engine are 16.7 and 0.5 L. Double injection strategy is used to generate the single- and two-stage combustion modes with different injection timing. NOx and total hydrocarbon emissions of the two-stage combustion mode are lower than that of single heat release mode in this study, and it is much easier to produce two-stage combustion mode at higher engine load. Diesel is also tested under double injection strategy just as the single heat release mode of straight-run naphtha, but the fuel efficiency and emission performance are worse than that of naphtha.
A family living with Alzheimer’s disease: The communicative challenges
Authors: Jones Danielle
Published: September 2013

Alzheimer’s disease irrevocably challenges a person’s capacity to communicate with others. Earlier research on these challenges focused on the language disorders associated with the condition and situated language deficit solely in the limitations of a person’s cognitive and semantic impairments. This research falls short of gaining insight into the actual interactional experiences of a person with Alzheimer’s and their family. Drawing on a UK data set of 70 telephone calls recorded over a two-and-a-half year period (2006–2008) between one elderly woman with Alzheimer’s disease, and her daughter and son-in-law, this paper explores the role which communication (and its degeneration) plays in family relationships. Investigating these interactions, using a conversation analytic approach, reveals that there are clearly communicative difficulties, but closer inspection suggests that they arise due to the contingencies that are generated by the other’s contributions in the interaction. That being so, this paper marks a departure from the traditional focus on language level analysis and the assumption that deficits are intrinsic to the individual with Alzheimer’s, and instead focuses on the collaborative communicative challenges that arise in the interaction itself and which have a profound impact on people’s lives and relationships.
National to Global Citizenship
Authors: Johnson John M.
Published: September 2013

Nation-states are located at a moment in time, beginning with the First Industrial Revolution, when parties struggled for military and political access to natural (largely fossil) resources. This produced horrendous consequences of 20th-century wars and conflicts, costing millions of lives. We now face the tasks of developing a biosphere consciousness, based on our recognition of common connectivity. This new era presents new and difficult challenges for scientists and intellectuals.
Cardiac Risk Assessment, Morbidity Prediction, and Outcome in the Vascular Intensive Care Unit
Authors: Dover Mary , Tawfick Wael , Hynes Niamh , Sultan Sherif
Published: September 2013

Objectives:

The aim of this study is to examine the predictive value of the Lee revised cardiac risk index (RCRI) for a standard vascular intensive care unit (ICU) population as well as assessing the utility of transthoracic echocardiography and the impact of prior coronary artery disease (CAD) and coronary revascularization on patient outcome.

Design:

This is a retrospective review of prospectively maintained Vascubase and prospectively collected ICU data.

Materials and Methods:

Data from 363 consecutive vascular ICU admissions were collected. Findings were used to calculate the RCRI, which was then correlated with patient outcomes. All patients were on optimal medical therapy (OMT) in the form of cardioselective β-blocker, aspirin, statin, and folic acid.

Results:

There was no relationship found between a reduced ejection fraction and patient outcome. Mortality was significantly increased for patients with left ventricular hypertrophy (LVH) as identified on echo (14.9% vs 6.5%, P = .028). The overall complication rates were significantly elevated for patients with valvular dysfunction. Discrimination for the RCRI on receiver–operating characteristic analysis was poor, with an area under the receiver–operating characteristic curve of .621. Model calibration was reasonable with an Hosmer-Lemeshow Ĉ statistic of 2.726 ( P = .256). Of those with known CAD, 41.22% of the patients receiving best medical treatment developed acute myocardial infarction (AMI) compared to 35.3% of those who previously underwent percutaneous cardiac intervention and 23.5% of those who had undergone coronary artery bypass grafting. There was 3-fold increase in major adverse clinical events in patients with troponin rise and LVH.

Conclusions:

The RCRI’s discriminatory capacity is low, and this raises difficulties in assessing cardiac risk in patients undergoing vascular intervention. The AMI is highest in the OMT group without prior cardiac intervention, which mandates protocols to identify patients requiring cardiac intervention prior to vascular procedures.
Computational Fluid Dynamics Investigation of Chronic Aortic Dissection Hemodynamics Versus Normal Aorta
Authors: Karmonik Christof , Müller-Eschner Matthias , Partovi Sasan , Geisbüsch Philipp , Ganten Maria-Katharina , Bismuth Jean , Davies Mark G. , Böckler Dittmar , Loebe Matthias , Lumsden Alan B. , Tengg-Kobligk Hendrik von
Published: September 2013

Objectives:

To evaluate hemodynamic changes during aneurysmal dilatation in chronic type B aortic dissections compared to hemodynamic parameters in the healthy aorta with the use of computational fluid dynamics (CFD).

Methods:

True lumen (TL)/false lumen (FL) dimensional changes, changes in total pressure (TP), and wall shear stress (WSS) were evaluated at follow-up (FU) compared to initial examination (IE) with transient CFD simulation with geometries derived from clinical image data and inflow boundary conditions from magnetic resonance images. The TL/FL pressure gradient between ascending and descending aorta (DAo) and maximum WSS at the site of largest dilatation was compared to values for the healthy aorta.

Results:

Hemodynamic changes at site of largest FL dilatation included 77% WSS reduction and 69% TP reduction. Compared to the healthy aorta, pressure gradient between ascending and DAo was a factor of 1.4 higher in the TL and a factor of 1.5 in the FL and increased at FU (1.6 and 1.7, respectively). Maximum WSS at the site of largest dilatation was a factor of 3 lower than that for the healthy aorta at IE and decreased by more than a factor of 2 at FU.

Conclusions:

The FL dilatation at FU favorably reduced TP. In contrast, unfavorable increase in pressure gradient between ascending and DAo was observed with higher values than in the healthy aorta. Maximum WSS was reduced at the site of largest dilation compared to healthy aorta.
Improving Classification Accuracy of Motor Imagery EEG Using Genetic Feature Selection
Authors: Hsu Wei-Yen
Published: September 2013

In this study, an electroencephalogram (EEG) analysis system combined with feature selection, is proposed to enhance the classification of motor imagery (MI) data. It principally comprises feature extraction, feature selection, and classification. First, several features, including adaptive autoregressive (AAR) parameters, spectral power, asymmetry ratio, coherence and phase-locking value are extracted for subsequent classification. A genetic algorithm is then used to select features from the combination of the aforementioned features. Finally, the selected features are classified by support vector machine (SVM). Compared with “without feature selection” and back-propagation neural network (BPNN) on MI data from 2 data sets, the proposed system achieves better classification accuracy and is suitable for the applications of brain–computer interface (BCI).
An Enhanced Model for combined heat and air infiltration energy simulation
Authors: Younes Chadi , Shdid Caesar Abi
Published: September 2013

The need for efficient, sustainable, and planned utilization of resources is ever more critical. Several building energy analysis tools have been developed to assess energy demands and lifecycle energy costs in buildings. Such analyses are essential for an efficient heating, ventilation, and air conditioning design that overcomes the pitfalls of an under/over-designed system. Studies have estimated air infiltration accounts for up to 50% of a building’s energy demand. This stresses the need that energy simulation engines accurately account for air infiltration. An Enhanced Model for air infiltration has been developed.
Dehydroepiandrosterone and metyrapone partially restore the adaptive humoral and cellular immune response in endotoxin immunosuppressed mice
Authors: Rearte Bárbara , Maglioco Andrea , Machuca Damián , Greco Daiana Martire , Landoni Verónica I , Rodriguez-Rodrigues Nahuel , Meiss Roberto , Fernández Gabriela C , Isturiz Martín A
Published: September 2013

Prior exposure to endotoxins renders the host temporarily refractory to subsequent endotoxin challenge (endotoxin tolerance). Clinically, this state has also been pointed out as the initial cause of the non-specific humoral and cellular immunosuppression described in these patients. We recently demonstrated the restoration of immune response with mifepristone (RU486), a receptor antagonist of glucocorticoids. Here we report the treatment with other modulators of glucocorticoids, i.e. dehydroepiandrosterone (DHEA), a hormone with anti-glucocorticoid properties, or metyrapone (MET) an inhibitor of corticosterone synthesis. These drugs were able to partially, but significantly, restore the humoral immune response in immunosuppressed mice. A significant recovery of proliferative responsiveness was also observed when splenocytes were obtained from DHEA- or MET-treated immunosuppressed mice. In addition, these treatments restored the hypersensitivity response in immunosuppressed mice. Finally, although neither DHEA nor MET improved the reduced CD4 lymphocyte count in spleen from immunosuppressed mice, both treatments promoted spleen architecture reorganization, partially restoring the distinct cellular components and their localization in the spleen. The results from this study indicate that DHEA and MET could play an important role in the restoration of both adaptive humoral and cellular immune response in LPS-immunosuppressed mice, reinforcing the concept of a central involvement of endogenous glucocorticoids on this phenomenon.
Diffuse large B-cell lymphoma in adults aged 75 years and older: a single institution analysis of cause-specific survival and prognostic factors
Authors: Smith Stephen D. , Chen Andy , Spurgeon Stephen , Okada Craig , Fan Guang , Dunlap Jennifer , Braziel Rita , Maziarz Richard
Published: September 2013

Background:

Very elderly patients (75 years and older) with diffuse large B-cell lymphoma (DLBCL) will be increasingly considered for cancer treatment as the population ages, but are underrepresented in clinical trials. Here we report outcomes of very elderly DLBCL patients treated in the modern era at the Oregon Health and Science University (OHSU).

Methods:

We queried the OHSU Tumor Registry for DLBCL cases treated since 2002. A total of 73 patients aged 75 years or older were analyzed under Institutional Review Board approval.

Results:

With a median follow up of 31 months, cause-specific survival was 58% and overall survival 51% at 3 years. Incorporation of an anthracycline did not influence outcomes. More than one extranodal site or poor-risk disease by Revised International Prognostic Index score were adversely prognostic, but pathologic features studied were not.

Conclusions:

Very elderly patients with DLBCL require prospective studies, which employ novel risk stratification and therapeutic approaches.
Cigarette smoking is a modifiable risk factor for Barrett's oesophagus
Authors: Balasubramanian Gokulakrishnan , Gupta Neil , Giacchino Maria , Singh Mandeep , Kanakadandi Vijay , Gaddam Srinivas , Wani Sachin B , Higbee April D , Rastogi Amit , Bansal Ajay , Sharma Prateek
Published: September 2013

Background

Cigarette smoking has been associated with an increased risk of oesophageal adenocarcinoma (OAC). However, the impact of smoking and more importantly smoking cessation on Barrett’s oesophagus (BO) is unclear.

Objective

The aim of the study is to evaluate the association between cigarette smoking and presence of BO in a large prospective cohort of patients with gastro‐oesophageal reflux disease (GORD).

Methods

Patients presenting to the endoscopy unit for upper endoscopy completed a validated GORD questionnaire and information on demographics (age, gender, and ethnicity), cigarette smoking [status (current/past), amount (pack years) and duration of smoking cessation], clinical data [medication history, body mass index (BMI), and family history] and endoscopic findings [BO and hiatal hernia] were recorded. Cigarette smokers (current and past) and nonsmokers were compared using Fisher’s Exact test for categorical variables and Mann–Whitney test for continuous variables. Effects of cigarette smoking and smoking cessation on BO risk was assessed by stepwise logistic regression analysis.

Results

A total of 1056 patients were included in the analysis [mean age: 57.2 ± 12.7years, Caucasian 880 (83.3%), male 985 (93.3%), and mean BMI 29.6 (SD: ± 5.6)]. 827 (78.3%) were smokers and 229 (21.6%) were nonsmokers. 474 subjects (44.9%) had a previous history of smoking. Anytime smokers were more likely to have BO (adjusted OR: 3.3; 95 CI: 1.7–6.3; p  < 0.01). Higher smoking burden (pack years) was associated with higher risk of BO in this GORD cohort (p for trend < 0.01). Duration of smoking cessation was inversely associated with risk of BO (p for trend: 0.01).

Conclusion

This study shows that smokers with reflux symptoms have about threefold higher risk of BO compared with nonsmokers, whereas discontinuing smoking is associated with a significant reduced risk. Smoking cessation appears to be a viable option to reduce BO risk in patients with reflux disease.
Prescription Assistance for Older Adults with Limited Incomes: Client and Program Characteristics
Authors: Upchurch Gina A , Menon Manoj P , Levin Kimberly S , Catellier Diane J , Conlisk Elizabeth A
Published: September 2013

Objective:

To describe the sociodemographic, medication-related, health services utilization and health characteristics of the community-dwelling senior citizens (≥65 y) with limited incomes who enrolled in Senior PHARM Assist, a community-based prescription assistance program.

Patients:

Senior citizens (n = 387) enrolled in the program between June 1994 and May 1996. All eligible participants were 65 years of age or older, had incomes below 140% of the federal poverty level, but were not enrolled in Medicaid. All the patients were living in Durham County and were taking prescription medications.

Measurements:

Self- or caregiver-reported. In addition to demographic characteristics, polypharmacy (taking ≥5 prescription medications in the last month), medication adherence (adherence to directions on the medication container), medication knowledge (client or caregiver stated appropriate purpose for taking the medication), adverse effects from medications, and activities of daily living and instrumental activities of daily living limitations were measured.

Results:

Eighty percent of the senior citizens lived below the federal poverty level, 82% were women, 53% were African-American, 53% lived alone, and the mean monthly income for a single person was $595 and for a couple was $939. They were taking, on average, 8.9 medications, were adherent with 71% of their medications, knew the purpose of 69% of their medications, and reported adverse effects from 10% of their prescription medications.

Conclusions:

This population of community-dwelling seniors takes, on average, a higher number of prescription medications than previously reported, posing a higher risk for the hazards associated with polypharmacy and uncoordinated prescribing, such as nonadherence, drug interactions, and adverse effects. There may be a greater need for future intervention programs to include a comprehensive educational component, such as a coordinated medication review, in addition to financial assistance.
Clinical Application and Evaluation of Vancomycin Dosing in Adults
Authors: Rushing Todd A , Ambrose Peter J
Published: September 2013

Objective:

To evaluate the accuracy of a vancomycin dosing method (study method) in estimating volume of distribution (Vd) and clearance of vancomycin (Clvanco) and the frequency with which it would provide serum vancomycin concentrations (SVCs) within a specified range compared with other published methods.

Methods:

One hundred and seven patients with 108 pairs of SVCs were used to calculate patient-specific Vd and Clvanco. Based on these patient-specific Vd and Clvanco values, the predictive ability of the estimated parameters from the study dosing method (Vd [L] = 0.17 [age] + 0.22 [actual body weight] + 15; Clvanco = creatinine clearance) was evaluated against three previously published pharmacokinetic dosing methods, using predictive performance analysis (precision and bias). Furthermore, the patient-specific pharmacokinetic parameters were used to simulate steady-state peak and trough SVCs, using first-order pharmacokinetic equations from doses derived from the study method, the three different pharmacokinetic methods, and two other published dosing schemes. The frequency with which each method would have achieved target peak and trough SVCs was determined.

Results:

The study method was found to be more precise and less biased (p < 0.05) than comparative methods in predicting vancomycin Vd and Clvanco. The study method also resulted in a higher frequency of steady-state peak and trough SVCs within the target range specified.

Conclusions:

The study method presented here provided a reliable estimation of vancomycin pharmacokinetic parameters that was easily applied to various patient populations to individualize vancomycin dosing, and frequently yielded SVCs within a predictable and desired range.
Zaleplon for Insomnia
Authors: Maidment Ian D
Published: September 2013

Objective:

To assess the effectiveness data of zaleplon.

Data Sources:

Primary and review articles were identified by MEDLINE (1985 to August 2000) and via secondary sources.

Study Selection and Data Extraction:

All of the articles identified from the data sources were evaluated, and all information deemed relevant was included in this review.

Data Synthesis:

Eight studies were identified. Two trials in a nonelderly population investigated the effectiveness of zaleplon and the incidence of withdrawal symptoms. Zaleplon's only significant effect on insomnia was to reduce sleep latency by six to 16 minutes. The tools used in the trials showed that stopping zaleplon after 14–28 days of therapy did not cause significant rebound events. Two recent studies that investigated the use of zaleplon in the elderly produced similar results, although one study showed that stopping zaleplon causes significant rebound events. Three studies determined whether zaleplon caused any hangover effects and concluded that there is a low potential for these effects in a nonelderly population. In healthy nonelderly volunteers, standard doses of zaleplon had no residual effects when taken as little as two hours before the subjects arose. One small-scale study indicated that the abuse potential of zaleplon is similar to that of benzodiazepines.

Conclusions:

Although zaleplon significantly reduces sleep latency, the effect does not appear to be highly clinically significant. Zaleplon's short half-life does appear to reduce the risk of hangover effects. Until further data become available, zaleplon should be considered to have the same abuse potential as benzodiazepines.
Once-Weekly Intravenous Administration of Recombinant Human Erythropoietin for Anemia following Hematopoietic Stem Cell Transplantation
Authors: Bilgrami Syed FA , Naqvi Bilal H , Fox Judee M , Furlong Fiona M , Clive Jonathan M
Published: September 2013

Objective:

To determine the response to once-weekly intravenous administration of recombinant human erythropoietin (rHuEPO) in individuals who develop severe anemia following hematopoietic stem cell transplantation (HSCT).

Design:

A serum erythropoietin (EPO) concentration was obtained by chemiluminescence immunoassay in recipients of allogeneic or autologous stem cell transplantation who had developed severe anemia (hemoglobin <8.5 g/dL). If the erythropoietin concentration was not as high as predicted for the degree of anemia, rHuEPO was initiated at a dosage of 40,000 units intravenously once weekly. The medication was administered through a permanent indwelling central venous catheter on an outpatient basis. Hemoglobin concentration was measured at least weekly for up to 12 weeks prior to the administration of rHuEPO, and for an equivalent period following the initiation of therapy. Packed red blood cells were transfused for a hemoglobin concentration <8.5 g/dL. The mean weekly transfusion requirements prior to and following the initiation of rHuEPO were compared.

Results:

Ten consecutive patients who developed severe anemia after allogeneic (n = 8) or autologous (n = 2) HSCT for a variety of hematologic malignancies were eligible for the study. The median age was 43.5 years, and the male to female ratio was 3:7. There was no evidence of renal failure, iron or vitamin deficiency, hemoglobinopathy, or active blood loss. The median EPO concentration was 102 mU/mL. rHuEPO was begun at a median of 41 days following stem cell infusion. Patients received a median dose of 580 units/kg/wk. Two patients developed severe intestinal hemorrhage as a result of acute graft-versus-host disease. The remaining eight individuals received their last transfusion of packed red blood cells a median of 27 days after the initiation of rHuEPO therapy. The mean weekly transfusion requirement prior to and following the commencement of rHuEPO therapy was 0.93 and 0.40, respectively. This difference was statistically significant (p = 0.024).

Conclusions:

rHuEPO 40,000 units intravenously once weekly may reduce packed red blood cell transfusion requirements in some patients who develop severe anemia after HSCT. However, its use should be limited to individuals who are either intolerant of, or unwilling to use, the subcutaneous route of administration.
Angiotensin-Converting Enzyme Inhibitors in Congestive Heart Failure: Practice versus Guidelines
Authors: Thilly Nathalie , Briançon Serge , Juilliere Yves , Dufay Edith , Zannad Faiez
Published: September 2013

Background:

Angiotensin-converting enzyme (ACE) inhibitors decrease morbidity and mortality in patients with systolic heart failure. In the practice of cardiology, ACE inhibitors are insufficiently prescribed by cardiologists.

Objective:

To measure the deviation between observed practice and clinical practice guidelines (CPGs), and to identify factors contributing to the deviation.

Methods:

CPGs have been developed from available international guidelines via a procedure involving a consensus group. A practice survey was conducted on 208 patients less than 75 years old hospitalized in public hospital cardiology units. Factors associated with nonadherence to CPGs were identified among characteristics of patients, practitioners, and cardiology units in logistic regression models.

Results:

In patients for whom the prescription of ACE inhibitors was not contraindicated, ACE inhibitor therapy was not initiated in 14%, and the CPR dosages were not attained in 51.2% of the cases. Factors associated with treatment not being initiated were age over 60 years (p = 0.001), increased ejection fraction (p = 0.005), and treatment with diuretics (p = 0.001) and digitalis glycosides (p = 0.008) at hospital admission. Factors associated with prescription of subtarget doses were age over 60 years (p = 0.024), low serum potassium concentration (p = 0.014), and absence of digitalis glycoside treatment (p = 0.039) at the start of ACE inhibitor administration.

Conclusions:

Our work has shown that cardiologists tend to adapt their prescription of ACE inhibitors to clinical situations that are not considered relevant in international guidelines. The implementation of CPGs in cardiology units should target adequate information about these situations.
Nesiritide for Acute Decompensated Heart Failure
Authors: Barclay Teresa S , Kim Joanne J , Lee Audrey J
Published: September 2013

Objective:

To evaluate nesiritide for the treatment of acute decompensated heart failure (HF) with respect to its pharmacology, pharmacokinetics, clinical efficacy, adverse effect profile, and outcomes.

Data Source:

Primary and review articles were identified by MEDLINE search (1966–March 2001). Data from the PRECEDENT trial and additional dosing/administration and safety information were obtained from Scios, Inc.

Study Selection:

All of the articles identified from the data sources were evaluated and all information deemed relevant was included in this review.

Data Synthesis:

Research into the cardiac natriuretic peptides has revealed that brain natriuretic peptide (BNP) is elevated in patients with HF and may counterregulate the pathophysiologic mechanisms involved in progression of the disease. Nesiritide (Natrecor), recombinant human BNP, is the first natriuretic peptide to be approved by the FDA for treatment of acute decompensated HF. Nesiritide is a potent venous and arterial vasodilator that reduces pulmonary capillary wedge pressure and systemic vascular resistance in a dose-dependent manner with minimal effect on heart rate. It improves signs and symptoms of HF; however, its effect on patient outcomes is unclear because of limited data. The most commonly reported adverse effects in clinical trials were dose-related hypotension and nausea.

Conclusions:

Nesiritide is an intravenous arterial and venous vasodilator that may be particularly useful in patients who may not tolerate the arrhythmogenic effects of dobutamine and milrinone or who cannot tolerate nitroglycerin and nitroprusside. Further well-designed comparative studies are needed to define nesiritide's place in management of acute decompensated HF.
A Retrospective Analysis of Cyclooxygenase-II Inhibitor Response Patterns
Authors: Castaldo Richard S , Mato Anthony , Kaul Alan F , Gorski Heather , Bosch Ronald J
Published: September 2013

Objective:

To summarize responses to cyclooxygenase-II (COX-II) medication use and describe physicians' reasons for switching or discontinuing therapy in the management of osteoarthritis.

Methods:

This retrospective medical record review evaluated all patients in a private clinical practice setting with a diagnosis of osteoarthritis who had been prescribed the COX-II inhibitor rofecoxib.

Results:

Of 144 evaluable patients, 81 had previously experienced treatment failure with celecoxib. Sixty-three patients had received rofecoxib as their first COX-II agent. A total of 101 of 144 patients remained on rofecoxib through the time of follow up. Patients starting celecoxib as their first COX-II agent discontinued therapy significantly earlier than those initiating treatment with rofecoxib (p < 0.001). Kaplan–Meier estimates of the median time to discontinuation were 17 weeks for celecoxib and 45 weeks for rofecoxib. There was no significant difference in the time to discontinuation in the first 6 months of therapy with a second COX-II agent between the groups.

Conclusions:

The majority of patients demonstrating therapeutic failure with 1 COX-II inhibitor may successfully be treated with another COX-II agent.
Gatifloxacin-Associated Hypoglycemia
Authors: Parilo Miguel A
Published: September 2013

Objective:

To report a case of prolonged hypoglycemia associated with glyburide and gatifloxacin use.

Case Summary:

An 82-year-old white woman with diabetes mellitus type 2 and chronic renal insufficiency developed postoperative pneumonia. She had previously been on long-term glyburide therapy. Protracted hypoglycemia after institution of gatifloxacin developed despite discontinuation of oral hypoglycemic therapy. After 2 days of intravenous dextrose, sustained normoglycemia was achieved.

Discussion:

Hypoglycemic reactions with glyburide and fluoroquinolone antibiotics have been reported, but not with gatifloxacin. Although drug administration error cannot be excluded, no documentation exists to support this. The onset of hypoglycemia soon after administration of gatifloxacin and reports of similar interactions favor the hypothesis that hypoglycemia was induced by a gatifloxacin–glyburide interaction.

Conclusions:

Fluoroquinolone-associated hypoglycemia has been documented, and an interaction of gatifloxacin and glyburide appears probable. Patients with diabetes should be monitored for the development of resistant hypoglycemia, especially if they are on concomitant oral hypoglycemic medications.
Olanzapine-Induced Depression
Authors: Swartz Conrad M
Published: September 2013

Objective:

To report apathetic and hypoactive depression caused by olanzapine.

Case Summary:

A 29-year-old white man and a 29-year-old white woman developed apathy, hypoactivity, blunted affect, depressed mood, and other depressive symptoms while taking olanzapine. Both showed a distinctly abnormal appearance. Clinicians attributed these symptoms to psychiatric illness, but the symptoms disappeared rapidly after drug discontinuation or dose decrease.

Discussion:

The only previous report of depression from olanzapine involved a medication interaction with fluoxetine. Another report described olanzapine-induced orbital-frontal syndrome, with childlike oversimplicity. If such symptoms are observed, the discontinuation of olanzapine is recommended.

Conclusions:

These observations suggest additional cautions when olanzapine is used outside of schizophrenia.
Amiodarone Interaction Time Differences with Warfarin and Digoxin
Authors: Matsumoto Kana , Ueno Kazuyuki , Nakabayashi Toshikatsu , Komamura Kazuo , Kamakura Shiro , Miyatake Kunio
Published: September 2013

Background:

Amiodarone has pharmacokinetic and pharmacodynamic interactions with various therapeutic agents. The mechanism of interaction between warfarin and amiodarone is the inhibition of warfarin metabolism by amiodarone, and that between digoxin and amiodarone is the inhibition of digoxin transport by amiodarone.

Objective:

To investigate the pharmacokinetic magnitude of the time differences between amiodarone–warfarin and amiodarone–digoxin interactions.

Methods:

Amiodarone was administered concomitantly to 79 inpatients who had been receiving fixed-maintenance doses of warfarin or digoxin. Seventy-seven inpatients were prescribed warfarin therapy, and 54 inpatients were prescribed digoxin therapy. To determine serum concentrations of the warfarin enantiomers digoxin, amiodarone, and desethylamiodarone blood samples were obtained with coadministration of amiodarone. Serum S- and R-warfarin, amiodarone, and desethylamiodarone concentrations were measured by HPLC methods, and serum digoxin concentrations were measured by a fluorescence polarization immunoassay.

Results:

A remarkable decrease of S-warfarin clearance was observed within approximately the first 2 weeks after coadministration of amiodarone. Only a small decrease in R-warfarin clearance was observed. Digoxin clearance was gradually decreased with time, and a good reverse correlation was obtained between amiodarone or desethylamiodarone concentrations and digoxin clearance.

Conclusions:

Relatively short-term monitoring of warfarin clearance is required when amiodarone is coadministered. Long-term monitoring of digoxin serum amiodarone and desethylamiodarone concentrations is necessary to detect the amiodarone–digoxin interaction.
Effectiveness of Sliding-Scale Insulin in Inpatients with Diabetes Mellitus
Authors: Dailey Amanda D , Lutomski Dave M
Published: September 2013

Objective:

To compare the incidence of hypoglycemia and hyperglycemia among sliding-scale insulin (SSI) regimens and determine patient characteristics that influence glycemic control in inpatients with diabetes mellitus.

Methods:

Main outcome measures for this retrospective chart review were rates of hyperglycemic (≥200 mg/dL) and hypoglycemic (≤60 mg/dL or symptomatic) episodes. Patients were excluded if a diabetic complication led to hospitalization. SSI regimens as well as patient demographics and clinical characteristics were evaluated for influence on glycemic control.

Results:

Seventy-four patients with 1020 capillary glucose measurements were analyzed. Regarding overall glycemic control, 80% of patients had ≥2 hyperglycemic events and 4% had ≥2 hypoglycemic events. Factors that significantly increased the risk of hyperglycemia were insulin use prior to admission (p ≤ 0.0001), corticosteroid use (p ≤ 0.0001), antibiotic use (p = 0.009), and dextrose-containing intravenous fluids (p = 0.004). Implementation of an SSI order form (which was associated with selection of more aggressive SSI regimens) significantly decreased the incidence of hyperglycemia (p ≤ 0.0001) without increasing the incidence of hypoglycemia. When analyzed for interactions among variables, insulin use prior to admission and concurrent corticosteroid use remained as independent predictors of hyperglycemia.

Conclusions:

Suboptimal glycemic control is common in hospitalized patients with diabetes. Patients receiving insulin prior to admission, corticosteroid therapy, dextrose-containing intravenous fluids, or treatment for an active infection are at increased risk. An aggressive SSI regimen does not appear to increase the incidence of hypoglycemia and may lead to better glycemic control. Whether initiating treatment at blood glucose concentrations <150 mg/dL would improve control remains unknown.